The Hidden Cost of Spay/Neuter

dog-begging-for-moneyThe evidence clearly shows that spay/neuter creates increased incidence of certain medical conditions in dogs. There are over 100 peer-reviewed studies we have referenced in the sections of this website dedicated to these particular medical conditions. We now refer to data from Embrace Pet Insurance and Healthy Paws Pet Insurance (two of the top five ranked pet insurance companies) to compile costs to treat these medical conditions (see Figure 1). These are medical conditions which are not only prohibitively expensive to treat, but often, despite best efforts, might very well cost dogs their life.

HAHD_Cost_Figure1
Figure 1. Medical Costs Associated with Spay/Neuter

The aforementioned insurance companies are very careful to provide a disclaimer. Essentially, they state that the cost of veterinary diagnosis, treatment (including surgical procedures) and medications can vary dramatically depending upon who is providing the care (board-certified specialist vs. general practitioner), whether specialty hospitals are employed (higher quality equipment, certified personnel), and where you live.

WHY SPAY/NEUTER? WHY NOT STERILIZATION!?!

Each year, the veterinarians in California actively oppose, or fail to support, a proposed law change that would allow veterinarians to perform sterilization procedures other than spay/neuter for shelter/rescue dogs. The law reads as follows:

CALIFORNIA Food and Agricultural Code

DIVISION 14. REGULATION AND LICENSING OF DOGS [30501 – 31683]

( Division 14 enacted by Stats. 1967, Ch. 15. )

CHAPTER 1. General Provisions [30501 – 30504]

( Chapter 1 enacted by Stats. 1967, Ch. 15. )

30503.
(a) (1) Except as otherwise provided in subdivision (b), no public animal control agency or shelter, society for the prevention of cruelty to animals shelter, humane society shelter, or rescue group shall sell or give away to a new owner any dog that has not been spayed or neutered.

From the perspective of a California healthcare professional, the veterinarians’ position is inexplicable for the following reasons:

  • It is the healthcare professional’s legal responsibility (continuing education is a requirement for license renewal) to stay current with the latest scientific findings, and in this circumstance the latest findings have shown spay/neuter to be harmful (this website alone references over 170 peer reviewed scientific studies which affirm this).
  • We have alternative hormone-sparing sterilization procedures which are not harmful and provide equivalent protection against dog overpopulation.
  • It would be unconscionable for a healthcare professional to subordinate their own clinical judgment and agree to perform harmful procedures purely to satisfy an outdated law, i.e., spay/neuter. As a professional, you should protest loudly and ask your professional organization to advocate for change.
  • The law should mandate the desired result, i.e., sterilization, and allow the healthcare professional to choose the best method of achieving said objective so as to best protect the health of each and every dog. This is consistent with the recently updated AVMA position as outlined on our Legal Issues of Dog Sterilization page.

There have been a few vets who have privately confided that the reason the veterinary community is satisfied to leave the mandate for spay/neuter in place is purely financial. It is an irrefutable fact that treating the adverse health consequences of spay/neuter provides veterinarians a financial windfall.

It is also a sad fact that veterinary medicine is fast being taken over by corporate entities. In January of 2017,  Bloomberg reported corporations now own 15 percent to 20 percent of America’s 26,000 pet hospitals, and consolidators, copying the model pioneered by VCA, are buying them fast. In September of 2017, the Washington Business Journal reported that Mars Inc. had just purchased VCA Inc. and its 800 small veterinary hospitals in the U.S. and Canada, its animal diagnostic imaging company and its doggy day care and overnight camp franchise, Camp Bow Wow. The Mars Petcare line already included Banfield Pet Hospital, BluePearl Veterinary Partners who operate emergency and specialty clinics, Pet Partners Veterinary Hospitals, as well as associated pet product companies Iams, Nutro, Pedigree, Royal Canin and Whiskas, among others.

According to Bloomberg,

“This is all happening despite laws in most states banning corporations from owning veterinary practices. As old-fashioned as it may sound, the idea behind the laws was that doctors employed by corporations might have a harder time exercising independent judgment on behalf of patients; commercial interests could intrude. Nonetheless, there’s a reason states allow complicated ownership structures—called management service agreements—that get around these laws: It’s what the doctors want. When it’s time to retire, vets expect to be able to sell their practices at the highest possible price, and these days that typically means selling to a corporation. ‘Just remember,’ Antin (CEO for VCA) says, ‘in every state we’re in, even the person who runs the state association, they’re a practicing doctor, and they want the freedom to be able to get value for their practice’.”

According to Praxis Veterinary Practice Brokers, California, Colorado and Florida make it easy for non-veterinarians to own veterinary practices. At this point in time, pet guardians in California have no protection against the obvious conflict of interest corporate ownership of veterinary practices as well as imaging facilities, and dog food/supplement companies, etc. has created.

In California, desperate to retain spay/neuter as the standard, even as the evidence against spay/neuter grows, veterinarians are now arguing that moving away from spay/neuter would cause sterilization costs to escalate dramatically. We argue that it is the vets/corporations who actually control these costs. Certainly vets can perform hormone-sparing procedures at a lower cost – considering these surgeries are much less complicated/invasive. It is contended that rescue organizations cannot absorb additional sterilization costs and if they are passed on to the adoptive family, this may curtail dog adoptions. In light of the “cost of care” information presented below, any rational person would gladly pay a little more at adoption in order to save thousands of dollars in healthcare costs over the life of their dog.

Within this page/article, we will examine the long term costs of caring for a dog who was spayed/neutered at an early age and failed to recover hormonally. Dogs can experience some of these medical maladies, or perhaps even all. Personally, we shouldered tremendous veterinary expenses with our own dog Billy as is outlined in “Billy’s Story”.  He suffered from CCL tear with resultant TPLO surgery on both knees, elbow dysplasia on both elbows, Atypical Cushings, diabetes, hypothyroidism, etc… This was primarily due to the long term consequences of his early neuter. In fact, it was the compound effect of neutering Billy (i.e., increased costs, increased suffering) that compelled us to create this website. This is not just about the money. The real tragedy of spay/neuter is the suffering of its canine victims, as well as their family members who must bear witness to this suffering. Furthermore, this is very much about the pain inflicted upon those who cannot afford to pursue all medical options for a sick dog, and are hence forced to opt for euthanasia of their family companion.

MEDICAL CONDITIONS ON THE RISE DUE TO SPAY/NEUTER

ORTHOPEDIC CONDITIONS

Cranial Cruciate Ligament Tear/Rupture

Cranial cruciate ligament tear/rupture is the most common orthopedic malady seen in dogs, often caused by early spay/neuter. Lack of sex hormones causes the tibial bone to grow too long, creating a steep tibial plateau which puts excessive stress on the ligament.

The remedy is TPLO (tibial plateau leveling osteotomy) surgery:  the average cost ranges from $2500–$5500 per rear leg. This range of costs may or may not include diagnostic scans. Generally this total cost does include pre-surgery blood work, the anesthesia, anesthesia monitoring, pain medication, the surgery itself, post-surgery care and to-go-home medications. Some hospitals may even include post-surgical physical therapy available at their hospital.

Hip Dysplasia

The lack of sex hormones causes abnormal growth/development of the bones associated with the hip joint.

The remedy is THR (total hip replacement): Typically a THR can cost between $5,000-$6,500. per hip. This range of costs may or may not include diagnostic scans. Most of the time these costs include pre-surgical bloodwork, anesthesia, surgery and all medications. In some cases, hospitals may even include post-surgical physical therapy with the complete surgical/recovery package. A total hip replacement is the definitive treatment for hip dysplasia which has been shown to be increased in incidence by early spay/neuter.

Elbow Dysplasia

The lack of sex hormones causes abnormal growth of bones associated with the elbow joint.

There is as yet, no joint modification/replacement option available to correct elbow dysplasia; surgery is generally palliative in nature. Arthroscopic surgery is sometimes recommended for young dogs who are candidates for surgical “clean-up”of bone fragments, calcium deposits, etc. The cost of surgical diagnosis and treatment can range from $1,500 to $4,000 per elbow.

CANCER

Osteosarcoma

Pets who suffer from osteosarcoma may experience treatment costs that extend well beyond the $10,000 mark. Because it involves a specialized anesthetic procedure, the cost of definitive diagnosis is typically around $800 to $1,000. The cost of surgery itself will depend on the surgeon’s degree of specialization along with the anatomical location of the tumor, but $1,000 to $3,000 is typical. Chemotherapy will typically add another $2,000 to $4,000 (for a single treatment, but can exceed $10,000. for multiple sessions). Palliative radiation tends to cost anywhere between $2,000 and $5,000, whereas “curative” radiation generally exceeds $5,000. Even with aggressive treatment (surgery and chemotherapy, with or without radiation), survival times average only ten to twelve months.

Lymphoma

As with many cancers that require chemotherapy and an oncologist’s assistance for best outcomes, the cost of lymphoma can be prohibitive. Pets who suffer from these tumors may experience treatment costs that extend well beyond the $10,000 mark, especially should owners elect to explore all available treatment options.

The cost of definitive diagnosis is typically around $500, but increases dramatically when the patient’s cancer is thoroughly investigated and staged. It’s not unusual for owners to spend several thousand dollars in this process.

The cost of chemotherapy in these cases varies widely depending on the protocol elected and the patient’s size. The cost of surgery itself will depend on the surgeon’s degree of specialization along with the anatomical location of the tumor, but $1,000. to $3,000. is typical. Radiation therapy in nasal cases tends to cost anywhere between $5,000. and $10,000. Some of the newer experimental approaches may be had for $15,000. or less, but these are largely unavailable except in veterinary school type settings.

Because lymphoma is a systemic disease, the best approach to treatment necessarily involves the use of systemic chemotherapy drugs. In most canine cases (between 75% to 90%, depending on the protocol employed), complete remission is achieved. The average patient enjoys a good to excellent quality of life for sixteen months before experiencing a relapse. Some lucky dogs may even respond positively to a second round of chemotherapy.

While a complete cure for lymphoma is considered highly elusive in the case of afflicted dogs (especially given veterinary medicine’s relatively non-aggressive approach to chemotherapy), several experimental approaches have been shown to extend remission duration in dogs –– dramatically in some cases. The most common of these involves whole body irradiation and bone marrow transplantation.

Unfortunately, many owners elect not to treat their pets due to the extreme expenses often associated with lymphoma.

Mast Cell Tumor

For all but the most aggressive and invasive mast cell tumors of the skin, surgery is the immediate approach to treatment. Removing them by a wide margin whenever possible is considered the gold standard first line treatment. Surgery to remove a mast cell tumor typically costs $500. to $1,000. If a board certified surgeon is elected due to difficult access to the site (for internal tumors or for less surgically amenable locations on the skin), costs are likely to increase two- to five-fold.

Tumors are graded by their propensity to spread, and depending upon the grade of the tumor, radiation and/or chemotherapy can be recommended. Should radiation therapy be deemed advisable, owners should expect typical costs to range anywhere from $4,000. to $10,000. If “cyberknife” radiation is applicable, costs can run from $5,000. up to $30,000. Chemotherapy costs will vary depending on the drugs elected but owners should expect a high price tag associated with the expense of these drugs, the need for specialized delivery, and the costs associated with close monitoring of these patients for weeks to months of therapy.

A cure can be achieved, but it depends heavily upon early diagnosis, and/or treatment that is both extensive and expensive.

Hemangiosarcoma

As with many cancers that require surgery for diagnosis and treatment as well as chemotherapy for best effects, the cost of hemangiosarcoma can be quite steep. Depending on the location of the tumor, definitive diagnosis may typically cost anywhere from $500 (for a small skin tumor) to $5,000 (should a tumor require immediate life-saving treatment in an emergency facility or treatment in a specialty hospital.

Treatment of the tumor post-operatively can be very expensive as well. Whether standard chemotherapy or metronomic therapy is employed, the high price of these drugs and the close monitoring these drugs entail means caretakers can expect bills totaling anywhere between $500 to $3,000 per month post diagnosis and surgery.

Unfortunately, the prognosis for most hemangiosarcoma patients is poor. Median survival times, even with aggressive treatment, tend to reach approximately only half a year’s time. Many owners elect not to treat their pets due to cost, perception of their pets’ suffering, or because of a poor long-term prognosis.

METABOLIC CONDITIONS

Hypothyroidism

The cost of diagnosis for hypothyroidism is relatively slight. Testing typically runs between $50 and $150. Treatment is generally considered manageable as well. Monthly expenses for medication tend to run in the $20 to $50 range. Annually, dogs must be re-tested to ensure adequate dosing. Again, this tends to remain in the typically affordable $50 range.

Allergies

Allergy treatments can vary widely, depending upon the allergen involved and how it affects a particular dog. Generally, allergies affect the skin and the treatments often utilized are itemized in Figure 2 below.

HAHD_Cost_Figure2
Figure 2.  Cost of Allergy Treatments

Urinary Tract Infections

Spay/neuter routinely increases urinary tract infections. In most cases, antibiotics will resolve the infection and their cost will be $30–$100 depending on size and antibiotic type for a 10–14-day treatment. In some cases early spay causes abnormal development of the vulva which predisposes the female dog to chronic urinary tract infections which can become resistant to antibiotic treatment. In these cases, surgery to remodel the vulva to eliminate folds where bacteria can proliferate is recommended. This surgery is termed episioplasty or vulvoplasty and can cost $1500.-$3000.

Diabetes

If specialist-quality intervention is required at the time of diabetes diagnosis, dog guardians can quickly amass veterinary bills in the $5,000. to $10,000. range. Most, however, are expensive to handle at the time of the initial diagnosis ($500. to $3,000.) but become more manageable as time progresses. Including the cost of insulin, syringes, veterinary monitoring and the premium paid in prescription pet foods, most diabetic pet owners should expect to pay an average of $100 to $200 every month.

We found the costs associated with diabetes were far greater than the estimates provided by the pet insurance companies. This is because they classify the expense of complications from diabetes separately. For example, dogs with diabetes frequently develop skin infections which can easily cost $100. or more per occurrence. Dogs with diabetes are predisposed to develop cataracts which can leave them essentially blind. The surgery to remedy cataracts is $1500-$5000. per eye.

Cushings

The cost of a Cushings diagnosis can be inexpensive or not, depending on the degree to which the dog’s symptoms confuse the clinician or on the number of affiliated problems a dog may be experiencing. $500 to $1,500 is considered typical for a complete diagnosis (though the low end of this estimate would not include an ultrasound).

Medical treatment can be as low as $50 a month or as high as $200 per month, depending on the dog’s response to treatment and the drug selected. Frequent bloodwork must also be factored in to ensure that patients are responding appropriately.

The cost of surgical options like adrenalectomy or hypophysectomy can be very high due to the need to see a board-certified specialist for these complex surgeries. A range of $2,500. to $10,000. is estimated for these procedures (the higher end for the more atypical approach of hypophysectomy).

BEHAVIORAL ISSUES

Behavioral problems are rampant among spayed/neutered dogs, and as we have explained on this website, every dog is affected differently. Expenditures to resolve behavioral problems are commonplace today, yet unheard of  years ago when spay/neuter was not the norm. Some examples would be:

  • Doggie day care: $240.-$550./month (per Thumbtack/Angie’s List).
  • Dog training: e.g. Shy dog classes at SFSPCA: $155.-$175.
  • Dog walker: $300./week for daily walks on weekdays (per local vendors).
  • SAM-e tablets for anxiety: $60./month

CONCLUSION

Let there be no mistake: pets in the United States are Big Business, and spay/neuter has become an integral part of the economic machine. According to the American Pet Products Association , in 2018, $72.56 billion was spent on our pets in the U.S. Remarkably, corporate entities have positioned themselves to benefit from each of these expense categories, excepting perhaps live animal purchases in some states. Figure 3 shows us the breakdown as to how these dollars were spent.

HAHD_2018_Costs
Figure 3.  Annual Pet Expenses for 2018

It is estimated that in 2019, $75.38 billion will be spent on our pets in the U.S. Figure 4 shows us the estimated dollar breakdown.

HAHD_2019_Costs
Figure 4.  Estimated Annual Pet Expenses for 2019

A well-educated public is empowered to persuade legislators to change law where blanket spay/neuter is mandated, even without the cooperation of the veterinary community. It does appear this is the only way California law will be changed, and perhaps this is true in other communities with similar legal requirements. If the law persists, generally dog guardians who have suffered with a dog adversely affected by spay/neuter tell us they have decided they will either purchase a dog from a reputable breeder or adopt a rescue dog in another locale which does not require spay/neuter. This will cause adoptions to be reduced in areas mandating spay/neuter, but not for the reasons veterinarians express. It bears mentioning that the expense of live animal purchases (the only category not dominated by corporate interests) is the only category whose overall expenses are projected to decrease in 2019.