Art by Angelica Alzona

These have been a shitty couple of years on the pet front. Last fall, Millie, my beautiful, miraculous boxer, started panting all the time. She was still a radiating core of joy and energy, but her panting was making it hard for her to get comfortable and her energy was slowly but noticeably waning. Also, her appetite was through the fucking roof—she’d always been a hungry dog, but this was ridiculous. She’d rocket out of sleep any time you went anywhere near the kitchen, and she would devour her meals with awesome speed and intensity.

I am a big, dumb idiot. I observed these developments over a period of weeks and mustered up nothing by way of reaction beyond what could be summarized as, “Huh.” My wife, thank God, watched more closely and thought more critically and eventually started asking questions.

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Being curious about the internal state of your pet can be a mighty expensive proposition. Multiple rounds of lab tests were ordered, several trips were made to several different specialists, prescribed diet changes were arranged, and on and on. Eventually it was revealed that Millie had something called Cushing disease.

Cushing disease, in dogs, can be a real motherfucker. What it really is is a bunch of symptoms, and those symptoms are caused by an overactive adrenal gland, unless they are caused by a tumor on the adrenal gland, unless they are caused by an enlarged pituitary gland, unless they are caused by a pituitary tumor, unless they are caused by over-treatment with glucocorticoids. Most vets have run across Cushing disease, and most have a specific treatment course with which they have developed a level of comfort. This will work out great for you and your wallet if your dog’s Cushing disease is caused by the specific ailment for which that specific treatment course is formulated. Otherwise, not so much.

So, there can be a bit of a trial-and-error approach to treatment of Cushing disease. Millie was put on a specific kind of medication, and specific other medications to help her deal with the potential side effects of this medication. And, within a few days of starting the medication, the panting and huge appetite went away. Sadly, devastatingly, incomprehensibly, they took most everything else away when they left: her energy, all the rest of her appetite, her alert and happy demeanor, and her singular trust and affection for all people. She would try to spend as much of her days as possible lying along in a dark and solitary corner of our dining room, in an uncomfortable twilight state.

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This transition happened so fucking fast that we were completely certain it was caused by the specific treatment Millie was receiving for Cushing. And so what followed was a period of months of desperately seeking any combination of treatments that would both relieve the uncomfortable symptoms of her disease and restore some precious part of her signature joie de vivre. This was a time of fitful, halting progress, misleading breakthroughs, and occasional terrifying setbacks.

It was February when Millie started having quiet, heart-breaking little tremors. She would lie still and look up at you and her head would wobble back and forth as if she was giving a tiny little “no” signal over and over for three minutes. In a desperate panic, I scooped her into my car one afternoon and drove her to an emergency vet office in town, where I happened to meet a completely new and different doctor who happened to be on duty, and who happened to have a different history with Cushing, and who took one look at my poor Millie and diagnosed things straightaway: she had a benign tumor growing on her pituitary gland, and it was causing her Cushing disease, and it was causing her to have seizures, and it was probably causing her a significant amount of persistent pain and discomfort, that might account for her preferring to be in a dark and quiet corner of the house, even if it meant being completely alone.

This was the first time anyone had broached this possibility, and I was knocked over by the thought that Millie might have been enduring migraines and loss of cognitive function for maybe months while her regular vet had us giving her medication that treats the adrenal glands. So, that was basically the end. A week later, Millie was gone. This was all excruciatingly sad and confusing, and though it happened over a period of many months, it really felt like a steep and sudden decline and ending. Awful.

While all this was going on, Pal, my other dog, a giant and gentle hound, was undergoing chemotherapy for lymphoma. He was diagnosed before Millie was even symptomatic, and he is still chugging along today, although he is very, very near the end. I probably don’t need to tell you that, on top of being exquisitely frightening and sad, all of these concurrent pet health problems have been massively expensive.

But! They have been manageable, and there is only one reason for that: a decade ago, when we brought these goofy puppies home, my wife thought to purchase pet health insurance. It has, quite literally, been a life-saver. It once helped pay for Pal to have a three-inch prime-rib bone surgically removed from his gut. It once helped pay for a really scary three-night stay at an emergency center for Millie, after she got into a trash can and ate whole huge mouthfuls of xylitol. It helped pay for every appointment and test associated with Millie’s Cushing—every panicked second-opinion and every new course of treatment. It has helped enormously to pay for Pal’s enormously expensive chemotherapy. It helped pay for Millie’s euthanasia, which was done peacefully in our home by a wonderful professional. And, very soon, it will help to pay for the same end for Pal.

Perhaps this will not surprise you very much: My pet insurance company is vastly better in every possible way than any other insurance company I have ever dealt with. The rates are reasonable. The claims process is incredibly simple and straightforward. The customer service is top-notch. Probably this is because it’s a hell of a lot easier to find and hire people who are patient and feel kinship with anonymous pets than it is to find and hire people who are patient and feel kinship with anonymous humans. (Consider that nowhere near a popular majority of pets will be voting for a malfunctioning orange foghorn for president in November.)

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In basic terms, here’s how it works: You pay a premium for some period of time, during and after which the following things are covered: emergency visits, emergency treatments, diagnostic appointments, and specific treatments for specific conditions. In order to make a claim, the veterinarian submits a one-page form, and then any subsequent treatments are covered as soon as I email in a photo of the invoice. I am reimbursed 80 percent of what I spend, deposited directly into my bank account, usually within a couple days. The coverage lasts until the pet is dead, on the rainbow bridge or in hell with Harambe or whatever.

Regular checkups are not covered, and most medications are not covered. This has meant that I have still spent a lot of money treating my dogs. But you sort of figure, going in, that having dogs (especially big dogs) will, at one point or another, be expensive. First of all, they eat a lot of food, and second of all, when they get bored and irritable and decide to take it out on random things, the objects of their displaced anxiety can be, like, a couch, or a trunk full of clothing, or an entire set of patio furniture. And the stakes are higher in other ways. If they are aggressive, you will not be able to simply pick them up and carry them away, and so you will probably want to pay for professional training so that they never kill anyone.

Pills and regular checkups and immunizations are no big deal, is what I’m saying—you should not be getting a pet at all if you can’t afford to pay for regular checkups and immunizations and medication. There can be significant upfront costs for covered treatments, especially in the case of emergencies, and knowing that you will be reimbursed a whopping 80 percent of this cash will not suddenly make the cash appear in your bank account when your permanently ravenous scent-hound somehow pulls an entire rib roast out of a closed and hot oven and gets a fifth of it, bone and all, into his gut in the space of four seconds.

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But I don’t think it’s an exaggeration to say that having such events covered by insurance can mean the difference between those becoming funny stories you tell about your still-living pet seven years after the fact, and an early death sentence. When Pal was diagnosed with lymphoma, the oncologist said, straight up, that treating him with chemotherapy would be really expensive, and most people don’t have it in their budgets, and so, for most dogs, a lymphoma diagnosis means they have a few weeks left to live, at most. There is no way in hell I would have even been able to start a single round of chemotherapy without pet insurance. Pal would have died before Millie even got sick. Instead, my guy has been sniffing and howling and snoring and counter-surfing for almost 18 months, now. Millie had some hard times, but insurance made it possible for us to explore whole menus of treatment options before things got too rough. Without it, she would have died of something else entirely, and years earlier—good and happy and fun years, too.

And that’s just it. The decision to extend the life of your pet, in the face of this kind of news, usually comes down to whether ending their life would deprive them of more good times than it would spare them bad ones. If you’re unable to afford a bunch of diagnostic testing and expensive treatments and follow-ups and all that shit, the time you have left before that ratio turns bad might be breathtakingly brief. In some instances—as in the case of the xylitol poisoning—if you can’t realistically afford immediate, expensive treatment, the good part of your pet’s life might already have passed. And that’s a raw deal, man: pets don’t get a whole lot of time to begin with, without being cut off prematurely because a whole lot of potential good times just aren’t in the family budget.

At any rate, look into it. Tomorrow my buddy will wake up with bright eyes and a wet nose and will wag his tail and march around the yard marking every damn shrub for the millionth time. He’ll eat breakfast and dinner and lay on his little bed and be glad to be around his people. Pal is sick, and getting sicker, but there’s still some good time left, and he’s getting to have all of it. Crazy to think a goddamn insurance company made this possible, but there it is.