Be Healthy Boise

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an integrative approach zach hagadone Welcome to the second edition of Be Healthy Boise, a twice-yearly health carefocused magazine from Boise Weekly. This time around, we explore the theme of integrative care.

From BW News Editor George Prentice comes a feature on community-based health care provider Terry Reilly. Odds are, even people new to the Treasure Valley have heard of Terry Reilly, but odds are also good that they don’t have a clear picture of the organization—even longtime residents often draw a blank when trying to describe what services Terry Reilly provides and to whom.

As reported in this edition of Be Healthy Boise, the roots of Terry Reilly stretch back to the man himself: A tireless community advocate and Idaho state senator, Reilly, along with his wife, Rosie Delgadillo Reilly, founded a low-cost clinic in their Nampa living room to offer health care to families and children in rural Canyon and Owyhee counties. In 1972, they recruited physician Bob LeBow to help oversee the now expanded clinic, then located in an old grocery store building.

More than 40 years later, both Reilly and LeBow have passed, but Terry Reilly has become one of the most used, expansive and vital community health care providers in Idaho: from simple check-ups to dental care and mental health services.

In an another exploration of wholistic health care, we present a column by Sun Valley-based Structural Integration practitioner Sonia Sommer, who explains that through a regimen of “self care” practices, we can avoid the costly—financially as well as physically and emotionally—pitfalls of the health care industry.

There’s more to this edition of Be Healthy Boise: including a column by BW Best of Boise Best Local Doctor winner Wajeeh Nasser and a look at the rising costs of pet care. The spirit of integrative care even animates the cover of Be Healthy Boise No. 2.

The cover image, photographed by Patrick Sweeney at Sage Yoga and Wellness, depicts the coming together of Western, Chinese and Indian medicine in an integrative approach to body, mind and spirit. An exploration of those themes will take place at the first-ever Women’s Integrative Health and Wellness Summit, March 7, 2015, at Sage Yoga and Wellness (242 N. Eighth St., Boise).

We hope you find the perspectives, stories and topics covered in Be Healthy Boise interesting and useful—and we’ll bring you more of the same in our next installment, set to print in February 2015. Until then, be healthy.

—Zach Hagadone

Be HEALTHY Boise Publisher: Sally Freeman Sally@boiseweekly.com

Office Manager: Meg Andersen Meg@boiseweekly.com Editorial Editor: Zach Hagadone Zach@boiseweekly.com Proof Reader: Jay Vail Contributing Writers: George Prentice, Wajeeh Nasser, Cindy Sikkema, Sonia Sommer Advertising Advertising Director: Brad Hoyd Brad@boiseweekly.com Account Executives: Tommy Budell, Tommy@boiseweekly.com Cheryl Glenn, Cheryl@boiseweekly.com Jill Weigel, Jill@boiseweekly.com Darcy Williams, Darcy@boiseweekly.com Creative Art Director: Kelsey Hawes Kelsey@boiseweekly.com Graphic Designers: Jen Grable, Jengrable.com Contributing Artist: Patrick Sweeney

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Circulation Man About Town: Stan Jackson Stan@boiseweekly.com

Bar Bar Inc. prints 34,000 copies of Be Healthy Boise, which is available free of charge inside the Nov. 12, 2014 edition of Boise Weekly at more than 1,000 locations, limited to one copy per reader. Additional copies of this edition of Be Healthy Boise are available at the Boise Weekly offices. No person may, without permission of the publisher, take more than one copy of each issue.

To contact us: Boise Weekly’s office is located at 523 Broad St., Boise, ID 83702 Phone: 208-344-2055 Fax: 208-342-4733 E-mail: info@boiseweekly.com www.boiseweekly.com Address editorial, business and production correspondence to: Boise Weekly, P.O. Box 1657, Boise, ID 83701 The entire contents and design of Be Healthy Boise are ©2014 by Bar Bar, Inc. Boise weekly is an independently owned and operated newspaper.

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Vote for Your Own Self Care Reform Sonia Sommer

Is the health care system making you feel sick, broke and helpless?

If the answer is yes, it could be time for you to stop outsourcing your wellbeing and take back control with a simple self care reform. You are not alone. Caring for your physical, mental and emotional health with intentional and continual actions is easy. More times than not, self care can be more effective than other treatments.

Everyone’s self care routine is unique, but here are three common benefits everyone will experience.

Self Care Could Save You Big Bucks My client, Mary, came to me as a last resort before back surgery. She was spending hundreds of dollars a month on health care, which covered few of her medical expenses. Her doctor had prescribed various painkillers which were providing only temporary relief and starting to make her feel nauseous around the clock. She’d missed weeks of work because she was in so much pain and wanted to avoid surgery because she couldn’t afford the $45,000 price tag it came with.

Health care costs in this country are astonishing. A family of four covered by a preferred provider organization will pay an average of $19,393 annually, according to a 2011 report by global consulting firm Milliman. Isn’t that statistic a bit staggering? Especially considering the United States Census is reporting that the median household income was $51,939 in 2013. That means 37 percent of that family’s income was spent on health care expenses.

By comparison, self care is virtually free. In Mary’s case, we were able to alleviate her back pain with proper exercise and stretching, which cost her nothing but time and effort. She treated the common root cause of back pain: tight and imbalanced muscles. By doing so, she completely avoided costly and possibly ineffective back surgery. Most importantly, Mary regained a sense of control over her body and her life.

Lose the Scary Side Effects Don’t you find it frightening to listen to some of the side effects of prescription drugs? Seizures, hallucinations, paralysis and death. Fairly serious. Risky behavior, enlarged breasts in men and 4 | BE HEALTHY BOISE 2014 | Be HEALTHY Boise

my personal favorite, “swollen, black or hairy skinned your knees? Didn’t your body repair ittongue.” Thanks, but I think I’ll deal with the self quickly and easily? That’s what it’s designed headache and the acne. to do—to self heal. All you have to do is give it the We’re a pretty lazy bunch, happy to pop a pill right circumstances. to solve our problems, rather than taking the time If you’re not sure what those right circumto figure out what’s really wrong. We want the stances are, ask your grandmother. A warm quick fix, the easy way out. The trouble bowl of chicken soup, a cuddle and a is, there isn’t one. good night’s sleep will cure a cold Short-term fixes are the just as well, if not better, than equivalent of a high-interest an over-the-counter medicacredit card: feel good now, tion. In fact, a lot of those feel much worse down the cold meds actually suproad. Maybe end up with press your body’s abila black, hairy tongue. ity to heal itself, which Do you know what only prolongs the illthe self care side effects ness and can make you are? When you exercise, feel worse. practice mindfulness and For many of us, our eat a healthy diet, your body is just something side effects might equal that hangs down from more energy, weight our head. We’ve comloss and better moods. pletely lost touch. GetDoesn’t that sound better ting to know your body than hallucinations? again can be like redisBesides, if you’re in covering a long lost old pain, that’s good infriend. It’s one of the Sonia Sommer is a Sun Valley-based formation. That’s your most important things practitioner of Structural Integration, body doing its job and you’ll ever do for your Mindful Awareness teacher and modtelling you there’s somehealth and well-being. ern shaman. She has been in private thing wrong. If your No one else can tell you practice for the past 17 years, working child told you she was as much about yourself with individuals from all walks of life, hungry, you wouldn’t as your own body. focusing on those seeking real transblock your ears and igThere’s heaps of formation and personal evolution. nore her, would you ? great information out No, you’d listen to what there in books and on she needs and feed her. the Web. Read up on Sonia’s Top Five Self Care Tips Too often when our what types of foods UÊ ÝiÀV ÃiÊv ÀÊÓäÊ ÕÌiÃÊ>Ê`>Þ body is in pain, we numb and activities are good UÊ >ÌÊ ÀiÊÛi}} ià it with drugs because we for your health—I UÊ iÌÊ>Ê} `Ê } ̽ÃÊà ii« don’t want to take the provide some tips on UÊ >Õ} Ê> `Ê >ÛiÊ ÀiÊvÕ time to listen and find out my website (soniasomUÊ i>À ÊÌ Ê > >}iÊÃÌÀiÃÃÊÜ Ì Ê exactly what’s causing it. mer.com) if you need meditation Listen to your body. It a place to start. Basic knows what you need. things like eating fresh foods, moving your body and learning to manage stress can make a huge difference to how you feel.

Often, you’ll feel better than you have in years.

If you’ve been bought into the common myth I invite you today to kick the quick-fix habit. that being in pain and feeling like crap is normal, Stop feeling sick and helpless within a broken you’re not alone. Pardon me, but that’s a load of health care system. Take back control, save money bulls#*t. and feel better than you have in years by creating Remember when you were a kid and you your own self care system.

Wake Up Feeling Fantastic

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On Hot Dogs, Bayes’ Theorum and a Good Ear Dr. Wajeeh Nasser

About 15 years ago I saw a patient in his mid 20s who had been feeling poorly for months. His concerned wife finally prompted him to come to the ER. His physical exam was normal and

the more questions I asked, the murkier his condition seemed to be. I was at a loss to explain his symptoms, so I ordered some blood tests and to my surprise, his glucose level was alarmingly high. He had developed diabetes; but not the kind that kids get when the pancreas quits making insulin. He had the adult form that usually develops slowly after decades of a poor diet and little exercise. But he looked reasonably fit, stayed active and had what he described as a fairly normal diet, so I was still confused. I called a diabetes specialist who kindly confirmed that something didn’t make sense. I went back into the exam room to discuss his results, and he appeared genuinely shocked by my findings. His wife, on the other hand, didn’t seem the least bit surprised.

“Tell him,” she said to her husband sternly.

“Tell him what?” he responded defensively.

“Tell him more about what you eat.”

“Well, doc, I probably should eat better,” he admitted with a sigh.

“So what exactly do you eat?” I asked pointedly.

“Oh, I like hot dogs.”

“Well, who doesn’t like an occasional hot dog?”

“He eats them every day,” his wife interjected.

I looked at him, seeking confirmation of what I considered to be an odd revelation.

“Yep, every day,” he acknowledged.

“What do you eat for breakfast?”

“A couple of hot dogs, doc.”

“Lunch? Dinner?”

“Just hot dogs.”

And so it went. Eventually he admitted that all he had been eating for the last year were hot dogs, to the exclusion of all other food. This was, as we say in medicine, a diagnostic key. You might 6 | BE HEALTHY BOISE 2014 | Be HEALTHY Boise

imagine that I looked at him a bit differently at this My job would be joyless and my diagnostic skills point. substantially handicapped, without the opportu“Why?” I asked, dropping all pretense of profesnity to understand my patients intimately. It may sional decorum. sound touching and anachronistic, but the medical He shrugged his shoulders and answered simply, literature is replete with studies which show that “I just prefer hot dogs.” the history alone will render an accurate diagnosis I bring up this case for a few reasons. It repreroughly 90 percent of the time. sents what I find most enjoyable about medicine, William Osler, one of the founding members of which is getting to know people in all of their madJohns Hopkins Hospital, said that “medicine is a dening complexity. Yet it also reminds me of the science of uncertainty and an art of probability.” threat that health care reform poses to doctors’ Physicians typically make decisions based on likelimost potent diagnostic tool—our ears. In this situhoods and not certitude. In order to improve the ation, the patient didn’t actually believe that his veracity of our conclusions, we modify our plans diet was the reason he felt poorly. (And he’s not as more information is known. This is essentially alone. I recently saw someone who only a Bayesian statistical application, where ate SpaghettiOs. It took a lot of the probability of an outcome is time and questioning, and in the updated as more data becomes end, insistence from his wife, available. Thomas Bayes lived to solve the mystery of his in the first half of the 18th diabetes. One of the concentury, yet his theorem is sequences of health care a powerful tool broadly reform, and its incumutilized in contemporary bent electronic medical medicine to help us unrecords, is that doctors derstand, for example, will be spending more the value of screening time documenting intests. For my purposes as formation mandated by a family doc, as I gather the federal government, more diagnostic clues, rather than having the my confidence increases liberty to exercise disthat I’ll find, if you will, cretion. So, increasingly, the smoking hot dog. doctors will be pursuAbout 10 years after ing preordained data to that first encounter with input into computers the “hot dog guy,” he Dr. Wajeeh Nasser is a family practiand engaging less with came into my clinic for tioner at Capitol City Family Medicine, patients. And when we a checkup. I was excited a former Boise Weekly contributor don’t have time to propnot only to see how he and “Best Local Doctor” winner in the erly listen to our patients was doing but to also 2014 Boise Weekly Best of Boise poll. tell their stories, we lose confirm my recollections our most important about his story. I walked means of making the right diagnosis. into the room and was greeted with open arms.

An oft-referenced medical aphorism states that, “Remember, me doc?” he asked with a Johnny “it’s more valuable to know the patient who has Cash smile. the illness rather than the illness the patient has.”

“Of course,” I replied.

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george prentice

Terry Reilly:

Then, Now, and Somewhere Down the Road George Prentice

The challenge of telling the Terry Reilly story is whether to begin in the present or the past. While the legacy of the 40-plus-year-old organization is rich with legacy and its footing is firmly planted in 21st century medical technology, it’s really all about the future for Terry Reilly Health Services.

“This is it,” said Heidi Traylor, putting on her hard hat. While the scene on Nampa’s First Street South is a series of metal and wooden frames crafted by a few dozen architects and builders, Traylor, executive director of Terry Reilly, could see something in her mind’s eye: a $6.2 million, state-ofthe-art 30,600-square-foot facility that will house multiple patient care teams, a laboratory, full pharmacy, X-ray, mental health services and medical administration.

“It’s ahead of schedule and on-budget,” Traylor said, as Boise-based Jordan-Wilcomb Construction teams filled the air with a cacophony of ear-piercing noise. “We’re hoping to be operational the first of March. What can I say? I’m an optimist.”

If only Terry Reilly were here to see it all. What began as a makeshift clinic in May 1971, in his Nampa living room, has become one of the national models for community health caregiving. Reilly’s “clinic” was soon moved into the old Square Deal Market grocery store at the corner of 16h Avenue North and Third Street North and was dubbed the “Nampa Clinic.” Soon thereafter, other clinics appeared in Garden City, Parma and Homedale.

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tion about the cost of health care. Through a series of visits to Terry Reilly clinics in Ada and Canyon counties, BW busted a few myths about the people who walk through those clinic doors and some sobering truths about how desperately Idaho depends on the community health center model.

Traylor first walked through the doors of the clinic in 1993 as an intern. She served as a therapist; program director for SANE Solutions, working with abuse victims and offenders; director of behavioral health programs; administrator of Allumbaugh House; and ultimately taking over as executive director of the organization in 2012.

“That’s me,” she said, pointing to a younger version of herself, part of a giant five-panel mural that hangs in the existing Nampa clinic—which still sits on the site of the original grocery store. “There’s me and many of the caregivers and a lot of our patients. And over there is Bob LeBow.” A graduate of Harvard and the Johns Hopkins School of Medicine, LeBow was recruited to come to Idaho by Terry Reilly in 1972 to oversee the Nampa clinic. Through the years, LeBow would care for untold thousands of patients, many of them without financial means. LeBow was the caregiver; Reilly was the advocate. Sadly, they’re both gone: Reilly was killed in an Eastern Idaho plane crash in 1986 while campaigning to become Idaho lieutenant governor. LeBow died in 2003, 15 months after a bicycle accident left him quadriplegic. Yet the very mention of either name elicits instant smiles on everyone we spoke with. They talked in glowing terms about the past, but they had plenty to say about the present—and even more to say about the future of Terry Reilly Health Services.

By the Numbers: Truths and Myths Approximately 30,000 patients walk through the doors of Treasure Valley Terry Reilly clinics each year. If you haven’t visited any of the 18 clin-

ics in Boise, Caldwell, Homedale, Marsing, Melba, Middleton and Nampa, you might be hard-pressed to paint a word picture of who those clients are, though. For instance, a common myth is that the poorest of the poor are the only people who access Terry Reilly services. While its mission insists on “affordable, comprehensive health care to everyone in our community,” Terry Reilly serves almost as many clients who are insured.

“Right now, about 45 percent of our patients are insured—private insurance, Medicaid and Medicare,” said Traylor, who added that at the height of the recession, the insured rate dropped to about 28 percent. “And that says more about what our patients went through rather than what our organization went through.”

The overriding factor is that, quite simply, Terry Reilly clinics don’t turn anyone away. If people can’t pay, the organization writes off the charge. If people are insured, great. If not, they may pay on a sliding scale. Clinics use a rather standard chart that has a row at the top indicating how many members are in a household; on the side column is the household income. Where the two intersect will determine how much of the bill the clinic will write off, in increments of 25 percent.

But here’s a bit of a stunner: Terry Reilly no longer asks for proof of household income.

“We made that decision about a year ago,” said Traylor. “And you know what? Nothing changed.

I think people are generally honest. I think it can be very shaming or embarrassing to ask for somebody to prove how much they do or don’t earn.

It’s not really treating people with integrity to say, ‘Prove to me how much money you have.’”

The organization has concluded that if a patient is intent on scamming the system to get free care, they’ll probably get away with it anyway. And so far, Terry Reilly has cont. 9 found little, if any, evidence of that.

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The reason for the change? That might be tied to another stunner. Boise Weekly learned that at least 51 percent of Terry Reilly board of directors must also be clients.

“Right now, I think about 75 percent of our board are people who access services at one of our clinics,” said Traylor. from 8

Mental Health Services

that mental illness is a chronic health condition; and we can treat it with the same stigma, or lack of stigma, as diabetes, Crohn’s or hypertension.”

Telling the Story “I would love to be able to tell our story the same way that the Treasure Valley YMCA tells their story.

They’re so good at that,” said Traylor, who pointed to Tami Fife, Terry Reilly’s new development and outreach director. “Not only does Tami have a heart and passion for what we do, she has the understanding of telling our story.”

A big part of that story is the community health model.

“I’m not sure if people really know what that model is,” said Fife. “It’s really transforming health care. I promise you that it’s reducing cost and putting more services in one place. That’s something that we really want to share.”

Over the years, Terry Reilly has told donors, supporters and grantors about the health service organization’s zero-pay program, its indigent services and homeless programs.

“But we haven’t told our full story,” said Traylor. “We want to honor our past, but we want to tell the whole story.”

A big piece of that will be when they take the keys to their under-construction clinic in Nampa.

“It was really important that we stay close to downtown Nampa, giving our clients easy access and plenty of parking,” said Traylor, wearing a hard hat. “We like what’s going on in downtown Nampa.”

Terry Reilly clinics have expanded—as have their patients’ needs— through the decades. LeBow famously labelled the early days, in the 1970s, as “seat-of-the-pants”: operations with patchwork funding; laboratory and X-ray work followed in the late 1970s; exercise and “healthwise” programs came soon after, as did more work with local schools. In the 1980s, clinics set up the so-called SANE (Sexual Abuse Now Ended) Program, dealing with both the victims and offenders of sexual abuse.

Programs to care for an increasing number of teen pregnancies came in the mid-1980s and more focus on prenatal care was introduced to the clinic.

Throughout the history of Terry Reilly, there has been a steady, sustained level of care for behavioral health issues, but while that care has remained steadfast, the national debate about mental illness has ebbed and flowed over time.

“I think it’s heartening and disheartening all at the same time,” said Traylor, who spent her early professional years caring for people struggling with mental illness. “It seems that the community conversation only starts when there has been a tragedy. All of a sudden, it feels like anyone who has some form of mental illness is brushed with the Heidi Traylor, executive director paint from that tragedy. Everything is about the extreme.”

She also stressed that Terry Reilly As a result, Traylor said, the larger would be keeping its current Nampa conversation distorts the real picture clinic on 16th Avenue North (the of what it’s like to live with mental original grocery store location) open illness. as a neighborhood care center.

“There are many people who “Oh yes, we’ll maintain a presence struggle with some form of mental here,” said Traylor referring to the illness that are loving, hard-working original site. members of society who want to do As for that five-panel mural that right,” she said. “So here comes the shows a very young Traylor and Bob optimist in me: The heartening piece LeBow in earlier years? is that perhaps we can talk about “These pieces of art…” Traylor mental illness a little more. I hope took a pause. “These walls are our we can get to the point where we say legacy.”

“It’s not really treating people with integrity to say, ‘Prove to me how much money you have.’”

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All Creatures Great, Small and Expensive Why veterinary care is so costly, and rising Cindy Sikkema

While the love we share with our pets is indeed free, the care we insist our pets receive is increasingly more expensive. According to the American Pet Products Association, American pet owners spent a whopping $55.7 billion in 2013.

Of that, 25 percent, or about $14.3 billion, was spent on veterinary care.

Vern Crouch and wife faced an agonizing decision earlier this year when their 7-year-old cat, Buddy, was diagnosed with kidney failure.

“We were devastated when we got the diagnosis” said Crouch. “Buddy had been part of our lives for years—he was quite the boy.” The veterinarian who diagnosed Buddy offered a costly solution: daily kidney dialysis treatment for 30 days, at a cost of more than $100 per treatment.

“I did the math in my head and realized we were talking thousands of dollars,” said Crouch.

Already faced with devastating medical bills of their own, spending that kind of money on Buddy simply wasn’t an option.

“Within 36 hours of receiving the diagnosis, we had to put Buddy to sleep,” said Crouch.

Their experience is hardly unique.

“Almost every single client I have has money concerns,” said Boise veterinarian Dr. Linda Donerkiel, owner of Boise-based The Pet Doctor. “So there are a lot of things people are deciding not to do based on cost.”

“For example, after a routine procedure like a lumpectomy, I always recommend blood work and that we send [the lump] into the lab to find out whether it’s cancerous and whether or not we’ve gotten it all. But most owners choose not to—they just hope for the best,” said Donerkiel.

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“And you have to totally respect that. You can’t tell people to go ahead with a procedure if it means they can’t pay their mortgage.”

Several factors are to blame for the rising costs of veterinary medicine, including increased vet school tuitions and a greater need for vets to carry malpractice insurance.

Even Obamacare doesn’t escape some of the blame, adding 2.5 percent to the cost of equipment such as X-ray and ultrasound machines—whether for human or animal diagnostics. In addition, advances in animal medicine have expanded to include things such as stem cell therapy and arthroscopy, laser surgery and prosthetics, according to Vet Tech, an online resource for veterinary technicians.

These advances have led to a new “standard of care” within the industry.

“It’s a catch-22,” said Donerkiel. “Each advance seems like a great thing, and it is great, except that the new treatment becomes the new standard of care. What used to be a straightforward surgery in the past now requires MRI or arthroscopic surgery, which ends up being five times as expensive.”

The result?

“People wait longer to bring their pets in or they don’t do as much preventative care as they used to,” said Donerkiel. Other times, pet owners have no choice but to do the bare minimum for their animals.

It’s a situation that has more and more pet owners considering animal insurance in the same way they think about insurance for their children.

“I always treat my dogs as if they were humans,” said Sherri Smith, owner of three dachshunds.

“And I’ll probably keep them on the wellness plan for the rest of their lives—primarily for the teeth cleaning coverage since it’s ridiculously expensive.”

Smith pays an average of $343 annually, per dog, for coverage that includes routine expenses such as vaccinations and teeth cleaning but does not offer coverage for injury- or illness-related expenses. For that, she would need to purchase a separate health insurance policy.

But Smith isn’t interested in a separate health policy, at least not at this point.

“You know, I looked into them a few years ago, and I didn’t like what they had to offer— what you got for your money,” she said.

Consumer Reports Magazine confirmed Smith’s findings in a 2011 report that read, “Pet insurance [plans] generally cost more than [they] paid out in our latest comparison of policies.”

To get an idea of pet health insurance premiums, Boise Weekly visited HealthyPawsInsurance.com, a top-10 provider of pet insurance policies. To purchase coverage for a 1-year-old male dog, Healthy Paws quoted a monthly premium of $39 for the best policy.

The catch is that many expenses are not included, such as veterinary exam fees, spaying/ neutering, vaccinations, dental care, parasite control and any type of pre-existing condition.

Were Smith to purchase health insurance policies in addition to a wellness plan, she would be looking at around $2,400 per year—an amount that is simply out of reach for many pet owners.

But when the U.S. Bureau of Labor Statistics shows veterinary care climbing at a staggering rate of 91 percent over the past 10 years, it leaves pet owners like Smith wondering, “Just how far can they can go?”

Perhaps the best advice comes from the Idaho Humane Society: “Be able to afford the pet you have, don’t get too many, and save up for inevitable services.”

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