Like many people, Mary Putnam recently had to refinance her house to pay medical bills.

In her case, though, the $16,000 she borrowed paid for leg surgeries and physical rehabilitation for her standard poodle, Pepe.

Putnam considers it money very well spent. Pets like Pepe are the beneficiaries of both radical improvements in veterinary medicine -- particularly in rehabilitation and cancer treatment -- as well as the growing number of Americans who consider their pets family members worthy of expensive treatment that's on par of quality health care for humans. And a place where much of the cutting-edge veterinary care is happening is at the UW-Madison School of Veterinary Medicine.

"If I hadn't come here, Pepe would be legless," Putnam said. "Or I'd have had to put him down."

Putnam and other owners don't face just big bills. They face big commitments: clinic visits, hours of rehab, pills and injections to be administered on strict schedules, monitoring the pet's behavior to prevent further problems. And while a doctor can be reasonably certain that a person recovering from leg surgery won't jump up on a bed, that's not necessarily the case with a dog. "How do you make a dog understand that he can't do what comes naturally to a dog?" she said.

Every week, Putnam drives 140 miles round-trip from her home in Rockton, Ill., to Madison, where she turns Pepe over to Courtney Arnoldy for an hour. Arnoldy, who was a physical therapist for humans for nine years before earning certification as a canine rehabilitation practitioner, will work on Pepe in collaboration with his surgeons and other members of the vet school staff.

Pepe's medical ordeal began with a limp that led to an unsuccessful surgery at another veterinary facility, which spiraled down into the dog's not being able to stand on either rear leg. For seven months Putnam had to carry the 54-pound down and hoist up his rear legs in a sling.

"I couldn't see putting him down just because he couldn't walk," Putnam said. "He's been a companion, guardian and partner to me all these years, and he was only 7 years old at the time." It was Pepe who sat beside her as she drove back to Illinois, through the Rockies, after her husband died shortly after they'd retired to Las Vegas.

Changes in society, medicine

In the past, pets diagnosed with cancer were routinely euthanized. Now, as it is with humans, all the options are weighed. The costs of fighting cancer in pets sometimes rises to $20,000, according to Robin Downing, a veterinarian and author of "Pets Living With Cancer." "So much depends on what the tumor is and how it is treated: radiation, surgery, chemo, supportive care, or a combination of all of these."

A whippet named Shelby was diagnosed with an aggressive form of non-Hodgkins lymphoma on his sixth birthday. Untreated, it typically kills dogs in less than a month.

"We were devastated," said his owner Cindy Kruser, of Platteville. "Shelby was young -- whippets can live up to 16 years. The reason we'd gotten a whippet was because they are known for their good health."

Oncologists at the vet school offered three choices: standard chemotherapy, which would have cost about $3,000 up front, with the prospect of many thousands more down the road; experimental chemotherapy for which the Krusers would pay nothing; or euthanasia, which until recently would have been the most likely option in cases like this.

"We were told there was no cure, but there could be a remission that could last up to a year," Kruser said. In the past five years, the Krusers had put down two beloved pets, including the 14-year-old Dalmatian that had grown up with their three children. "We didn 't think they could handle another euthanasia," she said.

The Krusers decided to go with the experimental chemotherapy.

"The decision to treat Shelby was easy, knowing that the drug would eventually be used in human trials, based on positive (canine) trials. We were proud that Shelby could be part of possibly saving human lives. That being said, if the study had not been offered to us for Shelby, we would have paid for treatment for him.

The first chemo treatment was brutal.

"He was deathly sick, feverish and vomiting," Kruser recalled. "But he went into remission after the first chemo." The Krusers drove the 150-mile round trip to Madison once a week for 15 weeks for chemo and checkups.

That was 15 months ago. Kruser reports that Shelby today is as bouncy as a puppy, and the golfball size lumps in his neck can no longer be measured. The word "cure" is still not being used. "We'd be so shocked if he got sick again. We know we could be setting ourselves up for disappointment, but we feel blessed. Maybe this is a miracle."

Since then, the Krusers adopted another whippet, Shelby's niece, and the pair can often be found sunbathing on a cot in the back yard. Because of the cancer, both dogs are on a healthier, and more expensive diet than Shelby had been on previously. Shelby takes a special supplement advertised as an immunity-booster that costs about $60 a month. They don't use weed killer on their lawn because some researchers believe it's a cause for non-Hodgkins lymphoma. And they're down to one trip to Madison every other month for check-ups. "No matter what happens, we feel good that we gave Shelby another year of quality life."

Costly, but . . .

Organ transplant is another frontier in veterinary medicine, and operations like feline kidney transplants that cost about $10,000 to $12,000 (or more if there are complications) are already fairly routine. Seven years ago, Nancy Fino was told that her cat, Max, was on "death's doorstep" because of kidney failure. Fino, who lived in Illinois at the time, asked about the possibility of a kidney transplant for Max, and was directed to the vet school in Madison, which was leading in the field of feline kidney transplants. Max stayed in the hospital for a month. Since then, Max's medical expenses average $1,200 a year, since he's on three medicines (two are taken twice daily), and every three months he has blood drawn and sent to Madison for analysis to see if dosages are still effective.

"Other than that, there have been no side effects," Fino said. "Thankfully, I had the money because I had been saving to buy a house. Because Max was still young (age 3 at the time of diagnosis), I thought he had his whole life ahead of him and there was no way I could not imagine giving him this chance. No regrets at all.

"Going through this is not for everyone. First and foremost, there is a great deal of expense involved, but also a commitment to the ongoing testing and administering of medication. The key to the success of this, I think, is the personality of the animal. Max is extraordinary. I have another cat who is completely uncooperative when it comes to taking medication. This is something that a pet owner has to give a great deal of consideration to."

Transplants also present ethical issues. Feline kidney transplants require a donor cat. The UW-Madison vet school resolved it this way: if the school buys a donor cat (which had been bred for experimentation), the owner of the cat who receives the transplant must agree to adopt the donor cat.

Success or failure of a potential treatment isn't the only concern for vets and pet owners. Although most side effects of chemotherapy for pets can be treated effectively with new anti-nausea and vomiting drugs, (including the only one approved for dogs, Cernia, which was tested in clinical trials of pet dogs being treated in Madison), it is difficult to determine how an animal is really feeling. Unlike adults, who can opt out of treatment if they no longer want to keep fighting a disease, animals can't tell us when they've had enough. "All our clients fill out quality of life questionnaires at every visit and we are very proactive about treating any cancer pain," said Dr. David Vail, who treated Shelby and is the director of the Center for Clinical Trials at the UW vet school. "It is more difficult, obviously, in animals to tell if they are in pain. But the clients seem to know them best, and act on behavior changes." A "quality of life" decision is made with clients when it is felt the pet's quality is no longer being maintained.

Mary Putnam believes that anyone who pursues heroic measures to save their pets' lives must be realistic.

"Pepe will never be perfect," she says. "He'll always have a limp. But he'll be with me for a long time, I hope."