POLAND - When Manny has a seizure, everything in the Ritchie household stops.

Ron Ritchie and his wife, Wendy, drop to the dog's side, reassuring him when he comes to, momentarily blind and disoriented. When he seizes in the middle of the night, they wake to the terrifying sound of their 125-pound family pet thrashing on the floor. When he seizes during the day, they have to choose between staying with him or going to work.

Veterinarians can't figure out why the 3-year-old boxer has violent, grand mal seizures once every couple of weeks. It's not for a lack of trying.

The Poland couple has spent about $5,000 in vet bills for Manny, plus $150 a month for anti-seizure medication. They sold one of their vehicles to get cash for an $1,800 MRI. They've made Manny's medication a priority, putting off other bills to ensure he never skips a dose.

The Ritchies have had Manny since he was 9 weeks old. They can't imagine doing anything less for the loving, laid-back dog who's become like a child to them.

"People have told us to just take him out back and shoot him," Ron said. "They just don't understand."

As Americans' concern for their pets' well-being has increased, veterinary care has risen to the challenge, and spending on veterinary care has ballooned.

Veterinary spending nationally rose from $12 billion in 1996 to $24.5 billion 10 years later, according to the American Veterinary Medical Association.

U.S. dog owners spent an average of $187 on veterinary care per household in 1996, according to the American Veterinary Medical Association. By 2006, that had almost doubled to $356.

Dental care is now routine for pets. Chemotherapy provides cancer treatment where once euthanasia was the only choice. Veterinary specialists, from cardiologists to ophthalmologists, are growing in numbers and popularity.

Even in Maine, where trends arrive slowly, registered veterinary specialties now include acupuncture (15), endoscopy (4), herbal medicine (3) and laser surgery (5).

"It used to be: 'Yeah, we have a dog. He's a great dog, but he's a dog,'" said William Bell, executive director of the Maine Veterinary Medical Association. "Now it's 'We have Toby.'"

Owners like the Ritchies have options.

If they can afford them.

By far, the biggest factors driving the cost of veterinary medicine are owners' desire for high-quality care and their ability to afford it.

At the Animal Emergency Clinic of Mid-Maine in Lewiston, the average visit costs about $260. Add an emergency with an overnight stay, surgery and oxygen and it's $1,500. The opening of the 24-hour clinic in 2000 is itself a testament to pet owners' longing for greater medical options and their willingness to pay for them.

A related cost driver: technology.

Today's vets have MRIs and sophisticated ultrasound imaging, laser surgery and in-house lab equipment that can give a nearly instantaneous reading of an animal's blood work. And X-rays? Gone digital.

"Just as in human medicine, veterinary technology seems to be heading up and up and up," said Michael Binette, a veterinarian at Norway Veterinary Hospital, which, in part, specializes in orthopedic surgery. "We've been able to get pets living longer and better lives."

But it comes at a price that makes many pet owners question their priorities.

Maida DeMers-Dobson, a retired teacher from Buckfield, started wondering last year after her poodle, Jack, broke his leg.

It took an emergency vet visit, a temporary cast, a two-day stay at the orthopedist's and surgery to fix him. The cost: $2,000.

"I sat there thinking 'How can anybody afford this?' I was blown away," DeMers-Dobson said.

She's impressed by the high quality of pet medical care - and she's thankful it's available - but she worries about one day having to choose between care for the family pets and paying the bills.

Even though she doesn't have the money, Christina Kelly of Poland can't imagine not giving state-of-the-art care to her pets. She's saved for months to pay for cataract surgery for her nearly blind 8-year-old rescue dog, Savannah. The operation will cost roughly $4,000.

Kelly's socked away chunks of her paycheck, set aside her state income tax refund and plans to use her coming economic stimulus check. At Christmas she asked people to contribute to a Savannah fund rather than give her presents. She collects bottles and cans, saves her spare change and is planning a yard sale.

Kelly has collected $1,100 so far. When Savannah, a papillion (a type of toy spaniel), has surgery with a New Hampshire specialist this spring, Kelly will put the rest on CareCredit, essentially a medical credit card.

Financially, it's a lot for a single nurse to handle. But Kelly is determined that her dog - all three of her dogs - get the best medical care available.

"They're just that important," she said. "There are times when I haven't found people as good as them. They haven't let me down yet, so I don't want to let them down."

Susan Moody of Chesterville didn't want to let her 11-year-old Lab-beagle mix, Wiggles, down either. Wiggles had been sick for months and needed a specialized ultrasound to determine whether she had a stomach tumor. If she did, the vet could remove it.

The cost: $300 to $800 for the scan.

Moody's income: $637 a month from disability.

With her budget already taxed by Wiggle's vet bills and medications, Moody sought out some of the programs available nationally to poorer pet owners. But most groups keep their information and applications online. Moody didn't have Internet access at home.

Finally, she got approved for $2,500 in credit from CareCredit. Moody made the appointment for the ultrasound for the end of April, then canceled and rescheduled for the first week in May because she didn't have the $3.50 she needed for tolls to get to the April appointment.

She had to wait until her next disability check arrived.

Before that happened, Wiggles died.

The Greater Androscoggin Humane Society gets a couple of calls a day from pet owners looking for help with vet bills. But aside from some limited spay/neuter programs, the shelter doesn't have money to help cash-strapped owners. Shelter staff point people to those national organizations (see list).

Many veterinarians sympathize with owners caught between caring for their pet and paying the bills. Often, they say, they'll give owners several options for care: low-cost, medium-cost and top-of-the-line.

"It took me a little while to figure it out, because when you come out of vet school you're kind of used to doing the top-of-the-line deal. We're going to do this blood work and this test and this test and hospitalize the animal, and we're going to do this and that. You know, that stuff can add up," said Binette, the Norway vet.

Since Jack's $2,000 broken leg, DeMers-Dobson has learned to always ask for options when she brings her two dogs and three cats to the vet. She requests an estimate and then talks to the vet about what's essential, what's not and what alternatives are available.

The savings add up.

When her Brittany spaniel, Cote, needed an antibiotic for an ear infection, the vet offered her a choice: pay over $20 for a special pet medication or $4 for a human medication that could be dosed correctly and would do the same thing.

"I was so grateful," she said. "I think it's really important for pet owners to feel OK asking those questions."

Dennis Hinkley of Buckfield asks those questions, too. But if the answer comes back "It'll cost a lot of money and there's no alternative," he said he isn't sure how far he'll go for his 10-month-old black Lab puppy, Bo.

Recently, Bo stopped eating. His vet believed he had a bulging disc in his back, but the MRI to diagnose it would have cost $1,500. The next best option, an X-ray, would have cost up to $200.

Hinkley, a MaineOxy employee, has two kids at home and a wife who works part time. He loves the puppy, he said, but, "Sorry, my family's got to come first."

Rather than pay for an MRI or an X-ray, Hinkley put Bo on anti-inflammatory medicine. It cost $40, and so far it seems to have worked.

"I think he's just like everybody, he did something that hurt him and he needed the time to recoup and he did. Hopefully everything will be all right," he said.

If the medicine stops working? Ultimately, euthanasia is an option.

"I won't let him suffer, and if it got to the point where he was suffering I'd put him down," he said. "That's just the way I was brought up. You don't let animals suffer."

Some people have told the Ritchies that is what they should do with Manny. But unless the boxer's seizures become an everyday event and the family has exhausted every medical recourse for him, Ron Ritchie is adamant that Manny will stay a part of the family.

No matter the cost.

"When we got Manny at 9 weeks old we took on the responsibility of him, a living, breathing animal," he said. "To just take him out back and bury him in a hole, it just isn't what we do."

The Ritchies aren't wealthy - he's a self-employed contractor and she works in the administrative offices of a local school system - but they've taken Manny to several different vets, including a neurologist and a holistic specialist. They've sought advice from the veterinary arm of Tufts University in Massachusetts. They've switched the boxer to bottled water and special food, and they're considering moving from their Poland rental because they believe area pesticides might have something to do with his condition.

"We have no money," Ritchie said. "We've gone basically without a lot to save this dog's life."

He added, "We're just going to hang with him."