People have gone to extremes to pamper their pets — but operating on a goldfish? That’s next-level pet parenting.

“I don’t really think twice about it,” Dr. Greg Lewbart, a vet who treats aquarium fish, tells WRAL in Raleigh, NC. “I just think, this is Teddy or this is Lucky or Tulip or Bubbles, and they’re a part of the family, and I am going to do my best to help that animal and the owner.”

He says that the North Carolina State University veterinary school treats about 50 fishy patients a year — ordering everything from CAT scans to chemo to surgery. Lewbart also make house calls as fish are difficult to transport.

Fish, of course, derive their oxygen through water, so vets use basic tools such as a tiny hose to keep H2O continuously pumping through the fish.

“They can live out of water as long as you keep their lungs moist or irrigated,” says Lewbart.

Koi keeper Pat Gupton of Chapel Hill, NC, has maintained the same fishy friends for decades.

“I’ve had some of these fish for over 30 years,” says Gupton of her koi fish, which can survive 25 years or more. “Once you get to know them, they have such distinct personalities.”

She’s been taking her koi to Lewbart for years.

“Your fish gets sick, are you just going to let it die? No, no no,” she says. “You are going to take it to the vet school.”

Fish may be small, but their vet bills can be pretty big. An exam could cost the pet owner about $200, and surgery could be thousands more.

“We’ve certainly had owners spend $1,000 to $2,000 on a pet goldfish,” says Lewbart. “There is a real bond that people form with their pet fish – not everybody, but a lot of people do.”

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Gupton says she’s spent a lot on her koi — but the joy they’ve brought her has been priceless.

“I will go without to have my fish have what they need,” she says. “If you have an animal, whether it is a dog, a cat or a fish, you have to take care of it. It is your responsibility.”