Thursday, October 20, 2016

The Misperception of An Outspoken Vet.

OK, so I have provided apologies before. I probably do it too often? Some ridiculous effort to provide a piece of genuine empathy to my audience and still seek permission to keep on chatting. Maybe it is a silly way to divert assertion of a strong voice or soften the edges while I deliver a punch? Or, perhaps it is even a trace of manipulation or deference for a spirit I don't always suppress?

So here I go again....

I am sorry if this  offends anyone. It is not the intention. Let me start there.

Everyday I question what I am doing and why? I have to provide a list of reasons to my internal self-check consciousness mechanism as I invest more time in what might end up as a completely futile effort. These moments of self-reflection are tidbits of a fractured To-Do list meets overwhelmed workaholic. I accept it as my own doing and dissect so as to provide justification to keep on repeating my self fulling prophecy. Here is a good example of my internal conflict meets slightly scattered over tired practice owner/vet/mom/wife.

Person with box walks into clinic. (Always a bad sign).
I over hear the following between vet tech and box holder; "He's not mine. I don't want him."
Said vet tech finds me to report; "Tiny kitten, head wound, quiet, barely moving found 4 hours ago. She wants us to take it. Can we please just take it and tell her to go?" I know full well this is a plea for two things:
  1. Tech wants to get box carrier out of office ASAP. It is closing time and she knows the argument is a lost cause.
  2. Kitten is in bad shape. 
Internal dialogue unfolds something like this: "Crap. Here I go again."

I walk out to meet said box holder. She repeats same story. "I found this kitten in my yard under a bush with flies on it. It isn't mine. I don't want it. So I brought it here. I figur'd you'd take it?"

How do I answer this?

"He's pretty close to dying isn't he?" She takes advantage of the lull in the conversation as losing leverage and adds a smear of additional pity to the plea.

"Well, maybe if you didn't wait 4 hours?" I mutter, knowing I had lost the battle at the arrival. I add insult to injury.. and peak in the box. Cursory exam; 2 week old kitten with swollen head, poorly responsive, dehydrated, who is dying in front of me. If I don't take him right now and help him right now I know he will die. I know this.

"What are you going to do if I don't take him?" Answer is not going to keep kitten alive. And the most idiotic thing to leave my lips follows, "I am not a shelter."
Yes, we take him.

Swollen head, abscess,
and fly eggs (will be maggots in about 2 hours).
I cannot win.. I just have to find acceptable decisions so I still want to wake up tomorrow and relive the hamster wheel meets Groundhog day life I am trapped within.

Sounds bleak, huh?

Well, I don't think its bleak. I think it is my real-life. How can I title this little public journal and not be honest?

Maybe the whole freakin problem is lack of honesty? Or, in my case, too much honesty?

Maybe it is the culture of whining and blaming and not stating our true feelings?

And maybe I am tired? I can be tired? We all get tired.. but remember that little internal inquiring voice? Yes, I listen to her. Too often I even argue with  her.

I understand I got myself into all of this. I am not asking for anyone's sympathies. I am not even asking for your understanding. I think I am only asking myself to be true to my vision. To not be swayed by others lack of interest, failure to find common goals, and indifference to the plight of others that I am trying to assuage and ameliorate.

Although my blogs and articles get some attention they also leave me open to explaining myself. Truth be told, I feel the conversations are fuel to perpetuate important topics. But like all people we get defensive and protective of unsolicited opinion.

And then my strong voice, fierce compassion and outspoken demeanor elicit this..

Hi Krista,
XXX .. just sent me one of your recent blogs regarding your policy on costs and economic euthanasia, which I thought was AWESOME! (sic)
Hope all is well, and keep on advocating for animals.

I should add a bit of background. The email is from a member of a vet group I belong to. I deeply respect him and believe firmly in the groups purpose and vision. We have firm common ground and a distant rapport.

Many thanks for the email.. To be completely honest I feel as if I  am a one woman crusader against a flurry of corporate run behemoths who are slowly, insidiously taking over vet med. It is shocking to me how few people seem to be left upholding the standards of the foundation our profession was built upon. There are so many wonderfully caring hard working vets but they have been strong armed into practicing what the owner/director mandates, or, they are too driven by a bottom line, or, they are leaving and/or killing themselves.

For example, yesterday I saw two clients who were given estimates of 4x what my clinic would charge. One was a cat who needed a dental and one extraction, estimate given by  "big city practice #1" was $1000. Estimate number two, the puggle with pendulous soft tissue mass wo palpable blood vessels at base of stalk, $800-1200. Cat dental at our clinic $400 (w full pre op bw), and mass removal $200 w sedation and local block. Both clients waited months to try to save up for the service at their clinic, both left when they called me to  inquire about doing at my clinic. You understand my gripe.

My intention with  everything  I am doing  is to reduce (as much as possible) economic euthanasia. I also feel strongly that vet med is way overdue for a reality check. If we still maintained our integrity we wouldn't need transparency. But sadly I think we have lost/abandoned both. And we both know who suffers when that happens.

My clinic is my beta for what I am building Pawbly to become. It is my attempt to build something on a small scale that I can use to prove my vision and scale up to provide universal animal assistance. 

It is a lofty goal which I am determined to achieve regardless of time, effort, and  investment (well I say that now $100K in). Pawbly and my clinic are the legacy I hope to leave behind for both the veterinary community and animals around the world. I will ask for help from every person  I meet  (the plight  of an entrepreneur) and keep going alone until it finds its grass roots ground swell.

I would love to chat with any of you about my project and how it might assist with your efforts. As with my presumptive business theory to build Pawbly upon I believe that people love their pets and that there are millions of us around the world who share this common viewpoint. All we have to do now is have  one place to meet and  exchange information, animal education and infuse it with inspiration. The result is helping pets and their people live longer happier and healthier lives. I know the pitch sounds like Dr Google, but it is quite the  opposite. I know pets need their vets I just have to convince the general pop that this is still the case, and we vets need to provide a stronger, more meaningful relationship built upon trust and affordable realistic options.

Ok, off of soapbox and off to the clinic to save another wet nose.

Have a wonderful day.
Please do keep in touch, and please let me know if I can participate in any of your endeavors.

Hi Krista,
HSVMA has started a coalition of people devoted to working on ensuring access to veterinary care.

From a larger perspective, I’m concerned about the tone and degree of angst in your thoughts below..,.
There is no doubt we both share valid concerns regarding whether our profession fulfills its potential in serving the needs of animals.
Its also become abundantly clear from my own journey as a vet x 30 years and from studies, that the line between compassion-advocacy-stress-burnout, can be a short one…
To be an advocate for animals, requires you ensure you remain healthy as well…

My reply;
Hello XXX,

I would love to be a part of the care coalition.  I had seen the write up in JAVMA and wanted to inquire about it. I hope to help our clients and pets in anyway I can. 

I realize that you don't know me. So perhaps I can reassure you and place my passion into perspective. I am a devoted dedicated and determined Italian. I spent 15 years in the military and at sea and if that couldn't break me nothing can. I am doing very well. But I am not giving up on helping my community and my profession. I appreciate your care and concern but I am good. I promise. And if by chance you hear that all the time and still ponder?. My cell is XXX-. 

I appreciate your prompt response and extended concern about my angst. Although I think it is more accurately described as frustration and optimism to provide a place for assistance. 

Take care 

.... and with that there is silence. Maybe we don't have common goals and firm ground? And so the internal debate marches on.

.... or maybe I am passionate about something and I want to improve it? Maybe this assumption that I am so delicate AND that all of this is possible, is taken by me to be yet another older, wiser man telling me to abandon my dreams and just be a little quieter?

It seems I am always fighting. Always. Internally, externally, and with everyone... self included. Is that somehow dangerous? Is it somehow the ephemerous spirit that is the catalyst for change when some conscious frustrated person sees inequality, suffering  and injustice? Damn it I see suffering everyday that I somehow have to make a decision about. Its my decision alone.  I cannot place it on my staff. I cannot turn my back.. and yes it means there is a conscious recognition of not choosing indifference, not abandoning  that needful soul and yay! now I get to defend and justify it to others who want to impress upon  me that there 'numerous years of experience should be my guide to a happy healthy lifestyle." Which leaves me feeling like I can't win.

Ugh! I cannot/will not apologize for this. It seems it might be harder than I thought to be an outspoken unwanted advocate?... and so I decide to stay the course, not abandon hope and keep pushing on.. even if it is alone. Elicit internal pep talk; Note to others in similar plights; I get it. Few people get you. Others will disclaim your credibility, intentions, or lofty aspirations.. Keep believing in yourself. In the end that's all you really have. You have to always be ok with that.

Maybe for me being an advocate is being  a strong voice in a field of hushed mice? Maybe for me I am ok with being my professions Rosa Parks? 

.... and so I internally debate again.. sit to write, throw it all out there naked, and push on.

I am not going  to walk away from a problem I think i can influence, improve and feel compelled to do... and yes, this is a decision I have made with the understanding of what the costs may be. I am an entrepreneur! I shout it and proclaim it! I know what I am willing to throw on the craps table. I know what the house holds. What the acceptable risk is, and I know that there are a lot of blank faces I have  to walk away from. I don't have the time to explain it to you. I  don't have the energy to waste trying  to convince you. And I don't have the capital to worry about whether you approve.

I am not going to walk this path and not try. I am not going to be a part of something I know I can improve but fear the consequences of others judging me, coddling me, cajoling, or castigating. I can't and I won't. So I walk away again knowing I did the best I could and took care of everyone I could along the way. Regardless of the unsolicited, albeit well intentioned advice I seem to attract.

Here is how you can reach me if you have a pet in need. I am at and Jarrettsville Veterinary Center in Jarrettsville Maryland. You can also follow me on Twitter @FreePetAdvice, YouTube, or on Facebook. If by chance you want to help a pet in need Please join us all on It is free to use and open to anyone anywhere who loves animals and wants to help them and their people.

Sunday, October 16, 2016

The Jarrettsville Veterinary Center Policy For Clients With Financial Constraints. 2016 Version.

Seems that my professional life on the case by case basis is going very well. I have clients and patients that I absolutely adore and look forward to seeing every working day. Truly, I love veterinary medicine and helping pets and their people. I am lucky and grateful to be one of those veterinarians who can say that with genuine gusto.

The trick however is that I also have to run a business. Too often those two facts can be at odds with each other. In order to practice medicine I have to have a building, trained staff, and stuff,, lots of expensive delicate highly fragile technologically advanced (did I say, expensive?) stuff.

The sign of a successful practice is most commonly considered to based on a spread sheet of elaborate charts, data, and numbers. But for me the sign of a successful practice is walking out each  night knowing that everyone who walked in the front door was treated with love, respect and compassion. The challenge is finding a balance between sharing that and keeping the lights on.

If I can't figure out a way to keep paying clients walking in the door I can't take care of  all the patients who come to me in need.. and to be totally honest I want to take care of the non-paying patients as much (sometimes even more.. see Weasely and Dunkin) as the well funded cases.

At Jarrettsville Veterinary Center we promise the following;
  1. We are here to help our clients and our patients whenever they need us.
  2. We do not deny care to anyone.
  3. We are transparent. Prices are posted online and provided for all goods and services.
  4. We are available 7 days a week. 
  5. We are accessible through Facebook, my blog, and all JVC clients are given my email.
  6. We provide options so that economic euthanasia is not a part of any patients treatment plan.

To do this we had to come up with a plan.

Here is the Jarrettsville Veterinary Center protocol (verbatim) for any client or patient with financial hardship.

Every patient should be treated the same. 

We provide an examination and an assessment for each case. We ask that the client pay for this. Our appointment fee is  $50. If they cannot afford this I will see them pro bono.

Financial concerns can be discussed after this. We are assuming that people can’t or won’t pay. We need to stop expecting that people can’t or won’t pay and start treating everyone equally. Assumptions have no place here. Prepare for every option and adjust as they are accepted or declined.

Any client who has financial constraints should be given all options to allow us to help them with the care of their pet. To assist our clients in caring for their pets, and to remain aligned with our clinics mission of never denying care, we are enacting the follow new policies;

Every client is expected to pay the initial $50 exam fee. This is where we start and this is what we relay to clients calling in seeking an appointment for their pet. IF, they state that they cannot afford this, it is at the veterinarian’s discretion as to whether they are willing to waive the exam fee. If the vet declines to waive the fee we can reach out to the rescues. If no one is willing to help with this call me and I will take the case over. (I will either see the pet pro bono, or authorize the JVC donation fund to pay for the exam).

Crocket and his million dollar smile!

After the exam the diagnostics need to be discussed. Every vet should become comfortable providing care with limited diagnostics. There is, in some cases, no other option. My goal for JVC is to provide care to our patients and to never turn away anyone in need. But, I am also most obligated to you, the staff. I will never ask you to do something you are not comfortable with, nor will I ask you to compromise or participate in something you don’t feel is right. If you feel caught in between call me and I will gladly help.

Our goal is to help our clients and their pets and we must do whatever we can to achieve this. We do not allow convenience euthanasia’s, walk-in euthanasia’s without prior DVM consent, and we should not allow them internally due to lack of resources.

If the client cannot afford the care needed or recommended for their pet, their options are as follows;

  1.  Seek care elsewhere if they choose to euthanize and we are unwilling to oblige.   
  2. Seek pro bono care elsewhere. We have a list of local rescues and clinics who might be able to help.  
  3. Continue services at JVC. Sign over the pet to one of our affiliated rescue groups. 
  4. The pet will be treated and cared for and adopted to a home via the rescue.

If they choose to stay with us and are unable to leave a deposit for the entire estimate, they are required to apply for CareCredit. CareCredit is the most expensive plan we offer, but, it guarantees payment. I ask for this because in many cases the client is not calling and is just telling us that they did not get approved. To use a payment plan the client is charged a set-up and a $3 per transaction fee.  To provide this option we must make sure that the estimate is accurate and there are no discounts. Also, please notify the client that they need to ask for the amount at the high end of the estimate. They are welcome to use our phone and we are happy to help them should they have any questions or concerns. 

Weasely. Our newest Good Samaritan case.

If CareCredit is declined can be offered. To be eligible for Vet Billing the client must leave a 30% deposit for the estimate.

Estimates must be accurate and must be given as a range. The client should ask for CareCredit at the high end, and will be given an a  Vet Billing payment plan for the high estimate. If the bill is lower we will shorten the payment period. All estimates need to be in writing and submitted in the chart. The client needs to sign the estimate and be given a copy.

If the client does not have the 30% to leave as a deposit they must either leave collateral OR go to a local pawn shop and provide the deposit. I am no longer going to accept no deposits left. And, there are no exceptions. If you have a problem call me, or the Hospital Administrator and we will resolve it.

I am persistently trying to offer assistance and run the fine line between taking care of pets and the staff. If any staff members feel compelled to assist a client and/or a patient they are welcome to donate their time and services. I appreciate the generous compassionate dedication of all of the JVC team but we are consistently helping people who do not pay us back and do so at the expense of us collectively.

Every client needs to be given a daily update of their bill and every hospitalized patient is required to be paid in advance at the beginning of the time of services.

Lastly, no pet will be euthanized or allowed to be privately cremated without the bill being paid. If a bill is not paid, or transferred to me the vet who provided the services will be held responsible for the invoice. (I never ever want this to happen! I will gladly shoulder the responsibility so that no one else has to cover someone else’s bill!!)

I am including a list of pawn shops. I am also including their hours of operation. There is no exception to the deposit policy.

For all clients leaving with any outstanding balance a written plan for repayment, a copy of a valid driver’s license and a signed copy of the repayment schedule plan with a witness signature must be done. All paperwork needs to be kept and included in the file or kept by the hospital administrator.

The intention of the policy is to provide assistance to the pets at risk of surrender to shelters due to lack of resources for medical issues, economic euthanasia due to inability to pay up front for needed veterinary care, or abandonment.

In short JVC will offer every single conceivable option to help a pet in need. We will take custody of the pet and find a home after the pet is well and we will never turn our back on a pet. I cannot provide all the care to all of the pets in the world who need us, But I can do so to those pets in our care.

This policy has been in place for almost 5 years. We have done miraculous life saving medicine  and built relationships based on  exactly what vet  med is intended for. If you follow our Facebook page you will see the faces of those we are able to alter the fate of.

Even with this policy I still have clients who want for JVC to pay for their pets care and refuse to sign a payment plan.. I also have clients who ask for us to pay for the care and then want to adopt the pet back. No one ever said it would be easy, but for us  it is the right  thing to do, and I can leave work everyday saying that I  did everything I could for my patients. If they walk into JVC they are my patient and I will never turn and walk away from them.

Related Blogs;

Shelter Medicine Meets Private Practitioner. Finding An Answer with An Agenda.

Dunkin, The Story of The Littlest Life, And  All That Matters.

Open Admission Shelters Are NOT Safe Houses.

Wellness Plans, Savings Plans and Surprises. Why your vet NEEDS to be your best friend.

The Jarrettsville Veterinary Center Price List for 2016.

As always JVC, and I, are here to help you and your pet. If you would like to meet the amazing staff and hear more about the ways that we can help you and your pet live longer happier and healthier lives we would be happy to show you how the face of veterinary medicine and the care we provide can ext end past the traditional options of hope and luck.

If you would like to learn more about pet care or ask a free pet related question please visit It is free to use and open to all of those who love pets.

If you want to help others and you have experience with pet care please join us on Pet care is about helping others and we are built on this alone. I also have educational videos on YouTube, or @FreePetAdvice.

And of course we hope that you will Please always Be Kind.

Wednesday, October 12, 2016

Has Your Vet Given Up On Your Pet? Or You? Would You Even Recognize It If They Had?

There are patients who make big indelible marks on my heart. One such pup is Myla. She is a sweet, happy, fluff of curls who is always smiling and always inquisitive about every human she meets.  I had seen Myla every week for the first few months of her life with her adoptive family. Those weekly visits were set up to separate all of her vaccines out into small accountable doses. It may seem odd to most, but in cases of super protective adoring parents, and with our very flexible charging and booking system we do things other veterinary clinics wouldn't consider. That puppy vaccine time frame lasted over four months. During which Myla and I became the very best of buddies. I had spent lots of time reassuring her that I was her friend and that the veterinary clinic was a place for snuggles, treats and affection. As always, I wanted Myla to know that we loved her, and that the vaccines, clinic and staff were not things to be afraid of. In fact, my goal is for them to not even ever realize that they are being vaccinated or examined. Building a bond of love and trust during those puppy visits often determines every other subsequent veterinary exam ahead. Making the vet visits enjoyable helps our patients, our pet parents and our staff. It is vital to our mission in assisting our pets live long, happy, and healthy lives.

Myla and I were back together almost 11 months later for a new health issue. Myla was about 20 pounds larger and almost doubled in size. I was excited to see her again and tell her how much I had missed her, but this time she wasn't as happy or outgoing as I had remembered.

Myla at 4 months old.. her last puppy visit with me.
Is a year too long for her to remember me? NO, she is a dog. Dogs are brilliant. She knew who I was but she had come to hate what I represented. She wasn't happy to be at our clinic and she wasn't happy to see me. Although I didn't yet know why?

Myla had been to our office last week for head shaking and a painful ear. As is often the case at a multi doctor practice open 7 days a week 12 hours a day there are times when other vets will see our once-ago puppy patients. The other vet, like all of our vets, is incredibly capable and intelligent, BUT, she didn't know Myla like I did. She had likely seen a long list of previous vet visits, a complete series of vaccines, preventatives, needed puppy diagnostics. The whole enchilada..but, this would not reflect how her original vet felt about her? Had I failed to note how special she was?

When I saw Myla close up and in person in the exam room a few moments later she slowly and shyly approached to say her "hello." The spirit of this spry girl seemed diminished and distant. As I clutched her face to give a nuzzled kiss I noticed that her third eyelids were elevated. This is not normal... she looked drunk and drifted.

Jekyll, my pup, demonstrates an elevated third eyelid..
he is actually trying to sleep and I am pestering him for a photo for this blog..
aah, the plight of being a vets pup.

"What is that about?" My first real acknowledgment to her mom as I pointed to her obviously abnormal eyes.

"The vet wanted me to sedate her for the exam. Last time one pill wasn't enough. So I gave two for this trip." She replied quickly and openly.

"WHAT? WHY?" I couldn't imagine why this girl needed sedation? She was energetic and happy but never bad. What happened?

Her mom went on to tell me that she knew Myla had "a bad ear". The previous vet had "packed it with a long lasting ear product last week and this week was to see if it needed to be done again."

I listened intently to try to make the puzzle pieces fit. How could my firm conception of Myla as a loving, gentle girl have evolved into this? In usual vet med detective mode I asked mom for more information. Myla is after all only a year old. Myla is too young for ear problems that need a muzzle to manage. She is a poodle mix; curly hair and floppy ears. We knew that she is a breed predisposed to ear issues. (See blog on Excessive Ear Hair, and Veterinary Ear Care Basics).
  • What was she doing at home to help the ears not get to this point? 
  • Why would sedation be needed. Never mind "doubling the dose?"
  • When is "packing the ears" a first time treatment choice?
  • What had happened to all of the advice I had given mom at all of those many puppy visits to help keep her predisposition for ear problems at bay?
  • How does a not long ago happy quiet sweet pup become so bad so quick?

Here are the answers to every question I posed above:
  • Home care was not happening. Hence the ear problem becoming a BIG problem needing a vet to manage, repeatedly.
  • If a little drugs don't do the job.. add more drugs. This includes sedation, management at home, and care from the vet. 
  • Packing the ears should not be the first treatment option (in my opinion).
  • The advice I had given those months ago had to be abandoned when Myla refused to allow them.
  • Myla has resorted to being a growling, biting, fighting, squealing,,, now drugged,, dog to avoid her painful ears from being touched. 

Myla has bad ears because her breed predisposed her to them being problematic. The rest was our fault.

Here are the predisposing factors influencing Myla's current ear dilemma;
  • Certainly a discussion of removing excess hair, and keeping her groomed is important. 
  • We also need to discuss how we can try to keep the ears open to the air when they are heavy floppy ears.
  • As with so many ear problems there is often an underlying allergy component. Therefore, keeping Myla on a good parasite (fleas especially) preventative and long term allergy control is all warranted. 
  • We need to understand and accept that her ears are ALWAYS simmering. They are ALWAYS waiting for that low boil of inflammation to become full blown infection. Thwarting the simmer before it turns into infection is vital or somewhere down the line she will need a TECA. She will lose her ear canals because they have become too damaged and a source of chronic pain and infection to treat any other way.
  • We need to be diligent in monitoring and treating them, even if that is daily. 
  • We also have to find a way to let Myla know that we love her and she can trust us.
  • Myla needs to believe that we are here to help, NOT HURT. That goes for inside her home and inside our clinic.

Here's what Mylas's mom was doing at home. She had started to clean the ears as we had recommended (see video here), BUT, Myla's ears hurt and therefore Myla wouldn't allow any kind of restraint. Myla associated anything to do with restraint or touching her ears with pain. She was now afraid of the pain that she believed was going to happen. Subsequently Myla's mom started to try to clean and medicate with soaked cotton balls, paper towels, Q-Tips and minimal to no restraint. The problem is that these don't work because her problem is deep within her ears and she needs a thorough washing/flushing. These short cut methods are the consequence left to owners because they cannot restrain. Worse yet, they DON'T allow the ears to be treated and therefore the snowball of ear problems perpetuate and of course, worsen. Pet parents are left feeling disgusted and that they cannot help their pet or assuage the vet. If left unchecked pet parents will often have to choose between what they think is just hurting their pet, or, doing what the vet says. Most pet parents will pick the side of protecting their pet from abuse at their own hands. They will either find another vet, or stop coming back to us. If they do come back to the clinic the vets are then forced to try to manage an unruly scared and desperate patient and left to do things like man-handle, muzzle, and/or drug. Even worse than these scenarios are the pet parents who take our "bad pet management" techniques as gospel and begin to emulate our own treatment of their dog. I have pet parents who return with a more fearful pet because they are FORCING their pet into compliance with more brute force, chains, muzzles, beatings, verbal chastising and utter determination to force submission of the pet into compliance. So now the pet is BOTH painful and bullied. These pets either have their spirit broken OR they fight back. These are the pets who are surrendered or euthanized somewhere down the road.That is the ultimate devastation of BOTH the vets and parents relationship.

Myla at her follow up appointment.
I am delighted to see a smile again.
Your pets ear canals are long tunnels that are "L" shaped. When there is infection or inflammation the tunnels get red, hot, painful and angry. They respond by swelling. This causes narrowing. A narrowed ear canal cannot breathe and it perpetuates and promotes more infection, pain, and irritation. You cannot open up this narrow tube without liquid.. lots of veterinary prescription liquid. Your pet needs medicine in that tiny painful hole that used to be a healthy open ear. The longer you wait and the worse you fail at delivering medicine where it needs to be, AND, the less likely that ear is to ever go back to healthy. Over time the ear closes. Literally swells and closes the infection, the pain and the disease inside. Your pets only options at this point is usually removing the diseased, scarred, non-functional ear canal. I know it sounds awful but these pets are in pain and they will be happier without the smelly infected very painful ear. They already can't hear out of it. You aren't losing function you are simply bidding disease adieu, finally.

It was time to have a sit down talk with Myla's mom. As I talked with Myla's mom and asked for help the technicians all forewarned me that "Myla was terrible last week." Well, of course she was. She is afraid, in pain, and we muzzle her, and then pile people on top of her.

Myla's mom loves her. She, like so many of us, doesn't want to hurt her. In truth all of us have failed her. Failing to address pain and failing to recognize it as the basis for her unruly behavior is inexcusable. Further the sedation we had given was not to provide pain relief, it was just to slow down her responses to it. We can do better.

Admission of a problem. 
  1. Myla has bad ears. Her breed predisposed her to this.
  2. Myla's ears hurt. Pain is treatable.
  3. Myla won't let anyone touch them. She has to learn to trust again.
  4. Myla is too young for any of these. Drugs to induce compliance are cheating her and her family of an adequate plan.
  5. The staff all knew who she was and all were willing to treat her as if she is Hannibal Lechter. 

Daily Checklist For Myla;
Myla's list of daily care now includes food, water, shelter, love, urinating, defecating, and ears. Every day I want her mom to make sure these are all in good working order. To avoid the narrowed, red, painful ears she has now we need to start treating for the pain AND disease AND then start a long term maintenance that her mom can actually do. For me this usually includes advising the ears to be washed as often as needed. Use your nose, eyes, and ears to assess the ears at home. 

Here is where we are going to refocus our efforts so that at the next vet visit, at the next health care need, and every step in the public everyone is safe and healthy.
  1. Pay attention to any condition appearing in such young dogs. These are the patients who need extra time and attention. They are the life long cases. Educate your clients so they can manage their pets optimally through the decades ahead.
  2. Mom needs to go back to basic obedience class and learn trust and basic commands. Both mom and dad need to attend. Obedience/Puppy classes are primarily to train parents how to communicate effectively with their pets. Not having both parents present is imperative to Myla getting clear, direct requests spoken (calmly and gently) in one easily understandable language.
  3. Mom needs some help from us on how to be able to hold Myla (this is ALWAYS the problem with bad ears long term). Myla was too wiggly and her mom couldn't restrain her. So the daily washing (see video on how to do this here) turned into soaking a cotton ball and trying to get that in the ear.
  4. Myla needs a team who is devoted to helping her mind, body, and soul.
Myla's follow up ear appointment with me.
She is her old happy self.
Sedation free and happy to take treats.
She trusts me again.

The point to all of these is that we have all failed her. We turned her in to this "BAD" dog. How did it happen? We forgot to train her to trust. We allowed her to voice an opinion that was detrimental to her health, and we forgot that parenting is the responsibility of the village. 

Myla will come back every week. In some cases it will just to sit in the reception area and make friends. In others we will gradually start to condition  her to accept restraint. In others we will begin to clean her ears. The goal is to condition and desensitize her fearful response to the clinic, restraint, and managing her ears. We are also going to be kind, patient and understanding. Using a drug or muzzle is too often a way to say that we are going to "just get through the exam and get what we can done." It is a terrible way to treat a chronic problem and it will make every subsequent visit that much worse. No vet wants this for their patients.

This is how I want my patients to be; calm, relaxed, smiling, anxiety-free.
If your appointment doesn't look like this ask your vet for help and guidance.
No one wants to be hated or afraid.

If you have a pet who is "required to be drugged," muzzled at the door, or has orange stickers all over their file that reads "CAUTION", please talk to your veterinary team about how to help your pet deal with their own anxiety, and how you can become the welcomed anticipated client not seen or treated like the skull capped grill faced killer craving fava beans.

End of her follow up appointment! Everyone feels better!
Myla returned a week later a different (or should I say the same) dog then she was at the last weeks visit. Her parents are dedicated to keeping her healthy and happy and are making great strides to helping her ears feel and be better. They are working with her anxiety, her fears, and we have almost completely eradicated the pain and infection. I left an open invitation to come back as much as they want to. I am happy to help take baby steps forward so that she is never stressed or not receiving the emotional AND medical care she needs and deserves.

Love you Myla!

Related blogs here;
Everyone Has Ears And No One Treats 'Em Right.

Ear Hematoma Primer

Ear Cleaning Guidelines.

Thursday, September 1, 2016

It isn't just high school anymore. Veterinarian Bullying and Veterinarian Suicide. How the vet clinic is the new homeroom.

There are a few key concepts to pet care that vets just intuitively get. Something about our ability to provide empathy, our understanding of biology, psychology, and determination of sheer will in the face of adversity. It is why we know to not give up on a sick kitten, parvo puppy, or judge a short coated wide nosed bully breed as automatically being guilty of the label "dangerous." We can sniff out disease, diagnose via one sentence in a chart without ever seeing the pet, and make spot-on assessments in whip cracking time. We are an intuitive deeply sensitive organic bunch.

Many of us chose medicine because we like a challenge.  A list of incomplete clues and playing detective. We also like gambling on gut feelings... we all do it. It is the fun of having little access to all the big expensive diagnostic tools that give you neatly packaged answers and remind you to always be humble. We also chose to study and practice this craft for the benefit of pets as the cuter cuddlier alternative to the humans we would rather avoid.

For too many vets the situation is this; One on one, vet to patient, we are incredibly adept and skilled... BUT, one on one vet to client, OR, vet to superior vet, we are falling apart. We are unable to voice concerns, stand up for ourselves, our patients, our integrity, our self respect, our emotional well-being, or the others around us as they are being bullied. We are victims of abuse in our own places of work and we don't provide ourselves a short term, long term, or even a differential plan to improve it. We are abysmal doctors in caring for our own disease.

Some of us live daily in a quiet self-imposed crippling torture. Some of us are leaders like practice owners, relief vets, self-employed, or practicing and living based on our own needs and desires. It is often the simple fact of the "haves" and the "have-nots" and the delicate piece of earth that remains in between. Status, titles, empowerment, entitlement, whatever the case, the "haves" decide and the "have-nots" put up with it. Many are associates living by a play book someone else directs and dictates. I have become increasingly aware of this group through my blog and a few secret Facebook groups dedicated to providing support and a safety net to those of us who are in danger or intimately aware at how high the suicide rate in our profession is. It is heart breaking to hear how many people feel trapped and desperately unhappy.  As this profession shifts hands to the next generation of intelligent compassionate women it seems to have also shifted into treacherous waters full of mental anguish. Veterinary medicine is replete with emotionally embroiled overabundance. The problem seems to be where to manage the excess when you have learned helplessness.

I usually try to not alienate anyone by providing generalizations, BUT, this is a plea for those who need it to get their own SELF HELP so I am going to be as direct as possible.

Why do vets allow themselves to be bullied? Studies show it is that they feel one of the following;

TRAPPED. People will die internally, or kill themselves if they feel trapped. Chew your paw off to get out of a leg hold trap. Put a bird, gorilla, elephant, whale in a cage too small, deny them love, stimuli and a healthy happy environment and they will unravel. We have all seen it. We recognize it, we diagnose it, and now we need to start treating it. We need to do this reflectively. We are no different than the dogs, cats, and caged beasts our clients have inadvertently messed up to the point of needing professional intervention.

CONFLICTED. We are asked, expected, or ordered to do things we do not agree with. Add a pathetic patient whose fate literally lies in our hands into the mix = recipe for disaster, lying, self loathing, and emotional heartbreak.

EXHAUSTED. We have this ludicrous idea and expectation that your self worth is directly proportional to your self destructive obsessive compulsive work ethic that denies and promotes not eating, not sleeping and not using the bathroom. In less civilized times it was termed "slavery." Except now it is viewed as "self-imposed and expected." Perversely it is rewarded to work to past the point of exhaustion. Who wants an exhausted doctor?

FINANCIALLY BOUND. OK, we are in debt up to our eyes. Some are drowning. Naive, blindingly stupid, immature debt because we absolutely had to go to vet school. (Starting to see a pattern of self-perpetuating stubborn behavior here?).


The "haves" hold this false counterproductive belief that if you work or reside in a profession built on a pyramid of power the minions at the bottom need a reason to stay complaint and stay quiet. The history of dynasties is built on this premise. You either "have" or you are a "have-not". High school meets real-life and still the same drama persists.

Women out there who are unhappy I offer this advice;

Try to understand what the most basic source of your discontent is.

  • Is it finances? Is it due to debt? If so is digging deeper, working harder, and sacrificing the balance that keeps you able to work in a healthy manner worth it? If you feel tied to a bottom line you will inevitably make poor decisions and perhaps even cost your patients the options that might cost them their lives. I know of associates who are requested to maintain an average client transaction that starts at a number. Client options therefore include those above the ACT or euthanasia. It is both criminal and unethical. There are "embedded costs" in services that inflate the basic service fee. Does an x-ray include a mandatory radiologists review? Why? You will in many cases be paying for something added that you don't need. You are financially bound.
  • Is it a boss or co-worker who makes your life hell? Do you take it? Do you ever ask yourself if you have to? If you want to? Or if the consequences are worth the courage it takes to stand up and demand something different? I will be the first to admit that I live on the other side. On the side that makes me incapable of being civil at times. In the face of cruelty, neglect and bullying I am quick to drop an F-bomb, and I am not picky about who I drop them around. I am that cat in the cage who always chooses to hiss, claw, and fight. It is as basic and primal as the feral cats response to fear of being eaten. I realize there are Cocker Spaniels out there. Everyone loves a Cocker Spaniel. We vets expect that their lowered ears and cowering submissive tail wag all say "Please go away, I am too afraid.. But I am paralyzed to do anything about it." "Oops, I think I just piddled on the floor...." You are exhausted and trapped. We know that some dogs will resort to biting via deeply seated redirected aggression, or a submissive dog pees. Cats, well, we all know they are smarter. They haul ass for a new home, or claw your eyes out. Be the cat.
  • Is it emotional disconnect from who you thought you were? The healer you wanted to be and the vehicle of lack of options that you have become? I would argue that this is a myth. I am living proof. I can't explain to you exactly how it happened, but at some point I decided I was going to live by and be true to the core of who I am. I save from suffering, I protect and provide happy healthy lives. I most importantly refuse to believe or accept the commonly broadcast brainwashing bullshit that "we can't save them all." We can, we merely decide to not be the one who plays God, determines life or death short of death shrouding above our patients. We ease suffering and we don't speculate for an easy convenient death. Yield your pink sword for only the battles already lost, not those being fought. You are conflicted.

Donatella and Raphael
I did some research on bullying on the adult level. I was particularly interested in this at the level of the military's response to intimidation tactics shown to subordinates. I think it is relevant for a few key reasons;
  1. Most vets work under another vet by reason of rank, length of employment, or experience.
  2. Most have binding contracts that dictate terms and conditions that must be met to insure continuance of said employment.
  3. Most vets are in debt and need to maintain continued employment to break even. Getting ahead is a dream way down the road.
  4. Most vets have learned, or been instructed to, keep their mouth shut in the face of adversity or confrontation. I know lots of vets who are instructed to stay in the exam room repeating treatment options and allow verbal abuse from the emotionally AND financially strapped client to get a treatment plan estimate signed and deposit placed.
  5. Most vets avoid job searching like it is water boarding. We loathe the hunt for a new home.
  6. Most vets cannot, yes, simply cannot, muster the little voice buried deep down that allows them to stand up for themselves. Ever. We are taught to take it. We take it to get into vet school, we take it once we get into vet school, and we keep on taking it. You practice what you are taught.
  7. Most rationalize the bullying. They learn when to avoid the bully, what the triggers are, and rationalize that they can minimize the hurtful altercations if they only can do..... The maneuvering to avoid the tickling down of nastiness is a dance that wastes your time and diminishes your ability to do your job of helping your patients.
  8. The options out are either insurmountable, inaccessible, or unfathomable. So people stay trapped.
How does the military address bullying? It provides outside resources. Is honest in its advice to not seek help within the team and add further dissension, and it reminds us that managements assistance in providing a safe workplace is critical. But what happens if management is the bully? And what happens if you, as next in command, are expected to both take the crap coming downhill, and figure out how to live by example, maintain your own code of ethics and want to protect those beneath you?

The military resemblance is solid.. So lets move onto a topic we all can relate to; dog training and behavior issues.

I found these 4 week old kittens on one early morning run in a tire on the side of the road.
In 1 day they transformed into marshmallow-love-muffins.

If we are so adept at identifying the source of the problem and making a diagnosis without most of the fancy expensive human medicine equivalents at our disposal then why is it that we can't fix our own problems? Why don't the skills and lessons we have already learned and mastered translate into the veterinary office bullying dynamics? Why aren't we rewarding only the good and ignoring the bad? Wouldn't things change if you just shut off your ears and walked away every time the boss started barking, growling, hissing or trying to spray/pee on you to mark their territory?

We know better, but we can't ask for, or demand, or even role model better? Reward the good. Smile and say "thanks" when you do something amazing. Miracles happen everyday in practice. Give yourself a gold star! Post on social media your favorite feel good moments. Empower and recognize yourself daily.

Remember that there are people who work for you so lead by example. We are all conditioning each other to act appropriately. Keep training your staff. Teach them new things, share the wealth of your experience and expertise. We all need and deserve praise, empowerment, a shoulder to lean on and a trusted co-worker as much as you do. It isn't about picking sides and building a team against your boss it is being the shining example of how to raise a healthy human in a dysfunctional family. This is every behavior puppy exam we see. We know how to do this. Train the parent to see the world through the pets eyes to enrich the bond and avoid the biting behavior case down the road. We do not condone yelling, punishing, hitting or being harsh to a puppy, or anyone in our care. EVER. 

Try to see yourself as the person you want to be? How can you get there? Is behavior modification needed? Do you need a trainer, mentor, or secret Facebook friend/group to help you muster the courage to keep yourself alive?

Staying in a toxic environment is detrimental to your quality of life. How many times a day do we discuss "assessing quality of life" with our clients? How many pennies are in your "bad day" jar? Choosing to stay is a behavioral learned condition. "How do I train my cat to go back to using the litter box?" To which we reply back, "We always treat the medical condition first, and then begin behavior modification training." If you are not feeling well please ask your doctor for help.

We are acutely skilled at understanding and categorizing the behaviors and responses our patients display. We assess and prescribe our reactive behaviors and treatments to these. Are you the "get out the drugs" when the frightened cat starts fighting back, girl? Or, do you act like the Cocker Spaniel with paralyzing fear and either ignore or be calmer/more gentle? We empathize with our patients and adapt accordingly. If your boss is using a newspaper to emotionally swat you into submission, rubbing your nose in your own excrement, bullying/intimidating you, or in any way making you feel anything other than valued, my best honest advice is to salvage yourself, guard your own self esteem, and walk. It is not lonelier, scarier, or worse on the other side of a hard decision. There is nothing more important to you than your life.. your own destiny in your hands. You made it through vet school. Most of us thought  that was almost impossible. It wasn't, you did it. You walked in, and you walked out, and the rest of your life is yours. Never surrender that. It is yours.

found in a dumpster emaciated, tail tip deglove, parasites-galore!

A very good friend and associate described her struggles with her emotional well-being in her previous practices as this: "I knew I was in need of help. I called the State Board and was told they couldn't do anything. I called a lawyer to ask for help with my abusive boss. She told me "it sounded awful and that she was sure she could assist and then asked me if I had $400 per hour to pay for her help?" I didn't know where to go. So I moved from one bad practice to another." Sounds like so many of us who get stuck in bad relationships, doesn't it?

There is this huge move in veterinary medicine to provide a Fear-Free (trademarked) practice. Essentially it is a certification to train the staff to provide fear free care, handling and services to the patients who are under our care. Why isn't this being taught to the staff and superiors at the clinic? Perhaps Fear-Free needs to start at the top and trickle all the way down?

Maybe its time to address our own health with our own advice?

Pray what you preach. Learn how to incorporate a healthy workplace into your life and as an extension of it. If you can't muster that voice follow your advice and decide your own destiny.

Here are some of my favorite training tips; How many could you incorporate in your life to improve it?

1. Get outside. Everything is better under a tree, in the grass, or bathed in sunshine.

2. Find something to hug. The toughest days are always easier to tackle with a kitten hug or a beagle kiss.

3. Remind yourself whose life you made better today. (PS the number of legs they walk on is not important).

4. You are a caretaker. Take care of yourself. Happy people have happy pets.

5. Dig deep until you find that treasure. Be the JRT! Work passionately and let your passion provide the answers to the tough questions.

6. Never surrender the bone. Hold onto to your soul and don't let anyone take it.

7. Retractable leashes are dangerous and self-deprecating. Walk side by side enjoying each others company, or go leash free and let the adventures of the unknown be your guide.

8. Reward a good day with a healthy snack and a long rest. Dx yourself with bilious vomiting syndrome,, have a snack before bed!

9. Collars, like monogrammed white coats, can be resized, redesigned and replaced. No one owns you.

10. Cancer, disease, and death are far more likely if you don't care for the whole package. Protect your life and be the  best friend to your best friends by taking care of yourself for the long haul. We know how to tell our clients how to do this. It is never easy to implement a change for long term benefit but that is not an excuse to not try.. you made it through vet school after all. You can do anything!


Walk into every situation, every patient and every dilemma with the attitude of "what can I do to help?" If the answer is "get the hell out!" listen. You are an amazing healer with an adept skill set even without all of the fancy expensive diagnostics to back your diagnosis up.

If I can help please find me on Facebook, at this blog, or at my vet clinic, all are listed at the end. I will really try to not sound like a Drill Sargent and I really will be on your side, no judgement, no harassment, no consequences, just love, support and encouragement on your terms.. no one is trapped.

Resources for vets;
AVMA Wellness and Peer Assistance support.

List of compassion fatigue resources via Jessica Dolce blog.

Compassion Fatigue blog. Krista Magnifico, DVM

About me;
Still wandering around in rose colored glasses. Still loving being a vet. Still filling my cup at every chance I take. And, still trying to save the world one wet nose at a time. I started as a way to help provide a safety net to those in need and those who can provide help. It is a free to use site intent on inspiring and empowering. Please join us in saving the pets of the world.

I am a small animal vet in northern Maryland. Jarrettsville Vet is in Harford County MD. A busy 7 day a week, 6 DVM practice where care is never denied and happy endings are always on the To-Do list.

I am also on Twitter @FreePetAdvice, Facebook, YouTube and in the yard/couch with my own four legged kids. If you need me, or you need help you can leave me a phone call, comment, or email. I will help in whatever way I can. 

Thursday, August 18, 2016

What Compels Vets to Forgive? Response to the veterinarians open letter to the vet who killed the cat with an arrow.

I recently read a published open letter from concerned veterinarians worldwide to Dr. Kristen Lindsey. Dr. Lindsay is the vet who killed a cat with an arrow and then posted it proudly on Facebook. She is likely to lose her license and has been the subject of an intense social media backlash. I have already written about this (here) and still feel as sad and angered as I did when it first happened.

A group of vets around the world wrote an open letter to her offering "support and an empathetic ear."  It was published without names to protect anonymity, but I am finding providing forgiveness  for this action a very difficult thing to do.

Clearly my biggest dilemma in life is this unyielding passion I have for animals. It is what compelled me to put up with the grueling list of "required items" to get into AND out of vet school. The degree of personal (and for many financial) sacrifice is what makes the career path both revered and sought after. It is earned. No one would argue otherwise. 

For me, personally, it is why I struggle within my day to day vet life. For every empathetic client who apologizes to me as I euthanize their very sick and suffering pet, I want to say, "Oh, God, this is not the worst part. The worst part is all of the other cases abandoned from assistance due to lack of resources, compassion and options. That's the shit that kills me everyday. Treatable meets unattainable because some human decided to give up than,,, well all of the reasons we get barraged with. People either don't care or can't afford to care. These are the pets that nibble away at my heart. To see a veterinarian so blatantly and callously NOT care about a cat, someone's pet who very likely might have, could have, or would have, been one of her patients, well, that's appalling and disturbing. How can she be a small animal vet and kill a cat like this? And then be so stupid and lacking of remorse to post it? There is not a viable excuse or reason? And now we, the collective group of vets already dealing with stress, anger, debt, suicide, and unresolvable emtional baggage are supposed to say "we care about you anyway?" It tells the world of loving pet parents that we are empathetic to her? For the record I am NOT empathetic to her. I think she needs professional psychological help and to lose her license but not empathy.

When I can take a breath and step back I start to think that maybe it is not lack of empathy but the world of greed, anger and caring that is the disconnect? Maybe if we could all care MORE we could make all of this better? Is that the intent of the letter? But, damn it that big-hearted-rose-colored glass-wearing 6 year old kid inside of me who refuses to let go of the dream of "someday being a vet so that I can save everything,' is still inside me. It makes me crazy with having to protect her from the sad reality of the world we live in. Everyone seems intent on killing everyone and everything else. How do you explain that a  6 year old? How do I tell the 6 year old who someday wants to be a vet that there are some bad people in the world? What do I say to her? To be kind, to be forgiving and to try to always see the good in others? 

Where is the problem of disconnect between vets and the public?
Here are some of the most common reasons I hear on the pet message boards;
1. More concerned about money than the pet. 
2. Inaccessible by either time, price, or indifference.
3. We lack compassion.
4. We are too expensive.
5. They don't trust us.

And I have to admit I do see all of these as being problems within our profession.

But, aren't we a part of the problem? Could we possibly be? Is this letter of open arms and acceptance to an individual who clearly lacks the moral and ethical fiber to stand amongst us not still a reason to forgive but not accept? DO we have to do both to be sincere with either?

I can only speak personally of course. I can tell you that we vets kill (yes, it is kill "to end a life" packaged pretty in a more palatable term "euthanasia") have gotten so comfortable with ending a life that we now have difficulty drawing lines to where "acceptable" meets "unacceptable". I spent about 30 minutes on a vet forum centered around trying to offer help to the staggering number of vets among us at risk for suicide, and still scattered amongst the many pleas for support through rough days, mean clients, rotten practice owners, and cases gone wrong their were members advocating euthanasia for behavior cases (who inevitably were the result of some human hand) because "there are lots of 'nice' dogs being killed already." I was struck by how easily we all have to justify actions that people are struggling with. And we wonder why we are all tired and suicidal?

Would everything be easier if we all just forgave each other? Would the inner turmoil so many of us have about so many difficult aspects of this profession get better? Or should we all take a long look in the mirror and ask ourselves if there is any reasonable expectation to be good an kind to each other and hold a moral compass high? There is a pervasive over arching anger problem among us, but at least we care to challenge each other to invest more of ourselves instead of becoming so hardened by the indifference we loose ourselves in the process. It is a matter of getting out alive, but surrendering your compassion along the way might just be as bad.

Can I forgive Kristen Lindsay? Yes. Just like I have to do with so many of the day to day travesties that walk into the clinic. Do I have to publicly profess that I hope she finds peace with herself and her actions? No. I am not that strong, and I am ashamed of her, the excuses, and the acceptance of caring so little. Perhaps that is the thread that still holds my faith in humankind?

Here is the letter to Kristen Lindsay, as it was published:

"Aug 11, 2016
By staff
Editor's note: The following letter was a collective effort from veterinarians via Facebook to send a message to Kristen Lindsey, DVM, the Texas veterinarian infamous for shooting a cat with a bow and arrow. Lindsey filed a motion for a partial new trial that was recently denied.

Also, a number of veterinarians originally signed this letter with their full names; however, after they received backlash on social media that included death threats, the editors and authors together decided to use initials for all signatories out of concern for personal safety.

Dear Dr. Kristen Lindsey,

The most important trait of any veterinarian is compassion, and we extend our compassion to you. As much as we find your behavior unacceptable for a professional in our field, we can still support you as a person.

As veterinarians, we consider life sacred and suffering abhorrent, including yours. Our profession is already fighting to maintain integrity in the public’s eye, and the veterinary community is now wrestling with the ethical issues—and clients’ subsequent reactions—raised by one of “us” being proud of killing a cat using a method not listed in the AVMA guidelines. Indeed, many supporters of this letter wish to remain anonymous so that they are not associated with these practices. Still, there are larger issues which we hope to address with you in this writing.

Our profession’s suicide and mental illness rates rank among the highest in the United States, and even the world. The fact that public shaming, like that aimed to you, can have serious effects on a person's mental and emotional stability has not escaped our notice, especially given the all too recent links shown between bullying (cyberbullying and other forms) and the preventable loss of our colleagues. Because of this we are concerned for your well-being, and urge you to seek help as necessary. While we cannot speak for you in any legal matter or otherwise—even if that means the veterinary profession may not be in your future—we hope that you find the support you need to emerge from this as a wiser, stronger and more effective member of the community.

You matter. We are here for you should you need a supportive or empathetic ear.



There is cruelty, neglect, pain, and suffering in every corner of life. For Cecil the Lion, the trophy hunting Trump kids, factory farming, feral cats left to repopulate without restriction who are not given medical care when URI hits to leave them victim to be eaten by predators, dogs surrendered by their owner who was too whatever to try another option and are actually told the dog will be killed, and the people who abandon anything I am not sure I want you to know that I am empathetic? Does it add a burden to my already heavy heart? Yes. But I am still here NOT euthanizing healthy treatable animals, still offering every single imaginable option to a person who is in need, and still not surrendering my soul to the excuses that make it easier to be paid to kill, give up, walk away, ignore, disconnect, etc..

This letter needs to be sent to the masses of us. All of us, vets, clients, staff. All. We all need empathy and acceptance. Instead we cling to the opposing conflicting laws of pets are property, herd medicine and its ag-gag laws, over inflated costs of care, and worst ROI of any profession, and for profit vet schools. It's ours to own. Forgiving each other when the shit storm takes possession is a nice start. But now it is time for accepting that we aren't the humble agriculturally rooted members of our community who helped everyone because we were happy and privileged to be in the position  to be blessed and empowered to do so. We like white coats and exceeding the avg client transaction quotas too much.

We have lost our integrity because we make excuses to justify giving it away. We do care but we gave up fighting for it so now we are trapped, alone, afraid and excusing the suffering by ending it. Just what we were all trained to do.

There isn't one member of this profession  that doesn't have bad days, make mistakes and get caught in between a rock and a hard place for your conscious to try to navigate out of. BUT a public display of a lack of moral integrity, compassion and cruelty is not where my empathetic ear is going to be offered. There are "too many nice people out there" who need it first.

About me. Typically I put links to my other social media accounts and activities. For todays raw post I will only add that I struggle with how to be a better member of the pet loving community I serve. I never wanted to be anything  other than the person  I am, and I understand that the world looks different from others perspective. I also understand that posting anything personal leaves me subject to opinion and  backlash. BUT if  I write it, post it, and publish it I own it and stand by it. I don't believe in anonymity. If you want to help other pets find your calling and feed your compassionate heart on

Monday, August 8, 2016

IVDD. The days immediately following the diagnosis. Recovery, post-op problems and how to conquer them all.

Without a doubt the fear, apprehension and sense of dismay is thick and overwhelming for most clients dealing with IVDD (intervertebral disc disease). It is persistent and pervasive at the time of diagnosis and for the first days to weeks of recovery, regardless of whether the patient is recovering post-op or with conservative care. With each case there are always many questions, with many remaining unanswered left to the decision of time, circumstance, and luck. It is the equivalent of sudden decisions, life changing odds and prognoses, and fate in some unnamed higher power's hands who refuses to show their face to claim responsibility. 

For these cases I try to reiterate and reinforce a few simple things;

1. Be Strong. Even if you don't know what to do or which end is up. Just stand, breathe, and believe you and your dog can get through this. We have wonderful tools to help heal, but giving up defeats them all.

2. Listen to your pet. They will look at you for help. They will wag. They will try. Take heed in them. They always decide, and they rarely give up. 

3. The first 48 hours are hard. The first week challenging. But if you can get through the first week and if things have gotten easier with encouraging signs of interest in food, better understanding of bathroom needs, a routine with a friend who needs a little more TLC, then you can get through this. 

4. Lean on someone as much as you feel you need to. Ideally this is your vet, your neurologist, your vets staff, your friend and fellow pet lover, or even those of us at Ask lots of questions. 

Don't leave the vets office until you have been taught and are comfortable with the following;

1. How to pick up safely. I like one hand on the sternum and the other behind the back legs supporting the pelvis. Hold on don't squeeze and don't let a nervous pet make you nervous. If you are worried about wiggly use a towel to wrap like a burrito and be safe.

2. Know how to check for a full bladder. Learn how to palpate, express and monitor. Yes, it takes practice, and yes! you can do it. (I promise, you can).

3. Learn how to monitor defecation, and keep it soft so it can pass easily. Every client gets worked up about lack of poop. I am usually not too worried. Even after 3 or 4 days. If your dog has a disc protrusion/extrusion they have a very painful time even sitting. They usually aren't eating for a few days. If your pet isn't eating there won't be feces for days. Also, posturing to defecate is painful. They either won't try, or they can't push the feces out. Every IVDD dog is placed on wet food and given an oral laxative to keep the feces from becoming dried and impacted in the colon. Use the wet food and laxative to desired effect. The dose is never set in stone, it is used when, if and as much as needed.

4. Learn how to safely use a sling. I want you to keep encouraging and challenging your dog to be a dog. Walk, pee and poop. That's dog basics. Use a sling, place their feet correctly and encourage them to support their weight. As the foot righting improves encourage walking. Physical therapy is 10% putting them in the right spot (I like outside in the cut grass for footing and softness if there is a spill) and 90% giving them the opportunity to go back to the life they remember.

5. Obstacles happen. Don't get discouraged, stay active and have faith. Sometimes medicine comes down to faith, and it is always the better for it.

6. Cage rest is imperative. Not encouraged, but rather, required. If  your pet is not used to being in a cage it is often very difficult to keep them calm. Calmness, quiet, rest and rebuilding of the broken damaged tissue is what is needed. How can you discourage movement if you cannot cage them? I will warn you that they will move faster, try to do more, push themselves to doing what they did before, and if allowed to make decisions, they will make bad ones. Keep them caged and know it is for the health, well-being, and sanctity of having a rest of their lives.

This is Wrangler. His stumble in the recovery process was licking his left knee to the point of an open wound. In spite of his e-collar he was wiggling his nose to the point of his knee and licking obsessively.

Now I firmly believe that our pets are always trying to tell us something. Wrangler was telling me that there was a problem ad he was trying to point me in the direction of it. Wrangler was leaking urine. He knew he was leaking and no one likes dripping pee. 

He needed some laser therapy for his knee, another e-collar, and a medicated ointment for his prepuce. We also instructed his family to palpate the bladder with each trip outside. First to get a urine stream going, and second to try to make sure he was emptying his bladder completely. Residual urine in the bladder turns into a possible pool for infection. An overly full bladder will leak.

Double e-collar anyone? If we can't make Wranglers nose shorter we have to make the e-collar longer.

Laser therapy had the lick granuloma cleared up in less than 3 days.

A drying healing knee. 

IVDD is the one disease that comes on like a freight train and sinks a  pet parent to their knees. It is frustrating, painful, and often seems overwhelming to parents. Have faith, be calm, be patient and don't give up early on. It is a disease your dog can conquer, even if you cannot afford the neurologist, the MRI, or the surgery.

I always try to add associated costs of care with my blogs. All estimates are in USD for East Coast USA
Here is the break down;

Conservative care; Non-surgical medical treatment. Cage rest.

  • initial exam to get a presumptive diagnosis. $40-$80. These cases are usually able to be diagnosed on the first visit and do not require advanced diagnostics like an MRI. They have a high incidence of suspicion that is usually accurate at presentation.
  • x-ray $100-$200. Should be done at initial visit if the vet suspects IVDD.
  • analgesics $50-$150. Includes NSAID or steroid, opioid patch, oral opioid. Do NOT decline these. Your dog needs them. There are lots of cost effective options (like a steroid at Wal-Mart is less than $10. Call me I will loan it to you. If you decline it is simply because you are an awful person.
  • Elizabethan collar $20-$40. They can be made. Ask the vet for an old xray film to make your own.
  • Sling, free, use an old shopping bag with the sides cut out, or use a towel. 
  • Cage; borrow from a friend if you don't have one.
  • Many places will recommend blood work. If you are tight on funds skip it. It is not going to make your diagnosis and it may not help with the treatment plan. It can be done later.
  • Follow up care. Ask how your vet charges for rechecks, phone calls, and emergency care. Expect to see the vet about 3-5 times in the first week or two.
Gold Standard care. No expense is too great, or, I have great pet insurance;
  • Includes referral to an emergency care facility for the first 24-48 hours. Usually $500-$2000 and for all of the items listed above.
  • Referral to a neurologist for MRI and surgery. $3000 to $9000.
  • After care at a facility to help recovery. May be 3-5 days $2000-$3000.
Personal Note; Nothing disturbs me more than a client being directed down a path they cannot afford to be on. If you cannot afford the decompression surgery and follow up care with a neurologist it is difficult for me to advise that you have an MRI done, UNLESS it is to rule out an untreatable life threatening condition like a tumor, blood clot, etc. If the vet or neurologist thinks it is a disc AND you know you cannot afford surgery DO NOT FEEL PRESSURED TO continue diagnostics. Elect cage rest (be compliant and follow up with your vet) and don't feel bad. Whatever you do, don't feel so bad that you give up and elect euthanasia.

For more information on this disease please see these related blogs;

If you have a pet in need you can find a community of helpful people at Pawbly is free to use and open to anyone who loves their pet and wants to help them.

I am also available for personal consults at Jarrettsville Veterinary Center in Jarrettsville Maryland. Or find me on YouTube or Twitter @FreePetAdvice.