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 dvm360.com staff
DVM360 MAGAZINE
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.

Signed:

Drs. MMK, DD, LB, JM, EA, DLB, CD, SS, AMvH, MK, MSH, RH, EKB, EE, EA, JGNM, LW, LS, BE, RS, CGN, KF, LPO, CR, NL, CR, LCH, SH, MEB, LTG, EA, RV, KWW, AW, DA, JLP, MML, HL, JP, BRP, JS, MvCP, LN, KS, KC, SA, CG, JH, JG, MS, BB, AG, JS, VH, LS, AHW, PG, CS, TKSR, JE, LP, CR, TKK, EKB, MD, JM, AH, NS, LE, ZJ, JT, CMC, MD, KN, MEG, VMG, KAP, KHP, MED, TMD, JMM, CLS, JCK, KPR, MYR, RAV, RO, KK, LAB, MSR, AIN"

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 Pawbly.com.

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 Pawbly.com. 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.com. 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.

Sunday, August 7, 2016

Re-Post Of Compassion Fatigue blog.

In light of the publishing of NPR's article on compassion fatigue, I thought I would re-post the original, unedited blog written almost 3 years ago. It was one of the few blogs that came to me in a downpour of words compelled to put to paper. Written in an hour it is one of the most honest genuine pieces I have ever produced (next to those on Savannah).
I can say things have gotten better. I know who I am and who I protect her inside. I accept the struggle and forgive more readily. I let go from the things I cannot change more easily and I listen to the voice that reminds me that giving is a gift, not a burden. I am less afraid and more empowered. I embrace the challenges instead of wishing it could be easier. I smile, hug my pets and am thankful for the good friends in my life.. I try to chose to cherish instead of grieve.  
To those struggling you are never alone. 

Compassion Fatigue. When the candle you are burning at both ends consumes you.



“The Lord giveth and the Lord taketh away.”  BUT in the case of our pets,  should it be “the Lord giveth and the vet taketh away?” How does the responsibility, the quest for providing a service, and the weight of the burden that this profession puts upon you keep you from becoming exhausted? And how does the emotional stress not accumulate to the point where that stress breaks you?

In the trade we coin it “compassion fatigue.”

It is the burden of the beast.

I read somewhere that something like one-third of US women are on some sort of tricyclic antidepressant. If the general public can’t make it through their normal day without some help how is our profession not supposed to end up not heavily self- medicated, depressed, or seeking a way out from under the mountain of emotional turmoil and  strain?

There is a common belief amongst vets that our profession has the highest suicide rate. We know what death from the end of hot pink syringe looks like. We talk about ‘quality of life,” “making hard decisions,” “letting go,” “saying goodbye,” and ending suffering” enough times to almost believe it ourselves.  And there is a knowing that if the cards are stacked against us, and the chips are really down we do what we practice, we take matters into our own hands, we end suffering.

How do we get here? It’s a long road and many small steps, heart aches, and tears on the way  to Oz.

Being a veterinarian can be exhausting. You can get to the marrow tired. It can eat you from the inside out to the point of being all consuming. A gluttonous feast of your soul until there is nothing left to give and nowhere to seek salvation. A curse? Yes, it can be a curse. To care so much, to invest your whole heart, which is what many of our clients want for us as we care for their family members, and then there are the clients who ask you to remove a pet that they see as a burden. To juggle these emotions, these responses, and these ends of the emotional spectrum make it hard to navigate through each day.

We are all provided preservation mechanisms to protect our most precious inner self. Your choices are yours. Mask the difficulty of dealing with the stress with drugs, alcohol, and addiction, withdraw and leave the profession, start caring less, investing less of yourself, or burn out. Veterinarians are determined, driven, type A people. We as a species hate to give up, we loathe defeat, and we give until the bank is empty. Wear your heart on your sleeve long enough and someone will take it. But like every other thing in the universe with enough wear and tear on the system it will break down.

Four years at a school learning about the biggest, heaviest, and bulkiest transport vehicles in the world, steel ships, and I know that one big wave, one scrape on the bottom, or a swipe from an iceberg and that tin can will crumble, crack and sink. Nothing is impenetrable or unbreakable. Ask the Titanic or the Costa Concordia.

Did I learn about burn out, or compassion fatigue in vet school? No, you learn it in the field with those tiny sacrifices, those tiny blows, and those moments between the lines. You wake up one day and you realize that your life, your dream, and your reality are not one in the same. You dread work, you can't process the grief, the exhaustion, and the demands placed upon you.

Compassion fatigue is burnout when the candle that you are burning at both ends runs out of wax and wick. The profession can put unrealistic expectations on us. Our ability to maintain a level of empathy for every client, every incident and every patient is unrealistic. Our ability to wear every hat, mirror every clients expectations, and maintain a personal protective zone requires a strict code of rationing emotional handsels. 

Palmer


How does a normal rational empathetic person put a pet that they have watched grow from infancy to geriatric to sleep in one room and then walk ten feet away to another patient who you are expected to be jubilant and clear headed to examine, diagnose, and treat? Somewhere along the way we learn to mask, shelter, or disregard our emotions. Somewhere it became expected, and we learned to push feelings aside and press on. It is a recipe for a sychopath and a schizophrenic. And we do it every single day.

I will be the first to freely admit that I grapple every single day of my professional life with compassion fatigue. When you invest so much into one thing you expose yourself to being bankrupt should your house of cards fall. Can I tell myself that this is just a job, yes? Do I believe that being a vet is just performing a job? No.

How do I keep going? I pay attention. All the time.

I try to put myself first, I have to. I say no, a lot. I stay true to who I am. If you don’t care about your pet I am not the right vet for you. I stand by my core values.

I am also very honest. I tell my clients when I have just had to say goodbye to an old friend, and that I might need a moment to collect myself, refocus and devote the time and attention that I want to to their pet. I also invest my whole heart into what I do. I know that I cannot practice any other way. To do this I have to understand that there are clients that I am not right for. I can’t care more for their pet than they do, and I can’t be a compassionate vet any other way. I give termination letters to clients that do not share my perspective and I stand by my true clients come thick or thin, hell or high water.


And every day I remind myself how much I love to be a part of my client’s family, and how lucky I am to be living my dream.

Here is the advice from the professionals;  
  1. Put yourself first. 
  2. Stay an active student. Learn, grow, and challenge.
  3. Exercise, eat well, take care of your temple. 
  4. Be realistic with your expectations.
  5. Attitude is everything, keep your chin up. 
  6. Seek help if you feel overwhelmed.

Help, and seeking help, is something the doctors often feel embarrassed, ashamed, or beneath us to do. We are comfortable and expected to always be giving the medical advice and unable, unwilling, and mute to ask for it when it applies to ourselves.

Symptoms of compassion fatigue include excessive complaining, isolation, compulsive behaviors, poor sleep habits, poor hygiene, apathy, difficulty concentrating, chronic physical ailments, and withdrawal from friends, family, or prior interests.*

The next time you see your vet, tell them that you appreciate them, and remind them that you know that we are real people with real hearts. And for as many times as we vets tell our clients who say to us that they "will never get another pet because it's too hard to say goodbye when we lose them," the same goes for us. Don't lose your compassion in the trenches of our daily life. Remembering to love, care for, and maintain our empathy is what keeps us human.



*This blog was based on the facts presented at the 2009 CVC Baltimore lecture given by Renee Rucinsky, DVM, DABVP of the Cat Hospital of the Eastern Shore in Cordova MD.


I started Pawbly.com as a way to help more people with their pets care.  Every pet parent will tell you that the worst part of pet care is not knowing what to do, where to go, or who can help. I also know that the best place for help is with a vet, or their pet care professional.  I hope that it remains a community of support regardless of socio-economic status or access to accredited care. I know that giving back can replenish a tired soul. Helping people and pets can be fulfilling and there is great need. If you would like to join us in helping others please visit us on Pawbly.com. We are a free open community dedicated to sharing information to empower people who love their companions. 

I am also on Twitter @FreePetAdvice, on YouTube and at the clinic Jarrettsville Vet, in Jarrettsville Maryland.

Wednesday, July 27, 2016

Ear Hematoma. The Complete Veterinarians Guide To Understanding, Treating and Avoiding Them.


I get these shaking head painful and swollen dog ear questions too often. Perhaps for me the 'old hat stuff' has progressed into dismay that I haven't adequately gotten the word out? Maybe the whole pet loving world doesn't know what an ear hematoma, or, aural hematoma is yet?

So here I go... pull out soapbox and cross fingers that I can spare a dog the excessive expense of an emergency visit, or, the worsening of a condition that allows the snowball to escalate in to needed a TECA (total ear canal ablation), and maybe even help a pet parent out there thwart a bug at the pass and save their pet from having an ear that resembles the one above.

If you think this is painful, you would be right! A hot, swollen, tender, blood filled pillow hanging off the side of your face blocking your ears from any kind of basic function, usually corking off infection inside your ears so it can stealthily fester and ferment while the world is far beyond reach, IS ouchy!

Note the perpendicular ear pinna and the head tilt.
I have seen many of these and in each case the degree of pinna damage, area of the swelling (base of ear or tip of ear), chronicity of disease (how many times has this ear flap been down this road?), and patient and client abilities and expectations.

I always discuss how the hematoma happened, or at least why I think it happened?

Possible causes include;

1. Ear Infection (about 40 % of the time). The ear is usually smelly and full of fluid, goopy soupy discharge, red, and painful. If your dog fits this description spend time talking to your vet about how the infection happened and how you can avoid it from happening again. Most of the repeat hematomas are infection or allergy. Your pet is very likely to be back here again. Avoid this if at all possible.

2. Allergies, about 40 % of the time. The ears are usually red but are not smelly or have any fluid in them. If your dog has allergies ask for a referral to a dermatologist sooner versus later.

3. Trauma, about 15 % of the time. The puppy and the adult dog are playing and the next thing you know someone needs an e-collar.

4. Idiopathic,, also known as, "we don't know?" I would guess these are about 2%

Here is a start to finish overview on Daisy's ear hematoma. There is a lot of helpful information in this. I hope it helps.


At the clinic I usually use a teat canula (this is what the dairy farmers place in the nipples of a diary cow with a clogged gland) to correct the severely swollen full pinna hematomas. For the very small fluid pockets at the ear base I remove the fluid and add a dilute steroid to stop the inflammatory process. For cats I use a through and through suture technique after an "S" incision is made on the medial side of the pinna.








This is what the ear looks like after three weeks of the canula being in place. The wrinkling and thickening of the ear pinna in these cases may be due to the chronicity of this ear hematoma, delay in seeking medical therapy, or not addressing the underlying problem adequately. This is why I advise getting these cases early and aggressively.



After 3 weeks the teat canula is removed. There should not be any discharge or swelling during the last week.





The ear is painful. We numb it with a local lidocaine block, but, we still place a muzzle.

The most important part of the treatment of an ear hematoma is to figure out what caused it. Both ears should be examined with an otoscope to look for infection, parasites, debris, polyps, and even tumors. I have found some crazy stuff in those ears, and every pet was telling me there was a problem by shaking, rubbing, or tilting their head to the side.


In many cases cytology of the ear may also be done. This allows us to diagnose the infection and more appropriately provide a focused treatment option.



The teat canula is sutured and glued into place. 

The end of the canula needs to be checked twice daily to make sure it doesn't get clogged. It is after all there to drain the fluid.




Daisy gives a shrug and smirk of disapproval.


Daisy is ready to go home.


A teat canula should stay in for three weeks. The e-collar should stay on for the first 3-5 days, and then if the head continues to shake, or the pet rubs or paws at the ear.

Here is the break down of Daisy's ear hematoma repair;
 Exam $50
 Aural Hematoma Repair $65
 Medications; NSAID and ear antibiotic $50
 E-collar $20
 Ear Cleaner $22
In most cases with client compliance we do not charge for re-checks or the canula removal.

For those pups who have itchy painful ears, or for those who have not progressed to hematomas (but are well on their way) I wrap the ear to the head. The disadvantage of this is if there is an infection in the ear. A wrapped ear needs air, monitoring, and care. Only wrap an ear that is NOT infected. And, be very careful to NOT cut these bandages off (you don't want to add injury to insult).



I always instruct my ear clients on how to clean their pets ears. Here is a video on how I recommend doing this. It should be quick, easy, stress and pain free. I also advise them on what to have ready at home if head shaking starts again. I typically advise keeping diphenhydramine on hand and starting to clean the ears as soon as a problem seems eminent. Red ears, head rubbing, pawing or scratching at the ears all indicate that it is time to look and smell under the hood.





Related blogs;

Ear Cleaning blog.

Ears; How to Treat 'Em Right.

There is a blog on cat (feline aural hematomas) here.

Another part of keeping ear healthy is removing excessive ear hair. Blog on Ear Hair Removal here.

If you have a pet question please find me on Pawbly.com. The Pawbly community is free for all to use. We hope to help pets in every walk of life and in every corner of the globe. If you don't have a pet question please just stop over and give a hello to someone in need of a friend or some free advice on how to care for their companions.

If you would like to meet me I am available for appointments at the clinic, Jarrettsville Vet, in Jarrettsville Maryland. Our prices are posted every year. Here is the 2016 Jarrettsville Vet Price Guide.

I am also on Twitter @FreePetAdvice. You can also find helpful tips and more videos on my YouTube channel. 

Sunday, July 17, 2016

Open Admission Shelters are NOT Safe Houses


People should be told the truth. Regardless of whether they can face it, deal with it, or do something about it. We all deserve honesty and transparency. Wouldn't you want to know what was going to happen to your pet if you dropped it off at a shelter? Shouldn't this sign be the first notification that you see? 

I have a very deep troubling sense of despair over open admission shelters. I will also be the first person to admit that I do not know how resolve the problem. 

In too many places of this world you will find the face of poverty, struggle and suffering. There are millions of lives on the brink of death in every corner of the globe. Compassion in some places has manifested into "open admission shelters". Shelters to house and feed and provide the very basic of care so that these animals are not on the streets, in the elements and at the mercy of predators. It sounds like a good answer doesn't it? It shields us from seeing and facing the stark divide between the "haves" and "have-nots". Wouldn't you rather be in a room with a meal then on the merciless ground without? Seems sensible? But what happens when the line at the door is too long for the number of rooms available to lodgers? It is a dilemma faced daily at open admission shelters. The dilemma of what to do when you have a contractual obligation to be the safe house for the lost and the unwanted. If your room is needed and your contractual obligation time frame to hold and house you is up you are most likely going to be killed. In medicine we call it euthanasia. In reality euthanasia is a kinder, more compassionate description of terminating a life. In the shelters the majority of euthanized animals are healthy and killed due to lack of space or resources. 

Buster. Our newest JVC addition.
Owner unable to pay for the cost of his chronic dermatology care.
He is being treated by us and with the help of  the folks at Long Green Dermatology.

He is a happy engaging pup in foster and looking for a new home.

Let's talk about why people surrender pets. Here is the data from PetFinder.com

Dogs:
  1. Moving (7%)
  2. Landlord not allowing pet (6%)
  3. Too many animals in household (4%)
  4. Cost of pet maintenance (5%)
  5. Owner having personal problems (4%)
  6. Inadequate facilities (4%)
  7. No homes available for litter mates (3%)
  8. Having no time for pet (4%)
  9. Pet illness(es) (4%)
  10. Biting (3%)
Two of the 14 homeless kittens we placed so far this Summer

Cats:
  1. Moving (8%)
  2. Landlord not allowing pet (6%)
  3. Too many animals in household (11%)
  4. Cost of pet maintenance (6%)
  5. Owner having personal problems (4%)
  6. Inadequate facilities (2%)
  7. No homes available for litter mates (6%)
  8. Allergies in family (8%)
  9. House soiling (5%)
  10. Incompatibility with other pets (2%)

Does it seem odd to you that these numbers don't even come close to approximating 100 %? It does to me too. I can say that after a decade in practice I have seen too many people turn to a shelter when they can't face the other options. What are the other options? Abandonment or euthanasia. (Perhaps there are others but those are too awful to even contemplate). 


It is inconceivable to me that some of these are on any list.

  • If you are moving you bring your pet. Period. 
  • Landlord doesn't allow,, well, what are you doing there to begin with? 
  • No homes for litter mates, no time, inadequate facilities, and too many pets all sound like lapses in good mature adult judgement.
  • Cost, well, cost is  something we can do something about. Cost is a relative, manipulative entity. There are options when it comes to this. This is where rescues, vets, and society can make a dent in shelter admissions. 
The list of reasons cats and dogs are surrendered is fraught with pet parents who either weren't prepared, weren't making decisions that put their four legged kids first, or simply are irresponsible. This notion that pets are peripheral disposable replaceable accessories is part of the reason there are so many pets in need. This mind set has got to change. How do we do that? We teach respect for life, love for each other, and manifest, nurture and foster kindness to all others. 

Paisely needed a surgery that only JVC was willing to try.
She is Harford County shelter rescue who has since been adopted and is doing great!

There has to be a better way? Has to be! There needs to be a shelter to serve as a holding facility for lost pets where people can bring them. For the few pets who are found and need a place to stay while mom and dad remain frantically searching the neighborhood there needs to be a safe house available. Some sort of central location for reuniting pets and their parents. The only justifiable existence is as a halfway house, a sheltering holding facility for reunions.


Laura (JVC Rescue coordinator) and Sammy.
Cecil County Animal Shelter rescue.
They closed their doors and she would have been euthanized if we didn't rescue her.

The old adage holds true. "You are either a part of the solution OR you are a part of the problem." 

How does my clinic, Jarrettsville Vet, become a part of the solution, if we are, as I believe every clinic is, a part of the problem? We are not going to be the place that decides, influences, or confers that veterinary care and the cost of it is too excessive for parents to provide. There is a considerable amount of fluff in the medical estimates we provide to parents. We, the vets who have been taught by the hand of the specialists at the Ivory Tower should always offer the Gold Standard of care, and we too, need to remember that Gold Standard is not always attainable or financially feasible. We are forgetting that if our client walks out of our hospital without an affordable AND agreed upon treatment plan that some of these pets will be euthanized or surrendered. We are a big part of this problem, and we have to take responsibility in being the force of change that provides for a solution.  

Laura and Chico.
Owner surrendered whose only other options were euthanasia or shelter.
He is now also in a new home
In the last year Jarrettsville Vet has gone to every emergency clinic and shelter in our area and left them with a plea; If any of our patients end up in their lobby for any reason with their parents feeling like they have no options other than surrender or euthanasize call us. Have the person surrendering call us, give our name and number to any of our clients who thinks that there isn't another option. We will do whatever we can to help, and, we will help.

Petey and Dr Allen, his new mom.
Owner surrender or would have been euthanized.

How has this been received? Sadly with disbelief and a deaf ear in some cases. In others with a rapid phone call, Facebook message, or even a behind the scenes emergency hotline call to one of the staff. Jarrettsville Vet has helped many pets get out of a shelter and into a home. Some of these have even been the original home. The majority of the surrendering desperate pet parents just needed help and a shoulder to lean on. Sounds incredibly easy, and it really is just that easy. 

Tanner, Number 2 Cecil County Animal Shelter shut down rescue.
Currently in foster. Ready for a new home soon.

To all of my friends, colleagues, neighboring vet clinics and those of you who think that there has to be a better way and more options there are. Jump in, lend a hand, stick your neck out, and save your patients life. I know you are not a rescue, I am not either. BUT, these pets come through our doors. Their stories are ones we know. We feel and hear our clients frustrations. We see their despair, and often participate unquestioningly in their final decision. We can do better, and we owe our patients more.

Talking about other options can be a difficult task in a time of emotional turmoil. Have I lost clients because I have offered other options? Yes. Of course. What I see as offering their pet a second chance they see as a possession they are determined to decide for. I may never see them again, and I am OK with this. Their anger at me is their shame in being unable to see a different option exists. My obligation is to my patients. They are not disposable, replaceable, and dismissed. Other clients know and believe us when we say that we are here to help, especially even when there are lots of bumps and tears in the road.


Murray and  Diedra.
Owner surrender.
Each owner surrender has been a euthanasia request replaced by a second chance. Every client was offered financial assistance, veterinary services at no cost, and options to keep their pet in their home. Every pet, just like every one of us, deserves a second chance and a friend in your corner at your darkest hour.

Thank you to those clients who help us in offering options that aren't routine. Thank you to the clients who help in providing foster care, making donations, volunteering their time and reminding all of us that this village can care for its own.

If you are interested in learning about different options to running a vet hospital out of the corporate box find me at the clinic, Jarrettsville Vet, on Twitter @FreePetAdvice. Or on our Facebook page.

If you want to help a pet in need please join me on Pawbly.com. We are a village of volunteers to help provide guidance and assistance in the virtual space of pet lovers worldwide.

Monday, June 27, 2016

Barking Puppy in the Middle of The Night.. Waking Me Up Before I Want To Get Up

Here is a question I get often. The dog who wakes the parents up too early. How do you re-train your pup to sleep in when you need an extra few winks?

Here is the question on Pawbly from Lindsay;

"After a few hours, usually between midnight-2, if I move or get up, she wakes up and wants to play. Starts walking all over me, pawing me in the face, etc. This is when I put her in her crate for the rest of the night. Every morning around 4:45 she starts barking continuously. I start getting up around 5:15 but am awake as soon as the barking starts. It drives me crazy and of course my husband sleeps right through it. How can I get her to stop barking in the mornings? Or how can I train her to sleep later, and wake up when I get her up? Please help!! I wake up earlier than normal to sit, drink coffee and relax before I have to start my day, and this pup is driving me crazy!! Thanks!"

Raven

Krista Magnifico, DVM, Founder of Pawbly answered ...

"Hello Lindsay,

I am not sure how much research you did on this breed, but I would say that this behavior is very normal for this breed. They are incredibly energetic and need lots and lots of exercise to keep them from developing a bad habit. Which is why they are such excellent farm dogs. Up early, out running after livestock ALL day,, sleep 8 hours at night, get up and repeat.

She needs more exercise, and you need to adjust your schedule to provide it. When I talk about an average exercise pattern for these guys I know some clients Aussies who run 10 -20 miles a day. Now I know that no normal person can provide this much, but try to get as much in as possible, dog parks, play dates, finding other friends with dogs to play with, doggie day care, anything like this will help.

Without drugs the only successful way to manage this is to get up and start exercising in the morning. I run my dogs (mind you I have less energetic dogs) 4 miles each morning. They sleep quietly until I get up at 6. ((thank goodness!). Here is the real dilemma with drug therapy to adjust a behavior; drugs are the least preferable and worst option. Drugs should only be used in two cases; 1. I am beginning the training program and need help transitioning, OR. 2. I have given up on training and accept that my dog will need life long medications to keep their behavior tolerable.

Your puppy is barking because she misses you and wants to spend more time with you. Remember being a kid on Christmas morning? Who could wait for the parents to wake up? We always woke them up at 4 am..

Best of luck!"


Annie
Lindsey commented ...
"Thank you! I will work on the place command with her! Also, she's getting spayed in a few weeks, does that cause a behavioral change in female dogs or is that mostly male dogs?"


Laura M., dog and cat owner, former reptile rescue owner commented ...
"I honestly don't know. I have not spayed my bitch...and I do not agree with pediatric spays."



Krista Magnifico, DVM, Founder of Pawbly replied ...

"At 8 months old I would not call this pediatric. adolescent maybe? But I would recommend spaying at this age. For most people accidental pregnancies would be occurring as common place. Most people cannot and do not have the ability to monitor and management intact pets after about 6-8 months old. I agree that there are benefits to the pets in some cases waiting to spay/neuter, but an average client with a pregnant dog can't manage puppies. Spay her asap. It wont help with barking, but it will help with not having to manage one more issue, or a whole bunch of little issues."




Laura M., dog and cat owner, former reptile rescue owner answered ...

"Have you worked on a place command with her?  That would help.  I'd also work on mental training late at night, just before bed, so she konks out.

Mental training at this stage would be obedience.  Work on things until she's 100% solid with every command."

Me and my Jekyll
There are some amazing conversations happening at Pawbly.com. Lots of different opinions, experts from all walks of life and helping pets just because we share a love for them.

Please join us in building a safe, credible place to share information, build relationships and help animals in all corners of the world.

If you would like to talk to me about your pet please find me on Pawbly.com (search for me and ask me a question). I can also be found at the clinic, Jarrettsville Vet, in northern Maryland. I am also on Twitter @FreePetAdvice.

Always be kind..

Wednesday, June 22, 2016

Play Biting, Mouthy Puppies and How We Screw Them Up.


Parenting is a universal task we all take on in varying capacities. The hovering mother hen, the satellite spoiling aunts, uncles, grandparents, and the over burdened exhausted "there was an old woman who lived in a shoe. She had so many children, she didn't know what to do;" We each raise our kids with our own experiences, abilities and ideas in mind. We treat our pets in the same fashion. Our pets, like our children, are a reflection of this. 

As a veterinarian I feel that it is our duty and obligation to raise happy, acceptable, responsible members of society regardless of whether your kids have two or four legs. The over bearing, demanding barking parent who jerks on a choke chain beating his dog into submission is raising a powder keg of frustration who is likely to erupt into some unprovoked fight when he gets the chance away from angry militia man dad. I see it too often. I had a client last week yank the choke collar forcing his 100 pound dog to the floor cowering. He then stood over the dog screaming "He's Got To Learn!!" What was his dog doing that was so reprehensible? He was looking over the front counter at the dogs playing. He was being inquisitive without permission. It was met by anger and force.  The action caused gasps of disbelief amongst the staff and clients who witnessed it. This is not parenting, this is bullying. It breaks my heart that some people are so demanding, cruel and forceful. What are you trying to prove? That you are an abusive jerk? (Well, don't worry its apparent). Abuse elicits fear. Fear breeds more fear. Never ever be mean. It is counter productive. If you (the human) have an anger, control, abusive issues get help. Join a gym. Move to a deserted island (by yourself). 


In every puppy appointment I see I discuss both the health aspects of raising a puppy and the behavioral needs to transition confidently into adulthood. I am also the vet who swoons, kisses, snuggles, and offers treats the entire time with rare regard to pending meal times. The exam time is not just about the stethoscope stuff, I am watching your puppies responses to a stranger, a new place with lots of weird sounds and smells, and I am challenging them with restraint, interaction and emotional stability. Clients don't see this, but a good vet is always collecting data and always making notes about places we can help you and your puppy on the road to successful adulthood.



There is great debate about dogs, mouth parts, and appropriate puppy training. I am not a militia woman. I understand the consequences of training versus discouraging inquisitive behaviors. I also understand defining limits in a healthy productive positive fashion. 

Fingers in the mouth is an important part of understanding limits, greeting, and acceptance. Dogs are not human beings. They absorb and interact with the world differently. I know that many people are vehemently apposed to any kind of mouth interaction. I am not so hard lined for a few reasons. Knowing your dog, your breed tendencies, your abilities, your training aptitude, environment and how you influence your dogs growth are all key to this.

It is important to remember that as a veterinarian who sees lots of pets, lots of people, and a huge varied range of ways they each raise their pets. I have to adjust what I say, how I say it, and why I offer advice. My goal is simple and consistent across every step of the journey;

Maintain and strengthen the bonds between a pet and their parents.


Here is the string of conversations that went on between a Pawbly user and three of the Pawbly Pack experts;

Question:

We have a 4 month old Golden Retriever puppy. She likes to do what they call "play biting". We thought it would eventually start getting better but it is as bad now as when she was a month old. It is very annoying. Will she eventually grow out of this or is it something we may have to look forward too for sometime.


Here are the Pawbly Pack experts replies;

Laura answered:
"She won't stop on her own - just like with anything you'd like her to do, you need to train her to stop.  Immediate corrections work but you need to be consistent.  If you had her at 4 weeks, you have an extra bit of difficulty as she should have learned valuable social interactions from her litter mates and dam.

Have you planned to take her to training classes?  If not, I would...it sounds like you would benefit from it."


My answer;
Krista Magnifico, DVM, Founder of Pawbly answered ...

"I don't discourage, nor get annoyed with play biting and I think it is incredibly important that puppies learn to explore the world, taste everyone and (almost) everything in it, and learn boundaries. A play bite is your puppies way of greeting, thanking and telling you that they love you. It is only to be discouraged if it is too hard. In which case a sharp "OUCH!" and walking away is appropriate. Telling your puppy to stop their expression of gratitude, curiosity, and friendship is disheartening. Please don't get annoyed she loves you and she is happy.

And yes she will grow out of it. She will also learn to explore the world through smell, sight and sound. The taste sense will decrease. I never ever want to curb or discourage a happy puppy, just teach boundaries. We ruin more puppies with ridiculous over bearing human demands. I just think it is tragic.

If you cannot grow to love the hand and mouth try a chew toy or some option for her to play with.

I totally agree with Laura about training and you cannot ever understand the importance of socialization. Although this breed is naturally very social,, hence the play biting.

Very best of luck"

PK Dennis, Terrier lover, Cairn rescue foster home, Feeds Raw answered ...

"She will NOT grow out of it!  You need to teach her that doing this us unacceptable to you!  Zak George has a great video on YouTube that shows you how to teach your girl not to put your teeth on you."


Krista Magnifico, DVM, Founder of Pawbly answered ...

"Let me clarify..biting has a negative connotation and needs to be addressed if it is truly biting. Being a mouthy puppy is normal and not equivalent to biting. It is normal interactive play for a puppy learning to understand the world. Your vet can help identify one versus the other. The overwhelming majority of puppies of this breed at this age are playing. They progress to biting because they are not being given adequate time and exercise. Then they are reprimanded which exacerbates their frustration and worsens their demand for time and play. I agree that Biting needs to be addressed and boundaries need to be established. But Discouraging mouth play and interaction (which is what I see overwhelmingly) is equivalent in your puppies eyes as being dismissed and treated as annoying.

This terrible advice to manage every second of a puppies life and extinguish their love and curiosity is making our puppies crazy and turn into them into unsocialized fearful anxious dogs. Parents drive puppies into corners where only bad things result and surrenders to shelters become reality. It takes time and a change in perspective to teach pet parents how to raise happy healthy socialized pets. Most of the time they mess it up unknowingly and unintentionally.

So if your puppy is biting they are trying to tell you something. Seeing that display of need as annoying concerns me deeply that you aren't understanding what she is trying to tell you. I see it everyday in practice and the statistics for pet surrenders prove it. If you have had her for two months and she has turned into a biter you have missed the expression and need she has been trying to express to you. She needs more of something and she is biting to try to get it. Reprimanding her for a failure of your understanding of her need will worsen the relationship you have with her.

I recommend that you find a positive reinforcement trainer to help meet her needs and assist her j to growing up as a happy healthy socially responsible member of her community."


Now I know these other two experts. They are truly experts. They have dedicated their lives to dogs. Their dogs are the picture of model dog behavior in every sense. They come to the training table with the highest of standards in place and a firm ability to implement and train almost any dog with any problem.

Here's where I differ in my approach; I have to do whatever I can to keep these dogs (almost ALL of them teenagers who have been screwed up by the unknowing mistakes of their misguided, over tired, under prepared pet parents) in the home, and get to the "happy place" as soon as possible. At 4 months old, if this person obtained this puppy at 4 weeks old, it is clear to me that this person has caused this problem by not knowing how to address it. How did that happen? They forgot to answer, or understand, their puppies needs and pleas. They are trying to extinguish a request in stead of understand and provide for it.

If I don't figure out how to bridge the gap between needs, expectations, and reality this puppy will end up being disposed of.

In my opinion of all the things pet parents need to improve upon behavior is the single greatest failure. (After we get this licked I am moving onto;
1. Sentient Beings. Animals understand us more than we give them credit for.
2. Spaying/neutering. 3 million dog and cat euthanasia's in the USA every year! What??.
3. Preventative Care. Want to save $$ and emergencies? Preventative care will help.
4. Responsible Ownership. Abuse, neglect should have real consequences. If you lack the ability to provide kindness please don't have a pet.

Then my work is done.

Oh, And there is still Pawbly. Pawbly is poised to help with all of these.... (note to self; eat more spinach, pace yourself).

If you have a pet question, or a pet related concern, please join us on Pawbly.com. We are here to help and always free.

I am also available for appointments and individual care at Jarrettsville Vet in Jarrettsville Maryland, or find me on Twitter @FreePetAdvice.

And YouTube has lots of videos on common conditions, treatment options, and at home care. Follow me there too!