Tuesday, September 30, 2014

The Holes In The Safety Net


There are days when it is all I can do to just drag myself home. The days like today when I am arriving home after 9 pm after arriving at the clinic at 9 am. Today I skipped lunch, took no breaks, (I am not even sure I had a bathroom break). And now here is is after 9 pm and I am rushing to feed my kids, eat, and sleep. I repeat this day Monday through  Friday.Today was a mirror image of yesterday, and tomorrow will be the same. It is exhausting and it is sometimes brutal. But I have home. I always have home. It is where I seek refuge, solace and peace. Where I harbor the possessions that I hold dearest and closest to my heart, my pets, and my home becomes my salvation.

The days like today when I have been on my feet for over 12 hours, faced death, sad cases, miracles, possibilities, smiles and comfort from my clients who long ago transitioned into friends and people who challenge me over $10 for a nail trim they don't want to pay for, (for whatever ridiculous inane reason that I am unable to understand), preferring instead to spend a half hour of my demanding busy afternoon arguing. There are hard, long, often demanding days. There are days when being a vet isn't a source of pride it is a source of resentment, frustration, and pain.

To add insult to my injured sleep deprived self, I talked with a friend who balked at the idea that my education and work ethic get me to less than half of a six figured salary. He actually laughed at my paycheck. He makes seven figures, he works hard, he has 4 years of college, I have 12..there is sarcastic bitter comedic justice in this, except I have yet to find it.

When I got home last night I learned from Steve Dale's column that Dr. Yin had died a "sudden and unexpected death." She is a pillar of the foundation of the humane behavioral advances we veterinarians have made in the last 20 years. As soon as I read her reps addition to her Facebook page I knew her death had to be due to suicide. Without knowing her personally, I have been a long time fan of her work, and a follower of her blog. She is a veterinarian who I identify closely with. She was woman who through words, actions, blogs, stories, educating and endless tireless determination has helped pets she never met the world over live longer safer lives. She leaves behind a legacy with ripple effects far surpassing any of our lifetimes. Dr. Yin was a mentor an inspiration and a person I referred to often as I sought to educate and advise others.

On the day that Robbin Williams suicide news broke I was at a mentors Hall Of Fame induction party. She is a woman I have known for 25+ years. She has shaped the course of my life, has helped pick me up at my lowest most desperate moments and is now fighting for her own life against one of the most grave diagnoses possible. Her smile, her conviction and her determination were the antivenin to the despair of a superstar comic who always made us laugh. I was struck by the sudden tragic loss due to depression and desperate fleeing from a demon we could not see and the juxtaposition of the fight for yet one more day to live battling for every last moment of the fleeting days my friend has left to live with her 12 year old daughter. It is symbolic of the professional life I live. Always apposing forces and always unknown mysterious, fleeting, possible outcomes.

If you underestimate the plight of our profession take a spin down Google lane and search "highest suicide rate by profession." You will be provided with the frightening statistics of suicide being the highest in healthcare, among those veterinarians.

Why? Well, from the depths of my soul I will say that I believe it is due to the overwhelming stress we internalize, the pressures we feel powerless to resolve alone, and the pervasive garble we tout everyday in order to keep clients happy, not lay guilt or blame on their feet and the massive tragic decisions we are asked to execute daily. We are asked and expected to treat life as a gift if the checkbook and client are able and willing, and end a treatable healthy life if the whim of society deems it necessary. We also have all of the tools and an experts bag of experience in ending life quickly, quietly and permanently whether that be ours, or others.

I received a request from the AVMA a few weeks ago asking me to fill out a questionnaire to help assess and understand the stress and depression that has become a palpable undercurrent of hushed whimpers and obituaries. I didn't compete it. I don't feel that the intent is genuine and I don't believe that the answers come from above. I think the help and support comes from each other, from our families, our colleagues, and our community. It is a product of our profession fracturing from the pressures of being unrealistic with where our passions, our purpose, and our place in society. We are struggling to maintain a way of life we cannot afford, we are drowning in debt, we are losing ourselves, and seeking peace in the most tragic places.

I have written about compassion fatigue. I have lived it, and I continue to live it everyday. I understand the fragility of life. The circuitous maze that this profession and life present and I am grateful for the safe supportive net that I am able to fall into daily. I am a soldier among the army of a profession who needs help, who finds little, and who believes that salvation and peace lie at the end.

Me and Lorie Blog Paws 2013


Tonight I also learned of the death of Dr. Lorie Huston. She is the author and creator of the Pet Health Care Gazette. When I began blogging she was the benchmark. The person who proved to me that there was an audience and a need for help in the online community. She was another kind, bright light whose words are prolific and timeless. She helped when others closed doors, and she was a smiling beacon of what I always believed a vet was cast to be, she was a compassionate generous caring soul.

I miss you ladies, you were both a pillar of support an inspiration and the guide for many a pet parent the world over. You touched lives you never knew and you brought pride to a profession who struggles to find caring and compassion in the minutes of the routine drudgery of a hard demanding profession.

My blog on compassion fatigue can be found here.

My shoulder, my ear and my support for my fellow animal friends lie here, in these words, in my heart, and in the foundation of what we are about, we are about healing and helping. Email me, call me, find me, you are never alone and you are the oxygen of our patients, our clients and our calling.

For those of you who feel sad, alone, and afraid of the demons that haunt your soul please hear me. You are never alone, your life matters, and you make a difference. There are miracles we never understand but yet they exist and they happen, you just have to breath and believe, that's all. Keep breathing and keep believing.

(Authors note..this is fraught with gramatical mistakes, I am sure. I remain unable to change the tense from is,, to was,, in many cases. I am unable to proof read clearly, and I am, as many of us are, stuck in that place of accepting that a life has ended and there is now a "was" instead of a "she is..") 

Bloody Urine. What to do when it's your cat's?


Cameron
The cosmos is sending me a flurry of bloody urine kids recently. As Sherlock Holmes would say, "There has to be a reason?" I guess without being able to put my finger on it I am left to deduce that is just the universe begging me to put another blog out for others to benefit from. (After 5 pets I got the message and got my butt to the desk to type this).

There are two ways these cases present at the clinic.
  1. Due to the lack of an opposable thumb your cat is unable to grab a marker and write on the walls "Need a little assistance here!" and so they are left with the next best way to inform you of their plight by peeing on your clothes, your bed, the carpet, or whatever place that isn't the one you provided. After the anger passes you notice that there is a pink tinge to the urine and you think, "Huh? maybe Fluffy is trying to tell me something?"
  2. Your cat seems to have developed a special affinity for the litter box and is repeatedly posturing to urinate/defecate, or you hear screams, moans, whimpers from the box as they are straining to take care of business.
To cement my point;
Your cat is only NOT GOING IN THE BOX, BECAUSE THEY NEED YOUR HELP.

They are not mad at you, they do not harbor spite, regret, ill-will, or any tiny yearning for you to look at them with disapproval, disappointment, disgust, or the most popular reason cats are sent to shelter/ purgatory/death.



Every cat with abnormal or inappropriate urination, (or even acting oddly in any way shape or form), warrants a trip to the vet.

Every vet has seen a cat die from a urinary blockage. A blocked cat is, in almost all cases, a treatable, reversible condition that if treated early enough can be completely cured.

Which leads us to discussing;

What are the urinary health clues to look for;
  1. Any cat appearing to have difficulty passing urine,
  2. Licking at the genitals,
  3. Frequently visiting the litter box,
  4. Producing small amounts of urine,
  5. Any change in color to the urine, (Even absence of color denotes a possible medical problem),
  6. Foul smelling urine,
  7. Not using the litter box, (going outside of the box),
  8. Painful belly,
  9. Distended belly,
  10. Reluctant to move,
  11. Lethargic,
  12. History of urinary tract infections, urinary blockage, crystals in the urine, etc.

Cameron snuggles with his mom.

My opening line to any and every urinary tract patient, suspected or otherwise, is the same. It is a simple and time proven dialogue.

Start with a physical exam! Because if your cat is blocked you won't be able to get a urine sample, (as you are waiting your cat might be dying). If you see your pet straining, or producing small amounts of urine bring in a urine sample if or when possible.

Cameron arrived with his mom and a small pill bottle sample of red urine. Cameron had a history of urinary problems. His writing on the wall is peeing in the dirty laundry bin. Of great benefit to both all of the laundry was done and the urine was visibly bloody. Mom poured a sample into a bottle and headed to us for a visit.


It is worth mentioning that there are a few important things to discuss about urine samples;
  1. The urine sample must be fresh. Get it to the vet as soon as possible. If you can't deliver it immediately place it in the refrigerator for storage. After 24 hours it should be thrown out.
  2. If, and when possible, obtain and use the first morning urine sample. These are the most accurate when we are analyzing concentrating ability, (i.e. how well your kidneys are working).
  3. Catch the sample midstream in a clean dry vessel. Last week a client delivered a sample that they had "scraped off the ground." We cannot separate dirt, mud, asphalt, cat litter (they do make sterile plastic litter for use in trying to get a urine sample from cats), or the dirt, bacteria and normal floor flora of your home. Don't waste your money analyzing a contaminated sample.
  4. Urine samples are best analyzed in the clinic as soon as possible. Crystals and sediment is influenced by time delay, shipping and handling. 
  5. Cystocentesis is the preferred method of collection in many cases. I know it sounds scary but veterinarians routinely use a needle and syringe to collect a urine sample from the bladder. 
  6. An ultrasound can be invaluable at looking at the internal surface and contents of the bladder. It is also very helpful in obtaining a cystocentesis in a small bladder.
  7. There are those urine samples that are so bloody they are difficult to assess for bacteria. If this is the case do a follow up urine sample as the color of the urine returns to clear or yellow.


Here's the thumb nail version of my bloody urine speech. Hematuria (blood in the urine) is a sign of a problem. The presence of blood DOES NOT diagnose infection. To diagnose a urinary tract infection you must have BOTH BACTERIA AND WHITE BLOOD CELLS in the urine. Sometimes we do see blood concurrently with infection, but often we do not. 

Hematuria

In veterinary medicine we do a very poor job of differentiating and diagnosing INFECTION VS INFLAMMATION. We skip a lot of important steps (often to save money), but we do so at the expense of our patients.

Inflammation will often cause blood to appear in the urine. 

There are a few things that influence urinary tract problems. They include; 
  • Genetics. We can't change your genetics, so, we move on to..
  • Exercise. There is a correlation to obesity and overall general health. Keep your pet at a healthy weight, trying to treat other diseases without addressing this is almost always futile, and ultimately costs your pet their quality of longevity.
  • Diet. This is imperative to be talking about. Listen to your vet and keep your mind open to different foods that just might cure your cats urinary problem. Heck, in almost all urinary disease cases I believe the diet CAUSED the urinary issues. I suggest a high quality wet food with added water. I see most of the UTI cases eating cheap, poor quality dry cat food.
  • Disease. Recurrent UTI's warrant further diagnostics. Look for things like diabetes, allergies, bladder stones, etc.

If you or I saw blood in our urine we would go to our doctor, provide a fresh urine sample that would be immediately checked with a urine dipstick. From the doctors office the sample would go to a lab where it would be grown in a petri dish to diagnose the type(s) of bacteria present AND the best antibiotics to treat that specific bacterial infection. This is called a culture and sensitivity. We often skip this test due to cost (about $100) and just provide antibiotic for two weeks.  

Without a C &S we guess what bug your pet has AND we guess which antibiotic is best to use AND we guess that we gave you enough to kill every bug. If the infection returns we don't know if we guessed any of these wrong. Guess less by doing a C & S.

A few  keys take home points:
  1. A straining cat can be a blocked cat and THIS CAN BE FATAL QUICKLY. Get to the vet immediately.
  2. Once you have one infection you are predisposed to others. Watch the size of the urine clumps in the litter box and encourage water intake. I love water fountains.
  3. Talk about diet and change the diet if needed. You get what you pay for and you are what you eat. I don't quite know why but vets don't discuss enough about why these happen, how to best diagnose them, treat them, or avoid them. It is my goal to not have your pet suffer twice with the same affliction. This is only attainable by discussing your pet with your vet.
  4. A cat not using the litter box is a cat begging for help. Not a reason to surrender, euthanize and NEVER EVER PUNISH A CAT. It is ineffective in all cases and will back fire on you every time.

Our last batch of summer 2014 babies up for adoption.
If you have a pet question or concern you can ask them for free at Pawbly.com. Pawbly is dedicated creating a place where people exchange pet care information to help pets lives across the globe.

If you want to talk to me about a pet care related item you can find me in person at the Jarrettsville Veterinary Center, in Jarrettsville Maryland.

You can also find me on Twitter @FreePetAdvice.

Sunday, September 28, 2014

What Can We Do To Help More Pets?



I ask myself this every day. I think about it with every pet and every client who walks in our clinic doors. If I see my job as helping pets and their people, and I see soo many in need, I am left asking, "How can I do more?"

Seems a normal extension of our mission statement to help others, (granted we at the vet clinic choose to help others through pet care, but we view pets as a part of the family, so it's all the same, right?). If that's our mission, then how can we help more pets locally that are not receiving care? We already do a lot of work through the rescues, but sadly all of this work is only AFTER disaster has struck. So, I am left pondering....

How can we help pets BEFORE, or better yet, 

How can we help them so that maybe disaster won't strike?




There are little things that we do at the clinic everyday already; The phone call advice to clients, the blog advice, the Facebook help, the connecting people in need with resources, the free exams for found kittens, the housing of a found pet, the list goes on and on... It is the life of a veterinary clinic and the reason we feel called to pet care duty and become a veterinary technician or veterinarian.




And so, I am pondering....

How can Jarrettsville Vet help those who need us the most?



It is still an open ended question,, and who better to answer it then to ask all of you?

Where do you see the greatest need?

What do you do to address it?




And how can we all as a community band together to help the pets in our own backyard?

I have my ideas, but let's hear your first.. What do you think I, or your veterinarian, should be doing more of to help more pets?

And I also wonder, am I alone? Do you ask yourself these sorts of questions?


And as always; my end of the blog reminder...

If you have a pet question, a pet need, or just want to join a group of friends who all adore their four legged kids, you can find us on Pawbly.com. We are a free, open, unbiased platform for all things pet. We are dedicated to helping you find ways to take care for your kids by providing a place for the free exchange of pet related information.

You can also find me at Twitter @FreePetAdvice, or in my Jarrettsville Vet scrubs trying to save the word one wet nose at a time.

Related blogs;






Saturday, September 20, 2014

And That's Why They Make Diapers For Old Ladies. Urinary Incontinence in Dogs.


"There is no better place to start than a physical exam." I am sure that I say that a hundred times a day. If there was a quicker, cheaper, easier way around this I would have built an app for it and single-handedly been responsible for closing the doors of the thousands of veterinary clinics around the world.

For as many times as I repeat those words, and believe them to ring true, I say with almost equal frequency and even more resolve "the best value to your pets health is an examination with you beside them." The whole idea of drive-by vaccines or dropping a pet off for an exam is ludicrous to me. Your pet can't speak, they can't give me important historical information, they cannot explain to me the environment they live in, the food(s) you feed, nor can they answer the rest of the questions I might have to help understand your pet, resolve their issues, and discuss the treatment options.

You see medicine is about solving a puzzle. Think of it as the Leap Year Sunday genius edition of the NY Times crossword puzzle with the clues being given to you from an interpreter, who doesn't speak English as their native tongue.


Fewer complaints ring true than the client who calls to report that their dog is "leaving wet spots." For those of us who share the bed with our dogs, the resolution of incontinence is paramount. The only way to diagnose this is with a pet, a history, a whole bunch of talking, a good examination, and a few diagnostic tests.

Here's my experience with urinary incontinence. Or what vets call "urethral sphincter mechanism incontinence" also known as "spay incontinence," or what I refer to as "the reason old ladies need diapers." For post-menopausal ladies, whether because of age or spaying, the decrease in estrogen can cause the bladder and urethra to become less diligent in their duties of maintaining focus while on the job. The essentially become worn out and less tolerant of the high demands placed on them.

I commonly see this condition affecting dogs who are 1-6 years old (middle aged), female, spayed, medium sized dogs.


It most often presents as occasional leakage of urine after a period of sleep. Clients report finding varying sized "wet spots" left behind after the pet wakes up. Why does urinary sphincter incontinence happen? Well, when you sleep muscles relax but the  bladder continues to fill. There is a point at which the pressure on the bladder overwhelms the poorly responsive sphincter and leakage occurs. I tell my clients to think of it as trying to hold a water balloon all day and night. When you fall asleep you will lose your grip and the water will leak out.

For the huge majority of dogs the diagnosis will be "spay incontinence." I know this, I state this, and we plan for this. BUT, there absolutely needs to be a thorough a precise exam and a whole bunch of questions and answers exchanged before we should prescribe a drug to treat the sphincter incompetence.


Here's where I start on gathering a history;
  • Spayed female? 
  • Age and history of when leakage began?
  • Describe the leakage events? When, Where, How much?
  • What does she look like when she postures to urinate?
  • What does the urine stream look like? Is it full and continuous or stops and starts? or small amounts with difficulty, or small amounts produced but taking a long period of time, etc.?
  • How much urine does she produce at the first attempt?
  • How many times does she posture to urinate after the first?
  • How long is it before she postures again?
  • What is the frequency and amount at the beginning of the day versus the end of the day?
  • Have you noticed any changes in amount of water intake?
  • Have you changed anything in the diet or feeding regimen?
Why are all of these questions so important? Well, because one clinical sign (urinary leakage) can be caused by a whole slew of reasons. It is imperative to be treating the correct cause so that you don't either a) cause another problem, or b) exacerbate a pre-existing problem.


After I have collected a full detailed description I perform a thorough examination of the urine, the urinary tract and pet.

The rest is hands on. A thorough physical exam starts at the tip of the nose and ends at the tail.
The kidneys are intimately entwined with the bladder. Don't over look a problem here. Urine specific gravity is important to be accurate and reliable. If urine specific gravity is low, take 4 first urine samples to confirm.


Vets are very good at being able to assess bladder tone. We get tons of practice with those blocked cats. (Oddly, cats have trouble emptying, dogs have trouble keeping). The bladder has a particular 'feel' soft, hard, firm, flaccid, easy to empty, fighting the pressure from your hands, etc. 'feel,' and you can tell a lot about the health of the bladder by its 'feel.' The rest of the urinary tract can be assessed with a rectal and vaginal digital exam. Any odd lumps, bumps, and twists and turns.

An ultrasound can help detect bladder thickness, stones, masses, etc. It is an excellent tool for internal soft tissue abdominal structures, filling and emptying issues. Radiographs can also assist, but they are rarely the last or only diagnostic needed. Choose your diagnostics carefully an understand cost and benefit scenarios.

Because there is a close relationship between the mind and the bladder, nerve function should be assessed. I have only seen bladder dysfunction/interruptions after pelvic injuries. These cases need to be correctly diagnosed and the complications of treatment plans evaluated realistically. Examination at rest, walk, nerves of the head, heart, anal tone are all important places to check.


HX & observed information;

  • Can the patient void normally?
  • Is there constant dribbling or is the patient only incontinent when recumbent or asleep?
  • Is the problem worse when the bladder is full or empty or it doesn't matter?
  • Is the problem worse after the patient has just voided?
  • Does the patient have a higher urine volume than they did previously?

Physical examination;

  • Is the bladder big or small?
  • Does the bladder palpate flabby or firm?
  • Does the bladder empty fully? We may take an x-ray to confirm.
  • Does the urethra (and prostate if male, vagina if female) palpate normally on the rectal exam (and vaginal exam if female)?
  • Does the patient have a normal neurologic exam including the autonomic nervous system?
  • How hard is the bladder to express....as hard as you expect for an awake patient or harder or easier?




The photos in this blog are of my dear patient Eden. Her mom sent them to me and added this about Eden's incontinence issues.

I adopted Eden at the beginning of March 2011 and didn't notice any symptoms of incontinence until the fall/ winter of 2012. I first noticed that there would be little dribbles on the carpet or on her bed after laying down. She seemed to need to urinate more frequently than usual and I would come home to occasional accidents in the house. The symptoms seemed to present themselves rather suddenly, and I think they progressed fairly rapidly, but I took her to see you very soon after the symptoms started for a diagnosis.

She was prescribed with Proin 50mg (half tab 2x a day) around Dec 2012/ Jan 2013. The medication seemed to take care of the issue, with only occasional accidents happening on days that I had to work overtime. However, within the last month, I began noticing more frequent accidents, usually on a daily basis during the work week. Eden also seemed to be spending more time than usual licking her rear end. I contacted you August 26, 2014 and we decided to increase her dosage of Proin to 100mg (1-50mg tab in the morning, 1-50mg tab at night). So far, the dosage increase has been effective.

On a personal note, the incontinence has been "inconvenient" for my hardwood floors, and I no longer have any area rugs down in the house. But I feel this is manageable and would rather refinish my floors years down the road if need be than confine Eden to one room or a crate while I am gone at work during the day. I have friends who don't understand and say that they would "just get rid of her", but of course, you know that would never be an option for me.

I have attached a few photos of the ham, feel free to use any you'd like.

I hope this helps. Let me know if there's anything else you need or any questions I haven't answered!

Thanks,

Eden's mom.. 

If you have a pet question you can ask it free at Pawbly.com. There you can also post photos, share pet experiences and help other pet people around the globe. Pawbly is free for everyone to use and dedicated to one simple mission; Helping people help their pets.

You can find me at my veterinary clinic, Jarrettsville Vet in Harford County Maryland, or on Twitter @FreePetAdvice.

Thursday, September 18, 2014

"Tis Better To Have Loved And Lost,"


...Than to have never loved at all."


The famous quote by Alfred Lord Tennyson was penned over a century and a half ago. But the words still ring true. It is painfully difficult to lose a loved one and for some the pain cuts so deep they close themselves off from ever letting their heart be vulnerable again.

Caught in a fan motor. This one month old kitten lost her front leg.
We are trying like heck to save her back leg.
Is there shame in not spaying and neutering the colony that lives in this factory?
Who pays the price of neglect?



Without the strong emotionally driven bond that we have between ourselves and our pets we would not have veterinarians. (Well, at least the kind of veterinarians that I am).

This is Lucky, two months old, he was found in terrible shape,
but, the man who found him and JVC  rallied to save him.
(Obviously, I have gotten a little attached.).
He has a long healthy life in Georgia (recently adopted) ahead of hi
m.
Is there shame in not seeing the value of a little fragile life?

This is what TLC and kitten determination looks like a few days later.

I read an interesting blog on emotions recently. It specifically focused on shame. How prevalent and pervasive it is in small animal medicine. It brought up some very interesting points that made me reflect on where I stand. (I love those kinds of blogs!).

Here is a small excerpt from the incredibly brilliant blog, Vet Changes World, on "Shame in Veterinary Medicine,"

"Our clients shame us, we shame them, we shame each other. I think we don’t even realize what we’re doing half the time and how much we’re hurting each other.

At the heart of defining someone as a “good vet” or a “bad vet”, a “good pet owner” or a “bad pet owner” is the idea and implication that some of just aren’t and can’t become enough.

I think a lot of what we call compassion fatigue is really shame fatigue. When we care for others around us, and still don’t feel “good enough”, it’s hard to have the energy to keep caring.

It’s a vicious cycle. We feel constantly judged by a colleagues and clients, so we judge them in return. There’s a part of many of us that feels “not good enough”, especially when we just can’t get our message across or when we lose a life despite our best efforts."

To read the entire blog please visit "Shame in Veterinary Medicine."

At the end of her blog were a series of questions that included; Have you ever felt shamed? Have you ever shamed someone? What would you do differently?

When all else seems questionable,
snuggle a pet who benefited by just you being you.
Two of the three parvo pups we helped to save last week.
Is there shame in abandonment?
What if that abandonment places the pet in a place where life-threatening disease is rampant?

Here was my reply;

Huh? Shame. I had to sit and think about this one for awhile,,,

Nope, I have no shame. Is that bad? Am I deficient in an emotion that would make me a whole human? Guess I should continue to ponder it...... I spend countless moments of every day navigating, tip-toeing and trying to avoid shame, guilt, and impropriety WHILE trying to aid a pet whose care, life, and well-being is in the hands of another person.

Do I think that some of my clients lack shame...Yep! But, they have to live with their own conscious,, and I don't think that me trying to shame them,, (gosh, I hope I don't do that), into anything works. I think shame breeds resentment and what would happen if those clients re-directed that resentment onto their pet?, Well, that defeats my whole purpose...

I am a work in progress. We all are. It is part of growing, to learn, to adapt, and to reflect on who you are and how your actions affect others. I accept the flaws, I analyze my actions and words, and I 

Judgments, Oh, how they plague me. If we could all stop judging each other we would stop arguing, and maybe get to that elusive place ere that peace and liberty thrive. 

Regret, Yep! got a few of those...

I prefer the direct, open, honest, dialogue that unfolds something like this, "Here's my thoughts on your pets condition... and, here's my recommendations to diagnosing and treating it." Sometimes it is that easy and sometimes I say that I cannot assist them in their treatment choice. It is never about avoiding a emotion, as I think all of companion animal medicine is centered on emotional attachment, it is about maintaining and strengthening the bond between a pet and a pet parent. Anything that violates this is beyond my scope of assistance and therefore warrants a change in my place in the relationship.

Shame, nope, no shame here. But I consciously, surreptitiously work at this.

But, I might be abnormal..I'm convinced I must be....

The pups head back to Black Dogs and Company Rescue.
Happy, barking, wagging, wiggle-babies almost ready for adoption!
Surround yourself with people who love and support you and be the beacon of hope.

So how about you?

Where does shame fall in your life? How does it motivate you? Or does it just perpetuate more negative thoughts?

And the rest?

Loving and losing? Can your heart grow bigger in spite of loss?

Judgments? Do they have a purposeful place in your life? Your pets life? The lives you influence?

And regrets. Just flush them..don't waste a single moment of your precious life on them. You to are a work in progress, where today is a new day and life is yours to share, embrace and enrich others.

Jekyll's advice on how to best deal with any sort of stress..

Related blogs;

Compassion Fatigue.

Regrets.

Taking A Stand And Facing Consequences.

If you have a pet question of any kind please visit me on Pawbly.com. Pawbly is a community of pet people, from the single pet parent to the boarded veterinary surgeon, all joining forces together in one place to help you take better care of your pet. It's a simple mission; to help you take better care of your pet. Pawbly is free for everyone and open to everyone who love pets. Oh! and stay tunes for our Pawbly app coming soon to the iTunes store.

You can also find me at the vet clinic, Jarrettsville Vet, in Harford County Maryland. We are open 7 days a week and offer exemplary pet care from acupuncture, to ultrasound, internal medicine, orthopedic surgery, cold laser and even Reiki. Please call for an appointment at 410-692-6171, or visit us on our website JarrettsvilleVet.com, or on Facebook, Jarrettsville Vet.

You can also find me on Twitter @FreePetAdvice sharing pet pictures and random pet facts.

Thanks! XOXO! Krista


Sunday, September 14, 2014

The Kitten House Of Cards


The most dreaded part of my being a vet is the deluge of unwanted, homeless tiny felines. It begins in early March and continues through October. Even as September descends upon us the kittens still bloom. This last week we had 8, (oddly all black or black and white), kittens arrive without a person to love them. Apparently the admission of having a soft spot in your heart for cats and the helping of those in need of a halfway house leads to the flood gates being flung wide open. The idea that everyone doesn't admire and adore cats of all sizes, shapes, and colors is almost impossible for me to comprehend. At the beginning, middle, and end of every disastrous day is a purring mass of fur and my encompassing arms. I take therapeutic kitten breaks daily. It is the single best part of my job, my workplace, and the life blood of my soul.



Every day there seems to be yet another kitten, from yet another person, that appears to have either manifested "out of thin air," was "dropped off by some transparent being," or came from the "cat-cornucopia-farm across the road that never spays or neuters their barn cats."



Every request is the same, "I can't keep it," or, "I'm not a cat person," (what the hell does that mean?),  "but I heard you guys like cats." All delivered with a tone of expectation and a demeanor of self-assured justified shirking of responsibility.



How do I respond to this? "Umm,,,, Yes, of course I like cats. I'm a vet. But, no, I can't take every cat from every person who asks me to." (Although secretly I do wish I could).

After school visit with the kittens.
Our daily ritual with my nephew.
Any species who can adapt so quickly, so efficiently, and so successfully to as many places and conditions as the domestic house cat has deserves respect and adoration. They are incredibly prolific and reported as being able to produce over 400,000 cats in seven years from one cat. Quite impressive and quite humbling to all of us who dedicate huge amounts of time and resources attempting to spay and neuter our way out of the millions of cats euthanized in the US every year.

Found by a client this kitten was caught in a fan motor.
She lost her front left leg, suffered some facial injuries and is being treated for a crushing,
degloving injury of her back left leg.
We are intensively trying to save her back leg.
Many Thanks to our technician Laura and Dr. Hubbard for caring for her.

We say that a cat has 9 lives because they are impressively hardy, smart, cunning, calculating, and savvy, all characteristics of a survivor. Every single one of us has much to learn from the cat.


When it comes to providing for a kitten there is a short list of needs that must be met.



Kittens are like a house of cards. It takes a few cards to be stacked, a shaky foundation and the whole structure can collapse. Should you ever find a kitten of your own they must be provided the following;
  • Warmth. Every newborn needs to be kept warm. Whether it comes from a cuddling mom, a warming blanket, a heating pad, a heat lamp, or just being kept close to your heart.
  • Keeping them clean and dry in an enclosed place out of the elements.
  • Food. Babies burn calories at an alarming rate. Keep them eating. For a kitten this is about every two hours of an age appropriate food. We have calorie dense wet foods to help, think the kitten version of Ensure.
  • Fleas. The blood sucking, life depleting parasite that is the demise of many a small soul. Remove them with a flea comb and soapy water, nothing else. Those adult flea preventative topicals can kill a weak, compromised baby, avoid them. Be patient and comb.
  • Parasites. The invisible intestinal parasites can, and do, grow to such numbers that they can steal the life from a kitten from the inside out. (Reminder, you will likely NOT see evidence of intestinal parasites in the feces, they are microscopic).
The kitten whole stole my heart,,again, Lucky.
This is Lucky, a two month old feral? (more like homeless) kitten. He came to us almost comatose. He was soo cold that he would not register on the thermometer for almost 30 minutes after aggressive warming was begun. He was emaciated, lifeless, and very pale. He was also covered in fleas, dehydrated, and suffering from an upper respiratory infection.

Within 30 minutes of warming him, removing his fleas, and feeding him he was lifting his head and purring. After 4 hours he was up and cuddling.

He is a miracle of gratitude and the best answer to a long day of not feeling like my life has a deeper meaning. He is the reason veterinarians do what we do.


Lucky was adopted yesterday.

We still have six kittens and four adults looking for a home to fill with a sense of purpose and completion.

Should you find yourself in need of a hug, a warm nose to snuggle, a purr to keep the night from lasting too long, or just the unconditional love of a pet please come by and visit Jarrettsville Vet to see and meet our babies.

Or, ask me a question FREE about how to care for your kids at Pawbly.com, or like us on Facebook at Jarrettsville Vet, or Pawbly. You can also follow me on Twitter @FreePetAdvice.



Sunday, September 7, 2014

Clues From The Waiting Room.

Veterinary medicine is all about collecting clues to make a diagnosis. For those of us with mute patients it is imperative to pay very close attention to the subtle clues. Those hidden, quiet, trained eye clues will often lead your way to the diagnosis, and therefore, a better chance of your treatment being successful.

Here's a very good example how this happens in my real-life.

Can you guess what this cat presented for?



(Here's a hint; This cat carrier is so heavy that the client has to employ a dish rag to keep the metal handle from digging into her hand).

This kitty was brought to me for limping.

She had been to the clinic three other times over the last year and a half. At four years old she has been overweight since two.

Can you guess why a young cat would have intermittent chronic lameness?

Without spending any money on diagnostics we spoke about how difficult it was for her cat to do the normal things that young cats do. She was reluctant to play, jump, or over exert herself. The limp came and went over the last two years. Her mom loved her to pieces, doted on her, managed her diet and her life and filled it with affection. But this kitty was 14 pounds. (She should weigh about 10). Four extra pounds when you are supposed to be 10 is a whole lot! The stress on the joints is significant and severe. There was a significant decrease in the range of motion of the joints, reluctance to palpation of the elbows, hips and knees, and a painful left rear leg. 

Her official diagnosis was degenerative joint disease.

We spent more time talking about her cats diet. Even though she was measuring her food, feeding only twice a day, and not giving snacks her kitty was not getting any smaller. 

My lecture about weight loss is always the same; "Weight loss is all about diet and exercise." It is very hard to have one without the other, BUT, when it comes to cats how do we approach the difficult task of  'exercising your cat?' 

My views on weight loss for cats has evolved. I used to recommend measured amounts of a high quality prescription or commercially available low fat dry kibble. I would recommend using the bags suggested feeding amount guidelines for the optimal body size. For example, if your cat is 14 pounds but has an optimal body size of 10 pounds feed the amount suggested for 10 pounds. Or, I would recommend to reduce the amount fed by 20 % every month until the desired weight was achieved. Which required monthly weigh-ins (cats are not so fond of these) then gradually increase the amount fed until you reached the quantity that maintained the ideal weight. I would even suggest providing 1/4 to 1/2 cup of dry food twice a day with small mid-day snacks to help curb the hunger and boredom cravings.  This changed when the epidemic of feline diabetes erupted. I have now changed my tune in response to the devastation that diabetes has cost my feline patients. I now recommend 1/2 to 1 can of a 5 ounce high quality or prescription wet food twice a day. For those kitties who are used 
to the potato chip pasta dry food diet, you can offer a small amount (like 1/4 to 1/2 a cup) of a high quality dry food mid-day snack is fine as we adjust from the carbs to the protein. It is imperative to minimize or eliminate commercial cat snacks (as these are almost always high fat, low quality, and full of salt to help palatability).  Cats are obligate carnivores and wet food is higher in protein, water, and much lower in carbohydrates when compared to bagged food. We call it the "Catkins" diet. 

Cats are smart, cunning, finicky little critters. Never try to force a cat to do anything. Every change in their world should be done slowly and with them thinking that it was all their idea. They are not dogs and when there is a war of wills they will win every time. In fact, they are so stubborn they will go on a hunger strike and for some cats this can be fatal  after a few days. 

Even with all of my savvy nutritional guidance I had still been trying to get cats into shape by only adjusting one side of the diet equation. I was never giving much advice about exercise. I would just say, "for the dog people I can say go take your dog for a walk, but you can't exactly take your cat jogging, can you?" in a smart curt smile. So I would talk about laser games, catnip stuffed toys, and anything that your cat enjoyed doing to encourage more calorie burning activity. Well, I began to think, why not? Why couldn't you take your cat for a walk? Turns out cats love to investigate, they can tolerate a harness (with a little time and patience) and they get to use their senses to keep them interested in the world outside of your four walls and the food bowl.

BIG DISCLAIMER TIME; There are amazing nutritionists available to help with your cats diet plan. And every diet plan should be monitored very closely with frequent veterinary visits and weigh-ins. Your cats happiness and health is your responsibility, reach out for assistance and support, there are lots of incredible resources to tap into.

If you are worried about your cats weight, or have any other pet question, you can find me and a whole bunch of other helpful people at Pawbly.com. I would love to hear about how you successfully managed and assisted in your cats weight loss. Did you employ any exercise? How did you manage to coerce your cat to walk on a leash? Or stay in a public safe place? Please join us in helping other pets and their families.

Or find me on Twitter @FreePetAdvice. Or meet me at the clinic anytime at Jarrettsville Vet, in Harford County Maryland.

Friday, September 5, 2014

Burnt Out From Being Burned

I had a wonderful lunch meeting yesterday with a woman with as much passion and determination as I have for changing the face of availability in veterinary care and in affordability.

Never go into business with someone who doesn't love a pet.
They  will never understand the nuances or repercussions business decision's on the life of a companion.
For more information on Electronic Vet Billing options here. 
It was such a breath of fresh air. I had lost much of the wind in my sails over the last few weeks. It is the life of a veterinarian who works too hard trying to will the world into manifesting the destinies you yearn for them. It is also the ups and downs of owning your own business, where people who you believe truly give a damn about you, and their pets, turn out to be disappointing dirt bags.

If people asked me what the single biggest obstacle to pet care is I would state, "lack of responsible pet ownership." Now we could argue and debate all day as to what this means specifically, but as the provider of advice, expertise, and care to large numbers of pets and their people I would say clearly and forcefully that it is NOT THE EXPENSE OF CARE that limits pets getting the help they need. Because if you truly believed that, there would not be so many people making such poor life choices. It is our uniform goal at my clinic to be accessible, affordable, and full service. There are very few instances where care at our clinic is in excess of $800. That's not to balk at eight hundred dollars as chump change, but can you imagine having an open abdominal surgery under anesthesia for less than a thousand dollars? Should you decide to go price shopping we are routinely about half of the price of those around us. It almost is irrelevant in too many cases how much something costs at my clinic. Unless the treatment options are under $50 to $100 dollars a significant number of people will tell me that they "cannot afford to treat their pet." Sure, there are some clients who use a "budget" as a nice way of declining care. There are others who simply choose to invest elsewhere, a car, a phone, an addiction. It is real-life. It is the worst advice I ever got whispering in my ear, the nagging incessant reminder that I invest too much of myself in my inescapable admission to loving a pet more than the owner does.



I don't live in the world of negligence and self-serving, I live in the world of "my pets are my kids, my responsibility and my obligation to do right by." I am not alone. But, I am not stooping to serve those who dispose of a pet when the cable bill is due.

Here's where the dilemma of poor people with poor choices becomes the bane of my existence.

The inevitable arrival of a dying pet who needs immediate assistance and an owner with a sad story and $50 cash to their name. They can't get credit, they don't have a friend to ask for help, (the list of reasons and excuses goes on and on), until you realize that you are merely wasting your time, getting nowhere, and witnessing the last few grains of sand slip through the pets depleted hour glass.

Do you think that you could walk away? Do you think that these kinds of cases won't haunt you? Ask yourself what would you do?

It has  become my latest obsessive mission to figure out how to manage these cases and get to a happy ending.

I used to be interested in providing a place where people could find pet care regardless of where they live. I've done that. Pawbly.com solves that. My quest has turned into "providing a method to get those in need the resources to get their pet treated."


How can I take what I know about social media, crowd funding, crowd sourcing, medicine, veterinary critical care, and create an innovative, effective, engine to serve the financial needs of pets?

In the last month the crew at the clinic have joined together to help 4 desperate dying pets. The owners all shared a desire to get help and a complete lack of available reserves to provide it. No credit, no emergency fund, and a list of excuses. All of these pets would have died if they had not been treated immediately. And most of them would have had been turned away at every other clinic they walked into.

I made myself a promise a long time ago, that I would not turn away a pet in need based on lack of funds. It's an almost impossible promise to keep. It requires that I cut needed corners, bend all comfortable decisions, and prepare myself mentally and emotionally to get burned. Its not the bending the list of ideal diagnostics, and preferred treatment options that is causing me to question y ability to continue this credo, it's the getting fed a load of crap, a boatload of promises, and being lied to your face. There seems to be no shame in lying, in mis-leading and in screwing a person who saved your pets life. It sucks to care more than the owner does and be screwed repeatedly. Of all of those cases not one person has shown up to put their money where their mouth is.

The one dog, the one case, that shaped everything.
Is there a little voice in the back of my head every single time I let someone pay us back later? Yes, of course there is. Do I still struggle to say, "I'm sorry I am not willing to help you at your pets most desperate hour," Yes. I really do. I'd rather be disappointed in the failure of others than abandon a pet in need.

So with that said, I know I cannot turn my back on a pet who will die without me, now all I have to do is figure out a way to not feel or be screwed. I always said I love a challenge. So here I go world,, I've been burned, I am bitter about it, but I'm determined...

I have a plan,, I'll let you know how it goes..

If you have a pet question to ask, or a lifetime of pet loving lessons to share please visit me on Pawbly.com. We are a community of pet lovers who can help you take better care of your pet. And, best of all we are always free to use!

Or visit me on Twitter @FreePetAdvice, or at the clinic, Jarrettsville Vet, in Jarrettsville, MD., where new payment plans will soon be in place.

Wednesday, September 3, 2014

How Client Behaviors Dictate Your Pet's Treatment Options

Katie, recovering well from  untreated Cushing disease.
Another JVC miracle..and her new  mom.

There are conversations that silently and secretively occur in the head and heart of every vet about every case to the oblivious acknowledgement of our client.

In a perfect world a pet arrives and we quickly, cheaply, and accurately realize the diagnosis.  The ideal treatment plan is then proposed to a willing, able, financially sound pet advocate, without regard to price, reluctant participation, or liability to either party.

In real-life the scenario is rarely ever close to this.

Here are a few good examples of how my real-life treatment decisions are influenced by my real-cases;

Case Number 1, The Cat Who Only Sees The Vet For A Wound;
A middle-aged outdoor cat arrives with a large infected, painful wound to the side of his face. The cat has been to see us twice over the last 8 years and always for the same presenting cause (festering abscessed wound). We have never vaccinated him, we have never performed an intestinal parasite examination, and we have never had the luxury to discuss all of the things that are a part of a normal routine physical exam.

Does this owner know that there are important health care topics outside of believing that our hospital is a minute clinic? Probably not. We treat the cat as if this is the only healthcare he needs, and the owners actions reflect this.


My approach and treatment plan for this cat is different than it would be for a cat I had seen for a routine physical exam within the last year. 

Why? Well, because I would be foolish and negligent to believe that this owner is going to view my services to their cat any differently in the next 8 years as they did in the past 8 years. I am also leaving myself open to getting my heinie slapped by all of the regulatory authorities that govern and enforce pet vaccination requirements.

Here's what this cat is going to leave my office with this time;

A rabies vaccination. Not ideal to be given while fighting an infection, but I'm hedging my bets this cat won''t be back in the three weeks we have requested twice before. AND, if he bites someone who is going to be questioned? Me!, and why would I want to live with the guilt of consequences of a person who dies from rabies?

An injectable antibiotic. The chances of this cat getting their full dose of antibiotics is low. We know that compliance is a real challenge for pet owners. Most people don't complete their own prescribed course of antibiotics, are we crazy to think that it's higher in our pets? And how many cats will willing return to their owner twice a day to be restrained, have their mouth pried open, and be pilled? You will likely get two chances and by day 3 be unable to find your cat for another week.

A cat with wounds this frequent, (and do I think that he's only had two in 8 years? No. I think that he's only had two severe festering abscesses in 8 years. I would bet he's had about a fight wound a week over 8 years), is at significant risk of FIV, BUT, this time he will go home with written instructions and a disclaimer about vaccines, parasites, wound care, routine care, etc. etc.. (always cover your heinie!).

Case #2, The Acute and Mildly Injured Lab and the NSAID;
The middle aged Lab with a sore joint  from playing too hard at the new doggie day care facility. I don't prescribe a once a day NSAID (non-steroidal anti-inflammatory) for these acutely injured first timers. Why not? They exist, in fact every NSAID has the ability to be reduced to once a day dosing, but for the acute recently prescribed NSAID I am asking the pet parent to use the lowest effective dose. The best way to insure this is to use the well documented poor compliance to the pets benefit. The  chance of overdose and potentially adverse side effects are significantly reduced by prescribing twice a day versus once a day. (For more information on NSAID's and lowest effective dose see here).

My Jekyll. Recovering from cruciate surgery, but on LED of Rimadyl

Case #3, The Incontinent Spayed Female Dog;
"Hey, Doc, Old Lil is leaving wet spots on her bed most mornings." For these girls I have always chosen the newer, perceived safer, PPA vs the old estrogen replacement because it is believed to have potential detrimental side effects to unborn offspring. Not such a grave concern in a spayed dog, but what about the woman who gives it to her pet and doesn't know she's pregnant. Yes, I would prefer to live without this on my regret list.



Case #4, "Hey, Doc I need more meds.."
I don't prescribe large amounts of narcotic prescription drugs. Why? Well, when the same sketchy guy comes back to your clinic weekly for more valium for his dog with storm phobias in January, "Doc, I keep spilling them in the toilet," and you get a little paranoid your stuff in on the playground poisoning your kids playmates.

My other pup, Charlie, who not only suffers from storm phobia,
but also yellow jacket phobia, and my husband dressed as a zombie.


Case #5, The Cat and the Harried Housekeeper;
I don't declaw young cats with behavioral issues, or older cats. Young cats need a back-up plan and the removal of the ends of their toes takes options off the table that they may need later in life. After all life will throw you curve balls, and life is all about keeping your options open.  I have had too many cats with "mysterious spontaneous litter box issues" develop "unwilling to tolerate any longer" parents that decide to evict and banish the declawed cat to the neighbors barn. Older cats have a tough time recovering from declawing even when it is done with a laser, post-op pain meds, and all the TLC we can deliver. It is a painful surgery and a cat with a behavioral issue becomes a pissed off painful cat with a vendetta.

Loon, surrendered for bad bathroom habits.
Now one of our residents.


Case #6, The Uni-quely Endowed Intact Dog;
I will not neuter a dog with only one descended testicle without an exploratory surgery. I have heard this being done (i.e. just removing the easy testicle you can find and calling it a day). The theory being that you save a nickel and look neutered. BUT, no ones' testicle's belong in their belly, and, this is in my opinion, more accuratley referred to as "mal-practice." Those testes are anatomically designed to be hanging low, where they are cool and left unrestricted. (Remember in elementary school when the health teacher scared the boys into wearing looser fitting shorts?) A pet with a retained testicle is called an exploratory surgery in my book. This surgery is about 4 plus times more expensive than a routine neuter. But that retained testicle will likely come back to haunt you if it is not found and removed before the pets first year. They will turn up later as a tumor in the belly. Talk about an expensive surgery, and hard lesson to learn. These cases often have a poor and grave prognosis.

For clients that are actively participating in their pets care, diagnosis, and treatment plan, the options are often varied and limitless. Ask your vet why they are recommending the options that they are? Ask about the costs, the consequences, and the amount of time your participation is expected to be? Also, ask about how the options you choose might affect future treatment options?

For those who prefer are more reserved hands-off approach you are in luck, the field of veterinary medicine is providing more and more treatment options. Ask about the differences in costs, and how to monitor best if you are not handling your pet daily?

The cost of convenience is more than just on your pocket, it is often the oversight and monitoring of the health, care and well-being of your pet.

Veterinarians are trained to treat pets. We should be prescribing treatments that put the pets condition first, but the only way a pet receives their medication s through the hands of their parents. The vehicle of delivery weighs heavy on our minds and significantly influences our treatment decisions. Talk to your vet about your abilities, concerns, and fears. We will listen.

Freeloaders.
Jangles, (in search of a home), and Loon.

If you have a pet question of any sort you can find me at Pawbly.com, where I answer any pet care related question, post photos of my pets and help others trying to navigate through the twists and turns of veterinary pet care.

Or find me on Twitter @FreePetAdvice, or even in the clinic, Jarrettsville Vet, in beautiful Harford County
Maryland.