Sunday, May 31, 2015

Facial Wounds. How to treat an eye wound as if it's your last good eye.


It might not look like a big deal,
but this wound under the left eye was infected causing Penny
to not eat and be lethargic.
It was also very very painful

This is Penny. She is a mild mannered senior girl who is true to her genetics and therefore is a bit temperamental and unforgiving if you challenge her for food. Then, in typical beagl-obsessive form she remembers she has an opinion and she growls with little forethought to potential consequence.

Such was the scenario last week. Penny growled and her housemate reminded her that she was not as quick as she thought.

Subsequently a swipe and a tooth wound up near her eye. This is not an unusual reason for a vet visit. In the trenches we call it "LDBD' or, little dog vs big dog. Penny's big problem was that she only had one eye, the other had been removed many years before. She, like all dogs who lose one eye was able to get along easily. But, it also meant that her remaining eye needed a little extra TLC to keep it healthy and maintain vision.


Almost every single bite wound ends up as an infection. If your dog gets into a fight and there is an open bleeding wound I recommend that you assume it is going to become infected and ask your vet to provide the following;
  • Clean the wound. A dirty wound, say one with gravel, or dirt should be cleaned with copious amounts of water. At the clinic we typically use a large volume syringe to flush the dirt and debris out of the wound. I know many people go directly to the hydrogen peroxide for wounds. It is not my first choice in almost any situation. Water really is the safest and easiest.
  • Only a few cleaners are safe for use around the eye. At the clinic we use dilute betadine solution. Betadine should be diluted to a light ice tea color, this is about a one part betadine to four parts water.
  • All topical antibiotics for use around the eye should be made for use in this area. Most of the over the counter topical antibiotics are not safe for around the eye.
  • An oral  antibiotic is almost always indicated. I prescribed an oral broad spectrum antibiotic with a good skin penetration.for 14 days. 
  • Pain management is indicated for at least 3-5 days. I prescribed Penny a NSAID for 7 days. (Please only use a veterinary prescribed analgesic. Many over the counter and human pain medicines are toxic to dogs).
  • An e-collars is recommended. If Penny's eye wound hurts she is very likely to rub it. One swipe of her foot and the delicate cornea can be injured. Our whole goal is to protect and minimize any possible damage to her remaining eye.

Penny's treatment plan consisted of antibiotics, pain relief, and protecting the eye. She healed quickly and without incident. Her cost of care was $167 to include all of the previously mentioned goods and services.

I write this blog with  the sole intention of helping people understand and help their pets live longer, happier, and healthier lives. If your pet is in need of help you can find a whole community of caring advocates at Pawbly.com. Pawbly is free for all to use and open to  anyone who cares about improving the lives of animals. 

If you live in the Northern Maryland area you can find me at the clinic trying to save the world in person one wet nose at a time. Jarrettsville Veterinary Center is a full service veterinary hospital with a big heart and an even bigger soul. Come by 7 days a week and say 'hello!'

I am also on Twitter @FreePetAdvice.

"I wash my hands of this cat."


Simon
This is a true story. True as I can make it and still protect the identity of the characters involved and the ironic sad truth that these scenarios happen.

The clinic we built centers around a mission of helping pets. Jarrettsville Veterinary Center provides our community with a safe place that provides exceptional medical care, and this doesn't cease when our clients can't pay, or give up being guardians. Very simply we care and are always more than a business.

Like all of us trying to live adherent to a higher calling we are challenged to follow through with our conviction when the hail storms fall. Life will dump crap on you just to see what you are made of. You aren't unlucky, you are instead being given a chance to shine amidst stormy weather.

Such was the case of our newest addition; Simon.

We had never met Simon before the day he was brought in to our clinic to be euthanized.

His story started out as many other indoor cats does. A cat like so many others who was adopted, vaccinated as a kitten, altered as a 6 month old and kept behind the doors of his family since. He was brought in to us as a middle aged tabby who had lived with his family for almost a decade.

Simon is a rather rotund soft soul who prefers to sleep sunny side up unabashedly flashing the staff unconcerned with the bustle of a busy veterinary practice.

Simon arrived in a cat carrier escorted by two sobbing women on a day when the reception area was packed. Crying clients carrying a pet in a vet clinic is the universal sign for departure over the rainbow bridge.

If we know that we have a patient coming in to be put to sleep we take great care in getting them into a quiet room quickly. Minimizing stress, strangers glances, and having to share your grief with anyone else is eliminated. Saying goodbye is never easy, but we do every single thing we can to make you and your pet feel that there is love even when there is goodbye. We didn't know Simon was a one way trip and the odd scene of a crying family eliciting and seemingly enjoying empathy from the other waiting clients was beyond disturbing. This is a job where uncommon things are common, but this scene was alarming and disconcerting. The technicians quickly found a free exam room and quickly alerted the unsuspecting vet that a euthanasia appointment had arrived.

The news of an unscheduled euthanasia for a seemingly bright, alert, and active pet quickly swept through the clinic. I walked by the exam room to take a peek at the lugubrious couple with the new arrival and the death sentence.

Two women lay on the floor sobbing as a fervent joyful feline sopped up the abundant attention doted upon him. They cried and smothered him with pats, strokes, hugs, and last sentiments of the wonderful cat he had been. It is a juxtaposing scene a veterinarian sees often, a grief stricken guardian sorrowfully pleading a good-bye that is too great to bear for any onlooker. BUT, there was Simon, happy as a lark, full bodied, well groomed, and soaking up the affection greedily.

Clearly, something was amiss with this? My curiosity and sixth sense of experience and regrets kicked in.

"What's the deal with Simon?" I asked the vet as she departed the exam room.

"He's been peeing on their laundry for a year." She replied with a sigh and disgust. "They can't afford to treat him."

"Has he ever had a urinalysis? Have they ever worked him up for a possible medical cause?" I asked. This is the usual response of a vet in these cases.

"No. They have never brought him anywhere. Never done anything about it." I could see the pain in my friends eyes. These are the cases that add nails to your coffin.

"What if we used some of the donation funds to help with the diagnostics?" I offered. I knew that keeping a pet with a family that loves them is the safest place for a pet. I would rather help a client through a financial tough spot and keep a pet in its home then try to find a new home for an adult cat. "What if we offered to pay the entire bill to get Simon the diagnostics he needed?"

"I tried that already. They just want to 'wash their hands of him.' Their words, not mine." Her face fell to the floor and the vice of a helplessness assassin replaced her normal vibrant optimism.

"What do you think?" I asked of her. I know that she was going to have to be the person who bore this burden. Working in a veterinary clinic can be a terrible place to have a conscious.

"Simon appears to be a healthy, sweet affectionate cat. I don't want to do it." She said meekly back.

"Then don't. Offer to have the cat signed over to us, and tell them to never come back. If they refuse explain to them that you don't feel right about it and walk away."

Elated and gleeful she burst out an "OK!" Her smile returned to her face.



I often feel like a parent to the staff at the clinic. That smile on her face is worth every disciplinary action of every board member reminding me that my job is to treat pets like property and comply with owner requests. The way we are asked and expected to treat the pets the law deems as property has ripple effects and consequences on us. I don't ever forget this. I stand by my patients, my staff, and the ability to help both. The law, well, that is a belief that changes with time, it is not a conscious with burdens to carry to the grave.

Simon's family left through the waiting rooms front doors wadded tissues in hand to a crowd of clients hugging and sobbing condolences of understanding and compassion. They further had the audacity to embrace every bamboozled empathetic person on the slow dramatic march out the door.

Simon's bloodwork and urinalysis confirmed he had a urinary tract infection. Like so many Pawbly questions I answer, people assume a cat is being spiteful and therefore not using the litter box, when in fact they have a real medically based problem. Poor Simon spent over a year trying to notify his family that there was a problem and their answer to him, "wash my hands of you."



I might live a long healthy robust life, but I remain steadfast in my devotion to pets and children. People, well, I just don't understand them? If I try to I feel disgusted. If I give up on them I loose my faith in humanity. Which is worse? So, I do what so many of us do. I do as much as I can for all that I can. Jarrettsville Vet remains committed to help pets in need. Thanks to the community and our friends we are able to continue to do this.


"You're welcome Simon. We love you too."

Simon is an outgoing, affectionate, charming boy. He loves everyone and everything and would make an excellent companion. He, now minus his urinary tract infection, is up for adoption at our clinic, Jarrettsville Veterinary Center, inn Jarrettsville, Maryland. We also have other pets in need of homes and we would greatly appreciate your help in spreading the word about them.

If you have pet experience that you want to share, or a pet question in need answering, you can find a group of caring knowledgeable individuals at Pawbly.com. Pawbly is free for everyone to use.

You can also find me on Twitter @FreePetAdvice.

Related blogs;

Peeing Outside the Box. The 20 Minute Cure.

Feline Marking. What is it and how to stop it.

When your Client Gives Up On Their Pet. Where do you stand? The cat and the line in the sand.


Related Pawbly questions;

How do I stop my cat from peeing on my lounge?

My cat Sally has been experiencing a lot of urination problems. What is cystitis?

Male tomcat not using the litter box anymore. Why?

I just adopted a cat from the shelter and he's scared of the litter box. What can I do?

Simon has been with us at the clinic for about 6 weeks. there has not been one single episode of him urinating outside of his litter box. He is a calm, happy, sweet boy who wants nothing more than a simple life shared with someone who loves him.

Can you imagine having your guardians "wash their hands of you" because you have an infection? Happens every single day in countless veterinary clinics around the globe. It breaks my heart.

Simon reminds me every single day that it takes so little to care but does so much when you do.


Thursday, May 21, 2015

Paralyzed Cats. When Happy Endings Meet Reality of Care

Happy endings are not as elusive as the fairy tales lead us to believe. 

Happy endings are what you make of the misfortunes that life throws you.

Faith
This is the story of Faith. She was found hit by a car unable to move from the waist down. When she was brought to me she had an obvious craggy projection from her spine and was emaciated, grateful, calm, and oh, yes, pregnant.


Faith had been rescued by a couple who wanted to make a happy ending for her happen. I am a sucker for optimism in veterinary medicine more so than any other human on the planet. It is my attempt to live in a world of real atrocities created by real people and still know that miracles exist in the small often overlooked corners of everyday life.


But, every story on its way to a happy ending has to have some bumps along the way. Faith was a list of unknowns in a list of seriously life challenging problems.

Here is how I start assessing paralysis in pets;

Breathing.
Every pet needs to be able to breathe to move oxygen throughout muscles and organs. Every accident victim needs to be calm, comfortable, and able to breathe. This is why seeing a veterinarian immediately after an accident is imperative. Pets with spinal cord damage high in the spine will die quickly as the brain can't communicate with the lungs.

Pain.
Trauma patients deserve to be managed with the plethora of pain management tools art our disposal.

Spinal cord injuries below the level of the ribs can involve the following and must be assessed;
  • Deep pain. Your veterinarian will pinch the toe hard enough to try to elicit a "deep pain response." This is often difficult to assess and should only be done by a veterinarian. Loss of deep pain is a very poor prognosis to return to function. It in most cases implies a total loss of nerve function to the limb.
  • Anal tone. A pinch with hemostats to the anus should elicit a "wink" implying that the anal sphincters are still functional and anal tone is in place. This is used to assess basic fecal continence.
  • Urinary continence is best assessed by the ability to urinate voluntarily. We monitor closely for when, how and if the pet pees without hesitation. The abdomen and bladder are gently palpated every few hours to assess that the bladder is still intact. 
  • Ambulation. A pet needs to be able to get up on four feet and walk, or a discussion about managing the paralysis needs to be had. There are pet focused carts and braces available from 
  • Quality of Life. I feel this needs to be added although the longer I practice medicine the more I realize that this is an incredibly personal heavily biased opinion. I have found that almost every pet who is beyond the point of imminent and obvious death has a strong, primal, undeniable will to live. My measure of quality of life is different than others, therefore, my perception of quality of life also varies. My pets are a lifelong obligation independent of amount of care required. As a veterinarian I know that there are options available for every ailment, every condition, and every situation. It really is merely a matter of resources and will. Quality of life is about their quality, your obligation to keep them pain free and function and their basic life's needs. 


Faith's initial needs were to allow  her time to heal from the accident. She was calm, happy, comfortable, eating, drinking and grateful for a warm bed and three square meals. Unless there is impending emergent medical treatment needed I prefer to watch and wait. A cat that is eating, drinking should be peeing within a day, and defecating within three. There should be ease in breathing and good mucous membrane color. Faith had great reluctance, trouble, and weakness in getting up, but, if you picked her up and supported her at the sternum (where the ribs end on the abdomen) her back left leg would paddle in a forward direction. She had a small glimpse of response from her brain to her back legs. She was, as so many cats are, down one life in a list of at least nine.

After my primary concerns of surviving a trauma were assuaged it was time to discuss Faith's pregnancy. She was not able to stand on her own. Her pelvis was broken  and she would likely not be able to deliver babies who may, or may not have been damaged in the trauma. I had to advise spaying her as soon as possible. It was the most harrowing feline spay I have ever done. Faith woke up having to carry half less of her morning weight.

Faith left the hospital four days later. Within weeks she could get herself up and walk a short distance.



Within six months is was apparent that her ability to urinate on her own was very unlikely. She needed to have her urine expressed at least twice daily. The long term problem with this need is that the bladder fails to empty completely with each manual palpation. This residual urine in the bladder allows for the fertilizer for urinary tract infections.

Faith also left a trail of feces without any knowledge, intent, or remorse.

She gained  considerable strength back, and was an active happy cat.



Faith's family found that her care required almost around the clock care. She went to live out her life at a cat sanctuary dedicated to providing intensive care for the most needy.

Faith's treatment plan included;

  • FeLV/FIV test $45
  • Exam $50
  • Vaccines $80
  • Spay $80
  • Intestinal parasite check $30
  • Radiograph $100 (is not always required). 


I was inspired to talk about Faith based on a recent question I received from Tracey on Pawbly.

My rescue cat is 3 yrs old, has nerve damage in tail from tiny kitten, has no control over bladder & bowels. Continuously soils himself. Lately he vomits foul vomitus, from faeces he swallows while grooming. Is it kindest to euthanise him?

I have always tried to keep him clean, bathed him etc. He has about 20 blankets which get changed continuously so he does not have to lie in his waste. But lately, he won't allow me near him to clean him and if I do get close to him he attacks me. One of my Great Danes always used to clean him, but now she doesn't seem too interested. I have tried everything, but it breaks my heart to see him trying clean himself and not succeeding especially when his stools are runny and he ingests his own faeces. Otherwise he is healthy, eats and drinks relatively well. I hoped that the nerves would regenerate and he would get some feeling back in his tail, but this never happened. He is a fighter and a survivor. He was found at about 10 days old being tossed between 2 dogs. We hand reared him. He had 2 hernias which were repaired but he nearly died during the procedure. But now I feel so sorry for him as we have other cats which climb on the bed at night, but we have to chase him off because its very difficult waking up at night with our bedding covered in faeces. I do have towels on the bed, but he chooses to lie where he wants to. It would also be impossible to use diapers as he has this really wild streak in him and will not allow us to fit it. My heart is breaking with this decision, but no matter how much it hurts me, I need to do right by him.

He was taken back at about 7 months when he was sterilized and the vet fixed 2 hernias at the same time. He nearly bled to death during the procedure, but he is a fighter and survived. I live in a rural area, so only have 1 vet close by. I haven't taken him back since then as I know they will tell me to euthanize him, but I am not sure if their reason would be for the cat's sake or mine. And all the decisions should be for the cat's sake. My vet told me when he was a kitten to euthanize him. I refused at that time

My reply;
Hello,
This is always a tough one to answer because it is based on personal opinion.
Therefore I can only answer for myself and my beliefs.
A living being in this condition requires a great deal of work, diligence and responsibility. He MUST be kept clean. Even he knows this. Allowing him to be covered in his own waste is not healthy or acceptable.
If he was kept clean it sounds to me as if you find his handicap as acceptable. I applaud this. We all have disabilities but they do not have to define us, nor do they have to be reasons to deny a chance at a life. He appears to have a strong will to live. This is how I decide when to euthanize to alleviate suffering. I do not euthanize because a living soul requires more work and effort to maintain an acceptable quality of life.
I do however agree that this kitten deserves to live a life and that at minimum someone needs to provide additional personal hygiene assistance.
This is my personal opinion. I know others would disagree.
My job as a vet is to be an advocate for the animal. That's how I define my role as a veterinarian. I am also an advocate and guardian for my pets in spite of the challenges life presents us with. If they want to live I will help them however I can for as long as I can. Compassion and kindness always come first.
Very best of luck.


Tracey's reply back;
Life is not perfect, therefore we cannot expect our pets and children to be perfect. Besides Dixie, my poor cat, we have a deaf, almost blind Great Dane and another Dane with a tail that had to be docked as it was also partially paralysed. None of these are in distress at all and have adapted to their differences. However the problem arises when the animals are suffering or perceived to be suffering by us, as how can we be sure that they are suffering. For instance, my deaf Dane does not suffer because he does not know he is different to the other dogs, but we tend to feel sorry for him and make allowances for this. The other dogs, however, do not feel sorry for him at all and therefore, do not treat him any differently as they treat each other. The same applies to Dixie, the cat. The other cats and dogs do not treat him any differently. But I can see that he does behave differently to the others, which I think is a direct result of his handicap.

My parting words;
It sounds as if you are an amazing parent. Only you know what's right based on your pet and the circumstances. It's not easy. I understand that. You can only do the best with what life hands you and try to not make selfish decisions. After that allow time to provide acceptance and forgiveness.

I write a blog about the pets and people I meet along the way of being a vet. Could I share this story? I had another patient with similar story and circumstances. I would like to write about you both. It raises important points to ponder when considering caring for a handicapped pet. I will hit use your name. I'm thinking about you and your kitty.

And PS. Vets are all too quick to recommend and provide euthanasia. We get so used to it that we forget to see each patient as an individual with their own desire to live in spite of the many obstacles they face.

Please do. Hopefully what I am going facing could help someone else in similar circumstances. Kindly send me a link to the blog once you have written it. Thank you

There are happy endings everywhere. There are also people doing amazing things for others far less fortunate with real-life challenges. This is one of the many reasons I love being able to spend everyday with animals. They will surprise, inspire, and impress you every single day.

Link to the original question can be found here at Pawbly.com

Photo courtesy of Eddie's Wheels

My favorite place for finding help for your handicapped pets is Eddie's Wheels. They make carts and equipment along with incredibly inspiring stories of animals who all have happy endings.

Photo courtesy of Eddie's Wheels
If you would like to ask, or answer a question and help an animal in need, please join  us on Pawbly.com. Pawbly is a free place dedicated to helping pets and their people.

For a personal appointment with me call me at the clinic Jarrettsville Vet in Harford County, or look me up on Twitter @FreePetAdvice

Wednesday, May 20, 2015

Finding Forever, Inspiration in a Time of Turmoil

Finley

Ten Things Your Animal Companion Wants You to Know  

1. Be faithful – To yourself, to your word, and to your commitment to me. I need to be able to trust you.

2. Be love – Surround yourself with love so you can in turn surround me with unconditional love as I do you.

3. Be clear – Before you ever bring me into your home; be clear with your intent, about what you want, and about what you intend to give back to an animal companion. Then ask yourself if you are ready to do what it takes to care for me.

Charleston
4. Be wise – Know what my needs are. Equip yourself with knowledge about what I require nutritionally, physically, mentally, emotionally and if you can…spiritually. Be creative in finding solutions outside of the traditional. And be aware that I need balance.

5. Be there – Do not bring me into your life if you cannot be there for me physically and emotionally. While I do sleep a good amount, my waking hours without you can sometimes be lonely unless I have another companion.

6. Be aware – Of how I and my needs may change as I grow older. Be cognizant of the slightest changes in my state of being. And be ready to address them holistically.

7. Be kind – Always. I have a reason for everything I do and you may not be aware of my purpose in any given moment.

Jekyll
8. Be compassionate – Your needs and desires are not more important than mine. Always remember that I have a purpose and destiny that is as important to me as yours is to you.

9. Be consistent – With feed, care, nurturing, timing. Patterns are important to me as is knowing what to expect.

10. Be the change – Be the change you want to see in the world. Speak up against abuse and neglect. Help others to change inappropriate attitudes and behaviors. Be a role model for love and compassion.

Find out more about Finding Forever A Book For A Cause

Sundae
This wonderful piece was from the amazing people at From finding forever.org

Magpie
If you love your pet and you would like to help others with their pets please join us at Pawbly.com. Pawbly is a community dedicated to helping animals around the world, and we are committed to doing this for free. Please join us today.

If you would like to follow me on Twitter I'm @FreePetAdvice. Or, I would love to meet you at the clinic, Jarrettsville Veterinary Center in Harford County Maryland.


Wednesday, May 13, 2015

My Top Ten Tips on how to convince your vet to help you even if your wallet is empty.


This is Finley, about the cutest kitten in the world.
When he broke his arm we fixed it for free.
We can afford to because we have generous vets and clients who help us so we can help others.
Accidents and illnesses happen. It is inescapable if you choose to care for other living beings. For all of us who entered the veterinary profession so that we could help animals the burden of being asked for help from those who cannot afford to pay for our services is nothing short of heart breaking. It is also omnipresent. We all realize that not having the funds to pay doesn't change the need, it only compounds the despair between those who want to care and feel helpless in doing so, and those of us who can help but feel entitled to be compensated. This leaves only bitterness on both sides left to resolve this divide.

If you are a vet you either turn a blind eye to the voice that is your conscious and you learn to accept being hardened by this reality. Or, you begin to find a way to help those in need at the expense of your debt burden.

If you are a caring person trying to help an animal in need, you too soon realize that it can be bank-breaking to continue, or even begin to try care. Or, you  find a rescue, shelter, non-profit who bridges the gap between traditional veterinary care and your growing fiscally driven indifference.

We get many questions on Pawbly from people who plea for help stating that they "can't go to the vet because they can't afford to go." I try to convince them that I am not truly trying to direct them to professional help as some sort of kick back scheme, but rather, I am trying to convince them to go because their pets life depends on it.

Some of us are students of our parents heeded warnings and have saved emergency funds for those inevitable 'rainy days'. The rest of us live by narrow margins without any wiggle room for the inevitable bumps  in life's road. Without going into a long winded commination about poor personal choices, I have to instead try to remind people that pets are living beings with complicated diseases and often involved etiologies. In almost all cases whatever is the presenting complaint is merely a tiny clue in the large pile of abnormalities that will help to unravel the mystery of the yet untitled illness. Vomiting, diarrhea, coughing, panting, lethargy, etc., are not things that reveal a disease, they are the prologue to the chapters of a diseases description that we must decipher before the last chapters of a treatment option can be read.

Is there a way to get help from the veterinarian for FREE? Much to people's disbelief I would say, "Yes!"

I am a big believer of being prepared for disaster and dark days. Much like having an emergency savings account. 'Tis much easier to ask for help when your vet knows you and believes in you. Start here. If you love your pets show your vet a little love. Those clouds loom on the other side of the horizon, have a favor lying in wait in your back pocket.

Here are some ideas on how to help you become the most valuable client to your vet and possibly convince your vet that they can't live without you even more than you can't live without them.

How can your talents might help your vet? 

1. Do you scrap book?
What about visiting the clinic every so often to take a few photos of the staffs pets? Or the special clinic pets, or even a few candid clients pets? Ask  your vet who some of their most memorable patients are and inquire to those clients if they could supply you with their favorite pet photos. Then make a photo album for waiting clients to peruse in the lobby.

A super creative client makes these cards for me to give out to staff and clients on
birthdays, special occasions, and just to say "Thanks."




2. Do you love to garden?
Maybe the flower boxes at the clinic need a little spiff up? Maybe you could volunteer to take over grounds keeping duties? I know one clinic whose local Master gardener sponsors the clinic and in return they get the best bragging rights in town.



3. Newsletter help. Love to write? 
Maybe  you could help provide content, interview a staff member, share a patient story, or help the clinic advertise their services? I would LOVE to have someone help me keep this monthly task up. I seem to always be trying to find time at the deadline to create the content for our Newsletter/blog.


4. Help spread the word on social media.
Keeping up with the daily social media Twitter and Facebook posts is sometimes impossible. Maybe you could help with posting a few happy pet videos a week? Even a

video


5. Grief Support Assistance.
Sadly, vets have to write many sympathy cards. Even more concerning is feeling like our clients who recently lost a pet have no one to lean on. Maybe you could offer assistance to help those going through the most difficult times of their lives? But all of us know what this grief feels like. And often all you have to do is just be a good listener. When I have a client who is struggling with  the loss of a companion I have a list of friends who can be there to offer support, a shoulder to lean  on, or a voice on the other end of the phone who understands and empathizes. The community of our vet practice extends beyond the hours of operation and the lives we lose along the way. It is one of the most precious parts of being able to share the love of our pets.



6. Love mowing the lawn?
I hate mowing the lawn. I would be elated to have a lawn mowing service, Or, better yet, a happy to provide a service in return client. Weeding, landscaping, even worse. There are many vets out there who would love a bit of hep in the green thumb department.

7. Decor in the clinic is a major undertaking for many vets.
We spend too much time in the exam room, or in the surgery, or even trying to . My favorite's are the paintings my mom does for the clinic. Who else would have original oil paintings as office decor that are changed out seasonally?



8. Snacks! 
Most of our days at the clinic are so busy that we often do not have time for lunch, or even a snack. We have just started to keep peanut butter, jelly, wheat bread, and salad fixings on hand everyday so that the staff can grab a quick meal on the run. We are also incredibly fortunate to have many clients who stop in with yummy snacks. One of our dear clients stops in weekly with bagels, another with muffins, and the greeting they receive when they walk in is equivalent to a ticker tape parade! It's a guarantee that we know their pets, and guaranteed the staff makes sure his pets get whatever they need whenever they need it.

9. Write an online review. Or, send a Thank-You.
We love to hear about how helping you take care of the important pets in your life feels.

10. How about forming social groups around our pets?
Dog walking expeditions, play date meetings, dog park excursions, or cat care counsels. All help to build and strengthen bonds between all of us and the pets we care for is what s central to our mission.

I still believe in the community of people that my practice is a part of. I know that my clinic's success is infinitely woven into our ability to serve each individual client and patient as someone who matters to our viability. If I don't help foster my community of caregivers I will not be able to provide care to those I started this journey in mind with. Our clinics success is measured by both our bottom line and our ability to assuage and quell that voice in our conscious that recognizes we are morally bound to help those whether or not they can afford us.

A big THANK YOU! to all of the many supporters, friends, and family that has become a part of the vision that Jarrettsville Vet has to never turn away a pet in need. Without you we couldn't help all of the pets that fill our days with purpose.

If you have an idea that has helped your vets practice please let me know. I would love to hear about it.

If you have a pet question, or pet experience that might help another pet parent, please visit us at our free pet centered platform, Pawbly.com. It is free for all to use and dedicated to assisting pets live longer healthier lives.

I can also be found on Twitter @FreePetAdvice.

Wednesday, May 6, 2015

Vet Billing Solution, Medical Bill Madness; What if human medicine was like veterinary medicine?

The following blog was written by my good friend, amazing pet advocate, and the founder of Vet  Billing, Suzanne Cannon. Vet billing provides veterinarians with third party billing option to help bridge the gap between paying the clinic in full at the time of service (which sometimes is not feasible for clients) and CareCredit (which not everyone is approved for). 

Medical bill madness: what if human medicine was like veterinary medicine?


dog doctors
Dog docs. Image courtesy http://threemilliondogs.com

Fenton’s complaint

Most recent case in point? An article written by Peter Fenton in the Washington Post on April 21, 2015, titled “Vets are too expensive, and it’s putting pets at risk.”  Mr. Fenton wrote the article after having his cat, Orangey, treated for injuries at an emergency vet clinic.  While Orangey’s injuries were minor and the treatment he received was limited to “essentials” (Mr. Fenton’s words), the cat’s 48 hour stay at the hospital resulted in a bill of $968.29.
Mr. Fenton, like many pet owners that have been in the same situation (this writer included), was shocked by the cost.  He claims that this isn’t because he doesn’t know anything about the cost of caring for pets – he and his wife have had cats for years.  What took Mr. Fenton aback was how drastically the cost of veterinary care has risen in recent years.
If there is any pet owner out there who hasn’t noticed that, raise your hand.  Yep.  I don’t see any hands.
What Mr. Fenton then set out to do was share his experience, including his outrage over the cost of emergency veterinary care (well, actually, veterinary care in general.)  However, instead of writing a piece that called for an honest exploration of the issue, Mr. Fenton instead took the path of blaming.  Maybe it’s just me, but blaming doesn’t ever seem to accomplish much, apart from inviting counterattacks.  Blaming stirs up strong emotions and knee-jerk responses.  And that is exactly what Mr. Fenton’s article did.
Mr. Fenton did a little bit of research, and based on that, arrived at the conclusion that “vet incomes are a big part of the reason for the rising costs.”  It seems that Mr. Fenton cherry-picked some statistics and quotes to substantiate this claim, and it made a lot of vets mad.  Really mad.  (If you want specifics, just read the explosion of angry responses to his article.)

Vets and income: Mr. Fenton connected the wrong dots

I’m not a vet, but I spend a lot of time working with vets, talking to them, and reading about current issues in veterinary medicine (not to mention having my animals cared for by vets.)  And I can flat tell you that rising vet costs have little to do with padding veterinarian’s wallets.  Very few veterinarians are earning money hand over fist (or paw.)  They come out of vet school with an enormous amount of debt  -  so much so that many of them accept that it will be many years before they can ever buy a house.  The average debt load for graduating vets exceeds $150,000.  Compare this to the fact that veterinarians earn far less than other medical professionals with an equivalent level of education (physicians, dentists.)¹  The mean starting salary for veterinary graduates who accepted a full-time position was just over $67,000 in 2014.
If that sounds like a boatload of money to you, divide that starting salary by the number of hours a veterinarian typically works (10 – 14+ hours a day, 60+ hours per week), and that salary turns into an hourly wage of about $23.51, or even less in some cases.  Equine vets fare the worst in terms of starting salaries, earning about $20,000 less than their companion animal colleagues.  (Still not convinced that vets aren’t getting rich at your expense? Take a peek behind the scenes at a typically long, hard, emotionally draining day in the life of a veterinarian here.  After reading this blog post by Dr. Lindsey Verlander, if you still believe that vets are “in it for the money,” then never mind – what I’m writing about here isn’t for you.)
Mr. Fenton asserts that veterinarians are charging pet owners out the wazoo for two major reasons: 1) to pay off their educational debt; and 2) to offset the inroads that online veterinary pharmacies and big box stores have made in taking revenue away from practices.  While these are two very valid concerns for today’s veterinarians, increases in veterinary costs can’t be attributed to just these two factors.  Let me throw out a much more common-sense reason for rising veterinary costs: significant technological advances in diagnostic and treatment options.

Expensive things are…well, expensive

Today’s pet owners have more choices than ever before when it comes to diagnosing and treating their furry companions’ ailments.  There are a number of medical interventions that have made the leap from human medicine to veterinary medicine.  I can name several that have become available in just the last decade or so (and this is by no means an exhaustive list:)
It seems obvious to me that advanced treatments would come with a hefty price tag -  that should be a no-brainer.  It’s also clear to me, as a dog and horse mom, that if there is a treatment out there that can save or improve the quality of my animal’s life, I am very likely going to want the option to choose that treatment.  And therein lies the rub: wantingsomething, and being able to afford that something, are two totally different things.
That’s easier to swallow though, when we’re talking about, say, a Mercedes Benz.  Just because I want a fancy car, doesn’t mean I have the money to pay for it.  And if I were to spend my time railing against Mercedes dealerships for not making their cars available at a price I can afford, I’m pretty sure I’d get laughed right off the parking lot, as well as skewered on social media.  And rightly so.  We Americans are very invested in our belief in the American Dream: in order to get what we want, we must be willing to work hard, make sacrifices, and be patient.  And we tend to get pretty irritated at those who think they deserve to get something for nothing.

If you can’t afford a Mercedes, you probably shouldn’t have a pet.  Wait – what?

This philosophy seems to work pretty well when it comes to paying for material things, like cars and clothes.  But when it comes to paying for health care — for ourselves or our family members (which for most of us, includes our pets), things start to get a little fuzzy.  And it’s all because of that powerful emotion we call love.

To really get to the heart of this, let’s pretend for a moment that human medicine is like veterinary medicine (cue Twilight Zone theme)…


Okay, okay — I’m asking you to suspend disbelief for just a little while.  And please don’t start furiously typing out a rebuttal before you’ve read this entire post — keep in mind that this section here is fiction.  I’m thanking you in advance for your patience.

You’re uninsured, but you did have an emergency fund…
So…let’s pretend that you are NOT one of the 2% of people out there who has insurance – instead you’re like the majority – uninsured. (I’m flipping the script here, so bear with me.  Only about 2% of pet parents have insurance on their pets.  See where I’m going with this?  If not, just hang on.)  Let’s also pretend that you maintain an emergency savings account, but all the funds you had in it ($2000, nothing to sneeze at) were wiped out by the fact that the transmission in your car conked out last month.  Your emergency fund today equals ZERO.

You work hard, but life is still paycheck-to-paycheck…
Let’s also assume that you are married, with two incomes.  Let’s say that you have a mortgage payment, two car payments, two children, one dog, and a host of other recurring expenses such as car insurance, a cable bill, utilities, groceries, gas, etc.  You and your spouse earn a decent living, and would be categorized as “middle class,” not “working poor.”  Still, you are like many other families with a similar financial profile, and try as you might, you end up living paycheck to paycheck because there just never seems to be enough disposable cash left over after you’ve met all your monthly obligations (including setting aside dollars for that emergency fund.)

You’re financially responsible, but things got tough when you were laid off a few years back…
Finally, let’s say that a few years back, you were laid off from your job.  You were out of work for a while, and during that time — out of necessity — a lot of expenses got charged to your credit cards.  You got behind on some payments, but once you were working again, you brought your past due accounts current, and haven’t missed a payment since.  But because you are still carrying balances on some of those cards, your debt-to-income ratio doesn’t look so good.  Not to mention those few late payments that were flagged and are now part of your credit report.

A panicked trip to the ER after an accident…
Now — Heaven forbid this should happen to any of us — but imagine that this morning, a bright sunny Saturday, your child runs out into the street after a ball, and gets hit by a car.  You rush your injured child to the ER, and immediately consent to whatever medical intervention is necessary to save his life.  Now imagine that, throughout the course of the night, your child’s condition varies, and additional procedures must be performed to ensure the optimal outcome – survival.  At each juncture, you are shown an estimate of the costs.  And each time, your eyes blur as you see the total costs rising astronomically.  The fact that you’re going to have to pay for this flitters through your mind and then vanishes, because at this moment, your emotional – not rational -  brain is engaged.  Your sole, all-consuming concern right now is the well-being of your child.

All’s well – but then there’s the bill…
Thank goodness your child survives his injuries, and is eventually deemed ready for discharge.  As you await discharge instructions, it comes time to pay your bill.  When you see the total amount due, you feel queasy and suddenly the room starts to spin.  You owe the hospital $100,000.  But you don’t have $100,000.  And you don’t have credit cards to charge to — because you’re still paying them off from when you were out of work.  Even if that weren’t the case, your measly credit limit of $5000 wouldn’t help, anyway.

The sympathetic patient care representative sees that you are distressed by the bill, and tells you not to worry – the hospital works with a company that will allow you to make payments over time.  She tells you that she just needs you to complete a short application form, and that you will likely be approved for a payment plan within a few minutes.  Relief washes over you with such force that you feel like your legs are going to buckle.

Saved by a medical credit card, right?  Nope…
A few minutes later, the patient care representative returns with a look on her face that tells you something is wrong.  “I’m sorry,” she says, “but you weren’t approved for a payment plan.  As you know, you’re responsible for paying your entire balance in full at the time of your family member’s discharge.  Is there someone you can call, who can help you make this payment?”

Well, no, there isn’t.  There isn’t anyone in your extended family who can just cough up $100,000.  And most of your friends are in the same financial boat as you are — they don’t have a glut of extra cash available at a moment’s notice.  Not to mention the embarrassment you would feel, calling up a friend and asking for money.  There’s really only one option that’s feasible for you: making payments.  It might take you a loooong time to pay this bill off, but that doesn’t really matter to you – your child is going home with you in one piece, and if making payments is what you have to do, you will do it.  If you temporarily have to work more hours or take on a second job, that’s OK.  You’ll find a way to make those payments.

But making payments isn’t an option…
You explain all of this to the patient care representative, who listens with a sympathetic ear.  She seems truly upset when she has to tell you that the hospital doesn’t make payment arrangements.  They’re not able to provide billing services – they simply don’t have the administrative manpower to manage it.  Besides, she tells you, since you weren’t approved for a payment plan through the third-party financing company the hospital uses, it means – and she says this as gently as possible – you’re not a good credit risk.  The hospital is, after all, a business.  If they gave a payment plan to everyone who needed it, she says, they would have to close their doors, and then they wouldn’t be there to help children like yours.

Hamstrung.
You and the patient care representative stare at each other in silence. Neither one of you knows where to go from here.  You’re doing your best, she’s doing her best.  You want to pay your bill, but you just don’t have all that money right now, today.  You need a way to pay.  The patient care rep wants you to pay your bill, too.  But she doesn’t have any other options to offer you.  You’re both stuck.

Left with no alternatives, you only have two choices, and they’re equally horrendous and unimaginable:  1) Euthanize.  2) Turn your child over to a welfare agency.

I can only guess at the number of times this kind of scenario plays out at veterinary hospitals – particularly emergency facilities.  I know it’s frequent – I’ve read more than my share of horror stories on this topic, written by both vets and pet owners.  Mostly, they just lash out at each other and call each other names.  Both sides want to deny that they play a role in perpetuating the problem.  Sometimes I feel that neither party wants a solution, because it’s somehow more emotionally satisfying to engage in verbal warfare.  Well, I think that’s a cop-out.

Pet owners and payment: when $5000 might as well be $100,000

Vets, you need to understand that most pet parents are a lot like the human parent I described in the fable above.  They see their pets as children, and they love them as fiercely as they do their human kids.  When you complain about us and tell us that we shouldn’t get upset because veterinary medicine is so much cheaper than human medicine — well, do you really expect us to do a happy dance because a $5000 veterinary surgery would cost ten times more if it were for a human?
That’s why the figure I used in my little story was $100,000.  It seems ridiculous, doesn’t it, to expect someone to be able to come up with $100,000 at the drop of a hat.  But for many, many pet parents, there isn’t really any difference between $5000 and $100,000.  Their vet bill might as well be $100,000, because they just don’t have all that money TODAY.  You can tell us what a bargain our vet bill is – compared to a human doctor bill – until the cows come home.  We still don’t have the $5000.  Sometimes it really IS about the money.  A LOT of times it really is about the money.  And it’s not because we don’t want to pay you.  It’s because we don’t have a feasible way to pay you, that you will accept.
So – if you don’t want pet parents to apply the human medical insurance payment model (where the only out-of-pocket cost is an affordable co-pay) to veterinary medicine  — stop beating us over the head with the mantra, “but it’s cheaper than human medicine!” You’re taking us right back to an erroneous comparison.  It’s the old apples and oranges thing — and it applies to both sides in this argument.

Unless you’re Donald Trump, stay away from having kids or pets – you can’t afford them

The other thing I hear/read from (angry) vets is that “having a pet is a luxury.  If you can’t afford to care for your pet, you shouldn’t have one!”  Well, I’ve addressed this in earlier blogs, but I don’t think it hurts to repeat myself on this.  That argument takes us down the proverbial slippery slope.  How many people can afford children, for the love of Pete?  I mean really, really afford them?  Are we going to become a society that prohibits people from having pets (or children) based on their income, or their credit score?  Are we going to penalize parents – pet or human – for not being able to foresee every possible disaster that might befall their kids, and for not having the money set aside to pay for all of these possible disasters in advance?

Pet insurance and back to Mr. Fenton – remember him?

Let me assure you that what I’m saying here is NOT intended to give pet parents a pass on educating themselves about the costs and responsibilities of pet ownership.  Pet parents, emergencies CAN and DO happen.  Don’t live in a bubble, thinking that your dog is never going to eat your trash and need an emergency gastrotomy.  Don’t think that your cat won’t get blocked, or will never get in a tussle with the neighbor’s dog (or cat or raccoon) because “he never goes outside anyway.”  Indoor cats do get out.  The most conscientious dog moms forget to put the trash out (me.)  Anything can happen.  Anything DOES happen. And when it does, and your veterinarian saves your animal’s life, he or she deserves to be paid.  So…
Please, please look into pet insurance.  Right now it’s really the only viable way to protect yourself from incurring a catastrophic financial injury along with your pet’s injury or illness. There are many more options than there used to be.  Many plans offer a fairly low monthly premium payment.  Ask your veterinarian – or anyone on their staff – who they use, and/or who they recommend.  The client care representatives at my own vet have been more than happy to share that information with me – who their insurer is, the amount of their monthly premium and deductible, the scary vet bill amount that they submitted a claim for, and what the turnaround time was for reimbursement.
And back to Mr. Fenton.  Remember him, about 3000 words ago? (Lol.)  I really wish he had used his experience tofacilitate an honest, open dialogue about veterinary costs, instead of making the chasm between vets and pet parents even bigger, by pointing the finger of blame at vets, and at the same time telling his readers that pet insurance is “rarely worth the price.” (WRONG.  If you don’t believe me, let me tell you how many times my schnauzers developed acute pancreatitis on a weekend, and how much it cost.)

Can we talk?

There’s already more than enough misunderstanding to go around.  Let’s stop fighting over the cost of vet care, and instead start talking about ways to realistically deal with it.  Both vets and pet owners have a role to play here.  This isn’t going to be easy, and this issue isn’t going to go away.  At VetBilling.com, we’re doing our part to contribute to the solution, but our efforts alone can’t fix this.  Ignoring the problem, or railing against it, doesn’t do anyone any good.  Especially our pets.  And please, remember that the most important thing vets and pet owners have in common is just that — ourpets.  We love them.  Let’s start from there.
Doggie Love

¹For comparison to veterinary salaries:  According to a 2010 survey by the American Dental Association, the average annual salary for dentists under age 35 was $178,470.  At that time, 54.8% of dentists reported that they worked between 30 and 39 hrs/wk.  Only 6% of respondents worked more than 50 hrs/wk.  By contrast, 1 in 3 (33%) of vets work more than 50 hrs/wk, often including weekends and holidays.  I was unable to find more recent statistics on dental salaries and hours worked.

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About VetBilling.com:

VetBilling.com was launched specifically in response to the rising cost of veterinary care.  It is our sincere hope that the alternative payment plan option that we offer to both pet owners and veterinarians will ease the tension surrounding the cost of veterinary care.  Our overarching mission is to end economic euthanasia and shelter surrenders that are due to cost.  We hope that by giving pet owners a reliable, systematic way to pay their vets, fewer beloved pets will have to be put down or sent to a shelter.  For vets, we provide all the support necessary to enable them to successfully implement our payment plan program. To maximize the potential for success, our payment plans are based on a signed contract, and payments are set up as automatic withdrawals from the pet owner’s checking, savings or credit/debit card account.  VetBilling.com handles every single administrative detail of these payment plans.  Our primary objectives are to keep pet owners on track with their payments, while simultaneously treating them with respect and compassion.  It is of utmost importance to us to protect and preserve the client-practice bond. 
There is no cost to the vet practice to offer our plans – vets receive 100% of their treatment fee.  There are no minimums, no monthly fees, and no payment plan is ever declined by VetBilling.com.
To learn more, please contact Bobbie Luterman (bobbiel@ebcs-solutions.com) or Suzanne Cannon (suzannec@ebcs-solutions.com), or call us between 9 am and 6pm Eastern at 800-766-1918 FREE.
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If you have a pet concern that you would like me to evaluate you can find me at the clinic, at Jarrettsville Vet in Jarrettsville Maryland. Or find me on Twitter @FreePetAdvice.