Saturday, October 21, 2017

Remembering the Vet Who Inspired Me Most. My Grateful Farewell to Dr Stephen Barsanti.

We never walk alone.

The building and shaping of a veterinarian is a collage. A little bit of pieces you borrow, collect, and compose from the others around you. While I know that compassion is the force that pulls you toward the journey of amassing the degree to publicly share your trade, the essence of who you are once you get there is made of little pieces of the peregrination you walk to that place where paper represents your destination.

There are mentors who come in all sizes and shapes, often in obscure and unintentional places or events. I was always that little girl..

The little girl who sought solace and comfort inside the calling of being alone with the animals. There was not ever another calling. When you are little and compelled it can feel lonely. I didn't have much guidance and veterinary medicine wasn't one of the options that met parental consent for "career" criteria. It was someone else's opinion and it drove too many decisions that my vote never counted for.

Then I started to try to spread my wings. As every resourceful child knows, false pretense can provide parental neglect and opportune access.

My childhood vet was Alton Veterinary Clinic, in a very small town by the bucolic Lake Winnipesaukee of New Hampshire. My parents had left the suburbs of Long Island to live the picturesque New England life. Again, it was not the postcard life I had ever contemplated. The singular exception to benefit my new quiet boring existence was the addition of having pets. In short order of buying land, old salt box home and a barn they acquired a horse, a dog, a cat, and a sheep. It was also the same time that I found Dr James Herriotts books for companionship. If divine intervention existed this was my beacon of hope to survive the winters even bird brained geese knew to flee from.

When the small town vet, of the newly minted Alton Veterinary Center, had their first child the opportunity to increase the veterinary staff from 3; Dr Stephen Barsanti, veterinarian, hospital receptionist, his wife Sherri, (who in short order became my second mom), and vet tech assistant, grew to 4, which now included a babysitter. I knew that this was my chance to get inside the building for longer than a nosy clients kids visit.

If you could time your transit to school by the Alton Veterinary Center (which was conveniently and tiny NH small town apropos two blocks down from the intersection of school and main streets) accordingly you could get front row unobstructed seats to the big picture window that faced the street for the weekday lunchtime cinema. Surgery!

That big flat glass window shielded me from where I knew the heart of the practice lay. That big multi-paned window, obscured from the neck down with a gossamer veil to keep the patients innards clandestine, was the peep hole to all the secrets of the magic that I longed to be elbow deep in. With the coveted title of "vet assistant" newly donned I was now allowed the back stage pass to see the innards in person, finally! Day by day I was lucky enough to be tolerated as the shy, intrigued, girl who got to spend lunchtimes, babysitting breaks, and eventually anytime I could sneak away from the banal obligatory school days. My earliest happy memories were those covered in smelly dogs, porcupine tatted pups, and Primo the parrot who barked when the afraid cat was the the adjacent exam room, or the pathetic meow when the hound was. That little home on corner was my utopia incarnate. I lived Dr Herriott's life for only that short time with Dr Barsanti. It was the magic of my adolescence and the compass to my lifelong path.

Dr Stephen Barsanti was the epitome of every professional veterinary battle we have forgotten to cherish. He was kind to everyone. He was sincerely compassionate. He was also inherently humble and generous to everyone and everything. He answered every 2 am call with a plan absent of an estimate. He was who I will spend my whole life trying to be more like. There are vets who leave two page obits in the veterinary professional rags, and there are vets like Steve who quietly walk out of a world they made a real tangible meaningful difference in. Not just in alleviating the suffering of their four legged patients, but in the hearts and souls of the communities they humbly served. The small town heroes who shaped lives, provided a foundation for dreamers, and passed on a legacy far beyond buildings, bank accounts, and honorary accolades.

Thank you to the whole Barsanti for sharing Steve with me during every Monday through Friday matinee surgery. On every 2 am cold downed horse call-out, and to a little girl lost in her own place in a world few others understood.  I will miss that smile of his, that charm destined to be much bigger than a baby blue off buttoned attendee shirt, and that laugh where any reality was not an impossibility.

Related blogs; Alton Veterinary Clinic

me, steve, diedra
Post script; I spent the day at home today after a long troubled interrupted sleep. Diedra's 15 year old rescue needed an emergency cholecystectomy (gall bladder removal) surgery yesterday. It was not a surgery I had ever done before, but her condition was grave and it was either jump in and try or surrender your patient to a possibly treatable disease. I always think of Steve in these cases. How he would have encouraged me to never be afraid. To always be the veterinarian I had dreamt of becoming. If I could diagnose it, and there was a possibility, you jump in. You never learn or grow otherwise. I know he would have been proud of me yesterday. I know he would have been singing praises regardless of the patient outcome. I know above all that there is grace in compassion and that it can be passed on beyond our days on earth.

Monday, October 16, 2017

Canine Pyometra. The Dog Edition. What You Need To Know To Get Your Dog Out Alive. Cost, Options, Advice. (warning surgery photos included)

Shyyann,, this is her pyo story
This is Shyyann. She came to see me on a Sunday afternoon. She had left the ER about an hour before where it was determined by an ultrasound that she had an infection in her uterus. She is 10 plus years old, the light of her dads life, and about the sweetest, kindest, gentlest girl you have ever met.

As with every single appointment, I get a brief synopsis from the technician who takes the vitals, documents the history and provides me a brief description of all of this along with the presenting concern. This day, it was Laura reporting Shyyann's story to me.

"They saw your video. She has a pyo. Everyone in the room is crying. She's a pittie. A really nice pittie. They are afraid you are going to tell them to put her to sleep. I don't know if they are here for a second opinion or to euthanize?"

She knows me as well as I know her. Laura dropped every hint she knew was important. She was smitten by this dog, and had great hope for Shyyann. She is my calm to the storms I too often find myself lost in. She is a big part of the reason I still hope and always try. I walk in the room.. as I always do.. ready to fight a war and looking for troops to enlist.

Thick hemorrhagic purulent (blood and puss) discharge.

Shyyann's estimate for her pyometra surgery was $2500. (Based on this estimate I know where she came from. Lately I am seeing pyo referral estimates ranging from $2,000 to $5,500). Through tears from her mom, (who just had a baby a few weeks ago), she said "we just don't have that kind of money. We don't have half of that."

What they did have, that one special thing that they all have, is a story. A story of a family who loved their dog. If you have that, if you can start there, you can make miracles happen. It is not about how much money, it is about how deep the love lies. It is where Laura and I, and the rest of the staff at JVC, reside.

Shyyann was sick. There was no doubt. She was depressed, weak, and tired. She hadn't eaten in two days, had been sick for weeks, and had been given a diagnosis devoid of one stitch of any kind of treatment to help her. I find that one simple act of omission an all too common theme. Don't use resources on anything before a mutually acceptable AND affordable treatment plan is in place! Especially when the diagnosis is acutely obvious. In the new age of "standard of care" we are forgetting to be resourceful. We are forgetting that our patients are OURS to be collectively responsible for. I hope we get ourselves back to the foundations of care. I also hope people can get drive-thru fluid therapy clinics if the primary care vets don't give them at least that. That one little act of $80 bucks (subcutaneous fluids and antibiotics) at my clinic can buy precious time and countless lives.

We cannot forget to treat while we collect scant resources and diagnose.

Shyyann, her family, and I had a long hard talk. Here's how I see it; she needs help immediately. The soonest I can get her this help is tomorrow morning. It will cost about $1,000. She is not the best surgical candidate. But that is the best I can do. I can give her fluids and antibiotics to try to help get her through the night. We talked payment plans, options, and faith.

Everyone left with a plan, and Shyyann's family left with hope. You can never steal that from someone. It will break them. It will ripple forward in ways you cannot imagine.

Here is Shyyann's surgery.

Distended angry uterus.

Think it didn't look big in the photo above?
50 pound Shyyann minus her 4.5 pound uterus

The surgery is done.

Waking up

Resting after recovery

The video of a prior pyometra surgery.. the message is always the same. Spay now, avoid the pyo later. 

So why don't people spay?

  • They cannot afford it. Please ask your vet, shelter, rescues for assistance in finding low cost options. Or, start saving. At Jarrettsville Vet we have Pre-Payment Plans to help.
  • They are afraid of anesthesia. Pre-existing conditions like heart murmurs, small pets, prior anesthetic adverse events, the list of reasons to be afraid shouldn't put your pets health in jeopardy.
  • You didn't realize that a pyometra could happen. (I hear this every single day!)

Here is what Shyyann's bill looked like at JVC is about saving lives, and providing options with data. Let the data set the standard of care and integrity via transparency be the guide.

If you care about pets, believe in making happy endings happen, and want to help others please join me on our Jarrettsville Vet Facebook page, our Pawbly Facebook page,and also on Twitter and YouTube.

Sunday, October 15, 2017

1:15 pyometras left this ER alive..

I asked people to share their pet care stories with me,, and oh my goodness, did I ever get them! The stories that have been forwarded about pet parents experiences in veterinary clinics, ER's and the treatment they and their pets have been given has crossed every single scenario about everything imaginable in between. Most are sad and very disheartening. This is a part of the current state of my profession.

I work as a vet assistant at an emergency vet clinic in XXXX. I find it very heartbreaking every time I have to tell someone who can't afford our services how much it would cost to test their pet! At our clinic our exam fee is $69.00 (just the physical), radiographs are $190, complete bloodwork is $160 and a parvo test is $70; that is just a start. Where I work all payments are due in full at the time of service no exceptions! If the pet needs surgery or hospitalization it is around $1000!! In the over 1 1/2 years I have worked here (using pyometra) I have only seen one survive (1 out of 15) and all the others have been euthanized.  What my employers have told me is the the reason why the policy is in place is because our clinic has been "used and abused" and people will walk out without paying their bill! I simply find this hard to believe. I wish that there was something I could do. One of the problems is that the clinic I work at is owned by ALL the veterinarians in the county (so they can get the weekends, evenings and holidays off).  At some points I wish I could quit my job because I am tired of the heart break from watching pets go without care or very little care because the owners can't afford anything better!

These are the statistics the veterinary profession is striving so hard to disregard, excuse and shift the light from. We try so hard to maintain our public persona of being "the trusted healthcare provider for your four legged family," yet we cannot hear, acknowledge, or accept the pleas, cries, and heartbreak from those we have abandoned? We don't want these testimonies made public. These are opportunities lost. These are part of the greater divide leading to skepticism and divisiveness. These are our patients lives, our clients grief, and significant part of the swell of tragedies on both sides of the exam room table. This is how we got here. Stop blaming, stop shaming, start talking.. even if it is uncomfortable in the exam room for that 5 minutes before the fate on the wall is written and sealed.

I am going to do A LOT of talking about pyometras. I have to. I have to because stories like the one above are happening at a proportional skyrocketing rate and no one is telling people they have options. That, that my friends is.. (well, I stated it clearly in my video),,, that, as a private practitioner to a community we have served for over 60 years is called killing our patients. Every night I fall asleep I wonder how many I won't wake to in the morning?

More than 1 in 15 pyometras is NOT what I see in private practice. In fact in 12 years, with (approximately) three times as many cases, I have lost 1. One in 45. That dog was euthanized because she was comatose at arrival and needed overnight care her family could not afford. She deserved better. She waited over a week before she came from two states away to find me. One in 15 happens because people are scared and vets don't offer it another way. Try! For GODS SAKE try! Try fluids, antibiotics, TRY EVERYTHING BEFORE EUTHANASIA. Let's see what the statistics look like after that motto of "compassion before euthanasia" is the cornerstone of our practice in practice.

There ARE ALWAYS (ALWAYS!!) options. Until these options are given to every single case I am going to keep talking. Here is where I will start.

Say the following instead;
YES! To fluids!
YES! To antibiotics!
And, yes, to finding a vet you can afford, who won't use words that revolve around anything else but giving you and your dog the help they need to try to recover from this infection. Help in understanding there are options, and that you have choices, and your  deserves a chance.

We, the veterinary profession, have compiled every single marketing brochure with a cute puppy or kitten being coddled by a smiling white coated stethoscope draped professional all beaming glee front and center. This is the persona we pitch. The stories that have been sent to me are far from what we lobby ourselves as. We pitch ourselves as the hands of healing and compassion and yet the public has become weary of our lured commercials. To many the profession has become an over priced commodity only sought when disaster meets impending death. The educational obligation we have to our clients cannot be over emphasized.

Where to go from here? Just say NO TO EUTHANASIA and YES TO EVERYTHING ELSE!

Recently I have been flooded with requests for pyometra consults. At every single one of these meetings I ask if the client was "ever told this might happen if they didn't spay their dog?". Every single one of them have all said "No, I didn't know this could happen, and I certainly had no idea it would be this expensive." Most thought the vet profession was recommending spaying and neutering as a part of  our revenue generating income stream. A compulsory line item equivalent to the vaccines, preventatives, and dental cleanings we propose as being 'needed' while they heard "optional". We are not informing clients as to why these items are vital to our patients health and longevity. And, if we are in some small ancillary footnote, we are not providing these with data, written take home explanations that we know to be true as our own real-life previous horror stories that a previous client learned the hard way. We know these cases, we have lived through them. Why not use these experiences as a pay-it -forward exchange? Why to are we not also giving estimates for procedures now and later? A real-life tangible cost risk analyses. "It will cost you $250 to spay now, or, $2,000 to spay a pyometra later. Either way, there will be a spay involved." We say this to ourselves, don't we? We have no hesitation asking clients to sign a medical release that places blame back on them when they go "against our medical advice" and leave the clinic without medications, hospitalizations, and follow up specialist consults, but, why not with the more routine day to day omissions? Do I lose clients over my hard sells and case based experience? Absolutely! I absolutely am much more concerned about my patients health than my clients liking me. They may question whether I am trying to up-sell them, but I put my experience into my practice and they can't turn around later and not say that "I didn't tell them this wasn't a possibility." Further, I put my money where my mouth is. Every client has the ability to pay forward for care, use third party billing, and in some cases I will give the client a break, or the product on the house. This marketing scheme is written into every manufacturer contract I sign, it is also provided with an in-clinic resource guide for clients with financial constraints.

I know the reply from veterinarians ready to jump and attack this blog. I know their defensive tone deaf ears and accusatory vitriol to these stories is all the same. Blame, shame, and excuse the heartbreak. We tell them and each other that "it is their fault. Theirs alone." It is not. Let the stories prove this to be wrong. We have yet to stand up to our accusers and provide culpability.

Clients are not given options based on numbers. All made available at the initial consult. Every single option given and then let the client decide. Veterinary medicine does not provide enough transparency. And the numbers don't lie. Give them prices, choices, and prognoses ALL UP FRONT.

Where are those numbers? Want to argue with your credibility intact? "SHOW THEM THE NUMBERS! Not just your own, show them mine too. Tell them that my clinic provides 90 (plus) % survival rate at $1100, and then give them yours. Let them decide what to do with their family members life. is about saving lives, and providing options with data. Let the data set the standard of care and integrity via transparency be the guide.

If you care about pets, believe in making happy endings happen, and want to help others please join me on our Jarrettsville Vet Facebook page, our Pawbly Facebook page,and also on Twitter and YouTube.

Sunday, October 1, 2017

K.I. S.S.

K.I.S.S = Keep It Simple Stupid. Something every vet learns in vet school.

So here it goes;

You either represent the establishment or the individual, 
if you are a caregiver the answer should be obvious.

Tori Star, surrendered at the shelter by a former client.
The shleter called us we brought her back to live at the clinic.
If you are a part of our family once you are a part of it always.