The Question

I think that I might have over extended?

If you asked me if I was willing to sacrifice every second of my own life for my pets I would, without hesitation, say yes. If you asked me to multiply that by our current veterinary clinic caseload I would ask for a few minutes to do the math so I could get a better idea of the scope of this question, and say,, (increasingly tentatively),,, umm,,, maybe? 

I cancelled my summer vacation this year. I cancelled last summers vacation this same time last year. I now live and work in a groundhog day recycling of 5 days on and 2 days off. The first of these days off is spent either cleaning litter boxes or sleeping. Typically sleeping then litter boxes. I have to do both, and I cannot muster the strength to do anything else. Never a wish for plans that would include me to be at my best and/or ready to slay another obstacle. It seems impossible to meet the demands of other peoples pet needs and take time off. Which, yes, I do recognize is the self-fulfilling recipe to my own demise. Please don’t tell me you told me so, or, rub my nose in it. 

In an appointment yesterday a client reminded me that he has been coming here for 20 years. He asked me if I was still working the same schedule? When I replied yes he reminded me that I couldn’t manage it back then either. I’m not sure if he was finding comfort in my consistency. A way to hold time still when the rest of the world, and the life we live within it, is rushing by. Or, if it was a gentle reminder that life is rushing by and I am not evolving, or, participating in witnessing it.

Dasa. Reminding me to take a minute and inspect before you open your mouth.

The question has its own problem. If I recognize how important and influential my pets are in my own life how do I ignore this in someone else’s life? How do I dismiss the blocked cat with $200 for the care it needs. The same cat who has never had veterinary care and a young girl crying beside it? I was once that young girl. Thank goodness my little small town vet had mercy on both our souls. He never made my families pets about our families failures,, and we had a lot of them. 

Did I ever tell you about our border collies and the porcupines? The number of times they would run off and return with a face full of quills? How my dad would insist they go to the vet at 10 pm so he wouldn’t have to deal with their crying all night? The pregnancies, twice, because we were too cheap to spay? And the dogs that ran away never to be seen again. Maybe all of this overworking now is to an effort to compensate for our prior offenses? Deal with the trauma of being an utter failure at basic pet care in my childhood.

Before you get all, “I’ve got all the answers for you uppity there’s absolutely no where else for these people, this cat, to go. Further, all of these (yes, damn it I am using the word ALL), are treatable. These cats, last stop missions, are my purpose. I just wish I didn’t feel so alone within them. (Tired, I should also add tired). 

Dr Barsanti and Dr Applefeld were my mentors. Old guys who were in vet school in the 70’s and both old school. They built a practice in a community they spent their entire career in. Their success was only possible because their community valued and trusted them. I learned more about running a business based on ethics and long term dedication from them. When I was in vet school I worked at a very busy, very profitable practice in southern Maryland. The owner had just bought the practice from his mentor. He was stressed and fiscally focused. A cat was found in need of medical help. The finder brought the cat in for help but could not afford the care it needed. He took it and told her he would take care of her. The staff was so excited to be able to help this kitten. They made her a super adorable bedded cage and snuggled her all day. At the end of the day he euthanized her without telling anyone. It was a cruel power play of insecurity and deceit. I left the next morning. He is still a miserable miser and everyone knows that he only cares about money. He and I will die within the walls of our clinics but I will carry the lessons all of these mentors taught me to my own exit having never seeing a patient as a burden.

Cookie.. who I would absolutely do anything for.

Maybe the question isn’t what I am doing wrong now, but how I see myself as still doing good whilst doing something else? Can I ever remove one part of this person from the other? The one that has 1 day to do and be anything else and still just sits at home petting my cats.

Fripp who encourages me to sleep in a little longer.

The Widows Walk

 Most days i feel like i am suffocating under the weight of this.

This dream of ownership that is the steel cage around my drowning body. The iron coffin pulling you into the depths of darkness where no one hears your screams. Alone. The other insulation of inexplicable despair.

I have made a pledge to not abandon my ship, even when I am the one sabotaging its own sea-worthiness. The widowed bride on the widows walk searching for a shadow on the horizon we secretly know will never manifest. The hope for a tomorrow brighter than today keeps our feet circling the nest night after night. I have no exit. No place to leave this ship that is a safe port. I can abandon her and let the pirates strip her for piece parts. Peel away her purpose in tiny mouse nibbles. The death of the whale at sea. The matriarch who wears herself so thin she cannot find a place to die peacefully or with grace. Recycled in carbon molecules invisible to any being that still possesses intentions.

I know why people walk away. Shutter the windows and doors. Exhausted and mute. 

At least my hair is clean today. It won’t look so obvious=. I wont have to try so hard to hide it. 

How does this dream become your nightmare? Like every other nightmare, you cannot wake up from it to shake it back into the recesses or replace it with a dream to begin in its place.

The Dilemma Of A Bite

What do you do when you get bitten by a dog?

I get this question about once a year. 

Today the question came from a friend via a phone call. He explained that he was just out walking by himself, minding his own business. He walked by a dog on a leash and the dog jumped at him and bit him on the leg. He did nothing to provoke it. He didn't pause, or turn, or make any gestures. He wasn’t talking to the dog or the owner. The dog was on a leash. He was just walking by.  After the dog bit him another person who witnessed the incident came up to him and told him that the dog had previously also bitten that same dog. 

He called me shortly after. " I don't know what to do?"

Every bite has a cause. A dog is as complicated and unique as any of us. They bite for a whole host of reasons. The secret is to unpack whatever is causing them to think that a defensive action is the appropriate response to a stimuli. The question is why do some of us react to a stressful, or fearful experience and decide to act upon it with a dangerous response?

The question is what do you do when you are bitten by a dog and what does the person responsible for that dog need to consider?

When I am talking to a client about a bite every veterinarian is always going worry about rabies because rabies is 100% fatal. So if a client comes to me and says I got bit by a dog or you know. My first piece of advice is to treat it as you would a car accident. 

1. Make sure everyone is ok. Call the police if there is an injury that might be considered severe, or life threatening. If you do not think it is life threatening seek medical care as soon as able. Be warned every animal bite will be mandatory for the medical provider to report it.

2. Collect information from everyone involved. You should get a picture of their id. Exchange each others information. Should this be something require legal action you will need that information for insurance, etc.

Most of the bite cases that I hear about come to see me typically because their dog got in a dog fight with another dog/animal and then the owner jumped in the middle and they were bitten inadvertently.

The difficulty is that once the police get involved lots of things can happen that people are not prepared for. One of them is that if this dog has any previous bite histories then the law can step in. I have been given a court order before to euthanize a dog for excessive bite history. The pet parent had fought in court to try to save her dog. She fought hard. She lost. Her dog had to be put down. I struggled with the decision. The reality was that this dog was going to be put down regardless of how much it crushes me to euthanize a healthy animal. If I didn't do it the shelter would. His mom couldn't be with him there. He would be scared and they would not handle him the same way we could. We sedated him calmly and peacefully and we all sat around him on a big blanket in the back field where he was peaceful. It was awful but,, well,,,, it was the least awful I could make it. This has played out 3 times in my career. There are times where I want to surrender my euthanasia license to save a piece of my soul that struggles so hard.

I believe that there are no "bad dogs" there are dogs who are desperately uncomfortable and do not know how to react appropriately when they are stressed. This case, like all of them, had warning signs. The worst cases of bites are when pet parents try to manage the situations by blaming others, or changing the environment to try to avoid a trigger. The problem is that the triggers change and evolve, and a dog who will react with aggression will likely do that for other scenarios and situations you cannot foresee. The other issue is that not every bite is going to happen on an adult in an area that is not visible. I have seen people have their faces bitten. Their nose or mouth removed. Requiring years of surgeries. I have also know of  examples where children and adults did not survive.

I always talk to people about that. I have to ask; what are you prepared to do? Sometimes my own dog has been on the leash and growled at another dog passing by and then the other dog responded with the same kind of tough-guy attitude. Then I get myself in the middle of it by reminding him to not be such a jerk. He is always on a short leash right beside me, and, I am always watching him. If there was a dog off-leash who acted like he does, came over to us with the same big-dog-sassy attitude, I am sure I would end up in the middle of a dog fight. He is just an insecure moron about some other dogs. I will never fully trust him and he is never allowed off leash because of this. I am his mom and I have to face the fact that in his head he thinks it is appropriate to be defensive and protective.  But in your case, you weren’t doing anything and a dog bit you. There was something that happened in that dogs' head but the problem is you didn’t illicit it. You weren’t one of those obnoxious people that walks up to a dog and sticks your you know, hands and face in their face and kind of violates their privacy just assuming that every dog is happy to meet a total stranger who oversteps their presumed welcome. You were just walking along. So the difficulty for me with your scenario is that if this was completely unprovoked and you already know somebody else has been injured then you probably have a responsibility as a citizen to report it because although you didn’t get hurt, you’re also a big strong, healthy guy and you’re not a child who you know might’ve really had significant injuries. I always kind of start with what’s the worst case scenario how would I feel if I didn’t address the worst case scenario? We all also have a civic responsibility to other people in the community.

"I know who this person is," he said.

.... wait what? 

"You know the person you know the person with the dog?" He did. They are a friend of a friend.

Then I would say the best case scenario is to start with the olive branch right like this visit at the end of the day is a dog who’s struggling with something right and if this is a responsible owner and I really am happy to talk to her. She needs to understand that her dog is struggling with something and she’s ultimately responsible for it and if she doesn’t address it, the court is going to step in and she will have to literally flee the state she will she will she will be given a court order to have that dog euthanized. They probably won’t cross state lines, but that’s what she’s gonna have to do and that’s what people have done and I’m not saying that’s what you should do but that’s what has to happen. She needs to understand that her dog is struggling with something and doesn’t know how to deal with it and is redirecting that aggression on somebody else if that means that she medicate her dog while she goes into training and that dog never leaves the house without a muzzle on. She should also have a vest put on it that says "do not approach, in training." Something that gives a visible warning. Then that dog is never let outside without a muzzle on. She can get a basket muzzle, which is not difficult or prohibitive with their ability to pant, eat and drink, but she needs to do something or she is one going to have to put her dog down. That will go on her record and she may not ever be able to adopt a dog again.

"Thank you."

People get defensive,, but there is a problem. And it will repeat and someone will be hurt. 

Disclaimer time. I am not a lawyer or behaviorist. This is my opinion based on decades of vetmed.

Photos above are the dogs of the Ukraine. I still think about them, and that place, every single day.

Pyometra Pricing Service List

I used chat GPT to find anyone who posts the price of a pyometra at their clinic.

The goal in medicine is to give our patients everything they need to get better. In a world of ever escalating prices I wanted to start a database of transparency. I also wanted to be able to have these resources at your fingertips so you can find affordable care in an instant should you need it.

Gizmo. One of our past pyometra surgery patients.

If anyone has any other clinics to add please message or email. Together we can direct people and their companions to places that save lives and offer affordable options, day or night.

The dog on the top has a normal sized reproductive tract.
The one on the bottom is a pyometra.
Two dogs of the same size and two very different reproductive tracts
(PS these dogs asleep and are recovering from their surgery)

This is the under $2,000 list;

1. Affordable Animal Surgery Las Vegas Nevada 3340 E Patrick Ln, LV, NV 89120  (702) 886-7774

• Pyometra surgery: approximately $600–$1,200.

• Provides emergency and advanced surgeries at transparent, lower-cost ranges than most emergency hospitals.

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2. Celina Pet Clinic & Surgical Center 1817 Light Farms Way, Celina, TX 75009, 

972-752-0057

info@celinapetclinic.com

• Pyometra surgery estimates: about $1,500–$1,900 (varies by species/condition).

• Offers a published list of surgical procedure prices that often fall under $2,000.

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3. Nashville Animal House Surgery Center 223 Largo Drive, Nashville, TN, 37211, 615-834-6441

• Pyometra spay surgery estimated around $1,700–$1,800.

• A surgery-focused practice providing lower-range surgical pricing than many traditional emergency hospitals.

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4. Nutmeg Spay/Neuter Clinic 626 Surf Avenue, Stratford, CT 06615

• Pyometra surgical add-on (~$800) plus basic spay cost.

• If pyometra is found during a spay procedure, they include the appropriate surgical charge.

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5. Loving Paws Animal Hospital 2695 Tamiami Trail, Units B/C, Port Charlotte, Florida, 941-766-8555

• Pyometra surgery pricing (approx):

  • Feline: ~$600

  • Canine under ~50 lbs: ~$800–$1,000

  • Larger canine: ~$1,200

• Offers clear surgical price ranges including pyometra.

6.  Plymouth Vet Clinic – 1201 E Jefferson St, Plymouth, Indiana 46563, 574-936-2266 

• publishes Pyometra/Spay starting at $1000 (varies by weight/emergency)

7. Faith Babirye Veterinary Surgery (Katy, TX) – 722 Katy Fort Bend Road, Suite 700, Katy, Texas, 77494 (281) 394-9484

• Pyometra surgery: $1,500–$3,000 under soft-tissue procedures.

8. Focus Veterinary Care – 307 South Main Street, Nicholasville, KY 40356, info@focusvetcare.com

            (859) 801 0700

• shows tiered pricing for pyometra based on size (e.g., $450+ to $1250+).

9. FairPet Surgery Center 115 Towne Center Parkway. Suite 111, Hoschton, GA 30548. 

            (706) 381- 0894  info@fairpetsurgery.com (Braselton, GA)

• Pyometra: $975 including hospitalization & IV meds.

10. Low-Cost Animal Hospital 6863 W Commercial Blvd, Tamarac, FL 33319 (728) 227-7754

•  Pyometra Surgery: $399–$599.

11. Veterinary Medical Center of Clayton 4798 Jonesboro Rd, Forest Park, GA (404) 366-4370

• Pyometra (infected uterus) $575+.

12. Four Paws Vet Clinic 4750 E Grant Rd, Tucson AZ (520) 321-0277 

•  Pyometra starting at $950.

13. Spay Now  8335 Guilford Rd, Columbia MD (301) 483-7080

• Feline – $400, Canine <40 lbs – $675, 41–70 lbs – $875, 71–100 lbs – $1,075, 101–150 lbs – $1,275

14. Shore Pet 125 Pullman Crossing Rd # 101, Grasonville, MD 21638, (410) 827-6464

• Feline $350, Canine $690- $920

Normal sized uterus

Pyometra uterus

This is the over $2,000 list;

1. Oakdale Veterinary Group  156 N Maag Ave, Oakdale, Cal (209) 847-2257

• lists Pyometra Surgery: $2,950–$3,500 on their surgery price sheet.

2. Animal Works 1002 W Drake Rd #101, Fort Collins, CO (970) 694-2625

•  Pyometra surgery: $2,400.

3. Jarrettsville Vet Center 3961 Norrisville Rd, Jarrettsville MD (410) 692-6171

• Canine and feline pyometra surgery estimates varying by size (feline $400-600, canine $800–$3200).

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🐱 Non-Profit / Low-Cost Programs With Potential Emergency Support

6. ASPCA Spay/Neuter Clinics (various cities)

• The ASPCA operates community clinics that have provided life-saving pyometra surgeries, sometimes fully funded or at significantly reduced cost for qualifying owners. Actual cost varies by location and program availability — contact the specific ASPCA veterinary clinic in your area (e.g., Los Angeles, New York, Miami, Oklahoma City) for pricing and intake guidelines.

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7. Planned Pethood International (Conifer, CO)

• Offers affordable emergency and routine surgical services for pets.

• While exact pyometra surgery pricing isn’t published online, the clinic emphasizes lower‐cost care and that single procedures are generally capped below more expensive emergency hospital rates. Call ahead for specifics.

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🐕 Regional Low-Cost Clinics (Examples From Around the US)

💡 Helping Hands Vet (Richmond, VA area)

• Offers pyometra spay estimates for pets under ~90 lbs from about $580–$995 (plus basic spay cost).

💡 H.E.A.R.T. Mobile Clinic (Anne Arundel County, MD)

• Mobile low-cost veterinary care with pyometra spays for felines ~ $200 and canines ~ $450 (clinic availability varies).

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🐾 Tips to Access Lower-Cost Pyometra Surgery

• Call multiple clinics — even full-service vets often have more affordable surgical pricing than emergency hospitals.

• Ask about payment plans or Care Credit / Scratchpay to spread out costs.

• Check local humane societies and spay/neuter programs — many offer vouchers or emergency surgical assistance.

• Non-profits often prioritize critical care cases when funding or programs are available.

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⚠️ Important: Pyometra is a medical emergency and delaying care can be life-threatening. Prices listed above are surgery estimates only — ancillary costs like diagnostics (bloodwork, imaging), IV fluids, hospitalization, and post-op care may add to the total bill. Always confirm total expected cost before scheduling. 

Clinic / Hospital	Foreign Body / Exploratory	Blocked Cat / Perineal Urethrostomy	Splenectomy	GDV / Bloat	Cystotomy (Bladder Stone)	Notes / Source
Celina Pet Clinic & Surgical Center	Endoscopic Foreign Body Removal: $1,600-$1,800	Perineal Urethrotomy: $2,500-$3,000	(not listed)	GDV: $3,000-$3,500	Cystotomy: $1,800-$2,500	Excludes other exploratory with R&A
Holly Vet Clinic	Gastrotomy: $3,500 + Enterotomy: $4,000	(not listed)	$3,000	GDV: $5,000	Cystotomy: $3,000	Pricing for major soft-tissue surgeries
Eno Animal Hospital (WA)	Laparotomy: $2,900-$3,900	Perineal Urethrostomy: $3,500-$3,900	$3,300-$3,700	Gastrop/ GDX (bloat) similar range	Cystotomy: $3,100-$3,500	Board-certified surgeon price list
Guardian Angel Veterinary Care (CO)	Abdominal explore/Foreign Body: $1,000-$1,500	Perineal Urethrostomy: $900-$1,100	Splenectomy: $700-$900	Gastropexy: $800-$1,000	Cystotomy: $800-$1,600	Lower-cost surgery pricing
Low-Cost Animal Hospital (Tamarac, FL)	Foreign Body: $499-$749	Scrotal Urethrostomy $599-$899 (PU often separate)	Splenectomy: $449-$699	GDV: $599-$899	Cystotomy: $499-$649	Affordable surgery price list
Oakdale Veterinary Group (PA)	(not listed specifically)	Perineal Urethrostomy: $3,000-$5,000	Splenectomy: $3,000-$4,000+	(not listed)	(not listed)	Referral price guide
Veterinary Medical Center of Clayton (GA)	Foreign Body: $800-$1,200	PU for cats & dogs: ~$925-$1,250	Splenectomy: $1,200	Stomach Tacking (bloat preventive): $525	Cystotomy: $800-$1,200	General surgery price list
All Pet Surgery Center (TX)	Foreign Body: $1,500+	Feline PU: $2,400-$2,900	Splenectomy: $2,000	(GDV not listed)	Cystotomy: $1,400-$1,600	General surgery pricing

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💡 How to Read This Table

• Foreign Body Surgery includes gastrotomy / enterotomy / exploratory for intestinal obstruction where available.

• Blocked Cat Surgery / Perineal Urethrostomy (PU) is listed where providers explicitly post that procedure.

• GDV / Bloat refers to surgery to correct gastric dilatation-volvulus (bloat) and related procedures.

• Splenectomy is removal of the spleen, often part of emergency abdominal surgery.

• Cystotomy is surgical removal of bladder stones or related urinary surgery.

PS I will keep making these posts,, building this database and saving every life I can.

PSS Please spay your dog when they are young and healthy. There are lots (and lots) of low cost spay and neuter clinics around the country.. Just ask ChatGPT for one near you!

Informed Consent Template, Pyometra

Based on the professional guidelines and clinical frameworks provided in the sources, an informed consent template for a veterinary clinic—particularly one practicing Spectrum of Care (SOC) or Incremental Veterinary Care (IVC)—should document the dialogue between the provider and the client regarding diagnostic and treatment options, associated risks, and financial obligations.

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Informed Consent for Veterinary Care

Patient Name: ____________________  Species/Breed: ____________________ Client/Authorized Agent Name: ____________________  Date: ____________________

1. Clinical Situation & Options

The veterinarian has explained the patient’s current medical condition, including a provisional diagnosis and the potential for that diagnosis to be revised as more information becomes available.

We have discussed a range of evidence-based care options tailored to my goals, resources, and my pet’s unique circumstances. These options include:

• Path A (High Resource/Gold Standard): Comprehensive diagnostics and intensive treatment. Patient will be transferred to a specialty hospital, and/or emergency facility for care. Cost of care is not expected to be beyond clients ability. Estimates can range from $4,000 to over $10,000.

• Path B (Incremental/Nonspecialized): Tiered diagnostic and therapeutic steps focused on the most pressing health issues and patient comfort. Care may be given here at Jarrettsville Veterinary Center, or your pet will be referred to another general care, or, procedure clinic. It is understood that there will not be 24 hour, or, overnight care provided.

• Path C (Stabilization/Palliative): Minimal intervention focused on pain control and quality of life. The patient will be provided subcutaneous fluids, antibiotics (injectable and oral) and analgesics (injectable and oral) and go home to be cared for. This may include transfer to another facility in the coming days. It is at the veterinarians discretion, and based on local/state/federal laws that this patient may be forwarded to appropriate animal control guidance for after care and follow up.

2. Risk Assessment & Uncertainty

I understand that:

• Every procedure, including anesthesia and surgery, carries inherent risks of complications or death.

• Choosing an incremental approach (Path B or C) may involve skipping certain diagnostic tests, which could result in a level of clinical uncertainty or a different outcome than the gold standard.

• The treatment plan is dynamic and may need to be revised based on my pet's response to therapy.

3. Financial Estimate

I have received a line-by-line itemized estimate of the charges for the chosen services. I understand I am responsible for these costs, including any recommended follow-up rechecks within 24–48 hours.

4. Emergency & Unexpected Procedures

In the event of an emergency or unexpected finding during a procedure:

• [ ] The veterinarian has my permission to perform life-saving measures up to $________.

• [ ] The veterinarian must call me at ____________________ before proceeding with any additional treatment.

5. Special Protocols (If Applicable)

• Community Cats: I authorize eartipping and the use of dissolvable sutures.

• Euthanasia: If a poor prognosis is confirmed during exploratory surgery or if the pet is suffering and no further care is possible, I authorize humane euthanasia.

6. Authorization

I confirm that the information provided has been explained in a manner I understand. I have had the opportunity to ask questions, and I consent to the recommended treatment plan.

Client Signature: ________________________________________ Veterinarian Signature: ________________________________________

Broken Windshield

I have a nice car. It feels nice, looks nice, and when Mothe Nature is throwing her best curved ball of weather it is unsurpassed in its squirreliness to claw us out of snowdrifts. The stereo system registers on the richter scale as the ground under its wheels vibrates the tectonic plates out of their millenia's rest. But, I have had to have the windshield replaced 4 times. Once in a while the car starts raining on the inside. The last it happened was last week when my husband had it inside the drive thru car wash to de-salt its black velvet coat. How do you stop the rain inside a car wash? Four times in and I am done. I am so frustrated by the lack of resolve from the dealership that I am dumping it and trying again with a new car. I loathe cars because I so loathe the buying experience. If I could reimagine the whole process I would buy into a monthly fee that makes me a member of a car replacement program. All of the cars are sold to members at cost. We get a new one every 5years or after considered a total loss by insurance. (See I do have all of the answers!). Oh, and its woman and minority only. Back to my point, I get so emotionally exhausted I bail.

Frippie and a new car on the same day.

Does this also bleed into other parts of my psyche? Yes, of course.

Yesterday it was the 8 year old doodle who has been to another vet multiple times, had a multitude of tests done and spent thousands. No answer. No resolution, and they are being told they need a specialist who will cost them $2,000 for the exam and tests and their dog might only have 3 months to live. 

Their dog started with one or two bumps, three months ago, and now has them everywhere, along with all of the lymph nodes being golf ball sized. They have followed all of the advice they have been given.Things are deteriorating and they no longer have faith in their vets ability to help them. 

She is emotionally, and now financially, exhausted. They need veterinary help as much as they need empathic hope. Maybe I cannot provide hope that their dog has a diagnosable and curable condition, but, I absolutely can give them hope that I won't abandon them or deny the grief that comes with acknowledgement that the good, healthy time is slipping away. They are losing their love. There is a big difference in how you deliver medical advice and how you see your ethical responsibility to a life that needs,,, well,, so much. 

This is what second opinions stem from. We all should be brave enough to find that someone, or someplace that you feel good about going downhill with, even as you hope and pray you won't have to.

I will forever bear the guilty burden of giving up on Jekyll and Savannah too early. They broke me mentally, physically and emotionally. I couldn't take another night of no sleep, no easing of their bodies painful beckoning. I, the veterinarian, their mom, gave up on them. I put them to sleep so I could finally get some rest of my own so I wouldn't make an exhaustion induced mistake on someone elses beloved pet. In a country that doesn't believe in humane euthanasia for its dying humans why  can't I provide thar for my companions? Why do I feel like I failed to let them die how nature chooses them to? Why do I always have to saddle the burden of their mortality as I am suffocating under the grief of losing them?

Jekyll

My hospital manager is facing the aging and loss of function (mobility and bathroom) in her older dog. We are at that place where we know we are losing our battle. We are at that place where we are throwing everything, and the kitchen sink at her in the hopes we can recover something that helps her feel better. Her diarrhea has been going on for weeks. Diarrhea, like vomiting, and not eating are crippling to deal with. They are all symptoms of a bigger disease, and there inlies the reason we call it medicine. They are clues given to us to try to uncover what the root cause is. What is causing this? If we cannot figure this out we are very unlikely to undo the inciting cause and rectify it. Having a pet who cannot get up and walk themselves outside to make a massive smelly mess of liquid diarrhea is exhausting. You cannot sleep because you want to be able to get them to a place that is easier to clean up than your bedroom floor. 

It is very important to remember that what we see in our few minutes in an exam room doesn't always allow us to know the burden that families carry at home. 

It is very important to acknowledge the impact of exhaustion.

Is it possible to have hope, empathy, and be exhausted? 

Is it possible to make good decisions we won't look back and beat ourselves up about after the fact and be exhausted?

I asked Jenn, my hospital manager to add her thoughts. 

The long goodbye.  It’s the slow decline of our beloved pet and feelings mixed with hope and defeat, a rollercoaster of emotions.  It’s a place I find myself with my beloved dog Hope.  Hope was rescued by Black Dogs & Company Rescue 12 years ago, a very pregnant stray on a dirt road in South Carolina.  She was being fed a handful of dry kibble once a day because that’s all the kind-hearted person who was helping her could afford.  The rescue intervened and tried to get her to Maryland before her puppies were born but Hope had her puppies under the safety of the wooden handicap ramp of a church.  Four little puppies entered the world in the dirt to a young emaciated mom.  Hope and the surviving three puppies made their way to Maryland when the puppies were three days old thanks to a volunteer pilot via Pilots N Paws.  Hope was our first momma and puppy foster, she was emaciated, filled with internal and external parasites, heartworm positive and pretty much feral.  It was a slow go to gain her trust but she loved my children quite literally from hello.  When her puppies were ten weeks old they all found homes, my children became her puppies.  It took a year before Hope was ready for adoption, she became our first "foster fail".  For twelve years Hope has watched my children grow.  Like a good mom you can literally see her ears that no longer hear much perk up and her cloudy eyes light up every time one of her children enters the room.  Her love for them has been unwavering.  She’s been a stoic stubborn old girl, I somehow always imagined the end would be something quick, symptoms hid.  Instead it’s been slow; arthritis that we have managed with monthly injections, then diarrhea.  Horrible, incurable, unstoppable, diarrhea.  It waxes and wanes from “soft serve” to bubbly, projectile water.  We’ve thrown every single medication at the diarrhea, tried countless foods and yet here we are.  Each day my old girl get a little more tired.  Phrases like "quality of life" and "letting them go on a good day" dance through my head on the sleepless nights.  I see the toll it takes on my family; my teen and young adult children tread lightly past her room, panicking when I’ve taken her to work with me thinking we made a decision without including them.    I see the toll it takes on my husband, his wife’s attention and thoughts on trying to get our dog through one more day of trying.  I see him bracing for the heartache that he fears will hit his household when we say goodbye, and I see a man who remembers a younger, fearful version of Hope, whom he spent so much time working through gaining her trust while I cared for her puppies.  We have an entire basket of medications, the treatment plan changes as we admidst defeat.  The wash machine runs constantly, we try to get a load or two of the family’s laundry in between.  I see the toll it takes on our other dogs. There’s Remi who was Hope’s best friend.  He had cancer removed a year and a half ago, he’s on borrowed time.  He lies with her some days.  I see how he looks at her, how he looks at me.  I see the younger dogs, their hesitation in walking past her room, how they give her great space when we walk her through the foyer to go outside….respect?  I look in the mirror and I see the toll it has taken on me, I can’t remember the last time I slept more than four and half consecutive hours.  And when I do?  Guilt jolts me from a deep slumber.  I jump up and run to the dining room that is cleared and now “Hope’s Room” afraid she needed me and I didn't hear her.  I see the bags under my eyes, my heart is caught somewhere between holding on to hope and giving up.  My body feels like I have been hit by a bus every single day, muscles hurt from lifting her in and out of my truck.  Caught in a place where I can’t plan life too beyond what lies immediately before me, that 25^th Anniversary trip? I’ve yet to buy my plane ticket.  And I see Hope, a dog that loves her children so deeply she’s caught between letting go and not wanting to let them down. 

While watching my mother die from brain cancer, I realized euthanasia is a gift we give our pets at the end, we ease their suffering.  We save them from the horrors of what lies in the final days of disease.  Each pet owner makes a very personal decision along with their vet based on what they can financially invest and physically manage to determine a time when it is appropriate to ease their pet’s suffering.  I find myself carefully watching for suffering, watching for signs that I am asking too much, watching for signs that my sweet old girl still wants to be here.  I learned that sometimes, when all we have is a single thread of hope that’s what buys us a miracle.  I’ve been there, at a place where most would euthanize to stumble upon a needle in a haystack that buys us quality time.  I found myself there when my Saleena was in kidney failure, she lived ten wonderful months.  When my shepherd mix Johnny Cash had a mystery intestinal illness that had his big 90lb body physically down for two weeks and found us seeking an oncology consult, and again when a large non-cancerous mass was crushing his lungs when he slept, we were given the gift of time as we teetered on letting go.  I found myself there with Bella, my dream come true golden girl who became suddenly very ill with a lung infection, we found a rare aggressive lesion on xray at the base of her lungs, again finding ourselves at oncology only to make a miraculous recovery.  It’s a fine line between hope and defeat.  I couldn’t imagine having given up on any of them and robbing them and us of quality years.  I’ve always known when all hope has been lost and when we are making a decision to end suffering at the end of a life well lived.  With Hope I teeter in this place, my heart torn. 

I am well aware that I am able to go to these great lengths for our pets because of the life I live.  Because I work in the veterinary field, I am able to bring my pets to work with me during these difficult times, I have access to brilliant veterinarians who see pets as part of our families.  I am sympathetic to pet owners who don’t live this life, who work long days, who have to make decisions based on what they can physically, financially and mentally manage.  My written feelings aren’t meant to make anyone feel guilty. We each make decisions for our pets based on our individual situation, and when it’s a decision made with a heart guided by love it’s never wrong.  

Is It The Delivery, Or, The Message?

It's beginning to feel like an island around here.

Dr Elizabeth Potter is challenging the insurance company system who denies care without following the law, or putting patients needs above profits.

Everyone is too afraid to be anything but A. A cheering squad, Or, B. The firing squad.

Then there's me, still here. Still squawking. I know I am here because I can physically, emotionally, and financially handle it. I know it's getting worse for those who have pets they love like family, and struggle to find care for. It is getting bleak and I know they also feel alone.

When you feel alone, afraid and alienated you seek companionship in the safest place you can; your pet. How ironic is that? Vetmed holds so much power. 

Do we forget that? 

Do we think that the shelters house so many extras that this one, this particular family pet, is replaceable? 

See the reaction from fellow veterinarians about this post here.

Here are some of the arguments I have heard vets provide as we justify the ever increasing cost of care.* 

• Our costs have increased.
• Our debt has increased.
• We want to practice better medicine and offer better treatment options. Think CT scanners, endoscope, big ticket/expensive equipment.

The reality is all of these, AND, there is a new player on the field; venture capital. They see limitless profits because there are almost no guardrails for pets, pet parents and the emotional bond is unparalleled. They have no emotional stake in the game. They never have to look into the eyes of the patients. parents, family. They have vets in gag orders. They are the fox in the henhouse. They are the evil in medicine. I mean that. I believe that. I see their consequences everyday. I have to look into the eyes of need, desperation, suffering and ask myself if I will be the only hand of mercy. I will hear everyday for the rest of my days a sneering, seething pessimists who want me to fail. They want the apple cart to land on my head and cause total system failure. That is the dilemma to being out here on this island, alone.

I feel like I have to explain myself over and over again. That is wearing thin. I suspect that people react to my message, but the intention, the audience, well that can get lost in the delivery. The passion comes through, but that elicits some stoking of the masses who finally feel heard and acknowledged from the source of their pain, AND, anger from my colleagues who (incorrectly) assume I am blaming them as the source of the problem.

None of this changes the (inarguable) fact that veterinary medicine is becoming out of reach to the majority. 

None of this changes the fact that all of us are deserving of love, compassion, hope and mercy.

None of this changes the collective responsibility to address the needs of our patients and pet parents. It is not ethical to simply shift the problem to the providers below you. (..and lets not dismiss the perception that specialty feels GP is below them. They don't have to make time, or compromise for patients who aren't their problem). How often am I reminded that "they simply cannot do it/whatever/for that price? When I want to reply, well, what can we do for this pet at an affordable price? (Please don't respond with "euthanasia").

I get so much, "you care, you figure it out." 

I get very little, "how can we do it together?"

I get back handed replies like; "she will die under the burden of trying."

The professional backlash feels like a deflection of some tapped into guilty conscious, some misplaced frustration. If it didn't strike a chord I would only fall on deaf ears. There would be no island, there would just be alone. Instead there is a purpose with a problem and a whole bunch of broken.

So, is it the delivery? Or, the message? ... and as long as treatable patients are dying so some billionaire can pay for his yacht docking fee on some tax-free sheltered island do I even care?

* "Over the past 2 decades, veterinary service inflation has surpassed general inflation rates by > 60% in the consumer price index, making it harder for pet owners to budget for their pets’ health care needs." Reference link here.

More about this on Instagram, Krista Magnifico

FaceBook, Jarrettsville Veterinary Center page here.

Pawbly.com, Ask questions for free. Share your pets vetcare experiences here.

Pet Good Samaritan Fund. The 501c3 we work with to help provide affordable care and support the other providers also providing life saving care to pets to avoid economic euthanasia.