Saturday, April 4, 2020

Linear Foreign String Body In A Cat. What happens when your cat swallows a piece of string and it gets stuck in their intestines.

This is Bella. She is a 3 year old indoor only long haired spayed cat. She was brought to the local ER about 1 week before I saw her. At that time she had not been eating for about 1 week and had been vomiting.

At the ER she was given an examination. They found a string stuck under her tongue. In vet med, especially with cats, checking under the tongue is a super important place to look for the culprit of a sick cat of unknown origin. All ER vets know this, and, I hope every other vet, and cat parent also knows this now. If your cat isn't eating get a really (really!!, and not always easy to do) good look under their tongue. About once in every 500 cats (my guess) we find the problem hiding here. The biggest fear we have with cats and linear foreign bodies, (like a piece of string or ribbon), is that the start playing with it and the little barbs on their tongues that allow them to be such successful groomers,  causes them to start swallowing the string. It is not uncommon for the linear foreign body to get stuck under their tongue as the esophagus keeps trying to swallow.

The ER vets advice was to run some blood work, take an x-ray and possibly even do an exploratory surgery to see if the string was able to be removed and how much damage it had done to her internally. It was a good and thorough plan, but it was also an expensive plan. Bellas parents could not afford any of this. The emergency exploratory surgery that was recommended included an estimate of $1500 to $4000 plus. Without any funds to do any of the recommended services the only thing anyone could do was cut the string under the tongue, which would at least relieve it from further cutting into and strangulating the tongue, and, hope (really, really hoping here) that if it was freed it would pass through the gi tract on its own.

Can you tell that she is in pain? Cats hide it very well.

So, that's what was done. Bella went home.

A week after the ER visit she came to see me.

She was laying on her side, very reluctant to move, and very painful. I took an x-ray and saw the classic "string of pearls" plication pattern. Plication is the gathering  of the intestines when something inside of it is pulling it together which is an indication that there is intestinal bunching.

After I saw Bellas x-ray, how painful she was when I touched her abdomen, and how sweet she was even though I knew she was beyond miserable, I just felt compelled to help her. Her mom told me that she had recently been homeless and that Bella had been the reason she got through all of the rough spots her life had recently given her. "Bella was everything, and, she just didn't know what she would do without her?" I understood exactly what she meant. I had been in just her shoes many years ago, before I went to vet school. It wasn't just Bella who spoke to me, who moved me to take pause and want to help, it was her mom too. They both needed me, and, I was pretty sure I could help. I could at least help to see what was going on inside. Whether I was too late to save Bella had yet to be determined, but, I knew that if I didn't help Bella she would die.

I told Bellas mom I thought that it would be best if she left Bella with us at the clinic. It was a Sunday,, and although we weren't going to be at the clinic late that day Bella needed fluids, antibiotics and pain medications. I also wanted her to be with us first thing in the morning on Monday so I could get her started on all the things she would need the day of her surgery.

I can't explain it to those who don't understand. I have almost given up trying. I knew that I could help Bella and I wanted to try. When I talk about finding and living your purpose I am talking about cases like Bellas. She is the reason I went to vet school. She is also the reason I still love being a vet. I can help her, it won't cost me a fortune to do so, and if I don't no one else is likely to intervene. Some people would think me unlucky to have cases like this. I think just the opposite. I think I learn my value here.

I told Bella's mom that I would keep her in the clinic overnight to do surgery the next day. She needed fluids, antibiotics and pain medication immediately.

The is what "bunched up" plication of the intestines looks like.

This is the string that I could see tearing its way through the intestines. It popped and poked out of about a hundred places along the whole intestines.

I spent about an hour gently removing the string from her very unhappy intestines. It was a slow, tedious process. Although we never want to see anything tearing through any organ, especially the intestines, it was actually fairly easy to remove the string. It had been in there long enough that where it was lodged it was cutting through. The holes it was making as it lanced its way through were pinpoint sized. Too small to suture. And there were far too many to even try to close. The point of the needle was going to do just as much damage as the thread had, and make her even more susceptible to leaking fluid that was supposed to stay inside her muscular tube of intestines into her open abdomen which will lead to sepsis, and probable death. 

The string ran the  entire length of her intestines. At the top of the intestines is the stomach. The stomach is a big pouch. Stuff only gets stuck here if it cannot be dissolved or digested in the acidic juices it produces, or if it wedges at the outlet, called the pylorus. In the top section of the intestines I grabbed the first place the string was tearing through. Very gently I pulled it out of the  stomach. Having one end is helpful. But, having it running through the whole rest of the gut was not. I could see and feel it running all the way down to the colon. It literally ran the whole gut. Not good!

I carefully pulled it out all the way down to (almost) the colon. We never, ever want to open the colon. So, I did what we all (vets) have done about a ba-zillion times. We glove up and go rectal fishing. I actually employed my smallest fingered person to help. As I tried to push the tiny amount of poop I could feel in the colon to her awaiting inside the rectum finger I hoped she could find the other end and then I could cut my end as she pulled it out. 

After a few minutes and a few fecal balls we had no luck. I cut the string as close to the large intestine as I could. I expected that there was only a few inches outside of the colon that had to advance and she would easily pass the rest. It was a little leap of faith, but, based on everything we had going against us I was hopeful.

I said a little prayer to her red, angry, yet peristalsis moving intestines. Peristalsis means the muscular tube is moving, and therefore still functional and the best indication it can recover that there is.

I carefully replaced all of her intestines back in her abdominal cavity and started to close her up.

As a veterinarian this is the place we all stop, breathe and hope. There is nothing more I can do.

There were still things to worry about. Because she is such a small cat and she has been unable to eat for so long and it had been so long with the string in her, she wasn't the best candidate for surgery. I had also spent a long period of time trying to remove the string with her whole belly open. This causes severe hypothermia pretty fast.. I know had to worry if she was going to wake up.

She came off the table at 95 degrees. Normal is about 101F. She had to warm up. We cuddled her in a big wrapped burrito blanket and heating pads. The techs stayed with her for about an hour. Pain meds were given and she actually looked happier from the moment she opened her eyes, despite the incision on her belly that ran sternum to pubis. She was awake and she was relieved of the excruciating pain I cannot even imagine how horrible it was. Veterinarians take an oath for this. How many of us forget pain is part of suffering? Relieving pain requires relieving the cause.

Here is her culprit. The string measured about 16 inches long.

Here she is the next day. Can you see the difference in her from day one? She is laying on her side. Stretched out and looking for attention. A different pose than curled up in the back of her cage and not wanting to engage, or say hello. She is inherently a social calm girl, but guarded, hiding, retreating and reluctant to move are all key signs that there is a problem.. Her parents saw not eating, I saw misery. It's why we ask all pet parents to call us the moment your pet isn't acting normally.

Here is her abdominal incision a few days later.

If anyone ever has the chance to give back, for just the simple pleasure of seeing a smiling face of gratitude back, take it. Paychecks come and go,, gratitude and all the joy it brigs last far longer.

I am sure people will think I am crazy for this, but, I donated my time for her. I felt really good about doing it.

This is Bella about 10 days post op. She is up, walking, comfortable and eating!!

I still love this cat. I am so glad she did so well.

Here is the cost breakdown of Bellas procedure;
walk in non-client Sunday exam $75
NSAID for pain $18

Day of surgery;
propoflo induction $60
exploratory surgery $350
surgical package (i.v. catheter, i.v. fluids, i.v. fluid pump, instrument pack) $250
anesthesia $125
additional suture packs $30
e-collar $15
overnight boarding 2 nights $40

Total for procedure; $950

I donated my time and $500 towards her surgery. I do so because I have the help of our internal Good Samaritan Fund. I have found that as much as I take from it our friends and supporters refill it.. I never let cost be a reason to deny care. I give more than I have to and in return I get more than I expect. It keeps me feeling whole and purposeful. It keeps me feeling grateful to be able to work, to help, and to be a part of someone else's story. Isn't that we all want?

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Please be safe everyone.

Friday, March 20, 2020

The Silver Linings Of COVID-19. The Life Choices We Surrender To A Virus.

There must be silver linings in the storms that life inevitably delivers. Lately I’m struggling to find them, identify them, and, keep a rosy eyed perspective as I attempt in earnest to magnify them.
It is the middle of March 2020 and the entire globe is focused on the pandemic looming around us called COVID-19. It is the fodder for previously produced thrillers too numerous to mention and the story is actively unfolding a little deeper and gloomier with each passing day. Everything that provides us our day to day normalcy is either under closure for safety reasons, or, threatened to become the next place shut down to ensure self- isolation to attempt to stop the spread of a tiny bug our immune systems won’t recognize and thereby might not respond to appropriately to save its host.

Fear based hysteria is influencing our very scientifically based safety precautions. The world has been our guinea pigs and we should remain thankful that we aren’t Italy, S. Korea, or China. There is some small saving grace in not being first country to start red dots that balloon into whole country-wide zones. You can learn a lot from the first guys mistakes, or misgivings. It isn’t a hoax, and this is our dress rehearsal. Fear is a great motivator and based on the grocery store brawls over toilet paper and sanitizers it can be the seasoning to remind us we have yet to evolve.

The COVID-19 mania is causing whole nations into forced quarantines. Communities are losing swaths of citizens and the novelty of a new big possibly highly virulent disease has scientists reeling over understanding it as fast as is humanly possible. We will have a vaccine for this faster than ever seen before in history. This will happen because we are so motivated to find it, and so practiced in the methods employed to do so. With each great advance comes an ever-increasing expectation. For me this virus is pure novel once in a lifetime science. Biology meets marvelous fragility. You cannot admire the incredible brilliance of microorganisms without conceding to their immense power. Take yourself out of the equation and the scales of survival are all pushed to equality. There is hope in mortality. Where one dies another survives. Without balance there is no beauty and humility. I know it sounds crazy to admire a virus, but we cannot convince ourselves we are so superior we forget to preserve the lives around us, can we? It is the silver lining to the once in a lifetime disease du jour.

Personally, for as much as I want to gawk and pine as the self-proclaimed science geek addicted to COVID-19 melodramas over the real-time emerging information and science of this new disease with the way it so effectively fertilizes its mark on the world, I have to take myself out of 30,000 foot view  and refocus on the other fish I have to fry. I have a hospital to oversee and a real fear that one disease for one species will strangle the ability for us to care for any other species. Every veterinarian I know went into vet medicine because we chose the other species over our own. The silver lining of unconditional love compelled us to serve one and allow the other to pay us for that. You learn fairly quickly that your heart may always lie with your furry patients, but your solidarity lies in the details of disease and its clear killing allegiance to its victims. There are times you must choose to protect the human at your adorable furred patients’ expense. I also have to brace myself for the lunacy of paranoia that people will abandon, or kill, their pets if the fake news starts concocting stories about that one 17 year old Pomeranian, who may, or may not, have or not had, we think it was two or three times tested? from a yet to be deemed credible internist in an otherwise yet to be relied upon country (China) who would rather control the news, their people, and their own reputation as being “powerful” than being honest and transparent. For now, your pets are safe. They won’t give it to you, get it from you, and they are still the best chance any of us will ever have at unconditional love as we are potentially put on house arrest.

My mom has been one of the billions of collateral victims held hostage by COVID-19. She was diagnosed with her stage 4 metastatic breast cancer at about the same time corona made its first victim. Her story of the duel between her body and its terminator started as COVID-19 patient zero found theirs. Her disease story started in December 2019. It has been a many months long process of finding her answers, providing her care, understanding her options with each choice and predicament, and uncovering resources and services to optimize an acceptable end of life plan. Its been a lot of shit to dig through while accepting the losses she never saw coming. For most of January and February she was in a hospital. She was released from that to her rehab facility early March. There was a choice here, but in retrospect it may have been the wrong one. At that time COVID didn’t exist on the radar. The choice was hers and the options were to go home, or, go to physician, nurse and therapist assisted 24/7 care? She wanted to go home. But she knew she couldn’t manage there in her current state. If she went home she had stairs to ascend and descend on her toothpick bones with lungs that wouldn’t propel her and an aluminum walker in her protective arsenal. She was now expected to be an 80-pound pack mule who couldn’t breathe. It wasn’t going to work. We, her family, the hospital staff, the social workers, everyone in her life, convinced her that a “short stay in rehab was her best chance at recovering some lost ground to be able to go home.” I put it plainly, “we are setting you up to fail, again, (this would be the third strike), at home. Your next stop, slip, bad card, etc. is hospice.” (Why I feel so compelled to tell her what no one else wants to say out loud to her has me facing the only regrets about this whole debacle that I expect. Personal notes; What the heck am I supposed to do? Lie? Purse my lips? Just live blissfully with the crowd in denial? I honestly don’t know. I do know that she prefers I shut up and act stupid. Just talk about the happy stuff” she pleads. I’m honestly trying).

My mom was transferred from the last 2-week hospital stay that proved fruitful in both diagnosing her and getting her indexed vocabulary of opioids in order to the rehab facility in Bel Air, MD. She was moved from an hour plus away hospital to a rehab facility within 30 minutes. We were hopeful that with her willing commitment to get a team approach to her muscle weakness, walker and oxygen dependency that she could go home stronger than the hospital bed, massive opioid slumber that pain eradication costs you.  She has nurses who provide a never-ending list of medication options on a daily rotation. She is now an expert on requesting and medicating the pain away. In vet med we caution every patient to find their “lowest effective dose.” That combination and frequency that permits the smallest amount of medications to produce the most tolerable degree of comfort without the sedation, if at all possible. My mom just wants pills delivered and pain eradicated no matter the consequence. There are lots of consequences. Desire to ambulate, breathing, and constipation rank amongst the greatest victors in the exchange. She also has lost the ability to manage these on her own and going home as such is going to be a real challenge.

It is hard for a fighter within me with no white flag in my wardrobe to concede. I cannot find a silver lining with all of her decisions. And yet she is holed away in confinement and I cannot meddle. Maybe that is both of our silver linings?

I call her daily. Dig for little tidbits of information. The interrogator in the room with civil rights and a fifth amendment defense strategy. She knows I dig. She attempts to pull the parent card, I usually remind myself to bow, she has the reaper to bargain with, why waste energy on me? There is her silver lining in having a common enemy and an hour glass with sand slipping away.

When we first went to visit her in the rehab facility I was taken back by the residents all lined up in their wheel chairs in the hallway outside their rooms. Some looked up at you, few smiled, almost none interacted if you said “hello.” They were the institutionalized form of ‘stoopers,’ the term we use in Baltimore City for the people who sit on their front steps and watch the city pass them by. When I was at the Academy we had “fall out.” We would all rush out of our rooms and line up like little soldiers, head bowed, cap covering our eyes (you are only a real person if you have eyes, I think was the point?). Shoulders pressed back, hands plastered to our sides, pushing the wall back into our rooms awaiting the next shouted directive to remind us that we had no place in the world and no one to save us. It was shit. I don’t know why I had no rational cognition of the person I was shaping myself to be under anyone’s command. Yet all these came flooding back to me as I walked those halls the first time all the while thinking, these people must be lifers?

I called her yesterday.
“Hey mom, what are you doing?”

“I’m in the hallway. I couldn’t stay in my room any longer, and I am not going to become one of those bed ridden people.” For her it is a simple step away from her worst-case scenario and not towards mine.

She is there. Locked away. Safe. And I am on the outside trying to not get swept away in the hysteria. Trying to understand all of the implications for all of my actions and decisions and knowing that little ferocious bug has me within my straw house in his favor.

At the finale of every long hard health battle beside the ones you love most there is a feeling of shedding the weight from your shoulders so heavy you couldn’t move out from under it until they passed. After yearlong battles with Jekyll, and before him Savannah, my beloved beagles I spent a year each fighting for and doting over, despite each day just being an accumulation of massive causalities that they gained along the way when they finally lost their battles there was this overwhelming feeling of relief. The burden, both emotional and physical, was now behind me. There was also immense guilt in that, but it was still true none the less. I can’t go see my mom and she can’t make me feel guilty, or neglectful, or even argumentative in my interventions as the over bearing guardian we swapped crowns for. Corona has taken these responsibilities off my plate. I cannot micromanage her, and, she has given up on that influencing her recovery. There is time passing between us that we don’t have. I can’t watch her with my calculating ever scrutinizing analytical medical eye. (As Diedra, my sister would me and say, I always have an agenda.” And she knows she is right). I am supposed to see what others don’t. I am supposed to be one step ahead of her next pitfall and help her side step it. And now remotely, my critiqued questions are blunted, and, or, more aptly ignored.

Her silver lining has been in the prisoners feeling of isolation and the oddly placed security that provides. She has people around her. She finds great comfort in that. Her self-imposed home isolation wouldn’t afford her that luxury. If she was at home she would not be able to have visitors. NOT ONE! She is the worst at risk patient there can be. She has precious limited time and she would be banished to spend those last days in solitude. At her rehab facility she has food delivered at her command, anything she requests, made to order and delivered without a tip required. She has people she can share her story with. For the first time in her 7-decade life she has learned what living with others is like. She never had a dorm, roommates in an apartment, or, anything where she had to share. She has never seen death, suffering, and disease cripple and control. It has been a lesson on humility, humanity, and empathy. She is enjoying exploring new experiences. Ones she would never had exposure too, and, honestly spent a whole lifetime avoiding.

I call her every day, at least twice a day. She is still her firing, pistol self. “So, mom have you met the people around you? Do you know the names of the people in the rooms adjacent to you?” I pick small sentences and direct questions. She is on elephant doses of opioids she can get lost in the sentence if it has too many curves. “Krista! Some of them can’t talk. I don’t have time for that.” And, the empathy recedes as the parent reprimands. I guess I am expecting too much. The vet in me wants to understand these people, and their conditions much more than the talking patients. Maybe that apple rolled too far from that tree?

The house is falling. The pain won’t win, but the body has lost its hope in walking independently. Stairs of any measure greater than one, and a tube in each nostril pushing atmospheric ether into her lungs that can’t muster the strength to tug on the diaphragm anymore. There are weak protests of pleas to let her “conserve her energy” which always sounds like handing the draw to the house. It is not a bluff but a fold.

I want her to know I am still sitting in the bleachers. Still rooting her on, and yet there is only the half-answered phone calls and the locked building that takes care packages at the front door. She is in there. Confined within her fear, and, passing precautions to me in the big scary germ filled freedom.
I know that if things get worse she will only have two options. Forced confinement if she is feared to be exposed or infected, and, home isolation if the bed she resides in gets too precious to permit her to stay in her already terminal state. How could it be worse? Die alone or die alone?

The veterinary clinic is being allowed to remain open, for now. The MD governor has us in his “essential personal” graces. We are rationing provisions, adapting protocols to minimize congregating of people, washing everything as obsessively as possible and trying to allow people, the staff most importantly, to do what they feel is best for them. They are able to take time off, stay home with their kids as all of the kids are out of school, and we will provide as much support as we can. There is no end date for a virus. Just curves charts and accumulated data compared against the previous days and weeks of data.

Life is a roulette game. Chance and luck, fate and frailty, and yet we are tiny specks in a timeline without boundaries. But she is my mom and her silver linings are fleeting locked up for her own good. I really only care how she chooses to spend her time. She has a team rooting for her while I cannot be seen or heard outside of her cell phone tucked away in her wheelchair. Her lifeline to the life she has on hold in the world of germs and equality irrespective of mass or intelligence scales.

Thank you for reading. If you would like to read more about my moms journey you can find it here.
Human vs Veterinary Medicine. My personal experience in dealing with both.

The Journey and The Pile of Regret Souvenirs.

For more blogs on subjects mentioned above see;

Terminal Mom. Losing my pups.

The Phantom Effect. Grieving the loss of your pet.

My Beloved Jekyll-pup. May you run through the fields forever.

Survivors Remorse.

The Distracted Hearts Recovering. Getting up and moving on after the loss of your pet.

I also host a free pet health network. If you have a pet related question you can find me there

I am also on YouTube, Facebook, and our clinic website

Be safe everyone, there is a virus out there.

Saturday, February 22, 2020

The Journey, The Missed Pit Stops and The Pile Of Regret Souvenirs

There were a litany of advantages to calling this blog a diary. It gives a considerable degree of artistic latitude and an avalanche of protection to the scrutiny of the squawkers so willing to judge and cast doubt.

Life lately is at a tipping point. That place where life changes indelibly and irrevocably. It is death lurking. The ominous threat has found my mom. She is 74, (everyone always asks me that, so, I will answer it from the git go).

She has breast cancer, no big thrill of the exotic here. Thing is it wasn't the most usual of presentations. It is a real example of how medicine and our options, lessons learned and advancements have influenced us.

Maize Quest Corn Maze October 19, 2019
My mom had a unilateral (one sided) mastectomy 23 years ago. At that time I was away sailing on big ships at sea. Pretty much out of reach for anything other than a fax, or satellite call which no one ever (ever!) made of short of, and singularly for one thing, and one alone; death. If you got called to take a satellite call you knew it was bad. You knew it was going to be really, really bad. Knowing this most family members spare you the notification until the ship hits the shore. No sense fretting alone for the rest for the months long voyage. I wasn't in the picture for her day to day life 23 years ago. She found a lump, went to her doctor and they had a small chat. She elected, (as she did this time too), to be as aggressive as possible. It was removed with very large margins that included the entire organ. The lump went with the breast. It is exactly what we do in vet med. (Except of course women like to have their boobs back after they are taken, so in human medicine there is this branch called "reconstructive." No such stuff in vet med). My mom is tiny, like really tiny. No one would ever know anything happened. She wore the same clothes and never missed a beat. Nothing was done for follow up, or clean up. Things have changed for oncology two decades later..

23 years went by,, and in mid 2019 she found another lump. It generated a quick call to her general practitioner, who sent her to dermatology under the suspicion of being an ingrown "something". The dermatologist sent her to a plastic surgeon who sent her to oncology. Took four months for this table tennis match to play out. Four wasted months with her prior history being dished out at each appointment and loads of passing the buck..

A fine needle aspirate at the oncologists led to a "high degree of suspicion" that her cancer was back. She elected for a matching mastectomy. It was done within a few weeks.

She stayed one night in the hospital post op. Went home with drains, but feeling pretty good.

Four days later she started with back pain. Over the next few weeks it got to the point she couldn't walk. Four doctors over four weeks and finally it was so bad she was admitted to the hospital for "pain management." Now I am not a human physician, and no one likes a back seat driver, and yes, hindsight is always 2020, blah, blah, but the fact that she, or anyone would have to go through so many weeks of being given driveled aliquots of escalating pain medications is something that NEVER happens at my practice. EVER. If a pet is brought to us in pain we provide lots of pain options. We don't start at skimpy and let pets suffer. If the client declines them I provide them for free. Pain under my care is not acceptable.

Over eight weeks of trickled paltry doses of every medication imaginable and available, some of which were included in her week plus hospital stay and the medications were still not enough to manage her pain. She, to this day, is still unable to leave her bedroom. Its heartbreaking to think you might end up spending your last days bed ridden from incurable, unmanageable intractable pain.

September 16, 2019, my house cook-out.

Early on, like right as the biopsy was delivered I sat her down to talk about what I know her doctors won't, we talked about ALL of the options.

"Mom, once you decide you are sort of committed to the journey that they have planned out for you. That is about six months of chemo and radiation. It should be something that you want to do so that you can have the best chance at the best outcome. It will be a long, hard, tiresome and toilsome  journey, but you have to have the long game in mind when you start that race. Or, you can sell everything you own, lock up shop, and just not get on that bus. Move to Paris, drink wine, enjoy whatever it is, wherever you want. It's your choice."

Things changed before the wait began at the bus stop.

After 5 days in the pain management hospital stay, and her tenth diagnostic proved still yet unfruitful, and me being there daily, we called another all hands meeting.

"My mom has been here for 5 days. She is on, or has been on, every possible pain medication including opioids. She has morphine given intravenously every 4 hours, and she is still in pain. This isn't soft tissue. This is something more insidious. We all know that,,, right?"

Quiet faces replied.

"What modality is left to find the answer? What haven't we done, or, need to do again?"

"A bone scan." Her doctor replied.

"Ok, can we get one?"

It was ordered and done a few hours later. That night all of her doctors met in private in the basement, which is apparently where the diagnostic machinery is housed. That night they broke the news to her. I wasn't present but it was reported back to me as, "it's really bad."

Didn't we all already know that? I asked myself. I had given up pushing her to do anything other than find an answer and not over exert herself which only brought on more pain than she could bear at week two.

All of this has been a cascade of events without enough time to really put our feet on the ground to make any sort of plans or decisions. It is a tornado of shit and no umbrella will shield you.

The prognosis is, they say, (they being her tiny oncologist who is unwavering, exceedingly smiley and abundantly optimistic, after all how else do you be, get,, stay this way, in this field? Or, she's really new to this?), one to three years.

This sentence, her stay of her own bodies execution, is also a really big terminal exclamation point. No subtly, no chance of a get out of jail card. It's like a done deal.

September 24, 2019, at JVC.
Now it is natural to presume that you know your parents fairly, if not exceeding, well. I would be so bold as to say that I know my mom better than anyone, her husband included. This whole new twist in our lives has me having to rethink those words. I am perplexed, perhaps even shocked and peeved, about her reaction to all of this. All of the doctors, all of the tests, all of the pokes, prods, probing inquisitive conversations, the constant turnstile of nurses, social workers, therapists, scars, bruises, drains and pill bottles, never mind the hidden emotional and mental anguish without a destination to dump them at. This is a journey of destructive accumulation not liberty, peace, or freedom. She will lose all of that if it hasn't already been willingly surrendered to this disease taking them, one by one. As they slip from her fingers she retreats deeper into her home. Her world shrinks to a place without public view. There is no plan for ticking off the Bucket List of life. No anger, no list of experiences to dive full-on cannonball dive into. No making the biggest splash to fully immerse and drown yourself in, damn the torpedoes! I'm having the greatest difficulty here. Feeling like fighting, arguing, and challenging every one, their expertise, their opinions. Why isn't she doing what I would do? Just living on my terms, my way, to the last breath,, And yet, maybe that's what she is doing, just not in the way I would wish for her?

August 25, 2019. My last photo of Jekyll. He died the next day.
It has been months but she has her medical answers. She has their recommended treatment plan. It's just not the plan I want for her. It's not the fireworks fanfare that a finale should have. She wants to stay home. Exist within her three rooms she has handicapped access to and be visited as often as possible.

Don't we all want to exit with the fat lady singing some crescendo to a lifetime worth reminiscing over?

And so for all the things she can't do, didn't do, and has't yet experienced, I find myself filling buckets of lists of experiences I can't live this life AND NOT DO! I can't accept having lived without having also nicked more notches into my belt. There are so many places yet to go. Things to see. Blogs to write. Videos to make. Things to eat on sun setting shores that span the globe. Hands to hold, pups to belly rub upside down, and cats to purr on my shoulder as we bid another long day of hard work I am immensely proud to be asked to participate in. I only have this lifetime to try to fit all of these into. I just don't know when to start. I don't know how to be my moms caregiver companion as I remind my own wanderlust to sit quietly, as it has for the decade of sea, the decade of clinic ownership, the decade of giving to the patients I so adore and the cement it barnacles in between my toes as she whispers her beckoned calls to stay with her, just a little longer.

Easter egg hunt 2019
Thank you to all who ask, who offer help, words of encouragement, concern and love. I am genuinely grateful.

To the girl I feel obliged to fill and conquer a Bucket List, I hear you too. We will go, soon enough, try to be patient a little longer.

Related story;

Human Vs Veterinary Medicine: Real-Life Case Meets the Dueling Ring. Who's Better and Why?

For the me inside still serving the greater good of the companions in our community I am here in the following spaces;

YouTube channel

Facebook Page for Jarrettsville Veterinary Center

Jarrettsville Veterinary Center website (with our price list) is the place for those who don't visit me at the clinic to help with their pets care, And it's

Wednesday, February 12, 2020

Blame The Other Guy. Where Fault In Vet Med Costs Us All

We all want to point the finger.. It is natural when we are smacked in the face with something so devastating we can't find the place to put our feet back on the ground. We point, blame, and spew angry hateful things when life sends us reeling for safer waters. It is so insanely common we do it in almost every aspect of our lives.

My cat Wren,, basking on the warmest spot in the house.
We are living in a time and place where people are struggling. Struggling to stay afloat as they yearn to get ahead, and, dare perhaps to even get ahead. We are also struggling to find a place where we are loved for some semblance of a peaceful respite in the all too chaotic world we wander within.

I live it. I live it every single day. I see the most needful in this world, and, I see it in the most compassionate of us all. Also, and this is vitally important to remember, I see it in the voiceless, meekest, and most vulnerable. I see it in the eyes that no one else looks into.

Have you ever tried to extinguish the life of a tiny creature still fighting to live? Do you know how soul crushing that can be? Do you know what the price for this act is?

Do you have to look into the eyes of the small, meek, suffering, struggling, and fighting to live anyway and ask yourself the really hard questions? How do you reason with your own internal understanding of ability without advocacy? Or, how about the person, your client, who is so devoted to their beloved pet that they can't see reason in anything? What if you don't have the resources or knowledge base to help manage this medical and emotional debacle? It's a mess at all sides and all levels. How to avoid all of this messy stuff? Just disengage? Turn yourself off and walk away. There is a lot of this going on in our society.

We live in a place and time where medicine can provide miraculous cures. We also live in a place where fewer and fewer people help their fellow man at a sacrifice to themselves. This is a time where costs of care are skyrocketing and indifference about who is responsible for this is thriving.

The tiniest creatures cross my threshold every single day. And with each face (and they all have a face, and a voice, and a personality and a huge list of needs), I have to ask myself what I am going to do about it? What am I going to do about meeting their needs as I try to remain within my own? How do I find the place where both can be met? How do I place a value, a price, a conciliatory explanation on finding the answer, within the confines of need, for a life that costs me, emotionally and financially when neither are secure, nor, established within mine? Who do I place first in line for a feast of rations?

I could concoct a million excuses. Find a bazillion reasons,, wouldn't you? Wouldn't you rather make her little needy desperate face someone else's problem? Let them figure it out. Just turn a blind eye, make an excuse, who cares? Right? Isn't that the point? Does anyone really care if no one else knows her plight? If no one else hears her heart stop in this wood, did it ever beat to begin with?

This is a blog about blame. The safest place to retreat to when you lack the conviction to do anything more.

So, lets talk about blame.

Veterinary care is too expensive. I mean isn't it? Five thousand for knee surgery. Ten thousand for hips to be replaced. Hit by car with multiple fractures, a few days, maybe a  week in the specialty clinic and you are looking at maybe twelve grand? Maybe more?

A blocked cat starts at fifteen hundred. A puppy with a sock stuck in his gut will set you back three grand,,, to start, complications, which can happen, will cause that to increase. And, remember these are all treatable. Maybe not accessible, maybe not affordable to the masses, but treatable doesn't change the fact we can help them.

So decide.. Take a chance, everything in health care is a chance, cough up a few thousand dollars.

Who pays if no one cares? What about if someone cares but no one can produce viable accessible options? Well I hope we all know the answer. The most obvious victim is the patient. They all too commonly pay for the blame with their lives. Why let them suffer any longer? There is after all no guarantee that they will recover? Why not just save your pennies from the risk of losing them, and your pet, and just blame the vet?

Your vet thinks that the blame is all yours, and, yours alone. Here's why;
  • You waited too long. 
  • You never got the preventative care to avoid this mess. 
  • You weren't prepared for the bumps that are inevitable in every living things life.
  • You should have had an emergency fund available.
  • You shouldn't have spent two grand on this dog when it was a puppy and not be willing to invest 500 bucks in them at age 10 of never having spent a nickel the last decade short of dry crappy kibble.
  • You should have saved your pennies for the pet you claim to so deeply love instead of getting your nails done, your tattoos done, your new car, your new phone, your boob-job. 
Your poor choices are not mine to bail out.

The venom knows no bounds.

Always observant. My pups Storm and Fripp.
We live in a country where we can't care enough to provide humans health care, or, hungry kids school meals. Or decent housing that is affordable at minimum wage.

You want to place blame? Go ahead it won't get us anywhere. But you can feel better about yourself can't you?

So here we are,,, living in a place where people want monthly wellness plans. They think they are getting a good deal. I mean aren't they? Well, maybe in the short run you are, but, ask yourself, better yet ask your vet at that corporate practice how much it is going to be for these;

If you have a male cat.. How much will it cost to unblock them? What if it happens at 2 pm on a Wednesday? Or 2 am on a Saturday? Are you prepared for these? Will they even help you if it does happen? Many, dare I say, most, will send you to the ER. Starts at about $1500. I know someone who spent $9,000. Can you afford that Wellness Plan now?

If you have a 3 year old Lab who ate 5 tampons and is now lethargic, vomiting and can't keep anything down?

What if you have a cat who likes to play with thread/string?

What about the German Shepherd with the basketball distended abdomen?

Or the dog fight dog who has multiple bleeding lacerations?

I know people who have spent $400 on a broken toenail. Want to place blame on exorbitant care costs? This seems like an easy target to start with.

If you are cold enough to look at these faces and not see a life worth fighting for then you will never understand why the blame is cousin to the hateful accusations you are going to get.

People love their pets. We veterinarians love our pets. If we don't love them anymore there is a blame based excuse at the crux of our armored indifference?

We are all choosing to live a life of blame based justification. It's safer here. No vulnerability, no guilt, no shame. No one cares after all, do they? Do you?

At this time and place the last local ER is closing its doors. For good. It was the last place I could send people at 2 am to have that sock, tampon, urinary stone, twisted gut, broken nail, etc.. to go. Now the only choices are two corporately owned clinics. They are bright, shiny, well-staffed and making some group of middle aged venture capitalists driving very nice cars, with very nice clothes and very cushy vacation homes in places we have never been. Want to live their life? Own a forty-thousand dollar bag that the K's tote their laundry in? Well, it's easy. It will only cost  you every other pet with a face you cannot see beyond the doe-eyes for. Just turn them away, kill them as a resolution to their ailment. You don't care do you? You love your stuff more. Its not your fault is it?

You have bills to pay. Vet school bills, a mortgage, kids to put through college, a car loan, and you need your car so you can get  to work. And those poor vet techs. If we don't pay them a decent wage we can't possible help the pets who need us. And if I don't buy the most expensive x-ray machine out there, and have loads of licensed techs I can't attract a decent vet to help me stay open all of the hours that my clients need me to.

Always adorable,, really innocent. Fripp.
So who's fault is it?

Maybe we all need to care more? Care about the choices you make? The businesses you support? The long term acute and emergent choices you make? Maybe the blame is so evenly distributed that one small change can start an avalanche of infectious cures? Maybe you are not prepared? Maybe you love your pets like children? And, maybe on some dark Saturday night at 2 am you will be living this nightmare that is called economic euthanasia so some corporate shark can drive a convertible in a snappy zip code? He doesn't care about you, or your pet? And, really, let's be honest, you don't care about him either.

Charleston. My senior, a local Humane Society find.
If you would like to learn more about veterinary medicine you can follow me here, at my blog, or my clinics website, or, our Facebook page Jarrettsville Vet Center.

I also have a YouTube channel, and the best place for free pet centered advice at

Sunday, February 2, 2020

Happy Tail in a Dog. Why Tail Amputation is Sometimes The Answer. Surgery Photos and Cost of Care Included.

Meet Max.

Max is a typical Lab, effervescent, energetic, and incorrigible. He has two speeds; On, as in Full-On, and sleeping. He is so energetic that he is crated during the day. I know lots of clients who think that their dogs have "outgrown" the crate, but, I think that having pets crated when you are not at home supervising them is a great way to insure a pet who rests and has down time. Mind you this takes training and acclimating, ideally starting as a puppy, AND, carting also helps us in the veterinary medical assistance in that we can prescribe cage rest so that pets are forced to relax and rest. It is especially important for the little dogs with bad backs. These pups need to rest, really sleep and rest. No access to anything. Please don't try to convince your vet that your dog will not jump pn and pff the couch when you leave. They are dogs, they are as sweet and innocent and as incapable of a good decision as a toddler is. Crate rest is an important life long training and healing tool. Max is a crated dog. He is also a happily to be crated dog. So he wags in his crate. He also wags out his crate. If Max has his eyes open he wags.

Max also lives inside. Outdoor dogs, wolves, all creatures in the great outdoors don't suffer from happy tail. They don't have walls to inhibit their happiness. And lets also be honest outside wild animals don't wag much. they have busy schedules to keep them busy and focused. Happy, well, happy is an emotion built on luxury.

When Max came to us he also came with a long, many year history of wagging his tail into beaten burger consistency submission,, that still never stopped the wagging.

A dog with a beaten, sore, painful paw (the other extremity) that we talk about on pets will carry that foot and not use it all to walk on. The nerves that feed the toes and foot are abundant and extremely sensitive. The tail, well it is primarily a bone rod with a paltry bit of leather like skin covering it. No fat, no thick skin like the sole of the foot, nope, just a somewhat flexible whip that swings aberrantly on a whim or a wish.

These are surgery photos from Max's tail amputation. We shave the entire tail from about 6 inches above the expected incision site to the end. We also tie it up so I can aseptically (keep the surgical area sterile) wrap it out. 

Draping the tail so that only a small area stays in the surgical field.

First cut is one of the most important. Every surgeon will tell you that they do A LOT of pre-planning and always keep a few back-ups plans in their back pockets. Once you start you have to be able to figure out every single possible scenario to get out with a happy ending, and what the pet parents were expecting.

Max's previous visit was to start antibiotics, attempt to wrap and protect the tail and discuss options for eradication of the condition we could never seem to manage long term. Max's dad, like all of us would be, was pretty frustrated that the tail never seemed to heal for long. A line of blood lashes lined the hallways. The tail would be found bleeding every night they came home from work. Max and the family never got a break.

Here is the conversation that I had with Max's dad when the subject of amputating the tail came up;
1. This might not be the end. A tail will always wag if the happy soul at the other end of it tells it to. Did you know that even pets with complete spinal paralysis can still (sometimes) wag? Yep,, a happy dog will tell you even through paralysis of all of its legs!
2. We have to keep the tail incision site, no matter how short that tail is, protected for weeks. That takes a huge amount of dedication and oversight on Max's family. An e-collar at all times, frequent post op visits, and protecting that tail are hugely important. If he is allowed access to his tail we will have to redo the surgery.
3. If the surgical area gets infected, traumatized (by him chewing, laying, or banging it on anything) I have to remove more tail. The tail is docked by removing segments of the tail bone, which is essentially pieces of vertebrae. You only have so many pieces and then you risk jeopardizing the spinal cord that innervates and commands Max's ability to pee and poop voluntarily.

Max is still under general anesthesia. His surgery is done, but, now we need to bandage the area before he wakes up and starts wagging again.

I've tried lots of splints, covers, and protective options on tails. The problems are always the same;
a. the tail tapers so that a big wag will cause the bandage to just fly off.
b. The tail, the incision and all healing tissue will respond better if it can breathe, so, the plastic cone enclosures I used to use left the tail stump wet, sweaty and delayed in healing,, air,, we all need air!
c. How to protect an incision and end of tail in 360 degrees and also allow air? 
My latest answer has been a spoon splint. It is the blue spoon shaped item to the right if the end of his tail above.

Bandages are the balance of protection, comfort, and durability. It is an art form that takes practice.

 This is Max (note; still smiling!).

He came to visit about 3 days post op so I could check his incision. As much as it is imperative that the incision site, and new end of his tail, stay protected post-operatively, it is also really important to check the incision frequently. Bandaging protects the healing tissue, but, it also hides a problem should there be one. Max also has an e-collar on 24/7 so he can't lick or chew the end of his tail. A dog, or any and every, post op patient will try to lick, bite, or chew at a painful area. So how do we know what is detrimental chewing curiosity, and, what is an indication of a hidden under the bandage problem? well,, we check the incision frequently, and, we pay attention to our patient. Not eating, or not eating well, pain, or signs of reluctance to do normal activities are all signs of a potential problem. Listen to your patients. They will tell you there is an issue, if there is an issue..

The incision is a little red, but holding well, and Max didn't mind us changing, cleaning, or re-bandaging the tail.

I also replaced the bandage in front of his parents (they are EMT's), so they can replace it at home if needed. We send home extra banding supplies,, JIC.

I want pet parents to see the surgical site at every visit. Everyone should know what it looks like at every visit. How else can they also monitor progress and know what normal and abnormal is? I keep parents involved in all aspects of their pets care. It helps them feel empowered, involved and invested. 

Max approves!

Bandage changes happen every 3-7 days. As long as the tail is wagging comfortably, being held at a normal height and angle and showing no signs of wetness, blood, or a bad smell we change it in the clinic with parents present. I expect it will need to be bandaged for about 6 weeks.

For more on Max read his story here;

The cost of Max's care;

Pre-op exam; $50
Pre-op blood work, full panel $170
antibiotics for infected end of tail $30
surgical cleaner for end of tail $15

Surgery costs;
surgical package; iv catheter, fluids, pump, anesthesia, instrument pack; $250
tail amputation $200
post op pain NSAID $16
splint application $50
additional suture $60
refill antibiotics $30
e-collar $16

Max's story is posted with his families permission. I thank them for allowing me to share his story, photos, and process.

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