Jake's Hail Mary

We at Jarrettsville Vet have some real advantages over other veterinary clinics I know. We have been around for a long time, like 50 plus odd years. It was one of the first clinics in Harford County, MD. 

One of the advantages of being an old timer is that we have some long time clients. They are not just old friends, they are family. We have seen them through many generations of both family and family pet members. It is one of my favorite parts of my job. Meeting the new puppy, or child, and watching them grow.

Some of our clients are three generations of family. One of these clients are the Vacey’s. 

Ms. Vacey takes care of her mom and often also comes in with her daughter. These three women represent three very different generations but they all share a deep love for their pets. I love to see them in the clinic and hear about the latest cat story, dog antic, and most of all it's amazing to see how much all of them care for not each other but their individual pets. They are some of the kindest, sweetest people you could imagine. I don’t know anyone who cares more or does more for their pets.

One day Ms. Vacey was in the reception area in tears about her dog Jake. 

I had seen Jake a few months ago when they came charging into the clinic with Jake who was blue and suffocating. 

Jake is an older yellow Lab. He suffers from a disease called laryngeal paralysis. This is most commonly seen in Labrador Retrievers and I see it more commonly in older Labs. It is a terrible and heart breaking disease. It lurks in the dog until without warning that one fateful day arrives. On that day it attacks the dog’s ability to breath. 

The episodes are brought on by stress, but that stress can be in the form of excitement, fear, anxiety, or really anything. 

Most owners tell me that one moment their pet seems fine and the next split second they notice that their dog can’t breathe. 

If you have ever felt like you are suffocating, or not been able to breathe, then you can identify. It is hell. It is torture. 

These poor dogs arrive at the hospital with their head held straight forward, their eyes wide open (fear), and they will not move. They won’t walk, they won’t respond, they just stay completely frozen in fear. 

Because when you can’t breathe you don’t care about ANYTHING! 

They are an emergency from the first split second they arrive. We bring them immediately to the back treatment area and we give a whopping dose of intravenous valium. I want them sedated ASAP! I give sedation before I place an i.v. catheter. I give sedation before I get permission to give it. I give relief before I think about anything afterward. I sedated Jake with a large amount of valium, and then I went to talk to his moms’. 

Within a minute Jake was sleeping and snoring. Slowly snoring and he was pink again. I sighed with relief for everyone.

I explained to his mom that this disease was progressive and that over time the nerves that control Jake's vocal chords continues to send fewer and fewer messages to the chords. So the chords open less and less. Over time you have to breathe through a narrower and narrower hole in your throat. And when that hole gets narrower the chords hit each other and then start to swell. It is a snowball effect. The further the snowball rolls down the hill the bigger it gets and the more disastrous it is.  

Some lucky dogs start with a small snowflake and a long low grade hill, so they can live years without any real emergencies. Maybe one or two rough sounding panting episodes but no “I’m knocking on deaths door wearing cyanotic (blue) skin.” But the unlucky dogs have episodes more and more frequently triggered by more and more routine things. It becomes torture for everyone involved. The owners don’t want to bring their pets anywhere, invite anyone over, go for walks, or play, etc. etc.  

The only treatment for this condition is surgery. We sew one of the vocal chords to the wall of the trachea so that the hole is open enough to breathe comfortably and the chords can’t hit each other. 

There are a lot of side effects to this surgery. Many dogs with this surgery aspirate. This happens because your throat is sewed open and sometimes you swallow food down the wrong pipe. The consequence of having food in your trachea is that is gets dumped in your lungs. Your lungs are only supposed to have air in them. Once you put fluid, or anything else down in them, they respond by getting inflamed and angry. And a whole new snowball starts forming. This snowball is pneumonia. You really need your lungs to be clear, calm, and only contain air.

After many months of small episodes of breathing difficulty Jake had another disastrous episode. His mom was here to talk about ending his suffering and putting him down. 

She couldn’t bear watching him struggle and was afraid the next episode would be his last. She was petrified that he would die on his way to the emergency clinic and she would be helplessly watching. 

I sat down next to her as she sobbed and told me how difficult this was for her. I listened to her tell me about the episodes getting worse and the frequency increasing.

I told her that I understood everything she was saying and that we had to do something for Jake. I didn’t want him to die during one of these episodes but I knew it was just a matter of time, and probably much sooner than later. I then told her that I was really reluctant to talk to her about this, but we had just done our first tie back surgery a few weeks ago on a dog much like Jake. I told her that this dog was doing incredibly well and that the owner was delighted with the results. I also told her that I knew I was discussing it at a really sensitive time.

I have had this “hail Mary” conversation before with owners when they come into the hospital having made a decision to put their pet down and I offer another option. I have had a few clients start yelling at me. Accusing me of only offering an opinion to make money, or harm their pet, even though I know that I would never offer any opinion that I didn’t think was in the best interest of my patients. It is a sensitive stressful time and there I am throwing a match on the fire.

After I finished explaining the surgery and the outcome of our first, (and last patient), Ms. Vacey put down her tissue and stopped crying. I could see by the look in her eye that she wanted a glimmer of hope and I had just delivered it. She said she wanted to go home and talk to her family. 

I said “OK, just call me with an answer or bring him in if he has another episode” and she left. 

She called the next day and said, “Sign us up as soon as possible.” 

The next week we did Jake’s surgery.

He has been a different dog since. His moms say that it was one of the best decisions they ever made. They tell me that he plays and barks, and seems to be happy and calm and young again.

It has been over 6 months since his surgery and he is a marvel. I adore him and I am so happy his moms are as supportive and invested in his health.

As an end note I have to say a big “THANK-YOU!” to the Vacey’s who came and fostered Sissy an older obviously over bred yellow lab that was found abandoned and never looked for by her former owners. After having Sissy at the clinic for a month we needed to find her a home. She is old, un-housebroken, and has an undercarriage of a well used mother, but she is sweet and gentle. When I called to ask Ms. Vacey if she would help us with Sissy she, her mom, and daughter, came over that afternoon to meet her. Not only did they all meet, but she quickly put a leash on her and took her home. It is the best home any dog could wish for. And for Sissy who was never a housedog and probably never loved, she will spend her last days full of love, affection and pampered comfort with her new and equally lucky, friend Jake.

Here are some pictures of Sissy, (they have re-named her Lilly)

Update;

Jake had his laryngeal tie back surgery in December of 2010. He spent 8 months happy, calm, and breathing normally. His moms told me that they would have been happy to have gotten a week of him being himself again. They also said that they never imagined that they could have gotten 8 months. He spent his last 8 months wagging and that was all they ever wished for.

If you have any questions about Jake, his disease, or the surgery to correct it, or any other pet question please ask me at Pawbly.

We are here for any pet question, at anytime, and always free.

Part 1 of Pet Peeves

I have a few pet peeves. We all have them. But it seems that when you become a business owner, wife, mom, or any kind of professional you develop these. Perhaps it isn’t that your list of things you are responsible for is getting longer, but that the list of things you have definite opinions about is getting longer. I get older, I get more responsibility, I get more pet peeves. It is a very simple linear formula.

Here are a list of some of my peeves and how I got them;

I nag all of my staff, and many of my clients who arrive without their pets on a leash or in a carrier, about how dangerous this is. I don’t care if it is the cat on the leash or the dog in the carrier, but it has to be one or the other. Imagine a big dog jumping up at you to see your cat and the cat bites you in fear, or worse, the cat jumps out of your arms, the dog runs after it and a child gets in the middle of the turmoil. Ask me how many cats I have lost on the grounds of the clinic? It is more than one, and that is 1 more than it should be. What about the dog that is afraid of others (people or dogs) and then lunges at the opposing party? If that dog isn’t on a (short) leash it isn’t under your control. Dog fights happen, and people are bitten. Just 2 days ago an owner lost her cat in the parking lot because she was taking the cat out of the carrier when she got to her car. We now have humane traps surrounding the clinic to try to find her.

I give out microchips for free because I know there is a good chance that at some point you will need it. I always tell my clients that I give them away and hope you never need them. But stats say 2 out of 3 pets will at some point slip away from their owners. I LOSE money by giving them away because I don’t want your pet to end up at the shelter. If you miss your 5 day window to pick up your pet, it may be euthanized, plus the longer your pet is in the shelter the more likely they are to get exposed to illness. A shelter is not an ideal place for your pet! So microchip your pet! Even if it isn’t free!

 If you cannot afford the basic care of a pet then please don’t get one. I know it is an incredible gift to feel the unconditional love of a pet, but that pet brings responsibility. If you want to love a pet love a pet in a shelter, or foster a pet for a rescue. You will still get that unconditional love and that wet kiss, and all of the joys of a pet but the bill will be someone else’s responsibility. Then when you have your feet on the ground adopt a pet and save a life.

Please don’t think that the de-wormer you buy over the counter is the same as the stuff the vets office gives you.  If it says “Do not use on cats” it means, “this will likely kill your cat if you use it on them.”

Please don’t let your pet suffer because you diagnosed them online and are treating with the stuff it suggests. What happens if you, or the all-knowing internet, is wrong?

If you are worried about your pet call and ask for advice. If you still are worried bring your pet to someone. And if even after that you are still worried go get a second opinion. Treat your pet like you would your child, all the same advice applies.

For dogs; I recommend the following; check a fecal once a year, get an annual veterinary exam, or twice a year if they are a geriatric pet, check blood and urine yearly if geriatric, use a monthly heartworm preventative, feed a high quality commercially available dog food, provide mental and physical stimuli and attention daily. Never yell, hit, or rub their nose in anything. Positive reinforcement works much better than negative. If you need advice seek a professional.

For cats; check a fecal once a year, get an annual veterinary exam, or twice a year if they are a geriatric pet, check blood and urine yearly if geriatric, feed a high quality commercially available cat food, provide mental and physical stimuli and attention daily. Never yell or hit. Clean the litter box everyday. Change the litter weekly. I love catnip applied to cardboard scratching mats. I re-apply the catnip weekly and I buy new mats every 6 months. If you need advice seek a professional. Cats only trust you if you are kind, patient, and consistent. Never apply a product, or give a medication or food without  talking to a pet professional first. Cats are very sensitive to many products and I never want to see another cat die because they were given a dog or human product.

Remember that an antibiotic prescribed to your pet is supposed to be used until gone. So don’t call me a year later and ask for more, and then explain that you need it because you have been “spot treating” with it. You are doing to your pet what your doctor tells you that you are doing to yourself, “using an antibiotic inappropriately.  And making “super-bugs”.” An antibiotic should be used until gone to kill ALL of the bugs, not used for a few days then stopped so you can ration the drug for the next time. Because what you might have done is killed the weak bugs and let the strong bugs live. Also if you are using the drugs sporadically and intermittently you are setting us up to try to treat an infection that now might be drug resistant. And please remember that an antibiotic should only be used when you have infection, not an itchy ear, or a red ear.

The correct term is spayed, not spaded.

A spay is a big deal, think hysterectomy, not drive-thru botox. Ask for pain medicine and don’t go to the cheapest place in town. And the answer to pre-op bloodwork is a “yes.”

If your dog is over 6 months old when you neuter him ask to “borrow” an e-collar overnight. Better to have one and not need it, than, well, you know the answer to that.

The more stuff you bring to the kennel the more likely it will be lost, or more likely not used at all. You see your dog in our kennel will poop, shred, or destroy your belongings. Or we will lose them, and “no, not on purpose.” So most kennels put your stuff in a bag to stow away until pick up time the minute you give it to us.

Whenever you call us trying to avoid coming in to the clinic and we try to coerce you anyway please remember we deal with worst case scenario. We understand that you deal with having to foot the bill and re-arrange your schedule, but we don’t want your pet to have worst case scenario disease and be left untreated. So play the devil’s advocate with us, and get your butt and your pet in the clinic.

Just because you “quicked your pets nail one time four years ago, and it bled forever” doesn’t mean that you can’t learn and perform this task on your own. Ask your veterinary technician to show you how to trim the nails and make sure you have the right tools when you are at home.

Please don’t be rude or disrespectful to the front staff or technician, because I promise you they probably know more than you do, and almost as much as the vet does. Be nice. You always get more out of everyone with a carrot than you do a stick.

And last for now. If you have a budget, or concerns about anything, speak up. We always have options and all we really want is to help your pet. We don’t judge and we don’t assume, so you have to talk to us. The care of your pet is a team effort and approach.

Sages long way home

I was called late one evening by one of my technicians. She told me that her neighbor had “dropped” their 4 month old pit bull puppy off of the porch, and she believed the puppy had a broken leg. I told her to meet me at the clinic with the puppy first thing the next morning. Now I know all of you are gasping in horror and thinking that I am a cold, inconsiderate, awful person because I was waiting until the morning. But I will remind you all that a broken leg is not a life-threatening problem. And to my defense I did give her instructions for pain medicines to get her comfortably through the night.

Many times in trauma cases we do not rush into surgery. We don’t rush into surgery because we need to make sure that the really critical parts of the body are o.k. We want to make sure your heart, lungs, liver, kidneys, bladder, intestines, etc. are all still intact. A bone, really almost any bone, is ancillary. Bones are just to protect other more important things, or help you get around.  

I met Sage puppy the next morning. She was the most adorable grey happy bundle of cuteness ever. I knew the minute that I saw her that I was going to try to make everything alright for her. I was dedicated to her from the first moment. It was impossible to not want to hug her, cuddle her, and love her. And that was all she wanted to do back. She was so happy and so sweet and soo adorable. (Man, I just can’t resist a pit bull puppy!  Especially a fat nosed doe-eyed wiggly butt pittie bull.)

Then I looked at her. She was limping on not one front leg, but both. Damn it! I knew what that meant. And then the girls confirmed it with an x-ray. She had broken the right elbow and the left wrist. God, she was a mess. My technician then divulged to me that the family who owned Sage was a very young couple with two children under 3, and the father was undergoing treatment for cancer. She didn’t have to tell me what she said next. They had no money. Really? Am I surprised? Why should I be? I wasn’t? But how was I going to fix two broken legs for free?

I called her family in to talk the next day. I wanted to meet them and decide how to procede. I had some hard questions and I wanted some honest answers.  A 3 year old little girl was being carried in by her mid-twenties year old mom, and barely thirty year old dad carrying a less than 1 year old baby. My first question was, “why would you get a puppy when you are facing cancer and two very small children?” I know it is a direct hard question, but I wanted to know. Why would you get a puppy when you can't afford anything, and you have two small children to raise? Their answer was, “I,” (this is dad speaking), “always wanted a pit bull puppy.” Ok, I understand, and yes, I completely empathisize with the severity of this disease, and the fear of leaving a wife and two small children, but a puppy is a big responsibility. Emotionally and financially. They had no funds to get her basic vaccines, so of course they can't afford a broken leg, (or two). I feel very strongly that a puppy, or any pet for that matter, is a responsibility, not a right. I told the family that we wanted to help Sage but that I would not do it for free. They had had Sage for months and not had any veterinary care for her. I felt that once we “fixed” her she would go right back to being uncared for medically. She still needed all of her vaccines, to be spayed, and then the monthly flea and tick preventatives.  

Sages family signed her over to us that day.

I called a staff meeting to decide what to do next. We collectively decided that we were going to fix Sage. I think that after that I sort of lost track of the plan. Because before I knew it the front desk had raised about $2000 for her care. I was so proud of the staff.  I decided that her wrist could probably just be splinted and as long as we paid very good attention to the bandage and kept it clean, and dry and changed it often so her rapidly growing bones wouldn’t be hindered by the stiff splint she would probably be ok on the left front leg. The splint did help provide her with some rigid support. The splint acted like a cane for her so she was very happy to place all of her weight on her front left leg. She quickly learned how to run around on three legs.

BUT, that right elbow was a big problem. It was beyond any of the vets abilities to fix. I called a few friends to see if I could coerce, beg, plead, for help. It took me three weeks to get an old classmate (and very good surgeon) to come and help fix her elbow. He had to come from his real job, as a specialist veterinary surgeon, to the clinic to help with he surgery. Between his regular job, and a significant delay due to traffic, he arrived at the clinic at 7 pm. We started Sages surgery right away. At midnight I looked across the table at my very good friend trying to help me fix a very bad, very old fracture, and I told him that I was ok with accepting that we might not be able to fix this leg. He stopped his struggling with the ulna and said, “I have never given up yet, and I am not starting tonite.” All I could do was smile and say, “ok.” Another 45 minutes later we had the bones lined up and 2 pins placed and we were closing up our incision. He left the clinic at 1 am. That was, and still is, officially the latest night I have had to stay at Jarrettsville Vet. (Yes, please say a little prayer that that record holds for the next 2 decades). I handed over all the money we raised to our surgeon. It was a small fraction of what he would have made on the same surgery in his clinic, and it was a ridiculously long night.

Sage woke up well.  We kept her heavily sedated on morphine and I carried her home to my husband already in bed. Sage recovered remarkable well. It took her a few weeks to learn how to bend her elbow again and regain the muscle in her forearm and biceps. But the whole time she smiled, jumped around, cuddled and kissed. She was so happy to have friends and dogs and cats to play with. She never skipped a beat, and she never slowed down a bit. Within 4 weeks she was almost unrecognizable as ever having had such a catastrophic disaster.

Sage had been with us for about 6 weeks. She was a part of our JVC family. She stayed at my house and with me for the first two weeks post operatively. She played with my puppies and she slept in my bed and was a welcome addition.

After her 6 weeks of recovery I felt an enormous amount of pressure from the staff and the incredibly generous clients who had contributed to her surgery. I called her family back and we sat down again to talk about Sages' future. I explained to them that I was very concerned that if anything happened to them that she would once again be at the mercy of the generosity of others. I also explained that raising a puppy required time and money. I wasn’t sure that they had either. But it was undeniable how much those kids loved her and how much she loved them, and I wanted the same happy ending that everyone else was rooting for. I asked them to sign a contract stating that they understood what the cost of her basic care would entail, and that if anything happened to them where she would need care that they would bring her back to us. Sage’s mom reassured me that they had multiple emergency plans in place. And that her parents would take her and the family if they needed an extra hand or place to live. I reluctantly gave in to the pressures of everyone around me and took a leap of faith and signed her back over to them.

Because they were neighbors with one of my technicians I also felt better about being able to keep a watchful eye over them.

I asked about her frequently and was told that she was doing fine.  Six months went by. My technician came to me again and said that Sage had been given away by the family. I was very upset by the news. I asked why?, and she told me that they couldn’t care for her any longer. I was furious. I had gone against my gut feeling, I had provided them with everything Sage needed for her first year, and I had made them sign a contract saying that they would give her back to us if they couldn’t care for her any longer. I asked if there had been a death in the family?, or if they had moved?, and my tech told me that "No, they were fine". She did add in that she hadn’t seen Sage in a while and that she thought that Sage was now on a farm getting more exercise and with people who loved her, because that what her neighbors had told her. My tech knew I was furious and she knew that I was going to try to track Sage down. She told me that she believed them and that she really thought Sage was ok, and better off in a different home.

Months went by. And then my phone rang at the clinic late one Thursday night. I remember my receptionist Michele (Nina’s mom) running back to the pharmacy where I was screaming, “Baltimore County Animal Control is on the phone!” and “They have Sage!” I picked up the phone immediately. The director of the shelter was on the phone. She told me the following; That sage had been brought in that day by a Baltimore City police officer. He had gotten her because a Baltimore City Animal Control officer had been dispatched to his house because his neighbor had called to complain about his pit bulls. You see in Baltimore County, and many other places, there is an extreme prejudice against pit bulls. He actually had two very nice pit bulls, but his neighbor wasn’t too fond of them. When the animal control officer pulled in the police officer saw a sweet grey female pit bull in the animal control van. He asked the officer where he was going with her. He told him that he had just picked her up because the owners had bought her off of Craigs List and then had decided that they didn’t want her anymore, so they called Animal Control. Apparently in Baltimore City Animal Control will come pick up an unwanted animal. But in Baltimore City ALL surrendered pit bulls are euthanized. When he told the cop of her impending fate the cop said, “well can I take her?” Now remember the animal control officer was there because the neighbor complained that he already had too many pit bulls, but for some reason he let the cop have her.  Now he had three pit bulls.

Three pit bulls was 1 too many for his house. He quickly realized. He started making some phone calls to try to figure out where he could bring her to try to find her a home without risking her being condemned based on her genetics. He found Baltimore County. They, unlike many others, do not euthanize based on breed. The staff at Baltimore County shelter told him he could bring her there and if she wasn’t adopted in five days, or if they couldn’t adopt her out, then he could come and get her. But at least she would have a chance at finding a home.  When he brought her to the shelter they scanned her for a microchip. We had micro chipped Sage as soon as she was surrendered to us, and it is my policy for this very reason that I do not ever allow a new owner to change the microchip information if the pet is adopted from us. (To date we have gotten three pets back that have been brought to shelters to be euthanized.)

I was soo happy to get that phone call. I told the manager that I would send someone immediately to go get her. She told me that the shelter was closed and that she would hold Sage overnight and let us come and get her in the morning. I gave her my name, my cell phone number, and I told her that we would pay the adoption fee to get her back. She told me not to worry and that she would be there first thing in the morning to meet us. I hung up the phone and relayed the entire phone conversation to the all of the staff who had been eves dropping the whole time. I called the technician who was neighbors with Sages' original owners and told her the whole story. We both had to convince each other that we wouldn’t do something vengeful. We were soo happy to know that Sage was safe, but we were all hurt, and infuriated that they had sold her.

At 8 am the next day two of my technicians went to the shelter and picked her up. She was not exactly the same dog we had remembered. She was skinny, and had a terrible coat, and was not the happy, outgoing, sweetheart she had been. She was now the result of neglect, probably abuse, and I can’t even imagine what else. I feared that she had been sold to go into fighting, and that maybe she was just lucky to have not been killed, because we hadn’t raised her to be a fighter. There were a million thoughts running through my head. But I stayed focused on the fact that at least she was back safe with us, and I had learned my lesson. I will always trust my gut feeling, and I will not let other people coerce me into ignoring my gut. I also spent a lot of time trying to keep myself calm. It was very very difficult for me to not call her original owners and say some really terrible things to them. I almost didn’t care whether he had cancer, and I almost didn’t care what he was thinking, or how he could have justified doing what he did. I will never forgive them for selling her and leaving her to face what would have most likely been a death sentence. Whether it be by lethal injection, dog fighting, or gunshot.

It became clear to all of us immediately that she could not be adopted out without a significant amount of re-training. She now bit people out of fear, and she couldn’t be trusted. It was three weeks of trying to rehabilitate her in the clinic before we all decided that she had to stay with us. Michele asked if she could “foster” her at home. She had just lost one of her Rottweiler’s and she had another Rottie dying from cancer. I was worried that the stress of losing two pets and taking on a behavior case might be too much for her. But I also knew that Sage needed to get out of the hospital and needed the one-on-one attention of her own owner. I told her “yes, on a trial basis.”

Sage went home with her, and she went back to being the puppy we remembered. She hasn’t had any issues, and she and all of us are so happy to have her back.

I don’t know how Sage, or us got so lucky, I am just very grateful that we all did.

Disney's Dilemma

A few years ago a very nice woman came into the clinic with her not very nice dog Disney. Disney was all black, about 40 pounds, and had a long fluffy full coat. She was always overweight even though she always tried to hide it all under a big full jet black coat. I tried many, many, times to convince Mrs. Nicks that Disney was overweight and needed a strict diet, (i.e. no more table scraps), but I knew that she lived with her elderly mother, who she cared for, and between the loneliness of caring for a mom with dementia, and the mom with dementia not ever remembering not to feed Disney table scraps, it was pretty much a lost cause.

The first two years of knowing Ms. Nicks and Disney we had the routine examinations, vaccinations, repetitive pleading of trying to get some weight off Disney, etc. etc. then one day Ms. Nicks called me to tell me that Disney was going outside trying to pee but only a few drops were coming out. And she kept going to the door, and Ms. Nicks kept taking her out, but all Disney could produce were a few drops of urine. I told her to bring Disney in right away. I was expecting to find that Disney had cystitis, (inflammation of the urinary bladder). So all I needed was a few drops of urine, and all Disney needed was an anti-inflammatory and an antibiotic and we were on the mend.

When Disney arrived I gave her an examination. I cannot ever express to the new vets out there how absolutely imperative it is to always give a full complete comprehensive examination.  Instead of finding an empty flaccid small sensitive bladder low in the pelvis, I found a very large full distended painful bladder that took up almost the entire caudal (back half of the) abdomen.  I took a gasp and swallowed the horrified look in my heart. We next went to x-ray. I was hoping to not find anything obstructing her ability to urinate, like a tumor, stones lodged in the neck of the bladder, etc. I was afraid to try to manually express her bladder by pushing too hard on it. You see at this point the bladder has been so distended for so long that often it is a thin weak balloon, and any amount of pressure can cause it to rupture. If the bladder ruptures it will spill the urine into the abdomen and the urine acts like caustic acid to the sensitive peritoneum (the lining of the inside of your abdominal wall). My next plan was to try to sedate Disney to place a urinary catheter. My first priority was to relieve her bladder distension and then try to figure out why this was happening to her. We placed an i.v. catheter collected our blood work and then gave some i.v. sedation. Within minutes there was a flood of dark pungent urine everywhere. I took a deep sigh of relief for Disney. We sutured the catheter in place and started her on the aggressive i.v. fluids I knew she needed to start correcting all of her kidney and electrolyte abnormalities. The next few days Disney seemed to feel more and more like herself. Which in Disneys terms meant she was less and less of a cooperative patient. When she was feeling well enough to not be able to be handled at all I called her mom and sent her home.

During her time in the hospital we ruled out everything except a neurogenic cause to her problem. This meant that the root of her inability to empty her bladder was because she either couldn’t squeeze the muscle of her bladder wall down tight enough to empty, or she couldn’t open the valves that keep the bladder shut. So I started her on all of the medications I could to try to tell her nerves and muscles to work the way they were supposed to. This plan worked for a few months.

Over the next year there were many interrupted evenings of meeting Disney at the clinic to try to repeat the procedures we had tried so successfully the first time. Each time it became harder and harder to get her relief. Until finally one evening I told Ms. Nicks that I would have to open up her abdomen and try to empty her bladder from the inside. I remember crying with her in the surgery room. I knew that Ms. Nicks knew that I was having as much of a difficult time making the decision as I was. I knew that my only hope of getting Disney off of the surgery table alive was with a urinary catheter being placed from inside the balloon instead of my usually threading it through the urogenital opening.  I looked into Ms. Nicks eyes, both of us sobbing, and she said to me, “I know you want to know why she can’t urinate, and I know you want to try to help her again, but I can’t put her through any more”. It was a hard painful decision for all of us. Ms. Nicks had lost her mom a few months ago, and she was losing her last companion. I knew that putting Disney under general anesthesia and exploring her abdomen and bladder might fill in some of the answers I had not been able to get before. But I also knew that we were at the end of her or her mom’s ability to treat her. I lowered my head and told her mom that I was so sorry. I then said goodbye to Disney and injected the pink syrup into her i.v. catheter. I turned off her monitors and I cried over her as she died.

I have talked to Ms. Nicks many times since that day. She still comes to our Christmas parties, and she still drops in to say hello every so often. I have even called her to see if she would be interested in helping us by fostering a dog. But she always tells me that she still isn’t ready for another dog yet. And I understand, and tell her that we miss Disney too. Even though I am pretty sure Disney never liked me back.

If you would like tolearn more about neurogenic anuria and cystitis please see the link below;
http://tinyurl.com/3fwekct

D.C.

This is the most personal story that I could write and share. It took me three weeks to be able to send it out into the world. Whenever an owner tells me how much they are grieving over their pet I think if how much I miss my cat D.C. I still can’t think of her or talk about her without crying. There isn’t a day in my life where I don’t think about her, grieve for her, and miss her like crazy. I understand how loss can profoundly affect your life.

To my kitty D.C; I say I love you, and I am so grateful for always helping me through the really rough spots of my life.

Here is D.C.’s story

I was looking for a kitty when I finally got my first apartment. I know most people get dishes and a sofa. I wanted a cat. Actually I wanted two but I told my roommates that I was only going to get one.  So I headed to where any responsible new pet owner would go for a cat, the pound. I, at that point, still considered myself a very knowledgeable, wordly, solidly standing in the “nothing shocks me anymore” veterinary arena. Suffice to say, I was so wrong. And I wasn’t just a little wrong. I was you aren’t even in the same galaxy wrong. I walked into the Baltimore City Animal Shelter with a plan and an air of confidence. As I crossed the threshold into the facility I was met by a foul smelling, disorderly, waiting room. There were a lot of people, I thought this was a good thing, I thought there were a lot of people there to adopt. Unfortunately I learned they were there for drop off and not pick up. Oh I was wrong on so many levels. I waited quietly and patiently to go in through the adoption rooms to find my kitty.

After some time I was escorted to the cat rooms. There were 2 at that time. They were the size of a closet. Lined on one side with cages, with just enough room to walk single file down the row piled three high of cages. There were maybe 30 cats in those 2 rooms. “Great,  I thought, there aren’t a lot of cats here they must have a high turnover.” Wrong again, they have a 5 day hold for these cats then they were euthanized. So all of those cats had been there less than 5 days, if they weren’t adopted or claimed by their owner, (which I swear never ever happened) they were euthanized on day 6.  I found out later that they routinely euthanized 70 plus animals a day. I spent a long time looking in those cages. This was a big decision and I wanted to make the right one. I had my boyfriend there with me. He picked out the small long haired cute grey kitten. She was almost irresistible. She was the obvious choice. I kept looking. In one cage in the second room in the middle of the racks of cages, there was a small, skinny  calico cat screaming. She had green snot pouring out of her nose and her eyes were all crusted shut. She was the cat no one would pick. I wanted her. I wanted her because she would meow and meow and meow. She wanted attention and she wanted a home. And I like anything that is assertive and demanding (no Freudian jokes! please?).  I asked the attendant if I could adopt her. she said she was too sick to be adopted, but I could put her on “hold”. If she was better she could be adopted. I was told that she had an upper respiratory disease that had turned into a lower respiratory disease and pneumonia. I filled out all of the forms and we left with one small grey kitten.

I called the shelter the next day. She wasn’t any better. I called everyday for the next 5 days. She was worse and not better. Finally on the 7^th day I went back to the shelter. I asked to see the manager. I explained that she wasn’t going to get better if she stayed there and I wanted to try to help get her better. I told her I would pay her adoption fee and take responsibility for her medical care. The shelter manager looked at me and I knew she was weighing whether or not she should break the rules for me and a sick cat. I took her skinny sick bony body home.

I spent the next months trying a lot of different antibiotics and running a lot of tests. She did eventually get healthier. She was always a petite cat, but she gained muscle and her coat got shiny and full. (I always tell my clients that cats get a poor coat within 1 day of being sick, so monitor coat quality closely). Her ocular (eye) and nasal (nose) green discharge also subsided with time.  But the one thing that never changed was her demanding meows. She would call for me every time I came home. It didn’t matter where she was. If she heard my voice she would scream for me. I always said hello to her cries, and she always came running for me. If I ever was upset, especially if I was crying, should would stand in front of me and meow until I stopped. More truthfully, until I focused my attention on her, but either way it always worked. Whenever there was an argument in the house she would stand between us and scream until we stopped. She really was my guardian and my most faithful companion.

I was so profoundly moved and concerned about the conditions at the Baltimore City Animal Shelter that I became their first official volunteer. I went to the shelter four times a week for 3 to 4 hours at a time to just walk the dogs and pet the cats. I was concerned because it didn’t appear that the animals were getting any attention from the over taxed overworked staff. After about 8 months I realized that I was really struggling with what I was seeing everyday. It was routine for them to euthanize 70 animals a day. I cried everyday I got home. I couldn’t carry this sadness and I couldn’t stop the death. I couldn’t help but get attached to these cats and dogs. I couldn’t bear not to see them the next day I came in. it burned a scar inside of me so deep that I changed careers at age 30. I spent 12 years in college so I could become a veterinarian. I bought my own clinic so no one else would ever have to tell me which pet gets a second chance and which one doesn’t.

D.C. died at the age of 19 in my arms, in my bed. She had struggled with chronic renal failure (kidney disease) for many years, and in the end she was too weak to stand. But she lay with me for two days and meowed every time I looked at her. It was so hard to say goodbye to her. Her fragile little body had lasted far longer than I ever would have guessed when I adopted her so long ago.

I went back to the Baltimore City Shelter a few years ago. I went into the room where I had found her.  I told all of the kitties there that I hoped that they found a loving home and that someone loved them as much as I loved my cat D.C.

For more information on chronic kidney disease in the cat please see the link below;

http://tinyurl.com/3bwedjy

If you would like more information on upper respiratory disease please see the link below;

http://tinyurl.com/3zelewn

If you would like more information on pneumonia please see the link below;

http://tinyurl.com/44jbebu

Levi's Luck, and why we don't get a DVM degree online.

Levi’s story began very oddly.

Our first meeting.

I was called to the front desk one afternoon because, "There was an older gentleman in the reception area who had walked into the clinic and requested to talk with me."

I always get nervous when someone walks in off the street and asks for me by name. I knew I didn't have any appointments with anyone and he obviously was not a drug rep. (They, for reasons still not understood by me, always show up unannounced). I went out to the reception area and introduced myself with a hand shake, a smile, and a "hello." 

The man stood up, shook my hand and told me that we had already met and asked me if "I remembered this meeting?"

I slowly and quizzically said “No.” 

“I was here a few years ago with a friend who was here to euthanize his beagle.” (Still no recollection of any of this on my part). “You talked him out of euthanizing the dog because you believed he had a treatable medical condition and you said you would not euthanize the dog unless he was suffering and not treatable. I was so impressed by your compassion that I wanted to talk about my daughters dog with you.” (There was no dog with him. First red flag... Check).  

He went on to tell me that he had a 2 year old yellow lab that had had 2 seizures. He explained that his daughter was having some personal difficulties and that he and his wife were taking care of the dog, named Levi, for her. He went on to describe that Levi was a very active dog and they kept him outside in a chained enclosure. 

Somewhere in this discussion I asked him if he "was a client of ours?" 

“No, we bring our dogs to the clinic up the street.” (Red flag number 2. Check). He mentioned several times that he and his wife were “on a fixed income.” (I always secretly laugh at this. I mean, who isn't?) He went onto tell me that he had diagnosed Levi’s disease already. 

I asked "who had done this for him?" I expected he would tell me that the vet down the street had. 

Instead, I got “we found it on the internet.” (Red flag number 3. Check). Every vet in the world cringes inside when a client tells them that they have been doing their own vet school training online. 

When I asked him "What he based this diagnosis on?" 

He told me, that "Levi has had 2 seizures. The last one had lasted over 2 hours." And, that “it was really hard to watch him seizing for 2 hours, so he thought it would be better to euthanize him then let him suffer through another one of these.”

It was very clear that Levi needed a veterinarian to look at him. I told him that I would be happy to set up an appointment.

He asked "whether Levi’s presumed diagnosis was treatable?" 

I told him that "it certainly could be, but Levi needed an examination and work-up before anyone should diagnose him."

He then told me he was going to go back to the vet up the street and have him put down. He thought it would be cheaper than treating Levi.

I told him that "I believed this was immoral and unethical." I told him it was "$50 for a euthanasia here, which we would not do, and $45 for an examination." He once again repeated "that they were on a fixed income and he was sure that Levi was not treatable," and "he wouldn't put a penny out for him."

I had to take a deep breath and get out of the reception area. I was about to internally combust. 

"What the hell?" I thought. Did this man seriously just walk in here to tell me he was going to euthanize his dog? Was he asking for a professional opinion? Or a consent to his medical diagnosis? God help me not castrate him, or start screaming obscenities to him.  I asked him to follow me into the exam room. (Note to self, need to install sound proof walls in examination rooms). 

I realized that this dog, whom I had never met, owned by this man who wasn't a client, had no hope unless I agreed to do everything for free. I am happy to do pro bono work, but, I am indignant to provide it to people who can pay but would rather buy a new car, gun, cell phone, tattoo, or new replacement dog than help their companion when they need them most. 

I told him that he "could bring Levi in and sign him over to us and we would give him an examination, blood work, and come up with a treatment plan." He reiterated to me that he "would not pay for anything!" (I am not sure which part of free he was confused about?)


He left. I went to my office to settle my nerves. (Usually this means I take my dogs for a long walk). 

He came back the next day with Levi. I knew the minute I saw Levi that this was the right thing to do. Levi came bounding in the clinic door, tail wagging, tongue lashing out air kisses to everyone and everything he saw. I stopped thinking about how disappointed I was with this man and I reminded myself why I never choose the easy road. When I saw Levi I knew instantly that I loved this dog. He was all love but no manners. He looked like he had just escaped from dictatorship lead solitary confinement. Oh my goodness was he the worlds happiest dog!

As soon as the legal papers were signed we began performing every test we thought relevant, made up a treatment plan and observed him very closely. He had a seizure within the first few days with us. After a week I began calling clients to see if I could coerce someone into fostering him. I was very worried he might be having seizures at night that we weren't privy to. 

A seizure is a disorder at the level of the brain. In simplest terms it is what happens when the internal wiring and circuitry of your brain goes haywire. I remind my clients that it is always a life threatening event. I always make sure that my clients with pets that have seizures have an emergency plan. This includes emergency medications they can administer at home, and directions to the emergency facility if the medications don’t work.

Levi was tested for Lyme disease and was strongly positive for it. I was hoping that the seizures were a result of the Lyme disease. He also had a lot of discharge from his right eye. His right eye had what we call entropion. This means that the (lower eyelid in his case)rolls in and rubs the eye. If you have an eyelash, or other foreign body in your eye, you know it immediately and you try to remove it immediately. Think about having a whole bunch of hair rubbing your cornea (eyeball) every second of every day. You would do what he was doing, squint and tear, a lot!

Levi lived at the front desk for about three weeks. For every client who approached the front desk Levi would jump up, wag, and greet them. It was impossible to miss him, and impossible to dissuade him. He wanted to announce to the world that he was free and friendly. For one of our visiting clients Levi's hello caused her to fall in love with him even faster than I had. 

Within minutes of that smile she announced that she was "going home to tell her husband about him!" And, that she "was coming right back for him." She announced that she wasn't going home to ask permission, (the respectful thing to do in your marriage), but she loved Levi and needed to break it to her husband without the four legged bouncing boy breaking the news not-so- gently for her.  She came back a few hours later and took Levi home. I gave her a large supply of anti-seizure medications, explicit instructions, my cell phone number and an emergency plan. Levi did great in their home. He is still having seizures and is being treated for epilepsy (not the dreaded "untreatable" disease the internet had diagnosed him with). We also surgically corrected the eyelid deformity. His new family loves him immensely. He comes to visit often, tail wagging, kissing, and cuddling up to all of us. I am grateful everyday that he found a great home and that they love him in spite of his life-long disease. Levi has a great support system and medical team, dedicated to his well-being.

It has been about 6 months since Levi came to us. Last week the receptionists came to me, again, to say that there was "a man here to see me." This time I asked "whether or not I wanted to talk to him?" As soon as I saw him my heart sank. 

I trudged toward him and muttered a reluctant muffled “Hello.” 

“Do you remember me?” This time my answer was a definitive “Yes”.  

“I know I am not supposed to ask, and, you don’t have to tell me.” (the transfer of ownership papers he signed state very clearly that once JVC takes responsibility for a pet we do not give the former owners any further information on that pet). I took a deep breath again. I didn’t want to give him the satisfaction of relieving his guilt, (although now that I think about it, maybe he wanted to feel as if his medical diagnosis had been correct?). 

"He’s dead right? You had to euthanize him because he wasn't treatable. Right?”  

I confessed to him that Levi was doing very well. He had a wonderful family who loved him very much. After which he told me that he was going back to the breeder to buy a new puppy. 

I shed my professional composure suit. “You have no right to ever own another pet. You dumped Levi. A pet, just like every other living thing, requires time, care, AND, it might even  cost you a nickel if anything happens to them.” 

He stood up, said to me, “I knew you would be tough,” and left.

I am rethinking the walk in and request to see me thing.

If you would like to learn more about seizures, please see my blog on "Seizures What I Tell My Clients."

If you would like to learn more about entropion please see Corky's Story.


Meet Levi. This is pre-op for the eye. I will post post-op pictures in a few weeks, (after it has healed).

Happy Birthday Levi

"There is no such thing as too big to be a lap dog. Is there?"

Shotgun

Another grueling long day comes to an end.

Everybody needs a shoulder to lean on.

Pets With Santa

It has been over three years since I first met Levi. He is still a sweet, gentle, loving boy to a family who lost their son fighting overseas for our country a few years before Levi came into their lives. Levi remains at their side, helping to shoulder the grief of a loss that is deep and intensely painful. He has brought love, life, humor, joy, and levity into a family. His former family has no idea of what a wonder this boy is. To see one family purchase, chain, and then abandon and then another adopt, rescue, love, and honor the same dog is a true miracle and reminder of what the best of humanity looks like. 

There is always love to be found out there. Never give up on the power of second chances.

Update January 2016; I still see Levi every few months. I has been 5 years of watching him wag his way in the door. Many giggling visits with his family. Many tales of lab antics, silly dog capers, and he has remained the joy in a family who believes that the love he spreads far out weighs the condition he came with.

If you have a pet in need please join us on Pawbly.com. We  are a free pet information network with the sole purpose of helping pets live longer happier and healthier lives.

Levi, January 2016.. he had a long day of playing in the snow.

Moe's gentle heart

I am a veterinarian. I usually don’t believe that your job should define you, but sometimes it is the most accurate summary descriptor I can use to characterize myself. I, like most of the rest of my colleges went into veterinary medicine because we like animals better than people. Not really an admirable quality, but honest. Of my many memorable veterinary experiences it is usually the pets that burn a place in my heart and head. This time it was the clients more so than my patient that made this case so memorable.

Any seasoned versed veterinarian will tell you that there are many important qualities to put in your holster on your way to becoming a great practitioner. You have to remember all of that stuff you were taught, tested on, and were supposed to have read, absorbed and understood while in veterinary school, then you graduate and have to learn how to integrate what you learned into what you are seeing, and on top of that, and probably the most challenging, you need to learn how to build a strong trusted relationship with your patients’ owners. Here is where the cavernous juxtaposition lies. We go into veterinary medicine because we like animals then we have to learn how to relate to people so we can help their pets. If a veterinarian can’t master this skill they may be able to practice great medicine but they will never feel as if they made a difference in a life. You see we have the ability to heal but without that human connection you can’t feel the difference you may have made in someone’s life. The longer I practice medicine the more I understand that it is the human’s lives I am impacting through the healthcare of their pets.

Those seasoned vets will also tell you that it is the people you help and touch and the lives on both sides of the file, owner and patient, that in the end leave you feeling as if your career, your talents, and what you give along the way are what makes this job rewarding. You also learn to not judge your clients. Sometimes the softest hearts come in the most unexpected packages. I have learned to treat every client as if they were my mom. You see my mom has a big heart but she is really bad at making healthcare decisions. Whatever her vet tells her to do she does. It isn’t an interactive experience. She cannot understand and decide what to do for her pets.  She wants her vet to decide for her. Unfortunately my dad has to pay the bills. So on many occasions the vet gets stuck in the middle of the healthcare professional and the accountant. I try very hard to present every owner with my professional findings and what treatment plan will be best for their pet. I also give estimates. Sticker shock is an unpleasant thing for all of us. But I cannot decide who gets offered the “great medical plan” and who gets offered the “discount corner cutting medical treatment” plan.

On one Sunday I met the Smitts. They were very kind, soft spoken gentle people. They didn’t dress fancy, and didn’t put on airs of being anything other than very concerned about their kitty Moe. They asked lots of great questions, were very involved in Moe’s care, and wanted nothing but the best care for their beloved kitty. They were clients that we hadn’t seen in a long while.  You see we keep tabs on our paper files that identify when the last time we saw you was. It had been so long that we didn’t have their paper file anymore. We only had a computer print out of the prior transactions they had with us. The last date in the file was the mid 90’s. Today they had brought Moe to see me because he was unable to walk, not eating well, lethargic, and had a large area of excoriation (abrasion) on the side of his head just below the right ear. I began asking for a more elaborate description as to the sequence of events with the wound to his face. They went on to explain that they believed he had ear mites and to treat them they picked up an over the counter ear mite treatment. Upon further inquiry I asked if this cat had been outside. “No, they replied, not in about 10 years or more.” I also asked if he had been vaccinated. “No, not in quite a few years.” I explained to them,( like I do to many clients), that an indoor cat still needs a rabies shot, and still benefits greatly from an annual examination.  It is a very common oversight amongst many cat owners. Veterinary medicine is just starting to get the word out to our clients, that we have been neglecting cats for too long. I understood that they didn’t intend to withhold care, they were just never told that Moe needed it.

My questions to the Smitts didn’t seem to be making my list of Moe’s possible problems shorter, but longer. I tried to politely recommend that in the future the diagnosing and prescribing be left to the vets. I had no doubt that they meant well I was just pretty sure that Moe wasn’t itching because he had ear mites, and that the well intended medication had not made him better. I was fairly certain that his problem lay in his brain, not his ear.

The inner ear lives right next door to the brain. Actually it is not so much as a neighbor but more like the other side of a duplex. There is a thin wall of bone that separates the two chambers but a problem in one side of the home can look a lot like the problem resides in the other. Because Moe was so weak, and unable to walk, I thought that he should be admitted to the hospital for fluids and aggressive treatment. I also explained to them that I had to have rabies on my list of possible diseases. I remind my client’s everyday that even indoor cats can be exposed to rabies and that it is important to have them vaccinated to protect them from this fatal disease. I use the saying “rabies kills everyone it meets” often. I have seen many rabid animals, cats especially, and I hope I don’t ever see anymore ever again. It is especially heart wrenching having to tell a family, including those with young children that they have been exposed. It is hard enough to lose my patients I don’t want to lose a person. They understood my concerns and agreed to have him hospitalized.

After 24 hours of i.v. fluids and antibiotics Moe stopped eating and was unable to get up at all. I called the owners and expressed my concern for him. They were always calm and kind and involved with his care. They came to visit him everyday. They cried over him in his cage. They offered him affection, all sorts of appetizing wet canned food. But nothing got him eating or better. Through every single poke, probe, needle, exam, and medicine he purred and cuddled. He was always so sweet. And his owners never gave up on him. They wanted him to get well despite every bleak prognosis we gave them.

Moe died a few days after he was admitted to the hospital. He purred everytime he was approached by every person in the hospital. He was a sweet, and gentle loving boy until his last breathe.

I hope that the Smitt's adopt another kitty. I can't imagine them not having a cat to share their life with.

I know that Moe was very lucky to have such kind and gentle owners, and I know he was a reflection of them. There is a part of me that truly wishes every kitty was as nice and gentle as Moe, and every client was as concerned and caring as the Smith’s.

If you would like to learn more about rabies please visit the link below;

http://tinyurl.com/3c8nh4a