Saturday, April 28, 2012

Part 4, Reader's Digest May 2012 Article, "50 Secrets Your Vet Won't Tell You"

Part 4 of the May 2012 Reader's Digest Article, "50 Secrets Your Vet Won't Tell You," by Michelle Crouch.

"Secret's" 16 through 21. This section is titled “What We’re Doing”

Number 16
“Sometimes we do things for free, just because we want to help the pet.” Sandy Willis, DVM, DACVIM, an internal medicine consult in Seattle WA.
I REALLY need to send this woman a card. Is there another vet out there with as weak a heart as me?
Actually on this topic I just talked to Dr. Leasure at VOSM. He is doing a femur fracture repair for one of my clients (I will write Ophelia’s story soon) at a lower cost (Chris please don’t kill me for admitting this), because the client is soo in love with his Ophelia and he wants her leg to be fixed by a professional but he cannot afford the cadillac fix. So Chris's heart, just like mine, and many other vets, is torn between trying to help our patients and clients by providing services more affordably and running a profitably (gasp) vet practice. Often this means some stuff is given away to our clients for “free”. It is hard to run a veterinary clinic as a business (ask my husband). I absolutely cannot run JVC like I would a clothing store. If you couldn’t afford the dress you really wanted I would tell you that I have some other more affordable dresses you could look at but I wouldn’t lower the price. Does anyone go to the grocery store and ask for a “discount”? I get asked for this everyday..(it makes me a little annoyed). I would much rather be told, “hey doc I have limited resources can we start at the conservative side?”
Anyone have any great ideas for me to not get cold hearted, jaded, or bitterly annoyed and not be giving discounts or free services everyday? Yeah, I don’t have any good ideas either.

Number 17
“New staff or training students sometimes practice injections or catheter placements on your pet. If you'd rather not allow your pet to be used in this way, make sure you say something beforehand.” Oscar Chavez, DVM
OK, here’s where my honesty comes shining through. I will tell you that you absolutely need to be at a veterinary hospital where you trust the staff and mission behind the hospitals name plate. It would be unfeasible for us to run a hospital without training our staff. One of the things I take the most pride in at JVC is that EVERY technician at my clinic can place a catheter AND give an injection. Every technician (and veterinarian for that matter) had to learn this. It takes practice. I let my staff practice on my pets and I let them practice and encourage them to practice until they feel confident doing it. BUT, they do not practice on sick pets. And if anyone is having a tough time placing a catheter, which happens to ALL of us, we swap out and let another person try. Asking me to not let your pet be used for training my staff says to me, “I don’t trust your staff." I will reply to you that, “I understand how much you care about your pet, and I will do everything to make sure your pet is treated with the utmost care and concern.” There is no “untrained” staff at my clinic. We are ALL "in-training" everyday. Medicine is a lifelong learning process. (In fact as I write this I am at the CVC Veterinary Conference in Wash DC, learning about all sorts of things. Those blogs to follow).

Number 18
“I’ll let you in on the secret of no-kill shelters: We had a contract with our local Humane Society that stated we’d euthanize the animals in their care that needed to be put down. One Sunday, they sent us 72 cats to put down. By the end, we were all emotionally devastated.” Jessica Stout-Harris.
I know no one wants to hear this. But here is the truth. THERE IS NO SUCH THING AS A NO-KILL SHELTER. Some are much closer than others, but no one is no-kill. If they say they are no kill then they are turning people away at the front gate to preserve their statistics. Which means these pets are instead being dumped at the city/county/public shelters where some of them have kill rates of 90% plus. If you dump your pet, (for whatever reason you think is justifiable) there is a VERY good chance they will be euthanized, and you are responsible for the death of that pet, the blood is on your hands. 
There is a terrible problem with pet overpopulation in this country. Pets are a life-long commitment that requires time, patience, emotional and financial responsibility. Please don’t enter into it lightly because the consequences can be devastating.

Number 19
“Behavior issues are the number 1 cause of pet re-homing, euthanasia, and death. Yet because it’s not medical, most of us don’t learn much about it in veterinary school.” Oscar Chavez , DVM
This is a true statement. Behavior medicine has blossomed to become its own specialty in the last decade or so. We have two behaviorists on staff at JVC and they get referrals daily from the rest of our staff. I have seen 3 month old puppies come in for their puppy shots already growling and biting. These guys scare the Dickens out of me. They need immediate intervention. I always recommend puppy classes to my clients, regardless of how many puppies that have had previously. We all need re-fresher parenting classes, and it is a great way to spend some real quality time with your pet and to get them socialized. I have had to euthanize countless pets because of behavior issues. It is the reason JVC has 5 cats, and 2 dogs looking for homes right now.

Number 20
“Your vet may not have gotten into vet school! Vets who can’t get into traditional U.S. veterinary programs due to bad grades and poor test scores often go to for-profit schools in the Caribbean, where, basically, if you can pay the tuition, you can get in.” A vet in Cal.
This is the first question I was asked when the client came in the other day to interview me. I was a little blown away. It is true there are many vet schools setting up outside of the United States. These schools market themselves as being "available to anyone who wants to be a vet." The criteria to get in to them is much different than the U.S. schools. I have seen both very poor veterinarians and exceptional vets come out of these "abroad" chools. Because of this I cannot say that you should cast a disapproving eye on them. Vet school, and the life you lead after it, are what separate the good from the bad vets, and even that is in the eye of the beholder. I went to Virginia-Maryland Regional college of Veterinary Medicine in Blacksburg, VA and I do believe I received a first rate education. But it was very hard to get into. If I had a more difficult time, and if I could have afforded it, (which I don’t think I ever could have) I probably would have gone abroad. I was that determined to go.
Oh, here’s a question for you? I have often wondered if “anonymous” is synonymous with “cowardly”? I think if you believe something enough to say it and have it published you should stand behind it. We are all entitled to our opinions but are we all to afraid to voice them?
And, for the record, as my interviewer was told, "all of the vets at JVC went to U.S. schools."

Number 21
“No regulation says vets have to check certain lists before they euthanize an animal, and lots of vets still do convenience euthanasia for owners who prefer the easy way out. We see a lot of euthanasia in November and December, for example, just because people are getting ready for the holidays. I refuse to do it.” Oscar Chavez, DVM
This is another sad but true statement. I have also been faced with these clients. But the discussion needs to be pursued a little further. 
What is going to happen to that pet if I don’t euthanize it?
Where is it going to go?
What is going to happen to it?
Before I flat out refuse to euthanize a pet that the owner clearly doesn’t want anymore I need to think about that pet. I have heard owners tell me “that if I don’t do it they will find someone who will!” Also a true statement. Or even worse I have had owners tell me, “if you don’t euthanize her now I will take her home and shoot her.” To that I respond, "that “shooting your pet is not a legal acceptable form of euthanasia and it is reportable and punishable by law.” Which always makes me feel a little better to say, but doesn’t make anything better for that pet.
I also know that if that pet is brought to the shelter the shelter staff (who are for the most part untrained, and definitely NOT veterinarians), will have to do it. As much as I am angered by the situation when it arises it isn’t right to send a pet to be killed by people who aren't trained and don't have sedation, etc. readily at their disposal. At least in my hands I can sedate the pet and make it a gentle stress-free event where the pet is told that someone is sorry, loves them, and that are a "good girl."
After that explanation it makes it sound like I do perfom these “convenience" euthanasia’s, which, in reality, I also refuse to do. If there is anyway I think I can treat this pet, or re-home it, I will not euthanize it. And if there is any way I can work with an owner to treat a pet I will talk until I am blue, and then resort to begging.

For assistance with any behavioral problems go to your vet and ask for help. If they are not trained in behavior ask for a referral. Please be careful if you are searching for a behaviorist on the internet. There are a HUGE number of people proclaiming themselves to be “experts” because they are big fans of Cesar Milan, and “have watched every episode”. Behavior modification needs a lot of time, patience and dedication, and absolutely no hard, harsh, mean or abusive treatment on your part. Sometimes it also needs medication to treat. This can only come from a licensed veterinarian.
 If you would like to make an appointment with one of our staff behaviorists, or if you want to meet our staff, or our pets, please visit

More “secrets” to follow…stay tuned.

Friday, April 27, 2012

Reader's Digest May 2012 article

Part 3 of the Reader’s Digest May article, “50 Secret’s Your Vet Won’t Tell You.”
This section is entitled “What We’re Doing”
Number 11
“A lot of veterinarians have told me matter-of-factly that they still don’t use pain killers for procedures that they know are painful. They think that dogs and cats don’t need it, or that feeling pain after surgery is good because it keeps them from moving around too much. But research has shown that pets who are in less pain heal faster, sleep better, and don’t move around as much.” Dennis Leon, DVM, director at Levittown Animal Hospital in Long Island NY
 OK, I know that none of you want to believe this, but pain medication and the whole idea of analgesia is a relatively new, novel, and for some vets, a radical concept. For those of you who price shop for your pets services this is often a missed item that you definitely want to know about when you think you are comparing a spay (for example) at two different vet hospitals. Some pain medications (especially the injectable NSAID’s are expensive, (at our clinic a 50 pound dog who needs a 24 hour dose of an injectable NSAID will cost about $40), so you want to know if this is included in your spay price and if not how can you make sure your pet has some pain medication provided. At my clinic I am always happy to sit down and explain to clients what they need to inquire about and what questions are very important to have answers to. Never forget the cardinal rule, “you get what you pay for.” At Jarrettsville Vet Center we give an injectable 24 hour dose of an NSAID, and then four days of this medication to take home after every dog spay. I want my clients to have something at home so that if their pet wakes up at 3 am screaming in pain that you have something to give them. (Haven’t you ever woken up at 3 am and needed an ibuprofen?)
If you get an invoice from your clinic and a pain medication isn’t listed I suggest you ask your vet why?
I will admit that I do not over medicate cats. This is a learned decision for me. I have had some cats get “soo pain free” that their original injury was made far worse because they decided they were well enough to try to bust out of their cage. I don’t want a painful cat I want a rested, calm, healing cat.
Also some cats seem to get dysphoric on opioids. This means they get vocal and act a little drugged. I always want to mention this to owners and sometimes we slow down on the pain meds.

Number 12
“At a veterinary meeting I attended, it came to light that more than half of the vets there had not licensed their dogs, which is required by law.” Patty Khuly, VMD
We, as vets are responsible to be good examples to our clients and our communities. Why wouldn’t you license your dog?

Number 13
“You should never give pets chocolate, because its toxic to most of them. But my cat is obsessed with it and is all over me when I’m eating it, so sometimes I give her a sliver. Just an itsy-bitsy, tiny one.” A vet in Cal.
OH MY GOD! This is a confession for your priest, not Reader’s Digest. Shut up! Don’t tell clients that we say one thing and then we do another. Think of the anarchy that could ensue? Think of the dying choco-holic kitties?

Number 14
“Every time we help a pet, we help a person. The classic example is the 80-year-old grandma who has nothing left in life but her cat. She’s a widow with very limited social contact, and the cat is what connects her to life. So when we help her cat, she’s really the one we are helping.” Phil Zimmerman, DVM
IS there really anything I can add to this?
Number 15
“When people surrender their pets because they can’t afford their problems, I often end up with them. I’ve got a three legged cat, a one eyed cat, three dogs that required major surgeries, one goat, and 11 chickens.” Sandy Willis, DVM, DACVIM, an internal medicine consultant in Seattle WA.
I am going to send Sandy a note telling her how happy I am to know that I am not alone! A goat? How does an internal medicine vet end up with a goat? I bet there is a great story there?
OK, here I go, dancing on the border of pissing vets off. Here’s my “secret” hint; if your vets office doesn’t have a clinic cat, or, your vet doesn’t have pets of their own, it might be time to see if they have lost their compassion? I once worked at a vet clinic where the vet would randomly euthanize the “house” cats, to teach the staff a lesson. He would let us try to save and re-home a cat, or sometimes a dog, but then would decide they were “too expensive to feed” any longer. He broke our hearts. The staff secretly hated him and we all left. If you take away your staffs empathy and compassion you take away the heart of your clinic, and nothing, seriously, no dollar figure in the world is worth that.
My clinic has a whole slew of pets that came in the door to be euthanized for various reasons. All of our guys were treated and are now up for adoption. (OH, please see our website! Wouldn’t you love a Staffie Bull terrier? He is as cute as a button?)
Just in case you don't visit our website..Here are some of our amazing pets.
Meet Lobo.

Meet Tink. Our favorite, the sweetest girl in the WHOLE world!

More “secrets” to follow…stay tuned.

Monday, April 23, 2012

Part Two "50 Secrets Your Vet Won't Tell You"

This is the second part of the May Reader's Digest article, "50 Secret's Your Vet Won't Tell You."

I wanted to go through the article and give each "secret" my own take on it.

I thought the article was very good overall. I think that there are also a few items that were missed. I thought that going through each secret and giving you the real inside reason, or explaining the secret would help. Because in typical Reader's Digest fashion the articles are short and to the point..But there is too much left out for me to feel comfortable with just listing them.

Number 6

"We're a vet hospital, not a dog hotel. People will get upset because their dog got a sheet instead of two fluffy blankets or because their dog didn't get hand-fed. We're just trying to get your dog better so he can come home and you can spoil him." Jessica Stout-Harris, a vet tech who runs

To this I respond; a hospital is a hospital. Dog or human. It is very important that our patients and clients feel comfortable while in our care. People are often upset because they are worried and stressed. So often it's not really about the blanket, it's about the disease. Clients want to feel that we value their pet as much as they do. I bet it is the same when your family member is in the hospital? We are all advocates for our sick family members when they are in the hospital and voicing a concern is an expected and acceptable response to leaving a pet in our care. And hand feeding is often a necessary and required action to encourage these guys to eat. We always encourage family members to come visit their pets and we want them to be as actively engaged in the healing process as possible. We also encourage them to fluff pillows, supply blankets, walk, and hand feed their pets.

I remind my staff that the doting parents might be a little annoying, as I am sure they would be if their child was in the hospital, but how many owners do we see that don't care at all? If I have to chose an owner it's ALWAYS the doting and demanding ones.

Number 7

"Here's a pet peeve: owners who don't want to pay for diagnostic tests but then cop an attitude because you don't know whats wrong with the animal. Since you wouldn't let me do the blood work or X-rays, how the heck do you expect me to know?" A vet in So Carolina

Goodness! Can I ever identify with this one. I can't even classify this as a pet peeve. I need to categorize it as one of the "most stressful parts of my job." It is very difficult to diagnose a pet when you cannot use many, or any, of the tools available to you in your tool kit. I can give you a list of possible diagnoses, but the list will be longer and longer as the tools available to me to figure out the puzzle of your pets ailments gets shorter and shorter. Imagine if you went to your doctor, you couldn't speak to them (because you are an animal and I don't speak dog or cat) and then they couldn't run any tests on you? What do you expect would happen? Well, there is a much higher chance that you would stay feeling sick longer and a much lower chance that they would be able to identify the cause of your illness. If you don't get a diagnosis it is very hard to start a treatment plan. Which further reduces your chances of recovery.

Now I understand that many of us live on budgets, and that these budgets have gotten tighter for many of us in the last few years. But if you ask me to play it very conservatively to begin with there is a much greater chance we will loose precious time, and even have to repeat much of the diagnostics we have done previously to get a more full picture if you decide to pursue this disease process later.

Number 8

"If you're visiting your pet in the hospital, and we say something along the lines of 'OK, it's time to let Fluffy sleep now,' often what we really mean is that you're in our way, and we're trying to treat other patients." Jessica Stout-Harris

OK, this seems to be deceitful and ridiculous to me. If you are concerned about not being able to adequately care for a patient then you politely tell the owner that you are going to do your best to take good care of their pet so they can go home with you as soon as possible. If we know the client wants and needs some alone time and the patient is stable enough to do so, we put them in a quiet private place to spend some time together.

If the patient isn't stable enough we assure the owners that we will do everything we can, and that we will notify them immediately if anything changes.

This job is all about trust. Without that there is no need to be a great vet, no matter how incredible your skills are trust keeps your patients and clients coming back.

If a client even gets a whiff of deceit, even in the tiniest forms like, "what we really mean is..." they will find someone they do trust and your skills that you spent countless hours earning, honing and practicing are worthless.

Number 9

"I understand the value of dog parks, but I personally wouldn't take my dog there. We see alot of dogs who were injured at dog parks." Rachel Simpson, a vet tech at Adobe Animal Hospital in Los Altos, Ca

I live in a rural area. We are lucky to have state parks, huge open areas, farms galore, and few townhouses or apartments. It is a dogs paradise around here.But for those of you who don't live in the country dog parks are a vital, necessary and absolutely essential part to raising a well rounded happy puppy or dog. Raising a dog is much like raising a child. They need lots of exercise, playmates, and friends to learn most of their grown up skills. In many ways the dog park is like the play ground. It requires that you keep a protective watchful eye over your kids and protect them if needed. It also means that if your kid turns out to be the bully you get help in teaching them how to become a respectful member of society.

Number 10

"Every time I save a life, every time I fix a patient, that makes everything worth it. And I love it when a client says, "I wish my physician would treat me as nice as you treat my pets." Phil Zimmerman, DVM

I treat every pet as if they were my own. I also expect my physician to treat me like I am as valuable as his family member. I tell my clients that it is an honor to be their vet, and it is an honor I try to earn everyday. I have also gone through the same process with my own physician. (In fact as of 2012 my husband and I have not only switched our health insurance we have switched our general practitioner. It was a pain in the butt, but worth it. We have benefited immensely from that decision. There is a reason JHU is the best in the world, just ask me). Find a vet, vet tech, doctor, and hospital you trust and love and then let them know how much you value them.

Your health care is your responsibility, be an active diligent and demanding participant in it. Its really all up to you.

Sunday, April 22, 2012

Earth Day TNR

As many of you know by now TNR stands for Trap-Neuter (god, it's always about the boys) and Release.

Jarrettsville hosted another TNR today, and in total we spayed and neutered 53 cats.

Many of the cats were females, which is great because we are heading into kitten season and every year Harford County is overwhelmed by more cats than it can feed and house.

Many wonderful volunteers came out to help control the pet overpopulation problem and support this cause.

I want to send a very big heart-felt Thank-You to all of the volunteers today. You all did a great job and you are an inspiration to us all.

Special Thanks goes to Jill, Julia, Phil, and Grace.

But my BIGGEST THANKS goes to JVC's own Dr. Morgan, Dr. Hubbard, and my amazing techs Laura and Amanda. I am immensley proud of you and grateful for your help, your compassion and your time. You make me so proud, and I love you!

One very large, very angry uterus.

Dr. Hubbard spaying a cat.

Dr. Morgan

Dr. Morgan, Laura and Amanda

Another cat, "in heat" uterus.


The recovery area. All the cats waking up under a watchful eye.

The First 5 "Secrets"




This is my take on the May edition of Reader's Digest article titled, "50 Secrets Your Vet Won't Tell You."

The article is divided into sections.

The first is "What We're Thinking".

Number 1

"People always ask, 'How do you handle pit bulls and rottweillers and big German shepherds?'
The truth is, the dogs that scare me the most are the little Chihuahuas. They're much more likely to bite." Mark Howes, DVM, owner and medical director of Berglund Animal Hospital in Evanston, Ill.

OK, to this I say, "Yes, very true." The little dogs are more likely to bite. They also give you less warning. Almost every fearful small dog says they hate you with teeth.

Most larger dogs are better at giving you very clear definitive clues that they are uncomfortable around you. Also, many times it is harder to get a muzzle on a small dog, especially the brachycephalics. And then there is the whole fear of proptosing (medical jargon for the eye literally pops out of its socket) an eyeball..It happens, and it is terrifying.

But if I have to choose between equally angry dogs I will take smaller than larger. I have seen five of us pile ontop of a dog losing his mind and still felt that the odds were not in our favor of maintaining control of this beast. A little dog can always be scooped up with something, (like a towel), and put into a cage or a carrier to allow him to simmer down and finish his spitting profanities at us. I have had to sedate a big shepherd with enough tranquilizers to make a charging herd of wildebeests sleep for a week. Only to find that  he can, and does, still come at me when I get within 12 inches of his face, or feet. (God, I have spent hours doing a nail trim on a bad dog that needed sedation).

Number 2

"We know when you're twisting the facts. If your dog has a five pound tumor hanging from his skin, please don't tell me it wasn't there yesterday." Phil Zeltzman, DVM

I will add to this; if you do tell me that it wasn't there yesterday, I am going to ask you "when the last time that you paid attention to your dog was?" I have had clients tell me that their "dog lives outside and they hadn't checked on them in weeks." (Yes, there are times I want to scream. That's why I blog..OK, slightly just kidding).

Number 3

"Most hospitals keep comprehensive records of behavior-of both your pet and you! If you are aggressive to the staff, you will be treated differently." Oscar Chavez, DVM

I actually wrote a blog about this. But my staff got so upset at me that I was being too brutally honest, and I told the truth, (which I think is appropriate if your blog is titled, "Real-Life") that I pulled it. (Someday I will get the courage back to re-post it).
I will also add that my staff has a memory like an elephant. They remember every aspect of almost every pet and owner. If you lie to them, yell, or (god forbid) swear, or disrespect them, they will remember. AND, if you say something to them and then something completely different to me, they will bring it to my attention and we Vets will believe the people we spend 40 hours a week with, our staff.

Veterinarians and veterinary staff have devoted their lives to taking care of your pet. We are in most cases significantly underpaid for the amount of school and training we have to have to work in this profession. This job is for most of us a labor of love. We all have bad days, but please always be nice to us. We will be nice to you, and more importantly, your pet in return.

Number 4

"Looking for a way to say thank you to your vet? Last year, one pet owner gave us a check for $100, saying we could use it at our discretion for an animal in need. That was a wonderful gift." Patty Khuly, VMD

Here at Jarrettsville Vet, we have the most incredibly wonderful, generous, and kind clients. I have had clients donate items for us to raffle off for our "pets in need fund." I have also had countless clients buy these raffle tickets. I have clients volunteer to help walk dogs, pet our clinic cats, donate food, blankets, towels, time and resources. I am amazed everyday that we are surrounded by so many outstanding compassionate people. I really believe that it is a direct reflection of what we give to our community.

When a clients cat came in with a blood pressure of over 250 I called another client who has their cat on blood pressure medicine and asked her if we could borrow some for our new patient who needed it ASAP. I told her that I had ordered some but it wouldn't be here until tomorrow afternoon. She immediately got in her car and drove us down a weeks worth. There isn't a day that we don't have clients bringing us bagels, cake, cookies, cards, or helping to pass out flyers of our "up for adoption" pets. There may be a few reasons I want to scream everyday, but there are a million more that I am forever grateful to have known the people that I get to see and become parts of each other's families because of JVC.

Number 5

"The reason your pet is fat is because you are fat too. I would never say that to someone in an exam room, but the fact of the matter is, if you have an owner who overeats and is inactive, they are very likely to have an obese pet." Oscar Chavez, DVM

How many times have I said this before. (Hint; see all of my Biggest Loser blogs).

It is a difficult task to get an owner to acknowledge that their pet is fat, and then admit that they are responsible for it. It is even harder to get everyone in the household to join forces to get healthier together. I have seen some families start walking and eating better simply because they love their pet so much. It wasn't enough of an incentive for them to live longer, feel better, and be healthier for themselves, but it was when it was for their dog.

Hey, whatever it takes.

More to come tomorrow.

Saturday, April 21, 2012

WHAT? You Need A New Vet? A Pet Parents Guide To Making A Hard Decision Easier.

I suppose there are a few justifiable reasons why I would lose a client; moving, specialty referral, or you decide to get a pet Boa Constrictor (I don't do snakes).

But admittedly, I am not the perfect vet for every client. I have learned to accept this. Every vet  has their own areas of interest, strengths, and limitations. Trying to be everything to everyone is not possible.

I have clients tell me that they are moving, and regrettably, need to find a new vet closer to their new home. I too have had the unfortunate task of driving my kitties to the Vet. I too hate hearing their incessant pleadings to be "let out of the torture chamber!" I too empathize with having my cat stuck in the carrier in the car, screaming those blood curdling, gurgling, guttural green-mile desperate calls. Only to be followed by vomiting and blow-out diarrhea. I know taking your pet to the Vet can be very stressful on everyone involved. I know we all try to make that trip as short as possible. I wouldn't want to drive my cats an hour away for their routine Vet visits, so sometimes it is necessary to say goodbye to one vet and start a search for another.

In my life before I was a Vet, when I had just moved to Blacksburg, Va. I went to three different vets before I found one that I both liked and trusted. I started my search in the phone book, (ah, the good ole days of phone books), and found a vet 2 miles from my house. I made my first appointment with him. It was a small single doctor practice. When I arrived with my cat I was put in a tiny closet sized exam room, "Very homey," I thought, "but that's OK." When the vet started his exam he started by picking up my small 6 pound cat and then they both got on the scale together. OK, this was a problem. How can you get an accurate weight this way? I mean what if he just had an especially big lunch? Or what if my cat lost a half a pound, (this is significant if you only weigh 6 pounds), and you take her half pound because you just ate 2 double whoppers? This guy was out. He was a cheap, old-timer, BUT, I had high standards and my cats were very, very, important to me.

Back to the phone book.

Vet number two had a nicer practice. Well, not by leaps or bounds, but, nicer. When I arrived there were about a dozen people in his reception area. "OK!" good sign! He is popular! People like him! I had come to inquire about some motion sickness medicine for one of my cats that I wanted to bring to see him. Belle got terribly car sick every time she went anywhere. I remember one time she had diarrhea all over my boyfriend in the exam room. He was NOT happy. Lesson learned; Always keep your cat in the carrier! Until the vet takes them out.

As I inquired about some sedation for my cat, the receptionist said to me, "Hold on honey, I'll be right back." A few minutes later she came back to me and said, "Here you go, give this to your cat and then come on in." I was pretty sure she had done the prescription herself because I had seen the vet go into an exam room and I know she didn't go in to ask him. But the real icing on the cake was when she checked me out and said, "$1.13, Honey."

"What!, a dollar?" I said. Now I knew why the reception area was so busy.

"Please tell the vet that he is part of the reason this profession is stuck in the dark ages. How am I ever going to pay back my student loans from vet school when other vets charge a dollar for a prescription?!"

She had no idea what hit her, and I was sort of a little taken back by my own vigorous reply. I never went back. I was a little embarrassed, and I didn't want my kitties to be getting anesthetized by a rag soaked in ether.

My third attempt was a whole 35 minutes away from my home. I actually passed 4 other vets to get to them. I decided on this clinic because they were open 7 days a week, (big sigh of relief for me, I always seemed to need them Sunday mornings), and had 5 doctors on staff. The clinic was always clean, smelled clean, and they had 4 clinic cats that littered the front desk like old fat men at a brothel.

So I know first hand how hard and tedious it can be to find just the perfect match for not only you, but your pets.

On Wednesday afternoon one of my technicians came to me saying that there was "an appointment here who wanted to interview me."

OK, I had never heard this one before. I stopped and looked at them quizzically. "Umm... What?"

She replied. "There is a women in Room 2 who made an appointment to interview the doctors because she needs a new vet. But she wants to interview the clinics first."

"OK," I said very enthusiastically.

I went into the exam room and said "Hello."

I was greeted with a firm handshake from a well dressed middle aged woman holding three large binders.

Maybe my technician confused "client" with "reporter" I thought?

She introduced herself and said, "After many years I am in the market for a new vet because my old vet only works fours hours a week now. He is moving towards retirement. He is now in his eighties."

"Good for him," I responded. (OMG, 80's?).

"Do you mind if I ask where you live?" I said.

"I live in Delta."

"I do too, I just think it is helpful to start looking close to home." She nodded in agreement.

She then pulled a magazine out of one of her binders. "Do you mind if I ask you a few questions? I just read this article in the Reader's Digest."

She handed me the copy. The article was entitled "50 Secrets Your Vet Won't Tell You."

So began the interview.

I picked up my own copy of the Reader's Digest the next day. I was happy to see that each of the 50 "Secrets" were submitted by veterinarians. It's actually a very good article. I would suggest you all query your vet about it. Many of these "Secrets" will tell you a lot about your vet and the practice you are supporting. But many of these "secrets" don't have cut and dry answers.

I didn't charge her for the interview. It was too entertaining and it appeared to me that this woman loves her pets, wants the best for them, and she is on a very tight budget.

I'll let you know if I ever see her again.

I think I am going to blog on every one of these "Secrets".

A great article on how this fellow blogger dealt with having to find a new Vet.

Friday, April 20, 2012

They Should Re-name it Dogicide

Every Tuesday evening I get to meet a new set of challenges it seems. I am the late Vet and the darker it gets the crazier the scene seems to set.
Tuesday was another for the blog books. In the middle of the booked evening I had on the schdedule one of my Receptionists came to me to notify me that she had just received a call from a woman who was not a client asking if she could come in immediately because her dog was bleeding profusely from the penis.
“Sure,” I said, thinking this is probably just a urinary tract infection. (I had seen 4 that evening already). This was just going to just be another tick in the evening’s cluster of unexplainable clustering pee issues.
I continued plowing through the appointments and figured I would meet the new client as I looked over some urine the tech had caught from their dog for me before I went into the appointment. I would then begin my dialogue about the physiology and treatment options of UTI’s as I tried to endear myself to the new client in the building.
A short time later I was called by my tech to come look at the dog in Room 2. As I walked in I saw a very timid small badger looking Australian Cattle Dog crouched over a puddle of very dark bloody…. umm, well maybe? urine? I actually wasn’t sure if the puddle on the exam room floor had come from his penis. It looked a iteensy-bit more watery than arterial blood, but not watery enough for me to believe it had come from the bladder, or might be urine.
“OK, not a simple UTI, fabulous.” I thought. Time to rethink the evenings plans. I put my files down and closed the exam door behind me. It was time to meet the new clients and do some investigative work. My tech knew to go into the other rooms and start offering some excuses and apologies.
I gave JD a look over. He was slumped, head bowed, pot bellied, and looking like he really felt crummy. His gums were muddy light pink and dry. He was dehydrated, shocky, had an elevated heart rate, respiratory rate, and a belly full of fluid, (I suspected blood based on his poor mucous membrane color and blood on my exam room floor).
I then turned my attention to the new client. She was a tall woman very obviously 8 plus months pregnant. She also brought her two pre-teen children who were hungry and bored already. We had some ground to cover, lots of questions to ask, and explore, and 2 kids that had better things to do.

When I asked if there was any chance of trauma?, like being hit by a car?, JD’s mom told me that he is never out of their yard. When I asked if he could have gotten into any poisons (like rat poison), she assured me that she lives on a farm with 10 acres and they never use poisons because they raise goats.
I was coming up empty despite my persistent queries and inability to make the clinical signs of this dog fit the history she was providing.

JD’s mom told me that he had been perfectly normal the day before and had seemed a little quieter in the morning but had just started bleeding this afternoon.
I asked her if I could take an x-ray. I was concerned about there being blood in the chest and I wanted to look for radiographic evidence of trauma. She consented. Three chest views, (left and right side down, and ventral (lying on the back)), and side and ventral abdominal x-rays all showed bleeding and clusters of bleeding, but no signs of trauma (broken bones). I returned to the exam room and requested we take blood to run a CBC (complete blood count) and chemistry panel. I hoped to only find a low PCV (packed cell volume due to blood loss) because blood loss was the only clue I had so far.

As I reviewed the diagnostics we had done I again questioned her about the history of this dog. I just couldn’t believe cancer would cause him to be fine one day and then bleeding profusely the next.
JD's PCV was 31%. I was surprised a little because he looked worse than 31%, and his TP was 5. OK, he looked as bad as 5.
The bloodwork revealed anemia, (low red blood cell count), low protein, and everything else was normal. OK, now very unlikely it was cancer. It was an internal bleed, but why?
At this point I had JD’s mom in hysterics telling me that her pregnancy wasn’t going well, she loved her dog but had NO money, and she needed to know what was wrong with him and why.
My night was now significantly running late and going south, fast. Nothing beats stressed out, like stressed out, guilt ridden, and an emotional pregnant woman with a sweet dying dog who needs A LOT of emergency care, and a $2500 budget.
I told her that JD was critical. I also told her that I was not sure why he was bleeding, but if he didn't stop soon he would likely succumb to dying via exsanguination. He had to be transferred overnight to the ICU emergency room. The moment I suggested this to her sobbing turned into firm persistent unequivocal denial of transfer.
“I won’t go there! I will never go there again! They are thieves and they don’t care about us or our pets!” OK, she was adamant and I was losing any hope of this dog making it through the night.
Compromise talking time.
“What if I call the other emergency clinic and see if they can monitor him for the night for less than $200?”
She doubted my ability to negotiate and she doubted their ability to execute a plan. I re-assured her that we all wanted to try to save JD and we all understand that all of us have budgets.
I called the ER and spoke to the DVM on duty. My conversation started something like, “Boy, do I have an interesting case for you!” All I had to say was $200 bucks, 8 months pregnant, and bleeding profusely from the penis and she realized my sarcasm was understated.
JD was transferred with some diagnostics, a long list of unknown answers, and a presumption of toxicosis but nothing to prove or back it up.
Thankfully the ER has the ability to run a coagulation profile, and thankfully it was within the $200 overnight budget. JD’s coags were “off the scale.” He had been poisoned by a rodenticide (likely) and he was bleeding out of the easiest hole his body could dump out of; his bladder.
Overnight I received text messages from the ER DVM saying that "he was holding his own and they had started Vitamin K."
JD returned the next morning whiter, more depressed, and breathing even harder. He now had frank blood coming from his penis. (Frank blood means thick, red staight bleeding). It is a scary thing to witness and significantly worsened his prognosis.
I had to have a difficult discussion with a now exhausted (she was at the ER until midnight), 8 month pregnant, still 2 kids in tow (also overtired), emotionally charged owner. Yippee!
“JD looks worse this morning. I had hoped that the Vitamin K would have stopped the bleeding by now. When I saw JD last night his PCV was low at 31%, and his protein was also low because of the acute blood loss. He is now 19% and his albumin (protein) is at a very dangerous 2. He needs to be transferred to the ICU for blood transfusions and I estimate this is all treatable but will cost upwards of $2000.”
Profuse hysterics ensued.
“OK, plan B: I will do the best I can here.” Crying stopped.
She asked if she and her children could say goodbye to JD just in case he continued to decline and didn’t make it through the day.

I also had her sign a “Consent for Euthanasia” form so that if JD became agonal (started to die) I had her permission to humanely euthanize him.
At 9 am we began our low-budget, no holds barred, quest to save JD. He received 4 units of fresh frozen plasma. (I have had this one treatment save more lives in my clinic than probably anything else. I strongly recommend clinics keep a few units in the freezer. It lasts a year, is easy to give and is really very safe. It saved my own dogs life (Savannah) and it saved JD).

The magic liquid elixir worth more than gold. The life-saving miracles of plasma.
After 2 units of plasma JD started urinating almost normal looking urine. Instead of it being frank blood there were only blood specks. He also began to eat, and breathe much easier.

This is the urine JD left on the towel. We were sooo happy to see only one speck of blood.

Lots of fluids means "I gotta pee! A lot!"

BIG improvement from the night (and this morning), before!
After 4 units I called his mom and told her that I thought JD had just dodged another big bullet.

Pink mucous membranes. Also a BIG improvement from the pale muddy pink of the night before.
She had told me the day before that he had already survived a fractured skull many years ago.
JD went home last night wagging his tail and smiling, head held high.
He is a miracle and another living testament to early medical intervention and treatment.

This is what a GREAT Technician does. She sits and hand feeds the patients who need love and encouragement.

Eating only because someone will take the time to make everything less scary.

I also had a visit from the Sheriff yesterday. Seems JD’s mom now believes that the neighbors intentionally poisoned JD.
I know how terrible the effects of rodenticides can be on pets. I am not a person who wants to share my home with rats, but this is a terrible way to die and kills too many domestic pets every year. Someday this product will be banned, but until then I urge all of you animal lovers to pick another way to rid your house of unwanted visitors.
After I finished this story I posted a Twitter message stating the following;
"Saved a dog from rat poison ingestion w vit K & fresh frozen plasma transfusion. This stuff kills more than mice, pls don't use it!"

I received a reply from Vet School Style stating,
"I had a guy say he didn't realize that bc it said "rodenticide" and not "dogicide."

JD's PCV was up to 23%, and TP 7.4 the next morning. He is one lucky boy!

He will stay on oral Vitamin K for the next two weeks.

1 week update. JD came to visit and he is back to his happy, energetic, sweet self. His color looks great, and his chest sounds much better also. We put him on anothr 2 weeks of vitamin K because we don't know what kind of rodenticide he got into. Treatment for rodenticide toxicity is 2-4 weeks. We are playing it safe by supplementing him longer.

JD's family came back in with him, and the son confessed that they had done a search of their home and found a box of rat poison. JD's mom tried to convince me that she didn't think it was the poison he got into because there weren't partially eaten pieces, and JD is "too smart to do something that stupid." I told her if they found it, he got into it.

As a side note; I just went into our basement to retreive our kittens who snuck down there (because it is off limits) after my husband went down to find a can of paint. Seems