Taking A Stand And Facing Consequences.

How many veterinarians work at a hospital that give them the latitude to express their own voice?

A place where they can stand up and say "NO!," when they don't feel right about what they are being asked to do?

I often wonder this?

The biggest reason that I decided I needed to own my own clinic after I graduated veterinary school was that I knew I would have some hard cases that required a decision to be made between the business and the patient. I did not enter veterinary medicine to get rich. Not that some can't but there are compromises every wealthy person makes. Some spend less time with their family in an effort to make a living, or sacrifice personal time to develop stronger business practices, and some sacrifice the reason they went into veterinary school. History and revenue sheets all indicate that to be successful in the veterinary business world you must treat the business like a business. You charge for what you do, you do what the customer asks, and you don't get emotionally or personally involved. Almost all successful big veterinary practices have established protocols, business plans, and spread sheets to maximize their revenues. It is exceptionally difficult to run a person to person to patient business based on a spread sheet. The intimacy gets lost in the numbers. There is lost revenue in time spent with clients talking, and there are muddy treacherous waters in having your own opinion and your own barriers. Then, should you still decide to side with the pet and stand in opposition to the owner there is the whole big messy ball of wax about what the hell to do with a pet that the owners no longer want? This is the place where associates get crucified. This is the place that your heart gets broken, your soul gets sacrificed, and the burn out and fatigue gnaw on you until you either break or become indifferent.

I have had to learn that my ability to care for other peoples pets is a tenuous complicated road of where my beliefs stand and, often, the great divide, of others. I have to remind myself every single day that I am the vet who worked a lifetime to be a healer and not anything else.

It is never an easy answer; the reasons that people make the decisions that they do about their pets, especially when it relates to end of life decisions.

Veterinarians are asked every day to be the person who will;

• end a life due to financial constraints
• end a life due to necessity
• end a life due to lack of perceived value
• end a life due to many reasons that are beyond my ability to justify..like moving, death, unmanageable medical needs, lifestyle changes, and such.

Last night was a repeat of a situation I find myself in every so often. Hard as I try to avoid it, it still happens.

I have told the staff repeatedly that we do not take appointment requests for new clients seeking to euthanize their pet. All requests should be booked as an 'examination'. IF the veterinarian examines the patient AND agrees that the condition warrants euthanasia the pet will be humanely euthanized. IF NOT, the client has been notified that the request must be consensual and cannot be expected. There are those who disagree with this position. I remind those veterinarians that there is a divide between the law and the beliefs of our desired clientele. Not one single small animal vet desires to work for clients who regards their pet as simply 'property'. If we did our average client transaction would never pay our mortgages. Don't ask for one, "patients = property and therefore protect against liability", and hope for the other, "client spends thousands to treat life threatening disease." We market our goods and services, encourage diagnostics, allow walk-ins, emergencies, provide surgical treatments always in excess of "replacement value" and then euthanize at whim. It is a contradictory incongruous hypocritical business model. 

And so I arrived at the exam room paperwork in hand for tonight's euthanasia. The clients had never been to see us before, I did not know this case, and I had no history to accompany the file. And there stood before me a happy, bright, inquisitive, young dog. If he was sick someone had forgotten to tell him. He had an obvious limp but he was happy to be here and anxiously awaiting a "Hello" from me. The night froze and I knew the story was about to get sticky. 

I am not sure how many vets would have stopped their incredibly busy night to talk to this couple? but I spent the next 30 minutes talking and trying to understand to their story, their concerns, and what my role in helping this pet was? In the end I stood between a husband who was unwilling to spend any more money on a case that he believed was not treatable, a wife who loved her dog desperately, and a dog who was happy, maybe not perfect, maybe not going to live another half decade, but today, at this moment happy and functional.

In this appointment debacle the husband and wife were at odds about what to do. The husband wanted to let the pet go. The wife stood quietly sobbing. The dog was running around the room wagging, jumping, playing, and soo happy to be round new people. And there I was thinking that I should have gone to floral design school. How do I pick a side on this one? It was a perfect example of the worst cases to be a part of. Where the hell do I go? What do I do? Who loses here? 

I had to walk away and get out of the room for 15 minutes to think about what I was about to do.

I found my associate and asked her. Her words of encouragement and advice put the wind back in my sails. "Screw them! Say NO! and get rid of them!" Now, I didn't go back and use this language, but damn it felt good to hear it! I needed her support and I knew then that my guts decision to refuse was the right one. 

This is the point where judgments are made. This was the point where I knew I was about to enter a landmine of emotions and risk my neck for a dog I didn't know. This is where the sick feeling in my soul reminds me that I better have a backup plan because the Board of Veterinary Medicine was going to get another letter with my name on it. This is where I had to decide if I could really stand behind my words, my thoughts, my beliefs, and my desire to elevate veterinary medicine to the place my clients believe it exists.

I refused to euthanize that dog. I offered every single option imaginable. If I am going to duck out of what my client wants I better be able to offer assistance to that pet and the only way that pet is going to get assistance is with some options. It is the luxury of my position, my lack of debt, and my compromise to sleeping at night with a clear conscious. When the husband told me that he preferred the dog dead versus in someone else's home I knew this was an examination and euthanasia to absolve myself of. How could dead be better than elsewhere? 

As the appointment ended I made one last desperate move. I secretly handed the wife my cell phone number. 

For those of us who live a life as a female I know that husbands often dictate the financial decisions. I know that there are millenia of women told to keep quiet while the husband decides where resources can be spent. I hear it every day. The women love and adore a pet that the husband does not. I know this sounds terribly sexist, generally broad sweeping and that there are some men who love their pets as much as any woman does. But in 10 years of practice here is what I have seen: In general men make financial decisions over emotional decisions (perhaps the reason of my clinics financial back seat?). Whereas women live by a more maternal guidance. We are programmed to nurture and men are more pragmatic. An expense is calculated and assigned a priority. Your pet doesn't drive you to work, pay the rent, or keep food on the table. BUT a pet is the center of many a woman's heart. I would give up a car, a trip, an expensive meal for the companionship and unconditional love of my pet. I cannot take every pet, and I cannot work pro bono consistently, but every time I have offered to help I knew it was the right decision for me. I would regret making a different choice. 

I often torture myself over the afterward.. What will happen? Where will that pet end up? To try to alleviate this I offer those clients lots of options. I keep talking even after I refuse to help them with their request. 

• "You can take your pet elsewhere if you are still electing to euthanize." I understand there will likely be a backlash from other vets about this. 
• "You can find or look for financial assistance through private companies. Like a credit card, bank, etc."
• "I can ask for help from my network of rescues, friends, etc."
• "We find some way to compromise to get your pet care." I think and behave outside of the box. I find a way to build a bridge between caring for their pet and avoiding shouldering the entire responsibility of a pet. In some cases the clinic will take responsibility for the care of a pet and then assist in finding that pet a new home. These cases remind my staff that there is a heart here. Our primary mission is to help pets AND people. We do not sacrifice one for the other.

Clearly, I understand that people have different feelings about their pets. Clearly, there are very few veterinarians in the world who do not understand that pets have moved into peoples homes and hearts and that this is very unlikely to change. But, there is still a great divide on who a veterinarian is at the seat of their soul and the tasks that they are asked to participate in.

I know that there are many veterinarians out there who are told to do as the client asks. If the client pays the veterinarian participates. If the client cannot pay the patient is left to...?? 

There is no doubt that compassion fatigue exists, that there is an over represented number of suicides in our profession, but there is a reason for these. A deep cumulative reason. A small incessant chipping away of the soul of the people we wanted to be, thought we were, and make excuses as to why we have become who we are. 

Our clients know who we are. They know where we stand, where our obligation lies and they support us. The days of clients asking and expecting services that are inconsistent with our mission are few. The clients that remain are our foundation, our support, and our cheering squad.

If, at this point in time veterinarians do not embrace that segment of society who loves and treats their pets as children we will lose our ability to be the provide both exemplary care and care with purpose. 

Update;

Two days later the wife called me. We scheduled a treatment plan for her dog. I will help her with costs, use some of our donation fund for him, and hope that we can find him a palliative care. Shoot, I am hoping for a miracle, and who knows? Sometimes there is salvation in trying.

A week later Charlie had surgery.. The end to his story can be found here.

Related blogs;

Compassion Fatigue

How Many Sides Does Your Equation Have?

When Trying Is All That Matters.

The Cat And The Line In The Sand.

If you have a pet question you can find me on Pawbly.com. Pawbly is free for everyone and created to help people find answers to their pet concerns. We are a platform full of dedicated caring people. 

You can also find me Twitter @FreePetAdvice. Or at the clinic, Jarrettsville Vet, where I get to hug, kiss, and enjoy the 99% of the wonderful things that being a veterinarian brings. 

Clones, Cat Nappers, and Cadavers

My muse, Wren.

There is not another human being on the planet that loves their pets more than I do, (OK, there might be a few of you out there, but you understand me)..add to that that I don't have any children other than my four cats, two dogs, and pet potbellied pig, and my pet-fanaticism is over the normal socially acceptable limit. (Yes, I do have a "crazy cat lady" coffee cup that I use proudly). I identify with the labels, I embrace the snickering, and there is nothing anyone can say or do to shame me into hiding it!

Oriole. In charge.

If I had to pick sides I would say that for as long as my feet are planted on this earth and my lungs draw breath I will have a cat beside me. They were my first pet and they will be my last.

Playing with Wren.

Because of my devotion to my kitties I read the latest press release from the University Of Georgia's Veterinary School about their second kidney transplant with great interest and contemplation.The University of Georgia continues to forge a path into the relatively new field of companion animal organ transplants. They  are now incorporating the use of stem cells to help the recipients body from rejecting the new kidney. This surgery was different from previous feline kidney transplants because it incorporated the pioneering approach of using harvested stem cells to help the recipient,  Arthur, the most recent kidney transplant patient, is a four year old Siamese cat who was dying of kidney failure. He had been diagnosed at age 3 and his only chance for long term survival was to find a donor and receive a new kidney via transplant. Stem cells were used because his body had not responded well to the more traditional anti-rejection medications used to help a donor accept a new organ. Arthur had been turned down for the surgery at two other teaching hospitals because of this. Without the use of stem cells Arthur would not have been a candidate for the surgery and he would have died from his kidney disease.

There are a few areas of Arthur's story that I find incredibly compelling and warranting further discussion.

First is the concept of organ transplant for pets. Next to cloning there isn't anything left that proves our affinity for our pets. Extending their lives with human equivalent medical and surgical options is a testament to our desire and ability to keep our pets with us for as long as possible.

The question has shifted from the impossible to obtain the service to the ethical of who is eligible?

This is how I watch tv every night;
Sharing the couch with a relaxed Magpie.

How close do our human medical and surgical options mirror our pets options? The line gets blurry and seems that the options are only now limited by our wallets.

Of comfort to my moral conscious is the fact that all kidney transplant donors are shelter cats. Those cats need to meet certain criteria to be donor eligible, but they must also be adopted into the family whose cat is receiving the kidney and remain a lifelong pet. The prince and the pauper are expected to be on equal footing after they share a kidney of the same origin.

Is every cat kidney transplant worthy? Yes, of course in my eyes. Every cat is capable of eliciting and demonstrating as much affection, improving the quality of their owners and families lives, and for that there is no dollar amount to prove a pet's worth and value.

Do I think that the majority of the public scoffs at the idea that I share my home with 4 cats who are given access to as much of my home as every other human inhabitant is? Yes.

Do I think that many people  lack the ability to understand why I am so crazy about my cats? Yes.

And, do I think that I would transplant an organ from one cat that I do not know, but would inevitably love as much as my others, to one of my resident kids? Well, yes, perhaps I would. I see my pets as my kids and it is my job and my responsibility to care for, protect, and provide what they need to live a happy healthy life.

Jitterbug, in a rare frozen pose state.

Here is where I hear my internal voice quibbling.

Where is my line?

Where is that point where I say this is too much? Having had a dog who underwent radiation therapy for a tumor that extended his life 6 months at considerable cost, I believe I would do that again. And for all of the difficulty Savannah's last year was, I would happily do that again. My dear old kitties had wonderful lives, even though saying goodbye was so terribly hard. For me, maybe there is truth in the knowing what the sadness for without that I would not know what the joy is. And for all of the many many pets whose lives I have been a part of, each pet and each story, whether they be long and thriving, or short and tragic there is always another chapter and often a sense of being a small part of a greater force in a mysterious universe.

Let me try to explain this.

Let's start with an easier topic to debate; Cloning. I have written about this before.

At some point there needs to be a long thought out discussion on not what is possible, but what is ethical.

Life isn't about cheating and stealing a way to live forever. Life is about learning to live and enjoy this time that you have. Don't wait until you are dying to realize that life was a precious gift. You get one shot, you know the old saying "life isn't a dress rehearsal," and the advice about doing the things on your bucket list now..well, there's truth in those words of wisdom.

Veterinarians know all to well that life is not fair. We watch puppies die of treatable and even avoidable disease and illness, (often because of just pure neglect and  poorly educated parents). We see 2 year olds die of cancer. Cats die from fleas, lack of resources, or just because they serve no perceived purpose to their owner. Many vets are asked, and required to euthanize routinely.

Cloning doesn't get you your pet back. It gets you a close representation of them. Your loss still needs to be addressed like everyone else's. Losing a pet that you love is really, really hard. But the memories are yours forever, and the difference that you made in taking care of them changes the world in which you live in, forever. Getting through grief is possible, and loving another pet is also possible. They will bring new joy to your life if you can open your heart and let them.

For as hard as it was to lose my dear cat DC and my Savannah, and all of the rest of them, I have a new set of rescues who are happily living a life of pampering and bliss in our home. I miss my departed pets, as I miss my departed friends. But I wouldn't ask to go back and re-incarnate them into the shell of what they used to be. What I miss is the spirit and the soul of who they were, that never can be replicated, duplicated, or re-born. That is the gift of life.

Life isn't fair, but it does go on.

My days at the clinic always include cat naps.

Find Arthur's Story Here.

Find more information on the University of Georgia's transplant program here.

For more information on stem cell use, research, and future use in medicine please see, Huffington Post here.

Or, See Pet Health Gazette and Jana Rade's blog here.

Previous blogs relating to this one;
Charlie Arrives
Pete The Vet, Blog On Cloning.
Savannah's Saga
How Many Sides Does Your Equation Have?

If you have a question about anything pet related you can ask a whole community of pet loving and dedicated professionals on Pawbly.com. Pawbly is free to use and open to everyone who loves pets.

You can also find me at the clinic, Jarrettsville Vet, or on Twitter @FreePetAdvice. 

Gassy Pets. What To Do With Those Dogs That Blast You Out Of The Living Room?

My two puppies,,,and Jitterbug, the cat, who thinks he's a dog.
Can you guess which has the gas problem?

I get some great questions on Pawbly. They run the gamut from life-threatening, to which I simply answer; "Get off the computer and get to the ER now!" to the funny and fairly common pet stuff, like today's from Elizabeth; "What can I do for an 8 month old puppy with terrible, smelly gas?"

All of us suffer from this from time to time, and pets are no exception. We all have the same biology so we share many of the same conditions.

A gassy dog is especially difficult when they sleep in your bed,,
but it does give you a convenient excuse.

Here is my answer;

Hello,
Gas, or flatulence, occurs for a few reasons. It is a normal part of digesting and processing food, so it will be impossible to stop all of it.

BUT, It can also be associated with poor diet, poor ability to digest food, and intestinal problems like worms, etc. so talk to all of these with your vet before dismissing  it as a normal puppy thing.

The more plant based your diet is the more likely you are to suffer from gas. The gas is a by-product of the guts bacteria breaking down the food we eat so that it can be converted into energy. Foods like beans, legumes, etc. are notorious for making us gassy, but they are excellent sources of protein and fuel for our body. Add to this that puppies have an incredibly efficient and over active metabolism (especially those large and giant breeds) and you can get a gassy puppy.

So, if we can't avoid farting puppies what can you do to minimize it? Well, you can see if a different diet will be easier on the digestive system? Some diets that are lower in fiber and filler can reduce the gas, BUT, I am always far more concerned that you stay on a very good, veterinary recommended, age and breed appropriate food. Ask your vet for their recommendations and then you can do your own in home food trial to see which food(s) might be easiest on his system. BUT, remember that each diet change should be done slowly and gradually (over a week or more) and then do a few weeks on the new food while you collect your data/observations.

I have a Great Dane patient who at 4 years old had recurrent bouts of bloat and terrible burping problems, so he is on a daily gas reducer..but I would never recommend a long term medication until the easier and safer to change stuff was eliminated.

I hope this helps,

Let me know if anything works, or if you identify what he is sensitive to.

Sincerely,
Krista Magnifico, DVM

The fumigator in our house is Charlie, on the right.
Why? Because he is a poop eater, and that gives him gas.
I know, so gross.

Dr. Chambreau is a holistic veterinarian who contributes many answers to Pawbly and offers a fresh perspective to the traditional veterinary protocols and treatment options. To read more about her please visit her here, or on Pawbly.

Here is Dr. Chambreau's answer:

Could you tell me what you are feeding, what supplements you give and how long the gas has been going on?  How are his/her stools - firm, soft?  When does the gas occur - anytime, or only after meals? If the stools are soft it would be good to have the stool checked for parasites by your local veterinarian.

The quick and easy answer is to begin using probiotics. My favorite is Mitomax, a super probiotic. I have had many animals' smelly gas clear up while using this, though sometimes they need to stay on it. Unlike other probiotics, it is very stable and is ok at the low stomach pH.There is an icon on my home page for it (www.MyHealthyAnimals.com). You could also get other pet probiotics if near a pet health store. (by the way, if you put in your city, we can be more specific in our answers)

The longer answer is to generally improve health. There are 7 keys that can help you do this, with a link on my home page.

Please let me know a little more and if you have questions about the holistic approach (7 keys to health). 

So, you see there is a wealth of information and interesting pet things to learn at Pawbly.com. Please stop in and say hello, ask a question, or even add some information of your own! Pawbly is all about helping people take better care of their pets.

If you want to see me in person, you can find me at the clinic, Jarrettsville Vet, or on Twitter @FreePetAdvice.

Top Ten Pet Wive's Tales

Madeline and I take a little work break.

If there is a trade that has been around since the dawn of time we adopt and accept a few of the old wive's tales as gospel and continue to use them as a foundation for making decisions for generations to come. Sadly, almost all of the most common wives tales have no basis as fact, and worse, almost all of them are completely wrong.

I seem to have a client a day who sites them as a reference for their medical knowledge, diagnosis, assumption of disease, lack of disease, reason for waiting to get help, etc. etc. Those wive's tales always seem to do much more harm than help, and always at the pets expense.

So, I decided that it's time to start dispelling those old wive's tales for good!

Here are my TOP TEN VETERINARY MEDICINE WIVE'S TALES. 

NUMBER 1. "A dog licks it's wounds to clean the infection."
OK, before the advent of modern medicine when we all lived in our own sewer this might have had a shred of efficacy to it. But with the invention of soap this became a true wives tale. Your mouth, your dogs mouth, every ones mouth, is full of bacteria. That's why a dog bite on your arm will cause infection. Saliva is not an antibiotic. Soap and water are. And just because we are on the topic of cleaning a wound, I will add my 2 cents on hydrogen peroxide. Hydrogen peroxide is best when used only on a "dirty" wound. A dirty wound is one where there are pieces of dirt embedded in your wound, like when you fall off of your bike and skin your knee in the dirt/asphalt. Think of the bubbles in hydrogen peroxide as those scrubbing bubbles in the toilet bowl cleaner commercials. After your wound is clean you need an antibiotic or soap. Don't use hydrogen peroxide after you have gotten the wound clean because those same bubbles are killers to your newly forming cells that are trying to heal your wound. Using hydrogen peroxide after the wound is clean will delay healing.

Most of the dogs that I see who are cleaning their own wounds, are self traumatizing them to the point of causing more damage than they would have if they could just leave the wound alone. Think of it as a scab that you keep picking. Your wound will never heal if you don't let it scab over and heal. And think of your tongue as a wet bath towel you have left on the floor for weeks. Yuck and Yuck.

If your pet has a wound it should to be cleaned by flushing copious amounts of water and soap to clean out any dirt, debris, and bacteria. After the wound is clean and dry we usually place protect bandages and antibiotics over the wound. There are exceptions to this! So if your pets wound is deep, and/or extensive you need to see your vet. Many deep wounds should be closed surgically after they are explored for pockets and deeper tissue damage. We also usually start oral antibiotics and a put an e-collar on. An e-collar will keep your pet from licking their wound and/or removing their bandage.

Many people are very reluctant to use an e-collar. But I really think that they are the only effective means of keeping your pet from causing any more damage to their wound then they already have. Also please know that there are many types of e-collars available. So if your pet isn't tolerating the one you have been given there are some other options. I really like the Jor-Vet soft e-collar. It is easy to clean, easy to sleep in, and goes out 90 degrees from the neck so dogs don't feel so claustrophobic with them.

NUMBER 2. Letting your dog have a litter to improve their emotional health. 
Your dog doesn't need to have a litter  for any reason, and the likelihood of things like mammary tumors (breast cancer) is almost 0% if you spay before their first heat cycle. They run the risk of unwanted, unplanned pregnancies, or uterine infections. These can be life-threatening, expensive, and cause emotional and financial hardship. The thought that female dogs need to have a litter or experience motherhood is silly. You are responsible for your dog, their mental health and their offspring. Providing a safe place full of love and exercise is what your pet needs mentally. See Coco's story.

NUMBER 3. "A mother bird won't take care of her babies if you touch them or the nest."
If you find a baby bird and you know which nest they belong in, you can put them back. But maybe the baby is out of the nest because it is learning to fly, in which case it will just plummet out of its nest again. A mother bird does a better job at raising their babies than you or I do so leave the baby alone and let it's mom resume her duties. In just about all cases she is watching you eyeing up her baby, she just thinks that you are too big to fight. (Oh, last thing to mention. Keep your inquisitive predatory pets in the house while the babies are learning how to fly).

NUMBER 4. "A dog won't lift its leg if you neuter him before 6 months old."
OK, lets differentiate between peeing (urinating), marking (territorial), and lifting a leg. Some dogs pee on four legs, some pee on 3 legs, regardless when they were neutered. But a dog that is allowed to become sexually mature will usually "mark their territory" by placing a small amount of urine as high as they can on a vertical surface. This might be a tree, a shrub, or your couch arm. Once a dog starts marking they may not stop even if you do neuter them. We recommend neutering at 6 months old so that your dog doesn't start marking your property because he thinks it is his.

This is my five year old mix, who usually pees on all fours, but will "mark" should the mood strike him.
He was neutered at 6 months old.

This is my other pup, Jekyll.
He was also neutered at 6 months old.
He usually pees on three legs, but rarely urinates to mark anything.

NUMBER 5. A wet cold nose is a sign that your  pet is adequately hydrated and doesn't have a fever, OR, a dry warm nose is a sign of a fever, OR, a pet that feels warm has a fever.
The only way to know if a pet has a fever is to take their temperature. A digital rectal thermometer should be used with proper lubrication and inserted deep enough to get an accurate internal temp. Dogs and cats have a normal resting temperature of about 100-102 degrees. The rest of your pet is just what it feels like at the time. How often are your feet warm, your hands cold and your temperature is still normal? Your pets nose can change from warm to cool, moist to dry, and any variation in between based on humidity, temperature, activity, metabolism, etc.. If your pet feels warm take a temperature, or make a visit to your vet.

Madeline's nose in our selfie.

NUMBER 6. Garlic and onions can be used to treat fleas, ticks, and heartworms. 
Ugh, these are not safe nor effective options. I have seen pets almost die from these. There are many affordable and safe options available, just ask your vet. And please, please, don't use garlic, onions, or any other crazy thing that you read might ward off parasites. (I once had a client soak his kitten in fuel oil..it almost killed the kitten. It was horrible and heartbreaking). See Top Ten Kitchen Toxins here.

NUMBER 7. One year of life for a dog/cat year is equivalent to seven human years.
Cat's can live to their late teens. All of my last generation of cats lived to see 18-20 years old. In fact I just read about a 32 year old kitty. Small breed dogs can also live to see their 16 or 17th birthday. Giant breed dogs live to about 7 to 8 years old. So, you see there isn't a linear conversion equation.

Taking care of your older dog. Savannah's story.

NUMBER 8. Dogs with black tongues are dangerous. 
Sounds a little bit like profiling based on color, or prejudiced opinion. Certainly dogs of all breeds have a few consistent traits, like Golden Retrievers tend to be silly and happy, Labs outgoing and playful, Jack Russell's driven and determined, and Chow Chows often have a black tongue. Every single dog has the capability of inflicting harm, and every pet should assessed independently by a person who can understand the subtle clues a pet gives. If you approach a pet always ask the parent if the pet is able to be touched or approached. Or be respectful and give a safe distance. Don't assume a pink tongue is a friend, nor is a black one dangerous.

This is Bismark, who would take great offense to being told that he was dangerous.
He is indeed a fine well-behaved sweet boy.

NUMBER 9. Dogs scoot their butts because they have worms.
Dogs that scoot usually have either anal sacs that are full, distended, impacted or infected. If the anal sacs are normal then check for itchy skin. For more information on anal sacs please see The Scoot Story.

NUMBER 10. Feeding soup bones helps keep teeth clean. 
Feeding, watering, adding, etc..all of those advertisements for products that promise to keep your pets teeth clean are full of malarkey. Your pets teeth will only stay clean if you brush them. A few minutes daily will help protect your pets mouth from dental disease, bad breath, dental infection, a painful mouth, difficulty eating, and even heart disease. Offering dry soup bones can lead to broken teeth (which should be extracted if the pulp is exposed) bone shards causing gastrointestinal upset, obstruction and sepsis. I know that no one wants to hear it, but the only safe and effective way to keep your pets mouth and teeth clean and healthy is the same way you keep your own, brush daily.

Lower canine is worn and fractured due to chewing.

OK, there are more out there, toss them to me. Let's see if we can think of any that might have one shred of credibility.

If you have a wive's tale to share please tell me!

If you have a pet question you can find me anytime at Pawbly.com. Pawbly is the place for all things pet! Pawbly is a community driven pet focused social media platform. It is free to use and everyone is welcome.

You can also find me on Twitter @FreePetAdvice, or on the Jarrettsville Vet Facebook page.

The Pets Are Never The Problem

Meiji, one of the many reasons that we do what we do.

Many of the vets I know went into vet school because we had a stronger affinity for pets than we did for people. I mean, after all, we could have gone to medical school if we wanted human patients. Most of us were little girls who loved puppies and kittens hands over little boys, or even adults of any kind.

The dilemma in this is that you also need to master human communication skills as you are mastering your veterinary skills. Those pets just don't march themselves in the vet office door without a ride and a chaperone.

Sampson, another happy customer.

The successful practices learn this, practice this, and train their staff with customer service on equal footing with patient care and quality of medicine. There are many, many great clinicians out there, and even a large handful few who are great with their bedside manner, but in the world of private small animal practice where you already have to be the doctor of general, surgical, ophthalmic, internal, cardiac, geriatric, pediatric, neurology, etc. etc., it is really tough to wear all of these hats and be the happy-happy "Hello, my name is Dr. Doormat, How Can I Help You?'.

If you are fortunate enough to ever stay at world class hotel, spa, or retreat you will see and feel first class service for yourself. Every moment of your stay is pampered, planned for, thought out, scrutinized and customized. Everything is placed at your fingertips by smiling, professionals impeccably dressed and waiting for your every desire and whim. It is an army of well trained, synchronized, experts. There is no whispering, no slouching, no dirty pants, faces, shirts, no excuses, no gossiping, no cell phone checking, talking, or distraction of any kind from their primary duty: customer service.

Dixie, one of the girls forever indelibly marked in my heart.

My challenge as a practice owner has always been to try to instill this degree of attention and service in my staff so that our clients can feel like a pampered celebrity, (even if they are carrying a fecal sample in their purse). It is an arduous almost unattainable goal. Everywhere I travel I take home lessons about customer service.

Here are some of my observations;

1. My dentist. A lovely, charming, holy-Moses crazy talkative guy. He keeps a little note book in my file of key terms to discuss at each visit. Things like "merchant marine" "vet here in town" "dogs" "cats" etc. He studies his notes before my arrival and they give him ample areas of conversation between my "rinse and spit" instructions. I go back regularly and I give him an A for effort. His receptionist, well, she opens her glass door to check me in and out and keeps herself walled off from the waiting room the rest of the time. It's a quick cursory "hello" and "goodbye" and even though I have said these to her about a hundred times before I couldn't pick her out of a line up if she was the only female. (Huh, I think she's a female?). You get my point. His dental hygienist, well, she is a peach. I adore her, I go back because I like to hear how she is doing and catch up. She also is a client so we share pet stories.
2. My doctor. Well, he is even more chatty than my dentist. I know every single thing about his adult (long out of college daughter) that he knows. If she ever needs a writer for a dating service I could fill out the 490 questions accurately. He talks about twice as much as I do in our 15 minute appointment and he's not the one with  the presenting compliant. His receptionist? An older woman who may have teeth, eyes, a face, and a personality, but has never revealed any of them to me. I stand by her desk, she says "hello" face in a paper, passes paper to me, mutters a goodbye. She is so terrible that I am indifferent to her. Why does he keep her? Well, she runs the show so he doesn't have to. His nurse? well, she is always a young, fresh out of school, efficient, well trained taker of my temp, weight, blood pressure, pulse, and respiration. She lasts about a year and then leaves to find a friendlier face then Rosy-the-receptionist to spend her 9-5 Mon-Fri with. I can't blame her. Why do I go back? Huh? I like my health care provider, he's close, and I know what to expect. (Probably bad reasons).
3. My hospital. I am part of the Johns Hopkins health care network. When I go in for anything I am assigned a patient assistance adviser within the first moments of arrival. I am given her name, her "anytime for any reason" hospital phone number, her card, an arm around my shoulder and a full on face plant of trust and reassurance that she is in my corner for any and every thing that I might need while I am under their care. It doesn't change the fact that no one enjoys being a patient, and that hospitals are anxiety ridden buildings, but it does make me feel that I am not so alone in this foreign place. The doctors are top-notch (although there is an undertone of practicing under a shroud of bureaucracy and red tape). The nurses are efficient, prepared and fall into one of two categories; A. confident and at ease, B. bitter and cold.

Boomer. Dixie's big brother.
Always a smiling face!

My point for all of this? Why wouldn't I extrapolate out the strengths, identify the weaknesses, assess them all independently and bring them into my veterinary clinic? We are all customers in other businesses, we know what good vs great customer care is. Why aren't we ALL being the business who cherishes their clients. Further, why aren't we all being the customers who lead by example?

The fate of small private veterinary practices lies in our ability to sell our clients on the value of our services. The goods we used to hold exclusively in our control and sell at hundred percent mark ups are gone. I am focused and committed to providing the best patient care, medical care, humane care and compassion that anyone could find anywhere.

How am I going to do it? Well, that's for another blog.

OK, everyone likes a hint: Pawbly (...learn all about it here!) and some new exciting things at the clinic are brewing..(that's another work in progress..we are getting there),,,stay tuned....

If you have a pet question you can find me at Pawbly, on Twitter @FreePetAdvice, and at the clinic, Jarrettsville Vet.

Related blogs;
What Is Pawbly?

DVM 360's article, Sell Clients On Your Service. July 2014

I want to hear from you! What burns your butt about your health care providers? Where do you find amazing customer service? What do you wish that your vet did differently to improve your visit?

Thanks for reading!

And as always, Be Kind..

Pet Friendly College. Sounds Like A Great Hook For Enrollment, But Is It Best For Pets?

My first response to the article about Lees-McRae College providing pet friendly dorms and allowing staff and students to bring their pets to class was....If I had heard of this when I was shopping for a college I would have been heavily swayed. If this is a hook for attracting students I would have bitten and been hard pressed for a reason NOT to go there. But, here’s where my parents would have chimed in, (and now me as the old lady that I have become). They would have reminded me that going to college is a full time job where, hopefully, I would be trying to manage classes, a social life, and a pet. Do I really think that I can do all of this?

AND,

Who do you think would get the short end of that stick 9 times out of 10?

Here is where the vet, and been around the block a few times old lady chimes in. Kids are still kids, even in college. It’s a period of transition and the fewer lives that these kids need to be responsible for the better. I also am deeply concerned about the financial commitment and strain that a pet places on anyone, in particular an already cash strapped college student.

I spent fifteen years in a college town. The burden on the local humane society, veterinarians, and rescues was compounded by the end of the year dog and cat dump as kids left for their summer break. The rest of the school year was a musical chair of rotating cats and dogs in and out of shelters as college kids adopted pets, with the best of intentions, only to surrender them when the dorm or landlord found out an extra illegal inhabitant was squatting in the kid’s room.

Here is my own,
  "Why college kids shouldn't adopt a pet story."
 Savannah.

There are also other issues of concern. The safety and well-being of other students. Most pets are protective of their space and the dynamic rambunctious environment of a dorm is likely to be too much for many pets. Dogs large and small become territorial and can become fearful or anxious or even stressed with the high traffic volume and noise of a dorm. The responsibility of kids to keep doors closed, thereby keeping cats and dogs in their rooms, and the accidents that will and do happen anyway can be exacerbated with high energy chaotic lifestyles. I have a difficult time enough just trying to remind my husband to keep the doors shut so the cats don't escape. Cats can and do become ill with stress, dogs fearful and anxious, and behavioral and medical problems are more likely to be uncovered, complicated, and more difficult to resolve simply due to the nature of a college environment.

So here are my thoughts on this, I'm interested in yours.

• What do you think about college kids having pets?

• What do you think is in the pets’ best interest?

• How would having a pet in college have changed your college experience?

• Do you have a story about a pet that became your responsibility because the original parent wasn't quite prepared to take full responsibility of a pet?

To learn more about Lees-McRae College please visit their website here.

To learn more about their pet policy please visit here.

Think a cat, dog, fish, or hamster is the ideal college pet?
I would vote PIG!
(Although post a sign about fingers and food...sometimes they can't distinguish them clearly).

If you have a pet question, or would like to share your pet experiences, you can find  me and a whole community of fellow pet enthusiasts at Pawbly.com. Pawbly is free to use and open to everyone who loves animals!

Or you can find me in person at Jarrettsville Vet, or on Twitter @FreePetAdvice.

Top 10 Symptoms Pet Parents Overlook, Dawg Blogger Vet Survey.

I was asked by my friend and uber-blogger dog research expert extraordinaire, Jana Rade, who writes the mega successful blog "Dawg Business" the following question for her latest installment of the vet survey series.

Veterinarians Answer: 

10 Main Symptoms To Watch For In Your Dog

Here is my response;

1. Shortness of breath, breathing difficulty. People often miss this subtle slow onset as lethargy, or panting. But a pet with an extended head and neck, open mouth, or abdominal involvement in moving air, is having difficulty breathing. This is a medical emergency.

• Jake's Hail Mary

2. Distended abdomen. Most pet parents don't notice this either, but it is one of the most important clues in bloat, which requires immediate surgical intervention.

• Splenectomy

3. Gagging, retching, attempting to vomit with, or without producing vomit or liquid from the mouth. This is also another sign of bloat, or an intestinal obstruction. Both require immediate veterinary care and intervention.

• Bloat, Gastric Dilatation Volvulus, and Grass Eating

4. Panting. Excessive panting can be difficult to distinguish from regular ordinary panting, but your dogs internal temperature can climb quickly and become life threatening. A panting dog, who becomes quiet, recumbent, and lethargic is in some cases a dying dog.

• Cats In Hot Weather
• Signs Of Heat Intolerance
• Death By Heat Stroke/Hyperthermia

5. Excessive chewing. Some people think that having lots of rawhides, toys, chewies, etc.. around will keep their pet from becoming bored, but in some cases these dogs learn to become fixated on oral stimuli, which perpetuates more chewing, and chewing on objects that are not safe. If your dog is an excessive chewer I worry about intestinal obstructions. We have seen 2 and 3 year old's undergo multiple exploratory surgeries. Think about whether your pet is bored. Dogs need exercise, mental stimuli, and a safe happy engaging environment. Feed that, not the stomach.

• Rock Chewing and OCD

Skittles.
The latest addition.
Found by the side of the road alone, but adapting well to  house with two small boys.

6. Persistent lameness. If your dog is limping and it either becomes more severe OR persists it is time for an examination, and at some point it is time for an x-ray, or even serial x-rays to identify cancer, osteoarthritis, and other possible soft tissue, or orthopedic conditions. The early these are diagnosed the better chance of successful treatment options.

• Heidi's Story, and Coercing Your Client

7. Obesity. Many pet parents don't realize how those pounds creep up. Because they are with their pet everyday they don't recognize that their furry friend is packing on pounds that can lead to diabetes, cancer, osteoarthritis, other diseases, and premature death. Obesity is an epidemic in the USA for both pet and their parents. This is a preventable disease!

• Survey on Obesity Blog here.
• Second Biggest Loser Contestant, The Obese Lab
• Fat Tuesday
• Project Pet Slim Down

8. Head shaking, licking paws, scratching..and all of the rest of the ways our pets try to tell us that their skin is bothering them. All of these clinical signs tell me that your pet has a struggle with a bug..those bugs can be bacteria, mites, yeast, fungi, fleas, ticks, aka; nasty small blood sucking/chewing/biting parasites. Get to a vet before your pet is bald, bleeding, red, and so itchy that they are miserable.

• Ear Hematoma
• The Ear Ache That Never Went Away
• Ears, No One Treats 'Em Right

9. Anxiety. As a parent it is our job to provide our kids with a safe household and the building blocks to become successful and acceptable members of society. If your dog barks, lunges, snips, bites, growls, snarls, harasses, challenges, cowers, urinates in fear, or is unable to deal with normal routine social interactions then your pet needs help. Don't just adjust your life to avoid, mitigate, or excuse the behavior, address it! Understand that you and your actions might be adversely affecting your pets ability to function appropriately and seek an unbiased credible third party to help. It is for the sake of you, your pet, and the rest of the members of society. Dog bites, attacks, and even deaths occur because people didn't pay attention to the many many warning signs their pet gave them.

• Curing Beau's Anxiety
• Surviving the Delusions

10. Bad breath. Bad breath is always bad teeth, (well, maybe not 100% of the time, but enough for me to say,,,) If your pet has bad breath see your vet. Further, have a dental cleaning that includes thorough probing of all teeth AND digital dental x-rays. Your pets oral health is intimately tied to their overall health, especially heart disease. If your pet has a murmur take extra efforts to keep the teeth healthy and clean.

• Bad Breath, Is It Food, Teeth, Or Your Nose?
• How Much Does The Average Dental Cost?

For the other participants answers please see Jana Rade's Dawg Business blog here
.

My sister and her family were here for the weekend.
We had beautiful weather and spent much of the time fishing and playing in the stream.
This is Lilly and Bandit.

If you have a pet question, or any additions to this list, please reply back, or find me on Pawbly.com.
Pawbly is a free open online community for animal lovers. We invite you to stop by, post a picture, share a story, ask or answer a question, and share your pets stories with us.

Or you can find me in person at the clinic, Jarrettsville Vet, or on Twitter @FreePetAdvice, squawking about all things pet.

Have a wonderful summer everyone!

A Simple Reason Your Older Cat Can't Walk

Midnight

"I think my cats kidneys are shot because she can't walk anymore."

Such was the way Midnight's appointment began.

Midnight is 16 years old, and chronic renal failure in  an elderly cat is certainly a good guess, and very likely affecting every 16 year old cat. To confirm kidney disease blood and urine must be tested.

There are some appointments that are incredibly time consuming, require complex and complete diagnostics, days of treatment options and attempts, AND, then there are the few that just take a few seconds of looking.

It was very obvious why Midnight couldn't walk.

Her very sharp toenails had grown into her soft foot pads, and every step she took was four needles driving into her skin.

OUCH!

Her diagnosis was easy: Overgrown nails.

Her treatment plan: Easy. Trim nails.  (See my Nail Trimming Guide here.)

Her Prognosis: Excellent, (far better than kidney failure), as long as her family keeps them trimmed.

After we trimmed all of Midnight's nails she had multiple open wounds in her foot pads. We sent her family home with foot soaks, antibiotics and a request to change her clumping litter to newspaper. 

I expect she will be walking better shortly.

As cats age their instinct to scratch and shed their nails decreases. Cats should be encouraged to scratch on appropriate surfaces by keeping them accessible and enticing them with fresh organic catnip re-applied weekly. Even with ample opportunities to scratch older cats tend to not shed their nails well. Older cats should have their feet and nails checked weekly, and trim as often as needed. If you are reluctant to trim ask your vet to show you how.

Related Posts;

Top 5 Things Overlooked By Cat Parents

How To Trim Nails

If you have any pet questions of any sort you can find me, and a whole slew of incredibly smart, very generous, dedicated pet people at Pawbly.com.

Or, you can bring your kitty (or pup) into the vet clinic for a visit by coming over to see me in person at Jarrettsville Vet.

Or find me on Twitter @FreePetAdvice.