Rebuttal to Peter Fenton's Washington Post Article, "Vet's Are Too Expensive, And It's Putting Pets At Risk."

The following article was written by Peter Fenton on April 21 for the Washington Post
Peter Fenton is the author of Eyeing the Flash: The Making of a Carnival Con Artist.

My response to each section is identified in italics.

Vet's Are Too Expensive and It's Putting Pets at Risk

After a terrifying encounter with our automatic garage door, my beloved 23-pound cat Orangey was in trouble — dazed, struggling to breathe and in pain. I rushed him to the nearest animal emergency clinic and quickly agreed to X-rays and pain medication.

 A 23 pound cat??!! The average cat should weigh between 8-12 pounds. Vets often remind our clients that "an ounce of prevention is worth a pound of cure." The best way to avoid healthcare problems is to stay healthy. Obesity is at epidemic proportions in this country and the collateral health costs are staggering. They include; arthritis, cancer, diabetes, among others and also significantly reduce both the length and quality of life.

I didn’t think about the cost of anything at first. But as care escalated, I began to worry about our running tab. Though Orangey’s injuries were minor (and the doctor agreed to perform only essential procedures), he was hospitalized for about 48 hours. All told, the bill totaled $968.29.

It is impossible to offer an opinion without an itemized bill or invoice. As with EVERY transaction in EVERY persons life it is prudent to ask before consenting to any care or service. My personal opinion is that $968 for a 24 hour emergency facility two days of care and work up after a traumatic injury is not excessive. And, it was probably not evident until after 48 hours of monitoring that there weren't any major injuries. Certainly, with an obese cat and a garage door there could have been. These could have included, lung, liver spleen or other internal organ perforation, pulmonary contusions, fractures, etc. Both Orangey and the owner were lucky. Plain, old lucky. I am guessing that radiographs were done, (I am also not guessing that they were done with consent) to rule out fractures. Radiographs at my clinic are $100 to $200 dollars. The x-ray machine is digital and cost the clinic about $90,000. Yes, ninety thousand dollars. How many x-rays do I have to take to break even? (This is the average cost for a good model). I feel obligated to say that I understand most people could not afford $900 out of pocket. The point is not that $900 is not expensive, $900 is a lot of money. The point is was the care Orangey received WORTH $900? I would venture to guess Orangey was given excellent emergency care for traumatic injuries which everyone agrees could have been life threatening. If $900 saved his life would that be an acceptable fee?

I was shocked. And not because I’m a novice pet owner — my wife and I have been rescuing cats for most of our married life. But when we started, vet costs were modest. That’s not the case anymore. According to a 2011 report by the American Pet Products Association, the cost of routine and surgical vet visits has risen 47 percent for dogs and 73 percent for cats over the past decade. Pet owners spent about $8 billion on vet care in 2000; by 2013, that figure climbed to more than $14 billion.

Perhaps 20 years ago an x-ray machine was more modestly priced? Perhaps 20 years ago the cost of a veterinary education was less than the average $150,000 of debt most new graduates bear? Perhaps the author didn't have 20 pound cats? Most definitely the standard of care was not a fraction of what it is today. A point I believe is tied to a few things; Liability. If we all didn't love to sue each other vets could practice medicine that was practical, versus fearing liability. Pets are companions now, not the same label was provided to most cats decades ago.

Disturbingly, many owners are reacting to sticker shock by not bringing in their pets at all. “An estimated 23 million pets in the United States are in homes where the caretakers live at or below the poverty line, and that typically leaves the animals without access to veterinary care,” Humane Society President Wayne Pacelle said in a November 2014 blog post. “Close to 80 percent of their pets have never seen a veterinarian.”

I believe this statement to be true. It is yet another sad reminder of the fragmented society we live in, and this trend does not seem to be getting better. The divide between the wealthy and the poor is only widening. As the demographic fragments the marketplace will respond. In the arena of pet care it is done as an emotional obligation to help pets versus an opportunity to create a business opportunity in a need based area. Non-profits, motivated by emotional need to provide care, are forming simply to provide care to the needy and under-served in our communities. The established vets are too busy trying to respond to the shifts in our business models to care enough to try to figure out how we can help those who cannot afford care. We vets don't want to be working for free (and not many of the rest of society does either), we just don't want you to be able to get help for free elsewhere. (Doesn't make much sense does it?)

Vet incomes are a big part of the reason for the rising costs. According to the Veterinary Medical Association, the mean annual professional income of private practice veterinarians rose from around $60,000 in 1995 to over $90,000 in 2007.* Vets argue that this jump to correct an imbalance. As Veterinary Advantage Magazine explained, between 1965 and 1995, veterinary fees lagged behind inflation. At the same time, student debt for vets grew exponentially. And pet owners began to turn to online pharmacies for medicine. As  Rob Foley of New York, who co-authors The Angry Vet blog, explains, this is a killer for vets. “When a veterinarian loses revenue through pharmacy sale losses, they must make up this income by raising other costs like exam fees or diagnostics,” he writes. “The money simply has to come from somewhere.”

Vet incomes. This is a point of deep contention for me personally. I will be honest. Everyone wants to quote incomes as if they are outrageous, egregious and unwarranted. What should someone who spends 4 years in college HAS TO make almost perfect grades, and then spend another 4 years in medical college to get a doctorate deserve? What would you want if this were yourself? Or, your child if they spent 8 years earning perfect grades? Did I mention that $150,000 of educational debt? A doctor a lawyer, they meet the same qualifications and make upwards of $132,000 lawyer, and $189,00 doctor. Outrageous that vets make $90? Why, because we treat animals? Shouldn't pediatric oncologists work for free then? 

However, even Foley admits that some veterinarians take advantage of pet owners: “I have seen bills run up. I have seen animals hospitalized who clearly did not need to be and animals operated on who did not have to be.”

There is not one profession that this statement can't be used for. There are bad people everywhere. Healthcare and patient care is based on trust. If you don't trust your doctor find one that you do. In general veterinarians are the most humble, hardest working and most honorable people you will ever meet. (That's why you want your daughter to be a vet isn't it)? There is nobility, pride and humility in being a veterinarian. Oh, yeah, there just isn't the pay, and the emotional guilt that people will lay at your feet is heartbreaking. Did I mention the suicide rate? That department we have cornered.

When owners can’t pay, clinics offer payment plans — but at a price. When my wife and I raised heck at the emergency room over Orangey’s charges, the vet whipped out a brochure detailing the clinic’s plan: a credit card with a high APR. We declined. But others might be forced to saddle themselves with additional high-interest debt. (It’s possible to get pet health insurance, but Consumer Reports says it’s rarely worth the price.) CareCredit, a division of GE Capital Retail Bank, is a major issuer of such credit cards to vets, dentists and other professionals. In an interview with VIN News Service, a company spokesperson affirmed that well over half the animal hospitals in the United States accept the company’s card.  An independent study found that vets who routinely offered the card to customers earned 17.2 percent more total revenue per year.

There isn't one veterinarian on the planet who hasn't tried their own in house payment plans. I did it for 7 years. My default rate about 75%. One year I wrote off $50,000 in unpaid bills which earned myself having to work for free for 2/3 of the year. It came out of my paycheck as the hospital owner because there was no other bank account to pull it from. Without third party billing options there would be no options for clients who don't have either insurance or savings accounts.

According to a 2013 settlement after an investigation into alleged predatory lending practices by the New York state attorney general, “Approximately 65 percent of CareCredit card holders apply for the card while they are in a provider’s office.” In other words, when Orangey or Fido is in distress. “In many complaints to the OAG (Office of the Attorney General), the provider completed the application information and submitted the application on behalf of the consumer,” the settlement states. “Some consumers were led to believe that they were signing up for an in-house, no-interest payment directly to their provider.” Here’s what they got instead: A deferred-interest credit card with charges that accrued at a rate of up to 26.99 percent on the total bill after a promotional period.

All credit cards are bad options. Is this something we don't know yet?

Some nonprofit clinics are trying to blunt the challenge these rising charges create for pet owners. Some nonprofit organizations have established spay and neuter clinics for low-income clients. The surgeries are performed at a fraction of the cost a private vet would charge.

There may be a few greedy veterinarians out there who see low cost spay/neuter clinics as competition. It is a futile endeavor to be upset about a client who couldn't afford us anyway. On-line pharmacies, spay/neuter clinics, and now traveling vaccine clinics are infringing on the once sacred veterinary hospital revenue turf. The marketplace is ripe for disturbing and we live in a land of entrepreneurs who see opportunity. Best to be honest and build a strong foundation of clients who see you as invaluable and indispensable. At some point their price point for our treasured virtues will be tested and scrutinized. Remember when your doctor made house calls, handed you a prescription, knew your first name, and then sent you a modest bill later? Those days are gone too.

But even this goodwill gesture upsets some segments of the veterinary community. A group of Alabama vets, for example, is waging war against the very concept of inexpensive spay and neuter clinics, alleging that they jeopardize the future of the profession.

Ma Bell fought hard to maintain her monopoly. In the end the consumer dictates the course of business. You can fight, scream, and tie up the courts for only so long. Alabama better start diversifying and finding their niche market, spays and neuters, along with flea & tick preventatives, and most likely even vaccines are not your bread and butter any longer.

Michael Blackwell, senior director of veterinary policy for the Humane Society of the United States, offered this response to their claim: “Unhappy with economic realities, some veterinarians are casting blame on the good-hearted souls within their own profession who work with animal welfare groups to make sure poor and financially strapped families have access to care for their pets. By blaming nonprofits, veterinarians are barking up the wrong tree.”

"Greed is the lack of confidence of one's own ability to create." Vanna Bonta

Thankfully, my cat Orangey is back to his old self. He’s purring on the desk beside me because of the care he received at the emergency clinic. Like most pet owners, I would have paid anything to save him. But veterinarians shouldn’t take advantage of our devotion to enhance their bottom lines.

So, let me get this right? We spent the whole article casting blame about how ridiculous veterinary salaries are (to which I might add the author doesn't disclose his). You further cast doubt that perhaps the outrageous bill was not warranted (because we dare not admit that we were not intelligent consumers but instead emotional worried parents who closed the garage door on our cat who most closely resembles a chair cushion), and now we are grateful that the emergency clinic did such a great job allowing our beloved family member to be back home with us. Mr. Fenton I think I lost your point? 

Let's recap:
1. What should a straight A 8 year college graduate earn who works 50-70 hours a week and gets bombarded with guilt because "this pet needs something that I either 'can't, don't want to, or don't feel responsible for' or else it will die" scenario be paid?

2. What is a pet? A right? A responsibility? Societies responsibility? The vets responsibility? Where does the burden of responsibility lie? If you treat your pet as a companion and member of the family their care warrants the equivalent. What is the prudent cost for this? Is modest cost in this day, with this classification?

3. Who bears the financial burden for other peoples life choices?

4. There is this odd emotional perception that vets (all who most certainly go into this profession with a deep seated calling to help animals, whom many of us vets believe are the most needy beings on the planet) to be met by a society that feels we, not unlike them, are wrong for trying to earn as much as we can so that we too can live in a nice house, with the nice car and the white picket fence. So, why can't we share this dream with the rest of our fellow Americans? Do you work for free? Do you get asked daily to work for free? Do you think that you should be paid what the degree of your earned and paid for education warrants? And the abusive guilt. That I would never wish on anyone.

5. If after 8 years of college that included studying, ulcers, and self sacrifice to have any kind of life at all, you graduated from vet school with upwards of $150,000 of debt and were then faced with justifying being paid for 2 days of emergency care, monitoring and a knowledge base broad enough to manage this, wouldn't you feel a bit bitter about NOT being compensated equivalently to what your peers are paid? 

6. Human healthcare model. If you were obese, hit by a solid object that weighed 10 times more than what you do (23 pound cat, estimate 200 pound garage door), then spent two days in the hospital, what do you think it would cost you? Let's say you had an emergency visit, digital x-rays and a 48 hour hospital stay. (1,700 for a one day hospital stay, times 2 days, x-ray $200, oh, wait, not even Mr. Foster knows what they did for Orangey for $900..).

7. The closing statement is particularly offensive and disturbing; "Thankfully, my cat Orangey is back to his old self. He’s purring on the desk beside me because of the care he received at the emergency clinic. Like most pet owners, I would have paid anything to save him. But veterinarians shouldn’t take advantage of our devotion to enhance their bottom lines." This was an emergency, Orangey was seen immediately, provided all of the care he needed and there is a cost for this. Perhaps, the author has no idea what the cost to run a facility of this magnitude entails? Should you ever find yourself in an emergency bind, perhaps under arrest? audited by the IRS? in court? etc, how much would it cost you to find someone who excels in their field of expertise at the drop of a dime? Probably more than $900. I don't believe that Mr. Foster was taken advantage of, I believe he was a poor consumer, who is now bitter, and his gratitude is mired in a diatribe of buyers remorse. Added to a poorly acceptable note of gratitude. 

It will become increasingly impossible to demand the same standard of care and NOT pay for it.

We all live in a country of unparalleled expectations, desires, and possibilities. We also all have to learn at some point in life that it is ALWAYS BUYER BEWARE. If you are not financially responsible get insurance, or simply do not adopt a pet. Should you choose to get a pet expect that there will be accidents to which you as the parent will be responsible for. There are options available for every pet parent and every situation. Should you be an otherwise educated, financially sound adult please don't moan about it afterwards. 

My last words. I agree that if you are not emotionally prepared for an accident it can quickly escalate out of control. Have a good solid relationship with your primary care physician. Most of my clients have both my cell phone and email information. I also provide help while my clients and patients are at the emergency facility. The landscape of medicine is changing. Are you ready for an educated empowered consumer? Are you one yourself?

Related blogs;
How to Get the Best Deal at the Emergency Veterinary Hospital.

There Has To Be Mercy Before Money

Making Vet Care More Accessible

Burnt Out From Being Burned

Compassion Fatigue in Veterinary Medicine.

I am a practicing veterinarian in  Maryland. If you would like to visit me in the clinic you can find information about us at Jarrettsville Vet, in Jarrettsville, Maryland. Or you can ask any pet related question at Pawbly.com. Pawbly is free for all to use and open to anyone who cares about animals.

I am also on Twitter @FreePetAdvice.

Beach Dog Safety Tips

My Charlie

Summertime is full of so many wonderful things like play, vacation, and long days on the beach. When the sun gets scorching and the Summertime is in full swing its time to head to the sand and ocean waves! But, for many of us the same beach dangers that exist for our two legged children also exist for our four legged pets. Here are a few of my favorite tips as you prepare your whole family for a trip to the beach.

Vacation planning
There was a time when we would plan our whole four months of summer around our one week long trip to the ocean. We drove 8 hours just to plop our pasty white skin on the shores of the North Carolina beaches. Why drive so far when the nearest ocean is only an hour away? Well, because in NC you can bring your puppies on the beach. Even though I had my pups by my side I found that one week was full of worry.

Here are some of the beach hazards I worried about;

Sunburn
Yes, we all burn, whether it be human pasty previously covered all winter legs, and puppy noses included. Which left us servant to applying copious amounts of sunscreen and the ever adjusting the umbrella. Best Tip; Avoid the beach between the hours of 10 am and 5 pm. Sunrise and sunset walks are both safe and magnificent!

My pig Strawberry, whose favorite spot is in the sunshine

Overheating
As the temperatures approach anything over 75 degrees F it is time to begin seeking shade and water. When your pet starts to pant they are telling you that they need to dissipate heat more efficiently and rapidly then they can normally.

It's not just the heat, it's also the humidity
We all know that the temperature on the thermometer is only part of the heat index equation. Wet, sticky days weigh us all down. If it is hot for you imagine what it feels like to a thick bodied, fur wearing pet who can only cool off by panting and sweating between hairy toes? The ocean breezes help to keep the heat and humidity down, but add the scorched sand, and the lack of cover and you might be forced to pick the cooler times of the day to visit, or keep yourself in the shade, under the wet sand, or floating in the ocean.

The sand is hot enough to burn your feet
Bring shoes and keep noses, toes, and bare skin off of the hot areas of the beach. The skin in the lower abdominal region of most pets is thinly haired and very susceptible to burning. Laying on any hot surface can burn.

Car rides
If you aren't staying in the car with them the entire time you are traveling then leave them safely at home. Stopping for even a few minutes can be deadly. There are no good options other than to stay with them in the car with the air conditioning on. Leaving your pet in a car even for a brief period of time can be deadly, will cost you a broken window, or a trip to the police department should some good Samaritan or busy body like myself stumble upon your car with your pet in it.

Be prepared
Bring lots of drinking water, a leash, a few poo bags, a towel to cover up with, an umbrella to stay in the shade, and beach safe toys. Play is a wonderful way to share time together but be cautious to keep cool and not over play or over heat. Ideally, play with a wet pup. The quickest way to stay cool is to keep the entire undercarriage wet. Panting excessively indicates a water soak, and rest until the panting slows. This may take 30  to 60 minutes. A purple, blue, or lethargic pet is an emergency.
Did I ever tell you the story about our 8 hour drive to the beach when we lost the A/C in the car on a 110 degree day? The dogs got so hot I was afraid they would succumb to heat exhaustion. Our choices were to find a hotel that allowed three dogs to stay until the sun went down, OR, fill the back of the car with 5 pound ice bags. We couldn't find a hotel, so the back of the Jeep turned into a frosty slumber party of pups.

The frozen popsicles can save the day
Kids and pups alike. Frozen water with a little bit of canned food, or even a tiny bit of cottage cheese for the pups, flavoring for the kids.

Fireworks frenzy
The loud popping of fireworks frightens most pets. More pets are lost around the Fourth of July due to fleeing the scene of a fireworks display than any other day of the year. Keep your pups inside a crate with a heavy (noise-dampening) blanket. Pets feel safer in small quiet places. Do not take them with you to fairs, or fireworks events. And, as always make sure that your pet is microchipped and that the microchip information is up to date.

The ocean can is its own monster
Pets are often afraid of the waves, the movement and the power of the tides. Be very careful swimming pets in pounding surf, and the same rip tides that can drown people can also be hazardous and fatal to pets. Pets are also inherently driven to drink moving water. Trying to train your fledgling pups to not ingest saltwater is difficult. Keep your pet on a leash, even a long leash at all times. If they are swimming you are best safely anchored on shore. Pets swimming in surf, riding surfboards, or sightseeing in ocean kayaks should always be fitted with life preservers.

If you have other beach safety tips to add please leave a comment.

Pleas also join me at Pawbly.com. Pawbly is a place dedicated to helping other pets in need and is free for all to use. You can also find me at the clinic, Jarrettsville Vet in Jarrettsville, Maryland, or on Twitter @FreePetAdvice.

The Backlash of Posting Your Kill.

In the last few days there have been two social media firestorms following the awful killings of two defenseless animals. While separate incidences and separate killers both have left a trail of disgust, dismay, and disbelief.

I am deeply troubled to be witness to both killings. A deranged thrill seeking, publicity hungry rogue militant desperate to find more social media attention in a yet unchartered and male dominated territory; killing big game. It's pathetic  and desperate and deeply saddening. She has abandoned any sense of morality or compassion and embraced the senseless heartless slaughter of paid for big game hunting. Horrific on more levels than the human psyche can measure, these people who travel to foreign lands to buy a place on a piece of land stocked with immobile captive prey are the saddest primitive forms of inhumanity known to this day. Her defense; the giraffe was old. Why then did she lay down next to it and smile? See the AVMA's Guidelines for the Euthanasia of Animals here. Euthanasia by gunshot on page 35)

I do think that Ricky Gervais said it best;
"What must've happened to you in your life to make you want to kill a beautiful animal and then lie next to it smiling?" See the Facebook page here. To read more about the backlash from this story read here.

Repulsive

 I am an advocate for animals, all animals, every size, shape and breed. I took an oath to protect them and to serve the public that included "protection of animal health and welfare, the prevention and relief of animal suffering." I am not an advocate to just dogs and cats, I am a veterinarian and I serve those who cannot speak for themselves. To those who love and serve unconditionally, and to the fellow creatures who we share this great planet with, I want to say in a loud boisterous voice that there are people who care and there is a public of consciously aware animal loving people who speak with a collective social media voice demanding that there be a better and more compassionate path forward.

Why are these stories so alarming? Surely they are not the first, nor only pictures of cruelty? I wonder of it is that these villains are young American women? Women  of social stature, or education status.

What could cause a veterinary graduate to believe that the act of harpooning a tomcat with an arrow is justifiable?

We live in a day and age of massive pet overpopulation. It is true. How many tomcats do you think the average veterinarian treats? How many of these cats come to us with a pet parent who cares enough  to find a cure to their ailments? Or wants to surgically alter them so that they can become integrated into the family setting? Yeah, not many.

What is it about the last two killings that struck such a sensitive nerve?

Is it that these villains are women?

Is it that the victims are defenseless kind creatures or domestic pets?

Is there such a definitive sharp line between what women kill? Is it really that this is a veterinarian and a cat? Or an empty woman who kills a giraffe?

Am I ever going to defend the senseless heartless killing of a cat with an arrow? No. Do I think that there is a correlation between the daily conditioning of a veterinarian to euthanize pets? Yes. Do I know that society rarely stands behind the rights and needs of unneutered male cats? They do not. Ask your local shelter what the adoption rate of a Tomcat is? I would argue that they have NEVER adopted out an intact male cat. Especially in light of the abysmal stat of 71% of cats that enter a shelter are euthanized. I could not find data on those that are intact male cats (Tomcats) but  based on 10 years of experience if they are older than about 10 months the chance they will be adopted is almost nil.

Is Kristen Lindsay's act heinous. Yes? Is it worse because this cat was owned by someone who loved him? Should it be? Is it a heinous act to kill an unwanted tomcat? Ask any vet you know. There isn't one of us who hasn't. Boasting about it with an arrow, well, no one is that stupid. Are they? There are guidelines, protocols and deeply thought out practiced methods employed by us vets to do it as humanely and compassionately as possible.

We live in a complicated passionate society. Is killing a pet brutal? Is killing a dog? A horse? A cow?  pig? A chicken? Should every vet try to help every animal? Is there a difference whether this is a pet? An herbivore?  A carnivore? A zoo animal? An over populated "pest" as considered by most city councils across the US?

I have many male veterinary colleagues who kill for sport. Maybe not a dog or a cat, but where does the distinction lie between pet and other? I don't know? For me there is no distinction. For social media there doesn't appear to be a distinction between a giraffe and a Tomcat. These are animals, pets to some, companions to others, and food to the rest. Before you cast stones and pass judgement ask yourself what is the difference, who are those that matter? Getting fuzzier isn't it?

This blog is written for the advancement of animal welfare and is intended to be my opinion only. As a practicing veterinarian my goal is to inspire, educate and assist the care and well-being of people who care about animals. I invite your thoughts and comments.

If you have a pet or animal related question I invite you to join me on Pawbly.com. Pawbly is an open pet centered platform for the free exchange of information.

I am also on Twitter @FreePetAdvice.

My thoughts on the Canine Influenza Outbreak

One of my acceptable risks.
Wendy gives a kiss and cures my bad day.

The flu outbreak in the Chicago area has many people asking for guidance so I thought I would try to provide some help with what we know now about the new canine flu virus called H3N2 strain.

As the owner of a large, busy veterinary practice I try very hard to help inform my clients, prepare them for any of life's challenges and most importantly I try to protect the most important pets in my life, my patients.

We have been asked many questions at the clinic about the virus, that range from; How we can prepare our pets for the chance of the disease knocking on our doorstep, how can we avoid it, and how we can protect our pets if it does?

I will try to provide the highlights;

The canine influenza virus (CIV) is responsible for the illness we call canine influeza or the dog flu. The CIV first appeared in 2004. A vaccine was made to protect against this strain and is widely available through veterinarians in the US. In 2015 another strain hit the Chicago area and quickly affected over a thousand dogs. This strain was not like the original and affects about 80% of the dogs it meets. Because of this the current canine flu vaccine may not protect dogs exposed to the new strain (H3N2).

The virus spreads very quickly via nasal secretions from coughing and sneezing and objects the virus can atach to as it hitches a ride to its next victim. Not all dogs will become ill, but even those not showing signs are capable of spreading the virus, usually in the first four days. With this said it is important to keep separate toys and belongings if you are visiting a dog park, a kennel, or a dog show. We know through other viruses that cross contamination is the vehicle to transmission. Trying to minimize exposure is the best key to protection that we have with this virus.

An affected dog can take one of two possible courses of action. One, become sick with the typical upper respiratory signs (looks a lot like kennel cough) that range from mild to severe and include;

• cough
• nasal discharge
• fever
• lethargy

Or, they can be carriers and may appear perfectly normal. These dogs can still transmit the disease.

About 10% of the dogs affected in Chicago were very severely affected and some even died.

This disease can be diagnosed at the vets office with a mucosal swab or blood test. The results take a few days to return but it helps us understand who is and is not affected as well as understanding the scope of an outbreak. It is also part of the vaccine guarantee that you receive when your pets are vaccinated at your vets office. We have twice in the past had dogs who boarded with us come down with kennel cough (they were vaccinated and we were not ever sure how they got exposed), but all were diagnosed AND treated for free because they had been appropriately vaccinated by our vets.

There are is no evidence that this disease can be transmitted to humans.

Me and Madeline share close quarters..

Here is my opinion and advice as a vet and dog mom. Every time you take your dog into a heavily populated high turnover environment you place them at a higher risk of exposure to disease. For many of us living in highly populated areas we have to understand that there are also benefits to boarding facilities, doggie daycares, pet stores, dog shows, and even veterinary hospitals. The happiest dogs are those that are with their families as much as possible. For my pups that includes coming to work with me daily. They are social pups who have been raised to be kind to other pets because I have consciously trained them to be this way which can only be accomplished from exposing them to lots of different dogs and people as they grew up. They are an important part of my family and I have always treated and raised them as such. The risk to this lifestyle is disease exposure. I do not take them with me to shelters, nor dog expos. I am too conscious about disease to risk this. I have decided where my line of safety lies and I do not tempt fate further than work and my hospitals kennel when needed. It is a degree of risk that I consciously accept. I live on a farm where my dogs get lots of exercise and therefore do not need a dog park. If I didn't have my farm I would be taking them to a dog park or public trails for exercise. Exercise and play are vital to a pets health and mental stability. A pet who is  excessively sheltered is at a greater risk for anxiety, fear, and health issues. The risk of public disease doesn't outweigh these. No pet should exist in a bubble.

The flu acts like the flu. It is pretty easy to kill (washing with soap and water seems to be very effective, which is why I wash my hands between every single appointment in the clinic), but it can be transferred to dogs via human hands. It can infect dogs and they may become silent carriers. So I cannot even suggest to you to stay away from the sick looking kids (like we do for our human flu patients). Your dog might contract the flu from a dog that looks and acts perfectly healthy. Therefore the only sage advice that I can give is to vaccinate your pet try to avoid high density dog areas, and the rest is good hygiene and luck.

For my clients I want to say the following. We do carry the flu vaccine here at the clinic. Like all vaccines the first time you get it you need a booster in 3 weeks for it to be considered effective. It is $25 per dose. We have carried this vaccine for a few years. When we started to use it we had quite a few adverse reactions and therefore decided to wait on requiring it for our boarders or groomers. I told our concerned clients then that I might someday change my position based on how this disease evolved and how much of a perceived threat it might become. I think I am officially changing my position on my recommendations.

As a vet I stand by the great success modern vaccines have brought to our society but there is always a degree of risk that is assumed as we crowd more organisms together. Disease is its own organism and has its own agenda for survival. There has to be balance in nature we forget that we are all a part of a larger ecosystem and that as we overpopulate over congregate and over extend our resources diseases will find a crack, a way of adapting and a foot hold to hold our numbers at bay. This year it might be H3N2, next year, next decade, next millennium it will be another. Good hygiene, good conscious thought to risk:benefit scenario and a respectful understanding of acceptable population limits are the only keys to trying to outsmart disease. Keep yourself healthy in mind, body, and soul and accept that we are all tiny organisms struggling to survive against and with each other.

The joy of happiness between species.

Related helpful articles;

Pawbly Canine Influenza Q & A

AVMA Canine Flu Frequently Asked Questions and Information Guide.

Chicago Tribune Canine Flu 

Steve Dale's Pet World

If you would like to ask a pet question please visit Pawbly,com. Pawbly is a free Q & A site dedicated to sharing experiences and educating pet people. It is free for all to use. I can also be contacted at the clinic, Jarrettsville Veterinary Center in Harford County Maryland. Or find me on Twitter @FreePetAdvice.

Bubba gives a kiss.

Parenting. If you breed your pet are you responsible for the offspring?

Charleston. My Harford County Humane Society rescue.

I have many dilemmas. They keep me up at night.. not the healthiest way of dealing, but it seems that during the day I am busy enough to keep the little nags at bay. Come sundown and sleepytime they rear up and tug at my conscious. Here's one I dealt with for the umpteenth time just the other day.

Said cute couple just starting their life together adopts their first four legged child. They love this girl to pieces. They dote on her, take her everywhere, and she, of course, sleeps in bed with them. There isn't one part of this pets relationship that isn't fully invested in their marriage. It is everything a vet hopes for a dog to find. Except, they want to breed  her.

My experience has shown me that the reasons for this vary immensely, but I find that breeders fall into one of four categories;

Best In Show

• These are the  people you watch on The National Dog Show on Thanksgiving morning. They are the pinnacle of expertise for their one specific breed. Almost all of them have dedicated their entire lives to the health, advancement and welfare of their breed. They know the family tree of their breeding line better than any of us could recall our aunts and uncles never mind our more distant relatives. They do not sleep with their dogs, their dogs sleep under security cameras.

Blue Ribbon

• The local breeders who manage one or two females, breed only after a complete vet work up, and sell privately to local families for upwards of $800 a pup. They work hard to provide healthy, well socialized family pets as an extension of their family business.

One Timers

• The amateurs who dabble in the idea of taking their self proclaimed prime canine specimen as a way of passing on their prides legacy. They learn quickly that the business of breeding doesn't come cheap or easy. The road to puppies may be paved with good intentions but one $3,000 emergency c-section later they are singing a different hard lesson learned tune.

Accidents/Cash Only/No Ethics

•  The people who breed because they never got around to spaying and neutering the brother and sister shih tzus who live in the house. Or, the person who is running short on funds and sees the Craigs List ads for "puppies for sale" that all seem to cost a few hundred bucks. Seems like an easy score right? Just breed your dog and grow your own at home business. I don't see these people much in practice. They do not seek veterinary advice, nor intervention when their lack of experience puts their prego pup in a serious pickle for a multitude of reasons. If you are contemplating purchasing a puppy from an ad see my blog on  Puppy Mill Cruelty.

The Black Dogs Rescue pups.

How do I talk to a person who wants to breed their pet honestly and openly when my lifetime of experience knows that there are a significant number of people out there in the world who purchase a puppy without the ability to care for them adequately and most definitely lack the ability to love them until they meet an untreatable end at a ripe old age? Here are some of the realities of pet ownership from this veterinarians perspective...

I know that people give up on treating a disease because it is cheaper to buy a replacement. Simple economics, right?

I also know that people surrender their older pets to get a newer edition, like it a status symbol, or the lease on the old car ran out.

That children who want a pet often lack the attention span to care for them when the monotony of daily feedings, poop clean  up and adequate exercise comes calling on a Saturday morning when the rest of their friends are headed to the mall.

The great breeders I know make a lifelong obligation to take back any pup the buyer no longer wants. They have contracts that require it. The best rescues also do this. Jarrettsville Vet has adopted out many an unwanted surrendered, abandoned, and denied convenience euthanasia pets to dozens of people over the last 10 years. Thankfully, many are in loving homes who share Christmas cards of "Thanks for helping us find our beloved Fluffy." But, I have many stories that attest to people's inability to love til death do them part. Even with a contract that states we will take our pets back "no questions asked" we get surprised. When an elderly woman who had adopted two cats many years prior became ill and needed to be hospitalized for two weeks her children (who promised to care for her cats while she was in the hospital) dropped them off as "ferals" at the local shelter. Luckily, those cats had our microchip and we were called to ask if our cats were lost? People can break your heart and destroy your faith in mankind.

The statistics in the US are awful. In the US we own 83.3 million dogs (all 2012 figures) and 95.6  million cats. The shelters house about 7 million pets and euthanize about 3 million dogs and cats a year. That means that 1 in 25 pets gets surrendered or brought to a shelter. Many of these are euthanized (about half of the dogs and three quarters of the cats). But think to of all of the pets that are euthanized at the hands of vets for the countless reasons we label as "convenience euthanasia." If I had to guess I would say that the 1:25 figure would be halved. Of the rest of the euthanasia's we perform many are due to plain old lack of funds to provide care. Halve that number again. One in 6. Add to that the number of pets that are not brought in for euthanasia, for instance, those that are killed outside of a shelter or vets office (think hit by car, disease, parasites, etc). and we are at 1 in 3. The statistics outside of the US in almost every other corner of the globe are even more abysmal.

How do you feel about knowing those odds? Me, not good enough to bring a soul into the world and bear the responsibility to provide for them for a decade or two should their parent no longer be willing to do so,,, and Lord knows I love me a puppy and/or a kitten. I just see reality too much. It keeps me up at night...

Stealing a moment with Max.
If you aren't taking time to kiss the pups what is the point of working?

Related Blogs;

So You Want To Rescue A Puppy? My advice on how to avoid the disasters of trying to do a good thing.

The Pain Of Breeding.

Breeders My Take On Them.

I am a veterinarian determined and dedicated to helping pets through the extension of educating and empowering people. For this reason I created Pawbly.com. We are a global community of compassionate people who know that there are options available for every pet need. We can help you find resources, understand your pets needs and link you to those who can assist. It takes a village to raise a happy healthy pet and we believe universal affordable pet care will someday be a reality. Please join us today.

If you would like to meet the amazing people at our clinic please stop by our Facebook page at Jarrettsville Vet, or find me on Twitter @FreePetAdvice.

Conditioning for a Socially Acceptable Canine Citizen

Every new pet visit I have is met with hugs, kisses, greetings, salutations, snuggles, and a long long list of questions.

The first appointment sets the stage for every visit to come. If your pet is happy with us, if we can figure out a way to make the appointment fun, engaging, informative and supportive then we have succeeded on every level.

My hope, as your vet, is that you will always feel comfortable understanding all of the aspects of your pets care, and if you are ever unsure that you will know we are a safe and supportive place to seek out the answers to your questions.

It's not a small task for a first appointment; to win your heart and your trust. Especially in light of the great deal of ground there is to cover.

At the clinic we use written literature, magnets, email, business cards, props, and anything else we can think of to provide you with all of the tools to raise a happy healthy pet. But we aren't trying to keep just your pet happy we are also trying to keep our clients happy. Behavioral problems are one of the biggest reasons pets are surrendered to shelters.

All vets develop their sixth sense by observation, practice and hard learned lessons. We listen very carefully for the hidden clues, the subtle innuendos and the first hint at a sign of the dreaded "behavioral issue(s)" territory. Most behavior issues stem from lack of socialization, appropriate conditioning and positive reinforcement.

Max

I saw the following list in a past issue of Dogfancy. The article was specifically addressing socialization. I often group socialization and conditioning together because it is hard to teach one without the other and your pet needs to learn both. I ALWAYS recommend addressing both through only one method; positive reinforcement.

At the clinic we provide our new pet clients with many "How-To" instructions and advice. I say 'pet' here, but in almost all cases I am really targeting the puppies. I am conditioning myself to say 'pet' because a few weeks ago I was reviewing the How-To list with a client who had just adopted her first dog (ever). I reviewed all of the How-To's and told her that I would write them all down so that she, (and now you), could have an online reference to review. (I thought it was a brilliant idea!) She could have a review sheet at her finger tips to help reinforce the litany of information that I had just dumped on her, and I would have a ready reference for the public! (Pure genius!) At her next appointment we started to review the how-to topics that we had discussed at the previous visit. We had discussed all of the puppy basics like housebreaking, leash walking, training, and puppy vet visits. When I asked her "how the house breaking was going?" she reluctantly said that "she was about 50% housebroken." When I asked her if she "had reviewed all of the how-to's I had written up and posted?" she replied assertively, "No, they were for puppies, Tinkerbelle is a one year old." (Not so genius am I?)

I smiled and paused. "Well, I know that she isn't a puppy, but she has never been housebroken so we have to train her to become housebroken. (I thought that the title "How to Housebreak Your Puppy" was pretty self-explanatory. Silly me for being so specific). Can you teach an old dog new tricks? Well, I am conditioning this old dog to say 'pet' and not "puppy'. I call every dog a puppy, who uses 'Miss', Madam' or 'Ma'am' anymore? (I'm not that old!). There is no such thing as too late to start, nor is the old adage about "teaching an old dog new tricks" true.

Here is Dogfancy's list of items that dog parents should use to help expose their pup to in order to help them develop into a socially responsible pup:

• All types of people
• Bags
• Balloons
• Bikes and motorcycles
• Cars, trucks, and buses
• Children of different ages
• Crowds
• Delivery people
• Grooming equipment
• Other dogs and puppies
• People in uniform
• People using walkers or wheelchairs
• Sand
• Shallow water
• Strollers
• Thunder
• Umbrellas
• Vacuum cleaners

Max

Here's what I would add;

The foundation of  this advice is for you to understand and acknowledge your expectations for both you AND your companion. 

I seriously doubt many (or any of my readers) are raising guard dogs, or personal protection pups. Therefore, I am only providing advice for raising a dog that you DO want to like other people. Your best bet to raising a pup that loves other people and is happy in the world we all live in is to carry your pup with you everywhere that you (safely) can. Through this one simple act your pup will bond to you, trust you, and learn to deal with the same world that you and I do. Now, this piece of advice comes with a list a few important caveats.. (Listed at the end, care of the marginally pessimistic, overly schooled by lessons learned the hard way, veterinarian).

Bellza

The single best way to address the world and all of the scary unknowns it envelops is to get out there and immerse yourself smartly in it.

If you brush your teeth in the morning then you should be brushing theirs to. When you feed yourself on a daily schedule you feed your pet (twice a day for dogs, three times for humans)  on another daily schedule. Exercise is a daily requirement  for all living beings. Sitting in parked cars is not safe for anyone. If you can't bring your pet to the store they stay home.

I follow my own advice. My pups come to work with me everyday. It is a daily conditioning to be a friend to all human beings. It is also a daily training exercise in tolerating other cats and dogs. Hard as it is for my bossy pittie-bull pup Charleston to be the unprejudiced jovial friend that his brother the beagle Jekyll is, he still 5 years later attempts to incite quarrels with most larger dogs. It is who he is. I know that I have to keep him on a short leash and remind him daily to accept others and not be a bully. I therefore do not take him into large crowds of dogs where I can not watch him adequately. He is comfortable around other dogs, but I must always give a conscious effort to slowly introduce him to new dogs. We provide him exercise daily but don't bring him to the Pet Expos, the dog parks, or the Petsmarts. If I could carry him in a bag I might..(he is 50 pounds), but I  cannot, so he stays out of situations that are not appropriate for him. I know my dogs because I understand them. I know that Jekyll will always see the world through rose colored glasses. He will always love every person he meets, and he will never refuse candy from a stranger. I keep him close because he cannot see the world for the dangers it holds. Charleston wears his heart on his sleeve. A tiny scold will break his heart, but he is also the kid who steals other children's milk money behind the lockers. He is a brat and a bully to other dogs. If he meets another dog who wants in on the action he will pop a cheap shot if your back is turned. But around people he is a love. I am never going to change the beings that they are. It would not be fair to ask them to change the fabric of their soul. But I am responsible for them so I watch them closely and introduce them to the world we live in cautiously and optimistically. I'm their parent if I don't believe in them who will?

Jekyll and Charleston

This whole surge in falsifying identities and 'service dog' vest adornment so that people can take their pets on planes, in restaurants and in hotel rooms is as ripe for disaster as it is ripe for abuse. Your pets don't need to sit next to you in the restaurant begging for a steak that isn't appropriate for them anyway. Leaving your dog in a car for any period of time, so that you can perform any menial task is just life-threatening and unnecessary. Don't do it. I'm sure no one does it on purpose; kill their pet via hyperthermia, but yet it happens every single year. Your pet is yours to protect, to provide for, and to be responsible for. You are a parent. Guide them, love them, and create a loving enriching environment with the intent of them being able to survive and thrive without you. They are not your identity, your reason, nor your crutch. They are their own person in the world that is not always kind, not always accepting, and not always shared with you.

I am also a doctor. I know disease lurks in the places of congregating canines. My pets are current on vaccines, protected against parasites, and not kept with the general population of my patients. I often work 12 hours a day which is too long for them to be left alone. They are no longer invited to our summer parties where one year my beagle ate her weight in Italian sausages which almost killed her. At another summer party Charleston caught the fish on the end of the fishing pole. Thankfully there were 4 vets (of course all female) present to sedate him and remove his fish hook while the husbands stood by weak kneed and useless.

Pepper, Peanutty, and Bella

There is little value in playing the blame game, but, the responsibility clause is as follows;
There is not one dog bite, dog attack, dog fight, or behavior issue that was not preventable nor came with a long list of predicating clues.

The first time there is an indication of a problem is the time to seek help. Start with your vet. There will be more issues in the future and you are probably (yes, unknowingly and inadvertently) contributing to the problem.

Your efforts to reduce the triggers, avoid the altercation scenarios and adjust your lifestyle to avoid another incident are ALL CONTRIBUTING AND REINFORCING THE PROBLEM.

You get out what you put in. A very simple equation that fits. If you can provide consistent affection, direction, and parenting you can raise a socially responsible companion. It is your duty as a parent, and the reward is well worth the time and effort invested.

Rebel

Lack of socialization at the earliest age, or first opportunity, is the beginning of a lifetime of behavioral social, and, often also, medical issues.

Oh, and lastly build a strong support system around them. Pet sitters, groomers, grandparents, siblings, and your vet. It will serve you both well for the lifetime of wonderful memories ahead.

Life is good.

If you have a pet question, or pet experience/advice that you think might benefit others please join us on Pawbly.com. Pawbly is a place to support, encourage, and strengthen the bonds between us human and our companions. 

If you would like to visit me at the clinic stop by Jarrettsville Vet, in Harford County Maryland. Or, find me on Twitter @FreePetAdvice.

Decubitus Ulcer, Pressure Sores/Bed Sores in Dogs. How you can treat and cure this in your home.

Belle

 Belle was brought to see me because she was licking at her elbow.

Can you see the wet hair around her elbow?

Pets lick for a reason. They lick because something itches, or hurts them. In Belle's case it was because her elbow was hurting her.

When I asked where Belle spent most of her time her parents told me that it was on the ceramic tile floors of the kitchen.

Belle is a Border Collie who spends her winters in the house with the inside temperature at about 65 degrees. Doesn't sound too bad until you add a thick dense long fur coat to the mix. Belle was a hot dog in the house so she was seeking the coolest place she could find, the hard, cool, ceramic tile floor.

When you are hot you lie down, stretch out and cover as much hairless surface area as possible on the coolest place you can find. Which is exactly what this smartie-pants Border Collie Belle was doing.

The problem with bony joints on hard floors is the same problem people confined to hospital beds have; bedsores! Belle had the equivalent of a bed sore, what we call a decubitus ulcer, or pressure sore.

She was licking to show us where it was hurting, but the result of licking can often be further traumatizing the wound and seeding it with bacteria.

Our plan for Belle consisted off the following;

1. Laser therapy twice weekly for three weeks, or, if the lesion persisted weekly therapy until closed.

2. Anti-licking deterrents. An e-collar, or protective leggings. Belle's mom is a crafty wizard when it comes to sewing. She made her these beautiful, soft fleece leggings. They slide on her legs, close at her shoulders with velcro and are cushioned at the elbows. Belle is both fashionable and protected. She wears them in the house and on walks. They are washable and do exactly what they are made to; they protect her bony elbows from the hard floors.

After 4 weeks her ulcer has closed and is not bothering her at all. I expect that she will continue to grown hair back on her elbow and as long as she has her legging on she won't have this problem again.

Belle's cost of treatment was;
Initial exam $50
Laser treatments $40 each session
Topical antibiotics and cleaner $20

For those of us less crafty, there is a commercially available alternative called DogLeggs.

If you have a pet question, an experience or story to share, or want to extend a helping hand out to other pets lovers you can find a whole bunch of helpful pet friends at Pawbly.com. We are dedicated to educating, empowering, and assisting other pet people, and best of all Pawbly is always free to use.

If you are looking for me I am at the clinic Jarrettsville Vet, in Jarrettsville Maryland, or occasionally stopping in for a hoot on Twitter @FreePetAdvice.

Heart Murmurs. What are they, what to do about them, and how much does treatment cost?

This is a great question! and one that I answer often! It is also one that is incredibly important to the health and longevity of your pup. My sister is on her second heart failure pup so I will give you the same exact advise that I gave her, (In fact I am also going to send her a little note to jump in and give her personal experience).

There is not a right or wrong answer here. But, here is what I think is the best answer. Heart failure in our dogs is most commonly associated with a heart murmur (I think that this is what you are referring to when you say 'level 3'?). We categorize a heart murmur on a scale of 1 to 6, six being the most severe. In may cases dogs have murmurs for years. Once identified they should be monitored closely with re-check exams at 3-6 month intervals, or sooner if there is any change in the clinical signs (like lethargy, coughing, increased water intake, reluctance to play or exercise, or weight loss, muscle wasting or anything else that seems different in attitude or behavior). If the murmur is progressing we monitor more closely or discuss further diagnostics or treatment options.

Ideally, I send every suspected heart failure pet to the cardiologist for an echocardiogram. These are incredibly helpful in understanding what the heart is doing and how it is affecting the patient. From the echo we discuss if, or when, it is time to start heart medications to help the heart work better. There are many helpful heart medications available to pets. Most are very affordable and have a very low complications or potential adverse side effects. An echo in my area of the Baltimore Washington area is about $600. Heart medications for my sisters dog is about $20 a month. Without an echo we are making an educated guess about what is going on in your dogs heart. This makes deciding a treatment option more difficult and potentially less beneficial.

Most of my heart patients do very well for years when on heart medications, monitored closely and kept on a good heart diet (ask your vet about these they are super beneficial) and kept on a calm, quiet, moderate exercise plan. My sisters first dog was initially diagnosed with a 5/6 murmur and lived 3 years after because she had the help of a cardiologist, medication, and a great prescription diet.

I am wholeheartedly in support of working up your pups case, getting as much information as you can gather from as many experts as possible and telling age to take a back seat. Proactive, diligent, and dedicated pet parents can lengthen the lives of their pets with both quality and quantity of good happy, healthy days.

Best of luck, and please let us know how your pups case goes. We are here to support you both!

Sincerely,

Krista