Sunday, February 28, 2016

Carry Each Others Burdens

Hank begs for a back rub, 24 hours post accident and happy on his analgesics.
You know those dreams where you slip down the rabbit hole and wind up in a land where up is down and down is up? The place where caterpillars spew advice via poetic puffs from a hookah pipe. Where tea parties incite riots and mice talk in drunken proverbs. There is such a place. Seems that veterinary medicine has landed itself in the Wonderland of who are we? (Big or small?) And how did we forget where we came from Alice?

One of the best pieces of  advice that my former practice owner and 40 plus year veterinarian ever gave me was, "Remember that every client you see is your neighbor. You will see them again and they will remember how you  treated them and their pet." It was sage advice that I have carried close to my heart since I bought this practice from him a decade ago.

When I first started practicing at my clinic I had to remind myself that first impressions count and trust could be built and broken by one brief visit.

The face of veterinary medicine has been slapped, scarred and dismissed over the last few decades. Gone are the days of blind trust, loyalty and high regard for our profession. Where did our impeccable reputation go? We slaughtered it. We have done it by ourselves and to ourselves. We forgot to treat each client as our friend, our neighbor and the guardian of our purpose.

How do I know this to be true? I see it every single day in practice. It breaks my heart, wounds my soul, and in-freaking-furiates my core.

Our profession was built by men and women on humility, hard-work, fortitude and integrity. We used to be a profession people trusted. We used to deserve it. We didn't have to prove it. It was there because our forefathers had built it.

The state of the profession now is fractured, injured, and almost intangible now.

Can we trace back the pivot point? Can we blame it on millennials who "question everything," and "research all aspects of their decision before taking anyone's word for it?" No, this happened before them. It happened sometime between when I entered vet school in 2001 and when I graduated in 2005. Before I went into vet school it was commonplace for veterinarians to provide free services and prescriptions for pennies. I was part of that hippie revolution protesting for fairer wages for the new wave of females in vet med. Proudly burning coveralls, pulling and palpating cows with all of the vigor of the dirty nailed muck booted farmers before me. I wanted to work hard, prove my credentials, and make a descent living from the return of my measly $40,000 vet school investment. I was one of those doe-eyed newbies star struck by the title and wanting to advance the profession from its humble Herriott beginnings. Did I no where I was going as I chased that white coated rabbit?

Some want  to point the blame of our predicament on greed. I'll accept that. We have created an ecosystem intent on providing an Ivory Tower standard of specialized care that is focused on exhaustive diagnostics paralled to the human care options available at the most world renowned medical hospitals. As a patient myself of the Johns Hopkins University medical empire I know what the best and the brightest from human medicine has to offer. I am blessed and grateful for access to state of the art medical facilities spear headed by doctors who shape the future of science fiction meets God into miraculous cures to the most elusive and aggressive diseases. To get in the JHU door I needed either limitless black holed deep pockets, or insurance. My patients in large part lack either.

Sedated for x-rays. A muzzle is needed for moving and positioning dogs in pain.

Today a patient named Hank arrived in shock and bleeding from a compound fracture of his femur in the back of the pick up truck he had previously traveled in without incident. He had been rushed to the ER immediately by his young, disbelieving emotional millennial parents. Within 1 hour his $215 ER examination, pain injection and consult produced two written estimate options. The attending veteran emergency veterinarian provided a low end estimate of $1700 and a high $4500. And, because it is customary in vet med there is always the third option of do nothing, and we throw in the last of death.

Not having immediate access to liquid resources of $1700 the clients left the ER and showed up at my clinic 20 minutes before we closed searching for another option.

In the back of the massive hyped/hopped up pick-up lay Hank bleeding, panting, face swollen, in pain, in shock, and in desperate need of help. A pet (or anything else) in shock cannot be sent home and cannot be placed in a cage 20  minutes before you close for 17 hours. Hank at minimum needed iv fluids, pain management and mercy.

His dad stood next to Hank quietly stoic contemplating the reality that he had to break the emotional tie to his dog that he could no longer provide for. The only words out of his mouth were to beg for me to not judge him. Judge him on what? Being a fool who thinks that a dog won't jump out of a car. (They ALWAYS JUMP! Yours just hasn't jumped yet). Judging him for not having $2K in his checking account. (I don't either). Judging him for not being prepared for disaster (who among us is)? The despair in this scene was palpable. The harsh truth was that Hank's life lay in the balance of veterinary greed and desertion to our duty.

The next few sentences were fraught with tears, blatant brutal honesty and conviction to not accepting the life in the cross hairs that lay in front  of me.

Here's what no one tells you. If a veterinarian starts to provide care they are committed to your pet. The real-life reality is that my clients could have declined every single line item on that $1700 list and walked out of the ER without their dog. The ER cannot call the police and they cannot throw Hank out the back door. Hank would have gotten much better care sitting in the ER then being sent in the back of a pick up truck to my clinic at closing time. With an iv catheter, iv fluids, pain medications and antibiotics Hank had a chance of survival. For these Hank's 18 hours of ER care would probably cost $500.

Now I admit Hank needs help. There is a femur actively bleeding sticking out of his leg and this will need to be addressed soon. There are many vets who think it is perfectly acceptable to call it quits here. My opinion is that God gave Hank four legs and you can search YouTube for lots of dogs playing in the beach sand on 2. Legs are accessories. I don't kill the body because a fixable leg isn't working. But right now Hank is in shock. Shock can be, and is treated around the world every single second for far less than $1700.

Hanks dad wanted "something for pain and to take Hank home to see what fate would deal." What was I supposed to do hand him a syringe of morphine and waive "adios?" Another vet failing a pet because there is a standard of care, an average client transaction quota, and a life no one is willing to compromise for? I had to plead with the clients to go back to the ER that had failed them.

It is utterly criminal that there is no option between shock in the back of a pick up truck and $1700. Does Hank have internal bleeding, irreparable head trauma, multiple life threatening fractures, and a whole long list of questions yet unanswered? Absolutely these are possible. Does Hank have a chance? Absolutely, unless his family gets intimidated and scared to the point that they don't even try. In the back of that pick up truck my technician could recognize that Hank had a chance. She saw normal mucous membrane color, shock, rhythmic steady chest movement, deep pain in his legs, ability to ambulate, and reason for hope.

I am angry about this place in veterinary medicine that we have alienated ourselves into. I know my clients are upset, frustrated, scared and distrustful. I don't blame them. Is Hank my responsibility? Yes, Hank is my patient. His family are my neighbors. We carry each others burdens. If I have to post my cell phone number on the billboards outside of the ER's I will. If I have to pay a vet to stay overnight every night at my clinic to provide a safe haven, I will. But, this lack of compassion and pricing our patients out of the possibility of a chance has to end. How much more trust can we afford to surrender? How can we promote a standard of care and emulate throwing a dog in shock out of our pet care facility?

Hank went back to the ER for iv fluids, pain medication, antibiotics, and an overnight stay. If tonight it is discovered that his injuries are life threatening he will be humanely euthanized by someone competent to recognize this. If he survives he will come to JVC tomorrow and JVC will help Hank face the next steps in his recovery process.

Hank had his femur fixed three days later at a local veterinary hospital. The general practitioner placed a plate for $2,000. Hank was up, wagging, and happy 24 hours later. These are the photos his mom sent us,, along with a big Thank You.. 

Hank and his mom.
Hank's bill ended up being about $3,000. I know it was an expensive lesson for them to learn about the dangers of transporting your dog in the back of  pick up truck. BUT, I want every person to know that most of the accidents, illnesses, and diseases veterinarians see ARE TREATABLE. In too many cases the sticker shock we vets provide our clients, (especially those after trauma or serious impending life threatening conditions), on those fat well-padded cost of care estimates, that we all know are based on "worst case scenario" and "ideal treatment options" results in pet parents making decisions they feel they have no other option to make. I simply do not believe that there is not a more cost effective, life sparing way to get people real help.

Here's to you Hank! May you have more happy days ahead.

I welcome your thoughts and hope that you will help in providing advice, guidance, and support to pet parents across the globe. is a free information and assistance network dedicated to helping pets and the people who love them.

I am also on Twitter @FreePetAdvice, or at the clinic Jarrettsville Veterinary Center in Jarrettsville Maryland.

Update; Hank had his fractured femur repaired three days after his accident. He is expected to make a full recovery. I think his parents learned a hard lesson. DOGS DO NOT BELONG IN TRUCK BEDS! We wish Hank many happy years running, wagging, and exploring the fields of Harford County.

Friday, February 26, 2016

2016 Price Guide

Examination Fees
Physical exam 30 minutes  $50
Comprehensive or extended exam  45 minutes $63
Annual or Senior Exam 30 minutes $45
Sunday walk-in examination $60
Consultation exam, 2nd opinion  45 minutes  $65
Consultation exam, behavior  60 minutes $100
Re-check exam  $30
Hospitalized patient exam    $30
In patient care    $40
Health certificate (includes certificate fee)     $45
Urgent care (emergency fee during regular hrs, including exam)    $75
Telephone consult - regular client     $30
Consultation w Specialist (doctor time)    $40


Average Costs for the Most Common Emergency Surgeries

Blocked Cat $1000-1200 (Price can vary based on hospitalization stay).
Pyometra Cat $400-600 (Severity of illness at presentation can influence cost).
Exploratory Surgery $1000-1200 (Price can vary based on severity of underlying disease).
GDV (bloat) $1000-1500 (Price can vary on other organ involvement).
Pyometra Canine $800-1200 (Price can vary based on severity of associated illness).
Splenectomy $1000-1200 (May require additional care at emergency facility post-operatively).

Integrative Therapy
Acupuncture, initial consult $95
Acupuncture treatment $75
Laser therapy (single dose <2 areas) $40

Cinderella and Aurora

Other Services
Anal gland expression (w/technician) $20
Anal gland expression (w/doctor)   $25
Microchip $10
Nail trim (canine/feline)  $15

Luna and Chase
Ear flushing/cleaning $25
IV catheter placement $40
Intravenous fluids, first bag $40, $20 each additional bag


Diagnostic Services
Blood pressure evaluation  $25
Corneal flourescein stain  $25
Ear swab & stain  $25
Schirmer tear test  $30
Tonometry  $40

Periodontal scaling;
Grade 1  $75
Grade 2 $95
Grade 3  $115
Grade 4  $150

Dentistry: Surgery
Surgical extraction, minor (surgeon's time)  $25
Surgical extraction, major $100
Average cat dental $250-$350
Average dog dental $350-$450

Diagnostic Imaging
Radiograph, digital (1 view)  $100
Radiograph, digital, additional (2- 3 views)  $150
Radiograph, digital, additional (4 plus views) $200
Dental radiograph, digital (1 view)   $40
Dental radiograph, digital (2-4 view)  $60
Dental radiograph, digital (4 plus views)  $80


Abdominal $200


Lab Fees (includes collection, lab fee, & interpretation)

Bile Acids (pre & post) $100
Biopsy $200
Bladder stone analysis  $215
Blood glucose (single)   $20
Bromide $200
Chemistry and electrolytes $95
Chemistry, CBC, T4 $130
Chemistry, CBC, UA $140
Chemistry, CBC, T4, UA $150
Chemistry, CBC, T4, UA, Fecal Elisa $160
Chemistry, CBC, T4, UA, Fecal Elisa, HW, Ehrlichia, Anaplamosis, Lyme $200
Coagulation Profile $40
Complete blood count  $45
Digoxin $100
Fecal Giardia ELISA  $40
Fecal Giardia w HW, Lyme, Ehrlichia, Anaplasmosis screen $70
Feline antigen heartworm test  $45
Feline leukemia, FIV, test  $35
Feline retroviral $60
Free T4 ED $105
Free T4 add-on ED $45
Fructosamine $75
CBC, chem panel w/electrolytes & T4 (health check)  $145
Canine heartworm $20
Canine heartworm, Lyme, Ehrlichia Canis, Anaplasmosis  $45
Cortisol 1 sample $95
Cortisol 2 samples $130
Cortisol 3 samples $160
Cytology $180
Histopathology (single specimen)  $200
Lyme test in house $20
Lyme titer $120
Immunity titer test (DA2PPV)  $95
Parvovirus test in-house  $40
Pre-Op Screen w/ CBC $40
T4  $60
Urinalysis  in-house $50
Urinalysis reference lab $70
Urine MIC Culture $200
Urine P:C $85

(This does not include pre-op examination, diagnostics, hospitalization care, or
Mass removal small $200-$400
Mass removal large $400-$600
Anterior cruciate repair, ACL, lateral fabella suture technique $400
Aural hematoma repair  $100
Amputation, toe, $350
Amputation, tail, $350
C-section canine  $400
Cherry eye, $250
Cystotomy  $300
Enucleation,   $300
Entropion, $250
Exploratory surgery  $600 -$800
Femoral head removal  $500 -$900
Gastrotomy  $300 - $600
GDV, Bloat, $700
Intestinal resection/anastomosis   $300 - $700
Lateral ear resection,    $300
Mastectomy, unilateral   $200 - $450
Splenectomy   $500 - $1000
Laser, additional fee  $100-$200
Surgical pack  $35
Surgical supplies/disposables  $20
ECG monitoring (during surgery)  $25
Blood pressure monitoring (during surgery)  $25
Perineal Urethrostomy (PU) $300-$450
Preanesthetic exam fee  $30
Preanesthetic sedation  $30
Local dental nerve block  $25
Wound repairs range from $50-$200


Feline Neuter $60
Feline Spay $100

Canine Neuter $175
Canine Spay less than 50 pounds $225
Canine Spay 51-100 pounds  $250
Canine Spay 101 pounds or greater,  $300
Canine Spay overweight or pregnant $400
(There is a $50 additional charge for pets over 12 months old, and a 60 day grace period for newly adopted pets from a rescue or shelter).

Distemper Combo 3 yr $30
Feline Leukemia $25
FVRCP + Leukemia $30
Kennel Cough $20
Lyme $30
Leptospirosis $20
Rabies $16

What sets us at Jarrettsville Vet apart? We have the best doctors and staff!
We all share a deep commitment to providing a kind, compassionate, hospital centered around caring for pets.
We provide excellent internal medicine, surgery, dentistry, ultrasound, orthopedics, behavior consultations, acupuncture, and even Reiki.
We are open 7 days a week, until 8 pm on Monday through Thursday.
We never deny care to a pet in need.
We have been a part of our community for over 70 years.

If you have a pet you would like to visit with us you can find out all about us on our Jarrettsville Vet Facebook page. You can also find me on Twitter @FreePetAdvice, or you can ask, or answer a pet question at Pawbly is a free online pet community dedicated to helping pets and their people who love them.

Saturday, February 20, 2016

If Wealth Were Measured In Good Deeds

Perhaps one of the greatest gifts of being a veterinarian is being granted a small peak into the lives of the pets we serve. That few minutes we spend with our patients and their family (even if it is only once a year) provides a tiny glimmer into the life our patients experience daily.

When we decided to open our off-season largely vacant boarding facility to any pet who needed shelter through the cold harsh months of January and February I hoped that a few of the neighbors who keep their "guard dogs" outside 24/7/365 would overlook their fortresses vulnerability for a few sub-zero nights and drive their dogs to our 4 star Jarrettsville Vet Center hotel. Quietly inside I knew that there was a very real chance that not one single of the many pets chained to a shack that legally passes as a 'shelter' would ever spend a night inside. Turns out I was a little wrong and a little disheartened to learn about the real need within our community.

I would argue with a full fledged authentic military snap salute that we in the USA are the wealthiest, most powerful, free, democratic society on the globe. Today in this great country we are also in the throws of the ugliest trench warfare I have ever seen. Right now in the USA we are in the middle of the process of picking the Presidential hopefuls that will run for our votes to govern this magnificent country. It is appalling to see how disrespectfully we trash each other. It is shameful to witness this at the same time that our boarding facility becomes populated by pets with the most basic desperate need for simple warmth and shelter. It is a slap in the face of the greed and selfishness that we Americans have become so rightfully accused of.

For the few local residents we have helped I have witnessed their story firsthand and become saddened by the reality that exists among those of us living in "the land of the free and the home of the brave."

Here are the stories of the people who brought their pets in for our free boarding these past few weeks. These are the stories of pets I don't see on the exam table. The pets who don't get even basic care because it is unattainable. The pets who might have frozen to death if we hadn't opened our doors and offered free care. These are the faces of real need and those who live without.

Miss Pink is a middle aged spayed white lab. She is sweet, gentle, loving and the companion to her mom who is homeless and living in her car. Her mom could barely scrape together enough money to buy gas so she could drive 30 miles each night so she could bathe in the bathroom of a 24 hour gas station. As the weather got colder they needed a better plan if they were going to survive. Because Miss Pink was not allowed in the local shelters her mom was left to make the only decision a loving parent can make; she opted to put her life on the line and live in her car with her dog. The temperatures plummeted to below 0, the universe dumped three feet of snow and Maryland was shut down for three days in late January 2016. Miss Pink came to stay with us for that Winter storm week. Miss Pink was then transferred to a rescue who will foster her for as long as the woman needs and she is in a safe, warm shelter.

Miss Pink
Last week we received a Facebook request to board 10 cats and a dog. The owners house had been deemed 'not safe for inhabitants' and the family needed help in taking care of their four legged family members as they looked for a new place to call home. Can you imagine not being able to stay warm in your own home? Their names are Beebo, Hope, Lil, Missy, Tin Tin, Chloe, Kitten Girl, Big Cat, Penelope, Tigger, and her dog Newbie.

Penelope and Beebo


Beebo and Hope

Kitten Girl and Chloe

Tin Tin and Lil
The cats all needed their rabies vaccines updated. Newbie was treated for fleas and severe flea allergy dermatitis. He was also vaccinated. They are headed to their new house on Sunday.

Cesar was the neighbors cat. He was seen and taken care of by the rest of the housing complex he resided at. As the weather turned the neighborhood caretakers called us and asked how they "could help a cat that wasn't really theirs?" Our advice; ask the owners, nicely. Cesar stayed at JVC for a few days and is in the process of being adopted to become an inside cat by the neighbors who love him as Cesar's original family is in the process of being evicted.

There were also four cats from separate homes who came to stay with us. All had the same story. They were all outside cats who had been fed, watched after, and were loved by friends and clients who worried about the drop in temperatures and their ability to survive outside. Every single one of these cats has been vaccinated, fixed, microchipped and adopted back into the homes that brought them to us. With a little help from us these cats lives will improve significantly because two parties cared enough to make it possible. I never believed that providing a place to stay could have so many positive ripple effects. Curing disease with an antibiotic, surgically removing a cancer that will take a life, and providing advice that assists someone to understand what their pets difficult behavioral responses are caused by are all satisfying affirmations that our professional abilities are purposeful. But, offering a hand and having it be compounded so impactfully, that is better than anything.

If your neighbor needed help and was brave enough to ask would you label them "a lazy welfare monger?" Wouldn't you just help them? Does division, hate, and nasty labels help us? Why are we so upset by the shit slinging of our elected officials if we aren't living by a different example? There are people in our community, our state, our country, and yes, even half way around the globe, who need help and all we can do is label and ostracize them?

Sure taking these cats and dogs in is full of liability. And sure they could bite, scratch and be carrying disease.  And yes, our good deeds might not go unpunished. There are thousands of easily justifiable excuses to turn a blind eye. BUT, it is the simple act of helping another that is what this country and planet needs.

I never imagined that there was so much need in my own back yard. I also never imagined how we could help so many people. I only knew that I couldn't NOT try. We put out a small box on the front desk of the clinic asking for help from our clients and friends so that we could help those who came to us asking for assistance. It was a little leap of faith. It has turned into a force of perpetual "paying it forward."

Who says Jarrettsville Vet can't shape the future of the USA, or even the world? We can start a kindness tsunami with a few little ripples. We started with 15 cats and two dogs.

Many thanks to all of those who help make others and the pets that need a little kindness through the cold days of Winter. The Good Samaritan Fund is a donation based pet provision place to help the pets in our community. Vets and staff donate their time and expertise to keep costs for care at the minimal. Everyone donates so that the pets in need can benefit.

If you would like to learn more about the amazing staff and stories of Jarrettsville Vet please visit us on our Facebook page.

If you have a pet in need you can get free expert advice at There are people who will help you and your pet. We may be in your back yard, like Jarrettsville Vet is, they  may be a world away, like Pawbly is, but they are there and we will help you.

Related Posts;
Free Boarding To Any Pet In Need.

Freezing Pets and a Vacancy.

Wednesday, February 17, 2016

Make It Count

Jitterbug thwarts work efforts.

Life doesn't always hand you roses.

Perhaps it is the  perspective of being  a veterinarian? In one work day a veterinarian will see the miracle of  joy that is the abundant fervor of a puppy intent on simple play and the excitement of each new person juxtaposed by the family who visits to say their final goodbye to their beloved family member of many years. Those who are immersed in everyday life and death know that there is no script, no fairness, and no guarantees that life won't deliver a fatal blow around the next corner.

Magpie finds a good spot.
My  husbands parents are elderly and facing hospice and long term care for their bodies that are tired and unable to  fight cancer and disease any longer. The real life reality of a short calendar and the few precious weeks or months that they have left is a hard fact to face, never mind accept. We are old enough to have accepted that death happens and lives leave your life in  unexpected and heart wrenching ways. My husband came home last week with the news that one of his co-workers had just passed away in his mid forties from cancer that had been diagnosed a few months ago. This man  is younger than my  husband and had been a valued employee and good friend for many years. His death was abrupt and hard to accept. Our nature is to categorize those things we find difficult to make sense of. For my husband this disbelief manifested in resolve to do the following;

Valentine's Day 2016 breakfast.

"If I am diagnosed with cancer and told that I have three months to live I want you  to know that I am going to say "screw it to a lot of things!" His proclamation of the life he wanted to live and the regrets he would have if the hour glass was running low probably sounds like something many people would say.

Kisses in the snow. Jekyll and Charlie live in the moment.

How would your life be different if you won the lottery? Or, if you were given the news of a terminal disease? That's where my husbands head is at now.

I know he is struggling with how to live a life that makes him happy and how to accept that life can be cut short.

It was late in the evening after a long day in the clinic when he told me how sad he was to have lost his friend. His day of phone calls, multi-million dollar budgets and the weight of a title in a large corporation where he is responsible for huge assets that took 40 years of hard work and an impeccable work resume to attain are very different from my day to day general practitioner responsibilities. I exist at the individual patient level. He exists at the global corporate level. I see life and death and  every aspect of every patient in between everyday. I got used to death a long time ago.

First puppy vet visit, Frances Jane, selfie.

"If I have 3 months to live I would live the life I have now." 

Mac preps for his neuter.
Hold on tight to those you love and take time to cuddle.
If you love pets and want to make a difference in their lives please join me on We are a free pet centered platform dedicated to helping pets live longer, happier, and healthier lives by educating and empowering their guardians.

I can also be found on Twitter @FreePetAdvice, and at the clinic Jarrettsville Vet, in Jarrettsville Maryland.