IVDD. Dr Kelcourses' Advice.

Matthew Kelcourse, DVM commented ...

Hello Sara.

I have managed hundreds of spinal patients in my years - from conservative home therapy to surgery; so I am copy pasting my client education handout I provide to my clients when the earliest signs of IVDD are evident. (I don't know well it may copy/paste but I could not see a way to attach the handout to this post.

Dr K
Intervertebral Disc Disease (IVDD)

What is IVDD?

IVDD is a degenerative condition that affects the cartilage discs that act as shock absorbers between each of the boney vertebrae of the spine. Degenerative means that over time, the daily stresses of normal activities take their toll on the cartilage discs, causing them to become more resistant and less resilient to the mechanical forces endured while running, playing and jumping. The condition is commonly referred to as a bulging disc, a slipped disc, a herniated disc, or a ruptured disc.

Who is Affected by this Condition?

Chondrodystrophic breeds such as the Dachshund, Shi Tzu, Lhasa Apso, Miniature Poodle and other small breeds (including mixed and designer breeds) that are known for having short legs in comparison to the length of their spine make up the majority of patients affected by this condition.





Why Does This Condition Affect Some Breeds More Than Others?

The shorter legs of chondrodystrophic breeds do not have the ability to absorb as much of the high impact energy of running and jumping as the larger, longer legs of some other breeds and this excessive impact energy is passed along to the spine and intervertebral discs. This excessive energy absorption the spine needs to deal with adds up; and the more they jump, the faster it adds up and the sooner the symptoms of IVDD begins to affect the patient.

The act of a dog jumping down from a height results in two very different but damaging actions:
• The high impact energy we discussed a moment ago is focused solely on the front legs when landing (instead of sharing the load with all four legs) and this energy is passed along to the spine and intervertebral discs.
• Upon landing on the front legs, a dog will arch its back while bringing the back legs down to the floor and this arching of the back will focus a lot of the impact energy in the middle of the arched back and neck.
• Simply said; the more often a dog jumps off the furniture or out of a car, the faster the spinal discs will degenerate and the sooner symptoms will begin to become obvious.

What are the Symptoms of IVDD?

The symptoms may vary for each patient, but the symptom first noticed by most guardians is pain and this pain may actually seem to manifest in many different ways:
• Poor appetite and/or decreased water consumption: back pain may cause nausea but may also be preventing a pet from comfortably bending over or leaning down to the food or water dish
• Not defecating on a normal schedule: the back may be too painful to position properly for defecation; so a patient may hold it in or sometime just release it while laying in their bed
• Difficulty finding a comfortable position for sitting or laying down
• Arching their back or neck as if their stomach is painful
• Noticeable decrease in activity levels (including playing, jumping, greeting at the door, etc…)
• Crying out in pain when picked up
• Excessive salivation (drooling)
• Vomiting
• Panting
• Whining
More involved symptoms in order of increasing urgency of medical attention are:
• Drunken Sailor Syndrome: the pet is walking around on wobbly limbs as if they got into the liquor cabinet. This is actually an indication that a bulging disc is pressing on the spinal cord and causing an interruption of communication between the brain and the limbs; causing a kind of balance disorder known as proprioception deficits.
• Dragging the limbs occurs when the interruption of communication between the brain and the limbs is severe enough to cause partial or complete paralysis of one or more limbs.
• Drooping Tail Syndrome: is when a bulging disc has traumatized the spinal cord to the point where all, or nearly all, communication between the brain and limbs has been interrupted and the pet is now dragging their limbs while also being unable to use a limp tail.

What are the Treatment Options for IVDD?

There are three stages of treatment options for intervertebral disc disease and the recommended treatment is determined by the the severity of the symptoms.

I. Conservative Outpatient Therapy: is ideal for those patients who present with early and minimal symptoms such as back pain and only mild proprioception deficits. Treatment begins with the use of NSAIDs (non-steroidal anti-inflammatory drugs); pain-relief medications; and sometimes a muscle relaxant while resting quietly at home.

II. Conservative Inpatient Therapy: is a 42 to 48 hour inpatient therapy necessary for patients who have moderate to severe Drunken Sailor Syndrome and treatment involves receiving an intravenous anti-inflammatory steroid medication administered through an IV catheter (called a constant rate infusion; or CRI); pain medications; muscle relaxants; and other medications that may be required.


III. Surgical Decompression Procedure: is reserved for patients with severe Drunken Sailor Syndrome and those having difficulty moving their limbs. Spinal surgery will always come with intrinsic risks and is therefor performed only when a surgeon believes the patient will not be able to walk and play normally again without surgical intervention. This treatment may require a few days in the hospital and entails the Inpatient Therapy described above (II.); performance of a myelogram (or other special imaging technique) to locate the exact position of the bulging/ruptured disc; and surgical decompression of the spinal cord at the identified location by performing a laminectomy to remove some of the bone covering the spinal cord to release pressure from the spinal cord.

What to do if You Suspect Your Pet has IVDD

The best thing to do is to contact your veterinarian as soon as possible to set up a physical examination. If the symptoms are more serious – such as Drunken Sailor Syndrome or worse – contact your veterinarian or your nearest veterinary emergency hospital immediately. This is important because the sooner treatment is initiated, the better the prognosis for a patient suffering with IVDD.

How do You Minimize the Risk of Your Pet Developing IVDD?

1. Keep your pet in a healthy body condition; feeding a proper diet and getting plenty of low-impact exercise – obesity is one of the major contributing factors increasing the risk of IVDD.
2. Prevent, or at least minimize, jumping off furniture, out of cars, etc…. You can help by placing pet steps at the edge of furniture: even if your pet doesn’t use the steps, it’s important they are there just in case they decide to use them some day.
3. Use a daily joint supplement like Glycoflex Chews that help maximize joint health; including the joints in the spine.

The original Pawbly question can be found here.

Dr. Kelcourses bio from Pawbly; Graduated from Tufts University School of Veterinary Medicine in 1992. Special interests in orthopedic and spinal medicine and surgery.

If you have a pet question about IVDD, or any other pet related question please come visit us at Pawbly.com. It is free to use and open to anyone who loves animals.

Related IVDD blogs can be found here;

IVDD. The first few days of diagnosis, treatment, options, costs, and encouragement.

IVDD. A Tale of Two Outcomes. Surgery vs Cage Rest.

Feeding tube in a feline. Why being aggressive saves you one of those 9 lives.

This is Minnie. Her story is a testament to how unfair life can seem, and why you have to believe in miracles..

Minnie and her surgical set up

Perhaps there is some deeply seeded catholic benediction my foreparents bestowed upon me that moves me to do the things I do? In too many cases I find myself inexplicably emotionally invested in my patients care. When the case is a cat with a poor prognosis and a back story fitting for the Hallmark channel I also find myself barging into them. 

For all of my intrusive Dr House desire I have grown increasingly impatient for owners to make up their minds when it comes to their pets direly needed treatments. Finding the way to promote being proactive without scaring them into more treatment paralysis takes conviction, dogged determination, and willingness to participate in the responsibility of every possible outcome.

Seems most clients need more prodding than I do to jump in and change the course it so obvious their cat is headed in. Call it my veterinary ability to forecast medical futures and having seen too many unhappy endings, but living with regret for cases that could have ended differently should time have been on our side, I have become more resolved to not let a patient fail if at all possible. A decade of experience in foretelling the future has reaffirmed that people wait too long to make treatment choices, most especially when it comes to their cats. Parents need to be motivated by death looming at the door. Not the tiny chimes of angelic bells on the horizon, No, people wait until cats are taking their last breath. Waiting in too many cases is letting biology keep its course toward death. DON'T WAIT FOR FATE TO DECIDE! If Mother Nature were to decide for us I would have to find another profession. Medicine and Mother Nature are polar opponents within science.

Cats are special critters. They may have nine lives but they need aggressive care when it comes to the following;

1. Warmth. Young and old cats need to be kept warm. Warmth is attainable only when they have dry fur and adequate muscle mass. Debilitated, diseased, skinny (cachexic) elderly and young cats need help. They need shelter and warmth. If they are unable to stand or walk you must monitor their temperature with a thermometer. They get very cod very fast and when you put them on a heating pad (wrapped in a towel always or it will burn them!) they warm up too fast. They need to be between 100 - 102 Fahrenheit. 

2. Parasite free. Fleas and intestinal worms are small lethal killers when found in great numbers. This idea of knowing that your cat "doesn't have intestinal worms" is not based on any shred of intellect. Unless your vet looks at the feces under the microscope ASSUME they DO have parasites. And, just because I ask you to assume this, please (pleeeease) don't go buy some toxic stuff at the corner store and throw it down your cats gullet without checking with your vet.. that stuff is toxic.. yes, terribly toxic... bleck!

3. Eating. Regardless of the cause (and it is SUPER important to identify the cause) you have to get a cat eating. Any cat not eating for over 48 hours is at great risk of hepatic lipidosis. I don't wait longer than 48 hours to decide what to do about an anorexic cat, I get aggressive, I put in a feeding tube. Kittens (anyone under 4 months old), need to eat every 4-6 hours. If they aren't they need to be seen by a vet immediately. Products like NutriCal, Karosyrup on the gums, or syringe feeding might buy you a few hours,, might,, and hours, not days.

This is Minnie, a middle aged petite all black domestic short hair feline. She had just been adopted by her new family a week ago. When she came to the clinic I was spying on her exam work up. The clinic has 5 supremely wonderful vets. We are an eclectic bunch with our own areas of expertise, strengths, diverse experience and most wonderful sense of camaraderie. We share each others successes, failures, frustration, and hard cases. But, when it comes to cats I always volunteer for the hardest and most bleak cases. Worse of all I want the sickest kittens and the broken bodies. They are my favorite cases to fight for. When I heard her story I was determined to get her case in my hands.. (bet you never knew that the vets arm wrestle over cases?).

Minnie was considered "unadoptable" at the shelter. A label that pretty much assures that only crazy people or rubber neckers will glance at you. Being at a shelter is hard enough for any pet, being labeled "not worthy" is unimaginable. Pity is a powerful motivator. I was enamored with her story, her little fragile broken spirit and two people who could cast aside her Scarlett Letter and love her in spite of the professional warnings.

Minnie had waited 2 years to get adopted and within 1 week she was falling apart. Poetic country song justice was being served. The first appointments of Minnie's new life had cost her family over $500. They were looking at and accepting taking the writing on the wall and giving up... until I stepped in (even if it more closely approximated a 'barging in'). 

Minnie presented to JVC with significant diarrhea. The kind that looks like brown water dripping out the anus. Hard to manage for all involved. Medications were sent home. They had minimal effect.

She returned shortly after for more help. Blood work and x-rays then lead to a diagnosis of a mass in her chest.. typically evidence of cancer. All of the vets converged on her case. It was a caucus of opinions, emotional outbursts, "what-if's?", worst case scenarios, suggestions on how to pitch the findings without costing Minnie her second chance, and managing liability, and expectations. Not to mention the heated debate about what treatment options to actually recommend. The negotiations of what to say, what to do, how to help your patient without condemning the unknown future that lies ahead is some of the most stressful moments of every vets life.

I did not want her new parents to be convinced that she wasn't worth another chance of trying..

In reality we guess waaay more than we should. In the obligation of providing advice we GUESS! Without a lung biopsy that white blob on the radiograph is an unknown. No one knows Minnie's past, there are no x-rays to compare, and further that bleb may not have anything to do with her parents presenting complaint. We saw it because we went looking. Differentiating between "incidental findings" and "life threatening"is something left to more invasive diagnostics that most clients do not pursue.

Vets are supremely confident guessers. Handing down a death sentence is a burden vets take too lightly. In an effort to cover all of our bases and be thorough, and cover our asses we throw around words like "cancer," "expensive diagnostics" and "poor prognosis." In the human field it takes weeks to months and massive numbers of tests before you get a diagnosis. Human medicine is elusive and mysterious and often frustrating becuase people are desperate for answers that are not provided UNTIL the discovery process is complete. It is as it should be. Maintaining pursed lips until we have a definitive answer saves lives. Prognosis? Well, that is only for the brave and the well armed. 

Within another few days she was losing weight and not eating. 

"Great," I thought. "I was so hopeful that maybe her chest mass wasn't something bad? And now she has to prove me wrong?" Ugh!

And still I thought,,, "How could everything unravel like this? How is it statistically possible that she is fine for two years in a shelter and within 1 week she is dying from cancer? Stress can explain the diarrhea. The not eating was the congestion, runny, nose, and sneezing like every other cat from a rescue gets." She fit that scenario much better than the 1 week collapse and cancer affliction.

And so it was settled,, I was going with the more plausible scenario, jumping in, and willing Minnie into finally having her 'happily ever after'.

So I did what I wanted to do. I asked her family to let me try? They wanted a happy ending as much as I did. The financial investment was getting concerning. I see it so often. The bill gets bigger, the answers get shadier, and the prognosis for "full recovery" is more and more in question. I get it. I also get that many vets don't want to make assumptions that certainly could be wrong, and we don't want to scare our clients into giving up. So, our answer? We make a deal. Barter for service. 

"What if I do the feeding tube placement for free?"

Or,

"What if you only pay me if the treatment in successful?" 

Deals, and discounts.. and you and I both put some skin in the game to influence the outcome.

Sometimes sheer will power can make miracles happen.

So Minnie got her feeding tube placed by the Good Samaritan Fund. She also got four days in the hospital to try a whole new set of medications. Me, well, I got to try. The longer I practice the more I am seeking the challenges, the battles between biology and faith. The more I realize that the beauty lies in the struggle. Happy endings take work and effort, they are not supposed to be quick and easy.

Now I am not a surgeon, nor an expert of any species of any kind of veterinary anything, BUT, I do place feeding tubes way before anyone else around me contemplates doing it. Being proactive saves lives. It is why we use preventatives, advocate for yearly examinations, and promote vaccines, examinations, and excellent animal husbandry.

Feeding tubes save lives. They are cheap (tube $5, anesthesia $100, and suture $5, skill about $40).. I also take a radiograph with barium (contrast) to show that I have the tube where I want it to be. When I have the bill in my own hands I take liberties other vets have to scrutinize. Minnie was my case to do as I thought best. I did everything I thought she needed. If your clinic doesn't have an in-house slush fund I urge you to consider why not?

There is the always resistance when I mention  or suggest a feeding tube. We humans relate to medical treatment options as if we are the patient. Your cat is not a human. There are many treatment options that pets seem to tolerate far better than we do. Broken bones, spay/neuter, illness, cancer, you can almost name anything. They often bounce back very quickly and never feel sorry for themselves. Minnie was losing weight and getting sicker, she needed help to maintain her body weight, deliver the medications she needed and have a chance. She needed a feeding tube. She needed it now.

Helpful Real-Life Vet Tip; Don't hesitate to put a feeding tube in a cat. EVER! (OK, I should never say never, or ever,, But I do mostly mean it here).

The myths behind feeding tubes;

1. They are invasive. Not hard to place not difficult to do. A few photos in a training manual and basic surgery skills.

2. They are extra-ordinary life saving measures. Not any more so than an iv catheter and we do this daily.

3. They are hard to manage. They aren't. A few simple instructions and they are a satisfyingly simple life savers..

4. They are cumbersome and bothersome to our patients. of all that I have placed not one cat has seemed to even notice them.

Here are some things to remember about feeding tubes;

1. They are transient short term lifesavers.

2. They permit for adequate food and medication delivery quickly and efficiently.

3. Cats can (and do) eat around them. We let Minnie decide when she was ready to have it removed.

After a few days of hospitalization she started eating very well. We sent her home with a few basic instructions on monitoring the tubes placement site to make sure it wasn't moving, looking infected, or had food caked around it. Feeding requires liquefying one of the many prescription foods and allocating the daily allowance over the 4-8 feedings prescribed. After each meal the tube is cleared by flushing a small amount of water. The tube is capped and tucked away in the neck bandage.

Food and water is offered and kept available at all times.

Most of these cases are given concurrent;

1. Probiotics (after all we are adding a lot of water to liquify the food and lots of water leaves likely diarrhea).

2. Appetite stimulant. I like mirtazapine. The point of Minnie's plan was to get her eating. Use all tricks, tips and tools available.

3. Address and correct Minnie's underlying issues. Feeding tubes buy you a little bit of time but they don't cure. Like all medical procedures we buy bits of time, we continue to search, 

Minnie went home for a few days to acclimate (again),  feeding tube in place. Her parents had a daily list of medications to give, and instructions on how to monitor her feeding tube. The biggest fear I had was pulling her feeding tube too soon. She had to be well enough that she was maintaining her weight, could stay on her prescribed medications, and be comfortable in her new home.

Things that indicate a problem;

1. Cat isn't eating or looking interested in food. A feeding tube can't stay in forever. Start an appetite stimulant, look for additional underlying issues, and don't forget to address behavioral components (a stressed or unhappy cat will not eat).

2. The feeding tube is vomited up, or coughed up and coming  out of the mouth. These cats will chew off the end of the tube and we don't want the tube to be swallowed. 

3. The entry site of the tube needs to be checked daily. We change the bandage that covers it daily. Infection is dealt with aggressively and immediately. 

4. Using a feeding tube takes practice and calculated amounts of the correct prescription food. Your vet needs to help you so that enough calories are given, enough water is used to move the food into the stomach, and a flush of water as a chaser is given after the food is delivered so that the tube doesn't clog.

Minnie has a new second (maybe we are on our third?) chance at life. She is being monitored closely. Given her own spot to acclimate to her new home, and get used to life after the shelter.

And me, well, I've got your back Minnie, and all of us at Jarrettsville Vet are rooting for you!

One week post op.

Many thanks to all of the friends of Jarrettsville Vet who help us provide second chances to those in need. The Good Samaritan Fund is available at the discretion of the staff of Jarrettsville Vet to our clients. If you would like to contribute please contact us here. The veterinarians who utilize the fund are not paid out of it. The vets donate their time if they elect to use the Fund. Everyone (we mean everyone) puts some skin in the game and is personally invested in the case.

If you have questions about anorexia, feeding tubes, hospital care, and how sheer will and determination can shape health and destiny, please find us on Pawbly.com. It is free to use and open to all who care about animals.

You can also find me on Twitter @FreePetAdvice.

And if you have a cat who needs a friend find me at Jarrettsville Vet. I am always looking for a case to champion and a cat who hasn't exhausted their 9 lives.

Pyometra Emergency. Saving your pets life when optimal options aren't possible.

Chloe is prepped for her big restoration and transformation.

There are many cases who find me. The power of social media and pet parent desperation often come to a head at my doorstep. It wasn't necessarily my intention to be the landing page for those who had no luck at other equally capable veterinarians hospitals, but I am finding myself to be the vet who offers options to those who are not receiving affordable treatment plans elsewhere. There is a great divide happening in medicine and consequently a huge number of pets falling into the growing chasm of divide simply because pet parents are being priced out of the care they need.

Chloe is a speck of a Yorkie. Demure, quiet, reserved and always trying to hide in the shadows of her moms arms who persistently protect her from having to face the world with a nose to the heavens.

Mom loves Chloe, but like so many others, life had gotten bumpy and difficult and Chloe's health care needs were being overlooked due to more immediate pressing matters until last weekend when Chloe wouldn't eat and was acting very sick and reluctant to move or play.

Chloe headed to the emergency clinic. Within a few hours her illness had a name; pyometra. Unfortunately that $750 work up cost her family all of the money they had. The price tag Chloe's mom was given for the treatment she needed was estimated at $2900. They walked out of the ER with antibiotics and a dog who still needed life threatening surgery.

I have this gripe that I cannot seem to convince the rest of the veterinary world to pay attention to.. the point of veterinary patient care, the reason people drive their pets into our door, is NOT JUST TO TELL THEM WHAT IS WRONG!!! OUR JOB IS TO DO THAT, AND (MOST VITALLY IMPORTANTLY), TO FIX THEM!! 

In fact, I am very certain that our clients are more interested in real help than real answers!

An invested vet will talk about the resources required to do both, diagnose and fix. Exhausting available resources and not getting to the finish line is not assisting our patients. It is short sighted, veterinary focused mismanagement of client and patient care. A good vet will talk about the most likely diagnosis, the available treatment options, the prognosis for each, and the costs associated with every step of this process. Spending all of Chloe's treatment resources before they get the help that will save their lives is simply cruel tragically failed patient care. 

Chloe has had a retained baby tooth, now mobile simply by touching it, for her whole life.
More information on this here.

Chloe had a laundry list of needs. By the grace of good luck her antibiotics were kicking her uterine infection to the curb and she was feeling better within two days. There was still much to address in her tiny 8 pounds.

People ask me all the time how they can affordably care for their pets? The answer is universal; Keep up with the day to day, month to month, and yearly stuff. Budget and plan for it. It is as important to your pets health as it is to yours.

Here is my short list of needed routine care to avoid the costly veterinary bumps in the road.

• Brush teeth daily.
• Eat a good nutritious wholesome food on a scheduled regimen.
• Get lots of sleep. Dogs have this concept mastered. We have some important lessons to learn from them. 
• Lots of interesting exercise. What do I mean by this? Let your dog be a dog. Sniff, tug, play, hide, walks that are adventurous. Let them explore the world.
• Play hard and sleep hard.
• Ideal body weight and muscle mass. Avoid lots of the diseases and disease processes that obesity predisposes your pet to. 
• Indoor cats need exercise and I warn about poor quality free feeding dry kibble. 
• Basic parasite prevention. For my part of the world this includes fleas, ticks, heartworm, and intestinal parasite preventatives.
• Spay and neuter by 1 year old.
• Obedience and socialization. What would happen to you if you were not able to care for your pet AND your pet refuses to allow anyone else near it?
• Microchips save lives every single day. Make a small investment for the best chance of a happily ever after that you hope you never need to rely on.
• Start a savings plan for the unforeseeable accidents ahead.
• Have a great vet who knows how much you love your pet and be there for each other. Here are my tips on how to get something for nothing from your vet.

Here is what Chloe needed;

• Dental cleaning with numerous extractions. Her mouth was so rotten that almost every tooth was mobile. Every client I show teeth like this to is always shocked that their pet gave them no clues there was such a significant problem. If you didn't brush your teeth daily yours would fall out too. Dogs get used to bad teeth and eat around them. Removing them resolves persistent oral infection and they will eat better afterward. The number of teeth to be removed is often also shocking to clients. In many cases dogs, like Chloe, will have a dozen, or more teeth extracted. If they are bad they are removed. No discussion here. Don't wake a dog up with bad teeth still on board UNLESS you have a dental professional who wants to stage the procedure. Ideal for the patient, more expensive for the client.
• Spay. Her uterine infection will return. Spay her as soon  as possible.
• Get an idea of her overall health before jumping into surgery.
• Caught up on vaccines and preventatives.
• Lay out a plan her mom understands and can afford so that she remains on healthy in the days, weeks, and months ahead.

The original source of Chloe's illness, her pyometra. 
Treatment; simple; uterus and ovaries are removed.

My clinic, my perception, and my obligation to my clients is deeply seeded in my ability to get them what their pet needs in an efficient and affordable fashion. 

Chloe's mom was deeply upset that her dog was in need of so much medical attention. She felt very guilty for both not knowing that her mouth was so diseased, but also that she had waited so long to provide the basic spay, vaccines and annual care she knew she needed. The luxury of going back in time when hindsight is present tense and everything is 20:20 is not something I waste much time on. We are here now, we cannot go back and undo, we can only learn, move forward and do the best we can in the present. 

Chloe's mom wanted to use her tax return to get her well. We had a budget. Budgets are a reality few vet businesses want to hear about. The reality is that most all of us live in the real world of budgets.

The conversation between Chloe's mom and I went something like this;

"Ideally we should put Chloe on antibiotics for two weeks and then give her a dental cleaning and remove all of her diseased teeth. The cost of this is about $800. She probably needs her spay soon too. The longer we wait the more likely it is that the uterine infection can resurface. This surgery is also about $800." Chloe's mom could barely scrape together the $800 for one, she couldn't do it twice. And, as every good family vet will point out, we still needed to get Chloe back on track AFTER the emergent disasters were addressed. Chloe needed about $200 of flea &  tick and heartworm preventatives. I feel very strongly that our mission is to help through the bumps and provide a path forward to help avoid bumps in the future. Every pet leaves Jarrettsville Vet with a short AND long term plan along with associated costs. 

"But how can I do both surgeries? I am so worried that she won't live through all of this if I don't do them? How do I choose between what is safe for her and what is possible for me to be able to afford?"

"We have to make a choice. We have to do what we can, accept what we cannot and tell ourselves that we did the best we could with the resources at hand." This is a concept that I think the veterinary profession is losing sight of. In some effort to promote our bottom lines, save our skin from the chance of liability we don't help people on the level they need us to. 

Chloe had her spay and dental surgeries a few days later. I asked our dental expert veterinarian to help. I wanted Chloe to get all that she needed and I wanted her little 8 pound body to be under general anesthesia for the shortest time possible. I was most worried about her getting too cold being under for the two hours it would take to do all she needed.

Chloe's bill...

Chloe's final bill for her spay and dental (which included almost a dozen teeth be removed) was about $760. It was by no means ideal. She had minimal additional blood work done. She had everything done at the emergency clinic the week before. It was all normal. We did not repeat it. We took a leap of faith, and a calculated risk. We also had the benefit of her being on antibiotics from the emergency visit. We scheduled her surgery on the last day of her emergency antibiotics and then resumed them the day after surgery. She was closely monitored and treated by experienced vets who wanted more than anything to get her back home with all of the needed care she came to us for. That's what your home town vet does.

Two weeks post-op and Chloe is doing great! She has a daily plan her mom understands. She is also on her needed monthly preventatives and will return every 6 months for examinations to make sure nothing else comes up to derail her health.

Chloe is an excellent lesson on finding a way to make a difference in a pets life while working within the real-life constraints of a family on a tight budget.

Update;
This is Chloe at her 2 week post-op visit. Her mouth and abdominal incision are all healing excellently! She received the last of her booster vaccines getting her all up to date on her medical needs. She is happy, active and on a path to maintain these. We are elated to see her back. Her mom knows we are here to help, and with a team in place to care for her, provide guidance, and be willing to face any bumps in the road together her chances of  trouble free future are the best they could possibly be.
Lots of love to Chloe and her family!

Life can be full of happy endings if you can bend, compromise and find help when it is needed. Keep looking if you can't it is out there, we promise!

If you would like to ask me a pet related question you can find me on Pawbly.com. Pawbly is free to use and open to anyone who needs a little  help in finding information or direction with their pets care. We also invite all of the pet lovers out there to join us and share your pet knowledge. 

Me and  the resident clinic governess, Loon.

If you would like me to meet your pet and assist in their care I am happy to try to help. Call me at the clinic, Jarrettsville Veterinary Center in Jarrettsville Maryland. We publish our Price List every year. You can find it here.

I am also occasionally visiting on Twitter @FreePetAdvice,