Saturday, October 29, 2016

Affordable Options Are Everyone's Right.

Harford County Humane Society surrender

For a huge part of the pet owning population the ability to find affordable care for many aspects of their pets health is unattainable. Many cannot afford to make good routine nutritional choices, attain routine veterinary care, provide little to no vaccines or preventatives, and even more cannot begin to find affordable options for complex disease(s) or emergency care. The size of the chasm of need increases significantly for people as the small choices for basic care grow into more complicated health concerns.

The reality of the intensive side of veterinary pet care, and by that I mean; emergencies, life threatening disease or conditions, or pet care that requires specialists, referrals or hospitalization, is that if you have deep pockets you can, and will, get state of the art unimaginable high quality specialized care. The state of veterinary medicine is at the point where amazing things are possible when clients have access to immediate funds.

In the real-world of this small animal general practitioner there are too many cases where the degree of assistance and the altering of prognosis with the likelihood of cure is directly proportional to the power to pay immediately.

Let me explain. Many difficult cases require more than one vet visit and more information than our eyes, ears and nose can identify at the initial visit. Running tests and making repeat visits to the vets office are needed to find the critical clues that help lead to the answers your pet needs to provide optimal care and prognosis. These can be expensive. As the wallet shrinks these key critical pieces for a best case outcome scenario fade.

In some cases I cannot even get close to a diagnosis. Without at least $500 I often can't get a narrowed down list of possible rule-outs to allow focused effective meaningful care. Seasoned trained well established vets dole out a boat load of convincing "educated guesses" when we are presented with pets who need answers and pet parents who don't or can't pursue diagnostics. It is sad and true that huge numbers of fates are decided on "guesses" educated or otherwise.

Even in the few cases that I can almost 100% definitively diagnose for less than $100 or $200 dollars, let's say for example DKA, fractures, blocked cat, obstructions, pyometra, GDV,  IVDD, neuromuscular disease, toxins, cancer, behavior cases, (the list is endless), I cannot provide cheap AND prognostically favorable answers for less than $500 (plus). It is always a dance of managing expectations, resources, and open honest communication, and always, always, trying to figure out a way to keep a pet in a home and happy on all sides. It is why so many vets learn to walk away indifferent.

I believe that vets are an integral part of a pets quality of life. We are their advocate for all facets of their care. Why then is it that we shirk away from guidance when there are financial constraints? How on earth can denying affordable options help maintain our credibility and integrity? If there is a pet care problem there are ALWAYS options. There are even affordable options. Perhaps they are not attainable under our roof but shouldn't we be obligated to provide them regardless? Is withholding affordable options a part of who we want to be? My clinic provides clients in need with resources of low cost spay/neuter clinics, vaccine clinics, surgical facilities and trainers, even though  we provide all of these services under our roof. Why do we do this? Because ultimately our patients shouldn't have to pay for our inabilities (vet AND parent included).

Our most recent endeavor is to curb the need for shelter surrenders of our patients.

Undoubtedly there are many sides to the problem of why people surrender to shelters. There are many sides that I cannot help. Of them I cannot convince a pet parent to love their pet. I cannot build a bond between a person who doesn't want to make a place in their heart or family to care about them. I cannot convince someone to not be evicted, or not rent an apartment that won't take pets, etc. BUT, I can help in behavior and health care issues that might cause some loving pet parent to consider surrender, abandonment or economic euthanasia because the cost of care is too great.'s  Top 10 Reasons for Relinquishment*
  1. Moving (7%)
  2. Landlord not allowing pet (6%)
  3. Too many animals in household (4%)
  4. Cost of pet maintenance (5%)
  5. Owner having personal problems (4%)
  6. Inadequate facilities (4%)
  7. No homes available for litter mates (3%)
  8. Having no time for pet (4%)
  9. Pet illness(es) (4%)
  10. Biting (3%)
  1. Moving (8%)
  2. Landlord not allowing pet (6%)
  3. Too many animals in household (11%)
  4. Cost of pet maintenance (6%)
  5. Owner having personal problems (4%)
  6. Inadequate facilities (2%)
  7. No homes available for litter mates (6%)
  8. Allergies in family (8%)
  9. House soiling (5%)
  10. Incompatibility with other pets (2%)

Jarrettsville Veterinary Center can help with some of these. Here is what we are doing to help the pets in our community;
  • Providing shelter for pets from excessive heat or cold for free. 
  • Providing payment options when care is denied elsewhere. 
  • Providing care when euthanasia is the only affordable options given, or, even taking surrendered pets when our clients pass away. 
We will do it. We can help and we will. Coming soon we will offer a pet food pantry and Pet Savings Plan to help our clients prepare for the rainy days every pet will at some point face.

This is our latest offer of assistance;

Dear Local Shelters/Rescues,

At Jarrettsville Veterinary Center we have a deep desire to help animals in need.  We want to be part of the solution in keeping pets out of shelters.  According to the ASPCA approximately 7.6 million animals enter shelters nationwide every year.  This number is shocking and we would like to do something to help with the problem in our community.  We are reaching out to the shelters and rescues in our area and asking for your cooperation.  When a pet is surrendered due to the owner’s inability to pay for the pet’s veterinary care we ask that you ask one additional question.  Please ask who their veterinarian is.  If Jarrettsville Veterinary Center is mentioned or listed on a vaccine history as the center where the pet received care please contact us at 410-692-6171 and ask to speak to Jennifer Taylor.  We would like to see what we can do to assist the owner and their pet.

Thank you so much for your cooperation in this matter, as a team we hope to help our patients who may find themselves in unfortunate circumstances.

Warm regards,
The staff of JVC

This is Heather. She was surrendered by her family to our local shelter. She is 3 1/2 years old and has not been treated for her diabetes diagnosed over a year ago. She was very, very sick from her neglected diabetes. Without immediate care she would have likely died within a few days. She was 113 pounds at arrival. This is almost 30 pounds more than she should be. If it weren't for the shelter staff calling us and our ability to help her she would have been euthanized. Somewhere someone failed her. This disease is avoidable and treatable. A lot could have been done for her to keep her from being surrendered. She needed to be given dietary options. Affordable, over the counter, options. She needed to be shown to how to be treated for diabetes. Affordably. She needed more than her family could provide. She is one of those pets in our community we are responsible for. We owe her more than she has been given and we will help her find her second chance at a new and healthier life.

Our goal is to offer options to help people so surrender or economic euthanasia isn't a needed option. Pawbly and Jarrettsville Vet are here for this purpose. We hope that you will join us in helping pets in your community. Education and options are often all that are needed to change and better the lives of those in our communities.

More on Heather soon.

If you would like to help a pet please join us at Jarrettsville Vet for one of our fundraisers, like Pets With Santa. Always the first Sunday in December. Or visit us on our Facebook page. You can ask me questions about your pet on It is free to use and open to anyone. I am also on Twitter @FreePetAdvice and YouTube.

Coot, our resident clinic cat, and I steal a snuggle selfie

Related Blogs;

What Are You Building? Leadership in a Compassion Based Clinic.

Medical bill madness: what if human medicine was like veterinary medicine?

Economic Euthanasia.

Veterinary Rescue Shaming and The Frank-Starling Law.

Rescue Economics. When The Expense Costs You Your Ability to Care.

Wellness Plans, Savings Plans, and Surprises.

Jarrettsville Veterinary Center Protocol for Clients with Financial Constraints.

Compassion Fatigue. When the candle you are burning at both ends consumes you.

Wednesday, October 26, 2016

Borrowing Battery Juice. How Recharging Keeps the Motor Happy and BUILDS Your Veterinary Practice.

Early morning run produces four 1 month old kittens. 
Cold hungry and at the mercy of an often unforgiving world.
There is too much anger and blame in the world. I am just as guilty as the next over privileged white American. Travel the world for any amount of time in any capacity at all and you will return to the land of the stars and stripes feeling lucky. Stick around the USA long enough and the bitterness of wanting more and giving less gets the best of you. Outwardly none of us want to carry each others burdens. If you are a vet you seem to get asked more than you imagine others do to keep helping as the extended open hands never stop coming. It is our lot in life to be asked and expected to help. We are often castigated if we refuse to help. I fear most vets say "NO!" to the Springtime eruption of abandoned kittens, owner surrendered peeing cats, economic euthanasia's for broken bones, bad skin and the behavior cases that would just be too much work to retrain.

Sam, JVC adoption from rescue,
Thanks to the Good Samaritan Fund 
Summer 2016
The excuses are plentiful;
  • "It isn't our job to provide homes for unwanted pets."
  • "If the client can't afford the care needed they shouldn't have ever gotten a pet."
  • "We are not the shelter. We are a business."
  • "If we do it for free everyone else will expect it."
  • "There are too many good/healthy pets being euthanized. Why should we champion the cause of the bad/sick ones?"
  • "What about the liability of a clinic cat? Or, worse, a behavior dog?"
  • "We have an obligation to care for our paying clients. We don't have time to care for both."
  • "What affects my bottom line affects my ability to take care of my staff."
  • "I can't love the pet more than their owner does."
  • "It's not my problem."
  • "It would take too much,,,, (insert the following here) time, effort, resources, care, etc."
  • And, the one no one speaks out loud but secretly harbors; "I don't care."

I will argue every point above. I can even simplify them all to a few basic tenets.
  • You probably do care more than the average person. That is why you busted your butt to get into and out of vet school. This is what makes you exceptional. Who the heck wants to lower themselves to mediocre? 
  • You are not as financially strapped as you portray. And even if you think you are I would offer this. If you are struggling as a vet you are doing something wrong, and it is NOT giving stuff away. It is not CAPITALIZING ON THE STUFF YOU DO GIVE AWAY. Our clients love us simply because we care about them and their pets. If you are not on social media you are losing about 30% of revenues you could have access to because you aren't telling your clients what you do. 
  • People want transparency. We all like to know what to expect as much as possible. If you don't provide it they won't trust you. 
  • You are replaceable. 
  • Any vet who doesn't have a clinic cat is a clinic who says "NO" too often. One of the ways I suggest a client pick their vet is to walk out of a clinic if THEY DON'T HAVE A CLINIC PET. My lawyer reminds me every time they can about how I need to remove my in-clinic herd. They are considered a "liability." This is one of the many defining qualities of why I am not a lawyer.
  • Your staff will stick with you because they believe in you and your clinic. They have choices to. They may think about leaving to make more money, but, they will stay because they know they are a part of the dream of who they wanted to be. Foster this at all levels of your business. It is the CORE of a hospital.
  • Having and helping the needy pets has turned the staff into an army of veterinary care foster parents. This has trained my staff more than I could have ever done on my own. JVC has kitten critical care specialists, puppy trainers, dog behaviorists, and a a clinic of "fear free" personnel because we are true to our mission. 

Let's talk numbers. Every vet who thinks that being kinder and more generous is going to adversely affect their numbers isn't utilizing the power of being the person your clients want and expect you to be. If anyone wants to talk my numbers I can tell you that my clinic Jarrettsville Veterinary Center has grown beyond my wildest imagination. I took a leap of faith, I followed my heart, I employ people I trust and believe in and we share in the joys of trying. We don't always win the battle between life and death, and we don't always decide fate but we don't take or make excuses. Everyone and everything is provided assistance and more often than not the pet wins a battle they would have otherwise died from.

Roadside kitten
Day 2; grateful.
Building a veterinary business HAS TO BE centered around improving pets lives. It is much more than a balance sheet and time cards. It is small miracles, long hours of trying to bend the laws of science and biology. It is also endless buckets of blood, sweat, and tears.

I asked my business partner if he was brave enough to publish our numbers? How much has our bottom line improved while our goodwill runneth over? Maybe if I put out hard numbers that would encourage more vets to think AND act outside of the rigid 'care for paying clients only' box? It is a factor of exponential growth based on a series of key decisions.
  1. Get rid of clutter. Clients who steal your soul, beat you up and cost your ability to maintain faith in mankind and compassion to your patients go. Period. If that means getting rid of 20% let them go. Quietly, peacefully and quickly. 
  2. Be very vocal and open about who you are and what your clinics mission is. Broadcast it.
  3. Embrace the free stuff. Use the talents of your staff, your reps, and your community. Ask for help with anything and give up control. If you don't let your assets sell your business it will never grow. 
  4. Be honest always. 
  5. Understand short term losses and long term gain. If you aren't a part of the long term gain your staff and your clients will see through you. 
  6. You don't have to be anyone other than who you are. Stop trying to be something you are not. BUT, hire to round out your abilities and services or knowingly and openly give up a piece of the client expectations. For example, the vet I bought my clinic from did lots of ear crops. He was very good at them and hence people traveled great distances to see him. Me, well, I like floppy ears. It took a while for me to break it to his followers, but I am not a cosmetic ear vet. I was honest and they were upset he retired and that was the end of it.
  7. Expect that notoriety brings visibility. Be prepared to grow and what that entails. It is a double edged sword. 
  8. Go into every interaction with a smile, an open hand of assistance and expect the best of people. If there is one or two who disappoint you have a fund set aside to offset the loss. You will find that more people are good than bad and that more cases can be won versus lost and you can build forward. In summary, "don't sweat the small stuff.. and you know,, it is all small stuff."
Another of the roadside kittens
How has being more compassionate, opening our doors and services to more people, and doing things others think are impossible helped us? Goodwill builds loyalty. Loyalty builds vet-client bonds, and one long term client who passes your name along to anyone who needs help for their pets is a dollar you never have to spend on marketing that was never going to drive your business into the big leagues anyway.

Gus Gus. Found in a dumpster emaciated. Adopted within 1 week.
I have learned that what comes around goes around. I don't have to hope to cast karma. I can see it. People care about their pets. Most of them care about them as if they are family members. I do feel that we veterinarians have an obligation to help the patients we are educated and empowered to serve. I just argue that care should not be based simply on a clients ability to pay out right. There are lots of resources available from many wonderful organizations. We at Jarrettsville Vet will tell you what we can do for your pet. We will also tell you how much it will cost. If you cannot afford this, or, if you would like to know what other outside options are available we will provide them. We also post all of our prices and provide examples of past surgery costs willingly and openly. If they cannot pay we provide options. Economic euthanasia is not a treatment option.

Abandoned bottle baby turned bossy self described Alpha Cat
You reap what you sew.

Ninja kittens decided they liked beds, food and cuddling rather quickly.
There is nothing worth the power of a smile and the joy that a pet brings. It is the most important part of our profession. It is the fuel that feeds the soul of a pet practitioner and supports the passion to be who we are and do what is not always easy.

Skippy Jon Jones
Good Samaritan Fund
Summer 2016

There are appointments where I know I spend more time playing and cuddling my patients than I expect to. These are always the moments I reflect upon each night when my husband asks me, "What was the best part of your day?"

River and Rose
I take the cases that have nothing left. Paisley needed a weird off the sidebar of my vet surgery text book surgery OR she was going to be euthanized. I sweated her surgery. I called my friends for advice. I put out a Facebook plea for guidance, and I jumped in when no one else would.

She now lives with someone who I adore. Paisely was the kismet to meeting a friend I cherish. She was a reason to try and the reward was worth the uneasy challenge. Life is not meant to be easy. Stop seeking easy. There is no reward there.

If I could pick diseases to specialize in they would include;
  1. Puppy Strangles
  2. Pyometra
  3. Demodex
  4. Parvovirus.
  5. Feline Inappropriate Urination
These too often are given up based on huge estimates of care. BUT, they are conquerable! And we shy away from them too often.

Incorrectly diagnosed as sarcoptic mange which almost cost her her life.
These are the faces of what we do. We help any pet from the local shelter who we think we can. We post them on Facebook like mad. We seek the comfort of a purr and a snuggle when we need to walk away from a hard case. We take time to remember who we are and why we are here. Keeping kittens helps the stress, the heart break and the reminder to push on. There are always souls in need and often we each help each other feel loved and needed.

Kitty and Sam
Good Samaritan Fund
Summer 2016

Every vet hopes to live and practice long enough to build a book of their career. To see the puppy they delivered reach teenage status. To save the kitten who had little hope if you hadn't intervened make it to spay/neuter surgery. To have enough cases to add opinions on preference of care. To see our clients children grow and have pets of their own. To build a book of stories that are worthy of brandy, long stormy days and reflection of glory days. We each are building our own legacy one patient at a time. Each one matters and each will build you into the person you decide to be.

Who I delivered via Cesarean section (my first) 11 years ago.

Medicine takes courage, conviction, dedication and ability built on practice and heart.

Celebrate, announce and revel in the bright spots. Take pride and be who you are without fear.. medicine takes no prisoners,, we are all "a ghost driving a meat coated skeleton made from stardust. So what are you waiting for." (My new favorite quote). Every vet has a bit of demented biology we relate to.. embrace it!

Making new friends everyday.
Taking lots of selfies to keep the batteries charged.

If you think all of this isn't possible I ask you a few questions.
1. How often do you feel that your batteries are on empty?
2. Is there anything you are doing that you don't feel proud of? If so, just say no. No fear and face consequences with pride in being true to your inner self. I swear I got rid of all my soul sucking clients and staff.. It took A LOT OF COURAGE! I stopped making excuses that cost my patients for my clients sake, and I abandoned my bottom line concessions. Every decision is made openly honestly and with being kind and compassionate at the forbearance. It is possible.
3. What are you waiting for?
4. Is your desire to calculate overpowering your ability to find peace and joy in being a vet?
5. What are you really afraid of? What if I told you that it doesn't really matter? That you matter much more.

If you are still in disbelief about all of this,, I can add; No good deed goes unpunished. Expect it. Be prepared for it. Be brave. And don't let the pessimists take over your orchestra. Approach them as you would disease. They are there to challenge you. Out smart and out live them. And walk away knowing you are only better because you faced a challenge.. and then don't look back or waste time letting it bother you. We have all learned that there is a force of some greater influence than we will ever possess. (And turns out you can kill  a cat with an arrow and still keep your license.. the rest is just money. We are over the ludicrous idea of having lots of money aren't we?).

As always I wish you kindness, peace and endless compassion. 

Related blogs;

If you would like to learn more about Jarrettsville Vet please visit us on our Facebook page, on our website, or find me on Twitter@FreePetAdvice or on where I answer pet questions for free. Pawbly is open to anyone who loves pets. It is a place for free information and resources to help pets and their families. I also have helpful advice on YouTube Krista Magnifico, DVM.

Thursday, October 20, 2016

The Misperception of An Outspoken Vet.

OK, so I have provided apologies before. I probably do it too often? Some ridiculous effort to provide a piece of genuine empathy to my audience and still seek permission to keep on chatting. Maybe it is a silly way to divert assertion of a strong voice or soften the edges while I deliver a punch? Or, perhaps it is even a trace of manipulation or deference for a spirit I don't always suppress?

So here I go again....

I am sorry if this  offends anyone. It is not the intention. Let me start there.

Everyday I question what I am doing and why? I have to provide a list of reasons to my internal self-check consciousness mechanism as I invest more time in what might end up as a completely futile effort. These moments of self-reflection are tidbits of a fractured To-Do list meets overwhelmed workaholic. I accept it as my own doing and dissect so as to provide justification to keep on repeating my self fulling prophecy. Here is a good example of my internal conflict meets slightly scattered over tired practice owner/vet/mom/wife.

Person with box walks into clinic. (Always a bad sign).
I over hear the following between vet tech and box holder; "He's not mine. I don't want him."
Said vet tech finds me to report; "Tiny kitten, head wound, quiet, barely moving found 4 hours ago. She wants us to take it. Can we please just take it and tell her to go?" I know full well this is a plea for two things:
  1. Tech wants to get box carrier out of office ASAP. It is closing time and she knows the argument is a lost cause.
  2. Kitten is in bad shape. 
Internal dialogue unfolds something like this: "Crap. Here I go again."

I walk out to meet said box holder. She repeats same story. "I found this kitten in my yard under a bush with flies on it. It isn't mine. I don't want it. So I brought it here. I figur'd you'd take it?"

How do I answer this?

"He's pretty close to dying isn't he?" She takes advantage of the lull in the conversation as losing leverage and adds a smear of additional pity to the plea.

"Well, maybe if you didn't wait 4 hours?" I mutter, knowing I had lost the battle at the arrival. I add insult to injury.. and peak in the box. Cursory exam; 2 week old kitten with swollen head, poorly responsive, dehydrated, who is dying in front of me. If I don't take him right now and help him right now I know he will die. I know this.

"What are you going to do if I don't take him?" Answer is not going to keep kitten alive. And the most idiotic thing to leave my lips follows, "I am not a shelter."
Yes, we take him.

Swollen head, abscess,
and fly eggs (will be maggots in about 2 hours).
I cannot win.. I just have to find acceptable decisions so I still want to wake up tomorrow and relive the hamster wheel meets Groundhog day life I am trapped within.

Sounds bleak, huh?

Well, I don't think its bleak. I think it is my real-life. How can I title this little public journal and not be honest?

Maybe the whole freakin problem is lack of honesty? Or, in my case, too much honesty?

Maybe it is the culture of whining and blaming and not stating our true feelings?

And maybe I am tired? I can be tired? We all get tired.. but remember that little internal inquiring voice? Yes, I listen to her. Too often I even argue with  her.

I understand I got myself into all of this. I am not asking for anyone's sympathies. I am not even asking for your understanding. I think I am only asking myself to be true to my vision. To not be swayed by others lack of interest, failure to find common goals, and indifference to the plight of others that I am trying to assuage and ameliorate.

Although my blogs and articles get some attention they also leave me open to explaining myself. Truth be told, I feel the conversations are fuel to perpetuate important topics. But like all people we get defensive and protective of unsolicited opinion.

And then my strong voice, fierce compassion and outspoken demeanor elicit this..

Hi Krista,
XXX .. just sent me one of your recent blogs regarding your policy on costs and economic euthanasia, which I thought was AWESOME! (sic)
Hope all is well, and keep on advocating for animals.

I should add a bit of background. The email is from a member of a vet group I belong to. I deeply respect him and believe firmly in the groups purpose and vision. We have firm common ground and a distant rapport.

Many thanks for the email.. To be completely honest I feel as if I  am a one woman crusader against a flurry of corporate run behemoths who are slowly, insidiously taking over vet med. It is shocking to me how few people seem to be left upholding the standards of the foundation our profession was built upon. There are so many wonderfully caring hard working vets but they have been strong armed into practicing what the owner/director mandates, or, they are too driven by a bottom line, or, they are leaving and/or killing themselves.

For example, yesterday I saw two clients who were given estimates of 4x what my clinic would charge. One was a cat who needed a dental and one extraction, estimate given by  "big city practice #1" was $1000. Estimate number two, the puggle with pendulous soft tissue mass wo palpable blood vessels at base of stalk, $800-1200. Cat dental at our clinic $400 (w full pre op bw), and mass removal $200 w sedation and local block. Both clients waited months to try to save up for the service at their clinic, both left when they called me to  inquire about doing at my clinic. You understand my gripe.

My intention with  everything  I am doing  is to reduce (as much as possible) economic euthanasia. I also feel strongly that vet med is way overdue for a reality check. If we still maintained our integrity we wouldn't need transparency. But sadly I think we have lost/abandoned both. And we both know who suffers when that happens.

My clinic is my beta for what I am building Pawbly to become. It is my attempt to build something on a small scale that I can use to prove my vision and scale up to provide universal animal assistance. 

It is a lofty goal which I am determined to achieve regardless of time, effort, and  investment (well I say that now $100K in). Pawbly and my clinic are the legacy I hope to leave behind for both the veterinary community and animals around the world. I will ask for help from every person  I meet  (the plight  of an entrepreneur) and keep going alone until it finds its grass roots ground swell.

I would love to chat with any of you about my project and how it might assist with your efforts. As with my presumptive business theory to build Pawbly upon I believe that people love their pets and that there are millions of us around the world who share this common viewpoint. All we have to do now is have  one place to meet and  exchange information, animal education and infuse it with inspiration. The result is helping pets and their people live longer happier and healthier lives. I know the pitch sounds like Dr Google, but it is quite the  opposite. I know pets need their vets I just have to convince the general pop that this is still the case, and we vets need to provide a stronger, more meaningful relationship built upon trust and affordable realistic options.

Ok, off of soapbox and off to the clinic to save another wet nose.

Have a wonderful day.
Please do keep in touch, and please let me know if I can participate in any of your endeavors.

Hi Krista,
HSVMA has started a coalition of people devoted to working on ensuring access to veterinary care.

From a larger perspective, I’m concerned about the tone and degree of angst in your thoughts below..,.
There is no doubt we both share valid concerns regarding whether our profession fulfills its potential in serving the needs of animals.
Its also become abundantly clear from my own journey as a vet x 30 years and from studies, that the line between compassion-advocacy-stress-burnout, can be a short one…
To be an advocate for animals, requires you ensure you remain healthy as well…

My reply;
Hello XXX,

I would love to be a part of the care coalition.  I had seen the write up in JAVMA and wanted to inquire about it. I hope to help our clients and pets in anyway I can. 

I realize that you don't know me. So perhaps I can reassure you and place my passion into perspective. I am a devoted dedicated and determined Italian. I spent 15 years in the military and at sea and if that couldn't break me nothing can. I am doing very well. But I am not giving up on helping my community and my profession. I appreciate your care and concern but I am good. I promise. And if by chance you hear that all the time and still ponder?. My cell is XXX-. 

I appreciate your prompt response and extended concern about my angst. Although I think it is more accurately described as frustration and optimism to provide a place for assistance. 

Take care 

.... and with that there is silence. Maybe we don't have common goals and firm ground? And so the internal debate marches on.

.... or maybe I am passionate about something and I want to improve it? Maybe this assumption that I am so delicate AND that all of this is possible, is taken by me to be yet another older, wiser man telling me to abandon my dreams and just be a little quieter?

It seems I am always fighting. Always. Internally, externally, and with everyone... self included. Is that somehow dangerous? Is it somehow the ephemerous spirit that is the catalyst for change when some conscious frustrated person sees inequality, suffering  and injustice? Damn it I see suffering everyday that I somehow have to make a decision about. Its my decision alone.  I cannot place it on my staff. I cannot turn my back.. and yes it means there is a conscious recognition of not choosing indifference, not abandoning  that needful soul and yay! now I get to defend and justify it to others who want to impress upon  me that there 'numerous years of experience should be my guide to a happy healthy lifestyle." Which leaves me feeling like I can't win.

Ugh! I cannot/will not apologize for this. It seems it might be harder than I thought to be an outspoken unwanted advocate?... and so I decide to stay the course, not abandon hope and keep pushing on.. even if it is alone. Elicit internal pep talk; Note to others in similar plights; I get it. Few people get you. Others will disclaim your credibility, intentions, or lofty aspirations.. Keep believing in yourself. In the end that's all you really have. You have to always be ok with that.

Maybe for me being an advocate is being  a strong voice in a field of hushed mice? Maybe for me I am ok with being my professions Rosa Parks? 

.... and so I internally debate again.. sit to write, throw it all out there naked, and push on.

I am not going  to walk away from a problem I think i can influence, improve and feel compelled to do... and yes, this is a decision I have made with the understanding of what the costs may be. I am an entrepreneur! I shout it and proclaim it! I know what I am willing to throw on the craps table. I know what the house holds. What the acceptable risk is, and I know that there are a lot of blank faces I have  to walk away from. I don't have the time to explain it to you. I  don't have the energy to waste trying  to convince you. And I don't have the capital to worry about whether you approve.

I am not going to walk this path and not try. I am not going to be a part of something I know I can improve but fear the consequences of others judging me, coddling me, cajoling, or castigating. I can't and I won't. So I walk away again knowing I did the best I could and took care of everyone I could along the way. Regardless of the unsolicited, albeit well intentioned advice I seem to attract.

Dear friends with more years of walking in these shoes than I have added their mutual concern and inability to understand both my perspective and point. For this reason I am going to try to add a bit of clarification as to my position and,, well, yes, angst.
I am frustrated with vet med and how I believe we aren't providing care to those in need and we certainly in too many cases aren't providing affordable options when clients need them. There is huge need and very little thought about our obligation to those patients. I am frustrated to feel alone in this dilemma. When I expressed that and asked for assistance in discussing what Pawbly is about I was  met with advice to be cautious. I don't want to in anyway be told or advised to be cautious. I want to create and foster change. To innovate where there are inadequacies. To be unafraid to try. It seems like that is as outside of anyone's viewpoint. You cannot be driving change and be afraid. Perhaps the pendulum of panic over our professions suicide rate and burn out has swung so far we are afraid to innovate?

Here is how you can reach me if you have a pet in need. I am at and Jarrettsville Veterinary Center in Jarrettsville Maryland. You can also follow me on Twitter @FreePetAdvice, YouTube, or on Facebook. If by chance you want to help a pet in need Please join us all on It is free to use and open to anyone anywhere who loves animals and wants to help them and their people.

Sunday, October 16, 2016

The Jarrettsville Veterinary Center Policy For Clients With Financial Constraints. 2016 Version.

Seems that my professional life on the case by case basis is going very well. I have clients and patients that I absolutely adore and look forward to seeing every working day. Truly, I love veterinary medicine and helping pets and their people. I am lucky and grateful to be one of those veterinarians who can say that with genuine gusto.

The trick however is that I also have to run a business. Too often those two facts can be at odds with each other. In order to practice medicine I have to have a building, trained staff, and stuff,, lots of expensive delicate highly fragile technologically advanced (did I say, expensive?) stuff.

The sign of a successful practice is most commonly considered to based on a spread sheet of elaborate charts, data, and numbers. But for me the sign of a successful practice is walking out each  night knowing that everyone who walked in the front door was treated with love, respect and compassion. The challenge is finding a balance between sharing that and keeping the lights on.

If I can't figure out a way to keep paying clients walking in the door I can't take care of  all the patients who come to me in need.. and to be totally honest I want to take care of the non-paying patients as much (sometimes even more.. see Weasely and Dunkin) as the well funded cases.

At Jarrettsville Veterinary Center we promise the following;
  1. We are here to help our clients and our patients whenever they need us.
  2. We do not deny care to anyone.
  3. We are transparent. Prices are posted online and provided for all goods and services.
  4. We are available 7 days a week. 
  5. We are accessible through Facebook, my blog, and all JVC clients are given my email.
  6. We provide options so that economic euthanasia is not a part of any patients treatment plan.

To do this we had to come up with a plan.

Here is the Jarrettsville Veterinary Center protocol for any client or patient with financial hardship.

Every patient should be treated the same. We do not assume how much someone cares for their pet, how much that bond is worth, and what to provide based on those two egregious assumptions.

We provide an examination and an assessment for each case. We ask that the client pay for this. Our appointment fee is  $50. If they cannot afford this I will see them pro bono. (Disclaimer to pessimistic critics who think I'm looney about now. This doesn't happen. In four years I have given away maybe two exams).

Financial concerns can be discussed after this. We are assuming that people can’t or won’t pay. We need to stop expecting that people can’t or won’t pay and start treating everyone equally. Assumptions have no place here. Prepare for every option and adjust as they are accepted or declined. Every pet is given the same care, the best options for optimal outcome and everything stems from this. Our primary obligation is to superior pet care. 

Any client who has financial constraints should be given all options to allow us to help them with the care of their pet. To assist our clients in caring for their pets, and to remain aligned with our clinics mission of never denying care, we are enacting the follow new policies;

Every client is asked and expected to pay the initial $50 exam fee. We state this at the first contact point. This is where we start and this is what we relay to clients calling in seeking an appointment for their pet. IF, they state that they cannot afford this, it is at the veterinarian’s discretion as to whether they are willing to waive the exam fee. If the vet declines to waive the fee we can reach out to the rescues. If no one is willing to help with this call me and I will take the case over. (I will either see the pet pro bono, or authorize the JVC donation fund to pay for the exam).

Crocket and his million dollar smile!

After the exam the diagnostics need to be discussed. Every vet should become comfortable providing care with limited diagnostics. There is, in some cases, no other option. My goal for JVC is to provide care to our patients and to never turn away anyone in need. But, I am also most obligated to you, the staff. I will never ask you to do something you are not comfortable with, nor will I ask you to compromise or participate in something you don’t feel is right. If you feel caught in between call me and I will gladly help.

Our goal is to help our clients and their pets and we must do whatever we can to achieve this. We do not allow convenience euthanasia’s, walk-in euthanasia’s without prior DVM consent based on the vet knowing the case AND the prognosis being grave with death eminent, and we should not allow them internally due to lack of resources.

If CareCredit is declined can be offered. To be eligible for Vet Billing the client must leave a 30% deposit for the estimate. If the client does not have the 30% to leave as a deposit they must either leave collateral OR go to a local pawn shop and provide the deposit. I am no longer going to accept no deposits left. A client invested in their pet will find a way. We will be creative and both place trust in each other with some form of collateral. Those that cannot leave a deposit and will not discuss collateral either don't have the emotional investment in their pet to ask for our help, OR, may be unable to provide adequate care for the pet. If you have a problem call me, or the Hospital Administrator and we will resolve it.

Estimates must be accurate and must be given as a range. The client should ask for CareCredit at the high end, and will be given an a  Vet Billing payment plan for the high estimate. If the bill is lower we will shorten the payment period. All estimates need to be in writing and submitted in the chart. The client needs to sign the estimate and be given a copy.

If the client cannot afford the care needed or recommended for their pet, their options are as follows;

  1.  If the client wants care for their pet and to stay with us and are unable to leave a deposit for the entire estimate, they are required to apply for CareCredit. CareCredit is the most expensive plan we offer, but, it guarantees us payment. I ask for this because in many cases the client is not calling and is just telling us that they did not get approved. To use a payment plan the client is charged a set-up and a per transaction fee.  To provide this option we must make sure that the estimate is accurate. Also, please notify the client that they need to ask for the amount at the high end of the estimate. They are welcome to use our phone and we are happy to help them should they have any questions or concerns. 
  2. Seek care elsewhere if they choose to euthanize and we are unwilling to oblige. Euthanasia is based solely on what is best for the pet. We do not provide this based on client request. It must be consensual AFTER the pet is examined and the vet determines whether the condition is treatable and request ethical. 
  3. Seek pro bono care elsewhere. We have a list of local rescues and clinics who might be able to help.  
  4. Continue services at JVC without financial obligation by signing over the pet to one of our affiliated rescue groups. From here the pet will be treated and cared for and adopted to a home via the rescue.
Weasely. Our newest Good Samaritan case.

I am persistently trying to offer assistance and run the fine line between taking care of pets and the staff. If any staff members feel compelled to assist a client and/or a patient they are welcome to donate their time and services. I appreciate the generous compassionate dedication of all of the JVC team but we are consistently helping people who do not pay us back and do so at the expense of us collectively.

Every client needs to be given a daily update of their bill and every hospitalized patient is required to be paid in advance at the beginning of the time of services.

Lastly, no pet will be euthanized or allowed to be privately cremated without the bill being paid. If a bill is not paid, or transferred to me the vet who provided the services will be held responsible for the invoice. (I never ever want this to happen! I will gladly shoulder the responsibility so that no one else has to cover someone else’s bill!!)

For all clients leaving with any outstanding balance a written plan for repayment, a copy of a valid driver’s license and a signed copy of the repayment schedule plan with a witness signature must be done. All paperwork needs to be kept and included in the file or kept by the hospital administrator.

The intention of the policy is to provide assistance to the pets at risk of surrender to shelters due to lack of resources for medical issues, economic euthanasia due to inability to pay up front for needed veterinary care, or abandonment.

In short JVC will offer every single conceivable option to help a pet in need. We will take custody of the pet and find a home after the pet is well and we will never turn our back on a pet. I cannot provide all the care to all of the pets in the world who need us, But I can do so to those pets in our care.

This policy has been in place for almost 5 years. We have done miraculous life saving medicine  and built relationships based on  exactly what vet  med is intended for. If you follow our Facebook page you will see the faces of those we are able to alter the fate of.

Even with this policy I still have clients who want for JVC to pay for their pets care and refuse to sign a payment plan.. I also have clients who ask for us to pay for the care and then want to adopt the pet back. No one ever said it would be easy, but for us  it is the right  thing to do, and I can leave work everyday saying that I  did everything I could for my patients. If they walk into JVC they are my patient and I will never turn and walk away from them.

Related Blogs;

Shelter Medicine Meets Private Practitioner. Finding An Answer with An Agenda.

Dunkin, The Story of The Littlest Life, And  All That Matters.

Open Admission Shelters Are NOT Safe Houses.

Wellness Plans, Savings Plans and Surprises. Why your vet NEEDS to be your best friend.

The Jarrettsville Veterinary Center Price List for 2016.

As always JVC, and I, are here to help you and your pet. If you would like to meet the amazing staff and hear more about the ways that we can help you and your pet live longer happier and healthier lives we would be happy to show you how the face of veterinary medicine and the care we provide can ext end past the traditional options of hope and luck.

If you would like to learn more about pet care or ask a free pet related question please visit It is free to use and open to all of those who love pets.

If you want to help others and you have experience with pet care please join us on Pet care is about helping others and we are built on this alone. I also have educational videos on YouTube, or @FreePetAdvice.

And of course we hope that you will Please always Be Kind.

Wednesday, October 12, 2016

Has Your Vet Given Up On Your Pet? Or You? Would You Even Recognize It If They Had?

There are patients who make big indelible marks on my heart. One such pup is Myla. She is a sweet, happy, fluff of curls who is always smiling and always inquisitive about every human she meets.  I had seen Myla every week for the first few months of her life with her adoptive family. Those weekly visits were set up to separate all of her vaccines out into small accountable doses. It may seem odd to most, but in cases of super protective adoring parents, and with our very flexible charging and booking system we do things other veterinary clinics wouldn't consider. That puppy vaccine time frame lasted over four months. During which Myla and I became the very best of buddies. I had spent lots of time reassuring her that I was her friend and that the veterinary clinic was a place for snuggles, treats and affection. As always, I wanted Myla to know that we loved her, and that the vaccines, clinic and staff were not things to be afraid of. In fact, my goal is for them to not even ever realize that they are being vaccinated or examined. Building a bond of love and trust during those puppy visits often determines every other subsequent veterinary exam ahead. Making the vet visits enjoyable helps our patients, our pet parents and our staff. It is vital to our mission in assisting our pets live long, happy, and healthy lives.

Myla and I were back together almost 11 months later for a new health issue. Myla was about 20 pounds larger and almost doubled in size. I was excited to see her again and tell her how much I had missed her, but this time she wasn't as happy or outgoing as I had remembered.

Myla at 4 months old.. her last puppy visit with me.
Is a year too long for her to remember me? NO, she is a dog. Dogs are brilliant. She knew who I was but she had come to hate what I represented. She wasn't happy to be at our clinic and she wasn't happy to see me. Although I didn't yet know why?

Myla had been to our office last week for head shaking and a painful ear. As is often the case at a multi doctor practice open 7 days a week 12 hours a day there are times when other vets will see our once-ago puppy patients. The other vet, like all of our vets, is incredibly capable and intelligent, BUT, she didn't know Myla like I did. She had likely seen a long list of previous vet visits, a complete series of vaccines, preventatives, needed puppy diagnostics. The whole enchilada..but, this would not reflect how her original vet felt about her? Had I failed to note how special she was?

When I saw Myla close up and in person in the exam room a few moments later she slowly and shyly approached to say her "hello." The spirit of this spry girl seemed diminished and distant. As I clutched her face to give a nuzzled kiss I noticed that her third eyelids were elevated. This is not normal... she looked drunk and drifted.

Jekyll, my pup, demonstrates an elevated third eyelid..
he is actually trying to sleep and I am pestering him for a photo for this blog..
aah, the plight of being a vets pup.

"What is that about?" My first real acknowledgment to her mom as I pointed to her obviously abnormal eyes.

"The vet wanted me to sedate her for the exam. Last time one pill wasn't enough. So I gave two for this trip." She replied quickly and openly.

"WHAT? WHY?" I couldn't imagine why this girl needed sedation? She was energetic and happy but never bad. What happened?

Her mom went on to tell me that she knew Myla had "a bad ear". The previous vet had "packed it with a long lasting ear product last week and this week was to see if it needed to be done again."

I listened intently to try to make the puzzle pieces fit. How could my firm conception of Myla as a loving, gentle girl have evolved into this? In usual vet med detective mode I asked mom for more information. Myla is after all only a year old. Myla is too young for ear problems that need a muzzle to manage. She is a poodle mix; curly hair and floppy ears. We knew that she is a breed predisposed to ear issues. (See blog on Excessive Ear Hair, and Veterinary Ear Care Basics).
  • What was she doing at home to help the ears not get to this point? 
  • Why would sedation be needed. Never mind "doubling the dose?"
  • When is "packing the ears" a first time treatment choice?
  • What had happened to all of the advice I had given mom at all of those many puppy visits to help keep her predisposition for ear problems at bay?
  • How does a not long ago happy quiet sweet pup become so bad so quick?

Here are the answers to every question I posed above:
  • Home care was not happening. Hence the ear problem becoming a BIG problem needing a vet to manage, repeatedly.
  • If a little drugs don't do the job.. add more drugs. This includes sedation, management at home, and care from the vet. 
  • Packing the ears should not be the first treatment option (in my opinion).
  • The advice I had given those months ago had to be abandoned when Myla refused to allow them.
  • Myla has resorted to being a growling, biting, fighting, squealing,,, now drugged,, dog to avoid her painful ears from being touched. 

Myla has bad ears because her breed predisposed her to them being problematic. The rest was our fault.

Here are the predisposing factors influencing Myla's current ear dilemma;
  • Certainly a discussion of removing excess hair, and keeping her groomed is important. 
  • We also need to discuss how we can try to keep the ears open to the air when they are heavy floppy ears.
  • As with so many ear problems there is often an underlying allergy component. Therefore, keeping Myla on a good parasite (fleas especially) preventative and long term allergy control is all warranted. 
  • We need to understand and accept that her ears are ALWAYS simmering. They are ALWAYS waiting for that low boil of inflammation to become full blown infection. Thwarting the simmer before it turns into infection is vital or somewhere down the line she will need a TECA. She will lose her ear canals because they have become too damaged and a source of chronic pain and infection to treat any other way.
  • We need to be diligent in monitoring and treating them, even if that is daily. 
  • We also have to find a way to let Myla know that we love her and she can trust us.
  • Myla needs to believe that we are here to help, NOT HURT. That goes for inside her home and inside our clinic.

Here's what Mylas's mom was doing at home. She had started to clean the ears as we had recommended (see video here), BUT, Myla's ears hurt and therefore Myla wouldn't allow any kind of restraint. Myla associated anything to do with restraint or touching her ears with pain. She was now afraid of the pain that she believed was going to happen. Subsequently Myla's mom started to try to clean and medicate with soaked cotton balls, paper towels, Q-Tips and minimal to no restraint. The problem is that these don't work because her problem is deep within her ears and she needs a thorough washing/flushing. These short cut methods are the consequence left to owners because they cannot restrain. Worse yet, they DON'T allow the ears to be treated and therefore the snowball of ear problems perpetuate and of course, worsen. Pet parents are left feeling disgusted and that they cannot help their pet or assuage the vet. If left unchecked pet parents will often have to choose between what they think is just hurting their pet, or, doing what the vet says. Most pet parents will pick the side of protecting their pet from abuse at their own hands. They will either find another vet, or stop coming back to us. If they do come back to the clinic the vets are then forced to try to manage an unruly scared and desperate patient and left to do things like man-handle, muzzle, and/or drug. Even worse than these scenarios are the pet parents who take our "bad pet management" techniques as gospel and begin to emulate our own treatment of their dog. I have pet parents who return with a more fearful pet because they are FORCING their pet into compliance with more brute force, chains, muzzles, beatings, verbal chastising and utter determination to force submission of the pet into compliance. So now the pet is BOTH painful and bullied. These pets either have their spirit broken OR they fight back. These are the pets who are surrendered or euthanized somewhere down the road.That is the ultimate devastation of BOTH the vets and parents relationship.

Myla at her follow up appointment.
I am delighted to see a smile again.
Your pets ear canals are long tunnels that are "L" shaped. When there is infection or inflammation the tunnels get red, hot, painful and angry. They respond by swelling. This causes narrowing. A narrowed ear canal cannot breathe and it perpetuates and promotes more infection, pain, and irritation. You cannot open up this narrow tube without liquid.. lots of veterinary prescription liquid. Your pet needs medicine in that tiny painful hole that used to be a healthy open ear. The longer you wait and the worse you fail at delivering medicine where it needs to be, AND, the less likely that ear is to ever go back to healthy. Over time the ear closes. Literally swells and closes the infection, the pain and the disease inside. Your pets only options at this point is usually removing the diseased, scarred, non-functional ear canal. I know it sounds awful but these pets are in pain and they will be happier without the smelly infected very painful ear. They already can't hear out of it. You aren't losing function you are simply bidding disease adieu, finally.

It was time to have a sit down talk with Myla's mom. As I talked with Myla's mom and asked for help the technicians all forewarned me that "Myla was terrible last week." Well, of course she was. She is afraid, in pain, and we muzzle her, and then pile people on top of her.

Myla's mom loves her. She, like so many of us, doesn't want to hurt her. In truth all of us have failed her. Failing to address pain and failing to recognize it as the basis for her unruly behavior is inexcusable. Further the sedation we had given was not to provide pain relief, it was just to slow down her responses to it. We can do better.

Admission of a problem. 
  1. Myla has bad ears. Her breed predisposed her to this.
  2. Myla's ears hurt. Pain is treatable.
  3. Myla won't let anyone touch them. She has to learn to trust again.
  4. Myla is too young for any of these. Drugs to induce compliance are cheating her and her family of an adequate plan.
  5. The staff all knew who she was and all were willing to treat her as if she is Hannibal Lechter. 

Daily Checklist For Myla;
Myla's list of daily care now includes food, water, shelter, love, urinating, defecating, and ears. Every day I want her mom to make sure these are all in good working order. To avoid the narrowed, red, painful ears she has now we need to start treating for the pain AND disease AND then start a long term maintenance that her mom can actually do. For me this usually includes advising the ears to be washed as often as needed. Use your nose, eyes, and ears to assess the ears at home. 

Here is where we are going to refocus our efforts so that at the next vet visit, at the next health care need, and every step in the public everyone is safe and healthy.
  1. Pay attention to any condition appearing in such young dogs. These are the patients who need extra time and attention. They are the life long cases. Educate your clients so they can manage their pets optimally through the decades ahead.
  2. Mom needs to go back to basic obedience class and learn trust and basic commands. Both mom and dad need to attend. Obedience/Puppy classes are primarily to train parents how to communicate effectively with their pets. Not having both parents present is imperative to Myla getting clear, direct requests spoken (calmly and gently) in one easily understandable language.
  3. Mom needs some help from us on how to be able to hold Myla (this is ALWAYS the problem with bad ears long term). Myla was too wiggly and her mom couldn't restrain her. So the daily washing (see video on how to do this here) turned into soaking a cotton ball and trying to get that in the ear.
  4. Myla needs a team who is devoted to helping her mind, body, and soul.
Myla's follow up ear appointment with me.
She is her old happy self.
Sedation free and happy to take treats.
She trusts me again.

The point to all of these is that we have all failed her. We turned her in to this "BAD" dog. How did it happen? We forgot to train her to trust. We allowed her to voice an opinion that was detrimental to her health, and we forgot that parenting is the responsibility of the village. 

Myla will come back every week. In some cases it will just to sit in the reception area and make friends. In others we will gradually start to condition  her to accept restraint. In others we will begin to clean her ears. The goal is to condition and desensitize her fearful response to the clinic, restraint, and managing her ears. We are also going to be kind, patient and understanding. Using a drug or muzzle is too often a way to say that we are going to "just get through the exam and get what we can done." It is a terrible way to treat a chronic problem and it will make every subsequent visit that much worse. No vet wants this for their patients.

This is how I want my patients to be; calm, relaxed, smiling, anxiety-free.
If your appointment doesn't look like this ask your vet for help and guidance.
No one wants to be hated or afraid.

If you have a pet who is "required to be drugged," muzzled at the door, or has orange stickers all over their file that reads "CAUTION", please talk to your veterinary team about how to help your pet deal with their own anxiety, and how you can become the welcomed anticipated client not seen or treated like the skull capped grill faced killer craving fava beans.

End of her follow up appointment! Everyone feels better!
Myla returned a week later a different (or should I say the same) dog then she was at the last weeks visit. Her parents are dedicated to keeping her healthy and happy and are making great strides to helping her ears feel and be better. They are working with her anxiety, her fears, and we have almost completely eradicated the pain and infection. I left an open invitation to come back as much as they want to. I am happy to help take baby steps forward so that she is never stressed or not receiving the emotional AND medical care she needs and deserves.

Love you Myla!

Related blogs here;
Everyone Has Ears And No One Treats 'Em Right.

Ear Hematoma Primer

Ear Cleaning Guidelines.