Monday, March 27, 2017

Ethical Fatigue. The Crossroads of Vet Med and The Public Conscious Awakening.

How did we get here? How did we get to this place where we can't help all of our patients, can't acquiesce to our clients requests and can't discern why we are still so unhappy?

Seems it might help when staring into the abyss, contemplating embracing it, and feeling like there is only something to gain if you do, that understanding how we got to this place that we might need to take pause and start figuring out these gnawing questions.

Two of my favorite rescue babies of 2016.
Thor and Weasely.
Rescued, treated, saved and adopted to a client home.
Happy, happy ending!
"Ethical Fatigue" is the new catch phrase making the rounds in the vet med publications these days. It is the evolution (and in my opinion, more clarified definition of the veterinarian's experience) of "Compassion Fatigue". Compassion Fatigue is the term adopted from our friends on the more glamorous side of the scalpel; the MD's. Veterinarians have always been seen as the slow step-child to 'real medicine'. We copycat the physicians tools, tips, tricks, medicine, even their white coats and still we can't even come up with our own names for our own unique disorders? We are, however, the profession with the highest suicide rate. Our once humble beginnings have been met by high societal pressures and unrealistic expectations.

Veterinary medicine, the once heralded career path of every bright, science-loving moderately nerdy girl shadowed by her own introverted personality who too often sought refuge and acceptance in the non-judgmental arms of animals is now the place of veterinarians who are offing ourselves at sky rocketing proportions. A huge multitude of factors have caused this. They include; huge debt loads (because a determined nerd never gives up on a dream,,, even one we cannot afford), ridiculous expectations from everyone (most notably ourselves), lack of ability to dig ourselves out of a self imposed hole (did I mention introvert?), and loss of ability to know which way to go when we can no longer navigate bad from worse. The more we feel compelled to help and invest ourselves the more we get stuck in the trap. The boa constrictor only swallows the prey that struggles.. they don't eat carrion. Those of us who invest too much can find ourselves lost in the plight and forget to save ourselves in the process. I am one of these people. A decade ago we called this "Compassion Fatigue," defined as "a state experienced by those helping people or animals in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper." Dr. Charles Figley. (More on Compassion Fatigue here). Today it's the "ethics" that are killing us.

Garfield, deemed 'feral' at the shelter he is so afraid he hisses at everyone.
If you challenge his bluff you get this; Love, affection and gratitude.
Misunderstood, misdiagnosed, and almost missed opportunity.
This is what vets do. We see past the misleading exterior.

Befittingly vets and medical doctors do not share the same exact burden with respect to patient care. We both deal with loss, long hours, stress of managing a balanced life and patient demands.... BUT, (there is a BIG BUT here), we veterinarians lack much of the team support and resources that human medicine provides. There is often no one else to lean on in vet med. We carry cases, often difficult, multidimensional, multi-specialty cases that one person with one lifetime of general medicine cannot manage. We also live in this conflicting dichotomy of purpose. Pets are in some cases the lifeline companion to our clients lives. The only thread holding them to life and happiness. This is an immense burden to shoulder, often made worse by the too often financial constraints these clients have. They need their pet desperately but they cannot afford what these pets need on a day to day basis, never mind the inevitable illness or disease. In other cases these companions are seen as annoying costly burdens that people all too easily unload as 'disposable'.

Ethical fatigue in veterinary medicine exists for reasons that human doctors rarely see or experience. (OK, I shouldn't speak for others). In veterinary medicine no one who needs insurance has it. Very few can afford the expensive tests, treatments and tlc needed to save the dire cases. The patients at the fringe live with families on the brink. They too often collide at the vets office. The vet was once the sanctuary for the meek, weak, and huddled masses. In the old days, before debt, McMansion's, fast food, and corporate take overs there was room for everyone to get help. I miss those days. I miss them desperately. I am left to decide whether I can always maintain "Standard of Care" as I try to offer assistance to everyone who needs it. I will not sacrifice that little girl I once was for a payment, an excuse about having 'overhead' and alienating yet one more person who used to believe I was in this for more than the money. If you have become 'one of those vets' your legacy will be shrouded in a gilded casket attended by your immediate family alone. These are not the vets we wanted to be. They are the vets society, drug companies, and the Jones' next door encourage us to become.

Sadie's first selfie
Half a century ago when veterinary medicine was simple, agrarian, and cheap these were less relevant. Now, based on student debt, some White Tower mandated governance of "Standard of Care" (most notably supported by billionaire drug companies reminding us that if we aren't with the times we either lose our clients, lose our patients, or lose our ass in state board reviews), the consequence of trying to be everything, worrying about everyone and somewhere reminding ourselves that we went to vet school because we cared got shoved out the door with the bath water. We have lost ourselves. We gave it up to a school we really couldn't afford. A profession that expects perfection and supplies only Kleenex, and clients who can no longer afford us, AND/OR no longer trust us. We even lost them. The last vestige of friendship in the cruel world of bottom lines and profitability.

I think it is bullshit. I do. I didn't go into vet med to make a million dollars (although I think this term is considered 'chump change' in any circle of any real business person acumen), I came to make a difference. I cared about the lives of animals and wanted to make them better. Not the few that could pay for my services, but every single one who came to me. I think, fear, and worry that the ethical dilemmas that we are facing is more aptly the subconscious yearning we are trying to suppress.

Mumford,, beaten, tarred and abandoned with
his adoptive mom who loves him more than anything.

I came understanding and accepting the ethics. (Maybe I am alone?) But the ethics don't scare me, and they damned sure am not walking away or giving up because of them. I am just not letting them decide my, or anyone else's fate. The ethics of vet med are the reason we have so much work left to do.

An AVMA study determined that the most common ethical dilemmas veterinarians face are;
  • Every pet in private practice is attached to a human being. Human beings come in all shades. Adoring; perhaps even to the point of hoarding to abusive, neglectful and cruel. How do you know which one you are about to meet? You don't. Those that reside at the barbaric end of the spectrum can take many visits to distinguish, and even then in many cases it is too awful to begin to imagine, and yet we have to. We don't want to be held culpable if we forget to look for the vile in our clients. Your ass is always on the line and often you don't see it coming. You need a team, at least for the benefit of different fresh perspectives. You also need emotional support when the judgement's are passed.
  • Pets are property. It is as non-sensible as it gets. Respect, cherish and provide for your patients as if they are family, but in the end they have almost no rights and they can be euthanized at any time. I saw a very sweet older found dog last week. She was as kind and endearing as they come. She was also too cachexic (sick) to be ignored. We started emergency treatments on her at arrival. All were done without owner consent and without security of reimbursement. I treated her because she needed me and she was so pitiful. She also captured the heart of my sister, our hospital administrator. When the owner came to claim her we pleaded that she stay with us for continued treatment. The owner declined. My sister pleaded that we intervene. "I can only offer help. I will follow up with Animal Control but remember if I push too hard he will just have her put down. I'm sorry." We found out she was euthanized after they claimed her.
  • Expectations. Veterinarians work incredibly long grueling hours, day after day. Vacations, complaining and shying away from areas of medicine that make us uneasy (like surgery for many) is both shunned upon and shamed. It is one of the trademarks of our predecessors we have to let go of. We are not the same people our veterinary ancestors are, (and I'm not even sure it made them happy either?). There has to be some acknowledgement in maintaining a healthy mind, body, soul and striving for balance. 
  • Euthanasia. The one place we receive the greatest amount of gratitude is also the one place that we are reminded (almost daily) that we are applauded and regaled for ending suffering. If every pat on the back was a genuine heart felt "thank you" for ending a life you learn to be comfortable and safe there. Think about that. Think about how reward based behaviors influence delicate hurting souls. 
  • Everything in this superficial material based world is about money. At least for the tv producers, malls, and magazines. If you don't have the biggest, the shiniest and the most exclusive designer whatever you haven't quite made the grade yet. I am also incredibly fed up with this side of medicine. The side that shames clients who cannot afford us, and berates them for "not thinking about and being prepared for the emergencies beforehand." There is no place for a cold unkind hand in veterinary medicine. There's enough of that out there in the world already. (For more on this see Why Your Vet Won’t Give You Credit blog.)
  • Toxic Workplace. You are either part of the solution OR part of the problem. Like every tragic case you try to save knowing that it might all be for naught you either try to ameliorate for the sake of your patient and your emotional stability, OR, you walk away damaging both. Be brave, as you already are (I mean who else whispers love songs and sweet nothings into pets ears as we are passing them into another place?). Be the gentle hand of compassion inwardly and outwardly. You can save every patient (at least from being worse off), you just can't convince every human.

Belle, spayed with the generosity of the Good Sam Fund
I have a busy, over extended vet hospital. We have a huge following and we do more than we have to. We do it all from a genuine place of dedication to the pets and families of our community. I know the practices around me also do more than they have to. I know some of them provide help that is very (almost crazy) affordable. They have there reasons and they make sacrifices to do so. I applaud them and I am grateful to them, (even if I have to have the too often uncomfortable conversation about the emergency consequences to not being encouraged or reminded to spay their dog. I do many emergency pyometra's because of this).

I also work around practices that charge up to $3500 for this emergency surgery. If you end up at one of these most of my clients can't afford it. The ethics of this are death due to economic euthanasia. The ethics of vet med are overwhelming.  We have overpriced ourselves out of accessibility and now we are blaming our unprepared clients for it.. even though we couldn't afford ourselves either (we don't admit this).

I have had to change both who I am in front of clients and how I practice medicine. I had to. I was going to want to swallow the abyss if I didn't. It was my ethical obligation to that little girl inside of me who finally got out of vet school.

Every client interaction starts with a deep breath. A moment of affirmation that "I am ok. I can do this and I have steps and plans in place if I need them." I start with an internal pep rally and knowing that I have a medic on the side line. I also have a team who supports me. I built this. It is as integral and important as having a firm understanding of veterinary medicine. I can manage a case on a shoe string. I don't back away from them and I never forget who I serve. I serve my own 14 year old rose colored glasses self AND my patients. My clients may have their own priorities in a different order, but all they have to do is care about their pet and we can make miracles happen out of thin air. By about now many of you might be wondering how I can possibly keep the lights on and the staff paid with this business plan? I make it work. We have a Good Samaritan Fund. We post like crazy on Facebook. I am honest, transparent and determined. I also never say no.. Well,,,, I never say no if I know that the client has no other options, I can help their pet, and that I will be ok with the outcome regardless of the roll of the dice. I go into every situation with a plan for a back up plan. I also remember where I came from. I grew up in a tiny town where the vet lived above the practice and routinely got calls at 1 am, often in the form of a hard knocking at the front door. He would get out of bed, help his clients and patients and never once complained, (he is a far better man than I). He worked 40 years like this. He retired with enough money to live the way he always had and he left a legacy behind more honorable than the fecals, rectals, and c-sections could have amassed by themselves.

Recipients of our Pet Food Pantry donations.
Every vet knows what the difference between right and wrong is. It is not that we don't understand NOR know which side of the ethical dilemma to stand on. In case you aren't sure here's where I start. What will ultimately help my patient most? I start here. I don't allow pessimism or the easiest answer to influence me. You have to be strong enough to live by these. You also have to be willing to lose clients because of them and be proud of who you are despite of all of this. You have to protect yourself from the abyss. You also need help to make things happen. Turn to your team. Lean on them. Build a community that reflects who you are. And most importantly never walk away from who you are. It is after all, ALL THAT YOU REALLY EVER HAVE.

Every client has my email address. The clients with critical cases also have my phone number. If I am asking them to invest more emotionally and financially in their pet, place more trust in our dedication to them AND their pet then I have to be ready to give it back equally. I am available as I would want my vet to be. I have never had a client abuse this (OK, one did he was a psychopath it wasn't my fault). I have had my share of abusive, demanding, neglectful clients, and I have fired them all. I cannot provide what they want, demand, or they were bullies who intimidated and I will not subject my team to them. There are boundaries. I provide ultimatums. But, we work very hard providing help and assistance and warnings. I am not going to ever let another person nudge me into wanting that abyss.. that is not going to happen,, there is enough of a fighter within the introvert to protect this. I had to learn that too.

Maybe we aren't alone if we collectively refuse to be shoved into the corner where only the abyss waits?

Proudly displayed at the front desk.
This little shoe box saves hundreds of pets every year.

So where do I see the debacle with Ethical Fatigue? I see that compassion is who we are. It is the BEST part of who we are. We do not surrender it and we do not run out of it. The ethics? well, I think we already know the answer to these questions.. we just don't have to comply. We all have a voice, a choice, and a skill set. Walk away. State who you are and embrace the differences between the person you grew into being. We all make mistakes, but we are not damned to repeat them.

Here's some of my crazy public displays of opinion and preference. Here are the ways I avoid making ethical mistakes;
  • A savable case is offered every option. CareCredit first, third party billing (yes, I assume some risk they may not pay, but almost everyone does), and then if all else fails the Good Sam Fund mounts a campaign to raise funds. 
  • We have a network of rescues and volunteers to help foster or adopt cases. Some cases are with us for months or years. They become a part of our clinic. Our mascot. Our cause. Our promotional pet of the month. They are a daily reminder of who we are, and are not. 
  • I ask for help, a lot and often. I now have a team on standby. They are my private reserve National Guard. They are also the support staff to my team. I have a team who helps our team. They are the most devoted amazing people and I am reminded that I am not alone, my quest is not in vain, and my community has faith in each other. 
It really is this simple. There are endings decided by fate. Medicine is like that. Immune to reason, fairness or pleas for mercy. But, there are happy endings more often than not anytime a client will let us try. How often have you labeled a case as that? They let us try. We all worked together. Not me, vs, for them, but for the we in together. That's where medicine came from. The humble place where value was exchanged in chickens, thank-you's, apple pie, and owing each other a favor simply because we are neighbors.

I cherish each Thank You letter as a badge of honor..
I have a keepsake box to remind me why I fight so hard
and how imperative it is that I never give up.

Where do we go from here? I think it starts by taking responsibility. Our debt and our over abundant life is not our clients responsibility. If you cannot afford yourself AND be a vet then you need to find a niche, think outside of the box, be creative. If you think you can pass it onto others you better have a back up plan.

Let's remember who we were and where the success in that lay. We owe it to ourselves and our patients to provide a vet for each member of our society. There is ample provision for the clients with unlimited bank accounts, why isn't there equal provision at all levels of the income chain? Let's remember what the other side of the exam table felt like? How many of us could afford $10,000 for an osteosarcoma treatment plan? How many of us would tolerate castigation when our provider told us we should have been prepared for this?

Lady Liberty

We need more dialogue, less criticism about "poor choices" and pet ownership being a "privilege". We need to remember where we came from and what we are here to do. No excuses and no abandonment of purpose and no sacrifice of ethics in the sticky spots. All of those belong to other professions who alarmingly have no suicide rates to speak of. There is always an abyss, and there is always a way around it. It is in these small decisions, these extensions of compassion and these building of trust that the greatest reward to a profession that will never pay enough resides.

We don't take pride in the 6 month old cat neuters, we take pride in the difficult grueling surgical cases, the multi-problematic medical cases, so, why not also in the helping those who need us the most regardless of personal financial gain? You won't go under and you won't go broke, and you might also never see the abyss again. Be smart, be proactive, be creative and ask for help. It will surprise you what you get back when you give away.

For ideas in how to make patient care more accessible please see my related blogs;

How Your Clinic Can Do It All. Being Kind and Being Genuine. Weasely's blog.

Affordable Options Are Everyone's Right.

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

It isn't just high school anymore. Veterinarian Bullying and Veterinarian Suicide. How the vet clinic is the new homeroom.

My Veterinary Rescue Shaming and The Frank-Starling Law.

We Don't See You. How Vet's Became Biased and Lost Our Clients in the Process.

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

What is veterinary ethics?
This girl worked at a local vet clinic,.She intervened when this 1 year old was brought in to be euthanized
for behavior issues. She protested, convinced her boss to let her try to rehome him and subsequently lost her job.
This dog has since found a loving accepting home and is playful, happy and adored.
He is getting the training he needs and she is in search of a better job.
Moral stress the top trigger in veterinarians’ compassion fatigue, JAVMA, Jan 2015, Susan Kahler.

The myth of compassion fatigue in veterinary medicine, by Dani McVety, DVM, DVM360 Jan 2017.

For help in reminding yourself what kind of vet you wanted to be a dozen plus years ago see;
  • Any James Herriott book, or If Wishes Were Horses by Loretta Gage, or, When Breath Becomes Air by Paul Kalanithi, or, The Patron St of Lost Dogs by Nock Trout, or, either book by Dr. Coston Ask the Animals or The Gift Of Pets (whose writing is as intoxicatingly poignant as it is exquisite).

Remember what your "Why" is.. Why did you want to become a vet? Why aren't you living that now? And, Why is it not feasible to move your life in that direction now? I promise none of these answers included "ethics."

For more information on me, and my vet clinic please see;

Here is our complete Jarrettsville Veterinary Center Price Guide for 2017

If you would like to follow our Facebook page you can learn more about us. If you have a pet question you can ask it for free at You can also find interesting pet facts, cases and stories at my YouTube channel and @FreePetAdvice.

Sunday, March 19, 2017

Kitten Season. The TURMOIL Of A Vet Who Doesn't Always Know What To Do.

This was the post I placed on my clinics Facebook Page this morning.

"Every Monday JVC provides TNR (trap neuter return) spays and neuters to our community cats. For the past three weeks every female has been pregnant. These cats are either without a home and/or feral. If not spayed the chances of the kittens being preyed upon or suffering from communicable disease is immense. It is not a life for a domestic animal. Please help us provide more assistance to the most needy in our community by spaying & neutering and supporting local charities that provide TNR services. Last year Jarrettsville Veterinary Center found homes for almost 100 unwanted pets. Let's try to cut that in half every year forward. Thanks to all who help."

The TNR cats arrive in a cat trap hiding, hissing, and afraid.
We sedate them through the cage and remove them when they are safe to handle and asleep.
This was one of the first replies I got back;

I am sure that must be difficult for you
UnlikeReplyMessage11 hr
Jarrettsville Vet Center We too often feel like we have no good options. These kittens die outside horrible deaths by disease or predators. These moms are feral. And the kittens become feral if not handled within the first few weeks. It is a vicious cycle only made better by allowing the moms to get spayed and be fed by the colony care givers. We don't even know they are pregnant because we have to sedate them inside the cage. If we don't spay them they will be euthanized when the colony numbers become too large. It is a side of society no one wants to see or admit too. All we can do is help those the volunteers trap and care for. Too many cats get no care, no feeding and no vaccines. Rabies is spread by these cats. Thank you for your kind thoughts.

A sleepy sedated cat is taken out for the exam and spay/neuter surgery
Here is what a typical TNR day looks like; The cats arrive they are in an individual metal trap. They were baited by food to go into it and as soon as they get far enough inside the trap door closes. Most of these cats are from a local colony that is managed by a team of volunteers who take turns providing food, shelter and over sight. They also know the colony. It is as good as we can get when a cat is dumped by a human. These cats were not born here from a wild cat. They are the byproduct of a society that domesticated them and then refused to take full responsibility for them. TNR is the only humane way to provide safety and compassion to a pet we forgot about.

waking up after surgery
Here's where I find myself swimming in an ocean of doubt, despair, and dismay; What do you do when there are too many cats in your area? Too many for homes? And too many to be ignored? After all I live in a very rural area of Maryland. Barns, horses, and farms are the halfway homes to cats who have no residence to call their own. For some the life of a 'barn cat' is a profession worthy of a warm meal, a safe bed, and veterinary care. For others, theses cats are tantamount to rodents. Unwanted scavengers who are not welcomed and not cared for.

For almost every community in our country a cat who is undeniably a domestic pet, they however have no rights, no status, and no obligatory list of provisions. Even though every cat is required to be vaccinated for rabies there is no oversight nor consequence when they aren't. If we took protecting ourselves from this zoonotic disease we should do a better job of protecting our domestic pets.

What do you do when every year, regardless of how hard you try to educate your neighbors about how prolific a cat can reproduce, more cats show up? The never ending revolving door of kittens so sick, so debilitated and so pitiful you are compelled to help, because you can, because you know that if you don't the prognosis goes from poor to grave, again, and again, and, again. There is exhaustion in taking them into the clinic, but, there is death, regret, and pain beyond compare when you don't. So, you do it,, again and again.

Most vet practices do not provide  TNR assistance. I am afraid that it isn't because there aren't any feral, homeless, or unspayed/neutered cats in the community, but rather because;
  1. They make more money on owned cats. Typically TNR cats receive only a rabies vaccine, their sterilization surgery and ear tip. At my practice a TNR spay is about $80, a neuter about $40. The average client with a kitten will spend upwards of $400 at my clinic. The vets time is more lucratively served on clients.
  2.  They don't want the hassle of feral cats. Big clunky cages strewn about the clinic, smelly cages (really BAD smelling cages), and the loss surgery time for others who can pay full price.
  3. There is never an end to these cats. The feral cat well never runs dry. I can say that for as much as the finances don't discourage me the never ending flood of unwanted cats feels like swimming in an ocean without a horizon.
  4. These cats are feral. They are afraid. I am sure there are some vets who would use this as a reason to avoid handling them. With practice and the right drug protocol I have never had a case or a cat I couldn't handle. 
  5. Disease. I cannot get around the argument that a feral cat isn't a possible source for disease transmission. I can however argue that this is the nature of our business. There is an equal likelihood in my neck of the woods that the "owned" house cat has been, or can be, exposed to the same disease. I cannot chose to not help them.
  6. The excuse that "there are places for these cats elsewhere" is a cheap excuse to turn your back on the members of our community we are supposed to be helping. An 'owned cat' should be treated as respectfully and professionally as an "unowned cat."
A very hungry orphan

These TNR cats are the off spring of cats who were;
  • allowed to go outside and got lost.
  • never spayed or neutered.
  • put outside because they were house soiling
  • put outside because they were not loved
  • dumped by someone who couldn't/wouldn't care for them
  • They are the consequence of a species we lack respect for.
Cats are magnificent creatures who are far more intelligent than we give them credit for.

Neutering one of our 2016 kittens

Here's the ethical dilemmas with TNR's. I don't know whether the cat I am sedating through a little wire square is healthy? Or if it is a male or a female? If she is a female I don't know if she is pregnant? If she is pregnant, how pregnant is she? What about if they are REALLY REALLY pregnant? Who wants to live with being an abortion vet? It certainly is NOT what I went to vet school for.. We use an injectable sedative that needs to be placed in the muscle. This sedative allows them to be handled. It also slows the heart rate, temperature, and blood flow. For unborn kittens this, and the general anesthesia needed to maintain adequate anesthesia, will often make trying to revive them impossible. Also, kittens who are removed from their mom before they are ready to be born have a low survival rate.

If the mom is feral (as all of these are) the kittens need to be hand raised. This requires feeding them every two hours. Making sure they stay warm, fed and cared for. It is a full time job that requires experience, fortitude and self preservation when they die at 2 am after a day (or days) of endless worry. To be dedicated and compassionate enough to provide this degree of intensive care and then have them die is.. well,, breaking. It can break you. If you aren't very careful, and somehow manage to volunteer for the next litter you learn to allocate yourself in more manageable amounts. I have tried on more than one occasion to save the late term kittens. I won't do it again. They die within hours or days, and they are so labor intensive it is heartbreaking on too many levels.

This is the uterus of a feral pregnant cat.
These babies are about a month old,, far too young to be viable
I know of many practitioners who are afraid to post to social media. They only allow chummy photos of happy kittens and puppies. I feel very strongly that honesty and transparency are paramount to building and maintaining integrity. I also feel very passionately and deeply about animals. I am a veterinarian so I do need to narrow that a bit to "pets". I am also trying, yes, still trying, to find that end of unwanted pets. To save enough lives along the way that it might actually make a difference.

Do I think about a backlash after I post a pregnant cat spay photo? Of course. I live in in the USA, abortion is under fire, and the collateral damage is possible.

If I wanted to live in the land of happy puppies and fluffy kittens I wouldn't be a vet. I would be a kindergarten teacher. I would blissfully obliviously portray the life I am paid to emulate. The real-life of a vet is unwanted pets. If you aren't happy about it do something. Join me for a TNR, adopt a shelter pet, or donate to one of the many rescues who take care of other humans neglect.

One of our JVC kittens is tested for FeLV/FIV 
You can spend your life tip-toeing around life and all of the sticky spots it provides you. I am too old and have too much left to do to waste anymore time living in life among the minefield.

The surgery table.
One cat is prepped for a spay, the other is being microchipped.
Being a veterinarian is part making people happy, part being true to a calling, and part trying to navigate through unchartered and unchapperoned shit storms. If it was easy we wouldn't be the lucky recipients of the "profession with the highest suicide rate." Do you think that we don't get asked to provide the ugly side of pets being property, disposable, and replacable daily? We do. It is why we are so sheltered, Why many of us are not your personal friends. Why our clients don't have our personal information and why we become the stoic, reserved, distant women of the profession.

The local Humane Society,, where they have more than enough cats to go around already
What do you do with the reality that most cats in my rural area are never going to be treated as a 'companion'? How do I turn away a basket of sick, dying kittens that some well intentioned kid found? If you think I can send them to the shelter, I need to inform you that in many places the shelter doesn't accept cats. In others I am sending the kittens to an overcrowded understaffed s-h-e-l-t-e-r. Where disease is more prevalent, more widespread, and the kittens are not likely to get the intensive care they need. I do not send kittens or sick, injured pets to the shelter. I do not shirk a responsibility I know I can manage better than they can.

Is leaving kittens outside to fend for themselves safe? NO! Absolutely not. They are little tiny meowing morsels. They cannot escape, defend themselves or feed themselves. So I am left having to decide what I can do to help these cats whom I feel equally devoted to. They have survived within the life we cast them away too. The babies we are asked to help get care beyond what the shelters can do. It has been a labor of building a network of people who know we will provide everything they need regardless of the bill and the owner being unknown and unwilling to step up. If you believe you can make a difference you must try. 

The kittens I found in a tire on the side of a deserted road.
They had been dumped there,,
If you are a vet you can have a hard time not hating people
The vet practice I am responsible for is doing whatever we can wherever we can, even if it isn't without sacrifice and hard decisions.

If I turn my back on them, and dismiss them as "someone else's problem, BOTH my conscious and my community cats pay.

If I turn my back on the reality of posting what is really happening in our back yards, I am as complicit as the pet parent who gave up on their cat. The vet down the street who is only worthy of paying customers, and society who refuses to embraces cats with the same degree of genuine love that the dog has earned.

If I turn my back on who I went to vet school to become I have no legacy to leave behind that I am proud of.

Two of the TNR cats we adopted out in 2016 proudly display their ear tips.
Does every pregnant cat break my heart, YES! Almost as much as every sick, debilitated, broken spirited, beaten up, hungry, scared cat does.. There is no end to the ethical dilemmas I face every day, I'm just not going to bury or ignore them.

Here is more about our dedication to cats;
TNR's are not charged an examination. For clients interested in our feline services here are our prices;
Rabies vaccine is $16, spay is $100, neuter $60. FeLV/FIV $45 Microchips are $25

Our routine kitten vaccination protocol;
  • We usually see kittens at 8-12 weeks. First visit includes FVRCP + Leuk vaccine, part 1 of 2 done 3 weeks apart. Fecal exam for intestinal parasites, $30, deworming about $15, microchip $25, Feline leukemia & FIV test $45, first dose of flea preventative $10. Cost of first cat visit is about $175.
  • Last kitten visit at 16 weeks, finish FVRCP + Leuk vaccine, 1 yr rabies vaccine, pre-op spay/neuter bloodwork ($50), about $150.
  • Feline Neuter $60
  • Feline Spay $100
Here is our complete Price Guide for 2017

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Monday, March 13, 2017

What Is Life Worth Without The Trials and Tribulations? Murray's Story

"What is life worth without trials and tribulations which are the salt of life." M. Gandhi

Tragedies happen every day. Certainly in veterinary medicine they are never in short supply. Where there is life there is death and swirling in between these is the cosmic array of every imaginable scenario. Between the ends of this pendulum is marked as much by luck as it is by foresightedness and preparation. Where to go when destiny is undetermined and fate seems close at hand is where tragedy can land you into utter sheer dismay. It is the place that I fear veterinary medicine fails our patients most often.

This is Murray. He died last week. He was in hospice care with my sister for a year. His original family brought him to us a year ago to be euthanized. He had a bladder tumor that made it hard for him to urinate voluntarily; therefore, he needed a diaper and belly band 24/7. His family thought that his life, the quality of his life, was over. They also didn't want to manage a dog in a diaper. My sister saw in him a flicker of the dog she lost a few years ago. That dog Daisy, was her dearest friend and she knew helping Murray was a way to keep Daisy alive a little longer. They needed each other.

Some of the most disheartening tragedies I see happen when clients get overwhelmed, confused, lost and left without guidance about what to do for their companion who lacks a living will and end of life instructions. The AVMA (American Veterinary Medical Association) provides guidelines to help pet parents through the difficult waters of making end of life decisions. The old version, although intended to provide simple assistance in the most dire hours of indecision, reduced the verdict to pennies allocated to labeled "Good Day" versus "Bad Day" jars. In the most inane, coldhearted binary method clients were suggested to make the decision to say goodbye to their pet based on which jar had the most pennies. Reducing a life to a scale based on a spate of pennies is not befitting of decision of this magnitude. Our clients deserve more than a "good/yes" or a "bad/no." We have come a long way from the days when we didn't even admit pets could feel pain. We are now more broadly focused on providing care without discriminating and dismissing that our pets are sentient beings. Like all beings who can think, feel, and love we are providing less black and white suggestions to make the grey area of end of life more empathetic. It is long over due and we still, as a profession, look at euthanasia as a too often routine procedure that denies a pet their true measure of worth in our lives. The new 2016 AAHA/IAAHPC End-of-Life Care Guidelines is far better at assisting in understanding what end of life options there are and how critical an unbiased compassionate team effort is needed to provide all options with maintenance of patient care at the forefront even in the last moments of a waning story.

We too often promote euthanasia without providing options, assistance, and empathy. Why do we offer every single line item on the robust complete treatment estimate to provide optimal chance of recovery for a disease and not do the same for end of life care? How many veterinarians, specifically, house-call-euthanasia veterinarians, one time ER visits, and the GP who has never seen the pet before, are sought to provide hospice care instead of a last treatment option syringe, in whatever time frame and capacity the situation dictates? I don't know of one. Worse yet, I don't know of any of these euthanasia-on-demand-vets who calls for a referral of the patients record before they deliver that final act. Shouldn't this be common practice? If it isn't is it because we are more concerned about how our clients view our services than whether our services are placing patient care first?

There is adventure left to be discovered
I think we short change pets in almost every facet of their lives. It is getting better. We, the veterinary community, are openly admonishing and endorsing the benefits of companion animals to our overall well-being. Perhaps simply motivated by the robust spending pet parents never seem to hold back from? Perhaps because we are moving away from our utilitarian view of pet care? Or, perhaps because we are finally admitting to also snuggling with our pets in our beds and not denying that it isn't inappropriate. Too often death is simply another example. Great leaders and spokespersons of our profession write long diatribes about the merciful end we provide and the gratitude that we garner from not prolonging their suffering. The one sentiment that breaks my heart more than any other is the over played "I'm so glad I didn't wait any longer. I waited too long last time. This time my pet died with dignity." It strikes me to the core because we have options for this suffering beyond the sleep of that pink syringe. We sacrifice and surrender grace, beauty, and sympathy in being a part of dying. When we deny ourselves AND our pets those last few days we negate the ability to see the full circle of what life's meaning holds. Life is not about making it easier. It is about understanding, accepting and rejoicing in the spectrum. Mercy,, well mercy, is the surrendering of self when the force of power will yield its hand regardless.

I have learned this lesson time and time again. It has brought me both pain and chastising. It has also brought me closer to the belief that we all share the same path. We all want to live surrounded by those we love, with free choice, driven by basic survival until those most basic needs are met and we can open ourselves to affection and purpose for others.

We try to cheat what is inevitable because we fear pain and suffering. Perhaps we are simply denying an emotion so profound it mirrors love and lust in its most primitive and intoxicating moments? Perhaps we are too selfish to make time for the inconveniences that end of life bring us? Why do we so willingly provide pee pads and clean ups to the not-quite-housebroken puppies, but refuse to tolerate diapers on our geriatrics? Why when life is fresh and young do we tolerate the same inconveniences that the end of life brings?

Where do we think we safeguard the sympathy as we sacrifice the compassion?

The dealer holds all the cards

As the sands of time slow to a trickle of grains left in the hour glass it is too often over looked as "inconvenient" for us, and "prolonging suffering" for our pets. I just don't see it as either. If you can find the time to slow yourself, and your life down, to a place where the grains of sand are not within your realm of reality you can transcend to a place where the true beauty of life resides. There is grace and peace within the last few moments of a life drifting to its close. In this tiny wrinkle of the reality of bustling day-to-day life, the stress of work, the pressure to maintain a kept house, and the worthless rituals of self-promotion that lie in hair-dos, manicures, and frivolities of superficial status that bear no true meaning of the life we get too little of.

Multitasking JVC style
I have begun to let go of the grip of power that medicine embrues you with. There is too much we don't know and too much we presume to be able to bend, will, and yes, ultimately decide. Too much that we don't allow to see the beauty within even if age, disease, and life has tempered it.. Too much we think we need to manage, decide, control and cheat ourselves out of.

Pets With Santa 2016
As much as no vet wants to admit it, sometimes we are wrong, and often we don't have enough information to be spilling the forecasts we do. Murray's life is a testament to that. He lived a year past his presumed expiration date. A year of walks, hugs, car rides (his favorite thing to do in the whole world), kids activities, face rubs, sleepy-times, and love. He had a year of being loved.

If you can't make time for the last pieces of life's puzzle to fall into place, and find the time to care for those companions who served you for so long, how do you expect others to do the same for you when your time comes. There is not a difference in value, or position, or placement in society when the times are good, don’t make them in times of hardship.
Waiting for the bus
Murray may not be the example for every case. But, he is not the exception either. Within the small walls of my clinic there are numerous others. Pets who we invested ourselves in, championed their plights, and fought for their second chance. But, for the most part all we had to do was not be afraid to offer options, support, and a shoulder to lean on. All, and every, to any pet we thought might need a second chance. All things are possible and miracles happen every day. If you ask for them you will find they outnumber, outweigh and surpass those tragedies, and the pennies once destined for the "Bad Day" jar.

If you have a pet question that you would like to ask me please go to Pawbly is free to use and open to all pet lovers. If you want to visit me at the clinic we are open 7 days a week. You can learn more about us on our website We publish our prices yearly, and always put our patients and compassion FIRST. Please also follow us on Facebook, my YouTube channel and on Twitter @FreePetAdvice.

Sunday, March 5, 2017

Living the Dream? Or Losing the Chance to get it Right?

Like all old married couples most of my enlightened interaction with my significant other comes in the form of oddly placed, off handed snippets of conversations based on our friends mis-fortunes and mishaps, or random half-hour sitcoms that all too often remind us of the life we are missing with our butts firmly ensconced on our equally outdated living room couch.

How often do we realize who we are, or, more likely don't want to be, based on our interactions with others? If you are like me, middle-aged, and taking that long dismal look into the abyss of the mirror that self-reflection curses you with, then you know what I am talking about.

The other night while attempting to displace the stress of our days work we sat zoning on the couch in front of the tv while a classic old film played. The main characters were a dapper black and white couple facing some oddly too coincidental sequence of events that left the tissue box on high alert. The tense, tear jerking moments of the scene revolved around how they would characterize each other once one of them was gone. Now I need to take a step back and set the stage of my personal life with you all all better. I have been married to my husband for 12 years. We were engaged for 4 years before we jumped into the big commitment. Based on the chronological time alone, we are supposed to know each other at least fairly well. Right?. Our life is boring, repetitive, and conditioned. We are not young, dapper, or fresh to this spinning blue-green marble. With age grows malaise and temperament. In consolation for this you achieve a bit of settled compromised resolve. (Or, so you think?)

True tests of relationships, whether they be long or short term, might just be surmised by a sitcom snippet. When I turned to ask my husband how he would describe me, he replied and described me as thus; "loves animals."

Two words. My whole four decades of being here, almost half of them with him, are reduced to two words? I am. I'm only. Two words.

I breathe....

I contemplate.....

I resist...

I would hope to be....

More Than.... Two Words.

I excused his curtness, and gross inaccuracy, to "Being Tired."

But, it hurt. I was wounded to hear that he thought I was only this. Surely, I am a bit more complex than one dimension?

What I wanted him to say was;

-animal advocate

The point is I guess I am living a life that doesn't represent who I think, hope, try to be? Or, maybe I am over complicating everything? (Again?). Maybe being passionate, crusading, and the rest are small parts of the most important and most notable part of me? I mean it could be worse? Right?

Back to the drawing board I go.. Large eraser, dry erase board clearing, and chalk dust mask in place. I am doggedly determined to get it right for the second act of this one woman show.

If anyone is looking for me, I will be sketching in my art studio (after I dust it), smelling the roses, lilacs, and glorifying in the beauty if the trees, grass, and critters outside my window, and, walking in the woods with my pups who all too often play second fiddle to whichever dying, desperate pet at the clinic that has captured my current focus.

I forget to take time to do these things. And, I LOVE these things. (I, at least, I loved to do these things).

I need to become more visibly literal. If the one person who I think knows me can't see me for the complicated, deep, drama queen I know I am, then, I have to be better at marketing myself.

I am, therefore, considering wearing more politically charged t-shirts. Placing brightly colored caricatured tattoos of Rosie the Riveter on my forearm, and donning a newsboy cap and referring to myself in the third person as "gumshoe." I can convince everyone I am more than my all encompassing and demanding 7 am to 10 pm job! (If I can find the time).

If there is one thing every vet knows to be true it is that life can be tragically, unexpectedly, and unforeseeably short. There isn't one vet who hasn't had to tell a tear drenched client that their 4 month old pup won't live to see tomorrow due to being born with an organ never equipped to last as long as it miraculously already has. The one year old non-responsive immune mediated landslide case. The two year old cat dying from cancer. The client who cannot afford the Hail Mary only attainable by the specialist two states away. Or, the client you saw just last week, who appeared to be perfectly fine, but died yesterday from a demon they kept hidden from the public. It is life. Precious. Precarious. Perfect on it's own mysterious terms.

This isn't a dress rehearsal, and tomorrow isn't promised to any of us.

Find me anytime at Our free question and answer site dedicated to educating, empowering and saving pets lives globally. I am also at the clinic, Jarrettsville Vet in bucolic Harford County, Maryland. We are open 7 days a week and available the rest of the time via our Facebook page. You can also find more pet care information at YouTube, and Twitter. You can find our complete Price Guide to all of our services at our website, (Yes, that's right folks. We tell you what we charge for everything!)