The Reason Veterinarians NEVER USE RUBBER BANDS!

There are a few Never, Evers! in veterinary medicine. They are the secrets that every veterinarian knows because one of our clients has learned the lesson the hard way. 

Like grandma used to say, "Never, Ever.. do this!" 

Here is my list of things that no sensible veterinarian would ever do. I hope they help you and your pet avoid a potential trip to the vet. 

This is Samantha. She is like many pets in that she licks her feet. 

She licks her feet for two reasons;

1. She has allergies.

2. The allergies have led to secondary skin infection on her feet. The licking causes infection, and dogs make their sore feet feel better by licking them. This is a cyclical snowballing syndrome. 

Her parents tried to discourage the foot licking by putting socks on her. But socks don't stay in place without help. So, they put a rubber band around the socks on her feet to keep them in place.

My Never Ever part of this story is, NEVER, EVER use a rubber band on a pet. In fact, I would even go so far as to say, if you have a pet in your house "don't have rubber bands in your home."

 This is even more important if you have small children and cats.

One of my worst rubber band story came from a cat who has an obsession with playing AND swallowing them. Two abdominal exploratory surgeries later, (to the tune of about $2500), and in all we have removed over 50 elastic bands from this "My Strange Addiction" feline edition episode.

My other "worst rubber band" story came when a cat was brought in for limping. Turns out the cat was frequently the Barbie doll replacement for the young daughter in the family. She routinely dressed up the cat, brushed her, and played house with the family cat. At some point she also tried to 'do her hair'. This included placing a rubber band on her leg. By the time I saw the leg it was swollen and the cat was unable to walk on it. It wasn't until we did surgery to amputate the leg that the rubber band was found acting as a tourniquet and cutting off the blood and nerve supply to the leg. Rubber bands have been found on tails, feet, legs, necks, and all with the same dire results.

In Samantha's case the sores from the rubber bands go all the way around her ankles and wrists. She may never grow hair back here. But, she walks normally, and it seems that no permanent damage to her feet or legs has occurred.

Samantha is a very loved dog. Her family didn't ever intend to hurt her. Accidents happen. It is our hope that her story will help others avoid the same situation.

If your dog is licking their feet excessively the answer lies in identifying and treating the underlying cause of the itch. This is almost always require a trip to the vet. There are some very good, very effective, and even much safer medications available these days. In cases where licking is severe and red, inflamed, smelly feet have resulted it is also important to get an antibiotic/antimycotic for the infection. If cost is a concern ask about over the counter options; Like foot soaks, topicals, or even over the counter antihistamines. As always, cheaper options are often available online, or at the local pharmacy.

It is also important to discuss prevention products like e-collars, booties, and pet shirts so pets cannot access the area that is bothering them. If you are considering stopping the licking by denying access to the area (with the use of an Elizabethan collar, booties, socks, muzzle, whatever) please remember that you are not helping your pet in an effective meaningful way. I see these as torture devices if used inappropriately, or incorrectly. How would you feel if you had poison ivy, allergies, an itch that was so compelling you couldn't stop itching it, and then someone put handcuffs on you? Don't put anything on your pet without asking your vet if it is ok to do so.

Stay tuned for more tips and Never, Evers!

If you have a story to share, or a pet mishap that you think others might benefit from please add it in the comment section below.

If you have a pet related question you can ask it for free at Pawbly.com. For more pet related information find me at my YouTube channel, my veterinary clinic's Jarrettsville Vet Facebook Page, or Twitter @FreePetAdvice.

Gratitude. The Grace That Hardship Gifts

Farewell 2017. It has been a year of ups and downs. A year I am struggling to find a reason to ever want to traverse through again. There were hard lessons and the end brings forth preparation for resolutions more reliant on self-preservation to protect from losing the part of myself I hold most dear. The end brings graceful acceptance and gratitude that I am still standing.

There are lessons in struggles. It is my belief that if you don't stop, dissect them, understand the cause to the pain, suffering, and disease, you are likely to be back here again. Medicine is the same. Every disease/illness/affliction has a cause; a sequence of events that allowed it to happen, a host response that saw some benefit to permit it to perpetuate and flourish, and there has to be a conscious effort to provide a cure or your host self will succumb, or, lie in wait to become the victim once again. Who wants to relive, revisit, and get stuck in the same merry-go-round of pain and struggle? You can throw in the towel to be replaced by a headstone and a memory, OR, you can learn to live and walk on stronger. Parvo puppies who survive never get parvo again.

I am here. Stuck between a belief that is the very core of the person, (the vet as they are one in the same) I am, standing beside what I believe in, and facing the reality that at some point I may have to chose to just get out alive if I cannot convince myself that I am strong enough to keep going. At some point you have to put up armor, stop beating yourself up, and care a whole lot less about what other humans think about you, while trying to not become as uncaring as these same people have become to you.

At some point you walk away older, wiser, and stronger. Or, you give up. You learn hard lessons and become grateful for them. They build you into a stronger, more resilient, gritty soul.

At some point you seek more credible sources for judging your own self worth and trust the puppies, kittens, your own kids, and your own patients, who love you unconditionally. If you can trust them perhaps you can even grow so much as to try to reciprocate it to all others across all species lines? I have to learn this. It isn't easy. I'm not having an easy time with much of it.

How many of my colleagues hope I give up? How many will celebrate in their successful destruction of another? Is their gain, my loss? Or, is it the concession to the chips I am willing to throw on the table? This profession of mine. Where death is so rampant, is trying to become the death of one of me. It is the sole source of the pain I am burying with 2017's departure.

The problem of killing each other, our companions, and our own soul is as pervasive as the hateful judgmental vitriol that spreads like cancer we cannot put into remission long enough to reflect on the gifts of gratitude and beauty we all know lies in the ripples of each struggle. Economic euthanasia, the indifference we hold with it, and the abandonment of serving all of those less fortunate then ourselves are my enemies. I bring these old enemies with me into 2018. But I do so with a resolve to search for healthier ways to do it, and more resolve to cure them. I HAVE to bring them with a clearer firmer steadfast course forward. 2018 holds new challenges, old struggles and back up plans I never thought I would have to consider. But as with each new beginning there will be an end. I just have to get out alive, and still care about the person I carry through every journey. My patients need the exact same commitment from me.

To every vet reading an obit to some soul who fell along this journey I hope that you remember compassion matters most while we are still trudging away from fates indifference.

I am grateful to be challenged. I am grateful to know who I am. To be able to walk away because there is a problem I can tackle better from the outside without fear of alienation, castigation, and recourse. You can be stripped and beaten but you decide if you walk away to hide, or to be who you were born to be. I'm here exchanging exoskeletons on the dawn of a new year ripe with possibilities, burgeoning on the eruption of the rebirth of humanity or demise of trust in loves endless hopeful potential.

At the end I am going to try to be grateful that life wasn't easy. I am most grateful that I am not hoping or expecting that it will get easier. To fear that wishing for easier is going to cost me more than I can die with. I can at least leave without feeling pushed out of the nest. I can leave for another quest, a higher purpose, a better resolve to a problem that fear prohibits my peers in facing. I am not going to read one more obit for one more vet that says "I never knew she struggled so much". This profession of excuses to protect us from feeling responsible eats us away.

I hear you. Each person out there struggling silently.

I would much rather stand with the masses I serve, the patients I hope to help than the hateful crowd whose infighting, neglect and sheer indifference marks time by obits to each other. Never in my life have I been treated so hatefully by strangers. I am not denying my contribution in the passion that emotional ties to our pets elicits, but, the problem of our societies hate and misery lies within our ranks as much as it lies outside of them.

Gratitude for the really difficult times of 2017 lies within my family too. This family extends from those who have known me through every year and decade to those who share their family with our Jarrettsville Vet family every day. If I have to carry a torch to find more compassion whilst feeling alone and damned I can only do so because I have them to remind me that I am not alone. Alone is a terribly heartbreaking place to be. Courage, determination, and conviction cannot offset crushing despair from loneliness.

Farewell 2017. I have few parting words to leave you with, therefore, I will greet 2018 with optimism, eagerness, and gratitude. I don't have to sum you up to want to leave you behind. I can just march forward less inclined to slow down to answer the demands of the angered mob, and more determined to build something worth preserving.

Here's my To-Do list for 2018;
1. "Get Out Alive" series. A blog, a plan, a schematic for the most common conditions that cause economic euthanasia to be chosen.
2. Storylines. We share, you learn, pets win.
3. Veterinary Patients Bill Of Rights.
4. Build a grassroots network unlike any before, more powerful than corporate controlled greed allowing the chasm between available and affordable pet care to grow wider and deeper. (This might be more than I can accomplish in one year).

Be who you are. Be not ashamed to be different, and always be kind.

For more information on me, and my vet clinic, Jarrettsville Veterinary Center, 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 Pawbly.com. You can also find interesting pet facts, cases and stories at my YouTube channel and @FreePetAdvice.

New Trainers

Shuffling toward the finish line. That's me; Stumbling. Swaying. Faltering.

I remember vividly watching the marathon runner on tv who collapsed mere feet before the finish line. Then by some miraculous intervention random runners, all strangers, scoop her up and carry her over the line. I am that runner. I'm exhausted.

I get home, I collapse, and I ask myself "if I ever want to put those trainers on again?" And yet, I am a creature of habit. A kinetic soul meant to wander. I cannot sit along the sidelines. I do not know where else to go and there is this nagging yearning to not walk away from the problem. I am here to  solve it.

It's Thursday morning. I need to go to work. I need to fix a broken leg on a kitten no one wants. No one would otherwise be responsible for. And, I need to convince myself to be happy about it.

I'm not really happy about it. It weighs on me. It eats me. It is what everyone else calls collateral damage to investing more than the bank account has available for withdrawal, and compassion fatigue. I know it well. Its the shadow that lurks behind me.. toe to toe, and it keeps me moving forward.

There is an endless need, and a short supply to meet it. It is an opportunity for ingenuity and innovation. If I can just find someone to carry me to the finish line. Maybe the new me on the other side of December will have new legs and trainers?

More information on me, this blog, and who we are at Jarrettsville Vet can be found here:

Pawbly.com is about saving lives, and providing options with data. Let the data set the standard of care and integrity via transparency be the guide.

If you care about pets, believe in making happy endings happen, and want to help others please join me on our Jarrettsville Vet Facebook page, our Pawbly Facebook page,and also on Twitter and YouTube.

Fate vs Indifference.

Perhaps I have had it all wrong this whole time?

Perhaps it is not that I am supposed to be forced into indifference, but rather the acceptance of fate? Fate beyond my stubborn dogged determination to thwart, remold, and re-imagine. Fate as the force that is dictated by something far beyond my perception.

I had to euthanize another kitten I had grown too fond of today.. One I had invested my heart and soul into, and another I refused to be "sensible, rational, or honest" about.

Last week it was Moana, the kitten with four broken legs who was too cute to refuse, and too pitiful to turn away. It was a massive exhaustive team effort to try to save her, her four broken legs and their open flesh of jagged bone. In the end the cost of trying amounted to many thousands of dollars and immeasurable stress as we all worry who might become a casualty in the disease no one unarmed wins; rabies.

Today it was Wallace. The kitten with the prolapsed rectum I spent countless hours trying to coerce into functional compliance. In the end his colon did stay inside his abdomen, but the rest of him decayed secondary to FIV (which we had tested in his intake). I lost two souls I battled over, cried over, sweated over, and refused to concede to. Even after all of this I lost. Worst of all, they had to die at my hand. I hate, absolutely hate, having to be this person. The hand of death, the last warrior in the duel I know I yield more weapons in.

I hate the grief process and the juxtaposition of knowing I did try everything, and am left to play the part of both the slayer and the fool, again.
How can I try so hard, (to bend and alter fate just a little?) and be disappointed,, again?
How many times do I keep trying even if heartbreak and losing is the cost?
Has every other veterinarian learned this lesson already?
I thought I had to avoid the "professional indifference" to preserve my "compassionate heart"?
But was this really just "unavoidable fate" the whole time?
Does acceptance lead to indifference?

I will never learn. I know no other way, and I accept the fate terms on the conditions I applied for.

So today I cried Wallace away with all the love he always had from all of us. I buried him in our pet cemetery to keep the others company. And, I moved onto another. Meet Scotty. Last week he was trapped, neutered, ear tipped and almost (should have) died on the operating table as he tried to bleed out for three hours in front of us. He didn't. He's turned into a love bug. And I'm thinking that this one might really be the one?

Scotty

 Wallace and Moana...

Celebrating on the day Wallace was adopted.

Moana

Post Script;

I secretly fear the repercussions of this post. The reminder I will get from some awful cold hearted venomous vet who has told me that I am #atrainwreck and an #idiot for every reason imaginable. Because I remain an eternal blind Polly-Anna. I try too hard. I think I can and it will be. Whatever reason they choose to hurl at me in hurtful fists and contempt. That they can take comfort in my failing is the side I grapple with confessing. It is the voice of the afraid, who still sits here heart-on-my-sleeve trying. Maybe losing here and there, maybe feeling like I haven't quite learned whatever lesson is supposed to bring me clarity. But still here. As if the self worth, doubt, and hardship isn't enough.

If you have any questions or comments please find me on Twitter at @FreePetAdvice, or ask me any pet question for free at Pawbly.com I am also at the clinic Jarrettsville Veterinary Center in Jarrettsville Maryland. 

get out alive..

at some point you get to the place where a choice is needed...

at some point you get to a place where your life is being surrendered, taken or foregone as not being your own any longer...

At some point you are just trying to get out alive.

There is hardship in life, no one gets out of it. It is as universal as it is inescapable.

I'm trying to remember why,,,,

why i am still here,

why i am still trying,,,

and why the world, the world that too often makes no sense, has no fairness, and holds the cards too close to the chest, still let me in.

There are little pieces of me everywhere. In each case I invested a little piece of myself. In some cases I invested more than the return might yield, and in the cases you cannot foresee you can go bust. It is the nature of the game. You can occasionally, outwit, and outsmart, but life cannot be outlived.

I hit the wall, I fell to the floor, I hid it, (I tried to at least), and I found myself at the place I know others have been... I found myself asking whether it was time?

you walk away knowing you have to,

or,

you walk away a different person,

simply to get out alive.

There is still a voice here. There is also still a soul, broken, beaten, afraid, and yet still determined.

Maybe only determined to get out alive, and maybe that's enough to resurrect the rest of me.

If this little place is mine, and there is a place for me to be simply me here, then I need to stay small, think large, and hope that courage is enough to sustain me,,

and I have to have hope,,, hope I can get out alive with some small voice I am not too afraid to abandon.

Is Suffering Really So Bad?

Preface: This is a blog about my experiences as a veterinarian and the professional dilemmas present, hence, it is titled as a "diary". This is not a one-off account and it is not intended to be proclamation of the state of the profession. If you are a pet parent and you pined over the passing of your pet to alleviate their suffering and you did so with love in your heart be at peace with that. For those within the profession who believe this doesn't apply to our day to day lives I hope it opens a productive conversation about who we are, what services we provide, and why there is such a divide between those with resources and hope and those without either. 

It wasn't too long ago that I was one of those many voices in the veterinary chorus.

"We treat our pets better than our own fellow man. We at least can deny them the long struggle and suffering to their death." It our professional credo that our pink syringe of stillness delivers mercy we deny our fellow man. The power, the glory and the compassion that a quick easy death brings was once my 'salvation lies in my arms' song.

It is a well known joke that the most sincere accolades given to our profession often reside with the provision of euthanasia.

Veterinarians, take pride in our merciful ability to provide an end to suffering. It is the one place where we are not bullied nor liable. The clients regale in our easy efficient willingness to provide it and it is the one safe place for a practitioner to practice.

Pride. Mercy. Suffering. They shouldn't be strung together in a cohesive sentence when compassion and healing are the thread that binds us to our professional oath.

I used to be that bold. That cocky. That drunk in my own delusional deliverance. I used to drink the proverbial, (not lost on my sarcasm), pink Kool-Aid with beaming pride.

Murray lived 1 year after his family brought him in to euthanize him
as he required a "diaper" for his bladder tumor incontinence.

I am a veterinarian, (with a few more decades under my belt), who has begun to question that the pervasive denial of struggling (or 'suffering' as we too willy-nilly coin it) has instead brought us to the place where life is cheap and death is easy. The pride in yielding either instantly is costing us our desire to face the struggles of life along with the acceptance that the marrow of living a full life with all of its deep, difficult, confounding troubles builds us to be who we weren't before.

Kittens dumped on the road,,
there are after all too many of them, and they can "fend for themselves."

The drive to and from work every day is exactly 22 minutes. I know this because my smart phone stalked me in my previous travels and knows what I am about do before I pull out of my 'park' position. It prompts me with push notifications to simplify my unconscious dependence upon it. Along the way I pass the local police station. Everyday the numeric tally of "overdoses" and "deaths"  creeps incrementally higher. It is the communities annual count up reminder in ticker tape tally form of local lives lost to the losing war on drugs. Overdoses have become our generations escape gone wrong to avoid the perils of daily life and the struggles it takes to get through. The lives behind those statistics often seek relief from suffering, escape from pain, boredom or anxiety. Drugs today are expansive and omnipresent in the big pharma saturated advertising society.* We can't settle to living in the middle of mediocre, and yet we deal the deadly wish for death when a struggle might be looming.

A treasured Murray moment.

In vet med we euthanize too much and too often. So much so that we can justify just about every conceivable scenario as a way to accept it. So much so that we HAVE TO OFFER IT AS A TREATMENT OPTION, a mandated, OPTION, to clients. If you are a practicing veterinarian you HAVE to tell people they can euthanize to TREAT their pets dilemma. It is so pervasive that I often find people who won't go to the vet for help because they FEAR WE WILL FORCE THEM TO EUTHANIZE. How did we get to the place where anyone feels they will be forced to kill their pet? Isn't that admission of fear enough to cause us to take pause as to the power we yield and the divide that exists?

I fear that we give up too often and now we have colleagues who build their whole career on providing that home catered "peaceful passage". The pervasive push for making everything easier has cost us our ability to feel the ends of the spectrum. Our kids are spared the edges where questions lie, the earth shifts beneath you, and the answers may not have a consolation prize, or a merit badge "just for trying." We give up so often that our profession has an alarming, suicide rate to prove it.

Now I am very well aware how much pride veterinarians take in being so compassionate to end the suffering of our beloved pets. (After all it is the place where you all love us the most). We are without question a big part of the "avoid the responsibility" problem. We, far too often, place the option to end 'suffering', (even when it is not 'suffering' by any stretch of any medically based imagination), to every single ailment imaginable. Parasites, infection, half-baked guesses of cancer, the homeless, the elderly, the sick and too young, the overwhelmed and too many to account for... the list includes every conceivable reason making a problem go away. Death, euthanasia, makes it all go away quick, cheap, and easy. We can call it suffering, but it has been too often my experience that we don't try. We don't want to be inconvenienced, and we don't want to invest in a potentially losing proposition. It is after all, cheaper, easier, quicker, and legal to do so. If our clients can't/won't/don't want to we can offer a "peaceful passage" and in some odd twist of humanity, be hero's for it. (No wonder we are confused about who we are and where we stand anymore?).

Life, death, and every trudging crippling, staggering step along the way can be brutal. Heartbreaking, mind numbing, fall to your knees in hopes the rain will cease to drive you into a shallow grave, hard. It can be unfair, unkind, and unyielding. Isn't that what we are supposed to teach our kids? Remind them to not feign from? And yet, why, WHY?, do we so malevolently permit it so eagerly when we acquiesce to providing death to so many?

Bottle baby from a feral colony.

We cannot have it both ways. The victim to a heartless hard society where drugs luring escape is so intoxicating we need a public billboard to be updated daily as the head count rises AND the compassionate society that bears peace via pink syringe to remove your responsibility to the life you don't want to face any longer. We give up too often because it is easier, cheaper, and we want people to like us. Worse yet, we do it to make our (the vets who need payment upon services rendered) don't/can't/won't try to make a life matter more. We all matter more. The beauty lies just as richly and deeply in the struggling/suffering and the despair as it does in the joy of sunny days and puppy breathe. If we deny the end of the difficult spectrum we cheat ourselves and others from understanding that they can get through it. To deny anyone any chance at hope that there is more to life than the quick and easy and chose to surrender to deny the edges is the true worst side of this society.


References;
1. Nine Reasons People Use Drugs. The Jennifer Act.

Wallace's Story; Prolapsed Rectum, Feline, Colopexy, How To Save These Cats, How Much Time It Takes, Costs, Prognosis

The cases that pull you into pieces,, return. Just to poke you at the tender marrow and remind you that you are a simply a whisper among the tsunami of burdens that another more powerful force decides. As with every hard lesson in the journey of life you will face the same challenges over and over until you learn said lesson, or, you expire. I have lost the battle of prolapses before. It is an adversary I hold personal contempt for.

Veterinarians influence, too often we don't decide. Sure, we can decide death, but that power is for the defeated and the exhausted. It isn't what happens at Jarrettsville Vet.

This is Wallace's story.

Wallace is a barn kitten. One of thousands in our community. Wallace had gone for a routine poop one day and out of his anus slipped his colon. We call it rectal prolapse. He came to us in desperate need of immediate veterinary intervention having never had even the most basic kitten stuff. He came to us too skinny, full of fleas, old cloudy injuries to both eyes, and his delicate colon swollen and protruding from his anus. It had been there long enough to become dry, distended from the tourniquet of circular sphincter anal muscle that opens when your brain tells you it is appropriate to unload, and turning tan from its normal bright happy moist pink.

Intestines are exceedingly intolerant of the outside world and respond almost immediately by drying, swelling and cascading to death. Dead intestines cost you your ability to decide when you poop, and what that poop looks like. For a barn kitten fecal incontinence is a show-stopper.

Moist tissue lives. Clean moist tissue has a chance. We immediately submerged him in a very dilute warm surgical scrub. Clean first, shrink second. As a nod to those vets before us who were still able to save little lives with little overhead nor extensive specialty training, we also had him sit in a copious handful of sugar. The sugar will "pull out" the fluid from the swollen tissue as it works like a hyperosmotic agent. It takes about 15-30 minutes to work. Although the tissue appears to be a fluid filled sac it is instead an edematous protrusion of tissue.

IT IS NOT POSSIBLE TO REPLACE THE COLON WITHOUT REDUCING THE SWELLING AND GENERAL ANESTHESIA. (It is too difficult and painful to do).

Practice pearl; This condition is an emergency and requires veterinary intervention immediately for the most successful prognosis.

After the tissue shrank we then applied huge amounts of lubricant. Here is where anesthesia is vital.. All of that tissue needs to go back where it belongs. This requires three people, holding the patient nose to the ground, butt to the sky, gentle traction and external palpation of the colon (located along and under the spine) to "milk" it back into it's original position, and at least four hands with fingers at 12, 3, 6, and 9 o'clock to gently push it back inside the anus. It takes time, patience, and anesthesia.

In some cases I also use a thermometer, or long cotton tipped applicator to help maintain the center of the tissue as we try to coax it back inside. It will go back inside, but you have to be gentle and patient. Once it is there it is required to place a purse string suture around the opening of the anus to hold it in place. There is an art to this. The right size of the anal opening, the correct amount of time to leave it in? It's an art I have yet to master.

Once the colon gets back into its intended place it is time to do the hard detective work. I have only had a few of these cases and they are difficult at every step and they stay that way for weeks. In theory the usual suspects are;

1. Parasites. Intestinal parasites cause diarrhea. In kittens the diarrhea can lead to tenesmus which is the persistent urgent need to defecate. You can strain for so long that the stop check mechanism that is the anal sphincters surrender and the contents they have kept at bay fall out.
2. Chronic diarrhea, or severe acute diarrhea. In kittens if it isn't parasites it can be a poor diet. Milk, kitten formula past nursing age, or sudden diet changes are all common historical findings.
3. Congenital spinal deformities. The spine protects the core conductor network to talk to the muscles that allow us to function. If there is a break or disruption along the pathway things don't function normally.
4. Trauma. Kittens in barns get hurt, intentionally or accidentally. 

What I have learned in these cases is that they are all one of two things; parasites and parasites. I do serial intestinal parasite (fecals) exams, and I treat anyway. I treat for every common intestinal parasite and keep on treating.

Wallace is like every other intelligent feline. He will forgive you once. He will tolerate you twice, and by attempt number three he will curse, bite, fight and defend his assertive ways by any means he feels necessary. He won't apologize to you afterward. (Even if you try to explain that all of it was "for his own good.") You have to be assertive, aggressive, hyper-vigilant and prepared to invest copious amounts of time into these cases. It is very unlikely it will be "fixed" at attempt number one.

Purse string Suture Technique and Plan;

I keep it in place for as long as I can each time. The literature varies on this advice. Some say 3-5 days. This is never long enough from my experience. I placed and replaced the suture. Each time I tried to leave the anal lumen opening a little larger.  The opening went from 0.5 cm to 1 cm diameter, using a thermometer, 22 gauge syringe cap, to 22 gauge syringe cover as my guide. Each time Wallace formed a fecal ball that needed to be manually broken down to pass, regardless of the food we fed, the laxatives, softeners and motility agents we tried.

Butt bath time, again, before the anesthesia and replacement of his purse string.

Once a purse string suture is in place it is time to;

1. Submit a fecal sample to the lab for analysis (I do not recommend doing this in the clinic alone).
2. Deworm prophylactically (for everything)
3. Start a liquid diet to maintain a soft, easy to pass stool. The purse string requires soft stool to permit passage.
4. Find a high quality high calorie diet and feed small amounts frequently. Dry food can be pulverized and liquefied if no other options exist. Remember adding water dilutes out calories. Feed every 2-3 hours, or whenever hungry.
5. Get them active if they are underweight and undermuscled. 
6. THESE CASES STAY INSIDE, UNDER HYPER-FOCUSED OBSERVATION FOR WEEKS! Wallace moved in with us. He cannot be left alone for more than a few hours. (These are not easy cases).

Wallace began straining to defecate again in about 3 days. We removed and replaced his purse string at all hours of the day and night, three times. These cases are so hard. Emotionally. Mentally. And yet that meow. Ugh, Wallace kills me with that meow.

Guide for anus opening, 22 gauge  needle cap. 

Another pursestring in place,, another waking up Wallace.

It is very important to not lose the patient in the treatment plan. Our immediate short term goal is to get him healthy and functional, but he needs to find a home, he needs to be happy, and he is a kitten who loves other cats. We kept him with others as often as we could. They helped him play and learn his social skills. Wallace also had underdeveloped rear leg muscle mass. Playing with others is the best way to build strength and stamina.

Wallace and Dory.

Sure enough, three weeks of purse string attempts failed. The last trick in the bag was a colopexy. A colopexy involves opening the abdomen to anchor the colon to the side of the internal abdominal wall. In essence you suture the straight section of the colon to the inside of the belly. It is not a difficult procedure BUT the following need to be discussed pre-op:

• These cats are typically already too thin. Thin cats with large abdominal surgeries get cold fast. Be ready for this. Be quick with your surgery, and keep them warm before, during and after.
• The tissue of the abdominal wall is like tissue paper. Scarify BOTH the abdominal serosa AND large intestine serosa to and including the layer of the muscularis to get adequate adhesions, take a long swath of suture (texts say 1-2 cm), I say at least a third of the descending colon. I also place a "tack" suture at the most cranial aspect of the colon. 
• Run two parallel lines of suture (deep and superficial about 2 mm to 4 mm apart).
• Go bigger on suture size than you think you might need. These fail. Failure and repair are less likely to be opted by a client already significantly emotionally disheartened and financially stressed. 
• If it can hold 4 weeks you are probably out of the woods. If it fails in this time frame it was a surgical failure. Go back, try again. 

Wallace's problem hinges on his flaccid external anal sphincter.
It took me about 3 weeks to determine this.
It is hard to diagnose when it has been repeatedly stretched.

An abdominal surgery in a tiny kitten always results in  hypothermia even though we tried to do everything to avoid it. Wallace warmed up quickly with cuddles and blankets.

The last attempt at a large opening pursestring.
I also neutered him knowing that my window of restraint ability was quickly closing.

Not so fun. a colopexy in a 2 pound, underweight, undermuscled kitten. The thickness of the abdominal wall is almost transparent. These are the cases I sweat. They are also the cases with nothing left to lose and a broken heart on the line. They are the reasons I still love vet med. Don't tread lightly behind a shield of excuses as to "why you can't/shouldn't." Jump in!

It has been 8 weeks of colonic coersion. The colopexy had its own set of setbacks. The colon was anchored to the internal abdominal wall. It meant that his internal muscular squeezing tube couldn't push the feces out. It was painful to push, difficult to do, and he became constipated with diarrhea as a result. He was not happy for the first week post-op. He felt like he had to go, was punished with pain when he tried, and then started to pucker around the large pursestring as a result.

After a week of adding promotility agents, adjusting and readjusting the laxatives we had to remove the pursestring again. 

"My last hope lies on this colopexy working on it's own." My last attempt in the same situation with a different patient had failed. After two months with the previous cat I had to euthanize as he was so fractious and his colon so compromised neither of us could continue. His name was Willy. I will forever bear the pain of that case. It marks me as a cautious reminder of investing too much and treading in poorly chartered diseases.

I always talk about cost of care with my cases. This one is really hard to quantitate. 

Each purse string surgery cost about;

• anesthesia, about $100
• placing pursestring takes about 10 minutes $50
• ecollar $10-25 (ask to make your own).

Monitoring is 24/7. Being prepared for it to reprolapse means keeping your cat under close supervision. These cats must be inside only. Must be checked frequently, and, must be brought to the vet as quickly as possible if they do re-prolapse. At least keep the tissue clean, moist, and away from self-traumatization until you can get to the vet. If I could grant you all one power it would be some way to be able to replace these without vet expense. I don't think there is a way to do it... (I'll keep thinking). 

The cost of the colopexy was;

• Anesthesia $100
• Surgery, abdominal colopexy $200 (probably should be more, find a vet who wants to try).
• pain medication needed. Cost about $25.

Wallace's meow.. one meow and you understand why we were so determined to win this case.

Update; Wallace was humanely euthanized after he developed severe respiratory difficulties and was found to be FIV positive (he had been tested twice before and was previously negative both times). He was a kitten who was loved beyond all measure. He will be missed. 

Related blogs;

Jekyll Arrives. My first prolapse patient.

So what happens if you find yourself with a pet who has this condition? You can come ask me on Pawbly.com for help. Pawbly is about sharing stories, swapping advice, providing encouragement and offering assistance to better help pet people in their pets care. It is free to use, open to everyone, and dedicated to improving pets lives globally.

What if you have a pet who has had a similar condition we would like to share your story. Please send it me us at wags@pawbly.com. We are collecting stories, pet care experiences and your pet care costs to help provide others assistance in understanding the world of veterinary medicine.

Pawbly.com is about saving lives, and providing options with data. Let the data set the standard of care and integrity via transparency be the guide.

If you care about pets, believe in making happy endings happen, and want to help others please join me on our Jarrettsville Vet Facebook page, our Pawbly Facebook page,and also on Twitter and YouTube.

Please note; I am not a veterinary surgeon. This case, as with all of the blogs I publish is based on my personal experience when no other options were available to the patients I treat. Please discuss your pet case with your vet. All care should be provided under the close supervision of your pets primary care veterinarian and referred to all specialists they deem appropriate.

Remembering the Vet Who Inspired Me Most. My Grateful Farewell to Dr Stephen Barsanti.

We never walk alone.

The building and shaping of a veterinarian is a collage. A little bit of pieces you borrow, collect, and compose from the others around you. While I know that compassion is the force that pulls you toward the journey of amassing the degree to publicly share your trade, the essence of who you are once you get there is made of little pieces of the peregrination you walk to that place where paper represents your destination.

There are mentors who come in all sizes and shapes, often in obscure and unintentional places or events. I was always that little girl..

The little girl who sought solace and comfort inside the calling of being alone with the animals. There was not ever another calling. When you are little and compelled it can feel lonely. I didn't have much guidance and veterinary medicine wasn't one of the options that met parental consent for "career" criteria. It was someone else's opinion and it drove too many decisions that my vote never counted for.

Then I started to try to spread my wings. As every resourceful child knows, false pretense can provide parental neglect and opportune access.

My childhood vet was Alton Veterinary Clinic, in a very small town by the bucolic Lake Winnipesaukee of New Hampshire. My parents had left the suburbs of Long Island to live the picturesque New England life. Again, it was not the postcard life I had ever contemplated. The singular exception to benefit my new quiet boring existence was the addition of having pets. In short order of buying land, old salt box home and a barn they acquired a horse, a dog, a cat, and a sheep. It was also the same time that I found Dr James Herriotts books for companionship. If divine intervention existed this was my beacon of hope to survive the winters even bird brained geese knew to flee from.

When the small town vet, of the newly minted Alton Veterinary Center, had their first child the opportunity to increase the veterinary staff from 3; Dr Stephen Barsanti, veterinarian, hospital receptionist, his wife Sherri, (who in short order became my second mom), and vet tech assistant, grew to 4, which now included a babysitter. I knew that this was my chance to get inside the building for longer than a nosy clients kids visit.

If you could time your transit to school by the Alton Veterinary Center (which was conveniently and tiny NH small town apropos two blocks down from the intersection of school and main streets) accordingly you could get front row unobstructed seats to the big picture window that faced the street for the weekday lunchtime cinema. Surgery!

That big flat glass window shielded me from where I knew the heart of the practice lay. That big multi-paned window, obscured from the neck down with a gossamer veil to keep the patients innards clandestine, was the peep hole to all the secrets of the magic that I longed to be elbow deep in. With the coveted title of "vet assistant" newly donned I was now allowed the back stage pass to see the innards in person, finally! Day by day I was lucky enough to be tolerated as the shy, intrigued, girl who got to spend lunchtimes, babysitting breaks, and eventually anytime I could sneak away from the banal obligatory school days. My earliest happy memories were those covered in smelly dogs, porcupine tatted pups, and Primo the parrot who barked when the afraid cat was the the adjacent exam room, or the pathetic meow when the hound was. That little home on corner was my utopia incarnate. I lived Dr Herriott's life for only that short time with Dr Barsanti. It was the magic of my adolescence and the compass to my lifelong path.

Dr Stephen Barsanti was the epitome of every professional veterinary battle we have forgotten to cherish. He was kind to everyone. He was sincerely compassionate. He was also inherently humble and generous to everyone and everything. He answered every 2 am call with a plan absent of an estimate. He was who I will spend my whole life trying to be more like. There are vets who leave two page obits in the veterinary professional rags, and there are vets like Steve who quietly walk out of a world they made a real tangible meaningful difference in. Not just in alleviating the suffering of their four legged patients, but in the hearts and souls of the communities they humbly served. The small town heroes who shaped lives, provided a foundation for dreamers, and passed on a legacy far beyond buildings, bank accounts, and honorary accolades.

Thank you to the whole Barsanti for sharing Steve with me during every Monday through Friday matinee surgery. On every 2 am cold downed horse call-out, and to a little girl lost in her own place in a world few others understood.  I will miss that smile of his, that charm destined to be much bigger than a baby blue off buttoned attendee shirt, and that laugh where any reality was not an impossibility.

Related blogs; Alton Veterinary Clinic

me, steve, diedra

Post script; I spent the day at home today after a long troubled interrupted sleep. Diedra's 15 year old rescue needed an emergency cholecystectomy (gall bladder removal) surgery yesterday. It was not a surgery I had ever done before, but her condition was grave and it was either jump in and try or surrender your patient to a possibly treatable disease. I always think of Steve in these cases. How he would have encouraged me to never be afraid. To always be the veterinarian I had dreamt of becoming. If I could diagnose it, and there was a possibility, you jump in. You never learn or grow otherwise. I know he would have been proud of me yesterday. I know he would have been singing praises regardless of the patient outcome. I know above all that there is grace in compassion and that it can be passed on beyond our days on earth.