The Journey, The Missed Pit Stops and The Pile Of Regret Souvenirs

There were a litany of advantages to calling this blog a diary. It gives a considerable degree of artistic latitude and an avalanche of protection to the scrutiny of the squawkers so willing to judge and cast doubt.

Life lately is at a tipping point. That place where life changes indelibly and irrevocably. It is death lurking. The ominous threat has found my mom. She is 74, (everyone always asks me that, so, I will answer it from the git go).

She has breast cancer, no big thrill of the exotic here. Thing is it wasn't the most usual of presentations. It is a real example of how medicine and our options, lessons learned and advancements have influenced us.

Maize Quest Corn Maze October 19, 2019

My mom had a unilateral (one sided) mastectomy 23 years ago. At that time I was away sailing on big ships at sea. Pretty much out of reach for anything other than a fax, or satellite call which no one ever (ever!) made of short of, and singularly for one thing, and one alone; death. If you got called to take a satellite call you knew it was bad. You knew it was going to be really, really bad. Knowing this most family members spare you the notification until the ship hits the shore. No sense fretting alone for the rest for the months long voyage. I wasn't in the picture for her day to day life 23 years ago. She found a lump, went to her doctor and they had a small chat. She elected, (as she did this time too), to be as aggressive as possible. It was removed with very large margins that included the entire organ. The lump went with the breast. It is exactly what we do in vet med. (Except of course women like to have their boobs back after they are taken, so in human medicine there is this branch called "reconstructive." No such stuff in vet med). My mom is tiny, like really tiny. No one would ever know anything happened. She wore the same clothes and never missed a beat. Nothing was done for follow up, or clean up. Things have changed for oncology two decades later..

23 years went by,, and in mid 2019 she found another lump. It generated a quick call to her general practitioner, who sent her to dermatology under the suspicion of being an ingrown "something". The dermatologist sent her to a plastic surgeon who sent her to oncology. Took four months for this table tennis match to play out. Four wasted months with her prior history being dished out at each appointment and loads of passing the buck..

A fine needle aspirate at the oncologists led to a "high degree of suspicion" that her cancer was back. She elected for a matching mastectomy. It was done within a few weeks.

She stayed one night in the hospital post op. Went home with drains, but feeling pretty good.

Four days later she started with back pain. Over the next few weeks it got to the point she couldn't walk. Four doctors over four weeks and finally it was so bad she was admitted to the hospital for "pain management." Now I am not a human physician, and no one likes a back seat driver, and yes, hindsight is always 2020, blah, blah, but the fact that she, or anyone would have to go through so many weeks of being given driveled aliquots of escalating pain medications is something that NEVER happens at my practice. EVER. If a pet is brought to us in pain we provide lots of pain options. We don't start at skimpy and let pets suffer. If the client declines them I provide them for free. Pain under my care is not acceptable.

Over eight weeks of trickled paltry doses of every medication imaginable and available, some of which were included in her week plus hospital stay and the medications were still not enough to manage her pain. She, to this day, is still unable to leave her bedroom. Its heartbreaking to think you might end up spending your last days bed ridden from incurable, unmanageable intractable pain.

September 16, 2019, my house cook-out.

Early on, like right as the biopsy was delivered I sat her down to talk about what I know her doctors won't, we talked about ALL of the options.

"Mom, once you decide you are sort of committed to the journey that they have planned out for you. That is about six months of chemo and radiation. It should be something that you want to do so that you can have the best chance at the best outcome. It will be a long, hard, tiresome and toilsome  journey, but you have to have the long game in mind when you start that race. Or, you can sell everything you own, lock up shop, and just not get on that bus. Move to Paris, drink wine, enjoy whatever it is, wherever you want. It's your choice."

Things changed before the wait began at the bus stop.

After 5 days in the pain management hospital stay, and her tenth diagnostic proved still yet unfruitful, and me being there daily, we called another all hands meeting.

"My mom has been here for 5 days. She is on, or has been on, every possible pain medication including opioids. She has morphine given intravenously every 4 hours, and she is still in pain. This isn't soft tissue. This is something more insidious. We all know that,,, right?"

Quiet faces replied.

"What modality is left to find the answer? What haven't we done, or, need to do again?"

"A bone scan." Her doctor replied.

"Ok, can we get one?"

It was ordered and done a few hours later. That night all of her doctors met in private in the basement, which is apparently where the diagnostic machinery is housed. That night they broke the news to her. I wasn't present but it was reported back to me as, "it's really bad."

Didn't we all already know that? I asked myself. I had given up pushing her to do anything other than find an answer and not over exert herself which only brought on more pain than she could bear at week two.

All of this has been a cascade of events without enough time to really put our feet on the ground to make any sort of plans or decisions. It is a tornado of shit and no umbrella will shield you.

The prognosis is, they say, (they being her tiny oncologist who is unwavering, exceedingly smiley and abundantly optimistic, after all how else do you be, get,, stay this way, in this field? Or, she's really new to this?), one to three years.

This sentence, her stay of her own bodies execution, is also a really big terminal exclamation point. No subtly, no chance of a get out of jail card. It's like a done deal.

September 24, 2019, at JVC.

Now it is natural to presume that you know your parents fairly, if not exceeding, well. I would be so bold as to say that I know my mom better than anyone, her husband included. This whole new twist in our lives has me having to rethink those words. I am perplexed, perhaps even shocked and peeved, about her reaction to all of this. All of the doctors, all of the tests, all of the pokes, prods, probing inquisitive conversations, the constant turnstile of nurses, social workers, therapists, scars, bruises, drains and pill bottles, never mind the hidden emotional and mental anguish without a destination to dump them at. This is a journey of destructive accumulation not liberty, peace, or freedom. She will lose all of that if it hasn't already been willingly surrendered to this disease taking them, one by one. As they slip from her fingers she retreats deeper into her home. Her world shrinks to a place without public view. There is no plan for ticking off the Bucket List of life. No anger, no list of experiences to dive full-on cannonball dive into. No making the biggest splash to fully immerse and drown yourself in, damn the torpedoes! I'm having the greatest difficulty here. Feeling like fighting, arguing, and challenging every one, their expertise, their opinions. Why isn't she doing what I would do? Just living on my terms, my way, to the last breath,, And yet, maybe that's what she is doing, just not in the way I would wish for her?

August 25, 2019. My last photo of Jekyll. He died the next day.

It has been months but she has her medical answers. She has their recommended treatment plan. It's just not the plan I want for her. It's not the fireworks fanfare that a finale should have. She wants to stay home. Exist within her three rooms she has handicapped access to and be visited as often as possible.

Don't we all want to exit with the fat lady singing some crescendo to a lifetime worth reminiscing over?

And so for all the things she can't do, didn't do, and has't yet experienced, I find myself filling buckets of lists of experiences I can't live this life AND NOT DO! I can't accept having lived without having also nicked more notches into my belt. There are so many places yet to go. Things to see. Blogs to write. Videos to make. Things to eat on sun setting shores that span the globe. Hands to hold, pups to belly rub upside down, and cats to purr on my shoulder as we bid another long day of hard work I am immensely proud to be asked to participate in. I only have this lifetime to try to fit all of these into. I just don't know when to start. I don't know how to be my moms caregiver companion as I remind my own wanderlust to sit quietly, as it has for the decade of sea, the decade of clinic ownership, the decade of giving to the patients I so adore and the cement it barnacles in between my toes as she whispers her beckoned calls to stay with her, just a little longer.

Easter egg hunt 2019

Thank you to all who ask, who offer help, words of encouragement, concern and love. I am genuinely grateful.

To the girl I feel obliged to fill and conquer a Bucket List, I hear you too. We will go, soon enough, try to be patient a little longer.

Related story;

Human Vs Veterinary Medicine: Real-Life Case Meets the Dueling Ring. Who's Better and Why?

For the me inside still serving the greater good of the companions in our community I am here in the following spaces;

YouTube channel

Facebook Page for Jarrettsville Veterinary Center

Jarrettsville Veterinary Center website (with our price list)

Pawbly.com is the place for those who don't visit me at the clinic to help with their pets care, And it's
FREE!

Blame The Other Guy. Where Fault In Vet Med Costs Us All

We all want to point the finger.. It is natural when we are smacked in the face with something so devastating we can't find the place to put our feet back on the ground. We point, blame, and spew angry hateful things when life sends us reeling for safer waters. It is so insanely common we do it in almost every aspect of our lives.

My cat Wren,, basking on the warmest spot in the house.

We are living in a time and place where people are struggling. Struggling to stay afloat as they yearn to get ahead, and, dare perhaps to even get ahead. We are also struggling to find a place where we are loved for some semblance of a peaceful respite in the all too chaotic world we wander within.

I live it. I live it every single day. I see the most needful in this world, and, I see it in the most compassionate of us all. Also, and this is vitally important to remember, I see it in the voiceless, meekest, and most vulnerable. I see it in the eyes that no one else looks into.

Have you ever tried to extinguish the life of a tiny creature still fighting to live? Do you know how soul crushing that can be? Do you know what the price for this act is?

Do you have to look into the eyes of the small, meek, suffering, struggling, and fighting to live anyway and ask yourself the really hard questions? How do you reason with your own internal understanding of ability without advocacy? Or, how about the person, your client, who is so devoted to their beloved pet that they can't see reason in anything? What if you don't have the resources or knowledge base to help manage this medical and emotional debacle? It's a mess at all sides and all levels. How to avoid all of this messy stuff? Just disengage? Turn yourself off and walk away. There is a lot of this going on in our society.

We live in a place and time where medicine can provide miraculous cures. We also live in a place where fewer and fewer people help their fellow man at a sacrifice to themselves. This is a time where costs of care are skyrocketing and indifference about who is responsible for this is thriving.

The tiniest creatures cross my threshold every single day. And with each face (and they all have a face, and a voice, and a personality and a huge list of needs), I have to ask myself what I am going to do about it? What am I going to do about meeting their needs as I try to remain within my own? How do I find the place where both can be met? How do I place a value, a price, a conciliatory explanation on finding the answer, within the confines of need, for a life that costs me, emotionally and financially when neither are secure, nor, established within mine? Who do I place first in line for a feast of rations?

I could concoct a million excuses. Find a bazillion reasons,, wouldn't you? Wouldn't you rather make her little needy desperate face someone else's problem? Let them figure it out. Just turn a blind eye, make an excuse, who cares? Right? Isn't that the point? Does anyone really care if no one else knows her plight? If no one else hears her heart stop in this wood, did it ever beat to begin with?

This is a blog about blame. The safest place to retreat to when you lack the conviction to do anything more.

So, lets talk about blame.

Veterinary care is too expensive. I mean isn't it? Five thousand for knee surgery. Ten thousand for hips to be replaced. Hit by car with multiple fractures, a few days, maybe a  week in the specialty clinic and you are looking at maybe twelve grand? Maybe more?

A blocked cat starts at fifteen hundred. A puppy with a sock stuck in his gut will set you back three grand,,, to start, complications, which can happen, will cause that to increase. And, remember these are all treatable. Maybe not accessible, maybe not affordable to the masses, but treatable doesn't change the fact we can help them.

So decide.. Take a chance, everything in health care is a chance, cough up a few thousand dollars.

Who pays if no one cares? What about if someone cares but no one can produce viable accessible options? Well I hope we all know the answer. The most obvious victim is the patient. They all too commonly pay for the blame with their lives. Why let them suffer any longer? There is after all no guarantee that they will recover? Why not just save your pennies from the risk of losing them, and your pet, and just blame the vet?

Your vet thinks that the blame is all yours, and, yours alone. Here's why;

• You waited too long. 
• You never got the preventative care to avoid this mess. 
• You weren't prepared for the bumps that are inevitable in every living things life.
• You should have had an emergency fund available.
• You shouldn't have spent two grand on this dog when it was a puppy and not be willing to invest 500 bucks in them at age 10 of never having spent a nickel the last decade short of dry crappy kibble.
• You should have saved your pennies for the pet you claim to so deeply love instead of getting your nails done, your tattoos done, your new car, your new phone, your boob-job. 

Your poor choices are not mine to bail out.

The venom knows no bounds.

Always observant. My pups Storm and Fripp.

We live in a country where we can't care enough to provide humans health care, or, hungry kids school meals. Or decent housing that is affordable at minimum wage.

You want to place blame? Go ahead it won't get us anywhere. But you can feel better about yourself can't you?

So here we are,,, living in a place where people want monthly wellness plans. They think they are getting a good deal. I mean aren't they? Well, maybe in the short run you are, but, ask yourself, better yet ask your vet at that corporate practice how much it is going to be for these;

If you have a male cat.. How much will it cost to unblock them? What if it happens at 2 pm on a Wednesday? Or 2 am on a Saturday? Are you prepared for these? Will they even help you if it does happen? Many, dare I say, most, will send you to the ER. Starts at about $1500. I know someone who spent $9,000. Can you afford that Wellness Plan now?

If you have a 3 year old Lab who ate 5 tampons and is now lethargic, vomiting and can't keep anything down?

What if you have a cat who likes to play with thread/string?

What about the German Shepherd with the basketball distended abdomen?

Or the dog fight dog who has multiple bleeding lacerations?

I know people who have spent $400 on a broken toenail. Want to place blame on exorbitant care costs? This seems like an easy target to start with.

If you are cold enough to look at these faces and not see a life worth fighting for then you will never understand why the blame is cousin to the hateful accusations you are going to get.

People love their pets. We veterinarians love our pets. If we don't love them anymore there is a blame based excuse at the crux of our armored indifference?

We are all choosing to live a life of blame based justification. It's safer here. No vulnerability, no guilt, no shame. No one cares after all, do they? Do you?

At this time and place the last local ER is closing its doors. For good. It was the last place I could send people at 2 am to have that sock, tampon, urinary stone, twisted gut, broken nail, etc.. to go. Now the only choices are two corporately owned clinics. They are bright, shiny, well-staffed and making some group of middle aged venture capitalists driving very nice cars, with very nice clothes and very cushy vacation homes in places we have never been. Want to live their life? Own a forty-thousand dollar bag that the K's tote their laundry in? Well, it's easy. It will only cost  you every other pet with a face you cannot see beyond the doe-eyes for. Just turn them away, kill them as a resolution to their ailment. You don't care do you? You love your stuff more. Its not your fault is it?

You have bills to pay. Vet school bills, a mortgage, kids to put through college, a car loan, and you need your car so you can get  to work. And those poor vet techs. If we don't pay them a decent wage we can't possible help the pets who need us. And if I don't buy the most expensive x-ray machine out there, and have loads of licensed techs I can't attract a decent vet to help me stay open all of the hours that my clients need me to.

Always adorable,, really innocent. Fripp.

So who's fault is it?

Maybe we all need to care more? Care about the choices you make? The businesses you support? The long term acute and emergent choices you make? Maybe the blame is so evenly distributed that one small change can start an avalanche of infectious cures? Maybe you are not prepared? Maybe you love your pets like children? And, maybe on some dark Saturday night at 2 am you will be living this nightmare that is called economic euthanasia so some corporate shark can drive a convertible in a snappy zip code? He doesn't care about you, or your pet? And, really, let's be honest, you don't care about him either.

Charleston. My senior, a local Humane Society find.

If you would like to learn more about veterinary medicine you can follow me here, at my blog KMDVM.blogspot.com, or my clinics website JarrettsvilleVet.com, or, our Facebook page Jarrettsville Vet Center.

I also have a YouTube channel, and the best place for free pet centered advice at Pawbly.com.

Happy Tail in a Dog. Why Tail Amputation is Sometimes The Answer. Surgery Photos and Cost of Care Included.

Meet Max.

Max is a typical Lab, effervescent, energetic, and incorrigible. He has two speeds; On, as in Full-On, and sleeping. He is so energetic that he is crated during the day. I know lots of clients who think that their dogs have "outgrown" the crate, but, I think that having pets crated when you are not at home supervising them is a great way to insure a pet who rests and has down time. Mind you this takes training and acclimating, ideally starting as a puppy, AND, carting also helps us in the veterinary medical assistance in that we can prescribe cage rest so that pets are forced to relax and rest. It is especially important for the little dogs with bad backs. These pups need to rest, really sleep and rest. No access to anything. Please don't try to convince your vet that your dog will not jump pn and pff the couch when you leave. They are dogs, they are as sweet and innocent and as incapable of a good decision as a toddler is. Crate rest is an important life long training and healing tool. Max is a crated dog. He is also a happily to be crated dog. So he wags in his crate. He also wags out his crate. If Max has his eyes open he wags.

Max also lives inside. Outdoor dogs, wolves, all creatures in the great outdoors don't suffer from happy tail. They don't have walls to inhibit their happiness. And lets also be honest outside wild animals don't wag much. they have busy schedules to keep them busy and focused. Happy, well, happy is an emotion built on luxury.

When Max came to us he also came with a long, many year history of wagging his tail into beaten burger consistency submission,, that still never stopped the wagging.

A dog with a beaten, sore, painful paw (the other extremity) that we talk about on pets will carry that foot and not use it all to walk on. The nerves that feed the toes and foot are abundant and extremely sensitive. The tail, well it is primarily a bone rod with a paltry bit of leather like skin covering it. No fat, no thick skin like the sole of the foot, nope, just a somewhat flexible whip that swings aberrantly on a whim or a wish.

These are surgery photos from Max's tail amputation. We shave the entire tail from about 6 inches above the expected incision site to the end. We also tie it up so I can aseptically (keep the surgical area sterile) wrap it out. 

Draping the tail so that only a small area stays in the surgical field.

First cut is one of the most important. Every surgeon will tell you that they do A LOT of pre-planning and always keep a few back-ups plans in their back pockets. Once you start you have to be able to figure out every single possible scenario to get out with a happy ending, and what the pet parents were expecting.

Max's previous visit was to start antibiotics, attempt to wrap and protect the tail and discuss options for eradication of the condition we could never seem to manage long term. Max's dad, like all of us would be, was pretty frustrated that the tail never seemed to heal for long. A line of blood lashes lined the hallways. The tail would be found bleeding every night they came home from work. Max and the family never got a break.

Here is the conversation that I had with Max's dad when the subject of amputating the tail came up;
1. This might not be the end. A tail will always wag if the happy soul at the other end of it tells it to. Did you know that even pets with complete spinal paralysis can still (sometimes) wag? Yep,, a happy dog will tell you even through paralysis of all of its legs!
2. We have to keep the tail incision site, no matter how short that tail is, protected for weeks. That takes a huge amount of dedication and oversight on Max's family. An e-collar at all times, frequent post op visits, and protecting that tail are hugely important. If he is allowed access to his tail we will have to redo the surgery.
3. If the surgical area gets infected, traumatized (by him chewing, laying, or banging it on anything) I have to remove more tail. The tail is docked by removing segments of the tail bone, which is essentially pieces of vertebrae. You only have so many pieces and then you risk jeopardizing the spinal cord that innervates and commands Max's ability to pee and poop voluntarily.

Max is still under general anesthesia. His surgery is done, but, now we need to bandage the area before he wakes up and starts wagging again.

I've tried lots of splints, covers, and protective options on tails. The problems are always the same;

a. the tail tapers so that a big wag will cause the bandage to just fly off.

b. The tail, the incision and all healing tissue will respond better if it can breathe, so, the plastic cone enclosures I used to use left the tail stump wet, sweaty and delayed in healing,, air,, we all need air!

c. How to protect an incision and end of tail in 360 degrees and also allow air? 

My latest answer has been a spoon splint. It is the blue spoon shaped item to the right if the end of his tail above.

Bandages are the balance of protection, comfort, and durability. It is an art form that takes practice.

 This is Max (note; still smiling!).

He came to visit about 3 days post op so I could check his incision. As much as it is imperative that the incision site, and new end of his tail, stay protected post-operatively, it is also really important to check the incision frequently. Bandaging protects the healing tissue, but, it also hides a problem should there be one. Max also has an e-collar on 24/7 so he can't lick or chew the end of his tail. A dog, or any and every, post op patient will try to lick, bite, or chew at a painful area. So how do we know what is detrimental chewing curiosity, and, what is an indication of a hidden under the bandage problem? well,, we check the incision frequently, and, we pay attention to our patient. Not eating, or not eating well, pain, or signs of reluctance to do normal activities are all signs of a potential problem. Listen to your patients. They will tell you there is an issue, if there is an issue..

The incision is a little red, but holding well, and Max didn't mind us changing, cleaning, or re-bandaging the tail.

I also replaced the bandage in front of his parents (they are EMT's), so they can replace it at home if needed. We send home extra banding supplies,, JIC.

I want pet parents to see the surgical site at every visit. Everyone should know what it looks like at every visit. How else can they also monitor progress and know what normal and abnormal is? I keep parents involved in all aspects of their pets care. It helps them feel empowered, involved and invested. 

Max approves!

Bandage changes happen every 3-7 days. As long as the tail is wagging comfortably, being held at a normal height and angle and showing no signs of wetness, blood, or a bad smell we change it in the clinic with parents present. I expect it will need to be bandaged for about 6 weeks.

For more on Max read his Pawbly.com story here;

The cost of Max's care;

Pre-op exam; $50

Pre-op blood work, full panel $170

antibiotics for infected end of tail $30

surgical cleaner for end of tail $15

Surgery costs;

surgical package; iv catheter, fluids, pump, anesthesia, instrument pack; $250

tail amputation $200

post op pain NSAID $16

splint application $50

additional suture $60

refill antibiotics $30

e-collar $16

Max's story is posted with his families permission. I thank them for allowing me to share his story, photos, and process.

If you have any veterinary questions please ask me for free at Pawbly.com

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