When The Veterinarian Decides Who Is Worth Care

"I need to talk to you privately."

It is the beginning of another chaotically busy day and this is my least favorite preamble to start it off with. I tell myself to stop what I am doing and just go face the discussion head on. Rip that band-aid off and then return to GO. It is the only way I will get to the end of the day intact.

Magpie

She is the vet hospital floor manager. She has been here for about 9 months. (New to us by the law of averages that the rest of the staff holds. Most have been here for over 5 years). She is the Sergeant who keeps the cadence. Monitors the staff and doctors to stay on time. Ensures the blood tubes are labeled and the diagnostic table stays organized and orderly. She fills in to hold a patient, address a problem with a client to keep the vets on schedule. Picks up the phone to answer the random, often completely inane question. (Like yesterday's; "my dog ate a treat toy. What do I do?" No idea of size of dog, size of treat toy, what said treat toy was made of, or how well their dog chews before swallowing). She is on her feet, in everyone's business, and still keeps a smile on her face and an optimistic cheer in her stride. She used to manage race horses. She is ideally qualified for this crew of, (authors note; I wanted to use the analogy about 'busy as a beavers' but it just might be construed aberrantly.. ;-) ),, let's say ants... yes, or bees, or thoroughbreds, they all substitute to make my point. 

Storm, morning naptime

The conversation centered around one of our oldest clients. Old in both age and years with our practice, (must be about 70, as he is about 85). His family has farmed the lands in this county for over a hundred years. He is known by every person who has lived here for more than a few months. He is an indelible character. Always a farmers baseball cap atop his head, (which I have never seen naked). Always a pair of pants missing fabric in key places. And, always a long tale about some physical ailment of his unrelated to the cat he has brought. And, yes, always a cat. He used to have dogs, farm dogs, (of course), but cats, he has  decided are far easier to care for, and he far prefers their company. He lives in an equally old, equally worn out, farm house. Every room of his home has been converted into a cat dormitory. Every room is sectioned by feline family. All of his cats, 40-something in total, are related. He is as old school rural farmer as they come. He absolutely, unequivocally loves his cats. They are his family. 

"I don't understand why you didn't tell him that he had to put the cat down?" She is referring to his cat that we saw late yesterday. His cat was pitiful. Dying, and in horrific shape. He was matted, foul-smelling from feces that had caked on his back end, and emaciated. He was also sweet, gentle, purred the whole time, and knew only love from a human. His cat needed help, he knew it, and he was here looking to us to provide it. We are, after all, doctors. This is, afterall, a hospital.

Her question is so heavy you can reduce to a few minutes and a clock that ticks impatiently. 

I know that I have to try to answer this for her. Find some analytical reasoning in her black and white perception. I also know that her question comes from a place of respect that she trusts me, and concern that she is a part of a patients suffering she doesn't feel right about. 

The answer to this question is seated in the ethos of who you are. It comes down to this; who are you here? Specifically, who are you in veterinary medicine. 

The successful small animal veterinarian is able to keep their business open because they understand every pet parent sees parenting differently. Veterinary medicine exists in a place of whim and will. Every pet in every home is there as a guest in the eyes of the law. While they may have some basic rights in a few states they are still considered property. Pets are the reason veterinarians worked so hard to attain a degree. They are our purpose. They influence us. When you are so deeply invested in something it becomes painfully purposeful. It becomes ingrained in who you are. This is a curse as much as a blessing. Understanding the emotional seat of pets is imperative. 

Frippie. Also morning naptime

If my purpose is to help pets I have to provide it within the confines of what works for their family and caregivers. Veterinary medicine is forgetting this. We are getting judgemental and restrictive as we become more profitable. We have influence tied to our preferences and our gate-keeping for their health. It leaves people like this farmer in a place where he now will not go to the ER, and he will not go to other veterinarians. They have judged him, lectured him, reported him, and he will not share his life and the dearest individuals he adores. His cats are his family. He will protect them as such. 

A practitioner who wants to stay in the community they live, work, and practice in, needs to meet our clients where they are, not where we want them to be. This is the key difference that specialty medicine is lacking. You cannot be a part of someone's story without being embedded within it.

His cats are crowded. He has too many. He knows this. He spends all day everyday cleaning for them. Feeding them. He treats them the way the rest of the world treats the animals they eat. Crowded and housed like they cannot have freedom to pursue free-will. Why do cats and dogs deserve different standards of care? Different living standards? Why if you think they are more deserving of minimum standards of care and yet not deserving of end of life care like humans are? Every hoarded started with love and good intentions. Every pet under their care still deserves care.

This is what she didn't recognize yet.

The view from my kitchen window

For every client that I see who doesn't want to euthanize their pet because they do not feel it is their place, their right, their duty, their decision to make, the profession has to be respectful of this. Hospice is their right as much as it any other aspect of dying is. This farmer has never put a cat down in my clinic. Whether or not I can do the same with my beloved pets is not relevant to his decision. He loves them. He cares for them. He dedicates his life to them. Do his cats love him back? Yes? Is he wealthy, influential, hold some power over others that can afford him a different set of rules or standards? Is this the country we live in now?  Is this yet another instance of inequity deciding who is or isn't worth empathy? How many cats are looking for homes in my county? (Hundreds). Do these facts influence our compassion?

A decade ago we had a long, hard conversation about his colony. It took me years to convince him to spay and neuter. It has been a decade of no kittens, which was very difficult for him to give up. It was what his cats needed. It took him a while to see their world from this perspective. There has been a huge decline in respiratory infection, illness, and death outside of old age from this. He needed to see the colony from this vantage point before he could give up the joy of having kittens. This is medicine. This is the emotional glue trap that having pets causes. This is the life every veterinarian chose even if we couldn't see, or comprehend it during the early years or vet school.

For more on veterinary care, my diary entries, and the current state of vetmed please follow this blog, see me on YouTube, Instagram, BlueSky, and our Jarrettsville Veterinary Facebook page. 

Pawbly.com for pet care questions and cost of care cases.

We also just started our non-profit Pet Good Samaritan Fund. See our stories of helping pets in critical need there.

They Will Break Your Heart.

The months within the abyss never clarified the question. Was the sense of abandonment worse than the sense of loss?

Twenty five years later I still can't find the answer. All those many years ago, when I was the new bride with the husband asking for divorce I couldn't answer this question for myself. Would it have been better/easier if I had been grieving over his casket. Widowed, alone, and yet everyone would know my story without me actually having to mutter the words aloud. Sparing me the humiliation that his truth held. I could have had a life again. Someday. Sure, I would have lived in the shadow of our wedded life contracting so fast. Being so fresh and small then wiped away cleanly. The nuptials of a black holed loss. Our life together compressed with so much into so little. A proverb of a marriage story. Just a few sentences; we came, we tied the knot, we died. The End. But, nope. Me, my marriage, this story, had to have mystery. Intrigue. Substantial tabloid worthy dirt to smear with shame, horror, judges and public notices. Mine had to have an arrest. A secret charge for child endangerment. A pregnant teenager. A mother of same said pregnant teenager who called our house aghast at the thought her daughter was capable of complicit consent. 

He had left before. But, he always came back. When he left for good I realized he had only come back as some sense of pity. Imagine that. He pitied me, and I was the one with the clean record. Nothing more than guilt kept him. After a few weeks not even that was enough. That's a slap in the face with a reminder to listen the next time. Listen to what people tell you. Not only to what you want to believe you hear. I hadn't heard him the first time. I hadn't wanted to. 

While you watch other married couples around you treat their spouses far worse than you know you ever treated your ex the truth remains that they never left each other and yours did. Yours did it in everyway to make it feel soo atrocious you lost your own identity in the mire.

All these decades later I am not grateful for the time my ex-husband and I had together. I am still fuming from the way he left. What shit came out of that departure. My dogs and cats, the dozen plus little lives that I have lost within this same time frame, well,  I am still searching my insides for those little pieces they took with them from the weight of their loss. I miss every precious moment of everyday I had with each of them.

Frippie in the poppies. (Poppies seem appropriate, right?)

At a continuing education conference a few years ago. Three of us sat cross-legged on the carpeted floor, all hoping that it didn't have as many germs as we knew it likely did, eating our bagged lunches. I, always the oldest of the group of my vet school classmates, had by this time, owned my own vet clinic for about 17 years. They, they were 10 years younger and about 14 years shy of my ownership anniversary. New to the game, still optimistic in making all of the pieces fit, sat and talked about motherhood, toddlers and juniors of their own, and finding that elusive balance to it all. Me, I ate. I know better than to offer unwanted, pessimistic advice or lessons. They had loads of questions about bookkeeping, scheduling of staff, adequate staff to veterinarian ratios, payrates. Marketing, websites, inventory buying power, and cases that seemed too odd to be real. Their questions required minimal time to answer. They were most inquisitive about our internal slush fund, its use and my unwaivering dedication to treating every patient who crossed our threshold. They asked many questions. The one that I had learned and they had yet to feel first hand was that one lesson that time makes truest. 

"What's the hardest thing you have been through so far in owning your clinic?"

"Heartbreak. The cases can be difficult. The acceptance of life just not being fair. But, the hardest part above all, without question, is the staff. They will break your heart. You won't see it coming. You won't be prepared for it when it happens to you. You will question everything."

Its bereavement in shades of grey. 

Frippie, cold Sunday at home.

The stickiness of this, my own veterinary clinic, is the same glue trap of my existence. There is such great emotional depth here that it is impossible for it to not bleed into every other moment of our lives. It is the same canvas that paints a families portrait. Dysfunctional, adoptive, ugly with infighting at times, yet still all coming together in times of disaster, trauma, and need. We are that bunch. Proud as I am to have them all home for supper, each with children of their own. This clinic, our veterinary hospital, has weathered storms. Tragic deaths. Departures from unforeseen epidemics. Boyfriends, babies, and ambulances. Waves of changing tides, yet still trying to stay the same course. I have to be the one to leave this time. Abandon the web in the hopes it doesn't force exodus to those that remain behind. If I can logically see myself as the common denominator to all of this then maybe the problems solution remains in the crossing out, cancelling of the common thread? Afterall, excision is curative in so many other cases.

Storm, also never sure of much.

"What do you want to do?" My husband sat quietly across from me. Worried about not being there for me as much as saying the wrong thing.

"I just want to be a veterinarian, and still have a little time left for the rest of the life we amassed." Our house, now finally done. The cats and dogs all healthy enough to not leave me counting days, and pills and obsessing over calories in, weight loss out, and the pennies in the 'good day' versus 'bad day' jar to help measure the quality of life scale.  

"What are you most worried about?" He loves to live here. In the doubting-Thomas shoes. The red spiked tail and pitchfork always at the ready in his back pocket. 

"I am always to blame." You cannot feel anything other than this. The imposter friend. The imposter boss. Never truly a part of the group. Never in on the inside scoop. The pulse of the practice. Always aloft in the crows nest looking for a speck of dry land, or, the iceberg. Sure both are there re-plotting their courses to intercept yours. The sweeping line leading to the bullseye dead-center on your radar screen. Game Over. You know you will go down with the ship. They won't save a seat on the lifeboat for you. They never even counted you into the articles. 

I left the conversation with my business partner/spouse/wise old owl that he is, with this. "I understand now why Dr S and Dr L just walked away from their practices. They had no other way out. They hadn't become different people. They just couldn't stay trapped within their own prison any longer." I am not sure he heard me. It wasn't a nugget of information for him anyway.

In the end you will find yourself alone. Life will remind you periodically to get comfortable with this. It will remind you to be at home in your own heart. That people will tell you who they are. It's up to you to listen. They will come, and go, and try to come back again. You might not be the same person the second time around. It's up to them to listen to that person too.

Serfina

Me, well, the animals, the pets I adore, the places I always invested my whole heart within, well, they never broke me. They might have stolen my heart. Sent me into grieving as violently as anything else ever dared to, but they never broke my heart in a text message or email. Humans, they are the glue trap you will chew your own arm off to get away from. They are the ones you have to become at home with indifference over.  There are people who come and go. They don't have a calling card to notify. They have a history of half hearted attempts. Broken wings. Fledglings who keep flying to a different nest, but, never set up a home. Well wishes and bon voyage. What else can you do?

 It has taken me forever to learn this. I am never the person to leave. There are cobwebs on every facet of my existence. I don't know if I am the wiser or the poorer for this. I just know I am still here. Roots, legacy and epitaph intact.

Waggle Partnership Letter

 Hello,

I am a practice owner who is a veterinarian with a big heart first, and a superhero ethos to save pets lives second. From this perspective, (and the current ethos of corporate take-overs in the vet sector), the burden of helping more in dire need by offering affordable care has become overwhelming. It was with all of this at our doorstep that we created our own 501c3 about a year ago. The Pet Good Samaritan Fund purpose is to encourage other vet clinics to offer more affordable treatment options to pets in dire need of interventional care. We did this because we know pet parents need help, and we also know pet providers need a safety net to reduce financial loss and risk.  

Sephora

My veterinary clinic, Jarrettsville Veterinary Center, is a small animal private practice that has always been committed to helping the pets in our community. We never deny care and we move mountains to make miracles happen. This is a daily endeavor at JVC. Yesterday was our first case that we utilized your platform through. In the past we have done all of our fundraising through our own social media outlets. While I cannot always defeat disease, fate, and the inevitability of death, we have never lost a case from having to resort to economic euthanasia. My whole existence as a human and veterinarian is committed to ending this widely accepted, (and almost unanimously approved vet med community), option. The thought that a deceased disease afflicted/beloved family member is better off dead than taking a financial risk/offer to be compassionate and fulfill our veterinary oath by actually treating the patient, is archaic, cruel, and unjust. I am as vocal about this personally as I am publicly. This profession has strayed from who we wanted to be, and why we are here, and the pet parenting public knows it. Our veterinary suicide rate, the massive buying of hospitals for coroporate profits, and the skyrocketing cost of care prove this. I believe that with key partnerships we can help pets, their families, and veterinary care providers. We can minimize financial risk to providers, and we can all feel good about caring, (and actually practicing medicine), again. It is merely a challenge to think outside of the capitalistic goals shareholders place and start offering palatable, beneficial, meaningful care that everyone can feel good about. I also know that the rest of the veterinary decision making practices need a template and examples of how it can work. Our non-profit and for profit vet hospital have made countless examples of how we can be both doing good and doing well.

Yesterday we saved Sephoras life because of two things; first, her family advocated for her, second we have the ability to do so. The rest of the happy ending outcome was a little bit of trying, asking, finding you, and having the other key factors in place. We have been here before. I am not afraid to try, and I am determined to leave vet med better than I came into it.

Surgery prep

I am hoping to connect with you and make more miracles happen by extending the ask to not just the public at large, but to the gatekeepers; the veterinarians who don't know what tools to access to be a part of a worldwide movement back to compassionate care that really saves lives. The lives of all of us who need our pets as the vital part of our wellbeing and the pets themselves. I truly believe that a big part of the answer to all of the unrest, unhappiness and fear in the world can be solved by protecting the place pets have in our lives.

Thank you for your time and your platform,

Sincerely,

Krista Magnifico, DVM

owner Jarrettsville Veterinary Center

Founder Pawbly.com

Founder Pet Good Samaritan Fund

pet parent, exhausted practice owner, and total-bad-ass pet savior in residence..

PS Sephora's pyometra surgery took me 30 minutes to do. It was the most rewarding, (easiest) surgery of  my day. Her moms gratitude was inspiring. This life I live (while exhausting) is so rewarding I wouldn't exchange it for anything. Not a yacht, or a villa, or a tiara. Who else gets to feel this good about 30 minutes of their day? The more you give the more you get back. 

We did not do any diagnostics outside of a 1 view lateral xray. We declined everything to put all of our efforts, and resources to her treatment plan. We take risks, there is great reward, and all of us feel good about trying. This is life. You jump in. You give yourself to others. That is medicine at its most powerful.

5 Star Google Reviews

If only there was a way to share all of the dirty laundry every local business owner had on their bad patrons. Some sort of deep state message board to alert others about the people who suck the life out of your raw hard-working hands. 

You know the customers I am talking about; the ones we get restraining orders on. The ones who cry in the exam room begging for help for their kitten, promising they will pay you back and ghost you a week after you saved its life. Full balance still on the books. The kitten you send home same day after not letting it die-on-deaths-door from a broken jaw and emaciated body because it couldn't eat kitten. The ones who stand over you like some possessed demonic warlord from the underbelly of hell and tell you that you are an "fing idiot!" because you advocate for vaccinating indoor cats for rabies. The ones who steal all of the snacks from the coffee bar, and the clock from the exam room. The one who starved to death two dogs and then dropped the last at the shelter. The one who runs for public office but euthanizes every photogenic purebred puppy at 6-8 months old for "aggression" and refuses to see them as living beings who deserve 10 minutes of your precious phony veneers facetime. The list,, oh my god,, my list. I bet the local dentist, pediatrician, doctor and meat guy all have a list of their own. Me, me at my little clinic, well, I run it a little differently than my predecessor. Me, well, you raise a finger, utter one swear word, lift one hand up against a staff member (or patient), well, I throw your a$$ out the door immediately.. No apologies, no excuses, no second chances. The staff knows that if someone treats them with anything other than total respect and appreciation that I will fire them. Our work is too difficult, too important and too hard to do with some human being being anything other than kind and compassionate. Let's say our vet clinic sees 50 people a day. On any given day one person acts like a total fool over stuff that never has anything to do with the quality of our medicine, or, the price of our care, and they still go postal. This week I had two people treat me pretty despicably. They both were called/emailed and told to go elsewhere.  

Seems there isn't a week that goes by that I don't see a social media post on one of the local pages with the question; "looking for good local vet." 

Every time it is posted I peruse. It's the best unsolicited piece of data to remind you who your true friends are. It is without fail that I will personally know at least 75% of the people who respond with our name. Of these about 50%  have my personal cell number. From these I will text with a personal "thank you" for their trust, confidence and loyalty to us. In many of the cases I truthfully divulge that this person is someone we fired. Most of these people are fired for being rude, bullying, or neglectful with care that isn't based on financial ability. (Did you see that I have mentioned this twice already? We help everyone who comes to us, and we never deny care based on financial constraints. Know how many vet clinics do this? Yeah, not many).

Dixie,,, I would save her everyday a million days over

The veterinarian side of me that knows the most harrowing details of how some of our local citizens treat their pets makes the community member side of me want to scream in all CAPS "Please don't throw my name in the recommendation ring." The way I figure it if this person lives in my town and they don't want to go to the vet practice with the same town name on our sign then let them go elsewhere. The people seeking advice on the FB page are probably out there for a reason. 

If you run a business then you already know what I am talking about. Every single business that gives a rats a$$ about their employees and values keeping them, (and lets be real honest here, they are absolutely my most valuable asset), has a black list. That list of people who are not welcome back. These are the people who walk out without paying. Yell, scream, throw profanities with saliva bullets at the front desk, or, obnoxiously kick their dog in the waiting room thinking we won't intervene or stand up to the big-mouth a$$hat they are. 

So, if you are really my friend, you won't mention my name unless you know this person personally. 

I don't want the business of someone who has already been banned from my neighbors practice.

....and if you are a person who genuinely is new to the area, and needs advice on who to patronize locally, go next door, introduce yourself to your neighbors. Ask them personally. Support your local private businesses and in return they will help pay your local taxes. 

One slightly broken kitten who slept over for a few days,,
wired jaw, feeding tube,, and soo cute!

,,,oh, and one last thing,,, if you do see any business with a perfect 5 star rating two things are likely; first, they are insecure and they paid for a perfect score (pathetic and insecure), or, they decided that it was more important to be popular and liked, then stand up for their patients. (Think about how many times I am asked to euthanize a pet because people can't ______ (insert anything here,, too cuddly, too friendly, too barky, too wiggly, too black, too hairy, too perfectly wonderful for some humans).

Me,, I am a solid 4,, solid. 3 for humans, 5 for the animals,, law of averages applies.

The Brink Of Humanity

The letter came in the form of an email. Buried in the list of a hundred others, 99% of them spam marketing. I was tired. It was late. It is a small miracle in itself that I didn't dismiss it at a glance and pitch to trash.

The letter was a thank-you for a pet I had seen, (and honestly only vaguely remembered seeing), at the end of a long Sunday. Sunday's are a blur. They are walk-ins, essentially emergency appointments, and the whole mission is to get in, get these patients triaged, offer options that need to include transfer to an ER,  (which none of them go to anymore due to cost), and then get the staff out at a reasonable hour. We are open for 2 hours and typically see 12 to 20 patients. This particular Sunday was Dec. 22. Christmas was just a few days away. Like every Christmas season I head into work knowing that a few Christmas miracles would arrive. I look for them. Those cases who just need a little bit of kindness, a compassionate hand, and maybe just a free exam. 

Sadie. So much of my story starts with this girl.

Dear Dr. Magnifico, 

I've been trying to find the words to thank you since last Sunday when you helped our Pearl. I'm afraid to let more time pass without trying, as I don't want to appear ungrateful. 

The past few years have been a complete struggle for our rescue, Hodgepodge. We have endured so many losses and hardships: life threatening illnesses, job changes, divorce, and even a tragic, unexpected death.  We kept plugging along until it was eventually just me caring for all of the rescue animals, handling admin work and records, meds, transporting, etc. We went from eight workers to one. Intake was closed. I worked 790, consecutive, 16-18 hour days, to keep this rescue going. I cried - a lot! I pushed thru my broken bones, covid, and pneumonia. (Additionally, my dad was hospitalized 14 times in one year with post-op complications of osteomyelitis, MRSA, sepsis, Steven's Johnson syndrome, and kidney failure. He seemed to be in competition with my blind uncle that I look after. I'd get one out of the hospital and the other would go in within days. It was a lot of running back and forth to hospitals.) Some days the animals didn't get fed or cleaned until midnight, and I was often at the barn at 2 A.M., but it got done. Fortunately, animals are very forgiving and they didn't seem to mind my crazy schedule. Unfortunately, caring for them and holding down things at the rescue left no time for fundraising or adoption events, so I carried the rescue financially again and I depleted my bank account.

My adult son could see my fatigue and kept telling me that I couldn't keep doing it, but I told him that I had so many lives depending on me - I had no choice but to keep going! I'd made a commitment to them that I wasn't breaking. I reminded him that things were constantly changing, and if our numbers could go down, that they could also go up. I was right! Amazingly, my dad's health eventually improved enough that he returned, my nephew and his three kids moved back to help out, and my 12 year- old niece has also moved in. We have two student volunteers from Hereford High, and another volunteer that comes by every Tuesday.  My daughter transferred from Salisbury to Towson, so she is local again. I am grateful for the noise, clutter, and help! We've also been able to do some fundraising which is nice and has helped keep the animals fed. 

Some days, I have no clue how I kept going for so long, or how I endured such long, hard days alone caring for 80+ animals, plus family members. (I have MCAS/EDS/POTS that I manage daily, and was in a car accident that left me with a TBI and whiplash. I tried for 2 years to heal, trying every remedy that was thrown at me, eventually having to have 3 occipital nerves severed and resected. Four months later, I fell at a car wash and broke the acetabular bone in my hip and got another TBI, basically undoing the prior surgery. My husband left me shortly afterward and we were divorced within four months.) So, the fact that this rescue is still here despite all of those setbacks, is pretty amazing.  

Hodgepodge has always tried to help people as well as animals. We have a hardship program where we foster and care for pets for free for various reasons: military deployments or training, incarceration, rehab, homelessness, hospitalizations, domestic violence, etc. Most pets are here for a couple of months, but we've had pets for as long as five years before they were reunited with their owners. (I don't know if you remember Moofin and Stormy, two Aussie's that were boarded at your hospital last summer? We paid their balance and brought them here for three LONG months before their owner got housing and took them back. Moofin was so bad, we almost discontinued our program...  ;) We have also paid for behavioral training and vet bills for strangers when funds allowed, to prevent the owner from euthanizing or surrendering their pet. We strongly believe in doing everything we can to help an animal stay with its family.  

I guess the point of this very lengthy email is to say that though we have struggled greatly and persevered, we really needed a break now. We needed to be the ones receiving kindness and compassion. We REALLY needed help. And, you came thru for us. We are so grateful! 

Your kindness and generosity are so appreciated! Thank you, thank you, thank you!

Happy New Year! 

My Frippie. Taken Dec 22, 2024,
modeling her new collar.

Medicine is about a lot of things, but paramount to all of them is compassion. The idea that people who are trained, capable, and in place to help, and yet choose not to via financial blackmail is unethical and archaic. There is a way to solve this. It will take enough broken hearts to force bankruptcy of the current model, or enough CEO's being shot in the back, to solve it. Sad that this is where we have pushed people whose only crime was loving the pet who provided their salvation. 

There is not one day in my life where I don't give something away. Meet some random, anonymous person on the street and offer a piece of unsolicited pet care advice. The aging dog struggling to walk. The pup with the glucose meter in the park. The Pawbly question. Always free, always in the spirit of having had someone else's kindness in passing their medical knowledge down to me for the sake of our collective patients, and patients yet to be.

Doc, Linear Foreign Body Surgery

In veterinary school we are taught to think based on provided data. I was taught the following numbers about cats; the average lifespan of an indoor cat is 12. The average lifespan of an outdoor cat is 3. In private practice I routinely see indoor cats living up to late teens. I have some patients who have lived to 20 or more years old. Medicine and science love numbers. Data. Tangible, emotionless, critically scrutiniz-able graphs. The problem with reducing a life to a number, or a population of lives to a grouping of statistics, is that we are each our own beings. None of us want to go the doctor to be told we have to meet the criteria of a bell curve and therefore be given a treatment option based on what a computer tells us to do based on the masses.

I use this analogy for other things; like the lottery, and contracting rabies. Both very unlikely, and yet we still participate against the odds that are astronomically not in our favor. (I know there are some anti-vaxxers out there, but goodness-me watching an animal die of rabies is about the most horrific thing you have ever seen!). My point here is that in veterinary school we are given statistics about how much longer indoor cats live than outdoor cats. Upon reflection I think these numbers are based on black and white. Totally indoor couch potatoes, and totally outdoor colony cats. Life, as we all know, isn't just black and white. Some of these cats are merles, shades of grey, don't-put-kitty-in-a-corner felines. Some of these cats need more than a couch and a bowl of dry cat food that sits out 24/7 and never gets a second thought about its contents or underlying sediment layer. Cats are compact, stealthy ninjas. I wish every cat parent saw them as little hidden predators. They need more stimuli than they often get inside, and on the flip side, outdoor only cats need way less stress. Outdoor cats have to spend their whole lives on the defense. Every moment (awake or asleep) is spent afraid. Afraid your safe harbor will be invaded, removed, lost, taken, destroyed, repossessed, or your food will follow the same dismal vanishing at any moment suit. You have to fight, or deliver babies, (then try to feed them when you have no food security yourself), and then hope you aren't eaten, run over, or attacked and left injured. This, is an unfair and unkind life. Human beings brought domestic cats into existence we are therefore responsible for them. They might fancy themselves as assassin, but they still want to be manicured and look pretty whilst furtively stalking the demise of another.

Indoor cats need a life of their own. They need to feel that there is a meal to hunt, grass to chew, eat, roll in, and a food source that brings joy and interest. (Sounds like me I know). Indoor cats are at greater risk for foreign bodies because they are searching for something to either play with or eat and have inorganic options to choose from. In the wild it is far less likely that they will chew, play, or eat an inorganic substance. They have no time, or energy for that outside of kittendom. In our homes we provide toys, they find toys of their choosing and they nibble, chew, and make poor decisions. Of the most problematic ingested foreign bodies are linear foreign bodies. The things like thread, ribbon, carpet (think long strings of synthetic fiber found in Berber carpet). For some pets they put something in their mouth and the reflex to swallow takes over. This is especially disastrous if you keep swallowing and ingest a long thin item. Cats are also poorly designed to avoid this because the tongue has backward facing barbs on it. They help with grooming, but also act like a Velcro-conveyer belt to move items into the back of the mouth and into the esophagus/stomach. Once they get the end of a linear foreign body in the mouth it is very likely to end up in the gi tract.

For some cats (and dogs) they seem to have an affinity for eating things they shouldn't. 

Cats swallow the following; Hair ties, string/thread, non-plant imposters, stuffing, rubber, plastic.

Dogs swallow; tampons (bleck!), socks, corncobs, rocks, balls (they tend to catch or retrieve and then swallow by accident), bones, and for the dogs who are constant chewers; pieces of plastic because they chew off tiny pieces of the items they gnaw on.

Doc is one of these cats. He has a history of swallowing things he shouldn't. As with every patient I see there is a story there. They have things to tell us, problems for us to help solve, and BOTH an immediate need and long term desire. Doc is one of these poignant cases. 

Doc came to us because his mom knew that he had a predilection for eating things. He had been to the ER previously for eating plastic off of a sippy cup. Emergency surgeries at the ER are always expensive. There is no way around the increase in charges with the access to 24 hour staffing and the inconsistency of volume. In almost all cases that I see an ER visit for a foreign body surgery is going to be over $4,000. Most people cannot afford this. When Doc had his second suspected foreign body his mom came to us. 

Doc presented to us as many of these cats do. Quiet, not eating and presumed guilty based on previous infractions. 

Doc had been to the ER. The ER had taken an xray and also suspected that there was a foreign body. They gave an injection for nausea, a pain medication and some fluids. He was discharged from the ER to see us for his surgery.

My biggest gripe with veterinary medicine remains in the increasingly larger gap between affordability and access to care. Almost no one can afford to go to the ER anymore. It has gotten increasingly futile to send our clients to them. If we cannot send clients and patients to the place they need to be because afforable options are not provided then I do what anyone who cries "wolf!" often enough does,,, I stop referring. It is now common practice to call the referral center before sending. We used to call to see if they had availability for transfers, now we just ask about affordability. 75% (or more) of the time clients cannot go due to cost. 

Doc was dropped off in the morning. I rechecked his xray to make sure it was consistent with the previous one. We never want to start a surgery without knowing how the patient is doing. Blood work had not been done so we took a sample and ran it through our in house machine. On physical exam Doc looked good. One of the very important pearls you learn is that the patient will tell you what you need to know. Doctors want to know data. We want numbers. The more nuggets of information we have on our patients the better we feel about our decisions and actions. This is also how we have become so profitable. There is gold in them there diagnostics. BUT, diagnostics do not treat your pets or patients. Diagnostics give you excuses to not treat them. Actions, not incomes, matter. Doc's xrays looked much like the last. Doc needed an exploratory surgery asap. 

Here is his xray;

Doc had a few things in his favor. He is a very sweet boy. (Fractious cats are really hard to manage without sedation. It is hard to give sedation orally when they are trying to bite). He also has a mom who recognized he needed help and then was willing to work with us to get it. She offered to surrender him if it meant treating him. As silly, (or whatever adjective you choose to add here), as it sounds, if you cannot afford life-saving care at least let the pet get care elsewhere. The people who watch their pets die so they can retain ownership are putting themselves above their pets. If a pets life at risk let them go and live. If more people offered to help in the caregiving process more animals would be saved. Never once has someone offered to help at the clinic to offset the price of care. I have three people who volunteer weekly so that their pets are considered employee pets and get care at little (or no cost). That is a parent invested in their family. 

Here is Doc's YouTube video:

The cost of Doc's care was trimmed as much as we could to allow for his treatment. We are so fortunate to be in a community where when we ask for help we get it. 

As a veterinarian who is trying to stay committed to her patients and insure that they get the care that they need, we made a promise to ourselves that we would help every patient who came to us. There would always be hope, kindness, and care offered. In some cases we will give away free diagnostics so we can help understand the disease process,  this gives incite into the patients prognosis and helps with the decisions based on them. In others we provide free euthanasia to provide peaceful passage. In others as long as we believe that the condition is treatable, and the outcome favorable for a return to a normal, healthy life we will use our non-profit; Pet Good Samaritan Fund to help bridge the gap between provider costs and client resources. 

Here is more on Docs case, and how we manage emergency care with a client who has financial constraints;

The goal of the PGSF is to provide a safety net for all whose focus is helping pets in need. 

Here is the link to the homepage; Pet Good Samaritan Fund Guidelines, application, and contact information can be found there.

Doc is like all of us; a complicated, unique individual with specific needs, desires, thoughts, feelings and compulsions. Doc has had two exploratory surgeries. Its time to listen, offer an environment with stimuli, safe things to eat, and enrichment. I have 5 cats. Each one of them likes different things. Two love to be outside. Crouching by the bird feeder. Climbing trees, digging in the dirt, or going for walks with the dogs and us. I have never had a cat with a foreign body, but, I do have a cat that eats cat grass everyday. I grow it for her. If I don't she will eat things that are not for her. 

My views on ideal cat care have evolved since the bar chart in vet school. We are who we are and finding what works for my pets is what works for me.

Here is the breakdown of Doc's care at my clinic Jarrettsville Veterinary Center, Jarrettsville Maryland.

• surgical pack; $250 (iv catheter, iv fluids, fluids, fluids pump, anesthesia 30 mins, surgical instrument pack
• exploratory surgery feline; $400
• additional surgical time; $70
• hospital boarding; $45
• surgical materials; (sponges, suture) $200
• medications; (surgical, peri-op, and post-op) $150
• x-ray; $175
• e-collar; $23

            total; $1400

You can find more about me on YouTube, Instagram, and Facebook

Corporate Acquisition Inquiry

I get these phone calls and emails daily. It seems that as the available pool of private practices gets smaller the tactics and tactful phishing gets more invasive and obnoxious.

Here is todays example. I have half a mind to add the phone number. The volley serve to texting me at 5 pm on a Friday.

Hi Dr. Magnifico, this is XXXX from VetEvolve. I hope it's okay reaching out by text. I am very interested in learning a bit about Jarrettsville and your plans for the future of the practice. Are you available for a quick call next week to introduce ourselves? 

Looking forward to hearing back.

XXXX

Practice Partnership Specialist 

xxx

George.
Multiple unblockings (UO) and a PU surgery

Myreply;

If you are reaching out bc you work for a corporate entity seeking ownership than no. It is not ok. It is predatory, rude, disrespectful and unprofessional. You are also working for people who intentionally and purposely make pet care so expensive it costs pets their lives. It also costs pet parents their ability to trust other veterinarians. Think about what your paycheck costs pets. 

Doc, linear foreign body surgery.

Thank you for sharing your perspective. I do appreciate your passion and commitment to the veterinary profession..and also the well-being of pets and clients alike.  

At Vetevolve, we are not about being predatory or undermining the trust between veterinarians and pet parents. Our focus is to support practices, maintain each unique culture, and provide resources to help teams thrive and better serve clients and patients. Affordability and access to care are priorities for us and we are striving to make a positive impact.

I understand completely if you aren't interested in further discussion, but I want to assure you that our intentions are grounded in supporting and preserving the veterinary community, not taking advantage of it. 

If you would ever like to share more about your concerns or ideas for improving the industry, I'd genuinely value the opportunity to listen. 

Warmest Regards,

XXXX 

Lola, pyometra surgery

I would be shocked if all of that pitching garbage had any teeth. Let me know which patients of the other corp owned practices who are turned away due to financial restraints that I can send your way for affordable care   I'll give them your name. 

Send me one case that you made affordable. 

You are drinking the kool aid. 

I just visited your website.  There isn't one word about patients. Every single page and line item is about people. So if your website is any indication of how much you care about your patients it's zero 

And for the record my husband and I have 40 years of combined service Bn the navy and coast guard. 

Don't say I didn't warn you. Eventually some bigger fish will send you packing. They treat their people as bad as their patients. 

Dixie, Pyometra surgery

I assure you,  my heartfelt thoughts are based on what I witness.  I don't have cases on hand from the hospital level...but our integrations and operations teams would be sure to provide  for any owners who are moving forward with discussions.

In reference to our website, I can direct you to the resources tab where there are videos and posts... where the veterinarians speak about community and their clients. By implication clients are happy because their pets are taken care of ...but you raise a great point ..a heightened awareness of protecting and caring for the animals could be more prevalent instead of mostly mentioning vets and their teams.

As for your combined service, I appreciate what you have done for our country... I admire all branches of our military. 

Lastly, I have my eyes wide open here....and it's not my first rodeo in M&A.  You have a valid point that companies merge or close without warning.,.being tied to PE does come with occasional risk...but if I can add on to the culture from what I have learned in the past few decades in the space, I will. So many of us here have come from other places and want to right some of the wrongs we have seen in the past.  I don't view that as having Rose-colored glasses ..its just because someone has to take the first steps to do it right.  

Thanks again for your thoughts..I do value your opinion...

Have a great weekend and much continued success this year. 

Garfield, trauma, fractured jaw

There is not one single thing that is in place in your organization that puts pets first. The whole concept of the corp ethos is about profits over individuals. As a civil servant it is unethical and deceitful to even try to portray otherwise. 

At some point you will ask yourself what your efforts contribute to our society. What legacy you are building. Who you are, who you represent are the antithesis of what the pets who we consider family need. They need love, compassion and kindness. Medicine should embody this in every molecule of our being. Every action, word and decision that we make. 

It is the dawn of shooting CEOs in the back and the public cheering them on for it. This is the world you built. These are the consequences of greed, wealth and your idea of power. 

It's shameful. I'm not afraid to tell you that. We, as the spokesperson to our companies, have nothing to say to each other. 

As the individual You just aren't looking deep enough into your own mirror. 

Seraphina and Dr Ahrens

...and PS XXX, my success is infinitely easier to achieve because of two factors; 

1. Your business model makes my new client patient appointments robust. Your "one and done" visit ratio is much higher than mine. You will price them out of care once and they will never come back. That's the price of playing with the lives of our family.

2. I possess qualities you will never have; genuine compassion and utter determination to save lives.

If you aren't saving the souls you came here to serve you are selling yours short. It is not about the "if they can pay we can help" it is about altruism and your own humanity.

"If you feel pain, you are alive. If you feel other people's pain, you are a human being." Leo Tolstoy.

If you are a veterinary professional looking to save the lives you came here to be the kind hand of healing for then please reach out. Medicine was never intended to be driven by profits alone.

For more on the cases above see the other blogs, my YouTube channel, Jarrettsville Vet Facebook page, and Instagram.