Bentley. Hypospadia. The cases you cannot win and the reason you never stop trying.

This is Bentley's story from the perspective of his foster mom... her name is Jenn.

"Our Bentley,

If love and hope could have saved our Bentley we would have had this one in the bag, but Bentley needed far more than our love and hope, he needed a miracle.  The hardest of realities is that sometimes we don’t get to see those miracles come to fruition.  Sometimes all we have is peace in knowing we tried everything possible to save a soul who wanted so badly to be saved.

We met Bentley in March of 2020, at the cusp of a pandemic.  His breeder, (accidental breeding), Kista,  had reached out to anyone and everyone who could potentially help Bentley. Bentley was born at her home, but, he wasn't a normally functioning puppy. Kista found a home for him, however, they became overwhelmed with his care and returned him.  After visits to numerous veterinarians and specialists she too became overwhelmed.  A costly surgical plan was laid out with no promises.  Funds were raised but not quick enough and not to the extent to cover the very costly surgery.  Bentley’s breeder knew either he received the help he needed, or, he would have to be humanely euthanized as his life had been reduced to suffering.  You see Bentley was born with deformities to the urogenital system that left him constantly leaking urine and in a constant state of infection; both in the form of urinary tract infections and severe urine scald and subsequent skin infections.  At only 5 months old Bentley associated any touch to his hind end with pain, and rightfully so.

The night we met him a quick gaze into his soulful milky-brown eyes and we were smitten.  Bentley wanted to live and he was worth a try.  The stars aligned; a rescue we often work with was available to have him signed over, donors promised to honor their donation and a skillful surgeon all came together along with our team at JVC.  Four days later Bentley received his surgical consult with Dr. Runnels, he was a candidate for surgery, best case scenario he could be fixed both internally and externally and live a happy healthy life, worst case scenario he would continue to leak urine.  Bentley had a surgical plan….and hope.  A week later he returned to Lititz Veterinary Center for surgery.  Surgery revealed ectopic ureters, a challenge to say the least, surgery was completed in the wee hours of the morning and two days later he was in his foster home.

Initially we were hopeful, Bentley seems to have some bladder control, his urine culture revealed antibiotic resistance and gave us an idea of which antibiotics to treat with.  A week of IV antibiotics and he seems a little better.  A happy, playful puppy emerged.  Full of wiggles and wrinkles and kisses.  His foster mom, Jenn, bathed him three times a day to keep the urine off his skin and his skin healed.  He met his happy-go-lucky furry foster sister and the two-legged foster siblings too.  He loved everyone he met, except the cats!  His foster dad practiced leash manners with him as they spent many hours walking together.  We wish life could have continued like this for Bentley.

One day Jenn noticed a second opening while Bentley was urinating; during his surgery an opening was created just under his anus for him to urinate from, one opening.  Now there were two.  His leaking increased and progressed to absolutely no bladder control at all. For all of the bathing and giving him fresh towels for bed, by the morning he was sloshing in his own urine, towels drenched puppy pads under his crate saturated.  Excitement and playing with another dog meant both dogs were quickly urine covered….and in need of a bath.  Bentley’s life was reduced to a crate or pen, towel changes up to eight times a day and constant sponge baths.  We had seen the result of keeping Bentley in a diaper, severe urine scald and skin infection so that option was off the table.

Dr. Magnifico and Bentley

Bentley returned to Lititiz Veterinary Center for a procedure that would send dye through his urinary tract, allowing the surgeon to make sure the urine was following the path it should.  The good news was that it was, the bad news was that there were no further surgical options.  The surgeon noted severe deformities to his anus. She told us how sorry she was that he was out of options, Bentley was such a sweet boy, all who met him at her office fell in love with him too.  A recommendation to try medications designed to treat incontinence was made.  We started him on Prion and once again hoped for the best.  Within a week Bentley began to show signs of fecal incontinence.  Even if he eliminated outdoors he would leave stool “nuggets” behind in his crate.  Keeping Bentley clean was a challenge, within minutes of cleaning him up and giving him fresh towels he was once again covered in his own waste, now not just urine but feces too.

The heartbreaking reality that Bentley’s tomorrow would not be better than today set in.  He was condemned to a life in his own waste.  He would never be able to do all the things that other dogs do; enjoy rides in the car perched on the backseat, snuggle in bed with his people, lay beside his own little boy or girl’s bed at night, enjoy movie night on the sofa with his people, play with other pups.  He would always need to be on a hard, non-porous surface so it could be scrubbed clean multiple times a day.  He would battle reoccurring UTI’s and live in a constant state of nausea.  He could literally fall into a state of serious neglect in a day’s time.  This wasn’t even worst-case scenario; it was so much worse.  Was Bentley left with quality of life? And worse where do we go from here?

We are left with peace in knowing we gave Bentley every chance we possibly could at a happy, healthy, normal life.  We spared no expense, we left no stone unturned, he was so very loved by all of us but especially by his foster family.  We never gave up on him, his fate was sadly decided in utero when cells came together as they should not have, we tried to undo what was already decided.  Sometimes we do not get the miracles we hoped for, but that will never stop us from trying."

Jenn and Bentley

Here is Bentley's story from my perspective. The veterinarian who gets too many calls for cases like these and has a very hard time not trying to help. It's a sticky predicament knowing you are the last stop. Knowing there aren't any options past you, and, telling someone who cares and wants to save their doomed companion that they have to give up hope. 

Bentley's story began with us, and by "us" I mean me and the Jarrettsville Veterinary Center crew, which is after all where he resides now, months ago.

His story with us started the way so many of them do. A friend had a friend who knew someone who had gotten a phone call/email/online request for assistance, "and, well, they know I get a lot of requests for veterinary help, but,, could I maybe look at this case and see if I could help them?"

The cases vary only in a few details, they are all in some panicked state of duress, and they all need much more than a leg up. They almost always need an immediate take over of medical, financial and everything else. The sick and the dying quickly are my forte. These are exactly the cases I want to help, and, exactly the cases no one else does. 

Most, dare I say, all, professionals prefer the cash replete, minimal output, not asshole clients. Add duress to almost any scenario and people morph into one of two characters; humble and grateful, or, angry, demanding rabidly vicious. Even under the best of circumstances I have grown unwilling to assist the asses. Let them take their problems elsewhere. There is a whole genre of medical professionals who don't want to know anything about you other than your ability to pay and their ability to meet your medical need. niceties don't matter to them, just as your face and your pets don't either. you will come, you will go and  they don't care as long as you pay. 

Bentley was one of the rare cases who had someone who cared so much they would make whatever personal sacrifice they had to just to do right by them. These people, the compassionate few without personal gain other than peace of mind for having a pet they love be helped are my cup of tea. They are my brethren, and for them I do crazy feats.

Bentley had a congenital disorder I had to look up when it was proposed to me. Bentley had hypospadia. He was four months old and his mom was desperate to find help for him. She was desperate for him to have a chance at a life outside of the only option she could afford; euthanasia. She had spent all four months  of his life looking for any possible way to give him that chance to live.

When I told the foundation who was offering to pay for $1000 of the $6000 she  needed to "try" to fix him that they could give her my phone number so we could talk about him the story of Bentley and JVC began.

"Hello, Kista? It's Dr. Magnifico from Jarrettsville Vet. How are you?"

And so it began. My last words for that phone call were what they too often are; "if you get to the point where you have no other options for him other than euthanasia call me back and I will take him to see what we can do." 

She was, and has remained, so genuine in her words and her intentions that nothing regretful can come from this. She has been 100 percent committed to him, and we have done the same in return. i cannot tell you that this story will have its "happily ever after" but, i can say that Bentley was loved and cared for every moment of his never-quite-right life. He has had what so many other perfectly healthy but never having known kindness for lack of specialty or luck of the draw.

Bentley's life lacked luck from inception, but, he always knew specialty. He was a special boy with a birth defect that the majority are culled for. It is just too difficult to treat. It always requires surgical correction, always at the hands of a boarded surgeon, and it has a pessimistic success rate. In fact it is so abysmally low you are less than 50%. more often than not it is not fixable. For these reasons I have never seen it. I am not a veterinarian for breeders, and breeders don't keep the puppies that they can't sell or breed. 

Bentley's beginnings begin with Kista. She is the person who was there from birth. Here is her version of his story. She was his champion. She was the person who pushed beyond all of the "no's" from all of the people she begged for help, and just kept pushing. She is what every child deserves, what every desperate soul in dire need of interventional care needs. She never gave up on him no matter how many others did. When she called me and told me about Bentley her dedication to him moved me. She is the person I wish every parent (pet and otherwise) would be. She is the reason I became a veterinarian. 

Bentley was born 9/1/19 (originally named Bear)
The first of October Bentley visited Oppossumtown Vet- they had no idea what was wrong with him so they took pictures and sent an email out to several veterinarians.
10/7/19 Opposumtown Vet called stating he had hypospadia.
I reached out to VSC in Leesburg, Chesapeake Surgical Specialists, and Dr. Walesby. Dr. Walesby recommenced that Bentley be at least 6 months for surgery. I made an appointment for Bentley to see Chesapeake Surgical Specialists in Columbia as they were the closest to my home outside of a surgeon in Frederick with bad reviews.

A lady had told her friend about Bentley and she wanted to meet him. Once she met Bentley she asked to take him home that night. I told her that I really wanted to wait until he seen the surgeon the following week as I had no idea the cost of the surgery but it had to be over $1,000. She still insisted on taking him home on 11/19. On 11/25 both Bentley’s new owner and I took him for his consult at Chesapeake Surgical Specialists. They recommended an ultrasound. An ultrasound was performed the following week. They estimated Bentley’s surgery to be $2500-$3500 plus $1500-$3500 to scope him first. This was way more than we expected. A GoFundMe was set up with Bentley’s new owner as the beneficiary. That raised $200 (I assume she used that for vet bills/antibiotics as she did not give that to me when she gave Bentley back to me). I reached out to the Frederick Humane Society who stated they may be able to help with $100 if we raised enough money. 12/27 reached out to Helping Hands in Richmond Virginia to see if they offered a low cost surgery option for hypospadia. Unfortunately they do not perform that type of surgery.

1/17 I reached out to U2SA who originally agreed to donate $550. They than Increased offer to $2000. They paid for Bentley’s owner to see there vet (Buckeystown Vet) and they recommended Bentley see a surgeon in Pittsburg and that it would cost around $6,000. U2SA then lowered there donation to $1000 as they did not feel hopeful but stated that they had a friend who would donate $500 (not sure if they ever sent that to Lititz) Buckeystown vet reached out to vet school in Blacksburg. Cannot do at low cost.

I contacted Barcs the end of January they were unable to help and referred me to Saving Grace Animal Rescue. I reached out 2-3 times and never heard back once I sent his ultrasound and estimate. This seemed to be the normal for most rescues. Very few got back to me.

Reached out to Little Angels pet haven and rescue 1/3.

Reached out to Pitbull and Paroles in January. Never heard back.

Reached out to Bissell pet foundation 1/22 never heard back.

Reached out to Sleepys dream 2/8. They are unable to help.

2/10 reached out to Rescue Well. They checked around for a rescue for Bentley with no luck as well.

Reached out to Always strong pitbull rescue 2/10.

2/12 Save the misunderstand.org no response. tara’s house- unable to help. Key to lions heart rescue- too much for them to take on.

Buddy foundation offered $1000.
Thought I had enough in donations with 2000 from u2sa and $1000 buddy and$500 thru me until I found out they wouldn’t do surgery without scoping costing $1500-3000 more.
2/24 Melinda with buddy foundation referred me to you!

2/26 reached out to Kennedy K9 camp. He said he would share the news and let me know if he found any help.

Reached out to McPaw and they were unable to help. Reached out to Animal Welfare League of Frederick and they were unable to help. Also reached out to Facebook page “I Love My Dog” and asked if they could share his GoFundMe. Reached out to Last Chance Animal Rescue and they shared his story.

Reached out to J and j trash service and family friendly to spread the word.
Reached out to the Aspca. Reached out to several others by phone and web forms but cannot recall the names.

What would you do for your pet? What if you felt personally responsible for their very survival? Aren't we all in Kista's shoes, and, aren't we all a parent of a potential Bentley?

Where are we now? Bentley needs help. He needs a miracle. He needs someone who will love him even if he cannot be perfect. He is a pup who is incontinent. An ailment that affects millions of people, but, people have options to stay clean and dry and manage this. Bentley can't live in a diaper. He cannot live outside like a wild animal. It is a long shot and a big ask, but, we have to try.

I wish I could say that I heal every patient who crosses my path. I wish I could say every case is a happy ending. I wish I could say that it is easier just passing the hard ones to someone else. Except in almost all cases there is no one else. I know this. I feel compelled to try. No one wants to try anymore unless they are adequately compensated. I took Bentley's case because the only option left was euthanasia. This might still be his ending. Not happy. Not a success, but, as in some tiny measure of hard to swallow acceptance that there was hope. we all need hope even in a world of not so promised happy endings.

If you are interested in learning more about Bentley please follow us on our Jarrettsville Vet FaceBook page.

I am also available on Pawbly.com. It is a free information exchange resource centered on pets and pet care. We are always hopeful to have experts from all walks of animal kingdom life. Please join us.

I also have case based videos on my YouTube channel. 

Bentley's Baffling Bug

It’s always going to happen on the busy nights.

You are booked, you get an emergency call, and then the avalanche hits you.

No chance of keeping your head above water. You just put your nose to the charts and plow on hoping to see sunlight sometime again, and avoid an angry client who will set you even further behind.

I understand why the other veterinary clinics around me turn people away when they call at 6:30 pm “begging to be seen immediately.” Where do these people AND our clients turn when they get home from work and realize their pet needs to go to the vet immediately? Why, into our doors, of course.

Does it infuriate some of our clients? Of course.BUT, if they need us in an emergency are they are going to call us, and we are going to tell them to come on in.

How else do I ethically take care of my clients?

I grapple with this.. There is not an easy answer.

On this particular night I was booked. It was another one of my usual just barely able to stay on time booked. And then the phone rang.

A very good client of ours had just gotten home to find their beloved four year old Welsh Terrier, Bentley, standing in the middle of the room acting oddly. He explained to us that nothing was disrupted in the home. Nothing seemed out of the ordinary, but Bentley just stood there shaking. He didn't know what was wrong but they were sure something was so we told them to come in.

When they arrived Bentley was quiet and calm in the arms of his dad. But when placed on the bench Bentley looked anxious, nervous, scared, and refused to move an inch from his dad.

I took my cursory two second glance over to try to mentally assess him and determine his place in line. Due to Bentley’s lack of distinguishing emergency features his file went in the line in the order of arrival.

Over the next two hours I visited Bentley three times.

The first official visit was to give him an examination.
Bentley on outward appearance had the look of a 'back' dog. He stood legs stiff slightly away from the body as if to distribute his weight as evenly and widely as was possible. A dog with back pain will stand as rigidly fixed as possible. The neck, legs, and torso resemble a star. They have short shallow breathing to minimize the movement of the chest. And a fearful guarded look in the eye, as if to say “Please, please, don’t touch me.”

On his exam I found very little to help me localize his lesion (source of pain/problem). Or even provide me any additional clues than my eyes and my gut were giving me.

Based on my belief that his problem was pain I ordered a heartworm test to look for Lyme disease. Because this requires a blood sample be taken I asked the technician to take enough to run a CBC and chemistry. About 45 minutes later I was still empty handed. When our diagnostics fail to provide an answer we term it “ruling out.” We ruled out Lyme, infection, organ failure, and a handful of endocrine bad guys.

Still no dice.

I was not getting any "Ah! Ha!" clues from Bentley.

He was painful and that was all I could deduce.

When I cannot make a physical exam make sense I look at everything. I even checked his anal glands. (I always check anal glands. Nobody else does, I know, but I have had more than one poor dog display odd behaviors because their butt feels plugged up). They were empty.

Back to the drawing board..I went back to check on him.

Bentley was also lying down now. His breathing had slowed and he seemed more comfortable.

I confided to his dad that I thought he might have a disc or nerve problem. In which case I was going to recommend rest, an NSAID, and a re-check in the morning.

The busy night was pulling me away again and it was nearing closing time. So we decided to give Bentley a band-aid treatment to get him through the night. I asked the techs to give him some sub-Q fluids and get him packaged to going home. Packaged to go home with a band-aid treatment plan includes a copy of the medical record, all diagnostics, and a flyer for the emergency clinic, just in case our band-aid fails.

After the fluids were given I went to take a last glance at Bentley.

Before I could get to him I saw fear in his dads eyes. He was petrified his dog was dying. I stopped dead in my tracks.

There are a few important lessons to learn on the way to being a successful seasoned vet.

1. Listen to your patient. Their opinion trumps everything else. I don’t care if every diagnostic is perfect. If your patient believes they have a big problem they probably do. Hedge your bets on them.
2. If your client thinks there is a big problem you best be sure you know there ISN’T before you send them on their way. Because if you are wrong you will never regain their trust and all of your years of hard work at accumulating all of your precious grey matter are for nothing.

I looked at Bentley. He was right back to his rigor mortis paralysis bugged-eyed painful self.

I repeated his exam at 8 pm.

Closing time was here and I still didn't know what was wrong with Bentley. I decided that we should run the only diagnostic that I hadn't done already. We took an x-ray. It was not normal. His lung field was cloudy instead of the normal black.

So I did what every competent doctor does. I punted.

Now the puzzle pieces were starting to make sense.

Bentley was in pain because his chest hurt.
Specifically something in our around his lungs was not allowing them to function normally.

To compound my ability to read his x-rays fully I had given him some sub-Q fluids. Those fluids were superimposing the lung fields.

(Small moment of regret and self-loathing).

Bentley and his go-home kit went directly to the ER.

He spent a day there and went home.

I called to check on him 2 days later hoping that he would be on the mend. His dad told me that he still was reluctant to move, wouldn't eat, and that he didn't know if it was because of the medications he was on.

I told him what I tell myself.

Trust your dog.

Listen to your dog.

I told him to come in tomorrow for a re-check. The next day Bentley was seen by another vet at our clinic. (The more minds the better). He agreed with me that Bentley was definitely in pain and we agreed it was time to once again do what every competent doctor does. Punt.

Bentley went to the referral hospital the next day. It took them two days and multiple specialties to think that he might have a lung lobe torsion.

Bentley then was transferred to the University of Pennsylvania’s teaching hospital for an exploratory thoractomy.

When Bentley arrived at UPenn it had been two weeks of anorexia, seven days of fever, and a handful of vets, car rides, diagnostics, and cash.

Do I think that his owners are incredible? Yes!! I admire their tenacity, dedication, and determination. There were so many leaps of faith. So many twists, turns, and unknowns, and they never ever gave up.  

But it got them their dog back.

 Do I believe that most people would follow through like Bentley's parents did? No. Most people cannot afford to. And most people use excuses to feel better about their decision. Are some of them justifiable? I don’t walk in their shoes, I cannot answer that.

But I know that every single illness, disease, and patient has a diagnosis AND a treatment plan. Some are merely easier, and cheaper to come to.

I saw Bentley 5 days later. Half of his torso was cleanly shaven and he had a long incision from his spine to his sternum to show as the tell to his story. But he was once again his happy, animated, and prancing self. You don’t need to be a seasoned vet to diagnose happy, you just have to be a person who identifies pain, joy, and all of the shades in between in another living soul.  

It has been almost 3 months since Bentley's surgery.

He was here yesterday and is as he has always been, all smiles!

And yet still happy to leave us..
Who can blame this dog for not liking a vet's office?

Bentley's mom has loads of photos of him.
He is naturally photogenic,
and one of a small handful of pets that actually enjoy having their picture taken.It's almost impossible to decide who is more adorable?

If you have any questions about this, or any other pet related item you can ask me at Pawbly.com, or find me on Twitter @FreePetAdvice, or @pawbly.