Cats with a urinary blockage always need to be addressed as an emergency. Unless you have experience with this condition before almost all of these patients arrive at the clinic as an emergency. Most commonly they have been blocked for some period of time and this leads to a higher likelihood of either bladder rupture or toxic changes to the heart.
Beau. Blocked three times. $8,000 for two ER trips, then he found us. Third block and a PU surgery; $1500 on a payment plan.
I have to recommend that you go immediately to a vet if you suspect that your cat has a urinary blockage. I also have to caution that most clinics either refer to the local ER, or, charge a hefty price to treat this.
Please go back to the first blog in this series now (go here) if you haven't read it already. The first chapter will define what a urinary obstructed cat looks like.
The singular goal of this is to get your cat out alive. If you are like most of us you live in financial constraints and your cat is a vital, beloved member of your family. The profession knows this, and the profession has profited greatly because of it. We know you love your cat, and we know your cat is going to die from this, soon, if you don't cough up the admission fee for us to treat it. It's the culture of the American way. Make as much money as you can from wherever you can. Ask yourself how you are a part of the problem and then ask yourself what you are doing about it. Sure, I am disappointed in my profession for killing so many treatable pets, but, this is the world we all decided to emulate. Every rich person has profited from the misfortune of another. Medicine should be the neutral, sacred territory. It isn't.
Here is my professional advice, as a veterinarian of 20 years, on getting your cat out alive when they have a urinary obstruction (aka a blocked cat).
Tips;
be nice
be honest
be insistent
be ready to challenge every interaction
never lose hope
never walk away without knowing that the only advocate in your pets life is you
be willing to surrender your cat if it means it might save their life.
ask for help from everyone. Build an Army around your cause and then help pay it forward. If you find a way to get out alive pay that forward to someone else. The current practice of blocked cats in almost every ER setting is so expensive it is forcing most of these cats to either suffer or be euthanized. There are only these two options. Why is it that we allow these cats to go home and die a horrific death of suffering? or shame you into paying for something that has such an incredible mark up we lose the ability to heal?
If your cat is demonstrating any of the clinical signs listed in the first blog on this (see here) then you must bring them to a veterinarian.
Start with the exam. Blocked Y/N if YES, then ask for a written copy of the exam findings. Immediately. If the staff or vet declines, ask them to give a verbal description using the form provided below. Do not leave your cat without this. You should always have a copy, or have documented a detailed list of what has been done for your cat and what you have consented to. This is very important to help manage your cAts care and the expense associated with it. A blocked cat should be diagnosed by physical examination alone. The cat will often have a painful bladder that is hard, large and unable to be expressed (able to produce urine). If you sign anything ask for a copy of it immediately.
From the initial examination an estimate is given for the expected, or recommended, treatment plan. Here is the first place that negotiations should begin. Here is the first place where I recommend that clients challenge the options being presented.
Next;
Is the estimate is affordable? IF YES, (your cat is blocked) and the estimate/deposit required is affordable walk away. Sign paperwork, get a copy, and walk away. Your cat is in good hands, and the safest place they can be. The veterinary clinics are set up to provide top tier medicine and provide appropriate treatments for the worst case scenario. The problem is that most people cannot afford this, and, in almost all cases you are charged for worst case scenario treatment even though most cases do not require them to be successful. The veterinary clinic benefits greatly by being prepared to treat your cat as the worst case scenario outlier even though most are not. No client should have to pay for Gold Standard care if the case does not need it. Further, if you cannot afford the first estimate you should be permitted to be given the treatment plan tailored to your cats needs at a price you can afford to get the best possible outcome. THIS IS NOT BASED ON THE AMOUNT OF TIME YOU CAN AFFORD, BUT THE CARE YOUR CAT NEEDS. I recommend that your cat stay on iv fluids and with a urinary catheter in place for a minimum of 3 days. Your cat should stay in their care until urine runs clear. Your cat decides the length of stay,, not the hospital. They should do the following; full blood work. ECG, abdominal radiographs, do ultrasound, do urine culture and sensitivity. Provide analgesics, appropriate urinary diet, appetite stimulant, stress free housing. The cost of this at a specialty hospital with ER has been reported as $6,000 up. Reminder; your cat has a chance of re-blocking. I.e. you and your cat may be back here again, soon. Budget accordingly.
IF NO;
If the estimate is not affordable; No? Everything from here is based on budget and time. The house decides your cats prognosis based on your budget. The smaller the budget the less ideal the care. Why do they get to decide that?
If blocked and you cannot afford the estimate; ask for all of the diagnostics to be declined before cutting the in hospital time. If the hospital will not do this ask to see the manager. Ask for the reason in writing. Do not leave with out this. There is this incorrect notion that vetcare is a one way street. We tell you what to do, and how much it is going to cost and you either pay or you hit the road. It is not the case. Veterinarians can decline to treat, but they are expected to give you a place to go for care. You can decline line items. You can ask for written prescriptions to fill elsewhere, and NO they cannot charge you for this. You can decline all diagnostics and ask for your cat to be unblocked. You can even decline pain medications, although I strongly disagree with this. Unblocking your cat, providing fluids (even in the case of a fluids kit you bring home to provide SQ fluids at home) is an option. Taking your cat home after they have placed an iv catheter and a urinary catheter is your right. In cases where the cost of care is so high I recommend that you tell the vet that you are transferring your cat to another clinic and they they be transferred with BOTH the urinary and i.v. catheter in place. I know of many (in fact I know of only 1 case where this was provided). In all other cases the specialty practice pulled BOTH catheters and then sent the cat to me. I had to replace both and this was detrimental to both the patient and the client. IF you paid for these you own them. Remind the practice this after you pay. (See form below).
If you cannot afford anything ask for a cystocentesis to remove as much urine as possible, go home find a general practitioner who will help. Call every rescue, shelter, veterinarian, put out a social media plea. Start a fund raising campaign. Offer to surrender your cat. Any person who refuses to surrender their cat appears more interested in ownership then compassion and the life of their pet.
<$500; exam, comatose cats can be catheterized without sedation or analgesia. Take a video of how your cat presents to the ER. Ask if sedation is needed? If not it should be removed from your invoice. place urinary catheter ask if you can go home with sq fluids kit and urinary catheter in place. The act of placing a catheter is traumatic to the urethra that is already not functional. Placing and then removing before the tissue has healed is problematic, if not further worsening the cats prognosis.
Decision Tree;
blocked -> Yes, AND I can afford the suggested treatment plan., sign forms, get copy, go home. See you in a few days. (Warning patients can re-block in days to weeks).
Blocked-> Yes, BUT I cannot afford first treatment option provided; I would like to decline all diagnostics to have a urinary catheter and iv catheter placed, and at least 3 days of both with in hospital care.
Blocked-> Yes, not enough money for multiple days iv fluids and urinary catheter treatment, then place both and take home. Find a vet who will help at an affordable price. Give this directive in writing. If your vet pulls the catheters after providing written or verbal directive see your State Veterinary Board and file a complaint.
Blocked-> Yes, cannot afford urinary catheter or iv catheter, decompress bladder (place a needle in the bladder and remove as much urine as possible. This will buy you a few hours to find a vet who can help. (Find me in Jarrettsville Maryland, or Denton County Animal ER in Denton Texas).
A "blocked cat" in vetmed terms is a cat who cannot pass urine normally, or, at all. "Blocked" refers to urinary bladder blockage. A blocked cat is a medical emergency and should be treated as such.
Here is how I treat a blocked cat, and, why/how these cases often come to find me.
Stripes. Presented blocked and unhappy about it.
The typical scenario for a blocked cat presentation is this;
Cat is
in and out of the litter box,
Often
crying, meowing, and/or, in distress
Little
to no urine is being produced
Client and blocked cat show up at vet office or ER. Cat is examined and owner is asked to produce a $2,000 deposit for care. Most struggle to afford this. Many cannot. Therefore, they call me for help.
Here is a look at how I manage blocked cat cases with financial constraints at my veterinary practice.
Almost all cats can be
diagnosed without diagnostics (outside of the above mentioned physical exam and history). I DO NOT RUN DIAGNOSTICS IF IT WILL AFFECT A PATIENTS ABILITY TO RECEIVE TREATMENT. This is a practice that has become all too common place and the systemic practice of economic euthanasia to allow for diagnostics is unethical and warrants state board and AVMA scrutiny and policy changes.
KEY POINT; This should be provided in documentation after the examination is done. At each client documentation/signature request the client MUST get a copy, and, there MUST be current patient status listed. A client has the right to deny diagnostics and still receive life saving care. The egregious practice of turning away clients if they will not meet a practices proposed standard of care, and the corresponding costs associated with them, is also in need of AVMA and state board examination. We allow the euthanasia of patients because we reduce them to property status when it suits our prejudice and financial gain discretion. A blocked cat is typically young, otherwise healthy and free from any other medical conditions. They may present looking, and feeling, bad, but, they are treatable in almost 100% of these cases IF UNBLOCKED.
Urine, rally bloody, from a recently unblocked cat
I am going to describe the typical blocked
cat cases that I see, and, how I manage them. Almost all of these are owned by people
who have financial limitations. I am also providing challengesto the typical way an ER manages these cases to help
highlight areas we can help allocate resources to as I call it, “get out alive.”
First challenge; diagnostics are not needed to diagnose.
Short of a very obese cat a competent physical exam AND thorough history will
diagnose the majority of these cases. Why does everyone run diagnostics? Why,
again, are we not talking about the client’s budget at the beginning of
spending their money?
Second challenge; diagnostics, regardless of their
findings do not influence the care needed. ALL of these cats need to be
unblocked immediately. In some very rare cases there are some patients who
should not be treated, or, have a poor prognosis regardless of treatment. (i.e.
geriatric cats with comorbidities, fractious, feral, unknown rabies history, cats
we will not be able to safely manage fluids/urinary catheter on, loss neural function, etc).
These patients/clients deserve to be notified before treatment, or estimates,
are provided. Futility* medicine should be as ethically bound as economic
euthanasia defaults, and over padded invoices that prohibit care ability because
finances have been drained in the diagnostic phase.
I would like to provide users with a step by step approach
to their cats care. Challenge the suggested treatment protocols to save clients
from economic euthanasia
Next challenge; vets
do not talk to clients about managing financial resources to allow for the expected
stumbles in this disease process.
Challenge; talk about
whole pet care, not point of care emergency. Who else talks to clients like I
do? I say, once we start treating we are all committed to a positive outcome.
This is NOT based on financial ability. It is based on needed patient care. Vet
med withholds this until it is perceived that clients are dry and then we offer
euthanasia as the only affordable option.
Challenge; these cats
are typically young (under 3-4 years old) and otherwise very healthy. We are over-euthanizing
young, previously perfectly healthy cats simply because we have priced them out
of care. These cases have been around for decades. Decades where we treated
them at minimal cost and saved the majority of these cats. Why are more cats dying
now? We priced people out of care while better educating the public on this
disease. That is unethical. This needs to be challenged.
Challenge; why do we
run blood work on ALL of these cats? And then tell owners that ALL of these
cats blood work looks bad, because, well simply they are sick, they are
critical and they do look bad. What were we expecting the blood work to look
like? We do it to make money, and, we do it to CYA, and we do it because someone
made us believe it was a liability otherwise? It’s time to challenge pricing
pets out of care while we CYA.
ChallengeALL of these cats in my experience go back to
perfectly normal blood work indices after their obstruction is removed and they
are given time to recover. They do not start out in kidney failure although all
of them have blood work that looks like kidney failure while they are blocked
and present for care. Vets use this to their advantage when discussing
euthanasia, or repeating blood work. It is deceitful.
In cases of financial limitations (this is decided up front
at the first visit/interaction) we have an ethical obligation to discuss what
we expect, what we have seen to be true, and that this is not a one and done
fix. We need to start with a whole cat case approach, not a singular point in
time under emergency induced emotional duress and take clients for a one and
done as much as we can get them for and to-hell-if the cat is euthanized
along the way approach. We know better, even if our clients don’t.
Challenge; This ridiculous, archaic practice of not having
vets discuss money (see equally ridiculous reasons here)
Challenge; most ER vets are unblocking without general
anesthesia between cases. We can do it so quickly that the charge given to the
owner is exorbitant. In many cases we can unblock a cat in the same time it can
take to pass an i.v. catheter.
Challenge a line item list of how a cat is unblocked is not
provided to the client.
Documentation on the procedure and the time necessary to
unblock is not provided. This should be provided before treatments are given AND confirmed before invoice is given.
Challenge; Removing a urinary catheter before 72 hours, or before the
urine is running diluted and clear is setting the patient up to reblock. I
would argue that we use time based estimates which are always egregiously too
short thereby setting the patient up to reblock. Veterinarians should expect,
and do, the cat to reblock within a very short period of time. We make more
money with the cats failure. The ethics of this should be challenged. If clients cannot afford to keep a patient in the hospital they should be allowed to be transferred to a primary care facility, i.e. their normal veterinarian (even if they do not have 24 hour care), and/or allowed to go home with the intravenous catheter AND urinary catheter in place to be monitored at home. Challenge; I have never seen this happen. In all cases these are removed by the ER facility. These critical goods are paid for and owned by the client. Removing them without consent is a breach of consensual care and a done to the detriment of the patient.
We should all expect that a cat that has blocked once, will soon block again. How many times can the client pay for this? We should be addressing this at the first visit. We should be using the clients ability for the expected treatment course, and not the typical one time financial hit. We require a deposit for care, and that deposit is typically exhausted within the first 12-24 hours leaving cats to be discharged before they are ready, and setting the client up for a repeat obstruction within days to weeks. Where a small percentage of cats are treated on the first obstruction many are not on the second. Further the trauma of the blockage compounded by the passing of a urinary catheter causes excessive damage to the patient urethra. I would argue that the removal of a urinary catheter prematurely causes an increased chance of reblocking and therefore makes the veterinary team responsible for re-current obstructions that frequently occur within days.
The inflammation from BOTH the blockage AND the urinary catheter always needs more than 12-24
hours to resolve.
Challenge; a client pays for the goods and services provided
to the patient. Why then do vets insist on removing these? At least we should
unblock and transfer elsewhere to provide these patients a longer fluid therapy
plan. We need to be documenting and insisting these cats continue care
elsewhere. Even if this at the owners home, if it cannot happen at a veterinary
facility.
Although not ideal we keep cats in our vet hospital for 3-5
days even though there is no overnight care.
These cats need fluid therapy AND urinary catheterization
for 3-5 days.
Unblocking a cat at my clinic; Client call to front desk with any of the above clinical signs is sent immediately to the Charge Tech. They immediately notify a veterinarian of the cat being blocked. If the cat is an existing patient we direct them to go to the ER immediately, or come to us. Upon arrival we immediatelyexamine to confirm bladder is large, painful and no
urine will pass. Do not squeeze too hard. Bladder can rupture. This is always a
surgical emergency, financially constrained clients will not be able to afford
this.
Treatment tree looks like this;
cold laser therapy of prepuce. Will reduce
inflammation and allow some sediment to pass.
massage penis to remove calculi. May allow urine
to pass,
attempt to place/pass a urinary catheter.
Catheter selection matters, avoid tomcats and red rubbers, try Tom Tiddle, 3.5
french. Lots of lube!
Start i.v. fluids as fast as able. These cats
die from dehydration causing cardiac fatality.
If unable to pass Ucath, try to relieve urethral
obstruction with olive tipped syringe and 20 ml saline to retropulse
obstruction back into the bladder. Lots of lube
If unable to olive tipped syringe decompress
bladder with 22 gauge needle. Remove as much urine as able. I leave needle in
bladder and switch out 20 ml syringes until bladder is soft. Warning, bladder
rupture is possible.
Continue laser, massage and retropulsion with
olive tipped. In almost all cases you can feel obstruction move as these are
done.
Attempt to place Tom Tiddle and suture stopper to prepuce. If able;
Flush bladder with sterile saline to remove as
much debris, and blood as able.
Place collection back onto Ucath
Start iv fluids. We use NaCl for ivf therapy
If a higher degree of difficulty in passing ucath take
lateral caudal ab xray to look for bladder stones. This may indicate a
cystotomy is needed.
Challenge; it is easier to unblock a cat then spay a large,
fat dog. Why then is this done at 4 plus times the cost to the owner?
Why is it ethical to be charging so much just because this
is an emergency? I would also challenge that these cats are easier to treat than a big aged dog spay, Which we do routinely and charge for at a fraction of the cost, because people can find this surgery at almost every veterinary facility. Where there is competition there is a lower price point. Further a spay is (typically) elective.
At home care after urine is clear; the following are my patients;
Teach owner how to palpate for the urinary
bladder.
Place patient on a steroid to encourage drinking
water and reduce inflammation.
Feed a wet food only urinary diet. Add water to
each meal. The diet should be a urinary prescription formula and it should be
used for the rest of the cats life.
Encourage water intake with a fountain,.
Encourage play.
Reduce stress in any and every way possible.
Monitor litter boxes lifelong. New litter
options are being produced to help guide clients in detecting and monitoring
for possible issues.
Use anti anxiety medications like gabapentin.
Or, long term medications like fluoxetine.
Use analgesics like transmucosal/dermal buprinex. Pain medications will help these patients quality of life. Reduce stress and reduce likelihood of recurrent stress induced cystitis, further reducing chances of reblocking.
Give sq fluids at home for days to weeks post op. Fluid kits are available on Chewy.com
We need to develop ways to allow in home care and supervision. Pawbly.com can help. Start a savings account for the next urinary
issue. If necessary discuss a PU surgery as the next treatment option. See VetBilling.com for pet savings plan options.
PU surgery.
Here is a video from my YouTube channel on unblocking a patient of mine. More videos can be found there. Link here
How do I get these patients treated for about $1,000 (and, yes, even I admit this is too costly for many people), I invest in my clients
AND patients care. We start with a goal. We talk about options. Every single option. They are all weighted equally to reinforce that we are in this together. From start to finish. If none of these seem acceptable to the client I ask, "what will it take for me to help your cat?"
We start there.
If you have a cat, particularly an adult (greater than 1 year of age), indoor, neutered, male on a dry food diet (particularly a grocery store brand) you need to ask your vet what would happen if your cat blocked? Would they refer you to an ER? If so. how much might this cost? Be prepared before this happens to you. Please follow my blog, my Jarrettsville Veterinary Center Facebook page, my YouTube channel for more on this, and other pet care issues. Please also stay tuned for a step by step guide to managing your cats emergencies, especially if you do not have an emergency pet care fund with at least $2,000 in it, as we are working on it now.
For more help you can ask our pet care professionals for free at Pawbly.com
There are tougher parts to this job than most people think. These are the eternal forces that pull you into and out of the ability to care. The profession calls it “compassion fatigue,” I call it surrendering your purpose. It is a fight I have every day. It is a fight I expect to have everyday as I continue to practice vet med with the public paying my way.
“I don’t know how you do it.”
“I always wanted to be a vet, until I realized I would have to do this.”
“I couldn’t do it.”
“This must be the hardest part of your job?”
I hear these weekly, and, on the really bad days, I hear them daily. The small talk, the dropped one-liners that are delivered to me as I am sending another life into the after life. They are the common conversation fillers from clients as I humanely euthanize their pet. They are the reminders of how dismal this job can be. How emotionally and mentally taxing the price is for pet care at this level as your chosen path. We tell ourselves it isn't our fault. That this task is our final act of compassion, but, the truth is we have to tell ourselves something to stomach the acrid taste of being the designated henchmen.
For the majority of clients that I see, saying good bye to their pets is a kind way to spare their loved ones further suffering and the passing is marked by overwhelming grief. For for a smaller group of people it is the only way out of a situation they can no longer manage. In either case I am always sure that this act is based on love. I have spent decades insulating myself from the other scenarios that bring euthanasia to the resolution of a pets treatment care plan. The cases who can no longer afford further care even when the condition is treatable, or, believe that the road to recovery may be too long and arduous to attempt. The disposable pets who are more affordably replaced versus ‘fixed’. The cruelty cases, the court mandated cases, the "found but don’t want cases," and the weak/dying/debilitated/desperate cases. I have somehow figured out a way out of being simply the euthanasia mother to these. It has taken stern warnings to the staff, repeated pleas to the receptionists, and a no-exception scheduling of walk-in euthanasia's. It has taken courage to stand this ground. I have been called terrible names. I have lost clients. I have been brought to the medical board, punished and chastised, and, yet I still stand firm on my position. I will not euthanize a treatable pet without offering every option imaginable, and extending myself further than is ever expected. I will not go to my retirement with blood on my hands. If, and when, I leave this profession, as I lie in my own grave I will at least like myself for standing up for my patients. It is not the path of my fore-fathers. The men who began this profession to serve the needs of their community. Veterinary medicine has changed over the last 100 years, most remarkably within the last 20. The place of our pets within our families has evolved. The desire to value our pets as family members has driven the wealth in the vet med profession and lucrative lifestyles we veterinarians can lead because of this, and, it should follow that our perspectives on these patients who allow us this should also evolve. There is a sphere of hypocrisy among our colleagues and within the leaders of the profession. The belief that we should not judge, and that we cannot maintain a healthy client base if we don't answer all of the client requests, (almost regardless of the basis of said request). These tenets have shaped us into appearing "indifferent" as we deny care to those who are financially constrained and yet also the exemplification of absolutely devoted to their pets, while we "humanely" euthanize the cases we feel are better off dead than neglected of the care we deem "most appropriate". All judgement calls. We readily, and, almost universally shirk emotional investment as we consistently and almost without exception buffer our own personal financial risk. We do so with the legal backing of the state veterinary boards and the national leadership. We un-apologetically (my least favorite over used axiom in the profession), deny based on any desire we choose. Veterinarians are emotionally scraping the bottom of an all too empty well, as we blame poor financial decisions of our creation, (if you cannot afford to go to vet school, and you cannot financially recover from that decision based on your current or projected salary whose fault is that), as we at the same time blame poor decision making on clients financial limitations whom we remind all too often need only have that pet based on responsibility versus rights. (My second least favorite vet med saying). It is an impossible game to play. I have learned this the hard way too. I hate myself for being the middle man between clients who don't value their pets as worthy of love, and the investment that this responsibility requires, and, then I hate myself most when I consider turning my back on a case I believe I can assist. I often sit trying to chose between which scenario I will hate myself less for. It is all about choices, and, getting out of this alive.
I am too often left with trying to discern what the hardest part of this for profession for me? I will admit it has changed over time. It has transitioned along with my courage to stay viable. Early on the hardest part was the angry and demanding owners who tried to remind me that; “I work for them, and, therefore it is my duty to fulfill their wishes to kill their pet/declaw the pet/etc.” I have bid them all adieu. I am financially secure enough to have this luxury. Truth is I have decided I could not go on like that so the financial loss was apparent either way. As I was figuring out who I was, I was realizing they didn't fit my perspective professional path. I, along with the rest of us, cannot be everything to everyone.
Then there was the period where I knew I was being tested to see if I could maintain my own choosing between doing the kind thing for my patient who had just been hit by a truck puppy and the manipulative demanding owner who wanted everything for free and then to have their puppy back. I wasn't sending her back to them. They had withheld lifesaving care I gave them for free the last time , an old yellow lab who died the most horrific death of denial of care, and it had left me heartbroken like no other case has before or since. I should have reported them, another lesson I have learned, and I hadn't fired them in time to avoid this (their new puppy to replace the dead previous lab) puppy and the truck, which the state board so firmly reminded me, that “euthanasia is a required to be offered option for every, (yes, they used the word “every”), condition.” I suspected I was going to pay for this decision when I was making it. My pocket paid a fine, but my heart did not. I still know it was the kind decision for Sadie, even if it wasn't the right decision in the state boards eyes. Sadie is alive and well almost 10 years later with a different family, (the original family tried to get the board to force me to relinquish ownership after they surrendered her due to lack of any funds to treat her. After I paid to have her fixed they sued me. The board offered to drop charges if I returned. I didn’t. They charged ahead for not offering euthanasia). You have to pick sides in life. Make hard choices. Decide whose integrity you care about most.
The hardest part for me after I earned and tested my titanium britches was the cruelty. It is the single undeniable force that breaks vets. Cruelty comes from only one side of our equation; our clients. It is the people who kill you. Chip away at your ability to remain centered on your patients and the care they need. Indifference is the dark side. The force that whispers in your ear over and over to just stop caring so much that the vulnerability leaves you marching to the fatigue that compassion can cost you.
How do I get around the cruelty? I use the tools I have at hand. I simply don’t tolerate it. I don’t turn a blind eye and I don’t ignore it. If it crosses my path, and it does, I take photos, I have frank conversations about what I am seeing, how I am documenting it and what needs to happen to keep me from reporting it. Doesn’t it seem odd that society has anti cruelty laws and yet you can euthanize for anything? I call out Animal Control to bear witness. I leave the judgement of inadequate care, neglect, cruelty in their hands. It is the job they signed up for. I am now the messenger, albeit hypervigilant, but that is part of my purpose to protect the pets I still call the love of my life.
The hardest part for me these days is the looking into their eyes, these patients who I have elevated to be the answers to cause and consequence, and asking the hard, deeply moving, philosophically governing questions. There are patients who are suffering and desperate to get better and there are others who are suffering, dying and don’t want to go on. Here is where I am finding my latest cross to bear. The part that is chipping away at my inner purpose and conviction to course.
When I can see the difference in their eyes and not be able to do anything to change it.
I will never let myself be any other kind of veterinarian than the one who shows up for her patients. Although our clients are an integral part of our ability to keep our pets healthy my love and my loyalties lie in the preservation of life and health of the cats, dogs, kittens, and puppies I pledged to serve. Not putting them first, in everything I do, is answering to the indifference that has plagued too many lives already. I entered vet med with the same single belief the rest of us do, we love animals.
If you take the time to look into their eyes they will tell you everything you need to know. I, as the practitioner also have to listen as I gaze. I have to believe what my heart and soul tell me, what so many of us know already, that they have a place in our hearts because they have a heart of their own. Isn't that everything in this lifetime worth fighting for?
For more information on anything and everything pet related please ask us for free at Pawbly.com.
If you are a pet care provider who is willing to help pets in need with your advice and compassionate words of kindness please consider joining us and adding your pet care experiences and thoughts at Pawbly.com. We are always in need of reputable professionals who can educate and inspire.
I have this terrible affliction.. It's a bibliophile thing... like obsessive. There is the smell,, the musty, powdery ashen parchment.. it's intoxicating just a tactile feast. Then you get the extra added bonus of that wealth of adventure, knowledge, and escaping story desire and it's euphoria I cannot resist.
When it comes to the challenging moments of my life, those little bumps along the way that cause me to trudge and shuffle, I turn to the poetry flavored feminist written chorus columnist-seasoned manifestos.
This is my new go-to;
This little green wonder is my hard copy to Gloria Gaynors anthem,,, you know the one; "I will survive," every jilted girls hashtag for getting over being disposed of. But, as with all personal rites of passage you customize a little. Accessorize, monogram, throw in a few extra expletives, drop an F-U to the waning fist pumping moments, spare a tissue drop a threat and a promise save yourself a wrinkle and rehydration requirements.Salt stains after all.
So, I buy a book I think can add a bit of stiffness to my tired bowing back, and then I spice it up.. just to taste,, as a former sailor I find starching, corner creases, a gigline, and a potty mouth help immensely.
Here is my edited version of an almost perfect book from the start;
Medicine, veterinary medicine especially is fraught with insecurity, imposter syndrome paralysis, fear, suicide, and getting through the day, never mind safely to retirement takes grit, courage, dedication and a strong overwhelming sense of purpose. For me it has been a series of challenges so incredibly devastating I have learned to fight for what I believe in every single case every single day. I also stay true to one thing above all else, my own path. So, if you need a little bolster of conviction buy yourself the outline of the story you are walking (or stumbling and trudging) toward your journeys happy ever after add indelible adjectives and your own sparkle, whatever it takes to get out alive and still like you best of all on the other side.
That's Brave Enough for us all.
If you like content that is animal centered and medicine flavored visit me at my other social media stops;
Pawbly.com the place for free pet healthcare advice. We share stories, experiences and open access to a worldwide pet community.
Jarrettsville Vet, my clinic, where miracles and hope are alive and never based on a price tag.
The cases that move me are not the easy quick ones.
Life works that way. Your greatest rewards often lie in the trenches during the greatest conflicts. It is our version of the battlefield stories that bond us in our darkest hours.
Yesterday was one of those days. (I seem to live in these days these days).
We get a call that goes something like this; (I only heard one side of the conversation. My receptionists side).
"I'm sorry to hear about your cat. You say that you found a clinic that would give your cat a free examination, (clearly a corporate marketing tool to drum up new clients I thought?), and, they say your cat is blocked? (A blocked cat is a cat who cannot pee and this is ALWAYS an emergency!)." long pause.. "I'm sorry did you say that you have seven (7????) dollars?" Her voice took a tragic upturn on the dollar sign part.
...short pause.....
"Ok, well,,, umm,, (pause) ummm,,, (deep swallow),,, let me get your information and I will call you right back." My receptionists are seasoned pros. They hardly get flustered. But, then again, who calls with $7?
At this point everyone within ear shot was huddling around her desk with muffled giggling. This is the giggle of the great battles. The first shot has been fired, the troops are gathering and a plan is about to be hatched. These are the stories of the place Jarrettsville Vet has become. These are the stories other vets get, most sarcastically laugh at and dismiss, disregard, or decide to just be bitter about. I was/am/try very hard NOT to be this person. I pay for electricity, wages (waaay above minimum btw) and blah, blah, blah, (excuses to not care), but it doesn't change the fact that there is still this guy, AND, there is still this cat.... so we listen to the stories. We gather the troops, and we devise a plan. The plan is always a conversation, a compromise and a quest. The goal however is always mutually consistent in the most critical component: We have to act fast AND we feel compelled to get help. We place phone calls. We are a place that listens and lives by our motto 24/7/365.
After a round table discussion we formulated a preliminary plan. The first phone call was back to the cats dad. We have a team dedicated to returning these phone calls. We have a shield for them in our first line of defense, our receptionists, then the team takes over. No one should be the single troop in a militia. The first test is in assessing the pet parents intention and integrity. He has to be able to compromise. Turns out he also has to be one other thing.. completely dedicated to his pet and follow through with our advice so we don't perpetuate another terrible predicament. Vitally important to the success of these cases is that he has to participate in this cats treatment, recovery and long term care. Thankfully we discover that he loves his cat and he is willing to do whatever he needs to keep him healthy. I can do just about anything as long as we start here. Everyone has to invest in CARING. Nothing of merit lives outside of caring.
Next step in the plan of attack;
We called our friends at the rescue. Circle the wagons, build momentum by uniting the troops. They have the ability to manage this cats care after we get him unblocked. They can manage the nursing care for the next few days while he gets his bladder and kidneys diuresed. It is nothing more than a medically induced flushing of his urinary system. "The solution to pollution is dilution."
They offered to pay for his after care. We would get him unblocked. Two phone calls and we are on our way to saving this cats life. Go Team GO!
An hour later we met Socks.. As always (ok,, truly always), the ones who need you the most are the ones who are the sweetest souls. This cat was pure love. Young, adorable, and desperate to pee. He purred the entire time we squeezed his rock hard massively overfilled bladder.
Here is his story in synoptic detail, video style.
There are articles and discussions of this condition listed below. While I am not here to argue that there are absolute benefits to maintaining ideal standards of care I firmly beleive that the biggest failure we provide is not offering assistance regardless of clients financial abilities. When we as a profession decide collectively to support our patients first I will with hold posting prices and offering cost saving options. Get Out Alive series is coming. Blocked Cats is first on my list. Next, pyometras.
The typical cost of a blocked cat at my clinic is;
Exam; $50 to $75
Radiograph $100 *
Intravenous catheter $40
Intravenous fluids $40
Intravenous fluid pump $40
Anesthesia $100
Urinary catheter placement $75
Hospitalization care about $100 per day. Usually stays for 3-5 days.
Bloodwork $150 *
Urinalysis $50 *
Feline Urethral Obstruction: Diagnosis and Management. By Today's Veterinary Practice. A very thorough description of how, why and what happens to these cats along with detailed description of treatment options. I recommend taking this article and discussing each step with your veterinarian as they provide an estimate for the cost of care. Know how much each step costs, know where your cat falls within the spectrum of the disease process and know that one size does not fit all! You may be able to cut some costs with the use of this step by step guide. Get everything in writing and GET OUT ALIVE!
Controversies in the management of feline urethral obstruction. Journal of veterinary emergency medicine. 2015, PubMed. Please read the prognosis section; "Feline urethral obstruction is associated with 90-95% survival, with reported recurrence rates of 15-40%." How many people cannot afford to treat their cat when the survival rate is this high? I would guess that there is not a single other emergency condition that pets get that has this high of a survival rate when compared to the number of economic euthanasia's due to cost. What is the rate of economic euthanasia for this condition? At my clinic it is zero. What is it elsewhere? (Good question? Anyone want to share their numbers? Speculative numbers?)?
Can these cases be managed at home? Without a veterinarians intervention or assistance? I would strongly discourage this. I feel the prognosis is far better with a urinary catheter placed and intravenous fluid therapy to flush the bladder, kidneys and remove the toxins and systemic imbalances, but here is a widely cited article on managing these cases at home. Which is better than nothing (although I would still argue it isn't enough!).
If you have questions about your cats care, the cost associated with this diagnosis and most importantly ever feel pressured to euthanize based on economics please ask/beg/insist on options and please seek a second, third, or even fourth opinion so that your treatable cat can GET OUT ALIVE!.
I am here for you. Find me on Pawbly.com and remember "never go quietly into the night."
Parting thoughts;
1. Get Out Alive. Ask about options. Insist on care. Document everything. There is help available even if you have to be insistent on it. This is an emergency condition and your cats life depends on your actions. Be kind. Always be kind. You can't ask someone to be someone you are not.
2. If you do not have any financial constraints almost every vet and emergency facility can care for your cat with this condition.
3. If you do have financial constraints ask for a written estimate. Go over each line item. Ask which is most imperative at the immediate time. Ask the vet to rank these. Start at number one. Stay at the clinic as each line item is addressed. Once your cat can be transferred to your vet it might be more affordable to get their care with them.
4. Ask about the incidence of recurrence for this condition? Ask how you might be able to avoid this? My advice is a diet and lifestyle change. Less dry food, less poor quality dry food, more exercise, less stress. (Ask about cat stressors? Often clients cannot, and do not see the world the way their cats do).
5. Ask about a PU surgery. Start planning and saving for it. The second, and definitely the third time a cat blocks we put this surgery on the table. This is about GETTING OUT ALIVE! remember. PU surgery info here. Perineal Urethostomy by Michigan Animal Hospital. Cost is between $1,000 and $3,500.
If you have a pet story that you would like to share, or an experience with this condition please add it to our Storyline page at Pawbly.com.
