Pyometra Emergency. Saving your pets life when optimal options aren't possible.

Chloe is prepped for her big restoration and transformation.

There are many cases who find me. The power of social media and pet parent desperation often come to a head at my doorstep. It wasn't necessarily my intention to be the landing page for those who had no luck at other equally capable veterinarians hospitals, but I am finding myself to be the vet who offers options to those who are not receiving affordable treatment plans elsewhere. There is a great divide happening in medicine and consequently a huge number of pets falling into the growing chasm of divide simply because pet parents are being priced out of the care they need.

Chloe is a speck of a Yorkie. Demure, quiet, reserved and always trying to hide in the shadows of her moms arms who persistently protect her from having to face the world with a nose to the heavens.

Mom loves Chloe, but like so many others, life had gotten bumpy and difficult and Chloe's health care needs were being overlooked due to more immediate pressing matters until last weekend when Chloe wouldn't eat and was acting very sick and reluctant to move or play.

Chloe headed to the emergency clinic. Within a few hours her illness had a name; pyometra. Unfortunately that $750 work up cost her family all of the money they had. The price tag Chloe's mom was given for the treatment she needed was estimated at $2900. They walked out of the ER with antibiotics and a dog who still needed life threatening surgery.

I have this gripe that I cannot seem to convince the rest of the veterinary world to pay attention to.. the point of veterinary patient care, the reason people drive their pets into our door, is NOT JUST TO TELL THEM WHAT IS WRONG!!! OUR JOB IS TO DO THAT, AND (MOST VITALLY IMPORTANTLY), TO FIX THEM!! 

In fact, I am very certain that our clients are more interested in real help than real answers!

An invested vet will talk about the resources required to do both, diagnose and fix. Exhausting available resources and not getting to the finish line is not assisting our patients. It is short sighted, veterinary focused mismanagement of client and patient care. A good vet will talk about the most likely diagnosis, the available treatment options, the prognosis for each, and the costs associated with every step of this process. Spending all of Chloe's treatment resources before they get the help that will save their lives is simply cruel tragically failed patient care. 

Chloe has had a retained baby tooth, now mobile simply by touching it, for her whole life.
More information on this here.

Chloe had a laundry list of needs. By the grace of good luck her antibiotics were kicking her uterine infection to the curb and she was feeling better within two days. There was still much to address in her tiny 8 pounds.

People ask me all the time how they can affordably care for their pets? The answer is universal; Keep up with the day to day, month to month, and yearly stuff. Budget and plan for it. It is as important to your pets health as it is to yours.

Here is my short list of needed routine care to avoid the costly veterinary bumps in the road.

• Brush teeth daily.
• Eat a good nutritious wholesome food on a scheduled regimen.
• Get lots of sleep. Dogs have this concept mastered. We have some important lessons to learn from them. 
• Lots of interesting exercise. What do I mean by this? Let your dog be a dog. Sniff, tug, play, hide, walks that are adventurous. Let them explore the world.
• Play hard and sleep hard.
• Ideal body weight and muscle mass. Avoid lots of the diseases and disease processes that obesity predisposes your pet to. 
• Indoor cats need exercise and I warn about poor quality free feeding dry kibble. 
• Basic parasite prevention. For my part of the world this includes fleas, ticks, heartworm, and intestinal parasite preventatives.
• Spay and neuter by 1 year old.
• Obedience and socialization. What would happen to you if you were not able to care for your pet AND your pet refuses to allow anyone else near it?
• Microchips save lives every single day. Make a small investment for the best chance of a happily ever after that you hope you never need to rely on.
• Start a savings plan for the unforeseeable accidents ahead.
• Have a great vet who knows how much you love your pet and be there for each other. Here are my tips on how to get something for nothing from your vet.

Here is what Chloe needed;

• Dental cleaning with numerous extractions. Her mouth was so rotten that almost every tooth was mobile. Every client I show teeth like this to is always shocked that their pet gave them no clues there was such a significant problem. If you didn't brush your teeth daily yours would fall out too. Dogs get used to bad teeth and eat around them. Removing them resolves persistent oral infection and they will eat better afterward. The number of teeth to be removed is often also shocking to clients. In many cases dogs, like Chloe, will have a dozen, or more teeth extracted. If they are bad they are removed. No discussion here. Don't wake a dog up with bad teeth still on board UNLESS you have a dental professional who wants to stage the procedure. Ideal for the patient, more expensive for the client.
• Spay. Her uterine infection will return. Spay her as soon  as possible.
• Get an idea of her overall health before jumping into surgery.
• Caught up on vaccines and preventatives.
• Lay out a plan her mom understands and can afford so that she remains on healthy in the days, weeks, and months ahead.

The original source of Chloe's illness, her pyometra. 
Treatment; simple; uterus and ovaries are removed.

My clinic, my perception, and my obligation to my clients is deeply seeded in my ability to get them what their pet needs in an efficient and affordable fashion. 

Chloe's mom was deeply upset that her dog was in need of so much medical attention. She felt very guilty for both not knowing that her mouth was so diseased, but also that she had waited so long to provide the basic spay, vaccines and annual care she knew she needed. The luxury of going back in time when hindsight is present tense and everything is 20:20 is not something I waste much time on. We are here now, we cannot go back and undo, we can only learn, move forward and do the best we can in the present. 

Chloe's mom wanted to use her tax return to get her well. We had a budget. Budgets are a reality few vet businesses want to hear about. The reality is that most all of us live in the real world of budgets.

The conversation between Chloe's mom and I went something like this;

"Ideally we should put Chloe on antibiotics for two weeks and then give her a dental cleaning and remove all of her diseased teeth. The cost of this is about $800. She probably needs her spay soon too. The longer we wait the more likely it is that the uterine infection can resurface. This surgery is also about $800." Chloe's mom could barely scrape together the $800 for one, she couldn't do it twice. And, as every good family vet will point out, we still needed to get Chloe back on track AFTER the emergent disasters were addressed. Chloe needed about $200 of flea &  tick and heartworm preventatives. I feel very strongly that our mission is to help through the bumps and provide a path forward to help avoid bumps in the future. Every pet leaves Jarrettsville Vet with a short AND long term plan along with associated costs. 

"But how can I do both surgeries? I am so worried that she won't live through all of this if I don't do them? How do I choose between what is safe for her and what is possible for me to be able to afford?"

"We have to make a choice. We have to do what we can, accept what we cannot and tell ourselves that we did the best we could with the resources at hand." This is a concept that I think the veterinary profession is losing sight of. In some effort to promote our bottom lines, save our skin from the chance of liability we don't help people on the level they need us to. 

Chloe had her spay and dental surgeries a few days later. I asked our dental expert veterinarian to help. I wanted Chloe to get all that she needed and I wanted her little 8 pound body to be under general anesthesia for the shortest time possible. I was most worried about her getting too cold being under for the two hours it would take to do all she needed.

Chloe's bill...

Chloe's final bill for her spay and dental (which included almost a dozen teeth be removed) was about $760. It was by no means ideal. She had minimal additional blood work done. She had everything done at the emergency clinic the week before. It was all normal. We did not repeat it. We took a leap of faith, and a calculated risk. We also had the benefit of her being on antibiotics from the emergency visit. We scheduled her surgery on the last day of her emergency antibiotics and then resumed them the day after surgery. She was closely monitored and treated by experienced vets who wanted more than anything to get her back home with all of the needed care she came to us for. That's what your home town vet does.

Two weeks post-op and Chloe is doing great! She has a daily plan her mom understands. She is also on her needed monthly preventatives and will return every 6 months for examinations to make sure nothing else comes up to derail her health.

Chloe is an excellent lesson on finding a way to make a difference in a pets life while working within the real-life constraints of a family on a tight budget.

Update;
This is Chloe at her 2 week post-op visit. Her mouth and abdominal incision are all healing excellently! She received the last of her booster vaccines getting her all up to date on her medical needs. She is happy, active and on a path to maintain these. We are elated to see her back. Her mom knows we are here to help, and with a team in place to care for her, provide guidance, and be willing to face any bumps in the road together her chances of  trouble free future are the best they could possibly be.
Lots of love to Chloe and her family!

Life can be full of happy endings if you can bend, compromise and find help when it is needed. Keep looking if you can't it is out there, we promise!

If you would like to ask me a pet related question you can find me on Pawbly.com. Pawbly is free to use and open to anyone who needs a little  help in finding information or direction with their pets care. We also invite all of the pet lovers out there to join us and share your pet knowledge. 

Me and  the resident clinic governess, Loon.

If you would like me to meet your pet and assist in their care I am happy to try to help. Call me at the clinic, Jarrettsville Veterinary Center in Jarrettsville Maryland. We publish our Price List every year. You can find it here.

I am also occasionally visiting on Twitter @FreePetAdvice,

Cat Dental Disease. How much does it cost and what does it entail?

This is Satin, a middle-aged domestic short haired cat who was found to have calculi and mild gingivitis on her last annual veterinary examination. Dental disease is one of the most common and most overlooked ailment that we see in veterinary medicine.

Dental disease can present in numerous ways, they include;

1. Drooling. Excessive saliva from the mouth.

2. Pawing or rubbing the face or mouth on things or using the paws to rub the face. Most cats doing this have brown matted fur on the inside of the lower front legs, or crusting of saliva on the chin.

3. Reluctance to eat. Trouble picking up the food.

4. Bad breath, or bad odor to the mouth.

5. Loose or missing teeth. These may be found, fall out in the food bowl, be seen projecting from the mouth at weird angles, or appear as empty spaces when they meow.

6. Dropping food from the mouth while eating. For instance they attempt to pick up the food with the mouth, shake the head, or drop the food. This is often caused by pain in applying pressure to the teeth to pick up the food and swallow it.

7. Weight loss. The pain or difficulty in picking up food causes weight loss.

8. Pain, or meowing when the face or head is touched.

Satin was deemed a Grade 2 with her dental disease. We use the grading scale as a way to explain and discuss the presumed severity of the dental disease.

Here are Satin's post dental cleaning photos.

Satin had a pre-op exam ($45) bloodwork and urinalysis ($130). Satin's dental included an i.v. catheter ($40), i.v. fluids ($40), anesthesia ($100), dental cleaning ($95), and post-op injectable 10 day antibiotic ($50). Satin also was microchipped ($10). Nail trims are free with exams and surgeries. He did not have any teeth removed. His total bill for his dental was $335.

Related Blogs;
Simba's Abandonment and Dental Needs.

How Much Does The Average Cat Tooth Extraction Cost?

If you have a pet question please find me on Pawbly.com. Pawbly is free to use and open to all pet people. Learn about your pets health, their behavior, and how to provide the things they need to flourish.

If you are in my neck of the woods stop by the clinic, Jarrettsville Vet and say "Hello." I am also on Twitter @FreePetAdvice.

Bad Breath..Is it the Food, The Teeth, Or your Nose?

Charlie, my pup, and his excellent pearly white teeth.
When you are examining your pets teeth it is important to look at all of the teeth under the upper and lower lip from the tip of the nose to the far back of the mouth (past the back corner of the eye).
The teeth that tend to see the most damage and tartar are the canines and the back molars.

I have been answering questions on Pawbly.com. Here is one of the most common questions I get;

"My 3 yr old Pom has terrible breath, and has since I became his mommy 18 mos. ago. Will brushing his teeth, improve his breath, and remove the tarter on his teeth??? If so, what toothpaste do you recommend? Toothbrush or finger brush?"

A professional dental cleaning includes general anesthesia, digital oral x-rays,
scaling, polishing and any needed extractions.
Many clients get very upset with the number of extractions that a pet sometimes requires.
If the teeth are compromised they should be removed.
It is far better to remove them now then to have a pet go home with a bad tooth
and the need to return a few months later for another extraction.

Here is my  answer;

"In general bad breath is caused by bad teeth. And the smaller the breed of dog the faster and worse the teeth seem to get. 

Brushing certainly helps keep the teeth from getting caked with calculi and slows down things like gingivitis and gum recession, BUT, if the teeth are already diseased (as evident by having bad breath), then you probably need a professional dental cleaning with your vet before the brushing will be beneficial.

My best advice is to make an appointment with your vet to have them look at the teeth. They can tell you whether it is time for  dental cleaning, or whether the brushing is enough.

A few points to mention:

Brushing needs to be done daily (at least 4-5 times a week) for it to be beneficial. (Afterall we brush twice a day, AND floss..so it makes sense that our pet needs brushing daily).

It doesn't really matter how, or what you use to brush. As long as you are making contact with the outside of the teeth along the inner cheek. Dogs and cats tend to get the worst calculi on the canine teeth and back molars. I recommend gauze squares wrapped around the index finger and then brush/rub the outer surfaces of these teeth just inside the upper cheek..(I will post a video later on my blog with a demo..KMDVM.blogspot.com). I don't usually recommend any fancy products..and pets tend to want to chew your finger if you use toothpaste.

Another thing to discuss with your vet is the food you feed. The soft chewy foods tend to stick to teeth and accelerate the tartar/calculi gum disease process. The flip side is that hard food might help little bit in adding abrasion to the teeth surfaces and probably don't stick to the teeth as much as soft food, you still need to brush daily.

All of those products that are marketed to keep teeth clean (like chew sticks, water additives, chew toys, etc). help a little tiny bit,,,but in the big scheme of your pups 15 year life span they don't make enough of a difference to allow you to not brush.

Last note, unfortunately, I have seen 3 year old small breed dogs who need dentals. So, have your vet take a peek at their mouth. 

Best of luck,, and thanks for the question.

I hope this helps!

Krista"

This molar (at the area of the bleeding, top maxilla furthest to the right, just in front of the finger),
 could only be assessed after we removed the thick layer of calculi.
The roots are exposed and the tooth requires extraction.
The tooth in front of it (to the left) is likely also compromised and likely needs extraction. 

A fractured PM4. Gum recession, and a diseased likely painful tooth.
Extraction is recommended.

If you have any pet related questions you can ask them for free at Pawbly.com..Or you can just visit us there and share your pet  photos, help others with pet questions, or create your own pet topic. Pawbly is a place where people who love pets help other pet people.

Or you can find me chirping away on Twitter @FreePetAdvice.

Or come visit me at the clinic, Jarrettsville Vet.

Here is an excellent blog on brushing teeth, Fidoseofreality.com.

I have every intention of posting a video of my method. It's on my To-Do list, which, gets longer day after day.

Kisses from and to a race observer at the annual
Our Lady's Manor Races in Monkton MD. yesterday.

Laddie, a dear JVC friend models in front of our banner.

The tissue paper that hides under your skin. Subcutaneous Emphysema.

There are the conditions that we read and learn about in vet school and can't fully understand until you see and feel it in person.

We learn about goose stepping and what kind of neurological condition it implies, but until you see a dog do it is just a foot note in the big cranial waste basket. You have to see it in person to appreciate that it does look exactly like it sounds.

Or, how about raspberry jam diarrhea. Yep, it looks exactly like the real thing.

The other day we saw Yeager, a Humane Society rescue dog with an abnormal facial swelling. Because veterinary medicine is practiced by the law of averages we assumed that Yeager, an older dog, had a bad tooth.

One of the most common ways that a pet with severe dental disease presents is with a swelling under the eye. (The other obvious way that a parent knows their pet has bad teeth is bad breath. IF your pet has bad breath I am willing to bet money that they have bad teeth. Have them checked ASAP, dental disease is the most common and most over looked pet health issue.)

How does this happen? Well, the tooth roots which are anchored in bone which is adjacent to the sinus cavity. The most classic facial swelling vets see is a periapical abscess of the upper fourth premolar, (the biggest tooth with the largest number of roots in the mouth). When the root gets an abscess it starts to swell and the easiest place for it to go is up toward the eye. If the swelling is allowed to continue it will eventually rupture and a draining tract will result.

Yeager is a difficult dog. He has abandoned the ability to provide a stranger the benefit of doubt. He prefers to growl, snarl, lunge and bite as an introductory "hello."

Unfortunately his demeanor required a muzzle for most of the handling he gets at the vets office. It is impossible to examine a dogs mouth with a muzzle on. And, for those patients with teeth that look bad the true test for the extent of dental disease, decay, and decisions lie in the dental x-rays.

Yeager was put under general anesthesia and the source of his swelling was at this point discovered to be a cut on the head from a fight.

Yeagers forehead sounded like tissue paper when you touched it. Commonly, we compare it to bubble wrap. When you press on the skin you can hear and feel a layer of popping crunching tissue just beneath the skin.

It is almost addicting to poke at.

What happens to produce this?

It is actually air trapped under the skin. And it crackles and pops when you press on it.

Air can be trapped by either trauma, where the skin is pulled from the subcutaneous tissue. Like separating layers of phyllo dough in baklava. If the skin is pulled out of its roots from the lower tissue layers and if there is a hole somewhere close that lets air in that air can get trapped between these layers.

It is called subcutaneous emphysema.

We see it in bite wounds, trauma, and tears in the trachea. Tears in the trachea can occur with intubation for anesthesia or bite wounds.

If the tear is a wound and the trachea is intact we usually can just watch, wait and provide pain management and antibiotics. We prescribe antibiotics because the air can actually be produced by bacteria that are trapped under the skin. Those bugs are trapped and they do what they always must do to survive. They eat, they replicate and their by-product is waste in the form of gas. 

For tears in the trachea surgical intervention is warranted. The thorax (chest cavity) needs to stay at a constant negative pressure for the lungs to bellow in their normal rhythmic in-and-out motion.

Any pet with subq emphysema, abnormal swelling, difficulty breathing, bad breath, or any signs of trauma should be seen by a veterinarian as soon as possible. Difficulty breathing is ALWAYS an emergency and should be seen immediately!

Yeager went back to the rescue with antibiotics and a careful note to monitor closely.

He is expected to make a full and uneventful recovery.

Related stories; 

A Good Deed and Two Bad Dogs

Abby's Story

If you have any pet related questions you can ask me, (and a whole bunch of incredibly smart people), at Pawbly.com. We are happy to help you and your pet and we are always free to use!

Or You can find me @FreePetAdvice on Twitter.

Have a wonderful weekend everyone! And please always be kind! And, one last thing, November is Adopt A Senior Pet Month. Please consider finding a place in your heart and your home for a pet in need.

Pheobe, adopted in the autumn of her life.
It saved her life and made her companion a happier less anxious pup.
Adopting an older pet will SAVE their life and it might enrich yours in more ways than you can imagine.
It is never about the length of your journey, but instead the steps you take along the way.

Taffy's Tongue Tumor. Part Three of the Mass Removal Series.

Taffy is a 13 year old long haired orange tabby. He has been struggling with a decreasing appetite for months. His mom has been trying every kind of food and every kind of texture to try to convince him to eat. It has been a roller coaster ride that has been full of frustration and worry.

His first visit to the vet revealed an irregular ulcerative red spot under his tongue. Despite trying antibiotics and watching to wait and see over time the mass had grown to cover over half of his tongue. Taffy's tongue was swollen making ti hard to hold in his mouth. The mass was painful and the pain made Taffy reluctant to eat, and he was now drooling constantly. The decreased food intake was causing weight loss and muscle loss. The muscle loss was causing him to have more and more difficulty in getting up and walking. (Quick cat tip: cats often show weakness in their back legs. They will walk plantigrade (with the hocks (ankles) dropped. So instead of walking on their back toes they walk on the foot from the toes to the ankle. If you notice this in your cat go to the vet. This is also one of the first signs we see in diabetic cats). He needed relief quickly or he was going to continue to slip downhill and that down hill slope will get progressively steeper as you slide into the abyss. At some point your pet will not be able to crawl out of that abyss.

I saw Taffy for his surgery a few days later. Before surgery I gave him another thorough examination, reviewed his pre-op history and diagnostics and took some x-rays to make sure that there wasn't any evidence of cancer. We thought that the lesion under the tongue might be cancer so we look very hard everywhere else to see if it has spread. IF the cancer had spread his prognosis would be much worse and the surgery might be done just for de-bulking, temporary relief purposes, instead of getting clear margins. All of these thing are vitally important points to discuss before surgery.

My point is to be proactive and not wait until that mass is your pets death sentence.

Induction agent being delivered to put Taffy under anesthesia.

After Taffy was sedated to be intubated we could see for the first time the complete source of his pain.

Intubating for inhalant anesthesia.

Looking down the throat to see where to put the endotracheal tube.

Looking to check before placing the endotracheal tube.

My very good friend, and fellow veterinarian, referred Taffy to me specifically because at our clinic we have a laser that we can use to remove masses. The laser reduces the bleeding and surgical time and she believed was the best tool to try to remove Taffy's tumor.

Taffy's tumor was in a tough spot. All the way in the back half of the underside of the tongue. Until he was under anesthesia completely we weren't really sure how big or how deep it was. Many times in surgery it is as much discovery and examination as it is attempt to surgically correct and/or remove. (That's why it is sometimes very hard to give a definitive estimate for services). I was not sure I was going to be able to remove this with even the laser, and I was not sure what "IT" was to begin with.

We began surgery with the laser. Removing the mass was made much easier with the laser but there is only so much tissue that you can remove at the base of the tongue and it is a fine line between enough to get Taffy comfortable and able to eat again and too much tissue removed and the tongue becomes non-functional.

Ready to be draped in for surgery.

OUCH!

Ready for surgery!

Begin lasering.

After the mass was lasered off the tongue was sutured closed. The tongue is essentially one large muscle, and muscle bleeds readily. In order to reduce the normal trauma that the tongue encounters as it moves in the mouth and rubs against the teeth I had to close the surrounding tissue.

The tongue is sutured and the mouth should be much more comfortable. I expect that with a few days of antibiotics and pain management that he will be back to eating voraciously.

The tissue should be sent out for a biopsy to diagnose the lesion and help treat it appropriately. The biopsy will also assist in prognosis and future treatment should it recur.

To adress the chance that the lesion might be related to dental disease we cleaned and polished the teeth. Taffy's owners will also be instructed on how to brush them and be advised to do this daily.

Taffy is part three of the "wait until the last minute" mass removal. This series was written to remind us all that medicine is often a juggling act. We are always juggling risk versus consequence. The important thing to remember is that the plan will change as the patient changes. Don't be afraid to re-assess, re-think, and change course.

Be proactive and try not to use age as a reason to deny possible life saving treatment.

If you have any questions or comments about this blog, or any aspect of veterinary care please leave me a comment. You can also find me, and a whole bunch of other pet experts at Pawbly.com. We are happy to help you and your pet live a long healthy life together.