Patient Ownership Amongst The Veterinarians

There is a secret to medicine that you only learn with decades of passage. The secret is to remain vulnerable. Remain hopeful, kind, and adoring to the companions that fill your life with gentle inclusion. Look into their eyes and feel what is reflected back. Be compassionate as the guide to healing both them, and yourself. The patients will never let you down, therefore, keep reinvesting in them. 

These patients that I am entrusted with, the small, the weak, the voiceless, they are my WHY.

Honey's Story Here

There are a multitude of reasons why vets stay at one practice for decades, or, their lifetime. I can tell you that with 20 years in, I will never leave JVC because my roots are so deep in my patients/clients lives that I can no longer dissect one from the other. These patients and families are my glue. They are my roadmap, compass, and cadence. They are my time, my waking moments, my daily guide and my nightly whispers. They are the first thing I check before bed. The first thing I wake up to, and the delightful fluff of the middle. My pets are an extension of who I am as much as everyone else's pets remind me how important they are to their family.

Last night I sat with a mid-20's guy who cried buckets of uncontrollable tears over the loss of his 6 year old cat. It was raw, and tragic, and gut-wrenching to be a part of. It was also the best example of a real moment of this life I am so honored and privileged to be a part of. It is a perfect reminder that all of us need to spend more time within. If you cannot feel empathy for a loss, as insignificant as others might think a cat's life is, then you are missing the only WHY that will ever give your life true color and beauty. 

Snoops Story Here

The WHY in medicine has to be more than the paycheck and the initials before or after your name tag. The WHY in medicine has to be so powerful that it gets you through the long, exhausting and grueling days. It has to be so powerful that you willingly and knowingly give up the yearning for beaches, and fast cars, and possessions as a way to remind others that you have achieved something envious. It has to be enough to be almost everything. Medicine is that way. The trick is to outwit it with willingness to accept its terms on your own. The trick is to adore it for all of its glory and ugly.

The WHY is all that matters when everything else is breaking your heart.

When the WHY takes the form of a fluffy kitten, a bouncing puppy, the client that you wait excitedly to see in your daily roster, or the cat that you spent months trying to save their leg and/or life, you get invested so deeply that you risk the green-eyed-monster of jealousy. Maybe we shouldn't admit this, and maybe, (in rare cases), we only mean it half-heartedly, but, veterinarians absolutely take ownership of their clients and patients. 

When you tread on that WHY we get seriously protective.

Dexters Story Here

You will a hear robust, boisterous, outcry if one of the other vets walks back holding a patient that another one of us has grown fond of. You will almost see bodily harm if we perceive that the pet parent is forming new bonds with another vet. Fistfights, or the bitter air of plotting passive-aggressive vengeance comes next. There have been occasions where (mysteriously?) one patient's appointment is switched with another's so that the vet can see the one they know and adore, versus the one they do not. It is a game of barter and bribe when one vet won't release possession of the others patient. You can almost get a day off if its the right patient on an otherwise difficult day. Our patients, and clients bring so much to our days that we bicker over them. We absolutely take it personally when one client chooses another provider, or, worse yet, refuses to see you. 

Sure, we take our jobs seriously, and our patient claims vehemently, but, there is a lot to this job, so don't infringe upon our own emotional needs. We need to feel like we have purpose. That our patients rely on us. We need to feel needed. With that comes ownership. It is impossible to not be personally invested and not jealous when the care falls into another camp. That our cup o'WHY is kept topped off.

Me and Goose.
I adore him as much as his family..
They are my WHY just as much as Goose is

Too often clients who say to me, "I know you are busy. I wanted to see you, but, I didn't want to ask for special treatment." This is most often because they have some need to be seen within the next few days or hours, and I am almost always booked weeks in advance. We have pets who we saw for all of their puppy visits. The cats who needed multiple urinary unblockings. The dogs who swallow socks; repeatedly. The cat with the leg that took 3 months of time, love, and dedicated worrying ourselves to pieces of harrowed existence, but is now walking on that leg that everyone else said to "just amputate." We take our little victories, our previous challenges, and we hold them near and dear.  These patients become our obsessive labors of love. If you went into small animal veterinary medicine you did it because dogs and cats compel some little piece of your soul which is meant to care for them. It is the best part of everyday to be with them. I live for these cases. I throw myself into them. When we win our war against their ailment we regale! We never forget these patients. As an extension of these cases we bond to the pets parents. We all go through this together. I feel for them as they feel for their pet, and maybe, just a little bit, for me. Don't all teachers, doctors, caregivers, hair stylists, manicurists, everyone who has to provide care or a service face to face with someone repeatedly, don't we all feel some sense of friendship past the business transaction? 

Allie, who is always this happy to see me.

I know I do. It's only human to get your feelings into the work you are passionate about.

"You can't add days to your life,

but you can add life to your days."

The best part of my job is all of the feelies. It isn't easy living a life based upon, and within them. Propelled, compulsed, and revolving around them. But, it is the heart/soul/integrity of medicine/rescue/life, so, you might as well embrace it and dive full on into it.

Anna Mollie.
A visit from her newly adoptive mom, many years ago,
 started a friendship that has become the one I treasure most.

Every great pet parent wants to have a veterinarian who knows what their WHY is. One who makes that WHY visible, palpable, obvious. The sticky-feely-WHY also makes us more human, more capable of being the companion our companions inspire us to be. 

Pippa. Whose family has become a part of my own.

P.S. I want to add that we have abandoned the ability to decline providers in an emergency. We all live within the same WHY here at JVC. None of us is here to diminish or infringe upon it. We are a team of equally emotionally burdened powerhouses. If there are open options for picking and choosing a vet, for example, we have multiple openings available with different vets, you can choose who you prefer to see. But, if you are in need of a same day appointment and you want to try to cherry pick providers when only one is offering to see you, you are out of luck. We have collectively decided to support each other and not permit the hard feelings declining a provider brings. 

Doc, Linear Foreign Body Surgery

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

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

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

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

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

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

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

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

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

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

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

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

Here is his xray;

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

Here is Doc's YouTube video:

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

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

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

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

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

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

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

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

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

            total; $1400

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

Corporate Acquisition Inquiry

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

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

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

Looking forward to hearing back.

XXXX

Practice Partnership Specialist 

xxx

George.
Multiple unblockings (UO) and a PU surgery

Myreply;

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

Doc, linear foreign body surgery.

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

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

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

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

Warmest Regards,

XXXX 

Lola, pyometra surgery

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

Send me one case that you made affordable. 

You are drinking the kool aid. 

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

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

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

Dixie, Pyometra surgery

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

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

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

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

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

Have a great weekend and much continued success this year. 

Garfield, trauma, fractured jaw

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

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

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

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

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

Seraphina and Dr Ahrens

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

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

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

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

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

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

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

Leave No Patient Behind

George is a 9 year old indoor domestic short haired cat who visited us about a month ago for straining to urinate in the litter box, and producing only small amounts of urine. 

He presented again to us yesterday; unable to urinate. George is now a "blocked cat" or, UO cat (for urinary obstructed) cat. 

He found us, like they all do, with a little bit of luck, and a parent with limited resources. 

When he arrived on Saturday morning at the vet clinic we suspected that he was blocked. We also hoped that his parents had a rainy day account of immediately accessible funds so we could send him where he needed to be; the ER. The ER these days require a $4,000 deposit for this. It is beyond my comprehension what they do with that $4k, but it seems ubiquitous enough amongst the lot of them so it must be accountable in some list of line items. 

Within 20 minutes of Georges arrival at my clinic my phone rang.

"Sorry to bother you, (I was away for the Thanksgiving holiday), but, we have a blocked cat here." 

"Is anyone there willing to unblock him?" I asked.

"Yes."

"Ok, then we will figure out how to pay for it later. Have the owner go through our emergency sheet. Have someone else in the room with them to serve as a witness. And, make sure she is ok with us sharing the story and photos. Call me if you need anything."

"Ok. What would happen if we didn't help these cats?"

"They would die at home a miserable death, or be euthanized. Just like all of the rest of the cats. You know that." I replied.

My office manager agreed to go over everything with George's mom. She was working from home, on her day off because that's what George needed from us. George is a perfect example of who we are. He is deserves to be cared for. He is why I went into veterinary school. He is my WHY as much as any of the regularly paying customers are. Maybe more so.

George, the morning he arrived at JVC.

Here is the Facebook post we put up that morning; Georges first FB post here

"This is George.  He has found himself in a hopeless situation today.  He is blocked, and his mom only has $400 available to help him.  At our practice unblocking runs $800 - $1,000.  Despite the lack of funds we’ve agreed to help him, because we know without help George will die.  George and his mom could use some help financially with the cost of his care and treatment over the next couple of days.  Donations can be called in or made in person directly to George’s account.   Donations can also be sent via PayPal to jarrettsvillevet@gmail.com, please note that your donation is for George.

A big thank you to our kind hearted Dr. Ahrens who agreed to stay late to help George today.  ❤️"

A few hours later we posted an update;

Waking up from surgery.

"George is out of surgery and resting!  Thank you to all who have donated.  Please know any funds raised in excess of what is needed for George will be used to help another pet in a predicament like George. 

We truly couldn’t do this without the kindness and generosity of those who support us in our mission to help pets like George."

Two hours after the first post was put up we had raised $1900 for George. 

I posted a video on his story. Find it here; Inspire an army to save lives video here.

George update

One day post op. Looking good George

He is feeling SO much better with the help of our rockstar Saturday staff. He is getting his sq fluids currently (he is awesome at it) & taking his meds like a good boy.

So, George is a miracle, right? I mean its an incredible thing to be able to be given the treatment you need at a price your client can afford? Why doesn't every veterinarian do what we do? 

Well, because they think they can't. I hope to set an example of how this can be done. And remind everyone how good it feels to help save these lives.

We take a can-do approach to these cases. We take a leap of faith that we can save these pets first of all. We only offer payment plans, pro bono, take a risk on non-payment for cases that we think will survive and have a good return to a quality of life. We do not offer this to patients used for breeding purposes, people who are abusive, unkind to the staff, and who we do not believe will continue to provide routine preventative future care. For all of the cases we do not offer pro bono, or potentially not pay us back, we do offer to have the pet parents the option of signing over their pets to us. We will find a home for them, or keep them as our own for the rest of their lives. While this might sound cruel or unkind there are situations where pet parents realize they cannot provide the care their pets need, and they put this above all else. These are the people we want to over extend ourselves for. Sadly, almost everyone would rather their pet suffer, remain without treatment, and ultimately die than give them up. There was a case of a 4 year old dog who swallowed a corn cob who died recently after the owners declined the offer to give lifesaving surgical intervention. They watched her die over 4 days while they tried to raise the $3500 the ER required as a deposit versus signing her over to the rescue who offered to take her and get her the surgery she needed. 

Here is the document we use for these cases. We ask the pet parent to initial each line and then give them a copy for their records. If people would come to me and say "I love my pet so much that I would rather have her treated and alive with someone else than dead with me." I would do everything to save them. I don't think I am alone with this. 

For more information on this please see our website; Jarrettsvillevet.com see the tabs for Financial Assistance and Immediate Help.

All clients who cannot afford the estimate for needed care at Jarrettsville Vet must agree to and sign the following;

___ I understand this is an emergency.

___ I understand my pet would be best served at an ER, ICU, referral center.

___ The only reason that I am NOT at the ER/referral center/ICU is that I cannot afford it.

____ I understand that my pets current condition is (we fill in our differential diagnosis here).

____ I understand that I may not fully understand the extent and severity of this condition without a referral or additional financial resources

____ I have been given an estimate for care;

I can   ______        or    _____       cannot afford this estimate.

____ I understand that the estimate may change as my pets status changes. We will offer a payment plan if we go over your estimate.

If I cannot pay the estimated deposit for care I will;

1.       Sign a letter of collateral. If the invoice is not paid in 90 days the collateral will be transferred to JVC at my cost and the item will be sold for payment. Collateral item is; ______________

2.       Allow my case to be shared on any social media platform of JVC’s choosing to try to raise funds for my pet and awareness for their condition. This will help pay knowledge forward and maybe spare another pet from this condition.

3.       Follow all suggestions to include full story write up, starting a Go-Fund Me, sharing the fundraising efforts of JVC, and assisting with future fund raising projects at JVC

4.       Volunteer at other non-profits to pay it forward.

____ I allow JVC to share photos, videos and pertinent patient info for an indefinite period of time at their choosing.

____ I allow JVC, Dr Magnifico have full access and rights to my pets story. Past, present, future,

___ I will provide updates as asked and allow JVC, Dr Magnifico, the GSF, TPGSF, to share my pets story.

___ I understand that JVC has offered to help me care for my pet as an extension of compassion, kindness and shared goals to help end suffering and provide care regardless of financial constraints. It is with this in mind that I will be kind, compassionate, and generous with the actions and comments about my pets care.

___ We reserve the right to refer care back to an ER/ICU/specialist at any time.

 

Our Immediate Need Policy and Expectations for Non Clients are as follows: 

· We strive to offer affordable options for pet owners.

We usually require a full deposit at the time of intake for any emergency services. Our team will go over an estimate for your pet’s care once your pet is assessed. 

Please visit our website for additional resources to help with paying the balance. 

CareCredit may be utilized. You can apply for CareCredit via their website - https://www.carecredit.com/applyo Payment plans will be offered only to existing clients who have applied for or exhausted CareCredit. Payment plans are provided via Vet Billing

· Any financial concerns must be discussed at the time of receiving an estimate. 

· If you cannot afford the exam fee, the estimate for diagnostics and the treatment plan we will ask what is feasible for you financially, emotionally and physically to care for your pet long term. You are asking us to put your pet above the cost of running a veterinary facility, paying our staff and the emotional burden we take on with these cases.  

You will receive a copy of our Client Rights and Responsibilities and be expected to abide by it. We will not tolerate abrasive behavior directed to our staff. We are here to help you and your pet and expect to be treated with kindness. 

We will work together as part of a team for what is in the best interest of your pet. 

In working within the confines of financial concerns we may discuss with you waiving some diagnostics to keep the estimate within your budget. 

If it is determined that it not feasible for you to care for your pet long term, or if you pet is in need of immediate emergency care and we can not come up with a reasonable financial plan we may discuss surrendering your pet to one of the rescues we work with so that may receive the lifesaving care they need. 

· Jarrettsville Vet is a small animal general practice, we do not have staff in the building overnight. In most cases you will be expected to pick your pet up before we close. 

· We are working your pet in as an emergency. This means that the veterinarian may defer update calls to the support staff. Please rest assured that if your pet’s condition worsens you will receive a call. 

· It is our policy that if your pet is in need of emergency surgery and is intact, they will be spayed or neutered at the time of surgery. This is non-negotiable, if you are not agreeable to this clause please seek services elsewhere. All patients will also be vaccinated for rabies and given a microchip with Jarrettsville Vet listed as the contact for the life of this pet.

· You will allow us to share your pet’s story on Pawbly.com and social media at the discretion of the veterinarian. 

· If you receive funds from our Good Samaritan Fund you will participate in JVC or Good Samaritan Fund fundraising or volunteering and agree to the terms and conditions of our Good Samaritan Fund Recipient Policy. By signing below, you are indicating that you have read and understand our Emergency Services Policy.

Blocked Cats, UO, How Far Has Veterinary Medicine Fallen?

Blocked cats are my professional obsessive jam. The urinary blocked cats, this one disease which is almost always curable, (and, lets be real honest, how often can we say that in vetmed?), affects primarily young otherwise perfectly healthy cats. It is also the most egregious example of how far vetmed has distanced itself from helping the patients who need us most. In the olden days, (i.e. the days of my formative veterinary exposure, when the music was 80's pop and the hair was big), the vets that I worked for would have never-ever, ever, even contemplated turning a blocked cat away. It wouldn't have mattered whether it was 5 minutes until closing, or, if we had never seen the cat/pet parent before. Nothing would have stopped the vets of the days before the specialists, the fancy ER's, corporate ownerships and astronomically expensive off-shore vet schools from treating these cases, and doing it affordably. Vetmed was so honorable in those days that we offered help and asked for payment later. There was a foundation of trust, a pragmatic approach with integrity, and every vet knew that they had to treat or the guy down the road would. We never passed the patient by. We always had the practices credibility on the line. Every client mattered, and, therefore every pet mattered. Euthanasia was reserved for the cases that failed to get better after we had done our best to provide what our patients needed, never before. 

UO (urinary obstructed) cats are the best example I can give of how much vetmed loves money, and how horrifically we fail the most underserved and vulnerable among us. If I had one wish it would be that every single veterinarian loved this jam as much as I do. Every single veterinarian would see these patients as miracles just awaiting our healing hands and a little reconstituting from a slow iv drip. How can I help other vets see these cases this way? How can I inspire and motivate a whole profession to look deeply into the eyes of a treatable feline, remind themselves to invest all that we are, and save them all? How can I remind us to be kind, to be compassionate, to help people who desperately love their pets like family, and  save the world, just because we can?  

This is Figaro. This is his story. His life, his chance at surviving his acute urinary obstruction, and all of the accolades, frustrations, desperations, and phone calls his mom had to make to save him. This is what vetmed has become. It is also everything vetmed should be ashamed of having become. 

Figaro is a young, healthy cat who has been loved, cared for, taken care of his whole life. He has been to all of his vet visits, and his mom has done everything she was ever told to do for him. He was perfect and loved, until he was sick, very sick, and his mom rushed him back to the place she knew he belonged. The place where people would help him.

Figaro's mom noticed that he was not feeling well. He wasn't walking normally, and he wasn't eating or drinking. She called her vets office immediately and they told her to take him to the ER. Which is technically the right answer, and all too often the only answer most small, private practices, already too busy to stay on time veterinarians will give. The biggest problem with this answer is that this is too often a place that most pet parents cannot afford to utilize. Most pet parents walk into an ER expecting that the veterinarians will help them. Save the lives of the pets they adore, and be treated with hope, respect and compassion. This is what you will get if you have deep pockets. Financial stability and access to about $3,000 to $30,000. This is what vetmed is today. This is what all of the things that veterinarians, corporate ownership, and lust for profits, salaries and mental well-being cost. It just costs lives too.

Figaro's mom went to her vets office anyway. She knew them, they knew her and she wasn't comfortable being sent somewhere else. They left her in the waiting room, took her cat to the vet in the back and the vet palpated a full, hard bladder and knew he was blocked. She sent her to the ER.

This is Figaro's mom's letter about her experience. I asked her to write it because she is not alone. Figaro is one of so many that I see. Figaro's mom was just brave enough to share her side. She is a survivor, and now so is her cat. She is an advocate, a voice, and a beacon of hope that the profession will start to listen. 

Maybe if enough people start to ask themselves how their part contributes to this responsibility will will begin again to protect with compassion. We will do so because we can, and because we want to. Because this does save the world. It does pay forward, and it is what we owe those who came before us and those who will follow after us.

The ER did what they always do in these cases. They alert you to the cost of the exam. The technicians collect a history and your pet goes to the back for an exam. The exam reveals a hard, painful bladder that cannot empty. You are given an invoice with every possible diagnostic needed, every bad turn, and every worst case scenario covered. In the last decade the estimates for this have gone from $2,000 to over $8,000. 

Figaro's mom was given a $2,700 estimate.

I don't send people to the ER without warning them of the estimate that they will be given. Why? Well, because I didn't go to vet school to send my patients to a euthanasia based on economics. I didn't go to vet school to send my patients elsewhere to be denied care. I didn't go to vet school to send my cases to other places who aren't going to help them. I didn't go to vet school to have my clients feel ashamed, embarrassed, humiliated, and helpless. In some cases these otherwise young, healthy perfectly normal perfectly fine cats are euthanized as the most "compassionate way" to treat this disease. We call this economic euthanasia. In other cases the pet parents can only afford a quick unblocking and then they get sent home. This treatment option, although relieving the immediate problem, makes the next unblocking (you the ones I get asked to do a day or two later) much harder to do. 

Figaro's mom had access to $400. Her estimate at the ER was about $3,000. They, (to which I have to add that I am surprised and hopeful that this is the first crack in the facade of finding a way to provide care outside of the approved corporate income driven recipe), offered care based on the clients ability. Was it great care? No. Was it ideal care? No. It was a quick palpation to diagnose and a passing of a urinary catheter to remove the obstruction and then he was sent home. 

He was sent home without all of the care he needed. He was heavily sedated, poorly responsive and his mom had been firmly told that Figaro needed to eat a special diet, and only this diet, for the rest of his life. He was so depressed, chemically incoherent and incapable of walking, eating, or responding to her pleas to eat the food and use the litter box (therefore proving to her that he wasn't blocked again). 

Figaro's mom called her vet the next morning. They couldn't fit her in until the next day. She was so worried that he needed to be seen sooner that she started calling other vets offices. She called explained Figaro's dilemma and then added that she had no money left. She kept calling when everyone turned her away.

She called us and told us that she was worried he had reblocked. We told her to come in to see us immediately. It helped that I was at work and the staff knows that this is my jam.

Figaro was not blocked. He peed as soon as I gave his bladder a gently squeeze. He was gorked on the medications from the ER, and needed the extra time that the $2,300 would have gotten. He needed intravenous fluids, pain medication and an antibiotic. He needed the toxins that build up in the kidneys after you cannot pee to be flushed out. So that's what we did. Figaro only needed a few things from us. He didn't need a long stay, or an expensive list of invoiceable items. He was a cat who needed just a little more help, with a mom who needed help on how to take care of him. Figaro and his mom needed us to be what all of us should be. Helpful on their terms.

The next day we got a call from our local Animal Control. They wanted to confirm that Figaro had been seen by us?

Seems someone had dropped a dime on Figaro's mom for cruelty and neglect after she had failed to show up for the recheck appointment she said she would. 

Here is where Figaro's story takes its next troubling turn. What was Figaro's mom supposed to do? She knew he needed help so she reached out to the place she had always gone to. They sent her elsewhere. They sent her to a place she couldn't afford. Then they give her a discounted service that isn't enough for her cat, and then call Animal Control on her. They report her. 

If she hadn't found us it is very likely that he would have been in much worse shape the next day, or that they wouldn't have given her a way to pay? What then? Likely AC would have forced her to find a vet, or, bring him to the shelter to be euthanized. Figaro deserves better, so does his mom.

Our Office Manager called the ER to inquire about why they called Animal Control to report her. This is the reply they gave us.

I did call the ER to discuss Figaro.  I spoke with their Hospital Director.  Please see highlights below from our conversation -

 

• ER saw Figaro to unblock him
• Owner only wanted Figaro unblocked and wanted meds to go home. 
• Owner seemed untrusting of ER and did not seem to understand how critical a blocked cat can be. 
• ER discharged Figaro under the impression he would be seen at original vet office the next morning, however no Direct Transfer of Care was in place
• ER has a pamphlet that they give clients who are struggling financially.  The pamphlet includes resources and information for Vet Billing, they did try to point her in the direction of Helping Hands and let these folks know they should try to find a vet that accepts payments.  I am surmising that this may be where they get our information from, if they go to the VetBilling website and search for a vet in the area who participates they find us. 
• The following morning owner called as Figaro was not doing better, they were surprised that she was reaching out as she had told them initially he would be seen at her original vet office.  It was in that conversation that she told them that she did not have an appointment with original vet office until the following day, 8/28
• It was at this juncture that they did call AC for a wellness check - they were concerned that owner did not understand how critical Figaro was and that she had been dishonest in when he would be seen.  They were concerned he would not be seen at all.

What would you do?

What would anyone with limited resources and a pet they love who is in desperate need of help do?

How does this profession address these cases? 

How does the veterinarian, who is justly worried about Figaro, do?

It is with all of this in mind that Jarrettsville Vet has started to have these discussions.

This is the letter we are now using with clients when we can't decide what to do with a case that burdens our hearts, pulls our compassionate souls from our guts, and leaves us unable to sleep at night. 

“We care about your pet and your pets care.  We are concerned that there was not a follow up appointment after the veterinarian recommended it. Your pets condition was not stable enough to provide a dismissal of care. Please call us to arrange a recheck appointment or let us know if you found a recheck appointment elsewhere.

If you have any concerns about the cost of this care, or any future care here at Jarrettsville Veterinary Clinic please call and ask for me or one of the other managers. We will be happy to offer options for you and your pet.

We have called the numbers we had on file and sent an email to address you provided. We hope to hear from you by the end of business tomorrow. If not we will these concerns on to animal control to be in accordance with the state mandates. “

What do you think?

Here is what the ER has come up with to help cases that come to us.           

The ER is 100% on board to do this and do regularly do so with a Direct Transfer of Care.

• With a Direct Transfer of Care they will send everything in place.  They will suture in a urinary catheter, send IV, etc.  They also will not fill meds there as the client could fill cheaper at their regular vet.
• A conversation between doctors is what initiates the Direct Transfer of Care.
• In the past owners have said they were transferring to their regular vet and didn't, they had a pet return septic when a catheter had stayed in place.  Therefore they will not leave everything in place without that conversation.
• If one of our clients is in conversation with one of our doctors about transferring care it is important that our doctor reach out to the ER so the Direct Transfer of Care can be in place.

Here is the site for Maryland reporting of animal cruelty. 

So where do I go from here with my resolute disbelief of how far we have come, and how much we are enabling suffering for both our clients and our patients. Well, I suppose you will have to wait and see.