The Cost Of Hope

 Hope. When there is everything, and nothing, there is still hope.

Hope, for me in vetmed, is all of those blocked cats who never see a chance at help
because we may it too expensive.

A long time ago there was a girl who was afraid. Of all of the things she was this one thing dominated. It was what propelled her, crippled her, and reminded her. It was the beast she lay victim to for all of the days. It was the affliction her mother had and her mother before her. It was everything and nothing. It was, and it was what she let it be. 

It was like this for a very long time. A lifetime, and then, a lifetime more. 

Mom in her barn for her first antique sale.
She was beamingly happy, can't you tell?

It took a long time to recognize the part of her she didn’t have to be. She knew that there had to be more to this journey. The one she woke up to everyday to repeat the whole pattern again. But when you carry a beast so big, and so heavy, for so long, it is hard to raise your eyes above it. Maybe fear is the antidote to hope? she thought. And, maybe hope was the cure for her fear? And with that it began; the daily ritual of pulling her bootstraps up and raising her chin above the horizon, just to see if maybe out there somewhere there was another option to her fear. Maybe there was a place she could leave it? Just to rest its weary head for a while. Maybe, it was as tired of her as she was of it? Maybe, they could exist without each other? The shell without the cortex. The cure without the disease. Maybe, if she could grow big enough and strong enough, she could outgrow its need for her, and with all things that persist long enough, her need for it? Maybe? Just maybe?

What happens is that time works its magic on you and you grow comfortable with even the most horrible. You get used to each other to a degree that makes it hard to coexist without each other, even when the other half is a cancer stealing you from yourself. A bad marriage arranged on the most horrific of terms. Life is like that. It will kill you if you let it. Leach you to anemia just to see what the reserve tank has in it. Medicine, the art of molecular life in the grips of another life, the host with its many moving parts all required to work in tandem even when they have opposing agendas, is just like this. A dance, a tango set to a music you cannot always chose. You try to lead but you know the tempo might change and there may be feet stepped on as you tip-toe across the floor. 

Isn’t life like this for all of us? The calculations of actions you make silently within to try to make it through life with as little turmoil, pain, and scarring as possible. At what point do we learn that if you don’t have one side of the coin its impossible to know the other. Maybe with age there is wisdom and the ability to excise the fear so you can live with just the hope?

Outer Banks. Duck

Today is Mother’s Day. The day that we all celebrate the origin of our existence on the double X chromosome in our own DNA. For me, 5/14 is the day my mother died. On this day at 4:14 pm in a little stone house not too far from my own, my mom took her last breath. I say this as it marks a date, impermeable, and in-excisable. The pivot point to which the calendar resets, and a life without another starts. I say this because that day changed so much within me. There is a book to write about her, and her impact upon me. A book that sits waiting for the time and the distance to write it without it eating me up. Consuming me like the fear that swallowed her and kept her trapped within.

Today I remind myself that there is life after another life passes on. I cannot call her gone. She is never gone. She is here all around me reminding me to always have hope. To always see the beauty and the joy in the life that exists even if you have a difficult time seeing through the tears. Today I talk about hope.

Today I opened my eyes before the sun came up. The sky crept from black to the darkest of blue. A grey-washed out kind of blue. Smeared in its blurry shadows. Quiet, heavy, and slumbered with a fog that keeps all of the earth’s tiny souls safe in their beds. The first rays of sunshine wake up the world and to this awakening the first chirp can be heard. It is my time to be alone and feel as if the world will remind me that I am never really solitary. One little chirp. Just a call in the almost-darkness to awaken the rest. I turn on my Merlin app, and start to record. I now know that this tiny rooster call is an American Robin. Maybe being afraid, and trying to replace it with hope is about seeing the bravery in the darkest of places and still singing?

The potting shed. Mom and Diedra's boys

I made a video the other week about all of the clients I see who come to me having to lay their pet to rest after disease, and age, and all of the many afflictions that life can wear you down from. They always ask me the same thing, without fail; they ask, “this must be the hardest thing that you have to do as a veterinarian?” And I always reply the same way… “No. You loved your pet so much that you made them a part of your family. They were loved every moment of their lives. How lucky they are for that, and I know they are so grateful to have been yours.” That is the hope in the face of fear. That is the beauty in the face of death. Maybe losing someone you love is about remembering the hope they brought you every day you were together?

With hope springs gratitude eternal. Is there anything we wouldn’t give for that?

Happy Mother’s Day to you all. (regardless of what your chromosomes or current children roster looks like)..

The first icy drink of Summer. A mojito from our mint patch.
Diedra, mom and me.

And P.S. go out and foster, adopt, and live life with someone else… pets count as kids these days,, so we are all moms here. Maybe there is life outside of the one you are living right now where hope springs eternal? And, maybe its time to go look for it? Let’s all look for hope in the love that reminds us we are all mothers. 

P.S. I write about all of the issues that being me brings. I know that I am not alone and I hope (there's that word again), that others hear me and know that they aren't alone either.

Investing Too Much. When, and Where Do You Draw The Line?

Perhaps I went into this for all of the wrong reason(s)?

Maybe not the wrong reasons, but, perhaps the expectations were unrealistic? Maybe there was too much of me in this endeavor for others? Maybe it's the other way around?

These are the questions I ask myself as I muck through the maze of my daily life as a veterinarian in general practice.

One of the many delightful faces of my vet life day

Yesterday I spent a long time, (to be honest 20-30 minutes), with a sobbing client as she dropped off her dog, Brunswick, for a forelimb amputation. She was, (as every single other amputation pet parent has ever been), reluctant to consent to this surgery. Of all the procedures that we do, and, for all of the many indications this procedure is recommend for, there is no other life-saving, pain alleviating surgery that is met with such pet parent reluctance and resistance. In my clinic over the last 15 years that I have been practicing, I would say that only about 1/4 of the pets who need this procedure, and, I believe would benefit immensely from, actually get it. Most pet parents will sacrifice the pet to spare the removal of a limb. There is this incredibly difficult and deeply rooted mental block on consenting to limb removal as a treatment option. We were at this place; sitting in the front office, debating whether to consent to cutting off the leg of her otherwise perfectly healthy and happy pup.

Brunswick is a timid 7 year old, 50 pound, mixed breed dog. She is a tawny brown with big erect triangular ears, a wide faced and her soft white body is liver spotted from neck to tail. She has a history of a mass removal from this leg that yielded a diagnosis of "lipoma" many years ago. That mass has returned, slowly growing within the armpit of her front leg. It is now pushing the limb out and away from her torso. It has gotten so large that it has exceeded her skins ability to further contain it. The underside of the arm was red, raw and ulcerating. The mass that has been slowly growing for years now is outgrowing her. The cold cruel eventuality of Brunswick's leg was lose the leg or lose her as she would soon have an open wound that would never heal but instead continue to erode her leg, cause her increasing pain, and chew its way up her neck and across her sternum. 

Brunswick walks front legged short stepped, cowboy style. It manifests as a limp. The mass is hidden from obvious view by her bushy hair. The dappled coat hides the magnitude of the mass until you pet her. The diameter of the upper part of her left front leg is easily twice that of her slender athletic right leg. Her demeanor is always stand-offish for a few moments, but, if you are patient, quiet, and gentle in allowing those few moments to pass she will warm up to you to flounder flop on her "good" side for a full belly reveal. It is her not so subtle invitation to focus your affectionate rubs on the tender fleshy part of her belly. She is easy to fall in love with. Her handicap simply reinforces her charm. Her mom adores her. She will tell you that "Brunswick is her first child." 

And, now,,, here we are. Sobbing. Crippled with fear and doubt, and stuck about what to do with it all.

Many conversations get to this point. That critical pivot point where biology, disease and prognosis has met the timetable of limited options. That juncture in a pets life where you have to choose? Are you a proactive parent seeking to gain as much time with your pet as medicine is able to provide? Or, do belong to the crowd that does not believe in surgical procedures for pets? Do you choose to invest multiple thousands of dollars, hours, and caregiving requirements to gain the precious commodity of more time with your companion. Do you value your pet as a member of your family? Are they one of your kids? Can anyone possibly speculate all of the twists and turns that lie ahead if you do, or don't, take action? 

Most pre-op surgical discussions go like this. 

In Brunswick's case we had already done multiple examinations. Two with me, one with the surgeon. At each time we (the "professionals") agreed the best resolution to this tumor was to remove the leg. There were about a dozen emails back and forth to discuss every possible question and concern. And,, yet,, here we were, crying at drop off. 

I sat with her and said; "I know how hard this is. Please do what you think is right. Not what anyone else tells you to do." I firmly believe that this needs to be said to every parent. The road ahead is too full of twists, turns, and potentially even life-threatening landmines. I should add the cost of care, but, for me it is not a part of the equation I will let decide options. If we believe a treatment option is needed we will find a way to make it accessible. (Note: we use multiple payment plan options to help people not let the financial burden be the deciding factor).

I try to ask myself who will benefit from these decisions? Who am I looking after? These are huge weighty decisions with dire consequences. I try to be unbiased, neutral, indifferent. I try to present facts, argue all sides. I soo often feel that I fail miserably at this. I am not ever able to remain indifferent. I am not on anyone's team outside of my patients and their family. It is the dark force that grips my soul surrenders my conscious heart at midnight.

Brunswick post op

Here's where the muck meets the sole. Brunswick needs this operation. She will die within a year from the mass if she doesn't have it. How do I advocate for that? A: I just have to be honest. Then I have to accept the consequences. But, I know Brunswick is loved and I know her mom is making this decision based on that. Seems silly to some, maybe? But that is always enough for me. I am not the vet for indifferent people who don't value pets. That I cannot do. That would kill me.

My pups; Frippie and Storm

These are the elephants I carry on my back all day every day. They remain cumbersome, consuming and catabolic even after I get home at night.

I didn't sleep much after midnight. That mystical witching hour.  My typical work day has me arriving home after 9 pm, a 12 hour day of work without breaks, meals or niceties logged in the record books.  My shear exhaustion leads me to literally passing out on a pillow having foregone the obligatory teeth brushing, face washing, moisturizing and evening medical supplement regimen. They are all tossed out the window for the sake of sparing my legs the 80 paces they would require. There are loads of nights like this. Wrung out dry. I enter home as this zombie-eyed shell. I sleep for 3 hours and the death cipher lets go her grip for the anxiety ridden stressed-out-Suzie to take claim. Its always this exchange of custody each night between the hours of midnight and 2 am. A shared custody battle as the sun sleeps. 

My Frippie always brings me a gift

Why does the day weigh so hard? Brunswick is one example.. this is another. This one happens too often these days. COVID has created a huge demand for puppies. None of them are being socialized appropriately and for some (often breed specific) it is causing potentially disastrous consequences.

The other emotional dilemma of my day was an 11 month old German Shepherd, (let's call her GS), who visited for a pre-spay exam with bloodwork. Her mom had brought her inside the clinic vestibule on a one foot leash to a tight prong collar. Even with moms double fisted grip she could not get GS to remain with four feet on the floor nor have any kind of focus. She had no control of her adolescent puppy, and, she knew it. She told me that she "doubted I would be able to get her blood." She passed my technician the one foot lead and watched us all as we struggled to lead her to the treatment area. All GS needed was a 5 minute physical exam and 30 seconds to pull a blood sample. These appointments are not charged for as they should only take 6 minutes to complete. That didn't happen.

GS was a happy, outgoing 75 pound determined to party firecracker. She was elated to be around people, and in absolute resolve in not sitting for longer than one split second for anything. She knew commands, and she knew how to decide to avoid them. She surged, jumped, boxed, and thrashed. She twisted arms, crashed heads, and started to lunge and bite to have her demands heard.

Our dinnertime excitement

I always stop here...... The three of us; myself, my technician, and GS. We all looked at each other. What to do now? Take a breath? Try a different tactic? All of the above? We took breaks. We tried treats. We tried calm quietness. I tried a large muzzle, just to see if that would settle her. Fifteen minutes into the endeavor and one thing was clear; Nothing worked. We were at the place where one of three things was going to happen;

    1. I lose my patience and I hog tie, muzzle and we pig-pile on her to attempt to bruticaine (brute-force-paralysis vet lingo), and see if she is so shocked by this she gives in.  I just turn into a cold hearted drill sergeant. Bark orders. Intimidate. Force her to be what I want her to be. Force her to hold this command until I feel she has learned who is in charge. Quickly restrain GS and get it done. Get the blood. Skip the exam. Smile and return her to mom. After all what she doesn't know isn't my problem. She can't claim naivete when she already admitted unruliness. Make friends with the owners, even if it  is at the patients expense. A lot of vets have learned this trick. Two faced. Sweet to people, not so much to patients. A bite will likely follow at some point. What the real consequence of this is; To hell with the next guy who has to deal with her.  Might work for some dogs, never works for shepherds. Shepherds are too intelligent, they cement resentment like dolphins. If I do this to her she will never again come happily into our doors.. She will start every future interaction with fear and aggression. A bite will follow at some point soon.

    2. I give up knowing the short game loss is worth the long term gain and we have a family meeting to try to find a way to make her appointments more enjoyable and productive. Her mom had already expected that today wouldn't go well. We come up with a plan for next time. This should include training at home with the family to allow others to handle her. Working with a trainer to help her focus on commands and execution of them with focus and safety. And medications to help bridge the gap as we work on training. 

    3. I just get bitten. No chance to compromise, or convince her that we are not trying to hurt her. She just explodes and bites as fast as she  can. She is done with us and she will remind us she is in charge. 

What happens when a "bite" happens? Paperwork, fear, and almost always the pet parents compounds the tragedy by isolating their dogs in an attempt to avoid future potential bite provocations. Muzzles, prong collars, yelling, over protecting orders and mounting anxiety across all fronts. It's a snowball. Attempt to avoid situations leads to a lowering of estimation of the pets perceived threats. They used to like everyone. They were puppies meeting a world of new sights, sounds and smells. Now they are guardians that bark at the door knocking, or, strangers. You can't take them out in public anymore because now they bark at everyone. Everyone is a perceived threat. They are 100 pounds and you cannot restrain that amount of determined muscle. They become isolated. We reinforce the idea that everyone is a stranger. I used to see them every two to three weeks. We had fun visits. Now I am the stranger. I ask for unreasonable acts of discipline and focus. They don't know me and they certainly can't see a reason to obey me. Hence the bruticaine and indifference. 

Buster

Who's fault is a bite? Well, for the huge majority of clients vets see daily they would say it is our fault. For every time I have handed back a shepherd to say "we need a different plan to make this visit enjoyable." I almost always get, "well, you don't know how to hold her. She is fine with me." Oh, how I long to reply; "Ok then you do the bloodwork and  the spay. I like my fingers and face." Or, "she would never bite me, therefore, you are the problem." 

Here's my advice; it is the advice that every seasoned pet care professional will give you. Train your dog to accept a muzzle. It is NOT a reflection of a persons failure. Nor the pets. It is a tool to provide assistance as we transition out of anxiety based fear laden actions and reactions. Every pet parent should openly and provide permission for a muzzle to be used if deemed necessary. Man-handling, bruticaine, that is not permissible.. ever (unless a pet is endangering another's life). How do we insure this? Trust. If you don't trust your pet care professionals ask to be present for all possible procedures. Ask, demand, insist that pre-anxiety medications be given. Set ground rules for care. Resistance is a flag for scrutiny. Leaving a practice because a person intervenes on your pets behalf is only going to hurt your pet. 

About 30 minutes after I aborted pushing GS any further I sent her home with a training plan and sedatives to try at the next vet visit. I chose to not push her, not exacerbate a bite, and not make it impossible for the next time. Here's what I got for that, a call from the husband saying "they had a bad experience with us and they are going elsewhere." I doubt I will ever see GS again. There is pride before a fall. There are Shepherds relinquished everyday because no one intervened on their behalf at this critical development time. And, worst of fall there are vets who get court orders to put animals down after a "bite" history deems them a danger to the public. Will the next vet push her so hard she bites? Or becomes passive aggressive? Or fears people so much she reacts with defensive aggression to everyone outside of her family? In my opinion she needs help. Will she  get it? It's one of the reasons I awaken at midnight with elephants.

Tex. His first puppy visit. My goal is to have every patients visit look like this.

The truth is that people pine as much as I do, if not more, on what to do for their companions. What is the right/best/safest/compassionate course of action to take? What will consequences for that looks like? Will I hate/berate/beat up/chastise myself for the action, or lack there of, I take? I have been in these shoes. At every moment of my professional life I remind myself that I am still that devoted pet parent who is in turmoil about what to do? Do I trust my own judgement? Do I have enough pertinent information to base my judgements upon? Is there trust here. Maybe GS's parents lack that? They just don't trust my call? The reality is that she is being set up to fail, not flourish, and her "bite" won't be on my account of failing her. 

Brunswick. One week post-op forelimb amputation

What these two cases have in common is that I did my best to make decisions, present options that were in the  best interest of my patients. period. I can fall asleep knowing that. The rest, the worry, the grief, the elephant on my shoulders that I failed them, their parents, or the relationships we have is the midnight hour that clutches my throat and drags me into the abyss of self-doubt of avenues from that first decision to "do no harm."

Magpie helps me motivate for another morning.

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.

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Lock Down At The Veterinary Clinic.

Twice. This has happened twice in about 4 years. The vet clinic has gone into lock down over a client showing up enraged and threatening us..

There are safety and terrorist drills that every place of business, social meeting area, community gathering place and institution needs to practice. Sadly, this also includes the veterinary hospital.

Both cases of lock-down were eerily similar; an enraged client came in seeking immediate action after their phone calls to the clinic were not answered quickly enough. The phone calls were belligerent, accusatory, demanding, threatening and intimidating to the girls at the front desk. The front staff are not naive to difficult phone calls. They tried to explain that the messages had been delivered and that someone would get back to them. This wasn't an acceptable answer.

The phone calls start as short and frequent. They quickly (within hours) escalate to demanding and threatening. The avalanche has started and you should expect the rest of the catastrophic destruction to follow.

The next action was to show up at the clinic enraged. Their anger has turned into threats and demands in person and with immediate expectation of engagement.

There is nothing you can say or do at this point other than to call the police. You don't know what these people are capable of and you cannot diffuse this situation and concurrently take care of your business. From my perspective I am also responsible for the health and safety of the other clients, staff and patients in our care. I don't dare risk their emotional or physical safety, and my ego doesn't believe I am a superhero who can swoop in to save the day. I have learned to NOT ENGAGE.

There is a back story to the culmination of these lock downs, (of course), they all went a little like this;

New pet parents arrive with Amish puppy mill, OR, Craig's List, puppy a few weeks earlier. It is very apparent to everyone that they are unprepared and uninformed about the cost, care, and responsibility of owning a pet. All routine pet services are explained in detail, associated costs provided and many are dismissed as being "not needed" or "too expensive". It is not uncommon, nor unreasonable to space out vaccines, visits, services and instructions for new pet parents rather than try to overwhelm and scare them away. We take our time and break the whole process into little easily digestible pieces. These visits take a huge amount of time and energy. They are also vitally important for the safety, well fare and well-being of these clients and patients. As is customary for us we offered brochures on products (preventatives are often confusing and difficult to understand the value of with new parents), and vaccine schedules. Written personalized instructions go home with the owner along with pre-booked next appointments. In this particular case I also strongly encouraged enrolling in a puppy/new pet classes. Phone numbers and recommendations are also given for these. We go to great lengths to provide a safety net and support network to new parents.

There are vet visits where you feel like a pre-puppy/pet-selection process should be law. There should be a screening process, an application, a review of the home and a waiting period. This requires time and patience. You can buy an Amish/Craig's List puppy/pet cheap and get them quick.

The clients admit to their pet purchase because they had been turned down by all of the rescues. People may castigate the potential adoption process but it has its purpose and reason and is often correct in their assessment of adopters.

Not everyone should have a pet. They are not little neatly packaged ready to go inanimate creatures. They are the worst example of Ikea's "lots of assembly required" challenges. They have needs. Their needs have zero respect for yours. There is no ideal time for a broken bone, infection or acute diarrhea episode. When they happen (and they always do) the unprepared new parents with angst and disdain always behave the same.. Anger, yelling and excuses about a "defective pet." (I cannot even tell you how many times I have had this discussion).

What I have to politically say nicely is "All pets come with and will have medical and/or behavioral challenges." They are intelligent, intuitive, needful beings. They need help with the challenges of life like all of us do."

BUT,

What I want to say is; "What the hell were you expecting? A pre-programmed self sufficient robot? Of course they cry for attention. Of course they will poop and pee in your house if you haven't trained them. Of course they need love and exercise!"

The worst cases of new pet parent failures end in death. I have come to know this, fear this, and see this. If you don't put time and attention into your children they fail to adapt to society and are ill-equipped to live happily in it. The behavior issues turn from disappointment to cast away outside to surrendering at the shelter to euthanasia appointment. It is the awful reality of property that fails to serve its owners purpose. Or, it turns into an anxious pet who bites or lashes out, which turns into death by euthanasia, or, abandonment which in too many cases causes death by predation or designation of "unadoptable" which subsequently leads to euthanasia.

At some point in this timeline a frustrated owner starts providing clues that the relationship is not mutually reciprocating of adoration. The parent cannot understand and assist the pet and the pet is still desperate for love and attention but unable to articulate their needs and wants, IF the vet, or pet professional doesn't intercede at this point it will cause a shortened cheated life for the pet.

Here is where our lock down happened. The new pet parents told us on multiple occasions to multiple people that he didn't want this pet. It is not uncommon for vets, and vet staff, to hear clients disparage and complain about their pets care and cost of care in front of us. Perhaps they do it to try to complain indirectly about the bill? Perhaps it is poor coping skills? Regardless, I am not able to ignore it. I have been heartbroken too many times to not intervene.

After an odd peeing incident and a heated visit with the dreaded "defective" label being thrown out as a reason to not pay, and not wanting the pet. I called to offer help and try to explain that these things happen. I attempted to explain that "perhaps she needs more time, more training and help? We are here to help her, and them. We can't do one without the other." What I feared was that her "odd behaviors" were a direct result of the anger and angst they felt toward her?

The next day the client shows up unannounced to leave her. "She is too much work and too expensive." The client is in such a rush he doesn't want to wait to sign papers. (You cannot just drop off a dog at a vets office). To be honest we only take them to get them into a rescue to try to save their lives. At almost every shelter in the country a surrendered pet is a most often designated a "euthanizable" pet. These pets pay for their humans inadequacies and instabilities.

Three days later the phone is ringing, the messages are stacking up, and a few hours later a very angry guy is at the front desk making demands.

It was lunchtime and my sister (our hospital manager) and I were out to get a few minutes of much awaited spring time sunshine. What the client didn't know was that I, the practice owner, had just returned from hospice vigil and hadn't been at the clinic for a few days. It is not something I felt I needed to share, but, it is not outrageous for a phone call to take a day, or even two, to be answered when they do not include patient health care requests.

The client was so belligerent that my mom (cleaning the clinic that day) hid in an exam room and called my dad to come rescue her.

Texts to my sister and I quickly escalated to phone calls for help.

"Call the police NOW! And, lock all of the doors" imagining them fearing for their safety as they were unable to diffuse the demanding lunatic in the front office.

That's my advice for every out of control situation. You just call the police. Let them try to manage the person who is not willing to talk like a mature adult. Never escalate, never engage, and never allow anyone to make you feel threatened.

The police arrived as the client departed. There is now a record outside of yours to corroborate your concerns. If you are worried enough inquire about a restraining order. It is a the best way to protect your business, your self, and your staff while at work. You also will benefit from having a police officer present at the time of request.

"If they show up again call us. We are one mile away. We will send extra patrol cars to visit today and tomorrow. We can even post one to stay if you need us." It was the most consoling offer of protection and peace we could have gotten. It was the only thing that allowed us to stay open the rest of the day.

Where am I in all of this? I am back to being afraid of people who will harm you if they feel embarrassed and/or not in control and the collateral turmoil of not trying to save the pet in the middle. It is the world we live in. Where guns are prolific and temper tantrums happen in traffic, workplaces and even school yards.

A phone call from their lawyer followed. "They want their dog back. They have had a change of heart." Lawyers ALWAYS get involved. If you are lucky, they get involved early. Lawyers at least have boundaries and repercussions if the client is a psychopath. Any, and every, mediator should be welcomed. It is yet another barrier to becoming engaged with an unknown unpredictable person. It is a way to provide leverage and pressure. Every vet needs to have a lawyer on retainer, or at least PLIT insurance. Call your lawyer as quickly as the hairs on the back of your neck take notice. The point about "not engaging" also includes passing the buck when appropriate.

My reply; "My job is to take care of my patients. I am still here to take care of them. The pet is in a home with people who love her and they don't want to give her up. It was stated to us on multiple occasions to multiple staff members that your client did not want this pet. I also need to notify you that the police were called when your client threatened the staff would not leave after being asked to. The police were called to the clinic to remove him and are on alert to return if he does. The clinic went into lock down because the staff was so afraid."

Why am I posting this? Well, because we have been threatened before. Threatened with lawsuits, physical harm, and intense harassment. I have had to go so far as to get a restraining order, (it takes four visits to the police and courtroom to get), and I know what the consequences to my patients are if I don't offer to help. I also feel compelled to share this story with other vets and vet staff to try to encourage them to say something when a client states they don't want their pet, threatens abandonment, physical harm or personal injury. Do not ignore a threat, ever! Document and get backup corroboration to support the claim immediately. This case has multiple entries in the medical record to support the statements made in both our presence and in phone calls/email exchanges. I was granted a restraining order because I had emails and witnesses to support the threats made.

Do I think this is the end of this? NO, I don't. I think this man doesn't take "No" lightly. I think that in some cases standing up for your staff and protecting the people you care about makes you a target. I also think this blog allows me a place to post fears, concerns, and educate all of us about how behaviors influence outcomes.

How hard it is to stick your neck out with people who threaten and intimidate? How easy it is to turn a blind eye on your patients to spare your butt? Vets have to ask themselves this question every single day. It can break you. I have had to become comfortable with repercussions in order to stay true to my ethical code of my obligation to caring for my patients. It is not a code my profession shares publicly. I also think that veterinarians deal with the a ridiculously ambiguous fundamentally unfit status of pets being deemed "property". It denies us ability to intervene, advocate and make meaningful life saving pleas. At will on demand euthanasia is a viable option to every pet owner. If I push to hard every patient can be euthanized, and some clients will do so just to spite and hurt others. That is absurd and reality.

Here are my tips for preparing your staff for potential Lock Down scenarios;

1. Never engage. Ever. The minute you feel threatened or that the situation is out of control just pick up the phone and dial 911. You don't have to warn the client, you don't need to explain, and you should never apologize. Just pick up and dial. Every front desk employee has a phone at their fingertips.

2. Start recording the event. Any other staff member should discreetly pull their phone out and hit record. Evidence will save you time and money.

3. Have a protocol in place. Get people outside. Lock doors so others don't walk into the heated situation as it boils over. And, never call in more civilians. The police are your only call.

4. Get photos. I had to get a restraining order on a client under daily psychiatric care who was threatening to kill someone. Of course he didn't exist in any social media platforms and has never had a photo of himself taken (that I could find).. It is harder to alert the staff to call the cops if he shows up if only a few staff members know him by face. We were given make and model of the cars the owned to post for staff's attention.

5. Stay on the phone with the police dispatcher. They can help you to keep calm and be safe.

End note; I really never imagined that being a vet who cares so much about pets would leave me to having to decide whether to stand by protecting their lives would leave me sitting in the cross hairs of my own. We live in a dangerous and unpredictable world. It shouldn't be governed by so much pervasive fear and hate, that's not what our pets bring us, that's simply humans.

Where is JVC going to go to help deal with the ever increasingly hotheads who are making the job of an underpaid vet assistant question why they stay? We will be adding video surveillance to the hospital. They will be in every public space, including examination rooms, and parking areas. We are also recording telephone calls. Too often I have a receptionist find me frantically befuddled to notify me that a "very difficult, angry client" is on the phone. Many of these phone calls include threats, harassment, profanities and requests they cannot acquiesce to. I ALWAYS take these calls. Overwhelmingly the client is nice as pie to me. There is some unwritten excuse to being able to be rude to the staff and nice to the doctors. For every client who does so I ALWAYS ask the client if they were rude to the staff? I know that most clients are put off that I ask, but, I explain that we are never rude to clients and it is expected this is reciprocated in return. Every single client had provided a firm and disgusted "NO!" For the repeat offenders they are given a written letter of warning and at the third infraction; fired. Every practice owner needs to both protect their staff AND hold clients to a standard with consequences. No vet staff member is ever paid enough to allow or tolerate abuse.

Clues to Lock Down worthy clients; (Note; I am not a psychologist AND I am way out of my vet hat boundaries.,, But, these have been my experiences. I add them as personal reflections).

1. They are usually new clients. Never people you have seen and known for years.

2. They have seen multiple practices over multiple years.

3. They provide red flags at every single interaction. Pay attention to the little voice that tells you to be careful.

4. They do not provide small talk unless it is somewhat uncomfortable and moderately inappropriate. Like asking for your private information, or, disparaging others to find a common enemy.

5. They seem to exist on the ends of the spectrum. Either too nice, or, too angry. You never know which you are going to get?

6. The pet goes from happy and jubilant one visit, to afraid and shy the next. ALWAYS pay attention to the pets and the kids. They tell you what you need to know.

Here is a reference from Psychology Today on Dangerous Personality traits. The men of this blog possess many (or all of them). Please read this article if you are a woman, vet, vet staff, person, employee, anyone and everyone.

Footnote; None of the photos in this blog are of the pets involved in these cases. The situations and scenarios are collected experiences based on previous situations within the clinic. Names have been omitted and references to actual clients have been altered to protect the staff from further harassment and client instability and instigation.

About me;
I am a small animal veterinarian and the owner of Jarrettsville Veterinary Center in northern Harford County, Maryland. We are here to help you and your pet at every step of their lives. Please check out our amazing Facebook page JarrettsvilleVet. Or find our 2017 Jarrettsville Vet Price List here.

If you would like to learn more about pet care or ask a free pet related question please visit Pawbly.com. It is free to use and open to all of those who love pets.

If you want to help others and you have experience with pet care please join us on Pawbly.com. Pet care is about helping others and we are built on this alone. I also have educational videos on YouTube, or @FreePetAdvice.

And of course we hope that you will Please always Be Kind to every living creature.

Fear and Guilt. Why these won't help your pet get better, and why our pets are smarter than we are.

 

Chloe smiles for our selfie.

The emotional attachment that we have with our pets is undeniable. It is the reason we take those cold early morning potty walks, go out of our way to purchase the gourmet snacks, kibble, sweaters and personalized collars, and choose to stay home on date night rather than leave the kids at home.  Our love for our companions drives us to baby talk and bedside cuddles. It also causes some of us to be crippled in the decision making process.

Those emotions also leave some us to be enslaved to an emotional roller coaster of inner turmoil.

You can't have one strong emotional attachment, like love for our pet, and not have the rest of the emotional baggage that goes along for the ride.

Guilt and fear are the ugly step sisters to love. I have to remind myself that my clients might not admit it, but much of their reasoning, reactions, and behaviors are due to guilt and fear.

These two terrorists harbor nothing positive for you or your pet when it comes to healthcare.

As your vet I will admit that I get afraid too. I also have a decade of experience to remind me that there are always consequences. Fear of knowing the truth doesn't allow you a different truth. It just provides you a shorter list of opportunities. Fear of anesthesia only leaves you with regret when the operable mass, dental disease, or failure to spay at 6 months old is now your pets death sentence. Fear of cost will cost your conscious. Fear of treating to spare your pet the pain of a treatment is an unfounded assumption.

There isn't one fear in your heart that we haven't thought of, planned for, nor provided an answer to. Say it out loud to us. We will listen and we will be your pets champion. BUT, this discussion can only happen with the foundation of trust in place.

You have to trust in your heart that we have your pets best interest in our hearts. If you don't nothing that follows, nor any decision that you make will feel right, settle peacefully, nor help you face the same emotional hostages the next time.

I know that we veterinarians can seem a bit reserved and composed when we talk about all of the scary things we do routinely. But, doing them routinely keeps us emotionally able to perform our jobs. Would you want a crying hysterical surgeon standing over you? No, we can't concentrate on your pet, or our task, if we are in a fog of fear, guilt, or emotional instability.

I had a very good reminder of these the other day.

One came in the form of a Pawbly question. Monalisa asked;
"Can a vitamin liquid supplement cause your 3 year old cat to die prior to your pet having a severe sickness?"

Here is my answer;
I receive many questions from clients reeling from the loss of their pet and desperate to try to identify what happened to ease their guilt and despair. The answer is always incredibly difficult to answer. Primarily because I empathize with the terrible burden of pain that it is to bear losing a pet.

So, first, I always remind my clients that their greatest gift to their pet was their love to them. It is the greatest joy to share your life with a pet, and the hardest thing to lose them. BUT, without you they may have never known love, or laughter, or what a real home is. That is everything. You were everything to your pet and I am sure your pet is grateful for the time they had with you.

Many pets die without us knowing why or what happened. Some of them can hide or mask signs of illness and this makes understanding that they need medical help difficult.

Can poisonings or toxicities occur? Yes, I am always very conservative with the products I recommend because the labeling and rules on pet products are not as strict and stringent as they are with human products.

Is it likely that it was the supplement? Probably not. But there is really no point in beating yourself up over loving your cat. I'm sure that you were trying to provide them the best life possible.

I hope that this helps, and please don't hesitate to ask about how we can help you care for your pets. That's what we are here for.

My deepest sympathies.

Your pet knows that life is something that you live in this moment. No fear, no regrets, no second to trade for this one. They also know that you are the best

And from a friend I received this;
I would like to talk to you about my dog who is 10. I am terrified about his lumpy leg. He had FNA twice in recent years. It was diagnosed as a lipoma, but so big now. Feel OK talking to you. 
If he needs surgery I think I'd like you to do it.

My friend also sent me this; The Secret Reason Your Clients Are Afraid.

My answer back;

"I'm happy to see you both. Please call the office and schedule an appointment."

That was 5 days ago. No call and no reply from my very devoted pet parent friend.

I sent a note asking if she had gotten my reply? She confessed that her fear was crippling her. She was so afraid she couldn't pick up the phone and call my office, or reply to my email.

"What if I look at it and decide it isn't significant enough to even discuss removing? Why don't we take it one step at a time?"

Where do I think my best advice lies? Well, I suppose we all need to be brave enough to open up the dialogue by opening up our mouths, confessing the emotions of our hearts, and build a meaningful relationship centered around trust.

Your pet lives in the here and the now. They are free from guilt and fear and live with love and joy. It is our job to think and act for a happier and healthier tomorrow. Be proactive and become the master of both your destinies.. and always keep a little bit of faith  in your heart.

Related Blogs;
There Has To Be Mercy Before Money.

Too Afraid To Fail. When Your Fear Costs Your Patients.

How Do Our Perceptions Lead Us?

To ask a pet question on Pawbly.com just sign up and ask away. All questions are free to ask and the Pawbly community will add their thoughts and opinions. Pawbly is free for all to participate.

If you would like an appointment with me, or any of the other amazing people at the clinic please find our information on our Jarrettsville Vet website or Jarrettsville Vet Facebook page.

I am also on Twitter @FreePetAdvice.

Too Afraid To Fail? When Your Fear Costs Your Patients.

Porter smiles with his mom.
He looks dapper even at 18 years old.
His story is here.

We veterinarians are all cut from the same cloth. It is the by-product of selective honing of skills to meet the scrutiny of the veterinary school selection committee that we eat, sleep, dream, and pray to satisfy.

If you spend a decade trying to be someone for someone else you get a little blinded and unforgiving.

Betsy, awake after surgery.
She had a mass removed from of her nose Monday.

We work so hard to become a vet that many of us believe that we have to be perfect, (at least to the outsiders eye). Sure, internally we can over eat, under eat, over caffeinated, over chew tobacco, over indulge, over shop, over drink, over criticize, the list is long and dark, but on the outside we have to look like the "perfect vet student candidate." We are conditioned to be someone on paper that will be worthy of an acceptance letter. It isn't a healthy way to live. It is the nature of the beast when you want so desperately to become a veterinarian.

Our fan belt baby.
Looking for a home.

Perhaps my viewpoint is a bit skewed? I spent the better part of two decades working for that acceptance letter. But I would argue that most veterinarians share a few common traits. We are hard working, obsessive, type-A, driven people. For most of us we attended vet school in our twenties, or quickly after completing college, and most of us have few real-life experiences to add to our over massaged over ambitious resumes. There simply isn't enough time to study, attend classes, build a competitive work experience history AND become an adult with real-life realities.

Gypsy gives me the eyeball.
I proceed with prudence.

Here's what real-life realities means to me. It means the good, the bad, the ugly, the sticky, the unpleasant, the grit of painful stuff that you cannot elect to experience.

Vet school student hopefuls, present students, and graduates need to fail. We need to know what failure feels like. Every human being will struggle with something along the way. The lessons you walk away with are just as valuable as the tests you ace, the acceptance letters you are graced with, and the accolades you strive to attain. Don't have an expectation to be anyone or anything else than the true core of who you are. Whether that be passionate, skilled, kind, generous, pensive, erudite, crafty, or personable. You can be that one thing without having to be everything else. You don't have to beat yourself up for being something that you are not. But, that shouldn't mean that you cant try to grow into a better practitioner.

Sadie snuggles with her mom, waiting for her first vet visit.

You have to fail. You have to at least leave yourself open to fail. This is a uniquely human quality. I can't use some dog training analogy. You know like I try to with fears, anxieties, conditioning, over coming these with consistent gentle reinforcement. You have to embrace and jump into your fear of failure. There is no other way.

Too many of us try to tip-toe into the surgeries, the difficult cases, the new stuff that we are cautious and afraid of.

Lucy recovers from her other cruciate repair.

My advice, be honest and be open minded. A pet in dire need is a very good excuse to get over your internal doubting voice. Always be honest, always be open and always treat your clients with respect and sincerity. You owe them all of the options. Unfortunately, many people lack the resources or availability of a referral. What happens to these patients? Twenty years ago there weren't many referral clinics. Thirty years ago a veterinarian had to wear every referral hat. It was a matter of both need and necessity and it was the expectation of every new grad. You were forcefully pushed into those deep unfamiliar waters. You knew it was coming, you knew you had to, and deep down you looked forward to carving each notch out of your new tool belt as you tackled broken bones, cystotomies, enterotomies, GDVs, pyometras, C-sections, enucleations, perineal urethrostomies, hit by anythings,, the list is long. It was common practice for the new kid to walk-in and the old guy to walk-out. No cell phone to call a life line, no techs to help you, you were SOL solo. I grew up in this kind of practice. There was no such luxury of some other guy. There was just you, your skills in some variance of expertise and a patient who would die otherwise.

My point is this. Be the person who saves a life. Jump in when there aren't any other options. Build yourself into the vet of our forefathers. Be honest, be trustworthy, and try. JUST TRY. What do you have to lose? In many cases it is a patient and an experience that both of you benefit from.

When all else fails find a friend in need and get some pet-therapy.

If you are looking for a safe, friendly, pet focused place to ask a question, share your pet knowledge, or just post cute photos you can find us at Pawbly.com.

You can also find me on Twitter @FreePetAdvice and the clinic, Jarrettsville Vet, in Jarrettsville Md.

Get Your Pet Ready For Fourth Of July!

Did you know that more dogs are lost on the Fourth of July than any other day of the year?

All of that booming, crashing, flashing lights and chaos is the equivalent of the apocalypse to your pet. (Remember they can hear much better than we can and they are not expecting the sky to light up and crash around).

Here are my tips for preparing you and your pet for a safe, uneventful Fourth Of July!

1. Keep your pet at home and AWAY FROM FIREWORKS! They scare them to pieces.
2. Keep your pet with you, leashed to you, or in your house, at all times when loud noisy activities are going on.
3. Use a reflective collar to alert motorists should your pet be out at night. Motorists often are not looking down, and if your pet gets loose the reflective collar might save their life.
4. Have your pets information on their collar. I like to embroider my phone number on their collar, so that if a tag falls off the information is still there, but there are also metal plates that can be mounted on a pets collar. 
5. Have your pet micro-chipped.
6. Have a tag on the collar with your pet's name, your phone number and "MICROCHIPPED" written on it, (if your pet is micro-chipped).
7. Assume your pet will over react to loud noises and be prepared for it. Any gunfire, fireworks, or even overhead airplanes can cause a pet to run. if you hear any loud noises look at your pet. If they are looking scared, perplexed, or anxious get them inside or on a leash immediately.
8. If you are inside and your pet is looking fearful place them in a safe, enclosed, secure space. The smaller the better (most pets feel safer in a small contained area like a cage versus a room). 
9. If they are still feeling overwhelmed by the noises, try to dampen them by placing a blanket over the cage to block out the noise.
10. If your pet is calmer with you then keep them next to you. Don't intensify their fear by baby-talking to them. This will often reinforce their fear. If they think that you are afraid too it will just  compound their insecurity. Be kind and gentle but not afraid.
11. Keep pets away from windows. I have seen dogs jump through a window to run.
12. For any pet that has had an issue with thunderstorms, or fireworks, etc. in the past, once they have a fear then they will likely have it forever. Expect this and prepare for it. Ask your vet for help with dealing with fear based anxiety issues. Most behavioral issues worsen and intensify with time. Expect this and prepare for it after the first occasion.
13. See your veterinarian about medications to help with fear and anxiety. But remember they need to be in your pet about 30 minutes before they need them. For thunderstorms this is often hard to time correctly. For fireworks give your pet the medication about 45 minutes before night fall.
14. Even with training to try to ease their fears (we call it conditioning) the chance of them over reacting to a threatening stimuli is present. There are things to try that might help. I would encourage you to try them. See a behaviorist and your vet for help in addressing your pets fears.

Be Safe Everyone! 

Related Posts;

The Fourth Of July, AKA, Your Pets Version Of The Apocalypse.

Keep Cool Through The Dog Days Of Summer.

If you have a pet question you can ask it for free at Pawbly.com. You can also answer questions, meet other pet parents, brag about your pets and join the community dedicated to caring for pets.

Or find me on Twitter @FreePetAdvice, or in the clinic at Jarrettsville Vet.

Alfred. Afraid

We all react to  stressful situations differently.

Some of us cower, close our eyes, and wait for the storm to pass.

Others plant our feet firmly in the ground, raise our fists, furrow our brow, puff out our chest and posture for a fight.

Some of us elect to jump in fists flying with little word of warning.

This is Alfred. He is a timid shy boy with a checkered past. He has learned that his world is upredictable and therefore it is safest for him to try to be very very small, quiet, and not make any waves.

His mom passed away a few years ago so he was shuffled into his relatives home. It was scary for him to have to go to a new place where he didn't know anyone. They also didn't know much about him.

Everyone has had to compromise. Many of us do not easily adapt to new places, and many of us like our world to stay as static and steady as possible. Little dogs with big attitudes, and bad experiences are challenges for veterinarians, groomers, and their family.

Alfred is a terror to be groomed.

He may appear quiet and reserved, but that is just to buy him a bit of time to internally ponder and calculate the distance, rate of strike, and target for optimal damage, and to do so with expert accuracy.

Every exceptional veterinarian and technician learns that compromise is the best way to deal with a fearful patient.

Here is the trick with Alfred. (It also works with my husband).

Let Alfred feel like his in in charge and he will submit to anything you ask of him.

He doesn't want to be groomed! Fine, Just hold his head so he cannot see the clippers. He thinks that if he cannot see the clippers then he is not being clipped. Works for us and it works for him.

Smile at him, tell him he is alright..he will believe you.

If you believe it, he believes it.

Sometimes less is more. Less stress, less restraint, gets you more cooperation, more willingness, and next time..well, next time we might not need to spend 20 minutes trying to convince you that we are not going to hurt you.

Trust. It is earned. It is imperative when you are a care taker.

If your pet is fearful, aggressive, difficult, or has any behavioral issues find an exceptional veterinarian or exceptional behaviorist and get help. 

Help for fear is love and patience. NOT choke collars, yelling, hitting and aggression.

Life, you get out what you put into it. Such a simple lesson. 

Alfred we know that life has thrown you some curve balls, but we are here to help you weather every storm, safely, and with a gentle loving hand.

Many Thanks to Kate and Kaitlyn for helping Alfred be less afraid.

As always, always be kind.

If you have any pet questions you can find me at Pawbly.com, on Twitter @FreePetAdvice, and @Pawbly.

And today, as with everyday, God Bless The Animals.