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.
This is a blog about foreign bodies.. This is a blog about saving lives at the precipice of death.
This is also a blog about Levi.. He has been a source of my writings before. He is one of those patients who teaches you, tortures you, and reinforces where medicine diverges from sentience.
Levi has not had the best of luck. He was given up by his first owner because "it was cheaper to get a new dog without a problem than to treat his epilepsy." We parted ways permanently and with sincere words of disappointment and I kept Levi.
Levi found his real parents a few weeks later. They have been inseparable and in love since... but,,, the seizures have required medications which produced polyphagic mania. Levi has become a voracious counter surfer, toy eater, and frequent flyer for pancreatitis and induction of emesis. He has been to the ER or us for eating two loaves of banana bread, 6 loaves of sandwich bread (in plastic bags), two sleeves of gauze, a ceramic butter dish, and numerous other less disastrous close calls.
He is an excellent example of the meat of this blog.
Levi
In my experience the foreign body dogs fall into one of three categories;
1. The "OCD needy" type. The dogs who are inside, with their people fully integrated into their family unit. Often a single female who bonds so closely to the dog that the dog can no longer deal with anything without her, see also separation disorder, OR, the embedded family dog with the busy active lives, the dog thinks of themselves as a human child (because that is the only reality they know) and can't deal with them being out of the house for any reason including school, work, social life. These pets eat their way out of the stress of being alone. Labs, Border Collies and German Shepherds are over represented in this category.
2. The "keep my mouth busy because my body isn't" pets. There is no exchanging exercise and tiredness with indoor activities. All dogs need the outside, their nose in the dirt/grass/leaves/sidewalk, brain chugging away on primal sight/smell/touch/sensory experiences. This is a core part of their being. If your current daily regimen isn't getting you the desired results change it. If your dog is chewing, biting, stressing, needing, whatever and they are inside the majority of them time get outside (with them (this is imperative)) and let them share their life with you.
3. The "demons inside of me make me do it" pets. Drugs, stress, fear, paranoia, imbalance, pain, gi discomfort, etc., are all reasons that dogs eat things other than their food. Do not ignore this group. We know that pain can be inside, hidden from view, and that many of these pets live with chronic pain and/or disease that manifests as chewing/eating/ foreign body ingestion (this can also include hair, wounds to the body, and pica).
Some of my gang in the sunshine
I have a long list of questions to ask owners when I get a pet in the clinic with a affinity for eating/ingesting items that are not provided to them in their food bowls.
There should be a long discussion with your veterinarian the first time (and even longer discussions with any subsequent infractions) your dog eats something that is non-sensical.
Levi arrives for surgery
In past blogs and videos I have mentioned the previous pica items that I have seen pets eat (see my blog about tampons, underwear, rocks, toys, balls, nuts, and even endless yards of Berber carpet which is a beast to surgically remove from intestines (it sort of melts and snakes through yards of gut making it almost impossible to extract). I find this behavior most commonly in larger breed dogs who are primarily inside and often younger versus older. I think there is a very strong correlation to obsessive-compulsive disorder, boredom, and behavioral problems. I am not saying that every dog who eats a sock, or other random non-food item needs a psych evaluation but I do think that every person involved in the pets life should at least be thinking about what their pet is trying to tell them, and why they are eating things that are not food. (P.S. an older dog who starts eating random non-food items is trying to tell you something. listen. dig. figure it out.)
The other group of indiscriminate PAC-MANesque pets are those on anti-seizure meds and steroids. These guys are driven by the drug that makes them voracious eaters who will eat a blanket if it even smells like it had a crumb hiding within it. Ask Levi the epileptic who ate a whole ceramic butter dish, lid included. (When we induced vomiting in him he spit out a collection of ceramic rubble akin to an archaeological dig... had I known what it would have looked like on the floor I would have thought twice about all the jagged ceramic edges transiting his esophagus AGAIN on the way up).
Doesn't anyone but me ever wonder what possesses them to eat these things?
Levi's catheter conundrums. When you have had i.v. catheters placed as many times as Levi has you surrender to the process and your veins are impossible to access.
When you bring up the discussion with your vet please make sure to be discussing the following items;
1. Diet. I always want to know what specifically you are feeding. This includes the dry food, the wet food, and the snacks. I want to know every item that you are putting in your pets mouth. Treats count! If you have a pet with an oral fixation on food they may become compulsive about always eating. You have essentially trained them to be constantly rewarded with food. Breakfast and dinner and play, love and exercise in between is the ideal way to spend the day. If you are feeding a deficient, substandard diet your pet will seek food/nutrients elsewhere.
2. How much exercise your pet gets? How much of it is structured? By this I mean is it a regularly scheduled daily event? Does the breed of your dog have an activity level that meets their needs? I often find that many house dogs are being asked to live a lifestyle that is too sedate and placid for their mental stability and health. Having a fenced in yard does not guarantee that your pet is actually out AND exercising in it. Please try to take daily walks of a measured distance. It is a wonderful activity to bond with your pet, provide enrichment and help both of your cardiovascular systems.
3. Stress. When I say stress for a pet I am talking about anything that your pet might find disconcerting. Not what you and I think about as stressful, but rather what your pet might see as stressful. Is there a change in activity in the house? Are their new or different noises? Or anything that their highly sensitive noses might be detecting? What about their super perceptive bionic ears? Or is anyone in the household upset? New neighbors? New family members? I know it is hard to try to think like your pet, but often they are picking up on something that is very disturbing for them and we are completely oblivious to it.
4. I often have my clients keep a daily journal of every aspect of their pets day so we can go over it together and try to identify any sources of any possible reason that their pet is now chewing on the furniture , or swallowing the items they find in the trash bin.
5. The "pacifier" dogs . These are the pups who we provide treat-stuffed-toys, bully bones, antlers, chewies, (etc., etc.) to in the hope we can keep them 'busy, 'quiet' 'entertained' for a few hours. Dogs with a high chew drive, or, those who have been repeatedly "pacified" by being given a treat when they are demanding attention are taught to be acquiesced only by chewing.. When the chewing leads to ingesting these items they can become deadly.
Levi post-op, I know he feels better already.
Levi was actually seen swallowing his toy. His parents knew it went down. They couldn't believe how huge the toy was, and that it could have even been swallowed. I can't tell you how many times I hear this! I have seen whole towels, beds, toys, golf balls, tennis balls, walnuts, and cutlery swallowed in one fell and fast GULP!. Since then he had a decrease in eating for a few days, persistent vomiting, lethargy, and general malaise. His belly seemed painful and his x-rays showed something in the stomach,, even though we were all fairly certain it wasn't food.
The size, material and amount of time since ingestion all matter.
If you know your pet has ingested something other than their food it is best to do the following;
1. Call your vet immediately. Ask for guidance on what to do. They may advise that you;
2. Call the Pet Poison Helpline. Although there is a cost associated with this in some cases of toxin ingestion the information they provide you and your vet is well worth it.
3. Induce vomiting. Only do this after confirming with one of the above.
4. Watch and wait. If the material is able to be broken down by the stomach or small enough and benign enough to pass through the gut you may never see it until it is defecated out.
Any sign of the following indicates an immediate trip to the vet or ER;
1. Vomiting that is persistent, intractable, or producing material that is stuck in the mouth. Vomiting of more than 4 times, or, lasts longer than 3-4 hours, or consistent over more than 12 hours. (These are my guidelines). OR, if your pet is acting quiet, lethargic, depressed, seems distended in the abdomen, or is trying to vomit but not producing anything.
2. Straining to defecate and not producing feces, producing scant amount of feces, or there is material protruding from the rectum.
Levi's stomach is full of... well, that's the fun of exploratory surgeries in pets. You never know what you are going to find in them.
DO NOT PULL ANYTHING OUT OF ANY END OF YOUR PET! If you pull and tear something it could kill your pet.
This came out of the back end of Levi on the same day that we removed his toy from his stomach.
This is the toy we took out of Levi's stomach.
When I examine a pet for a suspected foreign body I start with the following;
1. History: Many of these pets are repeat offenders. Serial swallowers. The first time it happens I go over all of the above information so that it never happens again. You can either decide to stop wearing socks, underwear and using sanitary products, OR, cage your dog when you aren't supervising, OR, don't train your dog to be a chewer. Every client with a chew-swallow dog knows they have one.. don't create, perpetuate, or hope the problem away. Or, buy pet insurance.
2. Exam; I know no one wants to go to the vet every time you fear your dog swallowed something they shouldn't have,, but, your vet can tell a lot about your dog based on an exam. I was called out of bed at 1030 pm to check on a dog who vomited up a sock and undies. Based on the exam I felt pretty comfortable he wouldn't need surgery that night. Which saved her about $2500 at the ER. "Has your dog ever eaten socks before?" I asked. "Yes, all the time," IS NOT what I want to hear at 1030 pm. He threw some of them up at 1 pm, has been lethargic and vomiting all day and I get called panic stricken at 1030 pm? "It's time to stop wearing socks and panties, cage your dog when you aren't there to supervise or get pet insurance. I'm going back to bed." About $50-$100
Exam for a blocked dog usually has the following; history of ingestion, painful abdomen, distended intestines, elevated heart rate, elevated respiratory rate.
3. Radiographs are the cornerstone for confirming a suspected foreign body obstruction. Start with a radiograph. Based on history, exam and radiograph you can try to manage conservatively with fluid therapy. Start i.v. fluids as quickly as possible. In some cases the fluids will help relax and restore pliability to the intestines and allow the obstruction to move through. Additional radiographs should be taken to confirm this. This is the conservative, avoid surgery (and cost associated with it) plan. Expect to pay about $200 for radiographs per series. Usually a few series are needed a few hours/day apart.
4. Ultrasound can be used to help confirm a suspected foreign body. If you can afford ultrasound make sure you can also afford surgery. About $200-$500.
My preference is to understand and discuss the best and worst case scenarios and keep the end game in mind as you manage the financial resources. If my client can only afford surgery we start there. Worst case scenario is that the patient needs surgery to survive this. Spending thousands of dollars to confirm this and then running out of money when you realize this is.... unethical, unimaginable, and happens far too often.
After about the third or fourth time going into the abdomen to cut out an obstruction it becomes nearly impossible due to the scar tissue and fibrosis inside and around the intestines. Please do everything to have the first obstructive surgery be the last.
Here's to Levi.. The epileptic with the phenobarb telling him to eat it.. We are pulling a toy out of his stomach today. He is also the butter dish eater.
Levi heads home
And to Buster, the sock and panty guy. Who dodged the scalpel thanks to i.v. fluids and time.
And to the countless other labs who can't seem to either stop chewing or aren't caught fast enough before swallowing.
When it comes to the surgery to remove a foreign body I offer the following advice;
1. Never euthanize based on price alone. Call for help if you cannot afford the first estimate given. Drive to wherever you can afford it. BUT, keep the pet on fluids, antibiotics and analgesics until you get there. I have had numerous pets wait overnight at the ER to have surgery the next day with us. Often at a savings of about $2000. It is not ideal, but it can save a pets life.
2. An obstruction is an emergency. The faster it is removed the more favorable the prognosis.
For those of you concerned about the prices of Levi's care his care was provided over three days and amounted to about $1400 for everything. If you are unable to afford surgery ask us how you may be able to pare down the price by visiting Pawbly.com for help.
We get a bunch of phone calls and appointments for limping dogs. Lameness is one of those things that can have a million causes and an equal number of options to fix it. Lameness also comes in many degrees of severity.
As a general rule of thumb there is no rule of thumb for these. A slow progressive lameness can be a bone tumor, a knee injury, or even a tick borne disease. An acute complete lameness could be a fractured bone, blister, or broken toenail. Or, maybe all of these but the other way around.
This is Bridger. He is an athletic German Shorthaired Pointer. I was lucky enough during his exam to have a mom who knew exactly when, and thought she knew how, his lameness occurred; He was running in the woods, she heard him yelp! and then he was limping. That was about 4 days ago.
Over the last four days his foot had become swollen and painful. His family thought the cause was a splinter so they lanced it and bandaged it. But, four days later, and still the foot wasn't getting better.
Here are a few important points to remember when dealing with a wound;
Listen to your client. Always give them the benefit of the doubt and then..
Pay attention to your patient. Your job is to do not (further) harm and to get them some relief.
Have a short term AND long term plan. Discuss all treatment options initially. For me, I usually take a somewhat conservative approach initially. Surgery might be on the menu but for this guy it was not option A. He was acting normally (outside of a wound). As long as I trust my clients ability to follow through with the conservative plan we try, talk, and prepare for Plans B-Z. There ARE ALWAYS options! Bridger's initial consult cost about $100.
Here are some tips for those of you managing a wound at home;
1.Few things in life beat the broad spectrum antibiotic powers of plain old soap and water. It cleans (and kills) almost everything. And it is safe. At the first sign of a wound supply copious amounts of soapy water.
2.Bandages.. I have a few good things to say about bandages. BUT, I also have a few bad things to say about them. They close in the bad stuff, like infection and close out the most important stuff, like your ability to see and smell the death, disease, and dirt that lies beneath. The only exception to this is to use a bandage as a way to supply compression to a wound as you drive your pet to the vet.
And should you choose to not heed my warning, I can state without doubt that bandages placed by good intentioned pet parents cause more problems than they solve.
3.Smell.. a bad smell is infection. Go to the vet.
4.A limping foot is pain.. Go to the vet. They will usually prescribe an NSAID.
5.Red skin happens before purulent (puss) happens.. Go to the vet at red skin and/or puss.
6.What appears to be a small surface wound can be a tiny portal to a huge festering deep wound. Deep wounds may need surgical intervention and exploration. In some cases a drain needs to be placed to assist in flushing out the infection.
After a day of soaking the foot and antibiotics Bridger's family woke up to this!
When an infection lets loose it can look like an explosion. After recovering from the shock of a blood bathed room they looked at Bridger's foot and saw the culprit. Which was easily removed. A large splinter had been the source of the infection, pain and inflammation. (Thanks to them for sending me photos!)
What did they need to do after the splinter eruption?
Keep soaking the
foot every 12 hours for another 2 days. Finish the antibiotic (always finish
your antibiotics!), and keep the wound clean and dry. If Bridger goes out on a
wet muddy day he needs a bootie. I wouldn't expect that he will need the NSAID
any longer. Once the foreign body is out they aren't painful. In fact, if they are I would suspect something else is still going on, so go back to the
vet. Here's another tip on pain medications. Listen to your pet. Use the pain medication IF you think your pet benefits from it. Do not just keep administering it without asking yourself if the pet needs AND benefits from it. All drugs have potential adverse side effects, these are best avoided by only using when needed and as prescribed.
Any pet question can be asked for free at Pawbly.com. Pawbly is an open pet centered community dedicated to helping you find better ways to care for your pet. Veterinarians, trainers, behaviorists and all of the rest of the pet loving people of this planet can be found in one place, Pawbly.com. Stop by and say hello, ask, or answer a question, or just pop in to learn more about pet care.
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