The Cat and The Line In The Sand.

Most vets go into veterinary medicine because they “love animals.” Those two words are on every vet school application and every job application I see. Don’t get me wrong it is a very important part of this job, but it is equally as important as “works well others,” and “wants to help people.”

It is a hard combination to find. Most of us vets like animals more than we like people. Turns out you need to have people bring in their pets into you AND then you have to be able to talk to them. They don’t teach you that in vet school..You have to learn that on your own. This one skill alone has been the kiss of death to many a vet. It is a big incentive to become a surgeon. Your people skills have a very limited time allotment, and you get to spend the majority of your time with your patients in a quiet permissive state.

My biggest single challenge has been this. When you are trying to save every possible pet that you can you are going to run into people who don’t feel exactly as you do. For some people pets are possessions of convenience. No one wants to admit this, but it is true.

I came to Jarrettsville Veterinary Center over 8 years ago. JVC was exactly the place I was looking for. A nice combination of country but for the sake of a descent cappuccino, suburbia was a stone’s throw away.  I inherited a clinic that practiced exemplary medicine from a congenial man who had been a vet for 40 plus years. He was loved by everyone and I had big shoes to fill.

I was a die hard dog and cat girl taking over for a man who had been doing this for a long time and had done every part of veterinary medicine along his way. Where he had cow, horse, goat, chicken, and every other species, with every possible ailment to back them up, I just had a pile of brand new textbooks and a “domestic dog and cats only, please” provision.

Every James Herriott story written served as the back drop for every dream I had in my teens and twenties. I wanted to live that life and be the American post-modern heroine who spun tales out of the people, places, and pets I met along the way, (but without all of the dirt, manure, and excrement).

Unfortunately, reality is never quite as easy and dreamy as the visions in your head want it to be is it?

I arrived at JVC as a shiny brand new vet school graduate ready to live some tales, eager to save some lives, and begging the bank to lend me more money than I ever thought I could pay back. (If I get to leave myself some advice in my next life I would say to be a little more patient, and stop jumping in the poison ivy in an effort to pull out the weeds. But I hardly listen to myself now either).

During my first month at JVC I witnessed the owner that I bought JVC from euthanize an 8 month old pure bred German Shepherd (that the owners had paid thousands of dollars for as an 8 week old) because he had terrible hips. I remember getting into an argument with him over it after he had put the puppy down. I was heartbroken for that puppy and decided I couldn't work in a practice where this was allowed to happen. In an outburst of complete unprofessional candor I told him that one of us had to go. We mutually agreed that once I had the reigns I could run JVC how I wanted to, and in the interim he would continue to run JVC how he saw best. The staff (god bless them) shielded me from anything they knew would upset me, and I endured the ignominy of the remaining days as “associate vet.”

When the reigns were turned over to me I announced to the staff that JVC would not provide “convenience euthanasia’s” and that in the future when clients called to schedule a euthanasia the staff was to tell the owner that euthanasia’s were scheduled as examinations and after the veterinarian had seen the pet and discussed the condition with the owner then, and only then, would a euthanasia be performed.” I know there were some clients who went elsewhere when they were told this. I decided before I issued the policy revision that I was OK with that.

A long time client came in with her cat one day requesting euthanasia. She explained that The Cat was “old, sick, and aggressive,” and for these reasons she wanted him put down. As I reviewed the chart I was concerned about a few things. First he was 10. Ten in cat years is about 45 in human years. She was clearly over 45. I don’t think she would have referred to herself as old, (nor do I for the record). He was underweight and scrappy looking. He also hadn't been seen by a vet in about 5 years.

I examined him and became concerned that some of his alleged violations might be medically explainable. I asked if we could try to figure out if some of these clinical signs might be disease related and I was met by a forceful, stern, uncompromising “No.” She had made up her mind and come to me for a euthanasia and nothing more.

It was her way and her wishes or nothing. Ask any Italian you know what happens when they are given an ultimatum and I would bet they will all say the same thing. “we are stubborn.” (I know I am stubborn. I am working on it, it's not a fast nor quick process, don't hold your breathe).

I tried to offer some compromises as I delivered my line in the sand. I, as politely as I could, tried to explain that ”I was not able to euthanize a pet that I thought might be treatable.” To the staff I explain it as “my conscience isn't for sale.”

After a few tension filled moments of unyielding wills, she signed The Cat's care over to us and left without a bill and in great palpable disgust. That was about 7 years ago.

One day many months ago the phones were ringing like the town was on fire. At these times the standard operating procedure is “that if you hear the phone ring more than 3 times everyone who is able is expected to answer.” Because the phones all seem to ring at once there are times that I answer. I answered a phone call with the sub-standard greeting of “Hello, Jarrettsville Vet.”

 I was met by a “Hello, I need to bring my dog in tonight so the vet can look at a wound that hasn't healed in a week.”

 “OK, I have an appointment open tonight at 5.” I said.

“Who’s on tonight? I won’t see Dr. Magestic.” (The name was wrong, but it was close enough to know she was referring to me).

“Well, that would be me, and I’m the only doctor on tonight.” I replied.

“OH! Sorry, I’ll call back later.” Click.

I sent a card the next day to her saying, “ I apologize if I have offended you, as I seem to have, and signed it K.Magnifico, DVM.

I got a two page reply a week later, that said the following;

“Dr. Magnifico,

I appreciate your personal note and the apology regarding my decision to not see you as a veterinarian. I think that I owe you an explanation of why I made that decision.

Since 1990 I have brought my pets to Jarrettsville Veterinary Clinic. In the past 22 years, the staff at the clinic has provided care to 4 cats and 5 dogs, all of which have been taken into our home as strays or rescue animals. I have always felt that the staff at the clinic respected me and partnered with me to make decisions regarding care/euthanization of my pets. I have previously had animals euthanized by Dr. X, Y, and Z. They were all caring, sensitive and understanding and supportive of the tough decision that I had to make for each of the animals.

When I brought The Cat in 2007, he was a sick 10 year old cat that attacked other animals and the occasional human. It was not easy to make the decision and I was stunned to be treated by you like a “bad pet owner.” I understand you professional ethics that prevent you from “euthanizing a pet just because the owner doesn’t want it anymore.” I cant understand, though, your complete lack of compassion for the animal, who was clearly sick, and the owner. I had more than one guest in my home offer to “put the animal out of its misery” but I thought that euthanization by a vet was most compassionate.

                I came home, after surrendering the cat to the clinic, in tears, and my husband and I agreed that we would never allow you to do this to us again. The only reason that we did not leave Jarrettsville vet Clinic is Dr. Z, who has provided exemplary care for our pets.

                You are, no doubt, an excellent vet as well, but I need a vet for my pets that respects me as an owner.

                                                                Sincerely, XXX

I have evolved a little over the years. There were examinations with pets whose owners requested euthanasia’s for such atrocities as “doesn't match furniture anymore,” to “not using litter box” (vets get this one A LOT!), to “whining excessively,” “moving,” “divorcing,” “new ___friend doesn't like pet,” to my personal favorite, “got new puppy.”  I have learned that pet care is a mutual process, where we both help the pet live a better life, or help end it’s suffering if there is nothing else we can do. I also better understand what I can and can’t do for both a pet and an owner. And I have drawn my line in the sand often enough to not feel pressured, bullied, or threatened into doing something I am not comfortable with. Saying “no” is a whole lot harder than saying “yes” but in the end I really only care about how I see myself when I look in the mirror. If I don’t like or respect who I have become than I will move on.

Here are my thoughts on her letter. A “caring, sensitive, understanding, and supportive  vet” shouldn't be a vet who lets you do what you want and doesn't offer to help you understand your pets needs. That’s what shelters are for. If you don’t want your pet, and you don’t want to help understand your pets needs I am not the vet for you. BUT I am caring and sensitive, maybe just more to your pet than to you. But I already confessed this flaw in the first paragraph.

The Cat was signed over to JVC and his first (and only ever) blood work panel revealed that he had hyperthyroid disease. Which explains ALL of his ailments AND his behavioral aggression. He began twice daily pills and became a docile affectionate cat. He was adopted by a family who spent the next 6 years revolving their lives around any and all of his needs. Cat was the nucleus of their family. We received postcards at every holiday, all from Cat, and he was brought to every Pets With Santa. When he passed away his family sent the most emotionally moving Thank-You card I am sure we will ever receive. Cat made their lives richer, fuller and deeper. He brought incredible joy to them, and I know for as much gratitude as Cat had for them, they had just as much for him.

I sent a reply to Cat’s former owner thanking her for taking the time to write and explain her thoughts. I also admitted that I will be the first to admit and self-scrutinize. My intention was two-fold, to try to help Cat and to try to end each day and my professional life without sacrificing my soul along the way. It is not an easy task, and I understand that I have lost clients along the way. I explained that I continue to try to help both my clients and their pets to anyone who asks.  I closed with saying that “thus far every pet that has been turned over to JVC, save for 1, has been adopted to a loving home.”

The one cat I put down was left to us by a client I loved dearly who died. Their cat was very, very, ill and as hard as I tried to get her well I was never able to. She was put down because she would no longer eat, and she was starving to death. Out of love and compassion for both them and Baby (their cat) I put her down. I still feel remorse for Baby, because I feel as if I failed her.

As for Cat's original mom, she called a few weeks ago requesting her records be transferred.

The worst advice I ever got as a vet was from another vet who told me "you can't ever care more about a pet than their owners do." My reply, "If I start to care less then who will take care of the rest of the world?"

If you have any pet related questions you can find me at Pawbly.com, or on Twitter. 

Midnight, My cat the hyperthyroid kitty

My first husband left me with a broken heart and a bitter taste in my mouth, but he did love cats. I always tell my clients that a man that likes a cat is a good guy. So I guess I have to stand by that one. Anyway, back to my point of this narrative, he came home one day to our little shabby apartment with a very small handful of black fur. She was pathetic in every sense of the word. She was barely big enough to be identifiable. You had to search for ears to put the label of feline on her. Otherwise she just looked like charred dryer fluff.

What could I possibly say to him? He had pulled into the gas station by our apartment and saw a little black mass hiding in the tires by the repair shop. He went over to her, started to play with her, picked her up and inquired with the attendant as to whether or not anyone claimed her as theirs. He told me that they knew she was there, but they had no idea how she had gotten there. Because she was playing so close to the busy road he knew he couldn’t leave her there to be run over by a car. So, I return to my original question. What could I possibly say to him? I just loved him for caring, and doing exactly the same thing I would have done. At the time it seemed so kismet.

So she stayed with us; and is with me still to this day. She is now 19 years old. She has seen me through a lot of challenges. 2 marriages, 1 divorce, college the second time around, vet school, 3 residences, and 10 other cats.

At the ripe old age of 19 she has certainly got her own little quirks. Her favorite toy still remains the hand knitted hand-made wool mice stuffed with catnip. You will occasionally hear a muffled but high pitched meow echoing from the third floor. If you don’t know it’s her you will think a cat is warning you of an impending fire. It is alarming and almost unrecognizable. It makes me so happy to think that at 19 she still loves her toys. She started out very small and she grew into still very small. She was delivered to me in the palm of a hand and is still transportable by one hand only. She never did weigh more than 6 pounds, even in her glory years.

At age 16 she developed hyperthyroidism. It is one of the 2 big old cat diseases. The other is kidney disease. And just for any of you out there reminding me that I am missing another big old pet disease I say whole heartedly YES! The third is cancer, but I was being species specific. Cancer has no species preference. We vets use the saying quite frequently, “cancer does whatever it wants.” It isn’t what an inquiring, probing, unsure client wants to hear from you when you are trying to read the tea leaves for their pet with cancer.

The classic hyperthyroid cat presents to us as; “Hey Doc I think my cat has worms”. Ok, I recognize the bait, and yes, I bite. “Why would you think that Mrs. Jones?” “Because Doc, she eats and eats and still she keeps losing weight.” “Oh, well maybe we should check into that” I reply. It is important to remember that the acceptance of any diagnosis is always easier if every member of the team is a willing and active participant. A client is always more likely to help treat if you can help them diagnose.

 It is a more difficult task to assess an individual’s behavior if you are also watching 7 others concurrently. (Yes I do have 8 cats. No giggling please.) This is the dilemma of inquiring about a patients’ behaviors, actions, etc., in a multiple pet household. So I had to ask myself the same questions I ask my clients. Was I sure that she was polyphagic (increased hunger/eating)? Umm.., no, not really. But was I sure her small body was shrinking? Yep! Definitely. A blood test later my suspicion was confirmed, and thus began our greatest challenge. The twice daily oral pill administration. OMG, did she fight me. And OMG was I determined to have my own patient treated. it took along time before she understood that i wasn't trying to suffocate her, and after months of practice she now willingly sits, and swallows her pill quickly and easily. this is often hard to convince owners of. Patience and practice are the cornerstones of pilling a cat effectively. Please don't give up after your first attempt doesn't go easily. Always ask your vet to help you. We will show you as many times as you need us to. And you can do it, I promise you can.

A lot of interesting things have happened to veterinary medicine over the last decade. Two of the greatest achievements we have made are; One, the advent of flea and tick prevention, (no I don’t know what we did before them). And two, almost all feline products are going topical. Easy to do? Hell Yes! As effective? Hell No! (usually). But I appreciate and applaud the efforts, and the marketing strategy. Offer a client a topical at twice the price of the original pill and guess what they will choose 9 times out of ten, Yep, they are great money makers. Many of my clients now use a topical hyperthyroid gel instead of pilling. i would say it works 60% of the time. 

So it has been a few years of medicating the disease that’s eats away at her. I send the sentinel down her throat twice a day and the weight is holding steady. She still can be heard prancing around the third floor with a stuffed catnip mouse in her mouth. And me, well, I have a wonderful sweet longtime friend. And I guess I still stand by my thoughts on the “good guys” qualities.

If you would like to learn more about a hyperthyroidism in cats please see the link below;
http://tinyurl.com/3f6web4