It's The Courage That Matters. Garfield the kitten and his broken jaw.

 The real joy in medicine is not the repetition of doing what you already have mastered, it's the courage it takes to trudge into unchartered territory with nothing to lose and a life in the balance.

...at least that is what I am trying to convince myself to believe these days.

Garfield, 24 hours post op

I get these cases more and more frequently as the garden of availability for care shrinks to a place of abysmal, if not completely absent viable options. It seems all too frequently the pool of practitioners would rather swim in the waters of comfort and ease doing vaccines and avoid the whole messy territory of risk critical care for the common people. With its potential for failure and lack of the obligatory at the ready/disposable $10k we are becoming a profession so pigeon-holed we are petrified to challenge ourselves out of our own comfort zones. Human medicine made this leap many decades ago. They parceled out the person into parts, made a specialty for each of those parts and consciously decided to ignore the whole for the rest. Those specialists now demand high dollars and police the gate of admission based on your anility to pay the entrance fee. You may hope to be seen as the sum of your parts, but in medicine you are just that piece-meal-parts. Vetmed used to do it all, and try to do it all for the sake of our patients. Now we just refer. Regardless of whether that works for anyone else but ourselves.

Yesterday was one of those days. Seems the more I call out the ER's for ditching treatable cases when they don't meet the non-negotiable deposit required, the more calls I get to take the cases with the worst traumas and the lowest budgets. Me and my big mouth.

Yesterday it was Garfield. A speck of a puff of orange fluff with his big green eyes and his cock-eyed jaw. It was obvious he had met some sort of trauma. A 2-pound kitten with a dare devil perspective and a primitive naive sense of caution. His dad cuddled him in the exam room nervously. He had come home from work last night and found him this way. Garfield would attempt to open his mouth and scream. He was in pain, his mouth wouldn't close properly, it was fairly obvious the dilemma lay here. Dad did what all of would. He headed to the ER, screaming kitten in tow.

As dad relayed the story my mind wandered off to my beloved Seraphina. The kitten who came to me so many years ago. She had been found in the middle of the road, another tiny speck, grey and mangled. Her chin hanging from her jaw bone, a pitiful meow to landmark the site. She had been the same dilemma; a very broken kitten, and no training to pull from vet school on how to treat her. She, unlike Garfield, had been a found, unwanted kitten. She was so broken that no one would have claimed her. If you don't have the love of a human who has already bonded to you it is very hard to instill a strong enough sense of empathy to pay for the couple thousand dollars a broken kitten of her magnitude that it required. With this she became ours. Our pet project to offer a chance to, fight like hell for, and find a way to solidify her perfect presence within. She remains to this day, perfect. She is the one being I find myself seeking when the Garfield days find me. As the veterinarian who never goes looking for her next companion she will remain the most beautiful, elegant, super model caliber pet I will ever call my own. She adores me as only a once-ago-lost soul can. 

Seraphina

Her story can be found below, just in case you don't know her already.

Seraphina, Lip Avulsion

Seraphina, The Why In Who I Am

Garfield's dad told me that his girlfriend had gotten a kitten, but they had broken up some time ago, she took the cat and left, and he just missed the cat. So, he had found a fluffy orange tabby of his own, and named him Garfield. The two had only been together for a few days, but he was already smitten with his kitten. Garfield was loved and his dad wanted him back to better with whatever means he had to do it. For as long as I have been a veterinarian this is all it takes for me. If a pet parent wants their pet better, if they are truly willing to move mountains to get them the help I will move the mountain with them. This is where the joy lies for me. It isn't in the assets and the accolades. It isn't the work-life-balance and the easy living of being the apex edification-aficionado in a profession you will never master fully. It is the little endeavors where we all put our heart and passion together to make the meaning of life humanity. Give me this a million times over and you can keep your yacht and Birkin bag.

The ER visit was a brief one. At two pounds, and with obvious fractures/dislocation of the jaw, this kitten needed a surgeon. They, kindly, gave a free exam, a bombshell of a projected treatment plan, and sent them on their way, with a comment that "Jarrettsville Vet takes these kinds of cases if you can't get help anywhere else." 

..and so the next morning, as my first emergency appointment of my already booked day, I met little Garfield and his worried dad.

A very brief exam later and I reiterated the same advice; Garfield is really small. Our options for treating this were limited. To make the dilemma even more precarious, I had to be really certain I knew what was wrong before I go jumping in all "damn the torpedoes" to render interventional aid. I had to know whether this was a broken jaw or a dislocated jaw. To diagnose a bone problem we rely on an x-ray. To take a picture of anything in a 2 pound kitten is fraught with impossibilities, They are too small to hold still. There's that. There is no way to not have your hands in the shot.. and the bones of a kitten are more mush than formidable. We tried three times to lay him in different positions to get a head x-ray. None were diagnostic quality. I went back to the exam room to lay it all out. It went something like this;

• Garfield is really small.
• Garfield is in pain and therefore does not want anyone to hold him anywhere near his head. (Where else can I hold a two pound anything?)
• Garfield should see a surgeon for his best chance at a life long functional mouth. 
• I don't think surgeons wake up in the morning and do anything for less than $2,000. If it is a fractured anything that number starts at $4,000. 
• I don't think I can get a diagnosis of what exactly his problem is without sedation. I have not sedated a two pound anything, ever.
• If I can manage the sedation I will need to intubate him to take an x-ray, and figure out what to do to try to treat him. I don't know if I have a tube small enough to intubate him.
• If I can get the above done I still don't know if I can fix it.

(Way to be all Debby-downer Krista)...Want to try?

They took a few minutes to talk about it. 

I returned to the exam room and they agreed the specialists were too expensive, (preach to the choir, and can I have an "amen!" brother).

"So, we would like you to try."

I am sure I muttered something sarcastic like; "thanks" and, "if this works you owe me a big gin and tonic." I tried to keep it light and I hated myself for offering. I don't know how to fix this? I don't even know what this is.

I walked back to the treatment area with an angry, screaming in pain Garfield. I had every justifiable reason to punt this case. It was 12 pm, I was booked solid with appointments until 7 pm, and I, have I said this yet?, did not know what I was doing.

I asked the techs to help. If I never have anything more than the support and kindness of the staff I am still the luckiest veterinarian on the planet. For every crazy, sad, lacking in the hope department case I take on they always jump in to help. "Damn the torpedoes" is our company huddle song. They won't abandon me, or these patients, and we are as close as any military unit I have ever fox-holed up with. This is the marrow of veterinary team building. 

I pulled up the smallest dose the smallest syringe we have and jabbed Garfield in his non-existent thigh muscle. He screamed, I was hopeful that maybe this was an indication the medication had hit its mark.

A few minutes later we masked him with a little aerosol of isoflurane to get him quiet enough to try to place a tube down his trachea. Anesthesia for neonates, sure I remember that lecture, (there is no lecture).

Tiniest tube in the rack, you know the one I have never used before. Yep, let's see how that goes. What do I do if it doesn't fit? We wing it? (We are already winging it).

2.5 endotracheal tube slips into the trachea like Cinderella's slipper. (I say a quiet prayer of gratitude).

Lowest setting for the anesthesia machine? Well, if he stays asleep we got that right. (He did).

Now thay the endotracheal tube in place that we saw the blood in the back of his mouth.
 This is the site of his fracture.
This was the clue we needed to focus the x-ray on.

Now it was time for the magic to happen. That place every veterinarian inherently learns by being a mental ninja of anatomy. Experience and the miracles our fore-parents instilled into us when there wasn't a textbook to follow. (Did I mention I had my Emergency and Critical Care Manual on the surgery table with me?).

Three technicians jumped in to help. There was a Fossi-fanfare of hands circling Garfield's little body.

Our dental expert took the time to take/retake and keep taking all of the dental x-rays until we finally got the picture we needed to confirm our diagnosis. There was a fracture in the mandible on the left side right next to the ramus, or angle of the mandible. (I know I swore here). There are ways to fix this, (did I mention I haven't done them myself), but you need bone on either side of the fracture site to stabilize it for the whatever many weeks it takes to heal a broken bone. It's also super helpful to have had 4 years of residency training in dental surgery.

Ok, check off numbers 1,2,3 we have a diagnosis.,,, and now what. A diagnosis isn't where this kitten needs to be. He needs help in the way of a treatment plan so he can get up and go live another 20 years fully and functionally.

 My dear friend Dave broke his jaw playing baseball in our senior year of college. He was pitching, his face got in the way of a slugger headed low and hard for center field. His jaw cracked upon impact. We were all there. He spent the next 8 weeks with his jaw wired shut after the surgeons put the pieces if it back together. Senior year at the Academy is called our First Class year. You show up, take your exams, pass your license test and drink to oblivion in between all of it. Four years of that pressure cooker and drinking (along with swearing) is your rite of passage. Dave wasn't going to miss out on any of this. To insure his airway could remain open if he ever got sick he carried around a wire cutter necklace. "In the event of vomiting cut wire" in bold letters. Safety first. We are trained merchant mariners who live everyday knowing the sea will claim your life if it deems appropriate. 

"Sure, I just wire his jaw shut."

I walked back into the exam room with the news. Want to keep going? Don't know what I'm doing but I will keep trying?

They nodded yes. 

Ok, if I wire the jaw to get the bone to heal how will he eat?

Let's place a feeding tube. I have actually done this but it was in a 10 pound cat. (Size matters).

Open Emergency Care Manual and read-re-read instructions.

An 8 French red rubber was placed. Three full body x-rays later, and a few minor adjustments and it was in. 

7th inning stretch and recap; pt is under general anesthesia with breathing tube in. HUGE accomplishment! Patient has feeding tube in, Second standing ovation! Patient have jaw closed with canine teeth lined up perfectly, YAY! But, how do I keep it this way? 

The dental/oral surgeons use a quick drying epoxy to lock the teeth together. I am not a surgeon therefore I do not need, or have, locking putty. I do however have suture. So I use what I have. "Damn the torpedoes!" I close Garfield's mouth with his canine teeth lined up as they should be. Put the anatomy back where it belongs and place stabilizing material to hold. I take a big bite of the inside of his upper lip with my suture and loop it down to the same place on the inside of his lower lip. Then I tie a knot. I remember Dave had just enough room to open his mouth to allow a straw. We blended every meal for him for 8 weeks. Steak, pasta, beer. Beer with NY bagels and cream cheese. Dessert, every kind of ice cream imaginable with more beer. Initially it was a great, albeit drastic, weight loss plan. It wasn't always palatable but we were young and resourceful.

..and so I used my dear friend Dave's treatment plan as I concocted Garfield's. He had just enough room to open his mouth, extend his tongue through his canine teeth, but, the canine teeth remained in their correct position because he couldn't open wide enough the unlock them.

Now, all he had to do was wake up well enough that I could remove his breathing tube. He had to be breathing, calm and stay this way, because I had just sealed our fate in NOT being able to re-intubate him. (This requires opening the mouth wide to see the hole for the trachea). This is where the courage lies. All of these things, most I had never done before had to work. They just had to.

I was not going to euthanize a kitten without throwing my butt in the very hot, very unchartered territory seat, I haven't done it in 20 years and I am not starting today.

I placed a pink turtleneck over his neck to secure the feeding tube as he was waking up.

Garfield needed to be held for the next two hours or he would caterwaul a cry that only a desperately afraid kitten can produce.

A few doses of gabapentin, buprenorphine and a Zorbium later and he was sleeping.

After all of this, everything going so perfectly, I just didn't feel right about sending him home with two grateful parents who still had no idea of what they were doing. Can't lose the race in the last few yards.

As I carried him back to his dad I asked if he would be ok if I kept him for the next few days. The site of Garfield with a neck bandage, black suture ends sticking out his his clenched mouth, and a long orange tube extending like an antenna from between his ears did all of the persuading.

Garfield stayed with me for the next few days. In my attempts to not over fill his stomach via the syringe I forced the gruel into his stomach with I had induced a hunger strong enough to convince him to lap up the blended kitten food with vigor. In 24 hours Garfield was eating on his own feeding tube still in place, jaw sutured closed, and yet he marched on. The biggest victory for his recovery I could have hoped for. 

It's smooth sailing from here kiddo! I told him at our next 4 am check in.

Garfield's YouTube video

Never, ever, ever give up on a kitten. They are braver, fiercer, and more stubborn than even the saltiest of the most weathered magicians we call veterinarians.

Garfield went home with his dad on Monday 5/20/24. He had been with me for 4 days. He had survived a traumatic event strong enough to break his jaw, sedation, general anesthesia, a feeding tube, and having his jaw sutured closed. He is a survivor. A little life with so much desire to thrive that nothing will hold him back. He is resilient, determined, and joyful no matter what he is faced with. 

His dad was so excited to see him again. To hold and to hug him. He was a smile and a thank you that we too often neglect to share with one another. I was full of pride, joy and purpose to have helped them both. There is no nobler profession and no greater gift to be given that we can give back so fully. Vet med has so much power within its humble existence. You just need to look for and acknowledge those tiny specks of fiery courage to let the spark build an inferno of love.

For Garfield's story and the cost of his care with Jarrettsville Veterinary Center please go to Pawbly.com storylines and search Garfield Broken Jaw

Leave Funds Available For Euthanasia. The things vets say to each other that would appall the pet parents they serve.

On a Facebook page for vets to assist other vets I saw this comment. It stopped me in my tracks. It also made me question where this profession is at, and, whether we want to change our collective persona. It was also another reminder that the veterinary world that I live and work in is a far cry from what others do. 

Storm in his holiday cheer

There are numerous Facebook groups dedicated to vets helping other vets with difficult cases, and, of course the clients that come along with them. It is our international social media network for vetmed advice. This particular post, like many of them, was about a perplexing case with a client who had limited resources, or as we like to coin it, "financial constraints" aka no money. Most of these cases have the typical presenting facts; dog, age, breed, spayed/neutered, pertinent history, along with presenting owner concerns, and, veterinarians physical exam findings. This particular case involved a cat who was having trouble breathing. Scant details about patients history, (and/or details the vet thought the client was withholding to look better; think marijuana, drugs, illegal ingestion or access to stuff), and therefore vet really only had that and their physical exam findings to go on. This is an all too common scenario. People show up with a very sick animal and little-to-no details about how, when, why, or even last time the pet saw a vet. Think; umm? don't know how long the pet has been like this? Don't know when, or if ever, it saw a vet? Don't know if they could have gotten into something (like weed or toxins)? Don't know when they last ate, or, went to the bathroom? Or any tiny tidbit of relevant helpful information to assist in this case. Turns out the vet thought the chest sounded too quiet, (indicating there might be fluid in the chest making breathing harder, and hence, breath sounds absent). When a client without any money for things like x-rays, or a chest tap (to try to remove the suffocating chest fluid) the patient has little help of getting help because the clients didn't have enough money to allow for the most basic of diagnostics. It happens with almost every case. We make do with little diagnostic dough on a daily basis. It is almost impossible for me to try to explain how hard practicing medicine is when you don't have the liberty to run tests.. like any tests. Even the most basic/cheap diagnostic tests. Try to analyze a sick, almost lifeless non-verbal being with just your eyes, ears, hands, and nose. We do it all day every day. We also get convinced to guess so much that it too often makes us believe that we are truly very good guessers. I dare say we are too often cocky with our presumptive diagnoses as there is no one to prove us wrong. The clairvoyant diagnostician with no data to ever prove us a charlatan.  

What was most shocking to me about this particular post wasn't that people weren't giving the advice I give my vets (which is listed below), but, worst of all that one vets advice was to; 

"not spend all of the clients money so that they could no longer afford euthanasia." 

I suppose I am deeply and ethically perplexed that this is valid advice. I also wonder how many of us veterinarians live here in this place where mercy only comes with a price tag? And, why would we want to? Aren't we being both neglectful and hypocritical if so? Aren't we both absent in our compassion towards our patients (and no, I did not say client,, because we all know that we love to punish them), but also hypocritical in our own advice of "it's neglect if people get a pet that they cannot afford?" Can we really be so cold and cruel to allow suffering if it doesn't make us money? Don't we dish that judgmental sputum daily? Blame the pet parents when their pet gets sick because they couldn't prevent the preventable? And then deny them a compassionate end when they run out if resources to permit it? Aren't we complicit in promoting negligence that perpetuates suffering because we do not offer affordable euthanasia's? I know of some places that charge $400-600 for euthanasia. (It is $125 here at my clinic). If you cannot afford it, AND, (big and here!) if we truly believe that it is in the pets best interest to be euthanized, should we then be doing it for free? Are we really reminding each other that we should spare the $600 to help save the pet so that we can euthanize them profitably? 

Holy Crap where has this profession gone?

I don't (and won't ever) add the cost of a euthanasia into the cost of a patients care. I also don't list it as a treatment option. It's an option, as it should be for every living being that suffers in dying, but lets not elevate it to a "treatment". It is not the last line item in the long list of charges for both goods and services that I feel the patient will need to get better. After all isn't that our primary goal? Getting patients better? Aren't we all collectively responsible for helping pets get and feel better? No veterinarian should withhold euthanasia due to cost. And yet it seems we do? I have never even considered adding/budgeting/listing this on an invoice when a patient is at the clinic asking for care. As if the tally of the 'total cost of care' needs to include this? Is euthanasia part of our "care" package? I am not arguing that it isn't, but, I am asking why we make room for this at the expense of doing what we all came here to do? Am I asking for too much room? Too much compassion? (Yes, probably). I am asking for a sliding scale of care. You know the kind that gives you a "freebie" euthanasia when financially warranted after a client has exhausted the meaningful list of possible curative treatment options. A rewards program of sorts so that we can care for pets by making them better versus incentivizing euthanasia. How many times do we send animals home to suffer while they die because we used up all of the funds beforehand? Doesn't that sound cruel? How can we preach being ethical and responsible and then send pets home suffering for our economic gain. Let one vet get charged with intentionally cruelty when they deny affordable euthanasia. Then maybe our collective conscious would outweigh our judgmental pragmatism. How sad that it might come to this?

Frippie, sock thief.

When veterinarians wonder why the state if the profession has come to this place where we can boast of our astronomical suicide rates, or, having made the worst return on investment possible by profession decision, or, the fallen trust status we used to boastfully proclaim, it is no wonder that we struggle and suffer to the degree we do. We created it. We are responsible for it, and now we wonder how to repair it? 

To my fellow veterinarians out there.. (whom I suspect will be pissed at me for my publicly stating this viewpoint) argue with me all you want.. and, then ask yourself whose side you are on? Who do you serve? If you said yourself, then ask yourself how she thinks that is compassionate care giving to be proud of.. ?

Zeba and Honeybrook waking up from surgery. Kept in kind oversight by Michele.

The following is the list, (long, short, detailed, and just silly I suppose) that I wish my mentor had given me before I started practicing vetmed. This profession is too reliant on learning hard lessons. Trial by fire, and thrown in to see if you can swim. For a profession too settled upon self doubt in the face of loads of guessing prognoses, not to mention our imposter syndrome frailties alongside the suicide factor it isn’t appropriate any longer. We can, and need, to do better.

Home at the end of a long adventure in the park.

The vet practice I bought has had a 17 year history of this sort of practice owner advice. My advice to the vets who follow. I keep the list growing. Accumulating pearls of practice to pay forward. A playbook for the other doctors and our staff. It consists of permission slips, warnings, and some basic ground rules as we all try to live within this landmine filled landscape full of wet noses, heartbeats and heartbreak trying to keep healthy the most important lives in other humans lives. We are just like them. Us, the veterinarians and staff, and them, our clients. We love our pets as the lifeblood to our souls in need of companionship, purpose and joy. It is imperative to always remember this.

My Frippie sleeping guard over our tree.

To the veterinarians and staff of Jarrettsville Vet, I ask you to ponder these;

I would like to start by saying one thing that I hope you hold true and tight to your heart. You have to be brave enough to be vulnerable and courageous enough to fail. Too many of us let our fear apprehend us. Too many lives slip away because of this. Jump in! Challenge yourself and be both proud and hungry for the next. Invest yourself into every patient every single time. Sometimes you will walk away with only that. And that is always enough. The rest is short loved transient and holds little value.

Likability matters. In medicine it is the single first influence to motivate your success. Smile. Engage. Offer more than you have to, and, more than the rest do. You can risk vulnerability but the reward more than makes up for the soft spot exposure.

The secret to the report card (the summary of the pets visit that we send home from every examination); it is the measure of your time with your patient. Let it reflect it accurately and definitively. People need a tangible piece of the experience. It is also the ticket to the next stop in many cases. Let it be the road map for where you came from, where you are and where to go next.

I summarize the report card as having the following key pieces in each;

• Summarize the exam findings. 
• Provide your presumptive diagnosis, or worst case scenario. State them both. It is our responsibility to hope for the best and prepare for the worst. This is life, both happen.
• List the diagnostics or measures to confirm this. i.e. “our next step is blood work, xray, u/s. Etc”
• Provide guidance as to what to do next, i.e. “if this, then that.” I tell every client what I expect and when I expect it by. I also leave a timeline. i.e. “if the coughing isn’t better in 48 hours call me. If the coughing leads to open mouth breathing, or is intractable, go immediately to the ER.”
• Give estimates for the suggestions you make. Use the support tools provided to generate this estimate. 
• Talk about payment options. We all too often just assume people have excessive disposal income. 
• Help people understand the journey. Be the guide and the sherpa.
• Lay out the plan but keep the focus on the needed steps to getting their pets quality of life back. I.e. do not exhaust resources so that treatment is out of reach. It sounds scary I know, but, if you think a pet is dying and needs surgical intervention, or, medication to survive and resources are tight, skip whatever diagnostics you have to to allow curative treatment to occur. 
• Never paint a picture you can't back up if the case ends up being the worst possible scenario. Being caught off guard, or, letting a pet suffer because you didn't educate the client in what to look for is negligence and makes us complicit in that patients suffering. 
• CYA every day and every interaction. We are dealing with disease. Potentially deadly diseases where many can be passed onto humans. We also have this sticky situation of having to protect the people around our patients. Dangerous dogs, feral cats, zoonotic vectors, and human limitations to the "ideal at home treatment" plans. 
• Always be honest. It's ok to apologize. It is always right to make it right. In some cases I just say that, “what do you think I need to do to make it right?” There is a drought of admission of responsibility in vet med. This too must change. We aren't fallible humans when we cannot be honest and culpable. 
• Pro bono is allowed. Anytime or place that you want to help a patient (or even client) for the sake of helping we will support you. Take a free radiograph to look for pulmonary edema vs a met lesion if it means you can sleep better at night. There is a serious mental health issue in vet med... don't let the few scant dollars it takes to help you feel better about what you are doing here preclude you from resting just a little easier at night. These cases follow us.. the dark shadow. The grim reaper at 2 am, is there a price for these? Yes, but don't let a few give-away diagnostics be the culprit. I promise that what you give away comes back 10 times over. You can tell the appreciative and needy from the rest. And to be honest there aren't many who will take advantage of you when they know that you are here because you care about their pet with them.

Here’s where we fail people. We don’t explain enough. Talk.. talk,, talk… but try to be clear and concise.

Two of the 52 cats we helped to save in our most recent pro bono endeavor.

• Take good care of the staff, they will return it in spades. You may be in that white coat at the head of the line but there is an Army behind you.
• Clean up after yourself. You look like a jerk if you are too good to get dirty, or, think that you are above it. 
• Ask for help. It is available everywhere. Us (the other vets), our broad network of specialists and referrals. (Hey, psst,, did you know that there is a whole enormous group of specialists out there that can give your vet free advice? So, if they tell you they don't know what's going on, or, need help figuring it out ask them if they asked for help from the vet team that supports them. i.e. referral lab, online specialists, Facebook groups. The vets who invest and care will utilize these for the benefit of their patients. If your vet isn't one of these move).
• Don’t send out a referral without a head up as to what they should expect once they get there. Most often this is the price tag, but, it might also include diagnostics which they might be unaware of. Explain as much as possible. Call for estimates, then tell them they are welcome to come back to us if the options from the specialists don't meet their needs. 

Clarke. One of the many faces that I find purpose in this cause.

• Everything is offered a referral. Everything. If they don’t trust us, if they are worried to "don't know what to do paralysis", or, if the molehill looks like it might have a mountain of ugly behind it, CYA and refer. I have a "three times I try and then I punt" rule. If I can't figure it out within three visits I punt to a specialist. Or, I at least strongly encourage/offer. Everyone's time is precious. Further (brace yourself) we are not always such impressive/perfect guessors.

I hope this list grows. I hope that others add to it. Maybe we can all learn from each other and we don’t need to trip so often to remind ourselves who we are or what we are capable of.

Most of all I hope that we remember how powerful the love of a pet in our lives is. That we hold it sacred and feel honored to be caring for each other and giving as much, if not more, than we receive with the spirit of our pets unconditional love to guide us and serve as the inspiration for us to follow.

Jennifer, the Office Manager and our beloved clinic cat Seraphina.
For more on Seraphina read her story here.

If you are a pet parent struggling I am here to help. You can find me at my veterinary clinic Jarrettsville Veterinary Center in Northern Maryland, or, for free pet advice meet me at Pawbly.com.

References;

What is the ROI of your college degree?

Professions With Highest Suicide Rates

How Much Does It Cost To Euthanize A Pet.

There Has To Be Mercy Before Money. Why are we failing our clients at the expense of our patients?

Loon, our resident house cat mans the front desk.

I have become almost completely obsessed with the idea of creating a place that both helps and changes the world. I suppose it is a lack of disorder in the few quiet times of my day. I watch my sister go from the chaos of work (much of which I have dumped on her) to her home of 2 kids, three dogs and two cats (one being 90% feral) and I realize that she only has time to sleep when her batteries flag red, flicker and cut power to the rest of her body. There is nothing outside of her immediate sphere of responsibility that she has much time to chew, ruminate, and ponder. Secretly, I think her empire will likely long out live mine. But, yet, I ponder away....how can I create a place of meaning, a work of compassion, and change the way we care for our pets?? Not only am I trying to build this on a community scale with my practice, I am trying to build it on a global scale with Pawbly.

Dr. Morgan works her magic.

I suppose I have earned my self appointed entrepreneur title. I see a problem and I immediately pick apart the opportunities to improve upon, or, resolve it. I actually don't look for how things are working well or efficiently anymore, I look for the hitches in the machine.

I am completely determined to disrupt (also obsessed with that word) the current flawed system that discourages people from seeking, diagnosing, and treating their pets. I would normally place a current stat about what percentage of pet people I am referring to, but (small thanks from my soul) no one keeps track of that*. From my own clinic I would guess that 80% of my clients are reluctant to seek after hours emergency care, 50% refuse to ever go,  (many based on previous experiences), 60% cannot afford specialty clinics, and when I speak about the entire pet population in my community I would estimate that 30% of the pets don't get any care outside of food and shelter and a rabies vaccine, and 20% aren't even considered a pet (feral cats).

That's a lot of pets falling through the cracks and in need of additional help.

Coot, (Loons brother), strikes a pose.

Where are the cracks? Well, they exist in every community, every facility, and every pet centered business. We have become a nation of haves and have-nots, and the gap grows larger with time. As my practice grows and persists I am reminded daily that for every pet I see I know there are at least 2 who need care but will not get it. It is my veterinary practices goal and motto to not turn away a pet in need. Sometimes that service is in the form of a free euthanasia to relieve suffering, a payment plan, a donation from our generous donors, or a free moment of my expertise. There has to be mercy before money.
For my clients I have an ear, a hand, and options. It is very important to have a relationship with your veterinarian so your pet has an advocate in their corner. I now am seeking to extend this relationship to the other care facilities that we refer to. This referral network goes up the financial spectrum, for instance, specialty facilities like surgeons, cardiologists, dermatologists, and down the financial cost lifeline, like, rescues, shelters, fosters, etc. Between all of these there needs to be an open communication network AND a safety net.

Of course it's time for a disclaimer. I have many clients who are very happy with the care they receive elsewhere in the wee hours of the night when my clinic is closed, dark and quiet, or those who are seeking a specialist to guide their pets care. In fact, while preparing for this blog I asked my clients what their experiences were. I received many emails from clients who had excellent experiences at all of the facilities we refer to. Many felt that the emergency and referral clinics were compassionate, flexible, and provided outstanding life saving care.

Unfortunately, I also have a few clients who live pay check to paycheck. For those with disposable income there are more options and more favorable outcomes. Everyone might think that I am crazy to care, or chase the smaller spare change when there are enough big spenders out there.. But I see too many pets with neglectful parents who are stuck between being able to and wanting to and I refuse to believe that there isn't a way to make a difference in the life and health of every single companion animal.

Finishing up a cruciate repair with a our amazing staff.

I believe that much of the root of the problem lies in differences in our perspectives. I own a small rural practice that has been in existence for 80 years. I am a part of a legacy that I intend on passing on to another person in a few decades. I know that my clinic serves families who came here with their grandparents pets. I hope to see the same children with their grandchildren. I have to build strong relationships based on trust. I live and I die by it. I am not a one time stop for a once in a lifetime tragedy, and I am invested in the care of my clients and patients. This concept of trust and building long term relationships is becoming more and more foreign and will cost more and more veterinary facilities. It is not the low cost vaccine clinics, spay/neuter clinics or online pharmacies that will be  the undoing of you, it the your inability to be a part of your clients family.

I believe that all of us who love pets as family members need more options. I also believe that veterinarians are generous, compassionate, and genuine.

Here is the key; Figure out a way to disrupt the current system to provide better oversight and assistance for  the people and pets that my clinic serves AND use that system to build global assistance. You see, I might truly be crazy, but I still care even after I turn on the closed sign. And, I care even if you live a continent away and think no one else does.

Stay tuned.. I have a plan....

So, I want to hear about your experiences. Your concerns, and where you think we need to be paying more attention so that we can help you take better care of your pet 24/7/365.

* There have been some studies done, most notably by Bayer, focused primarily on cats, but, I believe a HUGE portion of the cat population remains unclaimed, unseen, and certainly uncared for. Homed cats and dogs are not the only small animal companions that matter or deserve care.

I can be reached here, at the clinic, Jarrettsville Vet, on Twitter @FreePetAdvice, and anytime for any pet question, or pet health care epiphany at Pawbly.com.