"I wash my hands of this cat."

Simon

This is a true story. True as I can make it and still protect the identity of the characters involved and the ironic sad truth that these scenarios happen.

The clinic we built centers around a mission of helping pets. Jarrettsville Veterinary Center provides our community with a safe place that provides exceptional medical care, and this doesn't cease when our clients can't pay, or give up being guardians. Very simply we care and are always more than a business.

Like all of us trying to live adherent to a higher calling we are challenged to follow through with our conviction when the hail storms fall. Life will dump crap on you just to see what you are made of. You aren't unlucky, you are instead being given a chance to shine amidst stormy weather.

Such was the case of our newest addition; Simon.

We had never met Simon before the day he was brought in to our clinic to be euthanized.

His story started out as many other indoor cats does. A cat like so many others who was adopted, vaccinated as a kitten, altered as a 6 month old and kept behind the doors of his family since. He was brought in to us as a middle aged tabby who had lived with his family for almost a decade.

Simon is a rather rotund soft soul who prefers to sleep sunny side up unabashedly flashing the staff unconcerned with the bustle of a busy veterinary practice.

Simon arrived in a cat carrier escorted by two sobbing women on a day when the reception area was packed. Crying clients carrying a pet in a vet clinic is the universal sign for departure over the rainbow bridge.

If we know that we have a patient coming in to be put to sleep we take great care in getting them into a quiet room quickly. Minimizing stress, strangers glances, and having to share your grief with anyone else is eliminated. Saying goodbye is never easy, but we do every single thing we can to make you and your pet feel that there is love even when there is goodbye. We didn't know Simon was a one way trip and the odd scene of a crying family eliciting and seemingly enjoying empathy from the other waiting clients was beyond disturbing. This is a job where uncommon things are common, but this scene was alarming and disconcerting. The technicians quickly found a free exam room and quickly alerted the unsuspecting vet that a euthanasia appointment had arrived.

The news of an unscheduled euthanasia for a seemingly bright, alert, and active pet quickly swept through the clinic. I walked by the exam room to take a peek at the lugubrious couple with the new arrival and the death sentence.

Two women lay on the floor sobbing as a fervent joyful feline sopped up the abundant attention doted upon him. They cried and smothered him with pats, strokes, hugs, and last sentiments of the wonderful cat he had been. It is a juxtaposing scene a veterinarian sees often, a grief stricken guardian sorrowfully pleading a good-bye that is too great to bear for any onlooker. BUT, there was Simon, happy as a lark, full bodied, well groomed, and soaking up the affection greedily.

Clearly, something was amiss with this? My curiosity and sixth sense of experience and regrets kicked in.

"What's the deal with Simon?" I asked the vet as she departed the exam room.

"He's been peeing on their laundry for a year." She replied with a sigh and disgust. "They can't afford to treat him."

"Has he ever had a urinalysis? Have they ever worked him up for a possible medical cause?" I asked. This is the usual response of a vet in these cases.

"No. They have never brought him anywhere. Never done anything about it." I could see the pain in my friends eyes. These are the cases that add nails to your coffin.

"What if we used some of the donation funds to help with the diagnostics?" I offered. I knew that keeping a pet with a family that loves them is the safest place for a pet. I would rather help a client through a financial tough spot and keep a pet in its home then try to find a new home for an adult cat. "What if we offered to pay the entire bill to get Simon the diagnostics he needed?"

"I tried that already. They just want to 'wash their hands of him.' Their words, not mine." Her face fell to the floor and the vice of a helplessness assassin replaced her normal vibrant optimism.

"What do you think?" I asked of her. I know that she was going to have to be the person who bore this burden. Working in a veterinary clinic can be a terrible place to have a conscious.

"Simon appears to be a healthy, sweet affectionate cat. I don't want to do it." She said meekly back.

"Then don't. Offer to have the cat signed over to us, and tell them to never come back. If they refuse explain to them that you don't feel right about it and walk away."

Elated and gleeful she burst out an "OK!" Her smile returned to her face.

I often feel like a parent to the staff at the clinic. That smile on her face is worth every disciplinary action of every board member reminding me that my job is to treat pets like property and comply with owner requests. The way we are asked and expected to treat the pets the law deems as property has ripple effects and consequences on us. I don't ever forget this. I stand by my patients, my staff, and the ability to help both. The law, well, that is a belief that changes with time, it is not a conscious with burdens to carry to the grave.

Simon's family left through the waiting rooms front doors wadded tissues in hand to a crowd of clients hugging and sobbing condolences of understanding and compassion. They further had the audacity to embrace every bamboozled empathetic person on the slow dramatic march out the door.

Simon's bloodwork and urinalysis confirmed he had a urinary tract infection. Like so many Pawbly questions I answer, people assume a cat is being spiteful and therefore not using the litter box, when in fact they have a real medically based problem. Poor Simon spent over a year trying to notify his family that there was a problem and their answer to him, "wash my hands of you."

I might live a long healthy robust life, but I remain steadfast in my devotion to pets and children. People, well, I just don't understand them? If I try to I feel disgusted. If I give up on them I loose my faith in humanity. Which is worse? So, I do what so many of us do. I do as much as I can for all that I can. Jarrettsville Vet remains committed to help pets in need. Thanks to the community and our friends we are able to continue to do this.

"You're welcome Simon. We love you too."

Simon is an outgoing, affectionate, charming boy. He loves everyone and everything and would make an excellent companion. He, now minus his urinary tract infection, is up for adoption at our clinic, Jarrettsville Veterinary Center, inn Jarrettsville, Maryland. We also have other pets in need of homes and we would greatly appreciate your help in spreading the word about them.

If you have pet experience that you want to share, or a pet question in need answering, you can find a group of caring knowledgeable individuals at Pawbly.com. Pawbly is free for everyone to use.

You can also find me on Twitter @FreePetAdvice.

Related blogs;

Peeing Outside the Box. The 20 Minute Cure.

Feline Marking. What is it and how to stop it.

When your Client Gives Up On Their Pet. Where do you stand? The cat and the line in the sand.


Related Pawbly questions;

How do I stop my cat from peeing on my lounge?

My cat Sally has been experiencing a lot of urination problems. What is cystitis?

Male tomcat not using the litter box anymore. Why?

I just adopted a cat from the shelter and he's scared of the litter box. What can I do?

Simon has been with us at the clinic for about 6 weeks. there has not been one single episode of him urinating outside of his litter box. He is a calm, happy, sweet boy who wants nothing more than a simple life shared with someone who loves him.

Can you imagine having your guardians "wash their hands of you" because you have an infection? Happens every single day in countless veterinary clinics around the globe. It breaks my heart.

Simon reminds me every single day that it takes so little to care but does so much when you do.

Peeing Pebbles, the Struvite Soliloquy

Prepping a patient (Harley) for a cystotomy.

Today's question on Pawbly (http://www.pawbly.com/) was a good reminder of why an open ongoing dialogue with your vet is so important. 

I also was curious why this person was so adverse to a prescription diet? (The limitation of a one-way dialogue via email is that I can't ask question, I love to ask questions,,we will work on the chat version of this service as our next evolution to this service). I think that there is some adverse feelings towards prescription diets and I know they are expensive. I wanted to share this question and answer in my blog and I wanted to discuss another JVC patient with a similar history.

Here is the Pawbly question;

I have a Bichon Frise who recently (last Thanksgiving) had 62 stones removed. She recoved nicely but her pH is still high. She is eating raw (Nature Variety). I put in Berry Balance in her food as well as Ammonil DL-Methionine Tablets), Biotic pH and Milk Thistle. Her pH did look like it came down a bit and she doesn't seem to be in pain as much. Is there anything else that I can feed her without going to prescription dog food (Science Diet).

Here is my answer;

Hello and 

Thanks for your question.

Unfortunately I would need more information to be able to specifically advice you on what to do.

First, I don't know what kind of stones were in your dogs bladder?. (Note, 62!!! I have retrieved a whole mess of stones, but to be truthful I never counted them).

I think that you feel that you need to alter the pH to reduce the likelihood of the stones forming, but it isn't as simple as that in many cases. The pH does influence the ability of stones to form but there are other factors also.

So I am going to go out on a limb and presume that your dog had struvite stones?

Struvite stones are formed because of infection, and NOT pH. So, the task to prevent the stones is to treat and prevent the infection. OK, here's where is gets a little tricky. The urine may consistently stay high because of the UTI (urinary tract infection), the bugs that are the infection are urease producing organisms. These urease producing bugs are usually Staph, it is the infection that causes the struvite and the infection changes the pH. So, the way to get rid of your high pH and your stones is to get rid of your infection..I know one vet who says "if you get consistently high pH you get your pet in the vet."

Most bacteria are happy critters at a pH of between 4-9, and dogs and cats can't acidify their urine below 5.5 so you can't ever acidify the urine low enough to prevent a UTI.

Also the experts advice is to make sure that you are checking the urine frequently throughout the day and using a pH monitor (not a urine stick), these can be found at any home or garden store, they are the monitors people use for testing their water. (It will be a little expensive but it is accurate..) Also, if it is struvite you might be able to dissolve the stones and therefore avoid another surgery.

I am not an advocate for adding things to the diet. I don't think it will help your current situation and I have unfortunately seen too many very well intentioned people make a bigger problem than they started with.

To identify IF and what kind of infection your dog might have you will need a culture and sensitivity done. Your veterinarian will take a sterile sample of urine from your dogs bladder and submit it to the laboratory for them to grow on a culture. They can then specifically identify what type of bug is present and also exactly which antibiotic to use to kill them.

I will tell you that in my experience the little white dogs seem to have the most problems with urinary stones..and I think that the prescription diets work very well, and adding lots of water to their food and encouraging water intake with a fountain or soupy food helps.

IF, your dog didn't have struvite then you would need to talk to your vet about a treatment plan for the specific stone. I do not think that it is question of pH in almost all cases. And some stones can only be resolved by surgery.

I hope that this helps, and I hope that your dog stays happy and healthy,

If you need any assistance from us you can find me at Jarrettsville Veterinary Center, we have an ultrasound and we could take a peek at your dogs bladder to get a sterile sample and see if any stones are floating around.

Sincerely,
Krista

Not to long ago I was asked by one of the groomers if I could help her mother in laws dog who she had noticed was having bloody urine. She was pet sitting for their dog because her mother in law was in the hospital recovering from a serious illness. Turned out that she had 2 patients on her hands, one was recovering in the hospital and one was coming to visit ours. When she brought in Harley we were all amazed to learn that she had been hematuric (blood in the urine) for a very long time. As soon as the vet on duty palpated her belly we knew the source of her blood. She had a two fist sized sand filled sac of a bladder. It was very easily palpable and within minutes every set of hands in the building were on Harley. An x-ray put a digital picture to what we could already surmise. The next stop was asking me if I would extract them.

The bladder exteriorized from the abdomen and packed so that contents cannot spill back into the belly.
The bladder should be an empty sac but the numerous stones make it look full.
Can you imagine living with a bladder full of stones?

Removing stones from the bladder.

That's a big stone!

The next week Harley had her cystotomy (bladder surgery). 

Harley and her mom are both recovering well and we will continue to monitor Harley any signs of a return of her stones, or a change in pH, urine color, urine frequency, and at least twice yearly urinalysis.

The final stone tally. A bucketful!

Urinary calculi (stone) should be submitted for a calculi analysis. This is imperative in the treatment plan and prevention of future stones.

Guest Blogger, My Best friend, and her dog Banjo

Linda, in her store with her two guard dogs. Well, if wagging and barking "hello, come pet me!" is an alarm call

   Ever since Krista started writing her blog, I have threatened to write a guest appearance, mainly about Banjo, the rescue she changed our lives with, but also (like it or not, Krista) about Krista herself.

     There are some days that change your own history and the day I met Krista was just one of those days, although of course I didn't know it at the time.  My husband, Carroll, and I have an antiques store is an obscure and ridiculously remote part of southern York County, Pennsylvania called Gatchellville. About six years ago, I was in the house, which is located right across the driveway from the store, and my husband came in and said there was a customer at the front door of the store.  I reminded him that we were closed and that he should tell the gal to come back another day.  Carroll told me that he told her that to go away and come back another day but that she refused to leave!  Well, now I know that that is classic Krista.  If there is something she wants, she goes after it, and she doesn't leave until she has it.

     It turned out to be a lucky day for all of us.  Carroll and I had just moved to southern Pennsylvania.  Krista and her husband, Joe, had just done the same.  We all loved antiques, good food, old houses, and animals, and along with another couple, Barbara and Richard, we formed a band of brothers, so to speak. 

     We have spent the past six years pondering the universe, fighting over politics, drinking more champagne than I want to admit to, lavishing each other with gifts, and becoming a family. 

     Without knowing what was happening, these people have become the people who, without question, I would lend money, donate a kidney, flip hundreds of pancakes for, and in Krista's case, trust with my animal's medical care.

     Inevitably at the end of a workday, when Krista and Joe show up at our house for dinner (why do I do all of the cooking, by the way?), the topic is first and foremost people and their animals what happened at the clinic how people can be cruel, lazy, and downright stupid with their pets, and how it is a never ending uphill battle to make the world safe for the animals in our possession. We have to get this conversation out of the way before we can go on to other things like how our families drive us crazy, what antiques we saw at a show we went to, and who wants what gift for Christmas.

     I will tell you that Krista-Joe, too-do not suffer fools easily and pity the poor folks who come into her clinic who have neglected their pets.  In her case, the customer is not always right and she does not mind telling them.  Well, that's as it should be. 

     For me, I know she has gotten my own pets miniature poodles named Mason (who has since passed away), Noodle, and Banjo through any number of scrapes and I rest easier just knowing that she is at the other end of the phone in an emergency. 

Banjo, (foreground) and Noodle, (background) slumbering on their porch.

Two years ago, my little dog, Noodle, was attacked by a vicious Rottweiler in the back yard of our house.  We were minding our business, out for our evening walk, and this dog came out of nowhere and somehow mistook Noodle for a nice dinner sandwich.  It was one of the scariest days of my life. I thought that, not only would Noodle be gone, but that I would be attacked as well, and the two of us would be left to die alone in the field.

     By a miracle I was able to get away, but I thought that Noodle was dead.  There was blood everywhere.  However, I sensed a faint heartbeat when I got him into the house.  One phone call and five minutes later, I was at Krista's old stone house.  Joe was carrying Noodle in and she had turned the upstairs bathroom into a sterile emergency room.  

Thank-Goodness Noodle is still with us! Amazingly not too much worse for wear.  We were lucky that day.

     Another lucky day occurred last February when we got a call from Krista someone had dropped off a small white poodle and she thought we might want to adopt it. It turns out that the people had even offered to pay for euthanasia if it could not find a good home.  

     I wasn't looking for another dog.  The way we care for Noodle is the way some families might care for n entire squadron of five year olds-just dressing him in his daily sweater sets is a job-so I wasn't looking for another dog.

     But as is Krista's way, she was pretty insistent that we wanted this dog.  I agreed to come in and meet him the next day.  I wasn't excited. I figured there had to be a lot wrong with him if his previous family would just drop him off, unwanted.

Me and Banjo at JVC.

Banjo, in his first few days at JVC, Looking scruffy and scared.

 

When I met him, I knew I was right.  There was a lot wrong with him.  He had ear infections, urinary tract infections, matted fur, runny eyes, chronic diarrhea, and was positive for heartworm.  He was the scrawniest, most pathetic poodle I have ever seen; with a face that just cried out with is misery.  Please, please, please, won't somebody love me!?

     I knew if I just picked him up for one second I would be a goner. So I resisted for a full five minutes. Just staring at him from across the room. Could I commit to this pathetic little bundle of matted fur? To make him even more pathetic, he has a strange albino-ish coloring with pink circles around his eyes and a pink nose. He looks as if he is perpetually crying.

     I knew I had a little bit of an out by telling the folks at the clinic that we would leave the decision to keep this dog up to Noodle, the spoiled (and healthy and beautiful) poodle at home. 

Well, the two bonded like twin brothers who had been separated at birth and were reunited on the Oprah show.  From the second they laid eyes on each other, they have been inseparable, two peas in a pod, always shoulder to shoulder in their perch in the window.

Carroll, Linda's Husband, with their two peas, Noodle (left) and Banjo (right).

 

     This dog, who came with the cumbersome name of Jean Luc has been renamed Banjo and has learned to live with a family who loves him and spoils him, something that all dogs should hope to have. He still has some health problems, most recently a series of very worrisome seizures.  He has allergies, oddball rashes, ear infections, and I think he will always be pretty high maintenance.  But to me-and to my husband, Carroll, he is one of the most beautiful dogs in the world.   We are so glad that we were able to rescue him from the clinic in Jarrettsville. 

     Thanks, Krista.

Banjo, on the couch, (where he usually is), in plaid, (like he usually is), with his bone.



Disney's Dilemma

A few years ago a very nice woman came into the clinic with her not very nice dog Disney. Disney was all black, about 40 pounds, and had a long fluffy full coat. She was always overweight even though she always tried to hide it all under a big full jet black coat. I tried many, many, times to convince Mrs. Nicks that Disney was overweight and needed a strict diet, (i.e. no more table scraps), but I knew that she lived with her elderly mother, who she cared for, and between the loneliness of caring for a mom with dementia, and the mom with dementia not ever remembering not to feed Disney table scraps, it was pretty much a lost cause.

The first two years of knowing Ms. Nicks and Disney we had the routine examinations, vaccinations, repetitive pleading of trying to get some weight off Disney, etc. etc. then one day Ms. Nicks called me to tell me that Disney was going outside trying to pee but only a few drops were coming out. And she kept going to the door, and Ms. Nicks kept taking her out, but all Disney could produce were a few drops of urine. I told her to bring Disney in right away. I was expecting to find that Disney had cystitis, (inflammation of the urinary bladder). So all I needed was a few drops of urine, and all Disney needed was an anti-inflammatory and an antibiotic and we were on the mend.

When Disney arrived I gave her an examination. I cannot ever express to the new vets out there how absolutely imperative it is to always give a full complete comprehensive examination.  Instead of finding an empty flaccid small sensitive bladder low in the pelvis, I found a very large full distended painful bladder that took up almost the entire caudal (back half of the) abdomen.  I took a gasp and swallowed the horrified look in my heart. We next went to x-ray. I was hoping to not find anything obstructing her ability to urinate, like a tumor, stones lodged in the neck of the bladder, etc. I was afraid to try to manually express her bladder by pushing too hard on it. You see at this point the bladder has been so distended for so long that often it is a thin weak balloon, and any amount of pressure can cause it to rupture. If the bladder ruptures it will spill the urine into the abdomen and the urine acts like caustic acid to the sensitive peritoneum (the lining of the inside of your abdominal wall). My next plan was to try to sedate Disney to place a urinary catheter. My first priority was to relieve her bladder distension and then try to figure out why this was happening to her. We placed an i.v. catheter collected our blood work and then gave some i.v. sedation. Within minutes there was a flood of dark pungent urine everywhere. I took a deep sigh of relief for Disney. We sutured the catheter in place and started her on the aggressive i.v. fluids I knew she needed to start correcting all of her kidney and electrolyte abnormalities. The next few days Disney seemed to feel more and more like herself. Which in Disneys terms meant she was less and less of a cooperative patient. When she was feeling well enough to not be able to be handled at all I called her mom and sent her home.

During her time in the hospital we ruled out everything except a neurogenic cause to her problem. This meant that the root of her inability to empty her bladder was because she either couldn’t squeeze the muscle of her bladder wall down tight enough to empty, or she couldn’t open the valves that keep the bladder shut. So I started her on all of the medications I could to try to tell her nerves and muscles to work the way they were supposed to. This plan worked for a few months.

Over the next year there were many interrupted evenings of meeting Disney at the clinic to try to repeat the procedures we had tried so successfully the first time. Each time it became harder and harder to get her relief. Until finally one evening I told Ms. Nicks that I would have to open up her abdomen and try to empty her bladder from the inside. I remember crying with her in the surgery room. I knew that Ms. Nicks knew that I was having as much of a difficult time making the decision as I was. I knew that my only hope of getting Disney off of the surgery table alive was with a urinary catheter being placed from inside the balloon instead of my usually threading it through the urogenital opening.  I looked into Ms. Nicks eyes, both of us sobbing, and she said to me, “I know you want to know why she can’t urinate, and I know you want to try to help her again, but I can’t put her through any more”. It was a hard painful decision for all of us. Ms. Nicks had lost her mom a few months ago, and she was losing her last companion. I knew that putting Disney under general anesthesia and exploring her abdomen and bladder might fill in some of the answers I had not been able to get before. But I also knew that we were at the end of her or her mom’s ability to treat her. I lowered my head and told her mom that I was so sorry. I then said goodbye to Disney and injected the pink syrup into her i.v. catheter. I turned off her monitors and I cried over her as she died.

I have talked to Ms. Nicks many times since that day. She still comes to our Christmas parties, and she still drops in to say hello every so often. I have even called her to see if she would be interested in helping us by fostering a dog. But she always tells me that she still isn’t ready for another dog yet. And I understand, and tell her that we miss Disney too. Even though I am pretty sure Disney never liked me back.

If you would like tolearn more about neurogenic anuria and cystitis please see the link below;
http://tinyurl.com/3fwekct