Christmas Day!

Wishing you all a Very Merry Christmas!

Joe and I spent Christmas Eve at Brinton Lake, PA. We had the most amazing lunch at Terrain, and did a little last minute Christmas shopping.

A few stops in Anthropologie, and some goodies at Fresh Market, and my almost perfect day was almost perfect.

As we started for Longwood Garden it began to snow!

Nothing could have been more magical or romantic than that!

If you haven't been to Longwood Gardens it is the premier horticultural garden in the Mid-Atlantic region. It is breath taking. Where else can you walk among endless carpets of flowers, see blooming roses, and be surrounded by the heavenly scent of lillies. If you are in the Delaware, Philadelphia area make a special stop and set aside a few hours to be left in awe. Pierre DuPont's turn of the century vision for a country home and estate is beyond our modern image of what is possible.

And if my Christmas Eve wasn't perfect enough, Christmas morning was as my dearest friends house. Homemade scrambled egg casserole, fresh fruit, mini Bundt cakes, and piles of pancakes! So delicious! Not to mention the presents!

Merry Christmas!

Merry Christmas!

Merry Christmas to you all!

As the year comes to a close and we all gather with our families to celebrate Christmas together, I wanted to send a HUGE Thank-You to the Veterinarians, Technicians,  Receptionists, Kennel Assistants,  Groomers, and Administrative staff at Jarrettsville Veterinary Center for making 2012 a year full of inspiration, hope, compassion, and  love. I am so lucky to be surrounded by so many incredibly talented and devoted people.

There isn't one day at JVC where we don't see miracles happen. I know it is a true reflection of the selfless dedication to a job where people feel that they make a difference in the lives that we touch.

Here are some of the pets and families that we were able to help over the last year. Behind every picture is a pet who came to us in need, and behind every one of those pets is a story. Those stories are the reason we do what we do everyday.

Phoebe and Lady.
Lady is another dog, who has a big broad face, a constantly wagging tail,
and a fate that was uncertain until she found us.
Pheobe has been adopted by Brea's family.
She was brought to us to be put down because her mom of 8 years was going to need long term health care. Her mom thought that no one would love her.
She has blossomed into an energetic puppy.
She keeps Beau company and has relieved his anxieties.
She is loved and in great company.
Many Thanks to the family who love her exactly as she is.

Hugo, the happy rescue.
The MD breed profiling, has left a flurry of unwanted sweet dogs in need of a home.

This is Harley.
She came to us a very overweight dog, with severe hair loss,
and  the worst case of constipation I have ever seen.
She needed 3 weeks of hospitalization, about 2-4 enemas a day, multiple blood work checks,
and an intense amount of  time, and care to return her to the healthy happy girl she is now.
She is lucky to have a family that refuses to give up on her, and she received more than 80% of her care from the generosity of our donors.

These are just a few of the many cats and kittens that we in conjunction with No Kill Harford, have helped to spay, neuter, treat, care, and find homes for.
Many BIG THANKS to all of the people who adopted a cat or kitten from us.

We received a call  a few months ago from an overwhelmed client asking us to put his 6 6-week old puppies to sleep.
The staff was horrified and beside themselves.
They called me telling me that none of them would be a part of it, and every other vet in the building had refused to help also.
I replied "Well, I can't do it either."
Turns out they had all been exposed to a raccoon with rabies and faced a 6 month quarantine period.
The owner didn't want to raise them for 6 months, and couldn't afford their care for that long.
The puppies were transferred to No Kill Harfords' care, and have received all of their shots, and veterinary care from us for free.
 They are about 4 months into their quarantine and will be ready for adoption after the new year.
They are all doing great! And we expect them to continue to grow into normal loving pets.

This is Pirate.
He came to us with a terribly diseased infected eye.
A few weeks of antibiotics and TLC and he is a bouncy, bright kitten.
He will likely need to have his non-functional eye removed but it doesn't hurt him and he is going to make a wonderful addition to someones home.

This is Yammers. He is the loudest, most demanding little soul. He has been adopted.
But while with us he was vaccinated, neutered, FeLV/FIV tested and micro-chipped for a $50 adoption fee.
I will miss his demanding voice and effervescent personality.

Merry Christmas and Happy New Year!

My one wish for us all is to never give up on a life, no matter how difficult the challenge appears. Almost every single one of these pets needed an immense amount of time, care, and resources. But I firmly believe that where there is a will there is a way. The challenge is to not lose your faith along the way.

A very special Thanks to No Kill Harford, Adam and Kelly, for helping us to help these pets in dire need.
To learn more about No Kill Harford and their mission please see: http://www.nokillharford.org/

To learn more about the magic that happens at Jarrettsville Vet please like us on facebook,
or visit our website; http://www.jarrettsvillevet.com/

My Favorite Christmas Gift (so far...)

This was given to us by my very good friend Claudia.

She keeps chickens like I keep a pig, happy, coddled, named, and a valued part of the family.

I am saving them for Christmas eve dinner, with champagne, and desserts..

Happy Holidays to All!!

Cat Tips

Doesn't everyones bed look like this?
Three cats and a tentative-to-even-move dog on the floor?

I was enjoying the June 2012 edition of Veterinary Economics and thought I would highlight some of the items that struck my interest.

There has been a great deal of focus on trying to figure out innovative ways to try to convince owners that their indoor cats should be brought to us veterinarians on a yearly basis. The data shows that fewer and fewer cats are being brought into veterinary clinics each year. It is likely a combination of a tightening economy and an overall impression that “indoor” implies “a safer environment and not needing to be vaccinated.” Every pet health care person understands and admits that the most important part of any pets examination is the discussion that the vet has with the owner and the physical examination. Yes, in many states a rabies vaccine is required by law, but your cat is probably at a low risk for acquiring rabies, but it is still possible, and why wouldn’t we vaccinate your pet to protect both them and you? Also, the yearly examination is the time we can discuss things like diet, physical and emotional health, and help you both understand the aging process and how to best protect a body as it ages.

I am a cat parent. I have also had to address the stress involved in capturing, containing, traveling and waiting with my completely stressed out, crying in agony and breaking my heart kitty. I understand, acknowledge, and empathize. So how do I help make my cat clients feel better about a difficult decision to pry their cat out of its nap and come to visit the dreaded vet?

Magpie the magestic.
She always looks this intense.

Well the June article has some great tips. Here they are;

1.       “Even if you don’t have separate waiting areas for dogs and cats in your veterinary practice, make it easy for clients to separate themselves so a cat doesn’t suffer the stress of a dog nosing up to its carrier.” Great idea! No home bound kitty, (especially ones that don’t live with dogs and therefore must think that must be horrible flesh eating barking monsters quickly advancing toward their inescapable metal prison) wants to be sniffed by a dog in a foreign smelling, loud, scary hospital. All cats in carriers in a veterinary clinic are petrified. to try to minimize this we try to reduce the  dog exposure time by moving our cat clients into a room ASAP. I also recommend a blanket or towel over your cat’s cage to minimize the nosey dog exposure. Cats tend to feel safer in a small dark place, and it’s quieter. (See No Evil, Hear No Evil).

2.       “Move cats and their owners to an exam room quickly to reduce stress. If you can keep one exam room ‘dog free’ so cats don’t smell dogs in the environment, and treat that room with cat pheromones.” Oops, already said that! I try very hard to stay on time when I am in appointments. An efficient cat exam makes everyone happier. We have three dog exam rooms and 1 cat exam rooms. This allows us to keep the doggy smells out, and the cats on time. it also has minimal hiding spots for the occasional cat on the ceiling fiasco.

3.       “Make sure your practice environment is secure so if a cat gets loose it can’t escape through doors or windows.” I have some kitties that are so wound up and afraid that when the carrier opens they run for any corner or exit. We have had to pull cats off of drapes, and pry off of shelving. If I walk into a room and the cat is already screaming profanities I usually ask the owners to step out do I have one less potential victim to worry about. I have some cats who are so stressed out that we cannot even begin to examine them. I send them home with the number of our mobile vet. We have had to tear out dry wall to extract a cat that found a tiny hole behind our bookcase and wormed his way into our walls. My husband was not happy to tear down a wall and we have subsequently learned and sealed every other tiny hole or escape access to prevent any more inter office demolition.

4.       “Make it clear to cat owners that you care about cats by making sure that dog pictures don’t outnumber cat pictures in your reception area. You can also post photos of clients’ or staff members’ cats, provide books and magazines about cats, offer a range of cat products, post displays of cat breeds, and hang a bulletin board that displays feline information.” Here’s what we do; we have pets with Santa pictures in the cat room, I have my kitties framed photos up, and we have the cat room painted with cats. We also sell cat nail trimmers and an extensive full line of veterinary feline products. Or you can read my blog and get a really good idea of how important my cats are to me personally. And then there are the 8 cats roaming our clinic looking for that special someone to walk in the door and take them home to love as the incredibly majestic creatures that cats are.

5.       “If you have space in your facility, offer seminars or handouts on topics specific to cats such as life stage needs (from kittens to geriatric cats), dietary recommendations, tips on administering medications, and information about cat friendly boarding facilities. And consider offering kitten kindergarten classes.” Could anything be better that kitten kindergarten classes? Can we finger paint? Sign me up!

Wren, always kissing Oriole.
And Oriole always basking in the attention.

Here are some of the items that I would add: use a towel whenever possible. Cats hate slippery cold metal surfaces. And owners like to think of us providing a safe comfortable environment for their pet.

I have also heard some experts suggest “cat only appointment times,” to reduce the noise and anxiety in the clinic when dogs are sharing the same reception, waiting, and examination areas as the cats are. I think that’s a novel idea.

Oriole, trying to elicit even more attention from my husband.
She is pretty hard to resist!

I also think that offering “borrow-able, or affordable (there are cardboard carriers available for a few dollars) to any client coming into the clinic without a carrier or harness. I cannot even quantify how many cats have been lost forever because owners carry their cat into the clinic in their arms, and then lose their grip because something spooks their cat. Restraining and adequately holding a cat for transport is a dangerous proposition. Even the pros don’t take chances. I hold the scruff lightly, support the cat from underneath, shield their face and rush from point A to point B if I have to carry your cat to the treatment area for blood work or care. BUT I would NEVER EVER dream of carrying anyone’s cat outside without a sturdy safe carrier. Please, please, please, err on the side of caution, and don’t make the mistake so many of my clients have made, and use a carrier! Your cat’s life does depend on it.

I also make my cat owners feel loved by providing microchips to ALL of our patients free of charge. Cats are far more likely to be lost than dogs, so we protect them and offer the best assurance of them finding their way home to you by offering micro-chips for free to all patients.

May everyday of your kitties life be as happy as Wren and Orioles!

Anal Glands, The "Scoot" Story

There are a few old wives tales that I have made it my life mission to eradicate.

I have mentioned some of them in the past.

The item for today’s gripe is: scooting. 

“Hey Doc, I think that Boomer has worms.”

This the usual way the tale begins to unravel.

“Huh?” I say with a slight pause. “Why do you think that is?” (I have learned over the years to do less talking and more listening).  I expect to hear that Boomer is vomiting and his dad is seeing moving pieces of spaghetti in the vomitus. Or, that Boomer's stool sample had wiggling pieces of rice sized particles making an escape from their transport vehicle...

But instead what I usually hear is, “I've seen him scooting on the carpet.”

“Oh,” I reply, (why I sound surprised I’m not really sure at this late date). “Well let’s check the anal glands first, then talk about skin disease, and then intestinal worms.”

I say it in this order because in my experience this is the order of likely culprits for ‘itchy butt syndrome’.

Anal glands are in reality the anal sacs. These are found in dogs, cats, and all mammals, (yes, even us humans), and reside just inside the anus at the 4 and 8 o’clock positions. In a normal pet they are about the size of a raisin an should empty every time your pet defecates.

In the wild they prove a very effective defense mechanism for skunks to fend off potential threats. But some domestic animals have lost their ability to empty them voluntarily or efficiently. For these pets the anal glands become full or impacted, and they can also abscess causing a painful infection.

Some pets will ‘scoot’, or ‘drag their butt on the carpet’ in an attempt to relieve the pressure and discomfort of the over filled anal sacs.

The material in the anal sacs is normally a light brown mildly turbid foul smelling oily liquid that some describe as “fishy” but I describe as “pungent and offensive.”  In healthy pets the sacs are easily expressed and empty completely with a digital rectal manual approach. For those pets with difficulty emptying voluntarily the sacs will become distended and the fluid will become thicker. This further complicates the ability to express or empty the material. This makes them more painful to be expressed. If the sac is visibly evident externally and the skin covering it is red, or in the worst case has ruptured due to abscessing, then it will likely be impossible to empty, or even palpate rectally due to it being so painful.

For the cases that can't be expressed or even palpated, I start antibiotics, warm compresses, pain medications and  a re-check in 2-3 days.I also advise an e-collar and very close monitoring.

For the pets with thick and/or more difficult to express anal sacs I empty them as much as possible and schedule a re-check within a few days/week.  We often try to keep the sacs empty in the hope that the sac will return to its original size and not continue to accumulate fluid and hence need repeated emptying.

I have some patients who come in for scheduled anal sac emptying routinely. Some of them are monthly and some of them are quarterly. Every pet is different and the amount of time between assisted emptying varies significantly. How do we decide when to re-check? I usually say to come back in 3 weeks. If they are swollen and distended re-check again in two weeks. If not, try to re-check again in 5 weeks, etc..

For our clinic I would say that the hounds are the most popular breeds seen for anal sac issues.

For those pets who arrive with an impacted or abscessed anal sac we schedule re-checks more frequently and often need to prescribe an antibiotic, an analgesic and I also prescribe a topical antibiotic cleaner (because your butt isn't too sanitary to begin with, and I don’t like the idea of an infection next to the most unsanitary place on the body).  Pets with abscessed anal glands should also have an e-collar to go home with to try to discourage the licking that accompanies any painful condition.

I learned an important “veterinary pearl” from a veterinarian I worked with many years ago. He told me that “every pet that comes in acting painful or uncomfortable in general, or has weird behavioral symptoms, is panting, or that you can’t figure out what is wrong with them, should have their anal sacs checked.” This advice has proven to be correct many times.

If Boomer is still scooting after the anal sacs have been checked and are empty then the next usual cause is itchy skin..dogs with itchy feet, ears, or face often also have itchy butts.

For many of my clients who live with pets with recurrent anal gland issues I offer an in-house tutorial on ‘anal sac expression 101’. I have few clients that dare to try, but it isn't hard, so if you can handle the whole idea of performing a rectal exam, then ask your veterinarian, or veterinary technician to show you how.  Like everything else we do in veterinary medicine, learning how to be proficient at this takes practice.

There are some other aspects of anal sacs that should be discussed.

For future topics of discussion are;

1. Anal sac expression techniques. Why having your vet check them is important, and how your groomer expresses them vs how your vet does.

2. Long term treatment options for chronic anal sac problems.

3. "Why my dog?” What factors contribute to the problem?

I saw little Abby, the sweetest dachshund in the world a few weeks ago. She was brought in because her owners noticed redness on her butt. They had never seen her scoot, or lick, and she had never given them any clue as to having a sore butt or any kind of anal gland problem. After I palpated her anal glands and felt that the left side was indeed as swollen and painful as it looked we started Abby on twice daily compresses of an antibiotic/anti-fungal solution, or antibiotics and an oral analgesic. I rescheduled her for a re-check 3 days later and told her that I was fairly certain that the anal gland would rupture before then.

The anal sac on the left (at the 8 o'clock position) is very inflamed, bulging, swollen, and oh yes! painful! The skin covering the anal sac is thin and fragile. In many cases when the anal sac has progressed to this point it will rupture regardless of what you do. A ruptured anal sac is open to infection and should be treated topically so the infection does not persist or spread.

Three days later, sure enough, the abscess had ruptured. But little Abby was still wagging her tail, and no worse for the wear. This time I was able to empty the right side without causing her any pain. We decided to continue the antibiotics and compresses and discontinued the pain meds.

One week later the abscess and infection were gone. Abby, still happy as can be, was scheduled to be re-checked in a month. We are going to keep a close eye, (and palpate with a finger), monthly to try to avoid impaction and abscessing in the future.

For more information on anal sacs, or to learn about surgical removal of the anal sacs visit the blog on surgery palooza.

"Interest In Practice Ownership Wanes"

This is the title for the DVM 360 December 2012 article I just read.

As a 2005 graduate of VA-MD Regional College of Vet Medicine and a female I read the article with curiosity and dismay.

How can my fairy-tale idea of the perpetuation of James Herriott continue if the new generation of veterinarians don't want to jump on the saddle and take off into the next era of veterinary medicine? Will we become a profession of veterinary practices owned by big corporations and manned by local clock-in, clock-out women?

The point of the article seems to be that the "cost and a desire for a positive work-life balance factors into a decision to not own a practice."

I consider myself to be a fairly recent graduate. I know first hand how difficult it is to get into vet school. How many years we spend obsessing about how to get in, and how little concern we place on if we are able to afford it. It is all rose colored glasses and not listening to any piece of advice that might even sound like a dissuasion to doing what we feel 'we are meant to do.'

Once you finally get into vet school it is four long hard years of trying to stay in. We sacrifice family, personal lives, any degree of free time and live as cheaply as possible. We borrow to get through those four years of life, vet school, and basic necessities. Many of us already have an IOU from our four year college by the time we arrive at vet school. After all of those years of sacrifice we want AND need a regular life. We want to start dating, start a family, live in a house, go to the movies and eat out. Then the reality of how much we owe hits us. How the heck do we pay back our loans, buy a house, and try to leave a few moments for a personal life? It usually leaves us with feeling like the idea of practice ownership is not only out, it is yet another IOU to another institution when the previous banks have been chomping at our wallets relentlessly and indefinitely.

I graduated in a class of 90 students. Ten of my classmates were males. They have become a dying breed. DVM 360 calls it the "gender shift." I call it the best example of how things in veterinary medicine  are changing. A combination of women stepping into the shoes formerly worn by a "men-only" field and a driven professional workforce passionate about caring for those with no voice. I think it is very clear why there is a significant gender shift, but how do I explain why my fellow women veterinarians do not want to take the helm? They wanted to go to vet school, worked hard to get in, but then just want to work for someone else? Forever? Why?

The article also reiterates the financial hardships new grads face. The average student debt load of a new vet school grad is almost $200,000. The average starting salary is about $60,000. Add to that the cost of a new home, and the thought of needing time off to start a family, and the idea of buying or building a practice which starts at about 1 million, and it is almost insurmountable. I get it, I really do. I don't know what the answer is, but I am saddened to think it is just accepting that it is impossible to own your own practice and accepting to work for someone else for the rest of your career. Worse yet, most upcoming vet school graduates are resigning to this without even having their degree in hand.

I understand the difficulty in trying to find balance in life. We are all faced with this no matter which profession we choose. I also believe that veterinary medicine most closely follows in the footsteps of human medicine by about a decade. Human medicine has gone the way of corporate conglomerates that manage doctors who work for them. How many of us now go to large hospitals to see our doctor who works in a large building with a corporate logo on it? I remember the days of seeing our doctor in his house. He was a small one doctor practice with his own name hand lettered on the mailbox. It was also the same in our small town veterinary practice.

This the kind of veterinary practice I bought and still own. It is also the kind of veterinary practice I grew up in, aspired to own, and believe still best serves pets. If you need me I am there. If you are one of my clients you know that you can reach me at almost any time of day or night. Many of my class mates, colleagues, and competitors think I am crazy to be so available, but I have never had one client abuse this, and I know it has saved many a patient and bonded every client. Everything that goes on under under my roof is my responsibility. But what will happen to my practice when it is time for me to retire? Jarrettsville Vet might be sold to Banfield, or one of the other corporate practices. Perhaps two decades down the road there won't be anyone else to sell it to?

And perhaps the days of James Herriott will be like the story of old Doc Mag who used to make house calls?

I do not believe that there is a veterinarian out among us who is adverse or uncomfortable with hard word, dedication, and decision making. These are exactly the same skill sets that owning your own practice requires. Your practice is yours to shape, mold, and reflect your viewpoints. I knew immediately out of vet school that I would have a much harder road IF I worked for someone. I was expected to follow the same beliefs and practices as the former owner, and I couldn't euthanize every pet that an owner asked me to. I had a line in the sand that was about a continent away from his. We were from different generations and different perspectives. I like to be in control of my destiny more than I fear failure, long days, client rants, staff drama, and I also enjoy owning versus renting. 

My clinic employs seven other veterinarians. 5 women and 2 men. One of my associates used to own two clinics. He is now semi-retired and practicing what he wants when he wants. It would be nice to be able to sell my clinic to one of my associates, but I don't think it is in their future plans. I expect that at some point I will be looking to hire an associate with the plan of buying me out, I also expect that they will arrive at my doorstep in a suit and tie. 

Link to the article can be found here.