The Dilemma. What do you do when you don't think it's time to euthanize?

 

There was still a tag attached.

That’s what I remember most vividly. There was still a big cardboard tag, the kind that keeps you from being able to fit the merchandise in your pocket as a theft deterrent device, still attached to the obviously brand new toy she held so proudly in her mouth. It was the kind of tag that allows it to be hung on a rack for easy display whilst also providing the descriptor that announces the features of the toy that your pup might find most exciting and enjoyable. The colorful cardboard backing to allow plastic ties to prop up mouthpiece rope from the stuffed animal body and prohibit easy pilfering. That tag was hanging out of one side of her mouth as she clung to the beloved toy that dangled from the other. Toy and tag in tandem swinging from one end of her while the other wagged tail so hard it made her bony hips hula.

Her name was so endearing it made me stop to smile. Her name, a blossom in springtime, a flower in the glimmer of an eye, the baby of a movie star who wanted to be cool and still maintain cute. I’ll call her Honey. She was bright-eyed, exuberant, bubbly, bounding and exploding with joy to be around people. She is the lab pup every Labrador-lover dreamt of. She is pure love and kisses in your face the minute she gets close enough to steal your cheek unguarded. She is the reason I became a veterinarian. She is the reason every pet loving person grieves for decades when they lose their beloved pet. She is perfect. BUT, she is also old. 11 years old to be exact. She has not been to the vet in many years and her very dapperly dressed dad is sitting quietly in his designer loafers without laces, cross-legged in pressed, creased herringbone tweed pants. Where Honey is outgoing and energetic, he is stoic and reserved.

There is a foot of snow on the ground outside and every inch of landscape is slush and snow. I look at his buff-tan-kidskin leather loafers and wonder how he got from his car to our exam room on this yacht shoes missing soles. I look for an assistant who must have carried him in, knowing Honey wouldn’t have permitted an easy passage and yet he shows no sign of snow or wet.

I sit on the floor next to Honey and she cuddles up in my lap immediately. 

I am here in this room with them both, on the floor embracing Honey and delivering the hardest conversation I ever have to be present for.

This is Biscuit.. she reminds me of Honey.
I adore this girl,, and she knows it

I look at Honeys overdressed dad and say, “I’m sorry but the veterinarian doesn’t feel right about this.” He is quiet, his eyes narrowing and his composure tightening. He is waiting for me to dig in, and I see him returning the favor.

You see Honey is here, brand new toy in tow, wagging, happy and excited to be with us, to be euthanized. Her dad is here, holding her tight on a short leash, stoic, reserved and yet determined to make this a one way trip for her.

I go on to say; “We have a terrible problem with burnout, suicide and mental health. I do not force anyone to do anything they don’t feel right about.” I let the words fall around him hoping they landed softly enough to allow a crack in the façade to let the light in just a little bit?

I waited. I stroked Honey’s head and whispered a mental “I love you,” knowing I would likely never see her again.

These are the moments of the days of my veterinary life I despise. The moments that remind me to be brave and stay true to my heart,, even if I am alone in this.

I was the fourth person to enter this room with Honey today. The first had been our vet tech who had placed both in the Comfort Room as his appointment with Honey had been scheduled as a “QOL” exam, short for quality of life. We do not book euthanasia appointments with out a veterinarians prior consent. This is not a slaughterhouse. You do not drop off to pick up remains later. We are a family who loves pets as our own family. We take this request as a discussion and a decision not lightly agreed upon. If pets are truly property there is no conscious of grief to surrender yourself to. But we all know pets are so much more than this to all of us. We know that they are our truest friend. Our most adoring confidant, our reason for early wake-ups and long walks. When everything else in life seems questionable and unreliable your pets will remind you they are your constant. We don’t need much more than the belonging they inherently give us.

The technician came back to the treatment area to report that Honey was walking well, seemed happy as a lark, was carrying a toy to show us how delighted she was to have it, and that she was deeply concerned that Honey looked A-OK. She couldn’t imagine what kind of quality her dad was in search of. Honey had bounced up to her, thrust her toy in her face, dropped it to the ground and planted a big wet kiss on her face. The technician was smitten with Honey.

The second person to enter the Comfort Room was the veterinarian. In less than a minute Honey had given her the same welcome, and after a brief exam it seemed that Honey had aging back legs and might benefit from an analgesic and NSAID. The veterinarian also offered to run some routine diagnostics and see if we could provide some options to help improve her quality and spare her life. A discussion ensued about cost, benefit, possible side effects, and after a few moments Honeys dad said, “the family has decided. We are ready to put her down.” It hit like a blow. The veterinarian countered. “Would you consider surrendering her?” He nodded, she left and the office manager entered.

In the bowels of the hospital the staff gathered to hear what the veterinarian recalled. “He’s going to sign Honey over to us. Call Heidi, see if she will come down and meet Honey.” We started to make plans to find Honey a new home, and we started to draft a list of diagnostics to run to make sure we knew what Honey had going on inside. The techs were excited, bustling and congratulating each other on their interventional good deed. There was a levity that spread, it was hope packaged in healing hands and warm hearts. It is the lifeblood that feeds the marrow of a place like this. It is the small miracles that fill our long days with purpose and stories and the passing of intentions into matters that build our souls and fill our sails. For a place like our veterinary clinic it is the small wins to help make the inevitable tragedies more palatable.

A few minutes later the office manager came into the treatment area. We all knew by her quiet entrance that the news was bad. “He won’t surrender her.” The girls begged for a “why!?” She replied; “He doesn’t want her to be with anyone else.”

None of us could accept it. They all argued with how the hopes had been dashed so quickly. Had she asked the wrong question? Had it been lost on him in translation between a vet and a manager? Should we send the vet back in?

The girls suggested alternatives to save her life, spare her from being disposed of so coldly and unconscionably, ..

“Can’t we just say we euthanized her? He doesn’t want to be with her anyway?” The first option they threw out.

“What if we only give a little bit of the solution?” Like adding a splash of water to the euthanasia solution might dilute it to the place where it wasn't effective.

Desperate pleas for a desperate place. 

There were no answers left to offer. We only had one choice left.

Honey's dad wasn't going to let her have any other option than the one he walked into our door deciding she deserved. These places, these cases, these are the ones that kill you. For some of us, literally and completely. They destroy lives that care and our ability to care again.

I looked at the other veterinarian. She looked back at me. We both didn’t want to be the other persons answer. The mirror of responsibility to the staff who always had their hearts on their sleeves and worked so hard to just be a kind heart to a pet in need. We didn’t want to put the other in a place of heart-wrenching decision making.

“I can’t do it,” she said. “I just can’t.”

I looked at the office manager. “He is not going to surrender her.”

That left me. Alone, and with a Honey of a problem to reconcile alone. 

I walked into the room with Honey. The fourth person she brought her new toy to. The fourth person she was as excited as the first. I sat on the floor, she flopped, toy in tow bouncing with its cardboard tag alongside her tongue into my lap.

I whispered silently to her longing eyes of love, “I love you.” 

Honey is not alone. She has me rooting for her. Alone in a quest to remind her father, her family, whoever, that there has to be compassion, even in times of mercy, and we have to remember how precious each day is and fight for our chance at seeing tomorrow with love, hope, and kindness in our hearts.

Honeys dad tried to argue our stance. He made phone calls, he stood fast in his decision. When I cam back into the room some minutes later I handed him two bottles of analgesic hope and a paper that said Honeys treatments had been on the house. I added that I hoped it help her feel better and that we were here if we could help her again.

I extended an olive branch of defiance. I stood by my staff who would have been balling and questioning my cruelty had I chosen Honeys  family’s side. I stood by being kind when it wasn’t the right thing for me to do for her family. I stand here now not knowing if it was the right thing for Honey, and why I should be asking about it being anything other than that.

Here's more on Honey's case;

..and so the question remains? What would you do?

I posted this story within a few days of it occurring. I had to find a place to put the heavy heart I was carrying. This job, this heart on your sleeve, and this degree of emotional investment has a cost.

Three months later (to the day) we got a phone call. Honey was still alive and her family wanted to surrender her to us. We were blown away, excited, and relieved. We just didn't know what condition she would be in. We knew that her dad had been back once to buy more analgesics for her. He also wanted to surrender the other dog she was with. (WHAT!? Another dog)? We said yes!

Honey with her new friend Emma, on her first day in rescue

After I posted this blog, and the follow up news, the local social media pages blew up with stories about these two dogs. Here are some of the excerpts;

Here is the place Honey spent most of her life. I have heard from multiple people that she was either locked up in the cage outside or in a crate in the garage.

I want to reiterate that it kindness to bring her to us. To surrender her took effort and compassion. I am going to hold onto this.

The Blocked Cat. The Approach To Get Out Alive. Part Two

Cats with a urinary blockage always need to be addressed as an emergency. Unless you have experience with this condition before almost all of these patients arrive at the clinic as an emergency. Most commonly they have been blocked for some period of time and this leads to a higher likelihood of either bladder rupture or toxic changes to the heart. 

Beau. Blocked three times. $8,000 for two ER trips, 
then he found us. Third block and a PU surgery; $1500 on a payment plan.

I have to recommend that you go immediately to a vet if you suspect that your cat has a urinary blockage. I also have to caution that most clinics either refer to the local ER, or, charge a hefty price to treat this. 

Please go back to the first blog in this series now (go here) if you haven't read it already. The first chapter will define what a urinary obstructed cat looks like. 

The singular goal of this is to get your cat out alive. If you are like most of us you live in financial constraints and your cat is a vital, beloved member of your family. The profession knows this, and the profession has profited greatly because of it. We know you love your cat, and we know your cat is going to die from this, soon, if you don't cough up the admission fee for us to treat it. It's the culture of the American way. Make as much money as you can from wherever you can. Ask yourself how you are a part of the problem and then ask yourself what you are doing about it. Sure, I am disappointed in my profession for killing so many treatable pets, but, this is the world we all decided to emulate. Every rich person has profited from the misfortune of another. Medicine should be the neutral, sacred territory. It isn't. 

Here is my professional advice, as a veterinarian of 20 years, on getting your cat out alive when they have a urinary obstruction (aka a blocked cat). 

Tips; 

• be nice
• be honest
• be insistent
• be ready to challenge every interaction
• never lose hope
• never walk away without knowing that the only advocate in your pets life is you
• be willing to surrender your cat if it means it might save their life. 
• ask for help from everyone. Build an Army around your cause and then help pay it forward. If you find a way to get out alive pay that forward to someone else. The current practice of blocked cats in almost every ER setting is so expensive it is forcing most of these cats to either suffer or be euthanized. There are only these two options. Why is it that we allow these cats to go home and die a horrific death of suffering? or shame you into paying for something that has such an incredible mark up we lose the ability to heal? 

If your cat is demonstrating any of the clinical signs listed in the first blog on this (see here) then you must bring them to a veterinarian. 

Start with the exam. Blocked Y/N if YES, then ask for a written copy of the exam findings. Immediately. If the staff or vet declines, ask them to give a verbal description using the form provided below. Do not leave your cat without this. You should always have a copy, or have documented a detailed list of what has been done for your cat and what you have consented to. This is very important to help manage your cAts care and the expense associated with it. A blocked cat should be diagnosed by physical examination alone. The cat will often have a painful bladder that is hard, large and unable to be expressed (able to produce urine). If you sign anything ask for a copy of it immediately.

From the initial examination an estimate is given for the expected, or recommended, treatment plan. Here is the first place that negotiations should begin. Here is the first place where I recommend that clients challenge the options being presented. 

Next; 

Is the estimate is affordable? IF YES, (your cat is blocked) and the estimate/deposit required is affordable walk away. Sign paperwork, get a copy, and walk away. Your cat is in good hands, and the safest place they can be. The veterinary clinics are set up to provide top tier medicine and provide appropriate treatments for the worst case scenario. The problem is that most people cannot afford this, and, in almost all cases you are charged for worst case scenario treatment even though most cases do not require them to be successful. The veterinary clinic benefits greatly by being prepared to treat your cat as the worst case scenario outlier even though most are not. No client should have to pay for Gold Standard care if the case does not need it. Further, if you cannot afford the first estimate you should be permitted to be given the treatment plan tailored to your cats needs at a price you can afford to get the best possible outcome. THIS IS NOT BASED ON THE AMOUNT OF TIME YOU CAN AFFORD, BUT THE CARE YOUR CAT NEEDS. I recommend that your cat stay on iv fluids and with a urinary catheter in place for a minimum of 3 days. Your cat should stay in their care until urine runs clear. Your cat decides the length of stay,, not the hospital. They should do the following; full blood work. ECG, abdominal radiographs, do ultrasound, do urine culture and sensitivity. Provide analgesics, appropriate urinary diet, appetite stimulant, stress free housing. The cost of this at a specialty hospital with ER has been reported as $6,000 up. Reminder; your cat has a chance of re-blocking. I.e. you and your cat may be back here again, soon. Budget accordingly. 

IF NO;

If the estimate is not affordable; No? Everything from here is based on budget and time. The house decides your cats prognosis based on your budget. The smaller the budget the less ideal the care. Why do they get to decide that?

 

If blocked and you cannot afford the estimate; ask for all of the diagnostics to be declined before cutting the in hospital time. If the hospital will not do this ask to see the manager. Ask for the reason in writing. Do not leave with out this. There is this incorrect notion that vetcare is a one way street. We tell you what to do, and how much it is going to cost and you either pay or you hit the road. It is not the case. Veterinarians can decline to treat, but they are expected to give you a place to go for care. You can decline line items. You can ask for written prescriptions to fill elsewhere, and NO they cannot charge you for this. You can decline all diagnostics and ask for your cat to be unblocked. You can even decline pain medications, although I strongly disagree with this. Unblocking your cat, providing fluids (even in the case of a fluids kit you bring home to provide SQ fluids at home) is an option. Taking your cat home after they have placed an iv catheter and a urinary catheter is your right. In cases where the cost of care is so high I recommend that you tell the vet that you are transferring your cat to another clinic and they they be transferred with BOTH the urinary and i.v. catheter in place. I know of many (in fact I know of only 1 case where this was provided). In all other cases the specialty practice pulled BOTH catheters and then sent the cat to me. I had to replace both and this was detrimental to both the patient and the client. IF you paid for these you own them. Remind the practice this after you pay. (See form below).

If you cannot afford anything ask for a cystocentesis to remove as much urine as possible, go home find a general practitioner who will help. Call every rescue, shelter, veterinarian, put out a social media plea. Start a fund raising campaign. Offer to surrender your cat. Any person who refuses to surrender their cat appears more interested in ownership then compassion and the life of their pet. 

<$500; exam, comatose cats can be catheterized without sedation or analgesia. Take a video of how your cat presents to the ER. Ask if sedation is needed? If not it should be removed from your invoice. place urinary catheter ask if you can go home with sq fluids kit and urinary catheter in place. The act of placing a catheter is traumatic to the urethra that is already not functional. Placing and then removing before the tissue has healed is problematic, if not further worsening the cats prognosis.

Decision Tree;

blocked -> Yes, AND I can afford the suggested treatment plan., sign forms, get copy, go home. See you in a few days. (Warning patients can re-block in days to weeks).

Blocked-> Yes, BUT I cannot afford first treatment option provided; I would like to decline all diagnostics to have a urinary catheter and iv catheter placed, and at least 3 days of both with in hospital care.

Blocked-> Yes, not enough money for multiple days iv fluids and urinary catheter treatment, then place both and take home. Find a vet who will help at an affordable price. Give this directive in writing. If your vet pulls the catheters after providing written or verbal directive see your State Veterinary Board and file a complaint. 

Blocked-> Yes, cannot afford urinary catheter or iv catheter, decompress bladder (place a needle in the bladder and remove as much urine as possible. This will buy you a few hours to find a vet who can help. (Find me in Jarrettsville Maryland, or Denton County Animal ER in Denton Texas).

Pet Parent Consent For Care Form here.

If you know of someone who provides affordable, transparent care for blocked cats I want to hear about it. Email me at krista@pawbly.com

Consent to Care for a Blocked Cat. Pet Parents Edition.

 I, ________________________________________, authorize care for my cat __________________ to relieve his urinary obstruction in the most affordable means necessary to provide him immediate relief. I authorize pain management be given to him in any and all options possible including a written prescription that I can fill elsewhere. I understand that this may include declining best care practices and recommendations in an effort to help manage funds to allow him the best chance at cure/survival based on unknown future factors that might influence his healing and prognosis. 

I request all medical findings be provided as they are done and before other treatments are provided.

I request that if a catheter is placed (intravenous or urinary) that I be notified and offered the option to decline either, or any, be removed so that I might be able to transfer my cats care elsewhere. 

I understand that my cat has a very serious, potentially life threatening condition and that by declining treatments, and treatment options I may be worsening their prognosis. 

I understand that my cat has options for care. I request that decisions be made with my consent and with all options for care, and subsequent treatments in an open, up front, transparent manner. I request that more than one option be provided at each discussion.

I understand that euthanasia is my option at anytime. I understand that declining this as a case of economic euthanasia as a treatment option is also at my discretion.

I understand that denying care based on this document might be considered judgement, prejudice and impact my cats life. I understand that I am responsible for paying for his care and consenting with honesty and integrity is both parties right and responsibility.

I request the name of the veterinarian caring for my cat at all times to include transferring care should they no longer be on duty. I request this in writing at each transference of my cats care while he is here.

I request the name of the entity, or responsible party employing this veterinarian. I request this in writing at the time that I sign to consent of care for my pet.

I understand that my behavior is my responsibility. I will remain courteous and available for questions and discussions about my cats care.

I understand that the most important part of my cats treatment plan is to relieve the obstruction and provide fluids. I request that fluids be offered in anyway possible to allow me to care for my cat. I request the ability to take home an fluid bag to include the appropriate iv tubing and needles. If you cannot provide this I request a written script to purchase it elsewhere to include my veterinarians office, or an online provider (including Chewy.com).

If I cannot afford to hospitalize my cat based on the written provided estimate given to me, and signed by me then I request he have a cystocentesis to remove as much urine as possible so that he can be transferred to another provider. I understand that this is not without potential adverse consequences and I have consented to these with an understanding that my cat might die from any and all procedures and any and all treatments. 

I am asking for assistance in providing the best chance possible to my cat surviving this disease with the limited funds I have.

If possible I will relinquish ownership of my cat to get him the care he needs to survive.

I am grateful for your time, your medical skills, and your compassion as we try to save our cats life.

Sincerely, __________________________________________ (write and sign your name)

Raffles and Birdie

Please note this is a guide. I am not a lawyer, and I do not provide legal advice. 

For all of the documents veterinarians give to pet parents requesting signatures to authorize care it is time that pet parents start to advocate for their pets and find a way to get them out alive. All of those of us practicing medicine with our patients at the epicenter of care already practice this way. We already offer any and every option to keep these family members with their families.

Blocked Cat. UO. The Introduction. What Does A Blocked Cat Look Like? Part One of the Series for Feline Parents

The blocked cat. 

Beau. Blocked again, $8K in, his story is so typical,
and could have been another tragic ending.

Blocked cats are my lifelong veterinary mission. They are the place that veterinary medicine can offer the most impactful life changing care and they are also the single place we have the most alarming, dismissal statistics in actually doing it. 

The vital care needed for these cats is my passionate determined purpose. It is my hope to shed more light on this condition while inspiring others to offer more help with any, and every, degree of compromise needed so that we can relieve the suffering to save every blocked cat possible. I am proposing bold, ambitious, aggressive words of advice because of all of the many veterinary medical issues I am faced with in my day to day life there is no single other disease that has a higher prognosis to save ratio, while also escalating the cost of care so exorbitantly and unjustifiably that it has become cost prohibitive to allow most pet parents to provide it. When we allow the cost to exceed the ability to provide any degree of care the profession, the whole of the profession should be held accountable and culpable. The fact that we know most people cannot afford the ideal emergency care for this condition should be a wake up call for change. It shouldn't have to come from the outcry of the pet parents we have failed. It should come from inside the heart of our own code of ethics. With all of the miracles of modern veterinary medicine the blocked cat is both a product of our inability to educate on the appropriate care for cats before, during and after their UO, and, the profession denying every possible life saving treatment possible because we know you don't have another options to save your cat. Veterinarians, and the profession at large also knows that you cannot find affordable transparent pricing easily, if at all. We know you need us, and we know people adore their cats. We know how to take advantage of an emergency and the emotional turmoil this holds. We have profited from the intersection of emotional adoration, medical critical care, and no place for pet parents to find compassionate curative refuge. Further we have abandoned our compassion, empathy, responsibility and culpability in the process. If we are going to deny any modicum of meaningful interventional care it is time the veterinarians oath, the consequences and the challenging of what part veterinarians play in prolonging the suffering from UO's be challenged. When we offer no viable options we take responsibility for the cruelty that neglect carries.

I am here to challenge every single obstacle, empower and educate every single cat parent, and save every blocked cat I can. I am here to build a village so powerful it becomes an Army of causation for change. If the profession cannot provide affordable, transparent, compassionate care to these cats in the most dire need that is actually meaningful it is time to shift the paradigm of care based decisions back into the pet parents hands. Until the increasingly growing corporately owned monopoly releases the exorbitantly excessive costs that grip the access to pet care, and, the overseeing laws for pets being provided a higher elevation in status other than "property" are challenged there is only this, a public empowerment to permit great latitude for diversity of care based on the outcry of challenging the current Ivory Tower Gold Standard practices meant to benefit profits. The idea that we only offer what is both most profitable, albeit under the guise of ideal patient outcomes, is unrealistic and unethical. It is time to allow the conversation for ideal pet care to be shifted to an open two sided conversation. It is time to put patient options for ideal, or even viable, outcomes above all else.

This is the first part on a series of articles on this subject. This article will provide a basic overview of the condition, the clinical signs and the approach I recommend for every pet parent in the predicament of finding care for their blocked cat. The other articles will describe how to best customize your cats care to your abilities and preferences. They will also provide guidance for after care and help in addressing the likelihood of re-blocking.

Future articles will also provide a client based decision tree to help make the best decisions possible for their cat in real-time and with a team based approach to finding the best answers for you and your cat. Please follow on Pawbly.com for more help. There are also many amazing Facebook groups dedicated to this condition to help. If it takes an Army I will provide the troops and the battle plan. Never give up. Never lose hope. You are not alone and you are not helpless. Please also recognize that your voice, your pets story, these need to be heard and shared. If you find someone who won't offer options let the world know. If you find someone who will sit down with you and discuss any and every option to keep your cat alive and on the medical path to getting treatment to help them live a longer, happier life, please share this at Pawbly.com in the storylines section. It is time for all cat parents to become a part of the Army for change and care.

We are going to start here; educating, inspiring, empowering and reminding all of us that with compassion and hope anything is possible.

Urinary Obstruction, i.e. UO, or, blockage (or a "blocked cat" refers to the inability to pass urine out of your bladder, usually because the spigot is clogged. I describe it to clients as this; think of the bladder like a balloon. Think about someone tying off your balloon and then having to pee. In the beginning cats will go to the litter box frequently to try to empty the bladder. Over time the knot of the balloon gets tighter and the bladder gets larger, harder, more painful. While this is happening the toxins in the bladder become systemic to the body. The cats will often vocalize, (the loud, excruciating crying that sounds like a scream), is your cats way of saying "HELP ME!," In most cases this turns into a stupor and immobility, (lethargy that progresses to inability or unwillingness to move), because toxic doses of potassium are surging through the slowing heart, until it stops, OR, the patient dies after the bladder ruptures inside the abdomen. 

What a blocked cat looks like;

• frequent trips to the litter box
• meowing, crying, vocalizing in the litter box
• producing small amounts of urine more frequently
• licking at the area of the anus, prepuce, under the tail area
• not eating well
• not playful, happy, or calm
• agitated, not their normal self
• pawing at the litter in the box more aggressively, or frequently
• urinating outside of the box
• the urine looks bloody, or cloudy, blood spots on the tile floor, or bathtub
• angry if you touch or pet the belly area
• indoor, male, young cats are most common for UO

If your cat is doing any of these please go to the vet, or ER immediately. Waiting will worsen your cats chance of survival and make the cost of care more expensive.

Urinary blockage, (UO), happens primarily to young male cats (2-7 years old), who are indoor and being fed dry food, (usually poor quality dry food). They were previously otherwise happy, healthy, vibrant adoring cats. There is a horrific irony that the most vulnerable are often the youngest and the most beloved. The hidden joys in a home where the love of a cat who purrs you to sleep every night defines your ability to face a world outside your door that is too often unkind and unwilling to help.

Cash

It is my hope that veterinarians, and the veterinary medical community, start focusing on what we can do, regardless of cost, regardless of ideal standards of care, and let pet parents find help for a very treatable condition. It is also my hope that sharing successful stories, highlighting that these cats often have bumps in the road initially, but they can, and overwhelmingly do, go on to live long healthy lives. There is hope where there is compassion. 

Focus on this. I know that your cat is suffering from this disease, but I also know that these cats look like death when they arrive, and go back to living long healthy lives the majority of the time after they are treated. 

These patients are so young, and this is (almost always) treatable! Your cat and this issue are not uncommon. I hear about cases like yours all the time.

Here's where my Blocked Cat plan shifts the decision making, and optimal treatment options back to the pet parent for the best chances at saving these cats lives.

There is a storyline section where all of this can be added. My hope is to find a way to help everyone in your predicament. And I cannot possibly do every cat and every pu surgery.

So let’s start with the immediate. 

1. Diagnosis. Your cat needs this. A vet is needed. cost of exam $_____. This is a disease made by a physical exam, not thousands of dollars of diagnostics. Period.
2. Unblock costs this $____. You should ask for a detailed, exact list, of how this was done. It should be given to you in writing. (Insider secret; in some cases no anesthetic is needed, or given why do you have to pay for it? Keep a copy of everything you sign). 
3. Get every piece of your cats veterinary findings in real time. For example, as soon as your cat is examined you should be given, or write down all of the physical exam findings. 
4. If number 2 is not feasible, decompress by cystocentesis. Buy time by removing urine. Cost __. Get to a veterinarian who will help you affordably ASAP! You have (maybe) 12 hours.
5. Fluid therapy for 3 days. Maybe more. I treat until urine is clear and patient is acting normally again. 
6. If you cannot afford in hospital stay ask to bring your cat home with the urinary and iv catheter in place. Go to your vets office with these. They are often much more affordable than the ER, although not 24/7. If they will not keep your cat ask about having one of their technicians help you? These cats can be safely and effectively treated as an outpatient. They should wear an ecollar 24/7 to protect these catheters. Replacing the urinary catheter might cost you over $1,000.

If you cannot get these I recommend that you challenge every line item, impose upon every obstacle and call every local veterinarian, speak out on every social media platform and read the next series of my blocked cat blogs and YouTube videos. 

Your cat needs to be diagnosed, unblocked, and get i.v. fluids. Immediately! This is our most important minimum. The very bare basics. Now I have been a vet for a long time. I don't care how this happens, where it happens, or who gets paid for this. I want your cat to survive. We are talking about survival. We are talking about putting the patient above all else. 

Then your cat needs adequate time with the treatment plan for it to matter. In many cases people cannot afford the recommended number of hospital days the veterinary hospital is recommending. What happens next is almost as awful as remaining blocked, what happens next is the hospital decides length of stat based on available funds. WHAT SHOULD HAPPEN IS THE CLIENT AND HOSPITAL AGREE ON A PLAN THAT PROVIDES THE BEST CHANCE AT RESOLUTION BASED ON AVAILABLE RESOURCES. The hospital should be willing to compromise their financial gain by what the patient needs. There should be a plan that allows the adequate urinary and fluid catheters and decline the diagnostics that are advisable but not mandatory. These cats need three things more than anything else; 

1. urinary unblocking via indwelling urinary catheter

2. intravenous fluids to correct azotemia and electrolyte imbalances

3 time with both of the above..

If every person in the cats healthcare service plan was dedicated to getting these highly treatable cats the care they needed this blog, this whole movement for change wouldn't be needed. It wouldn't gain any traction, and it would be just another vet story in the mist. Instead my clinic phone rings every day with people in the most desperate place to find help. 

My point is that I don’t give up. I hope you don’t either. I will help but we have to figure this out for cats everywhere. In a profession that utilizes the tag line that "every case is unique and every treatment plan tailored" why aren't we allowing the pet parent to dictate the terms of the treatment plan so that an acceptable chance of cure is the only objective? To make this happen both parties have to agree that the only meaningful outcome is providing care to the best of all parties ability. Every cost, every line item on the invoice, and every out of the box option is acceptable and on the table. Consent for deviation of standard of care is provided and the patients life is above all else. For modern vetmed this will require stockholders to give up revenues to put the patients first. This is the war. Here is where the Army needs to be building their foundation and footing. Here is where the challenges are going to be fought. Here is where an insiders tips are lifesaving tools to keep at the ready.

If you are a cat parent please ask your vet how they manage these cases. If they tell you that they refer them to the ER ask the ER for an estimate for this before it happens to you so that you can be prepared for it. If the cost is too excessive find a general practitioner who is willing to help your cat in house. Ask what this estimate is. Be prepared before the emergency happens. Share your findings at pawbly.com, or leave a comment below. We are always looking to highlight practices, and practitioners, who offer help and don't discriminate based on financial ability.

Robert

I expect that these words, these tabs of advice, the backward driven decision tree of care to help you get your cat out alive in the minefield of highly profitable, almost absent empathy, for a young cat with their whole healthy long life ahead of them will be met with anger, accusation and venom by the colleagues of my profession who have euthanized before compromising what "ideal care looks like." Bring it on. It's time to put the patients above all else again. It's time to save every blocked cat we can.

There are other articles on this subject. Please follow along. Please utilize all of the resources I share. Please also become a part of this Army. Share your successes. Share your stories. Share the providers who cared enough to offer options outside of the first treatment plan they propose. Share the voices to build a village focused on the lives that so many of us consider our family.

I have been practicing veterinary medicine for almost 20 years. In 20 years I think I have treated hundreds of blocked cats. I have lost 2. I have never denied care based on cost. I have never recommended that euthanasia be chosen for this condition. I have learned how to do a PU surgery because I had to. I have been stressed, anxious, and afraid for my patients lives, but I have never given up on them. I will never give up on them. The profession of veterinary medicine owes these cats much more than we are providing them now. 

Krista

What can you do right now? What should your immediate take-away?

• You need to keep your cat on a good diet (I recommend a high quality canned food)
• You need to keep your cat happy, engaged, active, and think about their environment and how you can enrich it everyday
• You need to ask your vet how they would manage it if your cat blocked today? Would they refer you? What would that cost, and what would happen if you couldn't afford it? If they can't help you in a way that is meaningful to your cat getting out alive find another vet who can, and will. NOW.

See all of my blocked cat videos on my YouTube channel here;

Follow me on my veterinary clinic homepage, Jarrettsville Veterinary Center, here.

Jarrettsville Veterinary Center Facebook page here.

Ask me for help for free here; Pawbly.com

Disclaimer,, because you know this is the world we live in; I am not an internal medicine specialist, nor an emergency medicine specialist, nor a surgeon. I live, work, love, reside and chose to work in the trenches over every day general practice. I live in the place that the veterinarians before me made the most honorable yet humble profession in the world. I came here to save the lives that need me, and the rest of us, not become the wealthiest, nor the most exclusive. While I understand there are many others in this profession that will challenge my motives, and their own, I will say without hesitation that you are either here to serve your patients or get out of the way of all of the rest of us intent on just this. It is not about you, or even your perception of what "compassionate care" is. 

To Harry, The Best Cat Ever.

 "Harry was the best cat ever."

We ended the day, today, the last day of the year, on this.

Harry was a 16 year old debonair, distinguished, dark tabby dying from kidney failure, and all of the myriad of afflictions it brings with it. Kidney failure brings you a cascade of  collaterals. You are hungry, but too nauseous to eat. You are frail, but still want to try to jump up on the counter because in your kitty brain you are still a total badass, yet unable to gain any air. You are thirsty, drain the water bowl dry, pee out the buckets in piles voluminous and dehydrating, only to walk to the water bowl again, and again, to have the thirst never quenched and the march to the box never cease. You become tired from the anguish of your starving muscles from the anemia in your bones inability to replenish the red blood cells that let your muscles do your bidding. You fail in tiny stumbles until there is no wind left in the sails. Harry, well, Harry was the husbands cat, and the husband was in the car, to distraught to come inside to share in the goodbye.

Today was the last day I will be a veterinarian in 2023. Do I remember my fist day of 2023? No, but I will always remember today.

"Harry was the best cat I have ever had. I am 88 years old, and Harry was it." 

Harry's mom was short, quiet, smiling, gentle and full of pleasantries of gratitude that he was here with all of us, and loved. She held him for a moment, bent over to whisper that "you are the best cat ever," then kissed his forehead, and gave him a solid scratch under his chin. Harry was curled up, too tired to be afraid of the vets office. We stood nearby waiting for them to have their last moments together. Harry's mom wasn't remorseful about the days he didn't have left. When Harry was sleeping she looked at us and smiled. There weren't tears, nor fretful second guesses of hesitation. She said thank you to every staff member and left us with a laugh to replace the tears with her wisdom brought perspective. She told us how she had been coming to JVC for over 30 years. She told me that she first walked into JVC as a veterinary sales rep. She met Dr Wilson and knew immediately that this was the only vet clinic she would bring her pets to. She said that over all of these years this place was still full of love, and hope and kindness.

We shared stories about how Harry had found them, how they had found each other, and how much they all loved each other. 

Today was December 31st, walk-in appointments were from 1-3, an Harry was the caboose on the end of the year. The last patient I saw. The last person I shared the day with over the lifetime of a loved family member they would grieve and miss for years to come.

I had decided to open for Christmas eve, and New Years eve for the clients whose pets wouldn't make it the 12 hours ER wait, or the 24 hour closed day pause. For the patients like Harry. To be there on their last day is as meaningful, or maybe more so, on their last than it is on their first. The honor of being able to say goodbye to someone so loved they mark our life with stories that give our purpose placement. That was Harry.

As we all toast a glass to a year ahead I take a few moments to feel the weight and the gratitude that sharing little piece's of our most beloved companions brings. How can we walk forward with anticipation and joy if we don't remember what the past has brought us, or taken away. There is never a full cup without the vessels promise of empty and the chance to fill the cup again and start another day with the memories that made us who we are and how lucky we are to have been here. 

I set out to be a veterinarian all those many years ago to be a part of these stories. The happy ones, the sad ones, but most importantly the ones that remind us who we are when we put our whole selves out there to live every moment of the life we are given.

Rex, adopted 24 hours ago from a local shelter by one of our technicians.
The face of second chances and a better year ahead.
For Auld Lang Syne

Here's to you Harry, and your parents, thank you for being a part of every day that I get to live the best job ever. 

Raffles, my adventurous one

How Did We Get Here? The intersection of veterinary medicines needs and the professions gains.

I have tried to hold on, to not lose faith. I know I am not alone. I used to believe, heck, know emphatically, that every veterinarian came into this profession with the same common goal. We all came here because we loved animals in such a compulsory way that we would endure decades of schooling to help them in whatever capacity we could. We were pragmatic in knowing we could not always bend fate by sheer hopeful will, nor cure where disease had overtaken, but every so often some little wet nose would be saved by the hard work of our hands and the training of our mind. Vetmed was about this for all of us. Wealth from collecting and consolidating, or, fragmenting and focusing, well that was for the other white coats and their heart transplants and cancer ports. We vets were a humble, gritty, salt of the earth bunch. Quiet, yet trustworthy. Never a white coat spared for vanities sake. We were smelly, dirty, and proud of the badges of barn dust and species feathers we pinned in our caps. We boasted about having to be very skilled to fix a patient who didn't speak their ailments. We helped every patient who came our way. Each and every one of them, owned, beloved, lost, frail, unnamed, or otherwise was seen our duty, and our reputation on the line if we didn't at least try. We fostered compassion with every act of empathy. We were never too busy to be a beacon of hope in a world of cruelty. We were old souls that passed on our pearls of the profession from our weathered hands and thrifty resourcefulness to fresh faces of the next generations. We stood for the common man and their house pets inherent nucleus of the families whole. I set out to go to vet school to be this person. I bought my practice to perpetuate this long sought after lifestyle. I came into vetmed with all of this as our collective credo. The torch of quiet kindness for the sake of all the souls of the world we live within made vetmed the most honorable profession of them all. Without exception we were all cut, fashioned, and trained from this.  

Raffles. My Beloved kitty

I used to believe all veterinarians came here for this. The preservation of purpose. Perhaps we still graduate as this fledgling of hope and goodness, but, somewhere along the way the elevation of the status to pets being the glue and marrow of our all too complicated lives became so valuable it was extort-able, things changed. These voiceless, beloved to the point of needed beyond replacement value pets became fodder for greed. At some point it became permissible and acceptable to go to vet school at a price point the market could not support. With the incurring hundred of thousands of dollars of vet school debt, the corporate take over of the practices and the limitless, unregulated increasingly escalating cost of care, the professions barrage of whispered reminders that we are worth the six figures we command, the idea of being the one who cares for all as the oath we all took got lost. The profits soared, the costs climbed and the divide between the cans and the cannots grew in never before seen numbers. It became acceptable to place blame. It became permissible to deny care. It became excusable to turn the most needy away as we lacked the time, the willingness, and the empathy for them to make it worth our while. I don't know when that first denial to help because it was no longer profitable to even try happened, but it is now a systemic plague that has killed millions. We are part of this even if we can justify to myriad of reasons why. There is a shortage of veterinarians, and a squabble of people throwing obscene amounts of money at them, making it feasible by charging exorbitant amounts of money to feed the machine, and perpetuate the profession. We were once the place where all are welcome, all are cared for, and now we are the profession of the wealthy, or good luck finding help among the masses in the same boat as you are. I am going to tell all of those nameless, overlooked, dismissed and forgotten, broken hearted pet parents who have met the face of economic driven pet care that they are right. It is now very much about the money. If you are a person who loves their pets as family, spends most of your day insuring that your pets are comfortable and happy beyond the ability to provide the same for yourself than you have either learned this lesson, or will soon. If you are a pet parent who will need to hear the estimate for the cost of your pets care, and then have to negotiate for a higher credit limit to provide it, let's say you do not have $6,000 on hand for a 2 am ER visit, then you need to begin to plan for the ugly that lies ahead. Most vet professionals would insert a strong recommendation to get pet insurance. I will not. While I realize that the future of healthcare for your pet is not foreseeable to most, it is helpful to have some kind of financial plan. The hitch here is that you will not have access to this at 2 am when the deposit is required. You have to have an emergency fund of at least $2,000 and you have to be prepared before that fateful night happens, and you need to have insurance.

My Storm and Frippie.

I came into vetmed when every patient was given options to make them feel better. I came here when "tincture of time" and a pennies on the dollar analgesic plan was the norm. I came here at a time when vetmed didn't have access to the diagnostics, the specialists, or the corporate ownership and we saved more lives in spite of them. I came here when every pet parent was given equal access to our time, our talents and our unquestionable integrity. While it wasn't perfect, it served the patients with equal concern for their family. It came with generous hope, and unmitigated compassion. It was a time when euthanasia was only offered to spare an untreatable pet a suffering death. When equipment was purchased to save lives not bolster share holder dividends and entice/dazzle new talent acquisitions. We paid at point of sale, and never conceived of buying by marketing and passing the purchase price to clients in packages tied to services they couldn't opt out of. We were independent, privately owned, and working for the community who knew us by more than our credentialled monograms. We were faithful, devoted, and supportive of each other in a home-town baked-apple-pie way. I came here to pass the torch my predecessors granted me. Somewhere along the way we all decided we liked stuff, nest eggs, and the chasing of wealth more than the ability to be kind to all. We, the huge collective chasing the American Dream, we, all bought into this. We are all going to be reminded of it every time a life lies in the balance. What would you do if you were in our shoes? How many times do people tell me that they couldn't do my job because they would want to save them all? Where does the ability to chase the American Dream, profit upon the fruits of your labors, and the quest to get as much as you can meet the empathy needed to save the companions we call our lifes joy?

What Your Pet Wants For Christmas

In the heart of Macy's department store for the month of December rests a large red Santa's mailbox. It is nestled between the racks of clothes, flanked by flocked evergreen trees, and it is always easy to find as it is the center of the crowd in the middle of the first floor. I visit it each year as a reminder of how magical this time of year is to the little kids in all of us. The front mail door swings open with its traditional metal hinge melody so often it sounds like part of the caroling. Children, of every size, from every corner of the world, congregate here to mail their present list to Santa. Although I have never slipped an envelope into its red belly, I stop and watch as the other kids do. For each time that door is pulled open and the mouth of the North Pole is summoned to answer a request, I wish for that kid to know that the magic is always here. Not in a store, but in the hope of a wish put to paper. The feeling of anticipation that whatever you ask for might be provided. If you take pause, and allow yourself to be the witness to another's joyful excitement you will quickly be reminded about how sweet the gesture of writing a list and sending it to make-believe-land is. You can stand as an onlooker to this little spot of letters, wishes, dreams, and love and just lose the rest of the bustling patrons elbowing by. I always wonder what those letters hold. How many are asking for a toy, a doll, a childhood keepsake to mark the year in the timeline of a life that grows up. How many are for such basic wishes that no child should ever have to ask for. Food, clothing, a home to feel safe in. How many hold wishes like mine always did; a pony, a puppy, a bunny. Something alive for me to cuddle and keep safe. Some little life to love and be needed for.

How do you do a thoracocentesis?
One of our rescue kittens getting treated by my team.
Giggles are always on the schedule.

These days my life revolves around the little lives my home calls its heart. I have 5 cats, and two dogs, and I will admit with 100% honesty that I spend every day asking myself if I have fulfilled all of the items that they would have penned in their letter to Santa. They always have the basic needs of a cat or dog at their toes. The basic is food and water, a warm place to sleep every night, but the wishes meant for Santa's ears, they are the items that I ask myself if I am providing.

So I thought that this year I will share what I think my pets would ask for, should Santa remind them that their Nice days outnumber the Naughty.

Wren is the cat I call my beloved. She is the first one I go looking for at bedtime if she isn't already purring at the top of my pillow. She is aging, and less finicky. Less likely to call out in alarm when she hasn't gotten her way. She lets the kittens plow past her and grumps with the expiration of an old soul who hasn't got time for shenanigans anymore. She is wise, adored and Queen. She bows to no one, and puts up with even less. This year we got her a heating mat that has 10 settings, (she prefers 3), and we set it for 12 hours. She also likes her water changed daily. We keep a glass by the bed, and she prefers options even in this. It is more likely that she will drink from my overnight water glass, a tiptoe at a time to scoop it from the glass to her tongue. Even in this we share everything. (I know not to drink past bedtime). She prefers fresh plants in winter. It's too cold to go out for a green nibble. Reminding the housekeeping staff to bow to her as they pass. 

Wren

She has a window sill of her own. Packed with a bed and blankets. A perch to see the sunrise, and then set, and monitor the critters of her kingdom. For cats, every single one of them, this perception that they are the apex predator, the indisputable badass of their kingdom, is paramount. Every cat needs to feel they are free to make choices. Free to have opinions, and able to execute commands at whim. Finding your place in your own home when you are their servant is the key to an equitable, honest, and amicable life. Your cat always needs to feel that they are in charge, and this will not be threatened. It is part of the reason that there is a critical mass threshold for multi-cat homes. That one extra cat too many that tilts the apple cart and leads to marking territory, cat fights, and stress in the multi-cat home. She is the constant comfort for all of my days. The one who purrs when she sees me. Takes delight in me just being near. She is the epitome of why we all sacrifice so much for the pets we call family. 

Birdie

My two rabies quarantine kittens; Raffles (short for the state bird of Pennsylvania; the Ruffed Grouse), and Birdie, (the state bird of New York; the Eastern Bluebird), are wild, crazy, pure kitten energy rambunctious. These days my husband is retired. The two kittens follow him like ducklings, always underfoot. They grew up with the puppies, Frippie and Storm, and seemed to imprint on them as much as us humans, so they follow the dogs in and out for the am pee and the before bed bathroom. Unlike the dogs who stay wherever we are, they decide if it's time to come, or go, and beckon their wishes with long drawn out meows fit for drama soap operas of the B-rated variety. My husband stands near the door and opens it slowly for the kittens to come and go, based on which side of the door they scream from. He will stand their like a doorman and say, "I do this all day," with a prideful subservience only a parent could admit to. Their new favorite fancy is feathers. My dear friend Kim gave us a handful of her peacocks plumage and they have systematically disemboweled each frond. The confetti of a killer spread across the living room floor. Life for a kitten is easier, as long as it is quiet, safe and has ample food. They make the simplest things fun. You just need to remember their energy threshold requires they come in pairs.

Raffles

The dogs; Fripp and Storm. Two peas in the pod who could not exist without each other, even though they are so different. There is a firm two dog rule in this house. Two dogs to keep each other company. Two to play so hard during the day that they sleep well enough through the night, so their already exhausted mom can go to sleep as soon as she gets home from work. This couldn't work if they didn't have each other. Their Christmas list to Santa would very likely include a wish for the other. They are this couple. They would only ask for more time. More time together to go on long walks. Walks where they lead and decide which trail to follow. Time to find that ever elusive squirrel and finally make peace with the pursuit. More steak dinners. Fewer vacations for their parents that involve planes or trains. The kind of vacations we take with cars allow them to go, therefore they prefer these. They are family and they expect every family vacation will include them. They are greeted every morning by a whisper of a "hello" that allows them to jump on the bed and curl up on our pillows. They insist that bedtime follow the same principles. Every day begins and ends with a bed in the bedroom and a wish for a peaceful night of dreaming about the adventures of tomorrow. These house fellows of ours never want for more than time together. It is the most sincere wish for Santa anyone of us could ever desire.

Storm and Frippie

Here's to wishing all of you a very Merry Christmas and a holiday season where all of your time is loved and treasured with the family you call yours.

Pets With Santa 2023

If you need some hints on what your pet might want this Christmas, think about these;

- a place to call home. So many pets die in shelters, and so many others still live in horrific conditions breeding the puppies of the internet sales ads.

- a person to remind them that they are loved. We all deserve this.

- the gentle acknowledgement that they are the most beloved being in the world.

- a warm place to sleep.

- a collar (dog only) AND a microchip that says "you are mine" (and the appropriate contact information).

- a place of their own. We all need a place that is exclusively ours. A bed, a perch, a cage, a corner, a space.. a bathtub and a vanity (if you are me).

- current vaccines for the appropriate place you live. Nothing, no one, not one living being should die from a preventable disease. Watching a pet die from parvovirus, rabies, a pyometra, the list is exhaustive, the mental pain, and the enduring heartbreak these bring, is avoidable. Why are we still begging for this?

- spayed, neutered, and putting the life of your pet above all else. (Breeding them puts their lives at risk, and we already have too many unwanted pets in the world).

- a walk everyday that is just for you, (I am talking to your dog, but, I know lots of cats who love being outside safely. Maybe consider a walk with them too). We don't walk a dog to go from point A to point B, we walk them so they can get out, stretch their legs, employ their nose to investigate a world of scents we can only imagine. Let your dog do the walking, just be the chaperone.

- a catnip station, toys, water fountain and feathers. How about indoor cat grass year around. What does your cat love to get their claws into? Do you think your cat feels like they are a guest in their own home, or do they think that you are?

- photos on the wall, the mantel, the wallet, all of the places where terms of endearment lie. Doesn't everyone have their screensaver set to their pet?

- cats need lots of choices for litterboxes. If you have four floors in your home, and your cat has access to each of them a litter box on each is a sign that they are welcome. Also, choices are important. What if your cat is afraid to get in the box with the lid, or can't quite manage to jump on the top to gain access? Think about your cat aging, and struggling with the joints? Who wants to debate a painful poo?

- dogs come in every shape, size, and demeanor. Some are highly social others just want mom and dad, and don't need anyone else. Maybe a gift of learning to allow others to have value is a way to ensure that your pet has options outside of you and your life. Dogs are just like people. Aren't we each our own individuals?

- remind your pets that they are the most important part of everyday. Say "good morning!" Say "I love you!" Or, say, "you are the most beautiful girl in the world!" it doesn't matter what you tell them, but acknowledge them every time you see them. There will never be another life who loves you so devotingly. 

Spend some time thinking about how lucky you are to have your pets. How lucky are we to have each other. 

Happy holidays to all of us who love the pets we devote our lives to.

I want to hear about your pets list to Santa. What would they wish for?

Cheeto,, another broken kitten who needs us..
He will have half of his tail amputated tomorrow.
He came to us with multiple injuries,, and his story continues.
He is loved and he reminds us of our purpose.