Feeding tube in a feline. Why being aggressive saves you one of those 9 lives.

This is Minnie. Her story is a testament to how unfair life can seem, and why you have to believe in miracles..

Minnie and her surgical set up

Perhaps there is some deeply seeded catholic benediction my foreparents bestowed upon me that moves me to do the things I do? In too many cases I find myself inexplicably emotionally invested in my patients care. When the case is a cat with a poor prognosis and a back story fitting for the Hallmark channel I also find myself barging into them. 

For all of my intrusive Dr House desire I have grown increasingly impatient for owners to make up their minds when it comes to their pets direly needed treatments. Finding the way to promote being proactive without scaring them into more treatment paralysis takes conviction, dogged determination, and willingness to participate in the responsibility of every possible outcome.

Seems most clients need more prodding than I do to jump in and change the course it so obvious their cat is headed in. Call it my veterinary ability to forecast medical futures and having seen too many unhappy endings, but living with regret for cases that could have ended differently should time have been on our side, I have become more resolved to not let a patient fail if at all possible. A decade of experience in foretelling the future has reaffirmed that people wait too long to make treatment choices, most especially when it comes to their cats. Parents need to be motivated by death looming at the door. Not the tiny chimes of angelic bells on the horizon, No, people wait until cats are taking their last breath. Waiting in too many cases is letting biology keep its course toward death. DON'T WAIT FOR FATE TO DECIDE! If Mother Nature were to decide for us I would have to find another profession. Medicine and Mother Nature are polar opponents within science.

Cats are special critters. They may have nine lives but they need aggressive care when it comes to the following;

1. Warmth. Young and old cats need to be kept warm. Warmth is attainable only when they have dry fur and adequate muscle mass. Debilitated, diseased, skinny (cachexic) elderly and young cats need help. They need shelter and warmth. If they are unable to stand or walk you must monitor their temperature with a thermometer. They get very cod very fast and when you put them on a heating pad (wrapped in a towel always or it will burn them!) they warm up too fast. They need to be between 100 - 102 Fahrenheit. 

2. Parasite free. Fleas and intestinal worms are small lethal killers when found in great numbers. This idea of knowing that your cat "doesn't have intestinal worms" is not based on any shred of intellect. Unless your vet looks at the feces under the microscope ASSUME they DO have parasites. And, just because I ask you to assume this, please (pleeeease) don't go buy some toxic stuff at the corner store and throw it down your cats gullet without checking with your vet.. that stuff is toxic.. yes, terribly toxic... bleck!

3. Eating. Regardless of the cause (and it is SUPER important to identify the cause) you have to get a cat eating. Any cat not eating for over 48 hours is at great risk of hepatic lipidosis. I don't wait longer than 48 hours to decide what to do about an anorexic cat, I get aggressive, I put in a feeding tube. Kittens (anyone under 4 months old), need to eat every 4-6 hours. If they aren't they need to be seen by a vet immediately. Products like NutriCal, Karosyrup on the gums, or syringe feeding might buy you a few hours,, might,, and hours, not days.

This is Minnie, a middle aged petite all black domestic short hair feline. She had just been adopted by her new family a week ago. When she came to the clinic I was spying on her exam work up. The clinic has 5 supremely wonderful vets. We are an eclectic bunch with our own areas of expertise, strengths, diverse experience and most wonderful sense of camaraderie. We share each others successes, failures, frustration, and hard cases. But, when it comes to cats I always volunteer for the hardest and most bleak cases. Worse of all I want the sickest kittens and the broken bodies. They are my favorite cases to fight for. When I heard her story I was determined to get her case in my hands.. (bet you never knew that the vets arm wrestle over cases?).

Minnie was considered "unadoptable" at the shelter. A label that pretty much assures that only crazy people or rubber neckers will glance at you. Being at a shelter is hard enough for any pet, being labeled "not worthy" is unimaginable. Pity is a powerful motivator. I was enamored with her story, her little fragile broken spirit and two people who could cast aside her Scarlett Letter and love her in spite of the professional warnings.

Minnie had waited 2 years to get adopted and within 1 week she was falling apart. Poetic country song justice was being served. The first appointments of Minnie's new life had cost her family over $500. They were looking at and accepting taking the writing on the wall and giving up... until I stepped in (even if it more closely approximated a 'barging in'). 

Minnie presented to JVC with significant diarrhea. The kind that looks like brown water dripping out the anus. Hard to manage for all involved. Medications were sent home. They had minimal effect.

She returned shortly after for more help. Blood work and x-rays then lead to a diagnosis of a mass in her chest.. typically evidence of cancer. All of the vets converged on her case. It was a caucus of opinions, emotional outbursts, "what-if's?", worst case scenarios, suggestions on how to pitch the findings without costing Minnie her second chance, and managing liability, and expectations. Not to mention the heated debate about what treatment options to actually recommend. The negotiations of what to say, what to do, how to help your patient without condemning the unknown future that lies ahead is some of the most stressful moments of every vets life.

I did not want her new parents to be convinced that she wasn't worth another chance of trying..

In reality we guess waaay more than we should. In the obligation of providing advice we GUESS! Without a lung biopsy that white blob on the radiograph is an unknown. No one knows Minnie's past, there are no x-rays to compare, and further that bleb may not have anything to do with her parents presenting complaint. We saw it because we went looking. Differentiating between "incidental findings" and "life threatening"is something left to more invasive diagnostics that most clients do not pursue.

Vets are supremely confident guessers. Handing down a death sentence is a burden vets take too lightly. In an effort to cover all of our bases and be thorough, and cover our asses we throw around words like "cancer," "expensive diagnostics" and "poor prognosis." In the human field it takes weeks to months and massive numbers of tests before you get a diagnosis. Human medicine is elusive and mysterious and often frustrating becuase people are desperate for answers that are not provided UNTIL the discovery process is complete. It is as it should be. Maintaining pursed lips until we have a definitive answer saves lives. Prognosis? Well, that is only for the brave and the well armed. 

Within another few days she was losing weight and not eating. 

"Great," I thought. "I was so hopeful that maybe her chest mass wasn't something bad? And now she has to prove me wrong?" Ugh!

And still I thought,,, "How could everything unravel like this? How is it statistically possible that she is fine for two years in a shelter and within 1 week she is dying from cancer? Stress can explain the diarrhea. The not eating was the congestion, runny, nose, and sneezing like every other cat from a rescue gets." She fit that scenario much better than the 1 week collapse and cancer affliction.

And so it was settled,, I was going with the more plausible scenario, jumping in, and willing Minnie into finally having her 'happily ever after'.

So I did what I wanted to do. I asked her family to let me try? They wanted a happy ending as much as I did. The financial investment was getting concerning. I see it so often. The bill gets bigger, the answers get shadier, and the prognosis for "full recovery" is more and more in question. I get it. I also get that many vets don't want to make assumptions that certainly could be wrong, and we don't want to scare our clients into giving up. So, our answer? We make a deal. Barter for service. 

"What if I do the feeding tube placement for free?"

Or,

"What if you only pay me if the treatment in successful?" 

Deals, and discounts.. and you and I both put some skin in the game to influence the outcome.

Sometimes sheer will power can make miracles happen.

So Minnie got her feeding tube placed by the Good Samaritan Fund. She also got four days in the hospital to try a whole new set of medications. Me, well, I got to try. The longer I practice the more I am seeking the challenges, the battles between biology and faith. The more I realize that the beauty lies in the struggle. Happy endings take work and effort, they are not supposed to be quick and easy.

Now I am not a surgeon, nor an expert of any species of any kind of veterinary anything, BUT, I do place feeding tubes way before anyone else around me contemplates doing it. Being proactive saves lives. It is why we use preventatives, advocate for yearly examinations, and promote vaccines, examinations, and excellent animal husbandry.

Feeding tubes save lives. They are cheap (tube $5, anesthesia $100, and suture $5, skill about $40).. I also take a radiograph with barium (contrast) to show that I have the tube where I want it to be. When I have the bill in my own hands I take liberties other vets have to scrutinize. Minnie was my case to do as I thought best. I did everything I thought she needed. If your clinic doesn't have an in-house slush fund I urge you to consider why not?

There is the always resistance when I mention  or suggest a feeding tube. We humans relate to medical treatment options as if we are the patient. Your cat is not a human. There are many treatment options that pets seem to tolerate far better than we do. Broken bones, spay/neuter, illness, cancer, you can almost name anything. They often bounce back very quickly and never feel sorry for themselves. Minnie was losing weight and getting sicker, she needed help to maintain her body weight, deliver the medications she needed and have a chance. She needed a feeding tube. She needed it now.

Helpful Real-Life Vet Tip; Don't hesitate to put a feeding tube in a cat. EVER! (OK, I should never say never, or ever,, But I do mostly mean it here).

The myths behind feeding tubes;

1. They are invasive. Not hard to place not difficult to do. A few photos in a training manual and basic surgery skills.

2. They are extra-ordinary life saving measures. Not any more so than an iv catheter and we do this daily.

3. They are hard to manage. They aren't. A few simple instructions and they are a satisfyingly simple life savers..

4. They are cumbersome and bothersome to our patients. of all that I have placed not one cat has seemed to even notice them.

Here are some things to remember about feeding tubes;

1. They are transient short term lifesavers.

2. They permit for adequate food and medication delivery quickly and efficiently.

3. Cats can (and do) eat around them. We let Minnie decide when she was ready to have it removed.

After a few days of hospitalization she started eating very well. We sent her home with a few basic instructions on monitoring the tubes placement site to make sure it wasn't moving, looking infected, or had food caked around it. Feeding requires liquefying one of the many prescription foods and allocating the daily allowance over the 4-8 feedings prescribed. After each meal the tube is cleared by flushing a small amount of water. The tube is capped and tucked away in the neck bandage.

Food and water is offered and kept available at all times.

Most of these cases are given concurrent;

1. Probiotics (after all we are adding a lot of water to liquify the food and lots of water leaves likely diarrhea).

2. Appetite stimulant. I like mirtazapine. The point of Minnie's plan was to get her eating. Use all tricks, tips and tools available.

3. Address and correct Minnie's underlying issues. Feeding tubes buy you a little bit of time but they don't cure. Like all medical procedures we buy bits of time, we continue to search, 

Minnie went home for a few days to acclimate (again),  feeding tube in place. Her parents had a daily list of medications to give, and instructions on how to monitor her feeding tube. The biggest fear I had was pulling her feeding tube too soon. She had to be well enough that she was maintaining her weight, could stay on her prescribed medications, and be comfortable in her new home.

Things that indicate a problem;

1. Cat isn't eating or looking interested in food. A feeding tube can't stay in forever. Start an appetite stimulant, look for additional underlying issues, and don't forget to address behavioral components (a stressed or unhappy cat will not eat).

2. The feeding tube is vomited up, or coughed up and coming  out of the mouth. These cats will chew off the end of the tube and we don't want the tube to be swallowed. 

3. The entry site of the tube needs to be checked daily. We change the bandage that covers it daily. Infection is dealt with aggressively and immediately. 

4. Using a feeding tube takes practice and calculated amounts of the correct prescription food. Your vet needs to help you so that enough calories are given, enough water is used to move the food into the stomach, and a flush of water as a chaser is given after the food is delivered so that the tube doesn't clog.

Minnie has a new second (maybe we are on our third?) chance at life. She is being monitored closely. Given her own spot to acclimate to her new home, and get used to life after the shelter.

And me, well, I've got your back Minnie, and all of us at Jarrettsville Vet are rooting for you!

One week post op.

Many thanks to all of the friends of Jarrettsville Vet who help us provide second chances to those in need. The Good Samaritan Fund is available at the discretion of the staff of Jarrettsville Vet to our clients. If you would like to contribute please contact us here. The veterinarians who utilize the fund are not paid out of it. The vets donate their time if they elect to use the Fund. Everyone (we mean everyone) puts some skin in the game and is personally invested in the case.

If you have questions about anorexia, feeding tubes, hospital care, and how sheer will and determination can shape health and destiny, please find us on Pawbly.com. It is free to use and open to all who care about animals.

You can also find me on Twitter @FreePetAdvice.

And if you have a cat who needs a friend find me at Jarrettsville Vet. I am always looking for a case to champion and a cat who hasn't exhausted their 9 lives.

Pyometra Emergency. Saving your pets life when optimal options aren't possible.

Chloe is prepped for her big restoration and transformation.

There are many cases who find me. The power of social media and pet parent desperation often come to a head at my doorstep. It wasn't necessarily my intention to be the landing page for those who had no luck at other equally capable veterinarians hospitals, but I am finding myself to be the vet who offers options to those who are not receiving affordable treatment plans elsewhere. There is a great divide happening in medicine and consequently a huge number of pets falling into the growing chasm of divide simply because pet parents are being priced out of the care they need.

Chloe is a speck of a Yorkie. Demure, quiet, reserved and always trying to hide in the shadows of her moms arms who persistently protect her from having to face the world with a nose to the heavens.

Mom loves Chloe, but like so many others, life had gotten bumpy and difficult and Chloe's health care needs were being overlooked due to more immediate pressing matters until last weekend when Chloe wouldn't eat and was acting very sick and reluctant to move or play.

Chloe headed to the emergency clinic. Within a few hours her illness had a name; pyometra. Unfortunately that $750 work up cost her family all of the money they had. The price tag Chloe's mom was given for the treatment she needed was estimated at $2900. They walked out of the ER with antibiotics and a dog who still needed life threatening surgery.

I have this gripe that I cannot seem to convince the rest of the veterinary world to pay attention to.. the point of veterinary patient care, the reason people drive their pets into our door, is NOT JUST TO TELL THEM WHAT IS WRONG!!! OUR JOB IS TO DO THAT, AND (MOST VITALLY IMPORTANTLY), TO FIX THEM!! 

In fact, I am very certain that our clients are more interested in real help than real answers!

An invested vet will talk about the resources required to do both, diagnose and fix. Exhausting available resources and not getting to the finish line is not assisting our patients. It is short sighted, veterinary focused mismanagement of client and patient care. A good vet will talk about the most likely diagnosis, the available treatment options, the prognosis for each, and the costs associated with every step of this process. Spending all of Chloe's treatment resources before they get the help that will save their lives is simply cruel tragically failed patient care. 

Chloe has had a retained baby tooth, now mobile simply by touching it, for her whole life.
More information on this here.

Chloe had a laundry list of needs. By the grace of good luck her antibiotics were kicking her uterine infection to the curb and she was feeling better within two days. There was still much to address in her tiny 8 pounds.

People ask me all the time how they can affordably care for their pets? The answer is universal; Keep up with the day to day, month to month, and yearly stuff. Budget and plan for it. It is as important to your pets health as it is to yours.

Here is my short list of needed routine care to avoid the costly veterinary bumps in the road.

• Brush teeth daily.
• Eat a good nutritious wholesome food on a scheduled regimen.
• Get lots of sleep. Dogs have this concept mastered. We have some important lessons to learn from them. 
• Lots of interesting exercise. What do I mean by this? Let your dog be a dog. Sniff, tug, play, hide, walks that are adventurous. Let them explore the world.
• Play hard and sleep hard.
• Ideal body weight and muscle mass. Avoid lots of the diseases and disease processes that obesity predisposes your pet to. 
• Indoor cats need exercise and I warn about poor quality free feeding dry kibble. 
• Basic parasite prevention. For my part of the world this includes fleas, ticks, heartworm, and intestinal parasite preventatives.
• Spay and neuter by 1 year old.
• Obedience and socialization. What would happen to you if you were not able to care for your pet AND your pet refuses to allow anyone else near it?
• Microchips save lives every single day. Make a small investment for the best chance of a happily ever after that you hope you never need to rely on.
• Start a savings plan for the unforeseeable accidents ahead.
• Have a great vet who knows how much you love your pet and be there for each other. Here are my tips on how to get something for nothing from your vet.

Here is what Chloe needed;

• Dental cleaning with numerous extractions. Her mouth was so rotten that almost every tooth was mobile. Every client I show teeth like this to is always shocked that their pet gave them no clues there was such a significant problem. If you didn't brush your teeth daily yours would fall out too. Dogs get used to bad teeth and eat around them. Removing them resolves persistent oral infection and they will eat better afterward. The number of teeth to be removed is often also shocking to clients. In many cases dogs, like Chloe, will have a dozen, or more teeth extracted. If they are bad they are removed. No discussion here. Don't wake a dog up with bad teeth still on board UNLESS you have a dental professional who wants to stage the procedure. Ideal for the patient, more expensive for the client.
• Spay. Her uterine infection will return. Spay her as soon  as possible.
• Get an idea of her overall health before jumping into surgery.
• Caught up on vaccines and preventatives.
• Lay out a plan her mom understands and can afford so that she remains on healthy in the days, weeks, and months ahead.

The original source of Chloe's illness, her pyometra. 
Treatment; simple; uterus and ovaries are removed.

My clinic, my perception, and my obligation to my clients is deeply seeded in my ability to get them what their pet needs in an efficient and affordable fashion. 

Chloe's mom was deeply upset that her dog was in need of so much medical attention. She felt very guilty for both not knowing that her mouth was so diseased, but also that she had waited so long to provide the basic spay, vaccines and annual care she knew she needed. The luxury of going back in time when hindsight is present tense and everything is 20:20 is not something I waste much time on. We are here now, we cannot go back and undo, we can only learn, move forward and do the best we can in the present. 

Chloe's mom wanted to use her tax return to get her well. We had a budget. Budgets are a reality few vet businesses want to hear about. The reality is that most all of us live in the real world of budgets.

The conversation between Chloe's mom and I went something like this;

"Ideally we should put Chloe on antibiotics for two weeks and then give her a dental cleaning and remove all of her diseased teeth. The cost of this is about $800. She probably needs her spay soon too. The longer we wait the more likely it is that the uterine infection can resurface. This surgery is also about $800." Chloe's mom could barely scrape together the $800 for one, she couldn't do it twice. And, as every good family vet will point out, we still needed to get Chloe back on track AFTER the emergent disasters were addressed. Chloe needed about $200 of flea &  tick and heartworm preventatives. I feel very strongly that our mission is to help through the bumps and provide a path forward to help avoid bumps in the future. Every pet leaves Jarrettsville Vet with a short AND long term plan along with associated costs. 

"But how can I do both surgeries? I am so worried that she won't live through all of this if I don't do them? How do I choose between what is safe for her and what is possible for me to be able to afford?"

"We have to make a choice. We have to do what we can, accept what we cannot and tell ourselves that we did the best we could with the resources at hand." This is a concept that I think the veterinary profession is losing sight of. In some effort to promote our bottom lines, save our skin from the chance of liability we don't help people on the level they need us to. 

Chloe had her spay and dental surgeries a few days later. I asked our dental expert veterinarian to help. I wanted Chloe to get all that she needed and I wanted her little 8 pound body to be under general anesthesia for the shortest time possible. I was most worried about her getting too cold being under for the two hours it would take to do all she needed.

Chloe's bill...

Chloe's final bill for her spay and dental (which included almost a dozen teeth be removed) was about $760. It was by no means ideal. She had minimal additional blood work done. She had everything done at the emergency clinic the week before. It was all normal. We did not repeat it. We took a leap of faith, and a calculated risk. We also had the benefit of her being on antibiotics from the emergency visit. We scheduled her surgery on the last day of her emergency antibiotics and then resumed them the day after surgery. She was closely monitored and treated by experienced vets who wanted more than anything to get her back home with all of the needed care she came to us for. That's what your home town vet does.

Two weeks post-op and Chloe is doing great! She has a daily plan her mom understands. She is also on her needed monthly preventatives and will return every 6 months for examinations to make sure nothing else comes up to derail her health.

Chloe is an excellent lesson on finding a way to make a difference in a pets life while working within the real-life constraints of a family on a tight budget.

Update;
This is Chloe at her 2 week post-op visit. Her mouth and abdominal incision are all healing excellently! She received the last of her booster vaccines getting her all up to date on her medical needs. She is happy, active and on a path to maintain these. We are elated to see her back. Her mom knows we are here to help, and with a team in place to care for her, provide guidance, and be willing to face any bumps in the road together her chances of  trouble free future are the best they could possibly be.
Lots of love to Chloe and her family!

Life can be full of happy endings if you can bend, compromise and find help when it is needed. Keep looking if you can't it is out there, we promise!

If you would like to ask me a pet related question you can find me on Pawbly.com. Pawbly is free to use and open to anyone who needs a little  help in finding information or direction with their pets care. We also invite all of the pet lovers out there to join us and share your pet knowledge. 

Me and  the resident clinic governess, Loon.

If you would like me to meet your pet and assist in their care I am happy to try to help. Call me at the clinic, Jarrettsville Veterinary Center in Jarrettsville Maryland. We publish our Price List every year. You can find it here.

I am also occasionally visiting on Twitter @FreePetAdvice,

Wellness Plans, Savings Plans and Surprises. Why your vet NEEDS to be your best friend.

Me and  Loon,,
a cat brought in to be euthanized because she wasn't using the litter box.
Our resident cat for 7 pus years now, she reminds me everyday why I am here.
...and PS she has never missed the box since arriving,,
Yes, of course, love can cure everything!

Surprises are not welcomed in veterinary medicine. Surprises in veterinary medicine end up with big decisions, somewhat tenuous consequences and all too often unplanned big price tags. As a veterinarian I know the realities of these surprises all too well. I also know that many clients are not prepared for them. If your pet lives long enough it is almost inevitable that a surprise will find you because somewhere down the twists and turns of life you will be thrown a curve ball.

In the last month at Jarrettsville Vet we have seen our clients scrambling to find funds to manage the following surprises;

1. Abdominal mass from a splenic tumor that needed emergency surgery ($1200).  

   

   This is Buddy. His whole belly is almost one splenic tumor.

2. Jumping out of truck bed and breaking femur ($3000).
   

   

   Read Henry's story here.

3.      Aute pancreatitis causing vomiting, anorexia, lethargy and painful abdomen ($1000). Required 6 days of iv fluids and hospitalization.

   

   Lilly gets her catheter to start her week of iv fluids

4. Newly adopted shelter cat falls apart within one week of being at new home. Diarrhea, anorexia, respiratory infection, corresponding diagnostics and hospitalization for one week, including placing a feeding tube ($1500).

Cuddling with Minnie after placing her feeding tube.

One of the most important parts of being a veterinarian is to educate my clients. A world class veterinarian will provide their client with helpful advice so that most of the time they don’t need us. We will provide a well laid out plan for optimal health and longevity. In essence great vets are both excellent communicators, educators, and personally invested in your pets healthcare now and also a decade from now.

A worried patient awaits her knee surgery, $1500 at JVC.

Successful pet parenting is no small task. The planning for today's activities; the walking, feeding, providing exercise and mental health balance and trying to plan for the unknowns lurking somewhere down the road. Pets share almost every medical and emotional need that we pet parents do. Every possible ailment, disease, accident, injury and treatment option that the human medical options offer. It is not inconceivable for an average pet to cost over $10,000 in their lifetime. If there is cancer, organ failure, or complicated disease you can burn through that price tag in a few weeks.

The best advice that I can give you is to be prepared;

• Get pet insurance. Hope you never need it, but being able to care for your pet when they need you most is worth the monthly payments. Know what the plans limits are, but, be prepared for those too.
• Plan ahead. The advent of assigning typical pet visits into a yearly cost divided up into small payments was the ingenuously profitable brain child of corporate veterinary America meets budget conscious Americans who have difficulty saving for that someday rainy day. The success of these Wellness Plans has brought many private practice veterinarians into also trying to provide clients some basic wellness options broken into monthly fees and a contract.

I am a skeptic of Wellness Plans for a few reasons;

1. Your pet is not a numbered entity cast by a cookie cutter. Every pet has individual needs. The way a typical wellness plan addresses a participant is as a “typical” case. For example, if you have a dog like my pit bull you will never need ear cytology. Never mind need it twice a year  which many plans provide. If you are however my beagle, you will need it four times a year and both knees fixed within 3 months of each other. My pit bull has cost me nothing more than food, vaccines, and preventatives. My adorable beagle, the farm.
2. Contracts equate to consequences. You cannot get out of them easily. 
3. Life has too many twists and turns. Sure every vet will advocate the importance of an ounce of prevention, and the incredible importance of examinations, diagnostics, preventive care, a good solid relationship built around the vet, the pet and you, BUT, disaster will not be covered by your wellness plan. Many of the heart wrenching cases revolve around a surprise disaster and most pet parents are simply not prepared financially for these. 
4. Gimmicks. Wellness plans have gimmicks to influence and entice. What a pet parent wants is assurance that they will have options at affordable costs they can manage not a gimmick to influence a pet care decision.

Peanutty, Bella, and Pepper
all rescues and all a part of the JVC family.

If you are considering a wellness plan think about the following; 

1. How invested is your vet in your pets care? A great vet will go to bat for your pet at every instance. You are not a cookie. Every step in your pets care has options. The best vets have you prepared for both the foreseeable and unplanned events. Sit down with your vet and draw up a plan for the year. List all foreseeable needs, goods, and services. Make a yearly budget based on these.
2. What does the Wellness Plan entail? Break down the cost for each line item covered. For example; most plans provide preventatives (heartworm and flea & tick). But, they are calculated for the biggest size and most expensive preventative. Your chihuahuas year supply of heartworm prevention is about one quarter the cost of a St Bernard. Don’t pay for a giant when you have a portable peanut pup. Further, your peanut pup might not need both? 
3. I know of clinics who “use up” your plans services, (for instance the two free ear cytologies), on your first two visits in the hopes you will need more down the road. The plan can set people up for being taken advantage of and you will never know it. 
4. It is widely discussed in vet circles but not published that about 60%* of people will not take advantage of the wellness plan items they pay for. Whether it is fear of over anesthetizing your pet, inability to meet the calendar of available services, or lack of need? Wellness plans are sold to the client as a “convenience frequent-buyer program with small monthly payments, but they favor the vet practice. The game is always set up to protect the house.

Rye

Some pet insurance companies offer monthly payment plans to help offset routine care. I do not recommend these. Your money in someone else’s pocket leaves your decisions to others scrutiny. Do your best to be prepared for the routine stuff. If you think you want to purchase pet insurance look for those that just cover accidents and illness. These are the ones that will ruin you financially and lead to treatment plans that include “economic euthanasia.”

What’s the reality? Sadly, Americans are very bad at saving, planning, and preparedness for disaster. A monthly plan is a way to help defray some of the big financial hits at the vet, BUT, it will not help when surprises arise or disaster picks your number.

Have your own emergency fund. 

In my neck of the woods I recommend having three things;

1. $2500 in your own pets savings account. I know it sounds like a huge amount. But at least have $1,000. Almost every savable emergency can be started on $1,000. 
2. Have a credit card with room on it. Or, have available credit so you will be approved for CareCredit if needed. 
3. Have a vet and their cell phone number in your back pocket. I cannot over emphasize how much heartbreak, money, and guilt ridden consequences this can cost you.

Me and my shadow, Wren

If you aren’t good at saving and don’t have a vet to go to bat for you, get an insurance plan for surprises and disasters AND start looking for a vet you trust at some point your chips will fall and you need to be prepared for that.

What’s my solution? Jarrettsville Veterinary Center now offers a Pet Savings Plan through Vet Billing Solutions. We will tailor a monthly savings plan for your pet and provide an affordable easy way to do this. What’s the catch? Nothing. Not one single thing! It’s your money to use for your pet whenever and wherever you need it! No catch. No gimmicks. No contracts. Just more happy endings!

Madeline

Call us today and ask about it. Or find me trying to save the pet world anytime at Pawbly.com.

* Data from lectures at Idexx Management 2015 lectures on Wellness Plans.
In the end my veterinary practice is here to serve one purpose,,, help my community take better care of their companions. So, I am all ears. What can we do to help you do this? Please leave me a comment, or suggestion.

Related blogs;

Economic Euthanasia.

Vet Billing Solution; Medical Madness. 

Helpful related articles;
DVM360, 8 Mistakes to Avoid In Your Veterinary Wellness Plans.

Veterinary Practice News. Wellness Plans Allow Clients to Budget for Pets Preventive Veterinary Care

If you have a veterinary, or pet, related question you can find me anytime on Pawbly.com. Pawbly is open to anyone who has a pet in need or experience that they would like to share.

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Canine Vestibular Disease. Veterinarian advice on the diagnosis,treatment, along with associated costs, and advice from mom.

There are clients and patients I hold very close to my heart. They are extensions of my family and their pets hard times are the instances for my purpose. I try to be there for my clients at every step and through every trip up. I will be the first to admit that at times I cannot dissect the line between caring too much and passionately fighting for them when life appears to be dealing yet another unfair hand. There is incredible injustice in the world, and it seems that the small, the meek and the voiceless always seem to pay the heftiest price.

Seems to be getting worse. This sticky situation I find myself in repeatedly. Frustrating and costing lives everyday. What do I think about it? I think it is unconscionable, and I am going to do everything I can to stop it. It is not that there isn't help available it is that this help is either out of financial ability or out of accessibility. Part of Pawbly's mission is to remove both.

Minnie and Murray, Christmas 2009

This is the story of Murray. A 13 year lab and his incurable textbook bought of idiopathic vestibular disease. It is also a tale of who you see and how this can influence how your pet is treated and thus how much it will cost you..

There are a few not uncommon diseases that pop up out of no where that can scare the be-jeezus out of you. One minute your dog seems perfectly normal and the next they are unable to stand, their eyes are going haywire, and you don't know what is going on or what to do about it.

One of the most common and least dangerous of these is idiopathic vestibular disease (IVD). It is also known as geriatric vestibular disease, old dog vestibular disease, or, idiopathic vestibular syndrome.

This disease can affect both dogs and cats. For sake of completeness this blog will only discuss canine idiopathic vestibular disease. Cats are more difficult to categorize and I believe IVD is far less common and often confused with other diseases.

IVD seems to come on like a freight train. You wake up, you walk into the next room and out of no where your dog cannot stand up, walk, hold its head straight, or stop the violent eye movements that look like a demon has taken possession. It is very scary for everyone. Sudden afflictions cause hysteria. My phone rings and my good friend is incoherently yelling/crying in fear. Like every dedicated pet parent my friend ran immediately to the closest emergency clinic.

Murray 24 hours post initial ER visit 

At our clinic I would have recommend that Murray have the following diagnostics done;

1. Physical examination, with special emphasis on the neurological exam and inner ear (otoscopic) exam. 

2. CBC, chemistry, thyroid panel. With this disease all should be normal.

3. Tick panel. I write this, but I am not opposed to skipping this if the history, lifestyle or environment doesn't coincide.

That boy and his smile... it says it all.

At my clinic this is a $230 ($50 exam, $130 blood work, $50 tick panel) work up. For clients with a tight budget I will reduce the clinical work up to an exam. Veterinary medicine is about using our skills, experience and working with your client to care for their pet. An exhaustive work up is great, if it is possible. BUT this is not a treatable disease. An owner needs to be to given all of the information, all of the options, associated costs, and prognosis for every possible diagnosis. In some cases we save our patients lives by being honest and not running any diagnostics. 

Murray has been a patient of mine for almost a decade. He had his annual exam, geriatric blood work, tick exposure panel and is current on all vaccines and preventatives. He is the model patient with the model parents.  He is a lucky happy boy, but this early morning Murray's eyes were going from side to side in a rapid motion (nystagmus), he couldn't stand, his head was twisted to the side, and he was obviously afraid. His mom reacted to his acute condition the way many of us would. She feared the worst and ran for help. Which is exactly how every parent should react. Unfortunately at the emergency clinic gave an estimate that included all of this;

Not knowing what to do my friend handed over a credit card and walked out the door. When she got to the parking lot she called me. I was concerned to hear that all of the diagnostics we had just run were repeated. I was also perplexed to hear that a 2 day stay was recommended. "This is not a 2 day fix, and at a few hundred dollars a day you are paying someone else to not be able to treat your pet. save yourself the money you don't need to spend."

The first 24-72 hours of this disease can be harrowing and discouraging. 

Most pets cannot stand, do not ambulate, have difficulty eating, or nausea associated with eating and for most clients the idea of this as status quo for days, months or years seem insurmountable and unacceptable. I spend a lot of time talking and reassuring that this state of dysfunction is normal and will pass.

My favorite harness for big dogs who need assistance.
I call it the 'suitcase harness'.

I asked Murray's mom to provide her side of his story.. I think it is incredibly helpful to provide a parents perspective..

Murray and mom.. head tilt (to the left) is obvious.

"So the story starts with ......... Early on a Friday morning Murray got up to go outside and stumbled a bit. He walked really fast out the door to the grass peed and quickly laid down.  I thought he was having a bad arthritis day.....struggling with his hips..... My assumption.  He came back into the house and went right back to bed.  

When fed breakfast he would not get up and kept looking at me with a tilted neck and would not eat and kept staring at the ground.  At about 7:15 he wanted to get up to go out and fell very hard into the wall and door frame.  It scared him and me so much he peed himself.  Then he was so upset he kept trying to get up and was frantic now and was foaming at the mouth.  I got to him as fast as a could and his eye brows and eyeballs were shaking very fast back and forth.  He could not focus or hold his head straight or walk.  I thought he was having a stroke or seizures since his legs were very flailing.  My regular vet clinic did not have a doctor in yet it was only 7:30 am so I rushed him to the emergency vet.  They quickly assessed him and gave him something to calm him down.  (Valium I assume).  They came in about 10 minutes later and gave us the rundown of $ deposit and time to watch over him.  They would draw blood and keep him comfortable.  We should go home and call back at noon to see how he is doing.  They had us sign a release form and they explained that it would cost between $781 and $1515.09 and that we would need to leave a $625 deposit to get started.  Of course we did it because we were so scared and worried for him.  

Upon leaving I consulted my dear veterinary friend she advised me that I could take care of Murray at home with her as support.  We brought him home that evening incurring a $551.80 bill.  We used a t-shirt on him so we could help him walk and hold him up straight.  

Day 2 severe head tilt and labored walking and acute eye shaking.  

Day 3 we got a suitcase harness with a handle on the back to help him walk.  

Day 4 still with a head tilt no eye shaking andwalking a tad better. 

Day 7 noticeably better gait.  

Day 12 less severe head tilt and almost normal walking.  

Day 20 only a barely noticeable head tilt.....he pulls away from us and does not want help walking.  From the start we had to acclimate to his changing needs.  We kept his bed in the center of the house and moved all the furniture to around the walls so he would have clear walking paths.  We had to barricade the stairs so we had the peace of mind that he could not fall down the stairs.  We put runner rugs from the door to his bed and to the food dish and water bowl so he would not have slipping issues.  We installed a carpeted ramp outside our house to get off the deck.  He struggles sometimes but he tries hard every day to keep his schedule and his normal routine."

Murray about 3 weeks post ER visit.
His head tilt is almost completely resolved.

Here is why Murray's diagnosis of IVD makes sense;

1. Murray is an older dog. This is a disease of predominantly older dogs.

2. Murray's signs evolved very quickly.

3. Murray fit the billet of IVD. He recently had a full senior blood work done, is current on preventatives, and up to date on all recommended vaccines. He was fit as a fiddle a month ago.

Here is my advice should you suddenly find your dog with a head tilt, nystagmus, unable to stand and ataxic (wobbly walk or stand). Head to the vet. After an examination ask the vet what their first rule out diagnosis is. If they say IVD discuss which diagnostics are needed and which you can afford. Go from there. I  have some difficulty justifying spending money on diagnostics for diseases that are both unlikely and not treatable. Talk about your pets work up and treatment plan. If possible ask your primary care veterinarian for their help before handing over the credit card.
And, of course,Stay calm, always stay calm.

After Murray went home he needed the following;
1. A safety harness to help ambulate. Murray is a big dog. A sturdy harness to help keep him from falling over. He also needed help to stand and go to the bathroom. 

2. He was prescribed an anti-nausea medication (available over the counter) and sent home to rest. If your dog is nauseous and vomiting talk to your vet about an injectable 24 hour anti-nausea medication. In severe cases fluid therapy can help.

3. Assist your pet at all times needed.

4. Block off stairs and keep doors to adjacent rooms closed.

5. Baby proof your house for a little while.

6. Frequent trips outside to urinate and defecate. Often IVD patients do not defecate for the first 24-48 hours.

7. Hand feed four times a day. Smaller more frequent meals with help maintain adequate caloric intake and decrease the nausea.

Most dogs take days to weeks to recover. Some always have a head tilt, but ambulation should steadily improve and resolve over days.

Minnie, Gannon, and Murray at their annual exam three years ago

If your pet needs immediate help please ask your vet first. They are your pets best source for the most accurate answers and help your pet needs. If you would like to learn more about this disease, how to care for your dog with this disease, or have a pet related question please join us at Pawbly.com. Pawbly is a free open platform to help educate, empower and inspire pet parents around the world.

If you would like to meet me or become a patient of ours please come visit me at Jarrettsville Veterinary Center in Jarrettsville Maryland. I will do my best to help... but be warned I get emotionally attached. I cannot help myself.

If you end up at the vets office and feel that you cannot afford the care your vet recommends please speak up. Ask for help. Stay calm, and get your pet out alive with you.

I am also on Twitter, yelling into the void.. @FreePetAdvice.

Be well everyone!