Breaking Through. The Good Days That Chemotherapy Delivers and the Life We Enjoy Around Them

For 48 hours every week I have him back.

The youth, the joyful expression and the wanderlust spirit of the boy I yearn to preserve.

For those few blissful days everything is as it should be once again.

We are free, we are happy and we are explorers in a world with adventures yet to be discovered.

He is back with me again and I live in the moment alone - abandoning the painful yesterday of excruciating moments of death hovering around us.

For these few days there are walks, and wags and jubilant reunions.

We are as we were. Time has lost its grip on us and fate looms for another.

There are mornings of wiggle dancing on the bed.

Kingdoms to perch over and protect and beasts yet to face and foil.

There are barking bellows to beg a meal. couches to claim and companionship to solidify and cement. We are each others best friend and no fate awaits us.

Footnote;

Jekyll has prostate canner and urethral transitional carcinoma. This is a show stopper. A final act. You aren't cured of this. You, me, I am buying him as many "good days" as I can.

For everyone who thinks that chemotherapy is beyond what dogs deserve, you won't understand my grief. For those of you who think that dogs lose their hair, will to live, or are "miserable" while undergoing chemo I will testify that after 9 rounds (weekly) he is alive and functional, because of the chemotherapy. He has good and bad days. We have great days, and days where pain meds are his elixir of bearability. The idea that we give up when "terminal" is assigned is like trying to get through life with just the good days being acceptable. You don't/shouldn't get to chose one without expecting (and maybe even trying to embrace) the flip side. Life isn't a lesson on navigating the shore. It is about the greatness that lies in the depths of magic of beauty. There isn't more in the sunshine, there is equal luminescence in the darkness.

I am here to stand beside him through the joy of his sweet puppyhood as much as his dying oldness. It is a path together. For as long as we have. I will always let him decide, as I try to see the grace in every shade of the spectrum and make his journey full of love and life for as long as we have left.

If you have a pet story that you would like to share, or an experience with this condition please add it to our Storyline page at  Pawbly.com.

Please also follow me on Pawbly.com, our my vet clinic website Jarrettsville Vet, or our Jarrettsville Vet Facebook page. 

I am also on Twitter @FreePetAdvice, and YouTube. 

The Threats To Impending Death and A Vet Moms Promise

For the first time in my long pet mom life I am consciously taking a radical new approach to the impending death of my beloved pet.

Jekyll is dying. In little excruciating tiny steps and failing pieces. He is doing it with his beautiful velvety ears, bright shiny coat, and soft youthful muzzle all suspended and preserved with his outward beauty and youth still intact. His dying is so subtle that no passerbyer would recognize it. But he is slipping and being ratcheted into deaths grip with his soulful yearning eyes eclipsing into subtle tiredness. It is killing me. I cannot lie, nor belittle its impact upon me.

It is the hard jagged robbery of a life lived with effervescent jubilant joy meeting its final curtain call.

I feel cheated. He is being robbed.

AND, I won't stand still, nor quiet, for it! So, I do what I am trained to do. The whole reason I stepped into vet school. I fight with targeted tools and obvious intentions. The passionate, determined, unyielding sleuth who is ready to fight longer, harder, and dirtier than the microscopic thief holed up and harbored inside my pup. It is the lifeblood of being a fierce hot headed Italian determined to shape the world until it conforms to your pleading tantrums. The truth of diseases elusive lure belongs to everyone else. I, I spent decades learning in tutelage so that my pups fate could be altered, detoured, and selected. Or, so I convinced myself to believe. Surrender is for the other side to chose.

When medicine fails, faith is offered refuse.

Jekyll was always the affable, charming spirit who loves everyone he meets. Always the warm glowing light of the gathering. The star of the party, the beagle with a celebrity charisma to draw the entire crowd to him. He is a people pleaser. Everyone who meets him loves him. He has always been this way from the first moment he came to me those many years ago broken and unwanted.

Jekyll's life has been a long list of challenges. As I reviewed his medical record for his last specialist appointment I was reminded how bumpy our road together has been.

Brought to me to be euthanized at 8 weeks old as it was the cheapest option available, I refused. At the time I was a new practice owner in a rural farming community and I said "no" to a client request. It was a taboo, defiant gesture for the new girl to even consider uttering. Had I been working for someone I would have been reprimanded harshly. Clients decide, because clients are our paycheck. He was one of my first defining vet moments. The real life scenario to decide who I would become. I lost a client that day and gained my dearest friend. He was irresistable from the beginning. He was also in very dire need of multiple surgeries; a prolapsed rectum from too much cow dewormer left him straining to poo so hard he pushed his colon out of his body. He was adorable from the front and heartbreaking to look at from the back. Three surgeries over two weeks and a he graduated from pediatric patient to permanent resident at both the clinic and my side of the bed.

The next few years yielded even more bumps in our road. Bilateral cruciates left him hobbling and crippled after a long rabbit foray to the edges of his farmland horizon. He would obsessively drive his body into the grave to let a rabbit know his masterative prowess. At five he had a mast cell scare. This took one hellaciously aggressive surgery to remove them. The last surgery was a year ago to eradicate some funky foot tumor that was a total pain to both manage and remove. This adorable boy of mine has been a short medical text book of his own making. Thank goodness he landed in a vets hands if he couldn't find Daddy Warbucks front door.

This one, this last diagnosis to his current dilemma is to a disease we hardly see. This one might be the undoing of me.

When I said goodbye to Savannah it was after a long many year long decline due to old age and dementia. She was ready to go. Her body was spent. She had cashed in every last chance, and I was able to accept her passing as a life well-lived and a journey at its end. Saying goodbye is never easy, but acceptance is a gift. I could grieve and forgive and move on in time. Savannah had made it to 17. There is an easier gracious acceptance when the expected lifespan has been exceeded by many months. I could grieve her loss and be grateful for our time together. Jek's saga just has me angry and determined to cheat death's unrelenting shadowed hands. He is only 8! He is at his half way point. Who said its ok to steal half his life? I have, (are you listening?), beaten you at this game before.

We are going to exhaust each option to keep him happy and functional. After all, this disease of his, a tumor on his urethra and an overzealous prostate, makes it difficult for him to urinate and defecate. Life, for pets at least, is four basic functions; eat, drink, pee and poo. Ambulating and being happy are second tier preferences. Jek has half of his most basic functions up for grabs.

We are also keeping an internal daily bucket list. It is his list. Not some ridiculous crusade to make expensive trips to the ocean or 4 star hotels. He is all beagle. He seeks acrid excrement, purview over his kingdom, and trips in the gator and truck to fuel his King of the Jungle self designation. We are giving him his favorite things everyday; runs in the parks, chicken and delifresh dinners, belly rubs, long walks to see the wildlife, and lots of re-affirming accolades. He loves a few things and he will get them every single day.

Jekyll is an adventuring spirit. He loves to survey his domain from his front porch. We designed it, the whole front of our home, for him to have this vantage point. Dog bed, custom cushion and best view around. His preference is to stand guard on his front porch, post in command and barking should any critter muster his purview. He could spend the whole day there. He wouldn't let a soul pass without warning. It is his calling. His purpose. The genetic code of a long legacy of invaluable guardians he serves. He is unsurpassed in this single skill. He has earned his keep ten-thousand times over. His contribution to a deep commitment we both have for each other.

He is the pup who digs succulent gummy grubs in late Spring. The mole hunter gatherer meets praying mantis appetite. He was also the only dog I ever knew who would seek his own snacks from the labors of others work. He can be seen propelling himself off of his perch to march directly to the corn field across the drive, sniff the largest juiciest kernels where he sniffs, selects, and snaps! The corn ear is twisted twice and ripped from its stalk. The confident thief then saunters back to his perch to enjoy the spoils of his plantation. When the first ear filled him he would select a few to bury in the yard for a darker day with leaner choices. He is the self-reliant MVP should the zombie apocalypse hit. Grab him and run, he will keep you fed amongst any seemingly barren wasteland.

Each Summer a few randomly placed stalks erupt in various places of the yard. An ear here and there he forgot about, or never got around to needing. I know those volunteer kernels will live on for many years to come after he has gone from me. The remnants of the time capsule to remind me he is always here with me.

This time he is dying in front of me, mind still sharp, will still focused on adventures in the woods, and failing to respond to anything I try to cease the aberrant alien cells within him.

I won't get a neat package of decay this time. I will get failure of viable options, inability to provide human standards of intervention and fury to become, and will myself into providing mercy. I am not sure I can do this for him this time. I am not sure I can push him into another place without me.

Veterinarians are trained to say goodbye. To accept that life will not play by a fair hand. That you cannot pick the fate it delivers on your terms. That acceptance is how you define it and how you resolve the unimaginable.

This time I am going to try to get through this without the anger of disappointment and the heartbreak of feeling cheated. This time I am going to just see the good, dismiss the unchangeable the battle already won on a scale only he can feel and I can see. We will live each day on our own terms, without judgement, without guilt and without fear.

Beagles are built this way. To only see the good, to only look back if it helps get through today. Beagles are not built to be brave, just beautiful.

More  on Jekyll here;

Jekyll Arrives

Jekyll Loses His Tail Mo-Jo. Tail Droop.

The Things Only A Mom Knows. Planning for our pets lives beyond our own.

A Tribute To A Beagle, Jekyll.

Slowing Down Without Giving Up.

There are pieces that I write that serve a singular selfish purpose. A cathartic way of putting the shit out to dry and letting the world take care of it in for some hopeful wish I can get a bit of an emotional respite. I also feel that my adoration for my pets is felt similarly by so many others. Others who sit quietly at home struggling with how to say goodbye, and how to process a grief they fear others might mock at. To all of you who feel that the loss of your companion is one of the most painful things in life I understand. I also empathize. It is impossible. I know it. I feel it too.

Be who you are. The most precious and beautiful parts of everything are fleeting. Savor and celebrate them even if they hurt later. The hurt will fade and the joyful memories live forever. Protect your compassion with everything that you are for it is your most valuable asset.

If you have a pet story that you would like to share, or an experience with this condition please add it to our Storyline page at  Pawbly.com.

Please also follow me on Pawbly.com, our my vet clinic website Jarrettsville Vet, or our Jarrettsville Vet Facebook page. 

I am also on Twitter @FreePetAdvice, and YouTube. 

The Problem In Veterinary Medicine Exists In ONE Place, While The Answer Resides Everywhere.

The problem is the divide.

The divide can exist in education and intellect, a matter of resources, privileges and perspective. Or, it can exist in accessibility and willingness to assist.

Vet medicine is drifting to many of these divisions as the infrastructure for our services becomes more coldly organized, corporatized, and managed. Somewhere not too long ago we veterinarians needed help to become increasingly solvent in our business, (or lack there of), decisions. We were a profession of talented 'make-do' surgeons and 'Jack-of-all trades' practitioners and never the pencil pusher accountants everyone told us we should/needed to be. We lacked the business-infused intellect to help us grow out of our fledgling single owner practices into the shiny-gleaming white marbled fish tanked towers of our vision of what "successful" looked like. We were valuable, but, we just weren't bragging rights "profitable." Things changed. We surrendered the management of our practices to the suits to make easier money with less hard feelings and started to sacrifice those who we knew couldn't afford us to pay off our loans and increase our standards of care. The divide began.

Veterinary medicine is a profession built on trust. We are too poorly regulated and overseen to be anything else. The trust is never going to be present in any sort of guiding magnitude if it is built consistently and singularly on financial gain. They are inherently polar opposites. As the desire/need/cost increases and the inability to meet them rises, the trust decreases. It is the nature of humanities basis being neglected intentionally for profit.

There are endless days I spend stuck in the dilemma of "unmet need" meets "unwilling ability." It is what the experts would call 'ethical dilemmas' and trying to carry the weight of the increasingly indifferent world on your shoulders. I get asked, advised, and notified on a daily basis about the dangers of this predicament and my unwillingness to not walk away from them. Desperation breeds innovation and/or despair. I am stuck here trying to solve this great divide and looking into the desperate AND treatable eyes of the forgotten/unprofitable as I do so.

Me and Dimples.
Rescued by me from the local shelter, heartworm positive and a pit bull.
Needs love, care, and someone to vouch for her deserving a second chance.
She is one of the many faces we dispose of too easily.
She is one of the many reasons we lose our souls when we make excuses to forget these lives matter.

Every single day I am asked to provide some veterinary need or service to a client who has been turned away elsewhere. It is the second opinion for affordable options that someone else can provide but won't, usually because of inability to meet a standard of care that makes the cost inaccessible (or so they say?). Every day I am asked to help. Everyday I am faced with unwillingness and unmet need. Too often at life threatening crisis status state. The degree of unmet need is overwhelming. The depth of emotional ties that people have to their pets is also undeniable.

People LOVE their pets. Why are we ALL not starting here? Why are we starting at "ability to pay" as the measure of acceptable pet parent worth?

Henry. The face of cerebellar hypoplasia.
His devoted mom is fighting to bring awareness and compassion to these kittens.

When did the veterinary medicine goal become anything else other than providing assistance to save lives? Can't we all agree on this being the seat of the veterinarians soul?

I often feel stuck, tortured, and tormented by need versus ability and this great divide. I know I am not alone. There are others out there who love and care for pets, animals, and feel burdened and compelled to help them. We are being pulled emotionally, physically and ethically as the rest push them away.

Jasmine, our second PB heartworm positive rescue.
Both looking for a home and a sponsor.

The divide is also polarizing the ends of the spectrum. Caught in the middle are those of us, (overwhelmingly women, does anyone ask why this is?), who feel alone, abandoned and asking themselves where to go? We have to chose a side. Too often this act of inner reflection feels as if it will cost us our livelihood, or, our community. Too often we instead chose to give up on ourselves as we cannot chose.

Innovation is the child of conflict and this divide is ripe, ready, and in desperate need for disruption.

What if we fractured the system so significantly it forced the current managed systems to meet the pleas of the divide instead of growing it? What if the part of the equation that limits public social assistance is the key to the answer of the problem? What if we leveraged the worst part of the animal care equation to be the tipping point for revolutionary change?

Luna

What if obsession to solve a problem allows innovation that pushes boundaries, redefines public access, and empowers the person as a being and not a "thing"? They are all related. They are all the keys to the problem and the keys to the solution.

Luna, shelter rescue, learning to trust again even after humans have failed her.

Radical change is coming. The forces, the polarity, and the divide will collide and the demand, the integrity and the ultimate survival will become mandatory as it becomes transparent. The meek will inherit the destiny that compassion and trust inhabit. It is where this profession came from, and it is the place we will go back to. Less death lives there.

Related blogs;

Find What Breaks Your Heart and Change It.

Gratitude; The Grace That Hardship Brings. 

Mobbing and Lobbying, The Backlash to the Video Rant.

Ethical Fatigue and the Crossroad of Vet Med and the Public Conscious Awakening

Affordable Options Are Everyone's Right.

More information on me, my YouTube channel, my company Pawbly.com, and my vet clinic Jarrettsville Veterinary Center, and my clinics Facebook page, are all available to you and your pets needs anytime. Almost all of this is FREE! We are an Army of activists set on saving lives, our own included. Join us. You are all welcome and all pets are loved here.

Get Out Alive Blocked Cat Episode.

The cases that move me are not the easy quick ones.

Life works that way. Your greatest rewards often lie in the trenches during the greatest conflicts. It is our version of the battlefield stories that bond us in our darkest hours.

Yesterday was one of those days. (I seem to live in these days these days).

We get a call that goes something like this; (I only heard one side of the conversation. My receptionists side).

"I'm sorry to hear about your cat. You say that you found a clinic that would give your cat a free examination, (clearly a corporate marketing tool to drum up new clients I thought?), and, they say your cat is blocked? (A blocked cat is a cat who cannot pee and this is ALWAYS an emergency!)." long pause.. "I'm sorry did you say that you have seven (7????) dollars?" Her voice took a tragic upturn on the dollar sign part.

...short pause.....

"Ok, well,,, umm,,   (pause)      ummm,,, (deep swallow),,, let me get your information and I will call you right back." My receptionists are seasoned pros. They hardly get flustered. But, then again, who calls with $7?

At this point everyone within ear shot was huddling around her desk with muffled giggling. This is the giggle of the great battles. The first shot has been fired, the troops are gathering and a plan is about to be hatched. These are the stories of the place Jarrettsville Vet has become. These are the stories other vets get, most sarcastically laugh at and dismiss, disregard, or decide to just be bitter about. I was/am/try very hard NOT to be this person. I pay for electricity, wages (waaay above minimum btw) and blah, blah, blah, (excuses to not care), but it doesn't change the fact that there is still this guy, AND, there is still this cat.... so we listen to the stories. We gather the troops, and we devise a plan. The plan is always a conversation, a compromise and a quest. The goal however is always mutually consistent in the most critical component: We have to act fast AND we feel compelled to get help. We place phone calls. We are a place that listens and lives by our motto 24/7/365.

After a round table discussion we formulated a preliminary plan. The first phone call was back to the cats dad. We have a team dedicated to returning these phone calls. We have a shield for them in our first line of defense, our receptionists, then the team takes over. No one should be the single troop in a militia. The first test is in assessing the pet parents intention and integrity. He has to be able to compromise. Turns out he also has to be one other thing.. completely dedicated to his pet and follow through with our advice so we don't perpetuate another terrible predicament. Vitally important to the success of these cases is that he has to participate in this cats treatment, recovery and long term care. Thankfully we discover that he loves his cat and he is willing to do whatever he needs to keep him healthy. I can do just about anything as long as we start here. Everyone has to invest in CARING. Nothing of merit lives outside of caring.

Next step in the plan of attack;

We called our friends at the rescue. Circle the wagons, build momentum by uniting the troops. They have the ability to manage this cats care after we get him unblocked. They can manage the nursing care for the next few days while he gets his bladder and kidneys diuresed. It is nothing more than a medically induced flushing of his urinary system. "The solution to pollution is dilution."

They offered to pay for his after care. We would get him unblocked. Two phone calls and we are on our way to saving this cats life. Go Team GO!

An hour later we met Socks.. As always (ok,, truly always), the ones who need you the most are the ones who are the sweetest souls. This cat was pure love. Young, adorable, and desperate to pee. He purred the entire time we squeezed his rock hard massively overfilled bladder.

Here is his story in synoptic detail, video style.

There are articles and discussions of this condition listed below. While I am not here to argue that there are absolute benefits to maintaining ideal standards of care I firmly beleive that the biggest failure we provide is not offering assistance regardless of clients financial abilities. When we as a profession decide collectively to support our patients first I will with hold posting prices and offering cost saving options. Get Out Alive series is coming. Blocked Cats is first on my list. Next, pyometras.

The typical cost of a blocked cat at my clinic is;
Exam; $50 to $75
Radiograph $100 *
Intravenous catheter $40
Intravenous fluids $40
Intravenous fluid pump $40
Anesthesia $100
Urinary catheter placement $75
Hospitalization care about $100 per day. Usually stays for 3-5 days.
Bloodwork $150 *
Urinalysis $50 *

* optional if client cannot afford it.

For more information please see these articles;

Urinary Obstruction in Male Cats, ACVS article. One of the best on this condition. Please read this one!

Feline Urethral Obstruction: Diagnosis and Management. By Today's Veterinary Practice. A very thorough description of how, why and what happens to these cats along with detailed description of treatment options. I recommend taking this article and discussing each step with your veterinarian as they provide an estimate for the cost of care. Know how much each step costs, know where your cat falls within the spectrum of the disease process and know that one size does not fit all! You may be able to cut some costs with the use of this step by step guide. Get everything in writing and GET OUT ALIVE!

A protocol for managing urethral obstruction in male cats without urethral catheterization. Cats were treated in a hospital but not catheterized (which I feel is the most important part of the treatment plan). Read carefully and understand this protocol cannot, and should not, be  accomplished at home.

Controversies in the management of feline urethral obstruction. Journal of veterinary emergency medicine. 2015, PubMed. Please read the prognosis section; "Feline urethral obstruction is associated with 90-95% survival, with reported recurrence rates of 15-40%." How many people cannot afford to treat their cat when the survival rate is this high? I would guess that there is not a single other emergency condition that pets get that has this high of a survival rate when compared to the number of economic euthanasia's due to cost. What is the rate of economic euthanasia for this condition? At my clinic it is zero. What is it elsewhere? (Good question? Anyone want to share their numbers? Speculative numbers?)?

Can these cases be managed at home? Without a veterinarians intervention or assistance? I would strongly discourage this. I feel the prognosis is far better with a urinary catheter placed and intravenous fluid therapy to flush the bladder, kidneys and remove the toxins and systemic imbalances, but here is a widely cited article on managing these cases at home. Which is better than nothing (although I would still argue it isn't enough!).

If you have questions about your cats care, the cost associated with this diagnosis and most importantly ever feel pressured to euthanize based on economics please ask/beg/insist on options and please seek a second, third, or even fourth opinion so that your treatable cat can GET OUT ALIVE!.

I am here for you. Find me on Pawbly.com and remember "never go quietly into the night."

Free pet advice is available on Pawbly.com.

Parting thoughts;
1. Get Out Alive. Ask about options. Insist on care. Document everything. There is help available even if you have to be insistent on it. This is an emergency condition and your cats life depends on your actions. Be kind. Always be kind. You can't ask someone to be someone you are not.
2. If you do not have any  financial constraints almost every vet and emergency facility can care for your cat with this condition.
3. If you do have financial constraints ask for a written estimate. Go over each line item. Ask which is most imperative at the immediate time. Ask the vet to rank these. Start at number one. Stay at the clinic as each line item is addressed. Once your cat can be transferred to your vet it might be more affordable to get their care with them.
4. Ask about the incidence of recurrence for this condition? Ask how you might be able to avoid this? My advice is a diet and lifestyle change. Less dry food, less poor quality dry food, more exercise, less stress. (Ask about cat stressors? Often clients cannot, and do not see the world the way their cats do).
5. Ask about a PU surgery. Start planning and saving for it. The second, and definitely the third time a cat blocks we put this surgery on the table. This is about GETTING OUT ALIVE! remember. PU surgery info here. Perineal Urethostomy by Michigan Animal Hospital. Cost is between $1,000 and $3,500.

If you have a pet story that you would like to share, or an experience with this condition please add it to our Storyline page at  Pawbly.com.

Please also follow us on Pawbly.com, our Jarrettsville Vet, or our Jarrettsville Vet Facebook page, Twitter @FreePetAdvice, and YouTube. 

The Power Of NO. The culture of vet med and how we cannot utter nor accept "NO".

There is a culture in veterinary medicine. It is pervasive, overarching and in many cases detrimental. We cannot say "No". We are taught not to, conditioned against it, and therefore it persists and cripples us. Inside the profession of veterinary medicine there is never a welcomed voice of dissent. There is also not a culture of open acceptance that others have different goals nor sense of purpose. And, with all of that truth we still cannot say "No". Would any of us want to teach our children to be so passive and prejudiced to not question what intrinsically does not feel right? And, yet, we are these parents. You do as your profession has dictated. You accept the reality as it is laid out for you. There is not a line between species outside of human and non-human. It is confusing, painful and nonsensical to admit outside of our own ranks.

Luna. Rescued from the Humane Society.
Looking for a second chance and perfect in every way already.

Spend a few minutes explaining to outsiders how and why the way we practice medicine is so different and disparate within the separation of the type and/or species you practice on and it becomes apparent. There is a huge difference in the ethics and laws within our profession. Say, for example, if you are a food animal practitioner versus a small animal specialist. What about a feline exclusive practitioner versus a poultry practitioner? After all they exist on the same pieces of real estate. Do you think that any boarded feline specialist is paid to practice "herd food production management" by calculating acceptable losses for cost savings versus medical need based interventions? The spectrum is wide and the rules to play vary so significantly we cannot put them into words and rules without species delineation to qualify them as "just" and/or "appropriate" when in fact they are much more likely to be simply based on "archaic practices" and/or "profit margins." Within this large spectrum of diversity there is a lack of oversight, accountability and an almost complete abandonment of enforceable laws based on compassion at the end of the 'less than canine' spectrum. Ask the USDA slaughterhouse vets how differently humane euthanasia resembles the in home euthanasia's that are franchised and marketed to be the "peaceful passage" we would all want for our beloved pets. They aren't even remotely similar. Why is that?

Dimples. Rescued from the local Humane Society.
"Dimples lives her truth everyday.
She is kind, gentle, and longs for human companionship.
Living in the present and full of second chances -
please help us help us find Dimples her happily ever after." Laura 

How do we get to a point where vets assault patients in their clinic? Or shoot their neighbors dog? Or euthanize themselves with Euthasol? We are a fragment of society without a consistent code of ethics and the nuances to allow transparent public perception with the derivation from them. We are also an old, humble, gritty profession. We don't adopt change quickly enough even when the death rates and discord dictate the critical nature of the current time. We are a profession who says "Yes" to financial incentive more than "No" to the ethical divisions, or our obligation to all species to unite us. It is the power of being trained to not question abandonment of our own internal "No" response meets simple basic greed with an unwillingness to permit the other side into our discussions for "best practice" management.

I have found that I far more regret the "Yeses" than the "Nos". Maybe because it took me a long time to find my voice, assert an opinion and start to protect my own soul? It has become a matter of life: professional and personal, and death: personal and professional. How much does "Yes" versus "No" cost you? It is a question I would like to ask every veterinarian. I would also like to know how so many got to this pervasive place of indifference basking in shaming blame that seems so pervasive in general society today? Was it when you started to accept not saying "No" more often?

It is the nature of being a student to not question authority when your purpose is to absorb first. Every person in medicine remains a life long student. We veterinarians are all students our entire lives, UNTIL at some point you get to be in charge. Once you reach that pinnacled place you have to learn the word "No" as a matter of survival. In the end, (and there is always an end), it is all about survival. Not the financial kind, nor the status, popular, nor celebrity kind. It is about the little voice who guides your ability to even like yourself when the crowds leave you for the next new enlightened thing.

I was interviewing a new vet grad a few weeks ago. I was telling her about our clinic. How hard I work to protect the emotional toll being a veterinarian can take on you. How we are a practice that protects our patients and staff and the ethical crossroads that living the life of a veterinarian that can often present. "We are a safe place for our patients and staff first." She went on to tell me how this had already become a point of inner conflict for her. "I was at a practice where a chihuahua came in with a puppy who had been stuck in the birth canal for two days and the people had no money. We sent them away without anything to die at home. I will never forget her." It is a scenario that plays out every day, in every practice and I reassured her that here, under our roof, no person will ever leave without feeling like we hadn't offered every single option to make a happy ending possible."

That night I couldn't sleep feeling that we failed so many. We failed this new grad who is feeling and being taught to be powerless, voiceless and being conditioned to remain this way. We are failing our clients who were brave enough to seek help. And worst we perpetuate cruelty we blame the owner for without taking a moment to reflect upon ourselves as being complicit to it. Did that vet who turned them away ever follow up? Did they at least call Animal Control, (as awful as that ending might be?), at least the dog would be humanely (?) ceased in her suffering with a dead puppy stuck inside her? I would venture the answer is again "No". We don't speak up often enough, (even if we are now bound by law to do so. More on the Mandatory Reporting of Animal Cruelty here).

Our conversation resonated so hard with me that later that night I sent her this text message; "Hello. I wanted to say how nice it was to talk to you. I hope that you have a wonderful trip back to school, and most of all I really hope that you never lose your sense of compassion for even those it seems that you cannot help. (That last part of that sentence I also hope proves to be your most treasured asset as you leave vet school). I keep thinking about your chihuahua case. Indifference is learned and conditioned in vets. It is shameful so many vets abandon it for reasons I do not understand nor accept. You never have to walk away feeling helpless. I hope that you always remember that. Even 40 years from now when you have seen everything. Enjoy your last weeks at school. They are precious and life is never the same (which is definitely both good and bad ;-) ). "

I have learned to say "No" because I had an accelerated path of defining where my loyalties and ethics were rooted. I am not here to perpetuate outdated selfish practices and ethos. I am not here, in the trenches to believe the outdated, unmarketable internal dialogue we still cling to. We should not be a profession serving ourselves first. Protecting outdated cruel practices to protect profits, "property" designation, and disfigurement to our patients. I am here to serve my patients. Not only the patients who can afford me, but all of the patients who need me. (Where and why did the debate about pain management, declawing, debarking, and factory farming ag-gag laws take precedence over our obligation to be our patients advocate?).

There needs to be a reminder to all among us what the indifference, silence and bullying culture costs both us and the society we live in.

Questioning is the advancement of science. The innovation of professions. And most importantly the protection of liberty that every soul deserves.

We need to start pulling back the veils, dismantling the incestuous relationships with producers, manufacturers, lobbyists, and put our patients and our people first. Please start to question, and even mutter "No" to the slaughterhouse practice of overpopulation herd management (this includes, cows, horses, pigs, cats AND dogs).. "No" to toxic people.. "No" to clients who hit their dogs, threaten, deny basic care, neglect, harm, hurt, perpetuate disease via their neglect, and allow pets to die horrible suffering deaths. We see it, we don't do enough (or anything?) about it, and it undermines our ability to recognize it even in our exam rooms. It also makes us complicit. We are just as responsible, (perhaps even more so?), and we are part of the indifference that makes killing in society "ok". I may be a single solitary voice in a profession of pleasing paying people but the core of why and who I am is preserved and protected. It is also the influence I have every intention of fostering and perpetuating in my practice for my staff, my clients, and most importantly for my patients. It is time to have a voice other than the lobbyists hushed threats about what we will lose if we stand up and demand a kinder approach to serve the animals first. It is this internal conflict that each vet sees, feels, and knows that is the greatest consequence to our work-life inner peace.

Stuart and Falcon. rescued from the Humane Society.
A long story of their own and now ready for a home of their own.
Call me, email me, ask me about them, or any of our rescues.
They are all proof positive of the power of "NO!"

The profession is at a cross roads. Societies views of pets as members of the family, the financial incentive for us to acknowledge this, and the power of social media when we forget these are all testament to this. We are acting like we are making huge efforts to curb the suicide rate, job dissatisfaction, dwindling numbers of vets seeking ownership, and stagnant pay when compared to rising costs of our educations, but, we are still promoting, permitting and accepting a culture of exclusion and complacency. We are trying to empower, encourage and inspire each other while at the same time not acknowledging the most obvious reason we feel so trapped. Yet among all of this we don't have our own voice. We are sheep in a pack of masses huddling to stay alive while the wolves hover. I will attest to the pain found outside the pack. It might be better to follow the school and avoid the sharks but the inability to exercise your second amendment power is more than I can bear.

The profession has become a lobbying firm. You either adhere to the pervasive culture or get (forced) out. In most cases they won't really mind if it is at your own hand. It is stifling to live here. I hate it. I will come out and say I hate living here. I am losing hope. It is the fundamental lifeblood to a passionate person borne into a profession that alienates and destroys life on whims, economics and opinion. It is a reflection of the bullying that society does not adequately address nor protect.

There is a storm brewing. Maybe I will be some part of it? Maybe I will be yet another vet deemed collateral damage to a profession that doesn't say "No", doesn't have a voice of its own, and doesn't care enough about anyone or anything outside of its bottom line? We are far too worried about preservation of our power, our influence over lives without voices, and our lack of oversight from the human sides restrictive, profit driven corporate controlled medicine practices. The cruelty in vet med is alive top to bottom, across all species lines. The culture of accepting it is crumbling too slowly. And the death is both inside the pack and around us. Start to question who you are? Why you are here? And why hope for change is so elusive? Say "No" to being unkind, unwilling, and unable. We aren't sheep, and we aren't replaceable. I'm here to say "NO!" to being a part of  death of compassion of this new grad. I am also here to say "NO!" to sending a chihuahua home to die because we think we can't afford to care anymore.

There is liberation in having a voice that is your own to guide you. Being even more than who your white coat and oath asks you to be. There is the place where trust, integrity, innovation, inspiration peace, and purpose lives. If you can't learn "no" you will pay for the assumed "yes" whether it be in inconsistent drama based business, sleep deprivation, bankruptcy, or collapse. At some point something gives and you learn to say "No".

Where is your "NO!" living? What is your silence costing you?

Me and my Jekyll. Another "No", one of the best ones I ever muttered and stood up to.

More information on chihuahuas and dystocia here. Coco's Story.

More on Compassion Fatigue here

Get Out Alive blog here.

Gratitude. The Grace That Hardship Gifts blog here.

More on Fate versus Indifference In Vet Med here.

More on Ag-Gag Laws here.

AVMA Euthanasia Guidelines here.

More information on me, this blog, and who we are at Jarrettsville Vet can be found here:

Pawbly.com is about saving lives, and providing options with data. Let the data set the standard of care and integrity via transparency be the guide.

If you care about pets, believe in making happy endings happen, and want to help others please join me on our Jarrettsville Vet Facebook page, our Pawbly Facebook page,and also on Twitter and YouTube.

The Rabbit Hole. When Supply Outnumbers Demand, and Free Isn't Incentive Enough.

When it comes to pets there is an endless supply of "free" replacements available. Endless. There is NEVER a time where the shelves are clear at the shelter. There are multiple rescues within a 30 minute drive that have upwards of 500 cats available (begging for homes) under their roofs for adoption. The numbers are staggering, the supply unyielding and the consequences too often unimaginable.

At the present time cats are FREE and, with a FREE gift (for the holidays) at the local shelter. It is becoming a fairly common practice for high volume shelters to offer "free pets" in the busy and overcrowded periods. For example: The Spring kitten explosion. The housing of hoarder interventions. The days after the holidays when people deposit unwanted pets for vacation plans, new pets, and company visiting. Free is a wonderful marketing tool. BUT what happens if you can't even give them away? At the shelter they are advertising and including "a present as an extra bonus" incentive?!. (face palm). This is part of the problem. It is not an easy problem to solve, BUT, it has to be addressed. The best answers to overcrowding, over populated pets likely lie within all of society. But the brunt of it is shouldered by the shelters and rescues. They are after all the catch all for the castaways, forgottens, abandoned, and lost. They NEED to exist. You are not going to change these. People die, lose their homes, cannot afford to care anymore, etc, etc. Shelters and rescues NEED to exist for the pets no one wants, and those who are missing. Pets deserve a chance to find their own (old or new) family. BUT relegating them to "free" may not be our best way to preserve their safety and value?

Luna.
Rescued from the  shelter,, loving life at JVC

If the replacement value is so low and the supply so great this only leaves an emotional tie to keep the system running. The debate over emotional bonds between pets and their people is undeniable. If you haven't had your heart stolen by a purr, a wag, a nuzzle, or the unyielding unconditional love of a pet you haven't let your heart open long enough to enjoy the most wonderful part of sharing a life with the love of a companion.

Pets own us. They do with each moment we get to spend with them. The emotional ties have evolved into bestowing of names, personalized beds, blankets, and bowls, monthly treat deliveries and a market that grows faster than (almost) any other. It is so lucrative and strong that venture capital is pouring into it every-single-day.

Mouse. Abandoned three times. Then he met us.
Turns out he is deaf and a dog.
Embrace who you are and there is someone for everyone.

For those of us in the shelters, who know these unwanted cast-aways it is a tough acceptance that giving them away to the wrong people is worth the chance of euthanasia to reduce in shelter numbers. If people can't, or won't, invest in their pets care are they good parents? Are we setting everyone up for disaster and disappointment. After all no pet is really "free". They will need basic care this will inevitably include veterinary care, and this might even be more expensive than "free". It is a real-life dilemma that I don't have any other answer to than "anything is better than dead. I think?"

The Roaring Pet Market, Forbes article. Here

The Littles.. Stuart and Falcon.
Rescued from the shelter where they couldn't shake their upper respiratory infection.
They needed love, time, antibiotics, and antivirals.
Some cases are easy and some remind you why it takes 4 years to get through vet school.

If you have any questions or comments please find me on Twitter at @FreePetAdvice, or ask me any pet question for free at Pawbly.com I am also at the clinic Jarrettsville Veterinary Center in Jarrettsville Maryland. 

Triaged Medicine, The Veterinary Professions Answer to Who Gets What In Times Of Scarcity.

One of the hot topics on the human side of healthcare is how to manage limited resources in the face of an overwhelming need and critical shortages?

The scenarios range from anything like a massive flu pandemic where things like life saving medications or ventilators are in shorter supply than the demand requires.

Another would be oxygen in areas where natural disaster has hit. Think about a hurricane hitting an island and the power is lost. People need supplemental oxygen for surgery, respiratory disease, infection, burns, etc. What happens when the ability to provide supplemental oxygen is at a place of rationing?

What about food? Shelter? Medications? Or any kind of medical, health or supply that the masses need in a catastrophe? What about epinephrine pens that are now 800 times more expensive than it was a few years ago and needed in seconds to save lives? What about generic drugs that are no longer profitable (enough) to manufacturer but would be basic and life saving on a scale that hundreds of thousands of people might need immediately? Who would be given them if there wasn't enough for everyone?

Would you give it to the children first? The patient with the greatest chance of survival? The patient who provides the greatest contribution to society? Like the doctors? Nurses? Emergency response personnel? Yourself? Your family?

It is a tough thing to answer. It is also a real-life scenario in much of the world.

Does it happen in vet med? Of course. Every single day. Resources are limited. Access is limited. And not everyone gets the best of veterinary care even if it is available and accessible simply because they need it.

It is a common practice to utilize the skills, practice and lessons of another profession when trying to decide the best course of action in a current dilemma. So, why wouldn't human medicine follow our guidelines and protocols for the same set of scenario's?

The same scenarios apply in both human and veterinary medicine, BUT, the compassion is lacking on one side of the care giving side. Veterinarians provide care to those that pay for it. If it was free and available on the same scale to everyone who needed it we would face the same ethical decisions to deciding who gets what when they need it. But alas we don't. It is far simpler to ration based on economics. Cut and dry.

Should it be this way? I am not sure? I think that the reason we on the veterinary side don't provide everything we can to everyone who needs it being simply based on a case of economics limits our ability to understand more complex scenarios. It skews our reasoning skills, our preparation, our sacrifice for a common good. It reduces humanity to individually centered scenarios and decision making trees. It promulgates and promotes self preservation on an individual level. It is impossible to make life saving decisions in mass casualty scenarios when the individual is the source of the lack of compassion on a larger scale.

So the next time you need help ask not what you have access to, ask what you are willing to sacrifice to provide it. Maybe the abandonment of self is the salvation of all?

Resources and Inspiration;

NY Times article, Aug 21, 2016. Whose Lives Should Be Saved? Researchers Ask The Public.


More information on me, this blog, and who we are at Jarrettsville Vet can be found here:

Pawbly.com is about saving lives, and providing options with data. Let the data set the standard of care and integrity via transparency be the guide.

If you care about pets, believe in making happy endings happen, and want to help others please join me on our Jarrettsville Vet Facebook page, our Pawbly Facebook page,and also on Twitter and YouTube.