Cat Abscess: What to do when they aren't healing.

This is Chaussette.

She came in to see me because she was "lethargic, not eating, not playful, or acting like herself, and she was much more vocal than normal."

To me these were all very important clues that she was not feeling well, and particularly I thought the vocalization was her very smart way of demanding help and attention. Those cats are very very smart and will tell you there is a problem if you just listen and pay attention.

Always listen to your cat!

So began my exam of Chaussette; Even though her weight was normal, her mucous membranes were normal, she was walking fine, could open her mouth normally, and seemed to look normal, she had a fever (104.8 F, normal high end is 102.5 F) and a large mass on the left side of her neck. The big clue was the big mass on her neck.

She was also an inside cat.

The mass on her neck was painful to the touch and had a tiny area of a scab.

Chaussete had what I find most commonly on cats with no other history of trauma, no access to poisons or toxins, and a hard mass.  With the careful prick of a needle she had puss under that hard mass. She had an abscess. An abscess is an infection that has buried itself under the skin, or within the body. It is significant because it can be harder for the body to fight on its own and remain hidden from our view.

For those of you at home.. If your cat is not acting normally check them over from top to bottom, nose to tail. Let your hands be your eyes. If your cat has a mass it is important to see your vet. I do not ever recommend that you lance or open up the infection on your own. Here's why; It might not be infection. Don't poke without knowing your anatomy and worst possible scenarios.

Even after I was pretty sure it was an abscess I did not lance the wound and I did not open it up. Why? Well, I know people want to pierce an infection to let stuff out,,but,, it might also be allowing stuff in,, and the wound was very large. Too large for me to do much with while she was awake and in obvious discomfort due to a big festering wound on her neck.

Here is where a good discussion with your vet can make a big difference!

Chaussette's options were;

1. Gold Standard; Bloodwork done to assess degree of infection, organ function. Costs range from about $25 (PCV), to $300 USD for full CBC and chemistry. Chaussette was a young healthy cat. This step was not going to change our treatment plan (infection  needs to be addressed). 
2. Silver Standard; Placing a drain under general anethesia. Pre-operative blood work is recommended. General anesthesia cost $100, drain placement $40, pain medications and antibiotics about $40-$60.
3. Bronze; Try an antibiotic to see if that is all that she needs to heal her wound. 

Chaussette's mom wanted to try an antibiotic first. I discussed that it might work, but, I was a bit worried that based on the size of the wound it might not be enough? She elected to try a 7 day injectable antibiotic. I gave it a 50:50 chance. We talked about monitoring at home and the next step should the wound not resolve. 

Chaussette's initial treatment plan included;

1. Examination $50

2. SubQ Fluids $25

3. Injectable Antibiotic $50 (7 day dose).

4. Injectable NSAID $13

About a week later Chaussettes' mom called. She wasn't eating again and the bump was still there.

OK, time for Plan B. (Every prudent vet has a Plan B. Further, every vet talks about Plan B before it is needed!).

Chaussette was given subcuticular (sub q) fluids and injectable non-steroidal anti-inflammatory to help with the fever. We also started her on a different antibiotic. Any cat with a high fever is reluctant, if not down right adamant, about NOT eating. 

Whenever it is possible I provide as much of the immediate treatment plan as possible in the hospital. It might cost a little extra (you can always ask your vet about the cost differences), but, it gets those cats feeling better much quicker, and it can be awfully difficult, as well as down right dangerous, to pill a cat who is cranky because they do not feel good. It is especially difficult in Chaussette's case because her wound is on the side of her  face and it will be hard to not touch it when you are trying to open her mouth to pill her.

I gave Chaussette

The next day Chaussette went under general anesthesia and had a drain placed. The drain is a small flexible piece of rubber tubing that extends from the top of the wound to the bottom. The plastic tube (called a Penrose drain) stays in place with suture at either end. The drain allows us to flush an antibiotic solution under the skin to eradicate and kill the infection that has been hiding out under the skin. I usually put an e-collar, sweater, or bandage very loosely over the surgical area so the cat won't be able to scratch, lick, or pull it out. The worst thing that can happen is that a pet

Cost of treatment plan number 2;
1. Re-check appointment $30
2. Sub Q fluids (to get break her fever and get her comfortable for surgery the next day) $25
3. NSAID $12
4. Injectable Antibiotic, different and (stronger than first) $10 (one day dose).
5. Anesthesia $125
6. Drain Placement $75
7. E-collar $8
8. Daily oral antibiotics, 10 day course $32

The drain was removed about a week later and Chaussette abscess is now finally resolved.

Important tips for drains;

• We use the drain to flush a medical grade surgical solution around the plastic tubing.
• An e-collar is used so that Chaussette won't pull her drain out.
• The drainage should considerably subside over 24-48 hours. It should be gone by day 5.
• The drain must be removed within 2 weeks time or the plastic degrades in the body.
• Drains should only be used when the infection has abscessed and doe snot respond to conventional methods.
• Keep the area clean and dry. These patients MUST be kept inside and under close supervision.

If you have a pet question you can find me, and a whole bunch of really talented helpful pet people at Pawbly.com. Pawbly is free for all to use and open to anyone who loves and cares about pets and animals.

If you want to discuss your pets case with me you can find me at Jarrettsville Veterinary Center in Jarrettsville Maryland. 

I am also on Twitter @FreePetAdvice, and I have lots of helpful videos on my YouTube channel.

Veterinarian Position Available. The JVC Veterinarian Guide Book

Veterinarian Position Available

Wouldn't life be easier if we all were given little instruction manuals to help guide us along our path in life?

What about simplifying life into parts? Say, work life?,,,,

What if there was a color by number map to follow from 9 am-5 pm? The quintessential Garmin for our day to day work life?

Here's what my veterinary work template would look like;

• Arrive at work. Say "Good Morning!" to every person and critter you meet. 

• Glance at surroundings to make sure they look and smell ready for a full day of patients. For instance, pick up syringe cap beside waste basket. Throw in trash.   

• Walk into first morning appointment. Smile and greet Mr. Jones. Remark to him that Monster is looking better today. Pat Monster on the head in passing. 

• Help over burdened client at check-out counter. Offer to carry Mrs. Granny's 30 pound bag of litter to the car for her. And, ask if she remembered to check Fluffies urine after last months urinary tract infection?"

How awesome would it be if I could install a little step-by-step programmed guide into the day of every one of the employees at Jarrettsville Vet? You know, just as a little nudge to guide and prompt them to remember manners, be friendly, and be the advocate for excellent pet care?

OK, so maybe no one really wants a little recording of me nagging at them the whole time they are clocked in to work? It is a little Big Brother meets "mother you're driving me crazy!"

And, yet training manuals have become a universal standard operating tool to train, advise, and guide employees daily. In the veterinary hospital setting we can either provide weeks of shadowing on another employees heels, offer  written bulleted lists to memorize and regurgitate, or a combination of these.

I think I have learned that a new employee is a bit of hiring on a hunch, listening to your gut, asking probing open ended questions, offering a bit of rope to see if they help someone or hang themselves, and yes, providing a tool kit, safety net, and being a nosy, hovering, overhead nagging mom.

Call it matriarchal leadership, ownership responsibility, due diligence, etc.. it's all the same. I, as the owner of Jarrettsville Vet, have an obligation to my family, my patients, my staff, and my clients. Without direction and oversight our ability to meet both our own and our clients expectations, as well as provide exemplary care to our patients, is limited, if not impossible. I have to be a mom. And every mom will tell you that this is not an easy job.

The bigger and more successful my practice has gotten the longer my list of 'mom duties' has grown.

Luckily, every mom has kids who grow up and mature and require less oversight. I am incredibly fortunate to have four veterinarians who are the epitome of professional, talented and compassionate. I have 4 kids I never have to worry about. (OK, complete disclosure; one was in a terrible car accident recently and I worry about how to keep all of the wheels turning in the face of tragedy, illness, absence and crisis. A moms worry is never ending).

Such is the prologue to this blog....

Jarrettsville Vet has hired two new vets! We are welcoming two new graduates into our family. Dr. Hensler will start in late November and Dr. Knouse, who will start in June 2016.

Like every other new family member who joins a bustling finely tuned, (although sporadically chaotic machine), there will be a transition and change. With this in mind, I thought that it might be helpful if I put some of my pearls, hard lessons, triumphs, expectations, concerns, fears, complete paranoias, pet peeves, and hard lines on paper. (And, because I have this compulsive flaw to make all of that public, why not share it with the rest of the world? Really, I am sharing it because I have to set my new kids out into the word and I am a bit petrified of these kids making the same mistakes I made. Maybe this will help our clients be a bit more understanding of the newbies?).

How do you start a training manual/instruction guidebook? Maybe the best place to start is to reiterate at our most basic principle and core value?

• Help people help their pets. Jarrettsville Vet helps pets. Above all we are a place centered on kindness coming first. The first, and most important piece of advice I can give is; should you not know what to do ask yourself "what is the kind thing to do?" and then, do exactly that. Everything else is secondary. If you abandon this principle you will lose our soul in the muck of all the other clutter and in the end you will also lose your ability to walk away with a sense of purpose. Abandonment of this will tarnish the hard work it took you to get to where you stand now. 
• Be honest. No matter how terrible the plot gets your integrity, the greatest gift you give yourself, is on the line. Never surrender that to anyone. And never convince yourself that the consequences over shadow your integrity.
• Work hard. There is no escaping this key ingredient in the the recipe for the success in life.
• Be true, true to your patients first. They are who you work for. And, then be true to your clients. Too many vets get this misappropriated. Your clients will find you if they believe that you hold their pets life and happiness above all else. (I am not even going to add the little asterisk that reminds us that pets are property and human safety is paramount. I hope you already see the oxymoron in this?).
• Never stop being a student. After a decade in practice you may have mastered spays, neuters, and sick kittens, but you will not ever master the art of human communication, emotional turmoil, and the pathetic financial compensation proportionate to educational burden. Be a student who learns from others, cases, mistakes, and pass along what you pick up along the way to empower the others around you.
• Give everyone the benefit of the doubt, but be prepared.
• General practice small town veterinary medicine is about finishing the marathon, not winning the sprint.
• Get out alive. When all else is in question don't give up everything else in life.

Sully

Day to Day Pearls;

• Trust is the cornerstone to being entrusted with a pets care. Look people in the eye.
• Say "Hello," with a smile and eye contact to every person in the room.  Walk into every appointment with a "Hello." Introduce yourself. Shake hands if you want. You are going to make an impression, make it a good one.
• Greet every pet that greets you! Acknowledge your patients. Introduce your self to them too. Making long term relationships work happens if you extend yourself to others.
• Use your brain, your hands, your gut, your eyes, your ears and yes, your nose. These are the most important tools of your trade. Your successes and failures along with your experience will be built on these. Don't start any appointment with a textbook, rule out list, or notes! You will miss important clues if you don't keep your mind open and your brain picking at the puzzling case at hand. Books should be off limits until after you walk out of the exam room!
• Diagnostics are life lines as you try to unravel the pieces of the puzzle. Use them sparingly. Talk to clients about your exam findings and why you want to take the next step to help understand their pets disease.
• Give estimates of cost with each step. Your client doesn't know you and they need to trust you.
• A pet that looks bad should be presumed to be in bad shape. I once had a new grad walk out of a room with a "trouble breathing cat" without the cat. That poor cat was suffocating and the vet was on her way to back of the clinic get a tech to help retrain it. That cat would have been dead in 5 more minutes had I not seen him on the table suffocating. True story. She left shortly after. Walk into every room expecting to be an ER vet. You are always an ER vet, like it or not.
• Ask for help if you have that tiny little voice in the back of your head telling you to "proceed with caution." You will not be alone here and you are surrounded by amazing technicians and staff.
• Call the cops if you are afraid. Seriously, never engage in a fight  (verbal or otherwise). Pick up the phone and dial 911. People forget that there is back up right down the street.
• If you have a tough case and it is bugging you and you think that a radiograph will help you and your patient sleep better at night, do it. The revenues generated by a few simple diagnostics are not worth your compassion fatigue burn-out. Run them, don't charge for them, take it out of the Good Sam Fund, whatever.. Learn to protect and preserve your psyche.
• We can make anything possible, you have limitless tools to help. Use them. 
• Walk away from every appointment only after asking your client if they;
•  have any other questions?
• Need anything else?
• Tell them the long and short term plan
• Give instructions for expected resolution,
• Next steps needed if the problem does not resolve within __.
• Leave your contact information. I leave my email, or cell phone, for clients I am worried about.
• Thank them and say that it was nice to meet them.
• Provide a Report Card/Take Home Form to all clients
• If your client doesn't leave with saying "Thank You" to you, there is a problem. Go figure out what it is. Face all potential problems head on as soon as you recognize them. My nice way of saying "make it right" and CYA.

Buster

Behind the Scenes; Pearls of Practice;

• It is far safer for everyone if you and the techs hold the patients.
• If a pet is scared ask the client to wait outside. Often a pet is protecting the client, or, they get away with intimidating behavior around the owner. Diffuse the situation before it escalates.
• Pay attention to body language. A wagging dog tail is willingness to engage. Not friendly or curious sign language. Licking lips, tense body composure, and anxiety cause injuries and a client and patient who will be reluctant to return.
• If a client insists on holding, makes demands you are not comfortable with, or escalates an encounter, walk out of the room and take a breathe. Take a moment to think. Don't be forced or intimidated into anything. I have stopped appointments when horns get locked. You are responsible for everything that happens under our roof. Live in worst case scenario world, and be prepared for it. A fractious dog and a demanding pushy client are setting you up for the worst experience of your professional life. I promise your pride will survive if you walk away and say "No."
• Euthanasia's. Remember it is always about the pet. I know that no one wants to miss a vein when performing a euthanasia, but, taking a dying pet away from a grieving family is a question for you to ask, not the tech. Lay out a plan before the pet arrives, or talk to them when they do arrive. Talk about the procedure, ask about their concerns, sign pertinent forms, and check out before you touch their pet. Sedate a scared pet, take your time so that the clients don't walk away grieving more than they did walking in. Alert the staff that there is a pet passing away. Keep the clinic as quiet as possible, provide time, support, and compassion. 
• You do not work for a person, You are the vet you want to be. The person you dreamed to be. If you do not feel right about doing what is being asked of you share your voice. I will not euthanize a treatable pet. We have placed pets in homes, treated pro bono, and moved monumental mountains to hold this pillar of care true. If you still think that the impossible is not possible stick around a while. The more we try to make miracles happen the more commonplace they have  become. There is no room for skepticism, laziness, excuses, or disposable views here. 
• Everyone puts a little skin in the game. If you want to help a pet, or a person in need, we will support you. We ask in  return that everyone participate by putting a little personal skin in the game. Discuss expectations early on. 
• Give stuff away. It builds trust, diffuses pointless exhausting arguments, and keeps clients coming back. I do most re-checks free of charge. I also have a '3 second waiting room' rule. If I have seen the pet before and it takes me less than 3 seconds to dismiss worry I give a 'free visit' pass. Tiny bug bites, tick scabs, broken toe nails, better safe than sorry worried parents who just need to hear us say that "it will be ok, just watch it," don't need a $50 visit charge. I appreciate their proactive nature and they appreciate not being punished for it.
• Treat each client the same way you would your friends and family. If you are successful in doing that they will become a friend for life and you will cherish this above all else.
• JVC is not all about the money. We all deserve to be paid well for our time and talents but we never take advantage and we never use scare tactics to elicit compliance. 
• Give options. Lots and lots of options. Recommend 'Gold Standard' for the best care possible to be provided to your patient. Be honest about cost, prognosis and expected course of recovery. If 'Gold Standard' is not feasible talk, offer, and work until you get some treatment plan in place. Do not abandon your patient because of any obstacle. Find me if you run out of options. Practicing medicine successfully is about effective client communications and negotiations.

Going Home At Night;

• Check on every staff member. Check that they are OK. Say "Thank You" for their help.
• You are in charge of the people, pets, and property. If someone or something isn't working step up and say something. The staff is expected to follow your leadership at all times. I recognize that no one likes confrontation but you have to keep this place running smoothly and sometimes that requires being a mom.
• Check on every patient. Make sure that all treatments are done.
• If a pet is not calm, comfortable, and stable send them to the ER. They should not be alone at night, and no staff member deserves to come in to find a deceased pet. It is not fair to anyone.
• Lock up, be safe.

I have your back. Every single step of the way. Call me, or Joe, or Diedra.

This is the first job of the long hard journey you worked so hard to achieve. Be Brave, Be Compassionate, and Be the dream you always imagined yourself to be.

Welcome To Jarrettsville Vet Megan and Lindsey!

Kira

Related blogs;
Living and Working in the Land of Liability.

The Power of the First Impression.

Which Kind of Vet Would You Be?

How Do Our Perceptions Lead Us?

Compassion Fatigue.

Olivia,,(who is looking for a home).

If you would like to talk to me about your pets care or needs you can find me on Pawbly.com. Pawbly is a free online community dedicated to helping pet people provide the care and support they need. It is free for all to use.

If you would like to meet me in person I, and our stellar vets, can be found at Jarrettsville Vet in Harford County Maryland.

I am also on Twitter @FreePetAdvice.

Dunkin, The Story of the Littlest Life, and All That Matters.

It is a different sort of business that we run here at Jarrettsville Vet. Very rogue in the arena of veterinary hospitals. It is a mix of No Kill Shelter meets Dr. Mag-dolittle. I suppose I knew long ago that trying to be a great veterinarian and being the wealthiest veterinarian were probably mutually exclusive, at least for me. So, I decided early on in my veterinary career that I needed to create a few 'veterinary commandments' to live by. I believed that if I did this in the end I wouldn't stray too far from where my original new grad Pollyanna view point was. This list was to serve as a guiding tool kit for me, the veterinarian trying to grow up in the real world. I thought that if I could write down a few codes to practice by than maybe my naive vision of who I wanted to be wouldn't get beat up by the jaded experienced vet I was told I would inevitably become? That list has served me well. There are days where I have to walk out of the exam room and take a seat to ponder whether or not I can face myself in the mirror the next day if I go back and and comply with the clients wishes. There are times I walk back into that exam room knowing I am going anger and lose that client because I cannot, or will not, provide the service they are asking for. I cannot lose the vet I wanted to become to be the vet others expect me to be.

I have had many people remind me that "I cannot save every pet." Ten years later I still beg to differ.

Such is the prelude to our latest little addition to the JVC family. This is the story of Dunkin, and how little lives matter, even when all of your experience, training, and knowledge tell you to give up.

I have worked in animal welfare and advocacy for decades. It is the backbone to the reason I do everything. It is my roots, my cause, and my  purpose. It is also not my secret.

Jarrettsville Vet resides inside Harford County Maryland. As one of the oldest veterinary clinics in the county we care very deeply about our neighbors and all of the animals within our community. We care about these animals regardless of whether they have parents, resources, or luck. Being homeless, being alone, and being at the mercy of others is only a matter of circumstance and location.

There have been many years of turmoil between myself and the Harford County Humane Society. These have primarily been between differences in opinion in transparency and the actions of what I believe to be fair and just when it comes to caring for the unfortunate strays and surrenders of our county.  I have always felt that in the end those animals were the collateral damage to any and all disagreements. Therefore, JVC has remained committed to helping every pet every time we were asked regardless of how they got to where they were, or, the condition they were sent.

About 4 months ago the HCHS sent out a social media request to find immediate foster care or homes for 33 pets. Within a few hours that plea hit thousands of Facebook page's. It was the great power of social media put to the benefit of those in the most dire of need. One of those who answered the call was our technician. She asked me if she could go to the shelter and take one of those 33 as a JVC foster? This was about the 6th foster we have had in about that many years. I am flattered she still asks, but, she knows I will never say "no."

Taking on a foster from another facility is not an easy task for us. We have a credo at the clinic to not turn away a pet in need and often this manifests as us having to foster a former JVC patient while we find them a new home. (Presently there are 6 cats under our roof looking for homes).

In spite of this, off she went to pick one of those 33 dogs so that we could help keep at least one from being euthanized due to lack of shelter space. She returned that afternoon with two. The first was an older Boxer who was sweet but terribly weathered. Her belly was stretched with sagging skin and dangling nipples, no doubt from countless litters she had been forced to serve. She had a depressed manner that erupted into aggression when any other animal even looked at her. She had been a breeding bitch and learned that if she was going to keep herself alive she had to fend off the hungry competition. Life had not been kind to her, and she was not going to be kind to anyone except the hand that fed her. She, we believed, was our tough case to find a home for. But to make up for that hard case our technician chose a puppy as her second choice. She figured get one easy dog and one hard to place dog, and call it even? One old pet who needed us to find herself and trust again, and one cute little puppy who needed a quick make-over and off he would go with his "happily ever after" and no elbow grease to show for it. That seemingly easy-fix puppy was, Dunkin.

Dunkin was one of those 'so ugly they are cute' dogs. At four months old he was already incredibly charming and desperate to be loved by anyone. He had been found wandering the streets alone, brought to the shelter and so he sat waiting.

Of course we all believed that finding our old ugly Boxer a home would be far more challenging than the cute young Demodex puppy, I mean who wouldn't want a slightly defective, but certainly treatable puppy?

Oh, how true that ignorance is bliss statement is! That little Demodex puppy has proven to be our biggest challenge yet.....

Dunkin got his name from his donut sized umbilical hernia. After all, hernia's are easy to fix, aren't they? A few tightly placed sutures and all that extra skin gets tucked away. But, what every vet will tell you is that where there is one congenital birth defect there might be others.

Within about 3 days of having him we realized that he had other problems to add to his 'awful skin' and 'umbilical hernia' list. Dunkin also had megaesophagus. Megaesophagus is a condition where the muscular tube of your esophogus is dilated, weak, and distended. Instead of swallowing food and moving it quickly and efficiently into the stomach the pets with megaesophogus hold the food in the esophagus, inside the chest, and this prohibits the food from making its way into the stomach so it can be digested and provide the body the nutrition it needs to grow. This explained why he was such a fragile, thin, bony pup. Within 1 day of diagnosing this he also acquired the typical sequela to ME; aspiration pneumonia. Within two days of the pneumonia we diagnosed him with puppy strangles. Within 2 weeks of finding us Dunkin became a skeleton hovering on deaths door.

In the early days we hoped that Dunkin's condition would improve if we skipped placing food in his mouth so that it wouldn't pool in his dilated distended and poorly functional esophogus. Placing a feeding tube into the stomach requires an endoscope, which JVC doesn't have. So we sent Dunkin to Chesapeake Veterinary Referral Center in Towson. This was the first Go Fund Me campaign we made. Thanks to that feeding tube he put on the weight and muscle mass that he had not been able to do with his chronic incessant regurgitation. That feeding tube allowed him the nutrients and calories his body had robbed him off.

Dunkin gets fed (one of his many feedings a day) through his stomach tube.

Dunkin had gone from looking like a typically puppy with stress induced mange, to near death from pneumonia, to expensive feeding tube placement that all the specialists told us was likely to be futile, to a skeleton near death, to muscle gain and massive feedings done every 3 hours around the clock. Dunkin was as intense a case as there ever was. His first few weeks with us were roller coasters of doubt, denial, trial, error, and bleak prognoses. He was a cause we banded together around and a fateful catastrophic story that seemed to never relent. I was torn between my staff and my clients being hurt if he didn't make it, paying for services that even the experts thought were futile, and a puppy who had no hope if we couldn't at least try something. The problem was we never knew what that next something was?

Who says medicine won't break your heart? How can I ask people to pay for care if I am not even sure the pup will survive? Goodness was I worried that I had gotten everyone involved in a tragedy.

Dunkin says "Thank You Mom!"
He loves to eat!

As his social following grew so to did the facing of his many illnesses, diseases, and preparing the public for his poor prognosis. It is a wonderful and amazing journey to see so many strangers band together for one small life.

Dunkin's story has moved people to donate money when he needed to see a specialist. He has people who beg us for updates. People who stop by the clinic just to meet him (some of them even tell us that they aren't clients but they follow us on Facebook just to see how he is doing), and a team of supportive caretakers that has allowed his frail broken body to overcome obstacles most others would not have been able to.

In the early days we were trying to find him a home. We have since come to realize that his obstacles are too numerous and his condition to fragile and constantly changing to safely place him in anyone else's hands. He can be happy, eating, playful one day and hours later be suffocating from pneumonia and skin swelling. I have had to be honest and realistic with people who want so desperately to be able to will themselves and Dunkin his happy ending. We have had to turn down people begging for him to be theirs because the magnitude of his care is too great and the emotional strain almost immeasurable. There are tears of joy and tears of despair weekly around him.

Dunkin has 24/7 care and monitoring. He is fostered by our technicians and has been shuttled between three specialists. All  in the hopes of finding a root cause and crossing one problem off of his list.

Dunkin has become a part of our family. His story has been told in Facebook posts, visits, and inquiries from his long list of friends.

Do I know what Dunkins future holds? No, I don't. I know that he has a few conditions that we might not be able to ever resolve. I know that his megaesophagus is probably not treatable by anyone at this time. There isn't a surgery, or a procedure, or a way to make it better. He will have to eat standing up for the rest of his life. We will have to manage his sporadic aspiration pneumonia when they occur, and one of them may be so severe that we won't be able to cure him. He is a fragile medical conundrum. He is a little boy who isn't going to be handed anything. He will struggle, and face obstacles every single day. But he has taught us, reminded us, and shown us that it isn't about how many tomorrows you have. That you cannot be bitter and angry that you weren't born perfect, you can only live this day, wag and play and be happy to embrace this moment, because life is a precious, fleeting delicate thing that none of us get a calendar for.

Dunkin is one little puppy who needed a miracle and instead got a team of people who will never give up on him. He will be loved every moment of his life, no matter how long that is. He was a gift to all of us that we cherish. He mattered, one little broken puppy who matters more than any dollar, any scientific poor prognosis, and any unarguable bad case with almost no chance of a happy ending could bring. Do I know that his chances of long term survival are poor? Yes. Should that matter in how much we love him? How much we provide for him? and how much he enriches our lives? Well, I suppose that is why I still make decisions based on looking into my patients eyes and not my ability to become hugely profitable.

Dunkin has many people to thank. Without Amanda, Laura, and the doctors and staff at JVC he wouldn't still be with us. We also want to thank all of the people who love him, whether it be in donations, Facebook encouragement, or love. We are grateful to you all!

I wanted to add that since Dunkin was rescued from the HCHS significant changes have been made. Most notably there is a new director who has put a new face of transparency, cooperation, and compassion into the shelter. She knows that we are here to help with the pets of our community and we wish her the very best of luck in her new position!

I also want to add that Dunkin is happy. The one monumental thing we can learn from our pets is to not feel sorry for ourselves. To face each day with a wag and a smile, to never look back, and to always greet each person with love and hope. Dunkin loves life and we love watching him grow and remain the bright spot in every day we get with him. He will always be loved!

Update;

Dunkin passed away on November 7, 2015. He fought valiantly everyday to enjoy life. In the end his list of challenges became too great to manage. He was surrounded by the JVC family who loved him and he will be missed profoundly. 

We will choose to celebrate his life. We will remember how happy he was, how lucky we all were to know him and how much his little life mattered. The immense impact he had on others, and remember that where there is love, there is always hope. 

If you would like to share your stories of your beloved pets please come by the clinic, Jarrettsville Veterinary Center anytime. We would love to hear about your companions and how they enrich your life.

If you would like to ask a pet question please find me at Pawbly.com.

I am also on Twitter and Meerkat @FreePetAdvice.

Thank you all for being kind, and for keeping all of those little lives that matter close to your heart.

Celebrating a Decade. My first ten years in practice.

Joey and me,, selfie time.

I have grown to realize that it is important to celebrate the milestones in ones own life. It is an opportunity to take a peek down Memory Lane and appreciate all of those little steps it took to accumulate a path that lead to where your are. How often do we forget to enjoy the journey on the way to the destination? None of us do it enough. We get so caught up in the plowing forward, making it through the day, that we forget to reflect on how we got here and take joy in the being.

Some call it "taking a moment to stop and smell the roses." I need to remind myself to take more time and smell more flowers. The one true gift of living a veterinarians life is that we see lives pass in short tragic snippets. A one year old pup dies before your eyes of the most devastating quickly enveloping cancer known. One minute they are in your hospital being spayed, 6 months later they die within 3 weeks of a small bump that everyone hoped, and banked on likely being nothing more than a bug bite. After all, one year olds don't die of cancer? Do they? Yes, sadly they do.

Life isn't fair. It is fleeting, precious and short. It shimmers in the tiny moments you learn to stop and be grateful for.

This is Joey. He visited yesterday for his annual examination. It is the ninth he has had with me. Joey and I first met 10 years ago when his mom waddled into the clinic with his worried human grandparents in tow. Joey's mom, Sally, was very, very pregnant, but still true to the Labrador that she was, as happy as ever to to see us. Her human parents had done the best they could to prepare themselves, but when moment of delivery arrived they decided to leave it to the vet experts. Little did anyone know I was a far cry from anything considered a "veterinary expert". I was a brand new vet. I remember looking at Sally. Sally remained calm, grinning, and thankfully not asking for my references. I was just as you would expect;, nervous, excited, and desperately trying to recall every nugget of information I had stuffed into my brain those 4 years of vet school. Maybe Sally knew what I didn't? Maybe she sensed that I was going to do everything I could to take good care of her and her tiny baby specks safely snuggling inside her belly? Maybe she believed me when I told myself quietly that what I lacked in experience I sincerely made up for in ambition. In true professional manner I kept my fear and  insecurity to myself. Sally's first stop when she bobbed into the clinic was a preg check radiograph. Vet school teaches us to take a belly x-ray so we can count the babies. We are told to count the number of spines and the number of skulls as a way to double check the babies (they should both be the same number). But Sally's radiograph was a spaghetti storm of spines and backbones.. Sally's bloated belly had so many babies in it that we all took turns with our counts. Our best guess was "more than 10? We think?" (So much for imbibing professional confidence. Seems I can't even count? Sigh...)

That afternoon Sally and I delivered her 12 round wiggly furballed puppies. The pups ranged from chocolate, to golden yellow, and black. She had every lab color allowed. Thankfully, they were each perfect bundles of smooshed faces, paddled paws and cooing adorableness. 

C-sections are one of those places where a vet gets lost in the process of being immersed in a belly of new life. It is also undeniably one of the happiest occasions in a vet clinic. Christmas Village comes alive with helpers swaddling, rocking, rubbing, aspirating, and assessing newborns. The experienced technicians train the new technicians on how to stimulate breathing, tie off umbilical cords, warm lifeless bodies to elicit that miraculous first cry of "hello new world, I'm here!". It is not something we do daily at my practice, but is something that reminds us all that we have a strong maternal tug that science has yet to pinpoint and market in a bottle.

Joey was one of those 12 babies. I was the first face he saw. 

It has been a decade since I joined Jarrettsville Vet. A decade I have spent with thousands of other families. It is a gift that the general practitioner covets. What I lack in credentialed specialty fees of one time patients seeking surgery, echocardiograms, oncology, etc., I make up for in scrapbooks of the passing years. The beauty of adding a patina to the richness that only passing time and tender moments together brings.

Joey and I have been together through every puppy vaccine. The ace bandage that plugged up his intestines requiring his first abdominal exploratory surgery at the ripe age 4 months. His neuter at 6 months old. His next obstructive scare; the pot holder that smelled so good it needed to be eaten at 8 months old. The allergic reactions to some unknown instigator(s) and offender(s). The cruciate repair I did at age 3, which  was also the same year he had his second foreign body removal in his intestines (we never did figure out what that pile of stuff was?). After age 4 Joey was a less frequent visitor, (thanks to the gods his parents prayed to repeatedly). Like many Labs he sort of outgrew his dangerous habits. A few visits for diarrhea, anal sacs, and lumps and bumps sporadically over ages 5-9. Then today, at his 10 year visit it is time to remove a broken tooth. All of those years of lacrosse ball fetching has caused a fractured a molar. So next week our relationship moves into the oral cavity. Our first dental together. The crowing achievement to a lifetime of care and time together. 

Seems I am not doing too bad? A decade with Joey is a fairly accurate list of my veterinary resume that now includes lots of surgeries, vaccines, behavior consults, and a few harrowing moments about just how many times we can easily peek in a belly and incise into the intestines. It is a story of becoming the vet I studied so hard to become. He and I are greying muzzles and appreciation for all that got us here. Like most relationships we are at the place where we know each other and our love runs deep in spite of the many obstacles we faced along the way.

I will see Joey on Tuesday for his first dental and extraction. I know he will wag his tail and run to see me, just  as old friends do.. and I will tell him how lucky I am to know him, take his broken tooth out (worrying about him the entire time, just as I do all of my patients), and when he wakes up I will add another chapter to our book and remind him that I am expecting another decade together.

Here's to hoping that you take a moment to cherish the friends who you share your journey with. Please take time to tell them how much richer they make your life, and make time to celebrate the milestones along the way.

See you Tuesday Joey!

I would love to hear about your experiences! If you have a vet who is a part of your family please share what makes them so special, and how they helped to care for your pets.

If you have a pet related question please visit me on Pawbly.com. Pawbly is a free platform open to anyone who cares about animals. We welcome your questions, advice to others, and helping to build a place where animal care is shared open and freely.

If you would like to learn more about my life as a veterinarian you can follow me on Twitter @FreePetAdvice, on Facebook, or on YouTube.

New Grad Seeking First Job, What Not to Say and Do

OK, this blog needs to start with laying some ground work; the forepart provides credibility, and the second half provides apologies..

I have owned my practice for 10 years. In that decade I have hired 11 veterinarians. I have also  'elected to not retain' all but 4. Now, I am the first person to admit that these numbers are bleak.

Here's my justification for this; I have exceedingly high standards. I am always looking to hire a life long employee. The practice I bought was built on a foundation of this. Jarrettsville Vet has been in existence for almost 80 years. In those 75 plus years I am the third owner. I have a legacy of providing care to generations of families that I hold with great pride and humbling responsibility.

The backbone and ultimate success of providing exceptional care to veterinary patients lies squarely on the shoulders of the veterinarians. The cogs of the practices' engine are powered by the technicians and support staff but the life, death and direction lie in the hands of the vets. My practice is my ultimate responsibility and the amount of trust and liability that is employed by the vets I hire will make or break the practice.

It is a matter of perspective and position.

It is also the preamble to this blog..

I am again in the arduous place of finding a new vet to add to our roster. I have found that this is becoming a more difficult task with each passing year. The list of qualified candidates seems to be dwindling. There are fewer and fewer exceptional vets looking for new jobs. I also know what I am looking for someone who will seamlessly integrate into our existing bustling quirky family. I have gotten much faster at weeding out potential veterinary candidates.

Established veterinarians seek higher paying jobs with fewer hours and more restrictions. Their expertise pulls a higher price tag and a longer list of requirements. Jarrettsville Vet is a place that doesn't turn away pets in need. We are not about the money, therefore, I cannot hire a vet whose primary purpose is monetary compensation. More and more veterinarians are females and more of them have families. They want day work exclusively and in general seem to not want to do much, if any, surgery. I feel obligated to provide evening hours to our clients and we are open 7 days a week. I also want a vet who will be willing to do an emergency surgery when needed instead of punting it to the emergency clinic every single time. I am determined to hold on to a traditional veterinary hospital as we advance our services, reach, and assistance. I am also unwilling to sacrifice exceptional care and medicine. Our clients pay for, trust us, and return expecting these.

When you work as many hours as we do you have to maintain a healthy happy practice. Vets at Jarrettsville Vet have to be liked and likable on top of being intelligent, compassionate, and capable.

So, here I go again looking for a new vet...

There are a few veterinary specific career sites available for posting veterinary openings. This is the ad I posted a few weeks ago;

Small animal, 4 doctor, 7 day/week practice with high quality medicine, equipment, staff, and dedication to caring for our patients and clients. Excellent pay or commission, benefits, and work schedule. Must be proficient in surgery, taking great care of our clients and patients. We provide a happy, healthy, fulfilling place to work, without micro-management. We are a clinic with a big heart and dedication to living by our motto "compassion comes first." Please fax a resume to 410-692-6283, visit jarrettsvillevet.com, or stop in to say hello. 

This time I excluded "DVM equivalents," a choice I had allowed in previous postings. A DVM equivalent is usually a foreign trained veterinarian. Although I do not question their ability or proficiency I have not found any in our rural area. They are vets who live far far away (often the other side of the country, or another country all together). I am incredibly reluctant to hire someone to have them move to the quiet rolling hills of Maryland when I am not confident they will pan out.

That leaves me to getting applicants who are primarily new graduates within our area.

New graduates have their own set of advantages and disadvantages. They universally lack experience, but they do arrive ready to work hard and with the stamina that youth provides. They are malleable and genuine. They also often lack communication skills and the intuition of a seasoned vet. There is also a huge expectation for a commitment on the practices part to hand holding and mentoring.

New graduates are accompanied by a resume laden with graduation dates and locations. It is a short list of mostly irrelevant skills with no corresponding real-life meaning. A new graduates resume only needs two things for me to decide whether or not I will offer an interview. Location and school. The rest is fluff that will hurt a candidate as much as the candidates mistakenly believe it will help them.

Case in point; The sweetest well-dressed soon-to-be new graduate arrives with resume in hand, demure shy smile on her hopeful fresh face. Her resume has no date prior to her college graduation. She, and her overwhelming desire to be a vet, do not appear to exist prior to May 2012.

And so begins her interview;

"So, why did you choose a foreign vet school?" I ask.

"I was getting ready to graduate (from college) and I had missed the fall entry application times for the US vet schools. So, I applied to a foreign school and was accepted."
No qualifications or experience needed. Apply, get accepted, start 2-3 months later. I am left pondering.. Who decides at the end of college that they want go to vet school? Then impetuously decides to fill out an application.... Small road block in timing? It's OK apply to the paid ad that pops up first anytime you type in "vet school". Voila! for profit vet school at your service.

Question number two; "What are your interests within veterinary medicine?"

"I wanted to focus on Zoo Medicine but that takes really good grades. So, now I think I want to focus on physical rehab."
We don't have this at my practice, nor was there any mention of whether or not we might be interested in providing it.

Question number three; "What kind of practice are you looking for?"

"I am hoping to find a practice with a good mentorship program."
Every new vet, especially those without a shred of experience outside the classroom setting, wants and needs this. I admit I was one of these graduates. Any conscientious new vet needs to admit this. I suppose it would be far scarier to have a new vet so cocky that they thought they didn't need coaching? Every time I get an application that says "I love animals" as the 'reason for interest in this position' I want to throw something. "Mentorship" is on par with "I love animals."

As a practice owner I know every new grad need needs to be trained, A LOT. I sat listening to her blossuming excitement to enter a field she appears to know little about, has a path long and bumpy in front of her, and I am still baffled that she never spent a second learning about her career choice before she got herself $200,000 plus in debt.

I offered advice. I knew I shouldn't have, but I was burgeoning with empathy. She probably took it as chastising but this girl is entering a world that can break her heart, or kill her.

I am incensed by the lack of investment and parenting her vet school provided her as they set her out into the real world? It is, in my opinion, criminal.

"Do you have any experience in surgery?" This was a clear requirement in my job ad. There is no mention of it on her resume.

"I have assisted in surgeries, spays and neuters. I am a hard worker and willing to learn anything. I am hoping to find a mentor to help in this area." The overall mood was growing more somber.

"My clients and their pets are a responsibility I hold dear. I am not going to feel right about an inexperienced vet performing surgery on them. I am as worried about your skills as you are." This statement is met by an awed realization.

This is not going well. I cannot lie and assuage her. She was not prepared for honest bluntness. She will either walk away from this interview having learned a few things, and more prepared the next time, or, she will find an employer who knows how to provide alluring smoke and mirrors and make her feel all warm and fuzzy. She will jump on that job, that will either pay her peanuts, which she will now willingly, and knowingly accept, then get dumped on with ridiculous hours without that promised mentor by her side. She will be thrown to the wolves like so many of us are. Or, she will find a practice with other new graduates who will at least provide her comradery amidst the abuse. She will not likely find her utopia.

She will not however be very hard pressed to find, excellent pay, mentorship, and the vital training she needs with transparency. Not unless she works for a family member. No one else can invest the time and attention needed when they are already short handed.

"Do you have any other questions for me?" Our time was running out and the interview was closing.
We had intentionally not talked about money. An employer can tell much about a candidate by omitting key questions. I don't omit to be harsh, I omit to allow her to speak up, stand up for herself, and become assertive. She will need to learn it someday.

"Well, I know I need to ask about salary. Although I know nothing about it." She says, full on smile.

OK, honesty is always the best policy, but, please, don't go to an employer without knowing a few key important facts.

"Here are my concerns. I am assuming that you are in debt from attending the most expensive veterinary college on the planet. For this job to work for you long term you need to know how much you need to make to pay off your debt in a reasonable fashion. If you can't pay your bills you will not be happy here. Do you know what your numbers are?"

Blank stare.

Goodness am I worried about this fledgling.

She departed quickly. We both know that we aren't a good match. I sincerely wish her well.

If you are a new graduate looking for your first job here is my advice;

• Ask about your predecessor? Ask the boss, the other vets, and the staff. If there is not a consistent answer doubt the bosses perception.
• If the employer brags about "all of their fancy equipment" consider this smoke. Look for a mirror, they are lying around somewhere. The real heart of a practice lies in the people, not the stuff.
• Listen and take notes during your interview. I never see a new grad arrive to an interview prepared. They get so flustered and overwhelmed they forget to ask important and relevant questions. We all takes notes during an exam, key pieces of information to formulate our diagnosis, and yet, every candidate I have ever met with sits idly by nodding their heads. Poor SOAP practice.
• Stay unemotional. This is a big decision. Be objective.
• Invest time in knowing what you are getting into. It is unimaginable that so many new grads make a decision after an interview and a few hours on a working interview. We advise our clients to spend hours, days, and even foster a pet for weeks, before making a knee jerk decision to buy, adopt, make a life long commitment to their pet, and there we go being just as impatient and uneducated.
• Don't list other interests that do not pertain to your current job seeking quest. Why would I, or anyone else, want to hire you, mentor you, train you, and then have you leave in a year or two to pursue Zoo medicine, or physical therapy? At least talk to your potential employer about investing in you and a new modality to add to the practices repertoire.
• If you are graduating from vet school in debt you should have a very good idea of how long it will take you pay that off. There are rumors of federal law changing to require schools to discuss the debt you will acquire if you attend. Much like the reforms made to home ownership and credit cards. Consumers should be cognizant of the financial impact of the decisions they make. I know how blind desire to go to vet school can be. But, you will graduate and there will be a life after school. Five years into practice I promise you will be worried about how you will ever get out of your student debt.
• Research the vet, practice, and learn as much as you can before you show up for an interview. Google, Yelp and investigate the Facebook page of the vet practice. Sell the assets you share with the practice and the vets who work there. 
• Remember that a great practice will see you as an incredible asset. You are an investment and there has to be a return on our investment. If you don't fit in it affects the bottom line. If the practice cannot profit from you we will be forced to find another vet.
• Finding a job is equivalent to being a participant on a dating site. You show me your good side, I show you mine. Except I am eHarmony.com, I want a life long relationship based upon trust and knowing each other. Too many new grads unknowingly get wooed into a one year stand with an initial blissful courting period lacking a foundation for a career long commitment. 365 days later those yearling grads are left feeling a little jilted, over promised under-delivered, taken advantage of and left walking away looking for that second boyfriend with the complete opposite qualities that that first boyfriend had. Second jobs are too often rebounds. Spend the time answering the "436 questions to find your perfect match." And, be the smart other half to any healthy relationship, stay out of the minefield of unsupportable debt. Don't want the boyfriend with crippling credit card debt? Then don't be the DVM girlfriend with bankruptcy proof inescapable educational debt.

Important information for new grads.

AVMA guide to Financing Your Veterinary Medical Education.

AVMA Survey Reveals Bleak Situation for New Veterinary Graduates. 2012

Veterinary Practice News, Too Many Indebted Veterinary Chase Too Few Jobs. July 2012

High Debt and Falling Demand Trap New Vets. Ross student owes more than $300,00 after graduation.

DVM 360, Finding Your First Job.

My related blogs;

Too Afraid To Fail. When your fear costs your patients.

My Top 10 Advice to New Vets.

Compassion Fatigue

The Holes In The Safety Net. Suicide in Veterinary Medicine.

I am interested in your thoughts. Please leave a comment about your first job experience, or your thoughts on the veterinary career paths of your friends, I want to hear about your experience.

If you have a pet question you can find me at Pawbly.com. Pawbly is a free online advisory platform to help people and their pets.

If you would like to know more about Jarrettsville Veterinary Center please visit our website or Facebook page.

I am also on Twitter @FreePetAdvice, YouTube and Meerkat @FreePetAdvice.

Refining Your Specialty. A college students project.

I received a request for an online interview. I thought there were some very good questions that I might have benefited from if I had been a bit more inquisitive, slightly  more trusting of those who walked before me, and much less blindly determined to become what I believed I was destined to be.

Thomas

Hi,

My name is Christine and I'm very interested in veterinary medicine. I'm currently a student at XX University and I'm working towards becoming a veterinarian.  I found your blog and I have watched a few of your YouTube videos and I have really enjoyed them. I was hoping you could answer some questions for an aspiring veterinarian. I'm doing a project in one of my classes that is going to help us refine our specialty, so if you could please take a little bit of time to answer these question, it would be so helpful.


Thank you so much for taking the time to read this. I appreciate it so much.
Christine

Hello Christine,
Here are my answers,

1) What do you use in your every day work? (e.g. tools, critical thinking, computer, assistants, etc.)
 I  use my brain, my experience, and a few very important tools that include a stethoscope, microscope, x-ray, computer for patient records and research, and a whole host of ancillary things like in house lab equipment, surgery equipment, laser, tools for the eyes, ears, nose, throat, and the rest of the body (like a scale). Oh, and books, I still use lots of reference books!

2) What is a typical day at work for you?
 Typically I work from 9 am to 6 pm, or if I work the afternoon shift 1 pm to 9 pm. 5 days a week.

3) What are a few of the most important things you need to know to be a successful veterinarian?
You need to know who you are, what you stand for and why you are dedicated to becoming a vet. There will be many challenging days ahead and if your heart and soul are not invested as much as your time and money is you will end up like the many other veterinarians I know who have left veterinary medicine. Many of us enter vet school with the best and most noble of intentions, work our butts off to get in and out of vet school and then leave bitter and heartbroken when the realities of real-life practice settle in.

4) What is something important that being a veterinarian taught you, but that vet school didn't teach you?
That each case is a mystery with a plot, a heroine (or two), a few bad guys (cancer/disease, etc), a long list of characters, and lots of twists and turns along the way. Sometimes there are happy endings and sometimes life doesn't give you a "happily ever after".. but there is always a "The End"..but all the stuff in between the opening line and the last chapter are where the fun, the beauty, and the passion of purpose lie. That's the best part..that's what vet school doesn't teach you. That making connections, living a life you are proud of and that helps others (even if it a tiny rescued kitten that no one ever knows you saved) is what carries you through the tough times.

5) How has social media helped you in your field?
Social media has connected me with people and places I would otherwise never had the opportunity to assist. It is the reason I created Pawbly.com. I can help people around the world take better care of their pets. I have extended my reach and my purpose across all socio-economic and geophysical boundaries.

I hope this helps. I would like to use this for my blog. I hope you are ok with that? I think these were some excellent questions!

P.S. Please think long, hard, and objectively about vet school. No one tells you that  it can cost you a fortune and you will someday be questioning why you spent so much time, energy and money to make so little money. I know no one wants to think about income when you are in high school/college, BUT, someday you will want a house, a car, and to put your kids through college,,, and someday always comes. I worked for a vet for a long time who I loved and respected. He told me everyday to find another career. He said it because he loved me too. Neither one of us ever wanted to be anything other than a veterinarian, but being a veterinarian is hard work. Emotionally, physically, and often financially. I know veterinarians who owe more than $200,000 in student loans and make $50,000. They are 10 years out of vet school and have no way out from their debt for at least another 10  years. That just isn't fair or sensible.

Good Luck in school,

Krista Magnifico, DVM

Wallace

I welcome your thoughts and feedback. Join me here, or you can ask me a pet centered question at Pawbly.com. Pawbly is free to use and open to everyone who wants to help pets and their people.

I am also on Twitter @FreePetAdvice and at the clinic Jarrettsville Vet, living the dream (happy and not-always happy endings) in Jarrettsville Maryland.