Bentley. Hypospadia. The cases you cannot win and the reason you never stop trying.

This is Bentley's story from the perspective of his foster mom... her name is Jenn.

"Our Bentley,

If love and hope could have saved our Bentley we would have had this one in the bag, but Bentley needed far more than our love and hope, he needed a miracle.  The hardest of realities is that sometimes we don’t get to see those miracles come to fruition.  Sometimes all we have is peace in knowing we tried everything possible to save a soul who wanted so badly to be saved.

We met Bentley in March of 2020, at the cusp of a pandemic.  His breeder, (accidental breeding), Kista,  had reached out to anyone and everyone who could potentially help Bentley. Bentley was born at her home, but, he wasn't a normally functioning puppy. Kista found a home for him, however, they became overwhelmed with his care and returned him.  After visits to numerous veterinarians and specialists she too became overwhelmed.  A costly surgical plan was laid out with no promises.  Funds were raised but not quick enough and not to the extent to cover the very costly surgery.  Bentley’s breeder knew either he received the help he needed, or, he would have to be humanely euthanized as his life had been reduced to suffering.  You see Bentley was born with deformities to the urogenital system that left him constantly leaking urine and in a constant state of infection; both in the form of urinary tract infections and severe urine scald and subsequent skin infections.  At only 5 months old Bentley associated any touch to his hind end with pain, and rightfully so.

The night we met him a quick gaze into his soulful milky-brown eyes and we were smitten.  Bentley wanted to live and he was worth a try.  The stars aligned; a rescue we often work with was available to have him signed over, donors promised to honor their donation and a skillful surgeon all came together along with our team at JVC.  Four days later Bentley received his surgical consult with Dr. Runnels, he was a candidate for surgery, best case scenario he could be fixed both internally and externally and live a happy healthy life, worst case scenario he would continue to leak urine.  Bentley had a surgical plan….and hope.  A week later he returned to Lititz Veterinary Center for surgery.  Surgery revealed ectopic ureters, a challenge to say the least, surgery was completed in the wee hours of the morning and two days later he was in his foster home.

Initially we were hopeful, Bentley seems to have some bladder control, his urine culture revealed antibiotic resistance and gave us an idea of which antibiotics to treat with.  A week of IV antibiotics and he seems a little better.  A happy, playful puppy emerged.  Full of wiggles and wrinkles and kisses.  His foster mom, Jenn, bathed him three times a day to keep the urine off his skin and his skin healed.  He met his happy-go-lucky furry foster sister and the two-legged foster siblings too.  He loved everyone he met, except the cats!  His foster dad practiced leash manners with him as they spent many hours walking together.  We wish life could have continued like this for Bentley.

One day Jenn noticed a second opening while Bentley was urinating; during his surgery an opening was created just under his anus for him to urinate from, one opening.  Now there were two.  His leaking increased and progressed to absolutely no bladder control at all. For all of the bathing and giving him fresh towels for bed, by the morning he was sloshing in his own urine, towels drenched puppy pads under his crate saturated.  Excitement and playing with another dog meant both dogs were quickly urine covered….and in need of a bath.  Bentley’s life was reduced to a crate or pen, towel changes up to eight times a day and constant sponge baths.  We had seen the result of keeping Bentley in a diaper, severe urine scald and skin infection so that option was off the table.

Dr. Magnifico and Bentley

Bentley returned to Lititiz Veterinary Center for a procedure that would send dye through his urinary tract, allowing the surgeon to make sure the urine was following the path it should.  The good news was that it was, the bad news was that there were no further surgical options.  The surgeon noted severe deformities to his anus. She told us how sorry she was that he was out of options, Bentley was such a sweet boy, all who met him at her office fell in love with him too.  A recommendation to try medications designed to treat incontinence was made.  We started him on Prion and once again hoped for the best.  Within a week Bentley began to show signs of fecal incontinence.  Even if he eliminated outdoors he would leave stool “nuggets” behind in his crate.  Keeping Bentley clean was a challenge, within minutes of cleaning him up and giving him fresh towels he was once again covered in his own waste, now not just urine but feces too.

The heartbreaking reality that Bentley’s tomorrow would not be better than today set in.  He was condemned to a life in his own waste.  He would never be able to do all the things that other dogs do; enjoy rides in the car perched on the backseat, snuggle in bed with his people, lay beside his own little boy or girl’s bed at night, enjoy movie night on the sofa with his people, play with other pups.  He would always need to be on a hard, non-porous surface so it could be scrubbed clean multiple times a day.  He would battle reoccurring UTI’s and live in a constant state of nausea.  He could literally fall into a state of serious neglect in a day’s time.  This wasn’t even worst-case scenario; it was so much worse.  Was Bentley left with quality of life? And worse where do we go from here?

We are left with peace in knowing we gave Bentley every chance we possibly could at a happy, healthy, normal life.  We spared no expense, we left no stone unturned, he was so very loved by all of us but especially by his foster family.  We never gave up on him, his fate was sadly decided in utero when cells came together as they should not have, we tried to undo what was already decided.  Sometimes we do not get the miracles we hoped for, but that will never stop us from trying."

Jenn and Bentley

Here is Bentley's story from my perspective. The veterinarian who gets too many calls for cases like these and has a very hard time not trying to help. It's a sticky predicament knowing you are the last stop. Knowing there aren't any options past you, and, telling someone who cares and wants to save their doomed companion that they have to give up hope. 

Bentley's story began with us, and by "us" I mean me and the Jarrettsville Veterinary Center crew, which is after all where he resides now, months ago.

His story with us started the way so many of them do. A friend had a friend who knew someone who had gotten a phone call/email/online request for assistance, "and, well, they know I get a lot of requests for veterinary help, but,, could I maybe look at this case and see if I could help them?"

The cases vary only in a few details, they are all in some panicked state of duress, and they all need much more than a leg up. They almost always need an immediate take over of medical, financial and everything else. The sick and the dying quickly are my forte. These are exactly the cases I want to help, and, exactly the cases no one else does. 

Most, dare I say, all, professionals prefer the cash replete, minimal output, not asshole clients. Add duress to almost any scenario and people morph into one of two characters; humble and grateful, or, angry, demanding rabidly vicious. Even under the best of circumstances I have grown unwilling to assist the asses. Let them take their problems elsewhere. There is a whole genre of medical professionals who don't want to know anything about you other than your ability to pay and their ability to meet your medical need. niceties don't matter to them, just as your face and your pets don't either. you will come, you will go and  they don't care as long as you pay. 

Bentley was one of the rare cases who had someone who cared so much they would make whatever personal sacrifice they had to just to do right by them. These people, the compassionate few without personal gain other than peace of mind for having a pet they love be helped are my cup of tea. They are my brethren, and for them I do crazy feats.

Bentley had a congenital disorder I had to look up when it was proposed to me. Bentley had hypospadia. He was four months old and his mom was desperate to find help for him. She was desperate for him to have a chance at a life outside of the only option she could afford; euthanasia. She had spent all four months  of his life looking for any possible way to give him that chance to live.

When I told the foundation who was offering to pay for $1000 of the $6000 she  needed to "try" to fix him that they could give her my phone number so we could talk about him the story of Bentley and JVC began.

"Hello, Kista? It's Dr. Magnifico from Jarrettsville Vet. How are you?"

And so it began. My last words for that phone call were what they too often are; "if you get to the point where you have no other options for him other than euthanasia call me back and I will take him to see what we can do." 

She was, and has remained, so genuine in her words and her intentions that nothing regretful can come from this. She has been 100 percent committed to him, and we have done the same in return. i cannot tell you that this story will have its "happily ever after" but, i can say that Bentley was loved and cared for every moment of his never-quite-right life. He has had what so many other perfectly healthy but never having known kindness for lack of specialty or luck of the draw.

Bentley's life lacked luck from inception, but, he always knew specialty. He was a special boy with a birth defect that the majority are culled for. It is just too difficult to treat. It always requires surgical correction, always at the hands of a boarded surgeon, and it has a pessimistic success rate. In fact it is so abysmally low you are less than 50%. more often than not it is not fixable. For these reasons I have never seen it. I am not a veterinarian for breeders, and breeders don't keep the puppies that they can't sell or breed. 

Bentley's beginnings begin with Kista. She is the person who was there from birth. Here is her version of his story. She was his champion. She was the person who pushed beyond all of the "no's" from all of the people she begged for help, and just kept pushing. She is what every child deserves, what every desperate soul in dire need of interventional care needs. She never gave up on him no matter how many others did. When she called me and told me about Bentley her dedication to him moved me. She is the person I wish every parent (pet and otherwise) would be. She is the reason I became a veterinarian. 

Bentley was born 9/1/19 (originally named Bear)
The first of October Bentley visited Oppossumtown Vet- they had no idea what was wrong with him so they took pictures and sent an email out to several veterinarians.
10/7/19 Opposumtown Vet called stating he had hypospadia.
I reached out to VSC in Leesburg, Chesapeake Surgical Specialists, and Dr. Walesby. Dr. Walesby recommenced that Bentley be at least 6 months for surgery. I made an appointment for Bentley to see Chesapeake Surgical Specialists in Columbia as they were the closest to my home outside of a surgeon in Frederick with bad reviews.

A lady had told her friend about Bentley and she wanted to meet him. Once she met Bentley she asked to take him home that night. I told her that I really wanted to wait until he seen the surgeon the following week as I had no idea the cost of the surgery but it had to be over $1,000. She still insisted on taking him home on 11/19. On 11/25 both Bentley’s new owner and I took him for his consult at Chesapeake Surgical Specialists. They recommended an ultrasound. An ultrasound was performed the following week. They estimated Bentley’s surgery to be $2500-$3500 plus $1500-$3500 to scope him first. This was way more than we expected. A GoFundMe was set up with Bentley’s new owner as the beneficiary. That raised $200 (I assume she used that for vet bills/antibiotics as she did not give that to me when she gave Bentley back to me). I reached out to the Frederick Humane Society who stated they may be able to help with $100 if we raised enough money. 12/27 reached out to Helping Hands in Richmond Virginia to see if they offered a low cost surgery option for hypospadia. Unfortunately they do not perform that type of surgery.

1/17 I reached out to U2SA who originally agreed to donate $550. They than Increased offer to $2000. They paid for Bentley’s owner to see there vet (Buckeystown Vet) and they recommended Bentley see a surgeon in Pittsburg and that it would cost around $6,000. U2SA then lowered there donation to $1000 as they did not feel hopeful but stated that they had a friend who would donate $500 (not sure if they ever sent that to Lititz) Buckeystown vet reached out to vet school in Blacksburg. Cannot do at low cost.

I contacted Barcs the end of January they were unable to help and referred me to Saving Grace Animal Rescue. I reached out 2-3 times and never heard back once I sent his ultrasound and estimate. This seemed to be the normal for most rescues. Very few got back to me.

Reached out to Little Angels pet haven and rescue 1/3.

Reached out to Pitbull and Paroles in January. Never heard back.

Reached out to Bissell pet foundation 1/22 never heard back.

Reached out to Sleepys dream 2/8. They are unable to help.

2/10 reached out to Rescue Well. They checked around for a rescue for Bentley with no luck as well.

Reached out to Always strong pitbull rescue 2/10.

2/12 Save the misunderstand.org no response. tara’s house- unable to help. Key to lions heart rescue- too much for them to take on.

Buddy foundation offered $1000.
Thought I had enough in donations with 2000 from u2sa and $1000 buddy and$500 thru me until I found out they wouldn’t do surgery without scoping costing $1500-3000 more.
2/24 Melinda with buddy foundation referred me to you!

2/26 reached out to Kennedy K9 camp. He said he would share the news and let me know if he found any help.

Reached out to McPaw and they were unable to help. Reached out to Animal Welfare League of Frederick and they were unable to help. Also reached out to Facebook page “I Love My Dog” and asked if they could share his GoFundMe. Reached out to Last Chance Animal Rescue and they shared his story.

Reached out to J and j trash service and family friendly to spread the word.
Reached out to the Aspca. Reached out to several others by phone and web forms but cannot recall the names.

What would you do for your pet? What if you felt personally responsible for their very survival? Aren't we all in Kista's shoes, and, aren't we all a parent of a potential Bentley?

Where are we now? Bentley needs help. He needs a miracle. He needs someone who will love him even if he cannot be perfect. He is a pup who is incontinent. An ailment that affects millions of people, but, people have options to stay clean and dry and manage this. Bentley can't live in a diaper. He cannot live outside like a wild animal. It is a long shot and a big ask, but, we have to try.

I wish I could say that I heal every patient who crosses my path. I wish I could say every case is a happy ending. I wish I could say that it is easier just passing the hard ones to someone else. Except in almost all cases there is no one else. I know this. I feel compelled to try. No one wants to try anymore unless they are adequately compensated. I took Bentley's case because the only option left was euthanasia. This might still be his ending. Not happy. Not a success, but, as in some tiny measure of hard to swallow acceptance that there was hope. we all need hope even in a world of not so promised happy endings.

If you are interested in learning more about Bentley please follow us on our Jarrettsville Vet FaceBook page.

I am also available on Pawbly.com. It is a free information exchange resource centered on pets and pet care. We are always hopeful to have experts from all walks of animal kingdom life. Please join us.

I also have case based videos on my YouTube channel. 

Being me... Who do I blame for my grief?

This is a blog written in response to a meeting I had with a group (I'll call them Joey's Group) getting lots of attention in both the private arena of veterinary medicine and the many veterinary groups where vets seek shelter from the too often cruel world we live in. Pet parents who feel their pets suffered at the hands of their veterinarians  are growing angry to the point of building support groups centered around their pets injustice. I contacted them to try to understand their feelings and thoughts as well as try to understand their advice on how to resolve the injustices they feel are occurring. I also feel that I align with their pain more often than the vet forums my profession has created. I love my pets like they are children. My life is devoted to them. Losing them is an unbearably painful experience. Trying to imagine how that grief would change when I believed my pets loss was due to malpractice would probably make that pain morph into anger fueled by seeking retribution just so they could hurt a little bit as much as I was. This group wants more accountability, more legal means to seek compensation, and license consequences much harder and easier to obtain than presently found in the veterinary leadership. These members are hurt, angry, and now organized and seeking vengeance. Here is my attempt to introduce the difficulty that being a practicing veterinarian in this climate presents. This blog is not to chose sides, it is to attempt to inform based on my life's experiences.  

Our annual vet clinic Pets With Santa photo

I love my pets more than anyone could imagine. I also know that when it comes to that time of losing them it can cripple you. I have felt as so many of us do; that no one can understand my grief, my loss, and that only I can feel my palpably paralyzing pain and suffering. What do we do when the grief is so consuming? We either fall into ourselves as the introvert and hole up with the hopelessness so it drowns us in despair that feels too suffocating to begin to contemplate addressing, or, we lash out. We use our anger to fuel the pain of the grief that we know we must do something about, but, don’t want to lay up all emotional over. Putting that grief to something that makes a difference, fuels a purpose that gives that life you miss so tragically meaning, well, that’s the harder, longer more arduous path.

I wish that I could tell you I consistently chose the last. Unfortunately, I am a mom who has tragically and utterly bereft with grief in losing my two beagles, and my dear diabetic cat who (almost) broke me. To make their death even more bitterly corrosive I feel that I can only blame myself for their passing. I am after all a veterinarian, shouldn’t I above all others be able to make miracles happen? Isn’t that the reason I went into vet school to begin with? I dedicated my life to them, my career, every tiny tidbit of my professional knowledge base just so that when the time came that I needed all of those tools, resources, pearls of knowledge, I could bestow all of it into some cumulative tsunami of healing re-genesis. My kids, my dear beagles, cats, (and yes, two potbellied pigs), were, and, should have lived forever because I have spent every moment of my life to make that so.

My Storm. Who saved who?
Rescued before minutes before euthanasia. He had just been surrendered to a NC shelter who was about to kill him as they all evacuated an impending hurricane.

Of course, life is that elusive magical thing that only insures one other thing; death. We are all going to die. That inescapable ending looms for all of us, even those of us who deny it. 

What do we all have in common? How do we start to understand why I react, or not, so differently than you? We all love our companions as our own family. We allow ourselves to be vulnerable. It destroys us when that leads to heart break. My dearest friend lost his mom and his dog within 4 months of each other. What hit him harder? His dog, he confessed. I just last week lost my mom after a swift devastating 6-month battle with breast cancer. I have also lost numerous dogs, cats, pigs, and although each one reduced me to a puddle of emotional waterfalls, but my moms’ passing lingers in a different way. I can’t even quantify one versus the other, but, where grieving fatigue burdened by responsibility pain struck me with the pets, I am angry-furious about her loss. It is a different kind of anger that I didn’t have with my pets. Why is that? Well, because in my mom’s case I wasn’t in charge of medical care. Her medical team (all 20 or so of them) smiled, held her hand and then went on their merry way to their next patient. They gave paltry advice in dribbles of meaningless drops, and in the end, they failed her a million times over. She died in pain because it was the only way to treat her relentless and excruciating pain effectively. Palliative care was an afterthought. I say that because for 5 months her biggest single request was help with paralyzing pain. Always too little too late. I blame them not for her cancer, but for her suffering. I have lived a life as a practitioner never exchanging one for the other. Palliative care is as much apart of every treatment package as antibiotics and vaccines. They are interwoven, interdependent and unwaveringly provided upon each other. Diagnostic tests, referrals, care in all forms and fashions ALWAYS comes with the patient’s comfort placed first and foremost. Her doctors wanted tests with answers before focusing on her pain. When asked what she desired most she would reply every single time with the same singular answer; "help with the pain." They got all of their tests, (which took forever as she suffered), and she was only pain free for the two weeks before her death. Furious, unethical, malpractice. She, and all patients, deserve better. So, you see I understand loss and grief, and yes, blame too. Where do I go with this? I make my decisions as a veterinarian with an open honest heart. I remember with each patient that my job is to serve them, my furried calling, (the puppies, kittens are the ones that break you). You see as veterinarians we have to serve multiple parties. Too often I have to make an immediate on the spot and under great duress choice about loyalties. In some cases these cannot always be to serve my clients, the people holding the leash as their motives are not as transparent. Human motives are complicated, sticky, and it makes me incredibly vulnerable to try to unravel theirs as I try to focus on unraveling my patient’s needs. Add to the burden of paying clients seeking care that is not always putting patient needs first, I also have to answer to public health threats and law mandated requirements. I truly have to decide who outranks whom. Do I put the patient first (my heart always does), the government public health requirements (ever worried about whether your life is in danger because you might have been bitten by a rabid animal? What about the four year old kid that was?), or, the client who is abusive and threatens you if you don't give them what they want? (Ever gone to court to get a restraining order on them because you really fear they will show up and unload an automatic weapon on the whole lot of us?).

I want to end my moms story with a few thoughts. I went with her to every appointment. I brought every concern to their attention. I asked my mom at every interaction “what her goals were?” I never, ever let them lose sight of her in their process. I have a very clear conscious about what my intervening on her behalf brought us. She is not me. I fight. She wanted to be comfortable. Do I wish I had mettled with her medication plan? Yes, I would have adjusted it every 3 days when it failed to deliver. I would have put my license in jeopardy as they were unwilling to do with theirs, (I suppose?). But she would have passed away sooner, which would have been my choice, it wasn’t hers. I have to forgive for the things I cannot change. I am working on it.

My pups. My life.

There is a bond we have with our pets that elevates them to children, best friends, companions we fear we cannot exist without. That’s what all we have in common, you, the pet parent, and me, the veterinarian. That love, devotion and companionship drives us to madness, feeling broken, shattered unable to go on without them. It is loss at its most intense and we try to replace that loss with suffering elsewhere. We try to blame. I live it, I know it, and I also know why I do it. But, I also know what it is like to live a life as a veterinarian who feels vulnerable because I am a human. I make mistakes, assumptions, and I am asked to be someone I am not too often. I am not everyone to every case. Human medicine is built upon referrals. Clear defined lines in the sand with boundaries. My mom was shuffled to the point of being a patient under numerous specialties; oncology, surgery, nephrology, general medicine, and even mental health. She was not my mom for those few minutes in their office that she waited weeks for, no, she a time slot and a quick visit, then shuffled to the next hat in the next specialty. All of that fractured care meant not one of her medical team was personally invested. That’s what veterinarians never hope to be, and yet, pressures dictate we must too often. 

My Fripp. The girl who reminded me I could forgive, move on, and love again.

Perhaps this all sounds foreign to you? Let me try to explain how different it is to be a veterinarian in a humans world. This is how your vet sees you and your companion in a time of medical need;

• Established client-doctor relationships. Does your vet, or this vet caring for your pet, know you? How can I if time hasn’t provided the luxury or history? I am incredibly blessed now to have been at my practice for 15 years. The first five were painfully rough. I wasn’t the vet they were used to. I wasn’t the old charismatic-charming-congenially and perpetually smiling guy they had know for over 3 decades. I was the newbie. Which pretty much equates to "worthless". Having the advantage of knowing your clients allows the assumptions (the deadliest part of this profession) to be a little more palatable. For example on an almost constant basis I know based on previous experience how each particular client values their pet(s). I adjust my internal and external patient plan based on this. 

• Value is influential. I suspect that based on knowing and being a part of Joey’s audience, it was the most influential factor. If your veterinarian had known what the value your companion brings to your life it would have, (might have?), changed everything? If your pet is your life tell your vet. Ask for "gold standard" of care. Make it public knowledge that your pets life is of paramount importance to you. You may assume that everyone feels this way about their pets. That everyone thinks the sun rises and sets on their whiskered wet nose, but, believe me they don’t. Here’s what you don’t know. Loads of people do not love their pet as much as you and I do, or, even a tiny fraction as much as you do. Or, they have struggles in their lives you cannot imagine, nor perhaps even relate to. If I know I cannot be the Jack-of-all-trades to every patient don’t I also know that I cannot be the vet to all people? Should my absolute requirement to keep my business alive, which is also the lifeline to my staff, influence who I am for them? Do I take on cases I know I want no part of? Can I afford to do that? Decades ago it was expected that every vet take on every case and you that you adapt to the clients needs and demands, and, you do it without judgement or personal reflection. The vet I bought my practice from was beloved. I had shoes impossible to fill. I was lucky enough to not need the same degree of financial stability most other new practice owners, and, new graduates, need. I got rid of (yes, harsh term but true), about 30% of his clients because trying to be who they needed me to be was going to kill me, or, at least bankrupt me emotionally to the point I would have to kill myself (in some degree) or walk away from the part of me I had worked forever to manifest. He was the vet to everyone regardless of what that meant to the patient. He had clients who wanted to euthanize because it was cheaper to "just buy a new one." And so he did that. I am not second guessing his decisions, I am merely saying I couldn't do what he did for the reasons he did them. He never lost a client, I never euthanize a treatable patient. There is the right vet for you out there. I wasn’t the right one for part of the population he called his own. Maybe it would be helpful for every client to know their vet as much as they love their pet before disaster strikes? Understanding a pet’s emergency warrants a referral to an emergency facility. Understanding that they don’t know you, or your companion warrants a willing ready and able compromise that you are going to pay twice as much at the ER as you will almost any other general veterinary practice. Being honest implies a degree of humility that all sides are arguing for more of. 

• Money decides almost every case. There is almost no pet insurance in this country. Humans can walk into any ER at any time with any condition and they must be treated. Not so in vet med. You walk in and you are expected to pay. I can tell you that most clients decide patient care (even for their most beloved companions) based on price point. If you have a price point you are obligated to state it up front. If you don’t have budgetary limits go to a referral hospital at every occasion that your pet is not acting perfectly normal. It may not seem intuitive but let’s use human medicine as the example. Asking your GP to see you when you are vomiting/diarrhea blood, or poorly responsive, or purple, labored breathing, weak, unstable, etc., is ludicrous. You know, at least I hope you know, that every single human medicine receptionist and answering service in the country starts with “if you are having a life-threatening emergency please hang up and go to the ER” statement. For all of the veterinary audience expecting human grade care go to the ER, not your vet, at the onset of an emergency. You will absolutely need immediate access to funds. These days you should expect an upfront deposit of, up to, and perhaps significantly more than, $5,000 available on credit cards or in cash. Do you have that if it is 2 am on a Sunday morning? The expectation that your companion is your life and we veterinarians are all about the money leaves us no place to move forward cohesively or productively. This is the dilemma vets face every single minute. Invested and devoted pet parents want the highest standard of care, but, they cannot, or too often, will not, pay for it. Try being everyone at every price point to strangers. It’s a landmine field of fear-based existence. It is one of the many reasons we have the suicide rate we do. 

• Blame the other guy. The best way to understand who is to blame is to accept that we are all party to the case at hand. The rest of the hurtful banter is fuel for litigation. Where most victims feel that they had no party in the disastrous consequences that unfolded I can say from experience that losing a pet is not always unavoidable, but, if all parties were respectful, kind, patient and willing to listen the outcomes don’t need to scar everyone indefinitely. Medicine costs money to access and provide. I often have clients come to me with an open admission of having “$50 only" for care. The exam at my clinic is $45. Can anyone really expect a treatment plan for $5? Yes, they indeed do. Where others would say it is impossible, I would add it is my ethical obligation to try. In all cases of a client with a pet in need every patient is seen. After that an open honest conversation is had. The truly compassionate people will listen. The others get angry. Here is how these real-life cases unfold. For $45 dollars I perform a thorough physical examination. I am obligated to give my honest assessment. I rarely know the diagnosis by an exam alone. I then offer my diagnostic plan and proposed treatment options. A list of all of these are made with the appropriate cost estimates for each. If everything needs to be declined we focus on the treatment options. If all else fails, i.e. we cannot find a friend to help financially, we construct the best plan possible based on the options at hand. I will write a script to be filled at a big box store, or, donate to the cause myself, or, use funds from our Good Samaritan Fund, or start a social media campaign (with permission of course), or even offer to have the pet surrendered if the cost of care and, or, follow up care is believed to be too great. What often happens? A client gets irate. I hear things like, “I am all about the money.” Which I clearly am not if I let them come in the door with only $50. Or, worst of all, “I would rather have him dead than with anyone else.” Well, doesn’t that let me know how invested you are in your companions life? Those are the people I know I cannot help. The anger will kill us all. It makes it hard for me to like what I do, hard for me to remember where my allegiances lie, and hard for me to find that common ground. Anger will be the death of medicine. Not malpractice, not mistakes, liability or standard of care. Anger. You cannot love and let anger rule. Think this isn't really true? Meet Mufasa. He is at my clinic now. More on him here.

• Mistakes happen. People aren’t prepared for the emergencies that present. (That is the clients fault, right?). They aren’t prepared to make on the spot hard decisions which have to be made because pets aren’t people and the ER cannot provide care without consent. (Which we should add would also influence your ability to euthanize when you feel "it's time"). My mom, well, I wish she had this option. Suffering is something that should only be saved for the human who elects it for themselves. We've already discussed how people are expected to know things they cannot know; like whether you love your pet above all things. Whether you can care for a sick, debilitated animal, and whether you will walk away from telling the vet “to do anything and everything possible” and not feel like your vet profited from your pets ending in suffering. Who makes these mistakes? Are they all based on assumptions with unrealistic expectations influencing a vet to offer any and all possible treatments, even if they think your pet is going to die anyway? There is a consequence to every action and decision. Isn’t it more honest to say that both parties are responsible for a pets care and eventual outcome. Vets love to use the line “if you cannot afford a pet you shouldn’t have one.” Or, “having a pet is a responsibility, not a right.” Both are so offensive they drive a wedge of hatred into our clients we ask to trust us. Both are so counterproductive to both sides we must abandon them.

• Resilience. Why are the vets so cold and callous? Well, because life, our ability to survive, and I use the tag line all the time, “we all have to get out of this alive,” depends on our own resilience. Try euthanizing a treatable puppy because its owner knows its cheaper to euthanize than treat, and that puppy has about a $50 value to them. What would you do? Let’s add the fact that if that owner tells you to euthanize you have two choices, euthanize and harden your heart so you don’t have nightmares for the rest of your life, or, say no, and imagine it being drowned in the bathtub at their home. Which by the way is legal, and/or at least almost impossible to prosecute. Most vets know the death at their hands is far more humane, so we do it. How do you feel about our life choices now? Oh, and for all of you delusional Polly-Annas out there, I always, (ALWAYS!) offer to take the pet myself. Want to know how many people take me up on that offer? Less than 20%. They are offended. That makes them feel like they are a shitty person. They would rather have a dead pet than feel responsible.

• Abilities. Do you know how hard, like impossible it is to be the Jack of all trades? How can you be the master of any while you are trying to wear all of them? This expectation is unrealistic. A good vet will try to dabble only to be able to recognize when it is time to refer to a specialist. Think there isn’t a can of worms with that? You would be wrong. Many clients will become irate at the mention of a referral. Why would I dare assume that they can afford that!? If I can’t fix it, then, it isn’t going to be fixed (thanks for the pressure). Or, (and this is the excuse I most commonly get) “Doc, I trust you. I don’t know them. I don’t want to bring Fluffy anywhere else.” To which I always reply, “thanks, but we are here to do what’s best for Fluffy. She will be better served by someone who only focuses on this particular ailment.” What I really want to say is, “you are setting us all up for disappointment, despair, and an unhappy ending.” I would guess that 75% of the time people won’t go to a referral. At least on the first visit and recommendation. I can get a client to go about 50% after the third request for a cardiology consult.. that’s usually three years later. Not the optimal time to intervene on a heart condition. And yet, still I am so grateful they finally are willing to go I would never elucidate that disappointment. Think a human GP would do a heart assessment on you because, well, ya know, you know her and it is so much more convenient to not have to make another appointment or waste a trip elsewhere. NOPE!

People are hard. Pets, the whole driving force that veterinarians chose to work harder, make less money and deal with grief that drives a suicide rate every single pet loving person should be compelled to act on behalf of, are easy. Pets will not give you a false sense of security. They won’t take their grief and use it against you. They won’t blame you for loving them, although they aren’t always understanding of i.v. catheter placements, nail trims, and restraint. They are pure live in the moment unconditional love. They are why clients, heck even ourselves go a little crazy on the grief scale bereavement.

After all that spilling my guts to you, ranting about how incredibly hard my job is, how I am routinely set up to fail, asked to do impossible things and then expected to be a whole, fulfilled person on top of that, where do I go now? I am brutally honest. I fess up. I make hard calls. I clearly know that I am in the profession I have always wanted to be in. I treat people fairly. I love unconditionally (patients absolutely, people I am trying). I do not judge. I assume everyone loves their pets as much as I love mine. If they don’t they need to find a vet that suits them. I say no, a lot, and I stand by it. I don’t do convenience euthanasia’s. I don’t turn away clients who need me. I am transparent, honest and accessible. (Want to see for yourself? Go to my YouTube channel, my blog KMDVM.blogspot.com, or Pawbly.com to see real-life cases with costs of care included.) I stand by my patients every  time they need me. I call the authorities on neglect cases, and I stick my neck out for pets every single time. It has cost me huge. I will walk away still liking how I am, even if others don’t.

What is my job now? 

• Forgive. I have to know that I always did the best I could. It was never able to be perfect, but perhaps the flaws remind me that it was real. I got to live it. The textures added the uniqueness and that was what made it recognizable to me as my own.

• Let go so I can love again. Jumping back into another companion has always been fraught with too much scrutiny to make it easy. The one truly amazing part of my profession is that the more I put myself out there to help the more disastrous cases I place myself in the path of, (the moth to the flame), the more lives I learn I could make a meaningful change to. Hiding as the introvert so my grief, fear, anxiety and depression wallow over me leaves me just there. I may not be able to see out of this place when I am in it, but, damn I hate only knowing that landscape. Go to a rescue, hug another pet just for the sake of feeling their warmth. Jump back in. you will never be ready so don’t wait for that stop on the road of life. Try. You may fail, but the real magic only happens in the risk taking of trying.

• Not forget the whole reason I came to this place. The joy my kids bring to my life and the perspective I have to chose are those that tell me my life still has purpose. If I allow myself to stray from who I came here to be, allow the pain and loss to define me how is that a memory worth preserving. Action is an admirable quality. Putting someone before you is unconditional love, and remembering that forgiveness is the peace gained from a life well lived if only how it brightened others is the real magic to a perfect love story that never lasted long enough no matter how you tried to preserve it.

To the vets out there still assuming, still wondering about the expectations of our clients we don’t know well enough to dare to guess, and to those of us struggling with not being perfect at every avenue of medicine, I want to remind us all that we know who we are. Why we came here. You have to get out of this alive. For me, that is doing more than I have to. Being braver than I think I can be. Jumping back in when the lunacies of life pop-up in front of you, and yes, helping every furried creature that crosses my path. I cannot save them all but I am damned sure never going to stop trying. I have to take only myself to my grave, I darn sure don’t want to spend eternity with her still being angry that I didn’t try, and still like and respect myself along that long road to my coffin.

Here’s my advice for Joeys members;

1. Interview your vet beforehand. Tell them who you are, how you feel about your pet and what you are willing to do for them. Put that in your pets (all of them) medical records.

2. Expect a bigger bill when an emergency strikes. Also expect to be sent to an ER. Be prepared for both of these and be grateful for both.

3. Go interview the ER. If you are unhappy with them interview others. Here’s a pearl; go to a veterinary teaching hospital at any and all times possible. They are exceptional in all areas of companion care. You will never get better service or a more reasonable fee. 

4. Avoid corporate veterinary care if you are financially restrained. They are, in general, less willing to work with clients who need help with cost of care. 

5. Have available credit for emergencies. They will happen so you should be prepared. 

6. Ask to record every moment of every conversation with the vet (write down their name(s) and vet staff (names). If they are recording you, which most are, then you should be granted the same. If they decline write every word of every conversation down. Leave a copy with them as you leave. Paper trails matter more than any other piece of legal fodder. Sign the copy of the account and make a copy for them in their presence. If they deny a copy make a note. 

7. Ask for a copy of the medical record upon your departure from the clinic. If they do not have it ready ask them how long it will take? Tell them you are making a note of their response and return on the day and time they say it will be ready. If they decline make a note ask them if they would like a copy of your notes? Sign and date with time. (note longer than two days is unacceptable by most board standards, unless the patient is still present for care).

8. Never leave your pet behind if you don’t feel confident about it. Stay at the hospital. Tell them you are staying. Be a pest. Not rude, but your pet, like my mom was, is your responsibility. 

9. If you aren’t comfortable there move to another place. I am not the vet for everyone, I don’t even want to try to be. Its ok to admit that.

10. Have a follow up plan for each visit. If they aren’t telling you what to watch out for, and what to do about it, then you don’t have a follow up plan. Ask for it is writing. Every vet, like every descent doctor, has you leaving with a written plan. Accountability only follows reputability. 

11. For the crowd holding torches remember the anger and threats breed more of the same. Transparency is two-way, honesty is the same. I know that vet med lacks transparency. It is our greatest fatal flaw. It sets us up for unrealistic expectations. Lacking honesty is a grave sucker. No one goes through life happily if they aren’t honest. You cannot demand others have ethics or honesty. So, we are left only to be the example.

Want to know how is the center of every decision, action, and motive I have? Here it is.

Who are you here to be? And whose hand of loyalty do you hold? For veterinarians these are too often a difficult questions to answer.

If you would like to know more about my side of the exam table please find me at the following;

Pawbly.com. It is a place for all pet people to exchange information to benefit pets worldwide. It is free to use. We are always looking for credible, reputable pet care experts to offer advice, and we welcome people posting their pets stories so that others may benefit from them.

My blog can be found at KMDVM.blogspot.com. It is called “Real-Life of a Veterinarian” and that’s exactly what it is.

YouTube is Krista Magnifico, DVM. Meet my real cases and my real-life responses.

For everyone struggling you are not alone, your pets are never forgotten. Be well and I wish you peace. 

I’m wishing the same for myself. 

COVID's prisoners. Dying in the age of a pandemic. My moms story.

Vacuuming ants off the table. It’s what I do now. Daily, let me add. They are there not because of the flowers I cut for her yesterday, (as she chooses to believe), but, because there is always food on the table, or, around the table, or, under the table, (found a half an orange there yesterday, desiccated and chewed clear of its pulp). Food lies in small unbitten nibbles everywhere around her make shift hospital bed. All have been placed there sporadically, sprinkled throughout the day. There for encouragement. Should the fancy strike her. Which these days it rarely does. The ants keep her honest at least.

The hyporexic is my mom. She has stage 4 metastatic breast cancer. She needs a lot of help these days. The whole COVID crap has made dying a much lonelier event than anticipated. I have become the nurse and the house cleaner. My dad and my husband are the only others on her visitation list. It’s a small tight group. We all know too much about each other. It leads to fighting most of the time.

Hence, I vacuum. Or bide my oversight time cleaning, often.

Like all things in these days nothing is easy. To get to the vacuum I had to beat back the dust around and within the broom closet. To get it to turn on it had to unbury it from the cobwebs that quarantined it. To get to that I had to uncover the post Katrina WHO deposit of stacked bottled water that could serve Flint for the remainder of the year. This is the broom closet of a husband who never had to do housework before his wife fell ill, and, the paranoid couple who refuse to drink tap water after moving from a farm with well water. Trying to convince them that there is at least some oversight on the town water supply versus the farm well that I once saw a dead ground hog floating in is like yelling at the tornado to stop at your doorstep’s threshold. There is a mole hills mountain of poetic justice and politically driven pardons sitting here at my feet these days. I too often have to find the comic relief in the utter aging madness I have fallen into.

Quarantined with a dying person inside their house is a never-ending loop of t.v., feedings, medications, questions about if its ‘time again?” for medications, and self-checking her vital signs. The t.v. is tuned to CNN non-stop. It is her way she will tell you, of “still being a part of the world.” To which I remind her that that’s going to shit too. Maybe don’t turn there for joining society and being a part of the whole we left soo many weeks ago.

At her house I clean, like a mad person. It's my ADD that I cannot apply to CNN and the myriad of measured pills in their clock driven doses. Providing some degree of order, civility and modicum of acceptance that the world will go on around me is placed in sanitizing swipes at cobwebs too distant for her to see never the less attempt to reach.

Food is a battle. Like all aspects of her life now. She’s is wasting away. She is so thin and weak she can no longer stand without metallic wrap around support and hand grips. Shuffling from across the room to the small bathroom she exists between. My mom wants endless hours of all-day small talk. The escape she yearns for outside of the destruction her body is catabolizing. I am not a chatterer. I never have been, and asking me to figure that out for the last inning of the last game is too hard to go back to parochial school for. There is no room for normalcy here. I cannot seem to embed it in the cleaning to provide relief to the endless news cycles. And yet I continue to clean. Keep moving. Try to be productive and helpful as I uncover artifacts from a once functional home. Small items cause major melt downs. A half-eaten pie sitting useless in the fridge is a day long discussion on appropriate resolution. Obsessing on triviality and the time consumption it fills the day with is the reality of four people in too close proximity for too long already and no end in sight.

My mom's painting of Lilly.

“I cannot always be just as you want me to be.” I know it is not what she wants to hear. She wants me to be like the rest of her cheering squad. Professing love, sending her peace and Gods warm embrace. Telling her ‘this too shall pass’ and reminding her of all the beauty that surrounds her. The blissful passivity to all things holy and predetermined. The baking squad sitting on the bench proud to be sitting this one out. Gleeful to let the uniformed players who actually showed up for practice and have a discipline to put the blood sweat and tears in. I am not one of them. I don’t even know if I could become one? A spectator in her last hurrah.

This is the horrible place I am right now. Standing at the intersection of letting go and surrendering the hope I felt I would never unclench. She has stopped trying. I am not sure if it is all exhaustion that caused her to surrender her hope, or, the pain that her fear gave up. But all are gone.

Today was the day I decided I had to come to terms with goodbye being only a few moments away. For as much as we are so similar, my mother and I, I am most assuredly the human of voicing and reasoning while she is the soul of submission and omission. She won’t ever tell you what is right at the tip of her tongue. She will never confess. She will never say she is dying. She won’t give that up. She will only remind you with her every single action that she checked out a long while ago. I can look back now and know exactly when that happened. We were all sitting around her hospital bed when the doctor came in to visit, one week into her hospitalization to manage pain trip, to break the bone scan findings to her. “It is bad…. (long,,,, long pause…..)…. Really bad. She has cancer everywhere.” Yes, these were his exact words. She swallowed the words slowly and lowered her pale worn face and gave up. She had her pass to never doing anything again that she didn’t want to and she has ridden that pony into where we are today.

Cait

That discussion and discovery was over two months ago. At that time it had been over two months since her biopsy came back as cancerous. We now knew she had advanced metastic cancer in all of her bones which no longer allowed her to be candidate for chemo or radiation. They gave up on her as being too late, and she gave up on them as offering too little. She left to go home to try to come to terms with the cards dealt.

Today we are at her monthly oncology check-up. She was wheeled in, after being carried from her home to my car. COVID screening threw a new twist onto today's visit. We were met at a distance by greeting staff to check our temperature with a forehead thermal scan and provided and required to don a mask and gloves and asked a series of questions to try to insure we were not infected, or around anyone who was. Even the hospital is afraid.

4/14/2020, UPMC oncology

Two floors up we were met by the oncology nurses. Check in includes the cursory checklist on the clip board. They took her blood pressure and temp again. We collectively lifted her on to the scale and waited. As a veterinarian the scale is one of the most important diagnostic tools I rely upon. It doesn’t lie and it reveals a wealth of clues if you have been diligent in recording it. When the digital screen came to its stand still even the nurse wouldn’t say the value aloud. It was another long pause in a diagnosis of too many already. She recorded it and moved on. The scale read 76. As in 76 pounds. She is 74 years old. We started this collision course in December of 2019. Five months ago at 106 pounds.

I saw the blue numbers flash, swallowed my silence and gave up. Today I have lost hope for her. That hope for her chance to ever function again in the capacity that I have known her has passed.

It has been months of days that were up for as many times as they were down. She is painful, almost uncontrollably painful. She is on higher doses of opioids than I ever thought were humanly possible, especially for the fact that she barely ever hit a hundred pounds in her whole lifetime. She is not, as her oncologist put it today, “opioid naïve.” I was almost proud of her. It might be the first time she has ever surprised me with a title she didn’t earn from years of perfecting a skill. She is an amazing artist. She has always been an incredibly talented artist. She can sketch, paint, imagine any beauty into a canvas. Her work is all around us. At the vet clinic. Every room of my house, but a hard-core opioid aficionado I never saw destined for her resume. Today she was classified as becoming immune to their affects. Her body was acclimating to them. Starting to blow them off as inferior, paltry, innocuous. Today we carried her out of the house. Wheel chaired her into the hospital. Pushed her in a wheel chair into every room, every exam, and every treatment. She is a skeleton you can push without effort and pick up without exertion. She is bones and an oxygen pump spewing little hiccup-coughs into her nose. Her lifeline to failing lungs. She will need more drugs, at higher doses to get the pain at bay this time. Higher doses, shorter time frequencies and more side effects because of them. They will take away her pain as the collaterally steal her gut function, cognition, and conscious time.

4/3/20

There is nothing left for her to give up. There is only one last designation left to be made. No one wants to call it, although everyone mentions it. Hospice is all that is left for her. We can discuss a 24/7 assisted living home. A place that can help her with the things she can no longer do by herself. Bathe, prepare food, get water, manage stairs to get to her kitchen, her shower, or her bathroom. She is here. She won’t face it. She needs more than her family can give her. Once she lies down and cannot get up, which is likely at 75 pounds, that is the only option next to hospice. We got here so fast I cannot masticate the bitterness and the toughness of it. But the care facilities are all COVID magnets now. Sending her there surely leaves her a defenseless victim to this? Which is worse? I don’t even know?

my moms Easter canvas circa 2015

My dad is seemingly un-phased by the whole thing. The unraveling and the diminished ambulatory, unhappy being she is now. He is short tempered, over-burdened, and oblivious. I don’t know if this is a self-protective measure of avoidance? He goes through the motions and yet he doesn’t see the changes within her. “Hey, have you seen that bump on her back?” he announced yesterday.

“It’s her shoulder blade.” She is misshapen, misaligned due to a lifetime of scoliosis and the aging of osteoporosis. Her spine is “S” shaped and her shoulder has always been left elevated and prominent. She now lacks the 30 pounds to hide it.

The vacuuming leads to laundry. The monotony of never-ending laundry. Put in the dirty, smelly old people funk, and, POOF! Out it comes anew. Refreshed.

“Mom, we have to figure this out?” I implore her. I don’t think she cares to entertain my burdened inquisitive agenda. I think I am just speaking out loud. I think I am being my own therapist. She already has her plan laid out. The analytical doctor used to non-speaking patients hiding their illnesses and masking their diseases is who I am at my best. She is another patient puzzle to solve. I can solve this. It’s a cancer patient like so many I have had before.

D.C.

And yet, we haven’t figured her shit out. Not her treatments, not her desires, not her abilities, Nothing. That’s the truth. She won’t even talk about end of life stuff and I can’t let go of that. Doesn’t everyone plan? The finality exists only for me. I cannot ask her to apply any sense of wishes to an end that looms in front of us both. Her agenda is maximizing time into flowery closing scene experiences.

Ambrose

I’m venting now. I would do it aloud to try to mitigate my cortisol level, but I have to do it silently and furtively. The walker lurks too nearby to allow a release in the open forum of the room we are both imprisoned within.

No, I didn’t dissolution myself to believe this would be easy. But dying under house arrest in a pandemic that seems extra cruel. There is no way out. I could try my dads’ approach, be so caustic the best recourse is silence, and then do whatever I wanted to anyway, but then she would be completely alone. And she’s still dying without any chance of a better tomorrow so I type in hard puncture wound passes.

Easter box painting 4/3/20

There are days that are bad. Days so painfully long and full of so much demanding angst that I want this to end. Days that are full of meaningless errands. Answering a barrage of demands for things I cannot find sense in. Like removing Christmas decorations in April. Always with the same preamble “can you just do me one more favor…?” The red bow on the mantle. It should have gone weeks ago. It drives her crazy, which then in turn, of course, drives me crazy too. I have a home I haven’t vacuumed, cleaned, done laundry in in weeks, and I’m at her house cleaning it.

There is a disconnect between her preferences and her immediate, vital needs. The clock is ticking.

Yesterday was a bad day. The second in as many. It was a day full of moaning, crying, and pleading for the only relief I can give her, short of drug advice, companionship. She is alone too much. The loneliness causes anxiety which manifests into sleepless nights and further exacerbates her fear of pain and loneliness.

She is afraid to fall asleep for fear of not waking up. We should all be so lucky to die so peacefully. Me, I don’t want to wake up in the morning. Find some quiet place to bury my head under the bedclothes, a mummy wrapped for the long voyage to the underworld. She cannot find peace while awake. Her pain refuses to relent, and yet she cannot find salvation in sleep. It is a never ending roller coaster of unfair and unyielding.

It took her 30 minutes to muster the courage to sit up. Shaking, eyes closed, willing herself into moving the tiny rigid structure that used to house her options of freedom and choosing. She is now a prisoner to a broken body breaking down without any reconstructive abilities.

She is melting into nothingness. Evaporating, decaying, just crumbling. She cannot stand up straight. Cannot sit in a chair and face her dinner plate without being bent over and buckled into her own lap.

Oxygen is a commodity she obsesses over. She is hooked into a clear tubing pushing her lungs to accept what they can no longer obtain independently. She has multiple redundant units and miles of spare tubing. She checks her own oxygen levels hourly, half-hourly, obsessively. It is a race she wants to beat herself at. I have decided asking, inquiring about her obsessions merely feeds the monster that dictates them. The questions are met with anxiety ridden hostility. She has no patience for reason any longer. I try to talk about what she does with the information she collects. The nurses regimen of monitoring her own stats? This is another battle with no end point suitable to perpetuate the understanding of her data.

“Is 99 degrees too high?” She wants to be ready to alert the front line should she fall victim to COVID. It's part of her vitals monitoring ritual.

“Do you know what a normal body temperature is?” I ask.

“No,”

“Then you’re fine. Don’t worry.

We spent months trying to identify the source of her pain while we also tried to get it under control. We are back at square one. She has returned to that place where everything is impossible. Moving is too painful to do. We are here this time with 5 medications, three of them opioids, and drugs to chase the side effects of the drugs. “It wasn’t any fun there the first time around. Was it?” She nodded with a dejection of reluctant silent admission. We can’t go back there. Back to that place without answers, suffering met but a struggle to plea for anyone listen, hoping without precedence that one person will stop their busy over burdened life and actually hold her hand and invest their talents, dare even themselves, into her cause. There is an impressive amount of competence and excellence in her doctors, but,, there isn’t much in the way of genuine heart break for her plight. Maybe they have seen too many before her? Made themselves into little fortresses of medical indifference? A short dismissive hello, here’s what we can offer, a keep in touch, and a farewell to another time. The only thing left is to increase the doses of everything. Add an anti-depressant to help her sleep. Make the fear of not waking up a thing forgotten. Sedate her. Medicate and sedate is all that is left. What will that cost her I wonder? It will cost her everything she has left. And she will willingly surrender it. Pain is unacceptable. Pain and fear is her deaths last demand. We gave in to it as I surrendered hope today for anything else.

I can tell you a few things about this journey. I didn’t expect it to be easy. I knew it would be grueling, but I had no idea how alone we would both feel within it. Helpless, well, I haven’t accepted that one yet. We both have some coming to terms with the cards life has dealt us.

For more on my moms journey see the previous blogs here;

Silver Linings Of COVID-19.

The Journey. Missed Pit Stops and The Pile Of Regret Souvenirs.

For more information on me, my vet clinic Jarrettsville Veterinary Center in Jarrettsville MD, or for our Facebook page, or, free pet care help please go to Pawbly.com.

Me and my girl Seraphina, COVID 19 PPE prepared.

Thank you to all of my dear friends and family for helping me through this. I sincerely appreciate everyone's support.

krista

Linear Foreign String Body In A Cat. What happens when your cat swallows a piece of string and it gets stuck in their intestines.

This is Bella. She is a 3 year old indoor only long haired spayed cat. She was brought to the local ER about 1 week before I saw her. At that time she had not been eating for about 1 week and had been vomiting.

At the ER she was given an examination. They found a string stuck under her tongue. In vet med, especially with cats, checking under the tongue is a super important place to look for the culprit of a sick cat of unknown origin. All ER vets know this, and, I hope every other vet, and cat parent also knows this now. If your cat isn't eating get a really (really!!, and not always easy to do) good look under their tongue. About once in every 500 cats (my guess) we find the problem hiding here. The biggest fear we have with cats and linear foreign bodies, (like a piece of string or ribbon), is that the start playing with it and the little barbs on their tongues that allow them to be such successful groomers,  causes them to start swallowing the string. It is not uncommon for the linear foreign body to get stuck under their tongue as the esophagus keeps trying to swallow.

The ER vets advice was to run some blood work, take an x-ray and possibly even do an exploratory surgery to see if the string was able to be removed and how much damage it had done to her internally. It was a good and thorough plan, but it was also an expensive plan. Bellas parents could not afford any of this. The emergency exploratory surgery that was recommended included an estimate of $1500 to $4000 plus. Without any funds to do any of the recommended services the only thing anyone could do was cut the string under the tongue, which would at least relieve it from further cutting into and strangulating the tongue, and, hope (really, really hoping here) that if it was freed it would pass through the gi tract on its own.

Can you tell that she is in pain? Cats hide it very well.

So, that's what was done. Bella went home.

A week after the ER visit she came to see me.

She was laying on her side, very reluctant to move, and very painful. I took an x-ray and saw the classic "string of pearls" plication pattern. Plication is the gathering  of the intestines when something inside of it is pulling it together which is an indication that there is intestinal bunching.

After I saw Bellas x-ray, how painful she was when I touched her abdomen, and how sweet she was even though I knew she was beyond miserable, I just felt compelled to help her. Her mom told me that she had recently been homeless and that Bella had been the reason she got through all of the rough spots her life had recently given her. "Bella was everything, and, she just didn't know what she would do without her?" I understood exactly what she meant. I had been in just her shoes many years ago, before I went to vet school. It wasn't just Bella who spoke to me, who moved me to take pause and want to help, it was her mom too. They both needed me, and, I was pretty sure I could help. I could at least help to see what was going on inside. Whether I was too late to save Bella had yet to be determined, but, I knew that if I didn't help Bella she would die.

I told Bellas mom I thought that it would be best if she left Bella with us at the clinic. It was a Sunday,, and although we weren't going to be at the clinic late that day Bella needed fluids, antibiotics and pain medications. I also wanted her to be with us first thing in the morning on Monday so I could get her started on all the things she would need the day of her surgery.

I can't explain it to those who don't understand. I have almost given up trying. I knew that I could help Bella and I wanted to try. When I talk about finding and living your purpose I am talking about cases like Bellas. She is the reason I went to vet school. She is also the reason I still love being a vet. I can help her, it won't cost me a fortune to do so, and if I don't no one else is likely to intervene. Some people would think me unlucky to have cases like this. I think just the opposite. I think I learn my value here.

I told Bella's mom that I would keep her in the clinic overnight to do surgery the next day. She needed fluids, antibiotics and pain medication immediately.

The is what "bunched up" plication of the intestines looks like.

This is the string that I could see tearing its way through the intestines. It popped and poked out of about a hundred places along the whole intestines.

I spent about an hour gently removing the string from her very unhappy intestines. It was a slow, tedious process. Although we never want to see anything tearing through any organ, especially the intestines, it was actually fairly easy to remove the string. It had been in there long enough that where it was lodged it was cutting through. The holes it was making as it lanced its way through were pinpoint sized. Too small to suture. And there were far too many to even try to close. The point of the needle was going to do just as much damage as the thread had, and make her even more susceptible to leaking fluid that was supposed to stay inside her muscular tube of intestines into her open abdomen which will lead to sepsis, and probable death. 

The string ran the  entire length of her intestines. At the top of the intestines is the stomach. The stomach is a big pouch. Stuff only gets stuck here if it cannot be dissolved or digested in the acidic juices it produces, or if it wedges at the outlet, called the pylorus. In the top section of the intestines I grabbed the first place the string was tearing through. Very gently I pulled it out of the  stomach. Having one end is helpful. But, having it running through the whole rest of the gut was not. I could see and feel it running all the way down to the colon. It literally ran the whole gut. Not good!

I carefully pulled it out all the way down to (almost) the colon. We never, ever want to open the colon. So, I did what we all (vets) have done about a ba-zillion times. We glove up and go rectal fishing. I actually employed my smallest fingered person to help. As I tried to push the tiny amount of poop I could feel in the colon to her awaiting inside the rectum finger I hoped she could find the other end and then I could cut my end as she pulled it out. 

After a few minutes and a few fecal balls we had no luck. I cut the string as close to the large intestine as I could. I expected that there was only a few inches outside of the colon that had to advance and she would easily pass the rest. It was a little leap of faith, but, based on everything we had going against us I was hopeful.

I said a little prayer to her red, angry, yet peristalsis moving intestines. Peristalsis means the muscular tube is moving, and therefore still functional and the best indication it can recover that there is.

I carefully replaced all of her intestines back in her abdominal cavity and started to close her up.

As a veterinarian this is the place we all stop, breathe and hope. There is nothing more I can do.

There were still things to worry about. Because she is such a small cat and she has been unable to eat for so long and it had been so long with the string in her, she wasn't the best candidate for surgery. I had also spent a long period of time trying to remove the string with her whole belly open. This causes severe hypothermia pretty fast.. I know had to worry if she was going to wake up.

She came off the table at 95 degrees. Normal is about 101F. She had to warm up. We cuddled her in a big wrapped burrito blanket and heating pads. The techs stayed with her for about an hour. Pain meds were given and she actually looked happier from the moment she opened her eyes, despite the incision on her belly that ran sternum to pubis. She was awake and she was relieved of the excruciating pain I cannot even imagine how horrible it was. Veterinarians take an oath for this. How many of us forget pain is part of suffering? Relieving pain requires relieving the cause.

Here is her culprit. The string measured about 16 inches long.

Here she is the next day. Can you see the difference in her from day one? She is laying on her side. Stretched out and looking for attention. A different pose than curled up in the back of her cage and not wanting to engage, or say hello. She is inherently a social calm girl, but guarded, hiding, retreating and reluctant to move are all key signs that there is a problem.. Her parents saw not eating, I saw misery. It's why we ask all pet parents to call us the moment your pet isn't acting normally.

Here is her abdominal incision a few days later.

If anyone ever has the chance to give back, for just the simple pleasure of seeing a smiling face of gratitude back, take it. Paychecks come and go,, gratitude and all the joy it brigs last far longer.

I am sure people will think I am crazy for this, but, I donated my time for her. I felt really good about doing it.

This is Bella about 10 days post op. She is up, walking, comfortable and eating!!

I still love this cat. I am so glad she did so well.

Here is the cost breakdown of Bellas procedure;

walk in non-client Sunday exam $75

NSAID for pain $18

Day of surgery;

propoflo induction $60

exploratory surgery $350

surgical package (i.v. catheter, i.v. fluids, i.v. fluid pump, instrument pack) $250

anesthesia $125

additional suture packs $30

e-collar $15

overnight boarding 2 nights $40

Total for procedure; $950

I donated my time and $500 towards her surgery. I do so because I have the help of our internal Good Samaritan Fund. I have found that as much as I take from it our friends and supporters refill it.. I never let cost be a reason to deny care. I give more than I have to and in return I get more than I expect. It keeps me feeling whole and purposeful. It keeps me feeling grateful to be able to work, to help, and to be a part of someone else's story. Isn't that we all want?

Related Blogs;

What Gets Swallowed Must Go Through.... or else. Foreign Body Obstruction Surgery. Levi's blog.

For those of you interested in learning more about pet care please visit my YouTube channel. 

If you have any questions about your pets health you can ask me for free at Pawbly.com.

For more information on our clinic, Jarrettsville Veterinary Center please find us on our website JarrettsvilleVet.com, or our Facebook page, Jarrettsville Vet.

Please be safe everyone.