Why are we so focused on getting our pets to eat, instead of fixing the reason they don't want to? My dad and Shelby.

This is a story about how perspectives shape and influence decisions. How one small characteristic, a clinical sign, (as a veterinarian would label it), changes the quest of a pet parent and their companions’ journey. This is a story about my dad and his care of my recently deceased mom’s dog; Shelby. Shelby is 15 years old. A rat terrier by mine own expertly amassed breed-i-pedia visual inspection, a mystery by means of the trucking couple who sold her to my parents at a rest stop. 

She is short, squat, compact and spunky. She walks with a high step and a butt wiggle. A tiny stub of a tail to mark her cadence. She has always been stubbornly independent, and loyally devoted, singularly to my mom. My dad, on occasion cuddles her, but she remained the apple of my mom’s eye and the shadowed sidekick to her every move. 

My mom passed away in May. It had been a 5-month journey of surprise, horror and decline. Shelby, like all of the pets who live beside seriously sick, and/or, dying parents got left by the wayside. She was, short of the essentials of eating breakfast and dinner and the obligatory bathroom breaks, forgotten. When life gets reduced to impending imminent death the periphery gets pushed into the corners.

While my mom was struggling with her cancer and our lives were filled with obstacles and medical silent policemen causing you to halt, hinder and ponder, Shelby lost her advocate, parent and support system. She was still with us, but her needs took second place. She was still able to eat, walk, and maintain her bathroom schedule. There wasn’t anything to alert us she needed more, and we had a very sick, incapable and frightened mom to care for.

While my mom declined my sister and I began to increase our focus on Shelby. For all we could no longer do for our mom we refocused our time and attention to Shelby. It was what we knew she would want from us, and, it was most certainly what Shelby needed as my mom could no longer think, call for, or even provide any affection for her. Seeing my mom pull away from all of us, in succession of our ability to provide for her was heartbreaking. Within two weeks of her passing my mom stopped asking about Shelby. Within a week she stopped asking for anyone. As she withdrew, we refocused. It was a tiny way for us to still be taking care of her when she could no longer see anything outside of her immediate ability to breathe or stay comfortable. The moments of dying color you in a way that makes the world a murky vat of misery. There is no sky outside, and there is no future to dream of. We were all a part of the vacuum it created.

The other side of life will find you. There is an after after death. Shelby was on the other side. My dad had a two-week recession. A place he retreated to and couldn’t speak from. We all deal with grief in our own way. Shelby has become the soul we covet. The last piece of a person we all long to find, and resurrect and yet cannot. 

I see her looking for my mom, as I do too. This quest to find the thing you lost, misplaced and yet believe to be hiding. Waiting to be found again. 

Shelby is what I would call the last piece of a life I try to desperately to fan from a smoldering pile of ashes, life back into. She is the last piece of my mom that is alive. The houseplant you over water in desperate hope to grow with additional vigor, only to drown from good intentions. My dad, well, to be honest, I’m not sure how he sees her? An obligation to a promise no one can provide consequence for? A left-over piece to a chapter already finished? A companion when a couple has only one half? A broken piece from an engine with too many accessories? 

He called, texted and complained for weeks before and after my moms passing that “she was getting picky,” or, “wasn’t eating well.” All with a hint of responsibility that I, as the resident family veterinarian, had to fix. That her eating was my fault, my obligation, my responsibility to figure out. I had to have the answer to what the ‘right’ food option would be. He, left on his own, had decided that she ate the high-protein unlabeled dollar store options best. The kind of canned crap, that I seriously call ‘crap’. The stuff with gelatinous goo at both the top and the bottom, as if suspending the only product scantily considered ‘food’ in the middle section. Shelby, as I mentioned at the beginning, is 15 years old. She literally is these days, only as good as what she eats. She was eating sodium suspended protein (from yet to be determined sources) in a can, at the bargain price of 69 cents. No matter how hard I tried to argue about the short-term losses of his small victories of her eating, the long-term costs were further kidney damage. But, in the tragedy of a loved one passing, whose first true sign of demise is food refusal, the small gains are often enough to appease the immediate fears of loss.

The veterinarian inside of me has a problem separating perspectives here. I see all food refusal, “the picky eaters” the “poor eaters,” the pets who just start to eat less, select options with greater care and scrutiny as the beginning whispers for help. For many of my clients, and my dad now, the eating is a frustration met by compromises that delays our abilities to diagnose and treat. Sure, some dogs are given the latitude to become connoisseurs, choosing as a sign of stature and liberty, but, most become inappetant, hyporexic, because disease is telling them to do so. For many clients not eating is a slap in the face sign of failure. People fixate on eating as much as they do on having normal poops. It is, in absence of all other meaningful signs, the most important request from a pet parent. They don’t care why they aren’t eating, or pooping at less than desirable frequency or consistency, they just want it to be normal. Preferably, right now. (The request to the vet is; cause be damned, just fix it!).

In Shelby’s case the cause was not so clear. Shelby had bad teeth, (as every small dog over 8 does). She had needed a dental for about the last two years. Fear kept that from happening. Fear that her heart murmur would result in heart failure under general anesthesia, and death at a time of ombre dying transitions was too much for us to manage. We couldn’t risk Shelby while my mom surrendered. Shelby had her dental about one month after my mom passed away. It was overwhelmingly frightening for me to perform. I knew it would be a long procedure. I knew she wasn’t an ideal surgical candidate, and, I knew it had to be done. I knew that she would require extractions of numerous teeth, yet through the procedure there was this quiet calming peace around me. Peace that she was being watched over. That she would be safe and better on the other side of waking up. For as much as I was petrified to put her under anesthesia, pull all of those rotten teeth, get too cold, stay under just a little too long, and lose her ability to wake up, during the procedure I knew she would be ok. She was carried by mom, and I could feel her all around me, taking care of her, and me in the process to get through this last long surgical procedure to be benefited on the other side. For my dad he firmly believed that the excision of the bad teeth held the answer to her persnickety food denials. 

It turned out that this wasn’t so simple. Shelby woke up from her dental, slept for a few days a little more than she had before, and went back to turning her nose up at the offerings he proposed. Rotisserie chicken was nibbled at for about a week, maybe two. Then sliced turkey was plated, about a week there. To canned cat food, then hamburger or steak, but, only if it was freshly prepared. All the while, all these weeks, my dad texted requests for food options to save her.

Shelby had a thorough exam, a full blood work panel and every other diagnostic I could provide. X-rays, x-ray evaluations, blood, urine, fecal and every possible ancillary test from these. All were normal, or at least very close to perfect for a 15-year-old. There wasn’t a medical explanation for the inappetence. As each test was taken and passed, I tried to remind my dad that there was more to her health than bleeding and numbers. As with so many cases I see people forget, or omit to admit that we are all our own beings. That Shelby is more than a being with a mouth and an ability to urinate and defecate... they the ways in which we measure her, and her abilities are much more than our observations. Shelby was a soul who was confused and now grieving. Her world although still geographically located in the same place was no longer her own in the way that matters to her. It was upside down, inside out and missing its most imperatives pieces. She, just like me, was lost in the searching for the foundation of who defined us. With out my mom we had a tough time realizing who we still are. 

Shelby came to stay at my home for about a week last week. My dad, as he has been consumed with, was so worried about her poor appetite while away from home. Shelby, like all dogs, is resilient. She is capable of so much more than many of us give them credit for. My dad arrived early the morning of his departure with her in hand. He dropped off cans of food, the ones he had most recently had success with, her bed, a leash and her harness. He fretted, as my mom had always done also, about leaving her here, in my pack of three much larger dogs, and the four opinionated and bossy cats. 

“Just put her down dad, she will be fine. She knows where she is.” I said. She had been here for weeks when my dad was in the hospital about 8 months ago. She quickly adapted to our routine. Embedded herself in the pack that is our home. After a few days of adjusting she followed step on the daily walks. She took pride in being fed in her own space on her own time. She did very well with all of the activity a full house brings. 

“She’s suffering from boredom.” My words falling on deaf ears as he sorted through his own grief.

While my dad was away, she fell right back into our routine. Walks, bedtimes, carried to our bedroom to be sleeping next to all of the others. There is life here. She ate full bowls twice a day. Had long walks where she, like the rest, can smell the diet. Process the scents of the world she lives in. there are not the quick ins-and-outs of rushed bathroom breaks. She gets to explore, find questions in her head and answers in her feet, nose and sounds. She gets to be a dog, a family member and a companion again.

Here’s where my dad forgot what the life of a dog is about. 

Shelby, like all of us, needs, and thrives on being acknowledged at every single interaction. Her vision is failing, but she knows there are people around her. We always approach slowly, kindly and with a “hello.” She will lower her ears, bow her head, stand still, and we always (always!) take a moment to stop and pet her. Where she used o fear footsteps, fear being in the way, too close underfoot, she now revels in the affection. 

Your pets want to be your pets. Loved, cherished and acknowledged. 

This has to be the basis for everything that follows. It was the simple reason Shelby isn’t eating. She is bored, she is lonely and she is lost.

 For more information on anything and everything pet related please ask us for free at Pawbly.com.

If you are a pet care provider who is willing to help pets in need with your advice and compassionate words of kindness please consider joining us and adding your pet care experiences and thoughts at Pawbly.com. We are always in need of reputable professionals who can educate and inspire.

For more information on Jarrettsville Veterinary Center please visit our Facebook page, or website; JarrettsvilleVet.com

I am also posting lots of informative videos at my YouTube channel here.

The unprecedented times of veterinary medicine and the pandemic.

It is the middle of August 2020. We are 5 months into full on COVID-19 pandemic mode. Within my professional life as a veterinarian the ripple effects of this have reached places I never saw coming.

We are a 7 day a week, 5 doctor veterinary clinic about 45 minutes north of Baltimore, MD and we could not have imagined, never mind prepared for, what COVID has delivered. I have been a veterinarian, and practice owner for 15 years, and although there have been numerous rough spots along this journey there has never been a time where I more question my stamina, and fret for my patients, than now. The current state of our profession has become an ever growing chasm of unmet needs meets unparalleled exhaustion on all fronts. There is also no discernible end to this "new normal." The degree of personal stress, emotional questioning for well-being, and the public's visceral anger and ugliness has us all at a boiling point of which I fear great personal, professional and accessible losses will result.

Here is a break down of where we, my little vet clinic is, and, how we got here. Jarrettsville Vet used to be the routine general small animal veterinary clinic where doctors saw appointments with pet parents holding their pets on their laps, or on a leash, all the while going over important patient points. It was a calmer exchange where personal time was fostered. I have always been honored to be a part of a pets care, and, to a great extent also their parents life. Feeling needed an appreciated is the purpose so many of us strive for. In clinic personal care was delivered in real-time with multiple options given for treatment care and an all-for-one team approach. We have always taken pride in being transparent with affordable prices for a huge range of pet ailments. We do not turn away care for anyone who needs it. We have stayed true to our values and we have been in business for over 8 decades.  With this pandemic a few things have altered our approach on delivering this care. We have to wear masks, we have to stay distant, and, we still have to hold onto what makes this personal emotionally enriched care genuine. 

We began curbside services, thereby keeping the public out of the clinic because we could not provide adequate or acceptable social distancing, began in April. We split into teams to try to insulate at least half of the staff if a positive staff member would cause us to have to quarantine, or even shut down. We did everything we could to stay viable while also trying to stay safe. It has not been easy to lose the personal connections, most notably for the terminal, the dying, and the euthanasia's, as we tried to stay open with some semblance of doing the best we could in meeting our patients needs. We have had to rush dying patients into the clinic and witness them die without their families who were outside in uncontrollable hysterics. It is not who we were, nor ever wanting to be. 

With all of this change it has also brought along a never ending list of unmet expectations and needs. We are not unlike many, if not most, of the veterinary clinics in the U.S. right now. The current state of this pandemic has left us saying we cannot help, and, we cannot keep up. We also are afraid more then we ever have been. It is a mounting storm without ceasing winds to calm. 

What's the cause to our current patient care dilemmas?

Demand has over run supply.

There is an increasing demand for care, as there has been an increase in pet care ownership, and, a decrease in vet staff availability.

As of this week my clinic, we are booked about two weeks out for routine care. This has never happened to us before. We are now having to place blocked appointment slots into each doctors schedule for every shift to try to manage the same day requests for urgent cases. There has rarely, if ever, been a time before where we couldn't fit someone in within 24 to 48 hours for an exam. Almost all emergency cases were provided a spot within the same 4-8 hours. We  are a small town, deeply rooted within the community, practice and we know that long term relationships built us. To abandon our clients in their time of need only undermines the trust and reliability we have worked so hard for so many decades to establish. For most of the clinics around me they are booked days, weeks, or even months out. When they are and they get an urgent call the client is told to "call around," or, "go to the ER." No one wants to be told that. But, it is the reality across the board for all vet clinics. We are seeing more cases than ever. Why would we be immune to a pandemic, or, even over burdened with patients within it? 

The answers lie across our spectrum. 

Where did the increase in pets come from? This is the results of a multi-factorial burgeoning of demand.

• increase in adoptions/purchasing of pets.
• clearing of shelters.
• people have at home and personal time they never had before.

The shelters were placed on indefinite closure as they had to keep the public out. If they cannot allow the potential adopters in to help advertise their adoptable pets then the outflow was going to come to a halt. To avoid this many shelters offered free, if not significantly discounted adoption fees, to try to clear them before the next shoe dropped, (i.e. staff gets sick and no one is available to feed, water, clean and house). 

Pets have been adopted/purchased at record rates. Along with the increase in demand for adoptables has been an increase in now-full-time stay at home workers to have the pet they never had time for before. People hit the internet looking for a companion as they socially distanced from the rest of the human world. 

Dwindling supply for pet healthcare caregivers;

• vets and vet staff who are home self-isolating.
• staff were hard to find before the pandemic.

Just like a swath of the population, there are veterinarians, and veterinary staff who do not want to expose themselves, or their families to infection from a disease they are at high-risk for. I have staff members with elderly parents they are caring for. The risk is too great for them, and hence, they are on an extended undefined leave of absence. at any given time 10-20 % of my staff is out due to COVID influences. We started this pandemic short on staff. COVID has exacerbated it.

The stress of a trying to be everything to everyone and not knowing if any decision is right.

• the difficulty of managing a practice through ever evolving,and changing, information.
• the strategic planning needed to try to stay open and safe.
• the ripple effect of bad practices now magnified by a greater need.
• the poor planning of not being able to catch up as you try to prognosticate ahead.

The allegiance and the pressure to meet all the demands across all spectrum's of personal, professional and ethical standards. Feeling like I am expected to meet every need of every soul under this practice is overwhelming on our best days, add the stress of non-stop phone calls for help, and knowing my own physical limits are at the brink has me thinking that maybe the vets sending all the excess elsewhere are serving best by serving self first? 

The fear/anxiety/and division while trying to keep ourselves safe and alive.

We all feel it, don't we? The anger/fear/and degree of stress we have never before experienced, and now it's daily, worldwide, and on a magnitude we cannot comprehend by any previous experience. People are stressed in a way we cannot ignore as real, and, they take, are taking out, this anxiety out on us. Add the emotional element to the package and the boiling point lowers. If you fail to serve them they can, and have, opened a wrath that leaves you with bad reviews, crying staff, and yet another reason to not work when pay is available elsewhere regardless.

Burnout. The staff, outside of the doctors, and hospital administrator, are all on hourly pay.  I have to keep this in place, even though we need them all at almost every breathing moment, to force down time. They stay longer than needed. Ask repeatedly about leaving us, and whether we will be "ok?" And, yet I have to tell them to just walk away. There is not an end to the day past the automatic shut off of the phones. 

I leave everyday with an unsurpassed list of things being left undone, and a chorus of faces I worry about overnight. Will they be ok throughout the night? Will their families stay safe and healthy to provide them the oversight they need for their own survival? Can they reach me if needed?

The vets, we are maxed out. We feel compelled to help. To answer every call. It is what we are cut from, and yet, we cannot work enough hours to meet the demand. 

The place we have found ourselves.

Emergency veterinary clinics are seeing the cumulative effects to the greatest degree. Many of these new pet parents cannot establish a veterinary clinic based relationship. They are not finding a clinic who will see them in the time sensitive manner all new pets are ideally seen within. (I say three to seven days max!). 

Where do people go? they have been turned away at the vets office, the ER was already too expensive for many, and, now the wait is, and can be, from 4-24 hours. Puppies with worms, and/or, who are sick are being told by their vet that the wait to be seen is weeks. They don't have weeks to wait. So, parents head to the ER to be told the wait might be 24 hours. Am I responsible for this puppy? What about if I know that minutes matter for survival? What would you do?

A larger number of the clients going to the ER have no primary care vet. They are turned away at every vet clinic that they call. The ER is all they have left.

My clinic is open for walk-in appointments on Sundays. Sundays have turned into our receptacle for all the non-emergency cases I couldn't find time for during the week. I am taking Saturdays off to rest, because I have to. My core has to, and without being able to see the spill overs on Saturday they are told to come in on Sunday. Last Sunday for the walk-in hours of 1-3 pm, I saw 20 cases. All sick, all in need of care. I stay all day Monday through Thursday. I see everyone who is a client and calls. Fridays I go into work to catch up, to see the spill over. 

How am I coping? I am not sure I have a clear answer yet. I am desperate to keep the long game in focus. Remind myself that I carry the lives of my staff at my forethought, while reflecting on the legacy of the veterinarians who bore this clinics torch before me. Those who survived wars, depressions, and the plights of a rural community whose animals allowed them simple basic survival. Without the veterinarians who built this clinic I would not be here, nor, would my self-inflicted responsibility to carry on through whatever adversity facing us be so profound. We are deemed essential as we control the tide of zoonotic diseases, maintain a food supply, and protect the family members so many of us relegate our pets to. "Essential" adds a layer to this complicated bitter onion I never saw previously. With that I feel even more compelled to not lose my footing as I run this never to be seen horizon race. 

There are personal stories I have never shared. The clients who call needing immediate emergency care, or hiding within self-isolation and attempting to manage potentially life threatening cases via video calls. None of this is ideal for the patient, and yet I have made judgement calls I know I could be sanctioned for. I continue to practice medicine within a web of uncharted waters and a public as jarred as I am. 

Where I have seen this community come together and assist in ways I couldn't imagine outside of an invasion, I have also seen people react with vile vitriol I feel immeasurable to the insult at hand. The slightest, (seeming to me), insignificant annoyance reels people into fits of anger that leaves the staff fearing personal harm. I have forced clients in unprecedented numbers out of our practice in a desperate attempt to nix a fuse that I can only see more emotional trauma stemming from. We have had to add signs asking people to "wear masks and be patient," and, with these I still have people refusing. There are words coming out of my mouth that I feel will only add more vinegar to a wound surfacing before us. "This is private property that I own, it is my mandate that everyone wears a mask." To be met by spitting seething rebukes of "you cannot tell me what to do," and, "you cannot catch COVID outside." The point of helping a pet in need has soo often being overshadowed by an on-the-brink-of-breakdown of a human, and, too often I fear I am that human.

I am exhausted. More exhausted than I have ever been. This includes vet school training, working multiple day long shifts on the high seas, and the pains of being both a new grad and a new practice owner trying to shoulder a burden beyond my experience and expertise. The days I am working now start at 8 am and extend to, or even past, 9 pm. No bathroom breaks, no food, and so mentally stretched I have to tell the staff that I cannot safely handle another cases. For as much as I want to help, and cannot bear the idea of turning away a patient who may not get help otherwise, I have limits. If I push them any further I am going to make a mistake and it may hurt, injure, or even possibly kill someone. Fear, exhaustion, and pressure to be a vet, an employer to people I deeply care about, and keep the business alive when I feared for months I would not be able to, has me needing help I have never asked for previously. My village has become an interstate of traffic coming and going as friends leave food, walk my dogs when I cannot find time to, and help with laundry and household chores I cannot dream of returning to. I have had to say previously impossible "No's." "No, I cannot do a TNR." Or, "I cannot see that dying kitten," "I cannot take home that patient for overnight care as I fear I cannot get up if I fall asleep." No's I hate myself for uttering. No's that might cost me my personal legacy as I triage the others I am desperately trying to keep alive.

I have my email posted in every corner of every client interaction. We use Facebook messages, personal phone numbers are given to any client in possible need of immediate return. I have socially distanced from everyone outside of work so that I can remain at work with the least amount of risk possible. All decisions have been made to protect the hive. Isn't that what I promised myself at the beginning of this Pandora's nightmare box?

In the end, and the whole point of the lessons we are learning within this pandemic is, that we have to get out alive. For some this is best believed achievable by sheltering in place until the world rights itself again, a year, or two from now. Just stay away from people, accept the risks associated, and, hope this bubble approach doesn't cost you a fatal delayed decision. For others, like me, I go to work, I diligently wear a mask, wash my hands, stay 6 feet away from clients, and only allow close proximity for euthanasia's which we do in a separate location. And for the non-believers, the people who haven't seen a death from a bug you never saw coming, I am reminded that negligence is too often the backbone of all medical professions. 

Like all inferno's this pandemic is alike in that it will end. Will there be a Jarrettsville Vet on the other side? Yes, of course. It is bigger than me. It has always been bigger than me. There is comfort in this as the small one doctor practices shutter when the quarantine forces their closure. But, will I be alright with my choices? I am not sure? I, like all of the rest of us paddling upstream to a place we have no knowledge of, all feel the same. We all have to get out alive.

For more information on anything and everything pet related please ask us for free at Pawbly.com.

If you are a pet care provider who is willing to help pets in need with your advice and compassionate words of kindness please consider joining us and adding your pet care experiences and thoughts at Pawbly.com. We are always in need of reputable professionals who can educate and inspire.

For more information on Jarrettsville Veterinary Center please visit our Facebook page, or website; JarrettsvilleVet.com

I am also posting lots of informative videos at my YouTube channel here.

The hardest part is looking into the eyes of the patients who want to live and knowing you can't do anything to save them.

There are tougher parts to this job than most people think. These are the eternal forces that pull you into and out of the ability to care. The profession calls it “compassion fatigue,” I call it surrendering your purpose. It is a fight I have every day. It is a fight I expect to have everyday as I continue to practice vet med with the public paying my way.

“I don’t know how you do it.”

“I always wanted to be a vet, until I realized I would have to do this.”

“I couldn’t do it.”

“This must be the hardest part of your job?”

I hear these weekly, and, on the really bad days, I hear them daily. The small talk, the dropped one-liners that are delivered to me as I am sending another life into the after life. They are the common conversation fillers from clients as I humanely euthanize their pet. They are the reminders of how dismal this job can be. How emotionally and mentally taxing the price is for pet care at this level as your chosen path. We tell ourselves it isn't our fault. That this task is our final act of compassion, but, the truth is we have to tell ourselves something to stomach the acrid taste of being the designated henchmen. 

For the majority of clients that I see, saying good bye to their pets is a kind way to spare their loved ones further suffering and the passing is marked by overwhelming grief. For for a smaller group of people it is the only way out of a situation they can no longer manage. In either case I am always sure that this act is based on love. I have spent decades insulating myself from the other scenarios that bring euthanasia to the resolution of a pets treatment care plan. The cases who can no longer afford further care even when the condition is treatable, or, believe that the road to recovery may be too long and arduous to attempt. The disposable pets who are more affordably replaced versus ‘fixed’. The cruelty cases, the court mandated cases, the "found but don’t want cases," and the weak/dying/debilitated/desperate cases. I have somehow figured out a way out of  being simply the euthanasia mother to these. It has taken stern warnings to the staff, repeated pleas to the receptionists, and a no-exception scheduling of walk-in euthanasia's. It has taken courage to stand this ground. I have been called terrible names. I have lost clients. I have been brought to the medical board, punished and chastised, and, yet I still stand firm on my position. I will not euthanize a treatable pet without offering every option imaginable, and extending myself further than is ever expected. I will not go to my retirement with blood on my hands. If, and when, I leave this profession, as I lie in my own grave I will at least like myself for standing up for my patients. It is not the path of my fore-fathers. The men who began this profession to serve the needs of their community. Veterinary medicine has changed over the last 100 years, most remarkably within the last 20. The place of our pets within our families has evolved. The desire to value our pets as family members has driven the wealth in the vet med profession and lucrative lifestyles we veterinarians can lead because of this, and, it should follow that our perspectives on these patients who allow us this should also evolve. There is a sphere of hypocrisy among our colleagues and within the leaders of the profession. The belief that we should not judge, and that we cannot maintain a healthy client base if we don't answer all of the client requests, (almost regardless of the basis of said request). These tenets have shaped us into appearing "indifferent" as we deny care to those who are financially constrained and yet also the exemplification of absolutely devoted to their pets, while we "humanely" euthanize the cases we feel are better off dead than neglected of the care we deem "most appropriate". All judgement calls. We readily, and, almost universally shirk emotional investment as we consistently and almost without exception buffer our own personal financial risk. We do so with the legal backing of the state veterinary boards and the national leadership. We un-apologetically (my least favorite over used axiom in the profession), deny based on any desire we choose. Veterinarians are emotionally scraping the bottom of an all too empty well, as we blame poor financial decisions of our creation, (if you cannot afford to go to vet school, and you cannot financially recover from that decision based on your current or projected salary whose fault is that), as we at the same time blame poor decision making on clients financial limitations whom we remind all too often need only have that pet based on responsibility versus rights. (My second least favorite vet med saying). It is an impossible game to play. I have learned this the hard way too. I hate myself for being the middle man between clients who don't value their pets as worthy of love, and the investment that this responsibility requires, and, then I hate myself most when I consider turning my back on a case I believe I can assist. I often sit trying to chose between which scenario I will hate myself less for. It is all about choices, and, getting out of this alive.

I am too often left with trying to discern what the hardest part of this for profession for me? I will admit it has changed over time. It has transitioned along with my courage to stay viable. Early on the hardest part was the angry and demanding owners who tried to remind me that; “I work for them, and, therefore it is my duty to fulfill their wishes to kill their pet/declaw the pet/etc.” I have bid them all adieu. I am financially secure enough to have this luxury. Truth is I have decided I could not go on like that so the financial loss was apparent either way. As I was figuring out who I was, I was realizing they didn't fit my perspective professional path. I, along with the rest of us, cannot be everything to everyone. 

Then there was the period where I knew I was being tested to see if I could maintain my own choosing between doing the kind thing for my patient who had just been hit by a truck puppy and the manipulative demanding owner who wanted everything for free and then to have their puppy back. I wasn't sending her back to them. They had withheld lifesaving care I gave them for free the last time , an old yellow lab who died the most horrific death of denial of care, and it had left me heartbroken like no other case has before or since. I should have reported them, another lesson I have learned, and I hadn't fired them in time to avoid this (their new puppy to replace the dead previous lab) puppy and the truck, which the state board so firmly reminded me, that “euthanasia is a required to be offered option for every, (yes, they used the word “every”), condition.” I suspected I was going to pay for this decision when I was making it. My pocket paid a fine, but my heart did not. I still know it was the kind decision for Sadie, even if it wasn't the right decision in the state boards eyes.  Sadie is alive and well almost 10 years later with a different family, (the original family tried to get the board to force me to relinquish ownership after they surrendered her due to lack of any funds to treat her. After I paid to have her fixed they sued me. The board offered to drop charges if I returned. I didn’t. They charged ahead for not offering euthanasia). You have to pick sides in life. Make hard choices. Decide whose integrity you care about most. 

The hardest part for me after I earned and tested my titanium britches was the cruelty. It is the single undeniable force that breaks vets. Cruelty comes from only one side of our equation; our clients. It is the people who kill you. Chip away at your ability to remain centered on your patients and the care they need. Indifference is the dark side. The force that whispers in your ear over and over to just stop caring so much that the vulnerability leaves you marching to the fatigue that compassion can cost you.

How do I get around the cruelty? I use the tools I have at hand. I simply don’t tolerate it. I don’t turn a blind eye and I don’t ignore it. If it crosses my path, and it does, I take photos, I have frank conversations about what I am seeing, how I am documenting it and what needs to happen to keep me from reporting it. Doesn’t it seem odd that society has anti cruelty laws and yet you can euthanize for anything? I call out Animal Control to bear witness. I leave the judgement of inadequate care, neglect, cruelty in their hands. It is the job they signed up for. I am now the messenger, albeit hypervigilant, but that is part of my purpose to protect the pets I still call the love of my life. 

The hardest part for me these days is the looking into their eyes, these patients who I have elevated to be the answers to cause and consequence, and asking the hard, deeply moving, philosophically governing questions. There are patients who are suffering and desperate to get better and there are others who are suffering, dying and don’t want to go on. Here is where I am finding my latest cross to bear. The part that is chipping away at my inner purpose and conviction to course. 

When I can see the difference in their eyes and not be able to do anything to change it.

I will never let myself be any other kind of veterinarian than the one who shows up for her patients. Although our clients are an integral part of our ability to keep our pets healthy my love and my loyalties lie in the preservation of life and health of the cats, dogs, kittens, and puppies I pledged to serve. Not putting them first, in everything I do, is answering to the indifference that has plagued too many lives already. I entered vet med with the same single belief the rest of us do, we love animals.

 If you take the time to look into their eyes they will tell you everything you need to know. I, as the practitioner also have to listen as I gaze. I have to believe what my heart and soul tell me, what so many of us know already, that they have a place in our hearts because they have a heart of their own. Isn't that everything in this lifetime worth fighting for?

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It Never Ends Well. Anger, Outrage and Surrendering A Found Pet To The Jerk Who Owns Him.

It isn’t going to end well.. It rarely does.

Me and my latest "no good deed goes unpunished" saga. His story here

There is a very short time-sensitive period of inflection, that place where if just the right steps are taken at just the perfect moment a peaceful veil of sensibility can descend that might possibly allow a resolution where everyone wins, no one feels baffled or betrayed, and, most importantly, we might just be able to save a life. The challenge lies in both finding that inflection point, and, being able to influence it. Achieving perfectly timed recognition whilst positively influencing outcome AND being courageous enough for both is an exceptionally tall task.
It is rare to find a happy ending when so many varied ends of the personality chart are involved. Even rarer when a vulnerable young pet is involved, and almost impossible when the county government with their own agendas, restrictions, and noose hold abilities are in the play.

Rare, if not impossible. As of present I have only been fortunate when all others departed, and/or, abandoned the mission willingly.

This is a story about muddling up the lives of those you know need you. The lives that pet parents can't manage safely, and, the appalling tragedies that play out in the judicial system once the parties get sucked in. I have yet to see it end well. It has left me extremely tentative to intervene and even more compellingly paralyzed to turn away. I recognize the tragedy in my tentativeness will cost the ones who I am ethically and morally compelled to intervene on behalf of. I admit that becoming indifferent, accepting that this will never get better for them, and that failing every time previously is accepting defeat for any meaningful change moving forward. Giving up on the hope to have it get better is giving up on the meek and the voiceless.

These are two real-life stories of puppies who in the end were set up to fail on all sides of a custody battle between their families and the laws that are supposed to protect them.

We can't seem to learn this lesson. We have been repeating it for decades, and still, our hearts tell us one thing and our experience and hindsight teach us another.

Cora. Found wandering the road at the end of my driveway many years ago. She now has a wonderful home. She is one of the few who did soo much better the second time around.

Last night we repeated our "shame on us" lesson again. A very sweet young guy came in with an equally charming, albeit wired, young black shepherd to say he had found him a few miles away. He had brought him to us for assistance in finding his home. The dog was microchipped and within a few moments we had the information we needed to reunite him with his family.

A phone call was made. “We didn’t know he was missing,” was the first thing the owner said. Probably not a good sign. A quick flash to Facebook revealed an hour old post of another concerned citizen who had posted photos of the dog trying to get in their back patio door. Not a menacing act, not a dangerous dog, just a young smiling dog at a back door looking for options from a kind heart.

When a gruff, ruffled, stoic, and unsettling man showed up at the clinic a short time later without a leashed pet, or carrier, we all feared he was here to collect. He looked like the kind of guy who might sell contraband for fun, and intimidate for spite. Slicked back greasy grey hair, jeans that haven’t been washed in decades, and dirt, lots of dirt. He was scary, intimidating, short tempered and quick with the tongue. All of these he took pride in. None of us wanted to talk to him. We most especially didn’t want him to be here to claim this dog. We should have not called him. We knew that now. It wouldn’t change his ownership rights, but it wouldn’t have had to be us turning the dog over. You just know these things. You can accuse me of judgement, but give me a minute.

When we brought the dog out to him the dog took one look at the owner and his swiftly wagging tail, fell, dropped to his knees and halted in his tracks. That puppy was terrified. Think your dog doesn’t know what kind of human you are? They do. The guy immediately yanked the leash from us. The pup lurched backward, recoiled in fear and trepidation and exhaled a wind of crying moans. He threw the dog into the car as his dog frantically tried to escape from then beat him into submission and willingness.

Where will this go? No where good. He will break that dog into being a biter, or kill him into submission, and that guy who so desperately needs to bully and intimidate to validate his own worth will move on to another dog who looks like a breed he can dominate, this guy wont ever have a cat or a chihuahua his tiny fragile ego wont ever let him love something to earn what unconditional love gives back.

And for those of us at the clinic held horrified and hostage to witnessing this, well we will house these guys and surrender them to the cops at animal control next time. I will never permit the staff to have  to witness this again. Let the proper authorities bear witness and decide how to manage the asshat and the victim. At least they keep records of lost pets, make sure they are vaccinated, and put guys like this on the radar. Maybe if he has outstanding warrants for abusing kids he will leave this pup at the shelter for a better chance with another person.

What's the worst part of being a vet? No, it's not the tearful euthanasia as we bid farewell to a companion who was so beloved they have an entourage of sniffles, tears, and stories of a life everyone giggles about as they fondly remember it and sends them to heaven in the loving arms of their family. No, it’s the jerks who never gave a damn about their pets, outside of yelling, or beating them, or training them to be bait, and never will. The asshats who beat, ruin, destroy and produce animals that the BSL laws manifest from. This is the tragedy in being a veterinarian, being complicit to vicious evil people who own your patients and destroy them simply because they can get away with it. Think I'm wrong? The justice system is full of spineless prosecutors. Its not that they don’t know, or see, or hear, they just don’t act.

My Amish neighbors selling their never dewormed OR vaccinated (mom too) kittens.

Where do I intervene again? I will never call a microchipped pets owner again unless they are a client. I will only call Animal Control. I will willingly and knowingly subject these pets to perhaps never being picked up at the shelter (many owners refuse to look for them, or, don't think to check there, or, don't want to pay the reclaim fee). These pets might then be put up for adoption, or, they will be euthanized if the shelter deems it necessary. The other potential shelter outcome is exposure to disease an possible death due to that. It is the prayed for hope, which I have seen happen numerous times, that a pet who began in the wrong hands lands the dream adoption and gets their blissfully joyful second chance in a home full of love and devotion.

Wee Willy. Found as a two week old with a dislocated wrist.
He is now part of our JVC rescue.

The other story that will haunt me for the rest of my days is the puppy who I would meet weeks later in the shelter. His story with me began with an inquiry phone call from the young pups mom to my veterinary clinic as she was trying to find help for her puppy, (all four months old of him), who had been suffering with a broken leg for over a week.

This is a clear cut and simple case of 'no good deed going unpunished'. It is also another small whispering reminder that I need to start to listening to. I need to leave well enough alone and remember that bad cases can evolve into worst cases quickly. And, that unknowingly, un-wantingly and unwillingly these can escalate out of your hands into full blown disasters with the spark of a prelude in good intentions.

This puppy's story began with a phone call to the clinic. A cryptic phone call about a puppy with a broken leg who needed help the owners couldn't afford. As in all cases like this when we have a client we don't know and a puppy we know needs help, we start with an in clinic examination. We go from there. In many cases we can  make miracles from intentions. It didn't start here. An appointment for the examination was made, and then no one showed. We called to see why? No answer. No answer for repeated attempts for days.

Worry set in. We worried for as long as we could quietly. That worry turned into a phone call to Animal Control. They visited the puppies home. They found a puppy with an obviously broken leg who hadn't been seen by a veterinarian and the puppy was ordered to be brought to a vet within 48 hours. We were called again and this time we offered to help with an examination for free. The puppy, sweet, happy, playful, excited to see new people, had an old fracture. So old it wouldn't be likely to heal without significant and possibly repeated bone plates from a boarded orthopedic surgeon. This constituted as neglect in the eyes of Animal Control. The puppy was essentially seized by Animal Control as they mounted a case for neglect against the owners. The puppy was left at the shelter where he stayed locked in a cage for months. Over that time I saw him turn from a happy socially outgoing and sweet, albeit lame, puppy into an emotionally neglected pit bull with fear based aggression. He was euthanized due to behavior issues, with his still broken leg, a few months later. He would have been better off with a bum leg and a family who loved him. We, with the best of intentions, killed him. I see his face behind those double caged bars to this day.

This is the real life a veterinarian leads. It is the fodder for the nightmares that haunt me, and will never let me un-see, or un-live them. These are the voices of wisdom from the forefathers who always reminded me to "keep my own nose in my own business." Or, "to not judge others."

When do I intervene? Who is going to find a home where they are loved, and, isn't that all that matters? I don't know anymore? I don't know if "good intentions" are enough?

My Fripp. Who always reminds me to smile even when life is all seemingly lemons.

For more information on anything and everything pet related please ask us for free at Pawbly.com.

For more information on Jarrettsville Veterinary Center please visit our Facebook page, or website; JarrettsvilleVet.com

I am also posting lots of informative videos at my YouTube channel here.

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.

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