The Pet Problem is the headline of an article in today's New York Times, which of course all of us here at VBB central read cover-to-cover before office hours every day. It is required reading for this blog post, so, go ahead, click over there, and check it out. I'll wait.
No, really. I'll wait.
OK. Hi, welcome back. So, the problem of elderly people and their pets, and the mismatch between their life expectancies, is commonly encountered in the world of general practice companion animal medicine. In my experience, most very elderly pet owners love their pets and prioritize the care of their dog or cat above almost anything else in their life. The subject of what to do if or when the owner expects their beloved companion to outlive them is frequently raised in my exam room - along with the sad subject of what to do if Fluffy is going to die first, and the owner feels "too old" to get another pet. In the latter situation, I have been able on several occasions to match relatively healthy but older pets, whose owners have recently passed away, with recently-bereaved elderly owners whose pets have recently passed away. Talk about a feel good moment all around! But in the first situation, it's very difficult.
I have had owners ask me if I would be willing to euthanize their dog or cat, once they themselves have passed on. Euthanasia of a healthy pet is not something most general practice vets feel good about. Simply because the pet owner is old and dying, that does not necessarily give them the right to decide a pet should die. However, commonly, the elderly pet owner is him or herself feeling the loneliness that comes after one's friends and family have largely predeceased you, and the neglect when the few remaining family members you do have do not come to visit you or even call you to say hello. When your world is so small, and there is no one to see you and give you a hug every day, is it worth it? They may feel that for their pet, there is no chance of finding a new loving home, and therefore want to spare him that loneliness. I can understand that, but I have so far been able to convince my elderly clients that this is not the way to go.
I have had owners ask me if I would personally take their dog or cat. "Dr. VBB - you are so good with Timmy. You understand him. I would rest easy if I knew he could have a place in your home." I appreciate the sentiment, really. But, if I took home every needy pet I encountered, or even if I took home 10% of them, I would quickly find myself living in some kind of "Dogs Gone Wild" meets "Hoarders" scenario. This is not a practical solution.
If the pet is relatively healthy, rehoming through one of the local rescues is often a viable option. If the pet has special needs, it can be trickier, but I do my best to find a place for it by checking in with local colleagues and social networks, in hope of finding a match. Hey, it just struck me - "Veterinarian as Owner-Pet Matchmaker" would be an interesting elective, wouldn't it? Right up there with biochemical basis of disease!
Anyway. Sometimes we see the situation where it seems like the owner and the pet are in a contest - who's going to die first? We take the cat in for boarding while the owner's heart failure is treated in the hospital. The owner goes home, the cat goes home, then the cat comes back in three days later vomiting and dehydrated. It's in renal failure, this happens periodically. We diurese it and we'd be sending it home after four days but oops, owner is back in the hospital with pneumonia. We board the cat for a few weeks, then it gets to go home again. Then it comes back in. It's really sick, hasn't eaten in a few days, hey look, now it has diabetes. We get it regulated on insulin. We send it home only to have it bounce back again a few days later because the home health nurse taking care of the owner, who broke her hip and is recovering at home, can't give the cat its insulin. These situations become very very complicated sometimes. I think the worst is when the owner arranges for us to board the pet while they go into the hospital themselves, and then they die in the hospital, and no one tells us, and eventually, we call to find out what's going on and get yelled at by the grieving son or daughter who answers the phone for being so insensitive as to ask what arrangements have been made for the pet, "at a time like this." Not being psychic, we do not know it is "a time like this" if no one tells us. The guy who taught the Crystal Ball elective at my vet school was on sabbatical during my third year, btw.
I once had a client my own age who came in frequently with a very large dog. The dog was obedient to her and well-controlled by her, but had significant aggressive tendencies and was not safe to be around when the owner was not present. Unfortunately, this client was suffering from widely metastatic cancer. At times, she was not able to care for her dog due to her weakness while undergoing chemotherapy. I took care of this dog for about five years, during which time the owner had at least four or five brushes with death. We were able to board him successfully only by keeping him relatively sedated, which is really not optimal. Eventually, in this case, we did euthanize him when his owner passed away. She had asked me to do it, and I couldn't refuse. I did have to deeply sedate him via IM injection while a tech held him at arm's length on a rabies pole first, though. Very sad situation.
The idea of the pet trust is interesting. I'm not sure there are that many people who have enough of an estate to make this idea that popular. Including a pet in one's will seems like a good idea, although as pointed out in the article, that isn't completely binding.
Veterinarian readers - what kind of solutions have you come up with for your elderly clients who fear for the fate of their longer-lived pets?
Friday, February 3, 2012
Thursday, February 2, 2012
Spaying A Tomcat
You are not a real veterinarian until you have spayed a tomcat.
CAVEAT: This piece contains gross, and is not for the squeamish.
Veterinarians are human too. We make mistakes. And we laugh at them. Might think that means we don’t care. Nope. We care. We care so much we cry in the car on the way home sometimes. Over the things we see, or have to do in the passing of our days doing our job. We care because we cannot fix em all, and we never will. And we cry about some of the horrid things we have seen our public do to their animal friends.
Laughter is the medicine we take to make all that horrible stuff go away.
A uterus full of near term puppies or kittens we gently place in the freezer so they stop moving in there as quickly as possible. Maggots on anything. That time where the entire staff put in unpaid time to try to save the puppy some jerk couldn’t be bothered to vaccinate, and they watch it die from parvo, spewing bloody diarrhea and then jerking until it stops. And the check bounces because that jerk was also a liar and a thief.
Asking to charge is, after all, presumptive evidence of fraud.
Crying in the car doesn’t fix anything. Laughter does. Some of my friends hate this blog for they think it paints veterinarians in a bad light. They think. We shouldn’t mention all that bad stuff in public. We shouldn’t make jokes about it. Pretend it doesn’t happen. The world will think badly of our profession if we confess that this stuff gets to us. Well, if we truly didn’t care, if we truly were just in this for the buck, none of this tragedy would get to us. We’d just cash the checks and go down the path dancing and singing. I don’t know. Maybe my friends do precisely that.
I don’t. I find a way to laugh, instead.
We don’t spay tomcats. We spay those female cats, the queens. We neuter tomcats. So when you “spay” a tomcat, what you really do is surgically invade the abdomen looking for two ovaries and a uterus, and not finding such, you belatedly look under her tail, and her ovaries are right there. Just like in a tomcat.
OOPS!!!
This is a mistake. It is easily corrected, by simply changing the gender of the cat in the medical record, and then you remove her testicles from under his tail, and all is right with the world, until you have to explain to the client that Jill is really Jack, and I am an idiot for not checking first. So I laugh, and the other doctors tip a cup to me at the next meeting when I confess, and they laugh too, because they are real veterinarians, too.
We turn other un-pleasantries into humor too. We lance an abscess on a cat, and the foul smelling pus roils out, and somebody asks, “Where’s the crackers?”
We spend an hour picking maggots from the skin of the old collie, and somebody always mentions that when the maggots are busily eating the live dog, they sound like rice crispies. Because, how else to you cope with the horror?
The gross drunk calls the office from the tavern, over and over again, from two phones and using all three of our phone lines, shouting and swearing and insulting my female staff members for three hours, while his low-life friends laugh in the background. And then sober, he shows up the next morning to pick up his dog, and I get to talk with him. And I explain how to do the home care for his dog, and which pills to give when, and then when that’s all done, I quietly ask him if he has the balls to say to me, face to face, even some of the crap he threw at my staff the day before. He hems and haws, and shuffles back and forth, and then he says he is sorry. And I reply: “You’re not sorry…you are an asshole. You are a sub-human primate.” And I proceeded to fire him, to toss him from our practice for eternity. Goodbye. And now, I can laugh about it.
Every time I perform a euthanasia, deliver a humane death, provide the release from intolerable when that is the only thing left to do, and I stand there with the grieving folks left behind, and I tell them they did the right thing, that they did the only thing left to do, to provide a gift for a friend, I always tell a joke. Or six jokes. Because nobody goes home after parting with their friend, without laughing.
Because that is how we heal.
They care. So I owe them that.
Bloggies haiku
We made the top five
animal blogs of the year!
Help us take first place?
http://2012.bloggi.es
Seriously guys, our minds are blown. Seeing VBB on the list of finalists in the pet/animal blog category was a complete shock. We're so happy that we even made it into the finals, it might even be better if you do NOT vote for us now, because who KNOWS if our hearts could even take the stress of winning?
Well, we'd like to find out. So, in the spirit of encouraging us to continue - go vote! Thanks :)
animal blogs of the year!
Help us take first place?
http://2012.bloggi.es
Seriously guys, our minds are blown. Seeing VBB on the list of finalists in the pet/animal blog category was a complete shock. We're so happy that we even made it into the finals, it might even be better if you do NOT vote for us now, because who KNOWS if our hearts could even take the stress of winning?
Well, we'd like to find out. So, in the spirit of encouraging us to continue - go vote! Thanks :)
Wednesday, February 1, 2012
How can a vet love animals, yet not allow a client to make payment arrangements?
I get this question often. Unfortunately in the current economy , I get it more and more. I love medicine, and I love animals. If I didn't love animals, I would have chosen a different career. My salary allows me to pay my bills (including student loans), and live a comfortable middle class life. It does not allow me to take exotic vacations, purchase fancy cars, own a beach house, or go on wild shopping sprees. I am not a rich doctor. If I do take a short vacation, that means cutting back on other expenses that month in order to afford it. There are plenty of careers with similar education requirements which would allow me to earn more money. In short, I am not 'in it for the money', but yes, it is my career, and my only source of income. It is not a hobby. I'm sure my plumber likes being a plumber, but he expects to be paid.
The sad reality is that people often cannot be trusted. Most veterinarians already know what I'm talking about, so for non-vets who may not understand why we often can't extend credit to pet owners, imagine this scenario. You are approached on the street by a person whom you have never met. The person says to you, possibly while crying "My car just broke down, and I need $1,000 for an emergency repair. The engine just blew up. I have never taken the car to a mechanic before, and it has never had an oil change or any routine maintenance. I don't get paid for another week and a half. I've already asked all my family members, and they won't lend me money. I don't have a checking account or a credit card. I just tried to get a loan at one of those cash advance places, but they won't give me anything because I didn't pay them back last time. If you loan me $1,000, I promise I'll pay you back when I get paid" Would you do it? No? Well, believe it or not, this is a very typical scenario in veterinary medicine.
Several years ago, I received an emergency call while I was having a holiday meal with my family. The caller was someone we had never seen before. She told me point blank that she had called several other practices and they would not see her because she had no money. She told me she would have money the following week, and since I had not yet been burned badly, I agreed to see her. She had a true emergency. A little dog in labor with a puppy stuck in the birth canal. My plan was to attempt to remove the puppy, then see if the mother could have the rest naturally. If a c-section was needed, I planned to offer euthanasia at no charge to end the dog's suffering. I had no plans to do a free c-section, especially because I was not the practice owner, and did not think the boss would take kindly to it.
I met the owner at the clinic, and after an exam and a radiograph, I knew the dog was in trouble, and was not going to have the puppies without a c-section. I offered euthanasia, and the owner begged me to help her. So I did. She signed a paper promising to pay in full on the next payday. I gave up the chance to return to my family meal, even though I would not see some of my family for another year. I did not have a staff on hand, so I placed an IV, induced anesthesia and did the surgery by myself. I had told the owner beforehand that since I was working alone, I would not have time to attend to the puppies. I would focus on mom, and I would not do the surgery unless the owner agreed to let me spay her. The little dog did very well through surgery, and the puppies survived after all, despite not receiving immediate care after delivery. I felt good about saving the dog and the puppies, and confident that I (and my boss) would be paid.
Well, payday came and went, and I did not receive payment. After multiple phone calls, the owner came in and paid $20. That was the first and only payment I received. $20 covered the cost of the IV catheter, fluids, and anesthesia induction injection. It did not cover the gas anesthesia, suture material, monitoring equipment, radiographs, pain medication, overhead, or my time. This surgery should have cost at bare minimum $1,000. That would have covered expenses, and allowed a profit for the practice. Because yes, my boss and I depend on profits to pay practice expenses, pay employees, provide benefits to employees so they can make a living, attend lectures to keep current, and cover our own salaries. If we collected just $20 from each client, we would go broke. I continued attempts to collect money from the client, but her phone numbers were soon disconnected, and even the collection agency could not collect anything. She never had any intention of paying, and I was left feeling angry at being taken advantage of. Worse, I knew that the puppies probably never received basic care such as de-worming or vaccines, and that they probably grew up to have puppies themselves, and contribute to pet overpopulation. The puppies were purebreds, so it is quite possible the owner sold them and made money off of the deal. My boss was very nice about it, and chalked it up to a learning experience. Had she not been so understanding, I could have been in trouble, could possibly have even lost my job. Basically, I allowed this person to steal money from her. This is not an isolated incident either. Unfortunately, more often than not, when someone promises to pay, they don't. I have learned that if relatives, health care credit lenders, and credit card companies will not extend credit to someone, I should not either.
Does this mean we vets are heartless and never extend charity? Of course not. Most of us do. Some of us volunteer services to help animals in natural disasters. Some of us examine, vaccinate, and find homes for the abandoned animals that end up on our doorsteps. Some of us donate money to animal related charities. Some of us provide shelter for animals whose owners are temporarily living in battered women's shelters. Some of us do provide discounted services for local shelters or rescue groups. And yes, some of us do allow clients to pay later in certain situations.
What makes me willing to extend credit? If the person has been a client in good standing, and is hit with an emergency, or is going through financial hardship, I try to help. If the pet has been coming to me for years, getting routine care, I feel the owner is more deserving of help than the owner of an 8 year old dog who has never received any care. If the person is making an effort to do the right thing, I'm more likely to help. Let me share another story. I recently had the great pleasure of meeting a wonderful family who had just moved to my area looking for work. Their dog had received previous vet care in another state before the people lost their jobs. The dog was very sick. She had an infection which required immediate surgery, and the cost was beyond their means. They did not ask for me to reduce my fees, nor imply that I was obligated to do so. Instead, they went home, made phone calls, and managed to scrape together half of the expected fee. They did not say so, but I suspect they sacrificed to get that money. In short, they were TRYING. They finally asked if it would be possible to pay the other half the following month. After discussing it with my boss, we decided to allow it. The surgery was a success, and the owners were grateful. They sent us a nice card and treats the next week, and they paid in full exactly as promised. If all clients were like that, I'd never turn away a request for charity. Unfortunately, this family is in the minority.
So, this had been a very long-winded way to say that while I love animals, I do have to make a living, and unfortunately, that means some animals do not get the care they need. I will never turn away an animal in pain. My personal policy is to do euthanasia at no cost if needed, to end suffering. What I cannot and will not do is work for free for someone who has no intention of holding up their end of the agreement, and has no appreciation for my efforts.
The sad reality is that people often cannot be trusted. Most veterinarians already know what I'm talking about, so for non-vets who may not understand why we often can't extend credit to pet owners, imagine this scenario. You are approached on the street by a person whom you have never met. The person says to you, possibly while crying "My car just broke down, and I need $1,000 for an emergency repair. The engine just blew up. I have never taken the car to a mechanic before, and it has never had an oil change or any routine maintenance. I don't get paid for another week and a half. I've already asked all my family members, and they won't lend me money. I don't have a checking account or a credit card. I just tried to get a loan at one of those cash advance places, but they won't give me anything because I didn't pay them back last time. If you loan me $1,000, I promise I'll pay you back when I get paid" Would you do it? No? Well, believe it or not, this is a very typical scenario in veterinary medicine.
Several years ago, I received an emergency call while I was having a holiday meal with my family. The caller was someone we had never seen before. She told me point blank that she had called several other practices and they would not see her because she had no money. She told me she would have money the following week, and since I had not yet been burned badly, I agreed to see her. She had a true emergency. A little dog in labor with a puppy stuck in the birth canal. My plan was to attempt to remove the puppy, then see if the mother could have the rest naturally. If a c-section was needed, I planned to offer euthanasia at no charge to end the dog's suffering. I had no plans to do a free c-section, especially because I was not the practice owner, and did not think the boss would take kindly to it.
I met the owner at the clinic, and after an exam and a radiograph, I knew the dog was in trouble, and was not going to have the puppies without a c-section. I offered euthanasia, and the owner begged me to help her. So I did. She signed a paper promising to pay in full on the next payday. I gave up the chance to return to my family meal, even though I would not see some of my family for another year. I did not have a staff on hand, so I placed an IV, induced anesthesia and did the surgery by myself. I had told the owner beforehand that since I was working alone, I would not have time to attend to the puppies. I would focus on mom, and I would not do the surgery unless the owner agreed to let me spay her. The little dog did very well through surgery, and the puppies survived after all, despite not receiving immediate care after delivery. I felt good about saving the dog and the puppies, and confident that I (and my boss) would be paid.
Well, payday came and went, and I did not receive payment. After multiple phone calls, the owner came in and paid $20. That was the first and only payment I received. $20 covered the cost of the IV catheter, fluids, and anesthesia induction injection. It did not cover the gas anesthesia, suture material, monitoring equipment, radiographs, pain medication, overhead, or my time. This surgery should have cost at bare minimum $1,000. That would have covered expenses, and allowed a profit for the practice. Because yes, my boss and I depend on profits to pay practice expenses, pay employees, provide benefits to employees so they can make a living, attend lectures to keep current, and cover our own salaries. If we collected just $20 from each client, we would go broke. I continued attempts to collect money from the client, but her phone numbers were soon disconnected, and even the collection agency could not collect anything. She never had any intention of paying, and I was left feeling angry at being taken advantage of. Worse, I knew that the puppies probably never received basic care such as de-worming or vaccines, and that they probably grew up to have puppies themselves, and contribute to pet overpopulation. The puppies were purebreds, so it is quite possible the owner sold them and made money off of the deal. My boss was very nice about it, and chalked it up to a learning experience. Had she not been so understanding, I could have been in trouble, could possibly have even lost my job. Basically, I allowed this person to steal money from her. This is not an isolated incident either. Unfortunately, more often than not, when someone promises to pay, they don't. I have learned that if relatives, health care credit lenders, and credit card companies will not extend credit to someone, I should not either.
Does this mean we vets are heartless and never extend charity? Of course not. Most of us do. Some of us volunteer services to help animals in natural disasters. Some of us examine, vaccinate, and find homes for the abandoned animals that end up on our doorsteps. Some of us donate money to animal related charities. Some of us provide shelter for animals whose owners are temporarily living in battered women's shelters. Some of us do provide discounted services for local shelters or rescue groups. And yes, some of us do allow clients to pay later in certain situations.
What makes me willing to extend credit? If the person has been a client in good standing, and is hit with an emergency, or is going through financial hardship, I try to help. If the pet has been coming to me for years, getting routine care, I feel the owner is more deserving of help than the owner of an 8 year old dog who has never received any care. If the person is making an effort to do the right thing, I'm more likely to help. Let me share another story. I recently had the great pleasure of meeting a wonderful family who had just moved to my area looking for work. Their dog had received previous vet care in another state before the people lost their jobs. The dog was very sick. She had an infection which required immediate surgery, and the cost was beyond their means. They did not ask for me to reduce my fees, nor imply that I was obligated to do so. Instead, they went home, made phone calls, and managed to scrape together half of the expected fee. They did not say so, but I suspect they sacrificed to get that money. In short, they were TRYING. They finally asked if it would be possible to pay the other half the following month. After discussing it with my boss, we decided to allow it. The surgery was a success, and the owners were grateful. They sent us a nice card and treats the next week, and they paid in full exactly as promised. If all clients were like that, I'd never turn away a request for charity. Unfortunately, this family is in the minority.
So, this had been a very long-winded way to say that while I love animals, I do have to make a living, and unfortunately, that means some animals do not get the care they need. I will never turn away an animal in pain. My personal policy is to do euthanasia at no cost if needed, to end suffering. What I cannot and will not do is work for free for someone who has no intention of holding up their end of the agreement, and has no appreciation for my efforts.
........You might be a vet
While we have clever writers here, we know that we do not hold a monopoly on snark and silliness in our profession. This has been discussed in our top secret, Shor-Line "Fortress of Vetitude".
I would like to ask our reader's help. The topic is ".......you might be a vet" I'll get us started, and add your contribution in the comments. The only rules are that your contribution must be both plausible and funny.
If you've ever eaten ice cream with a tongue depressor.....ymbav.
If sometimes you think it's equally important to wash BEFORE you go to the bathroom......ymbav.
If you can't think of a bodily fluid you have not had on your body.....ymbav.
If you consider anal sacs appropriate conversation over a meal.......ymbav.
Please discuss amongst yourselves.
I would like to ask our reader's help. The topic is ".......you might be a vet" I'll get us started, and add your contribution in the comments. The only rules are that your contribution must be both plausible and funny.
If you've ever eaten ice cream with a tongue depressor.....ymbav.
If sometimes you think it's equally important to wash BEFORE you go to the bathroom......ymbav.
If you can't think of a bodily fluid you have not had on your body.....ymbav.
If you consider anal sacs appropriate conversation over a meal.......ymbav.
Please discuss amongst yourselves.
Veterinarians Behaving Very Badly
We have been getting some rather nice mail from various sources, one of which is the veterinary paraprofessional staff, such as vet techs, veterinary assistants, and veterinary receptionists. Many have said that they have the same client stories with a few variations, but some have also said they would have to include some stories about doctors that had some, um, personality issues as well.
So, I thought I would share a story from my days working as a lowly veterinary assistant prior to vet school. I worked for a small clinic for a veterinarian that I had known since I was about 3. He and his family went to church with my family. Before working for him, I thought he was a pretty affable sort of guy. At church, he always seemed gracious and happy. He was well respected amongst my family's friends.
With little trepidation, I went to work for him during the summer after my first year in college. For the most part, I was ignorant of the proper way to do small animal practice, so I didn't realize that rinsing and reusing syringes AND NEEDLES was not only dangerous to the staff (would you feel safe rinsing needles or popping a dulled, overused needle in the skin of some poor animal?) it was clearly not a good idea for sterility. I didn't know that most surgeons change gowns between surgeries.
However, the first time I saw him kick a sedated dog down the hall into the surgery area, I knew there was a serious problem. He started with dragging the dog by the slip lead, in a stranglehold. Then he just kicked it down the hall. It wasn't a little push of the foot to slide it down the hall, it was a kick.
I also saw him backhand a dog that was sedated prior to a euthanasia. Why did he do this? The dog was being euthanized because it was aggressive. Hell, the dog had almost bitten me at a prior exam when I was just talking to the owner and I would have never thought to do that.
At another euthanasia, this very sweet little old lady was having to put her darling long term poodle to sleep. She told me she was looking forward to seeing him when she was dead. Once the deed was done, she turned to this doctor and asked, "Dr. Insensitive, you believe I will see Pookie in heaven, right?"
He actually answered back, "No, the Bible tells us dogs don't have a soul, therefore they cannot go to heaven."
The poor little old lady was devastated. I was horrified.
I learned many things from him. One of the most important things I learned was that just because you were an AAHA hospital and had been named practitioner of the year in your state, it did not mean that you were a good and compassionate doctor. The other thing I learned was that I would honor the emotional needs of clients even if it meant denying my own religious beliefs. As an atheist, I gladly have bowed my heads when an owner wants to say a prayer over their pet. I have assisted in many goodbyes where I told the owner that I believed that Fluffy would be waiting in the afterlife. While I do not believe in convenience euthanasias, I believe very strongly that when someone makes a decision to say goodbye to a pet, whether for financial, medical, or behavioral reasons, I will try to be as respectful and compassionate as possible.
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