Planting Seeds Even if you Don’t See the Tree.

“A society grows great when old men plant trees whose shade they know they will never sit in.” Greek Proverb

Nearly every Thursday morning I attend a meeting of the Rutland South Rotary Club of which I have been a member since early December of 2010. It’s always a pleasant morning and I look forward to seeing the people and having the experience every week.

The motto of Rotary is “Service Above Self” and the club is involved in multiple community service projects, gives out scholarships every year and we give out dictionaries to elementary students every Autumn.

And every week someone comes in and speaks to us for a little less than half an hour about a topic of their choosing. Recently, we listened as the director of Meals on Wheels explained the logistics and importance of the program to us. They also explained their need for volunteer drivers. And it got me thinking. I always feel a little bit guilty when we have speakers talking about programs I would love to be involved with but cannot make the time commitment to. I simply don’t have the time to volunteer. Or at least not to commit to something routine. I volunteer my time when it’s possible it just doesn’t happen as often as I would like it to at this point in my life. Trying to commit to anything more than a one off time sensitive task, isn’t going to happen.

But as I was sitting there listening to the speaker explain how for some of the people receiving Meals on Wheels deliveries, those drivers are the only human contact those people will have for an entire day I got to thinking about how just informing one’s self about the needs and the people who work to meet those needs within a community changes a person’s perspective dramatically. I might not have time to volunteer right now, but if you’ve read my post about money, you won’t be surprised to read that I’d like to retire from working full time at an earlier age than you might expect. Maybe not as early as this gentleman but still earlier than expected. In fact I think the job market and entire economy would do better if we could all try to limit the length of our careers a bit more than we do. That’s a topic for another day, probably a long long time from now.

Even though this woman’s pleas for volunteer delivery drivers cannot be satisfied by me in my current place in life, I would not be surprised at all if it’s not something I do in the future. Especially if my retirement plans follow their intended path. In fact there are a lot of community minded things I would like to experience as time becomes more available. Half of the reason I would like to focus on putting my family in a position where my wife and I don’t have to work as much as we currently do is so that we can focus on the things we would like to do for and with our community

So as you are moving through life you will develop affections for issues and parts of your community. Don’t stop championing those causes and don’t stop encouraging people to take interest in them simply because you aren’t seeing the results you would like when you would like to see them. You never know what kind of an impact you’re having and you never know whose life you are reaching into with your actions or your words. For all we know, the seeds you are planting today might not bear fruit for years to come. That doesn’t mean that they aren’t worth planting now.

“Even if I knew that tomorrow the world would go to pieces, I would still plant my apple tree.” Martin Luther

Thanks for reading.

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Euthanasia Aftermath

I struggled with writing about this situation. I struggled with posting a blog about it. Please try to understand.

A few weeks ago a very good client of mine passed away unexpectedly. She had a little toy breed dog who had been battling some significant but non life-threatening medical issues for the past few years. We had developed a fairly good client-veterinarian relationship and the little dog had gone from being terrified by my presence to being quite happy to see me. I always did have a pocket full of cookies for him after all. Quickest way to a dog’s heart.

I was notified on Wednesday of the woman’s passing and the daughter set up a visit for the coming Friday to have the little guy put down. Apparently, no one in the family could take the dog and with his medical conditions the owner had left instructions to have him euthanized rather than have him surrendered to a shelter or rescue group.

I expressed some concern about the visit when it was scheduled and my employer and I discussed the dog’s history. He was 13 years old, had multiple health issues and could be aggressive when he was not feeling his best. We foolishly decided that I would have a conversation with the owner’s daughter when she brought him in for his visit.

The morning of the visit came. Not that these details are important but they play into the narrative so bear with me. My family was planning a trip to visit my wife’s family in New York. When we do that, I typically drop everyone off in the morning and then pick the kids up from daycare and then get my wife from work so we don’t have to leave a vehicle at her office over the weekend. As would be expected when you are getting five people together for a weekend away from home, I was running late that morning. Veterinary medicine is one of those professions where if things start getting a little out of hand, it snowballs quickly and getting caught up can be a challenge.

I arrived at work to a fairly busy appointment schedule. I am pretty decent at compartmentalizing my work, so there was no thinking about the four hour drive I had ahead of me until 4:30 that afternoon, but also when I’m in an exam room with a client, that’s all I think about. I didn’t plan ahead as much as I would have liked for the euthanasia visit coming in at 10:00 am.

The time came and a very distraught woman brought in a happy but slightly disoriented little dog. The woman was sobbing, able to get a few words out about her mother’s wishes and was in no place to discuss other options. We fell back on our training and guided the woman through the euthanasia process. We put the little dog to sleep and prepared his remains for cremation and because we were running behind schedule we went right into our next appointment. For some reason I feel like it’s necessary to inform you that this whole process took nearly thirty minutes and as we were preparing out back we weren’t happy about it but at the time I did not see a reasonable alternative.

I went for a walk that lunch break to process my thoughts, something was weighing on my mind. My wife called and she was in the middle of a pretty difficult situation and having one of the worst days a veterinarian can have. Little did either of us know she was about to have the worst day she has yet experienced as a veterinarian and in my opinion the worst kind of day a veterinarian can have. Not that that particular detail is important but it plays into the narrative.

I got back from the walk just in time for the first appointment of the afternoon. With appointments and callbacks I didn’t have a chance to even think about anything else until I got in my car that afternoon. When I got in the car I was on a schedule. I had to get home, pack the car for the weekend, I had a list of chores that needed doing before we left. The dogs had to be fed and they needed to do their business before we took off for a four hour drive. I packed the car and picked up the girls. We (they) talked about their day from the daycare to the practice my wife works at. Once at my wife’s practice we started discussing her day and it was such a horrible day the conversation took up a good section of the drive. It wasn’t until we were on the thruway, there is this place on the right hand side when you’re heading south that has log cabin homes on display it was there that my own thoughts started creeping into my consciousness. Like fog settling on a highway at night, they did not bring with them anything good. By then my wife was trying to get a nap in and I was left alone with the radio. I started playing back the day in my head and was overwhelmed with grief as I thought about the small dog I had euthanized that morning.

I still think about him a little bit almost every day. These are the thoughts that run through my head: I wonder if I had brought him home how long he would have really had left. I could have brought him everywhere with me and I’m sure eventually my wife would have come around. I’m just manly enough so that carrying a small white dog everywhere would have looked cool or ironic. How many times in my career is something like this particular situation really going to happen to me? This could have been a once in a lifetime opportunity to make a dog’s life a little better and I missed it. Not only did I miss it but I was the instrument that ended his life. I wish I’d had more time or had reached out to the owner’s daughter a little earlier. Maybe she would have been adamant that we follow her mother’s instruction but maybe we could have come up with a solution together. I’ll never know.

Self pity aside, this is not a situation that is all that unusual in veterinary medicine. We are often faced with the request of euthanizing a pet for reasons many people might disagree with. The idea of euthanizing a pet to meet the request of an owner after they have themselves died is also not that unusual. It happens. At one point in my career we had a patient whose owner had left him a trust fund and the remaining inheritance wasn’t to be released until the pet passed. You can imagine how the lawyer felt about those veterinary bills. But ultimately, decisions like this are always going to be a part of this profession. Some of them will be a struggle and some of them won’t. This one was and still is. I don’t think that the owner’s family did anything wrong by him, I just wish it had played out differently. Hoping there’s not a next time.

Thanks for reading.

A Walk in the Woods

“I took a walk in the woods and came out taller than the trees.” Thoreau.

The above quote by Henry David Thoreau only fits this story if the reader is enamored to irony.

This was hands down one of the best experiences of my career. I learned a ton, messed up huge, looked like an idiot and still somehow came out of it all with an awesome new client who owns two awesome dogs. Names have been changed to protect the innocent.

It was an odd phone call on a Thursday afternoon. One of the clients I have been fortunate to get to know personally called with a problem. Actually, the problem belonged to a woman she had just met. I got the rundown from my client and decided to call this woman I had never met about a problem I sort of understood. Right now anyone in just about any service profession knows that this situation can only lead to hilarity.

The woman – let’s call her Becky – had adopted a dog – let’s call her Sandy – from a rescue group. To say this dog had a rough life before being placed with the rescue group would be a touch of an under statement. The poor dog did not know how to live with people and would not come inside. So they were keeping her in an outdoor pen. The problem was; she escaped the pen and had been living in the woods by their home for a few weeks. She would eat food they left out for her and she stayed near their home but she was living in the woods. Winter was coming. As was hunting season. We wanted to have her inside before the flurries and the shooting started.

I thought long and hard about how to trap a dog that was living outside and didn’t want to be trapped. I called and emailed all of the people I could think of. I looked it up online, synthesized what I found online with responses I received from a few experts in the field of wildlife medicine and finally arrived at a plan I thought had a decent chance of success. I called Becky back and we set up a day for me to come out to the house and try to sedate her and capture her.

The day was mild but overcast. A technician and I – let’s call the technician Jess – drove out on the gravel road into a thick hardwood forest with expansive pastures and the beautiful homes that can only belong to craftsmen. The type of homes that someone has to build over a lifetime rather than have thrown up in a few months as a second home near their favorite ski mountain. We pulled into the drive of Becky’s house and met her husband – let’s call him Dave – we chatted a few moments while I laced some canned dog food with the tranquilizers we were going to hopefully capture Sandy with. I made friends with their older Labrador retriever – we’ll call her Lacey – and we discussed the plan. Then we loaded ourselves into the back of an ATV and rode down a carriage path into the forest. We stopped a few hundred yards short of where she was typically fed and we found a comfortable point on the forest floor to wait. It was an old growth forest with tall and sturdy Sugar Maples making up majority of the population. The gravel road was a few hundred yards to our left and just about twenty yards to our right was a steep hill that led to a marsh pond.

The sun burned off the cloud cover while we waited patiently for the dog to eat the laced meal. The plan was simple, after she ate the food and was properly sedated, we would sneak up on her and contain her with a slip lead on a pole. This is sometimes endearingly referred to as the “rabies pole.” Once she was on the rabies pole we were going to place a muzzle on her and lift her into a large crate. There she would peacefully sleep off the tranquilizers and we would get back to the office so I could see afternoon appointments. It was a foolproof plan.

Unfortunately, I’m not a fool. I’m an idiot. And the plan was not idiot proof.

Becky sneaked quietly up to where Sandy ate and placed the laced dog food. We waited patiently and quietly out of sight while Sandy made her way over and ate the meal. It took about forty five minutes for her to become drowsy and eventually she bedded down in some tall grass and didn’t move for over ten minutes. It was time to make our move.

We quietly made our way out to the gravel road and traveled down until we were lined up with where she was laid out on a small knoll. We crept through the brush until I caught sight of her and then with the rabies pole in my hands like a spear held by a gladiator, I began my approach. She saw me coming – likely from the road – but waited until I actually thought I was going to get her on the first attempt before she decided to make a drunken run for it. I was horrified she was going to stumble down the hill and end up passing out in the pond, so I gave chase.

Sandy stumbled her way through the brush because she had been drugged. I stumbled my way through the brush because I am just under six feet tall and uncoordinated. There were a few times where I came close to her but she eventually gave me the slip all together and I made my way back to the house. A little discouraged but not defeated. I still had another dose of tranquilizer. If she wanted to make like she was the Keith Richards of dogs, I was going to indulge her. When we made it back to the house I had Jess return to the office in my car. This was taking a little longer than I expected but I was determined to have Sandy in custody before I left that day.

I mixed up another batch of drug laced canned dog food and we locked Lacey in the house. We were waiting for Dave to get back with the ATV and decided to grab a few glasses of water while we waited. I set the plate of drug laced dog food down on the porch and stepped inside for a moment to place my empty glass by the sink. I opened the door to return outside and Lacey brushed past me on her way back into the house. I went to pick up the plate and noticed something wasn’t quite right about it. In fact everything was wrong. The plate was completely clean. Licked clean. By Lacey. The old, not scared very docile dog had just received a rock star worthy dose of tranquilizers. You know that pit of your stomach feeling when something goes terribly wrong? You know that skin too tight feeling when a well thought out plan has gone completely sideways and there’s no hope for success? I had both of those feelings at the exact same time. I could have burst into tears. Thankfully, before I did that I caught sight of the bumper sticker on Becky’s car that read, “Proud Mother of a United States Marine.” I couldn’t break down and cry over a little set back like sedating the wrong dog and not being able to capture a loose dog on the first attempt in front of a woman who had raised a Marine. She probably wouldn’t have known what to do and might have had to put me down out of pity. So I swallowed hard and tried to shrink the lump in my throat before explaining to Becky what had just happened. She took it surprisingly well and I did my best to explain that Lacey was going to be just fine and would sleep off the dose she had taken while simultaneously trying to keep her from seeing my fingers crossed in hope behind my back.

We went back out in search of Sandy and while we had a few more attempts at snaring her with the rabies pole, we ultimately concluded that it would be best to return another day. We went back to the house where we found a passed out Lacey  blocking the kitchen door. I moved her to a dog bed in the living room, apologized for the outcome of the day and walked to the end of the driveway to sulk, call work and wait for a ride back to home base. I dialed my wife to hopefully get some words of encouragement and my phone beeped at me twice to remind me it needed to be fed some electricity and then powered itself off. I sat back and tried to enjoy what had become a sunny and warm Autumn day.

Jess picked me up about fifteen minutes after I called. I took over the driver seat and we drove mostly in silence the whole way back to the office. Once at the office I immediately set out to purchase a blow gun with injection darts and prepared to make a more aggressive attempt at capturing Sandy.

I received a text message a few days later that Becky had finally captured her. I am happy to report that both Sandy and Lacey are doing fine and neither dog has lost any of their faith in me. Fortunately, neither has Becky.

I still haven’t used the blow darts to restrain an animal but I practice all the time and am pretty good with it. So if you ever have a need….

Thanks for reading.

First Contest!

The rules to this contest are completely subjective. You post a comment telling me what you think the reason behind the cow’s behavior is but you have to use as little anthropomorphism as possible. The comment I deem to be the best based solely on my personal opinion will win the t shirt  listed below.

So the rules are:

1. Post a comment explaining the cow behavior without applying anthropomorphism to them.

2. Lobbying for your comment, up voting someone else’s comment or adding multiple comments is strongly encouraged.

3. Any belittling or rude comments will be deleted.

4. The winner will be selected by me.

5. Contest results will be posted by midnight on June 1, 2015.

The shirt: 

It comes in other colors and of course different sizes. You can see more about it at the iheartdogs website.

The Big Casino

With apologies to my grandmother and other more sensitive readers, the working title while I was writing this post was “f@#king cancer.” I’m not sure why I felt the need to tell you that except that it illustrates how I feel on the subject. I would open my “drafts” file every few days and see this post and start writing, scrap it and start over. This post really only applies to terminal cancers. There are a few cancers that can be cured with aggressive and sometimes even modest surgical or medical approaches.

The big casino, the “C” word. The big C. It’s one of those things that comes out as a heavy weight attached to even heavier weights. Words like surgery – not so bad – often followed by horrible words like chemotherapy, radiation or metastasis. Chemo, the other C word. When I bring up the word chemotherapy in an exam room, I know the face I’m going to see. I wish I could put myself in people’s shoes and see what they were picturing when I say the dreaded chemo-word. But I can’t forget the things I know and I can’t erase my experiences. To me chemotherapy is time, it’s a chance to set the clock back a little bit. We can take a pet who is really sick and help them get back some of that quality of life they’ve lost. For some time. It’s a chance for people to come to terms with the fact they won’t get to see their pet grow old or that their older pet is dying.

People generally have someone in their circle of loved ones who has gone through the nightmare of chemotherapy. I think they picture that experience when making the decision and to me that’s a mistake. I would never knowingly suggest putting a pet through something as horrible as what some human cancer patients endure. In our world however, we aren’t going for maximizing the total number of days nor are we hoping to strike on the cure. Our aim is to work with you to find a way to maximize the total number of tail wags (dogs) or head butts (cats) we can experience before we have to make a tough decision.

Chemotherapy is typically a series of visits, monitoring and then administration of drugs that are designed to target rapidly dividing cells, turn off the pathways that these cells use for growth and sometimes they even prepare the body to do battle with the cancer by ramping up antibody production.

Sometimes this will followed by or in rare cases replaced by radiation oncology. Radiation can also be used to control symptoms in patients who have tumors that can not be operated on or in cancers that can not be cured. It involves “firing” ionized radiation in specially shaped beams that maximize the dose of radiation at the site of the tumor while sparing the healthy tissue as much as possible. For us here in Rutland, Vermont, the closest facilities that offer this service are in Boston and Montreal.

Chemotherapy and radiation oncology sometimes follow surgery, sometimes there is no surgery and sometimes they are used to shrink a tumor enough to allow surgery. It depends. No matter what course of action is taken our goal is always to maximize the number of tail wags or head butts you and your pet share.

That doesn’t mean there won’t be bad days. There will be nausea. There will be diarrhea. There might be vomiting. There will be blood. Draws, that should have said blood draws. Holy monitoring there will be a lot of blood draws. But we can manage all of these things. And if we know they are coming we can manage them effectively before they happen. An ounce of prevention and all that.

No one wants to tell you your dog has cancer and no one wants to explain options and decisions while your head is reeling from the initial blow. I can still remember one client stopping me mid-sentence and asking me in a very concerned and serious tone, “Dogs can get cancer?” She had no idea. And why should she? She had never experienced it nor had anyone she knew. But she had a mother who went through cancer and it was terrible. She was in no shape to discuss cancer in her dog. She just found out at the same time that not only could dogs get cancer but her dog actually had cancer. So we rescheduled the conversation for a few days later and boy did she come in with some internet articles for us to peruse. I am always slightly tempted to remind people that I also have internet access, at work and at home. But she informed herself and we made some decisions for her dog and he went on to do well for an acceptable period of time.

The one take away I want you to get from this or to pass on to a friend who is going through a tough time. Please, if you can, please at least sit down with an oncologist. If you’ve gotten far enough to diagnose the cancer into a specific kind, it should be compulsory to have a conversation with an oncologist. This is not because they great sales people and will talk you into maximizing your dog’s quality of life thus justifying my means with an end. No, all of the oncologists I know are way softer and sweeter than this hard boiled, fast talking, quick blogging country vet. I want you to sit down with an oncologist because they can give you all of your options and allow you to make an informed decision. I promise they won’t push or force the issue. But it will always be worth your time to find out what can be done.

So yes, cancer is terrible. Yes it is always bad news but it is a situation where getting all of your options explained by experts is always going to be worth your time.

Thanks for reading.

It’s the Season of Boom and Crash

No not the economy. Hopefully not anyway.

I’m talking about fireworks. And thunderstorms. And boats on the lake. And motorcycles on the road. And open windows letting all these noises in.

I enjoy all of these loud things but like your dog, I understand that sometimes they are just a little more than any of us want to deal with. Unlike your dog, I understand that the world is not coming to an immediate end simply because the sky is lighting up and making huge crashing noises.

An amusing anecdote about how thoughtless some dog owners can be. I once took my dog Moxie – who happens to be the most anxious dog I have ever met – with me when I went to see the fireworks over the Charles River and listen to the Boston Pops with my brother and his family. Here’s a picture of Moxie having a great time (why is there no sarcasm font?):

Moxie

As one might imagine, Moxie has zero fond memories of this trip. The stroller belonged to my nephew. We don’t walk our dog in a stroller. Not that I’m judging. We just don’t.

Sure, avoiding one of the largest fireworks shows in the United States is an easy way to help your pet through this season. But what about all the other stuff?

The first bit is the hardest to do. Don’t reward clingy behavior by going out of your way to comfort them and console them. That doesn’t mean you should give your dog the cold shoulder if they come to you afraid and seeking some affection. You are the one who is supposed to make it all better. But remain calm, speak to them in calm even tones and of course pet them. But don’t encourage them to be anxious by seeking them out and making them endure your comforting. If they are in their spot and staying calm, let them be. Instead all year, every day of their lives, reward them for being calm. Someone comes to the door and they didn’t bark? Oh that’s a cookie. A car backfires outside or a gunshot is heard during hunting season? That’s a cookie and a “good dog.” By ignoring them when they are acting anxious and rewarding them when they are calm, we are reinforcing the calm behavior. You are not reinforcing their fear by comforting them or by yelling at them to stop barking when they are startled but it does reinforce the behavior. It takes time but trust me it works. Also, be patient with yourself. This is hard work.

Then when a storm is coming or there will be fireworks or a biker parade, be around. If you are planning to get groceries but a thunderstorm is coming, put it off. The grocery store will still have food after the storm and you won’t slip on the wet floor and hurt your wrist. Be around your dog but don’t coddle them, instead play a game with them or simply go about the business of being calm, indoors and do what you normal do. When your dog calms down, give them a cookie. Reward the good behavior, ignore the anxious behavior. I know, it’s harder than it sounds.

If you can’t be around or if you are around but like to have the radio on, do so. Some quiet music can really help take a dog’s mind off the noises outside. Dogs (and cows and horses) really seem to respond to the tones and cadence of NPR. They also don’t feel guilty during the membership drive. So put on your public radio station and see if your pup relaxes a little bit. I will warn you however, I know at least a few dogs who have learned to associate the radio’s weather warning with impending thunder storms. They hear that buzzing siren sound and run and hide. So there’s that to think about.

Make sure your pup has access to somewhere to hide. Under a bed, inside a favorite crate or the kitchen table are all fine ideas. Just watch where your dog goes when there is a storm and then make sure they can always get there and most importantly, get back. If your dog feels trapped he or she might just recreate the garage scene from “Marley and Me.”

If your dog is really struggling you might think about ordering a thunder shirt. These snug fitting wraps apply a gentle calming pressure that makes your dog feel safe and apparently releases endorphins or something like that. I don’t know how they work, they seem to work and it reminds me of the squeeze chute Temple Grandin describes in her book, Animals in Translation and that’s my favorite part of the book so I have a completely illogical attachment to thunder shirts.

If that doesn’t work. Talk to your veterinarian. They may have ideas I haven’t thought of. If I’m your vet, maybe I’ll have more ideas by then. If I’ve had the appropriate amount of caffeine I might even be able look up other people’s ideas.

Thanks for reading.

It’s Not Just Ingredients

Recently, a certain high end pet food has experienced at least one lawsuit because the marketing on the outside of their bag did not match up with what was on the inside. I am willing to wager that a lot of the higher end pet foods that cater to niche markets of consumers who wish to include ingredient x or exclude ingredient y from their pets diets are likely to have similar issues in the near future. Words on pet food labels like “human grade” or “organic” and sometimes even “grain free” have rules about when they can be used on a label but not when they can be used in advertising.

Fortunately, pets don’t need ingredients. They need nutrients and they can get those nutrients from high end “top of the line” food and they can get those nutrients from low end bargain bin food. More important than the ingredients, to me, is that the company has control over the facility the food is manufactured in and that the food, at least the basic recipe, has been put through feeding tests before it reaches your pet’s dish.

Below is a fairly comprehensive list of ingredients you might see on a pet food label and how those ingredients are defined. It is worth noting that many pet food companies will advertise “meat as the first ingredient.” Ingredients are listed per weight, it is possible to list a meat first by using chicken and then also list Brewer’s Rice, Ground Whole Brown Rice, Rice, Rice Bran and Rice Flour separately. Sure Chicken comes first but that food definitely has more rice than chicken in it. Sneaky right?

The AAFCO (Association of American Feed Control Officials) sets guidelines and definitions for animal feed, including pet foods.

  • Alfalfa Meal – the aerial portion of the alfalfa plant, reasonably free form other crop plants, weeds and mold, which has been sun cured and finely ground.
  • Animal Digest – material that results from chemical and/or enzymatic hydrolysis of clean and undecomposed animal tissue. The animal tissues used shall be exclusive of hair, horns, teeth, hooves and feathers, except in such trace amounts as might occur unavoidably in good factory practice and shall be suitable for animal feed.
  • Animal Fat – is obtained from the tissues of mammals and/or poultry in the commercial processes of rendering or extracting. It consists predominantly of glyceride esters of fatty acids and contains no additions of free fatty acids. If an antioxidant is used, the common name or names must be indicated, followed by the words “used as a preservative”.
  • Barley – consists of at least 80 percent sound barley and must not contain more than 3 percent heat-damaged kernels, 6 percent foreign material, 20 percent other grains or 10 percent wild oats.
  • Barley Flour – soft, finely ground and bolted barley meal obtained from the milling of barley. It consists essentially of the starch and gluten of the endosperm.
  • Beef (meat) – is the clean flesh derived from slaughtered cattle, and is limited to that part of the striate muscle which is skeletal or that which is found in the tongue, in the diaphragm, in the heart, or in the esophagus; with or without the accompanying and overlying fat and the portions of the skin, sinew, nerve and blood vessels which normally accompany the flesh.
  • Beet Pulp (“beet pulp, dried molasses” and “beet pulp, dried, plain”) – the dried residue from sugar beets.
  • Brewer’s Rice – the dried extracted residue of rice resulting from the manufacture of wort (liquid portion of malted grain) or beer and may contain pulverized dried spent hops in an amount not to exceed 3 percent.
  • Brown Rice – unpolished rice after the kernels have been removed. Not a complete AAFCO definition.
  • Carrots – presumably carrots. No AAFCO definition.
  • Chicken – the clean combination of flesh and skin with or without accompanying bone, derived from the parts or whole carcasses of chicken or a combination thereof, exclusive of feathers, heads, feet and entrails.
  • Chicken By-Product Meal – consists of the ground, rendered, clean parts of the carcass of slaughtered chicken, such as necks, feet, undeveloped eggs and intestines, exclusive of feathers, except in such amounts as might occur unavoidable in good processing practice.
  • Chicken Liver Meal – chicken livers which have been ground or otherwise reduced in particle size.
  • Chicken Meal – chicken that has been ground or otherwise reduced in particle size.
  • Corn – unspecified corn product. Not a complete AAFCO definition.
  • Corn Bran – the outer coating of the corn kernel, with little or none of the starchy part of the germ.
  • Corn Germ Meal (Dry Milled) – ground corn germ which consists of corn germ with other parts of the corn kernel from which part of the oil has been removed and is the product obtained in the dry milling process of manufacture of corn meal, corn grits, hominy feed and other corn products.
  • Corn Gluten – that part of the commercial shelled corn that remains after the extraction of the larger portion of the starch, gluten, and germ by the processes employed in the wet milling manufacture of corn starch or syrup.
  • Corn Gluten Meal – the dried residue from corn after the removal of the larger part of the starch and germ, and the separation of the bran by the process employed in the wet milling manufacture of corn starch or syrup, or by enzymatic treatment of the endosperm.
  • Corn Syrup – concentrated juice derived from corn.
  • Cracked Pearl Barley – cracked pearl barley resulting from the manufacture of pearl barley from clean barley.
  • Dehydrated Eggs – dried whole poultry eggs freed of moisture by thermal means.
  • Digest of Beef – material from beef, which results from chemical and/or enzymatic hydrolysis of clean and undecomposed tissue. The tissues used shall be exclusive of hair, horns, teeth and hooves, except in such trace amounts as might occur unavoidably in good factory practice.
  • Digest of Beef By-Products – material from beef which results from chemical and/or enzymatic hydrolysis of clean and undecomposed tissue from non-rendered clean parts, other than meal, from cattle which includes, but is not limited to, lungs, spleen, kidneys, brain, livers, blood, bone, partially defatted low-temperature fatty tissue, and stomachs and intestines freed of their contents. It does not include hair, horns, teeth and hoofs.
  • Digest of Poultry By-Products – material which results from chemical and/or enzymatic hydrolysis of clean and undecomposed tissue from non-rendered clean parts of carcasses of slaughtered poultry such as heads, feet, viscera, free from fecal content and foreign matter except in such trace amounts as might occur unavoidably in good factory practice.
  • Dried Animal Digest – dried material resulting from chemical and/or enzymatic hydrolysis of clean and undecomposed animal tissue. The animal tissue used shall be exclusive of hair, horns, teeth, hooves and feathers, except in such trace amounts as might occur unavoidably in good factory practice and shall be suitable for animal feed. If it bears a name descriptive of its kind or flavor(s), it must correspond thereto.
  • Dried Kelp – dried seaweed of the families Laminaricae and Fu-caeae. If the product is prepared by artificial drying, it may be called “dehydrated kelp”
  • Dried Milk Protein – obtained by drying the coagulated protein residue resulting from the controlled co-precipitation of casein, lactalbumin and minor mild proteins from defatted milk.
  • Dried Reduced Lactose Whey – no AAFCO definition available.
  • Dried Whey – the product obtained by removing water from the whey. It contains not less than 11 percent protein nor less than 61 percent lactose.
  • Feeding Oatmeal – obtained in the manufacture of rolled oat groats or rolled oats and consists of broken oat groats, oat groat chips, and floury portions of the oat groats, with only such quantity of finely ground oat hulls as is unavoidable in the usual process of commercial milling. It must not contain more than 4 percent crude fiber.
  • Fish Meal – the clean, dried, ground tissue of undecomposed whole fish or fish cuttings, either or both, with or without the extraction of part of the oil Ground Corn (ground ear corn) – the entire ear of corn ground, without husks, with no greater portion of cob than occurs in the ear corn in its natural state.
  • Ground Dehulled Oats – presumably ground cleaned oats with hulls removed (ground oat groats). Not an AAFCO definition.
  • Ground Wheat – presumably a coarser grind of wheat flour. Not an AAFCO definition.
  • Ground Whole Brown Rice (Ground Brown Rice) – the entire product obtained by grinding the rice kernels after the hulls have been removed.
  • Ground Whole Wheat – ground whole kernel, presumably equivalent to AAFCO’s Wheat Mill Run, Wheat Middlings, Wheat Shorts or Wheat Red Dog, whose principal differences are in the percentage of crude fiber.
  • Ground Yellow Corn – same as ground corn, except that the corn used is yellow in color.
  • Kibbled Corn – obtained by cooking cracked corn under steam pressure and extruding from an expeller or other mechanical pressure device.
  • Lamb Bone Meal – (steamed) dried and ground product sterilized by cooking undecomposed bones with steam under pressure. Grease, gelatin and meat fiber may or may not be removed.
  • Lamb Digest – material resulting from chemical and/or enzymatic hydrolysis of clean and undecomposed lamb. The tissue used shall be exclusive of hair, horns, teeth and hooves, except in such trace amounts as might occur unavoidably in good factory practice and shall be suitable for animal feed.
  • Lamb Fat – obtained from the tissues of lamb in the commercial processes of rendering or extracting. It consists predominantly of glyceride esters of fatty acids and contains no additions of free fatty acids. If an antioxidant is used, the common name or names must be indicated, followed by the words “used as a preservative”.
  • Lamb Meal – the rendered product from lamb tissues, exclusive of blood, hair, hoof, horn, hide trimmings, manure, stomach and rumen contents except in such amounts as may occur unavoidably in good processing practices.
  • Linseed Meal – the product that remains after being mechanically extracted from ground flaxseed cake or chips after the removal of most of the oil has been removed. It must contain no more than 10 percent fiber. The words “mechanical extracted” are not required when listing as an ingredient in the manufactured food.
  • Liver – the hepatic gland (of whatever species is listed).
  • Meat and Bone Meal – the rendered product from mammal tissues, including bone, exclusive of blood, hair, hoof, horn, hide trimmings, manure, stomach and rumen contents, except in such amounts as may occur unavoidably in good processing practices.
  • Meat By-Products – the non-rendered, clean parts, other than meat, derived from slaughtered mammals. It includes, but is not limited to, lungs, spleen, kidneys, brain, livers, blood, bone, partially defatted low-temperature fatty tissue and stomachs and intestines freed of their contents. It does not include hair, horns, teeth and hooves.
  • Meat Meal – the rendered product from mammal tissues, exclusive of blood, hair, hoof, horn, hide trimmings, manure, stomach and rumen contents except in such amounts as may occur unavoidably in good processing practices.
  • Peas – peas.
  • Potatoes – potatoes.
  • Poultry By-Product Meal – consists of the ground, rendered, clean parts of the carcass of slaughtered poultry, such as necks, feet, undeveloped eggs, intestines, exclusive of feathers, except in such amounts as might occur unavoidably in good processing practices.
  • Poultry Digest – material that results from chemical and/or enzymatic hydrolysis of clean and undecomposed poultry tissue.
  • Poultry Fat (feed grade) – primarily obtained from the tissue of poultry in the commercial process of rendering or extracting. It shall contain only the fatty matter natural to the product produced under good manufacturing practices and shall contain no added free fatty acids or other materials obtained from fat. It must contain not less than 90 percent total fatty acids and not more than 3 percent of unsaponifiables and impurities. It shall have a minimum titer of 33 degrees Celsius. If an antioxidant is used, the common name or names must be indicated, followed by the word “preservative(s)”.
  • Powdered Cellulose – purified, mechanically disintegrated cellulose prepared by processing alpha cellulose obtained as a pulp from fibrous plant materials.
  • Rice Bran – the pericarp or bran layer and germ of the rice, with only such quantity of hull fragments, chipped, broken, or brewer’s rice, and calcium carbonate as is unavoidable in the regular milling of edible rice.
  • Rice Flour – milled rice
  • Soy Flour – milled soybeans
  • Soybean Hulls – consist primarily of the outer covering of the soybean.
  • Soybean Meal (Dehulled, solvent Extracted) – obtained by grinding the flakes remaining after removal of most of the oil from dehulled soybeans by a solvent extraction process.
  • Soybean Meal (Mechanical Extracted) – obtained by grinding the cake or chips which remain after removal of most of the oil from the soybeans by a mechanical extraction process.
  • Soybean Mill Run – composed of soybean hulls and such bean meats that adhere to the hulls and such bean meats that adhere to the hulls which results from normal milling operations in the production of dehulled soybean meal.
  • Tallow – animal fats with titer above 40 degrees Celsius.
  • Turkey – unspecified turkey. Not a complete AAFCO description.
  • Turkey Meal – the ground clean combination of flesh and skin with or without accompanying bone, derived from the parts or whole carcasses of turkey or a combination thereof, exclusive of feathers, heads, feet and entrails.
  • Wheat Bran – the coarse outer covering of the wheat kernel as separated from cleaned and scoured wheat in the usual process of commercial milling.
  • Wheat Flour – wheat flour together with fine particles of wheat bran, wheat germ and the offal from the “tail of the mill”. This product must be obtained in the usual process of commercial milling and must not contain more than 1.5 percent crude fiber.
  • Wheat Germ Meal – consists chiefly of wheat germ together with some bran and middlings or short. It must contain not less than 25 percent crude protein and 7 percent crude fat.
  • Wheat Mill Run – coarse wheat bran, fine particles of wheat bran, wheat shorts, wheat germ, wheat flour and the offal from the “tail of the mill”. This product must be obtained in the usual process of commercial milling and must contain not more than 9.5 percent crude fiber.
  • Whey – the product obtained as a fluid by separating the coagulum from milk, cream or skimmed milk and from which a portion of the milk fat may have been removed.

You now possess the power to define most of the ingredients you are likely to encounter on a pet food label.

Thanks for reading.

Veterinarian Admits He Is In It For The Money

It’s true. I am. Sort of.

Being a veterinarian is my profession. Like any other professional in any other line of work, I expect to be paid for practicing my craft. I don’t think that makes me a bad person. Quite the opposite really. I took the time to think out what profession would make me the happiest and what profession I had the most to offer to and I went out and became a professional in that exact field. When you put it like that, it’s really kind of admirable. The same is true of every veterinarian you meet.

Still, somehow I hear from people that veterinarians charge too much and should do more for the love of the animals. I understand that sentiment and in a way I do actually share it. I have said it before and I meant it, I would do this job for free if I could.

But I can’t. And frankly, I don’t want to. I like money, it allows me to do stuff that makes me happy. It allows me to provide for a family, and to indulge my children once in awhile. Money pays for the gas in my car, it pays for my house and our groceries. Also electricity, health insurance, oil for the furnace and someday it will allow me to stop working and still afford all of those things.

Even if I had enough money to pay for all of those things for the rest of my life, it would still cost money to provide veterinary care. So it would still cost money to come and see me. I also expect the staff I am working with at any given time to want to earn money for the hard work they put into caring for people’s pets. So there you go.

How much should it cost? I touched on this a little bit in a post about the expense of having pets. Because this is a business and needs to earn money, in reality it costs as much as the majority of people are willing to pay. That’s sort of an underlying fundamental of economics. If there are 100 people who will pay $30 for an exam but 80 of those people will also pay $45. You charge $45. You make almost 20% more money doing 20% less work. It’s kind of silly not to. If you had 1 person out of every hundred who would pay $4,000 for an exam and you felt comfortable charging that much, you should. I couldn’t do it. But I have self esteem issues.

I know what you’re thinking. I should want to help as many pets as I possibly can. I don’t know how else to put this. I am not a superhero. No veterinarian is. The thing about trying to be all things to all people is this: when anyone does that, everyone loses. I can’t see all the pets I would like to see in a single day and still maintain the standard of service that I hold myself to. It’s much the same way veterinarians struggle to be available all hours of the day and night and provide that same level of care. No one can do it. Anyone who says they can should have been a politician instead. By limiting the number of patients I see in a single day I am able to spend more time, be more thorough and create a more personal relationship with my patients and their owners. For people who shop for veterinary service based on price, Walgreen’s will be offering that service through a company called Shot Vet.

In actuality, if I was only in it for the money, I would do something along the lines of Shot Vet. Brief exam, packaged vaccine and preventative care options and low expectations. Even at the lowest cost package; I would make the same amount of money or more by seeing patients assembly line style. That’s assuming only a slightly higher number of patients each day than I currently see.

But this is my craft, I take a lot of pride in it. So does your veterinarian. We all work to provide the best medical care we possibly can within the confines of each situation and we do our best to charge appropriately for it. I could see four times as many patients and make more money by offering less expensive but also less thorough and lower standard services, but I take pride in knowing my clients and their pets, I take pride in offering complete veterinary care that is my absolute best every single time I step into the exam room, surgery suite, or treatment area. I don’t want to be good and make lots of money. I want to be great and make an honest living. I promise you, your veterinarian feels the same way.

So yes, we are in it for the money, we expect to be able to earn an honest living, and to provide for our families. And some of us, hopefully the majority of us, will earn enough to provide a comfortable lifestyle for our families. Because when a person isn’t stressed about making ends meet, they can focus on the aspects of their profession that they love. It just makes for better veterinarians.

Thanks for reading.

Homestyle Hooch

I’m sure this is the how to blog you’ve been waiting for a veterinarian to write. I take my job as a veterinarian very seriously. But I do drink a little.

I’ve brewed beer a number of times and really enjoy the process and of course, the results. But I’ve got three daughters under five, I work at least 50 hours a week, I am on call 24/7 for 7 days out of every 14 and brewing beer takes some time commitments I just don’t have. But still, good booze is expensive and budgeting is important. I wanted to find a way to stay solid on flavor but also keep more of my hard earned money in my bank account. I think I’ve come across a winner here. Update on May, 24 2015. I recently learned that this is not an original idea (I sort of figured someone would’ve thought of this before it’s so easy) here’s an article with much more colorful language and writing than my own.

The basic premise is simple. I took yeast, added it to fruit juice, let it ferment in an oxygen free environment and then enjoyed the bounty of nature’s labor. Here’s a step by step.

Step one: You’ll need some decent reusable containers. You don’t want to have to get new containers every time. You also need a collar that fits snugly over the top of the bottle and a vapor lock to keep oxygen out. We’re making booze not vinegar. I had these half gallon growlers lying around and picked up the vapor lock and collar from a home brewing store for less than 5 bucks. They are also reusable.

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Step Two: Next you’ll need a substrate (juice) and some yeast to turn the sugar in the juice into alcohol. I used apple cider from an orchard here in Vermont and I picked up a blueberry pomegranate juice that had no added sugar and no preservatives. I was going for fancy. The yeast was a gamble. The first time I tried this, I used Champagne yeast. It worked nicely but yielded a fairly low alcohol content. Not that I’m greedy but half a gallon yields a little better than 5 beers. If I brew a gallon that gives me just under a 12 pack. If I have to wait an entire week and get less than 2 beers per day before the next batch is done, I want them strong. So for this batch I used a super yeast. It will survive up to 20% alcohol by volume but there isn’t enough natural sugar in juice to get that much alcohol. Also, I don’t need that much. You can order super yeast from amazon here. I bought mine from the beer store in Ludlow.

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Here is a close up of the yeast.

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Step Three: The next logical step is to add the yeast and the juice to the containers and secure the collar and vapor lock. To activate the vapor lock, you just fill with water to between the lines that say minimum and maximum. The end result of this step looks like this.

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Step 4: Leave it alone for at least a week. If you leave it too long, the yeast dies and when they die they sort of throw up their guts and give your beverage that mealy textured cardboard flavor. The beverage is full of B vitamins when that happens so it’s not bad for you but we’re not making health food here. I left mine in the basement.

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Step Five: After a week. I moved the now fermented beverage into a secondary growler (I have a few of these things) and put that in the fridge. After a few hours it was ready to drink. The blueberry pomegranate came out really good. The cider was as expected but the blueberry pomegranate was unexpectedly delicious.

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So there you go, in five easy steps you can make your own homemade hooch.

Thanks for reading.

I don’t HAVE a body. I AM a body.

Human capacity for creativity and beauty almost always leaves me in awe. Our brains provide us with the ability to create and build this amazingly complex world that you and I are enjoying at this very minute. Even when the majority of us don’t understand how any of it works. I press some keys here in my office and you read these words on a screen practically anywhere you want to. And all of this equipment communicates without being physically attached to any other equipment. And it’s not magic. Someone out there understands how this all works. It amazes me.

The photo used at the top of the post today isn’t actually a landscape with a waterfall that’s been edited or created digitally. It’s all created within an aquarium and the effects are made by adding powders to the water and accenting it with lighting. You can find more works by the artist Kim Keever on the artist’s website.

There is a common and mildly annoying sentiment traveling across social media that goes like this, “You don’t have a soul, you are a soul, you have a body.” I understand the sentiment. We all want to feel special, unique and as if we are a once in a million year event. We also want to feel as if that uniqueness, that special “je ne sais quoi” is going to live on forever. I’m not going to tread too deeply into the afterlife on this tangent except to say that I personally don’t believe anything transcends the material world. In my worldview, if something can not be measured, it does not belong in the same discussion as things that can.

Back to our bodies and the idea that we are more than our material makeup. In a sense I agree, if it were somehow possible to transfer your brain into another body, not much would change. The sound of your voice. Probably the nuances of the mannerisms of your movement and maybe some facial expression. But you would be you. As ridiculous as that might sound, one Italian doctor is interested in making the nightmare a reality. So you are more than just your body, but at the same time, you could damage your brain in such a way so that you no longer recognize faces. Even this part of us that seems immaterial is bound to the materials we are made of.

So we are a collection of materials that come together for a unique moment to compose us. In time, we will die and all of those molecules, maybe even down to the atomic level, they will separate and join up with other molecules to make up something else. But for this brief moment in time, they make up you and me. That’s beautiful to me.

That collection of materials comes together to create some of the most beautiful things this world has ever seen. Every painting you’ve seen, every song you’ve heard and every book you’ve read was created by someone using the gray matter in their skull to control their muscle and bones to create a thing of beauty.

Here’s the thing about it to me. I don’t think I draw less beauty out of the world simply because I don’t see anything magical or supernatural about our ability to create beauty. I don’t think a beautiful starry night looks less beautiful to us than it might to folks who don’t know that stars are just big balls of fusion like our Sun. I don’t think a diamond seems any less beautiful or rare knowing that it is just a perfectly aligned crystal composed of carbon atoms. And I don’t think language, speech and spoken poetry are less wonderful because the sounds are made by simply moving two folds of tissue and placing the tongue and mouth a certain way while pushing air out of the lungs. In fact, I might even argue that looking at the world through that lens makes everything a little more beautiful, a little more amazing. Not only is it an amazing thing that the human species is capable of communicating using speech in multiple languages, singing opera or reciting Shakespeare but I think it is more amazing that we understand the mechanics of how it is possible. And it’s terribly simple. Vibration of air as it passes through a tunnel that changes shape. Here’s a video of some vocal folds at work. Amazing right?

While I understand the sentiment that being a soul who has a body is a great way to focus on the person you are. Remembering that you are a body that has a mind and the ability to do great things with that mind seems like a way more satisfying approach to life and provides you with the perspective that you get this chance, this life and that’s it. Make it what you want it to be now.

Thanks for reading.

The Critical Nature of Good Communication

Imagine you are out walking your dog and you run into one of your neighbors. Normally, your neighbor – an older gentleman – would be walking his dog as well. You ask your neighbor where his dog is and you hear a horrifying and sad story.

“I took him down to the vet last evening for constipation and two hours later we ended up putting him down.”

That’s a horrifying story right? It’s in fact a true story, I know this because it happened between a client and myself. But there’s more to the story than that and because the owner and I had an open line of communication, that’s not the way the story is told.

The whole story goes like this:

A client I have known for a number of years called late one evening and mentioned that their dog was struggling to go to the bathroom, seemed weak and had a bloated abdomen. There are a couple of red flags in that sentence that made me say, “Why don’t you bring your pup right down and we’ll take a look right away.”

The owner did just that and the dog was struggling to stand, did indeed have a distended abdomen and also had very pale gums. These are all very bad things.

I explained to the owner that I wanted to take the dog out back and look in the abdomen with ultrasound to see if I could get a sense of what was going on in there. The owner agreed and we did just that.

I put the ultrasound probe on the dog’s abdomen and immediately found what I was afraid I was going to find. The dog had a very large tumor associated with its spleen and that tumor was bleeding into the abdomen. I immediately returned to the owner and as gently as I could, broke the news that we were looking at a life threatening condition and we would have to be making some tough decisions over the next few hours. The owner returned home and the my staff and I went to work gathering as much information as we could to give the owner the best chance to make an informed decision.

I called the owner about an hour later and explained that the tumor appeared to be isolated to the spleen, was actively bleeding and we had a few options. I recommended referral to a 24 hour facility for further work up and possible surgery. The closest facility like that to Rutland, Vermont is currently a little over an hour away. The client understandingly declined the referral. Our next option was surgery at our facility and I explained the procedure, possible complications including the need for blood transfusions, treating arrhythmia and critical care. I explained that even after surgery we would still be a far cry from safe and there would be some significant monitoring and care that would be required for some time. We never did discuss the cost. The owner and I determined that it would likely be in everyone’s best interest to have the dog euthanized. If that sentence made it sound like it wasn’t the most heart wrenching decision the owner of this dog had made in a number of years, it’s only due to the limits of the English language.

We already had the IV line in place so we discussed cremation plans and the costs of everything. After getting the logistics out of the way, the owner spent some time with alone with their dog and then we went through the euthanasia process together. I left the owner in the room to collect their thoughts and have a moment to say a final goodbye.

When the remains returned, I asked the owner for permission to use the story for this post.

From my perspective, it is easy to see where the entire experience could have been tempered differently had any part of the communication not been open, honest and direct. Instead, every step of the way we discussed what was happening and what that might mean. It was probably the hardest moment this person has ever had as a pet owner but they were able to do what was best for their dog because the communication was open and direct. This probably has some meaning that carries over into all aspects of life but for now, promise me you’ll keep those lines of communication open with your vet and I’ll be happy.

Thanks for reading.

The Hardest Part of the Job

No, it’s not euthanasia.

It’s making hard decisions that might not pan out the way you want them to. And knowing that with your decision, someone’s pet has to pay the cost. And a person who is not you, bears the lion’s share of the emotional burden.

Let me tell you two stories. Details have been changed to protect the innocent.

Smitty came in because he had a tumor on his back leg that was really nasty looking. I mean picture the worst tumor you have ever imagined and then put spiders all over it, it was that scary. He came in to have it evaluated and it was determined it would be best if the tumor went away. So we scheduled the surgery. We in this story is myself and the Smitty’s owners. We scheduled it on one of my colleague’s surgery days. A small piece of information that is maybe a little important, Smitty had had a cancerous mass removed a little over a year before.

The day of surgery arrived. My colleague examined Smitty and looked at the previous surgery notes. Looking at what had happened, how he was doing and what her surgical schedule looked like, she decided that particular day was not a good day for surgery. So we put the surgery off.

The owners were less than happy and mentioned that they really wanted the tumor gone. I struggled with the idea for a little bit but had successfully removed a tumor from him a year previously and wanted to make my clients happy. I agreed to do the surgery. We scheduled it for the next Wednesday and I removed the tumor without incident. Smitty recovered wonderfully from anesthesia and went home that evening. The tumor went out for histopathology. I went home happy I’d done right by the poor guy.

The pathology came back as cancer but importantly, the dog came back with some serious issues at the incision site, he wasn’t eating or acting like himself. Some diagnostic tests revealed that his immune system was breaking down his red blood cells and that he also had an infection at his incision site. This was a problem. Actually, it was two problems and they were working against each other. On the one hand, we needed to treat the infection and get Smitty’s incision to heal. On the other we needed to suppress Smitty’s immune system and stop his body from destroying it’s own red blood cells. We attempted to do both.

As it played out, Smitty’s body started to activate clotting factors within his blood vessels, this lead to large spread dissemination of clots throughout his vascular system and this very quickly escalated into a crisis. We put Smitty on oxygen, started to increase his blood volume and turned off his clotting factors but ultimately his owners decided we needed to let him go. Smitty was euthanized while on oxygen therapy.

I made all of the decisions along Smitty’s course of treatment that eventually lead to his being put to sleep. The owners had informed consent, sure but they couldn’t fully appreciate all the risks we were taking. After all, they weren’t really taking them, Smitty and I were. And Smitty was anything but consenting. Each path was more difficult than the one that preceded it. I couldn’t leave the tumor in place. I had to address both the immune mediated disease and the active infection. At the end of the day, we were still left with a horrible outcome and Smitty went through a lot of discomfort before he passed. It is difficult to pull the positives out of cases like that.

Suzie a beautiful tabby cat showed up in the middle of the night on emergency. She had vomited and defecated on the floor. She was acting odd, weak, not walking and her extremities felt cold to the touch. Her vitals were normal and prelimenary diagnostics did not reveal any concerns either. I gave her two different types of fluids to expand her blood volume and improve her perfusion- bring blood to her cold extremities – and a drug to battle any nausea and help with any discomfort along her stomach and intestines.

I looked at her intestines using ultrasound. I would simply lay her on the table and she wouldn’t move. Would just lay there and let me ultrasound her without protesting. Normally, this cat would be all over the place. Not aggressive. Just really wiggly. I noticed that her intestines were all distended, fluid filled and not moving. I couldn’t find a single painful spot or any evidence that she had any foreign material in her intestines. But still, I was worried about something blocking the intestines and keeping them from moving. So I put about half a cup of contrast material in her stomach, the contrast material – barium – helps to encourage her intestines to move and it will outline anything that shouldn’t be there.

Did I mention I was doing this by myself?

At 2 o’clock in the morning I decided that the last thing I would do was give her another small amount of fluids to maximize her perfusion and let her rest for the night. I started her fluids on a slow drip and went outside and smoked two cigarettes in a row. (I hope my wife doesn’t read this post) I do sometimes smoke when I’m really stressed and tired. I was both of these things.

I left her a little after two. Knowing I had done everything I could do for her on my own and hoping that it would be enough. I laid awake in my bed all night, trying to sleep and waking back up with thoughts of Suzie alone in the hospital. Did I make the right call’? Was she going to be alive in the morning? A twisted intestinal tract in a pet can cause death in a matter of hours. I have never seen that in a cat but there’s a first time for everything and I really hoped Suzie wasn’t going to be the first I saw. Especially if I saw it after the fact.

I finally gave in at a quarter to 6. I got out of bed, dressed and kissed my wife good bye. I did my best to ignore her look that was equal parts annoyed at me for running off in the morning to leave her with the kids and concerned for my mental health because I let myself get so stressed over these things that are beyond my control. But this was my choice, my decision and as I drove to work that morning I was fairly certain I had made the wrong decision. I was sure I was going to find Suzie, expired in her cage. I was going to have to make that call and let someone know that the pet they had entrusted in my care had not survived my best efforts. I have had to make that call on other occasions but this one seemed to hurt more. Maybe because I had been alone and this was one hundred percent my decision making. Maybe because I had a nagging suspicion before I left that the cat had something wrong with her intestines. I didn’t know why. I did know it was the longest 25 minute commute ever.

Suzie was looking out at me from behind the litter box I prop up in the back of the kennel to give cats a place to hide. When she saw me she chirped and purred and rubbed against the front of the kennel door. I opened the door and she rubbed against my hands. Her feet were warm and she ate the small amount of canned food I set down for her, nearly as soon as  I set it down.

Her owner agreed to leave with with me until a little after noon and just before she left, Suzie deposited a barium colored bowel movement in her litter box. It was the best present she could have given me. Everything was working as it should be.

Sometimes – often – we are tasked with making big decisions with a limited amount of information. There are many times where we are making the best decision we can arrive at in the time we have with the amount of information we have available to us. Sometimes we are forced into a decision we would rather not have to make, emergencies happen, diseases come to a head and we have to act now or lose for certain. The hardest part of this job is dragging you – our trusting clients – along as we charge ahead and meet these situations head on.

Thanks for reading.

The Veterinarian Who was Always There

I have a love hate relationship with being on call. It’s more love than hate most of the time but there are definitely times it’s a hate sort of thing and I bet it’s not for the reasons you might think. Yes, having family dinners, a good night sleep or Christmas morning interrupted by a pet emergency  is less than ideal but then I know that most pet owners would also rather not be interrupted themselves. So I don’t cry, “Poor me” whenever I have to start the car at 3 am in the dead of Winter. And since the nearest properly equipped emergency clinic with 24 hour staffing is well over an hour away, our clients need us to be there for them at all hours. Still, there are parts of it I really don’t like and there are parts of it I am in love with. I figured it would be best to make a list of things I love and things I hate about being on call.

Love:

  • I love – absolutely love – being there for people at all times and in all situations. There is no better feeling than to talk to someone who is clearly having a really bad night and let them know that you are able to make it better. Then to come in and make it better, it’s quite a rush.
  • It is equally great being able to let someone know that the issue they are stressing themselves out over is likely going to be fine by morning or can wait until office hours to be addressed.
  • There is a certain rush we get dealing with a life and death situation as well. Those mornings where you come into work and see the dog or cat that by all accounts should and would be dead if it weren’t for the efforts of your veterinary team, that’s a cool feeling.
  • Continuity is important to me. If I am treating someone’s pet for an illness or an ongoing disease or if I just performed surgery on them and there is an issue, I like to be the one to see them for that issue.

Hate:

  • Hate is a strong word but I don’t like the idea of having a general practice veterinarian seeing emergency patients. Yes we can deal with emergencies but if you compared a general practice veterinarian handling an emergency compared to a veterinarian who works as an emergency vet, the difference is night and day. Experience is key there and while we do our best and cover the gaps, I don’t feel like there is a comparison between the two. In short, I don’t feel like general practice emergency coverage offers the same level of service emergency clinics do. That’s fine for most things but I still don’t like it.
  • The same idea goes for the facility. An emergency clinic is set up to be just that. There are marked differences between an emergency clinic and a general practice. In most general practices, the oxygen doesn’t reach the kennels. Meaning if you have a dog in respiratory distress, they need to be dragged into surgery and restrained while they receive oxygen. Same goes for monitoring equipment, anesthesia and sometimes even the areas the staff perform most of their work aren’t visible to the areas where the pets are being kept. It’s not a bad thing, it’s just that a facility that is purposefully designed to service emergencies is better for servicing emergencies.
  • The above two points are what I think clients miss out when using a general practice for emergency coverage but I also feel like my general practice clients get less than excellent service when i’m up until 3 in the morning even doing something as simple as pulling out quills. There’s no way a person could expect to get less than a normal amount of sleep and show up the next day to be as good as they would be at their job as if they were well rested. So I also feel like trying to offer emergency on call service makes my clients have to settle for less than my best during the day as well. I know, there are folks out there saying that they’ve done it for years and it works for them. I’ve seen it, I’ve done it and I can tell you honestly, you are not as good tired as you are fully rested. Hands down.

In a few bullet points that’s how I feel about being available to my clients 24 hours a day, 7 days a week. There are parts of it I feel are a compromise but I knew when I moved to Vermont, the most rural state in the U.S. according to the 2000 Census and second only to Maine in 2010, I expected there to be some compromises that had to be made. When I think about trying to juggle kids sports in the near future, the emergency coverage seems like a pretty small one.

Thanks for reading.