veterinary stories

How to finance your pet’s healthcare.

/ heathamc / 13 Comments

The standard of healthcare we are able to offer our pets in the developed world rivals the standard of healthcare we ourselves have access to. Options such as MRI, organ transplants, chemotherapy and even root canal therapy are utilized many times a day for pets in our world. The problem with having really high healthcare standards is that those standards are accompanied by really high price tags. All too often, my colleagues and I see pets that have issues that go untreated, preventative care that is incomplete or even pets that have to be put to sleep all because of poor finances. We hate that but we’re also not in the position to loan the money to our clients ourselves. Sometimes we do, in the form of letting a client make payments but our financial threshold for payment plans is really quite low. How then, are pet owners supposed to meet those expenses? The following is a list of ideas and recommendations I’ve developed through experience and stressed out brainstorming about trying to accommodate pet owner’s financial situations.

The best time to think about paying for your pet’s heath care is before you have a pet. I understand that we mere mortals don’t ever do this. In the off chance that one of the financial superheroes who will soon be our economic overlords might be reading this, allow me to offer them this piece of advice in the hopes they will look upon me with favor some day. If you are thinking about getting a pet, especially if you are planning on buying a purebred dog or cat from a breeder, try to put away three to four times the initial cost of the pet in a high yield savings account or even an online investment account like Vanguard or Betterment. After the initial account is set up, find out how much health insurance would cost for your new pet and transfer that amount of money into the account monthly. You’ll draw the money out of your account once yearly in good years and it will be there if you have an emergency or illness. If you never have to deal with an illness or an emergency, the money will have been well invested and you will get it back when you no longer need it. The same can not be said of insurance. Of course, if you have the money available to take this route you probably don’t need financial advice from a broke veterinarian.

For the rest of us there is pet health insurance. A quick internet search for pet insurance will yield dozens of viable options. The thing about pet insurance is that if things go well, it is not going to save you money on your pet’s healthcare. If your pet ends up with a few emergencies and a couple of sick visits over the course of a life time, you still aren’t likely to save money. Only when you get into the scary and stressful stuff that comes with taking care of our furry, feathered or scaly family members does the insurance start to pay off. By then, you’re not really thinking about the money. Trust me, I see it everyday. Insurance is great if you’ve been through a really bad illness with a previous pet and want the peace of mind that comes with insurance for your new pet or if you have a breed that is predisposed to health issues, even if it’s just allergies. That stuff gets expensive quickly.

Both of the options above require some planning. For many of us, the health care part of the equation comes into play long after we are smitten by puppy breath, kitten antics and the like. Most of our clients haven’t planned at all for an emergency situation or an illness and many haven’t even checked into the costs of routine preventative care before they bring a new pet into their family. And there is nothing wrong with that! Bringing a new pet into your life isn’t really a financial decision, if it was we would never do it. It’s a lifestyle decision and like many lifestyle decisions, cost is never the biggest factor. Still, things happen and we want to do our best for our pets when they aren’t feeling well or have an accident. Here are a few ideas about what to do if you’re already facing a medical expense with your pet.

Third party payment options are the number one way we typically deal with the expense issue. Right now the most common ones are third party lenders who will cover your bill today and you will pay them back over the next few months. Many of these plans offer interest free payments over a set period of time. Beware however, as the interest rate outside of this time period is often astronomical. I’ve seen an APR as high as 30%! That’s crazy! Still, it makes a huge difference when we can sort of put the money aside for a little bit and focus on what is medically best for your pet.

Recently a new model of the third party payment option has been offered to pet owners and veterinary clinics. Starting in 2013, a service called vetbilling.com began a third party payment plan for veterinary patients that doesn’t have the high interest rates. Instead you as the pet owner, pay an enrollment fee and a small administrative fee is attached to each payment. You pay the company and they make a payment to your veterinarian. It takes a lot of the pressure off the veterinarian’s office. I don’t expect veterinarians to offer this to every client, we can’t afford to have revenue trickling in, but for those unforeseen emergencies it will be a real life saver. Sometimes literally.

Why can’t my veterinarian just offer me a payment plan? It’s simple and complicated at the same time. The easy answer is; we can’t afford to. Current industry averages in veterinary medicine put our payroll expenses at roughly 40% of gross revenue and inventory/supply expenses at about 30% of gross revenue. That means that 7 out of every 10 dollars we earn goes right back into providing services for our clients and their pets. We can’t make payments on our staff salaries and most medical supply companies do not finance. Especially when we’re ordering from them biweekly in many cases. So if we offered payment plans and they were utilized by even a quarter of our clients with a short repayment period of three months, we wouldn’t have the cash flow necessary to make payroll or order supplies within the first month. We’d either have to borrow money to stay in business, go out of business or stop offering payment plans.

Finally, when facing larger than you can afford medical expenses for a pet you can always compromise. Your veterinarian’s job is to offer you the best care that they can possibly provide. Every single time you come to them with a problem. It is up to you to determine whether or not that level of care is worth it to you. The best way to do that is to have an open and honest conversation about the situation and how you feel about it. Simply saying the words, “I can’t afford to do it like that” will go a long way at opening the door to other options. Just keep in mind that when we start to cut down a plan to save money, we are also affecting the outcome to a certain degree. That’s not necessarily a bad thing. For example, I recently had a conversation with my doctor about an outpatient procedure I’m planning for this Summer. My insurance has a ridiculously high deductible and it actually ends up being cheaper for me to pay cash for most things because of the discount and save the insurance for big scary stuff. I asked my doctor if paying cash changed things at all. Turns out it does. Now I don’t have to go to the hospital, see an anesthesiologist and deal with recovery. Instead, we’ll do it in his office under a local anesthetic. There are many situations in veterinary medicine that are also like that but we can’t just assume you want the cheapest or bare bones method. You have to tell us and we have to warn you about the consequences. For example, if I have an anaphylactic reaction to local anesthesia during the procedure this Summer, I would be far less likely to die in the hospital than I will in the doctor’s office. Your veterinarian will be the best one to let you know in each specific case how making changes to a plan will affect the expected outcome.

Having pets in your life is always rewarding. It enriches your day and even helps with your mental and physical well being. There are going to be times where pet ownership is stressful and even downright scary. Don’t let money be the scariest part of the equation and don’t let it come between you and your pet.

Thanks for reading.

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How to catch a cat in a HavAHart trap

/ heathamc / 1 Comment

My employer shared the letter with me not because there was really anything I could change or that could be done about what had happened. It was more to let me know that she had received it and because it was too good not to share.

A few weeks previously, a couple had brought us one of their adopted feral cats for a bite wound on its back end. They had warned us about how the cat was and told us to be careful with her. We had listened and had found the small gray tabby to be a wonderfully easy patient. She snuggled up on us during her exam and we loaded her in to her carrier without incident when her owners came to pick her up. I find this to be true of many adopted feral cats. They turn into big loves so long as you let them set the terms.

We did the recheck in our Ludlow office. The owner was present for the recheck, she had not been present for the initial visit. I took the feral cat out of her carrier, she was nervous but after some chin scratching she rubbed up against my hand. When I went to lift her up to examine her abdomen the owner tried to intervene. The cat did not approve of the intervention, my response to the intervention or both. She exploded around the room, knocked the blinds off the windows and then hid behind the sink. I retrieved her and finished the recheck. The issue had resolved and would not require any further attention. The feral cat and her owner returned home.

The letter arrived the following week. I don’t remember the details anymore, I had saved it for a few years but must have discarded it recently. The basic premise was that I was an inept veterinarian who didn’t know how to handle feral cats and shouldn’t be allowed near animals. I do remember that the word “idiot” was used eleven times in the one page letter. It was directed at me every single time. Needless to say I was not this client’s favorite veterinarian.

Fast forward one month, exactly one month from the day of that fateful recheck exam. The same owners bring in another feral cat, this cat had just been captured by these feline rescuers and was still mean as could be. It likely goes without saying that they did not want any of the veterinary services to be performed by me. Completely understandable.

Then the cat got loose in the cat ward. Bear with me while I paint the cat ward into your mind. It’s a rectangular room, eight feet wide by sixteen feet long. There is a single door at one end of a sixteen foot wall and two large windows along the other. At the 8 foot wall nearest the door is a treatment table and scale for weighing cats and a cat kennel bay on the other end of the room. All in there are 10 feline kennels in that room. The cat ward also serves as the location for the server and data lines for the hospital so there is a shelf in one corner and a hole in the ceiling for all of the data lines to go throughout the practice.

We attempted to capture the cat but he wedged himself behind the kennels against the far wall in the cat ward and would hiss and strike at us as we tried to get him out. Fortunately, the kennels are on wheels so I wheeled the kennel away from the wall and climbed on top of the kennel to get at the feral cat. The plan was to corner the cat on one side of the space behind the kennel by advancing a broom towards him. Once he was in a position he could not bolt from I was going to jump down, throw a thick towel over him, scoop him up and return him to his carrier. Seemed easy enough.

Instead of being cornered, the cat decided that it was fighting time, he attacked the broom that I was advancing towards him without any semblance of fear. My plan had been to use the broom to guide him gently out from behind the kennels, his plan had been different. Once he latched onto the broom and realized it was good for climbing, it took less than a second for him to be crouched next to where I was laying on top of the kennels. We locked eyes. I sat still watching him as he glared at me, waiting for him to attack me. Instead he hissed once in my face, turned and jumped up through the hole in the ceiling and was gone. I sat for a long moment in silence. All I could think to say after that moment had passed was, “I can’t believe that actually happened.”

I got down from my perch and went to the hatch that led to the crawl space attic above the cat ward, stood on a stool and shined a flashlight inside. Two glowing green eyes peered back at me and after looking around the small crawl space, I decided he didn’t have much room to hide and I could probably capture him with the net. So I climbed up into the crawl space with a four foot long loop net and planned to capture the escaped feral cat. I was of course, wrong. The crawl space had roughly one million tiny places for a feline to fit that a human might not even see let alone climb into. And it was approximately 1000 degrees Fahrenheit in there. After a few minutes up there, I retreated to the safety and comfort of the treatment area and thought about what to do next.

We decided to set a catch and release trap with some cat food in the attic and wait until morning. My boss told me she would call the owners of the feral cat when she arrived at our Ludlow office for afternoon appointments and explain everything to them. That seemed fair, I hadn’t even lost the cat. I was just trying to be helpful. What we didn’t take into account was that we were at the tail end of road construction season here in Vermont and the commute took her considerably longer than usual. As a result, appointments started a little late in Ludlow and she struggled to keep up. In Rutland, the owners of the feral cat stopped by to pick up their cat.

I must have rehearsed what I was going to say to these people fifty times in my head before I stepped into the cat exam room. I was going to explain to them that I (the veterinarian they called an idiot in the letter they wrote to my employer) lost their feral cat in the ceiling of our practice. Then I was going to get out of the room. As soon as I closed the door behind me, my mind went completely blank. I stood there for what felt like an hour before I decided that I had to just go for it.

I do not remember a word that I said to them or a single word they said to me but I do remember that they didn’t smile. Not once. They left and we set a HavAHart trap with some canned cat food up in the attic.

You can get your own here: HavAHart

The next morning the cat was in the trap. We called the owners, they picked up the cat and we never saw those cats or their owners again. I saved the letter for years but apparently discarded it recently. I suppose I am ready to move on.

Thanks for reading.

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Never Hear Wolf

/ heathamc / 1 Comment

Being a veterinarian here in Vermont is pretty awesome all of the time. There are two seasons that are especially awesome to be a vet here; Winter and Summer. Both seasons bring in tourists and both seasons are a little bit slower for our regular clientele so we can focus on catering to our out of state clients without feeling like we are ignoring our regular folk. It’s a really fun situation. Also, I like skiing and swimming. Not at the same time of course.

I am using three out of stater stories to illustrate the importance of taking to heart the complaint a client calls in with.

1. It was the first July I was in practice. It was hot and my wife and I had only recently found out we were expecting our first child (we didn’t know it was a girl until she was born.) My in-laws were visiting and we were living in East Dorset at the time. There was a great little pick your own berry farm just down the road from us. The afternoon plan was, we were going to pick some berries then head down to Emerald Lake State Park for a quick swim before grilling some dinner on the deck. It was going to be a pretty sweet New England summer afternoon and night.

But I was on call and of course my phone rang as we were headed into the berry farm. I took down the client’s information and called while I was finding a parking spot. It was legal to use a hand held device while driving at this point. I might be the reason it’s not anymore. The client was visiting from Connecticut and their Labrador Retriever puppy had been spayed the day before. There was a problem with the incision. I called and the woman owner – a pleasant but slightly frantic pet owner – answered. She informed me that her dogs spay incision was open and she was pretty sure that she could see intestines.

I was fresh out of school, young and at least as excited about veterinary medicine as I am today. I told her I would meet her at the hospital right away. I told my wife what was happening and she – infected by my enthusiasm – agreed to walk the mile back to our house. In the heat. Pregnant. I left in a hurry and made the drive from East Dorset to Rutland in 19 minutes. Google map that. This story will be here when you get back. I have a client who is on a police force in Southern Vermont and lives in one of the towns I drove through way too fast. I am sorry. I am glad no one got hurt.

I pulled into the driveway and was kind of excited that I beat the client there. I got out of the car, grabbed my keys and went to unlock the door. Then I caught a glimpse of myself in the reflection in the window. I had on board shorts, an athletic shirt and flip flops. (Relax OSHA I have Crocs in the clinic (relax fashion police I’m a veterinarian I’m supposed to look terrible)) I wondered how anyone was going to take me seriously. I threw on a pair of scrubs and my Crocs.

The client arrived and I led them into the exam room. I carefully asked the dog to lay down and had a look at her incision. I’m not sure what I was expecting but I did my best to hold in a laugh, told the woman that the incision edges were just a little swollen and there was a small strand of subcutaneous fat that was poking through the edge of the incision. To ameliorate her concerns, I applied a bandage and told her she could remove the bandage in 24 hours and could apply an antibiotic ointment twice daily until the incision was healed.

2. The second incision emergency was in a Labrador Retriever visiting the Ludlow area from New Jersey one Winter. The owner carried her in as I was finishing appointments one evening. I remember it being already dark so here in Vermont it might have been just a little past noon on a Winter day. The dog had been spayed a few days previously and her owner was adamant that the incision had opened up while they were out snowshoeing that morning. A brief six mile snowshoe adventure in some fairly deep and fresh snow. He also mentioned that he was taking the dog cross country skiing tomorrow and that the dog’s intestines were poking through. In the same sentence. Both of those statements can not be true.

I took a look and he was half way correct, the incision was open a small amount at the very top of the incision. The intestines? No that turned out to just be an extra long suture tag from the closure. I trimmed the suture back a bit and encouraged the owner to apply a small amount of antibiotic ointment to the open part of the incision until it healed. And to try to tone down the exercise for a week or so.

3. Ah the rule of three. Also known as the comic triple. The third call came in the Winter as well. A young couple from Massachusetts had brought their recently spayed Labrador Retriever – a recurring theme in incision issues all around – with them on a ski vacation. One of their friends had come along with them and was watching the dog while they were enjoying a sunny and warm ski day. We got the call on a very busy Saturday morning. Labrador. Visiting from out of state. Spay incision is open. Something was sticking out. I told the receptionist to have them come right in. I remember turning and looking right at the two technicians we had working that morning and making a joke about it needing a good application of antibiotic ointment. I remember having a brief conversation about telling them to wait until they got home to their vet in Massachusetts because we were so busy. We decided to play it safe and that it would be quick and easy. I would probably just step out in the lobby, look, tell them it would be fine and would send them on their way.

All of our smiles and laughter disappeared when a trembling, nervous black lab was led into our treatment area. I could tell from where I was standing that something was wrong. Yes, I’m pretty good at recognizing problems but also she had something that should have been in her abdomen trailing behind her on the floor. So it wasn’t too hard. I could not tell if the dangling bit of innards contained intestines but it was large and starting to smell a little putrid so at that point, anything was possible. I was pretty worried about this little puppy. On top of that she was justifiably upset and nervous. We couldn’t get her to hold still for much more than a physical exam and even then getting a temperature was an exercise in futility. I desperately wanted to sedate this dog and determine how bad the issue was and what needed to be done as soon as possible. But the owners were still skiing and not answering their phones. Megan, one of our technicians sat with the puppy and tried to keep her calm until we got in touch with the owners. I carried on with appointments, putting the distressed little puppy out of my mind as much as I could while I examined other pets and addressed other concerns. Finally about an hour after the initial phone call, the owners called and gave me permission to sedate their dog. They were coming right down from Killington which is about a half hour drive from our practice on River Street in Rutland.

We sedated the dog and examined the incision and the abdominal contents coming out of the incision. A small amount of the omentum which is a lacy blanket of fat that covers and protects the abdominal organs was hanging from a very small hole in the abdominal incision. Fortunately, there were no intestines and just a few blood vessels associated with the omentum protruding from a two inch long section of open incision. By the time the owners showed up, I had the problem figured out and a solution worked up. We went over the plan, the costs and the expected recovery. We agreed on everything and we took the dog into surgery immediately.

The technician working with me in surgery, Alex, would feel like I was leaving a little bit out if I didn’t inform you that the surgery was not straightforward. During the removal of all of the omentum that had been outside the body a large artery was inadvertently transected with the needle attached to our suture material. The resulting bleeding was fairly remarkable and it took some time to get the bleeding stopped, clean away all the blood and be certain that the bleeding was not going to come back. We had allotted an hour for surgery and all in the procedure took us a little over two hours.

We had a few appointments we had to reschedule due to taking the surgery into overtime. So on top of a stressful and exhausting surgery, I had to make a bunch of apologetic phone calls while waiting for the lab to recover from anesthesia. The puppy recovered and we ended up sending her home later that evening. The puppy went on to make a full recovery.

I’m glad I had the puppy come right in. I’m glad I didn’t give in to the pressure of a busy day and the past experience of false alarms. Asking them to wait until Monday would have been a disaster. Hopefully they wouldn’t have followed that recommendation but more importantly, I’m glad I didn’t make it.

I hope that life will continue to throw enough of these experiences at me so I don’t get complacent or comfortable enough to start taking my clients concerns less seriously than they do. At least not until I confirm that the exposed intestines are actually just suture material.

Thanks for reading.

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A Walk in the Woods

/ heathamc / 2 Comments

“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.

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