WRVC Urgent Care
In our Fall newsletter, I wrote about how the clinic wants to progress into the area of urgent care. If
we are going to do this, our clients need to understand the concept of urgent care.
So what is urgent care and how does it differ from emergency care? This is important
because the two do overlap.
There are definite cases of emergencies. A pet hit by a car, a pet who is bleeding profusely, or
has collapsed. The bloated dog or a cat with a serious urinary blockage, the list goes on. These
cases are always seen promptly and are given priority. That is the way most clinics work.
But then there are the cases that owners request prompt care for but are not emergencies.
The vomiting pet, the pet with diarrhea, ear infections, the ADR cases (ain't doing right) and so on.
These are the cases that owners are concerned about that they want addressed promptly but are not
life threatening.
Typically, many of these cases are treated as what we call "day admits". We admit the pet to
the hospital for the day and work them into the schedule when we can. This is a nice service and it
is a good service, but it not ideal. What most clients want is to meet with a doctor immediately and
get the problem resolved as soon as possible.
Therefore, urgent care looks like this: An owner has a concern for a pets well being. It is
something they would like addressed promptly, not only for their pets well being but for their own
piece of mind. They are then able to call the clinic and get an appointment to see a doctor on short
notice. When they arrive at the clinic they are able to meet with a doctor with a minimal wait and
the exam and consultation will proceed from that point.
Another facet of urgent care that we deal with is the walk-in appointment. This is when a
client literally walks in the door with no forewarning with an emergency or urgent care case. While
accommodations are always made for the emergency case, walk-in urgent case may require some
waiting time to accommodate. Walk-in urgent care cases can add a certain stress onto a busy
schedule, but if a client is willing to be patient, they will be seen.
We still have clients that appreciate and prefer a day admit. Perhaps, their schedule does
not allow them to wait and they are perfectly comfortable leaving the pet with us for a period of time.
This is fine and we want to accommodate these requests as well. For many cases, a day admit is
preferable if ongoing diagnostics are going to be needed. The essential thing with a day admit,
however, is that clients must be available for a phone consultation as a case workup proceeds. State
law dictate this.
Urgent care is certainly not a new or unique concept or service. Implemented well, however,
it can certainly be a nice client service to offer.
A Good Cat
This fall, our cat of over 19 years died. He had been declining for some time and finally his body
was done, tired and worn out. He died on my birthday.
Timon was never unique in anyway. As a kitten, he never really played and this trait lasted
a lifetime. Toys and penlights that most cats would delight in held no interest for him. He simply
spent his time laying around, preferring to be next to someone and always occupying a space on the
persons left side. He could rest there for hours, eyes closed and purring contentedly. At Christmas
time, he loved to sleep under the tree, never once attempting to climb it, but sometimes burrowing
under the tree skirt.
Timon was also a gentle cat. He saw three young kids grow up and all of their antics (and
mine) never seemed to annoy him and I do not ever remember him biting anyone. I remember one
occasion when we told our son to pick up all of the stuffed animals and take them to his room. He
stuffed toy animals in his shirt, wrapped one around his head and had his arms loaded beyond belief.
It was such a sight that we took a picture of him. When we looked at the picture what did we see
looking out between the numerous stuffed animals but Timon's face. He contentedly went along for
the ride with no complaints.
Being a cat, he would act like a cat. He would surf countertops when no-one was looking,
hoping to supplement his diet. He would occasionally pee on something inappropriately, and even
defecate outside of the litter pan, but I could usually see a pattern and break it by closing certain
doors, relocating a litter pan or whatever. It was all doable, but any unwanted behavior always
frustrated my wife and I always felt the bad vibes. Still, Timon was loved by all. The kids loved
him, the dogs largely ignored him and my wife and I really did enjoy his companionship. And the
changes he saw in our household! He saw all of our kids grow up. He saw them leave and start
coming back (his all time favorite was our oldest son, Ryan. They always had a special bond). He
saw the introduction of a granddaughter and quietly tolerated Anna trying to pull his ears off. He
saw our family through almost two decades of life. I often wonder how he interpreted the chaos of
our house, the good times, the bad, etc. At face value, he took it all in like a wizened elder. On the
inside, I am sure he was saying, "Humans-what a dysfunctional mess".
Timon left life with very little ceremony or recognition. I think we had been preparing for it
for so long that his actual death was of no great surprise. I feel bad about this. Every life is unique
and needs to be immortalized in some way.
But, that is life. Few losses are ever recognized for very long. Life moves on. Always has
and always will.
Our lives are molded by those who come into and out of it. we are shaped by those around
us, and once in a while, someone has more impact than the others. The same can be said of both
people and animals.
Timon was a great part of our lives. He was a personality and an influence we will not
forget. While he was never flashy or unique in anyway, he was what he was- a good cat.
Not Always Right: Raptor Rehabilitation and Getting it Wrong
When I was a child, some of my favorite books were the anthologies of veterinary stories by James
Herriot. Many veterinarians would say the same: his charming, amusing anecdotes about being a
veterinarian in World War II-era Yorkshire were not the reason I became a veterinarian, but they
highlighted many of the joys (and frustrations) of practice that we have come to know through the
decades since he wrote them. My first copies were actually my mother’s books from her childhood,
and she would read them aloud to me at bedtime. Many a night my father would poke his head into
my bedroom to find us in peals of laughter, or with tears rolling down our faces, reading about James
Herriot’s adventures in veterinary medicine. One story that was always good for a wry laugh was
that of a cow he had diagnosed with a serious obstetric complication, which he had assured the
farmer who owned her would result in her inability to stand again. The farmer nodded and ignored
him, leaving the cow to lie there rather than ship her for slaughter, as had been recommended.
Some weeks later, James Herriot was in the area again on another farm call, and the farmer
gleefully called him over to see the cow—who was not only standing, but walking around the
pasture, right as rain!
The farmer kept that cow far longer than her milking life would normally have dictated,
because he was just tickled pink about how wrong the vet had been…Sometimes veterinary medicine
is like that.
It is called “practice” for a reason, and things don’t always go as expected or as
planned. The doctor, like everyone else, is not always right. I was forcefully reminded of this
recently with a wild raptor patient brought in for evaluation, a beautiful Bald Eagle. She was not
using her wings correctly, and was unable to fly. An examination revealed a wound on her wrist and
a great deal of thickened, calloused bone where bone should not be. An x-ray confirmed the worst:
her wrist was shattered in multiple places, the bones an unrecognizable jumble of fragments and
scarring. It was with a heavy heart that I pronounced her unreleasable: the injuries were too severe,
the damage too great for surgery to repair. Surely, she would never fly again. She was otherwise in
good health, so her caretaker, a wonderful and dedicated rehabilitator, resolved to keep her and find
a place for her as an education bird, rather than have her euthanized.
Well, given the title of this tale, you know what happened next: she went into a small
containment area to keep her quiet while she was fed back up, then just to see—just in case—was
put into a flight cage some time later. Healthy and well-fed, nature and nurture did what surgery
could not, and the wing knitted back together. The eagle flew. She hunted. And finally, she was
released back into the wild—that bird the veterinarian said would never fly again!
Every veterinarian strives to be right, every time. We want to be right not just for ego, but
so that we can make the best recommendations for our patients and our clients, to achieve the best
outcome we can. Nobody wants to make a mistake, particularly not in something like medicine,
where a wrong interpretation or an incorrect move can result in someone’s death. I work hard to be
right, even when it’s not always fun—diagnosing cancer, or the need for an expensive surgery, or any
terminal illness—because I want my patients to always get the best, regardless of what that means
for them. Every once in a while, though, it’s not so bad to be wrong… Fly high, Eagle!
A Time To Die
At the beginning of 2014, I predicted that three things would happen:
1. Sage, my mother's old black lab would die (she did so in June in my
arms).
2. Our 19 year-old cat, Timon, would die,and he did so in September.
3. My mother, an almost 90 year-old woman in failing health, would
also die. She did so in August.
I predicted all three events accurately.
While this may sound depressing, it is not. All three had a very long life. And all had a very
good life. All were blessed, and they grew to get old and died. I do not consider this to be a bad
thing.
If there is anything sad about the year, it is that while I euthanized Sage and Timon when it
was appropriate, the medical profession allowed my mother to suffer endlessly so that she could be
warehoused in a nursing home for over three years. In the end, her death was a blessing.
As veterinarians, we deal with death and loss on a daily basis. It is part of what we do. Pet
loss happens. It is inevitable. No one can change that. What we can change is when it occurs.
There is a time to die. When that time is varies from individual to individual. Some pet
owners are very quick to make the decision to euthanize a pet. Others will pursue every option
possible before making the decision. Many fall into the in between area. I will not judge and I will
not say that there is a right or wrong.
A veterinarian wears many hats; surgeon, diagnostician, treater, healer, a prognosticator,
advisor, and based on our clients' needs, maybe even a little bit of clairvoyant. We do it all. Some
better than others, and some days better than others. It is hard to be at the top of your game every
second of everyday. (Ask the Packers!)
I, personally, am a fairly good surgeon. I am a fairly good diagnostician. But, above all of
this, perhaps the best service I can offer my clients is assistance with end of life decisions. This is
when my human side come out. This is when I am the most practical. This is when my empathy is
at its peak. What greater gift can I give a pet then a peaceful, acceptable exit from this world? And
what could be more meaningful to a client?
I hate death. I do what I can to avoid it. But I also know, for all of us, there is a time to die.
If I can make that event even a bit acceptable for a client, then I have performed my greatest work.
For me 2014 was a year of incredible loss. But rather then feeling like a beaten man, I feel
that I have a new beginning. Selfishly, my life continues, and I need to enjoy that to the max. When
it comes my time to die, I wish to look back with no regrets. And whomever helps me through that
time will not only give a gift but also receive a gift.
Preparing for the Polar Vortex 2.0
I have to confess, though I have lived in Northern climes all my life, I am not really into
cold weather. Don’t get me wrong, I love sledding, snowball fights, building s nowmen in
the front yard, watching the world turn white… but then I like to retreat to my den of hot
chocolate and 75 pounds of blankets! I don’t appreciate -30 degree wind chills and endless
days of getting up in the dark and getting home in the dark and shivering all day in
between. I’m sure more than a few others out there can relate! Our pets are much the
same: while many of them enjoy a good romp in the snow, some are offended by the idea of
having to put their butts in a snow bank to pee. In either case, the cold weather we get
here (particularly if this year is anything like the last one) can be dangerous, particularly
for our smaller furred friends. Frostbitten paws and ears can easily happen when the wind is
howling and it’s too cold even to snow. Longer-haired dogs can get ice-balls matted into their paws
and coats, which is painful and can make walking a challenge. Some kinds of de-icers can be toxic to
pets, and the antifreeze we use to keep our cars running can be deadly, especially since many of
them like the taste of it.
Outdoor and stray cats will curl up inside the engine compartment of a recently-used car to keep
warm—which works fine, until the car is turned on again; the resulting injuries can be grisly.
So how can we keep animals, both pets and strays, safe this winter? Here are some tips:
 -Make sure outdoor dogs and cats have access to fresh, unfrozen water at all times. This
may require a water bowl heater, or a sheltered area and regular maintenance.
 -When the windchill is cold enough that you wouldn’t go out with any exposed skin, don’t
bring your pets out any longer than necessary; their ears and paws are the most
susceptible to frostbite. There are also products like dog booties and dog
earmuffs/headbands, if your pet will tolerate them.
 -Keep an eye on your dog’s paws when playing in the snow—if ice-balls are starting to form,
it’s time to go inside and thaw out. Dog booties can help here, too, as can keeping the
hair in this area trimmed.
 -Make sure your de-icer is non-toxic to pets, and store antifreeze securely. Address leaks in
your coolant system promptly (for both your car’s sake and your pet’s!)
 -If your car must be kept outside, bang on the hood several times to wake up any sleeping
critters and give them time to make an escape before starting the car. After it has
started, drive slowly for the first several hundred yards, to make it easier for a
frightened cat to hop out.
 Above all, have a safe winter for everyone, and stay warm!
Pets And Holiday Pitfalls
We are starting to come into the holiday season now, with Thanksgiving nearly upon us and
Christmas hot on its heels. Despite my dislike of the cold, I am like most people in that I have
always loved the holidays. The family traditions, the decorations, the good cheer… what’s not to
like? Well, the slush is less than loveable, but we can’t get everything we want. As much as I love
this time of year though, it is important to remember that it does pose some specific risks for pets.
In remembering, we can work together to minimize those risks. Among my top pitfalls for pets in
the holiday season:
-Rich foods. Ah, the turkey, the gravy, the buttered-up-everything! I love the feasting that comes
with Thanksgiving and Christmas, and most pets do, too. However, while all those calories can be
harmful to our waistlines, they can be much more damaging to our pets’ digestive systems. Too
much of a good thing can cause no small amount of GI upset, and can result in serious illness with
pancreatitis, especially with high-fat foods. While Taz loves his turkey snack on Thanksgiving as
much as I do, I try to limit him to a few small pieces one time only, to keep him from getting sick.
Here’s to moderation!
-Chocolate. This time of year, everyone is baking and exchanging chocolate everything with
everyone else. Yay! I could eat chocolate until I explode—just ask my technicians! But chocolate is
not safe for pets; it has a couple of different toxins their systems cannot handle. While a small candy
bar of milk chocolate is not going to kill a 90lb Golden Retriever, a single ounce of baker’s chocolate
can easily be fatal to a 10lb Chihuahua. That doesn’t stop them from trying to get to it! Keep
chocolate gifts, cookies, and baked goods out of reach for your pets, and everyone will be much
happier. And if you’re looking for a place to get rid of them, I know a veterinary office that never
says “no” to chocolate…
Festive plants. Poinsettias, lilies and the like are quite beautiful, but like the Sirens of
Ancient Greece, their appeal can make them deadly to curious pets who want a little
greenery in their diet. For a list of potentially toxic plants, you can go to
http://www.aspca.org/pet-care/animal-poison-control/toxic-and-non-toxic-plants
and learn more.
-Decorations. Christmas trees are wonderful, and decorating them is a time -honored
tradition in my house. Christmas trees are also about 100 accidents waiting to happen:
they can be tipped over, tinsel and garland can be eaten and become an intestinal foreign
body (followed by an intestinal foreign body surgery!), ornaments can be broken, eaten, and
stepped on, and light strings can be chewed and shorted out. If you have a c ompulsive
eater (dog or cat), be sure to place ornaments out of reach. I always recommend foregoing
the tinsel, since it is so easy to swallow and can be so hard to pass. Restrict access to the
tree if you have a climber, or teach them it is off limits w ith squirt bottles or penny-cans.
Unplug the tree when you aren’t around to supervise, and put the dangling end out of
reach so nobody gets any ideas!
-Guests. The holidays can be a wonderful time to reconnect with family we don’t see through much
of the rest of the year. I am excited to go back to Upstate New York to visit my family for
Thanksgiving this year, since we only get together every 6 months or so. Many pets of college-age
“kids” also will be thrilled to have their person home again. But just like the holidays can be
stressful for us (fight over the dishes, anyone?), they can also be stressful for some pets who are
unaccustomed to the hustle and bustle of 30 houseguests, or small children invading their personal
space. For these pets, it is important to provide them with a safe place to escape from the holiday
madness and rest, and set boundaries-or cat will or will not accept in terms of attention/affection.
An emergency room visit for a dog or cat bite because somebody got too “in-your-face” with a reserved
or fearful pet will make nobody’s Christmas merry.
The holiday season is full of love, joy, and magic in so many ways. I hope you all have a
happy, exciting, and safe time with all of your furry family members, and avoid any of
these pitfalls!
S.A.F.E.
A special thanks to all of our adopters this year! We had our first ever Home for the
Holidays Cat Adoption Event on November 22, 2014. With this event we were able to adopt out
eleven cats. If you are interested in helping a cat or dog find there forever home stop by the clinic
today!