Tuesday, May 17, 2016

Pyometra Emergency: Saving Chloe

by  Krista Magnifico, DVM

There are many cases who find me. The power of social media and pet parent desperation often come to a head at my doorstep. It wasn't necessarily my intention to be the landing page for those who had no luck at other equally capable veterinarians hospitals, but I am finding myself to be the vet who offers options to those who are not receiving affordable treatment plans elsewhere.

There is a great divide happening in medicine and consequently a huge number of pets falling into the growing chasm of divide simply because pet parents are being priced out of the care they need.

Chloe is a speck of a Yorkie. Demure, quiet, reserved and always trying to hide in the shadows of her moms arms who persistently protect her from having to face the world with a nose to the heavens.

Mom loves Chloe, but like so many others, life had gotten bumpy and difficult and Chloe's health care needs were being overlooked due to more immediate pressing matters until last weekend.

Chloe wouldn't eat and was acting very sick and reluctant to move or play.

Chloe headed to the emergency clinic. Within a few hours her illness had a name; pyometra. Unfortunately that $750 work up cost her family all of the money they had. The price tag Chloe's mom was given for the treatment she needed was estimated at $2900.

They walked out of the ER with antibiotics and a dog who still needed life-saving surgery.

I have this gripe that I cannot seem to convince the rest of the veterinary world to pay attention to. The point of veterinary patient care, the reason people drive their pets into our door, is not just to tell them what's wrong. Our job is to do that, and, most vitally importantly, to fix them.

In fact, I am very certain that our clients are more interested in real help than real answers!

An invested vet will talk about the resources required to do both, diagnose and fix. Exhausting available resources and not getting to the finish line is not assisting our patients. It is short sighted, veterinary focused mismanagement of client and patient care. A good vet will talk about the most likely diagnosis, the available treatment options, the prognosis for each, and the costs associated with every step of this process. Spending all of Chloe's treatment resources before they get the help that will save their lives is simply cruel tragically failed patient care.

Chloe had a laundry list of needs. 

By the grace of good luck her antibiotics were kicking her uterine infection to the curb and she was feeling better within two days. There was still much to address in her tiny 8 pounds.

People ask me all the time how they can affordably care for their pets? The answer is universal; Keep up with the day to day, month to month, and yearly stuff. Budget and plan for it. It is as important to your pets health as it is to yours.

Here is my short list of needed routine care to avoid the costly veterinary bumps in the road.
  • Brush teeth daily.
  • Eat a good nutritious wholesome food on a scheduled regimen.
  • Get lots of sleep. Dogs have this concept mastered. We have some important lessons to learn from them.
  • Lots of interesting exercise. What do I mean by this? Let your dog be a dog. Sniff, tug, play, hide, walks that are adventurous. Let them explore the world.
  • Play hard and sleep hard.
  • Ideal body weight and muscle mass. Avoid lots of the diseases and disease processes that obesity predisposes your pet to.
  • Indoor cats need exercise and I warn about poor quality free feeding dry kibble.
  • Basic parasite prevention. For my part of the world this includes fleas, ticks, heartworm, and intestinal parasite preventatives.
  • Spay and neuter by 1 year old.
  • Obedience and socialization. What would happen to you if you were not able to care for your pet AND your pet refuses to allow anyone else near it?
  • Microchips save lives every single day. Make a small investment for the best chance of a happily ever after that you hope you never need to rely on.
  • Start a savings plan for the unforeseeable accidents ahead.
  • Have a great vet who knows how much you love your pet and be there for each other. Here are my tips on how to get something for nothing from your vet.

Here is what Chloe needed:
  • Dental cleaning with numerous extractions. Her mouth was so rotten that almost every tooth was mobile. Every client I show teeth like this to is always shocked that their pet gave them no clues there was such a significant problem. If you didn't brush your teeth daily yours would fall out too. Dogs get used to bad teeth and eat around them. Removing them resolves persistent oral infection and they will eat better afterward. The number of teeth to be removed is often also shocking to clients. In many cases dogs, like Chloe, will have a dozen, or more teeth extracted. If they are bad they are removed. No discussion here. Don't wake a dog up with bad teeth still on board UNLESS you have a dental professional who wants to stage the procedure. Ideal for the patient, more expensive for the client.
  • Spay. Her uterine infection will return. Spay her as soon  as possible.
  • Get an idea of her overall health before jumping into surgery.
  • Caught up on vaccines and preventatives.
  • Lay out a plan her mom understands and can afford so that she remains on healthy in the days, weeks, and months ahead.
My clinic, my perception, and my obligation to my clients is deeply seeded in my ability to get them what their pet needs in an efficient and affordable fashion.

Chloe's mom was deeply upset that her dog was in need of so much medical attention. She felt very guilty for both not knowing that her mouth was so diseased, but also that she had waited so long to provide the basic spay, vaccines and annual care she knew she needed. The luxury of going back in time when hindsight is present tense and everything is 20:20 is not something I waste much time on. We are here now, we cannot go back and undo, we can only learn, move forward and do the best we can in the present.

Chloe's mom wanted to use her tax return to get her well. We had a budget. Budgets are a reality few vet businesses want to hear about. The reality is that most all of us live in the real world of budgets.

The conversation between Chloe's mom and I went something like this:

"Ideally we should put Chloe on antibiotics for two weeks and then give her a dental cleaning and remove all of her diseased teeth. The cost of this is about $800. She probably needs her spay soon too. The longer we wait the more likely it is that the uterine infection can resurface. This surgery is also about $800." Chloe's mom could barely scrape together the $800 for one, she couldn't do it twice. And, as every good family vet will point out, we still needed to get Chloe back on track AFTER the emergent disasters were addressed. Chloe needed about $200 of flea &  tick and heartworm preventatives. I feel very strongly that our mission is to help through the bumps and provide a path forward to help avoid bumps in the future. Every pet leaves Jarrettsville Vet with a short AND long term plan along with associated costs.

"But how can I do both surgeries? I am so worried that she won't live through all of this if I don't do them? How do I choose between what is safe for her and what is possible for me to be able to afford?"

"We have to make a choice. We have to do what we can, accept what we cannot and tell ourselves that we did the best we could with the resources at hand." This is a concept that I think the veterinary profession is losing sight of. In some effort to promote our bottom lines, save our skin from the chance of liability we don't help people on the level they need us to.

Chloe had her spay and dental surgeries a few days later. 

I asked our dental expert veterinarian to help. I wanted Chloe to get all that she needed and I wanted her little 8 pound body to be under general anesthesia for the shortest time possible. I was most worried about her getting too cold being under for the two hours it would take to do all she needed.

Chloe's final bill for her spay and dental (which included almost a dozen teeth be removed) was about $760. It was by no means ideal. She had minimal additional blood work done. She had everything done at the emergency clinic the week before. It was all normal. We did not repeat it. We took a leap of faith, and a calculated risk. We also had the benefit of her being on antibiotics from the emergency visit. We scheduled her surgery on the last day of her emergency antibiotics and then resumed them the day after surgery. She was closely monitored and treated by experienced vets who wanted more than anything to get her back home with all of the needed care she came to us for. That's what your home town vet does.

Two weeks post-op and Chloe is doing great! 

She has a daily plan her mom understands. She is also on her needed monthly preventatives and will return every 6 months for examinations to make sure nothing else comes up to derail her health.

Chloe is an excellent lesson on finding a way to make a difference in a pets life while working within the real-life constraints of a family on a tight budget.

Life can be full of happy endings if you can bend, compromise and find help when it is needed. 

Keep looking if you can't it is out there, we promise!

If you would like to ask me a pet related question you can find me on Pawbly.com. Pawbly is free to use and open to anyone who needs a little  help in finding information or direction with their pets care. We also invite all of the pet lovers out there to join us and share your pet knowledge.

If you would like me to meet your pet and assist in their care I am happy to try to help.

Call me at the clinic, Jarrettsville Veterinary Center in Jarrettsville Maryland. We publish our Price List every year. You can find it here.

If you have a pet question, or want to share your pet knowledge, please join the free online pet information exchange network that is dedicated to helping pet parents learn about how to best care for their pets. Pawbly.com is free to use and open to anyone who loves pets.

I can also be found at the clinic, Jarrettsville Vet, in Jarrettsville Maryland. We post our prices and fees every year and we have a wonderful Facebook page. I am also on Twitter @FreePetAdvice.

Articles by Dr. Magnifico:
Don't Make This Mistake: Ruby's Death To Heat Stroke 
Parvo: Cora's Story 
Jake's Laryngeal Paralysis
The Tip Of The Iceberg: The Unexpected Dental Dilemma
The Ear Ache That Wasn't Going Away: Tottsie's Story
Cody's Eyelid Tumor
Ruger's Mysterious Illness
The Day The Heart Stood Still: Timber's Story 
Different Definition Of Comfort Food: Levi's Story 
Savannah's Pancreatitis  
Histiocytoma: Rio's Mysterious Bump
Von Willebrand's Disease: Greta's Story 
Alice's Heart Murmur  
Jekyll Loses His Tail Mo-Jo 
Pale Gums Are An Emergency: Bailey's Story 
To Amputate Or Not To Amputate: Heidi's Story
Lessons From A Real-Life Veterinarian 
Charlie's Life Saving Lipoma Surgery  
Understanding and Diagnosing The Limping Dog, Why To Probe The Paw 
Angus' Dog Fight And The Consequences
When To Induce Vomiting And When It's Not A Good Idea  
Abby's Survived Being Run Over By Car But Sucumbed To A Mammary Tumor 
Palmer's Hemoabdomen: Nearly An Unnecessary Death Sentence
A Puppy That Doesn't Want To Eat Or Play Is An Emergency: Aurora's Story
Does Your Dog Like Chewing Sticks? Hank's Story  
Lexi's Bump 
Pyometra: Happy Ending for Pheonix 
Never Give Up: Bella's New Legs 
How Losing His Spleen Saved Buddy's Life

Do you have a story to share?

Your story can help others, maybe even save a life!

What were the first signs you noticed? How did you dog get diagnosed? What treatment did/didn't work for you? What was your experience with your vet(s)? How did you cope with the challenges?

Email me, I'll be happy to hear from yo


  1. People often 'look down' on other people who don't do every single little thing for their pets and think less of them as pet parents (owners/guardians) but it is a stark truth that vet care is vastly different than it was 20-30 years go. Improvements in technology are great, but they also drive up the costs. Sometimes 'old school' gets the job done just as well and doesn't put the owners in the poor house.

    It is nice to find a vet who is willing to work with an owner - and owners who are willing to ask the vet to work with them.

    1. Not everybody can afford all that stuff. Though if they spayed and did some preventive care, it would naturally be more affordable.

      But maybe they didn't have the money for that either. I know what it's like to be broke and be happy just to put food in the bowl (and on the table). So I know that one just doesn't always have the resources.

      Yes, Dr. Krista is awesome. She leaves no patient behind.