DoLittler: Blog

I’m not deputized as an officer of the law and I’m no trained tax collector. I have no desire play either role in the normal course of my veterinary life. And yet I’m effectively enjoined to act as de facto dog police multiple times every day as I explain pet license policies and procedures to my confused clients.

It earns me no money––and definitely no friends––but it wouldn’t do to leave my clients in the dark on this issue. Not when the fines for license laxity can extend to liens on your house in my municipality.

Then there’s the fact that veterinarians in my area are compelled by competition, historical expectations and infrastructure limitations to act as the County’s tag agency.

Though we do have the opportunity to opt out of this role, doing so means that our clients must drive to the one and only non-veterinary tag outlet for tags in the entire [large] county (in an industrial location, to boot). Since every veterinary hospital has always been expected to serve this function, it would enrage our clients if we suddenly refused to offer tags and forced them to go elsewhere.

Moreover, declining to serve as a tag agency would greatly diminish the license-based revenues for municipalities like mine. What would happen to our license-funded shelter? I shudder to think.

But our municipalities, so underfunded as many of them are, have a way of making things worse for everyone involved––themselves included:

Every few months yet another slice of my client pie is treated to a slew of nastygrams. The municipality-originating missives arrive in the mailbox with tidings of $60 to $180 fines. These are usually geared to the clients whose tag purchases came late that year. But sometimes they’re not. The messy database system at Miami-Dade County is such that even on-timers get cited every once in a while.

This year things got even worse: All my patients whose regularly scheduled rabies vaccines were deemed “not in best interest” (whether because they were ill, ancient or had suffered previous vaccine reactions) also received citations.

Here’s where I get angry––extra-angry. It’s not enough that I have to explain the law, deal with client complaints and help resolve these issues. I now have to explain to the powers-that-be that they cannot require vaccines in unwell animals.

It’s infuriating––enough to make my blood boil and make me want to fraudulently send the County death certificates in lieu of license fees (that’s one way to opt out once you’ve entered the system).

Want to know how much veterinarians loathe the system? Consider that at a recent veterinary meeting I happened to ask how many of those present licensed their own pets. One hand was raised. And she had just moved to the area. Figures.

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Today on DailyVet's post: To shampoo or not to shampoo...

In most municipalities in the US, dogs (and sometimes cats, too) require yearly licenses. The fees from these licenses are used to fund the animal services our municipalities provide. In some municipalities (like mine) there is no other source of municipal funding for animal-related services. Consequently, if people don’t buy tags...there will be no animal services.

Because the annual license has historically been tied to the timing of the rabies vaccine (thereby denoting the animal’s current-on-vaccines status), everyone refers to this license as the “rabies tag.”

But it’s more than that. Especially now that rabies vaccines are no longer required annually (veterinary science has deemed the every-three-year vaccine perfectly acceptable), it’s time the “rabies tag” graduated to a more apropos moniker: “the pet owner’s shelter tax.”

OK, so that’s not quite fair. After all, our municipalities do have a compelling interest in ensuring that each individual pet is cared for in a manner that addresses the public health imperatives of any given region.

The problem is how to enforce this kind of care. Whether it’s all about rabies vaccines, yearly stool checks or whatever else the public health officials of a given region deem necessary, there’s gotta be a way of setting a bar for animal healthcare. You may disagree, but I believe this regulatory infrastructure is crucial to public health. Think what would happen should a major zoonosis ever emerge to rival the threat of rabies.

A recap (since I know it’s confusing): So is the license about animal services funding, pet healthcare or public health?

Ideally, it’s about all three. Keeping tabs on pets’ health is undoubtedly in the interest of public health––especially when it comes to major cross-species diseases like rabies. The problem is that tagging for public health (as was historically the impetus behind individual licensing of dogs) is no longer the focus for most municipalities.

Instead, the license fees have become public funds for animal projects. In the most miserly municipalities (again, like mine in Miami), license fees are all that get applied to the entire County’s animal services budget. In other words, compliant pet owners pay the whole bill for any and all municipal animal care (shelters, animal control, cruelty investigation, wildlife encroachment, etc.).

Those who don’t own pets are typically pleased by this policy. Why pay for animals when we don’t own them?

Sadly, it’s this exact rationale that built the system’s stark fiscal divisions and thereby institutionalized it’s limitations. Though animal services extend to protecting public health as a whole and reflect the full spectrum of animal-human interaction, municipal officials are loathe to allocate funds to "pets” given the politically short-sighted distaste for choosing services for animals over those that more directly affect people.

However, the reality is that throughout most of the US, compliance with licensing only extends to about 30%-60% of dog owners. Where cat licensing is required, the compliance rate is far, far lower. Make no mistake, enforcing licensing is a logistical nightmare that relies on the responsible and law-abiding to support the whole of society in cases like Miami's.

Even worse is the fact that when the system fails its humans and animals (as it often will when so poorly designed), when strong-arm tactics are employed in enforcement (which is what municipal service providers feel compelled to do given their limited sources of funding), or when the law-abiding public begins to feel put upon (as is only natural given the built-in unfairness of the system), the entire organizational structure breaks down and nothing is successfully achieved.

More on this tomorrow, including the vet’s role.

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On Today's DailyVet post: Do tax breaks for your pet make you HAPPY?

The average price of a veterinary office visit in the US is right around $50. I’ve seen them as high as $250 for specialists and emergency hospitals and as low as $0 at places where the office visit is beside the point (as when vaccines, drugs, tests and procedures are all that are priced).

Most general practitioners like me, however, tend to price themselves somewhere between $25 and $75 for the basic visit. Here in Miami, my practice of employment charges $48 for a regular visit and $25 for follow-ups and “brief” exams. I’ll also charge $65 for a lengthier consultation (such as for a second opinion). And I think that’s fair. But not everyone agrees.

Before walking into our office, plenty of prospective clients like to call around and determine the price of the basic exam. For some, it’s a metric of what they might expect to spend in years to come should they avail themselves of your services. Makes sense...but not always.

Interestingly, the price of the office visit is sometimes a low-ball figure, one specifically designed to get you in the door. I happen to think it’s a disingenuous marketing ploy in most cases, but I get why someone might want to lower the barriers to entry for economically disadvantaged owners who might otherwise balk at the high price for a “simple look-see.”

But that gets me to my next point: An office visit should not be a “simple look-see.” Rather, it should always come with a full physical attached. If we don’t perform a full physical, it should be because 1) the pet has been seen in recent weeks, 2) is well known to me, and 3) the exam consists of a simple, isolated issue. Should all these criteria be met, I would hardly expect the owner to shoulder the full exam fee. I call these “brief” exams, as for chronic ear infections or simple lump checks for frequent visitors.

For the elements of a “full physical exam,” check out this post on today’s PetMD DailyVet blog.

Moreover, the exam should also involve a history-taking. In other words, the veterinarian should be asking you questions about the pet’s status. As in, “any coughing, sneezing, vomiting, diarrhea, lethargy, inappetance?” etc., along with “What does your pet eat? How are her bowel movements, What’s her exercise routine? Does she take any medications? Has she been taking her heartworm meds?” Deeper probing should accompany any abnormalities and deviations from what your vet recommends.

These elements are what warrant an exam fee. And I would always expect you to demand the full physical and history-taking along with having your questions satisfactorily answered. Anything less and you might think about seeing another vet...IMNSHO.

Are YOU getting what your pet deserves?

My email inbox always looks like a bomb went off in a pile of alphanumeric characters. (Incoming!) What’s worse, it’s clear that someone with the organizational proficiency (and taste) of a middle-schooler took to the “tag” button by way of adding a riot of pseudo-descriptive colors to the laundry list of lines.

It was amid this mess that I’d almost overlooked a crucial missive from a bereaved pet owner:

Dr. Khuly: I can't shake this terrible fear that my beloved cat Stevie, although he was euthanized two days ago, is still alive and suffering. To me he was my son, my baby for the last 10 years. I get frequent feelings of desperation that there's something I should be doing for him, that he still needs my help and I'm terrified that he's still suffering.

I even went back to the vet later that same day to see and hold him again and to make sure that he really was gone, and had them check again for a heartbeat with a stethoscope, but I can't seem to be convinced that he isn't just unconscious with a very slow heartbeat because of the cold in the freezer.

I'm insane with grief and this fear is compounding it. I also can't get past the fact that he's still there physically, in a freezer for another week until he's picked up for cremation, while I'm just ten minutes away. I'm dying inside about this.

The other horrible aspect was that he had an intravenous [catheter] inserted before the first injection (I insisted on sedation first and the doctor said that she needed to do the intravenous [catheter] because the vein might collapse after the first injection) and after the first shot he looked as though he tried to vocalize twice and I can't shake the horrible possible implications of this memory.

Could he have been afraid or in pain? Please tell me how to know and therefore accept that he's really gone for sure as well as whether or not he was likely suffering when he opened and closed his mouth?

Thank you for any answers.

Audrey

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Audrey: Perhaps I can reassure you by explaining that many of us have the same feelings after our beloved pets are gone. We agonize over those last moments and suffer the irrational (but understandable) fear that our pets are still suffering within their bodies even when we know they are gone and at peace.

I used to think clients like you were a little crazy until I experienced the same thing. It was after I euthanized one of my boxers 10 years ago. It was horrible. I couldn't let go of the vision of him inside the freezer. Then came another tragedy when one of my dogs drowned in a pool. Eight years later I still have nightmares of his final moments and horrible, unshakable visions of his body at the bottom of the pool.

Terrible as they are, these are all normal human experiences after traumatic events. You don’t have to go to war to suffer post-traumatic stress. For me, it helped to discuss my "crazy" thoughts with others and to find that they felt similarly or had the same burdensome thoughts.

Please, please know that Stevie is at peace now. Now all you have to do is let go of the obsessive thoughts so many of us suffer. Easier said than done, I know. Consider seeing a pet bereavement counselor or attending a group (many local organizations will offer free, pet grief group sessions from time to time).

My deepest condolences.

Patty

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Try as I might, there’s only so much I can say via email when questions like this arise. After all, what can one invisible human on the other end of a computer manage beyond an expression of sympathy and a request they seek more brick-and-mortar assistance?

Because, whether we do so or not, we all know that after an emotionally traumatic loss of a pet, availing ourselves of community services that address issues surrounding pet loss is one of the best things we can do––especially when friends and family don’t seem to understand how badly we’re hurting.

In my area I know where to send my grieving clients. I have a list of counselors that deal in pet bereavement (for minimal fees or a sliding scale) and in case of a serious lack of funds (or when a community feel is preferred), there’s a local pet bereavement group that meets at a nearby public library. But what do I tell my online help-seekers?

In cases like Audrey’s, when I know my emailers would benefit tremendously from the kind of professional or group-based support some communities offer, I wish I had a handy list of online places to start. But while I know there’s a long list of online organizations that deal in pet bereavement, I’ve never had any direct experience with them.

Here’s where you come in: For starters, help me suss out the best online resources for pet bereavement issues, including some that might help her find assistance locally.

Next up: Let’s help Audrey out. Show her she’s not alone. Give her your take on how she’s feeling. We’ve all been there, right?

Whatever your profession, you’ll have work days that will stay with you forever. Yesterday was one such adventure...in misery.

I was feeling flu-ish and crappy (a rare occurrence for me) and had decided to take the afternoon off (an even rarer occurrence). Since I don’t like to take cold meds I was sniffling into Kleenex, coughing into my elbow and handwashing obsessively when my first patient arrived:

A sixteen year-old girl I’d been following closely for the last few months for her arthritis pain, bloodwork abnormalities, disorientation and as-yet undiagnosed occasional respiratory distress.

But this visit was more routine: She’d run into a rose bush and had a a thorny puncture wound that had refused to heal with simple home care (plant-originating wounds can be like that).

As usual, I performed my basic physical and probed the owner on her other issues before clipping and cleaning the wound. Pretty stable, it seemed...

....until I applied a cold compress to the area, at which point she let out an uncharacteristic howl, stiffened, defecated and appeared to suffer a seizure. Then, in spite of a strong pulse, she suddenly stopped breathing. I didn’t even stop to explain my intentions to her owner...here's when I picked her up and ran.

Blood poured out her nose as we rushed her to surgery to place a catheter, intubate her and provide artificial respiration. EKG and pulse oximetry revealed the full extent of her agonal condition. CPR, epinephrine down the tube...then in her heart. Nothing.

Here’s when you might reasonably say...She’s sixteen. She’s had a great life. It was her time.

Yeah, but tell that to her tearful client too shocked and confused to utter a word, much less internalize the bizarre nature of this sudden, stress-related death. Nothing I said seemed to sink in. He was a walking zombie by the time I helped him put her into his car (for a family viewing prior to cremation). The lack of any fee for our efforts was completely lost on him, I'm sure.

So it was that my guilt had no sticking point. Useless human emotion though it might be, it dogged me––along with the cough, drip and rasping voice––all day long, then disturbing my sleep and chasing me into today.

Who brings a pet to the veterinarian and expects a sudden death?––especially one that resembles anything but the peaceful final moments we crave on behalf of our loved ones.

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Less stressful reading over on PetMD's DailyVet post on poop and what it can tell you.

More contentious stuff (waiting for the legal department to call) on USAToday's column.