V * O * T * E - November 2nd
It is your right and your responsibility!
Enjoy and please give us your feedback. We want to know what you would like to hear about. Please feel free to share with your family and friends.
Dr. Wilson's office is proud to introduce the latest advancement in aesthetic technology.
The newest and most comprehensive system "Lumenis One" is coming soon.
This advanced IPL has the highest-quality options available for you. The newest version of our already popular "Multilight" is faster, more comfortable and the most effective to date.
Conditions such as broken capillaries, spider veins, photo aging, and removal of unwanted hair are as safe as ever and no downtime is required.
This system includes LightSheer for hair removal, often called the "gold standard" by experts in the dermatology field.
We look forward to continuing to provide the best treatments for you! To setup an appointment and for further questions, please call 480-860-9383.
| Hormone Therapy Update |
by Dr. Deborah Wilson
I have promised to keep you updated on current research and thinking, particularly on the subject of hormones.
In a recent issue of Menopause Management, Wolf Utian, Executive Director of the North American Menopause Society, summarizes the final conclusions of the Women's Health Initiative Study.
He states, "Significant damage has resulted from the way the Women's Health Initiative (WHI) results were originally reported. Women have walked away from treatments often necessary for their health and well-being and have lost trust and confidence in their health providers and the care they recommend. Moreover, the public has been further fleeced and insulted by the plethora of snake oil salesmen now marketing a multitude of ineffective placebos for "menopausal symptoms." Pharmaceutical companies, with huge losses of revenues, have reduced research and development in this crucial area of women's health care. "Ambulance-chasing" liability lawyers have started class-action law suits with little substance to their charges, adding further burden to our national malpractice crisis. Many medical professionals have lost respect for the WHI writing groups for a perceived bias in the manner in which data have been written and reported; discussion and conclusions in the published papers often are at variance from the data they report. Clinicians no longer believe epidemiologists and vise versa."
The mass hysteria resulting from the premature halting of the WHI study 2 years ago has made it very difficult to have reasonable, objective conversations with our patients. Many, many patients stopped their hormones without consulting us. Most of those patients have re-started their hormones due do miserable symptoms of menopause.
What is the truth?
1) Estrogen is extremely effective at eliminating hot flushes, night sweats, insomnia, mood swings, and vaginal dryness. These symptoms can dramatically compromise a woman's quality of life, and the elimination of these symptoms can re-introduce a sense of well being into her life.
2) In the WHI study, there was a statistically significant reduction in the risk of fractures and colon cancer among hormone users.
3) Estrogen-only therapy for symptomatic relief, especially in younger women after hysterectomy and bilateral ovariectomy, has been demonstrated to be remarkably safe. Long-term therapy should not raise the risk.
4) It is true that the women taking combination estrogen (Premarin) and progesterone (medroxyprogesterone acetate), had an increased risk of breast cancer, but it was a very slight increase in risk. We do not know whether this risk increase is related to the specific drugs used, the way the drugs were used, or to one of the drugs and not the other.
5) It is true that both estrogen and estrogen combined with progesterone increased the risk of stroke, but no increase in coronary heart disease was seen. In fact, women starting estrogen as soon as they become menopausal are protected from heart disease.
6) Estrogen without progesterone decreased the risk of breast cancer.
After reviewing the data, I can say that I firmly believe that estrogen replacement therapy without progesterone is not only safe, but very beneficial. I would advise using bioidentical estrogen instead of synthetic estrogen, and I would advise estrogen patches, pellets, vaginal creams, vaginal rings, or topicals instead of oral administration. It looks like oral administration of estrogen increases the levels of c-reactive protein, which is related to increased risk of heart disease.
If a woman has a uterus, it is advised that she use a progesterone supplement along with her estrogen. Estrogen alone can cause overgrowth of the uterine lining, which results in abnormal bleeding and potentially even uterine cancer. The addition of progesterone prevents this.
On the other hand, though, it appears that it is the progesterone component of the estrogen/progesterone combination that raises the risk of breast cancer. In addition to this, many women experience unpleasant side effects from progesterone, such as water retention, weight gain, emotional instability, and fatigue.
We have found that we can minimize the side effects of progesterone by using low doses, by sticking with bioidentical progesterone and by adding the progesterone for a few days every few months only.
Some women absolutely do not want to take progesterone, but do not want to give up their estrogen. In some of these cases, we allow them to use estrogen only, and monitor the uterine lining very carefully with ultrasounds and endometrial biopsies. This regimen is reserved for only a few extremely reliable patients who are willing to follow the strict protocol and take the small risk of developing uterine cancer.
In conclusion, you are not necessarily making a healthy decision by avoiding hormones. As is true with most issues like this, there are pros and cons. Please feel free to discuss your individual situation with your health care provider.
After growing up in Florida, Dr. Dereska completed her medical training at the University of Florida at Gainesville, then entered a 4-year residency in Obstetrics and Gynecology at the Medical College of Georgia in Augusta. Training in this tertiary referral center for eastern Georgia and southern South Carolina provided her excellent exposure to benign and malignant gynecologic pathology and reproductive medicine. It was at the Medical College of Georgia that she began to develop a particular interest in Gynecologic surgery and the treatment of women with pelvic floor dysfunction and urinary problems.
Dr. Dereska, on completion of her residency, entered a 2-year Fellowship in Urogynecology and Pelvic Reconstructive Surgery at the Mayo Clinic in Scottsdale. She was trained in medical and surgical treatments for female urinary incontinence, pelvic organ prolapse and advanced minimally invasive laparoscopic surgery.
Her interests include management of fibroids, abnormal uterine bleeding, cervical dysplasia, ovarian cysts, female urinary incontinence and urinary dysfunction, and pelvic organ prolapse requiring surgical intervention. Dr. Dereska offers the following surgical services:
- Endometrial ablation
- Vaginal hysterectomy with or without removal of ovaries
- Laparoscopic total and supracervical hysterectomy
- Laparoscopic removal of ovaries
- Laparoscopic investigation of pelvic pain and treatment of endometriosis
- Laparoscopic tubal sterilization
- Vaginal sling placement for urinary incontinence
- Periurethral injection of bulking agents for urinary incontinence
- Abdominal burch and paravaginal defect repair
- Vaginal approach for uterine or vaginal vault prolapse
- Abdominal sacrocolpopexy for severe vaginal prolapse
- Conization of cervical dysplasia and excision of vulvar dysplasia
Dr. Dereska lives in Scottsdale with her husband, Paul, who is a practicing Emergency Room Physician. Nina and Paul have one daughter, Emma, who was born on June 1, 2004. They plan on adopting a dog soon. The Dereskas are both fitness enthusiasts, and Nina has participated in a few triathlons.
Hysterectomy is one of the most common surgical procedures performed on women, and is second only to Cesarean section for the Obstetrician-Gynecologist. The indications for hysterectomy are many, as are the surgical choices (abdominal hysterectomy, vaginal hysterectomy and laparoscopic hysterectomy). Women between the ages of 20 and 49 constitute the largest population of women undergoing this procedure. Traditionally, abdominal hysterectomy was the standard practice, but as advanced surgical instrumentation and training have evolved, minimally invasive approaches including vaginal hysterectomy and laparoscopic hysterectomy have become more accepted. The surgical procedure of hysterectomy involves the removal of the uterus and cervix, and can involve the removal of the ovaries and fallopian tubes if indicated. In certain circumstances, a subtotal (supracervical) hysterectomy can be performed removing the uterus only, and leaving a small portion of the cervix intact. However, this procedure can only be performed abdominally or laparoscopically.
Vaginal hysterectomy is a minimally invasive option for many women with a surgical indication for hysterectomy. Such indications include abdominal uterine bleeding, cervical dysplasia, painful menstrual cycles unresponsive to medical therapy, uterine fibroids, uterine prolapse, and in rare cases of endometriosis and early uterine and cervical cancers. Vaginal hysterectomy is performed under general anesthesia in a surgical center or hospital setting. The procedure involves the removal of the uterus and cervix, and possibly the ovaries and fallopian tubes, entirely through a vaginal incision. There are no external incisions on the abdomen. Your gynecologist must evaluate your medical, surgical and gynecological history thoroughly before choosing a vaginal route for surgery. Multiple studies have compared the outcomes and complications between vaginal hysterectomy and traditional abdominal hysterectomy which involves a moderate-sized abdominal incision. Data shows that the risk of one or more complications after abdominal hysterectomy is 1.7 times higher than the risk after vaginal hysterectomy. Additionally, the risk of post-operative fever is 2.1 times higher for abdominal hysterectomy than for vaginal, and the risk of requiring a blood transfusion is 1.9 times higher for the abdominal route. ALL hysterectomies, regardless of the surgical route, can be associated with certain risks such as excessive blood loss, damage to surrounding structures and urinary retention (temporary inability to urinate). You should discuss this further with your gynecologist when considering surgery.
Many advantages are attributed to vaginal hysterectomy as opposed to traditional abdominal hysterectomy. As mentioned above, fewer complications and a decreased risk of blood transfusion are experienced with vaginal hysterectomy. The overall surgical recovery time is between 3 and 6 weeks, with most women returning to work and normal activities by 3 to 4 weeks. Abdominal hysterectomy is associated with a 6 to 8 week recovery period. A one-day or overnight hospital stay is standard for vaginal hysterectomy. Women commonly need pain medications for the first few days to a week following surgery, although Motrin or Tylenol are often adequate for pain control alone. Fatigue is common after surgery and may last for up to 6 weeks. Vaginal spotting (not bleeding) is also normal for up to 6 weeks until the vaginal incision has healed completely. Women undergoing vaginal hysterectomy are asked to refrain from intercourse, douching and tampon use for 6 weeks until healing is completed. An examination is performed at 6 weeks to ensure proper closure of the vaginal tissue. Following vaginal hysterectomy, you will no longer experience monthly periods as the uterus and cervix have been removed. Gynecologic examinations are encouraged; however, on an annual basis following any hysterectomy.
The incidence of breast cancer was 30 percent greater in smokers compared to non-smokers, according to a study in the Journal of the National Cancer Institute. The prospective study looked at 116,544 women enrolled in the California Teachers Study beginning in 1995. Risk was highest for women who started smoking at a young age, began smoking at least 5 years before their first pregnancy, or had longer, more intensive smoking histories.
Arsenic levels detected in young chickens (the ones you are eating) measured up to 4 times greater than previously recognized, according to research from the National Institutes of Health, published in the journal Environmental Health Perspectives. Arsenic is added to animal feed to control intestinal parasites. In humans, chronic arsenic exposure is linked to skin, respiratory and bladder cancers. Chicken consumption has increased steadily from 32 pounds per person in 1966 to 81 pounds per person in 2000.
Farm-raised salmon, marketed as a "healthy" option, actually contains more cancer-causing pollutants than wild salmon, according to a study in the journal Science. A sampling of 700 salmon bought around the world from the most polluted fish in Northern Europe, followed by North America and Chile - the sources of most U.S. salmon. Farm-raised salmon had significantly higher concentrations of 13 out of 14 organochlorine pollutants tested, including PCB's, dioxin, toxaphene, and dieldrin.
Burger King has introduced the bunless Whopper, hoping to keep low-carb dieters loyal. The new sandwich ranks among the worst new restaurant menu additions, with 38 grams of fat, 85 grams of cholesterol, and 590 grams of sodium.
The more children watch TV, the less likely they are to eat fruits and vegetables, say researches from the Harvard School of Public Health.
Osteoporosis is a common, progressive skeletal disease which results from the gradual loss of bone mass over a number of years. Twenty percent of menopausal white women have osteoporosis and 52% have low bone mass at the hip. White and Asian women are at highest risk, Hispanic and Black women are at lower risk. Many diseases such as diabetes, thyroid disease, emphysema, and some gastrointestinal disorders can increase the risk of osteoporosis and fractures. Individuals who are being treated with certain drugs, such as steroids, anticonvulsants and chemotherapeutics, are at higher risk as well.
Approximately 1.5 million Americans experience osteoporotic fractures each year, most commonly at the spine, hip or wrist. Vertebral fractures are the most common and can result in severe, debilitating pain. For many, a fracture can turn a previously independent, healthy life into a life of dependence on others. The risk of dying within 1 year after a hip fracture is approximately 25%.
Throughout life, bone undergoes a process of remodeling in which packets of old bone are removed and replaced by new bone. A slow rate of remodeling probably serves to repair microdamage and keep bones healthy, but high bone turnover can compromise bone strength through a number of different mechanisms. Adults remove more bone than they replace, especially after menopause. Along with this, the bones lose mineralization. These 2 processes result in a loss of bone strength and increased fracture risk.
When estrogen levels fall after menopause, bone turnover accelerates, especially in the early postmenopausal years. This is why it is so important to begin having bone density DEXA studies around age 50.
Women who have a personal history of fracture in adulthood are at highest risk for another fracture. Other risk factors include a history of a fragility fracture in a first-degree relative, current cigarette smoking, low body weight (under 127 pounds), and over 3 months of steroid use. Women who have undergone premature menopause, either naturally or surgically, are also at high risk. Excessive alcohol use, lifelong low calcium intake, a sedentary lifestyle, and general poor health contribute to risk as well.
Bone mineral density measurement should be performed on all patients at risk for osteoporosis and fracture. Not only are effective, well-tolerated treatments for bone loss available, but knowing one's bone mineral density can have positive effects on a patient's bone-health behavior. Knowledge of one's bone density can influence decisions about lifestyle modifications such as exercise, diet, and calcium/vitamin D supplementation.
When you have a bone density DEXA study, you will be given a "T" score. This score tells you how different your bone mineral density is from what would be expected for a person of the same sex at peak bone mass. A "T" score of -1 or higher is normal. A "T" score of -1 to
-2.5 indicates osteopenia, or early bone loss. A "T" score of less than
-2.5 indicates osteoporosis.
If a woman has osteoporosis, treatment will always be recommended. If her bone mineral density falls in the osteopenic range, however, lifestyle changes may be suggested in lieu of treatment, depending on the severity of osteopenia. It is very important to obtain serial bone mineral density measurements in order to evaluate the rapidity of bone loss in an individual.
Generally speaking, if a woman's bones are normal, we recommend bone density DEXA studies every 2 years. In the case of a woman who has osteopenia or osteoporosis, we recommend DEXA studies yearly to evaluate the effectiveness of our treatment protocol.
Treatment for bone loss falls into 2 categories; non-pharmacologic and pharmacologic. The non-pharmacologic approaches include calcium and vitamin D supplementation, nutritional improvement, exercise, and fall-prevention strategies.
Both calcium and vitamin D supplementation have been associated with reduced bone loss and decreased risk for fractures in a number of prospective studies. Supplementation must be maintained long term in order to be effective. It is surprising that deficiencies in these nutrients are widespread in the United States. It is estimated that 90% of women and 50% of men do not get enough calcium in their diets to meet the intake recommendations put forth by the National Academy of Sciences. Although poor calcium intake is observed at all ages, it appears to be most common among older individuals.
Protein deficiency or excess in an individual's diet can also contribute to bone loss. It is important to eat a healthy, well-balanced diet with adequate protein. However, people whose diets are excessively high in protein, particularly animal protein, subject their bodies to large acid loads which causes excess urinary calcium excretion. This calcium excretion effectively steals calcium from the bones and causes bone fragility. If you have been following the "Atkins Diet", this is something to consider.
Aerobic, weight bearing and resistance exercises are all effective in increasing the bone mineral density of the spine. Walking benefits both the spine and the hips. Although an increase in bone density may occur, exercise also improves balance and strengthens muscles, which reduces the tendency to fall. Other fall prevention strategies, such as using non-slip tile, clutter reduction and night-lights are helpful in reducing the risk.
Many drugs are available which act to prevent the resorption of bone. These include estrogens, selective estrogen receptor modulators (Evista), bisphosphonates (Actonel and Fosamax), and calcitonin (Miacalcin). All of these drugs increase bone mass by reducing bone turnover. Fracture risk is decreased by preserving bone microarchitecture.
Unfortunately, osteopenia and osteoporosis can be completely asymptomatic until it is too late. Because women are not aware of symptoms, it is often difficult to motivate them to have a bone density DEXA study and take medication if necessary. When a hip fracture or vertebral fracture occurs, however, a woman's life can be devastated. Please talk to your care provider about a bone density DEXA study. She will review your history and make a recommendation based on your personal medical history.
by Dr. Deborah Wilson
Uterine Artery Embolization (UAE) is a technique for treating fibroid tumors that came into vogue about 6 years ago. At that point, the only mainstream option for a woman with large fibroids was an open total abdominal hysterectomy, which involved a large incision and a long recovery. We were all excited about the possibility of a good alternative. Unfortunately, we have been very disappointed in the results, and the popularity of this method has waned.
Recently, though, there was what I would consider to be a biased and insufficiently researched article in the Wall Street Journal about UAE, and we have been receiving calls inquiring about the procedure.
UAE is an procedure performed under local anesthesia by an Interventional Radiologist. A catheter is threaded through the femoral artery to the uterine artery and polyvinyl alcohol particles are placed in the arteries. These particles can be supplemented with gelatin sponge pledgets. The procedure can take from 45 minutes to 2 hours. The goal is to deprive the fibroids of blood supply and cause death of the tissue.
Almost all patients develop significant pain after the procedure requiring intravenous narcotics in addition to nonsteroidal anti-inflammatory agents. Many UAE patients spend days in the hospital due to the degree of pain they experience, and some need to be readmitted for pain or bleeding.
Major complications consist of infection, uterine infarction (death of tissue), nontarget embolization (embolizing the wrong tissue), and death. Other complications include premature menopause, cervical expulsion of fibroids, contrast allergy, groin hematoma, and significant radiation exposure. To date, 4 deaths have been reported with this procedure. There have been several cases of misembolization, with problems ranging from deep gluteal pain, labial pain and in 1 case, a stroke.
In my personal experience, I have had to perform hysterectomies on women who have had UAE previously and continued to bleed heavily. One woman experienced pain for 2 years before we finally did a hysterectomy.
This is not a procedure our practice would recommend. We now have quick, safe procedures for removing large fibroid uteri with an extremely low complication rate. The average operating time for a laparoscopic hysterectomy or a vaginal hysterectomy is 45 minutes to an hour, and we are able to remove large fibroid uteri this way. For women desiring to preserve fertility, laparoscopic myomectomy (removing the fibroid) is an option. Our patients experience very little pain, most of them not requiring any narcotics at all after the recovery room. They go home the next day and are back to their normal activities within a few days. The complication rate is extremely low, and a hysterectomy is a definitive procedure, not a procedure "that may or may not be successful," or might require surgery later on.
If you have fibroids and are interested in UAE, you are welcome to consult a radiologist.
Returning phone calls from patients has become a time consuming and frustrating problem. Dr. Dereska and Dr. Wilson reserve time after office hours to call patients about lab tests and other studies and to return phone calls made by patients. Most of the time, however, the patient is either not at home or not answering her cell phone. We leave messages. Most patients call back during office hours and our office takes a message because we are invariably seeing patients when the call comes in. Some patients, surprisingly, don't call back at all. We then leave more messages. The patient returns the call the next day and the doctor is in surgery and she leaves another message. You see the pattern developing.
In order to solve this problem, we will be transitioning over the next few months to e-mail communication. Alternatively, the nursing triage desk will deliver our messages and communicate with us if there are any questions remaining.
We hope this is acceptable to our patients. If it is not, let us know. We are hoping to reduce the tremendous amount of time we are spending placing phone calls, waiting for the message machine to finish its message (some are very cute, but by the time we have heard it 4 times, it gets old), and then keeping the chart out of file until we finally make contact.
Please make sure that we have a current e-mail address for you when you call or come in for an appointment.
Women are twice as likely to have Irritable Bowel Syndrome (IBS) as men. IBS often shows up during adolescence and peaks in the 30's and 40's. It appears to occur more frequently in people who experience excessive stress. The cause of IBS is unknown, but may be related to increased small-bowel and colonic contractions.
Treatment involves avoidance of dietary excesses, caffeine, and any dietary triggers that the individual can identify. Moderation in fat intake is also recommended. Patients with diarrhea as the predominant symptom may have lactose intolerance or be eating too much fruit or sorbitol. Patients in whom constipation predominates may have inadequate fiber intake. In patients who complain of bloating and flatulence, avoiding beans, cabbage, and uncooked broccoli and cauliflower may help.
Increasing dietary fiber can help avoid the constipation, but may increase bloating. Fiber supplements such as psyllium seed or methylcellulose relieve constipation by speeding up stool transit. The addition of stool softeners also helps.
A number of antispasmodic agents are available by prescription and can be quite effective in decreasing symptoms and reducing pain. Some antidepressants can also be effective. A few new drugs are available and have been developed specifically to treat IBS.
Surprisingly, old-fashioned peppermint oil appears to have direct relaxing effects on gastrointestinal smooth muscle and can be very effective.
Many women who suffer with IBS come to the gynecologist, thinking that they must have endometriosis. In fact, the symptoms of these two diseases can be surprisingly similar. Endometriosis tends to be worse for a week before the period, and IBS is also typically worse during this time frame. Both can cause cramping and bloating. Both certainly cause pain.
If you have symptoms of IBS, please bring this to your practitioner's attention. We can probably help.
Excerpted from the New England Journal of Medicine. November 27, 2003.
Dr. Wilson's husband, Steve Wilson, took on the position of Executive Director of the Second Chance Center for Animals in Flagstaff. See our first article about the Center in the June 2004 issue. Also, visit the Second Chance web site at www.secondchancecenter.org.
Second Chance is opening its doors in October to dogs and cats in the Northern Arizona area and on the Navajo reservation who would have been euthanized. Northern Arizona, and particularly the Navajo Reservation, have a shockingly high euthanasia rate in their shelters. People in this area are less likely to spay and neuter their pets and may even believe that a dog or cat "should" have 1 or 2 litters. It is a "live and let live" attitude that results in an unbelievable amount of suffering and waste of life.
Second Chance will actually send representatives into the shelters to take animals off of the euthanasia list and transport them to the Second Chance Facility on Hwy 89 outside of Flagstaff. PETsMART has donated a transport vehicle for this purpose. The animals will be examined, treated if necessary, immunized, and placed for adoption. Some will be transported again to shelters around the country that are not full. The Humane Society here in the Valley has offered to take some of these lucky cats and dogs.
Animals for adoption through Second Chance will be posted on the web site regularly, and Dr. Wilson will have posters up in the office as well. PLEASE, if you can offer a home to a dog or cat, do not buy from a breeder or a pet store. Contact Dr. Wilson or Second Chance and be an angel for an animal that would have, through no fault of its own, been euthanized.
Dr. Wilson and her friends have rescued 25 dogs from the Coconino County Shelter this summer. They have all been placed in wonderful homes. Thanks to all of the patients of this office who have adopted animals over the last year. One of these dogs is named Nefertiti, and she now lives at the Wilson house with 7 other dogs, 9 cats, and 30 parrots.
I'll be straight with you from the start. You let Nefertiti down. She trusted you and you failed her. If I were you, I would be ashamed of myself.
You adopted Nefertiti as a 12 week old puppy from a rescue organization in Flagstaff. You were her guardian for 16 months. According to the note you left, you took her for walks, let her sleep in your bed and fed her well. She bonded with you, as dogs do. You were her world, her heroine.
I don't know what circumstances led you to drop her off at the Flagstaff pound. I hope you had a very good reason. I hope you didn't simply tire of her, or your boyfriend didn't like her, or you had to move and it was too inconvenient to take her with you.
I hope that you were ignorant of the fact that the Flagstaff pound has a 50% euthanasia rate. I hope that you were unaware of the fact that during the early summer, with the huge influx of puppies into animal rescue facilities, an even larger percentage of adult dogs and cats are euthanized, even "perfect" ones.
Had you given it any thought, you would have realized that Nefertiti would not "show well" at the pound. You knew, according to your note, that she tends to bark at strangers. Didn't it occur to you that she would bark at a person walking past her cage? Well, she did just that. And after a month of sleeping on a cold cement floor, starving herself out of the stress of being caged, and barking at anyone walking by, she was scheduled for euthanization.
Nefertiti, however, was extremely lucky. On the day that she was scheduled to be euthanized, two kind women visited the Flagstaff pound and took four dogs off of the euthanasia list. Nefertiti was one of them. The women could see how frightened she was. They saw through the barking and took her home.
Nefertiti was skin and bones when I first met her. Even at her foster home, she wouldn't eat and continued to lose weight. She was not accustomed to being outside and sleeping in a kennel. She missed you terribly and was confused and depressed.
I took Nefertiti to my house with plans to adopt her out. I already have seven dogs. After two days, I knew that I couldn't let her go. She followed me everywhere, slept in my bed and finally, wolfed down her food. When I read the note that you had left with her, describing her eating habits, her sleeping habits and her idiosyncrasies, I knew how close she must have been to you. I could see that she had bonded to me and I couldn't let her down again.
Nefertiti is lucky. There are so many more dogs like Nefertiti who don't have an angel. They are dropped off at the pound, confused and dazed. Accustomed to a warm house and a soft place to sleep, all they have is a small pen and a hard cement floor. Most have been housebroken, and are loathe to urinate or defecate in their small pens, but they are only taken out to relieve themselves once a day. They get no exercise, nothing to chew on and the incessant barking terrifies them.
They wait for their guardians to come back. They wait and wait, but no one comes. People walk by and look, sometimes taking them outside for a few precious minutes, but most of the time the people leave with the cuddly, sweet puppy in the next cage.
After a few weeks, their time is up.
You should be deeply ashamed of yourself. You could have put an ad in the paper and chosen a good home for Nefertiti. You could have put flyers up on bulletin boards. Or, best yet, you could have taken her with you. She is safe, and she has my commitment for life. No matter what. But she is very lucky. There are thousands of loyal, trusting dogs and cats like Nefertiti who, after suffering the shock and confusion of being abandoned, will lose their lives.
Please, if you ever need to give up a pet again, be responsible and find a guardian who is worthy of the creature who has given you the greatest gifts in the world, love and trust.
Deborah Wilson MD
Address: 8997 E. Desert Cove, 1st Floor, Scottsdale, AZ 85260
Phone: 480.860.4791
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