Emergency Vet Interview

Justine Lee and her cats; Image used with her permission.

Although there are many wonderful veterinarians, it isn't every day that you meet one as qualified in her particular field as veterinarian Justine Lee, DVM, DACVECC. Ms. Lee is a board certified emergency critical veterinary care specialist. This means that she trained an additional four years on top of her regular veterinary training in order to better help pets in emergency and critical care situations.

Emergency Vet Interview

A Little About Justine Lee

LoveToKnow (LTK): Thank you for agreeing to talk to us about emergencies and felines, Dr. Lee. Could you tell us a little about yourself?

Justine Lee (JL): I've always loved animals and wanted to be a vet since I can remember. My passion for helping animals started when I found a baby bird when I was seven years old, and I tried to nurse it back to life. I was devastated when it died the next day (despite the fact that I dug up earthworms for it). Since then, I have always wanted to help hurt and sick animals. I'm fortunate to have always known what I wanted to do when I grew up! I grew up with fish, birds, cats and dogs, and my parents have always fostered my passion to become a vet.

LTK: In addition to your degree from Cornell University, you are a board-certified emergency critical care veterinary specialist. Can you tell us a little bit about what your work involves on a day-to-day basis?

JL: I went to Virginia Tech for undergrad and studied Animal Sciences to get more large animal experience. After continuing my veterinary education at Cornell, I went on to do a rigorous internship at Angell Memorial Animal Hospital (Boston, MA). I followed that with a residency and fellowship in emergency and critical care at University of Pennsylvania. I'm unique in that I'm not a "typical" vet because I've done extra training in the field of emergency and critical care (ECC). I'm one of about 300 specialists in this growing field (called Diplomates of the American College of Veterinary Emergency and Critical Care), and see the "sickest of the sick" either in the ER or the intensive care unit (ICU). I've always enjoyed the adrenaline rush and challenge of the ER, and I thrive on knowing that anything can walk through the door that needs my care!

LTK: Can you share a little about your work at the Pet Poison Helpline ?

JL: After being a clinical veterinarian for 13 years (with most of those being in the field of emergency), I decided to switch hats in 2009. Currently, I'm the Associate Director of Veterinary Services at Pet Poison Helpline, an animal poison control based out of Minneapolis, MN. I help with marketing, training, hiring, public relations and quality assurance. Most importantly, I help veterinarians and pet owners on the phone with a potentially poisoned pet. It's just as adrenalizing as working in the ER - you never know what the situation will be on the next phone call!

Most Common Feline Emergencies

LTK: What are some of the emergencies you frequently encounter with cats?

JL: One of the most common frustrating diseases I see is something called Feline Lower Urinary Tract Disease (FLUTD). It also is commonly called FUS (Feline Urologic Syndrome) or FIC (Feline Idiopathic Cystitis). This emergency basically presents when your cat can't urinate appropriately, or he is acting like he has a urinary tract infection (UTI). It can be life-threatening without treatment because it results in the inability to urinate, which is painful, causes severe electrolyte abnormalities and can result in kidney failure without treatment. I believe that poor kitty litter husbandry is one of the causes for this, and I have one chapter in my book, It's a Cat's World… You Just Live In It, that is dedicated to kitty litter boxes!

LTK: I know that many substances are toxic to cats. Do you have any tips for pet owners on how to keep their cats safe from poisons?

JL: One of the most frustrating toxicities in cats is lily poisoning. Specific lilies like Easter, Asiatic, Japanese Show and Day lilies can result in severe acute kidney failure. I'm particularly passionate about educating people about this common toxicity because my owner sister's cat died of this years ago. It takes just two to three leaves, or even the pollen, to result in potentially irreversible kidney failure. Since lilies are often the number one flower found in florist bouquets, it's important that cat owners never bring in a bouquet of flowers (or freshly cut flowers from the garden or yard) without educating themselves on this common toxicity!

Another common toxicity that I encounter is when pet owners leave their own medications out on the nightstand, and come back 15 minutes later to find the pills missing. Both human prescription medications and common OTC medications can be fatal to cats. After all, just one Tylenol can kill a cat! The safest thing to do is educate yourself on what is poisonous to cats, and you can find this information at www.petpoisonhelpline.com. More importantly, learn how to cat proof your house adequately. Keep all string, ribbon, etc. out of reach; keep all plants out of reach unless you have verified that they are not poisonous; keep your human medications out of your cat's reach, etc.

LTK: What is the most common cause of trauma in cats?

JL: Bluntly, it's letting your cat outside. I'm a firm believer in keeping cats indoors, particularly if you live in the city. Coyotes, mountain lions, dogs, cars, children, outdoor poisons and even other felines are all dangers to your cat. I've seen hundreds of cats brought into the ER from trauma that could have been prevented by just keeping the cat indoors. Indoor cats can be just as content, particularly if they've never tasted the great outdoors. Indoor cats live longer, and they are less exposed to danger and toxins outside. Alternatively, you can train your cat to walk on a leash. While this involves some dedication on the part of the pet owner, I've seen some cats walk very well on leash, so I do advocate supervising your cat outside on a leash.

Dealing with Euthanasia

LTK: I'm sure the most difficult part of your job is when an animal can't really be helped, and the owner must decide whether or not to euthanize her pet. Do you have any words of advice for a cat owner that might be facing this decision right now?

JL: Euthanizing a pet is such a difficult decision, particularly when we've become so bonded and attached to these four-legged felines! It's never an easy decision, but I believe it's such an important question that people should think about and discuss as a family. I personally experienced a euthanasia gone-badly (you can read about this at my blog), and since then, I've been a huge advocate that pet owners should find the best vet, conditions, environment, etc. for this tough-life decision.

The frustrating thing about cats is that they don't show signs until their disease is very severe. By the time your cat is hiding, it's often too late because he may have had illness for days to weeks. I always try to comfort pet owners in knowing that even if their cat was mine (as a veterinarian), I may not have noticed any clinical signs any earlier due to the stoic nature of cats. After all, wild lions don't advertise to the pride that they are about to die; they slink off to pass away in peace in private. That's likely why our cats do the same.

My three guidelines to assess your cat's quality of life are as follows:

1) Is your cat eating? A cat that hasn't eaten for several days often is very, very ill. While we can "jump start" them with IV fluids or temporary feeding tubes, it's important that we consider this as part of their quality of life. I never tolerate or recommend letting your cat become emaciated (I've seen too many thin cats) - it's just too chronically cruel and sad.

2) Does your cat act like he use to? If your cat doesn't want to be near you or suddenly becomes very clingy, something is wrong. If he isn't acting like he used to five years ago (or even as a kitten), he may have lost his luster for life.

3) Does he act like he is in pain? Unfortunately, cats are so stoic that it's difficult to tell. That said, hiding is the number one sign they show. Finding your cat repeatedly in your closet or basement is a sign that he may want to hide and go.

How to Find a Good Veterinarian

LTK: Let's talk about your book, It's a Cat's World... You Just Live in It. That title is so very true. I know that you share tips in the book on what to look for in a veterinarian. Can you give us the scoop on one or two of these tips?

Book cover; Image used with permission from Dr. Justine Lee

JL: I believe that finding a health care provider that you trust and believe in is imperative whether you are a two-legged or a four-legged client. Here is a list of things to keep in mind.

  • You need to feel comfortable with the doctor and technical staff. They should take the time to answer your questions.
  • The veterinary clinic should maintain an organized health record that includes detailed information about prescriptions, physical examination findings and blood work. You should also be able to receive copies of the blood work.
  • Your phone calls should be answered and handled well.
  • The office hours should be convenient for you.
  • You should ask about which payment plans or methods are available.
  • Find out the range of medical services they provide. Ask if they do in-house blood work and x-rays. Also ask if they have anesthetic machines, oxygen, a full pharmacy and referral options if necessary.
  • Ask how emergency calls will be handled.
  • Ask whether they provide non-medical services such as grooming, nail clipping and boarding. If they don't, ask if they can refer you to places for these services
  • Ask if the veterinarians are members of a state or professional association (such as the American Veterinary Medical Association).

Ask your breeder and other people you know about their vet. It takes research and forethought to choose the best veterinarian. Find a veterinarian who you feel is caring, compassionate and knowledgeable, one that offers you choices (from medical options to referral to a specialist) and is willing to work with you to do what's best for you and your cat.


Many thanks to Dr. Justine Lee for sharing her insight about dealing with pet emergencies. You can visit Dr. Lee's website at DrJustineLee.com.

Emergency Vet Interview