Wednesday, December 31, 2008

Love Her Or Liver

Ah, yes, liver. Some people love it, some people hate it. Some have never tried it. Myself, I love the liver. I don't especially like it cooked for dinner, but a nice liverwurst (on dark rye with a thick slice of crisp Bermuda onion and some mustard) can be a real treat. Moreover, this is my ace in the hole for medicating tough-to-pill dogs. It doesn't work for EVERY dog, but I'd say a good 98% would go for it. Liverwurst has a strong aroma (which helps disguise the smell of medication) and the flavor is enticing enough that most dogs don't care WHAT you put in there, they'll eat it. You could butter a scorpion with liverwurst and most dogs would eat it. Handily, liverwurst is easily shaped into a little meatball around a pill, too, so dosing is typically quite easy. I advise using the less-expensive kind, however; the gourmet version is stickier, and the meatball can be hard to get off your finger. It's like trying to throw peanut butter.

One important note: You should use only the amount of liverwurst necessary to get the pill into the dog.

I hit on the liverwurst idea several years ago, when I had a dog who needed long-term pain management. She took only a week to go through most of my pilling tricks: bread, cheese, canned dog food, hot dogs - all of those she learned to peel off the pill, eating the treat and spitting the pill cheerfully at my feet. She was difficult to pill otherwise - an American bulldog, she had a tongue that was capable of swelling at an instant's notice to a size that would fill a small cooler, let alone the back of her throat. Let me tell you, trying to get a pill past the muscular hump of her tongue whilst wrestling the rest of her muscular body was not a job for wimps. I'd have done it though, three times a day, except for the fact that it was an exercise in futility. Being an American bulldog, she was never offended by the pill wrestling; she appeared to consider it a good game. A good game which, at its conclusion, would wind up with me all hot and sweaty and covered in dog spit, her panting happily with a big goofy grin on her face, and the pill in a wad of unusable mush somewhere in the room (perhaps smeared across my thigh, perhaps mashed into the carpet, perhaps festooned along the wall in artistic loops and swirls.)

One day in desperation I tried liverwurst. For the next six months, three times a day, she never spit a pill. Not one. I believe in the power of liverwurst.

Mind you, pilling is not the ONLY power of liverwurst. One day while I took the pills to the bulldog, one of the Border collies counter-surfed the remaining package of liverwurst from the worktop. I returned to the kitchen in time to see him eating the yellow paper wrapper that had, only moments before, contained perhaps a quarter pound of liverwurst.

Oh, well. I resigned myself to a night of interrupted sleep, since I was sure I would have diarrhea (and lots of it) to deal with that night. As it turns out I was half right: no diarrhea, but Finn developed a horrific, cornea-melting gas that lasted for three days. It was powerful enough to wake me from a sound sleep (GAH! What is that SMELL?!?) It was powerful enough to imbue itself into any surface Finn laid or sat upon. It was powerful enough to sear the lining off your mucous membranes. I didn't dare wear my contact lenses. I think it was a close cousin to some of the lethal gasses released on WWI battlefields. I've never seen the recipes for any of those, but I wouldn't be surprised if they started with "First, find a dog. Next, feed it a pound of liverwurst..."

Poor Finn. He was sure I didn't love him any more, because I would not let him sleep on the bed, and any time he came near me - and at random intervals during the night - I would suddenly seize him and spray his behind liberally with grooming spray. (Hint: DO NOT use a food-scented spray such as pina colada. This will make you gag and put you off of pina coladas forever. Stick with baby powder scent or something similar.)

Apart from its culinary properties, the liver is an amazing piece of work. It processes our food, it stores fuel, it metabolizes medications, it manages our blood sugar (in concert with the pancreas); it makes bile and clotting factors and proteins, filters out bacteria from the blood, detoxifies poisons, conjugates and excretes all manner of things. Without it we would die miserably. Fortunately for us and our alcohol-swilling ways (amongst other behaviors), the liver has an enormous reserve capacity. You could go in there today with a tiny little hammer and whack 70% of your liver cells on the head and kill them - and so long as you left the support structures of the liver intact, it would repair itself. Alternatively, you could have a surgeon divide your liver in half and give half to a worthy liverless recipient, and (given a little support) each half of the liver would grow back, so that in the end you'd have two functioning livers, one in each person.

An amazing organ, the liver. Little wonder that when things aren't going well for the liver, things aren't going well for any other part of an animal.

Mind you, when things go badly for the liver, sometimes it's not the liver's fault, really. Sometimes it's that pesky gall bladder that's responsible.

The gall bladder's job - and here I know you'll be surprised - is to store gall (otherwise known as bile). It doesn't just store it, though; it is supposed to contract when we eat so that bile flows into the duodenum, where it will start to emulsify and break down our food (which, if the stomach has done its job, will by then be an indistinguishable mush of everything we ingested a while earlier). Once the food items are sufficiently tiny, they can pass through the lining of the gut and into the bloodstream, where they will be taken by the portal circulation to the liver, at which time the liver will perform its complex magic.

However, if your liver and your gall bladder do not get along, there will be trouble. If bile is backing up, for instance, because the gall bladder isn't sending it into the gut, the liver will end up being bathed in bile - which, after all, is intended to break down things like food, things like, oh, I don't know - the liver. If the gall bladder is infected, or has a stone or a tumor, your liver will be sad.... and so will you. Sometimes we can, by means of a combination of meds, fix this problem. Sometimes we end up at surgery. Sometimes, most unhappily, we lose. Even the mighty liver can become so damaged that it cannot rally in time, or develop cirrhosis, or have a tumor. But mostly, bless it, it gives us a fighting chance to win.

It's been a week for liver problems at the clinic. One of my nurses has just had her gall bladder out. Not three days later one of my liver patients - who had responded well to meds - came back for a routine recheck, only to have high liver enzymes again. Drat. Out comes the ultrasound, and - well, lookie here: a gigantic gallstone. Maybe you'd like to see the surgeons for that?

You know I'm going to have a third one, don't you?

In this case it's Pepper, my nearly-thirteen-year-old step-dog. She doesn't LOOK sick, does she? Pepper has had a prior bout with hepatitis, about a year ago. She really wasn't showing a lot of signs; she didn't vomit or act ill, but she ate only half her meal one night and refused it the next morning. This is a dog that never refuses food. In her, skipping one and a half meals is cause for concern. So, I emailed my boyfriend in Asia (where he was flying at the time) and asked for permission to do some workup. He green-lighted me, naturally, so I started hunting around and came up with some iffy liver enzymes and a few other things. Nothing very far off normal, but I put her on meds. A month later she was perky and lively and bossing around all the other dogs, just like usual.

All her follow-ups have been normal, and she's been well. But last night she refused dinner, and this morning she refused breakfast. And guess who's in Asia again? Sigh. Well, that's one of the perks of dating a vet; we notice these things and go after them. So, in we went (on my day off) and did some bloods. Hm. Liver numbers are off again, less so than last time, but off. While we're at it, let's just have a peek at that gall bladder. Which means laying Pepper on her back in a padded trough and shaving her abdomen for a little ultrasound action. None of these ideas is really okay by Pepper, but with the assistance of J and E and some soft talk, we prevail.

Hmm. Gall bladder doesn't look too bad, but those bile canals aren't looking quite right. Plus there are patchy areas where the liver looks swollen. Time for meds, prescription food, nursing care. Especially nursing care, which means cossetting and snuggling and keeping her toasty warm, dosing her food with active-culture yogurts for the probiotics (and the taste, no doubt), and of course letting HER sleep with my down comforter.

And of course, the meds. Guess I'd better go get some liverwurst.

Tuesday, December 30, 2008

White New Year's

To no one's surprise, I'm sure, we had a white Christmas up here. Not only was there good snow on the ground, snow was actually falling on Christmas day. SO pretty.

The snow kept up til Boxing Day, when I went back to work; fortunately my plow guy had been and gone; I'd have been surfing my truck backwards in snow up to the bumper otherwise. The truck on the left has not been shovelled out and is sitting on bare ground under all the snow (this is my "extra" truck, which I should probably find a home for, although it is almost old enough to order its own drinks if I took it to a bar.) The truck on the right is the one I drive; it's not really higher clearance than the other one, it's just sitting up on the snow pack.

Sunday the wind started; it knocked all the pretty snow off the branches and dropped the chill factor into the below-zero range. I tried to take pictures of the pine grosbeaks; it's tough to get a clear focus when the branches are swaying in the breeze. It's also tough with the wind numbing your fingers to the stiff-and-clumsy level and making you shiver so hard your whole body is shaking hard enough to clack your teeth together (hence the imperfect focus, sorry about that.)

Monday driving to work was interesting: all that beautiful snow on the ground, now being driven across the roads. Some places it becomes a low, fast-flowing river across the road, swift and opaque, obliterating all signs of the road itself. There you have to guess where the lanes are, where the shoulders are, where the pavement edges break off into the ditches. Some places it eddies in whirling snow-devil funnels, glittering and brilliant in the headlights. Some places it is flung thick and hard into the air, giant billowing sails of it, now hiding the oncoming traffic from view, now drawing aside its curtain of sparkling white to reveal the headlights in the other lane. Some places your best hope of avoiding a crash is to follow the red glow of the tail lights on the vehicle ahead of you. Some places you can't see beyond your own hood, let alone to the tail lights ahead of you.

For fun, in the places where the wind hits hard, driving the snow up to hiss and scour like sand against your windows, it also grabs your truck and bounces it around, tugging it fitfully toward the ditches and rocking it on its suspension.

Kind of makes you happy to get to work, you know?

The wind is gone now, but it's a good 25 degrees colder than normal for the time of year. One of my clients reported - as I was standing on tip-toes in the icy parking lot, trying to reach high enough up into his dog boxes to vaccinate his sled dogs - that he had 39 degrees (F) below zero at his house this morning. I feel like a piker: I had a balmy six degrees. (I even plugged my truck in last night. What a wimp.)
It looks like it will be cold and clear at the turn of the year; all the better to view the planetary conjunction that I hear will be occurring that afternoon (or night, I presume, for people in the lower 48). I'm on call New Year's Day, so I plan to have a quiet New Year's Eve at home, stuffing diazepam in to my dogs; two of them, plus the BFs' dog, have fireworks phobias, and we always have a lot of those on New Year's Eve. We kinda get screwed on the July 4th fireworks, as it isn't really dark enough to enjoy them, so people go nuts at New Year's. I live on a lake, so every last echo rolls across the ice to the waiting ears of my pooches. On the plus side, I get a great show (for free), and the one dog who isn't troubled by the noise runs from window to window looking for the best display.

All things considered, it's unlikley to be a restful night, even with a diazepam assist for the dogs; people are likely to go even crazier than usual, since it's the 50th anniversary of Alaska's Statehood. We're unlikely to get to sleep before one in the morning, if we're lucky. The next morning, we'll be trying to sleep in (calls permitting); it's likely to be a bit cold for skiing, and besides, I have to stay within striking distance of my truck for the on-call duties. We usually get to sleep in at least a little on New Year's; the people who stay in have been watching their dogs and keeping them home, for the most part and don't need me; the people who went out and partied, on the other hand, are all hung-over or tired and hence sleeping in. If all goes well - and no one needs my help - we'll be cozying up in our little house, tying to stay warm and wishing everyone all good blessings in 2009.

Monday, December 22, 2008

String Theory

I work alone on Saturdays, which can mean they get pretty crazy. Every so often there's more work than one person can do, and I have to call in another doc to handle the overflow. This last Saturday was pretty uneven; slow to the point of stagnation in the morning, it gradually got busier until noon. After that it was pretty much death, destruction, war, devastation and horror. It seemed that everything came in at once, and all of it was in need of big intervention: a cancer patient, induced into remission on meds, who had developed anorexia, a distended abdomen and bloody diarrhea; a dog in sudden collapse; a dog (most unfortunately) arriving DOA, most probably as a result of a cardiac event; a lethargic and vomiting cat which might have a urinary tract obstruction; a dachshund with a possible blown disc in its back; a lab with an ear infection whose owners had come in without an appointment, in the midst of all this, and who didn't mind waiting.

All of the above came in within two hours. The DOA was (sadly) not very time-consuming, there being exactly nothing I could do to help the dog, although I did my best to comfort the owners. The painful doxie was also pretty quick, as it had (most fortunately) no neurologic signs, and a sore hock instead of a blown disc. The ear infection, as the least critical and the only one without an appointment, had to wait til last. That left me with a collapsing dog, an ill cat and a cancer patient with a big belly and bloody stools, all at the same time.

I do my physical on the collapse first, advising bloodwork (which the owners agree to) and pulling my bloods. The owners want to wait for results, so I leave them and their recumbent Aussie mix in the exam room and go on to the bloody diarrhea. The dog's abdomen is grossly distended and soft; the dog is a bit portly to begin with, so the abdomen is always a bit indistinct, and with the added distension I am unable to distinguish structures. Additionally, the dog's respiratory pattern is a bit rapid and shallow. I take the dog back for an Xray (during which time we relieve at least some of his abdominal distension in the form of copious emissions of a paint-melting gaseous miasma emanating from the "buttockal area", as Jay Leno is inclined to call it).

Returning the dog to his owners to wait for the Xray to develop, I go on to the next room, in which the vomiting lethargic cat is waiting. When I walk into the room, the cat is lying quietly on the table, his demeanor a little withdrawn. Because SS has warned me this cat might have a bladder obstruction, I palpate his abdomen first thing, but his bladder is small and pliant. I do discover, however, that he is a little dehydrated and has some mid-abdominal discomfort. His chest sounds normal -although he is purring steadily, making it a challenge to listen to - his color is good, and he has no fever. I am discussing workup with the owners as I am doing my physical, laying out options.

"Let me just check one more thing before we decide what to do first," I say, rotating the rightward-pointing cat to the left, a move he tolerates with good grace. Grasping his head gently with my right hand, I press the pad of my left thumb between the arms of his mandible and hook the nail of my index finger over his lower incisors. I carefully pry the cat's mouth open, pressing up against the base of his tongue with my thumb to elevate it into view, and discover the one thing I was hoping not to see.

All along the root of the tongue is a knobby furl of inflamed tissue, infected and bleeding slightly. In the cleft of this, nearly buried amongst the thickened, reddened tissue, is a strait dark line.

Oh, crap. This cat has a linear foreign body. This means that he has swallowed a string, or a thread, or a bit of dental floss or tinsel, or something of a similar nature (ribbons, rubber bands - you name it). It has gotten hung up around the base of his tongue, and the ends are proceeding down into his GI tract. This is a bad situation; unfortunately, unless the string is pretty short, it works its way past the stomach and into the intestines. There the peristaltic contractions of the gut pleat the gut up on the string, the way that tightening a drawstring pleats up the fabric through which it is threaded. Because the string is anchored at the base of the tongue, the pleating tightens until the string starts to saw through the delicate inner tissues of the gut. If this is not relieved via surgery, the string will eventually cut all the way through it, leading to peritonitis and death. I have a particular "thing" for the looking for the linear foreign bodies, having been burned on one once as a freshman vet student. I've never forgotten. At that time I didn't know the trick of looking under the tongue for the string (having not yet gotten on to clinics, where the skills of physical exam are learned), and though I suspected a string, I didn't know how to find it. As a consequence of that and other circumstances, the cat ultimately died, despite surgery. In one sense, it was beyond my skill level, so it is perhaps not surprising that I didn't find it. But it bothers me to this day that I didn't know how to find it, and I'll never miss another one for want of looking.

I explain the consequences of the linear foreign body to the owners, who look grave. "How much would it cost to take him to surgery?" asks the mom. I ballpark her an estimate. Tears swim in her eyes.

"Let me talk to my husband," she says softly, in a voice husky with sorrow, "but I think he'll say no."

I step out to give them some privacy and go back to see my Xray on the cancer dog. I discover the reason for his anorexia and his abdominal distension. His stomach is so full of food that I can barely find his spleen and kidneys. His liver is mashed up against the diaphragm (gee, hmm, d'you think this could this be the cause of the rapid shallow breathing? Yikes.) In addition to which it appears the dog has swallowed two coins, most probably a quarter and a nickle, based on the size. They're small enough to pass through the gut, but there is the possibility of toxicity from the coins. This is most common in pennies, which have in more recent years been made with a high enough zinc content to be an issue. Unfortunately it's not possible to read the date on coins found on Xray, so if you suspect penny ingestion the safest thing to do is to remove them either via surgery or the induction of vomiting.

The owners are hilariously relieved that the dog isn't eating because he's obviously eaten WAY more than his usual share. I discuss the likelihood that the bloody stools are also a consequence of his dietary indiscretions, and warn them about the potential consequences of coin ingestion. The elect to observe the dog and call back if problems arise; the fact that the dog has an underlying cancer and is on borrowed time makes them understandably disinclined to put the dog through anything particularly strenuous or expensive. I release the dog to the owners' care, with some misgivings; it probably isn't a penny ingestion, but I dislike leaving the coins there. On the other hand, given the enormous amount of food present, and the fact that the stomach is so enormously distended that it overlaps the entire front half of the abdomen, it's entirely possible that inducing vomiting will be ineffective; the coins may have left the stomach and could currently be residing in a loop of gut that merely overlays the giant gastric shadow. Alternatively, even if they are in the stomach, it might not be possible to get the dog to vomit them up. I might be able to get them out via gastric lavage, but the owners don't want to anesthetize the dog. I guess we'll have to see if he can pass them safely on his own.

I go back to the recumbent dog, give them the results of the CBC (while the chem panel is still pending) and then back to the cat. The owner reports her husband has, with great reluctance, elected euthanasia. Both the owner and her teen aged son are crying, but realistically, the only possible outcomes we have are surgery, euthanasia, or a slow ugly death from peritonitis. If we can't do surgery, that means there really is only one choice.

I'm sorry, little man. But at least I can stop your suffering.

The owner signs papers and I take the cat to the treatment area where my nurse, E, and I gently and quickly euthanize him. Poor kitty. This is sad, especially so near Christmas.

While we are doing this, the receptionists are loading the ear dog into one of of the two recently-emptied exam rooms. Since my chem panel is still cooking, I go in, do my exam and collect an ear swab, while E is doing the body care for our string cat. I make a slide and am just heat fixing it when E hands me the bloods. I let her finish the stain while I go talk to the owners of the recumbent Aussie mix. The bloods show that the dog has one of two likely problems: either an infection or a tumor masquerading as infection (tumors can outstrip their blood supplies and become necrotic and infected). I can locate no primary mass, but sometimes you can't. I discuss options with the owners, who elect to have an expensive but effective injection of an antibiotic which is effective in the bloodstream for two weeks from a single injection. The dog has rallied a little, pinking up and seeming less distressed than before, so maybe all will be well.

At last I dispatch the ear infection and we close only 45 minutes late. I am sad about he string kitty, but realistically, it was either surgery or death for him. Poor little man. Any other alternative would have been a miserable suffering exit, something he never deserved.

Monday morning I come in and my nurse E tells me her cat - who had been anorexic and vomiting the day before - had defecated several lengths of thread (which, knowing better than to just pull on it, she had carefully trimmed away from his anus a bit at a time as he passed it over 12 hours). We checked under his tongue. Nothing hooked there. Big sigh of relief.

Meanwhile Dr, M brings in a cat back in a carrier.

"What's that?" I ask him.
"Vomiting cat, getting some bloodwork done," says Dr. M.
"Bet it has a string," I say sourly. "We had one in on Saturday and E had one Sunday, so we're due for our third one."

Dr. M looks startled, and I go up front to take an appointment. When I go back, the cat is being added to the surgery list. Because Dr. M looked under the cat's tongue. Guess what he found?

Sometimes things DO come in threes.

Sunday, December 21, 2008

Sunrise At Five Below

So. Winter solstice. The shortest day of the year. As you might imagine, in a land where the daylight varies so dramatically throughout the year, we pay a lot of attention to the solstices and (to a somewhat lesser degree) to the equinoxes. Many of us are more observant of the winter solstice than we are of New Year's, since for us, the solstice marks a more meaningful turn of the year than anything arbitrarily designated by calendar: Solstice marks the return of the light.

After today - my father's birthday, incidentally, and happy birthday to you, Dad - the days start to lengthen. Not much at first, mind you, a mere 30-odd seconds a day at my latitude. But just knowing that the change has happened, that we are irresistibly on the up-slope of the power curve, is somehow stimulating, fortifying as a hot drink on a bitterly cold night. Somehow the nadir of winter holds within it, at its very bottom, some treasure of magic, some strange tingling anticipatory power. It is as if the darkest time of the year holds within it the gift of light.... as if, only now that the light has been drained to its dregs, can this be uncovered, released, reborn into the world.

Last night, at a Christmas party, my friend J told me that she felt that this was a particularly powerful solstice: that this one was taking a lot away with it. I was intrigued by this thought. I think it might have occurred to her to word it that way because, for no reason she could identify, she was remembering with unexpected sharpness the death of her father, who died on another solstice a few years ago. I mentioned to her that, if you have to lose a loved one, for me it's a bit comforting to do so on one of the turning days, a solstice or an equinox. I don't know why it feels that way to me; perhaps it's something cultural that I absorbed too long ago to remember. Perhaps it's something different, atavistic, somehow wired into the mammalian brain, which must recognize the power of the changing seasons, or die.

That might be it. I have a tumor in my pineal gland. Probably why I can't tell that it's still dark outside when normal sane people think it is (a mental defect which will be detailed below).

Whatever the source, the winter solstice has undeniable power up here. If it happens that you are getting the winter blahs, or are grumpy because it's been unseasonably cold for the last three weeks (hmph!), the arrival of the solstice is enough to lighten your mood. After all, it really CAN'T last forever now, because the days are getting longer.

By some quirk of nature (or possibly that pineal gland tumor), I suffer from what my colleagues all assure me is a serious mental defect that is akin to some kind of dangerous personality disorder. To wit: My brain interprets the slightest change of color away from pitch black skies as "daylight". This means that if, by squinting, I can detect even the faintest hint of navy on the horizon of an inky black sky, I think "Woot! It's daytime! Let's go do stuff!" As my color vision is very good, I am evidently capable of detecting a color difference so faint that even a computer would not be able to electronically distinguish it (or so claim some of the more sourpuss types at work.) As a consequence, I think it's daytime long before or after anyone else seems to. I also think it's spring starting in about February, and doesn't start to be winter until sometime after Thanksgiving.

Most of my friends think I'm insane, or maybe just a bit foolish; after all, to them it is obviously dark outside. But I have to ask myself: Which one of us has the longest daylight and the shortest winter? So then which one of us is really being foolish?

The date at which spring happens for me seems to get earlier every year. Two years ago, I was pretty convinced winter was over about Valentine's day. Last year it was February 10th. This year.... who knows? This morning I'm feeling like it's practically over already, although perhaps that won't last when we get to the deeper cold of January. But unmistakably by February, no matter how cold it is, the season is on the move. The light is coming on so fast that you can detect obvious changes in a few days, even if you're not paying much attention, and the temperatures are coming up significantly. Sure, the greatest snowfall of the season usually occurs in February/March, but heck: that's just snow. It's not winter. In addition to which, there's enough daylight and warmth to go out and really enjoy it. Unlike, say, today, when at sunrise (which was technically 10:14 today, with sunset scheduled at 3:41 if all goes as planned) it was, on my front deck, 5 below zero. Which means those weather people lied to us AGAIN.

At any rate, it really IS light long before the sun comes up. This morning I think pretty much any normal human being - not just me and my brain deformity -would have said it was light by no later than 9:00, more than an hour before the sun actually came up. (I personally would have marked it long before then, of course, but I don't expect everyone to take part in my personal delusions). In the evening we'll have our long, graceful twilight, with our colored skies and slowly rising dusk.

But in the meantime.... a sunny morning, a steaming mug of hot buttered rum without the rum (what do you call that? Hot buttered water?), a silky drape of black and white Border collie across my feet, keeping them toasty.

I could do worse.

Thursday, December 18, 2008

Ode To the Many-Toed

I don't know if you're heard of the Founder Effect, but we have a bit of that here in Alaska, for obvious reasons. The founder effect is when a small population of animals that contains a particular genetic array is the source - the founders - of the entire future population. When the first handful of cats came to AK I'm betting there was at least one polydactyl tomcat, because polydactyl cats are pretty common up here; way over-represented in terms of numbers than any place else I've ever worked. It's an autosomal dominant trait, so once it arrives, it persists.

Many years ago, I was given a polydactyl kitten by a friend. He looked like a tiny alien, with a small triangular face and large triangular ears, a long skinny tail and longer skinnier legs, ending in a absolute plethora of toes. His front feet looked like catcher's mitts. He was the seventh of seven kittens born, and had seven fully functional toes on each front foot. Bet you can't guess what I named him.

Seven had five toes on each hind, of which four were normal functioning toes and one of which was a little vestigial toelet hanging from his leg by a flap of skin and a thin string of tendon, but not otherwise articulated with his leg. After twice seeing him get that toe hung up whilst jumping in or out of boxes (a favorite pastime for him), I decided that when I neutered him I'd have to take those dangly little mini-toes off too, or else deal with later injuries. The front toes, however, all worked in synchrony, completely normal toes but for their number, and they never seemed to cause him problems. Quite the contrary: he seemed more dexterous than any other cat I've ever had.

Upon reaching adolescence, he did what most pubescent male kittens do and turned into a cheerful thug. He spent an inordinate amount of time ambushing my old female, leaping on her with eyes and mouth stretched wide in a gleeful rictus of menace, enormous forepaws spread-toed and claw-out. She hissed, she growled, she used her Siamese Voice and spanked him, she bit him in the face and claw-slapped him for these offenses, all of which he took in good case, seeming to feel that that was a fair punishment - but never seeming to consider it sufficient deterrent. Ultimately, in defense of poor old Sojo, I did what I'd thought I would never do, and declawed him.

I was a bit worried when he learned how to escape the house by running out the door under the belly of a Border collie and then streaking madly for the trees where he could hide from me. After all, a cat's first line of defense is its claws, and here we have owls, eagles, foxes, coyotes, wolves, bears and numerous stray dogs, all of whom are capable of taking down an 8-pound cat even WITH claws, let alone without. I fretted a bit - I'd intended Seven to be a strictly indoor cat, and would never have declawed him otherwise. But evidently he had other plans for his life and was not only determined to escape the house, but showed a marked facility for it. I needn't have worried, though. Perhaps because of his polydactyly, Seven was a talented tree climber. He still had his back claws - those weren't harming Sojo any, so I left them alone - and evidently his multiple opposable thumbs allowed him unusually good grip, because even after the declaw he could skin up a tree like nobody's biz.

I don't know if Seven was handsy because of his polydactyly, or if that was just his personality, but he used to drive my BFs dog Pepper absolutely nuts by patting her on the head. Seven would be rolling around luxuriously on the seat of one of my slat-backed chairs, purring madly. Pepper would be staring at him, as is her stock dog wont, willing him to be still. Too well-bred to bite him, still she could not completely suppress the menacing lift of her lips if he should prove too wiggly, a move that works well on sheep, but was completely lost on Seven. Evidently he thought she was smiling at him, because he would reach out between the bars of the chair back and pat her gently on the head. This is NOT how these things are intended to go, in Pepper's opinion, and she would up the ante by putting on her Scary Stock Dog Face, which is comprised of a hot, steely glare, accompanied by a deep and menacing - but unnervingly silent -snarl with fully-retracted lips, exposing all her pink gums and the serrated rows of her incisors, between which her tongue is protruding. I don't know why having her tongue stick out like that made it scarier, but trust me, it did. She looked like she was both demented and rabid, and absolutely sincere in her intentions to wreak bloody mayhem upon the first creature so foolish as to move without her say-so.

And yet, Seven was never impressed by this move and did as he liked with impunity. Pepper would not bite him - would in fact only grip a sheep if it was seriously trying her, and even then it would be a quick correction and release, usually sufficient to allow the recalcitrant ewe to see The Error Of Her Ways. Often a grip was unnecessary, as she has the ability to clash her jaws together with a sharp, unmistakable report that carries across a small pasture. No sheep mistakes what that means, and most will turn and obey when they hear The Alligator Jaws Of Death clacking together like castanets. But even that didn't work on Seven, who just carried on blithely rolling around on his back and patting things inappropriately. Silly cat.

For a while, I thought Seven had developed some sort of bizarre mange hertofore undiscovered by veterinary science. He would be randomly covered with strange oval patches of alopecia. The underlying skin was normal, and there would be patches in various stages of hair re-growth, from complete baldness to nearly-complete recovery. These patches would appear at random intervals, new ones appearing sometimes days after the last, sometimes weeks or months between occurrences. I was stumped until one day I saw Seven, sitting on the futon, purring madly. Finn was watching him from a distance of one inch, his chin on the futon and his eyes glued to Seven. As usual, Seven was not inclined to sit still, kneading the futon with his big catcher's mitt feet, drifting out a dreamy paw as if to pat Finn on the head.

His Border collie Eye and presence not being enough to keep Seven still, Finn went for the grip. Finn also being too well-bred to bite, he would instead grip Seven's fur carefully in his incisors. Seven was offended by this move - what cat wouldn't be? - and he would pull away from Finn in a fit of pique, leaving a tuft of orange tabby fur between Finn's clenched incisors.

Ah. It is the Mange of Border Collie Frustration. I get it now. How foolish of me not to have recognized it at once.

One Sunday night about two years ago, Seven started to wail. This was not his usual "I'm bored and my evil mommy won't let me out into the snow" caterwaul; it was something entirely different, sharp with distress and with a deep moaning undertone of pain to it. I went searching for him at once, guided by his cries, and found him dragging his back end down the hallway toward me.

Oh, Christ. This is bad. It looks like a saddle thrombus, because very little else will abruptly paralyse the hind end of a cat in the absence of trauma, as well as causing the rapid, open-mouth panting indicative of marked pain. To be sure, I picked Seven up and felt his feet. The rear ones were cold compared to the front, and he had no femoral pulse on either side. His gastrocnemius muscles were clenched in a hard charley-horse cramp, and every few breaths he would draw deeper and let out another cry. I suppose I could have done an ultrasound to confirm my diagnosis, but there was no point: I was sure.

A saddle thrombus, for those who have not heard of it, is a blood clot that lodges at the back end of the aorta. There the aorta branches into the two main arteries that feed the hind legs, and a saddle thrombus sits atop that fork the way a saddle sits atop the back of a horse. If you're lucky, the thrombus will be small and won't completely block the blood flow, or will only block the flow to one leg. But Seven wasn't lucky. Both hind were completely blocked.

I gathered him up and went out to the truck, driving in to the clinic. Treatment for saddle thrombus is somewhat controversial, there being different schools of thought for how best to manage it. That was academic in Seven's case, though, as I had only the medications on hand in the hospital to work with. I did what I could for him that night and left him resting, as comfortable as I could make him, in a cage. I debated taking him home with me, but I didn't think he really needed the stress of a second car ride, not to mention a cluster of nosy Border collies all peering at him. Further not to mention having to withstand Kenzie's tender ministrations, as she is inclined to throw her stubby little arms around the necks of cats and lick them enthusiastically on the head. Maybe not the most restful convalescence I could devise for him.

Saddle thrombus carries a poor prognosis. Of those who respond to treatment, 90% will be dead in three to four months from recurrences. Not all will respond to treatment, so the number who make it past 4 months is small indeed. Moreover, the condition is caused by an underlying cardiac abnormality, in Seven's case something called hypertrophic cardiomyopathy. This is a condition in which the heart muscle is markedly and irreversibly thickened compared to normal, narrowing the chambers of the heart to tiny reservoirs which can only fill with and pump out a small amount of blood with each beat. This means that the thickened heart must pump faster to get an adequate amount of volume to circulate through the vessels. Unfortunately, the extreme thickness of the heart muscle means that it can't adequately perfuse itself with blood, so you have a poorly-supplied heart working harder than normal just to try to do the job. It's a bad situation. There are no physical exam findings for this disease, and chest films will be normal, although an ultrasound of the heart is diagnostic. It is a condition which kills a small number of healthy young human athletes every year, because the first presenting sign is sometimes death. But Seven rallied, gradually regaining full use of his left hind, and nearly full use of the right, although he suffered some muscle damage and had a dropped hock on that side. He seemed perfectly content with this arrangement, still running up stairs and jumping onto high shelves and sassing the dogs. Four months passed, then eight, then twelve, until I more or less stopped counting. I had promised myself that if he had a recurrence, knowing the grim prognosis and the painful nature of the recovery, not to mention the recurrence rate, I would not put him through a second round of treatment. I noted this in his chart at work, in case he should throw another clot whilst I was away, so that the pet sitter would not be faced with the decision. But eventually I forgot about it, that sword of Damocles hanging over Seven's little tabby head. Forgot about it for almost two years, until this last Sunday night, when the thread parted and the sword fell.

You don't forget the sound of that vocalization, the one that speaks of mortal distress. And the minute I heard it again, I knew what had to be done.

I bundled Seven carefully up in a towel and took him out to the truck. It is a measure of his distress that he did not cry on the trip to the hospital; he had withdrawn into some inner world, already stepping away from this one. At the clinic I gave his the euthanasia solution intra-peritoneally; his rear-leg veins would be useless due to the clot, and he was shocky and vomiting; no vein was likely to hold up to an injection, and I didn't want to put him through the struggle. Euthanasia via the IP injection is slow, but it's very smooth, and I cuddled him on my chest while he began to fall asleep, while his harsh panting slowed, while his clenched and trembling muscles relaxed, while the faint painful grunts left the undertone of his breathing. It was the best I could do for him: He died warm and safe and ultimately pain-free, and the last thing he knew was the hand of a friend.

I'll miss Seven, my little many-toed maniac. The dogs have been nosing around looking for him; as much as he annoyed them, he also entertained them. I knew, if I am honest, that this was a likelihood, and knew it for a long time. It doesn't make it easy, but it is some comfort to know that I gave him as good a run as I could give him, and made his death as easy and gentle as I am capable of making it. I can live with that.

Bye-bye, little cat man. We miss you.

Wednesday, December 17, 2008

In The Deep Freeze

It's been cold here. [Yes, I KNOW, it's December in Alaska, what did I expect, ha ha, very amusing.] I don't mean regular seasonable cold. I mean, colder than usual for the time of year. Those lying meteorologists keep promising us normal daytime temps (low to mid 20's) and standard nighttime temps (mid teens.) But what do we get? Some days our high temp doesn't break zero (although yesterday morning it was a balmy 3 degrees). This is more like January weather: clear, cold, very dry. I wouldn't mind so much if they didn't keep lying to us about it.

Mind you, when it's clear, it's sunny, so the cold does have its compensations. But the dogs don't want to be out in it for any length of time. Can't say I blame them, especially my lurcher, Ali Babba, who is the next thing to bald (having unfortunately inherited his fence-jumping whippet father's nearly-absent coat, rather than his imported Scottish BC mother's weather-resistant rough coat). I have bought Ali several dog coats in different designs. This is not easy, mind you, since Ali has a mighty deep keel and a wasp-waist that would be the envy of any corseted Victorian miss. Finding something that will accommodate his deep chest but not hang down so low that he would be walking up the inside of the hem as it droops to the ground is quite a challenge - but I managed it, more than once, and have purchased several nice examples, some fleece, some knit, one like a tiny horse blanket with a weather-resistant canvas outside and an imitation shearling inside. Unfortunately, I have discovered that all of them induce instantaneous paralysis.

It goes like this:
1. Pick up coat
2. Call Ali over
3. Chase Ali up the stairs and under the bed, where he is hiding because you have A COAT!
4. Hide coat under comforter
5. Coax Ali out
6. Get a death grip on his collar
7. Apply coat gently and with much praise
8. Release collar
9. Observe look of stark terror in eyes
10. Attempt to coax dog to move
11. Fail completely
12. Remove coat
13. Observe miraculous recovery.


All right, then, you have no one to blame but yourself if you freeze to death in the 0.9 seconds it takes you to run out, pee, and run back in (all at top whippet speed).

Another thing that's nice about the very cold weather is that every available molecule of water precipitates out onto some object. This makes for some pretty trees. It also means that should you be so foolish as to inhale while you are outside, your nostrils will immediately stick together, effectively gluing your nose shut (at least until it starts to run, at which time you will again be able to breathe through your nose. Although you may not want to.)

(All the above shots were conveniently taken from my balcony, so I don't have to put on shoes or bundle up to get them.)

I will admit we did have snow a few days ago. This was the sunrise (taken about 9:45 from the back step of the clinic):

By noon, we had this:

The dogs, of course, love when it's snowing, because it means it's considerably warmer and they can romp around and play. Or else stare quizzically at me, wondering if I am ever going to THROW something for them to chase.
Kenzie (in her winter "do", cosmetically inferior but thermally superior to the trimmed-up and jaunty look of summer), with Ali Babba head in the foreground:
Of course Ali has bigger concerns... because is that a fabric Frisbee in my hand, or could it perhaps be a cleverly disguised COAT?!?
Oh, okay. It's a Frisbee after all. The world is safe once more. All's well that ends well. Still, it pays to be alert, especially when one lives with a coat-wielding maniac. Because you never know when you'll have to go streaking off into the sunset to avoid her evil plans to keep you from flash-freezing yourself into a little black and white dog-sicle.
You can't trust her an inch.

Saturday, December 13, 2008

Barebacking in Alaska

So last night - and a chilly night it was, dropping to 15 below zero before morning - I ran some sheep feed out to S and R's after work. When I get there I bang on the door, which was promptly answered by R who says, "Two things: get inside quick, and go grab a plate."

"Oooh!" I say, sniffing appreciatively as I kick off my boots. "What're we having?"

"Roast kid," R says, pointing me at the roasting pan, "and mixed greens and baked parsnips. And you like red wine, right?"

"Mmm, yes," I agree happily, ladling out some au jus on top of a healthy portion of roast kid and shuttling over to the parsnips, which smell divine, baked with onions and butter to a lightly caramelized surface. The greens are mixed snow peas and fine-cut broccoli. Yum.

I fill my plate and go to the table, where everyone else has finished eating but is happy to keep me company with wine and conversation while I eat. Some neighbors are over, in a highly celebratory mood, and S's daughter YS is there too, drinking root beer and adding good cheer.

As always at Wildwood, the conversation is good and the company warm and pleasant. The food, it goes without saying, is always excellent. I'd never had parsnips before that night, but they were delectable, tender and flavorful. We chitchat about the sheep, the farm, people's lives, laughing and generally enjoying ourselves. Before long the neighbors go off to their own house, YS driving them in case they might have been a little more celebratory than is wise to put behind a wheel.

As S and R and I linger over the remnants of the wine, I ask if S doesn't mind me telling this story about her girls. She doesn't, so here it is.

I've known the Wildwood clan for over a decade, and when I first met S's girls, they were polite, personable, wiry and energetic kids of maybe 7 and 8 or so. At the time, they all lived in a smaller cabin than the house they now occupy (which they built a few years ago on a neighboring property, though they still own the cabin.) They have always had horses, and the girls have ridden and been around animals of all descriptions since early childhood. They have grown into lovely young women: smart, good-hearted, caring, generous and capable, with warmth and humor and a kindness that is wonderful to see. This is partly their good parenting, but it is in part the choices they have made, the people they have chosen to become. There's plenty of credit to go around, and I think it should be divided evenly amongst the girls themselves, and those who had a hand in rearing them. They have been taught since childhood to think of the welfare of themselves and others, and have internalised the lessons well. But no childhood is complete without a few miscommunications.

One summer day, S relates, when the girls were quite young, she looks up from her chores to see the girls riding double, bareback, on one of the horses, their little helmeted heads close together as they bob sedately along with the motion of the horse, their little riding-booted feet bumping gently at the horse's side. S's first thought is: How did they get up there by themselves? [As it turns out, they had the bright idea to put a pan of grain on the ground so the horse would stand still, then climbed aboard with the aid of an up-ended bucket.] And her second thought is: Where are their clothes?

"Girls!" S exclaims, in obvious agitation. "What are you doing?!? Why are you RIDING NAKED?!?"

Big tears form and roll down their little faces. "But Mom!" they wail. "You told us never to ride without boots and helmets, and we're wearing them!"

"And pants!" S exclaims. "New rule! Boots, helmets and pants!"

I about died laughing. I could just see their sweet adorable little faces, all big eyes and trembling chins and tear-streaked rosy little cheeks, completely bewildered as to why S's hair was standing on end. After all, they did everything safe! They made the horse stand still, they used a mounting block, and they were wearing their safety gear! How could anything be wrong?

Sigh. Bless their adorable little hearts. Oh, well; in those days this was a wilder place, less populated, fewer paved roads, a bit more rough-and-ready, more of the last frontier. Maybe it didn't seem unreasonable to the girls to be riding around naked in those days (and of course, things that seem unreasonable to adults often seem QUITE reasonable, even eminently logical, to little children). I guess what is sensible and logical is to some degree in the eye of the beholder, however, because another time S told me this story.

When she first moved to AK - well before the girls were even thought of - S was a new graduate, struggling to make ends meet. She had student debt, and had not been working long enough to have much of a bumper. She remembers one time spending literally the last of her money for the month on a 40# bag of dog food. It was going to have to last her the rest of the month; there simply wasn't enough to stretch her budget any further, but with luck she'd be able just squeak through with what she had - so long as nothing went wrong.

You know something went wrong, don't you?

That night, after a long day at work and doing chores and worrying about finances, S finally retires in the long summer twilight. Late in the night (or early in the morning, whichever) the dogs suddenly start going mad, barking and carrying on. She gets up and looks out the window.

Oh, son of a bitch. There's a black bear standing in the bed of her pickup truck, eating her last $20 in the world, in the form of the bag of dog food. Worse, this is a problem bear: any bear that takes food from human habitation is a hazard, dangerous to the livestock and pets and humans that live there and in nearby homes. Typically, unless you relocate them many many hundreds of miles away, they just migrate back to their neighborhood and resume being a problem; as a result, most such bears must be destroyed.

S jams on her boots and grabs her gun, loading it hastily. She runs outside, draws a bead and shoots the bear, dropping it in the truck bed. Right about then, as the report of the gun is fading from her ears, she thinks: Maybe I should go inside and put some clothes on.

Put some clothes on?!? I am thinking.

Because, after all, S tells me, butchering out a bear at one in the morning is all very, well but the mosquitoes are going to have a field day if you don't get dressed.

About here I give her a sidelong glance. "You went outside, completely naked, to shoot a bear?"

"I was wearing boots," S denies, faintly defensive. "Besides," she says, "I had to hurry, if I was going to get my dog food back."

"Get it back?" I demand, goggling slightly. She can't mean....

But she does. "I was down to my last $2o in the world," she reminds me. "There's no way I could afford to let that bear have my dog food. I gutted it, opened up the stomach and scooped out the dog food."

"How was it, after all that?" I ask her.
"Bit damp," she allows, "But not bad. I dried it out so it wouldn't mold."

She also - being a frugal type, and not wanting to disrespect the bear's sacrifice - butchered out the bear and put it in the freezer. It kept the wolf from the door long enough for her to get her feet under her, and to this day its hide hangs on her wall, a reminder of Providence. I wonder sometimes if that bear was visited upon her expressly to tide her through.

At any rate, if you're ever asked to do things bareback in AK, it might be best to clarify what, exactly, is meant by "bareback." Because it could mean you're riding without a saddle. Or it could mean you're riding without clothes. Or it could mean you're running outside in the wee hours with nothing but boots and a gun to defend the last thin margin of your survival. Bare-naked.... or bear naked, perhaps.

When I think of these two stories together, I have to grin. Maybe the bareback riders are a wee payback for S's own midnight adventures in the raw. You know what they say: the apple doesn't fall far from the tree.....

Thursday, December 11, 2008

Nothing Normal Times Three

Bizarre case du jour...

We have a cat (Frank) come in to be checked for a problem following a declaw. Evidently Frank has had a persistent discharge from one toe since the surgery - which was two years ago, but never mind that. If the owner had taken Frank back to the original doctor who did the surgery, it probably would have been repaired for free. This would be our policy, at any rate; we don't charge to re-check our surgical incisions, and in many cases we don't charge (or charge only the anesthetic fees, to cover costs) to re-do something on a surgery that needs attention for a reason other than owner negligence. (If the owner lets the dog chew all its sutures out and then roll in dirt, that's THEIR choice, but as they have ignored our after-care instructions, we then charge normal fees.) I have no idea if this is a good policy or not, but it seemed fair to the two owners, anyway, so that's what we do. However, since it wasn't our surgery we were correcting, we charged full fee. Still, the owner wanted a second opinion, so we were happy to oblige.

I happened that day to be giving a tour of the hospital to a friend of my nurse JG, and we went back into the wards. I was explaining what cases we had, and explained Frank's, at which time I got my first good look at little Frank. (Since Dr. J was his surgeon, I hadn't really seen our Frankie before then). The first thing I notice is that Frank is a calico, which means he must be a girl. The way calico happens (for the uninitiated) is that the cat has genes on the X chromosome that allow for either red coat color or black coat color. No cell can have more than one operational X chromosome, so in female animals, which have 2 X's per cell, one wads itself up into a Barr body and inactivates itself. This is random, so some cells will express red, and others will express black. If the cat has only the genes for red and black, but not the gene for spotting, it will be a tortiseshell, which is red and black mixed togehter randomly. If it has the gene for white spotting, it will be a calico, with the white spotting expressed along with random patches of either red or black, depending on which X chormosome (the red-bearing or the black-bearing) is being expressed in a given area.

Male cats, however, are XY, not XX. They only have one X chromosome to begin with, so there's no need for a Barr body. Their one and only X is always expressed, so if you have spotting genes, you would get a black and white cat or an orange and white cat, but not a black and orange and white cat.

I explain all this to JG's friend (who listens with every evidence of interest, though I suppose that's fairly esoteric and likely boring), who then wants to know why the cat is named Frank.

"I don't know, but I guess maybe they thought the cat was a boy and when they found out she wasn't they just didn't change the name," I speculate. This is common enough, after all, and people sometimes like to name their pets opposite to their gender deliberately, for unknown reasons. What the hey, the pet doesn't care, and for most owners that's likely a harmless amusement.

A few days later little Frank is in for a recheck. It's Saturday, which I work alone, so I see her. Except the owner says she's a he, absolutely; even Dr. J checked him and says it's a he, and besides, when it was time to spay him, they took off a nice pair of testicles. No WAY, I'm thinking. This cat has Kleinfelter's syndrome. He's an XXY male.

You hear about these things, of course, but I'd never seen a Kleinfelter's cat. It's pretty rare. In people I believe the symptomatic victims (because if I remember right, not all are obviously symptomatic) are unusually tall, and sort of spindly in build, narrow of shoulder and broad of hip, and nearly always sterile. I seem to recall they have potential bone and immunological issues, and some frailty of constitution. Now, I'd go for the 'sterile' part in this cat (and if he hadn't been before, he certainly is now, what with having had his testicles removed and all), but other than that he actually looks perfectly normal. Except for the fact that he's a calico with a penis. I'm sort of curious to see if he lives a normal life span (I don't believe human Kleinfelter's victims do, but this is all pretty vague... I took human genetics back in 1982, which makes it kind of a while ago. Maybe I'll look it up, just to refresh my memory.)

Horror story du jour...

I go in to work the other day (having been off for a couple of days) and hear Dr. J talking about thawing out a deceased dog for creamation. This makes no sense to me, since we typically store bodies in our freezer for the cremation service to pick up (they come once a week). So, since they are normally frozen before the cremation service picks them up, why do we need to thaw this one out...?

Turns out that the dog had fallen through the ice on a lake and drowned. Dr. J needed to get the ice off the dog to get an accurate weight (since the cremations are charged based on body weight). When Dr. J said the dog was covered in ice, I was picturing that the animal's coat was soaked through and had frozen. No. The dog's body had been frozen in to the re-forming ice. It had ice eight or more inches thick (I'm not kidding) frozen all around it when it was brought in. The owner had to chop the dog's body out of the ice to get it free of the lake. Yikes. I can only imagine what it must have been like for this poor man - who was no doubt distraught about the dog's death to begin with - to have to carve his way through all that ice, and then somehow get this large dog, plus all hte associated ice, out of the hole he'd made, and then get it in to the clinic. Dr. J (who is a strong guy) was estimating that there was a good 60 pounds of ice alone, let alone the weight of the dog. Even after melting for 24 hours there was still ice at least 6 inches thick laying in the run where they's laid the dog to thaw out. Poor dog. Poor owner. What a sad event.

Incomprehensible client behavior du jour... (or, Why this job will never be boring, or Why I'll never understand some clients...)

A client comes in to have one dog neutered and another vaccinated. Before I even go in a room with her I am mildly exasperated with her... she has let her male dog urinate all over the reception area and seems incapable of recognizing that if she lets him stand next to any vertical surface he'll do it again (a fact he has already demonstrated with great thoroughness). She also just has That Look, the look of someone I know I will have trouble communicating with. I can't describe it exactly, but my radar picks it up as someone who believes they are an animal expert, better qualified to understand their animal's medical and behavioral conditions than I am, and who is unlikely to either heed my advice or pay for it. Since I won't cater to their ignorance and will persist in correcting their errors regardless of the hopelessness of such attempts, typically I rub these clients the wrong way. Certainly they rub ME the wrong way, and it is always a struggle to keep them from knowing that; it is, after all, not their fault that I find this irritating, so there's no reason to take it out on them. This has the possibly negative side effect that I tend to overcompensate in the niceness department.

Unfortunately I get to vaccinate the female dog, who arrives in the exam room already muzzled. Oh joy, it's a Rottweiller in need of a muzzle. My favorite. [Here I must digress: I have nothing against Rotties in general, but I will say that due to their size and power, when they want to bite, they can be quite dangerous. Also, unfortunately, there is a population of poorly-bred Rotties up here - and some beautifully-bred ones, as well - but amongst the poorly-bred group are quite a number with incorrect temperaments and horrific orthopedics. Unfortunately, many of these dogs also have no training, having been bought by people either ignorant of or unconcerned with the quality of the dog they were purchasing, and most of whom do not follow up with apporpriate management.]

I look at the chart and see that they have the dog down as a labrador mix. Which in fact it may be, but if so, it owes none of its looks to that side of the family.

"So, we're seeing her for vaccines today?" I say. "We should put her down as a Rott mix, not a lab mix, since that's what she looks like," I add, scratching-out and writing-in on the chart.

"No, she's a lab mix," the owner says.

"Even so, we like to put them in the computer as what they most resemble in case someone finds them loose one day. If they call in, they'll say she looks like a Rott cross, so that's where we'll look in the computer. We'd never find her under lab mix."

"But you're messing up my insurance," the owner says. I don't tell her that I could care less what lies she tells her insurance company, or that if the dog needs a muzzle because she bites, most insurance companies won't cover her anyway even if she's a golden retriever, or even that in deliberately misleading the insurance company she is much more likely to be liable if the dog ever does bite anyone.

"We'd never find her under Lab mix in the computer," I repeat, and make no move to alter my scribblings. The owner subsides, looking disappointed.

On to the physical, during which our erstwhile lab mix is snarling and glaring at me, making abortive lunges as I crouch beside her while (attempting to) listen to her heart. This is a task rendered more difficult by the steady rumble of growls rattling through her chest. It is only possible to touch her because the owner has a good grip on the dog.

"None of that, now," I tell the dog firmly, partly for the owner's benefit (most of whom will take this cue to tell the dog to be quiet). The growling continues unabated. "I can't hear her heart over the growling," I tell the owner. "See if she'll stop for you."

The owner, who has been crooning "Good girl, it's okay, GOOD girl!" to the dog, says to me, "She's just talking, she likes to do that."

"Actually," I tell her, removing my (useless) stethoscope from the dog's chest (which is still vibrating with menace), "she isn't talking. She's looking me strait in the eye, which is a dominance gesture, and given the opportunity she'd be MORE than willing to bite me. Don't make the mistake of thinking she's all talk. She means it, and if I were you I wouldn't take a chance on putting her to the test. Also, don't tell her she's a good girl when she's growling inappropriately. I know you're trying to reassure her like you would if she were a child, but she isn't a child. She's a dog, and she'll read that as praise for the agression. When she does something like that you need to tell her to knock it off, and tell her like you mean it." I am having a very hard time keeping my annoyance and impatience out of my voice by now; even to my own ears I sound bitchy.

After a short wrestling match (during which more lunges are made toward my face), I manage both to feel the dog's abdomen and to vaccinate. I mention that the dog is fat and needs to have her food restricted (which puts me at strike four in the "Things that piss off clients" remarks column. Well, maybe I'll piss her off enough that this will not only be her first visit but her last, and someone else will get to wrestle her agressive Rott mix - oops, I mean lab mix. Sigh.)

After all this she has some questions about the effects of the neuter on the male dog. She's afraid that the neuter will leave an unsightly flap of hanging scrotal tissue, as happened with her other dog, a mastiff-pitbull cross (well, she does like her dogs big, it appears).

"Depends on the dog," I tell her, "but most of the time in a young dog the scrotal tissue will shrink up over time and disappear. If the dog is older or has a particularly pendulous scrotum, then it may persist that way."

"Hmmm, that must be it. Jeffery Dahmer was four when we had it done."

Here I am momentarily completely confused... how long ago WAS this? and how would SHE know when Jeffery Dahmer was four years old, unless she was a close personal friend? After all, he wasn't newsworthy until all that murdering and necrophilia and cannibalism and whatnot.

Then it dawns on me: she's talking about the DOG. She named her dog after a cannibalistic necrophiliac serial killer. I just KNEW we were going to be best friends, she and I.

"We had to do it, though," she adds. "He was getting to be too much of a pain." Oh, brrr. A giant sized mastiff mix (some members of which clan have been known to have aggression issues) who is being too much of a pain for this owner, who is quite tolerant of her Rottie mix lunging repeatedly at my face. That sounds just peachy.

I shake off the whole creepiness of naming your dog after infamy (and the weird perversity of being so proud of that that you have to refer to the dog always by the full name "Jeffery Dahmer", which isn't an easy or convenient-to-say sort of name), just in time for her to ask me, "Are you going to do the surgery today?"

"Probably not," I tell her. "On days when we have a lot of procedures like we do today, we usually put our faster surgeons on. Drs. J and P are both faster surgeons than I am, so I'll probably just do appointments today." The woman looks both disappointed and disturbed by this. I wonder if she has a dislike for one of them. Although this is her first visit, sometimes another client has referred them, and has passed along their personal preferences as well.

"Any time you have a doctor preference, you're welcome to state it, though, and we'll do our best to honor that," I add, since she looks so dismayed.

"I want YOU to do the surgery," she says. "I like the way you talk to me and explain things."


I KNOW I sound waspish and pissy to my own ears. Further, I have contradicted her and corrected her at every turn. And she LIKES this?

Then I stop and think: if she is has pitbull-mastiffs named after serial killers and dominance aggressive Rott mixes, maybe her standards of good behavior are not what I'd call normal.

Sunday, December 7, 2008

Slip-Sliding Away

It's a grey morning here in the Greatland, a foot of snow on the ground and the air raw and wet with threatened rain. Now, being of Scottish descent, I love rain; I just don't love it in December and January, when it makes my steep driveway at times completely impassible, even with the hubs locked and studs on. I love where my house sits - on small ridge overlooking the lake, with spectacular views of the Chugach and Talkeetna mountains - but the downside is my driveway. It's long, and while it enters the property on the level, it takes a U-turn about halfway and goes immediately up the hill. The first part of the hill is rather steep, which means that you want some momentum, but the U-turn is pretty much a hairpin, which means that you're of necessity going kind of slow. This is normally not a problem to negotiate; in fact, in my old truck I had mastered the art of doing a deliberate fish-tail at the U, revving it in the turn, letting the rear end of my truck skid sideways and fetch up against the snow berm, so that the instant the side-slip stopped and the right rear tire was at the far edge of the ice, my momentum, combined with the RPMs and the small slice of traction at the verge of the snow berm, would conspire to get me past the steepest part of the hill. The new truck, which has a locking rear wheel differential, does not perform this maneuver (although it has many advantages over the old truck, not least of which being that it is 18 years younger.)

However, there have been times when I've come home to find literal sheets of water rolling down the ice on the steep part of the drive, ripples gleaming in my headlights as the rain falls, diamond-bright through my high-beams. This is a daunting sight. It means that I am highly unlikely to make it up the driveway in the truck, which would be no big deal except that A) whatever I need to take into the house I have to now carry up the drive, and B) if the truck in 4-wheel drive with good studded snow tires on it can't make it up the slippery hill, I'm not going to have a much better time of it on foot, being as how I have only two wheel drive myself, have no studded snow tires, and am carrying an undisclosed number and weight of items in my hands.

Usually I'll make the attempt with the truck; having failed the first time to pass the steep bit, I'll have allowed the truck to slide back down. I'll back it up as far as I can against the snow berm (there are trees behind that, so there's only so far I can go) and try to aim her as strait up the drive as I can, if possible grabbing a little traction from the rougher ice at the plowed edge where the berm starts. From experience I know that I may manage, after two or three failed attempts, to hit it just right and, by pushing the revs, crest the worst of the steep to where the drive starts to level out a little and the laws of physics are again on my side.

One night a few years ago I came home to the cascading water rolling down my driveway. I'd known I would find that on getting home - it had been raining hard for a few hours and I'd been watching the water pour down the sloped back driveway at work - but all the same, it was a bit daunting. I was tired after a long day, and disinclined to make three trips to carry my groceries (purchased at lunchtime in the foolish optimism that it wasn't going to rain, since at that time it was only 26 degrees) into the house. But along came a storm front heavy with moisture and warmer temps, with the result that I was sitting in my truck, worn from the day, looking through the sweep of the windshield wipers at my own personal Waterloo.

I tried it. Three times I made it almost to the break-even point, but had to put in the clutch and step on the brake, letting the truck slither backwards down the hill with as much control as I could give it. On the fourth attempt I fishtailed so badly that the truck was sliding sideways down the hill, a move that prompted me to start thinking about roll-overs (which would kind of wreck my day, not to mention my truck, besides which - and here put on your surprised faces - I thought it might somewhat inhibit my morning commute the following day.)

Bowing to the inevitable, I let the truck slide side-on to the end-of-the-U-turn berm and managed, maneuvering gingerly, to park it in a position where I hoped it would not start to slide on its own. The lake edge is mere feet from the edge of the drive, and if the truck started to slide, momentum might carry it further over the berm than I would like, potentially even onto the lake itself. It wouldn't likely go through the ice - which is thick enough at that time of year, despite the rain, to be just another parking lot - but I couldn't picture being able to get it back up off the ice without some kind of major help. Even presuming that it stayed upright on its tires.

I gathered what items could not be left in the truck overnight and stepped with extreme caution onto the ice. It was every bit as slippery as I had expected, and my boots skidded incessantly as I shuffled my way carefully to the front of the truck, using its bulk as a bolster to help me keep my feet. I managed to get into the snow berm without falling flat on my back, and after that it went a bit better; the berm, usually so hard-packed that even the snow plows sometimes struggle with it, was soft with rain, but it provided the traction necessary to get me up the hill on my own two snow-booted feet.

Big sigh of relief. Put away perishables and let dogs out, then in to shake their wet coats all over me and eat their dinners. Make something to eat and hope optimistically that the rain will stop and everything will be better in the morning. Carefully avoid wondering how the hell I will make it down the steep part of the driveway in the morning if it doesn't.

Which it doesn't.

In the morning it is still raining steadily. Not enough, unfortunately, to have eroded all the way through the ice on the driveway. From my window I can still see the pale gleam of the ice in the reflected light from the house. Sigh.

I gather my lunch and a paperback to read while I eat, and I go down onto the ice, which is visibly running with water. I stick to the berm nearest the house, which will get me to the front of the truck without having to twice cross the ice on slopes without any support. The driveway is bordered by a steep up-sloping embankment on the near side, as it is cut into the hill upon which I live. The berm is slushy with rain and collapsing under my feet. For the first little bit I have willow scrub to hang onto, and the going isn't bad; it's the shallowest part of the slope and the willows have protected the berm a bit. All is going as planned, even when I get to the steep part of the slope.

For a while.

About a third of the way along the steep, the berm is collapsing faster than I am walking. I am side-stepping up the hill, reaching for better snow, still moving forward, hoping to outpace the berm collapse. If I can just get past this section, there are more willows to help me out and then I'm at the truck, home and dry. I'm golden for about five steps... and then my right boot hits the ice.

Now I have no chance whatsoever. The laws of physics are now against me, since there is zero friction on the water-slick ice. The weakened berm has no more strength than a wet paper towel, and collapses under my left boot, which follows the right in a graceful arc onto the ice, sliding sideways like a skier in a tight slalom turn. My left knee skims side-down onto the ice, and then my left hip. In the speed-of-light way of thought, my brain is racing ahead, estimating that if I slide as I am aimed I will hit my truck amidships, either going underneath it, or fetching up against a tire. I am afraid to do either, since I'm afraid I will get hung up under the truck, or the impact of hitting a tire might jostle the truck into sliding toward the lake, or both (a very untempting option.) There's nothing to do but try to steer. I twist up onto my seat (in the 3 milliseconds it has taken for all that to go through my mind) and lean, changing my course and aiming my feet behind the truck. At the last second I twist slightly onto my side so that my feet hit the berm pointed 45 degrees to the left, allowing me to bend my knees to take the impact and throwing an artistic arc of water glittering into the air.

I realize I am laughing, laughing like you do when you're on a really great roller coaster, laughing like you do when you're hand-galloping a horse going just a little faster than feels safe. I am also soaked, not just wet, but wringing wet, with ice-cold water. I get to my feet. My lunch and my paperback have both escaped my grasp on the way down, and have come to rest along the berm, about a third of the way up the steep. I debate, but end up going up to retrieve them, using the willows on the lower third of the drive to help me and crawling on all fours when I get to the steep part (what the hell, I can't get much wetter). I think about changing clothes, but can't envision getting to the truck any drier than I am now. I think about sliding back down on my seat, since I am still laughing to myself, and it WAS fun; but in the end I just use the willows and extreme caution.

I laughed all the way to work, little fugitive chuckles bubbling out of me unexpectedly as I drove the rain-wet (but luckily not icy) streets. I was a bit damp and squishy, but I was mostly dry by noon, and in all it wasn't a bad experience. I get a good laugh out of it even now. Which brings me to today, when I have to put up 25 bales of hay for the sheep. Because I just heard the faint rattle of rain hitting my windows and my driveway is just as steep as ever. Not to mention the fact that the farm has a bit of a slope I have to negotiate to go up to it (as it is also situated on a hill), and - just to make things easier - the sheep (and their hay barn) are at the bottom of that hill on the back side. The side with the steepest slope and the deepest snow. Yee-hah. This ought to be fun.

As it happens, my hay supplier, JW, is also the person who plows (and sands) my driveway. She's a bit late getting to the farm, as she has thought ahead and asked her husband to precede her up the driveway in the sanding truck. That means we only have to off-load the hay from the truck to the 6-wheeler, 5 bales at a time, which R will then drive down the hill to the hay barn to be stacked. Only it turns out that Mr. W thinks he can drive the truck down there and - and here's the big feat - get it back up again. Well, okay, then. That's easier for US, but I'm dearly hoping he has not overestimated his driving skills or his truck. The snow is deep and wet in the falling drizzle, and it would be all too easy to mire down back there.

We offload the hay and stack it in the barn (and THAT'S a lovely feeling, let me tell you, having a barn full of hay for your stock). Mr. W turns his truck around and makes a run at it. And mires down, tires churning, about a third of the way up. He backs it up and makes another run at it. We are all - S, R, me, and JW - watching as he mires in a second time, and a third.

"He's packing himself a trail," JW says suddenly, grasping what her husband is up to. And she is right, as his fourth try takes the truck, straining and flinging clumps of heavy snow off its tires, up to the top. We all cheer and trudge through the heavy snow up in his wake, and I pay JW for hay - and for sanding, if her husband will go on over and do my drive. He will, a thought that makes me feel completely content with the world, although he has another drive or two to do before me. I have a barn full of hay, my sheep are snug and have food against the winter, and if I dawdle long enough, I will be able to get up my driveway when I get home. JW improves my good mood by giving me a tub of home-made hot buttered rum mix (which I can tell you, from experience, is excellent). She trundles off in her husband's wake, and I chat with S and R for a few minutes in hopes of letting Mr. W get ahead of me in his sanding truck, but they have a tub of hot buttered rum mix of their own, and a sudden driving need to go buy rum and fire up their hot tub. So I get into my truck and drive home. I turn into my ice-white drive but when I get to the slippery part, it looks like a dirt road. Mr. W, bless him, has been and gone, and my truck doesn't even hesitate as it climbs up the hill.

So now I'm sitting here, a mug of hot buttered brandy (since I don't like rum) close to hand, looking out at the fading day. Winter has its compensations - many of them, for me, as I like the cold weather and the snow, and I don't particularly mind the dark. One of the best is the fact that, as satisfying as it is to put up hay for your stock, it is that much MORE satisfying to do it against the brunt of winter. Even better to have been working outside in the cold, and to come in to a cozy house to sit with a border collie draped across your feet, watching the leaden sky fade to a smoky lavender as you work on your computer, hot drink to hand.

Kinda puts the slippery driveway blues into perspective, don't you think?

Thursday, December 4, 2008

Tick Talk

There are a million stories in the world of veterinary medicine. It seems a fertile ground for tales of all sorts, and while it has its share of horror and sorrow and general weirdness, it is also a world bursting with stories of goodness, of kindness, of humor, of redemption and grace and amazement and joy, of miraculous recoveries and abiding love, of forgiveness and healing and the best that is to be found of both humanity and nature.

Sometimes, though, it's a strange combination of several of the above.

One day, when I was an intern working in Sacramento, I went into a room to see a German Shepherd for ticks. In Alaska a tick is a rare thing - I've seen eight in 13 years, and am surprised I've seen even that many - but in California it's not an uncommon complaint. In fact, it was common enough that the clinic where I worked had several tick spoons, little devices designed to remove an embedded tick without (one hopes) leaving the head behind.

All unsuspecting, I walk into the exam room where I find a lively, attractive Shepherd bitch and her owner, accompanied by the owner's good friend. The two women are friendly, happy salt-of-the-Earth sorts, and they look up smiling when I walk in. The dog echoes their demeanor, bright-eyed and cheerful, panting happily and waving her tail gently at me to telegraph her good will.

"So, you're here because Sasha has ticks?" I ask. The owner nods vigorously.

"Yes, and I can't get rid of them. They're all over her. I tried burning them off with a match, but it didn't work."

Ignoring for the moment the idea that on an animal that is nearly entirely covered in hair, tick removal by match might not be the safest route, I take a history and do an exam. Everything seems normal.

"Okay, now show me these ticks," I tell the owner.

"They're all along her belly," she says, inducing her dog to lie down and roll on her side to display her trim and barely-furred belly. "They're just disgusting, I can't stand them being on her. See? Look at them all! I tried burning them with a match, like I do when I get a tick, and it never hurts me - but every time I try it on her, she squeals and jumps up. Why do you think she does that?" she asks, looking at me anxiously.

"Because those aren't ticks," I tell her. "Those are her nipples."

The owner's eyes spring wide with shock. She looks at her friend, who is equally goggle-eyed.

"But... but they're all black," she says. I refrain from mentioning that so might hers be, if someone kept applying a match to them.

"Yes, well, sometimes they ARE black," I say. "That's perfectly normal. Sometimes the skin pigments itself in areas where it gets a little more impact from cold or friction, like a nipple might." I do not mention heat as a source of hyperpigmentation, in part because the nipples were pigmented before heat became an issue; the pigmentation, after all, is what decoyed the owner in the first place.

"Are you sure they're her nipples?" the owner asks doubtfully.

"Yes," I say patiently. "See how they're lined up in symmetrical pairs, in two strait lines along her belly? Ticks don't line up strait like that, but nipples do."

The owner looks at her friend again, who is this time biting her lips and giving her friend a sort of "well, that makes sense" kind of look. The owner looks at the dog, still laying with her tummy exposed, fanning her tail gently against the floor in appreciation of our attention. The owner looks at me.

"You mean I tried to burn my dog's ninnies off with a match?" she says, her eyes wide with horror.
"Well, yes," I agree, somewhat nonplussed at the term - which I might have applied to something in the room other than the dog's nipples - but catching her meaning.

The owner turns her round-eyed and horror-stricken gaze on her friend for a moment, upon whose lips a smile is being firmly suppressed. Suddenly the owner bursts out laughing. The friend starts laughing too. Sasha, getting into the spirit of things, gives an agile twist and leaps to her feet, wriggling happily and grinning at everyone. The owner hugs her and kisses her and rubs her ears, apologizing through her laughter for the matches, which earns her several kisses from the dog. I can't help but smile a bit too; the dog's reaction to the matches had fortunately prevented the owner from injuring her, so in the end no harm was done, and now the owner has new knowledge with which to arm herself against future errors.

I counsel the owner that there are safer ways to remove ticks than with matches, and if she's ever in doubt she can either check with a vet or look to see if the structure of concern is represented symmetrically on the opposite side of the animal. Things that are symmetrical from one side to the other are generally normal structures, I advise her, and best not approached with matches. The owner agrees that she'll never go near her dog with a match again.

The little trio marches on out to the front desk, paying their bill with much hilarity. The dog is of course not quite sure of the nature of the joke, but she's perfectly happy to enter into the spirit of the thing, eeling between the two women for attention and wagging her entire body with happy excitement. The last I see of her, she is prancing out the door between her owner and her owner's friend, still dancing with delight at their ongoing chuckles.

A week later I get a card in the mail, addressed to me at the clinic. On the front is a pretty scene, and inside it reads, "Dear Dr. H, thank you for taking care of me the other day, and thank you for telling my mommy not to try to burn my ninnies off any more. Love, Sasha."

I notice that Sasha has spelled my name accurately and given the correct clinic address. She has also included correct postage. Smart dogs, German Shepherds.

No ninnies there.