Wednesday, October 29, 2008

The Purple Toes of Doom

Well, you may recall that a few days ago I was rammed in the shin by one of my ewes, who at the time was apparently trying to break the sound barrier (and coincidentally, my shin.) It was like being hit with a woolly sledge hammer. Kinda hurt.

As is usual for these sorts of events I had a greeeaaaat big bruise on my shin, which I ice packed at my earliest opportunity. A few days later, I noticed I had an even larger bruise on the BACK of my calf, about 120 degrees rotation away from the original. Wha...? Could it be some sort of contra-coup injury, where the shock wave has travelled through the limb to create a bruise more or less opposite of the impact site? Then I noticed more bruises, pretty much circumferential around my leg. My ankle, not surprisingly, was about twice its normal size (presumably as the fluids from the initial bruise migrated south with gravity.) Unfortunately, all of the bruises hurt. I can only assume that the inflammatory mediators that were released with the initial injury went right along with the other fluids as they travelled about my leg.

Now, of course - having worked for many days with the Giant Bruise of Death on my shin - the top of my foot has a weird dusky corpse-flesh appearance, and my toes are mottled and splotched with a color like a ripe plum. I would happily document this for you in photos, but luckily for you my digital has suffered an untimely demise and my film camera has too long a lens on it to get the shot. So you will have to be content to take my word about the bizarre and increasingly gangrenous appearance of my leg from the knee down.

One of the many misfortunes of this event is that, even without socks on, my ankle is so swollen that I can't get my foot into my Sorrells without distinct pain and suffering. If I take the laces completely OFF and open the boot shaft as wide as it will go, it is still slightly excruciating to get my foot into it. God forbid I should do something so foolish as to, say, wear a sock, or perhaps (gasp!) an Ace bandage. I can't get my gym shoes on. My ugly/comfy Croc clogs are right out. I do have one set of old leather cross-trainers that I can (barely) flare out enough to accommodate my ankle. This is fortunate, because OSHA frowns on doctors working barefoot in the hospital. For added entertainment, sometimes the slightest brush of my slacks against my shin is cause for marked grimaces, and two or three times a day it's evidently time for Random Shooting Pain Hour. If that wasn't enough fun, the entire leg from knee to toes has become inexplicably but increasingly itchy, particularly on the surfaces of the bruises. Which naturally you don't want to touch, because they hurt, but you are DYING to touch, because they itch.

Helpfully (or not), the other day as I was limping around in the X-ray suite my nurse J remarked, "You're limping MORE now than the first day. Are you sure you don't have a giant clot in there, waiting to break off and kill you?"

Oh, excellent. That would be perfect. In some alarm I yank my pants leg up and inspect my shin for new disasters. Hmm. Still looks like crap, but it's the same crap as yesterday.

"I don't think so," I say doubtfully, poking things gingerly. "There's no cramping or cold or numb spots, and it's not worse than yesterday; I think it's just travelling around with gravity, you know, like when I sleep on my side and all the blood runs to the outside of my calf and stuff." But now I have a new disaster to think about. Oh joy.

Meanwhile J herself has had a recent fascinatingly disgusting injury, which may be encouraging her to her ghoulish speculations. She was doing something with her dogs and happened to have her hand palm-down on a hard surface. A flexi-lead somehow got jostled off a higher surface and fell directly onto one of her fingernails. This, I can tell you, hurts. There are tons of nerves in the hand, and they are MOST eager to report to you even the slightest injury, so I'm sure J was hearing quite a lot about how one should never allow a flexi-lead to fall on a nail-bed. Not surprisingly, in view of the nature of her job, J was finding this a bit unpleasant at work. She decided to soak her finger in DMSO. Now here please note that I am NOT advising anyone to try this at home, nor did I endorse J's decision to do so. But, it's not illegal, and she knows better than I do how she feels about these things - plus she's an adult and a medical professional, so even though I said "Well, *I* wouldn't do it," she went on ahead.

The first thing that happened is that J said her finger DID feel better. The next thing was that it got all pruney and turned a lovely corpse-flesh grey. Gak. Okay, still not my finger, so I just kept my mouth shut about it and went on with things.

A few days later the surface skin peeled off, and the finger was a normal color again (except for the nail, which is black. But it was black to begin with, so that's no big deal.) Now, several days on, she is on the verge of losing the nail (that was a foregone conclusion, and obviously her fate from the moment the flexi-lead fell.) It doesn't hurt, so J is inclined to press on the end of the nail which makes the bed of the nail pop up disturbingly. Brr. I lost a toenail once when I was a kid (courtesy of a little brother and a full jumbo-sized can of Dow bathroom cleaner), which experience I do NOT remember fondly. Seeing the nail bed popping up like that kind of creeps me out.

So here I am running around the clinic with my Purple Toes of Doom, and J is running around with the Black Finger of Death and suggesting that maybe I should soak my whole leg in DMSO. Somehow (and here I'm sure you'll be surprised) I have managed to resist this enticing suggestion, and am making do with my own self-made three-day-old-corpse coloring. If my shin doesn't start to look a whole lot better in a few days I may X-ray myself to look for bone chips, but I am NOT painting my entire calf with DMSO. I may look like I have some hideous tropical disease in my leg, but at least it's not all rubbery grey and pruney.

Meanwhile I'm plotting my revenge (and living for the day I get my stockdog back). Next time it'll be me and the Snapping Jaws of Menace (aka Raven the Border collie) against the Shetland Sledgehammer.

Wish us luck. We may need it.

Monday, October 27, 2008

The Great Pretender

So, the other day, Dr. S is puzzling over a case. It's a min-pin with vague malaise. The dog vomits sometimes and seems lethargic. Other times it seems fine. This has been going on, waxing and waning, for several weeks. Last weekend it was sick enough that it was taken to the ER and put on fluids to combat dehydration and anti-emetics to treat vomiting. It seemed better after that, for a few days, but now it's sick again. The blood work is normal except for minor calcium and protein disturbances and a little azotemia (elevated kidney values). The X-rays are clean, and the CBC (complete blood count) are normal.

So, Dr. S - who has been out of school only four years, I must point out, to my 14 - is bouncing the case off me, looking for inspiration or other points of view. This is a smart move; sometimes we just get tunnel-visioned or stymie ourselves and get stuck. She runs past me the X-rays, the bloods, the symptoms. I look at the bloods; the liver is good, the renal values are indeed elevated, but that might be as a consequence of dehydration and vomiting. The calcium may be off because of the vomiting, or because of the protein being off (these often run together), and the protein could be off because the dog has been intermittently anorexic for several weeks now. Could be a lot of things: a virus, a toxin, a parasite, a foreign body, renal failure, pancreatitis. Lots of other things.

Or.... it could be Addisonian.

Now, here you will have to forgive me. When I was in school, they told us we might see Addison's disease once or twice in a 20-year practice career. I, however, look for it behind every tree and bush. The reason for this is that I got rewarded for it, somewhat memorably, right out of the gate. The experience has stuck with me.

It happened like this: At the U I attended, we had something called PBL (problem-based learning). This was a study group, six or eight students assigned per group based on our rotation schedule. In PBL we are presented with an actual case - something that has presented to the U in the last decade or so. We are provided the complete information - signalment (age, breed, gender), labs, X-rays, what have you. If the actual test wasn't run, they give us the result that would have been achieved had it been run. It's a good idea - it gives us a chance to try our diagnostic skills, the identification of unknowns, without putting the well-being of a live animal on the line. The group is run by a clinician - in our case, Dr. G, the King Of All Things Renal. Dr. G is a tall, Scandinavian-looking fellow, with prominent light-blue eyes and rosy skin and fair, thinning hair, and is completely brilliant and endowed with a dry sense of humor and a deadpan delivery that renders him a great deal more hilarious than if he had mugged for the laughs. His face has the gift of simultaneously being completely expressionless and inscrutable, yet somehow, at the same time, eloquently expressive. On this particular Friday afternoon, he has presented us with a 5-year-old male neutered black standard poodle. The dog has presented with weight loss, anorexia, vomiting. The physical exam is unremarkable, except for dehydration and mild pallor.

"So," says Dr. G. "What test do you want to run?"

"I think we should test it for Addison's disease with an ACTH stim," I say. "JFK had that, you know," I add primly. This I know because the previous evening, whilst studying, I'd been watching PBS. [Yes, I know that studying with the TV on is an idiot idea, because it's too distracting; but sometimes I just needed to have something non-academic on which to focus every so often, when I needed to pause my brain and let it process.] That particular night had been a JFK special, from which I learned that he had nearly died, in his young adulthood, from an undiagnosed case of Addison's disease. It's a rare condition, rare as hen's teeth, and it has an even rarer variant, the atypical Addisonian. The atypical is as rare amongst Addisonians as Addisonians are amongst normal animals. The atypical has none of the lab anomalies that one would expect to see on the normal workup, and has to be diagnosed via special labs.

Naturally, the rest of my PBL group laughed when I suggested this. Some of them laughed because of my manner, meant to be humorous. Others laughed because you just never see Addisonians. A few just shook their heads. Dr. G gave me a Look. It was mild, calm, ordinary, and simultaneously just a bit outraged, with a definite edge of Shut up, will you? to it. Ooops, I thought. Dr. G thinks I'm being silly and doesn't appreciate it.

"How do you know JFK was Addisonian?" asks one of my classmates.
"Saw it on PBS last night," I said.
"You don't normally jump right to an ACTH stim test," interrupts Dr. G. "Don't you think you'd like to run some other tests first?" he suggests, with a pointed look.
"Okay," I said brightly, "but I still want to do the ACTH stim."
"What if I tell you he has normal electrolytes?"
"Could be an atypical. ACTH stim."
"What about doing a CBC and a chemistry?"
"ACTH stim."
"What about X-raying the abdomen to look for the source of the vomiting?"

Dr. G sighs. He gives me a look that somehow conveys exasperation, disgust, outrage and amusement at once. He hands over the test results. The dog has failed to stimulate. It's Addisonian.

"See?" I said, in the prim voice. I give him a sidelong look. He's shaking his head.
"Okay, now that Dr. H has ruined our PBL for the afternoon," he says to the group, glaring at me, "here's what you WOULD have found if you'd run the other tests." He passes out the lab data sheets, and then gives me an exasperated look. "You aren't supposed to guess it right off the bat," he says. "This is a difficult diagnosis, and most people miss it the first two or three times the dog presents, and a fair number of them die or go into severe crisis before they're diagnosed. They're rare, and I don't want you guys thinking you just go right to the diagnosis like that." He shakes his head. "Damn PBS."

As a result of this immediate success - which, it must be noted, can be credited to random good luck much more than any personal brilliance on my part - I have never forgotten that there is Addison's disease to look for, and that there are the rare lurking atypicals. I look for them always, and as a consequence, far from the one - or at most two - I should have expected to see by now, I have seen, as of today, a round dozen. Of those, only two were diagnosed before coming to our clinic; the others were diagnosed in our clinic. The very first one I diagnosed after moving to Alaska was an atypical (an even tougher diagnosis than the usual atypical, as the dog had a concurrent cardiac anomaly that afforded her far more than the usual degree of Addisonian mystery). Some of the ones diagnosed at our clinic were diagnosed by other doctors. In all honesty I can't say how much of that was because of me hopping around in the background saying "I bet it has Addison's disease, we should run electrolytes and do an ACTH stim." But you can bet your heiney that I WAS hopping around int he background, saying just that.

Flash forward to Dr.S's case.

I bet you know what I'm going to say.

"I bet it has Addison's disease. We should run an ACTH stim."
"Hmmm...." says Dr. S, musing. "That might explain a few things."
"I have to warn you, however, that if it IS Addisonian, I'm going to shamelessly take credit for the diagnosis," I add with a cheery grin. Dr. S laughs.
"If it's Addsionian, you deserve credit for the diagnosis," she says. "I wouldn't have thought of it," she said frankly.
"Well, it's rare," I allow, "and when you hear hoof beats, you should be looking for horses. This is a definite zebra. I think it's under diagnosed, though; I've seen nearly one a year since I graduated - all because of one twist of fate that had me watching PBS at just the right time."

So now flash forward to today. Dr. S shows me the bloods. The pre-stim cortisol should be over 80. It's one. The post-stim cortisol should be between 220 and 550. It's five.

Five. It's a wonder the dog is still alive.

The good news is that Dr. S had wisely started the dog on supportive care while pending the bloods, and the dog, while suffering some malaise, is stable. The further good news is that the meds have gotten a great deal less expensive in recent years, and our min-pin will live a normal life so long as she gets her meds. Had she not been diagnosed, she would have died.

Dr. S accords me my title of Queen of Medicine for making the diagnosis. I decide that we should BOTH be the Queen of Medicine. Because, in fact, it is an ass-kicking diagnosis, one that was missed by the other two doctors who have seen the dog, and even by the hotshots at the ER. We bounce around the clinic all afternoon with insufferable grins on our faces.

I love PBS.

Sunday, October 19, 2008

A Fool's Progress

So today was sheep chore day. This is something that really should not be attempted without a working stock dog, but mine is in training just now in North Carolina, so I'll have to do it the fool's way - without a dog.

First I went to Wildwood, to meet up with S and R, who have a stock trailer that we'll use to go get the last two ewes. R greets me with a cheery smile.

"Want to come see our new goats?" she asks. The answer to this is Yes, I really DO want to, since they've just that morning gotten a new doe and a buck. Now, I've been hearing for months how truly stinky the bucks are. At different times, both Dr. P and Dr. J have independently regaled me with the story of how they went one day to a farm to castrate a boar. A six hundred POUND boar, mind you, an enormous smelly kind of beast, who was kept in a barn (which does tend to concentrate the fumes.) There was also a buck in the barn. Both Dr. P and Dr. J - each without the other there to put words in their mouths, nor to egg each other on - told me that the smell actually burned their eyes. Literally an eye-watering stench. They also both said that the goat smelled so bad you couldn't even tell there was a hog in the barn, even if he was 600 pounds.

Anyway, at Wildwood we go on down to the pens. I can see the buck, but I don't smell a thing. Oh, wait a minute. I DO smell something, and I'm still 30 or so feet from the pen. Upwind, I might add. Urk. He does kind of stink. He smells like some kind of really rank, stinky cheese that has gone off - so not only is it even stinkier, but it's a really revolting sort of stink. And there's also an undertone of something else, maybe slightly sewer-like, or perhaps.... well, it defies description. Oh, well. He won't be around long (just long enough to breed the does), so I figure it's not really THAT bad a thing to deal with.

We climb back up the hill and S and I load up to pick up the last two sheep I'm adding to my flock for the winter. These are two moorits, so now, quite by accident, I have two of each of the colors I own: two moorit, two silver, two black, two white. The white are Trinity, the ram, and Gigantor, this year's ewe lamb. The moorit are Chanel and Olivia. The two black are Jacinto and Mesquite. The silver are Priscilla and (unimaginatively, perhaps) Silver.

I will defend the choice of "Silver" a little, though it's akin to naming a black dog "Blackie". I decided to name the three dog-broke ewes after towns in Nevada (in honor of the person I bought them from). Mesquite is near the Utah border, and perhaps not an inappropriate name for a ewe that's black as charcoal. San Jacinto is the name of one of my all-time favorite Peter Gabriel songs, so I named my favorite black ewe that (favorite because she's calm and pleasant, and is missing a little sliver off the edge of her right ear, which for some reason I find endearing.) Silver is for Silver City, which may not be creative but it'll be easy to pick out who I'm talking about (in part because Priscilla is a dark sooty grey, and Silver is really - well, silver.) But I digress.

S and I drive to the farm where my last two ewes await. The owner gathers the ewes up in a pen, and I help her and her son hoik them over the fence. The new ewes don't want to go into the trailer. They try to lay down at the threshold, folding their knees and trying to wedge them under the back of the trailer (or maybe that was just coincidental), requiring us to lift them up into the back. Once there, they're highly motivated to escape, and squirming yourself out the gate whilst leaving the ewe in the trailer isn't as easy as it sounds. These ewes are fast and a little wild, and extremely opportunistic. They're also fairly small, being Shetlands, so they don't need much of a gap to get out of the trailer, and once they hit escape velocity, they're not easy to hold onto. But the trailer is divided, so we use the partition to hold one ewe secure while we wrestle the other.

Loaded up, we trundle on back to Wildwood. Here's where it gets interesting. It's snowed recently, and the driveways are a bit slippery. I'm going to have to walk my ewes down the hill to the pen (S not wanting to take the heavy trailer backwards down the steep hill, and I can't really blame her.) I have Dave's partly-trained stock dog with me, but these sheep are not dog-broke in the slightest degree, and I can just picture them rocketing off in opposite directions into the woods, never to be seen again. It seems wiser to have them under some control, and we have a little stock halter. They won't lead, precisely -they're no more trained for that than they are dog-broke - but with a person in front and one behind we can pull and shove them down the hill. Probably. In my mind I'm picturing the ewe darting forward, slamming into my knees from behind, running over my prostrate form and then - if I haven't managed to drop the lead - dragging me on my face down the hill.

I'm SO looking forward to this.

As I contemplate my fate, I pause. What's that smell?

Oh, yeah. The buck. Now that the light breeze has died, it becomes apparent that his powers of stench are vastly superior to anything I have imagined them to be. In the time our trip took, I have forgotten the exact aroma, and moreover, I have seriously underestimated his ability to Make His Presence Known. The very air seems faintly sludgy with his rotten-cheese scent. No wonder S and R are eager to have him move along... or else to castrate him, once he has put his testicles to the use which God intended.

Oh, well. At least it's taken my mind off of my imminent demise: Death by sheep.

I manage to get the halter on the first ewe, Olivia. Olivia is strong and canny, and a willful wee bitch, and makes several attempts to escape during this maneuver. She is thwarted by the fact that I have a death-grip on her wool. We quickly apply a topical wormer while I hold her against the side of the trailer, and then we open the gate and point her outwards. Naturally, as soon as the halter is on, the very LAST thing she wants is to leave the trailer, but we shove her out unceremoniously, slipping on the thin ice on the drive. I find a patch of exposed gravel lickety-split and dig in while we adjust the halter, which is showing an inclination to slip off over her right ear. Now we make a halting, lurch-and-stop sort of progress down the hill, me on the lead rope, S's daughter YS pushing from behind, and S (who has injured her back and should probably be lying down) coming along to operate the gates.

We manage to get Olivia into the pen without either choking her to death by accident, hyper extending any joints, falling down or letting go. We release her into the pen, where she immediately joins the other sheep, seeking comfort. Back up the hill. Next is Chanel, who is calmer, and once caught, less inclined to try to rocket away. She is, unfortunately, less inclined to move at all, and in self defense we try using Pepper to see if she'll push Chanel forward. But Pepper wants to head her, not drive from behind, which isn't really helping us (unless we intend to walk her backwards the entire way). About this time R comes to the rescue, roaring up on her six-wheeler, and we heave Chanel into the bed, where YS holds Chanel balanced up on her woolly rump, all four legs pointing uselessly out, thwarting escape attempts. Resistance is futile, little sheep. You are becoming a member of the hive. Er, flock.

Well, that wasn't too bad. However. Now we have to worm the rest of the sheep. This means we have to catch the rest of the sheep. I did mention something about March hares, didn't I?

We have a strategy based on the combination of greed, guile and Pepper. We have food, and the dog broke sheep are (relatively) easily caught and wormed. That just leaves us Priscilla and Giagantor in the ewe pen. Unfortunately, there are five other ewes and four does in the pen, and they all want to split up and go different directions. YS and Pepper and I start quartering the pen, pushing Priscilla into the small enclosed area. She escapes at least twice, but we finally get her (and about 6 other animals) into the enclosure. Priscilla has been there before, however, and she makes a running start from the back of it, knocking other animals aside like tenpins. I run to the exit (this hasn't been that easy, and if she gets loose it'll be that much harder) and make a dive. At the same moment, Priscilla, now going approximately fast enough to escape the atmosphere of the earth, tucks her head into ramming position and puts on a last burst of speed. I grab wool just about the same instant as her skull makes contact with my shin. That pretty much drops me on the spot - but it drops me on Priscilla, and I don't let go.

"Son of a bitch!" I exclaim. "MAN, that hurts!" [Here I should perhaps point out that, having groomed race horses for several years - not to mention having hung out with pilots for a lot more years - I have a mouth on me that would make a longshoreman blush. Mostly, I keep it in check, but every once in a while you really need a good, pithy curse to vent your feelings. "Oh, golly!" wasn't going to cut it.]

"I know," says S, applying our topical wormer as quickly as possible. "It's amazing how much they can hurt you, isn't it? I got kicked in the shin by a sheep one year - and that doesn't sound like anything, does it, just a little kick from a sheep. They're not that big. It hurt for a year." She finishes with the wormer and I let go of Priscilla, who hops up and canters jauntily away. Me? It's two minutes before I can stand.

I go limping out to help corral the last of our ewes, little Gigantor. (Okay, she was giant as a lamb, but she's not even a year old, so she's littler than the other ewes.) Several times we have her trying to go into the protection of the enclosure, only to have Peanut - one of the does, with a pert little set of parallel horns sticking strait up on the top of her head like antennae - drop her head and make menacing thrusts with her horns, convincing Gigantor to pass the opening of the enclosure and race perilously by me. At last we manage to scoot her on in there - with almost everyone else. YS - an intrepid lass - wades in amongst the animals, trying to strategically place herself to corner and catch Gigantor. She's doing a good job, too, but at the last second Gigantor makes a quick feint to the right and YS's fingers just miss a grip on her. Luckily, other animals block her from veering left again and I manage to dart in and field her neatly, just as she's making a leap to clear the goat blockade. Once caught, she gives in with good grace and we worm and release her.

Phew. That's all the girls done. Now it's just Trinity. He, however, is a piece of cake. He's as greedy as they come, and he trots right up to YS when she arrives with a bit of grain. He's also conveniently equipped with handles - two large, beautifully curved handles - and once we have his horns in hand he stands placidly while we worm him. I don't trust him this time of year - he's a bit of a bastard lately, and his testes are about twice the size they were a month ago, hanging like a large woolly persimmon, impressively large and low now that they're reawakened to their mission, with the fall rut - so I make sure everyone is behind him before I let go. He ignores us all completely and walks calmly over to eat his dinner.

We walk past the buck, Truffles, to go back up the hill. The air seems thick and unbreathable with his rank scent. S tells me he started urinating on his face immediately on arrival (this is a normal, if completely disgusting, behavior), and described him choking while he was doing it. I theorized it was from the smell, but S disabuses me of this notion, because he was urinating up his own nostrils.

I am SO glad I am not a goat. But evidently the does are enchanted by him, pointing their noses skyward to catch his scent (as if they could miss it), flipping their upper lips backwards the better to funnel his stench - I means, his aroma - into their nostrils. I think I'll take my sheep, thanks. Even in rut Trinity doesn't stink, and he's never urinated up his own nose.

So now I am home, ice packing a rather spectacular bruise (which I dread to look at tomorrow). I have a probably-related cramp in that calf, and my hands smell faintly, and not unpleasantly, of sheep. However, everyone is wormed and de-loused, I have 30 bales of hay in the shed, I did not have to toboggan down the hill face-first at the end of a shank with sheep heels flying inches from my eyes, and all is more or less right with the world. However, even though I didn't actually touch the buck, my clothes smell faintly of rotting cheese, and something else I can't quite describe. I'm almost afraid to wash them with any other clothes, lest they all come out smelling like that.

Oh, well. I think I'll go make some tea with honey and whiskey in it - strictly for medicinal purposes, you understand. But meanwhile.... what is that smell?

Saturday, October 18, 2008

Gratitude, Sixth-Grade Style

So, from time to time I am called upon to do educational programs at some of the local elementary and middle schools. I generally take some X-rays to be displayed on the overhead projector (I have quite a collection of old films rescued from th to-be-culled pile), and sometimes a bone plate or some bladder stones. I also bring a dog, since this is the real reason for the programs, at least so far as my audience is concerned. Generally I take either Finn or Kenzie as my demo dog, as both of them adore children beyond all reason. Each has their advantages; Kenzie, my Westie, is small and engaging and kissy and less likely to be threatening to little children who are fearful of dogs. In addition (if the desks are arranged in a ring) she can walk desktops full-circle, to the delight of the children in the room (both because there is a dog in school, and because it walked on the desk! On MY desk! IN SCHOOL!) Finn, one of my Border collies, is three times Kenzie's size, affording more space for little patting hands, and he knows some endearing tricks (in addition to which he's less likley to be overwhelmed by being completely mobbed by children, since he's not as short and doesn't feel quite so "buried" if they all swoop down on him at once.) He's also unfailingly cheerful and has the most stable temperament of all my dogs.

When it's the middle school, I usually take Finn; for some reason Kenzie is less comfortable in "big kid school", so I reserve her for the second-graders. Finn is an equal-opportunity ham, however, and happily goes wherever I take him, regardless of the age of the children.

Finn is also (in my 100% unbiased opinion) a very good-looking dog, and one who does not require grooming to look spiff (although in the photo above he's had his belly shaved for surgery - a story for another time.)

I do the school programs in part because I enjoy them; in part because I try to do some community-minded volunteer-type stuff (after all, I get a great deal from this community, so I feel it's only right to give something back); and in part, I admit, because I live for the thank-you notes. I adore the thank-you notes. They're dear and funny and sweet, full of gratitude and charm. I admit I find the spelling and grammar errors endearingly amusing; this may be because I am myself an indifferent speller, and I can relate. (I am deeply grateful for spell-check for this reason, as well as because I'm an iffy typist and mildly dyslexic, to boot. And you should all be grateful for it, too, most especially as it seems NOT TO BE WORKING for this post, so you're going to have to suffer my deficiencies this time around. You poor things.)

At any rate, after one such school program at one of the local middle schools, I received in due course and as usual a hefty packet of thank-you notes. There are two distinctly different piles, evidently reflecting the different tones of the two classes. I suspect (though there's probably no way to find out) that the more formal ones came from the class where the teacher reminded me of my high-school gym teacher... kind of blunt and direct and a little bit brusque, but sort of funny (to an adult, at least) as a result of her bluntness. She struck me as more of a disciplinarian and therefore perhaps less likely to encourage a lot of extra creativity in the students. The other group (wildly creative) I suspect to have come from the class taught by the sexy piratical guy, the one with the shaven head and the van dyke. Kind of an offbeat persona, which at least implies that he might encourage a more creative approach in the TY notes. But I could have that compeltely backwards, and there's no knowing.

Anyway, many of the notes came with drawings of dogs and cats and various other animals (some of the more ghoulish kids drawing several Frankenstein-esque gashes sutured with something heavy enough to tie down a small plane). One made a rather adorable little pop-up thank-you doggie inside, and a couple wrote my name in snakes or other animal shapes. One girl engineered her card (with staples) into the shape of a kite (although I initially took it for a paper airplane, til I opened it). And one enterprising lad wrote an entire poem to me (or maybe it's a commercial jingle). I'll try to hit the highlights (and despite my usual egregious typing, the spelling errors you are about to see are faithfully copied from the originals - mostly, at any rate)...

Dear, Dr.
I am listening to everybedy talk whale there supos to work. Now the teacher is talking. I listen when I am wrighting. [I rather like the introspective tone of this beginning.] I like the part when you told me what dog apered the most. Another part I like is the xray of the dog that ate the rocks. And how you get thame out. The job that I whoud whant is Chane Reactions. Chane Reactions is a julury stor whare you learn how to make beads, neckleses, braslets and shapes. [Presumably spelling isn't a big part of the job]. Thank you for telling me about vets and what they do. I hope I can see you ageane. I whish you where hear rigt now. [That's rather sweet, isn't it?] I whish you luck with the animals.

Dear Dr.
Thank you for coming to our class about your proffession. I thought that the little dog you brought in at the end was really cute. I thought some of those pictures of the dogs that had been hit by cars were perrty gross. [No photos - WAY too graphic. Instead, a couple of Xrays of broken legs, bladder stones, rock dogs, pregnant dogs, etc.] I think it would be interesting to work on a snow lepord. [This evidently in reference to me telling them about working on snow leopards (oops, I mean lepords), rhinos, bison, etc, at the Denver Zoo when I was a student].

Dear Dr.
Thank you for explaining your job to us. I enjoyed seeing the pictures of the animals with broken bones and diseases. [This must be one of the ghoulish ones]. I especially liked your dog, I didn't get to touch it so I hope you can bring him again.

Dear Dr.
I thought it was weird how one of the dogs swallowed about 10 rocks. I was the one who guessed it. [I put up the Xrays and ask the kids what they think that is... I'm not sure it teaches them a lot about what it is to be a vet, but they really like it.] I think that if you like having dogs as pets you should get a canarie island bird dog. They are really nice becuase they always listen and they are very loyal. [Okay, this is the first time I've gotten advice on what breed I should own while doing one of the school programs. Clearly this child knows something I don't, since I've never heard of a Canary Island Bird dog. And if there's any breed on earth that always listens, I'm eager to learn more.]

Dear Dr.
Thank you for caming in and talking to us about your job as being a veteranarian. I think ispired alot of people. I think that you did a good job. [Ahhhh, my first rave review of the batch. Always nice to know you've performed well.]

Dear Dr.
I liked your prformens it was good. The best part about your prformes is that I diden't know that dogs would eat rocks. But I thought that all of the exrays were cool. I thought that the dog that got shot in the head and diden't even know wus the cooest. [TRUST me the dog knew when he got shot in the head. Even the densest, goofiest American Bulldog will tend to notice a thing like THAT.] Well, I won't to thank you again for comming in Thanks.

Dear Dr.
Thank you for comeing in to my class. I had a cat that had a broken leg. Your friend, Jess [I suspect this is one of the 2 kids who didn't get to tell me about his pet's injury/illness/visit to the vet during my 25-minute visit, since approximately 27 of his little classmates were doing so all at the same time.]

Now we come to the 'creative' batch, most of which were folded like cards, and many of which featured color drawings exhibiting various degrees of talent for color, form and gore.

To: Dr.
Thank you! [accompanied by a drawing of a dog with several Bandaids stuck to its head, a long incision on the neck apparantly closed with 30# test line, and (judging by the angle) a dislocated shoulder.] Inside is written: I'm glad you came. You showed us some x-rays and thanks for answering my questions about British Bulldogs
sincirly, Rory [underneath which is drawn a very stiff-looking dog all in black except for the end of its nose and its eye, which are white. The reason for the strange coloration is apparant in the caption, which reads "Full body cast".]

[On the front] THANKS [with grass, flowers, a biiiig sun, and a dog and a cat both apparently levitating above the flowers.]
[Inside] Rank roo rery much! Dr. Petit [I believe this is the Scooby Doo entry.] I think your job cool and I wold like to look into the job more because you make it look FUN! [All in blazing color.]

[On the front a picture of a dog through a window, which at first I took to be a little Harry Potter wizard dog because it looked like it was wearing a pointy hat. On closer inspection, however, it proved to be a dog with THREE Bandaids (two crossed in an X), a long scary incision with more of the heavy nylon rope-type sutures, and a bandage tied around its forehead, above which protrude the pointy ears, evidently glued together into a spike, which is what I mistook for the hat.] Dear Doc
[Inside] I am so glad that you came in because after I've lived all my life with animals I want to become a vet. The first time I wanted to be a vet was when I helped my mom save a lamb when I was in the forth grade. [Accompanied by a drawing of a dog covered from head to toe in an intricate crosshatching of bandages that would do a mummy proud. The only things not covered by the wrap are the muzzle, the eye, and the ears - again appearing to be glued together into that darn spike.]

Dear Mrs. Dr.
Thank you for comeing to our class! My favoret part was the exray's. Some day I might become a vetinairian. [Along with a vividly colored portrait of what appears to be a dachshund approaching a bonsai tree, possibly to urinate on it, based on the pose... or perhaps this is the one child in the class who noticed that Finn tried to claim one little boy as his own by urinating on his shoe. (Yikes.)]

[On the front, along with a drawing of a long-necked something that looks quite a bit like a llama] Dear D Thank you for coming!
[Inside, along with another sketch which I take to be an animal of some description, since it has four legs and a head with long pointy ears] Dear D thanke you for coming to our class. I learned somethings. I never new that dogs can get elphaseaha. [??? I *think* he means emphysema, which is the only thing I can come up with that comes even close; although I don't recall mentioning emphysema to them, I certainly might have done. I did say "testicles", after all, so I might have lost my head completely and said practically anything.]

[On the front, along with a head-on view of a cat with a VERY large nose - unless it's a tumor - and a dog which appears to be plugged into some sort of electrical device capable of making all its fur stand on end, not to mention producing a distinct look of alarm on its Crayola'd face.]
Thank you Keith A.
[Inside] Thank you for coming. If I need my gerbil worked on, I'll come to you. In the meanwhile, be carefull and have a good time. Sincerly, Keith A. P.S.: When handleing needles, don't pook yourself. [Sage advice, which I give you my word I ty to follow daily.]

Thank You Dr. [On the front, along with drawings apparently erased but still visible, of a muscle man hanging from the "o" on "you" - rather nicely done, actually - and a tree with what appears to be an orangutan in it, perched in the branches above what is either a small rhino or a really big warthog.]
[Inside] I reely liked the fact you have don surdry on a monky. [Here he must be again referring to my stint at the Denver Zoo, unless he has somehow gotten wind of that unfortunate encounter with Mickey Dolens and Davy Jones...]

Dear Dr.
Thank you for coming. It is a delight that you take time off work for us. I really enjoyed when you showed us the ex-rays. I think you changed my mind about a doctor. I'm going to be a vet. [Accompanied by a rather adorable drawing of a dog, although he does have little stars in his eyes which make him look like someone just cold-cocked him.]

And the piece de resistance (I hope I can do this one justice...)

On the front are drawings of a snake with a biiiig bulge in the middle, an apparently sneezy cat with (I kid you not) a box of tissues in its paws (clearly labelled, with one popped up out of the top), a dog with a ferocious grimace on its face and what looks like a Robert Jones bandage on its back leg, and small aquarium with three smiling fish in it. My little artiste has written "Thank You Dr.!" At the bottom of the page he's signed it "From: Jake". Inside, it goes like this (and I am NOT making this up):
If your cat is sick or your dog thinks he's a nick Call the VET!
If a snake swallows a ball or a pig takes a fall bring in your PET!
If your bunny is funny (hey, that's kind of punny) call the VET!
If your fish is almost a dish (while watchin' TV! (well, not the Omish!))[could he mean "The Comish"?] your pet's standards are MET!

Next to this is a hilarious picture of a snake (evidently the one that swallowed the ball, since it has a hugely distended middle) and a cartoon speech bubble saying "BURRRP!"

This was funny enough, but on re-reading it later for a second giggle, I happened to flip it over and on the back (where the Hallmark logo would be) he has written:
Protection Egenst (against) Total Ziffheads.
No animals were harmed in the making of this card.

I just howled. Partly I was pretty impressed with little Jake (whoever he might be - although I'm not at all certain what a Ziffhead is), and partly it reminded me of a card I made for my "little sib" in vet school.

There's s program in vet school where they assign all incoming freshmen a "big sib": an outgoing freshman who, having just finished the gruelling and scary first year is (one hopes) in a position to advise the new frosh about books, prof's, exams and so on. Traditionally, the big sib comes and leaves a card with words of encouragement or a small present on their little sib's desk just prior to the first exam, to loosen them up and give a little moral support before the scariest exam of first semester (and maybe of the entire program). On the morning of my first vet school exam, I got a card, a plateful of snickerdoodles, a new eraser, a new and freshly sharpened #2 pencil, and a petri dish full of M&Ms labelled (on lab tape) "M&M culture - eat on [whatever the exam date was]". I thought the M&M culture was a pretty good idea, so I shamelessly stole it for my little sibs (of which I had two). I also made little hand-drawn encouraging cards - a general one for the one I didn't know as well, but a more personal one for M, the sib I'd roomed with over the preceeding summer. I went to a bit more effort there since we were friends and she'd spent a lot of time with me AND my little vet-school sidekick dog, Merrik.

Inside her card I wrote something along the lines of, "You've worked. You've studied. You've come to recognise your classmates by smell alone. You are READY for this test. You can do this!" (and several other rah rah statements). On the back - unnoticed, I was told later, the first time around (shades of my go with Jake's card), I had drawn a picture of Merrik - a good likeness, if I say so myself, with her abundant curly/wiry terrier-mix fur and her big bat ears, and a pronounced squint on the right, where she'd lost the eye. Under this "logo" I wrote "HallMerrik: When you care enough to send the hairy pest." Evidently during the exam M was sitting and waiting for her turn at the microscope, killing time, so she idly picked up the card to read it again and just happened to flip it over. I gather she aspirated an unfortunate amount of coffee, and that some of her classmates were less than pleased to have her burst out laughing hysterically in the midst of the exam. Tight-asses.

So that's the best of the thank-you notes from that visit... but I assure you there are others, from other programs in other years and other schools. I'd like to say that they're from my little fans, but by far and away most of them are really from fans of my dogs. That seems fair; of the two of us - my dogs VS me - they really have the more difficult job; I get to live with them.... but they, poor things, have to live with me.

Friday, October 17, 2008

Moving Mountains

So today I get in a patient who had been in a dog fight the night before. The owner had stopped the ear from bleeding with some quick-stop (not its intended purpose, but in this situation it worked just great) and had wrapped up the bleeding wrist. The wife (who had brought in the dog) had only seen a puncture but she said her husband was sure there was an inch-long cut.

My patient, an absolutely enormous Newfie named (rather appropriately), Foraker, after the mountain, sits smiling benignly at me from the other side of the exam table. Usually this is not possible - either they smile at me from UNDER the table, or they have to stand up and put their front paws on the table - but Foraker has the approximate dimensions of a small and extremely cheerful black bear. Unlike many of his brethren, he has no eyelid abnormalities, and his eyes are a soft light brown, glowing with delight to be here in the hospital with a laceration on his wrist, meeting new people and making friends.

I take my history and then go around the table to examine Foraker, who wags his tail happily and snuggles up for a cuddle while I listen to his heart. I inspect his ear - which has a scrape and a small puncture, neither serious - and then we get around to taking his bandage off. Foraker, faced with the prospect of me handling his sore wrist, slowly subsides onto the floor and lays his enormous head between his paws. I cut his bandage away and inspect his wrist. There is indeed a puncture there, but I can't see a laceration. However, I can feel something, all right, under the thick woolly coat.

"D'you mind if I clip this?" I ask the owner.
"Nope, but if there's a big cut there I don't want to see it," she says. "I'm not good with anything past a puncture."
"Okay," I smile. "You can shut your eyes when we get to that part."

I fetch our portable clippers and begin bushwhacking through the thickets of Foraker's heavy coat. He looks away, as many polite dogs will do when you're doing something uncomfortable or anxiety-provoking, but which they're too well-mannered to object to. Every so often he rolls his toast-and-honey eyes in my direction, forehead wrinkled with worry; but he looks away again quickly, as if he can't bear to see what I'm doing, but he trusts me to do it right.

"Aww," I tell him. "You're a sweetie, aren't you?" Foraker thumps his tail and allows me to rotate his wrist to a rather awkward angle, trying to visualize the injury. Helpfully, he leans away from me, which allows better angulation. "Good dog," I tell him, giving him a pat, and he thumps some more and slumps gradually over onto his side, slow and graceful as a falling tree. Ah. Now I can see it.

"Yep, there's a laceration here," I say, and the owner, rubbing Foraker's belly, turns her head away and shudders slightly, with a comical expression of distaste. The lac is a little over an inch in length, and does need sutures. It's currently glued together by a fibrin seal, but that will fall promptly apart as soon as it's scrubbed (and would fall apart within 5 days if we don't stitch it, and most likely sooner.)

"Do you want to admit him so I can stitch it up?" I ask.
"Please," says the client, emphatically. "I don't have to see it, do I?"
"No," I tell her, smiling, and glance up as SS magically appears with a release form without my asking or even poking my head out the door (how does she DO that? She's like the ninja receptionist.) "Do you want an estimate of cost?" I ask the client.
"I don't care what it costs, I just want it closed up," says the owner, with another little shiver of distaste. Okay, then. We can do that.

I get up from the floor and coax Foraker up with me. I arrange for the owners to pick him up later, and he happily accompanies me out to be weighed. He barely fits on the scale. He's 161 pounds. Oh, goody. I get to lift him up onto a table. Then I get to lift him down again and carry his mountainous sleeping bulk to a run.

Or, I think... Or, I can do the surgery on the floor. Hmm. This idea has some appeal. It's a simple lac, and won't require a lot of fancy positioning. I can use an injectable and reversible anesthetic, prep him on the floor, drape off his arm.... Hmm.

When Foraker's turn in the surgery lineup comes, Dr. G (who is young and strong) tells me he'll lift Foraker up if I want. (I'm willing to bet Foraker outweighs Dr. G, but Dr. G spends a lot of time at the gym.) The techs unanimously vote to do him on the floor. Dr. G seems almost disappointed not to have to hoik this giant dog onto the table, but the techs win. They clean the floor where we will be doing surgery, and we induce Foraker. This requires four people, not because he struggles or objects in any way, but because he's inclined to bump his head affectionately against anyone within 6 inches of him, and his leg is as big around as the business end of a baseball bat. One person cradles his head, square and heavy as a gallon jug of milk. Another applies the tourniquet and braces his huge forearm. The third encourages him to tilt his massive chest to the side to properly position the leg vein-side up. The fourth injects the medication. This procedure is helped along considerably by Foraker's willingness to lay over half on his side for a belly-rub, thus exposing his vein to the best advantage.

Foraker is asleep within minutes, and one of the nurses huddles over him on her knees, clipping and scrubbing. The laceration opens up. There is a moderate amount of hair in the wound (by which I mean approximately enough to knit yourself a small hamster). My nurse carefully picks this out, places a drape under Foraker's leg, and brings me a tray of instruments. I sit cross-legged on the floor, with Foraker's draped leg balanced on my knee, and begin to stitch. Foraker twitches once, but for the most part lays somnolent as I suture him quickly up.

When we have a neat little incision line in place of our formerly yawning wound, we set a wrap and reverse his anesthetic. Foraker, apparently enjoying his medication, snoozes on. After a while he starts to lift his head, and then he rolls up onto his sternum, looking around, evidently surprised to find himself napping on the floor with two girls sitting by his head. This seems to strike him as a waste of good girl-time, and he thumps his tail sheepishly, as if apologizing for being so foolish as to have fallen asleep while they were petting him. One abortive attempt later, he makes it to his feet and proceeds back to his run under his own steam, his habitual smile back in place.

It's a good thing that Foraker is such a cheerful, willing, good-natured dog; if he wasn't, handling him would be difficult, if not dangerous (or even impossible). It's a bonus that his owners are as good-natured as he is, and apparently as devoted to him as he is to them. Dogs (and clients) like this remind you of why it is you do what you do, going in to work every day, making your own small contributions to the world. Little bits that add up, a piece at a time, until eventually... you're moving mountains.

Thursday, October 16, 2008

Poetic Justice

The other day at work we were talking about the security arrangements at the clinic. We have security cameras, an alarm system, and a series of interior lock-ups for the drugs, which require either a key, a combination, or both, plus the knowledge of where to look for the stash. This is a good thing, since certain veterinary drugs have become popular street drugs and as a result vet clinics are not-infrequent targets of those wishing to sell illicit drugs, or those wishing to use them themselves. (This has created any number of headaches for the FDA and subsequently for us as well, since drug logging has become a huge chore and a lot of heretofore unscheduled drugs are headed for the "controlled substance" lists.)

The alarm system has been updated here and there as the need has arisen. One of the first upgrades was after we were broken into (this was several years ago, before my advent here). We have lots of windows, and in the doctors' office there are large upper windows which are fixed and unopenable, but there used to be lower windows (like, a foot off the ground) that you can crank open when it's hot to get good ventilation (and yes, by "hot" I mean over 70 degrees, and we should just get a grip and not whine about it. Stupid Alaskans.) These lower windows are maybe 18 inches high and 30 inches wide, and don't open all the way - they're the type that has the little hand crank inside, so that the pane rises like an awning but never gets as high as parallel to the ground. Not a great big entry point, but where there's a will... Anyway, initially these windows were not on the alarm system, since no one thought that anyone would weasel through them, but someone did. (Subsequently they were on the alarm system AND had bars inside, but since that still did not keep people from breaking them out - although how they thought they'd get through the bars, I don't know - those windows were built over a few years ago, to the ventilatory detriment of the clinic.)

Our story takes place in the days before the multiple lockups for the in-use drugs, and before the motion sensors inside the clinic, although (fortunately) not before the policy of keeping only about one day's usage worth of drugs in the (then unsecured) cabinets, and the rest in a separate lockup. So once our thieves made it through the window, they got away with a small amount of drugs, but no cash and none of the big stores of goodies.

Naturally they grabbed what they could as fast as possible and scarpered with the loot. However, they were apprehended not much later that night - before they'd even made it home, in fact - and the next day the officer who made the collar came in to the clinic on followup. She was talking to our office manager SS about it, and told her that the only reason she pulled them over was that they were driving erratically. She had no inkling that they were our drug thieves until she got out of her cruiser and went to the pulled-over car. Why were they driving erratically, you ask? Had they intoxicated themselves by taking some of the drugs they stole from us?

Well, almost.

They had stolen (and evidently immediately ingested, perhaps in an attempt to dispose of evidence, or maybe just because they were really jonesing for a high) our apomorphine. Apomorphine IS expensive and therefore of monetary value to us, but of little street value. Why? Because it is used to induce vomiting.

Apparently reading the "morphine" part of "apomorphine", our heroes thought it was a nice opioid narcotic, suitable for a good recreational high. While it IS a morphine derivative, apomorpine is used IV to induce immediate vomiting. We suspend it in saline and use it as an eye drop for the same purpose (mind you, we generally use one pill to a cc of saline and give one or two drops, not the entire tablet). Evidently it's pretty effective as an oral drug as well, because it wasn't long after ingestion (they WERE still driving home, after all) before our heroes were given an opportunity to see The Error Of Their Ways. All over their laps. And the front seat. And each other. I have no idea how many pills they each took, but I'm pretty sure this was the cause of the erratic driving. After all, if you are simultaneously puking your guts out and dodging vomit from your partner in crime, I'd kind of expect that your driving skills might suffer.

Naturally SS thought this was hilarious. I admit I have to agree. No word on what the cop thought (I'm wondering: Now, did she have to transport them in the back of her squad car in that state....?)

Guess it's an example of "what goes around comes around" (or up, in this case) - sometimes sooner than others.

Wednesday, October 15, 2008

The Jaws of Victory

So one day, when I was an intern working an emergency shift, I walk into an exam room to find five people - two adults and three children - all huddled, weeping, around a small and somewhat elderly Pomeranian. The Pom is walking cheerfully around on the exam table, waving its fluffy tail, and at a casual glance doesn't look even a little ill, let alone ill enough to put the entire family in tears.

Hmm. Clearly there is something more to this case than meets the eye.

I ask the clients what we are seeing the pom for. The husband gathers himself together and says in a choked voice, struggling for control, "We think we have to put her down. She's having seizures. Our neighbor, who used to be a vet tech, says there's nothing you can do about it and it's best to just euthanize her."

Grr. First of all, there's LOTS that can be done about seizures in general (although specific cases may prove refractory, we haven't yet established if this is one of those cases.) Secondly, if you are not a doctor, you should not be diagnosing your neighbor's pet - especially with fatal diseases and grim outcomes that will needlessly upset the owners for no valid reason, since you have done no workup and are not a doctor and are therefore not legally qualified to make a diagnosis. Thirdly, DON'T tell me what I can and cannot do about things medical, especially if you have never met me and are just making an (incorrect) assumption that I will euthanize your neighbor's dog out of hand without even working it up. Suddenly I don't like the neighbor lady too much, even if she DID used to work for a vet. (Normally, having once worked for a vet - in any capacity - is something that predisposes me to like people, but in this case I may make an exception.)

Back to my clients. The kids are gathered protectively over the dog, crying softly, and the parents are doing their best to suck it up and answer my questions.

"Can you describe the episodes?" I ask (unwilling to call them seizures until we know that they are.)

"Well," the dad says, "She'll be walking around perfectly fine and then all of a sudden she throws her head back and turns it from side to side, making chewing motions."

"Like this," says the mom, helpfully pantomiming.

Hmm. Well, that could be any number of things, but the mom's act doesn't look that much like a seizure, at least not of the typical sort. I ask a series of questions: Does she fall over? No. Paddle her legs? No. Lose consciousness? No. Go rigid? No. Vomit? No. Urinate or defecate? No. Vocalize? No. Appear disoriented during the episode or after it? No and no. Which leaves us with: Is she perfectly normal in all respects except for what she does with her head? Yes.

Hmm. "How long do the episodes last?" I ask them.

"A few seconds," says the dad.

"And how often do they occur?"

"It varies," says the mom, wiping her eyes. "Sometimes she'll do it every few minutes, sometimes not for a day or two."

"Okay," I say. "Let's do a physical exam."

I get out my stethoscope and have a listen. The Pom's heart sounds fine and pulses are normal and synchronous, so the episodes, whatever they are, are unlikely to be of cardiac origin. I palpate the belly. Normal. As I am checking ears for potential infections that might lead to vestibular signs (which can be mistaken for seizures, strokes or poisonings) the dog suddenly points her nose at the ceiling, turns her head from side to side and makes gnawing motions with her mouth, her lips drawn back as far as they will go. This is accompanied by a soft, peculiar creaking/grinding noise.

"There! She's doing it!" exclaim at least three of the family in unison (somewhat unnecessarily).

"Okay," I tell them, as the dog, true to their observations, stops her odd behavior after about six seconds and resumes meandering over the table, sniffing industriously and wagging her tail. During the episode, I have learned two things: One, the dog has horrific teeth, and is seriously in need of a dental. And two, this is the cause of her so-called seizures.

"I'll be right back," I tell them, and I nip into the treatment area to grab a hemostat. I return to the exam room, where there is confusion and just the faintest glimmer of hope appearing on the faces of the parents. I grasp the little pom and gently ease her mouth open. She immediately goes into her act, jaws agape and pointed skyward, lips snarled back from her awful teeth, the strange creaky grinding noise emanating quietly from her mouth - because her upper right carnasial tooth has so rotted out of her gums that it is hanging loosely by a single root, and every so often when she opens her mouth it falls nearly out, tilts to the side, and wedges itself in between her dental arcades. Not surprisingly, this causes her to make all sorts of faces, and she makes gnawing motions because she has something - her own tooth, in this case - wedged between her jaws. The grinding noise is her other teeth working against the cross-wise loose one which will, after a few moments, get pushed more or less back into correct anatomical position, slipping the other two roots back into their sockets and terminating the dog's "seizure".

While the pom helpfully has her mouth open wide, her lips drawn back out of my way and her nose pointed usefully skyward, I dart in with my hemostats, grab the hanging tooth and pull it out. This requires good aim but little effort, because the tooth is literally hanging by a thread (if even that). I display the offending carnasial to to pop-eyed astonishment of the entire family. After a moment of wide-eyed silence, the mother starts to laugh.

"Is THAT what was causing her seizures?" she asks.

"Well, yes, although they weren't seizures," I say. "She does need her teeth cleaned; there are quite a few others not much better off than this one was," I add.

"We knew she had bad teeth," said the father, "But our neighbor told us she was too old to have them cleaned."

Sigh. That neighbor is really annoying me now.

"There certainly would be some risk to consider," I allow, "but the vast majority of the dental cleanings we do are on older animals, since young ones usually have good teeth. It's not impossible for there to be a problem under anesthesia, but it's rare, at least in our hands. And you can do bloodwork beforehand to minimize your risk," I add. "That would allow you to know ahead of time if there are any other health issues to consider before anesthesia, and if there were, your vet could then take precautions to make the procedure safer. Meanwhile it's not a bad idea to do some antibiotics, since that would make her mouth healthier, protect her heart and other organs from infection - and make her breath better," I add, since the Pom's breath is indeed eye-watering.

"Her breath does just about strip paint," the father agrees, chuckling now in his relief. Two of the children are snuggling the dog, despite her breath, and the other, burrowed into her mother's side, is still crying (although with relief, now, instead of sorrow.)

"Okay, so I'm going to advise that we begin antibiotics today, and that you see your usual doctor on Monday and arrange some bloodwork and if that looks good, a dental. And maybe don't let your neighbor diagnose your dog any more," I add, mildly.

"Oh, don't you worry about that," says the mother, darkly, looking at the tear-stained faces of her children. "I'll be sure to tell her exactly what was really going on with our dog." There is a certain grim and steely light in her eye, and I feel a bit sorry for the neighbor for a minute.

Now, I will faithfully report that the vast majority (with one or two notable exceptions) of the veterinary nurses I've worked with are worth their weight in gold. A good one is of inestimable value. Nearly all I have known are intelligent, capable, compassionate, skilled and tactful, and would never presume to diagnose an animal without a doctor's input - although several of them have, when asked by friends and neighbors to diagnose the dog, said, "Well, it could be X or Y or Z, but I'm not a doctor so I can't tell you for sure. I'd go see your vet and ask them about those things, and maybe ask for these two tests to make a diagnosis." This is entirely acceptable, and causes a good many dogs to get appropriate care. Most of them would not be so arrogant as to decide they knew what had to be done (in the absence of any workup or input from a doctor whatsoever), and would be kinder and more tactful (and more cognizant of the potential impact on the children) than to announce to a family who is devoted to their dog that it needed to be destroyed. It is possible that the neighbor in question wasn't actually a tech, but a less-educated assistant, or that she didn't spend long in the veterinary profession and didn't know any better, or that it was a looooong time ago that she worked in medicine, or that she worked in a practice that didn't do the workup before making the decision. I guess at the time, witnessing the deep distress that she caused - inadvertently, one hopes - I felt that she ought to have had the common sense and the kindness to suggest a trip to the vet rather than baldly announcing that the dog was having seizures (which it wasn't) and needed to be euthanized (which it didn't).

Still... in the end it worked out well, because the owners had the sense to come to the vet rather than believing to the neighbor and (for example) dropping the dog off at the SPCA to be euthanized. And it was a good one for me, because it's not often that you get to cure "seizures" with six seconds and a hemostat, and look like a hero while you're at it.

So maybe this wasn't quite snatching victory from the jaws of defeat, since the dog's problem wasn't of a fatal nature to begin with, and the only real threat here was if the owners had listened to the neighbor without checking. And after all, the alleged seizures actually resulted in the dog getting some good dental care (resulting in improved comfort and longevity for the dog), so those jaws resulted in victory for everyone.

Except maybe that neighbor.

Sunday, October 12, 2008

Swan Song

Snowing this morning.

Autumn is starting to fade, yielding her throne to winter, a slow graceful bit at a time. The leaves are mostly down now - which has the paradoxical effect of making the days brighter, since the light is no longer muted by foliage.

It's been warm for October. Last night I was at the annual Harvest Party held at my neighbors' farm, Wildwood (where I keep my sheep). As always, there was a varied buffet (barbecued pork, smoked salmon, roasted kid, kim chee, roasted squash, carrot soup, stuffed grape leaves, baked potatoes, wine, home-brewed beer, raspberry shrub, ice cream, cobbler - it goes on). There was also, as always, an excellent bonfire, made of dead-fall from the last year, blazing cheerfully, flinging spirals of sparks skyward, crackling and rich with the scent of burning spruce. It was an overcast evening, starless, but with a molten silver lake where the moon, just off full, lurked above the clouds. Even though it was about 40 degrees, I will say that eventually the heat of the bonfire was welcome; luxurious even, as the chill of deep night came on and a light thin breeze came up, sharp-edged enough to make me huddle up to the heat radiating from the embers. But it wasn't until late that it was needed, and when I left there (at 1:30 in the morning, redolent of the incense of fire) it still wasn't really what I'd call cold. Today when I got up it was raining, and though it's chilled down enough to fall now as snow, it isn't serious, here-to-stay snow. This will be gone by tomorrow afternoon, but for now it frosts the branches of the trees and muffles sound, making the very air somehow more intimate than before; somehow personal.

The first snow of the season fell a few days ago and, as I expect this one will, melted off a day later. The lakes are still open, the water growing chill and slatey under the grey skies, but still harboring the water birds for a few more days, offering them the last of the year's bounty before they fly.

One of the pleasures of living here, in a neighborhood riddled with lakes and marshes, is the water birds. I love the sound of the cranes as they fly by in pairs, eye-level to me on my balcony, their long necks undulating with their measured, powerful wing strokes, their slender elegant legs trailing in their own slipstream as they wing over the lake, calling to each other. I love the fast, powerful flight of the ducks, short-winged and sturdy as they rocket past my windows. I love the wheeling dips and dives of the Bonaparte's gulls and the terns. This year for the first time I had a kingfisher on my lake, a vivid, electric midnight blue as it perched, scanning for fish; then making hard, slapping dives into the water. That was exciting. But maybe best of all are the swans.

Every year, twice a year, the swans visit my lake during their migrations, north in the spring and then south again in the fall. I think it's the same pair (and their descendants), over and over, though of course I can't be sure. Some years they come down from the north with three or four or five cygnets; other years they have one or two or none. They circulate over several of the lakes around here, searching out the last of the food, visiting the houses where they know they are likely to find snacks in the offing.

There were five swans this year, some obviously still in the fading ash-grey plumage of youth. I didn't get a good opportunity to photograph them this year - I always saw them when I was on my way somewhere and didn't have 20 minutes to spare - but Dave had a better shot. He heard the swans calling to each other on the lake, dropped what he was doing and grabbed his camera and the end of a loaf of bread, and scooted on out to the shore.

Amongst other things, Dave is an excellent mimic, and he can call the swans in by honking to them in an echo of their own voices. The swans always come when he calls to them.

As beautiful and graceful as they are, swans are powerful birds, and pretty bold with it. They know their strength, and are not especially reticent around people. This is partly habituation - they know that, on the residential lakes, no one will try to catch and eat them, and some people will give them food - but it's partly that they aren't especially afraid of the dogs and people on the shore because they know that they can take most dogs, and can escape most people. They have a long migration ahead of them, and if someone offers them a few extra calories against the effort ahead, they aren't especially averse to venturing on-shore for them.

Pepper, of course, cannot resist the swans. She is too well-bred as a stock dog to chase or harass them, but she can't resist going down and staring at them, creeping along dock or shore to flank them, laying down to fix them in the force of her Eye. Unlike the JRT belonging to one of Dave's neighbors - who, like most of his kind, is absolutely convinced that he's tough enough to take on a rhinoceros, let alone a few birds - Pepper never dives in and swims out, trying to take on the swans in their own milieu (a fairly suicidal move, as the JRT discovered when they started pecking him in the head and pushing him under water. Naturally, this didn't really deter him much, but the combined efforts of his owners yelling for him to come back, plus the swans forcefully expressing their displeasure at his invasion, eventually got him back on shore.) Pepper will not go after them.... but she can't help watching them, intent, ready for action, honed to a sharp point of focus.

The swans have gone on now, to their southern environs. They'll be back in the spring, but for the moment they have departed on the trailing hem of autumn, leaving behind the rising breast of winter... and the echo of their song.

Friday, October 10, 2008

In Regatta Da Vida, Baby

So today was one of those days where I'm amazed I was even slightly coherent; it was howling gusty winds all night, screaming across my lake and roaring up the hill to slam into my house, tossing debris into the walls and rattling the windows, tugging at the eaves. I can drop off to sleep if it's a steady wind, even a gale-force one, but the slamming gusts are less restful. And this morning I woke to the machine-gun rattle of hard-driven rain pinging like hailstones against my windows. But it was warm, and the sky was dramatic with scudding rain clouds on the way to work. Everything has its compensations.

Besides, it's not by any means the worst wind we've had up here. One year, in February or March, it was so windy that it tore the roofs off of several buildings and froze pipes (even though it wasn't that cold in terms of ambient temps, the wind chill was vicious.) I had to plug my truck in, even though the ambient temp was over 30 degrees, because the wind was freezing the oil in the crank case. One of my clients, a long-haul trucker, had his semi blown over flat on its side (luckily he wasn't hurt.) Another truck - a tandem rig - got blown over, right off the highway, in the front yard of the clinic. The phone lines at the clinic failed; we could hear them ringing, but one my one the lines went out and we couldn't answer them. They just rang and rang, and we couldn't hear anyone, nor could they hear us. It was as if they somehow fused together; it took them two days to repair.

It was pretty dramatic. The entire town was talking about it for weeks. A little later in the spring, though, after the temperatures had gone soft and balmy, it had faded from people's minds - or so I thought. One day in early May my neighbors were having the Second Annual Rainbow Lake Regatta party. The regatta is sort of silly rafts toodling around the lake with various means of propulsion; the party is lots of food and alcohol, and that year there was music and a big fire. (The previous year it was warm, so no fire. Still lots of alcohol.) There were 3 kinds of wine and two kinds of whiskey, not to mention moose bratwurst and smoked salmon, amongst other goodies. It was actually a hilarious party... I can't remember much of the funny stuff specifically (though I laughed a lot) but I do remember this one story, which was when I realized that the legacy of that windstorm was not quite over.

At the time of the storm, it was still somewhat dark in the early morning, and after all that wind, very dry. One of our compatriots at the party, Richard (a trim, pleasant-featured, middle-aged man, with a certain kind of craggy and yet kindly good looks), was driving to work in that bitterly cold wind. After all the cold and dry, he was evidently feeling pretty chapped... not just his lips, but his whole face, as he'd been out in the wind a bit too much. He scrabbled one-handed around in his truck and came up with a chap stick, which he applied to his lips - not just the usual places, though, since his skin was also chapped. I've done this, and maybe you have too; if I've had a bad cold or something, say, and my entire upper lip has chapped: You apply the Carmex for about an inch around your actual mouth. Kinda attracts lint and hair, but oh so soothing. Richard thought as much, anyway, treating his chapped face with the lip balm. Mmmmm. Much better.

Anyway, he gets in to town and stops at the bank to make a deposit. Everyone is grinning and cheerful - maybe happy the worst of the wind is past, even if it is still blowing? Maybe just a nice friendly town? - at any rate, they all give him big smiles and he smiles back. The more he smiles the more they smile, and the more they smile, the more cheerful he's feeling. He's opening doors for other bank patrons, he's waving people into traffic in front of him, he's yielding right-of-way. Pretty soon he's having a great day, smiling and nodding at other motorists (all of whom give him a return grin), whistling his way to work at the school, generally enjoying himself.

Our Richard works in one of the portable units at one of the schools (a building off to the side, detached from the main school), so he goes into his office there and is doing some paperwork before he had to meet with school administrators and supervisors. He's on his way out the door to go to the main building when he just happens to catch sight of himself in a small mirror that hangs near the door. What the...?

See, now here is the hazard of driving to work in the dark. Things are not always what they seem. In his one-handed grubbing about for a chap stick, he is naturally not going to be looking away from the road for too long, and color is muted in the dark so apparently he didn't notice anything amiss as he applied, not chap stick, but his wife's fire-engine-red lipstick, to his lips. And all over his face. In a biiiiig raggedy clown mouth. Pretty much from nose to chin. (Evidently he was pretty generous with his application.) So here he is all happy and cheerful about all the friendly smiling Townies out after the Big Blow, all thrilled to be out and about again, all giving him grins and waves. But in fact, they're not glad to be out, they're not in a humanitarian mood, they're not relieved about the end of the windstorm, they're not even just being friendly. They're all in a smiling happy mood because they're amazed and bemused by his lipstick-laden face. And evidently too startled to ask him WHAT on earth he's doing covered in Cover Girl.

Not sure what kind of a riot he would've started had he gone in to the main building like that, but it's entertaining to think about.

He retired shortly thereafter.

I'm sure it was a coincidence.

Thursday, October 9, 2008

Blaze of Glory

So. Autumn in Alaska.

I love fall. I don't know why, but it seems like a time of awakening, ironically. When the world is preparing itself for harvest, for closing down its growth, for hunkering down to endure the winter, I am thinking of newness, of opportunity.

Maybe that's because I associate fall with a new school year, the start of a new career, the start of a new phase of my life. That's maybe not much of a surprise, given that I spent 24 years in school (not counting kindergarten and internship). But beyond that, it seems as if the big significant events of my life tend to initiate in the autumn, though fruition may be a long time coming.

It may also be that I track more with the animal cycles than with plant cycles or the phases of weather and the cycles of light and dark. This is the time of rut, when animals are initiating next year's life, preparing to create it in the secret depths of winter, to build it in the dark mysteries of long winter nights, to bring it out in the spring, new and surprising. You never know what it is you'll get; which ewes will twin, what color the lambs will be.

And I suppose, in its way, this is when the plants are seeding in next year's growth as well, sinking their resources into the ground for next year's growth.

So perhaps it's not surprising that for me fall is a time of expansion, of lightness, of anticipation and excitement and bright, active energy.

Mind you, it doesn't hurt that it's unconscionably gorgeous here in the fall. The air is crisp and sweet, sometimes softened by rain, sometimes honed to a sharp edge by the bite of impending winter. Fall is very often sunny and pleasant, warm with Indian summer, washed with light. This year in particular it seem that the flowers are bursting with last-minute glory, perhaps making up for time lost in the chill of this unusually cool summer. I defy anyone to look around at this and not feel at least a little bit of peace.

For instance: The other day I went to my hairdresser. I love my hairdresser. She gives me a head massage before she starts, and her salon (Studio 9, in case you need a haircut and a head massage) is in a small, converted house on the edge of a lake. So while she massages my scalp she turns my chair to look out at the lake, where the ducks are dabbling industriously and the gold of the turning leaves is reflected in the water.

It's soothing, to have someone massage your scalp in a leisurely sort of way, knowing that you have nothing to do for the next hour except allow someone to pamper you and make you look spiff. Add to that the beauty of the lake, the pleasant happy industry of the ducks, and it approaches a sort of cheerful floating bliss.

It's not just Studio 9 that's gorgeous this time of year. No matter where I go - the gym, my favorite sandwich shop, the drive to work, the store, my house - it's pretty right now.

That (above) is the view from the gym. This (below) is the view from The Krazy Moose, where you can get The. Best. Sandwiches. Ever. Those are the Talkeetna mountains reflected in the lake. One of the most excellent lunchtimes imaginable is to sit on the grass under the birch tree and eat a turkey/bacon/avocado sandwich whilst looking at that view. Slowly. So as to savor the entire experience.

Still, if you want the WHOLE spa experience, you should also include a visit to my dentist, where you can A) sit in the massage chair until they're ready for you, B) have a hot, fragrant wrap for your neck, C) get your hands paraffin-dipped and wrapped in little towels to keep them warm, D) look out at yet another lake just beyond your feet, E) have a really pleasant time chatting with the hygienist, the dentist and the receptionists and F) get really top-notch dental care. Plus - have I mentioned this? - you feel like you've been to the spa.

So let's review: The proper steps are: Get up a little late, go to Studio 9 for a head massage and a hair cut, then go to Dr. H's office for the spa treatment (oh, yeah, and a teeth cleaning and exam), then go to the Krazy Moose for lunch. Then you will be toooo relaxed to go to the gym so you might as well go home and look for swans on your lake, which, if all goes according to plan, will look like this.

Well, what can I say? It's a tough job, but someone has to do it.

So, we may have a long winter ahead, and we may have cold and ice and long dark nights and short frigid days ahead, but the summer has its compensations; light so long and deep that you forget that there even was a winter, beauty everywhere you look, air so soft and rich and tender that you feel you can almost dine upon it. And at the end of that, when it starts to wane and you're tempted to go melancholy and sad over the loss of summer.... then is when that crisp energy of fall starts up, and even if you are heading into winter and dark, you are at least going out in a blaze of glory.