Thursday, October 2, 2008

Tales From the Bark Side

I don't know about you, but I sometimes wonder if there's any truth in the common-knowledge sorts of beliefs, such as the idea that oddball behavior (and/or, quite literally, lunacy) increases at the full moon. I do think that particular wives' tale actually has some merit, based on the kinds of calls and cases we get during the full moon.

For instance, one spring evening a few years back, I get an emergency call for a gerbil with a degloving injury of the tail. As this is a non-life-threatening injury, the owner elects to wait til the next day for surgery. I gave instructions for nursing care overnight and the owner arrives in due course the following morning. It's probably a $4 pet which will live 2 or 3 years at most, but it came in for a $150 surgery (a gratifying sort of client - the monetary value of the animal is less important than the emotional and intrinsic value of the animal). Mind you, this is a procedure I've never done before, as I don't really do a ton of Gerbil surgeries (hmmm, now why could that be...?) However, the nature of veterinary medicine is that you get to see things all the time that you've never seen or heard of before. Luckily they train us A) to think, and B) to apply core knowledge to novel situations, so I figure I'll be able to wing it. I hope.

As you might imagine, it's a bit hard to inject anesthetic drugs into the teensy weensy gerbil vein and then get an endotracheal tube down the teeny weensy gerbil airway (partly because they don't make tubes that small, and partly because you'd have to open up the teensy weensy gerbil mouth and get past the NOT-so-teensy weensy gerbil dentition, which is impressively sized for an animal so teensy weensy). So, instead we box them down (which does NOT mean punching them in their tiny little rodent heads; it means putting them in an induction chamber and piping in the gas until they fall asleep.) We have an induction box for cats, but it's mighty large for a rodent about half the size of a cat's head, and would take weeks and weeks (well, a long time, anyway) to reach anesthetic levels of gas. I was kinda thinking we'd adapt a jar to the task, but then my eye falls on the induction masks we use for larger animals, like cats and dogs, in those cases where we have to mask down an animal rather than our usual IV-and-intubate regimen. I think: Hmm, maybe we can put the cat mask over the gerbil's head. Then I think: Maybe we can put the entire gerbil into the mask, up-end the open side onto the table, and use that as an induction chamber. It's small, it's compact, it's made for gas anesthetics, and it's handily equipped with a rubber gasket which will make escape attempts less profitable. Turns out it's the PERFECT fit for our little gerbil (appropriately, if unimaginatively, named "Gerbil".)

After chasing little Gerbil around her cage for about 4 minutes (she is a svelte and athletic little rodent, and an adept escapist), we manage to corral her with the assistance of a dry washcloth tossed over her head as a distraction. She isn't ALL that interested in entering the Anesthetic Chamber of Horrors (or so she imagines it, evidently, since she makes several abortive attempts to avoid admittance to the gasketed Hobbitty portal to her own personal LaLa Land). She is, however, no match for Jill's dexterity, and ends up adeptly threaded face-first into the cone, where she curls up cozily. On goes the gas. After a few minutes, little Gerbil falls asleep and Jill reaches her pinkie in and hooks the back end out of the mask so I can operate. There are itty bitty little vertebrae hanging out at the end of the tail, all naked and dehydrated. Dr. J has (in jest) volunteered to bring in a cleaver in case I prefer to do my amputation via the Three Blind Mice procedure, but I elect to use scissors to snip through the tiny jointed toothpick which is the distal third of the tail. I freshen the edges of the skin, point the tail-stump skyward and push the skin toward the table, like scrunching down the paper wrapper on a straw. A little nubbin of tail bone sticks up, which I trim back a little to give me enough skin to cover the tail stump. I pull the skin back up, like pulling up your knee socks in the third grade (though a bit more scaly and bristly than MY knee socks ever were, thank you very much) and throw in two sutures of a hair-thin absorbable. Off goes the gas. Jill frees the front half of our patient from the anesthetic mask and tenderly cuddles little Gerbil up in our washcloth to recover from her anesthetic, which takes about 91 seconds. Ten minutes later Gerbil is running on her little rodent wheel (tail tip jauntily adorned with purple suture) and drinking out of her water bottle (which, for her amusement, has a tiny plastic turtle toy floating in it.) Ta-da. Rodent tail-dock numero uno under my belt. (I bow modestly).

The next oddball thing was a client who caused me to win the stick-a-fork-in-your-eye-client-of-the-week award. They brought in one dog but had protracted lists of questions about two others. Dog number one is a Dalmatian who has previously lost a kidney to urate stones, a stone which forms as a result of an inborn error of metabolism. There's no cure, but by feeding a strict prescription diet you can generally avoid recurrences. The diet works by controlling urine pH and mineral content, which keeps the stones from forming - so long as you stick strictly to the diet and feed nothing else. The owner's concern is that our patient, JJ, is taking on the general size and proportions of a harbor seal. The owner is frustrated that the U/D is making JJ fat, and she isn't mistaken about the weight issues. The dog is nearly 100#, and should weigh maybe 65. Her neck, swathed in rolls of fat, is wider than her head, and she has a pronounced waddle. Rather sad, given the deep-chested athleticism she was bred for.

As I enter the exam room, the owner is feeding dog cookies to their new (four week old) puppy, who is along for the ride. (Who weans and homes puppies at four weeks?!?) The owner takes an additional handful of cookies out of the jar for her Dalmatian - who, remember, is supposed to be on a prescription diet to prevent stone recurrences, AND who is way way way too fat. So, yeah, let's give her a handful - not one cookie, mind you, but a handful - of decidedly NON-prescription dog snacks. Sounds good to me.

I narrowly prevent the owner from feeding the dog a pile of extra calories and inappropriate minerals. We get to talking about the dog's weight. The owner has decreased the dog's U/D by a third - but has substituted some of the Pedigree senior diet that their 13 year old boxer eats. They also feed pig's ears, dog cookies and a LOT of table scraps. Hmmm. That sounds PERFECT to me. The dog has already lost an entire kidney to stones, and is built like a sea mammal, so shovelling large piles of random non-prescription scraps down its throat is clearly a DANDY idea. Sigh.

I reiterate to the owners that the purpose of the prescription diet is to control the recurrence of stones, but that it is impossible for the diet to do this if you feed other items indiscriminately. They look at each other accusingly. "I told you so!" they say to each other simultaneously - which evidently means that BOTH of them are violating the dietary restrictions without compunction, but each is convinced that their own transgressions are NOT a problem, while their spouse's are. Sigh again.

After approximately 1,000 questions about the dog (as well as a nail trim, a procedure which is clearly NOT okay by our JJ), we get on to their month-old American bulldog puppy. Whom they have no idea how to feed. I understand them having questions about whether or not to feed a puppy milk replacer, but I don't get it that they're asking me if they should be feeding an adult food to the pup. (Hello? Do you not have two other dogs?) Luckily these are straightforward questions and readily answered, the more so since the answers are fairly obvious even to the inexperienced, so we dispatch them in short order (which, in this case, means about 10 minutes).

Last is their desire to breed their 13-year-old white boxer to their now-4-week-old puppy (who, you will recall is NOT a boxer, but an American bulldog). They have been advised by our office manager that the boxer is unlikely to live 'til the puppy is if breedable age, so they want to freeze semen. This would require us collecting semen from the dog, and also that the semen is of viable quality for freezing and reconstitution. The problems with this being that A) male dogs tend to begin to decline in both sperm count and quality at about 8 years of age, B) in order to collect a dog you generally need an in-heat teaser bitch to stimulate the male's interest (this is news to the owners), and C) since hand-collection of semen is a bit unnatural from the dog's point of view (what ARE we doing handling those parts in that way, they want to know, and just who gave us permission?), it's best if the dog has been taught to do this at some point in life. Generally this is best done in youth, when they will indiscriminately hump practically anything that will sit still long enough. Trying to get a 13 year old dog to go for this is typically a losing proposition. I'll let you guess if the boxer has ever had this procedure done in the past. But you'd better guess "no."

I explain all of this to the owners, who are a bit crestfallen. The boxer is a "five star champion", they say. Really? a five-star champion? Hmmm. It IS a white boxer; that's an automatic disqualification in the AKC. White boxers are excused from the ring immediately. And though I personally feel that coat-color fashions are way less important than certain other traits, and I myself do not show in AKC - or elsewhere - I have never heard of a "five-star champion." There are national and international champions of all sorts, but no "five-star" champions in the AKC that I - or any of my staff, several of whom DO show in the AKC - are aware of. So I am not sure why they have such a drive to not just breed their elderly white boxer, but to deliberately breed cross-breds which very likely will be hard to place in homes, since that there isn't a huge demand for boxer-bulldog pups by the public at large. Their yen to breed these two dogs together is particularly hard to understand in view of the fact that the boxer is seriously dysplastic and has marked arthritis in the hips and back. Given that this is a hereditary disease, and that American bulldogs ALSO have a tendency toward hind-end orthopedic disease, this seems like just a PEACHY idea. Not.

I have no idea if I managed to dissuade them from trying to collect the boxer - though I did suggest that if they really really need to breed this dog's bloodlines they might consider a grandson, as the dog has been bred in the past (presumably to other boxers, and evidently without regard to the coat color flaw OR the far more serious issue of soundness.) I admit that this was maybe a little craven - I'm kinda thinking that owners of purebred boxers may not be keen to stud their dogs out for deliberate cross breedings - but in all honesty, I AM kinda hoping that enough obstacles will crop up that they eventually abandon the idea. Regardless of the genetics involved, it really seems to me that these are people who should NOT be breeding dogs under any circumstances whatsoever. As nice as they may be, they don't seem at ALL clear on the concept as far as the health of the dogs they already have, and I'm just guessing here, but common sense may not be their strong suit.

Anyway, you could tell it was a full moon, because there were more oddball cases that week - most notably two different people who called for porcupine quill removal, neither of whom wanted to pay us to do it (one wanted us to hold the dog down for them while they pulled quills, and the other wanted us to drug the dog and send it home - fully anesthetized, mind you - so they could pull the quills themselves at home.) I ASK you - where on EARTH does this idea intersect with the world of reasonableness, common sense or sanity? Is it just me, or does this make NO SENSE WHATSOEVER?

Sigh. I really wish I'd been there to see Dr. P tell the hold-it-down-while-I-pull guy that he wouldn't do it. Dr. H got to tell the anesthetize-it-and-send-it-home guy that he wasn't going to do that (whereupon the guy started screaming at him that he didn't have the money to pay for us to do it and he's just have to shoot the f%*&$ing dog - because it's a well-known fact that being a complete a**hole makes everyone around you want more than anything else in the whole world to give you everything your little heart desires, especially if it is immoral, unethical, unprofessional and ILLEGAL. Not to mention just plain stupid.)

Oh, well. That's life on call, especially during the full moon, and sometimes the best you can do to try to cope is to go to bed and sleep a whole lot (presuming your dog Ali, who believes you should get up with the sun, will keep his whining to himself for a bit - I tell you, this is a lot less inconvenient when daylight does not commence at 4 a.m.) And you can cross your fingers that in a day or two the lunacy will have faded and things will be back to normal. Normal for us, that is....


MaskedMan said...

I wonder... Could the full moon / stupidity link be some kind of confirmation bias - The we remember the stories that occur during a full moon more because we link them with said moon-phase? Or is it perhaps that people see the full moon, have heard the theories, and either consiciously or subconsciously choose to act out the belief?

Whatever may be the cause, it's certain that anyone who does emergency medicine will see and hear all teh strangest that life can bring... But you have the bonus of adding that hardy, can-do Alaskan spirit into the mix. Which can only serve to stir the pot.

Yahoo! We's gunna pull us some porky-pine stickers! Get me my pliers, sweety!

Toffee said...
This comment has been removed by the author.
AKDD said...

MM, it COULD be a self-fulfilling prophecy, but you're right that it doesn't matter, really.... the end result is the same. I think what gets to me is the complete logic failures. If you and your spouse are doing exactly the same thing, and you know your spouse is doing the WRONG thing, then, logically, aren't you ALSO doing the wrong thing???? Hello....? (Sigh.)

Toffee.... AAAACK! I had a client who used to do that before trials - or so I hear. I never had this conversation with her, nor did I ever observe the behavior. But it's my opinion that stock trials and - um - "that" are completely unrelated for the dog, and since one thing has nothing to do with the other, it begs the question: Why, why, WHY? And: Is this REALLY the relationship you want to have with your dog? Really?

I had one of my males collected once. I made CERTAIN that there was someone else to do the collection, for that very reason. That was NOT the relationship I want to have with my dog. Brrr.

I'm not sure a full moon is enough to explain THAT behavior. Unless the person has their own personal full-time full moon. Yikes.

MaskedMan said...

Well, often enough, it seems people are living in their own little world, so why NOT their own personal Luna, too?

Anonymous said...

There was some research that showed that even the slight increase in light at night affected quality of sleep sufficiently to push many people from borderline sleep-deprivation into full-on sleep-deprivation.

You may notice that the full moon when it occurs during daylight hours does not tend to increase stupid sh*t people do. But it does definitely increase stupid shit people do at night. Even when there is light pollution (like city areas).

Infants and young children are noted for being particularly sensitive to it. So are teens and young adults (whose sleep is already disrupted a lot, and wonky). The progression toward the full moon is also part of it - so it is the result of a few EXTRA nights of less-deep, less-restful sleep. Blackout curtains do help. It seems like such a small difference, but ...

though the observation bias also plays a role, there is a small but notable increase in people being brain-dead-stupid/crazy around the full moon (usually including the two days past the full, or so). The less stable they were to start with, the more ya notice, too.

Oh, and NO truth to increased incidence of labor around the full moon, but there IS evidence that a storm front (with sudden/severe change in barometric pressure) can set off more labors than typical. Not a huge jump, again, because you'd have to be pretty ready to go into labor to have that small a change set you off. (I know some midwives who kept track of that for a while, and they got a 'storm surge' of their due-soons and overdues whenever there was a big front. Small fronts did zip.)