Thursday, December 11, 2008

Nothing Normal Times Three

Bizarre case du jour...

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

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

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

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

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

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

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

Horror story du jour...

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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


MaskedMan said...

Male calico..? Like hen's teeth, that. But *two* years with a discharge..? WTF?!

Ice story... ::shudder:: I spent enough time playing with ice, that those kind of stories hit pretty low.

The Rottie owner..? She sounds like an unrecognized sub... She needs to get more appropriate dogs, and go find herself a good Dom. Or find a Dom that wants dogs. Pop a whip at her, next time she's in, and see if she sits up and begs for you...

Jenn said...

Never a dull day at the office, eh?

I knew calicos only came in female, but I never realized an odd twist of genetics could produce a male calico. I guess I won't be judging a calico by her color any more!

Bizarre question...why did the man with the frozen dog bring a dead dog to the vet? Did he bring him in for the cremation services or was he hoping for a miracle?

Dog get all kinds. And I just had to ROFLMAO!!! at MaskedMan's dom/sub comment! Too funny!

AKDD said...

Jenn, the man brought the frozen dog in because he wanted it to be cremated. I think he couldn't deal with thawing it out in his garage; after all, it was the body of his beloved dog, so he probably didn't want to walk by it for two or three days while the ice melted off. Besides, we're set up to arrange for creaations; at the time, there wasn't another option for that unless the owner wanted to drive to Anchorage.

MM, my vet school nickname WAS "The Whip", but that was because I was quick with a snappy retort, and not due to any dominatrix predelicitons, I assure you!

Michelle said...

Very educational! I knew that female orange tabbies were rare, but I didn't know that male calicos were rare.

I have a Tortoiseshell, and my vet always comments on her "Tortie 'Tude". Whenever I take her in, she scrunches down into as small a ball as possible, and proceeds to not move for the whole examination, while rumbling under her breath like a small motorcycle for the duration. Her lung capacity is quite amazing. :)
Apparently she must think she's a Rotweiler!

Jenn said...

Ahhh...gotcha. I guess when the ground is frozen you really can't bury right away, either. Something I just don't have to think about here because while it does get cold, the ground never really freezes solid.

Barb said...

"Then it dawns on me: she's talking about the DOG. She named her dog after a cannibalistic necrophiliac serial killer."
Of course, that is a LOT funnier since the lady in question (and her dogs) are about, oh, 2000 miles away! :-)

SweetMotherOfMars said...

I wanted to thank you, I've been following your posts for the last few months. You are a wonderful author & I'm hooked.

So, if one X in each female mammal's cell turns into a Barr body, does that mean humans do not carry their skin color gene on their X chromosome?

If we did, wouldn't a few of us ladies have tortie-tude, too?

AKDD said...

You know, torties DO sometimes have some 'tude, but I'll tell you... excellent mothers and wicked good hunters, by and large. I think if you're going to do that kind of thing well, maybe a little 'tude doesn't go amiss.

SMofMars, I'm glad you're enjoying the blog! To be honest, I don't know where humans carry their pigment genes, but I'd have to guess it's not a sex-linked trait; otherwise you'd have hair and/or eye color distributed along gender lines. However, what Michelle says about orange tabbies being mostly male is true (IME, 80-90% of orange tabbies are male); but some perfectly normal female cats are orange tabbies, so there has to be some other mechanism at play there than a strict sex-linkage. It gets a lot more complicated when you have color dominance (like black being dominant over yellow) and/or color penetrance (as in, incomplete penetrance of red being a soft creamy orange, or incomplete penetrance of black being grey, etc), which happens in certain breeds and/or species, as well.

Meanwhile, I think we ladies should ALL be allowed some Tortie 'Tude! Look what we have to put up with! [carefully not specifying what that might be, so as to allow the biggest possible umbrella...]

Barb, you're right: distance lends enchantment... or in this case, amusement....!

I need orange said...

Always baffled that the simple "if you reward it, you'll get more of it" concept is so rarely understood. And even more rarely practiced.....

So the next time that dishonest rottweiler person comes in, you're going to tell her "Yo, *itch, curb your dog!" right?

:-) lol............

AKDD said...

Oh, yeah, I can see THAT going over well with the bosses....! :p :D I guess I'll just have to avoid the temptation. Dang it.