Wednesday, January 14, 2009

The Glamorous World Of Veterinary Medicine

[Author's note: Okay, you guys, I admit it: I've been cheating. Some of these stories are ones I wrote in previous years, to entertain my sister or my BF. I'm re-printing them here because most of you haven't had a chance to hear them, and some of them still make me laugh. Besides, I'm getting ready to travel; that means I have 2 zillion things to do in a very short period of time, so for a little while I won't have time to write new stories. So.... I hope you don't mind if I go to my archives to keep you entertained for a little while. If not, read on for one that happened in late February of 2003...]

It was one of those days today, lots of interesting events - too many for one story, though, so I'll start at the end and work backwards as I have the time.

The day ended with two just-before-closing emergencies. Since I'm on call, we told them both to come in. One is an Iditarod leader who just got bitten by another dog and has a one-inch laceration on its wrist. There are a select few clients from whom I will believe this assessment; it seems to be quite difficult for people to accurately report the size of lacerations on their animals. Unless it is a client who has proven their accuracy in this regard, I read "one-inch laceration" as "some kinda cut, which could be anything from a degloving injury to a puncture wound - on the owner".

Since Iditarod is starting this weekend, this dog needs to be seen ASAP. The dog is in Willow, though, and it's just started to sleet in earnest, so the owners estimate they might get in by 6:30 if the roads are passable. I elect not to try to make it home and back in 30 minutes (I can make the round trip in 23 minutes, traffic permitting, but it isn't worth it for the 7 minutes at home.)

As it happens, just a few minutes after this call someone rings in with a cat laying around and crying as if his stomach hurts. My receptionist quite rightly suspects an obstructed tomcat and tells them to bop on in lickety split. They arrive at six on the dot and I spend the approximately 22 seconds it takes to diagnose a blocked tomcat (this includes the time it takes to take the crate apart to get the cat out... it's isn't a tough diagnosis in general, and Zeke's bladder is approximately the size and hardness of a softball, in any case.)

Fortunately as I walk into the treatment area with my (eighteen pound) patient, I note that not only has JG not left yet, but M has stopped by for some reason and is chatting with her, so I have TWO nurses available. This turns out to be a fortunate event, as all three of us are ultimately necessary to pass Zeke's catheter, a procedure I can usually do alone. We clear away the surgery laundry that JG was folding on the treatment table and replace it with poor Zeke, who is purring madly despite his extreme discomfort - his owner says he purrs when he's nervous, which he has every reason to be about now; his life is on the line and I am all that stands between him and death. Fortunately we have a neat little toy to help unblock tomcats, an ultrasonic device which is supposed to break up the crystal plug so you can catheterise the cat, and I am keen to try it out. M gets out the dental machine, to which it attaches, and JG and I anesthetise the cat.

Now the fun begins.

Zeke, like the majority of my obstructed toms, is a bit (read: rather a lot, really) on the portly side. In addition, he isn't the "manliest man" I've ever encountered. I can find his prepuce amidst his chubby and luxuriantly furred thighs, but exteriorising his penis is another matter entirely. He is so fat (and admittedly he's remarkably under-endowed to boot) that I can't get more than the tip of his little Johnson to peer out of the sheath (although considering that I'm about to clip a hemostat onto it and run a catheter up it, this may indicate a certain degree of reasonable caution). It is impossible to catheterise a cat unless you exteriorise their little weenie first, and since Zeke's life quite literally depends on me catheterising him - and right now - I have to find a way. With JG holding Zeke's substantial thighs out of the way and M applying pressure to Zeke's peri-genital tissues I finally am able to get a bit more of him to extrude itself, like a snail emerging cautiously from its shell in fear of small boys with salt. I make a lucky grab with my hemostats (although about this time I bet Zeke's Johnson wasn't feeling especially lucky). It's not in the ideal position, but I am unlikely to get a better one; the minute you let go or try to hold it in place with your fingers while you move the hemostat, it slips through your grasp like a bar of wet soap and has to be laboriously fished out again (which, as you might suspect, I am reporting from personal experience with Zeke's very own penis, which is already a deep reddish purple from the strain of trying to pass his urethral obstruction, and would surely rather not be pinched any more with the hemostats than is absolutely necessary).

M has hooked up our ultrasonic toy and I manage to get the slender tip of it into the (tiny) urethral orifice. It is a SLICK little device and zips through the gritty crystal plug in Zeke's urethra like a hot knife through butter. Zeke's distended bladder, under considerable pressure until now, gratefully sends a high-velocity jet of cat urine geyserlike into the air, arcing gracefully above his prostrate form and onto my neck (liberally dousing of my nice long hair and my clinic coat). M and JG are frozen for a microsecond of dismay, but I start laughing, which leads them to conclude (correctly) that none of it went in my mouth, no matter what it looked like. The front of my shirt is generously sprinkled with Zeke pee, but while I will say I don't love the smell of cat urine in the evening (or any other time), I'm just as glad to be doused in it this time: it means I've just saved Zeke's life, which goes some way to making a shirtful of cat pee seem like a minor deal. All part of the glamorous world of Veterinary Medicine.

Meanwhile, my other emergency has arrived and the dog-handler is watching the circus with bright-eyed interest. I go to change my shirt - which, I notice, is dotted with tiny domes of sand, courtesy of the incredibly high crystal content of Zeke's urine - while we manage to express the rest of Zeke's bladder (primarily into the sink). The treatment area reeks of cat urine, and there is bloody urine and a visible sediment of sand on the treatment table, but I am feeling cheerful about this; Zeke is way better off than he was 10 minutes ago. The dog handler wants to know how it happened, what we're doing, how we'll prevent it recurring, whether the cat is anesthetized and so on. I answer absently, concentrating on getting Zeke emptied out and setting up to pass our catheter, but when I get to the part about prescription diets, she says sagely, "Just as long as you stay away from Science Diet," nodding firmly to underscore her point. This rather irritates me (in actuality, in my hands at least, it's the best on the market for this problem; I've had all other prescription and non-prescription crystal control diets fail at least once, but so far Hill's hasn't let me down.)

"Actually, in my opinion, that's the best diet on the market for this problem," I tell her, still working over Zeke's slumbering form; we've pretty well emptied him but we still have to place a urinary catheter that will stay in place until at least morning.

"It has soy in it," she argues. "That's really bad for them." I suddenly suspect she has Internet access. Sigh.

"Be that as it may, if this cat is going to recover, it'll be on that diet. Nothing else is as good for this problem," I reply, rather shortly, as I tease the catheter into the still-gritty opening of Zeke's urethra. After a little stutter, it passes into his bladder. Ahh. Success. Until it is pulled, the catheter will keep Zeke's bladder empty. This is important not only to prevent re-obstruction, but also because the bladder, having been stretched well beyond its normal limits, has lost its tone temporarily. In nearly all cases the bladder will regain its contractility, but it needs to stay small for a while to re-establish the tight connections between the smooth muscle cells that are responsible for contracting the bladder. Until this happens, the muscle cannot contract in synchrony to empty the bladder, and not only will bladder tone not re-establish, but re-obstruction is a risk. But I have hopes that Zeke will be peeing on his own in 24 to 36 hours.

Zeke having been stashed away in a cage, we get to Butch, who, it is revealed, actually has TWO lacerations, neither of them an inch long (sigh). By great good fortune, both have missed all the rather important tendons and ligaments and joint capsules and vessels in their vicinity. I will need to repair this without benefit of shaving (since this dog is intended to run the Iditarod in a few days and the dog can't have bare skin exposed in that kind of cold). Luckily it looks do-able. I spend a few minutes tracking down the record (the reception staff had pulled the handler's record, not the owner's). We anesthetize our lacerated leader and prep the wound without shaving it. I begin suturing, pleased to see that the wounds are coming together nicely. Meanwhile, the dog handler (who has ceased annoying me, mainly by dint of her genuine and sympathetic concern for poor Zeke), asks me, "Did you vaccinate Raymie's dogs for rabies?"

"Hmmm, I'm not sure," I say, wondering which "Raymie" she might mean. Ramie Reddington? Raymie Smyth? Some other Raymie I have never heard of? Apart from which, I have no idea how many Iditarod dogs I have vaccinated for rabies in the last 2 months, but it was somewhere between "a lot" and "REALLY a lot". I am only half listening as she burbles happily on, but suddenly JG recalls that I DID vaccinate Raymie Smyth's team, because she recalls M helping me, in a slick little tag-team. Now I recall it too... we counted out 17 vaccines (for the 17 dogs we were told he brought) but ended up one short. Raymie and his assistant, another musher, are counting and re-counting dogs and insisting there are only 17, but I am counting 18 - did they remember to count the one in the cab with them? Nope. That's it.

"Yeah, he [does she mean Raymie or his musher assistant?] said the shorter woman who was vaccinating was really good - very efficient. So I thought, I have to see who this woman is," says Raymie's handler now. Well, that would be me - the shorter woman: M and JG are rather taller than I am, as is nearly everyone else at the clinic. But now (apart from being rather abashed that I was short in correcting her on the diet issue, since she really is very well-meaning and clearly loves animals) I am wondering: just HOW does one vaccinate a dog for rabies in such a way as to impress someone enough to mention it? There's really not much to it: grab 'em and stab 'em, basically. Maybe they were just impressed that I was able to count to 18.... Just part of the outstanding service at the clinic, where amongst other things we are all smarter than we look.

15 comments:

Karl Katzke said...

It's OK, I figured it out back during the Run to Knik series, when the 2009 names didn't match. What year was that from, anyway? 03? 06? You're forgiven -- final proof that being good can get you a lot of latitude!

AKDD said...

Thanks! It's good to be forgiven! :D

That Knik series was 2003.

Holly said...

No problemo with the archives - it's all interesting reading.

MaskedMan said...

Just a note on the lead dog: Lead dogs are worth (in some cases literally) their weight in gold; A good leader wins races and purses for their musher; they generate stud fees, or deliver litters of prized pups; and they're usually very, very close companions to their musher. A small laceration is generally pretty small potatoes to a dog, so long as it can be closed and kept sterile. But a patch of bare flesh on the trail, in typical Iditarod conditions? NOT happening. Hence, the great care in suturing without shaving.

Oh, and immunizing 18 sled dogs isn't just your typical day in the office, despite my sister's nonchalance... "Grab and stab" sounds all nice and easy, but sled dogs are as muscular as any olympic athelete, with better reaction times. They're more slippery than eels, smarter than your typical mutt, and more 'squirmy' than a three year old child hyped-up one pixie stix. They don't like needles any more than the next dog, either. "Grab and stab" on a sled dog means 'no hesitation, no flinching."

Processing 18 sled dogs in short order really is a mark of skill and efficiency.

AKDD said...

MM: Awww, shucks! [blushes] Thanks!

Too right on the value of leaders: if you have no leader, your team lacks purpose, direction and drive. A good leader can keep the team going when they're flagging, and a poor one can demoralize and sink your team even if the dogs all have plenty in the tank. Dee Dee scratched one year as a consequence of not having a strong enough leader. That might be the only time she's ever scratched, actually; not sure on that.

Dragon43 said...

Can we Fed-Ex our critters to you for their vet needs? I am sure you are worth it... Takes the right stuff to be a GREAT vet and you have it......

MaskedMan said...

Dee Dee has scratched for personal health reasons before (her race was eaten by the dreadful Happy River Steps*); I only know of one team-related scratch for her though, and that was after she had to drop both her leaders. With no strong leader left, her team wallowed from fiasco to disaster to... Well, scratched.
It's axiomatic: No leader, no team.

*Descending into the Happy River Valley, the teams drop five hundred feet down a near-sheer canyon wall in a series of extremely steep switchbacks. The trail there is notoriously difficult, and it's usually hit on the second day, while the teams are still full, and the dogs are amped-up, hyper, and in all other ways extremely energetic. Imagine slaloming down a double black diamond mogul hill whilst being dragged by a runaway frieght train - That's less frightening than the typical musher experience on the Steps. Every year, without fail, the Steps eat someone's dream - Usually four or five dreams. Bad years have seen as many as ten scratches after transiting the Steps. In some cases, the Steps have reached four days and five hundred miles to eat a dream, as equipment damage and lingering injuries sustained in transit force a scratch. Even That Man (aka Doug Swingley) had to admit mortality after the Happy River Valley fed him to a tree.

AKDD said...

Dragon - gee, thanks! [blushing and digging toe into sand.] I think you should just fly up with them, possibly around the time of the Talkeetna Bluegrass Festival (which is in the summer and therefore in better weather.)

MM - I knew you'd know if Dee Dee had scratched other times! :)

Karl Katzke said...

It's funny to realize that there's such a broad range of passions and activities out there that some of us don't even have exposure to... And there's always someone who knows every last inch, tale, and story. The internet's kinda cool, ain't it?

Speaking of the internet -- My usual approach when I see something that I've never seen before is to hit Wikipedia for the basics. Not only is there no mention of the Knik 200, there isn't even a mention of Knik 'cept for KNIK-FM in Anchorage.

Della said...

Don't apologize for old stories. We'll be missing out on Great stories if you never tell the old ones.
I hope your travels are smooth and safe!

MaskedMan said...

@Karl;
A LOT of Alaska is completely unknown to outsiders. Partly, its because Alaska really *is* remote; Partly because there really aren't all that many people in Alaska, and partly because a lot of the people whom might be writing such entries in places like the Wiki simply are either too busy or are not connected to internet. Alaskan infrastructure is rather limited, away from the larger cities and towns. As an example, Charlie Boulding, the unofficial 'Face of Alaska,' lives in a place that can only be reached by boat, aircraft, ATV, or dogsled. Nor is he the only one... No roads, for another instance, lead to Nome. Not a single one - You simply cannot drive there from anywhere.

Maybe we can get AKDD to discuss the issue of people who live in the bush, and get into town maybe once a quarter?

Anyway, the end result is that much of Alaska is a well-kept secret. But Alaska isn't the only place - Try a Wiki search on pretty much any town or event in, say, the Yukon Territory, and see how much you get - Most events will generate a stub, at best.

Christy said...

As I read I could smell the pungent aroma of blocked tom cat lingering in my nose...thanks. :) lol It's been awhile.

"Grab 'em and stab 'em." You must have some real 'vaccination voo-doo' goin' on! :)

Today Wendy said...

Hi ADKK,

I've been lurking here ever since Hedra linked to you a while back, just loving the stories! A vet blog is not the usual sort of thing I'd read, but you've got a real gift for telling a story, and I'm just loving it :)

AKDD said...

Christy - no charge! All part of the service here at the blog! :D Not sure just how good my vaccine voodoo is, but I've certainly had enough practice tht I OUGHT to have some by now...!

Wendy - Thanks! That's especially flattering coming from someone for whom this isn't the standard fare. Glad you're enjoying it, and stop by any time!

Della, thx for safe travel wishes; I'll try to blog whilst on the road, but no guarantees.

Mm and KK... there may be some future stories in that.... but probably not til I at least make it to my destination and sleep off the jet lag, and maybe not til I get back. Gonna be a buuuusy trip!

Floyd said...

As someone who's devored the James Herriot's books, David Taylor's book Zoo Vet, and had some experience in the back as a tech assistant, I have to say this not only reminds me of the days were we'd walk to unlock the doors and there would be the first emergency of the day, and then 12 or 14 hours later we'd finally stumble out to our cars as the last emergency either went home or was stabilized and headed to the emergency clinic for over night work.
I'd say you have an interesting subject matter to begin with, but it's your writing that makes this blog such a joy to read.