Know Your Anatomy

One of the entertaining things about being a vet is that you have the opportunity to learn some new and interesting things about animals, on nearly a daily basis. I have learned, for instance, that when people mention that their dog "has his lipstick out", they most decidedly are NOT talking about cosmetics (despite the fact that there is every possibility that said "lipstick" may in fact at some point come into close proximity to the dog's lips.) I've also learned that when someone refers to the "yayhoo" they are not discussing some rube they saw on the road or at a grocery store. They're referring to some body part for which they either don't know the anatomical name, or else know it but don't feel comfortable mentioning it in front of a doctor. Ditto with "doodydads", "marbles", "jewels" and "boys" (testicles); "ninnies", "teetees", "tatas" and "boobies" (nipples or teats, depending on the species, plus or minus the actual mammary gland); "hoohoo", "cooch", "purse" (?!), "twink" and "her - um...." (vulva); "down there" and "you know" (penis or vulva, depending on the gender referred to); "manhood", "thing" (always tempting me to ask with a cheerful grin, "What thing is that, specifically?"), "peepee" and "wiener" (penis.)

Okay, I get that. People are either trying to be polite by being euphemistic, or are actually embarrassed to say certain words in public, much less in front of (gasp!) a doctor - who in reality might be expected to be less dismayed by such terms than the general public, after all - or, worst of all: in front of a female doctor. So I firmly suppress any evidence of hilarity and pretend that yes, I DO daily use the term "doodydads" when speaking to my colleagues about testes, and of course "purse" is commonly understood always to mean "vulva" in medical circles. Most of the time I can pull this off with a strait face and nary a twitch. Luckily I have mastered a thoughtful expression involving me biting my lower lip whilst nodding and going "Hmmm..." which passes for careful consideration of the medical conundrum at hand, rather than an attempt not to either grin widely or burst out laughing. ("Purse"?!? I ask you!) If I fail in this - which occasionally I do - people are generally mollified by me saying (so long as I can do it with a friendly smile and a twinkle), "I understand exactly what you are referring to - I've just never heard that particular term before. Good one!"

Then there are the other oddities. For some reason, about 30% of people tell me about problems they've observed with their dog's "back hips" (as if there were "front hips" to compare to). Likewise, we often get requests to examine the "front shoulder" (as if there were back shoulders) or the "back rear leg" (is there a front rear leg no one told me about in vet school?) I kind of get this too. For instance, my techs are constantly tweaking me for referring to the "back leg" of birds. They patiently remind me that birds have WINGS in front, not legs, so there are only TWO legs to choose from, not four. I DO actually know this - promise! - but habits die hard. I'm thinking "pelvic limb", for which my usual and owner-friendly term is "back leg"; sometimes I just reach in the "pelvic limb" box in my head and pull out "back leg" even when talking about birds. My bad.

So those all make a certain amount of sense to me, even if they do amuse me at times (especially that thing where I say "back leg" about birds. I don't know why this cracks me up when I forget and say that, but it does.) Not everything makes as much sense to me, though.

One time a dog was in for a surgical procedure, and it was noted to have a very large mat behind each ear. We shaved them off - these pull mercilessly at the underlying skin, and create infections by trapping moisture and bacteria against the skin, so it's a big favor to the dog. The owner was enraged. They thought that the mats were extra ears, and that their dog had a unique mutation that made for four ears. I ask you. Did they not notice that in its original form the dog only had the normal number of ears? Did they think their dog just suddenly decided, as an adult, to grow more ears? It's not a starfish. It's a dog, and dogs don't spontaneously grow extra ears. And worst of all, did they never LOOK at the mats and recognize them for what they were?

Yesterday Dr. G had a client come in asking him to examine their cat's dew claw. If you didn't know, the dew claw is the thumb, the pollux, the first toe, the little claw on the inside of the foot, the one above the other four toes (always assuming a normal number of toes.) Some dogs have this removed in the first week of life; this is very common in sled dogs, for instance, since booties rub on them and make a giant mess out of them. It is also not uncommon on hunting dogs that work in rough terrain where the dews can get caught or torn, injuring the dog. Some people who breed show dogs or pet dogs also routinely remove the front dews (and in nearly all breeds the back ones are taken off, if present, even if the fronts are left alone; the rear dew claw is generally not a normal toe and unless the breed standard requires its presence - as in Pyrenees, for example - the dog is generally better off without them, as they very often create a problem by getting caught on things or being a nail-trimming pain in the rump.) My personal opinion is that unless the front dew is likely to cause the dog a problem - as in deformity of the toe, or in sled dogs or other working dogs where the dew would be an issue - it should be left alone. It is a functional toe, and in dogs that do a lot of lateral movement (like Border collies or any agility dog) or dogs who make turns at speed (like any sight hound, and many "other breed" dogs who love to run and do it fast) it engages the ground and stabilizes the foot, minimizing the risk of toe dislocation. But I digress.

At any rate, the clients come in and ask Dr. G to examine their cat's dewclaw. Obligingly, he has a look at it. It seems perfectly normal, as he remarks to the client.

"No, no - it's on the OTHER side of the foot," the client says.

Well, no. It's not. The dew claw is always on the medial side, toward the midline of the cat. If there's something on the outside of the foot, it might be any number of things, many of which would be cause for concern - but one thing it unequivocally is NOT, is a dew claw. It turns out it's an abscess, already ruptured, with the fur cemented to the skin in a hard carapace, including two small spiky projections, stiff as paper mache`, that the owner (not understanding the anatomy) has mistaken for a dew claw.

The same day I have a dog in that the owner says needs a wire removed from its mouth. The dog got its foot caught in the chain link fence and commenced to trying to chew himself free. The owners, discovering this an unknown span of time after the onset, cut the dog loose from the mangled chain link. But the dog's mouth was making a strange clinking noise, as from metal chiming against teeth.

I examine the dog - a cheerful, strongly-built Labrador - who is remarkably cooperative about me prying around in his mouth.

"Hmmm, let me borrow him to the back for a minute, where I have some instruments that might help," I say, having ascertained the source of the problem. The dog happily trots to the treatment area with me, where he is persuaded to plunk his muscular hindquarters (that would be the back hind legs, if you're confused) onto the floor. I grab a tissue clamp and, with the redoubtable J holding the dog's mouth open for me, extract a large slab fracture off the surface of the carnasial tooth. Inspecting it, I learn two things: One, the tooth is fractured into the root. Two, this is an old fracture, as the root is already discolored, indicating that it is many many days from the time of the original fracture. The fence-chewing has just displaced it.

About then, Dr. S comes in. "Is that the wire-in-mouth dog?" she asks. I nod. "What kind of wire was it?" she asks.

"Wire made of tooth," I tell her, holding up my slab of carnasial. She gives me an incredulous look.

"Why did they think that was a wire?" she asks.
"Probably didn't look at it; it was making a sort of metallic chiming noise," I say, demonstrating by tapping the slab against the counter. For whatever reason, the tooth slab does make a musical ching that sounds exactly like a bit of metal pinging on the counter.

I go show this to the owner, advising them that the dog needs the rest of the carnasial tooth extracted; the open root canals are a source for infection, which means an abscess is pretty much guaranteed. Marvelling, the owner takes the musical tooth fragment, making an appointment on their way out for the tooth extraction (for which they do not show up.) Oh, well. Guess I'll see them during the next year or so, when the tooth abscesses. Poor dog.

On Monday, Dr. G gets to see a dog who is being brought in because it has a ball stuck in its throat. Really? And it hasn't suffocated? Reasonably enough, my receptionist SS asks if they're sure there's a ball stuck in the throat. Oh, yes, she is assured. The owner can see it. However, the dog is perfectly happy, in no distress, and wandering around under its own steam. SS is even less convinced that it is a ball in the throat, as this is likely to be life-threatening in short order, if not fatal. But the owner insists that they can see the ball. Okay, then. Bring it on in.

Two hours later, Dr. G brings back a dog who has a large swelling on its jaw. I can tell at a glance that it's a nice big juicy abscess.

"Ooooh, nice abscess! You lucky brat," I tell him, because I love abscesses.

"This is the ball-stuck-in-throat dog," he tells me. I goggle at him.

"Didn't the owner say they could SEE the ball stuck in its throat?" I ask.

"Yes," says Dr. G. "It was the owner's sister who looked at it and swore she could see the ball in its throat. The owner didn't even look, just took her word for it. She's pretty mad now, because she thinks here sister made her look like an idiot." Dr. G looks as though he thinks the owner has a valid point.

I look at the dog. It has short hair. There's absolutely no question that the swelling is NOT in the mouth, it's on the outside of the jaw. I can't figure out how anyone could even begin to mistake that for the back of the throat. After all, the owner AND her sister both themselves posses a throat. I'm virtually certain that both of them have at least once in life swallowed something - say, food. Now, maybe I'm wrong, but I'd just about bet that on its course down the throat, their food did NOT suddenly form a large round swelling on the outside of their jawbones. Of course, I didn't watch them eat, so I could be wrong. I'm just basing my assumption on several decades of swallowing food and drink (and once, accidentally, a marble) and never once having a baseball-sized swelling - or any other sized swelling - appear on the side of my jaw. Now, I know you'll think I'm bragging, but I'm fairly certain I was aware of this even before I went to vet school. I know! Amazing!

Sigh. Just another reason why it pays to know your anatomy.