The Perils Of Pepper

So you may recall me mentioning Pepper, the dog of my BF, the dog who introduced me to Border collies (and thence induced me to fall in love with them), my step-dog. Pepper is, as they say, a classy bitch. She is a full-on, working-bred stock dog, serious and intent when it comes to work, disinclined to suffer fools gladly, yet always ready for a game or a cuddle. She is friendly enough to people in general, but has her favorites, and will quickly abandon even a good game with a stranger in order to spend ordinary time with one of those she likes best. She is kind to her sheep without letting them push her around, she is bold and willing to conquer new skills, she is tireless as a sidekick. There is in her amber-brown eyes an undeniable courage and intelligence, and behind the quick mind and strong will is a sweetness that is offered only to those she deems worthy of this regard.

I will say that in her youth Pepper's idea of cuddling was more of a casual affair; she liked the attention, all right, but should there be any hint that something more interesting was in the offing - say, a game or a trip in the truck or airplane, or a chance to go to the sheep - she would without hesitation abandon the petting and be off like a shot onto bigger adventures. She liked her cuddles for a few minutes, and then she was done and would go off and do something else, and sleeping on the foot of the bed was a "sometimes-only, and only if you don't move around too much and annoy me" kind of proposition.

Pepper is 13 now, though, and she's mellowed. She's still up for a game or a trip in the car or a go at the sheep (although encroaching deafness makes this less useful and more dangerous to her than it used to be), but she's become more judicious. Instead of following me everywhere, for instance, or racing up or down the stairs should I look like I'm even thinking of going that way, she positions herself strategically in the house so she can watch me go from room to room, and only gets up to follow if I call her or if I do, in fact, do something interesting. She's more inclined to sleep on the bed, and significantly more into the petting and cuddling than she used to be. Fools don't bother her as much as they used to - although she is still capable of expressing, at a glance, the most profound disgust imaginable, should some ill-mannered puppy or other time-waster cross her trail.

With age has come its rewards, of patience and restfulness and the pleasure in simple things. But age has its down sides as well.

Early in the year, while D was out of town (and hence Pepper was staying, as she does when he is gone, at my house), I happened to glance over at her, curled on the futon while I was working at the computer. Nothing amiss; she was sleeping, her feet tucked under her chest, cat-like, her head laid on a dog-pillow I had there for just that purpose. But I glanced back a second time and a third, wondering: What is it that's bothering me about this? And on that third glance I saw it: her left wrist had a small asymmetry to it.

Hmm. Pretty subtle. Am I making that up? I got up and disturbed Pepper's rest by stretching out her leg and having a look. No, I'm not making it up. There's a mass there, maybe 6 millimeters across, maybe 3 millimeters thick, adherent to the underside of the skin, but otherwise movable. Thin, but distinctly different from her other tissues.

Well, hell.

I emailed D in Hong Kong (or wherever he was at the time) immediately and received his prompt permission to do whatever I thought was best. So the next day I took Pepper to work and aspirated the mass. Under the microscope I found a number of cells, varying in shape, but all with some disturbing features. Some had a prominent chromatin pattern, some had two nuclei, some had multiple nucleoli (all of which, I assure you, are not normal-cell features, and all of which are disquieting.) But I am not a pathologist, so I sent a slide off to be read by one. The report came back as a mesenchymal cell tumor of some type undetermined... but definitely a malignancy.

Damn. Pepper, my darling, beloved step-dog, who I adore so much and to whom I owe what can never be repaid, has cancer. Pepper, D's only dog, his perfect sidekick for 13 years. He loves that dog.

So I gave the results to D and we talked over what to do. At my urging we talked to the surgical specialists in Anchorage, in case they had better options for her, and because I knew they would be able to be completely objective - a task I was not certain I could accomplish perfectly, given my emotional involvement with the dog. The good news about her tumor type is that it is one that is unlikely to spread to other body parts. The bad news is that it tends to send tendrils out from the main body of the mass, making it difficult to get clean margins, especially in that position: there is precious little tissue to spare on the wrist, a high-motion joint with relatively tight skin. I was uncertain that I could get clean margins (short of amputating her leg), and I wondered if the surgeons might have a better shot at that.

The surgeons were excellent, as I knew they would be, and advised D clearly, giving him his options without the blurring of the line that I feared my emotional involvement with Pepper might entail. Ultimately their advice was essentially identical to mine - although they were able to answer questions about skin grafting that were beyond my expertise - but I felt better knowing that I wasn't giving D options that included an emotional bias.

Ultimately, the decision had to rest with D - Pepper is his dog, after all - and he elected to have the surgery done at our clinic. He left it to me if I would do the surgery of have Dr. J do it; in the end I asked Dr. J to do it. He has 30 years' experience on me, and while I might have done as good a job, I didn't want to leave that to chance. I wanted Pepper to have the best shot we could give her.

So, accordingly, Dr. J excised a long oval from the medial aspect of Pepper's wrist, including the tumor and as much associated tissue as he could reasonably take without compromising the joint or the circulation to her foot. That meant that it was not possible to close the skin entirely; even if you could stretch it that tight, doing so would constrict the circulation and the foot would slough, so some of the incision had to be left open. That left a line of sutures above and below the open area, under some tension, and an open area about the size of a quarter over the highest-motion part of her wrist. I set a splint on the leg to keep the wrist strait, to avoid popping the sutures through excessive motion. The wonderful and artistic J looked at it critically and said, "Do you think D would object to hearts on Pepper's splint? It's February after all, and then it would be a Valentine's splint."

"D isn't sentimental about Valentine's day, but I think it would be adorable," I said, settling the matter for J. "But we'd better put an airplane on it, too, so it won't look too girly when D takes her to the hangar. I don't want all the other little dogs to laugh at her because her mother dresses her funny."

So J cut out Vetwrap hearts, and I made a Vetwrap airplane, and we applied them to her splint while Pepper was waking up from her anesthetic.

Pepper adapted with surprising speed to her splint, learning immediately that she could scoot it along the floor in a rapid shuffle instead of picking it up and clunking it down, for which reason she was as mobile post-op as she was pre-op. I sent her mass off to be checked for margins and a more concrete diagnosis, and Pepper went scooting about her days in good cheer (although she was not a giant fan of the plastic galosh that had to be applied when she went outdoors, in the interests of keeping the splint dry). The histopath report came back a few days later: big margins to the sides of the mass, narrow margins to the deep side - but clean. That's good news, much better in fact than I expected. That means there's a decent chance the surgery was curative.

Meanwhile, Pepper had a splint change (a different airplane this time) and then graduated down to a lighter wrap. This was a bit confusing for her; at first she walked on three legs, waving the now-un-splinted leg in the air as if uncertain if it was okay to use it without the splint. Once she began using the leg, she was lame for several days (as a consequence of being in the splint, which enforces different weight-bearing on the limb, over-flexion of the shoulder and under-flexion of the wrist). Having already had an underlying subtle and intermittent lameness of the shoulder on the operated leg, that was more pronounced than I had hoped, but she grew more and more sound as she went along in the lighter wrap. Now she is back to normal gaiting on that leg - and as for her surgical incision, you can see for yourself.

Yesterday, when we were hammered with snow, she spent the afternoon running around in it, biting snow, chasing my big Finn dog through the drifts and making him behave himself - no mean feat, I assure you. He's a big goofball. He can't help himself. Luckily Pepper is equal to the task of getting him lined out and making him act right. AND she wins the Queen-of-the-mountain competition every time.

Pepper likes to bite the snow.




Sometimes the snow bites back!

Ha, ha, you missed me!

I am Queen of the Mountain, neener neener boo boo! (The mountain in this case being a great huge snow berm from plowing runways on the lake.)

Not bad for thirteen, eh?

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.

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....

Moose Tales and Farewell Trails

So today, a client calls in to tell us she needs her dog looked at because she woke up this morning to find it entangled in its runner cable with a moose.

Yikes. This doesn't sound good. Moose are large and (potentially) quite dangerous and have been known to stomp people - let alone dogs - to death. By and large moose are peaceful, if left alone, but if you piss them off, you'd better be carrying a gun or be really fast - or really lucky.

This is a picture of a cow moose and a pair of week-old calves. I apologize for the graininess of the pictures, but because I don't have a death wish, I took this photo from my second floor window (through a window screen) rather than trotting down to the driveway and asking her to pose. (It was also between 10:30 and 11:00 at night, and my film wasn't quite fast enough for the conditions.)

That's a 55-gallon drum in front of the cow, which she could probably step over without scraping her belly.

The next two pictures (which I took from my back porch, inside the relative safety of my six-foot chain-link fence) are to try to give some perspective; that's my Dodge Sport Cab that she's dwarfing in the driveway (this is a mid size truck, the top of the cab of which is about 5 feet high.)

Mooses is tall!

(Okay, I admit this one is just here because moose calves are sooo cute.)

So, this may give you some sense of my trepidation. I'm wondering how the woman managed to get the dog disentangled from the runner cable so she can bring it in, and if it will be reparable. But when the dog arrives, it walks in under its own steam. I ask the woman how she got it away from the moose.

"The moose untangled itself from the runner somehow," she tells me. "My dog was just laying out there and I thought maybe she was dead, but as soon as the moose walked off, she sat up. I think the moose walked into the runner in the dark and got snarled up, and she tore the runner down and got tangled up in the cable."

I do my exam. Miraculously, the dog has very few injuries. She has a small hemorrhage in the white of one eye - possibly from being kicked, but I can find no bruising in the surrounding tissue, so I suspect it's more likely from being choked by her collar while the moose was thrashing around in the cable. This is consistent with the other injury the dog has, which is a sore neck, which she is (unsurprisingly) reluctant to flex. Her chest is clear, she has no lacerations or fractures, no lamenesses, no neurologic deficits and no broken teeth. This is a lucky dog. I prescribe some pain medication and ask the owners to keep her off a leash, collar or runner for several days until she heals. About this time I notice that the owner is sneezing.

"Are you allergic to her?" I ask. The owner, still sneezing, nods. This explains why the dog was overnighting outside. "Urk, sorry about that," I tell her. "Can you set her up inside?"

"Yes, we'll figure something out," she smiles, sniffling. I certainly hope so; we've been in the room for about 10 minutes, and she's already watery-eyed and congested. Doesn't sound like a fun time ahead for her. I hope she has some good antihistamines.

So this is a moose story with a happy ending. The moose appears to have escaped unscathed and none the worse for wear, and while no doubt shaken up and a bit sore, the dog will be fine in a few days. Not all of them work out so well. The last patient I treated for tangling with a moose was a dog named Toby, who I also saw today. Toby had about a million things go wrong with him in his life; I first met him after a bite wound to his tail had become infected, which resulted in the amputation of about a third of it. Unfortunately, the infection had already spread to his legs, so as a consequence of that he lost a couple of toes about 2 weeks later. He healed up, eventually. But about a year later he developed thyroid disease. However, we stabilized him and he did well for quite a while, apart from some minor dings and boo-boos, and a little touch of arthritis developing in his later years.

Then one day Toby came in swathed in a bloody T-shirt. His owner had come home from church the previous morning and found poor Toby (who was out on a runner in his yard) trying to climb the side of the house in an attempt to escape the moose that was kicking him half to death. She managed to chase the moose off and rescue Toby. He was bleeding from a laceration under his right arm, so she folded up a T-shirt as a pad to absorb the blood and bound it under his arm using an ace bandage wrapped around his chest and criss-crossed in front of his shoulders. This assembly she covered with another T-shirt, tied at Toby's waist aerobics-bunny style to prevent him from walking on the hem of his shirt. He looked kind of CSI stylish in a slightly grisly way, actually, what with the blood stains and all, though (not surprisingly) he was moving a bit gingerly.

So, I took Toby's T off and unwound the ace bandage. The lac immediately began dripping blood. Hmm. This injury is almost 24 hours old, so I'm a bit surprised that it's still actively bleeding. I get a little closer look. There's a ragged tear, bruised along the edges, edematous, but not apparently infected. Just as I'm thinking Toby may have gotten off light, Toby takes as step forward to sniff and the trash can and I hear a moist sucking noise. Oh, crap. Could not POSSIBLY be. This dog is walking around perfectly fine, and has been for 22 hours since he was injured. His color is good. He has no respiratory distress. On auscultation, I can hear airway sounds all the way down both sides of his chest. So he can NOT have a sucking chest wound.

I tell Toby's mom that we'll need to suture him up, and I'll need to get a closer look at the wound before I know the extent of it. She readily admits him to our care and I replace his T-shirt and ace bandage bandolier to hold him while I make space for him in the surgery schedule. Once we anesthetize him and we have his airway under control, I take off his bandolier. Silence. I gently shift the flap of lacerated skin behind his arm about a half inch to the rear. Big sucking gasp as air rushes into his open chest. Toby's color immediately goes south. Crap.

I start bagging him and the tech starts prepping. I still can not believe that Toby's been walking around for a day with only a T-shirt pad and an ace bandage keeping him from dying of a pneumothorax. Not just walking around, but eating and drinking and peeing and pooping and generally leading his usual life, albeit with a slightly ginger gait and a new wardrobe.

Toby goes into surgery and we open up the laceration, lengthening it so we can expose his chest wall and assess the damage. There is a broken rib there - cracked in three places - and biggish tears in the muscles on either side of it. Miraculously, there are no injuries to the lungs themselves, apart from very mild bruising. Hmm. Turns out the easiest way to fix Toby is going to be removing the broken rib - and the lacerated muscles on either side of it, which are mushy and fragile from the crushing force of the blows - and wire his chest back together, one rib shorter. This we do, a tech patiently breathing for Toby while we wire his chest back together and chase the free air out of the space around his lungs, where air doesn't belong. Once we seal up the soft tissues, Toby is breathing well on his own and his color is good. He recovers without incident. I can't believe this dog. He's eleven years old, is hypothyroid and has undergone multiple surgeries, and is missing several of his original parts (such as his testicles, two toes, about a third of his tail, and now a rib.) He's just has the crap kicked out of him by a moose and he's juuuuust fine. Perfectly happy. Thanks for the stitches, and can I go home now?

Toby did great after that for about a year. Then, being Toby, he developed renal insufficiency. But, being Toby, that was not enough to kill him. He toddled along - on his 16 remaining toes - pretty happily on supportive care. I put him down this morning, sadly, because he had abruptly lost the use of his back legs. He was almost thirteen. I don't know if he had a disc blow out (perhaps in consequence of the old trauma of the moose attack, or for some other reason) or if it was more orthopedic than neurologic; his owner, understandably, decided not to pursue it in view of his age and other disease.

I'll miss Toby; he was a good old man, tough and resilient and apparently unfazed by the vicissitudes of his eventful life. I know his mistress will miss him a great deal more. I can never see her without thinking of him; they're kind of a pair, stumping cheerfully along in a sort of calm, hopeful way, with their bright gentle eyes and prosaic manner. I hope she can find another puppy; she's one of those I think really has a gap in her life without a dog.

There won't ever be another one like Toby, though. Happy trails, old man. We'll miss you.