Geri

This one is different. It is not a well-thought out blog post, with a coherent argument to make (so, in that respect, it's just like all my other posts). It's a lament for a friend. I'm not writing it for any reason that I need to write about it, so please indulge me, nod and smile. Feel free to back away if I get a little crazy.

Geri died today. It's strange to write it. I've known it has been coming for so long, and I have been on the other side of the table so many, many times, that you'd think I would understand it. But I don't. The sentence at the start of this paragraph makes no sense to me. But still, Geri died today.

It seems to be a cruel trick of the human brain that, on some level, we simply don't get death. We are aware that it happens - we can even take in the knowledge that it will, sort of probably, happen to us some day. But still, we don't get it. It doesn't make any sense. That personality that was such a vivid part of our lives, that was always there - it can't just be gone, can it? I mean, sure, we know they're dead, but... y'know... where are they? It doesn't make sense.

As I write this, it's raining outside. We buried Geri in the orchard. There's a part of my brain that is screaming at me that I've left Geri outside, alone, and it's cold, and she'll be scared. It's very, very hard to silence that part of my brain. This is what I mean. We just don't seem able to process it on some fundamental level. Maybe that's what grieving is. Geri is dead.

How can death have visited our happy little family? Its got no right. Sure, I've killed hundreds, thousands of animals myself. But Geri? It doesn't make any sense.

Geri was found as a stray in Exeter in 1997, and taken to the local RSPCA kennels. Being her naturally charming self (read: tart) she was quickly rescued and rehomed to a family in Totnes. Being far, far too clever for her own good, she quickly established dominance of the household and enjoyed a rule-free life of doggy leisure and luxury matched only by the Emperor Trajan's toy poodle in the first century AD. Her debauched lifestyle led to her being speyed at her local vets a year later, after a brief but eventful dalliance with the dog that lived upstairs. Though neither of them knew it at the time, this is where Geri met one of her future owners - a fresh-faced young vet student by the name of Kerry.

Fast forward a year, and Geri's career as Imperator of Totnes was, unbeknownst to her, drawing to  a close. Her owners, growing tired of Geri's habits of rolling in badger poo, jumping up to lick small children's faces no matter how muddy her paws were, and stealing other dog's property (they had to carry money on their walks to pay anyone whose tennis balls Geri took a fancy to, because once she grabbed it she developed acute selective deafness and galloped home to add it to her growing pile) had deemed her 'unhandleable', and were looking for an unsuspecting home upon which to land this dog with ideas above her station.

Which is where I enter the story. I graduated as a vet in 1999, and as it happened, I had just moved in to my unsuspecting practice home in Bridgwater (yes, I spelled it right; don't ask me why there's no 'e') and, having just taken on possession of the feline equivalent of Hannibal Lecter (you'll get your own blog one day, Vienna, I promise!) I had foolishly voiced the notion that I might one day 'quite like to have a dog too').

One chance encounter with Kerry and Geri's owners in Totnes later, and I soon found a brown and white lurcher being pointedly offered in my direction, complete with cow eyes, a sob story, and a heavilly edited history that skimped over Geri's more megalomaniac traits.

So, Geri moved in with me in the latter months of the second millenium (and don't go on about it not starting until 2001 - it starts whenever we said it does, okay?) and... was wonderful. 

It was a shock to both of us, at first. I didn't really feel ready for a dog, and Geri certainly wasn't pleased about the hassle of having a new subject to have to break in. Unfortunately for her, I was fresh from my animal training classes, and was keen to put the theory into practice. It was a titanic battle of wits. It quickly became apparent that Geri had more wits than I did, but fortunately, I had back up - Kerry, my then girlfriend, was still having her animal training lectures. Between us, we finally managed to iron out the most anti-social of Geri's numerous traits - at least when we were watching.

Geri was also horrified that she had to share her new house with another canid - Kerry's wonderful, but not necessarily bright, greyhound, Beattie - but eventually they settled into a relationship similar to that of Pinky and the Brain. You never did manage to take over the world, Geri, but I suspect you came close - behind my back, of course.

Geri was with me for the first few years of being a vet. Those were hard years; I was depressed, disillusioned and mostly unhappy. Geri was one of the bright spots in my life during those times. It's hard for me to write more about that, today, of all days, but... she helped a lot. She was the first dog I ever owned on my own, and she's been with my my whole career.

Three years ago, we started to notice that Geri was struggling walking up hills, especially on hot days. We realised that she had developed laryngeal paralysis, and when we took her to a referral practice, our surgeon told us that it was part of a larger neuropathy that would also gradually affect her hindlimbs, called geriatric onset laryngeal paralysis polyneuropathy (GOLPP). With this in mind, we opted against surgery to open up her larnyx, because we knew there was nothing that would help her legs. We didn't think that we'd have her for very much longer. Every month seemed a bonus, but she was dextrous, and smart, and she coped with the progressive disease. It started to rob her of her continence, but Geri was always a pikey little bugger, and didn't really mind wetting her bed once in a while. We got her dog pants, banned her from the sofa, and despaired at the occasional (eventually frequent) messes on the carpet. But she was happy.

Which brings us to yesterday, when Kerry first noticed the swelling on the side of her face. By the evening, her face was twice the normal size. I rushed to the practice to get some medication, hoping that it was just a tooth root abscess, and would start to settle by today.

This morning, the swelling was on both sides. I tried to take her for a walk, and Geri - my naughty little Geri, terror of white clothes and cat food hidden 'out of dog's reach' on tables everywhere - collapsed in the field, and looked at me.

We knew. It didn't matter what the cause of the oedema was. We knew it was time. So, after a few brief teary hours at work, we came back home, to found Geri lying in the same place we'd left her. Half an hour later our poor colleagues arrived (thank you so, so much, Emma and Leanne, and we are so sorry what we put you through) to do what needed to be done. Within an hour, we were burying her in the orchard.

We were lucky, so so lucky, to have such a wonderful dog for such a long time. She helped me through a lot, and she... well, she made it easy for us, in the end. We didn't think she would, but we knew it was time. She died with three of us tickling her. Not as many as she would have liked, because there never were enough tickles in the world for her, but I hope, perhaps, enough. It's unfair of me to feel cheated by this, when so many people have endured so many worse things, so much more unfair. Geri had a full life, and she went peacefully. I should be content.

Here's a few of the things that I'll never again experience -

Her strange wookie-like howls of pleasure when she knew it was time to walk

Her complete command of my tickling arm; she got so she only had to twitch one leg and glance in my direction to receive more cuddles

Those perfect little ears, and her grunts on pleasure when I massaged them

Her bouncing through long grass like a canine space hopper

That tiny little wet nose

Her propensity for eating seatbelts - never thought I'd miss that one!

Her swimming (only when she really had to)

Her sunbathing (even to the point of asphyxiation)

Her uncanny ability to push me off the best spot for sunbathing in the garden to steal it for herself

Her rare barks

Her honing ability to find anyone out on a walk that had treats in their pockets, and her charm to always - always - get a treat for herself

I could go on. Well, maybe that should be I should go on, but I can't. I can't piece any useful thoughts together any more. I told you this was just a lament. She was a dog, but the grief feels as real to me as anything I've ever felt. 

It's raining outside. Geri is dead.

It doesn't make any sense.

Approaching the station...

All right, I admit it, I'm running out of train-based puns for blog titles for The Express Diaries. I've still got 'off the rails' up my sleeve, but I'm hoping I don't have to use that one, to be honest. Anyway, it shouldn't be a problem, as this is a quick post to say that my latest novel, The Express Diaries, is at the printers. We've just signed off on the completed cover - want a peek? No? Tough, here it is.

Isn't it pretty? I'm so pleased with Eric's cover art. But enough ego-boosting for the artist, how about some for the poor writer, eh?

Well, as it happens, the Express Diaries has juts had it's first review over at Horrorzine, and it is, if I may use the vernacular, amazeballs.
(Am I using that word right? I feel I'm not using it right. Also, I've learned recently it really doesn't travel across the Atlantic very well. Don't worry, it's not in the book).

The review is from Dr. Kevin Hillman, and contains probably the nicest quote I've ever had in a review, which is...

'I would recommend this book to anyone, if only to show how writing should be done.' Horrozine.com

Aww. I'd better not read it again in case my head gets any bigger. Sadly it came in just a few days to late to plaster all over the cover in dayglo pink, which would have naturally have been my first choice. But don't take my word for it - head over to Horrorzine to have a peek at the full review. 

The Express Diaries can be pre-ordered from the 1st September from Innsmouth House, and we're expecting a release date of late September/early October. There'll also be an electronic version available on Amazon for all you cheapska... er... technophiles our there.

Right, that's enough from me for the time being. Veterinary blog to follow soon, I promise!

A load of BSL - Lennox, Dangerous Dogs, and Breed Specific Legislation

Okay, I admit it, I'm more of a dog person than a cat person. Now, I'm aware that immediately puts me at odds with the rest of internetdom - it seems you guys only need a quick picture of a cat doing something cute to keep you all happy. All right, you've twisted my arm - here you go.

Maybe it's that you have to look after dogs a bit more - I need to walk them, which, if not necessarily keeping me fit, at least keeps me moving. Maybe it's because my first cat was something of a psychopath. Poppet, our current feline friend, is much friendlier - she yowls for food, she rolls on her back, does all the requisite cute stuff, and a bit less pissing on the carpet than her predecessor.

With Poppet, I can see the pleasure cats bring (she still does pretty horrible things to mice, though). Anyway, the point is, I can see the appeal of cats, and furthermore I can see how dogs can be less appealing. They're smellier, and bigger, and, let's face it, some of them are pretty scary - which is a helpful segue, because scary dogs is what I've brought you all here to talk about.

Much as I like dogs, you see, I've often found myself at the pointy end of some which really didn't reciprocate my feelings. The problem with being a vet - a bit like being a postman, I suspect - is that it's one of those things that seems funny to people. 'Ho, ho, my dog bit the vet,' that sort of thing. The other problem, of course, is that I'm generally being horrible to the dog in question, which doesn't do wonders for our relationships. It might seem like a cliche, but I can't tell you the number of times people have said to me 'Well, he's never done that before!' with a suspicious look in their eye, heavily implying that the attack I have just experienced was probably my fault. When Hitler invaded Poland, I suspect that Neville Chamberlain said 'Well, he's never done that before!' with a similar expression.

So, dogs can be vicious. They can even be dangerous. Cats can too - I've got the scars to prove it - but they generally don't attack members of the public. When dogs do (as I think might have happened right before I started writing this post) it's a problem.

Lennox


If you haven't got sick of Facebook yet, you may have noticed recently there's been a lot of pictures cropping up recently of proud owners standing next to their dog/cat/lizard, and proudly proclaiming something along the lines of 'Tiddles was a wonderful Chinese water dragon for fifteen years, but today, SHE IS LENNOX'. It certainly confused the heck out of me when I first saw it, but I finally worked out what they're going on about, and it's a pretty sad tale. Lennox is, or was, a dog from Northern Island, that has become another victim of BSL - Breed Specific Legislation.

Now, I'm going to be honest here - I don't know a great deal about the Lennox case. I don't know just how aggressive, if at all, he was - he certainly hadn't attacked anyone. But I can tell you that the legislation that led to his demise and, by the looks of it, martyrdom, is a big steaming pile of doggy plop.

Breed Specific Legislation


Okay, it's probably time to talk about this BSL that I keep teasing you with. Breed Specific Legislation is exactly what it sounds like - legislation which is specific to a certain breed. In the UK, it is the Dangerous Dogs Act (1991), and it is this that is supposed to protect the public from violent dogs.

It doesn't. It can't. The basic premise is flawed. Four breeds are covered under this act (and I can still remember them, because I had to learn them for my public health exam) - the Pit Bull Terrier, the Japanese Tosa, the Dogo Argentino and the Fila Brasilero (okay, okay, I had to check the spelling of the last one. It's been twelve years, all right?). Now, it's entirely possible that you have never heard of three of those breeds. It's even possible that you might think I have got my exams confused and have started reeling of the names of dishes from a Michelin-starred restaurant, but you would be incorrect, they are actual breeds. The reason you might not have heard about them is that there haven't been any documented attacked by any of these breeds except the pit bull terrier since the act was passed. Yay! A success, tempered only by the fact that I can't find any evidence for any attacks by these breeds before  it was passed, either.

Still, don't get me wrong - all the above breeds are scary creatures, and you really would not want to meet any of them in a back alley on a dark night. You probably wouldn't want to meet them on a wide boulevard in bright sunshine, either. I once briefly encountered a pressa canary - a massive slobbery-tooth machine that was considered for inclusion in the act - and described my experiences in this blog post.

So, all the above being the case, what is my (and other people's) problem with the Dangerous Dogs Act, and similar acts around the world the like of which Lennox fell victim to?

Well, there are two pretty major flaws with legislation such as this, both of which have consequences that lead to suffering in the real world. My job is all about reducing suffering, and therefore this makes me unhappy, and has inspired me to write a blog with frequent usage of the word 'legislation' - which was never something wanted to do (and you're reading it now as well; more suffering caused by BSL, damn it!)

The first problem is, as those heroes at Monsieur Garnier's world famous laboratory might have it, 'the science bit'

The Science Bit - Breeds and Species


Let's take a step back for a moment. Forget about dogs. Let's talk about humans for a sec. You know humans, right? Funny pale ape-things. You've probably met a few around, they're fairly easy to spot, especially when it's sunny. I imagine you're pretty confident in being able to tell the difference between a human, and something that isn't human.

Here's a problem, though. I'd like you to come up with a definition for a human. Imagine I have a really, really big piece of chalk, and based upon your definition, I'm going to put everything human inside the circle, and everything inhuman - parrots, Frosties, Piers Morgan - outside it.

Easy peasy, you say. Humans reproduce with other humans, to make humans, don't they? Well, yes, they do, but there're a couple of problems with that definition. Firstly, it uses the thing you're trying to define as part of the definition, which makes things confusing. Secondly, it means that every child and infertile adult 'human' now has to stand outside the circle, in the inhuman camp.

Okay, let's try again. How about... a human is a creature that has the potential to mate with others of its kind to produce an offspring, even if it can't actually do it as an individual.
Hmm. Not great. How do you measure mating 'potential'? And also, how does this distinguish the human race from, say parrots?

Let's try a different tack. How about 'Humans are the only creatures that wear digital watches, ride motorbikes, and build atom bombs.'

Okay, we've got some merit here. I think it's fair to say that, at least on Earth, no other species has managed to construct an atom bomb, so you haven't got any non-humans sneaking into the circle. The problem is, we haven't all done that, so there's going to be a lot of humans standing outside the circle gazing in jealously at Robert Oppenheimer and his digital watch. The same applies to pretty much any technological innovation you try to use as your definition - there will always be some beings that you consider humans that get left outside, because they don't own a microwave, or can't read, or whatever.

How about genetics? There's got to be a good definition there, surely? Well, here's a basic biological fact - humans have 23 pairs of chromosomes. Shall we try that?

This time, standing outside the circle, we have everyone who has Down's syndrome, Klinefelter's syndrome, and anyone also who has a chromosomal disorder. Also, we've got a few plants that have managed to sneak into the circle due to their own chromosomal abnormalities.

Okay, at this point, let's do what any sane person would do - give up and look online. Here is the dictionary definition of 'human'

'A member of the genus homo and especially of the species homo sapiens'


Hmm. Cop-out, because now we've got to define 'homo sapiens'. Further googling and research could be done at this point, but I'll save you time... there is no line you can draw. There is no simple definition of human, and the reason is obvious when you think about it.

We have evolved, as we all know, from a common hominid ancestor - an ancestor that lived many millions of years ago (if, incidentally, you don't know this, then you really should read more; if you already know this but just don't believe it, then I'm afraid I'm going to have ask you to kindly fuck off, because we're probably not going to get along).

Now, going back to our circle of humans, let's think about that. I'm assuming that you all feel that your fathers, sons, mothers, daughters, brothers and sisters all belong in that circle, and I'm not going to argue with you (unless you're Pier's Morgan's father/son/brother/sister or mother). But think of the implications for our ancestors, slowly evolving into homo sapiens over millions of years.

At every stage along that long, long journey down through time, the hominds were able to breed with each other, and they looked and behaved, by and large, very much like each other. If you explained the circle to them, they would certainly feel the same about their fathers, sons, mothers, daughters and so on; you'd get the same opinion everywhere you went, until you reached a point where you could no longer communicate with the natives, and you'd have to observe them instead, and draw the same conclusion yourself.

The very, very laboured point I'm trying to make here is this - it may seem that the term 'species' is very, aheh, specific, and that it refers to a very definite thing, but it really doesn't. The only reason we find it so easy to tell the difference between ourselves and chimps (who happened to share a common ancestor with more recently than anything else currently alive) is because all the intermediates along the way are dead. If they were still around we would find the concept of a definite 'human' as hard to grasp as it really should be. That simple chalk line that surrounds our species is nothing of the kind - it's more of a gradation, a gradual fading away from humanity into another 'species'.

So, although we generally manage to tell the difference between apes and humans (uncomfortable encounters in nightclubs excepted), when you try and pin it down scientifically - or, more importantly - legally - you begin to realise it isn't a simple task. And we have all this trouble with species! Now try and pass a law against a particular 'breed', and you run into all manner of trouble.

I like to think that I can tell a westie from a daschund, but you could keep bringing me westies that had shorter legs, longer snouts, on and on until at some point I would just say 'Er, he's a westie cross, isn't he?' - and the point that I would say it is different from the point from anyone else. You simply cannot legally define one breed from another - no blood test will tell you, and no two vets, anatomists or breeders would agree every time for every dog.

Problem One

So, this is a major - in fact, to me, the major problem with breed specific legislation. I told you it caused real suffering, and it does. Here's what happens - in fact, this is pretty much what happened to Lennox, as far as I can tell (as I say, I don't want to go into the specifics, because I really don't know the case) - the dog warden, or member of the public, looks at your dog, which, whether it is a pit bull or not, has the misfortune of looking like a pit bull - and if this sounds unlikely, bear in mind that a lot of staffie crosses have something of a pit bull look about them. They get picked up, impounded and summarily put to sleep if the 'expert' who looks at them agrees that they are a 'pit-bull type'. If you don't want your dog to be put to sleep, you can challenge the opinion in court. Eventually your dog may be off the hook, but it will have had to spend many months if not years waiting in kennels for an opinion that is just that; an opinion. No one can possible prove that a dog is or is not a pit bull.

The problem is compounded by the fact that, because these dogs are banned, many people are not all that sure what they actually look like. It's a not-infrequent experience for us to have the police, RSPCA or dog warden turn up at our practice asking 'Is this a pit bull?'. If we answer thought that it was, and no owner was present when the dog was found, the dog would probably be put straight to sleep, however friendly/aggressive or otherwise it was (I say 'probably' because I've never had occasion to find out; I've always explained the impossibility of making such a judgement call). Experts, as mentioned about, measure the dog against fifty-seven or so different traits to see if it fits into what we class as a 'pit bull'.

So, we get to the crux of the problem - BSL is legislation that is based in appearance, not demeanour. In effect, the Dangerous Dogs Act is really the Dangerous-looking Dogs Act. The first downside of this is, as we've already discussed, that dogs that happen to look a bit like pit bulls are unnecessarily destroyed or at least put through great suffering, much to the distress of their owners.

Problem Two


Now, if you've made it this far, you've probably figured out the second problem by yourself. No one has been attacked in this country by at least three of the four dangerous dog breeds since 1991 (and, quite possibly, ever). People are, however, still getting attacked by dogs.

Here's a study from 2008 in America about the breeds most likely to bite you. It's a teeny bit dry and wordy, and studies like this are notoriously difficult to do, but cutting through the chaff, you can find the breed most likely to bite you. You know what it is?

The daschund. The loveable sausage dog. Closely followed by the chihuahua. Now, fair enough, these breeds aren't often represented in serious dog attacks, for obvious reasons - that is still reserved for the pit bull. This site has a better overview of dog attacks, referencing the original papers if you're interested in looking into it further. The point I'm trying to make is this; dog attacks still happen, and they are very frequently from breeds not considered 'dangerous' - it might seem funny to be attacked by a daschund, until your Achilles' tendon in severed by a lucky chomp when you're trying to get away from it.

The dangerous dogs act makes no provision for any of this. It certainly takes no action to stop these things happening. With an amendment in the legislation, breeds can be added to it, or even individual dogs in extreme circumstances - and these are the circumstances you'll probably read about in the paper.

So, the basic problem is this - the Dangerous Dogs Act (1991 amended 1997), along with all Breed Specific Legislation - is based on a fundamentally flawed premise. It leads to dogs being put to sleep unnecessarily, and fails to recognise that there are many dogs out there that are a danger to the public but that don't happen to look much like a pit bull terrier.

Solutions


I do enjoy my moaning - you may have noticed - but I like it do be at least productive moaning. Can anything be done to help the situation?

Here's a very obvious point - it seems absolutely crazy to me that an anatomy should be the key decision-maker into whether a dog is dangerous or not. Surely the more important characteristic is whether the dog is, y'know, dangerous. Behaviourists should be making decisions like this, not anatomists. I understand that there are certain breeds that can be more aggressive than others, but this is trying to solve the problem from a step behind. The legislation should have clear guidelines, drawn up by behaviourists, not lawyers, about the kind of traits that make a dog unacceptably antisocial in our society. If they're taken in, then they should be tested for these warning signs, with and without the owner present, and taking into account the fear and stress the animal is under.

Also, let's not be unrealistic here. We've all heard that there's no such thing as a bad dog, but a bad owner. Now, I have met a few - a very few - genuinely scary dogs that I couldn't imagine any amount of training could ever have fixed, but they are very much the exceptions to the rule above. If we allow dogs in society, then some morons are going to either ignore the warnings that they need better control over their dogs, or they're going to actively train them to attack. There will always be dog attacks (whether they are on the increase or not, is, incidentally, quite difficult to prove, despite what you may have heard in the media. See here for a quick discussion) - all I am asking for is legislation designed with the problems I have outline above in mind; legislation which isn't a rush job (the DDA of 1991 was hurried through parliament after a spate of dog attacks) and which, if at all possible, please, does the frikkin' job it is supposed to do.

Today, I am Lennox. Hope you are too.

Visiting Hours

Boil a vet's job down into it's very basic components and you're left with three parts; the elementary particles of veterinary life, if you like (incidentally, please don't boil a vet down into their basic components; you'll just end up with a nasty-smelling soup and an unhappy vet). These three fundamentals of the job are 'consults', 'ops' and 'visits'. I've talked about consulting and operating a few times before (here and here, for instance) but it's the last of the three that I'm going to talk about today. The dreaded visits.

(While I think about it, you could argue that there is a mysterious fourth particle, the OOH particle, representing out of hours (emergency) work - but I would suggest that instead all OOH is merely a dark mirror of the basic work; the veterinary equivalent of anti-matter - for every consult, there is an OOH consult. I'm getting a bit carried away with metaphor, aren't I? Must be the coffee).

So, visits are the part of the job where you leave the practice and visit your patient at their home. So...dreaded? Why dreaded? Why when a visit pops up on the board does that procedure you've been trying to avoid all day suddenly look a lot more attractive? (A visit? Oh, I'd love to, but, erm... well, I've got that constipated cat that I really need to clean out. Shame.)

Well, as with anything in life, there's pros and cons to visits. Let's do the cons first - I'm that type of person, you see.

(And I should point out at this stage that this blog is written from the perspective of a small animal vet; it can't help but be, because that's what I am. I'll just mention here that for a large animal vet (or the increasingly endangered 'mixed' vet) much of this doesn't apply, as their whole job consists of travelling from visit to visit, with brief trips back to the practice to scrape the worst of the cow shit off. Their visits are a little different though, as they are often to people that they already know and have visited many times before, and are often combined with some kind of surgical procedure (usually on the patient) and

First up - finding the place. People live in the craziest places - on top of hills, beside rivers, squeezed into the tiniest possible gaps on housing estates. Couple this with many people's complete inability to give directions to their own home, and you have a problem before you've even pressed the doorbell (I don't exclude myself from this group - never ask me directions to my house. I seem to notice landmarks that mean nothing to normal people. 'Go left after the tree that looks a bit like a pirate, and you'll come to a scary wood that would be a great setting for a ghost story...')

This isn't so bad if you're just heading out to clip a puppy's claws, but I have uncovered a hitherto unknown physical law, which states that the later the hour and the more urgent the call, the harder the clients house will be to find. Writing this, I can think of many stressful middle-of-the-night calls attempting to drive with an A-Z on my lap, swearing at the car, the map, my legs and life in general. Of course, now everybody has SatNavs, so complaining about this makes me sound as bad as someone moaning that there has been no good music made since 1994 (but seriously, have you heard what they're listening to nowadays?), but SatNavs are neither infallible nor particularly good at calming you down when you're stressed, so the problem still periodically raises it's head.

Secondly, people. I suspect that it won't be news to my readers if I suggest that people, although many of them can be caring, compassionate, big-hearted, generous, grateful and charitable, are, more often than not, just plain weird; and if they're weird when they're in the bank or doing their shopping, then that weirdness is likely to dramatically increase when they are safely back in their houses, away from the judging eyes of the rest of humanity (and if, incidentally, you don't understand what I'm getting at, then I'm afraid there's a fair chance that you're one of the people I'm talking about).

Partly this is a problem because you're out of your comfort zone on a visit, away from your safe consulting room where you know where the thermometer and hand wash is, and in a place where you don't know what the sticky patch on the floor is, or what that peculiar smell is, or just who that person is at the back who isn't saying anything, but just staring it you wearing only a towel. If I say that the village closest to my first practice had 'twinned with Royston Vasey' scrawled across it's welcoming road sign in black spray paint, you may understand why I've become slightly nervous of visits.

As well a people who are a little...well, different, there's people who are just plain unpleasant. I've been personally threatened with violence a couple of times on visits. Both times I had been called out to put an animal to sleep, and arrived to discover that some members of the family disagreed with that decision. Sadly, in both cases it was the members of the family with the largest fists and the shortest tempers.

That last point touches upon another problem with visits; what you're actually going out there to do. In most situations, people will bring their animals in to the practice, and visits usually only happen when people are housebound with no way of getting in to see us, or if the pet is of such a personality that it gets in far too much of a panic when it gets brought in - this often means that the animals we're off out to see are more skittish and possibly more aggressive than those we normally see in the practice, and we're going to see them with less manpower (usually just one vet, or one vet and a nurse), and we're invading their home territory to boot. Not really a recipe for fun.

The other situation you'll visit an animal at home, of course, is when it is the last visit they will ever receive. Some people choose to have their animals put to sleep at home, in familiar surroundings, so that they don't go through the stress of being taken in to the practice. Who can argue with that? It's what I'll do for my animals, too - but it does mean that a high proportion of home visits are euthanasia visits. The lack of manpower can cause a few problems here, too. I well remember a time, a few years into my career, when I visited an elderly woman who lived in a large house in a seaside village to put her great dane to sleep. It was a Sunday afternoon, and that meant that it was just me, no nurses. The procedure went smoothly (the poor dog was very, very ill) but then we were faced with something of a problem - although I am, of course, incredibly manly and strong, I couldn't lift an eighty kilogram dog by myself. The old woman was almost bent in two with back problems, but she didn't seem worried.

'Just a second,' she said, brightly. She opened the front door and hobbled out to a man who was passing by. 'Excuse me,' she said. 'Could we just have a hand lifting something?' The kind stranger agreed, and it was only when he walked into the living room that he realised exactly' what the 'something' was. Poor guy. He took it in his stride, though, only looking aghast for a few seconds before he helped me carry the dog. I often wonder what he told his family and friends about that day.

It was while I was working at the same practice when I received a call from a man asking me to visit him to put his canary to sleep. It was, of course, a Sunday afternoon again, and I was extremely busy, so I asked if there was any way he might be able to bring it in to the practice.

'I can't get near it,' he said, sounding nervous.

'Er...right. Is it somewhere you can't get to?' I asked, thinking it might have flown up into his loft or something.

'No, no, it's outside the front door, tied up, but he won't let me get past him. I can't even get to the car!'

The mental image of a massive bird, all wide-staring eyes and saliva-dripping from its beak viciously pecking anyone who dared to step near it confused me enough that it took me several minutes to understand that the man was actually talking about a presa canary - an enormous mastiff-type dog several rungs higher than the Hound of the Baskervilles on the 'violent bastard' ladder, and about as far from a gentle yellow bird as it is possible to get without watching a horror film. It turned out he'd bought it from his mate down the pub, and now it wouldn't let him leave the house. In the end we had to enlist the services of a vet with a blowgun, who darted it into unconsciousness so that the deed could be done.

I can also sadly remember the many times I have visited people to put their pets to sleep, and taken them back to the practice with me. There's something awful about taking someone's companion away with you, and leaving them alone in the house. I do always ask if someone is coming round to keep them company after I've gone, but the answer isn't always yes.

So, there's a lot of cons about home visits - but there's a few pros, too. It gets you out of the mania of the practice for a little while, and it's always nice to have a breather. Secondly, and principally, it gives you a chance to be nosey - the same kind of nosey as peeking into people's living rooms as you pass them by (I swear that's half the reason my wife rides horses; she gets a much better view from higher up, you see). I think this interest stems from the nagging feeling a lot of us have that we are the weird ones mentioned above; that there's something not quite normal about our own households, and other people do it differently. Well, we're right. After an extensive study of other households over the years, I can reassure you all that you're right; everyone is a bit strange, and weird is actually the normal state of affairs. It's the normal ones you've got to watch out for.

Well, that covers most things I wanted to say on the topic. In conclusion, I'd just like to add... sorry, just getting a message from the practice... what was that? A visit to do? Clip a canary's claws? Er... well, I'd love to, but I've got some impacted anal glands that really can't wait any longer...

Fundtastic!

Hi all

This is a brief and rather humble post (I know, normal service will be resumed shortly!) to say thank you to everyone who has funded The Express Diaries - we've reached our target in under a week, so my new novel will definitely see the light of day!

There's still some exciting rewards available for funders - see over at www.indiegogo.com/expressdiaries - but I really just wanted to say thank you all. You're all lovely. Especially you - yes, you, there.

I've been rather busy of late with promotions (which  I'm sure my twitter followers will be heartily sick of by now) and work, but I haven't forgotten about the blog - I'm hoping to do a little piece about home visits some time in the next week.

Until then - thank you! You're all, as I'm sure Stephen Fry would say if he were here, enormous buckets of loveliness.

As a reward, here's a rather excellent trailer that YSDC made for the book :

http://www.youtube.com/watch?feature=player_embedded&v=xU_ZUAlsT6E

All Aboard!

All aboard! All aboard the Orient Express!

Yes, it's officially my least imaginative blog title ever (and it's up against some pretty stiff competition, believe me)

This is a quick post to mention that my new novel, The Express Diaries, has now been officially announced over at www.yog-sothoth.com.

The Express Diaries is a pulp horror adventure set aboard Europe's most famous train, as our intrepid heroes race across the continent to try and thwart a twisted cult from fulfilling their evil plans (mwah hah hah!)

I've done a few teasers about the novel already - you can read a few sample sections here and here. The book itself is going to be funded one of them-thar new fangled fundraiser things. This is good for us, because it ensures the book will be paid for before we publish it - and what's more it's great for you, because there are some pretty exciting rewards up for grabs if you want to help out - such as being written or drawn into the novel yourself, signed copies of the artwork and book, and much more!

The fundraiser has now started - pop over and have a look at the exciting offers available! So, I hope you'll join me as we go full steam ahead on our train ride into adventure and darkness. Let's hope it doesn't go off the rails...


(What a line, eh? Garth Marenghi would have been proud of that one!)

Mistakes

Regular readers of my blog will probably be aware by now that the tone of my posts tends to vary wildly between flippant and maudlin - sometimes even within the same post. I'm going to be honest; this isn't one of the flippant ones. Consider yourself warned.

'Experience is the name everyone gives to their mistakes' - Oscar Wilde

There's a nice little word that you can use in medical terminology - you may have heard it before. I may even have mentioned it in the blog before. That word is 'iatrogenic'. It's especially useful for those of us in the field because it sounds nice and official, slightly intimidating, and mysterious. Here's what it means - the doctor did it. Your physician ballsed up in some way, and now you're ill because of it. If you've got iatrogenic Cushing's disease, it's because the doc gave you too many steriods. If you've got iatrogenic aural trauma, then it's likely he was a little overenthusiastic with his otoscope. If you're iatrogenically monorchid...well, you get the idea.

There's a reason that this word was created, and that reason, of course, is that doctors (or in the case of this blog, vets) make mistakes. You may be getting an inkling of where you think this blog is going, now, but you may be wrong. I'm afraid this isn't going to be an 'Alright on the Night' style list of amusing veterinary cock-ups, where the poor James-Herriot-alike accidentally drills through their own finger whilst attempting to pin a fracture (though, I must admit, I have known that happen). No, this is really a confessional blog, a penance for me for a mistake I made. I did warn you at the start.

You see, I've been reading through my blog posts recently, and much as I like them, I do rather give the impression that I never make any mistakes myself, and that the hard positions I've found myself in have been due outside influences. This is, I will admit now, not the case. I have - in common with most of humanity, I suspect - made many mistakes, both in and out of my career. It's possible that this blog post is one of them. But I am so weary of politicians and others in the public eye avoiding even talking about, let alone admitting to, errors they have made on the basis that they may - horror of horrors - actually be called to account for them, that I wanted to make my own claim to honesty here.

I've been a vet for a long time now - ten years - and it has been quite some time since I felt that awful 'out of my depth' feeling that lived with me as a new graduate. Considering how much I've learned since then (and see Oscar Wilde's quote above for the true meaning of 'learning'), I'm a little surprised, when I think back on it, how few serious problems I got in to. Most of them were learning how to communicate with clients effectively and fairly, or easily corrected surgical mistakes, but here is something that has stayed with me down through the years :

I was a new graduate - maybe three or four months into the job, and it was one of those evening surgeries - the kind where all your old cases come back to haunt you. Nothing has got better, some things have got worse, and even the vaccinations have got heart murmurs, or sinister-feeling lumps that the owner has never noticed. I've had many, many of them since, and have discovered that really all you can do is take things one at a time, and remain calm. Back then, watching with alarm the list of people waiting grow whilst I was trying to think about a Chinese water dragon that had just been presented to me 'off-colour' (as I recall, it turned out to have been dead for a few days), panic was setting in. It was the first time I had experienced anything like it.

I was on my own - my colleague (a keen surgeon - a classic of the breed, very interested in the technicalities of the work. The animals, not so much) had left me to take one of his spinal cases to...well, I remember it as MRI, but I wonder now if, all those years ago, it would have been far more likely to be a C-T scan. Doesn't matter) and no cavalry  was coming to save me. The 'complaints' list on the computer, a brief description of what was wrong with each animal, read like a thesaurus - 'worse','no better','no improvement'','poorly' etc - and I had just run out the back with my immobile water dragon to try and get a better look, when I got the phone call.

I forget the name of the breeder, and I wouldn't put it here even if I could remember, but she had phoned the practice to speak to my boss, and was upset that he wasn't around. She was even more upset to discover that the only vet she could talk to was the new graduate - and if she'd realised my state of mind at the time, she probably wouldn't have spoken to me at all. She had a reputation at the practice for being incredibly demanding - and any vets reading this will have a picture in their minds right away of exactly the sort of client I'm talking about. Flustered, with one eye on the water dragon (about which I was starting to suspect the truth - it's not quite as easy as you might think to immediately diagnose death in a reptile. Well...not if you've never seen one before. Anyway, that's not the mistake. I got that one right, in the end, it just took me a while) and another on the ever-growing waiting room list, I took the receiver from my nurse.

The situation explained to me was this : one of the breeder's bitches has just finished whelping. The births had gone fine, but one of the puppies had been born with a severe umbilical hernia - it's intestines had prolapsed through the large hole and the pup was not looking at all well. The breeder wanted me to go straight out to her and put the puppy to sleep.

This (like most things in those days) was not a situation I had been in before - I had never seen, or even heard of a puppy with such a severe problem. The breeder was adamant that the problem could not be fixed, and it certainly sounded serious enough to me. This is painful to write - but that's the whole point of this blog, isn't it? - but I agreed the puppy needed to be euthanased. 

That's painful to write, because it's wrong. It's a treatable condition with immediate surgery, and I have fixed a number of puppies in a similar situations since. I was wrong, but that wasn't the worst of it.

I couldn't get out on a visit; I knew that. I had a waiting room full of people and no back-up. I asked her to bring the pup in, and she absolutely refused - she couldn't (she said) leave her bitch, and all the other puppies, just to bring this one in.

I wince to think of it. Older now, and wiser, I would have told her to bring the whole lot in right away. I also would have told her the pup could have been saved. I didn't. I merely feebly protested that I couldn't make it out.

'That's okay,' the breeder said. 'I'll deal with it myself.' She wasn't rude, or annoyed. She had really just wanted to check whether I thought the puppy should be put to sleep or not. She put the phone down. I didn't ring her straight back. Instead, I got on with my evening surgery.

Twenty minutes later my boss phoned me. He had a number of missed calls on his mobile phone from the breeder in question. When he got back to her, he found out what had happened. It was here that I discovered that the condition could have been surgically corrected. My boss had also discovered what had happened to the puppy.

She had drowned it.

I cannot tell you, dear reader, the number of times I have played that phone conversation over in my mind, wishing I had handled things differently. I can't count the number of nights I have lain in bed, staring at the ceiling and thinking of the pup, struggling against calloused hands, bubbles escaping from its mouth. That one mistake, based on a lack of veterinary knowledge and poor client handling, has haunted me for years. Its taken me ten years to write it down.

I don't even know, at this stage, how bad that seems to someone else. Its grown to be so large in my mind that I find it hard to think and write about, even now. I've made mistakes since then, of course - some worse that this one. But it was my first one, my first realisation of what can go wrong in just a few seconds of thoughtlessness. The drowning puppy lives in my mind (and only in my mind - it's painful to think that it could still be alive even now, all these days, weeks and years later, if I had acted differently) as a symbol of failure, and mistakes. Whenever things go wrong - which thankfully is not so often, these days - I think of that pup.

So, my confession is done. Don't think for a moment that this is my only error in ten years. As you may have suspected, this blog was prompted by a mistake as well, and of a similar kind. A few moments thoughtlessness, forgetting what really is at stake if I don't try my hardest, may have cost another animal its life. I ignored my instincts and took an easier path, and I was wrong. Likely it would have made no difference - in fact, I'm almost certain that in my recent error of judgement, acting different would have merely meant that the animal ended its struggle in the practice, rather than at home. Almost certain. But I'll never know now.

I suppose the hallmark of a mistake, as opposed to simple bad luck, is that if you think back over the situation - like I have, many times, thought over my phone call to the breeder - and you wish you had done something other than what you did, then you made a mistake. And that's how I feel today about this new mistake. I could have acted differently, and I wish that I had.

I'm not perfect. I wonder, if any vets are reading this, how many of them have their own version of the drowning pup, that swims into their mind when things go wrong? More than a few, I suspect. I'm so sorry that I failed then, and I'm saddened to realise that the lesson, hard and painful though it was, still needs reinforcing to me from time to time. This post is a way of doing that.

Thanks for reading.

The 99p Challenge!

Ahh, - the 99p Challenge. A fondly remembered radio 4 show from back in the days when Simon Pegg wasn't immensely famous. And also, coincidentally - and for a limited time only - the new price of my fantasy eBook, the Ancients!

That's right - don't waste your money on a couple of Snickers bars (although they will forever be Marathon bars to me) or a litre of organic milk, when you can get a whole full length fantasy eBook instead. The Ancients is crunchy, nutritious, free of additives is ONLY ONE CALORIE! What more could you ask?

For the Kindle-types amongst you, The Ancients can be procured from your friendly local amazon store, amazon.co.uk. If you are lucky enough to live in the US (at least, for the purposes of this offer) then you can get the Ancients for the EVEN CHEAPER price of $0.99! (I've no idea what your chocolate bars cost over there though, but I can say from bitter experience of attempting to eat a Reece's Pieces bar that confectionary does not translate well across the Atlantic)

If you have a different eReader, or for some reason you like reading your eBooks in a different format every day, head over to smashwords, where your $0.99 will get you 8 different file types - including ePub, PDF and .doc, as well as being available for online reading.

So, don't delay! Join the 99p revolution - the challenge is simple! Merely click on the link, part with the teeny tiny amount of money, and enjoy your new eBook.

(Also, track down the 99p Challenge and listen to it - it's very good)

(PLEASE NOTE - YOU'VE MISSED IT NOW, SORRY. It's back up to £1.99 - but don't let that stop you!)

The Express Diaries - 2

With a clattering of iron wheels, a sinister plume of smoke, and a slightly-less sinister chuff-chuffing noise, The Express Diaries edges closer to it's terrifying final destination - your brain! 

And so, it's time to tease you a little more with a few glimpses into my new novel. They say a picture paints a thousand words - so here's a whole short-story's worth from Eric's easel...

Ms. Grace Murphy - young spinster, secretary to Betty Sunderland, and good friends with Violet Davenport



*****

"Within ten minutes we found ourselves standing in a quaint, cobbled courtyard, outside an old, glass-fronted shop. The window was filled with all manner of stuffed animals, and a weathered sign hanging above the door proclaimed

‘Wellington Fils

Taxidermie

50, Rue St. Etienne’

 Extract from the diary of Mrs Betty Sunderland

*****

‘But...how on earth are we supposed to find...’ Violet began, but at that moment we heard a great clanking of gears from somewhere above us. Looking up, we saw a campanile, some five stories up, and as we watched a pair of figures jerked in to view in front of the great clock face. A winged angel, sword in hand, and cloaked, hooded Death, holding his scythe, stood before each other. They began a slow, mechanical battle, whilst the chimes for six o’clock pealed across the courtyard. After a brief struggle, the angel retreated. It appeared that Death was victorious.

            ‘Where is more likely to be struck by lightning,’ I suggested, ‘than a clock tower?’

Extract from Milos Valinchek's journal

*****

And finally... another excerpt from the diaries themselves, where our intrepid party discover the tragedy that has struck an old friend...

Colonel Neville Goodenough’s Personal Notes, Saturday, October 24^th 1925

The cab drove away as I walked towards the door of the bedsit where our friend’s card suggested we would find him.  As the others watched, I knocked on the door, not at all sure what to expect.

            I admit that I was surprised after a few moments the door opened an inch or so, and Beddows peered out into the street, blinking in the grey light of the day.

            Now Beddows is a man fastidious in nature, and respected around town as one of the finest manservants a fellow could ask for. I have never seen him anything other than immaculately turned out, so to see the gaunt, dishevelled figure blink nervously at us without a hint of relief came as almost as much a shock to me as anything I saw in the trenches. I heard Betty and Violet gasp behind me, but he paid them no attention.

            ‘You came,’ he said, flatly, leaving the door open just a crack. He seemed to be waiting for something.

            ‘Now look here, Beddows,’ I said, stepping into the doorway, ‘I understand you’ve had some trouble, but we need to know if your master is inside. Are you going to leave us on the doorway like travelling salesmen?’

            This shook Beddows out of whatever spell had possessed him. He mumbled an apology, and opened the door. Ignoring our questions, and our coats, he ushered us down a short hall into a small room, whereupon the cause of the poor man’s discomfiture became sadly apparent.

            It was a tiny bedroom, grimy and dank. The drapes were pulled closed, shutting out what grey light would otherwise have filtered in from the street outside. As we shuffled into the room, our eyes becoming accustomed to the gloom within, we became aware of a dark figure lying on the bed. As we entered, the figure started, and emitted a peculiar noise, somewhere between a whine and a rasp, which immediately made me think of the field hospitals, and the poor devils who had been gassed by the Hun.

            We crowded around the bed, all eyes upon the figure. The poor man was covered by a thin white sheet to protect his dignity, but sadly there remained little of it left to protect.

            ‘Julius?’ Betty whispered, unbelieving. It was, indeed, difficult to recognise the poor wretch before us as our avuncular host of the previous evening. His hair and famous moustache were gone, as were his eyebrows. The skin of his face and arms was blackened and cracked, except for several large red and weeping sores. One of his eyes was glazed and white, and the other one flitted from one to the other of us, never resting in one place for long. The room stank of smoke and blood. Horrified, it was on my mind to grab Beddows and demand why he had not brought the professor immediately to a hospital, when Julius lifted one of his arms and laid a blackened claw upon Betty’s hand. He smiled, then winced in pain.            ‘My friends,’ he said, in a voice that was barely a whisper, making us crowd around the bed to hear him. ‘Thank God you have come.’

            Written down, Smith’s speech appears clear and rational, but be aware that in reality this was punctuated by numerous coughs, pauses and sighs. Often his voice faded into incoherence and several times he was silent for so long that we feared he had passed into unconsciousness. Despite this, he managed to talk for several minutes, and though his speech made little sense to me, and must surely have been coloured by delirium, I will try and lay down in these notes as sensible a version of his words as I can piece together from his broken voice and my own poor memory.

            ‘I cannot bear to talk for long. Please, for a moment, listen to me, and I shall try and explain how I came to this sorry state.

            ‘You are aware, of course, that I have been on the trail of the Sedefkar Simulacrum – at first, as an archaeological curiosity. Lately, however, I have come to realise it is something much more – a source of great power.

            ‘At the end of the Eighteenth Century it was taken apart and scattered. I initially planned to retrieve the pieces for the museum in the University of Vienna - but now I realise this was arrogant folly. The thing must be destroyed!’

            Betty began to ask Julius a question, but he held up his hand and was overcome by a fit of coughing. Beddows held a handkerchief to his mouth as he did so, and it came away stained with blood and some black substance.

            ‘Last night, as we returned to our home, Beddows and I were attacked by Turkish madmen. I know little of them, save that I believe they seek the Simulacrum themselves, for their own dark purposes. We barricaded ourselves indoors, so they tried to burn us alive. Fortunately, Beddows found a way out. Not before I...’

            He gestured helplessly to his crippled form, and his voice faded into silence. His one good eye looked around the room, and his voice was even hoarser than before when he continued.

            ‘To have come to such a place! To have fallen so far!’

            Betty laid her hand over his to comfort him, but he winced and drew it back from her, though he tried to smile.

            ‘I am afraid, my friends, to come out of hiding. They would stop at nothing, these men!’ He glanced across to his manservant. ‘Beddows has a plan to escape, but the less we speak of it, the better.’

            ‘Most of my notes were destroyed in the fire, or else taken by the Turks, but I managed to rescue something – the summaries of my researches. The Turks will know as well now.’

            He paused, his one eye staring at the ceiling, as if building courage for his next statement.

            ‘And so, my friends,’ he said, looking back at each one of us in turn, ‘It falls to me to pass this burden to someone other than myself. I dare not ask, yet I hope that you will take it for me. The statue must be recovered and destroyed before these men find it.’

            He suddenly sat up in the bed, his eyes wide and staring. ‘I cannot show you what I have seen! You cannot know what I know!’ he cried out. ‘I only hope, and pray....you must trust me! The statue must be destroyed!’

            Such strenuous effort had a grave effect upon him, and he fell back to the bed, exhausted. He began muttering under his breath, and it seemed was no longer aware that we were present.

            ‘I am sorry. For them, for me. For all of us. I am the lucky one. I may be spared. I am sorry. So sorry.’

            He voice failed, and his consciousness soon afterwards. His breathing slowed, but did not stop. I think all of us were relieved to see him asleep, and so temporarily released from his agonies. We looked at each other in shock, and then to Beddows, who stood quietly in the corner.

            ‘He is delirious,’ Alfonse said, sadly, ‘to be taken in by such a fairy story. I am sorry for him.’

            I nodded. Betty frowned, but it was Beddows who replied.

            ‘My master is not insane, sir – at least, he did not imagine the attack on the house last night! I saw them with my own eyes.’

            Alfonse fell silent, pondering. Beddows’s eyes met Betty’s, as she seemed the most sympathetic in the room.

            ‘Please consider my master’s words, Madam. He asked me to give you these.’

            He handed Betty a few pieces of paper covered in Julius’s cramped handwriting.

            Grace and Violet were looking at each other, each with a sceptical expression mirrored on the other’s face. Beddows was not slow to see it.

            ‘I do not know if my master speaks truly,’ he said, glancing at the figure in the bed. Julius’s mouth twitched in his sleep and a fearful expression crossed the manservant’s brow as he must have remembered the night of terror the two of them had just experienced. ‘I can only tell you that he believes it to be so. He thinks this statue is of great importance, and he is a far wiser man than I am. I cannot tell you what to do, but who amongst you would refuse the wish of a dying man?’

            The words ‘dying man’ echoed around the small room. Although it had not been spoken of before, it was obvious that Julius did not have much time remaining.

            ‘Please,’ Beddows said, his eyes on Julius’s sleeping form. ‘Read the notes. Consider his words.’

            Betty folded the notes carefully in half, and placed them in her bag. She laid her hand gently upon Beddows’s arm. He jumped, as if struck, but did not remove it. She looked into his eyes.

            ‘What will you do?’ she asked.

            ‘As the professor said,’ Beddows replied, ‘I have...I have an escape plan. There is someone who can...care for him. But I dare not speak of it. Please.’ He broke Betty’s gaze. Not since the war have I seen anyone look so lost, alone and afraid.

            Betty nodded, and turned to the rest of us. ‘We should go,’ she said. It didn’t seem right, leaving a wounded man behind, but there was little else we could do at this point. Both Julius and his manservant had requested we leave them alone now, and they did, as they said, have some sort of plan.

            Betty began to study Julius’s notes on the cab ride back from that dreadful room. I have a horrible feeling that she is taking his mad fantasy seriously.

It's what's inside that counts #1 - an idiot's guide to the spleen

'He who smelt it...would forever be the one who DEALT IT!'

It occurs to me that, as I am the author of this post, the title implies that I am, in fact, an idiot. I'll leave you to make your own minds up about that one. Anyway, I've been meaning to do a short series on internal organs for a while - don't ask me why, you may as well question why I write this blog at all - and that is dangerous territory, my friend.

All right, if you insist - I write the blog to vent my spleen about the inanities, injustices and insanities of veterinary life (as well as to plug my books, but I try and keep that to a minimum. BUY MY BOOKS! Ahem) and after several years of venting, I think it's about time I gave something back to the best-named organ in the body.

(It's not the best named part of an organ, however. There are many contenders for that crown. If I ever write another fantasy novel, I'm going to the best internal bits for it. Imagine a party of adventurers trekking through the Crypts of Lieberkuhn and over the dread Islets of Langerhans in search of the fabled Rosette of Furstenburg (it's a part of a cow. If you want to know more, feel free to google it, but it might put you off your tea))

So, lets talk about the spleen (not, incidentally, the intestinally-overactive superhero of the same name from Mystery Men, as shown above. I just couldn't resist reminding you all what a great film it is. And if it doesn't remind you because you haven't seen it, the go and watch it. Now! Really, it's far more entertaining than this blog). The spleen has an air of mystery surrounding over and above other internal bits and pieces, largely because you're quite likely to only have a very vague idea of what it actually does.Something to do with blood, maybe?

Well, don't feel bad. I know what it does, and it still feels vague to me too. This is because the spleen doesn't have any primary functions at all. It's a secondary organ. A middle man. The spleen is the body's equivalent of an estate agent, or a insurance broker, only far less likely to rip you off (though slightly more likely to kill you, so, y'know, swings and roundabouts).

Where is it?

The spleen is shaped something like a knobbly comma, and it sits (or lies, or does whatever it does when a spleen is relaxing) in your abdomen, on the left side, following the curvature of your stomach. The base (the tip of the tail of the comma) is held relatively tightly to the stomach, but the rest is more or less free to wobble around the abdomen as it sees fit. Sometimes, it sees fit to do this rather more than is good for it, but we'll come on to that.




What does it do?


Ah, the most commonly asked question about the spleen. The short answer is - nothing that the rest of the body can't do, but it helps. It serves a number of functions.

1. The spleen is a haemopoietic organ


(and not, sadly, as I commonly misspell it, a haemopoetic organ, which brings to mind images of it moping around in seedy bars, scribbling sad missives about blood into a tattered notebook)

Haemopoiesis is the production and maturation of blood cells, and although the spleen does a great deal of this whilst we are developing in utero, it sort of gives up about halfway through gestation and thereafter leads most of the hard work to the bone marrow.

2. It mops up old red blood cells


For the SF fans amongst you, imagine red blood cells are living in their own version of Logan's Run, only instead of 30 years, the allotted lifespan is about 120 days, and instead of a Sleepshop you're sent to on your Lastday, it's the spleen.

For everyone else...well, you probably get the idea from the bit in italics.

3. It is part of the immune system


Blood flow through the spleen is really rather complicated, but for brevity imagine that the spleen is like an airport security desk through which all the red blood cells, white blood cells, viruses, bacteria, parasites and other assorted bits and pieces are passed. If the spleen is doing it's job, then the foreign material is quickly grabbed by macrophages (my favourite white blood cell. How can you not like something whose name means 'Big Eater'? A bit like The Blob, only smaller and friendlier) and other white cells, and summarily executed. Okay, perhaps it's not that much like an airport security desk. Maybe it's easier to think of it like a giant lymph node? (I told you I was vague)

4. Blood Storage

The spleen is a reservoir for blood, as any surgeon who has ever accidentally nicked one with a scalpel can readily attest to (er...I imagine. It's never happened to me, naturally). Depending on you species, up to 30% of your red blood cells and a fair proportion (me, vague? Never!) of your white blood cells are waiting in there, ready to pounce. If there is a sudden need for red blood cells or oxygen, the spleen contracts and releases it's payload into the bloodstream. I was taught that contraction of the spleen is what causes the 'stitch' pain in you're abdomen when you're running, but I must admit I remain unconvinced - I'm pretty sure I've had a stitch on the right side of my abdomen, but maybe I'm just wired up wrong.

What can go wrong with it?


Well, here I'm going to talk from a more veterinary perspective. Because I'm a vet. You want to know about humans, go and ask Doctor Mark Porter. I'm going to tell you about the most common problems that I see in practice with the spleen.

The first thing to say is that, as a small animal vet, the majority of spleen pathology I see is in dogs. Possibly because they're smaller, or have less blood flow, or are simply luckier than dogs, cats are rather under-represented in the spleen-gone-wrong stakes. As far as other species - I don't think I've ever seen a spleen problem in a rabbit, and very rarely in small rodents, although ferrets seem to have their fair share of issues with the enigmatic organ.

The second, slightly more depressing thing to say, is that the most common spleen problem I see by far is the big C - splenic cancer. Because of it's functions - all blood-related - when cells go wrong in the spleen, they tend to be blood cells. Or, rather more commonly, blood vessels.

It can be a bit of a challenging diagnosis, because the symptoms of splenic haemgiomas (benign blood vessel tumours, good news) and splenic haemangiosarcomas (malignant blood vessel tumours, very much not good news) can be, like the spleen itself, rather vague and mysterious. The most common presentation would be a middle-aged to elderly dog (often labradors) who just 'aren't right' - quite tired, not exercising well, with not a great deal to see on clinical exam and very little exciting on a standard blood screen. You may be able to feel something in the abdomen, but these are big dogs, sometimes with small tumours, and the spleen is good at moving around, so quite often you won't feel a thing. If you're lucky, or skilled, an x-ray or ultrasound scan will reveal the presence of something that shouldn't be there, but not every time.

Because of this, the case can often grumble on for a little while, sometimes getting a little better on the medicines you prescribe, sometimes not, until it eventually presents collapsed, because that lump on the spleen has finally burst. It's pretty rare to a dog to bleed to death from a splenic tumour - it's bleeding into a closed space, after all, and there's only so much space it can fill up - but it's not going to feel well.

The spleen is also a pretty common site for secondary tumours - with so much blood passing through it, it's a fairly easy organ for cancer to take root. The course of these diseases will depend largely on where the tumour started and what it's doing there.

Because all of these tumours can grumble on for a long time without causing many symptoms at all, they have been responsible for the biggest and most impressive lumps I have ever seen in my career - the largest of which was a seven kilogram tumour removed from the abdomen of a thirty kilogram dog (I do have a piccie of this one, but it is rather bloody, so I'll leave it off the blog in the interests of taste).

A ruptured spleen can occasionally occur after a road traffic incident (I believe I'm not allowed to call them accidents any more, because there's always someone to blame. And where there's blame, there's a solicitor hoping to make money from it), with similar effect to the ruptured tumour above, though often with the added complication of other injuries.

I've already touched upon the third problem. As I said, the spleen is rather mobile, and likes undulating up and down the abdomen like a lumpy Mexican wave. On rare occasions, the spleen can actually spin itself right around, tying it's own blood vessels into a knot and causing the spleen to swell up like a bloody painful ballooon. It's very painful, and often occurs in conjunction with the stomach doing a similar head over heels - the incredibly dangerous and dreaded veterinary emergency GDV (gastric dilatation/volvulus) which we'll have a cheerful chat about when I get around to writing about the stomach.

What on Earth can you do about that lot?


Fortunately, you don't have to be a brain surgeon to sort this lot out, usually. Just an abdominal one. The benefit of the spleen having no primary fuctions is that, whilst it isn't exactly surplus to requirements, you can certainly cope pretty happily without one. Olympic athletes might miss the splenic contraction, and you might be prone to a few more infections (though this does seem to be more of a problem for humans than animal. The same is true of the Olympic thing, now I stop to think about it) but most of the time you can cope without your knobbly comma fine.

The procedure of choice for all the above conditions is a splenectomy - chop the spleen out. (...ectomy, in medical language, means 'to remove', whereas ...otomy means 'to cut a hole into'. ...infamy means something completely different.) Fortunately, the procedure is reasonably straightforward. It's really a matter of tying of blood vessels. And then tying off some more. And sore more. It's very good practice for ligatures, though for big spleens you may need a spare pair of hands and/or a lot of clamps. It can be pretty messy, especially if the damn thing has already burst before you got in there, and you will almost certainly need to give your patient a lot of fluids, or even a blood transfusion, as one way or another a lot of blood is coming out with it.

How successful the splenectomy is depends on the cause of the problem. If you're dealing with a tumour, and it's benign, then there's a fair chance that you've sorted the problem out. If you've got a haemangiosarcoma, then sadly the thing is pretty likely to have spread before you got in there - haemagiosarcomas are really, really good at metastasizing (spreading), especially to the liver, and to the heart. In fact, in a lot of cases the tumour you're removing with the spleen already came from one of those places. It's still a procedure worth doing, because your patient will probably be back to normal within a few days, bright and happy. But one day soon, and often within a couple of months, they'll be back in your consult room again, collapsed as before - for this reason, it's generally a good idea to send your removed spleen off to a pathologist so they can tell you exactly what was wrong with it.

The prognosis for the ruptured spleen and the splenic torsion is generally much happier, so long as you get to them in time. The dreaded GDV (I feel I should write it in capitals to simulate the awe and terror that those three letters can inspire in a new veterinary graduate) is somewhat harder to deal with, but you'll often do a splenectomy at the same time.

Summary


So, what have we learned? Amusing in name, confusing in function, slightly challenging to diagnose and relatively easy to treat. If by treat, you mean 'remove entirely' (much in the same way our current Government would like to treat the NHS).

The spleen, ladies and gentlemen. Gratuitous bloody surgical image below Look away now if you're feeling squeamish. (This one's from human medicine)