Love Supreme

Here's a link to my latest blog for the Veterinary Times, in which I use my superpowers for EVIL

Rabbiting on at the London Vet Show

Experience

Here's my latest blog for the Veterinary Times. It's about experience, and the dirty little secret that all medical practioners carry in their hearts. I hope it's of interest to you.

Experience at the Vet Times Online

The Conduit Sequence

Regular blog readers may be surprised to learn that I've also written some novels as well. I know I was. For the next few days, Soul Purpose, my first novel about a typical vet who has some extremely un-typical things happen to him, is on offer for 99p ($1.54) Come on! That's cheaper that a cup of coffee! Even a relatively rubbish cup of coffee from a less-well-known but taxpaying coffee shop!

Still not convinced you? Here's an extract to whet your appetite...

***

IV

The barn was an old building, rickety and wind-blown and, at this time of year, ankle deep in cow shit. It had a thin scattering of straw on the ground as if in an attempt to disguise the dirt. It didn’t work. The beam from the nervous farmer’s torch bounced around the room as if it would rather be in a nightclub. The acrobatic lighting added to Alan’s feeling of discomfort and displacement. It should have been a relief to be out of the driving rain but at this moment Alan would have gladly stood out in it naked until sunrise if it meant he could avoid seeing what had turned Mike White, who had calmly held prolapsed uteruses up on his knees and sawn rotten heads off stinking lambs to get them out of the ewe, as pale as his cows’ milk. 

‘What… er… what have you got for me, Mr White?’ Alan asked nervously.

Mike turned to Alan, his weathered face deeply troubled. He had been a farmer all his life. He had seen just about everything nature could throw at a person, most of it before he was twelve. Alan wasn’t at all sure that he wanted to know what it was that had shaken him, but thought he should at least have some warning about what he was approaching.

‘It’s the damnedest thing, Alan. Never seen anything like it in all me born days.’

‘What is it, exactly?’

‘I was ’opin you could tell me. Maiden heifer, just calved. See for yerself.’

Mike turned back again, and trudged forwards, his torchlight illuminating a cow-shaped form in the corner of the barn. Alan followed, squinting, trying to make it out. It was a Friesian-Holstein heifer, slightly on the thin side, and as Mike had pointed out, obviously just calved. She was standing and licking forlornly at a small pale object lying in the straw. Alan’s mouth formed the ‘w—’ of ‘what’ but whatever else he was planning to say was lost to posterity because at that moment Mike shone his torch directly onto the object. The word retreated from Alan’s mouth and hid, quivering, down by his diaphragm.

The thing the cow was licking was a calf - of sorts. Alan had seen foetal monsters before, bizarre furry blobs of flesh with incongruous feet, tails or even heads protruding. Accidents of nature, never meant to live. This was different - it appeared normal. Four legs, head, tail, everything in place. At least, Alan thought so. It was hard to make out, because the torchlight shone right through the calf, illuminating the bloodstained straw beneath, which reflected the light right through the calf again as if it wasn’t there.

The calf was transparent.

Alan’s brain didn’t quite grasp the concept as it zapped through his neurones the first time, so he tried thinking it again, more clearly this time.

The calf was transparent. 

He could see its ribs, its beating heart, its lungs, which were twitching and contracting as the neonate fought for breath. Alan watched in astonishment as the calf gave a feeble cough and a blob of pleural fluid travelled out of the lungs, up the trachea, and into the mouth, where the calf swallowed it.
The mother briefly glanced at the two intruders and then turned back to licking her miraculous calf.

V

Alan’s heart skipped a beat. A moment later, it skipped another one. It was preparing to skip a third when it received an urgent communiqué from his brain, suggesting that if it did so, there would be trouble. Reluctantly, it started up again, and then made up for lost time by hammering away at double speed.
Alan took a cautious step towards the calf. Mike stayed where he was.
‘What d’you reckon, then?’ the farmer asked.

Alan couldn’t tear his eyes away from the creature in front of him. He wondered if he was still asleep. Half of his brain was gibbering with sheer incomprehension. The other half was running through his notes, searching for the section headed ‘photo-transparent idiopathies’. Either he had forgotten all about them, or no such section existed.

The heifer looked up at him again. Alan had never been very good at reading bovine expressions.

‘Did she calve all right?’ he asked automatically, buying time so that his brain could stop gibbering and start working.

‘Reckon so,’ said Mike. ‘We didn’t help her out or nothin’, anyway.’

Alan was at a loss for what to do. Surely he should be gathering evidence, taking photos, something. This was obviously a whole new disease. He switched himself onto autopilot, clinical exam mode while he wondered what the bloody hell he was going to do.

The heifer was fine; normal heart rate, normal temperature, mucous membranes salmon-pink. A little bruised, but nothing out of the ordinary. She had cleansed fine - the shrivelled mess of perfectly ordinary placenta lay on the floor next to the calf.

The transparent calf.

‘Er… aren’t you going to look at the...?’ Mike asked from his safe distance, his voice dying off as he indicated the newborn with his torch beam.

‘Oh… erm… sure,’ mumbled Alan. He moved back around to the front of the cow and looked down.

It didn’t make any sense. How could it be alive? Weren’t there… reactions and things that had to happen in the skin? Didn’t it need to absorb light or something? Alan wasn’t clear on the specifics. Biochemistry was not his favourite subject.

Slowly, he knelt down beside the creature. It turned its head to him, making a weak mewling sound. Alan could see its larynx vibrate as it did so. It was clearly dying. The calf’s heart had slowed its beat since he had first looked at it, and the wretched thing was almost too weak to hold its head up. 

Alan was strangely reluctant to touch it; a quiet but insistent voice in the heart of his being suggested that it would be a really bad idea. The cow nuzzled her calf again. Slowly, desperately trying to shake the feeling that this was all a dream, Alan reached his hand out to it...

***

Convinced?

Get the rest here: http://www.amazon.co.uk/Soul-Purpose-Nick-Marsh/dp/1904853315 (or here for you colonial types: http://www.amazon.com/Soul-Purpose-Conduit-Sequence-Book-ebook/dp/B00BVMGVA4/

Drugs of the Devil!

I have a new post about the perils of antibiotic use over at the Vet Times website - you can find it here. There's very little satanism in it, so this may please or disappoint you depending upon your interests and religious beliefs. Enjoy!

That is not dead which can eternal lie...

The blog is not dead, only sleeping! The reason for the quiet here is that I've been commissioned to write blogs twice monthly for the Vet Times, as and the subject matter is very similar to the sort of things I normally pop here, my usual posts have died down.

I am still posting, though - you can find all my Vet Times blogs here! They're still just as funny/annoying/tedious as before, only now I'm getting paid for them. I may see if I can sell them some of this old rope I have lying around too...

Thanks for visiting, though! There's still plenty to see here. How about taking a look at my books - my humorous (well, I thought so, anyway) veterinary/science fiction novels Soul Purpose and Past Tense, my epic fantasy novel The Ancients, or my thrilling Orient-Express-based horror novel, The Express Diaries. Mmm, 1920's terror! The best kind.

If you're still bored or still have more lunch to eat, here's a list of my personal favorite blog posts (your opinion may vary, of course - feel free to comment, I'm still here!).

Dog #86324 - not a cheery one, but the most honest writing I have done, about euthanasia
Lingua Medica - my favourite informative post, detangling medical terminology
The Mutt's Nuts - this consultation still makes me shudder
Geri - a lament for my beloved lurcher, Geri
Breeding Difficulties - home truths about what it means to breed pedigree animals
A Disease of Economic Importance - the foot and mouth disease crisis of 2001

There are plenty more, so feel free to explore - just please remember to wash your hands afterwards. See you in the Vet Times ;)

Doctor of what?

Consulting is an art, not a science. No matter how well you know your medicine (and I am certainly not claiming any special expertise in that department), a consultation can often be spun in an unexpected direction by what we shall charitably call 'the human factor'.

Yesterday afternoon, I opened up the medical file of my next consultation - a booster vaccination for a cat. Something about the surname rang a bell, but I hadn't seen this cat before, and the client didn't seem to own any other animals. Something still nagged at me, however, so I clicked another button in the top right-hand corner of the screen. The button is marked 'Show deceased'.

Three more animals appeared under the clients name, all cats. The names all sounded familiar. Sure enough, I had seen all of them. Not only had I seen all of them, it was me that had been with them for their final consultation. I had put all of the owner's previous cats to sleep. The most recent had been several years ago, and try as I might I was saddened to find that I couldn't bring any of the cases to mind, or the client. Nevertheless, I was glad I had checked; I didn't remember the client, but it was a fair bet that they would remember me, having euthanised three of their previous pets. Now, at least, I could show a little tact, caring and diplomacy in the consulting room, even though I was just vaccinating their last remaining pet.

I stepped out into the waiting room, and quickly located a tall man sitting with his daughter, a cat box on his knee. I smiled at him, and with a quiet, respectful demeanor I called his cat's name.

The man looked up, smiled, and nudged his daughter in the ribs. 'Oh hello!' he called, cheerfully. 'It's Doctor Death!' He stood up and cheerfully walked towards me, while his daughter and I competed on which of us would rather a hole opened up in the ground and swallowed us up.

The man continued his own brand of peculiar gallows humour all the way through the consultation. 'Careful, Misty,' he said as I plucked the black and white cat from it's box. 'He should have a scythe, not a stethoscope!' I smiled politely while his daughter rolled her eyes and folded her arms, staring at the floor.

'Yes,' I said, trying to lighten the mood as I drew up my vaccination. 'It's a happier occasion, today, isn't it?'

'I'll say!' said the man. 'At least we won't need a coffin at the end of it!' I felt like saying that if he kept this up, then I couldn't promise anything, but I remained as ever, calm and professional. Still, it was a surprise that I had no memory of this man. If he was like this during a vaccination, God knew what he was like during an actual euthanasia.

'All done,' I said, putting his surviving cat back in it's box and closing the door behind it. 'There,' I said, smiling at the man, 'All of us made it through in one piece!' The man smiled and winked at me. His surprising attitude was growing on me. There was no malice at all in him. Why not be cheerful? The cats weren't suffering, and I had done a professional job. Doesn't joking about a dark subject make it something less to fear? Maybe we could all learn something from his attitude. I was starting to decide that perhaps I rather liked him.

I opened the door and let the man, his embarrassed daughter and his still-alive cat out to reception, where upon he announced loudly to the packed waiting room, 'This is the first time one of my pets has seen that vet and come out alive!'

I shut the door, and decided that maybe the best thing would be if a hole opened up in the ground and swallowed him instead.

Doctor, doctor, gimme the news...

Alright, I will. Because I am. A doctor, that is - as of last week.

You see, unlike many of our overseas colleagues, veterinary surgeons in the UK have long languished under tedious titles of Mrs, Miss or Mr. Not only do these titles call upon people to make a snap judgement on whether we're married or not, they simply don't sound quite as sexy as 'Doctor'. If anything, they make us sound more sinister - 'Mr Kildare' just sounds creepy, doesn't it?

There are those in my profession that will try to tell you that the vanilla title is right and proper. Human surgeons are known by them, after all - it's something of a badge of honour for them to go from Dr to Mr, in fact, and is a right granted them by the Royal College of Surgeons.

'Well,' say the misguided (and slightly less cool) vets of the UK, 'we're surgeons too, aren't we? So we should be Mr or Mrs too!'

Well, I disagree. For one thing, human surgeons undergo a metric craptonne more training than veterinary surgeons do - years and years more, in fact - so if they want to call themselves Mrs, I think they're quite entitled to. Secondly, as vets, we never got called 'Doctor' at any stage of our training, so it doesn't feel so much like a promotion as a, uh, nothing at all. Thirdly, I think I'd be more on board with it if surgeons had an entirely different title again, something like... I don't know. Powerman/woman? That would work. I could cope with being Powerman Marsh. (Pwn. Marsh - except if you're familiar with internet l33tspeak, that does sound a little like I just got my ass handed to me in an online game. I'll keep thinking).

Anyway, this particular powerman has strayed from the point a little. A couple of months ago, the RCVS - the august body that oversees veterinary surgeons in the UK - decided that vets are now entitled to use the title 'Doctor' - with a couple of caveats.

Firstly, when we use it in full we should add 'MRCVS' after our name, to signify that we are members of the Royal College, and not actually licensed to poke about inside another human being (well, not with surgical instruments, at least). Secondly, it is a courtesy title - it's up to us whether we use it or not.

When I heard about the news, this last point threw me into a dilemma. Was it really that important, I wondered, to be called a doctor? Is it something we deserve?

My point about training above wasn't just true of surgeons. It's a fallacy that it takes longer to train as a vet than as a doctor. The veterinary degree takes five years, just as the medical degree does, but then medical doctors have at least another two years of on-the-job training before they are fully qualified. Vets are just thrown in at the deep end, though the RCVS is considering changing this too.

In my career, occasionally a client would start a consultation with a 'Well, what it is, doc, is that...,'. Even on the rare occasions when I would point out that this title wasn't one that I had been granted, I would do it with a bashful grin (and possibly even come-to-bed eyes) that indicated I was not at all unhappy on being accidentally promoted, and it always gave me a little thrill.

But still. Doctor. I have been a veterinary surgeon for fifteen years, and a change in my title wouldn't change my experience, or my skills, or my simple honest-to-goodness dashing good looks. A courtesy title. If I actually changed it, would it just make me appear vain? Would my colleagues consider me so? Would there be two tiers of vets now? Ones that were secure in their own skills, and ones that needed something more? A veterinary surgeon, by any other name, would still smell of anal glands and hibiscrub, after all. This was a decision that required careful, considered thought.

Thirty microseconds later, I was logging in to the website of the RCVS, and ticking a box on my profile that indicated now, and forever more, I would be known as 'Doctor Nick Marsh MRCVS.'

Such decisions come at a cost. Households have been split on the issue. My wife, for instance, remains plain old Mrs Marsh - although this has less to do with any high-minded ethical stance, and more to do with the fact that she has forgotten her login details for the website.

As for myself, I find I am much the same person - with one added bonus. Thank you, The Simpsons. You have made me a very happy man.

Yours

Doctor Nick Marsh, MRCVS

For the blood is the life... Part one

Watch out, haemophobes! This one is about blood - specifically, blood transfusions in dogs and cats. For the first of this two-parter, we're going to have a look at how you might end up wanting to give a transfusion in the first place, before we get down to the meaty stuff in part two. Before we get too carried away learning about motion lotion, though, here's a quote from one of the true horror greats to get us in the mood:

'Something was pouring from his mouth. He examined his sleeve. Blood!? Blood. Crimson copper-smelling blood, his blood. Blood. Blood. Blood. And bits of sick.' 

Garth Marenghi, Slicer

Thank you, Garth. Blood. We all have it (unless you're a 13th generation cyber-mind reading this in the thirty-fifth century, but I can only cover so many angles with my writing) and we all have an idea of what it's for: to take oxygen out of your lungs and transport it to all your other bits to prevent them from being dead. It has other uses too, but this is the one you will be most concerned about if you start to run out.

Let's do a bit of jargon de-tangling here - us medical types love our jargon (see this post on the subject). The medical prefix for blood is 'haem' (or heme if you prefer; you know who you are. Go on then, just this once, I will do you a favor and leave the 'u' out of that favour. Happy now?). So: haemophobia - fear of blood; haemorrhage - blood loss; haematuria - bloody pee - and so on. Lack of blood - specially red blood cells, the Werther's original-shaped cells packed with the oxygen-loving haemoglobin that do the donkey work of moving oxygen around - is known as anaemia (presumably because anhaemia is awkward to say), and in its severe forms is what is going to make us reach for the blood bags.

Anaemia (and, so y'know, there's a lot more to know about anaemia, but let's keep it simple) is the most likely reason that you're going to find yourself at the business end of a blood giving set, and my extensive study of human literature has revealed that commonest form of human blood loss is, of course, vampiric attack. For dogs and cats it's a little different. We are not, at least in general practice, ER (my close resemblance to George Clooney to the contrary). If an animal has suffered such severe blood loss in an accident that it is in immediate need of a blood transfusion, then I'm afraid it is very unlikely to survive - principally because in general practice we are not allowed to store animal blood products, and so the dog or cat is going to have to wait for us to find a donor animal and drain it before it gets a snifter of the good red stuff, by which time it is highly likely to have given up waiting in a terminal fashion.

So, for vets in general practice at least, the most likely reason we are going to want to give a blood transfusion is either due to a slow semi-controlled bleed (like a ruptured splenic tumour) or expected blood loss (which reminds me of one of my lecturers telling us about attempted surgery to remove a tumour from a dog's aorta - the main artery from the left side of the heart; the vessel ruptured and our lecturer, a master of understatement, told us that the dog 'experienced brisk haemorrhage' which later had to be scrubbed off the ceiling of the op theatre), or because of IMHA.

IMHA

IMHA stands for 'Immune-mediated haemolytic anaemia' - please don't switch off, we can get through this, don't worry. Haemolytic anaemia we can already work out - lysis is the medical term for cells breaking down, so 'haemolytic anaemia' just means 'red blood cells breaking down, leading to a lack of blood cells'. I think HA is punchier, though.

As for Immune-mediated - well, as it sounds, this just means the disease is mediated by (i.e. caused by) the immune system going a bit tits up. Lots and lots of diseases are immune-mediated - all allergies, for instance. Just like The Force, the immune system is a powerful tool, but it can be used for evil as well as good. In IMHA, the immune system has decided that red blood cells are invaders and must be destroyed without mercy. Anything that stimulates the immune system - infections, drugs, and yes, sadly even vaccinations can trigger the immune system off in the wrong direction. Regardless of the In a grim parody of the Russian Revolution, all throughout the blood vessels, red cells square off against white. And red always loses.

The treatment for IMHA, like many of the immune mediated diseases, will be familiar to IT professionals. Switch the immune system off as quickly as possible, then let it come back online slowly and hope it's calmed down a bit. Steroids are the cheapest and most-frequently used drugs to do this, though there are a number of others. The problem is, it takes time for the immune system to stop popping the red-blood cells like an overactive needle-armed toddler in a balloon shop, and during that time the anaemia can reach severely (and frequently fatally) low levels.

PCV

Another definition for you (sorry) -Anaemia is - or at least can be - measured by the Packed Cell Volume - or PCV. If you spin down blood in a centrifuge, all the red cells will squish up together at the bottom of the tube, and the PCV is just the percentage of tube that is filled by these red cells - the lower the PCV, the fewer red blood cells you have. Dogs and cats normally have a PCV in the 30-40% range. Unless they're planning to run a marathon any time soon, they're going to be fine until it drops below 20%, where they're going to start looking a little tired. By the time it drops below 12% they're heading into trouble and are probably going to need a transfusion very soon. For dogs, if it drops much below, say, seven or eight percent, they are in serious danger of death. Cats seem to tolerate very low PCVs a little better, and I've know a few survive even with PCVs of five or six - but it's still brown-trousers territory for the clinician involved.


So, for whatever reason, we have a dog or cat with a worryingly pale gum colour and a PCV that is making us sweat. What now?

Let's talk about that in part two (although - spoilers - it involves sticking more blood into the animal).