Hello blog readers/spambots/ghosts in the machine
This a quick (and rather excited) post merely to mention that my book, The Express Diaries, is up for an ENnie award - so, yay, go Paul, Eric and me!
If you've read the book and enjoyed it, please consider nipping over to the voting booth and voting for us - it's in the RPG related category - and, not that I'm trying to influence your voting or anything, but '1' is for first choice etc.
Thanks for reading! New proper blog post to appear here soon, I promise. Unless you don't vote for us, I which case I'll throw my laptop out of the window in a huff. Yes, you.
Nick :)
Tuesday, 23 July 2013
Friday, 12 July 2013
The Bluffer's Guide to Neutering
Firstly, congratulations are in order, for today is graduation day for the veterinary students of Nottingham University - well done, new vets! Well-deserved! My lord, you all look so young. I hate you.
Ahem. Apologies. Also, I don't hate you. You have a long and likely happy career ahead of you, but you've got a bit of a learning curve ahead of you now. Well, okay, not so much a curve as an Everest.
Thinking enviously about your cheerful, fresh faces, has got me thinking about being a new graduate myself, you see, and of all the things I started worrying about the moment I realised that bloody hell, I had only bloody qualified as a bloody vet!
I'm good at worrying (and at whinging, as regular blog readers are no doubt aware). After I graduated, I was at the very height of my worrying powers, and could probably have worried for Team GB. Amongst the many, many things that I worried I wouldn't be able to do (blood sampling, consulting, driving the practice car without writing it off (it turns out I was right to worry about this one)) one that loomed very, very large in my mind was surgery - and, particularly, given my woeful experience at the time of graduation (five cat castrates and a half a dog castrate), neutering.
Neutering. The bread and butter of the general practioner's day. If you can't neuter something, you might as well hang up your stethoscope before you've even bothered to (very cooly) drape it around your neck.
I am here to tell you, new graduates, not to worry about it. Well, that's not entirely true. I'm here to tell you why it's totally pointless worrying about it (a subtle distinction), by showing it to you from my perspective as a equally fresh-faced, enthusiastic new graduate; and I'm going to do that (along with telling everyone else what neutering actually entails) that with the aid of my (please insert a fanfare mentally at this point)
BLUFFER'S GUIDE TO NEUTERING! (Or, how I stopped worrying and learned to love the ops)
(You didn't do that fanfare, did you? Tsk)
Neutering is the generic term for removal of an animal’s reproductive ability. For males, it’s castration (removing the testicles. You might think this is rather too obvious to spell out, but I have, in my career, been confronted by a furious owner demanding ‘where the fuck’ her dog’s testicles were after I had castrated him. A few awkward moments passed while I explained the procedure that she had signed for that morning. The owner had been under the impression that castrating her dog merely meant ‘giving it the snip’. She was especially annoyed because now, all the other dogs in the area would pick on him because they would spy his conspicuous lack of love spuds, and realise that he was an easy target. We sorted it all out in the end but it was, as I say, an awkward consultation). For females, it’s speying (or, if you’re American, spaying; all I’ll say on the matter is that you’re wrong about grey, and you’re wrong about this).
Castration is a relatively simple (if eye-watering, for male readers) procedure in both dogs and cats – relatively low risk exercises in ligation (tying off blood vessels) and suturing. As with all surgical procedures, there are a few variations in technique, based on personal preference, but they were good procedures for my new-graduate self to sharpen my surgical teeth on (if you’ll forgive the slightly disturbing mental image that metaphor creates). Speying... speying is a different matter. The medical term is ovariohysterectomy – the surgical removal of both the uterus and the ovaries (As opposed to the human hysterectomy – removal of just the uterus (hystera being the Greek word for uterus, and the same root word from which we derive the word hysteria – which probably tells you all you need to know about the male attitude towards women throughout history)) is much more involved surgery. The ovaries are inside the animal – just below the kidneys, to be precise – and so harder to get to. Ligation is trickier, because the blood vessels supplying the ovaries and the uterus are similarly harder to manhandle into a position where you can tie your knot (incidentally, our domestic pets don’t suffer from hormone deficiency problems in the same way that humans do, on account of having a different reproductive cycle – the oestrus cycle, as opposed to the human (and other primate) menstrual cycle. This explains both why female dogs and cats don’t go through a menopause as they age, and also why humans don’t come on heat – which is why you never see un-neutered male humans leaving their homes searching for other women. Oh, wait...)
With cat speys, the added complication, just to make things interesting, is that in the UK we have decided to make the flank approach to the uterus our approach of choice. Flank means what it sounds like – making an incision in the side of the cat’s abdomen, rather than the midline approach that we choose for every other abdominal surgery we ever do. I’m still not entirely sure of the reasoning behind this; I’ve heard arguments that it’s quicker, that you get less post-operative reactions, or that if you get a hernia it tends to be less serious in the flank – but I’m not convinced by any of them. A well-practised surgeon will be equally speedy with either technique, I’ve see my fair share of post-operative reactions with flank cat speys, and if you get a hernia then you need to surgically repair it whichever hole the internal organs happen to have popped out of. I can just about see the argument that it’s a useful technique for animals that are lactating, because your wound is further away from the teats, and so the mother is less likely to reject the kittens when they come to suckle. You’re less likely to get milk leaking into your wound and causing an infection (because if there’s one thing that bacteria love, it’s a bit of milk) – except that in lactating dogs we still operate midline and don’t seem to see any of the attendant problems.
The main problem with the flank cat spey is that if you make you incision in just the wrong place it is an absolute bugger to find that bloody uterus. In these early months of my career, I spent many, many hours peering into a cat’s abdomen, fruitlessly searching for its reproductive organs like Gollum forlornly searching for his lost ring, only to discover that I had yet again failed to penetrate the peritoneum (a thin membrane coating the abdominal organs, that shrink-wraps them away from hapless surgeons that fail to make their cut deep enough), or that my incision was to dorsal, or too ventral, or (on one occasion) so far back that I had managed to enter the poor cat’s abdomen through the muscles of its hind leg; this last individual seemed fine when it woke up but I made sure it had extra pain-relief at home. Even though my days of elusive uteri are long behind me, I have spent enough hours since helping out stressed and sweary foreign locums attempting this strange technique to wonder why it is we persist in our approach. Tradition, I suppose. I guess it's no weirder than putting trees in our houses at Christmas.
The last, and by no means at all the least of the ‘routine’ neutering procedures is the bitch spey. Ahh, bitch spey, my old nemesis. The bitch spey is the same surgery as a cat spey, in that you’re performing an ovariohysterectomy, but it’s much, much harder. I would contend, in fact, that speying a fat deep-chested dog is about the most difficult surgical procedure you’re likely to encounter before you start entering the realms of certificate-level surgery. There’s a feeling that only surgeons know – a warm, prickly, feeling, experienced during an operation that isn’t going very well; the surgeon’s sweats, we’ll call it: a terrible feeling that you want to escape, you want to be anywhere but standing here in this hot, humid operating theatre wondering what the hell you are going to do to sort this mess out. In my early years, I came to associate bitch speys with the surgeon’s sweats.
Here’s how I saw it: a bitch spey is a no-win procedure. You’re starting with a completely healthy animal who, given the choice, would probably rather not have you ferreting about in its abdomen, and you’re performing major abdominal surgery upon it. Those blood vessels of the ovaries, those difficult to get to ones up by the kidneys, are no small potatoes. If you don’t ligate them properly, the dog could bleed to death. Now, it’s worth pointing out that in my decade (and a bit mumble mumble) as a veterinary surgeon since, I have never once seen or even heard of a bitch spey bleeding to death either during the procedure or afterwards (although I have seen a handful need to be re-operated on to re-tie oozing blood vessels) but the knowledge that it was at least theoretically possible was very much on my mind as I learned my surgical skills. When abdominal fat, which obscures your vision and makes everything – including your suture material - as greasy and slippery as a bacon sandwich, is added into the mix, then you have a recipe for a young veterinary surgeon such as myself turning the air blue as he attempts to complete a procedure that he wishes he had never started, in the full blush of the surgeon sweats (although, apparently, it's not when I start swearing that my nurses get worried nowadays; it's when I stop swearing and go quiet). As well as that horrible feeling, I discovered to my surprise that during a long, hot and unpleasant surgical procedure is the time that I seem most likely to be afflicted with an ‘earworm’ – the internet term for a song repeatedly playing unasked in your head. There were many times in my younger days when I stood with my hands placed inside a still-living animal, surgical gloves covered with a slippery sheen of fat, feeling hot, stressed, sweaty and miserable, with ‘Memories are made of this’ inexplicably blaring at full volume within my skull. After several of these long, stressful and strangely lonely experiences, I started to develop something of a 'thing' about bitch speys.
Much as I started to do with consultations that I might have to see the next morning, I started to check the ops board the day before my ops day. A board that featured a bitch spey larger that fifteen kilos, or older than a couple of years (and so likely to be fatter) would mean a restless and worried night’s sleep for me. I grew to loathe them. However, I decided that the best way to deal with my ‘thing’ was to confront it full on, and do as many as possible, rather than try to avoid them (which is what I desperately wanted to do).
Thinking enviously about your cheerful, fresh faces, has got me thinking about being a new graduate myself, you see, and of all the things I started worrying about the moment I realised that bloody hell, I had only bloody qualified as a bloody vet!
I'm good at worrying (and at whinging, as regular blog readers are no doubt aware). After I graduated, I was at the very height of my worrying powers, and could probably have worried for Team GB. Amongst the many, many things that I worried I wouldn't be able to do (blood sampling, consulting, driving the practice car without writing it off (it turns out I was right to worry about this one)) one that loomed very, very large in my mind was surgery - and, particularly, given my woeful experience at the time of graduation (five cat castrates and a half a dog castrate), neutering.
Neutering. The bread and butter of the general practioner's day. If you can't neuter something, you might as well hang up your stethoscope before you've even bothered to (very cooly) drape it around your neck.
I am here to tell you, new graduates, not to worry about it. Well, that's not entirely true. I'm here to tell you why it's totally pointless worrying about it (a subtle distinction), by showing it to you from my perspective as a equally fresh-faced, enthusiastic new graduate; and I'm going to do that (along with telling everyone else what neutering actually entails) that with the aid of my (please insert a fanfare mentally at this point)
BLUFFER'S GUIDE TO NEUTERING! (Or, how I stopped worrying and learned to love the ops)
(You didn't do that fanfare, did you? Tsk)
Neutering is the generic term for removal of an animal’s reproductive ability. For males, it’s castration (removing the testicles. You might think this is rather too obvious to spell out, but I have, in my career, been confronted by a furious owner demanding ‘where the fuck’ her dog’s testicles were after I had castrated him. A few awkward moments passed while I explained the procedure that she had signed for that morning. The owner had been under the impression that castrating her dog merely meant ‘giving it the snip’. She was especially annoyed because now, all the other dogs in the area would pick on him because they would spy his conspicuous lack of love spuds, and realise that he was an easy target. We sorted it all out in the end but it was, as I say, an awkward consultation). For females, it’s speying (or, if you’re American, spaying; all I’ll say on the matter is that you’re wrong about grey, and you’re wrong about this).
Castration is a relatively simple (if eye-watering, for male readers) procedure in both dogs and cats – relatively low risk exercises in ligation (tying off blood vessels) and suturing. As with all surgical procedures, there are a few variations in technique, based on personal preference, but they were good procedures for my new-graduate self to sharpen my surgical teeth on (if you’ll forgive the slightly disturbing mental image that metaphor creates). Speying... speying is a different matter. The medical term is ovariohysterectomy – the surgical removal of both the uterus and the ovaries (As opposed to the human hysterectomy – removal of just the uterus (hystera being the Greek word for uterus, and the same root word from which we derive the word hysteria – which probably tells you all you need to know about the male attitude towards women throughout history)) is much more involved surgery. The ovaries are inside the animal – just below the kidneys, to be precise – and so harder to get to. Ligation is trickier, because the blood vessels supplying the ovaries and the uterus are similarly harder to manhandle into a position where you can tie your knot (incidentally, our domestic pets don’t suffer from hormone deficiency problems in the same way that humans do, on account of having a different reproductive cycle – the oestrus cycle, as opposed to the human (and other primate) menstrual cycle. This explains both why female dogs and cats don’t go through a menopause as they age, and also why humans don’t come on heat – which is why you never see un-neutered male humans leaving their homes searching for other women. Oh, wait...)
With cat speys, the added complication, just to make things interesting, is that in the UK we have decided to make the flank approach to the uterus our approach of choice. Flank means what it sounds like – making an incision in the side of the cat’s abdomen, rather than the midline approach that we choose for every other abdominal surgery we ever do. I’m still not entirely sure of the reasoning behind this; I’ve heard arguments that it’s quicker, that you get less post-operative reactions, or that if you get a hernia it tends to be less serious in the flank – but I’m not convinced by any of them. A well-practised surgeon will be equally speedy with either technique, I’ve see my fair share of post-operative reactions with flank cat speys, and if you get a hernia then you need to surgically repair it whichever hole the internal organs happen to have popped out of. I can just about see the argument that it’s a useful technique for animals that are lactating, because your wound is further away from the teats, and so the mother is less likely to reject the kittens when they come to suckle. You’re less likely to get milk leaking into your wound and causing an infection (because if there’s one thing that bacteria love, it’s a bit of milk) – except that in lactating dogs we still operate midline and don’t seem to see any of the attendant problems.
The main problem with the flank cat spey is that if you make you incision in just the wrong place it is an absolute bugger to find that bloody uterus. In these early months of my career, I spent many, many hours peering into a cat’s abdomen, fruitlessly searching for its reproductive organs like Gollum forlornly searching for his lost ring, only to discover that I had yet again failed to penetrate the peritoneum (a thin membrane coating the abdominal organs, that shrink-wraps them away from hapless surgeons that fail to make their cut deep enough), or that my incision was to dorsal, or too ventral, or (on one occasion) so far back that I had managed to enter the poor cat’s abdomen through the muscles of its hind leg; this last individual seemed fine when it woke up but I made sure it had extra pain-relief at home. Even though my days of elusive uteri are long behind me, I have spent enough hours since helping out stressed and sweary foreign locums attempting this strange technique to wonder why it is we persist in our approach. Tradition, I suppose. I guess it's no weirder than putting trees in our houses at Christmas.
The last, and by no means at all the least of the ‘routine’ neutering procedures is the bitch spey. Ahh, bitch spey, my old nemesis. The bitch spey is the same surgery as a cat spey, in that you’re performing an ovariohysterectomy, but it’s much, much harder. I would contend, in fact, that speying a fat deep-chested dog is about the most difficult surgical procedure you’re likely to encounter before you start entering the realms of certificate-level surgery. There’s a feeling that only surgeons know – a warm, prickly, feeling, experienced during an operation that isn’t going very well; the surgeon’s sweats, we’ll call it: a terrible feeling that you want to escape, you want to be anywhere but standing here in this hot, humid operating theatre wondering what the hell you are going to do to sort this mess out. In my early years, I came to associate bitch speys with the surgeon’s sweats.
Here’s how I saw it: a bitch spey is a no-win procedure. You’re starting with a completely healthy animal who, given the choice, would probably rather not have you ferreting about in its abdomen, and you’re performing major abdominal surgery upon it. Those blood vessels of the ovaries, those difficult to get to ones up by the kidneys, are no small potatoes. If you don’t ligate them properly, the dog could bleed to death. Now, it’s worth pointing out that in my decade (and a bit mumble mumble) as a veterinary surgeon since, I have never once seen or even heard of a bitch spey bleeding to death either during the procedure or afterwards (although I have seen a handful need to be re-operated on to re-tie oozing blood vessels) but the knowledge that it was at least theoretically possible was very much on my mind as I learned my surgical skills. When abdominal fat, which obscures your vision and makes everything – including your suture material - as greasy and slippery as a bacon sandwich, is added into the mix, then you have a recipe for a young veterinary surgeon such as myself turning the air blue as he attempts to complete a procedure that he wishes he had never started, in the full blush of the surgeon sweats (although, apparently, it's not when I start swearing that my nurses get worried nowadays; it's when I stop swearing and go quiet). As well as that horrible feeling, I discovered to my surprise that during a long, hot and unpleasant surgical procedure is the time that I seem most likely to be afflicted with an ‘earworm’ – the internet term for a song repeatedly playing unasked in your head. There were many times in my younger days when I stood with my hands placed inside a still-living animal, surgical gloves covered with a slippery sheen of fat, feeling hot, stressed, sweaty and miserable, with ‘Memories are made of this’ inexplicably blaring at full volume within my skull. After several of these long, stressful and strangely lonely experiences, I started to develop something of a 'thing' about bitch speys.
Much as I started to do with consultations that I might have to see the next morning, I started to check the ops board the day before my ops day. A board that featured a bitch spey larger that fifteen kilos, or older than a couple of years (and so likely to be fatter) would mean a restless and worried night’s sleep for me. I grew to loathe them. However, I decided that the best way to deal with my ‘thing’ was to confront it full on, and do as many as possible, rather than try to avoid them (which is what I desperately wanted to do).
I sweated and swore my way through a lot of speys. They got easier, but I never stopped worrying. what if I get a bleeder? What will I do? How will I cope?
Eventually, of course, my worst nightmare – the one that had deprived me of so many hours of sleep worrying about it- came true. During the spey of a particularly chubby Doberman, one of my ligatures slipped off an ovarian stump, and the dog’s abdomen began to fill with blood. I panicked, and called for a colleague, who very calmly scrubbed in with me, helped me find the stump, made me ligate it again, smiled, and walked back out whilst I got on with the rest of the spey.
This was a surgical epiphany for me, because I realised that all that worry and fear over what would happen if one of my stumps wasn’t ligated properly had been for nothing, because all that actually happened was that the operation took about ten minutes longer that it otherwise would have done. That’s all. Everyone, at some point in their career, has a bleeding stump from a bitch spey, and everyone goes through that same realisation – what was all the worry about? It didn't completely cure my nervousness of bitch speys, but it was the beginning of the end of it. It took a lot more bitch speys before I began to see them in my own mind in the way we describe them - routine - but I did get there eventually.
(Having written that personal odyssey through my earliest surgical steps, it occurs to me that the conclusion that may be drawn from it is that the best way to stop worrying about a surgical procedure is to immediately cause the worst complication that you can imagine on the basis that it will all get better from there. Please don't follow that advice, or crucially, if you do, please don't mention this blog to the Royal College of Veterinary Surgeons)
So, the months passed, and the stresses of surgery began to recede. Neutering, taking bloods, hitting veins, placing catheters (intravenous and urethral), placing ET-tubes and the scores of other practical things that I had lain awake at night wondering whether I would actually be able to do became easier an easier, as things do when you’re doing them all day, every day. All that worrying, for nothing. You see what I hadn’t realised is that, in veterinary medicine, as with every other aspect of life, it’s not generally the things you worry about that end up becoming a problem.
So, the months passed, and the stresses of surgery began to recede. Neutering, taking bloods, hitting veins, placing catheters (intravenous and urethral), placing ET-tubes and the scores of other practical things that I had lain awake at night wondering whether I would actually be able to do became easier an easier, as things do when you’re doing them all day, every day. All that worrying, for nothing. You see what I hadn’t realised is that, in veterinary medicine, as with every other aspect of life, it’s not generally the things you worry about that end up becoming a problem.
It’s the things that jump out upon you unexpectedly, like a phone call at three in the morning, that really cause you trouble. Err... have fun with that out of hours work.
Right, well that's all the worries of today's Nottingham graduates (well done again!) eliminated, as well as, I suspect, the worries of all future veterinary graduates from here on in. A good day's blogging, I think. Now, to relax in the sun with a drink. Oh rats, I can't, I'm on call. Can anyone hear the phone ringing?
Thursday, 30 May 2013
Dog #86324
I recall a drunken conversation, years ago, in a student bar at Bristol University. It's a conversation I'll be dragged into frequently in the future, but this is the first time. A trainee biochemist has discovered that I'm learning to be a vet, and is now informing me at length how much money I'm going to earn.
'Licence to print money,' he slurs, looking at my shoulder, 'it's a licence to print fucking money!'
Not quite understanding why he's getting angry, I try to say that I'm not so sure, that I don't think vets earn any more than teachers, but he brushes this aside with a wave of his hand.
'You, mate,' he says, finally focusing on me, and pointing a finger at my face, 'are going to make a killing.' He pauses for a moment, then concedes generously, 'A small killing.'
* * * * *
Usually, when I'm calling in my next consultation, I say the animal's name; I think it sounds friendlier. Dog #86324 doesn't have a name, just a number, so this time I just call out 'dog warden?' and see if anyone reacts.
At the end of the waiting room, a young woman sitting with a small, thin Staffordshire bull terrier looks up. The terrier sees me and starts wagging its tail. The woman smiles sadly, and stands up. My heart sinks, because this dog doesn't look at all aggressive to me.
I turn back to my consulting room as the woman walks towards me, and I wonder how long this is going to take. There's been a bank holiday this week, which means I have a busy day ahead. Consultations are, of course, fully booked, with a number of extras squeezed in. Downstairs, a dog that I saw this morning may or may not be bleeding into its abdomen from a ruptured spleen; tests are pending. A very busy day.
Dog #86324 runs into my room, pulling on her lead, closely followed by the young woman, who closes the door behind her. I glance at the computer. Our consultations are colour coded: yellow for normal, blue for extra 'fit in', red for emergency. Dog #86324's consultation is dark grey. As I turn from my computer, the little dog jumps up at my legs, wagging her tail. I reach down to pat her, and she takes my whole hand into her mouth and sucks it, thoughtfully. I remove my hand and turn to the young woman, who is still trying to smile.
'Okay, what's the story with this little one?' I ask.
The young woman who works for the dog warden explains that Dog #86324 is a stray, brought in a few weeks ago. No owner has come forward. The dog warden in Plymouth normally has a no destruction policy, but Dog #86324 has apparently been tested twice with other dogs, and has been deemed 'very aggressive'.
'I didn't see the tests myself,' the young woman says, as the terrier runs back and forth between the two of us, 'but I'm told they were pretty bad.'
I look down at the dog and hope that this is true. Because of these tests, Dog #86324 has been deemed unrehomable. Local animal charities can't take her in; they're already full with unwanted dogs that aren't aggressive. National Staffy rescue charities are completely full, and they have been for years now.
The young woman places a form on the table. At the top is written Dog #86324's identification number, and her estimated age (no more than 18 months). Halfway down, there are a few notes on her behaviour. 'Care with other dogs!' one note says. 'Very mouthy.' I think of Dog #86324 sucking on my hand, and the fact that she walked obliviously past two other dogs in the waiting room on the way to see me. The young woman and I both agree its a terrible shame. I turn back to my computer, and print off a euthanasia consent form.
We discuss the options; not of what we're going to do, but of how we're going to do it. We decide that sedating Dog #86324 first may be the best option. Sedation takes a little longer, and sometimes makes the animal feel a little sick, but the terrier is a bouncy little dog, and might get distressed with too much manual restraint. We don't know, of course. We barely know anything about Dog #86324. That's not going to stop me, though.
I walk out into the prep room to draw up the sedation. It crosses my mind that I've been looking for another dog. Maybe if I took Dog #86324 home, she would get on with Katie, our laid-back greyhound. Maybe the tests weren't accurate. I think this while I'm drawing up the sedation, but I don't do anything about it, nor do I ask any of the nurses or support staff if they might be interested in another dog. We've all been asked the question before, and I know none of them are looking. Well, I think I know. It's a busy day. I don't want to bother people with difficult questions today.
Back in my consulting room, Dog #86324 is lying on her back, having her belly rubbed by the young woman who works for the dog warden. She jumps up, pleased to see me, and bounces over, taking my hand in her mouth again. Her teeth hurt a little, but not a lot. She doesn't mean it. It suddenly hits me, very hard and very raw, that in a few minutes this dog will be dead, and that I will have been the engine of its destruction. I want to run from the room, and hide downstairs, and get on with the business of saving lives, not taking them. I don't. There's a form on the table saying that I shouldn't. Instead, I ask the young woman to hold Dog #86324's head, while I inject the sedative in the scruff of her neck. The dog's tail stops wagging for a moment, and she looks at me almost reproachfully. Seconds later, my hand is in her mouth again, and the tail is back in action.
I ask the young woman if she'd like to leave Dog #86324 with us now. The woman shakes her head, clears her throat, and says that she would like to stay. She says she always stays. I want to hug her. While she lifts Dog #86324 onto the table, I head out to reception to pick up my own form that I printed off. On my way to the printer, I'm handed the blood results for my critical inpatient. He's definitely lost a lot of blood somewhere. I'm going to have to scan the chest and abdomen to find out where. If we're lucky, its the spleen, which can be safely (if messily) removed. I start thinking my way through a splenectomy. It's a nice distraction.
Back in the room, the young woman and I each sign our respective forms; hers to acknowledge she gives consent for the humane destruction of Dog #86324, and mine to acknowledge to the dog warden that I have indeed put her to sleep. My signing is a little premature - Dog #86324 still has a few minutes to live - but it gives us something to do while the sedative starts to work.
I find I can't stand to be in the room, making small talk whilst we wait. I step out, and begin to gather the materials I will need: some clippers, a swab soaked in surgical spirit, and ten millilitres of pentobarbitone solution. I tell Rachel that I'm going to need a hand with a PTS in a moment. She nods. She's seen the consultation on the list too. We all have.
I take a moment to run downstairs and check on my inpatient. His colour is much improved for going on a drip, and he's already quite a lot brighter. We have a little time. Hopefully the bleeding has stopped for the moment. While I'm looking at him, my mind wanders back to my consulting room, and the inevitability that I have allowed to grow in my mind over what I'm about to do. Just a few months ago, in a similar situation, I brought a cat home rather than put it to sleep. That's not going to happen today. I wonder if it's anything to do with the form from the dog warden. It occurs to me which way I would have probably reacted during the Milgram Experiments in the 50s.
It's been long enough. I head back up the stairs. Rachel is waiting for me outside my consulting room door. I force a smile onto my face as I open the door carrying the clippers, the spirit, and the pentobarbitone-loaded syringe.
Dog #86324 is flat out on my table now, her third eyelids halfway across her eyes. As I enter, I try not to notice that her tail starts thumping from side to side again, weakly. The young woman looks up at me and sighs.
'This is Rachel,' I say, comforting myself with my standard patter. 'She's just going to help me raise a vein on... er... her leg.' I falter a little because of the lack of name. Rachel lifts Dog #86324 onto her front, and extends a small, thin forelimb towards me. The young woman tickles dog #86324's ears, not watching what I'm doing. I clip a small patch of fur over the forearm, and Rachel twists her thumb around the crook of Dog #86324's elbow, raising her cephalic vein. Even with the sedative in her system, her vein is good. Of course it is. Dog #86324 is a healthy young dog.
I flex her wrist a couple of times, ostensibly to help raise the vein further, but there's really no need in this case. It's more of a ritual for me at this point. I take the needle cap off, rotate the bevel of the needle up so that the sharpest part will hit the skin first. I push the needle through the skin, and pull back on the syringe. A red flush in the blue liquid indicates that I've hit the vein first time, and there's at least some professional satisfaction to take as solace there. Rachel releases the pressure, and I begin to inject the pentobarbitone.
Within a few seconds, Dog #86324 is unconscious as the general anaesthetic enters her brain. I keep injecting. Dog #86324 gasps a number of times, and then her respiration, dulled by the overdose, stops. Her heart continues beating for a few more seconds but by the time I've taken the needle out of her leg, and placed the stethoscope on her chest, it's already over. The young woman from the dog warden has started crying, softly, as we lower Dog #86324's head. I look at the small, thin body on the table, and wonder why I have just taken one life, and am about to try and save another. I try and remember taking my oath on the day that I graduated, when I spoke the words 'it will be my constant endeavour to ensure the welfare of animals under my care'.
Blessedly, I don't have time to think any more. There are already more people waiting to be seen. Within minutes, the heroic young woman who works for the dog warden, who always puts herself through this even though she doesn't have to, has gone, and Dog #86324 is being placed into a thick black plastic bag. I am consulting again, and thinking about how to perform a splenectomy.
I feel bad, but I'll be okay. I'll tweet about it later. I might even write a blog about it, show that I'm upset, even though how I feel makes no difference now to Dog #86324, who is as dead as she would be if I didn't care at all.
My splenectomy is doing well. It strikes me that the drunken biochemist, years ago, was absolutely right.
Dog #86324. A small killing.
'Licence to print money,' he slurs, looking at my shoulder, 'it's a licence to print fucking money!'
Not quite understanding why he's getting angry, I try to say that I'm not so sure, that I don't think vets earn any more than teachers, but he brushes this aside with a wave of his hand.
'You, mate,' he says, finally focusing on me, and pointing a finger at my face, 'are going to make a killing.' He pauses for a moment, then concedes generously, 'A small killing.'
* * * * *
Usually, when I'm calling in my next consultation, I say the animal's name; I think it sounds friendlier. Dog #86324 doesn't have a name, just a number, so this time I just call out 'dog warden?' and see if anyone reacts.
At the end of the waiting room, a young woman sitting with a small, thin Staffordshire bull terrier looks up. The terrier sees me and starts wagging its tail. The woman smiles sadly, and stands up. My heart sinks, because this dog doesn't look at all aggressive to me.
I turn back to my consulting room as the woman walks towards me, and I wonder how long this is going to take. There's been a bank holiday this week, which means I have a busy day ahead. Consultations are, of course, fully booked, with a number of extras squeezed in. Downstairs, a dog that I saw this morning may or may not be bleeding into its abdomen from a ruptured spleen; tests are pending. A very busy day.
Dog #86324 runs into my room, pulling on her lead, closely followed by the young woman, who closes the door behind her. I glance at the computer. Our consultations are colour coded: yellow for normal, blue for extra 'fit in', red for emergency. Dog #86324's consultation is dark grey. As I turn from my computer, the little dog jumps up at my legs, wagging her tail. I reach down to pat her, and she takes my whole hand into her mouth and sucks it, thoughtfully. I remove my hand and turn to the young woman, who is still trying to smile.
'Okay, what's the story with this little one?' I ask.
The young woman who works for the dog warden explains that Dog #86324 is a stray, brought in a few weeks ago. No owner has come forward. The dog warden in Plymouth normally has a no destruction policy, but Dog #86324 has apparently been tested twice with other dogs, and has been deemed 'very aggressive'.
'I didn't see the tests myself,' the young woman says, as the terrier runs back and forth between the two of us, 'but I'm told they were pretty bad.'
I look down at the dog and hope that this is true. Because of these tests, Dog #86324 has been deemed unrehomable. Local animal charities can't take her in; they're already full with unwanted dogs that aren't aggressive. National Staffy rescue charities are completely full, and they have been for years now.
The young woman places a form on the table. At the top is written Dog #86324's identification number, and her estimated age (no more than 18 months). Halfway down, there are a few notes on her behaviour. 'Care with other dogs!' one note says. 'Very mouthy.' I think of Dog #86324 sucking on my hand, and the fact that she walked obliviously past two other dogs in the waiting room on the way to see me. The young woman and I both agree its a terrible shame. I turn back to my computer, and print off a euthanasia consent form.
We discuss the options; not of what we're going to do, but of how we're going to do it. We decide that sedating Dog #86324 first may be the best option. Sedation takes a little longer, and sometimes makes the animal feel a little sick, but the terrier is a bouncy little dog, and might get distressed with too much manual restraint. We don't know, of course. We barely know anything about Dog #86324. That's not going to stop me, though.
I walk out into the prep room to draw up the sedation. It crosses my mind that I've been looking for another dog. Maybe if I took Dog #86324 home, she would get on with Katie, our laid-back greyhound. Maybe the tests weren't accurate. I think this while I'm drawing up the sedation, but I don't do anything about it, nor do I ask any of the nurses or support staff if they might be interested in another dog. We've all been asked the question before, and I know none of them are looking. Well, I think I know. It's a busy day. I don't want to bother people with difficult questions today.
Back in my consulting room, Dog #86324 is lying on her back, having her belly rubbed by the young woman who works for the dog warden. She jumps up, pleased to see me, and bounces over, taking my hand in her mouth again. Her teeth hurt a little, but not a lot. She doesn't mean it. It suddenly hits me, very hard and very raw, that in a few minutes this dog will be dead, and that I will have been the engine of its destruction. I want to run from the room, and hide downstairs, and get on with the business of saving lives, not taking them. I don't. There's a form on the table saying that I shouldn't. Instead, I ask the young woman to hold Dog #86324's head, while I inject the sedative in the scruff of her neck. The dog's tail stops wagging for a moment, and she looks at me almost reproachfully. Seconds later, my hand is in her mouth again, and the tail is back in action.
I ask the young woman if she'd like to leave Dog #86324 with us now. The woman shakes her head, clears her throat, and says that she would like to stay. She says she always stays. I want to hug her. While she lifts Dog #86324 onto the table, I head out to reception to pick up my own form that I printed off. On my way to the printer, I'm handed the blood results for my critical inpatient. He's definitely lost a lot of blood somewhere. I'm going to have to scan the chest and abdomen to find out where. If we're lucky, its the spleen, which can be safely (if messily) removed. I start thinking my way through a splenectomy. It's a nice distraction.
Back in the room, the young woman and I each sign our respective forms; hers to acknowledge she gives consent for the humane destruction of Dog #86324, and mine to acknowledge to the dog warden that I have indeed put her to sleep. My signing is a little premature - Dog #86324 still has a few minutes to live - but it gives us something to do while the sedative starts to work.
I find I can't stand to be in the room, making small talk whilst we wait. I step out, and begin to gather the materials I will need: some clippers, a swab soaked in surgical spirit, and ten millilitres of pentobarbitone solution. I tell Rachel that I'm going to need a hand with a PTS in a moment. She nods. She's seen the consultation on the list too. We all have.
I take a moment to run downstairs and check on my inpatient. His colour is much improved for going on a drip, and he's already quite a lot brighter. We have a little time. Hopefully the bleeding has stopped for the moment. While I'm looking at him, my mind wanders back to my consulting room, and the inevitability that I have allowed to grow in my mind over what I'm about to do. Just a few months ago, in a similar situation, I brought a cat home rather than put it to sleep. That's not going to happen today. I wonder if it's anything to do with the form from the dog warden. It occurs to me which way I would have probably reacted during the Milgram Experiments in the 50s.
It's been long enough. I head back up the stairs. Rachel is waiting for me outside my consulting room door. I force a smile onto my face as I open the door carrying the clippers, the spirit, and the pentobarbitone-loaded syringe.
Dog #86324 is flat out on my table now, her third eyelids halfway across her eyes. As I enter, I try not to notice that her tail starts thumping from side to side again, weakly. The young woman looks up at me and sighs.
'This is Rachel,' I say, comforting myself with my standard patter. 'She's just going to help me raise a vein on... er... her leg.' I falter a little because of the lack of name. Rachel lifts Dog #86324 onto her front, and extends a small, thin forelimb towards me. The young woman tickles dog #86324's ears, not watching what I'm doing. I clip a small patch of fur over the forearm, and Rachel twists her thumb around the crook of Dog #86324's elbow, raising her cephalic vein. Even with the sedative in her system, her vein is good. Of course it is. Dog #86324 is a healthy young dog.
I flex her wrist a couple of times, ostensibly to help raise the vein further, but there's really no need in this case. It's more of a ritual for me at this point. I take the needle cap off, rotate the bevel of the needle up so that the sharpest part will hit the skin first. I push the needle through the skin, and pull back on the syringe. A red flush in the blue liquid indicates that I've hit the vein first time, and there's at least some professional satisfaction to take as solace there. Rachel releases the pressure, and I begin to inject the pentobarbitone.
Within a few seconds, Dog #86324 is unconscious as the general anaesthetic enters her brain. I keep injecting. Dog #86324 gasps a number of times, and then her respiration, dulled by the overdose, stops. Her heart continues beating for a few more seconds but by the time I've taken the needle out of her leg, and placed the stethoscope on her chest, it's already over. The young woman from the dog warden has started crying, softly, as we lower Dog #86324's head. I look at the small, thin body on the table, and wonder why I have just taken one life, and am about to try and save another. I try and remember taking my oath on the day that I graduated, when I spoke the words 'it will be my constant endeavour to ensure the welfare of animals under my care'.
Blessedly, I don't have time to think any more. There are already more people waiting to be seen. Within minutes, the heroic young woman who works for the dog warden, who always puts herself through this even though she doesn't have to, has gone, and Dog #86324 is being placed into a thick black plastic bag. I am consulting again, and thinking about how to perform a splenectomy.
I feel bad, but I'll be okay. I'll tweet about it later. I might even write a blog about it, show that I'm upset, even though how I feel makes no difference now to Dog #86324, who is as dead as she would be if I didn't care at all.
My splenectomy is doing well. It strikes me that the drunken biochemist, years ago, was absolutely right.
Dog #86324. A small killing.
Monday, 27 May 2013
Trumpet Blowing
There's a clue in the name; this post is largely me blowing my own trumpet about some very nice reviews I've had for The Express Diaries. Annoying, I know, but it is my trumpet, and it does need a blow from time to time... and with that I think we'll abandon the trumpet metaphor - not only is it close to breaking, it's also veering dangerously towards innuendo territory, and no one wants a big one of those first thing in the morning.
If you're really not in the mood for me telling you how great I am, I've done another blog too! You have a choice between self-pimping or flesh-eating maggots, so I feel I'm catering for a wide audience here.
The Express Diaries is my 1920s-set tale of darkness and adventure on board the world's most famous train (note : not Thomas the Tank Engine; though, that does give me an idea...), and in the last few months it's had some very nice people say some very nice things about it, which I thought I'd like to share here because... well, y'know, the trumpet thing.
Jill McDole over at Impact Online said...
'Despite being an entirely serious and accomplished novel, Marsh manages humour in the grimmest of circumstances and catches the parlance of the times as if he were there in the roaring twenties. It charges full steam ahead into clouds of blood and intrigue, taking no prisoners aboard, and leaving a trail of death in its wake. As the action flicks from the different viewpoints of the various characters and articles of media, the story is constantly refreshed throughout. With a pace that Hollywood would be envious of, I couldn’t find any faults throughout the entirety of the story...
If you like your horror a little more classy, or perhaps you’re a fan of everything and anything Lovecraft, period horror such as Dracula or H. G. Wells (or even a good mystery romp like Agatha Christie), I urge you to buy the ticket and take the ride on The Express Diaries. Thoroughly recommended.'
If you're really not in the mood for me telling you how great I am, I've done another blog too! You have a choice between self-pimping or flesh-eating maggots, so I feel I'm catering for a wide audience here.
The Express Diaries is my 1920s-set tale of darkness and adventure on board the world's most famous train (note : not Thomas the Tank Engine; though, that does give me an idea...), and in the last few months it's had some very nice people say some very nice things about it, which I thought I'd like to share here because... well, y'know, the trumpet thing.
Jill McDole over at Impact Online said...
'The action and excitement is unrelenting; I finished the book in almost record time... The volume is also beautifully illustrated by Eric M. Smith...
... this is probably the best Lovecraftian work I have read in quite some time. While the book tells quite a grim story overall, a few touches of well-placed humor lighten this work just enough. I found the work to be very complete between the words and the illustrations and found that it pays a wonderful homage to those old god tales for which Lovecraft was so well known. This book is a must have for fans of his work as well as anyone who loves a good, old-fashioned horror story.'
All very kind! I promise I didn't miss out any horrible bits with the ellipses, but I've popped the link to the full review above in case you're the suspicious type (and who could blame you with all this bloody trumpet noise going on?)
Nathan Robinson at Snakebite Horror recently posted...
If you like your horror a little more classy, or perhaps you’re a fan of everything and anything Lovecraft, period horror such as Dracula or H. G. Wells (or even a good mystery romp like Agatha Christie), I urge you to buy the ticket and take the ride on The Express Diaries. Thoroughly recommended.'
There's a bit more, but modesty prevents me from quoting it. It very much doesn't prevent me from linking to the full review above, of course.
Lastly, the most recent edition of Knights of the Dinner Table (#196) also contains a very nice review by Paul Westermeyer. It's not so much modesty that prevents me from linking to this review so much as it being impossible, given that Knights of the Dinner Table is one of those old-fashioned paper magazine thingies (I know? Who knew they still made them!). Here's a few quotes from it, though...
'... this novel suffers from none of the self-indulgent flaws one usually finds in fiction inspired by game sessions. The character view points are each unique, and this is apparent as the view shifts with each entry...
Marsh's sense of humor and ability to portray character is excellent, his prose is very sure-footed... the train comes alive through his prose, the reader feels as if they too have taken the long journey, and despite the horror, like they might want to take another such trip...
If you enjoy horror, if you enjoy role-playing, then give The Express Diaries a read.'
I feel I should reiterate here that I'm not responsible for a lot of the imagination in the book - credit for that goes to the original writers of the Horror on the Orient Express game (of which there's a new edition coming soon! Yay!) and the Yog-sothoth players who created the characters. Oh, and of course, Eric Smith, who illustrated the book so beautifully, but I guess if someone must take the credit for all their hard work, I'm prepared to shoulder the burden.
This is getting dangerously close to acceptance-speech levels of annoyance, so I'll stop with the pimping now, but I did want to quickly mention UK Games Expo in Birmingham, which I've just returned from and am now slowly recovering.
UK Games Expo is rapidly (and possibly rabidly) becoming the biggest games convention in the UK. I was there last year, doing a reading from the not-then-released Express Diaries. Circumstances prevented me from a similar reading this year (though if you're a glutton for punishment you can watch last years' here...) but I did spend a happy few hours on the Yog-sothoth stall, talking to people who had already read the book, and selling it to people who hadn't. I had a great time, and met some really, really nice people - one of whom, Jonathon Hicks, has already done an excellent write up of the Expo, which saves me having to say much more about it, except that I will definitely be heading there again next year!
Right, that's enough self-promotion for one year. Flesh-eating zombie* maggots, anyone?
*Okay, okay, they're not actually zombies. It's a reflex when I write 'flesh-eating'
The Fly Strikes Back
The smell is always a clue; wet fur mixed with urine and a hint of corruption. It's not too strong, but I've smelled it often enough that by the time I'd lifted the rabbit out of the box I had a fair idea what was going on even before his owner had told me what was wrong.
He's not eating, I was told. Depressed, not moving around much. Could he have caught a chill? I started to shake my head and look down towards the tail area, and that's when the first maggot landed on the table and confirmed to me that fly strike was back in season for another year.
Let's digress for a moment, if only to delay talking about maggots for a few more paragraphs (they give me the creeps... more on that later, though). There are some species that seem to have been dealt a particularly poor hand where diseases are concerned. From a large animal vet's point of view, it's sheep. If you can think of something unpleasant happening to a creature, then the creature it usually happens to is a sheep. Cheesy gland, hairy-shaker disease, staggers, struck, braxy, foot rot, mouth rot and, yes, pizzle rot. Fly strike too, of course.
For the small animal vet, it's rabbits. As a species, rabbits have survived by being really, really good at making other rabbits. They're prolific, but not, on an individual level, very hardy. I've talked about some of the problems with being a rabbit before - there's many more pitfalls, the not least of which is fly strike.
Fly strike is probably not the best name for the condition (although it's certainly catchier than the official title of myiasis ) because the flies in question are neither forming a picket-line outside the rabbit's hutch nor physically thumping the rabbit - but an afflicted (or fly-blown) animal does look rather dazed as if it's just taken a left-hook, so maybe that's where the term came from.
So, here's what happens... the blowfly (lucilia sericata) likes to lay her eggs on tightly compacted fur, especially moist and smelly fur. She's keen on wool (which is why sheep suffer from this as well) and especially partial to rabbit fur. The eggs go on the fur, and within a short period of time (it varies depending on the temperature, but its often less than a day) the maggots hatch out. They burrow down to the skin, and they start to do what maggots do best. They start to eat.
Now, the more medically astute amongst you may be wearing a puzzled expression at this point. 'Hang on,' you're thinking, 'that's not right! Maggots only eat dead flesh, don't they? So they're not going to eat the rabbit alive, are they?'
Well, I'm very sorry to tell you that you're wrong, because that is exactly what they are about to do. It's true that, when clinically applied in sterile conditions, maggots of this very same fly have a preference for munching on dead flesh, and they are absolutely amazing in such situations at cleaning out (or debriding) all the necrotic tissue. Unfortunately, this is not a clinical, controlled situation. It's not even slightly a sterile one. It's probably technically true that the maggots are not so much eating the live flesh as killing it using acidic enzymes and inflammation caused by burrowing, and then eating the dead stuff, but such technicalities don't make a huge amount of difference to the unfortunate rabbit.
It's a quick disease - as I say, the maggots can hatch within a day, and the damage they can do in a short space of time is staggering. Unfortunately, because all this is almost always going on at the wettest, smelliest part of the rabbit - the anus and a genitals, both of which are hidden from a glancing view - all the owner tends to notice at first is that their rabbit has gone a bit quiet. The rabbits tend not to lick and bite at their burrowing attackers, possibly because there's a local anaesthetic effect (I really hope so) but more likely because doing so could be interpreted as a sign of weakness to a predator. Consequently, by the time we as vets are presented with a case of fly strike, the damage can be absolutely horrendous.
Fortunately, I have no pictures to display of the damage - firstly. I don't tend to take photos myself because when I see it I'm generally busy with the rabbit, and secondly, I'm not about to search for images of it because I've seen more than enough for this lifetime, thanks very much. You're very welcome to yourself, of course, but if you sensibly haven't done so, then I'll briefly describe the sort of things we see.
We're frequently presented with rabbits with what I would clinically describe as a 'large skin deficit' (and non-clinically as a 'big hole') often extending from the tail up over the back, or from the genitals forwards. If the rabbit is unlucky, the lesions will be deeper, extending into the subcutaneous muscles, through the perineum and on into the abdomen. It's not infrequent to lift up the fur on a rabbit's back to have the skin lift up right along with it, revealing a white seething mass of maggots burrowing their way forwards through the gore.
A brief digression on maggots (for those of you who are still with me!) - I try not to discriminate between species. None of us were given a choice what species we were born. Even with ticks, which seem to make most people squirm with displeasure (especially when you pop 'em out with the legs still wriggling) I try and keep in mind that it's only doing what evolution designed it to do. It's not their fault they're a tick, is it?
I'm not capable of that with maggots. There's a strange atavistic revulsion that comes over me watching those little white bodies wriggle about like stubby Lovecraftian tentacles that makes me want to be sick, run screaming and destroy the abomination all at the same time. I'm not proud of it, but I also suspect I'm not alone amongst mankind in having such feelings. I know its not the maggots' fault and that it's stupid even ascribing such things as blame to the larval stage of an insect, but watching them wriggle in a kidney dish after plucking them from the living flesh of a rabbit makes me feel the need to buy a flamethrower and get all Ripley on their asses, as well as giving me all manner of dark thoughts about the nature of the universe. As ever, Darwin said it best...
Ahem, let's try and get back to being professional. Fly strike is an emergency - the longer you leave it, the more trouble the rabbit is in. If the damage isn't too great already, we remove all the maggots from the wound site. That means physically plucking the maggots out with forceps, haemostats, cotton buds, fingers, and whatever else works to get them off the rabbit. We assess the damage - if the wounds extend into the abdominal cavity, or (as is also sadly not infrequent) we see maggots crawling out from the anus or the genitals, then there's no hope.
If there's a chance, then we clean the wounds, we treat for shock, pain, and infection, and we keep checking for maggots until they're all gone. So long as the tracks are not too deep, even very large skin wounds can heal surprisingly well; this may be some kind of testament to the healing power of the maggot even in these awful circumstances.
Well, there, that was less fun that it sounded at the start, wasn't it? Let's not beat around the bush - fly strike is horrible. Really horrible. Even to my clinically jaded eyes, it makes me feel full of horror and sympathy for its victims (victims? There I go again, as if the maggots are the criminals; it's hard not to anthropomorphise with this one).
Time is the key with fly strike. Get to it quickly, and it's easily fixed, or it never happens at all. Leave it too long and... well, you don't want me to go into all of that again, do you? Ugh. It made me feel queasy just writing about it, and it put me off my coffee. Shall we make a deal? You don't want to read about it again, and I don't want to write about it again. I definitely don't want to see it ever again. Here's a simple way to stop any of us going through it.
If you have a rabbit, check it. Check it every day - twice a day in Spring and Summer. Those eggs hatch more quickly than you think - clients find it often unable to believe the amount of damage in such a short space of time.
There's a few fly killers and fly repellents you can buy that you sponge around the back end of your bunny to try and prevent the eggs being laid or from hatching out. I'm not here to sell you drugs, but ask your local vet about them. They help. But they're not substitutes for checking. If you see eggs (like tiny little grains of sticky rice) get them off.
Your rabbit is going to be more at risk if it's overweight, less mobile, or if it has long fur. By far and away the biggest risk is rabbits with matted poo stuck around their back end, so clean it off! There can be a lot of clinical reasons for the mucky bum rabbits (teeth problems, weight problems, back problems, diet problems), and I'm aware some of them just seem to dirty protest however hard you try to prevent them, but you really need to be cleaning them daily and checking them more often than that in the Spring and Summer.
I know it's not a nice job, I know it's a pain, but I don't want to see another case of fly strike ever. Let's see what we can do.
He's not eating, I was told. Depressed, not moving around much. Could he have caught a chill? I started to shake my head and look down towards the tail area, and that's when the first maggot landed on the table and confirmed to me that fly strike was back in season for another year.
Let's digress for a moment, if only to delay talking about maggots for a few more paragraphs (they give me the creeps... more on that later, though). There are some species that seem to have been dealt a particularly poor hand where diseases are concerned. From a large animal vet's point of view, it's sheep. If you can think of something unpleasant happening to a creature, then the creature it usually happens to is a sheep. Cheesy gland, hairy-shaker disease, staggers, struck, braxy, foot rot, mouth rot and, yes, pizzle rot. Fly strike too, of course.
For the small animal vet, it's rabbits. As a species, rabbits have survived by being really, really good at making other rabbits. They're prolific, but not, on an individual level, very hardy. I've talked about some of the problems with being a rabbit before - there's many more pitfalls, the not least of which is fly strike.
Fly strike is probably not the best name for the condition (although it's certainly catchier than the official title of myiasis ) because the flies in question are neither forming a picket-line outside the rabbit's hutch nor physically thumping the rabbit - but an afflicted (or fly-blown) animal does look rather dazed as if it's just taken a left-hook, so maybe that's where the term came from.
Now, the more medically astute amongst you may be wearing a puzzled expression at this point. 'Hang on,' you're thinking, 'that's not right! Maggots only eat dead flesh, don't they? So they're not going to eat the rabbit alive, are they?'
Well, I'm very sorry to tell you that you're wrong, because that is exactly what they are about to do. It's true that, when clinically applied in sterile conditions, maggots of this very same fly have a preference for munching on dead flesh, and they are absolutely amazing in such situations at cleaning out (or debriding) all the necrotic tissue. Unfortunately, this is not a clinical, controlled situation. It's not even slightly a sterile one. It's probably technically true that the maggots are not so much eating the live flesh as killing it using acidic enzymes and inflammation caused by burrowing, and then eating the dead stuff, but such technicalities don't make a huge amount of difference to the unfortunate rabbit.
It's a quick disease - as I say, the maggots can hatch within a day, and the damage they can do in a short space of time is staggering. Unfortunately, because all this is almost always going on at the wettest, smelliest part of the rabbit - the anus and a genitals, both of which are hidden from a glancing view - all the owner tends to notice at first is that their rabbit has gone a bit quiet. The rabbits tend not to lick and bite at their burrowing attackers, possibly because there's a local anaesthetic effect (I really hope so) but more likely because doing so could be interpreted as a sign of weakness to a predator. Consequently, by the time we as vets are presented with a case of fly strike, the damage can be absolutely horrendous.
Fortunately, I have no pictures to display of the damage - firstly. I don't tend to take photos myself because when I see it I'm generally busy with the rabbit, and secondly, I'm not about to search for images of it because I've seen more than enough for this lifetime, thanks very much. You're very welcome to yourself, of course, but if you sensibly haven't done so, then I'll briefly describe the sort of things we see.
We're frequently presented with rabbits with what I would clinically describe as a 'large skin deficit' (and non-clinically as a 'big hole') often extending from the tail up over the back, or from the genitals forwards. If the rabbit is unlucky, the lesions will be deeper, extending into the subcutaneous muscles, through the perineum and on into the abdomen. It's not infrequent to lift up the fur on a rabbit's back to have the skin lift up right along with it, revealing a white seething mass of maggots burrowing their way forwards through the gore.
A brief digression on maggots (for those of you who are still with me!) - I try not to discriminate between species. None of us were given a choice what species we were born. Even with ticks, which seem to make most people squirm with displeasure (especially when you pop 'em out with the legs still wriggling) I try and keep in mind that it's only doing what evolution designed it to do. It's not their fault they're a tick, is it?
I'm not capable of that with maggots. There's a strange atavistic revulsion that comes over me watching those little white bodies wriggle about like stubby Lovecraftian tentacles that makes me want to be sick, run screaming and destroy the abomination all at the same time. I'm not proud of it, but I also suspect I'm not alone amongst mankind in having such feelings. I know its not the maggots' fault and that it's stupid even ascribing such things as blame to the larval stage of an insect, but watching them wriggle in a kidney dish after plucking them from the living flesh of a rabbit makes me feel the need to buy a flamethrower and get all Ripley on their asses, as well as giving me all manner of dark thoughts about the nature of the universe. As ever, Darwin said it best...
'I cannot persuade myself that a beneficent and omnipotent God would have designedly created parasitic wasps with the express intention of their feeding within the living bodies of caterpillars.'
Ahem, let's try and get back to being professional. Fly strike is an emergency - the longer you leave it, the more trouble the rabbit is in. If the damage isn't too great already, we remove all the maggots from the wound site. That means physically plucking the maggots out with forceps, haemostats, cotton buds, fingers, and whatever else works to get them off the rabbit. We assess the damage - if the wounds extend into the abdominal cavity, or (as is also sadly not infrequent) we see maggots crawling out from the anus or the genitals, then there's no hope.
If there's a chance, then we clean the wounds, we treat for shock, pain, and infection, and we keep checking for maggots until they're all gone. So long as the tracks are not too deep, even very large skin wounds can heal surprisingly well; this may be some kind of testament to the healing power of the maggot even in these awful circumstances.
Well, there, that was less fun that it sounded at the start, wasn't it? Let's not beat around the bush - fly strike is horrible. Really horrible. Even to my clinically jaded eyes, it makes me feel full of horror and sympathy for its victims (victims? There I go again, as if the maggots are the criminals; it's hard not to anthropomorphise with this one).
Time is the key with fly strike. Get to it quickly, and it's easily fixed, or it never happens at all. Leave it too long and... well, you don't want me to go into all of that again, do you? Ugh. It made me feel queasy just writing about it, and it put me off my coffee. Shall we make a deal? You don't want to read about it again, and I don't want to write about it again. I definitely don't want to see it ever again. Here's a simple way to stop any of us going through it.
If you have a rabbit, check it. Check it every day - twice a day in Spring and Summer. Those eggs hatch more quickly than you think - clients find it often unable to believe the amount of damage in such a short space of time.
There's a few fly killers and fly repellents you can buy that you sponge around the back end of your bunny to try and prevent the eggs being laid or from hatching out. I'm not here to sell you drugs, but ask your local vet about them. They help. But they're not substitutes for checking. If you see eggs (like tiny little grains of sticky rice) get them off.
Your rabbit is going to be more at risk if it's overweight, less mobile, or if it has long fur. By far and away the biggest risk is rabbits with matted poo stuck around their back end, so clean it off! There can be a lot of clinical reasons for the mucky bum rabbits (teeth problems, weight problems, back problems, diet problems), and I'm aware some of them just seem to dirty protest however hard you try to prevent them, but you really need to be cleaning them daily and checking them more often than that in the Spring and Summer.
I know it's not a nice job, I know it's a pain, but I don't want to see another case of fly strike ever. Let's see what we can do.
Tuesday, 26 March 2013
Badgers? Badgers? We don' need no steenkeen' badgers!
As I'm sure you're all aware (in fact, it could hardly have escaped your notice), it's election time again. I know that you haven't been able to turn on a radio or go to a news website without reading yet more about the upcoming elections for president of the Royal College of Veterinary Surgeons. I'm personally so excited by the magnetic personalities on offer that it's got me in an uncharacteristically political mood.
Right then, let's talk about tuberculosis. The bane of romantic poets everywhere, TB is a nasty, chronic bacterial disease caused by mycobacterium, a tenacious group of bugs that are particularly hard to get rid of. I don't want to make light of the disease it causes because it is, not to put too fine a point on it, a fucker. Treatable, but only with extremely long courses of antibiotics - and there are strains of it appearing that are resistant to almost everything we can throw at them - I do, however, want to have a little chat about why there's a whole load of badgers set to be killed in this country because of it (no pun intended) (okay, a little bit intended).
Before I share my thoughts with you on exactly how I feel about that, let's look at some background information. If you already know this stuff, then feel free to skip to the end (and if you don't really care what I think about it, then you're probably best just skipping the whole rest of the post, and finding one that has more jokes in it - maybe the one about the horrible kid I had in my consult room once, that's a good one - it ends with me zapping my testicles with radiation).
Still with me? Good. TB, you see, is not just a disease that affects humans. It can affect most mammals, actually, though some seem more susceptible than others - and there are two mammals in particular that are going to concern us today. The first is the cow. Cows get TB, and this is a problem because if we drink their milk unpasteurised, or eat their meat raw, then we can get TB too. Consequently, we have control systems in place to isolate, cull and remove infected animals from the cattle population and prevent spread of the disease. I don't want to get too involved with these control measures, because they're easily found elsewhere, but the classic intradermal TB testing that make up such a large proportion of a large-animals vets time have hitherto been highly successful at dramatically dropping the incidence of TB in cattle herds. Dropping, but - crucially - not eradicating. 'Hitherto' snuck into the post a few sentences ago because, sad to say, incidence rates of TB have been on the rise in the UK since the turn of the millennium.
Why the rise? It's safe to say that no-one knows for sure - it could be a consequence of the way the TB test is carried out (for various reasons, the intradermal test is far from a simple test to either perform or to interpret), the move from many, smaller herds to fewer, larger ones, increased movement of cattle around the country, the foot and mouth crisis or, more likely, a combination of all that, as well as other things.
Speaking of other things, that brings us onto the other mammal we were going to talk about - the opposum!
Just kidding. I meant the badger. Badgers are another mammal highly susceptible to TB (something like 17% of badgers killed by cars are found to have lesions on post-mortem) and debates have long raged about whether they are part of the problem with the current increase in TB in cows or not. Again, firm evidence is hard to come by (as with so much in the veterinary world) but the work that has been done (like this, among many others) that is there strongly suggests that badgers do, indeed, spread TB to cows.
So, here's the problem. The TB testing culling programme, effective since it was introduced in the fifties, appears to be failing. TB cases in cows are rising, and the disease is spreading. Badgers, on the best evidence we have, appear to be reservoirs for the disease - and it's very, very difficult (some might say impossible) to treat a disease in one population without doing something about the reservoir of it in another population. Like, for instance, killing them.
That's the dilemma. Nobody wants to kill badgers (except the chap in the video above) but our current strategy isn't working. Vaccinating cows against TB is illegal under EU rules. Vaccinating badgers is practically difficult, expensive, and unproven. Studies - including the best known, widest and most scientific study carried out - the report by Professor John Krebs - do show that culling badgers does lower the incidence of TB in cattle herds - albeit by a potentially disappointing 16% overall.
Those are, as Joe Friday might tell you, just the facts, ma'am - I wanted to make a clear distinction between the facts of TB and my opinion on the upcoming on-again-off-again badger cull (at the time of writing, it's on again) because, to be honest, this is not a clear-cut case, and it's helpful just to think about the background itself before you come to a decision on where you stand.
Where I stand
I'm sitting, actually, but from here on in things will increasingly be coloured by opinion rather than fact, so consider yourself warned. Before I tell you exactly where I'm sitting, I'd like to frame the dilemma in slightly different terms. You see, I was working for DEFRA as a Temporary Veterinary Inspector during the foot and mouth (FMD) crisis early on in the millennium. Down in Devon, as things became increasingly desperate, the pay improved considerably. FMD paid for a fair chunk of my wedding, in fact, and I didn't feel bad, because I thought we were doing the right thing. FMD was a terrible disease, and we were eradicating it from the country.
That's how I felt until I saw the piles of burning bodies, and realised that it's possible to become numb to euthanasia. I don't want to delve too deeply into that emotional quagmire right now, but I began to question just how terrible a disease FMD was to prompt such apocalyptic action. It's not transmissible to humans, and the symptoms it causes in sheep are relatively mild. Cows suffer badly with it, but - man, that's a really big pile of burning bodies. The biggest problem with FMD is how infectious it is - it spreads like the proverbial wildfire - rather than the suffering it causes to the animals. It is, primarily, an economic disease.
Let's leave the pyres behind us, for the moment, because that's a whole different debate - but it helps to demonstrate the point I'm about to make. Back to some science. TB in cattle is caused by mycobacterium bovis. It's zoonotic - that is, humans can catch it - but, despite the massive increase in TB in cows in recent years, m. bovis makes up around 0.5-1.5% of cases of TB diagnosed in this country - so, you're about a hundred times more likely to pick up TB from another human than you are from a cow.
Of these 0.5-1.5% of cases of TB, the vast majority of cases were picked up from drinking unpasteurised milk, or eating raw meat - both of which could also catch you a number of nastier and more imminently fatal diseases than TB. In fact, from 1990 up to 2005 (the time the study above was written) there was 1 case of TB that was confirmed to have been caught directly from a cow.
One case, in fifteen years. You might be thinking that one case is 'too many', but my personal opinion is that is a somewhat naive way of looking at the world. Value judgements are, and should be, made on the basis of risk, every day. The chances of any of us catching m. bovis from a cow are, by any standards, remote.
Now let's look at the proposed solution (or a part of the proposed solution - I don't think anyone is suggesting that a cull is replacement for testing and culling) - killing at least 60% of the badger population in the proposed areas (I say killing, because, to be honest, that's what is being done, and, to be honest, culling is not the most subtle euphemism for it anyway). The science suggests this could lead to a reduction in TB of around 16%. The killing would need to go on for about 3-4 years, and would have these benefits for about 6 years afterwards. Presumably, after that, you repeat the cull, though I'm not entirely clear on this point.
16% reduction for 6 years. So that, in human terms, would equate to... um... bear with me... something in the order of 0.05 less human cases of TB in that time. That's not a percentage, that's actual cases of TB prevented. To put it another way - one twentieth of a case of TB would be prevented in this way.
Don't get me wrong - TB is a terrible disease. Not least because of the enormous burdens it places on cattle farmers. The financial hardship, and the emotional strain, of having your herd yet again placed under restriction, has caused enormous unhappiness and, I suspect, its fair share of ill-health and even suicides.
We can't get complacent. We have so few cases of TB in humans because of high standards of hygiene and public health, and because of TB testing preventing infected animals getting into the food chain.
But... I keep thinking of those piles of burning bodies. If your solution to a problem is the mass killing of an indigenous species from your home, then your problem needs to be severe enough to justify such an act.
Is it? I can't believe that it is. The cull is wrong.
I have been tempted to dip my toe into the tepid water of veterinary politics a few times recently; I can often be heard whinging that the RCVS never present the views of veterinary surgeons to the public, seeming to prefer to leave that sort of thing to the British Veterinary Association instead... and I'm already boring myself, let alone you. Suffice it to say that I've decided the best way to present the views of a veterinary surgeon to the public is to, y'know, present them to the public.
So, here goes. I wondered about talking about the recent much-covered horsemeat scandal, but quite honestly I struggle to find a lot interesting to discuss about it. As a vegetarian myself, I struggle to see the ethical difference between eating a horse compared with a cow, sheep, pig or chicken (or dog or cat, come to that), and almost everyone I've asked (meat-eater or not) has pretty much the same opinion. This may be a function of the circles I move in, or it may be that the media is trying to create more of a furore about the whole thing than there actually is (heaven forbid!).
Instead, I've decided to talk about badgers. I may not be eminently qualified, being neither a large-animal practitioner, farmer or ex-lead guitarist of Queen, but I'll give it a shot. I'm aware the title of the post isn't, perhaps, the most sensitive that I've ever come up with, but when I tell you that the other post I was considering was one about dog racing called 'Fifty shades of Greyhounds' then you'll begin to understand what kind of brain I'm working with here.
Right then, let's talk about tuberculosis. The bane of romantic poets everywhere, TB is a nasty, chronic bacterial disease caused by mycobacterium, a tenacious group of bugs that are particularly hard to get rid of. I don't want to make light of the disease it causes because it is, not to put too fine a point on it, a fucker. Treatable, but only with extremely long courses of antibiotics - and there are strains of it appearing that are resistant to almost everything we can throw at them - I do, however, want to have a little chat about why there's a whole load of badgers set to be killed in this country because of it (no pun intended) (okay, a little bit intended).
Before I share my thoughts with you on exactly how I feel about that, let's look at some background information. If you already know this stuff, then feel free to skip to the end (and if you don't really care what I think about it, then you're probably best just skipping the whole rest of the post, and finding one that has more jokes in it - maybe the one about the horrible kid I had in my consult room once, that's a good one - it ends with me zapping my testicles with radiation).
 |
| A cow, yesterday |
Why the rise? It's safe to say that no-one knows for sure - it could be a consequence of the way the TB test is carried out (for various reasons, the intradermal test is far from a simple test to either perform or to interpret), the move from many, smaller herds to fewer, larger ones, increased movement of cattle around the country, the foot and mouth crisis or, more likely, a combination of all that, as well as other things.
Speaking of other things, that brings us onto the other mammal we were going to talk about - the opposum!
So, here's the problem. The TB testing culling programme, effective since it was introduced in the fifties, appears to be failing. TB cases in cows are rising, and the disease is spreading. Badgers, on the best evidence we have, appear to be reservoirs for the disease - and it's very, very difficult (some might say impossible) to treat a disease in one population without doing something about the reservoir of it in another population. Like, for instance, killing them.
That's the dilemma. Nobody wants to kill badgers (except the chap in the video above) but our current strategy isn't working. Vaccinating cows against TB is illegal under EU rules. Vaccinating badgers is practically difficult, expensive, and unproven. Studies - including the best known, widest and most scientific study carried out - the report by Professor John Krebs - do show that culling badgers does lower the incidence of TB in cattle herds - albeit by a potentially disappointing 16% overall.
Those are, as Joe Friday might tell you, just the facts, ma'am - I wanted to make a clear distinction between the facts of TB and my opinion on the upcoming on-again-off-again badger cull (at the time of writing, it's on again) because, to be honest, this is not a clear-cut case, and it's helpful just to think about the background itself before you come to a decision on where you stand.
Where I stand
I'm sitting, actually, but from here on in things will increasingly be coloured by opinion rather than fact, so consider yourself warned. Before I tell you exactly where I'm sitting, I'd like to frame the dilemma in slightly different terms. You see, I was working for DEFRA as a Temporary Veterinary Inspector during the foot and mouth (FMD) crisis early on in the millennium. Down in Devon, as things became increasingly desperate, the pay improved considerably. FMD paid for a fair chunk of my wedding, in fact, and I didn't feel bad, because I thought we were doing the right thing. FMD was a terrible disease, and we were eradicating it from the country.
That's how I felt until I saw the piles of burning bodies, and realised that it's possible to become numb to euthanasia. I don't want to delve too deeply into that emotional quagmire right now, but I began to question just how terrible a disease FMD was to prompt such apocalyptic action. It's not transmissible to humans, and the symptoms it causes in sheep are relatively mild. Cows suffer badly with it, but - man, that's a really big pile of burning bodies. The biggest problem with FMD is how infectious it is - it spreads like the proverbial wildfire - rather than the suffering it causes to the animals. It is, primarily, an economic disease.
Let's leave the pyres behind us, for the moment, because that's a whole different debate - but it helps to demonstrate the point I'm about to make. Back to some science. TB in cattle is caused by mycobacterium bovis. It's zoonotic - that is, humans can catch it - but, despite the massive increase in TB in cows in recent years, m. bovis makes up around 0.5-1.5% of cases of TB diagnosed in this country - so, you're about a hundred times more likely to pick up TB from another human than you are from a cow.
Of these 0.5-1.5% of cases of TB, the vast majority of cases were picked up from drinking unpasteurised milk, or eating raw meat - both of which could also catch you a number of nastier and more imminently fatal diseases than TB. In fact, from 1990 up to 2005 (the time the study above was written) there was 1 case of TB that was confirmed to have been caught directly from a cow.
One case, in fifteen years. You might be thinking that one case is 'too many', but my personal opinion is that is a somewhat naive way of looking at the world. Value judgements are, and should be, made on the basis of risk, every day. The chances of any of us catching m. bovis from a cow are, by any standards, remote.
Now let's look at the proposed solution (or a part of the proposed solution - I don't think anyone is suggesting that a cull is replacement for testing and culling) - killing at least 60% of the badger population in the proposed areas (I say killing, because, to be honest, that's what is being done, and, to be honest, culling is not the most subtle euphemism for it anyway). The science suggests this could lead to a reduction in TB of around 16%. The killing would need to go on for about 3-4 years, and would have these benefits for about 6 years afterwards. Presumably, after that, you repeat the cull, though I'm not entirely clear on this point.
16% reduction for 6 years. So that, in human terms, would equate to... um... bear with me... something in the order of 0.05 less human cases of TB in that time. That's not a percentage, that's actual cases of TB prevented. To put it another way - one twentieth of a case of TB would be prevented in this way.
Don't get me wrong - TB is a terrible disease. Not least because of the enormous burdens it places on cattle farmers. The financial hardship, and the emotional strain, of having your herd yet again placed under restriction, has caused enormous unhappiness and, I suspect, its fair share of ill-health and even suicides.
We can't get complacent. We have so few cases of TB in humans because of high standards of hygiene and public health, and because of TB testing preventing infected animals getting into the food chain.
But... I keep thinking of those piles of burning bodies. If your solution to a problem is the mass killing of an indigenous species from your home, then your problem needs to be severe enough to justify such an act.
Is it? I can't believe that it is. The cull is wrong.
Monday, 18 March 2013
Soul Purpose and Past Tense
Greetings, dreamweavers, and welcome to the dark recesses of my brain, guaranteed to fear you up badly (and in case that wasn't obvious, that was a small homage to the great Garth Marenghi) and the reason I bring up Romford's greatest son is because this little post is about two of my babies.
The rights of my first two novels, Soul Purpose and Past Tense, recently reverted back to me, having been published by Immanion Press for 6 years or so. I've been having a read over my oldies, and have performed a little routine cosmetic surgery on some of the more badly-aged paragraphs (hard to believe there was no such thing as an iPhone when I scribbled down Soul Purpose; Dark times, my friend, dark times).
I was always proud of these two - the 'Conduit' novels - stories of an unhappy vet who accidentally becomes a link between our world and the spirit world. I was also very pleased to realise that I'm a much happier vet now than I was back then. It must be the catharsis of all this blog writing. Well, that or the wine.
Anyway, after some deliberation, I've decided to release their slightly nipped and tucked forms onto the Amazon Kindle web store, where I hope they'll be very happy. The only tiny issue is that I'm effectively starting again from the customer review point of view, so if you've read them before I'd really appreciate a review on the new versions - sales of books on the kindle store are strongly review-driven, as people don't have a lot else to go on. I think you may need to have bought the new version of the book to do it, so if you're willing to re-write your review let me know, and I'll gift you a copy through amazon.
If you haven't read them before, bear in mind they are now to be found at a greatly reduced price, and I still get the same amount in royalties as I ever did - which certainly helps with the wine acquisition.
If you're interested, I'd advise you to wait a few weeks before purchasing, because I'm planning have a free book giveaway of Soul Purpose in two or three weeks. If you absolutely can't wait that long (and who amongst us could blame you?) then feel free to pop 'em on your kindlebox immediately.
Many thanks, pilgrims.
Nick
Soul Purpose is here on Amazon UK and here on Amazon US
and Past Tense is here on Amazon UK and here on Amazon US
The rights of my first two novels, Soul Purpose and Past Tense, recently reverted back to me, having been published by Immanion Press for 6 years or so. I've been having a read over my oldies, and have performed a little routine cosmetic surgery on some of the more badly-aged paragraphs (hard to believe there was no such thing as an iPhone when I scribbled down Soul Purpose; Dark times, my friend, dark times).
I was always proud of these two - the 'Conduit' novels - stories of an unhappy vet who accidentally becomes a link between our world and the spirit world. I was also very pleased to realise that I'm a much happier vet now than I was back then. It must be the catharsis of all this blog writing. Well, that or the wine.
If you haven't read them before, bear in mind they are now to be found at a greatly reduced price, and I still get the same amount in royalties as I ever did - which certainly helps with the wine acquisition.
Many thanks, pilgrims.
Nick
Soul Purpose is here on Amazon UK and here on Amazon US
and Past Tense is here on Amazon UK and here on Amazon US
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