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.

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...

'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?)

'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.'

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...

'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.