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Tuesday, 29 April 2008

Supervets

This week I am seeing practice with a group of specialist vets in order to improve my knowledge and clinical skills.

There are supervets and there are superbitches.

It's not the first time I have recieved an icey reception from female clinicians. They just don't like another woman on their patch, certainly not a blonde.

The men are a piece of cake. Maybe that's the problem.

Everyone eats healthily, ricecakes, fruit and whole carrots. I suspect the sort of people that get to their level of expertise are generally pretty obsessive about every aspect of their life. On friday I'll bring in chocolate cake and then we'll see just how strong willed they really are.

There are animals with tubes coming out of every part of their anatomy. Very, very sick animals being kept alive. It's quite depressing.

Today during rounds I found it hard to watch four incredibly bright people with Phds and many many letters after their names discussing the fate of Princess the cat and Nobby the terrier. It just seemed wrong, almost unethical because Princess is just a cat and Nobby is just a dog.

I wondered, had they become doctors just how many lives they would have saved by now.

Wednesday, 23 April 2008

Staff pets.

When the partners are in the pets are out.

But when the partners are out the pets are in.

This evening I had to trip my way over three staff dogs and one extra large fuffy dog bed to get to the reception computer, intercept two from being attacked by dogs in the waiting room and continuously shut the door to the tea room to avoid one from escaping and making his way to the cattery in order to eat his way through its occupants.

They are all without exception rescued which automatically gives them the right to be badly behaved and spoilt.

Worse still, I have to pretend to enjoy their company, even when they jump up at me for the sixth time with their muddy paws or growl when I won't share my food.

Lets get one thing straight now readers, something I've kept from you for a little while now.

I am a cat person.

I am not a dog person.

Dogs smell. I mean it, they really smell.

When you pet a dog. You get dog smell on your hand.

With a patient this is no problem, once the dog has left the room I can wash my hands.

I have to carry staff pet dog smell about with me all day to avoid causing offense to my colleagues.

One day I'm gonna get a dog, a big smelly, badly behaved, domineering, shaggy dog and boy will they suffer.......

Thursday, 17 April 2008

Obsessive compulsive learner.




























It's getting out of hand. I just can't stop.

As the deadline for my small animal internal medicine certficate approaches I have become feverish in my attempt to gain knowledge.

Purchasing books is an obsession.

If only I had time to actually read them.

I find it a comfort knowing they are there, just waiting.....

Tuesday, 15 April 2008

The chime of the bell.

Out at the branch surgery life moves at a slower pace.

We don't have all the mod cons but we offer a friendly service.

When a member of staff has a birthday there will be cake.

There are regular tea breaks, necessitating the bell:




























When the bell chimed six times in a row this morning we ran to attention.

A small child stood poised to ring again.

He was approximately five years old.

'My cat's here, he's having his balls cut off.'

Obnoxious children in the waiting room are the same wherever you are working.

Sunday, 13 April 2008

Community service.

As the nice lady in her sixties with the round glasses, hand knitted cardigan and woollen skirt hands me a cup of tea and a chocolate digestive she smiles and says 'We are definitely not WI you know.'


I am about to give a talk to the local 'wives' club.

I thought there would be four, but actually there are nearer to fourteen and as they stare at me from around the large oak table, I am very nervous.

'I think it is fair to say that veterinary medicine was not my first choice of career.' I begin 'But by the age of five I realised that I had not developed the ability to fly and lift heavy objects and it was therefore very unlikely that I would ever become Wonderwoman.'

During the next hour I try to demonstrate that there is more to a vet than being a vet.
That when I knock on a door in my street for the first time and the occupant who I have never met says 'Oh you're the vet then are you.' I want to say 'No, I'm the person who lives on the corner with a filthy ford focus and an uncut hedge.'

But that is quite clearly not what the wives want to hear. It is not what anyone wants to hear.

I labour on, getting bogged down with many questions about ropes and knots as I recount my first ever calving. I really can't remember the answers to their questions and since my first calving was a foetal monster, or an inside out calf called a 'schistosome' there wasn't much call for ropes.

What I do remember very vividly though is being very frightened at the time, not least because I had to call my male chauvinistic colleagues for help. Six hours later they had to perform a caesarian and realised what I had in the first five minutes, the calf wasn't ever going to come out because something was very wrong with it.

I finish my talk. I give them what they want. The girl that came from a grammar school, fought her way into vet school and came out the other end because she had always wanted to be a vet.

But I don't tell them the other stuff.

From a young age I was forced to give up a part of myself which I have always missed. My love for the english language, history and the arts. Cut short at the age of seventeen when I had to choose to study science.
I did love animals but I didn't love science and I endured it as a means of becoming what I had always wanted to be.
A veterinary science degree is not a challenge it is a vast array of facts, figures and principles which have to be applied and learned but never questioned.

For vets, being a vet takes up a large part of our lives. Members of our community like to define us by our profession but we are much more than a three letter word.

Some of us climb mountains, run marathons, paint, sculpture and travel,

and some of us just write blogs...

Thursday, 10 April 2008

Side effects

Most drugs have them.

Most of them we know about....or at least so I thought.

'I'm just wondering whether there are any side effects to the steroids my dog is on?' Asks Mrs Peters.

'Yes, they can cause an increase in hunger, thirst and urination.' I tell her.

'Oh.' She says. 'My husband's not going to be very happy.'

'Is there a problem?' I ask.

'We've just bought a new fridge.' She says matter of fact.

'But when that one appeared to be mysteriously leaking too, well, we did start to wonder.' She continues.

I think it's only right that I contact the publishers of the veterinary formulary to update their list of side effects for steroids, it should now read:

Excessive hunger, excessive thirst, excessive urination and replacement of white goods.

Wednesday, 9 April 2008

Country Bumpkins.

There is an unspoken prejudice against vets in rural locations.

The first time I became aware of this was when reading some notes belonging to a wealthy client's Labrador. The city vet had referred to us as the dog's 'vets in the countryside' together with the phrase 'may not be able to perform this procedure'.

If only he knew that this 'vets in the countryside' has:

A laboratory to rival most referral centres, including three fully qualified full time lab staff.
Blood gas analysis.
A digital X-ray sytem.
Three ultrasound scanners.
Four flexible endoscopes and two rigid ones.
An MRI
A ligasure machine for surgery and electrocautery.
ECG, blood pressure monitor, capnograph as standard during anaesthesia (well every numpty has that these days)
Seven drip pumps.
Two nurses overnight at the surgery.
Several vets enrolled on or having completed their certificates.

But we also know our limitations. We know when a pet needs to see a specialist.

But here too we are face prejudice.

Twice this year I have struggled to get very sick patients seen by referral centres including two Universities. When I have told them the animal needs seeing urgently they simply do not trust my judgement. 'We can see you in three days.' They tell me.

Today I phoned a referral centre four times begging them to take my patient. I was told each time someone would call me back. My patient died, only then did they take me seriously enough to return my call.

After a similar incident at Christmas, I phoned the Royal Veterinary College asking about the rules on referral centres and their obligation to take urgent cases. Apparently there are none.
They are only required to phone us with advice on case management. Since they consider me a country bumpkin unable to judge when an animal needs seeing urgently my patients have died or been too sick to travel when they have finally agreed on an appointment.

'You can always offer euthanasia.' The nice lady on the help desk at the RVC tells me.

'You try offering euthanasia to an owner whose only companion is a four year old, fully insured dog with a potentially treatable condition.' I told her.

Monday, 7 April 2008

Snow Bunny.

Every vet has one.

A pet they rescued in a moment of madness.

Mine has turned out to be quite an expense:

Cost of rabbit proof fence required to protect garden plants: £50

Cost of replacing the plants rabbit proof fence failed to protect : £100

Annual cost of most expensive low GI Burgen bread required to lure beast back into secure house at night : £50

Cost of replacing drill (wire mysteriously severed) : £40

Housing allowance: Half my garage

Annual hay,carrot and special low fat rabbit food allowance: approx £400


Watching him gamble in the snow: Priceless




Saturday, 5 April 2008

Critical care.

Meg is fitting.

Meg is fitting and I don't know why.

It's 4.30 am and I've been working on all nine kilos of her small whippet lean body for half an hour to keep her alive.

I've managed to work out the following:

1) She has septic shock.
2) An ultrasound shows she has fluid in her abdomen.
3) After wrestling with the fancy slide staining machine and then the microscope that doesn't want to illuminate I've managed to spot some familiar looking cigar shaped objects on the smear from the sample I took from her abdomen. I remember these from vet school.
They are evil bacteria.

Meg is on shock dose fluids, oxygen and intravenous antibiotics and pain killers because she is very very sore.

I'm trying to measure her blood pressure but it is too low to register on the machine. I'm also very worried because her white cell count is very low and her platelets that are important for clotting are also diminished. This means her body is not coping with the shock and the implications for her survival are grave.

Meg has a ruptured pyometra. This means her uterus has been infected with bacteria and now it has burst and the bacteria and the toxins that are now washing about in her abdominal cavity are poisoning her.

But now I can't worry about that because Meg is fitting.

Why is Meg fitting? Is it a bleed in her brain? Is it the toxins?

'Fuck!' I yell to the nurse. 'She needs glucose!'

As the realisation dawns I am sprinting to the cupboard, I blindly grab for the intravenous glucose. I inject it while I wait for the blood sugar reading on the glucometer. Her glucose is 1, this is very low.

The brain is the only organ in the body that can't make sugar and Meg's metabolic rate is very high as a result of the septic shock. Her body has greedily used up all the glucose in her blood and now her brain is running on empty like a stalling car.

I've never seen this happen before and just as I am congratulating myself for remembering in time I realise that Meg is not getting better, she's not the only one whose brain is running on empty. I have grabbed the wrong bag of saline. What a moron, two night duties in a row and the cogs are not as sharp as they should be.

Finally I get the glucose in and she stops twitching and lifts her head.

For the next three hours I do everything I can to keep her going. I just need to get her well enough to have the operation that might save her life.

When I can think of nothing more to do, I lean over her and whisper in her ear 'Don't die Meg, please don't die.' And then when the nurse isn't looking I kiss her silky forehead.

Meg made it to surgery.

She died two hours later.

It's hard.

It's hard because I willed her to live so much I truly believed she wouldn't die.

But I realise one important thing.

I gave Meg a chance.

I must never stop believing in dogs like Meg, because maybe, just maybe next time......

Thursday, 3 April 2008

Real case presentation.

Beth presented to me a week ago, she is a Staffordshire Bull terrier who had been anorexic and depressed for 4 days.



The frown and cute pricked ears are as a result of:
1) Deep concentration.
2) Tetanus toxin.
3) Too much television.
Answer:
Staffies are not known for their intelligence, making 1) very, very unlikely.
2) although rare in dogs, tetanus is the correct answer,
but we can't discount 3) because the owner of the last dog I diagnosed with suspected tetanus phoned me several days later to inform me that he was fairly certain the dog's facial expression had been the result of him sitting too close to the television set after it had been moved next to the dog's bed.
Beth has tetanus because she has a wound on her foot that has become infected with Clostridium tetani, this is releasing a toxin that is affecting the function of her nerves. The correct veterinary terminology for this is:
1) Bad luck
2) Sods law
3) Both because her owner has no money.
Beth's prognosis depends upon:
1) Prompt administration of tetanus antitoxin, penicillin, diazepam and supportive treatment until she can eat again.
2) How well she wags her tail for the nice lady in the accounts department when I bring her to meet Beth because we are never going to get a penny from the owner.
3) How long I can hide her from my boss.
Beth made a good recovery.
Her bill stands at £600.
It turns out my boss is a very nice man.

Tuesday, 1 April 2008

April Fool....

....no-one likes to be one, especially when the veterinary students are in.

Every Easter they descend upon us in droves as part of their educational work experience or 'seeing practice'.

As down trodden seasoned clinicians it is our duty to impart upon them all our knowledge.

They soak it up like little sponges.

If only they new the truth.

Namely, the only reason we like teaching them is because it's a huge ego boost to realise we still know more than they do. Until of course you get a bright, switched on one that knows all the answers, I tend to avoid these like the plague, unless they bake good cakes.

In addition if I don't know the answer to one of my own questions, rather than look stupid I make it up. Usually I find the addition of the word 'itis' to the end of a condition makes it sound genuine failing this a well timed cough over the word that you can't quite remember normally works because most of them are too bored to notice.

I have to admit I've grown pretty sick of hearing my colleagues giving mini master classes on their area of expertise whilst secretly enjoying the sound of their own voices.

It was with great satisfaction therefore that I managed to trick my colleague into believing that she was required to anaesthetise a moose for surgery this morning.

'I hate it when the farm animal vet doesn't warn me in plenty of time for this sort of thing' She started telling the students.

'I wonder if he's going to want to go into theatre.' She continued. 'I wonder how big it is?'

Before her master class could continue one of the students asked.

'Do you get a lot of moose in the UK?'

Finally the penny dropped. Thankfully she believed the joke to be the work of the large animal vet.

'You're good at practical jokes.' She asked me later. 'Have you any idea how I can get him back for this?'

Student lesson number one: Vets may be clever people but even the most intelligent individuals can sometimes be very very stupid, you just have to learn how hide it, so start practicing that cough now....