Client Conversations #10

Working in an affluent area sometimes turns up some unexpected responses.

Discharging a patient from the hospital, this was the conversation with our tweed wearing client:

“ He’s really starting to struggle now, his blood protein is very low. We need to get some nice, easy to digest, good quality protein into him – cottage cheese, egg or chicken are all good ways of doing that.”

“Pheasant?”

Willum's cleansing

     I was up at Willum’s farm doing some routine dairy work, the main job that morning was a cleansing. This is a particularly foul task. Once a cow has calved and the calf is up and about, she then pushes out the placenta, which has become detached. This normally happens less than 8 hours after calving, although it can be up to 24hours. Usually she will then eat the lot. It’s a useful evolutionary device – less smelly bloody mess about for the wolves to track you, and it’s a lot of good nutrition that would be a shame to waste. Sometimes after calving, the placenta does not come away and remains attached to the womb, especially if the birth was difficult or the cow has a metabolic issue. This is called retained foetal membranes. It leaves the cow with a load of tissue without a blood supply hanging from her vulva. Over the next few days, it starts to decompose, and the smell is pretty horrific. 

     At the time, the recommendation was to allow the tissue to rot for a few days to soften it up, then remove as much as possible without actively tugging or causing trauma to the uterus, and following it up with a hearty dose of antibiotics. This has been a staple of the rural vet’s workload for a hundred years and more. The recommendation now is that manual removal of the retained membranes is contraindicated – don’t do it, just snip off the worst of it, leave the rest alone and it will sort itself out in time. Unless the cow is sick, she doesn’t even get antibiotics. 

     But this was back then, when we were still removing the rotting membranes from inside cows, and that was what Willum had summoned me to do this morning. He greeted me enthusiastically, grinning and giggling from the start.

“I’ve got a right ripe one for you here, kept it special for you like”

“Aye, thanks for that, you’re a pal”

     He walked a quiet Holstein Friesian into the handling area. She was a bonny cow, classic black and white markings, soft eyes, slavery nose and chin, and a deep lowing moo when you talked to her. There was a long twisted rope of flesh hanging out of her back end, flapping around her hocks. It smelled pretty bad from a distance.

“I’ve been letting it cook for a few days, get it good an ready!”

     I donned two shoulder length plastic gloves on my right arm to protect me from both the bacteria and the smell. Rubbing some lubricant on my gloved arm, I handed Willum the manky tail to hold and pushed my hand in through the vagina and up into the uterus. Immediately a hot splash of foetid liquid poured out, spattering on my boots as I gagged and retched. Willum fell about laughing.

“You know Willum, you could do this yourself, you don’t need to be paying me to do it.”

“Are you joking, man? This is the best laugh ah get aal week, it’s priceless watching you an ya wee screwed up face hurling all ower the place. I wouldna miss it for the world!”

“You’re a real bastard, you know that?” I was assaulted by another wave of hot putrid decomposing flesh, and it was all I could do to hang on to my breakfast whilst clutching the handful of membrane I had secured. I eased it off the uterine wall, removed it, flung it on the floor and went back for more. I was very high up the womb now and was reaching for something at my very fingertips, my face and body pressed up against her rump as I stretched for an extra inch when suddenly she farted and shot a full stream of faeces directly into the side of my face and down my neck, inside my waterproofs. Willum collapsed to the ground and let go of the tail, which whipped me around the face. He was laughing so hard he couldn’t even stand up to help me. My lips were clamped shut, desperately trying to keep the muck out of my mouth. My ear was full of hot cowshit. I brought my left hand up and used the side of my finger to scrape everything clear of my mouth so I could breathe. Willum, dying of mirth managed to pass me a handful of paper towel, tears rolling down his cheeks, gasping for air between guffaws of laughter. I rubbed the worst off my face, still inside the cow up to my shoulder.

     “You Bastard.” I was not impressed, which made it even funnier for him. He was trying to apologise, but still weak with laughter I could barely hear him wheezing out “Sorry, but…”

     I finished up as quickly as possible and stood dejectedly in the yard. It was only lunchtime and I was filthy. Willum’s mother came out from the house, over to where we were standing.

“You’d better come in for a clean up and a bit o dinner, you’ve earned your bait the day lass!”

     I kept a spare shirt in the car, so I put away my kit, stripped off as much as modesty allowed into a mucky pile on the ground behind the car, and headed into the house. The bathroom was basic and pretty ancient. There was brown shaggy carpet on the floor with a crusty path worn through it, a freestanding bath and a chipped pink sink boasting a sliver of gritty soap. I took off the rest of my filthy clothes and set to work trying to clean myself up as best I could. The soap was Cusson’s Imperial Leather, an old cracked impenetrable bar with sand wedged deep into the seams on the fissured surface. It was about 40% label, that rigid square they set into the branded bars. It wouldn’t lather in the hard water. I dried myself with a stiff, scratchy towel and put on my fresh shirt. I thought I looked okay given the circumstances. I gave my hand a quick test sniff and recoiled in horror. My whole arm was stinking. 

     I felt better after a proper cooked lunch; knowing how awful the job was going to be they had even made me some trifle. After a bit of joshing over the table, I made my way back to the surgery. 

     The nurses immediately threw me out the building; despite a full change of clothes and repeated scrubbings with surgical soap my warm skin was releasing the aroma of dead rotting flesh. I had muck stuck in the folds of my ear, and a smear of blood through my eyebrow that I had somehow missed. But I also wore a smile, because for all the hardships and mishaps, the gruelling work and truly awful smells, farm work has always filled me with joy.

Chainsaw Massacre

This is what it looks like when your patient decides to chew the IV drip line running into their paw, then tries to shake the bandage off. This is their in-patient record which was clipped to the front of the kennel. They also chewed the corner of the paper.

(The patient made a full recovery, despite their best efforts)

Client Conversations #9

"I'm not sure if it's a boy or a girl, I don't know how you sex them. I've always had older rescue cats before. I tried to find out, I went online and Googled "sex kittens". I won't do that again!"

Every pet deserves a chance

     “You know I wouldn’t ask if I wasn’t desperate, but no-one will help him and his fish will die. Is there anything you could do?” 

     I took a long slow breath. “Okay, I can’t promise anything, it’s really not my area, but I can talk to him. Text me his number and I’ll call in the morning”. I hung up with a feeling of doom. I always worry when personal and work life collide. My soft hearted mate was lobbying on behalf of a friend of his who was a Koi carp enthusiast. He had spent all his spare time and money investing in special ponds and filtration systems to look after a handful of these friendly big fish. Now one of them was sick, and he couldn’t find a vet to treat them. His local vets all gave him the brush off saying they don’t treat fish. The fish vets out on the coast wanted to charge him an arm and a leg to do a full inspection including travel cost, full day consultation fee plus drugs, running to hundreds of pounds. They weren’t able to find that much cash at short notice having maxed out on setting up the facilities. He was getting desperate, and with every set back the infection was gaining ground, untreated for longer. 

     “Hello is that Paul? I’m Ranjit’s friend, Heather the Vet. He says you’ve got a problem you need a hand with? “

     Over the course of the next 10 minutes Paul told me all about his fish, not in abstract terms but as individual characters who had likes and dislikes, different personalities. He was clearly besotted. He had been caring for Koi for 8 years, learning as much as he could and giving them the best life possible. But now his favourite, Big Momma was sick. A minor scrape on her side had become infected and was spreading rapidly, killing off the scales on that side, affecting the muscle and causing pain and suffering. I didn’t want to get involved, but neither did anybody else and I wasn’t going to let this animal suffer just because it was inconvenient. His final sign off clinched the deal:

“She’s my favourite fish and we love her very much. Please help us?”

     In order to legally diagnose, treat and prescribe for Big Momma I had to officially register the fish as being under my care. We started by getting as many details as possible – the basics like name and address, then moving on to fish names, lengths, ages and weights. I needed as much information as possible. Next I wanted to see the lesions on Big Mommas side to assess the damage and also to chart progress. I asked for a set of photographs to be taken. Whilst I waited for Paul to email me with all the information I needed I did a little research about the best treatment for problems like this. I was delighted to discover that the most effective (and crucially, licensed) treatment is a relatively common drug that I had sitting on the shelf. All I had to do was dispense a five day course of antibiotic at 14milligrams per kilo of fish, and supply the equipment to inject the fish once daily.

     My phone pinged; Paul’s email had arrived and I could see the problem myself for the first time. The poor girl had an extensive infection causing necrosis of the skin and loss of scales. The raw flesh underneath was poking out. Based on the measurements I worked out the appropriate dose and ran to the post office – this fish needed the drugs by tomorrow or it might be too late. 

The infection spreading

     Over the following week I checked in regularly to see how Big Momma was getting on, and for days she seemed to stay the same – no spreading infection but not getting better either. And then, suddenly, a shift. The dead scales were still getting pushed out but instead of raw flesh underneath there was healthy granulation tissue. She was fighting back, making a scar.

The infection stopped, dead tissue sloughing and nice white scars forming

     It took two weeks of daily care, cleaning the wound , removing all the dead tissue and giving an injection of antibiotics, but I was delighted to receive an email telling me that Big Momma was back to normal, the scar was healing and she was eating and wanting tickled again. It was an odd one for me, but very rewarding, and for Paul and Big Momma it meant the world. 

A Sticky Situation (photos)

Those who throw sticks for dogs have never had to stitch up the throat of a dog with stick trauma injuries.

Tongue ripped right up to the tonsil. Wound caused by stick

Splinters and blood removed, wound flushed clean

A zillion tiny stitches in a space my fingers struggle to access

Rodeo Adventures

     “Wey hinny, it’s Darren up at Shielings, me Dad’s away on holiday an I’m looking after the beasts an there were this calving and it was reet difficult mind, an I think I might hae brocken it’s leg when it came oot an oh ahm gonna be sick lass, an I’m so sorry but ah dunno what to do. Me Dad’ll be ower upset. What am ah ganna dae? Can you come?”

      I’d visited Bobby’s farm a few times, up at the far North reach of the practice, well off the beaten track. The nearest village had one of those names that you can only pronounce if you’ve lived there all your days. I always timed my visits to coincide with lunchtime, partly due to the distance and timing to get back for afternoon surgery, partly due to Carol’s spectacular lunches. She was a quiet, serious woman in stark contrast to Bobby’s gregarious nature– especially when there were ladies to charm. A visit from us usually involved some pretty heavy banter and leg pulling whilst we got the job done. He liked to tell dirty jokes that would leave me lost for words, and watch my reaction. I never went into the house if Carol wasn’t home. 

     This time, Bobby and Carol were away off to the sunshine, leaving their son to run the place. I didn’t really know him, but the word at the mart was that he was great with machinery, but not much of a stockman. This morning he crossed the yard to meet me, visibly distressed. 

“Ah didn’t mean it an ah don’t know what happened, yon big calf got stuck and I had to jack it oota her. But now it winna stand an ah think it’s leg’s brocken…”

     I got him to lead me to the calf, still damp from birth, held in a pen on the concrete whilst the cow looked on through the gate, waiting in the deep straw. On clinical exam, three legs seemed okay but the front left was definitely out of sorts. The bones of the foot were not sitting in the correct place – the fetlock was dislocated. Darren had turned away and looked like he was about to throw up as I wiggled the hoof. I realised I knew what had happened, and thought I’d better fix the cause before it happened again. There was no point in giving him a hard time, it was an honest mistake made from ignorance rather than malice. 

     A calving jack is a clever little bit of engineering designed to help you manually pull a calf from a cow. It’s a long ribbed metal bar with a bracket at the top at right angles to make a capital letter T, the bracket sitting against the cows rump. Ropes are attached to the feet of the calf, and hooked on to a travelling section which gets cranked up the length of the long rod, easing the calf out a tiny bit at a time, pulling first the right leg then left as you work the jack handle. It wiggles the calf out, and has made calving an awful lot easier. There are a few pitfalls though, one of which is that attaching the ropes below the knuckle of the fetlock means that that the weak joint is put under a lot of strain, and it is relatively easy to pull it apart, dislocating the foot. 

“When you put the ropes on the feet for the jack, it’s a bit more secure and a wee bit safer to make your slip knot above that knuckle joint. You get a better grip and the bones are stronger there” He nodded vigorously.

“Ah’ll nivver dae that again. Will we have to shoot him? He’s a reet grand muckle calf an all. Ah cannut believe it.”

“Well, he’s still pretty fresh and bendy, I’d like to give something a try rather than just give up on him”

     I went to the car and brought out what I needed to make a “stookie” or plastercast. My plan was to get the bones back in the right place and hold them there for a couple of weeks. A bit of manipulation and the foot made it back into the right place, ready to be held firm. I soaked the plaster impregnated bandages in warm water and wrapped the leg up snugly, making sure to extend up beyond the next normal joint for support. It wasn’t the best looking plastercast I’ve ever done, I just prayed it would be enough. 

     I heard no more from the farm, but I was so caught up in other work that I didn’t have a chance to devote much thought to the calf. It was several weeks later when Bill came into the surgery and announced that Bobby had called and would like me to go out and take off the cast. I set off on the hour long drive up to the farm on the moor. 

     Bobby was in hearty mode when I arrived, full of the joys of spring. I was greeted with hug and much thanks for taking care of things whilst they were gone. Never one to accept compliments easily, I deflected it somewhat whilst we got on the quad bike and drove off across the fields. 

     The tiny baby calf was now a strapping fit beast, out and about in the field with it’s pals. The plan was to get alongside, hold it by the head, lay it down on the grass and remove the cast – we had brought some blades and a hacksaw with us. There were no handling facilities anywhere near where the cows were grazing. Bobby got close, stopped the bike and ambled up to the calf, hirpling with the classic farmer’s limp that comes from wrecked hips. As he drew level with the calf, its eyes flared and suddenly it shot off. Bobby lunged after it but it was long gone, leaving him to sail through the air and land on the soft ground with a thud. The calf had raised its tail up in the air and was belting along, clearly not troubled by the foot any more. A new plan was needed. We took to the quad bike. 

     Our new plan was ambitious - Bobby was to get as close as possible with the bike, whilst I hung off the side. When we got within touching distance, I was to leap off the back and catch the calf by the head. Bobby had misgivings about letting me do that, but I reassured him I was fairly hardy and would be just fine. So off we went. 

     It took a fair while to get close enough to the alarmed calf to even attempt to catch him. The first couple of tries I was almost ready to leap when he would suddenly change course and disappear at right angles. Then I had a go where I jumped a little too early and ended up sprinting along in my wellies to try and outrun him– I lost. I realised I was going to have to really go for it. We got close, I leapt and secured my arms in a big bearhug cum headlock around his neck. But he didn’t stop. He kept running, full tilt across the field with me attached, digging my trailing toes in, trying to use my weight as a brake. There was mud and cowshit everywhere as I skated across the pasture. I looked back and Bobby was trying to catch up on foot, wheezing like a rickety old horse. 

“GET THE BIKE!!!” I yelled across the field. 

     I managed to get my feet out in front of me, really dug in ith my heels and felt the pace slow. Gradually he started to wobble. I took my chance, changed my grip, turned his head towards me and with judicious use of leverage, cowped him onto his side on the grass. Grabbing a foreleg so he couldn’t get up and run off again, I shifted my weight onto his neck and waited for reinforcements. 

     The bike came roaring up behind me, Bobby wheezing and laughing and shouting all at once. 

“Bloody hell, where did you learn to do that! You really are a tough little bugger, aren’t you?!”

I didn’t have any spare breath to reply for a while. Eventually I coughed out the answer– I was the full back for the ladies rugby team at Uni and pulled in a pro tug of war team. 

     Whilst Bobby held the back legs to stop me from getting a kicking as well for my troubles, I removed the cast. It was a long and slow process, not helped by the conditions or the fact that I was now totally shattered, but little by little the plaster started to fold away from the cut I was making, and reveal a skinny but healthy leg underneath. There were a few places where the cast had rubbed at the skin, but they would heal quickly now that they were out in the open air. The joint itself felt pretty stable, and more or less flexed the way it should. 

     Swiping back the hair that was sweat-plastered to my forehead, I sat back on the balls of my feet. 

“Let’s let him up slowly and see what happens”

     He wasn’t interested in slowly. As soon as his feet were released he rocketed forward, nearly flattening me in the process, and galloped across the field. 

“100% cure! You know that costs extra, right?” I grinned. For once, I had the upper hand at Bobby’s.