Tuesday, February 16, 2010

Tuesday, 2/16/10 - Veterinary Tale Chapter 3 - A Man of Few Words

Sorry for no post yesterday - internet and telephone service to my valley were out for 48 hours. A transformer burned out and a new one had to be shipped in from who knows where before service could be restored.  That's the bad news - the good news is today's post is the latest chapter in Veterinary Tales.  I hope you enjoy it.   In case you missed the first two Veterinary Tales, you can find them in the blog archives from January 31st, and February 4th.  More on vaccinations and the immune system on tomorrow's Vet Tip of the Day.

Veterinary Tale Chapter 3 - A Man of Few Words
I excel in emergency situations. Throughout my life I’ve espoused the theory that there are basically two types of people. The ones who step forward toward crisis, and the ones who step back. Years ago a horse trailer pulled up in front of the large animal clinic at the University of Georgia where I was the resident on duty accepting emergencies. The driver jumped out of the truck, shouting over her shoulder as she rushed to the back of the trailer.

“It’s a really bad colic, and I think he just went down,” she said as she opened the door of the stock trailer before I could stop her.

I was standing about 6 feet away and what I saw was this woman standing there holding the door with her right hand, facing the open trailer. In the trailer, inches away from her face, was a horse in the process of throwing itself over backwards, its head and flying front feet coming directly at the woman. Without hesitation I jumped forward, shoving the gal to the side with my right arm while reaching up with my left arm and grabbing the horse’s lead rope. The rope was sailing through the air just ahead of the horse’s nose, following the trajectory caused when it snapped loose from the tie ring at the front of the trailer. As the horse’s owner went stumbling off to the right, I yanked the lead rope as hard as I could to the left, lunging in the same direction. The horse came tumbling out the back of the trailer, all 4 feet flying in the air, and hit the pavement left shoulder first. The owner was unhurt, the horse scrambled to his feet, and without pausing I headed into the clinic leading the horse to get emergency treatment started. James Bond eat your heart out.

This is the kind of thing I’m really good at – acting during a crisis. But the mass I’d discovered in my dog Sticky’s mouth was another matter all together. This was something I had time to think about, worry about, plan about – something that wasn’t going to be over and done within a short time, something that wasn’t going to go away. So I acted accordingly: I ignored it, just blocked it out, and when I did think about it, tried to convince myself that the mass was scar tissue that had formed at a tooth extraction site. I knew it had not been present 4 months ago, because Sticky had had her teeth cleaned by Dr. Mark Altman, my local small animal veterinary buddy, and a tooth had been extracted at that time. My denial continued for 5 days, and then I realized I had to face the music.

Here’s the thing. I’m a veterinarian, and while I don’t treat small animals, I am board certified by the American College of Veterinary Internal Medicine, and I’ve been practicing medicine for 22 years. I’ve seen my fair share of neoplasia (cancer) in large animal species, and I knew that the horrible thing growing in my dog’s mouth was not benign. On day 6, when Fern arrived at the office in preparation for the day’s calls, I asked for her help.

“Hey, Fern, I think we need to biopsy this thing in Sticky’s mouth,” I said, sounding all unconcerned.

“I was wondering what you were doing about it. I didn’t want to say anything, but it looks pretty bad, don’t you think?” Fern asked. Bless her heart; Fern is the soul of discretion. She’d come to work for 5 days without mentioning Sticky’s condition, even though I knew she’d been as upset by the discovery as I had. All nineteen year olds should have a fraction of her maturity and compassion.

Fern’s been one of my assistants since she was fifteen. She’s never wanted to be anything but a veterinarian, and I’ve been taking care of her horses since I met her family when Fern was eight. She announced she was ready to begin working for me when she was ten, and her mother and I struggled to dissuade her, pledging that if she was patient, she could start working at fifteen. Her intention never wavered, and for the past four years she’d been with me every summer and on weekends during the school year. We knew each other well, and worked in easy companionship most of the time. After all, I taught Fern early on my number one rule for employees: whatever goes wrong, it’s their fault. Once they get this down, the road smoothes right out.

I looked at Fern and nodded, “My small animal medicine is pretty rusty, but I do remember that oral tumors in dogs tend to be aggressive and malignant. But before we make assumptions, we need to submit a biopsy to be sure. They did pull a tooth right where the mass arises, so we cannot rule out that it is a mass of granulation tissue and not neoplastic.”

Fern gently held Sticky’s lip back while I took a scalpel blade and sliced off a small piece of the mass. My little PCD sat quietly, staring at me with absolute trust, without sedation or local anesthesia, as I performed the biopsy. She was just that kind of dog – she never made a big deal about anything. I knew the tumor would not have a nerve supply, so there would be no pain associated with the small biopsy, but most dogs would object to the restraint, especially around the mouth. But not Sticky, she didn’t move a muscle, just let Fern hold her lip back and wagged her tail slowly.

The biopsy safely stored in a submission jar filled with formalin, Sticky licked her bloody lips and jumped into the truck, ready to start the day. Fern and I looked at each other, hesitated a moment and then both burst out laughing.

“Sticky says, ‘come on you guys, let’s get going!’ “Fern said, her eyes shining with tears even as she smiled. “They just aren’t like us humans are they? No worries, just another day to live and enjoy. I don’t know, Dr. C, sometimes I’m just overwhelmed by how brave animals are.”

I climbed in and started the truck, motioning to Fern to join me. “I know, Fern, they teach us every day how to be better than ourselves, if we would just pay attention.” Sticky put her head in my lap, assuming her travel position. “Hand me a towel, will you – I’m going to have Sticky blood all over my pants for the rest of the day.”

“Here you go, Dr. C,” Fern said, handing me a blue surgical towel for my lap. “Maybe we should stop at the Frosty on the way to Roger & Barb’s and get her a soft cone – I bet that would feel good.”

“Good idea,” I agreed, “Today, whatever Sticky wants, Sticky gets.”

By the time we arrived at Roger Carlson’s cutting horse barn Sticky had lapped up her ice cream cone and was observing the world with her usual aura of ancient wisdom. Fern and I greeted Roger’s wife Barb and began preparations for the day’s procedure: castration of a two year old stallion.

Roger and Barb Carlson have been training cutting horses for over 30 years, almost as long as they’ve been married. They were high school sweet hearts, Barb the daughter of a local ranching family and Roger a Paiute Native American. They managed a training barn just over the California line, about 20 miles west of my office, in Sierra Valley. This was a picturesque area, located right at the transition elevation where desert and sage merged into aspen and pine stands peppering the steep Sierra Nevada foothills. I loved coming into this valley and had been excited about gaining the Carlson barn as an account. I inherited the work about a year previously from my friend Mark Altman when his small animal practice became so busy he no longer could provide adequate coverage to this area.

Mark was a real cowboy, a man’s man, a Deacon in the Church of the Latter Day Saints and one hell of an equine veterinarian. Guys like Roger Carlson and guys like Mark were born speaking the same language. When I first began working for the Carlson’s Roger’s wife Barb did all the talking, while Roger just watched me. I don’t think he said more than three consecutive words over the first year I came regularly to the barn. When he did finally begin talking to me, his dry humor and rare warm smile bowled me over. Roger had rich red skin, deep set dark eyes and a face etched by years riding outdoors in the high desert.

Today we were gelding one of his best young prospects. Roger brought the colt out into the center of the indoor arena and held him while I administered the first of two injections used for short term equine anesthesia. When my left hand closed around the colt’s neck to occlude the jugular vein I could feel his heart hammering through the skin against my thumb. I glanced at his eye to catch him glaring at me, his left ear cocked back and his expression saying loud and clear, “One wrong move and you are breakfast”. If only Sticky could talk to these young stallions and pass along some of her peaceful karma.

The first sedative successfully injected without incident, the colt began to relax, his head dropped, his lower lip drooped and he became wobbly. Ralph spoke to know one in particular,

“I guess this is the nicest colt I’ve ever raised.”

Silence.

“He certainly is a beauty, Roger,” I agreed. “Look at that hip, and the shoulder isn’t half bad either.” I added, thinking to myself – just lie down quietly and stay down until I’m done, you little monster.

Just as I pushed the plunger on the second syringe containing the ketamine that would cause the colt to drop, Ralph spoke again,

“You know when Dr. Mark used to do my colts he was done in no time at all.”

Silence.

“He’s quite a guy, that Dr. Mark” I mumbled, planning to wring his neck the next time I saw him.

“Why don’t you let me hold him while he goes down, Roger, “ I said, taking the lead rope into my left hand just as the youngster sank quietly to the ground with a deep groan. “How’s that for a smooth induction, oh Marvelous Mark?” I mentally complimented myself.

Fern moved in to tie up one hind leg, cover the colt’s eyes with a towel and scrub the scrotum while I gloved up and opened the emasculator and scalpel blade. I removed the first testicle and looked up to see where Sticky was. Don’t be too disgusted, but Sticky always knows when we are gelding a colt, and she is always sitting intently by the horse’s flank, waiting for her special treats. Soft ice cream cones are great, but they don’t compare to this. I spot her watchful eye and prepare to toss her the prize.

“Hold on there, doc!” Roger’s voice is actually raised a few notches, a new experience for me.

“I’m sorry Roger, I usually give these things to Sticky as a treat, but if you don’t want me too, that’s fine.”

“ I don’t care what happens to the damn things, but you move that dog up here by the colt’s head and throw ‘em forward to her – don’t you know that if you toss them over his head he’ll never look back?”

“Um, OK, no problem, come here Sticky,” I called, cursing Mark for not giving me a head’s up on this old western horseman’s tradition I’d certainly never heard before.

Sticky finished her hors d’oeuvres with relish, the colt recovered uneventfully from anesthesia, and Fern cleaned up and packed the truck while I stood with the now young gelding and Roger. More silence, but I figured I was better off saying nothing than trying to make conversation and sounding like an idiot. As I saw Fern finishing, I checked the colt’s incisions for bleeding and turned to Roger.

“Everything looks good Roger; he can go back to his stall now.”

Roger led the colt from the arena without a word and put him in his stall. I wrote up the bill and went out front to the travel trailer that served as an office to give it to Barb. We chatted as she wrote out the check and said thanks and good bye. I went out to the truck to leave. As I was pulling away from the barn Roger walked out. He spoke just loudly enough for me to hear.

“I guess Dr. Mark was right when he said you were OK.”

After a year, I was still thankful for small mercies.

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