The Travelling Vet

by Jonathan Cranston

  ‘This looks like a migrating foreign body,’ Dave said in surprise. ‘Can you find anything on the front of her shoulder?’

  I immediately turned my attention to the area Dave indicated, parting the thick fur and methodically feeling all over her shoulder. Moments later I found what I was looking for: a scab, just inside and in front of the shoulder blade. It was a healed entry wound.

  ‘There’s a scab here.’

  ‘Hold your finger over it, and I’ll reinsert the crocodile forceps and let’s see if they match up.’

  They did. As I pressed against the scab, I could just feel the tip of the forceps.

  ‘Well, that’s your answer,’ said Dave, turning to Jason. ‘Something’s gone in at the front of her shoulder and migrated through, and then burst out in her armpit. It probably happened a couple of weeks ago. Does that square with anything you’ve noticed?’

  ‘Come to think of it, there were a couple of days around that time frame when she seemed to be obsessing with that front leg and licking it more than normal. I guess that was why. What sort of thing could it have been?’

  ‘We see this sort of thing a lot. It’s often caused by grass seeds in dogs. They get them caught in their thick fur and then they gradually progress, penetrating the skin and then migrating. Usually they don’t travel too far before the owner notices and we remove them, but they can sometimes move deep into the body.’

  ‘We had a case when I was at vet school,’ I piped up. ‘The dog unknowingly aspirated one. It had a cough for months that wouldn’t clear. Six months later it developed an abscess on its flank, and when we cut into it, we found the grass seed.’

  ‘Yeah, I’ve seen something similar with a grass seed,’ agreed Dave. ‘But a thorn or splinter could also cause it.’

  ‘Poor Amira … So what’s the plan?’ asked Tony.

  ‘We’ll flush the track and wound again, then give her a course of antibiotics and pain relief, and then we should probably re-examine her in a week or two, depending on how things are going. You’ll be able to administer medication to her in her food, won’t you?’

  ‘Yeah, no problem. If we bury the tablets in some meat, she should take it without a problem.’

  ‘Great.’

  After flushing the wound again, Dave gently dried it with sterile swabs and then applied a wound cream before laying her leg down. We repositioned her on her side.

  ‘Before I turn her off, did you want to take some blood?’ I asked Dave.

  ‘Good, yes. Probably from her cephalic vein?’ The cephalic vein ran down the front of the leg below the elbow. Along with the jugular vein, it was generally the most accessible.

  Taking off his gloves, Dave handed me the clippers, some vacuum blood tubes and a needle. I clipped a small patch of fur on the front of her leg, below the elbow and Dave then raised the vein for me. Filling the two vacuum tubes, the job was quickly done.

  ‘Anything else we need to do?’ Dave asked.

  Unlike with our usual patients, whom we could recheck regularly, this was our one opportunity to ensure we had done everything we needed to. Once we woke her up, there’d be no second chance today.

  ‘I don’t think so.’

  ‘Good. Let’s turn off the anaesthetic and move her back into her cage. Then we can reverse her and wake her up.’

  I turned off the machine and disconnected the ET tube, then we manoeuvred her back into her cage and lifted her onto the floor. I untied the bandage that held the ET tube secure while Dave drew up the anaesthetic reversal agent. Happy that she was still stable, I removed the ET tube and pulled out her tongue to open her airway, Dave injected into her muscle, and we both evacuated the cage, closing and securing the door behind us.

  After about ten minutes, Amira started to stir, slowly lifting her head in an attempt to orientate herself, but with it came a rhythmic head sway she was at first unable to control, so after a few seconds she collapsed down again. For a further few minutes a gently swishing tail was the only indication that she was rousing, but then she rocked onto her chest and powered herself to her feet. Her head continued to sway, and she was very unsteady on her feet as she circled the cage, but her tail eventually maintained her balance. As time elapsed, she slowly settled and assumed a more natural lying position, attentive to our presence as her ability to focus grew.

  ‘Best to leave her now, but I’d keep her shut in for the next hour or two until she’s fully awake,’ Dave advised Jason as we headed out.

  ‘Will do,’ Jason assured us, and we said our goodbyes. ‘And about the medication?’

  ‘She’s had all she needs for today. I’ll get it put up at the practice, for someone to pick up.’

  That night I sat down and re-watched that second Planet Earth episode. As the snow leopard agilely navigated the cliff-face in pursuit of a markhor kid, the sequence came to life in an entirely new way as I now profoundly understood almost every detail, from the pad of her paws to the tip of her tail, of the animal’s unique anatomy, which allows it to thrive in such a hostile environment – where snow leopards dare.

  Snow leopards: fast facts

  Panthera uncia: The snow leopard

  Distribution: The mountain ranges of Central and South Asia.

  Description: The least aggressive, most secretive and camouflaged of the big cats, snow leopards are crepuscular, being most active at dawn and dusk. There is one species of snow leopard with two recognized sub-species.

  Names: The male is called a ‘leopard’, the female a ‘leopardess’, and their young a ‘cub’. A group of snow leopards is called a ‘leap’.

  Life span: About 15–18 years in the wild.

  Habitat: Rocky regions or mountainous meadows, between 9,800 and 19,700 feet in the summer, coming down to forest areas between 3,900 and 6,600 feet in the winter.

  Diet: Snow leopards are opportunistic carnivores, eating whatever meat they can find, including carrion and domestic livestock. They can kill animals up to four times their own weight, but readily take hares and birds, and are capable of killing most animals in their range except for an adult male yak. They can survive on a single bharal (or Himalayan blue sheep) for two weeks, consuming all edible parts of the carcass.

  Gestation: 90–100 days. Cubs are born between April and June, with litter sizes of between 1 and 5.

  Size: Up to 150 cm long, from nose to the base of the tail, their tail being nearly the same length again.

  Weight: 320 grams at birth, reaching 27–55 kg as adults.

  Growth: Leaving the den at about 4 months, cubs remain with their mother until independence at 18–22 months, and sexual maturity at 2–3 years.

  Body temperature: 37.4–38.8 °C.

  Adaptations for cold climate: A long, soft dense fur gives powerful insulation, short rounded ears reduce heat loss, large furry paws lend grip on rocky terrain and prevent sinking into snow, a long thick tail assists balance and stores fat and can therefore serve as a blanket for extra warmth, and a large nasal cavity helps the animal breathe the thin, cold air.

  Conservation: Snow leopards have no natural predators, but like so many creatures around the world, humanity is their biggest threat. The IUCN has classified them as ‘vulnerable’, with estimates ranging from 4,500 to 8,745 adults left in the wild. Poachers kill them for their thick fur or bones, which are used in traditional Asian medicines; global warming is reducing their habitat; and the overgrazing of domestic animals has led to a reduction in their natural prey, and therefore an increased contact and conflict with humans, who kill them to defend their livelihood. Unlike other big cats, however, snow leopards have never been known to attack humans and can be easily chased away. For more information on how you can help protect this magical creature, visit www.snowleopard.org.

  5

  GOAT

  ‘The lust of the goat is the bounty of God.’

  William Blake

  Martin headed into the practice with a spring in his step. The surfboard on the roof of his car wa
s reason enough to explain it.

  ‘Morning Martin,’ I said. ‘Catch any good waves?’ It was 8.30 a.m. and I had only just arrived myself.

  ‘It’s always so great. No better way to start the day. You got the bug yet?’

  ‘I need to get a wetsuit and a board first,’ I mumbled. Being a surfing nut was obviously one of the most important prerequisites to joining a vet practice so close to Woolacombe Beach in North Devon. So to confess I hadn’t even ventured in after six weeks at the practice was almost criminal.

  ‘You need to head to Second Skin in Braunton! Andy will sort you out with a suit and a second-hand board and then you’ll be away. Trust me, you’ll love it. Make sure you get a 5/3mm suit, then you can venture out in December without freezing.’

  ‘Thanks,’ I said, making a mental note to do just that. It wasn’t that I had been avoiding surfing – far from it. It was just that, with all the changes I had undergone since graduating, moving down to Devon and starting my career as a veterinary surgeon, I simply hadn’t got round to exploring any new hobbies, but I was still keen to do so. Next time I was in Braunton I would get my wetsuit.

  With that we both headed into the practice to see what the day had in store. Looking through the diary, I saw I had a couple of lame cows to see, a cow with mastitis, and then, as luck would have it I had a visit, booked for midday, to see Mr Giles at Home Farm to castrate a dozen of his bullocks. Home Farm was just outside Braunton, so if all went to plan and no emergencies came in I could grab my lunch and take a look at some wetsuits.

  And sure enough, at a quarter to two on that Thursday afternoon I found myself heading back to my car with a brand-new 5/3mm Second Skin wetsuit and with Andy on the look-out for a second-hand Bic 7ft9 Mini Mal surfboard – a good beginners’ board, apparently. Clearly, I would soon be just another North Devon vet driving around with my surfboard on the car roof ready for a pre- or post-work dip.

  As I sat in the car enjoying my lunch, I resolved to try out my new purchase at the weekend, and maybe even book a surfing lesson. I wasn’t on call and didn’t have any plans for Saturday. The holiday season was over, so what better way to pass the day? My phone rang, breaking my train of thought. It was Jackie, the practice’s farm and equine receptionist.

  ‘Jonny, you done all your castrations? Can you go to Mr Watts at Upper Hill Farm in Umberleigh? He’s got a calving that he’s struggling with.’

  ‘Sure, I’m just in Braunton now … Where is Umberleigh?’ Six weeks in, and I was still getting to know my way around. I had naïvely purchased a sat nav before I moved down, only to discover that farms located on either side of a valley could both have the same postcode; it might be a good device for London, but it wasn’t much use in rural Devon. Fortunately, Jackie knew every postbox, streetlight, pub and phone box in a 30-mile radius and could direct me with pinpoint accuracy.

  ‘South of Barnstaple, head out on the A377 through Bishop’s Tawton, and just keep going on that road until you reach Umberleigh, turn left over the bridge at the Rising Sun …’ I was furiously writing down her directions on a crumpled scrap of paper I found in the passenger footwell. ‘. . . and the farm is 100 metres down that road on the right.’

  ‘Great, thanks.’

  ‘It should take you about half an hour, depending on traffic. I’ll let Mr Watts know you’re on your way. It’s marked on the map so it should be quite easy to find … Oh, and he said the cow’s down in the field and he can’t get her in.’

  ‘I’m on my way.’

  ‘Thanks Jonny. Martin or Neil will be around if you think it’s a caesarean.’ And with that she hung up.

  I pulled out my Ordnance Survey map from the driver’s door pocket, opening it over the steering wheel, then folded it down to centre on Umberleigh, before spreading it on the passenger seat and setting off.

  Forty minutes later I pulled into the farmyard, having exhausted myself on the journey trying to play through every possible permutation of what I might find with the calving and how I would handle it. Every day of the last six weeks had felt like a cross between The Crystal Maze and Mastermind. Book knowledge and some basic practical skills had got me through finals, but I was now having to rapidly expand the repertoire of my practical skills and problem-solving capabilities to bring theory into practice. It’s that transition that makes the first-year post qualification far more stressful than anything at university. Having good supportive bosses and colleagues was the key and in that regard I had been very lucky.

  Mr Watts greeted me in that characteristic Devonian smile I was becoming accustomed too.

  ‘Good afternoon, young man. I don’t believe we’ve met, but Jackie says you’re all right!’

  ‘Nice to meet you, Mr Watts. You’ve got calving trouble I believe?’

  ‘It’s Arthur, call me Arthur – I can’t be doing with any of this formal talk, I’m just a man of the fields … Yes, indeed, she’s a fourth-calver, never given me trouble before, but she’s gone down in the fields … Tail is up and she’s pushing, but nothing is happening. I tried to have a feel and, well, it’s pretty tight, I can barely get my hand in, I’ve no idea what’s going on. So I thought this is one for the professionals.’

  ‘How long has she been calving for?’ I asked.

  ‘Oh, about two or three hours, I would think. I noticed her down this morning. Probably a spot of milk fever, I thought, so I gave her a bottle of calcium under the skin about eleven. She wasn’t calving then. When I checked her again at one she was still down, but straining – that’s when I had a feel and then called you. I mean, she might not even be calving, but she is due … It’s an odd one for sure, got me flummoxed.’

  ‘Well, let’s go and have a look.’

  He cast a disparaging glance at my Ford Focus estate. ‘Don’t think your car will make it in the field, so best grab what you need and come with me.’ One day I’ll get a Defender, I thought, as I tried to collect every possible item I might conceivably require.

  ‘You planning on camping?’ he asked as I loaded my two boxes of equipment onto the back of his Land Rover.

  ‘Is that all right?’ I bantered back. ‘Have you got a calving jack?’

  ‘Yeah, it’s in the field next to her.’

  ‘Great. Then we’re set.’

  We set off through the farmyard and down an old cobbled track with a high broom and gorse hedgerow on either side. The farm collie rushed out from one of the buildings and started in pursuit behind us, and Arthur slowed down.

  ‘Come on then, Fly,’ he cried, looking in his wing mirror. ‘They never like to be left out.’

  The dog effortlessly jumped into the back and then we continued on down the track. After about 200 metres he swung left, stopping at the gate entrance, which I hopped out to open. I could see the cow sitting up in the field, about 20 metres away: a Holstein Friesian. She seemed bright enough. I could see a large bucket of water and a pile of hay just in front of her and the calving jack discarded a couple of metres behind where she lay. Arthur drove through and I shut the gate behind him. As I strolled over to join him where he was parking up by the cow, I noticed the other cattle at the far end of the field grazing. There were probably thirty; this was the field of ‘dry’ cows – the ones that were no longer being milked because they were due to calve in the next two months.

  Arriving at the Land Rover I grabbed my box of rectal sleeves and lube, and approached the cow’s back end. Glove on, lube applied, I inserted my hand. I could immediately feel what Arthur had told me: everything did indeed feel abnormally tight. For a moment I too was confused, and then as I examined her further I realized my arm was having to twist like a corkscrew as I explored. And suddenly I knew exactly what was wrong.

  ‘What do you think?’ Arthur said.

  ‘She’s got a uterine torsion – that’s why you can’t get your hand in very far.’

  ‘A what?’

  ‘A uterine torsion. It tends to happen right at the end of pregnancy when the calf is so
big, the cow slips or rolls, and the uterus ends up twisting over on itself so that it prevents the calf from being born. We either need to untwist it or we’ll have to do a caesarean.’

  ‘Well, there it is!’ he said, removing his flat cap and scratching his forehead. ‘I’ve been calving cows for forty years and never to my knowledge come across this. Can we untwist it?’

  ‘We can have a go – but is there anyone who can give us a hand? This will be a three-person job. We need to roll the cow, but I need to keep my hand inside her to keep the uterus and calf in one place, then we rotate the cow around her and hopefully it will untwist.’

  ‘Well I never. I’m sure Mrs Watts is about, I’ll go and find her.’ He jumped in the Land Rover and headed back to the gate.

  My heart was pumping. Of course I knew the theory behind the technique of correcting a uterine torsion – it was a classic exam question – but actually executing the procedure was a whole new ball game. Unlike some vet students, though, I had been lucky enough to have witnessed it at first hand, when I was seconded to a practice in Fermoy in Ireland. I remembered Ian, the vet, stripped to the waist on a bitterly cold night, demonstrating how important it was to work out which way the uterus had twisted so that you unroll it properly.

  With Arthur gone, I kept checking and double-checking the direction of the twist; it was going anticlockwise, which meant the uterus had to be rotated clockwise to untwist it, or else rotating the cow anticlockwise if the uterus was held in place … Was that right? It seemed counter-intuitive to be rolling the cow in the direction of the twist. I went through it again in my mind, step by step. Yes … that was right, I was certain. Or if I was wrong, I suppose I’d be calling Martin or Neil to help me with my first caesarean!

  Arthur soon returned with his wife, a small, round lady with red rosy cheeks and a friendly smile. It looked as if Arthur had dragged her away from doing something in the kitchen; probably baking some delicious cake, I thought. Her floral dress and apron were visible under her threadbare, fern green quilted jacket, which she had obviously just thrown on when Arthur called for her, along with her wellies and beige bucket hat.