by Jo Hardy
The Equine Hospital was part of the Large Animal Clinical Centre. We’d been into the barn around the back during training, but until now we’d never entered the hallowed portals of the main building, which was a working hospital open to the public. Before starting we were given a tour by one of the more junior vets. It was an impressive place, with consultation rooms, an imaging centre offering bone-scanning, MRI, CT and X-rays, two surgical theatres, and three stable blocks, one of them the Intensive Care Unit. We would be back here again later in the year for equine medicine, surgery and orthopaedics, but this time our focus was the imaging suite.
Everything in it was large scale. It had to be. And, as we quickly discovered, imaging a horse was no mean feat. To take a CT (computerised tomography) scan, a human would be asked to lie on a flat bed while an X-ray tube rotates around their body. With horses, only the head and neck fit in the tube, so if any other part of the body needs to be imaged a standard X-ray has to be taken. The machine is suspended from the ceiling, with handles either side, while the radiographer moves it around the room like a submarine scope. It can be positioned anywhere around the horse, while someone holds a receptor plate on the end of a long wooden pole on the other side. Not easy, and it gets more complicated than that, because the angles have to be right so that the horse’s bones don’t get superimposed over each other.
Kitted up in lead gowns and gloves to protect us from the X-rays, we spent a lot of time learning the right angles to use, and then running out of the room while the image was taken (all bar the lucky two holding the horse and the plate) and back in again.
But our first job that grey February morning was to assist with bone-scanning, or to give it its technical name, scintigraphy, on a large grey Arab stallion. The clinician in charge that day was Jackie. In her mid-thirties and very friendly, she was aware of how nervous we all were and went out of her way to help us and make sure we were enjoying ourselves as well as learning.
The Arab stallion was lame, but there was no obvious reason why. Hence the bone scan, which is a good way of locating where the problem is when it’s not immediately obvious. Before the scan the horse is given an intravenous injection of a radioactive substance that spreads around its body, binding to areas where the bone is trying to heal itself and emitting radioactive rays that show up on the scans.
As one of the others stood holding the heavily sedated horse and stroking its nose, the scanner was moved around it, section by section. And, as we discovered, it takes absolutely ages. It’s not unusual to spend four hours scanning a horse, so we were taking it in shifts, holding the horse, observing the scans with the clinician or doing the other vital job – catching the horse’s radioactive pee in a bucket.
I was the lucky candidate first up for this job so, bucket in hand, I hovered around the horse’s rear end. I felt pretty silly and, to make matters worse, Lucy, who was holding the horse, kept catching my eye and making me laugh. As I lunged forward, just a moment too late to stop another waterfall of radioactive pee hitting the floor, Lucy snorted with laughter. ‘Just wait till it’s your turn,’ I mouthed at her.
It seemed like an age until we finished, but the end result showed that the horse had an inflammation in the pelvis. The only treatment, as Jackie the clinician explained, was rest and pain relief.
Over a brief lunch we chatted to the other three in our group. Now that we were underway, Grace had begun to get a little of her bounce back. Katy was quiet, but prone to cracking wicked jokes. And Jade was funny and very upfront – she said what she thought. They were all lovely, but I did wonder if, as we were going to be together so much, personality clashes would emerge.
Lucy and Jade were both trying out online dating, which led to a lot of laughter and discussion along the lines of, ‘Oh, look at him, what do you think? No, he’s definitely not my type, what about this one? That one looks like one of the horses, but here, take a look, this one’s quite hot.’
Grace, Katy and I weren’t in the market for dates, so we provided second opinions and back-up. Grace was living with her boyfriend, Miles, Katy wasn’t looking for a relationship and I had Jacques, the lovely South African I’d met during my gap year. By then we’d been dating long-distance for almost four years. We used Skype and our phones to stay in touch, but I missed him.
Apart from the horse pee/bucket challenge, things appeared to be pretty straightforward so far, but that afternoon we faced a much bigger test. An X-ray on the hock (the joint in the middle of the back leg) of a lame horse showed that a lot of things were wrong. This horse was elderly and the hock showed little bone protrusions, erosion, swelling and ankylosis, or bone fusion.
We had to stand round the X-ray and point out to Jackie what we saw, taking it in turns to come up with new things. This was a scene we would be repeating many times throughout rotations, in which students sweated and panicked, and clinicians looked patiently (or impatiently in a lot of cases) at them waiting for answers. If the person before you said the thing you had planned to say, you just had to come up with something else. The clinicians were never satisfied until they had squeezed multiple answers out of each of us.
Once we’d exhausted the list of visible irregularities, Jackie asked whether we thought the ankylosis was hurting the horse. My horse Elli had been through this, so I knew that once fused the bones in the two immobile hock joints no longer hurt because they had stopped moving. Feeling a touch smug, since everyone else had said yes, I said no, and was rewarded with a ‘Well done’ from Jackie, and ‘Just wait till we get to the cows’ and a wink from Lucy.
Next up was Honey, a lovely bay with a back problem. She had become unhappy with being ridden and an X-ray revealed that she had kissing spine; two of her vertebrae were touching each other, which must have been very painful for her. Luckily kissing spine is easy to treat; Honey would go for surgery, which could be done under local anaesthetic, and until then she’d be given pain relief via powder in her food.
By the end of the ten-hour day we were exhausted. Heady with relief that we’d made it through Black Monday, we raced each other around the imaging suite in the chairs on wheels, there for the infinitely more serious purpose of allowing clinicians to move around the horse while holding the scanner, but great for a little light relief before heading home.
Back at the house Andrew was cooking up a cauldron of pasta after his day in the QMH working on small animal imaging. Kevin, John and James were all away on their rotations.
‘How was your first day?’ I asked.
‘It was all right. Got pretty badly grilled over an X-ray image, though. They asked if it was an image from a dog or a cat. Surely I would know if I’ve just X-rayed a dog or a cat and I wouldn’t need to work it out from an image.’
‘So you couldn’t tell?’
‘Er, no.’
I laughed. Then it dawned on me I had no idea myself. ‘So when I get asked that question next week on small animal imaging, how exactly do I tell if it’s a dog or a cat?’
He looked at me and sighed, then went back to stirring the pasta. ‘You look at the vertebrae. Cats’ are long, dogs’ are short. Also the femur. Cats’ are straight, dogs’ are slightly curved.’
‘Thanks, appreciate it.’
I was grateful for the tip – at least that was one mistake I hoped to avoid. After four years of study there were still so many things to get wrong. Things we’d only realise we didn’t know when some gimlet-eyed senior vet put us on the spot. I could feel my cheeks burn just thinking about it. I hated messing up, but I was already beginning to realise that if the system of rotations was about anything, it was about making mistakes and then learning how to get it right, so that once we were let loose on the world as qualified vets we would know what we were doing.
I stuck a couple of pieces of cheese toast under the grill and went to Skype Jacques. At the end of March I would be heading to South Africa to see him and to do some work experience in the sun, and I couldn’t wait. Only six weeks to go. Six w
eeks of hard graft, endless grilling and a lot of wet noses.
CHAPTER THREE
The Vaccine Trick and Dermaholiday
Sometimes the simplest things give you the biggest headaches. Like administering kennel cough vaccine – something vets have to do all the time.
It should be so easy. You prepare the vaccine and then squirt it up the dog’s nose. And that would be fine, if it wasn’t for the snorting, sneezing, head-shaking canines determined to get it all out again.
I looked at the young retriever sniffing round the surgery, tail wagging enthusiastically.
‘Let’s put Jiffy up on the table, shall we?’ I said to the owner, who was dressed in a smart navy suit.
Once on the examining table, as his owner stood next to me, I held Jiffy’s head up, positioned the plunger and squirted – just as Jiffy jerked out of my grip, shook his head and snorted the vaccine all over his owner’s face and the front of her jacket.
‘What was that?’ she asked, startled.
‘I’m so sorry, it’s some of the vaccine, but don’t worry, it’s not toxic and it shouldn’t stain. Let me get you a tissue.’ My cheeks were scarlet.
As she mopped the vaccine off her face and clothes I could only hope that some of it had actually got into the dog it was intended for. And I made a mental note – always position the owner behind the dog.
I was on a fortnight’s work experience in a small, friendly veterinary practice close to my family home in Kent. It was a great opportunity for me to get some hands-on experience, with the added bonus of being able to see a bit of my family in the evenings.
This placement was one I’d arranged myself, as part of the sixteen weeks of EMS – Extra-Mural Studies – that we were expected to fit in between the compulsory rotations allocated by the college.
Puddlefoot is a country practice based in a building that looks a bit like a mobile home, but bigger. The staff I was working with included four friendly vets, a couple of them part-time, and a very helpful and chatty nurse, Chloe. The patients we saw were ninety-five per cent small animals, plus a few horses. The vets were encouraging and helpful, and with their supervision they allowed me to do consultations, give injections, scrub in to help during surgery and administer vaccines – hence the embarrassing scene with Jiffy and his owner.
That wasn’t my only vaccine disaster, either. My next patient was a tiny eight-week-old Chihuahua, a fluffy little ball with the minutest nose I’d ever seen. I took one look at it and my heart sank. No way was I going to get the whole vial of kennel cough vaccine into that nose. I drew up the vaccine into the syringe, and the dog started shaking its head before I’d even approached. All I could do, as I placed the syringe in front of one minuscule nostril, was hope that a bit would go in and that the owner, a charming elderly woman whom I positioned carefully behind her dog, wouldn’t notice how much of it dripped down the dog’s face and was snorted onto both me and the table.
As a final-year student I was being taught about the latest developments in the industry, and the practice vets were keen to know what I could pass on. When a cheerful collie came in with urinary incontinence, it was a chance to show off my knowledge because we’d done it as a topic just a few weeks earlier. The vets liked quizzing me on subjects, not only to help me reinforce what I had been learning but also to remind themselves. One of the vets, Cheryl, started asking me about the modes of action of different drugs that work on the bladder, so I drew a bladder on the whiteboard, with all the drug receptors. ‘It’s been years since I’ve gone into this much detail,’ Cheryl laughed. ‘It’s great to have a refresher.’
Most of the time I was the novice learning from everyone else, so it felt good to be able to redress the balance a bit.
The funniest case that week was a beautiful, glossy saluki crossbreed called Matilda, who had torn her ear on a barbed-wire fence. Ears bleed and bleed, and when their ears feel funny, dogs shake their heads. Matilda soon had the surgery looking like something out of a horror film, as her ear flapped from side to side, spattering blood up the walls and all over everyone in the room.
We treated the wound with cauterising powder and bandaged the ear to her head like a helmet. Then off she went, with her very charming owners, a young mum called Tina and her five-year-old daughter, Daisy, who giggled non-stop as we bandaged Matilda’s head.
‘You know, Daisy,’ I said, ‘at university they teach us to bandage on cuddly toys, so I’ve fixed the ear of many squishy doggies with poorly ears.’ Daisy giggled even more.
A couple of days later they were back for a change of bandage, along with Daisy’s cuddly-toy puppy, who now had a heavily bandaged head, which I duly admired.
The moment the bandage was removed, Matilda shook her head, opened up the wound again and redecorated the surgery with what seemed to be another litre or two of blood. We all sighed, cauterised the wound again and re-bandaged the ear, before wiping down the consulting room before the next client came in.
After the third time this happened, Tina was getting worried. ‘Is it ever going to heal?’ she said. ‘We seem to be going round in circles.’
We did, and although the ear wasn’t hurting Matilda too much, we needed it to stop bleeding. Once again, under Cheryl’s watchful eye, I bandaged it up, making Matilda look like a one-eared alien. ‘This time we’ll take our chances and leave it for an extra day or two,’ Cheryl said firmly. ‘The issue’s not that it isn’t healing. It’s healing pretty well, but every time we take off the bandage Matilda opens it up again. Next time she comes in, after the extra couple of days, it will hopefully have had time to heal a bit more and won’t reopen. But since there are risks to leaving a bandage on, if it starts to smell or you see anything soaking through, bring her back in straight away and we’ll have to come up with a plan B.’ We all gave a sigh of relief.
At the end of each day I drove back to my family home near Tunbridge Wells. We had lived in the same house since I was one, and I always loved going back to a proper meal and my own bed. Ross was away at university, so it was just me, my mum Clare, my dad Giles and the dogs, Paddy and Tosca. I’m close to my parents – we’ve always enjoyed each other’s company – so it was nice to catch up with them and fill them in on how the rotations were going. Each evening, Mum cooked my favourite beef stew or shepherd’s pie, and it was a rare treat to relax in front of the television with the dogs.
We’re all animal lovers and Mum was juggling her Open University degree in Humanities with Creative Writing with her other passion, working as a volunteer transporting rescue dogs to new homes. After we got Paddy, Mum realised that a dog being cared for by an animal charity is often miles away from the people willing to give it a home. A network of willing volunteers with transport is vital. Mum would get a call, often at short notice, asking her to collect a dog and deliver it to the new owners, or in cases where the dog needed to travel long distances, to be part of a team collecting the dog from the previous driver and taking it on to the next. The transport charity she helped out did much more than just delivering dogs from charities to new homes, though. It also picked up dogs from pounds when their time was up and they were about to be put to sleep, and took them to charities that would provide them with training, which would mean they could be put up for adoption. She was helping to save lives.
After my two weeks with the team at Puddlefoot, I packed my bags and headed back to the Queen Mother Hospital for dermatology, known by the students as ‘dermaholiday’ because it involved cushy hours, no emergencies and straightforward consultations, generally along the lines of ‘How long has your dog/cat been scratching?’
Dermatology is mostly about allergies, and a big part of the job is persuading the owners that they need to take the allergies seriously. A lot end up at the QMH with their dogs and cats because they’ve ignored the advice of their first-opinion vet and continued to feed Tibbles or Rover food that is making them itch and break out in rashes. Eventually either they demand a second opinion or their exasp
erated vet suggests they see a specialist.
The only real way to find out what’s causing the allergy, once you’ve ruled out parasites like fleas and mites, is by a process of elimination. The animal has to change to a hypo-allergenic food for six weeks to see if the problem clears up. If it does, after that you can gently re-introduce other foods, watching to see if there’s any reaction. If the food elimination doesn’t work, you can assume it’s an environmental allergy and start the process of trying to desensitise the animal, although in many cases it’s down to food and eliminating the allergen should be all that’s needed.
But for some owners it isn’t quite so straightforward. Take the very earnest lady, Mrs Hooper, who came in with her little pug dog, Muffin. A blood test had indicated that Muffin, who was scratching and rubbing his head on the floor, was definitely allergic but, as is often the case, the test hadn’t indicated what he was specifically allergic to. It only indicated he was allergic to a great number of things.
‘Start with his food,’ I explained to Mrs Hooper, under the watchful eye of the dermatology clinician, Annie. ‘Give him hypo-allergenic food and nothing else for six weeks, and see whether his condition improves.’
‘Oh, I’ve done that,’ Mrs H said. ‘It didn’t help.’
‘Are you certain that was all he had?’
‘Yes. Well, apart from his chews, but they’re chicken and chicken’s good for sick dogs, isn’t it?’
‘Well, it can be. Chicken is plain so it can be good for a dog with stomach problems. But in some cases it can actually be the problem. Plenty of dogs are allergic to chicken.’
‘No, it isn’t that because he was still scratching when he was eating beef chunks.’
‘I’m afraid that nearly all processed dog food, even beef chunks, has chicken in it. The company only has to have a certain percentage of beef in the food to be able to call it beef chunks, and the remainder is made up of other meat. So you really do need to give him the hypo-allergenic food on its own and nothing else. At all. No biscuits, chews or treats of any kind.’