by Jo Hardy
Abigail had an RDA – a right displaced abomasum – and she needed surgery to correct it, otherwise it would kill her. Right displacement is rarer and more of an emergency than left, and most of us in the group had never seen surgery for an RDA, only LDAs, so poor Abigail gave us a valuable opportunity to learn something new.
Diagnosing RDA or LDA is fairly easy. You have to put your stethoscope against the cow’s abdominal wall then flick the wall; then, if the gas-filled displaced abomasum is located the other side of the wall, you will hear a pinging sound. We all had the chance to listen to this, and everyone could hear it except me! ‘Oh yes, there it is,’ nodded Jade, Grace, Katy and Lucy, as each took her turn, but when my turn came I heard nothing.
‘Am I being totally useless?’ I said as I turned to the others. ‘You all heard it right here? Right?’
‘Well actually, a little higher up,’ Lucy helped. I moved my stethoscope a little higher. ‘Yep, there,’ she confirmed. Still nothing.
‘Seriously, I blame my tools. This stethoscope is useless! Luce, can I borrow yours?’
‘Sure thing,’ she said as she passed me her bright green stethoscope. I was still annoyed that the purple one I ordered had turned out to be royal blue.
‘Nope. Still useless. Urgh, I’m going to be an awful farm vet!’ I moaned.
Lucy stepped closer. ‘Show me exactly what you’re doing.’ So I did, and still got nothing. ‘You’re not flicking hard enough. You literally have to hurt the tip of your finger.’
I tried again. ‘Oh my word, I heard it. Lucy, you are a genius, thank you!’ I practised a few more times, just to make sure it wasn’t a fluke. And no, it wasn’t. I had just been too feeble with my flicks.
The surgery, which was done under local anaesthetic with Abigail still standing, involved cutting into her flank so that the vet was able to reach inside and put everything back where it should be. Cows are very resilient and can cope with this, where many other animals wouldn’t.
I got the job of giving Abigail the local anaesthetic, a lot of it, injected in an ‘L’ shape around the incision site to ensure that all the nerves in the incision area were blocked. There’s a knack to it that vets have to learn: the needle is inserted, the injection given and then instead of taking the needle fully out, you leave the tip under the skin and draw it along, while injecting more solution, so that you’re left with a bubble of anaesthetic under the skin. I hadn’t done that before, so I was a little nervous, and very careful, but it worked just fine and Abigail didn’t appear to feel a thing.
Lucy and James performed the surgery together. They cut a thirty-centimetre-long incision, got hold of the abomasum, stuck a pump into it and deflated it, before putting it back in place and suturing part of it to the abdominal wall so that it couldn’t float again.
Surgery like this is routine, and cows normally make a full recovery, but in the following days Abigail failed to improve as she should have. We were all concerned, and the regular checks on her were increased, but eventually James and her owner took the decision, after more investigations and careful consideration, to put her to sleep.
We all felt so sad as she was such a pretty cow and she should have been fine after the surgery. But clearly there was another underlying health problem which had probably been the cause of the stomach displacement in the first place.
It’s always hard for a vet to accept that they can’t help an animal and must let it go. You do everything you can to help an animal get well, but sometimes your best efforts just aren’t enough, and part of the job is knowing when to stop.
Our next patient was a steer, or at least that’s what it said in the name section on the admission forms the owner had filled in. A steer is a castrated bull, so we were a little surprised to find that what we had on our hands was a young heifer. James immediately re-named her Stella – well, it was a bit like steer.
Stella was fifteen months old and she had contracted tendons. One of her hind legs was completely straight and she couldn’t walk properly – she walked on the tiptoes of her hind legs and looked rather comical, although the condition was not in the least amusing for the poor cow. It is a congenital condition that a cow is born with and it gradually gets worse, so that by the time they’re a year or two old they can barely flex their legs.
Luckily the condition can be corrected with surgery. However, when James sent us into the pen to do what should have been a completely straightforward, standard admittance physical examination, it became very clear that Stella had no intention of cooperating. She ran round and round, with wild eyes and flaring nostrils. Anyone would have thought we were about to lasso her.
Stella had never really been handled before and was clearly very scared. We made a swift exit from the pen and James said he’d do the examination himself. The College, while happy to occasionally make slaves of their students, don’t particularly want them getting squashed!
The next day Stella was booked in for her operation and it was all hands on deck. She would need a full anaesthetic, which is quite unusual for farm animals, but she was so wild that there was no other way we could help her; operating on a moving leg certainly wasn’t an option. My rotation group was going to do the surgery with James, but the equine surgery rotation group was having a quiet day and was therefore sent over to watch while the anaesthesia rotation group was sent over to do the anaesthetic. So fifteen of us students were in the pen with James, a couple of other clinicians and a rather confused Stella.
Unfortunately she wasn’t the only one being temperamental; the anaesthetic machine was playing up, too. After a half-hour delay it was finally fixed, and a sleepy Stella was knocked out with an injection onto a clean straw bed. While operations like Abigail’s can be done with the cow still awake and standing, this one definitely couldn’t.
Once she was out the anaesthesia team leapt into action and put a tube down her windpipe to give her gas, and we got the go-ahead to operate. I was going to scrub in and help, and I hoped it would involve more than simply holding the instruments.
As James finished cutting the tendon, he turned to me and asked me how I felt about suturing the wound closed. I said brightly that I had every confidence I could do it, so he passed me a needle and the suture material – some strong catgut. The needle, however, was completely blunt and it was the only one we had, so from the outset I struggled to get it through Stella’s hide. With so many people looking on it wasn’t the time to look feeble, so I clenched my teeth and shoved the needle through, slowly making my way along the fifteen-centimetre incision. I’d closed about half of it when the anaesthetist yelled out that he was turning off the anaesthetic. As James said ‘Fine,’ I was thinking, ‘No, please, I still have loads to do.’
I knew that it meant I had no more than four or five minutes before Stella would be awake, so I tried to speed up. But the needle was becoming increasingly blunt, so the struggle to get it through was tougher each time. As I went in for the last few stitches Stella was beginning to move, so I was now trying to stitch a moving target with a ridiculously blunt needle. With one final push I got the last stitch in just as Stella kicked out and we all leaped out of the pen.
It was such a treat to watch her progress over the next few days. She started to become a little more trusting of people and began to tolerate us going into her pen. But best of all, she was learning to walk properly for the first time in her life. It would take her a few weeks to get the hang of it, but instead of struggling to get around she would now have a happy, comfortable life. Seeing the difference in her left us all feeling that being a vet really was worthwhile.
CHAPTER SIXTEEN
Man’s Best Friend
I looked around the crowded waiting room for my next case. To one side I spotted two elderly women deep in conversation, one with a Yorkie at her feet, the other holding the handle of a pink pushchair.
‘Mrs Grogan with Rio?’ I said.
Both women looked up. Mrs Grogan must have brought her friend a
long, and a baby as well, by the look of it. I smiled. ‘Would you like to come this way?’ They both got to their feet and followed me, along with the dog and the pushchair.
In the consulting room I offered them both a seat. ‘Now, is this Rio?’ I said, looking at the Yorkie.
‘Oh no, he’s here,’ said the woman with the pushchair, unzipping the cover. Two small heads emerged from underneath. ‘This is Rio,’ she said, lifting one onto the table. He loves football,’ she added, by way of explanation. ‘And his friend Wayne has come along to keep him company.’
Rio was tiny. He was a miniature Yorkie, rather than a standard one, and on the smaller size of miniatures. He couldn’t have weighed more than two kilos. He had hurt his foot when a fireguard fell on it, and the referring vet had bandaged a splint onto his front left leg. On such a tiny dog this unwieldy combination looked almost as big as the rest of him. My heart melted watching him trying to hobble around.
Gently I began to examine Rio, checking all his vital signs, while asking Mrs Grogan exactly what had happened, and when. She was halfway through the story of how Rio had jumped out of his basket by the fire to get his ball and knocked into the fireguard, when the other woman, who until now had sat quietly to one side of the consulting room with her dog, suddenly spoke.
‘I’m not sure I should be here,’ she said.
‘Really?’ I looked from one to the other. ‘Aren’t you together?’
‘No,’ they both said. ‘We just got chatting in the waiting room.’
I blushed bright pink. For ten minutes I’d had someone sitting there who shouldn’t have been in the room at all. Why hadn’t either of them spoken up sooner?
‘Goodness,’ I said, hoping I didn’t look as embarrassed as I felt. ‘Sorry about that. Would you like to go back to the waiting room and I’m sure you’ll be seen soon.’
Once she’d gone I turned back to Mrs Grogan, who was stroking Rio and fussing over him.
She finished telling me the story of the accident, with plenty of flourishes and sound effects, and then her lip began to wobble. ‘Doctor, will he get better? I can’t lose him, I just can’t. He and Wayne are all I’ve got.’
I did my best to reassure her that Rio was in good hands and we would do everything we possibly could for him. Then I left Mrs Grogan with both her dogs while I reported back to Vincent, one of the residents in small animal orthopaedics, where I was halfway through my week’s rotation.
Tall, with dark curly hair and the most seductive of French accents, Vincent was one of the RVC’s heart-throbs – most of the female students and nurses seemed to have crushes on him. I liked Vincent because he was a really good vet, thorough and very caring. And of course it didn’t hurt that I could listen to him talk all day.
He admitted Rio for X-rays so that we could see what had happened and establish if surgery was needed. To do an X-ray we needed to insert an intravenous catheter to administer the anaesthetic drugs through, but this was no easy feat. Even cat-sized ones were pretty big for Rio. I was pleased the film crew weren’t around that day, as getting it in was extremely tricky, and I was grateful that I wasn’t under the scrutiny of the cameras.
The radiographs weren’t good. Rio had clean fractures through all four of his metacarpals (the equivalent of the bones on the back of your hand) on that leg. They were completely displaced and unless we could insert pins he would probably never be able to use the leg again.
Vincent measured the width of his bones on the X-ray on the computer system to work out what size pins would be needed. There was an ‘Ah …’ and then silence. Rio’s bones weren’t much wider than 1.5mm, and the medulla, or inner region of the bones, was 0.6mm. As the pins would need to slip into the centre of the bones, that meant we would need 0.6mm pins.
This sent the orthopaedic team into a panic. Did pins so narrow even exist? They would be like the finest sewing needle. Even ultrafine wire is 1mm wide. A hunt began and after a few hours of searching through the large store of sterilised equipment and implants, some minute pins were finally found and Rio was booked in for surgery the next day.
I was due to scrub in for the surgery and I was looking forward to it. At the Queen Mother Hospital there was a surgery preparation routine that everyone followed: check phones and answer messages, go to the toilet, eat a full meal (even if it meant having lunch at 10am), have a glass of water, and let someone know you’re going into surgery so that your colleagues (or in my case the rest of the rotation group) don’t think you’ve gone AWOL.
Once you’ve gone through all of that, it was time to get into your scrubs – an outfit that, while lacking in style, more than made up for it in comfort. The blue scrub top and bottoms felt like pyjamas, and the white clogs were incredibly comfy to wear. An unflattering green hairnet indicated that I was a student (pink for anaesthesia, yellow for visitor, blue for staff), and it was all topped off with a white face mask, which I never liked as it would always slip up my nose into my eyes, leaving a mark over my nose and cheeks that would last for the rest of the day.
Rio’s surgery, although technically straightforward, was incredibly complicated and fiddly. As I peered as closely as I could get, Vincent ever so gently pushed each pin down the middle of one half of the bone, and then fed the other half onto it. As the bones were so small, he couldn’t use any force at all because they would have simply snapped.
After four tense hours, Rio had four new pins in his broken metacarpals. A post-operation X-ray showed they were well aligned and made him look like a miniature version of X-Men’s Wolverine, a thought that made us all laugh. Another huge bandage and a fresh splint were put on his leg, so that even if he wanted to use it, he wouldn’t be able to. It was vital that he didn’t put the slightest pressure on it over the next few weeks, as the pins were so thin that until the bone around them had fully knitted, they would easily bend.
Rio went home a few days later. Mrs Grogan was over the moon – I don’t think I had ever seen someone so happy. She had been convinced he wouldn’t be able to have his leg fixed and that he wasn’t coming home. She was so weepy, and so grateful, that I just wanted to give her a hug.
I did my best to explain to her the kind of aftercare Rio would need, and when she should bring him back, but she was too busy cooing to him and petting him. So I thought it best to tuck the written instructions into her hand and asked her to read them carefully when she got home. ‘Yes, yes, dear,’ she said, popping Rio into the pink pushchair, where Wayne was already snuggled.
It was mid-February and I was enjoying orthopaedics. Vets, like doctors, are divided into those that prefer medicine and those that prefer surgery, and for me it was becoming increasingly clear that surgery was more interesting and more satisfying. I really enjoyed being able to fix something then and there, rather than calculating medicines and waiting to see whether they worked.
This was my second week back at the QMH. The previous week I’d been in small animal soft tissue surgery, where we’d been back on those gruelling 6am starts and 6pm finishes, and that’s when we weren’t on checks, walking all the dogs out to grass and doing meds between 8pm until 10pm. We also had to be on call overnight, and although I was lucky and didn’t get called out, I kept waking in a panic, afraid that I’d slept through the phone.
It had been another hectic week, with one case after another coming in for operations, but the case that stood out for me was a super-friendly old chocolate Labrador called Hermes. Named after the Greek God of luck, poor Hermes was anything but lucky – he had visited the QMH thirty-three times in the previous few years with all manner of problems to do with his skin and his gut. His biggest difficulty was that he wasn’t holding down food. On his previous visit he’d had a camera inserted into his stomach to investigate and it seemed his exit to the stomach (the pyloric sphincter) was abnormally shaped. So he was back in for a U-Y pyloroplasty, which is essentially a reshaping of the stomach exit in which you make an incision like a U then stitch it back up in the sha
pe of a Y.
Hermes’ owners had gone abroad for a couple of years, and one of the staff had offered to foster him. He’d been in so many times that everyone knew him and loved him. And he returned the love; despite all the procedures he’d had, and the fact he was ageing and was a bit arthritic and creaky, he was always so happy to see us. It was nice to have a patient who would wag his tail cheerfully every time you came to visit him.
It was a long and complicated operation in a very hot operating theatre. There were always at least seven of us in there, and the heating was up high, as these animals are unable to regulate body temperature while under anaesthetic, so within minutes we were all sweating. This time we had the senior surgeon, a resident surgeon, a surgical nurse, who gets the instrument from storage if it is not present, the anaesthetist, an anaesthesia student, a student scrubbed in (me) and a student not scrubbed in, taking notes (in this case, Lucy).
I had been given the job of passing the instruments, but soon after the operation started I began to wish I was in Lucy’s place, quietly jotting everything down from the safety of the back of the room. Passing the instruments might sound simple, but it turned out to be a sweat-inducing nightmare. Of course, I knew the names of the basic instruments – scissors, scalpel, forceps and so on – but at the QMH there was a bewildering assortment of instruments and they liked to use the proper name of each one. Since most of them had been named after their inventors, it wasn’t forceps, it was De Bakeys; it wasn’t scissors, it was Mayos, and so on.
Not only that, but I was expected to pass said instrument in the correct way. The surgeon would hold out the palm of their hand, bark out the name of the instrument and I would be expected to slap the handle of the instrument onto the outstretched palm so that they could just close their hand around it.