by Jo Hardy
The ECG gave us the answer. Rocky had atrial fibrillation, a condition common in humans as well as in horses, which causes irregular and often very rapid heartbeat. Normally the heart contracts and relaxes to a regular beat, but when there is AF the upper chambers of the heart quiver instead of beating effectively to move blood into the lower chambers. AF doesn’t affect the horse much when it is at rest, but it affects it enormously during exercise. If the heart isn’t pumping properly the horse can’t function well and will become tired. There is also a small risk that it can progress to a more seriously irregular rhythm, which could dangerously affect the health of the horse and, in rare cases, cause death.
Luckily for Rocky, there was a cure. But it was not without risks, the cure being a drug that would poison him. It was called quinidine (not to be confused with quinine, in tonic water) and it had to be administered by stomach tube every couple of hours for up to seven doses. More than seven doses was deemed too dangerous, because at that point the drug could potentially kill him. It was a case of weighing up which was the lesser evil: the risk of death due to the heart problem or the risk of death due to the drug to treat it. The third option, unthinkable for a horse as magnificent as Rocky, was that he would be put down as he was no longer fit for his purpose.
Rocky’s rider and owners needed to think about which course of action to take, given the risks involved, so he was taken home.
A few days later, having decided to opt for treatment, they brought him back in. Evan handed over to me for the first step, which was to place a catheter into the jugular vein in Rocky’s neck, which I managed incident-free and which felt like an achievement since it was in front of the cameras. Meanwhile, Evan passed in a stomach tube and taped it to Rocky’s head collar. It looked a bit like a snorkel.
The first dose of quinidine was given via the tube, and nothing happened. No side effects and no change in the continuous ECG we had running. If the quinidine worked, at some point Rocky’s heart would quite suddenly convert to a normal rhythm and begin to function normally. We waited two hours before giving him another dose. Still nothing. This went on all day until it came to 6pm and time for me to go home. By then Rocky was on his fifth dose, and still nothing had happened, although he was looking more and more miserable.
I didn’t blame him. He was in an unfamiliar place, and he was being starved and poisoned. He must have felt very sick. We kept things light-hearted, guessing what time his heart would convert to a normal rhythm overnight, but as we all dispersed it was clear that everyone was worried.
I spent a restless night and I went in early the next morning, to be met by Evan’s tired face and most cheerful smile. That meant Rocky had made it; his heart had converted and he hadn’t died from the medication. Evan explained to me it was only after his seventh dose that he had finally converted, at around midnight. Thank goodness! Unfortunately he had developed a rather distressing side effect. Rocky had started having muscle fasciculations – violent twitches – over his right foreleg and neck. His muscles had been jumping around for so long that he was really hot to touch, and he must have been in a lot of pain due to the lactic acid build-up that this kind of twitching provokes.
We spent the day dosing him up with as much pain relief as possible, as well as calcium and other minerals to help his muscles calm down. It took a while, but three days later Rocky got the all-clear to go home. His rider came to pick him up and was over the moon. Although he was employed to ride Rocky and didn’t own him, it was clear how much affection he had for the horse.
A few months later the TV crew went to film Rocky being exercised at his yard. It was lovely to see him, and I couldn’t believe what an amazing recovery he’d made. He had come back from near death to become a superstar athlete again.
Meanwhile, I got my chance to have a go at some surgery. Paul told me I could castrate a stallion. I had performed castrations before on other animals (remember the boars in South Africa?) as well as on some young colts, but this was a proper surgical procedure on an adult horse, under full anaesthetic, on the operating table.
Stallions are usually castrated at eight or nine months old, when it’s easier to operate on them, and the procedure is often carried out in their own stables under heavy sedation. This one was older, however, and he had very well-developed testicles and needed to be knocked out. It was a far more sophisticated surgery than the boars, though. Instead of using emasculators, everything that was going to be left in was tied off with sutures, before the testicle was cut off using a scalpel. The reason why this isn’t done when operating in the stables with younger horses is that it increases the risk of infection, since the procedure isn’t being done in a sterile environment. But as this procedure took place in an ultra-clean and sterile surgical theatre, the risk of infection was much lower than the risk of bleeding and sutures could be put in.
Next on my list was a hernia case. A hernia is a defect in the abdomen wall, which allows the abdominal contents to fall through the muscles of the abdomen. The last thing you want is for the intestines to fall through because then they can become strangulated. But in this case the horse was young, about a year old, and he had a small hernia, so only some of the fat around his belly had fallen through. It needed closing, though, before it got any worse, and Paul was happy for me to go ahead and open the skin over the hernia, then push everything back through it and close it up under his supervision. Job done!
At the end of every day at the hospital I went home feeling great. I loved horses, loved surgery and enjoyed working with Paul and Evan and the rest of the team. Evan, in particular, taught me a lot. Some clinicians consider students to be a nuisance and some love to teach. He was one of those that loved to teach, so it was a real pleasure to shadow him. He would get me fully involved, explaining and describing what was going on at every stage.
One afternoon he asked me if I had passed a stomach tube before. I had seen several vets do it in the past and had held the swinging heads of unhappy horses that didn’t like what was being done, but I had never actually passed one myself. So Evan invited me to do one on a young horse called Ace that had come in the previous night with impaction colic.
I leaped at the chance. The difficulty in passing a stomach tube up a horse’s nose and down into the stomach is that you need the horse to keep its head still. It’s a procedure usually done without sedation, and some horses, unused to the hospital and the people and procedures, get frustrated and keep shaking their heads. Ace was one of those.
As the tube passes along the inside of the nose, even if the horse keeps its head still, it is very, very easy to hit the small bones in the nose that are covered with blood vessels, and if you accidently hit them you can cause massive nosebleeds.
That’s what happened when I passed the tube up Ace’s nasal passage. The blood vessels opened and blood streamed out of his nose. And as it did he shook his head and snorted, so that within minutes the whole stable looked as though there had been a massacre.
I was mortified, but Evan was kind, reassuring me that it happens regularly to even the most experienced clinicians. ‘Have another go soon,’ he said. ‘Let’s do a swap. After all I’m much better at doing the procedure than holding a horse while it’s done so I probably haven’t helped.’ He passed the tube and double-checked that there wasn’t any build-up of ingesta or fluid in the stomach, before pouring fluids down the tube to try to soften and budge the impaction. He needed a repeat of the fluids a few hours later, and this time Ace was significantly better behaved. Evan allowed me to pass the tube and, to my relief, this time it went fine.
To be fair, Ace really was a grumpy horse. During the next couple of days he started defecating again, a sign that the impaction had moved and broken down, and I was allowed to walk him out to graze. Each time I went to put him back in the stable he planted his feet outside the door and refused to budge. It took four or five people, pushing and yelling, to get him back into his stable and, in the end, most of the time a stable h
and had to push his behind with a broom to get him back in. If there was no help around, however, I could just about manage to get him in on my own by reversing him into the stable and pushing his chest, so that before he knew it he was in his stable.
At the start of my two weeks Paul had asked me if I wanted to be called out if there was an overnight emergency surgery. I was based at home, only half an hour away, so I had said yes please.
One evening the phone went at around 10.30pm. There was a horse with colic and it was in a lot of distress, Paul said. If it ended up having to go to surgery, did I want to come? I said absolutely. The next call was at midnight, the surgery was going ahead, would I like to help?
I leaped into my car and shot back to the hospital. By the time I arrived at 12.45am the horse was just being prepared for surgery.
It was a young pony called Sunny, just eighteen months old and dun – a black mane and tail and a sandy body. He was in a great deal of pain as his intestine had become displaced and had flopped around into the wrong part of the abdomen. When a horse has displaced intestines, the whole digestive process slows down, so it’s very common for them to have an impaction at the same time, and poor old Sunny did.
I scrubbed in and Paul started operating at about 1.15am. I was able to help with the anaesthetic and watch as Paul cut a hole in a healthy part of intestine, got a hosepipe and flooded it with water, then took the hosepipe out and milked out the half-digested matter from the intestines through the hole. The intestine dangled outside the body and a lot of sloppy stuff went into a big bucket. Once it was all out, Paul put everything back in place and sewed it all up. It was impressive, and it was all over in an hour and a half.
I got home at three, slept for four hours and was back at work by eight the same morning. We had to put a stomach tube into Sunny a couple of times a day after that, because his intestines had become very inflamed and were not really moving properly, and as horses can’t vomit there was a risk of a build-up of fluid in his stomach if we didn’t remove it. It was no fun for him each time, but he put up with our administrations with resignation and within a few days his insides were working efficiently again and we were able to start taking him out to graze on the end of a rope, several times a day.
I was sorely tempted by an invitation to apply for an internship at the equine hospital for after I graduated, but while I would have really enjoyed working alongside brilliant vets like Evan and Paul, and working with horses, in the end I decided against it. I knew I wasn’t ready to settle into a permanent job yet. I wanted to travel, and to try working in different practices for a while. I was accepted, subject to graduating, by a locum agency, which meant I could work for a few months after graduation and save some money. I wanted to go to Africa with World in Need; I loved the idea of teaching people in remote villages how to look after their goats. I smiled, remembering Doris the goat, propped on cushions in the back of the SUV. Whatever lay ahead for me, it wasn’t going to be tending to goats like that.
I had the idea of taking goat ‘goody bags’ out with me, and putting the basic care kit for goats in them – a hoof trimmer, a rubber teat to bottle feed, some plastic gloves and a basic healthcare guide. Whenever I had a minute I contacted charities, asking whether they would donate towards the cost of the goody bags, and I struck gold with the British Goat Society, which offered a generous donation, and the World Veterinary Services, which offered to sponsor some of the drugs I might need.
Gradually a clearer picture was beginning to emerge. And as my equine placement ended, so did three months of monsoon-like rain, and the sun came out. At last.
CHAPTER EIGHTEEN
Luca the Great Dane
He was huge. Absolutely enormous. In fact, closer to the size of a pony than a dog. Luca the Great Dane was the largest dog I’d ever seen. He was also one of the softest; a sweet-natured, soppy giant.
Luca arrived at the QMH during the first week of neurology, my final rotation. Neurology is an area of veterinary medicine that can be heartbreaking because many of the animals that arrive in the department are in a bad way. Quite a few of them have spinal problems and need to be carried, which isn’t normally too difficult; they’re either carried in someone’s arms or put on a trolley. But three-year-old Luca, who arrived as an overnight emergency, posed a challenge. His back legs had collapsed and he couldn’t walk, but at eighty kilos, or twelve and a half stone, he was far too large for any of our trolleys and too heavy to lift onto one even if he had fitted.
The problem with Luca’s spine might have been a slipped disc, a spine deformation, or even a tumour compressing on his spine. An MRI scan was needed for a proper diagnosis. But to get Luca to the induction room for his general anaesthetic required seven people: two to run ahead and open the double doors, four to help Luca along, holding his back end up in a harness, and one to follow behind with a mop, clearing Luca’s pee and poo as we went. Whatever was affecting his legs had also left him incontinent, which meant he left an unsightly trail everywhere. And being so big, he produced waterfalls of the stuff. But, to be honest, by this stage of my training I had been covered in a variety of noxious bodily fluids so many times that I barely noticed it any more.
Once Luca was under, we had another problem. He was too big to fit through the tunnel of the MRI scanner. It had been designed for humans, although most dogs fitted into it comfortably. Not Luca. It took a great deal of repositioning, holding bits of him down with Velcro straps and bending his legs, to get him through. But it was worth the effort because the scan gave us the answer to his problem; one of Luca’s vertebra had tunnelled into another, causing a compression of his spinal cord. It’s a condition called lumbosacral stenosis, or LSS, and it’s a problem that happens fairly often with large dogs, giving them considerable pain.
The only way to relieve Luca’s discomfort and to allow him to get his movement back was for us to perform a dorsal laminectomy, in which the top of the vertebra, where the compression is, would be removed. So Luca was gently woken and manoeuvred back into his kennel, given plenty of painkillers and left to rest overnight. The following day we took him into surgery.
I had been warned that it would be a long operation, so I prepared by eating a vast breakfast, shovelling down extra toast as I flew around the house getting my things together, and then I drove to the hospital. I was still munching when I arrived.
Getting Luca onto the operating table was the next challenge. He just about fitted, once six of us had lifted him on, but there was great concern that he could easily slip off, so we kept the level low and tied him securely on with straps.
The incision into his spine, made by resident vet Gareth, my supervising clinician for the case, was extraordinarily deep. It honestly looked as though we were cutting him in half. But once we reached his spine it was a really absorbing and fascinating operation. I knew that, unless I chose to be a specialist in this field, I would probably only rarely see an animal’s spine exposed, so it was an opportunity to learn. Gareth’s skill in cutting off the bone that was compressing Luca’s spinal cord was impressive. He had to be so precise; any major damage to the spinal cord could mean Luca might never walk again.
In the end the operation lasted five and a half hours. By the time we finished the seven of us in the room were hot, exhausted and very, very hungry. But it had gone well – now it was just a question of careful nursing and crossing fingers, toes and paws that Luca would make a full recovery.
The day after the surgery, however, Luca appeared depressed. He was whining pathetically and looking at everyone who passed him with his huge, droopy, sad eyes, so I decided to go and sit with him in his kennel. It was actually much comfier than sitting in the tea room as he had nice squashy pillows and blankets, so I decided that I would tackle two birds with one stone; get some revision done and keep Luca company whenever I had a bit of free time. I think he appreciated it; he kept flopping his head with his drooly jowls onto my lap.
Exams were looming frighteningly
close, and nerves were well and truly setting in. It was already almost April and the first one, the practical exam, was scheduled for the week after I finished neurology, so I was revising in every spare minute I had. The practical exam was a horrendous obstacle race of at least thirty timed challenges, with five minutes for each, all different, all involving solving a problem or identifying something. Just thinking about it made my stomach flip.
Luca was one of those rare cases that got under my skin. His big, solemn eyes, floppy jaws and lumbering body made me smile, and his gentle nature touched me. We spent a lot of time together on the floor of his kennel; me propped on the pillows, Luca propped on me, my revision papers propped on his head, as bit by bit he grew stronger.
We managed to get him back onto his feet, lifted by a hoist in a special harness, the day after his operation. I had to scour the hospital for a harness big enough, before eventually finding one in some far-flung cupboard. It was vital that he started to use his back legs as soon as possible, and although he couldn’t yet hold his full weight on them, he did well and the movement he managed was promising.
Over the next week we continued with his rehab, and as he started to get better he discovered that even though he couldn’t get up himself, he could crawl pretty effectively across the ground. After that, every time I opened his kennel door I had to be careful, because a 175-pound beast would hurl himself through it. Several times he managed to barge his way out and combat-crawl halfway along the ward, where he would stop and try to get everyone’s attention. It was extremely funny to watch.
After ten days he was finally able to get up by himself and walk almost unaided, although he was still a little wobbly. Everyone was delighted with him; the operation had been a complete success, and his balance and mobility would improve with time. He was ready to go home.