A Yorkshire Vet Through the Seasons
Page 4
Even after the epidural injection had done its work, it took some huffing and puffing from me before the two back legs were eventually in the correct position, pointing backwards towards the way out. I attached a rope to each leg and, with the help of a calving jack (a ratcheted device that allows an even and continuous pull to be applied to the calf), the calf slowly emerged into the cold, dark world of North Yorkshire on this wintery night. When calves come out forwards their eyes are open, and they peer around as they slowly emerge and slither to the ground. I always think this gives them a few moments to get used to their new surroundings. But a backwards calf does not get this luxury. Once everything is lined up, you have to get them out quickly, because there is every chance the umbilical cord will break before the head is out, and the calf will take its first breath while still in the birth canal, where instead of air, it could inhale a lungful of amniotic fluid. So, I always feel slightly sorry for them as they land with a ‘plop’ on the ground. It must be quite a surprise.
This calf, though surprised, was very healthy and had survived both the trials of its mother being spiked and a difficult, breech delivery. It looked well, as did the weary cow. Ray and I congratulated ourselves on two good jobs in one evening, and I began to think of a warm bucket of water to get cleaned up with before heading home. But this was not to be, because the cow had one final ‘while you’re here’ job to throw at us, as she calmly and serenely prolapsed her uterus.
The uterus of a cow is a very large thing. Moments before, it was enclosing and nourishing the calf, which was now wriggling around on the straw, looking for a teat to suckle. With one not particularly big push from the cow, the whole uterus turned inside out and appeared, hanging from the back of her body. It was about the size and weight of a large sack of potatoes but in angry shades of red and purple, with mango-sized swellings all over its outer surface where the placenta had been attached. This was another emergency.
A uterine prolapse (or, as the farmers call it, a ‘calf bed out’) is very serious, and must be replaced as soon as possible. The cow can easily die of shock, sepsis or peritonitis if the uterus tears. I have seen cows charging around a cow shed with the whole lot hanging out, wobbling and swinging all over the place, the delicate tissue covered in straw and muck. Sometimes the cow can even stand on it with her hind feet. Cases like this usually go one of two ways – either they are quite easy to replace, slipping back in without too much problem, or they are extremely difficult: the friable uterine lining bleeds and ruptures as you handle it, and the outcome is not a happy one.
At least this time I was on hand at the very moment it slid out, so there wasn’t time for the uterus to become swollen and dirty. Despite all its misfortune, at least the cow had the luxury of the vet being right there, and she would have the most promptly replaced uterine prolapse ever! I felt optimistic that it would go well, for despite the cow being on its third major life-threatening event in the space of an hour and a half, I was fairly sure this one would be easily remedied. The odds were in her and my favour. Or so I thought.
However, as it turned out, the calf bed was very difficult to replace, as the uterine lining was fragile and prone to tearing when I touched it. After many painstaking minutes, it popped back inside and I managed to invert it completely. The last job was to place some nylon tape sutures in the vulva to stop the whole thing falling out again. Thankfully the epidural was still in action, so despite the rather sturdy needle required to do this, she didn’t feel a thing.
Finally, I sat back on the bale of straw next to me and took a very deep breath, if not a sigh of relief. Surely my night’s work was complete. Three procedures on one cow, all in the same night, was a most unusual event, and both Ray and I felt that she must now be well and truly sorted. I didn’t linger on the bale for long, because she still needed a couple of injections before I could finally bid her, the calf and Ray good night – antibiotics to stop the otherwise inevitable infection, and pain relief, because goodness knows how much pain she must have been feeling. I shuffled back to my car boot to get the required medication. On my return, and to my horror, the poor cow suddenly looked terrible. Her head stretched skywards and she let out an enormous ‘Mooo’. Then she collapsed onto her side, took one last gasp and promptly died. The multitude of serious problems, one after another, was just too much for the poor cow’s system.
* * *
Ray has retired now, but we still regularly attend the farm. John, the farm owner, who has taken over the running of the farm from Ray, called me out recently to see a cow he described, somewhat unusually, as ‘lugubrious’. It was ‘just not right’. This didn’t really offer any clue as to the nature of the problem. The old phrase ‘if only they could talk’ is the perfect assessment of these situations. If only our four-legged patients could explain which bit was hurting – ‘it’s this bit just under my ribs’, or ‘there’s a terrible burning pain in my bladder’, or even ‘I’ve got a splitting headache’ – the job of a veterinary surgeon would often be easier. A lugubrious cow was a diagnostic challenge if ever there was one.
As I rolled up to the farm on this wet and miserable December morning I was unsure exactly what I would find. I quizzed John on the usual things – appetite, calving history, peculiar behaviour? Had there been any recent change in housing or diet? Were any other cattle affected? No – nothing to give me even the smallest clue. The group had been housed for a couple of months and their silage diet was just the same. The cow was in good condition but had started to look poorly a few days previously.
I could see she looked uncomfortable. Her rumen was not contracting properly. Her temperature was just above normal – 102.5°F, not especially high, just up a bit. Her eyes were ‘starey’, which is a rather non-specific description, but to those experienced in peering at cows, it often points towards pain somewhere.
‘Where does it hurt, old girl?’ I wanted to ask.
Her lungs sounded clear, but as soon as I listened to her heart, the cause of the problem became apparent. The normal, steady ‘lubb-dubb’ beat was obscured by loud bubbling, squeaking and gurgling, characteristic of a serious condition called traumatic reticulopericarditis.
It all made sense. Her rumen would stop its regular waves of contraction with this condition, and she would be in considerable abdominal pain. A cow has four chambers to its stomach, and the first one, called the reticulum, sits just behind the diaphragm – a thin muscular sheet that separates the chest from the abdomen. On the other side of the diaphragm is the heart. Cows are not very tidy grazers – they tend to hoover up anything in their path. Sharp bits of wire, from fencing or from the inside of the tractor tyres used to weigh down the plastic sheets on top of the silage, tend to settle out in the bottom of the reticulum. This wire, if it is spiky enough, can pierce the diaphragm and, in extreme cases, penetrate the heart. Infection gets in, and the sac surrounding the heart, called the pericardium, fills with thick pus. It makes the cow very poorly, it is very painful and it makes the heart sound like some sort of plumbing accident. This was exactly what I could hear. With the previous spike-related incident in mind, I quizzed John about any wire that could have got onto the grass or into the silage.
‘We don’t have any barbed wire on the farm,’ John assured me, ‘and we only use wrapped silage so we don’t have old tyres.’
This was not what I wanted to hear as it spoiled my confident, although quite unusual, diagnosis. John looked unconvinced, but I assured him that this was the most likely situation, and that we needed to operate to avoid the inevitable demise of the cow. Even if we did operate, the prognosis would be grave, but at least she would have a chance. John knew me well and was accustomed to my occasionally wayward thought processes, so he agreed to the operation with only a little persuasion.
‘Well, if that’s what you think, we haven’t got many options, have we? You’d better get on with it!’
And with that, he went to the tap to fetch two buckets of clean, warm water.
I clipped away some hair, scrubbed the skin and injected some local anaesthetic, then made a twenty-centimetre-long vertical incision on the cow’s left side. Once I had gone through the skin, I cut through into the rumen. The rumen is basically a huge fermentation vat, where the indigestible fibre in grass, hay and silage is broken down into useful nutrients by millions upon millions of micro-organisms. It is a special smell that emanates from a rumen, and one that lingers for days. I needed to reach through eighty litres of fermenting grass soup, right to the bottom and right to the front, into the reticulum, to feel for the wire that I was hoping to find.
After not much exploring, I found a large and contorted piece of rope. It was a halter. This was not what I expected but, whilst it was not supposed to be there, I didn’t think it was the cause of the problem.
‘I haven’t seen that halter for months!’ spluttered John in astonishment. ‘I thought one of you vets had driven off with it!’
I delved deeper, and suddenly, at the tips of my fingers, I could feel something hard. It felt like the head of a nail. I stretched as far as I could, wishing I had slightly longer arms. With my face jammed right up against the cow’s side, I managed to pinch it between my finger and thumb. I didn’t want to lose it. I pulled gently and the cow let out a grunt and jumped slightly. Like a magician pulling a rabbit out of his hat, I pulled my arm out, clutching in my hand a clean, shiny and very sharp four-inch nail!
There were gasps from John and his assistant Steven, who had arrived to watch.
‘Bloody hell!’ exclaimed Steven. ‘That is amazing!’
Then, from John: ‘That’s a brand-new nail. Keep that, Steven, we can use it for the fencing work next week.’
There spoke a true Yorkshire farmer, I thought.
Billy and Betty
Mrs Taylor was a regular visitor to the surgery with her dogs, Billy and Mitzi. Billy was a shih-tzu, and ten years old. At least according to our records he was ten years old. Mrs Taylor had no idea how old he was. ‘I think he’s six,’ she would declare confidently, despite computer evidence to the contrary. Mitzi was many years older than Billy, but even at the ripe old age of sixteen, the little black miniature poodle had boundless energy, and would constantly jump up and down, looking for anybody who would play with her. She was a live wire and full of fun. Billy, on the other hand, even though he was younger and fit and healthy, always had a ‘hangdog’ expression. Even when his tail wagged, it seemed that he was carrying the weight of the world on his canine shoulders.
I had known Mrs Taylor for many years. Before she had the companionship of these two little dogs, she and her late husband, Derek, had a jolly Staffordshire bull terrier called Butch. Staffies do not enjoy the best of reputations amongst the dog breeds, but they are in fact lovely dogs. Butch had a typically wide mouth, which made him look as if he were grinning from ear to ear. He had a tummy as round as Mr Taylor’s, and his love for Derek was outweighed only by his dislike of the neighbour’s cat.
The stout Staffy suffered from diabetes. His treatment involved daily injections of insulin and adherence to a strict diet. After weeks of adjustment and readjustment of his dose of insulin, Butch’s blood sugar levels remained stubbornly high. I just could not get the diabetes under control.
Derek brought Butch in to the clinic every week, for me to check his blood and urine. The pair always sat, inseparable, in the same spot in the waiting room. Butch loved his visits, happily panting and watching all the other patients come and go, while Derek clutched his jam jar of frothy, yellow urine, in much the same way that a regular at the local pub would sit, nursing his pint in his usual spot. Derek was excellent at catching urine from his dog, even though there was not much space under Butch’s tummy to fit a jam jar. He always provided an enormous sample. Only a few drops were actually required, but Derek took his job seriously.
‘It’s still high, I’m afraid, Mr Taylor,’ I would explain as the bottom square on the urine dipstick changed to dark brown instead of the duck-egg blue that indicated a clear result. Derek was getting used to this news.
‘Oh dear! Not again! Are we ever going to get this damn sugar under control?’
His accusatory tone suggested he thought it was my fault, maybe for not giving the correct type of insulin, or advising on the wrong dose.
‘Are you absolutely sure you are injecting the stuff correctly?’ I asked.
‘Yes, of course I am! How difficult is it, after all?’ came the reply.
‘And you are keeping it in the fridge?’
No reply this time, just a vigorous nodding of the head.
‘Butch is definitely just getting the food that we suggested, Mr Taylor?’ There had to be a reason for the sugar level still being so high.
‘Oh yes, of course! It’s blooming expensive is that food – do you think I’d let it go to waste? I’m a pensioner, you know, I wouldn’t waste good food,’ came his rather defensive reply.
‘Okay. We’ll have to increase the dose of the insulin again. Up by another three units each time and then we’ll have another sample in a week, if that’s okay?’
I waved the happy dog and rather disgruntled owner goodbye, hoping that a bigger dose of insulin would do the trick. I wasn’t completely confident that it would work. If we couldn’t get the blood glucose levels down with this increase, I would need to do more tests. Maybe there was another condition, running alongside the diabetes, that was making Butch’s body unresponsive to the insulin. But more blood tests would mean more expense, and I knew this wouldn’t go down well with the pensioner.
The following week, Butch and Derek were back, sitting in their usual place. Derek grasped his jar of urine while Butch grinned at all the cats, lined up in their boxes, and tried to make friends with the other dogs in the waiting room. Next to Butch was an elderly lady, who I presumed to be Mrs Taylor.
I called them through, as usual, and Butch careered left and right down the waiting room, sniffing and smiling at all the other patients, who were waiting their turn.
‘There you are,’ Derek grumbled as he plonked his jar on the consulting room table. ‘Let’s hope we’re on track this time! Oh, and this is my wife, Betty,’ he continued, as if it were an afterthought and of secondary importance to the delivery of Butch’s urine.
‘Thank you,’ I said. ‘Hello, Mrs Taylor. Nice to meet you.’
It was the first time we had met, as Butch was Derek’s dog and she did not take an active role in his treatment. I didn’t imagine there was much discussion over dinner in the Taylor household about Butch’s sugar levels.
I liked Mrs Taylor immediately. Some elderly ladies, with the advancement of years, lose their sense of humour in the presence of young vets (‘How can this very young man possibly know how to treat my precious little cat? He looks barely old enough to be out of school!’), but I could tell by the glint in Mrs Taylor’s eye that she definitely saw the funny side of life.
I dipped my urine test stick into the jar. It turned brown almost immediately – the glucose level was still very high. My heart sank. I was running out of ideas and I would need to do some blood tests today to check for additional problems.
By reflex alone, I repeated my usual diatribe of questions about extra food – maybe from next-door’s bird table or a bowl of cat food?
Just as Derek was about to open his mouth in anger at my repeated questions, Mrs Taylor intervened.
‘Oh yes, Derek feeds Butch all manner of sausage rolls and pork pies. Two or three times a day. Oh my, he does love them. I sometimes think old Butch will burst, he eats so many. Do you know, I’m not even sure whether it is Derek or Butch who eats more of them! Th
ey are a greedy pair, the two of them!’
It all started to make sense, but before I could make any comment and before Derek could offer his defence, Mrs Taylor was off again.
‘That’s why you’re such a fat pudding, isn’t it, Butchy boy?’
She patted the rotund terrier on the tummy and smiled at me, knowingly. I breathed a heavy sigh of relief. Finally, we had solved the mystery of the uncontrollable glucose levels.
‘Well,’ admitted Derek, ‘I suppose he does get the odd one or two. He loves them, you see?’
I raised my eyebrows.
Once the pork pie situation had been rectified, Butch’s health and waistline quickly returned to something like normal and I didn’t see him so often at the practice, his blood sugar levels being finally sorted.
Some years later, both Butch and Derek had, sadly, passed away. I rarely saw Mrs Taylor, except for an occasional visit to clip the nails of her two guinea pigs, upon which she doted. She had acquired the two dogs, Billy and Mitzi, shortly after her husband had died but they didn’t need a great deal of veterinary intervention. Both dogs were pretty healthy.
The problems with Billy began not long after Betty started getting weekly deliveries of frozen meals-on-wheels. Betty was baffled. She did not know why these meals kept appearing and she was certain she had no need for them. She knew what she liked and she knew how to cook. The pre-packed meals piled up in the freezer and the kitchen, and the obvious thing to do with them, as she saw it, was to heat them up and give them to Billy, who enjoyed them far more than he enjoyed his boring dog food. Billy was in danger of following in his predecessor’s footsteps. He certainly loved the meals-on-wheels, but being a shih-tzu with a sensitive constitution, the result of this diet of roast dinners and toad in the hole was that Billy would often develop bouts of diarrhoea. This, in itself, was not particularly serious and it never affected Billy’s ever-gloomy demeanour. However, the pasty, sticky consistency of the faeces meant that, once a little bit was glued onto his hairy bottom, it acted as a catalyst for more and more to become attached.