by Jo Hardy
The practice is a converted house, so it’s a bit of a maze, but it has two consulting rooms and two operating theatres. Two vets consult every day in three sessions – morning, lunchtime and evening – so the working day lasts from nine until seven, although by the time everyone has been seen and all the paperwork is done the vets are often there until eight or even nine at night.
Several years before Chris’s retirement a new partner was appointed. Bradley Curtis was a young, kind and caring vet, a million miles from the middle-aged, rather high-handed and intimidating male partner typical of many practices. Bradley’s view was that being a vet is about providing a community service, and he was so nice that all the clients ask to see him.
Alongside Bradley and Sue there was Jane Fairham, another very good and very experienced senior vet, head nurse Emma and nurses Becky and Dee, plus receptionist Bev. There was a vacancy for a fourth vet at the time, which was why I was there. They were looking for a vet who would fit in and were hoping to find someone by the time my five weeks ended.
Back in the consulting room I did my best to assure Mrs Stevens that I was still a fully functioning vet despite my scary voice and, a little reluctantly, she opened the cat box and lifted out an elderly ginger cat.
‘Markie’s off his food,’ she said. ‘He’s barely eating a thing.’
Judging by his very rotund girth, Markie didn’t look as though he was about to starve just yet, but any animal that is refusing to eat is a cause for concern.
I examined him carefully and discovered that one of his nostrils was blocked with discharge. ‘Cats go off their food when they can’t smell it,’ I explained to Mrs Stevens. ‘But we need to find out why his nose is blocked.’
Mrs Stevens explained that he’d had bouts of cat flu throughout his life; it had been an ongoing problem for him. Cat flu is usually caused by one or two different viruses and once a cat has had it the flu tends to flare up throughout a cat’s life, especially in times of stress.
Mrs Stevens went on to explain that she had recently had painters in the house and Markie had been hiding for days. The clinical signs, plus the history of stress, combined with a slightly elevated temperature meant that flu was almost certainly the problem.
‘I’m going to give you some antibiotics for Markie to prevent a secondary infection, which would make it worse, and some anti-inflammatories to help bring down his temperature as well as any swelling in his nose,’ I explained to her. ‘I’m also going to give you something to help with the nasal discharge. Hopefully we can unclog his nose and he’ll feel like eating again. Try warming up his food so it’s nice and smelly, or feed him really smelly food like fish, and bring him into the bathroom when you run a bath or have a shower because the steam will really help. Otherwise it’s just a matter of rest and recuperation. If he’s not improving in the next three or four days, please do bring him back. The next step would be for us to take an X-ray of his nose, just to make sure nothing else is blocking it.’
Mrs Stevens thanked me and left, clutching what seemed like half the pharmacy.
‘You OK, Jo?’ Bradley stuck his head around the door. ‘Heard you weren’t very well.’
‘I’m all right, I just sound awful,’ I said. Actually I felt awful, too.
‘Goodness. Well, as long as you can manage. Great. We’re full to bursting today.’
I was well aware of that. If I went home Bradley would have to see all the people and animals on the list and he’d be there past midnight. I swallowed another Lemsip and powered on.
Next in was a gorgeous chocolate Labrador called Chip. Bouncy and friendly, he was a typical Lab, but his owner, a woman in her thirties, looked worried. ‘Chip keeps trying to chew off his tail,’ she said. ‘He’s really hurting himself. I think it must be itching.’
I had a look. Chip was doing a good job of gnawing at his tail – it looked messy and painful. The skin just above the base of the tail was red and oozy, which looked like what we call a hotspot – in other words, a skin infection. I put a buster collar on him so that he couldn’t reach it. These funnel-shaped collars look awkward, but they do the job. Chip didn’t look happy about his sudden appendage, but I couldn’t let him injure himself. I gave his owner some steroid and antibiotic cream, which works really well for itchy skin, plus some flea treatment because if he had any fleas they would make it worse, and told her to come back in a week if he wasn’t better.
By 11.30am I’d seen three more dogs, four cats, a budgie with a sore foot and a gerbil with a sore nose and I felt as though I’d finished a whole day, rather than just the first session. Grateful for a break, I popped home, since it was just down the road, to have some comfort food in a rare patch of late-October sun in the garden. Reflecting on my morning, I was pleased with how it had gone. Despite being busy and feeling awful, I actually got quite a buzz from the intensity of the work, though it was hard to imagine how the Dacre House vets worked at that intense pace all the time.
Back in the consulting room I was confronted with an alarming sight. The guinea pig that had just been put in front of me had an eyeball that was almost out of its socket, making it look oddly lopsided.
Its owner held the guinea pig firmly in place. ‘This is Titus. As you can see, something is up with his eye.’
‘Yes,’ I held Titus’s head as I looked carefully at his eye. ‘It’s prolapsed. He’s either had a trauma to the eye, like a knock, or there’s a mass behind it pushing it out. Whatever the problem is I’m afraid there’s virtually no chance of getting the eye back into the socket again. The only realistic options are to put Titus to sleep or to take the eye out. That’s a bit risky because small mammals can be a little bit unpredictable under anaesthetic, but it’s the best thing to do. He’ll be much more comfortable afterwards and during the operation we’ll be able to assess whether there is a mass behind it.’
‘Oh.’ She looked shocked. ‘Well, we’ll definitely go for that; we can’t put him to sleep. But after the eye comes out will he just have a hole there? He belongs to my little girl, she’ll be terribly upset.’
‘It honestly won’t look too bad afterwards. There won’t be a hole; the skin around the eye will be sutured closed and he’ll manage fine with the other eye. But we have to get him through the operation first.’
I booked Titus in for surgery with Sue, who was due to be operating the next day, making sure he had a decent dose of pain relief to get him through the night. The operation went well, but afterwards Titus didn’t appear to be waking.
The problem with small creatures like mice, rats, rabbits and guinea pigs is that they don’t do too well under anaesthetic. The statistics for healthy animals passing away under anaesthetic is roughly one in 2,000 for dogs and one in 1,000 cats, but then it drops to one in 60 for rabbits, one in 50 for guinea pigs and the figures are even worse for small rodents. Sometimes they just don’t wake up, and even when they do they are prone to ileus, a condition in which the intestines stop moving, or to getting extremely cold. So when Titus didn’t come round as he should have, we were all worried. For a while it seemed to be touch and go, but eventually he woke and after a little while he seemed fine. I breathed a sigh of relief. There’s nothing harder than telling an owner that their beloved pet has died on the operating table. I made sure he had plenty of dandelions from the garden to encourage him to eat.
A couple of days later I had another worry with an anaesthetic. We had to do an X-ray on a very friendly Border terrier called Rocky who had a problem with his leg. I had administered his anaesthetic while Emma, the head nurse, was holding him and talking to him to distract him from the needle. Once he was sleepy enough, I intubated him so we could maintain him on anaesthetic gas, but he had taken only tiny breaths, and not a proper big one, in the past 30 seconds.
‘Emma, I’m not entirely happy with his breathing,’ I said anxiously as she was removing the stethoscope from her ears.
‘He’s got a wonderful steady heart rate and a good pulse, but I
can get Sue for you if you want.’
‘Yes please.’
Ten seconds later, Sue popped her head around the door, asking how she could help.
‘Well, I induced him and initially he seemed to go to sleep smoothly, but over the last minute he’s not been breathing very well. Just a couple of small breaths. Emma’s checked the machine and it’s all set up fine. His heart is good and his colour is nice and pink.’
‘OK, don’t worry, I see plenty of dogs that are just more sensitive to the anaesthetic than others and need a fraction of the usual dose. Let’s turn off the gas and just leave him on oxygen to flush it out of his system.’
Sue started giving a squeeze of the oxygen bag on the machine every 15 seconds or so to give him big breaths of oxygen since he wasn’t taking them properly himself. Two minutes later he started breathing deeply and fully for himself.
‘There we are,’ Sue said. ‘All fine again, now the anaesthetic is starting to wear off and he’s lightening up. You can turn it back on now and carry on with the X-ray.’
I was relieved and amazed at how calm Sue was. She had seen this happen many times throughout her career and exuded confidence and experience. I was grateful for her help and I would be more confident next time.
Halfway through the X-ray, Rocky seemed to go the other way; he started taking very large and quick breaths.
‘Something’s not right here,’ Emma said.
I put my ear to his head.
‘His tube sounds raspy. Let’s change it. It might be blocked.’
Emma turned off the gas and uncoupled him from the machine and together we changed his breathing tube. Just as I suspected, it had partially filled with mucus so he wasn’t getting as much oxygen as he needed. Once the new tube was in he settled into a good pattern and 10 minutes later we were done.
The X-rays showed some soft-tissue swelling but thankfully no fractures in the leg he was lame on. I breathed a sigh of relief.
‘Not an easy anaesthetic, that one. Clearly just a super-sensitive dog. Thanks for your help.’ I smiled at Emma. I wished I felt more confident with anaesthetics. It was one of my weaknesses and I promised myself I would work on it over the coming months.
By midweek I was feeling a lot better and my voice was just about back to normal. No more odd looks from clients puzzled by the new husky-voiced vet! Work was non-stop, but the friendly atmosphere in the practice helped make up for the long hours. Bev the receptionist was warm-hearted, Becky made us laugh, Dee, who was South African, always had a cup of tea ready, and Emma sorted out everything and everyone, impressively keeping on top of stock, staff and animals.
I was grateful for the warm and generous support that all the vets offered. I knew I could check with them if I had any concerns or doubts about a diagnosis or a procedure. That was comforting, because when you’re fresh out of vet school everything feels new and there were times when I missed knowing that a friendly clinician was looking over my shoulder.
During your first year as a qualified vet you have to fill in an online Professional Development Record for the veterinary governing body, the Royal College of Veterinary Surgeons (RCVS) – not to be confused with my old university, the Royal Veterinary College (RVC). On it you have to include every single case you see, ticking the boxes for the number of vaccinations, spays, heart conditions, allergies, equine cases, anaesthesias, euthanasias and so on. You also have to write up a handful of case studies and at the end of the year you have to have it all signed off by a senior vet who has seen your work and will vouch for you. Normally this would be done by a senior vet in the practice that you join, but as I was going from one practice to another as a locum, there was no one obvious to do this for me. So when Bradley offered to be my supervising vet it solved a problem for me and I was delighted.
Dinner with my old friend Abi made a welcome break towards the end of the week. Abi and I had been friends since she was 11 and I was 13. We met at the stables and bonded over our shared passion for horses; for years we rode together in the evenings and at weekends. She was the closest I ever came to having a sister – we look alike and we love being taken for sisters.
Abi studied history at university and then went to work for Teach First, the scheme that trains graduates for six weeks and then puts them into tough schools in low-income communities to work as teachers for the next two years. If they make it to the end, they become qualified teachers. It’s a great scheme, aimed at ending inequality in education and finding inspirational people to help and encourage kids who might otherwise fail, but the reality for Abi was tough. She is the gentlest person I know, and she found herself teaching seven- and eight-year-olds who constantly needed to be kept in line. She had to look for clever ways to do this, because she wasn’t the sort of person to shout.
Although our lives have taken us in different directions, Abi and I always make time to get together for a meal, a drink out or a girly evening in with a tub of ice cream and a film.
She had sent me a text a couple of days earlier: ‘Help me, I need rescuing from these kids.’
I rang her and asked if she fancied a takeaway and a comedy. ‘Sounds like bliss,’ she said.
Two days later, over a curry, I asked her how it was going. ‘Let’s put it this way,’ she said. ‘I’ll get through it, but I’ll be glad when I do. I swear some of the kids have got a diploma in winding teachers up.’
‘You’re brave,’ I told her. ‘Animals are easier to keep in line than your little monsters.’
It was great to catch up with one another’s lives and, as always, we promised to get together again soon. Not always easy, given the demands we both face, but ours is the kind of friendship that will survive anything. I can see us as little old ladies, still chewing the fat over a curry.
It’s funny how animal cases can come in batches. You don’t see a condition for a couple of weeks and then three come along at once. When I got back to work the next day the theme seemed to be elderly dogs.
Old dogs generally develop problems. We all do as we grow older, and dogs, just like humans, are subject to a whole range of age-related difficulties. It often requires time, patience and expense to keep an old dog going, but choosing to put them to sleep can be even harder.
Douglas was an old Cairn terrier who had recently been rescued. His owners, Mr and Mrs Miller, had been on holiday in the Highlands of Scotland and the bartender at the hotel where they were staying had Douglas behind the bar. The Millers got chatting to the bartender, who told them that Douglas’s owner, an elderly lady, was terminally ill with cancer and in hospital. The bartender had agreed to look after Douglas and the hotel owners had allowed her to bring him to work, but she wouldn’t be able to keep him permanently, she explained, because she was soon going to move abroad.
The following day the Millers told the bartender that they would like to adopt Douglas and two days later they drove back down to Kent with the dog settled in the back of the car on a lovely tartan dog bed.
Douglas settled into his new home and was given plenty of treats and love. Everything seemed fine, until he developed a bad dose of kennel cough, or canine infectious tracheobronchitis. Kennel cough can sound awful, as if your dog is choking on something, but in most healthy dogs it’s not life-threatening. However, Douglas was elderly, probably around 14, and when his new owners brought him in to the practice he was very ill.
Lethargic and floppy, his chest heaving up and down with every breath, he looked as though he wouldn’t last long. I put him straight onto high-dose antibiotics along with medication to bring down his temperature, mucolytic powder to help clear the mucus in his throat and a medicine that relaxes tight airways and opens them up.
I told Mr and Mrs Miller, a gentle and thoughtful couple, to take Douglas home, keep him warm and bring him back in a couple of days. Although they’d only had him for a few months they were devoted to him and terribly upset that he was so ill. They carried him carefully out to their car, promising to nurse him day and
night.
A couple of hours later, Sparky the Jack Russell was brought in by his owner, a short, quiet man who clearly loved his dog very much. Sparky, a sprightly little chap of 15, had developed another complaint that is common in older dogs – dry eye. This occurs when the immune system destroys the glands that produce tears and the result is very painful for the poor dog; the eyes produce a nasty discharge and can become ulcerated.
Dry eye isn’t curable, but luckily it’s manageable. I confirmed the condition using the Schirmer’s tear test: you take little pieces of paper, a bit like blotting paper, and insert them between the dog’s eyelid and the eye. The paper is marked along its length and it soaks up tears while drawing a blue dye along with it. If the moisture reaches the fifteenth marker, the eye is healthy; less than 10 and there’s a problem. Poor Sparky only managed the second marker, in both eyes. I started him straight away on an eye drop that contained a down-regulating drug to stop the immune system from attacking the lacrimal glands, which produce tears, and suggested the owners also use fake tears, which they could get from the chemist.
Sparky’s owner wasn’t well off and the eye therapy is expensive initially until the disease is brought under control, but luckily, unlike many of the animals that came to Dacre House, the dog was insured. I suggested the owner bring Sparky back in a week to reassess his tear production to make sure we were going in the right direction.
The last old chap I saw that day was an ancient beagle named Bailey. He trailed in behind his owners, looking very flat. Shoulders stooped, ears drooping to the floor, he appeared worn out. His owners, a very charming older couple, said that Bailey just appeared to have lost his spirit. Formerly a bouncy, lovable dog, he had become so lethargic that not even the prospect of food or walks excited him.
Lethargy can be due to a number of conditions, so I did a blood test. When it showed nothing abnormal, coupled with the fact that his clinical exam was entirely normal apart from looking depressed, I was suspicious that he was suffering from a dog version of dementia. Symptoms of canine cognitive dysfunction, or dementia, appear in about 50 per cent of dogs over the age of 11, although in many the symptoms are mild. The good news, as I explained to Bailey’s owner, is that there’s a very good drug that increases blood flow to the brain, which means the brain is getting a bit more oxygen and nutrients and is stimulated.
