I examined the guinea pig, whose name was Byron, and saw a lot of urine staining and scalding around his penis – a clear indication of urinary-tract infection.
The sisters, Myra and Val Hawken, explained that they’d just moved down from the western suburbs of Sydney. Byron’s problem had been around for years, but their old vet never seemed to pay it much attention. He’d prescribe the Baytril and the problem would go away, but within a month or so it always came back.
Myra and Val weren’t that old, but their clothes and buckle-up shoes seemed in keeping with their names – conservative and from a bygone era.
I explained again about not being a pharmacist and that we were obliged to examine animals before we could prescribe antibiotics. I explained that Baytril is an antibiotic that is safe to give to most ‘exotic pets’. (We use this term for any animal that is not a cat, a dog or a farm animal, though it frustrates most exotic-animal vets, as creatures like guinea pigs are hardly exotic.) A lot of vets will give an injection of Baytril and prescribe a bottle for take-home use simply to be seen to be doing something. Arties Medenis always said that you needed to give an injection, even if it was water, otherwise the client would think that you were not trying.
That’s what Myra and Val were expecting here, but instead they got me. They must have thought I was being a presumptuous smarty pants, trying to rip them off with all manner of expensive tests when all they wanted was the Baytril. But I pushed on. ‘I’ll give you the antibiotics this time around because it seems correct and you’ve had that treatment in the past, but if the infection comes back again, I think we have to draw a line in the sand and investigate.’
‘Well, we think that’s a really good idea,’ said Myra with a good deal of enthusiasm. ‘Let’s do that. Frankly, we’re getting sick of the whole cycle.’
I was shocked.
‘We’ll give you a call if it comes back,’ Val said.
I left and went about my rounds, not giving Byron any more thought until a couple of weeks later when Myra called on a Saturday morning. ‘It’s the guinea pig,’ she said. ‘We think the infection’s come back. Can we bring him in for you to have a look at?’
‘Of course,’ I said. ‘We’re free now.’ They were at the clinic within the hour.
Val explained that the Baytril had worked for a time but the infection was back now, probably worse than ever. I pulled Byron out of his cage and put him on the stainless steel table. The skin around his groin and back legs was stained dark brown. He stank and blisters were forming where the ever-present urine was scalding his skin.
‘He’s really miserable at home and he’s barely eating. He doesn’t like attention any more. It’s like he just wants to wallow in his own misery,’ Val said.
‘Where do we go to from here?’ Myra asked. Good question. I realised I had no idea. I’d been saying we couldn’t just keep on doling out antibiotics, but the truth was that I had no concept of what else we should do. I had to think fast. If this was a cat or a dog, what would you do?
‘Okay, we need to collect a urine sample,’ I said, full of authority and confidence. ‘And we need an X-ray.’
‘What is an X-ray going to achieve?’ Myra asked politely.
Gulp. ‘Ummm. It’s going to rule out a tumour or a cancer,’ I said with calm self-assurance. ‘And we have to make sure he doesn’t have anything that predisposes him to this condition.’
‘How much will that cost?’ Val asked.
We’d been going well but I expected to lose them now. ‘It’ll be about $150 for the X-ray and $25 for the urine test.’
‘Okay, good. Let’s do it.’
I took Byron out the back to admit him into hospital, along with his overnight bag containing grass, blankets, fluffy toys and pellets. This was one very loved guinea pig.
Geoff and Geoff were back there. ‘What have you got in the box?’ asked Geoff Scarlett.
‘A guinea pig.’ I saw their eyebrows rise up, and perhaps the hint of an eye roll.
‘Right, and what’s wrong with it?’
I explained the situation to Geoff and his face slowly fell. ‘We have never X-rayed a guinea pig before. Do the clients know how much this is all going to cost?’
‘Yep.’
‘Well, I guess we can give it a go.’ So with my bosses looking on, somewhat bemused, I collected urine and ultrasounded Byron. He was a very cooperative patient, but he didn’t like being jabbed and having the cold ultrasound probe pressed into his side. Through all the wriggling I noticed a funny shadow in the bladder wall. I did an X-ray to get a better look. At least with an X-ray all Byron had to do was sit there.
I had to figure out how to set the factors for the X-ray, a complicated task like manually setting an SLR camera. Given that no one had ever imaged a guinea pig at Berry before, we didn’t know what factors to use, but I managed to get a clear shot. When the image came out, my mouth dropped. There was an enormous white blob sitting in Byron’s bladder, obviously a bladder stone. It was highly likely that this was what was causing Byron’s problems. A bladder stone builds up from a tiny particle, layer by layer, like an oyster, and if there are bacteria in the bladder when the layer is forming, the bacteria will be trapped in that layer. So it becomes a big irritable ball of infection. If it dissolves a bit, the infection is unleashed.
I was pretty pleased with myself for getting to the bottom of it. Byron was the first guinea pig to have ever received that level of investigation at Berry vet clinic. On the other hand, this meant that we would have to embark on a surgery that none of us had ever done before, and that was a pretty intimidating thought, especially given Byron’s privileged position in the Hawken household.
I eventually summoned up the courage to call Val. I headed outside so that I could talk privately on my mobile. Sure enough, as soon as I got hold of Val, Jenny felt it necessary to hang out a basket of washing. There was no privacy and no hiding out the back.
I explained to Val that the stone was like having a pebble in your shoe, it was moving around and irritating the lining of Byron’s bladder. ‘Okay then, what are we going to do about it?’ she asked. I could tell that the two of them were trying to squeeze in to listen to the one phone.
I didn’t have a plan but I winged it, thinking of Byron as if he were a cat. ‘We’ll have to remove the stone,’ I said. ‘And that’s going to require surgery.’
‘Oh, dear. All right. Let’s do that then. Call us when you’ve done it.’ And that was that. They didn’t even give me the opportunity to recommend referral to a specialist. I could feel myself getting further in over my head, knowing that the Geoffs knew as much about guinea-pig surgery as I did.
This was my first experience of dealing with people who were pursuing treatment of animals that we wouldn’t normally consider to be of high value. Since then I’ve seen it all the time and it’s becoming increasingly common. Reptiles and small hindgut fermenters like guinea pigs are becoming more common as pets as backyards shrink. The veterinary profession has to move with it. A hundred years ago, horses provided the majority of vet work. With the rise of the motor car, that fell away and there was an increase in vet calls for cattle and sheep, but people seldom treated cats and dogs. That all changed after World War II and then we began to see this further shift towards smaller animals. An animal’s value was no longer simply as a productive asset, but as a friend and a companion. People loved their pets, and wanted to help them. And that’s why we were about to do a $350 surgery on a $7 guinea pig.
So I embarked on a surgical journey.
I went straight to our thick volumes of conference proceedings, those dusty great books with yellowy blue covers. On the spines, they had the topics of papers that had been delivered at various conferences. It was still in the early days of the internet so there wasn’t much online at that time. I hunted through the volumes until I found one on pocket pets. I rustled through pages that looked like they’d been typed on a typewriter and I found an item on surgery for gu
inea pigs. Eureka! I quickly read through the article, trying to glean what I could, but the only relevant line seemed to be: ‘Be careful not to kill the guinea pig with the anaesthetic.’ Thanks for that, I thought.
Next I called a specialist, Dr Tom Donnelly, in Sydney who focused on exotics and he talked me through my options.
He stressed that indeed the most difficult part of operating on these small pets is managing the anaesthetic because they’ve got a very high metabolic rate. They metabolise the anaesthetic very quickly, so you need to use a lot. And they’ve got a large surface area relative to body size, so they get cold very quickly – in fact, you can kill them with cold during the procedure. ‘They also have bizarre and difficult-to-navigate airways, so trying to get a tube in is difficult,’ Tom said. ‘Apart from that it’s not different from doing the procedure in a cat – midline approach, find the bladder, open it, get the stones out and stitch it up with a watertight pattern. Don’t starve the guinea pig at any point. Anaesthetise it with grass in its mouth and wake it up with access to grass or pellets because with its high metabolism it needs to eat constantly.’ At the end of the conversation Tom reiterated what I’d already figured: ‘Don’t kill the guinea pig with anaesthetic.’ And with that he was gone.
Feeling as ready as I was ever going to be, I enlisted Geoff Scarlett as my anaesthetist and also for reassurance. We knocked Byron out by placing a small cat mask over his face, flooding the mask with oxygen and what seemed like an enormous volume of anaesthetic gas. Once he was asleep, I was able to pass a tiny tube down his throat and into his lungs. The tube would serve to maintain a clear airway and provide continued anaesthetic gas to keep him asleep. We moved Byron into the sterile surgery and lay him on his back. Jenny clipped the bristly hair off his abdomen and did her best to clean the area of rank urine and bacteria. We covered his entire body with a large sterile green surgery drape that had a tiny operating hole in it. The idea of the drape is to provide access to the area of interest and cover everything else. It all looked a little ridiculous. I was no guinea pig anatomist, so covering Byron with the drape removed all my landmarks, making it that much harder to choose the spot where I would cut into him.
I made my incision and was soon into the abdomen. The bladder was readily visible because it was extremely inflamed and thickened. Usually a bladder resembles a thin sheet of cling wrap surrounding a pool of water, but this one was almost half a centimetre thick. I had to cut into the bladder to find the stone; however, when my scalpel sliced into it an enormous amount of blood came pouring out – a result of an increased supply to the very angry organ. The blood obscured almost everything. I felt around and was lucky to find the stone on first sweep. We were fairly certain there was only one stone, going by the X-ray, but some stones can be too small to see. So I continued to probe around, knowing that if I left one in we were dooming Byron to more infections down the track.
Meanwhile, Geoff was making hurry-up noises in the corner and when I looked up I realised that he was manually breathing for Byron – lightly squeezing a bag to imitate the normal rate of breathing. Byron had stopped breathing, though his heart was still pumping. This was an extremely dangerous situation and the words of Tom Donnelly were echoing in my head: ‘Don’t kill the guinea pig with anaesthetic.’
With this in mind, I sewed up the bladder with our finest suture material, checked that it wasn’t leaking then stitched up Byron’s abdomen and skin. Not long after we switched off the anaesthetic gas, Byron began to move his legs and he was soon up munching on a mouthful of fresh wheaten grass that Myra had provided.
I phoned Myra and again could hear the muffled breathing of Val on the other end of the line too. I informed them of the successful stone removal and Byron’s ready recovery from the anaesthetic. They were absolutely ecstatic with the result and I could hear Myra’s voice wavering. Val forgot herself and congratulated me over the phone. It was a very rewarding moment.
Two weeks later, when I went to Myra and Val’s place to remove the stitches, they were over the moon that he was doing so well – better than they’d seen him in years.
I was likewise delighted and relieved. I’d got through by the skin of my teeth, and the less said about it the better. I was trying to work my way back towards the door, but it was hard given how chatty and happy they were with Byron’s improvement. I didn’t want to hang around for any difficult questions like ‘How many of these operations had you done in the past?’
‘Well, Myra and Val, I’m so glad he’s come good. But I really do need to get back to work,’ I said.
‘Yes, of course. Before you go, though, could you have a quick look at Bessy, the rabbit?’
‘Sure.’
‘She’s got a bloody discharge and she’s been a bit lethargic.’
‘Has she also been showing signs of aggression?’ I asked with growing apprehension.
‘Yes, she has actually. It’s been really odd. We thought it was because Byron was getting all the attention.’
My heart sank. These were classic symptoms of a uterine tumour. And the treatment was . . . surgery.
IF I COULD TALK TO THE ANIMALS
James
After the fiasco of Winston the Pig, Ben and I returned a bit sheepish to the Manilla clinic.
Behind the desk, Suzanne looked concerned: ‘Where the hell have you been? I’ve been trying to cover for you. We’ve got Mrs Wilson’s cat waiting for its blood test and you’ve got to see a horse out at the Wrights’ place on the way home. What happened to you?’
‘Nothing,’ said Ben, shooting me a glare.
‘Nothing,’ I agreed.
I think she picked up on the vibe and didn’t press the point. Suzanne was a genius at knowing when to interrupt, especially with clients. She knew just when to prompt me, or when to get the dog out the back, away from the client so I had a chance to regroup and think. She was also the best pattern recogniser I’ve ever come across. She’d hear all the things the client was saying to me and what I was asking the client. Then when I’d pop out the back to get something, she’d appear with a file in her hand. ‘Sounds like what we had with Jake Smith’s dog a couple of years ago. Here’s the file.’
I’d flick through the file, perhaps a little dubious at first, but then I’d see that the symptoms matched exactly. Hmm, wonder what Tim did here? So I’d do what Tim had done and it would all come out hunky dory.
Suzanne spent a lot of time in the clinic on her own while I was out on farm visits. Someone would come in: ‘My dog’s twitching and vomiting and can hardly stand up.’
‘Where do you live? . . . Oh yeah, you’re right on the river.’ Her brain would flick through her mental file of similar cases. ‘It’s probably been bitten by a snake. Let’s get some urine and check it out.’
She’d call me and if I couldn’t get there she’d tell the client to go to Tamworth or that she could put the dog on a drip herself if they weren’t willing to go. I’d get another call saying it was on the drip. Then another saying not to rush back because it was looking heaps better. Suzanne covered for me all the time and made me look good. And she had a great work ethic.
Tamworth was a long way away, so the poor folk of Manilla either got me or they got no one. That helped. Plus the clients had seen many versions of me come and go over the years because Ben always had new grads cycling through.
Over the next two years I worked almost exclusively as the lone vet in Manilla, and the fear gradually subsided. With the help of Suzanne, things almost never went wrong.
Your first job as a new grad can be very stressful. It’s all eyes upon you. A hell of a lot of pressure. And the amount of support you get varies. Anthony and I now have the same problem, employing three new grads. They’ve all got different skills and personalities. You run a fine line between holding their hand too much and stifling them, or not holding it enough. Sometimes they think they don’t need help and they do. Sometimes they think they need help and they don’t. It’s a really di
fficult line we constantly tread and our first bosses had to tread that line too.
I remember one day early on a guy with a thick Spanish accent came in. His name was ‘Sandy’ Sanchez, and he was the only Spanish speaker in town. He mumbled something incomprehensible before starting a game of charades. Firstly pointing to himself, ‘Me Sandy,’ then pointing to the dog, ‘Is Pedro,’ and finishing with, ‘Is seeeeek – not good.’ I had to call Jessica in to translate. It wasn’t that she understood Spanish, it was just that she was Sandy’s neighbour and could understand his English a little better than Suzanne and I.
His strange-looking black-and-white cocker-spaniel/shih tzu cross was clearly sick. Typically a bright and bubbly dog with a massively overshot jaw, which gave him a permanently quizzical expression, Pedro was barely able to raise his head. I looked at him and saw that he had pale gums, and I felt a large irregular mass in his belly – not good. There was a little fluid in the abdomen so I put a needle in and extracted blood – not good either.
I broke the news to Sandy that Pedro had a growth inside his abdomen that was bleeding.
‘Is cancer?’ Sandy didn’t need charades for that one.
‘Probably,’ I replied, before attaching all the caveats that scientists like to apply – we couldn’t be sure unless we performed biopsies, looked for evidence that it might have spread. In essence, though, it was walking like a duck and quacking like a duck so it wasn’t likely to be a budgie. I used a lot of words, but I’m pretty sure Sandy only understood one, and that was ‘cancer’.
Village Vets Page 9
