I had always regarded myself as somewhat invincible and able to tackle any physical task, whether it was dehorning twenty cows, working all night on call, running the Three Peaks fell race or cycling to Everest base camp. However, now it seemed that I was, in fact, utterly and completely vulnerable and my health was in ruins. I had discovered my very own kryptonite. All it would take to make me sick and weak was one crumb of pork pie or one bite of a bread roll.
Despite being buoyed by finally having a diagnosis, and with it the possibility of managing the condition, I was not completely delighted to hear my fate. Itchy skin and general fatigue apart, dermatitis herpetiformis confers on its sufferers a massively increased risk of succumbing to a whole list of other serious diseases. Leukaemia, thyroid disorders and rheumatoid arthritis are high on the list. I knew about these conditions because my four-legged patients could be affected by the same problems. Not only would I have DH for the rest of my life, but I was now absolutely certain I would get one of these other horrible conditions. Apart from all that, how on earth would I manage without a pint? (Beer was full of gluten, so that was off the list.) This was surely the time when I needed one more than ever.
But: ‘Good news!’ the dermatologist told me. There was medication that would alleviate all the signs of this disease. I needed to take it, on top of my restricted diet. It was called dapsone. We had learnt about dapsone in pharmacology lectures with the medics at college, as its main use was in the treatment of leprosy. At least this meant that the tips of my fingers would be in robust health, I thought. It is nasty stuff, though. I needed regular blood tests to check my red cell count, since my blood cells could easily be destroyed by the drug. My liver enzymes and various other parameters also had to be looked at. At the start, I was being monitored more regularly than my chemotherapy patients. The list of side effects, which were genuine rather than simply written on the data sheet for caution, was startling, and extended as far as mental disturbances, and possible psychosis.
Despite all the negative connotations of my condition, new diet, and potentially toxic medication, I knew that making important changes to my lifestyle would result in a very healthy me again, and I embraced the start of a new era. I was extremely fortunate to have had DH flagged up so promptly. During my research into the disease, I learnt that the signs are greatly exacerbated by exposure to high levels of iodine. This explained why it came on so severely during the foot-and-mouth crisis. Had I not been so completely marinated in iodine over this period it might never have been identified.
The improvement in my symptoms on starting my leprosy medicine was immediate and dramatic. The itching stopped pretty much straightaway and the blisters started to heal. Once I had familiarized myself with my new diet, I began to feel much better and fitter. Nowadays gluten-free foods are readily available and do not carry the same freakish stigma of weak, pale hypochondriacs that they did then. Back in 2002 the bread was the size, taste and consistency of a beer mat, with an aftertaste of vinegar. Gluten-free pasta would instantly turn to gloopy soup and gluten-free flour, appetizingly referred to as ‘white mix’, was more like powdered Polyfilla. These gluten-free substitutes were not really worth exploring. The weekly Tesco shopping trip took on a whole new complicated twist, as every label and packet had to be scrutinized. Anne, who wasn’t the most enthusiastic of cooks at the best of times, took on the challenge of trying to do some gluten-free baking. She resorted to phoning her mother in Hampshire, to get her to make the same thing, so she could tell if it was her cooking skills or the gluten-free ingredients that had caused the strange appearance of her latest endeavour. The upside of this was that the successful outcomes in Hampshire would appear a few days later, parcelled up, brought by a postman who was weighed down with double-density loaves.
On a holiday to France with some friends, soon after my diagnosis in the summer of 2002, I hadn’t really quite got to grips with my new dietary constraints. While everyone else tucked into baguettes and cheese at lunchtime, I would eat half a Camembert and a tomato – not the most balanced of diets. However, once I got used to it, I quickly realized that a diet naturally free of gluten was, as long as I excluded neat cheese, a very healthy one. Rice, potatoes, fruit, vegetables, fish and meat, yoghurt, nuts, honey, wine and gin and tonic – it was a great combination and a mixture on which I now thrive. No biscuits, pies, buns or beer. I would urge anyone to give it a go. I do have to be incredibly strict though, because even the smallest crumb in the butter dish or half a teaspoon of wheat flour in a sauce or gravy will mess everything up. If I accidentally eat even the tiniest trace of gluten, it takes me about three weeks to return to normal and my immune system, apparently, takes months to recover.
At the time of our French holiday, Anne was pregnant, so the Camembert was off the menu for her, as well as the French wine (all in all, it was not a great choice of holiday destinations, under the circumstances). The DH was coming under control, life in Thirsk was gradually returning to some sort of normality and we were embracing the idea of bringing new life into our world. Anne was due to give birth the following January. This would surely be straightforward, we thought, as we knew all about animals. Surely a small baby is just like a young puppy, lamb or calf? We took the first ultrasound scan in our stride. We were used to looking at scans so it was no great revelation.
The same could not be said for Linda, a friend and client who had been coming to see me for several years with her cat, Toby. Toby was suffering from terrible gingivitis. It was painful and intractable, and the result of the body’s own immune system attacking the gum tissue, leading to an awful bleeding inflammation that made it almost impossible for Toby to eat. Some cats with this condition actually hiss at their food, as if blaming the food for the pain. Linda and I got on well, and I had started Toby on a new and innovative treatment. He was responding well to the medication, which was the same as that used in human patients to treat rheumatoid arthritis.
Sadly, soon after I had sorted out Toby’s sore gums, he got hit and killed by a car on the busy road near where the family lived. It wasn’t too long before they acquired a poodle called Rosie. Around the same time that Anne and I were having our scans, Linda, beside herself with excitement, brought Rosie in, also to be scanned for pregnancy. With a large grin on her face, she explained how her little poodle had arrived in this situation.
‘Well, Julian, we were at Bolton Abbey on a walk a few months ago and we met this lovely couple and they had a lovely little black poodle, a boy, and Rosie and he got on really well. They were such a nice couple – two teachers – and we swapped phone numbers and we said how we desperately wanted a litter from Rosie and they seemed keen and, well, they said next time she’s in heat, give us a ring …’
So you can imagine what happened next. When Rosie was next in season, a few months later, a rendezvous was arranged back at Bolton Abbey. Bolton Abbey is a beautiful place, in a sheltered bend in the River Wharfe. It is a great place for a walk on a Sunday and, as it turned out, a great place for two poodles to mate. Just opposite the ruined abbey, on the other side of the river, is a large, flat grassy area, where picnickers and children playing football or paddling in the peat-infused water congregate on a sunny weekend. There is a row of stepping stones to cross the river when the water level is low enough. On this particular Sunday, the picnicking public and their children were treated to a riveting spectacle as Rosie met her lover, Gabriel. Rosie was, apparently, gagging for it and did not even need the comfortable rug that the teachers had thoughtfully provided for the romance.
The couples’ own children were dispatched to play in the woods nearby and the adults settled down with their flasks of coffee, to supervise the mating. However, neither Linda, her husband, nor the teachers had experienced this kind of thing before and the humans did not prove to be much help. Luckily, Rosie and Gabriel had a better clue of how to carry on and, oblivious to the large number of onlookers, got down to business. The mating of a male and female canine cannot
be, in any way, described as subtle. Once the male has mounted, his penis swells, as if there is a Cox’s apple stuck half way down its length. This makes it impossible for him to retreat, as the pelvic muscles of the bitch clamp around this swollen gland. The result is a ‘tie’, where the two dogs are literally stuck together, at times with their backs to one another. It would have been impossible to disguise the scene. The picnic blanket was hastily held aloft, in the same way as you would when trying to change into your swimming trunks on the beach. It did little to hide the modesty of Rosie and Gabriel (who didn’t care anyway).
Three and a half weeks later, as I arranged the scanner and clipped Rosie’s tummy to facilitate a clear picture, I tried to warn Linda that the news might not necessarily be good. A mating takes plenty of planning; often pre-mating swabs or blood tests are taken to ensure optimum timing and the environment has to be just right for both bitch and dog. But to everyone’s surprise and delight, four pups were clearly visible on the screen. There was as much laughter in my consulting room that afternoon as there had been three and a half weeks earlier, on the serene meadows of Bolton Abbey. Rosie was having babies.
Linda proudly took a printout of the scan and tucked it carefully away in her wallet. I next saw her after the pups had been born. All was well with Rosie, and the puppies were in for their vaccinations and health checks. The story she told about the aftermath of the ultrasound scan made me laugh out loud. After she had left the surgery, euphoric at the prospect of a litter of fluffy little poodles, Linda had stopped off at the supermarket. The car park was pretty full so she parked in the only empty space she could find – in the section reserved for mothers and children. Immediately, a fastidious car park attendant rushed over to check whether she had any children on board. Since she clearly didn’t have any in the car, the attendant insisted that she move along to find a different place to park.
‘Honestly,’ blustered Linda, ‘what do I have to do? Do I really have to show you the picture of my pregnancy scan to prove that I can park here?’ and with that, she pulled her ultrasound scan printout of one of Rosie’s pups from her wallet, and showed it to the car park attendant with a flourish.
‘Oh, congratulations! I’m terribly sorry, madam. You are absolutely fine to park here if you’re pregnant. And if you would like a hand with your shopping bags afterwards, please give me a shout!’
Anne’s pregnancy progressed as smoothly as Rosie’s and it didn’t seem long before we were back at Friarage Hospital, this time not in the dermatology department but in the delivery suite. Once again, I expected it all to be straightforward. Between us, we had experienced thousands of births – lambs, calves, foals, piglets, puppies, kittens, guinea pigs. Admittedly, a human baby’s head is somewhat larger in comparison to its body, and to the size of its mother, than that of a calf, but how different could it be?
Ten hours later, Anne was fine and Jack was slimey, but also fine. I, on the other hand, was a wreck. Having witnessed my first human birth, summed up enthusiastically by the midwife as ‘Oh, isn’t it lovely to have a nice, normal delivery for a change’, I could honestly say that I would not have let one of my patients go through that kind of ordeal. I tried to phone our parents to tell them the news, but everyone was out. Desperate to tell someone, I phoned our friend Siân. She was also a vet and due to give birth, also for the first time, five weeks later. ‘It was awful,’ I blurted out. ‘I wouldn’t have let a cow go through that.’ Tactful!
Having a baby was a life-changing experience, for sure. Of course this was mainly because of the new baby that had arrived, but also because it gave me a completely different view of the levels of pain and discomfort that humans, and in particular women, are capable of enduring.
The following day, Anne and Jack were in the ward for mothers and new babies and everything seemed to be going smoothly. There was a calm atmosphere in there, and Anne and little Jack seemed to be the most relaxed of all. The first few days were going well. By day three, we thought it would be a good idea to give Jack a bath. He was still bloodstained and the gloopy birth fluids were still stuck on his head. I went to find a midwife to organize the plastic portable bath. When the midwife brought over the bath on a trolley, she explained that she would return shortly to show us what to do. ‘Fill it up with tepid water, and I will be back in a minute’ were her parting words. Some time later she had not returned.
‘How hard can it be?’ I thought. Bathing a baby is surely just like bathing a dog. Diligently, I set about filling the bath with tepid water. It mustn’t be too hot – I’d learnt this at antenatal classes. I was a modern father, and baths and nappies I would take in my stride. Tepid, though? We were both a bit surprised. To both of us, tepid meant just a bit warmer than cold.
I filled up the bath with water and dipped my elbow in to confirm it was not too hot. It was definitely not too hot, it was definitely tepid, but that’s what the midwife had said. ‘Gosh, how easy this is,’ I thought. I grasped Jack, like Simba in The Lion King, and plunged him into a bath of cold water. Judging by the noise and scale of his objections, I could tell something wasn’t quite right and midwives came running from all directions.
‘What are you doing?’ exclaimed the now rather cross midwife, who had finally reappeared. ‘You can’t bath a baby in cold water!’
Eventually Jack calmed down and realized his world was not coming to an icy and premature end, and we were shown the correct technique for baby bathing. The temperature had to be warm (and in our defence, the description of the temperature should really have been lukewarm, rather than tepid), not cold, and the baby needed to be lowered gently into the water rather than adopting the plunge-pool technique. We, and more particularly I, had a lot to learn about babies. Rearing one, I was discovering, was not quite the same as rearing a puppy or a lamb.
Poor Jack. We really just made it up as we went along, but by the time he was two, we thought we’d cracked it, and just before his third birthday, late and laid back, his little brother, Archie, arrived.
16
Bobby and Harvey the Inflatable Dog
With the arrival of Jack, life at home took a new and different turn. The life of the practice had also changed dramatically in the wake of foot-and-mouth. Farms that had been infected were just beginning to restock after the long cleaning and disinfection period. About a third decided not to return to livestock, and another third returned, but with smaller numbers and less intensive systems, requiring minimal veterinary intervention. The remaining third did restock and return to farming in a similar way to before the crisis. These farmers saw the epidemic as a brilliant opportunity to start from scratch and re-engaged with great enthusiasm. This was a very positive time for those of us in the profession who enjoyed a more integrated role as a veterinary surgeon on farms. It was extremely rewarding to be involved from the very first plans, and to have meetings discussing health and management strategies for new systems, what type of animals were suitable and what type of herd would develop. One dairy farmer, after a lot of research, invested heavily in a robotic milking machine. It was the first of its kind in this area and years ahead of its time. Others diversified into different breeds of cattle. Whole herds of beautiful brown South Devons, or shiny, black, pedigree Aberdeen Angus cattle appeared in the place of generic mixed-breed suckler cows, moving the emphasis away from quantity and towards the quality associated with traditional breeds. Apart from anything else, these herds looked very handsome.
The result of these new approaches was that the balance of work at the practice shifted significantly for the first time. Small animals became the dominant part of our working week, accounting for about 65 per cent of our caseload. This was in part due to the relative paucity of farm animals, but also because the pet-owning public was on the increase. Not only that, but there was much more demand from pet owners for more involved treatments, and the success of the television series Vets in Practice certainly helped. This series followed a cohort of veterinary students who q
ualified in 1996, the same year as I did. They were filmed as they progressed through their training and the early part of their careers. It was extremely popular, though I have to say, I was not a regular viewer. Most vets would steer well clear of yet more sick animals after getting home from a busy day. Nonetheless, it was a very well-made programme and it had some great stories and characters. For the second time in a generation the veterinary profession had been given a much-needed shot in the arm by a popular mainstream television series.
The move towards more small animal work provided some brilliant intellectual challenges. Farm work is all about the health of the herd, but with a pet there is the opportunity for in-depth investigations, and specific treatment of the individual. It gives us the chance to delve back into the enormous pot of knowledge we accumulated at vet school, and we can approach cases as a medic or a surgeon rather than a herd advisor.
At around this time, a dog came into the surgery that had the biggest impact on my small animal career so far. His name was Bobby and he was a Border collie. When I first met him he was a five-month-old pup. He was really quite poorly and had been in to see colleagues about three or four times already. On this occasion he was on the list to see me. His owner, Val, was a fairly new client to the practice and neither of us knew at this point that we would be seeing each other, with Bobby, two or three times a week for the next eighteen months and that we would become good friends.
: The Life of a Yorkshire Vet Page 15
