Mrs. La Perriere introduced herself and her husband at the door to the house. Classical music could be heard coming from within. She had brown hair threaded with grey down to her waist, knotted loosely behind her back, and her husband had an impressive shock of white, flowing hair and round glasses. Both had worn-out sweaters and jeans on, but still maintained an intellectual air.
“Call me Kay,” she said. “I will give you a tour of the farm and animals. We have had to fence the yaks, as they kept wandering over to the neighbours’, but the rest of the property is not fenced, and we want the animals to feel free.”
At this point I started feeling slightly concerned. The horses were nowhere in sight, and I felt it was a fairly sure bet that they had not been gathered up prior to our coming.
“The horses have not been handled much,” Kay said. “In fact, two have not had halters on.” It was reminiscent of breaking Ziggy many years ago, but these colts were much larger and more opinionated. I proceeded gamely on.
“Let’s put the yaks in the barn,” I offered. “It might be best to put the horses in the round pen to halter and castrate them.”
After half an hour, we had the yaks in the ramshackle barn. Inside were two stalls, both filled with large emus. As I negotiated the pile of manure, ducking the low beams, I inadvertently backed up too close to a half stall wall. With a thud, an emu pecked me soundly in the back of the head, almost drawing blood. I stumbled away.
Kay proceeded across a field with a bucket of grain. “The horses are almost always over this hill,” she said. Shortly thereafter, she appeared with one horse eating from the bucket, three others and the camel following. It took some doing to get the four of them into the round pen and haltered, but within an hour of arriving, we had the unsuspecting animals gathered up and hot water and equipment ready.
The wind had come up, almost irritatingly, so my gloves and syringes were blowing around a bit, as was the dust, and it became a bit harder to hear. Mrs. La Perriere stood by calmly, obviously not intending to help. Charlotte and I attempted to get near the first horse. We had to at least check its heart and colour before I administered the first dose of sedative, if indeed I could even get an injection into him.
I was four feet from it when it bolted out of Charlotte’s hands and across the round pen mixing with the other horses. She caught it again with the bucket, almost getting trampled by the hungry herd.
“Throw the rope around a sturdy post,” I advised her. “I’ll try to come back to him.”
Thankfully, this time the sedative was given successfully, and within twenty minutes, we had one colt gelded and his tetanus toxoid administered.
The first colt, a very nervous Arabian, got up very roughly, staggering and falling several times. This was going to be very different than the four Clydes I had had to do many moons ago on the clinic lawn — not surprisingly, just as different as these clients were to the elderly Lanark horseman of that day.
After two of the other colts were anaesthetized and lying on the ground recovering, we were tired and had dust in our mouths, eyes, and clothing. Our gear was dirty and scattered about. Thankfully, the fourth colt would not be caught, and we elected to call it quits for the day. Mrs. La Perriere promised to work on handling him before we returned.
She and her quiet husband appeared satisfied and paid cash, promising to call us back before black-fly season to do the fourth colt. Several days later, Elizabeth received a call and relayed to me that the owner had decided to let the fourth colt stay a stallion. They wanted at least that one to lead a free and natural life. I sighed, hoping he, too, did not visit the neighbours. A farm with no fencing is not the best place for a stallion, even in the quiet Lanark Highlands. We wished them all the best with their stock.
Charlotte and I had so many stories to tell from our “James Herriot” day that, despite any knocks we took doing the rough-and-tumble job, it was well worth it. Our day in the highlands meeting Mother Nature had been a fun and different experience from the everyday work of the now more urban clinic.
Autoimmune diseases are uncommon but not rare in veterinary medicine.
Always to be taken seriously, autoimmune disease is the manifestation of a complex process whereby the body turns on itself, usually targeting specific tissues or cells. If red blood cells are the targeted tissue, now recognized by the scanners of the body, white blood cells or lymphocytes, they will be rapidly destroyed, resulting in a profound anemia. If the joints are targeted, the disease manifests as severe polyarthritis; if it is the muscles, then it will be myositis or inflammation of the muscles. In rare instances, widespread tissues are attacked, resulting in a syndrome like lupus in humans. A.I.D. is severe, acute, and life-threatening if not diagnosed and treated immediately with a steroid that suppresses the overactive immune system.
Cinnamon was a regular. A golden retriever mix, she had come from the pound after being abandoned. She had a wonderful new owner, a retired schoolteacher, who had devoted great effort and expense to cleaning up her chronic skin problems.
“Cinnie hasn’t been feeling well for a few days,” reported Gerdie. “She hasn’t eaten at all today and not much yesterday.”
I examined the sweet dog, concerned by her distressed appearance. Was she in pain? A lot of possibilities ran through my head as I examined her. Did her face look strange and possibly swollen? I was alarmed at her temperature.
“She has a fever of 105 degrees!” I exclaimed. “What is going on here?” I ran through the possibilities. Viral, bacterial, and autoimmune diseases can all cause a high fever. Was there a clue? Pneumonia, or perhaps an abscess? At the worst, I suspected septicemia or a blood-borne infection, possibly from an internal abscess or peritonitis.
Cinnamon grunted as I palpitated her sides. Under the hair I found a small tooth mark, likely the result of a fight with Gerdie’s other dog, and an area of discoloured skin. Reddened and sore, I suspected it would go purple next.
“I found an abscess! It’s poisoning her,” I said. “We must start her on antibiotics and fluids and plan to lance it as soon as she is stable.” Gerdie nodded. We agreed she’d stay in hospital. I explained she would have a drain in her side coming out the bottom of the incision.
The next morning, the reddened area on her side was indeed larger, hotter, and darker red. I planned to anaesthetize her. Her fever was down to a respectable 103 degrees, probably, I surmised, as a result of her iv antibiotics and an aspirin-like drug that I had given her. I thought I was on the right track.
I laid out my endotracheal tube and checked the anaesthetic hoses and surgery table. All was in readiness for what should have been a routine procedure. However, as Erin gave the iv induction agent and the little dog went to sleep, I found I could not open her mouth more than one-half of an inch. It was absolutely frozen shut! I could hardly believe it and now had grave anaesthetic concerns. I must get a tube into her somehow. My mind raced.
Somehow I got a very small tube into her airway, giving me a moment to think. Her head did indeed seem swollen and slightly asymmetrical. Did she have an abscess behind one eye, causing difficulty opening the mouth due to pain? No, it would still have opened under anaesthetic, if not when awake. Myositis, extreme inflammation of the temporal muscles was the only other plausible diagnosis. Had this all started when muscle destruction resulting from the abscess on the side of her body coded her body to attack the denaturing muscle proteins? Or had the autoimmune myositis come first, attacking her head and her flank? Whichever, I started clipping her for an exploratory examination of the abscess and a muscle biopsy of her head.
“Have you heard of the new test they do in the States for anti-muscle antibody?” my associate vet asked, looking interestedly over my shoulder. “It would take ten days to get back, and we’ll probably have to treat her for autoimmune disease anyway, but it would be good to confirm it.” Of all the diseases i
n this family, myositis is actually the most rare. As Cinnie woke up, I debated whether to wait for the results or just start Cinnie on high doses of prednisone. We were all very concerned about her; she was one of our favourite little patients. She looked terrible, waking up shaved in several places, with a large tube coming out from under the pocket on her side.
“Let’s go ahead with the prednisone,” Gerdie said when the possibilities were explained to her. “On thinking about it, I feel she’s actually been sick for longer than I realized, maybe even a couple of weeks.”
“We’re not out of the woods,” I explained. “Autoimmune disease can be difficult to treat, prednisone has side effects, and unfortunately it can go into remission, then come back.”
“We’ve got to try,” she responded.
Cinnamon was awake but groggy when I gave her the first high dose of iv prednisone. By the next day, her head seemed slightly less swollen, and she had a brighter look in her eye. By day three, we had more progress, and she had advanced to eating gruel. By week two when we got the tests back confirming autoimmune myositis, she could open her mouth a couple of inches wide and went home on hand-fed soft dog food. The appearance of her head, however, was bizarre. All of the muscles on top of her skull had atrophied after the severe muscle inflammation, and she now had a hollow, pointy appearance to her head above both eyes.
“I can live with that,” Gerdie said. “Just don’t take her off the prednisone too soon!” I had discussed the gradual reduction of the dose of steroids over three months, and the owner was obviously terrified.
“We’ll watch her blood values and see if both of you can live with the side effects,” I said.
A month later, when the hair had grown back on her side and her mouth was opening well enough for her to eat hard food and yawn, we started reducing the dose of the life-saving drug. Cinnie was on the mend and playing with Gerdie’s other dog. All went well as we successfully withdrew the drug without a remission, but Cinnamon to this day has a head only a mother could love. Her muscles never regrew, but she can catch a treat in the air now with a satisfying “chomp”!
Charlotte had had a job offer in the city some thirty miles from her home. After much internal debate, she approached me one night almost in tears. We got along well, so she was very concerned about hurting me.
“I have a job offer I can’t refuse,” she said. “It’s a lot more money, and I will get to do much more at the back of the hospital as a vet tech.”
“Can I counter?” I said, upset at the prospect of losing such a valued staff member. The clients loved Charlotte.
“I have already accepted,” she grimaced. “I’m sorry. This is my two weeks’ notice.”
I accepted her resignation with regret, wondering why she hadn’t come to me if she wanted a change of position or a raise. I found it difficult sometimes to guess what was coming at me next regarding what the staff members were feeling or unhappy about. There is truth to the statement “It’s lonely at the top,” and I was finding it hard to always be the boss. Sometimes it would have been nice to just be part of the gang.
We planned a going-away party for her last Friday at Brentwood. It was to be held at a nice local restaurant, and I would bring a gift and a going-away cake. We all moped about for the two weeks, the atmosphere visibly restrained. On the Thursday night before the party, Charlotte phoned me, again in tears.
“I have changed my mind,” she said. “I did a trial day and it just wasn’t a fit; besides, I hated the drive. Can I come back?”
“Of course you can — you haven’t left,” I said, trying not to show how happy I felt. “The party will go on. We’ll celebrate your not leaving!”
She was embarrassed, but agreed to it. It was a good excuse for team building and a bit of leg-pulling.
I made a call to the bakery early Friday morning. “Can you change that cake for me, or is it too late?” I asked. “I need one that says, ‘Welcome Back Charlotte.’”
Even the lady at the bakery got the joke. “It’s no problem. We should be able to do that.”
We had a great luncheon on the outside patio. Charlotte was presented with many humorous, scratched-out, and revised cards. The crowning touch was the cake, worthy of a deep blush and a mandatory photo. We were all back to routine on Monday. It was the first time I had seen someone quit a job and never leave.
It was Saturday afternoon, and we had just locked the front door. It had been one of those Saturdays when every moment had been filled to overflowing. We had been running to get it all done. Fit-ins, emergencies, lab work, and food sales all combined to make a short break or even lunch impossible. I sighed as I packed up my records. “I’ll do these Sunday,” I said to Charlotte, “I’m too tired now.”
I had just started the car when my pager went. The lady on the phone informed me that the clients were already on the way. Their dog had attacked a smaller one belonging to a very elderly lady. They were pulling into the parking lot as I hung up.
The young couple was frantic. They helped the tiny, white-haired woman up the steps carrying her small Maltese-type dog in a very bloody towel. Her face was set and white, as if she were in shock. In the exam room I folded back the towel. The little white mixed-breed female was panting and looking right at me as I examined the deep gashes on each flank just ahead of her hind legs. She was in terrible pain, but did not offer to bite. I felt a crunch in her pelvic area.
“It looks serious. There may be a pelvic or hind leg fracture, and these wounds may penetrate the abdomen.”
I escorted them to my office, finding a seat for each of them. They were all crying now, and the young couple informed me the police were on the way. Someone had reported the incident.
“Please stay with Mrs. Weiss. I’ll give her dog painkillers and start fluids. I will need to take x-rays and clean the wounds,” I said, leaving them.
Mr. Hill came to speak to me while I was working on Trixie. His wife stayed with Mrs. Weiss, waiting. “She has Alzheimer’s,” he said. “She doesn’t drive. Her neighbour said they would come get her later. We feel awful … we don’t know what to do with Jack … this is the second time …” his voice trailed off.
“Please hold this,” I said, not able to devote my attention to him. “I have called in a technician, but I need help with the clipping.”
I was extremely concerned about Trixie. She continued to look stoically at me, but I had seen no movement in her hind legs. After Erin arrived, I left her washing the deep cuts and went to speak to Mrs. Weiss.
“I am concerned she may have a broken back. As soon as the painkillers have worked, I will take an x-ray,” I said.
A deep moan, almost a wail, started emanating from the tiny lady as she rocked forward on the couch. Her distress was painful to see. Mrs. Hill, sobbing, put an arm around her. “Her husband died last year, and she lives alone,” said Mrs. Hill. “We must call her son in Kingston.”
I carried on with my vet work in a well-trained, automatic manner, yet I felt shaken by the situation. Two policemen appeared and went into my office, and I heard low voices.
Trixie let us move her to the x-ray table and take the two views I needed of her back and pelvis. I gasped when I saw the images on the monitor. The fourth and fifth lumbar vertebrae were completely out of line. It was the worst broken back I had ever seen. I steeled myself to go back into my office.
I asked the Hills and the police to go into the waiting room and I sat down by the frail woman. “I will bring Trixie in,” I said, “but it is really bad, her back is broken.” She didn’t speak. “She’ll never walk again,” I added.
I wheeled the iv stand in and sat Trixie on her lap. We sat silently for a while then she started cooing to her little pet. “You’ll be fine, the doctor will help you.” Trixie mercifully slept in her lap.
After a long time, perhaps ten minutes, ha
d passed, I said, “You know what must be done.”
“She can’t live like this.” Mrs. Weiss nodded. In a moment of clarity she said, “I’ve had dogs all my life; these things happen. Go ahead.”
I went into the hall and told the Hills and the officers they could leave. I would drive her home. No neighbour had appeared, and yet it seemed all right. The clinic would be more peaceful, and I wanted to take my time. I locked everyone out. Erin left, almost in tears, and I pulled the injection of euthansol. Walking back into the office, I sat down, and it seemed we both rested for a while. The clinic was now dark and quiet. The late afternoon sun was coming in through my office window.
“When you are ready, you tell me,” I said.
“Go ahead.”
The final moments were fine, a blessing really, and it felt so appropriate to just sit with her for a while after. The light was dimming as we got up and I put Trixie in the back of the clinic.
“I’ll take you home and come back for her,” I said. “I’ll bring you back her ashes in a beautiful urn.”
We left the clinic, and I helped the heartbroken lady into the passenger side of the cold car.
“Where do you live?” I asked, easing my foot off the brake.
“I’m not sure,” she said. “Somewhere near the hospital, I think.” A fog had covered her face.
“It’s okay,” I said, feeling perfectly calm, “we’ll find it, it’s a small town.”
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