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A day in the life of a Vet

19 October 2003

As I grow older, I often realize that my father was right. He said that I should be a pharmacist instead of a vet. Then I balked at the thought of spending my life between 4 walls, never getting my hands dirty. Rural veterinary practice was all I was interested in. I was going to rush about the countryside, saving lives and being eternally appreciated, not to mention well paid.

I worked the past weekend. Saturday morning at least was civilised and the rest of the afternoon was busy, but manageable. We even managed to anaesthetise and examine a raucous sulphur crested cockatoo without anyone being hurt - including the bird. But then the sun set, the moon came out and the madness began. The first caller had a dog with bloat. Now this is a life-threatening condition in dogs where minutes can make a difference. I rushed about to make sure I had everything ready for emergency treatment and surgery, and ensured that the after-hours nurse’s phone number was next to the phone. Then the wait began. The estimated time of arrival was exceeded by nearly 40 minutes.

When the dog finally arrived, it was soon apparent, that although he was seriously ill, this was not an acute stomach torsion. After some careful questioning, the owner’s claim, that his dog was fine until 24 hours ago, when it refused to eat, was replaced by the admission that his wife had noticed that the dog was unwell a month ago. Some emergency! However, the dog was quite sick and with the owner’s help, I managed to carry him to a table and set up a drip. Just when the dog was finally stable and settled and the owner appeased that the dog would not benefit from immediate emergency surgery, the phone rang again. “Doctor, my cat’s stomach just burst open”. It is late. I am not thinking clearly. My tired mind conjures up images of the fireworks at the Strand. I see a cat fired up into the sky, clawing frantically at the night sky. It explodes in a star-burst of red entrails, silhouetting a flying fox against the smoke. I collect myself, suppress a giggle, and ask with measured voice “What exactly happened? Did the skin break open?”  “Yes, she was bitten by a dog a month ago, and there was a big lump. Now it has burst and there are guts poking out.” OK, this one does sound like a real emergency. “Bring her in right away!” I set up for surgery again. When the cat arrives, I find that she is called Smoky. There is a fair sized lesion on her belly where necrotic skin has sloughed off and an abscess has opened, but thank goodness, it is only through the skin. Some necrotic tissue and subcutaneous fat protrude from the lesion, but Smoky should survive the night. Her name is placed on Sunday’s lengthening surgery list. Meanwhile she goes onto a drip, pain relief and antibiotic. I clear away the surgical equipment.

The phone rings again. “We bathed our dog today and now her bottom is itchy. I think it is her anal glands”.”OK, you can bring her in, but there is an extra charge after hours”. Silence on the other end of the line, then “Umm, but do you think it is an emergency?” “Well no, it does not sound like one, she may be uncomfortable, but she should live, but you obviously think it is an emergency. Would you like me to see her tonight?” “Oh, no, we’ll see how she goes and call you tomorrow”. Sigh...

Then I went to watch World Cup rugby with the Annandale Afrikaners. The Springbucks played their hearts out and lost. I know the feeling, believe me.  I get to bed just after midnight. At 6 am I am roused from a deep sleep by the insistent ringing of the phone. “My little dog is a patient of yours and you vaccinated him 6 weeks ago. Now he is paralysed.” It takes a few seconds before I even register what language is spoken at that time of morning. The innuendo is lost on me. Slowly my brain starts to function.

Is he breathing normally?  Yes, but he groans a little.
Is he mentally alert?  Yes, but he seems a little distressed.
Did he sleep inside last night?  Yes, he slept on my bed.
Can he move his legs?  Yes, but just a little.
Is he in pain?  I don’t know.
I can see him now. Bring him to the surgery, I’ll meet you there.  
Oh no, we don’t want to pay extra. We just wanted to know what time you open today.

I am awake now anyway, so get up and make coffee. Later, at the surgery, the dog comes running into the waiting room on all 4 his paralyzed little legs. When I try to take his temperature, he spins around and nearly amputates my fingers. No neurological deficits there. He is obviously not an early riser either.

The day is busy. It takes careful planning to ensure I’ll have enough time to lance Lucky’s abscess, fix the burst cat, X ray the bloated dog and clean Minx’s sore ears with consults coming in as well. By 2 pm everything is on track. Then Susan bursts in though the door. Joan, can you come and help, please? A client who is a wildlife carer has a big trunk on the back of her truck. Inside this Pandora’s box is a hissing goanna. He thrashes his hard, rough, incredibly strong tail from side to side. I stare at him, mesmerised. Lana, the wildlife carer clambers onto the back of the truck in her miniskirt. The next moment she loses control of the situation and the goanna. He half leaps/clambers over me and rushes down the street with his ungainly side to side gait, but he is injured, and not as fast as he might be. Lana, myself and Susan, the vet nurse from Arizona, are in hot pursuit. He makes a stand, raising himself up on his hind feet. As a warning he blows up his throat and pokes out his very long eerily blue incredibly creepy tongue. Compared to this monster, a leguan is a thing of beauty and a joy forever.

The posse has now followed him into an empty lot between the road and a deep dirty ditch. If he goes down there, I’ll be blowed if I’ll follow him into the mud. Time for lateral thinking. When we were little kids, there were many leguans in Cradock. The local; people believed that they sucked your brains out with their forked tongues while you slept. They used to catch them and sell them to witchdoctors for muti (medicine). They would prop open hessian bags and herd them to the opening. The leguans went willingly, probably believing that they have found a safe hiding place. I send Susan to the surgery to look for a suitable bag. She returns with a black plastic body bag. It rattles in the wind and lifts off the ground and bears absolutely no resemblance to a cave whatsoever.  The goanna makes a last stand, hissing furiously, showing his creepy blue tongue, snapping at us, and slamming his rasp like muscular tail from side to side with deadly intent. Then Lana goes in for the kill. With the aid of a net, she half grabs him. I have no choice but to help. We subdue him and carry him down the street and into the surgery. Pop him in a cage, says I, we’ll deal with him later. No way, says Lana. I am not letting him go. However, I have a commitment to finish my booked surgeries first. I will give him a tranquiliser in the meantime. If that does not work, Lana will have to hold on. She agrees, looking very dishevelled and determined.  

What in the whatsisname do you use to tranquilise a goanna? There are hundreds of books in the office, but I find nothing on anaesthetising goannas. . Finally I find a reference to ketamine. The dose range given is 10 to 100mg per kg. What a range! I do not want to kill him, stressed out as he must be, and opt for 20mg per kg. This has no effect. I add 40 mg per kg. He settles down slightly. I tell Susan to give him isofluorane by mask. In the meantime I have anaesthetised Minx- a beloved 8 year old Border Collie. She is breathing too slowly and her colour is too pale. I ask vet nurse  Lachlea to speed up the fluid infusion and turn down the gas. Susan panics. The goanna has stopped breathing. He is lying on his back, looking pretty dead. I roll him onto his belly. His tail flicks dangerously. We change the gas concentration and tell Lana to hold on, but keep him on his belly.

Petra gets some paper towel. She screams. A giant spider just scuttled out of the towel holder. He hides behind the endotracheal tubes, with only his long legs sticking out. The radio on the shelf belts out pop music. It suddenly penetrates my consciousness. Kill it, I scream. They all leap on the spider. No, leave him alone! Kill the radio, before it drives me insane.

I continue cleaning Minx’s ears. She has managed to stay asleep through all the pandemonium.

Finally I can get back to the goanna, who is still wriggling furiously. Iso up to maximum settles him. Lachlea is tasked to make sure that he keeps on breathing. We suture the gashes on his body and inject antibiotic. What do you call a reptile specialist, someone asks. It’s easy, I say - a madman.  We put him back in the hot trunk on the hot truck before he is fully awake, urging Lana to get him to a cool , comfortable cage before he cooks.

I still have paperwork to do, and X rays to do and the first of the afternoon consults are already waiting. I phone the bloated dog’s owner about tomorrow’s plans. He has not paid anything yet. I tell him the treatment plan and estimated costs. He explodes. “I always pay your practice. I have 67 dogs, I have been a client for years, why are you talking to me about money? Just fix my dog.” I try to explain that money or not, said dog may not be fixable. I arrange a meeting and second opinion with the boss, whom he claims to know very well, for Monday, to discuss the case before we proceed with surgery. It is called pass the buck.  Next I treat a sick cat. The owner waits until I am done, then informs me that she left her wallet at home. I cannot help but wonder if anyone ever does that to a pharmacist.

The last client of the day brings in his dog that swung from a fence by her hind leg and shattered the bone. He has been to another vet and the leg is splinted quite effectively in my opinion. Why is he here? Because the other vet expected payment and he is not happy. I pass the buck again. I only work here. To pay my salary, my boss likes to be paid by people like you, mate. At least we have a credit agreement arrangement to help genuine cases. When, oh when will pet’s health insurance finally take off?

Poem

The poet goes out on a limb
weaves magic with words
the truth to disguise;
but truth will out and
the ice underneath is thin.

A lost lurcher.

While I was working at a small animal practice in England, a  kind Samaritan dumped a lost lurcher (type of rough looking greyhound) with a broken leg on us one Wednesday. I phoned the RSPCA who referred us to the town council. On Thursday a man from council phoned back, asking us to go ahead with the required surgery. I operated on Friday - a long and difficult bone plating. With much perspiration and perseverance I achieved a pretty good fix. I did not even mind missing lunch for the 5th day that week, I felt such a warm glow of achievement.

 

At some point during the surgery a man arrived to empty the freezer where dead bodies are kept. We were surprised to see him as he normally arrived on a Monday before we start work. He told us there had been a change in schedule. So he collected seven dead fish, two dead budgies and a rotten rabbit and left with his loot. (We were attached to a pet superstore). Watch this space.....

 

The dog woke up and had a hearty meal a few hours later. I took him out to sniff the trees before closing time, but he preferred to flood the surgery floor instead. After we left, his dinner passed through his intestinal tract as all good dinners do and he spent all night smearing it across his kennel walls. The next morning I took him out for a walk, leaving the poor nurse to deal with the mess. The dog, whom I had named Pula (Setswana for blessing), because we would be blessed if anyone actually paid for his treatment, sniffed the grass, greeted the passers-by, and had a large bowel motion just after we returned to the surgery.

 

There was work to be done, so Pula was returned to his kennel against his wishes. He vocalized his objections very loudly. The store manager complained that his customers would complain. Every spare minute we had, we tried to console Pula. We had several walks, pleading sessions and even a few firm requests to BE QUIET! Most of the day we could not hear ourselves think. Sunday was much the same. By Monday our nerves were sufficiently frayed to resort to the use of tranquilisers for the dog - though we needed it more, especially when another freezer man arrived and declared that the Friday freezer man was a fraud. A body snatcher on the loose?

 

By Tuesday the pet store staff were beginning to take an interest in Pula and started taking him outside during their staggered tea breaks. The dog was delighted with his new friends and admirers and we had peace at last. When they brought him in on Tuesday evening, he was gambolling like a calf, ecstatic with all the attention. The following morning Pula was raring to go out again. We did our customary walk to the bushes resulting in Pula soiling the surgery floor on our return as usual. Then he stood quietly to have his temperature taken and bandage changed before trotting expectantly to the cupboard where his tablets are kept. He had grown accustomed to the fact that he regularly received them with a tasty snack. The only thing we could not teach him was how to be quiet in his kennel. I was delighted when the shop staff came and asked if they could take him out again. When I checked on him later he was surrounded by friends and well wishers - even the staff from the shop next door were visiting him regularly.

 

Late Wednesday morning the council's dog warden arrived - being towed in by a large woman from a dog sanctuary. She introduced herself. As she is named after a bodypart, let's call her Mrs Bodypart. She sailed into my consulting room uninvited, demanding to know everything about the dog's treatment. I explained that due to the initial open fracture and severe bruising, the wound was still oozing and the bandage would have to be changed every 48 hours. When I asked whether she would be comfortable doing this, she declared huffily that she had been "doing this" for 35 years. Then she said it was not normal to change a bandage so frequently, she had never come across it in 35 years of dealing with dogs and implied that we were just doing it for the money. I patiently tried to explain that no, an open fracture accompanied by severe bruising was not normal, but given the abnormal state of affairs, we had no other choice but to change the bandage frequently. I did not tell her that my salary remained the same, whether I did a lot of work or a little work, and given the choice I'd rather do a little work, but this dog was my friend in a foreign land, and hey, the way he greets me in the morning is payment enough.

 

Meanwhile Mrs Bodypart was in full sail and demanded to be shown said dog, who happened to be visiting the loading bay. As everyone was momentarily occupied they had chained him to a pallet in full view of where they were working. Pula wagged his tail as he heard my voice. The next moment Mrs B went ballistic about the incredible cruelty and irresponsibility of chaining this poor creature up where he is not receiving any veterinary attention, being watched over by ignorant members of the public. I tried to explain that they were not ignorant, nor members of the public and were very caring. The dog was happy, we weren't ignoring him and anyway if he was indoors he was so noisy that we had to tranquilise him. Hoo Boy, I should not have said that! Now she was off on a new tangent. I tried to defuse the situation by asking whether she would be able to bring the dog in on Friday so that I could demonstrate how I wanted the bandage change done. No, she said, she was not bringing the dog back to this terrible place where he was chained up to pallets. She wanted to see the bandage change now. I tried to explain that doing it the second time in one day would incur unnecessary expense. More ammunition for Bodypart: "This is what it is all about, money....... etc. "

 

By now the "ignorant members of the public" were gathering around, jaws agape. I was afraid a fist fight might ensue if Bodypart kept hurling abuse, so I managed to head her off to the relative privacy of my consulting room. As a precaution, I called a nurse in as a witness and demonstrated the bandage change. This activity calmed me a little and I was able to take a step back and let it all wash over me. I thought about becoming a ferry pilot and wondered if having an engine failure over the North Atlantic could be remotely as stressful as this. Meanwhile the nurse, who in addition to her nursing qualification, had 5 years vet nursing experience and a basic law degree, tried to placate Mrs. B. When I got my engine restarted after a nice adrenalin rush off the coast of Newfoundland and returned to the present, Mrs B was telling the nurse how young and stupid she was and that she knew nothing about anything, let alone dogs.

 

This enraged me, and as I my imaginary near death experience over the ocean had given me courage, I said as evenly as I could: "I appreciate your concern for the dog, but I am very offended by your attitude. We have all done our best to treat him and make him comfortable and happy and we do not deserve such treatment."

 
She left amidst threats of reporting us to the company and anyone else who would listen.
 

We have thought long and hard on how to resolve this problem and have come up with the ultimate solution. We'll lure her in on Friday when Bodysnatcher comes ......

 
 

Rhipicentor nuttali found on African wildcat

An African wild cat, Felis lybica was found dead on the road near Rondegat, Clanwilliam on 14 February 2011. It had been hit by a vehicle. The cat, a mature adult male,  was in reasonable condition. The cause of death was trauma. There were no other macroscopic lesions on post mortem.  Five adult ticks, identified as Rhipicentor nuttali, were found attached to the cat's neck - one engorged female, about 15 mm x 10 mm in size, one female that had not fed, one partially engorged female and two males.

An identifying feature of these ticks were paired hooks near the attachment of the front legs on the ventral aspect, and a single hook near the hind leg attachment .
The genus Rhipicentor has only two species worldwide, R. nuttali and R. bicornis and both occur only in Africa. R. nuttali is widespread in South Africa. Larvae and nymphs have only been found on elephant shrews. The Cape elephant shrew, Elephantulus edwardii occurs in the Clanwilliam district. Fourie et al found that nymphs were most numerous between March and Sept,and larvae between May and October. In the lab the life cycle takes about 214 days to complete. It is believed that in the field it is likely to take a year. Adults are mostly found on their preferred hosts: domestic dogs, leopards ( Panthera pardus) and South African hedgehogs, (Atelerix  frontalis) in late summer.

These ticks have been seen (described) on dogs, cats, leopard, lion, hedgehogs, porcupines. Immatures are found on elephant shrew.
Dr. Gertrude Theiler found these ticks on dogs in the Clanwilliam district in 1962. They have not been described on Felis lybica before. They may cause paralysis in dogs.

Family Ixodidae. Resemble Dermacentor ticks.
References

Fourie LJ, Horak IG, Kok DJ, van Zyl W 2002 Hosts, seasonal ocurrence and life cycle of Rhipicentor nuttali (Acari:Ixodidae). Onderstepoort J Vet Res 69:177-87

Fourie LJ, Horak IG, Woodall PF 2005 Elephant shrews as hosts of immature ixodid ticks. Onderstepoort J vet Res 72:293-301

Lymphocytes - short note

LYMPHOCYTES

Unlike granulocytes and monocytes which move unidirectionally from bone marrow to blood to tissue, blood lymphocytes recirculate. The pattern is blood to lymph node to lymph and back to blood. Transit time in the blood during each circuit is estimated to be 8 to 12 hours. Recirculating lymphocytes are long-lived cells which survive for months to years.

Function

Lymphocytes are the cells of the specific immune system. B lymphocytes differentiate into plasma cells which produce antibodies (humoral immunity).

T lymphocytes are responsible for cellular immunity through the formation and release of molecules known collectively as cytokines.

Peripheral blood lymphocytes serve as the memory cells of the immune system. As they recirculate, lymphocytes monitor for the presence of antigens to which they have been previously sensitized. When lymphocytes activated by such contact enter lymphnodes, they can initiate both the cellular and humoral immune response through selective clonal expansion.

Scabies in Humans

 
Scabies is a chronic skin disease caused by the mite Sarcoptes scabiei.
 
The mite lives in the superficial layers of the skin  where it eats keratinized skin cells. As it eats, it makes tunnels. The mites are unable to live more than three to four days away from the host.
 
Symptoms:
 
Typical Scabies in humans presents as itchy papules, symmetrically distributed, mostly on the body and limbs. Vesicles and nodules are also seen.  The nodules are usually inflamed and very irritating. In infants lesions commonly occur on the hands and feet. This condition can be chronic. Infectivity is low as there are only about 10 mites per gram of skin.   
Occasionally secondary bacterial infection may obscure underlying scabies.  
 
Scabies can also be transient. The reaction is mostly allergic, mite numbers are low, (10 mites per gram of skin) and the mites do not reproduce. It disappears when the person is separated from the source of the scabies.
Some people may develop Crusted Scabies. The superficial skin layer builds up and thickens. It is more likely to happen in immunocompromised individuals, such as people with HIV, leprosy, Down's syndrome, certain cancers and also some ethnic groups, such as Aboriginals in Australia.
In Crusted Scabies, there are to 2000 mites per gram of skin. It is very infectious. Where patients have been treated in hospital wards, mites were found on walls and curtains.  The crusts are thick layers of keratinized skin mixed with mites, mite eggs, shed mite skins, mite faeces and bacteria.
Crusted scabies can spread all over the body, or be localized to certain areas. It is not necessarily symmetrical.
If the crusts crack, raw skin is exposed and the patient is prone to infection and septicaemia.
 
Diagnosis:
 
Diagnosis of scabies by identification  of the mite can be difficult.If affected skin is coloured with a felt tip pen, and the ink then wiped off the skin surface, the tunnels in the skin will often retain the ink and be visible. The mites, if found, can be seen and identified under a microcope. Your doctor will apply some saline or mineral oil to the skin and gently scrape the superficial layers with a  scalpel blade.
Diagnosis of crusted scabies by lab confirmation is easier, because of high mite numbers.   
 
 Treatment:
 
Typical scabies is readily cured with correct treatment.
 A 5% permethrin cream (Elimite or Nix) is applied from head to foot soles and left on for 10 to 14 hours (usually overnight). Do not apply to face, eyes, or mucous  membranes. The following morning the ointment is washed off by showering. The treatment is repeated after 1 week.
 
Ivermectin tablets (Stromectol) are very effective, but need a prescription.
 
Other scabies medicines are:
1%  lindane (Kwell, Scabene)
Malathion 0.5% (Ovide lotion)
Crotamiton (Eurax)
 
Although Scabies is effectively cured within a day or two of treatment, itching may persist for up to 4 weeks. Antihistamines such as Benadryl may be used to control  the itch.
 
In some cases Scabies is complicated by secondary infection and will require a prescription of antibiotic, eg Bactrim.