Timeless Spirit LogoTALES OF A COUNTRY VET

A Spiritually Enlightening Online Magazine. November's Theme: "Celebrate"
Volume 4 Issue 1 ISSN# 1708-3265
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Tales of a Country Vet

with Dr. Bruce Burton DVM

It was three thirty in the afternoon, December 24. We had just finished saying the final good-byes of our Christmas party at the animal hospital where I was working. The driving rain had subsided, and the wind from the southwest was pushing the final edges of the cloudbank overhead, into the mountains rimming the north edge of the Fraser Valley. So there was promise that the dream of all wet-coasters, 'a dry Christmas,' would be at hand.

It was my first Christmas after graduation and being low man on the totem pole, it was also to be my first Christmas on call. No problem. What could happen? Everyone would likely be concerned with rushing around and gathering up last-minute presents, redecorating the tree, visiting friends and so on. This time of year, animals are more or less left to fend for themselves in the bustle of holiday festivities and for me, this was just fine.

Nothing could spoil my anticipation of the coming evening and the dinner which awaited me. Aahh, roast goose, my favourite, browned perfectly, using a traditional Hutterite recipe we picked up from a neighbour in Saskatoon; roasted potatoes, sweet potato garnished with hazelnuts and melted butter, all washed down with a bottle of our favourite German Riesling. After the belt was unbuckled to make room for desert, the inevitable steamed pudding would be brought out, drowned in a rich rum sauce, to be slowly savoured beside a gently crackling fire. This would put a perfect end to Christmas Eve.

There were a few of the usual phone calls, but nothing I couldn't handle, "My cat ate some tinsel, is it poisonous?" and "Charlie! You know Charlie! He sort of looks like a cross between a wolf and a Pit Bull? Yah, you know him, we brought him into your clinic for his shots a few years ago. Well, man, like Charlie just ate our turkey, and is he, like, going to die or something?" The usual. Then, after snuggling down to watch "A Christmas Carol" with Allister Sim, that most perfect of Scrooges, we headed off to bed. Who could ask for more? And the evening followed the annual Christmas script exactly. Well, maybe I had a little too much goose, and certainly too much pudding, but never mind; the night was one long slide into blissful, uninterrupted unconsciousness.

Now, most vets love to hear the sound of the telephone, during regular hours, that is. However, after about six in the afternoon, without having changed one iota in pitch, tone or camber, the sound of the telephone mutates into a constant reminder that your life is not your own. It deprives young vets of any hope of rest or relaxation because at any minute an emergency may come in.

The telephone can instantly interrupt whatever meagre pleasures a poor vet may find for himself in the evening. You can never fully unwind, even when you are asleep. So, being only half awake, I wasn't sure if what I was hearing was, in fact a remnant of a bad dream, the return of Marley's ghost, or something much worse. A Dickensian fog still hung heavily over me, from the night before. I received a poke in the ribs, 'Telephone!' Alas, Diane heard it too.

"Hello?" I inquired plaintively of the phone. I tried to sound as feeble as possible. Vets can sound downright pitiful at times like this. Occasionally, and this is only a remote possibility, even if you are not an accomplished stage actor, you can enlist enough sympathy from the caller to make him or her reconsider the urgency of their call. Not this time.

"My dog's dying! Who are you? I need Jim! Where's Jim, I need him right away. Quick, get Jim for me… Ralph… dying … choking… get Jim…? This hysterical babble continued for about five minutes before I could calm the voice on the other end down long enough to get some idea of what was happening. My heart then hit the floor. "I'm sorry, what did you say? Your dog is a Gordon Setter? And he's been retching for about 20 minutes, I see, and has he ever bloated before? He has eh. Hmm. Once, about a year ago."

Bloat! Gastric torsion! The bane of all small animal practitioners. The one insurmountable emergency which can defeat experts and novices with equal voracity. Now, at this stage in my career I had never actually dealt with a gastric torsion in a dog, but I had heard and read all I wanted to. According to my mentors at the university, regardless of how well equipped and how well-staffed the hospital, only about 30% of dogs with a gastric torsion (or more properly a Gastric Dilation and Volvulous or GDV) survived, even with the best surgeons. And never having seen one, let alone diagnosed and treated one, I was already well on my way to a grade 3 ulcer, and I hadn't even put down the receiver. "Okay," I said with forced confidence, "I'll meet you at the clinic in 15 minutes."

The one thing I did know about bloat was it was one of the few true emergencies with dogs where minutes could mean the difference between life and death. In severe cases the stomach flips over completely and twists off the escape of any gasses produced. The stomach then steadily inflates like a balloon. As the stomach enlarges, it compresses the diaphragm. If the pressure is not relieved immediately, the animal stops breathing and asphyxiates. Off to the clinic I raced.

We arrived at the clinic at the same time. Deep down, I prayed that my long-distance diagnosis was wrong, but Ralph's abdomen was indeed enlarged and he was showing the classical signs of gastric torsion. I first tried to deflate him by passing a soft rubber tube into the stomach, hoping against hope that it would do the trick. Sometimes it does. At least in the textbooks. However, I knew that most often the twist in the stomach pinches off the esophagus and makes it impossible to pass the tube. This was the case here. It was impossible to get the tube into the stomach. Force would only make things worse. I took a pair of x-rays just to confirm the diagnosis. Bloat all right! Ralph needed surgery and he needed it now.

I put the options to Ralph's owners, Jean and Marty. Either put Ralph to sleep or perform a risky and expensive surgery. Without hesitation the owners pleaded for the surgery. Donna, the live-in assistant was there to help. Ralph's gum colour was muddy brown, a bad sign. However, as soon as he was connected to the anaesthetic machine and we were able to fill him full of halothane and oxygen, his colour improved dramatically. We also ran in some IV fluids to prevent further shock. Now the atmosphere changed from one of anxious despair, to that of quiet concentration and resolve.

The owners, comforted by Donna, began their subdued vigil in the waiting room. The time was twelve midnight. Ralph's entire abdomen was shaved and prepped. Often the incision has to be enlarged during surgery so a wide area is rendered sterile before the drapes are laid. As I drew the cold scalpel along the taught skin of the abdomen, the edges of the incision parted immediately from the underlying pressure. The stomach beneath strained to burst through the incision. Then as I incised through the linea alba (central part of the abdominal muscles) I had to guard the sharp edge to prevent it piercing the bulging stomach. Fortunately, there was no food or stomach contents loose in the abdominal cavity. This meant that the stomach had not yet ruptured. Very often in delayed cases the stomach is so weak it tears as soon as it is moved, and an already poor prognosis drops precipitously to grave.

Over the next twenty minutes I struggled to reposition the stomach, but it was impossible. Without deflating the stomach wasn't going anywhere. So I tried to deflate it by inserting a large bore needle. The pressure hissed through the needle at first, then it rapidly clogged with the thick half-liquid stomach contents. I then decided to incise the stomach with a scalpel, to enlarge the opening. At the same time I had to turn Ralph slightly on his side to prevent any of the contents from spilling into the abdomen. As soon as I made an opening in the stomach a mixture of gas and slimy, half-digested food exploded down the side and over the drape.

Fortunately, I had a good grip on the stomach and was able to direct the sludge out and over the drape. It continued over the surgery table and onto the floor. I danced around to avoid being covered with the gooey mess and at the same time had to hold onto the rapidly receding stomach. I then enlarged the incision so that I could more easily remove the entire contents of the stomach. I had Donna hold the edges of the stomach as I scooped out and flushed the remnants of his last meal.

Once Ralph's stomach was empty, I sutured the incision as tightly as I could. And then for security, I sewed it over once more. Afterwards I flushed his abdomen with antibiotics, in case some contamination had occurred. But it looked pretty clean. I then repositioned the stomach and spleen, (which was about five times its normal size). We then had to surgically attach Ralph's stomach to the bottom of the abdominal cavity to prevent a recurrence of the problem. Miraculously, Ralph was still with us. His heart rate and breathing were regular. I was feeling pretty proud of myself at this point.

Unfortunately, even though we had passed one significant hurdle, there were several more to be faced over the next twelve hours. If Ralph survived until then, he would be faced with the most critical part of the recovery, which was spread over the following three to five days. Often there can be a build-up of toxins in the spleen, which are released all at one time once the stomach and spleen are untangled. These toxins can have a catastrophic effect on the heart and other organs. But, the less reaction he showed, the better his chances. So, while we were far from being out of the woods, I was pleased that we were at least still in the game.

Ralph was placed on more IV fluids, antibiotics and other medications, to rest for the night. Donna was given instructions to check on him over the next few hours and phone me if any problems arose. I went out to explain the situation to the owners. Tears of joy flowed from the husband and wife. I wallowed in their heartfelt and sincerely expressed accolades, of how I was (at least for the moment) the finest veterinarian, maybe even the finest human being, on the planet. And I wasn't about to correct their assessment or minimize their astute powers of deduction. I agreed with them. In fact, I thought they might have actually understated my talents.

At that moment, and all the way home, I began to develop a pretty high opinion of my abilities. Not only did I feel like a leading talent within the veterinary profession, but I felt that finally I would be afforded the respect and dignity I, as a fully qualified veterinarian, deserved. Yes sir, as I pulled into my driveway and sat in the car after turning the engine off, I reflected on my exalted stature, and was on cloud nine. It was 3:40 am Christmas morning when I finally crawled into bed. As my head hit the pillow, Diane mumbled her usual "Did it live?" I was only able to grunt in the affirmative before the strain of the evening hit me all at once and I fell asleep immediately.

Life has a peculiar way of re-establishing order, and putting us firmly back in our place when we get too full of ourselves. I don't recall actually hearing the phone ring. Instead I remember getting a dig in the ribs, 'Phone?' Diane mumbled as she rolled over. Then, stumbling about searching for the receiver, which had been knocked flying somewhere in the inky darkness of our bedroom, I did see that it was 4:30 by the alarm clock beside our bed. I guessed that it was a.m. and not p.m. I was not sure if the previous evening had actually occurred or not. However, by the time I found the receiver, my head had cleared and I was surprisingly alert. My mind raced with the litany of possible complications, hoping against hope that Donna was phoning to ask a simple question and not to report Ralph's demise. The last thing I wanted to do was to have to phone Marty and Jean on Christmas morning and tell them Ralph had died. In my gut, however, I knew that there could be no other reason for her to call me at this hour. Resolved to the bad news, I picked up the phone. "Hello?"

For about 30 seconds, all I heard was very loud disco music, with shouting and giggling in the background. Over the din of Boney M and 'Night Flight to Venus' a rather slurred voice asked "Hey, you a vet…? I got a bird here, a budgie… and it's freaking out, man. Like he's been quiet all night, and now since we moved his cage onto one of the speakers, it's just freaking out, man. Is there something going around? Is he going to die or something?" I suggested they put the poor bird in a quiet bedroom, cover him with a towel and have several cups of coffee. By doing so, I helped the little budgie as much as I helped Ralph.

Fortunately, Ralph did indeed survive. He went on to sire several more litters and lived a happy and full life. But, in fact, it was I who had benefited most that night, not Ralph or Jean and Marty, or the concerned but brainless budgie owner. I realized it was necessary to put all achievements in their proper perspective. Sometimes you can accomplish as much with simple advice as with technical skill, and respect should be something you carry inside yourself, not what others bestow upon you. And that it takes all kinds to run this crazy world. For the rest of the day, the words of Tiny Tim echoed in my mind "God Bless Us, Everyone!"

Dr. Bruce Burton, DVM, B.Sc., M.Sc., works with the animals at The Greater Vancouver Zoo and with 'animal stars' in the local film industry. He has extensive expertise in domestic and wild animal biology, health care and nutrition, as well as fish and game-farming experience. In addition to his busy practice in Bradner, Dr. Burton teaches at The University of British Columbia, and is often called upon by the SPCA to help exotic animals in need.

He chooses to write down his experiences so they are not lost, but rather shared with others. He wants his children and grandchildren to be able to read them first hand. I hope you enjoy your own sneak peek into his daily routine!

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