Tools of the Trade

A 14 week old boxer puppy presented with 2 weeks of right rear leg pain. He was partial weight bearing, worse after exercise and had mild but definite swelling on the back of his hock (ankle). This area was painful, although I could flex and extend his hock with minimal complaint.

If you look above the text on the radiograph, you can see a slightly irregular outline to the bone as well as a dark area within the bone. Unsure as to whether this was definitely a bone infection, I posted this radiograph on VIN (Veterinary Information Network), an online forum of practitioners and specialists. Within hours, an orthopedic specialist got back to me with a confirmation of infection and recommendations on antibiotic therapy. Within days, this puppy was doing great!

The point of this story is that modern technological tools can augment clinical skills in a way that benefits patient, client and clinician. Without a thorough history and exam, I might have attributed the lameness to strain, sprain or a developmental disorder. Without good quality radiography, I could have easily missed the abnormal bone changes. And without the experienced eyes of a specialist, treatment would have been delayed. In this case the client benefited from an efficient (and less expensive) workup and early diagnosis and our puppy was able to enjoy being a puppy again!

Those who ignore history...

I recently was reminded of the importance of a good history in the diagnostic workup. A hamster presented with a recent eye injury. Now I approach "pocket pets" just like dogs and cats: thorough husbandry, diet, and health history questions, a complete physical, a list of possible diagnoses and the tests necessary to confirm the problem before treatment. True, the nature of pocket pets often limits the amount that we are able to do, but I like to give them at least the benefit of a good history and physical.

Well this little hamster's eye had been proptosed (bulging out of the socket and lids) for at least a day and all my historical questions left the cause uncovered--no change in the cage environment, no previous eye rubbing, no irritants in the house, and no history of known trauma. It wasn't until I asked if there was any interaction with the family dog that I was told that the hamster had been found in the dog's water bowl 2 days earlier!

This answered the trauma question. And fortunately for this hamster, I was able to sedate it, clean and place the eye back in place and, using our smallest suture, suture the eyelids together to keep it in place while the swelling resolved. One week later we took the sutures out and to my pleasant surprise, the eye appeared normal!

That reminds me of another great eye story, but that's a tale for another day.

My First Real Emergency

"The definition of an emergency is when you don't have time to refer to your emergency manual." This piece of wisdom was handed on to me the day before a very distressed Yorkie presented to the Cornell Veterinary Emergency Service. I was the on-duty doctor, and being only two months into my internship, the adrenaline provided unusual focus on "the ABC's of emergency care" (Airway, Breathing, Circulation). Based on the the blue gums and the lack of air movement despite violent gasping, I was able to stop at "A" and quickly came to the realization that I would be performing my first tracheotomy.

Hands shaking, I quickly gave some sedation, incised the roughly clipped skin on the neck, and made the stab incision into the trachea. A rush of air, several breaths, and the gums were turning pink again! 15 minutes later we had a very happy Yorkie and client.

It turns out that this pup had gotten ahold of a snake skin, part of which he had aspirated. During the tracheostomy it was dislodged (and swallowed!) After a night in the ICU for observation, the Yorkie was sent home and a healed beautifully. Several days later I received a thank you card from the client with Snoopy on the front. I forget what the card said, but the owner had drawn a little hole over Snoopy's trachea and written "ahhhhh". I still smile thinking about it. LR

Why I became a Veterinarian

As I was growing up, James Herriott's stories of the life of a British veterinary surgeon provided romantic inspiration for becoming a veterinarian. The mentorship of Robert Brown, a softspoken and wise veterinarian further fanned that flame. My chemistry experience at Va Tech almost diverted my attentions to a laboratory career, but I stayed the course. Research hadn't lost its appeal however, and as I progressed through veterinary school, I became focused on laboratory animal medicine.

Then I went through my internal medicine rotation with Dr. Michael Leib, and everything changed. I was hooked on clinical medicine, companion animals, and clients. Clinical medicine allowed me to combine my academic interests with hands-on skills. I greatly enjoy the physical aspect of procedures such as surgery, endoscopy, and ultrasonography and the intellectual challenges of case management. Being able to do all this while working with dogs, cats, and other animals was particularly satisfying. And getting to know people as clients instead of patients fosters a type of relationship that is personal, and at the same time more objective.

There were some hurdles on the way to this profession: an early allergy to cats and an initial sqeamishness in the presence of blood (I still don't like needles in me!). But since 1988, I've only had two or three days that I didn't look forward to going into work. And all those romantic notions of treating animals from reading All Creatures Great and Small: They're Real!
I hope to share some of them in this blog.

Len Rice, DVM