The Gift of Pets: Stories Only a Vet Could Tell (24 page)

“Okay, so tomorrow I’ll take her to surgery and see what we can do about fixing that fracture. For tonight, she needs rest and fluids. The pain medications will keep her as comfortable as possible till then. I’ll stay with her tonight till she is fully awake.”

“So she’s gonna be okay?”

“I don’t think her life is in danger. That’s the good news. But the fracture is a bad one. I don’t need X-rays to tell me it’s a fracture. But they will tell me how badly mangled the bones are on the other side of the fracture, where I can’t see. Once I get those, I’ll have a better idea what will be required. Certainly it’s going to be a surgical fix. But she’s young and a fighter, so I’m hopeful!”

The next day, with the help of my staff, I anesthetized Megan again and took X-rays of her leg. I was pleased to see that the bones beyond the fracture line that joined the wrist were not shattered. Still, with only about an inch or two of bone between the fracture site and the wrist bones, I didn’t have much to work with for the surgical repair. During surgery, I fashioned a pair of curving metal pins, which I introduced at the wrists. These entered the hollow center of the bone, crossed the fracture site inside the bone, and bounced off the opposite inner wall, curving and gaining purchase on the inner wall of the side they had entered. With one pin placed on each side, the bones were stabilized and the fracture site was protected. Though the repair had been a difficult one, I was confident the bones would heal.

The surgery had been stressful, and I was tired and wringing with sweat as I placed the last sutures. A metal plate would have been a better fix, no doubt, but I did not have that capability in my hospital, and Elaine had ruled out a referral to a specialist. The repair would have to be augmented with a bandage and splint for a few weeks, but I had kept my promise to Megan.

As she recovered from the effects of the anesthetics, I placed a sturdy plastic splint on the injured leg, then secured it in place with layers of cotton gauze and a stretchable bandage. Covered with a final layer of brightly colored moisture-resistant material over the cotton and sprayed with a mist of bitter-tasting liquid to dissuade her from chewing at it, the bandage was finished. It was bulky and heavy, to be sure. I knew it would take a few days for Megan to become accustomed to it, but I felt certain it would do the job. The rest was up to Megan. She needed rest now and weeks of quiet recuperation.

As I waited for Megan to come around completely from the anesthetics, I called Elaine and explained to her how important it would be for her to curtail Megan’s habitually vivacious approach to life. I heard her laugh apologetically into the phone, knowing how difficult a task I had assigned her. Megan was only a year and a half old at the time—still a puppy with a devil-may-care attitude. About that time, Megan, still heavily medicated for pain, lifted her head and wagged her tail. As the clinging fog of the analgesics wore off, I saw relief and the lifting of anxiety in her eyes.

During the next two days, while Megan recovered in the hospital, I noticed a special intensity in her eyes whenever I entered the room. She would attentively follow my motions and perk her ears up at the sound of my voice. Like few other patients in my career, Megan fell for me with a fervency that bordered on fanaticism. It was not just that she liked me. It was more than that. The inescapable fact was that she had a crush on me—like a teenager’s infatuation with an attractive teacher. And I was not the only one to notice. Lisa and the rest of the staff were greatly amused and teased me about having a “thing” going on with a patient. I brushed off their humor, flattered by Megan’s obvious devotion.

On the third day after surgery, I discharged Megan to Elaine’s capable care. I prescribed oral antibiotics and pain medication to ease the postoperative discomfort, and issued stern warnings to keep Megan’s activity level strictly curtailed. She was to go outside only on a leash and under careful supervision. Elaine was to keep the bandage dry and clean; this point I stressed at length. Because the bandage was constructed largely of cotton batting under the exterior wrap, any moisture at the toes would wick up the cotton, leaving the inside of the bandage wet. Since the outer layers were moisture-resistant, this wetness would be retained against the skin, increasing the discomfort, causing nasty dermatitis, and dramatically increasing the risk of infection at the surgical site. Then I sent Elaine and Megan home, flush with feelings of accomplishment.

Two days later I got a call from Ms. Farmer. “I’m afraid I’ve been a bad momma,” she said.

“Oh, I doubt that. What happened?”

“Well, Megan got out the back door when I let Max out. And before I noticed she was gone, she was swimming in the creek. The bandage is soaking wet. How do I get it to dry out?”

“You don’t,” I responded. “If the bandage is that wet, the only option is to bring her in and replace it. If we don’t, we’ll be sorry, and we’ll endanger all that we’ve accomplished with surgery.”

“I was afraid of that. Okay, I’ll bring her in.”

Megan was thrilled to see me when Elaine brought her in later that day. No reunion between parted lovers was ever more joyful. Her face shone with eagerness and her greeting was effusive as I met her in the lobby. While I removed the sodden mass of dripping cotton from her leg and replaced it with clean and dry bandage material, she lovingly caressed my hand with her paw and licked my arm tenderly. Before I sent them once again on their way, I reiterated my advice to keep her bandage clean and dry.

Despite my instructions to Elaine, and despite her most careful efforts to enforce them, over the next few weeks Megan became an accomplished escape artist. Whenever she was able to sneak out, she headed directly for the creek at the back of the Farmer property and plunged in for a swim, completely saturating the gauze and cotton bandage and necessitating a visit to our office for another bandage change.

Each time, Megan would bound through the front doors, tongue dangling in a sloppy smile and eyes bright with anticipation. When she caught sight of me behind the counter, she would woof excitedly, crouch down playfully, splay-legged, with her wagging hindquarters and flagging tail high in the air. Then she would run full tilt across the lobby, dragging Elaine at the end of the leash, and plop her front legs onto the countertop, complete with a sodden mass of bedraggled bandage.

I would, of course, reward such a shameless display of adoration with the lavish response it deserved. It underscored to me what a lucky breed we veterinarians are. What other doctors can interact with their patients so expressively and not get sued?

The problem was, however, that Megan began to look forward to our reunions altogether too much. In the eleven or twelve weeks after her injury, I replaced that bandage no fewer than ten times. I began to wonder if Megan was purposely soiling her bandage so she could see me again. Bandage changes became so routine for her that I’m sure Megan could have applied the bandage herself. But she wanted me to do it. During each rewrapping of the leg, she would occupy herself with loving, almost amorous, licking of my hands and face, resting her good leg comfortably on my shoulder. With each visit, it was obvious that her puppy love was growing.

After three months, the bones had healed adequately enough for me to remove the pins and wires and leave the bandage off. Megan was walking well, with hardly a trace of a limp, and her visits became infrequent. I missed seeing her so often. The staff teased me about being stood up by my mistress. But I knew better.

Megan was a patient of mine for many years—one of my favorites. A few gray hairs emerged on her muzzle a little earlier than I would have expected, a reflection perhaps of her trauma. Only a few things reminded us of those three long months. The wrist on her right leg didn’t bend quite as much as the left. A little scar from the surgery site decorated the inside of her leg like a tattoo. On cold mornings there was a little more stiffness when she first woke up. And whenever she saw me, there was always that special greeting, the unmistakable look of ardor in her eyes, the gentle tugging on my hand with soft teeth, and the unique connection between special friends. Megan was my girlfriend. Just don’t tell Cynthia!

Seventy-six Cents

Mrs. Garner and her mother were the proud companions of a lovely little Boston terrier named Mischief. Mischief was young, only about five years old, and was aptly named, given her penchant for always finding the perfect way to cause unmitigated consternation to her besotted owners. I had treated her through many bouts of gastrointestinal distress after she had consumed some offensive inedible she had found in the yard. Fortunately, she had always responded beautifully to these treatments and had bounced right back to her normal trouble-seeking self.

When I noticed Mischief’s name on the appointment book early one morning, I suspected another round of the same. But as soon as I entered the exam room, I knew this was a problem on a different order of magnitude. I could see it reflected on the faces of Mrs. Garner and her elderly mother; their faces were drawn and tense, their lips thin and tight with worry.

One look at Mischief and I knew that she was in danger. She, too, was tense and dull, her eyes cast in shadow and her short coiled tail still. For a moment she rallied when I entered the room, her tail making tiny circles and her face becoming animated. But before I could even respond to her, she was quiet again and panting heavily. Even that small an exertion had exhausted her.

“My goodness, Mischief is not feeling like herself at all, is she?” I asked, concerned.

“Not at all,” responded the elderly woman, her face etched with fear. “She’s been getting worse and worse over the last two days. Honestly, Dr. Coston, I don’t think she’s going to make it. Don’t you think we should just put her down? I hate to see her suffer.”

“I think it’s way too early to be making any decisions like that. I haven’t even examined her yet. When did all this start?”

“I first noticed her not feeling well maybe four or five days ago. I thought at the time it was probably the same old thing, so I didn’t worry too much about it. But it just kept getting worse. Now she won’t eat and is as weak as a dishrag.”

“Let’s take a look, why don’t we. Put her up on the table.”

Mrs. Garner lifted her onto the tabletop, where Mischief hunkered down, sad-eyed and submissive, bereft of any mischief at all. Having treated Mischief since puppyhood, I knew this lack of interest was foreign to her.

Every veterinarian develops his own systematic approach to examining a patient. This routine keeps one focused on the whole patient, rather than on just the most obvious problem. Such a comprehensive look has often saved me from making diagnostic mistakes that might have had life-threatening consequences. For me, this routine starts at the head. I examine the eyes and nose, then the mouth. From there, I feel the lymph nodes before listening carefully to the heart and the lungs with my stethoscope. I then turn my attention to the abdomen, probing with my fingers till I have felt the kidneys, the liver, the spleen, the bladder, and the intestines. I finish the examination by looking carefully at the skin and finally the musculoskeletal and nervous systems. It is important to perform the physical examination carefully on every patient, not being distracted from any part of it just because the problem seems immediately obvious. The additional information gleaned from a complete evaluation is often of vital importance.

Habits though, like rules, are made to be broken. And if there was ever a case where a problem seemed obvious upon initial evaluation, it was Mischief’s. As I lifted her lip and looked in her mouth, the sheer pallor of the oral tissues shocked me. So white were they that when I tried to blanch them by pressing on them with my finger to see how quickly the color would return, there was no discernible difference in the color of the gums. Mischief was terribly anemic. The remainder of my physical examination protocol was aborted as I whisked her away to collect blood for testing.

The results of the tests were just as alarming as the lack of color on her gums. The hematocrit, a measure of the red cell mass, was only 9 percent. It should have been at least 35 percent or so. Mischief had less than one-third of the red cells she needed to carry oxygen to her body—a level that, if it dropped any lower, would be fatal. Mischief’s condition was critical!

In this situation, it is the job of the clinician to identify the cause of this drop in red blood cells as quickly as possible and to institute treatment that will reverse it. The three categories of diseases that can cause these signs include blood loss, failure of the bone marrow to produce red cells, or destruction of red blood cells. Within each of these broad categories are a number of discrete causes, but getting to the correct category is the doctor’s first priority.

Blood loss is relatively easy to rule out. Since there were no external wounds on Mischief that were actively spurting blood, I needed to rule out blood loss in the gastrointestinal tract. This would show up in the colon as either bright red blood, if the bleeding was in the lower GI tract, or black and tarry stool if the blood loss was in the upper GI tract.

I pulled a glove out of the drawer below the examination table and pulled it on with a smart snapping of the latex at the wrist, a sound that usually evokes an emotional response from either the patient or the owner, and often both. The truth is, nothing pleasant can ever happen for a patient of any species after a doctor puts on a glove. Some orifice is about to be probed or some bodily fluid is about to be forfeited, against the wishes of the donor. These procedures are generally not consensual. In Mischief’s case, however, it was unavoidable. The normal-appearing stool on the finger of the glove ruled out blood loss as a cause of her anemia.

Red-cell production is measured by evaluating the number of immature red blood cells, called reticulocytes, which are present in the bloodstream. If the reticulocyte count is elevated, then it’s obvious that the bone marrow is doing its job at peak capacity. Mischief’s reticulocyte count had skyrocketed into the range where lack of red-cell production was inconceivable. That left only the category of red-cell destruction as the cause of her anemia.