Pellets Again

We had a lovely cat brought in on Friday night. He was lame on his right foreleg and had a wound. The vet snapped an x-ray as we were busy and everyone had different jobs to do. Usually it is nurses that do x-rays but at time we let the vets take them because we are generous like that.

Anyway l walked past and he was holding up a flattened piece of mishapen lead which had in a former life been an airgun pellet until it smashed into the bone in the cat’s front leg. . Looks like you lost a bit l commented, he grunted agreement and went back to snap another picture.

I went over to have a look on my return trip past the x-ray room and got that heart sinking feeling. There was several small shiny speckles lodged deep in the joint capsule. All the vet could do was put a thick support dressing on, and write the cat up for ongoing pain relief, and leave onward treatment as an ortho. decision.

I don’t know what will be decided a lot will depend on cost cheapest is to remove the leg. The more expensive option to try and save it may be carried out but with all things there is no guarantee of success and it depends on what else has happened that has not shown on the pictures.
I am not due back for some time and will have forgotten his name by then, l always write names down and loose them.
What l never loose is my anger at the stupidity of whoever shot that pellet and a wish to send them all to hell whatever the age of the shooter.

Bank Holidays Night's

Had a busy 4 bank holiday nights, with a high but not uncommon good weather case load which was yet again a good example to have pet insurance for dogs cats and rabbits.

Surgically we had a mix of major and simple cases with stitch ups, x-rays and repairs for dog or cat RTA’s or attacked by dogs (quite common), bloats, splenectomys, diaphragmatic hernia repairs (abdominal contents end up in chest cavity, breathing becomes somewhat difficult), pyo-metras (get your bitches spayed and avoid this), eye removals and other surgical cases.
Eyes always turn my stomach when they are hanging out; Eye pop outs happen a lot in the smaller flat faced dogs, a bang on the head and no proper orbit to hold the eye in place…. Splat.

Recovering all the above post op and general medical cases in such as: FUS (blocked bladder cats), fitting dogs, kidney or heart failure cases, haemorrhagic gastro enteritis (bloody shits-pouring out) vomiting and a general mixed medical bag of other medical cases.
There seems to be a spell of fitting dogs going through the area at the moment. Not sure if human nurses have spells where you get a lot of a certain type of medical case in.

In the exotics section we had a head tilt duck belonging to one of the staff who was very sweet, various rabbits another common patient, rats and ferrets.
Finally isolation was occupied just to make sure that there was a long extra walk to trudge during hourly obs checks.

One stray that was uninjured but came in as emaciated was not, he was just hyperactive. Weight did not get a chance to settle on him. He spent the weekend in as none of the rescue kennels collected.
When he came in I put him into a walk in kennel, went back 5mins later to dog ward and as l opened the door this white streak shot past me, stopped for a chat to Wibble and on my “oy you git” looked at me with a catch me smirk and shot up the passage. I cornered him at the connecting door.
Needless to say climbing out of a walk in kennel earned him a place in a smaller inescapable standard hospital kennel and he treated us to the “staffie bull terrier scream” all weekend. This seems to be an inherited trait that certain SBT have, no other dogs do. Think magnified nails on a board with full lung power for hours and it gives you an idea. He wanted out, his fault he could have had space.

A lunatic cat who was a recovering surgical case from yesterday decided last night he felt better and played the game of ‘fling yourself out the door because the human will catch you before the floor’. He also grabbed me nails out (the only way!) when checking the patient next to him so l had to have one hand fending off or tickling him through his kennel door.
I was playing 'squeeze the head' last night whenever l did his stats. Hold head between hands and squeeze gently but firmly. As soon as l stopped he would hassle me for “more more squeeeeeze pleaseee” honestly you would think he was the only patient in the place, a total purr bucket.

On Sunday l was holding a cat and trying to stop him pulling out the vet's eyes as he was in a bad temper when the evening nurse standing chatting mentioned that did l know the cat was peeing. I suddenly realised what the warm wet feeling was. I was soaking my entire tunic had soaked it up like a sponge. Needless to say l went on a dry top hunt.

A splenectomy (tumour ruptures on the spleen) came in on the second night and off the table at about 03:00.
Last night, which was thankfully my last night, we had a bloat dog with splenectomy. This happens quite often as the stomach twists the spleen gets involved and also flips and is unsaveable this does not involve tumours but trauma. He came off the table at about 4am.
On change over the student VN went to triage a dog and came back with a dog who had been retching. One look and l told her to go meet me at prep table while l set up drips as he was another bloat case.
The vet came over stole him for an x-ray which was great because he lifted him onto the x-ray table for me and saved me the hassle of lifting the dog onto anything so l could do his iv lines and take bloods. Rugby playing vet’s have a use l keep telling him that.

At least l was able to avoid the op. After l got fluid lines in and sent the bloods off with the student for running l passed it over to one of the newly arrived vet nurses who gave me a jaundiced “no need to be so happy” look over her mug of tea as l went off to finish patient change over, before running away to my bed.

Whelping

What a fun day yesterday. I was asked to go in early as there were no vet nurses or even auxiliaries on from 16:00 so l worked 16:00 to 03:30. I left a message when l left do not ring me today (Sunday) l am moving to Outer Mongolia and unavailable. So far no calls to work however it is not the days end yet.

Whelping and puppies was the theme yesterday. One caesarean on a bulldog before l got in l just discharged her. They had no box / blanket for the pups, so l said well take off your jersey wrap the 2 pups into your jersey. Not a chance they would do that. The idiot person with the owner pushed a puppy into each pocket and tried to do the zips up on the pockets. Idiot owner pushing bits of puppy’s back into the pockets as they squashed out. One pup may yet need to be put down it had a bad cleft palette but we were not allowed to do so, that’s a big loss of money.

I was told she was 14months old this was her 3rd caesarean. I said to the owners do they know what they are doing to her breeding her like that. And they got all uppity and could not decide if she was 18months, 2 years or 2.5years old, and if it was her 2nd or 3rd whelping.
Finally the male owner whined “We spent £3000 and all we got is these 2” pointing at the 2 little heaving cramped pockets on the friend, “we are loosing money on this you know”.
I just talked over him giving discharge instructions and ignored him. It was safer that way, for all of us.

Two more bitches in whelp turned up. One Bull Mastiff had had a pup stuck paws showing for most of the day. Well it varied they came out with a different reply to whoever asked how long the pups had been stuck.
She came in at about 1am. Pointless asking WTF the person had waited so long for, l tried over the phone and got no sensible reply.
The vet managed to pull the stuck dead foetus out in a pool of blood and gunk and the bitch went home.
The other SBT had ended whelping at about 17:00 and then started pushing non stop. She came in at 2am. X-rays showed nothing there and she showed no signs of pushing, again sent home.

A bulldog puppy 4 weeks old with a chest infection, the owner informed me that everyone accepts bulldogs have trouble breathing, just when the green gunk was pouring out his nose they got worried. (Hold hands by my side at this comment to avoid strangling the owner)
He was further puzzled at my question if it was eating solids yet and said he is only 4 weeks old, and anyhow l don’t know anything about it l never bred dogs before.
I had to give a quick lesson in puppy care. Then stomped through to get a vet to check the pup and bypass the wait in the waiting room. I left the owner sitting in the waiting room, with people looking at him wondering why he was breeding and knew nothing.

Both bitches that came in at 1 and 2am were pedigrees. They and the bulldog chest puppy were via a charity that paid the vet fees. If l gave vent to the feelings of all of us at work over the above then the post would be unreadable. Bulldogs are going for up to £3000 each, Bull Mastiff up to £1000. The bitch with no pups left was a SBT and hers are around £250-£300

When we get calls with owners wanting their pets to see a vet the animals always come first. If the person is elderly or disabled then we will go all out to help as much as possible. The frustrating thing is that often they do not qualify for help. We bend the rules as much as possible. The vets will also do what they can for this group when the person comes in. Just as well management is locked up at night in houses far away or they would have a fit. What they do not know means we sleep peacefully during the day.

There is the sensible owner group. May be insured (please god) or not insured but still want to help their pet.

Then group 3. After about a month on nights even new members of staff can recognise something in the caller’s voice. The following conversations are carried out by all the night staff with varying degrees of tooth grinding.

Often the animal may have been sick for days or hours (this can happen with the first 2 groups but most commonly with the 3rd group). It is a wake up call for owners when people ring and say they have a sick pet, are told the fees and are expected to actually pay. I think it is the first time reality almost hits on many of them.

Before they open their mouths to reply you know you have a choice of 2 answers.
“We don’t care how much it costs”. This really is true, they won’t pay so they do not care about cost. Or

They state that they are on benefits and are again told we are private you pay us for work done. There is a silence while they digest this.
Now at this point one of 2 things happen.
1) They ask if anyone can help them and l pass them on the details.
2) They start screaming that “You don’t care about animals, you are money grabbing scum” and other sweet words, really helping their case. This group l tend to yawn and doodle on a bit of paper, play with the computer and await the end of the hissy fit.
When the tirade dies down l may ask what stopped them ringing a vet during the day 4 days ago when it got it. The usual reply is that l am a money grabbing yadda yadda. Conscience at leaving a sick animal so long without care is not guiding the answer, it is crass stupidity.

Anyhow when l have told them who to ring l give advice on what to do with the animal while the calls are going on.
If they do not qualify then there is the discussion over payments and how we will go about dealing with that.
Generally once it is all sorted comes the final whine. I aint got no transport.
My comment is “So go call a friend”
The whine comes back “They are sleeping” or “They have been drinking”
My reply is along the lines of “Tough l have been working it is not my problem, we are already doing all we can to help you now sort something out for yourself and let us know when you are setting off”
When they realise that they better make an effort because we are not going to do it for them, funny how they manage to get down by taxi or a friend.

Vets legally are obliged to give first aid, even if that is putting the animal to sleep. If the owners can get a charity to pay fine, if the charity will only pay part or non then the owners are legally obliged to pay.

Insurance means that you won’t be able to afford a few beers a month. Do you not owe that to the pet. Some insurance companies are trusted by vets. You can pay the excess and the vet will claim direct for treatment. I think it is mainly Petplan who are accepted for this but some others are as well.

Humans do not have a right to animals; Animals have a right to responsible humans.

Hip Scoring & Breeding.

I was discussing hip scores with a client as she wanted to know if it was worth breeding (NO). Would her Labrador need a hip score if breeding (Yes).
Hip scoring is an x-ray taken of the patients hips to check for hip dysplasia. HD is abnormal formation of the hip socket, is very painful, and may require an artificial hip, or other surgery to correct it, or them if both sides are affected.
The bitch was too young at that point as she was only 10months old, a hip score is only done over a year old. Once scored the hips can not be re-scored, “you gets what you gets!.

Doing a hip score x-ray is one of those painful episodes in a vn’s life. In many practices x-rays are the vet nurses domain. Vets may pop in and check you have the view they want, and they always diagnose, but the setting up of patient and machine is for the vn.

The patient has to be lying on their back, usually supported in a plastic trough.
Wedges placed around so they do not roll over. Some dogs are thin, and roll like a boat on a stormy sea, no matter how you try and wedge them, using foam wedges and sandbags.
Each leg has to be the same height from the table top and pulled out straight (along the tail line) and together, at the correct angle.
This is an unnatural position and the legs do not like this. A foam wedge is placed so the legs do not loose the straight line and form a sort of hip to toe triangle.
Tape is often wrapped around or across the legs to hold the position and more wedges to support placed under the lower leg (away from the xray)
The pelvis must be flat and perfectly straight across the xray cassette.

Five x-rays (depending how good a day it is or isn’t) and slight readjustments to position or machine settings finally the decision is that the picture is as perfect as can be taken.
A few weeks later you get a rejection slip saying not good enough. This means back comes the dog, another anaesthetic and more muttering noises from the nurse!.
Usually things are ok on the second set but they look identical to the first set. The outcome to the nurse is the same. A frazzled bad hair day, that requires a large coffee or tea and a bit of chocolate to de-stress.

The score system is based on 9 areas per side with an overall score from 0 (best) to 106 (worst)/side.
Each breed has a mean score, indicating the breed’s predisposition towards hip dysplasia. 16 in UK for Labradors.
I know a boasting Lab breeder that told me she bred from a bitch who had a score on one side of 42. Most of the litter was destroyed, mum as well. It was ok though as she made money on the others. I did manage to be almost polite to her.

The particular client l had been discussing hip scores and breeding with decided against breeding. I threw the whole gamut of what was needed and could go wrong at her.
The £600 for a caesarean (which generally insurance won't cover), possible hand raising and 2 hour feeds of puppies.
And if the above did not happen you still have the cost of doing it properly. The food, the mess around the house (unless it is in an outside kennel), worming at the correct intervals of mum and puppies, arranging first vaccines, arranging insurance (free first 6 weeks), advertising. Looking for the correct sire and those fees and checking his health.

Many breeds are part of the hip have Hip Score scheme and other scoring schemes for hereditary problems. If you must have a pedigree for all pre health checks of the parents that the breed has available to it.
A Labrador should have had hip and elbow score and eye checks for Progressive Retinal Atrophy.
Many breeders do not do the above, do part, or do none. The sensible ones do everything and more but they do not usually make any money.

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I am driving home tomorrow back across the country after work. I do not think l will get to writing, instead l shall put finger to keyboard before work on Saturday.

Working Trip to the Seaside

Well l have had a weekend with no nursing and 2 days off, l feel spoilt with time off. Later today l drive across country till l get my feet wet on the other side.

I am going to cover a vn friend's job while she is away for the week. It is a regular cover for the 2 vet nurses. In this case Jill is away. I always stay in her flat but this time l baby sit her 2 hoodlums. Not kids that would be more than l could handle this is cats.
The worst part is Jill won't be there and Hub is of course not there so l am left to cook my own food. I am ok on stews but as to the rest, the dogs have turned my cooking down before and hub won't eat it, he cooks l wash up.

Wibble is the only dog allowed in the flat, not Jill's rules the cats rules. The last dog that a friend of hers tried to take in got shredded by both cats by the time it got over the doorstep. Both are rescue cats FJ her older cat knows Wib as he stayed with us for a time. Momo younger adult looks on Wib as a source of food as Wib is a fussy eater and leaves a lot of food, perfect.

Momo last Xmas opened the cupboard where the overripe Stilton cheese was in the bin awaiting disposal. When l visited 5weeks later FJ and Jill still carried gas masks for when Momo used his litter tray.
I once asked if there was anything that Momo did not eat and was told well he isn't keen on turnips.
I am waiting to see the new slimline Momo apparently through using Hills RD dry and making him hunt for food and using food bottles. Coke Cola bottles with holes in Momo has to bash about to get the food out. All other food, human and animal is battened down. Momo has lost about 1kg.

FJ is very fussy as any sensible cat is, he will only eat Hills Natures Best food. This is how cat's avoid all but accidental poisoning. Stick to a food you know is not going to make you sick. Cats that are poisoned are generally accidental poisonings, grooming after walking through something toxic, or eating a rat/mouse that ate rat poison, eating a bird that ate poisoned slugs etc. Some are like Momo and will try anything but those that have any cat sense are actually the fussy eaters. It saves their lives in the wild.

Both cats are obsessed with water and their idea of heaven is when Jill fills the bath puts in some bubble stuff for cats and lets them loose. First loo rolls, toothpaste etc are removed from the room. If left the hoodlums dart out of the bubbles grab them and haul them back for killing.
If no baths are on offer then especially Momo swims in the water bowl. Well more tries to fit as much of his body in as possible.

I take my camp bed and air mattress. This is always a worry for me l do not trust one of the pair not to decide to bounce on it with claws out, or pull themselves along under the bed claws making numerous holes in my bed. I glare at the pair of them muttering threats if my bed is punctured. So far this has worked.

The practice l am going to, unlike my regular place, is a small, first opinion practice, like 95% of vet practices in the country. They carry out general surgery work. Neutering, dentals, lump removals etc. They hold vet or nurse clinics depending on what is needed, advice or treatment. The more complex medical or surgical patients are referred on by the vet to specialists.
There is no one there over night but anyone who has to leave a pet is warned about this. If the animal is to be checked or needs meds then the vet goes back and checks on them. If a nurse is needed by the vet there is a week rota on whose nurse turn it is. The nice thing about being a locum is l am not on that rota.

Even in general practice the importance of insurance for pets is never to be underestimated. For instance a Pyo is a common problem in unneuted bitches, the uterus fills with pus.
Some people insist vets try and treat them medically but it never really works and the bitch is always falling ill. Removal is always the safest option. Very often the only first option is removal as the patient generally presents collapsed and critical.

Treated in general practice is about £300/400 but if referred you are looking at about £700+. Despite being common a lot of vet's do not want to do them so referral is suggested.
The patient has a lot of toxins in the system with the condition and sometimes to add to the trouble the uterus may leak pus internally during or if very full before removal. The best surgeon can not prevent this and if leakage happens the patient needs intensive vet and nursing work to pull them through.

Some of the insurance companies are starting to pull fast ones on their payouts but Petplan is so far the one l have heard has the least problems on claims, they are the biggest and best quality, yes you pay more but it is peace of mind.
Too many times l have seen patients put down because owners can not afford treatment and can not get a loan from bank, friends or family.

To get insurance some things to look for:
Life cover regardless of age.
Will it pay out for life or just a year or even worse a visit for a problem.
Will they cover an amount per/problem if so not good you may think that it seems a lot of money but it won't go far, not over the pets lifespan.
What is their yearly total the standard at Petplan is about £4000/year but they are just revamping their policies
Do you need to keep your pet vaccinated to qualify for insurance even if it is not related to the problem.
Some companies will not cover a pre-existing condition. With some for life, others if that has not been a problem for a set time they will re-include it in the policy.
Do not be fooled by "winner of...." awards that some places say they have.
How long do they take to payout. Some at least 3months, one notorious company one will only pay when threatened with the insurance ombusman.
A lot of vets will accept Petplan excess upfront but not the other groups. Even if you have full insurance they will make the person pay, if not in full, a large amount up front or get pre agreement for treatment before they do anything.

Well, on that gem, l may as well start thinking about packing and getting some food. My next blog will be sometime tomorrow evening as l am doing sensible work hours ending late afternoon.

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I arrived here after a long and boring drive in the dark, had a listen to radio4 and the Himalayan trip on audio from Michael Palin and the BBC.
Once here it took a couple of trips to get my junk, unloaded and about 30mins to pump my bed up.

FJ finally appeared from somewhere and allowed me to scratch his head in homage for a couple of seconds, then he flicked his tail and stalked off to clean where my grubby hand had been, he and Wibs ignore each other.
Momo is more accommodating. He ran over to say hello and almost but not quite sniffed noses with Wibs.
"Hi dog hi dog, you got any food handy, can't smell any on your breath, you wanna get her to get you some and leave me half your bowl, huh huh?"
He was underfoot till all food was down, bless him!.

I tripped off to work and later on in the day had a word with the practice owner about the blog. They preferred l did not write about the practice so l will fill in this week with various happenings over my years in the vn world instead.