Category Archives: Vet

Benedict who?

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New Year is almost here. I feel I have come a long way in 2014. Strange to think that less than a year ago, I drew up outside Tu Dyreklinikk and decided it was too daunting to walk in and ask if I could look around. I’m glad I changed my mind. That decision allowed me to meet some wonderful new friends, and has given me the opportunity to return to a life I hadn’t realised I was missing so much.

As I said in my last post, I was pleased that I was not working over Christmas. Jan-Arne was however, and somehow he managed to get himself on the front page of our local newspaper, JaerBladet after a Japanese Akita called Frøya accidentally got hold of a whole fruit and nut bar. Happily for Frøya’s owners, Jan-Arne was able to treat her, and by the next day, she was fine.

The picture at the top of the page is another of Jan-Arne’s patients. Lukas is a young Staffordshire Bull terrier with itchy skin. Feel better soon Lukas.

This week, I have only worked one day because New Year falls on a Thursday. I spent most of yesterday in theatre with Magne and Wivek. As usual I was on anaesthetic duty and it was an interesting day for me as Wivek was trying out a new form of pain relief called Recuvyra. Recuvyra is an opioid pain-killer, which is applied to the skin of a dog under its coat. It lasts for four days, so for operations which require analgesia for a few days, it is a good alternative to remaining in hospital, or coming back in for several days for injections. As always with new treatments, it will be interesting to hear from the clients how they got on. Yesterday’s patient, a sweet little Tibetan Spaniel with a displaced hip, seemed very stable throughout her anaesthetic and contented during the recovery period so I hope that when she went home, everything continued to go well. I remember when I started out in veterinary practice, there was much less consideration given to pain-relief, and very few pain-killers readily available. It’s one area where I feel the veterinary profession has made enormous leaps in progress and it is important for our patients that we keep up.

There were a few things that made me laugh. Obviously my Norwegian is still patchy, as when I asked Wivek how big the bladder dog was, (a lovely Schnauzer which was suffering from stones in her urine) she told me it was about the size of a grape. She was referring to the stones of course. No idea how I would go about anaesthetising a dog that weighed less than a box of matches.

For some reason, I was having difficulty with intravenous catheters, probably because Wivek was watching, and she always makes it look so simple. It’s much easier to find the vein with good lighting, so before I made my second attempt of the day (on the Schnauzer), I walked over and switched on the big overhead light. Except somehow, I got the wrong switch. I confess I was surprised when the light failed to come on, but not quite as surprised as Magne, who suddenly found himself plunged into darkness as he waited for us in the operating room. His face was a picture as he emerged.

The high point of the day though, was the moment when Wivek and I were discussing the Christmas period.

‘I went to see a film yesterday,’ she said, and gazed into the air for a moment. ‘I can’t remember the name of it though.’ She shrugged and then looked down to continue her suturing.

‘Not very memorable then,’ I suggested.

She frowned. ‘Good film, not a good name,’ she said. ‘It was about Alan Turing.’

‘Oh,’ I said. ‘The one with Benedict Cumberbatch?’

I have never seen such a blank look on anyone’s face. ‘Benedict who?’ she said. ‘I don’t know his name. The one who played Sherlock Holmes.’

I confess I was astonished. I thought that everyone in the universe knew who Benedict Cumberbatch was. Even if we had woken up the patient and asked her in dog language who it was that played Sherlock Holmes, she would probably have barked his name. So there you have it. If you want to consult Wivipedia, it’s probably better to stick to animals and Norwegian cookery. Whatever you do, don’t consult her about Tom Cruise. For her that would be Mission Impossible.

Anyway, to all of you who have supported me this year, thank you very much. I can hear fireworks outside already. By midnight, the sky will be bursting with light and colour. Happy Hogmanay, and I hope you have a wonderful time in 2015.

 

 

Salmagundi

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I can recall, as a teenager, being rather sceptical when an adult friend claimed that they could not remember what o-levels they had taken. During my schooldays, those exams represented something so huge that I couldn’t begin to imagine a time when they would be unimportant enough that forgetting was even possible. It was the same with adults and age. How could anyone forget how old they were? Well now I am that person. It was my birthday on Monday, and on Tuesday morning, after wishing me well, Dagny asked that fatal question.

‘So how old are you now?’

I glanced up from the dog’s leg over which I was hovering, trying to find the vein. ‘Forty five,’ I said without hesitation.

She stared at me for a moment with her head on one side. ‘That can’t be right,’ she said with a frown. ‘I was born in 1970 and I’ll be forty-five this year.’

I confess I was quite disembarrassed. I really don’t care that much (though I note I have frozen time when I was younger, rather than making myself more mature).  I was amused though that she had asked me, when she must have known the answer on some level already. Fortunately, I managed at this point to puncture the dog’s vein and slid the catheter into place. After years of working for Vets Now, with their ECC nurses, who would raise the vein for me in my (usually conscious) patient, and then stem the bleeding until the bung was in place, I fear that with a sedated animal and a tourniquet I very often find some blood escapes onto the table, or more often, onto the animal’s leg. This was the second dog I had catheterised for Dagny that day, and the second time I had fumbled it.

‘I think I’m going to call you Messy Lady from now on,’ she said.

Eleven o’clock arrived, and with it Jan-Arne. From him I received not only good wishes, but a birthday hug as well, but there was no time for chat as it was time to go back into theatre. Emerging a while later with a recovering patient to monitor, I was rather surprised to see Jan-Arne wandering around the practice with a fluffy white dog on a cushion. He walked out of the prep-room with it, and then reappeared and went and sat down in the computer chair, leaning back with the tiny animal rested on his stomach.

‘Vondt i magen,’ (pain in the stomach) he murmured, or at least I thought that was what he said.

‘Do you mean you have a pain, or is it your next patient you’re talking about?’ I asked idly and he looked up at me with a frown.

‘What are you talking about?’ he said.

‘Is it you that has a pain in the stomach, or your next patient?’ I asked again, indicating the computer-screen that he was examining.

He shook his head. ‘No, I just said my next patient was called Tommy,’ he said. Sometimes I wonder whether other people functioning in a second language experience quite so many mind-bending moments, but I suspect it’s just me.  Getting up, he walked back across the prep-room and out into the corridor that leads to the kennel-room and I assumed he was going to take the little dog there, but instead, he poked his head into the dental room, spoke for a moment and then reappeared, still clutching the small bundle of white fluff like Paris Hilton on anabolic steroids.

‘Now what should I do with this little chap,’ he said looking down.

‘You could always put it in a kennel,’ I said. His face brightened visibly.

‘So I could.’ he said

Thursday was a crazy day. First thing in the morning, when Marita checked the two cats that had been left for operations, she discovered that instead of being one male and one female, both were girls. Spaying a cat isn’t a big operation, but it takes a lot more time than castration. Happily, she managed both quite quickly, but even as I was preparing the second cat for its op, Wivek asked me if I could possibly take some stitches out of a dog, as three of her patients had arrived at once. I had to decline as I was in the midst of sedating and prepping Marita’s cat. Once that operation was safely underway, I found that the stitch-dog was still in the waiting room, so I took it in. Of course, some days nothing goes smoothly, so typically having taken most of the sutures out, I couldn’t manage the last one and had to fetch Wivek anyway as I was worried the owner might not be happy with this stranger prodding away at her dog with a pair of scissors. I finally managed to get back to Marita, who by now was finishing up her second spay, though her next patient had arrived half-an-hour early. It was one of those days. At eleven, Jan-Arne arrived again.

‘Good day, little British girl,’ was his greeting this time. I was just happily contemplating the word girl, when he enveloped me in another wonderful bear-hug.

‘Good day to you, big Norwegian man.’ I couldn’t help but smile as he disentangled himself and went to get changed. I was standing with Wivek and she looked after him with a smile and said something in Norwegian. I had been running around at this point, trying to catch up with the cleaning and I was wearing latex gloves and clutching a bucket of water and a cloth. I didn’t quite catch what she said and I asked her to repeat it. I still didn’t catch what she had said, partly because it didn’t seem to make any sense. She had definitely said something about Jan-Arne being smelly. Somehow in my demented brain there appeared a picture of me running along and swilling him down with the detergent and cleaning cloth. That couldn’t possibly be what she had said. I hadn’t noticed any bad smell.

‘Say it in English,’ I urged her.

‘If you want to know where Jan-Arne is, follow the smell,’ she said patiently and then corrected herself, ‘scent, might be better. If you want to know where Jan-Arne is, follow the scent.’ She had been commenting on his aftershave. I must confess I felt very relieved.

Despite the few spare catch-up moments, most of my day was spent tending to animals. Just before one, I noticed a lovely little dog, which Jan-Arne was preparing to x-ray. A few moments later, we were looking at an image of something that appeared to be in the dog’s stomach.

‘What on earth is that?’ Jan-Arne asked.

I however, knew only too well.  ‘It’s a dummy teat,’ I said.

‘What?’ He was looking up at me in some confusion.

‘You know, one of those things that babies suck. It’s quite a common foreign body.’ Poor little dog. There was nothing for it but to open him up. We put him on a drip first as he seemed a bit depressed and had been vomiting for a day or two. In the meantime, there was Jack, a gorgeously friendly Rottweiler with a cut on his foot. As I was working with Jan-Arne anyway, I began to help him with Jack, and was delighted to find that the owners were British. As I sutured the foot, Jan-Arne went to start preparing the little foreign-body dog for his operation. He came back, and we swapped over again, so that he could sort out a prescription and as I was in a hurry, I asked if he could please take a photo for my blog. Sadly, the photos don’t do him justice because he was a very handsome dog. Still, he has a lovely brightly coloured bandage which I hope my fellow-blogger icelandpenny can appreciate.

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My day ended with the successful removal of the rubber teat from the dog’s intestine. It’s a very fiddly job making sure that the gut is stitched back together securely enough to ensure there is no leakage, without narrowing the tube so much that nothing will get through. Finally I could massage fluids past the incision without anything bubbling out, and so after an inspection of the rest of the intestine, I gladly sewed up the muscle and skin. It’s always a bit nerve wracking after any such operation, as there is always a slight risk of complication. I can only hope that, like Linus, he goes on to make a full recovery.

 

 

 

 

 

Luna and Lusi

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Dagny and Magne both seemed on good form on Tuesday morning. Our first patient was a still-youngish cat with an eye that was massively enlarged by a tumour. From an anaesthetic point of view, eye evisceration can be slightly complicated. As the eye is removed, the nerve at the back of the eye can cause changes in the heart-rate and breathing, so I was keen to ensure everything was stable and the monitors were all functioning well. The eye was so enlarged, that I wondered how easy it would be to complete the operation, but happily it all went very smoothly and the wound came together well.

Much later in the day, and another lump removal, this time from a dog’s leg. As happens sometime, Magne asked me whether I would like to suture the wound after he had removed the tumour. I know he doesn’t much like the stitching part of operations, and I rather enjoy it. There’s something very satisfying about bringing everything together and ensuring the end result is as aesthetically pleasing as possible. So as Jaqueline was available to monitor the anaesthetic, I told him he could go and get a cup of coffee and I would close up for him. As I was finishing, Magne came back into the room.

‘She’s very good,’ he said to Jaqueline, ‘No-one can stitch as elegantly as her.’ I was caught between delight and humour. As pleased as I was with the compliment, I had to laugh at the word elegant because I don’t think even my nearest and dearest would ever use that term. In fact, my mum once told me that I walk like a gorilla. Still, gorilla-steps or not, I did walk out of theatre feeling pretty good.

The weather in Jaeren recently has been wild: storm following storm. My drive to work takes me along the coast and there is little shelter, so on Thursday, as another gale flung hailstones horizontally at the window, I decided I would head to work early. In the event, the road was clear, and the wind, though gusty, didn’t affect my speed much and so I drew up in the car-park some twenty minutes before I was due to start. As I dashed through the rain, I was happily contemplating a cup of coffee with Magne before work began, but as I pushed the door open and stepped inside, I was greeted by an unpleasant odour. Working in a vet practice, you get to sample a number of different smells, most of them quite unsavoury. This one I identified as diarrhoea, though as I paced along the corridor, I was alarmed to see what appeared to be a trail of blood. Even more worryingly, on closer inspection, the bright red trail was in fact the faeces that I could smell.

Entering the prep-room, I found Lusi, a black Labrador retriever, panting on the floor. Her head was on her owner’s knee. Her eyes were frantic, her body stiff. I had seen Gerd as I came in, and rushed back along the corridor, to see whether she knew where Magne was. It only took a moment to ascertain that I was the only vet in the building. A few steps back and I was crouched on the floor with the little grouping. Wivek had made a tentative diagnosis yesterday of a prolapsed disc in the spine. Lusi was meant to go to Bergen this morning for an MRI, but had become very distressed, and the bloody diarrhoea was hers. I assessed her immediately for shock, but she seemed mostly to be distressed. She already had a catheter in her vein, and my first act was to grab some Vetergesic because she was so obviously in pain.

A drip next, and as she still seemed very unhappy, I decided to give some diazepam to try to relax her. I wasn’t one-hundred percent sure that yesterday’s venous catheter (now attached to the drip) was fully functional and anyway, I wanted to take a baseline blood sample, so I felt it would be better to place a second catheter.  As she was still lying on the ground, and I didn’t want to move (and thus hurt her) unnecessarily, I ended up lying full length on the prep-room floor as I angled my head to try to get the best possible view. Not necessarily the best idea in a cream-coloured sweater. Fortunately the floor was, thanks to Gerd, now spotless again.

Diazepam (better known to the UK public as Valium) works partly as a sedative, but with spinal pain that is causing muscle spasm, it can really make a difference. As I injected, I could see her visibly begin to relax, and though she was obviously a bit disoriented, the panicky panting stopped, and her rigid muscles became pliant.  According to Gerd, Wivek was going to be in at nine, and any decisions regarding the next step would have to involve her. I waited with her for a few minutes, but as she now seemed much more stable, I was able to go and get changed.

What with the weather, and with all the distress, Lusi didn’t make it to Bergen yesterday, but spent the day at Tu with her owner. The plan was, that if she continued to be stable overnight, she would travel up today. I’ll try to provide an update when I know more.

Working with Lusi reminded me of one of the reasons I love being a vet. There are few things more satisfying than knowing that you have helped an animal that is in pain. It often seemed to me, when working in the emergency clinic, that giving intravenous pain-killers to dogs in distress gave such immediate relief that they were genuinely grateful afterwards. Often in general practice, our patients become frightened of us because they associate the vets with injections and pain, and to see the opposite effect in action, was always a happy event.

I still don’t think Lusi liked being at the vets all day, but I very much hope that she goes on to make a full recovery.

Last, but not least, today’s photograph is Luna, a Tibetan Spaniel that came in this week to see Marita. Isn’t she lovely! Have a good week.

Belated Bacon Powder

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As some of you might have noticed, I didn’t blog last week. Sadly, last Friday I was on my way to Scotland for the funeral of my much-loved father-in-law. Among the sadness however there were some bright moments. On Sunday morning with the official ceremonies behind us, we paid a visit to the Barras Market which was fascinating. I loved it, but felt utterly out of place: a real tourist in a land I couldn’t fit into, and I couldn’t help but wonder what it would feel like to be a part of that culture. Still Monday brought us back to Norway and to normality, and although for a moment I felt a little homesick, the return to work steadied me, as it always does.

Now and then at work, someone will bring in home-baking, and last week I decided to take in some scones (recipe here). I took in strawberry jam, and squirty cream to eat with them, and they went down very well. Jan-Arne, of course, who is as fascinated with food as I am, said that he had heard about scones, and that he had expected them to be much drier. I suspect that whoever told him about them probably had eaten one when it was a bit stale, because of course, they don’t last long.

‘So how do you make them?’ was his next question.

I explained that you used flour and baking powder, and then rubbed in some butter and brought it all together with milk, but I could see his face cloud over, and his next question really confused me.

‘But what makes it rise?’ he said. Before I go on, I should explain that in Norway, the self-raising flour that I took completely for granted when I was in the UK just doesn’t exist here. For almost all baked goods thicker than biscuits*, you use baking power, so it seemed almost impossible that he hadn’t understood.

‘Well, the baking powder makes it rise,’ I said, and his face suddenly cleared.

‘Oh!’ A long drawn out sound. ‘That explains, it. I thought you said bacon powder,’ and he went off into his trademark giggle.

At this point Wivek arrived and asked what we were laughing about, and so we explained. ‘We’d probably all get a rise if she had used bacon powder.’ was her rather dry comment.

I don’t remember so many outstanding cases from the past two weeks. I know that last Thursday, Perle, the dog in the picture at the top of the page was booked in for a possible operation to relieve a build up of fluid following cruciate surgery, but that when she came, the situation was beginning to resolve and so the op was cancelled. That meant that my normal morning anaesthetic duties were out of the window, and as there were a few rooms that needed cleaning, I decided to get on with them. After sorting out the kennel room, the lab, and the x-ray room, I was walking towards consulting room A with my bucket, when Jacqueline, who had been clipping the claws of a dog for Marita came out of the dental room and yawned widely. It really was that kind of morning.

Of course, nothing is reliable in vet practice, and despite having hours of time in the morning to clean, I shouldn’t have been surprised when mid-afternoon, at the time when if I was working in an office I might be winding down for the last half-hour of the day, an emergency operation arrived and as everyone else was busy, I rolled up my sleeves (well metaphorically. In reality, I donned a surgical gown and gloves) and got on with it.

Thursday this week was quite quiet as well. Lucky for me, as I am trying to get up to speed on everything before I start officially consulting next week. Years ago, I was so used to my job that almost everything could be done on automatic pilot. I would say the same things over and over when I admitted an animal for an operation, and I knew exactly which drugs I would choose for a typical skin infection or diarrhoea case. Although I have re-learned a lot of things since starting work, I also (because I have done it all before) am aware of how many things I don’t remember. In the UK, it is common to have all the tablets and medicines in the practice, so if you are a bit stumped about dosages or applications, you can just pop through to the pharmacy and read the box. Here, almost all the drugs are provided via a prescription, so you have to know where to look everything up, and even when you do, it’s all in Norwegian, so it doesn’t only take a second to read, as it would have done before. No doubt once I start, it will all begin to come together, but just looking at it from the outside, it is a tiny bit daunting. I don’t really have any real uncertainty that it is the right thing to do though. It’s time I was properly back in harness.

As part of the learning process, I did get to spend some time in consulting rooms with my colleagues, and late on Thursday I found myself practising writing up the computer in Jan-Arne’s room. He had just micro-chipped a cat, and idly he started to run the scanner over his own neck.

‘Wouldn’t it be weird and alarming, if I were actually to find something,’ he said idly. Picking up one of the unused chips, still in its covering, he held it up to my back and scanned it so that the machine beeped. Of course, having seen him picking up the packet, I knew he was just messing around, but even as I watched him, I saw a mischievous look come over his face.

‘Where’s Marita?’ he said. ‘I want to see how she reacts.’ Of course, Jan-Arne in this mood is irresistible, and barely able to supress a giggle, I followed him. We couldn’t immediately find her, but sticking our heads into the prep-room, we saw Jaqueline sitting at the computer.

‘Why don’t you try it on her,’ I whispered to him, but he shook his head.

‘She’ll never fall for it,’ he said. I couldn’t imagine that anyone would really, but still always ready for some fun, I continued to follow him until he tracked Marita down, sitting in the office beside reception, looking at the computer. Sidling up behind her, he waved the microchip reader at her and ostentatiously started to scan himself.

‘Wouldn’t it be weird if I found something,’ he said, his face completely deadpan. Then without asking, he started to run the scanner over Marita’s  neck and back, and I watched as he slid the chip up into place and ran the machine over it. Marita’s face was a picture as she heard the beep, and for a moment it was obvious she really thought he had found something, but as she turned, she caught site of the package in his hand.

‘Uh!’ she rolled her eyes at him and laughed ruefully and I must confess that what impressed me most about this whole scenario, was Jan-Arnes unerring instinct for playing pranks to maximum effect. He really is a fun guy to be around.

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*I have been told by a friend from Texas, that what I call a scone is called a biscuit where she lives, and that the thing I call a biscuit, she calls a cookie, so if the whole of the recipe discussion is incomprehensible in your part of the world, I can only apologise.

In Which I have to Speak Norwegian.

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So it’s been an exciting week for me on two fronts. Firstly on Monday, I was lucky enough to spend a day out with Åsulf from the large animal practice, and second, I am now officially employed by Tu Dyreklinikk as a Veterinary Surgeon and not as an assistant. Of course, the terminology might be confusing to those who work in veterinary practice in the UK, because there my official title was always “Veterinary Assistant” because that is the normal term for vets who are not partners. Anyway, I feel very proud of my new role.

Mostly the transition has gone smoothly. I have handled consultations before at times when things have been especially busy, or clients have arrived unexpectedly, so it wasn’t wholly new. But like most people I find any kind of change comes with a degree of uncertainty. My mind was distracted doing my assistant work in the morning (I start consulting at twelve) as I contemplated the cases I was to see later. Indeed I had a particularly embarrassing moment when I started to shave a dog’s leg for a cruciate operation. Unfortunately, with my head wrapping itself around the potential complications of a male dog who had blood in his urine, I started to shave the dog’s hip instead of the knee. It suddenly came to me, about two clipper strokes in, when the damage to the coat was so great that there was no way to hide it. I contemplated just shaving a massive area off to try to cover the error, but it would have been obvious, and so I had to crawl red-faced to Dagny and tell her. Happily she just laughed, although she did toy with me evilly when she came through by suggesting that I had shaved up the wrong leg. I was very restrained though. Even after she carefully aimed a spurting artery at me in a later operation, I refrained from trying to drop sharp scissors into her toes.

One of the conditions of my change of employment is that I am strictly to speak Norwegian at work from now on. Although I had started out well, I had fallen into the easy habit of speaking English most of the time with my colleagues, although to clients I have always tried to stick with Norwegian unless they have indicated that they want me to do otherwise. Naturally though, Dagny’s is very concerned that the practice’s clients are satisfied with my performance, and therefore she did spend some time with a very serious look on her face urging me to always speak Norwegian to the clients.

On Tuesday then, my appointment list was full. Happily my first client was Kari-Anna, the nurse who is on maternity leave, and her dog was in for a blood test, so that was pretty much stress-free, as was my next case which was a cat with a cut on its neck whose owner had left it for examination, so there was no owner, no history to take, and until the owner returned, no discussion at all. It fell therefore, that my first genuine official client was the owner of a dog that had been in a fight and had a wound over its eye.

Gerd brought the owner and patient through, and as I led the them into the consulting room, the owner said to me

“It’s okay if you would rather speak English.’

With Dagny’s dire warnings about language still ringing in my head, I replied in Norwegian that it was quite alright, and if it was easier for her, that would be fine. She started to laugh,

*I’m actually from Scotland,’ she announced, and after that we got on like a house on fire. I really hope that she will ask to see me if she comes back in.

Thursday was a little less busy than Tuesday. Today’s photo is of Trøffen, who came in to have a cyst removed from his head. Wivek was operating, and she called me through to the consulting room before she started to check with me whether I felt that she would be able to bring the skin together on his head if we removed the rather large lump. Trøffen is only eleven and a half though, and the cyst had already been emptied and had refilled, so there was a risk in leaving it as it might have become bigger. She decided to go ahead, and as you can see, she has done a beautiful neat job. Trøffen is a really lovely cat. Indeed I’m finding great pleasure in working with so many cats. Both Jan-Arne and Magne prefer dogs, and so I like to help out wherever possible. Magne was really impressed with me yesterday, when having easily taken a blood sample from a patient that has not always been wholly compliant, I also managed to give it a worming tablet. I guess I’ve always been fortunate, as most cats seem to like me as much as I like them.

The day out with Åsulf though was a revelation. It was utterly delightful from start to finish, even though the first visit was to a pig farm, and because of the way pigs smell and squeal, they have never been my favourite patients. I was very impressed though with Åsulf’s injection technique. He made it look easy, when experience has taught me that really it isn’t. As we went around, checking calves, examining cows (and yes, I did have my hand up a few cow’s bottoms) I felt completely at home. It just seemed so natural, and I really felt I could just slide right back into that way of life. It’s very different from small animal practice. And for the first time, I found I had very little difficulty with the language. For the first time, I felt that at some point in the future, it might not be impossible for me to work with production animals again. Anyway, for the moment I will continue with improving my Norwegian, and maybe I will ask Jan-Arne if I can go out with him again one Monday, as he now works there one day a week. Who knows. I might even be able to teach him something.

 

 

Fifty Shades of Tabby

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I found myself turning into Jan-Arne this morning. At least… I didn’t suddenly find myself with a shaven head, sporting a beard and infectious giggle, but I did drop my trousers on the floor. They shocked me by leaping out of the corner when I went back to check whether the washing machine had finished, half an hour into my shift.

I confess I was distracted on my arrival at work, firstly by a broken mirror in the car-park, then by the sight of a small muculent mess by the door. Such slimy treasures are not such an unusual finding outside a veterinary practice, but obviously it needed to be cleaned up. As I was juggling the twin thoughts that I needed a brush and shovel and a bucket of water, I was further disturbed by the realisation that I had taken the last large pair of trousers from the pile. I pulled them on with a slight feeling of guilt that I might be depriving others of their comfort, but still couldn’t bring myself to shoehorn my thighs into a medium pair. It was this action that prompted the return to the changing room where the washing machine lives. As usual, the ever efficient Jacqueline had been there before me and a new load of washing was chugging round as the first lot pelted around the drier.

Returning into the fray, I came upon Marita and Jacqueline lurking suspiciously in the lab. I was able to diagnose an escaped patient, and from their relative positions, I was also able to deduce the escapee was currently underneath the sink cupboard. Happily within a moment they had retrieved the animal, which turned out to be a small, very sweet-looking cat, the first of the day’s tabbies. Having joined in with the hunt, I was happy to help Marita as she went on to spay the cat, followed by the spay of its sister, which was another tabby. Marita is getting very efficient with her cat spays. In no time at all, she had finished both, in spite of the fact that the second was a slightly more complicated operation than usual. In fact, she was perhaps a little too efficient with the first one. As I was cleaning up the second, she went and injected the first little cat with the antidote to the sedative.

It was only then that we realised that we had to put a buster-collar on her. Despite the fact that she was obviously rather flighty (as demonstrated by her excursion under the cupboards), I hadn’t seen any suggestion that she was vicious, and so I decided to make a solo attempt. It soon became obvious this wasn’t going to work. Just getting her out of her cage was difficult. Calling for Marita’s help, I struggled to get her to keep still. She wasn’t nasty. She wasn’t showing signs of anger, or trying to bite. She was just really wriggly. And she really didn’t want a buster collar on. I was most impressed with the way Marita slipped the thing into place. It always amazes me how efficient vets become at some rather unusual tasks. I was dismayed to see a pool of blood appear on the floor however, and as soon as the buster-collar was in place, I lifted her up to inspect her wound.

‘Oh, it’s okay.’ There was relief in Marita’s voice. ‘It’s your blood.’

Indeed it was. Crazy as it sounds, I too felt relief. Far simpler to wash a couple of scratches than to re-sedate a patient, maybe have to open her back up to satisfy ourselves she wasn’t losing blood internally.

My day of tabbies continued with Tommy and Britney. Tommy was feeling a bit under the weather, whereas Britney was feeling much better, having seen Jan-Arne yesterday. The flood of tabbies was only interspersed with one small pug, who didn’t quite fit the pattern, but was nonetheless adorable. And my final tabby of the day was Lille Pus, who is pictured at the top of the page. How beautiful she is with those piercing yellow eyes. She was actually Jan Arne’s case, in for a spay, but Britney had been so much better than expected, that I had some time to spare and so I was able to give him a hand.

And then my work was over, and as I went out to my car (for once actually on time) I realised that I had never managed to find the brush and shovel to remove the broken mirror from the car- park. Luckily Irene, fount of all knowledge about where everything is kept, located it tucked away in the large animal section of the practice. Of course, never one to shy way away from some fun cleaning, she accompanied me out and I ended the day dancing around, picking up bits of glass on the Tarmac with Irene as the rain drummed down. There’s never a dull moment in veterinary practice.

 

Tøffen demonstrating his buster collar for IcelandPenny
Tøffen demonstrating his buster collar for IcelandPenny

The Cat Charmer and the Messy Chef

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There’s a game I remember from childhood parties at my grandmother’s house. A tempting bar of chocolate was set on an table in the middle of a ring of children. Each child had to throw a pair of dice and if you got two sixes, you had a chance to go to the table and eat the chocolate. Before you could do so, however, you first had to put on a large pair of mittens followed by a woolly hat and scarf. Then, and only then, could you go and attack the chocolate, which you had to eat with a knife and fork, but woe betide you if another child threw two sixes before the process was complete. I was reminded of that game this week in the dental room. Whenever we are using the ultrasonic descaler, we put on protective gloves and a face mask and normally this takes seconds.

However, for some reason, the latest batch of masks are different from normal. Rather than elastic which slides easily behind your ears, these have individual ties, one set at the top and one at the bottom. Twice this week, one of my colleagues has come to me and asked, ‘Could you just begin this dental for me?’ and both times I have found myself putting on the latex gloves first (as I have always done in the past) and then went to put on the mask and found myself fiddling around for ages, trying to tie the bows at top and bottom. It sounds easy, but what with trying to get both tight enough so that the thing doesn’t slide off, and with my hair getting woven in, all hindered somewhat by the tight gloves which seemed specially designed for hair tanglage, I was inexorably reminded of the chocolate game as I wondered frustratedly whether the colleague in question would return before I had even managed to don the protective clothing.

I seem to have spent a lot of time in the dental room this week (not all of it getting myself tied in knots). Dagny called me in yesterday as she had decided the dog she was working on needed to go on a drip. Irene came to help me to put in the i/v catheter and both of them watched with some sympathy as I doused the leg in alcohol and then started doing the traditional ‘my fingers are nipping’ dance where you jig around the room shaking your hand where the alcohol has entered a wound.

‘Is it sore?’ Dagny asked (in Norwegian you understand).

‘Yes,’ I gazed down at both thumbs which were stinging horribly. ‘I must have a hole.’ It took me a minute or two to register that both Irene and Dagny were laughing at me, and a moment longer to realise what I had said. Of course we have been in this position before, only in English and with the roles reversed. Existing in a language that isn’t your mother tongue really does lead to a lot of faux pas.

With their laughter still ringing in my ears, I set up the drip and hung it up on a hook on the wall and Dagny said something to me. Thinking it was something about getting the drip into place, I failed to turn round to look at her… only to hear a few seconds later,

‘Ahem. Sarah.’ It was that tone. The one that lets me know I have missed something. I turned round… and realised that as I had hung up the drip bag, I had inadvertently turned the spotlight out. Dagny was trying to work in the dark. Fortunately she just laughed at my expression and carried on. At least she was using the light as it was meant to be used. Later in the day, in a moment of confusion, Wivek pulled the light fitting into position against a cats jaw. This would have all been very well if she was needing more light, but as she was trying to take an x-ray at the time, it was somewhat ineffective.

The cat in question was a beautiful cat called Laila. Earlier I had gone into Wivek’s consulting room to help with her sedation. It can be difficult to get cats out of their baskets when you want to examine them, but I was amused to see that Wivek, in a continuation of last week’s singing, decided that the way to charm Laila from her cage was by chanting her name very tunefully over and over. It was at least partially successful. Laila’s head appeared as she looked outside to see who it was who was singing so beautifully. Poor Laila. It must have felt a bit like the Siren’s song: irresistibly sweet, but concluding with an injection that sent her to sleep. Though whether those who were seduced by the real Sirens woke up with beautifully clean teeth, no-one will ever know.

Marita too was thinking of a change in direction this week as she stood in theatre, removing some tumours from a dog. She had discovered the pleasure of removing lipomas (fatty lumps) from under the skin by ‘dissecting’ bluntly using her fingers. It’s amazing how efficiently a lipoma can be removed as they are usually well defined and ‘shell-out’ quite easily.

‘I feel like a messy chef,’ she commented idly as she ran her fingers around the mass. She didn’t seem particularly amused when I suggested that after she was finished, she could use the lumps to make meatballs.

This week’s picture is of Dagny suturing a puppy’s eye. The unlucky pup had been scratched by an angry cat and as you can see in the picture, Dagny used the microscope to carry out the repair to the cornea using tiny suture material that was about the same thickness as a human hair. After stitching up the breach, Dagny clipped a section of the conjunctiva and sutured a flap over the damaged area both to protect it, and to carry blood to the area, which has no natural blood supply. The flap will be left in place for at least six weeks. Dagny’s final act was to inject some fluid into the front of the eye to make up for that which had leaked out. The whole process was utterly fascinating. Best of all though, without such care, the pup would have definitely lost one of her eyes. Hopefully this operation will give her a chance to grow up with both.

Specialist eye instruments (tiny scissors and forceps)
Specialist eye instruments (tiny scissors and forceps)

 

Happy Birthday

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Tomorrow is Jan-Arne’s birthday and at nine o’clock this morning, I received a message from Wivek to say that she and Marita were planning a special lunch for him at the clinic. I immediately wondered how I could contribute, and after some careful questioning, I managed to ascertain that whilst the savoury food was all planned, they were lacking a coherent cake strategy. Armed with only butter, eggs, flour sugar and cocoa powder, I began to throw something together. Luckily I also found some decorations hiding in my cupboard and so with only moments to spare, I made it in on time to join in. The other food was delicious. Marita had baked the most fantastic focaccia and aioli, and Wivek had provided a wonderful chicken salad. Somehow or other, I failed to take a decent photo of either, which is not like me at all. Like many food worshippers, usually I can’t resist taking photos of beautiful meals. Still Jan-Arne certainly looks happy.

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Last weekend, Tu Klinikk held its first CPD weekend on the subject of anaesthesia. CPD is vetspeak for Continuing Professional Development and in the UK, all vets are required under their agreement with the Royal College of Veterinary Surgeons to do an average of thirty five hours each year. The requirement in Norway is not quite so stringent I understand. More a recommendation rather than a requirement, as it was in the UK until only a few years ago.

Anyway, the subject of the weekend was anaesthesia. I confess I was delighted by this as I have spent a good part of the year working as anaesthetist for Dagny and Magne. It is unusual outside of the universities for vet practices to have a dedicated anaesthetist who is a fully qualified vet. Generally the vet who is carrying out the surgery also technically oversees the anaesthetic as well, and the patient is monitored by a nurse (or more rarely, an assistant). I find it very rewarding to have a ‘specialisation’. The lectures were in Norwegian (the lecturer came from Oslo). In the morning this was fine. I found I could follow quite easily, though my one-cylinder brain stopped translating as soon as I tried to write anything down so I had to make do with listening very carefully and plucking at Wivek’s sleeve at the end of each section for the bits that I knew I should have noted down, but didn’t manage.

I also managed to answer some questions that the lecturer posed about anaesthetic circuits, though slightly to my chagrin, I had to answer in English. I still don’t actually know how to say “one-way valve” in Norwegian, though as Wivek already laughed at me for my translation of “gas-flow rate” on my poster in theatre, I should have remembered that I really didn’t have to translate that one, other than adding an extra “s” onto the word gas. Just to make it more Norwegian you understand.

On my return to the practice on Tuesday morning, I discovered that Dagny and Magne had invested in some lovely new kit in the form of a drip driver, an infusion pump and a new oxygenation unit, so we will be able to make some positive changes to our anaesthetic regime. Whilst I fumbled through the set-up on my first run-through, it was obvious that Tornado Tawse already had everything running as smoothly as a weir in high summer. I only wish I could make everything look so effortless.

Infusion pump and syringe driver.
Infusion pump and syringe driver.

Wivek, true to form, was the first to use the new anaesthetic kit, putting her first heart-murmur dog on a propofol infusion. Like Jacqueline, she too seemed perfectly calm and utterly self-contained. I must say I was relieved when she confessed to me later that she thought that her own heart was hammering away far more rapidly than the happily anaesthetised patient.

Feeling that I had to make some contribution to this wonderful new era, I managed to create two pages of flow rates for ordinary surgical patients and shock patients, but the final task I set myself on Thursday afternoon was the rather complicated calculation required to work out the flow rate for post-operative patients where we won’t be using the drip driver. To give a brief oversight, you first have to work out how much fluid the patient will need in an hour. From that, you have to calculate how many millilitres will have to pass through in a minute. Then you have to work out how many drops that will be… and finally you have to split the minute into that number of drops so you can give a “time between drops” specification. Given that there are also two types of giving sets: one that gives 20 drops per millilitre, and one that gives 60, it is perhaps unsurprising that my brain came unstuck somewhere in this process and exploded messily all over the computer screen. Fortunately Jacqueline was there to clean up the vetty mess before anyone noticed. Just as well she’s as patient as she is efficient.

Happy birthday Jan-Arne.

Cake worship.
All hail the chocolate cake..

 

 

Jan-Arne and the Well Preserved Eye

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Intravenous catheters can be frustrating things. When I was working in the emergency clinic, almost every patient we admitted had to be put on a drip, so back then I got quite good at inserting them. Nowadays it seems a bit more hit and miss. There’s a definite pattern though. If I’m on my own, generally I can get them in without too much problem. Under the benevolent gaze of Magnificent Magne or Jan-Arne, it’s usually not too difficult. But both Dagny and Wivek make the thing look so simple that I seem to go to pieces whenever they are watching. Dagny doesn’t even have to be watching. She only has to be in the room for the difficulties to take effect.

Early on Tuesday morning, Dagny had all her kit laid out for an operation and (tactfully) wasn’t watching me in my attempts, but stood chatting to one of the other staff. The dog was a dachshund, and its legs were so short, that even after I had shaved quite an extensive area of its foreleg, its body hair was so long that it obscured almost everything. With shoulders that were becoming decidedly tense already, I selected the smallest possible catheter and took aim. Slipping the stylet through the skin, I was encouraged by seeing a tiny droplet of blood moving up into the breach. Quickly, I slid the needle a nanometer further in… and the bleeding stopped. I had gone right through. Trying to keep my breathing steady, I withdrew a little, but it wasn’t to be.

I decided at that point upon a tactical withdrawal. Often it is better to start again with a fresh catheter, which can’t be blocked and hasn’t been blunted by its first traverse through the skin. Selecting a slightly bigger catheter (sometimes this works better as they are less flexible) I set the tourniquet back in place to raise the vein and once again tried heroically to keep the hair out of the way with the final two fingers of my left hand whilst still stabilising the vein between my finger and thumb. This time, the catheter went into the vein, but when I tried to slide the sheath down off the stylet, it just bent. Through all of this, Dagny had been carefully not watching, but I could tell she wanted to get on. I confess I was relieved as she finally elbowed me out of the way and did it herself. A few moments later, with the catheter triumphantly in place, she looked around for the laryngoscope so that she could put the tube into the trachea for the gaseous anaesthetic but it wasn’t there. Ever efficient with her cleaning, Irene had already tidied it away.

A little later, and another dog, this time a little pug dog (or mops, as they are called here). This one was having its corneas treated with the cryoscope. Marita came into the room and began to ask Dagny about the freezing effect, and how strong it was. Ever the scientist, Dagny thought it would be a good idea to try it on herself. She held it against the back of her hand for a moment.

‘It’s not sore,’ she announced airily, and moved the tip to a different place with a smile.

‘Ouch!’ A moment later, she was staring at a white mark on her skin- ‘Okay,’ she admitted ruefully, ‘Maybe it does hurt.’

Jan-Arne managed to injure himself this week as well.  On Wednesday, he had taken a biopsy and opened up the small container filled with formaldehyde that would preserve the sample while it was sent to the laboratory. With an aim that he presumably couldn’t recreate, even if he tried, he managed to drop the sample into the pot in such a way that some of the formalin splashed up into his eye. After much salt water washing, he was packed off to the doctor’s to get it checked over. Fortunately there was no permanent damage.

He has though, been evilly trying to tempt me with birthday cake all this week. He brought in the leftovers on Tuesday. Heroically I managed to resist. I’m not really sure how many birthday cakes one person needs, but he seems to have been very well supplied. Then again, he’s so generous to everyone that he deserves good things in return.

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The remnants of the cake were still there on Thursday, but I confess I found it much easier to abstain. Also, someone had brought in a pack of freshly baked boller. Boller are widely available in Norway. They are a kind of sweet bread roll or bun, often with raisins or chocolate chips inside. These ones had bits of Smash: chocolate with caramel and salt. After taking one and eating it, Irene announced that she had discovered a new taste sensation. Jan-Arne and I, both foodies, were looking at her very intently.

‘I had a piece of the boller with a bit of cucumber,’ she said, with wonder in her voice. ‘It was lovely.’

There was wonder in my head. Specifically I was wondering whether such a combination could possibly be delicious or whether Irene had finally lost the plot. I hadn’t come this far with my resistance to eating extraneous sweet things lightly however, and somehow I managed to curb my enthusiasm towards this idea.

‘You could design a new boller,’ Gerd offered. ‘An Agurk Boller.’ (Agurk being Norwegian for cucumber).

‘A Cucumboll?’ suggested Marita.

‘What’s English for boller?’ Irene asked.

‘Bun,’ came the reply.

And so the CucumBun was born. At least it will be, when someone takes the time to make it.

 

Todays picture is Chika who was in for her first vaccination.

Guts

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It’s been a week for exploratory laparotomies. For those who don’t know, a laparotomy is a surgical cut into the abdomen, so an exploratory laparotomy is where that surgical cut is carried out to investigate what is going on. Despite the fact that we have many ways to explore inside animals without surgery such as x-rays, ultrasound, or even simple palpation (still a valuable tool) sometimes there is no way to be certain whether there is a serious problem without opening up the abdomen and having a look.

My photograph is of Anette, a seven year old Cavalier King Charles who was thought to have eaten part of a towel. Happily for Anette, the towel had already passed quite a long way through and Magne was able to manoeuvre what remained down towards her rectum. I was the happy person who went in to retrieve it.

It is much more complicated however when it is necessary to cut into the intestine to remove the foreign body. There is a risk of contamination of the abdomen (any leakage from the incision either during or after surgery leads to peritonitis). Hardest for me is when there has been damage to the intestine. It can be a difficult decision whether to open and remove the object or to remove the entire section of gut which has been damaged.

Removing a section is technically more difficult and there is more risk of contamination afterwards, but if the damage to the intestine is severe, it may never recover. For me, those kinds of decisions can be the hardest part of veterinary practice. There is always a tense period after such an operation before you can be sure that the animal is going to recover. I don’t know whether other vets spend so much time agonising over such decisions post-surgically. I suppose though, it is that which drives me to want to be as good as I possibly can.

Jan-Arne assisted me with two of the operations. The final one was on Wednesday and he had asked me on Tuesday whether I could come in specially for an hour or two to help him. I was delighted to do so. He is always so keen to learn new things. I was also happy because for the first time since I have been working at Tu, Charlie had taken a day off work and was able to come and see round the practice and join me in theatre.

He watched with interest and also chatted quite a lot to Jan-Arne during the process. Jan-Arne, as I have said before, works as a large animal vet sometimes, generally covering out-of-hours work such as nights and weekends. Charlie was impressed, as am I, by his unending enthusiasm. Having spent a number of years in large animal practice ourselves, it is hard to imagine relishing taking on additional out-of-hours work on top of working more full time already, but Jan-Arne genuinely loves these opportunities to work with farm animals.

I haven’t talked too much about his history, but I am genuinely in awe of the way he lives his life, making the most of everything that comes his way. He told me that in school, he always wanted to be a vet, but the careers advisor threw cold water over the idea, and his young self lacked the confidence to tackle the heavy requirements that are necessary for entry into the veterinary world.

He spent, therefore many years working in hotels, administration and marketing of telephones. In his thirties however, he was struck down by horrendous pain from a neck injury following a car-crash he had in his mid-twenties. Faced with life-threatening surgery, he made the decision that if he came through, he wanted to follow his childhood dream to become a healer of animals.

He became the first Norwegian man to qualify as a veterinary surgeon from the University of Veterinary and Pharmaceutical Studies in Brno in the Czech Republic. Continually inspired by his dedication and love for animals, I am very proud to work alongside him and the other vets, nurses and assistants who make such a wonderful team.