Tag Archives: Operation

It’s a gas

The past two Tuesdays have been busy with operations. So much so that I rarely set foot outside theatre on either day. Last week I assisted with the anaesthetics for an exploratory laparotomy, two cruciate ops and a  fracture repair. This week  there was an entropion op (to correct in-turned eyelids), an eye removal, a mammary tumour operation and yet another cruciate. Both weeks I ended up staying an hour late. We passed part of the time talking about the Julebord (Christmas party). It won’t be happening for two months, and yet it is already the subject of much discussion. It sounds quite a wild event. Apparently last year, Jan Arne had a candle on his head. The dress-code is listed as “Pyntet” which is the same word that is used for a Christmas tree when it has been decorated, but sometimes things can be taken a bit too far.

Thursdays are a bit more varied for me. As has been happening lately, I arrived to find Magne having coffee with a couple of the vets from the large animal practice next door. He invited me to join them and seemed disappointed when I said no, but when I explained that if I didn’t get on, his room wouldn’t be ready when he needed it, a wave of approval washed over me from all of them. Dedication is my middle name!

I found myself back in theatre later in the morning when Jan-Arne had a cat to spay. We were just examining the cat to check that it was healthy for its operation, when Jan-Arne spotted the fact that the cat’s mammary glands were distended. Having inspected them, and decided that he could still go ahead, he said something and suddenly started to giggle.

‘What is it?’ I asked him.

‘I just realised I said “pussy milk”‘ he said, and started laughing more.

He was quite insistent that I must add it to my blog, though I did express some concerns over the possible Google Searches it might send my way. I quite forgot to mention that my parents would be reading. Hello Mum. Hello dad!

As ever, a flank cat-spay seems to cause enormous interest in the practice. At one point I looked up to see Wivek, Magne and Irene all looking through the glass windows in the doors of the theatre. Seeing me looking at them, they all pulled crazy faces. I so regret not having my camera. I had never noticed the resemblance Wivek has for Jack Nicholson before, but it was very striking. Luckily she didn’t have an axe.

The operation itself was more difficult than usual. Most young cats have very little abdominal fat, but this one had more than average. It wasn’t hard to find the first ovary, but the second one was difficult and so Jan-Arne asked me to take over. It took a while to track down the offending ovary, but having finally located it behind the kidney, we were all able to relax a little. It seemed that the cat was not quite finished with us however. As I returned all the intestines to their correct place and prepared to close up, there arose in the room a vile miasma. The stench of cat-fart wafted around the room to a wretched chorus of groans and fluttering hands. The cat’s bowel had been quite distended before I pushed it back into the abdomen. Undoubtedly I had caused the stink. Without looking up I made a general apology to Jan-Arne, Kirsty and Marita, all of whom were standing in the room to watch.

‘Sorry about that.’

The silence in the room was palpable. So much so that I looked up, puzzled, only to see a wall of astonished and horrified faces (well, there may have been admiration on Jan-Arne’s. He is a man after all). It dawned on me that every single one of them thought that I was personally responsible for the awful odour.

‘Hey, no!’ I said, looking round at them all. ‘I only meant that I had caused it by handling the cat’s guts.’ The look of relief that came over the faces was hilarious. So much so that I began to giggle, and then Kirsty joined in, and then suddenly the whole room was filled with laughter. It was hard to stand up. About five minutes later, I was able to control myself enough to wipe away my tears and begin to stitch. So much for professionalism.

 

The picture at the top shows Ingo, a French bulldog who was in for an intravenous drip following a bout of illness. He was very patiently waiting for me to remove his drip so he could go home. Feel better Ingo!

The Eyes Have It

It’s been an interesting and busy week in the clinic. Dagny and Magne were both away on holiday, and what with working an extra day and with not being so intensively taken up in theatre, I felt a wonderful growth of teamwork with Wivek, Jan-Arne, and particularly Marita, with whom I spent more time this week than ever before. Given that we were two vets down, and the clinic was still busy, I was pressed into more directly clinical work than usual, and although it can be stressful at times, when things go well there is a huge satisfaction in meeting the challenges and knowing that you are making things better for the animals.

Of course, as soon as Scary Boss Lady and Magnanimous Magne, the ocular specialists were out of the picture, two of the cases that came in were eye problems. The first, a handsome spaniel who had been out for a long moorland trek the day before, arrived with a very sore looking eye. He was in so much discomfort that he wouldn’t even let me look at it and the first thing I had to do was sedate him. It was then quite hard to examine the cornea, because his eye rolled down as he got sleepier and so I asked Marita to come in and give me a hand. The cornea looked to be all clear, and it was at that moment, that Connie, a student who has been helping out for the past couple of weeks pointed out that there was actually a tiny splinter of wood stuck on the white part of the eye. I was tremendously glad of Magne’s special tiny eye instruments as we clipped a tiny hole in the conjunctiva and removed it. It was wonderful to see him yesterday for his check-up looking much more comfortable.

The second case, the gorgeous seven-week-old pup at the top of the page came in on Tuesday morning. He’d had some kind of accident with his mother, and his eye had completely prolapsed from its socket. He too was in a lot of pain, and needed a full anaesthetic before we could start to try to put his eye back into the right place. Again Marita and I worked as a team to place some stitches into his eyelids before carefully sliding everything back into position. The stitches in his eye have to stay in for two or three weeks and although everything went well, we will only know for sure how much damage has been done to his eye when the sutures are removed. Happily Dagny and Magne will be back by then.

Jan-Arne has been his usual crazy, endearing self. I love the way he takes his time and gets to know the patients really well and goes out of his way to make them feel at home. I went in at the end of one of his consultations on Tuesday to find him sitting cross-legged on the floor. When I worked in the emergency clinic in Scotland, I gradually got more and more idiosyncratic and often consulted sitting down on the floor at dog level and I think he is the first other vet I have seen doing the same. I also overheard him yesterday singing back at a German Shepherd who had been singing at him. It was a beautiful duet.

And somehow, though the quiet week I had anticipated with only two or three vets consulting didn’t emerge, I still found a few minutes on Tuesday to complete the first part of a project I am undertaking with Wivek to set up a consistent anaesthetic protocol for the practice to ensure that we are completely up to date with providing anaesthesia that is both safe and provides a high level of pain-relief for all our surgical patients. Of course, as I am in Norway, I thought that it would be a good idea to provide the poster I was creating about Gas Flow Rates in Norwegian. Having showed it to Irene, who assured me it was fine, I proudly printed it out and laminated it… and then went to show Wivek. How was I to know that the word that means flow when it is water and electricity doesn’t apply to gas? And of course my assumption that if you exchanged the “c” in “maintenance” to an “s” would turn it into a Norwegian word seemed logical enough at the time. And litre… apparently the Noregians prefer the American spelling. Ah well, after six years in Norway, I am probably one of the most proficient writers of Norglish that the world has ever seen, and that is something to be very proud of.

Operation

I can’t write too much this week as on Thursday I was in hospital myself for an operation. This weeks featured photograph is of an incredibly laid-back and friendly cat called Loke after the Norwegian God (spelled Loki in English). Loke was Jan-Arne’s patient, but I spotted him through the doorway and couldn’t resist asking if I could take his picture. Typically enough, Jan-Arne found the time to tell me all about Loke’s history… as well as the cat’s.

I stopped on my way into work on Tuesday. I was early, and couldn’t resist taking some photographs of the beautiful sky.

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Sadly I didn’t manage to get a view of the sea, which was a brilliant blue turquoise under that rose sky. I am lucky to live in such a beautiful place, though I confess that the drive might be more daunting in winter when the snow comes. Thank goodness for spiked tyres.

I have been waiting almost a year for my operation. It seems there are long waiting lists in Norway for non-urgent things. I finally received a telephone call last week from the hospital offering me a time at short notice… and Dagny very kindly agreed to allow me to accept. She even signed her get-well message “Scary Boss Lady”. She seemed impressed too with my Norglish gas-flow chart. It’s all good.

I arrived home on Tuesday to a favin (Favyn? feel free to correct me, oh kind Norwegians) of wood for the stove.

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It’s all neatly stacked in the garage now, though I will have to call the chimney sweep before lighting up. The sweep comes around here automatically, but sadly I managed to miss him. Unlike British chimney sweeps, who use a big vacuum cleaner in your living room, Norwegian sweeps climb up on the roof and knock the soot down from the top. There’s normally a ladder on the roof of each house to aid this ascent. Then there’s a little door in the cellar where he can go in and scoop it all out. On Tuesday night, I received a text message from Charlie who was out for a cycle, to say that the aurora was good. I went out and jumped in my car to drive to the top of the hill, and found to my surprise that the snow poles had been set in place already. I guess they have to go up as soon as the temperature starts to drop, just in case. Sorry to any of my lovely Norwegian friends who are reading this. To me it still all seems quite novel and exciting. A bit like being permanently on holiday.

Anyway, I must go now. Thanks for reading.

Tornado Tawse

It was Jacqueline’s turn to earn herself a new nickname this week. Irene and I were standing discussing something (something very important you understand, we would never stand around gossiping) when something whizzed past us so quickly that it was almost invisible. My eyes tried to follow, but the thing moved so rapidly that I wasn’t able to focus. Fortunately Irene’s younger eyes were more efficient.

‘It was Jacqueline,’ she said with a smile. ‘She’s just so fast all the time.’

I couldn’t help but grin. ‘That’s true,’ I said. ‘The only way you can tell if she’s been there, is because everything  is suddenly tidy.’

‘Yes,’ Irene agreed. ‘Everything sparkles after she’s whisked through.’ And so Tornado Tawse was born.

But by now there was a sad look on Irene’s face. ‘When do I get a nickname?’ she asked. ‘Nearly everyone else has one.’

‘What about Scary Boss Lady Junior?’ I said, but she shook her head.

‘It has to be something like Magne’s, you know, starting with the same letter.’

‘You mean something like Impetuous Irene?’ I said. She looked at me suspiciously.

‘What does Impetuous mean?’

I thought about that for a moment. I didn’t know the Norwegian. ‘Well, jumping into things without thinking about them. Kind of crazy and wild.’

At this point there was a disturbance of the air, and we realised that Jacqueline was hurtling past. ‘Hey Jacqueline,’ I called out. ‘What’s impetuous in Norwegian?’ (Jacqueline is Norwegian, born of British parents, so she is bilingual).

Jacqueline stopped, but after a moment’s thought, she admitted that she didn’t know either.

‘Why?’ she asked.

‘We’re trying to think of a nickname for Irene. Something starting with ‘i’,’ I said.

An evil grin spread over Jacqueline’s face. ‘Irritating?’ she offered. ‘Irrational?’

Irene’s eyes widened as she glared at Tornado Tawse. ‘How about Irresistible?’ she said. ‘Incredible? Inspiring?’ I was glad to see she was smiling again.

‘Actually,’ I said. ‘I think that Impestuous Irene, is my favourite.’

‘What does that mean?’ she asked.

‘Absolutely nothing,’ I replied. Personally I like it. It may be a made up word, but it definitely suits her.

Thursday was a whirlwind day. It started quietly, and I had time to clean both the dental room, and the lab before the first operation, which was a cat spay of Marita’s. It turned out to be rather a difficult one, as the chest was quite deep and the ovarian pedicles were tight and so I scrubbed up to hold everything out of the way so that she could tie them off safely. It all went very well.

After we had finished, I saw a beautiful English Setter going into Magne’s room, and something made me follow. There then followed an interesting history taking session between Magne and the owner, which I managed to follow almost in its entirety, despite the fact that both were speaking quite quickly. I also, to my pleasure, came up with the correct diagnosis. The pleasure was only related to my diagnostic prowess, however. From the owner and animal point of view, it wasn’t great news because the lovely dog was suffering from pyometra. For those who don’t know, pyometra is an infection within the uterus. In some cases this is obvious because pus is discharged, but in some cases the cervix is closed and there is an internal build-up, and that is particularly risky as there is a chance of rupture. Magne and I took the bitch through to the ultrasound machine, and Wivek came and confirmed the diagnosis and measured the size of the uterus, which was quite distended.

I was unsure whether Magne would have time to go ahead with the operation immediately. Dagny wasn’t there, and she normally assists, but as the dog was already sedated, it was better to go ahead. I considered offering to operate alone (with Jacqueline to monitor the anaesthetic) but as it is normal here for two vets to work together on such operations, I didn’t want to risk anything going wrong. I’ve done many such operations alone in Scotland, but they were quite a long time ago now.

Anyway, after only a short consultation with the owner, and with Gerd, Mellifluous Magne announced that he would go ahead with the operation. He asked me to get the patient prepared while he saw his last patient of the morning, so with Jacqueline’s help I put in a catheter, set up a drip and intubated her. Jaqueline had set up the anaesthetic machine, and very smoothly everything was set in place.

The operation went amazingly well. I repeated my actions of the cat spay, holding everything out of the way for Magne to tie off the ovarian pedicles, and the enormous uterus was removed safely. All that remained was for me to stitch up, and Magne seemed delighted with that too.

After lunch, I helped Marita with another cat spay. It’s an odd thing. Normally a bitch pyo would be a complicated operation, and a cat spay straightforward, but not on this day. Cat spay number two was very unusual. Again I scrubbed in as Marita was having difficulty locating the uterus, and between us, we eventually managed to find what seemed to be the left ovary, which looked cystic. Odder still though, there was no uterus attached. We called Dagny through, just to make sure, and for a moment, my heart was in my mouth. If she immediately pulled out a normal uterus, I was going to look rather stupid, however she only found the same thing as we had, so after a brief discussion, she told us to go ahead and remove the one ovary that we had found. It was very unusual. There had been no sign of a scar on the midline when we went in, and after the operation, we carefully felt the cat’s flank, but there didn’t seem to be a scar there either. Anyway, after I had sutured the second cat-spay, it was time to go home, and I collapsed into my car tired but happy after a very busy day.

It only remains to say that the Julebord (Christmas party) is tomorrow. Irene, Jacqueline and I are all getting together for a beauty session. Irene always looks stunning, so I’m relying on her to do me proud. Hopefully there will be some photos to share.

Co-Operation

Tuesday morning began well with Dagny and Magne operating to remove the most enormous piece of detached cartilage I have ever seen from a dogs shoulder joint. It went so smoothly that I had a good feeling about the remainder of the day. Reality reasserted itself when I went through and carefully laid the dog in the kennel… and stood up, bashing my head off the door of the left upper kennel. Instinctively recoiling, I ricocheted and thumped the other side of my head on the door of the other kennel. It was that kind of day.

Next came a mammary tumour, which I had seen on the computer. I confess I had expected a dog (I saw the operation, and didn’t check the species because mammary tumours in dogs are incredibly common, and in cats incredibly rare). Again the same pattern, the operation itself went very well. I was doing this one on Magne’s behalf because he was running slightly behind schedule. As I inserted the last stitch, stripped my gloves off and walked out of theatre to wash my hands, Mobility Magne rushed into the room, brandishing a cat cage at arms length.

‘Can you do something with this,’ he gasped, before disappearing. I confess, I was somewhat surprised, but as the most disgusting stink assailed me, I realised that the cat in question had deposited something utterly rank in the cage. Luckily I have a strong stomach, so without further ado, I cleaned up the mess. Being a vet really is a very glamorous job. I am reminded at such moments, of James Herriot, comparing his vocation with that of a small animal surgeon and humorously self-deprecating as usual. He mentions that after his operations, “the final scene would have been of Herriot the great surgeon swilling the floor with mop and bucket”. Well even though I now work in small-animal practice, it’s not so very different. ReMorseful Magne (see what I did there) did proffer a partial explanation later when he told me that the awful smell was literally making him gag.

In the afternoon, I had a cat spay booked in, but somewhat to my surprise, two turned up. The owners, after being told by Magne that I sutured very beautifully, had asked that I be allowed to spay their cat, but they seemed confused when they arrived and saw only me. They had been expecting Magne to supervise. Fortunately at this moment, the man himself turned up and smoothed everything over. The highlight of my afternoon however, was when Irene was attempting to shave up the second spay for me. Because most cats here are spayed midline, she needed to be reminded of the landmarks I use when deciding where to incise. She had the cat laid out on a chair and seemed to be paying close attention as she felt around for the bony protuberances of the hip and thighbone. Finally, she found what she thought felt right.

‘Am I in the right place?’ she asked. Rounding the corner of the table to take a look, I was somewhat surprised to see her eyes were close to shut as she concentrated fiercely on what she was feeling, and that one of her fingers was on the shoulder and the other somewhere on the neck.

‘Um… well it would be if the cat was the right way round.’ I commented with a giggle. Fully expecting her to join in with my hilarity at this very funny joke, I was amazed when she opened her eyes wide and looked mortified. She really hadn’t noticed.

‘This stays strictly between us.’ Red-faced, she tried to silence me, but unfortunately nothing so amusing ever stays private here and she did continue giggling at herself for at least half-an-hour, so I guess she must have seen the funny side. I fear she may try to get her revenge by commenting to mention the very loud fart I let out when I was bending over to clean the floor in room B last week, but of course everyone will know that couldn’t possibly be true. I could never be so crudie.

Thursday morning began with a Caesarean. Dagny and Magne again, working as a team. Magne did the first part of the operation while Dagny revived the puppies, and then Dagny took over to stitch up. There were four healthy puppies, which is always a lovely event. Dagny had only had two hours sleep, but was still working as efficiently as ever. I have a feeling that her amazing cheekbones can get her through almost anything because she looked as good as ever too. Fortunately after the operation, she was able to go home and get a couple of hours sleep before the lunchtime meeting.

This weeks picture shows Wivek operating. It doesn’t get much more glamorous than this.

Fest!

There’s only a week left until Christmas, but there is still lots going on in Tu. Tuesday started with a bitch spay. The patient was a lovely little dog, and naturally her owner was worried. Happily, with Dagny and Magne’s nimble fingers, the operation was very swift and her owner was hugely relieved to see her friend back safely. Even with surgery that seems routine to us,  for every owner it’s a unique and frightening experience.

For some reason, every time I walked into the laboratory, Marita was there using the hairdryer. We have quite a lot of technical equipment in Tu, but there are also some much more down-to-earth items that we use, and the hairdryer is one of them. It’s used on microscope slides to dry the material before staining and to me this is usually a very prosaic action, but as Marita stood there with her left foot at a rakish angle, right hand merrily oscillating, she looked very glamorous. Maybe in a previous life she was a stylist to a famous film star.

Although the day was busy, somehow in the afternoon, Magne and I managed to sit down for a cup of coffee. I think it must be a first for us to have time to do that. As well as coffee, Magne took a chocolate from his advent calendar and immediately afterwards he began to cough. I wondered whether he was so over-excited that he was choking, but when I asked he assured me it was only kennel cough and he acquired it because he hadn’t been vaccinated with sufficient aquavit.

Thursday was the day of our Christmas lunch in the klinikk, but before that, I had to help Magne clean out a dog’s ears. Pio, who weighed in at about seventy kilos was probably the biggest dog I have ever seen. Happily, he was also very good-natured. He and I had a lovely cuddle.

Pio
Pio

As for the fest (party) of the title, everyone in the clinic was invited, including the large animal vets whose office is in the same building. In the UK, an office Christmas party might consist of crisps and mince pies, or on a good day, sausage rolls and turkey sandwiches. Here they serve risgrøt, or rice porridge,  which is liberally sprinkled with sugar and cinnamon, and garnished with butter. I still always find it slightly disconcerting to be presented with a plate of rice-pudding for lunch, but it’s definitely not objectionable. Somewhere in the risgrøt, there is usually an almond or two, and whoever finds one wins a prize. In this case, the winnings were three large bars of chocolate, and they were won by Gerd, Jaqueline and Jan-Arne.

Of course, no Christmas party would be complete without the Christmas Banter. This year it was provided by Scary Boss Lady and her Whipping Boy. It began with Dagny laughing at Jan-Arne for the fact that he had been caught for a second time leaving his trousers on the  floor of the changing room. Then she asked,

‘Is it true as well that you came to work in your pyjamas?’ Jan-Arne flushed slightly, but valiantly defended himself.

‘Well at least I don’t scuff my feet along the ground when I come in in the morning.’

Dagny frowned and shook her head. ‘I don’t scuff my feet.’

‘You do. Everyone can hear when you arrive.’

Dagny opened her eyes wide. ‘It isn’t true,’ she said and looked challengingly around the room. ‘A show of hands please, who can tell when I come in?’

I fear that the vote would have been unanimous, if only I had been keeping up properly with the conversation, but as usual, I was five steps behind.

I suspect that Dagny is one of those people who believe that attack is the best form of defence, and so she returned to a subject that had been going on since before the meal had started.

‘Well at least I didn’t open the chocolates that were meant to be eaten with this lunch. I think you should give your bar of chocolate back so we can all share it. Without another word, Jan-Arne carefully lifted up his prize and slid it into his pocket.

But all in all, it just goes to show, that however much effort you make, and however far you travel at Christmas, there will still always be someone who has to argue over who it was that ate all the chocolates.

Holiday

Even after many years, I still greet Christmas and the New Year with a heightened sense of joy that I don’t have to work on either day. All round the world, many wonderful people in the emergency services give up those days to help others, and I send my good wishes to all my friends and colleagues who have been, and will be working over the holiday period this year. I expect when I return tomorrow, there may be a few Christmas related cases. It only takes a moment or two for a dog to eat something that he or she shouldn’t, and chocolate and raisins can be toxic for dogs, as well as the simple problem of too much turkey.

Last Tuesday, the day began as I walked through the prep-room on the way to change into my uniform.  Linus, (whose picture you can see at the top of the page) had been very ill and vomiting for a few days, and he was in a lot of pain and seemed utterly exhausted. His abdomen was so painful that Dagny had to sedate him to examine him properly, and when she did, she could feel something. Whatever it was, it wasn’t visible on the x-ray (some items show up clearly, but not all do) so the only way to help Linus was an exploratory operation. His owners were naturally very fearful. Linus is eleven years old and as the lump wasn’t visible on the x-rays, it could be anything from a peach-stone to a tumour.

As Dagny readied herself for surgery, I prepared Linus for the operation. The monitors attached, I was concerned to find that the oxygen levels in Linus’ blood were very low: not very surprising as I could see that his gums were pale, nothing like the fresh pink colour they are in a healthy dog. I turned the intravenous drip as fast as it would go, and kept the anaesthetic levels to a minimum as Dagny began to cut.

It didn’t take long for her to locate the lump, and it was immediately obvious that it was a foreign body and not a tumour. The gut was inflamed where whatever-it-was had already passed through. I opened up the set of special clamps and the  multiple packs of gauze I had ready and Dangy placed them around the gut to keep everything clean.

Pausing for a moment, she looked up and smiled. ‘What do you think?’ she asked. ‘I’m betting on a kongle!’ Kongle is Norwegian for pine cone. Her attention firmly back on her work , she cut carefully into the segment of intestine and drew out what proved indeed to be a section of pine cone. Poor Linus. No wonder it had been so painful.

From that point in the operation, it was obvious that things were improving. As Linus’ guts began to function again and the fluids from the drip got to work, his oxygen levels climbed from sixty-two right up into the high nineties, which is where they should be when everything is functioning well.

‘Would you mind just quickly going and telling his owners that it wasn’t a tumour?’ Dagny asked, as with the hole in the gut closed, she began to stitch the abdominal muscles. ‘They were so worried.’  As everything was stable, I was delighted to run through and tell them. What better Christmas present could there possibly be for me and them?

There are one or two things I find difficult about being an assistant. It’s not so easy for me to telephone owners and ask for an update, as I might do with one of my own patients. But I hope that the signs that I saw during that operation boded well for Linus and that he and his owners have had a wonderful Christmas together.

Merry Christmas everybody.