Wednesday, 15 February 2017

Not Tempting Fate

Well that was an interesting week! Having been so pleased with myself for "staying safe" so far, I hope I am not tempting fate! I encountered three rather uncooperative patients who warned me that I was not doing such a good job of "staying safe" as I thought! The first came in the form of a 12hh, 26 year-old pony. I had seen this creature about a year ago and knew he needed sedation in order to get near him with a dental gag, but I didn't recall anything worse than that and he looked another year older and as if butter wouldn't melt. The owner had reported some behavioural changes of late, hence the visit. So off I went to check his eyes, etc... and we decided to test his ACTH, perhaps run a general profile and so forth. So I set about performing venopuncture of his left jugular, only to be met by a demonstration of his ability to walk on his hindlegs. It seemed innocent enough at first, although the owner was doing little to try and control or restrain him, standing mostly behind me holding only the end of the lead rope... I persevered, trying my trusty neck twitch over the jugular trick which nearly always works and tensions the skin sufficiently so that they often don't feel the needle go in. But this pony knew that trick and up he went higher and higher, leg over the rope several times, eyeing up the field shelter exit. He contacted my elbow several times, hard enough to make me wince but not enough to put me off. I tried for an intramuscular injection, however his next trick proved a little unsavoury. Whilst up in the air, spocking out with his beautifully small but quick feet, he spun round in a bid for freedom, taking the loosely-held leadrope across my neck as he went. The owner surprisingly kept hold and I felt as if I was going to be decapitated! So we decided this was not safe and I suggested some oral sedation with detomidine. The owner warned me he was difficult to worm but she had managed with patience - she thought she would have a better chance if I absented myself. So I gladly left the field shelter, checking regularly to see how much progress was being made amidst the moonwalk shuffling of feet that could be heard through the wall. However the passionately performed paso doble had found the pair migrating out of the field shelter and traversing the field at a fair speed... so the owner requested we call it a day. She agreed to attempting oral sedation, perhaps in food, on another occasion then we could arrive when the sweet little darling was a bit less "fired up". I wasn't sad to hear that it was all over, although I don't like giving up in these situations. The pony clearly needed a stronger handler in order for this procedure to be carried out safely, so I vowed to return the following week with a member of the practice technician team. Unfortunately, the owner then called to say she could not do the following week and could we make it the week after. I tried to conceal my elation as I told her that I would be on maternity leave by then and so the task would fall to my colleague. She expressed concern that he may be more difficult with a man, but I was thinking that it won't make much difference and I am confident that two expert pairs of hands can make light work of this pony!

The second horse came with much more warning. I was called to take some bloods for export from a few broodmares at a local stud. When I arrived the superbly professional team were waiting and when they realised it was pregnant old me they expressed some concern over one of the mares who was very needle-shy. We had a quick briefing on how difficult she was, what was required, and whether we would we need to call another vet. I said I was happy to try given their excellent planning but obviously if there was any risk to any of us we would need to have a rethink. They got the twitch on her with a bit of a fight and we gave time for it to work. When she was looking suitably subdued and happened to be right near the doorway I took the opportunity to place the needle and start drawing blood. Unfortunately the contorted position of her neck made the jugular flat and obscured by bulging brachio- and sternocephalicus muscles. It was a nightmare to try to get blood from! Then just as we were filling the last tube she took off and the vacuum was gone. So the incredibly skilled handler regained control and this time we had the other jugular towards me. I went in and with better positioning of the neck managed to get the last tube easily and without the horse really noticing. Phew, done! Should I have called a colleague? I really don't know but I can say I felt complete trust in the stud staff and knew that we were all looking out for each other by observing for signs that she was going to react violently. If only they'd been there for the 26 year-old pony...

Then came the third problematic equine in less than 48 hours... in the form of a donkey, would you believe. I had also attended to this little beast before so knew he could be a stubborn sod, but clearly he was having a particularly bad day. His routine dental required sedation which had been tricky to administer last time but not impossible. Unfortunately he knows that being handled is a precursor to something that he will not enjoy. So even attaching the leadrope was a challenge and in any case it had no influence over the direction he moved in or where he decided to stand. He used his little donkey companion as cover and when that did not work he resorted to turning his backside on us (and he does kick, so a threat not to be ignored!). Once we had cornered him and I could get to his neck he tried rearing, but he found this too much effort and resorted to barging off across the stable. This pantomime continued for too long, with several successful needle placements abandoned because he body-slammed us against the wall, pinning my arms so that I could not operate the syringe before he took off again (and I am no rookie with young and needleshy types but these horses were seriously extracting the proverbial urine!). I started to worry about his tricks as I was pretty uncomfortable a couple of times and he wasn't going to budge whilst I was anywhere near his neck. So we abandoned trying the intravenous approach and tried an intramuscular injection, however this had minimal effect despite a hefty dose and a long wait... I think he was pretty angry by this point although I find donkeys' expressions hard to read - what does a furious donkey look like? Perhaps I should have tried IM sooner, but it was hard to gauge his adrenaline levels. Then a sizeable man turned up to see the owner and he offered to help but he too could not anchor this remarkably strong ass and so we decided enough was enough, and besides I was running very late for my next appointment. The owner agreed to reschedule to a date when one of her other equid's flu vaccinations was due, and so she could administer some pre-appointment oral dosing. However this date will be after my maternity leave starts... damn. No seriously I'd like to see this one through also but there's no point in letting one's pride take over.

So I have changed my attitude to the remaining days of work before I finish - I won't be too celebratory about how well I've handled the pregnancy and workplace dangers just yet... Perhaps I'll be more thorough in inquiring about any new horse I'm going to see and less blasé about those patients who I know can be tricky. So good riddance to the broodmare, may we never meet again, and to the other two devils incarnate, this beef is far from over...

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