I pulled up in the early morning light, the palm fronds gently swaying in the breeze above the besser block angles of the vet hospital. The front door was already open, the nurse for the day bustling about, gathering up some errant bits of fluff shed by animals with a broom, punctuated by the busy, strident ring of clients needing attention. A sleepy spring day. I shook myself a little further awake, gathered my things from the car, called up Tikka, my irrepressible crazy white staffy. She jumped out, all muscle and attitude, tail thrashing with joy, and raced inside to jump all over the nurse. I never could get that damn dog to behave, she was a law unto herself. A cup of coffee was steaming gently on the bench, waiting for me. I gratefully sucked a mouthful in, and felt the kick of caffeine flow through my veins.
“Busy day?” I called out.
“Not too bad yet, but enough to keep us going,” came the cheery reply.
I went into the consult room, booted up the computer, logged in, and had a look. The morning consults were about 2/3 full, a nice way to start the day. Not so quiet as to be boring, yet not so busy as to be rushed. Then I heard the scuffle and chatter of our first client coming in, greeting the nurse, and the little dogs nails tick tackering on the floor.
“Would you like to come in?” I asked them both – a balding, slightly stressed looking man with a small fluffy dog.
“Ok!” he answered, and jumped straight up.
After they had come in, and I had squatted down to let his little dog sniff my hand (friendly, no signs of being nervous or aggressive, always a relief!), I asked what was going on.
“Excuse me if I’m a bit flustered, I didn’t expect to have to come in this morning, and I’m going to be late for work…. My little dog was peeing blood this morning – she seems right as rain otherwise, but it gave me such a shock! I thought I’d better get her checked over?”
“That definitely shouldn’t be happening, and yes, you did the right thing to come straight in, even if it has upset your day a bit. Pop her up here on the table, and I’ll have a look at her.”
She was bright enough, but looked somehow a bit uncomfortable. I checked her from head to toe – gums nice and pink, lovely shining clean teeth, heart sounded fine, temp normal, eyes bright and clear. Then I gently palpated her tummy. She was tense, and a bit tender, especially towards the back, where the bladder lives. I massaged my fingers in gently, deeper, seeing if I could actually feel the bladder. Eyes closed, I could build up a sense of the bladder- it was about 6 cm across, and felt a bit like a crunchy bag of marbles.
“I’m pretty sure your little dog has some bladder stones in there,” I told him. “I’ll need to do an x-ray to confirm that for sure, and if that is so, then I will need to do an operation to remove the stones. They will be irritating the inside of the bladder, causing the bleeding. I can’t be sure that’s all the problem, but it’s pretty unlikely to be anything more sinister. Are you ok for her to stay in and have all that done?”
“Oh yes,” He said. “Do whatever she needs! My kids love her to bits.”
I sent him out the front to sign the consent forms, and took her out the back, settled her into a cage. Tikka opened one eye as I walked back out the front, huffed, and went back to sleep. She could see I was busy, and the bed was comfy.
After I worked through the mornings consults, I gave the little dog a premed sedation. We had a quick cuppa, and then got geared up to take some x-rays. I turned on the machine with a gentle ‘thunk’, and it’s red glowing eye came to life. The nurse got the unexposed plates out, and we shrugged ourselves into the heavy lead gowns. We got the dog out, sleepy as could be, and gently laid her down, with a few sandbags to restrain her. She was happy to lie there, and soon we had a lateral and dorsoventral view taken. The nurse vanished into the dank darkness of the developing room, and I sat with the dog. She soon emerged with dripping wet pictures, and sure enough, there was the grey round shadows of 3 or 4 bladder stones.
We put her under with a full anaesthetic, hooked her up to the gas, and the machine that goes ping (to tell us when she took a breath), and the nurse clipped up and prepped her tummy while I scrubbed in. In a short while, I had the sterile drapes all laid out and clipped onto her, with just a glistening square of carefully prepped tummy exposed. I cut through the skin, the muscle wall, and gently exteriorised the bladder. I packed dampened swabs all around it, then gently cut through the wall. I pulled out all of the stones, and set them aside to show the owner later. Then I stitched the bladder up, popped it in, stitched the body wall and the subcutaneous layer with absorbable sutures, and laid out a neat ‘surgeons shop window’ line of stitches to close the skin. We turned off the anaesthetic, and laid her down on the floor on a towel to recover while we cleaned up. As soon as she showed signs of wakening, I slipped the endotracheal tube out, and soon she was sitting up, groggy but well. I put the bladder stones in a clear plastic pot.
He came back in with his kids to pick her up late that afternoon. They were wide eyed when I showed them her stitches, and the stones I had extracted! I explained that she would need a diet change, told them about her antibiotics, and sent them home. A week later she bounced in with the kids and mum to have her stitches out. I was told at length how gentle and careful they had been with her, and very closely watched as i gently snipped out the sutures….