I had been hard at work in my first job for about 4 months. A lot of the early nerves and tension had faded away, and I was feeling a bit more confident about being able to cope with whatever came in through the door. It was a quieter day, when a lady brought her little fluffy dog in to see me.
\”She\’s been limping on her hind leg, and otherwise she seems absolutely fine- happy, playing, eating well…\” I could see a shadow of worry in her face as she spoke.
\”She\’s only a pup, really, too- about 9 months old,\” I said. \”Let\’s check her over.\”
I examined her carefully, and the only thing I could find was that she was uncomfortable when I extended the hip joint of her sore leg. She whimpered a little, and gently mouthed my hand to let me know it hurt. She was a terrier cross, a small dog. Suddenly, a glimpse of a lecture from university popped into my head, in an intuitive flash.
\”Legge Perthes disease – the blood supply to the head of the femur (the ball that fits into the socket of the joint) is interrupted, and this causes the growth of the bone to be interrupted, so that the ball of the hip joint becomes stunted, causing a lameness. The treatment of choice is a femoral head excision.\” The lecturers dry tones echoed in my head as if he were looking over my shoulder.
\”I think I know what might be going on,\” I said. \”But I will need to take some x-rays to check out what\’s going on inside the hip joint. If it is what I think, we will have to do some surgery to fix it up.\” The dogs mum looked worried at that, and gave her little dog a fond pat goodbye.
There was nothing else on, so we suited up in the heavy lead capes, got the x-ray machine and x-ray plates set up, and then took some pictures. I went into the dark, dank, cramped, chemical reek of the developing room, shut the door, and turned on the red safe light. By the dim, ruddy glow, I pulled out the undeveloped films, carefully clipped them into the metal frames, and to the harsh buzzing cadence of the timer, I plunged them in the developer, rinsed, the fixative, and rinsed again. I shook the water off the films, the smell off myself, and took the still wet developed x-rays out to the viewer.
Bingo! A textbook case! The head of the femur on the lame side was half the size, deformed. I rang the lady back, and explained the diagnosis. She gave the go ahead to press on with the surgery, so I gave the little dog her premedication injection and dove into the library to study up on the surgery. It was one I had not done before, so I carefully memorised the steps- incise the skin here, dissect through those muscles there, incise the joint capsule, exteriorise the head of the femur, and saw off the head of the femur. I was confident, and a bit nervous.
We got the little dog out of her cage. My vet nurse for the day had set up the surgery. She held up a vein, and I slowly eased the anaesthetic into her vein, little by little, until she was deep enough to slip the tube over the back of her tongue, down the trachea, and gently inflate the cuff before connecting her up to the gaseous anaesthetic. We watched her carefully, checking her pulse, watching her respiration rate- giving her a higher dose of the gas at first, then backing it off to just the right depth of anaesthesia. Then the nurse clipped up and prepped the surgical site while I went and scrubbed scrubbed up.
I came back in, and the nurse opened up the sterile gloves for me. I grabbed a corner of the sterile packet, opened it up, and pulled them on. She carefully opened the sterilised surgical packs, and handed them to me. I laid them out on the tray, opened up the cloths, sorted the bright clatter of surgical instruments into order- towel clamps, mosquito forceps, scalpel holders, clamps, needle holders, forceps… Then I draped up the surgical site, leaving only a square of iodine stained, clipped bare skin. The initial incision, clamping off any little bleeders, perhaps tying a fine ligature on them if they were a bit bigger. Peeling through the layers of muscle, ever so gently, revealing the hip joint. Opening the joint capsule, working the head of the femur out, and carefully sawing it off with some embryotome wire.. Then sewing all the layers back up tight, until the skin was a neat row of sutures.
\”That went well,\” I said to the nurse, as the the little dog started to swallow a bit, and we gently removed the endotracheal tube. \”I\’ll pop her on a blanket here on the floor. Could you watch her recover while I give her mum a ring, please?\”
I told her mum that all had gone well, and a few hours later she came in to pick her up and take her home.
\”She might have a little limp on that leg after she recovers, but you will hardly notice. She\’ll still be able to run around and play, and do all the normal dog things,\” I told her. \”You will have to keep her really quiet for the next week or so though – I\’ll see you then to take out the stitches.\”
She gently picked her dog up, already frantically wagging her little tail, and took her home. A week later the little dog walked in on all four legs, hardly limping at all, and wagged her tail madly as I gently nipped the stitches out.