How James Herriot Helped Me Keep Perspective
Nov 15, 2011Rob's View From The Passenger SeatRob Koontz, DVM
I was called to look at a two-month old filly with laminitis in both front feet. For those that do not know laminitis is severe inflammation of the structure that holds the bone in the horses' foot in place. Disruption of this organ can be devastating. Laminitis, however, was a strange diagnosis because I had never seen a horse this young with laminitis, but with veterinary medicine you never know. I asked the owner "what is she doing that makes you believe she has laminitis". "Well", the owner started, "she's lame in both front legs, I called a friend in Iowa who is a veterinary and he said that it had to be laminitis".
I am always skeptical of long distance diagnosis but when I started to examine the filly she was indeed lame in both front limbs. I noted, however, that she had none of the other signs of laminitis that I knew so well. The owner would not believe me, but the symptoms did not fit, she could not have laminitis. "Well" he grumbled "if she does not have laminitis what are you going to do?"
"First we must isolate the lameness" I explained. I did this with diagnostic nerve blocks. I temporarily numbed her feet so she could not feel pain coming from the feet. When her feet were blocked she ran like a normal two- month old filly, she was sound. "There", her owner pronounced triumphantly, "that proves that she has laminitis". "No", I replied calmly, "that proves the pain is in the feet".
I explained that there are many structures in the foot that could cause lameness, not just laminitis. In fact I believed that this filly suffered from bilateral coffin joint infection. The coffin joint is the joint inside the hoof capsule, it is unusual for both front joints to get infected at the same time but it was a more plausible explanation then laminitis.
I knew I would have to prove to this owner (and to myself) that my diagnosis was correct. I carefully placed a needle in each joint and drew out some joint fluid. "Notice the cloudy appearance of the fluid" I explained "normal fluid is not cloudy, this shows it must be infected joints." Later the laboratory would confirm my diagnosis.
The owner reluctantly agreed to let me treat for infected joints. I started the filly on a powerful broad spectrum antibiotic regime. I flushed the joints to clean out the infection and put antibiotics directly into the joints. I planned to come out the next several days to flush the joints repeatedly.
On the second day the filly was noticeably improved. By the third day she was running and jumping like she did when her feet were blocked, but this time it was because she was pain free. I puffed up a little bit and declared, "She looks pretty good!" "I knew she would get better" the owner countered, "You see after you left I called the herb doctor and he treated her with essential oils."
He must have read the look on my face because he continued; "now, now, you veterinaries are fine but I believe in these oils." "My cousin had a horse with severe neurologic disease, some veterinary said the stallion would never get better; but the herb doctor treated him with these oils and he's fine."
It just wasn't fair; I was the "some veterinary" that treated his cousin's stallion. I did a thorough job of diagnosing the neurologic form of Equine Rhinopneumonitis. I most certainly did not say the horse would not recover. In fact I said that with proper treatment the stallion would do very well, than I proceeded to administer proper treatment.
Here I had correctly diagnosed two very difficult cases, applied the proper treatments and the horses' made full recoveries. I did all this and some sweet smelling oils got the credit. It just wasn't fair. Then I remembered the words of the great veterinary sage James Herriot who explained that veterinarians usually get too much credit when things go well and take too much blame when things go poorly. According to Herriot "Animals are unpredictable things, and so our life is unpredictable. It's a long tale of little triumphs and disasters. You really must love it to stick to it." Some day, I knew I would get the credit for a triumph I did not deserve.
I thought back to one of those triumphs. I was performing an ultrasound examination confirming pregnancy in a mare. Her owner asked; "boy or girl". The mare was not far enough along to determine sex and you certainly could not see color on a black and white ultrasound screen but I flippantly replied; "she's a chestnut filly with three white socks."
About a year later the mare gave birth to a wonderful chestnut filly with three white socks. Ignoring my protest; I had just been lucky, the proud owner told anyone that would listen that I was the greatest veterinarian. Her reasoning was that if I was that good with an ultrasound then I must know everything about reproduction.
I thought about James Herriot, the chestnut filly, and essential oils. I realized that even if I don't always get the credit, through all the little triumphs and disasters, I continue to love my career as an equine veterinarian.