Today served up one of those true examples of something not quite being as simple as one might initially have expected, this time in the form of a tricky case of hide and seek. Clinical hide and seek that is.
The afternoon saw a stray cat presented with a history of a swollen paw, with the concern being that it was broken. The fact that the cat was weight bearing and had a discharging wound on the front of the paw did make me doubt whether we were dealing with a fracture or, as I suspected, simply a bad case of infection on account of a cat fight. Anyway, the cat was duly tested for FeLV and FIV, both unfortunately common among the stray cat population, and was thankfully found to be negative for both. Examination of the paw under anaesthetic (it was too painful to examine thoroughly conscious) resulted in pus being expressed – so clearly an abscess was present – but there was something about the level of swelling that didn’t quite fit with a simple cat bite abscess. As such, x-
rays were taken after all and the cause of the swelling and discharging tract soon identified: a small radio-opaque foreign body present in the paw, sitting, based on the views taken, right in between the metacarpal bones, the equivalent in humans being the bones in the main body of the hand. The object was suspected to be a tooth and was, according to the images, in line with the open puncture wound on the paw.
Consent was received from the owners to take the cat to surgery in order to remove the mystery item; a simple procedure that I would be able to complete within thirty minutes before my afternoon consults. Or so I thought. As is often the case in all walks of life, from professional veterinary practice to business, and life in general, the initial simple imagined scenario – ie, I open the wound a little, find said object quickly and heroically remove it from the paw thus effecting a rapid resolution of the cat’s problems – ended up being anything but. Do you think we could find the mystery object? No. No we could not! For what felt like ages I found myself frustratingly exploring the area, having to extend my initial incisions to open the region up more and all the while wondering why on earth I was not able to locate the offending article. Further radiography, this time making use of needles and the mobile dental x-ray unit in order to more accurately ascertain the precise coordinates of the object, which was very clearly visible on the films, eventually led me to see what ended up being the tiniest of pieces of tooth lodged firmly between the two middle metacarpal bones and virtually imperceptible to the naked eye. With the tip of what was clearly a cat canine tooth finally extracated from our patient’s paw, I was able to finally close the area, dress it and let the owner know the result.
My team of nurses were, as ever, superb and the entire operation ended up being a lot more challenging that any of us had initially imagined it would be. Thankfully the fact that the surgery took longer than anticipated was not a major issue as my colleague was able to handle consults whilst I rooted around delicately but purposefully in search of a biological needle in a fleshy haystack.
The main lessons that I took away from the experience include the fact that apparently simple situations can sometimes become more complicated or time consuming than first imagined and being prepared to cope with and adapt to changing circumstances is vital. Everyone on my team remained calm and acted in a really smooth and professional manner during the entire process and it ended up being a great example of effective teamwork. Remaining calm in a stressful situation is so vital as you need to be able to think clearly and make decisions, actions which are difficult if stress is at high levels. Trusting the evidence gathered is also important as in this case I knew that there had to be something to be found, due to the unequivocal radiographic evidence, meaning that persistence was simpler to adopt than if doubt had been allowed to creep into the scenario.
All in all, a testing afternoon but ultimately a triumph of appropriate clinical process, access to decent, reliable diagnostic equipment, trust in one’s own ‘gut instinct, and the superb dynamics of a great team. A great result all round, with a more comfortable and happy patient as a result.