Saturday, May 21, 2011

Dark And Stormy Days

Since I last wrote, we’re  expiating the splendid weather that graced my part of the country during April. Instead of April showers we are dealing with May showers and with the only exception of my working in London last week, up here it has been nothing but very dark clouds and rain. I find something immensely appealing though about this state of the sky because my garden is completely out of control in the green department, with tall, tall grasses and the trees resplendent with glossy new leaves against this backdrop of dark grey. You wouldn’t believe how that sets them off!

But, of course, the first time it rains after a few weeks really is the very best time. I love the smell of the soil and the grass and there is little that I find more uplifting than writing early in the evening during the summer, when the rain is lashing down and birds are still singing on the branches. Have you ever noticed that? Birds sing in the rain, they are not at all like us, begrudging the weather and complaining about it. They have little parties out there, they tell one another stories and they don’t care at all that it’s raining. And they don’t even have brollies. We could learn a thing or two from observing birds in the rain. 

And, ah yes, London. I’m currently scheming to return to work there and, all being well, that’s precisely what I will be able to do very shortly. While this is appealing in many ways, I am not that thrilled to leave Victoria during the week (or William, but she is the one needing some special care at present). Yesterday I saw François again and I will most likely have to take her back to ensure that her ear is healing appropriately. The girl is fine but the new tissue within the opening is struggling to seal up properly. I’ve been kicking myself for the past day because I should have taken her back when I first found her with her paw in her ear two days after her operation. She ripped five stitches out then and it all went a bit awkward on the healing side of things, even though she is not bothered by anything. More on this as it evolves.

Friday, May 6, 2011

Victoria and Vet François Guillaume Saulnier-Troff

I think that the web is a very practical, helpful tool. Within milliseconds, you can check out all sort of data and if you’ve had a bad customer service experience, you can go on a forum and warn everybody and his uncle about it. Herein, in a sense, lies my concern dear reader; while people have short memories, the web’s memory isn’t short at all. 

When a few weeks ago I Googled the latest vet I was dealing with, a certain François Saulnier, I was flabbergasted that pages and pages of entries (and especially the most important few at the top) were all about ‘disciplinary hearings’, ‘unprofessional conduct’, ‘full charges’ and, the worst of all for me, ‘dishonest vet’. Dishonest vet? What? My François? Who the hell were these articles talking about? Why were they even there?

I am writing this enormous post for two reasons:

  1. These details will benefit any dog owner who is seeking an in-depth account of a benign canine ear tumour from the owner’s perspective; AND
  2. If you’re in two minds about taking your pet to this vet having read certain information available online, you may welcome the view-point of a very happy owner. 

Victoria’s Ear Polyp – How It Started

Victoria (background) playing with William

At the very end of March, I noted that Victoria’s left ear (Dalmatian, nine years old, spayed) was producing more and more wax despite my daily cleaning routine. She had always been a little precious about her ears and, up until Christmas 2010, I had never quite managed to clean hers as effectively and as often as William’s. When I noted that my efforts were paying off in the right ear but not the left, I began really to stick my hands and nose down there. I noted a smell that none of the other canine ears was producing and the wax that I was cleaning out of it did not look that waxy either, but rather resembled a discharge and was more liquid in consistency and far darker too. As I was massaging the cleaning fluid into the ear, I also noted an odd, squishy sound, as if a tiny sponge soaked with water were lodged in the ear canal. When I shone a light in it, I saw a white protuberance that completely occluded the canal and was, seemingly, growing out of it. 

Regular readers of this place will know that I am well-versed with many canine illnesses, ailments, accidents and disasters, but I have to tell you that even I got alarmed when I saw this thing (being disastrously hypocondriacal doesn’t help either...). Even though the growth did not look like a carcinoma (or at least not a carcinoma in its advanced stage, when they can be red or black, yikes), but was white and squishy, I was really worried that it could be the beginning of a malignant ear cancer, when the patient may still not show any symptoms. The day after, Victoria saw one of my local vets who confirmed that there was a growth in the ear and who booked her in for a biopsy two days later. 

The result of the biopsy indicated a ceruminous adenoma, which is a benign tumour that, although rare, tends to affect the skin inside feline, rather than canine, ears. Regardless of its rarity, Victoria appeared to have one and as sure as hell that thing had to come out, for it completely blocked off the ear canal and, consequently, its ventilation, potentially leading to infections with all sorts of dire consequences. Because the adenoma isn’t filled with liquid but is made of solid tissue, the biopsy could not reduce its size, neither could the vet move it in order to check the horizontal canal leading to the middle ear.

While discussing surgery, however, it became apparent that my local vet hospital, although rather stellar in many ways, currently does not have a soft tissue specialist. I remember feeling my stomach back-flip when the vet said this, for she indicated that there was a vet who could do the surgery but wasn’t yet fully qualified to do so. And who wants to do ear surgery with someone who is not yet fully qualified to do so? 

It then immediately occurred to me that the ChesterGates Referral Hospital, where I’ve been with William many times for his epilepsy when it was still the Cranmore MRI ten years previously, had expanded into a superb, snazzy hospital with all types of specialists. I suggested we asked them whether they had someone who could perform this type of surgery and later that day Victoria was booked to be seen by François Saulnier the following week.

Victoria and François 

When I met him I was as tense as a guitar string and, most likely, I may have come across as a monosyllabic idiot who did not really understand what was being said. In reality, I had barely slept since I had seen the growth inside Victoria’s ear as I was gripped by an anxiety I had never known before. While William always had me sitting on pins thanks to his epilepsy, health-wise, Victoria’s nine years had been as uneventful as a weekend in the Welsh countryside. To be talking about a potential total ear canal ablation and of the post-operative pathological report that would follow in order to ascertain what exactly had been going on, brought home the truth that, however obvious, had never quite crossed my mind before: she will not be around for ever. 

Even though I was invited to sit down, I stood like a fidgeting lamppost (if lampposts could fidget, that is) and remained pretty much silent throughout. François proceeded to draw a section of the canine ear and to illustrate the scenarios he could find once operating. 

  1. The growth could have been near the top of the vertical ear canal only, therefore requiring a partial ear canal ablation (the vertical one) and a clean up of what was left below.
  2. The growth could have been originating from the horizontal ear canal, therefore requiring a total ear canal ablation.

In scenario 2, there was also the possibility that the middle ear, which is the deepest part leading to the hearing apparatus, could be damaged to various degrees. Because the polyp lodged into the ear was blocking it completely, and the right ear was completely clear, it was hard to tell whether Victoria’s hearing had been affected in her left. As far as I could tell, she was behaving normally (and, crucially, she was not scratching her ear or shaking her head at all) and could hear me just fine (except for that ever-present ailment known as Selective Hearing, whereby ‘Come!’ in isolation does not work, but ‘Gravy bone!’ does). 

François then also spoke of possible outcomes as well as complications. The facial nerve could be affected if the polyp was deep inside the canal and had started impinging on it. A partial facial paralysis (affecting the eyelid, for example) or a loopsided look are possible, depending on the extent of the damage. Ear canal surgery that is not performed by experts may also lead to a facial abscess which will then need to be drained. If at all possible, hearing should be preserved, but the priority was to open up, remove the blockage and take it from there. The upshot was that only 1 in 1,000 dogs die under general anaesthesia and that a very healthy and fit, if slightly senior, dog like Victoria should be able to go through with it. 

I didn't really feel like I had a choice, dear reader. I wanted that polyp removed there and then, so I signed all the forms and left her at the hospital with François. 

When I left, although worried sick, I also had an underlying, if vague, good feeling about it all. Unlike William who has been prodded, pricked and poked by vets since he was a puppy, Vic has always lived the yearly shots as some dramatic absurdist pièce de théâtre in which she played the tragic heroine. The day before I left her with François I had a little cry because I thought that she won’t understand what’s happening to her and she will be scared to death and I won’t be there for her. In reality, she immediately seemed at ease with the guy, and quite happily sauntered off with him as I left (this is unheard of). I think that she had caught a whiff of a good vibe much more strongly than I, even though she probably paid no attention to the raft of thank you cards in his office. I did though. 

I sat on pins all day, knowing that the surgery itself would most likely happen in the early afternoon. In fact, François called as he started the procedure to say that the growth was quite big but seemed only lodged in the vertical ear canal. He would therefore most likely proceed to a vertical canal ablation. 

For three hours I heard no updates and I must confess that at that point I thought she was dead. I was imagining François sitting in the office with the fabulous Mr Skerritt, shaking his head and saying, ‘I did all I could’, with Geoff replying, ‘Yes, I know son. These things happen, I’ll call her’. I was this close to cracking when I called at something past 5 pm and spoke to reception. When the lady told me that Vic was fine and recovering well, but Francois could not yet call me because he had an emergency and was still in theatre, I almost put the phone down on her, so that I could have a good cry. Instead I blabbed something like ‘Oh she is alive then’ adding a little bit of hysterical laughter for good measure and rang off. Then I cried. 

Vic back home straight after surgery

I heard from him at 7.30 pm. He seemed slightly tired but upbeat, telling me that Vic was awake and fine, she was, in fact, looking at him with a bit of a wag going on. The polyp was indeed as extensive as we had expected it, but only just reached the curve where the vertical canal leads into the horizontal one. So he had removed the vertical canal and preserved the hearing function. Her bandages would be removed the morning after and she would likely be able to come home that evening. Again I hardly spoke (I was, in fact, struggling to breathe), threw in a couple of minor hysterical laughs, and that was that.

Post-Operative Developments

The following morning François called at 9 sharp to let me know that the bandages were off, that it all presented itself as it should, with a bit of side swelling, but nothing too drastic. He would monitor Vic through the day to ensure that no complications arose but I could go and pick her up that evening. Dear reader, I was thrilled out of my wits and surprised myself thinking, what a nice guy! A vet who calls you back when he says he will is a rare thing, trust me on this.

When I turned up in the evening, I was horrendously late (and I am a Virgo and I drive a Jag and I am never late) but François waited for an age so that he could give me more information about the operation. He did so by drawing once again the section of the ear canal and indicating exactly what he had done and where the new opening would be. He seemed really pleased to have been able to have preserved the hearing, as was I. But when Victoria arrived, and this will be of interest to those of you whose dogs may need the same procedure, she looked... well... terrible. She seemed to have turned into skin and bones overnight, her head was obviously half-shaven (well, at least she is a Dal, imagine how weird a half-shaven Afghan Hound must look) and I could tell that she had barely slept. Her ear presented itself well-cleaned if only ‘a bit odd’, as I said at the time, for the section underneath the pinna (=the ear flap) looked a bit swollen and, for lack of a better word, weird. 

Of course, I was the problem; I had never seen a post-operative ear canal ablation and could not compare it to anything I knew. François explained that the swelling was normal, and was already reducing itself. I could see the ends of the stitches which were in place in order to facilitate the inner healing but especially to ensure that the new tissue would not close the canal completely, as that’s the tendency of these wounds. I continued to ask moronic question after moronic question (‘Are you sure she is ok like this?’ being a prime example), but Francois didn’t seem to notice the idiocy and answered each and every one and then some. I left with the provision to return after ten days for the removal of the stitches but I was welcome to call if I was worried or had any questions. 

Unsurprisingly, Vic slept like a stone that night and most of the following day. She was eating but wasn’t excessively interested in food. She wasn’t bothered by the satellite dish she was wearing around her head and pretty much kept herself to herself. William barely took notice she was back (for all intent and purposes they may be boyfriend and girlfriend but he rather cannot stand her). 

Vic's ear two days after surgery, starting to look not that great

The (minor) problems started the following morning after the feeds, when she was obviously feeling more normal and bouncy and wanted to take good care of her wound. When I took a thirty-second detour in the porch to fill the water bowl, I returned to the cone burst open and her left hind paw stuck in her ear. I sorted her out but noted some liquid seeping out of the wound and down her neck. The stitches appeared in place but I was unsure and could not really see inside for fear of pulling something off, so I called François who told me to keep an eye on her without worrying too much. Of course I was welcome to take her back for a quick check, but in order to do so he would have to sedate her and he would prefer to do that only when the stitches were due to come out. So I cleaned the area as best as I could and tried to ensure as much as possible that she would not open the collar. But it wasn’t just about that:  I caught her throwing her head around in her bed and crushing her ear to the side of the collar on a few occasions. In other words dear reader... if there’s a will to scratch, there’s a way too, whether your dog is wearing a satellite or not.

Vic enjoying some time in the garden barely one week after surgery

Days passed rather uneventfully on the way to Easter, with Vic behaving more and more as normal. I would occasionally remove the buster collar so that we could sit in the garden together and she never once tried to scratch her ear while the collar was off. In fact, I think she rather liked the return of her full field of vision and the breeze gently flapping her ears.

Winking at me but not too pleased by her satallite dish

Meanwhile, François had called me again to let me know that the pathology report had confirmed that the growth was a benign ceruminous adenoma, as indicated by the biopsy, and that there was no (cellular) indication that anything more sinister had been afoot. I was growing slightly concerned by the pus-like, sticky discharge that was oozing from her ear though, hence we decided to book Vic in for the removal of the stitches a couple of days later. All was well in Steph’s World until I decided to do some online snooping to see how good this fantastic vet was. 

That’s when I landed on Google and found little other than upsetting reports. I just could not believe that what was deemed, in an attention-grabbing headline (it worked, for it surely grabbed my attention), a ‘dishonest vet’ was the lovely guy whom ‘everyone loves’, as one of his colleagues had said to me while I was in the waiting room the week before. There’s no need for me to resume past events; you can find out about it as easily as I did. Suffice to say, I was so flabbergasted, my heart plummeting to my ankles, that I decided there and then that, while it is human nature to report on dishonesty, betrayal, un-professionalism and more, I would make a point to counter-balance what I read about this vet with my own account of a very successful turn of events where he consistently acted not simply professionally, but humanely too. 

I’ll never forget the vet who told me, ‘Come on, get hold of yourself’ many years ago when I was crying about William whose continuous epileptic seizures and lack of control and non-stop overnight pacing were running me into the ground. Now that’s not what I call a professional, let alone humane, conduct. François, by contrast, has never been even remotely short, or too hassled to deal, with me, even after a 13-hour day spent in the operating theatre. So much for dishonest and unprofessional, dear reader.

What would I have done had I actually come across those reports before taking Vic to him? I wouldn’t have taken her, plain and simple. Doubt is a powerful agent and one that can stealthily destroy the most unshakable convictions, let alone our expectations of someone we've yet to meet. If you’re reading this because you’ve Googled him and you’re not quite sure, please reconsider. The guy is kind, unassuming, helpful and has plentiful experience to do a good job on your pet too if you've been referred to him. By the way, you may not find this information readily among those headlines, as most of the articles required a login, but the charge was then dismissed.

When Vic went back to have the stitches removed, it emerged that five out of the eight had already been ripped out but that, despite this, the tissue was healing just fine, even though a stricture had created itself. This means that the little outer hole (the new way in to the ear canal), was smaller and tigheter than it should have been as the tissue grows and tries to constrict itself around the wound. François therefore removed what remained of the old stitches and put another four in, this time length-wise so that the canal would be kept as open as possible during the healing process. After this procedure, which required some sedation, the seeping out of the ear ceased within two days and the area remained slightly scabby, but otherwise clean, with the ear at large soft as normal. The week after, the stitches were removed (two left... there’s just not keeping a bad dog down, is there), and the ear cleaned again, but François suggested that the collar should stay on for another week in order to minimise rubbing and scratching. The outer corner of cartilage near the ear canal was red, although it did not seem particularly sore, and I was now to apply Vaseline to the area three times a day for the following week. Before the time elapsed though, the cone was off, the ear clean and Vic was not interested in scratching at all.

The last meeting took place in order to have a final once-over. François had suggested that I may want to go to my local vet for this, but I was not so inclined. I do not think that a vet who does not have an in-depth knowledge and experience of ear canal ablations, whether partial or total, is in the position best to spot something even remotely awry when the new opening wasn’t even visible underneath the short hairs. 

A nice neat new little hole just above my index finger is what remains

So I went back, and I’m glad I did, because, not only did he clip the hairs around the opening so that I could see exactly where the new entrance to the ear is (believe me, not as obvious as it sounds!), but he also showed me how to clean the ear with a cotton bud. This had been a concern of mine since the beginning, as I had figured out that removing the vertical ear canal would have meant being much closer to the bulla when inserting, however carefully, the tip of the cleaning agent bottle or a q-tip. I needn’t have worried dear reader; cleaning is much easier this way and flushing is more simple now that I’m already half-way there. I should continue to clean the left ear daily for ten days and should also clip the hairs around the opening once a month to facilitate ventilation. Victoria is as good as new and is currently snoring softly in her bed.

If you stumbled on here because you were looking for further information about François Saulnier-Troff, I hope you found this account helpful and, hopefully, a little bit reassuring. The guy’s great, he has even given me his email address. What vet or, God forbid, GP does that? Lucky is that pet which is in his care.

Monday, May 2, 2011

Betrayal At The Park

I always go to great lengths in order to avoid paying a visit to Tatton Park without my dogs. It’s the highest level of doggie betrayal, isn’t it, as Tatton is their favourite place. In actual fact, it’s mine too, whether it is copper and crackl-y, blossoming and breezy or, my favourite, foggy and iced.

Today, though, the weather was yet again spectacular and I did take a very small detour into it from Knutsford, while the guys were at home. I am currently running  a canine geriatrics hospital, with Victoria still perambulating with a satellite dish around her neck following her ear operation and William in high spirits but with very wobbly back legs awaiting his first physio session. I cannot wait to be back with them both. 

Sunday, May 1, 2011

Spring Tales

I don’t remember a shower-less April, except for this April. With the only exception of Monday 4, a day which I remember clearly because Victoria was in hospital for a biopsy, I needed no heating on, no pashmina at all hours, no thick socks. If truth be told, it’s been a bit of a revelation. Spring around these parts is so ostentatiously wet and bad that anything other than comes as a bit of a shock. I just didn’t know what to wear, and I never not know what to wear.

I pointed my iPhone at everything that moved and didn’t move, taking pics of birds and trees, flowers, shoes, magazine covers, food, lattes and cappuccinos... the usual stuff really, but everything looked better in this light and especially with a backdrop of often very blue sky. From Easter to today, including the day of the rather stellar Royal Wedding (I love a good wedding me), everything was just perfectly full of colour and life. Good job I don’t have a job because that would have really thrown a spanner in the works, wouldn’t it? Imagine being locked away in a window-less office while it’s all crisp and green outside... Much easier to be at work in the depths of winter (provided there’s no snow, because if it’s snowy one must certainly wish to be playing outside in it). 

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