There’s nothing like a weekend on call to generate some weird conversations. Many of my calls seem to begin with the answering service saying, “it’s a bit of an odd one this, but…”. One such call came in a few weeks ago and I started thinking about the myriad of permutations regarding what you can get wrong, or right, during one of these, shall we call them, “off-textbook” scenarios.
The phone rings and “it’s a bit of an odd one this,” is a familiar starting point. This turn of phrase usually means it is nothing too serious, which is good, but I also know the next 20 minutes or so will take me into uncharted territory for which I am legally responsible for my advice. I know that with the “bit-of-an-odd-one” calls, this can possibly extend to the caller themselves and not just the subject matter. “Go on…”, I tentatively venture. “Someone has a five-month-old spaniel, and it’s just eaten a bird.” Silence, for a few seconds, as the next question forms in my brain: “Well, are they ringing about their dog or the bird?” “I think the dog,” replies the call handler, then we both exchange the telephonic equivalent of a funny look.
I can picture my own spaniel running down the beach one day. When I called her back, she was about 20 metres away and had found a whole dead pheasant washed up on the sand. She looked at me, looked at the pheasant, looked at me and ate the pheasant – from its beak to its claws, and every feather – then trotted up to receive her praise for coming when I called. As far as I could tell, there were no ill effects. I then thought of the raw feeders we hear so much about. As much as I don’t particularly agree with all that, there are a lot of dogs eating chicken carcasses every day with, as a population, relatively few ill effects. That train of thought takes me to a Husky I treated years ago before raw feeding was trendy, but that is what he was being fed: chicken carcasses. I can picture the radiograph clearly on the viewer. It was quite a long time ago, when you could carry a radiograph around the practice, hold it up to the office window and ask everyone what they thought. The guts were full of chicken bones, and there, dorsally, was the telltale pocket of free abdominal gas that indicated a peritonitis.
So, from a fairly odd phone call I took some time to consider my options. We all hear about the gold standard of treatment. What would my hypothetical gold standard here be? GA, X-rays, CT scan? IVFT, bloods? Does throwing the book at every case make you a better vet? I then considered the least I could do: nothing. Is that appropriate? If something went wrong, and this dog did get peritonitis, I could imagine the RCVS Disciplinary Committee or a civil lawsuit with a vet internal medicine specialist as an expert witness, someone who spends their life treating insured patients for whom the average GP has run out of ideas. I could imagine that they would have seen dozens of raw-fed peritonitis cases and would be astonished that I had not run bloods, X-rays, a CT, etc, etc. Then, I imagined the owner who must be sufficiently worried to call, but maybe just wants some advice. They may have friends who raw feed and would be astonished at the cost of throwing the book of gold-standard treatment at this bird-eating spaniel.
I let these mind games play out for 5 or 10 minutes. It makes me realise that much of what we encounter in general practice is “off-textbook”. Much of what we have to treat cannot be judged by specialists, who only see the pinnacle of unusual cases after we GPs have carefully weeded out the majority of presentations that get better with basic treatment and the clients who can’t afford referral.
So, what happened in the end? I reassured her that eating birds is, pretty much, what spaniels do. I told her the story of my dog and the pheasant. I told her to come in if the dog developed persistent vomiting, or became generally ill or painful. I was tempted to say, but stopped myself, that I didn’t think there was much I could do for the bird.