This week: Onion, the dog with layers of problems I am always telling hopeful young people who aspire to become veterinarians that it is a lot of hard work that does not end with university. It is actually quite hard to be completely free of work obligations, even when you are on a weekend break. It is rare for me to have a whole weekend off and on this rare occasion on a hot summer afternoon I found myself on one of the outlying islands. It was the weekend and the island was very busy and bustling with people. One of the reasons why people prefer to live on an outlying island is there is ample space to keep pets, especially dogs. The island was small and there was pretty much only one main path that circuits its way around the island. So it was not surprising that I literally bumped into a familiar face of a former nurse with whom I used to work. We bantered for a while, catching up on old times. I told her that we were heading out for a nearby beach for some swimming and relaxation. As I walked up the concrete path leading to the beach we encountered a small group of villagers that were stretchering a small mixed-breed dog down the hill. I assumed there was something wrong and that they were taking the dog to a nearby vet, so I did not think much more about it and headed determinedly for the beach. I had got as far as taking my shoes off when I heard the nurse I had bumped into yell my name. There was a sinking feeling in the pit of my stomach that my holiday was over and duty beckoned. It turned out the vet that worked the islands also had the weekend off and had decided to leave the countryside and head for the metropolis. I said my goodbyes to the beach and headed for the small clinic. The dog was already on the consultation table and there was a stench of rotting meat that usually announces the presence of an injury at least a few days old and heavily infected. Another nurse had shaved the wounded area clean and started disinfecting it. I examined what looked like a puncture wound in the dog's left flank. It was most certainly a few days old and was maggot infested. In the wound there were the maggots of the screw-worm fly. These flies lay eggs in wounds and once the eggs hatch the larvae start feeding on its living host, burrowing into its body. It looked pretty bad. After some initial pain relief and antibiotics I started the dog on an intravenous saline drip and took some blood. The blood revealed mild renal failure and a lack of red bloods cells indicated blood loss. It was a young dog and this sort of wound usually does not directly involve the kidneys. I was more than a little suspicious. I then took an X-ray of its abdomen, and lo and behold, there, near its left kidney, was a round metal pellet. Usually I would stabilise the dog's renal problems before attempting any surgery but it was clear that the bleeding was active and something had to be done to stop it. Fortunately, there was a bag of blood in the fridge that cross-matched successfully with the dog. We anaesthetised the patient and opened its abdomen. The pellet had ripped through the abdominal muscle wall and torn a section of the small intestine in two. The pellet was sitting neatly on the surface of the left kidney. Fortunately, the kidney was not punctured, but the presence of the pellet explained why the blood tests showed increased kidney enzymes. The bleeding was from an artery that was associated with the small intestines. I took out the pellet and stopped the bleeding. I had to remove the whole segment of small intestine that was infected and reattached the free ends. We in the vet business call this procedure a small intestinal anastomosis, which means the joining of two free ends of a severed small intestine. After that I used several litres of sterile warm saline solution to clean the abdomen and closed it up. It was a marathon surgery that took well over 11/2 hours. But it was far from over. I still had to remove the maggots. The only good news was the location of the wound. Being on the belly, there was a lot of skin to work with and I decided to remove the maggots and the surrounding damaged tissue whole. I excised the lot as though it was a large tumour, inserted a drain to allow for any dirty fluid to seep out after the surgery and closed up there too. The blood transfusion went well without any allergic reaction and with a little luck and a lot of champion nursing and supportive therapy in hospital, after a few days the dog left the clinic apparently wagging its tail. I was not there to see it as I had returned to the rat race by then at my regular job. The dog was named Onion and there were certainly layers upon layers of problems that fateful day, any of which could have killed him. Onion was probably the luckiest dog I have ever met.