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Equine November/December 2007 (Vol 2, No 6)

The Final Diagnosis: A Rarely Recognized Benefit of Arthroscopy

by Bo Brock, DVM, DABVP (Equine)

    We do our elective surgeries early in the morning for several reasons, the most obvious of which is that stress levels are at their lowest when people have been recently caffeinated. I especially love to do arthroscopic surgery at this time of the day, when nobody is in a hurry and there are few distractions.

    In the early morning, our clinic is a magnet for townsfolk. A resident group of these folks like to come by and hang out if a flat is being fixed, the rain has stopped for a while, or they're bored with the way their morning is shaping up. They figure, correctly, that something better is probably going on at the clinic and we've always got a hot pot of coffee brewing. One member of this group, Mr. Ford, showed up like clockwork every morning just as we were starting surgery. Somehow he knew to be there if we decided to start at 6:00 am, or, more commonly, he'd walk in at 7:00 am as the first horse was being anesthetized. Mr. Ford liked to watch almost as much as he liked to talk, and our surgery room often provided him with a warm refuge from the chilly morning air.

    Mr. Ford was a talker and had recently celebrated his 84th birthday in our clinic. Sometimes he'd tell the same story 10 days in a row and often several times in a row. The stories were often about World War II but just as often about the surgery he'd watched the previous morning. It didn't seem to matter what was on his mind, he'd stay at the clinic until about noon, telling the same couple of stories to anyone who walked through the door. Some people gave him strange looks and walked away, while others listened with interest. Very few of the latter group escaped in less than 30 minutes. I must have heard his story about the prize racehorse he ran in 1955 more than 1,000 times. Neither he nor I ever tired of it.

    One January morning, it was downright cold in Lamesa, and Manda, my veterinary technician, had arrived early to stoke the little gas heater in the corner of the surgery room. Based on the ice on the water buckets hanging in the paddock outside, we were going to need that heater to do its best that morning. We were in the middle of the first arthroscopy case of the morning, and Mr. Ford was in the middle of a story about how smart his dog was. We'd all heard this one countless times, and most of us had tuned him out while we fished around in the horse's knee for an elusive bone chip.

    I'm not sure who smelled it first, but we all looked up at the same time. Something was burning—and not a weak, "might be an electrical fire" type of burning. This was real smoke right there in the surgery room. While we were frantically looking around the room, Mr. Ford said rather calmly, "I'm on fire." Apparently, he'd backed closer and closer to the little gas heater, until his britches had touched the red-hot grill. No kidding—there were flames just above the back of his knees!

    At 84, I guess bending down to pat the back of your knees must be more painful than being on fire. In any case, Mr. Ford wasn't making much headway, so everyone in the room instantly went into "FIRE!" mode. Manda grabbed a surgery towel and started beating the back of his knees, but this seemed only to make matters worse. Other people ran in random directions, apparently looking for something they could use. I stood there in my surgery gown, gloves, and cap, with the arthroscope in the horse's knee, wondering if throwing and rolling an 84-year-old man on the floor was a good idea or not.

    Then, while maintaining sterility and a modicum of composure, I did the only thing I could: I pulled the arthroscope out of the horse's knee and pointed it at the flames. Manda read my mind and turned the fluid pump to full blast. A couple of seconds later, Mr. Ford's britches were soaked, and the crisis was over. The whole event was a comma in Mr. Ford's story, and he went right back into the same sentence about how smart his dog was. While the rest of us were dealing with the adrenaline rush that we'd just experienced, Mr. Ford acted like it happened every day. All I could think for the rest of the day was How many surgeons have extinguished a burning man with their arthroscope without breaking sterility? It made my day.

    Mr. Ford passed away a few months back. We miss him and all his tales. While he never told the story about his burning pants, we've shared it many, many times with others and think about him every time we have to crank up that little heater. He was one of a kind, burning or not.

    NEXT: The Leading Edge: Continuous Peripheral Nerve Block: A Novel Technique

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