Old dogs, new tricks?

I GUESS it’s just been one of those weeks. Monday started well and I was in full flow, advising an owner on the intricacies of diabetes in dogs.

What should happen is, after eating, glucose is absorbed into the bloodstream.

The rise in blood glucose stimulates the endocrine part of the pancreas to produce insulin (as opposed to the exocrine part which is responsible for digestive enzymes).

Insulin then drives glucose from the bloodstream into the cells of the body who use it for energy. Any excess is laid down as fat.

If there is an absence of insulin, blood glucose remains very high but the cells are starved.

This causes an increased appetite, weightloss and lethargy.

When blood glucose is higher than the kidney threshold, glucose spills into the urine.

Since the body is quite incapable of urinating sugar lumps, water must be added. Hence a dramatic rise in urinary output and thirst.

“I know all that,” said the owner. “I am a diabetic nurse.”

Next, I had to try to explain anaesthetic risk to a well-heeled gentleman.

I like to think of this risk in similar terms to crossing a road. Confused? Let me explain.

First of all, there has to be a good reason for crossing the road.

There must be some benefit that outweighs the risk.

Always, the risk and benefit must be balanced.

Then, before you cross the road, you have to make sure you are fit enough to get to the other side.

Of course, the level of health required will differ depending on whether you are heading briskly across a high-risk road like the M8 or just have to take a few steps on a country lane.

Note, however, that even the lane is not entirely risk free.

Next, and also well before starting to cross, you must look left and right and left again. What dangers are there? How heavy is the traffic? How fast is it moving? What is the road surface like? Is falling likely? Are there any obstructions? Finally, when all risks have been assessed, you wait for the appropriate opportunity and cross the road as fast as you can, continuing always to look left and right but not going so fast that you become reckless and fail to appreciate danger.

And remember, even once you reach the pavement, accidents can still happen.

“Very good,” said the man. “I am a consultant anaesthetist.”

At least he wasn’t a lawyer. Or a lollipop man…