All’s swell than ends well

THE swelling was quite large. But then I am used to palpating swellings.

Indeed, after 33 years of practice, I like to think that I have got swelling palpation down to a fine art.

It all involves the tips of the fingers. They must be sensitive to size, consistency, heat and discomfort.

They must be gentle, so as to avoid unnecessary pain, but they must also be able to assess tissue beneath the surface of the skin.

They must be strong enough to hold but careful enough not to crush.

They must be able to distinguish viscosities of fluid and recognise the difference in solidity between liver, kidney, prostate, intestine and a myriad of lumps, from histiocytomas to hamartomas to mast cell tumours. And you should be able to accomplish swelling palpation with your eyes shut.

But this one was different. It more than filled my hand, so the palm was required in addition to my fingers.

Its consistency varied throughout its substance. In areas, it was as hard as stone. In others, light and spongy.

Its position was unusual too, in that it occupied the front of the neck, from the chin of my patient to the start of her thorax.

But then my patient was slightly out of the norm. She was a hen – one of the more than half a million rescued battery hens that have seen a life of egg-laying in factory conditions replaced by scratching about in someone’s back garden.

The problem with these guys is, that suddenly exposed to the big wide world, they will eat just about anything they come across.

Grit, string, grass, baubles, hairbands all go down the hatch, only to be trapped in the crop, which is the part of a bird’s oesophagus whose job it is to grind up seed before digestion.

It kind of does the job of our teeth, because teeth in hens are pretty rare.

Pretty soon, the crop becomes totally impacted with this stuff and eating becomes impossible.

When gentle massage and lavage of the crop fails to produce a response, there is only one thing for it. No, not neck-wringing but surgery.

Using local anaesthetic, the feathers are plucked over an area and an incision made in the skin.

The crop is opened with a scalpel to allow the packed material to be emptied.

And then the whole shebang is carefully stitched up.

Hopefully the hen’s delighted owner won’t have to shell out for further treatment.