Do you remember those old sayings your grandmother used? I can
recall Grandma telling me
”
Don’t put anything smaller than your elbow in your ear.
”
I never tried, at least not when she was around. I followed her
rules.
Do you remember those old sayings your grandmother used? I can recall Grandma telling me “Don’t put anything smaller than your elbow in your ear.” I never tried, at least not when she was around. I followed her rules.
But one phrase she used never made any sense to me. “The exception proves the rule.” I always wondered what Grandma meant when she said that. Even now, I’m not sure of its significance.
We live by lots of rules. Even in medicine, there are “rules” that veterinarians follow. These are the norm, the common occurrences in medicine.
These are what we frequently see as we examine and treat our patients. And often they help us make a quick diagnosis.
For example, think of the little terrier that carries his rear leg as he runs. He may have a luxating patella because that is a fairly common problem in those smaller dogs.
But a German Shepherd pup that limps on his rear leg probably has something completely different. Hip dysplasia would be more likely for this dog because Shepherds are plagued by this malady and rarely have patella problems. Vets keep these trends, these rules in mind as they work to make a diagnosis. But we must always remember that some animals don’t follow the rules.
In medicine, we expect to see certain problems in certain situations with certain animals. Older dogs sometimes become hypothyroid, while older cats instead become hyperthyroid. (Cattle, sheep and goats rarely suffer any thyroid problems at all!)
In vet school, prospective doctors are trained to look for the more common, obvious problems when examining their patient, remembering all these rules. I can still hear my professors saying, “Look first for common problems, not rare exceptions. Usually you’ll find your diagnosis quicker.” My grandmother would have enjoyed telling these profs a thing or two. She loved the exceptions.
Unusual clinical cases are a challenge to veterinarians. These “exceptions to the rule” make clinical work more interesting and rewarding. As the old saying goes, “they keep us on our toes.” And when we solve a tough case, we feel a little extra satisfaction.
I had one of these cases this past week. Sunshine was a very sick kitten that lived outdoors in the hills above Morgan Hill. He suffered from intermittent nausea and severe weight loss. We examined him carefully and tested him for common diseases that can make a kitten so very ill. He didn’t have Feline Leukemia. In fact, he didn’t have any infection at all, even though his white blood cell count was very high. So we looked a little further. What we found was quite a surprise.
Sunshine had swallowed an intact rubber 0-ring – a gasket – and it was lodged in his small intestine. It was so large that we wondered “how could he have swallowed it?” And why he would even want to swallow something so big? He definitely didn’t follow the rules.
Some dogs will eat anything– a golf ball, a small toy, maybe a bottle cap. But cats and kittens don’t often ingest foreign material. They usually reject anything like this and spit it out. Once in a while a cat might swallow some thread or fishing line after playing with it. But larger objects like a rubber gasket rarely make their way into the stomach of a kitty.
In surgery, we removed the gasket as well as a a two-inch section of intestine that had been badly damaged. Our patient felt better the next day and is now eating well (Grandma would say “like a horse”). He should make a full recovery.
So does the exception prove the rule? I don’t know. I still don’t understand what that phrase means. But Sunshine would have made my grandmother proud. After all, he showed that rules are only there to be broken. He was the exception. And his owner will tell you that he truly is an exceptional kitty.
