Ruger’s HItchhikers

D. E. Larsen, DVM

The little shepherd pup was lying with his neck extended and head flat on the exam table, and he did not budge when I entered the room.

Kris was seated in a chair, but her two boys stood at the table with the pup.

“Which one of these guys are we looking at today? I asked.

Both boys stepped back from the table and pointed at the pup.

Kris, a short gal in her mid-thirties with well-kept blond hair, was a regular client, but I had not seen this pup before.

 “This is Ruger; he isn’t feeling very well today,” Kris said.”  We’ve had him for a little over a week. He was fine at first, but then he started slowing down. Peter wormed him, and he passed a mass of ugly worms. But he has just kept getting worse. Today he is just like this, and he won’t get up to do anything.”

“And boy, did he poop a gob of big ol’ worms!” Jason, the larger of the two boys, said.

I lifted Ruger’s head with my left hand under his jaw. He acted almost lifeless. I turned his lip up, and his oral membranes were white. Not a hint of pink in his mouth or tongue.

“What did you use to worm Ruger?” I asked.

“I’m not sure,” Kris said. “A bottle of liquid that Peter picked up somewhere. I think it was like piper something. It was a clear fluid, slightly yellow in color.”

“That sounds like it was piperazine,” I said. “That is a good dewormer for roundworms, which is what you saw. The problem with it is it does do anything for the other worms. But we need to get some blood out of Ruger and see why he is so weak.”

“Do you think this is serious, Doctor?” Kris asked.

“Looking at his white membranes, I think Ruger is probably critically anemic,” I said. “I would guess we will need to give him some blood first off, and then we need to figure out why he is in this situation.”

“Could all those worms do this to him?” Kris asked.

“Roundworms can cause some problems, but it is usually gut problems,” I said. “There are some worms, especially hookworms, that can do this to a puppy. But, I rarely see hookworms in an Oregon dog.”

“Ruger was born here, but his mother is from Alabama,” Kris said.

“We will collect some blood and look at a stool sample,” I said.

“We have been watching his stool and haven’t seen any more worms in it,” Kris said.

“We do a floatation, where we float the worm eggs to the top of the vial and then look at those under the microscope,” I said.

“And you said he was going to need some blood. Where does that come from?” Kris asked.

“Ruger is a little pup. We won’t need a lot of blood to make him feel better,” I said. “My dog is is big Chesapeake Bay retriever, and he volunteers to be a donor.”

“He volunteers?” Kris asked.

“Yes, it is sort of a reluctant volunteer situation,” I said. “He loves coming to the clinic, and most of the time, he sleeps in my office. But he knows that he is about to volunteer for something when we take him into one of these rooms. And he really applies the brakes.”

We collected a small tube of blood, and it was evident that it was very thin. It almost looked like the blood from a leukemic cat. And at the same time, we collected a small stool sample.

I made a smear of the stool on a microscope snd added a drop of floatation fluid. As Dixie was running a quick CBC on the blood sample, I stuck the slide on the microscope.

I was totally shocked at the view through the microscope. The slide was covered with hookworm eggs, hundreds, if not thousands, of eggs in the first low power field.

Dixie had just finished with the CBC and handed me the paper.

“I think it is good that Odie is here today,” Dixie said.

Ruger’s packed cell volume, the percentage of red blood cells to total blood volume, was ten percent. In the dog, this was one the edge of death. I had seen cats with a PCV of six percent. Most of those died, but some could be saved with an immediate blood transfusion. I am not sure I had seen a PCV this low in the dog.

I returned to the exam room, pondering how to present this information to Kris with the boys in the room.

“You look concerned,” Kris said.

“Yes, Ruger is in a very fragile situation right now,” I said. “His red blood cell volume is at ten percent, which is as low as I have seen it in a living dog. We will have to take him in the back and transfuse him with blood right now. In his condition, we will give him the blood that we have available. We will not do any cross-matching, but it shouldn’t be a problem with this first transfusion. Any undue stress and Ruger could be gone in a moment.”

“What caused this to happen?” Kris asked.

“He has a massive infestation of hookworms,” I said. “We just don’t see this in Oregon, but it happens regularly in the South. With Ruger, it reflects on his mother.”

“Can we take care of that?” Kris asked.

“Yes, we can treat the hookworms, but Ruger needs blood first,” I said. “If we get some blood into him, he will come alive in an amazing fashion.”

“If you want to reduce his stress, I think you should do the transfusion right here,” Kris said. “The boys can keep him calm.”

“Okay, if the boys are up to it,” I said. “Sometimes, owners transmit stress to the pet. All I have to do is convince Odie to volunteer, and then I will collect a couple of large syringes of blood from him. When I come in here, we will place a small winged IV set in Ruger’s front leg and inject the blood right out of the syringes. It will be a slow injection, but it will only take a couple of minutes. Ruger will make a dramatic recovery, probably before the injection is complete. So, you prepare the boys for their job, and I will go get the blood.”

I stepped to my office door and slapped my leg for Odie to come, and he jumped up and was beside me in an instant. When I walked to the surgery room, Odie stopped at the door, and we had to pull him into the room by his collar. 

I had two sixty cc syringes, each with three ccs of heparin added, that I used to collect blood from Odie with a jugular puncture. It only took a moment to make the collection, and Odie was wagging his tail when I set him on the floor. He knew he would get a can of dog food for his service. He was bouncing around Dixie as she headed back to the kennel with a can of food.

Back in Ruger’s exam room, Ruger looked like he was fading away. I quickly placed a winged IV set into his left cephalic vein and started the injection of Odie’s blood.

Both boys were petting Ruger and didn’t seem bothered by the procedure.

“I think you guys will be amazed at how quickly Ruger is going to get well,” I said.

“I don’t know,” Jason said. “He looks worse now than when we came.”

As I finished the first syringe, Ruger picked his head and nuzzled Jason’s hand. By the time the second syringe was empty, Dixie had to hold Ruger down so we could get the IV set removed. When Dixie released her grip, Ruger was licking the faces of both giggling boys.

“That is sort of amazing,” Kris said. “I don’t think I have seen anything like it before.”

“Red blood cells are sort of important,” I said. “Now we have to get a dose of Nemex into this guy.

Nemex was a flavored liquid, and Ruger lapped it out of the end of a syringe.

“Is that all there is to it?” Kris said.

“That is all for today,” I said. “But Ruger is probably going to have problems for his entire life. He probably got a massive exposure of infective larva from his mother. Many of those will encyst in his tissues to become active later. They won’t drain his blood like this when his size is bigger, but he will need to be wormed regularly.”

“And I guess that means wormed with something other than piperazine,” Kris said with a smile on her face.

“Yes, you will have to get the stuff here or read the labels well if you get them elsewhere,” I said. “For now, I would like to see Ruger next week. Just to make sure he is doing okay. I will repeat the worming then, and I can fix you up with medication to worm him every week for the following month. Then we can play it by ear, but he will probably need medication a couple of times a year.”

***

The following week, Ruger was a different pup when he came in for a recheck. He bounced through the door on the end of a colorful leash with both of Kris’ boys trying to corral him.

When Ruger was shown into the exam room, Odie was in the lab area. In a somewhat unusual move for Odie, he was up and came over to rub noses with Ruger.

“This is Odie,” I said to the boys. “He is my dog, and he is the dog who gave the blood that we gave Ruger last week.”

“He almost acts like he knows that he saved Ruger’s life,” Kris said.

“Sort of, doesn’t he,” I said. “He is a smart dog,” 

Ruger was doing well on his recheck, and his blood numbers were back in the normal range. He did require medication for his hookworm problem every three to six months for the following six years that he got to see me. Kris and her family, and Ruger, moved away at that time.

Photo by Torsten Dettlaff on Pexels.