D. E. Larsen, DVM

I hurried along Berlin Road as the last of the daylight was fading into twilight. Hank had an old horse down with colic. I always dreaded colic calls. Many were simple fixes, but there was no place close to send them for abdominal surgery if it was a complex colic. Few clients would be willing to take their horse six or seven hundred miles for surgery.

I slowed as I approached Hank’s place. The old workhorse was down in the front yard. I could see several guys holding the horse to keep him from rolling. That was my instruction to Hank when I took the call. Often, a simple colic became a fatal colic when the horse would roll and twist a gut.

“Good evening, Doc,” Hank said as I stepped out of the truck. “I’m sorry for calling you this evening. Old Bob has been getting worse for the last few hours. I could tell something wasn’t quite right with him earlier today, but the last few hours have been pretty rough. After talking with you, I got these guys to help hold him down.”

“Don’t worry about having called me, Hank. If you hadn’t called now, you would have called by midnight, and things would have been far worse then.”

“Well, thanks for coming,” Hank said. “We moved him out front here so you would have a little light. It doesn’t look like we will be done before dark.”

I look Old Bob over. For a horse with colic who was down, he looked pretty good. His pulse was a little fast, and his gut sounds were slowed, but otherwise, he looked pretty good.

“Do you think he will stand for us?” I asked.

“Yes, he has been up and down for the last couple of hours. After talking with you, I just didn’t want him to lie down and roll before we could get him under control.”

The guys got up, I think they were a little relieved, and I slapped Old Bob on the butt, and he jumped right up.

“If you guys hold him tight, and maybe one of you lean against his ribs on each side, I will do a little rectal exam.”

I pulled on a plastic sleeve and lubed it well. Then, standing on his right side, I held his tail out of the way, and I eased my left hand and arm into Bob’s rectum. He did not object. I advanced my arm and started to sweep the floor of his pelvis and posterior abdomen.

Bob’s pelvic urethra bounced with a massive spasm when I touched it. The urethra was full and expanded. That was a most unusual finding. I advanced my arm further, and Bob’s distended bladder filled the posterior abdomen.

“I am not sure Old Bob has been peeing,” I said. “Have you seen him pass in urine today?”

“To be honest with you, Doc, I don’t spend a lot of time watching the old guy pee,” Hank said. “Now that I think about it, I did see him all stretched out like he was trying to pee earlier this afternoon.”

“I think his urethra is obstructed,” I said as I removed my arm. I cleaned up Bob’s rectum and let his tail fall. “It’ll take me a few minutes to hopefully find my urethral catheter. I hope it is in the truck.”

I had to dig deep into the back of the vet box. The call for using a stud catheter does not occur often. I had debated about even buying one when I did my equipment order. But after some digging, I did find it, and the sterile pouch it was in was still intact.

“Lean a little harder, guys,” I said. “There is nothing we are going to do to this guy from here on out that he’s going to find pleasant.”

Old Bob was a good old horse, but when I started to try to get a hold of his penis and pull it out, he was not very cooperative. After struggling for a minute or two, I decided to do it the easy way.

“Okay, Bob, you have earned a little dose of Rompun. Rompun was a popular tranquilizer, and it also provided some pain relief. In most cases, it would allow bulls and horses to drop the penis out of the prepuce.

After a dose of Rompun, Old Bob’s head started to hang, and then, as if on cue, he dropped his penis out of the prepuce.

I passed the catheter up his urethra, and it came to a dead stop. I pulled it out and measured the distance on the side of Bob. The obstruction was just after the urethra turned out of the pelvic cavity and headed down toward his prepuce.

“I don’t know what it is, but I need to do a little surgery. If it’s a stone, we can maybe remove it. We can at least open his urethra and empty his bladder. And just doing that is going to make him feel a whole lot better.”

I clipped and prepped a surgery site over Bob’s urethra and a spot above his tail’s base for an epidural injection of lidocaine. Bob was still well tranquilized from the Rompun injection. I injected six ccs of lidocaine into his epidural space. After a few minutes, I checked that it had adequately numbed the surgery site.

The light was poor, but finding the urethra was a snap. I incised the skin over his urethra and quickly dissected down to the surface of the urethra. Incising the urethra yielded a gush of urine. I passed the stud catheter into the bladder and waited as the urine drained.

Then I enlarged the incision a little and inserted my gloved finger. There, immediately below my incision, I palpated a large stone. The stone was nearly two inches wide and wedged tightly in the descending urethra.

“Okay, Hank, I can feel a large stone right here,” I said as I inserted my finger and bounced it on the top of the stone. “I can remove it, I am sure. But I think it would be best to wait until morning when the light is better.”

“Is he going to be okay until then?” Hank asked.

“He will be fine,” I said. “I am going to leave this incision open, and he will pee out of this incision. I will put his tail in a plastic sleeve to protect it. I will give him a dose of antibiotics tonight. 

It will take another hour before the tranquilizer wears off. But you can put him in a stall or in a pasture, and I will be back here about nine in the morning.”

“These guys are going to be at work. Are you going to need any help?”

“This old guy is a pretty good horse. I think I will be fine,” I said.

***

Bob was at the feed rack eating when I returned in the morning. He sort of shook his head at me when I approached the fence. I wondered if he was giving me credit for making him feel better. I doubt it.

We pulled Bob out of his stall and tied him to the fence. I removed the plastic sleeve from his tail and then put a wrap on it to keep it out of the way. I prepped the incision and the epidural spot and repeated the epidural. Bob was not bothered by any of it.

With my finger, I palpated the stone. It had not moved overnight.

I extended the incision a bit and pushed on the bottom of the stone through his tissues. It popped out of the incision, and I caught it in mid-air.

“That was pretty easy,” Hank said. “Can I have that stone for a mantlepiece?”

This was an impressive stone. It was almost heart-shaped, and two inches across at the top, and nearly an inch thick. Smooth and light brown, it was most likely a struvite stone.

“Sure, you can have it. You probably should rinse it well before you set it out for viewing. Most of the time, these result from an infection in the bladder. We are going to put Bob on some antibiotics for a week or so, and I will check him in a couple of weeks when I take the stitches out.”

I passed the catheter into Bob’s bladder and then down the urethra until it came out in the prepuce. Just to make sure things were open in both directions. 

I closed the urethra carefully and then loosely closed the tissues over the urethra. Leaving a small opening at the bottom end of the incision to allow for drainage. Then I removed the tail wrap and gave another dose of Polyflex. I fixed Hank up with injections for the next week. 

“I want you to look at this incision every day. If there is a small amount of drainage, that is okay. But if there is a lot of swelling or a lot of drainage, I want to hear from you. I’ll be back in two weeks.”

***

On recheck, Old Bob was well healed and acted like there had never been a problem. I removed his sutures, and it didn’t bother him at all. He was the only horse I ever treated with a urinary tract obstruction.

Photo by Free Nature Stock from Pexels

D. E. Larsen, DVM

Today was a late spring day with mostly blue sky but some heavy dark clouds. Walt was waiting when Ruth and I pulled into his barnyard. Ruth was short with dark hair. She had worked for me for a couple of years and although not a farm girl she really enjoyed the farms we visited. Walt’s farm had offered a variety we didn’t often see with Draft horses along with the cattle.

Walt greeted us with his beaming smile and an outstretched hand. His handshake was firm and sincere. I knew these men judged the men they met by their handshake, something I didn’t learn in school, but I had learned long ago growing up around men who earned their living working with their hands.

The little steer calf was standing in the loafing shed twitching his tail and stomping his hind feet. When I moved a little closer, he pressed against his mother’s hind leg. Mamma shook her head at me and moved into the corner of the loafing shed. 

“He is pretty uncomfortable,” I said to Walt. “How did you recognize him out in the pasture?”

Walt was a tall, thin man with a broad smile on his face most of the time. Lean does not mean that he was not strong. Slim, wiry, and tough as nails, Walt could work most men into the ground. Walt had a team of draft horses, Belgiums, that he used to put up his hay in the field that was next to the highway. I am sure that many people would observe him and fail to realize how rare the spectacle was today. I always enjoyed watching the horses work and would often take the back road so I could stop and watch for a time.

“The little guy was not moving around at all,” Walt said, showing his obvious concern with a fading smile. “I notice him and his mamma standing over in the corner of the pasture, all by themselves. With all this stomping and tail twitching, I figured something must be wrong.”

“He is pretty young for a urinary stone, but this is what they act like early on in the course of things,” I said. “We don’t see this much around here, but it was common in Colorado where I went to school.”

Urinary stones in beef cattle in the Willamette Valley were uncommon, meaning that I would see a case once or maybe twice a year at the most. Often going several years between patients. 

It was surprising that Walt would recognize the stomping and tail twitching as enough of an issue to call me early. It demonstrated how some of these old farmers were so in touch with their animals that they knew when there was a significant problem.

“It is early yet, and he is uncomfortable because of his distended bladder. In a little while, one of two things will happen, either his bladder breaks or his urethra breaks. When that happens, the pain goes away, but the problem becomes much more difficult to fix. It is a good thing that you called early.”

The calf was easy to catch, and we tied his head and then ran the mamma cow outside. I was sure of my diagnosis but completed a quick exam. His temperature was normal, and his chest was normal. 

On the rectal exam, I laid my fingertip on his pelvic urethra. It was continually pulsating. This guy had a stone blocking his urethra for sure. 

I took a second rope and tied a loop in the middle of the bite of the rope. I slipped this loop over his neck with the knot lying between his front legs. The rope ends crossed in the middle of his back, ran down his sides, and came out between his hind legs. This was called a “flying W” and is a standard method to throw a cow. It was generally not used on a small calf, but we would have to tie him down for surgery.

I grabbed the two ends of the rope and pulled. The calf stiffened and fell on his side. We rolled him up on his back, flexed his hind legs, and tied each leg with the ropes in a manner that when he kicked, it would put more pressure on his back and add more restraint.

Once restrained, with me on my knees, I could palpate the length of his penis. Stones generally lodge at the point of the attachment of the retractor penis muscle in the sigmoid flexure of the penis. I grasped this portion of the penis with my left hand to stabilize it. With my right hand, I could easily palpate the stone.

“This is going to be easy,” I said to Walt. He was watching closely. Most of these guys had not watched a calf thrown so easily before.

“So far, you make it look easy,” Walt said.

We clipped and prepped the surgery site, and Ruth opened the surgery pack while I put on gloves. This was barnyard surgery at its best. There was fresh straw down, but the ground’s softness under my knees told me we were on top of a foot or more of straw and manure.

The surgery was brief, as I had promised. I injected the area with Lidocaine for local anesthesia, grasped the penis to stabilize it, palpated the stone, and made about a two-inch incision over the stone. I bluntly divided the tissues with a pair of forceps to expose the urethra with the bulge where the stone was located. 

Once this was exposed, I elevated the penis. I drove a scissors under the penis and out the other side to maintain the exposure and stable urethra and free up my left hand. I palpated the stone again, then carefully incised the urethra, feeling the stone’s grit as the scalpel pulled across it. I grabbed the stone and pulled it out of the urethra with forceps. I placed it on the surgery pack. I took a urinary catheter and ran it up the urethra toward the bladder. It was just long enough to reach the bladder. We relaxed as urine drained out of the catheter. 

I could imagine that the calf was feeling some relief at this point. When the urine stopped, I removed the catheter. I then ran it the other direction to ensure the rest of the urethra was open.

Now we had a decision to make, to close or not to close the incisions. I had the option of leaving the incisions open. I sort of favored this option because there may be more stones in the bladder, and they would have the chance of passing out the incision if it is left open. 

Barnyard surgery is not the best in the world, and closing the incision always gave the possibility of infection. And closing the urethra on such a small calf could lead to a narrow spot that could cause problems later. The only problem with leaving the incisions open was that urine would flow out of the incision for a week or so until there was enough healing to allow normal flow.

I was getting ready to discuss all this with Walt when the calf kicked. He got one hind leg free from the restraint. He kicked again, and the surgery pack went flying. The decision was made by the calf. I grabbed the scissors, releasing the penis to return to its normal position. Ruth started gathering instruments that were scattered through the straw. 

Walt was crawling across the straw on his hands and knees, concentrating on one spot. He ran his hand across the straw a couple of times. Then with a beaming smile raised his hand, he had found the stone.

“This is going on my mantle,” he said, still smiling. 

We let the calf up, sprayed for flies, and explained the urine flow issue to Walt. Things turned out okay, and I will never know how Walt could keep track of that stone in all the commotion.

Photo by Matt Seymour on Unsplash

D. E. Larsen, DVM

Raymond came through the door with little Sophie cradled in the crook of his arm. Sophie was a really small Chihuahua, and Raymond, her owner, was a large man. It was one of the things that I always found a little odd. Some of the largest men were attached to these tiny dogs.

After he stretched a towel out on the exam table, Raymond placed Sophie in the middle of the towel. Sophie, at four and a half pounds, was overweight. Her spindly legs looked undersized for her round body.

“She has blood in her urine, Doc,” Raymond said. “And she pees a little puddle every 5 or 10 minutes. The wife is getting upset with all the cleaning up after her.”

I looked at Sophie, her gray muzzle told she was past middle age. She should probably weigh two and a half pounds, not four and a half. Her membranes were normal, with normal capillary refill time. Heavy tartar on her teeth and some chronic periodontal disease suggested that she was a good candidate for a heart murmur. That was confirmed when I placed the stethoscope on her chest.

Chronic periodontal disease leaks bacteria into the bloodstream. These circulating bacteria take up residence on the heart valves, in the kidneys, and the liver. Poor dental hygiene, most common in small dogs on pampered diets, leads to all sorts of significant health complications.

She was heavy enough that it was difficult to palpate her abdomen accurately. But when my fingers reached the posterior abdomen, I bumped a hard firm bladder. Sophie immediately squatted and peed a small puddle of bloody urine onto the towel.

“Raymond, we are going to have to pick up the towel so I can get some urine off the tabletop,” I said as I lifted Sophie up so Raymond could remove the towel.

I sat Sophie down and felt her bladder again, more carefully this time. There was a large stone in the bladder. I could feel some movement in the stone, probably a couple of stones. They were large, making the bladder feel full, but there was little room for urine. Sophie squatted again, depositing a small puddle of bloody urine on the exam table.

I drew the urine into a syringe and placed a small drop on a microscope slide. A quick look at the slide under the microscope showed the blood but also many bacteria and struvite crystals.

Struvite stones were the most common type of bladder stones in the dog at that time. Struvite stones in the dog are caused by a urinary tract infection that leads to acidity changes in the urine, crystal formation, and then the development of stones. These stones grow with time. In male dogs, they often cause urinary tract obstruction as the small stones try to pass down the urethra. That seldom happens in the female.

Today there are diets that can dissolve struvite stones in the bladder. That was not the case in the 1970s and 80s. Stones as large as Sophie’s, are best removed by surgery, even today.

“Raymond, Sophie has a large stone, or more likely 2 or 3 large stones in her bladder,” I said. “These are caused by an infection in the urinary tract. She has a lot of bacteria in her urine. We need to do several things. We need to do a culture on her urine, and while we are waiting for the culture results, we will get her started on a good broad-spectrum antibiotic. We need to get an x-ray, so we can see how many stones we are dealing with, if there are stones in the kidneys, or a bunch of little stones also. We need to do some blood work to make sure Sophie’s kidney function is normal. These stones are going to have to be removed with surgery.”

“Doc, you sound like you are talking about a lot of money,” Raymond said. “I don’t have a lot of money. Are there some short cuts we can take.”

“We can shortcut some of the things if that is what you want to do,” I said. “You need to understand, shortcuts are great if everything works out fine. But if things don’t go just right, we end up spending more money than we would have doing things right in the first place.”

“What kind of things are you talking about, Doc?” Raymond asked.

“Looking at her urine, her kidney function is probably okay,” I said. But if it isn’t, and a random urine sample is not the best indicator of kidney function, we might be delayed in finding that out, and we could lose her. If she happens to have an infection that requires a particular antibiotic, we might not know that without a culture. If we have a bunch of little stones along with the big ones I can feel, we could leave a stone behind and have to do a second surgery.”

“She is sort of long in the tooth, Doc,” Raymond said. “Let’s put her on some antibiotics and do the surgery. If things don’t work out, at least we tried.”

“That is fine, just as long as you remember this conversation,” I said as I shook Raymond’s hand.

“Will I be able to take her home tonight?” Raymond asked.

“We are early enough that she should be able to go home tonight,” I said. “We will have her on c/d diet for a time. That will be important, nothing else.”

“You are going to ruin her life and make mine miserable,” Raymond said.

“You know, you are killing her slowly with kindness, don’t you,” I said.

“What do you mean, Doc?” Raymond asked.

“Look at her, Raymond,” I said. “She weighs twice what she should, her teeth are a mess. She should have those cleaned, and there will be many teeth that are not savable. The infection in that mouth could have been what started this bladder thing, and her heart valves are leaking a little. She needs to be eating dog food, period. But we can work on those things after we get this bladder thing fixed.”

I gave Sophie an injection of Amoxicillin and Gentocin. I planned to send her home on Clavamox. We gave her 80 ccs of fluids by subcutaneous injection and placed her in a kennel while we got the surgery room ready. Sophie was unhappy in the kennel, how dare we treat her like a dog.

After anesthesia was induced and the abdomen was prepped for the last time, I draped the incision site, first with towels and then a surgery drape. I made a short incision over the bulge in the posterior abdomen caused by the large stones in the bladder. I was able to squeeze the bladder out of the incision. It was the size of a full bladder but hard as a rock. 

I placed a couple of stay sutures to hold the bladder in position when I incised it and removed the stones. Then I made an incision into the bladder. The bladder wall was thickened from the chronic infection and the mechanical damage from the stones.

I popped the first stone out, then the next. Amazingly large stones for such a small dog. The bladder lining was burgundy red and almost bubbly from the chronic inflammation. I flushed the urethra in both directions and carefully explored the bladder to make sure no small stones were hiding.

Then I closed the bladder in two layers with Maxon and returned it to normal position. I was careful to remove a couple of drops of urine from the incision and flushed the area liberally. Then the abdomen was closed with a standard 3 layer closure.

Sophie recovered quickly and was probably more comfortable than she had been in months. Raymond was pleased with how lively she was when he picked her up.

“I want to see her in a couple of days, just to check the incision and feel her bladder,” I said. “If you get a chance, try to get a look at her urine in the morning. Mainly to see is the blood is cleared up. And Raymond, you have to be strong, c/d diet only for 3 weeks. No bacon off the breakfast table. You understand, we have come this far, don’t ruin it by being weak when she begs.”

“I will do my very best, Doc,” Raymond said.

“I can guarantee you, Doc,” Sue, Raymond’s wife, said. “He has spent our summer trip to the coast, and he will finish the job if he knows what is good for him.”

Photo Credit: D. E, Larsen, DVM