D. E. Larsen, DVM

I came through the back door of the clinic in Enumclaw, I liked to get into the clinic early. Jack was just cleaning up from an early morning call.

“You are here a little early,” Jack said as I squeezed past him at the utility tub.

“I have been coming a little early to organize the morning a little different,” I replied.

“A little different,” Jack said, “Things have run the same way around here for the last 30 years. I am not sure we need things to be a little different.”

“We have the surgery patients coming in during the late morning, and we don’t get to them until the afternoon after all the farm calls are done,” I said. “If we brought them in early in the morning, we could get the surgeries done before noon on most days. That way we could send them home in the evening. That would save a lot of cage cleaning for the girls in the morning. It would also be better than having them here overnight, unattended, following surgery.”

“Well, you might have something there,” Jack said. “I will have to give it some thought.”

“I have Mrs. Nielsen coming in this morning with a couple of cat spays,” I said. “If there are no urgent farm calls, I thought I would do the surgeries first thing this morning and send them home at 4:00 this afternoon.”

“Well, hopefully, I took care of our emergency for the day,” Jack said. “I had a calf to deliver at about 5:00 this morning. It was an easy pull. Tiny calf, one of those that you have to hold in there for a few minutes, so the farmer thinks he gets his monies worth. Then I hooked an OB strap on the legs and pulled it with one hand.”

“That sounds easy,” I said.

“But there is more to the lesson,” Jack said, anxious for me to listen. “One thing you want to do when you pull a calf is to go back in and check for another calf. Sure enough, I did that this morning, and there was another calf. It was backward, hind feet sticking into the birth canal, it was as small as the first one. Came out without any problems.”

“That is something that they always stressed in school,” I said.

“You don’t see twins very often, and it is easy to get used to thinking that there is no reason to check,” Jack said. “I seem to forget to check some of the time, just a good idea to do it every time.”

“Thanks for the update,” I said. “I will be sure to make it a habit. I have to hurry upfront so I can speak with Mrs. Nielsen when she drops off her two cats this morning.”

The girls had just completed getting Mrs. Nielsen’s cats into kennels when I got to the front desk.

“I am glad I caught you before you got out the door,” I said.

Smiling, Mrs. Nielsen said, “I am glad too, Ole wanted me to make sure I met you today. He is impressed with you, young man.”

“I just wanted to make sure that you were going to pick up these cats this afternoon,” I said, ignoring her husband’s compliment.

“That is different,” She said. “Always in the past, they were kept overnight. But Ole said, “Anything Dr. Larsen says is fine with us,”

“We are just changing the schedule a little, I will do the surgeries this morning, and they will be ready to go home anytime after 4:00. They will do better at home than down here overnight with nobody watching them.”

“And we close at 5:30,” Mary said, speaking over my shoulder.

“I will be here at 4:00,” Mrs. Nielsen says as she starts out the door.

The girls were used to a slow morning at the office. All three of us veterinarians would depart and do farm calls, usually not getting back into the office until the afternoon. Today I had two cat surgeries to do before starting on my farm calls.

“Let’s get the exams done on these cats and get set up for surgery,” I said. “I have been assuming that they were both females, but we better check.”

The first cat on the exam table was probably approaching a year old, and I didn’t have to look for testicles to know he was a young tomcat. His neck and cheeks were already growing thick, probably the life around the barn required these guys mature early if they are going to survive.

“This morning schedule just got a whole lot easier,” I said. 

We finished an exam, did his vaccines, and gave him a dose of atropine to start getting him ready for anesthesia.

The second cat must have been a brother as they looked like two peas out of the same pod.

“I am sure she was talking about spaying these cats,” Mary said.

“People are often confused about the term, spay,” I said. “I can’t say that I know where the term came from. It makes no sense to me.”

With the first cat on the surgery table, I gave him a dose of Ketamine by IV injection. I gave 0.4 cc IV. This was a dose that would provide excellent anesthesia and immobilization for about 20 minutes and would allow a smooth recovery within 30 or 40 minutes. Some residual pain control lasted for several hours with Ketamine. 

With the cat under anesthesia and on his right side, I plucked the hair from his scrotum. Mary prepped the scrotum as I pulled on a pair of surgical gloves. Jack had graduated in the 1940s. His method of castration in the cat was to incise the scrotum over each testicle, grasp the end of a testicle with a forceps and apply slow, steady traction, pulling the testicle out until the cords stretched and broke off. 

I had been told of this procedure in school and instructed to never use it as it was outdated. There were few complications with this old procedure, but time marches on. I used one of several methods. All involved incisions over each testicle. 

I would pull the testicle out until I could feel the cremaster muscle tear, clamp the cord with a hemostat, and place a ligature on the cord before removing the testicle. This procedure consumed a package of suture material and took a little more time. 

The other procedure and the one I used most often was to pull the testicle out of the scrotum, incise the tunic and separate the tunic from the testicle, then open the tunic with scissors down the length of the exposed cord. Then I would tie the testicular vessels and the tunic in several throws of square knots before removing the testicle and residual tunic.

With any procedure, it was over in minutes. We would clean the surgery area and return the cat to the kennel to recover. With Ketamine anesthesia, the blink reflex is absent until the patient is fully recovered. The surface of the cornea must be protected with the application of an ointment.

This morning, I had the two cat neuters completed, and the record work completed by a little after 8:30. I would be able to get through my farm calls almost on their regular schedule.

Then the phone rang. Both Jack and Don had already left on their calls. Mary answered the phone.

“No, Jack has already left the office. Dr. Larsen is still here, would you like to talk with him?”

Mary hands me the phone. “This is Harold, you know him, I think. He lives out on that little knoll. This is about the twins that Jack delivered this morning.”

I take the phone from Mary, “Hello, Harold,” I say. “What do you have going on?”

“Jack was here about 5:00 this morning,” Harold says. “He delivered a set of twins. Those two are doing well, but the old cow doesn’t seem right to me. She is uncomfortable, not really straining, but sort of doing little pushes.”

Harold was one of our younger dairy clients. He had a herd of 50 or 60 cows. He probably wasn’t the sharpest tack in the box, but he was generally pretty observant, and if he didn’t think things were quite right, it probably meant that I should check the cow.

“Harold, it sounds like I should run out and check the cow,” I said. “If you have her in where we can get to her, I can come right now.”

“I still have her in the calving pen,” Harold said. “I will go get a halter on her and have her tied up and waiting for you.”

Harold’s place was only a mile down the road. I checked to make sure I had water in the truck, pulled on a pair of coveralls and boots, and started down the road.

Harold’s place was laid out a little different for the area. His house, barn, and all the outbuildings were perched on top of a knoll. All his pastures were on the level valley floor, leaving quite a little hill for the cows to climb to the milking parlor and barn twice a day.

I filled a bucket of warm water from the truck, grabbed a bottle of scrub and one of lube and headed for the barn with a couple of OB sleeves in my back pocket.

Harold was waiting in the calving pen with the cow tied in the corner. The twin calves were running around, nursing on mom and then on Harold’s knees.

“They look like they are doing okay,” I said to Harold as I squeezed through the gate, blocking the way, so the calves didn’t escape.

“They are doing great, but I am not sure about this old gal,” Harold said as he rubbed the cow on her back.

She was standing okay, but her tail was raised. That would suggest some continuing contractions. With the calves out of there, that shouldn’t be happening. The calves were small enough, there should not have been any injury to the birth canal. 

“Will, let me get her cleaned up, and do a quick check on her,” I said as I tied a piece of twine to the switch on her tail. I tied the other end of the twine in a loop around her neck, pulling her tail along her side and out of the way.

“You must feel pretty good, getting two heifers out of such a good milker,” I said to Harold as I was scrubbing the vulva on the cow.

“Yes, it is nice. I don’t think I have had twins before,” Harold said. “In fact, I don’t think I have seen twins before.”

“They happen, but not very often,” I said as I pulled on an OB sleeve and applied a handful of lube.

I ran my left arm into the vagina. Everything was normal in the vagina. The cervix was still open, and there were still membranes present. Retained fetal membranes were not uncommon in difficult deliveries and in multiple births. 

I extended my reach into the uterus. There was the problem. All of a sudden, I was holding the tail of another calf. Reaching a little further, this third calf was in full breech presentation. It was maybe a little bigger than the other two but still small. I inserted a finger into the rectum, it tightened. The calf was still alive. 

Then came the bad news. There was no vulva, and reaching a little further, there were the testicles. Harold’s twin heifers suddenly became triplets with a bull calf. This meant the heifers were likely freemartins.

Freemartins are female cattle born twins to a male calf. In cattle, and occasionally, sheep, goats, pigs, deer, and camels, there is a fusion of fetal membranes, and the male calf shares some cells with the female. Those cells produce enough male hormones that the development of the female reproductive structures are affected, and the female calf is sterile. The male calf is only slightly affected, but there is some reduction in his fertility.

“There is good news and bad news Harold,” I said. “The good news is there is another calf in there, and he is alive. Getting him out will solve the immediate problem. He is in a full breech position, but I should be able to correct that with no problem.”

“And the bad news?” Harold asked.

“The bad news is the calf is a male,” I said. “That means that there is over a 90% chance that these little heifer calves are freemartins.”

“What is a freemartin?” Harold asked, “I have never heard that term before.”

“Heifer calves born a twin (or in this case a triplet) to a bull calf are affected by the male hormones, and their reproductive tract doesn’t develop correctly,” I explained.

“I guess the thing to do is just to sell them,” Harold said. “The market of heifer calves is pretty good.”

“We see that done, for sure,” I said, “but that is not very ethical. Then somebody spends a lot of time and money and ends up with a heifer who will not get pregnant. That is pretty unfair to the buyer.”

“Now you make me feel like I am cheating somebody,” Harold said.

“Just be honest,” I said. “Tell the buyer what the problem is, so they know what they are getting. Just don’t do anything that your mother would not approve of, that is the best test.”

“Now, let me get this calf out of her.”

I reached deeper into the uterus and could only touch the hock of the calf as the hind legs were both extended forward along the body on the calf. I could use a crutch now, a device to push the rump up and forward and making it easier to reach the hocks. We didn’t have that available in this practice.

I turned my arm so I could elevate the rump with my elbow. That allowed just enough elevation to allow me to grab a hock and pull the right hind leg back to the rear of the calf. Then I grabbed the cannon bone, midway between the hock and the hoof. By pushing the cannon bone up, then pushing the hock forward, I brought the foot to the brim of the pelvis where I could pop it into the birth canal.

Attaching an OB strap to this hoof, I could apply enough traction that I could reach the other leg with ease. I repeated the maneuver with the cannon bone. Once both legs were in the birth canal, I was able to pull this small calf with simple traction.

He hit the ground and I picked him up and swung him by his heels to drain a lot of fluid from his airways. Another couple of hours and we would have lost this guy.

“Will I guess having three calves for sale is almost as good as one to raise,” Harold said.

“This is probably the only set of triplets I will ever deliver or help to deliver,” I told Harold. “I will have to tell Jack to check for another after each calf.”

“Maybe you should check to make sure there is not another calf, Doc,” Harold said.

“Good point, Harold,” I said. “I am going to put some antibiotics into her uterus anyway. There has been a lot of in and out of there today. And she has a big bunch of membranes to pass. I opened a package of 5 grams of Tetracycline Powder on two sides and carried it into the uterus. I unfolded the pouch and dispersed the powder into the uterine fluids.

“You need to watch her close,” I said. “If she has not passed those membranes by tomorrow afternoon, we should recheck her.”

I cleaned up and headed back to the clinic. The afternoon discussions will be interesting today. 

Photo by Corinna Widmer from Pexels.

D. E. Larsen, DVM

I had just settled into my desk chair and started through the stack of files from the busy day. It was nice to be busy. It seemed to make these quiet moments more relaxing.

Just then, Ruth leaned in through the office door.

“Jason just caught me when I was locking the front door,” Ruth said. “He says he just needs to talk with you for a few minutes if you have the time. What do you want me to do?”

“Bring him back,” I said. “Talk is easy, and I can spare a few minutes.”

Ruth brought Jason to the office door, and I motioned him to the chair near my desk.

“What’s up, Jason?” I asked.

“Thanks for seeing me, Doc,” Jason said. “I know I’m late, but I just got off work, and I rushed over here as fast as I could. I was hoping that you could save my marriage, Doc.”

“Save your marriage!” I replied. “I think you have the wrong office. Down the way on Main Street, there is both an attorney’s and a councilor’s office. I can take care of your dog, but I’m not sure about your wife. I have enough trouble with mine.”

“Doc, I would trust your opinion on anything before I would trust any of those other folks,” Jason said. “But, my dog, Rex, is in the middle of this issue.”

“Okay, so let’s get to the problem,” I said. “This might take a while.”

About then, Ruth stuck her head through the door.

“I’m leaving now,” Ruth said. “Is there anything you two need before I go?”

“I’m okay,” I said. “But Jason just got off work. He might enjoy a Coke or something.”

“A Coke would be great,” Jason said. “Thanks.”

Ruth was back in a moment, carrying two cold Cokes. She handed one to Jaxon and set one on my desk.

“You just got off work yourself,” Ruth said. “I will lock the front door behind me.”

Jason opened his Coke and took a long swallow. 

“It’s all about dog food, Doc,” Jason said. “You wouldn’t think such a small thing would cause a big problem, but it is a major issue in our house right now.”

“There have been a lot of changes in the dog food industry in the last few years,” I said. “Most of it has been just in marketing. Not a lot of real changes in the food, just making people think things are different.”

“Well, if you remember, Doc, when we brought Rex in for his first visit, some five years ago, you said to just pick a major brand of food, and he would do well,” Jason said. “We picked Purina. And I would say it made a pretty good dog out of him.”

“I don’t remember that specific conversation, Jason, but that has been my standard recommendation since I started in this business,” I said. “You go to the grocery store and look at the pet food aisle. They don’t arrange the shelf by chance. The products that sell best get the most shelf space and the most favorable location. Just that alone will be a good indicator of what other dogs are eating. And a lot of dogs grow up and live normal lives on some pretty cheap dog food.”

“And that is where our problem starts,” Jason said. “About a year ago, my wife started watching the TV commercials about all these new-fangled brands of food that make a dog happier and healthier. And they cost a hell of a lot more than Rex’s old Purina.”

“And it’s all marketing, Jason,” I said. “They borrowed from the human food industry. And they play on women’s mothering instinct. You watch a dog eat. He inhales that food. It doesn’t stay in his mouth a second. Look at his vomitus right after a meal. The food in the vomitus looks just like the food in his dish. Sure, he jumps at a can of food, once in a while. But you offer that all the time, and you will lose three weeks of hunting season while you are getting your dog back in shape to retrieve all day.”

“I have been trying to convince Kate of that for months,” Jason said. “She is convinced that the fancy food is worth every penny.”

“If telling her that I said so will help with your argument, feel free to use my name,” I said. “That usually doesn’t help in my house, but it might be worth a try. But go talk with Mark or Mary down at Thriftway, tell them I sent you, and see what they have to say about how they distribute space on their pet food aisle. Take Kate along. Then figure out what percentage of dogs are eating what food. And talk about how well Rex did growing into a fine athletic dog on eat just plain old Purina. That might help; certainly can’t hurt. You can also take your label off the bag of food you are feeding now and compare it to the label on Purina, and even to the cheapest food on the shelf. You will find there is not a lot of difference, except for some of the vernacular.”

“I didn’t mean to take up so much of your time, Doc,” Jason said, “I thank you for your discussion. What do I owe you for the visit?”

“We’re square, Jason,” I said. “You bring Rex in this fall before hunting season, and let’s make sure he is in shape. He is approaching the middle years. So you don’t want to be asking him to do more than he is capable of. And it is not often that I get Ruth to deliver me a Coke. Just let me know how the battle goes. And, if worst comes to worst, tell Kate that you guys just can’t afford the new food. She will say it’s not that much. Then you say it’s not dog food, it’s those damn attorney fees.”

“Ha, that might do it, alright,” Jason said. “That hasn’t come up in the discussions yet, but it has been at the back of my mind.”

We called it a night. And it was several weeks before I happened to see Jason again.

“Doc, I really want to thank you for our talk a few weeks ago,” Jason said. “Your suggestion to take Kate down to talk with Mary did wonders. Mary was great. But the attorney’s fee comment ended any controversy. All is well at our house, and Rex is back on his old diet and happy as ever.”

Photo Credit: John Baker on Pexels.

D. E. Larsen, DVM

Sandy leaned against the exam door jam, she knew I would not welcome her message. Bob and I were looking at a dog with a serious skin infection that we had just kept for a skin biopsy.

“Elaine called, she is looking at that mare in labor and needs some help,” Sandy said.”She is out on Mountain Home Drive, on the Brownsville side, the owner is George, Robert’s brother. He really wanted you when he called in the first place. Elaine said the head was stuck in a poll position, whatever that means.”

I looked at Bob.

“Don’t look at me,” Bob said. “I have seen a mare in labor, let alone one with problems.”

Difficult birth, dystocia, in a mare was rare. I had been in practice several years before I had a call to assist a mare in labor. At a meeting once, during my time in Enumclaw, I had asked one of the horse doctors how they handle dystocia cases in the mare.

“I give one of you guys a call,” He had responded. “You cow doctors are the OB experts. I maybe see a problem in the mare once every four or five years.”

“Okay, Bob, you get this biopsy done, I will run out and help Elaine,” I said. 

Bob and Elaine had graduated a year ago, and had just joined me in Sweet Home. I had be excited, because it not only gave me some help, but Elaine was doing all the horse work. 

I double checked my truck, and started out to Liberty. Mountain Home Drive ran from Liberty, over the hill to Brownsville. I didn’t hurry, when Elaine had received the call, the mare had been in labor since last night. A few minutes was not going to make any difference at thiis point.

Elaine was waiting at her truck when I pulled up to the barn.

“I haven’t been able to accomplish anything,” Elaine said. “Every time I try to manipulate the head, the mare bares down, and I can’t move a thing.”

“You have to be careful,” I said. “I hear stories of broken arms if you get your arm past the brim of the pelvis when the mare strains. Let’s go get a look at what’s going on.”

“She has been in labor since sometime last night,” Elaine said. “She is getting pretty tired,” Elaine said.

“I assume the foal must be dead,” I said.

“I’m not sure,” Elaine said. “All I can feel is the top of his head and his ears. How would make that determination?”

“Well, if there is a posterior presentation, you stick your finger in the rectum and feel any contraction,” I said. “In an anterior presentation, you use the mouth, or an eye.”

“You can’t reach the mouth, maybe we can reach an eye,” Elaine said. “Let me try.”

The mare was lying on her side and straining every couple of minutes. She looked exhausted, not even lifting her head as Elaine did one my scrub on her vulva.

Elaine pulled on an OB sleeve and ran her arm into the mare. This induced a strong contraction as she moved her hand along the side of foal’s head to find an eye. 

“No reaction there,” Elaine said. “I guess that is pretty conclusive that the little guy is dead.” 

“Why would he be dead?” George asked.

“Several things go on in a long labor like this,” I said. “One just the stress of the contraction with the foal in an abnormal postion is enough to kill the foal after severall hours. But often, after three or four hours of labor, we see the placenta separate from the uterus.”

I scrubbed my left arm and reached into the mare to evaluate the status of the position. I usually worked bare arm in OB cases as it afforded better feel.

Elaine was correct, the top of the foal head was tightly pushed into the pelvic canal. I pushed on head, just to see if I could repel it back into the uterus. The mare stained, and I could not budge the foals head.

“So, if I push any harder on the head, there is a good chance it will rupture the uterus,” I said to anyone listening. “Then we have a dead mare.”

“The only other option is to load her up and take her over to the vet school,” Elaine said.

“She isn’t going anywhere,” George said. “I worrying about how I am going to pay you two, I can’t afford going over there.”

“We are not going to be doing a C-section here,” I said. “There other option is a fetotomy. All we have to do is remove the head.”

“They say to never do a fetotomy in a mare,” Elaine said. “There is too much risk of some major injury to the birth canal.”

“I guess it is a good thing I never knew what ‘they’ said,” I said. “I did one in Brownsville a couple years ago on a mare with the exact same presentation. I don’t think there is any other option open to us. We either do a fetotomy, or we euthanize the mare.”

“I’m with you, Doc,” George said. “If things don’t work out, at least we tried.”

“They don’t even teach fetotomies in school anymore,” Elaine said. “I’m excited to see this.”

“Yes, it is almost a dying art. I don’t talk with very many veterinarians who do them on a regular basis. I was tought in school to use a fetotomy rather than a C-section any time the calf is dead. The hardest part with this one will be threading the OB wire around the neck,” I said as I measured off a length of OB wire with my arms. “Twelve feet should be enough.”

I tied the OB wire to the wire threader, a curved heavy gauge stainless steel rod with a loop on both ends.

“If I can pass the behind the angle of the jaw and retrieve it from the other side, the battle is won,” I said.

Working with limited space and trying to be a gentle aa possible so I would induce a contraction from the mare, I managed to push the threader through to the other side of the neck. I grabbed it from the other side and pulled the wire through.

“Where are you going to make the cut,” Elaine asked.

“The best option will be to do a right angle cut through the neck,” I replied. “That will allow me to pull the head out and to use my hand to cover the exposed neck bone so the birth canal is protected. Once the head is off, things will happen fast. She will push out what’s left of the foal with one or two contractions.”

I threaded the two ends of the OB wire through the double-barreled fetotome and attached the handles to the wire.

“George, I’m going to let you do the sawing,” I said. “It’s an easy job. When I give the word, you just start with slow, long strokes. Sort of lean back and put a little weight on wire. You will feel when the wire saw breaks through the skin. At that point, you can quicken the pace a little. It won’t take long, these fetal bones are soft.”

I put my arm back in the mare and slipped the wire over the ears of the foal. Then I glanced and Elaine and told her what I was doing.

“So, I got the wire of the top of the head.” I said. “When I position the end of the fetotome along side of the neck, the wire will slide into position as soon as George starts sawing. And George, if I say stop, you stop instantly. It only takes one stroke to severe a finger.”

“Now you have me worried, Doc,” George said.

Once I had the fetotome in position, I motioned to George. “Okay, nice long, slow strokes.”

George acted like he had done this many times before. He felt when he was through the skin and quickened his pace, leaning back to weight to the wire. He was through the neck in four of five more strokes.

I pulled the fetotome out with my right hand and grabbed the ears on the foal’s head. With a firm tug, I pulled the head free and tossed it on the ground behind me. I covered the the neck bones with my left hand and gave just a slight pull on one of the legs with my right hand.

The mare strained, and the foal moved a bit. Then with one big contraction, the foal almost shot out. The placenta followed. I checked to make sure that it was all there and finally stood up and stretched a little.

“That looked awful easy,” Elaine said.

“Now we just need to give this gal some oxytocin to contract the uterus and some antibiotics. I also like to put about five grams of tetracycline powder in her uterus,” I said.

“Why do that?” Elaine asked. “It will just be discharged in short order.”

“I know, but I will sleep better tonight,” I said. “For one thing, it will give you a chance to check her uterus for any injury and to make sure there is not a twin in there.”

“It’s pretty unlikely of there being a twin,” Elain said. 

“You should always check, there are more than one story about that,” I said. “I’ll let you finish here, and I’ll run back to the office just to make sure Bob doesn’t need any help.”

George came out to the truck while I was washing up.

“Thanks for coming, Doc,” George said. “I feel better with you here.”

“We got a little lucky today, George,” I said. “But the mare should come along fine now. Keep a close eye on her and call if you have any questions.”

The mare recovered well and was looking good when Elaine stopped by to check on her the following day.

Photo Credit: Philippe Serrand on Pexels.