Charlie

 D. E. Larsen, DVM

  It was a bright sunny afternoon in early June when I pulled up to the gate of the McCubbins’ farm. Frank had a llama with a vaginal prolapse, and she was close to her delivery date. When I got out to open the gate, I noticed a feral momma cat with a litter of 4 kittens. The kittens looked to be about 5 – 6 weeks old. The remarkable thing about the litter was there was one Siamese cross kitten with long hair. My kids would love that kitten, but the whole group scattered when I tried to approach them.

  I continued on to the barn after closing the gate. Frank and his grandson were waiting for me at the barn. I casually mentioned the litter of kittens as I was collecting my things to deal with this llama. Vaginal prolapses are simple to deal with when they occur following delivery but are always tricky before delivery. One has to replace the prolapse and secure it in place without obstructing the birth canal. Careful monitoring is one option if the vulva is sutured closed. That is always unreliable, and if the vulva is sutured closed, the baby will die in a short time if it is stuck in the birth canal.

  Today I was going to try a trick not taught in my schooling but relayed to me over dinner at a local veterinary association meeting by on old veterinarian over twice my age. After carefully washing the prolapsed tissue, I lubricated the mass and carefully pushed it back in place. She did some straining, and it was evident that she would push things out again. 

  Now for the trick. I washed a wine bottle one last time and rinsed it with betadine and lubricated it with KY jelly. I carefully inserted the bottle into the vagina, blunt end first. It would serve as a pessary, preventing the vagina from prolapsing again. When the cervix dilated, and the baby entered the birth canal, the bottle would be easily pushed out and followed by the baby. This was a trick from the 1930s, or maybe before. The results were expected to be far better than any of the modern methods.

  Frank and I were talking while I was cleaning up and putting things away. He was intrigued by the story of how professional information was passed from one generation to the other. Often information from older generations never made it to the textbooks but still prove to be very functional. 

While we are standing there, Frank’s grandson approaches with the Siamese cross kitten in his hand. I asked what he was going to do with him as I carefully checked him over. The kitten was covered with ringworm.  

  “I’m going to keep him.” he replied.

  I told them that was fine but to be careful of the ringworm. I told Frank I would be happy to take the kitten if the ringworm became a problem.

  It was probably 2 weeks later when Frank called the office.

  “Are you still interested in taking that kitten?” he asked. “I have a grandson who is covered with ringworm.”

  Frank was happy to deliver the kitten to the clinic. We started with an anti-fungal bath and topical treatment. Naming him Charlie, he was an irresistible kitten. Even with careful treatment and stern warnings, our kids also developed a few ringworm lesions before Charlie’s skin was clear.

  Charlie proved to be a super cat. He grew large, measuring nearly 3 feet from the tip of his nose to the tip of his tail. He was a ferocious hunter. There was nothing safe in the back of our property. We had many molehills when Charlie arrived; by the beginning of Charlie’s second summer, he had eliminated the entire mole population.

  I would leave the bedroom window open and unscreened during the night, and Charlie would come and go as he desired. It was common for him to bring his trophies and leave them at the foot of our bed. Mice and bats were standard fares. One night I heard him come through the window, and he jumped up on the bed. This was something he did not do on any regular basis. Next thing I knew, he dropped a mouse on my neck. Thankfully it was dead.

  During Charlie’s 5th year, he went hunting one evening and never returned. There was nothing, Charlie just didn’t come home. Probably caught by a coyote. Or maybe by the great horned owl who hung out on the creek side of the hill.

  Charlie was missed by the whole family. But the return of the molehills was most disturbing.

Photo by Alena Vertinskava on Unsplash 

The Doctors Voss

I need to preface this little story. Dr. Voss was a Equine Ambulatory Veterinary at Colorado State University during my years as a student at that school, (1971 – 1975). He was an excellent instructor and veterinarian and very well liked by all the students. He went on to become Dean of that school and was held in such esteem that the new teaching hospital was named after him. This story is of a young instructor, adored by his students, and should be taken only to add to his esteem.

D. E. Larsen, DVM

When I was in Veterinary School, there were two doctors in town with the name of Voss. The older Dr. Voss was a well respected OB/GYN doctor; the younger Dr. Voss was a horse doctor.  He was in his mid 40’s and very well liked by all the students at the Veterinary School. 

  The young Dr. Voss was known to be quite a storyteller in the classroom or on farm calls.  He told stories to keep the atmosphere light, but he also used stories to drive home a point he was trying to make to the students.  

  One of his favorite classroom stories he used was to make a point about double checking yourself before administering a medication.  He always said, look at the bottle when you pick it up, look at it when you are drawing up the dose and then look at it again when you set it down.  That’s a good point, but students learn better with a story to illustrate the point.

  Dr. Voss had a story to go with that bit of instruction.  It was about a call for a horse with colic.  Doing a rectal exam on the horse, he could determine there was an obstruction at the colonic flexure.  He had administered mineral oil via a stomach tube and given a dose of pain medication.  Now he was planning to give a dose of medication to relax the contractions of the gut, allowing the mineral oil to work through the gut and loosen the obstruction.

  Dr. Voss continued the story: he grabbed the bottle of medication from the truck and drew 10cc into the syringe.  He walked over and administered the dose via the jugular vein.  When he returned to the truck to put the bottle away, he realized that it was the wrong medication.  Instead of relaxing the contractions of the gut it would cause strong contractions.  In the horse with an obstructed colon, this would most likely cause a rupture of the colon and a dead horse.  

  Realizing his mistake, he returns to talk to the owner.  “I think this horse is in a lot worse shape than I originally thought,” he says.  “I think this horse is probably going to be dead by morning. Not much more that we can do at this time.”

  The owner calls the hospital the next morning and reports that indeed the horse is dead.  Then he concludes,  “That Dr. Voss is the best veterinarian we have ever had on the farm. He predicted that death exactly.”

  The class roars at the story. The point is made and will be remembered by everyone for the next 50 years. And they didn’t have to make a single note.  It conflicted with the philosophy of honesty and transparency in treatment and medical records, but the critical point is there.  Was the story true?  Probably not, Dr. Voss was far too good of a doctor to make such an error, but nobody asked that question.

  The young Dr. Voss regularly hosted a large group of senior students at his house for poker parties.  Not a lot of money involved because most of us had very limited funds, but penny ante poker, a beer or two and good times.  On one such evening, the phone rang. 

  Dr. Voss answered the phone, “Hello, this is Dr. Voss, how can help you?”

The call gives everyone an early lesson on how the telephone was going to dominate our lives in the years to come.

  “Yes, this is Dr. Voss, what can I help you with Kathy?” he repeated into the phone.  The room was silent with all attention to the phone call.  The night crew at the veterinary hospital would take care of any emergencies, so this must be a unique client.

  After a brief silence Dr. Voss exclaims, “Oh, I see!”

A long silence this time, then another comment “Oh my!”

Then a more extended silence, “Oh, my gosh.”

Another long silence, everyone is straining to hear the call.  Dr. Voss finally speaks, “Well Kathy, I don’t know, but I can’t be of much help to you. You see, I am Dr. Voss, the horse doctor.”

 There is a brief moment of silence and then a loud ‘click’ that can be heard across the room as the Kathy slams the phone down.

  Dr. Voss hangs up his phone and beams with a broad smile, “I guess she wanted the other Dr. Voss,” he says.

  The room erupts in chaos as everyone tries to pump Dr. Voss for details.  What an evening. 

On a Thanksgiving Eve

On a Thanksgiving Eve 

D. E. Larsen,DVM

The barn was cold, but there was steam rising from the back of young heifer. A dusting of snow on her back was melting fast.  Bill and Connie Wolfenbarger had called with a heifer in labor.  They were not regular large animal clients but did visit the clinic with their small dogs.  I had been to their place several times to treat cows belonging to the Gilbert’s.

    When they discovered a tail hanging from the heifer’s vulva, they knew they had a problem. This meant the calf was in a true breech presentation and almost certainly dead. In a true breech position, the calf does not engage the cervix, and the cow doesn’t go into hard labor.  Most people will not notice a problem until the calf has been dead for a day or two.

    Tomorrow was Thanksgiving, I would miss some of the prep for the family dinner. The evening snowfall was light but continuing. Hopefully, I could make it home before the roads became a problem. Sandy’s folks were already at the house, so we didn’t have to worry about anybody traveling tomorrow.

    I tied the heifer’s tail out of the way and started to wash the her rear end. The hair on the tail came off with the slightest touch. I pulled on a plastic OB sleeve onto my left arm. With a little lube on my hand, I eased into her vulva to explore the birth canal. She strained hard when I reached the butt of the calf. No fluid was expelled with the strain. I pushed the rear of the calf with a couple of fingers. There was a spongy consistency under the skin and some crackling like I was popping air bubbles. The calf filled the entire birth canal, I could not advance my hand into the uterus, and I could not move the calf, it was wedged solidly into the birth canal.  I withdrew my hand, the sleeve was covered with hair from the calf and the odor was slightly pungent.

    “This calf has been dead for over a week,” I said as I removed the sleeve. “It is emphysematous, blown up with gas, I am not sure I am going to be able to get it out of her.”

    “What are our options?” Bill asked.  I knew their daughter was a small animal veterinarian, maybe in California. I did not know her, but I would assume they would be a little more knowledgeable than most clients.

    “Options are not many, the calf is in a breech position. That means its’ hind legs are retained and only the rump is presented. It is blown up so much that I cannot even insert my hand into the uterus. We are not going to be able to deliver this calf vaginally. I try not to do a C-Section on a dead calf, but with all the emphysema I won’t be able to do a fetotomy.  That leaves us with two viable options. Option one is a C-Section, which will be with risk and will be difficult.”

    “And the second option?” Bill asked.

    “The second option is to get your rifle and shot her now. It would not be fair to her to leave her in this situation,” I said.

    “Let’s do the C-Section,” Bill said.

    I double checked her halter to make sure she would not be choked if she went down. Then I change the tail, tying it to the right side. I placed a rope around her neck with a bowline and ran it along her side and tied it to ally fence, holding her against the fence. With her in a reasonably secure position, I clipped a wide area on her left flank, from her dorsal midline to her bottom of her flank.

   I prepped her flank with Betadine Surgical Scrub. The with 90 ccs of 2% Lidocaine, I did a large inverted ‘L’ block of her left flank. I blocked a wider area than usual because I may need to make a longer incision than is usually required. This was not going to an easy procedure. I repeated the prep after the block.

    After laying out the surgical pack and supplies, I pulled on a pair of surgical gloves, more to keep my hands clean than to pretend that this was going to be a sterile procedure.

    “We have a couple of major risks with this surgery,” I explained as I prepared to make my incision.  “The first one is that it is going be difficult to pull this uterus to the incision and second when I open the uterus, there is going to be no way to prevent the contamination of the incision and the abdomen. We are just going to have to depend on antibiotics.”

    Bill nodded, and I made a long incision down her flank, starting a few inches below her transverse processes and extending about 15 inches down her flank. The skin and subcutaneous tissues parted easily. Then I incised the muscles of the flank, they quivered as the blade divided them.  When I incised the peritoneum, the abdominal content did not sink away from the incision with a characteristic rush of air into the abdomen. The distended uterus filled the entire abdomen. There was no trouble finding it or worry about moving the rumen to externalize the uterus. The abdomen was filled with the uterus. 

    I reached into the abdomen to the tip of the uterus. Cupping my hand around the tip of the uterine horn, I pulled. The uterus did not move. I tried to rock the uterus in the abdomen. Sometimes you could swing the uterus enough to make it easier to bring it to the incision. This uterus did not budge. Again and again, I tried to bring the uterus to the incision.  I searched and found a hoof, I could not move the hoof.  

    I pulled my arm out, stretched and changed gloves. It this cold barn, but I was sweating profusely.

    “Do you think I could give you a hand?” Bill asked.

    “We might try that, if we could both get a hand under the end of the uterus, we might be able to make it move,” I replied.

    Bill stripped down to his waist and washed his hands and arms thoroughly.  I stood on the head side of the incision and ran my left hand down to the tip of the uterus. Bill on the other side of the incision inserted his right arm.  I guided his hand to the correct position.  We pulled, we pushed, we tried almost every maneuver. The uterus did not budge.

    Bill and I were almost nose to nose.  Bill had sweat on his brow and sweat dripping off the tip of his nose. He looked me square in the eye.

    “A woman couldn’t this,” he said.

    I smiled, “If you haven’t noticed, I haven’t got it done myself, yet.”

    We pulled out, and I rethought the situation.

    “I am going to try one more thing,” I explained. “I am going to open the uterus up here without externalizing it. I will then try to get a hold of the calf’s hoof and turn it up to the incision.  The risks in doing this are many. I could spill content into the abdomen, I could tear the uterus, and even with a grip on a foot, I might not be able to budge this uterus.”

    “And then, if this fails, we are going back to option two. We will get your rifle and put this girl out of her misery.”

    That said, I incised the uterus in the middle of the flank incision. With a surgical glove and an OB sleeve on, I ran by right hand down the inside of the uterus. There was a front foot, I grabbed the leg just above the hoof and pulled as hard as I could.  The uterus rolled and the hoof popped out of the incision. With my left hand, I incised the uterus over the hoof, and then I slipped an OB strap onto the hoof.  

I handed the strap to Bill. “Keep that foot from going back into the abdomen.”

    Pulling my arm out of the upper incision, I enlarged the incision over the exposed hoof. Bill was able to pull the entire front leg out of the incision.  I reached in and found the other leg. It came out quickly, and we attached it to the other end of the OB strap.

    With both front legs out, I enlarged both the flank incision and the uterine incision. Now I was able to pull the head out of the incision. Then putting things down, I helped Bill put a hard pull on the calf. It was sort like pulling a basketball through a knothole but when gas-filled abdomen of the calf finally cleared the incision both Bill and I almost fell as the rest of the calf followed with a swoosh.

    The membranes and the calf landed on the barn floor in a splat. Then the odor hit us. Bill and Connie both gagged and had to turn back to the side door.  When they opened that door, things were better, or maybe we were just adjusted.  Bill grabbed the OB strap and pulled the calf out the barn door, and I returned my attention back to closing up this mess.

    I washed and changed gloves. I put 5 grams of Tetracycline powder into the uterus and pulled the open incision to the outside. This was a long incision in the uterus, and then there was the small incision higher on the horn.  I elected to close the upper incision first, just in case the uterus would start to involute, and I would not be able to reach this incision.  I closed It with a simple continuous suture.

    The larger incision I closed with my standard Utrecht closure. After closing, I returned the uterus to the abdomen. I was concerned that there was probably a lot of leakage into the abdomen and pondered how best to deal with that event. There was no option to lavage the abdomen in the middle of this barn, so I just dumped another 5 grams of Tetracycline powder into the abdomen.

    I closed the flank incision with 4 layers. I used simple continuous in the peritoneum, interrupted mattress in the muscles and simple continuous in the subcutaneous tissues. I closed the skin with an interrupted mattress pattern.  No need to spray for flies in this weather.

    The heifer had to feel tremendous relief getting that mess out of her. She was going to need some additional antibiotics to keep her incision from falling apart. The easiest thing was to use some long-acting sulfa boluses.  I gave her 4 boluses of Albon SR. That would give her 5 days of protection.  

    I untied her tail rope and the sideline. She was as calm as could be expected.  I loosened the halter and slipped it over her head. She turned slowly and headed to the door, sniffing the floor a little as she passed.

    “She should be okay for tomorrow, but I will check with you on Friday,” I said to Bill as I was cleaning myself up.

    “She will be just fine,” Connie said.  “Our daughter will be home for a week or two.  She can check her tomorrow.  We will let you know how she is doing. You go home and rest for dinner tomorrow.”

    At least I was going to have a few days to rest up with the holiday.  I stopped at the clinic and cleaned all the equipment.  It would be a real mess if I left it for the girls on Monday.  I stripped down to the waist and washed thoroughly. The one mistake I made with the clinic was not putting in a shower. I thought I would wash here and go home for a shower.  Then probably have to start working on dinner for tomorrow. 

Friday morning, Bill called. “The heifer is doing great. Our daughter is impressed with how the incision looks. We told her the story, but I don’t think she really believed us. 

Two weeks later Bill called again to say they took the sutures out and the heifer continued to do well.

Photo by Ehoarn Desmas on Unsplash

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