Yuri Andropov (you’re a drop-off), with Puppies on Board

D. E. Larsen, DVM 

“What do you think, Doc,” Bert asked. 

“They are just drop-offs,” Jan added. “We don’t want to spend a lot of money, but my gosh, we have to do something for the poor little things.”  

“How do you get so lucky to have two of them dropped off,” I said. “Even for dachshunds, they the pretty thin. I lifted the skin on the back of the smaller one’s neck. It held that position for several seconds before slowly returning to normal. 

“She is dehydrated, not breathing well, her abdomen feels empty, and she is skin and bones. I don’t know; she may have a diaphragmatic hernia. That would be my guess, but we will need to get an x-ray to confirm that suspicion,” I explained. 

“I don’t know,” Jan said, looking at Bert for a clue as to what he was thinking. “Can we do something simple, just to get some meat on their bones? There is really no need to take an x-ray because we aren’t going to fix anything on a stray dog.” 

“Okay, let us hang on to them for a couple of hours. We will check a fecal exam and do a good exam. It could be a little deworming medication, some good groceries, and some TLC help. If not, we can decide on another course of action in a couple of weeks. What do you call them, by the way, just for the record?” 

“I don’t know; we have only had them overnight,” Jan replied. “We will think about that over the next couple of hours.” 

The fecal exam showed a massive infection of both roundworms and hookworms. Roundworms were almost always present in young dogs around Sweet Home, but it was unusual to see hookworms.

“A good dewormer and some canned food might do these pups a world of good,” I said to Dixie. “Give them a couple of weeks, and they will look like new dogs.”

The larger of the two pups had a normal exam, plus a 30-day pregnancy. That will add to the stress of recovery.

Palpation of the abdomen of the smaller of the two revealed almost no content in the anterior abdomen, and the empty abdomen allowed for the easy detection of a similar 30-day pregnancy. My guess was she had a diaphragmatic hernia (the wall between her chest and abdomen was ruptured). Dogs can live with this injury for a time if they survive the initial insult. Sooner or later, it will require surgical repair if the patient is going to survive. This growing pregnancy was going to be a problem for her respiration.

Bert and Jan returned to retrieve the pups in the late afternoon. 

“We have decided on Anna and Maria for names,” Jan said.

“Any preference on which name goes with which pup?” I asked.

Jan looked at the two little dogs watching her closely from the kennel. 

“Let’s call the small one, Maria,” she said.

“Anna checks out pretty good. They both are skinny and have a heavy burden of intestinal worms. We gave them some medication for the worms, and some good groceries will help put some meat on their bones.”

“That’s good,” Jan said. “”We are just going to do the basics for them. As far as we know, they could be gone tomorrow.”

“But that is only the half of it,” I said. “They are also pregnant. You guys really hit the jackpot.”

“And how does Maria check out?” Bert asked.

“Her problem is she very likely has a large diaphragmatic hernia. My guess is her liver, stomach, and a lot of intestines are in her chest. Sooner or later, this will become life-threatening. And as this pregnancy gets closer to term, her respiration may become an issue.”

“Do you think she can survive the pregnancy?” Bert asked.

“I don’t know. I think the best recommendation would be to spay her and repair the diaphragmatic hernia now.”

“She is just going to have to make do,” Jan said, glancing at Bert with a bit of a frown. “We have decided that we are just going to do the basics for now.”

“I understand that completely and they are probably lucky they found your house,” I said. “Make her a bed so she can sleep with her head and chest elevated. That will help with her breathing.”

“That is just the way it is going have to be,” Jan said.

“I know, but these little dogs grow on you after a while. Your thinking might change in the future.” 

With that, the visit was over. Anna and Maria slipped into the recesses of my memory for the time being.

A full 6 months later, Jan had Maria on the exam table waiting for my evaluation. Maria was a completely different dog; no longer skin and bones, she almost looked like a typical Dachshund.

“You can’t imagine how many dogs we had running around with all those puppies,” Jan said. “But they are all adopted, and that was a chore in itself. Anna has even found a home. But Maria has her chest problem. She had to sleep in a box with her nose held in the air when she was pregnant. We have decided we need to repair her chest.”

“We know this hernia is at least 6 months duration, maybe longer,” I said. “Maria might have some permanent lung damage.”

“So, what are our options?” Jan asked. 

“Not many options,” I said. “Fix her or not is just about it. If we repair the diaphragm and get the lungs to expand, we are probably home free. I have to hedge a little because her lungs have been collapsed for a long time, and we may have difficulty expanding them. If everything goes well, we can spay her at the same time.”

I looked at Jan with a curious eye. She was really attached to Maria now. I remembered warning her that these little dogs would grow on her. 

“When do you want to do the surgery?” Jan asked. 

“I think my surgery schedule is petty open right now,” I said. “We can schedule her any morning at your convenience, but the sooner, the better. We can monitor her all day. She will need a chest tube after surgery, maybe for the afternoon, maybe for several days. I don’t like to send them home with a chest tube.” 

“Let us take her back and snap a couple of pictures of her chest,” I said as I handed her off to Dixie. “It will only take a minute, and we will have them for you to look at in the morning.” 

“You warned me that I would get attached to her. I didn’t really believe you at the time. But she is so sweet, I think she is part of our family now.” 

“No breakfast in the morning and have her here at 8:00.” 

With the x-rays taken, Jan took a deep breath and gathered Maria up in her arms. Kissing the top of her head. She looked at me with some concern on her face. “This is a serious surgery, isn’t it,” Jan said. 

“Yes, it is a serious surgery,” I replied. “It would have been more serious had we done it when Maria was first dropped off. Her condition at that time would have made it very risky. I can do this surgery, Jan. It is not something that I do every week, but I can do this. She is in good hands.” 

“Doctor Larsen, I am not questioning your skill. I just feel so guilty,” Jan said. 

“You should always question a surgeon’s skill, for your dogs and for yourself,” I said. “You have no guilt here. If there is any guilt, it is for the people who dumped her at your driveway.” 

The x-ray showed Maria’s chest’s left side was filled entirely with abdominal content, liver, stomach, spleen, and intestines. No wonder the abdomen was mostly empty on palpation. The chest’s right side was intact, but there was some compression from the left side content. This was going to be a challenging repair. 

Jan was prompt in the morning, coming through the door a few minutes before 8:00 AM. We were ready for her. I usually did not start surgery until 10:00 AM, leaving some time for early morning appointments and emergencies. But with this surgery, I wanted to get through it as quickly as possible so we would have the whole day to observe Maria’s recovery. 

We were brief at the check-in. I went over the x-rays with Jan. They were dramatic films, even for a novice. Then we had Jan sign a release for surgery and say her goodbyes. 

“If we get exceedingly lucky and can pull her chest tube this evening, I will probably send her home,” I said. “I wouldn’t plan on that, but it’s possible. You should check by in the late afternoon. I will give you a call when I am out of surgery to let you know how things are going. This is a major operation, and there is a possibility we could lose Maria. I would not expect that, but there are some pitfalls we have to get across.” 

“We know you will do your best. That is all we can ask for,” Jan said with tears welling up in her eyes. “I will see you late this afternoon.” 

We went right to the surgery with Maria. I placed an IV catheter in her right front leg and started IV fluids at a slow drip. It only took a couple of minutes to get her under anesthesia and on the gas machine. I double-checked the seal on the endotracheal tube. When we opened her abdomen, we would have her on positive pressure breathing. Due

to her small size, we had her on a non-rebreathing circuit. We would have to breathe for her using the bag in the circuit. 

When she was prepped and draped, I made a long incision on the ventral abdomen. I needed an incision that would allow me the repair the diaphragm in the anterior abdomen and one that would also allow for the removal of the uterus. 

I would repair the hernia first, and if all went well, we could do the spay. If there were problems, the spay could easily wait for another day.

Almost all the entire abdominal contents were in the chest, passing through a large rent in the diaphragm’s left side. Maria had most likely been hit by a car. At her small size, she was lucky to have survived the severe blow that would have been required to cause this size of a diaphragmatic hernia. 

I started carefully pulling the contents back into the abdomen. The intestines were easy. The spleen and stomach proved a little bit of a challenge. The liver took some careful manipulations to pull it out of the chest without injury. After all the content was back in the abdomen, I packed off the large rent in the diaphragm with some lap sponges. 

Now we needed a little luck to expand the left lung lobes that have been collapsed for over six months. Using the bag, we put slow, steady pressure in the circuit to expand the lungs. Much to my surprise, these lung lobes expanded quickly, turning from a dense reddish-brown color to a fluffy pink in no time at all. There were just a couple of small areas along the edges of the diaphragmatic lobes that failed to expand. My guess was they would return to normal after a few weeks of normal respiration. 

With the lungs expanded to fill the chest, my concerns about a chest tube being needed for several days were probably unfounded. I placed and chest tube and attached a Heimlich valve. 

That done, I just needed to close the tear in the diaphragm, evacuate the air from the chest to form a good vacuum, and we would be done with plenty of time to do the spay.

I routinely closed the abdomen. It was a long incision. I was reminded of Dr. Annes’ comment from school, “Incisions heal from side to side, not end to end. Always make your incision long enough to get the job done”. 

Maria recovered quickly. I think she felt so much better with a fully functional chest that there was little post-surgical pain to control. I called Jan with a report on a successful surgery, and the news was warmly received. 

By the middle of the afternoon, we were able to remove the chest tube. Maria was dancing a jig around Jan as they started out the door. One happy dog with a new lease on life and one happy client. 

“We thank you, Doctor Larsen, and now Maria will be well enough to be adopted. That will be hard, but I have a special young boy in mind who can use a pet.”

Photo by Dayvison de Oliveira Silva from Pexels

The Toughest Dog on the Block

D. E. Larsen, DVM

Carol backed through the clinic door and turned around in a frantic search for someone, anyone, to help her. Her usual short permed hair was hanging over her eyes. Her dark green coat hung lopsided from her shoulders, and there was a large smear of blood on the left side. There was blood dripping from the knuckle of her right hand. 

She was holding her little toy chihuahua, Poncho, cradled in her arms. Poncho was an older chihuahua, black and tan in color. His main identifying feature was his tongue hanging out of the left side of his mouth. Like all chihuahuas, he was sure he was the toughest dog on the block.

Kari was the first one to reach Carol, and she carefully took Poncho from her hands. I was not far behind and took a quick look at Poncho’s wounds. His chest was torn open on the left side. I could see his lungs fighting to exchange some air in an open chest. 

“Get him back on some oxygen,” I say as Kari starts toward the treatment table. “I will be there in a second.”

I turned my attention to Carol for a moment.

Carol is a long time client. She is a short, trim lady in her late sixties. She has always been more than generous with others in the community. Often paying the vet bills of her family members and friends.

“You know Poncho, he just ran up to those big dogs who were fighting in the neighbor’s yard,” Carol says with tears in her eyes now. “This big shepherd just picked him up by the chest, shook him a couple of times, and flung him into the street. It happened so fast, there was nothing I could do. I just gathered him up, and here we are. Thankfully, my son was home so he could drive.”

“This is a major wound, Carol. There is a possibility that Poncho may not survive.”

“I know that, but we have to try.”

“I don’t have time to provide you an estimate. It may be expensive.”

“That is fine, Doc. Please do what you can to save him. I don’t know what I will do if I lose him like this.”

“Carol, if you can, have a seat and wait a short time. I will get Poncho stabilized and assess the extent of his wounds. If we are just dealing with a chest wall injury, things will be a lot better than if we have some lung damage along with it.”

I stepped back where Kari was providing Poncho some positive pressure oxygen via a mask. I quickly placed an endotracheal tube and started the ventilator. Then we looked him over for other injuries.

With everything looking okay except for his left his chest wall, I carefully examined his lungs. The ventilator had them working fine. I moved the lung lobes around a little and could not see any injury to the lungs or the heart.

“With any kind of luck, we will be able to close up his chest with little problem. I don’t see any injury to his lungs,” I say to Carol. “We will need to keep him overnight, at least, because we will have a chest drain in place.”

“I will be back at about 4:30, and maybe I will be able to have you rethink the overnight thing,” Carol says. “I won’t be able to sleep without him at home. Maybe you can wrap up the chest drain, and I can have him back at the first thing in the morning.”

“Okay, you check at the end of the day. A lot depends on how well the chest wall repairs and on how painful Poncho is following surgery.”

We packed the wound with moist gauze sponges while we clipped and prepped the wounds. Then came the task of figuring out the best way to close this chest wall.

Three of Poncho’s ribs were broken away from the sternum. I was able to wire those back into place. Then it was a matter of closing the muscles and moving other soft tissues around to provide an air-tight closure of the chest wall.

With a chest tube in place and a careful block of the region’s nerves with local anesthesia, we recovered Poncho. 

I had a continuous suction device on the chest tube, and Poncho acted fine when he woke up from anesthesia. He was a little guarded of the injury, but not obviously painful. The regional anesthesia was doing its job.

When Carol returned, there was no hint of her ruffled appearance from the morning. Her hair was fluffed as always, and she displayed a soft smile. Her coat was changed to a tweed. I would guess the green coat was already at the cleaners.

“There is mostly good news,” I said. “The chest wall repaired well, and Poncho is a little stiff but is otherwise doing well.”

“Is it going to be possible for me to take him home?”

“I have a suction device on his chest tube, and it is not showing much drainage. I think I can put a wrap on his chest and send him home. There is a little risk in that, but then, we don’t have 24-hour care available for him here.”

Poncho was dancing in the kennel and turning circles when he saw Carol. I had to catch him as he tried to jump to her when we opened the kennel door.

“We have bloodied one coat today, Poncho,” I said. “Let’s get you wrapped up for the evening before giving you to your owner.”

With a chest wrap in place, Poncho and Carol headed for the door. Poncho trying to lick Carol’s chin with a tongue that never seemed to track just right.

“We will see you the first thing in the morning, Doc. And I can’t thank you enough,” Carol said as she pushed through the door.

As promised, Carol and Poncho were the first ones through the door in the morning.

We removed the wrap and I was able to pull his chest tube. 

“It looks like you dodged a bullet this time, Tiger,” I said to Poncho. “I would guess that it would do me no good to try to tell you that you are a little dog.”

“That is for sure,” Carol said. “He was barking at the neighbor dog when I loaded him into the car this morning. I don’t think he learned a thing.”

“It is the nature of the beast. I think all these little guys think they are the toughest dog on the block.”

Photo by Quang Nguyen Vinh from Pexels

When do You Say When

D. E. Larsen, DVM

Nessie came out from under the feed rack, shaking her head vigorously as the small rat hung limply from her mouth.

Nessie was a small, straw-colored Cairn Terrier. 

“That’s the way to get ‘em,” Ayers hollered as Nessie discarded the dead rat and ran up the hill toward us.

Ayers laughed and stuck his hands into the pockets of his bib overalls. He looked at me with a broad smile, and his good eye twinkled.

“I love that little rag muffin of a dog,” Ayers said.

We had just finished working on a cow with pink eye. The white-faced cattle suffered a little in this dry and dusty weather of mid-August in the Willamette Valley. 

“Do you think that eye will be okay?” Ayers asked, his voice was more serious now.

“I know it looks terrible right now, but it will heal up and be back to normal when I come back and take those sutures out,” I said. 

“You always sound so confident in what you do, Doc,” Ayers said. “How can you be so sure of yourself all the time.”

“It is just a matter of knowing what you know,” I said. “I know what I know, and consequently, I know what I don’t know. When I was in the Army, I learned to express utter self-confidence when I knew something. I venture into gray zones of my knowledge at times. But when I do that, you will know it. I have no problem saying I don’t know something.”

“So, what do you know about cataract surgery in people?” Ayers asked. 

“I have never watched a surgery,” I said. “ But I know they are getting better and better at it all the time. I did a couple of cataract surgeries while I was in school. Luckily, we have a specialist in Oregon that does most of those surgeries. That is a surgery that you want someone who does a lot of them. Practice makes perfect.”

“Oh, I know,” Ayers said. “They say they are pretty good. But, you know, Doc, when you only have one eye, like me, it is a pretty big decision.”

“I can imagine your concern,” I said. “But, you have to consider the alternative. You don’t want it to get so bad that you can’t see.”

“I know that, but when do you say when?” Ayers asked.

“You are trying to get me to answer some of those questions that the eye doctor should be answering,” I said.

“I trust your opinion a hell of a lot more than I trust theirs,” Ayers said. “They spend a couple of minutes with me on every visit. They don’t know me from Adam.”

“Ayers, all I know is that cataract surgery is done when the cataract starts to affect your lifestyle,” I said. “That means that the neurosurgeon gets surgery a long time before grandma. But I would guess that with one eye, they would want to do the surgery pretty early. And I think you will be amazed at the results.”

“But what happens if something goes wrong?” Ayers asked.

“Pin that doctor to the wall,” I said. “You want to ask him about his record of complications. Now when you do that, he is going to respond with something out of the book. He will say that we see a 1% rate of serious complications. When he says that, and he will, you have to say that you don’t want what we see. I want to know what you see. That is very important. A good surgeon will not be bothered by that questioning. The guy with poor numbers will be upset with that question. You don’t want that guy. There are a lot of surgeons doing cataract surgery. You want to choose your surgeon well.”

“What do I do if he gets upset,” Ayers asked.

“You tell him that the appointment is over,” I said. “Then you ask him for a referral to somebody who won’t be upset with that question. He will know the best surgeon.”

It was several months later when I revisited Ayers. I made a call to his place to castrate a couple of lambs.

“I don’t know why I keep these sheep,” Ayers said. “Lord knows, I don’t make a penny on them anymore. I have an old ram who can hardly walk and only a handful of old ewes. And I am too damn old to do the most basic things.”

“I am guessing you are too soft to send them to the sale barn,” I said.

“Sale barn, hell, they would not bring enough at the sale to pay for the gas getting them there,” Ayers said. “I guess they have all earned their hole in the ground. My only problem is I will have to pay somebody to dig the hole.”

“How is your eye doing, Ayers?” I asked as I reached down to pat Nessie on her head.

“I wanted to thank you for your advice,” Ayers said. “I went ahead and had that cataract removed. The best thing I ever did, I wish now that I had done it years before.”

“That is good. I hope you can see better,” I said.

“I can see better than I ever have in my entire life. Hell, I can see that fly on that cow’s back,” Ayers said as he pointed to a cow standing about 20 yards out in the pasture.

“So surgery and recovery went well,” I asked.

“Surgery went well, but they had a patch over my eye for a day,” Ayers said. “I was blind as a bat. And the problem was everybody thought I should be able to see out of my glass eye. Even at the doctor’s office, they couldn’t understand why I was so helpless. And they had my records, dumb bastards.”

“I guess when you fill out your taxes this year, you should put Nessie down as a seeing-eye dog,” I said.

“She is already listed as a sheepdog,” Ayers said. “I should list her as a rat control dog. She is death on those things. Rats and those darn digger squirrels. Those squirrels can’t seem to learn that it is not worth it to clean up the grain out of the feed racks.”

“I have to run. I have a cow to look at over in Crawfordsville,” I said. “I am glad things are well with your eye. You call again if you need anything.”

“I’ll see you later, Doc. I think Nessie is due to come in to see you pretty soon. And boy, does she hate that trip.”

Photo by Lone Jensen from Pexels

%d bloggers like this: