The System is Made to Work

D. E. Larsen, DVM

“Doc, I have a young heifer down in the barn,” Rob said into the phone. “She is awake and staining, almost like she is in labor, but nothing is happening, and she isn’t much over a year old.”

At least she is in a barn, I thought as I looked out the window at the snow falling. It had been snowing since the middle of the afternoon and it is eight o’clock now.

“Where do you have her, Rob?” I asked. I knew Rob lived on a hill outside of town. I had to put chains on the truck to get home this evening, Rob’s slope was steeper than our hill.

“She is in the old barn down by the road, below the house,” Rob said. “You should be able to get to it pretty well with your truck, especially if you have chains.”

“It will take me a few minutes to get around,” I said. “I should be there in about 30 minutes.”

  “What do you think could be wrong with her, Doc?” Rob asked.

“We will just have to wait for me to look at her,” I said. “But you know, if it looks like a horse, it is probably a horse. And if she looks like she is calving, she is probably calving.”

“Doc, she is only a long yearling,” Rob said. “How could she be calving. That would mean she would have to have been bred when she was 4 or 5 months old.”

“I know, Rob, it doesn’t sound likely,” I said. “But I have seen it a whole number of times. The system is made to work, you know.”

“Okay, I will be waiting at the barn,” Rob said. “You might want to bring a lantern if you have one. There are no lights in the barn.”

I pulled on coveralls, boots, and bundled up against the cold before stepping outside to check the truck. I wanted to be sure the water tank was full, and everything was ready for the call.

It was a little chilly, but Western Oregon seldom saw the severe cold that we would have in Colorado. Nonetheless, I need to be prepared to do a C-section on this heifer, in a cold barn, with no electricity, and no help other than Rob. If I remember correctly, Rob would not be much help after the first cut was made.

The snow was coming down heavy now. Large flakes filled the sky. There were nearly 8 inches at the house, Rob’s barn would be at a comparable elevation. I was glad that I had put chains on the truck earlier.

I could see Rob’s lantern in the barn’s doorway, and the gate across the driveway was open. It needed an extra foot on the gas peddle to pull the truck in close to the barn.

“I was able to get her up and moved into the haymow,” Rob said. “There is not much hay in there, and it is a lot cleaner. She is down again and not moving much.”

The heifer was small, maybe 14 months of age, certainly not old enough to be delivering a calf.

“Let me get a rope on her first,” I said. “I don’t want to have to chase her around this haymow if she decides to jump up.”

After tying her to a post, I started looking her over. She had some udder development, and her vulva was swollen and relaxed. I washed up her rear end and pulled on an OB sleeve. 

A vaginal exam revealed an open cervix and a nose of a calf. There was no room for even the head of the calf to enter the birth canal. I stuck a finger in the calf’s mouth. The tongue recoiled at my touch, the calf was alive.

“There is a live calf in there,” I said. “And there is absolutely no room for it in the birth canal. We are going to have to do a C-section.”

“Can you do it here,” Rob asked. 

“If we get enough light fixed up, I will be fine,” I said. “I have done it in far worse conditions.”

We rolled her up on her back and propped her there with a couple of bales of hay. I tied her hind legs together and stretched them back, tying them to a post. 

I was all set, the belly was clipped with my battery clippers, and I had completed a surgical prep. I laid out the instruments and did a local block on the proposed incision line. Then I laid out an extra syringe of Lidocaine, just in case I needed it.

I stripped out of my outer jacket, and I was glad that I had put on a vest. I could feel the cold on my bare arms. This is going to be a fast surgery, I thought to myself.

I picked up the scalpel, but before I could make the initial incision, Rob interrupted the calm.

“Doc, I have to run-up to the house to the bathroom,” Rob said. “Are you going to be alright here?”

“I am going to be fine,” I said. “It might be good if I have a hand to pull this calf up out of her, but it will be a small calf. Get back here if you can.”

My memory was correct, Rob was not one to be around when there was any blood. I guess it was better he was at the house than passed out down here.

The surgery went well. I kept the incision as short as I thought I could. The calf was kicking his hind legs as soon as I incised the uterus. I grabbed the legs, stood up, and pulled the calf out of the uterus. 

He flopped on the ground and shook his head. I don’t think he weighed 50 pounds, but he was a vigorous little thing.

With the short incisions, I had things closed up in short order. I released the heifer’s hind legs and moved the bales so she could roll over and rest on her sternum. She was a little surprised when I pulled the calf over under her nose. 

I cleaned myself up and put my jacket on again. The warmth was welcome. The heifer jumped up when I released the rope around her neck. Rob came through the back door of the barn about that time.

“How are things going?” Rob asked.

“You have a spunky little calf, and his mom seems to have some idea what she is supposed to do,” I said. “I would keep them in for a few days to make sure everything is going to be okay. I will get back up here when this snow melts and check her over. You call if you think I need to look at her before then.”

“How did this happen, Doc?” Rob asked.

“You have to separate the bull from the herd after breeding season,” I said. 

“Will, I guess I don’t have a breeding season,” Rob said. “There always seems to be a cow or two needs some extra time to get pregnant.”

“If you want to rest from calving, where you are not calving all year long, you have to cull those cows,” I said. “They might be good cows, but every year they will be a little later, and pretty soon you lose an entire year. Plus, when you get around to selling your calves, you will get a better price if they are all about the same age.”

“I guess you are right,” Rob said. “I just never thought that a heifer could get pregnant at 4 or 5 months of age.”

“Like I said before,” I said. “The system is made to work.”

Photo by Will Mu from Pexels

Always have Rabies at the Top of Your List

D. E. Larsen, DVM

“We have a cow coming in this morning for Necropsy,” Dr. Norrdin said. “The ambulatory people have been treating this cow all week, and it died this morning.”

“It should be a good time for it, we don’t have anything in the cooler to work on,” I said.

“This cow died with neurological signs,” Dr. Norrdin said. “I want you guys to be thoughtful during this necropsy. Especially you, Larsen, when you remove the brain. Do you have any idea what I might be talking about.”

I had talked with a classmate earlier in the week about this cow. He was working on the ambulatory service this summer. Colorado State University had to scramble to keep students in the clinic during the summer months to keep up with the workload.

This cow had been looked at by two different clinicians and their students on multiple occasions. The cow suffered from a progressive neurological deterioration. People had their hands in the cow’s mouth and into the back of her throat, trying to ensure there was no foreign body causing some swallowing difficulties.

“What kind of a differential diagnosis list should you be working within your mind when treating a neurological case?” Dr. Norrdin asked.

I had been lax during the summer and was not used to coming up with immediate answers. This job was sort of one to do the manual labor of the necropsy room. It obviously provided a tremendous learning experience but from observation, not rote memory from a textbook.

“I guess viral encephalitis would be on the list, along with secondary bacterial meningitis from any of the respiratory viruses,” I said.

“You came close with your first guess,” Dr. Norrdin said. “You should always have rabies on your list. It should be at the top of your list, even though you will not see it often these days. The reason is that if you miss that diagnosis and fail to take care of yourself, you end up dead.”

“That is probably a good point,” I said.

“So be thoughtful, and work with your mouth closed today,” Dr. Norrdin said. “Hopefully, that will not be the diagnosis. If it is, we will have a mess. There have been over a dozen guys with their arms down this cow’s throat in the past week. The clinicians have really dropped the ball on this case.”

When the truck with the dead cow backed up the loading dock, we shackled the cow’s hock and picked her up with the hoist. This allowed us to move her on the track to the middle of the necropsy room floor.

We started the necropsy under the direct supervision of Dr. Norrdin. This was unusual in its self, we seldom had direct supervision at this stage. Dr. Norrdin was very worried about a possible rabies case, and he wanted to make sure everything was carefully documented.

When it came time to remove the head, I moved it to the butcher block in the middle of the room. I had become an expert at removing the brain from all the animals this summer. It was a skill that I would probably seldom use in practice, but I enjoyed being the best at something on the job.

With the skull on the table, I first had to remove the skin and soft tissue on the top half of the head. Then, with a large cleaver, I started shaving the bone from the skull to reveal the braincase. 

Once the braincase was exposed, the accuracy of my strokes with the cleaver became more critical. Finally, I would be able to lift the top of the skull cap and expose the brain covered by the meninges—those layers of tissues that become inflamed in meningitis.

There were several specific snips to be made to free the brain. Once this was done, I could lift the intact brain out of the skull and place it on the dissection table. Most of the time, I would slice the brain in a prescribed manner. In half, separating the right and left side. Then slice each side into quarter-inch slices, looking for any abnormalities. This time, Dr. Norrdin took over at this point. He did all the work on the brain and disappeared into the lab with the pieces.

There are several levels of diagnostic testing to confirm rabies as a diagnosis. The diagnosis of rabies is made in several ways. The one that is fastest and considered the most reliable, if present, is finding Negri bodies in the part of the brain called the hippocampus.

By the next day, rabies was a confirmed diagnosis in the cow. Most of us students had received several doses of rabies vaccine during our freshman year of school. Because of that previous vaccination and a positive titer, I only had to have a single booster vaccine. The students who had carelessly had the hands and arms in the cow’s mouth during the week preceding her death had to go through a complete series of vaccinations. 

That was a lesson well learned. But then, there is just a little more to the story.

A long year later, I was in Enumclaw Washington, ready to do a necropsy on a large dairy cow. Standing in the middle of the field, I sharpened my necropsy knife, the same one used to necropsy the rabid cow. As I stood there, the farmer had a whole list of questions. We stood and talked for some time. The entire time during this conversation, I continued to sharpen my knife on the wet stone.

Don’t allow anyone to tell you that a sharp knife never cuts you. After standing there sharpening my knife for 15 minutes, I lifted the hind leg of the dead cow and started the cut through the skin on her belly. This knife slid through the skin like it was butter. My stroke was so smooth, the knife flew through the prescribed cut, continued out into the air, and buried into the muscle of my lower left leg. Going into my leg a full inch. Ouch!

I stopped and put a wrap on the wound before preceding with the necropsy. By the time I was done, my left boot was sloshing with blood.

I did make a trip to the doctor’s office. We laughed at my careless actions and decided to leave the wound open. Antibiotics and a light wrap should take care of things.

Then I mentioned that I had done a necropsy on a rabid cow with this knife a little over a year ago.

“What do you think?” the doctor asked. “I would think that it would not be a problem at this point in time.”

“Will, the knife has been washed since then, but never autoclaved,” I said. “I would think that any virus on it would be long since dead.”

“I would think so also,” said the doctor.

“I am sure I still have a positive titer, just for insurance,” I said.

I did live, by the way.

Photo by Pixabay from Pexels

All the Better to See You With

D. E. Larsen, DVM

RC was a big orange tabby cat. I had first treated RC for a severe fracture of a hind leg when he fell from a tree. Repair of that fracture required a pin and many wires, plus four weeks of cage rest. He was a friendly cat but displayed utter self-confidence when he was in the clinic.

He sat upon the exam table, watching for me to come through the door when I entered the room. 

“My, what an ugly eye,” I said. RC’s right eyeball was swollen and bulging out from under his eyelids.

“I noticed this a little bit yesterday, and then this morning it was like this,” Nancy said. “It is painful if I try to touch it, but he seems to tolerate it well when he is left alone.”

“This is an advanced case of glaucoma,” I said. “It is a little unusual to see this occur with no prior warning.”

“Do we have any treatment options?” Nancy asked.

“We have a couple of options with an eye like this,” I said. “We can go to Corvallis to see the veterinary ophthalmologist, or we can remove the eye.”

“What is the ophthalmologist going to do,” Nancy asked.

“There are a couple of surgeries that can be done to save the eyeball, and maybe its vision,” I said. “However, with an eye that looks like this, the vision is probably already lost. She can also offer evisceration and implantation of a silicone prosthesis instead of removal of the eyeball. Some people think that gives a better cosmetic appearance. A blank, nonfunctional eyeball remains.”

“And what do we have when you remove the eye?” Nancy asked. “He will still have one eye, so I guess it won’t change his vision much.”

“I remove the eye and all the associated structures, including the eyelid margins,” I said. “When things are healed, we have a blank slate. If I do it right, that side of the face is smooth. If there is not enough dense tissue to close over the eye socket, there may be a little caved in appearance over the socket. Most cats get along fine with one eye.”

“I think that we will just have you take the eye out here,” Nancy said.

With that decided, we removed RC’s right eye. Dr. Maxwell had recommended that I submit that eye for a pathologist to look at. She thought it was unusual for such a sudden onset of advanced glaucoma.

I had the results from the pathologist when Nancy returned with RC for suture removal.

“He is absolutely normal,” Nancy said. “He does everything he did with two eyes. He still climbs his tree and everything.”

“I am not sure that he has always climbed that tree too well,” I said with a chuckle. “The pathology report says he had an autoimmune problem in his eye. They say there is a possibility that he may develop the same problem in his left eye.”

“I guess we will cross that bridge when it happens,” Nancy said.

In the following years, RC seemed to have more issues than I would expect to see in a middle-aged cat. But everything was manageable, and he was not bothered by the loss of his right eye.

It was almost 3 years to the day that Nancy rushed RC through the door. His remaining left eye had literally exploded overnight.

“He seemed fine last night,” Nancy said as she caught her breath. “Then I looked at him early this morning, and I could see that his eye was getting big like his other eye. A few hours later, I look, and this is what we have.”

“It looks like we have crossed that bridge you mentioned years ago,” I said. “This eye is going have to come out, there is no saving it now.”

“Oh my! How will he get along, being totally blind?” Nancy asked.

“To be honest with you, I haven’t had too many patients who were totally blind,” I said. “I did have a client with a calf that was born blind. It had no functional eyes. It did just fine. It knew the pastures, knew where the feed rack was and where the water was. It could go in and out of the barn as long as it was with another animal or two. That calf grew up and had several calves, all born with normal vision.”

“RC is so active, it will break his heart if he can’t go out in the yard and climb his tree,” Nancy said.

“I was at a veterinary conference several years ago,” I said. “One of the speakers was a veterinary ophthalmologist. He told the story of his cat, who, it turned out, was totally blind. He said they had dinner guests at the house one night, and the guy noticed that the cat was blind. The doctor had no clue. That cat had lived in the house for several years, and the ophthalmologist had not noticed that it was blind.”

“Okay, let’s get it done,” Nancy said.

The surgery was done, and RC went home with a blank slate for a face. It was a little eerie when he came back for suture removal. Sitting up on the exam table like he always did, he followed my every move with his ‘blank slate.’ Just like he was watching me.

“He is outside playing in the yard, just like he has always done,” Nancy said. “Yesterday, he was even climbing his tree. We are so pleased that we didn’t make the decision to put him to sleep.”

RC lived an almost normal life. As he aged, like many cats, he had his share of problems. Whenever RC was on the exam table, he ‘watched’ every movement I made. When he was in the clinic for hospital treatment, he would sit in his kennel and ‘watch’ everyone in the room.

RC lived to a couple of months short of his 18th birthday and died of chronic kidney disease. Chronic kidney disease is the number one killer of cats over 14 years of age. In those years, a male cat, neutered or not, was most unusual living to the age of 18.

Photo by EVG Culture from Pexels

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