A Deadly Shunt

D. E. Larsen, DVM

“How old did you say Jinx was again?” I asked Sue as I examined the thin pup on the table.

“She is six months old at the end of this month,” Sue said. “That is why I am interested in getting her spayed as soon as possible. I have had trouble putting enough money aside to have the surgery. But I think I have just enough now.”

“Has she always been this thin?” I asked. Jinx was skin and bones, had a potbelly, and was undersized for a six-month-old Doberman.

“She looked a little smaller than her littermates,” Sue said. “And she has never been able to put on weight. Jinx does some vomiting at times and has a lot of diarrhea. Once in a while, she will have a bit of seizure activity. Most of the time, those seizures are pretty mild.”

“With that history and with her poor growth and poor body condition, we should do some blood work before we schedule any surgery,” I said. “I know that probably shoots your budget in the foot, but I think Jinx is a good candidate for a portal-systemic shunt. That is a defect in her liver that shunts blood around her liver rather than through it.”

“That sounds serious,” Sue said. “Is there anything that can be done for it?”

“Depending on how severe the shunt happens to be, sometimes we can buy these pups some time with medical management and a special diet,” I said. “Fixing the shunt is generally a long shot, and that is way above my head. We would have to find a university to do that work.”

“If I can’t afford the blood work, going to a university for treatment is out of the question,” Sue said. “I think that I would just like to get her spayed and see how things go.”

“There is probably at least a fifty percent chance that she would die under anesthesia,” I said. “My guess is that the odds are worse than that.”

“It sounds to me that you don’t want to do the surgery,” Sue said.

“If we want to give her the best chance of survival, I think we should not do the surgery,” I said. “You could put the money for the spay into medication and a special diet, and we can see if she is manageable at all.”

“If anesthesia is so risky for her, a pregnancy would be just as bad,” Sue said.

“That’s probably correct, but with some careful monitoring, we can prevent a pregnancy the old-fashioned way,” I said.

“You know that doesn’t work very well. I think I would like to risk the surgery.”

“I’m sorry, Sue,” I said. “I can’t do this surgery without some blood testing first. And to be honest with you, I believe that those tests will show that Jinx has significant liver disease. We could try some medication and a special diet in place of the testing. Just to see if that improves her condition and appearance. That would be my lessor option to accommodate your budget.”

“I think I will just have to find a veterinarian who will do the surgery,” Sue said.

“That’s fine. Just be fair with whoever does the surgery if things don’t go well,” I said.

***

Sue left with Jinx. She was unhappy with me, but that was better than taking home a dead dog. I had learned that clients seldom remember the entire conversation after the dog dies.

I was told later that Sue found a veterinarian who would do the surgery on Jinx. The veterinarian was a mobile veterinarian who used a Eugene veterinary clinic to do her surgeries.

Sue met the veterinarian in Eugene, and the veterinarian apparently had no concerns about Jinx’s appearance on the exam table. That is if there was an exam. Many years later, the Veterinary Examining Board formalized rules that required a veterinarian to do a complete exam on the initial visit of a patient and at least annually after that.

Jinx went to surgery. I am sure the surgery was a success, but the patient did not recover from anesthesia.

It was sad news to receive. Jinx was dead. She must have been allergic to the anesthesia. That was often the story given by veterinarians who either did not know the truth or were afraid to admit the truth to the client.

The fact was, Jinx had a limited life expectancy with her problems. But her life was cut short when it did not need to be.

Photo by Jordon Whitt on Unsplash

From the Archives, one year ago.

Choose Your Surgeon with Care

Treating Blossom

D. E. Larsen, DVM

“David, don’t move for a minute!” Mrs. Bishop said as she came at me with a pitchfork.

Blossom, a Guernsey milk cow, was secured in her stanchion of the Bishop’s small barn. She supplied the Bishops and several neighbors with milk for most of the year. 

Today, her stall area was bedded down with a thick layer of fresh straw in preparation for my visit and exam. Mrs. Bishop keeps this little barn spotless. I envisioned Mr. Bishop milking and Mrs. Bishop standing guard with a shovel, making sure no manure hit the floor.

I managed to dodge the pitchfork as Mrs. Bishop retrieved the handful of manure that I had dropped onto the straw. I was cleaning out Blossom’s colon to do a good rectal exam, and there would be more handfuls to follow.

“Blossom has a full colon today,” I said. “This is going to take me a couple of minutes to clean things out, so I do a good exam. I have some boots on, so it might be better if you wait until I get her all cleaned out before you pick things up.”

“David, if you get this stuff on your boots, you will track it all over the barn,” Mrs. Bishop said. “You just don’t get in a hurry.”

Mr. Bishop was standing to the side, just watching the show. He was a quiet man, mostly bald but with some gray hair on the sides. He smiled and winked at me, just to let me know that Mrs. Bishop ran the show on this place, so I best just better relax and let it happen. I just didn’t want her to get my foot with that pitchfork.

With each handful of manure, Mrs. Bishop was right there with the pitchfork. I was sort of amazed at the thickness of the straw she had laid down.

I was finally at a point where I could start a good exam.

“Give me a little history on Blossom,” I said. “When did she calve?”

“She calved a little over six weeks ago,” Mr. Bishop said. 

“Yes, David, she calved six weeks ago, and she has not cycled yet,” Mrs. Bishop said. Her voice was stern, giving Mr. Bishop a look to let him know that she was the one that was going to answer all the questions. “She has been fine otherwise. We noticed a couple of days ago that she was not eating all of her grain and her milk production has down almost to half of normal.”

Holding onto Blossom’s tail with my right hand, I ran my arm into her rectum past my elbow. Then I swept the pelvic floor with my left hand. Blossom’s uterus was bulging under my hand. I could bounce my hand on it, but it was so distended to discern any content other than a lot of fluid.

“Did she have any problems calving?” I asked.

“She retained her membranes for a time,” Mrs. Bishop said. “We called your office, but Vicki said that you didn’t like to look at those for at least two days after calving. I think she passed those membranes sometime during the night of the second day. The membranes were really stinky. I had Robert bury them in the far corner of the pasture.”

I have been coming to the Bishop’s small farm on Gap Road out of Brownsville for a couple of years now, and that was the first time I heard Mrs. Bishop call Robert by name. I wondered to myself what would happen if I called him Bob.

“She must have a residual infection in her uterus,” I said. “Have you noticed any vaginal discharge?” 

“No, she has been fine,” Mrs. Bishop said.

I removed my arm and peeled my OB sleeve off, being careful to turn it inside out as I removed it and to not knock off any manure onto the straw. As soon as I had it off, Mrs. Bishop snatched it from my hand and disposed of it in her little garbage can.

I washed Blossom’s rear in and then scrubbed her with Betadine surgical scrub. I could see Mrs. Bishop watching me with questioning eyes as I pulled on a new OB sleeve.

“I am going to do a vaginal exam to see if her cervix is open,” I said.

“Don’t you need a speculum for that kind of an exam?” Mrs. Bishop asked.

“I have a large bovine speculum,” I said. “But I seldom need to use it. After a few years of training myself, I can almost see with my fingertips of my left hand.”

After applying lube to my hand and arm, it inserted my hand into Blossom’s vagina. The vagina was tightly closed at a point before my hand was in to my wrist. I frowned.

“You frowned,” Mrs. Bishop said. “There must be something wrong.”

“Just give me a minute,” I said. “Her vagina has some adhesions.”

I had never encountered anything like this before. My mind whirled through its database, but I could bring nothing up. I suspected a pyometra was present, but I had never heard of a vagina closed off from adhesions.

I pinched my fingertips together and advanced my hand and arm into the vagina. I could feel the walls of the vagina separate. It almost felt like they were unzipping. Just before I got to the cervix, it was open. And filled with fluid. The cervix was open to where I could insert three fingers. 

I pulled my arm out of Blossom’s vagina. The OB sleeve was covered with blood. When my hand came out, gallons of thick white pus followed and splattered into the straw.

“Oh, my God,” Mrs. Bishop said.

I was unsure what she was upset about. The obvious serious problem with Blossom’s reproductive tract, or the fact that now there were gallons of pus mixed with her straw and splattered around the stall.

“What has happened to our Blossom?” Mrs. Bishop asked.

“She obviously has a uterus filled with pus,” I said. “That happens at times. Why the vagina was closed with adhesions, I don’t know. I have never seen or heard of that problem before. But I think we can help her out now. I will give her an injection to ensure that she empties that uterus. Then, I will flush it with some antibiotics today. We will also give her some antibiotics by injection, and I will recheck her in a couple of days.”

“Okay, David, but you are going to have to give me a few minutes to get this mess cleaned up,” Mrs. Bishop said. “You need to go wash those boots of yours.  Robert, you need to get the big wheelbarrow in here. This is a real mess.”

As instructed, I went and hosed off my boots. It also gave me time to get all of Blossom’s medication ready. And I could watch the circus in the barn. Robert took his instructions without saying a word. Those instructions were detailed to the point where he was to dump the wheelbarrow.

When the barn was cleaned up enough, I got back to work. I flushed Blossom’s uterus with an antibiotic solution and gave her several injections.

“You are going to have to discard the milk while Blossom is being treated,” I said.

“Is it okay to give to the calf and the pigs?” Robert asked.

“Yes, Bob,” I said. “The pigs are probably going be happy to get it all for a change.”

“His name is Robert, David,” Mrs. Bishop said. “And the pigs always get a little bit of milk, but now they will think they should get more all the time.”

“I will be back the day after tomorrow to recheck Blossom,” I said. “I expect things to be much improved by then. You may have to deal with her discharging some pus today and tomorrow. After that, it should be better. You need to call Vicki or Sandy and schedule a time for my recheck.”

***

Blossom’s uterus was all but normal on my recheck, and the lining of her vagina was healed. I could hardly tell there had been a problem. I infused her uterus with some antibiotics and made sure the Bishops were up to speed on the antibiotic injections they were giving. 

“Can we have her bred when she comes into heat,” Mrs. Bishop asked.

“I would wait until the second heat cycle,” I said. “That will give her uterus more time to get back to normal. And when you have her bred, you should call me, and we should give her another infusion the day after she is bred.”

“You do that after she is bred?” Mrs. Bishop asked with a questioning tone.

“Yes, it takes about three days for the fertilized egg to get to the uterus. So we can infuse the uterus with a gentle antibiotic and just clear up any residual infection that might be present.”

***

Blossom continued to do well, and her breeding resulted in a pregnancy. My only concern now was that Mrs. Bishop would insist on an immediate exam if Blossom failed to pass her fetal membranes within a few hours of calving.

Photo by Frank Grün from Pexels