Under the Old Plum Tree
Don’t Die on Me Now
D. E. Larsen, DVM
I could hear the old ewe breathing as I approached her in the open pasture. I grabbed her by her long wool, and she made no attempt to move. This summer heat must be unbearable for her. It didn’t look like she had been sheared in a couple of years.
I parted the wool on her chest and held my stethoscope against the bear chest wall. I moved to a couple of spots. The air rushing in and out sounded like a freight train. This was severe bronchopneumonia. This old ewe was going die.
I walked over to the blueberry patch where the owner was working.
“This old ewe has severe pneumonia,” I said. “I can treat her with some antibiotics, but my guess is she is going to die.”
“How long do you think the old girl has to live?” Jim asked.
“Your guess is as good as mine. You maybe have heard the old saying, sheep are born looking for a place to die. I think if she doesn’t die tonight, she’ll die in the next couple of days.”
“Don’t you treat pneumonia?” Jim asked, hoping I would give him some optimism.
“Sure, we treat pneumonia. But when it involves the entire lung field on both sides of the chest, there is little chance that treatment is going to do any good.”
“She’s my wife’s pet. I would like to try to save her if that is possible.”
“I have a new antibiotic. It is the best one on the market right now. The problem, it’s a little expensive. But we could give it a try if you like. I can give her an IV injection now, and if she is alive tomorrow, you can pick up some more to give in the muscle.”
“Yes, I think I would like to try that if you think it will work,” Jim said.
“I didn’t say I think it would work. I think this ewe is going to die. But if you want to treat her, I think her only chance is to use the best drug available.”
“What would you do if she was yours?” Jim asked.
“I don’t usually answer that question, but if I had an old ewe that sounded like she sounds, I would put her to sleep.”
“I think my wife would want to at least try to save her. Let’s go ahead and give her an injection today, and I will check with you tomorrow.”
I went back to the truck and filled a syringe with an antibiotic injection along with some dexamethasone.
When I got back to the ewe, she hadn’t moved from where I had first looked at her. I used scissors to trim some wool away from her jugular vein. I placed a needle in the jugular, attached the antibiotic syringe to the needle, and slowly gave the injection.
Immediately, the old ewe sneezed a couple of times and shook her head. Then she fell forward, banging her nose into the ground, almost lifeless.
“Damnit, don’t die on me now,” I said to the ewe.
I had only seen one other anaphylactic reaction. That was in a horse in school when given a penicillin injection. That horse reared and went over backward. The horse was dead when he hit the ground.
I looked at the truck. It was probably forty or fifty yards away. If I ran, I could get the epinephrine and be back in fifteen or twenty seconds. I took off as fast as I could across the rough ground.
I grabbed the bottle of epinephrine from the refrigerator and a bottle of sterile water. Then I headed back to ewe at a run.
Epinephrine was one of the drugs that I had to have but never used. I always bought a new set of bottles every year to make sure it was not outdated.
I got back to the ewe and dropped to my knees. I drew a dose of epinephrine into the syringe and diluted it with sterile water. I gave this dose in the jugular vein. It had been more than the twenty seconds I had initially calculated but less than a minute.
The ewe blinked, turned her head, and looked at me. Maybe she would live to see the moon this evening.
She rolled up on her sternum and stood up. That was more activity than I had seen out of her. Probably stimulated from the epinephrine.
I gave her a hefty dose of dexamethasone. Probably not the best practice in treating pneumonia. But in this case, she needs all the help she can get.
“Jim, I had a little excitement with that injection,” I said. “The ewe had an allergic reaction. I was able to reverse it with some epinephrine, but it was a close call.”
“That’s good. Maybe we can have another miracle with the antibiotic,” Jim said.
“It’ll take a miracle,” I said. “Don’t be surprised if you find her dead in the morning.”
“You don’t provide a lot of hope, Doc,” Jim said.
“I provide hope when there is hope to give. Otherwise, I provide reality. There is some danger in that reality. Telling somebody that a patient is going to die is one of the riskiest things I do. If she lives, you will be telling me about her for the next twenty years.”
“I’ll call in the morning, Doc,” Jim said.
***
The phone rang early in the morning. It was Jim.
“Doc, the old ewe is dead,” Jim said. “Do you think that reaction had anything to do with her death?”
“Jim, it probably did do her any good, but the epinephrine gave her more energy than anything else. But remember what I told you before I treated her.”
“Yes, I know, you told me she was going to die,” Jim said.
The Canine Parvo Virus Pandemic
D. E. Larsen, DVm
Prologue
Canine Parvo Virus first emerged in Europe in 1976. It was felt to result from a mutation in the feline panleukopenia virus (feline distemper virus). Canine Parvo Virus was highly contagious and a sturdy virus that survived in the environment for months. By 1978 the virus had spread worldwide, causing a pandemic with high mortality in puppies and young dogs.
***
The air in the meeting room was warm and humid. The air conditioning was not winning the battle with the afternoon temperature of the early fall and the crowded room.
I don’t even remember the meeting topic. Maybe it was kidney failure treatments. But virtually all the conversation was concerning the recent outbreak of the Parvo Virus in Portland. Veterinarians were experiencing a mortality rate of near 95% in puppies and young dogs up to a year of age.
Treatment protocols were being discussed in every corner of the room. The poor presenter was unable to keep everyone’s attention. During the break times, those discussions intensified.
“I haven’t seen you at these meetings before,” George said as he cornered me at the coffee table. “Where are you located?”
“I just started a practice last year in Sweet Home,” I said.
“Sweet Home, where is that located?” George asked.
“You Portland guys never get out town, do you,” I said. “Sweet Home is on Highway 20, just at the eastern edge of the valley.”
“I’m not sure where Highway 20 is located.”
“It’s the highway from Corvallis to Bend. You know, the one that goes over the mountains.”
“Okay, a small town, I guess,” George said.
“Yes, it’s a small town. But you know, many benefits come with living in a small town.”
“How are you treating your Parvo cases?” George asked.
“I have to admit, up until today, I had serious doubts that the disease existed,” I said. “I haven’t seen a single case.”
“We are being swamped here in Portland,” George said. “How is it that you don’t see a single case?”
“I guess we’re on the edge of the population in the valley. It must be sort of natural isolation.”
“I have had several breeders who have tried to isolate themselves and have not been successful,” George said. “One lab breeder had a litter of twelve puppies and lost eleven of them before they were six weeks old.”
“I would say it is ridiculous to think you could isolate yourself in the middle of Portland,” I said.
“Maybe so, but they say this virus is tough. You can hardly get rid of it. All our disinfectants won’t kill it. The only thing that works is dilute Chlorox. Disinfecting the clinic after a sick puppy sneaks past the reception desk is a nightmare.”
“How do you handle a sick puppy?” I asked. “You can’t maintain an IV in the car.”
“We bring them in the back door to our isolation room,” George said. “When you give people the facts and the prognosis, there are not too many that want to try to treat a case. If the pup has a white blood cell count below two thousand, the chances of saving a pup are slim to none.”
“Well, for today, I am going to listen to the rest of the lecture,” I said. “Kidney failure is something I see regularly, Parvo, I don’t see.”
“Don’t be so sure. It is only a matter of time, and you will have a dozen cases the first week it occurs in Sweet Home.”
***
Of course, George was correct. My first case in Sweet Home came through the door in early 1978, and many followed. Mortality was high in those earlier cases. There was no standard treatment plan and no specialty drugs. Clients were reluctant to spend the money needed to treat a puppy with a poor prognosis. Whole litters could cost a small fortune to treat.
Some of my clients were able to isolate themselves and their dogs to keep the virus at bay. Their isolation was almost absolute. They would talk with me on the phone but would not venture into a veterinary clinic or pet store. Anywhere that another dog owner may walk was entirely off-limits.
***
“Barbara, we just got our first hundred doses of Parvo Virus vaccine in today,” Sandy said when Barbara answered the phone. “We are working off of a list, and you are near the top. Dave said we could do your dogs in the back of your van with no problem.”
“I understand that this is a killed virus vaccine, and it requires two doses. Is that correct?” Barbara asked.
“Yes, it requires two doses,” Sandy said. “Our plan is to use fifty doses and save the second dose. That way, nobody gets left without a booster.”
“I have a litter now that’s only five weeks old. Can we vaccinate them?”
“There is no maternal immunity to deal with. Dave thinks we should vaccinate them along with the rest of your dogs,” Sandy said. “They are telling us that the supply of vaccine is good, and in a few months, we should be able to order what we need. For now, it is a hundred doses at a time when they have it.”
***
A month later, we loaded Barbara’s last puppy back into the carrier after completing its booster vaccination.
“Now, we can start to relax a little,” I said. “In two weeks, we can consider these guys fully immune. You can start entering the real world with them at that time.”
“Oh, I don’t think so, Doctor,” Barbara said. “Last week, the AKC newsletter had some epidemiologist saying that we should continue our isolation even after our dogs are fully vaccinated.”
“Barbara, those epidemiology guys don’t live in the real world,” I said. “They sit in a marbled office, and they only talk to other doctors or the Ph.D. types. They have no concept of how people like you and me live. They have no idea how their recommendations impact your day-to-day life.”
“But what if we get an exposure?” Barbara asked.
“Barbara, this is a brand new vaccine that has been rushed to the market,” I said. “We know it works, but we don’t know how long it lasts. It is a killed virus vaccine, and we know that other killed virus vaccines give us an immunity that will only last a year or so, maybe less.”
“That is what I am saying,” Barbara said. “What if we had an infected dog on our property and then the immunity wears out, and we have a contaminated property?”
“When these dogs are immune, natural exposure to the virus is the best thing that could happen to them. It would give their immune systems a chance to develop a natural immunity to the virus. That’s better than any booster vaccination that man could make.”
“Okay, we have a meeting coming up with other breeders in a couple of weeks. We were thinking of not going because of the risks. But maybe we will go and see what everybody else is thinking.”
“Let me give you an example from another virus that I have a lot of experience with here in Sweet Home. Canine distemper was very common when I came to town. Two groups of dogs were highly susceptible to the virus. Dogs that had never been vaccinated, and dogs that had been vaccinated long ago and then lived a life that was isolated from the general population.”
“I haven’t heard of isolating against the distemper virus,” Barbara said.
“It wasn’t planned isolation. It was an old farm dog. He lived on the farm and rarely had any contact with other dogs. When the owner sells the farm and moves to town, the old dog is suddenly out in the street carousing with the neighborhood dogs. This is a new thing for the old farm dog. The old farm dog comes down with distemper. His immunity lapsed years ago, and he had no booster vaccinations. He had no natural exposures to boost his immune status. The other dogs were fine. Their immune systems saw the virus regularly.”
“You’re pretty confident in your opinion,” Barbara said. “It makes sense when you tell the story. We’ll have to give it some thought.”
“The world is a scary place at times,” I said. “But, we’d have never made it this far with forced isolation like you guys have lived through. This virus is everywhere now. It is probably at a point where you cannot practically isolate yourself from it. If not now, it’ll be there soon. You need to get your dogs out into the world again. Stop at a rest stop along the freeway and walk your dogs in the pet areas, something you would never have done last month. You need to think of natural exposures, and maybe when we have a vaccine with a little more confidence behind it, we can just do some boosters on a schedule.”
“Okay, I guess we can go visit my folks in Seattle. We haven’t seen them in over a year.”
“That’s good. Just make sure you wait a couple of weeks from this vaccination date.”
Photo by Jametlene Reskp on Unsplash
Memoirs of a Country Vet 