D. E. Larsen, DVM

By the time I entered the exam room, Callie was already unhappy. She was actually a nice cat; she just didn’t like the clinic. When Ruth got all her vitals, she was disgusted by the invasion of her privacy.

She perched herself in the middle of the exam table and glared at me, just daring me to be the next one to touch me.

Rebecca attempted to soothe Callie, but Callie raised her paw as a warning for Rebecca not to touch her.

“She’s just a little upset right now, Doctor Larsen,” Rebecca said. “She doesn’t like leaving the house, and the thermometer thing really gets on the fight.”

“She doesn’t like leaving the house because she usually comes to the clinic,” I said. “But I know Callie, and she is basically good. She just doesn’t like to have anything to do with me.”

“I don’t think it is you, Doc,” Rebecca said. “She just doesn’t like her routine disrupted.”

“You are just here for Callie’s annual exam and vaccines, I see,” I said. “But Callie looks a little unkept to me this year if I remember correctly. Has she been feeling okay?”

“She is doing pretty well, I think,” Rebecca said. “Now that you mention it, she is a bit thinner this year. Ruth said she had lost a couple of pounds. And unkept; maybe I just haven’t noticed since I see her every day. I guess we just attributed it to her getting older. But looking at her now, she has seemed to have lost that slick hair coat.”

I reached my hand out to pet Callie on the back, avoiding her head for now. She instantly swirled and hissed. And swatted me on my wrist, drawing blood.

Cat scratches could be serious, but bite wounds from a cat are much more serious. Cat bites account for the largest number of State Industrial Accident claims in the veterinary field. And a cat is the only animal to put me in the hospital from a bite wound on my hand.

“Callie, you and I are going to have to come to terms with each other if we are going to do an exam,” I said.

Then, with a distracting motion with my left hand, I grabbed Callie by the nape of her neck with my right hand. Even old cats are usually easily controlled with such a grip. I always felt it to be a learned response from when they were moved about by their mothers.

Once I had a hold of Callie, I could calm her enough for a thorough exam. After listening to her chest and abdomen with a stethoscope, I briefly peeked into her mouth. Then, I switched hands on my grip on her neck and palpated her abdomen with my right hand.

Her anterior abdomen was not normal. I finished palpating the rest of the abdomen and then returned to her anterior abdomen. I switched hands again and palpated with my left hand. I had been trained to use my left hand for rectal palpations, and I could almost see with my left fingertips. I could feel a mass projection from the lever. It was not painful, but it had a very irregular surface. It was the size of a large lemon.

I released my grip on Callie’s neck, and she settled on the exam table. I patted her head and thought I could hear a slight purr. She was calm, feeling that her torture was over. Rebecca could tell that I had spent much longer on the exam than was normal.

“What did you find, Doc?” Rebecca asked.

“Callie has a mass in her anterior abdomen,” I said. “It is probably a liver tumor. It is not painful, but based on Callie’s weight loss and rough hair coat, it is causing her some problems. We need some x-rays and blood work to better define things.”

“Doc, you know we love Callie,” Rebecca said. “But things are slow right now in Gavin’s construction business. And Doc, I am four months pregnant. There is no way we can spend much money on Callie right now.”

Rebecca and Gavin had been good clients for over five years. I would have no problem carrying an account for them. I knew that Rebecca had managed their finances carefully and that they were not going to overextend themselves.

“I could carry an account for you guys with no problem,” I said.

“Doc, it’s not that we couldn’t come up with the money or that we couldn’t make payments; it’s that we just can’t put ourselves in a position of uncertainty at this time,” Rebecca said. “Are there any lessor options available?”

“We need to talk frankly right now,” I said. “Rebecca, I don’t have any success stories to tell you about liver tumors in my hands. It’s almost a death sentence. And from what I can tell, that is probably the case for you and I.”

“Are you saying we should put her to sleep?” Rebecca asked.

“The only shortcut we could make would be to go right to surgery with no diagnostics,” I said. “I would do that for you if you understand that if there is nothing I can do, we put Callie to sleep instead of recovering her from the surgery. That way, we give Callie a chance. If things go well, she wakes up and gets a new lease on life. How much time we buy for her depends on what kind of tumor she has.”

“That sounds like a good plan,” Rebecca said. “At least I will feel like we did the best we could, one way or the other.”

“There will be several bridges to cross,” I said. “The first one will be for Callie to survive the surgery. Then, we will have to wait to see if the liver still works. And finally, her survival will depend on the malignancy of the tumor and what kind of metastasis are present.”

“I guess we better schedule it as soon as possible,” Rebecca said.

***

Callie seemed much more at ease with the clinic when Rebecca brought her in for surgery early the following week. The girls took her back and started the prep routine while I spoke with Rebecca.

“I just want to make sure you understand what is going to happen today,” I said. 

“Yes, Gavin and I discussed it again last night,” Rebecca said. “We have the utmost confidence in you, Dr. Larsen. And we trust your judgment. If there is a chance your hands can save Callie, that would be great. But if it is not to be, we are prepared for that also. Will you give me a call when surgery is over?”

“Yes, I will call as soon as we are done,” I said. “If it looks like I can’t do anything, I will call before we euthanize Callie. But I don’t plan to wake her up. I just want to make sure that is clear.”

“We wouldn’t want to put her through any more than what is necessary,” Rebecca said. “I guess I need to sign that little form in case you need it.”

Rebecca signed all the papers and went back to say goodbye to Callie one last time.

“I will be waiting for your call, Doc,” Rebecca said with tears in her eyes. “I am guessing that the longer I have to wait for a call, the better the chances are for Callie.”

“That’s right, Rebecca,” I said. “A lot of times, if things are bad, the decision is made shortly after the initial incision. Maybe I’ll have Sandy give you an early call for a progress report. That way, you won’t be completely in the dark.”

Once Rebecca left, we took Callie right into surgery. Once she was under anesthesia, we clipped her entire abdomen. We extended the clipped area to include some of her rib cage.

“Why do you want such a large area clipped?” Ruth asked.

“Hopefully, this will be a four or five-inch incision, starting at her rib cage and extending toward her umbilicus,” I said. “But we really don’t know what we will find when opening her up, so if we need to go longer, we will be ready.”

When Callie was all prepped and draped, I took a deep breath and made a four-inch skin incision. Then, I extended the incision through the abdominal wall through the linea alba. Once the abdomen was opened, I removed the falciform ligament to provide more room and visibility.

I placed retractors on each end of the incision and carefully reached into the abdomen with my left hand. The mass almost jumped into my hand. I moved some intestines out of the way and pulled the mass up to the incision.

This was an ugly mass. I worked it through the incision. The only good thing I could see was it was on a thin stalk of liver tissue extending from the left lateral liver lobe. That meant I could remove it. But looking at it, I don’t know how much time this would buy Callie.

This tumor was made of a mass of nodules. Each nodule was a centimeter in diameter, and the color was a pale red. There was a distinct demarcation between the tumor and normal liver tissue on the stalk. This stalk of liver tissue was almost an inch wide and less than a centimeter thick.

“Are you going to be able to remove that thing?” Ruth asked.

“That’s the good thing,” I said. “This looks like a snap to remove. The problem will be if this is malignant. It has likely already metastasized. We might not be buying much time for Callie. But we are here, and this is coming out. Time will tell us the rest of the story.”

“I will have Sandy give Rebecca a call and tell her the tumor is removable and we are going ahead with the surgery,” Ruth said.

“Yes, that is all we can say right now,” I said.

I placed six overlapping mattresses across the stalk to the liver tissue connecting the mass. When I tied these, crushing through the liver tissue, they ligated all the vessels and biliary tree going to the tumor. Then I incised through the stalk on the mass side of the ligatures. There was no bleeding. I sat the tumor on the tray and released the stalk of tissue back into the abdomen.

I carefully explored the rest of the liver and the anterior abdomen for a few minutes. I could find no other tumors and no evidence of metastasis. I had done all I could do.

I did a three-layer closure with Maxon, and we moved Callie to the recovery kennel. Then I went to my office to call Rebecca.

“Surgery went well and things were the best we could hope for,” I said as soon as Rebecca answered the phone. “The good thing is this tumor was on a small stalk of liver tissue and it was easy to remove. The bad thing is it is one ugly mass of tissue.”

“Do you think Callie is going to be okay?” Rebecca asked.

“She is doing well right now and recovering well,” I said. “I think she will better with the mass out of her belly, but as to what kind of survival time we have bought her, only time will tell. We could know a little more if we send this tumor over to the diagnostic lab and find out what it is and how malignant it might be.”

“If we spend the money to know a little more, does that allow us to do anything to change the outcome?” Rebecca asked.

“No, Rebecca, we have done all there is to do,” I said. “At this point in time, there is nothing left to do. All it will do is allow us to put a name on this tumor. What is going to happen will happen, and all the money in the world will not change the outcome.”

“I think we can live without putting a name on that tumor,” Rebecca said. “We will just take things as they come and love every day we have, Callie.”

Callie went home at the end of the day. She looked like she was feeling well and purred loudly when she saw Rebecca.

***

When Rebecca was in for suture removal two weeks later, Callie had already gained a pound.

“We are so pleased, Doctor Larsen,” Rebecca said. “Callie feels so much better since her surgery. She is eating better and almost plays a kitten at times.”

“Her attitude hasn’t changed much,” I said as we wrestled Callie to remove her sutures.

“I am a little embarrassed. You would think Callie would love it here now,” Rebecca said.

“Our patients seldom give us any credit,” I said.

***

Nearly five years later, Rebecca and her daughter dropped by the clinic.

“We just want to let you know that Callie died at home last night,” Rebecca said. “We are so happy to have had her for all these years. They were really good years for her. And most of all, Brigit got to grow up with Callie sitting on her lap every morning.”

“Thanks for letting us know,” Sandy said. “Pets give us so much of themselves. It is just sad that their lives are so short.”

“You guys and Dr. Larsen gave her almost five extra years,” Rebecca said. “And we can’t thank you enough.”

Photo Credit: Irfan Rahat on Pexels

David E. Larsen, DVM

Growing up in Southwestern Oregon, water was abundant. The majority or houses used spring water piped into the house from nearby hillsides. Many of those same houses would have a hand dug well in close proximity  to the house. These well were mostly never used and dated from a time when piping water from a long distance was a difficult task.

We moved onto the farm above Broadbent in December of 1949. The house water came from a spring, high in the hill, and it was a snowy and cold winter. We were able to keep the water from freezing by keeping a constant flow at the kitchen sink.

There was a hand dug well beside the house. The soil had a high clay content and the water from the well tasted like the clay. We never used the water from the hill.

In the late summer, the spring would dry up and we would use water from the river for the house. We would carry water from town to use for drinking water.

Now there is more concern with the use of surface water for drinking water. But in many houses and farms in Southwestern Oregon the practice is still common place.

When I was in high school, my brother recruited me to help dig a well for his brother-in-law who had just moved a trailer house onto some hill property. 

The three of use were able to dig a well about fifteen feet deep in a few hours. At that level we had three or four streams of water coming into the well. We guessed the inflow was about five gallons per minute and that it would be adequate for two people. Besides the water made any more digging almost impossible. Plus we were concerned about going deep because of the risk of a cave in. 

This well served my brother’s brother-in-law water needs for the two years they lived on the property. When they moved, I have no idea what they did with the well. Leaving it would have been a potential death trap for anyone or anything that might happen to fall into it.

After high school and two years of college, I spent 4 years in the Army. Then six years back in school to finish by bachelors degree and my degree in veterinary medicine. During these years I was far removed from well water. 

When we moved to Sweet Home in 1976, we bought a house on Ames Creek. The house had a drilled well that served our growing family with  an adequate supply of water for the several years we lived there with no problems.

In 1980, we moved to a larger house on a hill on the east side of town. The hill was known for water problems. Our neighbor beside us had a well that was six hundred feet deep. The neighbor behind us had three wells the barely met their needs. Ours was a drilled well, sixty-five feet deep that never failed our growing family of four kids and two adults.

After living in that house for twenty years, the county decided to straighten the road. In their construction, they did some blasting. Not long after that our well sputtered for the first time. It sputtered for a day and then it went dry. We were out of water.

We waited for a day. Thinking the well would refill and everything would be fine again. That next day, when we turned on the faucet, there was not a drop of water.

The next day at the office, I filled Dixie in on the details.

“Looks like our well went dry,” I said. “We raised four kids in that house without a blink. But the thing sputter yesterday and this morning there is not a drop of water.”

“That’s terrible!” Dixie said. “Have you called anybody?”

“I have a call in to a well driller,” I said. “I hope he calls back today. At least it is not the middle of summer when most wells go dry. He might be looking for work.”

“My Dad witches wells and has a pretty good reputation,” Dixie said. “I will see if come up and witch it for you.”

“That would be great,” I said. “Not that it matters, but how much does he charge?”

“I know that he won’t take a dime from you,” Dixie said. “It was never a business for him.”

Saturday morning, Dixie and her father, Gavin, showed up right after breakfast.

“Gavin, I hear a lot of people think a lot of witching water,” I said. “But I also hear a lot of folks who think it’s a bunch of malarky.”

“Well, I do pretty good at finding water,” Gavin said. “And you might need all the help you can get. This hill is well known for water problems.”

That was all that was said. Gavin set to work, back and forth across the hillside behind the house. For the middle of February, the ground was reasonably firm. 

I followed along behind Gavin and Dixie. Finally, the two bent copper rods in Gavin’s hands swung a bit.

“Did you see that?” Gavin asked. “That is just a little slip of water, we will keep looking.”

Gavin went up to the old well. The rods didn’t move a bit.

“No water here, just a dry hole,” Gavin said.

Gavin finally found an underground stream of water that he followed down the hill to our graveled driveway. He followed it right into our large garage. When he came out of the garage to scuffed some gravel with his foot.

“Put a stake right here,” Gavin said. “Your best water is right over there in the middle of the garage. But you can’t get a drill rig in there. This is the best spot outside of the garage.”

***

The first thing Monday morning Ed pulled into our driveway with his drilling rig.

I went out and talked with him.

“I had this place witched the other day,” I said. “He said to drill here where I drove a stake.”

Looking around, Ed rubbed his chin.

“Well, that’s good, because that is the only place I can get rig set up,” Ed said.

“What do you think about with water witching?” I asked.

“When we hit water, everyone thinks it is pretty good,” Ed said. “When we drill a dry hole, everyone thinks it is a bunch of bull shit. I suppose you know bull shit, Doc.”

“I know bull shit, professionally speaking,” I said. “But I also know Gavin. So this is where we will drill.”

“It will take me some time for me to get set up,” Ed said. “I will give you a call when I have something to tell you.”

It was about two in the afternoon when Ed called the clinic.

“Doc, I am at thirty-five feet, and I have water at about 3 gallons a minute,” Ed said.

“So, how functional is that for us?” I asked.

“Well, it can work,” Ed said. “You will need to get a tank to pump into and for just the two you, that will work pretty well. You might need to be careful with your water use if you have a crowd of people show up.”

“Can we go a little deeper?” I asked.

“We can go deeper, but sometime if we go deeper we will lose the shallow water,” Ed said.

“Okay, why don’t we go another ten feet,” I said.

“Ten feet, I will be there in half an hour,” Ed said. “Then you will want to go ten more feet, ten more feet every time I call. We are either going to drill this damn hole or not.”

“Okay, drill the damn hole,” I said.

I did not hear from Ed again that afternoon. When we got home, the well drilling rig and Ed were gone. There was a pipe sticking up out of the ground where Ed had been drilling. 

There was a message waiting on the house phone.

“Larsen, you are the luckiest SOB there is,” Ed said on the message. “At 90 feet I hit so much water I couldn’t measure it. Probably, a hundred gallons per minute, but I had to register it at fifty gallons per minute. Absolutely unheard of on this hill. You need to call Star pump, and they will fix you up. I will send the bill.”

Photo Credit Omar Al Faruq on Pexels

David E. Larsen, DVM

Dixie carefully closed the exam room door. She had just finished getting the next patient ready for my exam.

“This guy just arrived from California,” Dixie whispered. “The cat is old, and he is pretty proud of that fact. His name is Bob, and the cat’s name is Ruby.”

I entered the exam room and patted the old cat’s head. Then I extended my hand to Bob. Bob was a big man. Not fat, just a large older gentleman. His six-foot-four-inch frame towered over me, and his hand engulfed my hand. But I still managed a firm handshake.

“What are we doing for Ruby today, Bob?” I asked.

“You guys are right on the ball,” Bob said. “You had the names down without even looking at the record.”

“Well, we try hard, but we also cheat a little,” I said. “Dixie filled me in on the other side of the door.”

“Honest, too,” Bob said. “I like that. We just moved into town, and Ruby is probably the oldest cat you have seen. I just wanted her checked out. The move was long, and there was a lot of stress for her.”

“Moves are pretty stressful for cats,” I said. “Even short moves are often difficult for them. Does Ruby live inside?”

“Yes, she lives inside exclusively anymore,” Bob said. “In her younger days, she spent a lot of time outside. She is seventeen years old now. We try to take special care of her. Doc, you probably haven’t seen a cat this old.”

“We see a lot of cats in Sweet Home,” I said. “I rarely see a male cat that makes it to fifteen. Fourteen seems to be the magic year for them. But we see many sixteen-year-old female cats and a few who make it to seventeen. The oldest cat I have seen was twenty-three. She belonged to an old lady in the nineties. She told me she had to crawl under the bed to retrieve her cat for the appointment. That most of been quiet of a sight.”

“Well, seventeen is pretty old for a cat,” Bob said.

“Oh, yes, she is in a small group with dwindling numbers,” I said. “Do you just want an exam for Ruby, or do you want me to do blood work and a urinalysis?”

“Down south, we usually take her in for an exam every three months or so,” Bob said. “They never asked about a lot of lab work.”

“A lot of old cats die from kidney failure,” I said. “We should at least be doing a urine sample. And after a trip like she has just been through, it might be wise to run a blood panel, just so we can make sure everything is working like it should.”

“You will probably need to keep her for a couple of hours to finish that,” Bob said. “And you are  right, and we don’t want anything to happen to her that we can prevent.”

So, with that decided, we kept Ruby for a couple of hours, collected blood and urine samples, and completed a comprehensive exam. She passed everything with flying colors.

“Do you think she is really seventeen?” Dixie asked.

“She looks pretty for good for that age,” I said. “Did Bob bring any records from his previous veterinarian?” I asked.

“He said that she was never sick, so they didn’t bother with records,” Dixie said.

Bob was pleased with the results and made an appointment for a recheck in three months.

***

Three months later, Bob and Ruby were back in the clinic. Bob had quite a discussion at the front desk. Bob was sure our records were wrong, Ruby was nineteen, not seventeen as our file indicated.

“Doc, this cat just amazes me. She gets healthier as time goes on,” Bob said. “I am thinking that she will live to be thirty.”

As Bob loaded Ruby into his car, Dixie smiled at me.

“She probably will live to be thirty,” Dixie said. “If she continues to age two years every three months, thirty if not too far off.”

***

That became the routine; Bob and Ruby would be in the clinic every three months. Every visit, Ruby was two years older. 

Bob had some bad news on the fourth visit, just before Christmas.

“We will be moving in a couple of weeks,” Bob said. “All this rain is too much for us to endure. This move is going to be a short one, just over the mountains. We have bought a new house in Redmond.”

“I sorry to see you go, Bob,” I said. “But, you will have a dryer climate over there, maybe a little colder in the winter, but not near as much rain. Do you want to take a copy of Ruby’s records?”

“She has been as healthy as a horse on every visit,” Bob said. “There is no need for records. She will have her twenty-fourth birthday this coming spring. Probably the oldest cat most vets have ever seen.”

“I am sure she probably is, Bob,” I said,

We never had any news from Bob, but if it was up to him, I am sure that Ruby lived to be thirty.

***

It was a couple of years later when Jack came in with his old cat. He set the carrier on the floor, carefully pulled an ancient Siamese cat from the carrier, and placed her on the blanket he had spread on the table.

Jack was a large animal client from Brownsville. I had worked on his cows almost from the day we started practice.

“Doc, I have never asked you for a miracle, but that is what I am after today,” Jack said, tears welling up in his eyes. “This old cat is my daughter’s, and we want to get one more Christmas with her. This cat is twenty-six years old. So, I know I might be asking a lot, but our daughter is coming home for Christmas, and I am looking forward to one more picture of her and this old girl.”

“Jack, are you sure of the age?” I asked. “I mean, it is easy to lose track of the years with a cat.”

Jack struggled to get his wallet out of his hip pocket. Then he thumbed through old papers and receipts before finally pulling a tattered and crumpled old photo from the mess. 

“Here is the proof, Doc,” Jack said. “Sue was almost a year old in this photo. It was her first Christmas. And the kitten she is holding is this old girl right here. And Doc, Sue will be twenty-six next month.”

“Well, I would say I had better get to work if we are going to buy some time for this old gal,” I said. And what is this old gals name?”

“Well, we call her Cleo,” Jack said. “Actually, she was named before we got her and that name was Cleopatra.”

“Yes, I think Cleo is a better name,” I said. “Jack, Cleo is a little thin and might be dehydrated. Why don’t we plan to keep her overnight, do some lab work, and see if we can make her feel a little better for Sue’s arrival? Jack, Cleo is ancient. We can maybe buy her time, but we will not make her a young cat. You understand that, I hope.”

“Do what you can, Doc,” Jack said. “Like I said when I came through the door, we are after a miracle. So yes, we understand Cleo’s situation.”

We kept Cleo for the night. After collecting blood and urine samples, we started her on IV fluids.

My heart sank when I looked at the lab results. I had expected Cleo to be in kidney failure, but her blood values showed her failure was advanced. Cats seem to adjust to kidney failure and hold out pretty well right to the end. We were going to have to be lucky to be able to get her up for Sue’s visit.

I gave Jack a call with the news.

“Jack, I had expected Cleo to be in kidney failure, but the lab work shows a pretty advanced status,” I said. “If it was you or I, we would be on dialysis. Unfortunately, for Cleo, that is not an option. What we can do is limited. We will do some peritoneal dialysis this evening. That is where we fill her abdomen with fluid, allow it to stay to absorb some of her toxins, and then draw it off. That and her IV fluids and a special diet will get her through a few days. If you want to extend that time, we could use some diuresis, where we give her daily fluid to run through her kidneys to get as much use out of them as possible. But we are talking about weeks, not months.”

“Sue arrives the day after tomorrow,” Jack said. “If I followed all that, we can buy her enough time for Sue to say goodbye. Then I don’t think we will want to put Cleo through a bunch of misery to buy a couple of empty weeks.”

“We will get started on her treatment,” I said. “Plan to pick her up tomorrow. I think you can expect a couple of days, but three days without additional treatment will be the end of it. And Jack, just a word of advice: the one mistake people make is to wait too long before deciding to put a pet to sleep. It is better to be a day too early than a day too late.”

“Okay, Doc, we will pick Cleo up in the late morning,” Jack said. “That should give Sue a few good hours with her. That will be good. We will give you a call when we are ready.”

Cleo felt significantly better after treatment and a day of IV fluids. Jack was pleased with her progress when he picked her up.

It was two days when he called and asked to speak with me.

“Doc, I can’t thank you enough,” Jack said. “Sue and Cleo had a wonderful day yesterday. Sue was sad, of course, when I told her of Cleo’s prognosis, but they loved the time with each other. Cleo slept at the foot of Sue’s bed, just like in the old days. It was sad, but Cleo died during the night. That spared Sue the struggle to make that final trip to your office. Thanks again, Doc.”

“I’m glad we could them that time,” I said.

I was lucky that Jack choked up a little and allowed that to end the conversation. I was also a little choked up as I hung up the phone.

“Cleo died?” Sandy asked.

“Cleo died,” I replied. “At home and happy. Things worked out the best they could for everyone.

Photo Credit: Avelino Calvar Martinez on Pixabay.