Blood Please, Fill Her Up

D. E. Larsen, DVM

She came through the door in a rush, a young girl, probably in her early twenties, with a very limp, pale orange tabby cat in her arms. 

She stopped at the counter. “I need to see the vet. This is an emergency,” she said, visibly trying to maintain her self control.

Under a lot of financial stress for a new clinic, this was one of our most difficult situations to handle. This patient was an obvious need for emergency care. Still, we were not in a place where we could provide a lot of expensive medical care without some assurance that we would get paid.

Sandy escorted her to the exam room, and Ruth was right there to check her status. 

“I’ll get the Doctor,” Ruth said.

“We require payment at the time of service,” Sandy said.

“I have a credit card,” Valarie said.

I came into the exam room and lifted the lip on the cat, a year old female named Sissy, lying almost lifeless on the exam table.

“We have to be very gentle right now,” I said. “This kitty is hanging onto life with by thin straw.”

“This has happened before,” Valarie said. “She is positive for Feline Leukemia Virus. All she needs is a blood transfusion.”

“I wish it was that simple,” I said. “A transfusion will be like magic for her right now. But it will buy her very little time. She will be back here again, in the same condition. And one time, she will not survive the trip.”

“She does just fine after getting a transfusion,” Valarie said.

“That’s why she is here in this condition,” I said. “When was her last transfusion?”

“It was about 3 weeks ago,” Valarie said.

“The virus crowds out her normal bone marrow cells so she can’t make her own blood. These FeLV positive cats have a short time to live once we start to see symptoms. Sometimes it is dysfunctional bone marrow like this. Sometimes it is leukemia. Sometimes it is a nonfunctional immune system, and sometimes it is a lymphatic tumor in the chest or abdomen.”

“Can we just get some blood into her?” Valarie asked.

“Sure, we just happen to have a donor cat in the back today,” I said. “I just want you to know that this is not as simple as you seem to think. Any undue stress on this cat right now, and she will seizure and die, just like that.”

I wish I could say this case was unusual. But in the late 1970s and early 1980s, we would see cats in this condition often, maybe 2 or 3 times a week. The only thing unusual about this case was the cat was still alive.

Often, the client would storm through the door with a cat in a kennel. Throw the kennel on the exam table, and drag the cat out for an exam. With the trip’s stress and a PCV of about 6%, the cat would have a seizure and die right before their eyes.

We took Sissy into the back and placed an IV catheter. Her PCV (packed cell volume) was 6%. Low normal is 25%. I had only seen a handful of cats survive with a 6% PCV.

I sedated our donor cat with a small anesthetic dose and collected 60 ccs of blood into a syringe. Then I turned around and administered this out of the syringe into Sissy’s catheter. Sissy was back to life before half the syringe was administered.

When I sent Sissy home later that day, I again tried to caution Valarie that Sissy was a lucky cat today. And that this may not happen next time or the next.

“Valarie, Sissy looks good right now,” I said. “But she is running on borrowed time and borrowed blood. Likely, her bone marrow is not producing blood like it should. Two weeks from now, she will be in the same situation, and one time she will not survive.”

“She looks so good. I can’t thank you enough,” Valarie said as she picked Sissy out of the kennel and held her against her chest.

I am not sure if she didn’t hear me or just chose to ignore my thoughts. But she went out the door happy.

It was just like clockwork when Valarie rushed through the door two weeks to the day later.

This time we ran a PCV first. It was 4%.

“Valarie, I have never seen a cat that was alive with PCV of 4%,” I said.

“All she needs is some blood,” Valarie responded.

“Yes, some blood and some functional bone marrow,” I said. “We will try, but I have no confidence that she will live through the process.”

We took Sissy to the back treatment table. As predicted, she died while we were placing an IV catheter.

To say that Valarie left the clinic unhappy this time would be an understatement. Valarie left the clinic pissed off.

To her credit, Valarie came in the next day and apologized for her behavior. 

“I was pretty unhappy yesterday,” She said. “I realize that you had warned me of Sissy’s status several times. I am sorry I acted the way I did.”

“We all get upset at times of stress,” I said. “Losing a pet is a hard thing. This Feline Leukemia Virus is tough. It is very prevalent around here.”

It was half a dozen years later when a vaccine for Feline Leukemia Virus became available. The vaccine immediately changed the landscape for Feline Leukemia Virus associated diseases. 

Today that vaccine has fallen in use and in favor. It does have some problems. Those problems do not begin to compare with what was seen in the cat population before 1984. Those veterinarians who fail to endorse that vaccine were not practicing before 1984.

Photo by M Ruslan from Pexels

The Turpentine Compress

D. E. Larsen, DVM

I carefully started removing the wrap on the hindfoot of Lady, a large Golden Retriever. This wrap was composed of a couple of rags and what looked like an old tee shirt. 

I recoiled from the odor.

“When did this happen,” I asked Ralph.

“She got ran over yesterday afternoon. The foot looked so bad, and she was licking it so much, so I put a turpentine compress on it last night.”

“Turpentine!” I said. “What made you think turpentine would be helpful.”

“My grandfather always used turpentine on a wound on his cattle,” Ralph said with no hesitation.

I pulled the final pieces of cloth off the wound. Lady just laid her head down on the table, obviously resigned to the misery she was suffering.

This wound was a total loss of the skin from the hock down to the footpads. The skin was totally gone. The bare tissue looked almost cooked from the turpentine. I can only imagine how that must have felt when it was applied.

“Your grandfather maybe used it on some minor abrasions of the skin. That was maybe done in those days. Using it on a wound like this was nothing less than torture for Lady.”

“Gee, I am sorry, Doc,” Ralph said. “I was just trying to do something helpful.”

“This wound was probably not repairable last night. It is definitely not repairable at this point. This leg is going to have to be amputated.”

“When are you going to be able to do that surgery?” Ralph asked.

“We have a busy schedule, but I can’t allow Lady to sit in a kennel and suffer waiting for surgery. We will move things around and get her into surgery right away.”

“I don’t know, Doc,” Ralph said. “I am not sure she will be able to get along with only 3 legs. Maybe we should just put her to sleep.”

“Dogs wake up in the morning and evaluate their situation. They just get up and go with what they have. They make do. People worry more about amputations than the dog. You will probably have to count legs to know that she only has 3 legs.”

“What do you think it is going to cost?” Ralph asked.

“After what you put this dog through for the last 12 hours, you owe her whatever it cost. You owe her another few years.”

“Doc, I was just asking to make sure I can pay the bill,” Ralph said. “But if I decide to put her to sleep, that is the way it will be.”

“Ralph, there is not a judge in the county who will not believe me if I say this is a case of animal abuse,” I said. “Now, I don’t believe in reporting any charges of abuse when it was done out of ignorance, and the person seeks care. That applies in this case. Especially since you are here this morning and not next week. But if you want to put her to sleep, my opinion might change.”

“I am just trying to see where I stand,” Ralph said. “You do the surgery. I will leave a deposit at the front desk. When do you think Lady will be able to go home?”

“Going home will depend on how well she is doing in the morning. If she is up and about, I will probably send her home. She will need a few pain pills, but she is probably going to feel so much better with this foot gone that she will be bouncing around.”

“Where do you take the leg off, Doc?” Ralph asked.

“We could save you a little money by just taking it off at the hock joint. But Lady will do a whole lot better if we take it off in the middle of her thigh.”

“Let’s do what is best for her,” Ralph said. “You have me feeling bad enough already.”

We hurried Lady to surgery. The stench of the turpentine was nearly overwhelming in the surgery room. The surgical prep on the leg did little to lessen the odor or fumes.

I did a standard mid femur amputation. This started with a bivalve incision through the skin to provide big enough flaps for closure over the stump. Extra skin can always be trimmed off the flaps as needed, but if the flaps were cut too short, it would be a significant problem to shorten the stump.

I isolated the major vessels first. Double ligating the femoral artery to reduce any significant blood loss as the surgery progressed. After the vessels were ligated and severed, I separated the muscles quickly. I wanted to get this leg off and out of the surgery room as soon as possible, so everyone could breathe again.

When I finally had dissected down to the femur, I severed it with a Gigli wire saw. Once free from the body, I handed the leg off to be removed from the room.

At this point, I could take a deep breath and start closing the muscles over the bone to provide a well-padded stump. Then the skin was trimmed and closed. I had been a little faster than usual because I wanted that stinky foot out of the surgery room. It was a pretty brief surgery, less than an hour.

Lady recovered with some pain medication aid, but she had to feel so much better with that foot being gone. She was up and around by the early afternoon. Being a little older, it took her a few tries before Lady could handle getting up and down with only one hind leg. After those first few tries, she was acting like she didn’t miss the leg much.

When I could feel confident that Lady would be ready to go home in the morning, I gave Ralph a call.

“Ralph, you can pick up Lady any time in the morning,” I said. “She is feeling much better and is getting around on the one leg just fine.”

“That sounds good, Doc,” Ralph said. “I will be there first thing in the morning.”

When morning came, Lady ate a good breakfast and walked on a leash well. 

Ralph took care of the account and lead Lady out to his pickup. He lowered the tailgate, and Lady started to jump into the back. She made a jump but did not have the strength in the one hind leg to make it up to the pickup bed. Ralph was quick to catch her before Lady fell. Then she jumped up with her front feet on the tailgate and looked to Ralph for a boost. One little boost from Ralph and Lady was in the bed.

“She will do just fine,” I said to Sandy as I watched from the office. “Just give her a couple of weeks.”

Lady continued to do well. As predicted, one had to count legs to make sure she only had three legs when she returned for suture removal a couple of weeks later.

After the sutures were removed, I never saw Lady or Ralph again. That was not a surprise. I had been stern with Ralph, and for him to find another clinic was almost expected. Perhaps it was from embarrassment for his actions, but more likely, it was from the veiled threat of reporting his abuse.

Photo by Hemant Gupta from Pexels

The Salamander’s Tale

D. E. Larsen, DVM

Jake lifted his young son out of the pickup and handed him off to Sue as he opened the tailgate and let Bruiser jump out of the pickup bed.

They could already feel the cooling breeze coming from the river and providing some welcome relief from the Mid Willamette Valley’s August heat. 

Bruiser was excited, he had been here before, and he strained against Jake’s hold on his collar while Jake struggled to attach a leash.

Sue was double-checking everything in her bag. She didn’t want to make a trip up the bank to the pickup for some forgotten item. Finally, she was ready.

“Ok, let’s get to the water,” Sue said as she jostled Benny on her hip.

Bruiser strained at the end of the leash, trying to reach the trail leading down to the river. Jake had to lean back against the pull to keep from being pulled off his feet.

“Why don’t you just let him go?” Sue asked.

“We don’t know who is down there. I don’t want to end the day with a dog fight.”

They threaded their way down the trail to the river from the highway. The far shoreline was filled with people, kids, and dogs. This side was a little more challenging to get up and down from the road, but it was much less crowded for that very reason.

“I wish that the Cascadia State Park side was not so crowded,” Sue said. “It is so much easier to get down to the river.”

“We will enjoy the day so much more on this side,” Jake said. “Bruiser can run off-leash, and we won’t have to worry about all the dogs on the far bank.”

There was a small beach with soft, warm sand on this side of the river. Everywhere else was just smooth bedrock that the river flowed over. Several large holes of deepwater offered prime swimming areas. They were connected with short rapids as the water cascaded over the shale.

The breeze coming up the river was most refreshing, and Sue spread the large beach towel out on the soft sand and sat down with Benny. The little beach was shaded by the large maple trees the lined the river, so she didn’t have to worry about smearing sunblock on Benny.

“This feels so nice here. I wished we lived closer, so it wasn’t such a chore to get here,” Sue said.

“It would be nice,” Jake said as he released Bruiser from the leash and started to wade into the water. “When I was young, and we lived Sweet Home, it was an easy trip. But from Albany, it just seems like it takes forever.”

Jake dove into the deep pool. He popped up and looked back at Sue and Benny on the little beach. The cold water was a refreshing contrast to the valley heat.

Sue tried to get Benny to look at his father, and Bruiser was standing in the river with the water touching his chest. Being a Pit Bull, he was not a good swimmer and did not like the deep water. 

Jake thought he would do a deep dive and then take Bruiser up the shallow water in the rapids above this hole. Jake dove to the bottom of the hole.

This was a hole carved into the smooth bedrock of the river. The hole’s bottom was littered with large river gravel—rocks worn smooth from being tumbled down the river during the rainy season. As Jake turned to head for the surface, he noticed several trout feeding in the area where the water spilled into the deep hole. They seemed oblivious to his presence.

Jake returned to the bleach and grabbed Benny from his toys on the beach towel. He tossed him a few inches in the air. Jake would have thrown him high, but Sue would not allow that. Then he took Benny to the water’s edge, put his feet in the water, and splashed some water on his bare belly. 

“Would you play with Benny in the water while I take Bruiser up to the shallow water?” Jake asked Sue.

Sue set her book down and jumped up to take Benny. Jake motioned to Bruiser and headed up the stream toward the shallow water.

Bruiser plowed into the shallow water above the rapids. He splashed and ran, piling up a wake in front of his broad chest. Jake watched him and smiled. He liked this place so much as it reminded him of his days as a child. Few people knew of the little sandy beach. It was always like their little private spot.

Jake stood and surveyed the scene in front of him. The cool breeze coming up the river was in his face. Sue and Benny were playing in the water at the beach and the mass of people frolicking on the rocks at the deep holes down the river by the park. It was just about a perfect day, an ideal place.

Jake turned around and looked at Bruiser. Bruiser was standing in a shallow pool and had a yellow-bellied newt hanging from his mouth by its tail.

“Put that thing down!” Jake yelled at Bruiser.

Bruiser looked at him, then slurped the salamander into his mouth, chomped a time or two, and swallowed it.

“I hope that tasted good, you dumb dog,” Jake said. “Come on, let’s go back to the beach.”

Jake turned and started back down the stream to where Sue had just started drying Benny off with a large beach towel.

He looked to make sure Bruiser was following. Bruiser was foaming at the mouth a little and shaking his head, scattering foam into the water on both sides of him.

“I told you to put that thing down, now look at you. Come on, let’s go get you cleaned up.”

Bruiser started to follow Jake down the stream, staggering a bit as he ran across the rocks.

“What in the world happened to Bruiser?” Sue asked as they approached the beach.

“He ate one of those salamanders that are all over here this time of the year. I think they call them newts.”

“I seem to think that they might be poisonous. Just look at Bruiser now. He can hardly walk.”

Jake turned to look at Bruiser. He was stumbling and staggering to keep up with him. His chest was covered with the thick white foam that he continued to shake out of his mouth.

“I will wash out his mouth. That should make it a little better.”

“I don’t think so. I think this is serious,” Sue said. “I think we should take him to the vet. There is probably one in Sweet Home.”

“Maybe you are right. Let’s load up and run down there and have him checked.”

Sue hastily packed her things into her bag and grabbed Benny, and started up the trail. Jake put the leash on Bruiser and gave it a tug. Bruiser did not respond.

Jake looked closely at Bruiser. Bruiser’s eyes seemed to not focus on anything. He pulled on the leash again. Bruiser tried to take a step but fell face-first into the sand. Jake was anxious now. 

He gathered Bruiser up in his arms and clambered up the trail to the pickup.

“He is getting worse by the minute,” Jake said to Sue as he lowered the tailgate and slid Bruiser into the bed of the pickup. Bruiser looked up but did not try to stand. The pupils of his eyes were widely dilated, and he seemed to look without focus.

“Let’s hurry. We can stop at the store and get directions and have them call for us,” Sue said.

They loaded everything into the cab and sped off down the road to the store.

Sue ran into the little store. Joyce was behind the counter.

“Our dog swallowed a salamander, and he was foaming at the mouth and staggering by the time he got out of the water. I don’t think he can stand now. Can you call the vet for us in Sweet Home and let them know that we are on our way.”

Joyce gave Sue directions to the clinic and said she would call. 

“You guys drive safe going down that road out there. The traffic is pretty heavy today.”

Sue looked at Bruiser as she walked around the pickup to get in on the passenger side.

“He looks worse by the minute,” Sue said. “She is going to call, so they will be waiting for us.”

Jake pulled out onto the highway and turned on his emergency flashers. Then he pushed the gas pedal to the floor. It was going to be a challenging 13 miles.

Sandy took the call from Joyce. 

“It must be bad,” Joyce said. “She was really frantic. They should be there shortly if they don’t crash on the way.”

Sandy relayed the information to Terri and me. 

“What do you for that?” Terri asked.

“Those newts are highly toxic. This is probably going to be a dead dog. There is nothing to be done. A young guy in Coos County swallowed one on a dare when they were partying on the river bank a few years ago. He died.”

“So, these folks are going expect us to do something.”

“Let’s set up the endoscope. Maybe we can retrieve the thing from his stomach and reduce the dose. It will look like we are trying, but it is going to end with a dead dog. 

When I was in school at Oregon State studying under Dr. Storm in the Zoology Department, he talked about one of his graduate students’ studies on these newts in Western Oregon. They are called the Rough-Skinned Newt. They are very toxic around here, less so in some areas. I didn’t know at the time, but the student was from Myrtle Point. Older than me by a few years, but he was in high school with my brother. We called him Butch. He is pretty much the expert on the newt.”

We were all set up for Jake and Sue’s arrival with Bruiser. They came through the door in a rush. Bruiser was limp in Jake’s arms, Sue was carrying Benny on her hip. We guided them to the treatment table, where Jake laid him out on the table.

“I think he is dead,” Jake said.

I checked, he was dead.

“We should have been faster,” Jake said.

“I am sorry, Jake. This is a hard way to lose a friend, but being faster would have made no difference. Bruiser signed his death certificate when he ate the salamander. There is nothing to be done to treat this toxicity.”

“Do we owe you anything?” Sue asked.

“No, not at this point. Do you want us to take care of him for you?” I asked.

Jake gathered Bruiser up in his arms, “No, we will take him home. We have a place to bury him.”

With that, they were gone, almost as fast as they came.

“That was sad,” Terri said.

“So many people have no idea those little things are so deadly. As a kid, we played with them all the time. I never heard of a problem with them until I was in school at Oregon State.”

Photo by Dyann McCollum

Information Link: 

https://en.wikipedia.org/wiki/Rough-skinned_newt?fbclid=IwAR0czquFGih0kn0vgTXLlog0mplGLaeReWU7Dh8Lsfnw5GiIUkV88NJDHhU