Fleeing the Flea

D. E. Larsen, DVM

It is another hot August day in Sweet Home, and fleas are eating most of the dogs alive.

Returning from lunch, I could see that Dixie had started the sprinkler on the roof already. That helped keep the clinic cool. The water would run hot, coming off the roof.

Joseph was waiting with a worried look on his face. He was holding a limp Domino.

Domino was a little five-pound chihuahua. He was black as a young dog but was half gray now.

Dixie herded Joe and Domino into the exam room as soon as I put on my smock. 

“He is not doing so good this morning, Doc,” Joe said. Joe was in his early seventies and had lost his wife several years ago. Domino was about all he had left in the world.

We place Domino on the exam table on a fleece. I pulled up his lip, his membranes were white. I looked at his lower back and ventral abdomen, and he was literally covered with fleas.

“Joe, Domino is being eaten alive with fleas,” I said. “I am going to run a quick CBC on him. I can see that he is anemic, we just need to know how bad.”

After we drew a small tube of blood, I discussed the flea situation with Joe as I waited for results. The in-house blood machine would only take a few minutes.

“I don’t know why he would have so many fleas,” Joe said. “He has had a flea collar on since the first of the month.”

“It is a little complex, Joe,” I said. “You have probably had fleas laying eggs in the house all winter and spring. That flea collar might work a little around his head and neck, but for the most part, that little cloud of protection is about three feet behind him. When the weather gets hot, all the fleas come alive, and for a little guy like this, they suck the blood right out of him.”

The CBC showed a packed cell volume of less than 6% and a hemoglobin of 1.6 gm/dl. I don’t think I have seen levels this low in a living dog.

“Joe, Domino is very critical,” I said. “I need to get some blood into him right now. Any undue stress and he could drop dead in an instant. We will need him for a couple of hours, and I will talk about what we need to do when you pick him up.”

Luck was on Domino’s side, we had Riley in the clinic today. Riley was a large mixed-breed dog weighing over 100 pounds. I got ready to collect blood while Sandy called Riley’s owner.

“We have an emergency with a little chihuahua. We need to give him a blood transfusion,” Sandy said into the phone. “We only need about 35 ccs of blood and would like to collect that from Riley, if that is okay. That is a small enough volume that Riley won’t miss it.”

They consented, of course, and I drew the blood into a heparinized syringe. Then we turned around and administered to Domino via a jugular catheter. The risk of a transfusion reaction on an initial transfusion was low, and Domino’s blood values dictated immediate blood.

The result was almost instantaneous. Domino came alive again. His membranes pinked up, and he sat up and looked around as if to ask, “Where am I?”

I gave Domino a Capstar tablet. This was a new pill that provided close to a total flea kill in 30 to 60 minutes. I also gave him some oral Prednisone to reduce the inflammation in the skin.

When Joe returned, we had him fixed up with some topical Advantage for flea control, and I spent some time discussing year-round flea control. In the old days, we would have needed to use a flea bomb in the house, but those were almost impossible to find. The newer products did a good enough job that we did not have to treat the home.

“The important thing to remember is to maintain flea control all the time, year-round,” I said. “In August, when it turns hot, I probably spend 90% of my time treating dogs and cats with skin issues. And most of those issues are caused by fleas.”

“Okay, Doc, I don’t want to lose this guy,” Joe said. “I would have never thought that fleas could do that to a dog.”

“It all depends on the dog,” I said. “Domino is not much of a dog compared to Riley, his donor. Riley weighs over 100 pounds, and fleas could not do that to him. But Domino should be okay now, you just bring him by next week, and I will recheck that blood, just to make sure he is doing okay.”

Joe left with Domino in the crook of his elbow. Domino standing on his front feet, trying to lick Joe’s face. One happy ending.

Dixie had the next patient ready in the exam room. An older lady, who I had not seen before. Doris had a poodle, Daisy, who was scratching on her tail head, that area on the low back above the tail. This was the textbook appearance for Flea Allergy Dermatitis. 

“Daisy has been scratching herself raw,” Doris said.

I looked Daisy over from head to tail. Everything looked fine except for the skin. Daisy had a ribbon in her hair on both ears, she had probably just come from the groomer. I ran my hand over the sparse hair on her low back—fleas scattered in all directions.

“Doris, this pattern of hair loss is what we see with Flea Allergy Dermatitis,” I said. “We need to use some medication along with some flea control, and this will clear right up.”

“I overheard your conversation with the gentleman who just left,” Doris said. “I want you to know, Doctor, Daisy does not have fleas, and there are no fleas in my house. The groomer thinks this is a food allergy.”

I promptly parted the hair on Daisy’s back again and quickly captured a flea. I placed the flea on the exam table and squished it with my thumbnail. I didn’t say a word.

“We had to wait out there in your waiting room for almost ten minutes,” Doris said.

“We just happen to have a new veterinary dermatologist that has started practice in Eugene,” I said. “She would be the one who you should see to handle Daisy’s possible food allergies. I will send your records down to her and send you home with her telephone number. I think that she will be able to get you right in to look at Daisy since she has just started practice.”

Doris and Daisy left with the information. 

“That was quick,” Dixie said.

“I am too tired to spend my time talking to a brick wall,” I said. “The Dermatologist can tell her it is a flea problem after she does $500.00 worth of skin testing. I am sure she will believe her then.”

Photo by Liam Ortiz from Pexels

Colleagues

D. E. Larsen, DVM

I looked at the large black tumor on Dr. Walker’s old gray mare as I wrapped the tail. It was a good thing that the horse was gentle. There were no facilities, and I was at considerable risk, standing directly behind the mare. This tumor was the size of a small egg and located on the right side of her vulva. The lucky thing was it off to the side enough that I could remove it without disrupting the structure of the vulva.

After doing an epidural for anesthesia, I scrubbed the area and soaked it with Betadine. I had the tail tied to the side with a twin around the mare’s neck. I palpated the tumor to make sure is as superficial as I suspected. 

Removing the tumor was easy. I made a wide elliptical incision and took a sizable, deep margin. I laid the tumor on the surgery tray and closed the wound with two layers.

“I will send this in just to check on its malignancy,” I said. “There is probably not much else we can do, but it will be good for you to know.”

“I know,” Dr. Walker said. “She is an old mare, but we love her.”

“This is a melanoma, for sure,” I said. “Black tumor on an old gray horse is almost a description of a melanoma. I was always taught to cut early, cut wide, and cut deep. In this business, the initial surgery is probably our only treatment for these old horses.”

“How much do we owe you?” Dr. Walker asked.

“No charge,” I said. “I never charge a colleague, something I learned from Dr. Craig.”

“That’s not fair, I can’t make this much up to you,” Dr. Walker said.

“My goal in life is to have others owe me,” I said. “That way, I know that I have been doing good in my life. I have no expectation of repayment.”

The tumor was a melanoma, but not highly malignant. It would not have any influence on the mare’s longevity.

Some months later, Althea brought in a feral tomcat with a rotten mouth. It was a Friday evening, just after we closed.

The tomcat growled and hissed when I looked into the carrier. I could see raw tissue under his tongue and in the back of his mouth.

“How long have you had this guy, Althea?” I asked. “This is a bad case of stomatitis, and he has some teeth about ready to fall out.”

“I have been putting out some canned food for him for several weeks,” Althea said. “His mouth is very painful when he eats. It has taken me this long to get him into a carrier.”

“Maybe I will try to get an injection into him for tonight and have you bring him back in the morning,” I said. “I am not sure I want to keep him in the clinic overnight.”

Feline Leukemia Virus infection was prevalent in Sweet Home. This kind of mouth was one of the presentations we see in cats with FeLV.

“Do you think you can do that without getting bit?” Althea asked.

“We will find out,” I said as I worked a snare around the tom’s neck.

Once I had him snared, I pulled him out of the carrier and gave him an injection of Amoxicillin under his skin.

As I directed his head back into the carrier, he exploded. Up and down and around, he bounced on the end of the snare. When he calmed for a second, I grabbed him by the back of the neck with my left hand to pin him to the exam table. 

Now, the fight was on. There was no way he was going back in that carrier, and there was no way I could let go of my grip on him. The ketamine to sedate him was in the lockbox. I called Sandy to get the key from my pocket and get me a dose of ketamine. 

When she had a dose in a syringe, I let go of the snare for a second to give the injection. Ketamine burns when it is given in the muscle. Before I could drop the syringe and grab the snare again, this old tomcat turned and bit me on my index finger’s knuckle on my left hand. He held onto the bite, just to let me know that he had won the battle. I waited, thinking that one bite wound was better than three. Finally, the ketamine began to soak it. I could feel his muscles relax, and the pupils of his eyes dilated widely.

I carefully removed the rotten canine tooth, his right fang, from the wound on my left hand.

“It looks like I am going to hang onto this guy for the next 10 days,” I said to Althea. “I doubt if he has ever had a rabies vaccination, and if you take him home, he will be gone at the first opportunity.”

“Do you think he is going to be okay?” Althea asked as I started to tend to the bite wound he had just inflicted on my left hand.

“My guess is he is a feline leukemia cat,” I said. “That probably means that he is not going to do well. But I can check him out in the morning. Right now, I am going to take care of this hand. I will give you a call in the morning.”

I should have gone to the doctor that evening. But I flushed the wound several times with saline and betadine. I started myself on some antibiotics off of my shelf.

In the morning, I woke with a throbbing hand. My whole hand was swollen, and a lot of pus was draining from the wound. I called our doctor and arranged to meet him in the ER when he finished his morning rounds at the hospital.

One look at my hand and I was promptly admitted to the hospital. 

I have worked on almost every dangerous critter around, and a damn tomcat puts me in the hospital.

“What am I going to do with that cat?” Sandy asked as they settled me into a bed and started hooking me up to an IV.

“You get Dixie to help you put food and water in his kennel,” I said. “Anything more than that can wait.”

The culture came back as staph, and they moved me into isolation. My hand was feeling a little better with the IV antibiotics. About then, Sandy called on the telephone. Answering the phone is a real challenge when you have a couple of IV lines on one arm and the other hand in a hot pack.

“The cat died,” Sandy said.

“Good,” I said. “I don’t think I liked him anyway.”

“It’s not funny,” Sandy said. “What am I supposed to do now?”

“You call Dr. Walker,” I said. “I am certain she will take care of things. We need to send the head in for rabies testing.”

I had no more than hung up the phone, and Dr. Gulick entered the room.

“The cat died,” he said.

“Yes, I was just told,” I said.

“With you in here, how will we get the cat submitted for rabies testing?” Dr. Gulick asked.

“Sandy is going to get Dr. Walker to take care of things,” I said. “I don’t think there will be any problems.”

By Monday morning, my hand was doing well, and I was released to get back to work. 

I called Dr. Walker to thank her for taking care of things.

“I just wanted to call and say thanks for helping Sandy with that old cat,” I said.

“Are you doing okay?” she asked. “Those cat bites can be bad, and the mouth on that guy was as rotten as I have seen.”

“I was a little worried on Saturday morning,” I said. “But the IV antibiotics and the hot packs did the job, I guess. We will probably hear about the rabies results today. I think that cat was probably a feline leukemia cat.”

“Well, I hope it is not rabies positive, for both our sakes,” Dr. Walker said.

“So, how much do I owe you for your work?” I asked.

“How much do you owe me!” Dr. Walker said. “Are you kidding. You come all the way up to my place and stand behind our horse to do surgery, and you say, “No Charge.” You have to be kidding, you don’t owe me anything. We are colleagues, remember.”

Photo by hermaion from Pexels

One Wrong Step

D. E. Larsen, DVM

It was almost 8:30, and Debbie hadn’t come through the door yet. This was most unusual for her. I was mostly relaxed on arrival times for work unless someone took advantage of the fact. But Debbie had been working here since her senior year, and she was never late. We were concerned for her safety more than worried about her being tardy.

It was somewhat of a relief when she pulled up to the front door, another thing not allowed. But she got out of her car and reached into the back seat and pulled out a cat carrier. Her hair was not combed, and she was still in her barn clothes.

“I’m sorry, but Simba got stepped on by Dad’s horse, Rocket,” Debbie said while trying to catch her breath. “I have been all morning trying to get him into this carrier. He is still walking, but I think it is a bad injury.”

I took the carrier from Debbie and set it on the exam table. “I will get a look at him and get a set of x-rays,” I said. “You can go home and get cleaned up and relax a little. By the time you get back, I should have things figured out.”

“Thanks,” Debbie said as she opened the carrier door to give Simba a soothing pat on the head. “He is terrified and pretty painful, don’t let him bite you.”

“I will give him a little Ketamine,” I said. “That will give him some pain relief and allow us to get a set of pictures without a struggle. You hurry along now, we have a slow morning and will be able to get him taken care of without changing too much in the appointment book.”

Simba was a big cat. He was a Siamese cross, and like my Charlie cat, hunted all the time. This was an unfortunate accident. I drew up a small dose of Ketamine and gave it by IM injection. Then waited a few minutes for it to take effect. It was easy to tell when it was taking effect because the cat’s pupils would dilate completely.

When I was able to pull Simba out of the carrier, I ran my hand down his spine. It was fine until I reached his tail. Rocket must have stepped on him right at the base of his tail. His tailbone was completely depressed into the floor of his pelvis. He would probably have nerve damage to the tail and maybe to his rectum, but my primary concern was with his colon and his pelvic urethra.

We got a set of x-rays, and while they were developing, I did a rectal exam on Simba. With my finger in the colon, I could push the tail bone up into a normal position. That would need to be wired into place. I have seen some tails return to function after a few weeks or months following such an injury, but most are paralyzed. It was not worth the wait unless a client was really hung up about not taking the tail off. The colon seemed to be intact on the digital exam. We would wait to see what the x-rays said.

Debbie popped back through the front door just about the time I put the x-rays on the viewer. No fractures, only the displaced tail bone. The colon looked okay. Then the problem came into view. The bladder was lying in the ventral abdomen, with no attachment to the pelvic urethra. The tail bone had been pressed down against the pelvic floor, and it amputated the bladder from the pelvic urethra.

“Can you fix that?” Debbie asked, with some tears welling up in her eyes. She had seen enough surgery to know this would be difficult, if not impossible, repair.

“I can try,” I said. “But to be honest, it is probably not going to be something I can do. I am not even sure that Dr. Slocum could do this.”

“Taking him somewhere else is not an option,” Debbie said as a tear spilled over and ran down her cheek.

“I will open him up and take a look,” I said. “There might be another way to fix him. When cats are plugged, we sometimes need to do a perineal urethrostomy. Looking at this picture, that might not be possible. We could maybe do a prepubic urethrostomy. Just bring the bladder neck out through the abdominal wall on his posterior abdomen.”

“Would he be able to pee okay?” Debbie asked.

“That will depend on what is left on the end of his bladder,” I said. “If we were to get lucky, he could even have control of his urine. If not, he might just dribble urine all the time. But it will give him a chance at survival. We can always put him to sleep at another time if it becomes obvious that he is not going do well.”

“Okay, let’s go ahead and do what we can to save this guy,” Debbie said.

When multiple surgeries are going to be needed, the rule of thumb is to do the procedure that will do the most good first. In Simba’s case, that meant we would fix the bladder first, then worry about securing the tail bone and the amputation later. Probably, that would mean tomorrow.

With Simba under anesthesia and on the surgery table, I opened the abdomen with a posterior midline incision. Looking at the bladder, I am not sure one could have done a nicer amputation with a scalpel. It was severed right at the prostate, we could probably expect urinary control with a prepubic urethrostomy. The pelvic urethra was far enough into the pelvis that reattachment was not going to be an option.

So I brought the neck of the bladder out through the abdominal wall and made a nice stoma to prevent scar tissue closing the stoma. After closing the abdomen, we had ample time to turn Simba over and do the surgery to wire his tail bone in place, and amputate is tail.

Now it only remained to see how his bladder would work and if he could deal with peeing out his belly wall. Some animals could have a problem with urine scald with his urine soiling the skin around the stoma. But the cat is fastidious enough that we should not have that problem.

Debbie was pleased with the fact that Simba had a new lease on life. Simba recovered well and went home with Debbie that evening. When he returned in two weeks for suture removal. The stoma was healed well, and Simba was keeping himself clean.

“Does he have an awareness of where he is peeing?” I asked.

“I think he has learned already,” Debbie said. “At first, he was a little surprised when he would squat to pee, and it would come out his belly. But now, he just lowers his belly down and lets it go. He seems to have complete control. We have not noticed him leaking urine anywhere. Mom is pleased as can be. So are Simba and I.”

Simba went on to live a long life. I had worried and warned Debbie about chronic bladder infections. Still, Simba must have had enough urethral structure to prevent that problem.

Photo by Janko Ferlic from Pexels