Don’t Give that Injection

D. E. Larsen, DVM

I looked at the clock, 5:30 in the morning. I have no idea how long the phone has been ringing. I roll over and stretch to lift the receiver.

“Good morning,” I say.

There is an old lady on the line, she sounds frantic, it takes me a couple of minutes to collect my thoughts. I finally sit on the edge of the bed.

“I’m sorry, it is early, and I didn’t catch much of what you said,” I said.

“This is Opal,” the lady said. “I live in Albany and go to a veterinary clinic here. Julie works at this clinic, but she takes her animals to you. Mucho has diabetes, and the doctor here has been having trouble getting him stabilized on a dose of insulin. Julie told me yesterday that this doctor didn’t know what he was doing and that I needed to get Mucho in to see you.”

“I know Julie,” I said. “I am a little surprised that she would suggest that to you.”

“She said the Mucho will die if I don’t get him in to see you right away,” Opal said. “He has been having little seizures all night long. And I am supposed to give him another injection at 6:30.”

“I could probably see Mucho if you have at the clinic at 8:00 this morning,” I said. “But if you are going to bring him to see me, you do not give that injection this morning.”

“But those are the instructions that I have from my doctor here,” Opal said.

“This is what I am telling you, Opal, if you give that injection, I will not see Mucho,” I said. “If you give that injection, you go to see your doctor this morning. And if Mucho has been having seizures all night, you probably better call him before you give that injection.”

“Okay, I will not give the injection, and we will be at your clinic at 8:00,” Opal said. 

“Do you know where we are located?” I asked.

“Yes, Julie gave me directions,” Opal said. 

“Okay, I am going to try to get an hour of sleep, I will see you and Mucho at 8:00.”

Julie was a good client, and we had talked about her situation several times. She knew that she could get her veterinary services at much-reduced fees at the clinic in Albany, but just preferred coming to me. I am sure that she would lose her job if her clinic knew she was actively sending clients to my clinic.

Opal and Bill were waiting in front of the clinic when I arrived at 7:45. They were an older couple in their mid-70s. They were both short and slightly built, some would call them trim. Bill’s hair was thin on top and gray in color, and he had a well-trimmed mustache. Opal’s hair was white. Opal was the commander of the group, Bill followed and carried things.

Mucho was a white poodle, immaculately groomed without a hair out of place. He looked older and somewhat heavier than he should be, but I would stop short of calling him obese.

“Good morning, Doctor,” Opal said as I unlocked the door.

I held the door open as Opal and Mucho entered. Bill took hold of the door and motioned me to go ahead of him.

“It is going to take a few minutes for everyone to get here and set up to see you,” I said. “You can make yourself comfortable, and we will get you looked at as soon as possible. Do you have any records?”

I knew that was a mistake as soon as I said it. Opal pulled out a folder that was an inch thick.

“These are my records,” Opal said. “I didn’t want to ask our doctor for records because I didn’t know if Julie would get in trouble or not.”

I took the folder from Opal. “I will glance through these while we are waiting for the rest of the staff to arrive.”

At about the same time, Ruth came through the door, and Mucho stiffened in Opal’s arms and pull his head back, and then started twitching.

“On second thought, maybe we should take Mucho and get a look at him immediately,” I said.

“He has been doing this for most of the night,” Opal said.

We got Mucho into an exam room and collected a blood sample for a blood glucose level. The test would take a little time.  While we were waiting for the test result, we got an IV catheter in place and started a slow drip of D5W. I was sure that his glucose level was going to be quite low.

Just how low was the question, his blood glucose was 42. Had Opal given the prescribed dose of insulin at 6:30, Mucho would have never made it to Sweet Home.

Talk about an instant cure, with a small dose of 50% glucose, Mucho was up, and wagging is tail.

“That is amazing, Doctor,” Opal said. “What did you give him?”

“I just gave him a little glucose,” I replied. “You see, the insulin dose you have been giving has been too large. It just kept making his blood glucose a little lower each day, then finally, it is too low. So we have to do a couple of things. Number 1, we need to get him through today. And then, number 2, we need to start him back on a low dose of insulin and adjust it slowly every couple of days until we get him where we want his blood level.”

“How will we keep this from happening again?” Opal asked.

“I will do things a little different than your doctor in Albany,” I said. “I go slow, making sure his diet is the same every day, and adjust his insulin dose, so his symptoms are relieved. That means we will adjust his glucose to a level that you and Mucho can live with, not what some book says it should be.”

“That sounds a little complicated,” Opal said. “I want you to know, I won’t leave Mucho here. We will have to do this at home.”

“Except for today, that should be no problem,” I said. “It might mean that you will need to travel back a forth every couple of days, but we can do most of this as an outpatient.”

“You said, except for today,” Opal said.

“We need to keep Mucho for a couple of hours anyway,” I said. “Just to make sure he is not going to have a seizure on your way home. We need to know that he is out from under the insulin dose from last night. You guys could probably go eat breakfast. If you eat slowly and talk to each other a little, that would probably be long enough.”

And so it began. Opal and Mucho were nearly constant clients for a time. That first day went well, and we let Mucho go home without any insulin for a couple of days so we could get a fresh start on stabilizing his dose.

Mucho did prove to be quite a challenge. We ended up having to use a split dose of Regular Insulin and NPH Insulin.  He did very well for many years, giving his insulin every 12 hours, and eliminating all the little goodies from his diet pretty much did the trick.

This entire time, I worried about Julie’s job status. If Opal’s previous veterinarian knew she had sent Opal over here, he would not be happy. The problem was solved in a couple of months when Julie informed me that they had purchased a small farm in upstate New York and would be moving shortly. Things just worked out fine.

Photo Credit: Photo by Goochie Poochie Grooming from Pexels

Wild Horses

D. E. Larsen, DVM

Standing at the corral fence, we were looking at the ugliest horse that I had ever seen. She was an older roan mare that my father-in-law, Jim Leibelt, had just adopted from the Bureau of Land Management Wild Horse Adoption Center in Burns.

She looked like she had just stepped off a Spanish galleon, a real mustang in every sense of the word. Her massive head dominated her features. It made her appear unbalanced, almost like a trout living in a stream with little or no food source. Long hair hung from her lower jaw, making her head look larger than it was. Her hooves were large and splayed out from a lifetime on the open range. Her ribs were countable, indicating that grass on that range was sparse.

She paced up and down the far fence of the corral, uneasy with our presence. Her experiences with people had likely been unpleasant. She would rest her head on the upper rail at times as if she was trying to gauge the height. Just in case she needs to jump out.

“Are you sure want to pregnancy check her, Jim? I asked.

“I would like know, just so we can make some plans for taking care of a foal,” Jim said.

“How do you think we are going to do that without getting killed?” I asked. “I don’t think I am going to be interested in standing behind her.”

“I figure we can run her in the chute,” Jim said.

“I am not much of a horse doctor, but I don’t think that would be a good idea,” I said. “She would tear herself up in there.”

“The other option is to run her into the crowding alley and throw a rope on her, and you can check her reaching over the fence,” Jim said.

“We can try it that way,” I said. “We might get lucky.”

Jim opened the gate into the alley, and she ran right in when he started over the fence on the far side of the corral. He closed the gate, and we pushed her up the alley toward the squeeze chute. Jim lassoed her and tied the rope to a post at the end of the alley.

All hell broke loose. When the mare realized she was tied, she fought the rope for all she was worth. She pulled back, throwing her feet in all directions. Her front hooves seemed to reach the top rail of the alley. This fight went on for a surprisingly long time before she choked herself enough to settle down.

The walkway on the outside of the alley fence allowed me easy access to her. The major problem was it was on her left side with her head to my left. That meant that I would have to check her with my right hand. I was almost blind with my right hand rectally. That was sort of a funny thing. I trained myself to do rectal exams with my left hand, leaving my right free for any other tasks that may be needed. I could almost see with my fingertips of my left hand, not so with my right hand.

With a lubed plastic sleeve on my right hand, I took a deep breath and leaned over the upper rail. The old mare had decided that she caught; she did not move as I inserted my hand into her rectum. I advanced my arm, halfway to my elbow my hand bumped right into a foal. Pregnant for sure, I swept my hand over the fetal head and feet. I would guess close to 6 months. Good enough for family work.

“Jim, she is about six months pregnant,” I said as I pulled my arm out and stood up, thankful for being in one piece. “That is a rough estimate, but pregnant for sure. Now we just have to get that rope off her.”

I had never been more thankful for a quick-release honda. Getting this rope off this mare without a quick-release would be difficult if not dangerous. I grabbed the short leather thong on the quick-release and gave it a good pull. Then I quickly ducked as the rope flew when the mare threw her head up and quickly backed out of the alley. 

I was thankful that it was over. It was a little sad that she was not the only wild horse I would have to deal with in those early years. When BLM started adopting the wild horses gathered from the Eastern Oregon rangelands, it seemed everyone wanted a free horse.

***

I slowed the truck to a crawl as I made a couple of the sharp corners on Old Holley Road. I looked carefully for the driveway to the place on the corner. They had called to have a horse castrated.

A small group of people was in the pasture behind the barn, standing and talking while watching me pull my truck into the pasture. 

“Is this where I am supposed to geld a horse?” I asked after I rolled down my window.

“Yes, this is the place, Doc,” Ed said.

“Where is the horse?” I asked.

“He is in the shed there,” Ed said, pointing to a small shed behind the barn.

“Well, let’s get him out here, this pasture looks like a good spot to do the surgery,” I said.

“Can’t do that, Doc,” Ed said. “He is sort of wild. I don’t think he has ever had a hand laid on him. We don’t have any facilities for handling a wild horse. We just offloaded him into that shed, and that has been his home for the last few days.”

Great, I thought, now I get the rest of the story. I don’t know what they expect me to do with a wild horse, free in a pen, and has never been touched by man.

I entered the shed, there was a large gray stallion, cautiously eating hay out of the feed rack. He glanced at me but did not seem concerned at my presence. My guess was he had been around people at some point in his life. Many wild horses on the range have gone wild from some of the ranches in the area.

Just the week before this call, I had read an article in Veterinary Medicine, a minor professional journal. This article was about sedating a horse in this circumstance. They suggested using a full ten cc of Acepromazine, a popular tranquilizer, in a syringe, squirted into the mouth of the horse. There would be rapid absorption through the oral mucus membranes, plus whatever he swallowed. It just might be the ticket with this guy.

Ed came over to the truck when I returned for my rope and a syringe full of Acepromazine.

“What do you think, Doc?” Ed asked. “Are you going to be able to handle this guy?”

“My first thought was just to leave,” I said. “You need to be a little more forthcoming with information when you schedule an appointment. But I do have a trick to try on this guy. If it works, we can maybe get the job done. If it doesn’t, you are on your own.”

I returned to the shed and offered the stallion a handful of grain. He quickly nibbled at it and nuzzled my hand for more.

“You know what grain is and where it comes from,” I said to the horse who was still nuzzling my hand. 

I took another handful of grain and held out my hand for him, making him stretch his head through the feed rack to reach the grain. As he ate, I slipped the syringe into the corner of his mouth. He did not object. Then with a hard push, I shot the full dose into his mouth. He reared and pulled his head out of the feed rack, getting a good gash on the top of his head.

The reaction was rapid. Within a minute, his head was starting to hang down. Giving him a little more time for the Ace to work, I returned to the truck and got everything ready to anesthetize him and do the surgery.

Then I threw a rope around his neck and led a staggering horse out into the pasture.

Surgery was a breeze. Less than 2 grams of Pentathol was needed to put him under anesthesia. I laid him on his right side and pulled his left leg out of the way with a sideline. He was 4 or 5 years old, and his testicles needed a strong pull to break the cremaster muscles, but other than that, it was a standard castration. I removed the bottom of the scrotum and stretched the incision to allow for adequate drainage. Then I gave an injection of long-acting penicillin and his Tetanus vaccination. I didn’t want any complications with this guy.

“Doc, how would you recommend we tame this guy down?” Ed asked as we waited for him to recover. 

“I would get a halter on him and a long chain to a heavy tire or something he can drag around the pasture for a few days,” I said. “This guy is not completely wild. He knows what grain is, and with a little work, he will tame right down. If you work with him several times a day, you will have him tamed down quickly. Then you can figure out which one of you are going to try to ride him.”

That proved to be adequate advice. The horse was dragging the wheel around the pasture for a week or two, and then Ed had him eating out of his hand. He became an excellent horse for them.

Photo Credit: Photo by Rodolfo Quirós from Pexels

A Kitten’s Tale

D. E. Larsen, DVM

I noticed her sitting in the far corner of the reception area, patiently waiting for the crowd to clear. She was an older lady with white hair. She was short and petite, and well dressed for Sweet Home. She was tanned to a rough brown, and her face and hands showed the wrinkles that came from years of outside work.

My curiosity was getting to me. I stayed up front to see what she was going to want.

“Ma’am, is there something that I can help you with?” I asked.

She approached the counter with slow, measured steps.

“Are you Dr. Larsen?” she asked. “I have heard a lot about you from my friends. I am June. I have a small place up on 43rd. My husband has been gone for several years now. It is just my cats and me now.”

“Yes, I am Dr. Larsen,” I said. “I hope that your friends said good things about me.”

“Oh yes, Doctor, you are well thought of by most people in town,” she said.

“So, what is it that brings you to see us today?” I asked.

“If I had a kitten that needed its tail removed, is that something you could do?” she asked.

“Yes, we do just about anything here,” I said. “What happened to the kittens tail?”

Ignoring my last question, she continued. “And how much would such a procedure cost?”

That depends on how large the kitten is and if the tail problem needs any additional treatment,” I said. “If it is infected, there might be charges to take care of that infection. That is something I could give you a close estimate for when I look at the tail.”

“I mean, if there is nothing wrong with the tail, how much would it cost for a 3 day-old kitten?” she asked.

“You’re asking about docking a kitten’s tail?” I said. “That is not something that is done in most cases.”

“You dock puppies tails,” she said in a matter of fact voice. “There can’t be much difference, most of those pups have no real reason to have their tails docked.”

“You make a good point,” I said. “Some breeds need their tails docked, others it is purely cosmetic, or for some breed standard. If you have ever lived with a Cocker Spaniel in a Western Oregon winter, you would understand why we dock some tails.”

“I don’t see a difference,” June said. “I have a litter of kittens, five of them, that I would like to have their tails docked.”

“I would have to think about that one,” I said. “You are asking me to stretch my ethics a little.”

“Now listen, young man,” June said in a stern voice. I wondered if she had been a school teacher in her day. “There are not many options for these kittens. Placing kittens in homes is difficult these days. All my cats are fixed, but this little mamma cat shows up and has this litter of kittens in my woodshed. I can leave them there and let them grow up wild. They will probably die from distemper next year that way. Or I can find them homes. If a kitten doesn’t have a tail, it is easy to find them a home. I never call them Manx, I just say they don’t tails. My husband used to cut off the tails with his pocket knife. Now I need you to help these poor little kittens find homes.”

“What do you tell folks when they try to breed these kittens, expecting to get kittens without tails?” I ask.

“That only happened once,” June said. “Most people have them fixed like I recommend. That one time, I just said, what do you think I am, some sort of a geneticist. That word shuts up most folks around these parts.”

“You win the argument about the ethics of tail docking,” I said. “I am not comfortable with you deceiving people about what kind of cat they are getting.”

“So you would rather I got the neighbor boy to put them in a gunny sack and drop them in the river?” June said.

“Okay, I will dock the tails for you if you get it scheduled before they are 5 days old,” I said. “But, if any of these kittens end up here for their shots or to be fixed, I will not be a part of your deception. If asked, I will tell the truth.”

“I see, you would rather have them search for a real Manx kitten,” June said. “Half of which will have bowel and rectal problems for their entire life. Many of those will not reach adulthood. My kittens save a lot of little girls a lot of heartaches.”

“Your husband must not have won many arguments,” I said.

June had the kittens in the next morning. The procedure was brief, I prepped the tail, snipped the tails with scissors and closed the wound with a drop of Nexiban surgical adhesive. The kittens were asleep before they left the office.

I didn’t charge June. I felt her intentions were sincere. In those years, I donated a lot of services to the humane society. June was serving in the same capacity. I only hoped that the humane society didn’t get wind of her philosophies. 

Photo by Pixabay from Pexels