What are the Odds

D. E. Larsen, DVM

The young heifer strained hard as I tried to explore the four feet presented at her vulva. I slid my arm into the vagina alongside the legs. I could determine that these were two front legs and two hind legs, but were they from two different calves?

“She has been straining like that all morning, Doc,” Ole said.

We are in a small barn, just out of Enumclaw. I had been out of school for a couple of months. “A complex delivery like this is not fair,” I think to myself.

“She doesn’t look big enough for this to be twins,” I said. “This has to be an abnormal calf. I am going to push it back into the uterus a little, that will allow me to explore it a little better.”

Ole did not reply, I am sure he is second-guessing his request for me to check the cow. All the Norwegians seemed to want Dr. Larsen these days.

I pushed on the feet with both hands. Slow, steady pressure was needed to push the calf back out of the birth canal. I knew there was a risk of rupturing the uterus if I was too aggressive.

Finally, the calf was out of the birth canal, and I could feel the entire calf. Confused for a moment, but then I was able to define this calf. The four feet surrounded the head, and there was somewhat of an apron of skin surrounding the feet and head. Reaching over this apron, I ran into the exposed intestines of the calf. And I could feel a severely contorted spinal column.

“Ole, this is a mess,” I said. “This is a schistosomus reflexus calf. That is a fetal monster. This calf is sort of inside out. He has an open abdomen and chest, and his back is bent backward. The good thing is he is small, I should be able to cut him into a couple of pieces and get him out.”

“That sounds pretty gruesome,” Ole said. “Have you done that before?”

“I have done a lot of fetotomies, but never on a calf like this,” I said. “This is one of those things that a veterinarian is supposed to see once in a lifetime. What are the odds of me having one this early in my career? Seems like it is not fair for me to have to deal with it in my first few months of practice.”

I am sure I can recall that a fetotomy on a schistosomus reflexus calf was supposed to be complicated. It probably depends on the cow and the calf and the situation. This proved easy, I dropped an OB chain over the back of the calf and was able to pull it up between all the legs and pull the OB wire around the calf. With a fetotome, I was able to saw the calf into two pieces in short order. With a little luck, this one cut also severed the head. I was able to extract the three sections with hand traction.

“That looked awful easy,” Ole said. “I thought you said it was going to be a mess.”

“I think we got a little lucky,” I said. “She is a small heifer, it was a small calf, and only one cut was necessary. It could have been a lot worse.”

“It could have been a lot worse,” I thought to myself. Here I am, some thirty years later, and it is a lot worse.

I stand on my tip-toes to reach a little deeper into the cow. When I reach a little deeper, I find intestines. This is a large cow in a muddy pasture, and it is going to be dark soon. This has to be a schistosomus reflexus, but the fetus is not fully reflexed. This would be an impossible fetotomy, even for me when I was a young man. This is going to be a C-section, and it will be best to be done over at the vet school, where there will be more than one set of hands.

“George, this is a mess,” I said. “She has an abnormal calf in her. It is called a schistosomus reflexus. The calf sort of bends in two, backward, and the belly and chest are open. This one does not feel like it is fully bent backward, it feels sort of spread out flat. I am not confident that I can get it out. The best option would be to take her over to college and let them do it.”

Convinced that I am done working on the cow, I clean up as George and Sharon discuss the referral option.

“Okay,” George says. “Let’s go ahead and take her over there.” 

“Let me give them a call and make sure they will be waiting for you,” I said.

We called and made the arrangements, and George and Sharon loaded the cow up in their stock trailer and headed for Corvallis.

The school concurred with my diagnosis and elected to do a C-section. They used general anesthesia, which is risky in cows that have not been held off of food and water for an adequate time.

They were successful in getting the abnormal fetus out. George described the calf as a spider calf, one heck of a looking thing. 

Unfortunately, the cow died during the night. I never got any paperwork on the referral, probably because the referral was done on an emergency basis, and no paperwork was involved. My guess was that it was a death associated with the anesthesia. Still, I am sure the surgery would have been a difficult one. So, who knows. 

This was one of those cases where a lot of work was done, and a lot of expense was incurred, and there was no happy ending. 

With two, once in a lifetime events, I figured I was done with these schistosomus reflexus calves. I mean, what are the odds of having three.

Then, a couple of months later, came a late-night call to look at a cow for Alex and Debbie. A large Black Angus cow was in labor and some distress with no progress. When I arrived, she was laid out flat and straining, with no evidence of any progress.

“She has been like this for the last hour, maybe a little longer, Doc,” Debbie said. 

I cleaned her up and got down behind her. Actually, for these large cows, the exam is easier when they were laid out flat. More manageable, for the exam, but it can be a little difficult to keep oneself clean and dry. Thankfully, I had a good pair of rain bibs, and she was on a good bed of straw.

It did not take long to make a diagnosis. It had only been a couple of short months since I had worked on George’s cow. The calf in this cow was close to the same, but it was fully relaxed with four feet presented to the birth canal.

“This is not good, Debbie,” I said. “This is a fetal monster. In a large cow like this, it will be difficult to section it enough to get it out. The better option would be to go to the vet school for surgery.”

“How much is that going to cost?” Alex asked. 

“I sent a cow over there a couple of months ago for the same problem,” I said. “I don’t know what the bill totaled to finally, but it was over a couple of thousand dollars, I think. And the cow died.”

“We are going to have to think about that,” Debbie said. “This is a purebred, but she is nothing special. Actually, she is not much more than a commercial cow. I don’t think a thousand dollars pencils out for her.”

“Do you think we could make hamburger out of her, Doc?” Alex asked.

“You could eat her if you were starving,” I said. “But now, I think you would find the meat unacceptable. She is under a tremendous amount of stress, and this uterus is probably infected by now. If we are not going to try to save her, we should put her out of her misery now.”

That was the decision that was made. In the end, the feelings for the cow, and relieving her pain and distress became more critical than salvaging a few dollars. Their son ran to the house and returned with a 9mm pistol.

“How do we do this?” the son asked. “Shot her between the eyes?”

“The likely hood of missing her brain is high if you shoot her between the eyes,” I said. “If you are going to shoot her there, you want to use a large caliber rifle. With this pistol, you want to shoot her behind her poll, on the back of the head. That way, if you are on the midline, you can’t miss the brain.”

With that instruction, it was done. It was probably the best outcome for the circumstances. It was definitely the best financial decision. Sometimes in food animal medicine, one has to cut your losses. What may be the best medical decision is not always the best financial decision.

Photo Credit: Photo by Chelsea Cook from Pexels

Schistosomus reflexus links (These may not be pleasant to view for some people):

https://medcraveonline.com/JDVAR/images/JDVAR-02-00045-g006&7.png

https://inpractice.bmj.com/content/inpract/14/4/204.full.pdf

https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1751-0813.1996.tb09988.x

My First Ellwood

D. E. Larsen, DVM

The pup tried to lift his head as he laid on the exam table, but he just didn’t have the strength to accomplish the feat. He let it settle back to the towel on the stainless steel tabletop, resigned to his fate, whatever that may be.

“I don’t know anything about him, Doc,” Paul said. “I was working on the house I am building in Liberty,  he walked out of the brush and collapsed at my feet. I guessed that meant it was up to me to try and save him. I am just happy that you can look at him on a Sunday afternoon.”

Cachexia was one of those words I was forced to learn in vet school. Dr. Kainer, the freshman nemesis, seldom remarked about the words he heaped upon us. Still, he had indicated that we would rarely need to use cachexia in our records. If anything described the condition of this pup, it was cachexia. He was literally skin and bones, and completely out of strength. He was looking for a place to die, or maybe hoping for a miracle.

“Just off the cuff, my guess is his chances are slim to none,” I said. “We will spend a little money to figure out what is wrong with him unless we get lucky. And then treatment is going to be more expense.”

“I have an extra hundred dollars in my pocket today, Doc,” Paul said. “If that will buy him a new start, that would be great. If not, at least we tried.”

This was something I learned early when I came to Sweet Home in the middle 1970s. If you can save them for a hundred dollars, they will do it. If it was going to much over that, there would be careful consideration of the options.

I opened the pup’s mouth, it was almost dry, the saliva was white and mucus-like. This was from extreme dehydration. His tonsils stood out like bright red grapes hanging in the back of his throat. 

As I ran my hands over his body, I could feel every bone. He was like a skeleton covered with skin. He weighed 12 pounds, and as a young mixed pup, he should be over 40 pounds. Every lymph node was enlarged, noticeable enough that I didn’t have to palpate them. His abdomen was empty but gurgled with my palpation. The mercury in the rectal thermometer was just a little over 95, quite low for a July afternoon. A drop of liquid stool hung on the thermometer when it was removed from his rectum. I carefully transferred that drop to a microscope slide.

“I will take a second to look at this under the microscope,” I said to Paul. “If you would, make sure he doesn’t jump off the table.”

“Surely you jest,” Paul said.

I mixed the small sample with a couple drops of floatation solution and put a coverslip on the slide. Under the microscope, a diagnosis was confirmed with just one glance. Nanophyetus salmincola eggs covered the field. This pup had Salmon Poisoning.

“Paul, this pup has a very advanced case of salmon poisoning,” I said. “Actually, I have never seen a case this advanced. Most dogs are dead before they get this bad. I don’t know if we can help him, my guess is we will be throwing your money down the drain.”

“I said a short time ago, I have a hundred dollars to put into him,” Paul said. “You haven’t had to do any fancy blood testing to find out his problem, lets put the rest of it into some medication and see how he does.”

“Okay, we can wing it from here,” I said. “Ideally, we should check to see how his liver and kidney function is doing, but I will put him on an IV, run some fluids, and give him a couple of miracle drugs. We will see what morning brings.”

Working on this unnamed pup by myself was no problem. He did not move a muscle, not even a flinch when I inserted a catheter in his vein. I started a bottle of fluids at a slow drip. Then I gave a dose of Oxytetracycline as a slow IV injection. 

I drew on the experience of a couple of the men whose shoulders I stood upon. Doctor Annes at Colorado State always said that no patient should die without the benefits of steroids. And Doctor Haug from Myrtle Point always treated his salmon poisoning patients with Oxytetracycline and an equal volume of Dexamethasone. I usually gave a small dose of Dexamethasone on the initial treatment for salmon disease. Still, looking at this guy, he could probably benefit from Doctor Haug’s larger dose. I gave the larger dose of Dexamethasone as a slow IV injection.

Scratching his head, I wished him luck and turned to fill out the records. “Name of Pet” jumped out at me from the top of the paper. 

“So, guy, what are we going to call you,” I asked the pup. He sort of raised one eyelid, the first real response I had seen from him. I pondered the name.

“I think you might make a pretty good Ellwood, At least for the next few hours,” I said. “But, I am telling you, Ellwood, you had better get well quick. The ticket is for a short ride. I will be back and check on you after dinner.”

Anyone who has been around salmon poisoning knows that the odor of the diarrhea is most offensive. I have had clients tell of waking at 3:00 in the morning after their dog has had an explosive event in the hallway. Everyone in the house wakes up with a headache from the odor. The same thing can happen in the veterinary clinic, especially in a patient who is so dehydrated that their diarrhea has stopped. When they get some fluids, an explosive event often follows.

After dinner, I was a little apprehensive about opening the clinic door. I hoped I would not be greeted with a clinic filled with a salmon poisoning dog’s pungent odor. No odor, that was good. Now all I needed was for Ellwood to still be alive.

Much to my surprise, Ellwood was up, resting on his sternum with his head up and watching for me as I came through the kennel room door. He was a completely different pup.

“Will, I’ll be, Ellwood, you might just live after all,” I said as I looked him over. “You are so thin, I wonder if you would eat a bite.”

Because salmon poisoning dogs lose their appetite early in the course of the disease. Many will not eat for several days after treatment is started. And there is often some residual vomiting if food is given too soon. But I opened a can of mild intestinal diet food and placed a spoonful between Ellwood’s paws. It disappeared so fast that I almost questioned myself about if I really put it there.

“Wow, one more spoonful tonight, then we will give you more in the morning it this stays down,” I said. I thought I saw a slight wag of the end of Ellwood’s tail as I placed the second spoonful between his paws. Again it was gone in an instant.

In the morning, the bottle of fluids was empty, and Ellwood was standing up, and wagging is tail. I could almost say he was bright and alert.

“You are a sight, Ellwood,” I said. “How can you stand with those muscles of yours?”

I placed several spoonfuls of the canned food in a small bowl. Ellwood wolfed it down and wagged his tail. I put a small pan of water in the kennel, Ellwood lapped it up in short order.

“I think you’re well, Ellwood,” I said. “Never in my wildest dreams would I expect it today, especially on your budget.”

When Paul arrived at the clinic later in the morning, I think he was worried if he was going to have to dispose of the body or if we would do that for him. He was pleasantly surprised to see Ellwood up and wagging his tail.

“I think he had survived the disease,” I said. “He just needed some fluid replacement and drugs. I think you have a new pup.”

“I didn’t expect him to be alive.  I was thinking I was going to have to dig a hole for him,” Paul said. “Do you think he is going to be okay.”

“I am not sure my opinion means much concerning Ellwood,” I said. “I didn’t expect him to live through the afternoon yesterday.”

“Where did you find his name?” Paul asked. “I looked for a tag, and I couldn’t find one.”

“That is just a name that I thought would fit him,” I said. “He is sort of a fighter, a little like an Ellwood I know.”

We fixed Paul up with a special diet, medication, and instructions for the next week. He stood at the counter, with Ellwood on a leash, while I finished calculating the bill. 

Paul noticed my diploma on the wall behind the counter and held his hand out to shake. “Good job, thanks, Ellwood.”

Photo Credit: Photo by Magda Ehlers from Pexels

Salmon Poisoning Link: https://en.wikipedia.org/wiki/Nanophyetus_salmincola

Fetotomy on Whiskey Butte

D. E. Larsen, DVM

Jack had called first thing in the morning. He had a wild little heifer with a calf half hanging out of her. His directions sent me over the top of Whiskey Butte into some country I had not been through before. By the time I made the turn to his place, I was close to Cascadia. It would have been quicker to have come up the river on the highway.

Jack was talking from the moment I stepped out of the truck. He wanted me to know he could take care of this if he wasn’t so damn old. He also wanted me to know that he didn’t think much of that last vet he had out here from Albany.

“That guy was afraid of cows,” Jack said. “He didn’t even look at her, just handed me a little medicine and told me to give her a shot. Charged me forty dollars for nothing. Why I would shoot her before I called that guy again.”

We stood at the edge of the corral, and I flinched as the heifer charged the fence. Jack was watching me with a wary eye. It didn’t look like we were going to get much accomplished standing here watching her. I started over the fence with my lariat in hand. Jack stood by, watching, with a sly smile on his face.

Jack was a big man, standing well over six feet and weighing close to three hundred pounds.  His large belly would shake when he laughed. Jack had a large pointed nose and thinning grey hair topped his weathered face.

“I have a squeeze chute, but it is at the corral in the lower meadow,” Jack said, in a voice that matched his size.

I swatted the heifer on the nose with the lariat as she charged the fence as I was climbing down. That changed her attitude enough to allow me to get on the ground and throw a quick loop over her head. I took a wrap around the nearest post and slid out to the end of the rope. I snubbed her close to the post. Jack was watching open-mouthed as I reached through the fence for the second rope. I put the second rope on the heifer with a loop across her nose to fashion a halter. She was already choking herself on the rope around her neck. I tied her with the second rope giving her ample slack if she needed to lay dow. Then I released the tension on the first rope.

With her safely tied, I jumped back across the fence for my equipment.

“My God, where did you learn to handle cows like that, Doc?” Jack gasps as I hauled my OB bag and bucket over the fence.

“It just comes from growing up around them,” I said. “I get surprised by one every once in a while, but most of the time, I know what they are going to do before they do it.”

This heifer had a dead calf hanging halfway out of her. She was actually in pretty good shape, considering this calf had been hip locked for most of the morning.

“What are you going to do, just yard it the rest of the way out?” Jack asked as I started cleaning up the heifer. “I used to just hook on to em with a tractor and pull em out,” Jack continued. “If that’s the only thing you can do, I know some of em never get up again.”

“No, Jack. This calf is long since dead, there is no sense making it any harder on her than necessary. We are going to do this the easy way,” I explained.

Jack is quiet, thoughtful, rubbing his chin as he ponders what I am up to.

“So what are you figuring to do, Doc?” Jack finally asked as I begin assembling the fetatome.

“This rig here, that looks like a little Trombone is a fetatome. I am going to use it to cut this dead calf into several pieces so we can get it out of there without damage to the heifer,” I explain.

Jack is quiet, but quite watchful now. I thread a length of OB wire through the tubes of the fetotome, leaving a large loop hanging from the front end of the fetatome. I worked the loop over the head the feet of the dead calf and worked it down to the mid-abdomen. 

I ran the fetatome along the side of the calf to the leading edge of the hip bones. Then I hooked the T handle on the side of the fetatome to the chains on the front feet. This would hold the end of the fetotome in position as I made the right angle cut through the calf’s body.

Jack’s son Gene arrived just in time to lend a hand with the sawing.

“This will work a lot better if you can give me a hand with the saw as I hold the fetotome in position,” I say to Gene as I encourage him to climb into the corral.

After getting everything in position, I clamp the handles on the OB wire and instruct Gene on how to saw with long, slow, but strong strokes.

Holding the end of the fetotome against the calf’s hip to stabilize it, Gene starts sawing with the OB wire. The heifer has been pretty still through all of this. Concentrating on pulling against the rope tying her to the fence. The OB wire makes a rapid cut through the calf, and the front part of the body falls out of the heifer in short order. Gene is not prepared for that event and drops the handles as he moves to the far corner of the corral.

“Don’t take off on me now,” I kid Gene. “The real mess is still to come. We still have to the hips out,” I explain.

“I’m O.K,” Gene replies.

Jack snickers, enjoying the whole scene.

“I’m still not sure how you’re going to get the butt out,” Jack says. 

“Well, I’m going to split the thing in two, Jack, and it will slide right out,” I explain as I tie the OB wire to a long OB chain. I had the chain in a bunch in my left hand, and I reach in passing my hand over the rump of the calf. My arm is into the heifer to my armpit. I drop the chain over the back of the calf, reach along the belly between the hind legs, fishing for the chain. Finally, my fingers find it. I retrieve it pulling it out between the calf’s legs. I pull the chain out with the trailing OB wire around the rear end of the calf. I quickly thread the fetotome and position the front end of it against the severed end of the calf’s backbone.

“O.K. Gene, here we go again!” I say.

Gene begins sawing as I hold the fetotome. This is a difficult cut, cutting through a lot more bone. But the bone is soft, and after a brief rest by Gene, the OB wire slides through the last of the fetal pelvis. I removed the fetotome, reached in with my left hand, and pulled out one leg and half of the pelvis. When I pulled the second half out, the fetal membranes followed with a gush.

“I’ll be damned,” Jack said, shaking his head. “I been around cows my whole life, I’ve heard about this kind of stuff, but I never seen it before.”

I cleaned the heifer up and placed 5 grams of Tetracycline powder into her uterus. Then I gave her a dose of extended-release sulfa boluses. I knew that when we turned her loose, it would be some time before she let anybody on this ranch catch her.

“She should be fine,” I told Jack as I turned her loose. “You might want to send her down the road, Jack. She won’t provide you any production for another year.”

“Aw, she’s a big heifer, she’ll be fine next year,” Jack said.

From that day on, Jack would always tell everyone within earshot about my ability to handle cows and how I cut that dead calf out of that heifer, not hurting her a bit in the process. He always spoke in a loud voice and seemed unaware of who might hear him. He proved to be one of my best advertisers, often calling to me in his loud distinctive voice across crowded restaurants or meeting halls.

It never failed; right after the greeting, he would start explaining to anybody close to him.

“Best damm vet I ever did see. I tell you what, you should see him handle a cow. I had the wildest cow ever trying to have a calf, and he just crawled down into that corral and roped and tied her just like that,” he would say, snapping his fingers. And in a voice about as loud as the greeting.