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

The Taint That Ain’t

D. E. Larsen, DVM

It was 12:30 on Thursday, and we were mostly closed. Thursday afternoon was reserved for golf. But the phone kept ringing, Sandy had stepped into the back, and I was tempted to not answer. But duty calls.

“Good afternoon, this is Doctor Larsen,” I say as I picked up the receiver.

“Oh, Doctor Larsen, I am so happy I caught you,” the lady said. “I know you close early on Thursday.”

I recognized the voice. It was one of the sisters who lived on a small farm not far out of Sweet Home. They were older, maybe spinsters, but I did not know much about them. They were Edith and Elsie, it was almost impossible to tell apart in person. On the phone, I had no chance of knowing which sister I was talking to. Most of the time, their emergencies were minor problems or no problem at all.

“Yes, we are closed, I was just about to switch the phone over to the answering service,” I said. “Is there something I could help you with briefly.”

“This is Edith, I know that you probably have a golf game scheduled this afternoon,” Edith said. “But we were feeding our pig just now and noticed that he has some large swellings on his rear end. He doesn’t act sick, but if he has a large abscess, I would hate to have to leave it for another day.”

“Tell me about this pig,” I said. “How old and how big is he?”

“He is young, I think we got him in February as a weaner pig,” Edith said. “He is growing fast. He is getting big enough that we are going to have him slaughtered sometime in October.”

“Has he been castrated?” I asked.

“Castrated, will I guess. Don’t they usually do that to weaner pigs?” Edith said.

“Just where on the rear end are these swellings?” I asked. I was convinced now that they had just noticed the testicles on this pig.

“They on just below his butt, they are just bulging out,” Edith said. “They can’t be normal, Doctor. We would really like you to check them.”

“It sounds to me like you are looking at his testicles,” I said.

There was a long pause on the phone. Then I could hear the sisters talking to each other.

“He thinks they are testicles,” Edith says. 

“Testicles?” Elsie says. “I don’t think they could possibly be testicles. They are way too large.”

Now I remembered, Edith always did the phone calls and most of the talking. Elsie just seemed to disagree with everything that was said.

“Doctor, we don’t think they could be testicles,” Edith says into the phone. “These swellings are larger than a grapefruit. Each one of them.”

This discussion was going nowhere fast. And it was not going to be resolved over the phone.

“I’ll tell what,” I said. “I will be going right by your place on my way to the golf course. I will stop and just get a look at this pig. If it looks like something that won’t wait until tomorrow, I will stop by on my home and take care of it tonight.”

“Thank you, Doctor,” Edith says. “We were hoping you could get a look at him.”

“You be ready, I am leaving here shortly, and I won’t have much time,” I said. “I am just going to glance at him for now.”

“We will be waiting for you,” Edith said. “He is in a small pen, so it won’t be any problem looking at him.”

I pulled into the driveway, and both sisters were waiting for me. It was just a short walk to pigpen out beside the small barn. The thought occurred to me that I might not be acceptable on the golf course if I got splattered with pig manure, but I didn’t have time to put on coveralls and boots just to glance over the fence.

I could see the pig through the slats in the fence of the pigpen as we approached. This was a good looking young pig, probably over 200 pounds. He had a long body and black and white in color.

I approach the pen so I could get a good look at the rear end of this pig. One glance and I stepped away. 

“Those swellings are testicles,” I said.

“But Doctor, they are so large,” Elsie said. “Are you certain, I mean, I have seen lots of testicles but nothing like these?”

“I didn’t make the design, that is just way pigs are put together,” I said. “I am certain, and I have seen a few testicles also. Now you probably have a couple of choices to make with this guy.”

“What do you mean by choices?” Edith said.

“When pigs are not castrated, their testicles will produce products that can flavor the meat when they reach sexual maturity. This guy is close to market weight but has obviously gone through puberty. You may be okay if you slaughter him now rather than waiting until fall. Otherwise, castrating him now would be a good idea.”

“What do you mean when you say flavor the meat?” Elsie asked.

“It is called boar taint,” I said. “It is in the fat, and in bad cases, it will run you out of the house when you put sausage in the frying pan. Some people say it tastes like piss. It probably occurs in 20 to 30 percent of boars slaughtered. The larger he gets, the more the chances that his meat will be tainted.”

“We were hoping to get him bigger,” Edith said. “I mean, he is growing so well.”

“It might be a good idea to talk with the place you are going to have him slaughtered,” I said. “Some of those places won’t even consider hanging a boar in their cooler.”

“A boar, I have been told you can’t eat a boar,” Elsie asked. “When do you start calling him a boar?”

“I would say about when those testicles start hanging there, so they are noticed. That is why I would suggest you either slaughter him now or have him castrated.”

“And I suppose that castrating him is going to cost some money,” Edith said. “That will sort of change the economics of this whole project.”

“At this age, if I castrate him, it will require anesthesia,” I said. “And yes, it will cost a little money. Actually, there will be more expenses than just the surgery and anesthesia. The procedure always comes with some risks, and he will lose some of his growth. That is why it is so much easier to do it when they are a few days old.”

“We will give it some thought,” Elsie said. “But I think we will go ahead and slaughter him on our original schedule. The odds are in our favor.”

It was sometime in November when Edith stopped by the clinic to let me know that I was probably correct.

“Elsie still is determined to eat that pork, but I make her cook it outside on the barbecue,” Edith said. “It is just like you said it would be when it hits the frying pan, it runs me out of the house. I won’t touch the stuff, but Elsie isn’t going to admit that she was wrong in her decision. She says it ain’t too bad.”

Photo by Leah Kelley from Pexels