Rambo and the Eagle

D. E. Larsen, DVM

Walking down the fifth fairway at Pineway, I was relieved that I could see ball. 

“At least I am not in the ditch,” I said to Jim as we parted toward our respective balls.

Dr. French had always told me that the if you are paying attention to your practice, you will never have the time to be a good golfer. I could see his point, I took Thursday afternoon off to play with the Pineway Men’s Club and most of the time with a group or two once on the weekend. But I really felt that athletes are born, not made. Of course, with work and coaching, we could improve and reach our potential, but some guys are just born with a ball in their hands. We all knew them, they were stars in little league, and they excelled on the basket ball court. They are the ones who didn’t go out for football until they were seniors, and they made all league. The coach always tries to take the credit, but it is just the way it is.

And my slice was a good illustration. I could beat just about anyone on any one hole. But I could never hold my concentration for the next hole.

I got to my ball, it was in the short rough, about a foot from the ditch that ran down the right side of the fairway. It was a position I knew well. I could reach the green from this position on this short 5 par hole. This position actually set me up well with my ball flight. There was a slight dogleg to the the left, with my slice, I liked to call it a fade, I could start my ball left of the hole and it would run up the front apron to the green. I just needed to fade the ball, not slice it.

As I addressed the ball, I caught sight of Jack Wright’s cart starting down the eighth fairway. Rambo, his little poodle mix, always rode on the back of the seat in Jack’s cart. Rambo had already spotted me. I could hear him throwing a fit from two fairways over. 

Jack loved it, and here he came in his cart with Rambo barking up a storm over his shoulder. Just what I needed to hold my concentration on this shot.

“Good morning, Doc,” Jack said over Rambo constant barking, louder now that they were parked just across the ditch. “How is your game this morning?”

“It has been pretty good so far,” I said. “With a little luck, I will reach this green in two.”

“Rambo spotted you and wanted to say hi,” Jack said with laugh. “I think you are the only person he knows on this entire course.”

“Yes, I notice that almost every Thursday,” I said. “I don’t know what the problem is, I have never done anything to him other than his shots and stuff.”

Jack chuckled again, “He just wants you to know what he thinks of you.”

“Well, I guess it is good to be loved by my patients,” I said.

“I’ll let you get back to your game, good luck, and fly that ball right at the stick for a change,” Jack said as he turned the cart and headed back to his fairway. Rambo on the back of the cart, facing me and barking as loud as he could.

I addressed the ball again, trying to think what it was that I had done to Rambo to make dislike me so much. Then trying to brush that thought away, I took a deep breath and started my back swing.

I swung with all my strength, and caught the ball perfectly. The ball seemed to hang on the club face briefly, then sprang into a high flight. This was my Ping 5 wood, my favorite club. Probably because I could hit the ball straighter with it than any of my other woods.

The ball started out on a line about 10 yards left of the green and then started to fade to the right. Then the fade became a slice and it was struck hard enough that distance was going to be more than usual for this club. I held my breath and leaned to the left, as if to guide the ball a little.

The green ran on a diagonal left to right and the hole was cut in the far back corner. I had hoped to land in the fairway and run the ball up on the green but this ball was going much more to the right than I had hoped. Then it came down, and stuck on back edge of the green, maybe 10 feet from the hole.

I perfect shot and it surprised everyone, including myself. “Maybe I should talk with Rambo more often,” I said to myself as I picked up my bag and started toward the green.

Bruce West was coming down the sixth fairway. He pointed at the ball near the pin and asked, “Whose ball is that?”

Jim pointed at me, “Larsen’s, good shot, don’t you think?”

“If he makes the putt,” Bruce replied.

I could still hear Rambo barking as I walked up on the green. He was out of the cart and standing under the trees over by the eighth green, only thirty yards away. He pounded his front feet with each bark in a little bounce, just to add emphasis to his distaste.

Jack had loaded him up and headed to the ninth tee box just as I addressed my putt. I was relieved that the barking was fading off in the distance. 

One small breath, and I stroked the putt, straight putt, right to the bottom of the hole. “Take that Bruce,” I said as I stepped quickly to hole to retrieve the ball.

Eagles were rare birds for me on the golf course.

Photo Credit: Photo by Markus Spiske from Pexels

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