Ralph

D. E. Larsen, DVM

I arrived in Enumclaw, Washington, in early February for a two-week externship. I was close to completing my final year of veterinary school at Colorado State University. It was nice to be back in the Pacific Northwest, with its mild winter temperatures.

Since we would be moving to Enumclaw when I graduated in March, one of my chores was to find a house to rent. That proved an easy task. I rented a 3 bedroom house that had been vacant for a couple of months. It was a neat little house and would seem like a mansion to Sandy and the girls. We had been living in a small 2 bedroom apartment while in school.

A couple of classmates helped me load our entire household into a rented truck for our trip from Fort Collins to Enumclaw. Another classmate wanted a ride to visit his sister and brother-in-law in Portland. That worked out great for both of us, he was able to do most of the driving of the car, and I drove the truck.

My bother came to Enumclaw and helped unload the truck and set up the house. After everything was put in place, our two families gathered around the dining table for a meal of takeout pizza. 

Bam! The sound made everyone jump. There, hanging on the patio screen door was Ralph, not yet named. Sandy went to the door, and Ralph dropped to the ground and stood, waiting for the door to open. The kids were all excited, Sandy opened the door, and Ralph came in, looking like he had been waiting for someone to live in his house.

Ralph was a young tomcat. He was a typical tabby cat with black stripes on a brown coat. If he was hoping for a happy future of fathering kittens, he came to the wrong house. Ralph found himself on the kitchen table, under anesthesia, and under the knife. We neutered him the second evening.

It turns out that Ralph was left at the house when the previous renters moved out. He had been living in the neighborhood since the middle of December. He had some help in his survival, but not much. There was a lady several houses down who fed him tuna every night. Otherwise, his hunting skills kept him well fed.

There was a large open field behind the row of houses. We were located on the very edge of town at the time. Ralph hunted mice in the field much of the time. When temperatures warmed a little, Ralph would perch on another neighbor’s patio roof. He would jump from this high perch and catch birds as they flew across the lawn to the bird feeder in the middle of the yard.

Ralph was a great family cat. He loved the kids and made himself at home, sleep at the foot of Amy’s and Dee’s bed. He had lived outdoors long enough that hunting was very much a way of life for him, and he was at the door every morning after breakfast.

As the months went by, other cats came to our house. That was the way things were for a young veterinarian and his family. We had two female cats show up, both pregnant. So by the time we were ready to move to Sweet Home a year and a few months later, our family had grown. We had three girls, a new son and now, three adult cats and five kittens.

The apartment we lucky to rent in Sweet Home did not allow cats. So Ralph and the rest of the cats ended up spending a couple of months in Myrtle Point at my folks. We had a little concern about how they would cope with the upheaval, but that was our only option. The whole bunch did very well.

Ralph, in particular, was happy when we moved into our first house on Ames Creek. He could sleep on the girl’s bed again, and he had plenty of hunting grounds to patrol.

One morning I watched him walking down the hill across the road from the house. He seemed to be having a lot of trouble walking. My first impression was he must be injured, but as he got closer, I could see that he was dragging a quail. Holding the bird by its neck, the bird was dragging between his front legs. He brought it down to the front steps where is settled down to his dinner, scattering feathers everywhere. 

In those years, Feline Leukemia was rampant in the cat population. In my early years of practice, there was no testing available for the disease. I would see cats, weekly, come to the clinic with profound anemia, who would seizure and die on the exam table, just from the stress of the trip to the clinic.

We could buy some time for a few of these cats. Sometimes a transfusion would provide a few weeks, medications would help for a few weeks, but in the end, all of these cats would die. 

There was one week when I saw three yellow tomcats, all about 6 months of age, come to the clinic, and die. It was when questioning the owner of the third cat that we discovered that all three of those cats were from the same litter. 

In the years before the release of the Feline Leukemia Vaccine in 1984, losing entire litters from an asymptomatic mamma cat was commonplace. Sometimes that would happen before birth, sometimes shortly after birth, sometimes a year or two later. 

The virus was also transmitted through bite wounds and close communal contact for an extended time. I would see households of cats with a high incidence of infection. I would also see cats lost to immune failure, sometimes resulting in extreme infection following surgery or what should be a routine abscess.

This all came to an almost screeching halt with the introduction of the Feline Leukemia Vaccine in 1984. That vaccine has fallen into disfavor. There are few veterinarians practicing today who witnessed the carnage of the disease before 1984.

Ralph was unfortunate to have been born in the 1970s. That fact, coupled with his lifestyle, destined him to become a victim of the Feline Leukemia Virus. I noticed he was reluctant to leave the top bunk one morning. I looked close, his membranes were pale, his lymph nodes were swollen. 

I felt sick. Ralph would become the first of our pets that I would have to put to sleep. Sandy suggested I see if Dr. Craig would do it for me, but I knew it was my chore. I would do it at the house, sparing Ralph that final trip to the clinic.

Charlie and Betty, All Bad News

D. E. Larsen, DVM

 It was not long after this fishing expedition that we got the sad news. Lee called me at the clinic one afternoon. “I have some bad news,” Lee said, his voice almost breaking. “Charlie has prostate cancer. It is very advanced and has already metastasized. I am afraid he doesn’t have much time.”

  Not much time, everybody wants to know how much time they have when they get a cancer diagnosis for themselves or for their pets. I have never understood how doctors could be so blatant about the figures they hand out. Be it 1 year, 6 months, or 3 weeks, people always think they really know. As I veterinarian, I can read the book too, but the times are the best guess, at best, and complete BS, at worse. Charlie’s time went fast. In less than two weeks, he was on his death bed, and he was gone a few days later. Probably better that it went quickly, the end was pretty painful for him.

 Sandy and I closed the office and went to his funeral. We had lost Sandy’s mother a couple of months earlier, and we were starting to realize we had entered that age group where funerals seemed to be more common than weddings. Charlie’s service was small, mostly family. The preacher did an excellent job for having met Charlie on his death bed. Although we knew we were welcome, we almost felt like we were intruding. We both shed more than a few tears. Walking back to the clinic, we both decided, almost at the same time, that we should not be attending funerals for clients. We held that as a policy for many years until we started losing some good friends who just happened to be clients, sort of like Charlie.

 The week following Charlie’s funeral, Betty came to the clinic with her little dog, Taco. Taco was a little Chihuahua crossed with a Dachshund, black, short hair coat except with long hair on his ears.

 Betty puts Taco on the exam table and looks at me with great concern. “He can’t pee,” she says with tears in her eyes. “What am I going to do? I can’t lose him too, I just can’t.”

 “Let’s look first before we start worrying about something that maybe doesn’t exist,” I said.

 I start through an exam when his distended bladder jumps out at me. I can’t pee for sure, but there are a couple of drops on the exam table.

 Betty points to urine on the table, “that’s what he does everywhere, never more than a couple of drops.”

 I put an exam glove on and lube my left index finger. This will be a tight fit but should be no real problem. Dixie comes in and holds Taco as I insert my finger into his rectum. There are a lot of reasons for urinary obstruction, and some are quite simple to deal with. I reach the level of his prostate, and my heart sinks. Taco has been neutered for many years, and his prostate should be small and smooth on palpation.

 Taco’s prostate is grossly enlarged, solid, and hard, with extensions of this hard tissue in all directions. Both vas deferens are 4 times their normal diameter and hard and bumpy. This extends as for down each vas as I could reach. This was unlike anything I have ever palpated. Old intact male dogs often suffer from an infected prostate Their prostate may reach a massive size, maybe the size of a grapefruit in a large dog. Those cases resolve quickly with antibiotics and neutering. This is not an infected prostate. Prostatic cancer is now number one on my list, and there is no way I can say those words to Betty at this point in time.

 “Betty, he has a problem for sure,” I explain. “We need to get him under an anesthetic, pass a catheter, and drain his bladder. That is number one, then we can do some lab work and get some x-rays. We will also do a pneumocystogram, which is an x-ray where we fill the bladder with air. That allows us to see the lining of the bladder and the pelvic urethra. We should be able to get this done this morning. So if you set up an afternoon appointment, we can go over our findings.”

 After anesthesia, I pass a catheter quickly. I get x-rays, plain film and then a pneumocystogram. The prostate is large, and the urethra that passes through it is eroded and large with tissue hanging into the lumen. This urethral abnormality extends down the pelvic urethra for some distance. The neck of the bladder is also involved with an abnormal lining that extends into the prostate. This has to be prostatic cancer. Something I have not seen in a dog. Time to hit the books.

 It turns out that prostate cancer in the dog is rare. I know that already. It also seems to occur more commonly in neutered dogs. This is not well understood because prostate cancer is thought to be testosterone dependent. It could just be a numbers game. Veterinarians see many more old neutered male dogs than they see old intact male dogs. The pictures are disturbing, they look exactly like what I am feeling in Taco.

 At this time, there are few specialists to send Betty and Taco. She would not go anyway, she thinks I can do anything. The truth is, Taco is on borrowed time, just like Charlie was. My guess is we have very few options. Attempting to remove this prostate will be at the very edge of the ability of this clinic. And even with surgery, we probably will only buy a few weeks at best.

 Betty returns in the afternoon, and I reluctantly go over everything with her. The x-rays, the lab work, and the book findings. The diagnosis is prostate cancer, the only thing lacking to confirm that diagnosis is a tissue biopsy. The prognosis is grave, meaning I don’t expect Taco to survive this cancer.

 “How can this be happening?” Betty says with tears in her eyes.

 I can hardly talk. “We can find a specialist to send you to if you would like.”

 “No, no, Charlie would never allow that. If anything is going to be done, you are the one we want to do it.”

    “There is not much I can do, Betty. This surgery is at the very edge of my skill and equipment. And even if he comes through surgery, I may buy him only a short time, maybe a couple of weeks, maybe less.”

 “We have to try because it could be maybe more. I have seen some of the things you do. We have to try,” Betty says. “When do you want to do this?”

 “We will make time this afternoon,” I said.

  We had Taco under anesthesia and prepped for surgery, on a slow IV drip of Ringers Lactate, and we had passed an eight french urinary catheter into the bladder. His prepuce is reflected to the left side of his abdomen, and clamped in place with a towel forceps. 

 Then a posterior ventral abdominal incision is made, passing on the right side of the prepuce, ligating preputial vessels as they are encountered, the linea alba is exposed all the way to the pelvic brim. The linea alba is opened carefully, exposing the bladder and prostate. It looks far worse than it felt.

 The entire prostate is involved with cancer, and it extends down both vas, beyond my vision. I grasp each vas deferens and pull them free of any attachment. Then I thread a length of OB tape around the pelvic urethra and secure it approximately 1 cm distal to the abnormal tissue. I sever the pelvic urethra and telt the prostate and bladder up to allow me to pull the tip of the catheter out of the prostate. Next, I sever the prostate from any bladder attachment. Now I remove the entire prostate with both vas deferens attached. I ligate any bleeding vessels, examine the cut edge of the bladder carefully. I trim away any tissue that looked suspicious. Then, after reinserting the catheter into the bladder, and using 3-0 Maxon, I sutured the bladder to the pelvic urethra. We filled the bladder with saline and put it under pressure to check for any leakage. Everything was good.

   With a neutered male, we didn’t have to worry about sexual function, but I had to trim enough of the bladder that I was sure that Taco would leak urine. It probably wouldn’t bother Betty at this point, she will just have to find a diaper that fits.

   The closure was routine and recovery uneventful. Taco went home the next day. Betty was pleased, even though she knew that time was short. This would at least give her a short time to come to grips with the recent events of her life.

    Taco did live a couple of weeks longer than I had expected. Betty was sad but buried him out by the pond, near where Foster was buried. The horses were gone now, and the ranch was for sale. Betty planned to move east of the mountains to live with her sister. I am not sure what happened to Charlie’s fish.

 I could always deal with the death of a pet without a lot of emotion. I guess that is the farm boy in me. I still remember the calf that was born without a rectum. It was a perfectly healthy little calf but had no rectum. It did well for a few days, but it obviously had no future. I was in the seventh grade, and when I got off the bus on the calf’s 3rd day, Dad said, “I want you to go get the rifle and take that calf without a rectum up on the hill and shoot her.”

 Simple task, I got the rifle, an old Model 94 Winchester 25-35, pulled the calf out of the pen and tied a twin around her neck, and led her up on the hill for a couple of hundred yards. I sat down on a log with her at my feet. Her big brown jersey eyes looking at me, we talked a little about her problem. I must have sat there 10 minutes with her before I gathered enough strength to stand up, shoot her in the head, and, after ensuring that she was dead, returned to the barn to do my evening chores. 

 Pets and animals die at times, and they die sooner than people in the best of times. I could handle that in my mind. When we started to lose clients, often clients who were also friends, that became difficult, and that was something I never really was able to deal with satisfactorily. There was no family attachment, there was really no circle of friends in our friendship. They were sort of in that special place in our lives, business clients, but clients who we shared intimate facets of their life, and often cultured a special friendship. Their loss was just hard to deal with in our minds. 

Photo by Mylene 2401 from Pixabay

Charlie and Betty, The Fish Pond

D. E. Larsen, DVM

Over the next few years, Charlie would call for a post-breeding infusion on every mare on her second breeding. I don’t think we had a 100% conception rate, but it was close enough for Charlie and his clients to be pleased. On one of these visits, Charlie asked me if I wanted to look at his fish pond. He had dammed up the creek that ran through the back of his property, dumped in a couple of truckloads of fine pea gravel to provide for breeding, and planted it with trout. This pond covered nearly a half-acre, and the water was deep. The creek had year-round flow. These fish were sort of his pets.

 “I let my brother Lee, the pharmacist, bring his kids up to catch a fish once in a while,” Charlie said as he retrieved a coffee can full of pelleted fish food from the little shack beside the pond.

 Charlie threw the pellets into the water in front of us. The water was instantly alive with trout. These were no little trout one might expect to see at a fish hatchery, these were large fish. They looked like they were all 20 inches or more. I stood there amazed, probably had my mouth open.

    “I think they have pretty good reproduction with all that gravel I dumped in up there where the creek comes into the lake. I have not planted any fish for a couple of years, and the numbers don’t seem to go down any. I think there must be some freshwater shrimp in there because they all have pink meat. That or they eat their fill of all the goldfish that you see along the edges,” Charlie said, pointing to a group of 20 to 30 six-inch goldfish hiding in the willows.

 “If you want to bring your kids up, they can catch a fish,” Charlie said.

 “Will my son, Derek, and our youngest daughter, Dee, would love to catch one of these fish. I am not too sure about the other two. I wouldn’t want to catch more than we could eat anyway,” I said.

    “You bring them up tomorrow evening, I will honk when I go by your place on my way home.”

    The next evening Dee and Derek clambered into my truck with their fishing poles. I had set the stage, and they were excited.

    When we got to Charlie’s, he was waiting at the pond. He had a jar of old salmon eggs in his hand. He looked at the poles the kids were carrying. “I don’t know if these will work,” Charlie says as he examines the hooks and four-pound test leaders. “These are pretty big fish, but let’s give it a try.”

    Charlie places a small glob of salmon eggs on Dee’s hook. “Just cast it out there a little way, not too far,” he says.

    The eggs hit the water and begin to sink below the surface. Bam! A large trout rolls as it grabs the eggs. There is a sharp pull on the line, then nothing. When Dee reels it in, everything is gone, hook, line, and sinker.

    Charlie says, “I better get my pole,” as he heads for the shack.

 Charlie’s pole is an old rusted steel pole with about 12 – 15 feet of line tied to end. The line is heavy, it looks like a 50-pound test line. Tied to the tip of the pole with a half dozen granny knots. And with a large double hook at the other end of the line, probably a #4 hook size. The knot securing the hook to the heavy line is the same series of knots that tie the line to the tip of the pole.

    “Now this ain’t no fancy pole, but it catches these fish. We just put a big glob of eggs on this hook like this,” Charlie says as he baits the hook.

    He walks to the water’s edge with the baited hook. “Now I am going to throw this into the water, you need to stand here beside me,” he says to Dee.

 When you hook the fish, and it will happen as soon as this bait sinks, you just hold the pole and back up toward the shack there,” Charle explains. “I will get the fish when you pull him out of the water.”

    Charlie throws the baited hook into the water. About the time it disappears under the water, there is a tremendous tug on the line. Dee almost loses her grip but recovers quickly. 

 “Now, just back up,” Charlie reminds her.

 Dee backs up, struggling to hold the pole with the fish fighting on the other end of the line. A few more steps and this large trout is floundering on the bank. Charlie scoops him up and pulls a little club from his back pocket and wallops him on the head a couple of times. He holds up the fish, probably 23 inches long and close to 8 inches deep.

 We repeat the process with Derek. He is 3 years younger than Dee and has a little more of a struggle with the fish, but it doesn’t take long, and second fish is on the bank. This fish is slightly smaller but still an impressive fish well over 20 inches.

 “Any time you get hungry for a fish, just give me a call,” Charlie says as I load the fish and the kids into the truck.

 “Thanks a lot, Charlie, I will try not to take all your fish,” I say as we head the truck down the driveway.

Photo by Dan Gold on Unsplash