On a Thanksgiving Eve, From the Archives

On a Thanksgiving Eve 

D. E. Larsen,DVM

The barn was cold, but there was steam rising from the back of young heifer. A dusting of snow on her back was melting fast.  Bill and Connie Wolfenbarger had called with a heifer in labor.  They were not regular large animal clients but did visit the clinic with their small dogs.  I had been to their place several times to treat cows belonging to the Gilbert’s.

    When they discovered a tail hanging from the heifer’s vulva, they knew they had a problem. This meant the calf was in a true breech presentation and almost certainly dead. In a true breech position, the calf does not engage the cervix, and the cow doesn’t go into hard labor.  Most people will not notice a problem until the calf has been dead for a day or two.

    Tomorrow was Thanksgiving, I would miss some of the prep for the family dinner. The evening snowfall was light but continuing. Hopefully, I could make it home before the roads became a problem. Sandy’s folks were already at the house, so we didn’t have to worry about anybody traveling tomorrow.

    I tied the heifer’s tail out of the way and started to wash the her rear end. The hair on the tail came off with the slightest touch. I pulled on a plastic OB sleeve onto my left arm. With a little lube on my hand, I eased into her vulva to explore the birth canal. She strained hard when I reached the butt of the calf. No fluid was expelled with the strain. I pushed the rear of the calf with a couple of fingers. There was a spongy consistency under the skin and some crackling like I was popping air bubbles. The calf filled the entire birth canal, I could not advance my hand into the uterus, and I could not move the calf, it was wedged solidly into the birth canal.  I withdrew my hand, the sleeve was covered with hair from the calf and the odor was slightly pungent.

    “This calf has been dead for over a week,” I said as I removed the sleeve. “It is emphysematous, blown up with gas, I am not sure I am going to be able to get it out of her.”

    “What are our options?” Bill asked.  I knew their daughter was a small animal veterinarian, maybe in California. I did not know her, but I would assume they would be a little more knowledgeable than most clients.

    “Options are not many, the calf is in a breech position. That means its’ hind legs are retained and only the rump is presented. It is blown up so much that I cannot even insert my hand into the uterus. We are not going to be able to deliver this calf vaginally. I try not to do a C-Section on a dead calf, but with all the emphysema I won’t be able to do a fetotomy.  That leaves us with two viable options. Option one is a C-Section, which will be with risk and will be difficult.”

    “And the second option?” Bill asked.

    “The second option is to get your rifle and shot her now. It would not be fair to her to leave her in this situation,” I said.

    “Let’s do the C-Section,” Bill said.

    I double checked her halter to make sure she would not be choked if she went down. Then I change the tail, tying it to the right side. I placed a rope around her neck with a bowline and ran it along her side and tied it to ally fence, holding her against the fence. With her in a reasonably secure position, I clipped a wide area on her left flank, from her dorsal midline to her bottom of her flank.

   I prepped her flank with Betadine Surgical Scrub. The with 90 ccs of 2% Lidocaine, I did a large inverted ‘L’ block of her left flank. I blocked a wider area than usual because I may need to make a longer incision than is usually required. This was not going to an easy procedure. I repeated the prep after the block.

    After laying out the surgical pack and supplies, I pulled on a pair of surgical gloves, more to keep my hands clean than to pretend that this was going to be a sterile procedure.

    “We have a couple of major risks with this surgery,” I explained as I prepared to make my incision.  “The first one is that it is going be difficult to pull this uterus to the incision and second when I open the uterus, there is going to be no way to prevent the contamination of the incision and the abdomen. We are just going to have to depend on antibiotics.”

    Bill nodded, and I made a long incision down her flank, starting a few inches below her transverse processes and extending about 15 inches down her flank. The skin and subcutaneous tissues parted easily. Then I incised the muscles of the flank, they quivered as the blade divided them.  When I incised the peritoneum, the abdominal content did not sink away from the incision with a characteristic rush of air into the abdomen. The distended uterus filled the entire abdomen. There was no trouble finding it or worry about moving the rumen to externalize the uterus. The abdomen was filled with the uterus. 

    I reached into the abdomen to the tip of the uterus. Cupping my hand around the tip of the uterine horn, I pulled. The uterus did not move. I tried to rock the uterus in the abdomen. Sometimes you could swing the uterus enough to make it easier to bring it to the incision. This uterus did not budge. Again and again, I tried to bring the uterus to the incision.  I searched and found a hoof, I could not move the hoof.  

    I pulled my arm out, stretched and changed gloves. It this cold barn, but I was sweating profusely.

    “Do you think I could give you a hand?” Bill asked.

    “We might try that, if we could both get a hand under the end of the uterus, we might be able to make it move,” I replied.

    Bill stripped down to his waist and washed his hands and arms thoroughly.  I stood on the head side of the incision and ran my left hand down to the tip of the uterus. Bill on the other side of the incision inserted his right arm.  I guided his hand to the correct position.  We pulled, we pushed, we tried almost every maneuver. The uterus did not budge.

    Bill and I were almost nose to nose.  Bill had sweat on his brow and sweat dripping off the tip of his nose. He looked me square in the eye.

    “A woman couldn’t this,” he said.

    I smiled, “If you haven’t noticed, I haven’t got it done myself, yet.”

    We pulled out, and I rethought the situation.

    “I am going to try one more thing,” I explained. “I am going to open the uterus up here without externalizing it. I will then try to get a hold of the calf’s hoof and turn it up to the incision.  The risks in doing this are many. I could spill content into the abdomen, I could tear the uterus, and even with a grip on a foot, I might not be able to budge this uterus.”

    “And then, if this fails, we are going back to option two. We will get your rifle and put this girl out of her misery.”

    That said, I incised the uterus in the middle of the flank incision. With a surgical glove and an OB sleeve on, I ran by right hand down the inside of the uterus. There was a front foot, I grabbed the leg just above the hoof and pulled as hard as I could.  The uterus rolled and the hoof popped out of the incision. With my left hand, I incised the uterus over the hoof, and then I slipped an OB strap onto the hoof.  

I handed the strap to Bill. “Keep that foot from going back into the abdomen.”

    Pulling my arm out of the upper incision, I enlarged the incision over the exposed hoof. Bill was able to pull the entire front leg out of the incision.  I reached in and found the other leg. It came out quickly, and we attached it to the other end of the OB strap.

    With both front legs out, I enlarged both the flank incision and the uterine incision. Now I was able to pull the head out of the incision. Then putting things down, I helped Bill put a hard pull on the calf. It was sort like pulling a basketball through a knothole but when gas-filled abdomen of the calf finally cleared the incision both Bill and I almost fell as the rest of the calf followed with a swoosh.

    The membranes and the calf landed on the barn floor in a splat. Then the odor hit us. Bill and Connie both gagged and had to turn back to the side door.  When they opened that door, things were better, or maybe we were just adjusted.  Bill grabbed the OB strap and pulled the calf out the barn door, and I returned my attention back to closing up this mess.

    I washed and changed gloves. I put 5 grams of Tetracycline powder into the uterus and pulled the open incision to the outside. This was a long incision in the uterus, and then there was the small incision higher on the horn.  I elected to close the upper incision first, just in case the uterus would start to involute, and I would not be able to reach this incision.  I closed It with a simple continuous suture.

    The larger incision I closed with my standard Utrecht closure. After closing, I returned the uterus to the abdomen. I was concerned that there was probably a lot of leakage into the abdomen and pondered how best to deal with that event. There was no option to lavage the abdomen in the middle of this barn, so I just dumped another 5 grams of Tetracycline powder into the abdomen.

    I closed the flank incision with 4 layers. I used simple continuous in the peritoneum, interrupted mattress in the muscles and simple continuous in the subcutaneous tissues. I closed the skin with an interrupted mattress pattern.  No need to spray for flies in this weather.

    The heifer had to feel tremendous relief getting that mess out of her. She was going to need some additional antibiotics to keep her incision from falling apart. The easiest thing was to use some long-acting sulfa boluses.  I gave her 4 boluses of Albon SR. That would give her 5 days of protection.  

    I untied her tail rope and the sideline. She was as calm as could be expected.  I loosened the halter and slipped it over her head. She turned slowly and headed to the door, sniffing the floor a little as she passed.

    “She should be okay for tomorrow, but I will check with you on Friday,” I said to Bill as I was cleaning myself up.

    “She will be just fine,” Connie said.  “Our daughter will be home for a week or two.  She can check her tomorrow.  We will let you know how she is doing. You go home and rest for dinner tomorrow.”

    At least I was going to have a few days to rest up with the holiday.  I stopped at the clinic and cleaned all the equipment.  It would be a real mess if I left it for the girls on Monday.  I stripped down to the waist and washed thoroughly. The one mistake I made with the clinic was not putting in a shower. I thought I would wash here and go home for a shower.  Then probably have to start working on dinner for tomorrow. 

Friday morning, Bill called. “The heifer is doing great. Our daughter is impressed with how the incision looks. We told her the story, but I don’t think she really believed us. 

Two weeks later Bill called again to say they took the sutures out and the heifer continued to do well.

Photo by Ehoarn Desmas on Unsplash

The Scourge of the Garden, From the Archives

D. E. Larsen, DVM

Martha led her new young German Shepherd into the exam room and waited patiently for me to arrive. She had Duke sitting beside her, ears erect and waiting for whatever was to come next.

Obviously proud of her pup, Martha smiled when she shook my hand.

“Shake,” she instructed Duke. Duke extended a paw for me to shake.

“This guy is the smartest pup I have ever had,” Martha said. “He is already teaching the other two knot heads how to behave.”

“Do they get along okay?” I asked.

“Oh yes, they get along fine,” Martha said. “Even if Buddy and Zeus are jealous of all the attention that Duke gets right now.”

Duke was super on the exam table and took his shots like they were nothing. It was nice to see a young German Shepherd that was a great dog from the old mold. German Shepherds are a popular breed. When a dog breed becomes popular, so many backyard breeders pop up and start selling puppies. There is never a selection criterion, and the result is a bunch of pups with poor conformation and abysmal behavior.

“Do you think it would be possible for me to leave Duke here for a few minutes while I run to the store?” Martha asked. “The slugs are terrible this year, and they are eating my garden down to the roots. I have to pick up some slug bait.”

“We will gladly hang onto Duke for you, Martha,” I said. “But I am not a big fan of slug bait. It is terrible stuff, and dogs really like it. They will go right along behind someone is putting out in the garden and lick it up off the ground. Then it is a quick trip to vet, and hopefully, they didn’t get enough to kill to themselves.”

“I have used it before, and our garden is fenced for the deer, so we can keep the dogs out,” Martha said.

“That is probably good. Just be careful with the stuff,” I said. “There is no antidote, and it is all dose-related. We can control the seizures and provide supportive care until the effects wear off, but if they get too much, it cooks their livers, and once in awhile, they are gone before they get here.”

“I don’t know what else a person can use,” Martha said.

“I am no expert, but I hear that a shallow pan filled with beer works well,” I said. “The beer attracts the slugs, and they crawl into the pan and drown.”

“I’ve heard that also,” Martha said. “Maybe I will try it after I get them under control with some slug bait first.”

Martha picked up Duke and headed home when she was done at the store. She lived up the river, maybe halfway to Cascadia. 

We continued our day, and my conversation with Martha quickly faded into the background.

And then the phone rang.

A very frantic Martha was crying on the phone as she spoke with Sandy. 

“I had the grocery bag sitting on the table, and those damn dogs knocked it on the floor and tore open the two boxes of slug bait,” Martha cried. “Buddy and Zeus are in seizures, and Duke is looking sick.”

“Get them down here as fast as you can,” Sandy said. “We will be ready for you when you get here.”

Dixie came back and told me Martha was on her way to the clinic with all three dogs. “They at two boxes of slug bait,” she said.

“If they ate that much, there is probably not going to be much that we can do for them,” I said.

Martha came through the door with Duke a short time later. Duke was still on his feet but walking stiff-legged, and his eyes were dancing in the sockets.

“Buddy and Zeus are both dead out in the car,” Martha said with tears streaming down her face. “Duke is lucky that they ate most of the stuff.”

Duke only required a slight sedative to control his symptoms. We took care of the arrangements to get Buddy and Zeus cremated for Martha.

“If only I had listened to what you were telling me,” Martha said. “I feel so guilty. Why do dogs like that terrible stuff?”

“There is a movement underway to require they add a bittering agent to the stuff to try to make it less attractive to dogs,” I said. “That might solve a large amount of the consumption like Buddy and Zeus got into, but the small amount like Duke got might still happen. Al least most of those are manageable.”

“Well, for now, I am going to pick up some disposal aluminum pie plates and set them out filled with beer,” Martha said. “At least I have plenty of beer at the house. Bob won’t even miss a few cans.”

“It might be a good idea for us to keep Duke overnight,” I said.

“If it is possible, I would like to take him home,” Martha said. “He would be better off at home than here where nobody is watching him. And it is going to feel like the house is empty without the big dogs. I really think I will need Duke to cuddle with tonight.”

So Duke went home, and he was fine in the morning. He lucked out being the low man and the totem pole in this situation. That is not always the case when the low dog is left to lick up the leavings. But that is another story.

Photo by Rudolf-Peter Bakker on Unsplash

Bicycle Mishap for Tucker, From the Archives

D. E. Larsen, DVM

June and her two boys, Joe and Josh, were waiting impatiently in the reception with what looked like a rather painful Tucker.

Tucker was about a three-year-old Springer Spaniel who was usually bouncing off the walls in the clinic. Today he was standing, hunched up and reluctant to move. Something must be terribly wrong.

Dixie had them in the exam room, but Tucker was so painful that he was still on the floor.

“What’s up with Tucker?” I asked when I entered the room.

“Joe ran over him with his bicycle a couple of hours ago,” June said as Joe held up his elbow to show me a road rash he had sustained. “He seemed okay when it happened but then started getting painful. Just a little painful at first, but then it started getting worse. He doesn’t want to move now.”

I squatted down to look at Tucker, and he snarled as I reached out to touch him.

“I think I had better fashion a little muzzle for him,” I said. “He is so painful he doesn’t want to be touched.”

“He won’t bite,” June said.

“Under normal circumstances, that may be true,” I said. “But when a dog is painful, he will bite, I assure you. So just to be safe, I am going to tie his mouth with a loop of gauze.”

I took about three feet of roll gauze and made a loop in the middle with one throw. I placed the loop over Tucker’s muzzle and pulled it tight with the throw on top of his muzzle. Then I crossed the gauze under his muzzle and tied the ends behind his head.

Then leaving Tucker on the floor, I carefully started to run my hands over him to find the source of his pain. Tucker snarled at my very touch.

Tucker showed no response as my hands started at his nose and moved over his head and down his neck. There was no pain in his front legs or chest. I stood up and moved behind Tucker to carefully palpate his back and hips. He tensed and growled when I started to palpate his hind legs, but that growl stopped when I reached his knees and lower legs. I carefully pushed on his abdomen, no pain was detected. I moved back to his hind legs, and the growl started again. I lifted his rear up to look closer, and there it was.

Tucker’s right testicle was almost twice the size of his left testicle. I reached to touch the swollen testicle, and Tucker sort of exploded. Without the muzzle, I would have been bitten. Tucker maintained contact with my left arm with his muzzled mouth, just to make sure I wouldn’t try to touch that again.

“Well, it looks like I found it,” I said. “Tucker must have gotten a testicle ran over.”

“I am shocked,” June said. “I have never seen him act like that before.”

“Don’t hold it against him,” I said. “When these guys are really painful, that is their only defense.”

“What do we need to do with him,” June asked.

“I need to get him under anesthesia and figure out what happened to that testicle,” I said. “My guess is that it is going have to be removed. I just need to make sure there is not a hernia involved.”

“It looks like that is our only choice,” June said. “Can you do that right away?”

“I have a couple of things to do first, but we will give him some pain stuff while he waits for surgery,” I said. “The best thing would be to take both of those things while we are doing this. It really wouldn’t add anything to the surgery bill and would make a better dog out of him.”

“I will ask Jerry, but we have talked about neutering Tucker before, and Jerry is pretty dead set against it,” June said. “Sort of a guy thing, I guess.”

“Okay, but just between you and I, Tucker’s life will be much happier if he is neutered,” I said. “He won’t be worrying about that little chippy down the street. Or fighting with the big dog down there with her.”

“I know,” June said. “But I’m afraid there is no changing Jerry’s mind.”

“Okay, I will plan to only remove the injured testicle unless I hear from you,” I said. “We will be getting to surgery in an hour or so. Is that enough time for you to talk with Jerry?”

“I think so,” June said. “But if you don’t hear from me, just remove the injured testicle.

I gave Tucker a dose of Innovar for pain and put him in a kennel while we finished things up so we could get him into surgery.

June called the clinic just before we started into surgery with Tucker to confirm that Jerry did not want to remove both testicles unless necessary. 

“You could tell him a little white lie,” Dixie said with a smile. She knew I would not do that.

“I have to be able to live with myself,” I said. “Telling little lies makes that hard to do, and it leads to bigger lies. Pretty soon, you can’t remember what you said to whom.”

We prepped Tucker, and I made a mid-line incision in front of the scrotum. Then, pushing the injured testicle into the incision, I incised the soft tissues over the testicle and pushed the testicle out of the incision.

The problem was immediately apparent. There was a full two twists in the cord of the testicle, a testicular torsion. There was no saving this testicle. The bicycle wheel must have spun this testicle as it ran over it.

At this point, I opened the tunic covering the testicle. I completed a standard orchiectomy, removing the injured testicle and closing the incision.

We recovered Tucker from anesthesia, and we had the old Tucker back, bouncing around the kennel. He was ready to go home.

I called June to give her the news. 

“June, Tucker can go home anytime this afternoon,” I said. “He had a complete torsion of his right testicle. The bicycle wheel must have spun it around a couple of times. There was no saving the testicle, but Tucker is wide awake and bouncing around like the old Tucker we know.”

When Tucker was picked up, he was jumping up and licking at the faces of both Joe and Josh, showing no remorse for the accident, if he was even aware of it at all.

Photo by John Debrey on Unsplash