Room for Three 

D. E. Larsen, DVM

We were just finishing up with the morning’s surgeries when Sandy popped her head in the surgery room door.

“Dr. French is here with Willow,” Sandy said. “He doesn’t have an appointment, but I told him I was sure you would work them into your schedule. You’re the doctor, but it looks like she has a large mammary tumor.”

“Do I have any time available this morning?” I asked.

“I don’t think so,” Sandy said. “There are a couple of appointments that you might be able to rush through and come up with some time, but the only time you have is the noon hour.”

“Bring them back here, and I will long at Willow and keep her for any workup,” I said.

Sandy escorted Dr. French and Willow back to the surgery room.

“I didn’t mean sneak in on your schedule, Doc,” Dr. French said. “But, I think we have been a little negligent with Willow. I just noticed this large mammary tumor. I know I sound like some of my patients, but I swear, Doc, this thing wasn’t there last week.”

“Sometimes, in the dog, these tumors will be small for a long time, and then they just sort of explode,” I said. “I don’t have much time this morning, but if you can leave her, we can get a chest x-ray and some blood work, and I can talk with you here over a sandwich or something.”

“What’s your gut feeling, Doc?” Dr. French asked. “I mean, Willow is almost ten years old. That is ancient for a Great Dane.”

“You know as well as I do. It is sort of the luck of the draw,” I said. “If this is a hot tumor, we will not do much to change the course of things. Sometimes, removing this primary mass will buy some time, just because if it grows that fast, it will rupture soon. Then it will be a mess for you and uncomfortable for Willow. If she has cancer in her chest or elsewhere, we won’t buy her much time.”

“That’s sort of what I thought,” Dr. French said. “Go ahead and get an x-ray and do the blood work. I will bring you a sandwich at noon. Jane makes a wicked tuna salad.”

“You have a deal,” I said. “I love a good tuna salad.”

We got right to work on Willow, hoping to get some of the work done before our first appointment. The blood draw only took a minute. The x-ray was going to be a challenge. 

Willow was a great dog to work on, and with three of us, we were able to get her on her back on the X-ray table and snap a picture. The lateral view was easy.

“You get the films developed and bloodwork done, and Debbie and I will start on the appointments,” I told Dixie. “I don’t need to look at any results until Dr. French returns here at noon.”

The morning was filled with routine stuff that seemed to go by fast. A cat with a bite wound that would be an abscess next week if not treated today, a coughing dog that the owner was sure had a bone in his throat, and several vaccine appointments. Before I knew it, it was noon, and Dr. French and Jane were in the reception room with my lunch.

“Come on back, and we will look at what we found out,” I said. “I have been busy and haven’t seen any results, so you can help me look things over.”

We went back to the surgery room, and Jane laid out lunch on the surgery table.

“I can’t think of a cleaner place to eat lunch,” Jane said as she pushed a sandwich toward me.

Dixie came in and handed me the sheet with the blood results, and she put the X-rays on the viewer.

“There is plenty here for everyone,” Jane said. “You can tell Sandy and Debbie to come and get it.”

I glanced at the blood results, and everything was normal. I handed the sheet to Al. 

“For an old Dane, things look pretty good here,” Al said. “But let’s turn on the viewer and see what her chest looks like.”

“Maybe we should eat a few bites first,” I said. “I haven’t had a chance to review these films. I don’t know what we will find.”

“You just don’t want to miss out on lunch if it is all bad news,” Jane said.

But we all took a minute to enjoy one of the better tuna salad sandwiches that I have had. There was some idle conversation. Sandy had to catch up on how all their kids were doing. Their oldest daughter had just moved to Bend, and their other daughter was also considering moving there.

“Okay,” I said as I switched on the X-ray viewer. “Let’s look at this chest.”

“That’s a big chest,” Al said as he looked at the film.

“That is a big chest for this little clinic,” I said. “Willow was great. Otherwise, I don’t think we could have gotten a picture without sedating her.”

Willow’s chest filled the entire large X-ray. At the bottom of the film, you could see the primary tumor. I pointed this out to Al as he stood looking at the film. There were a few traces of bone visible in the primary tumor.

“The bone in the primary tumor says it is a mixed mammary tumor,” I said. “This is a common malignancy in the dog.”

“I don’t see anything in the lungs,” Al said.

I stood and carefully looked at the lung field.

“I always like to send these to a radiologist,” I said. “Those guys can see things you and I will never see.”

“Yes, I always think they make up half the stuff they say they see,” Al said.

Then I saw it. The first lumbar vertebra was half gone. It was eaten away by an extension of the mammary tumor. I pointed to it to bring Al’s attention away from the lungs. I didn’t need to say anything.

Al turned away and grimaced.

“Damn,” he said. “That just about does it for her.”

“We are probably lucky that it held together for the X-rays,” I said. “That could fall apart anytime.”

“Dave, we are going to just take Willow home and love her for one more night,” Jane said. “Could you come over tomorrow, after work, and put her to sleep at the house for us. I know that might be a lot to ask of you.”

“Jane, that’s no problem,” I said. “I would be glad to do it. The only problem is sometimes it is hard to know when the work ends here. But let’s plan on six o’clock, and we will call if it will be later.”

***

Jane, Al, and Willow met Dixie and me at the door when I rang the doorbell.

“We are all set up out in the backyard,” Al said as he ushered me to the back door.

It was a small backyard but well-kept. I could see that Al had dug a grave against the fence in the middle of the yard.

“I guess it is okay to bury her here,” Al said. “She is the third Dane we have buried back here. We are going to run out of room pretty soon.”

“As far as I know, there is no rule against it,” I said. “You could always call the city and ask, but that might be the best idea right now.”

“I have a chair over by the grave,” Al said. “I hope you can do this by yourself. Both Jane and I are softies when it comes to Willow. We have to wait in the house.”

I sat in the chair, and Dixie held Willow in front of me. Al and Jane melted back into the house. I picked up Willow’s front leg and placed a tourniquet at the elbow. Dixie patted her head as I slipped the needle into her vein. Willow was gone before the injection was over.

“This is so sad,” Dixie said. “Leading her out to her grave to put her to sleep.”

“Practical, though,” I said. “She is a big load to carry out from the house.”

Jane came out as we were picking up our things.

“Do you want us to help get her into her grave?” Dixie asked.

“No, our son is coming over to do that this evening,” Jane said. “You guys have done enough. I can’t thank you enough.”

Willow became the third Great Dane buried in their small backyard. I never checked the regulations on burying dogs in the city limits. If there had ever been any deliberations on the subject, they were unlikely to have considered the possibility of three Great Danes in a small backyard.

Photo by Matthias Zomer on Pexels.

What are the Odds, From the Archives

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

A Bat in the Bathtub 

D. E. Larsen, DVM

It looked like it was going to be another warm September day. The sun shone through the trees as I backed the truck out and headed for the clinic. Not a cloud to be seen in the sky.

Judy was already at the clinic when I arrived. It was hard for me to get there before her. Once she had Andi off to school, she would drop Bryon off at the babysitter and come to the clinic. It was difficult for me to be there first.

“Sudi is on her way with a bat,” Judy said as I walked through the door. “She sounded a little excited on the phone.”

“I’m hoping this is a dead bat,” I said.

“She didn’t say. She said she found it flopping around in her bathtub last night,”

“She is probably going to want it tested for rabies,” I said. “I guess I better call the lab and check their procedures.”

“I don’t think you need to be in a hurry,” Judy said. “She is just going to drop this thing off on the fly so she isn’t too late for her class. I don’t know why they start school so early these days?”

“They like to be out of school early,” I said. “They don’t worry about the little kindergartener up in Cascadia who has to get up five to catch the bus.”

Our conversation ended when Sudi burst through the door holding a quart jar. The bat was still fluttering in the jar.

“Dave, I caught this thing fluttering around in our bathtub last night,” Sudie said. “Frank thought we should have it tested for rabies. He read were Oregon’s bats carry rabies.”

“Were the kids sleeping while it was in the house?” I asked.

“Well, they weren’t sleeping when I caught the thing last night,” Sudi said. “But I have no idea where it came from or how it got in the house. I figured the cat must have brought it in and let it go.”

“Did you handle it when you put it in the jar?” I asked.

“No, I just scooped it up with the jar and put on the lid,” Sudie said. “I was going to let it suffocate, but the kids threw a fit, and I had to punch some holes in the lid.”

“Okay, I’ll get this to OSU,” I said. “You will probably have to pay for the testing, but that might be good. That way, without human exposure, you won’t have to deal with the public health folks.”

“Just let me know when you get the results,” Sudie said as she pushed open the door to leave.

After Sudi left, I called the lab for instructions. I spoke with Doctor Johnson, a new pathologist, probably a graduate student.

“I have a bat to send over rabies testing,” I said. “Are there any special instructions?”

“We can only do the testing if there has been no human exposure,” Dr. Johnson said.

“The client found the bat flopping around in her bathtub,” I said. “She didn’t handle it, just scooped it up in a quart jar. She thought the cat brought the bat into the house.”

“That sounds good,” Dr. Johnson said. “Is the bat dead?”

“No, it is still flopping around in the jar,” I said.

“It is a real hassle for us if you send it alive,” Dr. Johnson said. “We don’t have any way to euthanize it here in the lab. We have to get one of the pathologists from the necropsy side to euthanize it for us.”

“So you want me to euthanize it before I send it over,” I said. “Does that count for a human exposure?”

“You are supposed to be able to protect yourself,” Dr. Johnson said.

“Okay, I’ll figure something out,” I said. “How long will the test take if I get this bat over today?”

“This is Friday, you know. You will probably not get any results until Tuesday or Wednesday, even if you get it over here this afternoon,” Dr. Johnson said. “It is just going into our refrigerator. Getting it this afternoon will allow us to get started on it first thing Monday morning. That way, we should have results on Tuesday.”

I hung up the phone, and Dixie was looking at the bat with a frown on her face.

“What happens if this thing gets loose in the clinic?” Dixie asked.

We took the jar into the surgery room, wet a cotton ball with a few drops of Halothane, and dropped it into the jar. The bat was asleep almost instantly. 

“How long is he going to sleep?” Dixie asked.

“Your guess is as good as mine, but we don’t have to hurry,” I said. “We will let him soak in there for a few minutes while I draw up some euthanasia solution. Then I’ll dump him out of the jar outside so we all don’t get gassed. It will only take a second to get this injection into his chest. Then it is off to bus depot with him.”

***

I hadn’t given much thought to Sudie’s bat until the phone rang on Tuesday morning. It was Dr. Williams, the state public health veterinarian. 

“Dr. Larsen, that bat you submitted to OSU last week tested positive for rabies,” Dr. Williams said. “I just wanted to make sure I had the fact right.”

We went over all the facts again. Dr. Williams agreed that there had been no human exposure to the bat.

“Do you know if the cat was vaccinated for rabies?” Dr. Williams asked.

I quickly scanned Sudie’s file. Luckily for the cat, it had a current rabies vaccine.

“The cat is current on its rabies vaccine,” I said.

“That’s good. It would have to be euthanized if it wasn’t,” Dr. Williams said. “It is recommended that you booster that vaccine now,”

“How many cases of rabies in bats do you see in Oregon?” I asked.

“We only see a handful of bats that test positive,” Dr. Williams said. “But we don’t test very many bats. About ten percent of the bats that we test are positive. But that doesn’t mean much. How many people just throw the bat in the garbage. To get an idea of a population incidence, we would need to capture and test a bunch of bats from around the state. The funds for that sort of process are not available. And we would have all sorts of bat lovers down on us for doing that. So, that’s not going to happen unless we were to get into a lot of human cases.”

We sent a message to the high school to have Sudie drop by the clinic after school.

I think she snuck out early because she was waiting to talk with me at three in the afternoon.

“The bat was positive for rabies,” I said. “Luckily, the cat was current on her vaccines, so the only thing we need to do is booster her rabies vaccine early. You, Frank, and the kids are fine, with no significant exposures.”

“Why were you asking about the kids being asleep?” Sudie asked.

“The public health folks consider it a rabies exposure if a bat is loose in the house with sleeping children,” I said. “If the bat is captured and tests negative, they are okay. If it tests positive, the kids have to get shots. If the bat escapes and is not tested, the kids must get shots if the public health folks know of the incident. Those shots are serious things. Some of the side effects, although very rare, can be serious. The problem is rabies is a fatal disease. So any possible exposure has to be taken seriously.”

“We had bats in the house all the time when we were kids,” Sudie said.

“So did we, Sudie,” I said. “We even kept a tennis racket in the upstairs bedroom for that reason. We were just lucky, I guess.”

Photo by Peter Scott on Pexels.