Driving Blind, From the Archives

D. E. Larsen, DVM

This was one of extra busy days in the middle of July. The appointment book was full. Most of the problems were flea problems. I always became weary of discussing the flea life cycle with folks. We were trying to put out the fire that should have been controlled last winter.

I noticed Ed sitting out in the reception area. He had a small dog on his lap. I knew Ed from my days bowling for the Elks Club team in the Thursday night men’s league. Ed was older, probably in his 70s, balding, and he wore thick glasses. He was short and stocky and somewhat rounded by the years.

“What’s up with Ed,” I asked Sandy as she was passing on a run? 

“He has a flea problem with his dog, but no appointment,” Sandy said. “I told him we would try to work him in, but we were booked solid today.”

I stepped back into the exam room and started my rehearsed spiel on flea control. Flea control was difficult to impossible if folks had not been working at it all year round. When the heat of July and August hit, the fleas hatch from everywhere. They just about eat the poor dogs and cats alive.

“This is a typical case of flea allergy dermatitis,” I started. “The hair loss and the skin lesions are back here by the tail. It doesn’t take much looking to see the fleas scatter.”

I spread the hair on the dog’s back, and fleas ran in all directions. I turned her over and showed a dozen fleas on his belly.

“The flea collar doesn’t do a lot of good at this point,” I said. “His little cloud of protection is a few feet behind him as he runs around the house.”

“There are no fleas in my house, Doctor,” Mrs. Jones said flatly.

“This time of the year, fleas are everywhere. Getting them under control is difficult. It requires flea bombs in the house and flea dips on the dog. And then, the process needs to be repeated every week for several treatments. Sometimes we need to use a yard spray also.”

“I don’t have fleas in my house,” Mrs. Jones repeated. “We had to sit out in your reception area for almost 15 minutes today. That must be where all these fleas came from.”

“I can give you some medication that will help the skin, but without flea control, Chloe is going to have a bare tailhead until winter. If you would like, I can give you a referral to a veterinary dermatologist in Newberg.”

At about this time, I hear a big commotion in the reception area. I excuse myself for a moment. I get a brief respite from Mrs. Jones.

Ed is up on his feet and arguing with Sandy and Ruth.

I step out to the reception room. Ed is red-faced and clutching his little dog tight enough that his eyes are bulging a little.

“Doc, damn it, I have been sitting out here for 15 minutes, and this lady comes in, and they take her back before me. It is my turn.”

“Ed, Sandy told you we would try to work you in. We have a solid book of appointments this afternoon. That lady had an appointment. My policy is to see appointments on time if possible.”

“Damn it, Doc, I am telling you, it ain’t fair,” Ed said.

Now I was a little upset. I took a step toward Ed and pointed to the door.

“Ed, the door is right there, don’t let it hit you in the ass as you leave,” I said. “The next clinic is about 19 miles down the road.”

“No, I don’t need to do that,” Ed said, holding his hands out in defense of my approach. “I just wanted to make sure I was not being slighted by the girls. I will wait for my turn.”

Ed returned to his seat, and I returned to Mrs. Jones, probably not in the mood to discuss where Chloe’s fleas came from. I am sure everyone in the clinic had heard the altercation.

“I don’t need a referral,” Mrs. Jones said. “You can fix me up with what I need and see how it works.”

That was a lot easier than I expected, and it allowed us enough time to get Ed into an exam room.

When I finally got to Ed, we were both apologetic. We treated his little dog with fleas, along with most of the other dogs that day.

Several months later, Ed and his wife were in the clinic at a much quieter time. I had ample time for some casual conversation.

“Are you still bowling, Doc,” Ed asked?

“No, I have an old football injury to my left knee and figured I better give it up,” I said.

“I had to give it up, too,” Ed said. “My vision got so bad that I couldn’t see the pins at the end of the alley.”

“That would make it pretty difficult,” I said.

“Yes, and I don’t drive,” his wife said. “So when he is driving now, we drive the old pickup with bench seats. I sit really close to him, sort of like when we were teenagers, and I tell him what is coming down the road.”

“That sounds a little dangerous,” I said. “You guys maybe should get some help before you are in a wreck.”

“It works okay right now, Doc,” Ed said. “Our son is getting his job changed around, and he is going to move his family in with us pretty soon. Things will be better then, and I won’t be driving so much.”

“Okay, that sounds better, but you need to be careful out on that road.”

Photo by Carlos Esteves on Unsplash

Splints for Scruffy 

D. E. Larsen, DVM

Hugh and I were walking out to the small pig pen beside their small barn. The pen held a large sow with a litter of eleven piglets about five weeks old. The reason I was here was because now there were only ten piglets. One had been found dead this morning.

Scruffy, a ragged cross between how many breeds, I don’t know, but he was the size of a Corgi, but that was his only similarity to that breed. He was constantly underfoot on our walk to the pig pen. He would constantly try to brush against my legs as we walked along.

“Scruffy, you’re going to either trip me or get stepped on if you don’t knock it off,” I said.

“He does that to every visitor he likes,” Hugh said. “He just trying to get petted.”

We stopped at the low fence around the pig pen. Hugh had pulled the dead piglet out of the pen this morning. The pen looked small for all the piglets, the dirt had dried, but you could, but from all the dry mud on the sow and the piglets, it had been mostly mud not long ago.

“The wife thought I shouldn’t worry about this guy,” Hugh said as he placed the piglet on an old set of boards they had set up on a couple of saw horses. “She thought the sow probably laid on him, but I want to make sure there isn’t something else going on that we need to take care of.”

“These guys are older than the piglets who get laid on by the sow,” I said. “They are big enough and active enough to get out of the way. Let’s open this one up and see if I can see anything.”

I opened the piglet with a long incision from his chin to his pelvis and spread the ribs wide. With a quick glance, it was obvious that this piglet died from migrations of roundworm larvae.

“Hugh, you can see his liver is covered with white spots, and his lungs are congested,” I said. “This guy died from larval migrations. We need to worm this whole group, both the sow, and piglets, and get them out of this pen and out on pasture.”

“I always thought the worms were just in the gut,” Hugh said. 

“That is where they end up,” I said. “When an infective egg is ingested, it hatches in the gut and migrates from the gut, through the liver, and into the lungs. Then the larva is coughed up and swallowed back into the gut, where it becomes an adult worm. It is sort of a numbers game. The body can handle the damage if there are only a few worms. If there is a bunch, this is how things end up. The problem is the dewormers we have now only kill the worms in the gut. That needs to be done, but if you have another pig or two who looks like this inside, you might find them dead. But we can stop any additional exposure by worming everybody and getting them out of this pen.”

I fixed Hugh up with what he needed to deworm the pigs, and he had a small pasture he put them into. I patted Scruffy on the head and headed back to the clinic.

***

The following week Hugh was in the office waiting to talk with me. I figured he had lost some more piglets.

“How are your pigs doing?” I asked.

“Oh, they are doing great,” Hugh said. “I think they are really growing now, and they have had no other problems. I’m here today about Scruffy. He must have gotten out on the road last night. He’s sort of broken up this morning.”

“Did you bring him with you?” I asked.

“Yes, he is in the car,” Hugh said. “But Doc, we are really short on money right now. I wanted to make sure it would be okay to charge things for a bit. Otherwise, I will just have to put him out of his misery.”

“Hugh, good clients can always charge here,” I said. “Bring him in, and let’s get a look at what’s going on with him.”

Hugh carefully laid Scruffy on the exam table. Even being banged up, Scruffy looked at me with bright eyes, and his tail seemed to play a tune on the tabletop as it wagged away.

“I think he has a broken leg,” Hugh said.

I looked over Scruffy with him licking my forearm every time it came within his reach. His skin wounds were superficial. What we like to call road rash, just deep scrapes from being bounced off the pavement. His major problem was his fractures. Scruffy had fractures on both front and rear legs on his right side.

“Hugh, Scruffy has two broken legs,” I said. “Everything else is superficial, and I think we can repair both of these fractures with some surgery.”

“Doc, we are on a really tight budget,” Hugh said. “There is just no way we can pay for any surgery for Scruffy. Is there anything else you can do?”

“These fractures are both on his lower legs, so we could splint them,” I said. “A splint works pretty well on one leg. Dogs will learn to get around so well that sometimes they will wear right through the splint rods. But I have never tried to splint two legs. The legs will heal, but you might have a lot of nursing care during the month or two of healing.”

“That will be a lot cheaper than surgery, won’t it, Doc?” Hugh asked.

“Oh, yes,” I said. “A lot cheaper than surgery.”

“That’s what we will do then,” Hugh said. “If Scruffy becomes too much of a burden, we will just cross that bridge when we come to it. When can you do this?”

“We will work him into the morning schedule,” I said. “You can plan on picking him up this afternoon.”

We sedated Scruffy, but I would guess that I could have put his splints on with him awake. He acted like everything was fine throughout the entire process.

Thomas splints are easy to apply, but the splints are longer than the opposite leg. When dealing with one leg, dogs adapt to the splint very quickly. Often walking well the first day and acting like the splint is part of them by the third day. I was unsure how well Scruffy would adjust to having two legs in a splint.

When Scruffy woke up from his sedation, he had some difficulty just getting into a sternal position. He ended up with both splints splayed out to the right side. He looked and acted uncomfortable. But when Hugh came to pick him up, he was all happy, licking Hugh’s face when he picked him up, and his tail never quit.

“When do you want to see him again, Doc?” Hugh asked.

“I usually recheck these splints at the first week and every two weeks if everything is going okay,” I said. “You need to keep it clean and dry. I would guess that Scruffy will need some help, especially with his urination and BM. Let me hear from you if you have any problems. And for Scruffy, I would like to look at him Monday, just to make sure he is adjusting to his situation.”

***

On Monday, Hugh packed Scruffy into the clinic. Scruffy greeted everybody. He was back to his happy self.

“This guy is doing great,” Hugh said. “He had some struggles Friday night but was up on all fours when we got up Saturday. The only thing is his right legs are longer than his left legs now. So he sort of goes in circles to the left. But he gets where he wants to go eventually. We are embarrassed to say that we laugh at him now.”

We took Scruffy into the back of the clinic and set him down on the floor. When I called him, sure enough, he made a tight circle to the left and tried jumping up on my knees.

“You know, Hugh, I think he knows geometry better than most people I know,” I said.

Scruffy continued to do well, and we removed his splints after six weeks. His fractures were well healed, and he had to relearn how to walk in a straight line again.

Photo by Frágil y fugaz on Pexels.

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.