The High Price of New Drugs 

D. E. Larsen, DVM

Dolores pushed the door open and walked into a crowded pharmacy. She held Gary a little tighter as she squeezed her way through the people. It was a little unusual to see so many people in Sempert’s Drugstore in the middle of the morning.

When she got to the counter, she handed the prescription to the clerk behind the counter.

“The doctor said this might be expensive,” Dolores said. “I guess I need to know how much it will cost before filling it.”

“Sure, just a moment, and I will have Frank check it out for you,” the young clerk said.

A couple of minutes later, Frank, the pharmacist, came up to the counter.

“Good morning, Deacon. How are you today?” Frank asked.

“I am fine, but this little guy is not doing so well,” Dolores said. “The doctor said he has tonsillitis. He also said this new drug would work like magic to make him well.”

“Yes, it seems to work like magic, alright,” Frank said. “but it is a little expensive.”

“That is what the doctor said,” Dolores said. “I just need to know how much it will cost before I have you fill it.”

Frank looked around the crowded store. Several ladies were listening to their conversation now. Frank wrote the figure on a slip of paper and pushed it across the counter to Deacon.

“There is the cost, Deacon,” Frank said. “I wish it was less. If it is a problem, we could put it on an account for you so you could pay it over several months.”

Dolores picked up the slip of paper and looked at it. Her mouth fell open, and she looked at Frank with a questioning expression. Tears were welling up in her eyes.

“Yes, Deacon,” Frank said. “These new drugs are expensive.”

“But this is a month’s wages for my Frank,” Dolores said.

“Like I said, I can put it on an account for you,” Frank said.

“No, Frank wouldn’t like to do that,” Dolores said. “I will go talk with Mom and Dad and see if they can help us out with this. Frank won’t like that either, but I can’t let Gary suffer if this will make him well.”

“Okay, but I am going to fill this anyway,” Frank said. “If your folks can’t help, we will just put it on a card in my file, and your Frank won’t have to know a thing about it.”

“I will be back in an hour or less,” Dolores said as she pushed through the thong of people behind her. A tear fell down her cheek as she opened the doors to the open air.

“Deacon, what in the world is wrong?” Lila, her sister, asked as they passed on the sidewalk. “My Lord, I don’t know how long it has been since I have seen you with a tear on your face.”

“Gary has tonsillitis, and the doctor prescribed a new drug for him,” Dolores said. “It is going to cost a month’s wages. I don’t know what we are going to do to pay for it.”

“Heaven forbid,” Lila said. “How can a drug cost that much? These are just crazy times.”

“I’m going to run out to the folks and see if they can help us pay for it,” Deacon said. “Frank won’t like that, but I don’t know what else to do.”

“I’ll follow you out there,” Lila said. “I can watch Gary for you while you return and pick up the medicine.”

It was a short drive out to her folks. Lilia tended to drive faster than Deacon, and she followed close behind.

“Mom, I took Gary to the doctor this morning. He has tonsillitis, and the doctor prescribed some medicine that is supposed to work like magic.”

“That’s good that they have something that works good,” her mother said. “Kids are miserable with that stuff.”

“The problem is it is very expensive,” Deacon said. “I hate to ask, and don’t tell Frank, but could you help us out a little?”

“How expensive are you talking about?” her father asked.

“It’s a month’s wages for Frank,” Deacon said. “I don’t know how long it will take us to pay for this medicine.”

“I’ll write you a check, and don’t worry about paying us back,” her father said. “No grandson of mine is going to suffer for want of a few dollars. And Frank doesn’t need to know anything about it.”

“I don’t know how to thank you,” Deacon said. “Lila will watch Gary while I run and pick up the prescription.”

Dolores handed the check to the pharmacist and clutched the sack to her chest.

“Deacon, this formulation is brand new, and I had to reformulate it a bit for Gary,” Frank said. “This only comes in a capsule, and I doubt you could get a capsule down him. This liquid doesn’t taste very well, and you might struggle to get it down him. You can mix it with some fruit, like a mashed-up banana. Anything like that should work.”

Back at the house, and with the help of Lila and her mother, Dolores prepared a dose of the new medicine.

“The druggist said it tastes terrible,” Deacon said. “Do you have a banana I can mash up and mix with it.?”

“Yes, I’ll grab a banana for you and mix some chocolate milk,” her mother said.

“How do you think we should do this?” Deacon asked.

“Maybe give it in several small bites,” Lila suggested.

“If it tastes bad, you will never get the second bite into him,” her father said. “He is a finicky little guy.”

Dolores put the quarter teaspoon of medicine into a small spoonful of mashed banana.

“Here, Gary, take a sip of chocolate milk,” Grandma said as she held the class for the little guy.

Dolores quickly followed with a spoonful of doctored mashed banana. Gary took the dose without problem but made a face as he swallowed it. Grandma quickly handed him the glass of chocolate milk.

After dinner, Dolores related the events of the day to Frank. 

“The medicine is expensive, but Gary is almost well after just one dose this morning,” Deacon said. “We need to get another dose into him this evening.”

“Expensive; what do you mean by expensive, Deacon?” Frank asked.

“It cost forty-three dollars,” Deacon said.

“Forty-three dollars, we can’t afford that,” Frank said. “Where did you get the money to pay for it? You didn’t put in on one of the cards that Frank Henry keeps in his box, did you? “

“Dad wrote a check for me,” Deacon said. “He doesn’t want us to pay him back.”

“How can they charge that much for a little bottle of medicine?” Frank said. “I have to work weeks for that much money.”

“They said it is brand new, and before now, it has only been available for the military,” Deacon said. “I guess it costs a lot to make.”

Epilogue:  

The year was 1945, and the drug was Penicillin. Just months earlier, it was only available for the military and for civilians with extreme emergencies. It was first formulated for oral use in February 1945.

My mother was named Dolores, but her childhood nickname, Deacon, given her by the Felsher kids, had stuck and was used by friends and family for her entire life. I never heard my father call her by any other name.

My brother, Gary, struggled with tonsillitis for some time before having them removed.

The median annual income in 1945 was $1400. A logger was probably on the short end of that figure. I have no data on Dad’s monthly wage, but Mom always said the $43 figure was a month’s wage.

Photo by Ron Lach on Pexels.

My First Foal Delivery, From the Archives

D. E. Larsen, DVM

“Doc, this is Sid, Stan’s brother,” Sid said into the phone. “I have to go to work, but I have a mare down in the middle of the field, just over the little creek. She has a foal stuck. I don’t know how long she has been at it, I just noticed her as I was leaving the house. I would sure be grateful if you could get out here and take care of her. My place is on Wiley Creek, the first driveway past Whiskey Butte. I don’t think you will have any problems with her since she is down. She is a gentle old gal. I will stop by your office when I get off this afternoon.”

I hated these 5:00 AM phone calls. I didn’t know Sid, but if he was Stan’s brother, he was probably okay.

“Okay, Sid, I will get out there shortly, so it doesn’t disrupt my day,” I said. “Some times, when a stranger comes, a down animal will get up and run. I am not going to chase her around a pasture if that happens.”

“That’s okay, Doc, I understand, just do what you can,” Sid said.

“Sometimes, when a mare is having some birthing problems, it is a major undertaking to get the foal out,” I said. “That could run up a large bill.”

“This is an old mare, I don’t want to have to sell the farm for her,” Sid said. “If it is going to be a big bill, you call Stan, and he can come out and shoot her.”

With that, I rolled out of bed and dressed quickly. I was hoping I could do this quick and get home for a shower before I had to be in the office. 

This is going to be the first time I have seen a mare in labor. I have been in practice for nearly 4 years. I had seen movies in school, but birthing difficulty (Dystocia) in the mare is rare. I had heard my share of war stories about disasters in the delivery of a foal. The mare’s contraction is so powerful there are stories of veterinarians breaking their arm when the mare contracted.

One night at a local veterinary meeting, I talked with one of the horse vets. I asked him what he did with a mare in difficulty.

“I call one of you cow doctors,” he said. “You guys are the ones who do a lot of delivery work.”

That gave me more confidence for this morning. I knew it would come one day. I just thought it would be for an audience. This morning will be like getting a hole in one when you are playing golf by yourself.

Sid’s place was not far from our house, one creek to the east. I knew the place, but I had not been on it before.

When I pulled up the driveway, I could see the mare out in the middle of the field.  Not even a fence post close to her.  And the ground was too wet for the truck, if she gets up, the call is over. She was a large, black mare. Probably a Percheron, just what I needed. This foal will be a big one.

I loaded everything I could think I might need in the bucket, added some water and picked up my calf jack, a Frank’s Fetal Extractor, and headed out to the mare. This was like doing a plumbing job, I will be two hundred yards from the truck, and there will be something I forgot.

Sid was correct about the mare. She raised her head to glance at me and then laid it back down. My guess was she had been pushing for some time and was exhausted.

I wrapped her tail with some VetWrap and scrubbed her rear end well. I could see a nose, and both hooves poking out of the vulva. The hooves were massive. This was a large foal.

I attached nylon OB straps on each hoof. My thinking was this guy had an elbow lock. The elbows get bunched up against the pelvic brim and prevent the mare from pushing the foal out. It is usually readily corrected. I pulled on one hoof and could feel the elbow pop up over the pelvic brim, and the leg was over a foot ahead of the other foot. I pulled the second hoof, and then we were ready to go. I hooked up the calf jack and started pulling the guy out of there. 

The head came out with no problem. I don’t know how long momma had been pushing on this guy. He was alive but not by much. A couple of more jacks on the handle and I was at the end of the bar. I don’t think I had ever been at the end of the bar when pulling a calf. And this foal has just popped his elbows out of the vulva. 

I moved the OB straps up to his elbows and started jacking again. This guy just kept coming. I was at the end of the bar again, and his hips were not through the pelvis yet. I was lucky that I had brought my long strap. I placed it around his chest and started again. Finally, his hips popped through the pelvis. 

I set the calf jack aside and pulled him the rest of the way out. What a foal, long, and as black as his mother. He was just as tired as his mother. He shook his head as I was trying to clear mucus from his nose. I would pick a calf up by their heels and swing them. There was no way I could do that with this foal. Not only was he too heavy for me to lift, but I would have to be on a stepladder to get his nose off the ground.

After treating his navel with iodine and giving him an E-Se injection, I turned my attention to the mare. I gave a soft tug on the fetal membranes, and they slipped out with no problem. They were intact, and there was no other trauma to the vulva and vagina. I gave her a dose of Oxytocin to get the uterus contracting and a dose of long-acting Penicillin. Then I removed the tail wrap.

She rolled herself up on her sternum and then jumped up. I think she was very relieved. This foal must have been a real weight to carry around. She immediately turns her attention to the foal. If I had a little help, I would try to get some milk out of her to give a mouthful to the foal. There was no way I was going to try that with a free-standing mare. 

I gathered my stuff up and headed for the shower, thinking this foal delivery stuff wasn’t so bad, after all.

At noon, I drove back to Sid’s place. The foal was up and chasing Mom around the pasture.


Photo credits to Jan Laugesen on Pexels

The Ugly Pinna Hematoma 

D. E. Larsen, DVM

Sandy came back and leaned through the surgery room doorway.

“Kevin is on his way to the clinic,” Sandy said. “I tried to slow him down, but he was pretty excited. Finn, his cow dog, has a hematoma on his ear. I told him you were still in surgery, but he said he would come and wait.”

“He thinks a lot of Finn,” I said. “I am almost done here, so he won’t have to wait long.”

I quickened my pace, and I was putting the last skin sutures in this cat spay when I heard Kevin come through the front door.

“Go ahead and get Kevin into an exam room and get Finn’s vitals,” I told Dixie. “I will finish here, and I should be there before you’re done.”

When I got to the exam room, Dixie and just finished with Finn. Finn was standing on the table, wagging the almost stub of a tail. He didn’t have a care in the world. 

I expected to see a grossly swollen ear flap, but I could only see a slight bend on the right ear tip.

“What’s going on with Finn today?” I asked Kevin as I pulled off my surgery gloves and extended a hand.

“He has a hematoma on that right ear tip,” Kevin said, pointing to the bent ear tip. “I had a dog years ago with one that started like this, and I let it go a couple of days, and the whole damn ear filled up with blood. It was a hell of a mess healing up, and that ear flap was wrinkled and ugly for the rest of his life.”

“Yes, these things can be a mess sometimes,” I said. “Especially if they are a few days old.”

“When they repaired the one on that old dog, they made a big slice down the middle of the ear flap and then sutured the whole thing like a quilt,” Kevin said. “It seemed like it took forever to heal.”

“This is one of those repairs that if you go to the book, there are a couple of ways to do it, and that slice is one of them,” I said. “That is how I was taught in school. But when you start reading the literature, there are many ways to do the job. When you see that happen, it is because everyone is looking for a better way. I have changed the way I repair those large hematomas. I still suture them like a quilt, but instead of one big slice, I take a number of punches out of the skin with a biopsy punch. That seems to heal a lot better than the old slice.”

“What do you think about this little one?” Kevin asked.

“These things are snap,” I said. “I don’t suture these at all. Depending on what caused the hematoma, I don’t even use general anesthesia if the ear canal is not infected. I usually just clip the tip of the ear, inject a little lidocaine for local anesthesia and take one punch with a four-millimeter biopsy punch right at the tip of the ear. Then I place a Dr. Larson’s Teat Tube into that hole made by the biopsy punch. This teat tube is self-retaining, but I usually place a single suture to secure it in place. Then I wrap the ear and the head, so the flap is held down.”

“And then I would suppose you will use one of those cone things,” Kevin said.

“I rarely use those things,” I said. “They just make you and Finn miserable. I maybe use a half dozen a year. A few things need them, but most of the time, they are more trouble than they are worth.”

“I suppose you get a cut out of using the teat tube,” Kevin said.

“I wish,” I said. “I different Dr. Larson. It has been on the market for a long time. They are useful in cows for many things, but they also work great in this situation.”

“When can you do this?” Kevin asked.

“Let’s go back to the treatment area right now,” I said. “This isn’t going to take very long, and Finn will go home with you.”

I looked into Finn’s ear with an otoscope to make sure there was no problem there. Finding a normal ear canal, I wondered what caused this hematoma.

“What do you think happened to this ear?” I asked.

“We worked a bunch of heifers yesterday,” Kevin said. “You know these dogs, they work the cows hard when they are in the corral. I would guess that he got kicked or something.”

Back on the treatment table, we clipped Finn’s ear flap and prepped it with Betadine surgical scrub. I injected the skin where I planned to take the punch of skin with some lidocaine and then injected the remainder of the lidocaine in the syringe into the hematoma.

After waiting a brief time, I took a four-millimeter biopsy punch and made a neat hole at the tip of the pinna. Fresh blood spurted from the hole, and I squeezed the hematoma and expressed some clot material from the hole. 

Then I inserted the teat tube, so the retaining prongs were inside the hematoma and removed the screw top from the tube.

“I have done these without any sutures, but I find they stay a little better if I just take one suture around the neck of this tube and tie it to the skin,” I explained to Kevin as I worked.

I placed the suture using fine stainless steel suture material. Then I put a pressure wrap on the ear flap and wrapped it to Finn’s head so he wouldn’t flap his ears.

“Let me see Finn next week, and we will take things off,” I said. “He should be good to go at that time.”

Finn looked a little funny heading out the door, but he and Kevin were happy to go home.

We unwrapped Finn’s ear the following week, and the hematoma looked resolved.

“Let’s leave it unwrapped, and I will leave that tube in place for a few more days,” I said. “Just to see that Finn isn’t flapping that ear a bunch.”

“This has been so much easier than the last one,” Kevin said. “I will bring him back in three days.

“This one was easier because we did it much sooner,” I said. “This teat tube thing doesn’t work well on a large hematoma. Mainly because you can’t get all the clot material out of the wound. That clot material causes these ears to crinkle up like with your last dog.”

Three days later, I removed the teat tube, and Finn’s ear healed to its normal appearance.

Photo by Jaxon Castellan on Pexels.