D. E. Larsen, DVM

I was in the back room cleaning up from my morning farm calls. I had been in Enumclaw for a little over a year, and my portion of the practice was steadily growing. Today was a fairly typical Monday. The morning was spent on herd health work with two or three dairy herds, followed by a full afternoon schedule of office calls at the clinic.

I was hoping to have time today to run home for a quick lunch with Sandy and the girls. Sandy was over seven months pregnant, and I liked to be able to check on her during the day.

Just as I was pulling my shirt back on, Kathy popped her head through the door from the front of the clinic.

“Oh, good,” She said. “I see you’re ready to go to work.”

“I was hoping I had time to get a quick lunch,” I said.

“No such luck, Cheryl is on her way with her young tomcat,” Kathy said. “You should remember her. She is the one you tried to convince to have her cat neutered. He was that young orange tomcat you gave vaccines to a few months ago.”

“Yes, I remember, she was a pleasant young gal,” I said. “But sort of stubborn, I guess the cat still isn’t neutered.”

“That’s the one,” Kathy said. “She is pretty excited. I think Leo must be pretty sick.”

Kathy was right. Just as I stepped into the front of the clinic, Cheryl pulled into the parking lot. I watched as she rushed around and wrestled a large cardboard box out of the back seat. Plastic cat carriers were not common in 1976.

Cheryl was out of breath when she pushed through the front door.

“I think he is almost gone,” Cheryl said, as Kathy took the box from her. She followed us into the exam room.

Kathy placed a fleece pad on the exam table, and I lifted Leo out of the box and placed him on the padded table top. He was limp as a dishrag.

The instant he hit the table, he went into a seizure, and then he was gone.

Cheryl watched, horrified. “Oh, my gosh, what could have happened to him?” Cheryl asked. “He seemed fine yesterday.”

I raised Leo’s lip and then opened his mouth. His membranes were ghost white. Running my hands over his body, there was no evidence of any trauma.

“He has been in the house the last few days,” Cheryl said. “He couldn’t have been injured.”

“Give me a few minutes,” I said. “I will get a drop or two of blood and get a look at it. You can wait out front if you like.”

The Clinic in Enumclaw was not really set up to accommodate small animal clients. Historically, it was a dairy practice that took care of dogs and cats as an afterthought. After my arrival, the small animal practice began to expand a bit. Some of that was because I made an effort to be available in the afternoons. Being part of a younger generation in veterinary medicine may have also influenced the practice’s growth.

As soon as Cheryl left the exam room, I drew a small sample of blood from Leo’s jugular vein. It looked like red water. I was certain this was a Feline Leukemia death.

Sure enough, Leo’s blood showed a packed cell volume (PCV) of 6%, not compatible with life, and the blood slide was covered with abnormal lymphocytes. Quick chair-side diagnostics for feline leukemia were not available in 1976, but this was all I needed for the diagnosis in a dead cat.

I stepped out and motioned for Cheryl to return to the exam room.

“Leo died of Feline Leukemia,” I said.

“I feel so guilty,” Cheryl said. “Could we have done something for him if I had gotten him here earlier?”

“Cheryl, this disease is killing a lot of cats these days,” I said. “We lose cats every week. Had we seen him yesterday or the day before, we might have bought him some time with a blood transfusion and some medication. But the outcome would not have changed, and the transfusion only would have bought him a few weeks or a month or two at best.”

Cheryl carefully loaded Leo back into his box.

“At least I can take him home and bury him under his favorite tree,” Cheryl said as she headed out the door.

“That’s so sad,” Kathy said. “I wish there was something that could be done for these cats.”

“They’re working on it,” I said. “But it will be while.”

***

It was late in the day on Wednesday when I noticed Kathy hang up the phone and look at me with concern all over her face.

“That was a new client,” Kathy said. “She is on her way, she said five minutes. It sounds just like another Leo.”

It was less than three minutes when Marie came through the door with a cat carrier. She was in tears.

“I think he just died,” Marie said, the tears streaming down her face. “It happened so fast. He seemed fine this morning, and when I got home from work, he was stretched out on the front steps, unable to move. He had a seizure or something just as I pulled into the parking lot. There was a terrible ruckus in the carrier. And he looks dead to me.”

Kathy placed the carrier on the exam table, and I removed the cat.  A young orange tomcat. Sure enough, he was dead. One didn’t need a degree to determine that. I opened his mouth; no color to his membranes. There was no evidence of any other injury.

“He even looks just like Leo,” Kathy said.

“What do you think happened to Nacho, Doctor?” Marie asked.

“I could do some blood tests if you want, just to be more accurate in my guess, but I would I would guess he has feline leukemia,” I said.

“How did he get something like that?” Marie asked.

“It is caused by a virus. It is a common problem around here,” I said. “A young tomcat like Nacho could have easily gotten it from a bite wound from an infected cat. Sometimes the virus is passed from an infected mother to her kittens, either before or after birth. Some cats will live a long time with the virus, others, like Nacho here, not so long.”

“Could you have helped him if I had brought him in this morning?” Marie asked.

“We could have bought him some time,” I said. “Not much, maybe a week or two. Do you want me to do some blood work on him now?”

“No, I don’t need to be spending any more money on a dead cat,” Marie said as she placed Nacho back into her carrier. “Thank you for your information.”

Marie paid her bill and left with Nacho. I don’t think I saw her again.

***

Early Friday afternoon, the scene repeated itself one more time. Three leukemia cats in one week seemed a bit much. This time, it was a good client, Ellen, with Sunshine, whom we had seen many times in the last year.

Ellen came flying through the door carrying Sunshine wrapped in a towel. 

“I didn’t have time to call,” Ellen said. “Sunshine was flat out on the kitchen floor when I got home a few minutes ago. I think he is dying.”

We directed Ellen and Sunshine into the surgery room where we had an open table. She carefully laid him down on the table.

“I have been sick with worry all week,” Ellen said. “I talked with Cheryl on Monday, and then Marie called me last night. Leo and Nacho are both brothers of Sunshine, all from the same litter. Then I called Mrs. Wilson. She said her momma cat seems to have kittens that don’t live very long. Cheryl said you told her Leo could have gotten the virus from his mother. I am just sick over all of this.”

I carefully looked at Sunshine. I had vaccinated him as a kitten, neutered him at six months of age, and then saw him for his annual exam. He was a friendly, neutered male cat. It was easy to recognize why Ellen was so distressed by his pending death.

I opened Sunshine’s mouth. His membranes had no color. I tried to respond as I stroked his head and back, but he did not have the strength to raise his head off the table. I was as gentle as possible, trying hard to keep from inducing a seizure that would end his life.

I clipped a foreleg and prepped it so I could place a catheter.

“Ellen, I am going to place a catheter in his leg,” I said. “That is going to allow me to collect a blood sample, and if we are lucky, we will be able to give Sunshine some blood. There is a risk here. Sunshine is very fragile right now; he could die at any moment. If he struggles at all, he could die.”

“I understand, Doctor,” Ellen said. “Cheryl told me her story. It must have been horrible to watch.”

“You are welcome to wait out front,” I said. “This is going to take some time. If I can place the catheter, and if the blood shows what I suspect, then I will collect some blood from our donor cat. This might take half an hour.”

“That’s fine, Doc,” Ellen said. “Sunshine will rest better if I am here with him.”

“If I can get some blood into him, his response will look like a miracle to you,” I said. “But you have to understand, this is only going to buy him a few weeks. Maybe a month or two if we load him up with some medication.”

“I will make those weeks the best weeks of his life,” Ellen said. “I can promise you that, Doc. Go ahead and try, we will take any time you can buy.”

With Ellen petting Sunshine and murmuring into his ear, I was able to place the catheter and collect a small sample of very watery-looking blood.

Sunshine’s PCV was 8%, which may be why he was still alive, but it was still marginal. There were many abnormal cells on the blood slide. I headed to the back to retrieve our donor cat.

I sedated the donor and collected just over a hundred ccs of blood in two heparinized syringes.

“How long is it going to take to give him that blood?” Ellen asked.

“Sunshine does have time to have it dripped into his vein,” I said. “I am going to give it out of the syringe, as a push. It will only take a few minutes. Prepare yourself for a miracle.”

I started with the smaller syringe, pushing the plunger of the thirty-five cc syringe at a slow, steady pace until it was empty. Sunshine blinked his eyes and shook his head. Then, with Ellen’s help, he righted himself to his sternum.

I started with the larger syringe of seventy ccs. By the time that syringe was empty, Sunshine was licking at his catheter and Ellen’s hands. Now the tears came, Ellen gave me a hug, and sobbed out a thank you.

I gave Sunshine a large dose of dexamethasone and removed his catheter. 

“Okay, remember what I said, this is only going to last a few weeks,” I said. “Let me look at him on Monday.

Ellen wrapped Sunshine in his towel and put him on her shoulder, wiped her tears away, and worked her way through the now crowded waiting room.

“We will see you on Monday, Doc,” Ellen said as she exited.

***

It was almost three weeks to the day when Ellen returned with Sunshine and requested euthanasia.

“He had a great three weeks,” Ellen said. “But I can tell it is time, he hasn’t moved from his bed for two days now. We want to thank you again for that extra time.”

Photo Credit: Daniil Kondrashin on Pexels.

D. E. Larsen, DVM

Dee, actually DeLaine, was our third daughter. Her first-grade teacher was Mrs. Looney at Hawthorne School in Sweet Home.

During the summer between her first and second grade, we moved to a different house on the eastern side of Sweet Home, a short distance from the city limits. That meant the kids had to change schools to Foster School.

But the change was a little easier for Dee since her second-grade teacher was Mr. Looney. I was on the school board at the time, which allowed me to exert some subtle pressure on teacher selection. 

Anyway, it was an easy transition for all the kids. Our oldest daughter, Brenda, was in Junior High School, so she was not affected by the move. Amy, our middle daughter, was a very good student, and the change caused her no problems. Good students do well under any circumstances. Our son, Derek, was not in school yet.

The school year started, and things seemed to be going pretty well. The clinic was busy, and I probably didn’t pay much attention to the goings on at school. Foster was considered to be one of the better elementary schools in the district, if not the best.

Then came our first parent-teacher conference. For the most part, these were pretty routine. The kids were always at the top of their class, an asset to have in the classroom, and there was nothing else to say.

But our conference with Mr. Looney was a bit different this time. 

“Dee is doing well,” Mr Looney said. “That is everywhere except in her reading group. I have her in the highest group, but she is lagging a bit, and I am considering moving her to the next group down. What do you think of that idea?”

Sandy and I exchanged glances. This was new to us. We had never had to make any decisions about the girls’ education before.

“Just what does that mean?’ I asked, with some concern in my voice.

“It’s not a major change,” Mr. Looney assured us. “The second group is still pretty good readers; they just seem to read at a slower pace.”

“How close are you to making that change? I asked.

“There is no urgency. I just want to do what is best for Dee.” Mr. Looney said.

I scratched my chin and glanced at Sandy again.

“Give us a couple of weeks, and let me see is get her a little more involved,” I said. “Do you have any competition within the groups?

“I keep track of where they are in their assignments,” Mr. Looney said. “It is not a real competition, but the kids can check their standings if they want. Right now, Dee is the lowest in the group of eight students.”

“Okay, I’ll check back with you in a couple of weeks,” I said as we stood up to leave.

Sandy looked at me as I started out to the car. 

“What are you thinking?” Sandy asked.

“I’m thinking that Dee will do better if she is in competition with the rest of her group,” I said.

“How do you instill competition in Mr. Looney’s classroom without his help?” Sandy asked.

“I’ll have a plan worked out in my mind when I talk with Dee,” I said.

The following evening, after dinner, I started a discussion with Dee.

“Mr. Looney said you are at the bottom of your reading group,” I said. “Do you have trouble with your reading?”

“It’s no big deal,” Dee said. “Bobby is the best reader, and he brags about it all the time. I doesn’t matter to me.”

“So, I have a deal for you,” I said. “You get to the top of your reading group, and I will give you twenty dollars. But here is the rest of the deal. You can’t tell anyone about our deal. Not Mr. Looney, and not anyone else in the class.”

Twenty dollars was a lot of money for a second grader in 1980. I could see the wheels turning in Dee’s head.

“A twenty-dollar bill?” Dee asked.

“Yes, but the deal is off if you tell anyone,” I said.

Sandy was not impressed with my deal. If we had any disagreements about raising the kids, it was typically of this nature. Sandy strongly believed that everything should be balanced between the kids. If you give something to one, you give it to all. I believed that you gave a push to whoever needed it.

Most of the time, I gave in to Sandy’s thinking, but this time I stood firm.

***

I was in Foster school a couple of weeks later and bumped into Mr. Looney in the hall.

“I don’t know what you did, but Dee is doing a whole lot better in her reading,” Mr. Looney said.Ω

“So you are going to leave her in the top group for now?” I asked.

“Oh, yes, she is in the middle of the group,” Mr Looney said.

It was a few weeks later when I talked with Dee about her reading.

“Mr. Looney said you were doing better in your reading group,” I said.

“Yes, I have almost caught up to Bobby<“ Dee said. “He is getting worried.”

***

A few weeks later, Dee was at the top of her reading group. I stopped in to see Mr. Looney, not to double-check on Dee’s standing, but to see what he thought of the tactic.

“Dee was tickled when she made it to the top of the group,” Mr Looney said. “I was wondering what was going on. Last week, she was checking the standings every day. When she made it to number one, she said, ‘Great, I get twenty bucks!’”

“What do you think of how that happened?” I asked.

“Whatever works, I guess,” Mr. Looney said. “Now that I look back on it, the competition between the kids got everyone doing better. I am thinking that I am going to have to come up with a plan to try to keep the competition going.”

***

Once Dee experienced being at the top, she never looked back. All our kids were highly successful in school. Sort of making their father look like a dunce when you compared records.

Dee graduated from High School as the salutatorian  of her class. She got a B in typing. She typed 110 words a minute after the first semester, and never improved on that during the second semester. The teacher graded on improvement, so Dee got her B.

At Oregon State, she was named to the Pac-12 Scholar-Athlete Team in rowing. She earned a BS and then a Master’s degree in genetics. Ultimately, she earned a PhD in Neuroscience from the University of California, San Diego.

Not a bad purchase for twenty bucks.    

Photo Credit: kaboompics.com on Pexels

D. E. Larsen, DVM

A warning: This post is inspired by a bit of politics. Something I seldom address, but I have a few points to help people understand some of the difficulties “experts” have in making vaccine decisions.

1) The Polio vaccine

I was going on a long trip with my grandparents in the summer of 1956. Polio was a major infectious disease at that time. The polio vaccine had been released in 1955, and they insisted on my vaccination. In 1913, they had lost a nephew to polio. He died twenty-four hours after diagnosis. I don’t know, but I suspect that my grandparents paid for the vaccines.

I was lucky that the trip had not been in 1995. That year, Cutter Laboratories released a batch of vaccine that had been produced with a manufacturing defect and contained live poliovirus. This caused 40,000 cases of polio, with some 400 children paralyzed and ten deaths. The link below allows you to read the full account. I encourage you to read it.

The polio vaccine was reworked, and controls and testing were instituted. The vaccine was needed, but it needed to be safe.

2) The veterinary Pasteurella vaccine.

The Pasteurella vaccine, a killed bacterin, was first introduced for cattle in 1949 – 1950. Pasteurellosis was a leading cause of death in pneumonias and played a significant role in shipping fever.

This vaccine was the most used vaccine in cattle for the next thirty-some years. In veterinary school at Colorado State, I was told by Dr. Pearson to never use this vaccine. Dr. Pearson was highly respected and a master cow doctor.

“This is a terrible vaccine,” Dr. Pearson said. “You should never use it. In fact, I would suggest that you decline service to any herds that are using this vaccine.”

I followed Dr. Pearson’s recommendation to the letter, turning down at least one herd when the owner would not discontinue the vaccine.

Sure enough, in the early 1980’s, research told the world the the vaccine did more harm than good. 

Shipping fever was so severe because the immune system of the cow would send many white blood cells into the lungs to fight the infection. The white blood cells would engulf the bacteria, which would then kill the white blood cells. The accumulation of dead cells in the airways worsened the pneumonia.

The vaccine made it easier for the white blood cells to engulf the bacteria. This actually led to making the pneumonia much worse.

I was at a state veterinary meeting in the early 1980s, seated at a table with a group of young veterinarians. One of the new doctors from the new veterinary school at Oregon State University stopped by to speak with us.

He wanted our opinion on the new research and on our use of the vaccine. I was the only one at the table who did not use the vaccine.

With thirty years on the market, it was apparent that the veterinarians and experts could not recognize the problem with the vaccine.

The vaccine was withdrawn, and over the following two years, it was reworked and reintroduced. I never did use the vaccine, even in its new and improved version.

3) Feline Leukemia vaccine.

The feline leukemia vaccine was released in 1984. Before the use of the vaccine, I would see cats come to the clinic and die every week. Sometimes daily.

One week that stands out in my memory, I saw three eighteen-month-old cats come to the clinic and die on the exam table from the stress of the trip in their weakened state. They were all young male cats of the same color. When the third one came to the clinic, I finally questioned the owner. Those three cats were all from the same litter. 

That was a common event in those days. In my first years of practice, confirming a diagnosis was difficult, and treatment options did not exist. Today, diagnosis is easy, but treatment options are few.

Before 1984, the average age of cats was seven years. I never saw a male cat over fifteen, and females over sixteen were rare. Now that average age is around fifteen, and cats in their twenties are common.

When most of my patients were vaccinated, I rarely would see a case of feline leukemia. Cases went from one to three a week to two or three a year. Problem solved, right?

After a couple of years of use, there were reports of fibrosarcoma tumors at the injection site of the vaccine. These were reported to be occurring in about one in 20,000 vaccinations.

It would take me a long time to do 20,000 vaccinations in Sweet Home. But we made the recommended adjustments in giving the vaccine. It was in the early 1990s before we saw our first tumor. As reported, it was difficult to manage. 

We removed the tumor twice, but each time it came back, it was more aggressive than before. The owner elected euthanasia.

One cat lost from the vaccine over six or seven years, compared to a hundred cats lost to the disease every year, seemed like a good trade to me.

The location where the vaccine was administered was changed. Changing it to the left hind leg, low on the leg. I mentioned the tumor, but still strongly recommended the vaccine.

Over the following years, we would see a tumor every two or three years. To me, this meant the incidence was much more frequent than one in 20,000. But the results were still better than looking at a dead cat every week.

The vaccine manufacturers started covering the treatment cost for the tumors that did occur. Initially, if the tumor was large, an amputation was recommended. That would be life-saving in most cases. Later, I would see good success in removing the tumor if I got to see it soon enough.

Now there are few veterinarians who were in practice prior to 1984. The incidence of feline leukemia is very low. Cats are often kept indoors only, or at least mostly. Vaccine recommendations place the feline leukemia vaccine low on the list, and probably rightfully so.

My concern is that the virus is still around, especially in feral cat populations. If I were still in practice, I would give the client the information and allow them to make the decision. If it were my cat, I would vaccinate it, unless it were kept indoors only.

The vaccine is still on the market. The benefits outweigh the risks.

Photo Credit: My daughter, DeLaine Larsen. Cats are Wishbone and Crystal. They are KATA Alumni. KATA was a kitty rescue group in Sweet Home. Wishbone and Crystal live in San Francisco. We delivered them 12 years ago. When we picked them out, we entered an old chicken coup holding twenty or thirty kittens. These two climbed up my pants leg, so they got selected. I am certain they are littermates, but who knows for sure.  

The Cutter Incident: How America’s First Polio Vaccine Led to the Growing Vaccine Crisis

https://pmc.ncbi.nlm.nih.gov/articles/PMC1410842/