Prologue:  It has been a rough week for me. I have been having daily infusions of IVIG for my Myasthenia Gravis. The infusions take three or four hours, and the come in a set of five. Friday is my last one. This story is from the archives. First published December 16, 2019 and it fits the season.

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

D. E. Larsen, DVM

I was twenty years old, bouncing between school. It would be wrong to say I was struggling, but looking at my grades, you could draw that conclusion. 

In 1963, everyone graduating from high school with an aptitude for math was directed toward engineering. It had not taken me long to realize I wasn’t going to be an engineer. But if not an engineer, then what?

I had started at Oregon Technical Institute. Then, I transferred to Southwestern Community College, then to Colorado State University to try pre-veterinary medicine, and finally back to Southwestern Community College. You can sort of get the picture of a kid who didn’t know what he wanted to do but was having fun doing it.

In 1965, I was admitted to Oregon State University for the fall quarter. Because I spent too much money attending CSU, I decided to take the spring quarter off and work at the cheese factory so I would have plenty of cash for OSU in the fall. My major was still up in the air at that time; maybe zoology sounded good.

That spring, I started working full-time in the Safeway cheese factory in Myrtle Point. I had worked there part-time while in school and full-time in the summers since I was a junior in high school. It was an excellent job for a student. I made more money than working in a plywood mill, and it was much safer than working in the woods for a logging company. I could pay for all my college expenses with this job.

The thing I failed to consider in my well-thought-out plan was the fact that this was 1965. The military was in the middle of a buildup in troop numbers due to increasing involvement in the Vietnam War.

It was a month after I started working full-time that the letter arrived. When I came through the front door and set my lunch box on the kitchen counter, Mom handed me the letter, looking nervous.

“This came for you today,” Mom said.

I was twenty years old and not used to getting mail addressed to me. A note or two from girls in junior high and high school. Most of which I tended to ignore. But nothing that looked official.

This letter looked official; it was from the Selective Service office in Coos Bay.

I opened the envelope carefully and unfolded the enclosed letter. It was addressed to Mr. David E. Larsen. The writing that followed started simply,

“Greetings,” It said.

The rest of it was a blur in my memory, but basically, it said I had been selected and ordered to attend a physical exam to determine my qualifications for induction into the armed forces.

I set the letter on the table. Mom was still standing there, wringing her hands as she always did when nervous.

“I guess I didn’t plan on this,” I said. “I guess my student deferment doesn’t allow for time off to work.”

“What does it say?” Mom asked. “Can I read it?”

“It says I have to go take a draft physical next week,” I said as I handed Mom the letter.

So the Selective Service folks had my future etched in stone. I had a day off in a couple of days and used that time to travel to Coos Bay and talk with an Army recruiter. That was the best decision of my young adult life.

“Now that you have talked to me before taking your physical exam, you have the option to enlist rather than go through the draft,” the recruiter explained. “That allows me to give you some guarantees. I’m going to give you some handouts from a branch that’s looking for people like you. They want someone a little older than the average high school kid. Having a couple of years of college is a big plus. The Army Security Agency is probably right up your alley. You have to test well, but we will have that information after your physical. But if I can get you in with them, you will be pleased. The only hang-up right now is that they require a four-year enlistment. But, you know, that extra two years might save your life.”

The following Monday, I found myself standing out front of the Coos Bay Post Office with about twenty-five other young guys, waiting for the Greyhound bus that was going to take us to Portland.

The entire draft board came out the front door of the Post Office. The lady in the lead was carrying a stack of folders. She came right up to me and stopped. Then she shoved that stack of folders into my stomach.

“Here are everyone’s records,” she said. “Your in charge!”

“Who the hell elected me to be in charge?” I asked.

“Mr. Larsen, you are the oldest one here,” she said. “And you should know what that means. Your file will be at the top of the pile when we review the results. Now, when you get to Portland, you cross the street to the YMCA. They will have rooms ready for you. Everyone’s meal tickets are in these folders —take your responsibility seriously. We have a box for you to carry the records with, that way you won’t lose anything.”

The guy behind the lady stepped forward with a box and helped me load the records. We were no more than finished when the bus pulled up. We loaded onto the bus. Lucky for me, I got a seat near the front. It was going to be a five- or six-hour bus ride to Portland.

One guy from Powers sat with me. He had a fake ID and took orders, then made a trip to the liquor store during our quick lunch break at Taft (now Lincoln City). By the time we stopped at McMinnville, the bus driver threatened to kick us off the bus if I didn’t quiet everybody down. My first command position, I guess.

When we arrived in Portland, one of the guys was nearly passed out and had to be carried across the street to the YMCA. We laid him on the floor while everyone signed.

“Now, the guy on the floor has to sign in,” the clerk said.

“Can I sign for him?” I asked. 

“No, he has to sign,” the clerk said again.

So several of us lifted him up and helped him sign the paper. Then we carried him upstairs and laid him in the shower. That was another good decision, because it wasn’t long before he was vomiting.

We all had dinner in the cafeteria and a quick breakfast the following morning. Then, a brisk walk down the street, a couple of blocks to the induction center.

I don’t remember much about the day. The physical was a combination of individual exams, followed by a massive gathering of naked bodies around one room, where the doctors went down the line checking for hernias. “Turn your head and cough.”

Then everyone turned toward the wall. 

“Now, bend over and grab your ankles,” the doctor said. “Hold that position until we tell you to stand.”

The doctors stood in the center of the circle, checking everyone’s rear end. Once that was over, we dressed and started testing.

The room where the tests were given was crowded, and the windows opened to the street outside. There was a lot of street noise and exhaust fumes. It was a miserable time for a bunch of country boys.

After the testing was done, everyone loaded back onto the bus for the long ride home. We arrived in Coos Bay in the dark, and I had to work the next day. I had already lost two days of pay with this testing.

***

I passed the physical and I elected to enlist. I joined the Army Security Agency. The Army proved to be a good thing for me. I excelled in the environment, and had plenty of time to grow up.

After basic training at Fort Ord, California, I spent most of a year in training at Fort Devens, Massachusetts. Then I was in South Korea for thirteen months, followed by 18 months in West Germany. Most of my time in West Germany was on TDY pay, so I left the Army with a sizable chunk of change in my pocket.

I got out of the Army three months early to return to school at Oregon State. That first summer, I took a year of Organic Chemistry. I finished my degree with a BS in Zoology in June of 1971. I started Veterinary school at Colorado State University that September.

It was years later when I walked up the hill at Oregon’s Vietnam Memorial. The trail leads through multiple stations with long lists of the names of Oregon’s finest young men that didn’t come home. It was the last station, at the top of the hill, where I read the last plaque through moist eyes. That plaque said, “…Myrtle Point and Sweet Home gave more than their share…!”

I have always felt that that wasn’t the luck of the draw. They were fine young men, and I am sure they would have been the first to step forward.

Photo Credit: Sp4 Clarence Nishihara, Camp Humpherys, South Korea, May 1967.

D. E. Larsen, DVM

George was a large man, and he always seemed impatient. He was a retired police officer from California who moved to Sweet Home and built a new house out on North River Drive.

I had seen Charlie, his Corgi, on several occasions. Charlie was more enjoyable to work with than George.

“How long has Charlie been sick?” I asked.

“He didn’t eat last night,” George said. “I mean, not a bite. I tried to force him a bit, and he acted like he was going to throw up. Then this morning, he passed this foul-smelling diarrhea. Doc, I mean, I haven’t smelled anything worse, and all over my garage floor. He has never done that before.”

I lifted Charlie onto the exam table and placed a thermometer in his rectum. I just glanced over him as I waited for the thermometer. I picked up the skin on the back of his neck, and it was slow to return to normal, a little dehydrated. A couple of lymph nodes were swollen. I opened his mouth wide and looked at his tonsils. They were swollen and red, and his tongue was wrinkled from dehydration. 

I retrieved the thermometer. It showed a temperature of 104°. There was a drop of watery stool at the end of the thermometer. I quickly grabbed a microscope slide from the drawer and let the drop fall onto the slide.

“What do you think, Doc?” George asked.

“Give me a couple of minutes, George,” I said. “I need to get a look at this slide.”

“Come on, Doc, I was watching you. You already have an opinion,” George said. “I spent twenty-some years watching people. I know when they are keeping something to themselves.”

“George, when I see a dog who is not eating, has diarrhea, an elevated temperature, and swollen tonsils,” I said. “In my mind, that dog has salmon poisoning until I prove it otherwise.”

“No way, Charlie has never even seen a salmon,” George said.

“You want to know how many times I have heard that line?” I asked.

“Can bass cause it?” George asked. “I fish a lot. Foster Lake is full of smallmouth bass, and nobody fishes for them. So Charlie is in my boat a lot, but never a salmon.”

“This disease is carried by salmon, trout, and steelhead, not by bass,” I said. “If Charlie is out around the lake, or at the boat ramps, there are a lot of people who clean their fish and fish guts lying around. It doesn’t take much to cause an exposure.”

“Trout?” George asked.

“Yes, trout around here are usually infected,” I said. “It is a pretty complex disease. I will go over it with you after I get a look at this slide.”

“So, if you are pretty sure that this is salmon poisoning, why are you going to look at that slide?” George asked.

“You have a bit of a point,” I said. “The slide can confirm the diagnosis, and that’s important. But there is an old saying among northwest veterinarians that goes something like this: ‘If you see fish, you treat fish.’ Basically, what that means is I am going to treat Charlie like a dog with salmon disease, even if I don’t confirm the disease.”

“So, you are just padding the bill,” George said.

“If you want to look at it that way,” I said. “It’s only a couple of bucks, I could do it for no charge if you like, and add ten dollars somewhere else. It would still be a song compared to your bill at the hospital.”

I added a few drops of flotation solution to the slide, then slipped it onto the microscope stage. It only took a glance to see dozens of Nanophytes fluke eggs covering the slide.

Back in the exam room, I handed George a handout on salmon poisoning.

“That little sample is covered with fluke eggs,” I said. “Charlie has salmon disease. The good thing is, he is early in the course of the disease. Getting some IV fluids and a couple of injections into him, and he will be back to normal in no time. That is, in most cases, a dog will die from salmon disease, despite treatment. But that is rare.”

“While you were at the microscope, I was thinking,” George said. “Last week I  had a guy fishing with me in my boat. He caught a few trout. No, Charlie never ate one, but he did lick up some blood and stuff from the bottom of the boat. Do you think that could have done it?”

“It doesn’t take much,” I said. “I have seen sick dogs from when somebody hoses out a boat or the back of a pickup, and the dog licks up some blood from the driveway.”

“What do we do now?” George asked.

“Best thing is for you to leave Charlie with us overnight,” I said. “We will run a couple of bags of fluids through him, some IV doxycycline, and an injection to eliminate the flukes. I would expect him to be well in the morning, but once in a while it might take a couple of days.”

“Nothing about your place, Doc, but I really don’t want to leave him overnight,” George said. “Can we do this another way?”

“If you can leave Charlie for a few hours so we can get some IV fluids and antibiotics into him, we could send him home and recheck him in the morning,” I said. “That might increase his risk slightly, but in this case, I think we would be fine. The other problem, though, is a housekeeping problem. We have a dehydrated dog with explosive diarrhea. We are going to bring his hydration back to normal, and sometime this afternoon or tonight, he will have a blowout. If that happens in your house, you will have an unbelievable mess to clean up.”

“Charlie would never let that happen,” George said.

“You want to know how many times I have heard that line?” I asked.

“Well, let’s do it that way,” George said. “I can leave him till about four this afternoon. Then I can have him back here in the morning. Do you think that would work?”

We hung onto Charlie and got him started on some IV fluids. I gave him a dose of IV doxycycline and an injection of Droncit for the flukes. The liter of fluid was not quite complete when George returned, so we gave the remainder under his skin over his shoulder blades.

“I will see you in the morning, sometime between nine and ten,” I said as I handed George the leash. “And, I would recommend you let Charlie sleep in the garage tonight, just to be safe.”

“We will see you in the morning, Doc,” George said as he led Charlie out the door.

***

Nine o’clock, and George was at the door with Charlie. Charlie looked bright and alert. George looked a little tired.

“How is he doing this morning?” I asked George.

“He was looking for breakfast. I hope that was a good sign,” George said. “I didn’t know if I should feed him, so he is still hungry.”

We put Charlie on the exam table and gave him a good exam. Things looked great. Sandy came with a couple of bites of bland dog food. Charlie downed it in a single gulp.

“He looks great,” I said. “We will give him another IV injection of doxycycline and send you home with some pills. I think Charlie is well. How did things go last night?”

“You sort of amaze me, Doc,” George said. “You seem to know just what is going to happen. Charlie was feeling pretty good last night, so we decided to let him stay in his bed in the kitchen. Then, about three this morning, my wife and I woke up with a headache. The house smelled so bad that I knew something had happened. I was half expecting to find Charlie dead. When we stepped into the hallway, Charlie had made an unbelievable mess. There was diarrhea all the way down the hall, and even on the walls in a couple of spots. It took us hours to clean it up. My wife is still not talking to me because I didn’t leave Charlie here last night.”

“Will, that is all behind you now,” I said. “Charlie is doing fine, and you shouldn’t have to deal with that again.”

“That handout you gave me said something about lifetime immunity, but with a couple of hedges,” George said.

“Yes, the experts say there are three strains of salmon poisoning,” I said. “So it is possible for a dog to get it three times. I think in most cases, they probably get all three strains at the same time. I have seen a dozen or so cases where dogs have gotten it twice, and I think three dogs that have gotten it three times. However, in the three dogs, at least one infection was based on clinical signs rather than a confirmed diagnosis. So it is just not a good idea to let your guard down. Dogs can live without eating fish.”

“Don’t worry, Doc,” George said. “There is not going to be another trout in my boat.

Photo Credit: Julia Khalimova on Pexels.