D. E. Larsen, DVM

It was early Sunday morning when the phone rang. We were not out of bed yet. We didn’t have any firm plans for the day, but we had discussed going up the Calapooia River to swim. The weather had been warm and dry, and we wanted to take advantage of the river while it was still running full and clear.

“Good morning, Doc, This is Oscar. I hope I didn’t wake you up, but I wanted to catch you before you headed to go fishing or something. I bought this little wiener dog the other day. Cute little guy, he is about 6 weeks old. I fed him a pork chop bone last night. Boy did he like that, he attacked that bone like it was alive. But Doc, this morning, he ain’t feeling too good. In fact, he is pretty darn uncomfortable. I think maybe that bone got stuck.”

“Good morning, Oscar, we were just laying here thinking we didn’t have a thing to do on this beautiful Sunday morning.”

Otto had been in the clinic a few times. Oscar was a large man, with broad shoulders and a muscular build, white hair that he wore in a crewcut. He was gruff to most people but well-liked by everyone. I could picture this massive man with large rough and calloused hands carrying a little 6-week old Dachshund puppy into the clinic. I always found it odd when big men selected small dogs, but it seemed pretty typical.

“I know Doc, it is a nice morning. I suppose you have kids wanting to go swimming or something. But Doc, I’m afraid this little guy won’t wait till Monday morning.” 

“Okay, Oscar, I will meet you at the clinic in an hour,” I said. “That will give me enough time to get up and dressed and help with breakfast for the kids.”

Oscar was waiting at the door when I pulled up to the front of the clinic. He had the little pup tucked in the crook of his arm. If you didn’t look close, you would miss him. Oscar followed me through the door, and we went right to the exam room. 

It was apparent the little guy was in distress. He stood on the table, trying not to move, with his head and neck extended.

“I call him PeeWee,” Oscar said. “I am not sure why we got him, but he is a cute little guy, and he really likes me.”

PeeWee’s exam was unremarkable except for his discomfort. I had not been in practice too many years, but I had already learned the bone in the throat presentation was never a bone in the throat.

“How big was this pork chop bone, Oscar?” I asked.

“Well, I don’t know, it wasn’t too big, maybe the size of my thumb,” Oscar replied.

Oscar’s hands were massive. The size of his thumb would make two of most other men.

“Are you sure he swallowed it?” I asked.

“He was sure chewing on it. And I looked everywhere, under the kitchen table and everywhere. It was nowhere to be found.”

“Will, let’s take an x-ray and see if it is in his stomach,” I said. “It could have just scratched up his gullet going down.”

I took PeeWee back to the x-ray room. Getting an x-ray on Sunday morning was no problem. The problem was waiting for the developer to warm up so it could be developed.

PeeWee was uncomfortable enough that he laid on the x-ray table without any restraint. I quickly snapped two views for the chest and abdomen. One lateral with him on is side and ventral-dorsal with him on his back.

Oscar and I chatted a little as we waited for the developer to reach a temperature that would be functional. I had watched Oscar at the bowling ally, often wondering if they had needed special bits to drill the holes in his bowling ball. 

When the x-ray was finally on the viewer, my heart sank. There it was, a massive bone compared to the small chest of a six-week-old Dachshund, lodged in his esophagus right at the base of the heart. I was unsure that it could be removed by an endoscope. Endoscopes were new things in veterinary medicine in those years. It would mean a referral to a specialty clinic to even have someone try to remove it. And in the 1970s, that meant a trip to a teaching hospital either in Davis California or Pullman Washington.

“Oscar, this is a bad as it can be,” I explained. “This bone is lodged at the base of the heart, right in the middle of his chest. The best way to get it out is to go to a veterinary teaching hospital and see if they can remove it.”

“Doc, that isn’t going to happen,” Oscar said. “I am setting here wonder how the hell I am going to pay you, there is no way I can go somewhere else. It is going to be fixed here, or we will just have to put the poor little guy to sleep.”

In the few years I had been in Sweet Home, I had learned that price was often a limiting factor to medical decisions. If you could fix it for a hundred dollars, that was fine. If it was going to be more, then there was a serious discussion of putting the critter to sleep.

“The only way I can get that bone out of this pup is with surgery,” I said. “That means opening his chest and opening his esophagus to remove the bone. The book says not to do that if you can avoid it, and it is a surgery that will be very difficult for me with one pair of hands. By very difficult, I mean it is over my head in this clinic. We could lose PeeWee in surgery or after surgery.”

“Doc, if there is a chance you can fix him, go for it,” Oscar said as he stood up, towering over me.

“I don’t know what it will have to cost, Oscar,” I said. “You could be paying several hundred dollars for a dead dog.”

“You do what you can, I will just have to come up with the money,” Oscar said. “Do you want me to sign something?”

“Your handshake is good enough for me,” I said, extending my hand as I gathered PeeWee in my left arm. Oscar’s hand engulfed mine, but I shook as firmly as I could. “I will do this today and give you a call when we are out of surgery. He is going to have to stay overnight, maybe two or three nights.”

I gave Sandy a call, telling her I was going to need a hand with surgery. That meant that the kids would have to entertain themselves at the clinic, hopefully, not for the entire day.

While I was waiting for Sandy, I began setting up for surgery. Any thoracotomy for me was major surgery. I was thankful that I had the foresight when I made my equipment purchase to include a ventilator. The problem with that was the size of this patient. I was worried I would have trouble setting the volume of the breath low enough to accommodate this little guy. 

When we got going, the first part of things was pretty standard. I induced anesthesia with Pentathol and then placed an endotracheal tube. With gas anesthesia, I ran a high flow semi-open system that was sort of autopilot. That changed when the chest was opened.

I prepped the left side of the chest and did a local block at the fifth intercostal space using lidocaine. 

Then with a deep breath and a glance at Sandy, I made my incision. When I opened the chest, we started the ventilator. It worked great, and Sandy could pause it as I needed. I turned off the Halothane to prevent getting the pup too deep in anesthesia. I would turn it back on only as needed.

Moving as quickly as I could, I spread the ribs with a retractor and pushed the lung lobes aside. There was the bulge of the bone in the esophagus. I dissected to the esophagus between the Vagus and the Phrenic nerves. Then carefully packed off the area with moist sponges. I incised the esophagus longitudinally, using as short of an incision as I could. I grasped the bone with forceps, and it slipped out, expanding the small incision only slightly. 

I used a two-layer closure of the esophagus with 3-0 Maxon. Being careful to ensure the endothelial layer was securely closed. I place a couple of sutures in the soft tissues between the nerves and then removed the packing. Then we carefully inflated the collapsed lung lobes.

I placed a chest drain and used a Heimlich flutter value on the drain tube. Then I closed the chest by pulling the ribs together with two sutures of 2-0 Maxon encircling the ribs on each side of the incision. When I closed the soft tissues between the ribs, it sealed the chest.

We overinflated the lungs to help evacuate the residual air from the chest. Closed the skin and secured the flutter valve to the chest wall. This valve was nearly as long as the chest. It was definitely not designed for a 6-week-old Dachshund puppy. It sort of looked like a muffler on PeeWee’s side.

After a small dose of Innovar for pain, we woke up PeeWee. Waiting as long as we could before removing the endotracheal tube, just in case we had some respiratory issues. I think PeeWee felt so good with that bone out of his esophagus that he was not bothered by the pain of the chest incision.

PeeWee’s recovery was remarkable. He was bouncing around, looking for breakfast in the morning. I think he was disappointed with his liquid diet. By the end of the day on Monday, I was able to pull his chest tube, and we sent him home. Strict liquid diet for a week, and then it depended on the recheck. 

Oscar was a happy man when he picked him up. I cautioned him again about not feeding bones and to be strict on the liquid diet. He pulled out three hundred dollar bills from his pocket and pressed them into my hand. Never asking what the bill was going to be, he shook my hand vigorously and walked out the door with PeeWee licking his face. I was happy with the three hundred dollars.  

Photo by Dominika Roseclay on Pexels

D.E. Larsen, DVM

I stood at the small makeshift corral waiting for Albert to make his way from the house. Albert was old and arthritic. He walked pretty slow these days.

The corral wouldn’t hold a cow if she wanted out. The posts were propped up instead of set in the ground, and the old boards used for rails were ancient. Something Albert probably found in a pile behind the barn.

The cow standing in the middle of the corral looked more concerned with her next breath than trying to test the strength of the corral.

She was standing with her head extended and lowered. The swelling under her jaw was no simple bottle jaw. It spread down her neck to a massively swollen brisket. Even from my position at the edge of the corral, I could see a bounding jugular pulse.

“How are you doing these days, Albert?” I asked as I extended my hand.

“I think I’m too old for this cow business, Doc,” Albert said. “I have enough trouble getting myself dressed and fixing something that I can call breakfast. Let me tell you, Doc, this getting old stuff is no fun. And then when Verna passed on, it got even harder.”

“I suppose that was the hardest part,” I said.

“I watched you looking at my old Sally cow,” Albert said. “What do you think is wrong with her, Doc?”

“I think she is a pretty sick cow, Albert,” I said. 

“I know that, damit,” Albert said. “Why the hell do you think I called you.”

“I think she has a wire,” I said. “It is not a simple hardware disease. It has progressed to what we can call traumatic pericarditis.”

“If it is just a wire, you can go in and get it with surgery,” Albert said.

“Sally is beyond that stage, Albert,” I said. “Actually, we don’t go in and get those wires anymore. We use a magnet that pulls the wire back into the stomach. But Sally’s problem is an infection in the sac around her heart.”

“If it’s just an infection, you should be able to give her a shot and take care of that,” Albert said.

“It’s more complicated than that, Albert,” I said. “She has had that infection long enough; there is a lot of infection debris in the sac around the heart. After some time, that infection debris around the heart starts to mature, constricting the heart’s function. There is no fixing this, Albert. Your Sally cow is going to die.”

“How can you be so sure, just standing here looking at her?” Albert asked.

“I have seen it before, Albert, many times,” I said. “I do need to examine her just so I don’t miss something, but my confidence level in my diagnosis is very high.”

“You doctor guys make mistakes sometimes. I think just putting her on some antibiotics might be the way to go,” Albert said.

“Nobody is perfect, that is for sure,” I said. “I have always been cautious about saying an animal is going to die because once that is said, that will be the animal that will come back through the door for the next twenty years. But looking at Sally, I am certain that there is nothing we can do at this point that will help her.”

“It’s not that I don’t trust your opinion, Doc. It’s just that I don’t understand how you know so much,” Albert said.

“Last month, I did a necropsy on a cow up Wiley Creek,” I said. “She had the very problem as Sally. Before she died, she looked just like Sally looks. When I opened her chest, there was a piece of wire sticking through her diaphragm, the wall between her chest and her abdomen, into the sac around her heart. With all the infection debris, that sac was over an inch thick. Normally, it is thinner than the material of your shirt.”

“Okay, but how do you know that nothing can be done to help her?” Albert asked.

“When I was in school in Colorado, a cow came to the veterinary hospital in this very condition,” I said. “She was a valuable cow, and the owner wanted to save her at any expense. So the doctors at the vet school removed a rib over her heart and opened the heart sac to the outside so they could drain it and flush it daily. You could look in the hole and see the heart beating, and you could see the very thick sac around the heart.”

“So, did they save that cow?” Albert asked.

“No, that cow died,” I said. “The time to save these cows is when the wire first appears. In the old days, when I was a kid, and you were a young man, they would do surgery. Today we use a magnet. Once we reach this point, the ball game is over, and the cow dies.”

“Can I eat her?” Albert asked. “I mean, Sally is the last cow I have, and I want to save her, but if she is going to die, can I eat her?”

“She is not fit to eat,” I said. “Maybe if you were starving, you could eat her, but you would have to be pretty hungry to choke the meat down. There is not a slaughter outfit around that would hang her carcass in their cold room.”

“I don’t understand how a wire that the cow swallows can get from her stomach to her heart and cause all this problem in the first place,” Albert said.

“The cow is not very discriminating when they eat,” I said. “So if there is a piece of baling wire in the hay, they will just swallow it down with the hay. The second stomach, or compartment, is called the reticulum. It catches all of the foreign material. Suppose that material happens to be a wire. In that case, it can punch through the wall of the stomach, pass through the diaphragm, and into the pericardium. The way things are put together, the wall of the reticulum and the tip of the heart are separated only by the diaphragm. So that is a very short distance for the wire to travel. That injects a lot of infection from the stomach into the chest and the sac around the heart. When it first happens, the cow will be painful, not eating, and have a bit of a temperature. At that point, we treat her with antibiotics and a magnet. The magnet will attract the wire and pull it back into the stomach. Often times we just put a magnet into every cow. That is especially done in dairy cows. And, just a point of interest, the reticulum is sold in the grocery store as tripe.”

“So I would guess that is one reason they no longer use wire to bale hay,” Albert said.

“Baling wire was always around when I was growing up, but I would guess that hardware disease was much less common before the days of baled hay,” I said.

“So what are we going to do with Sally?” Albert asked.

“In my view, you have two choices,” I said. “You can put her down, or you can let her die. It won’t be a pleasant death if you let her die.”

“I think I would like you to give her some shots for a few days,” Albert said. “Just in case you are wrong.”

When I first started practice in Enumclaw, Washington, Don Henricksen, the older associate veterinarian in the practice, had warned me to always give a cow a shot before leaving her, even if it wasn’t indicated. If you don’t give her something, you will be accused of not doing anything, and you will be a villain if the cow dies. You will be a hero if you give her a shot and she gets well.

“I can give her a big dose of antibiotics,” I said. “But I want you to remember, this cow is going to die. I don’t want to hear any stories about how the antibiotics didn’t work. There is no chance of saving this cow.”

“Okay, but I just want to try, just to make sure,” Albert said.

I gave Sally forty ccs of Combiotic, a large dose. 

“It will be interesting to see what morning brings,” I said. “I will be back right after lunch tomorrow to give her another dose.”

***

The following morning, Albert was on the phone a few minutes after eight.

“Doc, I just wanted to thank you for trying to help Sally,” Albert said. “She was down this morning and struggling to breathe. I looked her in the eyes, and she asked me to put an end to my foolishness. So, Doc, I went and got my rifle and shot the old girl. That was the hardest thing I have had to do in a long time.”

“It is always hard to do,” I said. “But it was the right thing. Do you want me to come out and show you inside of that chest?”

“No, you explained things pretty well,” Albert said. “I have the neighbor coming with a backhoe, and we will bury her out under the old maple tree. I thought about calling the rendering company to pick her up but decided that she had earned her hole in the ground.”

“That’s a good thing, too,” I said. “Have you given any thought about what you are going to do with your pasture land now?”

“No, I haven’t thought about it,” Albert said. “I don’t want any more cows at my age.”

I know a couple of young guys who would jump at the chance to rent it from you,” I said. “They are hard workers and trying to get a herd started. I could send them your way if you would like.”

“That would be good, Doc,” Albert said. “Thanks again.”

Photo by Harry Dona on Pexels.

David E. Larsen, DVM

Dixie carefully closed the exam room door. She had just finished getting the next patient ready for my exam.

“This guy just arrived from California,” Dixie whispered. “The cat is old, and he is pretty proud of that fact. His name is Bob, and the cat’s name is Ruby.”

I entered the exam room and patted the old cat’s head. Then I extended my hand to Bob. Bob was a big man. Not fat, just a large older gentleman. His six-foot-four-inch frame towered over me, and his hand engulfed my hand. But I still managed a firm handshake.

“What are we doing for Ruby today, Bob?” I asked.

“You guys are right on the ball,” Bob said. “You had the names down without even looking at the record.”

“Well, we try hard, but we also cheat a little,” I said. “Dixie filled me in on the other side of the door.”

“Honest, too,” Bob said. “I like that. We just moved into town, and Ruby is probably the oldest cat you have seen. I just wanted her checked out. The move was long, and there was a lot of stress for her.”

“Moves are pretty stressful for cats,” I said. “Even short moves are often difficult for them. Does Ruby live inside?”

“Yes, she lives inside exclusively anymore,” Bob said. “In her younger days, she spent a lot of time outside. She is seventeen years old now. We try to take special care of her. Doc, you probably haven’t seen a cat this old.”

“We see a lot of cats in Sweet Home,” I said. “I rarely see a male cat that makes it to fifteen. Fourteen seems to be the magic year for them. But we see many sixteen-year-old female cats and a few who make it to seventeen. The oldest cat I have seen was twenty-three. She belonged to an old lady in the nineties. She told me she had to crawl under the bed to retrieve her cat for the appointment. That most of been quiet of a sight.”

“Well, seventeen is pretty old for a cat,” Bob said.

“Oh, yes, she is in a small group with dwindling numbers,” I said. “Do you just want an exam for Ruby, or do you want me to do blood work and a urinalysis?”

“Down south, we usually take her in for an exam every three months or so,” Bob said. “They never asked about a lot of lab work.”

“A lot of old cats die from kidney failure,” I said. “We should at least be doing a urine sample. And after a trip like she has just been through, it might be wise to run a blood panel, just so we can make sure everything is working like it should.”

“You will probably need to keep her for a couple of hours to finish that,” Bob said. “And you are  right, and we don’t want anything to happen to her that we can prevent.”

So, with that decided, we kept Ruby for a couple of hours, collected blood and urine samples, and completed a comprehensive exam. She passed everything with flying colors.

“Do you think she is really seventeen?” Dixie asked.

“She looks pretty good for that age,” I said. “Did Bob bring any records from his previous veterinarian?” I asked.

“He said that she was never sick, so they didn’t bother with records,” Dixie said.

Bob was pleased with the results and made an appointment for a recheck in three months.

***

Three months later, Bob and Ruby were back in the clinic. Bob had quite a discussion at the front desk. Bob was sure our records were wrong, Ruby was nineteen, not seventeen as our file indicated.

“Doc, this cat just amazes me. She gets healthier as time goes on,” Bob said. “I am thinking that she will live to be thirty.”

As Bob loaded Ruby into his car, Dixie smiled at me.

“She probably will live to be thirty,” Dixie said. “If she continues to age two years every three months, thirty if not too far off.”

***

That became the routine; Bob and Ruby would be in the clinic every three months. Every visit, Ruby was two years older. 

Bob had some bad news on the fourth visit, just before Christmas.

“We will be moving in a couple of weeks,” Bob said. “All this rain is too much for us to endure. This move is going to be a short one, just over the mountains. We have bought a new house in Redmond.”

“I sorry to see you go, Bob,” I said. “But, you will have a dryer climate over there, maybe a little colder in the winter, but not near as much rain. Do you want to take a copy of Ruby’s records?”

“She has been as healthy as a horse on every visit,” Bob said. “There is no need for records. She will have her twenty-fourth birthday this coming spring. Probably the oldest cat most vets have ever seen.”

“I am sure she probably is, Bob,” I said,

We never had any news from Bob, but if it was up to him, I am sure that Ruby lived to be thirty.

***

It was a couple of years later when Jack came in with his old cat. He set the carrier on the floor, carefully pulled an ancient Siamese cat from the carrier, and placed her on the blanket he had spread on the table.

Jack was a large animal client from Brownsville. I had worked on his cows almost from the day we started practice.

“Doc, I have never asked you for a miracle, but that is what I am after today,” Jack said, tears welling up in his eyes. “This old cat is my daughter’s, and we want to get one more Christmas with her. This cat is twenty-six years old. So, I know I might be asking a lot, but our daughter is coming home for Christmas, and I am looking forward to one more picture of her and this old girl.”

“Jack, are you sure of the age?” I asked. “I mean, it is easy to lose track of the years with a cat.”

Jack struggled to get his wallet out of his hip pocket. Then he thumbed through old papers and receipts before finally pulling a tattered and crumpled old photo from the mess. 

“Here is the proof, Doc,” Jack said. “Sue was almost a year old in this photo. It was her first Christmas. And the kitten she is holding is this old girl right here. And Doc, Sue will be twenty-six next month.”

“Well, I would say I had better get to work if we are going to buy some time for this old gal,” I said. And what is this old gals name?”

“Well, we call her Cleo,” Jack said. “Actually, she was named before we got her and that name was Cleopatra.”

“Yes, I think Cleo is a better name,” I said. “Jack, Cleo is a little thin and might be dehydrated. Why don’t we plan to keep her overnight, do some lab work, and see if we can make her feel a little better for Sue’s arrival? Jack, Cleo is ancient. We can maybe buy her time, but we will not make her a young cat. You understand that, I hope.”

“Do what you can, Doc,” Jack said. “Like I said when I came through the door, we are after a miracle. So yes, we understand Cleo’s situation.”

We kept Cleo for the night. After collecting blood and urine samples, we started her on IV fluids.

My heart sank when I looked at the lab results. I had expected Cleo to be in kidney failure, but her blood values showed her failure was advanced. Cats seem to adjust to kidney failure and hold out pretty well right to the end. We were going to have to be lucky to be able to get her up for Sue’s visit.

I gave Jack a call with the news.

“Jack, I had expected Cleo to be in kidney failure, but the lab work shows a pretty advanced status,” I said. “If it was you or I, we would be on dialysis. Unfortunately, for Cleo, that is not an option. What we can do is limited. We will do some peritoneal dialysis this evening. That is where we fill her abdomen with fluid, allow it to stay to absorb some of her toxins, and then draw it off. That and her IV fluids and a special diet will get her through a few days. If you want to extend that time, we could use some diuresis, where we give her daily fluid to run through her kidneys to get as much use out of them as possible. But we are talking about weeks, not months.”

“Sue arrives the day after tomorrow,” Jack said. “If I followed all that, we can buy her enough time for Sue to say goodbye. Then I don’t think we will want to put Cleo through a bunch of misery to buy a couple of empty weeks.”

“We will get started on her treatment,” I said. “Plan to pick her up tomorrow. I think you can expect a couple of days, but three days without additional treatment will be the end of it. And Jack, just a word of advice: the one mistake people make is to wait too long before deciding to put a pet to sleep. It is better to be a day too early than a day too late.”

“Okay, Doc, we will pick Cleo up in the late morning,” Jack said. “That should give Sue a few good hours with her. That will be good. We will give you a call when we are ready.”

Cleo felt significantly better after treatment and a day of IV fluids. Jack was pleased with her progress when he picked her up.

It was two days when he called and asked to speak with me.

“Doc, I can’t thank you enough,” Jack said. “Sue and Cleo had a wonderful day yesterday. Sue was sad, of course, when I told her of Cleo’s prognosis, but they loved the time with each other. Cleo slept at the foot of Sue’s bed, just like in the old days. It was sad, but Cleo died during the night. That spared Sue the struggle to make that final trip to your office. Thanks again, Doc.”

“I’m glad we could them that time,” I said.

I was lucky that Jack choked up a little and allowed that to end the conversation. I was also a little choked up as I hung up the phone.

“Cleo died?” Sandy asked.

“Cleo died,” I replied. “At home and happy. Things worked out the best they could for everyone.

Photo Credit: Avelino Calvar Martinez on Pixabay.