The White Cat

 D. E. Larsen, DVM

Dixie was having some difficulty restraining Mary’s cat. Mary had the cat wrapped in a towel when she entered the clinic. It was still straining to turn flips as Dixie struggled with it on the exam table. Mary had withdrawn from the exam table and stood against the wall, concerned and not understanding what was happening with her Ghost.

“Oh, Doctor Larsen, I don’t know what happened to Ghost,” Mary said when I entered the room.

I grabbed Ghost by the back of the neck to help Dixie control his movements. Ghost’s head continued to twist and turn, even with his body restrained.

“How long has this been going on?” I asked.

“Ghost has always been a little odd for a cat,” Mary said. “He started acting sick last week and was holding his head to one side most of the time. But this turning flips, like this, has only started the last hour or so. What is going on with him?”

“This is a vestibular problem,” I said. “He has lost his inner ear function. The world is spinning for him right now. I am going to get an injection for him that will sedate him so we can do an exam.”

After giving Ghost an injection of ketamine, we waited a bit for the drug to take effect. Then we removed the towel.

“White cat, and with one blue eye,” I said. “If he has always been a bit odd, I would guess he is deaf.”

“You know, Fred has wondered about that a couple of times,” Mary said. “Why do you guess that?”

“White cats have a genetically linked deafness associated with the white coat. Blue eyes are also on the same gene. Some of these cats, not all of them, will be born deaf or at least lose all hearing shortly after birth. White cats with two blue eyes will have the highest percentage of deafness. One blue eye, maybe less than half, will be deaf, and a few white cats with normal eye color will be deaf.”

“That explains the odd behavior,” Mary said.

“Yes, these cats seldom get along well with other cats,” I said. “There must be a lot of verbal communication that they never learn. When I was growing up, we had a white cat in the barn for a time. She couldn’t get along with the other cats and finally moved up on the hill behind the barn. She would come down to eat, but that was all.”

“Is his deafness causing this problem?” Mary asked.

“I don’t know if there is a correlation,” I said. “Most of the time, this is associated with an ear infection, and sometimes it just happens. Sort of like the same thing with people.”

“I have heard of people with dizzy spills, but I have never heard of them acting like this,” Mary said.

“I don’t know if anything this severe occurs in people,” I said. “They probably seek care earlier than a cat.”

With the initial questions answered, I started with an exam on Ghost. When I came to his ears, his problem was evident. Black debris filled both ear canals. Ghost must have had a chronic ear mite infestation.

I grabbed a forceps and tugged on the hardened debris in the left ear canal. It came out almost entirely intact and as a perfect casting of the ear canal. A flow of white pus followed the casting. 

“Well, that explains the problem,” I said. “I have never seen anything like this. We sometimes see an ear filled with mite debris but not solid like this stuff. Probably with his deafness, the debris in his ears wasn’t a big bother to him.”

“That looks awful,” Mary said. “What do we need to do?”

“We have him sedated,” I said. “We will take him back to treatment, clean these ears, and get him on some medication. He is going to need to keep him for a day or two. Usually, this balance issue clears up. Sometimes these cats will have a head tilt when they recover. They sort of realign themselves with the world as they see it. I have no idea how things will turn out with this infection in these ears.”

We took Ghost back and cleaned his ears. When we removed all the debris, I could see that the eardrums were intact. We flushed the ears to remove all the exudate and then instilled some medication for the infection and the ear mites. I gave Ghost an antibiotic injection and some dexamethasone.

“We will give him a little more ketamine before we leave tonight,” I said to Dixie as we put Ghost in his kennel. “That should keep him quiet until morning, especially in the dark kennel room.”

***

In the morning, Ghost was up on his feet, looking a little confused by his surroundings. His head tilted to the left, and his eyes still had a slight nystagmus.

“You look better than I expected,” I said to Ghost. He didn’t respond to my words at all. “Deaf as can be, I guess.” I opened the kennel door to pet Ghost. He was cautious of my hand but pushed back when I petted him.

“Sandy, give Mary a call and tell her that Ghost is doing better than expected,” I said. “We will send him home at the end of the day if he continues to do well.”

Ghost was ready to go home in the afternoon. We sent him home with medication for his ear mites and ear infection and some antibiotics for a couple of weeks.

His hearing never improved, of course. But Mary and Fred got along with him better now that they understood he was deaf. 

With time his head tilt lessened, but even several years later, he was not back to level.

Photo by Dids on Pexels.

On a Thanksgiving Eve, From the Archives

On a Thanksgiving Eve 

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

It’s Only a Bump, Doc

D. E. Larsen, DVM

Chuck was waiting patiently in the reception area. He was preoccupied with keeping his old dog, Hank, calm. Hank was sitting beside Chuck’s chair, and Chuck had his hand on his back.

Hank was a Mastiff and an old one at that. I have been seeing Hank several times a since I came to town. He was over ten years old, ancient for a giant breed dog.

“Ruth, let’s get Chuck and Hank into an exam room,” I said. “Chuck looks pretty worried.”

Ruth showed them into an exam room, and I gave her a few minutes to set things up before going into the room.

“How are things going, Chuck,” I said as I shook hands.

“I’m doing okay, but Hank here has bumped his leg,” Chuck said. “I debated about having you look at it. I didn’t want to waste your time on a little bump.”

“You don’t have to worry about wasting my time, Chuck,” I said. “And Hank is no spring chicken. Sometimes it is important to look at those little bumps.”

Hank was sitting, trying to ignore my presence. I guess he figured if I was talking with Chuck, he was safe.

“Let’s get a look at this bump,” I said as I knelt down to look Hank in the eye. A long drool of saliva fell from the side of his mouth, almost reaching the floor before it broke free from his mouth. “Where is this bump?”

“It’s right there on the inside of his left front leg, Doc,” Chuck said. “Low on the leg, just above that lower joint.”

My heart sank as I picked up Hank’s left front leg. There was this boney swelling on the inside of the lower leg. All the odds, and all my experience, said this was a bone tumor. 

“What’s wrong, Doc?” Chuck asked as he noticed my change of expression.

Chuck’s wife had passed away five years ago. Since that time, Hank has been his sole companion. How am I going to tell him that Hank is on borrowed time?

“Chuck, I think we should get an x-ray of this bump,” I said.

“It’s only a bump, Doc. Right?” Chuck asked.

“That’s what an x-ray will tell us,” I said.

“Doc, this isn’t like you. You are always straightforward, almost to matter of fact, most of the time,” Chuck said. “What are you thinking?”

“Chuck, I’m thinking this might be a bad bump,” I said. “This is where a lot of bone cancers develop in old giant breed dogs.”

“Bone cancer doesn’t sound good,” Chuck said. “Is there anything that can be done?”

“Let’s not get ahead of ourselves, Chuck,” I said. “Let’s see what the x-ray looks like, and then we can talk about what needs to be done. This will take us a little time to get this film. We have several people to take care of first. Maybe if you go over to Mollie’s, have a cup of coffee, and check back in about an hour.”

“All you’re going to do is take an x-ray, right?” Chuck asked as he patted Hank on the head.

“That’s all we are going to do,” I said. “You go relax for a bit, and we will have a set of films to look at when you get back over here.”

We worked through the other patients and managed to get an x-ray of Hank.

“I want to make sure those films are dry when Chuck gets back,” I said as Ruth hung the films on the drying rack in the dark room.

When I got a chance to look at films on the viewer, my fears were confirmed. On the distal end of the radius, there was a boney swelling with a star-burst eruption starting at the surface.

“Is that a bone cancer?” Ruth asked.

“Yes, when I was in school, this film would confirm the diagnosis,” I said. “Today, I probably can’t find a radiologist that would make that diagnosis without a biopsy, or at least cytology.”

“Chuck isn’t going to want to hear this,” Ruth said. “This old dog has been his whole world since Marilyn died.”

I could see Chuck walking across the street, coming from Mollie’s. I met him at the door with Hank on a leash.

“Let’s step back to the surgery room, Chuck,” I said. “We had a better viewer back there.”

I placed the two x-rays on the viewer. 

“So, here is the bump,” I said as I pointed to the lesion on the bone. “Chuck, I don’t have any good news here. In my mind, this is a bone cancer until I prove otherwise.”

“What does that mean for Hank, Doc?” Chuck asked.

“If I’m right, Hank’s days are numbered,” I said. “There are a couple of things we can do to confirm the diagnosis. The radiologist is going to say we need to do a bone biopsy. We might be able to get a pathologist to confirm the diagnosis with cytology on a needle aspirate. But most of the time, they will also want a biopsy.”

Chuck looked at Hank, sitting at Chuck’s side, sort of pressed up against his leg. 

“I don’t want to put this old guy through a bunch of surgery or other stuff,” Chuck said. “You sound like you’re pretty confident in your diagnosis.”

“When I was in school, not too awful long ago, these x-rays would be considered diagnostic,” I said. “Time changes things for the experts.”

“You’re about the only expert Hank is going to see,” Chuck said. “If this is a bone tumor, is there any treatment that will cure it?”

“Cure is a big word,” I said. “No, Chuck, nothing is going to cure this. We can talk about buying some time, but that comes with some expense for Hank.”

“Hank does have many dollars,” Chuck said with a wry smile.

“I’m not talking about dollars. I’m talking about the quality of life for his final days,” I said. “There is good evidence that if we amputate this leg, we can buy some time by removing this primary tumor.”

“Doc, it’s just a little bump,” Chuck said. “You can’t mean you want to take his leg for that little bump, can you?”

“Chuck, this little bump is going to grow,” I said. “In a couple of months, give or take some, this bump will be much larger. Then it will do one or two things. It will break open and drain, and/or the bone will fracture. Taking the leg removes all of that and allows Hank to live a little longer. The problem is Hank is a big old dog. He isn’t going to be able to handle an amputation like a young dog. And this amputation only removes the primary tumor. Most of the time, these tumors have gone elsewhere in the body by this point, so the amputation is not curative.”

“Doc, we aren’t going to take his leg off,” Chuck said. “Let’s just make him comfortable and give the old guy whatever time he has left.”

“I can agree with that, Chuck,” I said. “The only problem is that most people go too long. If this tumor ruptures, that is not a big thing, but it will be very painful for Hank if the bone fractures.”

Chuck was quiet for a couple of minutes while he looked at Hank and petted his head.

“Doc, I think we will go camp on one of the high lakes for a couple of weeks,” Chuck said. “Hank used to love going camping up there and going fishing. I haven’t done that since Marilyn has been gone. Hank and I have just sat around and grown old. We will go fishing for a couple of weeks, and then we’ll come to see you again.”

“That will be good for both of you,” I said. “I will fix you up with some pain medication. And by then, there will be enough change in this little bump, so we will know for sure what’s going on with it.”

***

It was close to a month when Chuck returned with Hank. The little bump had grown into a large swelling, and Hank was in obvious pain.

“We had a great time,” Chuck said. “It wasn’t like old times, but we still had fun. We even caught a few fish. But Doc, I’m afraid that you were right on all counts. I noticed this swelling was draining a little last night. Hank and I think that it’s time for him to go sit by the fire with Marilyn in that great living room in the sky.”

“How do you want to do this, Chuck?” I asked.

“We talked about that a lot last night,” Chuck said. “Doc, I just can’t stay. Hank and I decided that we want you to take Hank and send him on his way, and then if I could come back in a week or two and pick up his ashes, that would be great.”

And that was the way it was done. With tears streaming down his face, Chuck said goodbye to Hank, stood up, did a military about-face, and marched out the clinic door. 

Hank looked at me, and I imagined a tear from him as he lifted his sore leg and waited.

Photo by Anil Sharma on Pexels.