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.

I Don’t Have Fleas!

D. E. Larsen, DVM

The clouds were gathering in the sky, and everyone was hopeful that fall would finally be here. It had been a long summer. 

We were winding down for the day, and Sandy and I planned to take the kids to a movie. We had just switched the phone at the clinic over to the answering service when Sally came through the door with her Rottweiler pup.

“Doctor Larsen, I hope you have time to look at Brutus,” Sally said. “He is chewing a hole in his rump, and I have no idea what’s going on with him, but it looks bad.”

I looked over the counter at Brutus, a young Rottweiler. “Looks like fleas, Sally,” I said. “Do you want to try a shampoo and see if that works?”

“Doctor, this can’t be fleas. Brutus is never around other dogs,” Sally said. “And I don’t have fleas in the house. The other dogs look fine, and none of us ever have a flea bite. Besides, all the dogs have flea collars.”

“Okay, I will take a few minutes and look Brutus over, but we have plans this evening,” I said. “This might be a short visit.”

We took Brutus into an exam room, and I lifted him onto the table. He had an obvious sore on his tail-head where he had been chewing on himself. I parted the hair, and the fleas scattered.

I pulled Brutus close to me and held him while I pulled his legs off the table and laid him on his side. Then rolling him on his back, Brutus looked at me with his head held off the table. He wasn’t sure he liked what was going on.

“Now, Sally, watch his belly close,” I said as I scratched Brutus so he would relax and spread his hind legs.

Many fleas scattered, seeking cover in longer hair.

“Oh, my God, where did all of those come from?” Sally exclaimed.

“Sally, it is late August in the Willamette Valley,” I said. “Fleas are everywhere, and you can’t avoid them.”

“But he has a flea collar,” Sally said.

“Yes, that is better than nothing, but not much better,” I said. “Those flea collars do a good job controlling fleas around the head and neck. On a dog like Brutus, the little cloud of protection is about three feet behind him most of the time. I doubt if he spends a lot of quiet time.”

“The box says they work,” Sally said. “It said they would give total flea protection for six months.”

“Yes, I know what the box says,” I said. “But the box is talking about Denver. That is probably where they did all the testing. They don’t understand what fleas are in Denver. They don’t have fleas there. When I was in vet school at Colorado State, in four years, I never saw a dog that looked like Brutus. I never saw a case of flea allergy dermatitis.”

“That’s terrible. How do they get away with that kind of marketing?” Sally asked.

“I am sure they have the paperwork to back up their statements on the box,” I said. “It is just that things are different here.”

“Can we take care of his problem?” Sally asked.

“Sure, but it takes a lot of work to get fleas under control this time of the year,” I said. “We are told that there are products on the horizon that will work better, but I will believe it when I see it.”

“Why don’t I have any flea bites?” Sally asked.

“Fleas only like special people,” I said. “When we have fleas in our house, only me and one daughter will have flea bites. Nobody else will know there is a problem. If you watch when you drive around town, you will see a few dogs with little or no hair on their back half. Those dogs all have flea allergies. The other dogs probably have fleas also but are not bothered.”

“What are we going to do to help poor Brutus?” Sally asked.

“For this sore, we will give him some prednisone for a few days, along with a course of antibiotics,” I said. “For the fleas, I will send you home with a good shampoo, followed by some flea spray. Then, if you really want to get things under control, you need to use a flea bomb in the house and a yard spray for the outside. And then, hope for an early winter.” 

“I  really don’t want to do the flea bomb thing,” Sally said. “I had a friend that did all of that a couple of years ago. It seemed to take care of her problem, but it was a real hassle.”

“Some of these shampoos do a pretty good job at giving a week of protection,” I said. “It might work to just plan on giving Brutus a bath every Saturday morning for a while. We can always get more aggressive later if it doesn’t work.”

“Yes, that sounds good to me,” Sally said. “Just fix me up with the medication and the shampoo, and you can still make your plans for the evening.”

Sally and Brutus when out the door with a large bottle of shampoo, flea spray, and medication. 

As soon as Sally left, Sandy locked the front door.

“I bet she will be back next week or maybe in two weeks,” I said. “Giving Brutus a bath will probably be more of a chore than she thinks.

“Let’s get out of here before someone else catches us,” Sandy said. “If we don’t get to this Star Wars movie early, we won’t get a seat.”

Photo by Rachel Leibelt.