The Toughest Dog on the Block

D. E. Larsen, DVM

Carol backed through the clinic door and turned around in a frantic search for someone, anyone, to help her. Her usual short permed hair was hanging over her eyes. Her dark green coat hung lopsided from her shoulders, and there was a large smear of blood on the left side. There was blood dripping from the knuckle of her right hand. 

She was holding her little toy chihuahua, Poncho, cradled in her arms. Poncho was an older chihuahua, black and tan in color. His main identifying feature was his tongue hanging out of the left side of his mouth. Like all chihuahuas, he was sure he was the toughest dog on the block.

Kari was the first one to reach Carol, and she carefully took Poncho from her hands. I was not far behind and took a quick look at Poncho’s wounds. His chest was torn open on the left side. I could see his lungs fighting to exchange some air in an open chest. 

“Get him back on some oxygen,” I say as Kari starts toward the treatment table. “I will be there in a second.”

I turned my attention to Carol for a moment.

Carol is a long time client. She is a short, trim lady in her late sixties. She has always been more than generous with others in the community. Often paying the vet bills of her family members and friends.

“You know Poncho, he just ran up to those big dogs who were fighting in the neighbor’s yard,” Carol says with tears in her eyes now. “This big shepherd just picked him up by the chest, shook him a couple of times, and flung him into the street. It happened so fast, there was nothing I could do. I just gathered him up, and here we are. Thankfully, my son was home so he could drive.”

“This is a major wound, Carol. There is a possibility that Poncho may not survive.”

“I know that, but we have to try.”

“I don’t have time to provide you an estimate. It may be expensive.”

“That is fine, Doc. Please do what you can to save him. I don’t know what I will do if I lose him like this.”

“Carol, if you can, have a seat and wait a short time. I will get Poncho stabilized and assess the extent of his wounds. If we are just dealing with a chest wall injury, things will be a lot better than if we have some lung damage along with it.”

I stepped back where Kari was providing Poncho some positive pressure oxygen via a mask. I quickly placed an endotracheal tube and started the ventilator. Then we looked him over for other injuries.

With everything looking okay except for his left his chest wall, I carefully examined his lungs. The ventilator had them working fine. I moved the lung lobes around a little and could not see any injury to the lungs or the heart.

“With any kind of luck, we will be able to close up his chest with little problem. I don’t see any injury to his lungs,” I say to Carol. “We will need to keep him overnight, at least, because we will have a chest drain in place.”

“I will be back at about 4:30, and maybe I will be able to have you rethink the overnight thing,” Carol says. “I won’t be able to sleep without him at home. Maybe you can wrap up the chest drain, and I can have him back at the first thing in the morning.”

“Okay, you check at the end of the day. A lot depends on how well the chest wall repairs and on how painful Poncho is following surgery.”

We packed the wound with moist gauze sponges while we clipped and prepped the wounds. Then came the task of figuring out the best way to close this chest wall.

Three of Poncho’s ribs were broken away from the sternum. I was able to wire those back into place. Then it was a matter of closing the muscles and moving other soft tissues around to provide an air-tight closure of the chest wall.

With a chest tube in place and a careful block of the region’s nerves with local anesthesia, we recovered Poncho. 

I had a continuous suction device on the chest tube, and Poncho acted fine when he woke up from anesthesia. He was a little guarded of the injury, but not obviously painful. The regional anesthesia was doing its job.

When Carol returned, there was no hint of her ruffled appearance from the morning. Her hair was fluffed as always, and she displayed a soft smile. Her coat was changed to a tweed. I would guess the green coat was already at the cleaners.

“There is mostly good news,” I said. “The chest wall repaired well, and Poncho is a little stiff but is otherwise doing well.”

“Is it going to be possible for me to take him home?”

“I have a suction device on his chest tube, and it is not showing much drainage. I think I can put a wrap on his chest and send him home. There is a little risk in that, but then, we don’t have 24-hour care available for him here.”

Poncho was dancing in the kennel and turning circles when he saw Carol. I had to catch him as he tried to jump to her when we opened the kennel door.

“We have bloodied one coat today, Poncho,” I said. “Let’s get you wrapped up for the evening before giving you to your owner.”

With a chest wrap in place, Poncho and Carol headed for the door. Poncho trying to lick Carol’s chin with a tongue that never seemed to track just right.

“We will see you the first thing in the morning, Doc. And I can’t thank you enough,” Carol said as she pushed through the door.

As promised, Carol and Poncho were the first ones through the door in the morning.

We removed the wrap and I was able to pull his chest tube. 

“It looks like you dodged a bullet this time, Tiger,” I said to Poncho. “I would guess that it would do me no good to try to tell you that you are a little dog.”

“That is for sure,” Carol said. “He was barking at the neighbor dog when I loaded him into the car this morning. I don’t think he learned a thing.”

“It is the nature of the beast. I think all these little guys think they are the toughest dog on the block.”

Photo by Quang Nguyen Vinh from Pexels

When do You Say When

D. E. Larsen, DVM

Nessie came out from under the feed rack, shaking her head vigorously as the small rat hung limply from her mouth.

Nessie was a small, straw-colored Cairn Terrier. 

“That’s the way to get ‘em,” Ayers hollered as Nessie discarded the dead rat and ran up the hill toward us.

Ayers laughed and stuck his hands into the pockets of his bib overalls. He looked at me with a broad smile, and his good eye twinkled.

“I love that little rag muffin of a dog,” Ayers said.

We had just finished working on a cow with pink eye. The white-faced cattle suffered a little in this dry and dusty weather of mid-August in the Willamette Valley. 

“Do you think that eye will be okay?” Ayers asked, his voice was more serious now.

“I know it looks terrible right now, but it will heal up and be back to normal when I come back and take those sutures out,” I said. 

“You always sound so confident in what you do, Doc,” Ayers said. “How can you be so sure of yourself all the time.”

“It is just a matter of knowing what you know,” I said. “I know what I know, and consequently, I know what I don’t know. When I was in the Army, I learned to express utter self-confidence when I knew something. I venture into gray zones of my knowledge at times. But when I do that, you will know it. I have no problem saying I don’t know something.”

“So, what do you know about cataract surgery in people?” Ayers asked. 

“I have never watched a surgery,” I said. “ But I know they are getting better and better at it all the time. I did a couple of cataract surgeries while I was in school. Luckily, we have a specialist in Oregon that does most of those surgeries. That is a surgery that you want someone who does a lot of them. Practice makes perfect.”

“Oh, I know,” Ayers said. “They say they are pretty good. But, you know, Doc, when you only have one eye, like me, it is a pretty big decision.”

“I can imagine your concern,” I said. “But, you have to consider the alternative. You don’t want it to get so bad that you can’t see.”

“I know that, but when do you say when?” Ayers asked.

“You are trying to get me to answer some of those questions that the eye doctor should be answering,” I said.

“I trust your opinion a hell of a lot more than I trust theirs,” Ayers said. “They spend a couple of minutes with me on every visit. They don’t know me from Adam.”

“Ayers, all I know is that cataract surgery is done when the cataract starts to affect your lifestyle,” I said. “That means that the neurosurgeon gets surgery a long time before grandma. But I would guess that with one eye, they would want to do the surgery pretty early. And I think you will be amazed at the results.”

“But what happens if something goes wrong?” Ayers asked.

“Pin that doctor to the wall,” I said. “You want to ask him about his record of complications. Now when you do that, he is going to respond with something out of the book. He will say that we see a 1% rate of serious complications. When he says that, and he will, you have to say that you don’t want what we see. I want to know what you see. That is very important. A good surgeon will not be bothered by that questioning. The guy with poor numbers will be upset with that question. You don’t want that guy. There are a lot of surgeons doing cataract surgery. You want to choose your surgeon well.”

“What do I do if he gets upset,” Ayers asked.

“You tell him that the appointment is over,” I said. “Then you ask him for a referral to somebody who won’t be upset with that question. He will know the best surgeon.”

It was several months later when I revisited Ayers. I made a call to his place to castrate a couple of lambs.

“I don’t know why I keep these sheep,” Ayers said. “Lord knows, I don’t make a penny on them anymore. I have an old ram who can hardly walk and only a handful of old ewes. And I am too damn old to do the most basic things.”

“I am guessing you are too soft to send them to the sale barn,” I said.

“Sale barn, hell, they would not bring enough at the sale to pay for the gas getting them there,” Ayers said. “I guess they have all earned their hole in the ground. My only problem is I will have to pay somebody to dig the hole.”

“How is your eye doing, Ayers?” I asked as I reached down to pat Nessie on her head.

“I wanted to thank you for your advice,” Ayers said. “I went ahead and had that cataract removed. The best thing I ever did, I wish now that I had done it years before.”

“That is good. I hope you can see better,” I said.

“I can see better than I ever have in my entire life. Hell, I can see that fly on that cow’s back,” Ayers said as he pointed to a cow standing about 20 yards out in the pasture.

“So surgery and recovery went well,” I asked.

“Surgery went well, but they had a patch over my eye for a day,” Ayers said. “I was blind as a bat. And the problem was everybody thought I should be able to see out of my glass eye. Even at the doctor’s office, they couldn’t understand why I was so helpless. And they had my records, dumb bastards.”

“I guess when you fill out your taxes this year, you should put Nessie down as a seeing-eye dog,” I said.

“She is already listed as a sheepdog,” Ayers said. “I should list her as a rat control dog. She is death on those things. Rats and those darn digger squirrels. Those squirrels can’t seem to learn that it is not worth it to clean up the grain out of the feed racks.”

“I have to run. I have a cow to look at over in Crawfordsville,” I said. “I am glad things are well with your eye. You call again if you need anything.”

“I’ll see you later, Doc. I think Nessie is due to come in to see you pretty soon. And boy, does she hate that trip.”

Photo by Lone Jensen from Pexels

The Birds and The Bees and Bassett Puppies

D. E. Larsen, DVM

  We had just finished dinner and were supervising the girls as they cleaned up the dinner table when the telephone rang. 

Good evening, Doc,” Sandi said into the phone. “I hope you have finished dinner. Betty has been pushing for about 3 hours. She has broken some water, but there is no evidence of a pup.”

  I cared for quite a few Basset Hounds for a group of ladies who showed these dogs. They were relatively valuable dogs, and the ladies wanted meticulous veterinary care. Betty, a champion Basset, had been in labor for nearly 3 hours.

Her owner, Sandi, had been through this on multiple deliveries. Three hours of contractions without a pup was cause for intervention, and with each passing minute, the puppies were more at risk.  

“It sounds like we should get a look at her,” I said. “I can be at the clinic in 20 minutes.”

Of our four kids, Amy took the most interest in the goings-on at the clinic. She liked the people and the animals and showed compassion for both. Amy, our second grader, was ready to go to the clinic with me in an instant.

Sandi came through the door with a very pregnant Betty and two lady friends, recruited to help. 

We carefully lifted Betty onto the exam table.

“Judging from the size of this stomach, this is going to be a large litter,” I said. 

“She had 10 puppies in her first litter,” Sandi said. “I am guessing there is more this time.”

I cleaned Betty up. She did have some greenish fluid dripping from her vulva. This was an indication that her water had broken some hours ago. A quick vaginal exam failed to reveal any pup in the birth canal.

“You know the story,” I said to Sandi. “Betty has been in labor for several hours, and there is no pup in the birth canal. The longer this goes on, the more the puppies are at risk. Our options are to try some oxytocin or to go right to a C-section.”

The oxytocin injections could work magic, but it could also mean a long night. When bassets have large litters, you can end up with a C-section for the last pup or two because the uterus runs out of strength for continued contractions. With the extended time of labor, those remaining puppies are often lost. 

I enjoyed working with Sandi on these deliveries because she would always be quick to elect a C-section. I agreed with her in most of the cases. It made for a shorter night for me and usually a more successful delivery.

“Let’s not spend all night here. Let’s just go to a C-section, and everyone will be better for it,” she said.

  I called Dixie, my right hand at the clinic, to come help. Sandi had a couple of friends in tow. That would mean we had 4 gals to tend to the puppies, plus Amy. Sounds okay, but my guess was over 10 pups, maybe 12 or 13. We are going to be very busy for a few minutes when I start handing out puppies.

  While waiting for Dixie, I got the surgery room set up, giving Amy several chores to help. She conducted herself like an old pro.

“Amy, you need to bring a stack of towels and put them on that little table in the corner,” I said. “When we do this surgery, the puppies are surrounded by a lot of fluid, and it generally spills off the table onto the floor. We will need towels down to mop up that fluid.”

I had Amy help hold Betty after I rolled her onto her back. It probably wasn’t necessary to keep her on her back. Betty was sort of like a turtle on her back. Her belly spread out enough that she couldn’t right herself if she tried. I clipped her belly, and we placed an IV catheter and got some fluids going.

  As soon as Dixie arrived, we moved Betty into the surgery room and gave her a dose of IV Innovar, the morphine combination drug. This provided strong sedation, and we secured her to the surgery table and did a surgical prep on the abdomen. Then we used Lidocaine for local anesthesia at the incision line. This would allow us to deliver the pups with the least depression from anesthesia.

  “Now we start the surgery,” I said more like an announcement but specifically to Amy.

The surgery went well, and I had the abdomen open in short order.

  I started pulling the uterus out of the abdomen, one pup at a time. I laid it out across the drape on moistened towels. One puppy, then the next, and it kept coming. Finally, I had it all out, twelve pups, 6 in each uterine horn. This uterus, the pencil’s size in its non-pregnant state, laid out on the drape and towels. It was too large to stay up on the abdomen. Several puppy segments hung over the abdomen on each side, reaching the surgery table’s surface: quite a remarkable organ, the uterus.

  I made an incision on one side of the uterus and quickly started extracting puppies. I handed this first pup to Dixie, and she gathered it up and headed back to the heated box and the reversal syringes.

Now pups came in rapid succession. I would squeeze a puppy through the incision, clamp the umbilical, severe the cord, and hand the puppy to the next pair of hands.

They look like they are doing well,” Sandi said as she took the next pup and headed back to Dixie.

This continues. Finally, Amy is the only set of hands. She catches the pup in a towel and follows the girls to the puppy basket as if it is nothing out of the ordinary.  

Everybody was back for their next pup, and Amy assumed her place in the line. Finally, the last puppy, number 12, is delivered. I double-check the birth canal just to make sure there is not a pup hiding there.

Amy was back to watch the finish. “Now, I just have to remove all the placentas and make sure there is nothing left in the uterus,” I explained. “Then, I just close the incisions, and we are done.”

  With the uterus closed, I return it to the abdomen and close the abdominal incision.

“Nothing left except to wake Mom up and introduce her to her new family,” I explain to Amy.

Once everything is closed up, I give Betty a reversal drug, and she recovers rapidly. We return her to the kennel, and she is awake before we know it. She is an experienced mother, and she takes the pups as soon as we show them to her.

There was fluid covering the table, and the floor was soaked. My tennis shoes will be retired to the work shoe shelf. The towels that Amy laid on the floor have soaked up most of the fluid.  Now there is a little time to relax. Twelve live pups, Sandi and her friends, are pleased.

  We send Sandi, Betty, and pups home as soon and Betty can stand. She and her puppies will do better at home under Sandi’s watchful eyes. I relax a little and look at Amy. She has done well this evening.

“What do you think about all of this commotion tonight,” I ask.

She just shrugs, doesn’t say a word. Displaying a nonchalance that she probably got from me.

  The C-section became a forgotten evening until we went to a parent-teacher conference some weeks later. 

Mrs. Rose, Amy’s second-grade teacher, was a little gray-haired lady who was very prim and proper.  Adored by her students and their parents alike, she was an old-time teacher, very much into the three Rs. She kept a tight rein on her classroom, ruling it with a tender heart.

Mrs. Rose went over Amy’s progress, which was exceptional, and then looked at us with a wry smile.  

  “A few weeks ago, the whole class had quite a learning experience about where puppies come from and how they get here. Amy was very excited about her experience and very descriptive of the surgery she helped you do.  I don’t generally worry about discussing the birds and the bees in my classes. Your daughter sort of changed all of that,” she said.

Photo by Michael Morse from Pexels

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