Over-sized and Pocket-sized, A Spay is a Spay

D. E. Larsen, DVM

I pushed my left arm deeper into the birth canal of the young heifer, sweeping my hand left to right, trying to decide as to what was wrong here. 

Then I encountered intestines, this was not good. They were too large to be from the calf. This uterus was ruptured. I shoved my arm up to my shoulder. Finally, there was the calf. The calf was in a breech position. I stuck my finger into its rectum. A contraction, this calf was still alive.

I pulled my arm out and washed. “Sue, someone must have tried to pull this calf,” I said.

“Yes, my son Joe was here a bit ago, and he tried to work on it but said that he couldn’t get anywhere.”

“This heifer has a ruptured uterus. The calf is still alive. If we do a C-section, I can save the calf. I don’t know if I can fix the uterus or not.”

“Okay, do what you can,” Sue said. “This is Sam’s favorite heifer. She is kind of small, but he treats her like a pet. I hope you can save her also.”

The heifer was lying on her left side. This was probably good. A right flank incision might give me the best access to repair the uterus.

For me, c-sections on cows were a chore. But most of the work was closing things up. This one would depend on what kind of damage had been done to this uterus.

We clipped and prepped the right flank, and I did an inverted L block with Lidocaine. It did not take long, and we had the calf out, and she was shaking her head as she looked around at her surroundings in this small barn.

The uterus was mostly torn off the cervix. It was held by a narrow strip of tissue. There was no way to repair this.

“Sue, this uterus is almost completely amputated from the cervix. I don’t think that I can repair it,” I said.

“You spay dogs and cats all the time. Can you just remove it,” Sue asked?

The question stunned me for a moment. I looked at the torn mass of uterus and pondered the situation. 

The largest dog has a uterus with a diameter less than my index finger. By comparison, this was a massive uterus. But it was worth a try. Otherwise, we shoot the heifer. If the surgery doesn’t work, at least we tried before shooting the heifer.

“I hadn’t given that any thought, Sue,” I said. “I guess it is worth a try.”

I had difficulty reaching the left ovary. With that problem solved, I placed a transfixed ligature on each ovarian pedicle. After severing the pedicles above the ovaries, I hung the uterus out of the incision. Severing the remaining attachment at the cervix was no problem. I placed a couple of stay sutures in the cervix to keep it close to the incision when I removed the uterus.

With a good twenty pounds of uterus laying in the straw, now all I needed was to close the cervix and ligate a couple of bleeding vessels. Then it was a standard closure of the external incisions. This probably all took less time than a typical c-section.

After giving the heifer some antibiotics and a Dexamethasone dose, I let her up to tend the calf.

“What do you think,” Sue asked?

“Ask me in the morning,” I said. “If she survives the night, I would guess we are good to go. But don’t expect her to have a calf next year.”

“Is she going to be able to raise this calf,” Sue asked?

“That should be no problem. The uterus and the ovaries are not necessary for milk production.”

“Mom and calf were doing well,” Sue said when she called the following morning. 

When I was out to take the sutures out of the heifer, the incision had healed well. The calf was bouncing around, happy to be in this land of the living. 

“When you sell her, make sure you are honest,” I said. “Some poor guy will go nuts trying to get her pregnant.”

“My guess is Sam will make a pet out of her. She will probably never leave the farm.”

It was not long after this event when Pat called. Pat was the elementary teacher with a bunch of classroom pets. It had not been too long ago that I had repaired a fracture on a hamster’s leg for one of her pets.

“It’s Sally, Doc,” Pat said. “She has to be days overdue for delivering babies. And now she is not feeling well. The kids think she has a problem.”

“Tell me more about Sally,” I said.

“Sally is a mouse. They have a gestation for something like 20 days,” Pat said. “We have been watching for babies for over a week now. I am certain that she has to be 4 – 5 days overdue. I can get away for a few minutes shortly, can a drop her off for you to look over?”

“Does she bite,” I asked?

“Sally is the sweetest little mouse,” Pat said. “She loves to be petted and handled, and all the kids love her. That is why everyone is so upset.”

Sally was just as Pat described, sweet as could be. I rolled her onto her back and rubbed her belly in a manner that became palpation. Sure enough, Sally was pregnant with what felt like 8 babies. They were hard as marbles with no feeling of fluid in the uterus. These babies were dead.

I called and talked with Pat. 

“Pat, her babies are dead, and there is a bunch of them,” I said.

“What can we do,” Pat asked?

“If we don’t get them out of there, Sally is going to die,” I said. “She is already dehydrated. I think I should try to do a spay on her. If, by chance, there are any live babies, we could save them. But I don’t think there is anything alive in her uterus.”

“You do what you think is best. The kids and I trust your skills,” Pat said.

We gave Sally a dose of Ketamine for anesthesia and some subcutaneous fluids for her dehydration. I used a razor to shave her belly, and with a surgical prep completed, she was ready for surgery.

With her fur gone from her belly, you could see the lumps in the uterus through the belly wall. 

“I think I am going to need some magnification,” I said as I put on my loupes. “Things are going to be pretty small in there.”

I opened the abdomen and externalized the uterus, two horns of the uterus, one on each side, with 4 hard nodules in each horn, each about the peanut size. The babies were long dead, and all the fluid had been resorbed from the uterus.

The anatomy was the same as a dog or cat, just a lot smaller. I Iigated the ovarian vessels and the uterine body and removed the uterus with the dead babies.  

Closing the abdomen required only a couple of sutures. Sally recovered slowly from the Ketamine, but she was up and eating when I checked her in the morning.

Pat and her class were happy with the results, and we were paid with twenty-some pages of hand-drawn pictures with thank you notes. 

The entire class brought Sally in for suture removal. Typical of classrooms that visited the clinic, some students struggled to be as close to the action as possible. Then some sought the comfort of the reception area.

Sally enjoyed the attention. And she managed to live a year or two longer than a mouse in the wild.

Photo by Colin Davis on Unsplash

Run for Your Life

D. E. Larsen, DVM

Joe always wanted Comet checked for one thing or the other. He was waiting for his turn in the exam room with Comet on his lap. Comet was a young Whippet. There was not an ounce of fat on his entire body. I could about define every muscle on him, just looking.

“What’s up with Comet today,” I asked as Joe placed him carefully on the exam table?

“I have been reading about heartworms, Doc,” Joe said. “I thought maybe I better have you check Comet and get him on some medication.”

“We have just completed a statewide heartworm survey,” I said. “One of the drug companies paid for it. Most of the clinics in the state collected blood samples from 100 dogs. They ran all those samples, and they say we have about a two percent incidence of heartworms in native Oregon dogs.” 

“That doesn’t sound like it is too serious,” Joe said. 

“Not too serious at this point, but they claim that is pretty standard for how heartworms invade an area. It will be in low numbers for several years, and then all of a sudden, it is a major problem.”

“Well, even if it is a low-risk thing, I think I want to get Comet on some medication,” Joe said. “You know how I am about him. He means as much to me as any of the kids.”

“I know, Joe, you have him with you all the time,” I said. “The kids come and go.”

“Now, don’t you tell my wife that I said that. She would be upset with me,” Joe said.

“Let me get a blood sample from Comet, and we will see if we can get him on some medication,” I said. “This new drug, Ivomectin, is a little bit of a problem with Greyhounds and Whippets. But the dose used for heartworm prevention is low enough that it is not an issue.”

“Whatever you think, Doc,” Joe said. 

“The risk of the medication causing a problem is very small, Joe. But then, the risk of infection is also minimal. At this point, where you live out on a hillside with few neighbors, I think it is your call.”

“That hillside is one of my concerns,” Joe said. “We are getting into quite a coyote problem. They are getting so brave that they come right down into the yard and bother Comet. I don’t him catching anything from them.”

Comet tested negative for heartworms, and we started him on a new preventative medication. 

“You give him one of these tablets once a month,” I said. “Try to give it on the same day of the month, but you have a few days leeway if you forget.”

It was several months later when Joe returned to the clinic. He was distraught, and his body odor told that he had not bathed in several days.

“Doc, Comet is gone,” Joe said as he leaned hard on the counter, tears welled up in his eyes. “Those coyotes ate him, I am sure.”

“What happened,” I asked?

“Three of those damn coyotes came into the yard and started to attack Comet. Before I could do anything, Comet took off like a shot. You know those Whippets can run. The coyotes were right on his tail.”

“I doubt that those coyotes could catch Comet. I know of ranchers in Colorado who keep Greyhounds to hunt coyotes. Those Greyhounds just run them down.”

“Maybe a half-hour after they left the yard, the whole pack of coyotes were yipping up a storm. I am sure they got him. And he hasn’t been home, and that was four days ago. I don’t know what I am going to do without him.”

“Joe, you need to go home and take care of yourself. Take a shower and get cleaned up. Maybe have the kids help you build a little memorial in the yard of Comet. Then go out for a good dinner. Comet would want you to have a normal life.”

“Yes, you are probably right, Doc,” Joe said. “I brought this package of pills back. I only used a few, and maybe you can give them to someone who doesn’t have the money to afford them.”

“We are not supposed to do that, but we keep a few things in the cabinet, just for such a client.”

“That poor man,” Sandy said after Joe left. “That dog was his whole life.”

“He will be okay,” I said. “It will just take a little time and some diversion.”

It was only a few days later when Joe exploded through the door. Exuberant, he had a smile from ear to ear. He had combed his hair, and he was well dressed.

“Doc, I want to thank you for your advice,” Joe said.

“You look happy,” I said.

“Let me tell you the story,” Joe said. “I went home the other day and tried to take your advice, but I couldn’t get myself up to it. I laid around another couple of days. Finally, I looked at the yard, and boy, it needed to be mowed. So I went out and started the lawnmower, mowed the yard, and then I took the boys down to Hoy’s Hardware to buy stuff for a memorial. And what do you know, when we got home, there was Comet, sitting in the middle of the driveway, waiting for us. I was so happy. I almost ran the pickup into the house.”

“That is great news,” I said. “I bet that Comet ran so fast and so far that he didn’t know the way home. When you started the lawnmower, you probably gave him some bearings on how to get home. I didn’t think a coyote could catch him.”

“You are probably correct,” Joe said. “This time of the year, I mow the lawn at least once a week, maybe twice, if I get bored. So Comet would know the sound for sure.”

“I would give you those pills back, but I gave them to an old guy this morning,” I said with a smile on my face.

“That’s okay. I will gladly buy some more,” Joe said.

“No,” I laughed. “I will grab them for you. I was pulling your leg a little.”

Photo by Mitchell Orr on Unsplash

The Lost Ball

D. E. Larsen, DVM

“I don’t know what is wrong with old Ben, Doc,” Gavin said as he picked his dog up and settled him on the exam table. “He started vomiting once in a while several weeks ago. I just didn’t think much about it. But now, he vomits everything he puts in his mouth. He takes a drink and turns around pukes it up.”

“Let’s give him a good once over, and then we will talk about what diagnostics we need to do,” I said.

Ben had obviously lost a lot of weight since I had looked at him, but everything else was pretty unremarkable.

“How long has he been vomiting, Gavin,” I asked?

“I said several weeks, Doc. But you know how time slips away. It could have been longer. I never noticed how thin he was until just now.”

I stood him up, but Ben was a little reluctant to remain standing. Finally, with Gavin holding him under his chest, I started carefully palpating his abdomen. He was thin enough, I could just about define every structure in his belly. 

The mass just sort of jumped into my hand as I palpated his mid-abdomen. Small, round, and solid, it was the perfect size to obstruct the small intestines. 

“Does he chew on rocks or anything like that,” I asked?

“No, he doesn’t do much of anything anymore. He is getting pretty stove up. He does retrieve my golf balls when I am chipping in the back yard.”

“Golf balls,” I said as I felt the mass again. “Have you lost any of those balls?”

“Gee, I don’t know, Doc. I really don’t keep track of them. Do you think that is his problem?”

“I can feel a solid round mass in the middle of his small intestines,” I said. “It is of the size that it could be a golf ball. It could be a tumor or something else.”

“What do you think we should do,” Gavin asked?

“We could send in some blood and get some x-rays to try to define the object. Or we could just do exploratory surgery. We can fix it, or it may be something that we can’t do anything about. Really, the only way to know is to go in and look.”

“Are you saying it could be cancer?”

“Could be, but I would bet on the golf ball. It was probably rolling around his stomach for a few weeks causing him to vomit. Then in the last day or two, it started down the small intestine. That is when the vomiting really got going. If it is the ball, it is a simple fix. If it is a tumor, we can probably take it out, and then it just depends on what type of tumor it is.”

“Let’s just do the surgery,” Gavin said. “When can you do it?”

“I think we can do it the first thing in the morning. We will give him some fluids overnight and get him started on some antibiotics. If everything goes well, he should be able to go home the following day.”

“Do we have any special care,” Gavin asked?

“Not much. We will keep him on fluids and nothing by mouth for 24 hours. Then he will be on a soft slurry of a diet for a week.”

The surgery went well. Finding the foreign body was not an issue. There was virtually no fat in the omentum or anywhere else in the abdomen, for that matter. Ben has had this problem for a lot longer than Gavin had recognized. I explored the intestine’s entire length and palpated the stomach for any trace of another foreign body. None was found.

When I opened the intestine and squeezed a well-worn golf ball from its lumen, it was apparent that it had been in the stomach for some time. The cover of the golf ball had lost most of its dimples.

I closed the intestinal incision, rinsed the area well, and replaced everything into the abdomen. I closed the abdominal incisions, and we recovered Ben.

Ben felt immediately better on recovered. I think he was looking for a steak dinner. “That’s okay, Ben,” I said. “We will give you some liquid steak tomorrow morning.”

When we placed a small bowl of water in Ben’s kennel in the morning, you would have thought that he had been in the desert for a week. It just disappeared. Then we followed with a small bit of dog food mixed to a slurry. Ben lapped that down and was wagging his tail for more.

Ben was bouncing around when Gavin came to pick him up. He was ready to go after having several small meals of slurry.

“He is doing well,” I said. “He is acting like he hasn’t eaten in a month. And that may have been close to the case.”

“He sure looks better. Thanks, Doc,” Gavin said.

I tossed Gavin the golf ball in a small plastic bag.

“It looks like it has been in his stomach for some time,” I said. “You want to keep it in that bag or air it out outside. It smells pretty bad. And you know the rules. It is a stroke and distance for a lost ball.”

“I think that Ben’s golf ball retrieving is over,” Gavin said as they headed out the door.

It was a couple of weeks later when Gavin brought Ben in for suture removal. Ben was a completely different dog. He had gained at least 10 pounds. You could still feel his ribs, but they were not visible, just looking for him.

“He is back better than he has been for a long time,” Gavin said. “That golf ball must have been in there for months.”

“Yes, as long as it was just bouncing around in his stomach, it was only causing him some vomiting. When it entered his intestines is when it caused him some major problems.”

We removed the sutures and patted Ben on the head as I sat him on the floor. He was straining at the leash to get out the door. 

“They never give me any credit,” I said as Gavin was being pulled along toward the door. “They just know this is not a pleasant place to be for any amount of time.”

Photo by Siddharth Narasimhan on Unsplash

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