Ruger’s HItchhikers

D. E. Larsen, DVM

The little shepherd pup was lying with his neck extended and head flat on the exam table, and he did not budge when I entered the room.

Kris was seated in a chair, but her two boys stood at the table with the pup.

“Which one of these guys are we looking at today? I asked.

Both boys stepped back from the table and pointed at the pup.

Kris, a short gal in her mid-thirties with well-kept blond hair, was a regular client, but I had not seen this pup before.

 “This is Ruger; he isn’t feeling very well today,” Kris said.”  We’ve had him for a little over a week. He was fine at first, but then he started slowing down. Peter wormed him, and he passed a mass of ugly worms. But he has just kept getting worse. Today he is just like this, and he won’t get up to do anything.”

“And boy, did he poop a gob of big ol’ worms!” Jason, the larger of the two boys, said.

I lifted Ruger’s head with my left hand under his jaw. He acted almost lifeless. I turned his lip up, and his oral membranes were white. Not a hint of pink in his mouth or tongue.

“What did you use to worm Ruger?” I asked.

“I’m not sure,” Kris said. “A bottle of liquid that Peter picked up somewhere. I think it was like piper something. It was a clear fluid, slightly yellow in color.”

“That sounds like it was piperazine,” I said. “That is a good dewormer for roundworms, which is what you saw. The problem with it is it does do anything for the other worms. But we need to get some blood out of Ruger and see why he is so weak.”

“Do you think this is serious, Doctor?” Kris asked.

“Looking at his white membranes, I think Ruger is probably critically anemic,” I said. “I would guess we will need to give him some blood first off, and then we need to figure out why he is in this situation.”

“Could all those worms do this to him?” Kris asked.

“Roundworms can cause some problems, but it is usually gut problems,” I said. “There are some worms, especially hookworms, that can do this to a puppy. But, I rarely see hookworms in an Oregon dog.”

“Ruger was born here, but his mother is from Alabama,” Kris said.

“We will collect some blood and look at a stool sample,” I said.

“We have been watching his stool and haven’t seen any more worms in it,” Kris said.

“We do a floatation, where we float the worm eggs to the top of the vial and then look at those under the microscope,” I said.

“And you said he was going to need some blood. Where does that come from?” Kris asked.

“Ruger is a little pup. We won’t need a lot of blood to make him feel better,” I said. “My dog is is big Chesapeake Bay retriever, and he volunteers to be a donor.”

“He volunteers?” Kris asked.

“Yes, it is sort of a reluctant volunteer situation,” I said. “He loves coming to the clinic, and most of the time, he sleeps in my office. But he knows that he is about to volunteer for something when we take him into one of these rooms. And he really applies the brakes.”

We collected a small tube of blood, and it was evident that it was very thin. It almost looked like the blood from a leukemic cat. And at the same time, we collected a small stool sample.

I made a smear of the stool on a microscope snd added a drop of floatation fluid. As Dixie was running a quick CBC on the blood sample, I stuck the slide on the microscope.

I was totally shocked at the view through the microscope. The slide was covered with hookworm eggs, hundreds, if not thousands, of eggs in the first low power field.

Dixie had just finished with the CBC and handed me the paper.

“I think it is good that Odie is here today,” Dixie said.

Ruger’s packed cell volume, the percentage of red blood cells to total blood volume, was ten percent. In the dog, this was one the edge of death. I had seen cats with a PCV of six percent. Most of those died, but some could be saved with an immediate blood transfusion. I am not sure I had seen a PCV this low in the dog.

I returned to the exam room, pondering how to present this information to Kris with the boys in the room.

“You look concerned,” Kris said.

“Yes, Ruger is in a very fragile situation right now,” I said. “His red blood cell volume is at ten percent, which is as low as I have seen it in a living dog. We will have to take him in the back and transfuse him with blood right now. In his condition, we will give him the blood that we have available. We will not do any cross-matching, but it shouldn’t be a problem with this first transfusion. Any undue stress and Ruger could be gone in a moment.”

“What caused this to happen?” Kris asked.

“He has a massive infestation of hookworms,” I said. “We just don’t see this in Oregon, but it happens regularly in the South. With Ruger, it reflects on his mother.”

“Can we take care of that?” Kris asked.

“Yes, we can treat the hookworms, but Ruger needs blood first,” I said. “If we get some blood into him, he will come alive in an amazing fashion.”

“If you want to reduce his stress, I think you should do the transfusion right here,” Kris said. “The boys can keep him calm.”

“Okay, if the boys are up to it,” I said. “Sometimes, owners transmit stress to the pet. All I have to do is convince Odie to volunteer, and then I will collect a couple of large syringes of blood from him. When I come in here, we will place a small winged IV set in Ruger’s front leg and inject the blood right out of the syringes. It will be a slow injection, but it will only take a couple of minutes. Ruger will make a dramatic recovery, probably before the injection is complete. So, you prepare the boys for their job, and I will go get the blood.”

I stepped to my office door and slapped my leg for Odie to come, and he jumped up and was beside me in an instant. When I walked to the surgery room, Odie stopped at the door, and we had to pull him into the room by his collar. 

I had two sixty cc syringes, each with three ccs of heparin added, that I used to collect blood from Odie with a jugular puncture. It only took a moment to make the collection, and Odie was wagging his tail when I set him on the floor. He knew he would get a can of dog food for his service. He was bouncing around Dixie as she headed back to the kennel with a can of food.

Back in Ruger’s exam room, Ruger looked like he was fading away. I quickly placed a winged IV set into his left cephalic vein and started the injection of Odie’s blood.

Both boys were petting Ruger and didn’t seem bothered by the procedure.

“I think you guys will be amazed at how quickly Ruger is going to get well,” I said.

“I don’t know,” Jason said. “He looks worse now than when we came.”

As I finished the first syringe, Ruger picked his head and nuzzled Jason’s hand. By the time the second syringe was empty, Dixie had to hold Ruger down so we could get the IV set removed. When Dixie released her grip, Ruger was licking the faces of both giggling boys.

“That is sort of amazing,” Kris said. “I don’t think I have seen anything like it before.”

“Red blood cells are sort of important,” I said. “Now we have to get a dose of Nemex into this guy.

Nemex was a flavored liquid, and Ruger lapped it out of the end of a syringe.

“Is that all there is to it?” Kris said.

“That is all for today,” I said. “But Ruger is probably going to have problems for his entire life. He probably got a massive exposure of infective larva from his mother. Many of those will encyst in his tissues to become active later. They won’t drain his blood like this when his size is bigger, but he will need to be wormed regularly.”

“And I guess that means wormed with something other than piperazine,” Kris said with a smile on her face.

“Yes, you will have to get the stuff here or read the labels well if you get them elsewhere,” I said. “For now, I would like to see Ruger next week. Just to make sure he is doing okay. I will repeat the worming then, and I can fix you up with medication to worm him every week for the following month. Then we can play it by ear, but he will probably need medication a couple of times a year.”

***

The following week, Ruger was a different pup when he came in for a recheck. He bounced through the door on the end of a colorful leash with both of Kris’ boys trying to corral him.

When Ruger was shown into the exam room, Odie was in the lab area. In a somewhat unusual move for Odie, he was up and came over to rub noses with Ruger.

“This is Odie,” I said to the boys. “He is my dog, and he is the dog who gave the blood that we gave Ruger last week.”

“He almost acts like he knows that he saved Ruger’s life,” Kris said.

“Sort of, doesn’t he,” I said. “He is a smart dog,” 

Ruger was doing well on his recheck, and his blood numbers were back in the normal range. He did require medication for his hookworm problem every three to six months for the following six years that he got to see me. Kris and her family, and Ruger, moved away at that time.

Photo by Torsten Dettlaff on Pexels.

Cookie’s Litter, From the Archives

D. E. Larsen, DVM

“Dr. Larsen, This is Maude, from Brownsville,” Maude said into the phone. “Cookie, my best milk goat, is about ready to deliver. She is so large that she has been down for two days. Can I bring her up to your place so you can look at her?”

“That’s fine, Maude, you just need to know that we are not in the clinic yet,” I said. “We are still practicing out of our house on Ames Creek.”

“I think I can find it,” Maude said. “It doesn’t bother me, and Cookie is used to an old barn, so a garage won’t be a problem for her.”

When Maude arrived, and we got Cookie unloaded, her appearance was amazing. She had been down for two days because her abdomen was so massive, she could not support it standing. I was worried that she might even have a Hydrops Allantois, but I could easily palpate a couple of very active kids in the uterus. 

The only time I had seen Hydrops was while I was in school at Colorado State University, in a cow bred to a Bison bull. In that cow, you could not palpate any fetus. And on C-Section, the calf was dead. Hydrops is common in cows bred to Bison bulls. The Beefalo’s calves come from Bison cows bred to a Bovine bull. 

“We have some decisions to make, Maude,” I said. “If we wait for her to deliver, there is a good possibility that she will suffer significant musculoskeletal injury from being down for such a long time. If we do a C-section, we take a chance on the kids being early. That will mean that all of them may not survive.”

“You say, all of them,” Maude said. “How many do you think are in there?”

“I think a bunch,” I said. “I have seen 4 lambs in a ewe, and she was almost this big. There is about a 1 in 10,000 chance, and it might even be higher in the goat. There are at least 3 kids in there, I think there may be 4.”

“I think I am more worried about Cookie than I am about the kids,” Maude said. “It would be nice to get a bunch of kids out of her, but I want you to know that Cookie is the priority in this event.”

“So, I hear you say that you want to do a C-Section,” I said.

“Yes, that is what I want to do,” Maude said. “When can you do it?”

“Maude, I am just getting started here,” I said. “My days are not full, I can do it right now.”

“Good, can I stay and watch?” Maude asked.

“You are more than welcome to watch,” I said. “In fact, you might be put to work if we have 4 kids in there. I see you have a couple of bales of straw in the back of your pickup. Is there a chance we could use one of those to bed her down. She would be more comfortable than on the bare concrete.”

“That is what I brought them for,” Maude said. “Let me pull them out of the truck.”

We used one of the straw bales to bed Cookie down in the back of the garage while we set up for surgery. Sandy sets some chairs out for Maude and her driver.

“Once we get set up, things will go pretty fast,” I explained to Maude. “I will roll her up on her back, and we will clip and prep an area in front of her udder. I will make an incision, then we will start pulling kids out as fast as I can. If there are 4 of them, everybody will have a kid to take care as I close up things for Cookie.”

“I have never seen anything like this before,” Maude said. “I guess I will be okay. At least if there are kids to care for, I will have something to do.”

Paula had everything ready, so we rolled Cooked up on her back. Again, I was amazed at the size of her belly. It spread out in both directions. 

“I don’t think she could roll off her back if she tried,” I said to Paula. “You better tell Sandy to get every spare towel she can find. We are going to spell all sorts of fluid out of this uterus.”

With the abdomen clipped and prepped, I made the incision on the ventral midline in front of the udder. My kids watched from the kitchen doorway, and Maude sort of stretched her neck to see better.

“I thought there would be more blood,” Maude said.

“As long as I can avoid these large milk veins coming from the udder, there should be very little blood,” I said.

I extended the incision through the linea alba, pulled the omentum forward, so it was out of the way. Then I reached in to grab the head of the first kid I encountered. I drew this head through the abdomen incision and incised the uterus carefully. 

The kid’s head popped out of the incision and shook. I think she was ready to be out of there. Grabbing her neck, I pulled her the rest of the way through the incision. There was a rush of fluid that came with her. I handed her back to Maude. Maude was waiting with a towel.

“This kid is the same size as a single,” Maude said.

“No wonder she is as big as a house,” I said as I reached in and grabbed the second kid by the head also.

This kid came out fighting also. And like her sister, she was the size of a single.

“Two girls so far,” I said. “In a couple of years, you’re going to have so much milk you won’t know what to do with it.”

I reached in and grabbed a couple of hind legs in the far uterine horn. I tugged, and they did not move a lot. I felt close, I had one leg from two different kids. Correcting my error, I pulled the third girl out by her hind legs.

“Maude, there is another one in there,” I said. “And this one is another girl.”

Sandy stepped up, with the help of our girls, to take this kid. Maude had the first kid standing already. Everybody was busy now, and there were smiles all around. Nothing like baby goats to make people happy.

I reached in and pulled out the last kid, another girl. 

“This probably sets some sort of a record. Quadruplets, and all females,” I said as I handed the last kid to Paula.

I started pulling as much of the fetal membranes out through the incision as I could. There is no way to take them all out with damaging the uterus. But I would pull out a bunch and cut them off with scissors. We had all the towels and straw soaked with uterine fluids. 

“This is probably going to take as long to clean up this mess as it took for the surgery,” I said, more to myself than to anybody else.

I closed the single incision in the uterus. It was about a six-inch incision, sort of amazing that you could drag 4 kids through that incision. After returning the uterus to a normal position, I closed the Linea Alba with a sliding mattress suture using #2 Dexon. The external incision was closed in a conventional two-layer manner.

“Cookie, you are going have a flabby belly for a time,” I said as we rolled her off her back and made her comfortable on a clean spot in the straw. She wanted the kids, so Maude started handing them over to her one at a time. It didn’t seem to bother her at all to have all 4 of them to care for. 

“What do you think we should do with her now, Doc,” Maude asked.

“I think we should milk her out and get some colostrum into the kids,” I said. “It is early enough that leaving the kids with her for the day will probably be the best. I will give her some IV Glucose and Calcium just to give her a little more energy. I am guessing that she isn’t going to be up until morning. I would like like to keep her until then. I don’t know if I can handle the 4 kids running around the house.”

“I will go home for the day,” Maude said. “I have a lot of chores waiting. I will get back here around 5:00 this afternoon if that is okay. I will take the kids home. That is not a big thing. I have plenty of colostrum in the freezer, and I don’t leave the kids with my milkers anyway.”

“That will work fine,” I said. “Then, we will just see what morning gives us with Cookie.”

Cookie was up and looking for both food and a milker when I checked her early the next morning. Luckily, Maude pulled into the driveway about when I was heading into the house to give her a call.

“I guessed that Cookie would be up and ready to be milked,” Maude said. “I figured you would appreciate getting her out of here early.

“I think she will be ready for the milking stand by the time you get home with her,” I said. “She should be good to go. I see she passed her membranes last night. Just keep an eye on her, and I will drop by to just glance at that incision in a couple of days. I generally leave those sutures in place for about 3 weeks, just to be safe.”

Cookie healed with no problems, and the kids became a great addition to Maude’s milking string.

Photo by Brenda Timmermans from Pexels.

Jerd 

D. E. Larsen, DVM

Peggy was lying on the kitchen floor and reaching as far as possible under the wood cookstove. 

“I can almost reach him,” Peggy said.

“Leave him alone. He will just scratch you,” I said. “Jerd doesn’t like us.”

Jerd was our grandmother’s cat. He was a short-haired, white cat with one blue eye and one yellow eye. He was a loner and spent much of his time hunting and sometimes fighting the other barn cats. And he was death on grandkids. He was fine when we were watching him from across the room. But try to touch him, and he was all claws.

The only time he would tolerate our presence was when we were helping him find mice in the haymow of the lower barn. We could scatter hay, and the mice would run in all directions. He seemed to be able to catch one with each paw and one in his mouth.

Peggy reached a little further, and there was a low growl and then a hiss. Peggy withdrew her arm with a long set of scratch marks on the top of her hand. She was crying by the time Grandma got to the kitchen.

“I have told you, kids, time and again, to leave that old cat alone,” Grandma said. That was probably the first time I had heard her speak in a stern voice. “Now, let’s get in the bathroom, wash this up, and put some Merthiolate on it.”

“That stings,” Peggy said through tears from the scratch and now the fear of the treatment.

“It helps if you blow on it after putting it on,” Grandma said.

***  

A year or two later, during silo filling time, we little kids were stuck in the house with Grandma and the other women preparing lunch for the crew. It was more like a Thanksgiving dinner. 

Uncle Rodney pulled up to the back gate in his tractor with a sickle mower attached. He came through the gate and up the steps to the back porch. Grandma and a couple of the other ladies were waiting for him on the back porch.

“Mom, I just wanted to tell you that Jerd was out in the grass hunting mice, and the mower got him,” Uncle Rodney said. “It cut off all his legs, so we knocked him in the head to put him out of his misery. I think he must have been deaf. Otherwise, he would have heard the tractor coming.”

“That was the only thing you could do,” Grandma said. “What have you done with him?” 

“Duke is burying him over under that big myrtle tree on the creek bank,” Uncle Rodney said.

“That’s a good place for him,” Grandma said. “I’ll miss the old guy, but the grandkids will probably be safer with him gone.”

***

 Many years later, my mind drifted back to that day on Grandma’s back porch. I was waiting at the clinic for a client to bring in a cat that had been injured by a sickle mower in the fading light of the summer evening.

As I thought about Jerd and his behavior, he probably was deaf. That was why he was so antisocial with people and why he never hung around the barn with the other cats. White cats do have a genetic degeneration of the organ of Corti in the middle ear. So it is very possible that he was deaf.

And the sickle mower took all of his legs. I am wondering just what this lady will be expecting for the treatment of her cat tonight. And how many legs will it be missing?

“Good evening, Doctor Larsen,” Sally said as she came through the door with her cat peeking out of a bundle of towels. “Thank you so much for coming in this evening to look at my Oliver.”

I took Sally and Oliver into an exam room and placed the bundle of towels on the table.

“Tell me again, what happened to Oliver,” I said.

“Jim was trying to get the last of the field mowed this evening,” Sally said. “Oliver must have been out there, hunting in the tall grass. Anyway, Oliver got caught in the sickle blades, and he is a real mess. When Jim called out to me to bring a towel, I was afraid he had been hurt. I saw Oliver trying to walk as soon as I got to the tractor. I just scooped him up and headed back to the house. That’s when I called you.”

I carefully peeled the towels away so I could get a good look at Oliver. Oliver seemed resigned to his fate but didn’t display any obvious discomfort. What a mess, both of Oliver’s hind feet were severed just below the hock joints. His right front leg was severed at the middle of his forearm. There was only a minor laceration on his left front leg.

“Sally, there is not much I can do for Oliver,” I said. “Maybe we should be thinking of what would be in his best interest.”

“Can’t you just sew up his wounds?” Sally asked.

“Yes, I can sew up these wounds, but I am not sure how well Oliver will be able to motivate,” I said. “Are you sure you want to deal with him in that situation?”

“I just can’t give up on him over an accident that was not his fault,” Sally said.

“I am pretty certain that his stumps won’t hold up to any outside activity, and I am not sure how well he will handle the litter box in the house,” I said. “I don’t have a problem with repairing his wounds, as long as he will be in a situation that is livable for him. We could always rethink our decision later if you have difficulty dealing with Oliver at home.”

“Can you do this tonight?” Sally asked.

“Yes, after I get him under anesthesia, I will clean up these wounds and close things up,” I said. “I might have to shorten his stumps a bit just to be able to make more functional stumps.

“Will I be able to pick him up in the morning?” Sally asked.

“Probably, but call first,” I said. “I will need to check him over and make sure his pain is under control before sending him home.”

I gave Oliver a hefty dose of ketamine to start anesthesia and provide some pain control. 

In the surgery room, I prepped the wounds and trimmed the stumps on both hind legs, removing all the remnants of the metatarsal bones. This allowed me the ability to form a smooth, well-padded stump on each hind leg that could maybe serve Oliver pretty well. 

I smoothed the bones on the right front leg and closed that stump. It would not be as functional as his hind leg stumps, but it would heal well.

I infused a little lidocaine into each repair to help with pain on recovery, but with the ketamine onboard, he should be okay until morning. I settled him into a well-padded kennel.

“We will see you in the morning, Oliver,” I said as I closed the kennel door. “We will see what morning gives us.”

***

In the morning, Oliver was up and looking for breakfast. He seemed to be doing well in the kennel. Hopefully, he will do okay at home.

Sally was in the early afternoon, and Oliver was happy to see her. We sent him home with instructions to stay indoors and keep incisions clean and dry, and use a pelleted litter

I saw Oliver once more for suture removal, and Sally reported he was doing well at home. The incisions had healed well, and the stumps looked like they would be serviceable. He didn’t use his right front leg stump but moved around on his hind leg stumps and his good left front leg.

After that last visit, I never saw Sally or Oliver again. One can only hope that Oliver’s life was tolerable for him.

Photo be Sergio Souza on Pexels.