Sunday, July 26, 2009

Not always Rabies

Living in North Dakota brings with it some unique experiences. One thing very common here that I haven't had to deal with anywhere else is Rabies. It is a big problem and we have several cases a year. I know you are all having flashbacks to Old Yeller right now. We actually see cases very commonly in cattle as well as dogs, cats, horses and really most of the species we deal with. We rarely see a foaming at the mouth animal that is trying to bite someone. Generally ours are just acting funny or walk funny or can't stand up. Rabies is endemic in both skunks and raccoons in the state so we have a doubly great chance of contracting rabies.

Since it is so common we have many clients that have animals acting unusual and almost always the first question out of their mouth is, "Could it be Rabies?". Not surprisingly our very diplomatic answer is generally, "It could...and there are some other things we should think about". A case this week was one of these.

A cow presented with history of drooling with her tongue hanging out and acting a little funny. As she walked off the trailer I was pretty sure that it wasn't rabies. The tongue was hanging out and she was drooling but she also had a big lump on the side of her cheek and was very thin. My immediate thought was that this cow had broken her jaw. Another doctor was right there with me and began examining her mouth and immediately piped up with, "well you guessed wrong". One quick look in her mouth showed that a broken bone was the problem, but it wasn't hers...she had half of the pelvis of a calf jammed sideways in her mouth and was completely unable to close her jaw or move her tongue. Of course we took it out, gave her antibiotics and an anti-inflammatory and sent her on her way.

Just goes to show you that your first guess, and all too often your second guess isn't always right. That and not every cow that "foams at the mouth" has rabies.

Sunday, July 12, 2009

I wish not

Most of the time I love my job as a mixed animal veterinarian. There are very few times that I look at what is going to be coming in and have an unpleasant intrinsic reaction. One thing that can really make me want to run and hide or pretend that I am doing something really important so that another doctor will have to take that appointment is as simple as three little letters: DRC. Now anyone involved with the medical world knows that there are acronyms for all kind of medical things. In fact I read a medical record that went something like this.

Patient BAR, MM pink, moist CRT< 2 sec, EEN clean clear, H/L/T aus WNL. Abdominal/LN palp WNL. HR 110 BPM, Resp 28 BPM, Temp 100.6 F, EDUD WNL

I think you get the picture

Anyway back to the DRC. If any of you get squeamish you might want to stop now. DRC means Dead Rotten Calving.

These are particularly popular this time of year because most of the cattle are out on the pasture and not checked as often as usual. Some of these cows may have been calving for a couple of days before they are found. Combine that with hot summer weather and you have the perfect recipe for a rotten calving experience.

On this particular day I decided to take one for the team and tackle the DRC. Sometimes they really aren't that bad, but the fact that I could smell the cow while she was still outside did not bode well. The apologetic owner (as they almost always are with this kind of thing; one even brought me doughnuts as a peace offering) said that he didn't know how long she had been calving. She was out in a pasture that doesn't get checked often and they even thought that she was open (not pregnant) and that was why she was in that pasture.

I was delighted to smell two legs that appeared to be front legs hanging out the back out of my patient. The fact that 1/2 of the hair had already sloughed off the legs was a pretty fair sign that she had been at it for more than a couple of hours. Once I started manipulating and pulling on the feet the half rotten skin tore open on one leg revealing the bones beneath. Fortunately I already had my gag reflex under control and I was in for the long haul. As the long bone was only succeeding in tearing my plastic sleeves we decided to pull it off. I know that sounds gruesome but guess what - Junior died three days ago and he can't feel that we just pulled off his femur.

Yes, I did say femur. The legs only looked like front legs because they had decomposed sufficiently to allow all the bones in the joints to separate and bend any way that they wanted.
Without further ado, a lot of lube, some careful manipulation, and about 40 minutes we were able to remove the remainder of the partially decomposed calf.

Now many of you would say, "serves you right for being a large animal vet!" And to be honest, when confronted with such cases I have had similar thoughts. Why didn't I go into small animal where everything is easy?

Well wouldn't you know the next day I had another experience. The schedule book said dog whelping. Hey that sounds like fun.

First, I will say as a veterinarian I try not to judge people and how they are with their animals. While I will not jump on the band wagon that many veterinarians do about the evils of breeding dogs when there are so many in shelters etc etc (you can feel that way if you want to) I do occasionally run into a person that I say should absolutely not be breeding dogs. This was just such a case. Because of that there will be no reference whatsoever to owner age, gender, identity or breed. I will simply say that she was a larger breed dog.

The conversation went something like this.
Owner comes in and says, "I am not sure what is wrong with her, I think she might be having a problem.
She had one puppy without any trouble but now I don't know what is going on.

My turn,

"How long ago did she have the first puppy"


"Well, I guess it was the night before last so about a day and a half ago"


stunned silence.
Thoughts whirling though my head: you have got to be kidding me, your dog had a puppy almost two days ago and she has a large piece of placenta hanging out the back of her vulva and you think there MIGHT be a problem?
Don't say anything rude, even though you are thinking it right now.

On vaginal exam of the dog I could feel just the tips of two feet. Unfortunately, I was unable to get a good enough hold and the feet weren't out quite far enough so we gave her some oxytocin and some time to get her back into labor.

Half an our later I was able to get a good hold on two back feet and wouldn't you know - the hair just sloughed right off in my hands. The dead puppy was backwards and dry and was not wanting to come out. Thankfully with a lot of lube and manipulation and way longer than I have ever had to work on another puppy the very dead, nasty puppy came out. Yes, small animal vets do get their occasional nastiness too.

Radiographs showed no more puppies, which sparked two very choice remarks from owner;

"Dang it there are no more puppies?!?"

"When we breed her again will she have any problems?"

I wish not to have these experiences again...both the nasty part and the choice owner...but I am young and will probably have even better!