Timeless Spirit Logo    TALES OF A COUNTRY VET

A Spiritually Enlightening Online Magazine.  July Theme: "Flow"   Volume 1 Issue 5  ISSN# 1708-3265

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Tales of a Country Vet
with Dr. Bruce Burton DVM

Dead! A common yet versatile adjective, noun, or adverb, used to emphasize the absolute.

Long before I became a vet I was well acquainted with the word. I have been both 'dead right' and 'dead wrong'. More than once I have found my way across the Gulf of Georgia by 'dead reckoning'. At other times I ensured my safe arrival by lining up the end of the Iona jetty so that the light house was always 'dead-ahead', avoiding 'dead-heads' whenever possible.

I've passed 'deadbeats' on the sidewalk, and worked where the 'deadwood' had accumulated for years, and with some who appeared 'brain-dead'.

Using my 'deadeye' for accuracy I have, on occasion, drilled holes which were 'dead centre'.

More than once, I have mistakenly shouted a joyous greeting to someone who was a 'dead-ringer' for an old school friend. I've met and missed 'deadlines', lamented the sombre notes of the 'dead march' on Remembrance Day and stumbled over 'deadfalls' in the forest.

I've examined cadavers, which were 'dead-as-doornails'; watched races which ended in 'dead-heats' and lived on a 'dead-end' street. I've never been to the 'Dead Sea', but I've read about juries which were hopelessly 'deadlocked'. Buster Keaton was the definitive 'deadpan' comedian. When a dog is anaesthetized it suddenly becomes a 'dead weight'. When I was about twelve years old, I sprung all the traps on a muskrat trap line and remember being informed I was 'dead meat' by the owner of said traps when I was eventually caught.

I would venture to say, 'dead' is a term used commonly by all of us. It is an abstract method of describing the most extreme and definitive state of an object or action. Medically, it has a more specific and terminal implication; describing an entity which once possessed life, but does so no longer. A being, bereft of all life.

Or, as John Cleese so confidently and aptly pronounced "This is an ex-parrot!" However, outside of Monty Python, we normally don't declare an individual to be 'partially dead', or 'relatively dead'.

It's either dead or it isn't.

Because of our pre-occupation with trying to keep animals healthy and alive, it follows that vets are exposed to actual death more frequently than most members of the public. As a result, we get pretty good at determining whether or not an animal is possessed of this state.

Physicians have machines and lawyers to help them determine if their patients are dead. Veterinarians must rely on their senses. Absence of a heart-beat, lack of eye reflexes, fully-dilated pupils, non-response to painful stimuli, lack of breathing, purple gum colour. Collectively, these clinical signs help us to decide whether or not our patients have departed the world of the living.

Sometimes we encounter death as the end result of a long, but eventually unsuccessful battle against disease or injury. Sometimes we intentionally inflict death to prevent unnecessary suffering in hopelessly afflicted individuals. After years of experience, we veterinarians become exceptionally skilled at assessing both the likelihood and the presence of death.

Well, at least most of the time we do.

The phone call came through about 8 P.M. It was New Year's Day. "Sorry to bother you on a holiday, but Henrietta is having kittens… and… well… I don't know, but… uhm… I think she may have prolapsed." I knew Henrietta was a Himalayan feline, and Himalayans have a much higher incidence of having difficulties when giving birth, as do all short-faced cats.

I've dealt with prolapses in many species. In addition to cats I've worked on cows, nanny goats, ewes, bitches, and mares; all of which can have post-partum prolapses. I've even worked on prolapses in exotic species such as Yak, deer… and even parrots.

Upon her arrival, I noticed Henrietta's uterus was indeed prolapsed, although she took no notice of it. As soon as I tried to examine it closely she flopped on her back and rolled around in an unexpected burst of playful activity. I could feel at least one more kitten inside her and she was definitely going to need surgery. I called Geoffrey, my sixteen-year-old son, to assist me.

"It's likely we'll have to amputate the uterus." I told Elsie. "That's okay," she said haltingly, still catching her breath, "this was… going to be… her last litter… anyhow." I reminded her the chances of us getting a live kitten, or kittens, was very small, considering the stress and the time between her last kitten and now… but there's always a chance.

After administering the anaesthetic and placing Henrietta on her back on the surgery table, I cleaned and sterilized her bare skin. The instruments were laid out, and she continued to breathe regularly. Everything was going perfectly. I wasn't sure if we would be able to replace the uterus or how the surgery would go, but she seemed stable, so I grabbed the scalpel and made my incision down the centre of her belly.

Normally, a heavily pregnant bitch or queen has a series of very large veins crossing from one side of her abdomen to the other. In making the incision, it is impossible to avoid cutting these, so I was prepared for a lot of blood. However, as I drew the blade and the skin parted, there was almost no blood at all. Actually, there was a leakage of fluid from the veins, but it was so pale, it hardly appeared to be blood at all. It resembled diluted cranberry juice, rather than the thick, crimson fluid I was accustomed to. This was not good!

I left the surgery room and called out into the waiting room. "Elsie, this looks very serious… you said Henrietta hadn't bled very much at home. Are you sure?"
"Yes, we kept her in the open box at home and it's in the bathroom. If there was any blood, we would have seen it… and there wasn't much on the towels either… why do you ask?" Elsie looked worried.
"Well, look at this!" I held up my barely pink-tinged gloves. "Her blood is extremely dilute… has she had any flea problems or any accidents recently?"
"You don't have any rat-poison in the house… anything like that?"
"No, none!"
"Does she get outside? Go to the neighbours?… " I was fishing for some clue as to why she was so anaemic.
"No, never. She's never outside."
Frustrated, all I could say was "Okay, all we can do is try to minimize any bleeding during surgery but if we're going to save her, we can't stop now." So, with a knot in my stomach I pressed on.

The uterus of a cat is a Y-shaped structure. The left side was in its normal position and contained one lifeless kitten. I removed the kitten. It was covered in the green mucous called locia, which is normally present during the birthing process and is released as the placenta detaches from the wall of the uterus.

This locia was very thick and gooey, almost paste-like in consistency; meaning the placenta from this kitten had likely become detached from the uterus a long time ago. And the longer the kitten had been cut off from the oxygen supply provided by the blood in the placenta, the less likely the kitten would have been alive.

The kitten was thin and dehydrated. There was no movement. I rubbed it several times, checking for signs of life. There were none. So I handed it to Geoff and told him to inject a small amount of doxipram (a breathing stimulant) into her tongue and rub the chest. Anything, to try to get it started. I changed gloves and returned my concentration to Henrietta.

"Dad, I can't tell if the kitten's breathing or not."

"Okay, just give it to Elsie and come back, I need some suture packages opened." He passed the kitten on and we both worked on getting the uterus back into the abdomen, he pushing from the outside from under the drape, and me pulling on the inside. And, somewhat surprisingly, the uterus was suddenly slurped back into position. I examined it closely for any tears. None were evident.

What had at first appeared to be a tear, was actually the remnants of one of the earlier placentas. Clearly the uterus was swollen, and parts may have been devitalized - so removal was still the plan. I infused some oxytocin intravenously to shrink down the uterus before removing it. This acts to salvage as much blood as possible.

The oxytocin worked almost immediately. I could see the organ shrink down dramatically before my eyes. I then set to remove the ovaries and uterus. And again, somewhat miraculously, there was almost no haemorrhage. Through the entire surgery Henrietta's vital signs had remained steady and stable, and blood loss was almost non-existent. I couldn't have hoped for a better outcome.

Then, just as I was putting in the last row of sutures to close the abdomen, Elsie hollered from out front "I think the kitten's alive!" I smiled knowingly, thinking to myself, "There's no way that kitten would be alive, probably just a reflex, but once I finish here I'll check it."

"Good!" I returned in full volume. "Keep rubbing, I'm just about done in here!" I placed the last stitch and rolled Henrietta on her side. "We'll leave her on the pure oxygen as long as possible, just watch her while I check out the kitten," I said to Geoff as I snapped off my gloves.

"Okay, lets put it down on the table." I motioned to Elsie. The limp little lump was completely immobile. The contours of its tiny skeleton were clearly outlined under the thin layer of dehydrated skin and irregularly matted and fluid-stained white hair. "I don't think so," I mumbled out loud. I placed the paediatric stethoscope to its chest. Silence.

I strained to hear anything… nothing…"no, I don't…" I paused."… Hold it… wait a second… " I could feel the slightest tinge of movement, then the little kitten made a tiny, convulsive attempt to breathe.

"Hold everything!… I can't believe it… but maybe this little gaffer wants to live after all!" I grabbed the tuberculin syringe and injected a bit more doxipram and vigorously massaged its chest…

Nothing… then a tiny shot of epinephrine and more massaging… nothing… then another convulsive breath… Smiles emerged all round. "This is still along way from surviving, but it appears to have some life, so keep working on it". I left the kitten with Elsie and went back to Henrietta. She was starting to come around so I disconnected her from the anaesthetic machine and the oxygen and placed her on the treatment-room table. The IV was still running slowly.

She started to lift her head and paw at the breathing tube, so I removed it. She seemed great! And I was relieved. I returned my attention to the kitten, which had once again stopped breathing. Janeane, Elsie's daughter, had taken over the resuscitative duties but was being far too gentle.

"Here, Jeneane, you've got to be more aggressive. Here… like this." And I took the kitten from her. I showed her how the harder I rubbed the more the kitten responded, until it was back breathing again; albeit slowly, very slowly and erratically. But breathing, nonetheless.

I then looked back at Henrietta. She wasn't breathing. I waited for a second, and grabbed her tongue. Purple. I pulled on it (this often elicits a breathing reflex). No response! Her eyes were dilated and unresponsive. I listened for a heart beat. Nothing!… nothing… nothing…

I waited and concentrated as hard as I could… nothing… then faintly… in the deepest recesses of my acoustic senses… I thought I could hear a flicker of movement, but nothing approaching a heartbeat - probably just the echo of my own pounding heart.

I cupped my mouth around her face and blew, hoping some air would enter her lungs. Since the endotracheal tube was out, I couldn't do anything else. But with her pushed-in face, it was futile. No air seemed to enter the chest.

I grabbed the bottle of epinephrine and injected a quarter of a cc. into the IV catheter and immediately squeezed and released her chest. External heart massage was all I could do.

Elsie could see her beloved pet was either dead or dying. On E.R, everyone who 'flat-lines' is easily brought back to life with a little CPR, and some electroshock (a room-full of skilled specialists and a million dollars worth of state-of-the-art equipment doesn't hurt either). In real life, this rarely happens.

I worked on Henrietta for the next twenty minutes, alternating between giving her epinephrine injections, massaging her heart, and blowing into her slimy little nose and mouth; all to no avail. She was dead. I was even more devastated to lose her because I had believed the surgery had gone so perfectly well. Clearly, her anaemic state was just too severe and that, combined with the trauma of the surgery and the hours of stress associated with the prolapse was just too much for her small body to handle.

I touched her eyes. No response. I shrugged my shoulders and turned to Elsie apologetically. "What can I say?… She was doing so well and then just…." My voice trailed off. I could see in her eyes Elsie wasn't blaming anyone. She was there the whole time, and it had all happened so quickly.

I turned around once more, placed my stethoscope under Henrietta's chest… and this time I though I could hear something. Oh so very faint, but something! There it was "buh&#133buh buh…" The unmistakably wonderful sound of a beating heart!

I couldn't believe it. It was faint, but it was real. I removed the stethoscope once again to ensure it wasn't my own heartbeat, and put it back. No. It was Henrietta, and her heart was beating regularly and getting slightly stronger with every beat. Gradually, the 'buh's turned to booms. I shook my head with a relieved smile, and said, "Well, her heart's beating."

Then Henrietta took a breath. Again, smiles all round. We couldn't help ourselves. After another few seconds, another breath. Shallow, halting efforts… but clearly, she was breathing on her own. I touched her eyes; still no response. Not a good sign. Normally, animals respond quickly once the anaesthetic begins to wear off. "Well, Elsie, she's trying, so we might as well give her every chance." I placed her back into a mask where she'd get pure oxygen again.

Over the next half hour, her breathing and heart rate improved to almost normal levels. However, this was all that improved. Her eyes remained fixed, dilated and unresponsive. I was worried she had suffered brain damage and my spirits began to sag, yet again.

"All we can do now is wait it out. We're not out of the woods by any means. This is one sick little kitty. She's already died on us once. It's a miracle she is still with us. She's going to have to be kept on an IV and monitored very closely, at least for several days. We may need to give her additional medications and oxygen. If she doesn't respond soon, I'm afraid she may be technically alive but remain in a coma-like state permanently. I honestly can't say how she will do, even if she does wake up." I could see Elsie's face fall. "But at least we still have a chance, right?" she whispered. I nodded silently, forcing a reluctant smile.

By this time the kitten had once again lost any sign of life. Elsie had picked it up mechanically and had been automatically caressing it during the emergency with Henrietta, but now it showed no life-signs. I listened again with the stethoscope. Nothing. I listened as hard as I could. Still nothing. "Well, we didn't expect it to be alive anyhow," said Elsie with resignation in her voice.

Then she asked, "At least there's still hope for Henrietta, isn't there?" I took her aside as they were leaving. "Some hope, yes, but I'm afraid Henrietta's chances are not very good. I don't want you to get your hopes up too high." "I know, but as long as we try…" Sadly, they headed out the door and I returned to the business at hand.

I placed the kitten's tiny carcass on a towel on the table, I'd put it in the freezer after I finished with Henrietta. As soon as I felt she was breathing strongly enough, I placed her in the intensive-care room and set the temperature to keep her nice and warm.

I checked on her several times that night. By two A.M. her heart and respiration rates were essentially normal, but there was no other improvement. Her eyes were still fixed and dilated. No response when I touched them. So I placed a protective lubricant in each eye and closed the door. I was saddened by the knowledge that even though she was technically alive, she would never return to her old self.

Next morning, I grabbed the file on the way into the kennel, preparing myself to phone Elsie with the sad news that Henrietta was either no better, or had died in the early hours of the night. The files were sitting on the treatment table beside the tiny carcass of the kitten, which I had forgotten to put it into the freezer the night before.

There were some towels that needed cleaning in a plastic bin on the sink so I tossed the lifeless little lump in with the towels and the gauze sponges I had used in the surgery. I'd clean them all up together.

I was fumbling through the file looking for Elsie's phone number when I heard a squeak. In my aggravated state there was only one thing that would make that sound. "Mice!" I said aloud. "Those %$#@ little #$%^'s get into everything!" I looked around for the source. Silence. I waited patiently. "Squeak!" It seemed to be coming from near the plastic bin. "How'd they get in there? Well, at least I'd be able to vent my wrath on them… didn't quite sound like mice, though" Then I thought "No!… It couldn't be…"

I half raced over and sure enough, in amongst the stained towels and gauzes the tiny kitten was squeaking and squawking at the indignity of being tossed in with the rest of the post-surgical garbage. I stood there in stunned silence. I just couldn't believe it. How had this little guy survived all night on his own after being pronounced dead not once, but several times? And not only was he alive, but moderately vigorous. He even had a sucking reflex! Unbelievable!

Well, that changed everything! If Henrietta had survived the balance of the night, and if we could keep her going for a few more days, then she might be able to at least suckle this little guy, and maybe even the other two kittens at home. I cupped the kitten tightly in my hands to keep it warm and went in to check on Henrietta.

As soon as I opened the door she was up and meowing loudly. She wasn't just still hanging on, she was bouncing around the cage twisting her IV tube in multiple knots, rolling on her back and then up and rubbing the side of the cage. I reached in to grab her and she immediately greeted me with her usual, overly affectionate head-butt. I was on cloud nine! This was too much for me to take in. I was grinning from ear to ear. This was one phone call I was eager to make.

When I called, it was all I could do to keep a rather sombre tone to my voice, just to make the news that much more incredible. They had been forewarned to expect bad news, but when I told them about Henrietta's miraculous turnaround, they were ecstatic, and the news of the kitten was a totally unexpected bonus. By the next day Henrietta was hard at work feeding and caring for her brood.

After that emotional roller-coaster ride, I was 'dead certain' it was a great start to the New Year.

Dr. Bruce Burton, DVM, B.Sc., M.Sc., works with the animals at The Greater Vancouver Zoo and with 'animal stars' in the local film industry. He has extensive expertise in domestic and wild animal biology, health care and nutrition, as well as fish and game-farming experience. In addition to his busy practice in Bradner, Dr. Burton teaches at The University of British Columbia, and is often called upon by the SPCA to help exotic animals in need.

He chooses to write down his experiences so they are not lost, but rather shared with others. He wants his children and grandchildren to be able to read them first hand. I hope you enjoy your own sneak peek into his daily routine!

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