by Dr. Jan Pol
“How come?” I asked
“I don’t know. He just told me not to bring him in.”
“Okay, go ahead and come on over.”
He was raising this goose for his 4-H project. I have always been a big supporter of the 4-H. He walked into the clinic carrying his goose under his arm and put it down on my examining table.
“Hello, goose,” I said to him, rubbing my hand over his body. “What’s bothering you?”
That goose stood there letting me check him over. It was surprisingly tame. Its temperature was normal, but when I felt his breastbone I noticed there wasn’t too much muscle. “What are you feeding him?” I asked.
As the young man started to answer that question, that goose did what geese do best, and he did it on my examining table. “Okay,” I said, “Thank you very much. That’s exactly what I want.” For a vet this is a very good thing. I took a sample—believe me, there was no shortage of sample material on my table—and examined it under my microscope. Aha! It was loaded with worms. That was the problem. I asked the young man, “Where do you have him housed?”
“In the barn right now because it’s so cold out.”
Meanwhile, that goose was honk-honk-honking away happily. He was having a fine time. I showed the young man the sample under the microscope and he saw the worm eggs. “This is the wormer,” I said, handing the product to him. “Treat him with it and make sure his pen is as clean as possible.” I never heard from him again, so it must have worked.
Sometimes, though, even my microscope isn’t sensitive enough. A heartworm is a parasite that grows in the hearts of mostly dogs and cats. It is spread by mosquitoes; when an animal is infected, the worms travel through the bloodstream, and they can cause severe damage to the heart, lungs, and other organs. It’s a serious disease that can be effectively treated—but if it isn’t treated, it can be fatal. Years ago, heartworm was almost unknown in Michigan, but we see it more often now. Heartworms can be a foot long, and they don’t lay eggs because they are living in the circulatory system, which is enclosed; instead, just like some snakes, they give birth to live worms—what are called microfilaria. We used to test for heartworms by examining a drop of blood under a microscope; if we saw those little wiggly things, then we knew, Oh yeah, this guy’s got it. But even if we didn’t see them, depending on the symptoms, we still took preventive measures. Now, instead of looking for microfilaria, we test chemically for the presence of the antibodies that the animal produces to fight the heartworms. This test allows us to positively confirm the presence of heartworms much earlier than we were previously able to do and to start treatment to safely eliminate them. These are the type of do-it-yourself tests that we do all the time now, making it possible for us to check for a lot more things than ever before. They provide more information and they do it faster and, in many cases, less expensively than in the past.
The temptation is to rely completely on these tools and just go ahead and ignore decades of experience. I don’t do that; I can’t. Young vets today depend way too much on diagnostics. An animal comes into the clinic and they run $500 worth of tests, hoping something will show up. In the human medical business doctors run every possible test because they’re worried about being liable if something unexpected should happen. That’s a problem that vets don’t have; cows don’t sue. I try to use my experience to make a preliminary diagnosis, and based on my examination and my experience, then I’ll use a specific test to try to confirm it. If the test results don’t back up my diagnosis, then I’ll reconsider that diagnosis.
I pay attention to test results, but I never depend on them solely. I’ve seen that machines don’t always give you the right answer. There have been many times when I did the blood work on an animal, and all those modern tools told me the animal’s liver was not bad at all. After the animal died I opened it up, and the liver was completely shot. There was just enough liver function that the enzymes tested normal. As I had learned when I was just starting, even an X-ray, which in many situations can be very valuable, can’t provide all the answers.
Back in Harbor Beach, we didn’t even have an X-ray machine. One day, a woman brought in her dog, which had stopped eating. That’s not a clue that leads in any specific direction diagnostically. We checked the dog over and didn’t feel any problems during the physical examination. We did all the regular tests, and everything showed up pretty normal, but that dog wouldn’t eat. Dr. Hentschl was on the board of the local hospital, and sometimes they let us use their X-ray machine. Most of the time we anesthetized the animal so it would stay still during the procedure. These days we hardly do that just for X-rays. For me there’s too much risk involved, so we’ll just hold the animal still. It takes a little bit longer to do it that way, but that’s just the way I want to do it.
The X-ray technician was very good. He took the X-ray and looked at it. Nothing there. Okay, let’s try again. The next day he took another X-ray. Again, didn’t see a thing. We didn’t do barium studies in those days because that would force us to take repeated X-rays every few hours. Finally, the dog died. When an animal dies for reasons we don’t understand, I always want to do an autopsy. I want to learn from that animal. As soon as we opened up the dog, the answer was right in front of us. He had swallowed a chestnut, and that chestnut had completely closed his intestinal tract. But it hadn’t showed up on the X-rays. It was just like the broom bristle in Utrecht. I was the third man in the practice so I didn’t speak up, but what we should have done was open up that dog and find out the problem. Dr. Hentschl was very conservative in his treatment, though, so this wasn’t something he usually did. I understood that—operating would have been expensive without having any idea whether it would make any difference.
One problem with X-rays is that not much shows up on them except bones and stones; soft materials don’t show up very clearly. Sometimes, though, even when you can’t see anything specific, the X-ray tells you what you need to know. When we look at the X-ray, for example, we might see a pocket of gas in front and nothing behind, so obviously there is something there that is plugging the intestinal tract up. In that situation we’ll put the dog on the table and open it up. Often, there it is.
“So are you missing a glove?” I said to the owner.
“Oh my gosh. How did he eat that?”
I had opened up the dog, took out a whole glove in one piece, and sewed him up. For two days we gave him no food, kept him on an IV, and then sent him home happy.
I tell owners that dogs will eat anything, especially if it has blood on it. That glove had been worn when the dog’s owner was skinning an animal, so the smell of meat was on it. Believe me, sometimes even I don’t believe what we find inside an animal: socks, nylons, and we even sometimes treat dogs that have eaten rocks. This guy brought his hunting dog in with the usual complaint: He’s just not eating. When I ran my hands over his gut I felt something hard in there. We didn’t know what it was until we opened up the dog and found three rocks in his stomach. The dog’s owner figured out what had happened. He had to butcher a deer on some rocks and blood had dripped on them. Hey, that’s pretty good, this dog must’ve thought, and then swallowed those rocks. Then when they got caught in his stomach and intestine, he didn’t feel so good.
If an object smells like food, a dog will eat it. There are plastic plugs that parents put under the nipple on a milk bottle so the milk doesn’t drip out until you’re ready to feed a baby. I took five of those rings out of a dog once. He had smelled the milk on them and decided that tasted pretty good. “Where’d he get all these rings?” I asked the owner.
“I don’t have any idea,” he told me. “We just knew they were missing.”
I’ve never treated a cat that had eaten a rock; instead, cats eat stringy things. A professor at a small private religious college brought his kitten into the clinic just after Christmas. That kitten had quit eating. Uh-oh. I know what’s around the house during
Christmas. I felt the animal’s body, and its intestines were very thick. That meant there was something inside, because if something gets plugged in there, it pulls everything together. “She was playing in the Christmas ribbons,” he said.
“Oh, did you miss any?” I was pretty sure I knew the answer to that question.
“Well, we couldn’t tell.” We opened her up and I took out a piece of tinsel maybe a foot long. It was shiny and looked interesting; why wouldn’t a curious cat eat it? Fortunately it hadn’t done any damage. We sewed her up and she bounced right back to normal in a day.
After all the years I’ve been doing this, I know when to take an X-ray, but there are still people who think it’s always necessary. On one segment in the show I treated a calf with a front leg that got broken when a cow stepped on it. I couldn’t even guess how many broken limbs I’ve treated, so when I feel a broken bone, I know exactly what’s going on. In most situations an X-ray isn’t going to show me something that I don’t already know, and it’s going to cost the farmer as much as $200 to fix a calf worth $100. It’s cheaper for him to shoot it. That’s harsh, I know, but that’s the economics of farming. They brought the calf into the clinic, and I could feel where the fracture was; when I straightened it out, you could actually hear the snap. The camera crew winced. After the bone was back in place, I wrapped the leg in cotton, encased it between two pieces of thin, pliable bushel-basket wood, and taped it up. Boy, did I get criticized for that by some lady watching the show. She complained to the state that I didn’t take an X-ray. How could you fix a broken bone if you can’t see it? she wanted to know. But I did see it—with my hands. Oh, I was angry when I was notified about that complaint.
I never hesitate to use a good tool if I feel I need it, but if it isn’t going to give me more information than I already have or can get in an easier way, I won’t use it. A lot of large-animal vets use ultrasounds to do pregnancy tests on cows, for example. It’s the hot way of doing this test. But I’m not one of them. For me, at least, using an ultrasound would take longer and would cost a lot more to get basically the same information that I learn by hand. Also, the ultrasound is a good tool, but it does not work if the cow is more than three months pregnant. If a cow is one or two months pregnant, it’s very nice. If a cow is three months pregnant, you can still do it, but there are many times we do pregnancy tests for cows that are four or five months pregnant or more. I had a couple of heifers that were six months pregnant or more and I examined them with an ultrasound and showed the results to the farmer. “What do you see?” I asked him.
“I have no idea,” he admitted.
“Well,” I told him, pointing to a hazy image, “that’s the leg of the fetus.”
He squinted his eyes and said, “Oh yeah. Now I see it.”
I get the same results when I do the test by hand. I reach inside there—admittedly, sometimes I have to dig out some manure, which is not my favorite thing to do—and I go right to the uterus, and within ten seconds I know if that cow is pregnant or not. Then I palpate the uterus to confirm that and see how far along she is. I still have to confirm it because I’ve made some mistakes; there are times when the uterus is enlarged and has good fluidity, and I come to find out that the uterus is full of pus. One time, I examined a cow that had more than a gallon of pus in her uterus. We got it out and she’s fine; she survived.
Most of the time when I finish my examination I have a pretty good idea what’s causing the problem. Then I make my prognosis; I tell the owners what to expect. I’m always completely honest with them about that. If the problem can be treated, I tell them the cost. If there are options, I tell them all the options. There are many times when people ask me, “Are you sure, Doc?” I tell them, “I’m as sure as I can be.” There have been a few times when people tell me they disagree; okay, in a short time we’ll find out who’s right. If the cow gets better, thank you very much.
Sometimes people say I’m too blunt, but I can’t lie. I can’t tell them, “Here’s a bunch of pills. Just give them to him, and in a week he’ll be better,” when I know that isn’t what’s going to happen. I want people to be prepared for what to expect. We’ll always do everything possible to keep the animal alive, but we are not God; we only can do so much.
When I’m treating small animals especially, there are always people who don’t want to hear the truth. Sometimes they have no idea how sick their animal really is. Many, many times, people have told me, “Oh, it’s just a cold,” or “It’s just a kidney infection,” and I end up discovering the animal has cancer and will live only a few more weeks or months. I make it as easy as possible for them, of course, and I’ll do whatever is possible to make the animal feel better and to take away the pain.
With our animal patients, just like with humans, there are times when all the symptoms add up to nothing that makes sense, and I can’t make a diagnosis. That is really frustrating: We know there is something wrong, but we just can’t figure out what it is. Then I’ll tell the owner, I don’t know exactly what’s going on with this animal. When that happens I’ll treat the animal symptomatically and see what happens. If an animal is dehydrated, for example, maybe I’ll give it Gatorade. I know there are vets who say Gatorade is no good for animals, but I’ve been using it for a long time without it ever causing a problem. It works just as well in animals as it does in people; it rehydrates and replenishes lost minerals. Dogs don’t drink it usually, but when they’re throwing up and have some diarrhea, that’s what I give them. For that purpose, Gatorade is fantastic. For certain viruses, just keeping animals hydrated over a period of time is enough to make them better. Maybe I should do a commercial for Gatorade.
Sometimes the best treatment is aspirin. Aspirin is an anti-inflammatory painkiller that works in most animals just like in people. There are aspirins for cows that are about three inches long and about eighty times stronger than the aspirin we buy in the drugstore. One time, I remember, I was on the road, and I had such a splitting headache that, oh my gosh, I had trouble driving. I got mad at myself because I didn’t have any regular aspirin with me. Then I thought, Wait a minute. I stopped the car, opened a jar of aspirin, and licked a cow aspirin. A few minutes later, I was good to go. The headache went away. Anyway, a lot of times when I’m not sure what the problem is exactly, I’ll recommend aspirin and see what happens.
I also give animals Pepto-Bismol and Kaopectate. Kaopectate actually comes in gallon jugs, and I use it with calves all the time. I mix it with milk or any other electrolytes they’re being fed, and it coats the intestinal tract. Both medications remove acidity and coat the intestinal tract, so once the calves quit throwing up and start keeping fluids down, we got it made.
I’ll try anything that makes sense and won’t hurt the animal. When a treatment doesn’t work, we’ll just try the next one. There’s a disease that only horses get called uveitis, or moon blindness. As a result, horses go blind, usually in one eye. The history goes all the way back to Alexander the Great, when it was thought the blindness was caused by changes in the moon cycles. It starts as an infection that progressively gets worse if it isn’t stopped. I’ve seen several cases in the Amish horses in Michigan. My sister had it on her farm up in Canada too. Usually we try to treat it with antibiotics, but most of the time that treatment doesn’t help very much. When we found uveitis in an Amish farmer’s herd, I just decided to improvise. We have a vaccine for a bacterial disease that dogs get called leptospirosis, or seven-day fever. We don’t have a lepto vaccine for horses, but I could get the dog vaccine. I bought a 25 cc dose and sent it to the Amish farmer, and it seemed to work: He had no more horses come down with moon blindness. Sometimes you just have to think outside the box and cross your fingers.
I don’t give up easy. If I try something and it doesn’t work, I’ll try something else. I never run out of trying. When nature tells me there is nothing more I can do, I’ll reluctantly accept it and do what I can to make t
he patient comfortable. But if there’s hope, I always tell my clients, if they’re willing to try, I’ll do it. I’ve got nothing to lose.
There are times when my clients don’t want to accept my diagnosis. There was a fantastic gentleman, a Korean War vet named Rupert, who came in one day with his small dog. Rupert had been a client for a long time. He’d had another dog that he loved for a long time, and that dog had gotten diabetes. We’d kept it alive as long as possible, but finally we had no choice; we had to put it down. Honestly, when I did that, I thought, This is the end of Rupert too. But I was wrong. Instead he spent several months going from dog pound to dog pound and to all the animal control centers until he found a dog that looked just like the one he had lost. It was wonderful, as if he had gotten his best friend back. The two of them came in to see me one day while the crew from Nat Geo Wild was filming. As the cameras were rolling, Rupert told me he was there because his dog was not eating.
It wasn’t all that hard to see the problem. That dog had gained too much weight. I examined him and I didn’t find any physical reason that would cause a substantial weight gain. I asked Rupert, “What have you been feeding him?”
The dog basically ate all the same things he did, he told me. “He’s eaten chicken breast with me; he’s eaten steak with me . . .”
That was the problem; he was killing that dog with love. I remembered what I had learned in school so many years earlier. “He isn’t sick. He isn’t eating because he’s just not that hungry. You can’t feed him off the table like that,” I told him. “It isn’t good for him.”
“But he likes it,” Rupert replied.
