"Well, Didja Skin'Em?"

 Some of the lab's clients are rather ... colorful. My favorites are the guys that run small beef cow/calf operations. I learned years ago how to schmooze with just about anybody, and some of these crusty old guys can get downright chatty with the right schmoozing. I never fail to learn something new and useful. Maybe I learn a new word, or get more detail about a management procedure. It's always a lot of fun. In fact, I see the time I spend talking to them on the phone or in person as part of my job, not an interruption.

There are two important reasons for this. Firstly, I can always get a more detailed history from them directly than they will ever write down on the submission form. I get them to tell me all kinds fascinating details about how they are managing, or in some cases, mismanaging their herd. And secondly, I'm building their trust in the lab. Building their trust in me and my team's ability to help them solve their problem. 

We recently had a guy bring in a couple of young pigs, about 5 or 6 months old. Yeah, I know, pigs aren't beef calves. But this guy was cut from the same cloth. It wasn't my day in necropsy but I always get called when producers show up because everyone in the lab knows that I like to chat with them. I was standing on the dock, looking down into the bed of his truck at two dead pigs. Body condition looked good. They were clean, well kept. But certainly dead. And he was telling me and my colleague that the entire pen of nine pigs was sick. I let him talk on until he mentioned staggering. Ah ha! I asked him, were any of them dog sitting (that means sitting back on their haunches like a dog) or head pressing (that means pressing their head into a corner)? Yes, he said, all of them. Head tremors or seizures? I asked. Yes, that too. Turns out he had some nice videos of these exact behaviors, which he showed me on his phone. How about the water supply? Hoses and spigots still working? Tanks full? Oh, well, yeah, it seems that he did have a bit of trouble with the water supply in that pen when we had a freezing spell a few days earlier. Only that pen affected? Yes, only that one. 

They literally teach you about this in vet school: water deprivation leading to sodium toxicity and death in pigs. The videos were magnificent--I had him send them to my work cell right away. The water deprivation leads to an electrolyte imbalance that affects the brain. The neurological signs I asked him about are considered textbook signs of the sodium toxicity.

I was so excited to get this case for us to work up that I never let him feel bad about killing his pigs. I gave him some advice about how to save the remaining pigs, and thanked him for bringing the case. He called me two days later and reported that he had followed my advice and saved the remaining pigs in the pen. With some ingenious sample collection, my colleague and I were able to make a convincing argument that it was indeed sodium toxicity that was the problem. We considered other differentials such as pseudorabies (also called Aujesky's disease) and rabies that could cause the same neurological signs, but we tested for and eliminated the first and rejected the second as reasonable (unlikely to affect an entire pen at the same time). In the end, it was a solved case and a happy client!

At the other end of the spectrum is the old guy that called up a few weeks ago wanting to bring in a calf that had died overnight. He had lost five or six calves in a 24-hour period. My brain was spinning out a list of possible differentials when he said, I think they were shot. Oh, okay, I said, we can take a look and see if that is the case. Odd differential, as I was thinking about things like lightening strike or infectious agents that can kill several animals at the same time. But sure, getting shot is possible too. 

So I did the necropsy on this calf and didn't really find much of anything except that it had a lot of intestinal worms. Those absolutely can kill a calf if the parasite burden is high enough, but the calf was in good flesh and it wasn't a definitive finding. I found nothing else that was particularly helpful or diagnostic as to the cause of death. And as is my usual procedure, I called the producer to let him know this. He started yelling at me, saying, I brought that calf in so you could prove it was shot! I told him that there was no evidence that it had been shot. He replied, well, didja skin'em? I paused, trying not to laugh, and said, sir, I did a complete, thorough necropsy and there was no evidence of any projectile trauma in this calf (no, we don't skin animals for most necropsies). 

By this point, I have unfortunately seen quite a few animals with gunshot wounds and I am confident in my ability to identify that. Definitely no gunshot in this case. But this old crank managed to get the county sheriff's office involved and they contacted the lab director for more information last week. We sent them the final report and I thought that was the end of it. 

But no, no, my year will not end so quietly. This cranky old guy is bringing us another calf today. One of seven more that died last night. He still thinks they are being shot! I'll try again to find a cause of death. I hope this calf tells us a better story, although I suspect that he won't be satisfied with anything less than being presented with the bullet that killed the calf.

'Tis the Season...For Bovine Abortions

 Winter is the season for bovine abortions. Two-thirds of bovine abortion cases are closed with no cause determined. That's an average that holds true in veterinary diagnostic labs across the country. As a side note, miscarriage is not used in vet medicine. Vets use the word abortion to cover the loss of a fetus in animals.

Despite the statistics, I recently had a bovine abortion case for which I was able to get a diagnosis. The fetus looked like all aborted bovine fetuses, that is, not very diagnostic. But this time the vet sent us some placenta, a very rare sample indeed. Bovine placentas are membranes studded with these raised, thick, slightly cup-shaped structures. There are two parts to these structures, a dam side and a fetal side. They supply nutrients and blood and waste removal for the placenta.

At first glance, this sample was fairly typical for placentas (even unicorns have "typical"). It had been picked up off the ground so it had bits of leaves and grass and dirt stuck to it. It was torn so had probably been partially eaten by the dam, foxes, or the farm dogs. But some of those cup-shaped structures looked off to me. Wrong color, wrong texture. I made sure we trimmed those in for histopathology. Turns out they had fungus growing deep inside of them! There was a strong immune response to the fungus, causing disruption of placental function, early fetal death, and the subsequent abortion.

They teach us about all the causes of abortion in vet school. Even so, my histopathologist said it was the first case of fungal placentitis that he'd ever seen in his decades-long career. It will probably be the only one I ever see too. So for once I had a rare successful bovine abortion case. 

On the other end of the scale is a bovine fetus I unwrapped a couple of weeks ago. I always do a physical examination of animal remains before starting a necropsy. As I was looking this one over, I noticed that it was missing both ears, the right eye (crows, most likely), the last couple of centimeters of its lower jaw, and then...whoops! I turned it over and found that it was missing all of its abdominal organs. All of them, including the skin of the abdomen and the umbilicus. Neatly removed along with all of the ligaments that hold them in there. The abdominal cavity of that fetus was smooth and clean as a whistle. Farm dogs are efficient. Amazingly, the diaphragm was intact so I sampled what I could--lungs, heart, thymus. Not much hope of getting a diagnosis from this one. I called the vet and asked her why she sent me the case. Turns out she had received a call from the producer about the abortion, and she told him to box the fetus up and get it to the lab. She didn't know it was in such bad shape. I gave her a pass as this does happen now and then. 

Production animal necropsies come with unique challenges. In order to get diagnoses for the cause of death, we have to be flexible and creative with the samples that we get. 

Except for maggots. I don't do maggots.

Bird-Shaped Bags of Maggots

 We get a lot of backyard chickens submitted to the lab for necropsy. The State Vet has a grant that pays for the necropsies and surveillance testing of these birds, so there is no cost to the owners. It's a good way to encourage people to submit birds. And it allows the lab to keep at least a partial eye on reportable diseases in the backyard bird population that represent threats to the commercial poultry industry in the state. 

Unlike commercial poultry, which are usually submitted live, with as many as 10 to 20 birds per case, backyard birds are usually already dead when the owners bring them to the lab, and there is usually just one bird per case. 

I've seen enough backyard birds wrapped up in Walmart plastic bags or scented trash bags that just the sight (or smell) of either is enough for me to know it's a backyard bird necropsy. For the record, scented trash bags, and scented dog poop bags, make me gag. The smell of dog shit layered with "baby fresh" scent is just nasty. It still smells like shit, but now with extra steps. A dead bird wrapped in a scented trash bag is still just as dead.

Many backyard bird owners don't know much about livestock husbandry. Their intentions may be good but execution is often weak. We see chickens stuffed with intestinal worms, literally so many worms that the chicken starved to death because no food could pass the ball of worms in its gut. We see birds filled with tumors caused by the Marek's disease herpesvirus. That disease is reliably preventable with a vaccine administered by a hatchery at the day of hatch. We hear tales of woe in which the owner got some birds from a neighbor, from the nice lady at the flea market, from this guy over in Conway, and they put the new (surprise! diseased!) birds in their flock with no quarantine period, and ended up with a visit from a livestock inspector come to depopulate their entire flock because they now all have a very transmissible, reportable disease. I ask owners about their biosecurity measures, and get a puzzled head tilt from most of them. But all of that is ultimately a matter of education. 

One small problem with some backyard bird owners is that they wait too long to bring us a dead bird. Autolysis, the changes that happen to tissues after death, is rapid in birds. I don't expect most people to know about autolysis, but I do expect them to have at least a basic idea about the other thing that happens to dead animals that are outside for more than a few hours. And that thing is maggots.

I don't do maggots. 

Thankfully, the surveillance tests we conduct can be performed with a tracheal swab so I don't need to dive in and collect rotten tissues. I've had enough bird-shaped bags of maggots submitted for necropsy that my techs know that I won't even unwrap those birds all the way. Once I see maggots spilling out of the Walmart bag shrouds, I cut a hole in the bags for the head, flick maggots out of the bird's mouth to swab the trachea then tell my techs, I don't want to see any more of this. And away it goes to the incinerator, maggots and all. 

Changes, and A Tale of Cow Conjunctivitis and Pneumonia

Things have been grim this year. Pandemic. No toilet paper in the stores. Being afraid to even go in said stores. Losing my little old Mimi. 

I've decided to take the blog in a new direction. A bit of an experiment, just to see how it works. This is nothing new--CircusK9 has evolved more than once since I started it lo these dozen years ago. 

I want to talk more about my job. I love my job. Despite the inherent ick factor that some people might have about the subject, my job provides me with an endless stream of absurd and interesting tales.

Like this one. I have developed a good working relationship with a clinic in SW Arkansas. This three-vet practice sees all species, and they send most of their necropsy cases to the lab. Because of the distance from their clinic to Little Rock, and because they are not on the route of one of our regular couriers, the vets often conduct field necropsies of production animals and send us a "box of parts" instead of the entire cow. Cheaper and faster.

One of the vets has been working with a beef cow-calf operation for some weeks that is having a big problem with conjunctivitis in the herd. The usual bacteria responsible for this is Moraxella bovis. That's the one you learn about in vet school. But that's not what they got back from swab samples. They got a species of Mycoplasma. They started to treat the conjunctivitis but some of the cows began dying from respiratory disease.

Cows are prey animals and have an amazing capacity for hiding respiratory disease until things become pretty disastrous in there. I've opened up cows to find 80% or more of their lungs full of pus and bacteria, and heart and lungs stuck to each other and the body wall with expansive fibrin adhesions. This is not good. Most vets who work with these animals, including me, suspect that cows harbor subclinical bacterial pneumonias pretty much all the time, and are just waiting for some stressor--transportation, parturition, change in weather, change in feed--to cross that line into severe respiratory disease.

So my friend sent me two boxes of parts from two cows from the conjunctivitis herd. He also sent some horrifying pictures of the conjunctivitis--I will spare you. I never really got anything definitive from the parts other than confirming that it was a bacterial pneumonia. He kept calling me to talk about this Mycoplasma they had isolated from the eyes, not Moraxella. It was a species I had not heard of, and I initially thought I just wasn't understanding him clearly. He often calls me when he's in a windy field standing over a dead cow so there is lots of background noise. 

See, Mycoplasma bovis is a common culprit in bovine respiratory disease. Mycoplasmas are special bacteria--they don't have cell walls. They like to form microabscesses which are very difficult to treat. In fact, cows with Mycoplasma pneumonia are often not treated (they are culled). The lungs my vet friend sent to me did not look like Mycoplasma lungs. They looked like Mannheimia or Pasteurella lungs. But we failed to culture those bacteria. And you can't really culture Mycoplasma. We rely on PCR tests to identify that one. But I didn't initially request a Mycoplasma PCR because, well, the lungs didn't look like Mycoplasma lungs.

It's weird how distinctive these different bacterial infections can be. And after you see dozens of gnarly cow lungs, you get a feel for how the different bacterial pneumonias present grossly. My pathologist agreed--the tissue damage we saw on the microscope slides of the lungs was most consistent with Mannhemia. How come we didn't culture it? Sometimes that happens. Failure to culture doesn't mean it wasn't there.

But my vet friend kept going on about this "bovoculi"--and I finally put it together. 

Mycoplasma bovoculi--get it? bov = cow, oculi = eye--is a Mycoplasma implicated (link will open a PDF) in the past few years in a particularly nasty cow conjunctivitis. I found out that it likes to hang out with its friend Mycoplasma bovis. Which we found in the lungs of these cows when I had the PCR test run.

Some vet school adages really prove to be true, over and over. Common diseases commonly present uncommonly. I missed the Mycoplasma connection in this case, but I guarantee it won't happen again.

Sweet Mimi

Yesterday, Mimi's burdens became too heavy, and I had to pick them up and help her take the last steps of her journey. 

Little old girl, you can now run fast, run far, and take long naps in the sun.

You were with me for 15 years--it will never be long enough. 

Quicksilver Let's Play House 9/5/2005-11/11/2020

Well Hello, Little Frie....Oh Fucking Fuck

As I was walking to my car yesterday morning to leave for work, I noticed ...something... in my far peripheral vision.

 

 

Yeah. I had passed within a couple of feet from her.

She was a real beauty, as you can see. But I'm afraid I'm not willing to share my property with poisonous snakes, so I had to dispatch her.

I calmly put my bags in the car, and opened the garage door. I went in and put on my knee-high work boots, grabbed a shovel and a hatchet, and did the deed.

I briefly considered taking her body to work to take a look at (I have the PPE, the tools, and a way to properly dispose of her). But then decided that was probably taking things just a wee bit too far.

Tales From The Necropsy Floor: "My eyes! My eyes!"

A couple of weeks ago, on a Monday, I was doing a necropsy of a cow that I had taken in over the weekend. She had been in our cooler for at least 36 hours but had been dead for at least a day or so when we put her in there. That's a long way of saying she was definitely dead and bloated.

When I was reaching across her to remove the muscles and fat of the abdominal wall to expose the abdomen, I accidentally nicked her enormous, gas-distended rumen with my scalpel. The blast of gas and aerosolized rumen liquid shot up my face and right into my eyes.

Uh-oh. 

I had an N95 mask on so my mouth and nose were protected. But not my eyes. I wear glasses but have not yet found safety goggles that don't damage my extremely expensive and utterly necessary eyeglasses. A face shield would have been useless. I stopped to wash my face but the inoculation had already occurred.

Sure enough, 48 hours later, I woke up with red, painful, gunky eyes. This progressed to a piercing headache that I couldn't tamp down with ibuprofen, and quite a bit of pain when I had to move my eyes. 

I finally gave up the following Monday, called in sick to work, and hauled myself to an urgent care clinic. I was diagnosed with conjunctivitis, of course, but also something called epi-scleritis, which meant the muscles and other tissues around my eye were involved too. 

Better living through the standard pharmacopia, however: antibacterial eye ointment (oily, gross) and diclofenac, a stronger NSAID than anything I could get OTC. I even got a steroid shot in my butt at the clinic. I started feeling better in just a few hours. 

While this sort of thing is a fairly typical hazard of my profession, and I was not exposed to anything really nasty, it will certainly change my behavior in the future. For starters, I think I will decompress those rumens first thing!

Tales From The Necropsy Floor

At the lab, we see a colorful array of species and their endlessly variable disease presentations. There is a seasonality to some of our cases--more kittens in the spring, more cows in the fall, more cow abortions in March through May. But that doesn't mean we don't see kittens in winter, cows in summer, and abortions any time of the year. 

Backyard poultry cases always liven up the necropsy floor. They usually have interesting parasites, internal and external. And when it's an older laying hen, it almost always has cancer. Invariably, those older hens come wrapped in scented trash bags. I am not sure exactly why so many backyard bird owners submit their birds wrapped in scented trash bags. Maybe there's an instruction manual that I haven't come across yet. 

My colleague and I divide the week's necropsy cases up between us, mainly so I can get admin work done and be free for meetings and such. And even though I have my days on the floor, and X has his days, we often end up working necropsy cases at the same time. While it can get kind of chaotic for the tech who has to bounce back and forth between us, it's a great opportunity for us to learn from each other. We look over each other's shoulder, poking and prodding and asking questions, and we argue about differentials and diagnostics.In fact, we argue about these things all the time, but when we have the animal remains in front of us, there is an extra dimension to the discussions. To be clear, I don't use "argue" with a combative connotation. It may get heated but it's always professional.

My colleague X and I have radically different styles when doing necropsies, and although we usually arrive at the same list of differentials for any given case, we get there by separate routes. That doesn't mean our conclusions are not sound or supported by gross findings, but it does highlight how many different ways that diseases can present themselves. 

Performing a necropsy requires a systematic approach to ensure that you don't miss anything, and my colleague and I use the same basic approach for all cases. But there are stylistic differences. For the gross pathology component, I tend to lay all tissues out and examine them as a group while he examines each tissue and organ as he goes, but the end result is the same. Swabs get taken and sometimes fresh tissues are set aside for other tests. For the histopathology part, selected tissue samples are placed in formalin. We use formalin as a fixative to firm up tissues so we can cut very thin slices and put them onto microscope slides.

The biggest difference in our styles is how we select tissues for histopathology. I have a very parsimonious style, so, for example, if the spleen is normal, I'll place a small piece of it in the formalin jar and discard the rest. My colleague thinks big. Very big. It's not unusual for him to place entire cat heads (he was interested in one of the eyes) and the complete bodies and all viscera from small chickens in the formalin jar. This has become a bit of a running joke back in the histo lab because when my cases are laid out for trimming, there is a neat little pile of tissues, easy to sort and select. When his cases are laid out for trimming, there are enormous, macabre mounds of organs and appendages.

Yesterday, I picked up a backyard bird case from him in order to even out our case load for this week. But I didn't tell the technician that I was taking the bird. She thought my colleague was doing all three cases that afternoon, and she set out equipment at each station with him in mind. 

The chick was about 4 weeks old, not even as long as my palm. But the technician had a three-liter formalin jar all ready to go. Three liters, nearly a gallon of formalin, for tissues from an animal that didn't even weigh 50 g. As I tossed my tiny little pile of tissue samples into this massive jar, I glanced over at my colleague who was working nearby on a cat and I loudly said to the technician, "Well, it's obvious that you expected X to be doing this necropsy instead of me!" He looked up, blinked a couple of times over his mask, and all three of us cracked up.

I am grateful that I work with a colleague like X who can take a bit of good-natured teasing and not alter his style one tiny bit.

"Dr. A Never Met An E. coli That She Didn't Like"

For the great majority of our necropsy cases, we can identify the cause of death right away. There might be a few specifics to sort out, like confirming the specific kind of cancer. But we can usually get most of the diagnosis while on the necropsy floor. 

There are always exceptions. I mentioned in a previous post the handful of cases we were seeing of young dogs with bloody parvo guts that never tested positive for parvovirus. Cultures of tissues from these cases did result in scant to moderate growth of E. coli. Usually, that alone isn't enough to provide a diagnosis.

We culture E. coli and its friends in many of our cases. But not all E. coli are the same. E. coli is everywhere, inside you and outside. It can be considered an environmental contaminant. Animals poop it out, it can live in the soil--you can't get rid of it. But we use sterile techniques to acquire our culture swab samples. So when I get any growth of E. coli, especially from poultry cases, I lean heavily to that as a possible cause of death. 

We've recently had a run of necrotic, hemorrhagic pneumonias in companion animals. Some of them had scant growth of E. coli from lung swabs. But your generic environmental contaminant strain of E. coli doesn't cause that kind of tissue damage. You need a hemolytic strain for this. Our bacteriology group had not been mentioning anything about hemolytic behavior in their reports.

Well. I asked the bacteriology supervisor about this, and it turns out her techs had failed to report the culture results correctly, and the bacteria they cultured were in fact hemolytic. 

I was able to correct the couple of cases that we still had open, but there were half a dozen other cases that were likely hemolytic E. coli infections. But because I've "never met an E. coli that [I] didn't like," according to our pathologist, I had fortunately included a diagnosis of "colibacillosis, suspected" on those cases. 

One of the important aspects of getting a diagnosis is integration. Clinical history, what you see during necropsy, results of tests for viruses and cultures of bacteria, what you see through the microscope when you look at the stained tissue slides, what you learn by reading published literature--all of these disparate types of data get rolled up into a narrative of pathology for each case.

There is one more component of that integration that is much harder to describe. It is a combination of the pathologist's experience, bias, application of the rule that "common diseases present uncommonly" (which means don't go looking for uncommon diseases right off the bat), and a type of gestalt that can develop when you see several similar cases cluster in time (there is definitely a seasonality to some diseases, and some diseases are more common in some species than others). 

The title of this post has complicated subtexts. It is an acknowledgement that I was right in proposing colibacillosis diagnoses for those cases. But it also contains a warning about jumping to diagnostic conclusions without considering all of the differentials. It isn't always E. coli's fault. 

Except when it is.

Lessons From The Past

Early on in the pandemic, I found myself most strongly affected by empty shelves at the grocery store. It was stressful enough to be leaving for work throughout March and April and May when all my neighbors were staying at home. It was stressful to insist back in March that my team at work wear masks when nobody else at the lab was doing so. But seeing large gaps and entire aisles with nothing but stray scraps of paper and dust on the shelves made me the most anxious. Increased my heart rate. I hated going to the store. I stopped my normal weekly trips and stretched out my visits to once every three weeks. 

The weird mass hysteria over toilet paper and paper goods also affected me in an unexpected way. I found myself looking at a paper towel and thinking, well, I've only used this corner of it. I can use it again. And I would carefully set it aside for that purpose.

My grandparents lived through the depression. They are long gone now, but as a kid, I would see them hoard bits of wire and string, re-use a kleenex all day, save tag-ends of soap and cooking grease to accumulate in jars and cans. I distinctly remember thinking at the time that this was odd behavior, but I never really made the connection until now. It's not odd at all when you see those empty store shelves.

I was already thinking a lot about this when I encountered an example of how this pandemic has changed our behavior at work too. 

We use a particular kind of disinfectant to clean the necropsy area at the lab. There are many cleaners that will effectively kill the biological agents that we know are present, but lots of those cleaners are corrosive. We use disinfectant in our boot wash and apply disinfectant solution to many different types of metal, plastic, and ceramic surfaces and tools, and we are ourselves exposed to it. We prefer to use neutral types of disinfectants. 

When we started running low on our stock, we placed an order like we always have. And weeks passed. It wasn't available from that vendor. This vendor might have it, but delivery would be in October or later. Another vendor said, yes, we have it, then the next day said, oops, sorry, no we don't. I started evaluating our options. We could use commercial grade bleach but it really was a choice of last resort. Bleach wasn't available from any vendor either but our bacteriology section had some bottles we could have borrowed. Then our Safety Coordinator came up with a bottle of a very concentrated phenol cleaner that nobody else at the lab wanted to use. Just mixing this stuff up into a solution required full PPE to protect the user. I said, I'll take it! We wear full PPE in necropsy anyway. We could make it work. It wouldn't corrode our boots or our metal tools. If things became dire, we could switch to bleach.

Just a few days later, our shipment of neutral disinfectant arrived. After a brief celebration, I told my team to prepare a purchase requisition for more. The new normal is that we need to order supplies and equipment many weeks in advance. We can no longer wait until we actually need something.

Remember how we started: the pandemic has affected us in subtle ways. I decided that we will reserve our precious neutral disinfectant for important things like tables and equipment. And the phenol cleaner will be used for the boot wash bucket, which is mixed and emptied daily. I told my two technicians, both in their late 20s/early 30s, about my grandparents and the Great Depression, but I am sure they didn't understand how that related to using phenol cleaner for the boot wash.

Hoarding. Choosing less desirable items to preserve things we have decided are more desirable. Using less. Not odd behavior at all.

Disappointing

I like science. I like learning about science of all kinds, and the people involved in making and doing those science things. So last night I decided to watch Radioactive, the Amazon film that was billed as a biopic of the famous physicist Marie Curie.

I didn't quite make it to the 30 minute mark. Marie Curie was presented as a person with the social skills, attention span, and emotional maturity of a 12 year old boy. In fact, the entire POV of the movie felt like it was made through the gaze of that 12 year old boy. Jerky scene cuts. No continuity. No character motivation. The sets were either grey or just too damned dark since the average 12 year old boy could easily confuse dim sets for actual, you know, skill in directing, acting, and editing. Marie Curie was uptight and buttoned up until the gratuitous nudity and sex scenes. All in all, a waste of time for an adult looking for a well-told story about an interesting historical figure.

Whew!

Some random musings.

It's hot here in Little Rock. Like Saudi Arabia hot. I don't miss the baby-powder-fine dust that coats everything in the Eastern Province. But the heat, the humidity, the haze in the air--it feels very much the same, just with trees in the landscape.

I've been to two agility trials recently, both hosted by the same club. They did a fantastic job at redesigning the way that agility trials happen to remove cluster points and to manage the flow of people and dogs. In June, I was voted in as the Agility Trial Director of our local dog training club, and I was so happy to be able to pick the brains of the host club. Our club has a trial on the books for the end of October. Can we hold it safely? I'm not sure, but I'm going to at least work on identifying as many risks as possible and seeing if we can reduce them.

These particular trials were held indoors in a youth soccer facility. The club required everyone to wear masks while in the building, unless you were running in the ring or eating or drinking at your setup. The compliance was astonishingly high. I mentioned this with some surprise to my lab director after the first trial, and he said it might be due to the fact that dog show people are used to following rules. And yes, at dog shows, there are lots of rules. So I think he's probably right.

Two agility trial pet peeves: exhibitors that just let their dogs bark and bark and bark, and exhibitors that cram big dogs into crates that are obviously too small for them. Some handlers have elaborate setups, with arrays of crates, personalized crate covers, color-coordinated everything, a fan for every dog. One guy went to the other end of the spectrum, and didn't even have a chair or ground mat or much of anything except some toys and his dog, and just plopped himself on the floor with his dog in the middle of his chosen crating space. I'm not advocating such a spartan trial experience, but I do think handlers should pay attention to making their dogs comfortable.

At work, our necropsy and biopsy submissions dropped off quite a bit in March and April, but seem to be back to normal levels now. We've had some very interesting necropsy cases in the past few weeks. Our first heat stroke dog came in last week (a French Bulldog). I expect to see more as temperatures are expected to be even higher in the coming 2-3 weeks. We've also been seeing a lot of puppies with horrible bloody enteritis that looks like parvo, quacks like parvo, but isn't parvo. Those are frustrating as those cases often represent a kennel health issue and submitting vets need answers quickly. We do our best.

I had my second case of canine caval syndrome this past week. My colleague has had a few as well. It's associated with chronic heartworm disease. Not all dogs with heartworms get caval syndrome but when it develops, it's very bad. Worm leave the right side of the heart and move UPSTREAM into the large veins. I found an adult heartworm in one of the large veins above its heart, but we've also found them in other cases in the descending caudal vena cava. This dog also had heartworms in the arteries in its lungs; in our exerience, this is a common finding in dogs with heartworms. This dog died of seizures with blood pouring from its mouth and nose. Horrifying. Among the many things that go wrong once this develops, red blood cells get shredded as they try to squeeze past the worms in the veins, and cardiopulmonary collapse is inevitable. Sadly, an entirely preventable death. The take home message is this: get your dogs tested annually for heartworm disease, and give them monthly preventatives to kill larvae in their bloodstream.

I had a very exciting day last week when I got a call from a guy who said, his daughter found a bat in their bathtub, the public health vet told him to get it euthanized and take it to the lab so he was calling the lab to find out how to accomplish that. In just a few seconds of conversation with him, I realized that the most important thing was to get that bat away from this family. Asking him to cart it around to a vet wasn't a good option. At the lab, we don't euthanize animals. I don't have a DEA license and we don't keep euthanasia drugs on site. But all of our commercial poultry submissions are brought in live, and we euthanize those with CO2 gas. I decided that I could use that method on this bat. Quite a bit of capering and hand flapping ensued as my tech and I worked together to come up with a plan to euthanize the bat and keep both of us safe. All turned out okay in the end. Bat was rabies negative.

As an aside, everyone at the lab is required to have a rabies vaccination, and our titers are checked yearly. It doesn't mean there is no risk to us, but we were better positioned to deal with that tiny bat than that guy and his family.

And this week I had to work with a wild cottontail who had neurological signs then died. My god, the list of differentials was a horror show: rabies (unlikely, but it was a mammal so rabies has to be on the list; it's unlikely because small, delicate animals like a rabbit would not likely survive an attack by a rabid animal and thus live long enough to develop symptoms themselves), tularemia (zoonotic and reportable), rabbit hemorrhagic disease (also reportable, may be zoonotic), tick-borne blood parasite Encephalitozoon cuniculi, Baylissascaris worms in the brain (zoonotic, deadly to humans). And heat stress, always on the list for rabbits wild or farmed or kept as pets. Samples had to be obtained and sent to national vet labs and the state health department for testing. We did the necropsy in a fume hood and discarded all of our PPE as soon as we finished. It was nerve wracking to work with this animal. 

Never a dull day at the state vet lab.

Home Repair Fuckwittery

On Friday, I discovered that the GFCI outlet in my bathroom had suddenly stopped working. Pushing test and reset had no effect. I finally got around to working on that little home repair problem this morning.

I started by taking off the face plate and pulling the outlet box out of the wall to make sure all of the wires were properly connected. Everything looked good. Like I am an expert, pssht, but at least there was indeed a ground wire connected to the box, and two white wires were inserted on one side, and two black wires were inserted on the other. Okay, symmetry is good.

I next made a trip to my circuit breaker box, which is stupidly and inconveniently located on the outside of the house. No breakers were tripped.

Now I was facing the possibility of having to replace the GFCI outlet. With home repair, it's always half a dozen steps back before you can take a step forward. I needed to turn off the power to that outlet before I started messing around with it. But none of the fuses in the breaker box were labeled. Why would they be? Are they labeled in your house?

Excluding the large voltage ones which certainly powered the fridge, HVAC unit, and washer and dryer, I had 17 mystery fuses to sort out.

I turned on all the lights in the house and garage, and began systematically working my way through the fuses, filling out a table as I went along and turning off lights once I figured out which fuse controlled them. I had to go back and check a few of my "unknowns" when I realized that half a dozen outlets in the kitchen were not on the same circuit as the one that controlled the overhead lights.

It took me well over an hour of traipsing back and forth. I never figured out which circuit controls those kitchen outlets. But I did find the circuit for the upstairs bathroom--yay! Even better, the process of throwing breakers on and off reset the GFCI--yay again! No replacement needed.

Unfortunately, when I was pushing the box back into the wall, I neglected to remember it was live and gave myself a bit of a shock. Not enough to trip the damned GFCI again, thankfully. But enough for me to call it a fucker, and to make a trip back outside to shut off power to the bathroom.

I finished my day of home care by planting some flowers, and vacuuming the car then driving it to my favorite car wash. I also cleaned the upstairs bathroom, vacuumed the house, and started some black beans in the slow cooker.

It's not much, but it's a start. I rebuilt the rock wall myself.

As a reward for my virtuous activities, I am out on the deck with the entire pack, even the annoying cat, enjoying the beautiful breeze and balmy temperature.

Archie is off patrolling the perimeter.

Non-Stick

The blast from the past in the bedbug post reminded me that I wanted to post this tidbit too.

Back in 1994, I acquired a set of non-stick cookware. It was a big purchase for me at the time. I was extremely proud of my 10-piece set of Circulon pots and pans--not the top of the line but reasonably priced and durable. I can certainly attest to the durability part: I hauled that set of pots and pans and lids all over the U.S. and even the world. Like Harry and Mimi, the set went with me to Saudi Arabia and back.

Circulon, circa 1994.

For decades, I have been diligent about never using metal utensils when cooking. There's plenty of plastic and wood options out there. But even with care, well made things still wear out. The saucepan was the first casualty--even boiled pasta would stick to the bottom. I kept the pan but it got shoved to the back of the cabinet, replaced with a series of cheap pans and lids I picked up here and there. The skillets went next. They became increasingly hard to clean as the non-stick coating was worn away with use.

Out with the old...

So last month, 26 years after that first acquisition, I decided to get a new cookware set. I went with Calphalon this time, another 10-piece set. One less pot, one more lid--but that lid is for the sauce pan! What a luxury!

...in with the new!

Cooking with the new pans has taken some adjustment. They heat up much faster, and more uniformly, than the old ones, so I have to use lower settings on the stove. I had
forgotten how nice non-stick coatings can be to use and to clean.

The old set is boxed up and sitting in the garage. I can't bring myself to throw it away. I have a history with these pots and pans. I could pull out the still-usable pots and donate them, but I can't bring myself to separate them from the rest. Who knew owning a set of cookware was going to be such an emotionally demanding relationship?

Argh! Bedbugs!

I am working my way through my second interaction with bedbugs. The first time I encountered these savage little blood-sucking bastards was way back in 1995 or so. There was no question then that I picked them up on a trip to Thailand. This time, they came back with me from a hotel in Fayetteville, where I stayed for two nights for an agility trial. The trial was in mid-March, so it took a while for them to make their way from the travel crate containing dog bedding in the garage upstairs to the bedroom.

Over a period of three nights, these disgusting pests ravaged my legs and arms. The pustules don't always appear right away so it took that long for the full horror to be exposed. Bedbugs often leave bites in short tracks. And the itch gets worse over several days. I had many dozens of bites on my legs, fewer on my arms. I will definitely have some scars from this.

The solution now is the same as it was in 1995. Wash everything that can be washed, and dry on high heat. Wash it all again just in case. Tear the bedroom apart, moving all the furniture away from the walls. Vacuum, vacuum, vacuum. Empty canister after every vacuuming, carry the trash bag to the can outside, and spray the canister with alcohol.

Then I applied diatomaceous earth. I piled that stuff up along the baseboards, rubbing it into the carpet. I rubbed it into both sides of my futon and all of the bed frame crevices. I let everything sit for a week, vacuumed it up, and repeated. Make sure you wear a mask when using diatomaceous earth (we should all have plenty of masks these days) since breathing those tiny silica particles is not good for you.

After two weeks, I decided to move back into my bedroom. Sadly, I may not be done, since I got a single bite on my knee two nights ago. I will have to move back downstairs tonight, and treat the bedroom again this weekend. But I'm just as persistent as bedbugs, and I will prevail.

Notes From A Pandemic

I was chatting with the director last week. Even before COVID-19 changed everything, we would chat 3 or 4 times a week, and that seems to be a habit in which we continue to indulge. Often, the director describes some proposed change to lab activities, and asks me, on the spot and with no preparation or notes, to riff on what I see as all of the consequences of that change, good and bad. This is not to say that he asks me for advice, as the process is not that direct. He asks me for my perspective. Even so, I know that he has modified his arguments for and against proposed changes based on what I say. I'm just coming up on my tenth month at the lab, and as a supervisor, I'm a relative newbie. But I think that he appreciates that I've been around the block a time or two. And my newness can be beneficial since I look at things with a fresh eye.

While the central topics of these chats are nearly always some administrative or technical process at the lab, we usually spiral out into fairly wide-ranging discussions of politics and science. We tiptoe around religion and similar landmine topics.

We of course talk about how the pandemic has been affecting us personally. With some exceptions, mainly administrative employees who can work from home, all of the technical employees have been coming in to the lab every day. Back in early April, when the stay-at-home measures were being widely implemented, I mentioned to him that it made me anxious to be the only person on my street who was going to work--daily I was driving past all my neighbors who were out walking or gardening or playing with kids. He said, yes, I know, when I get up in the mornings, my house is the only one in my area with lights on inside.

So last week, he mentioned that he had been feeling... he hesitated, so I said, feeling an existential dread? And he said, yes, of course, that (crazy how we both just rolled right past such a huge elephant in the room), but that he'd also been having real trouble focusing on projects that required planning for the future. We decided that the best word to describe this was "viscosity."

I told him that I had been feeling the same thing. There are a bunch of quality management documents that need my attention and even though I have time set aside for that type of activity, I couldn't seem to get to those tasks. It seems easier to focus on small activities of the moment--spending more time examining the biopsy submissions, spending more time reading up on a specific disease I found in a necropsy. We were both feeling dragged down, unable to tackle projects that required us to envision where we wanted the lab to be in six months or six years.

We decided that we shouldn't be too hard on ourselves. If we (we personally, and the royal "we" of the lab) got through this pandemic without making any big mistakes, that would be okay.

Azza Goes To The Vet!

Azza has always been a bit of a problem when it's time to go to the vet. She has to be muzzled, and I restrain her for procedures rather than risking her biting a vet tech. To my knowledge, she hasn't had her temperature taken in years. We have managed to get blood from her though. And vaccinations are routine. I always take treats, but with variable success. Sometimes she is just too stressed to take treats, other times she hoovers them up.

Azza has a protein allergy that cropped up in 2014 or so. I've tried numerous select protein and hydrolyzed diets, but the only one that keeps her gut calm is Royal Canin's Ultamino. Made from chicken and duck feathers, it is the only allergy diet that doesn't contain any protein sourced from animal flesh. It is freaking expensive, too.

I recently learned about Royal Canin's hydrolyzed diet made from soy protein. It is a lot less expensive than Ultamino. A test with a small bag and a few kibbles of SP mixed with her Ultamina seemed to suggest that she tolerated it well, and found it tasty. So I ended up mixing one bag of Ultamino and one bag of the SP diet for a 50/50 mixture.

This was in December. In January, I noticed that she was licking and scratching her inguinal area (the patch of skin between legs and torso that you see when a dog rolls onto its back) until the entire area was red and even bloody, that her inguinal lymph nodes were enlarged, and, more alarming to me, that the caudal-most glands in her mammary chain were enlarged, firm, and sort of lumpy (these would be located on either side of midline in the inguinal area).

Keep in mind that at my job, I see the worst cases of disease in all species. My mind always goes to the absolute worst diagnosis for every case. Fortunately, I've been able to train myself most of the time to take a step back and come up with a more workable differential list. But not this time. This was a problem in my own dog. And I had only one differential: cancer. Lymphoma, mast cell, mammary gland. It was all bad.

I monitored the lumps for a few weeks, and Azza's scratching intensified. I finally made an appointment at my vet. This was back in February before the pandemic was in full swing.

In the exam room at the clinic, I muzzled Azza, and amazingly managed to get her onto her back so Dr. Craig could do a quick physical exam. We got her back on her feet and removed the muzzle. She drifted over to sit next to the vet tech, who I had already schooled in how to behave around Azza. While the tech was petting Azza's head, Dr. Craig said, I see this kind of thing all the time. Like, 15 times a week. I think it's just atopy, basically seasonal allergies.

Whew. Big sigh of relief. Of course, atopy makes more sense than cancer. This is her first spring here, and literally every tree is spewing pollen.

But we couldn't for sure rule out the diet change as a possible contributor. So he recommended I stop feeding the soy diet, and start her on a short course of Apoquel. Apoquel was a real game-changer in vet med when it was introduced. It provides targeted immune suppression that isn't as harsh as giving immune-suppressive doses of steroids. Dogs taking Apoquel typically don't have the excess drinking, urination, and panting that are common side effects of immune-suppressive prednisone.

That weekend, I spent two hours sorting nearly 30 lbs of kibble into piles of SP and Ultamino. The kibbles are roughly the same disc shape but slightly different colors. It was incredibly tedious. I bagged up the SP and gradually mixed it in with the terriers' kibble.

Azza began to improve immediately. I finished the Apoquel, waited a few days, and she blew up again with scratching. So it probably wasn't the soy protein at all, but it was good to eliminate that as a variable. Azza is back on a longer course of Apoquel. Once the heavy pollen season is past us, she may be able to stop taking it until next spring.

Oh, and did you catch that little detail about our vet visit? That Azza let the tech pet her on the head? That was a miracle that I never expected to see. I will never be able to fully let my guard down when I take her to the vet, but this is a big step forward for her. And it also tells me that I chose the right vet for my pets!

Notes From A Pandemic

Don't bother going into Kroger or Wal-Mart here in Little Rock. There's still plenty of panic buying and hoarding going on. I am baffled at their failure to limit the number of "essential" items that someone can buy. All paper goods, most cleaning supplies, eggs, all forms of milk, canned goods, pasta, vitamins and supplements and OTC medications--rows and rows of empty shelves. However, Whole Foods and Trader Joe's still seem to have a decent supply of food, particularly fresh food. Need deodorant? Too bad. Need a nice head of cauliflower? Trader Joe's has big ones for a decent price.

It's interesting how the word "essential" has taken on new, even sinister meanings. In its unavailability, toilet paper has become essential. My job is essential. I am the only person along my street that still goes to work every day. No teleworking is possible for people who do lab-based work. My schedule hasn't really changed all that much. It feels strange to be going through normal daily routines when nobody else around me is doing the same.

At the lab, the number of necropsy and tissue biopsy submissions has dropped off quite a bit. We didn't have a single new small animal necropsy case last week. Still plenty of goats, chickens, and calves, though. Veterinary clinics are generally deemed essential businesses (there's that word again) even in areas where there are more stringent business closure actions than here in Arkansas. But they have to limit the procedures they can perform either by decree or because they have limited PPE and have to ration it out for the critical life-saving procedures.

We wear N95 masks when we do necropsies. We now have to ration them by wearing them for several days in a row. Even so, we are at much lower risk than human health care providers who have to re-use their masks. Sure, our exposure risks include some bacteria and viruses that can kill us, but those cases are rare, relatively predicable (we can identify those high-risk cases early), and we can further mitigate risks by moving the necropsies into a fume hood (if it's a small animal). Nurses and doctors are definitively being exposed to a virus that can kill them--their risk skyrockets with increased exposure. It's a bad situation for them.

Our lab has donated swabs and masks to the Department of Health. And it looks like some state employees who have experience in running PCRs are going to be seconded to the Department of Health. Their regular job may not be essential but their knowledge is.

Stay home if you can. Wear gloves when you have to buy gas. Limit your trips into the grocery store--and wear gloves in there too. No nitrile exam gloves? Use winter gloves and wash them. Alcohol in a spray bottle makes an excellent, clothing-friendly disinfectant. Don't panic. Check on your neighbors. Be polite.

Phone Call

While I don't regularly have to work after-hours or nights or weekends, there are exceptions. On Christmas Eve, I did a necropsy on a police K9. On MLK Day, my colleague and I did a necropsy on a racehorse that collapsed on the track that morning. These are high-profile cases that require us to provide a fairly immediate response. All after-hours cases come in via a dedicated phone that my colleague and I swap between us every few weeks. Right now, I have that phone. Last night, it rang at 2:17am.

I was asleep but jerked awake right away. I fumbled around a bit, and managed to answer the phone in time. It was a guy who told me that his dog had just died. He wanted us to do a necropsy so he could find out what happened.

I always try to manage expectations for these companion animal owners, because necropsies are not magic. Our track record is very good, but we don't always find a cause of death in every case. And for this kind of case, we wouldn't be doing the necropsy until Monday. We briefly talked about a few logistics (we have a dock cooler where companion animals can be dropped off after-hours).

But it turned out that what this guy really wanted was to talk to somebody about his dog. I was that somebody.

So I took a deep breath, sat up and rearranged my pillow and blankets. I spent about 20 minutes on the phone with this guy, talking about sharing our lives with dogs. Talking about seeing our dogs get old. Talking about grief. My eyes kept drifting across my pack--Archie curled up under the covers at my feet, Azza under her own blanket at the other end of the bed, Mimi tucked up next to me, belly in the air, and the cat curled up next to her. I kept this guy on the phone to make sure he heard the words he needed to hear.

Don't misread this. This story isn't about me. It's about being a caring human being. Life lessons.

A Love Letter To My Colleague

I've had a couple of long posts simmering in my brain for quite some time, and I thought I'd give one of them an airing. This post is about my colleague, JX. And no, I'm not really in love with him, but this is definitely a love letter.

JX and his wife, both Han Chinese from Xinjiang (that fact alone prompted me to write more than 1000 words on the current political situation in Xinjiang, which I subsequently deleted, as it's not the point of this post), have been in the US for close to 10+ years. He's got a good applied veterinary job with the state, she's got a good research job with the enormous medical research university here. Between them, they hold many degrees and accreditations.

Now I've got to loop in some old hair-raising tales from our lab. For years, the board-certified veterinary pathologists were stabbing each other in the back. They would sit on cases like they personally owned all data and test results. They would claw and scratch anyone who even dared to ask about the status of a case. They would literally close their office doors and refuse to communicate with lab techs, submitting veterinarians, farm managers, and especially co-workers. Cases would drag on for months.

My colleague JX was hired into this quagmire with the expectation that he would handle all veterinarian-submitted cases that didn't involve tissue or a body. And that's what he did for several years, until that toxic workplace imploded on itself.

I was told by the current lab director that the first time my colleague JX went onto the necropsy floor, the board-certified pathologists wasted no time showing up in the director's office to complain about the "contamination."

And here we are, at the heart of this post. Racism, egotism, white privilege. It all makes me sick to my stomach.

When the implosion occurred, and the racist, egoistic, privileged pathologists quit en masse, my colleague JX was left to hold down the fort in necropsy for months until I showed up in July of last year. Talk about trial by fire. He was certainly qualified but had limited necropsy experience to that point. JX was thrown into the deep end of the pool...and he excelled. He rose to the occasion, and he learned what he needed to learn despite the lack of supervision, guidance, and mentorship.

When I arrived, I met a seasoned gross pathologist, a solid veterinary diagnostician. He freely and generously offered his opinion...but only when asked. He acknowledged that our lab section was in desperate need of supervision...but he didn't want to be the person in charge. When I was made supervisor of our section, he told me, "I have your back. I will support all decisions that you make." How awesome is that? Any supervisor ever would be over the moon to hear that from a high-level report.

And here's the thing. JX might not be in charge, but I don't make very many decisions without consulting with him first. He and I talk about our active cases every day--we discuss what our differentials are, what ancillary tests we might want to run, what results have come in and how they are to be interpreted, and what is important and what is just of "academic" interest. Our discussion are loud, lively, and often involve citing references to each other. Our lab director told me privately that he often has no idea what we are arguing about most of the time, but that he loves overhearing us. In fact, JX and I work so closely that we do necropsies together, and even trade cases between ourselves. This drives Receiving crazy as they want to know "who has this case" but I tell them, JX and I will sort that out later.

JX took in a racehorse today. He texted me to let me know. I replied, "When do you want to do the necropsy?"--it's his case, after all. It's a holiday on Monday and the lab is officially closed and our techs are not available. He said, "Your thinking?" and I replied, "Insured. We shouldn't wait. Tomorrow morning?". He replied, "9am". Perfect. He's in charge, I will be his tech, and it will be a fantastic morning in necropsy with my colleague.

I've had plenty of colleagues and mentors in my checkered career(s). But JX stands out. Professional. No drama. Amazing powers of observation (he found a PDA in a calf, super rare). Thorough but level-headed, so he isn't obsessive. He is kind. He is perfectly happy to indulge in black humor. He thinks outside of the box. He is willing to take risks. But he does not want to be in charge. And here I am, bossy-pants, ready to tell everyone what to do. Match made in heaven.

This is a love letter to my colleague. JX, because of you, I am a better veterinarian, a better gross pathologist, and a better manager.

Some Unusual Production Animal Necropsy Cases

This is the season for beef cows to be calving and sheeps to be lambing, so we are seeing a spike in those animals coming into the lab for necropsy. As a result, I've had four very interesting cases in the past couple of weeks. It's a good thing my professional interests in reproductive pathologies has expanded to include neonatal pathologies!

In case 1, a four-day old beef calf was brought in. Like nearly all of these cases, it was "fine the night before, dead the next morning." The calf had compelling evidence of infection with the bacterium Clostridium. Clostridium species are anaerobic, and live in the soil, so they are everywhere. You already know about two common Clostridium species because they cause botulism and tetanus, diseases that affect both humans and animals. In cattle, other species cause necrosis of skeletal muscle tissue, with a preference for muscle around the thigh and hip joint so the disease is referred to as "black leg." The bacteria also have a preference for heart muscle. In addition to making black patches in muscle, these bacteria produce gas that makes tissues "bubbly" (emphysematous is the doctor word), and they cause gelatinization of fat. Clostridium infections also have a very distinctive "sewer" smell that is usually strong enough to defeat face masks. A lot of the other clinical signs of Clostridial disease are caused by circulation of endotoxins that the bacteria secrete.

So this calf was infected with Clostridium but it wasn't clear at first why. Yes, it died from the clostridial infection and the endotoxemia, but there had to be some precipitating event. Neonatal calves don't have a fully functional rumen yet, and when they nurse, milk bypasses the rumen and goes straight into the abomasum, the glandular chamber of ruminant forestomachs. This calf had huge, greasy, white chunks filling its abomasum, which was itself larger than it should have been. Abomasal bloat has been linked to overgrowth of ... yes, Clostridium bacteria. And Clostridium bacteria have yet another special talent--they cause agglutination of milk proteins. We cultured the same species of Clostridium from the abomasal fluid, from affected skeletal muscle, and from heart muscle. Even though the dam had been vaccinated for Clostridium, a sequence of unfortunate events cascaded through this calf to cause its death.

In case 2, another 2 to 3 day old beef calf was brought in (actually, on the same day as the calf in case 1). This calf had nearly identical clostridial lesions in skeletal muscle and its heart. However, there was no evidence that this calf had ever nursed. The diagnosis in this case was something called failure of passive transfer. When neonatal mammals don't get colostrum from their dams, they become susceptible to many viral and bacterial diseases. This calf never got any antibodies from its dam. Although the first case makes it clear that colostrum is not the only factor for survival (necessary but not sufficient), a complete lack of it is nearly always fatal for these neonates. If it hadn't been Clostridium, it would have been some other virus or bacteria that would have killed this calf.

In case 3, a 10 day old beef calf was brought in. Good necropsy technique means you conduct it in a systematic manner, and try to do it the same way every time, no matter what species you are working on. The actual order of things can vary somewhat, but most pathologists lay the animal on its side, open the abdomen, remove one half of the rib cage, then fully examine all thoracic structures (more or less the lungs, heart, esophagus, trachea, larynx, oral cavity). When we opened the abdomen, it was obvious that the problem was somewhere in there, but I stuck to the program and examined the thorax first. No lesions at all. Everything looked fine.

When you work on the abdomen, you often remove the liver and spleen and kidneys on their own, then examine the intestinal tract from one end to the other. In this calf, the forestomachs looked okay but the small intestines were necrotic and bloody. I was gently tugging on the entire intestinal tract to pull it out to examine it in more detail when suddenly the colon just popped out. I stood there holding a blind sac in my hand for several seconds before it registered what I was seeing. Normally, the colon attaches to the rectum, and normally, you shouldn't be able to "pull out" the colon. This colon did not connect to anything. Normal colons are fairly muscular organs, but this one was distended and flabby. Then I noticed that the muscles lining the pelvic inlet were green and covered with shaggy bits of fibrin. And then I noticed that the two sets of anal sphincter muscles (one is skeletal muscle, the other is smooth muscle) were completely missing. There was no anus or rectum in this animal. There was a hole in the skin below the tail, so on my initial physical exam it looked normal from the outside.

This was an extremely rare and severe case of the congenital abnormality called atresia ani. This abnormality can vary from mild forms in which the anal opening is absent but all of the other organs are present (this can be corrected surgically if it is identified early) to cases like this one in which the colon doesn't reach all the way to the rectum/anus. This case was even more severe because of the additional absence of anal sphincter muscles.

Because the animal couldn't defecate, the intestines became necrotic. Bacteria and dead cell contents leaked out (there may also have been a small rupture, hard to tell when the tissues are so altered), causing septic peritonitis. Circulation of dead cell contents caused septicemia and shock and death. I shared details of this case with a few colleagues and was told that I may never see this rare abnormality in my career again.

The fourth case was a pregnant ewe. Like the calves, she was "fine the day before, dead this morning." I spoke to the owner when he dropped her off, and I learned that she was late term and that he didn't have very good management practices. Sheep and goats that aren't dewormed regularly get a nasty abomasal worm called Haemonchus that makes them anemic and can kill both young and adult animals if not treated. Haemonchus was high on my differential list--present until proven otherwise. But sheep and goats are also quite susceptible to something called pregnancy toxemia, especially if they have multiple fetuses.

This ewe was small, 120 pounds, and extremely overconditioned (fat). A quick physical exam eliminated anemia even before we opened her up. Now Haemonchus was off the list (and in fact, we found no parasites in her intestinal tract). She had three nearly full-term fetuses, all about the same size and without gross defects or evidence of early death. No evidence of viral or bacterial placental infections. Her uterus was enormous, and had squashed her rumen up next to her spine and forward towards her lungs. The papillae that line her rumen were hard and shrunken. Her liver was huge and yellow. All of this, sadly, pointed to pregnancy toxemia.

It affects ewes who are either super skinny or super fat when they are in late gestation, and who have multiple fetuses. The energy demands of those fetuses cause the ewe to first use up her liver glycogen stores, then to begin to use her body fat stores to keep the fetuses alive. In the case of the skinny ewe, there is no body fat and she dies. In the case of the fat ewe, the amount of fat sent to the liver overwhelms it completely, and she begins to pump out ketone bodies and develops rumen acidosis. The papillae respond to the rumen acidosis by becoming keratinized. The liver cells become stuffed with fat and stop working. And she dies.

Pregnancy toxemia is preventable but it requires fairly close monitoring of the ewes before and during pregnancy, and adjustment of their diet to keep them in good condition before they become pregnant. It's also important to identify ewes who have multiple fetuses, usually via ultrasound, so they can be separated and fed separately.

These were not my only cases in the past two weeks (the intake of dog and cat cases is fairly regular), but I thought it was cool that all four of these production animal cases came in so close together. I also appreciated these cases because they really stretched my diagnostic skills.