D E Larsen DVM
It was early Sunday morning when the phone rang. We weren’t out of bed yet. We didn’t have any firm plans for the day, but we’d discussed going up the Calapooia River to swim. The weather had been warm and dry, and we wanted to take advantage of the river while it was still running full and clear.
“Good morning, Doc,” the voice on the other line greeted. “This is Oscar. I hope I didn’t wake you up, but I wanted to catch you before you headed out to go fishing or something. I bought this little wiener dog the other day. Cute little guy. He is about six weeks old. I fed him a pork chop bone last night. Boy, did he like that. He attacked that bone like it was alive. But, Doc, this morning, he ain’t feeling too good. In fact, he is pretty darn uncomfortable. I think maybe that bone got stuck.”
“Good morning, Oscar,” I said. “We were just lying here thinking we didn’t have a thing to do on this beautiful Sunday morning.”
Oscar had been in the clinic a few times, and I knew him from the bowling alley. He was a large man with broad shoulders, a muscular build and white hair he wore in a crewcut. He was gruff to most people but well-liked by everyone.
I could picture this massive man with large rough, calloused hands carrying a little six-week-old dachshund puppy into the clinic. I always found it odd when big men selected small dogs, but it seemed pretty typical.
“I know, Doc, it is a nice morning, and I suppose you have kids wanting to go swimming or something. But, Doc, I’m afraid this little guy won’t wait till Monday morning.”
“OK, Oscar, I will meet you at the clinic in an hour,” I said. “That will give me enough time to get dressed and help with breakfast for the kids.”
Oscar was waiting at the door when I pulled up to the clinic. He had the little pup tucked in the crook of his arm. If you didn’t look close, you would miss him. Oscar followed me through the door, and we went to the exam room.
It was apparent the little guy was in distress. He stood on the table, trying not to move, with his head and neck extended.
“I call him Pee Wee,” Oscar said. “I am not sure why we got him, but he is a cute little guy, and he really likes me.”
Pee Wee’s exam was unremarkable except for his discomfort. I had not been in practice for many years, but I had already learned that the bone-in-the-throat presentation was never a bone in the throat.
“How big was this pork chop bone, Oscar?” I asked.
“Well, I don’t know,” he replied. “It wasn’t too big, maybe the size of my thumb.”
Oscar’s hands were massive, and the size of his thumb would make two of most other men.
“Are you sure he swallowed it?” I asked.
“He was sure chewing on it. And I looked everywhere, under the kitchen table and everywhere. It was nowhere to be found.”
“Well, let’s take an X-ray and see if it is in his stomach,” I said. “It could have just scratched up his gullet going down.”
I took PeeWee back to the X-ray room. Getting an X-ray on Sunday morning was no problem. The problem was waiting for the developer to get warmed up.
Pee Wee was uncomfortable enough to lie on the table without restraint. I quickly snapped two views of the chest and abdomen: one lateral with him on his side and one ventral-dorsal with him on his back.
Oscar and I chatted a little as we waited for the developer to reach a functional temperature. I had watched him at the bowling alley, often wondering if they had needed special bits to drill the holes in his bowling ball.
When the X-ray was finally on the viewer, my heart sank. There it was: a massive bone compared to the small chest of a six-week-old dachshund, lodged in his esophagus right at the base of the heart. I was unsure that it could be removed by an endoscope, a new thing in veterinary medicine then. It would mean a referral to a specialty clinic. In the 1970s, that meant a trip to a teaching hospital either in Davis, Calif., or Pullman, Wash.
“Oscar, this is as bad as it can be,” I explained. “This bone is lodged at the base of the heart, right in the middle of his chest. The best way to get it out is to go to a veterinary teaching hospital and see if they can remove it.”
“Doc, that isn’t going to happen,” Oscar said. “I am sitting here wondering how the hell I am going to pay you. There is no way I can go somewhere else. It will be fixed here, or we will just have to put the poor little guy to sleep.”
In the few years I’d been in Sweet Home, I had learned that price was often a limiting factor in medical decisions. That would be fine if you could fix it for $100. If it was going to be more, there was a serious discussion of putting the critter to sleep.
“The only way I can get that bone out of this pup is with surgery,” I said. “That means opening his chest and esophagus to remove the bone. The book says not to do that if you can avoid it, and it is a surgery that will be very difficult for me with one pair of hands. By very difficult, I mean it is over my head in this clinic. We could lose Pee Wee in surgery or after surgery.”
“Doc, if there is a chance you can fix him, go for it,” Oscar said as he stood up, towering over me.
“I don’t know what it will have to cost, Oscar,” I said. “You could be paying several hundred dollars for a dead dog.”
“You do what you can. I will have to come up with the money,” Oscar said. “Do you want me to sign something?”
“Your handshake is good enough for me,” I said, extending my hand as I gathered Pee Wee in my left arm. Oscar’s hand engulfed mine, but I shook as firmly as possible. “I will do this today and give you a call when we are out of surgery. He will have to stay overnight, maybe two or three nights.”
I gave Sandy a call, telling her I was going to need a hand with surgery. That meant the kids would have to entertain themselves at the clinic, hopefully not for the entire day.
While I was waiting for Sandy, I began setting up for surgery. Any thoracotomy for me was major. I was thankful for my foresight to include a ventilator when I made my equipment purchase. The problem with that was the patient’s size. I was worried I would have trouble setting the breath volume low enough to accommodate this little guy.
When we got going, the first part was pretty standard. I induced anesthesia with pentothal and then placed an endotracheal tube. With gas anesthesia, I ran a high-flow semi-open system that was sort of autopilot.
That changed when the chest was opened.
I prepped the left side of the chest and did a local block at the fifth intercostal space using lidocaine. Then with a deep breath and a glance at Sandy, I made my incision. When I opened the chest, we started the ventilator. It worked great, and Sandy could pause it as I needed. I turned off the halothane to prevent getting the pup too deep in anesthesia. I would turn it back on only as needed.
Moving as quickly as possible, I spread the ribs with a retractor and pushed the lung lobes aside. There was a bulge of the bone in the esophagus. I dissected to the esophagus between the vagus and the phrenic nerves, then carefully packed off the area with moist sponges. I incised the esophagus longitudinally, using as short an incision as possible. I grasped the bone with forceps, and it slipped out, slightly expanding the small incision.
I used a two-layer closure of the esophagus, being careful to ensure the endothelial layer was securely closed. I placed a couple of sutures in the soft tissues between the nerves and then removed the packing. Then we carefully inflated the collapsed lung lobes.
I placed a chest drain and used a Heimlich flutter valve on the drain tube. Then I closed the chest by pulling the ribs together with two sutures of two-aught Maxon encircling the ribs on each side of the incision. When I closed the soft tissues between the ribs, it sealed the chest.
We overinflated the lungs to help evacuate the residual air from the chest, then closed the skin and secured the flutter valve to the chest wall. This valve was nearly as long as the chest. It was definitely not designed for a six-week-old dachshund puppy. It sort of looked like a muffler on Pee Wee’s side.
After a small dose of Innovar for pain, we woke Pee Wee up. We waited as long as we could before removing the endotracheal tube, just in case of respiratory issues. Pee Wee felt so good with that bone out of his esophagus that he wasn’t bothered by the pain of the chest incision.
Pee Wee’s recovery was remarkable. He was bouncing around, looking for breakfast in the morning. I think he was disappointed with his liquid diet. By the end of the day Monday, I could pull his chest tube and we could send him home. He would be on a strict liquid diet for a week, and then it depended on the recheck.
Oscar was a happy man when he came for Pee Wee. I cautioned him again about not feeding bones and to be strict on the liquid diet. He pulled out three $100 bills from his pocket and pressed them into my hand. Never asking what the bill would be, he shook my hand vigorously and walked out the door with Pee Wee licking his face. I was happy with the $300.
– David Larsen is a retired veterinarian who practiced 40 years in Sweet Home. More of his stories are available on his blog at docsmemoirs.com.