Toby’s Bullet Wound

 D. E. Larsen, DVM

Ann rushed in the door with Toby clutched to her chest. After five, we were technically closed, but Ann had an emergency, plus she was a friend, a neighbor, and a long-time client.

“Toby has a broken leg,” Ann said to Sandy as she stopped at the front counter. “I think he has been shot.”

“Dave is in the back finishing up some treatments,” Sandy said. “Let’s get Toby in an exam room and see if Dave can get a look at him.”

Sandy got Ann and Toby settled into the exam room and came looking for Ruth and me.

“Ann is upfront with Toby,” Sandy said. “She thinks he has been shot, and his leg is broken.”

We had just finished treating a pup and quickly returned him to his kennel.

Ann was almost in tears when I entered the exam room. Toby was laid out on the exam table, curled up in Ann’s coat, and seemed as comfortable as he could be with a fractured femur. Toby was purring.

I carefully examined Toby, trying to leave him curled up in Ann’s coat.

“The leg is broken for sure,” I said. “It looks like a bullet wound, probably a twenty-two, based on the size of the hole. This leg seems a little limp to me, and I am a little concerned that there be some nerve injury.”

“Can he be fixed?” Ann asked.

“Oh, yes, he can be fixed,” I said. “There is an exit wound on the leg, so it doesn’t look like the bullet hit anything else. If there is a nerve that was damaged, that might not be fixable.”

Ann had been a nurse, and she knew what that meant.

“You are saying that he might lose his leg,” I said.

“We might not know that until surgery,” I said. “We will get an x-ray and prepare to repair the fracture. If I find significant nerve damage when we get to surgery, I will amputate the leg.”

“When are you going to do this?” Ann asked.

“There is no reason for Toby to wait until morning,” I said. “He is uncomfortable, even if he seems okay. I will do this right now.”

“Can I wait here?” Ann asked.

“Whatever you would like,” I said. “You can wait here, or you can check back in an hour or so. I guess Toby will recover pretty rapidly following surgery. He could probably go home with you tonight if I could recheck him in the morning.”

“That would be good,” Ann said. “Maybe I will just stay and bother Sandy if she isn’t too busy. You are generally pretty fast with your surgeries.”

Toby’s x-ray showed a bullet path through the leg with some lead fragments scattered in the tissues after the bullet struck the bone. There was a mid-shaft fracture of the femur, and the bone was broken up pretty bad. I couldn’t see any nerves on the x-ray, of course, but I was pretty sure there was significant damage to the nerves in this leg. 

I stepped out front and spoke with Ann before starting surgery.

“There is a nasty fracture of the femur,” I said. “It looks like the bullet went right through the bone. There is lead scattered in tissues, so it was definitely a bullet wound. The bone is repairable, but I think there is major nerve damage to this leg. I will look before doing anything, but I think we are going to have to amputate this leg.”

“There are no other options?” Ann asked.

“Based on the responses in the lower leg, I am guessing that the sciatic nerve is injured, maybe severed,” I said. “If that is the case, there is no other option other than amputation.”

“Okay, I guess he will do okay on three legs,” Ann said.

“A cat with three legs is not slowed down a bit,” I said.

Returning to the surgery room, Ruth was waiting with everything set out.

“Let’s not open the bone pack until I get a look at the inside of this leg,” I said.

After draping the hind leg for surgery, I opened the thigh on the lateral surface and dissected down to the femur by separating muscles. This was a fracture with many pieces of bone, and it would be a difficult repair. 

I explored the wound, looking for the sciatic nerve. There it was. The sciatic nerve was completely severed by the bullet. It made the decision easy. This leg had to come off.

“We go home early tonight,” I said to Ruth. “Finishing this amputation won’t take long. You can put all that bone stuff away. That bullet did half the job of amputating this leg. I will be done shortly.”

I ligated the vessels and trimmed up the jagged end on the bone with a rongeur. Then I sutured the muscles over the end of the bone to form a nice stump and closed the skin in two layers.

Toby recovered quickly, and Ann was happy to take him home for the night.

“Plan to bring him by in the morning and leave him for the day,” I said. “That way, we can make sure we have his pain under control and that the incisions will be okay.”

“Will he have to wear one of those collars?” Ann asked.

“I rarely use one,” I said. “If I use a half dozen of them a year, that is exceptional. Good tissue handling during surgery is the key to rapid and infection-free healing. Besides, the animals hate them, and so do their owners.”

“Okay, we will see you in the morning,” Ann said. “I am sure that Toby will enjoy the night at home other than in your hotel.”

•••

Toby looked great when Ann dropped him off at the clinic the following morning. It took him a few days to figure things out, but by the time we took his sutures out two weeks later, you couldn’t tell he only had three legs.

“I hate to think that there are people out there that get their jollies by shooting at cats,” Ann said. “And people worry about coyotes and the cougars getting their cats. I think people are probably the bigger problem.”

“Yes, it’s too bad that we will never know who was responsible,” I said. 

Photo by Oswald Yaw Elsaboath from Pexels.

A Stone for his Mantle, From the Archives

D. E. Larsen, DVM

Urinary stones in beef cattle in the Willamette Valley were uncommon, meaning that I would see a case once or maybe twice a year at the most. Often going several years between cases. I do not recall ever seeing more than one case on any one ranch.

With that in mind, I found it uncommon when Walt called with a little steer calf who was standing around twitching his tail and stomping his hind feet. Uncommon, in the fact that Walt would recognize that as enough of an issue to call me early. It demonstrated how some of these old farmers were so in touch with their animals that they knew when there was a serious problem.

Walt was a tall, thin man with a broad smile on his face most of the time. Thin does not mean that he was not strong. Thin and wiry, he was tough as nails, and could work most men into the ground. Walt had a team of draft horses, Belgiums, that he used every year to put up hay in the field that was next to the highway. I am sure that many people would observe him and fail to realize how rare the spectacle was today. I always enjoyed watching the horses work and would often take the back road so I could stop and watch for a time.

Today was a nice late spring day with mostly blue sky, but some heavy dark clouds. Walt was waiting when I and Ruth Slagoski pulled into his barnyard. Ruth was short with dark hair. She had worked for me for a couple of years and although not a farm girl she really enjoyed the farms we visited. Walt’s farm had offered a variety we didn’t often see, with draft horses, along with the cattle.

Walt greeted us with his beaming smile and an outstretched hand. His hand shake was firm and sincere. I knew these men judged the men they met by their hand shake, something I didn’t learn in school but I had learned long ago growing up around men who earned their living working with their hands.

“I have them in the back of the loafing shed. The little guy is really uncomfortable,” Walt said. Showing his obvious concern with a fading smile.

We walk into the shed and the black baldy mamma cow and her calf were standing on the back wall. The calf was twitching is tail constantly and stomping both hind feet as if to a rhythm. “Walt, this guy probably has a stone plugging up his urethra and he can’t pee,” I explained. “It is early yet and he is uncomfortable because of his distended bladder. In a little while, one of two things are going to happen, either his bladder breaks or his urethra breaks. When that happens, the pain goes away but the problem becomes much more difficult to fix. It is a very good thing that you called early.”

The calf was easy to catch and we tied his head and then ran the mamma cow outside. I was sure of my diagnosis but completed a quick exam. Temperature was normal and his chest was normal. I did a digital rectal exam and laid my finger tip on his pelvic urethra. It was pulsating constantly.

He was a small calf, I am not sure I had seen a stone in this young of a calf before. I took another rope and tied a loop in the middle of the bite of the rope. I slipped this loop over his neck with the knot laying between his front legs. Then both ends of the rope went up over his back, crossing in the middle of the back, then down his sides and out between his hind legs.  This was called a “flying W” and is a standard method to throw a cow, generally not used on a small calf but we were going to have to tie him down for surgery.

I grabbed the two ends of the rope and pulled, the calf stiffened and fell on his side. We rolled him up on his back, flexed his hind legs and tied each leg with the ropes in a manner that when he would kick, it would put more pressure on his back and add more restraint.

Once restrained, with me on my knees, I could palpate the length of his penis. Stones generally lodge at the point of the attachment of the retractor penis muscle in the sigmoid flexure of the penis. I grasped this portion of the penis with my left hand to stabilize it. With my  right hand I could easily palpate the stone.

“This is going to be easy,” I said to Walt. He was watching close. Most of these guys had not watched a calf thrown so easily before.

We clipped and prepped the site for surgery and Ruth opened the surgery pack while I put on gloves. This was barnyard surgery at its best. There was fresh straw down but the softness of the ground under my knees told me we were on top of a foot or more of straw and manure.

The surgery was brief, as I had promised. After clipping and prepping the area, I injected the area with Lidocaine for local anesthesia, grasped the penis to stabilize it, palpated the stone and made about a two inch incision over the stone. With a pair of forceps, I bluntly divided the tissues to expose the urethra with the bulge where the stone was located. Once this was exposed I elevated the penis and drove a scissors under the penis and out the other side to maintain the exposure, stabilize the urethra, and free up my left hand. I palpated the stone again, then carefully incised the urethra, feeling the grit of the stone as the scalpel pulled across it. With a forceps, I grabbed the stone and pulled it out of the urethra and placed it on the surgery pack. It was about the size of a pea, off white in color. I took a 22 inch, 8 French urinary catheter and ran it up the urethra toward the bladder. It was just long enough to reach the bladder. We relaxed as urine drained out of the catheter. I could imagine that the calf was feeling some relief at this point. When the urine stopped, I removed the catheter and then ran it the other direction to make sure the rest of the urethra was open.

Now we had some decisions to make, to close or not to close. We had the option of leaving the incisions open. I sort of favored this option because if there are more stones in the bladder they have the chance of passing out the incision. Barnyard surgery is not the best in the world, and closing the incision always gives a possibility of infection. And closing the urethra on such a small calf could lead to an even more narrow spot that could cause problems later. The only problem with leaving the incisions open was that urine would flow out of the incision for a week or so until there was enough healing to allow normal flow.

I was getting ready to discuss all of this with Walt when the calf kicked and got one hind leg free from the restraint. He kicked again and the surgery pack went flying. The decision was made by the calf. I grabbed the scissors, releasing the penis to return to normal position. Ruth started gathering instruments that were scattered through the straw.

Walt was crawling across the straw on his hands and knees, concentrating on one spot. He ran his hand across the straw a couple of times. The with a beaming smile raised his hand, he had found the stone.

“This is going on my mantle,” he said, still smiling. 

We let the calf up, sprayed for flies and explained the urine flow issue to Walt. Things turned out okay, and I will never know how Walt was able to keep track of that stone in all the commotion.

Photo by Matt Seymour on Unsplash

Robert W. Davis, DVM 

D. E. Larsen, DVM

Preface:

Dr. and Mrs. Robert W. Davis Veterinary Anatomy Scholarship (1983)

“For almost four decades, Dr. Robert W. Davis served Colorado State University and the veterinary profession as a professor in the Department of Anatomy. A 1935 graduate of the Colorado A&M’s (now Colorado State University) Division of Veterinary Medicine, Dr. Davis had a distinguished career and his contributions to the College, University and veterinary profession were truly remarkable. He was recognized as an outstanding teacher whose enthusiasm and integrity positively affected the lives of many graduates. During its early history, Dr. Davis helped to place the College at the forefront of veterinary medical education. Dr. Davis was inducted into the Glover Gallery of distinguished faculty and alumni in 1990. The Dr. and Mrs. Robert W. Davis Veterinary Anatomy Scholarship was established by faculty and alumni in their honor.”

***

The snow on the ground from last week’s storm was almost gone, and we had bright sunshine. Everyone’s spirits were improved with this hint of spring in the air. 

I found myself spending more time looking out the window than concentrating on the dissection of the horse’s leg on the table in front of us. Ben and Chuck, my anatomy lab partners, were busy tracing the digital nerves running down the cannon bone.

Doctor Barr sort of jolted me back to the present when he came up beside me.

“Larsen, Doctor Davis is out in the horse barn and would like to spend some time with you,” Doctor Barr said. “He will be waiting for you at the outside stalls, and you can enjoy the sunshine.”

Doctor Davis was small in stature, but the muscles in his forearms showed his strength. The vessels on the back of his hands stood out as he extended his hand to shake.

“Dave, I noticed you looked a little bored in the lab,” Dr. Davis said. “I thought I would give you a change of pace today.”

I was surprised that Doctor Davis had singled me out. We had a class of eighty-four students, and the lab was a beehive of activity.

“It is an old habit,” I said. “I just learn at a different pace than a lot of guys. Looking out the window just gives me a little contact with my world.”

“Let’s look at a real leg on a living horse,” Doctor Davis said. “We will try to instill some clinical significance to all this anatomy stuff.”

***

Doctor Davis had been a veterinarian in the Army during World War II. He served with General Frank Merrill on his march across the jungles of Burma. He had been the veterinarian who cared for the mules used by Merrill’s Marauders. If for no other reason, I had great respect for this man.

***

“Are you used to working with horses?” Doctor Davis asked.

“I have been around them most of my life,” I said. “But, other than riding, I haven’t really worked on any.”

“So there are few things we need to go over about working on a horse,” Doctor Davis said. “The horse is a powerful animal, and it can cause serious injury to the careless handler. The only way to avoid injury from a horse is to be in the right place at the right time, and the only way you can be sure that will happen is to be at the right all the time.”

“That makes sense,” I said.

“The horse strikes with his front feet,” Doctor Davis said. “He strikes straight forward. If you are in front of him, you are at risk. Work from his shoulder if you can. The same thing can be said about the other end. The horse seldom cow-kicks. He kicks straight back, so work from his hip if you can. We put a horse in stocks at the hospital while working with them. That protects both the horse and the doctor. But you will be in situations where you will be working with an unrestrained horse. You just have to learn to protect yourself.”

We got down to the project at hand after that brief instruction. During the next hour, Doctor Davis showed me a roadmap of the horse’s leg. His calloused fingertips followed the path of nerves, vessels, tendons, and ligaments. I learned more in that hour than in the preceding weeks of dissection.

“With practice, you will learn to see with your fingertips,” Doctor Davis said. “In this profession, where you will be without an x-ray in many cases, seeing with your fingertips becomes vital to your success.”

We led the horse out to the paddock and let him run when we were done. 

“I would guess you were in the service,” Doctor Davis said.

“Why do you say that?” I asked.

“You’re older, and you conduct yourself with a bit of military bearing,” Doctor Davis said.

“I was in the Army Security Agency,” I said. “I was at a couple of listening posts on a couple of borders, no major action. I was in South Korea and West Germany. Interesting times and it allowed me to grow up. Nothing like what you went through.”

“That was a long time ago,” Doctor Davis said. “You will do well in this profession. It was fun spending some time with you today.”

“Yes, I learned more about the horse’s leg today than I learned in the lab over the last two weeks,” I said. “Thanks a lot for your time.”

“The freshman year is the hardest,” Doctor Davis said. “There is just so much to learn. It will get better when you get over to the hospital and start working on live animals.”

Photo by Barbara Olsen of Pexels.