Two Down at Once

D. E. Larsen, DVM

The appointment said 1:30. I looked at my pocket watch, it said 1:30. I stood in the driveway, wondering what to do now. At least I wasn’t far from the clinic.

Finally, Paul comes out of the house and down the walkway to my truck.

“Sorry for the hold-up,” Paul says as he extends his hand. “Sue was supposed to be here by now. It is her horse, but I guess I can give you a hand, up until there is blood. I don’t do blood.”

Paul is a big guy, well over six feet tall and well-muscled. He stands and watches as I get my things together. Horse castrations were basic surgery,  but I wouldn’t say I liked the procedure. I guess I was just not a horse vet. A lot of guys did the procedure with the horse standing. But with most owners lacking adequate facilities, I was reluctant to do standing castrations. That, and the fact that I watched a classmate lacerate his arm with a scalpel doing a standing castration in school.  I found that a good dose of Pentathol works wonders. It laid them down comfortably, and recovery was fast enough and smooth for the most part.

“Where is the horse?” I ask.

“He is out in the pasture. Sue thought that would be the best place to do this,” Paul said. “He is not a problem to handle. Sue said, you were going to sedate him.”

“Yes, I give an anesthetic, lay them on the ground to do the surgery. They recover without much of a problem.”

“Are you going to be okay if I leave after you get him on the ground?” Paul asked.

“Yes, I will be fine. I tie a leg up, and the surgery if relatively rapid.”

“I would do more, but blood is just one of those things I can’t handle,” Paul said with some anxiety in his voice.

“Well, there is not much with this, and once we get him on the ground, you can just walk away,” I said.

I handed Paul a few things to carry and stood, waiting for him to lead the way to the pasture. I was hoping that he was correct about the horse is no problem to catch. Often the owner has that story, and when the vet arrives, the head goes up, and there is no catching him.

There was no problem today. I picked a nice level spot in the pasture and sat my things down. Paul brought Pepper over with a lead on his halter, and we were set to go.

Pepper was a nice looking young horse, probably less than two years old. He was a gray roan. That probably lead to his name.

I soothed Pepper a little. I had drawn up three grams of Pentathol into a 60 cc syringe. I stood at Pepper’s left shoulder, and Paul was standing at my shoulder, holding the lead. Pepper was as calm as one could expect. I held off the jugular vein with my left hand, palpated it with the back of my right hand, and then slipped the needle into the vein. I glanced at Paul, and he was doing fine. I drew back on the syringe to ensure I was in the vein. A small flashback of blood came into the syringe. It looked like an upside-down reddish mushroom. With everything in place, I started the injection. Then I glanced back a Paul.

There he was, flat out on the ground behind me. That small mushroom of blood in the syringe was all it took. He was out like a light. At least he had some soft ground to land on. My problem now was I had started the injection and couldn’t stop midstream. I gathered the lead rope in my left hand and delivered a full two gram into the vein.

I was able to guide Pepper’s fall back and to his right side so he would end up well away from Paul. The with Pepper on the ground, I slowly gave the other gram of Pentathol to get him well under anesthesia.

With Pepper under control, I went over to check Paul. He was starting to come around when I got down beside him. I helped him sit up, and then after a moment, I helped him onto his feet.

“I’m sorry, Doc,” Paul said. “It doesn’t take much blood to do me in, I guess. Are you going to be alright here? I think I am going back to the house.”

With Paul under control and gone, I put a sideline on Pepper and took a wrap on his left fetlock. Then I pulled that foot forward and up, securing it out of the way. Then I prepped the scrotum with Betadine Scrub and sprayed it with Betadine.

Everything was set for surgery now. I incised the scrotum over each testicle, extending the incision into the testicle, so the tunic was also incised. Then, hooking my finger in the pocket formed by the everted tunics, I pulled both testicles, and their tunics, out of the scrotum.  This freed all the tunic attachments. 

Then I clamped an Oschner forceps across the cord and removed the testicle and tunic with the emasculator. I held a firm grip on the emasculator for a moment to ensure a good tissue crush. I sprayed the cord with an antibiotic and released the forceps. This allowed the cord to retract into the scrotum. The next testicle was removed the same manner. Then with scissors, I removed the bottom of the scrotum between the two incisions. I stretched the opening to ensure adequate drainage and sprayed the area with an antibiotic spray. I sprayed a large area with fly spray, including the tail.

With everything done, I picked up everything and moved out of the way. I removed the sideline and grabbed the lead rope. While I was waiting for Pepper to recover, I gave him a booster to his tetanus vaccination. And since Sue was usually at work during office hours, I gave him a good dose of Dual Pen. I didn’t use antibiotics following surgery if there were no problems, I just thought this might save me a return trip.

It was not long, and Pepper opened his eyes, then with one motion, he righted himself to rest on his sternum. Then he stood up, I needed to steady him a bit, but he was good to go in no time at all. I removed the lead road and gathered my stuff, putting almost everything into the now-empty bucket.

After getting everything put away in the truck, I glanced out to the pasture. Pepper was grazing, almost as nothing happened. I went to the front door and knocked. Paul was a little slow to open the door but looked okay when he did.

“I was just checking to make sure you were okay,” I said.

“I am okay, Doc,” Paul said. “I will have Sue stop by your office to pay the bill and get any instructions.”

“Good enough, you take care of yourself,” I said. “Pepper is up and eating. You don’t need to worry about him, Sue will check him when she gets home.”

Photo by Jan Canty on Unsplash.

Midge

D. E. Larsen, DVM

I had met Midge when she was 2 days old. I was looking at a cow at Ron’s place. I mentioned that we were looking for a dog for the kids.

“We happen to have a new litter of pups. Lab mixes, I would guess,” Ron said.

“The mother is a lab?” I asked.

“No, she is an Australian Shepherd. Well, mostly Australian Shepherd.”

We finished up with the cow, and Ron took me over to the pump house. There was Bessie, curled up in her box with a litter of 8 black puppies. All the pups only had short stubs for a tail, inherited from mom.

“You bring your kids back in 6 weeks, and they can have the pick of the litter,” Ron said with a broad smile.

“You have a deal, I am sure they will enjoy picking out their pup from the bunch. But you had better give away any of the pups you can. The pick of the litter is not that big of a thing for the kids. You wait on us, and you might end up with 7 dogs running around here.”

The kids marked off the weeks on the calendar. They were excited to be getting a new puppy. We all loaded in the car and headed out to Ron’s ranch. It was a warm day in the early summer, and the whole valley was green and growing. It made for a pleasant drive, out Pleasant Valley Road, and over the hill on Berlin Road.

Both Ron and Helen were waiting for us when we pulled into the driveway. The kids were bailing out of the car as soon as it came to a stop. Ron led the parade to the pump house. When he opened the door, the whole litter came tumbling out, falling over one another. They were happy puppies and happy kids. And the black lab mix pups all had legs not much over an inch long.

“These pups are fine, but you know, I don’t think they are black lab crosses,” I said to Helen as we watched the kids. Amy and Dee were on the ground with pups swarming over them, trying to lick the faces. Brenda had made her selection and had scooped her up early. My guess is that would be our pup.

“They have to be labs, there was no other dog around here,” Helen said, looking at Ron for support.

“The only other time there was a dog on the place was when Les came over,” Ron said.

“Yes, but Les’s dog was a Dachshund,” Helen said. “There is no way they could have got together.”

“My guess is when there is a well, there is a way,” I said. “You know the system is made to work. She probably laid down for him.”

Brenda loaded the little female pup into the back seat with the other girls. They had named her Midge before we were out of the driveway. Her legs were never over three inches long, and she conducted herself like a perfect little German Lady.

Block and Tackle C-Section

D. E. Larsen, DVM

Another 3:00 AM emergency, I thought to myself as I started loading things up for my trip into the barn. Glenn was not a regular client but often helped out down the road at Ayer’s place. This large old barn told a familiar story of bygone days, once a thriving little family dairy farm, now the kids are grown, Glenn stove up enough to just being able to manage a few cows and the market for milk from small dairies has long since dried up.

I shook off the chill of the early morning air, hopefully it will be a little warmer in the barn.  Glenn was waiting with the large barn door pushed open slightly. 

“Morning Doc,” he said with a smile, “sorry to call you so early but she has been at for several hours with no progress.”

I could see the heifer tied to a center post. A large Simmental heifer with a single foot visible at her vulva. The foot was huge, this was not going to be a simple morning. 

I approached the heifer cautiously and scratched her forehead. I should have known, she was like a pet, probably the only replacement heifer Glenn had and a far cry from a wild range heifer.  I adjusted the halter to make sure it would not choke her if she went down during the exam and then moved to her rear end. The second hoof was just inside the vulva, the soles of the hooves were up. These were hind feet and they were very large, nearly filling the entire birth canal.

I tied a length of twine on the switch of her tail and secured the other end in a loop around her neck. This held the tail out of the way.  Then I scrubbed the vulva with warm water and Betadine surgical scrub. After pulling on a plastic OB sleeve I carefully inserted my hand and arm into the vulva to explore the situation. There was just enough room for my arm and the two legs of the calf. I could reach the cervix and palpate the calf’s hocks. This was a massive calf. I strained to reach past the hocks to the rump of the calf. No vulva, this was a bull calf. I inserted a finger into the rectum. There was a strong tightening, he was alive.

“Glenn, this calf must weigh 150 lbs. His two legs and my arm fill the entire birth canal,” I explained.  “The only way he is coming out of her is if we do a C-Section. He is in posterior presentation, he is alive but I don’t know if you and I can lift him out of her.”

I thought about the situation. Glenn was a small man but I knew he was no weakling. I have had difficulty in the past bringing the uterus up to a flank incision with a large calf in a posterior presentation. It would be best to use ventral midline incision. Laying the heifer down would be no problem but then lifting this calf out of her was going to be tough. 

“Glenn, do you have a block and tackle?” I asked.

“Sure, Doc, what do you want to do with it?

I pointed to a spot in the rafters that could hold the block.  “Let’s hang it there, I will lay this heifer down and roll her onto her back. Maybe we could block her up with a couple of hay bales.”

Glenn hung the block and tackle while I got things together for a C-section. The block and tackle looked like it could lift 1000 pounds. These C-sections always took me a couple of hours, probably no chance of getting back to bed before office hours.

We moved the heifer over to where I wanted the throw her. Tied her to a post and place a Flying W on her. This is a standard rope throw that I often used. It always amazed these old farmers and the story would be told over many a cups of coffee.  I put the rope over her neck in the middle of the rope, tied a loose knot that fit between her front legs.  Then threw each end over her back so they cross in the middle of her back. Then put the ends between her hind legs, exiting on each side of her udder.  I grabbed these ends, pulled hard and leaned to the right at the same time. The heifer made a hard flop onto her right side.  Glenn looked at me and smiled. By his reaction, I am certain he had never seen that before. I rolled her up on her back, and tied each hind leg to the rope so when she stained or kicked against the rope it would putt more pressure on Flying W and increase the restraint. Then we placed a bale of hay against each shoulder to maintain her on her back.

This done, I stood up and stretched a little. “I hope you can get me an extension cord?” I asked.  

Glenn had one hanging on the wall near the door and he had it plugged in and stretched out in no time.  I plugged in my clippers and clipped the ventral abdomen from the umbilicus to the udder and to both side. I scrubbed it with Betadine Surgical Scrub and wiped the incision are clean. I used 2% Lidocaine for local anesthesia, about 90 cc and left 30 cc in the syringe in case I needed more.

I did a second prep of the area and wiped it with alcohol, then spayed it with Betadine solution. I laid out my surgical pack on a hay bale and opened 4 packs of #2 Dexon suture material and a scalpel blade. Then I put on a pair of surgery gloves and dropped to my knees beside the heifer. I made an incision through the skin on the midline, about 12 inches long. Extended this though the subcutaneous tissues and exposed the linea alba (white line in Latin, that fibrous band on the abdominal midline). I made a small incision through the linea alba and inserted a thumb forceps to protect the abdominal tissues from the blade. I opened the linea the full length of the incision.  

I pulled the omentum forward and there was the uterus filling the abdomen. With one hand I tried to externalize the uterus, I could hardly move the head.  I found a foot and moved it to the incision.  I incised the uterus, using the space between the toes as a guide to the incision.  With this foot exposed through a small incision in the uterus I attached a nylon OB strap to it and hooked the loop of the strap to the hook on the tackle block.

“Take up some slack and put just a little tension on this foot,” I instructed Glenn.

I enlarged the incision just a little to allow me to reach in and find the other foot. I pulled it out and attached it to the other end of the OB strap. “A little more tension,” I said.

As the legs extended through the uterine incision, I enlarged it toward the head of the calf. Now, with most of weight on the block and tackle, I could left head of the calf to the incision. I worked the head through the incision, looked at Glenn and said “Pull”.

The calf glided out through the incision with ease. I guided the hide feet out and away from the heifer and Glenn lowered it to the floor.  Indeed, this was the largest calf I had delivered, ever bit of 150 pounds. 

He snorted and shook his head.  Glenn was all smiles. I took a towel and wiped the mucus from his nose and mouth and rubbed his chest a little.  “He will be up before his Mama,” I said.

I changed gloves and started back to work on the cow.  I removed some of the membranes through the incision but most were left to pass vaginally.  I dumped a package of 5 grams of Tetracycline powder into the uterus. I closed the uterus incision with #2 Dexon in a continuous Utrecht closure. I returned the uterus to the abdomen and covered it with omentum.  Then I started on the closure of the linea alba. I closed the linea alba with an interrupted sliding mattress closure using doubled #2 Dexon sutures. Then the free edge was closed with a simple continuous suture using #2 Dexon. 

With this done I relaxed a little, thinking to myself, if I dropped dead now the rest of the incision would probably heal on its own.  About this time, the heifer strained against the rope. The right foot came mostly free and she kicked hard. The hoof caught me on the left side of my jaw and felt like a very solid punch. It was hard enough to almost set me back on my butt. I shook my head and realized that I was okay.  I got back to my knees and retied the foot with an extra wrap or two.

I changed gloves and completed the closure. I used a simple continuous in subcutaneous tissues and a standard mattress on the skin, all with #2 Dexon, I didn’t want to have to crawl under this heifer to take out any sutures.  I sprayed the incision with Furacin spray and the whole area with fly spray.  Done at last, I thought as I stood up, pulling my gloves off.

Glenn had the calf on his feet already.  I took a bottle of Betadine and filled his umbilcal cord, saturating the surrounding area.  Then I gave him a 200 pound dose of MuSe, a vitamin E/Selenium supplement. This calf looked a month old already.  

We untied the ropes and moved the hay bales. The heifer rolled to her side and onto her sternum in one motion. When Glenn pushed the calf toward her, she jumped to her feet and took control of the calf. I gathered up my stuff and got everything back in the truck. We untied her tail and removed the halter. 

“I’ll leave her here for now.” Glenn said.

“Yes, I would keep her close for a few days, just to make sure everything is okay,” I said.  “Call if you have any concerns, but I would expect things to be fine.  She should pass the rest of her membranes tomorrow or maybe the next day.”

I got back in the truck and rubbed my jaw a little.  Opened my mouth wide, everything was okay. My guess is that foot was slowed down by the rope a little, otherwise it would have been worse.

As I headed back toward town the sky was starting to show some light in the East. I would get home for a shower and breakfast before I was due at the office.  No rest for the wicked. Sort of reminded me of my Army days.

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