The Perfect Shot

D. E. Larsen, DVM

I thumbed through the journal, scanning the pages for something interesting before discarding it onto the pile on my desk. I seldom read anything cover to cover, but I could rapidly review the pages and pick out any interesting articles. Those articles I could quickly scan a little closer in a manner that would allow me to retrieve it later if needed.

This journal was a lessor journal, titled Veterinary Medicine. It occasionally had some practical articles from real practitioners, not just a bunch of university types who had no fundamental concept of what private practice was like.

The article that caught my eye today was on a do it yourself blowgun and dart that you could use to get a capture drug into an otherwise wild critter. Lord knows I seem to have my share of those.

It was relatively easy to make. Using a four-foot piece of PCV pipe for the blowgun and darts fashioned from a couple of 3 cc syringes. The blowgun was nothing to make. The dart took a little time.

The flanges on the back of the syringe were trimmed off, so you had a smooth barrel. One plunger stopper was inserted into the barrel of the syringe. It would deliver the dose when the syringe was loaded, and the chamber between the plungers was charged with air.

  The second plunger was used on the back of the syringe. You used silicone gel to secure a bundle of one-inch long yarn pieces to serve as the fletchings, like the feathers of an arrow. Using a bright color for the yarn may aid in finding a dart that missed the target. This plunger was secured to the syringe’s back by driving a couple of 20 gauge needle through the syringe and clipping them off flush with the edge.

The journal’s plan called for a 16 gauge needle, plugged with superglue at the end, and a side port in the needle. This port was made with a small file close to the end. I found that to be an unnecessary step. I just used a standard 16 gauge needle that was one and a half inches long. Plugs for this needle were fashioned from a strip silicone gel pushed out and allowed to dry in a strip. Cutting a quarter-inch piece and inserting it on the end of the needle would plug the hole, and then it would be pushed up on the needle when the target was struck. This would allow the drug to be delivered.

With a syringe and needle inserted into the chamber between the plungers, you could control the free plunger in the barrel of the syringe dart. Inject air, drive the free plunger to the end of the dart. Insert the dart’s needle into the drug and withdraw air from the chamber, thus drawing the drug’s dose into the dart. Then plug the dart’s needle with a silicone stopper, and inject air into the chamber between the plungers to charge the dart.

I fashioned several darts and even practiced with the blowgun. It worked remarkably well and had a surprising range. With a strong puff of air, I could send the dart for over 30 yards. The dart held its line in the air. The trick was in the elevation. To fly the dart 30 yards, one needed about 30 degrees of elevation. Hitting a target at that distance would take a little luck.

My opportunity to use this dart came only a couple of weeks later. Margery was a client with a small acreage out in the valley. She had lost her husband some years before, and now her son and his family lived with her.

“Doctor, my grandson bought this cow and turned it out in the pasture,” Margery said. “It is wild as can be. He can’t get close to it, and it has an ugly looking eye.”

“Do you have a corral or even a smaller pasture you could run her into?” I asked.

“No, Bob never used that pasture for anything,” Margery said. “It just has a fence around it. And that fence ain’t much, just steel posts and barb wire.”

“It doesn’t sound like I could get a rope on her very easy, and if I did, I probably wouldn’t have anything where I could tie her,” I said.

“I could park the pickup out in the pasture,” Margery said. “That would give you someplace to tie her. It might help you get close to her also. But I can guarantee you she will be running fast.”

“You tie a wild cow to a pickup, and she will swing around on the end of that rope and cave in the side of your truck,” I said. “Maybe both sides before she is done.”

“That would not be good,” Margery said. “Maybe we are just going to have to shoot her. I can’t see just allowing her to suffer from an infected eye.”

“There might be another option,” I said. “I do have a blowgun dart that I could tranquilize her with if I managed to hit the target.”

“That might be worth a try,” Margery said.

“The thing that you have to understand is that if I come out and chase a cow around a pasture for an hour and don’t catch her, you will still have a bill to pay,” I said.

“That is only fair,” Margery said. “But I would like you to try.”

I stood at the gate with Margery’s Grandson, Jason. The brindle cow was at the far end of the pasture, head up, and watch us.

“Jason, this is not much of a fence,” I said. “If we get her really excited, she could go right through it.”

“Grandma is pretty worried about her suffering with this eye,” Jason said. “If we can’t catch her, she is probably going to make me shoot her.”

“We will give it a try,” I said. “But what about next time? You need to build corral up here in the corner so you can get her into a small place and get a hand on her.”

“She wouldn’t go into it,” Jason said.

“You solve that problem by making a fence that funnels her into the corral,” I said. “You get her used to going into it by putting the water in there and a feed rack. This time of the late summer, there is not much food value in this grass. If you had a couple cows, you would need to be feeding them already. I don’t see any hay stored around here. What do you plan on feeding her this winter?”

“I guess I haven’t thought about that,” Jason said. “I was just thinking that I would get a calf out of her and start building a herd.”

“That’s a good plan, but you need to cover all those little bases,” I said. “Let’s go see if we can take care of this eye, and then you can come by the office, and I can give you some ideas on a corral system that won’t break the bank. And I can set you up with a couple of guys who might have some extra hay.”

“How do you want to catch her?” Jason asked. 

“I am going out into the middle of this pasture and have you go out around her,” I said. “If you can walk her down the fence line, I will try to get one of these darts into her. I have 3 darts loaded with a dose of Rompun. If I can hit her with one of them, we will have her.”

“Grandma bought a halter to put on her when we catch her,” Jason said. “She thought it would help next time.”

“We can put it on her, but a corral will be what will help next time,” I said.

“And she is not going to walk down that fence line, she will be running at full speed,” Jason said as he started toward the far end of the pasture.

I walked out to the middle of the pasture, and the cow was watching both of us now. She was turning this way and that way, not sure which way to go. I load a dart into the end of the PCV pipe.

As Jason approached the corner where the cow was standing, she started down the fence line, picking up speed as she came. I raised the blowgun to my mouth and took a deep breath. Pointing it in the air at about a 30-degree angle, I waited as she approached what I guessed was the launch point. She was running full speed now, with one strong puff of air into the pipe, I launched the dart.

The dart flew in a high arc, the cow continued at full speed. I held my breath as I watched the arch of the dart.

Pow! The dart struck her on the side of the neck and stuck. I could not have placed it better if I had been standing by her side. I smiled as I looked at the end of the PCV pipe. Jason came running up to me.

“Wow, that was a good shot,” Jason said.

“Lucky, Jason, lucky is different than good,” I said. “You stand here with me for a couple of minutes. She will settle down and then just lay down. When that happens, I will let you run up to the gate and get my bag and my bucket.”

Rompun is an excellent sedative for cows. It is not ideal because there are times when a patient will appear asleep, but they can still jump up defensively. But this cow was well sedated.

The left eye was ugly looking but did not look like a simple pink eye. There was a large ulcer on the cornea. I lifted the 3rd eyelid with a pair of forceps. There was the problem, two large grass seed awns stuck in the corner of her eye.

I removed the grass seeds. Then I did an injection of Amoxicillin under the upper eyelid and another injection into the space behind her eye. I didn’t think we would be catching this cow again any time soon.

Then I sutured the 3rd eyelid up over the ulcer with a single mattress suture of 00 chromic catgut. That would give enough healing time, and the suture would dissolve on its own. Then we sprayed her face for flies.

By the time I had things put away, the cow was up and acting like she would be okay.

“That eye will heal just fine,” I said. “We should not need to do anything more with it. Now you be sure to come to the office. I won’t hit her with a dart like that in the next 10 tries.”

“So, should I build a corral or just buy one of those that you can set up?” Jason asked.

“It is just dollars and cents,” I said. “The commercial systems are good. And they are fast and easy to set up. You could probably do it cheaper with a few post holes and some posts and lumber.”

“Well, it’s Grandma’s money,” Jason said. “It might be a lot easier if I got a few of those panels and set it up that way.”

“Either way works,” I said. “Sometimes, when you’re a young man, it is better to do things yourself and get a feeling of accomplishment. And, Jason, you should be very careful and thoughtful when you are spending Grandma’s money.

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It’s Her Job

D. E. Larsen, DVM

I stepped out of the crowding ally quickly as Ervin released the cow that I had just checked. The next cow was charging down the alley with Ella right on her heels.

Ella was a middle-aged Border Collie. She had been on the farm enough years to know her job well. When one cow left the chute, Ella had another one heading down the ally. The cows also knew Ella. If they failed to follow her instructions, they would have her biting at their heels.

“You trained her well,” I said. As Ervin caught the next cow in the headgate.

“Wasn’t any training involved,” Ervin said. “She watched my old dog a couple times when she was a pup. The rest was just instinct. She loves these days or the days when we change pastures. The rest of the time, she is just waiting for me to head for the pickup. She likes to go to town in the back of that thing. Bouncing from side to side as we go down the road and then guarding the truck with her life when I go into the store. It is only different when I pull into your parking lot. She knows that place, and she doesn’t like it much.”

“I see a lot of working dogs,” I said. “Most of them live to work. And most of them are pretty good at what they do. But Ella has to be one of the best. I think she has the cows trained. They just know what she wants them to do.”

I had been to Ervin’s place many times before, but usually just for one or two cows. This was the first time that we were working through the entire herd, checking for pregnancy status. At most places, it was a job to keep the crowding alley full and have the next cow ready to go into the chute. Not so with Ella here, she was in total command of the herd, and she worked hard at her job.

Ervin was one of the older ranchers in my practice. He was tall and thin and always looked like he shaved about four days ago. His face was long and accented by a somewhat pointed nose. The few tufts of gray hair on his head were covered with an old beat-up cowboy hat, and he always wore cowboy boots. That told of his roots coming from Montana. He was probably the only true cowboy in my client base.

We worked through Ervin’s herd in about three hours. Ella was resting at the back of my truck as I was cleaning up and putting things away. Her tongue was hanging out, and she was panting a lot, but I think she was hoping that there was something else to be done.

Two days later, Ervin pushed through the clinic doors with Ella following with very guarded steps. Ella stood close to Ervin’s leg as he waited at the counter. She was a little hunched up in her stance.

“What’s going on with Ella this morning?” I asked as I opened the door to the back.

“I don’t know, Doc,” Ervin said. “She was a little slow yesterday, and I just figured she was tired from working those cows. She is getting a little older, you know. But this morning, she doesn’t want to move. And she wouldn’t jump into the bed of the pickup. I loaded her into the cab for the trip into town. I figure she must be close to death for her to want to ride in the cab.”

Ella tensed when I started to pick her up to put her on the exam table.

“Do you think she could have been kicked the other day?” I asked.

“That is what I was thinking,” Ervin said. “But if she did, I didn’t see or hear it happen.”

I ran my hands down her back and along the muscles of her back and hind legs. There was no indication of any pain. Then I palpated her belly. She tensed at my initial touch. When I palpated her abdomen, I immediately detected a large tumor in the middle of her gut. This tumor was the size of a cantaloupe. That is a massive mass for a dog of Ella’s size.

Ervin, she has a large tumor in her abdomen,” I said. “We need to get some x-rays and see if we can determine what it is and to check the status of her lungs.”

“Can you do anything to help her, Doc,” Ervin asked.

“It all depends on what it is,” I said. “We might not really know until we get in there and look. And then with a tumor of this size, if it is malignant, we might not buy Ella much time.”

“Okay, I want to try to give her a chance,” Ervin said. “I don’t want to sell the farm, but let’s see what we can do.”

We took a set of x-rays of Ella’s chest and abdomen and drew some blood if we were going to be doing some surgery. When the films were developed, I put them on the viewer for Ervin to see.

“The good thing here is the lungs look clear,” I said. “But look at the size of this mass in the middle of her belly. This could be just about anything. I think the only thing to do is to go in and look. If we can get it out of there, we will do that. If we can’t get it out, then you have to decide if you want to wake her up or not.”

“When can you do this, Doc?” Ervin asked. 

“We can do her the first thing in the morning,” I said. “You can leave her overnight if you like.”

“Oh no,” Ervin said. “You give her something to make her a little more comfortable, and I will take her home. If this is her last night, she will be on the farm and beside the fire in the house tonight.”

“I am amazed at her grit,” I said. “She worked those cows the other day just like nothing was wrong.”

“Well, Doc, that’s her job,” Ervin said. “It’s just like the old farmer out in the field hoeing his corn. A fancy city slicker comes up and asks him what he would do if he was told he was going to die tomorrow. The old farmer thinks for a minute and looks around at his cornfield. Well, he says, I guess I would hurry up and get my hoeing done. No different with Ella, she just figured it’s her job.”

I was amazed at the size of the tumor when Ella’s abdomen was opened the following morning. With exploration, it was determined to be the right kidney. Her left kidney appeared normal, and her kidney numbers were normal in her preoperative blood.

I carefully isolated the renal artery and triple ligated it first. Then with careful dissection and ligation, I removed this mass. It was a full 10 inches in diameter.

Ella recovered well and bounced out of the kennel when Ervin came to pick her up. She is an excellent example of why the closure of the incision is so vital in these dogs. I doubt that she is going to restrict herself much.

“What do you think, Doc?” Ervin asked.

“Surgery went well, and the rest of her abdomen looked good,” I said. “We will just have to wait on the report from the pathologist on what type of tumor this is and what kind of a prognosis we can expect.”

“I guess it doesn’t really matter,” Ervin said. “We are not going to put her through any of the stuff that they put you and me through. That stuff probably doesn’t buy much time anyway.”

A couple of weeks later, Ervin and Ella bounded through the door. 

“Doc, I want to thank you,” Ervin said with a broad smile on his face. “That tumor most have been bothering Ella for a long time. She has been like a puppy ever since the surgery.”

“I would bet that if you or I walked around with a mass the size of a small watermelon in our gut, we would be slowed down a little,” I said. “Let’s get Ella up on the table and get those stitches out, and then I will go over the pathology report with you.”

Ella’s incision was well healed. It has always amazed me how well dogs, cats, and cows tolerated abdominal incisions. When I had an appendectomy, I didn’t walk up straight for a month. Ella has probably been running around the barn and the pastures for over a week now.

“The pathologist says Ella’s tumor was an Embryonal Nephroma,” I explain. “This is a rare kidney tumor in the dog. But for the most part, it is considered benign. So maybe we have dodged the bullet. Let’s hope so, at least.”

“That good, Doc,” Ervin said. “But you know, at my age, and Ella’s age, we just take what the world throws at us when we get up in the morning.”

And in Ella’s case, the world did throw her a curveball. She was fine for the next 6 months. She worked and enjoyed life right to the very end. Then one morning, as if that final straw was thrown onto the camel’s back, Ella could hardly catch her breath.

Ervin rushed her to the clinic, and we took a set of x-rays of her lungs. Those lungs were full of cancer. 

I didn’t have to tell Ervin a thing when I went out front to discuss the films with him.

“I guess that pathologist didn’t know what he was talking about,” Ervin said.

“That’s right, but we probably can’t blame him much,” I said. “He has probably seen about as many of these things as I have. And that is only in Ella. He was just reading out some book for us.”

“I don’t want her to suffer no more than she has already,” Ervin said. “I think it is about time for her to buy that last lotto ticket. I have a place next to the corral that will be perfect for her.”

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Where is the Volar Pouch

D. E. Larsen, DVM  

Dr. Adams was a massive man, both in his physique and in his professional reputation. He was not tall, less than six feet, but very muscular. His rugged facial features made him appear to have a scowl on his face in the best of times. In those moments, when he was mad at a horse or a student, some would say he was fearsome.

There was a story while we were in school about Dr. Adams attending a meeting of equine veterinarians. The first presenter was doing a ground-up portrait of the perfect equine veterinarian to lighten the audience. 

He started with the feet, then the legs, on up to the chest and arms. The picture was that of a cartoon gorilla. In actuality, it portrayed Dr. Adams pretty close. Dr. Adams was in the front row and was becoming red in the face because it seemed everyone except the presenter recognized the similarity to Adams. I have no idea if the story was true, but it was told a lot in those years.

However, he was a great teacher. When I was assigned to him for my senior rotation in large animal surgery, I was thrilled. That thrill did not last long.

On the first Monday morning of my two-week rotation, the Junior student and I waited in front of the large animal surgery room. Finally, Dr. Adams arrives at 8:00 AM sharp.

“Good morning, Guys,” Dr. Adams says. “You two are lucky. We have a busy couple of weeks coming up. I want to get off to a running start here.”

He throws up an x-ray of the lower leg of a horse on the viewer.

“Where is the Volar Pouch, Larsen?” Dr. Adams asked. 

“Um,” I stammer.

“Jon, same question?” Dr. Adams says to the junior student.

“I guess I don’t know,” Jon replies.

“Okay, let’s get started on the day,” Adams says. “But, you two have an anatomy test in my office at 1:00 PM on Wednesday. If you fail that test, you fail the rotation.”

And if the rumors of Adams’ power were correct, we will play hell graduating if we fail the rotation. This was not only intimidating, but it was also damn scary.

When the casework was done for the day, Jon and I were in a rush to get home. I had managed to get through the first 3 years of Vet School with little studying outside of the classroom and clinic. Now, I had a couple of nights to review the anatomy of the horse in exquisite detail. 

Dr. Adams was the author of Lameness in Horses and enjoyed the reputation as the leading authority on the horse’s legs. That gave us a clue. Make sure you know every detail of the anatomy of the horse’s legs.

For the next two nights, I reviewed my anatomy notes from my freshman year. I committed the equine section of Sisson’s book, The Anatomy of Domestic Animals, to memory. My memory is pretty much photographic. I can save pictures in my mind, but not text. On occasion, I can save captions to the photos for a brief time.

Finally, Wednesday came. We had surgery scheduled for the morning. Dr. Adams was a skilled surgeon. In this jumper, there was a chip fracture of a carpal bone. A significant amount of the time involved getting the horse under anesthesia and positioned on the surgery table. The surgery was brief in Dr. Adams’  hands. The chip was removed, and Dr. Adams left the closure to his intern and senior student, me.

“Don’t forget the test in my office at 1:00,” Adams said as he pulled off his surgery gloves.

“We’re looking forward to it,” I replied with an unseen smile, but I am sure it reflected in my eyes.

Adams smiled and departed the surgery room. 

When the horse was recovered, and back in the stall, Jon and I had a full hour and a half for a final review.

“I am going to take Sisson and go grab a coffee and a sandwich over at the MU,” I said.

“That might be good,” Jon said. “I will join you, but I think I have had my quota of coffee for the week.”

There was no real conversation at the table. We ate a quick sandwich, and both did a final review of Sisson. My pages turned much quicker than Jon’s. When the time came, we got up and walked back to the hospital. 

Dr. Adams’ office was on the second floor of the hospital. When we turned the corner to his office, we ran into a crowd of classmates. Word of our test had spread through the classes, and everyone wanted to watch. It must be like a crowd viewing a hanging. We worked our way through the crowd and took our seats in the office.

These professors all tried to present themselves as intimidating as possible. I found it almost laughable. In my last year in the Army, it was common for me to make presentations at general staff meetings, for generals with 2 or 3 stars on their collars. They were much more formidable than any professor. So in this situation, I was pretty relaxed. Jon was not so much.

Dr. Adams wasted no time. He started firing questions, some oral, some with x-rays on the viewer, and some with pictures from slides projected on to the wall. Like all tests, they are easy if you are prepared. I think the fact that both of us didn’t miss a question was getting to Dr. Adams. 

“You haven’t asked about the volar pouch,” Jon said.

“I figured that would be the question you studied first,” Dr. Adams said. “But since you mention it, why don’t you tell where it is located and what it is, and why it is important on that x-ray I had Monday morning.”

“The volar pouch is an extension of the joint capsule and is located between the cannon bone and the suspensory ligament, just above the sesamoids of the fetlock. If it is distended, it indicates inflammation in the joint.”

“That’s a good answer, Jon,” Dr. Adams said. “You should not overlook that on an x-ray.”

“If you did an adequate clinical exam, you should know it is distended before the x-ray is ever taken,” I said.

“That’s a good point, but in this business here, I am often looking at x-rays of horses that I didn’t examine,” Dr. Adams said.

Finally, he puts a picture on the wall. This was a picture of the two planter nerves on the lower front legs of a horse. There is a nerve that communicates between these two nerves. It crosses the leg at an angle. . You could tell which leg you were looking at by the directing that this nerve was running between the two primary nerves. This was a picture right out of Sisson.

“Larsen, what leg is this?” Dr. Adams asked.

“The left leg,” I said. “The left front leg,” I added.

“How do you know that?” Dr. Adams asked.

“That is the picture out of Sisson,” I said. And then, looking at a blank wall, I used my finger to trace the words in the caption of that picture as I read the caption.

The hallway audience erupted in laughter.

Adams shook his head and smiled. “That’s all I have, I can’t top that.”

That could have been the only time I ever saw the man smile. There was never a mention of the test in the remaining time days of the rotation. We learned a lot, and even though I was not fond of horses, I learned everything I could from the man.

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