The Thomas Splint

D. E. Larsen, DVM

The heat was stifling, and the room was packed. The air conditioner just couldn’t keep pace.

“I hope he finishes this up a little early,” I say to the guy sitting next to me.

He loosens his tie. “Yes, we all need to get out into some fresh air.”

The speaker, a short, gray-haired orthopedic surgeon who teaches at Ohio State University Veterinary School, starts to field some questions from the audience. 

“If nobody asks anything, we are out of here,” I say to the guy next to me. He ignores the comment but unbuttons the top button on his shirt.

Then comes the first question, then another. “Didn’t these guys listen to the lecture,” I say, more to myself than to the guy next to me.

“They must be his residents, they can’t be wanting to stay in the sweatbox any longer,” says my new friend in the tie. 

Then comes another question, “What about using a Thomas Splint on lower leg fractures?” some guy in the front row asks.

“I went to school over twenty years, and I never sat in the front row one day of all that time,” I say.

The guy looks at me out of the corner of his eye but doesn’t say anything.

“I haven’t used a Thomas Splint in 25 years,” the Professor says. “If you are going to repair a fracture, you should repair it the right way.”

“He is a long way from the real world,” I say to this guy next to me.

“What do you mean by that comment,” the guy says, almost like I said something that upset him.

“I mean, he would starve to death in Sweet Home,” I said. “Everybody doesn’t have $3000 to go to a university for a fracture repair on their dog. What do you suppose happens to those dogs?”

“We can’t take care of the world,” this guy says, tightening his tie.

“We don’t take care of half the dogs in this country,” I said with a stern voice. “It is great to sit here and learn how to repair a fracture with equipment that only a fraction of the clinics in the state can afford. But when push comes to shove, you better be able to apply a Thomas Splint on the dog of the little girl who will heartbroken if her Dad puts her only friend in the world to sleep because he cannot afford a surgical repair.”

“And what do you do when the repair fails?” the guy says as he slips back into his sports coat.

“You can say at least we gave it a shot,” I said. “Then you better go back to school and learn how to do it correctly. I have used Thomas Splints on everything from a 6-week old kitten to a 700-pound cow. I haven’t had a failure. There have been a few legs that healed a little crooked, but functional.”

“Let’s slip out of here, and I’ll buy you a beer while you tell me a couple of cases,” my new friend says.

“Okay, but you have to agree to one thing first,” I said.

“And what do you want me to agree to?” he said.

“You have to take that damn tie off if you are going to buy me a beer,” I said. “We had to wear a tie every day in vet school, I haven’t worn one since. Probably won’t until my daughters get married.”

We were in the back of the room, so getting out the door without disrupting the class was easy. This guy takes his tie off as we head to a little bar in the hallway. 

“This feels better,” he says as we find a table.

I am not sure if he means having his tie off or if he is talking about the cool air in the bar. I finally notice his name tag. He is a speaker and a professor at the University of California at Davis Veterinary School.

“How long have you been at Davis?” I ask while we are waiting for a beer. “I knew a guy who did an internship there.” 

“I have only been there a few years,” he said. “What did your friend think of the internship.”

“He died,” I said.

“Oh, I’m sorry,” he said. “How did that happen?”

“He crashed a small private plane,” I said. “He would have been better off just going to work.”

“You have my interest in your comments on the Thomas Splint,” he said. “Convince me that you know what you are talking about.”

“I will compare two cases,” I said. “They were separated by a few years but are good illustrations. Both tibial fractures that involved about half the length of the bone, shattered in the middle half of the bone. One from a gunshot and the other, we did not know what happened.”

“Did you repair both with a Thomas Splint?” the Professor asked.

“The first case was a large Malamute who belonged to a nurse,” I said. “He was chasing the neighbor’s cows, and the neighbor shot him. Shattered the middle half of the tibia. When I first saw him, I stabilized the fracture site with a pressure wrap and a Thomas Splint.”

“That was probably better initial care than many dogs get in a small clinic,” the Professor said. “Then what happened.”

“The dog was brought in by a friend,” I said. “When the nurse finally got there, and we reviewed the films, she wanted a surgical repair. I said that this repair was way over my head. At that time in Oregon, we had limited options for a referral. There was a surgeon in Eugene, and we sent the case to him. This surgeon, who I knew, was amazed when this 140-pound dog with a shattered tibia walks into his clinic. He repairs it with a plate and bone grafts. They have all sorts of complications and followups, but the bone did finally heal. I don’t remember, maybe I never really knew how much the bill totaled. I think she paid something like $4000. This was in the 1970s, that was a whole lot of money.”

“I have seen similar repairs,” the Professor said. “I would guess your estimate was close. And the problems with getting one of those fractures to heal are many.”

“So, do you want to hear the other case?” I asked as I noticed that my beer was still mostly full.

“It must have been different,” the Professor said.

“The second case was a similar fracture in a Blue Heeler,” I said. “We didn’t know how the fracture occurred. The dog belonged to a girl who worked for me. This girl was a bright, good looking girl, who was in a poor marriage. She was in love with this dog, he was probably her closest friend in the world. She had no money. She cried when we looked at the x-rays. The x-rays were probably identical to the first case, but no bullet.”

“So you don’t have many options at this point,” the Professor said.

“Very much between a rock and a hard place,” I said. “I tell her, I cannot repair this surgically. She says there is no way she can pay for a referral; her husband would kill her, she says. I guess I believed that was probably more true that I wanted to know.”

“So you put this leg in a Thomas Splint,” the Professor said.

“We discussed options rationally,” I said. “She was done crying. I said the best option of sending her for surgery was not an option, so what else can we do. Number one, we can cut the leg off, she will do okay without the leg. This girl agreed, but wanted to hear the other options. Number two, we can put her to sleep. There were more tears now, she didn’t want to talk about doing that. Then number three, we can put the leg in a splint. She thought there is no way this fracture was going heal in a splint. I teach my help well. So I say that when a splint works, it works well. If it doesn’t work, which that is a possibility with a fracture like this, then we can fall back on the amputation.”

“So you put the leg in a Thomas Splint,” the Professor said again.

“Yes, I put the leg in a Thomas Splint,” I said. “I checked the leg weekly, only because she worked for me and it was easy to do. At 8 weeks, the leg was healed. I left it in the splint of another 2 weeks, just for insurance. The leg was straight and functional. The bone was thickened with a lot of callus formation. The girl was ecstatic. I think I charged her only for the expendables which came to far less than $100. The leg healed better that the leg on the Malamute and in much less time and with much less trouble.”

“So you think we should put all these orthopedic surgeons out of business,” the Professor.

“I never said that at all,” I said. “But I think for him to stand up there a say that he hasn’t used a Thomas Splint in 25 years is condescending. The Thomas splint has fixed more fractures in years past, than he ever will. And in veterinary medicine today, there is still a place for it.”

“You make a good point,” the Professor said. “When we came in here, I thought I was going have a lesson to teach you. I apologize, I think it was the other way around.”

Photo by Product on Unsplash.

Link to Thomas Splint: https://images.app.goo.gl/jVCjHjzwTCw9NZXU8

A Bear in the Backyard

D. E. Larsen, DVM

Odie, our Chesapeake Bay Retriever, stepped out the door onto the covered patio. His nose in the air, he sniffed the air. He made a muffled “woof,” he knew the bear was there, he stood watchfully, waiting.

I noticed Odie’s behavior. It was quite different than his usual bold bounce into the yard with a loud bark, announcing his dominance over his domain.

I looked, scanning the tree line of tall firs across the yard. Seeing nothing, I opened the door to speak with Odie. Just then, the hackles on his back stood up. I looked again, and there stood a large black bear at the edge of the trees. 

“Odie!” I said. “Get in here.”

The last thing I needed was to have Odie tangle with a bear. 

Odie came back into the house, and from behind the closed patio door, barked loudly and jumped at the door, banging his nose on the glass.

“Aw, your brave from this side of the glass,” I said.

Odie wagged his tail. I swear he knows every word I say.

Unknown to us, Oregon Department of Fish and Wildlife had captured a pair of problem bears who were in the yards of Corvallis area residents. They had planned to transport them to the upper reaches of Quartsville Creek, and release them there. Their plans were squashed with a heavy snowfall overnight. In their view, their only option was to release them onto some timberland on the Eastern edge of Sweet Home. It only took a few days for our bear to establish his territory in our backyard.   

Living near the top of a hill on the Eastern edge of town, we were used the having a wide assortment of wildlife in our backyard. Deer were a constant fixture, along with raccoons, wild turkeys, and an occasional cougar passing through. But a resident bear was cause for both alarm and a change in lifestyle.

Odie could cope fine. And he was a good signal as to how close the bear was to the yard. If Odie was cautious and quiet, the bear was close at hand. If he was loud and boisterous, the bear was off bothering one of the neighbors.

The cats were another story. We kept the cats indoors at all times. The exception was Charlie, our avid hunter, who insisted on being out most of the day and also most of the night. The other exception was the old feral tomcat who had adopted our backyard. He would have nothing to do with the house.

We were able to get along pretty well. The kids stayed inside most of the time. They only had to hear a few stories of people being mauled by a bear to convince them it was essential to give this bear a wide berth. I moved my rifle out from the gun safe and propped it in the corner by the patio door.

“I don’t know what is more dangerous, the bear or your rifle propped in the corner?” Sandy said.

“When I was growing up, there was a rifle and a shotgun in every house I knew,” I said. “Kids knew it was not safe for them to touch a gun. So you just need to have a little lesson for the kids.”

Then, one Saturday afternoon, the neighbor called.

“Dave, this is Herb, can you come over for a minute? The bear is my utility shed.”

Herb lived next door in a modular home. He had a deck on one end of the house, and small storage shed attached to the deck.

I went over to Herb’s, avoiding the shed, I went in the front door. I had no more than arrived when the bear drags a 40-pound bag of dog food out of the shed.

Here is the bear, sitting on the steps leading up to the deck, legs crossed with the bag of dog food between his hind legs. He was scooping dog food out of the bag with his front paws and eating it like someone eating popcorn at the theater. 

“What should we do?” Herb asked.

“In my opinion, my professional opinion, when a wild animal begins to display behavior that is unlike anything wild, it is time to shot him,” I said. “We can’t have him rummaging around inside of sheds and garages. Next time it will be a house. Maybe we should call the state police.”

Herb calls the state police.

“They say not to shot him,” Herb says. “They said to make a loud noise and scare him off.”

“A loud noise, like what my rifle makes?” I asked.

“I have some firecrackers,” Herb says. “An M80 should make a loud enough noise.”

“That should be enough noise to make him jump,” I said.

Herb retrieved an M80 and opened the back door. The bear was still sitting there, eating his dog food popcorn, without a care in the world, utterly oblivious to us. Herb lit the firecracker and tossed it toward the bear. It landed on the deck, only a few inches from the bear’s butt.

“Crack!” The firecracker explodes. In a blink of the eye, that bear was 20 feet up a fir tree located 30 feet from the deck.  Had he came in our direction, he would have been on top of us before we had a chance to move.

After this event, I called the state police game officer, myself. I had spoken with him on other occasions. 

“This is Dr. Larsen,” I said. “I am one of the families up on 50th Avenue who is dealing with this bear in our back yards. He is starting to rummage through sheds and garages. In my professional opinion, I think it is time to shot him before someone walks in on him and gets mauled.”

“I am not going to give you permission to shot him if that is what you are asking,” the officer said.

“I am not asking for permission, I am telling you what I am going to do,” I said. “I am okay with letting a judge decide how valid my professional opinion should be considered.”

“Give me a day or two, and I will have the Fish and Game guys get up there and recapture the bear,” the officer said.

“I will give those days unless I find him inside a building again,” I said.

It took a few days, and they recaptured the bear. The second bear had been causing similar problems over on a hill on the other side of Wiley Creek. They captured him at the same time. I was told that because of the heavy snow still in the high country, they released both bears out in the middle of the valley.

It was only a few weeks later when there was a story in the newspaper. Both bears had moved into Junction City and were causing havoc. The Fish and Game people had to shoot both bears.

A Summer Evening on Strychnine

D. E. Larsen, DVM

Bill was brief and to the point on the phone. “I have a dog here who seems to be having a short seizure every few minutes,” Bill said. “We were wondering if you could get a look at him?”

“I have only been in town a couple of days, and I don’t have all my stuff,” I replied. “Does he have a history of seizures, or is this a new thing.”

“There is a bunch of kids here today,” Bill said. “They have been running all over the hills. One of the girls thinks he has been poisoned.”

  The sun was down, and the twilight was fading when I pulled into Bill’s driveway. It looked like a large group gathered on the front lawn of the farmhouse. Guys and gals all about high school age or a little older. A young liver and white Springer Spaniel was in the middle of the group. He was quiet, but immediately seizures when I closed the car door.

Dixie, a young blond, hovered over Max. The others showed little concern. 

“He has been getting worse, almost by the minute,” Dixie said. “He got into something down by the road, along the fence line. I think it must have been poison.”

“Was there an old deer carcass down there, or anything like that,” I said. “Sometimes, dogs can get pretty toxic from a belly full of rotten meat.”

“No, we stopped and looked,” Dixie said. “We couldn’t find anything.”

The guys were throwing a football, and it bounced past us. Max’s legs stiffened, and he stood like a sawhorse for a moment before falling onto his right side. All four of his legs were extended and shaking, and his head pulled back over his shoulders. His entire body was stiff, with every muscle contracted. His respiration was only is short, rapid, inefficient little puffs of air.

“This looks like strychnine,” I said. “Try not to stimulate him, I will get an injection for him.”

The bag that I carried was limited at this point. My pharmacy supplies were still arriving daily. I did have some Pentathol, which I mixed rapidly, with sterile water.

Max relaxed when the first few millimeters were in his vein. I continued the injection until he was completely relaxed and breathing comfortably. Then I placed an IV catheter in his front leg, capped it, and taped in securely in place.

“Strychnine kills when these convulsive seizures eventually cause respiratory paralysis,” I explained. “At this point, we need to keep Max quiet, in a darkened room and sedated.”

“How long does this injection last?” Dixie asked.

“Not long enough,” I said. “It is best to use some pentobarbital. It is longer lasting, but it is no longer available to veterinarians. This stuff is about the same, but shorter duration. It does accumulate, so with each dose, the duration is longer.”

Bill was standing over us now. “What are we going to do with him now?” Bill asked. “I’m not going to sit up with him all night. And I wouldn’t know how much of that stuff to give him.”

“I am without a clinic,” I said. “Right now, we are house hunting, and we are in a two-bedroom apartment with a baby and 3 other kids. And no pets are allowed. But I guess Max is a patient, not a pet. I can take him home with me and keep him sedated tonight. If I give you a call in the morning, can you come by and pick him up?”

“I am an early riser,” Bill said. “You give me a call, and I will run right in and get him. You sound like your pretty sure he is going to be alright.”

“You want me to be honest?” I said. “The only time I have seen strychnine toxicity was in a lab in school. There is not much to do unless you get to them early. At this stage, there is no way I can give oral medication. It is just a matter of keeping him sedated until things wear off. He will look a little hungover in the morning, but other than that, he should be good to go.”

“When I talked with Stan at the feed store, he said you seemed to be a straight shooter,” Bill said. “I like it when a guy is honest, even if it is not to his benefit.”

I gave Max a small second dose of Pentathol before loading him in the back of our station wagon. He was still asleep when I carried him into the apartment.

“Where are you going to put him?” Sandy asked.

We were bursting at the seams. The three girls are in one bedroom, and Derek, who is a couple of months old, is in our bedroom in a small crib. I bedded Max down in the bathtub. I would be up hourly for the first half of the night. Then I could probably stretch the checks out a little. With the darkened room and quiet environment, he probably won’t need too much more Pentathol tonight.

In the morning, Max was awake. Like I had told Bill, he looked like he had been out drinking all night. I offered him a small bowl of water from  Sandy’s best dishes. He lapped in it up and was looking for more. I gave him another bowl before I called Bill.

“Bill, Max is awake and doing well,” I said into the phone. “You can pick him up at any time. We probably are not going anywhere this morning, but the girls will be up shortly, and they will want to keep him if he stays around too long.”

“I’ll be right in,” Bill said. “His kennel mate is sort of acting lost this morning.”

The girls were up, and they squealed when they found a dog in the bathtub. 

“No, he is not ours, and you can’t keep him,” I explained.

Max was licking hands and faces, I think he enjoyed the attention but was looking for a bite to eat also.  

“Can I give him some cereal for breakfast?” Brenda asked.

“You can just give him a small handful,” I said. “His stomach is probably a little upset right now.”

Bill knock at the door was a welcome sound.

“Good morning,” I said as I opened the door. “Max is going to be happy to see you, I think. He hasn’t quite figured out where all these little girls have come from yet.”

“He likes kids, always has,” Bill said. “Is he walking, or do I need to carry him?” 

“I haven’t had him up, but when the girls got up, he really perked up,” I said. “I am pretty sure he will walk out of here. Did you bring a leash?”

“He wouldn’t know what a leash was,” Bill said. “He will just follow me.”

We stepped to the bathroom door, and Max looked up and jumped out of the tub in an instant.

“Come on, Max,” Bill said as he handed me a check. “Thanks a lot, we are happy to see you in town. Let’s go home, Max.” 

Max’s tail stump was going a hundred miles an hour as he crowded to get through the door ahead of Bill. Bill smiled and chuckled, something I would learn was characteristic for him.

In the following year, Dixie would come to work with us. She was our most stable employee, working on and off for over over 30 years.

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