The Needle in the Brier Patch

D. E. Larsen, DVM

It was hard to see in the night with this heavy rain. I was glad that I had put my rain pants and boots on when I left the house.  I pulled on my raincoat as I stepped out of the truck.  I was wet before I got the jacket on, the rain was drenching. I peered at a blank wall of small fir trees and brush. Ayers McElfresh had said to come to this corner of his place when he called this morning. 

Finally, I could see two shadowy figures move out from under a fir tree.  They were hunched, in heavy rain gear and wide brim hats.  Sort of looked like a scene out of a Jesse James movie.  

The phone had shocked me awake from a sound sleep, the clock said 3:00 AM. It was Ayers on the phone. Ayers McElfresh was an old logger with a small farm on Scott Mountain. He had lost an eye in the woods, and I always had trouble making eye contact with his good eye rather than his glass eye.

“Doc, I have a cow down up on the hill, she is in bad shape.  Glenn Hill and I have been looking for her all night.”  I hung up the phone and pulled myself out of bed and quickly dressed. The truck was cold at first but started to warm as I headed down the hill to the highway through Sweet Home.

The rain seemed heavier as I turned up Scott Mountain Road.  Ayers had reminded me not to come to the house. “They would meet me at the upper corner of his place.  The cow was close to that corner.”  I slowed the truck as I turned the corner, straining through the night and heavy rain to get a glimpse of Ayers.  There they were, a couple of shadowy figures moving out from under a large tree. Dressed in rain gear and both wearing wide brim hats, they looked like something out of a Jesse James movie.

I waved as I stepped around the back of the truck.  Ayers and Glenn Hill, a neighbor, both waved back.  “Bring your stuff, and we will spread the wire so you can get through the fence.”

Spreading the fence wire for me was quite an honor. My grandfather would have tanned our hides if he had seen any of us kids stretching the fence wire when we were growing up.

“This is that half Holstein cow.  I raised her from a calf.  She is about 5 or 6 years old.  Calved yesterday, we have been looking for her all night.  She rolled down the hill into a big old patch of Himalayan berry vines.  One hell of a fix, she is flat out Doc.”

I grabbed the bucket filled with supplies and headed across the ditch full of runoff and ducked through the barbed wire that Ayers and Glenn were holding apart for me.  I peered into the tunnel in the brier patch.  Ayers shined his flashlight down into the tunnel, maybe 30 feet down the hill, you could see the cow.  She was lucky her head was uphill, probably why she was still alive.

“How the hell did you find her?” I asked.

“Let me tell you, it wasn’t easy.”  “We looked all night in this damn rain, almost gave up but finally worked our way up to this corner.  Glenn is the one who noticed this hole in the brush.  I was surprised to see her down there.” 

With a deep breath, I squatted down, and sort of duck walked down the tunnel of briers to the cow.   Her head was up, allowing the rumen gas to escape.  If it were downhill, she would be dead already.  

    The rain clothes provided protection from more than constant rain.  There was minimal room, and every stray movement was met with a tangle of berry vines.  My exam was very cursory.  I had already made my diagnosis of milk fever, I just wanted to make sure I wasn’t going to miss something obvious.  

    The temperature was low, 98°,  her udder normal, no vaginal discharge, rectal exam shows firm dry stool.  All this was consistent with the diagnosis.  Response to treatment will be the last confirmation.

    I grasped the nostrils with the nose tongs and pulled her head back, tying the tongs to the hock with a quick release knot.  I opened a bottle of Cal Dextro2 and secured the IV set to the top.  Everything was sterile, but that was sort of joke at this point.  The rain was still heavy, but the vines caught the downpour and converted it to large heavy drops.  Mud and rain, couldn’t keep things clean.  

    I took the needle out of the autoclaved pouch and leaned against her neck to further stabilize her.  Holding the jugular vein with my left hand, needle in my right hand, held by thumb and forefinger.  I struck the jugular with the heel of my right hand twice in a rapid motion and then turned my hand and seated the needle into the vein on the third stroke.  Releasing my grip on the needle as it passed through the skin kept it from piercing through the vein.  Then I quickly threaded it down the vein.  I learned this technique when I worked in the feedlots while in school.

    Hooking the IV set to the needle, I started the infusion at a rapid rate for the first bottle.  Giving it too fast could cause a cardiac arrest (dead cow).  Seldom happened to a cow this far advanced, her blood calcium could be below 4.0. 

    I leaned back and rested a little, looked at Ayers.  He was concerned, hadn’t said a word, just held the flashlight and watched.

    “Milk fever!” I said.  “Not an uncommon condition in older dairy cows.  She would have been dead in the morning, good thing you found her.”

    “Is she going be okay?”

    “I think you will be surprised.  Might take a couple of bottles here and a little time but there is a good chance she will walk out of here.”

    When the first bottle was done, she was a little more alert but not struggling against the restraint.  I started the second bottle a little slower.  I couldn’t decide what was worse, the torrential downpour or the constant large drops.  

    By the time the second bottle was done, she was struggling against the nose tongs.  I pulled the needle out and put everything back into the bucket.  I moved around to her side and pulled the free end of the rope, this released her nose.  Her head swung around and almost knocked me down.  I was able to pull the nose tongs out of her nose.  She kicked and righted herself to her sternum.  Then in one motion, sprung to her feet and raced up the hill and out the tunnel.  Glenn who was watching from the entrance had to jump out of her way.  Ayers went flying one direction, and I went the other.  The bucket and its contents were scattered.

When I got off my back, Ayers was still unhooking himself from the briers. 

    “Damn glad I was dressed for the rain.”  He said as he gathered the light and started to give me a hand.

    I grabbed the bucket, a little bent now, and started putting things back into it.  Everything was there, except the needle.  Before me was a mire of mud, cow tracks, and footprints.  I swept my hands across the wet ground.     

    “What are you looking for? 

    “I lost the needle.  Should be here somewhere.”

    Ayers helped me look for a minute or so then looked at me with his one good eye and asked, “Is it valuable?” His eyebrow over his good eye raised up a little for emphasis.

    “No, not valuable, just not the kind of thing you don’t want to leave behind.”

    “Look Doc, it’s 3:00 in the damn morning, raining like hell.  Here we are in the middle of large brier patch at the far corner of my place.  There isn’t going to be anybody in here for the next 100 years.  Just leave it.”

    Made sense to me, besides I had a full day ahead of me.  So I left the needle.  We crawled up the tunnel and into the drenching rain.  It felt good to stand up straight again.

    Glenn was still standing there, looking somewhat like a drowned rat.  “That was some show.  What did you give her Doc?  I might need some of that stuff.” 

    I crawled back through the fence and stuffed things into the truck.  I will have a chore cleaning things up in the morning.  I peeled my raincoat off, just about as wet inside as outside.  

    I pulled myself into the truck and shut the door.  Dry at last.  Will be a short night tonight, I thought as I started up the hill looking for a spot to turn around.

The sun was hot, dust stuck to the back of your throat.  It was one of those August days in the Willamette. Valley that made one wish Fall would come early.  I leaned over the low gate to get a better look at the horn on the old ram, trying not to disrupt his interest in the alfalfa in the feed rack.  Every movement stirred up more dust.

    Flies were gathered around an ugly spot on the side of his head where the tip of his horn was buried into the skin.  A full curl plus some, this old ram would be a trophy in the wild. 

    Ayers had called worried about his ram.  Arthritic enough that he probably had problems getting around to service the ewes. It was late in the day before we had been able to work him in.  The good part was I could go home after this, the sad part was it was the hottest time of the day.

      Ayers had been a little embarrassed about having me look at the old guy. 

“He probably ain’t worth the cost of the call, poor old guy probably should just put him out of his misery,”  Ayers had said when called.

    Ayers was an old logger who ran a few sheep and cows on a forty-acre ranch out in Liberty.  He had lost one eye when a broken cable had recoiled and struck him on the right side of his head.  Probably lucky that it didn’t take his head off.  Ayers was a big raw bone Scotsman, well over 6 feet with broad shoulder and a sturdy frame.  His calloused hands and course complexion told of many years of hard work and exposure to the elements.  He was tough as nails but had a soft heart when it came to his animals.  

    “Sure enough, the tip of that horn is buried in the skin.  We probably don’t want to take the whole horn off, that would be pretty hard on a ram this old.  I should be able just to trim the end and solve the problem for a couple of years”.

    “Couple of years?  This guy will be lucky to survive the winter.”

    We put a halter on the ram with a little struggle and snubbed his chin to the upper corner of the stall.  I retrieved a short piece of OB wire from my bag and threaded it around the tip of the horn.  Then I clamped a handle on each end.  Positioned the wire saw about one inch from the skin.  Leaning back to apply my weight to the wire I started long slow strokes to get the wire embedded.  At that point, I quickened the pace.  Smoke rose from the horn.  Makes the smell on the old dentist drill seems like nothing.  Only took a few seconds and the tip of the horn flew over my left shoulder as I fought to regain my balance.  Checking the horn where the tip had been, and there was no blood.  A good thing about the wire saw, the heat generated usually cauterized any vessels.  

I used a prep blade to shave the wool away from the wound.  A few maggots had already hatched and were scurrying to avoid the Betadine.  The horn had left hole almost to the bone.  It would do well after I cleaned the wound and applied Betadine ointment and Screw worm spray.  Long-acting Penicillin injection completed the treatment.  I released his head, removed the halter and opened the gate.  The ram looked at us like we were crazy, he returned to the alfalfa in the feed rack.

“This must be your last call? ”  Ayers asked, knowing full well that I wouldn’t have anything scheduled after 5:30 on a Friday afternoon.  He had asked to have a drink with him on each visit for the last 6 months.  I had always had the excuse of having more to do.  

“Yes, this is my last call today.”

“I have a new bottle of Pinch, best scotch that I know.  Come on up the house and have a drink.  You can wash up there.”

“Sure, I’ll put things away and pull the truck up there.”

Ayers was holding the door for me when I got there.  

“New bar of soap right there at the sink, a clean towel is hanging on the hook.”

After washing Ayers lead me to the dining room table.  His wife was sitting at the kitchen table and did not respond to us.  I knew that she was suffering from Alzheimer’s.  Her care had really confined Ayers in recent months.  Ayers grabbed a couple of large drinking glasses as we entered the dining room.  New bottle of Pinch was on the table.  I think he had planned this visit.  

“Just a moment, I have a new bottle of Soda, don’t want to ruin good scotch with an old bottle of Soda.”  

Ayers returned from the kitchen with ice and a new bottle of Schweppes Club Soda.  He added a few ice cubes to each glass.  Opened the Pinch and poured first 2 fingers then 3 into each glass.  Filled the glasses with Soda and sat down with a noticeable sigh.  

“Love this stuff, about the only thing I have anymore.  She doesn’t remember anything now,” nodding his head toward his wife, “makes things pretty tough.”

I wasn’t quite ready for a counseling session and never was very good at small talk.  Taking a sip of the drink, I was a little surprised that it was pretty good.  I hadn’t drunk scotch since early in my army days at Fort Devens.  This was maybe going to be easier than I thought.

“Must be difficult, do you have anybody to help?”

“Lady comes in the mornings, helps to get her up and through the bathroom and shower.  Fixes breakfast and cleans the house a little.  When she leaves she just sits there in the kitchen until bedtime.”

We continued to talk, mostly about Ayers’ early days in the woods before he lost his eye, then about the developing cataract in his only remaining eye.  Cataract surgery was advanced enough that most people when through it without a thought or worry.  It would be different if you only had one eye.  That low complication rate doesn’t mean much if you are the one with the complication.

     “Do you remember that night that you lost that needle up in that brier patch 4 or 5 years ago??”

“Do I remember?  That was quite a night, pretty hard to forget.”

    “Well, a couple of months ago I decided to clear some brush up in that corner.  Don’t know why sure don’t need any more land.  I can’t do as much as I used to do.  I was working along, and damned if I didn’t step right on that needle!  It went through the sole of my boot, through my foot and poked out the top of my boot.  Damn that hurt!  I sat down and pulled it out, that hurt like hell too.”

    “I was a real mess for a while.  Limped around for better than a week.  I was going to go to the doctor and get a tetanus shot but started to feel better, so I forgot about that.   Must have been okay, I’m still alive.  Maybe because that was a sterile needle?’

    “I don’t know, Ayers, that needle couldn’t have been too sterile, laying in the mud and dirt for the last few years.”

    “Well, no matter now.  I was the one who wanted you to leave it so I could get back to bed.”

    Not much else to say, they don’t make them like Ayers anymore.

Photo by Kids from Pexels

Mixed Marriages

D. E. Larsen, DVM

My first attempt at a little humor.

D. E. Larsen, DVM

People and families have dealt with mixed marriages for eons. The first thing that comes to mind when one brings up the topic is the marriages of mixed races. Some of the first mixed-race marriages in this country were between the Mountain Men of the early Western Frontier and their American Indian wives. Since those early days, there have been many other racial mixes. Nowadays they are just about too numerous to list. 

    Mixed marriages between individuals of different religions are also commonplace and as cultures co-mingle, these continue to increase. Christian and Jews, Catholic and Protestant, Christian and Buddhist, Christian and Muslim, Buddhist and Hindu and the lists go on, even to throw an Atheist into the mix.

    All of these mixes bother others far more than they bother the couples in the mix. The couples usually have minor accommodations to make to one another and once those are sorted out their problems are over.  As the population becomes more diverse, children of the mixed marriages have virtually none of the issues that children of mixed race or cultures had to deal with in the past.

    There are other mixes that are more difficult for couples to cope with in their daily lives. I would guess that most of these are just pushed aside by one of the partners and life goes on.

    There is a mix, however, that is virtually never discussed, either before marriage or after marriage. It is a mix that adds stress to the daily life of the involved couples and their families.  It causes untold financial expense for the family. It confuses children as to which side should they chose. It hangs over the dinner table like a thick fog every day. At lunchtime, it can start an argument, leaving the couple frustrated and feeling there is no resolution. Accommodation by one partner or the other seems impossible. Large family gatherings and Holiday meals are times of great stress.

    I tried to warn my son so he would not repeat the same mistake made by me nearly 50 years ago. But like all young people, he had to make his own mistakes.

    “How can I even bring the subject up for discussion?” He asked.

    “Just look in her damn refrigerator,” I said. “Is it Best Foods or Miracle Whip?”

PeeWee

D. E. Larsen, DVM

It was early Sunday morning when the phone rang. We were not out of bed yet. We didn’t have any firm plans for the day, but we had 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, This is Oscar. I hope I didn’t wake you up, but I wanted to catch you before you headed to go fishing or something. I bought this little wiener dog the other day. Cute little guy, he is about 6 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, we were just laying here thinking we didn’t have a thing to do on this beautiful Sunday morning.”

Otto had been in the clinic a few times. Oscar was a large man, with broad shoulders and a muscular build, white hair that 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 and calloused hands carrying a little 6-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. 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.” 

“Okay, Oscar, I will meet you at the clinic in an hour,” I said. “That will give me enough time to get up and dressed and help with breakfast for the kids.”

Oscar was waiting at the door when I pulled up to the front of 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 right 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 PeeWee,” Oscar said. “I am not sure why we got him, but he is a cute little guy, and he really likes me.”

PeeWee’s exam was unremarkable except for his discomfort. I had not been in practice too many years, but I had already learned 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, it wasn’t too big, maybe the size of my thumb,” Oscar replied.

Oscar’s hands were massive. 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.”

“Will, 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 warm up so it could be developed.

PeeWee was uncomfortable enough that he laid on the x-ray table without any restraint. I quickly snapped two views for the chest and abdomen. One lateral with him on is side and ventral-dorsal with him on his back.

Oscar and I chatted a little as we waited for the developer to reach a temperature that would be functional. I had watched Oscar at the bowling ally, 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. Endoscopes were new things in veterinary medicine in those years. It would mean a referral to a specialty clinic to even have someone try to remove it. And in the 1970s, that meant a trip to a teaching hospital either in Davis California or Pullman Washington.

“Oscar, this is a 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 setting here wonder how the hell I am going to pay you, there is no way I can go somewhere else. It is going to be fixed here, or we will just have to put the poor little guy to sleep.”

In the few years I had been in Sweet Home, I had learned that price was often a limiting factor to medical decisions. If you could fix it for a hundred dollars, that was fine. If it was going to be more, then 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 opening his 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 PeeWee 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 just 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 PeeWee in my left arm. Oscar’s hand engulfed mine, but I shook as firmly as I could. “I will do this today and give you a call when we are out of surgery. He is going to 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 that 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 surgery. I was thankful that I had the foresight when I made my equipment purchase to include a ventilator. The problem with that was the size of this patient. I was worried I would have trouble setting the volume of the breath low enough to accommodate this little guy. 

When we got going, the first part of things was pretty standard. I induced anesthesia with Pentathol 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 I could, I spread the ribs with a retractor and pushed the lung lobes aside. There was the 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 of an incision as I could. I grasped the bone with forceps, and it slipped out, expanding the small incision only slightly. 

I used a two-layer closure of the esophagus with 3-0 Maxon. Being careful to ensure the endothelial layer was securely closed. I place 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 value on the drain tube. Then I closed the chest by pulling the ribs together with two sutures of 2-0 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. 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 6-week-old Dachshund puppy. It sort of looked like a muffler on PeeWee’s side.

After a small dose of Innovar for pain, we woke up PeeWee. Waiting as long as we could before removing the endotracheal tube, just in case we had some respiratory issues. I think PeeWee felt so good with that bone out of his esophagus that he was not bothered by the pain of the chest incision.

PeeWee’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 on Monday, I was able to pull his chest tube, and we sent him home. Strict liquid diet for a week, and then it depended on the recheck. 

Oscar was a happy man when he picked him up. I cautioned him again about not feeding bones and to be strict on the liquid diet. He pulled out three hundred dollar bills from his pocket and pressed them into my hand. Never asking what the bill was going to be, he shook my hand vigorously and walked out the door with PeeWee licking his face. I was happy with the three hundred dollars.  

Photo by Dominika Roseclay on Pexels