The Ugly Pinna Hematoma 

D. E. Larsen, DVM

Sandy came back and leaned through the surgery room doorway.

“Kevin is on his way to the clinic,” Sandy said. “I tried to slow him down, but he was pretty excited. Finn, his cow dog, has a hematoma on his ear. I told him you were still in surgery, but he said he would come and wait.”

“He thinks a lot of Finn,” I said. “I am almost done here, so he won’t have to wait long.”

I quickened my pace, and I was putting the last skin sutures in this cat spay when I heard Kevin come through the front door.

“Go ahead and get Kevin into an exam room and get Finn’s vitals,” I told Dixie. “I will finish here, and I should be there before you’re done.”

When I got to the exam room, Dixie and just finished with Finn. Finn was standing on the table, wagging the almost stub of a tail. He didn’t have a care in the world. 

I expected to see a grossly swollen ear flap, but I could only see a slight bend on the right ear tip.

“What’s going on with Finn today?” I asked Kevin as I pulled off my surgery gloves and extended a hand.

“He has a hematoma on that right ear tip,” Kevin said, pointing to the bent ear tip. “I had a dog years ago with one that started like this, and I let it go a couple of days, and the whole damn ear filled up with blood. It was a hell of a mess healing up, and that ear flap was wrinkled and ugly for the rest of his life.”

“Yes, these things can be a mess sometimes,” I said. “Especially if they are a few days old.”

“When they repaired the one on that old dog, they made a big slice down the middle of the ear flap and then sutured the whole thing like a quilt,” Kevin said. “It seemed like it took forever to heal.”

“This is one of those repairs that if you go to the book, there are a couple of ways to do it, and that slice is one of them,” I said. “That is how I was taught in school. But when you start reading the literature, there are many ways to do the job. When you see that happen, it is because everyone is looking for a better way. I have changed the way I repair those large hematomas. I still suture them like a quilt, but instead of one big slice, I take a number of punches out of the skin with a biopsy punch. That seems to heal a lot better than the old slice.”

“What do you think about this little one?” Kevin asked.

“These things are snap,” I said. “I don’t suture these at all. Depending on what caused the hematoma, I don’t even use general anesthesia if the ear canal is not infected. I usually just clip the tip of the ear, inject a little lidocaine for local anesthesia and take one punch with a four-millimeter biopsy punch right at the tip of the ear. Then I place a Dr. Larson’s Teat Tube into that hole made by the biopsy punch. This teat tube is self-retaining, but I usually place a single suture to secure it in place. Then I wrap the ear and the head, so the flap is held down.”

“And then I would suppose you will use one of those cone things,” Kevin said.

“I rarely use those things,” I said. “They just make you and Finn miserable. I maybe use a half dozen a year. A few things need them, but most of the time, they are more trouble than they are worth.”

“I suppose you get a cut out of using the teat tube,” Kevin said.

“I wish,” I said. “I different Dr. Larson. It has been on the market for a long time. They are useful in cows for many things, but they also work great in this situation.”

“When can you do this?” Kevin asked.

“Let’s go back to the treatment area right now,” I said. “This isn’t going to take very long, and Finn will go home with you.”

I looked into Finn’s ear with an otoscope to make sure there was no problem there. Finding a normal ear canal, I wondered what caused this hematoma.

“What do you think happened to this ear?” I asked.

“We worked a bunch of heifers yesterday,” Kevin said. “You know these dogs, they work the cows hard when they are in the corral. I would guess that he got kicked or something.”

Back on the treatment table, we clipped Finn’s ear flap and prepped it with Betadine surgical scrub. I injected the skin where I planned to take the punch of skin with some lidocaine and then injected the remainder of the lidocaine in the syringe into the hematoma.

After waiting a brief time, I took a four-millimeter biopsy punch and made a neat hole at the tip of the pinna. Fresh blood spurted from the hole, and I squeezed the hematoma and expressed some clot material from the hole. 

Then I inserted the teat tube, so the retaining prongs were inside the hematoma and removed the screw top from the tube.

“I have done these without any sutures, but I find they stay a little better if I just take one suture around the neck of this tube and tie it to the skin,” I explained to Kevin as I worked.

I placed the suture using fine stainless steel suture material. Then I put a pressure wrap on the ear flap and wrapped it to Finn’s head so he wouldn’t flap his ears.

“Let me see Finn next week, and we will take things off,” I said. “He should be good to go at that time.”

Finn looked a little funny heading out the door, but he and Kevin were happy to go home.

We unwrapped Finn’s ear the following week, and the hematoma looked resolved.

“Let’s leave it unwrapped, and I will leave that tube in place for a few more days,” I said. “Just to see that Finn isn’t flapping that ear a bunch.”

“This has been so much easier than the last one,” Kevin said. “I will bring him back in three days.

“This one was easier because we did it much sooner,” I said. “This teat tube thing doesn’t work well on a large hematoma. Mainly because you can’t get all the clot material out of the wound. That clot material causes these ears to crinkle up like with your last dog.”

Three days later, I removed the teat tube, and Finn’s ear healed to its normal appearance.

Photo by Jaxon Castellan on Pexels.

My First Ski Trip 

D. E. Larsen, DVM

The Harz Mountains were located not far to the south of Schöningen, where I lived in the Army in Germany. They were not tall mountains like in southern Germany, but they had some ski resorts.

Our group from the maintenance shop was at dinner in Braunschweig. We would occasionally gather for a meal at a large Chinese restaurant in the middle of town.

“I have to leave early tonight,” Burger said. “Milstid and I are going skiing in the morning.”

“Skiing,” I said. “Where do you find enough snow to ski around here this time of the year.”

“They have one hill open this weekend at the Harz mountains,” Burger said. “It’s artificial snow, but it’s good to practice on before we get some real snow next month.”

“You ought to come along, Larsen,” Milstid said. 

“I have never been on a pair of skis,” I said. “Besides, I don’t have any equipment.”

“There’s a ski shop right across the street,” Burger said. “They could get you outfitted in no time.”

I took another drink from my liter mug of beer and gave it some thought. Money was no object to us. Wobeck, our outstation, had been on TDY pay for the entire year, and we lived like kings. I carried five hundred dollars in my pocket all the time.

“Come on, let’s run over there right now and make sure they can get you bindings installed tonight,” Milstid said.

I downed the remainder of my liter of beer and stood up, signaling I was ready. I had no idea what this ski adventure would involve.

A small group of us crossed the busy street and entered the shop. The sales lady spoke a little English, and Milstid and I spoke a little German. Beurger’s German was pretty good.

“This guy is going skiing in the morning if you can get him outfitted this evening,” Burger said in German.

“What do you need?” the sales lady asked.

“Everything,” Burger said. “Skis, bindings, poles, boots, ski pants, jacket, gloves, and hat.

“That is a lot of stuff. How are you going to pay for it?” she asked.

“Deutsche Marks,” Burger said. He turned to me and asked. “Do you have enough marks on you?”

“How much are we going to spend?” I asked. 

The sales lady answered without needing a translation. “This stuff will cost between one thousand and fifteen hundred marks.”

“I think I have two thousand marks in my pocket,” I said. “I was hoping to have some left for tomorrow.”

“He is just beginning,” Burger said. “He wants a good set of skis but doesn’t need the best skis on the rack. Are you going to be able to mount the bindings tonight? If not, there is no reason for us to buy anything.”

“Let me check with the guys in the back,” the lady said as she scurried off to the shop in the back.

“She was probably pricing things thinking she could sell you the best skis,” Burger said. “We will be under a thousand marks if we go down a notch on the skis.”

The lady came back, looking a little rushed.  

“Yes, they can do the bindings, but let’s pick out the skis, boots, and bindings first, so they can get started,” she said.

With Burger’s help, they picked out things and fitted my ski boots quickly. The guy from the back shop came out and ensured everything was ready.

“It won’t take long,” he said.

While the bindings were being screwed on the skis, we picked out all the other stuff. I thought I was set with pants, a jacket, gloves, and a hat. 

“You need heavy socks for those boots, or your feet will freeze,” the lady said.

“And you better buy a pair of good long johns,” Milstid said. “Otherwise, you will wear those Army ones, and they itch when you get sweaty.”

The bill was just short of twelve hundred marks when everything was totaled up. At four marks to the dollar, just under three hundred dollars. Almost pocket change to me in those days.

We loaded everything in the car, stopped at the bar several doors down the street, visited with the Norwegian twins, and had another beer. 

“Now we need to get home and adjust those bindings,” Milstid said. “And then we need to get some sleep. Burger is serious about his skiing, and he plans to leave before seven.”

We got back to Schöningen, and Milstid laid the skis out in the middle of his apartment, put the boots in the bindings, and started adjusting. Then he had me put the boots on and stand up on the skis.

So, here I am, standing, clamped into a pair of skis in a small apartment.

“Now fall over,” Milstid instructed.

“Fall over. What the hell are you talking about?” I asked.

“Just fall, forward would be best,” Milstid said. “I need to see if these bindings are adjusted right.”

“If they aren’t, I will probably break my leg,” I said.

“No, not here, but on the ski slope, maybe,” Milstid said.

I fell forward, catching myself with my hands before my nose hit the ends of the skis. The bindings popped at the right time.

“Good, we are ready to go,” Milstid said. “We will be by your place at seven.”

When we arrived at the ski area, there was no snow in the parking lot.

“It is not looking so good for snow,” I said.

“They have been making snow on one slope,” Burger said, pointing up the hill to where a group of people was waiting for the rope tow.

We loaded up, and I threw my skis over my shoulder like I knew what I was doing, and we headed out.

“I guess we want you to start with the snow plow,” Milstid said. “If you get that down, we will give you some other moves.”

We got to the slope. It didn’t look like snow to me. It looked like ice. They had a couple of a row of irrigation sprinklers on each side of this short slope with a big bend in the middle, and the entire area was covered in ice. It was a little crunchy under your feet, but it was ice.

We put our skis on. I slipped a little but didn’t fall. 

“Okay, this is how you snow plow,” Milstid says as he positions his skis with the points touching. “You do this to turn right and this to turn left.”

“Now we are going up to the top of the slope on this rope tow,” Burger said. “The only thing you need to remember, once you grab that rope, don’t let go. It doesn’t matter what happens. Just don’t let go!”

The line was moving pretty well now, and I could walk on my skis with the help of my poles. I watched the people ahead of me. They would grab the rope, flex their knees and take off up the hill. Looked like a piece of cake.

Pretty soon, it was my turn to grab the rope. I grabbed it with both hands, and my ski poles dangled from my wrists. The rope immediately pulled me off my feet. 

“Don’t let go. It doesn’t matter what happens,” Burger’s last words rang in my ears. “Just don’t let go!”

I hung on. I struggled to get a better grip, almost stabbing myself with a ski pole. My skis bounded along as I tried to get my feet under me. I finally got my left arm over the rope. I could hear the muffled laughter coming from the group behind me. With my arm over the rope, I made one pull to right myself. I planted my left ski under me, stood up, and placed the right ski beside the left. It looked like I knew just what I was doing. 

A roar came up behind me as everyone was amazed that I had regained my feet halfway up the tow. Everyone was clapping and laughing at the same time.

When I reached the top of the tow, I pushed myself off with my ski poles, brushed myself off, and waited for Milstid and Burger.

They both arrived with broad smiles. Milstid repeated his demonstration of the snow plow, and then off they went down the slope like old pros. 

I inched myself over to the edge of the slope. I could see some people struggling on the hill, but most people were handling the ice just fine. 

This slope was steep at the start and leveled out some as it made a wide sweeping turn to the left. I took a deep breath and pushed off with my poles. I covered the steep area much faster than expected. I positioned my skis in the snow plow, easily turned to the right, and quickly came to the ice’s edge. Milstid hadn’t said anything about stopping. I bounced over the edge of the ice and came to a stop on the grass.

I got turned around just in time to see Milstid and Burger zoom past on their second trip down the hill. I walked back onto the ice. I made another loop, skiing out onto the slope and making a right turn back to the edge. I tried harder to stop this time and promptly fell on my butt. But I did come to a stop.

It soon became apparent that I could turn to the right just fine, but I had trouble turning to the left. I waited for an opening in the traffic and skied across the slope to the left side, making some progress at getting down the hill. One more time, crossing the slope to the right side. From here, the hill was much gentler, and I could go in a straight line all the way to the bottom.

I waited for Burger and Milstid.

“Hey, Guys,” I said. “I need a little more instruction.”

They spent a few minutes and made sure I had both turns down and could stop. Then I followed them to the rope tow.

“I think I have this thing figured out,” I said. “It won’t take me by surprise again.”

I grabbed the rope and sailed to the top without incident. The person ahead of me on the rope tow was a kid about eight years old. We came off the tow and slid toward the edge of the slope. I stopped beside him. He looked at me and smiled, probably recognizing me from my earlier performance on the rope. 

The kid pushed off and went down the slope almost as well as Burger and Milstid. I took a breath and followed. I was going very fast and made it all the way to the sweeping left turn. I was still going straight and ended up in a pile in the grass on the right side of the slope. 

“Last time I will follow a kid,” I thought to myself.

I improved on each trip down the hill. By the end of the day, I was bruised and tired, but I could almost make the left turn in the slope and was a master at the rope tow. Things got better when we got to some real snow, but I don’t think I was ever as good as that eight-year-old kid.

Photo by Paul H on Pexels.

A Shot in the Dark, From the Archives

D. E. Larsen, DVM

The phone jarred me awake, it took a moment to orientate myself. I glanced at the clock, 3:00 AM. I sat up on the edge of the bed and shiver a bit as the chill of the bedroom air hits me.  I picked up the phone.

It was Jack, “Good morning, he said, I have a call, a downed cow with a uterine prolapse. I would like you to come along so I can show you how we do things. I’ll pick you up in a few minutes.”

I sprang up, pulled on my pants with a quickening heart rate. This was exciting stuff for a new graduate. This was my very first emergency call, and I could hardly contain my excitement.

I had finished vet school 3 months ahead of most of my class due to a new schedule at Colorado State University College of Veterinary Medicine. They had divided the class into 4 groups, each group took their quarter break at different times in the school year. My group had Spring Quarter off. 

Sandy and I had 3 kids, and at this time, we were close to being broke. I got a temporary license and went to work. This was Wednesday night, actually Thursday morning, of my first week in a professional position.

I was a little surprised at my excitement. I was no kid, I was 30 years old. I had spent 4 years in the Army Security Agency. Mostly at top-secret border sites in South Korea and Germany. I had been through some exciting and tense times. I had regularly briefed generals who visited the locations. I had been in the middle of the scramble for intelligence during the Russian invasion of Czechoslovakia. And here I am,  excited about going out at 3:00 in the morning to look at a sick cow.

Jack was a big man. I considered him an old man. He had been in practice for over 30 years, graduating from Washington State in 1943. He must have been all of 57 years old. 

Jack lived only a few blocks away, but I was dressed and waiting when he pulled up in the truck. The cow was at Fred’s place, only about a mile out of town.  

It is common for a dairy cow to get milk fever around calving time. It results from low blood calcium levels due to a delay in mobilizing calcium from the bones to meet the demand of milk production. Most of the time, it is rapidly progressive, and the cow will be down and unable to rise. If not treated promptly, it will result in death. The uterus can prolapse with or without milk fever.

We pulled into the barnyard. Cows were lined up for the morning milking, and the milker was busy in the parlor. We walked through the loafing shed and found the cow flat out in the straw and manure.  Her uterus was completely everted on the straw. The cow was comatose, suffering from advanced milk fever and probably compounded from shock associated with the uterine prolapse.

I started to collect some vitals on the cow, laying my stethoscope on her chest.

“Looks like we’re going to need some help with this one.” Jack says. He has already seen all he needs to see for his diagnosis. I tuck my stethoscope back inside my coveralls as Jack starts toward the milking parlor.

“We need some help with this cow.” Jack says to Charlie, the milker. “We will need the tractor with the frontend loader.”

“I can’t help, Fred is particular about milking time.” Charlie replied. “You need to get the hired man up to help. He lives in that small house across the barnyard.”

I follow Jack across the barnyard to the hired man’s house. I feel a little like I did in school, following some doctor around waiting to learn something but nothing really to do with yourself otherwise.

Jack knocks hard on the door of the little house.

“Who’s there?” The hired man calls out from inside the house. A light comes on.

“This is Doc,” Jack replies in a loud voice, leaning into the door to make sure he is heard. “We’re here to take care of a cow down with a prolapsed uterus.  We need you to get up and give us a hand.”

There is a short pause.

“I don’t get up at 3:00 in the morning for no damn cow,” the hired man replies. The light goes out.

Jack’s face reddens and he leans into the closed door, almost pressing his forehead into the door. 

“I don’t get up at 3:00 in the morning either if I don’t get any help!” Jack booms at the door.

There is no reply from inside the small house. Jack turns and steps past me, almost brushing me aside. He walks briskly to the truck. I follow, not sure what is next. Jack pulls open the door, reaches under the seat and pulls out a pistol, checks the clip, and chambers a shell. He heads back across the barnyard.

Jack finally calms himself enough to talk. 

“No reason for the cow to suffer because of that lazy bastard.”  

Jack places the gun against the back of her head and pulls the trigger. The cow stiffens and is gone.

”At least she won’t suffer any longer.” Jack says as he heads back to the truck. 

We drive home without talking. Jack drops me in front of the house.

“See you in the morning.” He says as he pulls away.  

Photo by Corinna Widmer from Pexels

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