You Can’t Make a Cow Dog out of a Hound Dog, From the Archives

D. E. Larsen, DVM

Dr. Jensen carefully placed Blue on the exam table. Blue was a growing Bluetick Coonhound. He was about 5 months old. Dr. Jensen had acquired him to replace one of his border collies that he had lost a few months ago.

“Good morning, Mark,” I said as I entered the exam room. “What’s up with Blue this morning?”

“I was driving out to the cows in the far pasture with the dogs in the back of the pickup,” Mark said. “I wasn’t going very fast, and this damn little cottontail darts across the road and into the grass. Blue makes a dive for the bunny and does about three cartwheels when he hits the ground. So he comes up carrying a hind leg. My guess is he either blew out a knee or injured his hip.”

“Did you get any x-rays?” I asked with a smile.

“I know. All you need is someone coming in with all the answers before you even get a look at the patient.”

“Let’s get at this guy. It looks like he has been growing since his last visit,” I said. Which leg is he carrying?”

“It’s his right hind leg,” Mark said. “I haven’t seen him touch it down, so it must hurt.”

“You have to watch it with those observations,” I said. “Someone might think you are a real doctor.”

Starting at Blue’s toes, I went over every bone in his foot and hock. Then, after palpating the lower leg bones, I came to his stifle.

I carefully slipped my left hand under Blue’s stifle and elevated it slightly. Blue didn’t say anything, but he lifted his head off the table and looked at me. I took his stifle in both hands and tested for a ligament tear.

“His knee is pretty stable,” I said. “It must be his hip.”

With my left hand on his hip, I moved his leg forward and back. I could feel some grinding deep in the hip joint.

“There is some crepitus in his hip,” I said. “We need to get an x-ray, but my guess is he fractured his femoral head. Most likely at the growth plate.”

“Let’s get a picture, then there will be something concrete we can discuss. I need to sedate to get a good x-ray. Do you have something to do in town, or do you want to just check back later?”

“I will run over to Mollie’s and get a cup of coffee and read the newspaper,” Mark said. “How much time do you need?”

“A half an hour should be fine,” I said. “In the off chance that you get lucky, and this is just a luxated hip, I will go ahead and replace the hip while he is sedated.”

“But you seem pretty sure this is a fracture,” Mark said.

“Blue is five months old. The growth plate in the femoral head doesn’t close until 6 months. It takes less force to fracture the grown plate than to luxate the hip. So at this age, it is almost always a fracture.”

•••

“Well, that is quite a picture, and it makes it pretty obvious,” Mark said as I put the x-ray on the viewer. “What are my options?”

“Some will say that a surgical repair is the best option, but I am not sure that I agree with that opinion,” I said. “Actually, it is a simple repair. You just reduce the misalignment and place a couple of small pins to hold in place.”

“Why the hesitancy then?” Mark asked.

“That little piece of bone that is knocked off the femoral head has a precarious blood supply. It is an easy repair, and it heals well, then in a year or two, you end up with avascular necrosis. Sort of like Bo Jackson.”

“That doesn’t sound good. Then you are looking at a new hip, I guess.”

“At this point in time, nobody that I am aware of is hip replacements in the dog,” I said. “What you end up with is a femoral head ostectomy. So I am beginning to think that we should just be doing the ostectomy from the get-go.”

“An ostectomy! You just take the femoral head off and throw it away? That sounds pretty drastic.”

“The dog has four legs. The ostectomy removes the bone to bone contact and actually works pretty good. Not perfect, but pretty good. You will always see a difference, but your neighbor never will notice.”

“What about a duck cast?” Mark asked. “That is what they do with kids.”

I gave some thought to that possibility. However, I had no idea if it would work, and I had no idea how the pup would tolerate it.

“To be honest, I doubt that it is written up anywhere,” I said.

“I don’t want to get a lot of money into this pup,” Mark said. “He might not work out well for me on the ranch. I would like to try a duck cast.”

“One problem is Blue is his rapid growth phase. Six weeks might not be a big deal in growth in a five-year-old kid, but it is a big deal in a five-month-old hound, and a cast will become constrictive. But with a little thought, I could probably fashion a spica splint that holds that right hind leg up. We might be able to make it work. And the good thing is that if it fails, we can always resort to the ostectomy.”

“Do you want me to leave Blue here now?” Mark asked.

“Yes, I should be able to get this done and have ready to go home this afternoon,” I said. “You can plan to pick him up around four or five.”

•••

It took a couple of tries, but I could get the hip in place and fashion a splint to hold his right hind leg up at a near ninety-degree angle and still be able to poop and pee. He looked a little funny, but I think it might just work.

Dr. Jensen was in the office right at four to pick up Blue.

“He looks a little funny, but this might just work,” I said. “You need to keep him restricted, and this splint needs to be clean and dry at all times.”

“I think his buddies are going to laugh at him,” Mark said.

“I want to check him every week to make sure we don’t have to adjust this for his growth,” I said. “I am really interested to see what kind of results we get.”

•••

Six weeks passed rapidly, and Blue was on the x-ray table with the splint removed. The hip had healed beautifully, and Blue was happy to have four legs under him as I lead him out front to see Mark, who was waiting anxiously.

“The x-ray looks great,” I said. “Blue should be good to go. Just take it easy for a few weeks until he has all the strength back in that leg.”

“My only problem will be keeping him in the back of the pickup when the rabbits are scurrying around in the pasture,” Mark said.

“I can tell you the real problem that you have,” I said. “You can’t make a cow dog out of a hound dog. These dogs have memories from their grandfathers buried deep in their DNA, and when that rabbit ran across the road in front of him, Blue knew he was a hound, and he gave chase.”

“Well, you might right, Doc,” Mark said. “But he is just going to have to learn his place. And thanks, Doc. Blue thanks you also.”

I followed Blue’s status for a couple of years before Dr. Jensen decided to change his status and concentrate more on his doctoring and less on the cattle market. Blue was perfectly normal on his hip as long I knew him.

Photo by Cynthia Smith on Unsplash

The First Laceration 

D. E. Larsen, DVM

As I got in my van to head to the clinic, the sun was peeking out over the eastern horizon. It looked like it was going to be another great spring day. I thought how lucky I was to have such good weather for my first weeks of practice in Enumclaw.

I entered the back door of the clinic. I was the first one in the office. When I was in the army, I learned that being the first to arrive and the last to leave always caught the attention of the supervisors, whoever they happened to be. I figured it was a good habit to keep in practice.

I went to the front counter and checked the appointment book. There were only three farm calls scheduled for the morning. The procedure was to get the planned farm calls out of the way first, then we could concentrate on the stuff in the clinic.

My name was on the appointment to castrate four bull calves. That should be an easy call, I thought.

Ann, the owner’s wife, entered the front office about then.

“I put you down to do those castrations,” Ann said. “Is that something you can handle yourself?”

This was my second week out of school, and everyone wanted to make sure I could handle everything before sending me out on my own.

“I have done a lot of castrations in school,” I said. “I shouldn’t have any problems.”

“Well, the note says bull calves,” Ann said. “But, Billie always calls everything a calf. These might be close to yearlings.”

“I shouldn’t have any problems,” I assured Ann as I started checking everything to ensure I was prepared to make the call.

It was a short drive to Billie’s place, and Billie and Sue were waiting with the calves in the crowding alley. Ann had been spot on in her assessment. These young bulls were well past weaning. They all probably weighed over six hundred pounds.

“Hi, I’m Doctor Larsen,” I said as I shook Billie’s hand. “Let’s get the first one in the chute, and we will make short work of this job.”

“I was hoping you would take this call,” Sue said. “We have heard good things about you.”

I poured some warm water into my bucket and squirted some Betadine into the water. I put my instruments in the bucket, a large forceps, scissors, the emasculator, and a scalpel with a new blade.

“You seem to be practiced at this for being a new vet,” Billie said. “You must have done this before.”

“I went to vet school in Colorado,” I said. “Castrations were a common procedure for us in school. I have done this quite a few times.”

“So, Jack usually just cuts the bottom of the sack off when he does his castrations,” Billie said. “We seem to have quite a few that have some swelling afterward.”

“On bulls this size, I like to make a cut down each side of the scrotum, do the castration, and then continue those incisions across the bottom of the scrotum,” I said. “That way, we end up with two flaps, and there is no place for fluid to accumulate. When the bottom of the scrotum is cut off, it works great on little calves, but this size, that scrotum sort of closes up too fast during the healing process, and you will see some swelling.”

That discussion put Billie at ease, and I stepped behind the first bull. I grabbed the scrotum and squeezed the testicles down tight against the skin. Then with one swipe of the scalpel, I opened the side of the scrotum, cutting into the testicle at the same time.

The bull jumped and kicked a little, hitting my right forearm. The scalpel, held in my right hand, found the heel of my thumb on my left hand, making a neat laceration a little over an inch long. Damn, that hurt.

I stood up and returned to the van. I wrapped my hand with some gauze and pulled on a surgical glove.

“Are you going to be okay with that cut?” Sue asked.

“I think so. It won’t take long to finish here,” I said. “Then I can go take care of this hand.”

“We don’t have any problem with waiting on the others,” Sue said.

“I will be okay,” I said. “But I think we will tail these guys. Let me show you what I want you to do, Billie.”

I showed Billie how to bend the bulls’ tails up over their backs, putting enough pressure on the tail to cause a bit of a nerve pinch. This helped immobilize the bull and lessened the procedure’s pain.

I finished the first bull, and the other three didn’t take much time. There was no more dancing in the chute with Billie bending their tails.

When I was done, and all the bulls were sprayed well for flies, I went to the truck and pulled off the surgery glove. It was filled with blood. I put another wrap on my hand and another glove for the drive back to the clinic.

“How did things go?” Ann asked as I walked into the clinic. “It didn’t take you very long.”

“The castrations went well, but I cut my hand a little,” I said.

Ann watched as I pulled the surgery glove off. 

“That looks like it needs to be sutured,” Ann said. “We have a busy morning, but you should go to the doctor and get that taken care of before it gets infected.”

“I think I will sew it up myself,” I said.

“Now, how can you do that with just one hand?” Ann asked.

“That won’t be a problem. The problem will be getting it injected with some lidocaine,” I said. “I’m not very good at sticking myself with a needle.”

We went into the surgery room and laid out a surgery set and suture. I drew up a dose of lidocaine in a syringe and scrubbed the laceration with Betadine. Then after several attempts, I injected some lidocaine around the cut.

Placing the sutures was no problem with my right hand. But I wished I had practiced my one-hand surgery ties a little more. But, with some help from Ann, I got the wound closed.

“That looks pretty good,” Ann said. “But what about a tetanus shot?”

“I just had one last fall,” I said. “I should be good to go.”

The rest of the day went along well. I kept my left hand gloved just to keep it clean. 

Sandy was quick to notice the glove when I got home.

“What happened to your hand?” Sandy asked.

“I cut it on my first slice of a scrotum,” I said.

“Very funny, let me look at it,” Sandy said. “Who sutured it?”

“I did it myself,” I said.

“They do have state comp insurance, you know,” Sandy said. “You should have gone to the doctor.”

“We had a busy day,” I said.

***

Sue was in the clinic a few days later to pay her bill.

“I just wanted to check on your hand,” Sue said. “And Billie wanted to let you know how pleased we were with your job. Those steers acted like nothing had happened. They had no swelling at all.”

“My hand is healing well,” I said as I held my hand for her to see.

“That looks good,” Sue said. “Who sewed that up for you? I might want to go to that doctor.”

“He did it himself,” Ann said. “Can you believe that?”

“When it happened, I thought it would be the end of the call,” Sue said. “But he just wrapped it up, put on a glove, and finished the job.”

Photo by Jonathan Borba on Unsplash.

The Shadow Knows, From the Archives

D.E. Larsen, DVM

I first met Dr. Al on a hillside up 50th Ave on the East side of Sweet Home. I was in the middle of doing a C-Section on a 15-month-old heifer who was stretched out on the ground. Dr. Al was visiting at a neighbor’s house and came out to watch. I think he was surprised at the surgery in the middle of a pasture.

“How does a little heifer like this get pregnant in the first place?” Al asked.

“If they cycle and are not separated from the bulls, the system is made to work,” I answered. “I have done this on heifers under 14 months of age.”

About now, I had entered the abdomen through an incision on the left flank. The inside of the abdomen of a cow is always sort of a mystery to MDs. Al looked on with interest as I pushed the rumen aside a brought the uterus up the incision.

“That looks pretty simple,” He said.

“All surgery is pretty simple as long as everything goes well,” I replied.

I incised the uterus and had both hind feet sticking out of the incision. I secured the feet with an OB strap and handed the strap to the owner standing behind me.

“Pull straight up and then let him down to the ground easily,” I instructed as I guided the calf out through the uterine incision.

The calf hit the ground, raised his head, and shook fluid out of his nose.

“He is going to be up before mom,” I said.

“Now, how do you close all of that?” Al asked.

“It won’t take long,” I said. “I use a single layer on the uterus with number 2 Dexon in a pattern developed by Utrecht University in the Netherlands. It closes the incision securely and does not leave any of the suture material exposed to the abdomen. That way, there is little chance for adhesions to form and less loss in future fertility. The rest is just routine abdominal closure.”

“You won’t have any infection problems?” Al asked. “I mean, you’re out here in the pasture, with only gloves on, instrument pack opened on the ground. In people, we would have a mess.”

“I never, knock on wood, have an incision infection on a C-Section,” I said. “Maybe your hospitals are the problem.”

“Ha, that might be,” Al said. “Thanks for letting me watch. It was fascinating.”

Following that meeting, Al’s family became regular clients. They had a Great Dane. Al always enjoyed sharing similarities in our professions and the differences. I think he envied the lack of regulatory restrictions I enjoyed. He often spoke of early days in practice in Colorado and how he enjoyed making house calls and having close relationships with his patients.

Great Danes never seem to live very long, and it wasn’t very long until they were in with their Dane with an enlarged breast. It had developed very rapidly, and chest x-rays showed tumors in the lungs and in the vertebra already. There was nothing we could do at the time except to provide comfort care for a short time.

It was not long after the loss of their Dane that Al’s wife Jane and a daughter brought in a new German Shepherd pup. They were going to try a new breed. German Shepherds were a breed that I was always cautious about. There are many super dogs, but there seemed to be an increasing number of screwballs.

“We have always had Great Danes, but they never seem to live very long,” Jane said. “A friend has a German Shepherd that seems to be a great dog. So anyway, here we are.”

“He is a pretty good looking pup and well behaved already,” I said. “What are you going to call him?”

“We haven’t made the decision just yet,” Jane said. “Al wants to call him Rudy, the girls and I are thinking Shadow is a better name.”

“We will write Shadow on the record,” I said. “That is how it usually works out.”

I lifted Shadow up on the exam table. For a young German Shepherd, he looked good. Both ears are erect, teeth are good, and he is responsive to the people around him. Ruth hands Shadow a tennis ball to chew on as I start with his exam.

I start at the nose and work toward the tail.

“Everything looks good,” I tell Jane as I put my stethoscope to my ears.

The lung sounds are healthy, and the heart sounds strong. I almost put my stethoscope down and then remembered to check the left anterior thorax, which I always try to remember on young pups.

My expression immediately changes. Jane, who worked alongside Al for many of his early practice years, instantly recognizes the concern on my face.

“What is it?” she asks.

“There is a machinery murmur in the left anterior thorax,” I said. “That almost always means there is a PDA, a patent ductus arteriosus. That is a vessel between the aorta and the pulmonary artery that normally closes at birth. In Shadow’s case, it did not close.”

“Does it need to be fixed, or can he live with it?” Jane asked.

“He can live with it for a short time, but when he starts his rapid growth phase around 4 – 5 months, it will become life-threatening,” I explain. “Virtually all of these dogs will die before they reach adult size. Some small breeds might live longer, but not the large breeds.”

“How do we fix it?” Jane asked.

“Right now, in the dog, the fix is a surgical one,” I said. “They go into the chest and ligate the vessel.”

“You say they, does that mean you don’t do that surgery?” Jane asked.

“I have never done one, but I could probably do it,” I said. “We do have a cardiologist in Portland. He would be a better choice.”

“I don’t think Al is going to be up to sending a new puppy to a specialist for surgery,” Jane said.

“Will, we don’t have to make the decision right now,” I said. “You have Al listen to this heart and give me a call this evening. We can go from there.”

It was after dinner when Al called.

“I’m not sure I hear what you heard today,” he said.

“Put your stethoscope on the left side of the chest and move it way to the front of the chest, almost under his elbow,” I instructed.

There was a pause on the phone.

“Dang, do you think that is a PDA?” Al asked.

“It is a PDA or a large defect in the ventricular septum,” I said. “In veterinary medicine at this time, a PDA can be fixed. A septal defect cannot.”

“We are not going to Portland with this pup,” Al said with a finality in his voice. “Can you do this surgery?”

“I can do the thoracotomy,” I said. “But ligating the PDA, I have never done, but it should be something that I can do. The important thing for you to remember, this is a veterinary clinic. I am the only veterinarian. If I make a mistake, if I were to tear the ductus or puncture a vessel, the ball game is over.”

“I have watched you in surgery, I don’t think you will have any problems,” Al said. “You go ahead and get set up and schedule it, we will have him there.”

Jane had Shadow in the clinic at 8:00 AM sharp on his surgery day. She was obviously worried and understood the gravity of the undertaking. She patted Shadow on the head as the girls took him into the exam room, then she shook my hand as she wiped a tear from her eye.

“We are hoping for the best,” she said.

“I think we can do this with little problem, I will call you when he is recovered,” I said.

We completed Shadow’s exam and had him under anesthesia in short order. We clipped the entire left side of his chest, laid him on the surgery table on his right side with a towel roll under his chest to facilitate spreading his ribs.

When he was prepped and draped, I made a curved incision between his 4th and 5th ribs. I continued this incision down to his intercostal muscles. Then I carefully divided these muscles and opened the chest.

My surgical philosophy was to work fast. I had sure hands and utter self-confidence, in the environment of a veterinary clinic surgery room, the longer an incision was open, the better the chance of having an infection.

We had Shadow hooked up to a ventilator with his chest open. We paused the ventilator and moved his anterior lung lobe out of the way and packed it off with a moist lap sponge. I could put my finger on the PDA, the mechanical murmur shook the whole heart. I isolated the vagus nerve and pulled it out of the way with a loop of umbilical tape.

Now I was at the most critical point. I had to bluntly dissect a pathway around the PDA so I could place the ligatures. This dissection, especially on the deep side of the short vessel, could result in a catastrophic tear in the vessel that would most likely lead to a fatal hemorrhage.

I took a deep breath and began the dissection. My inexperience made me a little more aggressive with the dissection than a surgeon who had seen a vessel rupture. It only took me a couple of minutes, and I could grasp the middle of a length of 0 silk and pull it through the open pathway around the vessel. 

I divided the silk into two ligatures.  Then I slowly tightened the ligature closest to the aorta.  I moved to the ligature on the pulmonary artery side. I slowly tightened this ligature. Then I took another deep breath.

I returned the vagus nerve to normal position and placed a couple of sutures to close the soft tissues in the area. I removed the packing from the lung lobe and allowed the ventilator to expand this lung lobe. I placed a ten french chest tube with a 3-way stopcock on the outside of the chest. 

I did a nerve block on the intercostal nerves to help control pain and closed the ribs with 4 sutures placed around the 4th and 5th ribs. After insuring an airtight closure of the chest wall, the remaining closure was routine.

After putting a light wrap on his chest, we moved Shadow to a kennel to recover, and I began to relax. Looking at the clock, surgery was less than 50 minutes. I listened to Shadow’s chest. Nothing but good heart sounds. This guy should have a long and healthy life.

“Surgery went well, we were done in less than an hour,” I told Jane.

“Oh, thank you!” she said. “I was so worried.”

“We will keep him overnight, just to make sure everything is okay. But if I can pull his chest tube in the morning, he can go home.”

Shadow went home in the morning. After his hair grew back, nobody ever knew he had had a problem. 

Some years following Shadow’s surgery, one of Al’s daughters called. She had a friend in Bend, Oregon, who had a dog with a PDA. Her friend was being referred to Portland for surgery and could not afford the fee. They were hoping I would do the surgery.

I declined. Working with an established client, who I had a good relationship, I could feel confident they understood the risks. It would be far different from someone I did not know. They would likely have a whole different set of expectations.

The last time I saw Shadow, it was almost twelve years to the day following the surgery. Like a lot of his breed, old age was not kind to his body. He was crippled with arthritis in his back and hips. His life had become a struggle. You never heard him complain, but his efforts to get up and down had become unbearable for Jane. Al had died a couple years before, and the girls had moved on with their lives.  

Shadow’s last trip to the clinic with Jane saw tears in her eyes as they were on the first trip. The clinic where we had years before given him an opportunity for a full life was where we gave him a silent and humane end to that life. Putting Shadow to sleep was one of the most challenging things I have had to do. May he rest in peace.

Photo Credit:https://www.pexels.com/@carl-adrian-barcelo-1978030