Where is the Volar Pouch, from the Archives

D. E. Larsen, DVM  

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

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

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

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

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

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

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

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

“Um,” I stammer.

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

“I guess I don’t know,” Jon replies.

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

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

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

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

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

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

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

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

Adams smiled and departed the surgery room. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The hallway audience erupted in laughter.

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

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

Photo by Laila Klinsmann from Pexels

A Chilly Birth

D. E. Larsen, DVM

I stood looking out the living room window. The world was blanketed with six or eight inches of snow. This was unusual for Sweet Home. 

“Are you going to the office this morning?” Sandy asked. “Nobody has come down the road yet.”

“You need to call the girls and tell them not to worry about coming in early,” I said. “Maybe check about noon, and we will see what the snow is like then.”

“I don’t think you should plan to go to the office in this stuff,” Sandy said. “The county won’t get around to plowing this road until this afternoon or tomorrow. Last night’s news said it would be cold, down in the teens or the single digits today.”

“I have a dog in the clinic that needs to be taken care of, and I can forward to phone to the house so you can answer any calls,” I said. “Judy cleared the morning appointments before she went home last night. But with this snow and these temperatures, we are bound to get a call with a downer cow that is half frozen.”

“You shouldn’t be out on these roads until they are plowed,” Sandy said. “You won’t do anybody any good if you wind up in a ditch somewhere or worse.”

No sooner than those words were said, the telephone rang.

“Good morning, Doctor Larsen. This is Sue out on Berlin Road,” Sue said. “Our first ewe had a lamb sometime last night or this morning. She is doing okay, but the lamb is nearly frozen. This is a young ewe. I don’t think she knows what she is supposed to do. Can you come out and get a look at it?”

“I’m not sure I can get up your hill, Sue,” I said. “I guess I’ll put chains on the truck and try it. If I can’t make it, you need to get that lamb in under a heat lamp in the barn or in the house, dry it off, and warm it up. Then milk the ewe and get some milk into the lamb.”

“Bob is gone until tomorrow,” Sue said. “Maybe longer with this terrible weather. I can’t do those things, Doctor. That is why I am calling this morning. I don’t think we have a heat lamp, and I will not bring that lamb into my house.”

“Sue, I am not going risk my neck to try to save your lamb if you are not going to do your part,” I said. “If that lamb is not dried off and warmed up, it will die. So if I come out, you will end up with a lamb in front of your fireplace.”

“How long are you going to be, Doctor?” Sue asked. “I guess we will have a pet lamb for a little while this morning. At least the kids will be happy.”

“I have no idea what shape the roads are in, Sue,” I said. “My truck is in the garage, so I can put the chains on without laying in the snow. But our road is not plowed, and I doubt if have your road plowed either. I will get there as soon as I can, but I am sure it will take more than an hour. While waiting, you run a load of old towels or blankets in the dryer so they will be warm for the lamb.”

When I hung up the phone, I went to the kitchen and filled a thermos with coffee.

“You be careful out there,” Sandy said.

I pulled on my down vest and then my heavy jacket. 

“I’ll be alright,” I said. “I will give you a call when I get back to the clinic. I will stop there and forward the phone. Just take names and numbers, don’t make any promises. This will probably be a slow day. At least I can put the chains on in a dry garage.”

With chains and four-wheel drive, the truck thought it was driving on dry pavement. I stopped at the clinic, checked the dog, and forwarded the phone to Sandy at home. Then I headed out to Berlin Road. Sue’s place was up the hill from Pleasant Valley. It might be a challenge to get to today.

There were no tire tracts in the fresh snow. Things went well, I slipped a bit on the first corner going up Berlin Road, but otherwise, things were fine. Sue must have been watching for me because she was heading out to the barn as I pulled into her driveway.

I realized how cold it was when I stepped out of the warm truck. I filled my bucket with warm water and grabbed my bag before heading into the barn.

Sue had the ewe and lamb bedded down in a pile of straw just inside the door. The ewe seemed comfortable but concerned about her unresponsive lamb.

The lamb was very cold. His mouth was cold, and there was hardly a suck reflex when I stuck my finger in his mouth. The ewe had done a pretty good job drying him off, but the cold was more than he could handle.

“This guy is so cold, he could be too far gone to save,” I said. “I’m going to milk this ewe and get some milk into him, and then we will take him in the house to warm up.”

“Will the one feeding be all he needs?” Sue asked. “I’m not sure I can milk that ewe, and I am not going to town for milk replacer in this snow.”

The ewe was fine to milk, and I emptied both sides of her udder. Then I gave the lamb a good meal via a feeding tube.

“The plan is to get this guy warm enough to take a bottle,” I said. “There is enough milk here for two feedings. Hopefully, by then, you will be able to reunite the lamb with this ewe. I would leave the ewe right here.”

“I called Bob, and he is coming home this evening,” Sue said. “At least he will be able to care for things then.”

“This lamb will do much better if we can get him back with his mother,” I said. “But he has to be up and about and able to nurse. If he doesn’t nurse, you feed him with a bottle and leave him with mom as long as he can get up and around and keep warm.”

“Doctor, if I take this lamb in the house and he dies, what am I going to do with him?” Sue asked.

“What does Bob do with dead animals?” I asked.

“I have no idea,” Sue said. “This farm thing is his business. I’m a city girl, and this is more time I have spent in the barn than all of last year.”

“I don’t think this lamb will die if we get him warmed up in the house,” I said. “But if he does die, you call me first so I can have you check a couple of things to make sure he is dead, and then you can just set him outside for Bob to deal with when he gets home. The temperature outside is colder than your freezer right now.”

I picked up the lamb and handed Sue the bucket of milk from the ewe.

“Okay, I will help you get this guy settled in a warm spot in the house,” I said. “Did you warm up some towels or blankets?”

“Yes, the drier is running, and the kids have a spot ready in front of the wood stove,” Sue said.

The lamb was starting to stir a little when we got to the house. The feeding was doing its job. We balled him up in a pile of warm towels, and the fire in the wood stove was roaring.

“You kids can help by petting this lamb and rubbing him to help him warm up,” I said. “You want to keep the dryer going and keep warm towels around him.”

“I have a heating pad,” Sue said. “Would that be okay to use?”

“It would be better not to use a heating pad,” I said. “We see some horrific burns from those things, especially in animals who can’t move around much.”

“What am I supposed to do with this milk?” Sue asked. 

“I brought you a couple of lamb nipples,” I said. “You can use them on a Coke bottle. Just make sure you sterilize it first. I want you to feed this lamb four ounces every two or three hours. I think you will have three feedings. Hopefully, Bob will be home by then.”

“Can I call you if I have any questions?” Sue asked.

“Yes, you can call,” I said. “But you are not my only client. When people start getting up and around, I might not be immediately available to the phone. But someone will answer, and I will get back to you. Sue, you are going to be fine. Look at the kids. This lamb will be up and ready to get back to mom in no time.”

“When should we put him back in the barn?” Sue asked.

“You get at least two feedings into him,” I said. “And if he is eating vigorously, you can put him back with mom. If Bob is not too late, it would probably be better to wait until he can put him out there and make sure he can nurse on mom.”

“That’s a good idea,” Sue said.

I left feeling that the lamb had a good chance of survival, even with Sue’s reluctance to become a farm girl. I slipped a little on the same corner going down the hill. And there were still no tire tracks in the snow other than mine.

When Bob got home, he called to let me know the lamb was back with his mom and nursing well. 

“Do you think I should get a heat lamp for him tonight?” Bob asked.

“That might be a good idea,” I said. “Those things are good to have around when we get a cold snap like this.”

“I hope I don’t have any more lambs until it warms up a little,” Bob said. “How do these newborns survive in a country like Montana?”

“Some of them don’t,” I said. “They try to miss the severe weather and protect things as best they can. But if you drive through that country, you will see animals with short ears where they have lost their ear tips to frostbite. Sometimes the tails on cows will also be frozen.”

The lamb did well. The ewe took him back, and they enjoyed the straw bed in the barn. Bob had a couple more lambs before the weather returned to mild temperatures typical of western Oregon. And I don’t think Sue ever became the farm girl Bob hoped she would.

Photo by Carolina Schornsteiner on Pexels.

Dancer’s Dilemma

D. E. Larsen, DVM

Dancer was standing in the exam room when I entered. Unlike her usual demeanor, she barely acknowledged me. She was concentrating on her next breath.

Dancer is a walker hound. A fine confident hunter, she is one of Leon’s leading girls. For Dancer to be distressed, she must have a major problem.

“Do you want her on the table?” Leon asked.
“He looks like we should leave her on the floor for now,” I said. “How long has she been breathing like this?”

“I noticed she was slow yesterday,” Leon said. “She was the last one back to the truck, and usually, she is leading the pack. But this morning, she has just been standing the breathing pretty hard.”

I pat Dancer on her head. She had no response, and she didn’t move when I knelt beside her. I noticed that she was breathing with a lot of abdominal movement.

I put my stethoscope on the left side of her chest. I could hear breathing sounds, and her heart sounds were normal. When I moved to her right side, there were no sounds.

I listened closer. I could hear muffled heart sounds, but no breathing sounds. I thumped her chest on the right side. The normal chest should sound hollow. On Dancer, it was a dull thud.

“I think her chest is full of fluid, probably mostly on the right side,” I said.

“Same as Roxy?” Leon asked.

We had lost Roxy to a prothorax not long ago. Her chest was filled with fluid on both sides, and we lost her before getting too far along in the treatment. When I opened her chest, I found the cause quickly. That is unusual in a prothorax. Roxy had a porcupine quill sticking out of her right lung. She had probably inhaled it when she tangled with a porcupine some months before her death. It took some time, but it finally migrated to the outside of the lung, contaminating the pleural space and causing the pus-filled chest.

“Probably, but it sounds like just one side of the chest is involved,” I said. “Hopefully, we will have a favorable result this time.”

“What do we need to do?” Leon asked.

“We need to get an x-ray,” I said. “But I am going to drain a lot of this fluid first. That will make her comfortable. Then we will decide how to proceed. My thought is to open her chest with a small incision, flush out all the exudate, and place a chest drain. That way, we can reduce the scarring in her chest. If the left side is not involved, we will be lucky. The mediastinum, the structure which divides the chest, is usually not complete in the dog.”

We clipped the right side of Dancer’s chest and prepped it with Betadine Surgical Scrub. I rigged a sixty cc syringe on a three-way stopcock with a discharge tube to a one-liter bag. After using some lidocaine for local anesthesia, I inserted a fourteen-gauge needle into the chest and started aspirating a thick exudate.

It did not take long to fill the one-liter bag. We changed the bag and had nearly a half liter before I could feel the needle bumping into some lung tissue. I withdrew the needle and reserved the last bit of fluid for culture.

Dancer looked like that elephant just stood up off her chest. She wagged her tail for the first time as she took a deep breath.

Her x-ray showed that there was still a lot of fluid on the right side of the chest, even after I pulled a liter and a half of exudate out of her chest. The left side was clear.

“I think I should open this chest and flush all this exudate out,” I said. “That way, we can start with a clean chest, and the antibiotics will work better. Then I will place a chest tube, close the chest and hang on to her for a few days.”

“Do you think this is another quill?” Leon asked.

“I would doubt that, but was she in the fight with the porcupine?” I asked.

“No, she wasn’t involved with the porcupine,” Leon said. “But what else could it be?”

“It only takes a little puncture into her chest from the claw of one of those bobcats she runs,” I said.

“Yeah, there is plenty of opportunity for that to happen,” Leon said. “So I guess I just wait for your call.”

“I will keep you posted,” I said. “But I will keep her for at least three days. I will flush this chest daily through the chest tube. I want the drainage to be clear before pulling the tube.”

We hooked Dancer up to an IV and got some IV antibiotics started. Then we went to surgery. I opened her chest on the right side between ribs five and six. A lot of foul-smelling yellowish fluid was in the chest. I explored the chest wall and the lung lobes as best I could but found no apparent cause.

It took multiple saline flushes before the fluid suctioned out of the chest was clear. I placed a drain tube and secured it to a suction device. Before I closed the chest, I instilled a dose of antibiotics.

Dancer’s recovery was unremarkable. By closing time, she was up and around and looking for dinner. Her breathing was close to normal, and she felt much better than when she came through the door.

The first thing in the morning, I flushed a half liter of saline into Dancer’s chest. To encourage the fluid to do a little slouching about in her chest, I allowed her to follow me on my morning rounds.

Dancer showed genuine interest in the other patients in the clinic. I wasn’t sure how she would respond to the cats, but she seemed to understand that we were taking care of them. At the end of rounds, I lifted Dancer up on the treatment table and drew off the fluid I had infused earlier. It was almost clear.

“I think you are doing pretty well, Dancer,” I said. Dancer looked at me like she knew exactly what I said.

We repeated the procedure that evening. And by the next morning, Dancer jumped down from the treatment table after her infusion and waited for me to start my rounds. She rubbed noses with dogs through their kennel doors and stood on her hind legs with her front feet on the lower kennels to watch the cats.

When the fluid was clear on the third day, I pulled the drain tube and started to go call Leon. Dancer followed me to my office and sat at my feet while I called Leon.

“Things are looking pretty good with Dancer,” I told Leon on the phone. “She is eating well. The fluid coming out of her chest this morning is clear. She can go home. The only problem is she will miss taking care of all the other animals in the clinic.”

“That sounds great,” Leon said. “We will be right down to pick her up.”

Dancer went home on antibiotics and returned to normal. She lived a good life and had a couple of litters of pups.

Photo by Leon Olson of Sweet Home.