A Bladder Rupture

 D. E. Larsen, DVM

September was one of my slowest months in the large animal portion of my practice in Sweet Home. Pink eye cases probably accounted for most of my cattle calls during the summer months. Those cases were all but gone with the cooler days of fall. Cases of pneumonia were not happening yet, and the herd work usually didn’t start until October. I was happy when the phone rang, and Sandy was obviously talking about a steer.

“Alice called,” Sandy said. “She has a steer with a swollen belly. I told her she called at the right time and that you would be out shortly.”

“Must be a water belly with a ruptured bladder,” I said. “I don’t know if I will be able to help her with this one.”

I double-checked the truck. Dixie had called in sick today, so I would be on my own. With Alice to help, that would probably not be a problem.

Alice was waiting at the corral when I pulled into her driveway. The steer was in the chute. His belly filled the chute, even without any squeeze.

“I noticed this guy’s belly this morning,” Alice said. “What do you think?”

“I think he probably has a stone plugging his urethra,” I said. “When that happens, something breaks. Usually, it is his urethra. But sometimes, it’s his bladder. The bladder rupture is the most difficult to handle. I’m not sure I will be able to fix him.”

“This guy is close to weaning,” Alice said. “I can’t shoot a good-looking steer like this without trying to save him.”

“Okay, who knows, we might just get lucky,” I said. “Let’s start by seeing if I can find a stone first.”

We put a halter on the steer and tied it to a post in the corral before letting him out of the chute. When we opened the headgate, the steer had difficulty pulling his full belly through the open headgate.

Once he was out, I put a rope throw on him. I used a flying W. Once he was down, I rolled him on his back and tied his hind legs with the free ends of the throw rope. 

After clipping his belly, I could see the stone in his urethra.

“This is much easier when the urethra hasn’t been leaking urine under the skin,” I said.

I prepped the surgery site and used local anesthesia. I grabbed the penis through his skin and palpated the stone at the attachment site of the retractor penis muscle on the sigmoid flexure. The stone was easily palpated.

Holding the stone firmly, I incised through the skin and dissected it to the urethra. I made a short incision over the stone, and it popped out.

“That was simple,” Alice said as she retrieved the stone from the ground.

“I am going to leave this incision open,” I said. “He will have urine coming from it for a few days before it heals. And if there are other stones, hopefully, they will fall out of this incision rather than plugging him up again. Plus, if we can’t fix the bladder, I won’t have wasted time closing this incision.”

“How are you going to fix the bladder?” Alice asked.

“I am going to be honest with you, Alice,” I said. “This is something I have never done, and I don’t know if it is even written in the book. I did listen to a description of the procedure by Dr. Annes when I was in school. That was a clinic discussion. I probably wouldn’t have listened well if it had been in a classroom. Do you have a front-end loader on your tractor?”

“I appreciate your honesty, and no, I don’t have a front-end loader,” Alice said.

“We need to hang this guy by his hocks. That way, his guts will fall away from his pelvis, and I will be able to deal with his bladder.”

“How are we going to do that?” Alice asked.

“Maybe I can get his rear end high enough by hanging him from a fence post,” I said.

I released the throw rope, and the steer rolled to his side but did not attempt to get up. I tied his hocks together with the rope and pulled him over to the fence. 

This steer was close to five hundred pounds. I took a dally wrap with the free end of the rope on the post. I pulled hard, but the steer’s butt didn’t come off the ground.

“Let me give you a hand,” Alice said.

Alice was an older lady in her sixties and had run this ranch by herself since her husband died. She grew up on a ranch in the Dakotas, and she was tough as nails.

Alice took a grip on the rope between the steer’s hocks. We pulled together and took up the slack on the rope. With two or three pulls, we had the back half of the steer hanging from the top of the post.

“Is that going to be good enough?” Alice asked.

“I think it is going to have to be,” I said.

I prepped the steer’s abdomen and made a ventral midline incision starting at his pelvic brim. When I opened the abdomen, I was amazed and relieved that the bladder was hanging in full view. I explored the bladder, both with my gloved hands and visually. I could find no defect.

“What’s the problem?” Alice asked.

“The bladder is right here in the middle of the incision, but I don’t find a defect,” I said. “I guess it could have leaked when it stretched far enough and then closed up after it emptied some.”

“What are you going to do now?” Alice asked.

“I am going to close the abdomen and leave a drain in place to empty the urine out of his abdomen,” I said. “If he can pee normally, and if my theory is correct, we might be fine.”

Alice was quiet. I guessed she probably thought this was a goner steer. But I made a separate stab incision and placed a large penrose drain. Then I closed the abdominal incision, sprayed for flies, and gave the steer a long-acting antibiotic.

I released the rope and lowered his butt to the ground. After untying the ropes, I helped the steer to his feet.

“What do we do now?” Alice asked.

“I think just turning him out in a small pasture would be the cleanest place for him,” I said. “If you keep him in the corral or a stall, he will get dirtier than in a pasture. I will get back here in three days and take that drain out if his belly is down. Then we will just cross our fingers and watch him. With any kind of luck, we will be home free.”

***

Three days later, I was back to check the steer. I stood and watched him in the pasture while waiting for Alice to finish her work at the barn. His belly looked normal, and he was grazing well. I was lucky to see him pee, and he only had a few dribbles from the urethral incision.

When Alice was done, we ran the steer into the chute. I snipped the retaining suture on the penrose drain and pulled it out.

“He looked good out in the pasture,” I said. “Eating well, and his urine flow looked close to normal. I will check back next week. Don’t celebrate until then, but I think we may get lucky.”

***

When I stopped by Alice’s place the following week, she was not home. I watched the steer in the pasture for some time, and he looked as normal as any steer out there.

I left a note on her gate, saying she could throw a party now, we were home free.

Photo by Jorge Jimenez on Pexels.

The Quail Hunt 

D. E. Larsen, DVM

Mom was just setting the table for dinner when I came into the house after doing chores at the barn.

“Dana called a little bit ago,” Mom said. “He wanted you to call him back. He wanted you to come up and stay overnight this weekend. I think they have moved to a house in Broadbent. It would be no problem for me to drop you off this evening after dinner or tomorrow.”

This spring, we moved from our farm out of Broadbent to a dairy on Catching Creek. It would be good to spend some time with Dana again. He will be going to high school this fall, and I will be in the eighth grade.

“Do I have time to call him before dinner?” I asked Mom. 

“I think so. Your Dad hasn’t come in from the barn yet,” Mom said.

Mom had written the number down, so I wouldn’t have to look it up in the phone book. I sat on the phone bench and dialed the number. His mother answered the phone.

“This is Dave Larsen,” I said. “Is Dana there?”

“Just a moment,” his mother said. “I think he is outside.”

I waited several minutes before Dana picked up the phone.

“Hi, can you stay overnight this weekend?” Dana asked.

“Sure, Mom said she could drop me off this evening or in the morning,” I said.

“Why don’t you come over tonight,” Dana said. “That way, we can climb Robin’s Butte tomorrow. Maybe we can get Jeanne to go with us.”

“That will be fun,” I said. “I will come over as soon as we finish dinner.”

Robin’s Butte was one of the tallest hills around. I had been up it a couple of times, but not often. There was quite a view from the top. You could see all the way to Myrtle Point and beyond. And it looked right down on our Broadbent farm, just a mile south of the Butte.

“You better get a change of clothes packed if you’re going to climb that Butte,” Mom said. “And you check with Dana’s mother to see if they are bothered by poison oak. That Butte is covered with it; some people will get it from your clothes.”

We took the Old Broadbent Road from Catching Creek instead of going to town and out the highway. It was not far, less than five miles. Dana had moved into a large white house almost across the street from Broadbent school. 

I hated our move. Leaving Broadbent in the middle of the school year and attending the junior high school in Myrtle Point meant that I had to make new friends and deal with new teachers. The teachers at the junior high actually thought I should do homework. I had never done that at Broadbent and wouldn’t start now. All my Broadbent friends would be at the high school in Myrtle Point when I got there.

Mom dropped me at the front gate of Dana’s house. 

“I’ll be back to pick you up before dinner tomorrow,” Mom said. “They have enough mouths to feed. They don’t need to feed you.”

“That’s okay,” Dana said. “He can eat dinner here tomorrow, Dad and Chuck are gone this weekend, so it won’t be a problem.”

Mom nodded her head, “Okay, I’ll be here about seven then,” she said.

“Let’s drop your things in the bedroom,” Dana said. “I called Jeanne, she is riding her horse this evening, and she is excited to see you.”

Jeanne was a year younger than me. I have known her forever, and she was a special friend. I was probably more excited to see her than I was about seeing Dana.

When we got to her place on the edge of Broadbent, Jeanne was down on the highway with her horse. We had one horse, and Jeanne was riding bareback. Dana and I took turns riding double behind Jeanne.

“We are going to climb Robin’s Butte in the morning,” I said. “Do you want to come with us?”

“Sure, but I have a problem,” Jeanne said. “I am watching my cousin tomorrow. He might be too small to go on that climb.”

“How old is he?” I asked.

“He’s four. Well, he’s almost four,” Jeanne said.

“I was all over these hills when I was four,” I said. “He is big enough to make the trip.”

When I slid off the horse, I realized that the close contact with Jeanne had a significant impact on me.

“Jeanne is going to go with us in the morning,” I told Dana. “She has to bring a little cousin with her. He’s only four but should be able to make the trip.”

We continued to ride, taking turns until the sun was low in the sky.

“I have to go take care of the horse,” Jeanne said. “What time are you going to be here in the morning?”

“Sometime after breakfast,” Dana said. “We will give you a call when we leave the house.”

Dana and I started back to his house on the railroad tracks and then cut across the rough ground to the backyard of his house. Neither one of us spoke on the walk home.

In the morning, after a quick breakfast of cereal, we called Jeanne and headed out. It didn’t take us long to cover the ground to Jeanne’s house, and she was ready and waiting outside with her young cousin.

“This is Matthias,” Jeanne said as she introduced her cousin.

“He’s pretty small,” Dana said. “Are you sure he can make the trip?”

“He’s four. I was all over these hills when I was four,” I said. “He’ll be fine. Uh, Matt? You don’t mind if we call you Matt, do you?”

Matt didn’t say a word. I guess he was shy. 

We started out, walking up past the barn and through the pastures behind the barn and then crossed the fence onto Lloyd Lackey’s place. We were aware of the property boundaries but were not concerned with trespass issues. I doubt that we had heard the word. I never saw a no trespassing sign until many years later when the Californians started to arrive in large numbers.

After the Lackey place, we started to climb. When we reached the edge of the timber, Matt had to pee. Jeanne took him into the timber and helped him pee.

“Matt has a second hole where his pee comes out, and he has problems with it sometimes,” Jeanne said. “They will fix it, but they want him to be a little older.”

“How did that happen?” Dana asked.

“I don’t know,” Jeanne said. “I guess it is just one of those things.”

We finally reached the ridge line that ran to the top of the Butte. It was easy walking along the top of the ridge. The timber was on the north side of the ridge, and nothing but grass and poison oak on the south side.

“My great uncle Ern always said that traveling along the top of the ridges was the easiest way to go,” I explained as we traversed the ridge. “He said all the old Indian trails used the top of the ridges.”

It wasn’t long, and we were on top of the Butte. No trees were on the top, and we could see for miles in all directions. Matt sat down for a bit. That was the first time that he showed any hint of being tired.

“On the way home, it’s all downhill, Matt,” I said. “We could almost run the whole way.”

We all sat down with Matt and chatted about nothing stuff. I pointed to all the places on our farm that were in clear view, and Dana showed Jeanne the route we had taken last summer when we crossed Neal Mountain to their old home near Gaylord. Then it was time to go.

The trip down the ridge and back across to Lackey’s place seemed to take no time. I even noticed a smile on Matt’s face as we covered the ground with downhill ease.

When we got back to Jeanne’s, we went in for a glass of water, and then she wanted to show us her horse again. Matt stayed in the house, and the three of us started out to the barn. That is when we jumped a large covey of quail.

“Quail!” I said. “That’s a bunch of them.”

“Do you have a shotgun?” Dana asked. 

I am sure that it was Dana who asked for the shotgun.

“Yes,” Jeanne said. “Dad has a shotgun.”

We quickly returned to the house, and Jeanne retrieved the shotgun from the corner of the utility room. We grabbed a few shells from the box on the shelf.

“We only need a couple of shells,” I said. “We will only get one or two shots, and they will be gone.” 

We headed back to the barn, and Dana stopped and loaded the shotgun. We carefully approached the barn, and the quail ran out of the open side door. 

I am sure it was Dana who put the gun to his shoulder and fired one shot, and took out four birds. The rest flew, and the birds were all gone by the time Dana pumped a second shell into the chamber.

Like a group of triumphant hunters, we gathered the dead birds and returned to the house. We stopped and unloaded the gun, and Jeanne returned it to its place in the utility room.

We took the birds into the house, and that is when Carol, Jeanne’s mom, came to see what we were shooting. She saw the dead quail and didn’t seem pleased with our fresh kill.

“Oh, no!” Carol said. “Those are your Dad’s quail that he feeds every night. He is not going to be very happy. What were you thinking, Jeanne?”

I looked at Dana and motioned with a quick movement of my head.

“I guess we better be going,” Dana said. “We have some stuff to get done down at the river.”

Neither Jeanne nor Carol acknowledged Dana’s comment. We just excused ourselves and left.

I was never sure how much trouble Jeanne got herself into that afternoon. I heard that she had to clean and cook the birds herself. I don’t know who ended up eating them. We did remain friends through high school, and then, as with many young friends, life took separate paths.

Epilogue:

As I think back on that weekend so many years ago, I realize that it was the first time I found myself competing for the attention of a young lady. Dana and I were good friends, probably as close as two boys of that age could be, and we found ourselves pitted against each other for the attention of a girl who had been our friend for years. We both must have been aware of the competition, but we didn’t allow it to come to the surface. 

Jeanne never mentioned the quail hunt to me during our high school years.

Photo by Frank Cone on Pexels.

On the Wheel with a Broken Wheel, From the Archives

D. E. Larsen, DVM

Pat was standing at the counter, clutching a shoebox in her hands.

“I know we impose on your generosity, Dr. Larsen,” she said. “But the class is heartbroken over Blossom. Can you get a look at her?”

“Don’t feel like you’re imposing, Pat,” I said. “I see all the classroom pets in Sweet Home at no charge.”

“I think this is a major injury,” Pat said. “You are maybe not going to be able to fix it.”

“Let’s get a look at Blossom,” I said as I led Pat into the exam room.

I opened the shoebox, and Blossom was huddled in the corner of the box. She was almost in a ball, and her fur was fluffed up. This was definitely a hamster who was not feeling well.

I started to reach into the box to pick Blossom up, so I could get a better look at her.

“Oh, be careful, Dr. Larsen,” Pat said, reaching out for my forearm. “She bites at times, especially if she is unhappy.”

I put my hand over her body, securing her head between my thumb and index finger. I carefully lifted her from the box. As I turned her over, her injury was visible. She had a fracture of her right tibia.

“Is it bad?” Pat asked. She had probably not been able to bring herself to look at the injury.

“Blossom has a fracture of her tibia on her right hind leg,” I said. “I am not sure that it is fixable. There is a lot of displacement.”

“We knew it was bad,” Pat said. “The class is very upset. It was that way when we came to school this morning. If there is anything that can be done for her, you would be their hero.”

“I think I am hearing that replacing her might not be an option,” I said. “Or at least, not if there is any chance of fixing her.”

“I told the class that I was sure you would do everything in your power to fix her, but we might have to talk about what to do if she can’t be fixed,” Pat said.

I looked at Blossom closely and mulled over repair options in my mind. I could possibly fashion a Thomas Splint that would work. That would be difficult to manage in a classroom pet. It would be easy to amputate the lower leg. She might do surprisingly well on three legs, but the classroom would have some difficulty with the decision. Just maybe, I could get an intramedullary pin into this bone. I could attempt to pin it, and if unsuccessful, I could go ahead and amputate the lower leg at the fracture site.

“Okay, Pat, here is my plan,” I said. “I don’t think that trying to splint this leg is a good option. There is a chance that I could repair this fracture with a pin on the inside of the bone. I am not sure about that, my experience base for repairing hamster fractures is zero. But I think I should try to pin this fracture. If I cannot get that done, I will amputate the leg at the fracture site. Blossom needs to stay overnight. That means you will need to bring her cage down, so we are not tearing the clinic apart tomorrow, looking for a fugitive hamster. You also need to prepare your class for the possibility of Blossom losing her leg, She will do well with 3 legs. It is just that some kids might be upset with that option.”

“Okay, I can bring the cage down after school,” Pat said. “We have a cage that the kids take her home in on the weekends.”

“That will be good,” I said. “I have some time this afternoon. We will do this then. I may well be done by the time you get back here with the cage.”  

I put Blossom entirely into a large dog facemask to induce anesthesia. When she was asleep, we secured her head in the smallest cat facemask. This allowed for reasonable control of anesthesia and access to the fracture site.

After prepping the leg, I covered the foot with a sterile gauze. Securing it with a couple of purse-string like sutures around the top and bottom of the foot.

I made a short incision over the fracture site on the inside of the leg. Bending the leg, I could expose both ends of the fractured tibia. Looking at the size of the medullary cavity, I selected a 20 gauge needle to use as an intramedullary pin.

I snipped off the sharp point on the aluminum needle. Then I inserted the blunt needle into the bone of the distal fracture fragment. This needle fits perfectly. And without any pressure applied, I measured the depth of insertion to be 3 mm. My plan was to bury this IM pin. This was something I had done in repairing fractures of the radius in tiny dogs.

I snipped the needle hub off and inserted the needle shaft into the proximal fracture segment. When it was fully seated in the upper bone fragment, I measured and snipped the needle to leave just over 2 mm of the exposed needle shaft.

Now it was a simple task to toggle this exposed needle shaft into the distal fragment. It required a little stretch, but it popped into the distal fragment quickly. The bone ends slid together better than expected. This proved to be an excellent repair. I closed the incision with a couple of sutures of 5-0 Dexon in the subcutaneous tissues and then closed the skin a couple of subcuticular stitches with the same material.

Blossom was placed in her shoebox with a warm towel for her to recover. By the time Pat had returned with the cage, Blossom was up and running around like nothing was wrong with her leg.

“Oh my, she acts like nothing is wrong,” Pat said as we moved Blossom into her larger cage.

“So, I think Blossom is doing well enough that you can take her home tonight,” I said. “You need to drop her by tomorrow just so I can check her over really quick. I want to make sure she is still using the leg and that the incision is okay.”

“Do I need to do anything for her?” Pat asked.

“I would bed her down with a fluffy towel for the night,” I said. “Other than that, I don’t think we need to do anything. I think we are home free.”

“I want to thank you, Dr. Larsen, from the bottom of my heart,” Pat said. “And I am sure the class will be thankful also.

The following week Blossom was in for her checkup with the entire class. We went into the surgery room, where there was room for the group. Blossom was the star of the show, and her broken wheel was healing well.

“She is back to running on her hamster wheel, and she doesn’t even limp when she runs,” one of the little girls said.

Photo by Frances Goldberg on Unsplash