It’s a Wire Cut 

D. E. Larsen, DVM

The phone rang a second time. I looked at Sandy and Dixie, but they made no move to answer it. I looked at the clock. It said five fifteen. The phone rang a third time this Friday afternoon.

“It’s a wire cut,” I said as I reached for the phone.

“How do you know that?” Sandy asked.

“It’s after five on Friday,” I said. “This is a wire cut that happened on Tuesday, and she needs it sewn up tonight, so she can go riding tomorrow.”

I picked up the phone.

“Hello, this is Doctor Larsen,” I said into the phone.

“Oh, Doctor, I am so glad I caught you,” Wendy said. “Bullet has nasty-looking wire cut on the right front leg.”

“Did this just happen?” I asked.

“No, Bob said he saw it Tuesday night,” Wendy said. “I have been busy at work and couldn’t take time off during the week. I was lucky that I could get off a little early to get here to call you.”

“Where is this cut located?” I asked.

“It’s on his right front leg, near his elbow,” Wendy said. “It looks infected, it is all puffy, and there is some yellow stuff in the wound. It is almost two inches long.”

“Being three days old and on the upper leg, it can wait until morning,” I said.

“Doctor, it is so infected. I’m afraid it is an emergency,” Wendy said. “I was hoping you could run out here this evening and take care of it. I am supposed to go riding in the morning.”

“Wendy, It was an emergency on Tuesday, and maybe even on Wednesday,” I said. “On Friday evening, at best, it is a convenience call. It is not an emergency to look at a wound that has been neglected for three days. Especially a wound that can be treated as an open wound with little difference in the outcome.”

“Doctor Larsen, I did not neglect this wound,” Wendy said. “I was just too busy to deal with it. I would appreciate it if you could look at it this afternoon.”

“I can look at it, but there will be an after-hours fee,” I said. 

“But you are still at the office. Why should I have to pay extra?” Wendy said.

“Because it is almost five thirty, and this is not an emergency,” I said. “Otherwise, I could look at the first thing in the morning.”

“Okay, I will pay the extra fee if you can come tonight,” Wendy said. “But I won’t be able to pay you tonight.”

Sandy handed me Wendy’s account card. When we charged her in the past, it was always over ninety days before she paid.

“You know our policy is payment at the time of service,” I said.

“Yes, but this is an emergency,” Wendy said.

“Wendy, this is not an emergency,” I said. “This wound can be handled as an open wound with very little difference in the healing. You can come to the office in the morning and pick up some medication, and I can give you some instructions on treating this wound.”

“My friend thought it should have sutures,” Wendy said.

“It is three days old and in a location that heals in spite of how it is handled,” I said. “If your funds are limited, I suggest treating it like an open wound. You can do that, or I can come out first thing in the morning and show you how to do it.”

“Okay, Doctor, I will be here at eight,” Wendy said. “I think I can convince my friends to a little later start for our ride tomorrow.”

***

Wendy was waiting with Bullet tied to a fence post when I pulled up in the morning.

“Good morning, Wendy,” I said. “Let’s look at this wire cut so you can get on your ride.”

This cut was actually above Bullet’s elbow. It was just over two inches and didn’t appear to be into the muscle tissue. There was some minor swelling, but not anything that was a problem.

“I have to be honest with you, Wendy,” I said. “If you did nothing with cut, it would heal just fine. I will clean it up, shave the hair away from the wound, and give you some ointment to keep on it. There is a little swelling, so I will give Bullet a long-acting penicillin injection. I don’t think he will need any more antibiotics. I will also booster his tetanus vaccination.”

“Your sure it will heal?” Wendy asked. “When Susie looked at it, she thought it needed sutures.”

“Tuesday night, I would have sutured it,” I said. “After two or three days, there is a good chance that the sutures would break down. Then you would have put a lot of expense in the surgery just to get back to treating it like an open wound.”

“That makes sense, I guess,” Wendy said.

I scrubbed the wound with some warm water and betadine scrub. Then with my shoulder firmly planted in Bullet’s side, I swabbed the wound firmly to remove all the accumulated exudate. Bullet never flinched.

“Now, I’m going to shave the wound edge,” I said to Wendy. “In wound treatment, if you can only do one thing, it should be to get the hair away from the wound.”

With the wound cleaned up, it didn’t look nearly as bad. Wendy looked at it closely.

“It doesn’t look bad now,” Wendy said.

“I’ll apply a little Furacin ointment,” I said. “I will leave you this small jar. You should do this once or twice daily for a week or so. By then, this will be nearly closed up, and you can relax on the treatment.”

I gave Bullet an injection of long-acting penicillin and tetanus vaccination.

“Why does he need a tetanus booster?” Wendy asked. “I give him a vaccination every year.”

“The horse is pretty susceptible to tetanus,” I said. “The protocol is an annual vaccination and then a booster with any wound. Failing to do that, I would be in jeopardy of a malpractice lawsuit, and Bullet would be less protected.”

“Have you ever seen a case of tetanus?” Wendy asked.

“Oh, yes, and most of those just die,” I said. “I have talked with a couple of veterinarians who say they have saved horses when they were given a blank check on treatment expenses. I have never seen that happen, but I am sure it does.”

“Can I ride him today?” Wendy asked.

“I don’t think he will notice this cut,” I said. “You noticed that he didn’t object to my treatment. Riding him will probably make his muscle feel better.”

“And I can give you a check this morning,” Wendy said. “However, it would be better if you could wait till the end of the month before depositing it.”

“That will make Sandy feel better,” I said. “I will make sure she gives you a call before she deposits it. And if you are concerned about how this wound is coming along, you give me a call.”

***

Bullet’s wound healed nicely. In fact, Wendy was surprised that there was almost no scar when it was healed. And Sandy deposited her check on the first of the month, and it went through with no problems.

Photo by Jacque B on Pexels.

Her Blanket is Missing 

D. E. Larsen, DVM

I rolled over and looked at the clock; it was one thirty. Then the phone rang again. Yesterday had been a hectic day. I was tempted to let the phone ring, but Sandy elbowed me in the ribs.

“Hello, this is Dr. Larsen,” I said into the phone.

“I’m so sorry to wake you up, Doc,” the female voice answered. “This is Barbara, and Sierra’s blanket is missing.”

Barbara was a good client and a breeder of registered Malamutes. Most months, she visited the clinic several times, and it was unlike her to call about a simple problem.

“Barbara, you called because you can’t find Sierra’s blanket?” I asked.

“It’s gone, Doctor,” Barbara said, close to tears. “I know you think I am crazy, but the whole thing is gone. She has been in her kennel, and I think she ate it.”

“When do you think this happened?” I asked.

“I woke up just now because Sierra was gagging and making some terrible sounds,” Barbara said. “She is really distressed, and her blanket is missing. There is no way the blanket could get out of the kennel. She had to have eaten it.”

“If that happened, I probably should check her,” I said.

“Oh, thank you, Doc,” Barbara said. “She is so distressed. I don’t think it would wait till morning.”

“It will take me at least a half hour to get to the clinic,” I said. “I was sound asleep.”

“I’m so sorry, Doc,” Barbara said.

“That’s okay, I wasn’t going to come to help you look for a blanket, but if it is a medical emergency, that is just part of this job,” I said.

I got up and pulled on my clothes.

“Are you going be alright with this alone?” Sandy asked as she rolled over.

“I guess it will be Barbara and me,” I said. “We can’t drag the kids to the clinic on a school night at this hour, and Judy and Dixie are in the same boat. Hopefully, it won’t be something that requires surgery.”

Barbara and Sierra were waiting at the clinic when I pulled up.

Sierra was standing at the door and gagging and trying to vomit. The noise she was making was loud, almost a bark.

“That doesn’t sound good,” I said as I unlocked the door.

“She has been doing that constantly since she woke me up,” Barbara said.

I did a quick exam on Sierra. Everything was okay except for some abdominal distress when I palpated her belly.

“Make yourself comfortable, Barbara,” I said. “I am going to get a couple of x-rays of Sierra’s abdomen just to make sure something is in there.”

As soon as the x-rays were developed, I held them up to the viewer. Her stomach was stuffed with what we could assume was her blanket. The thing that was most concerning was a lot of content was making its way down the small intestinal tract. Fabric in the small intestines can result in a string effect where the gut accordions up on the string, which can wear through the gut wall in multiple locations.

“Barbara, it looks like the blanket is in her stomach,” I said. “The most disturbing thing is it has started down the small intestines. We should plan an exploratory surgery and get things out of there.”

“Can you do that tonight, Doctor?”

“It would be better to wait until morning when I have help,” I said. “But the problem is the longer we wait, the greater the potential for major intestinal injury. I have seen string foreign bodies that were fatal events.”

“If you can do it tonight, that would be great,” Barbara said. “I am no medical person, but I could help as much as possible.”

“There is a risk for me to do this surgery alone,” I said. “I am going to be opening the gut, maybe in a couple of places, and there will be a risk of contamination.”

“And you said there is a risk if we wait until morning,” Barbara said. “I elect to assume the risk tonight.”

With that settled, I had Barbara help me get Sierra on the surgery table and under anesthesia. I set up the surgery for the worst-case scenario, laying out several sets of gloves, multiple suture packs, and an extra surgery pack for closure.

I gave Barbara a two-minute lesson on sterile technique, showing her how to open suture packs and gloves. Then I got started with the surgery.

I made a long incision on the ventral midline and opened the abdomen. Sierra’s stomach was stuffed full with the blanket.

After securing the stomach and packing it off with lap pads, I opened it with a small incision. Then I started teasing the blanket out of the incision.

How stupid was this dog to eat the whole thing? The blanket just kept coming. Sometimes in pieces, sometimes in long strips. After removing most of the blanket from the stomach, I could see some blanket was still in the esophagus. Luckily, I could pull it into the stomach and remove it. The bad luck was the blanket pieces were starting into the small intestine. I was able to retrieve some of it, but I would have to open the intestines to get the rest. 

After closing the stomach incision, I started exploring down the small intestine. It was stuffed with content for a considerable distance. 

I picked a midpoint and hoped I could get all of the blanket out with one incision. 

“I am going to have to open the intestines to get the rest of the blanket out,” I said to Barbara, sitting in a chair in the corner of the surgery room. “The problem is every time I open the gut, it increases the chances of contamination of the abdomen and the incision. Those chances are increased with me working alone. But we can’t leave this stuff in there.”

“I am amazed that she ate all of that,” Barbara said. 

“It’s probably good that we are doing this surgery tonight,” I said. “By morning, she would have had this blanket most of the way down her gut.”

I isolated the selected loop of the bowel and opened it with a one-inch incision. I started pulling blanket material from the incision. It was easy to pull the fabric down through the incision from the upper portions of the intestine, but I had difficulty removing the material from the lower portions of the gut. When I had pulled all that I could from this incision, there was still blanket content lower in the tract.

From the second incision in the gut, I got the rest of the blanket. I was careful to flush the incisions and ensure everything was out of the gut. I instilled some saline and gentamicin into the abdomen before closing the incision.

After giving Sierra a dose of IV antibiotics, we recovered her in a kennel without a blanket. She was comfortable on recovery and not showing any of the distress that was apparent when she came to the clinic.

“I think she will be fine here for the rest of the night,” I said. “I need to check her over in the morning before sending her home.”

“When should I check with you in the morning?” Barbara asked.

“Not too early,” I said. “I might not be here at opening time, and I need some time to check that incision before sending Sierra home. We are going to have to keep a close eye on her incision. Plus, we need to give her some fluids again in the morning, and we will need to have her on nothing by mouth until the following morning. Then we can give her liquids for a few days before starting a soft diet.”

Sierra was feeling well by the time Barbara came to pick her up. I cautioned Barbara to watch the incision closely and lined out the diet and antibiotics regimen more time.

***

Only three days later, Barbara was back at the clinic with Sierra.

“I was worried about being a nuisance,” Barbara said. “But the incision is starting to weep some fluid at the upper end this morning.”

“You are not a nuisance, Barbara,” I said. “This is what you are supposed to do. We need to correct this incision now. It would be breaking open tomorrow had you not brought her in today.”

We went back to surgery with Sierra. I opened the incision. The first few sutures of the incision were starting to break down. I removed all the sutures and derided the infected areas. Then I closed the incision with stainless steel sutures. 

I kicked myself out of having the forethought to use stainless steel in the initial closure. All the newer suture material will break down in an infected closure, but stainless steel will not allow dehiscence.

Sierra healed well after that, and Barbara was both thankful and apologetic every time she saw me for many weeks following Sierra’s recovery. She also changed to using commercial kennel mats instead of blankets.

Photo by Mark Sc on Pexels.

The Camping Trip that Wasn’t, From the Archives

D. E. Larsen, DVM

I stood up to peddle harder as the last half mile was steeper. I wished I had one of those new bicycles with gears to shift. When the advertisement said you sell to your neighbors, they didn’t remind you that your neighbors were two miles away, uphill.

At 12 years of age, I had embarked on my first venture as a salesperson. Lured by a flashy magazine ad, I was going to sell garden seeds and earn enough to purchase a pup tent. It sounded simple, I had a few neighbors, and they all had large gardens. And I had a large family. Grandma’s can always be depended on to buy stuff.

“And who are you selling them for?” Margaret asked.

What a dumb question, I thought. You think I would ride my old bike for two miles up that hill to sell them for somebody else.

“I am selling them for myself,” I said. “I am going to get a pup tent.”

“I thought you might be selling them for the Boy Scouts or Church or something,” Margaret explained.

This is going to be more challenging than I thought. She would donate to some group, but she was hesitant to help some kid achieve his goal.

“That is why I need a pup tent,” I explained. “I have to work at home so much, I don’t have time to join the Boy Scouts. So I have to go camping by myself.”

I thought that was a good comeback. Margaret knew I worked in the barn and in the fields. But then, she also knew my parents. And they would not deprive me of joining the Boy Scouts if that was what I wanted to do.

“I will buy a couple of packs of the peas,” Margaret said. “I don’t have my seeds yet, and it is probably close to the time to be planting peas.”

I figured I would have to come up with a better storyline if I was going to sell all these seeds. And tomorrow, I was going to go the other direction. There were only a couple of small hills on the way to Broadbent.

As the spring progressed, I did manage to sell the necessary allotment of seeds. Although, I would guess my mother bought more than she planned to buy. I placed my order for the pup tent and waited anxiously for its arrival.

I tore open the box when it did arrive. The tent was much larger than I expected. And it was heavier also. Made from heavy canvas, at least it would be durable. It would be difficult for me to carry along with a pack, that was for sure.

I quickly had it set up in the back yard. There was plenty of room for two people that were my size. You couldn’t stand up in it, but that was no problem in my view.

It rained the second day after I had pitched it in the backyard. It didn’t leak one drop, but it took three days to dry out.

Summer came, I planned a camping trip to the back of our 160 acres with my friend from up the river. Dana and I could easily carry the tent, sleeping bags, and my brother’s pack with all the necessary supplies.

We were all packed up and ready to head up the hill when Dad came out to wish us well.

“We are planning to go to the movie tonight,” Dad said. “You two can stay up the hill if you like, or after you set up camp, you can come back and go to town with us. I have a good flashlight, you could go back up the hill when we get home.”

What a dilemma, a movie was hard to pass up in the mid-1950s. Movies were really our only source of outside entertainment. My Dad liked to go to the movies, and we would go a couple of times a month. I knew that Dana did not go that often.

“What do you think?” I asked Dana.

“I think it would be a good idea,” Dana said. “We could go set up camp, come back and go to the movie, and then walk back up in the dark to sleep.”

“Okay, we will go to the movie,” I said to Dad. “We probably will be back in time so we can eat dinner before going.”

With that, we were off. The trek was not long, we crossed the upper fields and crawled over the fence at the pasture’s end. Then we followed the cat road along the creek until it turned up the hill to the burn.

The burn was where they had logged the timber and burned it over to make good pasture for the cows. It was a good-sized area and open so we could watch the deer and other animals.

We picked a spot on the old landing and set up the tent. We threw everything else into the tent and headed back to the house for dinner.

“We don’t want to be late,” I said. “Dad won’t wait for us.”

We hurried along and got to the house just as mom was setting the table for dinner.

“This is a whole lot better than eating that can of pork and beans you would be heating over a fire,” Dad said. “You never know what you are missing until you don’t have it.”

My older sister pulled the car into the garage and came rushing into the house.

“I just had a cougar run across the road in front me,” She said, trying to catch her breath. “I was right down there at the end of Herman’s field.”

Dana’s eyes were large, as we turned around and tried to see if anything was in the field, some half-mile distant. There was nothing there.

“Are you sure it was a cougar?” Dad asked.

“We should call Uncle Robert,” Mom said. “He might want to get his dogs on its track tonight.”

“Yes, I am sure it was a cougar,” Linda said. “It had a long tail, and it moved like it didn’t have a care in the world. Are you boys camping up on that hill tonight?”

“We are going to the movie first,” I said. “We already set up camp. We will walk up there when we get home after the movie.”

“Well, I sure would not be walking up on that hill tonight,” Linda said. “That cougar probably is headed right up the creek.”

“They are brave boys,” Dad said. “We will find out tonight.”

When we got home from the movie, the night sky was clear, and the stars were bright. The moon was not up yet, and there were no lights around to distract from the milky way.

“So, do you boys want my big flashlight?” Dad asked with a little chuckle. “It is going to be pretty dark up along that creek. Or are you a little concerned about that cougar your sister says she saw?”

That was just a little hint that he was not sure he believed my sister. But it was still possible and something to think about.

“I guess we could probably sleep here tonight,” I said. “And then we could go up and cook breakfast at the campsite in the morning.”

“I think I would feel a lot better about things if you slept here,” Mom said. “That cat could carry you off before you even knew it was there.”

That was all we needed to hear. If Mom thought we should sleep in the house, we would sleep in the house.

We were up at the crack of dawn and headed up the hill. We were both well versed in the out of doors. We had a cooking fire going in no time, and I mixed the pancake batter.

“I am not sure those are going to look much like pancakes,” Dana said as he watched me trying to turn over the pancake in the little cook set fry pan.

By the time we sit back to eat, the pancakes were in a jumbled heap on the plates. But it was cooked, and a little syrup made it all better. We ate quietly, both of us thinking that Mom would have made a better breakfast.

After watching a few deer and the digger squirrels, we packed up the camp. Dana just folded the pup tent into a square and threw it over his back. It was all downhill to the house. We started off, chuckling about looking for cougar tracks down at the creek. That made us walk a little faster.