"An apple a day....."

Fall in the Northeast is probably my favorite time of year. The red, orange, yellow and gold colors are abundant and make the scenery even more beautiful than it already is. Dunkin Donuts has pumpkin donuts, pumpkin coffee and pumpkin muffins and the fresh apple cider can’t be beat!!! Along with the fresh cider is an abundance of fresh apples to make pies, apple crisp, applesauce… and the list of my favorites goes on.

We’ve all heard the saying “an apple a day keeps the doctor away.”  As much as I love apples, cows tend to love apples too.  Unfortunately, when cows try to eat apples, it’s more of a request for a visit from the doctor than it is to keep her away….. 

I’ve had two calls in the last week from clients that thought their cow was not eating or drinking, was coughing and acting “off.”  The most recent call was much more emergent in the fact that the farmer brought the cow in from pasture and she was extremely bloated. The owner thought he felt something hard in the cow’s throat, but wasn’t really sure if it was real.  When I arrived I found #100 lying down, very uncomfortable, with an extremely distended abdomen, cold ears and obviously in distress. 

Severe Rumen Bloat

As I’ve discussed before, when a cow bloats, it causes severe pressure on their diaphragm and lungs and prevents them from breathing easily and efficiently.  As you can see from the picture, she was severely distended, so my first order of business was to relieve the bloat and allow her to actually be able to catch a breath.  In order to relieve her bloat, I placed a red trocar in the rumen as I have also discussed in a previous post. Once the bloat was relieved, and she was able to take a breath, I was able to examine the rest of her.  As I was looking at #100 I was asking the farmer if he had any apple trees in the pasture.  His response was “yeah a pile of them.” 

The obstruction visible in the shaved area

Feeling the cow’s neck, I was able to palpate a large baseball size lump, about half way down her neck.   I was pretty positive she tried to eat an apple and she ended up swallowing it whole and was now choking on it.  Because cows do not have upper incisors, they can’t just bite into part of an apple. Usually they end up putting the entire apple in their mouth and then try to bite it with their molars. If the apple is hard it may not break and can shoot directly down their throat, or the cow will just try to swallow the apple whole.  It’s great if they can actually get the apple to their stomach without any trouble, but if the apple is bigger than the esophagus, it can cause some major issues.

The first call I had with this issue, was a small beef cow, which must have eaten a smaller apple. By the time I arrived, she had passed the apple on her own and had started to nibble on hay and drink some water.  She was started on some anti-inflammatory medicine to help with the soreness and any trauma the apple caused on its way down.  She was in a much better way than #100.

The approach that I take when I am faced with an animal choking is to first sedate the animal.  When an animal is choking, much like a human, they begin to panic and all their muscles, including the esophagus, will tense. With sedation, we hope that the animal will relax enough that we may be able to massage the obstruction down the esophagus, or when we pass a tube down the esophagus, we will be able to move the obstruction with the tube.

  

Once #100 was sedated, I took a firm tube and tried to move the apple down the esophagus. It wouldn’t budge.  Because the esophagus is a smooth muscle, and kind of an important muscle to have, it’s crucial not to be too forceful when trying to remove an obstruction, causing more damage. When the apple wouldn’t move with the gentle pressure of a tube, I went to my next plan- pumping water down her throat to try and “flush” the apple down, rather than adding more force.  As I was pumping the water in, she was spitting it right back up as fast as I was pumping it. After trying to pump 3-4 gallons of water down her, I decided it was a futile effort.  Now I’m not sure what I’m going to do… The poor cow was still coughing and trying to burp to get the apple up, and what I was doing was not working. 

Another view of the obstruction

 

I thought about pumping mineral oil down her throat, to "slide" the apple down, but because she was spitting up the water so forcefully, I was afraid she would do the same with the oil and possibly aspirate on the oil.  It’s pretty much a death sentence if she ended up aspirating oil.  And, even if we were able to move the apple down the esophagus further, because of the size of it, there was still a chance that the apple would lodge where the esophagus meets the stomach or somewhere in the esophagus where it passes through the chest cavity.  I didn’t see many good outcomes with this idea.

So, in my gut, I figured we were headed for surgery, but I wanted to bounce ideas off of another vet first, so I called another vet in the practice.   She was wondering if there was any way I would be able to put something down her throat to mash the apple up into smaller pieces so it would pass.  My concern was the trauma to the esophagus in trying to pass something  that would do the "mashing," and then what happens if we lose that down the throat too??????  She also suggested I try to reach down and grab it as someone pushes it back up to me.  Well I do have long arms, but they aren’t that long… And I kind of need them to do my job, so I wasn’t real keen on putting an arm down a cows mouth and have her, as a  natural reaction, bite down on it…..

So, now I’m back to surgery as my option.  Any other choke I have dealt with, cow or horse, I have been able to relieve the obstruction with all the aforementioned ideas, which means I have never actually done a surgery on a choke case.  Well one of the great things about veterinary medicine is that you learn to improvise, and you do so under duress.  I know how to do surgery, I mostly remember my anatomy- well at least the important things in the neck region; like the jugular vein, carotid artery,  and some pretty major nerves, so I’ve got it covered…..  Ha!

  

I tied the cows head up in the air so that I was working directly under her. After I clipped and washed the area, I blocked it with lidocaine and started my exploration.  Being careful not to cut through any major things, I took a great deal of time NOT using a scalpel, but rather using my fingers and scissors to dissect through the tissue.  Once I reached the esophagus, I was able to cut over the top of the apple and see that it indeed was an apple; a yellow-green one at that!

 

Now for my vet friends reading this, I know you aren’t supposed to cut directly over the obstruction, but based on location, I didn’t want to sway too far in either direction. So I went with it.

  

After a fair amount of work, using scissors and my fingers, I was able to get the apple removed from the esophagus. I could tell that #100 was feeling much better the minute I removed the apple because as she coughed, I had a face full of saliva and rumen juice spew out at me through my opened esophagus.  I sutured her closed and could tell that it was truly closed when I no longer had saliva coughed in my face.  I then sutured the muscle layers closed and then partially closed her skin, leaving a space for any drainage that may occur.  I was concerned about infection because it wasn’t a truly sterile procedure and I am not 100% sure I removed all apple chunks or rumen fluid that may have come through the opened esophagus when she coughed.

The culprit in pieces.

   

She was placed on an anti-inflammatory medicine and antibiotics. When I called to check on her the next day, the farmer said she had started to pick at some food but wasn’t eating with vim and vigor quite yet.  I can only imagine how sore her throat must be with having the apple stuck in there for who knows how long, and then me trying to get the apple to move with tubes, and finally the surgery. 

 I still worry about aspiration pneumonia, infection in the incision, as well as the esophagus forming a stricture at the point of my incision and suturing.  I am very fortunate in the fact that cows have an amazing ability to heal and surprise me every day with that ability.   This was certainly a new one for me.  I never did mention that #100 was due to have a baby in less than a month.  After all this, I really hope she will be able to have her baby and go on living a happy life AWAY from the apple trees!!!!

Finally! A Prolapse with Pictures!

I was on call this past weekend and had quite an array of calls. The first was for a left DA; pretty routine procedure that went well. The second call was for a weak goat that, after performing a fecal, was found to be loaded with intestinal parasites (worms). He was treated with electrolytes, dewormed and sent home. Hopefully he had not lost so many nutrients and blood from the worms that he is able to recover after a couple rounds of dewormer.  The next call was for a cow that had calved earlier that day and suffered from a uterine prolapse.  The final call of the weekend was a calving. 

I know I’ve discussed other emergency calls where I’ve had to attend to a prolapse, but never had any pictures to show you what it really is. When I arrived at this farm, the cow was out in the pasture and I had to have them run back to the barn to get water, so I had some time to actually take a picture!  

Uterine prolapses are one of the few TRUE, emergency- drop- everything -and – come calls that we get in dairy practice. This condition usually occurs in older cows that have already had one or two calves. It can happen in first time mothers, but is not quite as common.  Normally prolapses will occur within the first 24 hours after a cow has had a calf. If she has made it through the first 24 hours without any trouble, it is pretty rare that she will prolapse at that point.

For those that have never seen a uterine prolapse, it is when the entire uterus, which I remind you just had an 80+ pound calf inside it, completely inverts and falls outside of the vagina. It is the uterus, inside out, outside the cow. Sometimes the bladder will also come out with it, and in really bad cases, there may be some loops of intestines that also have prolapsed. 

 In the picture you can see these large “lumps” on the uterus.  These lumps are called the “caruncles” and are the attachment points of the placenta (cotyledons) for the calf.   The best analogy I can come up with for a uterine prolapse, is a pair of pants that you have taken off, and instead of grabbing the ankle and pulling, you start at the waist and completely turn them inside out. 

Prolapsed uterus

There is no definitive “cause” of a uterine prolapse; however there are certain conditions that predispose cows to prolapse.  A difficult calving where the cow strains a great deal, continues to strain and/or has a very large calf, will predispose a cow to having the uterus prolapse, as well as when the cow is hypocalcemic (low blood calcium). Calcium plays a role in smooth muscle contractions in the body. The uterus is considered a “smooth muscle” organ, so when the cow is low on calcium in her blood, the uterus is not contracting down like it should, after the cow has calved.  

Some of the biggest concerns we have about cows with a uterine prolapse is shock due to blood loss, traumatic damage to the uterus as it is outside the cows’ body, and entrapment of the intestines in the inside-out uterus, causing an entirely different issue.  The uterus is suspended in the cow from two ligaments that attach to the side if the body. Inside each of these ligaments is a major vein and artery.  As the uterus is prolapsing, turning inside out, headed out of the vagina, it stretches these ligaments and therefore the veins and arteries inside them.  The concern is when they have been stretched to the point that they have ripped and as tension is released on these vessels, the cow starts bleeding internally and can easily bleed to death in a short time.

So how do we take care of this 50+ pound organ that is supposed to be inside the cow that is now outside??? Well, first and foremost we give the cow an epidural, or spinal, to prevent her from feeling the procedure and also to prevent her from continuing to push and strain against us as we try to replace the uterus.  The cow can be standing while we fix her, or can be laying down with both back legs extended directly behind her. We then wash the uterus being sure to remove as much bedding, mud, debris, etc. from the uterus as possible.  

Now back to the pant analogy.  We can fix the pants by going from the waistband, back down the leg, grab the cuff and pull it back up through. Well in a cow, we can’t jump inside the cow, and reach from the inside to the tip of the uterus and pull it back through. Instead, we have to start gently pushing the uterus back in, starting close to the vulva and working it back inside. It would be like starting with the cuff of the pants and pushing it back through to the waistband.

As we are pushing the uterus back, we have to be sure not to rip off any caruncles, or push our fingers through the sensitive and damaged uterine tissue.   If a tear does occur, then we can suture the hole and continue on. It’s just better if we avoid making a hole in the first place. 

Replacing the uterus is quite a workout, if I do say so, but I can replace a nice “easy” prolapse in about 20 minutes.  I have also worked on them for over an hour  only to have the cow push it back out just as I have it almost all the way in.  The longer the uterus is prolapsed, the more edema the uterus will get, it can dry out and become less pliable and can be severely injured from other cows or herself.  When a cow does have a uterine prolapse, we recommend the farmer keep her quiet, keep other cows away from her, and try to keep the uterus as clean and moist as possible until we can get there. 

After the uterus has been pushed back inside the body, we have to make sure it is completely everted so it doesn’t re-prolapse. We then give the cow an injection to help with the smooth muscle contraction and shrinking the uterus back down so it can’t come back out.   Finally we give the cow some calcium in the jugular vein and start her on antibiotics in case we didn’t get every little spec of dirt off the uterus before we replaced it. 

Some practitioners will place a “buhner stitch” in the cow’s vulva after replacing the uterus.  It is a stitch that essentially closes the vulva up and allows only enough room for her to urinate. As a practice we have decided to do this, but it really is more of a placebo effect for the farmer.  If the uterus was replaced properly, and the cow was given the appropriate medication to start the uterus shrinking back down, there is no need for this stitch.  If the uterus was not replaced correctly and the cow continues to strain, or the medications were not given to start the uterus shrinking back down, she can re-prolapse and this stitch will do nothing to stop it.  For the cows that do have a buhner stitch placed, it is removed about 4-5 days later.  The picture shows the stitch placed after I replaced the uterus on this cow. 

Buhner Stitch Placed

This cow stood during the entire procedure and walked to another part of the pasture and started eating when we were done.  I think she will be fine and should breed back in a few months with no issues.

Boys! Boys! Boys!!!!!

Today I had a unique opportunity to attend the New York State Fair Dairy Cattle Birthing Center. This is the first year this exhibit has been at the state fair and boy was it a hit!!! The Exhibit was brought to the fair by the New York Animal Agricultural Coalition and Cornell University.  Its goal was to allow those who may not come from a farming background to witness the live birth of a calf and speak candidly with members from all aspects of the dairy industry about animal agriculture and dairy farming.
 

Feeding one of the bulls from yesterday his breakfast!

The cows came from 6 different dairy farms all within an hour from the Syracuse, NY fair grounds.  Each farm supplied 6 cows that came in for a 2 day stay.  The cows were induced so that they would hopefully calve within their time at the fair.  Thursday was the 2^nd day for the cows from this particular farm so three had calved the day before.  All three had male (bull) calves.

The first cow of Thursday, had her water break at 9:30 in the morning.  As we were waiting for the cow to progress further into labor the tent began filling, and filling, and filling with people. By the time the cow was in full labor there had to have been at least 200-300 people in the tent watching.  By noon the first cow had calved with yet another boy!

It was a wonderful opportunity to answer questions that people had about cows in general. Most of the common questions that were asked were things that I have discussed before in previous posts, however I will reiterate the most popular questions asked today.

The most popular questions we had were:

How long is a cow pregnant?  Well the average gestation for a cow is very similar to a human in that it is 9 months or approximately 280 days.

Why don’t you let the calf nurse the mom? This is really for the health benefit of the calf. Although we strive to keep the calving area very clean, it is still not a sterile hospital room. There is still manure and bacteria in the environment.  Because the calf is a newborn, it has no immune system. We want to clean and disinfect the teats of the cow and harvest the colostrum as cleanly as possible rather than have the calf possibly ingest bacteria from the cow’s teats. We also remove the calf from the mom as quickly as possible to ensure that the calf is protected and cared for appropriately in case the mother does not have a good motherly instinct.

What happens to the male calves? Since only the females produce milk, the bull calves are either raised to be used for breeding purposes or sold to be raised for meat. 

My most unusual question of the day was from a young boy in the crowd, who bravely walked through hundreds of people to approach me with the microphone. Now, any dairy or beef farmer reading this may chuckle to themselves as I did when the question was asked.   

The question was:

Can cows have mental problems?  Now this question was being asked as the head of the calf was in the birth canal and only the front feet and tongue were sticking out. I mentioned chuckling to myself earlier because those of us that work with cattle day in and day out, understand that every cow has their own personality and yes, sometimes they are quite crazy and we do wonder if there is a mental problem…. In this case, I presume the boy was wondering if the calf was getting enough oxygen with the head stuck in the birth canal.  Because the umbilical cord was still attached, we assured him that the calf was still getting oxygen, but it is something that we carefully watch to be sure the calf hasn’t been in the birth canal with the umbilical cord pinched off, for TOO long causing oxygen deprivation and therefore some neurologic issues.

As we were finishing up havesting the colostrum from the first cow, a second cow’s water broke.  She had her baby around 2:30pm and it was the 5^th bull of the group!!! When we look at yearly averages, it truly does end up 50:50 males to females. However, there may be stretches of time where there are a large number of bulls born and then another stretch of all females.  This farm just happened to bring 5 cows that were all pregnant with bulls! The 6^th cow had not yet calved by the time I had to leave so maybe the 6th time is the charm for a girl!

The farm owner harvesting the colostrum from the first mom of the day!

I could go on and on about questions that were asked and the answers to those questions. I strongly encourage you to ask questions of myself or other members of the dairy industry if you have them. As our t-shirts said today:  “Ask me! There’s no UDDER place to get the answer!!!”

Overall it was a wonderful opportunity for members of the dairy industry to share our story.  I had countless people come up to me throughout the two births today  and tell me how much they learned from their time at the Birthing Center.  I truly feel blessed to have been born, raised and continue to work in the dairy industry. Although we still face challenges, this industry is truly amazing, and there are so many people that work so hard to ensure that the products you get from a dairy farm, are the most wholesome products they can be!

 I am so proud of the hard work that went into this exhibit from various people, the farmers that took time out of their very busy schedules to share their personal stories, and tirelessly care for these animals.

Udder Fibro..... what?????

I was called this week to one of my regular herd check clients for a cow that was “bleeding from her udder.”  This is usually classified as an emergency, get here ASAP kind of call, as cows can bleed to death in a matter of minutes if the cut is severe enough.  I’ve mentioned in a previous post, that cows must pump an average of 500 gallons of blood through their udder a day, to produce 1 gallon of milk. So cows that are making 80 pounds of milk a day, are pumping about 5000 gallons of blood through their udder during the course of the day.  There are two major vessels and many smaller veins that supply the udder with all this blood. SO, when a farmer calls and tells you that they have a cow bleeding from her udder, yes, it truly IS an emergency.

Luckily I had just finished a herd check and was close to the farm so could get there quite quickly. When I arrived, the herdsman had the cow restrained in a hoof trimming chute and was holding pressure on the bleeding area.  Luckily it was NOT one of the major milk veins bleeding, but rather a large mass on the front of the udder.  We often refer to these masses as “Udder Rot.”  Not a very scientific name, that’s for sure, but it gets the point across.  The true scientific name is Udder Cleft Dermatitis.

These udder rot lesions are often very foul smelling and can become quite an issue when not taken care of at an early stage. The lesions are most commonly found in front of the two front teats and right where the udder attaches to the body wall. They usually start from some kind of irritation to the udder, such as a mange mite, edema or pressure necrosis of some kind. Once the skin is irritated, bacteria from the environment move in and enjoy the nice warm, moist habitat and continue to “eat away” or cause further damage to the area.  The bacteria that inhabit the lesions, are what causes the foul smell that is often associated with udder rot.

Because the body is amazing and does everything it can to heal itself, it can sometimes overcompensate.  When this occurs, as it did in this case, there is excess production of tissue that looks like a giant wart (fibropapliloma) or “proud flesh.” Some of this has to do with the bacteria that are in the lesion and the rest has to do with the body trying to heal itself.  There are lots and lots of blood vessels in this tissue but no nerves.  When the mass gets caught on something or stepped on or even bumped, it can start bleeding and can bleed quite severely. 

In this case, the cow had the mass hanging from the udder and there was another cow that was showing signs of heat (or estrus). Exhibiting natural estrus behavior, this cow tried to mount the other cow and the mass on the udder was aggravated. 

Because of how large this mass was, and the number of blood vessels that I know course through the udder, I was not brave enough to surgically try to remove the mass and then make the udder “normal” again. Instead my approach was to cauterize the bleeding vessels and have the herdsman start to aggressively treat the mass with a killing spray.  As you can see from the picture, there is quite a bit of blood on the chute. There was probably about 3-4L of blood on the ground which is significant. Her mucous membranes were starting to get pale, but she still had the strength to stand.  With a little fluid therapy, Iron injections and TLC, I think she will be just fine.  

A blood transfusion is an option if the cow had lost a more significant amount of blood. However, a cow can lose up to 6L of blood without any risk. She may be weak for a day or so, but again, the body is amazing and new red blood cells had already started making their way into circulation, the minute she started bleeding.  

To prevent further issues with these types of udder rot lesions, the best thing to do is to catch them early, and spray them with a copper sulfate or tetracycline mixture. The area is warm and moist which the bacteria love. To disrupt that habitat, the sore needs to be dried out and the bacteria killed.  Treating the animals for mange mites also helps decrease the incidence of udder rot lesions.  When they get to be large pendulous masses like this cow, not many veterinarians look forward to the call of when, not if, but when, these masses rip and start to bleed.

It's Fair Season!

So here it is, the last day of the month and I’ve realized I have only written one post all month. What a slacker!!! Actually, we have been swamped at the clinic and to be honest when I get home at night, there’s not much energy left to write… Unfortunately, this is one of those “boring” posts with only one picture, but this is what I have been up to for the last few weeks: 

Aside from my routine herd checks, and the sick cows (which have been numerous with the heat), I’ve vaccinated probably close to 200 animals for the fair season. This area has a few pretty big fairs so there are LOTS of animals that need their “fair shots”. “Fair shots” include a respiratory vaccine and a rabies vaccine for cows, and only a rabies vaccine for sheep and goats. They all need an official identification number and a health chart that certifies that animal had no infectious diseases at the time of the veterinarian’s examination. It is easy work, but tedious.

Rabies Vaccine, Respiratory Vaccine and Official ID

Every animal must have an “official” identification number which is a metal tag in cows or a “scrapie tag” in sheep and goats. In the picture to the left you can see the metal tag with an individual number on it. These are cattle tags and are often referred to in New York as “21 tags.” The first two numbers (21 for NY) identify what state the animal was born and raised in. Each state has their own number, ie. Vermont is 13, Maine is 11, etc.  Following the “21” for NY, are three letters and then 4 more numbers. No two of these tags are the same. If an animal is sold and moved across state lines, this metal tag is in their ear and is the lifetime identification as to where that animal originated. No two animals anywhere in the country will have an identical number on their metal tag/scrapie tag.

An individual official identification is part of the animal traceability act that is happening all across the United States. There has been much discussion over the ruling because many farmers and ranchers feel like we already have enough of “Big Brother” watching over us, and this is one more way for them to do so. Unfortunately, what many of these farmers and ranchers don’t realize is the thousands of animals that move across state lines with no identification and possibly carrying infectious diseases with them. In the livestock industry, we are closely monitored with animal movement. Let me just ask you this… How many times have you driven to visit family or friends a state or two away, and taken your dog or cat with you? Have you had a health certificate from your veterinarian with you on every trip? Technically if you are crossing state lines with any animal, you should. In the cattle industry, ANY time an animal is changing ownership, heading for a show, going to an auction or even going to get slaughtered, they must have one of the approved official identifications. 

As an industry, we are not as diligent as we should be with this information. Most sales, cattle shows and auctions will require the appropriate identification and corresponding health certificate. The information then gets sent to the State Department of Agriculture for filing. However, private sale of animals occurs just as, if not more frequently and often does not have the aforementioned documentation. An animal heading for slaughter does not have to have a health certificate, but it must have an official ID.  So, why all the fuss?

 Let’s say I have a really good cow on my farm in NY, which I decided to sell in an auction. The person that buys my cow has a farm in Wisconsin and my animal does not have a “21 tag” in her ear.  Now my animal is loaded on a trailer and hauled from New York, through Pennsylvania, Ohio, Indiana and Illinois up to the farm in Wisconsin and has stopped at other farms along the way, for water breaks for the cow. Well come to find out, my cow is infected with Foot and Mouth Disease (a HIGHLY contagious blistering disease). Now that she is in Wisconsin, multiple cows at the buyers’ farm have all come down with symptoms of Foot and Mouth and require a very strict quarantine to prevent further spread. The farmer in Wisconsin knows he bought a cow at an auction, but has no idea who the seller in the auction was, or what state the animal originated from, because there is no identification tag. Where do we start looking to find other possibly infected animals? How does anyone know where the source of the infection came from??? How can they really quarantine the appropriate animals??? If my cow had a “21 tag” in her ear, State and Federal Veterinarians know to start looking for the source right in NY and can quarantine appropriately. 

Now we haven’t had an outbreak of Foot and Mouth disease in the US since 1929 and this case may seem extreme, but is used as an example of the reasoning behind the ruling.  The same thought process can be used for diseases such as Mad Cow disease, Rabies, Brucella and numerous other diseases where the point source of a disease is critical to know.  

The regulations are phasing in over the next couple of years, so there is time to comply.  The reasoning behind the ruling makes sense and it’s only a matter of time before the U.S. falls victim to a terribly contagious disease as so many other countries have.  When that time comes, I’m confident all farmers are going to appreciate the headaches they are going through now, to put the special identification in the ears.