If I could choose to be an animal it would not be a pig.
It had already been a very busy weekend on call with more than enough challenging and patience-trying cases to go around. I was driving home and was one block from my house when the phone rang yet again; a heifer with a uterine prolapse, could I please come right away. I called my wife and reassured her with these foolish words, "He doesn't live very far away, so it hopefully won't take very long."
As I may have mentioned previously we have had an awful weather winter. Record snowfall combined with record flooding. Then to make this weekend extra nice we got rain, followed by snow, followed by pouring rain, then more snow, then a little more rain. I think wet and cold pretty much miserable sums it up.
When I arrived at the farm the farmer greeted me with, "She was going crazy in the chute so I tranquilized her, and now she laid down". Normally that would not be a problem but this chute happened to be a small old chute that neither side would open on and she was twisted and cramped sideways with her legs tucked far up underneath her. Normally I would try and get both legs out behind the cow and the uterus goes in much more easily but that was not an option. Hoping that maybe this time would be the exception and everything would go in easily I went right to work.
I got the uterus cleaned off nicely and starting stuffing things inside without too much ado. It was like the heifer had a threshold for a specific amount of uterus that she was willing to have inside of her. Once I got to that point and tried to push any more she would give a big abdominal thrust and push everything back out on top of me. Not one to give up easily it quickly turned into a push-o-war. Me pushing in and her pushing out. Now the part that I failed to mention was that this chute we were working in was outside in the middle of the corral. In order to get a good angle on this laying down, butt twisted sideways and downwards uterus, I got to play pig in an 6 inch deep puddle of muddy water and you-know-what-else-turns-water-brown. Fortunately I was wearing my waterproof bibs, OB top, and overshoes. Unfortunately, that was not enough and I still ended up stinking and soaking. I don't understand the thrill that pigs get from that. The worst part was that she was winning and the uterus was not going in.
Next we tried letting her out (with a halter on tied to the side of the chute). Of course she was too sedate and wouldn't move so the farmer got his loader tractor to pull her out of the chute to put her in a more workable position. Perhaps she could sense our intentions as the loader pulled up toward her head and she suddenly had enough energy to stand and walk out. Now I was able to get the uterus back into the heifer without too much trouble...just a little dancing back and forth through deep mud, trying not too get my shoulder dislocated.
Today I did not love being a cold, wet, dirty, and my wife would add stinky, country vet.
Sunday, April 26, 2009
Sunday, April 5, 2009
C-section on the side
Many times I have pondered how things would be different had I decided on human medicine rather than veterinary medicine. Often when working with farmers or pet owners they comment on how much smarter veterinarians are than human physicians because we have to be able to diagnose the problem without the luxury of verbal communication from the patient. Add to this the frustration when the statement "hold still, this will only hurt for a minute" has absolutely zero affect on my patients. I guess the closest comparison could be with pediatric doctors working on babies. At best this is a weak comparison as I don't know many babies that would like to kick you into next week or toss you over the fence for doing something painful to them.
Some of these uncooperative patient thoughts came to mind on a recent calving call that I went on. I arrived a the farm just as yet another blizzard was starting. An unimportant side note but this one dropped somewhere between 15- 20 inches of snow and brought the grand total less than two inches shy of the all time snow record for the area. Loving winter here for sure. Back to the story. The cow was a smaller cow expecting her second calf. When I arrived she had a very large set of feet sticking out the back end and the farmer had already tried to pull it. Some of our farmers are not very experienced in offering assistance but this was not one of those. I knew even before getting to the farm that this was most likely going to be a C-section. The set up was a very common calving pen for our area; a head catch next to a wall with a swing gate that fastened with a chain to the wall to hold the animal relatively still for calf deliveries. I noted as we were pushing the cow against the wall that some pressure had to be put on the gate to get it close enough to hook the chain. The top half of the gate could then be swung open to allow easy access to the left para-lumbar fossa (the area in front of the hip bone and behind the ribs where we make our incision for a C-section). I proceeded with my c-section; all appeared to be going well as farmer Jake and his adult son were both there and ready to help.
No sooner had I completed my incision into the abdominal cavity then the cow decided she was tired of standing and laid down. In the clinic this is no problem at all as we just open one side of the chute, position the cow on her right side and continue the surgery there. Instead we were dealing with the setup on the farm and were just starting to find what problems we were going to have. With her now laying down body wedged against the gate it was impossible for the three of us to apply enough pressure to be able to unlatch the chain. Complicate this with the open hole in the left side of the cow with her trying to rub her rumen and other intestines against the far-from sterile swing gate. Fortunately we were able to bend the latch and get enough pressure to release the cow. Unfortunately this freed her to immediately push against the wall with her feet and roll onto her left side. Suddenly the swing gate was very sterile in comparison to the barn floor covered in straw, dirt, urine, feces and anything else nice that you might find on a barn floor. While I futilely attempted to keep my hands covering the 15 inch incision, farmer Jake and son tried to push the cow up off her left side. A quick phone call brought reinforcements from the house in the form of the other adult son and our cow was able to be tipped up to be sitting upright.
After scrubbing up again as best I could I was ready to get this calf out and reached in to try and pull the calf over to the opening in the body wall. She had other ideas and decided that now was as good a time as any to try and push the calf out with all her might. With each new push came part of the rumen, often accompanied by intestines protruding out of the incision, each time only inches from touching the dirty floor before I could get them back in. As this was definitely not working we readjusted again and laid her over on her right side hoping for better success.
Stupid cow, as I had by this time named her in my mind, was trying her best to be as uncooperative a patient as possible. I am not sure why she had such a death wish, but it sure seemed like she was doing everything in her power to get herself started on a really good abdominal infection. Even on her right side she continued to push with all her might and would repeatedly pop out her rumen and intestines despite my best attempts to keep everything inside. First point against me: the cow was repeatedly pushing her guts out. Second: the calf was very large and in the down horn; as absolutely far from the incision as it possibly could be. Third: the rumen was very full and putting a great deal of pressure down on the calf. What had originally appeared to be just another night at the office was turning into anything but. After several unsuccessful attempts to move the calf anywhere near the incision with constant pushing from the cow my thoughts of human physicians being able to ask their patients to hold still reverberated in my mind. Farmer Jake must have been having similar thoughts as he asked if we could sedate the cow. After expressing my concerns about likelihood of losing the calf he still felt that was our best option to complete the surgery and I had to agree.
An IV injection of xylazine in the underside of the tail worked almost immediately and I was ready to pull out a calf. Unfortunately (this seems to be a recurring theme in this story), though we had solved point one against me, points two and three were still insurmountable and I had to do something I have never done previously and hope to never have to do again. Because I could feel the feet deep inside the cow, but was completely unable to move them, I needed to get some extra help. I took my scalpel, held tightly between my thumb and forefinger to cover the sharp edges, and reached deep inside the cow. The whole time in my mind I was praying/hoping/wishing that she didn't override her sedation and decide to push just at the wrong time. Thankfully, I was able to blindly cut the uterus over the point of the hoof, without cutting my fingers or her intestines in the process. With access to the hooves I was now able to put a chain around them and have my two helpers pull the calf up and out. It made me feel better that the two of them together still had to sweat and struggle to get the 130 lb calf out.
Now the race was on to see if we could revive the very sedate calf before it died. A slow IV of tolazine to reverse the sedation, combined with an injection of the respiratory stimulant dopram did wonders for the comatose looking calf. Fortunately, he quickly came around and was trying to stand up even before I was done sewing up the cow. Before too long the sedation began to wear off for the cow and she began pushing and kicking but with two guys sitting on her neck and shoulders and one more holding her back legs tied to a post we finished the job. She appeared no worse for wear and I was off again; into the blizzard to help some other cow that wouldn't stand, or lay, still when I told it to.
Some of these uncooperative patient thoughts came to mind on a recent calving call that I went on. I arrived a the farm just as yet another blizzard was starting. An unimportant side note but this one dropped somewhere between 15- 20 inches of snow and brought the grand total less than two inches shy of the all time snow record for the area. Loving winter here for sure. Back to the story. The cow was a smaller cow expecting her second calf. When I arrived she had a very large set of feet sticking out the back end and the farmer had already tried to pull it. Some of our farmers are not very experienced in offering assistance but this was not one of those. I knew even before getting to the farm that this was most likely going to be a C-section. The set up was a very common calving pen for our area; a head catch next to a wall with a swing gate that fastened with a chain to the wall to hold the animal relatively still for calf deliveries. I noted as we were pushing the cow against the wall that some pressure had to be put on the gate to get it close enough to hook the chain. The top half of the gate could then be swung open to allow easy access to the left para-lumbar fossa (the area in front of the hip bone and behind the ribs where we make our incision for a C-section). I proceeded with my c-section; all appeared to be going well as farmer Jake and his adult son were both there and ready to help.
No sooner had I completed my incision into the abdominal cavity then the cow decided she was tired of standing and laid down. In the clinic this is no problem at all as we just open one side of the chute, position the cow on her right side and continue the surgery there. Instead we were dealing with the setup on the farm and were just starting to find what problems we were going to have. With her now laying down body wedged against the gate it was impossible for the three of us to apply enough pressure to be able to unlatch the chain. Complicate this with the open hole in the left side of the cow with her trying to rub her rumen and other intestines against the far-from sterile swing gate. Fortunately we were able to bend the latch and get enough pressure to release the cow. Unfortunately this freed her to immediately push against the wall with her feet and roll onto her left side. Suddenly the swing gate was very sterile in comparison to the barn floor covered in straw, dirt, urine, feces and anything else nice that you might find on a barn floor. While I futilely attempted to keep my hands covering the 15 inch incision, farmer Jake and son tried to push the cow up off her left side. A quick phone call brought reinforcements from the house in the form of the other adult son and our cow was able to be tipped up to be sitting upright.
After scrubbing up again as best I could I was ready to get this calf out and reached in to try and pull the calf over to the opening in the body wall. She had other ideas and decided that now was as good a time as any to try and push the calf out with all her might. With each new push came part of the rumen, often accompanied by intestines protruding out of the incision, each time only inches from touching the dirty floor before I could get them back in. As this was definitely not working we readjusted again and laid her over on her right side hoping for better success.
Stupid cow, as I had by this time named her in my mind, was trying her best to be as uncooperative a patient as possible. I am not sure why she had such a death wish, but it sure seemed like she was doing everything in her power to get herself started on a really good abdominal infection. Even on her right side she continued to push with all her might and would repeatedly pop out her rumen and intestines despite my best attempts to keep everything inside. First point against me: the cow was repeatedly pushing her guts out. Second: the calf was very large and in the down horn; as absolutely far from the incision as it possibly could be. Third: the rumen was very full and putting a great deal of pressure down on the calf. What had originally appeared to be just another night at the office was turning into anything but. After several unsuccessful attempts to move the calf anywhere near the incision with constant pushing from the cow my thoughts of human physicians being able to ask their patients to hold still reverberated in my mind. Farmer Jake must have been having similar thoughts as he asked if we could sedate the cow. After expressing my concerns about likelihood of losing the calf he still felt that was our best option to complete the surgery and I had to agree.
An IV injection of xylazine in the underside of the tail worked almost immediately and I was ready to pull out a calf. Unfortunately (this seems to be a recurring theme in this story), though we had solved point one against me, points two and three were still insurmountable and I had to do something I have never done previously and hope to never have to do again. Because I could feel the feet deep inside the cow, but was completely unable to move them, I needed to get some extra help. I took my scalpel, held tightly between my thumb and forefinger to cover the sharp edges, and reached deep inside the cow. The whole time in my mind I was praying/hoping/wishing that she didn't override her sedation and decide to push just at the wrong time. Thankfully, I was able to blindly cut the uterus over the point of the hoof, without cutting my fingers or her intestines in the process. With access to the hooves I was now able to put a chain around them and have my two helpers pull the calf up and out. It made me feel better that the two of them together still had to sweat and struggle to get the 130 lb calf out.
Now the race was on to see if we could revive the very sedate calf before it died. A slow IV of tolazine to reverse the sedation, combined with an injection of the respiratory stimulant dopram did wonders for the comatose looking calf. Fortunately, he quickly came around and was trying to stand up even before I was done sewing up the cow. Before too long the sedation began to wear off for the cow and she began pushing and kicking but with two guys sitting on her neck and shoulders and one more holding her back legs tied to a post we finished the job. She appeared no worse for wear and I was off again; into the blizzard to help some other cow that wouldn't stand, or lay, still when I told it to.
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