If it is not number one then this day has to be close. Number one worst day ever, that is. It started out with food poisoning trips to the bathroom from 2 am to 7 am, but I won't go into details. After laying on the couch for a couple of hours without further problem I decided to go into work. Since no one else at work wanted to be locked in the same room with me I was sent out to "look" at some lame cows. After being told that they were all in the corral I wondered aloud why they were not bringing them in. "Because it isn't convenient for them and they won't do anything that is inconvenient for them." Great. Just to understand my displeasure a little I will describe the options.
Option One:
Bring the cows in and look at them at the clinic. We have a hydraulic chute that we can tip each cow up on her side with straps that go around each foot so that they are unable to kick and we have easy, clear access to all four feet to perform whatever type of foot work the cow is in need of. I think it is a wonderful invention that is safe, easy, and allows for the optimal result from a medical standpoint.
Option Two:
We regularly look at lame cows on the farm when they are out on pasture (often many miles from the home place) and the owner is unable to get them in to bring them down to the clinic to work in the wonderful hydraulic chute. In the case of the pasture cows we tranquilize them with the dart gun and work on their feet while they are heavily sedated and laying down. Although not as good as the clinic, this is still a generally effective diagnostic and treatment system.
Option Three:
Look at the cow on the farm in their working facilities. In other words, standing in whatever kind of chute they have, tying up the leg in question and trying to get a decent look with the cow kicking and fighting the whole time.
Yes, I was going into option three with a group of five lame cows. The first cow was brought into the chute and the hired man put a rope around her hind leg and tied it up to the side of the chute lifted about 18 inches off the ground. After repeated kicking convinced her that her foot was there to stay she stood quietly and I began my exam. Reaching down I began to move the toes to have a better look and suddenly a sharp blow sent me reeling. I rolled backwards out of the chute area, laying on the ground with my hands over my face trying not to black out.
"Do you need an ambulance? Do you need an ambulance? Go call the ambulance. Are you knocked out? Are you okay? Wow, you are really bleeding. Do you need an ambulance?"
"No, don't call an ambulance yet. Let me just lay here for a minute."
With my brain in slow motion I figured out what had happened. The cow had kicked me in the head (I still don't know how she was able to get enough slack in the rope and reach high enough) my head had bounced off the back end of the chute palp cage and then I rolled back out of the way. I had a small gash in the bottom of my eyebrow about a quarter inch from the side of my eye that had half of my face covered in blood and a large goose egg on the opposite side of my head where I had bounced off the chute. My brain did not take long to ask itself, "Why did I ever come into work today?"
Some warm water, surgical soap, bandages, and several Ibuprofen later I was ready to take charge of the situation. Each cow came into the chute for her IV injection of Xylazine and then she was released into the pen to let the tranquilizer take effect. I wasn't about to get kicked in the head again and I wasn't concerned about the added expense to the farmer for sedation of all the animals. Not surprisingly I didn't hear one word of complaint out of the farmer either. Two hours later, after lots of sweating and unpleasant words being thrown in the general direction of the two more stubborn cows, our project was complete.
The best words I heard as I was getting ready to leave the farm were, "Next time we will bring them down to the clinic."
Sunday, September 6, 2009
Sunday, July 26, 2009
Not always Rabies
Living in North Dakota brings with it some unique experiences. One thing very common here that I haven't had to deal with anywhere else is Rabies. It is a big problem and we have several cases a year. I know you are all having flashbacks to Old Yeller right now. We actually see cases very commonly in cattle as well as dogs, cats, horses and really most of the species we deal with. We rarely see a foaming at the mouth animal that is trying to bite someone. Generally ours are just acting funny or walk funny or can't stand up. Rabies is endemic in both skunks and raccoons in the state so we have a doubly great chance of contracting rabies.
Since it is so common we have many clients that have animals acting unusual and almost always the first question out of their mouth is, "Could it be Rabies?". Not surprisingly our very diplomatic answer is generally, "It could...and there are some other things we should think about". A case this week was one of these.
A cow presented with history of drooling with her tongue hanging out and acting a little funny. As she walked off the trailer I was pretty sure that it wasn't rabies. The tongue was hanging out and she was drooling but she also had a big lump on the side of her cheek and was very thin. My immediate thought was that this cow had broken her jaw. Another doctor was right there with me and began examining her mouth and immediately piped up with, "well you guessed wrong". One quick look in her mouth showed that a broken bone was the problem, but it wasn't hers...she had half of the pelvis of a calf jammed sideways in her mouth and was completely unable to close her jaw or move her tongue. Of course we took it out, gave her antibiotics and an anti-inflammatory and sent her on her way.
Just goes to show you that your first guess, and all too often your second guess isn't always right. That and not every cow that "foams at the mouth" has rabies.
Since it is so common we have many clients that have animals acting unusual and almost always the first question out of their mouth is, "Could it be Rabies?". Not surprisingly our very diplomatic answer is generally, "It could...and there are some other things we should think about". A case this week was one of these.
A cow presented with history of drooling with her tongue hanging out and acting a little funny. As she walked off the trailer I was pretty sure that it wasn't rabies. The tongue was hanging out and she was drooling but she also had a big lump on the side of her cheek and was very thin. My immediate thought was that this cow had broken her jaw. Another doctor was right there with me and began examining her mouth and immediately piped up with, "well you guessed wrong". One quick look in her mouth showed that a broken bone was the problem, but it wasn't hers...she had half of the pelvis of a calf jammed sideways in her mouth and was completely unable to close her jaw or move her tongue. Of course we took it out, gave her antibiotics and an anti-inflammatory and sent her on her way.
Just goes to show you that your first guess, and all too often your second guess isn't always right. That and not every cow that "foams at the mouth" has rabies.
Sunday, July 12, 2009
I wish not
Most of the time I love my job as a mixed animal veterinarian. There are very few times that I look at what is going to be coming in and have an unpleasant intrinsic reaction. One thing that can really make me want to run and hide or pretend that I am doing something really important so that another doctor will have to take that appointment is as simple as three little letters: DRC. Now anyone involved with the medical world knows that there are acronyms for all kind of medical things. In fact I read a medical record that went something like this.
Patient BAR, MM pink, moist CRT< 2 sec, EEN clean clear, H/L/T aus WNL. Abdominal/LN palp WNL. HR 110 BPM, Resp 28 BPM, Temp 100.6 F, EDUD WNL
I think you get the picture
Anyway back to the DRC. If any of you get squeamish you might want to stop now. DRC means Dead Rotten Calving.
These are particularly popular this time of year because most of the cattle are out on the pasture and not checked as often as usual. Some of these cows may have been calving for a couple of days before they are found. Combine that with hot summer weather and you have the perfect recipe for a rotten calving experience.
On this particular day I decided to take one for the team and tackle the DRC. Sometimes they really aren't that bad, but the fact that I could smell the cow while she was still outside did not bode well. The apologetic owner (as they almost always are with this kind of thing; one even brought me doughnuts as a peace offering) said that he didn't know how long she had been calving. She was out in a pasture that doesn't get checked often and they even thought that she was open (not pregnant) and that was why she was in that pasture.
I was delighted to smell two legs that appeared to be front legs hanging out the back out of my patient. The fact that 1/2 of the hair had already sloughed off the legs was a pretty fair sign that she had been at it for more than a couple of hours. Once I started manipulating and pulling on the feet the half rotten skin tore open on one leg revealing the bones beneath. Fortunately I already had my gag reflex under control and I was in for the long haul. As the long bone was only succeeding in tearing my plastic sleeves we decided to pull it off. I know that sounds gruesome but guess what - Junior died three days ago and he can't feel that we just pulled off his femur.
Yes, I did say femur. The legs only looked like front legs because they had decomposed sufficiently to allow all the bones in the joints to separate and bend any way that they wanted.
Without further ado, a lot of lube, some careful manipulation, and about 40 minutes we were able to remove the remainder of the partially decomposed calf.
Now many of you would say, "serves you right for being a large animal vet!" And to be honest, when confronted with such cases I have had similar thoughts. Why didn't I go into small animal where everything is easy?
Well wouldn't you know the next day I had another experience. The schedule book said dog whelping. Hey that sounds like fun.
First, I will say as a veterinarian I try not to judge people and how they are with their animals. While I will not jump on the band wagon that many veterinarians do about the evils of breeding dogs when there are so many in shelters etc etc (you can feel that way if you want to) I do occasionally run into a person that I say should absolutely not be breeding dogs. This was just such a case. Because of that there will be no reference whatsoever to owner age, gender, identity or breed. I will simply say that she was a larger breed dog.
The conversation went something like this.
Owner comes in and says, "I am not sure what is wrong with her, I think she might be having a problem.
She had one puppy without any trouble but now I don't know what is going on.
My turn,
"How long ago did she have the first puppy"
Owner
"Well, I guess it was the night before last so about a day and a half ago"
Me
stunned silence.
Thoughts whirling though my head: you have got to be kidding me, your dog had a puppy almost two days ago and she has a large piece of placenta hanging out the back of her vulva and you think there MIGHT be a problem?
Don't say anything rude, even though you are thinking it right now.
On vaginal exam of the dog I could feel just the tips of two feet. Unfortunately, I was unable to get a good enough hold and the feet weren't out quite far enough so we gave her some oxytocin and some time to get her back into labor.
Half an our later I was able to get a good hold on two back feet and wouldn't you know - the hair just sloughed right off in my hands. The dead puppy was backwards and dry and was not wanting to come out. Thankfully with a lot of lube and manipulation and way longer than I have ever had to work on another puppy the very dead, nasty puppy came out. Yes, small animal vets do get their occasional nastiness too.
Radiographs showed no more puppies, which sparked two very choice remarks from owner;
"Dang it there are no more puppies?!?"
"When we breed her again will she have any problems?"
I wish not to have these experiences again...both the nasty part and the choice owner...but I am young and will probably have even better!
Patient BAR, MM pink, moist CRT< 2 sec, EEN clean clear, H/L/T aus WNL. Abdominal/LN palp WNL. HR 110 BPM, Resp 28 BPM, Temp 100.6 F, EDUD WNL
I think you get the picture
Anyway back to the DRC. If any of you get squeamish you might want to stop now. DRC means Dead Rotten Calving.
These are particularly popular this time of year because most of the cattle are out on the pasture and not checked as often as usual. Some of these cows may have been calving for a couple of days before they are found. Combine that with hot summer weather and you have the perfect recipe for a rotten calving experience.
On this particular day I decided to take one for the team and tackle the DRC. Sometimes they really aren't that bad, but the fact that I could smell the cow while she was still outside did not bode well. The apologetic owner (as they almost always are with this kind of thing; one even brought me doughnuts as a peace offering) said that he didn't know how long she had been calving. She was out in a pasture that doesn't get checked often and they even thought that she was open (not pregnant) and that was why she was in that pasture.
I was delighted to smell two legs that appeared to be front legs hanging out the back out of my patient. The fact that 1/2 of the hair had already sloughed off the legs was a pretty fair sign that she had been at it for more than a couple of hours. Once I started manipulating and pulling on the feet the half rotten skin tore open on one leg revealing the bones beneath. Fortunately I already had my gag reflex under control and I was in for the long haul. As the long bone was only succeeding in tearing my plastic sleeves we decided to pull it off. I know that sounds gruesome but guess what - Junior died three days ago and he can't feel that we just pulled off his femur.
Yes, I did say femur. The legs only looked like front legs because they had decomposed sufficiently to allow all the bones in the joints to separate and bend any way that they wanted.
Without further ado, a lot of lube, some careful manipulation, and about 40 minutes we were able to remove the remainder of the partially decomposed calf.
Now many of you would say, "serves you right for being a large animal vet!" And to be honest, when confronted with such cases I have had similar thoughts. Why didn't I go into small animal where everything is easy?
Well wouldn't you know the next day I had another experience. The schedule book said dog whelping. Hey that sounds like fun.
First, I will say as a veterinarian I try not to judge people and how they are with their animals. While I will not jump on the band wagon that many veterinarians do about the evils of breeding dogs when there are so many in shelters etc etc (you can feel that way if you want to) I do occasionally run into a person that I say should absolutely not be breeding dogs. This was just such a case. Because of that there will be no reference whatsoever to owner age, gender, identity or breed. I will simply say that she was a larger breed dog.
The conversation went something like this.
Owner comes in and says, "I am not sure what is wrong with her, I think she might be having a problem.
She had one puppy without any trouble but now I don't know what is going on.
My turn,
"How long ago did she have the first puppy"
Owner
"Well, I guess it was the night before last so about a day and a half ago"
Me
stunned silence.
Thoughts whirling though my head: you have got to be kidding me, your dog had a puppy almost two days ago and she has a large piece of placenta hanging out the back of her vulva and you think there MIGHT be a problem?
Don't say anything rude, even though you are thinking it right now.
On vaginal exam of the dog I could feel just the tips of two feet. Unfortunately, I was unable to get a good enough hold and the feet weren't out quite far enough so we gave her some oxytocin and some time to get her back into labor.
Half an our later I was able to get a good hold on two back feet and wouldn't you know - the hair just sloughed right off in my hands. The dead puppy was backwards and dry and was not wanting to come out. Thankfully with a lot of lube and manipulation and way longer than I have ever had to work on another puppy the very dead, nasty puppy came out. Yes, small animal vets do get their occasional nastiness too.
Radiographs showed no more puppies, which sparked two very choice remarks from owner;
"Dang it there are no more puppies?!?"
"When we breed her again will she have any problems?"
I wish not to have these experiences again...both the nasty part and the choice owner...but I am young and will probably have even better!
Sunday, June 21, 2009
Guts?
Before starting practice I thought I had a pretty good idea of the types of things I would be seeing and the calls that I would get from clients. Of course I was wrong in that assumption and now it is to the point that when someone calls and tells me something, I believe almost anything they say is possible. Earlier this spring I got back from a day in the country to find an interesting case waiting for me. The owner said that he had a newborn calf that the guts had come out of the navel when it was born. I have seen this occasionally and asked how long it had been out and how clean they were. He said, "Oh, the guts aren't actually out there is a big ball of skin around them". Of course now I was curious and thinking that we had just a regular hernia. As always you don't know until you look so out we went to peek in the back of his pickup to see what we had.
Mildly confused is how I started out as he was right there was a sack full of something hanging out of the calf's navel. It was a thin sack with no hair on it that looked mostly just like connective tissue and the contents were about the size a women's basketball. Once I started to feel it my confusion moved up to a moderate level. Part of the contents were very soft and squishy, and part was very firm; almost like muscle. The hole in the navel was very small and I was unable to return any of the contents back into the abdomen. Because the sack was not clear I couldn't see the contents and decided to cut it open for a better look. At this point I was expecting that the "squishy" part was normal small intestine and the "firm" part was small intestine the was twisted or strangulated and was very full and tight. Not to my surprise; I was wrong. To my surprise; when I cut the sack open, I found some small intestine and a large section of liver. No one has to go to years and years of school to know that no part of the liver should be hanging in a sack outside of the belly. You also don't have to go to school to know that a volleyball sized piece of liver did not go through a hole as big as two of my fingers. That the leaves the option that the liver (or at least a section of it) was actually formed on the outside of the body.
Now that we had established what we were dealing with the discussion went something like this:
So the liver is outside of the body?
Yes.
Can you put it back in?
Yes
Does it have a chance?
(This is where my philosophy is that honesty is the best policy)
I have absolutely no idea.
Since we know that this part of the liver was formed outside of the body I don't know anything about he connections to the blood supply, whether the liver will function properly, what other malformations there may be, or really anything to indicate whether this calf could live.
Wow, that's really interesting. So what would it cost to operate on it? Well, what the heck, I am curious to give it a try and see if it will live.
So we proceeded to do a liver-returning-into-abdomen surgery in the back of his pickup and sent him on his way.
That was two months ago.
The other night I was out to their farm to fix a broken leg on a calf and son number one says "Well your miracle calf is still alive, in fact you can't even pick it out from the rest of the calves unless you know which tag number it is!"
Now when people ask me is there a chance I think I will repeat what I heard somewhere:
"Where there is a heartbeat there is hope."
Mildly confused is how I started out as he was right there was a sack full of something hanging out of the calf's navel. It was a thin sack with no hair on it that looked mostly just like connective tissue and the contents were about the size a women's basketball. Once I started to feel it my confusion moved up to a moderate level. Part of the contents were very soft and squishy, and part was very firm; almost like muscle. The hole in the navel was very small and I was unable to return any of the contents back into the abdomen. Because the sack was not clear I couldn't see the contents and decided to cut it open for a better look. At this point I was expecting that the "squishy" part was normal small intestine and the "firm" part was small intestine the was twisted or strangulated and was very full and tight. Not to my surprise; I was wrong. To my surprise; when I cut the sack open, I found some small intestine and a large section of liver. No one has to go to years and years of school to know that no part of the liver should be hanging in a sack outside of the belly. You also don't have to go to school to know that a volleyball sized piece of liver did not go through a hole as big as two of my fingers. That the leaves the option that the liver (or at least a section of it) was actually formed on the outside of the body.
Now that we had established what we were dealing with the discussion went something like this:
So the liver is outside of the body?
Yes.
Can you put it back in?
Yes
Does it have a chance?
(This is where my philosophy is that honesty is the best policy)
I have absolutely no idea.
Since we know that this part of the liver was formed outside of the body I don't know anything about he connections to the blood supply, whether the liver will function properly, what other malformations there may be, or really anything to indicate whether this calf could live.
Wow, that's really interesting. So what would it cost to operate on it? Well, what the heck, I am curious to give it a try and see if it will live.
So we proceeded to do a liver-returning-into-abdomen surgery in the back of his pickup and sent him on his way.
That was two months ago.
The other night I was out to their farm to fix a broken leg on a calf and son number one says "Well your miracle calf is still alive, in fact you can't even pick it out from the rest of the calves unless you know which tag number it is!"
Now when people ask me is there a chance I think I will repeat what I heard somewhere:
"Where there is a heartbeat there is hope."
Saturday, May 23, 2009
6th Grade
Calving season is finally slowing down. Although the entire season has potential for unusual and unexpected things, sometimes the end brings the biggest surprises. Yesterday and the week before I had similar experiences. I was told by one of our office personell that there was a heifer coming that was calving. Now for those of you who are not particularly farm animal terminology savvy a heifer is a young female of the bovine or cattle species. In general that name applies to all females up until they have their first calf. Naturally I assumed that my soon to arrive patient was the typical two year old heifer having her first calf.
When the heifer arrived I soon realized that something was not as previously assumed as the heifer was much smaller than would be expected. This was particularly evident as I had just been out to Bangs (Brucellosis) vaccinate the heifers of this farmer and knew that he fed is cattle very well. In fact she looked no bigger than any of the those just coming yearling heifers I had vaccinated a few months previously. I am sure by now that many of you have guessed that she actually was one of those heifers and was now just over 14 months.
The first heifer's calf was delivered by a C-section.
The heifer from yesterday was a small black angus heifer that probably didn't even weigh 800 lbs (mature weight can be anywhere from 1100-1800 lbs). The owner had looked at her ear tag and found that she was just over 13 months old. Of course I did the math in my head and realized that this heifer had to have been bred when she was a 4 1/2 month old calf at her mother's side and here she was 9 months later with her own bouncing bundle of calf. I guess this is what would be the animal kingdom equivalent of a 6th grade pregnancy.
When the heifer arrived I soon realized that something was not as previously assumed as the heifer was much smaller than would be expected. This was particularly evident as I had just been out to Bangs (Brucellosis) vaccinate the heifers of this farmer and knew that he fed is cattle very well. In fact she looked no bigger than any of the those just coming yearling heifers I had vaccinated a few months previously. I am sure by now that many of you have guessed that she actually was one of those heifers and was now just over 14 months.
The first heifer's calf was delivered by a C-section.
The heifer from yesterday was a small black angus heifer that probably didn't even weigh 800 lbs (mature weight can be anywhere from 1100-1800 lbs). The owner had looked at her ear tag and found that she was just over 13 months old. Of course I did the math in my head and realized that this heifer had to have been bred when she was a 4 1/2 month old calf at her mother's side and here she was 9 months later with her own bouncing bundle of calf. I guess this is what would be the animal kingdom equivalent of a 6th grade pregnancy.
Sunday, April 26, 2009
Wallow
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.
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 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.
Subscribe to:
Posts (Atom)
