What are the Odds

D. E. Larsen, DVM

The young heifer strained hard as I tried to explore the four feet presented at her vulva. I slid my arm into the vagina alongside the legs. I could determine that these were two front legs and two hind legs, but were they from two different calves?

“She has been straining like that all morning, Doc,” Ole said.

We are in a small barn, just out of Enumclaw. I had been out of school for a couple of months. “A complex delivery like this is not fair,” I think to myself.

“She doesn’t look big enough for this to be twins,” I said. “This has to be an abnormal calf. I am going to push it back into the uterus a little, that will allow me to explore it a little better.”

Ole did not reply, I am sure he is second-guessing his request for me to check the cow. All the Norwegians seemed to want Dr. Larsen these days.

I pushed on the feet with both hands. Slow, steady pressure was needed to push the calf back out of the birth canal. I knew there was a risk of rupturing the uterus if I was too aggressive.

Finally, the calf was out of the birth canal, and I could feel the entire calf. Confused for a moment, but then I was able to define this calf. The four feet surrounded the head, and there was somewhat of an apron of skin surrounding the feet and head. Reaching over this apron, I ran into the exposed intestines of the calf. And I could feel a severely contorted spinal column.

“Ole, this is a mess,” I said. “This is a schistosomus reflexus calf. That is a fetal monster. This calf is sort of inside out. He has an open abdomen and chest, and his back is bent backward. The good thing is he is small, I should be able to cut him into a couple of pieces and get him out.”

“That sounds pretty gruesome,” Ole said. “Have you done that before?”

“I have done a lot of fetotomies, but never on a calf like this,” I said. “This is one of those things that a veterinarian is supposed to see once in a lifetime. What are the odds of me having one this early in my career? Seems like it is not fair for me to have to deal with it in my first few months of practice.”

I am sure I can recall that a fetotomy on a schistosomus reflexus calf was supposed to be complicated. It probably depends on the cow and the calf and the situation. This proved easy, I dropped an OB chain over the back of the calf and was able to pull it up between all the legs and pull the OB wire around the calf. With a fetotome, I was able to saw the calf into two pieces in short order. With a little luck, this one cut also severed the head. I was able to extract the three sections with hand traction.

“That looked awful easy,” Ole said. “I thought you said it was going to be a mess.”

“I think we got a little lucky,” I said. “She is a small heifer, it was a small calf, and only one cut was necessary. It could have been a lot worse.”

“It could have been a lot worse,” I thought to myself. Here I am, some thirty years later, and it is a lot worse.

I stand on my tip-toes to reach a little deeper into the cow. When I reach a little deeper, I find intestines. This is a large cow in a muddy pasture, and it is going to be dark soon. This has to be a schistosomus reflexus, but the fetus is not fully reflexed. This would be an impossible fetotomy, even for me when I was a young man. This is going to be a C-section, and it will be best to be done over at the vet school, where there will be more than one set of hands.

“George, this is a mess,” I said. “She has an abnormal calf in her. It is called a schistosomus reflexus. The calf sort of bends in two, backward, and the belly and chest are open. This one does not feel like it is fully bent backward, it feels sort of spread out flat. I am not confident that I can get it out. The best option would be to take her over to college and let them do it.”

Convinced that I am done working on the cow, I clean up as George and Sharon discuss the referral option.

“Okay,” George says. “Let’s go ahead and take her over there.” 

“Let me give them a call and make sure they will be waiting for you,” I said.

We called and made the arrangements, and George and Sharon loaded the cow up in their stock trailer and headed for Corvallis.

The school concurred with my diagnosis and elected to do a C-section. They used general anesthesia, which is risky in cows that have not been held off of food and water for an adequate time.

They were successful in getting the abnormal fetus out. George described the calf as a spider calf, one heck of a looking thing. 

Unfortunately, the cow died during the night. I never got any paperwork on the referral, probably because the referral was done on an emergency basis, and no paperwork was involved. My guess was that it was a death associated with the anesthesia. Still, I am sure the surgery would have been a difficult one. So, who knows. 

This was one of those cases where a lot of work was done, and a lot of expense was incurred, and there was no happy ending. 

With two, once in a lifetime events, I figured I was done with these schistosomus reflexus calves. I mean, what are the odds of having three.

Then, a couple of months later, came a late-night call to look at a cow for Alex and Debbie. A large Black Angus cow was in labor and some distress with no progress. When I arrived, she was laid out flat and straining, with no evidence of any progress.

“She has been like this for the last hour, maybe a little longer, Doc,” Debbie said. 

I cleaned her up and got down behind her. Actually, for these large cows, the exam is easier when they were laid out flat. More manageable, for the exam, but it can be a little difficult to keep oneself clean and dry. Thankfully, I had a good pair of rain bibs, and she was on a good bed of straw.

It did not take long to make a diagnosis. It had only been a couple of short months since I had worked on George’s cow. The calf in this cow was close to the same, but it was fully relaxed with four feet presented to the birth canal.

“This is not good, Debbie,” I said. “This is a fetal monster. In a large cow like this, it will be difficult to section it enough to get it out. The better option would be to go to the vet school for surgery.”

“How much is that going to cost?” Alex asked. 

“I sent a cow over there a couple of months ago for the same problem,” I said. “I don’t know what the bill totaled to finally, but it was over a couple of thousand dollars, I think. And the cow died.”

“We are going to have to think about that,” Debbie said. “This is a purebred, but she is nothing special. Actually, she is not much more than a commercial cow. I don’t think a thousand dollars pencils out for her.”

“Do you think we could make hamburger out of her, Doc?” Alex asked.

“You could eat her if you were starving,” I said. “But now, I think you would find the meat unacceptable. She is under a tremendous amount of stress, and this uterus is probably infected by now. If we are not going to try to save her, we should put her out of her misery now.”

That was the decision that was made. In the end, the feelings for the cow, and relieving her pain and distress became more critical than salvaging a few dollars. Their son ran to the house and returned with a 9mm pistol.

“How do we do this?” the son asked. “Shot her between the eyes?”

“The likely hood of missing her brain is high if you shoot her between the eyes,” I said. “If you are going to shoot her there, you want to use a large caliber rifle. With this pistol, you want to shoot her behind her poll, on the back of the head. That way, if you are on the midline, you can’t miss the brain.”

With that instruction, it was done. It was probably the best outcome for the circumstances. It was definitely the best financial decision. Sometimes in food animal medicine, one has to cut your losses. What may be the best medical decision is not always the best financial decision.

Photo Credit: Photo by Chelsea Cook from Pexels

Schistosomus reflexus links (These may not be pleasant to view for some people):

https://medcraveonline.com/JDVAR/images/JDVAR-02-00045-g006&7.png

https://inpractice.bmj.com/content/inpract/14/4/204.full.pdf

https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1751-0813.1996.tb09988.x