A Hasty Exam

D. E. Larsen, DVM

“Dick, give me a quick rundown about what happened here,” I said as I was unloading a few things from my truck.

Dick had called earlier, a little frantic. He had just pulled a calf from a cow and had a lot of problems with the pull. Now, he said, the cow had a prolapsed uterus.

“I have pulled a lot of calves, Doc,” Dick said. “Now don’t get me wrong, I know you are supposed to be pretty good at the OB stuff, but I have done my share. This calf had both hind legs back, just his butt at the birth canal. You know, I called Dr. Jones from back in Montana, and he said to just push the butt forward and reach down and grab the legs. So that is what I did, and it wasn’t as easy as he made it out to be. But I got the calf out, and it was dead. Then I looked at the cow, and her uterus is hanging out, just like you can see now.”

“A lot of backward calves are dead when you get them out,” I said. “Especially if they are breech like you describe this one. The calf just doesn’t engage the cervix to cause the cow to start contracting. So we often just don’t notice the cow is in labor until after the calf is dead.”

“Well, now I am worried about the cow’s prolapse,” Dick said.

“What did Dr. Jones have to say about that?” I asked.

“He said I better give you a call,” Dick said.

I started washing the cow up, and I tied her tail out of the way with a twin tied around her neck. 

“This doesn’t look good,” I said. “This is just her cervix hanging out of her vagina. I am not sure I have ever seen this before.”

I pulled on an OB sleeve and pushed the cervix back into the vagina. My hand just advanced through the cervix into an open space. There was no uterus attached to the cervix. I reached deeper. I could feel gut, rumen on the left, and even her right kidney. I reached down, there in the bottom of her abdomen was the uterus. I could grab it, but I could not pull it to the pelvis on the first try. Dick had ruptured the uterus in pushing the calf forward. It is sort of amazing that he could get the calf out of there.

“Dick, this cow is in bad shape,” I said. “You tore the uterus completely off the cervix. It is lying in the bottom of her abdomen. She has got to be losing a lot of blood.”

“What are we going to do now, Doc?” Dick asked.

I walked around to her head. Lifting her muzzle up, I looked at her oral membranes, they were ghost white. I kicked myself, I should have looked at her first, before just concentrating on the obvious cervical prolapse.

“Does this chute have a side release, Dick?” I asked.

“Oh no, Doc, this chute is probably older than the two of us combined.”

“Well, the first thing we are going to do is get this cow out of the chute before she drops dead,” I said.

“This is a pretty big pasture, we might have a hard time catching her,” Dick said.

“You are going to have on heck of a time getting her out of this old chute when she is dead,” I said as I popped open the headgate.

The cow staggered out of the chute. She walked a half a dozen steps, stopped and stood for a moment, and then fell over, dead when she hit the ground.

“What the hell happened?” Dick asked.

“Dick, when you were pushing that calf’s butt forward, you pushed a little too hard,” I said. “You tore her uterus right off the cervix. That pregnant uterus has some massive blood vessels, so she has been bleeding inside since that happened. Couple that with some shock, and you have a dead cow. There was probably no saving her, once the rupture occurred.”

“What would you have done differently, Doc?” Dick asked.

“Tissue feel is something that is learned,” I said. “I probably would not have pushed his butt in the first place. Not that that was wrong, some vets do that, I am usually able to get the hind legs up without pushing the butt that much.”

“Well, maybe Dr. Jones didn’t explain things good enough,” Dick said.

“You get what you pay for Dick,” I said. “Had you called me first, the calf probably would have still been dead.  But the cow would be alive. You need to decide who is going to do your veterinary work, me, or someone else around here, or Dr. Jones in Montana.”

Photo Credit: Photo by John Lambeth from Pexels

Don’t Be Too Smug

D. E. Larsen, DVM

I pushed the winch out to the end of the track and jumped up on the truck’s bed. I secured a chain around the hocks of the dead horse. With the shackle secure, I connected the hook on the winch cable to the chain and lifted the horse up and pushed it into the necropsy room.

This was the summer of my sophomore year in vet school. I was lucky enough to land this job as a necropsy technician in the Colorado State Veterinary Hospital. Up to this point, it was proving to be a tremendous learning experience.

There was a joke in the profession that had a punch line something like; a veterinarian can eat his mistakes. I was never good at remembering jokes. This summer, I got to see the mistakes and the pathology associated with the profession.

I positioned the dead horse in the middle of the necropsy room and lowered it to the floor. I unhooked the winch and removed the shackles, before rolling the winch to the side, out of the way for now.

Dr. Norrdin was on duty as the necropsy pathologist this week. I enjoyed working for him because I got to do most of the necropsy, and he was always challenging my knowledge, usually in a game-like manner.

“Okay, let’s look this guy over closely, read the notes and then come up with a possible diagnosis before we start the necropsy,” Dr. Norrdin said. “You have to be prepared to defend your suspected diagnosis. Then we will find out who was closest to the actual diagnosis.”

This was a young horse, less than four years old. Found dead in the paddock this morning. He was never observed to be sick, ever. Looking over him, there was hardly a mark on him. The only thing evident was his front teeth were punched through his upper lip and protruding out of that lip.

Dr. Norrdin quizzed the resident first, the junior technician next, and finally came to me.

“What is your diagnosis, Larsen?” He asked.

“Cardiac Tamponade,” I said.

“Cardiac Tamponade!” Dr. Norrdin remarked. “How in the world do you arrive at that diagnosis from looking at a young, healthy horse?”

“A young, healthy, dead horse,” I corrected. “This young heathy horse, who has never been sick a day in his life, was dead when he hit the ground. His death was sudden. We know that, not because he was unexpectedly found dead in the morning, but because his front teeth are punch through his upper lip. He hit the ground nose first. Who has seen a horse, standing in a paddock, fall nose first? This had to be a sudden cardiac event.”

“But Cardiac Tamponade,” Dr. Norrdin said, “I have not seen a Cardiac Tamponade in the horse. You know the saying, when you are in a barn and hear hoofbeats, you look for a horse, not a zebra.”

“And, the proof is in the pudding,” I said as I stuck my knife into the dead horse’s ventral midline on his chest.

“If I am correct, we will know in a minute or two,” I said as I sliced open the skin from the end of his sternum to his jaw’s angle.

With the junior technician lifting up the right front leg, I severed all the muscle attachment to the ribs, and we reflected the front leg over the horses back to expose most of the ribs. Then I severed the lower cartilage attachments of the ribs to the sternum. The other technician, standing at the horse’s back, pull up several ribs as I cut the intercostal muscles. 

There is was, the pericardium, that sack around the heart, distended with blood. I was vindicated, my diagnosis was spot on. Cardiac Tamponade occurs when the pericardium fills with fluid, usually blood. That constricts the hear’s function. If it is a slow accumulation, it can be recognized and corrected. If it is sudden, it results in sudden death.

“I’ll be damn,” Dr. Norrdin said. “Now, let’s find out just what happened to allow Larsen to win the game.”

“Verminous arteritis,” I said.

“Now you are really sticking your neck out,” Dr. Norrdin said. “But this time, I think you are probably correct.”

We opened the pericardium and drained a surprising amount of blood. The heart was small in appearance because it had not been able to fill with blood. And there it was, a hole in the aorta, right where it came out of the heart. This hole, the size of a match stick, would have filled the pericardium with blood in seconds. A very sudden death would have resulted.

“You guys pull the heart and lungs with the aorta attached,” Dr. Norrdin said. “Try to keep the aorta intact all the way down to the mesenteric artery.”

In the horse, one of the critical intestinal parasites, a large strongyle, Strongylus vulgaris, has a larval stage that causes severe damage and inflammation to the mesenteric artery, the main artery to the gut. This is one of the leading causes of colic in the horse.

We opened the aorta from the heart to the mesenteric artery. There were lesions the entire length of the aorta. The root of the mesenteric artery was swollen and heavily involved with verminous arteritis. This is the standard location of those lesions. The fact that lesions were also located along the entire length of the aorta was an indication of a massive infestation with this dangerous parasite.

“If this horse did not die from this cardiac tamponade, he would have died from severe colic before long,” Dr. Norrdin said. “This is as extensive of an arteritis as I have ever seen.”

“Do you think the rupture of the aorta was caused by the parasite?” I asked.

“Oh, most definitely! This owner needs to get his horses on a rigorous parasite control program, or he will be losing a lot of horses,” Dr. Norrdin said. 

“And Larsen, don’t be too smug,” Dr. Norrdin said. “You will never see another case like this in your life. These once in a lifetime cases, just happen, early in your career and later in mine, but only once. Had this been on a test, all of your answers would have been marked wrong. You just had a lucky guess here today.”

Of course, Dr. Norrdin was correct. I never saw another case like this. I never read of another case like this. But having seen the damage from uncontrolled parasitic infections, it is much easier to make strong recommendations to horse owners about their parasite control programs.

Photo Credit: Photo by Pixabay from Pexels

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