Eperythrozoonosis

D. E. Larsen, DVM

Jack was at the corral gate when I pulled into his upper barnyard. He was opened the gate as I stepped out of the truck. There in the middle of the corral was a young llama lying down and obviously not feeling well.

“Jack, it’s good to see you. How are things going?” I said as I got out of the truck.

“We are doing well,” Jack said. “But this little gal is looking droopy this morning.”

Llama had a strong herding instinct and they rarely showed any sign of ill health until they were in very serious condition. For this little llama to be down in the middle of the morning was a sign she was likely very sick.

“How long has she been like this, Jack?” I asked.

“I guess I don’t know,” Jack said. “I looked at all of them yesterday. I can’t say for sure that I saw her, but I sure didn’t notice her being sick.”

I grabbed my stethoscope and a couple of blood tubes went in the corral with Jack. We had to coax Sugar to stand. I raised her lip and looked at her oral membranes. They were pale, in fact, they were almost white. 

Trying not to get ahead of myself, I took stuck a thermometer into her rectum and listened to her chest and abdomen while I was waiting on the thermometer. Everything was normal except for the obvious anemia.

“Jack, I am going to get some blood out of her. I might need to run it back to the lab before I treat her,” I said. 

I drew a couple of tubes of blood. The blood was almost like water. Obviously, red but it was thin enough that her anemia must have severe. I collected another small amount of blood with a syringe and made several blood smears so they would not have any artifacts from the additive in the purple top tube that keeps the blood from clotting.

“Jack, this is a severe anemia,” I said. “It might even be life threatening, this blood is very thin.”

“What can cause that to come on so fast?” Jack asked.

“I probably didn’t come on so fast,” I said. “These llamas will hold out until they are near death before they will show any signs of illness. It just got to the point where she could not cope with it any longer. I don’t know what it can be. I have seen anaplasmosis in cattle that were this anemic when I worked in the feedlots in Colorado. I haven’t seen anaplasmosis here, but I guess it is possible.”

“Do you think she is going to be okay while you run to the lab?” Jack asked.

“That’s a good question,” I said. “I think with how this blood looks that I should treat her with some tetracycline now. In cattle, prompt use of tetracycline will reduce mortality. Blood transfusions are sometimes necessary, but I need some supplies from the office to do that. I will be able to tell from the initial blood results if a transfusion is needed. I will be sending this blood to the diagnostic lab in Corvallis to check on the diagnosis, but I will look at it in my lab first.”

I gave Sugar a dose of intravenous tetracycline and also some dexamethasone. The dexamethasone was probably controversial, but I always remember Dr. Annes saying, “No patient should die without the benefits of steroids first.” I would at least help to slow the immune response if a blood parasite was the cause of this anemia.

“Jack, I have some time today,” I said. “I will run back to the lab and get this blood looked and also get it on the way to Corvallis and then I will come back here in an hour or two if Sugar needs any additional treatment today. Either way, I will give you a call.”

Back at the clinic, I ran a quick complete blood count. Sugar’s packed cell volume was eighteen percent. Values below fifteen percent were considered to require a transfusion.

My next step was to stain one of the blood smears I had prepared from the  blood collected with the syringe. Under the microscope it always took me a moment to adjust my thinking when looking a llama blood. All the red blood cells were elliptical. 

This slide showed a lot of basophilic strippling. This was indicative of an anemia and was often seen in anaplasmosis in cattle. There was no evidence of any anaplasma organisms on the red blood cells. But there was something there that I couldn’t identify. I would have to send the blood and the smears to the lab.

“Jack, I think the Sugar is okay for today with the treatment that I did earlier,” I said when I called Jack. “I am sending the blood to the lab with a currier, so they will get it this afternoon. She is anemic, but not bad enough to require a transfusion. There is a blood parasite there, or some infection on the red blood cells. We will have to wait for the lab results. I will drop by in the morning to give her another injection and to recheck her blood.”

“Are you sure about not needing a transfusion?” Jack asked. “These little gals are pretty valuable, you know.”

“Her blood is above the line that we draw,” I said. “That said, it’s man that draws the lines, in nature, everything is a continuum. But if we do a transfusion too soon, the bone marrow gets the message that it doesn’t have to work so hard. Sometimes a transfusion given too soon, does more harm than good.”

***

I was in the corral looking at Sugar when Jack came out of the house.

“I thought you said it would around nine when you got here this morning.” Jack said.

“I probably said that, but in this business, I have to to do things when the time becomes available,” I said. “I’m sorry if I hurried you. Sugar is looking better this morning.”

“I thought she was up and about when I watched her out the window this morning,” Jack said. “Did you get any results from the lab yet?”

“The diagnosis is eperythrozoonosis,” I said. “Does that help you out any?”

“Doesn’t do a thing for me,” Jack said. “Does it come with a common explanation.”

“This is an infection of the red blood cells,” I said. “A small organism, a mycoplasma, infects the blood cells and the body removes those cells because they infected. It is sort of a number’s game. If enough red cells are removed, the patient becomes very anemia.”

“How did she get it?” Jack asked. 

“I don’t know that we know for sure,” I said. “Biting insects and ticks can spread it. Also using non sterile needles and surgical instruments can spread it. I am not sure if she could have gotten it from her mother. But that is a possibility. This treatment will make her better and she will unlikely have any more problems, but it is unlikely to eliminate the bug from her system. You just need to remember that she could be carrier for the rest of her life.”

“Do I have to do anything more for her?” Jack asked.

“I am going to come by every morning for another few days, just to give her an injection,” I said. “If you leave her here, you don’t need to be here. I will just run by and give her an injection. After that I will repeat the blood, and if it looks like it is needed, I will fix you up with some oral medication for another week. That will be some powder to put in her water. I think the injections will clear things up her.”

Sugar recovered with no complications and became a part of Jack’s llama herd for the next several years. That was when the llama market collapsed and Jack sold his herd, twice. The final time, for pennies on the dollar.

Photo by Erik McLean on Pexels.

From the Archives, one year ago

A Saturday Afternoon Outbreak, click on the link:

https://docsmemoirs.com/2020/11/23/a-saturday-afternoon-outbreak/

Once in the Wilds of Afghanistan

D. E. Larsen, DVM

The large poster on the wall with a picture of W. C. Fields caught my eye. “Once in the wilds of Afghanistan, I lost my corkscrew, and we were forced to live on nothing but food and water for several days.” He was talking about wine, but it reminded me of my army days when beer was the preferred beverage.

We were gathered around the dinner table in the small country restaurant in the middle of Nebraska. There were six of us, all senior veterinary students, spending a week pulling calves in a progeny test herd of six hundred heifers for a company supplying semen to the cattle industry. 

The practice of cross-breeding using bulls of exotic beef breeds was becoming a popular option in the mid-1970s. There were a couple of problems with the practice. One, the bulls involved were selling for extremely high prices, some as much as fifty-thousand dollars. And two, with some of these exotic breed bulls, the incidence of dystocia (difficulty calving) was high.

This test herd was utilized to document a calving ease figure for the bulls used to sire the delivered calves. This figure was then used for marketing the bull’s semen, giving the rancher more confidence that his cows would have the cross-bred calves with undo complications.

The experience provided to us students was invaluable. We learned from the numerous obstetrical problems and had to help manage this herd of six hundred heifers in an open pasture of nearly forty acres. We also had to meet a client’s expectations, something that we had little experience with while in school.

The six of us were given a school car to drive to the ranch. The six students we were replacing jumped in the car with a bit of glee and drove it back to school. On the ranch, we had a pickup to drive to the village for our meals at this small cafe and an old military three-quarter ton to check the cow herd.

Divided into three shifts, we were responsible for checking the herd of heifers every two hours, twenty-four hours a day. We kept track of the heifers and the time of their labor. We tagged calves and recorded data on their births. And we moved to the barn, any heifer having difficulty with delivery. 

During the week we were there, the weather was brutally cold. There was just a light covering of snow on the ground. Still, the temperatures hovered between zero and ten to fifteen below zero the whole time.

After dinner, Jim Logan and I began our first shift of watching the herd and taking care of any problems.

The canvas roof and sides on the old military truck didn’t hold in the heat very well. We noted a heifer with a new calf down by the creek, separate from the main herd on the first trip around the herd. The calf had been tagged, so there was nothing we needed to do. 

On this first trip through the herd, there was a heifer that needed to be brought into the barn. I got out and herded her slowly while Jim followed in the truck for most of the distance before he went ahead to make sure the gates were set up for her entrance.

She knew she was headed to the barn and that it would be warmer there, and she led me more than I herded her. Once inside, with the propane heater turned on full blast, it was slightly warmer but still cold.

Jim had things set up, and I pushed the heifer right into the chute. 

Jim cleaned up the cow and checked her quickly. 

“It looks like we lucked out with this one,” Jim said. “I think we can pull this calf easily. We might even get an hour of sleep before our next herd check.”

Jim hooked up the calf puller and jacked the calf out of the heifer as I completed the paperwork. We tagged the calf and moved the pair into the holding pen in the back of the barn. This calf was lucky. Mom would have him cleaned up and dry before he would be turned out to the cold in the morning. We headed to the house for a cup of coffee and a short nap in the recliner before our next trip.

As the evening wore on, the cold became overwhelming, and we became busier with the calving. 

On our second trip through the herd, we brought two heifers into the barn. With the propane heater blowing full blast, the water still froze as it hit the ground.

“This one is going to be a tough one,” Jim said. “You better check it, too.”

I washed and pulled a plastic sleeve on my arm. The warmth on the inside of the cow felt good. It reminded me of morning milkings when I would lean against the cow’s belly to keep warm.

“I agree, this is going to be a tough fit, but I can slide a hand between the pelvis and the calf’s shoulders,” I said. “I think we should try to pull it.”

“What are we going to do if we get into a hip lock?” Jim asked.

“With both of us here, we should be able to turn those hips to an oblique position and get him out,” I said. “I say again, I think we should pull it.”

We hooked the calf jack onto the front feet and started the calf out. He slid through the birth canal with ease, and we were just about thinking we were home free, and then he came to a dead stop.

“Damn, his hips must be massive,” I said. 

“Okay, let’s push him back a bit and get those hips on a diagonal,” Jim said.

When we started pushing on this calf, we realized how big he was.

“He must be over a hundred pounds,” Jim said.

After a bit of push back to disengage the hips from the pelvis, we put a twist on the calf. As we turned the hips to a diagonal position, taking advantage of the broadest measurement of the pelvic canal, the calf almost fell out the rest of the way. As his hips cleared the pelvis and the calf’s weight pulled his hips and hind legs the rest of the way out, Jim had to catch his head, so it didn’t bounce on the floor.

“That was close,” Jim said. “I don’t think his father will score very well.”

We cleaned up after this heifer and ran the second one into the chute. I checked this on first, this time.

After washing her rear end and tying the tail out of the way, I ran my hand into the birth canal. I talked my way through the exam to give Jim my impressions first hand.

“These feet are massive, larger than the calf we just delivered,” I said as I advanced my hand deeper into the birth canal. “There is nose, but I can’t fit hand over the top of the head. This calf is so large, his head won’t even come into the birth canal. I think this is going to be a C-section.”

Jim checked the cow and agreed. We both glanced at the clock.

“We are going to have to hurry to make the last check,” Jim said.

It was surprising how fast we could be with two professionals working on the same problem. We had the left flake clipped and prepped in no time. I had the lidocaine drawn into two sixty cc syringes by the time Jim finished the prep. Jim opened the surgery pack and scrubbed while I completed an inverted ‘L’ block. When I stepped away, he was ready to make the incision.

When we had the abdomen open, it was a little chore to roll the hind feet up to the incision. Once the feet were there, we incised the uterus and attached a set of chains to the feet. 

I started to pull the calf out of the incision, and Jim carefully enlarged the uterine incision as needed. When the butt of the calf cleared the incision, I cried, uncle.

“I am going to need a hand with this monster,” I said.

Jim put the scalpel aside and grabbed one of the calf’s hind legs. We both pulled hard, and the calf finally flopped out of the uterus. 

“He looks two weeks old,” Jim said.

I took care of the calf while Jim started with closing up the heifer.

“He is going to be on his feet before we get momma closed up,” I said as I gave Jim a break and finished closing the flank incision.

We were only a few minutes late to do our two-hour herd check after getting momma and calf back in a holding pen.

The cold struck us both as we stepped out of the barn. The old three-quarter-ton turned over slowly, but it started with a cough as the battery waned. Jim started the truck down the hill, and I turned the heater up full blast, but it was still blowing cold air.

We started around our route. And as I huddled over the heater vent, hoping for some warmth, Jim turned toward the edge of the herd.

“We better go check this heifer. It looks like she has a new calf,” Jim said.

I glanced up and realized that this was the heifer with a tagged calf that we had noted earlier.

“Jim, she has been there for several days,” I said.

“Several days!” Jim said. “This is our first night. This might be a long week.”

As the week wore on, the cold was unrelenting. The only warm spot was inside a cow. Thankfully, the little house that we stayed in was kept warm as toast.

As we talked about our plans following graduation, all the guys from Colorado and Wyoming badgered me about the Pacific Northwest.

“Larsen, I don’t understand why you want to work out there where it rains all the time?” John said.

“It might rain a little, but it is a warm rain most of the time,” I said. “And the water doesn’t freeze when it hits the floor. And you don’t have to find a cow’s belly to get warm.”

Image by Hans Benn rom Pixabay.