Benefits of Experience

D. E. Larsen, DVM

The phone jarred me awake. It was going to be another late night, and I thought calving season was over. I glanced at the clock as I picked up the receiver, 1:30.

“Doc, this is Jack. I have a llama who gave birth tonight,” Jack said in an excited voice. “They almost always birth during the morning, but this one came tonight, and she has a problem.”

“What’s going on with her, Jack?” I asked.

“I think she has a prolapsed uterus,” Jack said. “And she is not doing well. She hasn’t even looked at the baby.”

“Llamas rarely have birthing problems,” I said. “But when they have problems, it is when they give birth at night.”

“Can you come out and get a look at her, Doc?” Jack asked.

“It won’t take me too long,” I said. “You know I am in bed.”

“I know, Doc,” Jack said. “I’m sorry, but it is like when we used to have to Hoot Owl in the woods. You just got to get up and go.”

“Don’t do anything with her until I get there,” I said. “If she is not feeling well, she might be in shock. We don’t want to add any stress. Where do you have her, Jack?”

“She is in the little barn up here by the house,” Jack said. “I will have all the lights on for you.”

I have seen very few birthing issues with llamas. One with a prolapsed vagina that I ended up delivering the baby, and that was about it. If this is a prolapsed uterus, it will be a first for me. Unlike a cow, this llama is probably worth about $30,000.

Jack was waiting at the barn door when I arrived. He was having trouble standing still.

“I am glad you could come so quick, Doc,” Jack said as I stepped out of the truck. “She doesn’t look good to me at all.”

I gathered my stuff for the first trip into the barn. A stephoscope, bucket of warm water, BeI gathered my stuff for the first trip into the barn: a stethoscope, bucket of warm water, Betadine scrub, and a dose of Oxytocin. Jack had the cria under a heat lamp. Mom was paying no attention to the baby. That in its self was an unfavorable sign.

She did have a prolapsed uterus. The membranes had already passed. This did not look bad, just one horn of the uterus was prolapsed. But Momma did not look good. Her oral membranes were ghost white and she was resting on her sternum and not responsive to my attention.

“Jack, there was a day that I would blame her condition on blood loss but I think she is in shock,” I said. “Let me run back to the truck and I will get a couple of bags of fluid and some medication and we will see if that helps her before we do anything with this prolapse.”

“Is she going to be able to breed after this?” Jack asked.

“We have to worry about her surviving the night before we worry about her breeding again,” I said. “Actually, Jack, I doubt is there is much data on fertility in the llama following a prolapse. Most of the time they breed back in the first month or so following delivery. I would think that is not going to happen, but I have no data or experience on the top of my head to support any opinion.”

I hung a bag of fluids from a nail on a nearby support post for the barn and placed a 14 gauge needle in her jugular vein. I ran the fluids as fast as they would flow and added 20 mg of Dexamethasone Sodium Phosphate to the first liter.

Halfway through the second liter, Mom was looking for her cria and acting like she would live. I slowed the flow and gave 10 mg of Oxytocin IV. Then I turned my attention to the prolapse.

This was a fraction of the size of a bovine prolapse and the oxytocin was already contracting the uterus. I scrubbed it vigorously with Betadine Scrub. Then I lubed it with J-Lube, a powdered lube that, when wet, became as slick as anything I knew.

A couple of pushes and the uterus popped back into its normal position. I ran my hand through the cervix and made sure the uterine horns were completely returned to normal. At the same time I put a couple of grams of Oxytetracycline powder in the uterus. Then I sutured the vulva closed with several sutures.

I have never experienced a prolapse that came out a second time. Especially if Oxytocin was given to contract the uterus. But, be it training, or just making myself and the owner happy, I always sutured the vulva for a 1 – 3 days.

I cleaned up Mom and removed the IV. A gave good dose of long acting antibiotics and she jumped right up, looking for her baby.

“My guess is we are home free, Jack,” I said. “I will run by and recheck her in a couple of days and get those suture out. You just need to check her over real well in the morning. Make sure is eating and taking care of the baby. You call if you have any questions about how she is doing.”

The trip home at 3:00 in the morning gave me time to ponder. Would I have been so quick to give fluids to this gal if had not been able to peek inside of the belly of Ag’s cow a couple of summers before? I am not sure of the answer to that question. I guess once you know the correct answer, it is hard to think of another solution.

Photo Credit: https://www.pexels.com/@belen-rubio-1986517

The Shock of it All

D. E. Larsen, DVM

Ag had called, “We have a cow with a prolapsed uterus out in the calving pasture. Alice and I are going to bring her into the barnyard. Can you come out and get a look at her?”

     I glanced at the clock, it was almost midnight. I thought to myself, “Ranchers must never sleep during calving season.”

     I could see the cow in my headlights as I pulled into the barnyard. Standing with Ag and Alice on each side of her, she was still a hundred yards out in the field.

      I opened the gate and pulled out into the field. I stopped and closed the gate before driving out to where the cow was standing. I left the lights on when I got out of the truck.

This cow, a large Charolais, was either very tame or very sick. She did not flinch when I pulled up in front of her in the truck.

“I think she has decided this is as far as she is going to go,” Ag said as I stepped out of the truck.

I could see her uterus hanging out of her, almost reaching the ground. This was always a bad sign. These cows, who have lost all inner attachments of the uterus, had a poor prognosis in my experience. I assumed that to be from the rupture of the ovarian vessels and blood loss. Even when I replaced these uteruses, over half of these cows would die.

“That uterus looks like bad news to me,” I said. “Let me get a look at her before we start on putting things back together.”

“She walked to this point pretty well,” Alice said. “But then she just stopped. We have been standing here for 15 minutes before you got here.”

     I lifted her muzzle so I could look at her oral membranes in the lights. She was ghost white. 

“I think this cow is going to drop dead any minute now,” I said. “That uterus has lost all its ligament attachments and is hanging out full length. She is probably bleeding inside.”

“Let’s try to hamburger her,” Ag said, looking at Alice.

“I’m willing to help,” Alice said. “If we get her gutted tonight, we can get Chuck out here in the morning with his mobile slaughter truck.”

Both these ladies were in the 60s, Alice probably older. It is past midnight, and they are talking about butchering a 1500 pound cow like it is just a small chore.

“What do you think, Doc?” Ag asked.

“I think it might be marginal, but the USDA says that a cow is fit for slaughter if she has passed her fetal membranes,” I said. “This is a lot of hamburger, if the meat is no good, you can probably determine that before you process it. That way, you are only out the slaughter cost. And in this case, maybe just an extra hour of work.”

“I will go get the tractor with the frontend loader,” Ag said as she started toward the barn. “I guess you can go, Doc.”

“Actually, I think I will stay and give you gals a hand,” I said. “I am a little interested in what she looks like inside.”

About the time Ag returned with the tractor, the cow collapsed. Alice cut her throat, shackled her hocks, and lifted her off the ground with the tractor’s loader. Then the work started. My headlights provided ample light, and they both worked with practiced repetition. 

When the abdomen was opened, I expected to find a significant amount of blood. There was none. I looked at the ovarian vessels. The ovarian ligaments were ruptured, but the vessels were intact. My thinking that these stretched out uterine prolapses resulted in substantial blood loss was just wrong. This cow died from shock.

This would change my approach to treating these cases. It is not always possible to give these cows a large volume of fluids out in a distant pasture in the middle of the night. Like in this case, many are probably too far gone by the time I get to them. But for some, a good dose of Dexamethasone and a bottle of Glucose or Calcium might be enough to do the trick.

I called in the morning, just to check with Ag on the status of the carcass. My guess was that saving 500 pounds of hamburger would not be as appealing after a night’s sleep and clearer thinking.

“What did Chuck think of the cow?” I asked.

“We didn’t even call him,” Ag said. “Things just didn’t smell right this morning. It was a good thought last night, but not so much now.”

“That is probably the best,” I said. “It would be one thing if you were starving to death, but when we have access to the world’s best meat supply, there is little benefit in trying to salvage marginal meat.”

“That is just about what Alice said,” Ag said. “She wasn’t hungry enough to want it.”

“There was some good to come out of last night,” I said. “I have always felt some of these cows died from blood loss. But there wasn’t a drop of blood in that belly last night. She died from shock. That will change the way I treat these cows with a massive prolapse. I will treat them for shock first, then worry about the prolapse. That is how we learn things, that is why they call it practice.”

“Now, I just have to get the rendering truck out here before the dogs get into that gut pile,” Ag said.

“That would be good. Otherwise, I will see a sick dog or two for you,” I said.

Photo Credit: johnhmarble@icloud.com

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