D. E. Larsen, DVM

“Doc, this is Harold. You have to come quick. There is blood everywhere. I think she is bleeding to death!”

Then the phone went dead. I looked at the clock, 4:50. At least it is not 3:00 AM. That means something happened during the morning milking. What could have happened that would cause a cow to bleed so much in a milking parlor?

I jumped out of bed and dressed quickly. I have been going to Harold’s place too often, it seemed. This time I have to hurry into a mess that I can’t even begin to imagine. Hard to say what I was going to be walking into.

It was a short drive to Harold’s place. The driveway up to the barn was a little steep but well maintained. I pulled the truck as close to the milking parlor as I could. I jumped out of the truck and hurried to the door.

Harold was waiting for me and held the door open. He was covered with blood.

“Are you alright?” I asked with genuine concern.

“I am fine, but you need to look at this cow, quick.”

We went into the parlor, there was blood on the floor, running down the floor drain. The cow is a big animal, and losing a gallon of blood is probably no big deal. But I don’t think I was prepared for this much blood on the floor.

I got to the cow, still standing in the milking stall. Blood was still streaming from where a teat should have been.

“What the hell happened?” I asked.

“She had mastitis. I have watched you guys whack off a dozen teats before, so I just took my knife and whacked it off,” Harold explained with a motion of this hand to show how he had whacked the teat off.

“Harold, when we have cut a teat off, it is because the mastitis is so severe that the tissue is dead,” I said. “This teat is very much alive. I will explain more after I get this bleeding under control.”

I ran back to the truck and grabbed a bucket of water and scrub, scissors, a needle holder, and a pack of suture material.

After a rapid swab of the area, I started placing some mattress sutures around the bleed base of the teat, or where the teat should be. As I got all the way around the opening, the blood flow finally stopped. Harold was correct about one thing, this cow could have bled to death. In these large dairy cows, the udder receives a tremendous blood supply. This is evident when you look at the large veins running forward from the udder on the ventral abdomen. These veins are garden hose size.

With the bleeding stopped, I cleaned the wound as best I could. This quarter was obviously lost. I just hoped that we could keep the infection under control, so the cow was not lost. 

When the cow loses a quarter, the other quarters will show a compensatory increase in production. In this way, she does not lose 25% of her production, but more like 10 to 15%. So most of the time, the cow can remain a productive member of the herd. With the antibiotics that will be needed to prevent a significant infection, this cow’s milk will be suitable only for feeding to the calves, and the barn cats. She may lose a month of production, at least two weeks.

Finally, I relaxed enough to talk with Harold. He had been frantically trying to keep the milking string moving while I had been working on this cow.

“It is important for you to understand what went on here tonight,” I said. “When you cut that teat off, you threw away a quarter that could have been treated for mastitis and returned to full production. When we cut a teat off, it is because the infection is so severe that the whole quarter has gangrene, and the tissue is dead. That is why there is no blood when we cut a teat off. So, next time, if the teat isn’t black, don’t cut it off.”

“Doc, there ain’t going to be no next time,” Harold said. “I am just going to call you first. I just thought I could save a few dollars and look what happened.”

“This is going to take a little time for this wound to heal,” I said. “I am not sure just how we will handle it. I want to talk with Don and Jack in the morning, and we will come up with a plan. We are not going to be able to completely close the wound because there is going to be some milk drainage for a time. I think we might be able to close most of the wound and just place a rubber drain, but I want to discuss that plan before we do it.”

“Just tell what I need to do with her,” Harold said.

“For now, you need to keep her in a clean stall by herself,” I said. “I will be back later this morning, maybe with Don, and we will work on this wound again. You will need to discard her milk until we completed her antibiotic treatment.”

“Can I use it for the calves?” Harold asked.

“That will be fine, but you should milk her last, so there is no chance of getting any antibiotics into your holding tank,” I said. “Otherwise, you might end up buying a tanker truck full of milk.”

With that, I cleaned up and headed home. I figured I would just have time for a good breakfast before I had to be at the office.

“What did he do?” Don asked, somewhat, not believing my story. 

“Yes, He just took his knife and cut the damn teat off,” I repeated. “I thought I was walking into a murder scene when I entered the milking parlor. So now there is a big hole into the milk cistern. I placed a bunch of mattress sutures to get the bleeding stopped but I wanted to talk to you about how I should close the hole.”

“I agree about placing a drain for a few days and suturing most of the hole closed,” Don said. “Maybe this would be a place to try that closure that was in the Veterinary Medicine journal last month. That would probably hold better than sutures.”

“I have some time this morning, let’s run out there together,” Don said, “I want to see this.”

Harold was waiting with the cow in the parlor when we pulled into the barnyard.

Harold had cleaned up the blood from the morning fiasco, but there was still some blood on his apron hanging by the door.

“We are going to close up this wound, and hopefully it will heal without too much of a problem,” Don said as he looked closely at the gaping hole on the bottom of the udder. There was some dried blood around the wound and a slow drainage of milk from the hole.

We scrubbed the wound and sprayed Betadine around and into the wound. I injected a good dose of lidocaine around the wound. Then I placed a small Penrose drain in the front edge of the wound and secured it with a couple of sutures.

Neither Don nor I had done this new closure that was written up for teat lacerations, but it was simple enough. Teat lacerations were challenging to deal with, especially if they extended into the milk channel. This closure was fast and simple and provided a wide spread of the tension, so there was little chance of tearing the tissue.

After apposing the wound edges with a couple of towel clamps, I took three 18 gauge, 1½ inch needles, and placed them across the wound, evenly spaced, and entering and exiting about 1/2 inch from the wound edge on each side. Then using umbilical tape, I closed the wound by lacing around the needles, much like you would close the body cavity of a turkey before putting it in the oven.

This proved so simple and provided a tight closure with the tension distributed across the entire length of the wound. It would be unlikely to tear out. Both Don and I wondered why it had never been published before. I cut the sharp end of the needles off with a wire cutter and sprayed the area with some Furacin wound spray.

“I will be back in 3 days to check this wound,” I told Harold. “You need to give her an injection of 10 ccs of Polyflex each day. Otherwise, don’t do anything to the wound. If you notice these needles fall out, give us a call. And don’t cut off any more teats.”

Photo by Matthias Zomer from Pexels

D. E. Larsen, DVM

I stepped through the small gate into the crowding ally behind the chute. Ag swung the tailgate open, and I grabbed the tail of this large Charolais cross heifer with my right hand. I worked my gloved left hand into her rectum. There was enough squeeze on her that she could bounce around.

I had been doing this for most of the day. We took some time for a lunch of a special soup Ag had made for the day. Homemade bread and a hearty soup would make the afternoon go faster. The most significant advantage of the lunch break was my left arm got a rest. 

In the big cattle country, a cow doctor might have herds of 400 cattle to check every day for a couple of weeks. Their arms became accustomed to the workload. For me, it was one or two herds a week, and most of those herds were less than 100 cows. My arm was in shape enough to do over a hundred cows, but I had to rest it every chance I could.

I was skilled at rectal palpation. Using my left hand, I would first attempt to retract the uterus. This would bring the uterus into the pelvic canal where I could feel along the entire length. I would first feel the membranes slip between my fingers when I pinched the body of the uterus near the bifurcation. If present, this slip was a positive sign of pregnancy. Then I would explore down each horn of the uterus to find an amnionic sac or a fetus. Based on the size of the amnion sac or the fetal head, I could age the pregnancy to plus or minus 3 days.

A uterus with pregnancy over 90 days duration could seldom be retracted. One could usually find a fetal head by sweeping your hand along the length of the pregnant uterine horn. After 120 days of pregnancy, the fetus was generally out of reach until very late in pregnancy. Aging a pregnancy after 120 days was difficult, and getting between plus or minus 15 days was considered the best one could do. Inexperienced veterinarians could miss the age by months.

The obvious benefit of pregnancy exams in a commercial herd was to enable ranchers to cull the cows that were not pregnant. In that way, they would avoid the expense of winter feed for those cows. On rare occasions, I would detect a problem in the breeding program by finding a high number of open cows. Most of those problems could be seen by adequate observation during the breeding season.

The primary goal was to have cows fall into a 42 – 84-day pregnancy window. Cows outside that window would be culled. This would select for productive breeders, cows who would become pregnant on the first cycle she was exposed to the bulls. Then those cows not pregnant on the first cycle would have a second chance at pregnancy. By culling cows who could not breed back with two cycles, we were able to condense the calving season to a shorter time. This would allow ranchers to concentrate their observation of the calving and render help as needed. Having the age of pregnancy helped in knowing just when a cow was due to calve.

Failing to cull a cow who was outside the prescribed pregnancy window selected for infertility. First, you would have one cow that was a problematic breeder, then 5 years later, you would have that one cow and three of her daughters. The ball game was lost then.

It obviously would take several years of work to arrive at the desired calving window. With Ag’s herd, we probably had over 70% of the herd calving in the first 21 days of the calving season. This was ideal, and it allowed for some elective culling.

Elective culling would allow you to cull individuals based on other factors than fertility. Cows with better milk production would wean calves with a higher weaning weight. Cows with poor udder conformation might cause a lot of extra work at calving and could be susceptible to mastitis. In any herd, there are cows with behavior issues, culling them would reduce stress on the rancher and on the herd.

I always told my clients to cull the last cow in the chute.  If you have 100 cows in the corral to work through the chute, there will always be the last cow. She is seldom last by chance. 

Ag never listened to me on this point. She had to large Brahman cross cow that was almost impossible to get into the chute. So difficult, in fact, that I had only checked her one time. We would try and try to get her in the chute.

“Let’s just forget her,” Ag would say. “She is always pregnant. She is too mean to not be pregnant.”

“I am telling you, Ag, you need to get rid of that cow,” I would always say.

And true to form, after 5 years, there was the old mama cow and then 3 of her daughters, all trying to be the last one in the chute.

Photo by Jorge Zapata on Unsplash

D. E. Larsen, DVM

I came through the back door of the clinic in Enumclaw, I liked to get into the clinic early. Jack was just cleaning up from an early morning call.

“You are here a little early,” Jack said as I squeezed past him at the utility tub.

“I have been coming a little early to organize the morning a little different,” I replied.

“A little different,” Jack said, “Things have run the same way around here for the last 30 years. I am not sure we need things to be a little different.”

“We have the surgery patients coming in during the late morning, and we don’t get to them until the afternoon after all the farm calls are done,” I said. “If we brought them in early in the morning, we could get the surgeries done before noon on most days. That way we could send them home in the evening. That would save a lot of cage cleaning for the girls in the morning. It would also be better than having them here overnight, unattended, following surgery.”

“Well, you might have something there,” Jack said. “I will have to give it some thought.”

“I have Mrs. Nielsen coming in this morning with a couple of cat spays,” I said. “If there are no urgent farm calls, I thought I would do the surgeries first thing this morning and send them home at 4:00 this afternoon.”

“Well, hopefully, I took care of our emergency for the day,” Jack said. “I had a calf to deliver at about 5:00 this morning. It was an easy pull. Tiny calf, one of those that you have to hold in there for a few minutes, so the farmer thinks he gets his monies worth. Then I hooked an OB strap on the legs and pulled it with one hand.”

“That sounds easy,” I said.

“But there is more to the lesson,” Jack said, anxious for me to listen. “One thing you want to do when you pull a calf is to go back in and check for another calf. Sure enough, I did that this morning, and there was another calf. It was backward, hind feet sticking into the birth canal, it was as small as the first one. Came out without any problems.”

“That is something that they always stressed in school,” I said.

“You don’t see twins very often, and it is easy to get used to thinking that there is no reason to check,” Jack said. “I seem to forget to check some of the time, just a good idea to do it every time.”

“Thanks for the update,” I said. “I will be sure to make it a habit. I have to hurry upfront so I can speak with Mrs. Nielsen when she drops off her two cats this morning.”

The girls had just completed getting Mrs. Nielsen’s cats into kennels when I got to the front desk.

“I am glad I caught you before you got out the door,” I said.

Smiling, Mrs. Nielsen said, “I am glad too, Ole wanted me to make sure I met you today. He is impressed with you, young man.”

“I just wanted to make sure that you were going to pick up these cats this afternoon,” I said, ignoring her husband’s compliment.

“That is different,” She said. “Always in the past, they were kept overnight. But Ole said, “Anything Dr. Larsen says is fine with us,”

“We are just changing the schedule a little, I will do the surgeries this morning, and they will be ready to go home anytime after 4:00. They will do better at home than down here overnight with nobody watching them.”

“And we close at 5:30,” Mary said, speaking over my shoulder.

“I will be here at 4:00,” Mrs. Nielsen says as she starts out the door.

The girls were used to a slow morning at the office. All three of us veterinarians would depart and do farm calls, usually not getting back into the office until the afternoon. Today I had two cat surgeries to do before starting on my farm calls.

“Let’s get the exams done on these cats and get set up for surgery,” I said. “I have been assuming that they were both females, but we better check.”

The first cat on the exam table was probably approaching a year old, and I didn’t have to look for testicles to know he was a young tomcat. His neck and cheeks were already growing thick, probably the life around the barn required these guys mature early if they are going to survive.

“This morning schedule just got a whole lot easier,” I said. 

We finished an exam, did his vaccines, and gave him a dose of atropine to start getting him ready for anesthesia.

The second cat must have been a brother as they looked like two peas out of the same pod.

“I am sure she was talking about spaying these cats,” Mary said.

“People are often confused about the term, spay,” I said. “I can’t say that I know where the term came from. It makes no sense to me.”

With the first cat on the surgery table, I gave him a dose of Ketamine by IV injection. I gave 0.4 cc IV. This was a dose that would provide excellent anesthesia and immobilization for about 20 minutes and would allow a smooth recovery within 30 or 40 minutes. Some residual pain control lasted for several hours with Ketamine. 

With the cat under anesthesia and on his right side, I plucked the hair from his scrotum. Mary prepped the scrotum as I pulled on a pair of surgical gloves. Jack had graduated in the 1940s. His method of castration in the cat was to incise the scrotum over each testicle, grasp the end of a testicle with a forceps and apply slow, steady traction, pulling the testicle out until the cords stretched and broke off. 

I had been told of this procedure in school and instructed to never use it as it was outdated. There were few complications with this old procedure, but time marches on. I used one of several methods. All involved incisions over each testicle. 

I would pull the testicle out until I could feel the cremaster muscle tear, clamp the cord with a hemostat, and place a ligature on the cord before removing the testicle. This procedure consumed a package of suture material and took a little more time. 

The other procedure and the one I used most often was to pull the testicle out of the scrotum, incise the tunic and separate the tunic from the testicle, then open the tunic with scissors down the length of the exposed cord. Then I would tie the testicular vessels and the tunic in several throws of square knots before removing the testicle and residual tunic.

With any procedure, it was over in minutes. We would clean the surgery area and return the cat to the kennel to recover. With Ketamine anesthesia, the blink reflex is absent until the patient is fully recovered. The surface of the cornea must be protected with the application of an ointment.

This morning, I had the two cat neuters completed, and the record work completed by a little after 8:30. I would be able to get through my farm calls almost on their regular schedule.

Then the phone rang. Both Jack and Don had already left on their calls. Mary answered the phone.

“No, Jack has already left the office. Dr. Larsen is still here, would you like to talk with him?”

Mary hands me the phone. “This is Harold, you know him, I think. He lives out on that little knoll. This is about the twins that Jack delivered this morning.”

I take the phone from Mary, “Hello, Harold,” I say. “What do you have going on?”

“Jack was here about 5:00 this morning,” Harold says. “He delivered a set of twins. Those two are doing well, but the old cow doesn’t seem right to me. She is uncomfortable, not really straining, but sort of doing little pushes.”

Harold was one of our younger dairy clients. He had a herd of 50 or 60 cows. He probably wasn’t the sharpest tack in the box, but he was generally pretty observant, and if he didn’t think things were quite right, it probably meant that I should check the cow.

“Harold, it sounds like I should run out and check the cow,” I said. “If you have her in where we can get to her, I can come right now.”

“I still have her in the calving pen,” Harold said. “I will go get a halter on her and have her tied up and waiting for you.”

Harold’s place was only a mile down the road. I checked to make sure I had water in the truck, pulled on a pair of coveralls and boots, and started down the road.

Harold’s place was laid out a little different for the area. His house, barn, and all the outbuildings were perched on top of a knoll. All his pastures were on the level valley floor, leaving quite a little hill for the cows to climb to the milking parlor and barn twice a day.

I filled a bucket of warm water from the truck, grabbed a bottle of scrub and one of lube and headed for the barn with a couple of OB sleeves in my back pocket.

Harold was waiting in the calving pen with the cow tied in the corner. The twin calves were running around, nursing on mom and then on Harold’s knees.

“They look like they are doing okay,” I said to Harold as I squeezed through the gate, blocking the way, so the calves didn’t escape.

“They are doing great, but I am not sure about this old gal,” Harold said as he rubbed the cow on her back.

She was standing okay, but her tail was raised. That would suggest some continuing contractions. With the calves out of there, that shouldn’t be happening. The calves were small enough, there should not have been any injury to the birth canal. 

“Will, let me get her cleaned up, and do a quick check on her,” I said as I tied a piece of twine to the switch on her tail. I tied the other end of the twine in a loop around her neck, pulling her tail along her side and out of the way.

“You must feel pretty good, getting two heifers out of such a good milker,” I said to Harold as I was scrubbing the vulva on the cow.

“Yes, it is nice. I don’t think I have had twins before,” Harold said. “In fact, I don’t think I have seen twins before.”

“They happen, but not very often,” I said as I pulled on an OB sleeve and applied a handful of lube.

I ran my left arm into the vagina. Everything was normal in the vagina. The cervix was still open, and there were still membranes present. Retained fetal membranes were not uncommon in difficult deliveries and in multiple births. 

I extended my reach into the uterus. There was the problem. All of a sudden, I was holding the tail of another calf. Reaching a little further, this third calf was in full breech presentation. It was maybe a little bigger than the other two but still small. I inserted a finger into the rectum, it tightened. The calf was still alive. 

Then came the bad news. There was no vulva, and reaching a little further, there were the testicles. Harold’s twin heifers suddenly became triplets with a bull calf. This meant the heifers were likely freemartins.

Freemartins are female cattle born twins to a male calf. In cattle, and occasionally, sheep, goats, pigs, deer, and camels, there is a fusion of fetal membranes, and the male calf shares some cells with the female. Those cells produce enough male hormones that the development of the female reproductive structures are affected, and the female calf is sterile. The male calf is only slightly affected, but there is some reduction in his fertility.

“There is good news and bad news Harold,” I said. “The good news is there is another calf in there, and he is alive. Getting him out will solve the immediate problem. He is in a full breech position, but I should be able to correct that with no problem.”

“And the bad news?” Harold asked.

“The bad news is the calf is a male,” I said. “That means that there is over a 90% chance that these little heifer calves are freemartins.”

“What is a freemartin?” Harold asked, “I have never heard that term before.”

“Heifer calves born a twin (or in this case a triplet) to a bull calf are affected by the male hormones, and their reproductive tract doesn’t develop correctly,” I explained.

“I guess the thing to do is just to sell them,” Harold said. “The market of heifer calves is pretty good.”

“We see that done, for sure,” I said, “but that is not very ethical. Then somebody spends a lot of time and money and ends up with a heifer who will not get pregnant. That is pretty unfair to the buyer.”

“Now you make me feel like I am cheating somebody,” Harold said.

“Just be honest,” I said. “Tell the buyer what the problem is, so they know what they are getting. Just don’t do anything that your mother would not approve of, that is the best test.”

“Now, let me get this calf out of her.”

I reached deeper into the uterus and could only touch the hock of the calf as the hind legs were both extended forward along the body on the calf. I could use a crutch now, a device to push the rump up and forward and making it easier to reach the hocks. We didn’t have that available in this practice.

I turned my arm so I could elevate the rump with my elbow. That allowed just enough elevation to allow me to grab a hock and pull the right hind leg back to the rear of the calf. Then I grabbed the cannon bone, midway between the hock and the hoof. By pushing the cannon bone up, then pushing the hock forward, I brought the foot to the brim of the pelvis where I could pop it into the birth canal.

Attaching an OB strap to this hoof, I could apply enough traction that I could reach the other leg with ease. I repeated the maneuver with the cannon bone. Once both legs were in the birth canal, I was able to pull this small calf with simple traction.

He hit the ground and I picked him up and swung him by his heels to drain a lot of fluid from his airways. Another couple of hours and we would have lost this guy.

“Will I guess having three calves for sale is almost as good as one to raise,” Harold said.

“This is probably the only set of triplets I will ever deliver or help to deliver,” I told Harold. “I will have to tell Jack to check for another after each calf.”

“Maybe you should check to make sure there is not another calf, Doc,” Harold said.

“Good point, Harold,” I said. “I am going to put some antibiotics into her uterus anyway. There has been a lot of in and out of there today. And she has a big bunch of membranes to pass. I opened a package of 5 grams of Tetracycline Powder on two sides and carried it into the uterus. I unfolded the pouch and dispersed the powder into the uterine fluids.

“You need to watch her close,” I said. “If she has not passed those membranes by tomorrow afternoon, we should recheck her.”

I cleaned up and headed back to the clinic. The afternoon discussions will be interesting today. 

Photo by Corinna Widmer from Pexels.