Being a food animal veterinarian, day 8

Day 8 was not like the other days. My rotation-mate Delilah and I signed up to spend the day assisting with embryo collection at a farm that works with my school to preserve heritage breeds. The farm acquires (usually on loan) individuals from heritage breeds of sheep, cows, and goats. They superovulate and breed the females, then collect the embryos and cryogenically store them. Del and I kept asking what the plans were for the embryos. No plans! We are just storing them in case they are needed some day when these breeds are extinct.

The facility was beyond lovely, a 1920s folly farm that looked like a crazy cross between a medieval castle and a Mexican mansion. Biosecurity was a big concern there, so we had to cross a little bridge with a foot wash on the way in, and multiple signs about the premises said things like “This is private property. Please go away immediately.” The grounds were so immaculately clean that it was hard to believe there were animals there, but there were, beautifully cared for (with lots of pasture!). The farm was restored and updated, so you would for example pass through a stone archway into a modern cryogenic storage facility. Also, it had the cleanest bathroom I had encountered on a farm yet, but then again, that is not saying much. Most farms have bathrooms that rival the worst truckstop bathrooms, so that the vets who drive the trucks will say things like “hang on, we’re passing by a gas station in less than an hour” when you ask about facilities.

Del and I traded off assisting on surgeries and running anesthesia for three ewes. We premedicated, intubated, and maintained each ewe under anesthesia on gas. Then we helped Dr. Thery go in laparoscopically to make sure she had in fact successfully been superovulated. Ideally the ovary would look like a bunch of grapes. We would count the post-ovulatory structures on each ovary. Then we would laparasopically find and grasp the uterus, and pull it out of a small incision. Once it was exteriorized, we flushed it to get all the embryos out of it. The embryos were carried over to the lab, and we watched on video as they were identified, counted, and graded (the more vs less viable ones selected out). We closed up the ewes and recovered them. Each ewe would be kept for two surgeries, then returned to her owner.

It was a lovely day, and of course the surgery experience was a fun bonus. Del and I had some interesting conversations about whether this effort to preserve heritage breeds was worth the investment. Whether or not it is, it was a beautiful facility, and nice to see how a farm can be run when money is essentially not a factor.

Being a food animal veterinarian, day 7

Day 7. Just me and Dr. Gray (my favorite doctor to ride with). He blasted out of the clinic at high speed, announcing that we were extremely late and that we were going to check on a herd which had a problem with cystic ovaries. He tossed me a copy of Merck’s Veterinary Manual and said, “Let’s get smart about cystic ovaries.”

He and I at least knew what cystic ovaries are, but I am betting you do not. What you want an ovary to do is to grow a bunch of follicles, and then have one follicle decide it is the queen follicle and ovulate an egg. You probably know what happens from there. If this process is stymied at some point so that the follicle just hangs out and doesn’t develop, but becomes a bump on the ovary full of liquid, it is a cyst. The cow may recover from this and return to a normal reproductive cycle, or her system may become confused by the particular mix of hormones circulating and get hung up. The a veterinarian has to figure out what is going on. The most common explanation is that the cows are not eating well enough, so we came prepared to look into that.

We pulled up at a lovely little farm. This was a hobby farm in the sense that the owner had income from elsewhere, but a real farm in the sense that he was trying to make a profit on selling milk. He actually had a farm store where you could buy milk from that farm (unheard of!) and ice cream made from the milk (even better!). I purchased both, since the cows were out on grass, which made me happy. (The milk later spilled in Dr. Gray’s truck and went bad so that he became cranky with me, but that is a different story.)

Herd check. Why did the cows have cysts? The usual veterinarian for the herd was present; we had been called out as consultants basically because we had an ultrasound machine to help us better see what was going on inside the cows. We checked cow after cow. Some follicles (excellent), some post ovulation structures (also excellent). No cysts. It turned out that what had appeared to be cysts were actually normal structures. The cows were in fact somewhat skinny, so we also did some education about how to body condition score a cow. This was a learning experience for me; it is more complicated than with a dog, involving a flow chart. We also gave advice about how to synchronize the cows so that the farmer would know when to breed them. Without a solid synchronization program (or a bull, which most people find dangerous to keep around), you just have to watch the cows to see when they might be in heat. They are in heat for such a short period of time, less than a day, that it is very easy to miss. Best to know ahead of time when it’s going to happen.

We got back in the truck. I ate my ice cream sandwich for lunch. It was a good lunch.

The next farm was very different. Instead of the welcoming committee of three people who had received us at the first farm, we were left to find the sick cows on our own. Eventually one of the employees handed us a list of numbers: three cows with possible twisted stomachs (displaced abomasums) and one that might have a dead calf inside her. Usually farmers catch the cows up for us and have them in headlocks, but not here. Go find them!

The sick pen had dozens of cows in it. Dr. Gray and I wandered through until we found our girls, then chased them into a small side area where we could put them into the single head lock one by one. The cow with the presumed dead calf was pretty sick, so Dr. Gray dealt with her while I checked TPRs (temperature, pulse, respiration) and gave physical exams to the other three. I couldn’t see him, as he was behind a barrier from me, so I was on my own.

First cow: already in the head lock thanks to Dr. Gray. Normal TPR. No pings (the sound they make when you thwack your finger against their belly and they have a twisted something or other inside there). Looked bright and alert and not dehydrated. I relayed this to Dr. Gray, he came over and double checked, said we would just recommend some oral fluids, and I should move on to the next cow.

Second cow: obviously not in the head lock. I released the first cow and tried to get the second cow in. They will move away from you, so you can basically chase them into where you want, but she would not actually put her head in the lock. They weigh a lot more than you; sometimes you can shove on the back end and they will be nice about it, but there was no way this girl was cutting me a break. It was a little embarrassing, but I did my TPR while she was loose.

This time Dr. Gray came back with blood on his arm up to his shoulder, looking stressed. He checked over the cow (who he also failed to get into the head lock), gave her a rectal exam (this was all with a bare arm — iew), gave her the same diagnosis as the first cow, and went back to what he was doing. I walked back to watch as he shot the sick cow with the dead calf inside her in the head with a captive bolt gun, standard euthanasia technique on farm for a cow who cannot make it on to a truck to be shipped to slaughter.

Dr. Gray explained that the cow had had a dead calf in her for several days, and had a large rip in her uterus, which she could not recover from. I will save you from some of the gorier details. He was clearly somewhat bothered by the fact that the calf had died at least four days before and she had not gotten medical attention before then. “To be fair,” he said, “the calf wasn’t in the birth canal so she probably didn’t show any signs of labor for them to notice.” I said, “Is this maybe a case where on a smaller farm, someone would have realized something was going on with the cow which was supposed to have freshened a few days ago?” He allowed as to how that was probably the case.

Then we checked out the fourth cow, the one which was also supposed to have a displaced abomasum. Amusingly, this cow stuck her head into the head lock enthusiastically. We were running late, so Dr. Gray did this exam himself, and did find a problem. He is a fan of a toggle procedure to fix displaced abomasums, so that is what we did, instead of the surgical procedure I had seen previously. With the help of a farm hand, we sedated the cow, put ropes around her, pulled her over on her side, and rolled her on to her back. Once she was on her back, her stomach floated into the correct place. Dr. Gray put two pins into her belly, puncturing through the skin and into the stomach. He used the pins to secure the stomach in place. The cow was allowed to stand up and was good to go (with dextrose, steroids, oral fluids, oral calcium, and B vitamins to help her out).

Then we washed off in a bucket. There was a lot of scrubbing to be done. And that was day seven.

Olympic level dog training seminar

The nice thing about having weekends free on your ambulatory rotation is that you can do the things normal people do with their weekends, like go to incredibly geeky dog training seminars about the details of learning theory. I went to a seminar on improving the cues you give your dog with the brilliant Kathy Sdao. Some of her main points, below.

• A command is something you give with the expectation of making the animal obey. A cue is something you give to say “you know that behavior that you have learned is a really good thing to do, because you often get paid to do it? Now would be a great time to do it!”
• Oh, for those of you who aren’t dog training geeks, I should back up. “Getting paid” is dog training lingo for the idea that dogs don’t work for us just because they love us. Do you do work because you love your boss? Dogs get paid with food, praise, life rewards (getting a ball thrown), etc.
• You can’t control a behavior. You can only control what happens before and after a behavior, and therefore the animal’s expectation for cues that predict a good or bad time to perform the behavior, and consequences of the behavior.
• You certainly can use cues which are difficult for your dog to distinguish, like down and out, which have the same internal vowel sounds and are very similar to the ear if you don’t have human-level language skills. However, why would you? Choose words that make things easy for your dog by being easy to distinguish from each other. Your dog is the one who is struggling to understand language, something his species does not excel at.
• We know it, but it’s worth repeating: a dog doesn’t refuse to perform a behavior for spite. That’s only something humans do. A dog who doesn’t respond to a command or cue does so for only one of two reasons: a) he doesn’t understand what is being asked of him, or b) he doesn’t feel it is worth his while (he is not being paid sufficiently).
• We think of cues as verbal or gestural. Of course, dogs are more comfortable with gestural cues in general. (One participant found that her dog completely ignored a verbal cue which she had always given paired with a gesture.) You don’t have to make gestures only with your hands! Some people with small dogs find that the dogs respond very well to foot gestures, which are closer to their eye level.
• Cues that we give without meaning to include eye movements, where our attention is, body language (the classic story of the dog refusing to lie down unless the owner bends forward, because that may not be the cue the owner taught, but it is the cue the dog learned). Tone of voice. Time of day. Antecedents like picking up your keys. My dogs have learned that “okay,” spoken while I am on the computer, means I have decided to get up and get myself off the keyboard, even though it is something I say unconsciously to myself and not intentionally to them.
• Dogs live in a sea of information coming from us. Sometimes it is hard for them to pick out the cue we want to give. You think you are just raising your hand to indicate sit, but the dog is taking in tone of voice, where you are looking, if you are bending forward, what your other hand is doing, the position of your feet. It isn’t obvious to the dog that the hand (or word) is what he is supposed to be paying attention to.
• Kathy gave two examples to illustrate that point. The first: you know the feeling you get when you are tuning a radio and you can’t quite get the station, and have to listen to it through static? Dogs live in that world all the time.
• For those who know the invisible gorilla illusion — if you don’t know to look for something, you may not see it. If the dog is paying attention to how far forward you are leaning, he may not even hear the word you are saying to him. After all, words come out of your mouth all the time, and he usually doesn’t understand them. Why should he pay attention to this one and assume it has some importance? Why should his brain even filter is so that he hears it at all?

We played a fun game with the participating dogs called “Prove It.” The handler asserts something like “my cue for sit is the word ‘sit.’“ The challenger says, “Yeah? What if you say it with your eyes closed? With your hand over your mouth? Looking at the ceiling? Whispering? Standing on a chair? Will your dog still do it then?” I worked with a handler whose dog did standard commands flawlessly, promptly, and enthusiastically. When her handler told her to sit while looking at the ceiling, the dog stared at her hopefully, trying to figure out what she was supposed to do. (During this game, we took lots of breaks to give the dogs easy tasks and reward them.)

Fun day learning about how to communicate with your dog, and gave me good insights into my own training methods. Kathy Sdao is an excellent teacher. If you are a beginning trainer, her classes may seem a little arcane to you, but I highly recommend her if you are a learning theory geek, or someone who teaches other people to train dogs.

Being a food animal veterinarian, day 6

Day 6. Another herd check. It’s becoming routine. To be fair, I tend to end up riding with the clinicians who do herd checks, because I want to spend these three weeks working with cows. I have so far avoided riding with the clinician who specializes in horses, because equine medicine bores me silly. I like horses, just not horse medicine. And I really like cows, who are endlessly sweet and amusing, and I like herd health, or population medicine. Put me on a farm with a few sick cows and I am perfectly happy to spend hours talking about what is wrong with farm management which is causing these cows to get sick. Ask me to actually do procedures on an individual cow and I start wondering when we are moving on to the next farm.

So. Day 6, herd check. After all the rectal palpations there is inevitably the one or two sick cows to check on, or in this case, three. One was six weeks fresh (gave birth six weeks ago). You always, always ask how fresh a cow is, or if she is not particularly fresh, how many days in milk (how long she has been giving milk, i.e., how many days ago she gave birth — I have been told things like “this cow is 510 days in milk”). They get different diseases depending on where they are in the whole calf-milk-breeding-no milk-calf cycle. This one, being six weeks fresh, should have been past any problems with her uterus recovering from labor, but was not. Which was why we were being asked to look at her. We recommended infusing her uterus with dilute iodine to get rid of the infection.

The next cow had aborted two days previously. She still had bits of placenta hanging out. Normally retained placentas clear themselves within a day or two, but this one was hanging in there a little long, especially for having quite so many pieces still stuck in. My syllabus says it is “controversial” to “manually clean” the uterus of retained placenta (i.e., go in and pull the bits out by hand). It is usually better to let nature take care of this, as upsetting as it is to see cows walking around with pink stuff dangling out of their private parts (what small animal owners inevitably refer to as “down there” and what farmers will refreshingly refer to as “vaginas”). In this case, we manually cleaned. Well, the vet cleaned, and I watched. Good times.

Sick cow #3 had some hair loss on her heels and at the head of her tail. The clinician took one look and pronounced her as having mange. We applied a parasiticide: the vet handed me a big bottle and told me to pour it along the cow’s top line. The stuff was bright purple. Now the cow was bright purple. More fun than cleaning placentas.

Farm two. A big farm, but a well run one. They were having a diarrhea problem with many of their calves (“calf scours”). We drew blood on some four day old calves to check to see if they had gotten enough antibodies from their dams in the colostrum (milk full of antibodies) that they drank in their first few hours of life. (Back at the clinic, the answer was that two of them were fine, and two of them were borderline for not having enough antibodies.) This was a great example of a herd health problem. Why were these calves getting sick? It seemed to be some management problem, but where exactly was the farm going wrong? If the calves weren’t getting enough colostrum, why not? The guy in charge of calf management spent a long time talking to the vet to try to figure it out. So far, we still have no answer. I hope they manage to find one.

Being a food animal veterinarian, day 5

Day 5. I was refreshed after a weekend of sleeping 13 hours a night (still catching up after my exhausting small animal surgery rotation the previous month). I signed up to ride with Dr. Gray and my classmates Will and Anna.

Farm one. A largish farm for a family farm, but run by people who clearly really cared about their cows, a mom and daughter team. Anna performed a castration; Dr. Gray said I could show her how since I had done one before (making me an expert, clearly). There was a long discussion about whether to use lidocaine (a painkiller) or not, as there always is when calf castration is discussed. Since this is something I’ve thought about a lot, I was able to present the usual pro and con arguments to my rotation mates. We used lidocaine. The calf was a lot bigger than the one I had done before. My advice: do them younger. The restraint is a lot easier.

Then we did the usual herd check. One cow had had a forced extraction recently, a difficult birth ending in having the baby pulled out of her using chains. Dr. Gray did a vaginal exam, which is more uncomfortable for the cow than a rectal exam, such that students are not allowed to follow after and do their own exam. She had multiple internal lacerations, so Dr. Gray recommended antibiotics and pain killers. This was one of those sticky situations where pain killers weren’t absolutely necessary, just indicated for the cow’s comfort. He thought the farmer wouldn’t want to give them and considered not even suggesting them, but in the end did suggest them (“if you wanted to give some banamine, it wouldn’t be wrong”) and the farmer promptly agreed. I had thought she would, since she seemed to really care about her cows. Veterinarians, it is not wrong to just suggest the best care, even if you think your client will say no! You just have to find a way to do it in a way that won’t make your client feel uncomfortable if they do feel they can’t afford it.

Overall, I mostly liked how these cows were kept; the health of the cows was clearly a high priority on this farm. I am still not happy that the industry standard keeps cows on slippery concrete where they are bound to develop foot problems (10% of a herd is expected to be lame on any given day), walking in manure so that they are caked with it up their legs, and not getting to eat the grass that they evolved to eat.

Second farm of the day: we preg checked (pregnancy checked, rectally) about 100 cows. PHEW. Luckily there were three of us. As the herd check started winding to a close, Dr. Gray put Will and me on the task of giving the cows the injections that they needed. When a cow was preg checked and found to be open (not pregnant), with structures on her ovary to indicate that she had recently ovulated, she got an L written on her side in orange chalk. When she was pregnant she got a P. Otherwise she got nothing. I injected all the P cows with a multiple vaccine. Early pregnancy is a good time to vaccinate so that the mom will pass on the antibodies to the baby in her colostrum after birth. Will injected the L cows with Lutalyse. This is a hormone (prostaglandin F 2α) which causes them to reset their estrual cycle so that they will ovulate in the next three days and can be bred again. In general the female vet students avoid handling Lutalyse, because if it gets in our system we get very bad cramps. I was glad to have Will there to give those injections.

Being a food animal veterinarian, day 4

Day 4. Friday! I was hugely looking forward to having an actual weekend off, with no responsibilities in the hospital for the first time in 5 weeks.

I was one of the first students in to the clinic. Dr. Cole caught me and my classmate Will as I was coming in and told us that a client had just pulled in. She was bringing her extremely elderly and sick dog in to the clinic for euthanasia. The clinic technically doesn’t handle small animals at all, but Dr. Cole was willing to help out the client in this case. We euthanized the dog in the back of the truck, lying comfortably on his blanket. Will and Dr. Cole handled the actual euthanasia, while I talked to the owner about her dog, what he was like.

I rode with Dr. Thery that day. We went out to a small farm which produces artisanal raw cheese for sale in New York city and directly to restaurants in the area. I loved this farm. The cows were all out on grass all summer. The barn was old but very well maintained, not overly dirty. The cows were extremely friendly; even the calves were not head shy at all. We did a herd check, popped an abscess on a cow’s flank, and vaccinated and TB tested a mess of heifers (about to be sold across state lines) and calves.

I kept ducking out of doing the actual medicine to go talk to the farmer about how she makes grass feeding work. Grass feeding is the norm for beef cattle before they go into feedlots, but for dairy cows, conventional wisdom is that they have to be handled too much to make it work. What a pain to have to round up all your cows twice a day for milking! But the farmer shrugged that off. The cows want to be milked, because their udders get uncomfortably full. They come back in to the barn voluntarily. Once they know the routine, it’s no problem.

I wish all farms could be like this one. I know that’s a pipe dream, but I still really want to find a way to support farms like this one, to make it just a little easier for farmers to do what I consider to be the right thing by their animals.

Surgery rotation vs ambulatory rotation

Surgery: Get yelled at if you hold your hands below your waist, even for half a second, while you are sterile
Ambulatory: Perform surgeries on manure-encrusted surfaces

Surgery: Why would people who are in the operating room just to observe want chairs?
Ambulatory: Spend 1/3 of your day sitting in a comfy truck seat

Surgery: Discover that it rained when you see wet ground upon leaving for the day
Ambulatory: Discover that it is raining when you have to change into your coveralls standing under the open sky

Surgery: Your patients have names like “Sweetie-Boo” 
Ambulatory: Most of your patients are addressed as “Boss” or “Girl,” except for one who acquires the name “The Cow We Had to Take to the Vet Clinic”

Surgery: Special room to scrub in, covered in signs with complicated procedures for doing so
Ambulatory: Scrub in using soapy water in a bucket

Surgery: Dress is business casual
Ambulatory: I consider most of my t-shirts too nice to wear (you have to be prepared to get poop on everything)

Surgery: You think your patient has developed feline idiopathic cystitis? Don’t worry about it. We don’t do internal medicine, just surgery
Ambulatory: We do internal medicine, surgery, theriogenology (reproductive medicine), dermatology, cardiology, neurology, ophthalmology, population medicine, public health