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

Being a food animal veterinarian, day 3

Day 3. I signed up to ride with Dr. Cripi, just him and me. I was hopeful that I would get to do more hands on stuff when I was not competing with other students for opportunities.

I expected to get right in the truck and head out, but Dr. Cripi said that a cow was being brought to us this morning. Some farms are so far outside the clinic’s usual area that they are only worth visiting if there is some other work in the same region. These farms can be our clients, but have to let us schedule our visits to groups of them on the same day. When they have emergencies, they have to bring their animals to us. This was why the cow was coming to us now.

She got off the truck nicely and we put her in the stocks so that she was restrained and could easily be examined. Dr. Cripi noted that her eyes were sunken, indicating dehydration. Some other students were standing around as well, and we all got to examine her. A large part of examining a cow is trying to identify problems with its complicated GI system. If part of the GI is displaced to somewhere it shouldn’t be (a fairly common problem, especially in cows that are fed too little roughage in their diets, e.g., are not out on pasture or fed mostly hay) then that part of the GI will start filling up with gas. You can “ping” the cow to hear this. You snap a finger hard against her side while listening with your stethoscope. This was the first ping I had ever heard, as I had never before examined a cow with a displacement. It sounded like a basketball bouncing on a metal floor. I referred to the ping as “gorgeous,” which amused the farmer no end.

This cow had an RDA, or right displaced abomasum. This means that the cow’s true stomach, or abomasum, had floated up on the right side of the cow. (Normal location: right side, but a lot more ventral, e.g., closer to the ground). We performed standing surgery on the cow to fix the problem. We did not sedate her, as she was so sick that Dr. Cripi thought sedation would make her lie down, which would make the surgery much more difficult. We did give her a local block in the area where we would be cutting. Then she was shaved and prepped (aseptically scrubbed) over her right side.

First we scrubbed in. This was hilariously different from scrubbing in to surgery in the small animal hospital, which I had done a lot of on my surgery rotation over the previous month. A cow holding area is going to be inherently dirty. We scrubbed our arms off with iodine and put on long surgical gloves (they have to go up to your shoulder, because you’re going to be reaching deep inside a big animal), then normal sterile gloves on top of that.

Then Dr. Cripi made a maybe 5 inch incision in the cow’s side. She didn’t seem to notice; hurray for local anesthetics. He pointed: “See? Her abomasum is right there. That’s huge!” The abomasum was hugely distended with gas and floating right under the surgical incision. Dr. Cripi put a needle into it, attached to a long tube, and let a lot of the gas out. He had all the students smell the gas: a sort of sweet smell, much nicer than rumen smell. (The rumen is the largest and possibly most important part of the cow’s complicated four chamber stomach, the part that feed first falls into to ferment.) The farmer declined to take a sniff, and made a face.

Once the abomasum was somewhat deflated, Dr. Cripi tacked it to the body wall with tacking sutures. Then he closed the incision’s lower layers with the biggest needle I have ever seen in my life. Then he showed me how to close the last layer, the skin. I have done my share of small animal skin closures, and this was really different: that cow’s skin was insanely thick and tough. If you’ve sewn leather, you know what it’s like. I had to really put my back into it to get the needle through.

Then we dosed the cow with a liter of intravenous fluids plus dextrose, and a liter of electrolyte solution. I got to hold the fluids up “as high as you can!” If it is going to make your arm tired, it is the student’s job.

Then the cow walked politely back on her truck and went home.

We got in our truck and headed off to our first farm, with Dr. Cripi angsting about how late we were the whole way. En route, we talked about our lives. Some ambulatory vets use the ride as a teaching opportunity (Dr. Mulain); some ride in silence (Dr. Thery); some just want to chat (Drs. Cole and Cripi). Dr. Cripi had a pretty interesting life, it turned out, spending five years just traveling the world before realizing he wanted to work with food animals as a veterinarian.

Farm number one: a herd check. Checking cows in a herd for pregnancy seems to be the bread and butter of the practice. It was a typical concrete floor, feces-covered barn, but with a particularly open design that I really liked, basically just a roof over the cows, no walls. I asked about their plans for winter (this was a brand new structure). They intend to put up some cover then, but nothing permanent. We worked with a fantastic view of rolling Connecticut hills. It was a lovely scene to look at while putting one’s arm up a cow’s butt.

This farm’s staff included a scrawny kid just out of his teenage years who noticed that a female had arrived and immediately took off his shirt. This became even more hilarious when I was told that it was my job to castrate a  bull calf and that the kid would help restrain. I later asked Dr. Cripi if the kid took off his shirt every time a female vet student appeared. Dr. Cripi rolled his eyes and said yes.

How to castrate a bull calf: the vet will draw a diagram for you on a paper towel, hand you a scalpel, and send you on your way. I asked if we used lidocaine for analgesia; he said I could if I wanted to. I said yes please. (The debate in use of lidocaine for a local block in castration is that arguably it is more unpleasant to have a needle shoved into multiple spots in your scrotum and have something that burns injected than just to have the stuff ripped off real quick. Personally I think pain meds are mandatory, but even more so if the job is being done by someone who’s never done it before.) I gave the calf lidocaine injections at various locations around his scrotum and waited five minutes for it to take effect.

My experience in castrating dogs and cats was helpful. I cut off the tip of the scrotum, squeezed the testicles out. They are slippery and don’t like to come out, but I had done this before on a smaller scale and knew how to squeeze. Then I grabbed them and pulled until they came off. (The hardest part was getting a grip. In small animal medicine one uses little four by four pads to hold on to them, not your hands.) The kid asked why we didn’t just cut them off. I said that Dr. Cripi hadn’t said, but my guess was that the bleeding would be worse if you cut; ripping provides some hemostasis.

Farm number two. En route, the sun came out. My spirits immediately lifted. It is amazing what a difference some blue sky makes. At this farm we had a sick cow who was two weeks fresh. This means she gave birth two weeks ago and has been being milked for two weeks. The stress of parturition means that many of these fresh cows are at risk for a variety of diseases, like a displaced abomasum such as we’d seen earlier that morning. In this case, she seemed to have some nerve injury from when the baby passed over the obturator nerve along the pelvis. We prescribed rest, TLC, and anti-inflammatories (banamine is what you give to cows).

Farm number three. Another hobby farm, but a somewhat bigger one. This farmer had quit her previous job to just be a cow farmer, and her husband’s income was presumably supporting the operation. The cows were out on grass in a truly lovely setting (we drove over a little covered bridge across what I have to describe as a sparkling brook on the way in). The cows were spotlessly clean. Normally you sort of hesitate to pet them because of all the manure all over them (at least until you have manure on your hands, which inevitably happens). These cows were so clean that I actually sniffed one and discovered that natural (manure free) cow smell is a lot like horse smell. The farmer had put the sick cow into a holding area, which had a concrete floor which was also spotlessly clean. No huge masses of spider webs! No dead birds in the rafters! Crazy! The farmer actually hovered with a bucket to catch the urine when the cows peed, which is farther than I would go in her place, but I really did appreciate the cleanliness. As Dr. Cripi pointed out, these cows were basically pets.

This cow had a left displaced abomasum (same problem as the first patient of the day, different side). LDAs are actually a lot more common than RDAs, which is too bad, as you still have to cut on the right side of the cow (the rumen covers everything on the left side) and as you then have to reach across the inside of the cow to get to the abomasum on the other side, it becomes quite a process. This cow was dry (no longer being milked) and due to freshen (give birth) in a few weeks. Dr. Cripi was amazed that she had an LDA. Dry cows almost never get displaced abomasums; it is a disease of fresh cows. Cows out on grass also almost never get this disease. This particular cow also turned out to have pneumonia, so maybe the stress of that had caused the displacement. Weird.

So, same surgery, except that Dr. Cripi had to reach through the cow this time instead of having the abomasum pop right up under his incision. I did not get to close, as I had inadvertently contaminated myself on the cow’s side while trying to prevent the drape from falling off of her.

Last farm of the day: again, a horse owner. Her horse needed his yearly vaccines. He was 31 years old! He was a super nice horse. Dr. Cripi sat down and handed me the vaccine bottles. I drew them up and injected them into the horse’s neck. He never flinched. Old patients can be the easiest ones to handle.

End of day 3: less wet, more confident, starting to have fun.

Being a food animal veterinarian, day 2

Day 2 of my Ambulatory rotation. Still raining. I rode with Dr. Cole and one other student.

First we visited a lovely hobby farm, meaning a farm which is not expected to bring in enough revenue to support the owner. These owners bred and showed registered Ayershire cows, and sold their milk as a sideline. They had full time jobs elsewhere. This was a tiny barn, milking around just 20 cows, very clean relative to other barns (I never had to wade through an ankle-deep sea of manure, which is more than I can say for some other farms we visited), and the cows seemed very healthy.

Next we did a herd check at another, larger farm. More rectal palpations. I complained to Dr. Cole that I had no idea what I was doing when I put my arm in there. He walked us through a guide of how we should approach the situation, complete with an actual size model of a cow uterus. Awesome! Here are his instructions, because I know you are desperate to know:

1. First you feel for the vaginal canal and/or the cervix. These are fairly caudal (the direction of the cow away from the head) so don’t overshoot them.
2. Follow the cervix cranially (forward). Behold the body of the uterus.
3. The body of the uterus may have fallen off the floor of the pelvis into the abdomen. If so, grab it and pull it back up onto the pelvis so you can handle it.
4. Follow the uterus to the right. Ovary! Not necessarily round. It may be more elongated. Often golf ball sized.
5. Do the same on the left.

I got to where I could find the vaginal canal and/or cervix and the uterine body pretty reliably. I am still bad at finding the actual uterine horns. If I hunt around long enough I can blunder into the right ovary, but it is awkward to reach to the left, so I have yet to find the left ovary. (You palpate with your non-dominant hand so that your dominant hand is free to do things like write down your findings. So I palpate with my left hand. Since you face towards the cow while you’re palpating, reaching to the right is easy and reaching to the left is hard.)

Next stop was another farm for a herd check, 2 rabies vaccines, and 2 health certificates for some calves that were being taken to the fair. We’ve actually done a fair number of health certificates this week. Autumn is town and county fair season, so the kids are all taking their cows out to show them. At this farm I got to see one cow being prepped for the trip by being buzzed down smooth with some clippers.

The last farm was a herd check, 3 calves to dehorn, and 3 lame cows to check on. We tied each lame cow to a post by the head, then lifted the problem foot by means of a complicated rope pulley system that I supposedly learned in my Clinical Skills class but which I certainly could not duplicate on my own. (“Throw a half-hitch here... That’s not a half hitch! Well, do you at least remember how to do a quick release knot?”) The cows would then kick and freak out, so someone had to tail jack them to keep them distracted. Tail jacking means holding the cow’s tail straight up. To do this you have to stand very close to the cow and lean into the tail. She won’t kick you once you’re close, because they kick out to the side, not back. But getting close can be tricky. I learned: get in and tail jack her before they lift her leg and she starts hopping around and kicking. That works much better. (Trim feet down so you can see the problem. Declare the problem to be hairy heel warts. Yes, that’s an actual disease, caused by a species of bacteria. Apply powder antibiotic and bandage the foot. Done.)


Day 2 done. Still cold. Still wet. Starting to feel more like I know what I’m doing.

Being a food animal veterinarian, day 1

The first day of my ambulatory (food animal medicine) rotation, I got horribly lost on the way to the clinic, which is about an hour from my home. I came in late and missed half of the orientation. Ambulatory is so called because its vets go to the clients rather than vice versa. There are eight students on the rotation right now, but we break up into groups of one to three and ride along with individual vets.

Day one, three students, Dr. Mulain.

Farm one: herd check! Lots of rectal palpations to discover the pregnancy status of cows. If not pregnant, they would get an injection of a medication to reboot their reproductive cycle, so that their owner would know when they were going to come back into heat and therefore when to breed them. Dr. Mulain palpated first and we followed after, one student per cow. Mostly I put my arm in and waved it around aimlessly, hoping to randomly encounter a uterus.

We also dehorned some baby calves at this farm, and checked up on a lame cow who had had a claw (half her foot) removed a few weeks ago. Her bandage was removed and the clients were told to clean her foot regularly. We checked another lame cow, trimmed back her foot, and cleaned out a sore on it.

Farm two: a steer had been hit by a car! The barn had been broken into by thieves the night before and the inhabitants had escaped. The steer was covered in road rash, which we cleaned. His tail was mangled, and we amputated it. His biggest problem was a dislocated hip. We provided anti-inflammatories and advice that he was unlikely to be able to live with a dislocated hip, but that there was a small chance it would heal.

This farm also produced a calf who had injured her eye a few days before. The eye was not salvageable. We put the calf under general anesthesia with an injection and laid her down on the barn floor, then removed the eye. It was an odd experience for me, as I had just finished my small animal surgery rotation. The levels of cleanliness vary tremendously between the two rotations, to say the least.

Farm three: a house with two elderly horses in a tiny barn out back. One had been suffering from neurologic disease for years and was now increasingly lame. We cleaned out an abscess on his hoof and put on medication and a bandage. The horse looked like he was minutes from expiring, but the vet told us that he always looked like that and always pulls through.

So ended my first day of ambulatory, cold and wet. I trust that the weather will improve, though. September in New England is always lovely.