Chapter 7
Thanks Doc, I Needed That!
The traditional calving season on the Canadian Prairies occurs from February through to May each spring. Many calls meant trips to farms, often many miles away from the clinic. And that meant a lot of a large-animal veterinarian’s time each day was spent in a vehicle.
As the operating costs of mixed-animal practices increased, veterinarians could ill afford the non-productive, non-money-generating hours that driving to and from calls consumed. These were hours that could otherwise be devoted to the ever-growing (and more lucrative) small-animal case load.
Consequently, mixed-animal clinic policies changed. Many clinics began requiring producers to transport their animals to the cleaner, warmer, safer, and much better-equipped confines of their large-animal clinic. Here, vets and their assistants could perform their duties much more efficiently. Today, this has become the accepted norm.
One calving-related condition we frequently saw in mama cows and first-calf heifers is known as a “prolapsed uterus.” Whenever this occurs, the entire uterus (calf bed or womb, in lay terms) is expelled through the pelvic canal by the powerful abdominal pressure exerted by the cow pushing during and/or immediately after giving birth. The uterus ends up either laying on the ground – still attached, of course, but out behind the cow, fully exposed to all the environmental elements – or, if she stands up, hanging downward, sometimes far enough that it can actually be just touching the ground.
In a large 1,500-pound cow, the uterus can be the size of a large pillowcase and weigh upwards of 50 pounds, maybe more. This situation is an emergency, and it requires immediate veterinary intervention. Shock, excessive blood loss, trauma, and accidental punctures or tears through the muscular uterine wall can be further complicated by intestines herniating out onto the ground. If the patient is not kept quiet and in a warm, clean environment (which is more the exception than the rule), it can be just minutes before, as the saying goes, “The flies could walk upon her eyes!” Hence the very real urgency of addressing the problem.
We never, ever recommended producers load up any cow with a prolapsed uterus into a stock trailer to transport her to the clinic – or anywhere for that matter. “Leave her quiet and right where she is until we arrive” was our general advice.
Well, like the majority of a veterinarian’s calving calls, uterine prolapses occurred at any hour of the day or night. One year, Dr. P and I renamed Easter Sunday “Prolapse Sunday” after we were called out to service and replace eight prolapses between the two of us over one 24-hour period, interspersed with other calls.
Typically we expected to do four or five a week. Eight over one 24-hour stretch was extreme, and the most we ever did in that time.
I reported to work one morning after Dr. P had served as the first-call after-hours vet. While checking the appointment book for the day that lay ahead, I glanced at the after-hours calls Doc had tended to throughout the night. Sure enough, one was a prolapsed uterus in a cow.
During our brief morning update discussions, Doc didn’t report any unusual or untoward cases. Everything he had dealt with through the night was routine. No reason to expect any complications or fallout from any case.
The day was uneventful, the usual run of cases. The night, with me on first call, passed. We always alternated after-hours duty during the weekdays. The sun rose on another day, and we were busy working our way through the day’s appointments. Then a call came in from a large-animal client.
Doc was out of the clinic at the time, so I took the call. The client was one that Doc had serviced two nights earlier. The producer stated that Doc had come out to the farm in the middle of the night to put a calf bed back in a cow. All seemed okay the next day, but for the past 24 hours or so, the cow had been hunched up and straining periodically.
There could be a number of reasons why this was happening – some traumatic, some anatomical, amongst other potential causes.
After further discussing the events of that night, it sounded as if everything went by the book to me. So why the straining now?
From miles away on the phone, it was near impossible to know for sure. I suggested bruising and trauma and resulting soreness along the birth canal might be the issue. In the back of my mind, I was a little concerned that this cow might be thinking of trying to push out her calf bed for a second time.
We always placed a strong, skate-lace-like, circumferential purse-string stitch completely around the vulva, the outer slit-like opening through which any prolapse would have to pass to get to the outside world. Still, there were rare occasions when the odd cow would try to force the uterus back out through the vulva after the vet had placed it back, hopefully in its rightful anatomical spot deep inside the cow’s abdomen. But now, since the vulva was stitched tightly closed, the skin and tissues all around the perineal area would actually rip apart, resulting in one heck of a mess. When this happens, it makes for a more complicated uterus replacement than the first time, and a much more involved surgical repair of the entire perineal area.
Despite knowing this, I recommended an injection of a long-acting antibiotic as a precaution and an injection of dexamethasone (a steroid intended to reduce swelling and decrease inflammation) in the hope that this would bring her some relief from the discomfort she was obviously experiencing. Before hanging up the phone, I told the caller that if she wasn’t any better the next day, he should get back to me and we had better examine her. The producer complied and did as I prescribed.
The next afternoon, this same client called again. He informed me that the steroid had maybe helped a bit but, as the day had worn on, the cow was actually getting worse. She was noticeably hunched up all the time now and pushing harder and more frequently. I told him he’d best bring her into the clinic so we could check things out. He said he was busy the rest of the day, so he’d have to bring her in the next morning.
I somewhat reluctantly agreed to this, not really believing it was the wisest thing to do. I recommended he give her another steroid shot for that evening.
I was quite concerned that, despite the passage of time since the initial procedure and Doc saying all had gone routine, this cow might indeed be trying to re-prolapse.
The third night passed. The cow was now straining non-stop. Still, at least she hadn’t re-prolapsed. The producer called to say he had the animal loaded up and was on his way in. When the cow walked off his trailer and into our handling chute, I could see that her abdomen looked extra full.
Her eyes were bright. She seemed alert. In general, she looked more anxious than anything but certainly not sickly. Her tail was extended directly out behind her and as soon as she was in our chute and her head caught in our restraining head gate, she assumed a very noticeable hunched-up posture and the straining and grunting began.
“Well, let’s have a check of things,” I said, walking around the backside of this cow.
As large-animal veterinarians, we spend an inordinate amount of time with an arm or instrument up either the rectum – which I jokingly began to call “the sewer” – or just below it in the vulva/vaginal region – which I frequently referred to as “the playpen.” I often wondered why it was that the good Lord during creation decided that it was the best idea to place the playpen right under the tail, directly below the sewer.
But the longer I was in practice and the more times I dealt with medical and surgical conditions of the south end of cattle, horses, sheep, pigs, etc., the more I came to realize that God got it right again, despite my questioning His wisdom earlier in my career. For example, the current arrangement ensures that each and every newborn enters into a clean, uncontaminated and welcoming environment by avoiding having to pass right over the “sewer” during the birthing process on its first entry into the real world. Shame on me!
As I took a closer look at the area under this cow’s tail then, I could immediately see a large, swollen donut-shaped swelling occupying her entire perineal area. Its appearance reminded me of one of those big circular orange buoys you see lifeguards carry around at the pool – the ones they throw out to any person in distress to latch on to. Only this one was under the skin. Looking closer, I could identify a very swollen vulva, but where was her anus?
Where on earth was her anus?
I began probing the very swollen area with my gloved hands and immediately it became evident.
Aha!...