This webinar will cover a practical and evidence based approach to the Ovine clinical examination. Through the WEBINAR, I'll introduce myself, discuss considerations for arrival on farm. Also how things might work.
If your practise has the facilities to examine sleep at the clinic, we'll then discuss your core essential equipment, needed the importance of the hands off or over the gate examination. Consider appropriate handling, and then we'll go through the systematic approach with benchmarks and relevant data sets as well. And then importantly, at the end, we'll also discuss the particular nuances and alterations that you need to consider for the clinical examination of Ra MS.
So that's breeding rams and teaser ra ms as well, and then also considerations for neonatal lambs as well. So I'm David Charles. I qualified 2019 out of Bristol Vet School.
I've worked initially in mixed practise, doing small animal and companion animal and then in pure farm since completing my certificate of advanced veterinary practise in 2023 in Leap and I set up Midlands advanced breeding services in 2021 offering services, including laparoscopic A I of sleep across the area. So when we think about arriving on farm. The most important thing as soon as you arrive is going to be your P PE.
So your personal protective equipment, as with anything that we're doing this should be a good pair of boots, appropriate waterproof top and trousers. So for me, as you can see in this particular I prefer to go for brands such as Kiwi Kit. I find that they have more durability.
And also you've got those neoprene cuffs as well. So not so much for for sleep. But when you're doing cataract or potentially if you are doing sort of sleep obstetrics, there's a lot of biosecurity benefit there from those neoprene sleeve cuffs and very relevant for sleep work as well.
You can get versions with padded knees, which really helps. You're gonna want night trial or latex gloves as well. And you know, particularly in summer as well, you might wanna consider a boiler suit as well.
Importantly, in all scenarios, this should be either freshly laundered or disinfected, using an appropriate disinfectant. So for most things, that's something like F 30 a 1 to 49. Dilution.
Obviously, though as mandated by Defra if we're TB testing or there's any suspicions of TB on on the holding, you do want a 1 to 20 dilution there, and, as you know from your essential skills on your OV training, always consider appropriate parking in terms of biosecurity as well. Many practises now have the facility to examine sleep at the practise. This can be really beneficial, particularly at this time of year as we come into lambing and spring, because we can see a much greater number of sleep in a smaller amount of time.
And also it can make it more cost effective for clients as well as many practises will have either a reduced or no call out fee to examine sleep at the practise in hours. It's also beneficial if you're working in a mixed practise scenario, because if you're busy and all your vets on the road can't get something, if a client can bring it down, it might be that a small animal vet has a gap in consults and can go and see an animal at the clinic. So your same P PE considerations apply.
If you look at this picture here, I think It's a very good set up because you can see there's a nice drain in the floor, and where you've got these ceramic tiles around, it will be very easy to disinfect. It's important when we are thinking about these kind of facilities at practises. It's not just about the tables and the equipment.
You also need to think about floors and walls as well. You've got a good sink there for washing. But one thing that probably I think you might struggle with is if you're going to store particular medications there, you would probably need a lock on on that cupboard as well.
But if it is just a lambing room and you've more just got things like lube and you've got your lambing ropes there, then I. I think it's very good. One thing that you do need to be very hot on.
Those things are coming into the clinic, particularly as we come into lambing season is the zoonotic risk and appropriate discarding of any biological materials? This is something that I'm always very mindful of when things come down to the clinic because you've probably got a lot of non clinical staff around as Well, so reception or your practise might have cleaners, these sort of things as well. And we don't know if any of them are pregnant If they might be pregnant, anything like this.
And we know that a lot of the pathogens encountered overwhelming season have zoonotic potential. And a lot of them can be particularly nasty, for pregnant women. So we're gonna think about the equipment that we're gonna need.
You're gonna go to the back of your car on a good day. It might be nice and tidy and look like this. And really, what I like nowadays is a a good toolbox or a carry case, normally some sort of plastic with, a form of lid as well.
Like I used to like the kind of tack trays. But then I find that you get a lot of environmental contamination when you put it down on farm to actually do your clinical examination. So a handy tool box or even something like an a seal tub that's got that lid there as well can be quite useful, and you can fully disinfect it as well.
In terms of equipment, different vets will have different opinions. I like to take as much as I think I might need with me straight away, because I think it reduces unnecessary trips to the car. And I find it makes me look more prepared when I'm dealing with clients as well, which is particularly useful for our new or graduated colleagues.
Or if we're going to a farm where we don't know the client because we look like straight away. You've given that professional look and you're very switched on and you've thought about what you're gonna need for this visit. So smart of core equipment that you might need obviously stethoscope.
Digital thermometer nicl gloves always have lots of pairs. Rectal gloves. Phone In a good disinfect case.
Obviously, you can use it to take pictures of Leland's. If you need a second opinion, you can do that. And obviously you've got your torch there, which I use quite often to double up for things like your pupillary light reflex test mark a pen to write on any samples that we might take.
So that's your vacutainer sample pots, particularly this time of year. Think about taking your BHB strips and your ketone metre as well for potential pregnancy toxaemia cases. Obviously as well.
Make sure you've got enough fan 30 with a bucket and brush to disinfect with as well. We can't always rely that where we're going, they'll have a bucket or something to hand. So the first step is your distant examination.
Some people call this the over the farm gate. It's the same kind of examination. It's this idea of having a good look at the individual or, quite commonly, the group before you get into the pen.
So what can we assess from a distant examination? We can consider the demeanour of the animals locomotion. It's the best way of doing this.
I like the Warwick scale for a handy mobility, scoring, circling and ataxia and neurological considerations. Head tilts and turns are often easier to view hands off, and also you can look at things for circling, listeria cases, for instance, quite often, if they're on a small straw pen, you'll actually see circling marks in the straw there, as well as an indicator and another key reason for the distant examination. We talk very often about affected animals hanging back and separating from the flock, obviously the best way to see that is to look at the whole group.
Remember, sheep are prey animals, so once we get in there and we start handling them, we're going to see masking and manipulation of observable or recordable characteristics once we've started to disturb them. So once you've done your distance examination, you've made your notes taken a good history as well. Obviously, we're going to consider the options for safe restraint.
Obviously, you you can see your sleep on the sleep holder. This is quite useful in in a number of scenarios, However, depending on the skill of the person holding them, it can be a bit limiting. And it can give the sleep a bit too much movement unless they are trained.
Sort of maybe in the pedigree scenarios, to be on the halter and stand like in a showing manual restraint So we can have standing manual restraint like we see here. Or they can be in laal recumbency as well. For examination, we can put them through a sleep brace.
This has pros and cons. I like it for things such as body condition, scoring. It's also good if you want to take your blood samples.
But I find you're very limited when doing a full clinical examination because you lack really the access to the sides and the the vent aspect of the sleep as well. And unless in this, like in this scenario, you've got a good group coming through. Sometimes I find they've just got too much room to move as well.
Some of our clients have hit turnover crates. These can be quite useful as well, and so they are ones to consider. I find we see more of these, perhaps when we're coming into breeding season, because people are regularly turning over the the ewes or the rams to to look at the reproductive, organs as well.
So hands on examination comes next, once they're adequately restrained. So what's important here is that you have a systematic approach that you yourself are confident and competent in, and that, you know, will encompass an examination of the whole animal. In the literature.
There's a number of ways described so nose to tail systems based tail to head a myriad of different combinations as well. What we'll go through for the structure of the rest of this webinar is the approach that I take to go through the over and clinical examination, which we'll discuss in more detail on the next slide. But one thing to be aware of when you're doing your full over and clinical examination is you need to avoid diving into a problems based examination and the example I commonly give when I'm talking to people about the approach to the O and clinical examination is the sleep that's had a dog attack.
Unfortunately, these are still far too common. But one thing that you find if you jump straight into a problem based examination, you'd end up looking just at the wound, which is obviously very important. But if you just look at the wound, you're gonna miss checking the capillary refill time, the mucus membranes, assessing hydration and looking at other signs of hyper bulemic shock and things that you might need to act on before you consider how you're gonna treat that particular wound.
So as I say, this is how I approach the over a clinical examination, and this will be the order that we go through for the rest of this webinar. As you can see, it's a kind of modified nose to tail approach, so the first step for me is to take a body condition score. I think what's quite important here is to reinforce to clients as well.
If we're trying to get them to do regular monitoring as well is, you can't do a good and accurate body condition score unless you get hands on and you touch the animals. Absolutely. You can pick out real Emaciation without needing to do a clinical examination.
But when you're looking at the nuances between a A 2.5 or a three or a three and a four, you need to be hands on, particularly if they're in full fleece. So what you want to do is locate the short ribs of the sheep and directly there you want to feel just after the 13th long ribs so that last set of ribs and feel there you want to use the balls of your fingers and your thumb to assess the level of fat.
Cover over the vertical processes or the spinach processes, and then with your thumb, you want to feel the level of roundness, or muscular and fat cover over the horizontal processes or transverse processes. What some people would call the short ribs there and then your last step is to assess the eye muscle and the cover by pressing your fingers into the area. Between those two processes, as well as we can see demonstrated on the picture, it's important to note that there is no year round body condition.
Score target. It varies between the seasons, and it also varies when we're looking at lowland, upland or hill breeds. As demonstrated here, you've got variations between topping midpregnancy late pregnancy.
And then, obviously, as you'd expect, we'll expect the ewes to be in a a lower body condition score at weaning time because they've put a lot of energy into producing milk to rid the lambs. Clients ideally, should be doing regular body conditions growing, particularly at handling or other management procedures. This will mean that they can pick up changes sooner and in, say, ill thrift cases.
They can detect this sooner and call for veterinary investigation. Your next step will be considering head, neck and oral cavity, so the first step I reach for is to assess the eyes and the ocular mucous membranes so these can be good indicators of dehydration If we think about sunken eyes, you can assess for ocular discharge as indicators of disease, you can look for uveitis and other ocular disease or conditions, and more and more we're encouraging people to look at the ocular mucus membranes using for macular testing when we're considering Endo parasitism so humongous contorts or things such as advanced vertices. Obviously, when we're looking at the eyes, we can do a PLR test, and we can also do menace as well to look at those cranial nerves and then move on to look at the submandibular and carotid lymph nodes, we're gonna consider things such as abscesses, salivary mules and link.
There you consider things like your pitting edoema, so that idea that when you press into it, it leaves, a pit that takes time to fill back out. Some people will call this bottled or colloquially as well. This usually is from systemic anaemia or hyper hyper pro anaemia can be things such as ova, neons, disease or chronic endoparasite as well.
At this stage, I like to also assess nasal airflow, and this is easiest done by getting some straw or some bedding, and you can just hold it over the end of the the nose there over the nostrils and assess the airflow by looking at the movement. Then we move on to oral cavity and the intra oral examination. In ideal situations, you might have a sleep gag to hand to make this easy.
Remember, best way of ageing sleep is via tooth eruption. We can consider lesions of the oral mucosa. There are some really important diagnoses here that we need to be really looking at the oral mucosa for so blue tongue, foot and mouth disease thankfully not seen for a while.
But we need to be mindful. Keep them on our differentials when we see or mucosal lesions. Or as seen in this picture, you can also get a particularly nasty oral form of off viral lesions as well, and we could consider cloaked or other obstructions.
I then move to the neck and I assess swellings or abscesses. I assess the range of motion and you can auscultate and palpate the CR. I called trachea there as well.
So this photo on the right is from a case that we got involved in that was sent to the University of Nottingham for a a postmortem and the diagnosis that we found was these you were presenting with neck swellings and some of them were just found dead. This was picked up on clinical examination and what we actually found was that it was a series of drench gun injuries which were setting up abscesses in the left rear pharyngeal causing hematoma and gangrene, erosions and the ones that were presenting as sudden. Death was due to these gangrenous erosions eroding the edge of the carotid artery.
And we were seeing them effectively mass bleeding out and dropping dead. Once I'm happy, I've assessed sufficiently the head, neck and oral cavity. I'll move on to the thoracic examination.
Firstly, I'll do auscultation of the left and right lung fields. It's important that you do this on both sides, so do consider how the animal is restrained. And if you need to move to osculate both sides, I divide it into three.
So a dorsal mid and a ventral. I'll then do bilateral heart auscultation for the right hand side. You've got good markers as seen in this picture.
The electron L is just cranial on to the a V and on the left hand side. You can also listen to the the valves, knowing you've got the pulmonic above and the aortic below. What's important when you're doing this is make sure that with your hand as you place your stethoscope on, you want to make sure that you part the wool for maximal diaphragmatic contact.
Yeah, if there's particular lesions or any kind of evidence of rubbing, you want to examine the ventral thoracic area for brisket scores. And at this point, I'm also looking at the fleece and the skin for evidence of any, dermatological lesions, any endoparasite lesions and these sorts of things as well. We can then add another layer to the thoracic examination with some disease specific screening so we can consider the wheelbarrow test or transthoracic ultrasound to look for OP.
A. And obviously your ultrasound as well will let you pick up any free fluid. And also you can get very good images like here of abscesses within the lung, considering our core parameters here for a resting heart rate, we're looking 70 to 80 beats per minute, but do note that in particularly stressed animals or animals that get stressed either being brought in or on physical restraint for examination, we might see an artificial elevation, and you want to see a resting respiratory rate of 12 to 20.
And quite often I will actually assess the respiratory rate very much hands off to either when the animals in the pen by itself or if it's standing on a halter because we know then it should be before we see any artificial elevations from handling. We then move on to the abdominal examination again. It's important to make sure that we're considering the left and the right hand side.
So starting on the left, I will auscultate ballot and palpate the Riman, knowing that I'm looking for three turnovers in two minutes on your palpation or allotment. This is where you can commonly pick up areas of bloat as well as this presents commonly on the left side. I'll then move to Auscultate and palpate the right hand side, and I will listen for that B barmy or that toilet flush sound as well.
Some people will talk about allotment of the ventral abdomen as part of a pregnancy diagnosis. I find personally that this has a place, but I find it's unreliable and unless they are very late in gestation, it can be hard to do reliably and to definitively pregnancy diagnose as more and more farm practitioners are carrying ultrasound scanners in their cars. Anyway, If I'm involved in doing a pregnancy diagnosis check, I will just do transabdominal ultrasound to assess for cotyledons or presence of foetuses.
And that's much more reliable again. As with the thorax, make sure that you're considering fleece and skin there as well, and in particular presentations as well as pregnancy diagnosis. There's a role for abdominal ultrasound, so blocked grammes considerations of Riis.
This image here is an ultrasound that we did of a blocked male that had Riis and you could do our bladder measurements there and track this as well and then move on to consider the perineal area. And obviously part of this is taking your rectal temperature as well, so we can met a perineal staining. Using DAG scoring and an elevated score might indicate scours.
Knowing that there are many causes so nutritional, parasitic or infectious would be the three main groups that spring to mind. And we also know that if we have an elevated DAG score, we are going to see an increased risk of blow fly because those larvae will survive in the moist fleece of the scours. I'll use my thermometer.
Take a rectal temperature, looking at 38.5 to 40 degrees. Again.
As with all the species, make sure that you're making contact with the mucosa for an accurate reading. When we consider Dag scoring, most people use this 0 to 5 scale and what's important. Not so much for the clinical exam, but when we're talking to clients about this is that it's consistent and reliable.
So you want, ideally the same person doing it in the same year within the same flock for reliability. And if we're giving advice on when to do this, lamb should be di school at weaning weaning, plus four weeks weaning plus eight weeks if they're still there, weaning plus 16 weeks as well Adult sleep. It's more commonly in as and when perhaps around when deciding about faecal, a counts and other parasite control measures for the female, I then move on to the vaginal examination for the vaginal examination, make sure you've got appropriate lubricant, and if you're in the periarterial period, make sure that you are using, rectal gloves, particularly because we know there are a lot of zoonotic risks around the periarterial window, especially if it is a potential abortion even outside of the perrotte period.
The vaginal examination has its place, but you need to be very careful to ensure that you're not causing any trauma to the soft tissues. Commonly, you're gonna be using your vaginal examination to assess stage one or Stage two labour and make obstetrical assessments. So assessing male presentations considering if you've got foetal maternal oversize and cases of incomplete cervical dilation are assessed through viral examination post.
Partly, we will also be able to detect things such as retained foetal membranes. A retained lamb. This is a common common cause of the you that presents not quite right a day, two days after they've had maybe a single or occasionally twins.
You then do your examination, and this is where it's important that you do your postpartum vaginal examination because you might just find another alarm in there that's starting to decompose and causing the adult you to go downhill and obviously postpartum as well. Consider vaginal or uterine tears on your differentials list. Prolapse assessment.
I do, this part of the vaginal examination and remember normal lochia might occur for up to three weeks. Postpartum. The next step now for me is to move the sleep to the tipped position like this.
However, unlike in this picture on the left, I tend to recommend that the client tips the keep for you because it's a lot easier to do the next steps of the examination. If you're not restraining the keep and therefore you can move and examine it a lot freer for the female. Next, we're gonna consider the other.
So unlike dairy cattle, there isn't a validated scoring system for the udder or teat of use. So the mainstays of the udder examination are going to be assessing appearance for swellings, abnormalities, erythema and areas of tenderness. Palpation can be good indicators if we see areas of tenderness or swelling as potential risks for mastitis commonly.
Obviously, your mastitis and sleep is going to be staph aureus or E. Coli mastitis Lambs can be a very good indicator of poor other health as well, So if we do have cases of egy Latia, we will probably see hollow lambs and you may well have swollen, painful teeth from where the lambs have been trying hard to feed, as we say palpation areas of tenderness, swelling or heat for mastitis. But we can also detect in Commemorating masses.
This is something that clients also probably do quite a lot when they're making decisions in the late summer about which use to breed from again. They'll assess this and then in clinical cases or potential mastitis indicators. Consider cold areas and areas of sloughing tissue for advanced cases.
If we are worried and we can express milk, then obviously do a visual assessment. Consider if it's watery, blood tinged and there are labs now that will run cultural sensitivity as required as well for treating your post bacterian lack of milk let downs as well. We can consider oxytocin.
So for oxytocin S 2 to 10 IU per U. We've had good success with this in the last few years, and in our cross group order of 209 cases, we found that this was backed up outside of just my practise as well, with people within our group having good response to using oxytocin to encourage milk let down unfortunately, hearing injuries to the other or teeth remain common and then move on to consider limbs and feet so as you would for small animals. Actually, I like to use the sap and sperma prick, so I'll use SAP to assess the lung bones, so I'd want to consider any swelling, any muscular atrophy and any pain on palpation as well as I.
Then move on to the joint. I use the sperm pneumonic so swelling or effusion across the joints. Any pain on manipulation, any areas of instability.
I consider if there's limited range of motion and again I will do a full manipulation of the joint. It's also a good chance to assess the limbs and the feet fully for any cuts, so this could be from wire or other trauma and abscesses as well. Although I find abscesses are less common on the distal limbs, they tend to be more around the body or the neck and the head there.
We'll then move on to the feet as well, so we'll consider foreign bodies any discharge maloa advanced foot rot. In really bad cases, you'll see maggots as well, which can also increase your risk of blow fly strike as foot strike is a less common presentation compared to your more traditional breach strike. When I'm looking at the feet, I always have in the back of my mind these common causes of Rover and lameness.
So foot rock, scold cod less commonly hoof toe granulomas as well. And for me, by following this system here, this shows that I've done a full approach. And I know if I've gone through this order and considered these areas that what I've done is a full nose to tail approach.
This is the point, then, where you might then dwell more in and look at specific areas. If you've got, say, those leads that they need looking at or it's given you enough to then know where you're gonna take your samples or if you're gonna use your vain is take blood. If you've seen things on your fleece and skin assessment, you might then reach to do some dermatological sampling next.
So we're now gonna talk about the considerations for clinical examination of Ra. MS follows the same systematic approach, so make sure that you're still doing a full nose to tail or systems based or tail to head whichever approach that you're comfortable with and know that you can do confidently and competently. Which will mean that you've covered the entire animal in your clinical examination.
But there are some key differences to what we've just discussed. So the first one is body condition, score targets ahead of the mating season. We're gonna want to see a high body condition score of 3.5 to 4.
This is because we know that over two breeding cycles they're gonna lose approximately 16%. So if the body condition is too low, they're not gonna have the energy in the reserves to get through a full breeding season. But if the body condition score is too high, it can mean that they become a bit lazy and they have this real inability to mate.
And then as we get into winter as well, the literature says that you're looking for a body condition score around 3.0 to successfully over winter in your ra ms. When the animal is tipped up, I then consider my examination of the external genitalia so you can see here.
This is the benefit of having somebody else hold the tap for you while they're tipped up because it gives you much better access to do your assessment. So palpation of the testicles within the scrotum, A full scrotal examination, not just your circumference with your breed standards or your age standards. But also consider the skin the fleece.
So chops Bovis can be particularly nasty and cause identification of the skin of the scrotum as well. So that could be on your differentials and something that you check for at this point as well as you can see in that top picture, you're gonna palpate the spermatic cords as well. And you can also assess the distal Penis.
And if you can extrude it, you can also collect that vermiform appended. That's particularly important in cases of potential urethral obstructions or urolithiasis common things that you might feel on palpation of the testicles. Within the scrotum.
You should be able to feel orchitis epididymitis hyperplasia you'll get from your circumference, but also your palpation there as well. More and more we see, practitioners are also starting to do testicular ultrasound as well. And as we discussed before, remember ultrasounding the bladder and also the distal Penis can be very useful in cases of blockages.
This photo here shows using a reliable measuring tape to take our scratch circumferences there being quite useful because you can then make sure that they are fully brought down into the scrotum. But then you can take your measurement with one hand so that you've got that pressure around the neck of the scrotum so that you know, you're measuring around the widest point. Pre bringing examinations could be a whole webinar in themselves.
And so to really go into them is definitely beyond the scope of this talk. But there are some key things that we draw out as part of any clinical examination of rams, and this largely falls into considering the five TS of MOT as the A H DB put them out. So particularly as you're coming into breeding season but actually as part of any thorough clinical examination of the Rams, always gonna be collecting teeth.
Gonna be collecting feet testicles. We've discussed tone. Always.
Any clinical examination that I do of any adult sleep involves a body condition, score assessment and knowing what should be expected at that time of year in that system and in some cases for that breed as well, and then consider treatment. This is always important with your clinical examinations to consider if the farm is given anything that might be masking things as well. So when you are taking your history, always draw out what the client has done before I find for our farm animal clients.
Compared to, say, our companion animal owners, the farm is far more likely to have given some intervention or some treatment prior to calling the vet out. Compared to your normal pet owner. Considerations for spiritual circumferences are detailed here, and there's some very good guidance in the veterinary society certificate and documents there as well.
But this really draws out that there are variations between breeds and there are some core variations for different ages as well. We're now gonna think about neonatal arm considerations and the changes we need to think about here. So really important when we're thinking about neonatal lambs is the individual, but particularly the group, because we could be picking up things that are just the tip of the iceberg, really, for something that might be a devastating flock wide problem that's about to happen.
So if we're starting to see early issues with failure of passive transfer. This could be that the ES aren't in the right condition, and the whole colostrum of the whole flock might not be the quality we need. And you really need to consider the group and how we can get ahead of this to protect the other lambs that are coming through.
I think this is something that we see a lot with. Neonatal Lambs is quite often the clinical exam gives us information that will protect all the lambs that are yet to come. As more commonly, we're seeing the problems, perhaps in the first born one.
So again, infectious diseases. It's considering what that individual will tell us, what we can do for that individual, but also what we can do to protect the rest. Data is really important, and we've done a webinar last year on using flock data and how it can help us, but particularly with neonatal lamb, clinical examinations think about things like, Is this an unexplainably high amount of losses in the 1st 24 hours of life?
Is this breaking that 2% abortion target? Do we need to think about vaccinating in the face of an outbreak. Biosecurity, Further testing zoonotic risks all of these things that really your neonatal lamb clinical examination can pull out and help you.
And again, the age of the neonatal lambs really will have a huge impact on the differential diagnosis list. Whether it's things in the 1st 24 hours of life or those first couple of days, it makes a real difference to maybe what goes on to your list of differentials so, as always, follow a systematic approach. But there are some key areas that I think I would highlight and make sure that you draw your attention to.
Firstly, have you considered your hypothermic indicators? So the posture have we got this abdominal tuck? Are they doing this standing on a sixpence posture where all four feet are tucked in really closely together when they're standing on to almost a point?
Some people also call it standing on a teaspoon. Consider your rectal temperature. If it's under 37 degrees, that's obviously hypothermia interventions required.
If we're under 32 degrees, we need to be taking some severe and aggressive action. So considering IP glucose rearming boxes and obviously when you're doing this and you're considering your rectal temperature and your hypothermic indicators. The ability to lift the head is very important, as quite often that, coupled with the temperature, is going to be the point.
When you decide when you can get in the stomach tube, we're gonna assess the mouth as well for either genetic abnormalities. So prog natia brag or watery mouth. So is the suck reflex present.
Is there excess salivation? Is it another congenital thing? Is there a cleft palate?
Assess the umbilicus? Has it been treated appropriately by the client? Has it dried up properly?
Is there an umbilical hernia? Is there a remnant? Are we starting to see early signs that might make us worry about naval ill later in life joints?
So over the last 10 years or so, we periodically see these outbreaks of smell and beg virus, and we'll quite commonly see fused or fixed joints presenting Use your sperm pneumonic when we're looking at assessing the joints in any age. It works really well and for neonatal lambs as well. I really consider any neurological or neuromuscular changes so early CCN trace element deficiencies.
This lamb here was presented to me last lambing season with spastic tetraparesis, a permanent head turn. We also saw nystagmus and an intention tremor, and this was diagnosed as a case of dental sway back. And it was actually the first of a wave of trans related deficiencies that we saw in that lamb crop.
And being able to know your considerations early and drawing into these areas meant that then we could give appropriate advice and start to look at protecting the rest of the lambs to come as well. So overview where we're looking with our neonatal lambs, the core parameters because more of these are different to the adults than, say, the ra MS R MS. Really, your main core parameter differences is around your external genitalia, your heart rate and everything remains the same.
We know with all species that core parameters are often different compared to adults, because we've got an increased metabolic rate and a different surface area to volume ratio in our neonates as well. So these core parameters come from the li, so you're looking 80 to 100 beats per minute for your resting heart rate. A higher respiratory rate at 30 to 40 mucous membranes remain salmon pink Kentucky with AC RT of under two seconds.
Skin. 10 time As you'd expect, you want less than three. But remember that more than five can be an indicator of dehydration, rectal temperature.
And when I'm taking my rectal temperature, I will check that we have got a patent rectum and anus as well. We do still see quite a lot of re A I and other cases in lambs. I like to look at the eyelids as part of my clinical exam of any NN.
A. We can see entropion still very commonly. More and more clients probably are treating this themselves, though, but we will still get a good number presented to us every year, and it still remains particularly prevalent amongst textiles.
Have a gentle palpate over the skull. Make sure there's no crevice on palpation that might indicate any fracture or trauma. Sometimes this can be like a layover, or also it can just be from obstetrical difficulties or improper use of obstetrical aids like the snare or the rope as well.
If clients aren't careful, can cause problems. Obviously, we don't worry about a room and turnover rate in our neonatal lambs, but we will still draw due care and attention to perennial staining as well. So to summarise what we've covered in the last 45 minutes or so are key things that we want to consider really dwell into five key points, so be prepared when you arrive.
Make sure you've got suitable equipment. You've got appropriate P PE. It's adequately cleaned and disinfected, and please do make sure that you have appropriate restraint and you've got the people there to help with handling if you need it, I find it's probably more common with the small remnants than cattle.
I think you know, it's very common that cattle are already presented to you in a crush. I think a lot we see more and more Oh, the the you just in the pan over there and we don't necessarily, particularly in a busy lambing period. Always get if we don't ask enough hands to handle the the individual or to pick them out of the group, et cetera.
Make sure that you take a really thorough history and you've got the information that you need. I appreciate for a lot of us. If we're dealing with clients that we have a pre-existing relationship with or it comes in over the phone.
A lot of that history taking happens, actually, before we step foot on the farm. But I like to use the technique when I arrive on the farm. If I've got a lot of history before to just bring up those key points again and really focus mine and the client's attention on what we're potentially gonna be looking for and make sure that you do your over the farm gate or your distance examination first, it can pull up a lot of information that we might not see if we just jump straight into the hands in Be systematic.
You don't necessarily have to use my system that I've outlined today, but make sure that you have a system that's reliable, that you know will let you cover all of the stages and that you are confident and competent at as we've discussed, there are quite a lot of differences that we need to have in the back of our mind when we do clinical examination of Ra MS and neonates and as with everything, really make sure that you take really good clinical notes. This a benefits you. It also benefits your colleagues.
If you see a case and then somebody else needs to follow up on it over the weekend or if they start to have an outbreak of something, it's good to be able to track. Look back at the incident cases, and also it means that you can link your test results and everything as well. So we we could definitely be doing it.
And one way that I quite like of doing this is I either take a notebook around with me and scribble a few notes after each visit, so that then when I get to the office and write up, I'm not trying to remember all of my readings. All of my clinical exam findings from the whole day or the other thing I know a lot of vets do is they'll just take addict phone or use voice notes on their phone to just do a quick summary at the end of every visit. And this can work really well as well.
So as we all know, the over and clinical exam is one of the main skills that we need to have if we're doing any heap work and for me, having this systematic approach means that I'm drawing all the information I can out. It's guiding the testing that I'm doing. And it's my way of knowing by following this system that we've covered everything in a systematic order.
And we've got a plan going forwards to the next step of the consult, which would obviously be diagnostics. Or in some cases you might go straight to treatment. As I say, the point of this webinar was to make sure that we were really grounded in the literature and the latest evidence.
So here are the references and thank you for listening.