Hi everyone and welcome to today's webinar where we're gonna be discussing the down cower and also the downer cow. So what are we gonna try and cover today? It's quite a big topic covering those two conditions.
So we won't focus in a lot of detail on some of the potential causes, but we'll try and look at the common causes of a, a recumbent cow. Understand how we can differentiate between the causes, based on our clinical exam and any other diagnostic tests that we might be able to do. We'll consider some different treatment regimes, depending on the cause.
And then we're gonna look at the downer cow syndrome and first of all, understand what the difference between those two terms is, what is the difference between a down cow and then a downer cow. Because I think sometimes people use them fairly interchangeably. And then we need to talk about, the treatments and prognosis for these, these different cases.
And we might do some of these learning objectives as we go through the different stages rather than following this order. OK, so going down to very basic definitions, a down cow or a recumbent cow is a cow that is unable to stand, for whatever reason. And then a downer cow, is a cow that remains recumbent despite the initial cause, having been treated and and resolved.
So, a down cow that remains down, enters this downer cow syndrome. So when I get called out to look at a a recumbent cow, the main groups of differentials that I'm thinking about are toxic conditions, maybe an acute abdominal event, a neurological problem, some form of trauma or metabolic causes. And if we look at those in a little bit more detail within our toxic conditions, that might be a toxic mastitis, a toxic metritis, or a septicemia.
It's probably worth saying that the majority of downed cows, probably are seen following a calving event, not necessarily within the first day or two, but normally in their history, we will identify that they've recently calved. Our acute abdominal events, this isn't an exhaustive list, could be an abomas or vvulus, could be an acute peritonitis, intestinal or cecal vvulus, or even a wire, so a traumatic reticular pericarditis. All of those painful, abdominal conditions could result in a cow who is unable or unwilling to stand.
Then we of course have neurological and split these into our peripheral neuropathies, and probably the most common ones that we would see and describe are obtuator shown by the, the two pictures, . So I'm just gonna change my. These two pictures of obterator nerve paralysis, where we have legs splayed out and the cow struggles to bring them back in underneath her body.
Classically seen, if a cow slips on a wet surface and, and sort of does the splits. Then we might have sciatic nerve paralysis, where we might see these dropped hocks and some knuckling, again, typically seen with some form of maternal foetal disproportion. Where the foetus has been sort of stuck in the pelvis, for a long time.
Or we might get peroneal nerve paralysis, er which is generally just seen as knuckling, and, probably the prognosis for that one is fairly good, but it can result in them being unable to stand if they have a bilateral er peroneal nerve problem. And then of course we might have some central nervous system disorders. Again, this list isn't exhaustive, but Listeria, BSE, meningitis, would be ones that might be on your list.
Hopefully not BSE, on your, on your top of your differential list. Then we might have traumatic problems, which will often be related to a calving injury, but maybe due to the housing, maybe due to bullying and mounting injuries. And these could include a sacroiliac, luxation or subluxation, dislocations of the hip, pelvic fractures, injuries or fractures of limbs, or tendon or ligament ruptures.
And then the metabolic causes, and you'll all be aware of hypocalcemia or milk fever, hypomagnemia, or grass staggers, and then hypophosphattemia as well, another, another mineral that is essential in the transport of the two above. And then hypokalemia as well might result in a, in a recumbent cow. So what do we do when we get to the farm, you know, often the call is the farmer has a down cow, so we get there.
I, if it's not a farm I'm, I'm particularly, used to, I might ask some questions about farm history, the main ones being. Is, do they see a lot of downed cows? Have they had problems with metabolic issues in the past?
Then moving on to that specific cow history and I think the key question is, has this cow recently calved? When was that? Did she have any assistance?
Where did she calve? How soon after calving has has she become recumbent? And then another key question that I always like to ask is, is what has the farmer treated this animal with already?
I think with most down cows, farmers will have given some form of calcium, bolus, often under the skin, or by oral drenches quite commonly now by farms. But we wanna know what's happened because that may change what we find on our clinical exam and also might affect some of our diagnostic tests. As always with farm, our full clinical exam is by far the best tool that we have available, and doing a thorough general clinical exam, is essential in trying to localise which system is involved.
But because of those differentials that we talked about, we do wanna make sure that where we can safely, we want to do some musculoskeletal manipulation. Obviously the cow is often. Laying on one side, so it's difficult to assess those limbs that are underneath.
So it may be worth rolling them onto the other side so that you can examine all of the limbs. We can do some neurological tests, again, the limb has to be uppermost for that to be possible, and we can do some sort of head level . Neurological examinations as well.
We would want to look at the other. And again, look at the surroundings where the cow is. If she is down in a cubicle or down in a fairly dirty area, we need to be aware that if we are stripping out that udder, we are opening the teak canal and potentially allowing bacteria in.
It is an essential part of for ruling out er toxic mastitis. And then also to rule out both a toxic metritis or rule in er or perhaps a pelvic fracture, a vaginal exam or a rectal exam are are are also really useful. If we want to take some samples, again, be aware of what treatments the farmer has already given so that you can let the labs know or you can interpret any results in light of that.
But we might want to take a milk sample to check for mastitis pathogens, and we might want to take a blood sample to look at mineral levels. So what are some of the common clinical findings with these different sort of differential groups? Well, in toxic conditions, we might see injected mucous membranes, the cow is likely to be dehydrated.
And in the case of mastitis or metritis, there will be toxic secretions, either from the udder or, or on vaginal exam. Abdominal events, well, it really depends on what structures involved, and this is where we might be listening to gut contractions, we might be listening for that audible ping, whether that ping could also have a splash related to it on beotment, and that might help identify which part of the GI tract might be involved. With musculoskeletal, we're probably looking at whether there's limited range of motion.
Thinking about trying as best we can, it's difficult in large cows to isolate each joint to move them independently, so that we're getting a true reflection of what's going on. We might feel some crepitus when we manipulate that joint, so I will often put a hand on each joint and then move the limb with the rest of with my other arm. We might also get a pain response on palpation.
Vocalisation or the cow really resenting you, moving the limb in that way. Be aware that, you know, lots of cows will resent you, manipulating their limbs anyway. For the neurological conditions, again, depending on where the lesion is, we'll be looking for neurological deficits on our examination.
And then for our metabolic, we all know there are some very classical signs described for, for hypocalcemia, hypomaggnacemia and hypophosphattemia. So very much dependent on which mineral is involved, we may see different things on our clinical exam. So going into a bit more detail with the toxic conditions, as we said, general science would be mucous membrane discoloration, then maybe dehydration, possibly tachypnea and tachycardia.
With toxic conditions, depending on when you examine the animal, you might see a high temperature, but they can also have a low temperature. Specifically with toxic mastitis, we're gonna get a watery or hemorrhagic secretion from the affected quarter, and it may be hot, swollen and hard. Be aware that multiple quarters might be affected.
With a toxic metritis, we will often see a red, brown foetid, uterine discharge, and the cow is often seen, with some excessive abdominal straining. Because of the inflammation, as you perform a vaginal exam, again, you may see excessive straining from the cow. With some of these abdominal events, if there's an abbemasal volvulus, you might see some signs of colic and then our audible ping, where that Abemasum has moved to, an acute, diffuse peritonitis, .
Often there'll be a ping on both sides, but you won't get the splashing on ballotment like you might with a like you should with an Abamazel, . Displacement. Intestinal volvulus, often it's really just signs of colic, and again, we might get pings, sort of linear pings, depending on which segment of the intestines is involved.
Cecal ulvulus, that very caudal right-sided ping, may be evident. And then with a traumatic repticular pericarditis, we might get muffled heart sounds, pain vocalisation. It's not really possible to do the, the common tests that you would in a standing animal of Withers pinch or the bar test, in an animal that's recumbent.
With the neurological causes, peripheral, with an obtuator, we're gonna see splayed legs with a sciatic, they'll be unable to stand if it's bilateral. But you will, if they do get up or you lift them, you will see these dropped hocks and knuckling, the sciatic branches into both the tibial and then the peroneal nerves, so you see effects of neuropathies in both of those. And with peronial, we tend to just see a knuckling, and again it can be unilateral or bilateral.
Traumatic causes, if there's a pelvic fracture, what I've generally found would be some crepitus when you're, rectling that animal. And often as you're sweeping sort of round the, the pelvic brim and the pelvic inlet, you will feel an abnormal, shape to the pelvis, an abnormal step, and you might get vocalisation over that area because it, it's painful when it's palpated. If there's a limb fracture, you know, if it's not immediately obvious visually, then often when you're trying to do range of motion in these limbs, you will see that fracture there and if your hand is over the right area, you will feel crepitus as well.
Hipluxations, thankfully, I think are fairly rare in an adult cow, because they don't have a good prognosis, but they tend to have a very abnormal appearance when you look at the, cow from behind. However, again, a recumbent animal is quite difficult to judge symmetry. There'll be an abnormal range of motion, and you might feel crepitus as the bone moves over the acetabulum.
With the metabolic causes, with milk fever, it's described this classic S bend in the neck. There's usually a low temperature, dry hard faeces, ruminal stasis, and quite commonly muscle fasciculations, with hypomagnestemia, they may be hyperthesia, so the cow kind of overreacts to stimuli. And again we might see muscle fasciculations.
Obviously with, grass staggers or hypomagneaemia, it can rapidly turn into seizures and convulsions and death, so, . I, I don't think you see them as recumbent for long as you would in a a milk fever cow. Hypophosphattemia, fairly similar signs to hypocalcemia because of the co-transport effects.
But again, it's described the creeper cows, cows that are recumbent but will kind of commando crawl forwards. Some texts do suggest that that is more likely a hypoer phosphotemia than a hypocalcemia as the main cause. And then with hypokalemia, er we'll see generalised muscle weaknesses and muscle fasciculations.
So in most cases, er, from our thorough clinical exam and the history that we get from the farmer, we can narrow down er the differentials. If we think it's a metabolic disease and we're not sure and the we're not sure which one it might be, because they do share some similar signs, then we might want to take some serum blood, to diagnose. And generally, again, I would recommend using the, the reference ranges that, that which of whichever lab you use, but generally a calcium less than 2 millimo per litre, a magnesium less than 0.7.
A phosphorus less than 1.4, or a potassium less than 3.5 would be suggestive of low levels of that, that mineral, and we will see Maybe calcium and phosphorus both low, we might see calcium, magnesium and phosphorus low, it really depends on how long the cow has been like that.
Be aware that if the farmer has treated that animal, you might get a normal blood result, even though that is, is what the problem was. . If you are gonna take bloods, then obviously take them before you administer any IV mineral treatments.
Also be aware that if this cow has been recumbent but not offered food and water or hasn't eaten, that may also affect the mineral levels, er energy levels and actually might make our blood results worse than they, they were originally. For central nervous disease, that may only really be fully diagnosed on postmortem. And if you can't rule a recumbent cow into any of the other, groups, then I think a postmortem, would be a very useful thing, particularly if, it's it's.
An unusual event on that farm. Treatment, lots of different treatment options depending on what we think the cause might be, . And depending on, you know, where that cow is, whether she is being offered food and water, er fluids will often do these cows, a lot of good.
For toxic conditions, especially, fluids very useful, whether you give them intravenously or oral, orally, if you are gonna give intravenous fluids, you could start with a hypertonic saline, sort of 3 litres, run it of a 7.2% run in fairly quickly. This could then be followed by .
Oral fluids Because obviously providing full fluid replacement through an IV route in a 700 kg cow is not only time consuming, but it's actually can be very costly for the farmer as well. So often a hypertonic bolus followed by oral fluids, is quite useful. I find that a good prognostic indicator is if you give them those hypertonic fluids and then you stick a bucket of water in front of them, and if they then drink.
Then that's quite a good sign, that they might recover. And if they don't drink, you can then just, use your stomach tube, stomach pump, and, and put those fluids into them. NSAIDs, always useful.
NSAIDs do have anti-endotoxic properties, although some of the products available do promote those properties more, all NSAIDs will have some endo anti-endotoxic, properties, . So I think it is a, a key part of treatment for toxic conditions. Antibiotics for a toxic metritis or a septicemia, I think is, you know, a no brainer and definitely indicated.
For toxic mastitis, there are still a lot of debate about whether we need to because it's, you know, the toxins that are caused in that condition, which are caused by the dying bacteria. So if we use a cial antibiotic, we might actually lead to further toxin release. Static antibiotics will stop those bacteria multiplying, but then we're relying on the cow covering and her immune system fighting off that infection.
So again, I think take case every case as it is, and decide on antibiotic use as you feel it's appropriate. . Bear in mind that the majority of these toxic mastitis are due to gram-negative bacteria, coliform, so E.
Coli or clepsella. Some people like to use in mammary products, some people will just use IV preps, again, I, I think take into account, the situation in front of you. Another important part of treatment for these toxic conditions is to remove as much of that sort of toxic material as possible.
So in a toxic mastitis, that would be to strip out the other. So using oxytocin might help with, with letdown. I don't really like to give, oxytocin to cows that aren't gonna be sort of lifted to be stripped, because obviously milk is then gonna leak onto the ground around, potentially toxic milk, .
And the oxytocin is gonna cause the teat opening of all four quarters, so you could potentially lead to spread of that bacteria between the quarters if only one's infected. So ideally, give the oxytocin when the farmer is going to lift the cow and then strip, strip her out into a bucket so you can remove that material from the pen. With the uterus, if it's a very toxic cow, then often the uterus wall is quite thin.
So actually you try and flush, there may be risks of perforation or rupture. I like to start them off on a parental antibiotics. And then once they've kind of turned into a more muoid, discharge, where on rectal palpation, the wall of the uterus feels, thicker, I then might do a flush.
And I tend to just use, warm water flush. I don't like to put in any iodine or, or chlorhexidine. I know some people do.
And if you are going to, I would just recommend that it's very, very weak, when you do that. For acute abdominal events, again, depending on the cause, we might go down the medical management route. We might decide that surgery is the way forward.
If they're really sick and recumbent, then fluids, would be useful prior to any, operation, anti-inflammatories, . Again, these are often painful conditions. But if we are going to perform surgery, providing the anti-inflammatory prior to starting surgery is suggested.
Antibiotic, again I think case by case, . If when we open up these animals, they have a a very necrotic looking GI tract and we're gonna keep going with surgery, then yes, antibiotics might be useful. With a peritonitis, I think a long course of antibiotics, probably my recommendation is normally twice daily of a, amoxicillin or .
Potentiated amoxicillin product off licence twice daily for 5 to 10 days. If we are going to operate and we find that there is a diffuse sort of peritonitis, we could do an abdominal lavage. Again, try and get any fluid that you're using to flush an abdomen up to sort of body temperature so that we don't shock the system.
And again, really we wanna flush it out until the fluid is running clear, which obviously in the abdomen of cow is a huge volume. For traumatic causes, if we can, we might want to immobilise the fracture or replace a luxation. However, I think in an adult bovine, these are very difficult procedures to do, adequately.
I know texts that say with a, a hip luxation. Unless you get it in with the in the 1st 30 minutes to an hour, by the time all the soft tissues have contracted, you're not gonna do it, unless you go down the surgical route, which again, you have to put the economic value of the animal. The same with immobilising fractures.
Is using a cast adequate in a adult bovine? Probably not. Does the farmer want to go down the route of .
Fracture repairs surgically, again, the cost is, is probably quite prohibitive because of the cost of implants. And if you were gonna move these animals, for surgery, to a referral centre, for instance, then you would want to immobilise, these traumatic injuries for the travelling. NSAIDs, you know, I think, again, these are painful conditions, however.
You know, if we think about Meacam as being the equivalent of aspirin for us, if I broke my leg, I'm not sure that aspirin would do too much, but we need to make these animals as comfortable as we can. If we're gonna try and just sort of monitor these and and and manage them on farm, then we probably want to insist on rest and very restrictive movement. But.
In these traumatic incidences, I think that culling the animal is often the only thing that we can do. For peripheral neurological conditions, so tend to be due to damage, so infla inflammation around the nerves, corticosteroids or NSAIDs, I tend to reach for the corticosteroids first. However, I think, if I think the animal is, acutely painful as well, then I would prefer to use NSAIDs.
In the past I have used them in combination and although, you know, we often get told you shouldn't use NSAIDs and steroids together. I think in some of these animals, as long as you're, as long as they're eating and you're, you know what signs to look out for, then actually using them together isn't a problem. Again, we wanna rest them with restrictive movement, but we do want to get the farmers to lift them regularly, get the cows using the legs, and also providing some TLC and.
I think with all of these down cow conditions, if the farmer isn't prepared to put in that TLC and put in that care and management, then actually for the welfare of the cow, culling is often the best option. For our central nervous system, conditions against steroids, NSAIDs, antibiotics, depending on the cause. Remembering, you know, if we think it is central brain, we need to be choosing antibiotics that will cross the blood brain barrier.
If there is inflammation in the blood brain barrier, then actually most antibiotics will cross it. However, generally, lipophilic drugs will be the ones to select. But again, we might offer supportive therapy with fluids, er but we might just need to cull that animal.
Metabolic conditions, generally giving the minerals that if we know they're deficient, then we can use those. My general feeling is for a, a recumbent cow that I think is a a milk fever, I will generally give a bottle of calcium into the vein, a bottle of magnesium under the skin. A bottle of calcium under the skin and an an injection of phosphorus into the muscle or even spike my IV calcium bottle, with phosphorus, .
There is a question as to whether subcutaneous calcium alone is adequate, and that's because in these cows they often have a decreased peripheral profusion. So actually, will they absorb that calcium? And I think that's why often if we go to farms where a farmer is given a bottle of subcutaneous calcium, the cow is still recumbent.
Possibly if he'd given that first bottle into the vein, then the cow would have recovered much better. I have been, I think my record is going to a pharmacy a down cow where the farmer had given 6 bottles of, calcium under the skin before phoning us. So, you know, always worth asking, what the farmer has done.
There are oral drenches available, and if you're giving oral fluids, maybe thinking about some of these . These commercial sachets which have minerals, energy, probiotics in, might be useful to do as well. And again The farmer needs to provide some TLC and if they're not prepared to, then, you know, the animal should probably be cold, and that TLC has to include that animal having individual access to food and water.
I think it's often forgotten about, particularly if an animal is in a, in a group pen. One of the things that I always say to farmers is, if they put a bucket of food in front of a down cow and a bucket of water, even if it's exactly the same food that is available to all the other cows in that yard, they will come and eat from that bucket. So you do need to protect that food and water for that individual cow.
So that was kind of a whiz through the down cow, and I'm sure all of you will have seen down cows, recumbent cows and will have treated them and had good success. So when is a down cow or downer cow? And downer cow syndrome is when a cow has been recumbent for over 24 hours and there is no specific cause for the recumbency.
So the initial cause has been treated and is resolved, but the cow is still down. The cow is more typically in sternal recumbency. Sometimes when we go to the farm, they will be in lateral, but if we sit them up, they will sit in sternal quite happily.
And it's usually related to a calving event which has led to one of those down cow, . Problems which has then led to this Dower cow syndrome. So we think about this, we've got these primary factors that we've just talked about, er, often related to carving.
The cow then ends up in sternal recumbency, so we get compression of her soft tissues. So these are the secondary factors of the Dower cow syndrome. This leads to mechanical venous constriction in the upper half of the hind limbs, venous congestion and thrombosis, and edoema of the tissues.
And that will lead to a chemic necrosis of, of the muscle. But also when we get these con oppression of the soft tissues, we'll also get contraction of functional muscles which again will affect the cow's ability to use their limbs. And that contraction can also lead to muscle damage and haemorrhage, so that's a tertiary factor.
And we can identify this with raised AST and CK on the blood profile. So how important is this secondary damage? This is a really nice paper er from Porter Natal, that looked at not only .
Downer cow syndrome, but also nursing care. And they found that secondary complications following a recumbent cow were very common. 84% of cows showed some form of secondary damage, whether that was nerves, compartment syndrome, or skeletal damage.
And once they were recumbent for more than 24 hours, it was that secondary damage that was more important. So this is why we call it a specific Dower cow syndrome. By day seven of recumbency, 57% of cows with no evidence of secondary damage got back up.
But only 17% of those cows with some form of secondary damage, were able to rise. So the secondary damage if cows develop it is significant. So what do we now need to think about when we go to see these cows?
Firstly, how long has that cow been recumbent? When did she calve? Were there problems?
Were there some primary factors that were identified? Did she rise after calving or did she, has she been recumbent since? What treatments has she received?
Has she risen since those treatments or has the farm moved them? Where did she become recumbent, you know, did she become recumbent in a field and the, the, the farmer has hoisted them back into the barn? Now, that may have led to traumatic secondary factors.
And also have the farm provided that TLC that we've talked about? Lifting the cow, turning them regularly, offering food and water. Clinical exam, again, just a general clinical exam.
We want to look at the general demeanour. What position are the cow's, limbs in. One of my, prognostic indicators normally related to sciatic nerve damage, is if the back feet are so far forward that they're touching the elbows, then, that's a very poor prognosis, .
In my experience for sciatic nerve damage. Are the cows making attempts to rise, are they crawling forward, or are they just laying there? Are they able to turn themselves or are they preferably just staying on one side?
And again, we want to manipulate the hind limbs, do a rectal examination. Although we've talked about Dower cow syndrome, some of those other recumbent cow conditions may lead to secondary traumas, secondary neuropathies, which may not have initially been treated. Can we do further diagnostic tests?
Yes, we can look at muscle damage, CK will be elevated for 1 to 2 days after, . After the damage has occurred, and then AST will be elevated for 1 to 2 weeks. Is there still an underlying primary cause, you know, if they haven't provided food?
Is there hypomagnacemia, hypocalcemia, hypophosphattemia? Is she now ketotic? What's the beta hydroxybutyrate doing?
Is there any effect on her liver enzymes? Is there something else that's occurred, that may be keeping her down? A very simple test to do for a a a downer cow would be to look at the urine, and we can either assess myoglobin levels in serum or urine, through a lab, but even just looking at the urine, and again, the more sort of orange or brown the urine is, the poorer the prognosis.
That prognosis will depend on what we find on our clinical exam, whether the cow is making any attempts to rise, what the degree of any ischemic necrosis and damage is, how bright the cow is, and what the quality of the nursing on the farm is. Remember that 50% of downer cows, when treated appropriately, will rise, within 4 to 7 days. And after 10 days, it's very poor.
I have seen a beef cow where the farmer was exceptional with the care and was turning the cow really regularly, far more regularly than, than, I thought it was sane to do for him, but. He had a cow rise after 2 weeks and went on to breed fine. So again, looking at this paper from the Australian Veterinary Journal, just showing that, As we increase the day's recumbent, the number of animals that recover, does reduce.
So what's our approach to this Dower cow syndrome? I'm gonna say it again, TLC is really vital and it's critical for a a a good prognosis. Now this may be limited by the labour available on the farm, .
Whether she is at grass, and if she's at grass, we need to make sure that there is some shelter available. We need to make sure that there is good footing wherever she is. So if she is on in a, in a cubicle or on in move her to a a a bigger yard area, not just straw on top of concrete because that can actually just slip out of the way.
Often putting on a, a yard that hasn't been, dug out recently, gives a good footing, but we need to make sure there's plenty of straw to take the pressure off of the muscles, and just support her while she's down, but we'll also provide her good footing when she wants to try and stand up. We need to make sure that that bed is comfortable, dry and clean. We don't want her to pick up any environmental pathogens, particularly in her rudder.
If this is a cow that calved not long ago, she is going to potentially be leaking milk. We do need to ensure that the farmer is gonna turn the cow. And again, you'll see a lot of different suggestions in how often a cow should be turned.
Some people say twice a day, some every 8 hours, some every 6 hours. I've seen some papers saying every 2. Fundamentally, once the cow is on one side for over 4 hours, there will be a degree of damage.
Now I'm not saying that getting a farmer to. Move a cow every 4 hours is realistic with everything else that's going on, particularly, you know, if it's a busy time calving on a beef farm or because of milking and everything. So we need to look at a compromise, but I don't feel that leaving them 12 hours is probably suitable.
I generally would recommend 6 to 8, but making sure that they are on a big comfortable bed. In a cow that can move herself unless concerned. Because they will often rotate themselves, but if a cow cannot do that, we do need to encourage the farm to, to do, to turn her as often as possible.
As I said earlier, we need to make sure that animal has good quality food and water in front of them at all times. And ideally protect that cow's food and water from the other animals er in the group. .
You know, these cows, if we put these food and water in front of them and then they creep forward to try and get up, they might knock their water over. So we do need to be regularly checking that they actually do have access to the food and water we've put in front of them. I've seen cows that have had food and water in front of them.
They've got up and managed to turn themselves around 180 degrees, so their head is no longer by their food and water. So. Again, the farmer needs to be monitoring these animals closely and regularly.
Hopefully you'll be able to see, this, this is from the, Poulton paper that I, I mentioned, . And this is again from from Australia, and this was a list of nursing recommendations for the Dower cow. And as you can see there's quite a lot there, .
And again, I'm not saying that farmers should be, will be able to do all of these, but as their study showed. The more of those nursing recommendations that the farmer did undertake, the better the prognosis for the cow. So score one, which is the blue line, was where over three quarter of those recommendations were implemented.
The red line is where 50 to 3/2 to 3/4. Score 3, which is the green line, where, where a quarter to half were implemented, and then the score 4 is the purple line or the lilac line where less than a quarter were. And as you can see, where less than 25% of those, so less than 25% of those recommendations are implemented, no cows recovered.
They saw a slight recovery rate where a quarter to 50% were used, but once we got up to 50% to even 100%, actually the recovery was, was fairly similar and that's why those blue and red lines kind of follow each other quite well, so. Let's, you know, if you give a farmer a list of 100 things, they're probably not gonna do, even half of them. So if we can actually think about what the key recommendations are and which ones that farm is going to be able to implement, then it might be if we can offer 50, it might be more likely that the farmer will do, you know, somewhere near that figure.
I don't think there are 100 recommendations, but I think hopefully you get the idea. So what is our approach gonna be? If there is still an underlying condition, we wanna further supplement that.
As I said, if they haven't had access to feed, they may now be hypocalcemic or hypomagnemic, hypophosphatetemic. So we need may need to repeat our mineral treatments. They may need further anti-inflammatory drugs, lots of those conditions, you know, ischemia necrosis, compartment syndrome are painful.
So, steroids or NSAIDs, NSAIDs, if they're painful is probably the, the, the preferred option. And then if they have developed any mastitis from being down, then we need to consider treatment for that as well, as we do not want these cows to develop, a new toxic condition. We need to support this animal and help her rise so that we can maybe provide some physio, allow them to move their legs a little bit, .
For some of these conditions, so obtuator, putting hobbles or a soft rope on the hind legs will stop those legs splaying and will give them more support once they're stood, give them more strength. Again, if there's muscle weakness which is laying, leading to splayed legs, those support devices may just keep the legs more stable. The bagshaw hoist, that is the classic hip hoist.
However, again, I would recommend that you just watch how the farmer is using those. They shouldn't be lifting the cow completely off the ground with them. There should be a slow raise until the cow's back legs are stood on their tips, and then encourage the cow's front end to stand.
What you want to do is you want the cow to have some weight bearing on, on all four limbs so that they generally as you support them with that hoist, will sway from side to side, and that will just get some muscle flow going. Inflatable bags, I haven't seen these used in the UK, but, you, you may be aware of them for, say, using an equine surgery, where you can slide the bag underneath the animal and then inflate it to just support the animal and take the weight off, off the limbs. The picture shows a sling, and there are various types of slings available, but these slings or nets or harnesses support the whole body and can be easier in .
Getting the cow sort of lifted, lifted up evenly so they're not just laying down on their front limbs. And then some of you may have seen the water flotation tanks or the Aquacal, it's one of the commercial names. I saw a few of them, some farms had their own and we had one at the RVC when I worked there, .
But I haven't seen many in the last 56 years, but they are really useful. When I visited the states, I've seen people use them for physiotherapy for other conditions in, in large ruminants, including valuable balls, where they just get sat in the flotation tank for for half a day, and they're quite happy with it. So, you'll have all seen hobbles.
You can, if they've got really severe spleen, you can put the hobbles slightly higher. I get nervous about this with them being too tighter and might damage the, the tendons. This is our bagshare hoist.
So again, the, the cow's pelvis is not designed to have all of its body weight pushed through it, so. Farmers, you sometimes do see them lifting cows to move a down cow from where they are to a more convenient area. This, they shouldn't be lifting this animal off the ground, by, by it's pelvis.
If they do need to move a cow from a long way, say, in a field, one of the best ways to recommend to do it would be to, get a gate, put a tarpaulin around that gate to fill in sort of the the holes, sedate the cow, and then secure a in lateral recumbency on that gate and then slowly drag her by tractor, back from the field. I wouldn't want a farmer to lift a cow and transport her by a hip hoist. Here's another couple of types of sling.
This one again, I get a bit nervous about if we look at the size of this udder. Because she is still not putting weight on these legs, she is putting a lot of pressure on her milk veins. In this cow, if she wasn't putting any weight on her hind legs, I would be putting her back down, .
And trying a different method. These ones are quite nice, where they're supported behind the tail, they're supported around the neck, and this cow obviously has stood, so she's not putting uneven weight on that sling. For those of you who haven't seen them, this is the Aqua cow, .
Designed for basically they have a winch inside so you can put the cow on the mat, winch her into the aqua cow, close it all up, fill it with warm water, preferably use warm water. If you put cold water in, yes, the cow will warm it up, using her body heat, but obviously we don't want to put more demands on her body if we're forcing her to heat up the water around her as well. So.
That's why it's quite useful on dairies where they often have access to large volumes of hot water, but again, not hot water, we want it to to be sort of body temperature. The cow is not going to sink in it, they're narrow enough that they shouldn't, fall to one side. The rumen acts as quite a nice buoyancy aid, .
And you can put food and water in front of them and keep them in for as in there for as long as you need to. This is a different tank in the bottom left, . Again, I, I get a little bit nervous about this one because of the width that the cow could potentially go laterally.
But I think that's why they've secured her with sort of a, a, a halter. They're quite easy to drain, so if there was a problem, you can drain them quite quickly. How are we gonna prevent these conditions, as we said, you know, recovery isn't great, particularly if they develop Dower cow syndrome.
So we can prevent this by preventing the predisposing factors, with prompt treatment of disease and with good nursing of those recumbent cows. If the cow doesn't get up. Then we need to think about what can we do with that animal.
So the options for the possible options, and I'll come into more detail on these in a second, we could transport the animal live to a slaughterhouse for slaughter for human consumption, emergency slaughter on farm, and transport to a slaughterhouse for processing, with a farmer and veterinary declaration, or slaughter and dispose of the fallen stock. So, can we do those things with a down cow? Well, can they be transported?
The welfare of animals transport order er says that animals. That are unfit for transport, as animals that could not base get into a trailer of their own accord, so animals must not be dragged or pushed, they shouldn't be lifted, . If they are going to a place for veterinary treatment, then this should be done under supervision of a veterinary surgeon, .
But this is not allowed for animals going to slaughter. So option one, not permitted. Emergency slaughter.
So this is, we need an otherwise healthy animal that has suffered an accident that prevented its transport to the slaughterhouse. Is it an emergency? A downer cow is not an emergency.
We've already said that this has had a a primary factor that has then led to prolonged recumbency. Was it an accident? Well, the initial trauma may have been.
But as soon as we've waited, and tried treatment, it is no longer an accident. Was the animal healthy? Again, depends on the cause er of that initial down cow.
And does she fulfil the antemortem conditions which are to do with withdrawals? So actually a downer cow, a down cow might be eligible, a recumbent cow might be eligible, but a downer cow would not be eligible. So that's the end of the presentation.
If you do have any questions, you can send those in to the guys at the, the webinar vet and they can pass them on to you on to me. Thank you for your attention, and I hope to speak to you again soon. Take care.