Thank you very much, Richard, and, good morning, good evening, everybody, depending on where you are, but, good morning from here. Yeah, nice to be, involved with the webinar, so thank you for the opportunity. I spoke in the UK last year at the British Cattle vets and spoke on a similar topic.
So if any of you were there, you might have heard me from there. And if you weren't, well then, that's good because we can catch it up today. So yeah, we, what we're going to be looking about is trying to, how to improve our outcome when we're looking at recumbent cows, as the title suggests.
Now, my practise is, right down the very bottom of southeastern Australia, down in, South Gippsland. So it's one of the key areas of the dairy industry in Australia. We're pasture-based.
All our cows are outside. None of the cows are housed at any stage during the year. So they'd be out eating lots of green grass, supplemented by, silage and hay.
They're fed, grain or pellets, usually somewhere around about 1 tonne per tonne, per cow per year, something of that sort of area. So not big, supplementary feeding by what a lot of you people would be used to. Hence, our production isn't quite as, as high as, you might expect.
We average about 440 kilogrammes of milk solids per cow per lactation. In my area, we've got about 300 dairy farms that we service. Average production, average herd size is somewhere around about the 260 cows, and that ranges from 80 up to, well, there's a couple of herds even in the, in, the 11, 1200, but, most of the herds are in that sort of 20 to 500 type mark.
So that sort of gives a bit of background, but to say our cows are outside all the time, and that does influence and affect some of the stuff I'll be talking about, which may be different, particularly if you're in, say, Scandinavia or if a more of a house situation. Anyway, the outline of the presentation, so there's a couple of different ways that I consider we can improve our outcome when we're looking at recumbent cows, and that starts really with a very, high quality clinical examination. Obviously, we need to know what we're dealing with.
It's a no-brainer, but, it's something that's often not done very well when down a cows are concerned. We need to make sure we are going to treat the cow appropriately and in the correct time frame for the specific condition slash conditions, and I'll talk more about the S on the end of that as we're going through. Euthanasia is an important part of it, and I'll talk extensively on that aspect.
We can improve our prognosis by euthanasia a cow, and that might sound contradictory in a way, but, sometimes the best thing we can do is actually put the poor old girl out of her suffering. Understanding the role of secondary damage, and this is a very, very important part of downer cow management in particular, and that relates to the nursing care, which is something I will talk about as well. So that gives you a bit of an idea of the areas I'll be focusing on.
So we've been called out, it's a nice sunny day, and, Farmer Joe's got his favourite cow down and, wants to get the bed out because he's, concerned that he doesn't know what's going on and over to us, so, . What I want to do, just to start with some definitions, just to, clarify that at the start, if I'm talking about a down cow, a down cow to me is a cow that is recumbent. So it means nothing more than that.
So it can be any mental state. It can be really, really acutely sick, or it can be bright-eyed and bushy-tailed. And the length of time it's been down is anywhere from immediately right through to however long that you might have it down for.
So there's no specification of that other than that she is recumbent. As opposed to a downer cow. A downer cow is a cow, in my definition, that has been down for more than a day, and she's bright, alert and responsive.
So, your cow that's down with, acute toxic mastitis is obviously a down cow, not a downer cow. The cow that went down with milk fever yesterday that's still down today and unable to get up, but it's trying to get up, well, then she's a downer cow, obviously, as well as a down cow. So that means that all downer cows are down cows, but not all down cows are downer cows.
Hope you got that one. OK, so, I'll be talking about both down and downer cows, but when I'm talking specifically about downer, that's what I'm meaning, so just to make sure we understand that because different people have different definitions. So coming to the downer, emphasise, downer cow, if I take a a text, a quote out of, one of the UK textbooks that a lot of you will be familiar with, that was a, a, a quote that, stands out to me that it's the sort of thing that a lot of vets find very difficult and challenging, and I suppose the reason that you're listening to me today is you're hoping you might be able to get some insights to improve it.
If you're real good at these, you probably don't need to be listening to me. But it is the sort of area that can be challenging, there's no doubt about that. Now, why am I talking to you?
As Richard said, I've done a PhD there back in over the last number of years. The sort of things I looked at, and I won't go through that in detail, but just to give you a bit of an oversight, because when I first started off doing a master's when I was looking at the importance of secondary damage, number one, and how the reaction with nursing, occurred. That was what Dairy Australia wanted me to Investigate, so we could then put some information up on the website to better inform our farmers.
And a lot of that was the protection of the dairy industry from a welfare point of view. And I, had been mucking around down the cows for a long time and had some grading systems for femoral and and sciatics and was interested in carving paralysis. So, all that sort of stuff followed in from there as well.
I end up looking at 218 downer cows over two calving periods. We have seasonal calving here, so most of our cows would calve within a three-month period of the winter time. The reason that the cows went down for their primary recumbency is shown on your screen there, which is a nice good cross section of the reasons cows go down in our area.
And having a couple 100 cows was a pretty good, cohort. There's a couple of, articles I've published in the Australian Veterinary Journal, which are there for you can have a look at if you want some more details later on. Just an overview, the outcome that day 7, 24% of the cows had recovered.
The others, there were 46 of the cows still being nursed, and the others were dead, either euthanized and or died. And those 46 that continued to be nursed, the final ant came end up giving, just on a third of the cows eventually recovered, which is not a really good, outcome, but we'll talk about that as we go along. The cows were able to be destroyed by the farmer at any stage, they weren't required to be nursed ad infinitum.
OK, so how can we improve our outcome? To me, one of the main starting points is the examination, working out what the heck's going on, getting a good accurate diagnosis, and then working out some sort of prognosis. So, what I do with my examination is, I've based it really on what, you'd be doing with a gold standard smaller animal examination, which, a lot of us are very good at doing.
And that would include assessing gait and posture and postural reactions. Now, in a dog, that's easy because you can do wheelbarrows and, all that sort of stuff quite happily. We'd be doing patella reflexes as well as flexible with raw reflexes and those other sort of things.
So that's what we do in a small animal. So that leads me to the first poll question. I'm interested to know what you guys are doing as far as a patella reflex is.
So could I just get an idea of, of that, please, Richard, sir? No problem. So I've just launched the first poll question, and the question is, assessing patella reflexes in down cows, I emphasise down cows as part of your neurological examination.
I always do, I sometimes do. I don't normally do in cattle but usually do dogs, and I don't normally do in cattle or dogs. So if you can just select A, B, C or D.
We'll give you about 1015 more seconds. As I say, there's no right or wrong answer, it's just to give an idea of what your current practise is. If you have, if you are having any difficulty answering or completing the poll question, you can just pop A, B, C or D into the Q and A box and I'll keep an eye on that.
OK, so a couple more of you to respond. Fantastic, and I'll end the poll in there. So, results are 89% of people have said I don't normally do in cattle but usually do in dogs, and then 11% have said I sometimes do.
Terrific. OK, that's, typical with my experience talking to vets. I'd stress that the patella reflex is a very important one, and I'll talk about that later on, but that's good.
And then the second one just quickly again, thanks Richard, so. Keeping me on my toes here, Phil. So the second poll question is.
Lifting down cows as part of your neurological examination, assuming the facilities are available, you usually do, you sometimes do. You don't normally do it, or I don't do it as it is not legal in my country. I'm not sure if we've got anyone from Scandinavia in tonight.
So that's usually do sometimes do, don't normally do, or I don't do it is not leaving my country. OK. Anyone else want to vote?
Got a couple more people haven't voted yet? OK. We will end it there.
So, a bit more of a spread this time, 33% have said they usually do. 22% have said they sometimes do, 44% have said they don't normally do it. Terrific.
OK, that's good to know. And, to me, that's a very important part of it. So, when you're looking at the large animal neuro examination, to me, to be able to do a very good one, you must do your flexor with raw reflexes, and I need to do them in the both the recumbent and also the lifted position, particularly when you're talking about front legs.
Patellar reflexes is an essential part, as is lifting unless it's not possible to do that, because unless we lift the cow, we can't assess the posture and the postural reactions, and that often gives us a lot of information as to what's going on. OK, so treatment, . Obviously, the treatment of the cow, whatever her primary conditions she went down with, she's got to treat that cow appropriately.
Now, I'm not going to spend much time on this because, there's so many different reasons a cow goes down that the treatment's going to vary dramatically. And, I'm sure you guys can do that as well as I can. However, I'll make a couple of points.
One is with regard to milk fever, which is a common, obviously, reason for them to go down. In our situation here, by the time I see a cow that's gone down with milk fever, she would have had a bucket load of calcium pumped into her hinge venously and or subcutaneously. Nearly all of our farmers treat cows intravenously.
If I see a cow that's got low calcium levels that responds to an intravenous, infusion, if I see that once a year, that would be as many times as I'd do it, and it's really exciting. . Other places, farmers, if they're not doing that, you might see a lot of cows that are hypercalcemic, and that would affect, a bit of what you're doing.
But for me, by the time I get called to a cow down with milk fever, it's usually the next day, or sometimes even 2 or 3 days later. And whilst I often will still run calcium into them, that to me is an unimportant part of the, of the, course, because the farmer's done that already. So that brings us to the non-steroidals, which are an important part of the treatment for down and particularly downer cows.
It's obviously indicated for a lot of primary reasons, and because of the secondary damage that occurs, it's often affecting the musculoskeletal conditions, so muscle and nerve that I'll talk about. And obviously, mus and non-steroidals are indicated in that way. So, for me, all downer cows need to get some non-steroidals, and, The other treatment obviously will depend on what's going on.
I use hobbles a little bit. If you've got cows that have got some tendency to have the abduction from operator nerve damage, then, that's something that, I carry around in the car and use and can help improve outcome. It's nothing worse than a cow that's got the, bit of an operator paresis that falls over and dislocates the hip.
So if we can prevent that with hobbles, that's great. And the other thing I do, which is a bit peculiar, is I do some electrostimulation for my down cows, which is basically a physiotherapy. So I've got a little video here.
I hook it up to, an electro stimulator machine and, turn the sound down. There's a pairs of needles, there's a pair there hitting up the perineal nerve that links up to the top of the hamstring. And a couple of ones picking up the sciatic nerve coming out from there.
So by turning up the, getting the frequency right, you can get a really nice muscle fasciculation on that. And obviously with the cow dam, where you've got pins and needles in the legs or compromise to that muscle, that can help improve the outcome. In fact, some of the milk fever cows that I see that have been down just for the first day that can't quite get up.
A lot of them, it's just a lack of strength in the muscles from pins and needles, you know, from sitting in the chair for too long, that sort of effect. We that on for 5 minutes each side, and a lot of those cows jump up and run away. Now, I won't talk about that anymore, but, if people are interested, they could email me, and I've got some notes I'm happy to share with them on that if they're interested.
OK, euthanasia, so euthanasia, . Is an important part of Dan cows, because a lot of these cows aren't going to get up, it's important that we can recognise those ones, and if that's the case, and we just tell the farmer that needs to be euthanna, that is a good outcome for the cow. Now, a lot of these are fairly obvious and you would be familiar with them.
Obviously a cow that's got a poor, or hopeless prognosis, we need to identify that. That comes back to doing a good examination. With my grading systems for my cytic and my femorals, things like that.
As well as giving a good examination of what's going on with my cow and getting my specific diagnosis. If I can then quantify the level of damage that the cow has got, a lot of these cows, they say, look, that's a really severe nerve damage that she's got. The best thing to do is to euthanize too, because, she's going to take weeks and weeks of high-quality nursing to get up if she ever will.
And if the farmer's not prepared to do that, then euthanizing her on the first day is a much better outcome than you saying, right, yeah, look, she's got, she's down. I'm not really sure what she is. We'll give her some non-steroidals and, nurse her and see how she goes.
And the cow gets destroyed a week later. She had no chance of getting up in that week anyway. So, if you can euthanize her on the first day, that is a good outcome in my mind.
And there's a couple of other trigger points there. These are all in the notes for you to read later on if you're, if you want to review them. Persistent lateral recumbency is a good reason to euthanize a cow, which can often be a brachial nerve paralysis.
If they can't, if they bend over on their side, that can be a big problem. And then the other one that I'll highlight separately is a cow, and this comes back to the nursing, which we'll talk about, is a cow that's unable or unwilling to nurse the cow at a high level. And when I say unwilling, I don't mean that she does, he doesn't care, it's just that he hasn't got the time or the facilities.
If that's the case, if they're not up after a couple of days, the cow should be euthanized. So, cows like that, or being nursed in those sort of situations, to me, they've got no chance. Identify them, euthanize and move on.
You've done a good job. I've justified your fee. Now, as well as the animal welfare aspect from the individual cow, it's also a, a serious potential industry issue, with the pressure we are under these days by, interest groups, animal welfare.
This is a picture I took of, one of the farms that I turned up when I was doing my research, one of my local farmers. Things had gone pretty haywire. These 4 cows are all alive.
They're being nursed, so to speak, in brackets, by the farmer. Now that is just disgusting and terrible. They were all destroyed that afternoon, fortunately.
But if, that's the sort of image that gets on the front page of the newspapers or on the telly by animal rights activists, they can really do some serious damage to the, the, reputation of the dairy industry. So we, as key stakeholders in our industry are important to make sure the farmers understand that that is not acceptable, make sure that doesn't happen. And as I say, if they can't nurse the cow at a high standard, euthanize the cow after a couple of days, and do not let that happen.
OK, so let's turn our attention to secondary damage in down down the cows. There's a nice picture of South Gippsland on a nice, sunny day. So this leads to my third call question please, Richard, so fantastic.
So I'll just launch that now. So the third question is in regard to the outcome for downer cows, now, just bearing in mind the definition that Phil gave at the start of this presentation. So in regard to the outcome for downer cows, the main driver for most cows is A, the primary condition, B, the secondary damage, or C, the primary condition and or secondary damage.
Give you a little bit of time to complete that question. And give time to have a little sip of his coffee, keep him awake. It's all finished.
Mm. OK, so in regards to the outcome for the down for downer cows, the main driver for most cows is the primary condition, the secondary damage, or the primary condition and or secondary damage. I'll just end the poll in there.
So, quite an even split. We've got 38% have said the primary condition, 38% have said the secondary damage, and 25% have said the primary condition and or secondary damage. Terrific.
All right, thank you. And I'll answer that in a few slides time, so that's, good to know. Thank you.
Because that leads to my thought process when I'm looking at a down and particularly a downer cow. So specifically for a downer cow, So, obviously, I want to know why that cow has gone down, what the primary condition is. Now that's a no-brainer, and it's very important if we get that wrong, then we're on the wrong track.
Particularly for, when we're seeing a cow down in that first, you know, it's initially gone down. When we're talking about down a cow specifically, then secondary complications is an important part of it, and that's what we need to be continually thinking about. If we're seeing a cow that's gone down with milk fever yesterday, that's still down, or even down this afternoon when you're seeing it, she's still down, she's bright-eyed and bushy-tailed.
She's trying to get up and she can't. If we are still only focusing on that primary milk fever and run some calcium in, which will do nothing because she's got plenty of calcium running around the system. If that's the end of our process and we don't do any more, we really haven't done a good job.
We then have to say, we don't say, OK, look, she just needs a bit more time to get up and walk away and you've done nothing. We then click into the secondary mode and say, right, let's go looking for what else is going on, and, do a neuro exam, and you're gonna find lots of things that are probably the reason, which, I'll run through. So that secondary complication is in bigger, bigger and bolder font because it's more important as a rule, once it's a downer cow.
So very important to understand the role of secondary damage in in down the cows. Just, to hop on this a bit, when I did my analysis by the different groups comparing the outcome of the different primary groups, there's no statistical difference in the outcome of them, which meant that a cow that had gone down with milk fever yesterday that was still down, was no more or less likely to get up than the cow that went down with calving paralysis or went down with a back injury or whatever. Now, that doesn't mean very much because of the variation within them, but that's interesting.
So that turned my attention to looking at how important secondary damage was, and as you can see there, . Nearly 80% of the cows that I saw had what I considered clinically important secondary damage. And that was defined as secondary damage that would contribute to the recumbency in its own right, or delay and prevent the recovery from the primary condition.
So this was stuff that was stopping that cow from, or slowing that cow from recovering. 80%, that's a huge, figure. And there was a lot of cows that had more than one thing going on concurrently.
OK, so secondary damage is very common in downer cows. How important is it? What I did then, I actually compared the, outcome at day 7 of cows that had clinical in secondary damage to those that didn't.
And as you can see, 14% of the cows that had got up if they had secondary damage compared to 57% of those that didn't have any damage. And when we put some stats on that, the odds ratio of recovering if you had secondary damage was nearly 8 times less than if you didn't have secondary damage. And the P values see there is highly significant.
So that's a huge figure, and that really focused my, brain as to how important the secondary damage was. The other thing that I looked at was the 149 cows that didn't make it, that would either died or destroyed. I made a clinical judgement as to why they did not recover.
And in my mind, only 15% of those cows were lost solely from the primary cause. And obviously, that's important if they've got a broken back or a really bad paralysis or a fractured leg or something, they're not going to get up, no matter how much secondary damage they get. So the primary damage is still very, very important.
But only 15% were destroyed from that. If I looked at those, I consider a combination of both primary and secondary. There's another 13% of my cows.
So that left a whopping 72% of my cows that did not recover, were lost solely, and I stress the word solely, in my opinion, from secondary damage. So, that's a huge, huge figure. And, really, it just shows how important and how influential secondary damage.
So that means the answer to Paul question in my mind is, is B, that it's a secondary damage. And whilst the primary is not unimportant, I don't, don't underestimate that, but the main driver, is actually secondary damage. And that means again, if we're not thinking about secondary damage in looking at down the cows, we're gonna be on the wrong tram.
And that's one way we can really improve our outcome is to focus our attention on secondary damage. OK, so what sort of things I mean talking about secondary damage? Let's, run through them, have a bit of an overview.
One of the big ones was, compartment syndrome, so secondary muscle damage. There's a cow sitting out there. It's on a pretty hard surface that, she was being nursed on this, sawdust, and she crawled off that in the middle of the night and was sitting on the, on the gravel.
So secondary damage is, as you would know, caused by sitting on hard surface, particularly if they're not swapping sides. So you're getting compromisation of the, mainly the hamstring muscle, you get an increase of, fluid within the area. Because of the compartments in the hamstring, you're going to get a buildup of pressure, which causes an ischemic mind crosis, which then causes you damage.
There's 168 cows that I, blood tested, and 61 of them had levels above what, was a critical threshold for, recovery. Some work based on Clark, which is referenced in my notes. But, if they were above that, they had less than a 5% chance of recovering.
So these are very high CK levels, time adjusted by the day. So prevention, we need to be make sure the cow is being nursed on soft deep bedding, and I'll talk about that, and we need to make sure they're being rolled regularly if they can't swap their sides by themselves. Secondary sciatic nerve damage that gets caught up in the same complex.
Your sciatic nerve and its branches coming through the hamstrings are very susceptible to that pressure damage, and that can then cause secondary sciatic nerve damage. It might effect with, present with a, knuckling of the forelimb, which in a cow that didn't have primary nerve damage, or it might have some other, areas that's showing up as well. So same causes the, compartment syndrome.
10% of my cows had secondary sciatic nerve damage. Prevention would be exactly the same as the muscles, so soft deep bedding, regularly rolled. Cribbers and crawlers, .
In the textbooks, it's not uncommon to have comments like that, that, creepers have a more favourable prognosis. A cow out there in the paddock crawling around, it gets the circulation going and, that's good in a lot of people's mind. So that leads to my fourth poll question please, Richard, so.
No problem. So the 4th whole question is, femoral nerve damage is? A only usually only associated with a calf born following hip lock.
B, usually associated with the calf form following hip lock, but occasionally can occur in down cows struggling to rise, or C, a common secondary condition in down cows struggling to rise. Again, I'll just give you 1520 seconds to consider your options and select on the answers. OK, so, femoral nerve damage is A, usually only associated with the calf born following hip lock.
B, usually associated with the calf born following hip lock, but occasionally can occur in down cows struggling to rise, or C, a common secondary condition in down cows struggling to rise. Oh, and the polling there. I would also say, just remember you can also post any questions you have throughout this presentation so we can come to it in the end.
I don't think we've had any yet, so please do pop any in the Q&A box. So on to the results. We've got 14% of said B, usually soaked through the calfal full and hip lock, but occasionally occur in downed cows, and then 86% have said a common secondary condition in downed cows struggling to rise.
Excellent. Well, that's good. Thank you.
Because, if you read the textbooks, femoral nerve damage is, often said to be only occurring in calves, and they would say that it's the sort of thing that can occasionally occur in down cows. So your typical femoral nerve would be the legs getting out there behind. Femoral nerve innervates the quadricep muscle, which is your stifle extensor.
And to stand up, they need to be able to extend the stifle. And, it's also hip flexor, so the leg tends to go out behind them when they can't get up. .
So Correct is that it's a very common condition. In my, work, 22% of my cows actually end up with secondary femoral nerve damage. I had quite a few primary femoral nerve damages from my back injuries, but, very, very common in, in, down cows as a secondary thing.
For a cow that's crawling around that can't get up, she's going to get the legs out behind her. That's then gonna cause, damage to that low lumbar area where your lumbar, your femoral nerve comes off L4, L5, and it's gonna stretch those nerve roots and cause haemorrhage around the nerve roots and cause a secondary femoral nerve damage. So, a cow crawling is a bad thing in my mind, and I have changed my opinions on that from, prior to my research because I had no idea how common that was.
So how are we going to do our diagnose it? Well, that comes back to patellar reflexes. So for those guys that, aren't doing patellar reflexes, which a lot of you weren't, can I strongly encourage you to start doing patellar reflexes?
Very easy. Roll the cow over on the side with our hoof testers. We then, set up the, the leg, so it's about rough in a neutral position, about 90 degrees through the stifle.
And then a nice firm strike with their hoof testers on that patellar ligament, and you get a moderate extension. So very easy to do, . And if we got a femoral nerve damage, we're going to have a depressed or absent, patellar reflex.
But interestingly, if we've got damage to the branches of the sciatic that innervate the hamstring muscle, and that's quite common, you'll end up with an exaggerated unilateral patella reflex. The reason it's increased is because there's fluidity in that hamstring, so there's less resistance, against the quadricep contracting. So if we're doing patellar reflexes, we can actually identify some forms of sciatic nerve damage, as well as femoral nerve damage.
So we're getting double our bung for, for our buck. So, a really good test to do. OK, so, I won't talk too much more on that, but, let's go to whole question 5, please, Richard, just to change to the back, the front leg, sir.
No problem. So moving towards the front of the cow now, just launched the poll question and it is for imb damage in down cows is unusual, occurs occasionally, or is a common secondary condition. That is for immb damage in down cows is unusual, occurs occasionally, or is a common secondary condition.
Just give you another 1015 seconds to answer. OK, we're in the pole in there. OK, so no one said a unusual.
44% have said occurs occasionally, and 56% have said it's a common secondary condition. Terrific. Yep, and that's, that's right.
It is something that's very common. If you read the textbooks, it tells you that it's not. They tell you the forelimb is not really likely to be damaged, as, there's a couple of quotes out of, a, cattle book here is saying that, you know, the way the cattle, the cow is structured, that they're sitting there, they don't get damaged to the forelimbs, unlike the hind limbs.
However, if the cow gets over on the side, that's a whole different category of, fish. Your, brachial plexus comes out, crosses over the outside of the rib cage and underneath the scapula. So a cow that's lying there in lateral recumbency, that's got casts, particularly on a hard surface, those lachial plexus is very likely to get squashed between the scapula and the ribs, and or the radial nerve can be damaged when it's crossing over the humerus.
Now, it's hard to diagnose unless you're picking the cow up. What I've found is that if you're examining a cow on the ground, and doing the flexor withdrawal reflexes. All of the cows that I saw with brachial plexus paralysis, on the ground, they had a normal flexor withdrawal reflex.
I did not find any of them that had analgesia of that pattern, and that was the same with my radials as well. So testing her on the ground would not actually identify that she had a, a four limb neuropathy. But when we picked her up, that was a whole new category, because she's unable to lift the leg properly in that raise position due to the extra weight of the leg.
So you can get brachial where the whole limb is affected, or you can get radial where it's only the lower part is. So the difference is that the radial, the shoulder, and usually the elbow is functional, but the lower limb is not. Now how do we diagnose that?
Well, oh sorry, the cause, well, obviously lying on extended appearance, how common. So yes, see, question 3, answer three is the answer in my mind. Look at that, there was 38 of my cows end up with either a radial or a brachial, so that's 17% of these cows had a secondary .
For the neuropathy. So it's very important that the farmers are nursing the cows well and monitoring them so that if the cow does get, cast on the side, they can be sat up, and it's important they're on soft bedding. So if they do end up that in the middle of the night, then they're not gonna get this pressure damage.
So how do we diagnose it? What we need to do is do a flexor withdrawal reflex in the standing position. So we lifted the cow up, she's not standing on the front.
Maybe that's because she's sulking, maybe that's because she's got some damage. So we go around and we do the flexor withdrawal reflex. This is the the good leg.
We do that, we zap that with our zapper or squeeze it with their hoof testers. The cow will lift the leg upwards in a way. That's quite a normal reaction there.
Even though she's not bearing weight on it. We come around the other side, which has got the brachial plexus paralysis. We give that a zap and she goes, Oh, m, that hurts.
I can't, I don't like that, but she's actually unable to lift the that leg up. Whereas in the recumbent position, that cow could pull that leg away quite happily. In the raised position, she's got to lift the weight of the leg up, which you cannot do.
Now if it's a, sorry, if it's a, a radial, she'll be able to lift the upper part of the leg up, but not the lower part. So you can then differentiate between brachial and radial on the basis of the strength of that. And, it's, so all of those, 38 cows I diagnosed, are diagnosed in that standing position.
The other thing you can do is actually in the state raised position is assess the muscle tone of the limb. And if it's a brachial plexus paralysis, the whole limb will be flaccid. Whereas in a normal one, it will be, it'll have normal tone.
The radial will have normal tone in the upper limb, but lower limb will be flaccid. Second dislocated hips are very common, in recumbent cows. 30 of my cows end up succumbing to a secondary dislocated hip.
And that's, so therefore, to try and reduce the chance of that, we need to confine them, with barriers so they can't try and stand up and fall over and do silly things as they often do. Exposure, common in my area because a lot of the cows are being nursed outside. Maybe be different if you guys, if they're all inside, but, a cow sitting out in South Gippsland winter in the middle of, this time of the year ain't a good place to be.
Quite a few of my cows actually had, what I considered clinical exposure with subnormal temperatures, and some of them actually died from it. So, Very important, it's a no brainer, but, farmers think, well, you know, the cow sits, she grazes outside all the time. Why do I need to bring her inside to a shed?
Well, sitting on a cold wet, paddock's different to walking around in a cold wet paddock, as you would imagine. OK, so this is a, a thing, and, again, it's in the notes, so I'm pretty sure, just showing what the incidence of all those different things are. But what's, I want to make the point here is just what the wide variation of secondary damage is.
I've covered through the common ones, but there's an enormous amount of things that can go wrong with the cow once she's down, and that's why we need to do a thorough examination and go looking for all those sort of things. OK, so let's go to nursing. Look at, problem that time's getting away from me, but, nursing is, a question I'd like to ask, Richard for the last poll question, please, sir.
OK. So I just launched the last poll question. And the question is in regard to nursing of the downer cow, I leave that to the farmer and focus on the cow's treatment protocol.
I discuss it with them, but largely leave it to them, but I consider it extremely important to act, so active engage in its implementation. That's the downer cow we're referring to rather than the down cow, and that is A, leave that to the farmer and focus on the cow's treatment protocol. B, discuss it with them, but largely leave it to them, or C, consider it extremely important, so active engaged in its implementation.
OK. Anyone else left to vote? Give me 5 more seconds.
And we will end it there. OK, so 11% have said A, leave that to the farmer and focus on the cow's treatment protocol. 22% have said B, discuss it with them, but largely leave it to them, and 67% have said C, consider it extremely important.
Excellent. And that's what I like to know, because, yes, it, extremely important, and, I'll show you some information as to why I consider that to be the case. Because whilst we're good, as a rule of being the vet, we're pretty good at working out what to treat it with and or euthanize the cow.
A lot of us do not put enough emphasis on being the nurse, which by that means that we really need to actively engage in the nursing environment of the, of the cow. So, why do I say that? Well, in the textbooks, they agree with me, or I agree with them, but yeah, certainly that, you know, nursing is an important part of it.
And this quote here actually says it's the most important part of it, and I would, agree with that, to be honest. And that's gonna come back to the ability and the knowledge of the farmer to implement it. And that again comes back to my euthanasia trigger point.
If the farmer is unable or unwilling to be able to nurse a cow at a high level, it really does make the very poor chance of success. So therefore, euthanasia after a few days is a good option. And there's another quote there from from Weaver along the same sort of lines about how important that is.
So that means that we need to actively engage in it, and we need to actually talk about this when we're on the farm and work through a bit of a nursing plan. A lot of farmers really got no idea about, the secondary damage that I've outlined. And as you can see, the prevention of most of those secondary damages come back to soft, deep bedding in a confined area.
So that means we need to have some sort of nursing dedicated area set up and established, that's ready to go so the farmer can move the cow there quickly and efficiently and leave her there to give her the best chance. Now, nursing out in the paddock, some textbooks say that that's the best thing to do. I'd disagree, unless, well, if, if it's not too hot and if it's not too cold out in the paddock it's not too bad, but the ground can't be too hard.
And what is, as a general rule, if it's warm enough to be outside, the ground's gonna be too hard to be nursed. If the ground's soft enough to be outside, as a rule, it's going to be too cold. So that's sort of a, doesn't work together in our favour.
And what I don't want the cow is crawling around, as I said, because of that femoral, and that's gonna happen if the cow's out in the paddock as a general rule. And obviously if she's down the paddock, it's harder to monitor her when she's lays over, we want to make sure we can sit her up as soon as she goes over to don't get those brachials. So we need to have her somewhere closely located, sheltered, protected, all that sort of stuff.
So, Bessie, our favourite cow that I started off with, she was being nursed in the paddock and was fine the first day, and I came back 3 days later, and the poor old girl had, had exposure because we'd had half an inch of rain overnight with the cold southwesterly wind blowing, and it was, she had, exposure and she, she actually died that night. So paddock nursing, we don't have control over the environment, which is so important. So, nursing plan and all this sort of is in, in the notes.
There's a whole lot of factors that we need to, consider. What I did with my work, I actually ended up coming to what I concluded to be gold standard nursing for Dan cows. And this is the second article in the ABJ that I said.
And I've stipulated here all the things that I see that we, that are important as far as high quality nursing goes. So what I did to ana analyse that is I actually then, put the cow into one of 4 quartiles of compliance to that gold standard nursing during her, nursing period of time, as shown there. And some of the analyses I grouped grades 1 and 2 in all that satisfactory nursing and compared that to unsatisfactory nursing grades 3 and 4.
Now, I showed you before, we had a 7 day outcome of 24% and an overall of 32%. If we go and analyse that by our four nursing scores and have a look at our final recovery, look at the differences there in those figures. That's, really jumps out and goes, wow, that's fairly significant.
If we put some figures on that with our satisfactory versus unsatisfactory, so that's excellent and good compared to poor and very poor at day 7, you can see there the odds ratio of recovery if they're being nursed at a satisfactory level was over 7 times greater than those being nursed at an unsatisfactory level. And if we look at the figures for the final recovery, that odds ratio is now blown out to twelvefold. Highly statistically significant.
So one of the major, major things that we can do to improve the outcome of the cow is to actively engage in the nursing and get in there and make sure the farmer's gonna understand how to nurse a cow properly. If we're just gonna throw a shot of some Medicam at it and run away and think we've done a good job, we're not gonna make a heck of a lot of difference. If we engage in the nursing, we can really, kick some goals.
So that's one of my major points, and, again, I'm I'm pleased that 67% of you guys are, actively engaging. And what I'd encourage you to do is perhaps to look through my gold standard nursing and make sure that you're looking at all of those things and, making sure the farmer's got a good understanding of it. To show the difference between unsatisfactory and satisfactory nursing graphically, this is the figure there, and as you can see, the, the, the way difference in the recovery is significant, as I said.
But the other thing I want to point out here is that the cows being sat nursed unsatisfactory, only 4 of the 52, 4 of the 67 of them got up. They did in the 1st 3 or 4 days, the 4 that did get up. After day 5, none of them recovered, and some of them were nursed even up to into the 4th week.
Whereas the cows being nursed satisfactorily, not only do we have a lot more cows recovered, but we had cows recovering into the 2nd week, we had cows recovering into the 3rd week, and we actually had one of the 4 cows that was. They still being nursed in the 4th week recovered. 3 of them were being nursed satisfactory in the last week, one of these recovered.
So in my mind, if a cow was being nursed at a high level, there's no end point in how long she should be nursed for, providing her welfare is, is satisfactory, of course. They need the time to recover from the primary condition. They need the time to recover from any secondary damage that might have occurred.
Although if we've got high quality nursing, we're gonna have a much less chance of getting secondary nurse, a secondary damage from occurring. But rather than shooting the cow after a week or a certain period of time, which a lot of people advocate, If she's being nursed at a high level, I'm quite happy for that cow to be continued to nurse if the farmer wants to, whether it's worth it or not, that's another matter. But that's up to the farmer.
Whereas a, a, a no non you know no discussion goes into if the cow is not going to be nursed at a satisfactory level. If she's not up in the first couple of days, she's got Jack. Chance of getting up, so let's destroy her and move on.
Let's not have a cow being nursed, sitting out there in an unsatisfactory condition for a week or 10 days before the farmer pulls the pin. She's got no chance of getting up, so let's euthanasia and move on. So that's, two cows there, one's being nursed at a high level.
This cow actually was the one that had the high, had a very high CK level that we then put into a nursing area and she recovered over a few days. Whereas this guy on the left there, she's got a very poor chance of getting up, so let's use the nose her and move on. So deep soft betting's very important, .
Some of our farmers have got floatation tanks, which is platinum standard, and they're getting much better recoveries than what I'm getting with my gold standard, so, they are really good, expensive, but, often worthwhile, and I'm not sure what the your locals availability of such things are, but they can be really good. Rolling is important. A cow that can't swap herself from side to side needs to be rolled 7 or 8 or 10 times a day.
Farmers won't do that, but if you explain to them the importance of that secondary muscle damage and the secondary sciatic nerve damage, they'll understand it. It's obviously injury related with your nursing, as far as the bedding, I mean, so deep, soft bedding is very, very important, particularly if they can't swap from side to side. So talk about that so they understand it and then they're more likely to do it, particularly if they've got the cow nurse somewhere where they're walking past it multiple times during the day.
This was a cow that wasn't able to rotate herself. She had a mild calving paralysis affecting the right leg. Every time she tried to stand up, the strong leg would push her onto the weak leg, which means she spent the whole time sitting on her, her compromised leg.
She got secondary muscle damage on top of the mild primary damage and got destroyed because of the secondary effects. She wasn't being nursed very well, and she went from a good outcome to a poor outcome because the nursing was crap. There's lots of aspects of nursing.
I'll run through these very quickly because we're only had a couple of minutes, but, obviously making sure the farmer understands lifting. Lifting is the best thing if it's done correctly, and by effective I mean that she's bearing at least 2/3 to 3/4 of her own weight. If she's not, if she's hanging there, then obviously that's a, the worst thing, even though some farmers still think that's good.
And the reason it's got to be done under supervision is because the cow that will stand effectively, she might only stand there for 5 or 10 minutes. If the farmer's gone off and doesn't come back for half an hour, comes back and finds her like this, well, then obviously there's a lot of massive damage has occurred, and then, that's the worst thing. So we're talking about effective and supervised lifting is very important.
If a cow's not standing well, putting a chest strap can improve the compliance quite markedly, so that's something I use a lot and is very good. Now, as far as, some resources for your farmers, the Dairy Australia website, we've got a lot of information on that, which I've put on. It's had hits from all around the world, and I'd strongly encourage farmers to use it.
We have, a number of resources. There's, actually 9 videos now, 6 of which I've got showing here. One's how to move the down cow, which, in a paper situation, rolling a cow into a front end load of buckets is a very good way of doing it.
The head needs to be secured. Actually, the head's not quite in the right position there, I hate to say, but, pulling the head around and tying it means that she can be moved very quickly. There's videos talking about how to roll her down a cow, lifting, the nursing areas, caring, just sort of general short information aimed at farmers and really, really good stuff.
There's a flow chart there, which I won't talk about now because we're running out of time, but that sort of schematic thing as to all the things that the farmer's got to do. And the longhand version of that is there's an eight-page fact sheet covering all the things that I've talked about today, that farmers then can read. They have a good understanding of the nursing, the secondary damage, the things that goes wrong and all that sort of stuff.
So, lots of information there to share with your farmers. So take home images to finish up spot on time. So the way we can improve outcome for recumbent cows, which is what we're talking about, just to, sum it all up, make sure we know what the heck's going on, thorough examination, looking for both primary and secondary damage.
And when we're looking for secondary damage, do your patellar reflexes, lift your cow up, looking for front leg neuropathies. All those things you're gonna get a much better idea of what's going on if you do a very good neurological examination. That leads to getting the correct diagnosis so that we can correctly treat the cow for both the primary condition and then influence and change our, modify our treatments if needed, depending on what secondary complications there are.
Treat her appropriately as a no-brainer, as I said, but making sure that if euthanasia is the best course of action, then that is implanated quickly and early, and that's going to be affected by her nursing as well as by her her conditions that she's got, and, because we need to actively engage in the nursing environment of our cow. So, Richard, I have done well. It's, I've got 30 seconds left, and, I shall now say thank you, everybody and welcome any questions and comments.
Fantastic. Thank you, Phil, and I think you definitely deserve the prize for the most, on time speaker, so absolutely fantastic. That's because I want to go back to sleep.
Well, that's an incentive. No, not at all, no. That was good.
I enjoyed that. Fantastic knowing it was that was absolutely fantastic, thank you very much. Some really good content in there, some really good, guidance for, as you say, you know, what the gold standard is and then also just touching on the platinum standard, .
As Phil says, he has kindly provided notes, to go with this webinar, which will be available on when the recording is up in the next 24, 48 hours. The notes will accompany that there as well. He's, Phil has also kindly provided some multiple choice questions.
So once again, they will be attached to the, recording. So once you've skipped to the recording, you'll be able to answer multiple choice questions at the end as well. Quick question, Bill, just from me, you've also, I noticed in the, on the file you've also provided some details of the charts and tables.
Are we all right to put them with the notes as well? Is that for people to be able to have a look over as well, is it? Yes, please, yeah, that's right, because yeah, that's that's good, yeah, and .
So the, the Dairy Australia ones, a lot of, vets actually refer the, you know, talking about nursing and then say, look, as well as that, you know, it's a lot of information that you're gonna take on, jump onto the website, dairyustralia.com.au, put in the search button, Dan cows, and then there's a lot of information there that they can then read and absorb.
And because that'll give them more information than you can tell and gives them a better understanding of what's going on. Fantastic. I've just got someone has just asked they missed the patella reflex interpretation.
I had a quick glance through while you talk it came through earlier. Is there much detail in the notes about the patella reflex interpretation or, what, also where do we find it. So I've gone through the notes bit, but I was just wondering how much information on the patella bit is in the notes itself.
Not a lot, no, because that's sort of the, you know, the neurological examination is a whole new subject, that's something I had did talk a bit about in the, at different conferences. So, but yeah, basically, if you've got, an, an absent or depressed patellar reflex with the tendency of the cow to the legs go out behind when she's trying to get up, that's indicative of a femoral nerve damage. I've actually got 4 gradings of femoral nerves, because some of them you can actually, I'll stand up and then they walk around, quite happily, but they have a, when they sit down, they're unable to stand up again, right through the ones that are in that full frog leg position.
That's part of my thesis, and I will be writing up some journal articles in time, but, yeah, that's another subject, and if anybody wants to some more information, then my email is there, and I'm more than happy to send some more information, if, if they require that, so. And perhaps that's, the topic for a future webinar if you'd kindly come back. That's right, that's a whole new ball game.
That's right. So that's about a 3 hour one though, Richard. I'm sure we can find time for you, Phil.
Not a problem. So yeah, so hopefully, as I say, there are some notes, but obviously, this webinar has been recorded. It will be on our website within the next 24, 48 hours, so you can refer back and listen again, which hopefully will assist you as well.
Some have had some lovely feedback for you as well, Phil. Minka, who's a regular attendee of our webinars, said excellent webinar. I must listen again.
And we've also had Dragos as well saying awesome information. So, some really, really, a really positive feedback coming for you there. Doesn't seem to be any other questions coming through.
I think you must have given them more than enough, food for thought for them to take away and hopefully, as you say, implement some of those practises into their day to day, working, so that is absolutely great. All that leads me to. Do is, there is a short questionnaire at the end of this presentation.
So for those who've attended, really appreciate it if you could, just take a couple of minutes at the end just to put your feedback because I'm sure Phil would like to receive the feedback because we do share it with the speakers, but we also use it to help develop our programme for the coming year as well. So please do take your time. I'd like to thank Lewis, who has been, on the other computer, just checking everything's running smoothly, so thank you to Lewis for all your assistance tonight.
Thank you to yourselves for attending and obviously last but not least, thank you to you Phil for getting up at, a very early time. Well I presume you're getting up at 3 a.m.
Was it to, make sure you're up and ready to go? 4 a.m., yeah, and it's 6 now, so it's nearly time to get up, so it's still dark outside, but anyway, that's alright, sir.
I really appreciate you giving up your time and putting across such a fantastic presentation and we look forward to working you on another webinar in the near future. Thank you very much and thank you for your attendance and I enjoyed it and I hope it's been some good information so good talking to you all. Thank you very much, good night.
Oh good morning.