Saturday, February 4, 2012

Sometimes, it's about "Where Not To Be."

At the veterinary school where I went, during the summer between 3rd and 4th year, every student had to participate in a 16 week externship involved in one way or another with large animal medicine, with an emphasis on food animal medicine. (Equine medicine was OK, but you were encouraged to be involved in mixed practice or dairy or beef practice.) I was familiar with cows. I had worked on beef cow and dairy cow farms for the previous 9 summers. I was a country boy who knew his way around a farm and knew a thing or two about cows.

I hadn’t found or even looked for my externship practice until a few weeks prior to the start date. The faculty member in charge of the externship program called me to his office, and told me I had to find one. And there was only one recommended practice left in my area, but he warned me, I’d have to have a ‘good sense of humor’ to be paired up with Dr. C. There was no way he would let just anyone go with Dr. C., because he was known to be somewhat, let’s say irreverant in the veterinary world. So, naturally, I signed up with Dr. C.

First day on the job, I met Dr. C. at his office at 0730 hrs and he told me we had to get going to see a dystocia case... a cow who was having troubles calving.

The interesting thing was that the cow was at a research facility... a farm owned by a huge feed company where they tried to determine best food types and such to maximize milk production. I had heard of this place... it was supposed to be a pristine barn and beautiful grounds.

We got there, and Dr. C. introduced me as his summer assistant, and I carried the bags into the barn. It was gorgeous! The walls were white as white could be. The floors were spotless. The stalls for the cows were incredible. There wasn’t a cobweb to be seen. It was like walking into a hospital. But it was a fully functioning dairy barn.

We found the cow in question. She was in a calving pen that had the cleanest, most sweet smelling straw, about 2.5 feet deep, and she was milling around, looking uncomfortable. There were three or four farm hands looking on from outside the pen.

We took a history. The farm manager told us that the cow appeared to be pushing but nothing was happening. Dr. C put on a glove and had a feel around. Then he looked at me and told me to have a go. I felt the cow’s vagina. I could feel one of the calf’s hoofs, but beyond that it was all tight and closed down. I knew what the problem was. I looked at Dr. C and he asked me what I thought. I immediately said, “Uterine torsion!” He said, “Yep. How do you fix it?”

I had never seen a case of uterine torsion before this. But I knew all about it because we were taught about it in our Large Animal Medicine and Surgery class. The uterus of an at term cow is like a big bag filled with the calf. And the bag is confluent with the vagina, and the calf needs to go from the uterus through to the vagina and birth canal in order to get to the outside world.

But in the case of uterine torsion, at one point during the pregnancy, the uterus turns on its long axis, twisting the vagina and effectively blocking the way out. It’s kind of like a bread bag. You seal it by twisting. And similarly, you correct the problem by twisting. But you cannot effectively twist the gravid uterus... you turn the cow.

I looked at Dr.C. I did not want to look like a chump in front of these farm-hands. I knew what to do, but there was that moment of uncertainty.

“We have to roll the cow,” I said.

“Yep. Which way?”

I put my hand back in the cow. With my fingers splayed out and moving my hand forward in the cow’s vagina, I could determine that the twist was to the right. I thought about this... if the torsion was toward the cow’s right (clockwise as looking from the cow’s back-end), the only way to correct the twist would be to turn the cow in the same direction. I said to Dr. C, “We have to roll her to the right... in the same direction as the torsion.”

“Are you sure?”

“Yes, I am.”

Dr. C. was playing with me, I thought. He knew for certain which way was correct, but he was going to make me work for the answer.

He said, “OK, you put your arm in the cow and hold the calf’s foot while we roll the cow. If the twist gets worse, you’ll know it. If it gets better, we’ll keep on going."

I wasn’t sure what the point was of me holding the calf’s hoof. But I did as I was told. The farm hands cast the cow (made her lay down) and I laid down in the deep straw behind her, put my hand in and held tight to the calf’s hoof. Dr. C told me that I was going to try to prevent the calf from rolling as he and the farm hands were rolling the cow. Sure, I was a strong young man, but this was kind of like one-arming a 40 kg bag of feed from the floor onto your shoulder. I wasn’t sure I could prevent the calf from rolling with the cow! But I sure as heck was going to try.

Dr. C. and the farm hands rolled the cow clockwise, to the right, and when they got half way (it’s not often you see a cow on her back!), Dr. C. asked me, “How is it? Is it tighter or looser?”

“I think it’s looser!”

“Are you sure it’s not tighter? Because if we’re rolling her the wrong way, you’re probably going to break your arm!”

I was sure we were going the right way, but there was that little moment of hesitation. I wasn’t sure I wanted to risk my arm.

“No, it’s all good! Keep rolling her!”

“OK, keep rolling!” he said to the farm hands.

As the cow got to 270 degrees of rotation, everything got better. I could feel the vaginal walls open up as the twist relieved, and then I was introduced to the secondary effects of relieving a uterine torsion.

Gallons of fluids from the cow’s reproductive tract washed over me while I was laying behind her. Not a few drops. Buckets of fluids. Probably 20 gallons or more covered my upper body... head, shoulders and torso. All the fluids that should have previously come out, but couldn’t because of the torsion, were now on me.

It was 0930 or so, and we were on our first call of my 16 week externship, and I was covered in amniotic fluid.

But it was all good because I had a lovely little Holstein heifer calf in my arms.

Dr. C. taught me a lot about cows that summer... but the most important thing I learned was not to find yourself behind a cow when you’re correcting her uterine torsion.

And I will never forget Dr. C. hosing me down in the barn yard before he would let me back into the truck.


  1. Hah! I have been hosed off in a barn yard before too. When I was in undergrad, one of my professors was the school farm vet. If there was an emergency, he would put a note up on the board to meet at the dairy, or stock barn, or horse center...wherever he was.

    So, during class, you would find yourself roped into assisting when whatever he was doing. Then you had hope it was fast enough that could actually help with the procedure. But sometime the procedures were messy. Like an 18 inch abscess on the shoulder of a horse...spewing nasty stuff straight up in the a gushing geyser. Or the time the horse with the trephined opening (drilled hole) in the sinuses sneezed necrotic junk all over my face. There were several times I had to haul ass to another class right after the experience. If it was another animal science class, then it was fine. If it was something else, people got pretty pissy. I learned to carry extra clothes and to wash my hair using the hose and wash rack at the barn.

  2. Awesome story. Thank you for that valuable lesson.

  3. Getting rotten amniotic fluid ( trying to deliver a rotting calf ) spewed on me was my "baptism" into vet. med. I had to take off my clothes & rinse myself in bleach water before my wife would let me into the house.

  4. A change of clothes is always important when working on large animals especially if your in a mixed animal practice. Little ol church ladies with their foo foo dogs give you a funny look when you come in covered in crap from the cow you had to look at over lunch!