Calving and Dystocia: When to call the Vet

"They didn't say anything about this in the books, I thought, as the snow blew in through the gaping doorway and settled on my naked back.
I lay face down on the cobbled floor in a pool of nameless muck, my arm deep inside the straining cow, my feet scrabbling for a toe hold between the stones. I was stripped to the waist and the snow mingled with the dirt and the dried blood on my body. I could see nothing outside the circle of flickering light thrown by the smoky oil lamp which the farmer held over me.
No, there wasn't a word in the books about searching for your ropes and instruments in the shadows; about trying to keep clean in a half bucket of tepid water; about the cobbles digging into your chest. Nor about the slow numbing of the arms, the creeping paralysis of the muscles as the fingers tried to work against the cow's powerful expulsive efforts.
My mind went back to that picture in the obstetrics book. A cow standing in the middle of a gleaming floor while a sleek veterinary surgeon in a spotless parturition overall inserted his arm to a polite distance. He was relaxed and smiling, the farmer and his helpers were smiling, even the cow was smiling. There was no dirt or blood or sweat anywhere."

So begins James Herriot's book All Creatures Great and Small. If you have never read his books, you really should. From the first paragraph you are hooked. But this post isn't about James Herriot, rather it is about cow calving and when you should call your veterinarian for assistance. We are just starting into spring calving season here on the Palouse. I had my first middle-of-the-night calving call just a few weeks ago. It is sometimes all I can do to drag myself from my warm bed and venture into the cold blustery dark, but when a new, live calf is the result of my labors (no pun intended), it does make it all worthwhile.


Before we go into the particulars about when to call the vet, let's talk about the normal stages of parturition (labor and delivery). The first stage of labor, which is the dilation of the cervix, often goes unnoticed. You may notice the cow looking uncomfortable, getting up and down, looking around at her sides. The first stage can take up to 8 hrs or more. The second stage commences when the cervix is fully dilated and the calf can begin it's journey through the birth canal. You may see the cow behaving oddly, laying down to push a little, getting up and pacing around. Usually, the bag of fluids that surrounds the calf will rupture in a gush and "strings" from the amniotic sac will hang from the vulva. Soon afterwards, you should see the front feet appear and the nose not far behind. The second stage ends with the delivery of the calf. The second stage should not exceed 1 to 1 1/2 hours. The third stage is the delivery of the placenta and usually takes 4-8 hours.

Dystocia is what we call a difficult and/or prolonged parturition (labor and delivery). Dystocia can occur for many different reasons that fall into two generalized categories: 1) something wrong with the cow, and 2) something wrong with the calf and/or it's position. Things that can go wrong with the cow include weakness due to poor health or nutrition, uterine torsion, scar tissue adhesions, or hormonal imbalances. Problems with the calf include malpositions, deformities, multiple calves, or being too large to be pushed through the pelvis.

So, the question still is "When do I call the veterinarian to check the cow?" Well... there is no set answer, but here are some guidelines I suggest. Call your veterinarian if: 1) You think the cow should have calved and she hasn't. I regularly hear, "I thought she wanted to calve two days ago, but she hasn't shown anything yet." 2) Part of the placenta has been hanging out or you have seen fluid drainage for 1 1/2 hours. 3) Part of the calf has been out for 30 minutes and it still isn't on the ground. 4) The fluid, placenta, or calf is stained yellow. 5) The toes are pointed down instead of up. (This usually occurs with a backward calf.) I feel you will save more calves and cows (and thus more money) if you assist earlier as apposed to waiting too long.

This old diagram shows a backward calf that
will need assistance to be delivered alive.

Notice the toes pointing down with the backward calf.
If these were front feet they would be pointing up.

This is a nightmare that usually occurs at 2 AM,

with 20 degrees and 20 mph winds up my back...
and she has been this way for 2 days.

This presentation usually occurs when
the calf is dead during stage one of parturition.
It is the calf's job to get it's feet up into the vagina.

So, this has been a brief overview of calving and dystocia. Hopefully I have helped you to make decisions about when to call your veterinarian out to check your laboring cow.

PS Always go back inside the cow's uterus and check for another calf if you have had to assist her with calving. Just a tip.

Urolithiasis (bladder stones)

Meet "Miss Scarlet the Grange Dog". She came to visit us a few weeks ago with the complaint of not feeling well and having to urinate all the time. The only problem we could find on physical exam was a small amount of malodorous vaginal discharge. Since she had never been spayed, we had to consider that she might have pyometra (infection in the uterus). Surgery to remove her uterus and ovaries was scheduled, and antibiotics and pain medicines were started. When Miss Scarlet was anesthetized we were able to palpate her abdomen a little better. While she was awake, she kept her stomach muscles so tight that we could not effectively palpate. A very hard structure was felt in the caudal abdomen (towards her tail end) -- in the area of the bladder. Since there should not be any hard objects in this area, it was likely that she had, along with the infected uterus, a stone in her bladder. The medical term for this is urolithiasis.

Surgery consisted of opening the abdomen, cutting into the bladder and removing a large "rock", flushing the bladder and urethra, and then suturing the bladder closed. Next, the uterus and ovaries were removed because of her pyometra. All went well and Miss Scarlet was returned to her owner a new "lighter" dog.

This is a picture of the freshly removed stone.

This picture shows some objects for size reference. Scarlet is a 10# mixed breed terrier. As you can imagine from the size of the stone, there wasn't much room left in the bladder for urine. This reason, combined with the irritating nature of the stone, would make it so that Miss Scarlett felt like she had to urinate all the time. Add to this the irritation and discomfort from the uterus and you can understand why she didn't feel 100%.

Here are some examples of stones we have removed from other patients. Sometimes there is just one, sometimes there are hundreds -- like small gravel. These stones are very hard. Often the stones are passed out the urethra before they get large enough to cause trouble. If they are not passed they can irritate the lining of the bladder, cause bloody urine, and make the dog feel like it has to urinate often. The stone can also temporarily (or permanently) block the passage of urine, and when this happens, it is a medical emergency. Surgery must be performed immediately to remove the stone or stones so that the dog can urinate.

Crystal formation is enhanced in urine that is alkaline (has a basic pH), and is inhibited in urine that has more acidic pH. Diet is a big contributing factor to the pH of the urine. Meat based diets tend to make more acidic urine, and plant based diets make more alkaline urine. Bacteria, which like to grow in an alkaline pH, make by-products that also contribute to crystal formation. Bladder stones in dogs are sometimes found following cases of infection in the bladder (cystitis). The inflammation and bacterial by-products form debris in the bladder which provide a starting place (or nidus) for the crystals to begin forming. Once the crystals start, they can form onto each other and build and build until they make stones. So you can see that urine pH and bacterial infection go hand in hand with urolithiasis.

Not all stones are caused from inflammation, some dogs such as Dalmatians, produce bladder stones because they cannot metabolize certain substances well. In the case of some Dalmatians, they cannot metabolize uric acid and so they make uric acid stones. This type of stone formation can be possibly corrected or prevented with special diets. Other dogs, such as Schnauzers just seem predisposed to form stones for some unknown reason.

Bladder stones can look very impressive on a radiograph as shown above. This radiograph is not from Miss Scarlett, but of a dog that had the largest stone in the above stone comparison.
Can you see the more dense central portion of the stone? This could be a different type of stone within the larger stone. It is not unusual to have multiple types of stone within the bladder at the same time. It sure looks uncomfortable to me!

Welcome Kasey

We'd like to welcome Kasey to our team. Kasey was born and raised in Whitman County, where she and her husband continue to live and raise their children. Kasey has first hand experience with farm life and enjoys riding her horses and being with her dogs. She also has a pot-bellied pig living at her home, but she would tell you it belongs to her children.

Kasey is working in the mornings (and occasionally filling in for Penny in the afternoons). She replaced Jenny, as Jenny has quit to focus on to other important things in her life.

We hope you will give Kasey a warm welcome when next you visit our clinic.

Spinose Ear Tick

Blogging has been a little hit & miss lately. Sorry. It is not that we haven't been busy, or that there haven't been interesting cases, to the contrary. It seems like we've had a rash of crazy trauma cases, and those aren't the type of thing that lend themselves to blogging. It's not like you can ask an owner if you can stop and take picture of the bleeding, mangled dog before you begin treatment. And asking whether or not you can blog about their poor pet seems in bad taste. So, that's how it has been.


Anyway, last week we had a rather mundane "check dog ears" from the western part of the county. And this is what we found -- a spinose ear tick (Otobius megnini). The spinose ear tick can infest many warm blooded animals, but seems to prefer cows, horses, dogs, cats, and even humans. It can be a real problem in livestock, causing poor condition with heavily infested cattle. We have seen several of these ticks in the past few years, all from the relatively arid parts of Whitman county. In dogs, infestation of the spinose tick causes severe head shaking, pain, and digging at the ear. Severe oozing skin infections can result from the bite. Most people assume that there is just a grass seed or awn in the ear canal.


As it turns out, only the nymph and larval stages of this tick feed on blood. The adults apparently do not feed at all, and can live for up to 2 years. The feeding stages of this tick like to crawl into ears, especially deep into the horizontal canal and attach to the skin where they feed on blood and wax in the ear. The spinose ear tick can cause tick paralysis and can also spread diseases such as Q-fever, tularemia, Colorado tick fever, and Rocky Mountain spotted fever (although not necessarily in this area of the country). Treatment for infestation involves applying an acaricide solution (typically permethrin or amitraz) directly into the ear canal if the tick cannot be removed manually. In cattle, permethrin impregnated ear tags are helpful in prevention of infestation.

Kind of gives you the creeps, huh?

Palouse Empire Fair

Every September, for the past 23 years, Dr. McGraw has spent the week and weekend after Labor Day out at the Palouse Empire Fair. At first glance, this may seem like a dream job, but after you found out about the hours of service you might think otherwise. Dr. McGraw is on the fairgrounds from about 6:30 AM until the barns close at 10PM, but as you can see, Dr. McGraw takes this all in stride.

Most of the years that Dr. McGraw has served as the fair Veterinarian, he has also had children at the fair showing one animal or another: pigs, horses, bottle calves, sheep, and the occasional chicken. This year it was a black bummer lamb, and a beautiful red and white short-horn bottle calf.


Official duties for the fair Veterinarian include: checking in animals as they arrive at the fair to make sure they are healthy and free of infectious diseases, treating show animals that get sick while at the fair, and occasionally treating rodeo stock or rodeo contestant animals. Unofficial duties include: putting chicken eggs in the rabbit cages (much to the surprise of people in the rabbit barn), hiding prize ribbons where 4-H or FFA contestants cannot reach them (not very amusing to some people), and putting goose eggs in the pigeon cages (poor, poor pigeons!). Dr. McGraw can also be seen helping out in any barn that needs an extra hand, visiting people he only sees yearly at the fair, and perusing exhibits in the buildings.

The last day of the fair, Dr. McGraw organizes the "Ol' Fogies Fitting and Showing Contest." This is the 17th year he has served as the official organizer. The first year, the prize for winning the "Ol' Fogies" contest was a political campaign button with a pig's tail attached (never fear, the poor pig lost it's tail when another pig bit it off). The prize is currently an old women's bowling trophy. Needless to say, all the "ol' fogies" have a good time at the showing contest.

This year, the weather was fine and most of the animals were healthy at the fair. We like it that way. See you at the Palouse Empire Fair in 2010!

Cats, Bats, and Rabies

Awhile back, one of our client's cat brought home a bat, and she called me asking what they should do with the bat and if they should be worried about rabies. The cat, bat, and children were all in the back yard together, and whether or not the children touched the bat was unlikely, but uncertain. We get asked these questions often enough that I decided to write a post about cats, bats, and rabies and try to address these questions to the best of my ability.

1. What should you do if your pet catches a bat?
DO NOT touch the bat barehanded! This is very important. Put on thick leather gloves and put the bat in a container that can be disposed of. If you think any person may have been exposed to the bat --touched or bitten -- phone your county Health Department and tell them the situation, then phone your physician as well. If only your pet has been exposed to the bat, phone your veterinarian. The bat will need to be sent in to a laboratory for rabies testing. Most public health departments will send the bat off for testing (for free) if a human has been exposed, but not if only your pet has been exposed. If your pet has been exposed, the bat should still be sent off, but at your expense (around $40). It is important to know if the bat is infected with rabies or not.

2. What should you do if you simply find a bat laying in your yard or in your house in broad daylight?
The same applies as above. DO NOT touch it with your bare hands. If it is outside, just let it be and see if after 10 minutes or so it has gone elsewhere. The problem lies in the fact that most bats that are found in broad daylight are ill, and some of them may be ill with rabies. If the bat is still there and you have children or animals, it is best to dispose of the bat as indicated above. You may want to call your veterinarian or public health official first.

3. What is the big deal with rabies anyway?
Rabies is a virus that is spread via saliva from the bite of a rabid animal. The virus travels through the nervous system, and once it reaches the brain it is deadly. The incubation period for rabies is quite variable among mammals and depends partly on how far the virus has to travel before it reaches the brain. So for example, if a rabid dog bit your face or a bat bit your cat's face, the virus wouldn't have very far to travel before it reached the brain. However, if you were bitten on the toe, the virus would have a long way to travel via the peripheral nerves to the brain. Incubation periods in dogs and cats range from 2 weeks to 6 months (but average 3-6 weeks). In the U.S. rabies is not the huge problem that it is in many parts of the world, but still-- infection with rabies without treatment is deadly --that's the BIG deal.

Image of dog with "furious" rabies

4. What animals can carry rabies?
Any warm-blooded animal can be infected with the rabies virus and thus spread it. In our area of the country we have no terrestrial rabies -- that is to say, no animals that live on the ground are endemic for rabies. In the northwest, our primary source of rabies is bats, and the rabies viruses isolated from infected terrestrial animals have all been found to have originated from bats. In the southwest and mid-west the main sources of rabies is skunk and fox, and in the east and northeast the main source is raccoons.

5. What are the symptoms you might see if your pet was infected with rabies?
The first stage of the disease is the "prodromal phase". In this phase your pet may show anxiety, nervousness, or apprehension and may do a lot of hiding. A fever may be noted especially in cats. Your pet may be irritable and try to bite, or it may be docile and friendly if it is normally aggressive. The second stage is the "furious phase". In this phase your pet may be hypersensitive to auditory and visual stimuli, may become restless and roam more, and may be irritable and vicious. The final stage is the "dumb or paralytic phase". In this phase the nerves that go the head and throat are affected causing the jaw to drop and the animal to be unable to swallow -- thus the stereotypical drooling and foaming. The animal may be thirsty but unable to drink, that is why another term for rabies is hydrophobia. An animal may exhibit some or all of these symptoms. Death is inevitable once symptoms are observed. A VERY few people have survived, and there are anecdotal accounts of dogs surviving.

Image of dogs with "dumb" rabies

6. How is rabies diagnosed?
The only way that we have of diagnosing rabies at this point is submission of brain tissue for microscopic inspection, so unfortunately euthanasia is a must for diagnosis.

7. Are all bats infected with rabies?
No, not all bats are infected with rabies. In fact, only about 10% of bats that are submitted for rabies testing are positive. That means that the percentage of rabies positive bats in the wild is probably much less, because normally you wouldn't find a bat just hanging around where you or your pet could catch it unless it were sick (possibly with rabies). However, if it was me or my child, I would not play the guessing game. I would presume a bat was rabies positive until proven otherwise.

8. What is the best way to prevent rabies infection?
Vaccination. Vaccination of pets is the only way you can help to prevent your exposure to rabies. That and steering clear of any wild animals that are acting suspiciously. Dog and cat vaccination protocols are strictly regulated: First vaccine at or after 16 weeks followed by a booster at one year. Then another booster every three years (at least in our good state of Washington). You should have your cat and dog vaccinated for rabies even if it is strictly indoors, because bats can come into a house through the smallest opening. Also, if your dog were to ever bite a person (heaven forbid), up-to-date rabies vaccination will be important to help keep your pet from being euthanized. There are also a rabies vaccine for people -- veterinarians are required to be vaccinated against rabies since they may be more likely to come in contact with a rabid animal than the average person.


The bottom line is: Educate your children not to touch a bat if they (or their pet) finds one and vaccinate your pets against rabies. Just last year a young boy and his dog were found playing with a bat in northern Whitman County. Luckily someone found them and captured the bat for testing because the bat was found to be positive for rabies. The little boy had to go through prophylactic treatment for rabies infection and the unvaccinated dog was euthanized.

One more bottom line: If there is any doubt as to whether a human has been exposed to a bat bite, err on the side of caution. Another tragic story from Washington State occurred about 15 years ago when a bat was found in the room of a young girl who was sleeping. No bite wounds were found on the girl so no further medical attention was sought. Unfortunately, about a month later the little girl died from rabies. The bat was dug up from the backyard and was positive for rabies. So sad.


Here is a collection of helpful links where you can learn more about bats, rabies, and such.
Living with Bats
Journal of the American Veterinary Medical Association --Rabies Survey 2007
CDC- Bats and Rabies
Whitman County Department of Public Health

(images courtesy of http://www.vaccineinformation.org/rabies/photos.asp)

Parvo Virus

In the past month or so, we have treated several cases of puppy parvo in the clinic. It seems that we cannot stress enough how important it is to get your puppy or dog properly vaccinated against parvo virus. This very common disease can quickly turn a happy, healthy dog into a sick or dead dog in just a few hours to days. The virus and disease is described well at the following site: {Canine_parvovirus} Usually, the first signs we see with parvo viral infection can easily be mistaken for a simple upset gastrointestinal tract --a little vomiting and the dog no longer wanting to play. This is usually followed in a day or two by diarrhea, and then bloody diarrhea. Unless the dog is treated quickly, death from dehydration and electrolyte imbalance can occur quickly.

Parvo virus is everywhere, and I mean EVERYWHERE. It is a very sturdy virus -- only reliably killed with a strong bleach solution. It can last in the ground or on other surfaces for years. You never know where your puppy may come in contact with it, and of course puppies are always sniffing, licking, chewing anything they can find. Take your unvaccinated puppy to a friend's house where several years ago another dog have parvo diarrhea all over the yard and unbeknownst to you, you just infected your puppy with parvo.



It is the saddest thing when a puppy comes in and is deathly ill with parvo. Sad because in most cases, the illness and possible death could have been avoided if the owner had been correctly informed about vaccination. Often the owner is mistaken told by a breeder that the 6-8 week old puppy has been vaccinated twice already and needs no further vaccination. Or, the owner mistakenly assumes that since the puppy has been vaccinated at least once by the breeder, then it is up-to-date. This is just not true.

How the vaccination works is a little complicated, so hang in with me. Puppies are born with some maternal antibodies already running around in their blood, and then they receive more antibody protection through the colostrum they nurse from the mother dog in the first 24hrs post birth. This maternal antibody protection, against myriads of diseases, lasts anywhere from 6-10 weeks of age depending on many factors. A vaccine stimulates the body to make their own antibodies (not passive antibodies from the mother) and memory to make more antibodies when challenged by a virus or bacteria. So, for the vaccine to work, there must be very little of the maternal antibodies left in the puppy, and as the age for this varies greatly from puppy to puppy -- we are stuck doing sort of a crap shoot when it comes to vaccinating puppies. To try to make sure that every puppy is adequately vaccinated, we need to cover both ends of the spectrum. Some puppies may run out of maternal antibody by 6-7 weeks while others will still be protected until 10-11 weeks. accomplish this at 8-10 weeks. And since most vaccines need at least two doses to be fully effective, we need to start vaccinating around 6-8 weeks and continue with boosters every 3-4 weeks until 14-16 weeks. So, there it is-- it all comes down to immunology -- not money sucking veterinarians trying to make a buck. We especially don't like to see sick and dying puppies in the clinic when we know it could have been prevented.



A couple more thoughts on parvo. It makes me cringe to see young puppies taken out and about to parks, the river, and other public places. Knowing what you now know about parvo and immunology, it should make you cringe too. You really shouldn't feel safe taking a young puppy to a public area until it has had at least 2 (or better yet 3) vaccinations for parvo. Also, just because you have an old dog, don't think that you don't have to worry about parvo any longer. An old dog that has not been vaccinated in a few years can be just as susceptible to parvo as a young unvaccinated puppy -- an aging body and other illnesses can make the immune system not as strong. Oh, and one more thing -- we recommend getting your vaccines from your veterinarian because you just don't know how the vaccines from the catalogues or feed store have been handled and stored. Vaccines are temperature sensitive and cannot be sure they have been kept cool. Our vaccines come on ice overnight from sources we trust -- if they are warm, we send them back. No sense taking risks.

A couple of good sites to visit about parvo:

http://www.avma.org/animal_health/brochures/canine_parvo/parvo_brochure.asp
http://en.wikipedia.org/wiki/Canine_parvovirus