Bringing new life to an elderly cow (June 1, 2022)
June 1, 2022
EDITOR'S NOTE: The following column contains anatomical language.
"I wish Dr. Ball was here," I thought to myself as I drove my left arm deeper into the rectum of this old, fat cow.
Dr. Ball was the chief obstetrics instructor at Colorado State when I attended. He was tall and thin, and it seemed that his arms were long enough to reach his knees and his fingers were at least 6 inches long. He could do anything in a rectal exam.
"How am I going to get this uterus retracted?" I thought as I swept my hand across the floor of her pelvis. I could just grasp the cervix; the rest of the uterus hung over the brim of the pelvis and was heavy and resisted my attempts to pull it back so I could get a better grip.
"Bob, I don't know if I am going to be able to retract this uterus," I said as I looked at an anxious owner. "Let's review her history one more time."
I pulled my arm out and removed the OB sleeve. I could do 100 pregnancy exams in a couple of hours, but this old cow had already tired my arm out. I leaned on the railing of the crowding alley, resting my arm as I talked with Bob.
"How old is this cow?" I asked.
"She is going to be 19," Bob answered. "She is my first and is the genetic base of my entire herd. I realize it is a big request, but I would love to have another calf out of her."
"When was the last time she had a calf?" I asked.
"Three years ago," Bob said, "probably a little over that."
"When was the last time you bred her?" I asked. "I mean, is there a possibility that she has a pregnancy? I have not even been able to get the uterus up where I can check for a membrane slip."
"No, I quit wasting semen on her well over a year ago," Bob said. "I hadn't had a bull before we moved. This young guy I have now might get a chance at her if you say go."
"So, this is the situation," I started to explain. "This cow is 19, very over-conditioned – fat, in other words. She hasn't been pregnant in over three years and has a uterus that is out of reach. That most likely means there is some chronic pathology in that uterus. That all adds up to a slim chance of getting her pregnant."
"What is the first step in trying?" Bob asked.
"The first step is to retract her uterus so we can decide what might be going on inside of it," I said, a little unsure that I had been clear enough in my explanation. "In school, we had Dr. Ball. He could retract this uterus in a heartbeat. Without Dr. Ball, we used large cervical forceps that could clamp on the cervix to help pull the uterus up where you could get a hold of it. I don't have such forceps. But I have a large Oschner forceps that has some teeth on it and might be able to provide a little traction. The only problem would be it could put a small tear on the cervix if it doesn't work."
"If that is what it takes, let's do it," Bob said. "This is probably the last time we have a chance of getting her pregnant."
"Just to be clear, that chance is less than 25%," I said. Why did I give such a figure? Never give odds to a horse owner, or probably a purebred cow breeder. They will take you up on it every time.
I tied the cow's tail out of the way, tying it with a loop of twine around her neck. That way, if we forgot to untie it before releasing her from the chute, we would not pull the end of her tail off.
After prepping her vulva, I tied a length of gauze to the handle of my 12-inch Oschner forceps and carried the forceps into the vagina with my left hand and arm. Along with the forceps, I brought a guarded culture swab.
The cervix was large but felt relatively healthy and was tightly closed. I advanced the guarded swab to the cervical opening and pushed the swab into the uterus. I pulled the swab back into the guard, pulled that out with my right hand, and handed it to Bob.
"Hold onto this for a minute," I said.
Then, back inside, I clamped the forceps on a stout external ring of the cervix at the top. Then I tested the gauze with a firm pull. The forceps held, and the cervix did retract a little. I withdrew my hand and made sure the gauze followed and hung outside the vulva.
"Bob, do you know if this cow cycles normally?" I asked.
"Yes, she cycles as regular as can be," Bob said. "You can almost set your calendar on her every 21 days."
"Do you know when she's due to cycle?" I asked.
"She should cycle in the next few days," Bob said.
I changed the sleeve on my left arm. I pulled the fingers off an OB sleeve, pulled it on my arm, and then stretched on a latex exam glove. Finally, I covered it again with another OB sleeve with the fingers removed. This would provide much better sensitivity in my fingertips.
"This is the plan," I started. "If this uterus feels like it is salvageable at all, I will infuse it today with an antibiotic. Then if she cycles, you go ahead and breed her with the bull and call me. We will infuse her again, 24 hours after breeding."
"I would rather breed her with AI [artificial insemination] semen and save the bull for the last resort," Bob said.
"OK, I just want to try on this cycle, just in case we get lucky," I said. "We will have the culture results back by next week and be able to make an antibiotic selection based on that culture. If she doesn't get pregnant, we will go through a series of infusions. We might be working on her for several months."
I drew an infusion of Furacin solution and Neomycin into a 60cc syringe, to which I attached an infusion pipette. I handed this to Bob, then I took the culture swab and set it aside. That done, I lubed my left hand and arm and pushed as deep into the rectum as I could. I grabbed the cervix and, at the same time, with my right hand, pulled on the gauze attached to the forceps. The cervix and uterine body retracted into the pelvis. I reached forward and flipped the entire uterus back into the pelvis - sort of amazed myself.
"This uterus is the size of a uterus with a 90-day pregnancy," I said.
Out of habit, I checked for a membrane slip; there was no pregnancy. The uterus was thick and dough-like, with no significant fluid present. Probably just a case of very chronic uterine infection, endometritis, I thought. The ovaries were active and felt normal, with a receding corpus luteum on one ovary.
"OK, hand me that syringe," I said.
Holding the cervix, I worked the pipette tip through the cervical rings and made the infusion. Then I allowed the uterus to return to its position. I pulled my arm out and removed the sleeve, carefully turning it inside out. I prepped the vulva again. Then with a new sleeve, I retrieved the forceps from the vagina.
And so it began, a months-long battle with an old, chronically infected uterus, trying to bring about a pregnancy. I went through a week of antibiotic infusions based on culture results. We used post-breeding infusions after every breeding attempt. We used artificial insemination, and we bred her with the bull. She continued to cycle regularly. At least she didn't raise any hopes by missing a heat period.
I was at wit's end, and then I remembered a conversation with Don in Enumclaw, Wash., on our way back to the clinic from performing some pregnancy exams.
Don enjoyed picking my mind. We had gone to different schools, and sometimes our views on how to do things were completely different. We both modified our thinking in small ways from our discussions.
"I want to tell you," Don started, "if you ever get in a situation where you want to get a cow pregnant, I mean, if you have tried everything and you really want her pregnant. You infuse her with dilute Logul's."
"That is probably the only absolute 'never do' that Dr. Ball told us," I said. "That is supposed to do far more harm than good."
"I am just saying," Don repeated, "if you really want to get that cow pregnant, use an infusion of dilute Logul's. It works, maybe not every time, but it works."
"I don't know," I replied, somewhat skeptical of the advice.
"You do an infusion; the cow will cycle in 6 to 8 days, skip that cycle and breed her on the next cycle. You can do a post-breeding infusion if you like. You will have a 70 or 80% conception rate on that breeding. And most importantly, you will have a pleased client. I know what the literature says. And I know how you were taught, but in this case, my experience trumps all of that. Just file it away in your mind and try it if the need arises."
On my next trip to check the cow, the uterus was improved. After all the treatment, it sort of felt normal now. I could retract it into the pelvis in a pretty standard manner now. So things were improved, but still, no pregnancy resulted.
"Bob, I have one more trick we could try," I started as I explained the new plan. "There is a treatment that I was taught in school never to use, but the guy I practiced with when I was in Enumclaw swore by the results in just this situation. We have pretty much exhausted the book. We have worked through everything, and the uterus is better. You can probably remember the difficulty I had during her first exam. But today, the exam goes easy.
"What I suggest is an old-time treatment. I do an infusion with dilute Logul's. This infusion wipes out the lining of the uterus. And then the lining of the uterus is regenerated from a few remaining cells."
"Sort of like a chemical D&C," Bob said.
"Yes," I said. "I guess that is a good way to look at it."
"It doesn't look like we have any other choice," Bob said. "Let's do it."
It took me almost a week to get a bottle of Logul's. It was not something in the regular supply line. When it came, I had no recipe for mixing a dilute solution. I sort of went by the old port wine formula that I used for Betadine. I mixed a solution, and we gave Bob a call and set up a visit.
The infusion was no problem. The old cow was used to the chute now. I noticed that when we turned her out of the chute and started discussing the breeding schedule, she was hunched up a little. There must have been some significant discomfort with the infusion.
"Expect her to cycle in eight days or less," I said. "Don't breed her on this cycle, but breed her on the following cycle. We should plan a post-breeding infusion just to be on the safe side."
Her cycles went right by the book, eight days and 21 days after that. Bob called when he had bred her. I had hoped he would use the bull, but he used artificial insemination. He probably figured he'd gone through all this trouble; he wanted a good calf.
I marked my calendar for her next expected cycle. The date came and went, and there was no call from Bob. Too early to celebrate, I thought, but just maybe, she is pregnant. At 42 days after breeding, Bob called.
"She still hasn't cycled," Bob said with some excitement in his voice. "When do you want to check her?"
We waited until 50 days. With her uterus being larger than most, I didn't want to be in a situation where there was a question with the exam.
When 50 days came, the exam was brief. The uterus felt the best that I had seen in this old girl, and a 50-day pregnancy was present based on a membrane slip and palpation of the amnion.
I was relieved and happy. Bob was happy. And I am sure the old cow would enjoy not being run through the chute every few days. And the bottle of Lugol's probably sat on my shelf for the next 20 years before I discarded it.
– David Larsen is a retired veterinarian who practiced 40 years in Sweet Home. More of his stories are available on his blog at docsmemoirs.com.