Saturday, February 6, 2010

No Guts, No Glory

On Thursday, I was presented with an interesting case. A young Brown Swiss cow had not been feeling well for a few days. She was not producing milk and was very constipated but she continued to eat. One of my partners saw her on Monday and treated her conservatively with epsom salts and other laxatives in order to dislodge the blockage. If that treatment did not work, he instructed the client to call later in the week for re-evaluation.
Needless to say, the Swisser could not poop. As much as a cow eats, she needs to poop. So we got the call to figure out the problem. Problem was, I was scheduled to perform a drumming demonstration for Sasha's elementary school class. My daughter was Star of the Week. On Thursday, the Star of the Week was to receive a surprise visit from a relative whom would entertain the class with a demonstration. I was scheduled to be there at 11 am and the constipated Brown Swiss call came in at 8:30am. I thought I had plenty of time to pick up the call and make it to school to surprise my daughter. Boy was I in for a big surprise!
I arrived at the farm at 9:15 am and immediately looked over the cow. She was standing and ruminating, even eating. But her manure was skant and dark like digested blood. Palpating her rectally, her intestines were grossly distended. Something serious was wrong. Distended intestines without manure could indicate a mesenteric torsion, intestinal volvulous, hemorrhagic bowel syndrome, or intussusception which collectively equal - DEATH! So, we had 2 choices: euthanasia or surgery. The cow was young, plus she was owned by another person. Consequently, my client elected to try to save the cow at all cost. Time to don the surgery gloves. I was thinking to myself, "I have plenty of time to knock this surgery out and make it to school." On second thought...
I prepped her, blocked her with lidocaine, scrubbed up, donned the gloves, grabbed the scalpel blade and in I went. I started gut puddling and encountered a loop of intestine that felt larger in diameter than normal. I fished it out and closely examined it. The intestine had telescoped into itself forming an intussusception. Much to my pleasant surprise, the intestinal tissue looked normal indicating that this intussesception was fairly new. If this was causing her problems, we were on Easy Street. I pulled it apart and stuffed it back in and started puddling some more and then I found it. I pulled out a second bigger, badder, meaner-looking intussusception. It was swollen, edematous, and even hemorrhagic. Clearly, the tissue was dying and needed to be removed.
The Intussusception swollen and edematous
Intestine pulled out of intussusception with blood clot.
There goes my appointment. The cow's abdomen was open. There was no going back. Annisa was not going to be happy and Sasha was going to be hugely disappointed. I was becoming an emotional wreck, but I had a job to do. I had to save this cow and deal with the famliy consequences later. We now had 2 options, euthanize the cow or try to remove the dying intestine. "No Guts, No Glory." Pun intended. The dairyman held the intestines for me as I attempted a resection and anastamosis. I clamped both ends where we had normal tissue, tied off the blood vessels, and hacked away the intussusception. No going back. I sewed the ends together with two lines in a simple continuous pattern using catgut suture and oversewed the everted ends. We opened the clamps and ingesta started flowing through. Two leaks were identified and quickly sewed shut. The anastamosis was starting to look good. We rinsed off the intestines with saline solution and heavy doses of Penicillin in order to reduce adhesions and infection which could compromise the anastamosis. By this time, the cow had it. She layed down which increased my anxiety level. When cows go down, they usually want to die. So, we stuffed the intestines back, said a "Hail Mary!" and closed her up. I did my job. The cow was still alive and my wife was frantic wondering what she was going to do to cover for me at school. I left after giving the client a laundry list for post-surgical care.
Now the saving part shifts to the client in whom I have a lot of faith. She will require heavy supportive care over the next two weeks, including aggressive fluid therapy in order to maintain adequate blood perfusion of the intestine which will promote healing. She'll also need aggressive antibiotic therapy, laxatives, and high quality feed. I stopped in the following day for a check-up and was astonished by what I saw.She was standing, eating, chewing her cud, and manure was passing. The client told me that he shed a tear after the ol' girl ripped a piece of hay out of his hand as he passed by - an indication that she was determined to fight. That statement confirmed why I chose this profession. Oh yeah, about my appointment at school. Annisa tried to call me multiple times to no avail. After hopping in the truck, I made the apologetic phone call. Fortunately for me and my daughter, Annisa rescheduled the demonstration for 2:30 pm which conflicted with a herd check appointment. However, my understanding partners made arrangements to cover for me so I could see Sasha. Thanks guys!