Overview of Bovine Secondary Recumbency

A thorough physical examination should be performed when the cow is first presented. The rectal temperature should be within the normal range. If it is lower than normal, some level of shock might be present. Recession of the eyes into the orbit or persistence of a skin fold for >2 sec indicates dehydration. Pallor of the mucous membranes suggests toxemia, in which case a weak pulse and tachycardia may be present. The respiration of a recumbent cow may be labored by virtue of the pressure of the abdominal contents on the diaphragm.

Vaginal exploration is mandatory in every peripartum, recumbent cow and may lead to discovery of a decomposing fetus. Damage to and infection of the wall of the vagina is common. Metritis and an associated toxemia can contribute to postpartum recumbency.

Rectal exploration is essential for differential diagnosis. The degree of uterine involution should be appropriate for the number of days postpartum. Ballottement of fluid in the organ or lack of tonicity should be noted. Unexpected anomalies may be palpated. Adhesions, lumps of necrotic fat, and enlargement or turgidity of the cervix or vaginal wall are all sequelae of a difficult birth. Hip dislocations and fractures of the pelvis may be palpated per rectum, particularly if an assistant vigorously manipulates the upper limb of a cow in lateral recumbency. Movement of the head of the femur in the obturator foramen may also be detected in cattle with caudoventral hip dislocation. Craniodorsal dislocation of the hip, the most common direction for hip dislocation, or fracture of the femoral neck or proximal femur should be suspected if the affected limb appears shorter than the contralateral limb. Pelvic fractures can be associated with sciatic nerve paralysis, whereas hip dislocation may be associated with some degree of obturator nerve paralysis. If either condition is suspected, the sensory state of the limbs should be evaluated by judicious and humane application of an electric prod to the distal limb. Involuntary sternal recumbency may be associated with lymphosarcoma of the spinal canal, vertebral abscesses, or bizarre traumatic injuries.

Mammary gland examination should always be performed on recumbent cows. A toxic infection of the udder with an organism such as Escherichia coli can be a primary cause of recumbency. However, such an infection may be precipitated by the recumbency, especially if the udder is engorged and remains unmilked.

Blood samples are not usually taken when treating routine cases of hypocalcemia. However, hypocalcemia, hypophosphatemia, and hypokalemia should be assumed to be present in all recumbent cattle, and determination of the biochemical status of cattle unresponsive to calcium therapy frequently helps guide treatment and prognosis. Hypokalemia and hypophosphatemia are commonly quoted causes of creeper cows (cows able to crawl but unable to stand). Alert downer cows may have normal serum concentrations of calcium, potassium, magnesium, and phosphorus. Downer cows have increased serum CK, AST, and LDH; cows that do not recover have higher serum AST and CK activities than cows that do recover. Increased serum CK activity is a specific indicator of muscle damage; however, CK activity peaks shortly after the start of muscle damage and declines noticeably within 4 hr. For this reason, increased serum AST activity is the best prognostic indicator in recumbent cattle, with higher AST activities indicating a poorer prognosis. In cattle with severe muscle damage, the urine may contain myoglobin as well as higher than normal concentrations of protein. The age and mean serum concentrations of phosphorus, magnesium, sodium, bilirubin, glucose, and urea are not significantly different between recovering and nonrecovering cows.

Ischemic necrosis and rupture of muscles of the thigh region are common necropsy findings in downer cows. Hemorrhage and rupture of adductor muscles may be seen if the animal “spread-eagled” itself while struggling to rise on a slippery surface such as wet or icy concrete. Traumatic and inflammatory injuries to sciatic and peroneal nerves are also found in downer cows. Damage to intrapelvic nerves, such as the sciatic and obturator nerves, account for most cases. Decubital injuries to the lateral aspect of the stifle can be associated with damage to the peroneal nerve.

On every day of the recumbency, an attempt should be made to bring the cow to its feet. Several simple but effective techniques can be tried. In one method, the clinician stands with feet pressed under the cow at a point below the scapulohumeral joint. A sharp blow is delivered by driving the knees into the muscle mass below and caudal to the scapula. This method must not be used on the thoracic wall unprotected by the muscle mass to avoid fracturing the ribs. If the animal struggles to rise, an assistant should grasp the root of the tail with both hands and lift. Lifting on any other part of the tail may cause damage. Recently calved cows can be motivated to rise if they hear their own calf bawling with hunger. The calf is best restrained close to the cow but out of her sight. Some workers use electric goads and various anecdotal or traditional methods of inflicting pain to stimulate a cow to rise; these measures have a low success rate in inexperienced hands and are not recommended.

The value of hip clamps is controversial. Their proper use requires experience, skill, and a delicate touch. Continual use causes trauma and pain that is counterproductive. The forelimbs support 60% of a cow’s weight and, therefore, the use of a canvas sling under the sternum is almost mandatory for consistent success. A chest band is required to prevent the sling from slipping backward. If the sling is suspended from the tine at one end of a fork lift, and the hip clamps from a tine at the other end, minimal trauma results. If a fork lift is not available, a T-bar suspended by a pulley from an overhead beam (or a tripod for animals at pasture) will serve. The jaws of the clamps must be well protected with synthetic foam or rubber secured in place with a wrap of duct tape.

Hip clamps should not be applied too tightly and should lift the cow slowly to allow time for the circulation of the limbs to become reestablished. The device is lifted until the hindfeet just touch the ground. Often, the cow will hang with the limbs slightly flexed. This should not be confused with unilateral flexion, which indicates peroneal paralysis. Next, one assistant on each side of the cow presses a shoulder into the paralumbar fossa while facing the hindlimb. The device is slowly lowered as the assistants attempt to force each hindlimb into a weightbearing posture and to reduce the flexion by manipulating the stifle and hock. As soon as any weight is supported by the two limbs, the device should be lowered 1–2 in. This process may have to be repeated several times.

Even if the cow does not stand, the lifted position provides an opportunity to manipulate the limbs, auscultate for crepitation, and perform vaginal and rectal examinations.

The chances of resolution are considerably enhanced by moving the cow to a location with an earthen floor. In warm, relatively dry weather, the best location for a recumbent cow is grassy pasture, although this means that a method to lift the cow must be readily available. Otherwise, the location selected should have a roof and some protection from the elements. These conditions often exist in a hay barn or implement shed, which may have the added benefit of allowing installation of a pulley system to lift the cow.

Moving the cow requires rolling her into lateral recumbency. The cow can then be slid over dry straw for a short distance by pulling on a rope attached to a lower forelimb and a halter rope. Transportation over longer distances can be accomplished using a suitably prepared farm gate hauled by tractor. The longest dimension of the farm gate is closely applied to the back of the cow still in lateral recumbency. A tarpaulin is placed on the gate to protect the cow from contact with the ground. Dry straw is spread on the tarpaulin, and the cow is rolled over onto the makeshift stretcher. The halter should be tied to the gate to minimize struggling, and a sack placed over the eyes to minimize alarm while the cow is being moved. The tail is best tied to the hock of the upper limb. Once moved, the cow should be restored to sternal recumbency. A few cows, particularly if <12 hr postpartum, will rise immediately after being moved to a location with good footing.

Recumbent cattle should be examined daily to determine any change in ability to rise or bear weight. The chance of improvement is very low if the cow does not show any improvement within 5 days of moving to a location with good footing and correction of any serum electrolyte abnormalities.

It is vital that recumbent cows be provided with clean water at all times. A shallow rubber feed bowl prevents spillage. If the cow does not drink, she must be given fluid therapy either by drench or parenterally. Every effort must be made to roll the cow from one side onto the other at least three times a day, with more frequent movement being desired. If this is not done, the weight of the cow results in continued ischemia of the muscles of the hindlimb and exacerbation of compartment syndrome.

Protection from the elements is essential. Rain and wind can reduce body temperature considerably and worsen shock if present. A windbreak of straw bales is vital. Straw bedding should be provided to help insulate the cow from the ground. A recumbent cow does not require a warm environment; however, in a cold environment, an inactive animal can gradually succumb to hypothermia.

The downer cows most difficult to treat are those that do not try to eat. A cow that salivates on its feed will not eat it later. Rather than being offered large amounts of feed, the cow should be tempted with sweet hay. This should be cleared away every 30 min if not accepted. Placing bitter-tasting weeds such as ivy or dandelion in the mouth may provoke salivation and an interest in eating. Lettuce and cabbage leaves are accepted by some cows. In extreme cases, the cow can be drenched with rumen contents.