On that particular day, Mrs Dill had brought her dog, not a Jack Russell this time, but a little Pekinese, to see Mr Sinclair. Donald Sinclair was the larger-than-life senior partner of the practice, upon whom the character of Siegfried Farnon was based in the Herriot books. Like many old veterinary senior partners, his retirement was long overdue and his eyesight wasn’t as good as it had been. After an examination and the appropriate injection of penicillin, Mrs Dill went back to reception and joined the queue to pay. When she got to the desk and opened her handbag to get out her purse, she was surprised to find the handbag full of oily white antibiotic solution. The Pekinese had not received a drop of the medicine!
‘Oh my goodness! I have penicillin in my bag!’ she said with surprise but, unswervingly dignified and polite, she paid her bill, arranged her next appointment and left the practice, unperturbed by the blatant mistake. Apparently, the dog made a full recovery.
The Mystery of the Floppy Heifers
‘Can you come and have a look, Julian? I had one of your young vets out on Sunday, but this heifer’s still not right, and there’s another one out in the field that looks like it’s heading the same way.’
I could tell from the tone of Robert’s voice that he was worried about his heifer. He was a very experienced farmer and had seen most of the diseases and problems that faced both dairy cows and their calves. He would usually give me a diagnosis before I arrived on Mowbray Farm, but today was different.
I confirmed that I would be with him as soon as I had finished afternoon surgery, but first I needed to speak with Laura, my colleague who had treated the heifer the previous Sunday. The animal had been in one of the sheds. Robert had brought her inside on the Saturday because she looked poorly – lying down when all the other animals were standing up – but, Laura explained, there was not much to go on.
‘To be honest,’ she said with a frown, ‘I couldn’t find a lot wrong with her, other than that she was lying down and wouldn’t stand up. I gave her some calcium, some anti-inflammatories and multivitamins and said to call back with a progress report. I was hoping you’d be able to have a look at her, actually, because I don’t really know what to do next.’
It was a frank and honest assessment that left me without many clues. Being a veterinary surgeon is like being a detective. As well as carrying out our clinical examination, we have to quiz the owner in detail to gain as much information as possible about the behaviour of the animal, its environment, its diet and its demeanour. Hopefully, from all this, and with the help of laboratory tests and imaging, we can then make a tentative diagnosis. In farm animals, diagnosis can be even more difficult. Clinical examination may yield less information because of the large size of the animal and, sadly, financial constraints often limit how many laboratory tests can be undertaken. For farmers trying to scrape a living from their stock, a test that costs more than the value of the animal is often not a feasible proposition (unless, of course, there are implications for the whole herd). This afternoon, I had the feeling that I was going to have to draw on my years of experience as much as anything else.
When I arrived, I found the heifer lying down, with her head lolling to one side. Her mentation didn’t seem quite as sharp as it should have been and she moved her head slowly, as if she had a headache. The first thing to do was to perform a thorough clinical examination. This was certainly going to be a diagnostic challenge.
Her temperature was slightly elevated at 102.8°F. This was a starting point, but not a tremendously helpful one. A sky-high temperature always means infection in a cow, and if we find this at the beginning of our examination, everything else is straightforward. A slightly increased temperature might indicate an infection, but not necessarily – so no certainty so far. When I listened to her rumen with my stethoscope, the contractions sounded weak. Her lungs were clear, rectal examination was normal, her reflexes were normal and her legs seemed to work okay. I felt sure she could stand if she had the urge or the impetus.
I questioned Robert, trying to identify what might have triggered the problem. She was one of a batch of about thirty yearling heifers out at grass in an established pasture, not heavily fertilized. They had been there for about four weeks, hadn’t been moved recently and were just eating the grass without any supplementary feed. They had been wormed and vaccinated with the usual things. There was one other heifer with drooping ears, who didn’t look quite right. She was still in the field, which was about two miles away, with the rest of the group. There were absolutely no clues and no predisposing factors.
The only thing I could come up with that vaguely fitted with the signs was a condition called thromboembolic meningoencephalitis. This is a disease caused by a bacterium called Haemophilus somnus that usually causes pneumonia (the name has now been changed to Histophilus somnus, but it’s hard to get the name you originally learnt at university out of your head). On occasions it can lodge in the brain of a young bovine and cause a condition that is also known as ‘sleeper sickness’ because it makes affected cattle look as if they are asleep. The disease usually affects housed cattle rather than those out in an airy, grass field but otherwise the signs fitted.
I administered an intravenous antibiotic of a type that would cross the blood-brain barrier and therefore reach any bacteria in the heifer’s brain. I also gave her a strong painkiller to fix the presumed headache, then explained to Robert that I would need to come and repeat the process the next day. After this, Robert climbed into his tractor and I followed him in my Mitsubishi, to the field where the rest of the group were grazing. I wanted to see the other animals, particularly the one with the drooping ears that was causing Robert concern, in the hope that this would provide me with more of an idea about what might be going on.
The route to the field wound between two hedgerows that were bursting with colour from the wild geraniums and cow parsley that spilt over onto the track. It wasn’t muddy, but the deep ruts were baked dry, making it much more suited to a tractor than my four-by-four. I bounced along the track, blissfully unaware that it was a journey with which I would become very familiar over the next few weeks.
The bunch of heifers looked pretty normal, standing in the field, grazing. We leant on the gate and studied the animals but neither of us could see one with drooping ears and, after a quarter of an hour of scrutiny, I felt happy that there were none showing any similar signs.
Robert said he would stay for a while, but after arranging a time to re-examine the affected heifer the following day, I waved goodbye.
Twenty-four hours later I was back, repeating my perfunctory tests on the heifer, who looked a bit better. She was standing up and had drunk some water, but her head was still well and truly pointing into the corner of her pen, and she was still showing no interest in her surroundings. Her temperature was now back to normal, so I repeated the same treatment with cautious optimism. Haemophilus somnus cases usually take several doses of antibiotics before they show any sign of recovery, and some don’t respond at all, so it was still early days for this treatment.
Robert told me that he had spent half an hour watching the cattle in the field after I had left and he had been back there again this morning, but had seen nothing suspicious. I knew he would have been watching them like a hawk. Again, I made arrangements to return the following day to give another intravenous dose to the poorly heifer, then headed back to do battle with a clinic full of dogs and cats.
The next day, Robert phoned the surgery just as I was getting ready to set off to his farm. He was very worried.
‘Julian, there are another three heifers that do not look right. I think they’ve got the same thing. One is quite bad-like and the other two not as bad, but there’s sommat up with them. I thought I should let you know ’cos you might need to bring more bottles of stuff to inject them wi’.’
When I arrived, the sight in the pen was a sorry one. Four yearling heifers were in the large pen, out of place because on a hot, dry summer day like today these anim
als should have been grazing in a grassy paddock. One, my first case, was standing, staring into the same corner as she had been the previous day. She looked pretty much the same. The optimist in me said that she looked a little brighter, but the realist was telling me that she was not progressing as well as I would have hoped. The other three animals were all lying down and one – the worst – had its head curled around as if it was looking at its flank, trying to go to sleep.
I examined them all. Two of the new cases were not too bad and leapt to their feet when I went up to them. They were soon trying to escape, so we ushered them, one at a time, into the cattle crush so I could check them over. The worst one, though, made no attempt to stand up. Again, no specific signs were evident when I examined the animals, and the clinical picture still looked more like Haemophilus somnus than anything else, but I still had a nagging feeling we might be missing something. It was time to take some blood samples to try to reach a definitive diagnosis.
Robert was happy with this and, even though it would add an extra hundred pounds or so to the bill, we both knew it was the best thing to do. I returned from my car with a handful of vacutainer tubes and took a blood sample from the tail vein of each of the heifers. I treated all the animals with antibiotics again, and headed straight to the veterinary laboratory in Thirsk, where I could hand in the samples. It was always useful to grab a quick chat with one of the pathologists when we called in at the lab on our way back to the practice. On this day, though, no one was available, which was a shame because I could have really done with their thoughts. I would have to save the conversation for when the blood results were back, in a two or three days’ time.
It was an anxious wait. I made a couple more visits to see Robert and to check the rest of the heifers in the pen. I also went back to the field, on my own, each lunchtime to look out for other early cases and to scour the hedgerows for anything that might be causing the problem. Any clues that I could find must surely be helpful. I searched for poisonous plants, as there are a few that can cause peculiar illnesses in cattle. I also poked about in the hedge bottoms for old batteries (used to power electric fences) or rusting old metal, which could have been covered with poisonous lead paint. Lead poisoning can cause neurological disease in cattle, although it is usually manifested by blindness and the heifers’ signs didn’t really fit.
When the results finally came chugging out of the fax machine, I was crestfallen. All four samples were negative for Haemophilus. I called the lab.
Gary, the duty vet, explained that this negative result would tend to rule out the disease, although a definitive diagnosis could only be made (as all good pathologists always tell us) by a post mortem examination of an affected brain. Gary assured me that this would give the certain answer. The only problem was, none of the animals were dead.
I immediately called Robert to tell him the results of the blood tests and to discuss Gary’s suggestion. It was obvious what must happen next and Robert agreed that we should euthanase the worst-affected animal. The next morning, though, standing in the pen in which I had spent more time recently than anywhere else, the decision did not feel so easy to make. It felt as if we were giving up on whichever poor animal we chose, and it was even more frustrating because we had put so much time, care and emotional energy into trying to save the heifers, not to mention all the drugs I had given them.
I phoned Gary, to tell him that a carcass would be with him within an hour. The worst part was choosing which animal to sacrifice. We both felt like judge and jury as we perused the pen of sick heifers, deciding which was the one least likely to survive. At this time, the first heifer was stoically surviving, although she still spent much of her time staring at the wall, occasionally putting her head in the bucket of water that Robert would offer her, or nibbling on the pile of silage nearby. One of the new cases – the heifer with her head lolling against her side – was certainly the most serious and this was the one that we picked. I drew up a big syringe of the drug used for euthanasia, knowing that it was unlikely that I would actually need the full fifty millilitres that I had loaded, as she was so weak. Whilst it felt wrong to pick any one of the patients, it was in fact, probably the kindest thing to do – she was very poorly and clearly suffering.
As I predicted, she didn’t need the full syringe. Within five minutes the back door of the trailer was closed and Robert was taking the animal to the lab for an appointment with Gary.
Gary must have worked through his lunch break, because I got a call midway through afternoon surgery with the results of the first part of the post mortem examination.
‘Hello, Julian!’
Gary’s tone sounded optimistic, but as it turned out, it was only the excited voice of a pathologist in action.
‘There’s absolutely nothing to see in this heifer. No lesions at all, I’m afraid. Nothing to go on. Of course, we will be doing histology on the brain, CSF cytology and immuno-histopathology on the brain and meninges, just to be sure. Then there is toxicology on the liver, kidneys and whatnot. That’ll take a week or so, I’m afraid. Some of it needs to go to Weybridge, you see. So far, not a sausage.’
The phrases ‘and whatnot’ and ‘not a sausage’ seemed utterly incongruous amongst all the other technical terminology, but I knew what Gary meant. I also knew what this meant for my chances of a speedy diagnosis and my chances of stopping the progression of the herd’s illness. I was no further forward.
Gary continued, ‘Is there any chance that it could be lead poisoning?’
‘I’ve been all around the field and can’t find anything at all, Gary,’ I replied, miserably. ‘It’s a pretty bare pasture and nothing toxic. Certainly nothing that I could see, anyway.’
‘Let me think about it, Julian. I’ll get back to you after I’ve had more time to think. Meantime, we’ll wait for the next results.’
And with that, Gary went off the phone and back to his post mortem samples.
Gloomily, I put down the receiver, only to pick it up again to relay the unhelpful news to Robert.
He was even gloomier than I was, as I spoke to him on his mobile. He was standing in the field of heifers, where yet more were sick, ears and head drooping downwards. Worse still, two of the initial batch had died despite the injections that we had been giving. Put off by the negative results that I had just passed on, Robert was not keen on sending these two carcasses to be tested. At this point sending samples to the lab seemed to be a fruitless and expensive pastime.
After a day or so of waiting for Gary and his histology results, the situation at Mowbray Farm had not improved. A handful of new cases had appeared. A couple of the early cases seemed to be rallying slowly, but nothing dramatic. The next phone call from the lab delivered more negative results. The histology of the brain had ruled out my presumed diagnosis of Haemophilus.
‘I’ll come and have a look at the farm, if you’d like, Julian,’ offered Gary. ‘Two heads are better than one.’
We arranged to meet the next day. It is the sign of a serious situation when a ministry vet leaves his office and reaches for his immaculate Wellington boots, and I was glad of any extra input that he could offer.
Gary followed me to the farm and donned his spotless wellies and virginal, white waterproof overall. I showed him the sad collection of dopey heifers in the shed. He asked all the same questions that I had asked to Robert, who must have been sick of repeating the same answers over and over again. Then he reached for his stethoscope and pulled out his thermometer. Now, I know a bit about stethoscopes. I use one many times a day. There are two types. The good ones have ends made of brushed aluminium, with thick, flexible, rubber pipes and snug earpieces that make it easy to listen to the subtle sounds that signify life and health in our patients. The other type is often handed out free with a drug order or a consignment of dog food, and is more suitable for a child’s play set than as an aid to diagnosis. It was the latter that Gary used to examine some of the heifers. I could tell that his examination was n
ot particularly detailed, but this did not matter because, as he pulled his plastic stethoscope from his ears, he declared his diagnosis with aplomb.
‘I think this is a case of botulinum poisoning,’ he announced.
I was surprised by the assurance with which he had reached this conclusion. I had always associated botulism with cattle eating dirty or contaminated silage, or animals drinking from a muddy, duck-infested pond. The field was bone dry and the water came from a water trough. I’d checked this – it was clean and the water was fresh, coming as it did from a nearby spring. The cattle had not eaten any silage for about two months. I could not imagine how on earth the herd could have been exposed to botulism. I also remembered from my university days that achieving a proper diagnosis was very difficult. To test for the disease we would need to take a sample from one of the dead heifers and inject it into mice, to see if they died of botulism. This was not a palatable idea and was certainly not going to happen if I had anything to do with it. It was true, though, that botulism caused neuromuscular paralysis and would result in weak cattle, reluctant or unable to stand. It could look like this outbreak. As I understood it, the mortality level would be very high and affected cattle would succumb very quickly. Anyone familiar with ‘botox’ injections into a wrinkled face is aware of the muscular paralysis that occurs. Gary was suggesting that this effect was occurring on a grand scale.
‘Let’s go and have a look at the paddock,’ Gary suggested.
‘Do you use poultry manure as fertilizer?’ he asked Robert as we clambered into our respective vehicles to embark on the bumpy ride down the flower-lined track to the field.
‘We have used it in the past on the arable land, but not on this field,’ confirmed Robert.
‘Do you know if there is any of it piled up, nearby? Maybe that other farmers are using?’
‘Not that I know of.’ Robert looked as perplexed as I was by this new line of questioning.
A Yorkshire Vet Through the Seasons Page 12
