Cattle rectal exams

Re: Cattle rectal exams

David Mills — Sat, 21 Jan 2012 00:23:00 GMT

If you were interested in courses then the SAC do scanning and palpation courses, and BCVA were starting them in 2010 when I was still in farm practice - don't know what stage they're upto (I think they come packaged with other days that could be useful to new grads).

Re: Cattle rectal exams

james herriot lied — Fri, 20 Jan 2012 23:32:33 GMT

[quote user="Michael Woodhouse"]

If I can do a better job for the clients using the scanner then I will use it. I [personally] believe I can PD faster, more accurately and with less trauma to the foetus using ultrasound.

[/quote]

Agree unequivocally - after ten years of fairly high level cattle practice (early adopter, presenting at BCVA, used in fluff pieces for nationwide drug company releases - if only my partner and kids gave a sh*t I'd be arrogant), I went through ferts ONLY with a scanner in hand. But I started out without one, and it served me well. I learned functional anatomy and got that sensitivity of touch to a higher level than if I'd started out with ultrasound. It helped that I'd done a lot of rectalling with some great cattle vets whilst still a student, but I'd maintain that a good grounding in the basic art of rectalling is a better foundation than access to toys.

It does speak volumes, though, that complete strangers on vetsurgeon are interested in helping young vets with their skills, when similar help from within the practice doesn't seem to be entirely forthcoming. In my practice, we'd be investing a bit more, and not using busy-ness as an excuse. What would be wrong with getting a friendly farm client to supply a few cows on a Saturday morning, when nobody was on the clock? Free farm visit, two vets, charge for the drugs only, and an assistant who didn't feel the need to look for theoretical advice on the internet.

Apologies - no offence intended, but we need to look after the newbies.

Re: Cattle rectal exams

Michael Woodhouse — Fri, 20 Jan 2012 23:11:47 GMT

[quote user="Busybee"]Does anyone know of anywhere I could go on a practical rectalling course? CPD or otherwise? We just don't get enough throughput of fertilities/pds - it may be over a year before my next one![/quote]

Glad you got on OK.

This shouldn't be something you need to pay for. Do you have any dairy farms in the practice that would let you palpate some cows? Even your friendly farmer from today? Failing that come out of your anonymity and tell us who you are and where you are working - there may be someone relatively close to you who can help. If you're close to Yorkshire send me a PM! What about any friends doing more dairy work?

I still think the ultrasound makes you better. It doesn't replace manual palpation but enhances it, and does let you confirm what you are feeling. I use it almost all the time for dairy fertility work, just don't always bother with beef herd PDs where they are well in calf or empty. Just been able to assess the clarity of the fluid, categorise the type of cyst and treat accordingly, check the calf has a heartbeat, etc etc. If I can do a better job for the clients using the scanner then I will use it. I [personally] believe I can PD faster, more accurately and with less trauma to the foetus using ultrasound.

Re: Cattle rectal exams

Lorna McHardy — Fri, 20 Jan 2012 20:13:12 GMT

[quote user="Busybee"]

they had a vet come out once who declared 28/30 cows not in calf and gave estrumate....turns out they were ALL pregnant!

[/quote]

<wince>

Re: Cattle rectal exams

Busybee — Fri, 20 Jan 2012 19:53:04 GMT

Well, it went ok! Lovely farmer who didn't mind in the slightest that I was going to get the cows re-checked on Monday - they had a vet come out once who declared 28/30 cows not in calf and gave estrumate....turns out they were ALL pregnant!

Out of 12 cows, two had whites (easy!), two were definitely not doing much so gave CIDR, I think three weren't doing much and the farmer didn't want to treat and the rest definitely had bumpy ovaries, and though I could have a good idea as to whether most were CLs or cysts (or follicles!) I wasn't sure, said so and these will be re-checked Monday. But I did manage to feel the ovaries in all but two I think. So I'm pleased :)

Does anyone know of anywhere I could go on a practical rectalling course? CPD or otherwise? We just don't get enough throughput of fertilities/pds - it may be over a year before my next one!

Re: Cattle rectal exams

Anthony Todd — Thu, 19 Jan 2012 23:36:44 GMT

[quote user="Julian Earl"]Also, despite what David says, it is possible to be 100% accurate with manual palpation[/quote]

Agree; pregnant, not pregnant or [occasionally] can't tell/ strange/ uterus or a bloody steer you ***stards.

Very occasionally was it not possible to get the empty uterus and both ovaries intra pelvic and in your cupped hand.

Re: Cattle rectal exams

Julian Earl — Thu, 19 Jan 2012 23:03:04 GMT

[quote user="David Mills"]

It's all very well and good sitting back 20 years qualified and saying 'I'm alright, Jack'. That's the problem with LA work - most of it is of this anecdote based stuff. All very well and good for you and Mr Earl having the experience, and I wish you well with it. Trouble is, its uncorroborated. You may not get them all right - what about a luteal versus follicular cyst? Or early pregnancy? Mr Earl can't spot 4.7 weeks but he can 5 weeks - provided service dates are right. 100%? Really?

There's something missing in this manual PDing game in that no-one ever tells you how many they check back, which is a lot certainly when compared to scanning. Every day not pregnant for a dairy cow has been estimated at a £2 per day loss at least. Add this to the learning process, the ones you get wrong along the way and it starts to add up rather.

Why not ask your farmer? Do you want a method that can detect as early as 26 days (sooner in some hands), tell you if its twins and tell you EXACTLY (not simply 'well we'll stick a prid in and see what happens') why its not seen bulling in as close to 100% of cases and is by far and away the most accurate method or do you want a manual method that takes longer? At £2/minute and on a hard-pressed farm I think we know the answer.

[/quote]

4.7 weeks or 5? That's much the point I was trying to make. Yes, at 5 weeks I can either feel the Satsuma, or it's not there. That does remind me of one point that I forgot to mention in my helpful hints which is to make sure you check the whole uterus. Always (which is one reason why I believe that people should be fully able to manipulate uteri before they start scanning).. But yes, at 4 weeks I would be less sure although that may be in part because I do not PD cows manually at 4 weeks for fear of damaging the foetus and therefore have less experience at it. As far as I am aware, damage and foetal loss has not been a problem at 5 weeks, or even 4.7.

On a general note with regard to PD-ing cows, I have long felt that it is something that one should be good at when leaving college, i.e. it should be a core skill. You will learn to be quicker and also better at detecting unusual findings, but a yes/no PD at eight weeks should be very accurate on day one. Why? Because it is very difficult to learn in practice due to (a) requiring a second vet to be present to check every cow; (b) the availability of artifical cows at university; (c) getting it wrong can be very expensive for the farmer and the practice, and (d) time constraints in practice.

Your comments about follicular cysts vs luteal are correct: they are relatively obviously different on scanning and less so in some cases on palpation and a scanner is a big advantage for these.

The comment about correct dates is a non-sequitur surely? If the date is wrong then they are not (say) five weeks as expected to be so accuracy becomes irrelevant just as it does if the farmer has the date wrong by a few days; then it is not a five-week pregnancy that we are discussing. Wrong dates do occur of course but almost invariably they are out by close to three weeks so the wrong date is not generally an issue in the way that you suggest.

Very few cows are checked back as well - that is a problem when a scanned cow looks (say) twenty five days pregnant but there is no service date, so too early to be sure and difficult to know whether fluid seen is oestral mucus. Also, one rechecks cows where the calf not may be viable for some reason. With manual PDs, the reasons are the same but different: palpable fluid, but possibly a very early pregnancy etc.

RE. the benefits of accuracy: I recall reading somewhere that if you were less than 95% accurate then you were losing money for the farmer. I haven't costed it, but I would be very unhappy at only being 95% accurate anyway.

Re: Cattle rectal exams

David Mills — Thu, 19 Jan 2012 21:49:34 GMT

[quote user="james herriot lied"]

At about two quid a minute, the farmer has a right to expect competency and a professional standard. Muddling through is rather short-changing the client - after all, these cows are his/her income, and times aren't exactly good.

...

Not having a scanner for fertility visits is NOT unacceptable. It's a wonderful tool, but those of us over a certain age did very well, thankyou, back in the age of dinosaurs.

[/quote]

Can't quite see the logic here.

Re: Cattle rectal exams

Busybee — Thu, 19 Jan 2012 21:45:15 GMT

[quote user="james herriot lied"]do it without charging for a while - it's honest, mutually beneficial and MUCH less stressful for you[/quote]

We kind of are - I'm going out Friday and my boss is going to the same farm for a TB test on Monday and he's happy to check any I'm not 100% sure on. I won't charge for any cows I'm not sure on and want him to check Monday.

We're a busy practice and it's often impossible to be able to go out and shadow a more experienced vet as other jobs come in

Re: Cattle rectal exams

Busybee — Thu, 19 Jan 2012 21:39:56 GMT

[quote user="Braden Collins"]If you are CERTAIN they are not pregnant but can't work things out further, consider using some form of oestrus PRID/CIDR and PG combination method that would normally be used for synchronising cattle for AI or ET. You will sort many of the common problems with this combination and the farmer will have a time frame by which to AI.[/quote]

Keeping the CIDR (we use these rather than PRIDs) in for 7 days with PG on day 6?

Re: Cattle rectal exams

james herriot lied — Thu, 19 Jan 2012 21:13:07 GMT

I'd throw a bit of a curveball in here, which mightn't be universally popular, but please don't take it as a personal criticism: none of us are born knowing how to do this stuff, it's not exactly innate (or normal, if my non-vet friends' opinions are anything to go by).

I'm thinking that your bosses know you're not experienced at this, but they're sending you out anyway. At about two quid a minute, the farmer has a right to expect competency and a professional standard. Muddling through is rather short-changing the client - after all, these cows are his/her income, and times aren't exactly good.

You need to get out with a more experienced vet and just palpate. There's no great trick, and certainly no short cuts which can be accessed by advice. It's just a certain sensitivity of touch and knowledge about how cows vary. Marriette's idea was pretty great: do it without charging for a while - it's honest, mutually beneficial and MUCH less stressful for you.

After nearly twenty years, I've never done a thyroidectomy. Every time one comes in, I arrange to watch a colleague perform it, but something always comes up. I COULD probably muddle through it, but don't feel comfortable with doing that. I'll get round to it, I'm sure.

Not meant in any way as a criticism - as I say, we're not blessed with the ability to do this stuff straight out of the trap. A couple of months of practice, and you'll be rifling through them in no time.

I also agree with Julian about building up skills before worrying about using a scanner. Not having a scanner for fertility visits is NOT unacceptable. It's a wonderful tool, but those of us over a certain age did very well, thankyou, back in the age of dinosaurs.

Re: Cattle rectal exams

Julian Earl — Thu, 19 Jan 2012 20:17:47 GMT

Despite what others say about a scanner, I think it is very important - crucially important - to become skilled at manipulation of the uterus and ovaries before you ever use a scanner. Most new graduates - and farmers for that matter - become proficient at reading the screen well before they become proficient with the manipulation. I don't think it takes thousands to become proficient either, I think it just takes regular hands-on work, preferably with someone supervising if you are not sure. Ten a day for a couple of months maybe?

Also, despite what David says, it is possible to be 100% accurate with manual palpation although (a) there may be cases where you are not sure and they need to be rechecked; (b) it is possible to be careless, and (c) if/when one eventually get round to using an ultrasound, it facilitates much earlier manual diagnosis as well. Before I started scanning, I was just about confident with a six-week pregnancy, and extremely confident with an eight-week one. Having scanned for some years now, I can manually PD down to five weeks with confidence.

A second point about scanning as well: I found that it was helpful with earlier stage pregnancies as I mentioned, but the big improvement was for identification of structures on ovaries. Ovaries that felt like they had a small firm CL actually had a follicle; some "follicles" were cystic CLs or at least had much thicker walls than anticipated; cysts are very easy to identify; predicting the time of oestrus PG injection is made feasible, and so on.

As for helpful hints, the first I would suggest is that you nearly always have to go in beyond the uterus and scoop back to get the uterus. Several newer grads seem to go in and work their way cranially rather than starting cranially and coming caudally.

Also, think of the ovaries attached on a piece of string up to 10cm long on the tip of the horn - in theory they can be in any direction but are usually ventral and lateral and can often be found by feeling from the horn tip to the body wall, eventually identifying them by pressure on the peritoneum at it were. Some inactive or post-oestrus ovaries are very small and hard to find. They can be little bigger than a peanut in some cases, but still can usually be pinned against the body wall.

For scanning, but less usefully for manual PDs, the foetus is to be found in the thickest part of the swollen portion of the horn. When you scan and identify fluid - stop! Get a fix on it, and move one way then the other to see in which direction the fluid-filled region enlarges. If just PD-ing manually, if you feel carefully along a fluid-filled region, you can eventually feel the amniotic sac at about 35 days as a satsuma-sized and -firmness swelling inside the horn.

Also, you can pull the uterus caudally very firmly if you cannot scoop it backwards. Grasp the cervix and pull slowly and steadily. Hold for ten seconds or so, then release and often it will stay put; if you release straightaway the uterus will spring away again. Anyway, after releasing you can repeat the pull and hold until eventually you can reach one or both horns. To demonstrate to students or new grads how hard I pull, I hold their rectalling hand with my rectaling hand and I pull as though pulling on a uterus - they must pull back to keep our hands still. Most are surprised by how they need to pull back but then know the force that I apply. Try this with someone in your practice if this is an issue.

Finally, if examining cows for fertility, don't forget to always do a vaginal first. Heaps of mucus is a giveaway even if the rectals prove difficult.

HTH.

Re: Cattle rectal exams

Virginia Campbell — Thu, 19 Jan 2012 19:49:20 GMT

[quote user="Braden Collins"]take your time because a farmer will remember how wrong you were for a lot longer than they will remember how slow you were.[/quote] love it!

Re: Cattle rectal exams

Busybee — Thu, 19 Jan 2012 18:55:10 GMT

Thanks guys, all very helpful :) And no, we don't have a scanner much as I'd like one :( We may be about to take on some more large animal work so will try again to persuade the partners!

I did a fair amount of rectalling when at uni and when seeing practice but obviously use it or lose it and try as I might to rectal as many cows as possible, sometimes time or farmers just don't allow.

Re: Cattle rectal exams

Hannah Wynne Richards — Thu, 19 Jan 2012 10:24:49 GMT

It's years since I did fertility work,and scanners weren't available then,but I can only repeat practice

When I worked (mid 80s ) in a hill farming practice, every autumn we would get a rush of PDs Cows would have calved in the spring, run with bull over the summer,and at housing the farmers would want them checked so as not to feed an empty cow over the winter No service dates to go on There would be about a month of doing a lot of PDs then nothing for a year It would be amazing how much more confident I would be at the end of the month-next year I would be unsure again on the first few farms

Wynne

Re: Cattle rectal exams

mariette asselbergs — Thu, 19 Jan 2012 07:11:12 GMT

In our practice we have a scheme which benefitted both the new graduate, the farmers involved and eventually the practice: We offered farmers monthly fertility visits at the cost of visit plus material used, no time fee for the first 4 months. The condition was that the graduate would see and examine ALL cows from calving up to pregnancy diagnosis. This meant that she knew exactly of each cow what was going on and built up experience with the normal situation. For the farmers it was initially time consuming, but they were very pleased that a number of cows were picked up early when still not clean, or not pregnant. They also built up good records. After 4 months we started charging for time, initially a fixed time fee, independent of how much time it took, then 3 months later the real time.

In this way we signed up a few farmers for monthly visits which are now including other health aspects as well, and our graduate got a good experience. All depends of course on having time to do it, but it has been worth it for us.

Mariette

Re: Cattle rectal exams

Braden Collins — Thu, 19 Jan 2012 02:20:30 GMT

Good advice on the scanner. Without that, only experience with several thousand head will get you good enough. Apart from that, take your time because a farmer will remember how wrong you were for a lot longer than they will remember how slow you were.

If they are mature cows, I would start of by pushing my arm fully in then working backwards, brushing downwards with your fingers as you slowly pull back. A mature dairy cow can have the uterus and ovaries nearly at full arms reach.

Make absolutely sure it isn't pregnant (a suprisingly comon cause of cows not cycling!)

Empty the rectum if needed - if it is full of crap the rectal walls become tight and you won't feel anything through it.

Compare the ovaries - are both small? is one soft and large or firm and larger?

Question the heat detection methods - they may be having silent oestrus. Modern dairy cows can be in oestrus for less than 18 hours and in some cases may show signs for a matter of hours so if you feel they are cycling but not being detected work on this.

If you are CERTAIN they are not pregnant but can't work things out further, consider using some form of oestrus PRID/CIDR and PG combination method that would normally be used for synchronising cattle for AI or ET. You will sort many of the common problems with this combination and the farmer will have a time frame by which to AI.

Re: Cattle rectal exams

David Mills — Wed, 18 Jan 2012 22:02:38 GMT

Scanner, scanner, scanner.

At 18 months graduated (or ever, I'd wager) it's impossible to be super accurate by palpation alone unless you've done them virtually every day (if it was straightforward farmers would do it themselves).

Plus, form a client-vet perspective if you're a new grad its important to be as good as possible as early as possible so use everything to make your life easier.

If you've no scanner, well, it's unacceptable - in your place I simply wouldn't do it without. Otherwise, Mr Woodhouse gives sound advice. I would say sweep either side of the rectum if you're struggling, and forget about following horns. And cross your fingers that there aren't any Freemartins.

Re: Cattle rectal exams

Michael Woodhouse — Wed, 18 Jan 2012 21:57:02 GMT

Remember your anatomy. If you look at the textbooks or cadaver specimens you will see the ovaries are further back than I imagines, often not that far cranial of the cervix. If you go to the bifurcation you are too far forwards. I rarely try to follow the horns to the ovary, my normal technique is to have my wrist at the level of the cervix and run rectal wall through my fingers exploring to the sides.

Once ovary located I trap it between my first two fingers and palpate it with my thumb. Often a CL feels like a distinct lump on the ovary and is firm in texture. Follicles are softer and easily compressible. I leant a lot 'testing' myself with the ultrasound scanner. Palpate first and scan to confirm. Sometimes the CL takes over the whole ovary. Remember that a CL can have fluid in the middle, it just has a thicker wall.

Do you have access to a scanner? I use it even if not PDing as you get a lot of useful extra info.

Make sure you palpate the uterus well - a major case of 'not seen bulling' cows on some farms have undergone immaculate conceptions!

If in doubt give it a PRID/CIDR.

Remember to retract the uterus into the pelvis in bigger multiparous cows.