Downer cow syndrome

Question 1

Define downer cow.

Answer 1

Cows that are
* sternally recumbent for at least 24 h+
* the cow eats and drinks
* the cow has been treated for metabolic/ endotoxemic diseases or these diseases have already been excluded.

e.g. Disease like milk fever can cause downer cow syndrome secondarily.

Question 2

Causes of downer cow syndrome.

Answer 2

A cow down with milk fever that then receives calcium and gets up, does not count as a true downer cow.

But a cow down with milk fever that then receives calcium and still doesn’t get up, will be a true downer cow.

Question 3

How to differentiate metabolic/endotoxemic and “true” causes of downer cow syndrome?

Answer 3

Metabolic/endotoxemic causes:
* Apathetic
* Anorexic, do not drink or ruminate
* Does not try to stand up
* Does not try to change side she is lying on
* Specific symptoms
* Milk fever
* Hypomagnesemia
* Ketosis

“true” Downer cows:
* Alert
* They eat, drink and ruminate
* Tries to stand up and change the side
she is lying on.
* Crawls
* Pain reaction

Question 4

whats your first ddx

Answer 4

endotoxemic mastitis

Question 5

What treatment do you give this cow first?

Answer 5

You suspect endotoxemic mastitis

You give IV fluids + via drench into the rumen.

You give IV calcium based on anamnesis of recent calving. (no harm in covering this base)

You give IV antibiotics for the endotoxemic mastitis.

+ NSAIDs

Question 6

What do you do next, if Enni the cow doesn’t get up after being treated with IV calcium and antibiotics etc.?

Answer 6

Redo your anamnesis to try to find some clues.

Do another thorough clinical exam.

Try and localize the problem the cow has with getting up and standing. Check the spine, pelvis and legs for potential signs of fracture.

Palpate muscles thoroughly, look for pain and swelling.

Check the tone of the anus and tail. Do rectal exam (always do in downer cows!).

Question 7

Describe signs of Spinal fractures in cattle.

Answer 7

• No tone in the hind limbs, anus or
  tail.
• No pain reaction at the hind limbs
• Asymmetric position of the line of
  processus spinosus and processus transversus.
• Asymmetric vertebral line
• The position of hindlimbs is
  abnormal.
• Sacrum is in abnormal position.

Spinal fracture cattle should be euthanized promptly.

Question 8

What’s your ddx?

Answer 8

Glutavac test pos tells you about inflammation via fibrin acute phase reaction.

ddx spinal fracture, nerve damage
localized to caudal part of sacrum or first part of tail based on lack of tone to the caudal part of the body but with functioning legs.

Question 9

So far ddx spinal fracture, nerve damage but you need to investigate more.

What do you do next?

Answer 9

Orthopedic examination:
* Legs
* Position
* Palpation
* Pain reaction (pinch between claws very firmly, you may use a tool)
* Swollen areas
* Fractures
* Tone of the legs

Check peripheral reflexes e.g. patellar.
If only one patellar reflex is affected or neg. then you may have an issue with one femoral nerve. If both patellar are neg., you can safely localize to the spine.

Also, lift the cow up! To examine her properly.

Question 10

Nervus femoralis originates from what vertebrae?

Nervus ischiadicus originates from what vertebrae?

Answer 10

Nervus femoralis or L4-L5
Nervus ischiadicus or L5-S1

Question 11

If the cow has been lying down 24 h, no response to treatment, you are not sure about the diagnosis.

What should you evaluate next? (3)

Answer 11

• Electrolytes (Ca, K, Mg, P)

2 Muscle enzymes (secondary damage):

• CK (creatine kinase) activity increases rapidly 4-6 h after injury. Specific for skeletal muscle damage. Severe muscle damage, if over 20 000 IU/l.
• ASAT (aspartate aminotransferase) activity increases slowly, 24 h after injury.
  Severe muscle damage, if AST over 900 IU/l.

Question 12

Serum calcium is probably the cause of a downed cow if serum total calcium is less than

Answer 12

1.5 mmol/L

Decreased muscle contraction capacity and impaired transmission of nerve impulses to
muscles.

Question 13

Serum Magnesium is probably the cause of a downed cow if serum total magnesium is less than

Answer 13

0.45 mmol/L

Nerve signals are not transmitted between neurons and muscle cells or in the cells.

Question 14

Serum phosphate may be the cause of a downed cow if serum phosphate is less than

Answer 14

0.32 mmol/L

Question 15

Serum potassium may be the cause of a downed cow if serum potassium is less than

Answer 15

2.2 mmol/L

• No muscle tone at all!

Question 16

Describe checking Muscle enzymes in downer cows.

Answer 16

• Should be analyzed a few days after the cow has stayed down. The serum sample can be stored in the fridge for 3 days so if its a saturday, take the sample anyways and send it on monday.
• If both CK and AST are increased, muscle myonecrosis is active and it’s started recently.
• If CK is decreasing but AST is increased, injury has happened within the last 7-10 days and there is no active myonecrosis going on.

The higher the activity of AST, the poorer is the prognosis.

• If CK is decreasing, but AST is still somewhat increased, the prognosis is better.

Critical threshold values – if above that, only 5-13 % of cows stand up:
* ASAT >890 IU/L for 7 days
* CK – depends on the days recumbent

Question 17

Obturator nerve paralysis versus tibial?

Answer 17

When you have the cow lifted - there will be more flexion on the hindlegs in obturator paralysis as opposed to tibial in which the leg is fairly straight.

Question 18

Describe Secondary damage of the muscles and nerves in downer cows.

Answer 18

• Cow compartment syndrome :NB! 2-3 h is enough to produce secondary damage to muscles!

Damage of the peripheral nerves
* Hard ground
* N. radialis especially

• N. femoralis damage – crawlers
• Freezing of peripheral body parts
• Decubitus
• Necrosis due to pressure when lifting up the cow the wrong way.

Question 19

What could happen due to lying and crawling? (3)

Answer 19

Secondary problems like:
Cow compartment syndrome
N. femoralis injury (the nerves stretch when a cow crawls)
Damage of peripheral nerves

Question 20

Once the dairy cow has been recumbent for more than 1 day, there is no
significant difference in recovery between different

Answer 20

primary causes of recumbency
(metabolic disease, infectious disease, trauma etc.).

Prognosis depends on the severity of secondary damages and the prevention
of them.

The better the care of a down cow, the better the prognosis.

Question 21

The point of Management of a downer
cow is to

Answer 21

prevent secondary damage/injury

Question 22

Environment of the downer cow should include:

Answer 22

• Soft litter (straw, sawdust, sand, peat) – min 30-40 cm & change everyday.
• Protect against exposure: wind, rain, sunshine, cold.

Movement restriction to avoid femoral nerve damage. No sharp edges around in case of fall. Should maintain sternal position (if lateral, can aspirate rumen contents). Use hay bales or other for maintaining sternal if needed.

• Fresh water available all the time, Change 2 x day. Drench her if she’s not drinking.
• Fresh feed needs to be available all the time, Hay/silage. Can offer concentrates, molasses etc. Drench is won’t eat.

Question 23

How often should you lift a downer cow?
What else can you do for her?

Answer 23

• Lift up 2-3 per day at 15 min at time
• Do not leave hanging! You can cause damage if you leave them hanging from hip holders or slings too long. Especially the hip clamps can cause tuber coxae/hook pressure necrosis.
• Turn from one side to another every 4-6 hours (NB! Cow compartment syndrome can occur after 3 (-6) hours).
• Physiotherapy
• Massage
• Hobbling meaning attach hobbles to their back legs to give them support. The back legs can slip sideways if they’re hobbled.

NB! Don’t forget to milk the downer cow!

Question 24

What supplements can you give to support the cow when you suspect muscle damage? (3)

Answer 24

selenium
vit E
vit B complex

Question 25

What might you do on day 2 if she’s still down?

Answer 25

Give IV Ca2+ another time.
Give IV glucose and IV magnesium to cover those bases.
Give NSAIDs.
Drench with water and propylene glycol.
Lift up 3 x day.
Continue nursing care.

Question 26

Tetanus causes excessive salivation, tonic spasms, circling and cranial nerve deficits.

Select one:
True
False

Answer 26

False

Tetanus doesn’t cause circling and cranial nerve deficits.

Question 27

Cranial nerve functioning is tested by different reflexes, which are invoke in different structures of head.

Select one:
True
False

Answer 27

True

Question 28

Polioencephalomalacia leads to
Polioencephalomalacia is caused by
Poisonings cause usually /

Answer 28

Polioencephalomalacia leads to necrosis of the brain tissue.

Polioencephalomalacia is caused by deficiencies and poisonings.

Poisonings cause usually softening of the brain tissue.

Question 29

Euthanasia should be considered, if

Select one or more:

a.
if secondary problems are severe or if the situation of the cow gets worse during management.

b.
if the farmer doesn’t want to manage the downer cow.

c.
the trauma is so severe, that it cannot be treated.

d.
if cow doesn’t respond to calcium treatment in second treatment time.

Answer 29

b, c

Question 30

Downer cows should be lifted up for 2-3 times per day. The most common way to do this is to use hip lifters. When these are used, only hip lifters are needed for lifting, cow is lifted so that hind limbs don’t touch the ground and she is left there hanging for at least 20 min.

true or false

Answer 30

false

Question 31

The lower lipid solubility and larger molecular size of antibiotic, the higher is the diffusion from blood to brain tissue.

true or false

Answer 31

false

Just the opposite. Large molecular size and low lipid solubility inhibit the diffusion to the brain.

Question 32

Muscle enzymes, which are analyzed from downers are

Answer 32

creatine kinase and aspartame aminotransferase.

Question 33

ASAT activity rises slowly and is best analyzed when?

Answer 33

after a couple of days after cow has been recumbent.

Question 34

High CK and ASAT activity indicate

Answer 34

active muscle damage.

Question 35

The longer the ASAT activity is high, the…

Answer 35

the poorer is the prognosis.

Question 36

If cow has nervous disease, changes occur mainly in

Answer 36

Behaviour

Posture and gait

Question 37

In femoral nerve paralysis, how is the hindlimb positioned?

Answer 37

stifle is flexed

cow can’t bear weight to the limb

hip is extended

Question 38

The main secondary problem, in downer cows is

Answer 38

cow compartment syndrome, which can lead to muscle necrosis and which severity is diagnosed with muscle enzyme analysis.

Question 39

Which parameters are graded during the neurological examination of a cow?

Answer 39

Neurologic examination is made after general clinical examination and you should concentrate on the behavior, posture, gait, cranial nerve functioning etc.

+ pain reaction
+ body temperature

Question 40

Pain reaction can be tested by

Answer 40

the nasal septum tactile response

withdrawal reflex

Question 41

Disease, which affects cows in every age, causes clinical signs seen on the picture (stiffness, tonic spasms, rigid limbs, opisthotonos) and is with no treatment. What causes this disease?

Answer 41

This is tetanus and it is caused by toxins of Clostridium tetani.

Question 42

Overextended hock joint and flexed fetlock are seen in paralysis of

Answer 42

tibial nerve paralysis.

Question 43

Perineal reflex and tail tonus give us information about the function of

Answer 43

spinal cord caudally from sacrum