Submitted by dasko2 on Tue, 01/12/2021 - 15:11

The Veterinary Detective:
The Case of the Calves That Weren't Quite Right

 

released January 12, 2021

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Dr. Ashley Mitek: Hi, I'm Dr. Ashley Mitek, a member of the faculty at the University of Illinois, College of Veterinary Medicine.  Over the next several weeks, we're presenting a mini-series called "The Veterinary Detective". In each episode we discuss a case with a veterinary clinician who walks us through the diagnostic process to help us understand how they apply clinical reasoning in their practice.

Today we take a look inside the world of food animal veterinarians. When a farmer calls for help with sick calves, but can only report vague symptoms, lacking even the most basic history, where do you go from there?  We’ll answer that question in this episode we call “The Case of the Calves That Weren’t Quite Right”.

Joining me is Dr. Jim Lowe, a livestock veterinarian at the University of Illinois College of Veterinary Medicine and Director of the i-Learning Center.

Dr. Lowe, thanks for joining us. Let's start at the beginning. Tell me about your patient and their illness.

Dr. Jim Lowe: So Dr. Mitek. So, this is an interesting deal, right? So, I'm a food animal guy, and it's pretty traditional that we have farmers who buy one group of feeder calves every fall, and they feed those calves through the next summer, and then they sell on the market, and they start feeding them again. And so, my client Henry -- and, you know, Henry's not a spring chicken anymore, and so, Henry, and like his dad did before him, and his grandpa before him, bought a group of calves, 165 of them, which is two truckloads. And they brought those calves in and plunked them in the yard, which is just the lot next to the barn. And they started feeding those calves. So, a couple of weeks ago, they bought those calves, and they weighed 650 pounds, like they always weigh. And he brings them in, and he called me, and he said, "Doc, Doc, they're not right. We need to take a look at them."

Dr. Mitek: So, your presenting complaint is "Doc, they're not right." And we often talk to the students about starting with a signalment -- age, breed, sex, species. So, these are feeder calves, which are the black and white kind? Or the all black kind? Or, what exactly is a feeder calf, and how old are they?

Dr. Lowe: So, those are all good questions, right? So, we're now unpacking some farmer-ese, which is important. And so, when we think about feeder calves -- let's step back a little bit and talk about the beef industry for two seconds. When we think about beef cattle, these are not black and whites, not dairy cattle. We have two basic groups of cattle we have in the country -- dairy cattle, which have been bred and selected for milk, and the vast majority of those are black and white or Holsteins. And then, the others would be Jerseys, which are little short things. The Holsteins are German, and the Jerseys are British, off the Isle of Jersey.

And then, we have huge numbers in this country, five or six times as many, beef cows. And so, those cows are bred and selected to be hamburger steaks. So, beef cows in this country are grass converters. We raise cows to convert grass, because they're ruminants, into protein. That's how they work. And so, because mama cows that have babies need grass to graze on, we tend to have those parts of the country where we have a lot of grass -- so, the South, the West. We don't have many here in the Midwest.

But once those calves are weaned, they need more energy to eat. So, once they're off mom, we  try to feed them a higher-energy diet. That means typically corn in the United States. We have corn in the Midwest. So, we have kind of two segments to the industry. We have where grass is, mama cows. We have a few brood cows in Illinois, but it's not a big industry in Illinois. But in the Midwest, we have a lot of feeder cattle. So, we bring those calves after weaning. Feeder calves are calves that have been weaned. And they are going to be fed and raised for somewhere between six and nine months before they go to slaughter, before they go to harvest to become steaks. And so, that's the primary source of steaks and chops and roast and those kinds of things.

So, these calves -- and Henry has bought calves for years out of Kentucky. So, the South has got a lot of cattle. This is the same practice that my dad's family did growing up. They bought calves every fall out of the Sandhills in Nebraska. So, another area, a lot of grazing, a lot of mama cows. And so, these cows historically would have been red or black. Now they're almost all black, they're Aberdeen Angus crosses, again, a British breed. And we do that because they're really tender and have a lot of marbling, so, good, high-quality steak.

And so, Henry buys his calves out of Kentucky, out of the Bluegrass sale barn, and he's done that for years. And so, these calves come up. And so, what we know about these calves are, they weigh 650 pounds, and they came from Kentucky. We don't know much more than that. And that's one of the things, when we work in the cattle business, we have to deal with a lot of ambiguity a lot of times. And we have to deal with that and we have to understand that. So, we don't know how long these calves have been weaned. We don't know if they've had any vaccinations. We don't know what they were eating. All we know is that the truck door opened up and off they came. And they weighed about 650 pounds. And this is what's going on.

So, we can do a lot of things to say -- because when they come through a sale barn, they've all got an individual tag on their back. And so, do they come from the same sale barn? Have they been co-mingled? Do they all look the same? If I've got five different colors of cattle, it probably tells me those aren't all from the same farm. And if they're all black, they might be from the same farm. And so, we looked at these. And just a bit of inside knowledge, when cattle come out of Kentucky, they're probably commingled.

Dr. Mitek: Why is that? Why do you know that if they come out of Kentucky they’re comingled?

Dr. Lowe: In the South, the land properties tend to be quite small. So, the average cow herd tends to be quite small. In the West, the properties tend to be quite large, so the cow herd tends to be quite large. So, if I'm going to buy 165 calves, and they came from small cow herds, they're going to have to mix multiple cow herds to get my group of 165. And that's even more important because we typically -- like, Henry only buys steers. So, he only buys male castrates. The heifers stay at home a lot of times, and they'll be the replacement cows. And so, we're buying half the cow herd. So, the average cow herd in the United States is something like 30 cows. So, there's 15 steers every year. So, to make up Henry's 165, he's got to have 10 or 12 or 15 farms in there just to get that together.

So, when we think about this, right, these become key bits as we think about, what are we doing with disease, and how do we understand that. And that might be different than a group coming from Montana, where the average cow herd might be 1,000 cows, and you could buy 165 steers out of one ranch, and they would have come together. And so, as a veterinarian, that's a very different disease, that's a very different risk profile. It's a key bit of the signalment, to understand how do I need to think about what's likely to happen.

Dr. Mitek: I just want to go back a second. So, you get a phone call from Henry saying, "Doc, my..." it's not cows, that's not the right word…

Dr. Lowe: Feeder calves.

Dr. Mitek: "My feeder calves are not right. Can you come out and look at them?" You know roughly what size they are, what weight they are. And now, at this point, when you start to problem-solve, you're not yet on the farm, but you're headed out there, what is going through your head? So, you already know from the relationship you have with Henry that these are from multiple different farms. And are there other things you're thinking of right now, before you get to the farm? Are you thinking of what questions you're going to ask him? Where's your mind at right now?

Dr. Lowe: So, you're going to think through, right, like, okay, Henry, when did they come in? So, how long have they been there? He said a couple of weeks, so let's say 14 days. And you're going to ask him, "Well, Henry, did you vaccinate those calves off the truck?" So, I want to know what Henry did after they got there. Henry may have bought all the supplies from us, but it's pretty typical, farmers do their own work. So, we wouldn't necessarily go process those calves at arrival. So, when we think about those calves, we try to make sure Henry has a good plan. So, he's probably going to give them a modified live respiratory vaccine for the viral respiratory agents. And we'll talk about that. So, BVD, it's the herpes virus and BVD virus and parainfluenza and BRSV.

Dr. Mitek: What's BVD?

Dr. Lowe: Bovine viral diarrhea virus. There's a couple of strains of that that we vaccinate for. So, that'd be really common. We're going to give a four or five-way modified live viral vaccine. And we're going to try to protect them against Clostridium. So, we're going to give them a seven or eight-way kill Clostridium toxoid, bacterin toxoid so it can protect them against blackleg or blacks disease. Really, that's the two overeating diseases, but those are the two you're really trying to work against. And then, they're probably going to need to put parasite control in those calves. So, they're going to de-worm those calves in some way. And so, we're worried about internal parasites, or strongyle type parasites in these calves, which we're going to probably treat a couple of ways, because of resistance. So, we're probably going to use a couple of classes of de-wormer to de-worm those calves. So, we would probably use albendazole or quote-unquote "white wormer," which is given orally. So, fenbendazole or albendazole, part of the bendazole brothers. And then, we probably are going to give a quote-unquote "clear warmer," which is an avermectin or a macrocyclic lactone. And so, that would be the prototype drug in that class, is ivermectin. But we would use Moxidectin or other products today, or Doramectin. So, we're going to use an injectable-type wormer.

And then we worry about external parasites as well, so, lice in cattle particularly. So, we're probably going to put a topical product on for that. So, we may use, again, an ivermectin type pour-on, which is cheap and not absorbed very well, but works really well on lice. Historically we used an organophosphate. We use less of that today for obvious reasons.

So, we've got this parasite control plan, and we've got an immunization plan at the time of arrival. And that's what we're going to do. And so, I ask Henry, "Hey, Henry, did we do those things?" And Henry's gonna say, "Yep, we worked them off the truck, Doc. They showed up Monday night. We worked them Tuesday morning. Great. Like we always do.”

So, right, we just want to know, did we do those things? But, we've got to think about what the consequences are. We're giving a modified live vaccine. So, that can induce some disease. And, are they quote-unquote sweating because of that? We'd expect that over the next three or four days, right? Like when we get vaccinated, little kids get vaccinated, right? They have a fever after that. And so, you can see that happen. And so, what happened, etc. So, we're two weeks out. So, okay, they got vaccinated, they got de-wormed. I don't feel too bad about that kind of thing. And then, I'm going to ask Henry when I'm on the phone with him, "Well, what do you mean they're not right, Henry?" And so, "I don't know, Doc. They're hanging back."

Dr. Mitek: What does “hanging back” mean?

Dr. Lowe: Well, we have more farmer-isms. We have to work through our farmer-isms here. So, normally, when they say hanging back, what they're saying is that we expect these calves to come up to the feed bunk when they're fed in the morning quite aggressively. They're hungry, right. They've got good diet. And so, these calves are not approaching the feed bunk, or not being aggressive with the other calf mates. They're hanging off to the side. They're not behaving normally.

And so, that's really, when we think about disease in these prey species -- and this is a key bit. When we think about cows and pigs, and even horses, they're very different than dogs and cats because dogs and cats are predators. And these other species, the sheep and cattle and pigs and horses, they're the prey. They're the things predator eats. Prey critters tend to try to hide their illness pretty well. And so, they tend to be often quite sick before they show you disease. And there's an old saying that says sick sheep seldom survive. And it's not because sheep immune systems are terrible. It's because they're a prey critter and they absolutely refuse to show you illness because they know if they're sick, that's the one the wolf is going to pick on. So, there's this big evolutionary bend that they're going to try to hide sickness from me. And so, when they start to be sick, they start to not want to eat, they start to do these things. So, we talk a lot when we work with cattle, right, when we work in stockmanship, we say you've got to give the calves the confidence to show you that they're sick. And that's proving to them that you're not a predator.

So, good stockmen like Henry that have done this forever -- and we've certainly got great young stockmen as well -- do that. Their natural behavior with these cattle is not threatening. They're not loud. They're always moving. And if you think about a cat hunting a mouse, right, it's going to go up and stop when it sees the mouse move. All predators hunt. So, you walk into a pen of calves, you walk in there and you stop, and don't move, they can't see you very well, and now they get nervous. So, it's learning these stockmanship skills to say, "Hmm, they're willing to show me sickness today," which is really, really important.

Dr. Mitek: So, you go out to the farm, and you have this conversation with Henry. You know that they seem to have had their preventative care provided to them, their vaccines, de-wormers, all that kind of stuff. So, what are you going to do now to look at the calves and try to understand more from the veterinary side, what actually is wrong with these guys?

Dr. Lowe: I think, Ashley, the key here is that as a veterinarian -- we're both veterinarians -- you've got to go look. You just can't do it on the phone. And so, when you get to the farm, I've got to get out of my pickup truck. I can't just talk to Henry. I've got to go get in the pen with those cattle, and I've got to go look at those cattle. And now my stockmanship skills become important.

So, when I got to the farm, we move these cattle around the pen, gave them some confidence, and identified the ones that both Henry and I thought were sick. So, they're depressed. They don't want to eat. You'll hear the term hanging an ear.

Dr. Mitek: One ear is lower than the other?

Dr. Lowe: Yeah. Again, I'm giving you all the good farmer-isms today.

Dr. Mitek: Is that in a veterinary textbook anywhere?

Dr. Lowe: No, that's in a farmer textbook.

Dr. Mitek: Okay.

Dr. Lowe: And so, what they're really saying is, right, if cattle are feeling good and getting after it, they'll turn and both of their ears are forward and erect. And so, we worry about horse ears a lot, right? If you've been around horses, if a horse pins his ears back, you'd better be paying attention because he's not comfortable with you. It's the same thing with cattle. So, when cattle are alert, their head's up and their ears are forward. When they don't feel good, they'll drop those ears off the side of their head. So, a calf's ears should be up and forward, and all of a sudden, it's just relaxed, like he just is not willing to put his head up. That's him hanging his head down, like, "Oh, God, I feel crappy." And so, they'll hang an ear, is what the term you'll hear. So, it's really just meaning, instead of being bright and alert, they're eh, they don't feel very good.

And so, we identified, in this group out of 165, 10 of them that we thought didn't feel very good. So, we take those calves, and we'll pull those calves off. And so, obviously, we just don't walk up to them and say, "Hey, Bob, what's wrong here?" And they're big critters, and they're prey critters, so we will separate them off and put them in the alley in the chute. So, an individual animal at a time will go in and get caught in the head gate, and we can restrain them so they don't thrash around. And then we do a physical exam.

Now, one of the key things about being a food animal veterinarian is understanding that critters don't like to be restrained like that. Remember, they're prey. And so, being quick about it becomes an extremely important thing. So, when we bring the calf in, we want to be prepared. We're going to do our physical exam very quickly. We want to focus on the key things that are going on. And we want to get that calf back somewhere where he's not restrained fairly quickly. So, we need to move fairly quickly. So, these aren't like some half-hour process here. This is a, get after it, learn what you need to learn, and move on.

When we think about it, any creature when they don't feel good, us included, right, we have to think that their immune system's stimulated. And so, they've got some cytokine response, and the old immune system's kicking in here. So, we're going to try to assess what's going on. And we think they're not eating, so we've got to first start with, which organ system is involved? So, we're going to do some relatively simple stuff. First of all, we're going to look. We're going to try to understand, how fast are they breathing? Are they breathing more rapidly than normal, or not more rapidly than normal? Are the breathing with more effort or not more effort? Do they have dysthymia or not? Are they tachypneic? Are they dyspneic? And then, we want to know, do they have a temperature? Right? They don't feel good. Is that lack of feeling good associated with a fever? So, we're going to put a thermometer in their rectum and take their temperature.

So, if they're dyspneic, tachypneic, and have a fever, right, it's not probably particularly difficult to say it's likely that the respiratory tract is involved. And I now probably have systemic involvement, because I've got a fever, right? It's gone beyond just the respiratory tract.

Dr. Mitek: Dr. Lowe just mentioned two important terms, tachypnea and dyspnea, which are ways to describe abnormal lung sounds. Tachypnea describes rapid breathing, and dyspnea refers to labored breathing.

When you examine those calves and you find the sicker ones, you run them to the chute, you do your physical exam. That seems like that would be a huge amount of stress, right? And you talked about why it's important to minimize the time you put them through that. I guess my question would be, how do you differentiate whether your abnormal findings are due to stress versus actual disease?

Dr. Lowe: So, if we think about that, right, so, I can be tachypneic and I can be febrile just because of stress. So, if I have a fever, that does not mean that they have disease. That's a fever of unknown origin. And if they're just tachypneic, i.e. breathing rapidly, that can just be stress. So, for me to confirm that I've got a respiratory tract involvement, I've got to put a stethoscope on their chest, and I've got to say, are those sounds normal? And I can auscultate them. And, remember, an auscultation is just listening to the air movement. So, if there's turbulence, I'm going to hear sounds. And so, that means I probably have airway disease, which is bronchopneumonia, which is really, really common in these boogers.

Now, I can have tachypnea and dyspnea and no changes in auscultation. And that can be for a couple of reasons. One, it's not airway disease, it's tissue disease, it's interstitial pneumonia. Or, I can have consolidation -- so, the pneumonia is severe enough, so now I don't even have air movement in that tissue. So, I may need to use alternative diagnostics. We've all got ultrasounds around. Even cattle guys carry ultrasounds all the time to preg-check. Well, you can use those to examine a lung. So, we wouldn't start with an ultrasound. We'd start with a stethoscope. But if that lung doesn't sound -- okay, I've got bronchopneumonia, I can isolate that. If that doesn't work, maybe I need to put an ultrasound on their chest and say, "Ah, is there consolidation there or not? Is there an interstitial pattern? Is there fluid in the chest?" And so I've got to correlate all those signs to say, "Yep, I know I've got respiratory disease."

Dr. Mitek: So, once you've got these calves through the chute, and you're finding so far on your problem list that their febrile, they're dyspneic, they're tachypneic -- and I'm assuming it's pretty consistent across all the 10 that come through.

Dr. Lowe: Yep.

Dr. Mitek: Then, from that information, where are you going in your problem-solving brain? Are you starting to think about -- you mentioned diagnostics -- that maybe you want to put an ultrasound on one of these calves, or several of them? And then, are there any other diagnostics you're simultaneously thinking of? I would imagine, right, once you have them in the chute, and you let them go, it's going to be hard to get them back in the chute if you decide an hour later, "Oh, I wish I had taken a nasal swab," or whatever it is.

Dr. Lowe: Yeah. So, we're going to do everything in a couple of three minutes. We're going to do it while they're standing there. And we're going to think about all 10 of those independently. So, right, we're going to say, okay, calf 1 comes in. He has elevated lung sounds in the cranioventral region on the right side. So, if we remember our anatomy, right, the calf's got a funny auxiliary lung lobe, which comes off on the ventral part of the trachea in the front. So, the right front tends to be where gravity works. That's where bronchopneumonia ends up, because the bacteria are coming down the respiratory tract. So, he's got elevated lung sounds there. And, he's got a fever.

And so, when we think about classifying these, we're going to create a case definition. And so, that's how severe is it? How long has it been going on? So, is it mild, moderate, severe? Is it acute or chronic? Which organ system's involved? In this case, the respiratory system. So, we're going to call it pneumonia. And which bit of the respiratory system? We now know it's the airway, because I can hear that. So, I've got bronchopneumonia. And depending on how much lung involvement there is, and how much muffling there is -- so, as we get more chronic, so, if I have more consolidation, I might call that chronic and severe. Or, it might be mild and acute. Those things tend to go together. It's pretty hard to get severe acute pneumonia. I mean, the calf tends to compensate pretty well for that. And so, I'm going to put those things together. And then I'm going to devise a treatment plan, all in the matter of a few minutes here.

Dr. Mitek: So, let me go back a step. What was your case definition for these feeder calves? So, they had bronchopneumonia. Was it acute or chronic? And then, what were the other factors?

Dr. Lowe: Four of them were mild acute bronchopneumonia. Three of them were moderate acute bronchopneumonia. And three of them were moderate chronic bronchopneumonia. So, if we think about that, the progression of disease occurs over multiple days. So, what we're seeing is, probably those chronics that came in were probably sick when they arrived, and they're probably the source of disease for the rest of the population.

So, I now know something about what's going on from an epidemic standpoint, that there's disease spread within the population. And I also know that old Henry probably missed sick cattle four or five or six or seven days ago, because he's got some chronics in the population. So, right, I'm now processing this to say, I've got multiple case definitions, and I have to think about, okay, how do I help Henry find the next set of sick calves? Because there's going to be more.

Dr. Mitek: Dr. Lowe just mentioned ausculting abnormal lung sounds in the process of examining these calves.  Auscultation is listening to sounds from the heart, lungs, or other organs, typically with a stethoscope. Learning to differentiate normal and abnormal sounds is often key to making the correct diagnosis. 

Let’s start by listening to normal lung sounds of a feeder calf.

Could you even hear it? Probably not easily. And that’s normal. In general, it can be hard to hear lung sounds in a healthy bovine patient.

Now let’s listen to abnormal lung sounds of a feeder calf patient that Dr. Lowe was talking about.

Now you can probably hear the difference, when you compare it to the normal lung sounds.  This is from one of the feeder calves that had bronchopneumonia.

With the information you have now that you've done your physical exam, what's your next step?

Dr. Lowe: So, we're going to treat each calf as it comes through. And we're going to use an antibiotic to treat those calves. They've got bronchopneumonia, right, BRD, or bovine respiratory disease. A, common, and B, routinely worked out deal. I mean, we still do a fair amount of consulting work in feed yards. We collect a lot of data on which antibiotics they respond to based on chronicity and not chronicity, etc, etc. So, we would pick an antibiotic that's appropriate.

Back to the stress bit, we're really lucky today in food animals. We've got antibiotics that are long-lasting, so we can give one injection and it's going to stay on board for six to eight days. So, we don't have to retreat these boogers and re-stress them. So, that becomes important. And then, we're going to think about, particularly based on the chronicity bucket, which antibiotic we pick based upon their tissue distribution. So, those mild cattle, there's a whole class of antibiotics, the macrolides, really these triamilide antibiotics, which stay on board for seven days, and they distribute into the airway really, really well. So, those acute cattle where we don't have consolidation, we want to think about a macrolide and put that on board. The cattle that are a little more chronic, I'm going to go look for an antibiotic that's going to actually penetrate that tissue better. So, the florfenicol type products are actually advantageous there.

So, we're going to select our antibiotic, probably not based on resistance patterns, because it isn't very useful as a guide for treatment in food animals or in cattle respiratory disease. I'm really trying to make sure, can I get the drug to the bug? So, that's principle number one. Pharmacokinetics is important. And distribution is important. And then, the other bit is, what can I do to get the calf's immune system going again? Antibiotics don't cure pneumonia. Antibiotics give the immune system a fighting chance to cure pneumonia. So, you try to knock it back and let the immune system get over the hump. And so, we're now going to say, what do I need to do to get that calf going?

So, treating the calves in the chute is part of our plan. And that's certainly a part of the deal. And we're getting those calves antibiotics. But the real treatment occurs when we let those calves out. So, we're going to try to separate those calves from the herd. And we're going to say, listen, I need to give that calf food, water, and a dry place to sleep because it's that food, water, and a dry place to sleep that's going to let that calf's immune system get after. So, we're going to separate them. We're probably going to bed them a little deeper. We're going to feed them a really, really palatable forage. So, we're going to go try to find grass, hay that's really good on the rumen, doesn't cause any inflammation in the rumen. The rest of the calves will probably eat a bit of corn in their diet, or maybe quite a bit more in their diet. So, their rumen's going on it. So, there's GI disruption going on at the same time. So, we're going to remove the GI disruption. We'll put them on a really palatable diet. Get them off where they don't have to compete. They've got all kinds of space. Bed them deep so they're comfortable. Give them four or five days. It's the hospital. We literally put them in what we call hospitals. So, they go in a hospital pen, and they get a little TLC for a few days. And let the antibiotics work, but more importantly, we let that immune system start to work. And we let that immune system get ahead of the curve.

Dr. Mitek: I think one of the things that, as a food animal vet, maybe you do different than maybe a small animal vet like myself, is you're really comfortable treating the patient before you have a diagnosis. And you have a diagnosis as a body system that you know is affected. But, can you talk about, does it matter to you that you don't know exactly what bug is causing their disease?

Dr. Lowe: Everything we deal with particularly in respiratory disease is all commensal. It's there every day. So, remember, disease isn't the bug. Disease is the fact that the host didn't maintain homeostasis. And that the host didn't maintain those bugs in check. And so, when we look at that, right, I think about that in every case I deal with. And it's always back to, why is the host not compensating? Why has the host not maintained that? And so, we view treatment very much as a holistic approach, to say, yeah, I've got some things in a bottle that I can use, but the bottle is only one-tenth of what we're actually going to do to solve the problem.

Now, I worry about which pathogens are there a lot when we're trying to do disease control or transmission control, particularly in the pig business. We focus a lot on which pathogens are there, because we have epidemic pathogens that we're trying to eradicate, or we're trying to keep out of farms. So, we do focus on pathogens there. But, you know, this is the same way human docs treat things. Community-acquired pneumonia, right, that's a whole batch of things that people get sick from. And it includes all the bugs. And the answer is, as my friend Dr. Wade Taylor told me one day when I asked him if the calf had IBR, which is herpes virus, and his answer was yes. And I asked him something else. He said, yes. He goes, it has all those things. They always have all those things. And who cares? Our job is to treat the calf, to fix the critter. And so, I think that, that's where we tend to think maybe a bit differently.

The other thing I got taught very, very early in practice is that your job isn't to put a name on it, your job is to fix the problem. And nobody cares what it's called, they just want it fixed. So, I think we as veterinarians -- and we see our colleagues on the human side doing the same thing, right? We chase and chase and chase diagnosis. And I've seen enough of my friends, and etc, that work in the human side, they're sick, and they're sick for weeks, and we continue to chase a diagnosis. And, would you just do something? Like, treat it symptomatically! Fix it! And I think that's a key message we have to remember as veterinarians, right? Somebody's going to pay us to fix the problem. If we're not fixing the problem, no one cares what it's called. They'd like to know what it's called. Knowing what it's called is handy. And sometimes that's really important in guiding what we need to do. And sometimes it doesn't matter at all.

And taking that to the extreme, right, we do some work with St. Jude's Children's Research Hospital, which is funny -- I'm a pig guy, and I'm working with Children's Research Hospital. But, they do a lot of influenza work. And that's how St. Jude started. They were doing infectious disease in little kids. So, they still have a huge infectious disease department. They do cancer now primarily. And so, if you just think about the ends of the spectrum, a diagnosis is really important down to the level of which genes are being expressed in these cancer therapies. And so, that's where it's not just the name of the disease, it's some sub-bit of a sub-bit of a sub-bit, but that's a really critical bit to solve the problem. And so, they've radically changed outcomes of some of these little kids' cancers by looking at specific genotypes of the tumor. And yet, there are other things like pneumonia or community-acquired pneumonia where those are commensals that the immune system's gone wacky, and we need to be able to go fix the wacky immune system, not the bug. And so, understanding that becomes really important as we think about, what are we trying to solve as a veterinarian?

Dr. Mitek: What ended up happening to these calves?

Dr. Lowe: Yeah. You told me not to pick a case where they all died. And I'm only a moderately bad veterinarian, so I do have a few cases where they lived. So, as expected, right, this is a small herd, all these calves lived. We had another 15 or 18 that got sick. All them lived. And so, that would be expected. So, we would expect on a normal group of calves that 20% of them are going to get sick with respiratory disease. That's just kind of bog standard on these kind of mixed calves together. 20% are going to demonstrate -- I don't know how many actually have the disease. 20% are going to get treated for it. Probably a higher percentage have it and can get over it on their own. 20% get treated. And of that 20% we treat, we're going to expect 3% or 4% to die. So, not 3% or 4% of the population. 3% or 4% of those that we treat. So, 1% to 1.5% of the cattle that we see that show up in a feed yard for these things are going to die from respiratory disease.

Dr. Mitek: Well, thank you for presenting this great case. I guess it's cases. You had multiple patients in your case. I'm going to ask you the question we ask everybody at the end of the show, which is, as a new veterinarian, what did you tend to do wrong?

Dr. Lowe: Do we have three hours? I think the biggest thing you tend to do wrong as a young veterinarian is a couple of things. I've been fortunate. I've hired and started a lot of young veterinarians. Solidly in the double digits over the last 20 years. That's a fantastic experience, to watch young vets grow and develop and move forward. But, I think we're all similar. I think they all tend to make the same mistakes. And I think I made those mistakes as well. And I think one of those is that you have to go look. You can't take people's word for what they're telling you. And so, you just have to go look.

And you have to continue to not believe your own genius. And I think, right, we graduate, and we think we understand the science, and we think we understand these things. And somebody told us this is how we're supposed to do it, and we go do it and doesn't work, and then we don't know why. And so, the critical bit of getting better is reserving the right to be wrong. Assuming you're going to be wrong, and then going to fix it. I've never had a client that was mad at you for being wrong. I've had many clients mad at me because they didn't think I cared as much about it as they did. And I don't mean that there's a big empathy bucket there. That's not what they're looking for. They're looking for compassion, and empathy and compassion are very different. It's the emotional engagement on our side. So, they don't expect you to be empathetic, they expect you to be compassionate and understand them, but not taking on emotionally. And, right, that's part of our job, is to put on our big-kid pants and be the adult in the room. That doesn't mean we're not compassionate and we don't feel for them. But we stay unemotionally involved.

And then, they've got to be convinced that you're as worried and you're working as hard on the case as they can. And so, if you got to go follow up four times and not get paid, that's what you need to do. If you need to call him back the next day, that's not the technician calling him back, that's you calling him back, saying, "Hey, Henry, how are those calves doing?" And I don't send anybody a bill for that. I don't do anything. And I think, as a young vet, you don't recognize that it's that interpersonal connection that builds a client base, and builds your skills and understanding of, how do I be a better caregiver, and a better care provider, and do that in a way that I'm not emotionally exhausted, but my clients know that I'm all in. And they've got to know you're all in. But that means you've also got to be mentally there enough to be all in. And I think that's the challenge, is that balance of caring, but not being emotionally involved.

Dr. Mitek: I think that's great advice. Thank you for coming on the show, Dr. Lowe.

Dr. Lowe: Thanks, Dr. Mitek.

Dr. Mitek: And that’s the case. Our thanks to Dr. Jim Lowe, and to all of you for joining us.  Please subscribe and tell your friends about the show.  It's available on iTunes or the podcatcher of your choice.

One last thing. In addition to this podcast we offer a wide range of learning opportunities for veterinary students and veterinarians. You can learn more about those by visiting  online.vetmed.illinois.edu

I’m Dr. Ashley Mitek, your veterinary detective.

 

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