Hubert Karreman, VMD, Penn Dutch Cow Care
Amanda Gervais, University of Vermont Extension
In this video, Dr. Hubert Karreman of Penn Dutch Cow Care in Lancaster, PA demonstrates how he conducts a physical exam on a dairy cow. The video was shot at the Vermont Technical College in January 2011.
Watch the video clip at https://www.youtube.com/watch?v=O6uUNmZiLZY
My name is Hubert Karreman. I’m a veterinarian in Lancaster, Pennsylvania and today we are here at Vermont Technical College with the herdsman Andy Wood and our Holstein cow, Alimony. What I plan to show you is how to do a physical exam.
A little about me: I work with organic dairy herds in the Lancaster, Pennsylvania area plus all around the United States, and consult with other people in other countries as well. One thing I want to say is a physical exam on a cow is the same whether she is organic or conventional, so this is fine for everybody who is looking at this; it doesn’t matter how you farm but I’m going to work you how I, as a veterinarian, look at cows and examine them.
What we just heard from Andy is that she's a healthy girl and she does look good. She has a nice shine on her. It's winter time and normally cows will be shiniest when they're out on pasture in the summer and that's probably due to some of the compounds in the pasture that they're eating. In the wintertime, they have a little sheen (I don't know if you can pick that up but that's really good) instead of just a dry, long hair cow, I like to see a shiny cow—that's the first thing I look at.
Generally you can see her ears moving. You can see one ear up and one ear forward. One ear is forward with attention to what's happening in front here and the other one will come back here when I'm talking at a certain point. They are kind of like little antennae. You can tell by their ears where they are listening to by the direction of the ears. We have a machine in the background going and this ear is picking it up, yet this one is keeping attention here and that's good, that's a normal cow. If her ears were down, that's really bad. Ears being down on a cow is terrible, that means they are not happy, they are not feeling well, they’re sick. Cows hate having their ears messed with but certain times, especially with younger animals, they can have an ear infection. In an ear infection, you will see one ear drooped down compared to the other one and if you see that, especially in a calf, you'll want to get a little sniff of the ear if she’ll let you and it should simply smell like the fur of a cow.
If you bring a cow's nose up towards the roof, it will roll her eye down the opposite way. You can see the whites of her eyes really good this way. That's a normal white of her eye up top of her pupil if you hold the head like this. You can see the tiny red veinules in the top and that’s normal. But if they're throbbing or thickened, that can be a sign of a toxic cow, a sick cow.
The pupil – the blue in the center of that brown there – should be like a rectangular box. That is very difficult to catch but it is contracting and now it’s a slit, just a blue slit and if I take it away, the pupil will enlarge to a rectangle again. One thing with the pupils is that the muscles in the eye are dependent upon good muscle tone, just like the cow standing up, just like her digestive system needs to have good muscle tone and that is highly dependent on calcium, especially. When a cow would be down that's just fresh or just standing and has very slow contraction of that pupil, it could be a sign of low calcium.
We also want to look at the drainage here. There is a little bit of drainage here from her eyes, nothing terrible but sometimes they get gunky, snotty eyes and that would a sign you would want to consider that that something's going on. Usually it is connected with the nasal area like a cold or something like that.
If you look at her nose, it is nice and moist. See that nice shiny moist nose? That's a good nose for a cow. It's good moisture; you don't want it dry. A dry cow nose is just like a dry dog nose, you want a nice wet nose.
You should be able to use you sense of smell and smell her breath. It should smell like a normal cow, it might have a little bit of rumen scent to it. You'll want to smell each nostril. If you smell a foul scent, like a hospital incubation plate smell, there could be an infection going on in the respiratory tract somewhere. On the nose, it should be equal exhaling out of each nostril, no blockages or anything like that. Now she has a pretty black nose but you can look in there sometimes. With her it's going to be a little bit hard, but it should be moist and glistening just like the outside.
When you are drenching a cow, the head should be just about parallel with the ground and the mouth a little bit open. When drenching a cow, the nose should be about here, but never, never nose to the sky, never. When your nose is up, it's very much easier to get into the windpipe.
When you stand behind a cow, your left is her left, so when someone says give something from the left side, your left is her left when you're standing behind the cow and your right is her right.
On the left side of the cow is her rumen. The rumen occupies about this much of the abdomen at least on the surface and then it goes all the way towards the midline inside and around. It holds 35 to 50 gallons of rumen contents at any given time. You can listen to the rumen best behind the last large rib here and below the short ribs. You can listen right here—below the short ribs and behind the last long rib—and you can feel the contents of the rumen and how fibrous or not fibrous the diet is, fiber meaning hay (versus grain) by pushing in here. It should feel kind of doughy up top here because this is where the fiber raft sits. The fiber raft is very important in the cow's rumen because cows are herbivores and are meant to eat only plant materials. So you want to feel some resistance here, really good resistance and not just real easy in and out. And this is where I’m going to lay the stethoscope as well. I’m going to listen for a rumen contraction. The way you do that is you lay the stethoscope here and every minute-and-a-half to two minutes, you should hear basically, as I am right now, a thunderstorm happening really close to your stethoscope. That's a contraction of the rumen. You'll hear a thunderstorm in the distance when that contraction is starting, coming towards you and then happening and then moving away. And you can actually hear it if you just put your ear on the cow.
So the heart rate of a cow is generally just like ours, about 72. With someone like myself who the cow doesn't know me too well, she's a little bit stressed; it might go up to 80. I’m going to listen to her heart, she's just been fed some hay and that is very nice looking hay and she's enjoying it. I’m going to bring the stethoscope behind this shoulder blade area, upper leg muscle and listen. I'm listening to the heart, you can't hear it of course, but this is where we listen to it. It should be very easy to hear. It should not be muffled. I usually look at a watch and go for about 15 to 30 seconds and figure out what her heart rate is. So that's where you listen to the heart.
The lungs on the cow are generally in this area here, a lot of them are shielded by the shoulder blade but they come back into here and through here. I'm going to listen to the lungs where I can with the stethoscope. The lungs I'm going to listen up here. Cows will take about 24 plus or minus breaths per minute. If they are eating like she is (and I'm glad she eating, that means she's content right now and happy). These lungs should sound like a bellows, like you're pumping air into a fire. This is the area we're listening to the lungs. If I hear a real rough, sand-paper sound up here, sometimes it will mean they have a viral respiratory infection that is starting, and usually there is a high temperature associated with that. The more serious respiratory problems are when the secondary bacteria invade down here and we get a second bacterial invasion and the bacteria being heavier than viruses, they tend to be down in this area and you’ll hear rougher sounds here.
Sometimes unfortunately when you put the stethoscope way up front underneath (and you can do this on the other side as well), you'll hear a windpipe sound which is potentially the only sound coming through her trachea. The trachea is on the right side of her neck; the esophagus is right here (left side) and that's what the hay is going down right now. Sometimes with lungs that are a problem, you'll hear just a windpipe sound and that’s not good. So we've listened to the heart, the lungs, and the rumen.
Sometimes you'll see bloat on a cow (again, your left is her left) where this left side will be bloated out. That's where the bloat is, it's a rumen gas cap over that fiber.
If you have a fresh cow, there is a condition called "twisted stomach" or displaced abomasum, and you can listen for that with a stethoscope. If she’s off feed, fresh ten to fourteen days, you can listen to her rumen, make sure that's functioning every minute-and-a-half or so turning over like a thunderstorm like it just did, listen to her heart and lungs, and then you're going to place the stethoscope over these large ribs here, put it between the ribs, and you're going to flick the ribs real hard with your fingers. This is testing for twisted stomach. If she were to have a twisted stomach, she would have a sound of basically a tin can bouncing down an alley, or a ping, or chimes, or a basketball sound. It's unmistakable. A twisted stomach is not the rumen, it is the abomasum which usually lies on the floor of the cow becoming like a balloon and it has to go up because it's got air in it which it shouldn't. It will come up right behind these ribs, between the rumen and the ribs and so it gets really tight and that's why you can hear that high pitched ping sound when you're flicking.
The trachea, the windpipe, is on the right hand side. It important to know because if you’re going to pass a tube down a cow's throat into the rumen which is on the left side, you always want to make sure that when you bring the tube in, that you stay left of center (swallow has two “L”s in it) stay left when you pass a tube because then it goes into the esophagus. On the right side is the windpipe, the trachea.
Here is the jugular vein. You can see it extended here, bringing blood back from the head to the heart; it is on both sides of the neck. You can see it when I push here to stop the blood, you can see a little pulse up here and it will fill up when I hold it off, and you can see it right here. It runs the length of the jaw back down to the brisket. If I'm going to I.V. a cow, give an intravenous fluid, I'm going to want to have her head down because it fills up the jugular vein generally better. I'm not going to want to be too close to her jaw because there are a lot of vessels here, arteries and what not, and you don't want to be too much back here. But right about mid area in her neck is where you want to put in a needle for an I.V. fluid. You want to have the head tied up real good so she's not freely moving her head of course.
Here is a 14 gauge by 2 inch needle commonly used for intravenous administration of fluids on adult cows. Here is a 16 x 1 inch needle commonly used for intravenous administration of fluids on calves. Here is an 18 x 1.5 inch needle commonly used for intramuscular shots or under-the-skin shots for any animals, mainly cows. And here’s a 20 gauge by 1 inch needle, they get thinner as we get higher in numbers (so this is thin compared to the 14 gauge) and I use this on calves or goats or sheep, and especially horses.
Here’s the 14 x 2 inch I.V. needle. We’re going to use this size needle to give an I.V. to a cow. Here I have an I.V. line without a bottle. These I.V. lines I really like a lot – they are clear with blue (versus the tan ones). The old-fashioned tan ones have a very floppy top, these tend to be rigid in cold weather but that’s okay. With the tan ones, you can’t see through too well but you can see the white and black through there on the cow. It is very handy to know if you are in the vein or not. What we would do with this cow is we would use the I.V. needle; I would take an I.V. needle and I hold it like this. I hold it by the hub, and with her head tied, and with the jugular vein prominently showing, I would stab her real hard with the heel of my hand essentially allowing the needle in but stabilizing that needle until I would get the I.V. line attached.
The height of the bottle, when the needle is in the cow and her head is going to be strapped to something so she’s not moving around, I hold the bottle this high. This is a bottle of Calcium Boron Gluconate 23%. This is the height and if you hold it higher, it goes in faster—that you do not want to do with calcium because you can kill a cow by causing heart block with calcium going in too fast.
You can hold a bottle of anything up here you want other than calcium; it can be dextrose, hypertonic saline, Vitamin C, Lactated Ringer's solution as high as you want. But calcium, no higher than the backbone, whether the cow is standing or lying down. And if you lower the bottle lower than the point of needle insertion, blood should come back in the line which lets you know you are still in the vein in case she moved around a little.
A sign of a cow being somewhat low in calcium (she’s standing, she’s fresh, she’s a little slow). There will be little muscle twitches you’ll see along the shoulders, and also back here at the leg and maybe here. They will have cold ears and might have a very mild bloat. That's a sub-clinical low calcium. The muscles that move the skin are affected.
Here we are looking for ketones from the urine, that's the easiest and most effective way. You have to wait two minutes for this but if a cow is ketonic, this little pad is going to turn purple as most people know. The ketones would mean that she is needing energy in the bloodstream, she has low blood sugar and then the liver can convert fat to usable energy called ketones. It tells you that the animal is not taking in enough energy for whatever reason.
Now we’re on the right side of the cow, again we have the short ribs, we have the major ribs, and the abomasum or true stomach (like mono-gastrics have in people) sits underneath here a little right of center. This is where the fourth stomach sits, the abomasum. And the omasum, the third stomach, sits in this area here but in, and that's fed from the rumen, and the reticulum up front on the other side. Up here we have all the intestines, this is where all of the food is absorbed, all the nutritional absorption from either the microbes in the rumen going downstream when they die, they get absorbed, all their proteins and also other nutrients like minerals and all. Magnesium is absorbed across the rumen wall but other minerals are absorbed in the small intestine here. It is normal to hear a ping (like we heard over on the left side where we tested pings for twisted stomach). If you hear a ping in this area, I would not be alarmed at all. A cow milking 100 pounds or a good amount of milk can have a ping here -- that's the gas in the spiral colon moving by. Usually you’ll hear a kind of ping, ping, ping, right here, you don’t even need to flick it, you can just sit and you’ll hear gas moving through the gut normally.
If a cow is off feed, and you've listened to the left hand side and the rumen is not moving or it’s sounding very smooth like the ocean hitting the beach and not a thunderstorm like it should, and you don’t hear a ping there, and she’s completely off-beat and she doesn’t look happy at all. Then you want to go to the right side as well and ping on the right. You shouldn’t hear anything on a normal cow than just thuds. If you hear a high-pitched ping in this area and the ping even comes down into this area, a real high ping, you’re going to think of a right-sided twisted stomach and those need surgery that day.
On the right side of a cow if she were to be pregnant six and a half months or more, you can push in here and what we call "bumping a calf." You’ll push in here and you will feel the actual calf’s body parts, some bony part right here by going back and forth. You will feel that at about six and a half or more of gestation. It is kind of a nice double check for farmers, the vet called the cow pregnant at 45 days, you didn’t think about her at all, and you want to make sure she’s still pregnant when you dry her off to give her a two month vacation from milking, you can just go like this a little and will likely feel the calf bumping up against your hand on the other side if she’s six-and-a-half months pregnant or more.
You'll see how the cow is sometime shifting her weight a little bit. It is milking time here, she may be feeling like she wants to get milked (I wouldn't be surprised) but if a cow is off-beat and she's treading a little--we call this "treading" --just shifting her weight on her back legs, that's a colicky sign in a cow and that's not good. Cows, unlike horses, cannot roll when they have colic so they show this movement, shifting her weight off her back feet.
Now we're going to take the temperature of this cow. Normal cow temperature will range from 100.5 to 102.5 F. Anything above 102.5 F is a fever. Now, if it’s a hot day outside, they will all run hot but if one animal out of tis higher than the rest, it’s a fever. What we normally do is we will lubricate the thermometer and put it in rectally here. But if the cow has diarrhea and she’s sucking air in, has diarrhea and sucking air in, you don’t want to take the temperature rectally, you want to take it in the vulva. That will give you a real reading whereas if you take it in the rectum when they have scours or diarrhea, it will be false low.
You’ll wet the thermometer a little and you always want to make sure it is shaken down and if you like a digital thermometer, that’s fine but they’re very sensitive to getting wet. I’m going to lift her tail and hold it in there a little. I usually leave it in for about a minute.
While we are waiting, we will pull up on the skin in the shoulder blades and this is a test for hardware disease. A cow that has hardware disease or a piece of metal in her first stomach, the reticulum which is over on her left, will not drop her back because it’s painful to do that. In a normal cow, if I left her skin off her back at the withers, you’ll most likely see her back curve like that. Some cows with hardware disease might curve their back but they won’t do it two times in a row. If she had hardware disease, she won’t do this a second time. And she does do it a second time so she wouldn't have hardware disease if that's what they thought was happening.
Okay, now we’re going to see what her temperature is – it is 101.8, totally normal. Sometimes you have to move these mecury-type thermometers around a little.
With a cow, any cow any time, you will see me put my hand on her tail and you will notice, the tail goes toward her body just reflexively. Do that first with a cow, let her do that. Don’t come up to a cow and take her tail and lift it up. Let her reflexively say hey I’m guarding myself a little bit. And then take the tail up and reach in. And then I flip it over. I’m reaching in to feel for the uterus to see how it is going along and she has what we call a good tone, maybe coming near heat. I think I feel a follicle on the left, I don’t know when she was checked last? Early on. You can see the clear mucus right here, she’s in heat right now with this clear mucus. I thought she wasn’t near heat and actually she’s in heat.
A farm that has a lot of cows that show a heat at 45 to 50 days and not again until 120 to 130 days fresh, you might want to consider breeding cows sooner than the voluntarily waiting period of 60 days, so some farms will breed her now. But she won’t peak as high in milk but you’ll get her bred back. That’s especially true with first calf heifers.
So I’m feeling the kidneys now (I’m up to my biceps), they should feel like a patchwork or quilt work. I feel the rumen inside here, it is very firm so you are getting a fair amount of effective fiber into her. And then, like I said she’s in heat. When I’m inside here, I can feel for internal lymph nodes and various other things you only know about after reaching into cows a lot.
I felt some undigested corn in here but there's not too much there. Sometimes if you have manure that's more firm and you take it out and squeeze it and you get liquid droplets coming out and firm manure up top, that can be a sign of poor digestion and also hardware if they suddenly have gone off feed.
We’ve looked at the cow from the head through the throat, both sides of the abdomen, the lungs, the heart, we’ve reached into the abdomen as we’ve could rectally. Another thing we can still look at visually before we get to the udder is the hooves.
The hooves on cows (maybe more in tie stall situations) are usually pretty easy to be seen as far as any type of irregularities. The hoof grows down from the hoof-hairline junction and there is any kind of stress on a cow, she will show a growth line or a stress line. If you look on a cow on all four hooves, you might see a line half way down the hoof. And you know that some major stress happened. It takes about five to seven months for a hoof to grow down to the ground and regenerate itself. It is something to look at and usually the whole herd has it. It is something to take note of.
Now I’m going to come to the udder. She's really full of milk. We’ll wash off the teats because we want to check her milk quality and then once we do that, we’ll let our friend, Alimony, go to the milking parlor with her friends because she’s really going to start dripping milk here in about 30 to 60 seconds. That is the reflex time from this tactile touch. If you are having trouble with a cow letting her milk down, you really want to vigorously do this, like a calf would be bumping up against the udder because it is a tactile stimuli by touch that gets them to let down their milk.
They all look nice and clean but what’s most important is right there at the teat end. The teat sphincter is a little bit everted here, coming out, meaning it is a little prolapsed, and that will gather dirt easier. I am going to look at each of the four teats and make sure they are clean. That is the entry way for environmental bacteria to get into the udder. If you see this little white ring here, that means that this cow either the milking machine is on her too long or there is a fluctuation in vacuum, too great of a fluctuation during the milking time. And this one is a little bit extruded or coming out and they shouldn’t be at all. All four teats are like that (you can see it right here, a little white ring by my index finger, and it's a little harder to see on the black teat).
We are going to check her milk quality by the California Mastitis Test (CMT), which takes this paddle and even through these letter are here, I can never keep track which quarter is which so I hold the plate like this, with the handle the same direction of the tail. So now I know that this will always be right front, right hind, left front, left hind, even if I'm out here. Now, strip out some milk into each of these plates. I will take an equal volume of this CMT fluid and swirl it around and we'll look for any type of thickening or gelling of this fluid. I don’t see any. If there was, I would take note. This is normal milk, this is great. And then we’re going to watch the drips coming off—the drips are all like raindrops and that’s good that there is no gloppiness to it. So she has a good CMT so her milk is totally normal and she’s a healthy cow, and we should let Alimony go be with her friends.
- Jodarski, G. 2010. Physical examination of a dairy cow [online]. Organic Broadcaster. Midwest Organic and Sustainable Education Service. Available at: http://www.mosesorganic.org/attachments/broadcaster/livestock18.2cowexam.html (verified 07-12-2012).