A middle-of-the-night crisis, a vanished farmer, and only the cat to lend a hand
A twisted uterus is a fairly common occurrence at this time of year, and the outcome can vary from one-man fix to Caesarian birth to hysterectomy to euthanasia
‘I’m flat-out trying to fix cows and find farmers.” This was the response I got from a friend of mine, a fellow vet, when I asked how the spring had been treating him so far. He was referring to the scenario many vets have found themselves in, particularly in recent years: when they arrive on farm , there is often no sign of the farmer, or any person at all for that matter.
The farmer in question doesn’t have enough hours in the day (or days in the week) to be waiting around, so the animal that requires attention is left restrained in the head-gate while the farmer heads off to try to tick a few more jobs of the endless to-do list.
This usually occurs during daylight hours so, when it happened to me at 2am last weekend, I was somewhat taken aback.
The phone had woken me from a deep sleep half an hour earlier. The farmer told me there was a cow calving and there was “something funny” going on. At that hour of the night, I reckoned it must be something that needed immediate veterinary intervention.
When I arrived on farm, however, there wasn’t a soul to be seen. Inside the calving shed, there was a cow restrained in the headgate, forcing intermittently. I rang the farmer but it went straight to voice-mail.
Undeterred, I examined the cow and found that there was indeed “something funny” going on. She had a twisted uterus. This is a condition that usually happens as the cow is calving, but sometimes it can happen a day or two beforehand.
The uterus twists around on itself with the fixed point (the cervix), becoming strangled. Imagine you were holding a plastic bag by both handles and you twisted the bag around; the neck of the bag gets twisted closed.
It’s the same with the uterus. The degree of the twist will determine whether you can get your hand in or not. In this cow’s case. It was twisted around 180°. With a little bit of manoeuvring, I could get my hand in to feel the calf’s feet, having to follow the direction of the slightly twisted cervix in a half-circle, up-and-over motion.
The only ‘help’ that had arrived at this stage was the well-fat farm cat Dermot, who wasn’t a whole lot of use to me as I began to try to untwist the twist.
Firstly I had to figure out which direction the twist was in — clockwise or anti-clockwise. With experience, you can tell by the way the tissue of the cervix feels on the way in, but sometimes, it’s only when you try to move the calf and you feel the cervix tighten on your arm that you realise you are moving in the wrong direction.
The twist in this instance was anti-clockwise so, I grabbed the calf ’s leg up as close to the shoulder as I could and pushed in a downward, clockwise motion. This didn’t yield any success, so I changed tack somewhat and began to try to rock the calf over and back, putting more strength into the clockwise ‘rock’.
After a few over-and-back motions, I could feel some progress and with one good push downward, the uterus gently untwisted. Any vet will tell you that you get one of the greatest feelings of accomplishment when you manage to untwist a uterus.
However, if you aren’t properly ‘gowned up’ in suitable waterproof attire, this feeling of elation will quickly dissipate as all the fluid that has been sitting in the twisted uterus is forcibly expelled, all over the person standing behind the cow.
The calf’s feet were nice and small and I didn’t even need ropes to pull it out. A tidy little Friesian heifer took her first breaths, while Dermot jumped down off the wall for a closer look. I gave the cow some pain relief, along with some oxytocin to help her pass the placenta.
I washed up and came back to the pen to observe the cow licking the calf. A nice ‘win’ — on my own and in the middle of the night.
Every year, we see a few uterine torsions, and sadly, some of them don’t have this happy ending. Recently, I examined a cow that was close to calving and had become very sick. She too had a twisted uterus, and it was more than 360° so it was as if there was a knot in the cervix.
Unfortunately, this twist had happened a few days previously and our options were limited. On further examination, it became apparent that the only option was to put the cow to sleep. The uterus had ruptured and peritonitis had set in. It was amazing that the cow was only presenting as slightly off form, given that her insides were basically stuck together. Euthanasia was the kindest thing to do in this situation.
On other occasions, the elation of managing to untwist a torsion is replaced by a sinking feeling when you realise that the cervix isn’t open enough to allow a normal calving. After the exertion of solving the torsion, its tough to have to face into a caesarian.
Adding to the hardship is the fact that the uterus can be very friable and weak. Even the slightest pressure can cause a tear or a rip. Stitching up a uterus that is thinner and more delicate than normal can be a very difficult task. It’s vital to stitch the uterus closed watertight, as any leak will result in peritonitis.
On some occasions, we have had to admit defeat and a full hysterectomy is the only option. It’s a drastic decision, but if it saves the cow, then it’s an option.
Back to the cow that myself and Dermot the cat calved on our own… the farmer’s jeep sped into the yard, just as I was about to leave. He had gone to pick up his son from the nightclub in town after calling me and would have been home if he hadn’t gotten a puncture on the way. He was delighted that the cow was calved, especially as I had to manage alone.
If the vet is on the way to calve a cow, it might be worth letting the young fella organise a taxi home. There won’t always be a Dermot the cat on hand to pick up the slack.