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On the Farm with Penn Vet's Field Service
Pennsylvania Ag Connection - 05/19/2017

It's a Tuesday morning at Walmoore Holsteins, Inc., a dairy farm in Chatham, Chester County, and fourth-year veterinary student Meghana Pendurthi has found a firm pelvic mass during palpation of a young cow.

This cow was separated from the rest of the herd for an exam due to suspected illness. Palpation per rectum allows a veterinarian to feel many internal structures inside the animal, such as the reproductive tract, lymph nodes, and a portion of the GI tract, including part of the rumen, one of the stomach's four compartments, to make sure it's filled appropriately.

Staff veterinarian Sarah Depenbrock listens to Pendurthi describe what she felt during her exam, and then asks: "What do you want to do? How do you want to sort it out?"

Standing behind the cow, which is restrained in a chute, Pendurthi suggests an ultrasound of the area to get a better sense of what the mass might be.

"What else could we do?" Depenbrock gently asks.

Pendurthi suggests vaginal palpation, a procedure in which the vet inserts a gloved hand into the cow's vagina to assess the area.

Depenbrock first completes the remainder of the physical exam. At one point, she presses a stethoscope to the cow and taps on her side. If she hears a "ping," like a tap on a metal pan, that tells her something in the animal is distended with gas and fluid.

Next, Depenbrock pulls on a long-elbow-length sleeve, and explains, "I love ultrasound, but we try and do as much as we can with our physical exam and basic diagnosis first and move on to other types of diagnostics once it's indicated."

Feeling around inside the heifer, Depenbrock concludes the mass that Pendurthi identified is inflammation of the vaginal wall associated with calving trauma--and not an abscess pocket or other lesion.

Pendurthi quickly runs through the entire diagnosis: This first calf heifer has metritis, a uterine infection; vaginitis; and mastitis, inflammation of the mammary gland, and will be treated with antibiotics and anti-inflammatory medication.

Depenbrock puts red cuffs around the cow's back ankles, so the milkers will know she is receiving treatments and so her milk will be thrown away. The cow's electronic record will also indicate that she is on medication.

They release her from the holding pen, and she scrambles up a small ramp through a system of corrals in the barn to make her way to a pen with other animals receiving treatments.

Then it's on to the next case.

Field Service offers both routine and emergency care for equine and food animal clients within a 30-mile radius of the hospital. This service treats more than 24,000 patients at local farms annually. Within Field Service, the food animal clinicians see cattle, sheep, goats, and a handful of pigs and camelids (including alpacas), and the equine clinicians see horses. At Walmoore Holsteins, the veterinarians and students palpate for pregnancies, determine the sex of the calves using ultrasound when the cows are about 60 days into their pregnancies, and help with the reproductive synchronization program.

"The farm's milk production is going to be directly linked to how successful we are at getting cows bred and getting them to calve on time," Depenbrock explains, "so it's a big part of what we do here."

They also examine and prescribe courses of action for sick cows. Usually a drop in milk production is the first sign something is wrong, and when that happens, Walmoore's farm manager, Charlene, will pull aside cows from the 841-member herd so Field Service can take a closer look.

"Depending on what we find with our sick cows, we talk to Charlene about the different options and decide what to do with the cows," Depenbrock says. "We also keep tabs on what specific problems we're seeing so we can talk to her about any underlying herd problems. We might see an increase in one type of problem that prompts us to ask about feed changes or have a conversation with the nutritionist, for example."

Field Service is built on relationships between the veterinarians and students and their clients, says Michaela Kristula, the section chief and associate professor of medicine. Kristula came to the Field Service in 1984 as an intern.

"We have a long history with Walmoore farms," says Kristula, who is part of a team that helps the farm to plan for the future. This team includes team facilator Mark Meyer; Bob Munson, a nutritionist who used to work at New Bolton Center; David Galligan, a professor of animal health economics at New Bolton Center who is focused on the profitability of farms; the farm's accountant, loan officer, and the farm's owner, his wife, and father. "Everybody is working together, trying to make the farm better. It really does work that way."

Walt Moore, the farm's owner and a fourth-generation farmer, says they've worked with Field Service for 45 years. In the past three decades, they've also worked extensively on animal nutrition with the Center for Animal Health and Productivity, which is run by Galligan out of New Bolton.

Moore sells his milk through the Land O'Lakes coop, which requires suppliers to be part of the FARM, or Farmer Assuring Responsible Management, program. This program was created by the National Milk Producers Federation to show consumers that dairy producers have a caring relationship with their animals and employees. As part of the initiative, producers must have written protocols in place for finding and treating sick cows, and specific training programs such as stockmanship for their employees.

Penn Vet Field Service The Penn Vet's Field Service examines and prescribes courses of action for sick cows. Usually a drop in milk production is the first sign something is wrong. Photo by Denise Henhoeffer "That's fallen into veterinarians' laps to make sure all the farms are in compliance," Moore says. "Field Service has helped us implement different breeding protocols, and our breeding has dramatically improved recently."

Back in the barn, Depenbrock examines the sick cows with Pendurthi and Raisa Glabman, also a fourth-year veterinary student. Pesato is working on pregnancy checks with fourth-year veterinary students Gretchen Landin and Colleen Stewart. He lets the students palpate first so they can practice by hand before using the ultrasound. The goal is to identify non-pregnant cows as quickly as possible to get them back on track.

"This is their time to practice their physical exam and get good at a variety of basic skills," Pesato says. "They can learn different techniques from each clinician, which will help them become better, well-rounded vets."

The rotation is a popular one--Pendurthi, Glabman, and Landin have all taken it twice and Stewart has taken it four times.

"Field Service is one of the few rotations at New Bolton Center that allows students to get out into Chester County and into rural Pennsylvania and see what food animal medicine is like," Pesato says. "This is a really nice service to work on because I get to show them lots of real-life scenarios at the farm level."

Pendurthi, a native of Bethlehem, Pa., says she came to vet school intending to go into aquarium medicine, but fell in love with cows and issues around food security after taking an introductory dairy seminar before the very first day of class. Post-graduation, she plans to get an master of public health from Vanderbilt.

"Field service is great because you get to see how a bunch of different farms do things, what's important to them, and why the work they do is important for the surrounding communities," she says. "Pennsylvania is really cool because you have a combination of the big dairies and small dairies, and it's fun to see how they fit the different food niches that consumers are looking for."

Ultimately, the goal is to help all farms be productive and healthy in an efficient way, says Kristula, and give the students a robust learning experience. She is grateful that Walmoore Holsteins allows students to learn on the farm's cows.

For his part, Moore is happy to oblige: "It's an opportunity to educate to see if we can keep building the next round of veterinarians."

Pesato adds that even veterinary students focused on small animal medicine can learn a lot from working with food animals.

"The concepts of veterinary medicine are overarching, so you learn physical exam skills, basic surgical techniques, and how to handle difficult situations; all that stuff--it goes between small and large animals. It's something that a lot of people appreciate."

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