When Parts of the Body Turn Inside-Out
I would be remiss if I didn’t tell you about a relatively common condition seen in cattle — mostly dairy cows — and sometimes sheep and goats. I am reminded of it as spring nears and birthing season gets in full swing. I am talking about a prolapsed uterus.
Apologies in advance for those of you who are squeamish; I’ll try to keep the details to a minimum. But suffice it to say, a prolapse is when an internal body part decides to become external. Therefore, a uterine prolapse is when the uterus is pushed outside of the body. Clearly, this needs to be seen by a veterinarian pretty quickly.
Most, if not all, cases of uterine prolapses occur in cattle and small ruminant mothers shortly after birth. Low blood calcium levels cause most cases of uterine prolapse. Calcium is needed for proper muscle contraction and at birth, when the body’s calcium stores are rapidly shunted to the mammary glands for milk production, sometimes the body is left in a condition called hypocalcemia, which means low (hypo-) blood calcium. With calcium levels not high enough for proper muscle contraction, as the calf or lamb is delivered, the uterus accidentally comes out, too, sort of like a twisted version of throwing out the baby with the bathwater.
Obviously, this is uncomfortable for the mother, to say the least. Worse still, this predisposes her to infection and hemorrhage if any of the large blood vessels in the uterus are torn. When I’m on my way to such a call, I will direct the farmer to keep the animal quiet and down, and to keep the uterus clean and moist.
Dealing with a bovine prolapsed uterus really is an event to behold and to learn how to deal with them is really only done through experience; nothing in the textbooks prepares you for the real thing. The real thing is that this organ in an adult cow is extremely heavy and bulky and swollen and doesn’t really want to go back whence it came. To make matters worse, incredibly, having a prolapse makes a cow more apt to strain and continue to push so you’re working against continued contractions to push something weighing easily fifty pounds through a hole about the diameter of a cantaloupe.
Clearly, an epidural is a must in this sort of situation. While I give the local anesthesia a few minutes to work, I go about cleaning the uterus as best I can with warm water. Then I don gloves and I wear a sort of “waterproof” smock made from a clean trash bag. You’ll see why in a minute.
Then I start to push. As my old boss would say: “You’ll push and push and push and push and just when you think it’ll never go back in, it goes back in.” She’s right. Little by little you gently work the uterus back inside the cow. Sometimes, it’s one step forward and two steps back, such as when the cow decides to buckle down and strain against you, but eventually it goes in, although sometimes it takes more than my hands. This is where the waterproof smock comes in.
I always get completely filthy when I repair a prolapsed uterus in a cow. This is partly just due to the nature of the condition, but also because as my arms tire, soon my torso begins to bear the weight of the uterus. It turns into a full body workout!
Once the uterus is back inside where it should be, I lavage it with an antiseptic solution. This helps clean it further but also turns it right-side-in, since it was put back sort of inside-out, if that makes any sense. To keep the cow from pushing it right back out, a few stitches are placed on the outside of the vulva to keep it mostly closed (still allowing for urine to pass). These stitches can be removed in one to two weeks.
Then, the cow gets IV calcium, and perhaps some other fluids and antibiotics, depending on her condition and how damaged the uterus appeared.
Despite how horrific this all sounds, these cows recover and their fertility remains intact. Same with sheep and goats. Yet again, I’m astounded at how well ruminants bounce back from major illness.
Dr. Anna O'Brien