10.22.96-------begin here-------

Clinical correlation w/GI specialist Bill Donwick (? sp) from new bolton

-opening remarks about snow in buffalo NY and how they used to give him 
an oshkosh snowplow for the day.

story: as a young vet, worked holidays, including xmas, and it snowed 36 
inches that day, and at the 16th call of the day it was snowing so hard 
there wasn't even a snowplow, so he stoppd and picked up his wife and 
took her w/him. the only way to see where you were going, was to follow 
the telephone poles and zig zag. so he got to where he was going, and the 
farmer's kid was plowing snow. he went in, and there was a cow having 
dystocia, w/twin dead calves. the farmer was milking, it was getting 
dark, so the wife had to pull the chains to put traction on the calves, 
and she's feeling sick. all of a sudden, the barn started shaking. he 
thought the tractor had just driven into the hayloft or something. but 
then the wife told him to run, and he saw the farmer running by, and his 
wife started running out, because the barn was falling down from the wt 
of the snow. but he didn't run, just stood near beam. barn fell onto his 
car. yikes. so they delivered the fetuses and went on their way. this 
made the news, of course. his wife was really pissed because she wasn't 
in the article. the farmer said that was because he wasn't sure it was 
his wife, so he figured he'd better not mention it at all....

take home message: when the barn fell in....at that time it was common to 
not bale hay, just chop it. this barn was built in the 40s, and when it 
fell in, it of course disrupted the roof, and the roof nails fell into 
the hay. now, the farmer had to feed the hay. there was no alternative, 
dead of winter, no other feed around. but there were so many nail in the 
hay, that after the cows ate the hay, you could come and sweep away the 
nails. but, cows are not as good as sheep or goats at picking out 
nails....because they don't have prehensile lips, and because they take 
food in w/their tongues instead of their lips. so, cows aren't that 
selective about what they take in. once they grab it w/the tongue, they 
swallow it. and so cows get hardware dz, where sheep and goats don't. so, 
these cows would eat the nails, and the vet had to do 
reticulorumenotomies and remove these nails.

so, to get the nails out of the reticulum/rumen, you operate on the L 
side, because the rumen is on the L side. and you make this incision in 
the paralumbar fossa, which has 3 anatomical boundaries. the three 
boundaries of the paralumbar fossa in the cow are the 13th rib cranially, 
the transverse processes of the lumbar vertebrae dorsally, and the tuber 
coxae caudally

so if you make an incision in the paralumbar fossa, you know there are no 
blood vessels in the way, and the rumen will be underneath. the thing 
with the cow is it's so big, you have to make the right incision or 
you'll just have to close the first incision and make another one in the 
correct place.

[slide: 3 day old bull calf with no anus- not an uncommon defect]

[slide: radiograph of pelvis of calf w/barium enema having been given. 
this calf had abdominal distension and had not passed manure. there was a 
patent anus present. the barium went up to a point and stopped in a 
"blind pouch" appearing spot in the cranial abdomen. this calf had no 
attachement between the front and back parts of GI tract: had atresia 
coli. in calf, almost always occurs in spiral colon.]

[slide: upside down rhinoceros which weighed 4700 lbs and was 27 yrs old 
and was at the bronx zoo. she had leiomyomas of the uterus/vagina -not 
uncommon in elephants and rhinos. had never calved. needed to remove the 
uterus to save her life. well, rhinos are ruminants...but...argh. first, 
had to make her lie down, so they gave her some M99, which is very toxic 
to people - one drop on skin can kill you. so you need to have someone 
standing near you w/antidote, 'cause if it gets on you, you're down and 
out before you can give yourself the antidote. 2 mL of this will make the 
rhino lie down and sleep for 7 hrs. so they gave it to her, and got her 
in dorsal recumbency so she's laying kind of in a trench. they had to 
stand on mattresses, and everything was so huge, they used obstetrical 
chains to tie around the uterus to try to get it out. the skin was 3 
inches thick, took 12 scalpel blades. so, they got the uterus out and one 
of the ovaries. but, she bled to death the second day after the surgery, 
because he couldn't get a ligature on the blood supply to the left ovary. 
on the right side, he got a twist tie on there, but he couldn't reach the 
left ovary, so he'd had to just tear it off.]

take home message: anatomy is extremely important. before you do anything 
surgically, you MUST know the anatomy. need to constantly review.

[slide: GI tract of cow. not an equine forelimb] realize that the OUTER 
loop of the spiral colon is the one which goes to the rectum. 

what's different between the way the ileum approaches the cecum in the 
cow as opposed to the horse? we'll find out tomorrow. oh, ok, now. in 
cow, there is an ileocecal fold, with connective tissue in between. the 
horse doesn't have that piece of mesentery, so is subject to ileocecal 
intussusception.

[slide: radiograph of elbow showing a nail which has punctured the 
diaphragm and entered the heart. there's only 3/4 of an inch between the 
reticulum and the heart.]