Busy Friday

We started off our Friday by revisiting the horse that had the unilateral mucopurulent discharge from her right nostril.

We noticed that the discharge had cleared up with the penicillin, which was great.  The horse’s mouth was still a bit malodorous, but this could be because the horse was eating its hay from a manure-laden area.  We gave this horse another 40 mLs of penicillin intramuscularly into the neck muscles, and were on our way.

We then continued on to Mark and Jane’s veterinary practice.  We drove by the High Court of Botswana.  I want to take a picture of this for my boyfriend back in the US (who is a law student!).

I took a picture of the Sbrana Pyschiatric Hospital on the way, which is a huge establishment here in Lobatse.

Jane had explained to me earlier that this psychiatric hospital was built because HIV very prevalent here in Botswana (about 1 in every 3 people is infected).  Infection with HIV/AIDs tends to negatively affect peoples’ mental health in their old age.  Mark also said that he has seen a few escaped patients before trying to climb over the fence where it is the highest, when about 5 meters away the fence is really low.  If only they realized!

There is also what I like to call a “fake Hollywood” sign here in Lobatse, haha.

The people here have built a sign in big white letters on a small mountain here in Lobatse.  It’s like the Hollywood sign in the US, only it’s a little more makeshift.  It reads “Welcome to Lobatse 35th Anniversary 2013”.

In any case, we arrived at the clinic, and I was able to update my blog again for a bit.  We also got the results back from the piggery today on the swabs and aspirate of ascites that we sent for bacteriology.  Three different bacteria were found at his piggery: Trueperella pyogenes (formerly Arcanobacterium pyogenes), Streptococcus dysgalactiae, and Staphylococcus hyicus.  Janine and I will be writing up a plan for controlling these pathogens at his piggery.  Trueperella pyogenes is primarily an environmental bacteria, so this can be controlled by cleaning the environment and preventing injuries to the pigs, such as by properly clipping canine teeth and evening out the rough flooring.  This pathogen can also cause abscesses, which would explain the abscesses we saw.  This bacteria was the most dominant of the three bacteria found, so environmental cleaning and hygiene is of the utmost importance in his piggery.  Streptococcus dysgalactiae and Staphylococcus hyicus are both contagious pathogens that can be transmitted between pigs, so proper cleaning of farrowing pens and restricting movement of the piglets until they are weaned will help control these pathogens.  Staphylococcus hyicus is the causative agent of “Greasy Pig Disease”, which would explain the pustular dermatitis we saw (it causes an exudative dermatitis).  Streptococcus dysgalactiae can cause arthritis and joint swelling in piglets, which would explain the “joint ill” piglets we saw.  Trueperella pyogenes would also explain bacterial infection from any injuries the piglets have.  It turns out that the dominant pathogen, Trueperella pyogenes, for which the antibiogram was done, is resistant to trimethoprim-sulpha (TMS), which is the antibiotic the piggery owner is using!  We will recommend switching antibiotics to enrofloxacin (Baytril) or tetracycline, as this pathogen is sensitive to these.

After looking over the results from the piggery and looking up information about these pathogens, I heard some commotion in the waiting area, and came out of the office to witness a young Staffordshire Terrier lying on the floor of the waiting room in the middle of a petit-mal seizure.  His eyes were twitching and his legs were fairly stiff.  Mark was there, and grabbed my stethoscope to listen to this dog’s heart in the middle of the seizure.  Mark said that he did not hear anything abnormal with the dog’s heart, so it was likely not a heart problem.  After about a minute long seizure, the dog was up and walking again, wagging his tail.

Mark explained that it is rare here to witness a seizure here in Botswana, at least in his experience.  I have seen a couple of seizures at a veterinary practice I used to work at in the US, but we also saw a lot of emergency and specialty cases there.  Apparently this dog had been having these “fits”, as the owner described them, for a couple of days now, which is why the owner brought the dog into the clinic.

Once the dog was up and walking around, we took his temperature and it was 38.2 degrees Celsius, which is normal.  The seizures could be due to a tumor or even an aneurysm.  Some infectious pathogens could also be implicated, such as canine distemper virus (although this dog was not showing any clinical signs of having distemper), Ehrlichia, and Babesia.

This dog was then started on a medium dose of Phenobarbitol daily to control the seizures.  He was started on 4 mg/kg of Phenobarbitol daily.  He was a 20 kg dog, so worked out to be 80 mg of Phenobarbitol daily.  The tablets, however, were 30 mg each, so this dog would be placed on one 30 mg tablet twice daily (BID), coming to 60 mg daily.  It is a little less than the recommended medium dose for seizure control, but hopefully will suffice.  Mark explained that if there is only one seizure per week, that is acceptable, but if there are three or more seizures per week, the daily dose of Phenobarbitol should be increased.  If the seizures continue beyond with an increased dose of Phenobarbitol, you can also add Potassium Bromide to the Phenobarbitol.  Mark explained that he finds Potassium Bromide to be more helpful in German Shepherd Dogs, Dobermans, and Collies.

Janine performed an ear prick on this dog to look at a blood smear for any tick-borne parasites that could be causing the seizures.  A drop of blood from the ear prick was placed onto the end of a slide, a blood smear slide was made, the slide was stained using the Rapi-Diff stain, and then placed under a microscope to look for parasites (such as Ehrlichia or Babesia).  No tick-borne parasites were found on the blood smear.

This dog will also be given 2 tablets of Doxycycline 100 mg to take once daily for the next two days, to help fight off any undetected parasites this dog may have that could be causing the seizures.  The owner thanked us, and was on her way with her dog.

Shortly after the Staffordshire Terrier left, an owner brought in his young puppy to the clinic.

Janine and I went in to the examination room to retrieve the history on this puppy.  The puppy was 8 weeks old, was not yet vaccinated, had been vomiting and was lethargic, but was not having any diarrhea.  There were other puppies in the litter, but none of them were vomiting or sick.  The owner said that he gave this puppy a tiny piece of Brufen (which is the same thing as ibuprofen, a non-steroidal anti-inflammatory drug or NSAID).  The owner said he also gave this puppy Vitamin B orally.

Janine and I then went to consult with Mark, who would be treating the case.  Janine went over the puppy’s history with Mark, and explained that with the ibuprofen she might be worried about acute renal failure.  She also said she might be worried that giving the Vitamin B on an empty stomach could cause vomiting.  Mark explained that with a very small dose of ibuprofen, he wouldn’t be too concerned about acute renal failure.  He recommended treating the symptoms (mainly the vomiting and lethargy).

This dog weighed around 2-4 kg, and was prescribed a ¼ tablet of 10 mg Metoclopramide twice daily (BID) for 4 days.  So, that’s 2.5 mg Metoclopramide BID (5 mg Metoclopramide daily).  The metoclopramide is an antiemetic and increases gastric motility, meaning it will help stop the vomiting and move digesta along the intestinal tract.  We also fed this puppy some A/D (a palatable canned dog food) mixed with activated charcoal, which will help bind up any potential toxins in this dog’s stomach.  The puppy was given some activated charcoal to take home to mix into its food.  Additionally, we gave this puppy a subcutaneous injection of 0.1 mLs of Penicillin.

Another dog came in after the puppy left.

This dog was very skinny and had been fairly lethargic for the past couple of days.  The dog was visibly shaking.  Upon physical examination of this dog, we noticed a large cluster of ticks on its ear.  These ticks we identified as Rhipicephalus sanguineus, which are vectors for the parasite Babesia.  This dog’s ears showed signs of what Mark said is called “Cold Agglutin Disease”.

This is basically where there is decreased circulation to the ears and the ears die off at the tips and edges.

We performed an ear prick using a needle and made a blood smear to look at for tick-transmitted parasites.  This dog’s blood smear was positive for infection with the tick-borne parasite, Babesia.  Babesia causes what is called biliary fever.

The treatment for biliary fever is an injection of Berenil.  We gave this dog 0.5 mL of Berenil intramuscularly into his neck.  We also gave this dog 1 mL of Dexamethasone injected subcutaneously into his neck.  Dexamethasone is a corticosteroid, which will help reduce inflammation.  We also gave this dog 5 mL of Hepatonic orally, which is a nutritional supplement, and sent the owner home with a bottle of Hepatonic to give 5 mL of Hepatonic daily.  The dog was then on its way with its owner, and was actually looking better than when it arrived already (maybe happier to be leaving).  Janine explained that if you don’t catch biliary fever early, the dogs often die.  Luckily, this owner caught it early.

Once this dog left, we then got in the truck and headed to the Botswana Police Station to get some immigration paperwork certified for Janine.

We also stopped at the Department of Immigration Services to fill out some more paperwork.  Tons of paperwork to do!

We then drove to a feedlot so that we could inspect their sick pen.  On the way, we drove over some railroad tracks.

I’ve been reading the book, “The No. 1 Ladies Detective Agency,” by Alexander McCall Smith.  It’s a book about a lady’s detective agency in Botswana, and these railroad tracks remind me of her book, as she talks about these.  It is quite sad, actually, as she talks about how someone was killed crossing over them.

In any case, we then visited a feedlot to perform an inspection of their sick pen.  This feedlot was on the same farm as the two sick little piglets we had visited last week.  Upon observing the sick cattle pen, we discovered three cows that had clinical signs of acidosis; they looked sore and appeared dehydrated from the wrinkles in their neck and their sunken eyes.

Two of the three were also grinding their teeth, and one was lame in its right hind leg.  Mark recommended treating these cows with magnesium oxide for acidosis.

There was another cow in the sick pen that was breathing very heavily, with pronounced expiratory effort.

Mark said that this cow likely had a lung infection with Pasteurella, as it was pushing hard to breathe and looked very uncomfortable.  Its penis was also fully extruded, likely from all of the heavy pushing it was doing to breathe.  Mark recommended this cow be shot as soon as possible.  The farm owner’s son had a gun, and shot it right then and there.

It is good that the cow was put out of misery so quickly, so that it didn’t have to suffer any longer.  I guess my problem with this situation was that the cow hadn’t been removed from the pen before it was shot, so it was in a pen with other cows that were very spooked by the gunshot.  I think that shooting a cow in the head is the most economically feasible humane form of slaughter here in Africa for most farmers, and should be done as soon as possible when the animals are in pain.  But I would have liked if the cow were separated from the other cows first.  Cattle are very easily spooked, and I would think that shooting a cow in a pen with other cows may lead to the other cows growing very fearful, especially of humans.

Once this sick cow had been shot, we also saw another cow (not in the sick pen) that was giving birth.

You could see her fetal membranes starting to protrude from her vulva (maybe not so well in this picture; when she flicked her tail you could see them best).

After observing this cow for a minute or so, we were then on our way to observe their goat pen.  They have a little Australian Cattle dog (Mark calls it an “Australian heeler” dog) at this farm to help herd the cattle.

The dog tries to bite the cow’s heels to herd them.  I think the cattle have gotten smart to this tactic, as I saw some of the cows give the dog a swift kick!  Don’t worry, the dog was fine!

We arrived at the goat pen, and there were two goats that the farmer wanted us to take a look at.  One of the goats the farmer suspected had Heartwater disease.

Heartwater disease is a tick-borne rickettsial disease caused by the parasite, Ehrlichia ruminantium.  Heartwater disease causes neurological signs, and is frequently fatal once neurological signs set in.  The goat was staggering, falling down and then paddling, and had a bit of nystagmus (fast uncontrollable eye movements).  This goat was showing clear neurological signs consistent with Heartwater disease.  This goat had tons of ticks in its left ear.

The owner had apparently dipped this goat for ticks this morning and had given the goat alamycin, an antibiotic.  We gave this goat 2 mL of Dexamethasone intravenously into its jugular vein.

Dexamethasone is a corticosteroid, which can be useful in reducing inflammation in neurologic disorders.

The second goat the farmer wanted us to look at was having severe diarrhea and also had severely overgrown front hooves, to the point where it wouldn’t stand on its front legs.

We gave this goat 3 mLs of trimethoprim-sulpha (TMS), an antibiotic, intramuscularly to help alleviate the diarrhea.  We recommended that the farmer give this goat 3 mLs of TMS tomorrow and the next day.  We also trimmed this goat’s hooves so it could stand on its front legs again.

We noticed another goat that also had severely overgrown hooves and trimmed these as well.

The farmer invited us to sit down and have some soda.  We happily agreed.  I noticed that on his table he had a old bottle of Amarula, a drink that Janine recommends I bring back to the US!

I’ll look for this at the airport.  After finishing our sodas and chatting for a bit, we then said our goodbyes and left this farm, on our way to visit a second feedlot.

The second feedlot we visited was the one with the hungry cattle last time.  We drove by their feed storage shed and saw that it had very little feed in it.  There was probably enough feed in their feed storage shed to last one day for all of the cattle (if that).  It’s Friday afternoon and it’s very unlikely that they will get more feed before Monday.  It’s really sad that this is the case, especially because they have around 3500 cattle on their farm.  These cattle will likely be starving again over the weekend, and we will likely see more deaths from red gut.

We drove to the designated postmortem area of their feedlot to perform another postmortem examination on a cow that died suddenly this morning.  Upon opening up the cow’s abdomen, we saw that there was peritonitis with serosanguineous fluid.  The small intestines had noticeable hemorrhaging.  Upon opening the small intestines, we saw that there were hemorrhages in the wall of the small intestines.  This cow had yet another case of red gut, or overgrowth of Clostridium perfringens type A causing a Clostridial enteritis.  We emphasized to the farmers that these cattle need to have ample feed at all times so that they aren’t starving, and don’t subsequently overeat.

After finishing the postmortem examination at this feedlot, we drove to a third feedlot to look at their sick pen, in particular a down cow that the farm owner was concerned about.

We arrived at their feedlot, which is incredibly well organized and maintained.  We saw that they had tons of feed in their storage shed and very few cows on their feedlot.  While it is great that they have so much feed for so few cows, they could certainly handle more cows on their feedlot!  We spoke with the owner of the farm, who is working on signing a contract with the Botswana Meat Commission so that they will provide him with more cows.

A lot of feedlots here like to stay updated on how other feedlots in Botswana are doing.  I guess because they want to know how their own feedlot compares.  This feedlot owner told us how there is a feedlot in Molepolole that had 38 deaths per 1000 cows.  They are only allowed 3 mortalities per 1000 cows by the Botswana Meat Commission standards, so this is an awfully high number that will likely get them banned from the Botswana Meat Commission and European Union programs.

After chatting with the owner of this feedlot, we walked over to their sick pen.  On our way over, we noticed that one of the cows in the feedlot had a huge abscess on her proximal left hind leg.

Mark recommends cutting this abscess open so that it can drain.

When we arrived at the sick pen, the down cow there could barely even lift its head without struggling.

This cow had a chronic middle ear infection.  Janine explained to me that this middle ear infection causes vertigo, so the cow can’t get up without feeling like the world is spinning all around.  This cow would need to be culled.

There was also a cow in the sick pen that had severe bloating, or chronic bloat.

The entire left side of its abdomen (where one of its four stomachs known as its rumen is) was severely distended, and it looked very uncomfortable.  Mark said he would definitely find plastic in this cow’s rumen if he were to open it up.  Janine later explained that it had likely eaten plastic and this plastic would likely be blocking the cow from eructating properly.  This cow would also need to be culled.

After examining the sick pen, we then drove back to the vet clinic in Lobatse.  When we arrived, we unpacked the truck and were getting ready to leave when a man showed up with his cat.  His cat had apparently been vomiting.  We performed a physical examination of the cat, and the cat was so sweet – she purred all throughout!

There were no abnormalities found on physical examination of this cat.  We then gave this cat 1 mL of Metoclopramide subcutaneously to stop the vomiting (it is an antiemetic) and to aid in gastric motility.  We also gave this cat 1 mL of penicillin subcutaneously to help fight off any bacterial infection.  Both of these medications will hopefully help settle the cat’s digestive tract.  This cat was also sent home with oral Lactapet, which is a laxative, as we thought the vomiting may be because the cat was constipated.

This man and his cat then left the vet clinic, and we headed home for the night.  Tomorrow, Mark will be flying to Maun to dart wildebeests, and I’ll be staying with Janine for a while.  Hopefully we’ll have some time to relax and unwind this weekend, as this past couple of weeks have been pretty busy!  I’ll write again soon.