Levels of Care Available to Farm Animals In Northern New England;
The veterinary profession is suffering a population decline; according to Sarah Zhang’s July 2022 Atlantic piece “The Great Veterinary Shortage,” the United States’ annual attrition rate for veterinarians is 16%, while the attrition rate for veterinary technicians and technologists is 23.4%. This shortage is even more stark in the world of large animal medicine; according to a December 2021 article in The Indiana Prairie Farmer, “The economic challenge of finding large-animal veterinarians is partly due to a dynamic shift in the career.” Only 10 in 84 Purdue DVM graduates entered large animal practices upon graduation in 2020, with one major challenge to large animal practices cited as the distance vets must travel between farms as large farm operations become defunct. It is more remunerative for practices to focus on small animal care, which requires less travel, less physical hardship, and more billable hours. The equipment required for large animal diagnosis is often prohibitively expensive for large animal practices to obtain, which means that even when rural animal guardians are able to secure a veterinarian, access to lifesaving equipment and procedures is unavailable.
Another notable challenge to retention of DVM graduates with large animal focuses is the draw to research; DVM graduates who are not drawn to small animal practice may reasonably use their interest in large animal (food animal) medicine to work with the USDA or in other research or administrative capacities, pulling more qualified practitioners from the field.
These challenges to the maintenance of the large animal veterinary community have a direct impact on the levels of care available to farmers and to animal sanctuaries.
Levels Of Care
In Maine, available large animal practitioners are often mobile, with no fixed surgery or offices. All their work is done in the field, which means that they are limited to offering primary care services: the administration of vaccines and antibiotics, fecal and blood analysis, suturing acute injuries, eye, ear, and dental care, and rudimentary radiographs. The limits on this field work preclude secondary and tertiary care.
The large animal practice in Maine that offers onsite care can offer a clean surgical space for routine procedures like castrations and spays on young animals, but does not have the equipment for any secondary care procedures like ultrasounds, exploratory diagnoses, or growth removal. They will also not perform spay surgeries on pigs over 100 pounds, even in emergency circumstances. Spays in pigs are crucial not only for the prevention of reproductive cancers– an almost inevitable life-ending fate for large female pigs– but is also necessary for promoting reasonable behavior. Pigs on their 21 day heat cycle can be destructive and aggressive, endangering both people and property. Tertiary care– what we might call emergency care, or heroic measures– is unavailable as well.
With these limitations, it could be said that all medical care beyond the primary level thus becomes “emergency care'', as the closest opportunity for resolving medical problems is available at Tufts University’s Cummings School of Veterinary Medicine. If Tufts is unavailable, the next closest option is Cornell University School of Veterinary Medicine.
In February of 2020 our pig Agatha presented with inappetence and lethargy. Our local vet gave her painkillers and recommended prunes to counteract constipation. Over the course of a month Agatha declined slowly. Two more calls to the vet found no answers but they prescribed sucralfate on the chance that she had a stomach ulcer. At no point were we advised that she might be terminally ill. Thirty days after she first showed symptoms she began to have seizures and before a vet could come out to euthanize her, she died. The opportunity to work with Tufts to give Agatha an ultrasound would have given us the information that would have saved her weeks of suffering. Our team is sure that Agatha had a reproductive cancer. We could have euthanized her before her pain grew worse.
In March 2022, our Anglo-Nubian goat Lucy presented with sudden inappetence and hypothermia. Our local vet injected her with subcutaneous fluids and Vitamin B, as well as painkillers. We asked for a fecal analysis to detect parasites, and the next day were told that her parasite load was “within range.” We were advised against deworming her due to concerns about parasite immunity in goat-specific parasites. Two days later, a second local practice was called for a second opinion, and an examination with a stethoscope showed that her rumen was not functioning properly. A nonfunctional rumen can lead to death in ruminants. A local sanctuary 90 minutes away offered us medication designed to rebuild the cultures of the rumen. Lucy remained anorexic and lethargic. Our local (second) vet advised staying the course, but Lucy was clearly uncomfortable. We had our first referral to Tufts, where their fecal analysis showed a heavy parasite load, so heavy that it had nearly killed her rumen. This parasite load came from years of not having been properly dewormed by her former owner. Lucy required three transfaunations (infusions of the juice of the rumen of a residential Tufts cow with a fistula) in order to repair her rumen.
The faulty fecal count from our local vet, the poor advice about deworming, the willingness to let Lucy wait in discomfort, are all reasons that Tufts was the right choice for Lucy’s situation. She had a simple problem (parasites) with an expensive solution. Had she received the care she needed from her previous owner, she could have avoided this illness. Many animals that come to sanctuaries have past lives of neglect, ignorance, or outright abuse to contend with.
In April 2022 our pig Phryne presented with sudden immobility and disorientation. Our local vet examined her but was unable to do field radiographs due to Phryne’s size. Her hope was that Phryne had a dislocated spinal disc. We transported Phryne to Tufts, where she was given an ultrasound. The medical team determined that instead of a disc, she had a spinal infection. They put her on heavy duty antibiotics, but she declined and we made the decision to euthanize her. The knowledge that Tufts gave us about Phryne’s condition allowed us to make the humane decision for her rather than allowing her to “rest” in hopes of recovering a theoretically injured back.
In May of 2022 our pig Hermia presented with significant vaginal bleeding. The local vet opted not to examine her, deciding via phone that she must have had a ruptured blood vessel. Since he had no ability to ultrasound her, he had no examination to perform. Knowing the high prevalence of reproductive cancers in unspayed female swine, we called Tufts and spoke to a doctor who told us to bring her in as immediately as we could without having to pay for an emergency fee. Hermia’s ultrasound showed a large mass on her uterus. The surgeon in charge removed the mass, which he called “the size and shape of three mangoes,” and completed an ovariohysterectomy to prevent further reproductive tumor growth. After her surgery, Hermia was a different pig; she had energy; she lost weight, especially around her eyes, improving her vision; and she became more confident and less prone to react defensively to us and other pigs. Her spay surgery also meant that she no longer suffers the fluctuations of behavior that unspayed pigs experience every three weeks. She is no longer aggressive, a danger to property, or prone to injure other pigs or humans. Proactively spaying pigs is not just about preventing piglets; it is about preventing expensive illnesses and protecting other pigs, humans, and our facilities.
In June 2022, Charlotte presented with a hind leg that could bear no weight. Our local vet did field radiographs but found nothing remarkable. She said, “I don’t have a lot of experience reading pig radiographs.” Because painkillers made no difference to the leg’s ability to bear weight, we took her to Tufts for an ultrasound, which found that Charlotte had significant changes in her femur due to degenerative bone disease, which had caused her patella to luxate. Charlotte was the only survivor of her litter and was thrown in the garbage by her farmer on the day she was born, so we’re uncertain if this was congenital or due to infection. The danger in doing nothing was that Charlotte would outgrow her ability to hold her weight on three legs. But this was not a “do nothing” situation due to the commitment of our medical team. The surgeons tapped her joint fluid and lavaged the area. The joint fluid was, to paraphrase, at 99% infection rate, The solution to Charlotte’s problem was to heavily medicate the stifle joint in hopes of removing all infection, and then plan to create an implant to replace the patella. This procedure was only confirmed once our surgeon had consulted with a surgeon from the small animal hospital, as no one had ever performed this on a pig before.
It took Charlotte several weeks to clear her infection to the point at which the surgeons were confident about installing an implant. Once they exposed her stifle joint, they chose to perform a trochlear wedge resection, which avoided the need for an implant. This was a choice we appreciated as it reduced the risk of returning infection. Six weeks after this surgery, we returned to Tufts for a reevaluation, and the surgeons were “extremely happy” about her condition. Charlotte is a farm pig, which means that by the time she’s fully grown she may reach 300 or 400 pounds. The idea of her struggling to support that amount of weight on an arthritic and essentially dissolving leg is too inhumane to contemplate. Our opportunity to provide her with compassionate, creative, and cutting-edge care not only improved her quality of life; it allowed the veterinary students on her case to follow her journey and witness a practice of care never performed before. One of her medical students told me that she never liked pigs until she met Charlotte. Due to her ability to withstand anesthesia and her comfort and popularity in the hospital, Charlotte will return to Tufts in late winter for a spay surgery. We are determined not to let all of our commitment to her get lost to reproductive cancer. This procedure will also help her have, as our surgeon said, “more reasonable behavior,” as she has extreme behavioral challenges when on her cycle.
Lucy (Part II)
When she was last at Tufts, Lucy’s doctor mentioned the size of her udder, noting that if it continued to grow she might require a mastectomy. This fall we noticed that her udder had grown so large that it was impeding her movement. Our local vet offered to remove the entire udder in the field, but could not offer us any diagnostic tools; she could not tell us if Lucy’s udder was distended due to cancer or due to fibrotic tissue. Without this knowledge, we could not make an informed decision. If Lucy had a tumor, and especially if it had metastasized, we did not want to perform an invasive surgery that would not help her in the long run. Imaging of Lucy’s udder and chest confirmed that her udder was packed full of fibrotic tissue: not beneficial, but not cancerous, and that her chest was free of growths. The surgeon also told me that a mastectomy on this scale in the field would almost certainly lead to death. The risk of blood loss was too great to perform this procedure outside a hospital with a supply of donor blood, and the recovery would be significant.
Lucy’s surgeon said that of all the caprine mastectomies she has been a part of, Lucy had the strongest and easiest recovery, proving that she was the right candidate for this surgery and that it will improve her quality of life immensely. Had we chosen to have our local vet perform this mastectomy, even if Lucy had survived, we would have had no information about her overall condition, whether she had cancer, or if such an invasive procedure was the wisest choice.
On the morning of November 18, 2022 our Nigerian Dwarf Goat Ziva separated herself from her flock. On closer examination she was found to have a distended abdomen, labored breathing, and an extremely low Famacha score. Our local vet came as soon as she could and diagnosed what we knew was happening: bloat. Bloat occurs when a goat’s rumen fills with either gas or food and cannot be emptied. The rumen, if not released, can grow until it crushes the lungs and the goat dies in great pain.
Our vet passed an esophageal tube twice in an attempt to release some gas, and had some success on the second attempt. She advised us to drench Ziva with baking soda and vegetable oil, keep her on high dose painkillers, and walk her every hour or so. I put her in a blanket to reduce the cold stress on her body. She ate a little hay that night. We expected Ziva to improve overnight. The next morning she was worse, so we drenched her again. She began to refuse to walk. I called our local vet who said that if we didn’t want to stay the course we should just go to Tufts, because an emergency call for her (it was a Saturday) wouldn’t be that much more expensive than a visit to them (this is not true). Ziva could not walk to the car and had to be lifted inside. The team at Tufts X-rayed Ziva’s abdomen and told us that she was gravely ill, that her rumen had compressed 80% of her lungs, and that even if we opted for a rumenotomy, she would most likely not survive the sedation. We opted to euthanize her, and she passed after the sedative took effect. Had we not had the ability to take her to Tufts, we would have had nothing but the advice of our local vet who would have left her to suffer through the weekend.
The dearth of qualified large animal veterinarians in Northern New England is exacerbated by the lack of medical facilities prepared to fully treat large animals. Unlike companion animal medicine, large animal medicine lacks research, funding, and general facilities. Farmed animal sanctuaries play a unique role in large animal medicine due to their desire to pay for tertiary care, something farmers are unwilling or unable to do. When sanctuaries have the ability to pursue the highest level of care, they participate in the growth of knowledge in the large animal field.
However, in most instances taking large animals to Tufts or Cornell or other major animal hospitals is not about supporting intellectual expansion; it is simply about the search for diagnostic and preventive care that allows us to make informed decisions about our residents’ needs. The inexperience, incorrect diagnoses, failed treatments, and bad information we have faced from our local vets have not only interfered with the mission and values of Darrowby Farm Sanctuary; they have caused unnecessary suffering in our residents. Access to Tufts is crucial to the success of our mission.