This Real Science Exchange podcast episode was recorded during a webinar from Balchem’s Real Science Lecture Series.
This Real Science Exchange podcast episode was recorded during a webinar from Balchem’s Real Science Lecture Series.
Shakespeare wrote, “The eyes are the windows of the soul.” Dr. Ollivett believes the lungs are the window to calf health management. The lungs are an indicator organ: respiratory disease is a symptom of management failure. Failure of passive transfer, diarrhea, septicemia, poor nutrition, a dirty environment, and heat or cold stress can all negatively impact the lungs. Often, this can manifest as subclinical pneumonia, where the lungs are abnormal but the calf externally appears completely normal. (3:51)
Dr. Ollivett reviews the defense mechanisms of the airway. When a veterinarian takes swabs to assess a respiratory disease problem, the bacteria and viruses that live in the nasopharyngeal area just ahead of the trachea are the most representative of those bacteria and viruses that are present in the lungs. The bacteria and viruses in the lower nasal passages are unreliable indicators of what is present in the lungs. (6:28)
Is coughing a good predictor of pneumonia? Research shows that if calves are coughing, it is highly likely they will test positive for a respiratory pathogen. One study showed that coughing was the best predictor of observing pneumonia on lung ultrasound, but only 37% of calves with pneumonia on ultrasound also had a cough. Dr. Ollivett observed similar results in commercial settings, where only about 10% of calves with pneumonia on ultrasound had an accompanying cough. This suggests that a cough is not a good early warning tool for pneumonia. (10:29)
Dr. Ollivett believes respiratory disease exhibits an iceberg effect, where considerably more subclinical respiratory disease exists than clinical respiratory disease. She provides examples of necropsied lungs from dairy calves to emphasize the point that calves can appear completely normal, but have the same or more damage to their lungs compared to calves exhibiting clinical signs of pneumonia. In her work, Dr. Ollivett has found that the sensitivity of lung ultrasounds to find lung lesions in animals with subclinical disease is 88%. (16:32)
What does it take to perform a lung ultrasound? Dr. Ollivett gives an overview of the process and describes what normal and affected lungs look like. Depending on the farm, 50-80% of cases can be subclinical for one to two weeks before we see signs of pneumonia. With lung ultrasounds, you can treat affected animals sooner while also getting a good assessment of where management can improve to better prevent pneumonia cases in the future. (27:37)
The prevalence of the disease is roughly equal to the incidence of the disease times the duration of the disease. Prevention of disease reduces the speed at which disease occurs, thus decreasing the incidence of disease and lowering its prevalence. On the other hand, identifying sick calves sooner should reduce the duration of the disease, also lowering its prevalence. In addition, effective treatment that reduces the duration of disease supports antimicrobial stewardship. Dr. Ollivett details criteria to evaluate treatment failure in your operation, as well as discusses antibiotic therapy in conjunction with lung ultrasounds. (34:29)
Dr. Ollivett emphasizes the impact that the gut has on the lungs on most dairy farms. She feels that as an industry, we are far too comfortable with abnormal manure in 7- to 14-day-old calves. After any abnormal manure, calves are more likely to have abnormal lungs in the next couple of weeks. Ensuring good passive transfer and maintaining a clean environment will reduce lung lesions. (50:50)
To keep calves breathing easy, Dr. Ollivett shares recommendations to reduce management failures before, at, and after birth. These can include clean and adequate space in maternity, clean calf bedding and equipment, the excellent establishment of passive transfer, adequate average daily gains in early life, and routine lung ultrasounds. (53:21)
Dr. Ollivett answers questions from the webinar audience about evaluating treatment protocols for effectiveness, technicalities and landmarks of performing lung ultrasounds, how soon after birth to begin lung ultrasounds, using lung score to determine when to treat with antibiotics, and if lung ultrasounds could be used to cull animals with lung damage before they enter the milking herd. Watch the full webinar at balchem.com/realscience. (55:44)
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Introduction (00:00:00):
The following podcast is taken from a webinar presented by Dr. Terry Ollivett from the University of Wisconsin School of Veterinary Medicine. To view the full webinar and access the slides referenced during this podcast, visit alchem.com/real science and scroll down to the webinar presented on May 4th, 2023.
Dr. Terri Ollivett (00:00:22):
All right, well, thank you. It's great to be with everyone this morning and talk about something that I am, have become more and more passionate about over the last decade as we've learned more about how we can use this tool using lung ultrasound to monitor cattle health. Particularly right now, the emphasis is in young cow health, but this is a tool that can be used in adult cows as well. And today I'm gonna really be talking about, you know, how do we keep these animals breathing easier, using the lung ultrasound? And, and, and by, by breathing easy, what I mean is how can we detect disease sooner? And I wanna show you the audience, some, some different examples of using videos using pharm data to show you how, what subclinical pneumonia really looks like, how early we can detect it compared to clinical disease, and kind of what it means for you when you walk out into your barn when you hear a cough or see a sick calf. So hopefully I'll be able to provide some answers for you today and give you some food for thought to think about how, what you're doing right now to provide oversight of these animals in your, in your operation.
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Dr. Terri Ollivett (00:02:27):
I think many of us are familiar with the phrase, the eyes are the window to the soul. This is a Shakespeare phrase from a long time ago. And in my mind with young calves, young dairy calves particularly, I see the lungs as the window to calf health management. So when things go wrong in the lungs, it tells me that there's something going wrong in their environment. And I don't just mean the ventilation or the facilities, but everything around the life of that young calf, right? I think the lungs are what I call an indicator organ. So when I see respiratory disease in a calf operation or in a calf bar or in young stock, it really tells me that there's a management failure happening, right? The lungs and respiratory diseases symptom of management failure. So I, I will talk a little bit about the bacteria and the viruses that are involved in respiratory disease, but I tend to look at respiratory disease more holistically as a symptom of management failure.
Dr. Terri Ollivett (00:03:30):
For instance, I'm gonna list several things here that when they go wrong, we can see it manifests as pneumonia in the lungs. So if you have failure, pass a transfer. We tend to see higher rates of pneumonia in those calves. If you have diarrhea in your young calves, we tend to see pneumonia a week or so later. If you have septic calves, we end up seeing it in the lungs. If you have poor nutrition, a dirty environment, cold stress, even heat stress, we can see it manifest as pneumonia in the lungs. And more often than not, it manifests as subclinical pneumonia, which means the, the lungs are abnormal, but the calf externally looks completely normal. And, and because of this sort of mantra, I suppose I would say I've developed something called the wean clean philosophy, which means if we are managing calves properly, you know, to the best you know, to what they need, they're gonna get to and through the weaning period with clean lungs, right? So if we get calves to 60 days, 70 days, 80 days, however old they are, when you're weaning them and they have nice clean lungs, at that point, it tells me that things are working in your program, right? So just keep that tucked in the back of your mind.
Dr. Terri Ollivett (00:04:51):
In the next few slides, I'm gonna talk a bit about the airway defense mechanisms. Get into a little bit about the organisms that are involved and, and, and really focus in on, on coughing calves because, you know, for a long time, coughing is kind of that hallmark symptom that a cap has. Respiratory disease, of course, they can have a fever, they can be breathing heavy, they can be depressed, they might have droopy ears or a snotty nose. But I think cough is that one thing that we always associate with, oh, probably need to treat her. She probably has pneumonia. And I'm gonna get into a little bit of what the lungs look like in those coughing, coughing, calfs. So just to start with those airway defense mechanisms, thinking about how that calf is built in order to protect its lungs from disease. So in this slide at the top part where it says particle entrapment can think of this as starting at the, at the nose at the Aries.
Dr. Terri Ollivett (00:05:47):
So the nostrils and the nasal passages and the arrow goes all the way down into the deep, into the lungs. And so all the way along that path between the opening of their nose and their, their nostrils down to their lungs, there's different mechanisms in place. You have little hairs in your nose if the calves have little hairs in their nose that are gonna help trap particles to prevent them from going down. In the lower airway, you've got what we call the mucociliary apparatus and the cough mechanism, this is an a little function, a little escalator, basically on the surface of the respiratory tract that kind of constantly moves all the bad things that get down in the lower airway up and we can, and then the calf can cough them out. Down in the lungs there are products called innate defense proteins.
Dr. Terri Ollivett (00:06:31):
So there's a proteins that can help. Some of them have antibacterial properties. You've got cells down there, these alveolar macrophages. You've got neutrophils that can come in when an invader or pathogen has gotten down there. And the animal can then, you know, create that immune response to get on top of any infection or inflammation that's going on down in the lower airway. So there's pathways all the way down in the respiratory tract to try to help prevent bacteria and viruses from getting down there and to deal with them once they do get down there. And so what I'm looking at here is just kind of a a side view of a calf. So we can, I'm gonna talk about different parts of the respiratory tract. I just wanna show you what I'm specifically talking about. 'cause When we talk about where pathogens are or where bacteria are, it becomes helpful to kind of think and visualize exactly where on the calf we're talking about.
Dr. Terri Ollivett (00:07:22):
'Cause You'll often hear me, I'm gonna talk about deep nasal pharyngeal swabs. We'll talk about tra washes a little bit. But when we're taking deep nasal pharyngeal swabs, if you've done this or your veterinarian has done this, or maybe if you're not familiar with it that's a technique where we take a long, long swab and we are gonna go through the nasal passage through the nostril, and we're gonna sample the back of the throat here. So deep in the back of the throat just before the opening to the trachea. Number two here is that trachea. And if we go down that trachea or the windpipe that's heading down into the lungs, and so there's pretty good work that suggests bacteria and viruses that live back here in the nasopharynx are pretty similar to what we would find down in the lungs if we were sampling the lungs. Okay? That's important because you have to think about if you're a veterinarian or if you're a veterinarian on this call and you're taking respiratory samples. If we're taking upper airway samples, we wanna make sure that we sample an, an area that's gonna be most representative of what's going on in the lungs where the primary disease is happening. And that nasopharynx is a very good place to do that.
Dr. Terri Ollivett (00:08:29):
The nasal passages itself, we can take samples from there, but the bacteria, the organisms we isolate from the nasal passages, it does not correlate nearly as well with what we would find in the lung. So it's not as reliable and indicator if we're trying to determine a pathogen profile for what's causing respiratory disease in your calves and your farm. So what I wanna, what I did was I went through and looked at some research and again, trying to focus in on what, what, what does a coughing calf really mean, right? And there's a paper here from a few years ago now it's from 2010, where they actually looked at the cough sound description in relation to respiratory disease in calves. Again, remember with lung ultrasound, the whole premise of this talk is that we're thinking about how can we diagnose disease sooner? Okay? What does it mean when we see clinical signs, right?
Dr. Terri Ollivett (00:09:19):
Those visible signs of disease. So we're gonna focus on coughing here. And in this study, they had 12 weaned dairy calves that had clinical respiratory disease, which means they were visibly affected. So they had some clinical sign associated with respiratory disease, and in particular, they all had a positive cough. Okay? So you can, you know, these calves you walk in and they cough as soon as they see you. And what they found in this study was that these calves were very highly likely to have pastor Ada most commonly and more common than the viruses that we can see here. B-R-S-V-B-H-V-P-I three B, BD, hopefully if you vaccinate for respiratory disease, these four viruses look very familiar to you because it's gonna be in most of your modified live vaccines that you're using in these calves, okay? But more often than the viruses, these calves had pastoral moda, it's gonna be the most common bacteria that we see and in young calves respiratory disease, okay? So take home that I wanna tell you here is that those calves that have a cough all have some respiratory pathogen associated in their respiratory system. Okay? So, so if you hear a cough, cal cough
Dr. Terri Ollivett (00:10:47):
But then the next thing I wanted to know was, well, what do those calves, what do their lungs look like? Because just because a calf has a respiratory pathogen associated in its respiratory system, does that mean that they actually have pneumonia? Right? And so this is a study that was done in, oh boy just last year here in 2022, where they looked at the differences in the association of cough, other clinical signs, and they compared its ultrasound and lung consolidation in a mixture of calves. So dairy calves, al calves, and beef calves. This is a study out of Europe. And what they found when they looked at clinical disease versus lung ultrasound was that cough was the best indicator, right? So in that last study said if calves are coughing, weaned calves have a cough. They've got pathogens there, more bacterial than viruses, but they've got pathogens.
Dr. Terri Ollivett (00:11:45):
This study says if they cough, they are highly likely to have pneumonia. Okay? But it wasn't extremely sensitive. Okay? So cough out of nasal discharge, ocular discharge, ear position cough was the best clinical indicator to say that they had pneumonia on the ultrasound, but only 37%. So out of a hundred calves that had pneumonia on the ultrasound cough only found 37 of them. Okay? So still not a very good test for finding calves that truly have pneumonia, okay? Right? So that's what that's saying. Over here on the left hand side in the red coughing, calves have ultrasound and graphic lung consolidation, which means pneumonia, but most consolidated calves don't cough, right? It's not a good early warning tool. And what I wanna show you is some real life lung ultrasound data from a herd here in Wisconsin that does routine lung ultrasound scores, right?
Dr. Terri Ollivett (00:12:46):
And I'll get into the details a little bit more about what these lung scores mean, but for right now, I just want you to know that a score is zero means the lungs are completely normal. A score one means they're very mild changes, they might be a little bit associated with viral disease but typically quite mild changes. Score two through five means that calf has bacterial pneumonia. A two is very mild bacterial pneumonia, and five is very severe bacterial pneumonia. Okay? You can see the number of animals that we scored and the percentage of animals that had each of those lung scores. So most of the calves out of these two over 2000 animals were in that score two or score three category if they weren't normal. And what I'm also showing you is a number of calves that were coughing in each of those categories and the percent of calves in that category that had a cough, right?
Dr. Terri Ollivett (00:13:42):
And what we found here is that yes, if they had a cough, they were 2.1 times as likely to have pneumonia, okay? But when we looked at the whole picture and again looked at the sensitivity, so of all of the calves how sensitive was cough in identifying them with pneumonia? The sensitivity was only 9.7%, so about 10%. So in our real life, you know, commercial herd routine lung ultrasound scanning that we're doing, if a calf was coughing, highly likely that it had pneumonia twice as likely to have pneumonia than a calf that wasn't coughing. But only 10% of the calves of pneumonia were coughing. Okay? So somewhat similar to that last study where if they cough, they're likely to have pneumonia, but if they don't cough, it really tells us nothing. Okay? Again, it's about that subclinical pneumonia. Subclinical means they don't have any visible signs of disease.
Dr. Terri Ollivett (00:14:46):
And so it should make perfect sense that there are a lot of calves out here with pneumonia that don't cough. Okay? Alright. So I'm gonna show you some videos here to kind of highlight that difference between clinical and subclinical pneumonia. So we've got three calves here, and I think about this as a bit of an iceberg effect. So, you know, we talk about iceberg type diseases. A lot of times we have mastitis, right? Subclinical mastitis, you have a lot more subclinical mastitis than you do clinical mastitis, yoni's disease, you have a lot more subclinical yoni's disease than you do. Sub a lot more subclinical yoni's disease than you do clinical ketosis. There's a lot more subclinical ketosis than you have clinical ketosis. And now that we have ultrasound available to us, we can now say the same thing for pneumonia. We have much more subclinical BRD subclinical pneumonia that iceberg underneath the water compared to clinical BRD.
Dr. Terri Ollivett (00:15:46):
Okay? Now we have a tool that we can actually use to find it because we're not gonna rely on what the calf looks like, but instead we're gonna rely on what the lungs are telling us. And so these three calves, this calf on top, this is a five week old calf, this is pretty textbook respiratory disease, right? We've got a calf, if you were to feel its top line is very thin, you can see it's when it stands to the side, it's very has its head and neck stretched out. Its ears are droopy, it's breathing labored, it does not wanna move. This calf is very sick and there's usually no trouble in saying, okay, this calf probably has pneumonia. Well, then we have this calf in the middle. You'll notice hopefully the video is playing at the same time as mine. That I just induced a cough in this calf.
Dr. Terri Ollivett (00:16:31):
This is a 10 week old calf. You see she's got droopy ears. I'm inducing a cough. And here she coughs multiple times. So based on our University of Wisconsin calf health score, the clinical respiratory score, she is positive for clinical respiratory disease. She has multiple inducible coughs and she has bilaterally, or she has both ears are droopy. Okay? So she has visible signs of respiratory disease. The reason I'm looking at this calf on that day at my visit to the farm is because she's so small. So this calf actually weighs 105 pounds, and I told you she was 10 weeks old. She should be just about as big as this heifer here on the back at 10 weeks old. You know, if they're growing according to our gold standards where we want them to double their birth weight by eight weeks of age, this calf should probably weigh at 10 weeks old.
Dr. Terri Ollivett (00:17:19):
She should probably weigh around 210 pounds. So she is severely stunted, okay? She has clinical respiratory disease today, okay? And so one might think that, well, she probably is a chronic pneumonia and that's why she's so small. Well, the calf on the bottom is a three week old calf. And once the video catches up, you can see I accidentally hit the slow, slow mo button for, for extra dramatic effect here. But this calf is sucking on my finger, chasing me around her pen. Happy, happy, happy. No cough, no nasal discharge, no droopy ears, no fever, just happy as a clam. All right, well I have the, I had the opportunity to, well, the first calf, the second calf needed to be euthanized, right? These were chronic poor doing animals. So they were both euthanized and I necropsy those animals. So you can see what their lungs look over on the right hand side of the screen.
Dr. Terri Ollivett (00:18:16):
This bottom calf here, although happy looking, I knew based on ultrasound that this calf had severe pneumonia or I was highly suspicious of it. This was very early on in our research on using lung ultrasound. And so because this calf was a research calf, we did euthanize this calf and do a necropsy so that we could confirm that what we saw in the ultrasound was indeed pneumonia. Okay? So what I want you to think about is, if you had to pick which one of these three calves had the worst lungs, most of you would probably say one or calf two, calf one or calf two. Most people, unless they know it's a trick question, would never say that calf three has the worst lungs. And when we look over here on the right hand side and we see the lungs of each of these calves taken from the same day that video is taken, I'll orient you just so you really know what you're looking at here.
Dr. Terri Ollivett (00:19:06):
We're looking at the right lung where the calf is laying on their left side. So the head would be over here to the right of the screen or the right of the image. The tail would be to the left of the image, the top of the picture. It would be like the spine, and then the bottom of the image is the sternum. And so we've lifted the rib cage up and we're looking down into that right lung where we have one lung lobe that's completely consolidated. It's red and firm right here in front of the heart, which is located right here. We have a normal lung lobe right here, just behind the heart. Then we have a second lung lobe that's completely consolidated here behind the heart, and then more normal lung up here towards the back. So for this first calf with two lung loaves completely consolidated like that because each of these lung loaves is roughly about 6% of the mass of the whole lung, we can say that there's 12% of the lung affected in this first calf.
Dr. Terri Ollivett (00:20:00):
Okay? Hopefully that makes sense to you. Let me go to this middle calf who looks like she's got chronic stunting pneumonia, and we look at her lungs and we only see a few small, what I would call lobular lesions. So maybe one or 2% of the lung is affected, right? I call the, the first calf has low bar pneumonia where the whole lobe is affected, right? Second calf has a lobular pneumonia, very mild pneumonia, only one or 2% of the lung affected. And then we come to that third calf. And again, we have one lung lobe completely affected, and a second lung lobe completely affected. So again, this calf is probably in that 12% lung affected. So the first calf and the third calf have similar amounts of lung affected with pneumonia and look completely different clinically. So that's the take home. This third calf down here on the bottom, this is what subclinical pneumonia looks like, right?
Dr. Terri Ollivett (00:20:58):
You can't pick them out, right? They are prey species. Part of my rationale for why calves do this, they don't want to tell you they're sick, right? Way back when, when they were trying to prevent themselves from being chased down by some wild predator, they didn't want to give any indication that they were sick. Okay? I, I think that's probably why we see subclinical disease in these animals because they are trying to hide the fact that they're not so fit right? And we can't shame farm employees. We can't shame veterinarians for not picking up on these clinically because they just don't have clinical science to tell you that they're sick, but yet they can have extremely abnormal lungs, right? When I talk about the scoring system that I use I referred to it earlier as score zero through score five. And I'll just show you what the lungs look like for each of these scores.
Dr. Terri Ollivett (00:21:54):
So again, we're looking at the right lung oriented, just like I showed you in that previous slide where for each image, the head would be to the right and the tail would be to the left, the spine is up at the top of the picture, and then the sternum is down here. So we're looking into that right lung. A score zero is gonna be nice, spongy pale pink lung. A score two is gonna be that lung, very small patches of lobular lesion. This is a score two in the upper right hand picture, which is just a slightly larger score. Two. So there is quite a bit of variability in a score two calf, you can have a few centimeters of disease or you could have 10, 20, 30, or 40 centimeters of disease. Okay? These red firm areas, A score three means that that calf has at, has one lobe that's completely consolidated.
Dr. Terri Ollivett (00:22:41):
A score four means there's two lobes consolidated. And score five means that there's at least three lobes completely consolidated, right? And when it comes to pneumonia in these young calves, these lobes, this pattern of disease is extremely repeatable, extremely similar from calf to calf to calf. When it comes to bacterial pneumonia, bacterial pneumonia likes to start in this front lobe first in most calves. And then we see it in this lobe here, the right middle lobe, and then the lobe in between, we'll see it as well. So if there's one place that we're gonna look to find pneumonia, it's gonna be up here in the front of the heart. We're the most common place to see pneumonia.
Dr. Terri Ollivett (00:23:29):
Now you notice there's not an ultrasound score one picture in here, and that's because in young dairy calves, we just don't see very many ultrasound score One lesions. That ultrasound score one is typically it's gonna be viral in nature or it might be secondary to septicemia. It's a heavy, wet, rubbery lung. We call that interstitial pneumonia versus broncho pneumonia that we're seeing here. And in young dairy calves, we just don't see very much of that. Maybe one to two to 3% calves will have that kind of a pneumonia. If we do see that in a, in a dairy operation or in dairy calves, then we really gotta start thinking about other diseases that mimic respiratory disease like salmon, osis, semia. And, and again, yes, viral disease can do it. If you happen to be raising Babs that aren't vaccinated because they're gonna go to a stud, then we might see a little more viral disease in those young animals.
Dr. Terri Ollivett (00:24:27):
But for the most part, your dairy heifers that we're raising that are pretty well vaccinated, we don't tend to see a lot of the ultrasound score. One disease in our work has shown that the sensitivity of lung ultrasound to find these lung lesions in, in animals without subclinical disease or even if they do have clinical signs, it's gonna be greater than 88%. So that means, you know, if the animal looks sick or even if the animal doesn't look sick, we're gonna find at least 88 out of a hundred of them with our lung ultrasound. Okay? So remember what we saw back a few slides ago about how sensitive the cough was. We're much more sensitive or much more capable of finding capsular pneumonia. When we used the lung ultrasound I think the sensitivity was about 35% were cough. Clinical signs were probably up around 60 to 65% sensitivity.
Dr. Terri Ollivett (00:25:19):
So if a calf has multiple clinical signs we can find 50, 60, 65 out of a hundred of them. Okay? So hopefully you're getting a picture that the ultrasound is a much more sensitive tool. If you're using, I'll just go back one slide to further emphasize this point of how sensitive lung ultrasound is. You know, we as veterinarians like to wear a stethoscope. And so how good is that stethoscope of finding these lesions? Well, the sensitivity of stethoscope is only about six to 10%. Okay? So using a stethoscope, we only find six to 10 calves out of a hundred that have these lung lesions. Okay? So not very sensitive at all.
Dr. Terri Ollivett (00:26:01):
So what am I looking at on the ultrasound? So here on the left, the video is playing for you. Just gonna show you what it looks like to ultrasound a young dairy calf. So this is a one man job. We restrain, we do the scan, we enter the data into an app that we have on our phone. This is a student who I think this is his second day learning how to scan. By his third day, he's gonna be even faster. I expect to be able to scan about 30 to 40 calves an hour without a helper. With a helper you can be up in the 70 to 80 calves an hour. This is a tool that's meant to be fast and meant to be done on large groups of calves in a short period of time. Okay? So we just get that calf in the corner, put some alcohol on the side of its chest, and then we use our ultrasound, the same ultrasound that your veterinarian uses to diagnose pregnancy in a cow.
Dr. Terri Ollivett (00:26:52):
So using that rectal probe. And what we can see are the images shown here to the, to the right. I'm gonna pause this one on the right and actually go back here. So if we look at the loop on the right, that's the normal lung and I'm showing you this is one lung lobe. Here's a second lung lobe, the same third lung lobe, fourth lung lobe, fifth lung lobe. Back to the front. This is the whole scan, what you've just watched. It takes about 15 seconds to do a scan from the front to the back of the calf. And what I want you to appreciate on this video here, I get to the right loop, is there are a lot of horizontal white lines. This bright white line is the surface of the lung. And then when we see horizontal white lines underneath it, that tells us that lung is air filled and that lung is normal and that's gonna be compared to the lung onto the left.
Dr. Terri Ollivett (00:27:51):
So I'm gonna get these in the anatomical correct location. Okay? So these two images that you're looking at here are anatomically in the same spot on two different calves. So we're looking at the lobe right in front of the lo in the heart. I see a vessel right here, just the same vessel over here that tells me I'm looking at the cranial cranial lung lobe. And in the calf on the right I see horizontal white lines and the calf on the left that has broncho pneumonia or bacterial pneumonia, I now see the architecture of the lung. It's this gray kind of speckled appearance. I can see a blood vessel in the middle of the lobe that's pulsating and when the clip is live. And so I'll let this go and you can see here's consolidation. There's some normal lung. Here's consolidated lung, normal lung consolidated lung, normal lung consolidated lung, and then a big lobe of consolidation.
Dr. Terri Ollivett (00:28:46):
So this calf I just showed you in that ten second clip has three lung lobes that are completely consolidated. So it's a score five. Okay? So again, just so you can get a visualization of what the difference between abnormal and normal is between these two calves. Now normal calves do have this structure here. This is the liver. So this is why ultrasound takes some training because liver looks a lot like consolidated lung. All right? So we need to make sure we don't make that mistake. Alright, so that calf that I just showed you, that was an ultrasound score five, here's the abnormal lung, abnormal lung, more abnormal lung, and more abnormal lung. So what I just showed you was this lung lobe, the right middle lobe, the fifth rib space showed you the fourth rib space, the third rib space, the second rib space, and the first rib base.
Dr. Terri Ollivett (00:29:42):
It's very systematic. When we do a scan, I can tell you exactly what lobe is affected and how severely it's affected with the technique of ultrasounding that we do. And that's why it's such a good indicator for pneumonia. Okay? All right. So I just showed you a little bit of what the ultrasound looks like, the sensitivity of it. We're gonna talk here in a little bit about treatments and some more information. But I did wanna point out here that because right, we're, we're detecting disease after it's already happened. And a lot of folks would say, well, you know, we need to be preventing it. It's why, you know, we need to make sure that it doesn't happen. And that's absolutely true. So even though I'm gonna focus on detection of disease here, prevention, everything you hear about maternity management, passive transfer, hygiene, nutrition is absolutely critical, okay?
Dr. Terri Ollivett (00:30:31):
And we're gonna get into that towards the end of this talk. But because depending on the farm, 50 to 80% of cases can be subclinical for one to two weeks before we see them, alright? So we may not even understand the full extent of the problem if we're not looking for it. Okay? If it takes us one to two weeks to identify pneumonia in a cath because we're waiting for them to look sick, we're already one to two weeks behind getting them treated. We're already one to two weeks behind getting a good response to treatment because they're already becoming chronic by the time we see them. Okay? Failure to cure and relapse of those sub clinicals to become clinical or relapse of the clinical cases after treatment can happen right underneath our nose because we're so late to be treating them when we're working just off clinical signs. Alright? So the lung ultrasound, we can use that to see what you as a veterinarians, you as producers might be missing right in your system. Remember I said the lungs are an indicator of management failure. If we start looking at the lungs, you'll get a better handle on what is going right in your operation and what is going wrong.
Dr. Terri Ollivett (00:31:48):
Now I put this little caveat up here about salmonella. Now when I say 50 to 80% of calves are are subclinical for a week or two before we see them, that's with typical Ella pneumonia. The bacterial pneumonia is mania. Mycoplasma, salmonella. If you are dealing with salmonella, septicemia, salmonella, Dublin, salmonella, Newport, tyria in young calves, these calves can really look sick. They look visibly ill. They look like they have respiratory disease, they're droopy, they're breathing heavy, they have a fever, they might be coughing. Oftentimes those salmonella calves, their lungs don't look that bad, okay? So that changes a little bit of the relationship. There are operations that do have a bigger salmonella issue than they do pastor, but the ultrasound helps you and your veterinarian sort that out so you can manage it differently, alright? And when we are able to identify who is affected with disease more accurately we can do something about it, right?
Dr. Terri Ollivett (00:32:52):
So, 'cause I I did a PhD in epidemiology. They told me I have to put some epidemiological equation on the screen at some point during my talk. So you guys are my witnesses that here is my, my epi snippet of the day. What this equation says is that prevalence, so that's the amount of animals with existing disease is roughly equivalent to the incidents or how fast they get disease times the duration of disease. Okay? Let that sink in a little bit. How many calves currently have disease is related to how fast disease occurs and how long a calf has disease. So when we focus on prevention, we're gonna reduce the speed at which disease occurs. So we're gonna cut incidents, which is then gonna drop prevalence. But if we get calves identified early, get them treated properly, we're gonna in theory cut the duration of disease, right?
Dr. Terri Ollivett (00:33:53):
So if we can cut the duration of disease, that's also gonna decrease prevalence. So both prevention and proper treatment are gonna be associated with the level of overall disease that you have on the farm or in your operation, right? Effective treatment that reduces the duration of disease supports and the microbial stewardship as well, right? We have more and more prop, more and more pressure to use antibiotics properly. And this is one way that we can ensure that we're doing them. Alright? So to put this in practical terms, what does that mean for you? Think about in your own herd, this is just a simple example to put some numbers to it. So a lot of times calves when we start looking with the ultrasound calves will be developing pneumonia by week three of age. So between 14 and 21 days of age, and let's say for this operation, you get five new cases of BRD of pneumonia per week, right?
Dr. Terri Ollivett (00:34:46):
So five cases, five cases, five cases all the way up to we at week eight. So the middle row, this is meant to show you a herd that has a good cure rate, meaning that 80% of their calves respond to treatment after the first time they're treated. So let's say we get all of these calves treated and 80% of them respond. So that means for the five new cases, four of them respond to treatment each week. So by the time we get to weaning, there's, there's gonna be our five new cases, but because there's one chronic leftover from each week, we've got five chronics. Okay? So 10 cases for herds that have bad cure rates because they don't detect disease soon enough, let's say 40%, they're only gonna cure two calves per week, which means that by the end of the weaning period, or by week eight, they're gonna have 15 chronics, all right?
Dr. Terri Ollivett (00:35:41):
Versus five chronics for that herd that has good treatment response. So I just wanna use this to visually show you that if you get good treatment response at weaning, you should have more calves weaning with clean lungs again, which is our goal. If we can get them to wean with clean lungs, they are less likely to flare up after you wean them. Meaning is that stressful period where everything changes, right? Their diet changes, their facility changes, their friends change, they go from individual housing to group housing or small group housing, the large group housing a lot of stress happens. And so if they have subclinical pneumonia or anything brewing at that time, we add that stress to them and then they flare up and become clinical afterwards. So by getting them to that time period to that transition period with cleaner lungs, we should have less problems in the postan period.
Dr. Terri Ollivett (00:36:34):
And it helps again with this antimicrobial stewardship, right? If we're gonna treat calves, we better hope that we're actually fixing the problem in their lungs with our antibiotics. Otherwise, it's a lot of drug to use, it's a lot of labor to get them treated and it's a lot of pressure from an antimicrobial standpoint when it comes to antibiotic resistance. Alright? So how do you know if you have some evidence of treatment failure in your operation? So some things that I think about if you're treating a lot of calves multiple times, right? I don't know what the exact number is, but most literature you'd see would probably say that most, like on average 25% or more get retreated. That's based on clinical disease. To me we gotta figure out, out what that number is exactly, but if you, you gotta and figure out what it is for you and your operation.
Dr. Terri Ollivett (00:37:19):
But if you feel like you're treating too many cabs for clinical disease, if you've got poor growth, if you have mortality due to respiratory disease mortality, you know, when it comes to respiratory disease, most calves don't die immediately from pneumonia, right? So keep in mind it, it may be delayed weeks to months, right? Because it really takes chronic chronic disease to kill a calf. So if you're getting deaths in your two, three or four month old calves, you may have to back up and look at your pre-weaning h calves to figure out that it's actually respiratory disease starting earlier that's causing death later on. High prevalence of subclinical pneumonia, meaning, so if they're getting treated but they're not responding and they're not meaning clean. Or if you don't have good resolution with seven to 10 days after treatment of the first case of disease, right?
Dr. Terri Ollivett (00:38:06):
So when I see these things suggest to me that we have some evidence of treatment failures in addition, if you have a positive bacterial culture from lung tissue, so you do do an necropsy following treatment, that's another indicator of treatment failure. Alright? I, I keep track of my time here guys 'cause I could keep you all day if I had that opportunity. So let's talk a little bit more about respiratory disease and antibiotic therapy. So in general, this is just my little schematic to show you how I think about what we're doing when we treat these calves, right? So this calf in the upper left big snotty nose have clinical respiratory disease. We can see the pneumonia in this left lung here, this red firm tissue in multiple lobes. And there's gonna be bacteria down in that lung lobe that is causing the recruitment of white blood cells and which is results in this consolidation or this red firm lung tissue, right?
Dr. Terri Ollivett (00:39:01):
So that bacteria, the reason we're giving an antibiotic, right, the therapeutic is because we wanna kill the bacteria that's down in the lung. And if we do that, and if we are successful in killing the bacteria down in the lung, or at least getting it to a level where then the body can take over and finish doing the job, the rest of the way the neutrophils or the white blood cells that are causing this consolidation those will eventually go away. The lung can become re aerated and become normal looking again, right? So if we are doing things right, this is what we should see. So this is proper treatment response, right? So on the ultrasound, what this calf in the upper middle picture would look like is just a big consolidated lung lobe. And then once that calf is responded to its treatment, we should be able to expect to see normal lung on the ultrasound.
Dr. Terri Ollivett (00:39:54):
Now, what we found over the last several years is that's just not always the case. So this is a challenge study where we infected calves with pasteurella ada, one of the most common bacteria to cause pneumonia. And we did this because we wanted to look at the effective treatment. And so we had 17 calves that were given ampicillin or poly fluex. This was a bi sponsored study for full transparency. And we had 11 calves that were treated with saline. And I know it's small, but you can see in here on the wa on the x axis of each of these figures is just time relative to challenge. Okay? And on the y axis for the top figure it says ultrasound score three plus that's the percent of calves that had low bar pneumonia. And I've just shown you images over here of what an ultrasound score three or higher calf can look like.
Dr. Terri Ollivett (00:40:43):
So pretty significant pneumonia. And so here the dark gray calves are saline treated calves. The light gray bars are the, are the antibiotic treated calves before challenge. So minus one day, then the calves were challenged, there's no pneumonia in those calves. Then we take samples or we take our ultrasound measurements two hours, six hours, 12 hours and then once a day for 14 days after that challenge. And what we can see is the saline treated calves and the antibiotic treated calves, they both develop pneumonia can be as early as six hours, but by 12 24 36 hours or seeing a large proportion of calves with low bar pneumonia, okay? Some, you know, roughly 70% of those calves had severe pneumonia at that point. But then we see the proportion of calves with low bar pneumonia drops precipitously between day two and day five and day six in those antibiotic treated calves.
Dr. Terri Ollivett (00:41:42):
Now these calves would've been treated right around the 12 to 24 hour time point. Their first time of treatment, they would've gotten treated once a day for three days. So by day, let's see, 1, 2, 3 by day four, everyone probably had their antibiotic at that point. But we can see the proportion of calves with severe pneumonias going down and then it stays low so that only one out of 17 antibiotic treated calves had severe pneumonia at this 0.6, seven, eight days later. Where you can see during that same time period, the saline treated calves really didn't have much of a diminishment of their low bar pneumonia. Stayed pretty consistent throughout the study. And so when we first saw this, this looks great for ampicillin, this looks like, hey, ampicillin is doing a good job. We're getting a significant improvement in the percentage of calves with severe pneumonia in the first few days of treatment.
Dr. Terri Ollivett (00:42:35):
Okay? But what we saw here because we continued to monitor these calves with ultrasound is that around day nine we started to see an uptick again. So that by day 14 we actually could not tell a difference between treatment groups and the percent of calves that had low bar pneumonia. All right? So good early impact of the antibiotic, but we had a relapse here. Okay? So, and when you look down in the bottom figure, this is a percentage of calves that had clinical disease. A couple things I want you to take away from this is that there was not nearly as much clinical disease as there was pneumonia. You can see the bars are much shorter here on the clinical disease figure compared to the pneumonia figure. And the response is very variable, right? It's hard to say see any pattern between one group looking better than the other.
Dr. Terri Ollivett (00:43:26):
Sometimes the saline calves were higher, sometimes the antibiotic calves were higher. So if we had only done clinical picture for this study, we would not have been able to see any pattern of pneumonia whereby using the ultrasound we could see the progression of disease, the onset, we can see the resolution of disease and then we can see the relapse of disease. That is the power of using ultrasound that you can with detail measure the changes in the lung in response to an intervention like this. Okay? Again, these are what some of those lungs look like at the end of that study. So significant pneumonia despite treatment and when we looked at cultures of those lungs on day 14, the percentage of calves that had culturable sali, pastoral melsa in them was not significantly different than the calves that were not treated. So we gave antibiotic but we did not result in improved bacterial standpoint in the lungs.
Dr. Terri Ollivett (00:44:26):
Okay? This is PCR and the same samples again, similar, we see similar amounts of PCR positive calves, whether they were treated with an antibiotic or not. Okay? We repeated this study several times or repeated this challenge model several times. And you don't need to know the difference between the blue and the and the yellow bars. But what you can see here is again, we bumped the, the dosing up, we went to the high end of the dose, the long end of the duration, but we still saw a relapse in these calves. And then it wasn't until we went to twice a day, which is off-label, which you have to talk to your veterinarian about doing. Did we see a relapse or disease not occur? So my take home point of these slides and this information is that not only does subclinical disease exist, right?
Dr. Terri Ollivett (00:45:15):
Treatment failure exists, but we can't always see when it's happening because the calves are subclinical the whole time. Okay? So we can get some response and then we can get some relapse without happening without knowing it's happening. If we use the ultrasound, we can figure out what treatment protocol works best for our caps. Okay? We have objective evidence to say we need to do this treatment protocol, okay? Instead of just guessing when the companies that made the antibiotics that we have available to us, we're studying them, we're figuring out the dosing protocols. Ultrasound wasn't a thing back then using lung ultrasound. It was all based on clinical signs. It was based on the presence of a high fever or the presence of difficulty breathing or depression, right? So the dosing strategies that are on the labels for these drugs aren't intended or don't necessarily focus on treating lungs, treating infection at the lung level.
Dr. Terri Ollivett (00:46:11):
So that's why we need to use the ultrasound now on your farms, on your operations to really figure out is what we're doing actually working, right? This is a field study where we really showed the same thing. These calves were scanned twice a week every week until about 52 days of age when they had their first bout of respiratory disease. A little more than half of 'em were clinical, a little less than half of them were subclinical. By the time they got to weaning only 15% were clinical now, but we had 65% of the calves that were still subclinical despite being treated. And, and to make this picture even worse, so 80 per these, all these calves got treated, 80% of these calves got treated twice. 65% of these calves got treated three times, right? So they went drax, baal, nlo. Okay?
Dr. Terri Ollivett (00:47:02):
So good drugs. I'm not throwing any drugs under the bus here. But we could document relapse or recurrence or just continuation of a case of pneumonia. Even though now it's gone subclinical when we use that ultrasound, right? And why do we care about about that when cals have subclinical disease at the weaning period, more likely to become clinical in the post weaning period. And this is a lot of disease to still have present when a calf has been treated three times already, right? So three courses of antibiotics, 80% of the calfs still have pneumonia. Okay? So you gotta figure out, is this happening on my farm, right? If we're just going based off the clinical signs, we still have a lot of false security that things are doing okay, right? And again, knowing whether or not these calves wean clean is important.
Dr. Terri Ollivett (00:47:52):
Just gonna go through some slides here to show you and a, a real dairy what their treatment looks like when we have started weekly scanning. And what I wanna show you here is just how volatile lung lesions are, right? From week to week to week to week, okay? Here's pneumonia treatments by month, again, up and down, up and down, initial distribution of age at first treatment that is this was gonna be prior to initiating lung ultrasound into their program. So you could see that calves were getting treated around a month of age. When we implemented lung ultrasound on a weekly basis, we could see that now calves are getting treated by about 10 to 20 days of age. Alright? So using that lung ultrasound in that commercial setting, co scanning the high risk calves every week, we're able to bring the treatment age down from instead of 35 days, we brought it down to 20 days.
Dr. Terri Ollivett (00:48:54):
And calves are growing better, they are less likely to get pneumonia in the post reading period. We're using a lot less drug because we're treating small calves. All right? So I think I am beginning to run out of time. I just want to just quickly touch on something here. And I know this is about respiratory disease and using lung ultrasound. But when it comes to raising these calves, the impact that the gut has on the lungs I think is astronomical on most dairy farms. So I think in general as an industry, we are far too comfortable with abnormal manure in these seven to 14 day old calves, right? Rhoda, Corona, crypto salmonella, we say every farm has 'em probably, but not every cash should have it. And not every cash should have abnormal manure, any abnormal manure and the calf can be bouncing around its pen.
Dr. Terri Ollivett (00:49:42):
But any abnormal manure, these calves are more likely to have abnormal lungs within the next couple weeks. So it's really important. Make sure you understand what your calves look like from a a manure consistency standpoint. When I go to a farm to work up a pneumonia issue, I often end up working up a GI problem, right? Because it goes undetected in so many cases and it has such a strong relationship with the onset of pneumonia that if I can just fix calfs, they don't have abnormal manure, I usually don't have to do anything. And then pneumonia takes care of itself. Passive transfer is the same way. Make sure you're adhering to the new standards. For passive transfer. Raising the bar, getting 70% of your calves above 5.7 40% or more of your calves above 6.1. You'll see an improvement in your lung diseases, in your lung lesions.
Dr. Terri Ollivett (00:50:33):
And we're gonna get there by making sure calves get four liters of corum in the first couple hours and then a by a tube and a second meal by bottle, by nipple bottle at about 12 hours. Alright? Keeping that environment clean is extremely important. I don't have time to finish going through all of these slides, but from the first point where that calf comes into the, into the world, whatever it comes across on the way to the calf barn, wherever it lives, we need to make sure that the environment and feeding equipment are extremely clean. I put this up here because I think this is an extremely good resource for producers. This is from Dr. Jennifer Van oss. We collaborated with Dr. Socket to create some fact sheets that she has available on her website under animal welfare at Cas Cals in at Wisconsin.
Dr. Terri Ollivett (00:51:24):
Six or seven different fact sheets. The hygiene one goes through in detail how we think calves environment and calf feeding equipment should be clean. This is really important. We can use luminometer to make sure that it's working effectively. And so sorry to kinda rush here at the end, but we do need to make sure that in order to keep them breathing easy, right? We have to of course use the ultrasound to make sure that we're we're detecting disease. But use that ultrasound to know when problems are starting, know when management failure is happening and where does management failure happen? It can happen before birth, right? It can happen when we get too many animals calving in at once. We don't have enough space in maternity. The bedding gets dirty, the calves get dirty when they're born into that at birth, right?
Dr. Terri Ollivett (00:52:13):
They could be born into that dirty environment. We can not meet our past transfer girl goals. We can have them cold stressed and then after birth making sure that they're growing at least a pound a day in that first week. Regardless of weather. We need to make sure we're feeding enough, feeding enough volume, feeding enough pounds making sure that we're doing it consistently the same meal the same way every day. Deep straw bedding, jackets as kneading, cleaning appropriately and monitoring, using that ween clean routine to figure out when disease is starting and whether or not things are working properly to prevent the antibiotic pressure on the calf biome. So with that, I apologize for kind of rushing through the end. I'm happy to take whatever questions there are.
Dr. Terri Ollivett (00:53:04):
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Speaker 3 (00:54:07):
Dr. Olive, our first question comes in from Steven and he's asking, what is your goal for treatment success for a specific treatment protocol with only one treatment? How should we assess if our treatment protocol is effective?
Dr. Terri Ollivett (00:54:21):
Yep, that's a really good question. And take a couple things into account. First we wanna make sure it's the first time the cap has been treated, okay? And what my recommendation generally is that we go to a farm or you go, a vet goes to the farm and I'm not sure if you're a veterinarian or producer or a nutritionist, but the vet gets to the farm, gets a list of calves that were just treated for the first time today or yesterday, scans those calves, figures out what their scores are and then they're gonna come back the following week. So come back seven to 10 days later and re-scan those same animals, re-scan the ones that were treated for the first time. And again, see which ones have improved, what percentage has improved. And I would like to see 70 to 80% of those calfs. So most of those calves to have significant improvement in their lung scores. So, and, and down to almost zero. So if, even if they're score five, it's the first time they've been treated and it's not chronic, meaning they're not small, they don't have thin top lines, they haven't been treated already a bunch of times. If it's a new case of disease and a young preen dairy calf, I expect 70 to 80% of those calves or more to have almost normal lungs scores. 70 to 10 days later, maybe up to 14 days.
Speaker 3 (00:55:39):
Alright, very well. Next question comes in from Dorte. How can he assess the cranial pars of the cranial lobe? Do you have the textbook pictures for the different ICS that I can use as guidance?
Dr. Terri Ollivett (00:55:53):
Yeah, I'm just gonna can you guys see my screen again?
Speaker 3 (00:55:58):
Yes. Mm-Hmm,
Speaker 4 (00:55:59):
Dr. Terri Ollivett (00:56:02):
So when we watch what I want you to see when, when Austin scans this calf, she gets, let me just press forward a little bit here. Just gonna put the alcohol on there. The key to, first off, the key is knowing your landmarks. Each rib space has a specific ultra sonographic landmark that tells you where you are. So you don't have to count spaces. And so when we're, for instance, I'm gonna show you on this right hand image here. Lemme get up there. So there we go.
Dr. Terri Ollivett (00:56:53):
So in this first image on the right hand side where I see these vessels, I know I'm in the first rib space. Okay? It's a little hard to get me to stop. There we go. We have lung steps down and around these two vessels. Those are my landmarks that tell me. I'm looking at the lung lobe in front of the heart, the right cranial cranial lung lobe. And the way you're gonna do that, you can see Austin's hand is on the side of the calf's chest, that right cranial cranial lobe. The first rib space is way up underneath that for, so he's going to push his hand up underneath the triceps of that calf, so up underneath the elbow in order to see that. But he's gonna watch his landmarks as he goes from rib space to rib space to rib space to be able to see that that spot calves, pre-weaning calves, they're pretty flexi bendy.
Dr. Terri Ollivett (00:57:37):
So adult, it does take some effort to get up there. It is possible in adult cow. We are not gonna be able to get up to the first roof space from going behind the arm like that. We're gonna actually have to come in front of the leg to see that roof space up front. So if I play this normal image again, and I'll show you, this is one, this is one rib space. It's the, probably the sixth rib space. This is the fifth rib space, fourth space, third space, second space, and first space. So just by looking at the landmarks I see on that screen, which I'm not telling you what they are right now, but we know where we are. If you go, I'm gonna stop sharing here for a second. If you go to our dairyland initiative website
Dr. Terri Ollivett (00:58:23):
Google Dairyland Initiative website calf help module, wean clean, I have a training video there that will go through all of the landmarks and provides videos and shows you how to do the actual technique. It does take some handholding. And it's not something that I would expect somebody to be able to do without somebody that's already been trained working with you to do that because it's really easy to see what you wanna see on an ultrasound and you don't want to misdiagnose a calf with bad pneumonia just because you don't realize you're actually looking at the liver that has happened. Cats have died and been euthanized because of veterinarian, saw a liver on ultrasound, not realizing the landmarks they were looking at were incorrect. So there is any of my materials online or you can contact me or have your veterinarian contact me. I'm happy to help figure out how to get you trained.
Speaker 3 (00:59:13):
Alright, thank you. Dr. Olive, I see we've crossed the top of the hour. I wanna be respectful of your time. Do you, do you have a few more moments for some more questions?
Dr. Terri Ollivett (00:59:21):
I have plenty of time for questions. No rush. Alright.
Speaker 3 (00:59:23):
Very well. Next question comes in from Jos Jose how many days after calving should I start with the ultrasound protocol?
Dr. Terri Ollivett (00:59:33):
Yeah, that's a great question. And part of my, I should have put up a slide for my wean clean protocol, but one component of that ween clean protocol is that we do what's called 12 by seven scanning. Okay? 12 by seven. Scanning means we take 12 calves at seven days of age and scan them 12 calves at 14 days of age, 12 calves at 21 days of age, 12 calves at 28 days all the way through till we at one visit. And we see the proportion of calves that have pneumonia within that age group. Okay? Now, most calves, if they're indoor housed calves, you're gonna see a, a the development of pneumonia around that 14 day age group, or maybe at the latest, the 21 day age group. So seven days we'll have zero, then 14 days, maybe you'll get 20% or 25%, 21 days you might have 60%.
Dr. Terri Ollivett (01:00:26):
So I use that seven day staggered kind of windows to develop a bit of a point in prevalence to figure out when disease is happening. Now, if you feel like you're dealing with a post weaning problem, you don't have to start at seven days of age. You can say, well, I I treat calves at 90 days of age. Well back up a few weeks and pick your 12 calves that are 60 days old, 12 calves that are 70, 70 days old, 12 calves that are 80 days old where you can find where is that uptick, where is that onset of disease. It'll be different for every farm and every operation home Raised hutch calves outside, they can be very late in the pre-weaning period before you start to see disease. Or you might not see any disease because they're outside. They don't have much stress if they're fed well and everything well taken care of sourced calves that are had raised outside, they have similar levels of disease as indoor, individually housed calves. Right? So kind of next tier of, of lung disease and then your indoor group house calves, we have the highest level of disease in the earliest onset. So it depends a little bit on the operation where you'll find that onset of disease.
Speaker 3 (01:01:38):
All right. Next question's from standard in practice. Would you recommend treating calves with LS two or do you only treat LS three pneumonia or higher? And then there's a follow-up question. Could treating animals before they reach labial or pneumonia help improve cure rate and prevent relapse from acuring?
Dr. Terri Ollivett (01:01:58):
Yeah. Great. Great question, Stan. So in practice, my standard recommendation is that if we're finding disease early, so we're routinely scanning calves that are at risk. So 14 to 21 days or 21 to 28, whatever the age risk is, risk age is for that farm. The rule of thumb is gonna be score two. And a score two means they have at least one centimeter for the whole lung, one centimeter of consolidation. If they have one centimeter or more, they've never been treated before and they're a young pre wean calf, our data says treat them. Our data also says treat them if they're clinical, even if they don't have lung disease. So don't forget, you still have to look at the calf. Yes, if you get a calf treated when they're a score two, they are much less likely to become a score three calf. And that's the best treatment response we get is when we can get 'em treated at a score two, so one centimeter or more.
Speaker 3 (01:02:50):
All right.
Dr. Terri Ollivett (01:02:52):
One, I I'll just add one thing. 'cause If you start doing this, you've gotta be, you gotta realize if you're a veterinarian or if you're the producer, if you start finding a disease sooner and you're using a more sensitive tool, you might panic When you see the list of calves that need to get treated after you start doing this, don't panic. The disease level hasn't changed. You're just finding them now. All right? But they're gonna perform better after you get them treated sooner, okay? So, so be okay with that. Be prepared for that. And if you're a veterinarian or somebody that's gonna be doing the scanning, make sure you warn the operator that this is gonna happen. So they don't get scared by saying, oh my gosh, we have twice as much disease. Okay? For every clinical cath out there, we can expect two to four sub clinicals. Okay?
Speaker 3 (01:03:33):
Okay. Marian would like to know if most of the veterinary clinics in North America if, if, if they're using this protocol.
Dr. Terri Ollivett (01:03:44):
So I I I, I see the question here with the Veterinary Clinics of North America. It's a journal. It's a, it's a, oh, okay. It's a book out there. Yep. And yes. Look in the 2016 vet clinics in North America, and I have a chapter in there that I wrote with Sebastian Budinski that's got the technique, it's got the scoring system, it's got different ways to use it in that. And then I think in, there's another vet clinics 2020 ish maybe, where we actually, I did a review looking at housing types and its association with pneumonia, so not directly related to ultrasound, but gives you a little more information on, on housing prevention of pneumonia. But that 2016 vet clinics will have the technique in there.
Speaker 3 (01:04:25):
All right. Very well. I think I was telling me before Dr. Olivette that I, I first heard about you while I was at the Western Dairy Management Conference and was speaking with a veterinarian and and a dairy farmer. And, and they were very excited about using this tool to diagnose damaged lungs and then being able to pre predict or, or call animals before they got into the milking stream. Can you talk a little bit about about that?
Dr. Terri Ollivett (01:04:52):
Yeah, so what we do know if a calf has our data would say that if a calf has ultrasound graphic pneumonia, just three centimeters, that's not very much at all in the first two months of life, she is gonna make about 1200 pounds less milk, 525 kilos, depending on where in the world you're coming from. First lactation milk. So it's a substantial, substantial amount of milk. It's interestingly, very similar to the amount of milk lost when calves don't grow as well. So, good work out of New York shown that if calves don't grow as well, they don't make as much milk for lactation either. I think the rule of thumb there is about 1500 pounds for every pound of average daily gain that you will lose in that first lactation. So 1500 pounds, 1200 pounds, very similar. My guess is that the reason those numbers are so similar, 'cause calves that didn't grow very well in that New York study probably has some clinical pneumonia, right?
Dr. Terri Ollivett (01:05:45):
Driving that. So there is that long-term performance deficit that's gonna happen from these calves that have pneumonia. Now, because a lot of, some farms have 60, 80% of the calves that will develop pneumonia. We can't get rid of all of these calves, right? But we can do what we can to manage it and control it and minimize it. The more severe disease they have, probably the bigger milk loss is gonna happen. In the West coast folks that are using lung ultrasound regularly, they're using it more as a CHO tool later on. So they can find animals that are performing subpar or have, you know, been treated multiple times or still have chronic lungs and they're gonna call them, you know, at four or five, six months old versus keeping them all the until they come, you know, get pregnant, get bred.
Dr. Terri Ollivett (01:06:34):
If they do keep them, we do know that these animals will get bred later. They will have in later and they'll be more likely to have dystocia so there are and be less likely to make it to their first lactation. So of these long-term impacts of having disease, ultrasonic graphic disease in the pre-reading period. So you've gotta decide for you and your operation kind of what question you wanna answer. Do you wanna use it as a CHO tool? It can be used as a CHO tool. And what I usually say is, I, I don't say well get rid of every score five calf. Well, you might have a lot of score five cals, and you might not wanna get rid of all of them. But you may have a batch of calves that you need to make room. You're gonna figure out who's got the worst lungs and get rid of them first.
Dr. Terri Ollivett (01:07:16):
I think lung lesions trump genomics, right? If a calf is your highest genomic calf, but she's a score five and she's been treated four times already, she's not gonna meet her genomic potential, right? It's, it's there. In our adult cow study that we did, it does not appear as though the lung lesions stay with that animal until she calves in. We often say, oh, she had terrible lungs as a calf, and then she kind of peters out after she has her calf. I think that is some epigenetic engineering and printing that's going on. I, I think the switches have been flipped when she was a baby calf that determines her survivability later on in life. I don't think it's because she still has consolidation in her lung. I don't think that's why she fails when she calves in. 'cause Most of those cows, their lungs actually look fine, even though they had terrible pneumonia as calf, most of these young lungs will clear up, but whatever genes have been turned on or off during calf hood is what's causing that cow to not be a productive member of society later on in life.
Speaker 3 (01:08:18):
All right. Well, Dr. Olivette, that's gonna do it. And on behalf of Alchem and Dr. Olivette, thank you for joining us today.
Dr. Terri Ollivett (01:08:25):
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