Baa's and Bleat's - The AASRP Podcast
Baa's and Bleat's - The AASRP Podcast
Challenging Kidding Cases with Dr. Daniela Luethy
Join us for this discussion about pain control options in goats with Dr. Daniela Luethy from the University of Pennsylvania as we discuss kidding complications in goats that are seen at veterinary teaching hospitals. The primary paper discussed is titled:
“A Multi-Center Study of Uterine Tears and Other Reproductive Complications in Periparturient Goats Presented to Veterinary Teaching Hospitals”
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10658512/
Collaborating teaching hospitals included the University of Florida, Michigan State University, Auburn University, Iowa State University, Louisiana State University, Texas A&M University, UC Davis, University of Pennsylvania, and the University of Tennessee.
Topics discussed include descriptions of kidding complications seen in veterinary referral hospitals with emphasis on uterine tears.
Dr. Luethy also references a paper titled “Sedated cesarean sections are associated with increased kid survival compared to general anesthesia in goats: retrospective cohort of 45 cases (2011–2021)” by Dr. George Lane and colleagues at the University of Florida.
To learn more about the AASRP Research Fund visit: https://aasrp.org/Main/Main/Research/AASRP-Research-Grant.aspx?hkey=546d2e15-f2cd-4ce8-a837-a16cfd4f3790
If your company or organization would like to sponsor an episode or if you have questions about today's show, email Office@AASRP.org
Today we'll be talking to Dr. Daniela Luthey from University of Pennsylvania School of Veterinary Medicine. Welcome, Dr. Luthey. It's so great to talk to you. I'm working hard to say your Swiss name correctly, so feel free if I do it wrong to correct me. How are you today?
Daniela:Great. Thank you so much for having me. I'm excited to be here. And a big thank you to the AASRP for sponsoring this. I think this podcast is a great idea.
Sarah:Great. Thank you so much. Can you start with a little history about kind of where you've been and where you went to school and how you ended up at UPenn?
Daniela:Yeah, absolutely. So I am a UC Davis uh grad. So I graduated from vet school in 2014. And then I moved across country to Pennsylvania for my rotating internship here at New Bolton Center. And then I stayed for a residency in large animal internal medicine, for which I was board certified in 2018. And then I stayed as a lecturer here at Penn's New Bolton Center for a couple of years before moving to Florida, where I was a clinical assistant professor for a couple of years. And that's actually where I did the study that we're going to talk about today. And then I just very recently moved back to Pennsylvania, where I'm now an assistant professor of large animal medicine. My background is I was very much an equine vet and very interested in, you know, being a horse vet. But throughout my years of training, I developed more of an interest in small ruminants and particularly goats over the years. And so that has sort of driven a lot of my clinical research to sort of answer a lot of the questions that arise in my case management about some of these small ruminants that we see.
Sarah:Awesome. One of the things that I keep saying in this podcast is how we all overlap. I'm also an Aggie. I went there for undergrad, though. And then I also moved all the way east. So that's exciting. Yeah, I went to Wiscons Wisconsin for vet school. And then now I live in Buffalo. So we are close. Penn, Pennsylvania, New York are very close neighbors. I did not get a short stint in the warm state of Florida, unfortunately.
Daniela:Yeah, it was lovely. Nice and warm. Beaches are lovely.
Sarah:Right, right. Yeah, that's that's fun. So today, Dr. Ludi and I will be talking about her 2023 paper entitled Multi-Center Study of Uterine Tears and Other Reproductive Complications in Periparturiant Goats presented to veterinary teaching hospitals. This is published in the Journal of Vet Internal Medicine in 2023. I love this paper. I pulled it out. I cold emailed you just because I wanted to talk about it. Those of us that deliver goats on a or kids or she or lambs on a regular basis, I can't tell you how many times I'm like, how did you get a uterine tear? I barely did anything. Or, you know, the owner's like, I only put my hand in twice, and there's intestines in the uterus, and you're just like, what is happening? And so I was really interested to talk to you about this and kind of see what you found and you know, any suggestions you have for us moving forward. So talk to us a little bit about how this paper came about, what questions you were trying to answer with this project.
Daniela:I work in a referral hospital setting. So I see very often critically ill pregnant does. And I, similar to your experience, I've seen a number of does with uterine tears. But there's one in particular that sticks out and really sort of drove this research for me. So in spring 2021, I had a doe who I won't name for privacy reasons that came in for pregnancy toxemia. And she ultimately kitted and delivered three kids, but she subsequently developed signs of sepsis or sort of severe systemic infection. And eventually we diagnosed her with a large uterine tear. And just this just didn't make sense to me. She wasn't a dystotia, she didn't have significant vaginal manipulation. It just didn't make sense, and it really bothered me because I couldn't figure out or understand what were her risk factors for uterine tears. You know, was her uterus friable? Was it somehow related to her pregnancy toxemia? And so I decided.
Sarah:Oh, I just want to stop you and define the word friable for our non-vet listeners. So friable is a very hard word to define, but also very, very useful. It kind of, we use it when it's tissues that are broken down, they're weaker, they tear easily.
Daniela:Yeah, absolutely. I think that's a great definition.
Sarah:Okay, sorry to interrupt.
Daniela:Not a problem. So I decided to build this study to try to answer this question. And because I wanted a lot of animals, I enrolled as many vet schools as I could to try to get a lot of goats in a fairly short period of time. So by that fall, we were collecting data and we collected data until July 2022. And so, like I mentioned, I did this project while I was at University of Florida, but I collaborated with eight different vet schools for data collections. So I really have to thank all of my collaborators at all of those vet schools, which were University of Florida, Michigan State, Auburn University, Iowa State, Louisiana State, Texas AM, UC Davis, University of Pennsylvania, and University of Tennessee. So a lot of schools contributed cases. And I was also really lucky to have a veterinary student, Lizette, who was able to participate in this research through the Florida Veterinary Scholars Program, which is a summer research program for vet students. So I think you certainly know as well, right? Goats continue to gain popularity both as production animals and also as pets and also as animals that are rescued by sanctuaries. And there's also a shortage of vets who are willing and able to see small ruminants. And so we often see sick goats presented to university teaching hospitals. And unfortunately, there's just not a lot of literature available about a variety of conditions in goats. You know, we certainly see a lot of pregnancy toxemia or that sort of state of negative energy balance in late pregnancy, particularly in does that are carrying multiple fetuses. And we know that pregnancy toxemia has negative impacts on dough survival as well as kid survival. We certainly see retained fetal membranes or retained placenta, but we're not really sure how common that is in goats. And then we don't really know how common metritis is in goats as well. It seems like it's not particularly common compared to, let's say, dairy cattle, but there's no known reported prevalence of metritis that I could find in any paper. And then certainly we see tons of dystotia in you know university teaching hospitals because you know goats are referred for that. Um and similarly, we just don't know that much about dystocia in goats. And then certainly I think one of for me is kind of the big question was uterine tears or kind of you know rupture of the uterus, which we can commonly see after dystosia, but we don't fully know kind of why those happen. You know, certainly we we know dystocia is probably a risk factor, but beyond that we don't really know. And so the goal of the study was to look kind of at all of the pregnant doughs that were presented to these university teaching hospitals and report the frequency of reproductive complications we were seeing in those codes, and then also to look for factors that were associated with the development of uterine tears in those goats.
Sarah:Wow, that was a a lot of questions. So just to kind of clarify a little bit, so similar to our previous podcast with Dr. Jones, this was a review study, but you had set up like some sort of questionnaire or something ahead of time that you had sent out to these schools. Is that correct?
Daniela:That is correct, yes. So we had questionnaires, and so the admitting clinician on the case would fill out this questionnaire that would collect a variety of data. So things like the GOAT's age, read were they a first-time pregnancy or multiple pregnancies in the past, blood work findings, information again about some of these complications, survival, you know, treatments administered, kind of a variety of things. And then those forms were returned to me and we collated all of the data.
Sarah:Nice. All right. So let's jump in to some of the things that to me seemed very obvious. Like, you know, goats don't get a lot of uterine prolapses. For those of us that have boots on the ground, we know that, you know, they're not beef cows and dairy cows. I just feel like, and I think you had one, is that correct?
Daniela:That is correct. Yeah, we had one uterine prolapse out of 198.
Sarah:But that also can be like that's something easy. Most vets, if you have a dairy vet, you know, if you have a bovine dairy vet and you called with a goat with a prolapse, they'd be like, oh yeah, I do prolapses all the time. You know, so it I guess it's possible that maybe you guys just wouldn't see them. I don't know.
Daniela:Yeah, I think you hit on a really important point, which is that the population of goats that were referred to these university teaching hospitals don't necessarily represent the general population of goats.
Sarah:Even though you say that, I still like as I was reading it, I was like, yes, in my goat world, and so my I only see pet goats. I don't have any huge dairies or anything like that. I have like the I mean, I have a few people who raise for meat and have over a hundred, but for the most time, it's like I have four goats in my backyard. But from what I see, I felt like these like the numbers of C-sections, the number of prolapses, the number of like to me, I felt like they were spot on, actually. But you know, again, the vet doesn't see the easy pulls, right? The like, you know, this one's head and legs are just tangled and I just need a little shift because most people who own goats can do those themselves. But honestly, I I felt like it was a pretty, a pretty real representation.
Daniela:That's that's really good to know in here. Because obviously I have the sort of bias population that I see, right? That is very different from, let's say, the population that you you see. So it's good to know that the numbers kind of make sense to you as well.
Sarah:Yeah, yeah. So let's dig into the results. So you not only looked at the, and maybe we won't have time to get into all this, you not only looked at the uterine trauma or issues, but you also looked at them compared to age, weight, breed, size of the goat. Um if they had been bred one time or multiple times. And a huge part of this was who had shoved their hand in the back of this goat. So, you know, had the owner had a vet when they came in, was it a faculty member, was it a student, was it a resident? Who, in case anyone doesn't understand, a resident is a veterinarian. They just aren't board certified yet. So they also have a lot of experience, and they're not like that students who haven't done as much. Um, how many kids they had, how many were alive. So there was so much data. Your statistics were hugely important, I'm sure. Okay, so what do we need to know? What was the like aha moment? What was the super interesting of all of that things that you were like, yes, this is important. This is new information, this answers this question.
Daniela:Where to begin? You're you're absolutely right that we, I mean, we generated so much data, and and honestly, it didn't all make it into this paper because it it couldn't. Right. But I I think a couple probably the take-home points would be one was kind of just the overall frequency of certain complications. So we saw retained fetal membranes in about a quarter of the goats. We saw like some vaginal or perineal trauma in about 20% of the goats. We saw uterine tears in 18% of goats or 32 of the 198, which is I think a kind of shockingly high number to me, you know, as far as like raising alarms that we we do, you know, uterine tears potentially can be life-threatening or fatal complications.
Sarah:And so can I ask how those were diagnosed just by uterine like palpation by somebody, just reaching in and feeling them?
Daniela:So that's a great question. So they were either diagnosed by palpation, so vaginal palpation at surgery, so at C-section, and then diagnosed at surgery, or at necropsy or post-mortem exam. Yeah, but that's a that's a great question. Other complications we saw metritis in about 13% of goats. It is important to mention that we only follow these goats to hospital discharge, so it's possible goats could have developed metritis after hospital discharge, and I just don't have that data. Complications after C-section in eight goats, and then kind of some, you know, again, uterine or vaginal hemorrhage or uterine prolapse where they're quite infrequent.
Sarah:Just to define a few of these terms. So fetal membrane is a retained placenta or the cleanings, they just they didn't clean while they were in the hospital, I guess is how we would define that. And matritis is just a uterine infection. So they what are what showing a temperature, not eating well, had gross discharge, stuff like that kind of all falls under metritis, right?
Daniela:Yes, correct. Yeah, thank you for adding those definitions. Those are those are important. Yeah, so as far as the uterine tears, because again, that was kind of my my driving for this study. There were again 32 goats with uterine tears. All of them were reported to be dystocias. There was no difference in those that had this uterine tears or not having uterine tears as far as the age, the weight of the goats, admission time, which was an interesting question for me, you know, after hours admission versus daytime admission. No effect of were they a first-time pregnancy or multiple historic pregnancies. And then important for me was there was no effect of the experience level of the in-hospital vaginal palpator. So whether it was a student or a resident or a faculty member, it didn't seem like that had an effect on the occurrence of uterine tears, because that's important for for me to know, right? Because I I teach veterinary students, and and if if I had seen, okay, well, when vet students are palpating, maybe there's you know an increased risk, and we need to sort of figure out, you know, we obviously we still need to train our vet students, but we we don't want to, you know, do any harm to the to the animal. But it didn't seem like that had any effect.
Sarah:Great, that's great to know.
Daniela:Yeah. Uh and then, you know, overall, certainly goats with uterine tears were significantly less likely to survive to hospital discharge than goats without uterine tears, but I want to circle back to that um at some point because I I want to talk about kind of the fine details of that. And then kind of, you know, most importantly, when we sort of tried to build a model to say what are predictors of uterine tears, the two things that really stuck out were small breeds, so either Nigerian dwarf or pygmy goats, and manipulation on the farm, as far as vaginal manipulation on the farm, trying to resolve the dystopia by a layperson before admission to the hospital. And so I think that is really important because those are things that we can try to educate clients, you know, and particularly in small breed goats, you know, if if there is a dystopia, the best thing is to try to get a veterinarian quickly to try to resolve that rather than trying to resolve it on their own.
Sarah:Oh, if only we could preach that gospel on a more regular basis. Can we shout it from the mountaintops? Yes, please call me. I'm right here. Please call me. Yes. I don't want to be the fifth person to reach into this goat. I want to be the second.
Daniela:Yeah, no, I think it's a really important point. And obviously there are limitations to that, right? Again, the shortage of veterinarians, you know, limitations in geography, you know, and proximity to a veterinarian. Obviously, there are some limitations there for sure.
Sarah:My favorite thing to do when people tell me they don't have a vet is to search the AASRP, find a vet by location, and be like, no, actually, there's four people that say they do goat work and you're within, you know, a 45-minute drive of you. But yes, so find those vets. Use our AASRP website and look for a vet. Sorry, total, total side note there. So, okay, so lay person manipulation definitely increases uterine tears. What else?
Daniela:Yeah, so I mean certainly not surprising, but I but I think still good information to to have because you know, now you can point at this and say, look, this increases, you know, the risk for your goat. So, you know, call me sooner. Yeah. Yeah. And then, you know, again, this the small breed, which I don't think is really surprising either, right? Like they're they're smaller, they have a smaller, you know, pelvis size, you know, the the hand to pelvic ratio is is you know probably higher. So it's not surprising. But importantly, this didn't explain all of the uterine tears. So there's still there are still uterine tears happening that aren't explained. You know, we saw uterine tears in large breed goats, and we saw uterine tears in goats that didn't have any manipulation on the farm by a lay person. So there are certainly still factors associated with the development of uterine tears that we we don't fully understand and and that I can't answer based on the data I have currently.
Sarah:All right, so we know where more work needs to be done.
Daniela:Yeah, and then just to circle back to the to the uterine tears as far as the association with survival, because I think this is an important point. So obviously, uterine tears can cause abdominal contamination, you know, fetal fluids or or fetuses even within the abdomen, and then certainly increase the risk of perinitis or sort of generalized abdominal infection. And so we often associate these with being fatal or life-threatening complications, but they can potentially be addressed and corrected, and the goats can potentially survive. So when we kind of you know looked into the fine-grained details of those 32 goats, 16 or half of them basically were euphanized as soon as the tear was diagnosed. So either in surgery or based on the vaginal palpation, just given how severe it was. But 11 goats had attempts at surgical correction of the uterine tears. So they, you know, the surgeon, which I am not a surgeon, so I can't speak to the you know the surgical aspects of that, but you know, the the tear was corrected. And of those 11, 10 survived a hospital discharge. So there's probably many factors that go into that. But if it's a fairly acute infection or sorry, acute tear. And there's not a lot of significant abdominal contamination, then potentially you can fix that tear and the goat can go on and do well, which I think is really important because we we do have a lot of clients with pet goats, and you know, those goats are part of their family and and they want to do everything possible. So it's good to know that you know we can potentially save some of these goats.
Sarah:Well, I might I might embarrass myself here, but at the beginning of my career, I very much euthanized. If it had a vaginal tear, euthanized it. And then I had an older vet who has passed away very in the old school. He's like, why? They can survive that fine. And so since then, I literally just load them up on pain meds and antibiotics. And I'm probably 50-50 with survival. And I tell people I may be back tomorrow. The second she stops eating and her temperature goes up, we're done. But you know, it's worth a try. But so did any of these not have surgical correction? Or was your that your only options?
Daniela:Were four goats that the admitting clinician who filled out the questionnaire didn't have any, like they just didn't provide any information. So I don't know what happened in those four goats. Um, my suspicion is if a uterine tear was diagnosed in hospital, chances are probably, you know, surgical correction was either attempted or or you know the animal was euthanized. But I, you know, I also unfortunately don't have you know the fine-grained details of you know exactly where was the tear, you know, was it dorsal versus ventral? You know, was it, you know, how big was it? You know, I do have some information about, you know, did it affect the the uterine body or uterine horns, but I, you know, I don't have kind of all of that information. And I I think certainly that probably plays a role as well, right? A smaller tear, a tear that's dorsal, you know, probably is gonna have a better prognosis than you know, a huge tear with fetuses three in the abdomen, that's sort of so a dorsal tear would be like, I guess you'd say on the top of the uterus, like more towards the dose spine.
Sarah:So if you think about gravity and stuff, the fluid and stuff aren't necessarily as likely to come out of it. I'm just trying to make this a little bit clearer for a producer. So dorsal would be like the top, I guess.
Daniela:Yes, yes, that's correct. Yeah, thank you for defining that.
Sarah:All right, all right. So anything besides uterine tears that was, you know, really answered a new question for you, or you got a new answer.
Daniela:I I think that was certainly kind of the the big takeaway. Um the you know, other things as far as you know, certainly a big proportion of the goats that were in this study were presented as dystotias, which makes sense because they were referred to a referral hospital. So I think eight eighty-two percent of the goats were you know had dystocia when they were admitted. And as far as reasons for dystocia, about 40% were what we call fetal maternal mismatch, so kind of a you know disproportion between the size of the fetus and the size of the of the dough. Um, about 35% were fetal malpositions, so the fetus was malpositioned inappropriately within um the you know vaginal canal for delivery, and then about 10% were in inappropriate cervical dilation. So kind of just having a little bit more data about what are the causes of dystocia, I think, is is certainly also important. And then overall, you know, about half of the goats did have at least one reproductive complication. So important to know that they they do happen not infrequently, but again, aren't necessarily fatal in all cases.
Sarah:Nice. One thing that I really liked that I took away from the paper is that does do well with c-sections that are just under sedation and not general. Because those of us doing them in the field obviously are just doing them with sometimes not even sedation, sometimes just local blocks or epidurals. And so, you know, having some data that shows that, yeah, that's a good idea. It, you know, it helps me sleep at night.
Daniela:Yeah, absolutely. I and I think there's some I think George Elaine just recently published a paper looking at kind of that in in goats with C-sections. And certainly it seems like the outcome for the goat and also for the kids is is better with sedation rather than or just local rather than full anesthesia. And as for me, I'm often the person receiving, you know, the the kids, the critically ill kids, and certainly my ability to resuscitate them, you know, and improve their outcome is certainly better with sedation only or just local for the for the goat.
Sarah:Yeah, yeah, for sure. And I don't know, terminal C-sections is something I definitely occasionally do, especially for these bad pregnancy toxemia cases. And I find that if I, you know, heavily sedate the mom, because she's not gonna live, so I always feel bad for her, it's really hard. I mean, with the terminal C-sections, a lot of times the kids already aren't doing well, but I'm trying more and more to just do those with local, having a little bit more success, but not hugely. But the terminal C-sections are always a hard thing.
Daniela:Yeah, no, I I think certainly if you're doing a terminal C-section, there's there's probably a reason, right? And so I think that certainly is gonna impact the the kids' survival as well. And you know, we we sort of looked at kids' survival, but not particularly closely within this data set. But you know, certainly I think there's a lot of other literature that talks about, you know, let's say pregnancy toxin in particular and its impacts on on kid survival. Right.
Sarah:Anything else you would say is a takeaway for the veterinarian out in the field who are hands-on with these goats, not that you guys aren't in the hospital, but anything else specifically that we can add to our toolbox?
Daniela:I I think we hit on the on the main points. You know, I think again, just that there are risk factors associated with uterine tears and and certainly in small breed goats, kind of cautious and early veterinary intervention is is really important.
Sarah:All right. So our final wrap-up question. I'm sure you read on our little script here. What do you see? And this can be in your field, outside of your field, shoot for the moon, um, as the next problem that researchers need to think about and address in small ruminant medicine.
Daniela:I think there's like the obvious things, right? Like endoparasitism and you know, anthalomantic resistance, which is is a is a huge problem. And then, you know, the other big problem would be, you know, urolophyasis or or you know, urinary stones and goats. And I feel like those two diseases make up such a huge proportion of you know, goat diseases. For me, I I think one of the things that it is really important is more and more. I feel like again, you know, goats are I like to say goats are the future. Like people love goats, you know, and and goats I I think are just more and more people have goats as pests, you know, or kind of small hobby farms. And you know, the goats are part of these people's family. I I had a a goat patient in Florida that would go out on the boat with the owner, you know, just like they she had a little life jacket. So there, you know, there's a there's they're part of people's family. And so I think clients are expecting a level of care that's much more similar to companion animal medicine or small animal medicine. And despite that, I think currently we still have a lot of limited research and literature on a variety of diseases affecting these goats. So I think we really need more research into goat diseases and treatment of these goat diseases, and also more research funding, which I think you know the AASRP is is certainly doing. So thank you for that. And then I think as a veterinarian, also how to balance these goats that are pets and parts of you know these people's families, but also balancing, you know, their status as production animals and you know, trying to maintain appropriate rules, you know, as far as amduca and ferrad and extra label use of medications. And so I think that that is something that we we definitely need to address to sort of continue to elevate veterinary medicine of small ruminants, but within you know the the boundaries of we we need to continue to make sure that we are following, you know, laws and and rules and regulations.
Sarah:Yeah, that is huge. I can't people don't like it when you tell them their baby is a uh food animal, and I can't give it the medication because that's illegal. And also, I need you to send me a picture of a goat in a life jacket, please.
Daniela:I will send it to you. It's so cute. All right. I have some concerns about her safety on that boat, but she seems to love it. So she she she's living her best life.
Sarah:That is awesome. That is awesome. People do love their goats. Goats are the new dogs for sure. All right. Well, thank you so much, and I hope you guys enjoyed this episode of Boz and Bleats, the American Association of Small Ruminant Practitioners podcast. And we will see you next month.
