Production medicine: Marriage of dairy science and veterinary management (Proceedings)

Production medicine probably means something different to each of us, which has also been the case with written treatment plans definitions, our standards for accountability of welfare, defining the KPI's to monitor, and our drug protocols.

Historically many practitioners considered arranging the pregnancy check of groups of cows on a prescheduled regular basis as production medicine. Our herd check times has certainly allowed a lot of time to discuss the various management group issues over the back of the cow while our hand was doing its job, but fertility work is only one portion of production medicine.

Our training has been in medicine; the diagnosis and treatment of individual cows. As our herds have gotten bigger we have organized this diagnosis and treatment philosophy of the individual cows into the proactive written treatment protocols. We are able to predict what to expect based on the health conditions common for a management group. Writing treatment plans is still not production medicine. It is allowing some medical decisions to be made in our name because we know what we expect to happen at various stages of the lactation cycle.

Dairy science has requirements and recommendations about the basic sciences that apply to all ages and management groups such as nutrition, housing, milk harvest, immunization, and genetics. Establishing a standard package of key performance indexes served the double purpose of monitoring the performances of individual management groups on a regular basis and supplying the same data to all the team members to improve our ability to communicate. The question is to communicate about what?

The answer varies, but basically it is to understand the effects of specific management practices on the health aspects of the cow. Dairy science has demonstrated that various management practice decisions or facility short comings has an odds ratio for serving as a risk factor for some condition.

For example:

     • Poor sanitation of the udder as measured by udder hygiene scoring is associated with an increased incidence of mastitis.

     • Increased standing time is associated with increased claw horn lesions.

     • Developing one fresh cow condition increases the risk of developing an LDA. The odds ratio is different for each metabolic condition.

     • A failure of absorbing adequate colostrum at birth is still measurable as decrease production for lactating cows.

The team concept has flourished because the interplay between these factors is just an endless list. Our role is to understand the presence of these and then use our broad base of management group involvement to prevent a management decision being made that benefits one management group at the expense of another except by conscious decision.

Production medicine represents a huge level of knowledge:

     • Requirements for each of the basic sciences by management group

     • Recommendations to maximize the productivity of each management group which may differ from the requirements

     • Management decisions relative to the care package that create pre disposing risks for conditions

     • The consistency of delivery of the management plan by dairy personnel

As our herds have gotten larger the effects of weaknesses in any management group on the productivity of whole have been only too easy to identify. The impact of many of the production medicine concerns is measurable by comparing the epidemiology of the conditions with the expected pattern with an awareness of the predisposing factors that result from previous management decisions.

To prioritize which management deficiencies are most significant it seems getting the first step right is critical for almost any process. Applied to the cow:

     • For the life cycle of the first step is birth to wean.

     • For the lactation cycle the first step is the dry period

     • For the health care standard operating procedure the first step is detection.

     • The care package required or recommended for the new calf is defined as the 5 C's

     • Colostrum

     • Calories

     • Comfort

     • Cleanliness

     • Consistency

The specific levels of adequacy of the 5 C's are measurable by some specific measureable levels just as the causative agent for the pneumonia can be cultured. The pathogens responsible for the disease are well known and are expected. Therefore production medicine is to not allow either management practices or medicine science be consider exclusively.

A parallel consideration is the start of a new lactation. For production medicine the start of the new lactation is not calving, that is when lactation starts. The effects of the care package for the dry cow and fresh cows are critical to us. Five known recommendations from the UW veterinary school for transition cow management are:

     • Bunk Space for all cows to eat together; recommended 30 inches per cow

     • Large sized free stalls

     • Manage regrouping policies – (no moves 3-10 days before calving)

     • A daily fresh cow screening program based appetite and attitude assessment

     • Sand based free stalls

An important addition to the basic sciences as seen in the transition cow recommendation is to understand and incorporate the cows' natural behavior whenever appropriate.

These two management groups share the fact that a level of health care issues are guaranteed and both management groups have alternate performance measures that could be included as KPI's such as growth or peak milk. Just as with the pre wean calf the incidence and pattern of the fresh cow health events becomes a significant measure of the level that known recommendations are deficient.

In both, successful prevention of health issues is possible by combining management change with early diagnosis and treatment of the medical conditions.

For the organ based management groups such as the udder, the foot, the respiratory system, and the digestive track, combining the investigation for known management risk factor to the fact that our record system can give clear indications of the pattern of clinical and even sub clinical infections of these organ systems is production medicine. Writing treatment protocols was proactive based on what conditions expected. Production medicine is applying this same proactive mentality to the writing the SOPs for health care delivering to a management group based on knowing the odds ratio for a negative aspect of the management plan for specific conditions.

The records used for accountability of welfare and drug usage and to tabulate herd KPIs as the yard stick we can use to measure the affects of the management practices deficits. They will let us apply our knowledge of the expected against the actual results to "diagnose" the affects of the care package offered. Remember that:

     • Udder health risk factors needed to be identify revolve around allowing exposure of bacteria into the udder

           o Contact between cows infected with contagious pathogens and those uninfected

           o Exposure of cows to environmental pathogens after milking

           o Exposure of cows to contaminated milking equipment

     • Foot health risks may be either exposure to infectious agents or claw horn lesion development

           o Infectious agent levels is dependent on sanitation

           o Claw horn disease involve more factors such as;

     • Standing time

     • Nutritional management

     • Corrective trimming of the foot

     • Respiratory tract risks revolve around exposure

           o Risk of exposure to pathogens relative to colony forming unit concentration

     • Digestive tract

           o Fecal oral pathogen exposure

We were trained to do a physical exam on a cow to diagnose an individual condition. The physical exam is based on detecting difference from normal for the organ being examined. We can use our records from the cow (who never lies to us) to conduct a herd physical exam and apply the same principles of evaluating the management group performance to diagnose the effects of management practices and decisions on productivity in a repeatable physical exam of the dairy.

Conclusions

     • Production medicine is combining our knowledge of the care and keeping of life cycle management groups with the known medical challenges of the management group.

           o Management decisions about meeting the 5 C's of care impact the levels of health events experienced by the pre weaned calf

           o Management decisions about the care of the transition cow impact fresh cow health.

     • Production medicine application for organ based management groups is identifying and addressing potential risk factors to an organ system like the udder or foot.

     • Measure performance and compare the results to the expected outcomes.