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JAVMA, Vol 231, No. 2, July 15, 2007 Vet Med Today: Reference Point 227
A
major animal welfare issue facing the livestock
industry is the care, handling, and transport of
nonambulatory cattle. Consumers, researchers, practi-
tioners, and animal protection organizations have ques-
tioned the quality of care provided to and management
of nonambulatory cattle and raised questions about pos-
sible food safety concerns. Veterinarians and producers
continue to be challenged with providing quality care
for nonambulatory cattle. In addition, veterinarians are
recognized as a credible source of information for con-
sumers, regulators, and policy makers. Thus, it would
be beneficial to provide peer-reviewed information to
practitioners and others who must make clinical and
policy decisions.
Several sources
a-f
were searched by use of various
key words to identify relevant peer-reviewed citations
for the information reported here. In addition, govern-
mental and lay reports were reviewed to ascertain poli-
cies, regulations, and historical data concerning non-
ambulatory cattle. Existing peer-reviewed information
was considered adequate by the authors for the devel-
opment of recommended on-farm management prac-
tices that could result in a decrease in the incidence of,
an improvement in the prognosis for, and a benefit to
the well-being of nonambulatory cattle.
Definition of Nonambulatory
or Downer Cows
Wide variation exists in the case definition and relat-
ed terms applied to nonambulatory cattle. The colloquial
term downer has been used since the 1950s to describe
cattle that are too injured, weak, or sick to stand and
walk.
1
The term creeper has been used to describe cattle
that are unable to use their hind limbs but that could
propel themselves short distances with their forelimbs.
2
More recently, the term downer has commonly denoted
cattle that are unable to stand after 24 hours of recum-
bency but that can maintain sternal recumbency.
3
Such
cattle are sometimes referred to as alert downers to dif-
ferentiate them from lethargic or moribund recumbent
cattle that are unable to stand. The inclusion criteria
A review of the causes, prevention,
and welfare of nonambulatory cattle
From the Veterinary Medicine Extension (Stull) and Western
Institute for Food Safety and Security (Payne), School of Veterinary
Medicine, and the Department of Animal Science (Berry), University
of California, Davis, CA 95616; and the Veterinary Medicine
Teaching and Research Center, University of California, Tulare, CA
93274 (Reynolds).
Address correspondence to Dr. Stull.
used to define cattle as nonambulatory are critically
important when making comparisons among scientific
studies, particularly when examining incidence rates
and prognosis.
Incidence of Nonambulatory Cattle
The incidence of nonambulatory cattle in the
United States has been estimated in a number of sur-
veys conducted by industry, academia, and the gov-
ernment. Assessments of culled cattle in holding pens
at 21 slaughter facilities throughout the United States
provided estimated overall incidences of 1.15%
4
and
0.8%
5
for nonambulatory cattle during 1994 and 1999,
respectively. Based on estimates of the number of non-
fed cattle slaughtered at federally inspected facilities,
71,117 and 49,520 cattle were nonambulatory at pro-
cessing plants during 1994 and 1999, respectively. Esti-
mated incidences in those reports were between 1.1%
and 1.5% for nonambulatory dairy cows and 0.7% and
1.1% for nonambulatory beef cattle.
In 2001, 7,382 nonambulatory fed and nonfed cat-
tle arrived at 19 slaughter facilities in Canada.
6
Approx-
imately 90% of the nonambulatory cattle were dairy
breeds, and 10% were beef breeds. Interestingly, the
nonambulatory condition reportedly originated dur-
ing the transport process in < 1% of the affected cattle;
thus, the nonambulatory condition originated in most
cattle while they were still on a farm.
Surveys of nonambulatory cattle sent for slaughter
may not accurately represent the on-farm incidence of
the condition. Slaughter facility data may overestimate
the rate of nonambulatory cattle because such cattle
are preferentially marketed. Conversely, slaughter data
may underestimate the on-farm rate because of failure
to capture the number of cattle that were treated and re-
covered or that were euthanized on the farm. The pro-
portion of cattle that were treated and recovered may be
considerable in the case of dairy cattle with periparturi-
ent hypocalcemia.
In a governmental study
7
in which questionnaires
were mailed to dairy producers in 21 states, it was re-
ported that 78.2% of the dairy operations had had non-
ambulatory cows during 2004. Total numbers of dairy
and beef cattle (adults and calves) on US farms that were
Reference Point
Carolyn L. Stull, phd; Michael A. Payne, dvm, phd; Steven L. Berry, dvm, mpvm;
James P. Reynolds, dvm, mpvm
Abbreviation
BSE Bovine spongiform encephalopathy
228 Vet Med Today: Reference Point JAVMA, Vol 231, No. 2, July 15, 2007
unable to stand or walk for any reason at any time dur-
ing the year were reported to be 465,000 (0.40%) and
450,000 (0.38%) for the years 2003 and 2004, respec-
tively. Analysis of these numbers suggests that during
any given year, the number of nonambulatory cattle in
the United States may approach 500,000.
8
These num-
bers do not specify the proportion of cattle that recover
versus the proportion of permanently nonambulatory
cattle. Compared with the 1994
4
and 1999
5
estimates of
approximately 50,000 to 70,000 nonambulatory cattle
sent to federally inspected slaughter facilities, this sug-
gests that a large proportion of nonambulatory cattle
recovered, died, or were euthanized on the farm.
Perhaps the most complete description of on-farm
incidence of nonambulatory dairy cattle was an evalua-
tion in 1986 of 738 Minnesota dairy herds representing
34,656 cow-years at risk. In that investigation, a case
definition of a cow recumbent on its sternum for > 24
hours for no obvious reason was used, and overall an-
nual incidence ranged from 0.4% to 2.1%.
9,10
Differenc-
es in reported incidences may be attributable to differ-
ences in herd health and management among dairies.
Regulatory History
On May 3, 1993, a news broadcast in Los Angeles
provided graphic footage of nonambulatory cows being
moved on the tines of a fork lift at a single slaughter
facility. This served as the impetus for legislative efforts,
and legislation to address the transport, handling, and
slaughter of nonambulatory cattle for human consump-
tion was passed in California in 1994.
11
That law reg-
ulates slaughterhouses not inspected by the USDA as
well as stockyards and auction markets. The regulation
prohibits the buying, selling, or receiving of a nonam-
bulatory animal and makes it unlawful to drag or push
with equipment a nonambulatory animal while in tran-
sit or on the premises of a stockyard, auction, market
agency, livestock dealer, or slaughterhouse. Equipment
that may be used to move nonambulatory animals is
restricted to a sling, stone boat, or other sled-like or
wheeled conveyance. A violation of the Downed Ani-
mal Law of California is a misdemeanor.
Colorado, Illinois, Oregon, and Washington have
adopted similar legislation. A series of federal bills
failed to pass after being referred to committee. The fed-
eral bills were introduced between 1999 and 2003 and
would have made it unlawful for a stockyard owner,
market agency, or livestock dealer to transfer or market
nonambulatory cattle, sheep, swine, horses, mules, or
goats.
The most profound change in US regulation of non-
ambulatory cattle came after the first case of BSE was
diagnosed in the United States on December 23, 2003.
The infected animal, a dairy cow imported from Canada
to a farm in Washington, focused public and regulatory
attention on the practice of including nonambulatory
cattle in the human food supply. Seven days after the
initial case of BSE was reported, the Secretary of Ag-
riculture announced an immediate ban on all slaugh-
ter of nonambulatory cattle for human consumption.
The published interim rule
12
defined nonambulatory,
disabled livestock as animals that cannot rise from a
recumbent position or that cannot walk, including but
not limited to those with broken appendages, severed
tendons or ligaments, nerve paralysis, a fractured ver-
tebral column, or metabolic conditions. The provisions
in this definition have been contested by some livestock
industry groups on the grounds that the definition may
include nonambulatory cattle that are not BSE suspects
and that could still be suitable for human consump-
tion; thus, their exclusion could cause a detrimental
economic impact to producers.
Many countries, including Australia, New Zealand,
Canada, and member countries of the European Union,
have policies to prohibit the transport of nonambula-
tory animals (Appendix 1).
13-17
Similarly, the World Or-
ganization for Animal Health (Office International des
Épizooties, an animal health coalition of 164 countries)
has established standards
18
regarding livestock trans-
port by land. Those standards specify that each animal
should be inspected by a veterinarian or animal han-
dler to assess fitness to travel. Animals found unfit to
travel should not be loaded onto a vehicle, except for
transport to receive veterinary treatment. Animals that
are unfit to travel include those that are unable to stand
unaided and to bear weight on each limb. These and
similar policies may become future trade barriers for
members of the Office International des Épizooties or
trading partners who are unwilling to comply.
Other Policies on Disabled Livestock
The AVMA recently revised its policy on ambula-
tory and nonambulatory disabled animals. The current
policy, which was approved in 2006,
19
is that at no time
should a nonambulatory animal be dragged. The policy
maintains that when there are nonambulatory cattle
on a farm, producers should contact a veterinarian for
assistance if the animal is not in extreme distress and
continues to eat and drink. Nonambulatory animals
that are in extreme distress and have an obviously ir-
reversible condition should be immediately euthanized
or humanely slaughtered (state laws permitting) on the
farm.
Negative publicity, particularly when related to
slaughter procedures and BSE, has raised concerns
among retail food companies about the humane treat-
ment of nonambulatory cattle and the safety of prod-
ucts derived from them. The Food Marketing Institute
and National Council of Chain Restaurants have collab-
oratively developed an animal welfare program for their
members, who include food retailers, wholesalers, and
chain restaurants. The program endorses the AVMA’s
policy on the handling of disabled livestock and em-
phasizes that under no circumstance should a disabled
animal be moved by dragging or otherwise pulling on
its limbs or extremities.
20
Since 2002, a number of retail
restaurant chains, including McDonald’s, Wendy’s, and
Burger King, have prohibited suppliers from obtaining
products derived from nonambulatory cattle.
Food Safety of Beef Products Obtained
from Nonambulatory Cattle
The issue of food safety of nonambulatory cattle
suspected to have BSE was the basis and platform for
the development of the federal interim rule. Although
JAVMA, Vol 231, No. 2, July 15, 2007 Vet Med Today: Reference Point 229
nonambulatory cattle have been banned from the hu-
man food supply since 2003, data on food safety of beef
products from nonambulatory cattle are limited. In a
study in Canada,
6
there was a carcass condemnation
rate of 37% for nonambulatory dairy cattle arriving at
19 slaughter facilities. The prevalence of Escherichia coli
O157:H7 in fecal or tissue samples from nonambulatory
dairy cattle (4.9%) was 3.3 times that in ambulatory cat-
tle (1.5%).
21
In another study,
22
6 of 20 nonambulatory
cattle sent to a slaughter facility were identified as fecal
shedders of Salmonella spp. Conversely, nonambulatory
cattle did not have a higher incidence of positive results
for antimicrobial residue tests than did randomly tested
ambulatory cattle.
23
Although we are not aware of any
published research data on specific factors that affect the
quality of meat obtained from carcasses of nonambula-
tory cattle, it is reasonable to assume that the number
and severity of bruises caused by the pressure of their
own body weight resulting from being in a recumbent
position for even a few hours, along with any bruises
or injuries caused by the handling and transporting of
these cattle, would cause excessive trimming of the car-
casses and compromise meat quality.
Signs of progressive or nonprogressive neurolog-
ic conditions (including persistent recumbency) are
consistent with BSE.
24
In countries with a high preva-
lence of BSE, nonambulatory cattle could represent a
greater risk of BSE infection. However, in the United
States, the risk of a cow contracting BSE is extremely
low. During the past 7 years, samples have been ob-
tained by the USDA from > 735,000 cattle, which has
allowed the USDA to estimate a BSE prevalence of
< 1 in 1 million cattle.
25
Of the 2 indigenous US cattle
in which BSE was diagnosed, 1 had a history of be-
ing nonambulatory. The USDA’s updated Harvard Risk
Assessment evaluated the impact of risk management
measures that have been or could be adapted to control
BSE in the United States. Removal of nonambulatory
cattle from the human food supply was estimated to
reduce human exposure to BSE-contaminated material
by approximately 3%.
26
Causes and Diagnosis
Numerous reasons exist for cattle to lose the ability
to stand and walk. The causes of pathologic recumben-
cy can be divided into general categories, including in-
juries, metabolic derangements, and infectious or toxic
diseases. A detailed discussion of these conditions can
be found elsewhere.
27-32
Most nonambulatory cattle are
of dairy origin. The condition occurs most often within
1 day of parturition and frequently results from peri-
parturient hypocalcemia or complications associated
with calving.
3,29,33
In 1 study,
33
investigators evaluated
risk factors for downer cow syndrome in dairy cattle for
the 30 days after parturition in 12 Holstein dairy herds
in New York. Clinical hypocalcemia (odds ratio, 5.6),
stillbirth (odds ratio, 4.9), and dystocia or retained fe-
tal membranes (odds ratios, 5.7 to 6.1) were all risk
factors for recumbency. In another study,
7
the 3 major
causes for nonambulatory cattle identified by dairy pro-
ducers located in 21 states in 2004 were hypocalcemia
(19%), calving-related injuries (22%), and injuries re-
sulting from slipping and falling (15%). In beef cattle,
the primary cause of nonambulatory cattle is calving
paralysis.
3
Secondary recumbency is a condition in which a
nonambulatory animal has pressure damage to muscle
and nerve tissue, which results in prolonged or perma-
nent recumbency.
18,34
Compartmentalization syndrome
(a human medical condition) is an associated patho-
logic diagnosis in which increased tissue pressure in a
confined anatomic space causes decreased blood flow
that leads to ischemia and dysfunction of contained
myoneural elements. Crush syndrome (another human
medical condition) is used to denote the systemic ef-
fects of muscle damage, including renal damage, car-
diac arrhythmias from hyperkalemia, and increased
activity of creatine kinase.
35
Clinical complications
can develop extremely rapidly in cattle that develop
secondary recumbency. In a study
35
in which 16 cows
were anesthetized for 6 to 12 hours, only 8 could stand
unassisted within 3 hours after cessation of anesthesia.
The remaining 8 cattle ceased attempts to stand and re-
mained recumbent (usually sternal recumbency) until
they died or were euthanized. The hind limb positioned
underneath the body in each of these 8 cattle became
rigid and swollen, and cattle voided dark-brown urine
indicative of myoglobinuria. Necropsy revealed that the
proximal portion of the thigh of affected limbs had ex-
tensive damage to the sciatic nerve and pale, necrotic,
fetid muscle. Thus, during a period of recumbency with
a duration of only 6 to 12 hours, pathologic changes
can develop that compromise the success of nonambu-
latory cattle to subsequently stand and recover.
Prognosis
The wide array of primary causes and the range in
severity of secondary nerve and muscle damage make it
challenging to provide a prognosis for nonambulatory
cattle. A careful medical history and physical examina-
tion will greatly assist in the effort. Physical examina-
tion of nonambulatory cattle should include assessing
the animal for signs of metabolic or infectious disease,
musculoskeletal injuries or accidents, neurologic con-
ditions, and other causes. Results of physical examina-
tion will aid in making a diagnosis, but it is difficult
to perform a thorough physical examination in recum-
bent cattle.
36
Clinical assessment of limb strength and
peripheral nerve function and transrectal palpation
are aided by elevating the patient with hip clamps or
a sling.
When the primary cause of recumbency lends itself
to treatment (eg, hypocalcaemia, calving paresis, and
acetonemia [ketosis]), then the duration of recumben-
cy and quality of nursing care become critical prognos-
tic information. In a study
37
of 84 hypocalcemic cows
treated within 6 hours after becoming recumbent, 83
(98.8%) became ambulatory. Another researcher sug-
gested
34
that 6 hours is the threshold for the induction
of secondary recumbency in anesthetized cows. Dairy
producers who responded to a questionnaire indicated
that approximately half of the nonambulatory cattle
that recover and remain in the herd were nonambula-
tory for < 6 hours. Thus, dairy cattle that have been
nonambulatory for > 6 hours are considered to have a
poor prognosis.
7
230 Vet Med Today: Reference Point JAVMA, Vol 231, No. 2, July 15, 2007
The quality of nursing care will also affect progno-
sis.
28
A study
38
of 64 nonambulatory cows in the United
Kingdom revealed that the single best prognostic indi-
cator was the quality of nursing care, compared with
other factors such as bedding provisions, attitude, at-
tempting to stand, body condition, environment, and
clinical blood variables.
Some physical examination findings and diagnoses
immediately suggest a guarded to poor prognosis. Frac-
tures, luxations of the hip joint, abscess or metastatic
neoplasia of a vertebral body, inoperable gastrointes-
tinal tract disease, and gangrenous mastitis are condi-
tions for which further expenditures for treatment and
nursing care are unlikely to be efficacious. Limbs that
are rigid, swollen, or lacking sensation are suggestive
of muscle or nerve damage. Cattle with fractures or hip
joint luxations have a poor prognosis. It can be diffi-
cult to diagnose fractures in nonambulatory cattle in
on-farm settings. Crepitus may be masked by muscle
mass over the femur, and diagnosis of fractures is often
presumed on the basis of limb placement and mobility.
Hip joint luxation in adult cattle has a poor prognosis,
but treatment can be attempted by open or closed re-
duction techniques.
39
For a number of enzymes, serum activity is greater
in nonambulatory cattle than in healthy control cat-
tle.
40,41
In 1 experiment,
34
mean activity of serum cre-
atine kinase, a specific indicator of muscle damage, was
greater and peaked later in permanently nonambulato-
ry cattle, compared with cattle that recovered. A single
measurement of creatine kinase activity is not useful
because of variability among animals and a lack of asso-
ciation between creatine kinase activity and duration of
recumbency.
28
Clinical pathology data have limited di-
agnostic or prognostic value for individual animals.
28,39
Treatment and Management
of Nonambulatory Cattle
Because secondary muscle and nerve damage may
develop rapidly following the onset of recumbency and
greatly reduce the likelihood of recovery, nonambula-
tory cows should be treated as medical emergencies.
Obtaining a complete medical history and conducting
a thorough physical examination prior to treatment
will be helpful in reducing animal discomfort and costs
associated with treating and nursing patients with a
poor prognosis. A prompt decision should be made af-
ter careful consideration of the extent and duration of
pain, likelihood of successful outcome, availability and
cost of treatment and nursing care, and value of the ani-
mal. When evaluation of these factors indicates that a
clinician should not initiate treatment, then the animal
should be euthanized.
Treatment and care of nonambulatory cattle should
have 2 goals: to correct the primary cause of recumben-
cy and to minimize secondary nerve and muscle dam-
age. Nonambulatory cattle should be placed in an area
to provide shelter from precipitation and sun and that
is secure from predators. Ambulatory cattle and other
animals should be segregated from nonambulatory
cattle to reduce trauma and allow the nonambulatory
cattle to be able to eat and drink. When nonambulatory
cattle require relocation for additional treatment and
care, movement should be performed in an appropriate
and humane manner. Cattle can be gently rolled onto
sleds or carefully placed into large front-end loaders for
transport.
42
To prevent further injury, stress, and pain-
inducing trauma, nonambulatory cattle should never
be dragged.
To minimize secondary nerve and muscle damage,
nonambulatory cattle should be placed on a soft sur-
face that provides adequate traction. Various bedding
materials can be used to provide a soft, clean, dry, non-
slip surface. Twelve inches of sand bedding can be used
to improve the likelihood of recovery and decrease the
development of decubital sores and urine scalding.
43,44
Sand also facilitates examination and care of recumbent
cows while providing traction for secure footing and
easy removal of manure.
Nonambulatory cattle should be maintained in ster-
nal recumbency. Cattle in lateral recumbency become
bloated when rumen contents obstruct the esophageal
hiatus. When necessary, hay bales can be used to assist
in maintaining cattle in sternal recumbency. Recumbent
cattle should be repositioned every few hours, alternat-
ing between left- and right-sided sternal recumbency, to
prevent secondary, permanent ischemic muscle necro-
sis and nerve damage to the compressed hind limb that
is located under the body of the recumbent animal.
45,46
Caretakers must ensure that water and feed are easily
accessible to nonambulatory cattle at all times. Con-
tainers should be secured to prevent spillage.
Another option for minimizing the effects of pres-
sure damage to nonambulatory cattle is the use of
commercially available lifting devices. The use of hip
clamps, airbags, slings, and flotation tanks to assist in
the diagnosis, management, and treatment of nonam-
bulatory cattle has been described.
28,47
Lifting a recum-
bent animal immediately reduces tissue pressure in
the compressed hind limb.
28
Often, a nonambulatory
animal needs some assistance to stand; circulation will
return to an affected limb once the animal is standing.
Devices such as hip clamps and slings can be beneficial
if used carefully by competent and trained personnel.
28
Hip clamps are potentially dangerous lifting devices
because support of a large amount of an animal’s weight
is transferred to the region around the tuber coxae.
29
It is best that, when used, hip clamps are applied to
cattle that can stand and bear weight once in a standing
position; however, under no circumstances should an
animal be left unattended in one of these devices.
43
Use
of well-padded hip clamps may be tolerated for 10 to 15
minutes twice daily for several weeks. Hip clamps may
be tolerated better when suspended over the cow from
a stabilizing cart surrounding the animal and combined
with the use of a sternal support band, both contribut-
ing to lessening potential tissue hip damage and pain
from the hip clamps.
43
Single belly-band slings and air bags are ineffective
for use in nonambulatory cattle because they compress
the abdomen and compromise respiration. Innovations
in sling design with numerous adjustable straps provid-
ing support to the thoracic (ie, brisket) and inguinal ar-
eas have allowed for the safe support of nonambulatory
cattle for extended periods.
28
Ideally, slings should be
used to lift a recumbent animal to a standing position
JAVMA, Vol 231, No. 2, July 15, 2007 Vet Med Today: Reference Point 231
to enable the animal to bear at least some weight on its
limbs for up to a few hours; the animal should then be
returned to sternal recumbency. The process should be
repeated several times each day to relieve pressure and
prevent damage to muscles and nerves.
Flotation tanks use water to gently lift nonambu-
latory cattle to a standing position, thus minimizing
pressure damage that could result from the use of other
lifting devices. Careful screening of candidates should
be conducted to eliminate nonambulatory cattle that
have a poor prognosis (eg, fractures, illness, and spi-
nal cord injuries), which will greatly increase the like-
lihood that flotation will result in recovery.
47
A typi-
cal flotation system involves positioning a recumbent
animal on a rubber mat, moving the animal into a wa-
tertight tank (or box), and filling the tank with warm
water. The tank should be filled with water as quickly
as possible to minimize struggling by the animal.
29
It
is important that the water temperature be maintained
close to that of the animal through repeated additions
of warm water or use of a bath heater. Cattle typically
can remain in a filled flotation tank for 6 to 8 hours,
but durations in the flotation tank of up to 24 hours
are possible. It may be necessary to repeat flotation ses-
sions daily for up to 10 days to enable affected cattle
to recover and stand unassisted.
48
Successful recovery
rates range from 44% in 1 study
49
to 90% when candi-
dates for flotation were carefully screened for selection
in another study.
47
Nonambulatory cattle should be evaluated daily to
assess their ability to stand or bear weight. It is often
helpful to assist an animal during its attempts to stand;
this can often be accomplished by lifting at the base of
the tail.
Nerve and muscle function can be assessed on
nonambulatory cattle by pinching the skin between the
claws of the hooves with fingers or hemostats; alterna-
tively, as a last resort, an electric prod can be used in a
judicious manner.
50
Repetitive use of an electric prod
must be avoided; a clinician should be able to deter-
mine during the initial 1 or 2 attempts whether an ani-
mal is able to stand. Application of hobbles may assist
in preventing excessive abduction of the hind limbs in
weak cattle.
36
Medical treatment should address hydration sta-
tus, inflammation, infection, and metabolic derange-
ments. Cattle that cannot maintain hydration should
be treated by IV or oral administration of fluids. Anti-
inflammatory drugs may minimize tissue damage,
inflammation from trauma, and effects of endotox-
emia.
51
Corticosteroids that currently are available and
labeled for treatment of pain or inflammation in cattle
include dexamethasone, which has no labeled with-
drawal period for milk or slaughter, and isoflupredone
acetate, which has no labeled withdrawal period for
milk but a 7-day withdrawal period for slaughter. The
nonsteroidal anti-inflammatory drug flunixin meglu-
mine has 36-hour and 4-day withdrawal periods for
milk and slaughter, respectively. Flunixin meglumine
should be used only in accordance with label direc-
tions (ie, IV administration) in cattle because IM or SC
routes of administration can result in violative tissue
residues.
52,53
Euthanasia
Veterinarians should assist owners in making
appropriate decisions to euthanatize nonambulatory
cattle. These decisions should be made in a timely
manner and should involve use of appropriate tech-
niques that ensure death of the animal. Cattle with
signs of severe and uncontrollable pain or extreme
discomfort or that have a poor prognosis (as described
previously) should be euthanatized immediately. Ex-
treme physical discomfort has been described as the
product and duration of pain.
54
Signs of acute pain in
nonambulatory cattle include recumbency, guarding
an affected body part, swollen or obviously fractured
limbs, vocalization or attempts to vocalize, labored
breathing, bruxism, and decreased food intake.
55
Ap-
propriate methods for euthanasia of cattle include
captive bolt, gunshot, or euthanasia solution.
56
Eutha-
nasia must be performed by a veterinarian or, where
allowed, by trained personnel. Use of IV administra-
tion of barbiturate-containing euthanasia solutions
may be limited in certain areas because of regulations
or policies established by rendering companies. Car-
casses must be disposed of promptly and appropri-
ately, taking into consideration local environmental
regulations and availability of rendering services.
Methods of carcass disposal include rendering, burial,
burning, anaerobic digestion, and composting. When
an injectable euthanasia solution is used, scavenging
animals should be prevented from having access to a
carcass because of possible residues of the euthanasia
solution.
Prevention
In 1 study,
57
nonambulatory dairy cattle were 3.5
times as likely to be culled from the herd as were
lactating cattle without disease. Furthermore, cattle
were frequently culled near the beginning of lacta-
tion, resulting in costly losses in milk production.
Thus, the periparturient period is a critical time
for cattle. One of the primary goals of bovine prac-
titioners should be to assist owners with cattle
management to prevent nonambulatory cattle. Vet-
erinarians may make recommendations in several
areas, including appropriate nutrition, herd health
and breeding programs, cow comfort, sanitation,
and calving procedures and facilities (Appendix 2).
The leading risk factors for recumbency in cattle are
hypocalcemia, complications associated with calv-
ing, and injuries.
7,33
Therefore, periparturient cattle
should be closely observed, although monitoring
by remote video cameras may be a suitable option.
34
Trained, responsible personnel should be available to
promptly provide assistance. Detailed reviews
58-61
for
the prevention of periparturient paresis and obstetric
complications are available and may be of assistance
when developing strategies for commercial produc-
ers. Minimizing lameness in dairy and beef cattle will
contribute to the prevention of nonambulatory cattle.
Careful and quiet handling along with facilities that
provide safe, nonslip surfaces will assist in prevent-
ing injuries and falls, which is especially important
for periparturient cows.
62
232 Vet Med Today: Reference Point JAVMA, Vol 231, No. 2, July 15, 2007
Conclusions
The exact number of nonambulatory cattle on US
farms or feedlots or sent to slaughter facilities is diffi-
cult to ascertain, but estimates may approach 500,000
animals/y. The incidence of nonambulatory cattle is
greater among dairy than among beef breeds. Regu-
lations and policies on transport of nonambulatory
cattle and their inclusion in the human food supply
have been developed on the state, national, and in-
ternational level. There are limited data on the food
safety of beef produced from nonambulatory cattle
sent to slaughter facilities. However, the prevalence of
E coli O157:H7 was greater in nonambulatory than in
ambulatory dairy cattle in 1 study.
21
Analysis of the
literature supports the practice of treating nonambula-
tory cattle as medical emergencies because secondary
muscle and nerve damage develop rapidly following
the onset of recumbency and reduces the likelihood of
recovery. Dairy cattle that have been nonambulatory
for 6 hours or more have a poor prognosis for recovery
and remaining in the herd. Most nonambulatory dairy
cattle are the result of periparturient hypocalcemia or
complications associated with calving; thus, the peri-
parturient period is a critical period. Conducting a
thorough physical examination prior to treatment
will be helpful in avoiding costs associated with treat-
ing and nursing patients that have a poor prognosis.
Treatment of nonambulatory cattle is complicated
by the difficulty of making an accurate diagnosis of
primary and secondary problems. All decisions on
medical treatment should take into consideration pain
management, prognosis, withdrawal times, and final
disposition of the animal. Quality of nursing care is
a major determinant for successful recovery. At the
least, cattle should be moved by use of a method that
minimizes pain and discomfort; placed on soft, deep
bedding; provided with access to feed and water; and
repositioned every few hours, alternating between
left- and right-sided sternal recumbency. Use of one of
the various lifting methods will probably increase the
likelihood of recovery, assuming the primary cause of
recumbency can be successfully treated. Veterinarians
can assist producers in adopting prevention and treat-
ment practices for nonambulatory cattle. Euthanasia
should not be delayed in cattle for which there is no
hope of improvement or that have a poor prognosis.
a. BIOSIS, Thomson Scientific, Philadelphia, Pa.
b. MEDLINE, United States National Library of Medicine, Bethes-
da, Md.
c. Food Science and Technology Abstracts, International Food
Information Service Publishing, Reading, England.
d. CABI, Center for Agriculture and Bioscience International,
Oxfordshire, England.
e. Current Contents, Thomson Scientific, Philadelphia, Pa.
f. AGRICOLA, National Agricultural Library, Beltsville, Md.
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Appendix 1
Regulations for transport of nonambulatory animals in various countries.
Country Regulation
Australia Prohibits transport of nonambulatory livestock to slaughter in all states and territories.
Canada Prohibits loading or transport of compromised animals that cannot be transported without undue suffering during the
expected journey.
13
Nonambulatory animals cannot be transported, except to a veterinarian for diagnosis and treatment or to receive proper
care and attention.
14,15
Members of the Animals that are injured or that have physiologic weakness or pathologic processes shall not be considered fit for
European Union transport and, in particular, if they are unable to move independently without pain or to walk unassisted.
16
New Zealand Animals must be able to stand and bear weight on all limbs and be sufficiently fit to be able to withstand the journey without
suffering unnecessary pain or distress. To bear weight means that the animal must be able to support weight on all limbs
to stabilize itself during transport.
17
Any animal with a broken limb must not be transported for slaughter. An animal with a broken limb must not be transported
for any reason unless it has been treated by a veterinarian.
17
Continued on next page.
234 Vet Med Today: Reference Point JAVMA, Vol 231, No. 2, July 15, 2007
Appendix 2
Management procedures for the prevention and treatment of nonambulatory cattle.
Nutrition
Diets of nonlactating and periparturient cows should be balanced, es-
pecially for all macrominerals, to minimize the incidence of hypocalce-
mia and acetonemia (ketosis). Veterinarians should consider analysis
of forage mineral content and consultation with a professional nutri-
tionist for herds with a high prevalence of these conditions.
Body condition of heifers and cows should be evaluated because ex-
cessive condition (ie, fat) contributes to hepatic lipidosis and parturi-
tion problems. Dairy heifers should achieve 65% of mature weight by
first breeding and 85% of mature weight with a body condition score of
3.5 (scale of 1 to 5) by first parturition.
Herd Health
Veterinarians should provide a prompt diagnosis and prognosis for
cattle that are injured, sick, or nonambulatory.
Nonambulatory cattle should be treated as medical emergencies.
Cattle that are nonambulatory for 6 hours or more are considered to
have a poor prognosis.
High-quality nursing care should be provided to nonambulatory cattle.
Nonambulatory cattle should be maintained in sternal recumbency and
repositioned every few hours, alternating between left- and right-sided
sternal recumbency.
Lifting devices (eg, well-padded hip clamps, slings, or flotation tanks)
and hobbles should be readily available to assist with nonambulatory
cattle. Personnel should be trained and competent in the use of lifting
devices or hobbles.
Common mastitis control methods should be implemented, including
teat sanitation; teat dipping; evaluation of milking machines for proper
function; and, possibly, the use of vaccines to prevent or minimize the
effects of mastitis. Bedding for lactating and nonlactating cows should
be clean and dry to help prevent exposure to mastitis-causing patho-
gens.
A hoof health program should be instituted that consists of routine
hoof evaluation and trimming procedures, use of antiseptic footbaths
to prevent infectious foot diseases, and frequent observation for early
detection of hoof and limb disorders.
High-risk cattle should be culled from the herd before they become
nonambulatory. This may include cattle with a history of metabolic dis-
orders or lameness, older cattle, cattle with poor temperament, and
cattle in poor body condition.
Plans for euthanasia of cattle should be developed and implemented.
Cattle with signs of severe and uncontrollable pain or that have a poor
prognosis should be euthanatized immediately. Euthanasia must be
performed by a veterinarian or, where allowed, trained personnel.
Cow Comfort
Cattle should be handled quietly and gently to prevent injuries and
falls.
All facilities, dry lots, and pastures should be maintained to provide
safe conditions; areas that may cause or result in injuries or slipping
should be repaired immediately.
Safe footing should be provided for cattle. Concrete floors should be
grooved to prevent slipping and falls. Rubber floor mats also may be
used to provide secure footing in high-traffic areas.
Clean and dry housing should be provided for lactating and nonlactat
-
ing cows.
Sick, injured, and nonambulatory cattle should be provided with clean
bedding, suitable ventilation, access to feed and water, and adequate
shelter from precipitation and sun.
Nonambulatory cattle should be separated from ambulatory cattle and
other animals to reduce trauma and allow the nonambulatory cattle to
be able to eat and drink.
Nonambulatory cattle should be placed on a soft surface that provides
adequate traction, such as sand or other deep bedding, to minimize
secondary nerve and muscle damage.
Calving procedures and facilities
Heifers should be bred to calving-ease sires to reduce the risk of dys-
tocia.
The calving area should be clean and dry, have adequate lighting, and
provide good traction for safe footing. The calving area should allow
for close observation of periparturient cattle.
Trained, responsible personnel should be available to provide frequent
and careful monitoring of periparturient cows for dystocia and evi-
dence of metabolic disorders.
Necessary treatment for nonambulatory cattle should be promptly pro-
vided. Personnel should be educated on proper obstetric techniques
as well as when to call a veterinarian for assistance.