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Ask the Vet, July, 2024: Holistic Approaches for Treating Metritis in Cows

By Alex Schaff, DVM, Midstate Veterinary Services, Cortland NY

My dad’s a tool guy. For any project, he always has the tools needed and the skills to know how to use them. Beyond the Dewalt and the Black & Decker, my dad also collects tools from a bygone era–hand tools with unique curves and mechanisms for specific jobs that have become obsolete as a result of multipurpose power tools. However, he doesn’t just collect these tools, he also has collected knowledge of older ways that often solve issues like no power tool can.

Like my dad, I appreciate tools in my truck and knowledge in my head for my veterinary practice. Similarly, in addition to my regular practice, I also enjoy learning about how cows used to be treated. The other day, a farmer explained to me how right displaced abomasums were often treated with a drench of coffee grounds. As an open-minded practitioner of medicine, I want all the tools and skills to care for cows thoroughly. This means using a combination of modern and traditional medicines to optimize and support cow health, embodying a truly holistic approach.

To guide me, in addition to my close mentors, I highly recommend the research of Dr. Stephen LeBlanc from the University of Guelph, Dr. Hubert Karreman’s series of books on Treating Cows Naturally, Dr. Bradford Smith’s Large Animal Internal Medicine, and the previous NODPA Ask-A-Vet columns from our very own, Dr. Dayna Locitzer. If only we could have these veterinary legends guiding us as we care for our cows. Opting for second best, I hope to distill their knowledge along with my own to tackle a topic that I encounter often: metritis.

Understanding Metritis

When we talk about metritis, there’s a scale of severity of uterine infections. Endometritis, the least severe, is inflammation of the endometrium, the innermost layer of the uterine wall. Metritis is the inflammation of all layers of the uterine wall. Pyometra is the accumulation of pus and stinky discharge in the inside of the uterus, usually following a case of metritis.

Uterine inflammation is exacerbated by bacterial infection, which occurs when bacteria enter the uterus. This can happen at calving, at natural and artificial insemination, reproductive examination, and due to defects in the natural barrier like the vulva, and the cervix. While bacterial contamination is inherent to calving, conditions like dystocia, vaginal tears, stillbirths, retained placentas, cesarean sections, uterine torsions and prolapses, first parity calvings, and summer calvings all increase the risk for metritis.

Why Do Some Cows Get Metritis?

While all cows have uterine contamination after calving, not all get metritis. Why is that? Every disease sits on a triangle between the animal’s immune system, the environment, and the causative agent, usually bacteria with metritis. In most cases, bacteria are eliminated naturally during the puerperium, the period after calving when the reproductive tract, primarily the uterus, returns to its nonpregnant state. During this time, uterine defense mechanisms, including white blood cells, and a variety of inflammatory mediators, rush into the uterus to clean out the debris and bacteria. In the case of metritis, the uterine immune system is overwhelmed either due to reduced immune function, high bacterial load in the environment, or the virulence of the bacteria. The primarily causative bacteria are gram-negative anaerobes, specifically Fusobacterium necrophorum, Bacteriodes pyogenes, and Prophorymonas levii, but other suspects include Trueperella pyogenes, and coliforms, like E. coli.

Economic Impact

According to Stephen LeBlanc of the University of Guelph in Ontario, each case of metritis costs on average $513. This cost is due to reduced fertility, more days open, increased culling, and milk loss. Uterine diseases affect fertility due to the unique anatomy of the female reproductive tract. The uterine vein and the ovarian artery wrap around each other, causing an exchange of blood between the ovaries and uterus, including bacterial byproducts, noxious gasses, mineral abnormalities, and inflammatory mediators raging in the infected uterus. As a result of a uterine infection, the ovary can have poor cyclicity, abnormal corpus luteums, and altered reproductive hormones, leading to issues related to egg maturation and fertilization. This leads to fewer pregnancies and more pregnancy losses.

Detecting Metritis

To minimize the detrimental effects of metritis, early detection is crucial. Focus on cows during the first 3-14 days after calving, particularly those at highest risk: cows with assisted hard calvings, retained placentas, twins, near-term abortions, and premature calvings, especially during the summer. Rumination/health monitoring systems like SCR often help to identify ill cows early. Beyond technological aid, observe them when they come into the parlor or are locked up during feeding. According to LeBlanc, evidence suggests that walking the barn, rather than just observing in the parlor, will help you identify a greater number of clinical cows. Check the smelly cows, especially those with vaginal discharge that is custard-colored to reddish-brown, cloudy, and foul-smelling. Additionally, watch for changes in appetite, milk production, and temperature (normal is 100.4-102.8F). Dr. Guy Jodarski of Organic Valley advises that cows off-feed, feverish, and depressed should receive veterinary attention. If metritis progresses to septicemia, symptoms may include fever, depression, partial to complete anorexia, decreased milk production, laminitis leading to being down, abnormal vaginal discharge, and straining. At this advanced stage, the prognosis worsens, and veterinary intervention becomes less effective. To prevent escalation, have your veterinarian check fresh cows with ultrasound during regular herd checks to detect uterine abnormalities early.

Treatment Strategies

Treating uterine infections early and effectively is essential, as chronic infections are particularly challenging to cure, especially with organic therapeutics. While antibiotics and hormones are the standard treatment on conventional farms, there are many tools that can be utilized across both systems. One primary method is uterine lavage. In its simplest form, warm saline is infused with a sterile stomach tube into an open cervix to remove accumulated fluid, bacterial debris, and pus. This fluid should be allowed to return through the tube, inspected, and repeated until the fluid returning is no longer cloudy, continuing daily until the fluid clears or the cervix closes.

Drs. Locitzer and Jodarski recommend a similar infusion of 50% dextrose, which has proven effective in reducing abnormal discharge and improving reproductive performance after metritis diagnosis. However, this method should not be used for large pyometra cases, as the bacteria will thrive on the sugar.

Administering medications directly to the uterus has sparked debate due to the risk of irritation and inflammation. If this approach is chosen, be aware that adverse reactions may occur, and treatment should be stopped if they do. Despite this, strong evidence supports the benefits of uterine administrations. Iodine, administered as a 1-gram bolus or as a dilution, is the mainstay of antiseptic use, as recommended by my mentor Dr. Doug Evans and Dr. Bradford Smith. This can be administered daily to every other day as needed early after calving.

Exploring Botanical and Herbal Medicine

The world of botanical and herbal medicine is vast. For those interested in herbal medicine for cows, I recommend the instructions in either Dr. Hubert Karreman’s The Barn Guide to Treating Dairy Cows Naturally or Treating Dairy Cows Naturally: Thoughts and Strategies. These texts describe botanical uterine infusions, as well as oral and intravenous treatments to promote uterine and overall health.

Preventive Measures

Preventing uterine infections starts with minimizing bacterial contamination before and after calving. Keeping the maternity stall clean is crucial. When assisting with calving, ensure that our hands and equipment are as clean as possible, and if possible, clean the vulva with a mild disinfectant to prevent bringing bacteria into the uterus. Use clean OB sleeves and keep chains and hooks in warm water diluted with iodine in a bucket. Interestingly, beef cows rarely have issues due to uncontaminated pastures and unassisted calvings.

Post-calving, maintaining uterine health is essential. Dr. Karreman suggests providing a sterile saline uterine lavage or a botanical infusion of caulophyllum and/or pulsatilla in lukewarm water after calving. Additionally, preparing for calving involves providing a sufficient dry cow diet, which includes a properly balanced calcium and phosphorus ration, and ample vitamin E and selenium to support the cows’ health and immune systems. Avoid feeding dry cows high energy diets that lead to obesity, as this can lead to greater metabolic problems, retained placentas, metritis, and displaced abomasums. So monitor your cow’s body condition closely.

Conclusion

Just as my dad harnesses the best of old and new tools to tackle any project, we too can blend traditional and modern animal care practices to optimize cow uterine health. By embracing a holistic approach, and using all the available tools including uterine lavages, antiseptics, botanical therapies, and preventative medicine, we can give our organic cows the best fighting chance to join the milking herd. Wishing you all a nice summer from the green rolling hills of Central New York.

Dr. Alex Schaff is a veterinarian on the large animal team at Midstate Veterinary Services in Cortland, NY. He and his colleagues work with dairies, beef operations, horse stables, sheep and goat farms, and homesteads of all sizes throughout Central New York. Born in Upstate New York and trained in Colorado, he is happy to be serving close to home. Dr. Schaff's interests include surgery, emergency work, preventative medicine, holistic herd health, and agroecology. Dr. Schaff can be reached at Midstate Veterinary Services, 806 RT 13, CORTLAND, NY 13045, (607) 753-3315, info@midstatevet.com