Downer cow syndrome (Bovine secondary recumbency)

Unable to rise and stand > 12 – 24 hours

Secondary tissue damage from pressure-induced ischemic necrosis of muscles of hindlimbs and pressure
damage to nerves of forelimbs (lateral recumbency) and hindlimbs

Alert downer cow

NO signs of systemic illness or change in demeanor
Able to eat and drink
Maintain sternal recumbency

Non-alert downer cow

Altered mentation
Signs of depression or lethargy, systemic illness or central nervous disease

Common in periparturient and early-lactating cows

Etiology and Pathogenesis

Alert
Periparturient hypocalcemia (milk fever)
Dystocia  calving paralysis from nerve injury
Musculoskeletal injuries from slipping and falling

Primary causes of non-alert downer cows

Systemic illnesses and infectious diseases e.g. toxic mastitis or metritis, right displaced abomasum or
abomasal volvulus, peritonitis, ileus, and hemorrhagic bowel syndrome, as well as metabolic disturbances
such as severe ketosis and hepatic lipidosis or liver failure.

Compartment syndrome
Compression of muscles, nerves, and blood vessels within enclosed compartment
Cause ischemic pressure damage of muscle and nerves

Pressure myopathy
Damage to and functional loss of sciatic nerve + peroneal and tibial branches
Sciatic nerve damaged by compression against caudal femur, secondary swelling of surrounding muscles

Pressure damage to peroneal branch of sciatic nerve (over lateral condyle of femur)

Necrosis of the caudal thigh muscles.

Renal failure
Severe and prolonged myoglobinuria due to obstruction of renal glomeruli by large amounts of myoglobin

Splayed out limbs

Indicate obturator nerve paresis or paralysis, rupture of adductor muscles, hip dislocation, or fracture of
the femur or tibia

Physical examination

Toxic infection of udder by Escherichia coli or Klebsiella pneumoniae = primary cause of recumbency

Cauda equina syndrome

Damage of nerve bundle extending from caudal end of spinal cord
Decreased or absent tail and sphincter tone
Paralysis of urinary bladder  assess size and tone of urinary bladder during rectal exploration

Diagnosis
Physical examination
Serum biochemical analysis, urinalysis
Alert downer cows
Normal serum concentrations of calcium, potassium, magnesium, and phosphorus

Fresh urine
Dark discoloration consistent with myoglobinuria due to excretion of myoglobin through kidney after
severe muscle damage

Milder cases
Positive result for hemoglobin and protein on the urine stick.

 serum CK, AST, and LDH activity = presence and severity of muscle trauma

 serum CK activity = specific indicator of muscle damage

CK activity peaks shortly after muscle damage  declines within 4 hours because of short half-life

Repeated blood samples at early stages of recumbency

Differentiate between acute (primary) and sustained (secondary) muscle trauma
Very high but rapidly declining CK activity = acute trauma
Elevated values with moderate change = ongoing secondary pressure damage

AST activity
 AST activity =  prognosis

The serum concentrations of phosphorus, magnesium, sodium, bilirubin, glucose, and urea are not
appreciably different between recovering and non recovering cows.
Parameters determined in CSF from recumbent cows were also studied for their prognostic value. Animals
with elevated total nucleated cell counts and/or protein concentration >0.4 g/L in CSF were found to have
notably lower short-term survival rate.
Lesions
Ischemic necrosis and rupture of muscles of the thigh region are common necropsy findings in downer
cows. Hemorrhage and rupture of adductor muscles may be evident if the animal “spread-eagled” itself
while struggling to rise on a slippery surface such as wet or icy concrete. Traumatic and inflammatory
injuries to sciatic and peroneal or tibial nerves are also found in downer cows. Damage to intrapelvic
nerves, such as the sciatic and obturator nerves, account for most cases. Decubital injuries to the lateral
aspect of the stifle can be associated with damage to the peroneal nerve.
Treatment of Bovine Secondary Recumbency
Correction of primary disease including hypocalcemia, other electrolyte abnormalities
Excellent nursing care, pain management, hydration
Daily assisted attempts to rise; use of a flotation tank as indicated
Attention to animal welfare concerns
Treatment of downer cow syndrome is guided largely by the findings of the physical exam and the
suspected or confirmed primary and secondary causes. In addition to addressing etiologic causes of the
recumbency, the treatment plan must aim at preventing predictable secondary disturbances (such as
inflammation) or metabolic disturbances (such as ketosis or electrolyte imbalances that may result from
anorexia).
State-of-the-art pain management and maintenance of adequate hydration are of paramount importance
as supportive care measures that will help to maintain or stimulate voluntary feed intake. NSAIDs are
indicated in most cases of involuntary recumbency to alleviate pain, discomfort, and secondary
inflammation in damaged muscle tissue. Large single doses of steroids have been advocated on the basis of
empirical evidence in animals with (suspected) fresh nerve trauma.
Recumbent cows with decreased or no feed intake may develop secondary energy and mineral deficiencies
reflected in ketonuria, hypokalemia, or hypophosphatemia. Minerals like potassium, phosphorus, and
calcium, as well as propylene glycol, can safely and effectively be administered orally as drenches.
Monitoring the hydration status is an important part of downer cow management.
Recumbent cattle should be examined and, if alert and responsive, stimulated to rise or hoisted daily to
determine whether the ability to rise or bear weight has changed. If there is no sign of improvement within
7 days after a cow has been moved to a place that has good footing and serum electrolyte abnormalities
have been corrected, the prognosis is poor.
Some recumbent cattle appear to lose interest in trying to stand; these cattle may benefit from use of a
specially designed flotation tank that has a volume of ~2,500–3,000 L. Alert downer cows are loaded into
the flotation tank by being dragged on a mat into the empty tank. Doors are then put in place, and the tank
is filled with lukewarm water. Both cold and hot water should be avoided, because they can induce
hypothermia or hyperthermia. Cattle should be encouraged to stand after the water reaches the level of
the scapulohumeral joint. Cattle that can support their own weight should be permitted to stand for 6–8
hours; however, the water in the tank should be removed as soon as the cattle exhibit trembling. The
water in the tank must be maintained at approximately skin temperature to prevent hypothermia. This can
be done either by circulating the water through a heating system or by regularly adding warm water to the
tank. Cattle that remain standing should be encouraged to walk slowly from the tank on a nonslip surface.
Cattle able to walk out of the tank after the first flotation treatment are 4.8 times more likely to survive
than those that do not walk out of the tank. Cattle that stand on all four limbs during the first flotation
treatment are 2.9 times more likely to survive than those that had an asymmetrical stance or were unable
to stand. Reported success rates in returning recumbent cattle to normal ambulation range from 37%–
46%.
Hobbling may be considered in cows suspected to have obturator or sciatic nerve damage, to prevent
overabduction that can lead to muscular damage. Ropes should never be used for this purpose. A soft,
nylon strap may be wrapped twice around the middle of each metatarsus, allowing a distance of at least 3
feet between the legs.
Assisting Cows to Rise
The value of hip clamps is controversial. Their proper use requires experience, skill, and a delicate touch.
Continual use causes trauma and pain that is counterproductive. The forelimbs support 60% of a cow’s
weight; therefore, the use of a canvas sling under the sternum is almost mandatory for consistent success.
A chest band is required to prevent the sling from slipping backward. Suspending the sling from the tine at
one end of a forklift and the hip clamps from a tine at the other end minimizes trauma. If a forklift is not
available, a T-bar suspended by a pulley from an overhead beam (or a tripod for animals at pasture) will
serve. The jaws of the clamps must be well protected with synthetic foam or rubber secured in place with a
wrap of duct tape.
Moving Recumbent Cows
Moving a downer cow requires rolling her into lateral recumbency. The cow can then be slid over dry straw
for a short distance by pulling on a rope attached to a lower forelimb and a halter rope. Transportation
over longer distances can be accomplished using a suitably prepared farm gate hauled by tractor. The
longest dimension of the farm gate is closely applied to the back of the cow still in lateral recumbency. A
tarpaulin is placed on the gate to protect the cow from contact with the ground. Dry straw is spread on the
tarpaulin, and the cow is rolled over onto the makeshift stretcher. The halter should be tied to the gate to
minimize struggling, and a sack placed over the eyes to minimize alarm while the cow is being moved. The
tail is best tied to the hock of the upper limb. Once moved, the cow should be restored to sternal
recumbency. A few cows, particularly if <12 hours postpartum, will rise immediately after being moved to a
location with good footing.
Dragging a recumbent cow over the floor without protection for body and skin or carrying the cow while it
is hanging on hip clamps is inadmissible because these procedures are likely to inflict additional physical
damage and pain on the animal. Moving injured cows in such a manner not only is illegal in many countries
but also hurts the production animal industry through negative publicity.
Supportive Care of Recumbent Cows
Recovery from downer cow syndrome strongly depends on the quality of patient management and nursing
care. Moving the cow to a site with an earthen floor improves the changes of resolution considerably. The
optimal site depends on climatic conditions. If the weather is warm and dry, grassy pasture is best, but a
ready means to lift the cow is essential. In less ideal weather conditions, a shelter with a roof and other
protection should be provided. Hay barns and implement sheds can provide the necessary protection, and
it may be possible in such structures to install a pulley system to lift the cow.
Protection from the elements is essential. Rain and wind can decrease body temperature considerably and
worsen shock if present. A windbreak of straw bales is essential. Straw bedding should be provided to help
insulate the cow from the ground. A recumbent cow does not require a warm environment; in a cold
environment, however, an inactive animal can gradually succumb to hypothermia.
Lateral recumbency must be avoided. If it occurs, immediate correction is required to prevent bloating,
regurgitation, and aspiration of gastric contents, as well as pressure lesions to the brachial plexus and
radial nerve. The cow should be rolled into sternal recumbency. To maintain this posture, however, the
limb the cow was lying on should be drawn from under the body. For example, a cow presented in lateral
recumbency on the right side should be rolled into sternal recumbency on the left side. To maintain sternal
recumbency, some animals may require support under the shoulder; straw bales can be used for this
purpose. Tilting the recumbent cow in 6- to 8-hour intervals from one side to the other is labor-intensive
but of paramount importance to limit secondary pressure damage to muscle and nerves. This repeated
tilting defines state-of-the-art nursing care for downer cows.
Attempting to stabilize a recumbent cow on a concrete surface is highly undesirable but sometimes
unavoidable. Until the transport of the recumbent cow onto a softer surface with more grip can be
arranged, the cow's rear legs should be hobbled to prevent slipping and splaying during an attempt to rise.
A common approach is to bed the cow on a layer of least 10 inches of dry straw sitting on top of >6 inches
of wet, sticky bedding (feces). If the concrete beneath the wet layer becomes exposed by the cow's
movements, more must be added. Although the footing is good with such a manure pack, the cow's skin
may become soiled with urine and feces. A deep bed of sand (> 25 cm) is more effective for housing a
recumbent cow. A sand bed usually drains well, and good hygiene can be maintained if voided feces are
removed several times a day.
The downer cows most difficult to treat are those that do not try to eat. A cow that salivates on its feed will
not eat it later. Rather than being offered large amounts of feed, the cow should be tempted with sweet
hay. Any hay not accepted should be cleared away every 30 minutes. Placing bitter-tasting weeds such as
ivy or dandelion in the cow's mouth may provoke salivation and an interest in eating. Some cows accept
lettuce and cabbage leaves. In extreme cases, the cow can be drenched with rumen contents.
Prevention of Bovine Secondary Recumbency
Effective strategies to prevent milk fever are important to decrease downer cow syndrome. All dairy cows
should be monitored closely around calving for early signs of parturient paresis.
The critical issue seems to be the length of time (several hours) from when clinical signs of milk fever begin
until treatment. Every cow that has been successfully treated for hypocalcemia should, if necessary, be
moved to a location with good footing and remain there for 48 hours. Straw over sand provides good
insulation and good footing.
Injuries from slipping frequently occur on concrete floor with insufficient grip. Overcrowding and an
unrelaxed or even stressed attitude of the cows in the herd will further increase the risk of slipping injuries.
Texturing or grooving the surface of the concrete, as well as calmly handling the herd, can improve the
situation.
Animal Welfare Considerations of Bovine Secondary Recumbency
Although it is possible for a cow to rise after being recumbent for >14 days, the cow should not be
unmonitored during this period. As long as the cow looks bright, occasionally struggles to rise, and
continues to eat and drink, recovery is a possibility. However, if the cow becomes listless, shows no
interest in feed, or has decubital lesions or starts to lose condition, euthanasia on humane grounds must
be considered, irrespective of how long the cow has been recumbent. Euthanasia should also be
considered if it is apparent the animal owner is not able or willing to provide the required basic nursing and
veterinary care. A cow that has decubital lesions, a poor appetite, or shows signs of wasting is unsuitable
for salvage slaughter. Attempting to transport recumbent animals except for the purpose of providing
veterinary care is illegal in many countries and considered an act of cruelty.
Key Points
Bovine secondary recumbency is a complication of a primary recumbency of >24h duration that was not
treated or was unsuccessfully treated and has resulted in an inability to rise or stand due to secondary
muscle and nerve damage. "Downer cow syndrome" is a colloquial term and more broadly refers to
prolonged inability to rise in cattle for an undetermined reason.
The condition is most commonly observed in dairy cattle in the periparturient period, frequently as a
complication of periparturient hypocalcemia or calving paralysis that was unresponsive to treatment.
Pressure damage on muscle and nerve tissue is considered the most important causative factor.
A thorough physical examination of the recumbent cow to identify all relevant primary and secondary
causes contributing to recumbency is the basis for successful treatment
State-of-the-art nursing and supportive care greatly increase the chances for a positive outcome.