The author is a senior partner in the Evansville Veterinary Service, Evansville, Wis.

Walter watches his preweaned calves very carefully. In the past, he has tried to figure out such obscure things as odor change in a diarrhea outbreak, severity shifts, shifts in the pattern of disease such as age at diarrhea, prevalence shifts in the number of cases being seen, or more days to clinical cure.

For preweaning diarrhea, we have three treatment plans which depend on severity of the condition. His mild case is a Code 3 to 5 manure score with little change in appetite or attitude. A moderate case is a manure Code 4 to 5 with some affect on appetite and attitude. The severe case is a manure Code 4 to 5, loss of appetite, depressed, and dehydrated.

First, let's define the manure codes used:
3=formed but pasty
4=formless and puddles out

Mild cases get oral fluids in addition to their milk and electrolytes, moderate cases have a systemic antibiotic included, and severe cases are treated with the moderate treatment until they can be seen by a veterinarian. Walter records every case treated with the severity and treatment used, and you can see from the manure scores that trigger a mild recording that he is intent on finding mild cases and supplementing fluids and electrolytes. This also means that the recorded incidence is high because he is intent on early detection of mild cases. The normal "pattern" of cases is known by age at symptoms and severity. And the common pathogens that caused diarrhea in the past have been cultured and are known.

The phrase production medicine gets used very freely by all of us, yet I suspect it means something different to all of us. The definition that matches the rest of this story is that it is a combination of what we know about clinical medicine and what we know about the management needs of the herd or a specific population in the herd. In this case, it is the management needs of the preweaned calf.

Two-pronged approach
The bottom line is that the diarrheas are caused by a pathogen. But the management factors that surround the calf also factor into pattern of diseases we see. Therefore, expanding the definition of production medicine to our cowside (calfside) application is to include in the differential diagnosis for any outbreak the management practices the calf is exposed to plus the bugs we know are the clinical medicine cause.

By recording conditions treated, we very simply get the medical history to use for health care decisions for the individual calf first. But it also gives us an unbiased quantitative measure of a situation change. This change either can be on the clinical medicine side of production medicine or the management side. As long as both sides are being considered, changes can be resolved.

Walter didn't need records to note that the diarrhea "pattern" had shifted. The records are used to measure the shift or shifts of the condition patterns that occur over time either in the proportion of cases or their severity. In Walter's calves, both shifts could be seen at different times. True to my training, I look for a change in bugs involved, but we will keep changes in the management of the calf as possible contributing factors.

The five Cs
The recommendations for management of the preweaned calf are stated in the five Cs of calf management:
- Colostrum
- Calories
- Cleanliness
- Consistency
- Comfort

Some potential pathogens always are with us which is why we want to supply the five Cs so the calf can manage these challenges itself. The name of the culprit hadn't changed, and I didn't even add the name because it is not important to the points we are considering. There are a couple of questions about the bug to consider. Had the level of "challenge" changed, had the bug changed and gotten stronger, or had the strength of the calf been compromised? These questions send us to the management side of production medicine and an assessment of changes in the five Cs:
-Colostrum management hadn't changed, and we can use the laboratory to assess that.
-Calories being supplied hadn't changed.
-Cleanliness hadn't changed which answers the question about level of challenge.
-Consistency of feeding times and amount fed hadn't changed, so calories should be stable.
-Comfort hadn't changed and is excellent.

In the October 25, 2009 issue, page 645, was a very interesting column by the Hoard's staff about heifer raising that includes a table about energy utilization at two temperatures for growth. The question then becomes: Did the night temperatures drop enough to make this the "culprit" because it also takes significant energy to defense a challenge? The answer is no, the culprit still is the pathogen cultured, but meeting the calorie requirement at different temperatures is definitely on Walter's management agenda. We learned that colder weather is upon us and still colder weather will follow.

We didn't rule out the possibility of simply more bugs in the environment from a calf shedding large amounts or that maybe a strain of the pathogen did get stronger. We know the name (pathogen) didn't change, and we can't measure the other two.

The solution is rather clear. We intensify the management of all five Cs. Making sure colostrum management is excellent and identifying the individuals that were less than perfect; manage the calorie intake to times when additional needs are present; always minimizing the challenge of bugs with cleanliness; maximizing the consistency of their feeding in interval being meals, amount being fed, and formulation of diet; and, finally, maximizing the management of comfort to minimize the shifts in weather that are a fact of life.

The health records maintained by Walter are designed to be able to quickly monitor shifts in either number of cases or change in the pattern of severities.

We recognize that changes in any of the five key management areas or a culprit (pathogen) change are going to be visible in these health records and that they are not going to specifically identify what changed.

As the temperatures drop, "intensifying the management" of all five Cs will be at the top of our agenda.

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