C (1:42)

That's pretty impressive.

B (1:43)

Pretty impressive. And I. One of my favorite things to do with my kids when, back when we lived in Mississippi, I would take them to school every day because it was on my way to work. And we'd always put on some Looney tunes on the YouTube for them. I wanted to make sure they were steeped in the classics.

C (1:56)

Oh, they need to. Yeah, they need to have the classics well ingrained in them.

B (1:59)

Oh, they're just such great, great cartoons. But if I had to pick one of them that I just love watching over and over again, it would have to be Foghorn Leghorn, especially while you're in Mississippi.

C (2:12)

I always got a Kick assume.

B (2:14)

He had all these little sayings and expressions just, I thought were always so funny.

A (2:18)

Oh, they were a blast. Those cartoons are fun, and it's good they do it for your kids because you got to make an effort, because they're not just.

C (2:24)

They're not just.

A (2:26)

They were on before. But that's what I tried to explain to our kids is you watched whatever was on tv. You didn't pick what you wanted to watch.

C (2:33)

You watched what was available a little bit different.

A (2:36)

But I appreciate you guys being here and what I thought we're gonna do a little different format. So I've got a couple things that I wanted to throw out and get your opinion on, and several of them are either or. And you can pick why, and you may pick both in some scenarios. So the first one I want to throw out at you is, are we better off to treat disease early or treat disease. Precisely. Meaning we wait until we're sure that that animal is sick, or should we. If we're like, yeah, they're a little bit sick, I'm going to treat them early.

C (3:08)

Which.

A (3:08)

Which of those is better?

C (3:10)

I like the question, actually, because I think it's something we should always ask because I'm not always good at identifying disease. And we usually mean that as I miss disease and I'm too late. Well, sometimes maybe we're treating too early, and most of our treatments have some negative effects, whether it's just labor and time and money. But sometimes, you know, just getting the animals up, moving them away from their feed source, doing. We disrupt some things. So we need to think about any interaction that we do could have some positive and negative effects. And, you know, I think about myself. You know, some days I'm a little more energetic than others. Some days, you know, things are working well or not. But that doesn't mean I'm ill, as in I would respond to a treat. So I actually kind of like that idea because there isn't a. To me, there isn't a good answer because you could kick yourself for, I should have treated this animal yesterday. And that may be a true assessment that you were a little slow to help that animal out. How many times, though, do we treat an animal and the next day it's awesome. And we think that we're the one that made that difference. When, you know, maybe they were just a little off. They were just a little off. I liked the question, and I didn't really answer it. No, at all.

A (4:23)

You did talk a long time, but you didn't answer the question.

C (4:25)

Yeah, we'll hear what Todd has to say and then maybe I'll think of something smarter to say.

B (4:29)

Todd, really, to me, I'm looking at this, I'm framing the question and should I be sensitive or specific in my diagnostic approach? Is that a fair way to reframe the question?

A (4:38)

Yep. But you gotta define those so sensitive being I'm really good at finding them when they're sick and specific when I call them sick, I'm pretty sure they're.

C (4:49)

Sick, but also point out the opposites of when I'm really good at finding them sick. I also treat some that didn't need it.

A (4:55)

You can't have both.

C (4:56)

And if I'm really specific and I only treat the ones that are sick, I'm gonna miss some that I should have treated. So there's always a trade off.

B (5:04)

That's right. And I can think of clinical scenarios where either approach would be beneficial or detrimental. Clinical scenario that comes to mind for being too sensitive. Treating scouring calves and as a result creating more scouring calves because I'm contaminating equipment, I'm contaminating my clothes and I'm actually creating more cases of scouring calves because I'm overly aggressive at going in to the calving pen and getting those calves and treating them for scours. Clinical scenario where being too specific could hurt me. I wait until the animal is at a pathological state where they already have consolidation, they already have fibrinopluritis of the, of the chest cavity or you know, adhesions and fibrous attachments. That animal has enough pathology that if I wait that long to treat it, even if I could kill every ant, everybody microbe in that animal system that was causing disease, it still would not recover because there's so much residual damage that's left. So in that situation you might want to be more sensitive. So it really depends upon the type of disease, the secondary consequences of my treatment, all of those things can result in adverse consequences that I don't want.

C (6:28)

Well, you know, one of the ways I think about this is also I think producers and veterinarians, a lot of times when we think of problem solving, we're thinking of trying to come up with an answer in a very short period of time and then sticking with that answer. One of my mentors and I can't even remember all who all influenced me is don't be trapped into thinking that I have to make the decision that I'm going to stick with right now. My decision can be I'm going to try to not treat for a while and continue to monitor and be perfectly willing to change my mind in 12 hours or 24 hours. Or I could go ahead and treat now, but continue to monitor in 12 or 24 hours to see, maybe I'll just turn him back out with the others. And so somewhere along the line, somebody taught me that tomorrow is a great diagnostic test. And what that really means is the difference in that animal today and that animal in 12 hours or that animal in 24 hours is a really important piece of information. And so maybe that animal is declining faster than I thought. Well, then I need to change my approach and get more aggressive. That animal is really improving rapidly. Then I maybe change my approach and back off intervention. And so that part of the answer to your question is don't lock me into a decision today that I'm going to have to stick with for the next two or three days. Let me make a decision today and act on it and then reassess it in 12 hours and reassess it in another 12 hours and be flexible to. Because I'm not good enough today to Predict the next 12, 24, 72 hours and be right all the time. But if I get multiple points to change my mind, I get a lot more accurate. If I think of my intervention in total, it's like, yeah, I was wrong 12 hours ago, but I'm right now. I think is a good way to approach problems. And it also puts us more into the mindset of staying on top of a problem. Just because I acted doesn't mean that now all my thinking is over. If I act, I need to maintain vigilance, observations, frequent observations, reassess, be willing to change my mind.

A (8:40)

I like that. I like being willing to change your mind. The other thing that I would throw in is we sometimes take these decisions and try to make them in a vacuum and you can't do that. And often that individual is part of a group and my expectations for that group today should impact my decision. So if I, if I think I've had a bunch of sick cattle yesterday and I had a bunch of sick cattle the day before, a small sign of illness is probably interpreted as, that's probably illness, we need to treat it. And if they've not been responding to treatment, I'm going to try to treat earlier. Conversely, I haven't had any illness, I don't expect any illness. The same small sign of illness I might ignore and use your tomorrow as a good diagnostic test. But. But don't take that. While we're not Great at making individual animal diagnoses all the time as precisely as we want. We're pretty good with knowing what's going on with the group. Do I have several that are sick, in which case my bar is lower for finding a sick animal, whereas if I haven't had any sickness, I don't expect any sickness, My bar is probably a little bit higher.

C (9:49)

I think that's very fair. That's very fair. And you consider things like weather, both the current and future weather, and you know, any other outside factors that honestly make our decisions better when we include more information.

A (10:03)

Okay, so including more information, which leads me right into my next either or question. Do you prefer a standardized protocol that all cases get the same treatment if they, they have the same diagnosis, or do you veer towards, we should have some individual variation based on severity of illness or other factors or our assessment of those animals. So do you like having this diagnosis, gets this treatment, or do you like having you pick your treatment based on the individual calf or case?

B (10:37)

Again, I'm going to go back to what Bob was talking about earlier with being flexible in your approach to the problem based on the information that you're getting. If I'm experiencing an outbreak of disease now, I'm operating with different protocols than I would be if, if I had relatively low levels of disease occurring in my group of animals. And so I, I do like to have protocols in place because I like to have plans in place. I like to have a rational thought out, logical approach to how I'm going to deal with problems. But it also has to be able to adapt. It can't be inflexible. I have to be able to adapt to changing conditions and changing probabilities. You know, we talked a lot about how different types of scenarios would influence the way that you make decisions. And I, I relate that back to pretest probability. And that's a concept. Whenever we run a diagnostic test or whenever we're trying to decide what's going on and what we're going to do about it, we have to think about, okay, before I even make this decision, how likely is it that we're dealing with the thing that I think we're dealing with? And if I'm in the middle of an outbreak, then it's pretty likely. If it's pretty low key, then it's not likely at all. And so I think you have to have protocols because I think you need to have a plan. I think those plans need to account for the possibility of things going really sideways on you. But I Also think that you have to be able to be flexible in how you apply those protocols and have contingencies for, hey, if things are going a certain way, this is going to be our approach. But if it's going this other way, then we got to modify the approach accordingly.

C (12:17)

Yeah, I think I hear what Todd's saying, and I like the idea that you kind of changed the term from protocol to a plan. Because, you know, I as a veterinarian working with producers, yeah, I want protocols in place and you could think of diseases that are kind of expected. So scours and young calves, you need to have a plan. If you live in an area with anaplasmosis is fairly common, you need to have a plan. If I'm bringing in feeder calves, I need to have a plan for that arrival processing. But all of us have experienced, both veterinarians and producers, where it's a little bit different, it's a little bit better, it's a little bit worse than typical. And so I need some flexibility to modify it. So I really like the idea of having a plan. Part of the plan is exit strategies of when do I modify the plan, when do I add something to it, when do I think about being more aggressive and actually move the cattle to a new environment or bring in bedding or change my chemical antimicrobial interaction. So maybe this isn't as much of a debate as you wanted because I think a protocol to start with shows that you've kind of done some prior planning, but sticking to your protocol for every case doesn't make much sense either.

A (13:24)

Yeah, I'll debate a little bit because I think if you have a good protocol in place, it is easy to want to change it on a not. Not necessarily a case by case basis, but to make exceptions. Right. I want to do this with this case and I want to do this with this case. And the challenge I have with that is evaluating. As you said, there are times we need to change. And a lot of my evaluation criteria may be on specific metrics, like what was my treatment response rate, what was my case fatality risk. If I am varying that protocol for some cases, and let's just say, for example, I'm good at picking out severe cases or I treat them a little bit different than others, then I need to really have two different evaluations.

B (14:12)

And.

A (14:12)

And it's hard for me to know when do I need to change my base protocol if sometimes I used it here and sometimes I used it here.

C (14:19)

So you're kind of worried about basically jumping off of your protocol too quickly and then you don't have a way to evaluate over time.

A (14:27)

It's easy. And I want to because I want to do the right thing. Right? I want to do the right thing by the animal. If I think this individual animal is more sick and maybe I want to give them an additional treatment or I want to do something different, it's hard for me to evaluate if that works or if it doesn't, if I don't have enough cases. So if I have the occasional variation from the protocol, fine, I'm okay with that. But I think, for the most part, I think it is stick with your plan until your metrics tell you something that you need to change it. The only thing I don't like about the occasional variation is you just gave me, if you were giving me the protocol and I'm treating the cattle, you just gave me freedom to make decisions on an individual basis, which I'm like taking advantage of.

C (15:13)

Yeah, right, right. I see what you're saying, and I think it's, it really comes back to how much different than expected do you need to be to go off protocol and, and hopefully your protocol, which I.

A (15:25)

Need to have lined out beforehand.

C (15:26)

Yeah, I'm agreeing. So you basically want your protocol to cover a wide range of, you know, again, we'll talk about calf scours or pneumonia in newly received calves or anaplasmosis. My protocol needs to be basically kind of a broad brush that would handle a lot of the cases and I would only alter that if it was outside that. Well, I think that all well and good, you're still stuck with the when do you stick with the protocol and when do you deviate from it? And is it frequently that you deviate or not? Frequently. And, and a well designed protocol would probably imply that I don't deviate very often because it was designed to cover most animals, which, it gives you a.

A (16:10)

Chance to collect those metrics and then have a decision point, hey, I need to change something. Something's not working. Most of us are impatient, especially when you feel like something's not working. But unless you document that process, a lot of our memories are driven by those severe, worst cases, negative. I mean, it's back to the which does it hurt more to have a loss or does it feel better to have a win? And most of us would say it takes several wins to offset a loss. Which means it would be easy for me to jump ship on my protocol early if I have a few calves that don't do well. So I'm Arguing? Yes. I think you should have a protocol and stick and deviate until you decide to change, and then you change the protocol.

B (16:56)

I think what it really boils down to, or what are your criteria for change and how do you assess those criteria? I use this example sometimes when I talk to friends of mine, clients, other veterinarians about disease outbreak investigation. Because what will often happen is we'll see a bunch of cases of disease and we'll think, oh, no, we're doing something wrong, or we did this, and that's creating this problem. And I liken it to playing dice with my kids. We have dice games sometimes that we like to play as a family. And sometimes my kids will take the dice and they'll. They'll say, oh, please, oh, please, oh, please. Or they'll blow on them, or they'll shake them three times and then throw them on the table. And if they get the result they wanted, they think, oh, it worked. You know, I did this thing and then I got the sevens and I wanted the seven on this case, or I didn't want the seven on this case. Oh, I shouldn't have blown on those dice. And I try to explain to my kids, no kids, there's.

C (17:48)

There is random variation.

B (17:50)

There's random variation, and there's a certain probability of you getting a seven, and it's higher than you getting snake eyes. And so you should just plan on getting more sevens than snake eyes when you roll those dice. But I tried to show them that, however, and one time you get ones all over the place. I'll roll the dice 30 times and you guys count how many times I get sevens versus times I get snake eyes. Well, I'll be danged if I didn't end up with, like 10 elevens. And so they thought, oh, these dice are loaded, and they weren't. But sometimes life is like that. It doesn't always follow a perfect, which.

A (18:24)

Is why it is nice to be able to track it and go forward. Because when you're given a treatment and coming back, I think that is where you want to.

B (18:32)

That's right. So if I'd have rolled those dice 300 times, it probably would have created a distribution of outcomes more like what we would expect. But the point I'm trying to make there is you have to understand kind of what's going on in that system and what the probability of the outcomes is going to be and live with the reality that sometimes you're not going to get the results you wanted, even though you actually made the best choice based on the probabilities for treating that particular problem. And that's why protocols are nice. They should. Those protocols should be built upon what we think is the most likely, the most likely outcome, the most likely result.

A (19:09)

But the point that you inadvertently made is if I know the likely probabilities or outcomes, but I only do it a few times, such as these protocol deviations, it is similar to I blew on the dice or I did this, and it may or may not have. If I don't have enough, I can't really figure out what the actual probability is. So one last question for you guys, and this is a agree or disagree statement, and we'll focus this time just on respiratory disease. And there's been a lot of discussion. Antimicrobial resistance, antimicrobial use. The statement is, many cases of brd that are treated and die. Antimicrobial resistance has played a role in their death.

C (19:56)

I would disagree with that, personally. I'm not saying never, But I've seen enough lungs, when we necropsy calves that have died of pneumonia to recognize that there's a lot of things going on. There's the animal's response, there's the length of the disease before it's first treated, all those types of things that matter. So antimicrobial choice, antimicrobial timing is important, but antimicrobial resistance as a cause of treatment failure is probably not first on my list when an animal dies of respiratory disease.

B (20:28)

I want to be careful when I say this. I think antimicrobial resistance is a problem in general. I think that we need to be cognizant of antimicrobial resistance. But I disagree with the notion that a lot of our treatment failures currently in the cattle industry are due to antimicrobial resistance. And the reason that I have it's slightly different from Bob's is I don't think that respiratory disease in cattle is a bug problem. There are pathogens that are involved in respiratory disease, But I don't think you could say there is one particular pathogen or one particular bacteria or species of bacteria that is creating this problem. And that's why we have so many cattle getting sick. If it were the case that it was one particular bacteria, and if that bacteria was the major determinant of disease, and if that bacteria were developing resistance to all of our therapeutics, then I would be more concerned about antimicrobial resistance with regards to the ability of our ability to treat disease. But that's not the case. There are so many other factors that influence the Severity of disease, whether an animal gets disease, whether they recover from the disease, that have very little to do with the actual pathogen factors. So while antimicrobial resistance is something I think we should be take very seriously, I think it is something that we should be cognizant of. I don't think that is the major reason that we have treatment failures in the cattle industry for respiratory disease.

A (21:51)

I'm going to agree with you guys on this one. And I'm going to use a little bit different logic of we find it right. We will find. If we treat animals with antimicrobials, you will find antimicrobial resistance as a matter of degrees. But finding it does not mean that that was the causative factor in the death of the calf. And as you said, there are multiple pathogens, multiple areas. So prevention and diagnosis. And Bob, you alluded to this in saying it's not just the pathogen, it is the calf's response to that pathogen. What is the animal doing? What's the environment that they're in? Are they in a suitable environment that promotes recovery? So I think prevention, ideal diagnosis is our next step. And we talked about that a little bit at the top of when do you diagnose them in that process? Because that makes a difference in treatment response as well.

C (22:41)

Hey, but I'm going to be careful, particularly for respiratory disease in cattle because it's a syndrome. And a syndrome is different than. And we talk about diseases in humans or animals that are a specific. So rabies, one germ causes one disease. Well, respiratory disease is a syndrome. A number of viruses, a number of bacteria, and certainly a number of animal factors are involved. Syndromes are a lot more complicated. And so when you say diagnose the problem, I'm not thinking diagnose the pathogen that's currently today causing the problem because there was another pathogen that set them up yesterday. There was immune function differences, there was environmental stresses. So when I say diagnose the problem, it's diagnosed what's in the environment that's not ideal, what is about the calf that's not ideal, and what's different about the pathogens in that animal. So don't think diagnosis means germs.

A (23:33)

Good clarification, because you're thinking the same way I am. You knew I'm thinking diagnosis of they diagnosed with the syndrome, not necessarily specific pathogen. And I would agree with you guys that I think we do. See, Todd made a great point. Antimicrobial resistance, important. We should be aware of it. But. But it shouldn't necessarily be deemed as the cause of all our death or our treatment failures. It's easy to to put the finger there, but I think figuring out how do we do better at other aspects of preventing having fewer cases, doing some of those other things. Excellent. Well, I appreciate you guys sharing your thoughts and debating a little bit today, and thanks for joining us. If you have questions, comments or things you'd like us to talk about, you can send us an email at bciasu Eduardo.