Monitoring Subclinical Ketosis and Equipping Farmers with Practical Solutions

- All right, let's start today's session.

I would like to welcome everybody.

Before I will give the microphone to our speaker, Just would like to mention a few things.

This webinar is recorded and the recordings will be available in the Penn State Extension website.

All attendees are encouraged to ask questions and if you ask, please type them into the Q&A box.

And I think you know the speaker will answer as you type it in as they come.

After this webinar, I will be sending surveys to all participants and I would like to ask you if you can just take five minutes of your busy time and fill the survey, the Penn State Extension would truly appreciate it.

And now to our speaker.

Today, speaker is Dr. Luciano Caixeta who is Veterinarian and currently resides at the University of Minnesota St. Paul.

Dr. Caixeta grew up in bovine practitioner's family in Brazil and he also earned his Doctor of Veterinary medicine in Brazil in 2008 and then continued his business education at the Cornell University in New York where he earned his PhD in 2017.

He also worked as a Clinical Instructor in Dairy Population and Health Management at Colorado State University.

And currently, as I mentioned before, he's with the University of Minnesota, a member of the Dairy Production Medicine group.

Over the years as a practitioner, he has been dealing with the direct or indirect effects of the metabolic problems such as ketosis, displaced abomasum, fatty liver, hypocalcaemia, typical the transition from whey gestation to a early lactation in dairy cows.

So today, Dr. Caixeta is going to discuss what dairy producers need, can do, need to do, and what tools they can use in order to successfully monitor subclinical ketosis in dairy cows.

Luciano.

- Thank you Lunak for the introduction.

Welcome everyone for the webinar.

So I was mentioning I'll talk about some of this monitoring subclinical ketosis and tools that we can use and solutions to address this issue.

One thing that I'm not gonna talk because I'm not a specialist, will be talking about diet formulation and all that and how to use that to our advantage.

So this is definitely not a nutrition-heavy talk, it's mostly a dairy production and management of the cows talk.

And every time I, like Lunak mentioned, feel free to add your questions to the Q&A box and I have it open on my second screen here and I can, as soon as I see them, I can answer those.

It's usually easier to answer as they come because it makes more sense within the topic we're talking and we might be able to use the data that's on the screen.

So every time I talk about ketosis or any of those metabolic diseases, as was mentioned, one of the reasons that I investigate and do research in metabolic diseases is through my clinical practice and clinical training.

I was always dealing with problems of the transition period.

So as mentioned, milk fever, ketosis, DAs, you name it.

And it gets really frustrating as a veterinarian, it's easy to fix, we can all fix those and we know how to fix it.

However, it makes more sense, at least in my mind, to work on preventing it and studying and understanding why they are happening, and understanding how we can prevent it to avoid it to happen in the first place, which then saves all of us time and money 'cause once that disease is installed and you have a cow that has a DA or a cow that has a ketosis, she already compromised her production for the entire lactation.

So if we could work before and have them not have those issues, then it's better for all of us.

So that's the main driver of the research that I do and the investigations that I have within the transition cow.

So like I said, I like to start it and always remind what's the transition period.

It's a super challenging period for the cow and the farmer that's taking care of the cows.

If we're look into literature and all the people that look into when diseases happen in the dairy cow, about 75% of the disease cases that we have, we have happen within this period and most, more precisely between calving and the first like 60 days.

So that's why it's very important for us you understand this period, understand how the cows will adapt to this challenges and how we can manage them and help them successfully transition through those.

And one of the reasons that we call it a transition period and we all have heard this term, but I like to think it as more like transitions period because this is various transitions, it's either different diets or different pans.

So the cows are moving from different places and transitioning into a new environment on a regular basis in a very short time period.

So it's super challenging for those cows and that's why it's important for us to just provide them as much as you can so they can truly adapt and respond to this drastic physiological and immunological challenges that they have during this period.

So to put that in context, the transition into lactation super challenging and one term that you probably all heard and we're working on not using that as much is the negative energy balance.

And what I say we're trying to not use that anymore so much because it's not just energy that those cows are in deficit, they're in deficit of all nutrients.

So they are not eating as much as they need to support that calf and the a large amount of milk they're producing, so they are not in need just of energy, but they're actually in need of protein minerals and all that.

So one thing to exemplify this is negative nutrient balance or this deficit in nutritional deficit of this case is a cow in the transition period, a cow that goes from a dry cow not lactating to lactating cow, she has in about two days, if you count the day before she calve to the day after she calve, her energy requirements are increased by 300%.

And the calcium, just to pick one that's has been studied a lot and people quantify it, the calcium demands are increased by 65%.

So it's a huge demand on those cows and I like to use a lot of analogies to get people to grasp on these ideas.

For us, if you think about us humans, the analogy or the the equivalent of this transition of cows will be equivalent from us just being on the couch, not doing much to running not one, but two marathons in a day.

So that's how much energy and how much nutrients more we need or the cows will need in those two days.

And if you want to have numbers, some people are more visual understand this, but some people would like to see numbers, this is a table that was done by Dr. Drackley a few years back and he uses just some softwares the NERC at that time to calculate what's the energy demand for those animals.

So if you think about in the first two columns here, have a cow and the second two columns we have a heifer that's calving.

So if you look from pre to post, their maintenance doesn't change much, then there's pregnancy.

But if you go all the way to the bottom line here, you can see that in two days, a cow will basically double the energy that she needs for supplying all the energy that she needs for their milk production and maintaining or staying alive.

And a heifer there's a 75% increase.

So it's not as massive as a cow because they are smaller animals and produce less milk.

However, there is a sizeable increase.

So there, this is something to always remember and by knowing those numbers and understanding these, it always help us think better about why we're paying so much attention to those animals.

And why are those animals in such stress when they're after calving?

So important to know.

And what we see here, it's a very short crash course of the physiology.

What happens is if the cow needs that energy and let's focus on the energy, what they'll do is that they'll mobilize some of their body reserves.

And one of the body reserves that's very high energy is their adipose tissue or their fat deposit.

So what they do is they mobilize their fat to supply energy for the cows.

And then the fats mobilizing two parts glycerol, which provides carbons for a whole lot of biochemistry that happens and they provide energy for the cows and the NEFAs, which most of us on the dairy industry have been accustomed to this nomenclature, which is non-esterified fatty acids, so those fatty acids goes into circulation.

And what happened to those fatty acids is one thing that you will see is, for example, the memory gland would take up some of these fatty acids and put into milk.

So that's one of the explanations for the higher fat content of those cows in early lactation.

So if you were testing a cow way early, like within their first week, within their first 10 days or any of the early lactation cows, they would have a higher fat content on their milk because there is a lot of this mobilized fat that it's circulating that's going to milk.

So there are some groups that look into, if you look at the different sizes of the fatty acids that are in the milk, so there's fat in the milk and they're all, there's a different host of different sizes of the fat in there.

People can measure it and determine, but basically, what it is, is the cows mobilizing fat from their back that in some of it is coming out in the milk.

And for her to use that as an energy source, what happens is it goes through circulation, get to their liver.

And in their liver what they'll do is they will use that fat either to produce the energy that they need, which is the cycle of the ATP here.

But what we see very often is what's important for us today to remember is that they have some partial oxidation that also happen in the liver and that leads to the production of ketones.

And the cow have three ketones, but acetoacetate, beta-hydroxybutyrate and those are the ones that we measure in blood because they're more stable.

So that's the pathway that we're, it's important for us today because we are measuring those ketones in either urine, blood, milk and those are what we were using to determine if a cow is ketotic or not.

And the ketone bodies in circulation, they can be used by different peripheral tissues, by other tissues and organs in the cow as the energy source.

So that's how this fatty acids or the the fat that's mobilizing got to be something that the cow can use.

The other thing that can happen, and we mentioned already in the introduction about fatty liver is, if all those pathways that I talked before are overwhelmed, then the cow cannot really produce the capacity to produce ketone bodies is overwhelmed.

Then they'll start accumulating some of these excessive fatty acid that's being mobilized in the liver.

And what happens is by accumulating fat in the liver, they decrease the capacity of the other cells to function properly and then it just snowball into her not having, being able to produce these other sources of energy.

So Jake Rogers have a a question here about which test is most accurate to determine the ketosis level.

And I'll purposely not answer it right now because in two or three slides, I'll have a table with that information.

Just a hint, maybe it's actually the next one.

No, if you want, I'll get to that point later in the presentation, but if I don't have it just send another message and I'll specifically address what you're looking for.

But so going back to, I mentioned they use this fatty acid produce the ketones and the ketones are circulating used for energy and it's a physiological adaptation that a cow have and that's beneficial to the cow unless it's excessive, and you do have very high levels of those ketones circulating, which then causes the cow to have some of the issues that we often see is like the cow lost appetite, they're depressed and many times they go even down and don't get up and they have their nervous ketosis where they're chewing on everything.

And those are visible signs that we can use to determine if the cow has, in this case, mostly clinical ketosis.

But we can do tests to determine if the cow has just a slightly higher concentration of ketosis, which that's when the testing comes about.

And like I mentioned can use BHB milk, urine and blood, and what happens is they measure different things, but they can all be used to a certain extent at the same level.

So when I'll talk here to as a veterinarian, I'll talk a little bit on this differentiation between subclinical and clinical ketosis.

And it is hard to make that differentiation if you're not testing.

If we're testing, then yes, it's easy for us to determine because the definition is based on their blood BHB levels and the presence of clinical science.

So it's easy to do if we're measuring blood, not as so easy to do if we're only using clinical signs or the urine test, but it still can be done.

And the reason I mentioned the subclinical, which is just slightly elevated blood BHB versus the clinical which is the high like very elevated BHB concentrations is because that leads me to treat the cow differently because the cow that has just a slight elevation in BHB, they do not need as intensive treatment as the cows that have a very high BHB and which is also something that will touch base later.

But before we go into that, the treatment, it's like why do we care about ketosis and we care about it is because it has been shown over and over again that the cows that have ketosis, they'll have produced less milk, they have lower fertility so they don't have good as good reproductive performance as their non-ketotic cows.

They are more likely to have other diseases and because of all those combined, those cows are more likely to be removed from the herd.

So overall, it has some direct effect, direct impact, but it also leads indirectly to other things that will lead the cow to potentially leave the herd.

And when we think about the epidemiology of the disease, most of the cases will be happening within the first 10 days.

So in this graph what we see is like, and here we're using the blood BHB, which is the most accurate way of us to perform the test.

Not say it's the best but it's like the most accurate.

So if you wanna be very precise on what you're measuring, you measure the blood BHB and then here just have the percentage of the cows that have a first positive high BHB.

And in this case, it's a 1.2 millimoles per liter over the days in milk.

And what you can see is that the high BHB, the high proportion of cows having their first test happens around their five days and most of the cases happen up to 10 days in milk.

Past that we still have someones coming through, but they are not as frequent as the before 10 days in milk.

So keep that in mind because they're being important when we talk about when we should be testing those cows and when is most effective time that which us test a cow.

So we have a question here about, does reduced reproductive performance only refers to conception rate or would a farm see a decrease in calcium heat?

Most of the pathway for the decrease reproductive performance that we see right now and it has been proven, it's related to the conception and that actually the conception because it's associated to decrease in the quality of the oocyte.

So what happens is those cows with high BHB in early lactation, that's when that oocyte, especially from our first breeding is starting to develop and we have some epigenetic changes.

So some changes, the structural changes and in the functionality of the oocyte that one, this oocyte that's ovulating around 80, 90 days when we're breeding the cow, it was starting to develop when the cow have high BHB and the high BHB has a malefic effect on those eggs, that those eggs are not as good as they could have been if they were in a calf that didn't have high BHB.

So the majority of this impairment of repro performance is because of the conception rate.

I'm not aware of any association being demonstrated on this ketosis and intensity or intensity of estrus or showing estrus.

So, which is, it's a good question that we could certainly look more into it.

I personally have not seen any of that connection being made.

So mostly it would be referring to the conception rate.

So here comes to the question that Jake asked before.

So what test is more accurate?

So the blood test, it's very accurate.

Any measures beta-hydroxybutyrate, so BHB and what we use for measuring ketosis in this case, if it's above 1.2 millimole per liter, we have a cow that we call as ketosis and that's measuring the blood ketone bodies.

Some good things about it.

It's a cow side test.

If you can pull blood, you can do that very easily, in 10 seconds you have a result.

Although it is more expensive than the urine test, I don't have the information here on the the milk test, but more often people are using either blood or urine.

I don't see besides the BHB, the DHI-BHB testing, I don't see a lot of farms here in the US using the, at least where I'm at in the Midwest using the milk test for BHB.

We do see a lot of that in Canada.

But comparing blood to urine, one of the things to keep in mind is that the urine ketone bodies, the KetoStix or whatever urine measurement that you're taking, it's measuring a different ketone body.

It's the acetoacetate, it's also a cow side test pretty fast and it's much cheaper than the blood test and you don't have to, as long as you're pretty good at making the cows pee, you don't have to take blood and sometimes getting the calves to pee it's a challenge, but those are the two tests.

They are good and the question about do we, which one's more accurate?

So I'll show you here is comparison that was done by Dr. Klibs Galvao in University of Florida over a decade ago.

And then what he did is he collected the blood test and measure with the BHB meter and they also collect the KetoStix and measure what the results were.

So what he was trying to see is like comparing both of those, can I use the urine test which is cheaper and easier to do in substitution to the the blood test?

So what he was looking at is like what the negative and any of the results like the trace and above, so he used this and then he compared.

Just a second...

Dog decided that there's danger outside.

So hopefully this will be a little quieter but what he compared and when we look into this, if we're looking into those that 1.2 millimoles per liter cut-off point that we have for subclinical ketosis using the blood test, if we use the urine stick and you have from trace and above as your parameter for being positive, then you're pretty close to the both tests being equal even though they're testing and they're measuring different metabolite, different ketone body.

So if you look at the sensitivity and specificity, so the number of false positives and false negatives would be basically the same for those two tests.

So both tests are accurate in different ways, right?

So if you're using either one comparing blood and urine depending on the calf in this case, 1.2 and the five or milligrams per this deciliter or trace, they can be very similar even measuring different ketone body.

So either one can be used and they are both effective.

So I hope that answers Jake's questions from before.

And then this is when I ask you to remember like the classification that I have by clinical and subclinical cases and why that's important is because the clinical cases are cows that will benefit from having IV dextrose.

So if you have a cow that do have really high blood or urine BHB especially those cows, they're down and they're chewing on everything because they do need that energy and they're trying to get it from anywhere, they do need and you should have provide them half or one bottle of the dextrose IV.

The reason I have half or one is it has been determined that half a bottle is what the cow need and giving more it's not beneficial or maleficial, so it's the same like the cow truly needs half of it and if you're giving a full bottle she might just like dispose of that extra glucose that you're giving the cow so she's not using it for the energy that she needs.

However, it depends on the size of the farm, if let's say if you have a larger farm and you have multiple cows to treat in a day, then yes, you can give the half bottle.

But if you don't and you have that half of dextrose solution to use later, what probably gonna happen is a lot of bacteria grow in it because you have a lot of substrate for that bacteria to grow.

So if you are in the case that like you might not use that bottle within the next half a day or the next few hours, they might as well give them all the whole bottle and she might use a little more, especially with larger cow.

But even if she doesn't use it, it's not that's gonna cause her to die.

It's just like she will, the kidneys will filter out that glucose and it will go away.

But the one thing that it's we give and it's common for both of those cows in the clinical case, the cow needs a intensive treatment right away.

So we give that IV dextrose, but we do following that it's a 3-day protocol that you're gonna give them 300mLs or 10 ounces of propylene glycol.

So that's the treatment we do as more supportive and keeping the cow going after that.

And I often like to include some vitamin B on that, on the treatment for those cows just to increase her appetite 'cause that's one of the things that'll help her bring more energy into her body.

On the other hand, when we have those subclinical cases or those ones that don't have very high BHB, they don't need the dextrose and they just need the 3-day of propylene glycol plus or minus vitamin B.

So that goes depending on your conversations with your vet and your protocols, the most important thing is certainly the propylene glycol.

The one thing that I would like to show too is, I've been through many farms where the protocol for treating any case of ketosis is IV dextrose.

So it has been shown in many places already that it's not that important.

And one of the things that giving IV, you can destabilize a little bit the equilibrium between insulin and glucagon.

So the hormones that control the energy usage on the cow.

So what was done here, and I like this paper because it was very practical.

So what they did in this, all the cows that have high BHB and in this case of anything that was above 1.2, they divided them randomly into three groups.

The first group, they only got that 3-day of propylene glycol, the 300mL or 10 ounces.

The second group they got the 10 ounces of propylene glycol for three days, but in the first day they got a full bottle of dextrose IV.

And the third group, what they did is again, still the 310 ounces of propylene glycol three days in a row and they all got one bottle of dextrose IV every day.

So three groups going from the least intensive and the recommended treatment to a very intensive where you have overwhelming her with this propylene glycol, which is a precursor of glucose plus glucose in their veins.

So what they found with this, and that's what I wanna...

I hope that you you get as a take home message is that by giving and they have like about 120 cows in each group.

So it's a sizable study, it's a good number of cows to make that comparison.

That was in four farms in upstate New York.

So not very far from where you are.

So they saw no improvement in the resolution of ketosis, no reduction in the any adverse event.

So the number of diseases that happened after treatment was the same and there was no difference in milk production.

So basically, what we're seeing is we have this the, I'll call quote-unquote, "bare minimal," but that like the standard protocol that we are suggesting compared to protocols that go above and beyond that is not beneficial to the cow.

So giving dextrose to those cows, they're not down, they don't have nervous ketosis, it's not beneficial.

It is also much harder to give that dextrose to that cow that is not unhealthy and not really sick.

You have to restrain them, it's not a fun job.

So that's one more and this is a scientific and data showing that just the propylene glycol, it's what you need to get those cows back on their feet.

The one thing that you could do, and I'm aware that you talked about we can use DHI-BHB to monitor those cows.

The other thing you can use if you're a farm that's testing with blood tests, you can test and use the blood BHB to monitor your transition period.

And just to determine do I have too many cows with ketosis, which is usually a sign that something is wrong or something went wrong in my transition, therefore we have workouts they're showing this sign to me or not.

So this is has been published a few years ago and basically what you do, we will suggest farms should be monitoring if they have the capability of measuring blood BHB or using the DHI just check how the BHBs are, and hopefully, in most of your farms you're well-managed and you're gonna have less than 15, less than 20% of the cows being at risk or being diagnosed with it.

And then you just keep monitoring.

It gets a little trickier when you get to a higher level and the higher level is just like an alert for us to, something is wrong.

So you check that, you check the incidents and if you have some cows then it's worth like sampling them and treating them twice a week or treating those cows that are positive.

And sometimes you have a situation where things are very out of place and it might as well check and treat all the cows or even treat all the cows because something went wrong and you have a lot of metabolic issues.

Hopefully, none of you is dealing with this scenario.

But what's important to know is when you're monitoring whichever alert level you set up as your trigger, think about it.

And if you're above it, what you have to do is like go and investigate what's happening in the transition period and not just the fresh cows, but also the dry cows 'cause often what I see is I spike in the number of ketosis in the fresh pan and then you talk to the farm or you have access to some data and you see like the the closeup pan or the dry cows, or either overstocked, or they didn't have feed in front of them, so other things.

So try to use this as your proxy or the reason for you to go investigate and find what the problem is, fix the problem and then within a few weeks you go back and recheck to make sure that the changes that you made were helpful and made it improvements.

So with this, I would like to also talk a little bit about some of the questions that I talk and hope this will be practical advice for all of those.

One question I have is like how often should we screen for ketosis and when should I look for cows with ketosis?

And the other question that I always got was like I've checked for ketosis, a lot of cows with high BHB, but they don't seem sick, they don't have other diseases, they're making a lot of milk, is it worrisome that I have those cows?

So on that question about the timing, so when to test?

So what we did is we worked with a farm here in Minnesota that we have a good contact and a grasp of what's happening.

So we enrolled 360 cows multiparous cows and we have cows that were not ketotic and the ketotic cows.

And the cows, they were ketotic, some of them had ketosis in their first week.

So between two and nine in this case, and other cows have ketosis in their second week of lactation.

So this is just to show you that maybe when the cows are producing or having this high BHB or ketosis, it makes a difference.

So what we saw is the cow that have ketosis in their first week they produce less milk.

And in here we have a number, it's about 2,000 pounds for the whole lactation, so it's 8% decline.

Those cows also positive in the first week they took longer to get pregnant and it's about a cycle.

If you look here, it's 21 days and there is a 14% difference in their pregnancy by 150 days and they're more likely to leave the herd and there's a two point times more likely to leave the herd than the cows that do not have high BHB in their first week.

However, when we look at the same outcomes for the cows that had high BHB in their second week, there was no evidence of a difference.

So what's showing to us is like the high BHB happening in the first week, it's probably the one that it's leading us to the cow has some issues that her liver is not functioning well and she just cannot produce all the glucose and all the energy that she needs.

However, the second week cow, what's likely happening is this cow is producing a lot of milk and then she's mobilizing fat and then because she's mobilizing fat, if you go on one of the previous slides then she's producing a lot of ketone bodies that circulating, but this cow can use it.

That ketone body should produce more milk.

So in a sense what we're trying to say is like the cow having high ketosis in the first week, she's likely, the sick cow, they cannot cope with it.

And the second week is probably the cow that is mobilizing fat just to support that milk production.

And that's the "cause" quote-unquote, of that high ketosis high BHB that she has.

Then the other question that I got is, so high BHB but my cows producing too much milk.

Is that a problem? So what we did is, and this is a much larger trial, we have over 2,000 cows, same idea, farmed here in the upper Midwest.

We got there the cows with hyperketonemia ketosis, then we divided them in high, low and medium milk production.

So we have the top 25% cows as the high milk yield, the bottom 25% as the low milk yield, and the middle as the mid-milk yield.

I don't have a way to show you what their milk production were because that was my explanatory variable.

So because I'm using milk to explain how they'll do, I cannot really show you their milk production because it'll be biased.

But we're looking to their reproduction, and what we found is those here, if you look, it's a little hard to see, but if you have the ketosis cows that high producing and ketosis cows that the mid-production, so the top 75% of the cows, independently if they have ketosis are not, they're all here together.

So what this is telling me is that once we start breeding cows and they start getting pregnant, this line goes down.

So this is showing me that all this high producing and being mid-producing cows, if they have or they have not ketosis, they're getting pregnant as fast as the non-ketotic cows.

However, my low-yielding cows, so my poor doers, if they have ketosis they take much longer and up to 50% of them don't even get pregnant by 150 days.

So that's telling me that the ketosis affect cows differently.

So what people are seeing and adopting at the farm is like my cow has high BHB, but she looks fine, it is true.

So those cows here are the cows, I have high BHB, but I'm fine and I'm using that to produce more milk.

So those are in some sense, one of the best cows we have.

Because I wanted to look into how those cows do in milk production, then instead of using milk production as my affect modifier or the thing that modified the the the way the cow use, I'm using now rumination time.

So I went there, I have cows with high BHB, cows with not high BHB and then I have some cows they're a ketotic and they're ruminating really well and they other ones, they're not ruminating well.

And it's the same thing, top 25, the half medium 25, 75, in bottom, 25.

And here is like the lactation curve for those cows in the first three like her tests, but here's a easier way to look at it in this way.

When we look into those cows that have ketosis and in this case, they're all, the ketosis cows are all in yellow.

The cows with ketosis, they're always producing more milk than the cows that do not have ketosis.

But what we see is the high rumination time cows or the cows, they're healthier and they keep ruminating more, they produce much more, they produce, here I have 14 pounds more of milk per day than the cows do not have ketosis.

So those cows here, it's yet another information showing those cows are mobilizing, they have high BHB, but they're using that to produce more.

So that that's one of the things should lead us to think like not all high BHB is the same.

So yes it's important to monitor it, but there's a caveat.

So you need to think about how your cow's doing.

So knowing and understanding cow and all the signs that they show, it's something that's very important when monitoring those animals.

And then this is just the last topic that I wanna show.

This is data that we're currently working in the lab and I mentioned to you, we use the blood BHB and we use 1.2 millimoles per liter as the cut-off point, but is it really different?

So if you think about one and 1.4, is it very different?

So what we did is we plotted and we have about over 2,000 thousand dataset and we are looking, does the BHB in week one does that influence our milk production?

And we use milk week four milk production as just a sign of how well the cow's producing in our lactation.

So what we see here is if we use that 1.2 millimoles per liter, we're seeing that the cows they're producing the most in their peak milk production, they have a high BHB in their first peak much higher than 1.2.

So if you were to be considering a cow to be sick or not doing very well at 1.2 that we're missing a lot of cows.

So there's a lot of cows, they're very successful cows that we are considering them to be unhealthy just because we're looking at it as if it was a linear correlation that's not what it is.

When we look into the second week, which is like we showed before, those cows are producing more milk, mobilizing more, then we have it even more.

So you see the peak milk production that cows with, in the second lactation with BHB of 1.9 are the ones that are producing the most peak meal production and at 1.6 are the ones that are producing the most milk at the fourth week.

So there is some room for us to understand better how those cows are do using this BHB and what can we do at the farm to not freak out about a cow having high BHB because that's definitely not the end of the world.

They can do well.

So knowing the BHB concentration is important but we cannot use that as a sole parameter to determine if the cow is good or the cow is bad.

So with that, I think I'm just a couple minutes over of my 45 minutes minutes that I promise, but some of the take home message that I think are important from this presentation.

So very few cows in a herd should receive dextrose IV and hopefully that's something that you can bring back home, talk to your veterinarian, your people that you're working to.

If you have a dextrose as your first line of response to your ketosis cow, maybe you can revisit those protocols because it is time-consuming and the propylene glycol, it's a much easier thing to administer and it's as impactful as dextrose.

And in my opinion, I didn't go into all the physiology of it and all the adaptations that happen, but propylene glycol, it's a better treatment for ketosis.

The one thing that I didn't even touch was dexamethasone and that's something I hope it has been weeded out of all the protocols because there's no benefit of using it and it was used back a couple decades ago as part of the treatment, but that's definitely discouraged these days.

I have shown data showing that not all high BHB is the same.

And if you go on the fourth in some case high blood, it's not an issue.

High blood BHB is not an issue and it's something that's actually the cow is using that to that advantage to produce more milk.

And one thing that it's hard to define, but healthier cows and having people that can really understand their cows and really can read the cows so healthier cows will produce more milk independently if they have high blood BHB or low blood BHB.

So understanding and seeing those cows as healthy cows and cows, they're doing well, it's something that's very important and it might help you instead of treating all the cows that have high ketones because of urine stick or blood measurement and not treat them all because they are not all of them needs treatment.

As a matter of fact, we are actually doing a randomized clinical trial now testing that.

So do I need to treat all cows or not?

We're about halfway through it.

So in probably like another 6 to 8 months you're gonna have some results to determine if we truly need to treat all cows or not.

And if we don't, we're also investigating which cows we don't need to treat that they'll do well.

So that's what all I had, you have my contact information here, feel free to reach out.

Email is usually the easiest way.

I would like to thank the opportunity to speak to all of you.

Happy to answer more questions and thank all the sponsors that have sponsored all the work we have been doing here 'cause without them I wouldn't be able to have results or even the time to chat with you about it.

So open to any questions.

- Thank you.

I would like to ask you one thing, maybe you know this, maybe not.

Do you know anything about the prices for those tests?

Both blood test or the urine, or milk test for that case?

- Yes, the milk test, I'm a little bit out of the loop.

I don't know.

The urine test, last time I priced it was about 15 cents per test.

The blood test, the cheapest I've seen is about a dollar per strip, a dollar per test, - Dollar per strip.

I supposed it depends where you buy it and so forth.

- Correct, yeah, and there's multiple different meters, right?

So the meters, they all have different prices, but I'll say between 1 and $2 you're probably gonna get, most of them will be within that range.

- Okay, good information.

- Plus your needle and syringe, right?

- Sure, sure, sure.

Yeah, very good information.

Thank you very much, appreciate it.

Just would like for the audience, if you're interested about the nutritional aspects of ketosis and how to fix it.

There is a follow up webinar tomorrow at 11 o'clock on the Penn State website and the speaker is a Dr. Robert Vinson from Penn State Extension and also next week, January 30, we'll be talking about management aspects of ketosis in Dairy Herds.

And again, the speaker is Dr. Vinson from Penn State Extension.

With that, if we don't have any other questions, I think we are just on the hour top well, so I would like to thank you Dr. Caixeta for his time and I would like to conclude our webinar.

Thank you very much to everybody.

- Thanks for the opportunity.

Well, there's one hand that went up.

- Okay.

- Is it okay if I allow them to talk?

- [Michal] Oh, go ahead, go ahead please.

- Oops.

- Can you hear me? - Yes I can.

- [Attendee] Okay, sorry, I was typing my question and you were gonna end, so I put my hand up.

I'm sorry if I missed this point.

I was just wondering, would you expect to see a higher incidence of clinical ketosis on a farm as a way to suspect that there might be subclinical ketosis on the farm?

- That's hard, right?

So it's very like, I'm gonna use an iceberg analogy and that's always was this concern, but like if you have too many of the clinical cases, that's definitely the tip of the iceberg that you're seeing and you probably have a much larger number of cows with subclinical cases in the farm.

So in my opinion, if you're waiting until you see a spike in clinical cases to be concerned about the subclinical ones, you might be missing a lot of opportunity because it might be that you have already a ketotic problem and situation at a farm that is just invisible because you're not seeing a lot of the clinical cases 'cause the clinical cases are very extreme cases, right?

We don't see very often.

So if you think about it, if you were to measure, when we do research we measure very often, right?

So we can see up to 30% of cows having subclinical ketosis and we barely see any 1%.

I'll say 1% is a number that we might see on records and of clinical cases.

If I am on the farm testing once a week, which is even more than people do, here in the upper Midwest 17 to 20%, that's what I see of subclinical cases.

So trying and I hope that's answering your question is if you're hoping to wait until you see a spike on your clinical cases, you just have a much bigger problem and it might be too late or wouldn't- - [Attendee] Okay, well said.

Thank you very much.

Yes, that was always my, I guess approach up to now was that well, we shouldn't spend money or time looking for subclinical ketosis because we don't see clinical ketosis problems.

But in this case maybe it's in everyone's interest to always be spending time or money to be looking for these problems 'cause there's something we might not be able to see visually.

- So the one thing, yes, but the one thing that I also usually recommend to people is like, you have some other parameters you're looking at a farm at at your cows to decide that.

So you might be looking to, if you have daily milk, their milk deviation and all the kind of things or you have some sort of other ways to determine which cows you need to look at.

Because what I see is like yes, it's important you don't have to test every single cow at day-5 or day-7 milk.

That's something that it's just cumbersome and you have them walk for too long and having them locked is actually worse than not doing.

But if you have like 10, 12 cows that you can check a week just to make sure like yeah my numbers are good that I'm not having 80% of my cows with subclinical ketosis, that's something that's good.

The one thing that I recommend to people is if they do guess a subset 8, 10, 12 cows depend on the size of the the farm, right?

But they just to have an idea how things are going and then use the ketosis test that they're using to make treatment decisions.

So I have a cow, she's not eating, she's not making milk and then she doesn't have metritis, DA, all the other things that you look for and then you look and she has ketosis, then you treat the ketosis.

But just don't go looking for ketosis just to treat cows because what happens is if you go there and test, like I said 20% of your cows would probably have high BHB or some test positive.

But not all those cows 'cause you test some of those cows and they're eating well, they have a lot of milk and they truly are not sick, but they have their high BHB because they're using that to milk.

So like I said, I'm doing a clinical trial and I have half of the cows, I'm treating half I'm not, and I look at the data at the farm and by doing that it's random, right?

Like I'm not looking if she's making milk or anything when I decide she gets treated or not.

But I'm not seeing any difference on their new production, the repo performance.

So there are cows that you can still look for it and you can use the test to make treatment decisions, but don't go looking for it just because you need to treat something.

- [Attendee] Okay, yeah, I appreciate that response.

Thank you very much.

- All right, we had additional hands up, but seems to me this- - It disappeared.

- Yeah, that it suddenly logged off.

So I guess that's it.

That we wrap up, you know, the presentation.

Thank you very much and wish everybody good day, thank you.

- Thank you.