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    How to Conduct A Cow Health Examination

    a close up of a brown cow standing in front of a pond
    Mixie, a rescued cow at Edgar’s Mission Sanctuary. Photo: Jo-Anne McArthur / We Animals Media

    This resource has been fully reviewed and updated by a member of The Open Sanctuary Project’s staff as of August 23, 2022.

    Much like the common advice given to humans, it’s important to regularly check the health of cows with a routine physical examination rather than waiting until a cow is showing signs of distress or illness. Not only will this help you get to know what all aspects of a healthy cow look and feel like, but familiarizing a cow with human handling might help them stay calmer in stressful situations. Be prepared to check them over every six to eight weeks*! For more information on why regular health examinations are important, check out our resource here.

    *An Exam Every Six to Eight Weeks Means Daily Observation
    Our recommendation to conduct routine health examinations every six to eight weeks must be done in conjunction with daily observation. Caregivers should be trained to observe animals both for behaviors that are abnormal for the species and also behaviors that are abnormal for each individual, keeping in mind issues that are common in a particular species and their warning signs. Thoughtful observation plays a crucial role in catching health issues before they progress into more serious situations. Read more about daily observation for cow resident health and well-being here.

    Residents With Challenging Backgrounds
    Close daily observation can be difficult with certain individuals or groups who come from challenging backgrounds. They may be more likely to hide signs of illness or injury, or they may not allow you to come close enough to them to thoroughly assess their well-being on a regular basis. Challenging backgrounds may include individuals who are not socialized, have lived feral, or were abused or malnourished. If you care for individuals who came from a challenging background, it is imperative to make time to foster a bond of trust so careful observation is possible. A monthly health exam is recommended for these individuals until they exhibit signs that they feel safe and you are confident that close daily observation is possible.

    a green cow

    New Resident? Conduct An Intake Examination!
    If you are conducting an initial health examination on a new resident, check out our intake examination resource to learn about what you should check for and document!


    Before conducting a health examination, it’s helpful to gather any supplies you may need and have them arranged nearby for easy access. Having everything you will likely need nearby can make the examination go more smoothly and, in the event that the individual must be restrained in some way for part or all of the exam, will reduce the amount of time they must be restrained. If you are performing an exam on someone with a known health issue, you may need additional supplies besides those listed below. Otherwise, supplies to have on hand during cow health exams may include:

    • Recordkeeping supplies
    • Gauze squares (​​non-sterile is typically fine, but there may be times when sterile gauze is necessary)
    • Exam gloves
    • Cow-safe topical disinfectant (such as dilute chlorhexidine)
    • Saline flush
    • Cow-safe ointments or creams such as a triple antibiotic ointment or silver sulfadiazine cream 1% (SSD)
    • Cotton-tipped applicators
    • Tweezers
    • Headlamp, penlight, or flashlight
    • Thermometer and lubricant (good to have on hand in case you suspect someone is ill based on exam findings)
    • Towels
    • Stethoscope
    • Fly treatments or deterrents (during fly season)

    What About Hoof Care Supplies?
    You may be wondering why hoof trimming tools are not on this list. While there may be times when an experienced caregiver does a little bit of maintenance on a particular resident’s hooves, we recommend working with a professional farrier or experienced veterinarian to have cow residents’ hooves regularly assessed and trimmed. Additionally, we recommend consulting with a veterinarian if you suspect a resident has a hoof issue.

    Conducting The Exam

    Ask An Expert
    Prior to regularly conducting cow health examinations, you should have a veterinarian or compassionate care expert give you hands-on training in order to be the best cow health advocate possible. Being trained to rapidly distinguish healthy conditions from abnormalities can be crucial in early health issue detection and effective treatment!

    Additionally, you must be trained in proper technique in order to ensure both caregiver and resident safety. This includes understanding how to safely approach and be around cows, being able to read their body language, and being thoroughly trained in any restraint methods used.

    Before beginning individual exams (and, if possible, before entering your residents’ living space), it’s a good idea to take a few minutes to observe the group. Make note of their behavior, activity level, and general appearance. If residents are up, observe how they are standing and moving and whether or not they are actively eating. If they are lying down, make note of how they are positioned, whether or not they are chewing cud, and whether or not they are away from the herd or are the only one lying down. 

    If you use some form of restraint for health checks, now is also a good time to observe the respiratory rate of individuals in the herd since this may become elevated once residents are moved and restrained. While you can certainly assess the respiratory rate for each individual, for starters, you may simply spend a few minutes observing the group, checking to see if anyone appears to be breathing more rapidly or with more effort than the other residents. You could then take their respiratory rate and further evaluate them during their exam (or, depending on other signs they are presenting, you may opt to call your veterinarian). To assess a cow’s respiratory rate, watch their chest movements, counting how many times their chest expands/contracts over one minute. The normal resting respiratory rate for an adult cow is 12-36 respirations per minute and the normal resting respiratory rate for a calf is 30-60 respirations per minute. Note that these are resting rates. Individuals who are active will have an elevated respiratory rate. In addition to being an indication of illness, an elevated respiratory rate can also be indicative of a cow being stressed, hot, or in pain.

    During this general observation of the group, watch for anyone who stands out as looking or acting differently from the rest of the herd. While this may not necessarily be an indication of a health concern, it certainly warrants further observation and assessment during the exam. For example, if you notice that only Gertrude is lying down while the rest of the herd is up grazing, you’ll want to keep an eye on her and gather more information to determine whether or not there’s a problem brewing.

    For the individual exam, some residents may allow you to check them without being restrained (perhaps while lying down, while eating, or while being brushed), but you may find that you cannot perform the entire exam in one “session” when doing it in this way. For example, while checking an individual who is lying down, you will be unable to thoroughly check one side of their body and will not be able to observe how the individual looks while standing (but you might get a great view of the bottom of their feet!). In this case, you would want to be sure to check their other side and assess their comfort standing and walking before considering their health examination “complete.” Be sure to take good notes so you can keep track of the areas that still need to be checked.

    Get Serious About Safety!

    Before we talk about how to conduct a cow health exam, there are some important safety considerations to discuss. While touch plays an important role in health exams, generally, when it comes to cows and other large mammals, such as horses, you may have to rely on visual evaluation in order to avoid putting yourself or others at risk of severe injury. Below, we’ll mention some of the more common safety risks that come up when performing certain parts of the exam, but please be aware that these are far from the only possibilities. We’re not saying this to scare anyone or to discourage folks from rescuing or caring for cows. We know from personal experience that it’s not uncommon for caregivers to focus solely on the resident’s safety while making concessions about their own. Because sometimes the same folks who dedicate their days to caring for others need gentle reminders about caring for themselves, we’re here to remind you that caregiver safety is just as important as resident safety.

    While cows are not inherently dangerous, it is important to consider the size and strength difference between some full-grown cows and humans. This size difference, plus their speed, powerful swinging head (not to mention horns in some cases), and ability to kick, can result in serious injury. Particularly if you do not have a lot of experience working with cows or are working with a new cow resident whom you do not yet know well, it may be that you must rely more on visual assessment than you would for other species. You’ll also want to consider the individual cow and how they react to restraint and human touch. That said, it’s important to note that even folks with a great deal of experience working with cows may not be able to safely perform more than a visual inspection during certain parts of an exam, and cows who are generally very amenable to human touch may react very differently if they are startled or are in pain. 

    In addition to the considerations listed above, whether or not you can touch certain parts of a cow’s body will be impacted by different restraint methods. While some cows may be able to be safely examined without restraint, others may require restraint, such as being tied off with a halter or being guided into a chute system. Make sure you are properly trained in whatever restraint method you use and that you are aware of the resident and caregiver safety risks of each so you can prevent injury. For example, some chute systems have panels with horizontal bars, and this may seem like it makes touching the cow much easier than if the panel was solid. However, reaching through the bars can result in serious injury to your limb if the cow moves (which, among other things, could result in your limb being crushed between their body and the bar) or if the individual kicks (which could result in a much more serious injury than what the kick alone would cause since you have the added force of your limb being thrust into the bars). Proper training is imperative to avoid putting yourself or your residents in situations that increase the risk of injury. 

    When In Doubt…
    Unless you are a qualified veterinarian or have been trained to handle specific conditions, The Open Sanctuary Project strongly advocates that you promptly report any health concerns you find during the course of an exam to your veterinarian or care expert. You should be the resident’s advocate, not their doctor. Please note that while we do call out some specific findings as requiring an immediate call to your veterinarian, this does not mean that other findings are not urgent as well.

    Additionally, if you see something that you think warrants a hands-on evaluation but do not feel you can safely do so, be sure to enlist an experienced veterinarian for assistance.

    Up next, we’ll go over important components of a health examination. Please note that while these “steps” do not have to be completed in the order listed below, it is helpful to have a set order you follow consistently so as to avoid accidentally missing a step.

    Check their weight and body condition
    Monitoring your cow residents’ weight and body condition gives you important information about their health and, particularly in the case of unhealthy weight gain, their risk of certain health challenges. A healthy, mature cow should generally maintain a steady weight, though seasonal diet changes may result in slight herd-wide fluctuations (extreme herd-wide fluctuations are an indication that you should reassess the herd’s diet). If at all possible, it’s a great idea to invest in a scale that can accurately weigh your residents. This may not be possible for everyone, in which case, you will rely primarily on a visual assessment of an individual’s body condition. We recommend working with a veterinarian for proper training in body condition scoring to ensure the most accurate results. However, it is important to consider that the body condition of a sanctuary cow may be different from that of a cow whose body is exploited for milk production or breeding. Additionally, the body condition of a Hereford is going to be different from that of a Holstein. 

    It is not uncommon for sanctuary cows to be above the “ideal” body condition. Obesity can predispose individuals to health issues such as foot and leg problems, so it’s important to provide residents with a diet that does not lead to excessive weight gain. However, it’s also important to consider that because sanctuary residents are often considered “over conditioned” and have a higher than “ideal” body condition score, in the event that you are worried that an individual has lost weight, these concerns may not always be taken seriously if the individual in question appears, by industry standards, to be at an ideal weight. This is one of the many reasons why tracking body condition scores and, whenever possible, the resident’s weight is helpful. It gives you more information to share with your veterinarian regarding what is normal for the individual in question.

    If a resident is losing weight, be sure to work with your veterinarian to determine the cause. You’ll also want to discuss how the individual is doing overall. Losing weight despite a healthy appetite will suggest different possibilities (such as Johne’s disease) than weight loss accompanied by inappetence. Particularly in elderly cows, weight loss might be the result of dental disease and may require permanent alterations to the individual’s diet.
    Check their head and neck
    While caution should be observed during all portions of the health exam, when examining the head, make sure that either the cow’s head is securely restrained or that you keep your own head out of their head swinging range. It’s easy to get wrapped up in performing the exam, but you must take care as a cow swinging their head (or horns!) into your head can result in serious injury! Even the friendliest cow might swing their head unexpectedly, so caution is always advised.

    Look at their head for any sign of asymmetry or a head tilt. If a resident has a head tilt or one side of their face is drooping, this is cause for concern, and your veterinarian should be consulted. If an individual has a very dirty face, this may be an indication that they have trouble getting up and are using their head to assist them in this process. It’s a good idea to pay close attention to how these individuals move and to observe them while rising.

    If the individual has horns or scurs (horn-like tissue that, unlike a true horn, is attached to the skin rather than the skull), be sure to check that these are not growing in such a way as to cause injury or irritation to the face. Work with your veterinarian to determine the best course of action if a horn or scur is causing a problem. 

    Feel along the neck for any lumps or lesions. To check for dehydration, pinch the skin on their neck and observe how long it takes for the skin to return to its normal position. In a well-hydrated cow, the skin will bounce back into place within one second. In a dehydrated cow, the skin will hold the tent shape before slowly returning to normal.
    Check their eyes
    Cows should have clear, bright, alert eyes. Carefully lifting the cow’s head into an upright position (if possible and safe to do) will allow you to check the white of the eye. Thin blood vessels in this area are normal, but thickened blood vessels should be noted. The pupil is most easily seen with a light and will often appear as a bluish horizontal rectangle or narrow slit (it contracts and expands in response to light). A slow pupil response could be a sign of low calcium. Check the eye for cloudiness, discoloration, lesions, or growths. Also, check the third eyelid for discoloration or lesions, as this is a common site for eye cancer. In the early stages, eye cancer lesions can be as small as a grain of rice, and surgical removal (by a licensed veterinarian) is easiest when lesions are small and contained to the third eyelid, so careful evaluation of this area is important. 

    Check for ocular discharge, which could be a sign of illness, injury, or irritation (such as from flies). Speaking of flies, during fly season, be sure to watch for early signs of pinkeye (and talk to your veterinarian about vaccinating your cow residents for this contagious condition). Signs of pinkeye include runny and squinty eyes, redness and swelling, holding an affected eye closed, and, as the disease progresses, thick ocular discharge and a cloudy/opaque cornea.

    Also, pay attention to how the eye is sitting in the socket. If a cow’s eyes appear sunken into the head, this often indicates dehydration.
    Check their ears
    A cow’s ears should move in response to the sounds around them. They should not be droopy unless this is typical for their breed. Droopy and/or cold ears are typically a sign that a cow is not feeling well. The ears should not have any discharge, crustiness, or odor.
    Check their nose
    A cow’s nose, including inside their nostrils, should be shiny and moist, not dry. However, nasal discharge beyond a small amount of clear fluid is cause for concern. Their nose should also be free of lesions. If you place your hand in front of their nose, you should be able to feel an equal amount of air coming from both nostrils. Their breathing should not be labored, elevated, or have abnormal sounds (such as wheezes or rattles). Open-mouth breathing, coughing, or a foul odor on their breath are also cause for concern (a hint of rumen smell to their breath is not unusual). Contact your veterinarian if a resident is showing any of the signs listed above.
    Check their mouth and jaw
    Feel along the lower and upper jaw as well as down the bridge of the nose for any lumps, lesions, or areas of swelling. Also, make note of the area under the jaw, checking for fluid build-up (bottle jaw). Anyone with bottle jaw or oozing lesions on the jaw should be evaluated by a veterinarian.

    The cow’s lips should not be loose, and their tongue should not be hanging out of their mouth. Also, check for excessive drooling, which can indicate an issue. Checking inside a cow’s mouth is challenging (and should not be performed unless you know how to do so safely!). An exam of the inside of their mouth may be best to save for when your veterinarian assesses your residents. However, while we’re on the subject of a cow’s mouth, we want to point out that cows do not have upper front teeth which is sometimes alarming to new caregivers! Instead, they have a dental pad.
    Check their rumen
    As ruminants, assessing the digestive tract is an important part of evaluating cow health. While your veterinarian can perform a more in-depth evaluation of a cow’s digestive system, you can assess your cow residents’ rumen (and get an idea of if they are eating) by observing and feeling the paralumbar fossa on their left side, which is the triangular area behind the last rib and in front of the hip (hook) bone (as highlighted in the graphic below). Make sure you are checking the cow’s left side (if you stand behind the cow and face them, your left is their left) – the rumen, which is the largest stomach compartment, sits in this area. 

    If the cow has eaten recently, the paralumbar fossa will be about flush (give or take a little) with the last rib. If they have not been eating, this area will be depressed with a clear outline of the triangular area. If the paralumbar fossa is distended significantly past the last rib and/or feels tight, this indicates bloat, a potentially life-threatening condition. Other signs of bloat include labored breathing, grunting, open-mouth breathing, extending their neck, frequent urination, and other signs of discomfort. As the condition progresses, the cow may become recumbent. When you tap on the paralumbar fossa of a bloated cow, it may produce a kettle drum-like sound. Contact your veterinarian immediately if a resident is showing signs of bloat, as prompt intervention is imperative.

    A healthy rumen should feel doughy with some resistance when pushed. You can also listen for healthy rumen contractions by placing a stethoscope or even just your ear against this area. You should hear a rumen contraction (sometimes described as sounding like a thunderstorm, dull roar, spinning washing machine, or flushing toilet) approximately 1-2 times per minute. You can listen to a normal rumen contraction here. If you note long gaps between contractions or weak contractions, please consult with your veterinarian.
    a pink circle highlights the area of the paralumbar fossa and shows the triangular outline
    Within the highlighted area is the triangular recess of the paralumbar fossa located behind the last rib and in front of the hip bone.
    Check their sides, underside, and back
    While checking their rumen does require checking part of their left side, you want to also take time to check the rest of their left side as well as their right side, underside, and back. Look (and when safe, feel) for any lumps, swelling, wounds, etc. While checking the cow’s left side, you can listen to their heart and record their heart rate. To do this, place the stethoscope on their left side, right behind their elbow. An adult cow’s heart rate is typically around 72 beats per minute but can be quite variable and still be healthy. Particularly if the process of the exam is stressful for the individual, you’ll often find that their heart rate is elevated. Consult with your veterinarian if you have any concerns about a cow’s heart rate or the way their heart sounds.

    Be sure to check for pressure sores, particularly in the areas that typically make contact with the ground when the cow is lying down. Early signs of pressure sores include hair loss and irritated or thickened skin before becoming open sores or scabbed areas.

    When checking male residents, also check (often just visually) their prepuce for any signs of swelling, scabbing, oozing, or prolapse. If they urinate during the exam, watch that they are not straining and that they have a normal stream of urine. Straining, dribbling urine, or producing a weak stream of urine could be signs of urinary blockage, and your veterinarian should be contacted immediately. Check the udder of female residents, looking for signs of mastitis such as heat, swelling, firmness, pain, or discharge. Contact your veterinarian immediately if you suspect mastitis.

    Please note that some adult cows have a noticeable navel which will appear as a lump on their underside (in males, it will typically blend into the prepuce). Folks sometimes confuse this with a sign of concern or mistakenly think it is the prepuce and end up thinking that a female resident is male.

    When checking a cow’s back, make note of any arching when the individual is standing. Their back should be fairly flat. Arching could be a sign of hardware disease or another issue. Contact your veterinarian immediately if you suspect hardware disease.
    Check their legs
    This is another portion of the exam that may rely more on a visual assessment. Carefully check their front and back legs for any signs of swelling, particularly noting if there is asymmetry between the right and left corresponding legs (i.e. note if a cow’s front right leg is larger than the front left leg). When checking the front legs, be sure to continue your observation all the way up into their shoulder area and in the back, all the way up to the hips. Particularly when checking their back legs, look for any signs of pressure sores (hair loss, irritated skin, scabs, or open sores). While a cow’s hips should be symmetrical and level, it is not uncommon for the hips to be uneven, particularly in older residents. Your veterinarian can further assess the individual and make care recommendations. While observing the legs, make note of any muscle twitching which could be cause for concern.

    In addition to checking the appearance of the legs, also check for any signs of pain by observing how they stand and move. They should bear weight evenly, and there should be no crepitus (cracking or crunching sounds) when they move. Osteoarthritis is quite common in cows as they age, so it’s important to keep a close eye on their mobility and discuss any concerns with your veterinarian. An appropriate pain management plan is an important part of caring for arthritic residents.
    Check their feet
    Check the cow’s hooves for signs of overgrowth or hoof cracks, and consult with your veterinarian or farrier if someone needs their hooves trimmed. Check the coronary band for swelling, redness, warts, or other lesions. If you are able to feel this area, you can also check for heat or pain. Also, check that the individual does not have debris stuck between their claws, which can make walking uncomfortable. If the individual is lying down and will allow you to do so, you can check the bottom of their feet, looking for areas of bruising, discharge, inflammation, or necrosis. Make note of any unusual odors coming from their feet which could be indicative of footrot or a ruptured abscess.

    Pay attention to how the individual is standing and walking. A cow with an abscess in their foot may refuse to put any weight on the affected claw, which can be quite alarming. However, once the abscess is opened, either by a veterinarian or by rupturing on its own, the cow will be much more comfortable. If you are concerned that a cow has a hoof abscess, have your veterinarian out right away to assess.

    Be sure to contact your veterinarian immediately if a resident is showing issues with their feet. To help ensure cow resident hoof health, be sure to have their hooves evaluated and, if needed, trimmed by a professional at least every 6 months (though some individuals may need more frequent trimming than this).
    Check their rear end
    A cow’s rear end and tail should be relatively clean, though they may have loose stool while on pasture which can result in some poop on their tail or bum. Check the tail for signs of injury (including fracture) or paralysis. If the hair at the end of their tail is close to touching the ground, it should be trimmed to prevent other cows from stepping on it (which can result in terrible injury to the tail). 

    Check that their rectum is not prolapsed. When checking females, be sure to check their vulva, looking for prolapse, discharge, discoloration, or scabbing.    
    Check their hair and skin
    The cow should have a smooth and shiny hair coat, though their winter coat may look a bit rougher than their summer coat. Check for any areas of hair loss (seasonal shedding is normal), which could be an indication of external parasites. If you are able to touch the cow, feel for any lumps, sores, or dry patches. Be sure to investigate if a cow is showing signs that part of their body is itchy (signs include licking or rubbing the area), and be sure to look more closely at any area that is covered in flies, as this could be a clue that they have an open wound and are at risk of developing flystrike.
    Isolate if necessary
    If you notice that a cow is unhealthy, it’s crucial to consult with a veterinarian or compassionate care expert and prioritize accurately diagnosing the problem. Depending on the health concern, it may be necessary to isolate the cow in order to protect the rest of the herd from a potentially infectious disease. However, with some illnesses, such as pneumonia, once a cow is showing symptoms, the other residents in the herd may have already been exposed. In these instances, you will need to weigh what is in the best interest of all of your residents. A sick cow who is isolated from their herd may become more stressed, which could delay recovery. Depending on the health concern, separating the cow with a calm companion might be a good compromise.

    You can read more about considering alternative living arrangements in response to a health issue here.

    Though it may seem like an overwhelming amount of factors to be aware of, once you’ve gotten to know a cow and what good cow health looks like, you’ll be an excellent cow health ally in no time!

    Writing It All Down

    As you may know, regular documentation is a critical part of responsible sanctuary animal care. In order to maximize the value of your cow health examinations, we’ve developed a free printable cow health exam form for sanctuaries and rescues!


    Clinical Examination Of The Cow – Clinical Exam Routine | University Of Glasgow 

    Large Animal Internal Medicine 5th Edition | Bradford P. Smith (Non-Compassionate Source)

    Cattle Medicine | Phillip Scott, Colin D. Penny, and Alastair Macrae (Non-Compassionate Source)

    Healthy Cow Check-Up – How To Perform A Physical Exam | eOrganic (Non-Compassionate Source)

    Identifying Sick Livestock With Dr. Lisa Lunn | UAF Extension (Non-Compassionate Source)

    The Genetics of Horned, Polled and Scurred Cattle | National Cooperative Extension (Non-Compassionate Source)

    The Basic Clinical Exam: Key To Early Identification Of Sick Animals | AgriLIFE Extension (Non-Compassionate Source)

    Non-Compassionate Source?
    If a source includes the (Non-Compassionate Source) tag, it means that we do not endorse that particular source’s views about animals, even if some of their insights are valuable from a care perspective. See a more detailed explanation here.

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