15 minute read

Using Systems Perspectives to Reimagine our Practice Mental Models from Animal Health and Production to Broader Constructs of Well-being

Using Systems Perspectives to Reimagine our Practice Mental Models from Animal Health and Production to Broader Constructs of Well-Being

T.Robin Falkner D.V.M. Technical Consultant Elanco Animal Health Christiana, TN 37037

Introduction and Overview of Presentations

As a veterinarian, I have long viewed myself as a part of the animal health infrastructure. But within my mental models I have struggled to define and manage animal health as meaningful positive outcomes versus as simply the absence of negative (sickness) outcomes. I found my own training lacking in the concepts of wellness or well-being. It is common in many production systems for primarily negative clinical outcomes like morbidity and mortality to be measured, recorded, and managed. These metrics are often interpreted in a false dichotomy where the absence of such clinical failure is conflated with wellness or well-being: usually animals that are not diagnosed and treated for clinical disease are for practical purposes considered “well”. How might my practice approach change if I took a perspective of well-being as the management of continuous variables of desirable outcomes (well-being metrics and behaviors) instead of as the dichotomous absence of something unwanted (clinical disease)? Another important consideration was a desire to identify proactive variables not compromised by the long delays and randomness often inherent in current metrics like morbidity, mortality, and profitability. Additionally, embracing well-being as the managed output of client systems allows one to better take a broader, positive ownership of animal health. Often, in diseasecentric animal health mental models, it was easy for clients to view themselves as the victims of disease or of “high risk cattle” produced by others. Or as a veterinarian to identify as a savior who rides in to save the day from such villains. I have found that the active ownership of system well-being outcomes provides a superior internal systems perspective from which to better manage outcomes within our control when compared to a disease victim or savior mindset. While it is unpleasant and discouraging to take ownership of negative outcomes viewed as outside of one’s control, it is empowering to take ownership of positive systems outputs seen as within one’s control. Much of the power within a well-being mental model change resides in this empowered ownership.

One of the basic underpinnings of Systems Thinking is that mental models / paradigms exert the highest Leverage Points in a system.1. This is also frequently represented in Goodman’s Iceberg Model2 where the base of the iceberg is Mental Models, described as the values, assumptions, and beliefs that guide and/or constrain one’s perspectives. New or expanded mental models

can help one see new things, interpret in new ways, and provide new insights that can have tremendous leverage in complex systems. However, changing mental models is also recognized as a difficult undertaking since they tend to be very deeply ingrained frameworks that determine how we understand the world and take action3 As such, one’s mental models are comfortable biases that are hard to overcome or change.

Example: Managing Failure is Managing to Fail

A personal example might illustrate the shortcomings of a prevailing management-of-failure animal health mental model: When observing recent feeder cattle placements with a client, I noted that several animals had mild lameness symptoms. Closer observation revealed approximately 10-15% of animals had detectable quality-of-movement issues. When the experienced and capable caretakers were queried, they reported a very low level of lameness with only a couple of animals treated across multiple groups. Further investigation revealed that there were underlying physical injuries resulting from maintenance issues in the processing facilities, which were repaired with immediate observed improvements in the quality-ofmovement observations of new placements.

The individual animal observations and judgement of the caretakers were not inconsistent with my own—none of the mildly affected animals I observed met the current case definition to be pulled for examination and/or treatment. However, the sheer number of mild cases was a potential an early indicator of multiple system problem(s) of serious concern requiring immediate investigation and intervention at the system, not individual animal, level. There was not yet a signal in the animal health metrics that any problem might be arising—few animals had yet required treatment for lameness. There was nothing being measured and recorded that allowed detecting an interim degradation of the wellness outcome of musculoskeletal soundness. Caretakers were obviously not in a mental model of managing systems outcomes unless those outcomes were the simple sum of individual failures. Here is an example of how an approach based on evaluation, management, and metrics of individual animal failure (lameness requiring treatment) lacked the needed sensitivity and utility to proactively manage system-wide positive (or negative) outcomes before failure occurred. In this instance, the presence of mild, easily overlooked symptoms in a large number of recently arrived animals potentially had more significance than a modest increase in clinical lameness. And at an earlier intervention point. The unrecognized slight decrease in quality-of-movement in a large number of animals was potentially the harbinger of a yet to emerge, devastating problem that could impact the ability of the client to maintain market access in an environment where mobility scoring at harvest presentation is a metric used to assess animal welfare.4. In fact, low mobility scores could potentially put the client out of business without access to a market for finished animals.

The example reveals that cattle caretakers (caregivers), including veterinarians, often have mental models tuned to recognize and respond to individual failures (clinical disease) instead of system success (true well-being metrics). We likely do not apply the same “eyes” and mental model for quality-of-movement evaluation in feeder calves that we would use in the pre-

purchase exam of a work horse for the same client. Nor view an outcome like “soundness at harvest” as a very complex systems output instead of a simple sum of individual outcomes. It would be hard to argue that relatively minor mechanical injuries at processing would not potentially predispose animals to other “causes” of lameness. Or that pulling and treating animals for lameness might not create additional lameness in those animals or pen mates. Or that increasing levels of lameness might result in increased attention and more aggressive pulls and treatment of same. This is potentially creating a vicious, not virtuous, cycle where lameness produces more lameness. Especially if animals are passing back through still defective facilities. In this way, at the Stress—Husbandry—Resource Constraint—Clinical Disease Interface, by treating a symptom we often can create more of the symptom or new symptoms. Conversely, measuring and managing for a wellness behavior (like quality-ofmovement) would be more likely to recognize potential issues early, diagnose key underlying factors accurately, and intervene in a more virtuous manner. In the example scenario, had one waited until an unacceptable incidence of nonresponsive lameness cases accrued and performed diagnostics on them---it is unlikely that the predisposing, underlying cause would have been within diagnostic reach and identified. In the example, few animals required treated for lameness and the potential problem was “nipped in the bud” before it became a system wide issue because a wellness outcome and not a failure outcome was managed.

When I systematically examined many other animal, human, and even non-biological outcomes in beef cattle production systems, from Bovine Respiratory Disease Complex to employee turnover to pen maintenance, I found the false dichotomous management of failure outcomes instead of proactive continuous variable management of success outcomes was common. Many failure outcomes were likely symptoms of problems and interactions elsewhere in the system. Not uncommonly, the simple, intuitive solutions to one symptom potentially created more problems. Additionally, in many cases, constructs and metrics for scoring system success outcomes did not exist in the mental models of personnel within the systems. (See Figure 1)

Any system measured and managed at a failure breakpoint will likely eventually fail because it will not detect and react to early signs that a risk of catastrophic failure has increased. When an engine starts smoking and knocking is not the point to intervene, and the underlying “cause” may not be within diagnostic reach. Long delays in system failure metrics are common. Imagining other examples where “managing failure is likely managing for failure” is not difficult, and the humbling examples where significant animal health investments have not been accompanied by overall reductions in failure outcomes, like Bovine Respiratory Disease Complex (BRDC), 5 may represent shortcomings in failure-point-focused animal health mental models. Maybe BRDC is not best managed by focusing on BRDC failure, but instead by focusing

on overall “well-being” throughout the system. Not just animals, but people, customer relationships, facilities, environment, etc. Might we even view maintaining animal health product efficacy within a construct of system wellness? Or the retention and development of highly engaged employees and loyal clients / customers as “symptoms of systems well-being”? If we flipped our current mental model and viewed BRDC as an outcome (symptom) of low wellness in the system---instead of viewing wellness as the absence of BRDC---might that have higher potential utility in making progress? Can we in effect expand the boundaries of a preventative medicine philosophy to encompass broader constructs of well-being to be managed (outside of a pathogen/disease centric paradigm)?

In my presentations, I will discuss my own journey in transitioning mental models from “managing to fail less” to “managing towards success” using systems science approaches. The audience will be engaged in discussion on expanding the mental framework of practice to better simultaneously influence multiple meaningful positive outcomes in client systems. The first and difficult obstacle is in clearly defining success as something other than the dichotomous absence of failure, then developing with clients a shared vision and metrics around those new mental models.

Animal Wellness Behaviors

There is considerable emerging science underpinning new constructs of animal wellness behaviors and well-being, along with recognition that there is considerable overlap and interaction between stress behaviors and animal sickness behaviors. 6 The display of sickness behaviors by stressed animals can confound the timely and accurate identification of disease, leading to mistreatment. There is long held and widespread recognition that physical, nutritional, and/or psychological stress can directly increase the incidence of disease7 and the physiological mechanisms have been extensively studied8 . Better managing well-being in production systems can have very high leverage—reducing the stressors underpinning decreased wellness behaviors can not only decrease disease directly, but by increasing wellness behavior expression can improve the sensitivity and specificity of disease diagnosis. This can improve treatment response while also further decreasing the stress on cattle and valuable, limited resources like people and therapeutics when unnecessary treatments are reduced. If these freed up resources are then applied to achieving better wellness outcomes, a virtuous cycle (feedback loop) can be created. Conversely, managing at the failure break point can often result in a vicious cycle (feedback loop) where stressors and limited resource constraints are compounded, resulting in systems collapse. In the presentations I will model and discuss these relationships and complex interactions, wherein managing disease can produce more disease, and managing well-being can produce more well-being. Some might argue that these two approaches are the same, representing the “two sides of the same coin”. However, the mental models underpinning the two approaches are so fundamentally different as to represent a complete paradigm shift—and what is observed, how it is interpreted, and the actions taken will bear little resemblance to each other.

Objective of Presentations

The objective of my presentations is to give the attending veterinarian some systems insights and tools to better help clients reimagine their management systems into a well-being perspective. I believe there is much potential for redesigned systems---that focus resources on creating broad systems well-being (success) instead of managing disease (failure)---to produce more desirable outcomes for our profession, our clients, their animals, and greater society.

Disclosure

The views in this abstract and associated presentations represent solely my own. I am currently employed by Elanco Animal Health (EAH) as a Technical Consultant and was sponsored by EAH to present at this meeting. I can identify no potential conflicts of interest in the animal husbandry and systems practice content of this presentation, or other influence, arising from my relationship with EAH.

References

1. Meadows, Donella. (1999). Leverage Points: Places to Intervene in a System. The

Sustainability Institute. Hartland, VT 2. Goodman, Michael. (2002). The Iceberg Model. Innovation Associates Organizational

Learning. Hopkinton, MA. 3. Senge, Peter. (2006) The Fifth Discipline: The Art and Practice of the Learning

Organization. Doubleday (A Division of Random House), New York. 4. Edwards-Callaway, LN and MS Calvo-Lorenzo. (2020). Animal welfare in the U.S. slaughter industry—a focus on fed cattle, Journal of Animal Science, Vol 98:4. 5. Vogel,GJ., CD Bokenkroger, SC Rutten-Ramos, and JL Bargen. (2019). A retrospective evaluation of animal mortality in US feedlots: Rate, Timing and Cause of Death. Bovine

Practitioner 49:113-122 6. Hart, BL and LA Hart. (2019) Sickness Behavior in Animals: Implications in Health and

Wellness. in J Choe et al (ed’s). Encyclopedia of Animal Behavior (2nd ed.). Vol. 1.

Academic Press. Amsterdam. 171-175 7. Williams, Don. (1984) Stress and Its Effects on Cattle. in F Baker and M Miller (ed’s). Beef

Cattle Science Handbook (1st ed.). CRC Press. Boca Raton, FL. 8. Verbrugghe, E, F Boyen, W Gaastra, L Bekhuis, B Leyman, A Van Parys, F Haesebrouck, &

F Pasmans. (2012). The complex interplay between stress and bacterial infections in animals. Veterinary Microbiology, 155 2-4. 115-27.

Food Animal

Austin Hinds, DVM, MS, DACVIM_LA

University of Missouri Columbia, MO

149

ANEMIA AND BLOOD TRANSFUSIONS IN SMALL RUMINANTS

C.Austin Hinds DVM, MS, DACVIM-LA University of Missouri

Anemia is a common problem in small ruminant medicine. While gastrointestinal parasitism is the primary cause, there are a few other causes worthy of discussion. In this session, we will discuss the best ways to identify anemia, how to identify the underlying cause, and practical treatment strategies. We will also cover non-transfusion treatments of anemia, when to do a blood transfusion, and practical blood transfusion techniques.

Common Causes of Anemia

Gastrointestinal parasitism, specifically haemonchosis, is by far the most common cause of anemia in small ruminants. Haemonchosis leads to chronic blood loss anemia. Although blood loss anemias are usually considered regenerative, chronic blood loss results in iron depletion and, therefore, iron deficiency anemia. Iron deficiency leads to a microcytic hypochromic anemia due to decreased production of hemoglobin. The other common cause of non-regenerative anemia is chronic disease in which iron is sequestered in an unusable form in the bone marrow.1 Because copper is necessary for optimal iron absorption and release from body iron stores, copper deficiency also leads to an iron deficiency anemia.2 Acute blood loss is usually associated with trauma. Hemolytic anemia in goats and especially sheep occurs as a result of copper toxicity or other toxins. Clinical signs of hemolytic anemia are icterus, hemoglobinuria, anemia in the face of a normal or high plasma protein, and a strong regenerative response. With acute blood loss or hemolysis a regenerative response will occur within 1-2 days.1

Cutoffs for treatments

Animals with chronic anemia are able to adapt well and can become profoundly anemic before clinical signs are apparent to their owners. This tolerance to severe anemia is by two mechanisms. First, with acute blood loss, blood volume is lost and animals can die from shock before they would succumb to hypoxia. Cardiogenic shock occurs when 30% of the circulating blood volume is lost acutely.3 Second, as an animal becomes more anemic, hypoxia leads to the increased concentration of 2,3 DPG. This molecule decreases hemoglobin’s affinity for oxygen, allowing it to offload more readily at the hypoxic tissues. Animals with chronic blood loss can survive severely decreased hematocrits. In general, an animal with chronic blood loss can get to a hematocrit of around 10% before significant weakness or lethargy occurs. Many animals will present with single digit hematocrits and some as low as 3-5% and still survive. The most important aspect of treating anemia is stopping the loss of red cells. Since haemonchosis is usually the cause of the anemia, using a dewormer that is very likely to kill the worms is of utmost importance. When determining if a patient needs a blood transfusion, it is good to consider hematocrit and clinical signs. When the hematocrit drops below 10%, a blood transfusion is warranted. Animals that have a hematocrit below 10% but are still bright and alert can recover without a transfusion if there are limitations on being able to perform the transfusion. Animals that have a hematocrit of 10-14% but are very weak or are exhibiting signs of shock usually require a blood transfusion. Animals that are alert and still eating and the hematocrit is above 10, can usually be managed without a blood transfusion.

Methods for transfusions

A good blood donor is one that is of significant body size and therefore blood volume, and has a good hematocrit – usually above 30-35%. While many blood groups/types are known in ruminant species, the likelihood of a serious transfusion reaction in a non-sensitized patient is very low. Blood type is not considered when performing most blood transfusions. Volume of blood to needed can be calculated3: �����������������(�) = ×(������������������ℎ�(��) ×0.08)

A goal hematocrit of 14-16 percent is ideal. A healthy donor can donate up to 20% of its blood volume (10-15 ml/kg). Blood can be collected in commercially available blood collection bags or bottles, depending on availability. Most blood collection systems come with a needle attached. Often inserting an IV catheter into the jugular vein of the donor facilitates easier and more secure blood collection. Sodium citrate can be used to make anticoagulant blood collection bags, but blood must be used immediately if this is done. Blood products should always be given through an inline filter.

1.Pugh DG. Sheep and Goat Medicine, 2nd ed. Maryland Heights, MO: Elsevier; 2012.

2.Harvey JW. Veterinary Hematology: A Diagnostic Guide and Color Atlas, 1st ed. St. Louis, MO: Elsevier; 2012.

3. Balcomb C, Foster D. Update on the use of Blood and Blood Products in Ruminants. Vet Clin North Am Food Anim Pract 2014;30:455-74, vii.

Food Animal

Rosalie Ierardi, DVM, MS

University of Missouri Columbia, MO

153

This article is from: