Tag Archives: Tuberculosis

Testing for Tuberculosis

I was tempted to call this week’s entry TB, or not TB but that feels wrong. Although I have enjoyed this week, the subject is serious and there are sad overtones. I suppose the animals that go to slaughter following our test would have ended up there anyway eventually, but their lives will be cut short and it is a loss for the farmer, though he will receive some financial compensation for the cattle which are culled. It can’t be easy, knowing there is disease in your herd.

Though the aim to wipe out TB is laudable, for each farmer affected it can be a major headache. When we find TB on a farm, all cattle movements on and off that farm are limited. Restrictions are put in place and the only place those animals can go, is direct to the slaughterhouse. This means that if there are more animals on the farm than grass for them to eat, the farmer can’t send the excess stock to market. He either has to buy in food for them, or send them to be killed, even if they are animals that would be more valuable sold live. A young breeding cow has more value than the price of its meat, for example.

So it’s a difficult juggling act for the farmer. Throw in there the fact that our tests aren’t perfect, the disease is unpredictable and eliminating it can be difficult and you have the perfect combination for resentment of the people coming on the farm to do the testing and represent the government who put all these rules in place. We were very lucky this week that the farm owners were philosophical. It’s time consuming for the farmer as well. We tested close to four hundred animals this week. It took the best part of four days and even then, there are some retests that need to be done. Then in a couple of months, the whole thing will need to be repeated. On and on until the tests come back clear.

I met up with the team on Sunday night in the hotel where I would be sleeping for the best part of a week. I had met S the vet before. She took me out on some welfare visits a couple of weeks back, but there were two animal health officers coming too to carry out the blood testing and keep the paperwork in order. There was also another TB team, who would be skin testing at another farm in the area, so we were quite a big group. Though the food and conversation were good, we all retired early, ready for the hard work that was coming the next day.

It was interesting to me to go out testing. Thirty years ago, I used to carry out TB skin tests in the area, though in those days, there was no known TB in the area and all the tests were routine herd tests where we didn’t expect to find anything. The farm where we tested this week has already had TB confirmed. Culled animals had been found to have TB lesions present and culture results – where they attempt to grow bacteria in a lab from a possibly infected source – had shown that bovine TB to be present.

As far as I could see, the skin test hasn’t changed much at all. Two patches of skin on the neck are clipped (so you can see where you injected) and two types of tuberculin are injected: avian and bovine. Tuberculin contains purified proteins from the tuberculosis bacteria and in the UK, two types are used.

Because other harmless bacteria can be present in the environment, avian tuberculin is also injected, to try to rule out animals which have developed an immune reaction to those harmless bacteria, but still capture those that are infected with the harmful cattle strain. What this means, in terms of the test, is that if the animal produces an immune response, a lump develops at the injection site. If the lump at the bottom (bovine tuberculin) is bigger than the lump at the top (avian tuberculin) then the animal is classified as a “reactor”. That animal must then be slaughtered and checked for disease.

What was new to me though, was doing blood testing for TB in addition to the skin test. The blood tests are relatively new, very expensive, and there is a limited capacity for doing them in the UK. The animal health officer – SW – who arranged the test, had to call the lab in advance and book in our samples. The blood in the tubes also has to be kept within a certain temperature range and as it is winter, that meant that as soon as the sample was taken, it had to be placed in an insulated box with a heat pad. At the end of the day, a courier came, who would drive the samples directly to the lab.

Though it was a dull day on Monday, the test started well. SW was taking bloods and was wonderfully efficient at it. The arrangement with the needles was a bit different from what I remember in the old days. We used to use a test tube, a needle and a small, plastic needle holder. In between blood tests, you would unscrew the needle from the holder and replace it with a new one, so the holder was reused. Now, presumably due to the number of needle stick injuries that caused, a new needle holder is used for each animal. In addition, you don’t put the protective cap back on the needle. Instead there’s a green plastic flap that you flip into place to cover the needle. Doubtless it saves a lot of sore thumbs, but there is an immense amount of plastic waste.

This is K, the other animal health officer, taking a sample from the cow’s tail.

I had forgotten how messy blood testing cattle is. It was a beef farm, so the animals are always a lot wilder than dairy cattle. The animals are run up a race (a narrow fenced passage) and into a crush, where their neck is trapped so that they can’t move forward or back. That doesn’t stop them fighting it though, and as they scrabble about, the air fills with flying dungbombs. Of course, when you’re taking a sample from the tail, you’re also directly in the splat zone. I did a few samples and was briefly proud of how clean everything was… and then a cow sent the traditional jet of liquid shit directly at me and I spent the rest of the day with half my jacket and one trouser leg well and truly coated.

SW and K made a wonderful team. I was worried at the start that I would be a complete spare part, but they quickly involved me. Despite all the flying faeces, and the potentially serious nature of our visit, it was wonderful being back out on a farm, in the thick of the action, doing the job that I trained for all those years ago.

We had bought packed lunches in the shop in the morning. As we walked back to the cars, I was reminiscing with S the vet about the old days. When you spent the day on a farm testing, it was normal when you broke for lunch, to find a wonderful three course meal waiting for you in the farmhouse, courtesy of the farmer’s wife. Though it was already starting to be more common for farmer’s wives to work, it was still a regular part of that life back then, but I had been told it was uncommon now.

Of course, with four of us there, it would also be a big ask, but to my delight, we were invited into the farmhouse, where there was delicious, warming farmhouse soup, sausages, cheese and rolls and pancakes with butter and jam. Given what we were there to do, it was fantastically generous and it added to that feeling of deja vu I had all week.

We spent all day on Monday and Tuesday, injecting the skin test and taking blood samples, then on Thursday and Friday, S went out to read the skin test and I accompanied her, partly to do the writing (making sure you record the numbers and make sure the right animals are identified is crucial) and partly to see what the skin reactions are like and how they should be read. Though I’d seen a few avian reactions years ago, I never found any reactors and I was half hoping we wouldn’t find any.

But that hope only got as far as the third cow. Unfortunately, she had a lump where the bovine tuberculin had been injected, but no reaction at the avian injection site, which meant that she was a reactor. It was quite a chilling feeling for me, partly because the cow would have to be slaughtered and partly because I now knew that here was an animal with an infection that could be passed to humans. We’re not allowed out on farms to test without having had a BCG vaccine, but it was an unexpectedly sobering thought.

Things went relatively well from there, though there was one other reactor, and that was last years calf from the infected cow. Interestingly, the blood tests came back on Friday, and though it had picked up TB in the calf, the cow tested as negative. It will be interesting to see what is found when the two of them are culled. Though it’s not nice to see a young, recently weaned beast being sent off, it was some consolation that the cow would have company. Cattle tend to be stressed when they are isolated from the herd, and the farmer is required to isolate reactors as soon as possible.

There were also some more positives from the blood test, so they will be sent off too. Then, as I said back at the start, the herd will need to be tested again, and maybe several more times, but hopefully it will eventually be cleared. Officially Scotland is TB free, but in southwest Scotland, where animals are regularly brought in from Ireland, it’s always going to be a problem until they find a better solution. And as this is part of my patch, it looks as though we will be working on it for some time yet.

And for those of you that have made it this far, here are some gratuitous food photos from the Craignelder Hotel, where we stayed.

Tuberculosis

The rain is hurling itself against the window as I write this, having returned home after half a week in Stranraer. The wind there was relentless and felt like it was filled with icicles. Not quite the balmy, maritime climate I might have hoped for. Despite the chilly wind and the sleet that fell, the fields were still green and many animals are still outside. So different from the months of snow and ice in the far north. I finally found the time to take a few photos when I was out and about, which I’ll share in between the streams of reminiscence!

It was strange being back. A lot has changed in the last thirty years, although one thing that hasn’t changed much is the little lodge house I lived in back then. It now has oil central heating, where once the only warmth came from a coal fire, and the wheelie bins are out front, rather than tucked away at the back door, but other than that, it still looks much as it did when I lived there. I swore, after those eighteen months that I would never again accept a house without central heating.

The practice I worked in is long gone. The younger of my bosses sold it to the neighbouring practice (now Academy Vets) years ago. I went into Academy Vets as I had to chat to them about a case. I thought I didn’t know any of the staff, but I discovered that one of the senior vets had seen practice with me when he was a student, which illustrates how long ago it all was. My older boss is still around, apparently. Hopefully I can visit him, next time I’m over.

Simpson’s the bakers is still there on the main shopping street. I remember Anne, the kindest receptionist ever, asking if I wanted anything from Simpson’s at lunch time on an almost daily basis. I bought a sandwich: coronation chicken on white bread and they must still be using the same recipe as they used, all those years ago. It was as delicious as I remembered, though it now comes in plastic, where once it was in a white paper bag. The cakes haven’t changed either: very traditionally Scottish, all intensely sweet, no fresh cream and some very garish icing.

I was quite surprised (and rather saddened) by how unfamiliar a lot of it seemed, though I did keep tripping over memories over the course of a few days. I thought the Morrisons supermarket was new, but when I went in, it dawned on me that it was the precious supermarket that was built when I was there. It was Safeway when it arrived in town and was a wonderful addition. Before that, there was only a dim and narrow W.M. Low’s that I would walk around, looking for something for dinner, finding no inspiration. Morrison’s was closer to the centre than I remember and I don’t recall using a roundabout to get into it, but maybe I’ve just forgotten. A colleague who grew up in Stranraer reminded me that the old cattle market was knocked down to build it, and I do recall that as well, but only in the vaguest of ways.

Mostly I drove around, thinking how unfamiliar it all seemed, though when I drove away from Academy Vets (where we used to take dogs for x-rays as my practice didn’t have one) I knew exactly how to get to Lewis Street, where McTaggart and Williamson used to be, and for a few moments, I felt as if time had shifted.

Though my time in Stranraer wasn’t particularly happy, it is where I met Charlie. He took a job in my practice, having spent time as a student doing extramural studies around the corner in Academy Street. We were married twenty three years and have three wonderful children together, so it was a significant time in my life.


Anyway, enough reminiscing and back to the present. This week I have been learning about tuberculosis. It’s important that I do as I will be taking over several TB outbreak cases in just over a month’s time, when my Stranraer colleague goes on maternity leave. Although I’m learning a lot at high speed, I am now reaching the stage when I can see just how much I don’t know.

There’s an online course I need to take, as well as having time for the cases to be handed over. I am finding out where to look up case handling and I’ve an offer of help with the tracing and epidemiology, but I am still going to need a lot of guidance. Each case is different, depending on whether there were signs of TB found when an animal went to slaughter, or whether it was picked up during a skin test, and beyond that how exactly the case progresses, once a positive skin test occurs. There are a multitude of pathways, depending on those factors. I did the skin testing thirty years back, but there were no positive skin tests back then, so the rest is new to me.

Now in addition to skin tests, they can take blood tests and are beginning to understand some of the genetics. Tracing where it came from (and where it might have spread to) is now becoming more clear. You can sometimes tell where a strain might have come from, because it is genetically similar to a separate case. When I was testing, thirty years ago, there was no TB in the area. The aim is to return to that situation, but I think that will take a very long time, if it’s possible at all. Only time will tell.

Yesterday, R and I visited a farm where the investigation is just beginning. One of their cows had a small reaction to the injection during a routine skin test. When tested again, sixty days later, she reacted more. Now she will sadly be taken to slaughter, where they will check her for visible signs of TB and also do a PCR check, where they look for TB DNA. After that, whatever the result, the whole herd will have to be checked again. Until they get the all-clear, with no reactors, they cannot sell any of their animals, or move them off the farm, other than for slaughter. It’s a huge blow to any farmer to find out some of his cows will have to be culled and that there is disease in the herd that can spread to humans. I hope, for their sake, that the tests all come back clear.

I had left my car in a car park in the middle of nowhere while R took me to the farm, and on my return, I was quite surprised to see a van parked beside it. R headed off and to my surprise, the driver of the van came over to chat to me. He was wizened as if he had spent a lot of years battling the weather, but he seemed cheery as he told me he was a mole exterminator! He is seventy five, he said, and still tending to over seventy farms, though in his heyday, he cleared a hundred and twenty. I confess that it had never crossed my mind that the job of mole exterminator existed, but he seemed very upbeat about it and was obviously very efficient. It did cross my mind that perhaps I should consider a new career, but he said he thinks he has someone lined up to take over his patch when he finally gets too old.

Anyway, I’ll leave you with some food pictures. I ate every night in the North West Castle Hotel and would highly recommend it!

Sea bass with creamed potatoes, prawn and chive butter and seasonal vegetables
Breast of chicken with mash, haggis and peppercorn sauce

… and the piece de resistance…

Strawberry cheesecake

Delicious! See you next week.