Is there anything worse? The non ambulatory cow represents one of the most frustrating clinical conditions large animal veterinarians face. A definitive diagnosis is often difficult to obtain, and even when we do, successful treatment is often limited by logistics, economics, and an honest prognosis. The diagnosed down cow, however, represents an opportunity to make a positive impact on animal welfare and overall herd management. This session will provide a practical approach to the down animal, including differential diagnoses and realistic treatment options.