Treating Mastitis

I'll try to make this post fairly comprehensive in describing the way we are treating Siobhan's mastitis, in case it can help anyone else.  A quick recap . . .

Wednesday, Feb. 19 I discovered Siobhan had mastitis when I got clumps in my first few "mastitis check" squirts of milk from her left front quarter (from here on out, LF or affected quarter).  I immediately called my vet and described the slimy clumps that did not smear away like cream and the salty taste to that quarter's milk.  I also mentioned that I believed her self-sucking on that quarter might have caused it.  The vet said she could not have mastitis and self-sucking could not cause mastitis.  That was that.  I was on my own, and what an emotional ride the next few days turned out to be.

I immediately took the following steps:

• Called two fellow Dexter owners who milk and asked for advice.
• Posted on the ProBoards Dexter forum and the Keeping a Family Cow Forum asking for help.
• Called Tennessee Quality Milk Laboratory on one friend's advice and ordered a milk testing kit from them.
• Ordered a CMT (California Mastitis Test) Kit from Jeffers, who could deliver it the quickest.
• Called Hamby's Dairy and talked to the tech.  On his recommendation, I ordered two tubes of Tomorrow and Dynamint udder balm.  He was quite knowledgeable about mastitis, by the way.  Unfortunately, his advice for a self-sucking cow is to cull her--but I was not going to give up on the calf I raised and trained to milk!
• Began milking Siobhan out two to three times a day in the affected quarter.  I was only getting a tablespoon of milk from that one, and it began decreasing each day at first.  I used hot compresses, mint udder balm and massage to try to break up the hard lump that her mammary tissue had become.
• Went back to OAD (once a day) milking on the other three quarters, putting off trying to dry her off.  Milk needed to be flowing through her quarters.
• Found a mint udder balm at TSC and began using that while waiting for the Dynamint.
• Put a weaning ring in Siobhan's nose, using hot water to soften it so it would spread wide enough to go in.

By Friday, Feb. 21 my "Mastitis Arsenal" had arrived.

First is the CMT Kit.  I'll show how to use that farther down, along with a very helpful video I got from KFC (Keeping a Family Cow.)

Be sure you have a gallon of distilled water on hand so you can mix up the CMT reagent.  I lost the day my kit arrived because I didn't have distilled water on hand and our tap water tested unusable. Be sure to label the excess that doesn't fit in the spray bottle because it looks a lot like iced tea!

Next was the all-important milk sampling kit from TQML.  Let me just say here that Susan at the lab (and later her boss) were extremely helpful throughout this whole time.

The kit came packed inside a styrofoam cooler for shipping and included an ice pack to freeze, multiple sample tubes (on top of the cooler), detailed directions, intake forms, gloves, paper towels and plenty of alcohol wipes.

Rather than try to describe the process of collecting the samples, since there was no one to take photos for me, I'll just give you the link the the very thorough instructions on the TQML website.

Finally, my Dynamint arrived, and I switched from the TSC brand to this highly-touted brand.  My Tomorrow also arrived, but I have not used it since my team of online advisors have urged me not to dry Siobhan off until the mastitis clears.

The first step in doing the CMT is to always hold the paddle in the same direction.  (Blogger won't allow me to rotate this photo the way I want to--grr!)  The paddle is made to be held in the left hand with the handle pointing to the cow's head so you can milk right-handed.  In that case, cup A corresponds to the LF quarter.

I had a moment of bizarre mental function and held the paddle with the handle pointing toward Siobhan's tail.  I'm going to sound like your mother here:  Do as I say, not as I do!

Next you squirt milk from each quarter into the corresponding cup.  Fill the bottom of each cup, then tip the whole paddle at an angle to let the excess milk drain out until the milk in each cup reaches the 2 ml line.  Don't worry, if you tilt as shown here, the milk from one cup won't run into the other cups.

Once you have 2 ml of milk in each cup, put one squirt of solution, which equals 3 ml, into each cup, then swirl.  Sorry, no photo because I couldn't manage holding the paddle, squirting the reagent, and taking a photo at the same time!

Gently swirl the paddle for 30 seconds, and compare your results to the color brochure included in the kit.  You can see here that the upper left cup, the one with milk from Siobhan's LF quarter, looks blotchy while the others are a homogenous color.  This great CMT video shows the whole process in action and compares normal and positive results.

Once again let me say, Do as I say, not as I do!  I was trying to show the gelled consistency that the positive mastitis test takes on.  However, I did not know what germ I was dealing with, and it turned out to be one I shouldn't have been sticking my finger in!  At the time I took this photo, I didn't know about the great video linked above, which shows very clearly the degrees of gel you get.

Let me also include a disclaimer here:  The CMT merely shows you a SCC, Somatic Cell Count.  It is simply an indicator of mastitis.  Cows with normally high SCCs will show up differently, and you really need to have a normal baseline for each cow so you'll know if her results change.  The CMT also does not tell you what germ you're dealing with, and that is why you need a lab to test milk samples.  Knowing what I know now, I highly recommend testing your milk cows once a month.  Since Siobhan has had mastitis, I'll be testing her regularly in the future even if her calf is the one milking her.  If I ever milk her again, I'll test once a week.  It's a bit of a nuisance, but SO worth being able to detect mastitis before it manifests itself clinically!

When my milk sample test kit arrived on Friday afternoon, it was too late to get it mailed overnight to TQML.  Here is where something amazing happened.  Susan-from-the-lab called me and made an incredible offer:  She had to work that weekend, so if I would drive the samples up to Knoxville on Saturday, Feb. 22, she would get the test started right away.  The lab was closing the second half of the following week, and she wanted me to have the results before they closed!  So I spent 6 hours on Saturday driving the samples up there, and Susan got the tests started that day.

Monday Feb. 24 I got the bad news.  Siobhan's mastitis is caused by Staphylococcus aureus, known to the dairy world by the dreaded moniker of Staph A.  The research I did quickly had me in floods of tears, for many a cow has had to be put down for antibiotic resistant Staph A.

Susan, and her boss Dr. Almeida who also called me, advised me to do several things:

• Isolate Siobhan from my other cows.  You can see her above galloping all over the Home Pasture in glee, completely oblivious to the seriousness of her condition.
• Use extreme sanitation measures to avoid any contamination of the good quarters from the affected quarter, because Staph A is extremely contagious.
• Wear gloves while handling that quarter.
• Begin treating her immediately with udder infusions of Pirsue, pirlimycin hydrochloride, the only drug that Staph A usually responds to.

Here's where our story gets a bit long and rather troubling, but I feel it's very important to share it.

Armed with the CMT and proof from the UT lab that Siobhan did have mastitis, I called my cow vet.  Let's call him Dr. W.  To my dismay, Dr. W was out of town through Wednesday, Feb. 26.  His partner, Dr. M does not do large animals and did not come to the phone, but after several rounds via the receptionist, he finally agreed to let me pick up (only) two tubes of Today, even though I told him that UT said she needs Pirsue.

I headed to the office, crying most of the way.  When I broke down in tears in front of the receptionist, she called Dr. M.  I pleaded with him that I needed Pirsue and that time was of the essence.  Early treatment is the best hope for recovery, and we had already lost 6 days since Dr. W did not think Siobhan had mastitis.  Finally he checked Dr. W's truck; there was no Pirsue, although he agreed to give me a prescription so I could order it online.

When I got home, I discovered that USDA-regulated antibiotics can only be ordered by a vet.  So I called Dr. M back and asked the receptionist if he could order it for me.  I was absolutely incredulous when the answer came back that we had to wait until Dr. W returned on Thursday!!!

Thus began a round of frantic phone calls.  One Dexter friend, Sheri, offered to turn out her barn looking for her Pirsue, although she wasn't able to find any.  Our pet vet referred me to a clinic up in Soddy Daisy, TN, who don't do cows anymore so they referred me to a clinic farther away in Dayton, TN.  It took them hours to get back to me.  Meanwhile I called every dairy farm in the area, asking to know who their vet is.  The larger dairies never answered my desperate messages, but two smaller organic farms did get back to me the next day.  When the Dayton vet finally called back, I was out milking Siobhan.  He was not helpful, but Kara begged a referral from him and got the name of a roving vet in the Chattanooga area, Dr. Patrick Tyree.  I left him a message.  Finally, one of my Dexter friends, Fran, after commiserating about how incredible it was that my regular cow vet refused to help, suggested that I call my horse vet.  In desperation, I did, and to my astonishment, Dr. Michael White offered to order a box of Pirsue for me and thought he could just get it out for the next day's truck.  I hung up quick to let him get to work!

The morning of Tuesday, Feb. 25, two things happened.  I got a message from Dr. White saying the company had failed to get the Pirsue on the truck, but it would go out the next day.

I also got hold of Dr. Tyree.  Here is where I began to think that the Lord was working on Siobhan's behalf.  Yes, he does cows.  No, he doesn't usually come to Chickamauga, but he would.  Yes, he has Pirsue on his truck!  And if I would meet him up in Collegedale, TN, he would give me some Pirsue AND a shot of Excede, which he said she also needed.  I was on the road in minutes!  I met Dr. Tyree in the parking lot of TSC for our first consultation.  He gave me a box of Pirsue--that elusive, hopefully life-saving medication I had been pursuing for over 24 hours!  He explained how to use it.  He gave me a syringe of Excede and explained how to give a sub-q (subcutaneous) injection, telling me it would work for 8 days.  I asked if Siobhan's self-sucking could have caused the mastitis, and he said yes, because her frequent sucking on the teat would keep it open, allowing bacteria to enter.  Then we talked dairy cattle, and he showed me photos of his own dairy cattle that he and his daughters raise, train to milk and sell.  He even sells milk shares.  I didn't want to scare Dr. Tyree off of treating my animals in future, so I managed to refrain from giving him a great, big hug, although I said "Bless you!" and said he's my new cow vet!  I do believe my car rather hovered over the freeway on the way home, that's how high I was floating!

So on Tuesday, Feb. 25 Siobhan got her first Pirsue at 2:00 pm.  Normally I milk in the morning, but since I was to milk OAD on all four quarters now, leaving the Pirsue infusion in the LF quarter for 24 hours, our schedule has changed.  Siobhan will get 8 days of Pirsue.

I couldn't take a photo of me infusing the Pirsue, and apparently I couldn't even take a very good photo of the tube!  But you can barely see the narrowest part of the tip, which is all that goes into the teat.  It squirts right in, and Siobhan didn't bat an eye!  I can actually feel it sloshing around inside, very strange!  Most people say not to massage it in, but Dr. Tyree told me to massage it up into the quarter, and I am definitely following his advice!

The next hurdle to cross was the injection of Excede.  I knew I needed reinforcements for that!  We had to wait until Herb could get home during daylight hours, which he arranged to do on Wednesday, Feb. 26.  Kara came along as photographer.  We walked Siobhan down to the Lower Pasture where the head gate is.  May I say again what a blessing it is to have a cow that will lead?  I can't urge you enough to halter train your cattle!

We had quite a procession welcoming Siobhan back, and Royal barely bothered to meet her before he decided to get to business.  Siobhan was not impressed!

Once she was safely in the chute and head gate, she and Royal met in a more conventional manner.

You can see one more item in my mastitis arsenal in this photo:  my Anti Self-Sucking Halter!  I'll do a future post on exactly how to make a similar one.

I'm a nurse, and I know how to give a sub-q injection, but I have never seen such a HUGE needle as this one!  I soon realized why--that Excede is really thick!

Herb is not grimacing in sympathy here; he is straining to help hold Siobhan still.  She inherited her mother's hate of needles, and she gave us quite a rodeo.

After this photo, Kara had to lay the camera down and come help hold Siobhan so I could finally finish the injection.  It took three entire minutes to get all the medication in!

This is not a good photo, but it gives you an idea of the size of that needle and helps you understand why Siobhan was rearing by the time we finished.  But we got 'er done, took out the weaning ring, and turned the poor girl loose in her own pasture again.  I bribed the little boys to stay in the round pen with some soaked alfalfa cubes so she could walk back across the pasture in peace and quiet.

This has been a long story, and it's not over yet.  It remains to be seen if this Staph A will respond to the Excede and Pirsue.  Now that she's had a systemic antibiotic, I'm adding a dose of Probios to Siobhan's feed every day when I milk her.  She'll get her last dose of Pirsue on March 8, and we have to wait three days after for it to clear her system before testing her milk again.  Because the weekend intervenes, I won't be able to send off the samples until Monday, March 10.  We probably won't know anything until at least Thursday, the 13th.  During all this time I'll continue OAD milking and go back to stripping out the affected quarter twice a day.

The Lord willing, Siobhan's mastitis will have cleared up, and we can dry her off--a process that is causing me great anxiety.  The final hurdle will be to test her milk about three days after she calves to see if she freshened clean in that quarter.  There are a lot of Ifs here.  We'll deal with them if and when they happen.  For now I'm just treating my girl and praying for the best outcome.  I'll be sure to let you know what happens.