Mastitis spread from BL to front 2 quarters now! What to do?

[Nyomi]

Hey everyone. 
My earlier thread (about helping Maybelle's edema after birth)... has gotten heaps better - but last TUESDAY (7 days ago), she was absolutely fine in the morning but in the arvo, she was droopy and not wanting to come in for milking (& feed). I milked Bessie first instead, but when I went to get Maybelle, she was laying down in the shelter, drooling, hot to touch, with cold ears... yikes! Fearing milk fever, I ran up to the house and called the after hours vet, who came within 30mins.... and found her up on her feet and chewing on some hay I'd put for her, but she had a fever of 40.5C! (side note; I'm in Australia .

Maybelle's a 7-year-old pure Jersey cow, solid & strong condition who calved on the 28th Dec (2 weeks prior) - with all 4 quarters working strong. 

The vet dismissed the milk fever, but since she had a fever, he ran some tests and did an internal exam, which produced some bloody mucus from her uterus, so he suspected Metritis (left over afterbirth still in uterus). It was bright red blood in mucus, not rank smelling or black/brown, but he said it could be the cause of the fever anyway. 

He gave her a 2-week anti-biotic shot (I HATE A.B's, but since she had a fever, and I didn't know what else to do, I said yes). He also gave her an anti-inflammatory shot and a shot to help the uterus contract and expel anything else in there. 

After his exam, she was so hot and exhausted looking, I didn't have the heart to force her up the small hill into the stanchion and milk her out. **silly me!!** I hoped the calf would take care of her for the night, and she would feel better in the morning. Nope. Mastitis - hard and hot - in her back left quarter.  

I machine milked the 3 quarters (separated her milk from Bessie's) and put a plug in the machine, so I could hand milk that quarter - which I did. I stripped it out, and it was watery white with flakes.

I iodine teat-dipped her as always, before and after, and use warm soapy water with a little bleach, wear fresh gloves per cow and fresh cloths in the water - and use fresh part of washer on each teat etc. 

Anyway, she her skink also went very cold and clammy. 

The Vet (who pinched each of her teats with his finger and thumb to see milk sample - which she didn't like, ugh), said that the antibiotics he'd given her should be enough, and just to keep stripping her out twice or more a day, and leave calf on her. 

But she didn't improve. 

She was very weak, barely eating anything and lying down a lot. She could barely stand for 2 mins to let the calf suckle. She'd lay down while the calf was suckling (not getting much), which made me start to worry that the calf wasn't getting enough. I had to go out several times a day with buckets of feed and water and put them under her nose for her to eat and drink - which she did, thankfully. I was so worried her rumen would stop etc. The calf started to drink her water and eat some of the grain - with minerals, electrolytes, VitC and molasses in it, too. 

Day 3-4 (FRIDAY), I got a different vet out (from same practice, but asked for vet most familiar with dairy cows), and she said she's not too dehydrated (didn't need/warrant an oral drenching), but she still had a fever of 39.7C. She suspects ACUTE MASTITIS. 

So she gave her a 3-day anti-biotic shot, another anti-inflammatory, and an anti-biotic infusion up the teat canal (called Mastalone - one treatment per day, for 3 days). She didn't push/work the serum up the canal after injecting it, and said I didn't need to (when I asked about her not doing that, as I'd always seen others run it up the teat)??

Saturday morning, Maybelle was up at the stanchion waiting, more alert & hungry! Yay... Been improving her appetite since then, but this morning (Monday morning), the 3-day anti-biotics have ended, and she's now developed hard, swollen mastitis (not hot) in the front two quarters!!! *almost crying* It's watery whitish, same as the Rear Left was at the start. Her back quarter now, when I get anything out, is like a dark brown cordial now.

I finally got the calf to take the bottle last night (she fought me for ages & refused to have it 2 other times! - the vet said she wasn't too concerned about the calf at that stage), but she drank 2L last night, and 3L this morning, (and 3.5L this afternoon) - of fresh warm milk from my other cow, Bessie. The calf (still not settled on a name for her), is still alert & running around heaps - phew!

But what do I do about Maybelle? I'm about to go into the vets in a couple hours as the vet prescribed more teat/udder syringes (Mastalone), and a shot/dose of another 3-day antibiotic. 

What are my chances she'll survive? Will the udder recover? The vet nurse talked about black mastitis and the udder sloughing off to leave a big open wound that would need more anti-biotics, daily cleaning and dressing... 

Thanks in advance for your help & advice!

Nyomi

[Kelsey]

That's classic coliform mastitis.(toxic mastitis) You're doing everything right. The good news is that by the time the cow is sick and the udder is swollen and milk is icky, the original bacteria are likely already deceased. What you're seeing is the effect of the toxins that the dying bacteria release.
Typical treatment is to manage the symptoms - anti-inflammatories and supportive care (making sure she's hydrated, eating, not ketotic).
Most vets give systemic antibiotics (to cover other possibilities like metritis), but udder infusions aren't going to do anything.

So, keep those quarters emptied.as frequently as possible (4+ times per day ideally, at least for a few days). Keep her eating and drinking. Anti-inflammatories according to the vet.
From what I've read it doesn't usually leave lasting damage to the udder but cows can go off feed or get dehydrated and then die from that.

[Nyomi]

Jan 15, 2023 23:35:09 GMT -5 Kelsey said:

That's classic coliform mastitis.(toxic mastitis) You're doing everything right. The good news is that by the time the cow is sick and the udder is swollen and milk is icky, the original bacteria are likely already deceased. What you're seeing is the effect of the toxins that the dying bacteria release.
Typical treatment is to manage the symptoms - anti-inflammatories and supportive care (making sure she's hydrated, eating, not ketotic).
Most vets give systemic antibiotics (to cover other possibilities like metritis), but udder infusions aren't going to do anything.

So, keep those quarters emptied.as frequently as possible (4+ times per day ideally, at least for a few days). Keep her eating and drinking. Anti-inflammatories according to the vet.
From what I've read it doesn't usually leave lasting damage to the udder but cows can go off feed or get dehydrated and then die from that.

Thanks Kelsey!
The 2nd vet did a ketosis test, and she was okay, thankfully. 
I found out later, that Maybelle didn't like my 'enriched feed' and was only eating a little cause she didn't like it, not because she off her feed as much as I thought. When I gave her some plain dry grain, she gobbled it up & wanted more! So I thought I was giving her more 'goodness' by adding minerals etc to the small amount of grain, but she'd only eat a few mouthfuls. I would have been better off just giving her plain grain to keep her strong, then give her the extras later.
This morning when I cleaned and treated her Rear left Qtr, I could only get a squirt out of ALL quarters - due to the calf getting to her first. 
Before I was bottle feeding, the calf was at her as soon as she was on her feet, and wouldn't relent. Even now though, after bottle feeding, the calf still sucks on her for a good 10mins (poor Maybelle!), until calf finally understands it's over. Should I feed calf more? 2-3L twice a day is the norm, yeah?

[Nyomi]

Also Kelsey - great to hear you think she could recover her udder function. The vets were very unwilling to promise anything; saying it could go as bad as black mastitis where the udder sloughs off in dead chunks & will need to be treated as a sore, open wound, yet she'll live, or she could recover well, but they both said she'll probably lose that quarter's function. Have you had success in treating mastitis like this, where the udder heals & recovers, even though she's producing brown cordial like liquid?
And do you think I should give her another round of Anti-biotics, or just another shot of anti-inflammatory?

[kim'scows]

Will the vet give you some oxytocin? I’ve found that VERY helpful for acute mastitis, as it forces a milk letdown and makes it easier to get all that gunk out of the infected quarter/s.

[Nyomi]

This afternoon after going to the vets and collecting the Bivatop 200LA anti-biotic (45ml given to me in 2 syringes, with 25ml in one and 20ml in the other), I was getting prepared for the arvo milking, when I read the label on the clear zip-lock bag that held the two syringes. At the bottom, it stated: "MWP (milk withdrawn period) 7 days; do NOT feed milk to bobby calves." My calf is just 18 days old today! (Bobby calves are calves without mothers under 30-days-old)

Maybelle has already had this antibiotic shot (given as 2 shots, 3 days prior), and Harriet (calf - trying out the name) has been with her 24/7, feeding from her often (trying to get anything - and she definitely sucks from the infected quarters).

So I instantly rang the vets and got their afterhours service. I spoke with a different vet, who was... more surprised at the administration of Mastalone udder infusion, since the calf would be taking it directly!!! That was my fear - which the vet said was harmless to the calf. This vet said the same active ingredient is in both, and that it can accumulate in their bones (mostly when used long term), but the bone thing "isn't a problem until their much older - so not to worry - it'll most likely be okay and won't hurt her right now." Wow. Just... wow.

She said she was going to ask the earlier vet why she'd prescribe and get me to use Mastalone on a nursing cow, so I'm looking forward to the answer tomorrow.

But more than that - I researched Bivatop (I think that's how it's spelt), and it says 1ml per 10kgs body weight. Maybelle is not 450kgs (nearly 1000lbs!) she'd be more 300kgs. Maybelle is a pure Jersey and very skinny at the moment. Ribs showing badly and very planked sided - nothing like she was a week ago. So 45ml is a huge dose for her. Then, the vet medical website also stated not to give more than 10ml in any injection site. She'd already received 2 massive shots, and I was supposed to give her 2 more shots, 25ml and 20ml, one in each side of her rump. So double dosed and twice as much at each injection site. WOW.

Has anyone else found this to be okay? Is the website wrong? Or is the vet playing a bit fast and loose here?

So I didn't give her the Bivatop or the Mastalone. I stripped her out (got very little from her stretched and rock hard udder & teats), while she gobbled down 2kgs/1 lb of stock grain mix, 14% protein.

I'm very concerned & worried that she's going to get worse. Her udder is terribly tight and swollen; rock hard - can't massage it much other than rubbing the skin, which I've been doing with peppermint oil drops in coconut oil base.

PLEASE - your advice on how to proceed will be much appreciated.

[Nyomi]

Jan 16, 2023 5:48:55 GMT -5 kim'scows said:

Will the vet give you some oxytocin? I’ve found that VERY helpful for acute mastitis, as it forces a milk letdown and makes it easier to get all that gunk out of the infected quarter/s.

Hey Kim - I will definitely ask. Thank you - being able to milk her easier sounds great. Maybelle's udder is soooo tight and swollen hard - rock hard - even the skin of her teats this arvo were, I swear, at their limit. Poor thing! I'll definitely ask tomorrow about the oxytocin - thank you!!

[avejoseph]

What an ordeal for you and Maybelle! I am not an expert here but I did deal with coliform mastitis once but not this bad. How often are you trying to strip out those infected quarters? It needs to be more than twice a day. Her udder is going to be very sore but once that watery liquid passes you are going to get chunky stuff that needs to get out of the udder. Keep using some of your udder mint massage oil too.
Like Kelsey said, her body is reacting to the toxins being released by the dying bacteria in her udder. If this is her only ailment, she may not need more antibiotics but the anti inflammatory would help support her right now. Udder function can return after coliform mastitis but it can decrease the amount of milk you get this lactation.
Does she still have a fever? How
Much are you feeding her? Is she drinking water?

[kim'scows]

Jan 16, 2023 6:07:22 GMT -5 Nyomi said:

Jan 16, 2023 5:48:55 GMT -5 kim'scows said:

Will the vet give you some oxytocin? I’ve found that VERY helpful for acute mastitis, as it forces a milk letdown and makes it easier to get all that gunk out of the infected quarter/s.

Hey Kim - I will definitely ask. Thank you - being able to milk her easier sounds great. Maybelle's udder is soooo tight and swollen hard - rock hard - even the skin of her teats this arvo were, I swear, at their limit. Poor thing! I'll definitely ask tomorrow about the oxytocin - thank you!!

You needed the oxytocin a week ago, not tomorrow. The very best thing you can do for her is get that gunk out ASAP. That is what is keeping her sick. Her body is trying to flush out all the toxins. This is a very serious situation.

And for the record, while oxytocin is very helpful to have on hand so you can use it swiftly in situations like this (if you could have given it at the FIRST sign of a hard quarter, she likely wouldn’t be this sick now), oxytocin should NOT be used for training cows to milk or merely to help with edema. If used that way, you can end up with a cow that’s a junky and won’t let down at all without a shot of oxytocin.

[Nyomi]

Hey AveJoseph,
Her fever is much less today - Just a little warmer than normal.
I work full-time but did strip her out at lunch time - only to get 1 squirt the calf was doing a great job at keeping her empty - but now that I'm bottle feeding her I know I'll have to strip Maybelle more often. I'm going to try for 4 times a day; 6am, 10am, 2 or 3pm, & 6pm. Tonight, I got 6 squirts from her worst quarter, but only 2 & 3 from her front ones. Her good quarter gave nothing at all - prob due to the calf preferring that one.
It's so great talking to some one who'd been through this! Thank you for your support
I'm so relieved to hear she may regain some of her udder function. I was just hoping she'd survive, even if she went dry, I'd want to keep her as a companion cow to my other Jersey. But hearing she may be able to feed her calf again... that's a wonderful bit of hope. Thank you
Apparently, she's all maxed out on anti-inflammatories - can't have anymore, and she's still under the 14-day coverage of the first broad spectrum AB that she got 7 days ago... but she's still developed more mastitis, so maybe it didn't do anything, I don't know.
I'm shocked that it's gone from 1 qrtr to 3! I was even MORE pedantic than usual, but suspect the calf spread it from teat to teat, my iodine teat dipper, or perhaps my bleachy warm water isn't strong enough?? The vet nurse gave me some alcohol teat wipes to use instead - which she swears by. What do you use as a teat wash/dip etc?
Maybelle's free range grazing again, and also gets 2 big scoops (bout a 4L container) of grain in the morning, sometimes at noon and definitely at night, plus approx 2-4 flakes/slices/fingers of prime lucerne/alfalfa hay per day - she does have to share the hay with Bessie, so it's hard to be precise how much she eats of it, but they get 4-6 to share each day (split into 2 feedings after am & pm milking. She gained weight while pregnant on 1 scoop am & pm, so have more than doubled it for now.  Do you think she needs more? 
Yes, she's drinking, too. Have to fill their tubs almost as often as before - but they also have a creek they can drink from freely. 

[kim'scows]

And just wanted to add, like others have said, she doesn’t need more antibiotics at this point, she needs to flush those toxins out of her entire body. bigredcow said vets will give an IV of hypertonic saline solution which will cause the cow to drink a lot of water, which will help her flush the toxins out of her blood stream.

[Nyomi]

Oh, ok. Thanks Kim. I've never used Oxytocin before, but have read others use it.
Any tips on getting her to either let down or to soften the hard mass so it passes out? When I milk her, her teats are thin & floppy - though very tight and swollen around the base, and she won't let or can't pass anything except a squirt here and there. I rub her and leave the teat for a moment, and might get another squirt, but then nothing and nothing and nothing... It's like she either can't let it out, or won't??? That's why I was excited about the oxytocin - you sure it won't help now?

[kim'scows]

Jan 16, 2023 7:27:13 GMT -5 Nyomi said:

Oh, ok. Thanks Kim. I've never used Oxytocin before, but have read others use it.
Any tips on getting her to either let down or to soften the hard mass so it passes out? When I milk her, her teats are thin & floppy - though very tight and swollen around the base, and she won't let or can't pass anything except a squirt here and there. I rub her and leave the teat for a moment, and might get another squirt, but then nothing and nothing and nothing... It's like she either can't let it out, or won't??? That's why I was excited about the oxytocin - you sure it won't help now?

It will help now, that’s what I’m saying—you need to see if you can get some right away, not wait till tomorrow.

The way to use it is, clean/prep the udder for milking, then give the shot IM (I’d do 2cc). Start milking. Within 1-3 minutes, the oxytocin will hit her bloodstream and you should get some letdown. Work as fast as you can to get as much gunk out as possible. You’d be amazed. I think when they are sick like this, the stress of it all makes it harder for them to let down, and also the chunks clog up the udder. But a strong dose of oxytocin relaxes the milk ducts and helps get things moving.

[bigredcow]

You might have to massage pretty rough to loosen crud out. A dose of banamine would help reduce inflammation and give you more space in the gland to work with. Plus a mint cream (uddercomfort, dynamint, and the like)

If she's SICK sick, a dose of dexamethasone will say "Woah Nelly" to that immune system for a day and let some endotoxins clear out before adding more. It's not the live bacteria making her SICK sick, it's the pieces of the dead ones.

[kim'scows]

Jan 16, 2023 6:07:22 GMT -5 Nyomi said:

I'll definitely ask tomorrow about the oxytocin - thank you!!

Oh duh, I just realized you are on the opposite side of the earth from me. You probably don’t want to be getting your vet out of bed for some oxytocin. It’s morning where I am, so I’m thinking why wait till tomorrow??? Sorry :-P

[farmel]

I dealt with it once and it’s terrible! I eventually dried that cow off and her udder has had no trouble in the dry period.

The tissues of the udder swell and become inflamed with the infection, making it very tender and sore; it was my experience that deep massaging of the quarters to break up the mastitis was counter-productive.

[avejoseph]

4 times a day is a lot better than two times a day. You could post pictures of her if you want people to comment on her condition.

I’m going to guess the calf passed the mastitis around. Unlikely it was the iodine dip and it is not recommended to use any water to clean the udder even with bleach. You can typically get a cow clean enough using dry cloths and teat dip. If not, just use a damp but not dripping washcloth. I still wouldn’t use that in the teat area, more just on the udder.

Hopefully the oxytocin will help because you want to see that chunky gross stuff come out as soon as possible. It will get easier once you get that stuff moving.
It sounds like she’s eating and drinking better so that’s good.

[Kelsey]

If she's not letting down, because she's used to the calf nursing, that's going to be a big problem. The oxytocin will solve that.

However, if she is letting down, then I would just assume the udder tissue is completely swollen and she's not producing much milk. But you need to keep it moving, which is why milking 4+ times per day is advised.

As far as feed, lactating cows need FAR more feed than pregnant/dry cows. Like 3-4x as much. Dry cows shouldn't need grain, but a lactating cow will need about 3#/gallon produced. It's important to increase amounts gradually though. I don't advise letting cows split a measure as there's no way to know they're getting the proper amount.

Sorry your vet screwed up the meds. It's not an uncommon thing. I always double check withdrawal times and dosage in case there's a mistake.

[Nyomi]

Thank you everyone, for your comments, support and advice. I really appreciate it!

This morning is Tuesday - so this time last week she was fine, but displayed first signs of illness last Tues night.

I read your above posts before milking this morning, so I went in with a more determined and encouraged frame of mind. Thank you.

Maybelle came into the stanchion on her own, slow and steady - she's still weak and heavy footed when she walks. She eagerly licked up 3 big scoops of grain (instead of 2) - and I'll keep increasing it a little more each feed time

Her udder was clean already, just dusty really, so I rubbed coconut oil with several drops of peppermint oil mixed in, all over her udder - avoiding her teats with the peppermint. I was amazed at how she didn't mind the more forceful long stroking massage, though I did get a tail swish now and then - so I just moved to a different area, or changed my gloves again (I think I went through a dozen or more gloves and a stack of alcohol wipes!)

Anyway, to help her 'let down' as usual, I decided to turn on the milking machine... the ticking noise always started her streaming from the back quarters, and it WAS easier to strip the teats, but there wasn't enough in the teat to actually milk like normal, so I had to strip the teat just to get a squirt. I used plain coconut oil on her teats, as the gloves I have at the moment are terrible (rubber, not nitrile - but I have new ones in the post).

She filled approx half a cup, from all 3 yucky quarters, and about a quarter cup from her good quarter (milked on it's own, didn't cross contaminate).

The front 2 are still milky whitish (looking more milky than water), but... the back quarter had bloody red colouring to the browny water (when squirted onto the concrete floor). Is this bad/worse, or a sign of healing?

And before she left the outside pen, I donned another pair of gloves and got a few more squirts from each quarter! So I'll keep at her the next several days, every 2-3 hours, and just get whatever I can out of her.

The calf is still with her 24/7, and Maybelle is a great mum

She urinated (a lot) when walking back to her paddock, and also did a fresh plop which was a little on the drier side, but not dehydrated-firm.

[bigredcow]

The bloody / Brown quarter is probably toast but I would continue stripping it out until it at least becomes clear serum. Hopefully it doesn't turn into gangrene. Is it still as warm as the rest of her udder?