Editor’s note: Seventh in a mastitis series
For any given case of mastitis on a client’s farm, do you know how your client will treat it and if that treatment will be the same every time? Producers may use the same treatment for every case regardless of the type of mastitis case they are facing, or they may try a different treatment every time based on nothing more than “the last one didn’t work.” As a veterinarian, you know this “shotgun” approach isn’t in the best interest of the cow, and in turn will not be in the best interest for the dairy.
Paul Rapnicki, DVM, University of Minnesota, says everything good that happens on the dairy happens by teaching people to do the little things right, and implementing workable mastitis treatment protocols is an example of helping clients do things right. The veterinary school at the University of Minnesota has been very active in working with practitioners to help them develop, with their clients, appropriate treatment protocols.
“Different farms have different challenges,” says Rapnicki. “Some need more time and effort spent in mastitis protocols, and the individual skill level of the person actually delivering the treatment can be variable farm-to-farm. For example, if giving IVs is part of your treatment protocol but the person on the farm is not able to administer IVs, you will have to find another alternative.”
How are decisions made now?
Before designing mastitis treatment protocols, it’s important to find out what type of mastitis problems exist, how treated cases are handled, what products are used, and what method of case evaluation the dairy uses. Mike Hodgman, DVM, a practitioner in Zumbrota, Minn., says, “We start with this basic information because developing and implementing a protocol is a process of educating clients and their employees on using proper treatment methods and products, and maintaining usable records for ongoing monitoring.”
If the dairy has current DHI records and/or records of mastitis cases that have been previously cultured and their antibiotic sensitivity patterns established, Hodgman can get an idea of the predominant mastitis organisms the farm deals with. “It’s important that the veterinarian become aware of how these cows are being treated for mastitis and what products are used,” he says. “We can then help them evaluate treatments and educate them on using appropriate products and minimizing residue risks.”
Rapnicki says you need to make a list of what the farm is doing currently, or at least what it believes it’s doing, as far as treatment decisions. “Then you put a system in place so that every time treatment is administered it’s recorded. This allows you to then check back periodically to see if the dairy is really following what it has decided is its policy.”
Deciding on herd policy is something the owner/manager must do, and this is where the veterinarian can be of assistance. If the producer is using treatment records to help with individual cow decisions, you can go back and see if those decisions, whether they are made by the owner or an employee, are consistent with herd policy. “When faced with a problem, we need to know how the on-farm person will make a decision on that day,” says Rapnicki. “We want to provide them with information to make that decision better and record it so we can collect information to see if herd policy is being followed.”
But treatment protocols are difficult to monitor if it’s not clear what goals the producer is seeking to accomplish. Hodgman says five typical goals of treatment, which may vary from farm-to-farm, may be: milk and udder return to normal; somatic cell counts dropping to an acceptable level; elimination of bacteria from the udder; maintaining or increasing production levels; and minimizing residue risks.
And goals must revisited periodically when monitoring the success of protocols. Hodgman says, “If the SCC does not return, for example, to less than 200,000, then that may be a treatment failure even though the producer may see milk secretions returning to normal. At this point we need to revisit the protocol to make sure it is being followed, products are being used as labeled and preventive measure are in place.”
Records are key
Maintaining good records on treatment decisions can assist you and your client in monitor- ing policy compliance and whether protocols seem to be working or not. But you need to demonstrate to your clients that record keeping doesn’t necessarily mean another burdensome task, but that it can actually help streamline protocols. “If we don’t use the records to tell us how good the producer has been in making the treatment decisions, and we don’t know what they’ve been doing in the past, how do we know whether we need to improve our protocols or not?” asks Rapnicki.
“Accurate treatment records allow us to identify how good the individual animal treatment decisions have been,” he says. In addition, the disease records help to identify what types of particular disease problems a dairy is facing. In many cases, mastitis is the most common reason that cows will be treated on a dairy. A mastitis treatment decision is the most common medical decision made on most dairies.”
Hodgman likes to use DairyComp 305 for maintaining and evaluating records, but on some dairies he also uses the American Association of Bovine Practitioner’s mastitis workbook or the 10-point dairy quality assurance record manual to track cases. He and Rapnicki also like to use scattergraphs to show producers where problems are happening on the farm.
Scoring and culturing
To help clients record information and make treatment decisions, Hodgman educates them on scoring mastitis cases. A 3-point scoring system is used as follows: a score of 1 indicates abnormal milk; a score of 2 indicates abnormal milk and swollen quarter(s); a score of 3 indicates abnormal milk, quarter swelling and a clinically sick cow. What’s important about the scoring is that it helps the producer identify the cow’s response to an infection and then allows for a treatment decision to be made by way of the protocol. In some cases no treatment may be appropriate.
For example, while waiting for cultures, Hodgman says with a score of 1, they may do nothing and take a wait-and-see approach. A score of 2 may get anti-inflammatories and supportive care while a score of 3 might warrant antibiotic intervention along with supportive care. “We try to avoid giving antibiotics first thing. We want to educate clients on the scoring of mastitis cases so the treatment decisions are logical and are based not only on the abnormal milk but also by how the cow looks. In many cases antibiotics can be avoided at least until culture results are available.”
And how important are cultures even if you or the client believes you’re working with the same bug in every mastitis case? “The appropriate treatments are so different from one organism to another,” says Rapnicki. “Strep. ag and E. coli both cause mastitis, but the best treatment is almost 180 degrees opposite for these two pathogens. We need to be treating animals more appropriately with antibiotics because a lot of the resistance issues occur when we expose pathogens to the wrong class of antibiotics, give too low a dose or don’t treat long enough.”
“Culture results allow us to treat appropriately and identify areas in need of improvement,” adds Hodgman. “Identifying mastitis pathogens gives us direction when treating individual cases but also where to allocate resources when dealing with a herd problem.” For example, Hodgman says cows freshening with mastitis might tip him off to checking dry cow and transition cow facilities, dry off therapy and days dry.
There are several reasons that any protocol or management system fails. Rapnicki says non-compliance and clients believing protocols will create more work for them are two common reasons they can fail. “They can also fall apart if everyone from the owner down to the person treating the cow does not understand why the program is for the benefit of the dairy. That’s why it’s important in protocol development to understand what the capabilities and limitation of each dairy are. If a protocol calls for two people to handle a treatment but there’s only one person available, it will not work.”
Hodgman says another problem is the failure of treatment protocols to be fully understood and completely carried out on the dairy. “If everyone took the time to read the labels and directions on a box of mastitis tubes, and used them accordingly, I believe we would have more treatment successes and fewer treatment failures. Often a product that requires two doses will not get the second dose if the dairyman perceives the animal as being cured after the first dose.”
Hodgman also cautions clients against using their own mix of drugs to treat mastitis. “It’s important to educate the client that using some of these products in an extra-label manner puts themselves at risk of residues in milk and meat and they need to monitor these carefully.”
“I think protocols help to facilitate that shift from ‘here’s what you do when a cow is broken’ to ‘if you know which cows are breaking, how often are they breaking and where are they living when they’re breaking, we can start preventing it’,” says Rapnicki. “You start to see what’s causing the diseases in the first place and that in turn can lead you to offering other production medicine services to your clients.”
Defining treatment protocols
Paul Rapnicki, DVM, outlines a series of steps by the herd’s management and veterinarian to design treatment protocols.
1. Herd policy decisions are made:
It must be determined which specific events will require medical decisions (mastitis, pneumonia, milk fever, diarrhea, lameness, etc.).
The specific options that will be available for each event must be determined. Within each event there should be a subdivision for the definitive diagnosis, especially for specific pathogens (such as Strep. ag or Staph. aureus mastitis). Treatment options by the veterinarian should define the product, active ingredient, dose, route of administration, duration of treatment, milk and meat withholding times, etc.
2. Individual cow decisions are then made:
Determine how the appropriate protocol will be chosen.
After a protocol is chosen, determine how the protocol will be delivered to the cow and how information will be recorded. The veterinarian and dairy management need to consider these questions, among others, before deciding on administration of treatment: Who will be making the cow-side decisions? How will the sick cows be found? Should the cow be treated or culled? How will treated cows be identified? How will treatments be recorded? Where will sick cows be treated and housed?
3. Records are used to monitor trends:
Easy access to treatment history allows better cow-side decisions. Every time a person is required to make a decision, having a source of information available can help him/her to reach that decision more quickly and better than if no information is available.
Evaluate if the stated herd policies are being followed. Well-designed record systems allow better individual cow decisions and is the means by which management can monitor what decisions employees have been making and if they are correctly following herd policies.
Evaluate if the herd policies can be improved.