It is relatively straightforward to define metritis as an abnormal uterine discharge (i.e., foul smelling and watery) in a post-partum cow. Whether or not she has systemic signs such as pyrexia is a qualifier that may further define the severity of the clinical episode and often determines if intervention (e.g., antibiotic treatment) is warranted. Similarly, mastitis can be simply defined as abnormal milk (i.e., flakes, clots or watery) likely associated with infection. The degree of milk abnormality or systemic involvement, again, defines severity and commonly serves as criteria for treatment decision making.
Censoring cases that don’t warrant therapy presumes we know they don’t have an impact on health and productivity worthy of attention. For example, maybe we assume that a cow with a flake or two in the milk is likely going to be no growth on milk culture and doesn’t need treatment. However, by recording those episodes maybe we find 40 percent have a more severe clinical episode within two weeks that is treated. Does that mean they should all be treated on that first flake? I don’t know, but if recorded, we, as the health management professionals on the dairy team, can evaluate the epidemiology and economics of such cases and provide more evidence-based prevention and treatment protocol recommendations.
I am optimistic that industry-wide agreement on the minimum clinical signs that define a disease can be achieved quickly through a cooperative, concerted effort. In the meantime, lack of standard disease definitions should not preclude accurate and consistent recording of disease, whatever the definition. Most clients want to know how they compare with their peers. Capitalize on the desire to benchmark to achieve greater consistency in disease definition and treatment among your clients (see “Recommended Disease Definitions” at goodhealthrecords.com).
Treatment decision making has been the greater challenge thwarting adoption of standard disease definitions. From the veterinarian to the calf doctor, each has pride and strong conviction that his/her treatment protocols are “the best.” Perhaps this is why in a survey of over 200 dairies we found 11 different drugs besides intramammary antibiotics being used to treat mastitis. Sixty percent of uses were extra-label; 7 percent were prohibited. Metritis was treated with 10 different antibiotics; 85 percent of uses were extra-label and 7.6 percent were prohibited. Is so much variety truly medically necessary? I believe that this “creative” drug use is fostered by misconceptions of the uninformed. What is the quality of evidence you have for your treatment protocols? Accurate and consistent health records and the ability to efficiently evaluate them would allow informed decision making based on evidence rather than perception.