Could it be mastitis?

Dr. Aoife Byrne is a veterinary surgeon based at Chapelfield Vets in Norfolk.

Dr. Aoife Byrne is a veterinary surgeon based at Chapelfield Vets in Norfolk.

XL Equine vet Dr. Aoife Byrne DrMedVet MRCVS describes a day on the road, where she saw a very young patient.

My Monday morning began like every other, with frantic receptionists calling me from 8am with 'extra' calls to squeeze into my already packed day. On a Monday I'm usually doing zone visits, covering a large area of our practice territory. The day involves 80-90 miles of driving with anything from 15-20 stops at livery yards, studs & clients homes.

I'll do mostly 'routine' work like flu & tetanus vaccinations & dentals - the so called 'bread & butter' jobs of ambulatory equine practice. I'll also do medication checks for bute & take blood samples from horses & ponies having daily treatment for Cushing's disease.

That afternoon while I'm out & about on the road I receive a call from one of our newest vets who's telephoned me for some advice on a case she's just seen. It was a 10-day-old Connemara filly foal with a warm & painful swelling involving one half of her mammary gland. When the area was gently squeezed it produced a pus like liquid from her teat. I run through a list of possible diagnoses in my head. Could it be an umbilical infection which had gone unnoticed & spread or an abscess from a wound or injury? The clinical symptoms fitted perfectly a diagnosis of mastitis, but this was at the bottom of my list as the foal was only 10-days-old as my colleague gently reminded me - far too young to have mastitis! 

 

Ten-day-old filly foal Anoushka had swelling of her mammary gland

Ten-day-old filly foal Anoushka had swelling of her mammary gland

But I think back to my internal medicine professor at university who's favourite phrase when teaching his students was "Everything is possible & nothing is impossible..." - wise words to live by in veterinary medicine!

I phoned a senior colleague for advice - he'd never heard or seen a case in his career. As I was finished my visits for the day I headed back to the clinic & found my textbook on neonatal foal medicine but there was no mention in that. Time to do a quick search online of the veterinary literature & this proved fruitful as I found a few case reports of foal mastitis! So it was possible!

The recommended therapy was exactly what an adult mare would receive - antibiotics & anti inflammatories. In the meantime Anoushka had arrived with her dam at our clinic for hospitalisation & treatment. Our first step was to take a blood sample to check her haematology & biochemistry & secondly a sample was taken from her teat, which we sent away to a lab to culture. If bacteria grew they would be then tested against a panel of antibiotics to find the most suitable treatment. But that process would take a minimum of 2 days. In the meantime, we selected a broad spectrum drug which would kill the most likely culprits involved in a mastitic infection.

The mare & foal settled in well to life at our clinic which was good as they would be staying a minimum of a week or longer if the infection persisted. When the lab results came back we were relieved to find Staph & Strep bacteria had grown & were sensitive to the antibiotics we had chosen for the foal - so far so good. A few days passed & despite treatment the painful swelling of Anoushka's udder continued - it was now becoming firm like the worst kind of abscess. What could we do? We discussed various options & came up with a plan - to apply a warm compress to the area which would soften & hopefully encourage the build up of infection to drain through the affected teat.

Making a warm compress was not a problem, the difficulty lay in keeping it applied to the udder for hours at a time. We racked our brains for ideas - a nappy? But even the toddler size was too small for Anoushka. Then I had a lightbulb moment! I phoned one of my colleagues who I knew was out on visits & would be coming back to the clinic past Tesco.

Our phone conversation must have been hilarious to anyone listening - "please pop into Tesco and buy me a pack of ladies knickers". "Em, ok... what size?" "Large - as I need to fit a compress in them." "Any preference for colour?" "Has to be pink - she is a baby girl after all!" My colleague laughed - the penny had dropped as she realised the knickers were not for me!

The hilarity continued as the equine team now had the difficult task of getting a very boisterous foal to step in & out of a pair of knickers three times a day! Visiting clients to our clinic also had a laugh as they watched Anoushka gambol around her paddock in her pink polka dot briefs!

In combination with the daily medications, the knicker compress worked a treat & four days later we were able to send Anoushka home as her mastitis had resolved.

In veterinary work an unusual case does pop up now and again requiring some novel treatment plan to be invented with no guarantee of success so it's very satisfying when it works creating a happy ending for the client & the equine team.

To find out more about XL Equine visit www.xlequine.co.uk