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Mastitis, or bacterial infection of the mammae, occur in one or more lactating mammary glands of the post partum bitch. It may occur in the pseudopregnant bitch as well. Affected females may develop systemic illness signs like fever, depression, anorexia and neglect of offspring. Escherichia coli, staphylococci, and B hemolytic streptococci are common bacterial pathogens.
Antibiotics (ABO) are the treatment of choice and should be based on bacterial culture. There is no evidence that antibiotic at high concentration in the milk have an adverse effects on the nursing young. Covering the affected glands and allowing nursing to proceed is desirable. If the dam is depressed and not eating or rejecting the pups hand rearing may be needed. Antibiotic infusion may be helpful in cases of pre-abscess.
Glactostasis is the accumulation and stasis of milk within the mammary glands. It most often occurs during weaning and pseudopregnancy. Warm compresses may be helpful in releasing the milk. Low doses of diuretics or glucocorticoids may be helpful.
Agalactia, lack of milk production is rare. Poor nutrition, particularly rations of low quality protein or inadequate calories may be the cause. In nervous bitches reluctant to nurse, tranquilization may be needed to increase production. This condition may have a genetic component.
Galactorrhea, is inappropriate lactation, not associated with pregnancy or parturition. During pseudopregnancy it may be accompanied with nest-building, adoption of inanimate objects, and irritability. The hormone prolactin is responsible for milk production. This condition is almost always associated with thyroid dysfunction. Administration of replacement therapy will reverse the signs. Androgens, estrogens and progestins are contraindicated. PG2a therapy is effective in euthyroid bitches.
A diagnostic dilemma may exist for the clinician when a healthy bitch presents with a vaginal discharge and differentiation between a vaginal or uterine problem is not obvious.
The diagnosis of pyometritis is made as follows:
Pyometritis can be predicted through a guarded swab anterior vaginal culture, in the anestrus period. The presence of abundant growth of; e coli. pseudomonas sp. or mycoplasma canis is diagnostic. Given an estrogen prime and progesterone stimulation with the next estrug, a uterus with these organisms will eventually exhibit pyometritis. The average age of 1st pyometritis episode in purebred dogs, in my practice, is 2 years.
150 micrograms/kilogram (body weight)/b.i.d. 5 days in the bitch. 50 micrograms/kilogram (body weight)/b.i.d. in the queen, using serum Progesterone levels as an endpoint.
Serum Progesterone below 1 nanogram/ml following treatment is the endpoint for PG-2a injections. Our practice and PAL will do overnight progesterone testing. Make special request on the PAL lab form for "overnight results, attn: Nancy. Send overnight mail to our practice for a call to your practice with the results by 3pm the following day. Start progesterone sampling at day 4.
Analogs, to date, are too hard to dose effectively with out severe side effects.
Management of subsequent estrus cycles is critical to assure pregnancy. If breeding is not desired on the next estrus, use "Cheque" drops to postpone the next estrus until the breeding is desired. Cheque (Upjohn) is administered orally, daily at the rate of O.lml/10 lbs body weight. Monitor serum liver enzymes every 60 days. Keep in the normal range or lower dose. Some spotting during what would have been the next estrus is sometimes seen at the lower therapeutic levels in this regime.
The development of secreting mammary tissue following estrus is to some degree normal. Bitches that lactate, show nest behavior or take on "toys" as pups are probably suffering from pseudopregnancy. Serum Progesterone levels above 2ngm/ml after the 40 days post ovulation are diagnostic for pseudopregnancy. Strong correlation exists between prolonged ovarian luteal phase and early signs of thyroid dysfunction. Check TT4, fT4, and autoantibodies in all suspected cases. Levels at the low end of laboratory normal ranges are strongly suspect. Use thyroid replacement, O.lmg/10 lbs body weight, b.i.d. and recheck in 45-60 days. Retest following progesterone phase of the cycle, 3 days following the removal from medication to reassess thyroid function before the next estrus.
PG-2a, administered 10 days into diestrus (10 days after ovulation) will eliminate pseudopregnancy by shortening diestrus. (dose see above) In this case a single dose for 3 successive days is all that is necessary to prevent the signs of pseudopregnancy.
Estrogens are contraindicated as abortifacients. There are two approaches to chemical abortion in the bitch and queen using PG-2a.
One is to shorten the ovarian luteal phase by administering PG-2a at day 5 of diestrus for five (5) days.
The second is to wait for confirmation of the pregnancy at 28-30 days by ultrasound or palpation and administer PG-2a for 5 days or until the serum progesterone below 1 nanogram/ml for two successive days.
Persistent vaginal discharge, 7 days post partum, accompanied by mastitis and unthrifty pups is a scenario described as postpartum metritis. It may be corrected by the removal of uterine debris, ABO therapy, and vaginal douching with saline/ABO solution. Use a daily administration, S.Q., for 3-5 days Remember that this lactation period is stressful and may worsen preexisting conditions such as, thyroid dysfunction, vWD related bleeding. If the bitch is afflicted and/or a carrier of vWD, following the administration of sulfa drugs, vaccines or heartworm preparations her condition may worsen.
