Adventures in Acute Septic Mastitis

While medically mastitis is mastitis, mastitis can, however, present in more than one way, and have drastically different lead-ups and outcomes, there are actually three types of mastitis.

The most common type, simply labeled Mastitis (or acute mastitis), many breeders are aware of and what to watch for:

• mammaries that are warm to the touch
• firm mammaries, or firm areas on/around the mammary
• milk that is off-colour, stringy and/or sticky

Fast acting treatment (such as warm/cold compresses, massaging the breast, if the milk appears normal allowing a strong puppy to nurse on the gland and antibiotics) can often turn this around, and all is well within a couple/few days. This type of mastitis is typically due to clogged milk ducts and bacteria. ‘Regular’ mastitis can/will turn septic if treatment is not administered quickly.

Subclinical mastitis is the second type. There are no signs in the bitch, however it is evident in the puppies. Gassy, hungry, crying puppies can indicate subclinical mastitis, which can also lead to neonatal deaths.

Then there is the third type, Acute Septic Mastitis (ASM), also known as Gangrenous Mastitis. With this type, there can be no warning, there can be no cues to give the breeder a heads up that something is brewing. It can strike a bitch within two hours, and leave her fighting for her life. There can be NO warning, I cannot stress that enough. I have heard about ASM a few times, and in the back of my head always thought, ‘there must be some sign the breeder didn’t see’, I can now say I was wrong, it can happen without warning, and literally minutes count.

When one of my girls has a litter I do mammary checks a minimum of three times a day, they are placed on Sunflower Lecithin (helps prevent clogged milk ducts, which can lead to the more common ‘type’ of mastitis), and the bitches temperature is taken every 8 hours day and night minimum (and taken more often should I suspect there might be something brewing (for example, mastitis, low calcium etc.)).

Below is a day by day account of the experience what one of my girls went through when struck by ASM, including some very graphic photographs.

To preface the below, here is some additional information:

• the bitch was a textbook attentive mother throughout
• all puppies were gaining weight
• all breasts were being utilized by the puppies
• there were no warm or hard areas on the breasts
• as she had a c-section, she was on antibiotics for 7 days, the final dose was given 24 hours before this happened

Special thank you to all the Doctors, Technicians and Staff at East Oshawa Animal Hospital!

***Since this has happened I have received about a dozen calls from other breeders who have had a girl deal with this type of mastitis. Unfortunately, three of the bitches did not make it. This is a very serious condition and time is of the essence when dealing with it. For any questions please contact me directly and NOT leave a comment below, as I may not get notified.***

The Timeline of Events

Day 1

The day started out like any other, dogs fed and exercised, puppies weighed and their bedding changed, house cleaned and dog laundry in the wash.

At around 2pm after the 9 day old puppies had just been fed and cleaned from top to bottom by their devoted mother, we headed outside, dogs were playing. We came in after only fifteen minutes or so, due to the warm temperatures. About an hour and a half later the puppies were starting to look for their next meal. I called Mum over to the whelping box, she got in but not with her usual enthusiasm. She laid down and all the puppies scurried over. Immediately I noticed she wasn’t cleaning them. That wasn’t like her, she had always cleaned them while they nursed. I knew something wasn’t right, removed the puppies and called her out of the box, she wouldn’t move not even to lift her head. I grabbed the thermometer and phone, as to call my vet. While I’m on the phone the thermometer reads a temperature of 106.1F or 41.2C (101 to 102.5 degrees Fahrenheit or 38.3 to 39.2 degrees Celsius is considered a normal canine temperature). Of course, my vet says get in the car now. I threw some towels in the sink and ran cold water over them, grabbed some cold water bottles out of the fridge, packed them all around her for the short trip to the clinic.

Upon arriving at the clinic vitals are taken. All breasts felt soft, and not abnormally warm, milk samples were taken for examination under a microscope, those too were normal. The vulva was normal, as was her post whelping discharge. Her temperature was still very high, and she was put on fluids and antibiotics while waiting for lab work to complete. After an hour and a half her temperature has come down, but not by much, it was at this time we decided to give her metacam, to help bring the fever down, with the catch being that puppies wouldn’t be able to nurse for several days afterwards. Of course there was no hesitation, do what must be done and hand raising the puppies for as long as needed isn’t a problem. Blood work was all within normal limits, except for her white blood cell count (WBC), which was low. A low WBC is not uncommon at times like these, we know there is a massive infection somewhere, and that acts as a vortex drawing all the white blood cells to it.

It was decided that she was too ill to return home that night, so off to the ER vet we went, arriving at 8pm. After another examination and discussing the plan (which, thankfully, my vet had called and spoken to the ER vet while we were on our way), I left the ER at 11pm. When I left, all breasts were still very much normal, we were leaning more and more towards a diagnosis of metritis (inflammation of the uterus).

Arriving home shortly after 11:30pm, homemade formula was quickly made up to start bottle feeding the babies. At 12:30am my phone rang and it was the ER, they called to tell me that in the 90 minutes since I left, one of her rear breasts had turned black and hard and her temperature was now smack dab in the middle of the normal range. Two breeders, three vet techs and two veterinarians had all previously deemed the breasts normal, I can say with utter confidence, we didn’t miss anything and it happened ‘just that fast’.

Day 2

It was a relatively uneventful night, I was getting updates from the ER roughly every 3-4 hours. At 8am, things were looking positive, and it was thought she would be home by noon. A short time later, I got a call that she was now vomiting, they wanted to keep her there for observation and more fluids. After another battery of tests and bloodwork, some anti nausea meds, she was looking and feeling much better and I was able to go pick her up at 8pm.

I could not believe the state of her breast when I saw it, of course, being a Golden Retriever, her tail was wagging and she was so happy to see me.  The below photos are graphic, and will get much much worse the further you scroll.  Fair warning.

During the first few hours home we were alternating moist warm and cold compresses (frozen cabbage leaves).  The warm to try and draw the infection out, and the cold to bring some relief. There was no question by this point that the breast was going to rupture.

Day 3

We continued the warm and cold compresses.  The warm to try and draw the infection out, and the cold to bring some relief. The blister, seen on the first two photos, burst in the afternoon. The breast is extremely firm, the black dead tissue is cool to the touch.

Day 4

The warm compresses are being continued, the cabbage was still being done but not at the same rate (with the hope of drawing that infection out with the more frequent warm compress). The fact that she tried to eat the cabbage when it was on her, makes me think she is feeling much better.  She has severe oedema in the rear leg, hock and pastern on the same side as her infected breast. She is very hesitant to walk up even one step (unfortunately there is one step that has to be taken to get to the yard), level ground doesn’t seem to be a problem. Her temperature has remained normal.

As with yesterday, she wants to be with her puppies. We had to compromise, and as long as I give her some cookies now and then, she seems ok with the arrangement of sleeping on a bed right beside the whelping box. As long as she can see them, she is content.

Day 5

The warm compresses are being continued (roughly every 30-45 minutes). Temperature has remained normal. Eating, drinking and eliminating are all normal. Activity level has increased, and she continues to camp out on the bed beside the whelping box, she has also been sticking her head in to clean them.

Later in the evening the breast finally ruptured. It was extremely hard still, and tender to the touch, but her movement improved.

Since there is now an open wound, I have started spraying the area with colloidal silver a several times a day. This will continue until fully healed. She will remain on oral antibiotics and probiotics for some time.

When a breast ruptures, or is medically lanced, due to mastitis, it is important to keep the area clean, and NOT close up the wound. The bacteria is anaerobic, meaning it does not require oxygen to grow and when exposed to oxygen will die. This is the type of tissue damage that needs to heal from the inside out.

Day 6

Today we started laser therapy. The laser is excellent for helping soft tissue wounds, it promotes circulation and healing.

From the AKCCHF:

Cold laser therapy is a noninvasive procedure that uses light to stimulate cell regeneration and increase blood circulation.

Often called low-level laser therapy, cold laser therapy or Class IV laser therapy, by any name, is still a relatively new concept that is being used more recently to treat dogs with arthritis, tendon or soft tissue injuries and to promote wound healing.

And, the good news about laser therapy for dogs is there’s no need to shave or clip the area to be treated and the dog doesn’t need to be sedated during the process. That means that treatment can be applied multiple times a day or a number of times per week.

Laser therapy won’t cause your dog any unwanted side effects. The laser used for this type of treatment will not burn your dog’s skin.

We were also given different physical therapy exercises to assist in lymphatic drainage and mobility.

Late into the evening another hole appeared, within the same hole that was there the night before. Drainage had increased considerably, and the breast was becoming noticeably softer.

Day 7

Not much has changed in our routine for today.  An epsom salt poultice is applied three times a day, and frequent cleaning of the area with gauze and warm water.  The dead areas of skin are sloughing off very fast.  The below photos are taken throughout the day and night, the progress can be seen as they have been posted in chronological order with a description.

Day 8

The necrotic tissue is quickly sloughing off. A second laser treatment was done today, and we have now incorporated flushing the open area three times a day with a saline solution.

To make your own saline solution:
For every 500ml of boiled water add 1tsp of salt (regular table salt)

Additional physical therapy exercises are being incorporated.

Most of the black tissue around the nipple is hard, if you were to brush your finger across it imagine the feeling of toast.

Day 9

The necrotic tissue is sloughing off at an even faster rate than yesterday. The area directly surrounding the nipple is still very tough, the rest of the necrotic tissue has taken on more of a chewed bubble gum feeling.

The puppies are back to nursing on Mum, roughly every 3-4 hours. The breast is always protected during nursing (via wrapping in a damp cloth dipped in epsom salt solution and squeezed out, then in a dry towel, and there is always a human hand on the towel to ensure it doesn’t move), this is to prevent any discomfort or further damage.

There is very little discomfort while cleaning/flushing the breast, she often falls asleep while this is done and physio starts.

Day 10

All of the oedema is now gone, and stairs are no longer hesitated.  It’s amazing, despite having a large hole in her mammary, how normal her behaviour is. One would never know there was anything wrong.

These girls amaze me.

Day 11

Laser treatment number three today! Everyone is very happy with the progress, and the granulation tissue. Granulation tissue is new connective tissue and microscopic blood vessels that form on the surfaces of a wound during the healing process. Granulation tissue typically grows from the base of a wound and is able to fill wounds of almost any size.

There is still slight congestion in the rear leg, continuing the exercises and massage should take care of that no problem.

Day 12

Granulation tissue continues to grow, and more of that lighter coloured dead tissue has sloughed off.

It is amazing to note, through all of this there has been no interest in licking the area or ‘tending to the wound’, as I would have expected. At times I question if she knows there is a hole larger than my fist.

The slight congestion in the rear leg has dissipated.

Day 13

Laser treatment #4 today. It’s amazing how fast the wound is filling in from the bottom up, appearing much more shallow than before.

Leg stretching exercises continue, with a couple of new ones implemented.

It must be noted, we are seeing a much faster rate of healing in the 24 hours following a laser treatment, than on the days the laser is not done (and a laser treatment can only be done every other day).

Day 14

Not much to report today, the wound is healing up very nicely!

We continue with flushing it 2-3 times a day with saline, and I continue to spray it and the area around it will colloidal silver 5-6 times a day.

Day 15

Still not much new to report.

From here on out I will just be posting photo updates, unless anything changes.

We will continue the laser therapy every other day, saline rinses, spraying multiple times a day with colloidal silver and physio exercises until the wound is completely healed.

Day 16

Day 17

Day 18

Day 19

Day 20

Day 21

Day 22

Day 23

Day 25

Day 27

Day 30