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Pam Ruegg DVM, MPVM joins The Moos Room to discuss treatment of non-severe clinical mastitis, best practices for produces, how to apply her research in the field, and her mastitis celebrity status. Part 1 of 2.
Hosted by members of the University of Minnesota Extension Beef and Dairy Teams, The Moos Room discusses relevant topics to help beef and dairy producers be more successful. The information is evidence-based and presented as an informal conversation between the hosts and guests.
[music]
Joe: Welcome to The Moos Room, everybody. Today, it's good and bad. Bradley is gone. He's on vacation, but good--
Emily: Shoot.
Joe: I know, but the good news is that we immediately replaced him and it's okay. One of my old friends, Dr. Erin Royster, is here. She is here to help us fill Bradley's shoes today, help us talk through our topic today. She has brought a colleague and a friend. Pam Ruegg is here today to talk about mastitis. Specifically, we're going to focus down. Mastitis is a big, big, big topic. Emily is super excited to talk about all things mastitis.
Emily: Yes.
Joe: We're going to focus down today, so thank you Erin and Pam for being here today.
Erin: This is Erin. I'm really thrilled to be here, and I'm super thrilled that Pam agreed to come and talk to us about mastitis. Obviously, anybody who's ever even thought about mastitis knows who Pam is. I'm just so excited to talk about some of your recent research and to hear your thoughts on mastitis and specifically mastitis treatment.
Pam: Thanks, Erin, and Emily, and Joe. It's really good to be here. It's not very hard to lure me into a conversation about my favorite topic.
Joe: We're continuing, and I don't think I've told Emily this. We're continuing our trend, and our trend is that we really only find guests that are either former Extension or basically do exactly what Extension does, just in a different role. Pam used to be with the University of Minnesota, Wisconsin Extension. Tell me a little bit about your time there.
Pam: First of all, I got to correct you. I was never with the University of Minnesota, Wisconsin, and as a former badger, I can't let that slip by. I was at the University of Wisconsin-Madison for 20 years.
Emily: You really screwed that one up, Joe.
Joe: What did I say?
Pam: You said University of Minnesota, Madison.
Emily: No, you said University of Minnesota, Wisconsin.
Pam: Yes. [laughs]
Joe: Where did that come from? I was like, I know-
Emily: Dad brain.
Joe: -you were at Extension. I know you were at Extension. That's just a hot mess for an intro.
Emily: A mess that is heated. I do want to share really quickly that, yes, anybody who thinks about mastitis, has read the word mastitis, knows who Pam is. Today we record on Zoom, and for just a little bit, it was just me and Pam. I was like, "Oh, my God." I was star-struck when I first got on because, yes, I have done mastitis work in my college days and in my first seven years with Extension. It's like, I have used a lot of Pam's stuff, and so definitely a little star-struck. Having a fan girl moment, but I'm excited.
Pam: I got a comment on that, Emily, because recently, I was talking to my sons who are in their 20s, and I was bragging a little about myself. I said, "I'm a mastitis celebrity." My older son who's a journalist in California said, "Well, big deal. What are there? About a hundred people who care?" [laughs] It's always good to have kids.
Erin: Yes. Come on, there's at least 200.
Pam: Yes. That was my answer, Erin. I said, "Well, our National Mastitis Council meeting has about 400 people every year."
Erin: [unintelligible 00:03:48]
Joe: That's more than a hundred. All right. As we do, there's two questions we ask every guest. Emily, take it away.
Emily: Your first question for both of you, so you're each going to answer this, what is your favorite breed of beef cattle? Pam, I'm going to have you go first.
Pam: Oh, man, I got to think on beef cattle. Belted Galloways.
Erin: You stole my answer. They're the right color.
Pam: They're the right color.
Joe: Wow.
Emily: I love it.
Joe: Erin, that was going to be your answer as well?
Erin: Totally. Absolutely.
Emily: Oh, my gosh. Belted Galloway just comes surging in. I love it.
Joe: You are both the first people to choose that. Emily's happy because of her answer on the dairy side for sure, and the similarities there. With that, we got Herefords at six, Black Angus at four, Black Baldy at two, Belted Galloway now at two, Brahman at one, Stabiliser one, Gelbvieh one, Scottish Highlander one, Chianina one, Charolais one, and Simmental one.
Emily: Question two is, what is your favorite breed of dairy cattle? I'm going to have Erin go first on this one.
Pam: Okay.
Erin: Oh.
Emily: You can steal Pam's answer now, Erin.
Erin: We'll see. I don't know. The thing about the Belted Galloways is, if you don't have to work with beef cattle or know anything about them, I feel like they're an obvious choice. They're super cute to look at. Depending on how you're supposed to answer this question, I think I would have different answers. If you ask me what kind of dairy cow I really like working with, I'm going to pick a Jersey. I really like working with Jerseys, come on. [crosstalk]
Emily: Okay. We're just asking a general favorite.
Erin: If you ask me what kind of dairy cow I like to look at, I'm going with the Randall Linebacker. They're so cool to look at.
Joe: Just pick one. Please, pick the right one.
Erin: Fine, Joe. I'll pick Jersey for you.
Joe: Yes. That's what we wanted. That's what Bradley wanted as well.
Emily: I am shaking my head in dismay.
Joe: I love it. A little bit of coercion. Thank you. All right. Pam, go for it.
Pam: I am officially neutral on this subject and will not comment. I think it would destroy my credibility. [laughs]
Joe: Okay. If you're refusing to answer for real, we'll allow it. That does tie up Holsteins and Jerseys at seven, which is wonderful to see Jerseys coming back into the lead there. Brown Swiss at four, Dutch Belted at two, Normande at one. Oh, and my bad, Montb�liardes at two. They are above Normande here, and we have one neutral vote.
Pam: Yes, absolutely.
Joe: All right. Now that I have probably recovered from my dad brain moments earlier, we're going to get into the topics today. Really, I think the place to start is we really got to lay the foundation for where we're going today and what we're talking about. The big thing is that, today we're talking about clinical mastitis. We're not talking about subclinical mastitis, we're not talking about surveillance testing too much. We might get into it just a tiny bit. That's really what we need to know. We're talking about mild to moderate clinical mastitis. We're not talking about really severe cases or any of those extremes. That's really where the most recent research has had some changes and the recommendations have potentially changed. There's even really, really recent research that Pam has done that I'm excited to talk about.
I was reading the abstract yesterday and completely amazed at some of the results. We'll get into that soon.
We've all heard about culture and making sure that a lot of-- Emily and I have talked about it a lot, that we prefer that people culture and find out what actual pathogen is the problem in a case of mastitis. Erin, Pam, walk me through why actually getting a microbiological diagnosis is the way to go.
Pam: Back when I started as a baby veterinarian, we were taught that mastitis was caused by three bacteria. Streptococcus agalactiae, which you treated, and they responded. Staphylococcus aureus, which you didn't treat, you culled them, and E. coli, they died. That's what we were taught back when I was a baby veterinarian.
The therapeutic principles that evolved from mastitis, all the drugs, all of the treatment protocols that everyone learned coming up were based in that foundation that there were three pathogens basically causing most mastitis. What has happened across the course of my career is we have almost fully eradicated Streptococcus agalactiae. It's a very rare pathogen today in modern dairy farms. Staphylococcus aureus is massively controlled on most farms through prevention. While there are herds and it's around on most farms, you can find a few cases, we don't typically recommend treatment as the primary strategy. Then we've had a huge shift overall in the types of bugs that cause mastitis. I would say the big difference today on why we need to culture is because we're dealing with a disease that's caused by a big variety of opportunistic pathogens that all present with the same clinical signs. What we see when we see a case of mastitis is inflammation as a result of an infection. We don't know if the infection is active, we don't know if the cow's immune system has already successfully eliminated most of the colonies, and we don't know if-- even if there's an active infection at that time, if it will respond to an antimicrobial, or if you even an antimicrobial in order to effect bacteriological cure. We're dealing with a bacterial disease that's caused by a lot of different bugs. In order to effectively manage it, we have to know what those bugs are.
Joe: I hear over and over again when I was in practice. I can tell by the appearance of the milk whether it's a coliform of not, or what type-- Basically the basic bacteria that I'm dealing with. How do you feel about that?
Pam: You absolutely can't. What's interesting as well, I'm a huge advocate of on-farm culture, and we started doing it in 2000, so it's 21 years that we've been working with it. You can't even use on-farm culture to really speciate most bacteria. No, you can't look at the milk, you can't guess. Not going to tell you.
Joe: Erin, anything to add on this topic right now?
Erin: What Pam said is right. The whole reason why we advocate for culturing is to help people make better decisions, and ideally have better outcomes. I would say the outcomes in the cow are just part of that making better decisions. There's other factors that go into that like practicing good antibiotic stewardship, right? Yes, culturing, good idea.
Joe: Perfect. It's become more accessible now too, right? Especially the on-farm cultures. Pam said it's been around for a long time, people have been using it for a long time. It's not that expensive to get into in my mind, as far as what you need to get started. What are the big barriers on why people are not culturing on-farm?
Erin: The herd size and the rate of clinical mastitis is probably the big one. I think for smaller dairies that might only have a case or two at a time, or a case or two per week, or a case or two per every couple weeks, it's not really worth their time and investment to get into it. I think the other big one that I have seen is just the skill set and mindset of the dairy. If it's just not something that they're interested in, if they don't have someone on the dairy who can really take it and be really good at it, and make it their thing, it's not going to work out.
I say that because we have some small dairies that do it even for a few cases, and they really love it and get a lot out of it, and it's because it's their thing. They have the interest and the skill set to do it. I think you have to have both the number of cases to make it worthwhile, and/or at least someone who's really into it that can do it well on the dairy.
Pam: Just to add one more thing. I agree 100%, Erin, with your comments on that, but I'll add one more thing. You've got to have somebody in the milking parlor who can take clean samples and the time. If you've got a milking parlor where they can't get all the cows milked every day, and you want the guys in the milking parlor to take the samples, you might as well wait until you can figure out some way to get all your cows milked every day. If you can't collect an absolutely aseptic milk sample, you're going to fail at this little project.
Erin: That is a super important point.
Joe: Yes. The first step, and it can all go wrong right away. Here's my plug, and I know Emily's shaking her head. The plug is for veterinarians, and I do this all the time. It's my one time now that there's more veterinarians on the call than not. It feels good. I'm not outnumbered by Brad and Emily.
With these small herds, there's a lot of clinics that can do some of this culturing for you, and have trained personnel, technicians. It's wonderful to see some of the clinics pick that up, because I saw a lot of value in it in practice, and farmers really appreciate it. Just a complete blanket plug for veterinarians being involved in this process as well, and definitely getting your technicians involved. I know that's something that Pam has said in the past. There's a really nice spot for veterinary technicians in this process as well.
Okay, let's move on so we can continue with this conversation about mastitis. We've talked about why you should culture, those kind of things, especially when it comes to antibiotic use judiciously. One of the things that we've danced around a little bit is case selection, and how there are cows that, when it comes to treating mastitis, they're just not good candidates for that option. Who are those cows, Pam? Who is not a great idea? Who's not someone that we should really spend the time and money on?
Pam: That's a great point to bring up, Joe. I think the important thing to bring up on this one is, this is something you can do even if you're not going to do on-farm culture, is review the history of the cow before you decide to give her an antibiotic. You don't need any special tools to do this. You just need a decision that you're going to do that.
The thing that you want to select when you're looking at a cow that has a non-severe case of mastitis, is you want to try to avoid cows that are long-term chronic cows that have been treated previously with antibiotics and have recurred. The reason for that is encapsulated by that famous Einstein quote that the definition of stupidity is doing the same thing over and over again and expecting a different result. That's exactly what we're doing when we continue to give antibiotics to a quarter, or even a different quarter of a cow that has been treated multiple times. Cows that have had two or more previous cases of mastitis and present with another one, you want to think hard about use of antibiotics and then probably discourage it.
Cows that are affected with long-term chronic high somatic cell counts, especially cows that maintain high somatic cell counts across multiple lactations. Those cows probably have a type of mastitis caused by bacteria that infiltrate deeply into the mammary gland tissue. Those are often very non-responsive to antibiotics, and so your probability of having a successful outcome is really low.
Cows that have been affected with pathogens which are known to be non-responsive. Mycoplasma, prototheca, pseudomonas. If they've been affected with those, your odds of having a successful outcome are pretty low. You really need to look at the characteristics of the cow.
The other thing is, if you've got a cow who's in late lactation and has a bunch of other bad things going for her, don't waste the antibiotics on her. Make the right decision to give her a new career. Being a beef cow is a shorter career, but it's not a bad career. It still fulfills an important societal need.
Emily: It is still a delicious career.
Pam: Exactly.
Emily: You were getting at this, Pam, but I'm curious to know, are there other more nuanced considerations, just thinking about days in milk, or different things with that, or if they're open, or bred, or other little things to look at? Especially for those farms that are maybe doing a good job but really trying to hone in on just those small things to save the money, or to figure out how to use their antibiotics.
Pam: I don't have data where I would make days in milk based decisions about antimicrobial usage for non-severe cases of clinical mastitis. I would say that cows very early in lactation-- When we make a decision not to use an antibiotic, what you're betting is that the cow's immune response is going to be sufficient to eliminate that bacteria, achieve bacteriological clearance on its own. The guiding philosophy that you need to think about is, do I believe that cow has the ability to mount an effective immune response? If you've got a cow two days in milk that just had twins, has a body condition score of two and a half, and is projected to produce 38,000 pounds of milk, and maybe has a retained placenta, maybe she's presenting with a non-severe case, but maybe that's--
Let's add another factor there. Let's say it's 90 degrees out. In those instances, I personally, regardless of what a culture is going to say, probably am not going to be as comfortable making a decision not to use an antibiotic in a cow like that. I don't think that the speed and magnitude of her immune response will be the same as maybe that same cow three months from now that is in positive energy balance, probably been bred once, and is probably starting to decline in milk yield, et cetera. Maybe the weather's cooler.
I think overwhelmingly, apart from any rules, you want to be making clinical judgements about the immune capacity of those cows.
Erin: There's two different things that we're talking about here. One is we started talking about cows that shouldn't even be considered eligible for treatment because they have chronic clinical mastitis, they have chronically high somatic cell count, they have non-responsive pathogens, or they're a cow that rather than continue to get antimicrobial therapy, they need to have a career change and become a beef cow because of some set of farm-specific criteria for culling. I think that might be what you were asking about, Emily, more like, at what point do we decide not to continue treating cows because of some other factors like she's old, she's not pregnant, she's lame, what have you? I think those criteria of-- We can come up with some general good culling criteria, but they're always going to be a little bit farm specific depending on herd capacity and things like that. The other criteria that you started talking about, Pam, was when you're making the treat or no treat decision probably based on a pathogen result. If we're talking about a no treatment decision, evaluate the immune status or the ability to respond to that infection on her own. I think that that is a more nuanced approach because we talk a lot about the treat, no treat. We're not going to treat [unintelligible 00:20:58] we're not going to treat gram-negatives. We'll talk more about this I'm sure, but that's another important factor is looking at the cow and saying, do I have reason to suspect that even though she's infected with an E. coli, which typically has a high spontaneous cure rate, she might not actually be able to mount an effective immune response right now because she's immune suppressed or heat stressed, she just calved, she had twins, like all these other things? That is an important component of that decision-making on an individual cow level.
Pam: I think that's great clarification, Erin, because I was going off on all sorts of tangents. [laughs]
Erin: Two brains are always better than one.
Joe: I really like how you said that, Pam, with betting on the cow's immune system. I feel like I've thought that way in the past, but never recognized it. Am I willing to put money that this cow is going to be able to make it without additional support in some way? Sometimes you go down the decision tree and it's like, I'm not betting on her to make it without supportive care, so I need to get her some fluids and all these other things. You work through all the different things you can do and sometimes you do end up with antibiotics as something you need to do for this cow. I really like how you put that. That's perfect.
We've been talking a lot about using culture and pathogen-based treatment. Let's step back just a second and talk about, if I absolutely decide I'm not doing that, I don't want to do that at all, I'm not going to use culture to guide my treatment decisions, and I'm just going to treat everyone, what are the best practices if that's where we're at on a certain dairy or that's the decision that's made?
Pam: I think that's a really practical question because that's the reality on plenty of farms. They don't have the manpower, they don't have the capacity, they're not big enough, whatever, and they don't want to make a wrong decision. We've looked at that quite a bit and the reality is, what you have to think about is what percentage-- If you had 100 cases, for example, of mastitis, what percentage of those probably really need the antibiotic therapy in order to clear the bacteria? Which is what you're trying to achieve with an antibiotic.
On a typical farm, probably there's somewhere, and these numbers evolve, somewhere around 30% to 40% maximum of those cases that are presenting non-severe that may benefit from antibiotic therapy.
This is an average farm that doesn't have an outbreak of a particular pathogen. You got a mix of pathogens, and of those 30% to 40%, some of those aren't going to be eligible because they're chronic or whatever, these criteria we talked about earlier. You want to devise your treatment strategy, your overall treatment strategy to benefit them without a negative economic consequence for your farm or an overuse of antibiotics.
The best strategy that we found based on economic analysis, decision tree analysis, and others, is to use a narrow spectrum gram-positive drug for the labeled duration on the product. I don't think there's any reason to differentiate between products. The spectrum of activity is virtually identical for most of the intramammary products. What you want to do is select the drug that you're comfortable with and use the shortest duration on the label.
Erin: If there is an audio version of bolding something, Joe, can you do that in the file? Maybe make that a big echoey boom when she says that.
Joe: Maybe I could do that because that is really key. I think that it is the reality in the field, that there are farms that just, for whatever reason, lifestyle, other things going on, manpower, labor, everything, it's just a reality. It's really nice to see there's a very clear recommendation out there, and I'm glad that you said it. There's no ifs or buts. It's very clear. Just narrow spectrum gram-positive coverage on label duration. Don't differentiate between products, period.
Pam: That's it.
Joe: Perfect. I love it. It can't get any clearer than that.
Emily: Podcast is done. It's over, Bradley.
Joe: Shut it down.
Emily: Got it.
Erin: Now that we've made that so simple, can we now make it more complicated?
Joe: Sure.
Erin: I think the biggest issue that I have seen with this, why people mess with this, and I know you're going to be excited that I'm asking you about this, is the short duration therapy, we're talking about two or three treatments over a day to three days. The cow's not normal at the end of treatment, so shouldn't I keep treating her?
Pam: That is the scariest part of a short duration treatment. I can actually remember the first time that-- This was actually Alfonso Lago's work when we went to farms and convinced people to use really short duration treatment with Sandra Godden's work and all. The manager of the farm that I was enrolling, the first farm that we enrolled said, "Okay, I'm willing to do this, the selective treatment, using on-farm culture, but I'm really worried about the short duration treatment. Are you sure that the label treatment duration is going to be fine?" I was like, "Oh, absolutely. I'm sure." As I left the farm that day, I really respected this farm manager, I was just sweating bullets. I was just sweating bullets myself because while I believed it, I still wasn't confident enough. I really appreciate that feeling because I felt it. That study was a long time ago, and since that time, we have collected a lot of data on duration of abnormal milk. Duration of abnormal milk is basically how long does inflammation last in response to bacterial infection? It lasts from three to about six days. The average is four to five. That is with or without treatment, with or without bacteriologic cure, with or without pathogen, irrespective of pathogen. The scary thing with that short duration treatment is, for most cases, you're going to stop your antimicrobial while the milk is still abnormal and you're just going to wait out the milk withhold period. The data we have shows you don't need to be scared about that. The milk's going to go back to normal. In 85% of those cases, no later than seven days, regardless of treatment, but in most of them, somewhere between day four to six.
Erin: We're talking lots of data now, multiple studies, multiple herds, multiple states, lots of cows. We pretty much know now that cows with clinical mastitis have abnormal milk for about four to six days no matter what you do.
Pam: That is why a five-day treatment feels so good because when you give five days of treatment, on your last treatment, you're like, "Oh look, it works so great." The vast majority of cases, the milk is normal, but those things aren't related. In fact, almost all data shows, when you have a non-treated control group, you have about maybe half a day longer abnormal milk in the treated group, the ones that get intramammary treatment. Just putting something in the udder stimulate some inflammation.
Erin: I can relate to that squeamish feeling when someone pins you down on something. It's something that you believe, but you don't have really data that makes you like, "I can for sure say this 100%." Mine is that students would always ask me, "If we know that clinical signs last four to six days, how long should we wait to re-evaluate that cow and decide whether or not she needs something different?" I would always say, total shooting from the hip like, "I think I would wait like 8 to 10 days. At least 8 to 10 days." Then I would say, "It maybe depends on the risk tolerance level of the producer and how long they can stand," blah, blah, blah. I noticed in one of your recent papers, in your discussion, you say 10 days. Wait 10 days.
Pam: Yes, wait 10 days, and that's because we monitored-- In our last two trials, three trials, we monitored abnormal milk for 10 days. That's the longest we've gone, that's why I'm saying 10 days. It's also because I recently did this review article. I reviewed all the clinical mastitis trials for the last 20 years that I could find in English language papers. It's published in Frontiers. It's open access. Anybody can get a hold of it. There's only 26 clinical trials, and of those 26, only six have a negative control group and I did three of those.
The data in there on days of abnormal milk, while it's hard to parse out because people define things differently, is really consistent with that 8 to 10 days or so, the clinical cure outcomes, et cetera. I think you can easily wait 8 to 10 days. The other issue is, what are you going to do? Really, what are you going to do? We don't have any magic bullet cures to make the milk go back to normal and we don't have any evidence that changing antimicrobial treatments is going to speed that up.
Erin: Back to your earlier point, there's not really a reason to differentiate tubes. They pretty much all have a similar spectrum of activity against gram-positives. No magic bullet.
Pam: No magic bullet.
Joe: I think sometimes in a beef mind, sometimes in a dairy mind. For me, this is super similar to a feedlot when you treat and your pole criteria and you have a no treat window. After an animal gets treated, you have this period of days that you say, "We're not treating again. It doesn't really matter because we've done everything we can." That's the same kind of thing we're doing here. We've treated, there's not really another option, we know the milk is going to be abnormal anyway till six days. Just wait the 8 to 10 days and then re-evaluate and see what's going on. When would you reculture? Is that something you can do? Is that still that 10 days, or are you going to wait a little longer? How does that work?
Pam: That by the way is a great question, Joe. I don't really know the answer to that or how to use culture in the short run. The reason for that is based on the trials we've done over the last few years including this gram-positive. When you give an antimicrobial, an antibiotic for treatment, you�re not sterilizing that gland. What you're doing is reducing the number of colonies that are there, and then the cow's immune system-- You're tilting the advantage to the immune system so the immune system comes in and scavenges and cleans that up. The speed of that response, the speed of bacteriological clearance is highly, highly dependent on the bacteria. For E. coli, in those recent trials, we had spontaneous cure rate and treatment cure rates that were well over 95%. That's because E. coli die off really rapidly because they stimulate such a large immune response because of the nature of their gram-negative cell wall. They're dead rapidly so the cell count drops rapidly. If you culture an E. coli, probably on day six, you're going to find a lot of culture-negatives there because it happens fast. If you culture a strep on day six, you're going to find streps because what you get is a much slower decay curve. It takes much longer to achieve bacteriological clearance. I do not recommend using culture to make a retreatment decision. I don't know at what point you would, but probably not before 21 days.
Joe: What I'm hearing is, we should wait 8 to 10 days to reassess, but if we see abnormal milk again, we can't culture. Then how do you make your treatment decision?
Pam: If the milk remains abnormal-- Let's say you're out 14 to 21 days, you got abnormal milk. You might want to reculture that. Somewhere in that two to three-week window, you do a reculture, but you go through the same treatment algorithm on that. What do we know about this cow? Is this her first treatment or her second treatment? Is it the same quarter? In some herds, you get a large level of reinfection on herds because you have a lot of infection pressure. This is really true on manure solids, herds that have wet manure solids. Recurrence rates are high but it's not necessarily because you didn't cure them. It's because you get a lot of new infections.
14 to 21 days you could reculture, see how the cow is doing. You may or may not want to use an antimicrobial at that point. It would be, I think, an individual case decision at that point. In my experience, and in the data that I have looked at, there are no good short-term indicators of response.
You expect milk to go back to normal in five to six days, so three to five days, let's say, somewhere in that range. If it stays normal, you're good. What you'd expect next is to have a gradual continued decline in the quarter-level cell count. Of course, nobody monitors quarter-level cell count. We measure monthly cell counts which are commingled.
The cell count will go down gradually, and that is also pathogen dependent because cell count is a lagging indicator after bacteriological clearance. You're going to have a rapid decline in cell count with say E. coli successful clearance. With streps, it's going to take six weeks for that cell count to gradually come down because your die-off on the bacteria take longer. I think if you're looking at long-term indicators on, was our treatment successful? That cell count about six weeks out is probably the best one we've got.
Joe: That's the cell count at the cow level you're talking when you're saying that?
Pam: Yes. I think you can look at cell count at the cow level. You always have to remember, if you have only one infected quarter, it's going to be all diluted out by four. You'd expect it to come down faster at the cow level. We measure quarter-level cell counts in our studies just so we know what's going on. That's why I'm fairly confident in the speed.
Joe: We�ve laid the groundwork here, but we really need to get into the specifics of pathogen-based treatment. Once we culture and we know what we have, now what? We said that there's not all that many cows that we know absolutely benefit from antibiotics, and then there's even fewer because there's some that aren't eligible. Let's walk through, okay, I've cultured and I've gotten results. When do I treat and when do I not treat, which is probably just as important?
Pam: I'm going to work through it from simplest decision to hardest decision. How about that?
Joe: What's up, everybody, this is Dr. Joe Armstrong. That's where we had to cut it today. There's too much good information. We're going to have to split this one into two episodes. Sorry to leave you on a cliffhanger there, but please come back next week. We will be back with Pam. She'll walk through the whole decision tree on what you need to do once you have a culture result. You guys know how to reach us, themoosroom@umn.edu. That's T-H-E-M-O-O-S-R-O-O-M@umn.edu On Facebook, we're @UMN Beef and @UMN Dairy, Twitter @UMNmoosroom, and that's plenty of plugs for today. We'll catch you guys next week.
[00:37:49] [END OF AUDIO]
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