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Uterine infection/vet incompetence?

Equine-Reproduction.com Bulletin Board » Breeding Problem Mares - Volume 1 » Uterine infection/vet incompetence? « Previous Next »

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nonenonenoneMy problem is very similar to Cass, I need some adviceAnonymous03-06-06  07:33 pm
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Cass Utter (209.252.133.126)
Posted on Monday, September 03, 2001 - 12:15 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Last March I bought a TB broodmare, 5yrs old, she was recouperating from near starvation, and strangles resulting in abortion at about 8 months. The woman I bought her from bred her before sending her to me. When she was far enough along (30 days) I took her to my vet and had her ultrasounded. No pregnancy. Vet said try again. After the second disappointment, I was told to breed her again and put her on Regumate immediately. After this attempt there was again no pregnancy; but lots of healthy follicles. They then decided to culture her (by this time she had been unsuccessfully bred 4 times this season). The culture came back infected and I brought her in for uterine lavage and 3 days of naxcel. At the vet's, this mare who had kicked at the dr. in anger while in the stocks, was treated in the stall unsedated the last 2 days. -- Dr. was afraid she'd step off the side of stocks and injur herself, something that never came close to happening the several times she had been ultrasounded. -- 21 days later she was recultured and the infection still exists. I was told that the bug is Klebsiella Pneumoniae. That the first culture came back 'heavy' and the vet said she didn't realize that what they really meant was super heavy. She said she treated it with Naxcel which is a strong antibiotic but it only 'dented' the bug (which, she said, given the mare's unhappy medical history was not surprising). The second culture came back 'moderate'. This time she would use Amicason (sp?) which was the really strong antibotic (given the mare's history why wasn't the most aggressive used to start with?). I was then told that if this didn't work then there was nothing else to be done.

I am trying to educate myself as to the most aggressive way to treat this infection. I have lost confidence in my vet (by conveniently not culturing her and not aggressively treating the infection they have gotten about $500 extra out of me), and I certainly don't want to give up on this very nice mare after all this effort. In your experience what course of treatment do you believe would have the best chance of success?

Thank you very much for any information you can provide.
 

Kelly (63.172.47.208)
Posted on Tuesday, September 04, 2001 - 12:14 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Cass- The first red flag should have been the abortion at 8 months. Your vet should have taken this information seriously and taken steps to insure that your mare was fit for breeding. A culture should have been taken before the first breeding. At that time, your mare could have been treated agressively for the infection, and breed on the next heat. It is my opinion that with a heavy infection, the more agressive antibiotic should have been used.

Not all vets are good at repro. This particular vet may have done all that was in their knowledge to treat your mare. Unfortunately, it was not enough, and has cause you a loss of time and money. Change vets, start early next year with a culture and cytology report. There must be a suitable invironment for conception. A biopsy, considering her history, may be in order. It is not a lost cause yet!
 

Knoble Knight (206.157.249.104)
Posted on Tuesday, September 04, 2001 - 02:50 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Cass, I would not say your vet is incompetent but I would have handled your situation differently. First, considering the condition of your mare, recovering from strangles, malnutrition, foal loss, I would not have told you to breed her until next year. Even without the positive culture it would have been a very low probability of conception and just prolong her recovery. A thorough exam should have been done after the 2nd unsuccessful breeding if not before. If these were AI breedings it would be absolutely unacceptable to procede, as you were advised to do, without a proper exam.

Your vet may have relied on an antibiotic sensitivity test from the culture thus the reason she used the antibiotic she did, (test showed antibiotic would be effective against Klebsiella). Kleb is somewhat common and quite treatable but some strains are persistent. 2g of Amikacin Sulfate diluted with saline to a volume of 60 Ml daily for 3 days should do the trick. Ask your vet what she would recommend. Since your mares immune system was severely depleted and the treatment first used should have cleared it up in most cases, especially if a sensitivity test was used, you could give the vet another try.

I would also recommend using a regimen of immune boosting vitamins with added digestive aid enzymes that will help replace destroyed bacteria needed for proper digestion as antibiotics destroy both good and bad bacteria, and also considering her past condition. You could also ask your vet about possible vitamin injections. Although your mare may look healthy now, she has gone through a terrible time in the recent past and it may take some time to fully recover.

I commend you on your care and concern for this mare and hope she produces wonderful foals for you in the future.
 

Horse Pro (207.144.178.74)
Posted on Tuesday, September 04, 2001 - 06:23 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Cass I must agree with KK on this one. In a service related profession such as veterinary medicine. Competent professionals are rewarded with a continuing practice and those who are not, donít stay in business. I think incompetent is pretty strong for this situation. Exercised poor judgment perhaps, had the case been worked up differently the outcome would have also been different. Itís difficult to judge hearing only one side of the story. Should you change vets? I wouldnít unless this vet has shown a consistent inability to provide the service you expect. I would never change vets based on the negative results of one case. There are just to many factors to consider, before making such a change. One must assume that you selected this vet for some reason other than convenience. If you did not, then perhaps a re-evaluation of your selection process is in order. Your vet is perhaps your most valuable partner in this horse business. Without whom, you may as well close your doors and pursue some other business or hobby.

I would suggest opening a dialog and discuss your concerns for how the case was handled. A good working relationship is based on good communication and mutual respect, that works both ways. If you base your relationship on emotion of the moment, you can look forward to a difficult time of it.

Vetís are human to.

Best of luck with your mare and a better working relationship with your vet.

HP
 

Kelly (63.172.47.183)
Posted on Tuesday, September 04, 2001 - 07:33 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

The fact that this vet told you that if what was done, did not work, there was nothing else to be done, leads me to believe that this vet is not being cooperative. Where was the communication and expalnations? You are not the professional, it is their job to explain what you are paying for.

Once you have lost confidence, I can not blame you for wanting a change of vets. Now that you have a better understanding of your mares condition, you may be able to have a more succesful relationship with another vet. I work with a number of different vets, because each client has their own preferences. It is not neccessary for you to stay with a vet that you are not comfortable with. There are plenty more out there that will take your concerns into consideration. That vet should have initiated the dialog and explained what your options were. It is obvious that none of this had happened. The fact that it took 4 times of unsuccessful breeding before a culture was suggested is enough for me. I am with you, make a change, it is your right and your money.
 

Cass Utter (209.214.184.70)
Posted on Wednesday, September 05, 2001 - 12:45 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Thank you all for your advice. Please know that I like this vet very much personally and I have thought long and hard, and not in anger, about changing vets. I have talked with another vet, who recommends an uterine biopsy before proceeding with further treatment or breeding. Considering her sad history this sounds like good avice. What do you all think?
 

Kelly (63.172.47.206)
Posted on Wednesday, September 05, 2001 - 02:24 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

It sounds to me like you have found the right vet!
 

Cass Utter (209.252.133.113)
Posted on Wednesday, September 05, 2001 - 02:30 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Thanks Kelly. I just picked up my horse's records. I am so upset I can barely type. I was told 2nd culture was moderate- it is still heavy.
 

semenfrezr (66.12.92.252)
Posted on Wednesday, September 05, 2001 - 07:12 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Cass,

You might want to wonder about an underlying fungal or yeast infection since she doesn't seem to be clearing up. A biopsy is a worthy investment at this point (considering the late abortion, that should have been the first thing done).
Did you get a breeding soundness guarantee when you purchased the mare?
 

Anonymous (64.12.105.57)
Posted on Monday, November 05, 2001 - 04:35 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

I have a stud that last year we had a lot of problems with klebsiella. Could not get it cleared up. My vet offered some suggestions but did not work. Has anyone had this similiar problem.
What treatment did you use?



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