Understanding Mastitis: From Perspective of Inflammation

Dr. Singh, Is Sodium Citrate the same as Trisodium Citrate? I really want to try this but want to make sure I'm getting the right chemical. Also, I can use it as a drench giving it to the goats individually to make sure they are getting the right dosis according to their individual body weights.

Hi Linda, So thrilling to get a quick reply. Sodium citrate is usually in mono-, di- and tri- Sodium citrate, however, you should try to get Tri-Sodium citrate because it has more buffering power than the other two forms. Because the cardinal cause of mastitis is the disturbance of pH in the udder and with the result everything goes upside-down which can ONLY be corrected by the administration extraneous Citrate-orally or I/V at the optimum dose. I would suggest you to start it as a drench because it is not that difficult in goats. The optimum dose as a drench could be 5gms dissolved in about 50ml of water once daily till recovery -which is usually 3-4days. We can also make a schedule for the prevention of mastitis before parturition, if desired. Please don't hesitate to ask any questions regarding this or any other health problem in your goats. Jasmer singh Ph D.

Do you raise dairy goats and if so where. We have a herd of Saanans and Alpines that we use to help introduce better production genetics in the herds of the small subsistence farmers. To do that we hand milk all the does, record their production, and choose young herd sires from the best. We also raise our goats to be resistance to the parasite population on our farm. We use intensive management. That permits us to keep close vigilence on each and every animal. That's why I feel that maybe collaboration in the trisodium-citrate udder inflamation project might benefit many subsistence farmers but only if the trisodium-citrate is easy to obtain. On Google I only found sodium/citrate. Is it used in other industries such as food preservatives? Maybe some industry here in Santo Domingo would be importing it.

We can try Sodium bisulphate instead of Tri sod citrate as an superior acidifer as compared to citrate and much cheaper and affordable.

I have used sodium by sulphate in cow mastitis as dose rate of 25 gm bds as orally and got a good result. Antibiotics and vitamin A is must with it for 4 to 5 days.

In summary we have seen 10 professionals plus myself respond to this thread...5 from India, 1 from South Africa, 1 from Lithuania, 1 from Pakistan, 1 from New Zealand, and myself from the Dominican Republic. We all agree that we need some type of natural treatment to stop udder inflamation before it reaches the extremes of mastitis. We have not offered causes of the inflamation which may be simply swelling at parturation from the entrance of milk. Most agree that there seems to be some promise offered with tricalcium citrate but it is not always obtainable. Dr. Lyttle reports that in New Zealand it has been put under trial but that the herds are so large that it is impossible to administer correctly and, in addition, it is not possible to measure results due too difficulties in managing large herds. Dr. Pearson in S. Africa seems to feel that it is just more of the same. Dr. Pandey reports that sodium sulphate is effective when used with antibiotics and Vit. A (which of the 3?) Dr. Jurate sees it as just another method. I'm thinking that nature has it's solution because animals in their natural habitats seem to have restricted diets after parturation so maybe the diet is the key. We increase feed prior to kidding to provide energy for the growing fetus(s) but maybe that is what causes the inflamation? It seems that this discussion has raised more questions. In reality, we need to find the solution that will be manageable for both commercial set ups and the small subsistence farmer. When we have new information or more conclusive data, we should continue this discussion. Meantime, I sense that it is not heading for the goal that we all want which is the prevention of damaged udders, lost production, and dead kids. We, here at La Hacienda Caprina Alpinita are prepared to carry out trials and data collection and will cooperate with any plan that seems to show promise. So technicians and veterinatian professionals, thank you for your work and please continue to investigate. If we can be of help, let us know. May God grant you all a productive 2015! Linda McMillan, Hacienda Caprina La Alpinita, Juan Tomas, La Victoria, Santo Domingo Norte, Republica Dominicana.

Part of the challenge with this issue is the terminology of the discussion and also the philosophy of those participating. As a summary here are some key points to consider: 1. Mastitis means inflammation and not infection. If there is an indication for antibiotics then a bacterial mastitis must be present. however, the foundational thinking raised by Mr Jasmer Singh et al (thank you for your work and continued enthusiasm on this issue) is that even when we have a bacterial or infectious mastitis, the pathogens may well be opportunistic invaders subsequent to the physiological and pathological changes in the mammary gland and this gives a very sound reason why antibiotics are not 100 % effective even when a culture is confirmed and antibiotic resistence is ruled out. Consideration must be given here to other secondary invaders such as mycoplasma, mycotic or algal microbes. 2. Looking for a solution suitable for mastitis prevention for both subsistence farmers and large commercial operators in my view is likely to lead to frustration. Because of the many causes and contributing conditions of mastitis and a predominant tendency for many to reach for an antibiotic solution as the first line of support for this mastitis, there are a minority interested in the thread of this discussion, for now. Only as antibiotic resistance becomes an ever increasingly challenging human health issue will a tipping point be reached -until then only farmers operating within organic frameworks or those more conventional farmers looking for alternative solutions to antibiotics as a first line of defence (or sometimes last line) will be willing to follow the protocols developed. 3. The sodium tri-citrate protocol we find most useful are for individual support of animals (particularly cows at rates identified in the original work published by Mr Singh et al) where mastitis is detected - the earlier the better - and where there is no evidence of wider bodily responses to infectious disease such as raised temperature, elevated respiratory rate, recumbency or changes to normal heart rhythm, or significant changes to the udder itself which would indicate a more severe local response and may indicate the use of anti-inflammatories and antibiotics (subject to culture) as additional therapy. 4. There may be some species difference in levels of active pH buffering requried and there is also a possible indication for intravenous use rather than drenching depdning on the severity of or progression of symptoms, however this will undoubtedly be controlled in different countries through different legislation. continued in next post...

Linda, reading your response and in particular the closing remarks about "damaged udders, lost production and dead kids" could there be nutritional, housing, kidding and other environmental conditions contributing to these issues. We see all of these issues when metabolic disease is present and it may be fruitful to step back from the mastitis focus and ask what else could be involved? Good luck for 2015.

I would give an Ayurveda understanding of Mastitis. We were able to manage Mastitis successfully based on Ayurveda treatment without any antibiotics Name of the condition in Ayurveda: Sthana Vidradi Etiology Due to stale, very dry, or fermented food., Incomplete sleep.,Wrong feed habits or wrong daily routine (in case of cattle, staying confined to the stable, not having a daily roaming routine, etc).,Not feeding the baby properly. , Injury (external or internal)., incomplete milking Signs and symptoms Local changes: Reddish/blackish swollen udder with extreme pain and tenderness at times, hard and warm to touch., Milk changes: Milk is often yellow or curdled, has blood tinge at times, and also a few suspended particles seen in the milk of the affected udder. There are three stages of this disease: Samavastha: When the doshas have just lodged themselves in the breast – heaviness in the breasts, slight pain, anorexia, etc., Pachyamanavastha: When the doshas start getting expressed – tenderness in the breasts, swelling, fever (slight), reddish or blackening of the udder, Pakvavastha: When the doshas are fully expressed –extreme pain and tenderness, swelling, fever, etc. This condition can be managed with simple combination of medicinal plants which can bring back the disturbed balance ofPitha This could be an alternate way of looking at a disease and manage it successfully Dr. M N Balakrishnan Nair

In my reseach work, we used some homeopathical preparations for Bovine SCM treatment. In our cases, treatment efficiency with homeopathical preparations were only 53,33%. The preparation was not effective against mixed microflora inflammations. Some authors recommends treating affected cows with homeopathic preparations if the general milk SCC is less than 250 103/cm3. The search for effective treatment and prophylaxis preparations is very necessary. The health of an affected udder depends on it’s resistance to accessed pathogens. A weakened cow’s udder’s parenchymal cellular and humoral immunity remains non-resistant even to conditionally pathogenic microflora which often cause subclinical infammations.

I have really appreciated the time that each of you have taken to continue this thread. While we are talking about animals and not people, the underlying principles do apply. The following website defines adequately mastitis in humans and as I read it, I see some of the comments unfolding in my dairy goats, expecially within the first 3 months of lactation and with first time lactations. http://www.medicalnewstoday.com/articles/163876.php Possibly one of the major causes is the genetics we have bred into our dairy goats....high production....and the feed that we give them which promotes and sustains the production. We see these every kidding season when we notice that the newborn kids drink the milk from one side of the udder and have no need to drink from the other side. We begin milking our does after 24 hours unless they are engorged with milk at which time we will milk some of the colostrum off. I want to clarify that here at the Alpinita Dairy Goat facility we do not have a major problem with mastitis but we do see inflamation in a small percentage of our freshening goats. If that inflamation makes a doe more susceptible to mastitis at a later date or the formation of abscesses (...to prevent complications, such as an abscess in the breast.) it is of utmost importance that the possible damage to the udder of an otherwise genetically productive doe then we must do that. In the beginning of this thread I took a great deal of interest because I am very interested in treating whatever symptom naturally without the intervention of antibiotics. That is not always possible but the tri-calcium citrate idea was intriguing. Dr. Lyttle's comment "there are a minority interested in the thread of this discussion, for now. Only as antibiotic resistance becomes an ever increasingly challenging human health issue will a tipping point be reached -until then only farmers operating within organic frameworks or those more conventional farmers looking for alternative solutions to antibiotics as a first line of defence (or sometimes last line) will be willing to follow the protocols developed." is well-taken. Sometimes I believe that there are many interested people like myself but they either do not have acces (no computer, no internet, no access to threads like this one or we do not have professionals such as you folks are to help us with the protocols. It's rather like global warming isn't it? We see it happening but shrug it off as if it will just go away. I have a healthy herd of wonderful milk-producing dairy goats. They are being raised under intensive conditions but are healthy and happy. Herd health is closely monitored daily. So, how can we contribute to advancing natural resistance and lessening antibiotic dependence? Our herd is available for use to investigate legitimate and useful methods to promote herd health such as the one that this thread is about: natural means of controlling inflamation of the udder at parturition to avoid later complications of either infectious or non-infectious mastitis.

We have used the fresh herbal formulation. our field trial indicates 97 per cent efficacy. the study is being published

Can you expand or send website to read more about your herbal remedy?

Breast cancer- a filibuster or an imbroglio /a conundrum. This concerns ‘that why young women suffer more from breast cancer’ which is the subject of discussion. The results of these clinical studies were accepted for presentation at the “2nd Biotechnology World Conference held during 18-21 February 2013 at Dubai UAE”.  Lactogenesis is the ultimate stage of reproductive cycle in almost all the mammals. Citrate plays a pivotal role in this process and maintain lactation for production of milk to feed the new born. Citrate is synthesized in breast and its levels in milk increase many-folds around parturition and reach its peak in 2-5 days. The cardinal roles played by citrate in breast are to: maintain the normal pH (~6.50) through equilibration of Ca2+ and H+, sequester Ca2+ and prevent its clumping, thus, preserves the fluidity of milk, maintain the proper constituents (fats, lactose etc.). Milk production increases from 50ml to about 500ml within a week after parturition. Whenever there is disturbance in the synthesis of citrate all the functions proceeding in concert go haywire and the disease process takeover. Due to deficiency of citrate the Ca2+ become free and cause injury to the secretory epithelium and induce swelling causing mastitis. In severe cases Ca2+ clump together and form flakes which block the ducts causing milk stasis, particularly during early stage of lactation due to ample supply of milk. Under these conditions the tight junctions between secretory epithelial cells become compromised and leaky. There occurs swapping of ions like Na, K, Cl, Hco3 and citrate and transudation between blood and milk bringing the pH (~7.40) of milk equal to that of blood. Injury inflicted by Ca2+ and alkaline pH in breast provides most conducive medium for the establishment of environmental pathogens such as: Staph, Strept, E. coli etc. Infection in breast triggers body defense mechanisms causing migration of leukocytes primarily PML, generation of reactive oxygen species, interleukins and an inflammatory reaction is set-up in the breast. Under these conditions mother may not like to suckle milk or the child may not like to suck and mother usually wean off the child which further exacerbates the condition. Consequently with passage of time there occur, primarily Ductal Carcinoma In Situ (DCIS), some cases of Lobular Carcinoma in situ (LCIS). However, rarely there could be tumors of hormonal origin in breast which are usually independent of milk production units.  Furthermore, free Ca2+ form calcifications which are depicted in mammograms having different shapes and sizes and comprise of two types: Macrocalcifications (1-5cm) are usually benign and Microcalcifications are sometimes implicated in malignancy. Chemical constitution of these calcifications is calcium phosphate and calcium hydroxyapatite which could be identified by Raman Spectroscopy and has often been reported to be involved in breast malignancy. Altogether, and the perusal of literature extant, there is ample evidence that Ca2+ pumps and channels are characteristic features of certain cancers-including breast cancer. Recent data reveals that inflammation is a critical component in tumor progression, and inflammatory cells orchestrate the microenvironments at the site of infection and chronic irritation give rise to many cancers. The situation in breast inflicted with mastitis is no different as briefly explained above. This modus operandi points that young women suffer more from breast cancer because of the hyperactivity of the breast due to pregnancy, lactation and the reproductive cycle (hormones). Malignancy in breast is usually preceded by mastitis. Mastitis if ignored or under treated may lead to breast abscess and inflammatory breast cancer which is a very serious condition. However, the simmering mild inflammation and infection in breast may remain as subclinical mastitis for quite long periods and ultimately end-up as breast cancer. The inflammatory cells and cancer cells are obligate companions in this crime. The incidence of breast cancer after menopause probably could be due to post-menopausal hormone therapy i.e., estrogen and progesterone or may be both hormones and citrate deficiency. Diagnosis and Treatment: We monitored the pH of milk/secretion from the breast which was recorded to be in the range of 7.2-8.2. Data on number and stage of lactation, palpation of axillary lymph nodes, duration of the problem along with mammography in some cases was also recorded. Consent of the patient and the guardian was obtained before initiating the treatment. Fifteen clinical cases of women aged 35-64 years having varying degrees of affliction in the breast were treated. The treatment consisted of six grams of tri-Sodium citrate dissolved in 50ml of water given orally once daily one hour after the meals in the morning. After one week of treatment the patients were examined who felt relieved from majority of symptoms of inflammation and body temperature became normal. The breast milk/ secretion pH was ~6.6 at which the presumptive causal organisms of mastitis cannot grow and multiply. It took 8-12 doses of tri-Sodium citrate, depending upon the extent of damage to breast tissue for complete recovery. The treatment did not produce any side effects. Estimation of citrate in milk /secretions of breast are recommended and monitoring the pH of milk throughout lactation, with graded pH papers, is considered to be cardinal biomarkers of breast afflictions. These two biomarkers need to be monitored throughout life which are safe, easy, cheap and desirably reliable. Here we would like to add that Tamoxifen which is the earliest and considered most effective drug used against breast cancer comprises of tamoxifen citrate. It needs to be determined, whether the efficacy is due to tamoxifen or synergized by citrate moiety in it? K. S Dhillon Ph D, Jasmer Singh Ph D, Jarnail Singh Lyall M.B.B.S. Tags: Lactogenesis, Reproductive cycle, DCIS, LCIS, Treatment of Mastitis, Breast cancer, Citrate, Menopause, Postmenopausal Hormone Therapy, Young women.

Hi Linda and others I would like to give full mechanisms of the development of mastitis in animals in detail in my next comment. However, the basic modus operandi is the same as above in mastitis in women because the synthesis of milk is similar in almost all the mammals except some compositional variations in milk. Jasmer Singh Ph D

Since tri-sodium citrate plays such an important role in managing udder health in animals, how do ruminants such as goats obtain trisodium citrate? Is it synthesized in the diet? Does it pass in the placenta that they often ingest? Is it obtained from forage products that they consume? How can it be supplemented? Is it natural in some plants?

Mastitis occurs not only because of bacteria that arise from external environment but also because of change in acid-base balance of blood. Increase in concentrations of cat ions such as Na+, K+. Mg+ would alter pH of blood towards alkaline > 7.5 which is congenial for growth of gram negative bacteria, they are the most common organisms that cause acute mastitis. Therefore, it is very important to calculate DCAD (dietary cat ion an ion difference) for your feed formulation. The DCAD values vary with seasonal temperature and humidity and raw materials used in dairy feed formulation. We at Zeus Biotech Ltd, Mysore India, can get your DCAD values calculated and balance using ammonium chloride, potassium chloride, potassium sulphate or sodium chloride and sodium bicarbonate etc, we are good in maintaining DEB for poultry and DCAD for dairy formulations. It balances Na, K, and Cl, S ions in feed of dairy cows and poultry Dr.channegowda Consultant Veterinary Nutritionist

Hi Everybody, I think the discussion on the thread is becoming quite interesting, however, the crux of the problem needs to be solved. The reproductive cycle in mammals consists of primarily three segments i.e., oestrus cycle, pregnancy and lactation. The first two are mainly regulated by hormones but the third involves hormones plus metabolic processes. Mastitis is our subject of discussion which usually occur during lactation. At the time of parturition,1-2 days before or after ( in Dairy animals and/or women), the Citrate content of udder rises alarmingly manifold and has been called the " Harbinger of lactogenesis". Citrate plays a pivotal role in udder for the synthesis of milk and its other components for the nutrition of the new-born infants. Citrate also maintains the normal pH of udder as ~6.5 (slightly acidic and unsuitable for bacterial growth), sequesters calcium (Ca2++) thus, preserves the fluidity of milk and all the processes of lactation proceeds normally. Under conditions of disturbances of citrate production in the udder everything goes haywire. Due to deficiency of citrate Ca2++ become free and clump together forming flakes which behave like lime and inflict injuries to the secretory tissues and there is swelling of the udder -Mastitis. Due to this swelling the " tight junctions " between secretory epithelial cells become compromised and leaky. There occurs frank exchange of fluids and ions like Na, K, Cl, Hco3 and Citrate between blood and milk resulting in rise of milk pH up to 7.2 or even higher (we have recorded to a level of 9.0). Injury inflicted by free Ca2++ and the alkaline pH in the udder provides the most favorable medium for the growth of environmental pathogens like Strept. Strept, Esch.coli etc. which are usually isolated from mastitic milk. Due to the presence of these infectious agents the body defense mechanisms are triggered and the defense cells mostly polymorphs reach the site of infection and an explosive inflammatory reaction ensues showing the signs of clinical infectious mastitis. Similarly it may remain as sub-acute or become chronic mastitis. Now the treatment of mastitis also involves the replenishment of Citrate deficiency in the udder through extraneous administration of Citrate either orally or I/V . Hence, when the Trisodium citrate is administered the pH of the udder is maintained at normal level as ~6.5 at which the infectious agents present are scavenged off because they can not grow and multiply at this pH and malady is cured. Therefore, the monitoring of pH and Citrate content of udder are the most crucial biomarkers for maintenance of udder health. The treatment is safe ,economical easy to administer,no wastage of milk, no public health hazard no culling of animals. This treatment also help keeping the most valuable genetically improved animals and can be effectively employed as a prophylactic for controlling Mastitis in dairy animals. Jasmer Singh Ph D

The treatment is safe ,economical easy to administer,no wastage of milk, no public health hazard no culling of animals.....sounds like the perfect thing and yet I can't find it in the Dominican Republic. Why is it difficult to locate? Are there any natural ways to supply it in the diet. Would offering bicarbonate (baking soda) free choice be effective?

Has any body tried Trisodium Citrate solution Intra Mammary to the affected Quarter? It will be interesting. It will be worth a trial.