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Author Topic: PYOMETRA and Why You Should Spay Your Females  (Read 17750 times)
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kahlua
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« on: February 02, 2011, 10:44:01 PM »


In summary...

PYOMETRA is a term that means pus in the uterus, which is a serious condition and almost always means surgery. This pus formation in the uterus results from infection, hormone imbalance or mucous buildup inside the uterus. Most dogs and cats suffering from pyometra are presented because of loss of energy, increased thirst and poor appetite. Plus a good tip-off would be a foul smelling, purulent (means pus) vaginal discharge. If that swollen, enlarged uterus happens to rupture internally, the dog will rapidly go into endotoxic shock and whatever the veterinarian does may not be enough to save the dog.  [Source: http://www.thepetcenter.com/sur/pyo.html ]

* Symptoms: As the body attempts to flush out the build-up of waste products through the kidneys, the animal will drink excessive quantities of water (polydipsia) and urinate large amounts frequently (polyuria). She will lick at her vaginal area while the cervix is still open and the uterus is discharging a white fluid. She may run a low-grade fever and if blood work is done, she will show an elevated white blood cell count. As the uterus increases in size and weight, the dog shows weakness in the rear legs, often to the point where she cannot rise without help. As the dog enters kidney failure, she stops eating and becomes very lethargic. [Source: http://www.peteducation.com/article.cfm?c=2+2109&aid=918]

* Treatment: Once the diagnosis has been confirmed your pet should have an operation to remove her womb as soon as possible. This is the same operation as carried out to routinely spay a female dog, however in a sick animal suffering from pyometra it carries much more risk. The risk of not operating is even higher; most animals will die if surgery is not performed. If the womb is not removed, toxins are released from the infection which get into her blood and make her more and more ill. Eventually these toxins can cause kidney failure. [Source: http://www.stortvet.com/html/pdf/Factsheets/Dog/24_265517.pdf]

* Prevention: SPAY.
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« on: February 02, 2011, 10:44:01 PM »

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kahlua
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« Reply #1 on: February 02, 2011, 10:47:43 PM »

PYOMETRA
Article Written by Dr. Daniel A. Degner, Board-certified Veterinary Surgeon (DACVS)
Source: http://www.vetsurgerycentral.com/pyometra.htm

Key Points

The word pyometra can be divided into two root words

    * Pyo means pus
    * Metra refers to the uterus

Pyometra starts after a dog goes through a heat cycle, usually within about 3 to 5 weeks
Spaying is the treatment of choice
Prognosis is usually favorable, providing that the patient is not profoundly ill

Anatomy

    * The uterus is a Y-shaped organ that has two horns
    * An ovary is located at the end of each horn of the uterus


Pathophysiology

    * The word pyometra can be divided into two root words
          o Pyo means pus
          o Metra refers to the uterus
    * Pyometra starts after a dog goes through a heat cycle, usually within about 3 to 5 weeks
    * Stimulation of the uterus with abnormal levels of hormones (estrogen and progesterone) cause the lining of the uterus to become thickened and fluid accumulates inside the uterus
    * Infection develops in the uterus
    * As the infection progresses, the uterus fills with pus
    * If the pet has closed pyometra the cervix is not open and pus cannot drain to the outside
    * If open pyometra is present, the pus can drain through the cervix
    * The infection is life-threatening; closed pyometra may cause a pet to become more ill than open pyometra


Clinical signs


    * Pus may or may not drain from the vagina/vulva (see photo below)
    * Increased thirst/increased urination
    * Enlargement of the abdomen as the uterus fills with pus
    * Lethargy
    * Poor appetite
    * Weight loss
    * Enlargement of the abdomen
    * Fever
    * Dehydration
    * Clinical signs are variable from pet to pet





Diagnostic tests

    * Complete blood cell count usually shows an elevated white count
    * Chemistry profile to evaluate function of internal organs
    * Radiographs of the abdomen
    * Ultrasound of the uterus (photo below shows a uterus filled with pus - black structure)
    * Culture of the pus from the uterus
    * Biopsy of the uterus if cancer is suspected

     


Treatment

    * Fluid therapy via an IV to correct dehydration
    * Antibiotics
    * Transfusions of plasma, Hetastarch, whole blood
    * Surgical removal of the uterus; photo below shows a very enlarged uterus that is filled with pus



     
Nonsurgical Treatment

    * Fluid therapy
    * Antibiotics
    * Prostaglandins help the uterus to expel pus and alters the hormone levels of the ovaries
    * This treatment should not be used if the pet is quite ill
    * This treatment should not be used if your pet has closed pyometra
    * This treatment may not work and surgery will need to be done
    * If this treatment is successful, the next time the dog goes through heat, pyometra will usually recur unless the dog is bred and becomes pregnant

 

Aftercare


    * Antibiotic therapy
    * Restrict activity for 3 weeks
    * Encourage eating and drinking
    * Check incision for signs of infection

 

Potential complications

    * Anesthetic death
    * Bladder infection
    * Peritonitis, which is infection of the abdomen
    * Abdominal abscess formation
    * Disseminated intravascular coagulation, which is a clotting disorder from the infection and causes death in many patients.
    * Sepsis – poisoning of the body by toxins from bacteria

 
Prevention of pyometra

    * Simply having your pet spayed at a young age will prevent pyometra and will decrease the risk of mammary cancer


Frequently Asked Questions After Surgery

When should my dog have the first bowel movement after surgery?

    * Many dogs will not have a bowel movement for the first 4 to 5 days after surgery
    * Reasons that a dog will not have regular bowel movements after surgery include:
          o The dog has been fasted prior to surgery
          o Dogs do not eat well during the hospital stay
          o They frequently do not eat well when they go home
          o They are fed highly digestible food that produces little stool
          o Pain medication that contain narcotics (such as morphine, fentanyl patches, and tramadol) can be constipating
    * If a pet does not have a bowel movement on the 5th day of being home, a stool softener such as metamucil can be fed
          o Dose of metamucil is 1 tsp per 25 Kg mixed in with each meal (canned dog food); feed immediately after mixing, as the metamucil will gel the food and may make it less palatable

My pet had surgery and will not eat.  What can be done?

    * Dogs
          o Most pets will not eat their regular dog food after surgery, especially if it is kibble.
          o Offer a cooked diet having a 1:1 ratio of a protein source and carbohydrate source.  The protein source can be any meat (example: chicken breast, turkey breast, lean hamburger) that is low in fat and should be cooked (drain off all fat after the meat has been cooked).   The carbohydrate can be pasta, potato or white rice.
          o Try canned dog food; to enhance the flavor sprinkle a very small amount of garlic powder or chicken or beef broth (Chicken-in-a- MugTM or Beef-in-a-MugTM products)
          o Try Gerber strained meats for babies such as the chicken, beef, turkey, or veal
          o Try Hill's A/D diet available at most veterinary hospitals
          o Hand feeding: place a small amount of food in the mouth so that your dog gets the flavor
          o Warm the food slightly in a microwave, as the food will be more aromatic; stir the food before feeding and test the temperature on the bottom side of your wrist; it should only be luke warm.
          o Remember that most pets will not eat the first day or two after they get home from surgery
    * Cats
          o Offer smelly foods that contain fish such as tuna or smelly cat foods
          o Try Gerber strained meats for babies such as the chicken, beef, turkey or veal
          o Hand feeding:  with your finger place a small amount of food on the roof of your cat's mouth; use a syringe to get soft food into the mouth
          o Warm the food slightly in a microwave as the food will be more aromatic; remember to stir the food before feeding and test the temperature; it should be only luke-warm
          o Some cats will only eat dry food, try kibble if your cat normally has been fed that food
          o Petting and stroking your cat frequently will help to stimulate appetite
          o Remember that most pets will not eat the first day or two after they get home from surgery
          o Appetite stimulants such as cyproheptadine may be helpful
          o If your cat refuses to eat anything for 7 days a stomach tube or nasogastric tube should be placed to provide nutrition so that a serious liver problem (hepatic lipidosis) does not develop

My pet is vomiting.  What can be done?

    * The first thing for you to discern is whether your pet is vomiting or regurgitating.  Both will result in fluid or food being brought up.  Vomiting always will have heaving or retching of the abdomen prior to expulsion of the vomitus.  Regurgitation is not associated with heaving and the pet usually just opens the mouth and fluid or food will be expelled.  Usually the regurgited material will be clear or brown colored fluid.
    * Next is to identify the cause of the vomiting or regurgitation.
    * Causes and treatment of vomiting after surgery
          o When some pets return home after a stay in the hospital they may drink excessive amounts of water at one time and then vomit; if this appears to be the case, the water should be limited to frequent smaller amounts.
          o Medications such as antibiotics, narcotics or nonsteroidal anti-inflammatory medication commonly cause vomiting after surgery.  In order to see which medication is causing the problem, the administration of each drug should be separated 2 hours apart.  Usually the pet will vomit or appear nauseated (drooling and sick look) within 1 hour of administration of the medication that they are sensitive to.  The antibiotic in some cases may be changed to a different one, or may be discontinued.
          o Stomach upset from anesthesia is a potential cause of vomiting and will pass within a couple of days.
          o An uncommon cause of vomiting after surgery is internal organ failure.  Blood testing will confirm this problem. For this reason vomiting should not be ignored if it persists for more than 24 hours.
          o If your pet had surgery of the bowels or stomach, vomiting is always a concern, as it may indicate that infection of the abdominal cavity, called peritonitis, is present.  Do not ignore this sign.
          o Symptomatic treatment of vomiting involves withholding food for 12 to 24 hours, then introducing small amounts of bland food such as rice and lean cooked hamburger, if your pet does not vomit after that then gradually wean him/her back onto the regular diet after 3 days.  In order to decrease the acidity of the stomach, Pepcid AC 0.5 mg/kg can be given by mouth twice daily for 5 days.  Metoclopramide and Cerenia are good anti-vomiting medications for dogs and cats.  You should always consult a veterinary healthcare professional before administering medication.
    * Causes and treatment of regurgitation after surgery
          o The most common cause of regurgitation is reflux of acid from the stomach into the esophagus while your pet is under anesthesia.  Acidic fluid from the stomach can cause a chemical burn of the esophagus and result in a bad case of heart burn, called esophagitis.  This results in poor motility of the esophagus, therefore water and food will accumulate in this structure.  In most cases, esphagitis is self-eliminating and will resolve within two or three days.
          o If the esophagitis is severe the esophagus may develop one or more strictures.  A stricture is a narrowing or stenosis of the esophagus and does not allow passage of food down the esophagus, in regurgitation that lasts longer than one week.  This problem should be brought to the attention of your pet's doctor within the first two weeks so that it can be treated by ballooning the stricture (minimally invasive procedure, as it is done with the aide of an endoscope).  If an esophageal stricture is chronic surgery is needed.
          o Symptomatic treatment of regurgitation caused by esophagitis includes feeding bland food, and administering a coating agent (sucralfate) and an acid blocker (omeprazole or other).  Consult a veterinary health care professional if the regurgitation continues for more than a couple of days.

How do I know that my dog is in pain following surgery?

    * Signs of pain include
          o crying
          o biting if you get near the surgical site
          o grimacing (lips are pulled back and the the dog looks anxious)
          o tragic facial expression
          o panting
          o restlessness and unable to sleep; pacing
          o if abdominal surgery was done the pet will not lie down on the incision, or will continually sit up in spite of appearing very tired
          o the worst pain will be for the first 2 to 3 days after surgery

What can I do to control my dog's pain?

    * Narcotic medications that control pain: tramadol, butorphanol, Duragesic (fentanyl patch)
    * Anti-inflammatories used to control pain: Deramaxx, Rimadyl, Previcox, or Etogesic
    * If an orthopedic surgery has been done cold packing the surgical site may be helpful
          o A cold pack may be a pack of frozen peas, crushed ice in a Ziploc bag, or a cold gel pack; place a thin barrier between the skin and the cold pack.  An alternative to a cold pack is to freeze water in a styrofoam cup; after frozen cut the bottom of the styrofoam cup out. Cool the surgical site around the incision by rubbing the exposed ice directly on the skin in a circular pattern.  Cooling the surgical site helps to numb the area.

How do I know that my cat is in pain following surgery?

    * Pain is more difficult to assess in cats versus dogs, as signs can be more subtle and they usually do not vocalize when in pain
    * Signs of pain in a cat include the following:
          o biting if you get near the surgical site
          o growling or deep cry
          o not wanting to eat
          o hiding and not wanting to be near owner (remember that this could also be caused by the cat just being upset about leaving home and coming back)

What can be done for pain at home for my cat?

    * Pain medication such as buprenorphine or a Duragesic (fentanyl) patch
    * Tylenol will kill a cat as they lack abundant glutathione enzyme in the liver
    * Anti-inflammatories can be used, but the dose is much less than dogs

Is it okay for my pet to lick the incision?

    * If a dog licks the incision, the healing process may be delayed.
    * Licking can remove stitches and cause the incision to open
    * Licking can become a severe habit that is difficult to break
    * Licking can cause infection as the mouth has many bacteria
    * Dogs will frequently lick the incision when the owner is not watching such as at night time; if the skin looks red or excoriated the most common cause is from licking.
    * To stop your pet from licking the following can be tried:
          o Elizabethan collar can be placed on the neck; this will not help stop your pet from scratching at the region
          o Cervical collar (bite not collar) is a less awkward device and can be effective at stopping a pet from licking the surgical site
          o A tee shirt can be used to cover an incision on the chest or front part of the abdomen; gather the waist of the shirt up over the dog's back and wrap an elastic band around this part of the shirt.
          o A bandage or sock can be used to cover an incision on a limb; fasten the top of the sock to the dog's limb with tape.
          o Bitter apple can be applied around the incision; many dogs will continue to lick  after application of this topical
          o Bitter Apple and Liquid HeetTM (obtain this from a drugstore...it is used for sore muscles) mixed in a 2:1 ratio can be applied around the skin incision
          o Antipsychotic medication in some cases is needed
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kahlua
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« Reply #2 on: February 02, 2011, 10:48:37 PM »

Pyometra & Infections of the Uterus in Dogs
Drs. Foster & Smith, Inc.
Marty Smith, DVM

Source: http://www.peteducation.com/article.cfm?c=2+2109&aid=918

Pyometra is a disease mainly of middle-aged female dogs that have not been spayed. In the past, we thought pyometra was simply a uterine infection, but today, we know that it is a hormonal abnormality, and a secondary bacterial infection may or may not be present. Pyometra follows a heat cycle in which fertilization did not occur. Typically, within two to four months after the cycle, the female starts showing signs of the disease.

What causes pyometra?

The two main hormones produced by the ovaries are estrogen and progesterone. An excessive quantity of progesterone, or the uterus becoming oversensitive to it, causes pyometra. In either case, cysts form in the lining of the uterus. These cysts contain numerous secretory cells, and large quantities of fluids are produced and released into the interior of the uterus.

Female Reproductive TractThis fluid, along with a thickening of the walls of the uterus, brings about a dramatic increase in the overall size of this organ. The uterus is made up of a body with two horns. In the unaffected dog or cat, the horns are smaller than a common pencil. However, in cases of pyometra, they become large, sac-like pouches the circumference of cucumbers and 12 to 18 inches long. Normally, the entire uterus in a 40-pound dog will weigh two to four ounces, but in cases of pyometra, this typically ranges from one to four pounds.

As the disease continues, fluid spills out of the vagina causing the animal to lick this area in an attempt to keep itself clean. Bacteria commonly colonize the uterus by entering through the cervix. This produces an even greater response by the body, as it showers additional fluid and white blood cells into the affected organ.

After a while, the cervix closes. This effectively traps all of the fluid within the uterus. Still, the body continues to transfer more fluid and white blood cells into the organ, causing even further dilatation and growth. The uterus can rupture, spilling its contents into the abdominal cavity. If this occurs, the dog or cat usually dies in less than 48 hours. In most cases, this does not happen.

The body will attempt to eliminate the problem by carrying the wastes and excess fluid through the bloodstream to the kidneys. However, the amount of material in a dog with pyometra is too great to be eliminated in this fashion, overloading the kidney system. The normal toxins that should be excreted from the body build up, and the animal goes into uremic poisoning. Untreated, she will die from kidney failure.

Symptoms

As the body attempts to flush out the build-up of waste products through the kidneys, the animal will drink excessive quantities of water (polydipsia) and urinate large amounts frequently (polyuria). She will lick at her vaginal area while the cervix is still open and the uterus is discharging a white fluid. She may run a low-grade fever and if blood work is done, she will show an elevated white blood cell count. As the uterus increases in size and weight, the dog shows weakness in the rear legs, often to the point where she cannot rise without help. As the dog enters kidney failure, she stops eating and becomes very lethargic.

Treatment

Since toxicity may develop very quickly in dogs with pyometra, it needs to be treated promptly. Dogs will receive intravenous fluids, usually for several days, and antibiotics. In most cases, the preferred treatment is a complete ovariohysterectomy (spay). This removes the ovaries, oviducts, uterus, and all associated blood vessels. These animals can be a surgical challenge because of their poor overall condition. In some females valued for breeding, prostaglandin and antibiotic therapy may be tried instead of surgery. The prostaglandin is given for 5-7 days and causes the uterus to contract and expel the fluid. In mild cases, when the cervix is still open and the fluid is draining, the success rate is excellent. This therapy should only be used in dogs 6 years of age or younger, who are in stable condition, and have an open cervix. Prostaglandins can have side effects, especially after the first dose, including restlessness, panting, vomiting, increased heart rate, fever, and defecation.

Prevention

The best prevention is to have all female animals spayed at or before six months of age. If the animal is used for breeding, then spaying the animal after she is past her breeding years is highly recommended. Pyometra is a fairly common and serious problem and is just one of many compelling reasons to have your female pet spayed at an early age.

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kahlua
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« Reply #3 on: February 02, 2011, 10:52:50 PM »

Pyometra ('pyo' or womb infection)

Source: http://www.stortvet.com/html/pdf/Factsheets/Dog/24_265517.pdf

Pyometra is a common disease in un-neutered female dogs that requires major surgery to cure. Though potentially very serious, many animals respond well to the treatment and
can expect to make a full recovery. The best way to protect your female pet against pyometra is to have her neutered.

What is pyometra?

Pyo = pus, infection; metra = womb or uterus

Pyometra is a serious infection of the womb resulting in the accumulation of infective fluid (pus) within the cavity of this organ. It is usually seen in older, female cats and dogs who have not been neutered.

Pyometra may be classified as open or closed. In open pyometra, a common sign is a discharge from the vagina. This discharge may be bloody or yellow or cream coloured. In closed pyometra, no discharge to the exterior occurs. If the pus does not drain out though the vagina, your dog may become very sick and develop toxaemia (blood poisoning). The presence of this poison in the body has serious effects on other body organs and systems and can lead to life-threatening conditions such as kidney failure. Untreated, pyometra can cause death from dehydration, toxaemia and kidney failure.

A less common problem, stump pyometra, occurs in females who have been spayed (neutered), but in which a small remnant of womb remains within the body and becomes infected. Because only a small amount of womb is present, signs tend to be less severe, but this condition also needs treated to prevent complications.

What causes pyometra?

Each time a female has a season (usually about twice a year) she undergoes all the hormonal changes associated with pregnancy - whether she is pregnant or not. The changes in the womb that occur with each cycle make infection more likely with age. Infection is usually caused by a very common organism called E. coli. The disease often occurs in the weeks or months following a heat or season period. Injections with some hormones to stop seasons or for treatment of other conditions can also increase the risk of pyometra developing.

What are the signs of pyometra?

Pyometra is obviously only seen in females (since males do not have a womb). It is more common in older females (above 6 years of age). The signs usually develop around 6 weeks after the female has finished bleeding from her last season. Early signs of pyometra may not be very obvious. You might notice that your pet is just licking her back end more than usual. She may be off colour and off her food. Often she will be very thirsty and because she is drinking so much may start to wet in the house. Sometimes the pus escapes from the womb and a reddish-brown or yellow discharge may be seen at the vulva. As she gets more ill she may start to vomit, become very depressed and unwilling to get out of her bed.

Symptoms are likely to worsen over a period of days to several weeks. If untreated signs progress to dehydration, collapse and death from toxic shock.

How do vets diagnose pyometra?

Your vet will probably suspect what is wrong with your pet from your description of the symptoms although they may want to do some other tests to confirm the diagnosis and also to make sure that your pet is well enough to withstand an operation. Blood tests may be taken to see if the toxins from the infection have entered the blood and could be affecting organs elsewhere. X-ray and ultrasound examinations may be undertaken to confirm that the uterus is enlarged.

Is there any treatment for pyometra?

Once the diagnosis has been confirmed your pet should have an operation to remove her womb as soon as possible. This is the same operation as carried out to routinely spay a female dog, however in a sick animal suffering from pyometra it carries much more risk. The risk of not operating is even higher; most animals will die if surgery is not performed. If the womb is not removed, toxins are released from the infection which get into her blood and make her more and more ill. Eventually these toxins can cause kidney failure.

Before performing the operation your vet may want to give your pet some fluids (into her vein) and antibiotic treatment. Surgery might be delayed for 12-24 hours to give your vet time to get your pet into a better condition to tolerate the surgery. She may need to stay in hospital after surgery for continued treatment.

Very occasionally dogs have been treated with special hormone injections to empty the womb without having to perform an operation. However, this treatment is only considered in valuable breeding bitches and is often not successful.

In very old animals with pyometra and clear evidence of organ failure, eg kidney and liver failure, or where other major problems such as serious heart disease exist, euthanasia may be the kindest option.

Will my dog get better?

Pyometra is a serious disease and unfortunately a proportion of patients will not pull through despite treatment, owing to organ failure and complications. Overall, many dogs and cats do recover remarkably well and it is certainly well worth pursuing treatment.

If your pet recovers from the operation then there is a good chance she will return to her former health. In fact many owners report that after the operation their dog or cat is better than she had been for a long time before. It may be that the infection had been building up for a long time before the animal became really ill.

How can I stop my dog getting pyometra?

The only way to be sure your pet won't develop this condition is to have her neutered. If you are not intending to have puppies from her then she should be neutered at as young an age as possible. Not only does this remove all the complications associated with the reproductive cycle but, if a female is neutered before her first season, she is also protected against mammary (breast) cancer developing in later life. Ask your vet for details about the best time to have your pet neutered.

Although pyometra may be more common in bitches that are not neutered and have never had puppies, it is not exclusively a disease of these animals. Breeding does not guarantee protection and indiscriminate breeding of pet dogs and cats is not to be encouraged.

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« Reply #4 on: July 18, 2011, 11:37:54 AM »

Just saw this now, nice post  ayos!

I had a female golden that got pyometra when she was old, our vet never told us about the risk of pyomtera.
We had no choice but to do emergency spay surgery and she was lucky to survive it.
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« Reply #5 on: July 18, 2011, 12:53:41 PM »

Need to practice the RH bill on our pets.  Grin

An emergency spay is so much more expensive (and risky) than a normal spay - so hopefully more people consider this for their pets.
« Last Edit: July 18, 2011, 12:54:32 PM by kahlua » Logged

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