3. Pyometra in old female dogs - To spay or not to spay? Is there a choice?

DRAFT - CYSTITIS + PYOMETRA IN AN OLD DOG


From: ...@singnet.com.sg>
Subject: Question re Dog Licking Herself More Often
To: drsing@toapayohvets.com
Date: Tuesday, June 24, 2008, 6:31 AM

Hi Dr. Sing,

It has been a while since we last corresponded.

Can I please get your advice as my dog XXX has been licking her private parts
more often recently? There's no discharge on the floor, and she's
eating per normal and active as usual. Normal urine and poo too. However when I
check inside her vulva, I see a clear discharge. It isn't much and
doesn't ooze or drip out of her body too.

Her vulva is not swollen or red; it is just normal in colour with one or 2
faint tinges of pink. When I check, her vulva feels soft to the touch, but the
part right after that, i.e. the area between the vulva and the anus, feels
firm/hard to the touch. Is that normal? NO

Is
there anything I should worry about? FYI, XXX is 9 years old and unspayed.

Could her licking be related to the possibility of her coming into heat soon?

My dog's last heat was in Feb 8 through 25. The one before that was in Sept
23 through Oct 11. It was 5 months or 20 weeks between last year's heat and
the most recent one in Feb. Do you think my dog is going on heat again soon?

When does a female dog start licking herself before her season? 2 weeks before
or?

Please advise. Thanks very much!

Best regards,
Name given

E-MAIL REPLY JUNE 24, 2008
Re: Question re Dog Licking Herself More Often - PYOMETRA
Tuesday, June 24, 2008 9:20 PM
From:
"David Sing"
View contact details
To:
...@singnet.com.sg
Cc:
drsing_98@yahoo.com

Most likely on-line diagnosis (which is not recommended or advised) is that your dog is suffering from open pyometra. In this condition, the womb of the old dog has been infected by bacteria. Large amounts of pus are produced inside the uterine tubes.

Toxins from the bacteria get into the bloodstream to damage the kidneys and other organs. In time to come, the dog cannot cope with the licking away of the copious flow of vaginal discharge. The dog gets septicaemia and starts vomiting more and more often.

The only treatment of pyometra is surgery to remove the womb and ovaries (spay). Pyometra can be an emergency in many cases as many Singapore owners delay treatment thinking that the unspayed female dog is just having heat.

I just had a 12-year-old Golden Retriever with "heat" 2 months ago. (I presumed the dog licked her vaginal discharge so the owner did not see any more discharge). 2 weeks ago, sticky yellow vaginal discharge attracted flies which would not be swatted away. She vomited 2 days before surgery. Would not eat.

Depending on its health status, some dogs die before, during or after surgery. As many Singapore pet owners consider spay as "cruelty" but are uneducated as to what is pyometra, they often seek surgical treatment very late and the vet sometimes gets blamed for the death of the dog during or after surgery.

In your case, you have no choice but to see your vet and get a professional examination and opinion. It seems that your unspayed dog has been infected for some weeks. Female dogs spayed when they are young will not get pyometra for obvious reasons - they don't have the womb. There are pros and cons of spaying.


UPDATE ON JUNE 25, 2008
Dog seen on Jun 25, 2008

Active, eating. No fever. Bad teeth and infected gums.
No copious vaginal discharge. A dot of pus seen on tissue paper.
Had a urine test at another vet some time ago - protein ++ in urine.

Palpation of uterine horns: some swelling felt. Around 1 cm thick uterine horn.
Palpation of bladder. The dog "yelped" and hunched her back, indicating acute pain response at the area where the bladder and uterine horns are located. It was good that the owner saw the pain response.

Diagnosis: Pyometra and likely a bladder infection. Owner said the urine is clear.

Advice: Antibiotics for 10 - 20 days. Spay on around 10th day. Dental work around 60th day.
On Day 2 after consultation, owner said that the vulval swelling had subsided.

This is a case of early pyometra. As the owner is close to the dog, she noticed the dog's unusual behaviour of licking the vulva. As to chances of survival during or after spay operation, this dog has a 75% chance of survival after antibiotics for 10 days. No vet can guarantee 100% for any old dog under anaesthesia.

Blood tests and X-rays will add to veterinary costs but some owners may not want to incur high costs. Surgery and general anaesthesia at Toa Payoh Vets is around S$500 - $1,000.


E-MAIL ON JUN 29, 2008

From: ...@singnet.com.sg>
Subject: FW: Kong Yuen Sing sent you a message on Facebook
To: drsing_98@yahoo.com
Date: Sunday, June 29, 2008, 1:54 AM

Dear Dr. Sing,

Thanks so much for your
detailed replies to my questions as usual.

My dog seems to be much better after starting on the antibiotics. The redness
on the vulval/anal area has gone off a fair bit, and most importantly, she
has not been licking her vulva that much. I observe her very closely and I see
her licking her vulva only once or twice a day. So that means that the
antibiotics are working very well as they should now that it's Day 4 on the
antibiotics. I'm glad we listened to your advice to put her on the course
of antibiotics first before the surgery.

You mentioned that if "IF THE INFECTION HAD GONE AND THE WOMB IS BACK TO
ALMOST NORMAL SIZE, I CAN HOOK IT UP. INCISION WILL BE LIKE THE USUAL SPAY
INCISION. AROUND 1-1.5CM.

IT IS POSSIBLE THAT I CAN HOOK THE WOMB OUT IF IT REVERTS TO NORMAL SIZE AFTER
ANTIBIOTICS. IN SUCH SITUATIONS, THE BEST TIME TO SPAY HER IS 1 MONTH
LATER."

I thought a lot about what you said, but I don't think we can wait as my
dog's last heat was Feb 8 through 21, so she is due for her next heat very
soon, whether she has a 5-month or 6-month period in between cycles this time.
If she goes on heat again while we are waiting, then we will need to wait
another month or so. Moreover, she had a UTI or bladder infection after her
heat the last time, so I'm concerned she will get the same problem again if
we let her go on heat naturally.

I am planning to let her undergo surgery as scheduled this coming Friday 4
July. It will be Day 9 of the antibiotics.

Do I give her the antibiotics on Friday morning even though she has been
fasting since 8 PM on Thursday night?

Will you be able to tell from palpation of her uterus whether it has gone back
to almost normal size, before you start the surgery, and thus decide whether to
hook out the womb out (and have a smaller incision) or open her up
slightly more
(and have the 4 cm incision) ?

How much would your transport man charge for a one-way trip from your clinic to
my home in Woodlands St 82, if I can't pick her up myself?

Thanks & best regards,
XXX

E-MAIL REPLY JUN 30, 2008
To:
...@singnet.com.sg>

No antibiotics on day of surgery.

Not able to palpate the size of uterine horns in your dog if it is small due to recovery from bacterial infection.Will try to hook out first.

I believe the transport man (independent contractor) charges $50 but you can pick up your dog even late towards midnight as we have somebody around or let her rest till the next day. You need to phone us first.