4. Pyometra in a toxaemic Golden Retriever

"Flies just would not go away when I swat them," the 65-year-old grandmother with a fair 5-year-old grandson came to the surgery. She was surprised at the tenacity of flies: "They just swarm onto the dog's vaginal discharge."

This was not good news. Flies are attracted to decaying flesh as moths are to candle light. Kamikaze flies who just cannot resist necrotic flesh.

The 12-year-old Golden Retriever had some vaginal discharge 2 months ago. The grandmother attributed it to the dog having heat. In the last 4 days, the dog passed out thick glue-like mucus from her vagina. She stopped eating for 2 days and had vomited.

"Your dog had a severe womb infection. She vomited because toxins could have damaged her kidneys and internal organs, " I did not give much hope of survival for this dog. "Why didn't you spay the dog after the breast tumour operation?"

My past procedure was to remove the breast tumour first and then spay the female dog later. In this way, hormones feeding any new breast tumour would not be available after removal of the ovaries.

The slim and fair grandmother laughed: "You said that XXX would not survive 9 months as her cancer could have spread to her body. Can you recall? breast cancer was as large as a tennis ball!"

I checked my records. It was September 2005 when the large breast tumour was removed. It was a solitary gigantic lump as large as a tennis ball. Now, in Jun 2008, the dog had a long scar where the tumour was. There was a small breast tumour around 2 cm in diameter.

My 'prediction' of 9 months' of life for this Golden Retriever had been way off the mark. It was now 33 months after tumour removal. Why would I give a definite 9 months, I cannot remember. Why not 3 months or any other number? No vet can foresee the future. But I did not argue as the grandmother had a sharp memory.

Now the dog was very sick. She had fever of 40.5 degrees C. She was not eating. She yelled in protest of great pain on the operating table when I stretched her legs to see the long 15-cm scar of the tennis-ball-sized breast lump.

She was now in poor health. If flies just zeroed into her vaginal discharge, it indicated that her womb tissues had rotted. Flies are suicidal and sticky when the tissues and discharges stink a lot. They seem to appear from nowhere and are large bodies flies from the vegetation near the house.

The grandmother understood the big risk of dying on the operating table. I boarded the dog one day to give her antibiotics, anti-fever and drips. The dog felt good 24 hours later and ate a full meal after canned food was added.

Now I had to decide. To operate 36 hours after admission or wait another day? The infected womb might rupture anytime as it was decaying. Her temperature had dropped to 37.5 degrees C, one degree below normal. She was sleepy and lethargic. This was a life and death situation. If the surgery was delayed another day, she would die due to toxic blood infusing her whole body. If the surgery was performed, she might die on the operating table as chances of survival were deemed below 50%. So, which decision to make?

The dog was given just gas anaesthesia and intubated. Her large thin-walled uterus and ovaries were removed. The reddish brown pus was copious. Bacterial toxins had seeped into the blood system by permeating past the uterine walls. The uterine horns were purplish in colour when the normal ones would be light pink.

The dog survived the surgery. After waking up, she vomited a big mass of food on the operating table. I had taken out the endotracheal tube some 2 minutes ago.

This was an abnormal event as she had been starved >12 hours prior to surgery and should not vomit anything. This indicated that the stomach was not moving the food along the gut. Another abnormal feature was the dark bluish black blood of her omental blood vessels. Normally they would be reddish.

Such negative signs were not good for the dog. I phoned the grandmother to come to see the dog after surgery which was completed around 11 am. I assessed that this dog would not survive and it would be good for the grandmother to see her. She was the dog that brought newspapers to the grandmother every morning and kept her company. However the grandmother's two adult sons needed her at the airport - one going abroad and one returning to Singapore.

At 7 p.m, the Golden Retriever just passed away quietly due to heart failure. Her gums and tongue were cyanotic. We informed the grandmother. She came around midnight.

5 days later, the grandmother came to pay the bills. "My daughter said there would be nobody in your surgery during lunch-time," grandmother said. "But there ought to be somebody."

Grandmother was correct. I had just returned from visiting abalone farms in Xiamen, China.

Grandmother was sad in her heart. Every dog's death is saddness for everyone involved. I asked grandmother to sit down and we reminisced in the consultation room. Just to know more about XXX.

Grandmother said, "XXX dog behaved strangely the night before going to the vet. She dog walked around the house and went to the back garden to stroll by herself."

"Does XXX not wander around usually?" I asked as the bungalow would have ample garden for her to roam.

"No," grandmother said. "XXX does not go to the back garden by herself at night."
"She also went to my daughter's bedroom to sit and wait patiently."

"Why would she do it?" I asked.

"She waited till my daughter gave her a second piece of Pokey biscuit. My daughter said to her 'You are permitted only one Pokey biscuit. Go away. Mommy will scold me'" the daughter told XXX off.

"But XXX would not go away. My daughter gave her a second Pokey biscuit stick and after eating it, XXX left."

Was the dog saying good-bye to the family members and the house? It is hard to explain such behaviour. Some animals might know that their life would be ending soon and wanted to say good-bye.

Grandmother stoically said to me: "My grandson keeps asking when Jesus will bring XXX back." The 5-year-old was too young to understand that death was permanent.

Would spaying her when she was younger prevent pyometra and prolong her life? Without the womb, she would not have pyometra and therefore would live to a ripe old age of another year or two? It is hard to say. Anaesthesia in dogs older than 8 years are high risk.

No vet can be assured of 100% survival in such cases. Sometimes it is best to pass such high risk cases to other vets. The daughter still grieved her loss daily for the past 5 ddays. "I guess she would be angry with me," I said to the grandmother. No comment from her.

Grandmother was stoic. Her friend had just got a stroke. She was widowed some 2 years ago and had now fortified herself.

"This dog was adopted as a puppy when there was a newspaper advertisement in the Straits Times looking for homes for the puppies to be given free," grandmother recalled. "I saw the advertisement when the newspapers were delivered at 5 am. Usually papers come at 7 am. So I went with my two sons and the owner gave us XXX. XXX used to bring the newspapers into the house every morning."

Grandmother had lots of work to do with so many dogs and children. "At one time, I looked after 8 dogs. Friends asked me to care for them for a while. They just did not come back for the dogs. I have 3 children to cook for and look after."

What an active energetic life, grandmother must have had. Though she was now 65 years of age, she looked much younger and trimmer than a 50-year-old. Usually grandmothers look matronly but she was a model for the slimming saloons.

"I cured one terrapin with enlarged closed eyes just by researching the internet," the grandmother said to me. That was great news. Most Singapore women of her age would not touch the computer.

"I can remember important dates and do calculations fast," the grandmother reminisced. "I would tell my children the price per kg for things they bought. But lately, I am not able to calculate so well."

It was good that she came during lunch time as we had some time to talk about the dog. "I can't stay long to chat," grandmother suddenly saw that time had passed so fast. "I have to go to Hong Kong,"

"Why do you have to rush to Hong Kong?" I appreciated the grandmother taking the trouble to pay the bills without being asked to do so.

"To look after my grandson for a week while my son and his wife had to go on holidays" she said. "There are two maids looking after him too."

All grandsons must surely love her very much but the one who loved her the most was the 5-year-old boy who stayed with her in Singapore. This 5-year-old boy came with the grandmother during the consultation and later around midnight to see the dog. A fair-looking boy with big eyes. He asked his grandmother for the past days with questions the grandmother told me, such as:

"Why Jesus take away XXX?"
"Why XXX has not come home?"
"Only one (pre-school) classmate knows when I said that XXX had gone to see Jesus."

The grandson had come with the grandmother during consultation as his pre-school had closed due to the presence of hand-foot-and-mouth disease prevalent in Singapore at this time.



It is extremely high risk to operate on toxaemic pyometra and old dogs. If the owner had returned to get the dog spayed one or two months after the breast tumour removal in 2005, this dog might still be alive. She might have died during the spay surgery too but the probability of her dying on the operating table when she was 10 years old would be much lower.

Singapore owners generally have not reached a high level of awareness stage that the dog must be spayed after removal of the breast tumour. They just forget about the spay once the tumour is removed. It is not prudent to remove the breast tumour and spay at the same time in old dogs as the prolonged anaesthetic time increases the risk of death on the operating table.

My present procedure would be to spay the dog first. If the owner did not return to get the breast tumour removed 2-4 weeks later, the female hormones feeding and growing the tumour would be removed as the ovaries would be taken out during the spay. Ideally, spay and mammary tumour removal should be done at the same time. But the surgery would take a long time and at the end of the long surgery, the dog might die on the operating table.

No family member can forgive or forget a death on the operating table. So it is best not to take foolish risks.