Monday, February 27, 2012

886. Closed pyometra email


E-MAIL TO DR SING DATED FEB 28, 2012



Hi Dr Sing


I would appreciate your advice on my dog's case.


My dog is an unspayed female Shih Tzu whose age is estimated to be around 5-6yr old(no exact age as we adopted her when she was found abandoned and in bad condition). Her weight is 3.95kg.

Her last heat ended around 30th November 2011.
She is suffering from bad case of skin problem and is drinking more water and has slimmed down. Her appetite is good with no vomiting and diarrhoea. No discharge or blood in urine observed.


I sent my dog to the vet for her skin problem and the blood test results showed elevated WBC (26.92+). As she is observed to be drinking more water coupled with elevated WBC and her unspayed status, the vet suspected it might be closed pyometra.

No X-ray or ultrasound was done due to financial concerns. Skin scrape was negative for demodex. According to the vet, blood work showed no other abnormalities. However, her T4 readings is quite low (1.3) on the normal range (1.1-4.0 UG/DL).
I can email you the blood work results once I get them scanned should you require them.

Vet prescribed Baytril 50mg tablet(1/2 tablet daily) and to recheck in 2 weeks time. She is also too skinny and vet gave Troy Nutripet gel to supplement her diet.


I am very concerned about the dangers of pyometra and would like to seek your advice. As her body is already stressed by her skin condition and her malnourished state, I am very lost.
I do not know if putting her on the antibiotics and supplementing her health in preparation for the surgery while observing for sudden changes before the next consult would be advisable? Or should I just opt for early surgery since her bloodwork suggests generally healthy organ functions.
Do you think it is possible for her to be operated by you without performing the imaging tests? What is your estimated total charges for the surgery? Please kindly advise. Thank you very much.


Best Regards
Name given




E-MAIL REPLY FROM DR SING DATED FEB 28, 2012


E-MAIL REPLY FROM DR SING DATED FEB 28, 2012

I am Dr Sing. Thank you for your email.
It is risky to diagnose closed pyometra by email without examination of the patient. I will give you my opinions based on your email report on the understanding that it is best to have an examination by me, if practical.


1. Closed pyometra occurs in a dog that has her heat period around 2-3 months ago and your dog was in this situation. She had increased white cell count and was drinking more. I presume she has weight loss over the last 2-3 months. Pl email your vet's reports and blood test results.

2. However, skin disease and poor health can also cause increased white cell count and thirst due to skin infections and itchiness. Drugs may also increase thirst or appetite if your vet had earlier treated the dog.

3. As your dog has good appetite and no vomiting, it is possible that, at the time of consultation, she does not have closed pyometra, assuming she had not been given any drug to treat her skin disease or other health problems.

QUESTIONS

3.1. Did your vet palpate the abdomen and let you know the results of his or her palpation as to whether he or she felt an enlarged uterus? Abdominal palpation is an alternative to X-rays and ultrasound and if the uterus is enlarged, it can be palpated by the vet. Closed pyometra can be confirmed just by palpation but imaging is sometimes necessary to "convince" the owner of the presence of the enlarged uterus.

3.2 Did your dog have fever at the time of consultation? What was the rectal temperature?

3.3 When did the weight loss start? Was it after November 30, 2011 or was the dog losing weight for many months?

4. In reply to your questions about spaying your dog without imaging, it is possible. My estimated charges for the operation would be around $250-$300 for a normal spay and around $500 - $600 for a pyometra spay as this takes a longer time and requires IV drip.

5. It is prudent to wait 2 weeks or longer for your dog to recover from the infection and put on weight, before any spay surgery is attempted. The skin disease should be cured first. The cause of the weight loss may be due to the start of closed pyometra if weight loss is recent.

Another blood test can be done to check the total white cell count prior to surgery, if possible.

6. Closed pyometra is sometimes difficult to diagnose when the uterus is not full of pus. Usually there is loss of appetite. Yet you said your dog has "good" appetite but is losing weight. Why? A typical Shih Tzu with good appetite at middle age should be weighing more than 3.95 kg, at around 5-6kg. Therefore, I don't think that your dog has "good appetite."

I hope the above answers your questions.

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