Wednesday, August 29, 2012

1067. Pyometra in 3 Miniature Schnauzers reviewed

Yesterday, I reviewed 3 cases of Miniature Schnauzers with closed pyometra.

CASE 1. This was operated by me in 2009. The father prohibited surgery as the first dog died when given by an injection by Vet 1. However, the dog continued vomiting and so there was no choice. The surgery was a success but the dog continued vomiting. I had already told the young lady that the blood tests revealed kidney failure before I operated. The dog did survive but since the kidneys had failed, she vomited for the next 10 days. Euthanasia was done. This was a case whether the older baby-boomer generation has not much knowledge of the high fatality of procrastination in seeking surgery early.


CASE 2. In this case, operated by my associate vet recently, the older baby-boomer generation was the 60-year-old mother who did not want any surgery in case her vomiting dog died on the operating table. vomit and so why not wait. My associate vet warded her for 3 days with treatment given. One sister (Sister 1) took the dog back as the dog did not vomit. Conclusion was that the dog had some stomach infection. Then on the next evening, she brought the dog back and told me she was vomiting again. I was on reception duty and that is the best place to pick up complaints and feedback from clients. Three days had passed and the mis-diagnosis was gastritis. I examined the dog in the presence of the associate vet (Vet 1).

"A history of heat somewhere around Christmas" Sister 2 meant that this dog had heat around June. Now it was August, 2 months after the end of heat and so it was possible that pus had accumulated in the Schnauzer and caused vomiting.  Abdominal swelling and pain on the lower 1/3 of the abdomen.

"It is closed pyometra," I based my diagnosis on the 3 factors mentioned above. "An X-ray will be useful but it is not necessary. The solution is to spay her soon." The sister did not believe me. Vet 1 stuck to the diagnosis of stomach infection (gastritis) as the history given was that the heat period was more than "3 months ago" or "unknown" and advised an X-ray of the abdomen. So there was a delay of one day. "How's the X-ray interpretation?" I asked the associate vet. "Is there closed pyometra?" Sister 1 came and requested that the operation be done the next day as Vet 1 was busy with cases till past 8 pm during her visit. and Sister 1 wanted a vet who would be not so tired doing surgery. This is the situation with multi-family interactions on the veterinary duties.  "This dog could still be operated after 8 pm," I said but since Sister 1 had said so, I did not object. This closed pyometra dog had already been over 6 days since the first consultatio by Vet 1 and delays in surgery are not good for the dog's health and prognosis.

Vet 1 did not think the X-ray showed closed pyometra although I disagreed with Vet 1.  "However the owner did not mind getting the dog spayed," Vet 1 said.

Spaying showed closed pyometra. The dog was standing and barking the day after the operation. However, post-op complications set in after 3 days of hospitalisation. Complications of wound breakdown do occur in surgeries for all vets. The dog became recumbent and the 3 sisters and mother were visiting her every day. "Why is the dog vomiting?" one sister asked me at one visit one evening. I told her that the dog would be operated by Vet 1 to close the stitch. Vet 1 operated late at night at around 10 pm on Aug 27, 2012. A drainage tube was inserted. As post-op complications do happen, I monitored this dog daily.

Yesterday, Aug 29, 2012, she started eating, wolfing down the steamed fish but ignoring the whole bowl of cut pears yesterday morning at 10 am. The mother had cooked the fish and came to give her the food. On Aug 28, 2012, this dog also wolfed down the fish given by the mother.

 "Since she eats the food fast, she has recovered from the operation," I said to Sister 2 who came yesterday evening to visit and asked me if the dog could go home. Vet 1 was busy consulting and could not spend time with multi-family visits.  "We have to wait and see the next few days," I said to Sister 2.        


CASE 3. Another Schnauzer with closed pyometra was operated by Vet 1 on Aug 28, 2012. The uterus was packed full with pus, much fuller than that of Case 2. In the evening, I could see that the dog post-op was not well. She was shaking in her body and then she pushed her head against the crate's bar, as if trying she had headache. "What's wrong with the Schnauzer? She looks very sick," one young lady who was visiting her vomiting Shih Tzu hospitalised asked me. I told her that the dog had an operation.

I had seen such head butting against the crate behaviour from distemper puppies with fits and it is not a good sign of health. The young lady owner came in the evening and wanted to take this dog back. "A dog that is not eating should be hospitalised and given drips," I said to her and Vet 1. "Why is the dog not on drips?" I asked Vet 1 who was preparing to send the dog back home as requested by the young lady who would not be in Singapore till the next Saturday (10 days later).

Vet 1 said, "The dog flung off the IV set." I said to Vet 1: "If the dog dies at home, all the family members will not only bad-mouth you, but also Toa Payoh Vets. This dog should not be allowed to go home (to give her a better chance of survival on IV drip. The lady owner had been shown the swollen pus in the uterus). I could not believe that the young lady wanted the dog back on the same day after surgery as most owners accept the vet's advice. Maybe it was economics, but here there was the dog successfully operated but could die a few days later due to the lack of IV drips.  "Get the owner to sign a letter stating the possiblity of death and that the dog was discharged against medical advice by you and I," I instructed Vet 1.

It is tough nowadays for vets as clients want their own way. But there must be a firm action to let the lady owner and her family members know that the dog could die due to the lack of post-op IV support. The vet has to be alert and mindful of the consequences of the failure of IV support since this dog was not in good health. The young lady phoned her family. I noted that the dog was hospitalised. In this case, it was likely economics.

In conclusion, in all 3 cases, had the dogs been spayed when they were younger and healthier, closed pyometra would never be present and much financial expenses and more worries would not be present. But many Singaporean owners think it is cruel to spay the dog. So, there are more cases of pyometra seen and it is not guaranteed that a dog that survived the operation would remain alive after surgery as you could see in Case 1.

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