Sunday, November 14, 2010

202. Golden Retriever with yellow discharge

"I did not want to spay her when you advised," the mother said. "I was worried about the death during anaesthesia." Now, the dog had lots of dirty vaginal discharge and I said; "She is suffering from pyometra - a womb infection." It is best to spay her as soon as possible"

The dog came in at night. My associate vet diagnosed pyometra and put her on a IV drip with antibiotics. He would operate the next day.

I had not seen this dog for some years after the initial first 3 vaccinations. The worried mum phoned me. "My associate vet is able to perform this surgery," I said. "Pyometra is one of the common surgeries."

However the mum insisted that I operate. So I took over the case from my associate vet who had no hard feelings over this as the dog was under my care since puppyhood.

As the owner was very worried, I had the dog on IV drip and antibiotics for 3 days. She had an excellent appetite on 36 hours after being seen to, but still it was safer not to rush into surgery as scheduled. Total white cell count was high indicating a bacterial infection of the blood system. It would be best to kill all bacteria using antibiotics

Dog was 33 kg. Domitor 0.3 ml IV was given. Gas mask using isoflurane gas was inhaled for 15 minutes as this dog was now stronger now after the 3 days of IV and antibiotic. I intubated her and maintained her on isoflurane gas. In retrospect, Domitor could be given at 0.4 - 0.5 ml since no other sedatives like Zoletil were added. But isoflurane gas is the safest way.

A big swollen uterus, as in closed pyometra. As thick as the bigger hot dog you will see during barbecues. Some cysts appeared in one uterine horn near the ovaries. I took a picture for reference. Normally no cysts are seen but pyometra is cystic endometrial hyperplasia complex. So cysts are usually found inside the uterine tubes but these cysts were outside.

The dog was sent home 48 hours after surgery. She was not seen again as she had licked off her stitches on the 10th day. In any case, the stitches were self-dissolving.

Closed pyometra does present with vaginal discharge as the cervix opens during the later stages. Abdominal palpation in this dog did not reveal large uterine tubes. However the blood test with high white cell count was useful. In any case, purulent vaginal discharge in large amounts around 2 months after the heat is a quick diagnosis of pyometra. A rush into surgery is not advised as the dog is septicaemic. I would advise 3-4 days later.

However, some owners want the dog operated and back home on the same day of diagnosis as they feel that the dog should not be separated even for one day. For such owners, the vet needed to use his common sense and judgment.

In this case, Vet 1 had X-rayed and took blood test and confirmed that the Maltese of 6 years had pyometra. Vet 1 phoned the next day for the dog to return for surgery. Pyometra is a much longer surgery than a normal spay and so the vet costs would exceed $1,000 with the x-rays and blood test. The surgery quoted by Vet 1 was $800 which was a reasonable cost. Unfortunately the owner felt it was too high.

"You will need to get the dog operated soon" I advised when the owner phoned me for a quotation. She wanted to wait till the weekend, 3 days later. After all, the dog looked well after Vet 1 had given antibiotics. "Delays mean more infections and complications. When the dog dies because you delay surgery, you tend to blame the vet as being incompetent in anaesthesia."

There was little difference but since I did not need to repeat the blood test nor take X-rays or ultrasound, my quote would be deemed lower.

The dog came in for surgery. An IV drip plus antibiotics was given 3 hours before surgery. Domitor 0.1 ml IV was given via the drip. The dog was masked and given isoflurane gas. She slept fast and was intubated. Isoflurane gas was given. I monitored this case very closely as it was a high risk case since the operation was done on the second day after Vet 1 had diagnosed closed pyometra. The 3rd day could be too late as the dog could die from septicaemia.

The dog was not normal in the sense that the tongue was pale and bluish. Her re-breathing bag showed signs of very slow breathing and cessation of breathing. This was a touch and go case. The family expected 100% survival but this case could be the type of high-risk case best done by other vets. I disconnected the endotracheal tube when the dog was not breathing well and re-connected when the dog felt some painful reaction from the surgery.

The dog survived and went home on the same day. She was OK.

Pictures will be at later.

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