Tuesday, August 16, 2011

543. Clinical Research - The old poodle would have lived longer if not for pyometra

I had a review of this case of pyometra today Aug 14, 2011 at 6.54 pm at the Surgery as part of my clinical research on pyometra in old female dogs seen at Toa Payoh Vets.

This dog survived the surgery and anaesthesia despite a serious heart disease. But she died two days after the surgery, of heart failure.

I first saw this poodle, female, unspayed, 9 years in 17 March 2009 for an "asthmatic" attack. he had heart murmurs and was given oral lasix. As she had bad breath, I advised dental work. No teeth was extracted as they were in good condition. Only dental scaling done under isolfurane and oxygen gas anaesthesia.

July 20, 2009, Vet 1 prescribed some medication for a "swollen face" and a review in 10 days' time.

Aug 5, 2009, I extracted the left upper PM4 tooth as it was an oro-nasal fistula which presented as a "swollen face" to Vet 1.

July 8, 2011 - Vet 2 recorded a grade 5/5 heart murmur. The blood test showed a normal total white cell count. However the monocytes were high suggestive of a chronic infection.

Total WCC normal. Monocytes 14% (1.4 x 10(9)/L). Neutrophls 60%. L 22% E.38% Basophil 1.04%, urea high but creatinine low.

July 21, 2011 - Ultrasound showed swollen left and right uterine horns. A diagnosis of open pyometra was made. The dog was operated the next day and the swollen womb was taken out. She survived the surgery but died 2 days later.

This is a typical case in which the dog would have lived longer if she had been spayed when she was one year old. In addition, she had bad teeth which seeded bacteria damaging the heart valves over her last few years of life. 11 years of life is considered a long life in Singapore's small breeds.

I have stopped advocating spays in young female dogs as many Singapore owners feel that it is cruel to deprive a female dog of her reproductive organs or have some other reasons. Reproductive disorders come in when the female dog is old, leading to much sadness and money spent.

In another case, the owner of a 13-year-old dog could not decide whether to get her operated as she was discharging pus from her vagina for the past weeks and was no longer eating. Finally, he asked me to operate but he wanted the dog home on the same day after operation to care for her. The dog surprisingly survived the surgery and anaesthesia for 7 days with him treating her at home. On Day 3 after surgery, the dog had fits and came down for IV drip. She passed away at home around Day 7. This second case showed that it was very difficult for the owner to request euthanasia and the option of surgery, as in the first case, was too late as the dog was very ill by then. So, the survival rate was very low. However, it is not always death for old dogs with pyometra. The chances of survival are very slim.

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