Thursday, August 16, 2012

1045. The vet "suspects pyometra"

A vomiting female dog. Gastritis or closed pyometra?

Miniature Schnauzer, Female, 8 years, not spayed. An old client of mine but I had not seen the dog for the past 7 years since the puppy vaccination. This is a common situation as the owner might have gone to other vets or just left the dog alone.

August 11, 2012
According to Vet 1's medical record,

Presented for vomting several times, abdominal disension was notes and "suspect pyo" was recorded. Blood test was recorded as the total white cell count and neutrophils as "moderately" increased. Advised spay.

The dog was warded for 3 days. Vomiting disappeared on the 3rd day and the owner (Sister 1) wanted to take the dog home on August 14.

August 15, 2012
I was at work in the evening of August 15 and saw Sister 1 with the dog. She said: "My dog is still vomiting." I checked the records and examined the dog. I put her on the consultation table, palpated the swollen abdomen.

The dog gave a yelp as I palpated. "There is a swollen abdomen which is also painful," I said. "The total white cells of 22.4 (normal 6-17) is high. The neutrophils are 96.3% which indicated a bacterial infection as normally they are around 70%. Based on the findings, this dog is suffering from closed pyometra. An X-ray is not needed unless you want it done."

However Vet 1 said an X-ray would rule out any foreign bodies inside the stomach or intestines as the one of the owners (Sister 2) had said that the dog ate some things.

August 16, 2012"How's the X-ray?" I asked Vet 1. "Does it show pyometra?"
"There is a lot of gas," Vet 1 did not think there was pyometra. "In any case, the owners agreed to the spay."
I saw Sister 1 in the evening at around 7.30 pm. She said: "Now the dog is eating and there is no vomiting, it will be better for the operation tomorrow since it is already late."
"We can still do surgery even at 8 pm," I said.

August 17, 2012The dog was operated. The dog's uterus was full of pus. So far, so good today August 17, 2012. The dog was on her chest and looking around. If vomiting returns, this will be bad news as the kidneys could have been severely damaged.

Time is of the essence in closed pyometra cases as toxins are being absorbed into the blood stream from the swollen uterus. The antibiotics given killed some bacteria and stopped the dog vomiting. So Sister 1 wanted the dog home.

But the toxins are not expelled as the cervix has closed. So the dog starts vomiting again. Toxins damage the kidneys and liver if the owners delay surgery further. Some older generation would not want surgery till the dog collapses.

Owners need to be properly educated. "Vet 1 says 'suspect pyometra'", Sister 1 remarked. Therefore, since the dog had stopped vomiting on Day 3, she wanted the dog home. X-rays or ultrasound should be advised and done during the 3 days of hospitalisation. The vet must be spot on in his or her diagnosis of closed pyometra based on history of heat around 6 months ago in around December 2011, (in this case, Sister 3 said the heat was in Feb or March 2012 throwing Vet 1 off track and thinking of gastroenteritis.)

An older unspayed female dog.
A swollen painful abdomen
A high total white cell count with high neutrophils and low platelet count
are clues to a tentative diagnosis of CLOSED pyometra. It is an emergency.

This case's blood test results are:
Total white cell count 22.4 (6-17)
N=96.3%   Abs = 21.7
L=3.6%     Abs = 0.81
M=0.1%    Abs = 0.02
E=0.1%    Abs = 0.02
B=0%    Abs = 0.00

Platelets 107 (200-500). No platelet clumps but few giant platelets present.

The vet must not confuse the owner with the wording "suspect pyo." as owners don't know the severity of this closed pyometra situation which could kill the dog if surgery is delayed.  

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