Thursday, December 6, 2012

1206. Closed pyometra in an old Shih Tzu X

Dec 6, 2012
Ideally, it is best to use evidence-based medicine to get a diagnosis of closed pyometra. X-rays and blood tests are what the vet professors teach the new graduates.

However, in real life, there are clients who can't afford the tests. In this case, I usually get a good history and abdominal palpation of a big swollen uterus and operate to remove the uterus. There is always a possibility of no pyometra but a swollen bladder or an abdominal mass but economics prohibit more exploratory tests.

"It is how you present your case," I said to Dr Daniel. "If the owner has budget constraints, two X-rays add to the vet costs. There is a big orange-sized swelling in the abdomen. It could be the bladder but you said Mr Min had seen much urine being passed. Therefore, this globular swelling could be the uterus distended with pus."

The owner did not know when the last heat occurred. However there was vomiting yesterday and a complaint of sticky matter in the "urine." The dog was not eating much for the last 10 days. These clues point to pyometra. X-rays and blood tests will confirm.

The owner decided on X-rays.

There is closed pyometra, according to the X-rays. The uterus had swollen so much that the intestines were displaced forwards.

"Don't operate immediately," I said. "Give the IV drip and antibiotics 24 hours and operate after that. This ensures a better chance of survival, in my experience."

The owner will discuss further at around 7pm. There is no alternative but surgery to cure this dog. However, there is financial hardship for some owners and the newly graduate vet must the heartlander economics and provide the least cost surgery.

Friday. Dec 7, 2012. The dog is better after IV drips yesterday but the rectal temp is below normal at 37.7 C.

The owner agreed to a blood test.
1. Kidney disorders. Urea 22  (4.2-6.3). Creatinine 188 (89-177).
2. Total WCC 62 (6-17) with N=98%. L=1.7%, M 0.3%. E & B =0%
3. Platelets 191 (200-500).
4.  Haemoglobin 9.9  (12-18)
5.  Red cell count 4.8  (5.5-8.5)

Surgery is necessary today but the risks are high as the dog has septicaemia and may die on the op table.

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