1371. Tips for newly graduated vets and pet owners - closed pyometra

TOA PAYOH VETS toapayohvets.com Date:   17 April, 2013     Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits Against Medical Advices: Closed Pyometra   Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS Date:   17 April, 2013   toapayohvets.com  Be Kind To Pets Veterinary Education Project 2010-0129 SCRIPT FOR VIDEO  HOOK INTRODUCTION Pyometra is an infection of the womb. There is the open pyometra where the owner can see brownish sticky vaginal discharge and the closed pyometra where the presenting sign may be a swollen abdomen. TWO CASE STUDIES Two closed pyometra cases from my case files, in two breeds of dogs of similar ages are presented. Both dogs had large swollen abdomens as the presenting sign.  The Miniature Schnauzer survived the anaesthesia and surgery but the Siberian Husky did not. The Siberian Husky was very thin when she was operated as an emergency case by me. She had been treated by Vet 1 with antibiotics but had not responded and there was a delay in seeking veterinary attention. .  Miniature Schnauzer       X-ray showed swollen uterine bodies X-ray showed swollen uterine bodies Uterine bodies swollen with pus Dog is OK after surgery 5618 - 5621.  Closed pyometra anaesthesia and surgery is highly risky compared to a spay and costs much more as it is a long surgery. The dog survived the surgery performed by Dr Vanessa. The owner was most happy as the dog survived the anaesthesia. Siberian Husky         Weight loss and distended abdomen X-ray showed swollen uterine bodies Uterine bodies swollen with pus   2094 - 2906.  Spay your female dog when she is young as the younger Singaporean generation usually has to work long hours and has little time  for her when she is older.  In this case, pus had accumulated in the womb which weighed 4 kg. The Siberian Husky had lost weight considerably and was only 18 kg when presented for surgery. Her net weight was 14 kg as the pyometra womb weighed 4 kg. She was extremely high risk for anaesthesia and passed away on the operating table when an emergency spay was done by me.  For reasons unknown to me, Vet 1 had prescribed antibiotics for the swollen abdomen. There could be financial distress on the part of the owner as regards further testing for the swollen abdomen. The owner might just want some antibiotics. In such situations, the vet should record in writing his advices for evidence of close pyometra in his case file.  In this Siberian Husky, there was a delay in seeking surgical treatment. The dog was too ill to survive the anaesthesia and there was much sadness, unhappiness and resentment by the family members towards Vet 1.   TIPS & ADVICES for the Dog Owner: 1.  SEEK PROMPT VETERINARY ATTENTION when your dog does not eat around 4-8 weeks after her heat period. That is when pyometra develops. Many younger Singaporean dog owners feel that it is cruel to sterilise their dogs. As they become busy in their careers, they neglect their older dog's health. The dog is well provided for in food and there are the parents and the domestic worker to look after the dog. They don't have time to bring their dogs for walks and when their dogs are not well, they delay seeking veterinary treatment or second opinions.   2. SPAY your female dog when she is young and healthy. Pyometra surgeries to remove the womb are high-risk anaesthestic cases since the dog is already very sick. Some do die during anaesthesia. TIPS & ADVICES for the newly graduated Veterinary Surgeon: 1.  DIFFERENTIAL DIAGNOSIS Pyometra should top the list of differential diagnosis in female dogs presented with distended abdomen with or without vomiting. The onset of estrus should be asked and recorded in the medical case sheets. However, some owners give incorrect dates of estrus and this could lead to a mis-diagnosis of closed pyometra as gas in the stomach and intestines. In some cases, the owner's mother knows the onset but she is not present during consultation.    2.  HIGH MEDICAL COSTS Compared to a spay, pyometra surgery costs a lot more. If the owner desires the least medical costs, he will not want to pay for the blood tests and X-rays. I usually advise a spay to be done soon once the dog is fit for surgery. Evidence-based medicine should be practised but compassion will be needed for financial distressed owners.             3.  AGAINST MEDICAL ADVICES The vet should record "Against Medical Advices" on the medical records, if the owner declines blood tests and X-rays of the swollen abdomen. This written advice will be a defence in cases of complaints and litigation. A good vet will be meticulous in writing his case records and advices given to the owner. Write your advices as you talk rather than wait till the end of consultation as you will have omitted certain information.   CREDITS FOR MORE INFORMATION   Update will be on this webpage: http://www.sinpets.com/F5/201304017closed _pyometra_dogs_toapayohvets.htm More info at: Dogs or Cats To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326 Toa Payoh Vets Clinical Research

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