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Date:   22 September, 2008

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Toa Payoh Vets Clinical Research
Making veterinary surgery alive
to a veterinary student studying in Australia
using real case studies and pictures

PYOMETRA IN A SILKIE TERRIER
Case written: May 26, 2004. Case updated: Sep 22, 2008
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS.

"Doc, are you sure you have the correct diagnosis just by touching her stomach?"

"Your bitch may not survive the next two days," I had to be brutally frank on a joyous day, the day Christ was born. "Her rectal temperature had dropped to 37.3 deg C despite treatment.  That is way below the normal of 38.5 deg C."

Mr Lim's aged mother had lived long enough to know about deaths. She suppressed her sorrow but tears just cascaded down.  The Silkie Terrier was her constant companion as all the children had grown up and had their own families. They had no time for her now.  She said, "I did not know she has this disease."    

I had to inform her to prevent misunderstanding, as usually the veterinary surgeon is blamed when a dog dies after an operation.  "Your son brought the bitch for her annual vaccination last month. I advised him to get the womb removed because the bitch had a persistent swollen vulva, an abnormal condition of the reproductive system." 

The normal bitch usually has a swollen vulva only when she is on heat and this swelling subsides after 2 weeks.  In this bitch, the swelling persisted for the past years. She would have a hormonal imbalance and would be licking her private parts frequently to clean up evidence of vaginal discharge.  I advised spaying but most Singaporean owners don't want to spay the dog for various personal reason. 

She had a very high fever of 39.9 deg C two days before surgery. She was not eating and had vomited a few times. Her abdomen was distended, as if she was pregnant. She had passed "watery pinkish blood" in her vagina in small amounts.   I was consulted again because the bitch was not eating for 5 days and had been vomiting.

The diagnosis was pyometra, an infection of the womb.  The recommendation was surgery to remove the womb as soon as the bitch was stabilised with fluid therapy some six hours later.

"
Doc, are you sure you have the correct diagnosis just by touching her?" Mr Lim was incredulous.  "Just by using the fingers and palm of your left hand to press the abdomen back to front?  And you know what's the problem with my mum's Silkie Terrier?"

"If you don't mind paying more money, around $200 more, there is the blood test, the ultra scan and the X-rays to confirm the diagnosis of pyometra," I suggested, being used to such questioning.

"Or you can seek a second opinion from another veterinary surgeon, but you have to do it immediately as your bitch is very sick."  

Dog owners are more sophisticated nowadays and they ask many questions but they are not willing to pay more for laboratory and other tests. In 2004, Singapore was again mired in retrenchments and cost-cutting after the Severe Acute Respiratory Syndrome (SARS) outbreak.

Every second counted in this case. I advised further:  "If the bitch is not operated, she will die soon.  If she is operated, she may die during or after the surgery."

The surgery was a simple operation,  but the very poor health of the patient made it a very high risk anaesthesia and surgical procedure. 

Mr Lim was uncomfortable with the thought of death of his mother's best friend and asked: "What are her chances of survival?"

"About 10% of survival after surgery in this case," I estimated. 

Mr Lim frowned and wrinkled his fore head. 10% meant the dog had a very low chance of survival.

To operate or not to? It was Hobson's choice for the dog owner. 

Mr Lim authorised the surgery to be performed. Two large uterine horns filled with creamy yellow pus were removed. The ovaries were also removed.

Now, 20 hours after surgery, the Silkie Terrier was lethargic.  She ate a little, but that was not good enough to give her a good chance of survival.  She was not vomiting and that was a good sign. 

I offered some food to her.  She suddenly snapped at my fingers.  This was a "dangerous" dog.  It was a good sign that she was more active. However, it would be difficult to feed her the nutritious food after surgery.

It was better that the family brought home the bitch to nurse her. "The bitch used to growl at everyone when she first came to my residence," Mrs Lim said. "She just does not like anyone to touch her mouth. She would accept food from my hand."

Would this Silkie Terrier recover better at home? If not, Mrs Lim would still spend time with her rather than let the bitch die away from her owners.

The Silkie Terrier just sat on her chest and looked at the family. She did not wag her tail unlike yesterday when the family visited her five hours after the surgery.

The family was not sure that the Silkie Terrier should go home as she might not be receiving treatment.

"I have given the necessary treatment," I said. "She might be depressed here as she associated me with the pain of surgery. She could be a "manja" dog."

The family members looked at me blankly. What is a "manja" dog? Manja in the Malay language means "seeking and loving attention".

Some small breeds will eat only if hand fed by the owner. They are so intelligent that they know that if they stop eating for 2 days, the owner will buy a different brand of food or offer other types of food to feed them.  Such dogs may starve if they stay away from the home for a few days and I was not going to risk this happening.

"Take the Silkie Terrier out of the cage," I said. "Put her outside on the grass."

The Silkie Terrier passed urine, walked a bit and stood still.  Well, at least she looked better.  She was bundled with a towel and went home with Mrs Lim.

A large family of 7 adults came to see her on this Christmas Day. The dog sat in the front seat with Mrs Lim and the driver while the others hopped onto the back of the lorry on this gloomy day. 
 
Would she survive the next two days? I hope I would be proven wrong. It was a miracle that this Silkie did not die on the operating table as the owners had delayed seeking veterinary treatment for a long time.
 

NOTES:

1. Vaginal discharge of a sticky type or bluish reddish colour over 10 days may be a sign of pyometra. The bitch usually cleans herself up and you may not see the discharge.  Do consult your veterinarian soon if you spot any.  High fever, vomiting and pyometra mean that the bitch has poorer chances of survival. as in this case.

2. CLOSED PYOMETRA. The pus accumulates and swells the womb. There is little vaginal discharge seen, as in this case. In OPEN PYOMETRA, the vaginal discharge is copious and the observant owner may see the sticky yellow or reddish stains on the floor or sleeping area.

3.  Spaying of this bitch means the surgical removal of the womb and the ovaries.  This would have prevented the development of pyometra in this Silkie. However, not every un-spayed bitch would develop pyometra.  

4. Hobson's choice means a choice without an alternative; the thing offered or nothing. "Hobson's choice" is said to have had its origin in the name of one Thomas Hobson at Cambridge, England. He kept a livery stable and required every customer to take either the horse nearest the stable door or none at all.
 

For non-spayed female dogs, pyometra is easily diagnosed if she passes a lot of dirty reddish brown blood some 2-6 weeks after her heat. Some of the vaginal discharge is starchy and yellowish. Others are sticky and dark reddish brown. 
The womb of a female dog with pyometra taken out from the abdomen and placed on the surgical drape.  The uterine horns are greatly distended with pus and can be as wide as 3 - 6cm in diameter (bigger than the width of an adult's finger).
The womb of a normal female dog. The uterine horns are very thin, usually less than 0.5 cm in diameter.

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