Vet Tales: Understanding Pyometra in Pets

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Really, the goal is just to use our stories to bring veterinary medicine to life for the pet caretakers of the world. And we're doing it because we believe that educating these caretakers is the most powerful thing that we can do to improve the life quality of all of the pets that we love. Okay, hello, everybody. Hello, good morning. This is Dr. Dame. Yeah, Dr. Dame. Right into it. Into it. Dr. Keith, and this is Vet Tales.

Yes. Yeah, I like the fact that we're never quite on point when we start. Nothing. Ever. It's like we don't have any continuity in how we introduce the podcast. Yeah, I just feel that like 20 questions from first to fifth graders this morning. Yeah, so you're already like on brain fright. What was... They were great questions. Yeah, give us a couple. Do you do surgery on monkeys? And I gladly said, heck no.

But I did tell them about people who do. because i know people who do somebody's got to somebody's got to do it and then another one was are you sad when the pets leave you and i'm like yes but i took that probably differently than the way the kid was asking oh yeah yeah yeah but that's interesting a lot of good questions yeah yeah cool i think that's great like starting i mean educating people about veterinary medicine and they're little people.

Yeah. I didn't have a very eventful morning. My most exciting part of my morning was taking DayQuil again. I've been on Mucinex the last couple of days. At this point, I can't tell the difference between Oklahoma allergies and the longest cold of my life. I've never had the back of my nose so closed up. Oh, it's wild. I normally drain through the front of my nose, but it's from the back. That's not fun. It's probably TMI. I'm so sorry. I'm going to live on the internet forever.

Forever. All right. All right. Well, as will all my snorting and snotting for the next hour. That was you though. That was me.

Okay. Today's topic. Today's topic, we're going to talk about pyometra. Pyometras. Yeah, we did prostate on our last talk. And so we thought, okay, like prostatitis, whatever, like a nice counterbalance to that is the female specific disease of uterine infections. Pyometra literally means pus-filled uterus, purulent exudate within the contained cavity of the uterine body. And they are, no, it's also makes them very, very ill. It's emergency. It is life-threatening for sure. Yeah.

Dogs will die of it if you don't do something. Especially, especially closed pyometra. So there's two kinds of uterine infections. There's open and closed pyometra. The open means that there is some drainage of the fluid out of the cervix, out of the body. And so these owners will actually see discharge from the vulva and that tells them like, hey, something is wrong. And they're not tend to be doing as poorly. Right. Yeah. Because some of it's getting out.

The closed hyometra, the cervix is completely closed off and the uterus starts to fill up and look very similar to a pregnant or gravid uterus. So, but it is not babies. It is just infection. Mm-hmm. So a typical presentation is going to be an older female intact dog with a fever, feeling really lethargic, maybe not eating and drinking, not wanting to get up. And then sometimes there's discharge from the vulva. Sometimes there's not.

Sometimes you have distended abdomen. Sometimes you don't. My first question every time I walk into those rooms is, when was that last heat cycle? Yeah. And they always say about three or four weeks ago. go. Yeah. And then you go, well, let me go. Get an ultrasound. I have a sneaky suspicion. Yeah. Yeah. So that's kind of how they present. That's kind of their signalment. And then the next diagnostic. Yeah. Like Dr. Keith said. Yeah. Ultrasound and CBC. Yeah.

Yeah. At minimum. But those are going to be where you find your two biggest confirmers. So ultrasound is a slam dunk. if they have a fluid filled uterus, you know, and you like, so for context on a normal female that has a uterus still, unspayed female, you really don't see the uterus. You can't really find it on ultrasound because it just maybe looks like an intestine. I mean, you just really can't tell. But as soon as they get fluid filled.

Within the uterine body, you can tell immediately. And it looks very, very different than a pregnant uterus. Yeah, it's crazy. Yeah. And I mean, on x-ray too, it looks wild sometimes. Yeah, you can. You can see it. It'll get massive. It's just like a really long water balloon. Yeah. Throughout the abdomen. Yeah. And the water tends to be very, like on ultrasound, instead of it being just like black, like urine in the bladder, it'll just be like this, you know, black bubble.

This will be more like white, speckly, fluidy. You can see it kind of like sloshing around with all the particles. And you're like, oh, that is definitely pyrilynexidae, a.k.a. pus. And then on the CBC. Elevated neutrophils. Now, I have seen normal white counts. Me too. For different reasons.

Are they on the downswing? Yeah. So just to talk about neutrophils and infection briefly, Briefly, like, let's just say you have this normal amount of neutrophils, you know, so let's say 12 to 18,000 neutrophils are white blood cells that are specifically in the frontline soldiers that go out and whoop up on bacteria. That's their job. And so they, there should be constantly a normal amount just like circulating in the bloodstream being like, hey, you know,

belong here, bam, bam, bam. Bam. And they go to these fisticuffs and they eat up the bacteria and digest it and poop it out. I don't know if they poop it out. I just ate that up. I think they find themselves some macrophages. Yeah, exactly. Dr. Rich is going to have a heart attack if he listens to this podcast. Yeah, that's so funny. I had Dr. DeFay. Oh, well I had DeFay for that, but for like virology But actually, I had Dr. Ritchie for cellular immunology. Really?

Yeah. He was teaching point-toes? He taught macrophages, neutrophils, applied clinically. Yeah. Yeah, him and Comfort and Snyder. Yeah. Also, all wonderful veterinarians. And some of them are even in a band. I should be in the Hall of Fame of something. Yeah, they did the pathology band, the ACVP. I sang in it. I know. Tantrum. Anyway, so the neutrophils are these frontline soldiers. And so they're just like floating around the bloodstream looking for trouble.

Well, so trouble shows up, right? And they call on their friends and they're like, hey, guys, there's a fight over here in the uterus. We need back up. And so the first thing that actually happens is that you're going to see a slight decrease in the number of circulating neutrophils because they all just jumped out of the bloodstream and into the fight. Yeah.

And it's a huge brawl. And then there's a recruitment sent notice up to the bone marrow and the bone marrow is like, oh man, we're getting whooped in the uterus. And so they start just massively producing large numbers of neutrophils. So then you have this huge neutrophil count, right? So it might jump all the way up. I've seen it go from like a normal at 18 all the way up to 80,000. Yeah. Yeah.

60, 80,000. But if then all of these soldiers also go to the uterus and are also getting just demolished by the bacterial load in this uterus, then you can actually see that number start to drop and it will look normal for a minute as it gets down from 80, 60, 40, 20. Now we're back to 12. Oh, this dog looks great on blood work. If you're just looking at Your CBC and not looking at the whole picture. Or the dog. Or the dog. Probably.

Very sick. Yeah, very sick. And then eventually you can actually get where we have a neutropenia or like a low neutrophil count, like 4,000. Because we have literally deployed all the soldiers. There's nobody left. The bone marrow is not able to keep up with the demands. And then we're septic. And that's the pot of osmosis gems. It's just a movie that Natalie probably doesn't know. I don't know. I was like, wait, what? I'll have to shower. Okay. All right.

Y'all can Google it. Osmosis joke. That's a millennial joke. I actually am a millennial. Thank you very little. I'm the oldest millennial. Okay, but I'm like Gen Z millennial. I'm like Gen X millennial. Yeah. I'm like right at the cusp. Same. Same, but it's another cusp. My humor is very internet based. That's fair. That's fair. I'll show you what Mine is definitely movies that largely have Jim Carrey in them. Yeah. Hey, Bill Murray's in Osmose. Okay. All right. Yeah. I mean,

that goes all the way back. Like Ghostbusters. This is like early 2000s though. Cartoon. That's a very long career. He's great. He's hilarious. Yeah. He really is. Groundhog Day. I love Groundhog Day so much. That was a holiday at my house. What? We celebrated Groundhog Day. So my parents are from New England. So like Groundhog Day is a bigger deal to them. That's fair. Like Punks and Tony, Bill, whatever. My mom would like make us watch him look at his shadow.

We would watch that movie on Groundhog Day. As you would eat chili on Groundhog Day.

As all small children should be watching this movie where he tries to kill himself with a toaster and just totally insanity and drive off i one love that movie too my that's just a testament to my mom making tradition we watched it weekly because we have traditions we're going on the stage just more things to celebrate yeah yeah absolutely anyway so i intended to yeah where were we we were talking about neutrophils so you have

this dog that's then flat in front of you you've done your ultrasound you found the fluid-filled uterus yeah then your cbc you're like crap there's so many neutrophils yeah are no neutrophils or maybe it's normal but most of the time there's so many yeah so then you got a couple options but really just one but technically textbook wise in the rare chance that this dog is needed.

For reading yeah we will send you to a specialist to probably to do because there's a lot of hoops to jump through when it comes to hormonal supplementation when you're dealing with a, pyometra and you're trying not to do the most common treatment and so a lot of times we would then refer to like a repro person to start by a lot of times how many times have you ever done I've never done that. I've never done that. Okay, same, same, never.

I've never done this. Same, okay. But it's like, if you're like, she's a prized dog, I need to breed her again. Yeah, she's in the Westminster, like we can't be, we can stay in this dog. Which has been none of my clients ever. Yeah, same. So you would get referred because it is a huge undertaking to do the hormonal kind of medications and then the antibiotics to try to get them out of the pyometra while maintaining their intact status.

Yeah, yeah. What do we do, Mozog? Wait, so spay? Yes. Yeah. So now I will say, like, I have had some open pios that the owners caught early and they don't want to go to surgery, mostly because of fear of anesthesia, not because that they want to save this dog's reproductive status. I have treated them medically with great reservation. And then you just go, okay, but I really think you should spay before the next heat cycle or guess what's going to happen again. gay.

And so sometimes I am treated medically until the dog was in a better position, like a more stable position. And then we went ahead and proceeded with the spay like in a month. If you get some closed, you will get more stable before the procedure. Yeah. So like, yeah, it's not uncommon for us to hospitalize for a day or two before surgery so that the patient is more stable for anesthesia and surgery itself. But the ultimate goal is get out the defective uterus because it ain't going

to do no good For anybody. And then antibiotics. Oh, man. Yeah. And anti-inflammatories. I'd say most of the time, once you get the uterus out, they do very well. Yeah. Depending on how long it's been going on. Yeah. They can be in a pretty critical state when they come in. Yeah. And if we're going to emergency surgery, there's always the chance that they aren't going to make it out that. But I would say 99% of the time.

Absolutely. And once they get through the surgery, like, they do really well.

It's getting through the surgery. I mean, we had that one. This is a bit of a sad tale. So, brace yourself for impact. Close the ears of small children in the car. We had that older pit bull that came in, and she was in actin DIC.

See like she was dying as she came in from a pyro so we weren't able to even she was here for like 30 minutes before she was gone she was yeah yeah and yeah pyometra so the point of this whole story really is if you are not intentionally breeding your dog spay them because when they get older the chances of pyometra increase and increase and increase their anesthetic risks increase and increase and increase and so you just kind of put yourself

in a perfect storm of trouble yeah what What was your go-to, because if y'all don't know, Dr. Keith bred beautiful Cavaliers. I did. And they're the sweetest dog. Yeah, that's how I got through vet school, financially, is raising Cavaliers. Yeah. I love her Cavaliers. We still see some of them. They're the best. How did you manage when you were like, okay, you know, Abby is done breeding. Yeah. So here's my next step for her. Yeah. Just so people realize.

If they are breeding dogs, yeah. Yeah, if you're if you because I mean, yeah, there are a lot of dogs that we do intentionally want to have puppies from for whatever reason. You know, if maybe just want to litter out of your dog, maybe you actually are raising them intentionally to, you know, further develop a breed or, you know, whatever your economical reason might be. So my rule of thumb typically was four litters, but that was different for every dog.

So like my first Cavalier, Eliza, I bred her at two and then we did a second reading.

We skipped a cycle and then we did two breedings. And on her last one, her uterus was just atonic, meaning like it was just like sitting there like a limp noodle, not having any contractions at all. And so we spayed her at the time of C-section.

Bailey was another one and she only had three litters but her last litter had several puppies with some pretty decent umbilical hernias so i was like okay i do not want to continue this that you know this happening and so we spayed her but it was after she weaned the puppies because she had them all normally like on her own yeah abby i think again was like it was four she had no trouble with any of them at that point she was about four and we decided to go ahead and yeah

she might have been five i would say most people are what seems to be the trend is you know typically people start breeding their dogs at two but at least that's what we recommend twink tiller two and then by four or five when you've you know had the litter or the multiple litters that you wanted to have you should probably say that because there's no point at that point for them to have the uterus because they're just at a high risk of developing yeah they just it's just Yeah,

things start falling apart on them if you start doing more than that. Mm-hmm. Let's say you don't start breeding your dog until they're older. You might be okay not spaying until you're like six, but really dogs over six years old, especially even in small breeds, but like in big dogs, really you need to cut them off at four. Yeah. You don't have a super long window where they do really well with gestation. Now that being said, no. Listen to me now and hear me later, as Dr. Ritchie would say.

You absolutely will see 12-, 13-, 14-year-old dogs get pregnant. Oh, yeah. I had a dachshund one time right out of vet school that came in because she was struggling with urinating, had a bladder stone and free puppies in her abdomen. And we were like, oh, smokes. And that dog had a horrible labor and delivery process. It was awful. So they absolutely can still get pregnant. Like, they don't go through menopause.

Is they will definitely cycle or they'll start to have weird cycles and that's when we start seeing those pyometries when the hormones aren't regulating correctly the cervix isn't closing off tightly post heat cycle and bacteria is ascending into the uterus and then the cervix may go ahead and close or not fully close and the infections are cooking yeah i just had a 14 year old dog last summer that was pregnant and was diabetic. Oh, yeah.

And we don't know if it was like gestational diabetes or if it, which is, I guess, a thing after a lot of research in dogs, which I had not known that, that it can happen or it can trigger diabetes. And so that was a whole issue because she was... How old was that husky dog that you just had that was pregnant and had the sores on her back? Oh, she wasn't that old. She wasn't? Okay. Man, she looks rough.

Yeah it was a doozy it was a doozy yeah but i'm really good mom did good yeah all the mom is perfect all the puppies are great yeah the owners are wonderful yeah she just got herself in a pickle she got to go and do a pickle but yeah that 14 year old dog with the diabetes i was like this is this is awful and i'm 90 sure so i did a because with the ultrasound which we're going to to do a pregnancy episode next time, but I found that they were not even alive anymore in the puppies.

And so it became an AA emergency of like, okay, well, she has puppies that aren't alive. Plus she's diabetic. We have to do a scary surgery because who wants to put under an uncontrolled diabetic, but also she's presumably getting infection from the puppies. Right. Absolutely. So yeah, it's definitely, so stay your dog. So if you have a dog that is un-stayed for whatever reason, your main thing for pyometres is to watch them really closely about a month after their heat cycle.

Because you may or may not have been trying to breed them, right? So like a lot of people are like, there is no way this dog is pregnant and she hasn't been out of my sight. And then she starts getting a big tummy and it's like, well... Either A, she's pregnant, or B, you have a uterine infection. And you'll start to see those symptoms around a month after the heat cycle ends. Heat cycles in dogs are about three weeks long. It's seven days in, seven days of receptiveness, seven days out.

So you'll see the bleeding the first seven days. But then you got 14 more days of heat cycle. And then you have for the next month, you just need to be on high alert.

Super common in dogs that have abnormal cycles. So if they're not cycling every six months, like you would expect, those dogs are at higher risk for pyometres. Bulldogs are higher risk for every disease on the planet, essentially. And I see a lot of pyos and pit bulls. I don't know if it's just because we have a lot of pit bulls here. I was going to say that too, but I didn't know if that was just incidental. Right. If it's actually a genetic thing or if it's just because we have a lot of pit

bulls here that maybe aren't spayed. Yeah. I'm not sure. Yeah. But definitely, that is one of the most common breeds I see. I've seen it in every dog, imagine. Yeah, I mean, I had a great dame that had an open pyometra. Owners were really on it. She had a weird heat cycle. I know the owners well, actually. The sweetest people, they didn't necessarily want to spay. It was open. So I was like, hey, we're going to treat this. We're going to see.

But I don't give it a long time. I told them, I was like, give it 24 to 48 hours. If we're not feeling better, we have got to spay her because she's not going to be okay. Because at any moment it could close and it could be an emergency. And then boom, yeah. 48 hours later, you've got. Yeah. She never closed, but she continued to not do well. So then they stayed and then she recovered. Yeah. You know, as far as cats go, I have seen, yeah, I've seen a couple of pios in domestic short hares.

And then I have a Savannah breeder that any of your Savannahs or Bengals where you're taking these F1 to F4 generation cats where you're taking a wild cat and a domestic short hair breeding this mix. There's a lot of reproductive problems that happen with that. I wonder if we don't see it in cats very often just because people are more likely to spay and neuter their cats. I don't think so. You don't think so? I mean, think about it.

Like, how many cats have we got running around out there? That's true. And I just think cats are a little more efficient and productively. We don't have as much breed variation in the cat. You know, like when you talk about a Cornish Rex versus a domestic short hair, you're talking about coat difference, maybe slight facial features. But with dogs, you're talking about Great Danes to Chihuahuas and Bulldogs to, you know, Irish Wolfhound and everything in between.

And so you have a lot, you're messing with reproductive system. And I think that's why you're seeing that more with like Savannahs and Bengals. But they have a lot of failed pregnancies because if those genes don't line up properly, the fetus will not develop. And so it may go from like a one-week-old pregnancy to a pyometra pretty frequently. And so I've dealt with a lot, a lot of pyos in those savannas. Yeah. So that is another way you can get a pyo is a failed pregnancy early on.

Never thought about that. Yeah. Well, I had the opportunity to present myself. So I also raised bangles for a while, too. And that's how I saved that money for our adoption on Grayson. So, I mean, if you if you don't, you know, I'm never going to judge people breeding for those purposes, for sure, because I've been there. But just having all the information at your, you know, at your fingertips and making sure that you're aware and then you can do it responsibly.

But if you're not intentionally breeding, spay and neuter your pets. Yes. Said Bob Barker. Yes. At the end of every episode. He didn't. Maybe he was. Yes, maybe. Okay, cool. I think that's all we have to say about this. Yeah, next episode will be pregnancy. Yeah, which I'm excited about. Yeah. I love talking about it. I was very nervous about talking about it when I first started, but now I'm much more comfortable. And I like printing off little checkmark lists for the owner. Oh, yeah.

Yeah. Yeah, for sure. It's a fun time. So, I mean, unless you're like, dang it. Yeah, I have a buddy who just had a dang it moment with his dog. And I was like, man, I look back at the records. And two months ago, I said, recommend to spay. I mean, I don't want to be like, I told you so. But I did. Those puppies are really cute. Yeah. The dog's fine. But we were worried because it was a mastiff with a, like, 30-pound border collie. So, it was. It was a little touch and go, but she did great.

Yeah, it's amazing what moms can do, what Mother Nature can work around. The last week, though, she was like Violet from... It looked like she'd actually swallowed a sideways football. Yes. Oh, my gosh. So bad. Violet from what? From Willy Wonka. Oh, no. Yeah. I have no idea. Violet. That's what she looked like. She couldn't get up on anything. She was a little like, didn't touch the ground. Oh, God.

All right. Okay. That's all for today, guys. as always if you have questions comments concerns you can email us text or call northside veterinary hospital or ask your veterinarian that you go to if it's if you're not here so um we'll be. Music.