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Real world implications
What a cornucopia of practice management issues, legal questions and ethical considerations this little tale presents. And how commonly veterinarians and their clients face this dilemma out there in the general pet owner universe.
As I mentioned, one of my associates was in a similar position just a few weeks ago. A dog presented with an open pyometra and the client refused immediate ovariohysterectomy. Our clients reasoning was simpler, however; she couldnt afford a routine spay, let alone an emergency pyometra procedure, until she sorted out her finances.
First, lets consider the two dogs level of suffering. Both patients had wagging tails, showed good appetite and were bouncing off the walls, yet they were harboring a diseased uterus and exhibiting a substantial purulent discharge. Suffering? They were probably just uncomfortable.
The emergency doctor in the first account appears to have provided her client with only two treatment options: spay immediately or euthanize immediately. Ill leave it to you to decide whether an offer of a short period of “wait-and-see,” together with antimicrobial and other nonsurgical therapies, would result in so much pain and risk to the dog that a legal threat aimed at the owner was preferable.
Second, was a threat really the best way to handle this matter? Maybe I could more comfortably accept that strategy if the patient had a “closed” pyo, was febrile or PU/PD, or at least was presenting some clear indication that a short period of medical management and observation would be detrimental.
When my associate was faced with her pyometra case, she advised the client that the need for a spaying procedure was very likely. But she added that instituting medical therapy and allowing a brief delay so the client could get her financial situation in order was not an unreasonable alternative.
I think my practice did a good job of keeping the lines of communication open with this client. If my associate had badgered the woman into either euthanizing her dog or grudgingly accepting the spay procedure under threat of legal consequences, all the outcomes would probably have been negative.
Chances are, the client would have never returned. She would have shared her horrible experience with anyone who would listen. Worse yet, she might have contacted the state board to report that shed been coerced—not only into following one practitioners advice, but into purchasing the recommended services from that one specific provider.
Surgery in a Veterinary Outpatient Community Medicine Setting Has a Good Outcome for Dogs with Pyometra
This study, conducted at a veterinary teaching center, found a high survival rate (97% [129/133]) among a population of dogs with surgically treated pyometra. This high survival rate was also seen in dogs who were operated on by less-experienced clinicians, were treated as outpatients, and potentially had treatment delays until surgery could be performed. There was no overall difference in survival rates between the type of treatment facility (referral hospital vs. community clinic), even though surgical experience and postoperative case management were very different between them. At the referral hospitals (compared with the community clinics), dogs waited less time between diagnosis and surgery, stayed in the hospital longer (up to 3 days), and underwent surgery performed by individuals with more advanced training in surgery.
The Emergency Pyometra in Dogs: Risks, Symptoms + Treatment
One of the tragedies in a veterinarian’s existence is having to euthanize an ailing animal because a basic precaution was not taken at the right time. For example, if a cat’s guardian elects not to vaccinate his/her feline against feline leukemia (FeLV) and then permits the cat “outdoor privileges,” the cat may come across a carrier of the virus and end up being stricken by this incurable disease, ultimately dying because a vaccine was not given that should have been part of the initial wellness plan for an indoor-outdoor cat.
Pyometra is another disease that is entirely preventable, but often is not considered as part of the essential health promotion plan for each dog or cat in the family. This condition is much more common in dogs and, from Greek, is translated as “a uterus full of pus.” It can happen to any unspayed female, whether she has had pregnancies or not, and first appears as an unknown cause of a decreased appetite and a noticeable increase in water consumption and urinations. With luck, the dog is experiencing an “open” pyometra, in which the cervix is dilated enough to permit a creamy discharge to appear on the dog’s backside, her bedding, or her urination spots. A “closed” pyometra means that the cervix does not permit the uterine discharge to flow through to the outside, therefore leaving the guardian with no clue as to the cause of the dog’s malaise. I cannot recommend strongly enough that this is an area in which prevention — by ovariohysterectomy (more Greek!) before the female matures into adolescence — is essential and not optional.
If you suspect that your dog has pyometra, she must be brought for radiographs and emergency surgery as quickly as possible, before the infection becomes increasingly septic and fatal. Since this is such a dangerous condition and is often such a challenging surgery if the uterus becomes massive and heavy with toxic contents, then what might have been an uneventful quick surgery before the female’s first heat for $200-$500 quickly becomes a challenging emergency that may cost upwards of $2,000 – $3,000. Unlike the quick post-operative recovery that a young pre-heat dog or cat experiences, the pyometra patient may will feel ill for days and require lengthy treatment with antibiotics and possibly intravenous fluid therapy — IF she is not euthanized for financial reasons.
I cannot recommend strongly enough that this is an area in which prevention — by ovariohysterectomy (more Greek!) before the female matures into adolescence — is essential and not optional. One final benefit: if the dog is spayed before her first heat, she has zero chance of developing breast cancer. Please do not believe the old myths about ”having one litter makes the dog/cat a better pet,” but rather have your female companion, cat or canine, spayed before there is any chance of this potentially fatal condition taking your beloved friend from you.
NYSHA’s VP, Dr. Holly Cheever, is a partner in a small animal practice, the Village Animal Clinic, in Voorheesville, NY. She sits on several boards for animal issues, is a speaker and consultant across the nation, and has testified before Congress about animal abuse in circuses, as well as in New York City regarding the carriage horse trade.