Log of Amber's Illness:
11/23 Amber has been vomiting for 24 hours, and is now depressed and dehydrated. She has been licking her vulva all night. At one point I found some pale sticky discharge in the vulva, more mucoid than anything else, but containing a few flecks of old blood, (confirmed with hemoccult). No foul odor. Her belly is apparently painful, as she walks stiffly with an arched back. Temp 102.8 pr. Abdomen is flat, There is a smooth ovoid mass approximately 4 x 1.5 cm. palpable in mid abdomen. Bowel sounds normal. Had a B.M. this am. At this point, because of her dehydration and depression, I knew that she needed help. I called my regular vet, - away - referred to Enterprise Animal Hospital.

12:15 p.m. : Enterprise. Seen by Dr. McCoy, gave history as above. Also gave history of breeding Oct. 30, and the pizza episode on 12 November. The mass in the abdomen was first palpable (by me) on the 14th. She had been relatively normal in the intervening 9 days. I expressed my concern about pyometra to Dr. McCoy, in view of the breeding, the fever, the mass and the toxicity. He said he needed x-rays and ultrasound. I questioned the need for x-rays and U.S. in assessing pyometra in a 13 lb. bitch whose entire abdominal contents are easily palpable with one hand. He insisted, and as I had no other choice, I had to go along with the program. I told him that this was a valuable breeding bitch, and I would not consent to hysterectomy while any medical means were available.

He listened to Amber's chest, and palpated her abdomen. He did not do a vaginal exam to determine the presence of discharge in the vagina, or the condition of the os. He admitted her to the hospital. A 200$ deposit was requested and paid by credit card.

3:00 p.m. : Dr. McCoy reports hypoglycemia, no other labs available. Treated her with glucose and antibiotics. Temp is coming down. No more vomiting. Good urine output. X-ray shows a ? mass in abd. (same as palpation). Thinks it is pyometra. Says it is closed because no drainage seen..

11/24 10:00 a.m. :  Ultrasound confirms palpation - tubular structure. Dr. Crusher advises immediate surgery. I explain situation. She reluctantly agrees to give prostaglandin Rx.

3:00 p.m. : Labs :CBC (WBC=5, no shift, Hb=14) and chemistries normal except for low K⁺. Discussed possibility of home care of my animal. Told it is "illegal" to treat my dog at home despite my qualifications to administer meds etc. Asked Dr. McCoy to call Dr. Wright (reproductive specialist in Penn.) if any doubts about therapy. Gave telephone number. No response to luteolyse, based on observation of vulva. Told him that she is very clean, and he would not see anything externally on this bitch. Again urged to have surgery. Agreed to wait over night with I.V.s.

11/25 11:00 am :  Dr. Crusher announces failure of luteolyse Rx. Says either spay now or euthanize. Says bitch has closed pyometra. Uterus will rupture if Rx continued. Failure of treatment based on no visible pus. I asked if we could just give medical therapy a little more time - only 2 injections were given. She said no, she would not treat her any further medically - spay or euthanize were the only choices.

12.00 p.m. : Picked up dog at Enterprise. Had to pay additional $813.50 in order to get her out. Abdominal mass smaller and quite soft. Some tan discharge in vulva. Drove directly to Chesterfield Animal Hospital, in Pennsylvania. Dr. Wright examined. Vaginal exam revealed open cervix, small amount of tan drainage in vagina. Single uterine horn palpable, soft, about 1x3 cm. No danger of rupture. No reason to spay. Gave me some luteolyse and baytril to give at home. (Treating an animal at home under the care of qualified owners apparently not "illegal" in Pennsylvania.) Total bill $50.00.

11/26 Temp 100.5. No abd. mass palpable. Small amts of drainage -- hard to find because Amber is very fastidious about keeping herself clean. No more vomiting except for immediately after injection. Ate good amount of my food (won't touch dog food). Drinking, well hydrated.

11/27 Temp 100.4 Very little drainage now. Well hydrated. Vomiting after injections, but otherwise fine.

11/28 Temp 100.2 No drainage. Uterus not palpable. Eating well. Playing.
11/29 Temp 101.0 Really eating now. Uterus not palpable.
11/30 Temp 101.1 Belly ok. Last luteolyse today. Acting herself. Eating. Stool normal.
12/3 Temp normal. Off antibiotics today
12/10 Temp 100.5 Amber well, gaining back lost weight. Has been entirely normal since 11/30.

4/18 Amber has just whelped 4 healthy pups.

This log of Amber's illness (names changed) is absolutely true. It illustrates several points:

1. Pyometra is a medically treatable problem that vets tend to regard as a surgical problem. Humans have a similar problem, variously called "pelvic inflammatory disease", "salpingitis", or "tubo-ovarian abcess", depending on its various features. Hysterectomy is not the routine treatment in humans.

2. That breeders have to secure a veterinarian they can trust for emergency services before they face an emergent situation.

PYOMETRA
Pyometra is thought to be the result of a hyperplastic (overgrown) uterine lining, which becomes infected due to the lush growth medium which the hyperplastic endometrium provides. The basis of this endometrial hyperplasia seems to be the prolonged retention of the corpus luteum in the ovary.

In the normal mammalian reproductive cycle, the egg matures inside a bubble in the ovary, which grows, reaches the surface of the ovary and breaks, releasing the egg. The ruptured follicle has an important job to perform. It thickens into a solid structure, the corpus luteum, which secretes a powerful hormone. This hormone, progesterone, causes the lining of the uterus to thicken and become ready to accept the fertilized egg. Meanwhile, the egg has been traveling down the fallopian tubes to the uterus, and if it encounters a sperm on the way, it becomes fertilized, and upon reaching the uterus, burrows into the endometrium and begins developing into a little mammal.

If no fertilization takes place, the corpus luteum finally gives up, and degenerates, ending the production of the endometrial stimulant, progesterone. If pregnancy does occur, then the corpus luteum goes into overdrive, producing hormones to maintain the uterine stimulation until the placenta is developed enough to take over this function. It is thought that so called "false pregnancy" and pyometra are the result of failure of the corpus luteum to know when to quit. Pyometra results when a bacterium, usually a coliform, finds an overdeveloped juicy endometrium, and sets up housekeeping.

The disease can be quite a serious matter. Probably there are many minor infections which the body takes care of in the normal course. However when the uterus becomes distended with pus, either of two things can happen: drainage is established into the vagina, or there is no drainage. If there is no drainage, the uterus may continue to fill with pus until death intervenes from toxicity, or the uterine develops gangrene, ruptures, and death results from peritonitis. During the process, the large numbers of bacteria are liberating toxins, which can cause fever, kidney failure, and circulatory collapse. (toxic shock)

In pet animals, who ought to be spayed anyway, the solution is easy and permanent : take out the whole apparatus. In animals whose reproductive potential is important, the approach must be threefold:

1. Treat the infection with antibiotics, and other appropriate supportive treatment.

2. Evacuate the uterus to remove the dead tissue, bacteria and bacterial toxins.

3. Tell the corpus luteum to stop doing its thing.

Prostaglandin, a naturally occurring hormone has come into use in the past 20 years as a useful adjunct in treating pyometra. Prostaglandin has two important actions. First it caused powerful contractions of smooth muscle - of which the intestinal and uterine walls are composed. Secondly, it acts as a "luteolytic" causing the breakdown of the corpus luteum. It is thought to be one of, if not the major contributors to labor contractions, and is used as an adjunct to childbirth. It is also used in human medicine as an abortifacient.

Prostaglandin, in concert with adequate antibiotic therapy can save the reproductive tracts of most bitches with pyometra, provided the problem is identified while the animal is still in good enough condition to treat. The contraindications to medical treatment would be an animal with overwhelming sepsis, or a greatly enlarged uterus containing pus under pressure, which cannot drain - a "closed pyometra". In the case of a distended and thinned uterine wall, the smooth muscle contractions caused by prostaglandin might rupture the uterus with death the almost certain result.

Most small animal veterinarians have never treated a case of pyometra medically. Perhaps in vet school they may have seen it done, but by and large they have a fairly automatic response to pyometra . . . spay. The added advantage of a surgical fee is not unwelcome either. Even those who are willing to try drug therapy are often unhappy about it because they feel insecure in their judgment from lack of experience.

Advice to the breeder:
Know about and be alert for pyometra. It is most common after a season: several weeks to several months. Early signs may be irritability, loss of appetite, low grade fever. The animal may move slowly, with her belly tucked up. She will be reluctant to run or jump. She may start vomiting several times a day. Frequent licking of her vulva may be the only sign of a discharge, especially if it is not profuse. Any bitch who exhibits these behaviors, should have her temperature taken several times a day. With small bitches like Lhasa Apsos, palpation of the belly is easy and useful. A smooth oval or tubular mass in the abdomen can be stool, a pregnancy or pyometra.

Pregnancy becomes palpable 3 to 4 weeks after breeding. A three week pregnancy feels like a pea. By 4 weeks, the masses are easier to palpate and are about the size of a marble or a medium grape. At 5 weeks, the masses are more difficult to palpate, as they become very soft, and are about the size of a damson plum. At six weeks the masses are too soft to palpate. At about 7.5 weeks fetal parts become recognizable. Stool can be differentiated simply by "matching" her and re-examining. Any remaining mass in the abdomen after stool, or if pregnancy is ruled out on account of size, is suspicious for pyometra. If she won't let you feel her belly, or if her belly is rigid, this is not a good sign.

Assuming you find signs as described above, get her to the vet.  However, do not wait, as I did, until you have a critically ill anumal to anticipate a possible emergency. Choose your vet with a view to possible emergencies. Try to find out before hand if he/she has breeders in the practice. If the practice serves other breeders, get their names and check it out. Ask how pyometra would be managed if you should have a valuable bitch with it. Find out availability for emergencies: who covers the practice. If another practice covers emergencies, find out the same information from them. Let the vet know what your needs and expectations are before you find yourself in emergent circumstances. If he feels unequipped to fulfill your needs, he has an opportunity to (gracefully) get you situated with a practice which can. A reasonable practitioner will not be threatened by your candor, but will appreciate the opportunity to explain his approach and his provisions for consultation, or to recommend another practitioner. Be leery of a vet who is evasive or patronizing. A good practitioner wants to establish a sound and continuing relationship with his client, based on mutual trust and respect.

You should have your backup system in place, but if you are in a situation with an unknown vet, demand full explanations of any procedures and charges, and don't settle for less than clear and complete answers.  Ask for second opinions if necessary. (And not from Dr. X's assistant).  A practitioner who really knows his stuff doesn't need to impress you. You ask a straight question - you get a straight answer.  If he doesn't know something, he'll tell you so, and then he'll find someone who knows.  You are paying for these services - you are hiring the practitioner to work for you.  Both parties to this contractual relationship are entitled to respect, and you are entitled to value for your money.  Don't be intimidated by a display of superior knowledge.  Sometimes there's less of that than you would imagine. (All of the above applies equally well to choosing a physician for yourself)

My experience was the result of having nothing but healthy dogs for 24 years, and it being Thanksgiving day.  I had failed to establish a backup system that I could trust, but as soon as my bitch was in the hospital I called other breeders, and got hooked up with a competent, though distant, vet.

If you feel you have been treated improperly or charged excessively, contest the bill. Everything in life is negotiable.  Don't threaten lawsuit unless there has been actual and sizable loss.  It will cost more to hire a lawyer than you will recover. (of course if you are filthy rich and want to make an expensive statement...go ahead). You have other means at your disposal. Your State Department of Consumer Affairs is an agency from which your vet will not welcome an inquiry. The best advice is: Don't find yourself in the same predicament as I did.  Find someone you can talk to and who gives you straight answers. Vet your vet ahead of time!