Pyometra in Pets: Understanding, Diagnosis, and Prevention
As pet owners, we always want to make sure that our furry friends are happy and healthy. However, sometimes unexpected health issues can arise, leaving us worried and unsure of what to do next. In this episode, we're going to be discussing a condition called pyometra - a potentially life-threatening infection that can affect female cats and dogs.
Derived from the Latin words "pyo" meaning pus and "metra" meaning uterus, pyometra is an abscessed, pus-filled infected uterus that can have devastating effects if left untreated. Listen in as we dive into the causes of pyometra, the difference between open and closed pyometras, common clinical signs to look out for, and the most common treatment options available. We'll also be discussing the importance of prevention and the steps you can take to keep your pet healthy and avoid the development of this serious condition.
What You’ll Learn:
What a pyometra is and how it affects cats and dogs.
How pus can enter the uterus and lead to the development of pyometra.
The difference between open and closed pyometra, and their respective clinical signs.
The common clinical signs of pyometra in your pet.
How veterinarians diagnose pyometras and the limitations of available tests.
The most common treatment options for pyometra and their potential risks.
The difference between pyometras in cats and dogs.
The potential causes of pyometra in pets.
The severity of pyometra and its potential to be life-threatening.
Preventative measures that can help reduce the risk of pyometra in pets.
Ideas Worth Sharing:
“Like with most infections and diseases, there is no test for pyometra that is 100%. We take our best guesses based on what we see on our diagnostics and our physical exam and determine what it most likely is going to be.” - Tyler Sugerman
“Yes, pets can die from pyometra. That’s why it is important to get your pet to a hospital as soon as they start showing signs.” - Tyler Sugerman
“The only way to prevent a pyometra is to spay your dogs and cats.” - Tyler Sugerman
Resources Mentioned:
ASPCA 888-426-4435 or pet poison helpline 855-764-7661
Read The Transcript:
Welcome to Vetsplanation. I'm your veterinary host, Tyler, or you can call me Suggs. This podcast is about educating pet parents about what is going on with their furry little loved ones. As an emergency veterinarian, I understand how hard it is to explain complex diseases in terms that are understandable for pet parents in a few short minutes before the next critical case comes in.
In this podcast, we can dive deeper into understanding of what our pets are going through and break down those complex medical terms into easier to understand chunks of information.
Just a quick disclaimer: this podcast is for informational purposes only. This is not meant to be a diagnosis of your pet. If you have questions about diagnostics or treatment options, please talk to your veterinarian about those things.
Remember, we are all practicing veterinary medicine, and medicine is not an exact science. Your veterinarian may have different treatment options. The information I provide here is to help pet parents, and it's not related to my place of work. I'm here for you guys to provide free information and knowledge.
If you like our podcast, consider sharing this podcast with at least one friend or someone else who has pets and could benefit from this.
Now, let's jump into this week's episode.
Tyler Sugerman: Hi guys, welcome back to Vetsplanation. So, today we're going to be talking about Pyometras, something I see quite often in the ER actually. So, we're go talk about what pyometra is, who's affected by it, how they get pyometras, and then how we diagnose it and the treatment options for it.
So, first, we're going to start out with what is pyometra. So, “pyo” actually means pus, and then “metra” means uterus. So, this literally translates to a pus-filled uterus.
The animals that most likely get this, we’re going to talk about just dogs and cats. There are lots of other animals that can get this but dogs and cats that are intact females, mainly they have not been spayed or not been fixed. And then usually, it's the older females. So, I typically see them over six years old, but any age can get this as long as they've been through heat cycles.
So, like a two-month-old puppy wouldn't be able to get it because it hadn't actually gone through a heat cycle. But I have seen the youngest one so far for me has been a nine-month-old puppy that has had a pyometra. But it's not very common, it's usually going to be the older females that end up getting this.
And that's usually because the fact that there is a certain hormone that helps make all of this happen, and that's called progesterone. And we'll talk about what progesterone does in a little bit, but they've had so many heat cycles and so much progesterone acting on their uterus that it makes it a really good area for a pyometra to occur.
So, I'm going to do a quick anatomy for anybody who's watching this on YouTube, you can see my terrible drawing, I'm sorry. But anybody listening in I'm just going to go over the anatomy really quickly.
So, you have the vagina that goes into and attaches essentially, to the uterus. The uterus has a cervix that is either open or closed, and then it goes into this Y-shaped inside the body. So, where the cervix is, is roughly about where the pelvis is, and then inside the abdomen is where this Y-shape is to the uterus. They kind of go to each one of the kidneys, they're touching each one of the kidneys essentially.
And then on top of that uterus is going to be the ovary, and the ovary is what produces all the hormones to make ovulation happen and also, to make pyometra happen as well. But the essential thing is to know that we have this big Y-shaped uterus that's in the abdomen. We have the body of the uterus which has the cervix that attaches to the vagina.
So, that's going to be important later on when we talk about what the treatment options are and I'll go over that again later. But let's talk next about how does pus get into the uterus because we see pus is in there but how did it get there in the first place?
So, there's quite a bit of different things that can happen. Usually, this is going to be from a bacteria, there are lots of different ways that bacteria can get in there. So, technically, the uterus itself is sterile, it has no bacteria in there. That cervix keeps everything out.
But the vagina actually does have normal bacteria to it. If they didn't have normal bacteria, it would actually cause a lot of yeast infections instead.
So, it normally has bacteria in there. But sometimes, you could have other things that happen. So, you could have bacteria from the vagina go up into the uterus, you can have diarrhea that occurs, and that diarrhea just drips down from the anus into the vagina, and goes up into the uterus and that creates an infection.
You could have lots of different other scenarios, we'll talk about again some of those later on. But basically, to know that bacteria goes from the vagina up into the uterus causing this bacteria in a place that's normally supposed to be very sterile without any bacteria.
So, the other thing that happens is that we have to have the female go into heat. So, when they're not in heat, their cervix is closed and nothing goes up in there. So, all that bacteria in the vagina, it's not a big deal. But as soon as that cervix starts to open or we start to get a good blood supply going, progesterone comes in to tell the uterus that we're ready to go into heat.
So, progesterone does a couple of different things. It helps the body, or it helps the uterus, swell up to prepare for pregnancy, so it makes it much larger. The other thing is it has a large blood supply that goes to it as well. So, we have a ton of blood supply going there. It also makes an ideal place for bacteria to want to go to. So, it'll ascend or go up from the vagina into the uterus.
The other thing that progesterone does is it stops the uterus from contracting. So, it tells it to stay open, make a really moist area, and then don't contract. We're essentially preparing for a baby to go in there because it's waiting for that to happen. Like that's what the body's trying to do and that's what progesterone is trying to do. But all of those things that are preparing for a baby are also really lovely for bacteria, they love it.
So, we have bacteria that goes up into their white blood cells come in because that we have the really good blood supply, so have a lot of white blood cells that come in that are trying to attack all that bacteria but can't.
And then we have a bunch of the cells from inside the uterus that are dying off as well. So, now, all of that bacteria and white blood cells and those dying cells from inside the uterus are all combining to make pus essentially.
This usually happens about four to eight weeks after going into heat, but I've definitely seen it at other times as well, that's just like the average is four to eight weeks. I've definitely seen it as well at two weeks after going into heat.
Now, the next question I would ask would be like, “Well, if there's pus in the uterus how does that make it sick? If it just stays in this uterus why are they getting sick?”
So, the reason why is that there is bacteria that's starting to create a ton of toxins in it as well. Those toxins leak across the walls of the uterus into that really nice blood supply that's been created, and now blood supply goes everywhere. It goes all over the body.
So, it can go to the brain and the kidneys and the lungs, and all that bacteria is just spreading everywhere, and that is what makes them sick as well. There's also the fact that we have a large amount of pus that's in there that's filling up the uterus that can make them ill. And again, we'll kind of talk about that in just a bit. But now, all those toxins are going to all the organs, creating a havoc, and making them very ill.
So, what are the clinical signs that we're going to see? Now, there's two types of pyometras.
One is called an open pyometra and one is called a closed pyometra. So, we'll talk about the open pyometra first. The open pyometra is where the cervix is open. So, stuff can definitely move from the vagina up the cervix, into our uterus because that cervix is open allowing all that bacteria to move in there.
But the nice thing is that when they do have an open pyometra, is that the — this is kind of the lesser of the two evils. We don't have to worry so much because all this bacteria and pus and stuff that's developing in the uterus can also leak out of the cervix as well and into the vagina.
So, a lot of times the first clinical sign that people will see at home is that their female pet is actually leaking this yellowish or whiteish fluid. That's a good indicator that there's probably going to be infection in there.
Some people mistake it for just being a urinary tract infection, but it's actually a much bigger deal than that, it's usually going to be pyometra. Not to say that you can't just have a urinary tract infection — I've definitely had that, but it's usually going to be pyometra.
So, like I said, clinical science says the first thing you're probably going to see that pus coming out. The other things are they might be lethargic, so just really depressed and not really wanting to do anything. You might see that they're not wanting to eat and maybe vomiting as well.
Those don't always occur though because with that open pyometra, all that pus can start to come out. It doesn't all come out, it's just that it kind of spills over and leaks. Like if you were filling a cup of water and if you just kept filling it, that cup of water is eventually just going to spill over and you're going to see all the water on the table.
So, it's kind of the same thing, is that pus is filling up the uterus, but the uterus isn't getting gigantic. It's just filling up as much as it could possibly stretch in a normal instance, and then spilling out through the vagina instead.
So, because of that, they don't always get lethargic or in appetent. Some not wanting to eat or vomiting, just only sometimes. The other kind of pyometra we see is called a closed pyometra. So, that is where the cervix is closed. So, that bacteria is able to go up into the uterus, but nothing can get out, that cervix is now closed.
So, that uterus fills up and it stretches really large. I mean, they can get really big to the point to where I’ve definitely had to have two hands to get one side of that uterus out. So, it fills up really large, that's really uncomfortable for them. They have tons of bacteria in there, tons of white blood cells.
So, some of the clinical science we'll see from them is one, they're much sicker, like you know that they're sick, they feel terrible. They usually will have a fever, they'll be lethargic. So again, like not wanting to do anything, not wanting to move, they're vomiting, they're not wanting to eat, they're drinking a ton of water, and then also peeing a lot as well.
They have a really distended abdomen, so their belly just looks like it's getting really big. Some people mistake that for them actually being pregnant. And then we will not see pus from this one coming from the vagina because again, that cervix is closed and those are very closely related, so nothing is able to come out of there, it's all swelling up inside their abdomen.
We always will do blood work on them, and some of the blood work abnormalities you might see for our closed pyometras are going to be that they either have a really high white blood cell count because their white blood cells are there to fight off infection, and so they'll create a lot more of them so that that way hopefully, they can send it to the uterus to be able to fight off as much infection as possible or at least, into the bloodstream to fight off infection.
Or the other thing as you might see, a really low white blood cell count, and that's because all those white blood cells that the body has made are now put into that uterus to try to help fight it off as best as they can. They've actually done a study that showed that if the pet does have really low white blood cells, they're more likely to be sicker.
They get something called a peritonitis, which is an inflammation of the lining of the abdomen. So, all those organs become really inflamed inside the belly. They'll also a lot of times have elevated kidney values. So, that's from a couple things.
One is they're really dehydrated because they've been vomiting profusely, not eating. They are drinking a lot of water, but they just cannot catch up with as much dehydration as they have. And it's also from the toxins. So, again, those toxins go everywhere and one of those places is usually the kidneys, so they can end up with almost a kidney failure because of those toxins.
It's another common thing. Like they do usually get elevated kidney values but it's not as common for them to get kidney failure from it, but it is a possibility. So, I've talked about the two types of pyometra. So, how do we diagnose pyometras? This one becomes a little bit tougher depending on which one we're talking about.
So, the open pyometras are a lot harder to diagnose and the close pyometras are a lot easier to diagnose in a way. So, one thing we'll usually do is we'll take radiographs or X-rays so that we can see possibly this really large fluid-filled structure at the bottom of their belly. It just kind of sits at the bottom there. So, we can see these really large tubes in the bottom of the belly, and then we know that that's going to be the uterus that normally sits there.
There's also the problem with the open pyometras, if we're trying to do X-rays or radiographs, is that it's really difficult to be able to see that when it's an open pyo. Because remember on a closed pyo, nothing can get out, all the pus is trapped in there. So, those uterine tubes, they fill really full and so we can see those really easily on an X-ray.
Versus the open pyometra, it's a much harder to see at an X-ray because again, they're not feeling more than they normally would. They're not swelling more because all of that's just pouring out because that cervix is open. So, not as easy to see those.
The next easiest way to do it is to look at an ultrasound. So, an ultrasound that's usually my first go-to for our pyometras, but not everybody has an ultrasound. So, for ultrasound, we're looking for that tubular structure inside the abdomen.
So, I'm literally looking for this little body that's right here underneath where the bladder would be. And then I'm also looking for that Y-shaped uterus and seeing if it's really large and if it has a lot of fluid in it. Even if it’s an open pyo, I can still see that much better. I can still see that it’s larger than normal and it has fluid filled in it.
So, if I see a uterus that's pretty bigger than it normally should be, and then it has a lot of pus coming out of their vulva, then I know that they are going to have an open pyometra. Versus if it's a closed pyometra and I look on ultrasound and it's a really large structure that has just tons of fluid in it, then we know it's most likely going to be a closed pyometra.
I will say one of the harder things though is that you have a lot of structures that all sit in that area too. You have the colon that sits in the same area as your uterus, and if that has a lot of fluid to it, again, it's going to make it a little bit harder for us to tell if it's the colon that has a lot of fluid in it or if it's the uterus that has a lot of fluid in it.
Most of the times, most veterinarians can tell because there's layering, it's the best way to describe that. It's like a layer of a cake in the colon but it doesn't have that in the uterus. I've definitely had it to where that colon was so distended with fluid that I couldn't even see those layers and didn't know if it was a pyometra or not. So, it's not about 100% test.
I always tell people there is no test that's 100%, that's kind of one of those. We take our best guesses based on what we see on our diagnostics and our physical exam, and then determine what it most likely is going to be. So, now once we have diagnosed them with a pyometra, how do we treat pyometra? What are the pros and cons of each one of these treatments?
So, usually, the number one treatment is going to be a surgery, it's called an ovariohysterectomy. “Ovario” means ovaries and so hysterectomy is to take out the uterus, so we're taking out the ovaries and the uterus.
Just our quick side note on this, this is not the same as tying tubes in humans, some people get those mistaken. There's not something you can undo with this, literally it's taking everything out, so this is a really complicated spay. In a regular spay that's usually what people will do. That's usually what the vet does is take out the ovaries and take out the uterus.
Now again, going back to our anatomy, we're talking about this treatment and how this is affected here. We have your uterus that is connected to the cervix but that's also connected to the vagina. We cannot take that part out.
So, instead, we have to cut between either where that Y-shape is to the uterus, between that and the cervix, or cut between the cervix and the vagina. So, we have to cut between one of those areas, but we cannot take out the vagina. So, there's always going to be some little piece of the uterus that's going to be left in there. So, we're not taking out 100%, we're taking out the majority of it.
Another important note is that some people will only take out the uterus when they're doing certain types of space, and that's just called a hysterectomy — not an ovariohysterectomy. And with that they think that … there's been research is done saying that if you leave the ovaries that they're less likely to get certain diseases, they're less likely to be overweight, things like that.
I think that's a lot bigger in Europe than it is here, I don't hear of a lot of doctors that do it here. I've only had one that I knew of and that was at my teaching hospital and they did it on my cat. I would say so far I haven't had anything that looks different from my cat that was spayed that I did, that I took out the ovaries and the cat that they did that they did not take out the ovaries. So, I haven't seen any difference there.
But the important thing is part of the pyometra, you have to take out the ovaries because that's where all the progesterone is coming from. So, if we don't take out the hormones, the thing that's causing all of those hormones to increase, then we’re not going to be able to get this pyometra under control. So, we have to take out the ovaries and take out the uterus at the same time.
We also are giving them things like antibiotics and pain medications because remember, there's bacteria that's in there so we need to make sure that we get rid of all the bacteria that we can through that part that we cannot take out that's right above the vagina, and also, in the bloodstream because we know that a lot of that stuff can go in the bloodstream as well.
So, we want to try to get all of that under control as much as possible. Giving them fluids to rehydrate them and bring down those kidney values, a lot of these things are done prior to doing the surgery because we want to make them as stable for surgery as possible.
We don't want to rush into a surgery but at the same time we have to be really careful as to how long do we try to help support them and get them stabilized for surgery versus that pus is still in there, and they cannot heal until that pus is out.
So, we really have to make a decision as to when it is safest for that pet to do that. Which means that we might be doing stabilization before surgery, during surgery, and after surgery. So, this is much more complicated than the spay, because the spay usually have a healthy pet that's going under anesthesia.
We're doing the same procedure, we're still taking out the uterus and the ovaries, but the uterus is much more friable. It's more likely to break down when we're doing a pyometra surgery than we're doing just regular spay.
And during a spay, I don't have to stabilize them during surgery, I don't have to stabilize them after surgery, they usually do just fine. Versus like I said our pyometras I have to stabilize them before, during, and afterwards. So, it's a much more complicated ordeal.
We do usually hospitalize them afterwards. I would say not every hospital does that. I think that some hospitals just try to do it very early, that way they don't have to hospitalize them with like overnight care like at regular general practices. But since we're 24 hours, this is done all hours of the day and night. So, usually they do stay on fluids and pain medication and antibiotics through the IV after their surgery is done as well.
And then depending on how bad it is or depending on what we see, sometimes they'll also ask for something that's called a culture and sensitivity. It means that we take a sample of the pus that's in the uterus, and then we send that sample out to the lab, they grow that sample to tell us what bacteria was in that uterus, and then they also tell us the best antibiotics for that bacteria.
So, the reason why is because we have to just take a while guess a lot of times. We're guessing as to what bacteria is most likely in that uterus, and then from there we're guessing as to what the antibiotic is that will most likely fix that bacterial infection.
We don't always know, so a lot of times it's just our best guesses. And if we do this where we take this culture, we still send them home with antibiotics, but then we call later on and say like, “Maybe yes we were on the right antibiotics, no worries, we don't have to worry about changing it, or you know what, it wasn't the bacteria we thought it would be, and therefore, we need to change our antibiotics to a different antibiotic to make sure we get rid of this infection completely.”
And that’s unfortunately, isn't something that happens right away, it takes time to grow bacteria. There's not some way to make it grow faster, like it grows when it grows. So, to send it out, I always tell people, you'll hear from somebody in one to two weeks sometimes before we actually know if this is on the correct antibiotic or not, but still sending them home with antibiotics.
Usually, after surgery, after they've been stabilized before, during, and afterwards as soon — as they're eating, they're usually ready to go home. There are definitely cases … I've had one case recently that their kidney values were off the charts before the surgeries even started and it was still high by the time the surgery had ended.
And so, that dog ended up having to stay in the hospital for I think four or five days if I remember correctly before it was able to go home. Because we needed to get those kidney values under control, and we needed to get that patient eating.
So, ideally, we want them to eat. Ideally, they're only there in the hospital for about 24 hours and that way they're able to go home, eat and go back to living normally again. Now, like I said, that is the most common treatment. It is really quick, the pros of this, it's going to be really fast that we're able to resolve this.
Surgery only takes 30 minutes to an hour typically in order to be able to take out that uterus that has all that pus filled in it. It's limiting the possibility that it's going to come back again, that it's going to reoccur again. So, as long as all of the ovary was taken out, they most likely will not get pyometra again, and I'll get into that in just a minute.
But some of the cons are like surgery has to be performed on a patient that is not always stable. As I said we try to stabilize them as much as we can before surgery, but sometimes, we don't have that luxury and we have to take out that uterus immediately. And so, sometimes we have to perform the surgery on a pet that's not as stable in their anesthesia as we would like them to be.
There's also a risk of rupturing this already friable uterus, like I said I've had uteruses that are just giant and that I've had to use two hands to be able to pick up just one piece of that uterus, and they can be really small. Like when I'm talking about this, it looks like a Y-shape, but this can be a really giant Y-shape that winds back and forth.
So, it's not as straightforward as my picture but it can be really hard. And sometimes when you're picking them up, it could be so friable that just even me touching it can rupture that uterus, and that way have bacteria in the abdomen. We try very hard not to do that but sometimes, it's just the tissue, it's nothing else that we could've done about it.
So, some of the alternative treatments, there's one in particular that I'm going to talk about, it's called prostaglandin injections. Now, there was a protocol that was put together in the eighties as a way to spare reproduction because if we do surgery, that pet cannot reproduce anymore, they can no longer have puppies or kittens. But for this protocol, they can potentially have a litter after this.
So, the interesting phase is it’s not technically approved for use in the U.S. it's approved in the UK, but it's not actually approved in the U.S. for dogs and cats. So, not everybody has this drug. I don't even think that our clinic carries this drug because it's not an approved drug. But it's a hormone and when you inject this hormone, it does the opposite of progesterone.
So, like I said, progesterone makes the uterus want to have a baby in it, it prepares it for it. Whereas our prostaglandins they do the opposite of that, they're trying to expel everything. So, it is like those muscles of the uterus are contracting to push everything out, and it's trying to get out all of that pus. Like that's our goal, is to get all the pus out of there.
But the thing is, is that you can only use this drug if it's an open pyometra. If that cervix is closed, if you're trying to squeeze everything through this closed cervix, something is going to rupture. So, we don't want that to happen either because then they go from being pretty sick to extremely ill on their deathbed. So, we don't it want to rupture, we don't want to do prostaglandins unless they're in an open pyometra.
With an open one as long as it's open hopefully it can expel all of that stuff. They're still put on antibiotics for that because there’s still bacteria that we need to get out of the bloodstream and also whatever is left in that lining of the uterus.
And then the other thing is that if you're going to do this protocol, it should be on a dog that is a breeding dog. Like you specifically have this dog for breeding or you know that you will be breeding them on the next cycle because they have to be bred on the next cycle. If they're not, then there's a 77% chance that it's going to occur again on the next cycle. So, they need to be bred.
It doesn't necessarily mean that they have to take those puppies all the way to conception like all the way to birth, but they do have to have bred and hopefully, have conceived some puppies.
Now, the other problem with this is after you've expelled all of that, there is a higher chance that they will not be able to get pregnant or that they will not be able to have a litter normally because that uterus is now damaged, it has scar tissue on it, and they can't always get pregnant or that pregnancy isn't always a viable pregnancy.
So, statistically, they say about 50 to 75% of them will be able to become pregnant and carry out the term but we still have a higher chance that they will not be able to become pregnant. It's also recommended during that time that they are hospitalized when you're doing those injections.
The reason is because that uterus is contracting. I don't know for anybody who had to do — I think it's Pitocin if I remember correctly, for any people who have had a baby and had to expel that tissue afterwards, that's what they use, is pitocin and it contracts the uterus and from what I saw my wife had to go through, that was pretty painful. I think if I remember correctly for her that was more uncomfortable than even giving birth.
So, that's kind of what this is doing. It's contracting the uterus constantly to try to push out all of that stuff. So, we want to give them really adequate pain control if we can. So, again, we want to hospitalize them if possible.
We also want to try to do the culture and sensitivity still. So, we want to be able to take a swab of that bacteria to send it out to the lab to know exactly what bacteria it is, and which antibiotic is going to be the best.
Some of the side effects of this drug, we have to remember that this isn’t just working on the uterus like prostaglandins, that’s just a hormone. And hormones can work in lots of different places, not just the one place that we’re thinking of which would be the uterus.
So, it also causes them to be really restless. They can have anxiety, panting, drooling profusely, pacing, their heart is racing, they can have vomiting, increased urination and then increased defecation as well.
If somebody says, “Hey, I can't hospitalize but I can do these injections and I know I'm going to be breeding my dog on the next cycle,” then I just warn them about what the biggest potential side effects can be. And those big life-threatening ones are going to be things like respiratory distress, so they can't breathe very well.
Ataxia which means that they're really wobbly, or muscle tremors so they're just constantly shaking. Those are actually signs of them being septic and we need to have them hospitalized immediately for shock.
So, we need to put them on fluids and now, we have a lot more treatments that we have to do. And then if that's the case, then likely they also will not be able to breed, they're going to have to have surgery as soon as they're out of shock.
So, some of the pros of doing it this way, of doing the injections are going to be that you can have future pregnancies. If we do the surgery, then there are no future pregnancies, that's it, the uterus is gone.
But with this one you can have future pregnancies and they usually say almost every heat cycle, she should have bred so that that way, you just decrease the chances of her having this pyometra. And then as soon as you get to a point to where you know that you don't want any more puppies, spay her at that point.
You're also avoiding surgery, at least for right now. Like I said, you probably will want to spay her right after her last set of puppies because we know that statistically, she is more likely to get pyometra.
Some of the cons though are pyometras are more likely to occur. Like I said, if she's not bred for each one of those cycles then the pyometra is more likely to come back.
It takes a longer period of time to resolve, so surgery is going to be 30 minutes to an hour to take out the uterus hospitalized for 24 hours. Versus this can be anywhere from one to four weeks for this to resolve just using the injections.
There's also a possibility of uterine rupture still. So, if that cervix closes up or if there's so much force and that cervix is not fully open, that uterus can still rupture and if it ruptures, then again, we're in the same position that they become extremely ill because all of that pus is now leaked into the abdomen causing what's called a septic peritonitis.
Meaning that all that bacteria is just creating havoc on everything inside their belly. If somebody is pregnant at the house, I usually warn them about this because it can cause pregnancy loss even for women. So, a human woman, so you do not want anybody who's in the house who could potentially be pregnant to handle this product.
It even causes pregnancy loss in dogs and cats. So, we also have to be really careful to make sure that when somebody comes in, they're like well there's just a bunch of discharge that's coming from the vagina that we check to make sure that they're not pregnant. Because if they are, we are going to abort that pregnancy by doing that unfortunately.
And then the biggest thing I think that the biggest con is that it doesn't always work. So, sometimes, giving the injections, you've given the use injections for three, four weeks, and at the end of that, you still end up having to do surgery because it didn't work. So, we just never know who is going to work with and who it’s not going to work with.
I've only had to do it a couple of times and I'd say I think two out of the three, it did work on. But that third one it definitely did not work, and we did it for that four-week time period. We knew which type of antibiotic to use, I mean we're on top of everything, but it just still didn't work.
I'm going to talk a little bit real quick about a special note for cats. So, a lot of the steam stuff applies but there's a couple of differences with cats and dogs. So, with cats, it can be a little hard to tell if they have a pyometra, they're very good at hiding their symptoms.
So, a lot of times if they have an open pyometra, remember the cervix is open and all that pus is draining out through the vagina. If that happens, the cats are constantly licking themselves, they’re constantly cleaning themselves.
So, you usually cannot tell if there is going to be fluid that's there or not because they've already cleaned it up. The other thing is that a lot of times, these cats are eating, drinking, they look totally fine even with a closed pyometra.
People will also again, think that they're pregnant because their belly's just getting bigger and bigger, until suddenly you come home and they're lateral, laying on their side, not moving, meowing and they look terrible because they've gotten to the point now that they're so sick that all of those toxins have gone all throughout the body, their bacteria's all throughout the body and they're very sick at this point. So, they’re really good at hiding those things.
So, diagnosis and treatment are the same but again, it is harder to diagnose the open pyometras with them than it is the closed pyometras. Same treatment options, usually surgery, the other one can be doing the injections as well, but again, it's not technically approved in the U.S. for that.
So, now, we're going to talk about a super interesting part of this, something called a stump pyometra. So, when I was talking before about what we do as part of the surgery, is that we have to take out the uterus so we're taking out that Y-shape to the uterus, and then may or may not take out the cervix. That just depends on the surgeon and whether you can get to it or not.
But there's still going to be part of that uterus that's left that's attached to the vagina. So, you can have that little, tiny piece become infected as well. We call it a stump because if you imagine a tree, if you cut down the tree, you still have that stump at the bottom there. There's stumping still attached to the ground, that's essentially the same thing. We still have a part of the uterus that's attached to the vagina so it's going to be called our stump.
Now, there has to be some sort of progesterone that is being put onto that uterus. So, that could mean that there is a remnant of that ovary left. When we do this surgery, sometimes those ovaries are almost touching the kidneys and we can't take the kidney or we don't want to — you technically can but you don't want to.
So, you sometimes can leave a little tiny piece of that ovary. Well, if that ovary is enough to be able to start producing progesterone, then that stump becomes widened, it becomes fluidy and it has a lot of blood supply to it so bacteria easily wants to go in there.
The other thing is you can have microscopic pieces of the ovaries so it might look like we got the entire thing but then you could find literally microscopic. Like you can't even see this type of pieces that are left causing this progesterone to increase and causing these stump pyometras.
The third thing that can happen though is that you could have a person who is usually on estrogen for menopause. There's those lotions and stuff that they use for it. If somebody has that and you're putting lotion on yourself and then your cat comes and licks it, or your cat cuddles with you in that area, that's the most common. I mean your dog can lick it and stuff as well, but I'd say I've seen it more in cats.
But let's say a dog licked it or something, that can actually produce — so even though it's not estrogen they’re licking, estrogen makes progesterone higher. So, they can actually produce more progesterone which again we're back into the same boat. Now, we have progesterone in this cat or dog system that goes to that tiny little stump. The vagina has all the bacteria in it that lets it in and now we have a stump pyometra.
There are other weird things like that that can happen too. They have the same clinical science as a pyometra, so a lot of times, they're still lethargic, they don't want to move, they're not wanting to eat, they're vomiting, they don't have a distended abdomen because their uterus is essentially the big part of it is gone, now, we just have a tiny part of it.
And they're a little bit harder to diagnose because you can sometimes see them on radiographs or on X-rays because you'll see a swelling that's underneath the bladder, you can see them on ultrasound. But again, you have to know that it's that and it's not something like the colon.
And then there's also hormone testing. Hormone testing has its ups and downs, it's pros and its cons. So, I can send out blood work to see if the progesterone is high. If the progesterone is high, we know that there's something that's influencing that dog to have more progesterone, and either there's a remnant that's left inside there of the ovary or we have to start asking is there anybody in the household that potentially has estrogen that could be causing this?
But if you're coming in because you think that the dog or cat has a stump pyometra, that you think that the dog is really sick, I don't have time to wait for that progesterone testing. A lot of times, I have to send that out and then I don't really have the time to wait for it to see if it comes back.
They do have some testing that you can do in the clinic, and I haven't looked into too much about the reliability and stuff of it, because it's usually used more for when you're worried about timing of reproduction stuff. That's not my forte, I'm not a reproduction veterinarian, I do emergency.
So, there are some people that do have in-house testing for that. But if we have to send it out; that means they have to be sent out, it has to come back, you have to run the test, it has to come back. But that's going to be a couple days to a week and we don't have a couple days to a week to wait to see if we need to do that or not see if we need to go in.
The treatment options are sort of similar so we can't do those prostaglandin injections. It has to be surgery, but you have to remove that little tiny stump as much as you possibly can because again, there's only so much we can take, you can't go all the way down to the vagina. So, we have to take out as much as we can of that stump.
But also, we have to try to find if there's a remnant of the ovary. So, if there's a piece of that ovary that's left in there, then we have to be able to take that out. But again, if it's microscopic, that's almost impossible. If it's so small that only a microscope could see it, how are we going to see it just looking inside the pet?
So, sometimes we even just have to take biopsies of the area and hope that maybe we'll find pieces of the tissue and know where to go for the next time.
Sometimes we also send these out to surgeons to be able to do because it could be so difficult to find them that sometimes we need somebody who that's what their job is, is to do surgery all day every day. Sometimes we need those surgeons to be able to go in and look for it as well.
Alright, so now, I'm just going to talk about some of the frequently asked questions that I get. So, I've had people ask me like is there anything else that can cause pyometra? And so, technically, yes. This usually goes for breeding animals.
Sometimes they'll be given injections of progesterone, like long-acting progesterone to try to help delay or suppress their heat cycle so that they can get the timing right for their breeding. It can also be due to postpartum metritis. So, what that means is, is that after the dog or cat had puppies or kittens, they can get inflammation or infection of the uterus afterwards.
So, you can have it like a couple of weeks right after they've had puppies or kittens, because of that. Because that cervix is usually open still while they’re having those puppies and kittens. It can also be due to administering estrogens.
We talk about the estrogen creams from like people who had estrogen on them but also people have been known to give estrogens which promote more progesterone again pushes us into this state where pyometras like to happen and it's usually given to prevent pregnancy.
I hadn't ever heard this term before, but apparently, there's something that they call the mismate shot. But that's essentially giving the estrogen to prevent a pregnancy. And then the next best question I have is, can pets die from this?
So, yes. And again depends on what type of pyometra and open pyometra, they're not as likely to die, but a closed pyometra, they are more likely. And I definitely get a lot of people ask like, “Can I wait to see if my regular veterinarian can do it the next day?”
So, if it's an open pyometra, well, it’s like, “Sure, we'll give them antibiotics. You just know that you're running a risk and hopefully, your vet can get her in tomorrow.”
That doesn't always happen though. I definitely know that regular veterinarians have a really busy schedule, they're usually backed up on all their appointments or their surgeries. They have a very specific set number of surgeries. So, if somebody cancels, then great, then you might be able to get in.
But don't be surprised if they're like, “Hey we just have too packed of a schedule, there's no way we can take on this extra surgery.” And so, you might end up back in the ER after that as well. Because we really don't want to wait on these, we want to get that out as soon as possible. The longer we wait, the worse it's going to get.
Now, for a closed pyometra, if I have a pet parent who comes in and is like, “Hey, I can't afford this or can I wait until my regular veterinarian opens in the morning, and then I'll do it with my regular veterinarian?”
I am less likely to say that that's okay because these pets are usually much sicker. They usually need immediate care; they usually need to be stabilized and they need to have surgery immediately. Because if not, they are going to become very, very sick and now, you are going to be in a worst situation than you were before. So, for closed pyometras, I usually say don’t wait, it needs to happen pretty quickly.
Another question I get is, “If this is just an infection, why can’t we just use antibiotics?” Antibiotics alone , just don’t do surgery. It’s a totally valid question. Because I’m like hey, this uterus is filled with pus, with tons of bacteria, so you would think that if there’s tons of bacteria, we just give you something that fights bacteria, we just give antibiotics.
Well, the problem is that there is so much pus in that uterus that there is no way that that antibiotic no matter if I gave it IV, gave it by mouth, there’s no way that it can penetrate all that bacteria that’s in there. Get through all the dead cells and get through all the white blood cells, it cannot penetrate all of that.
So, yes, we do need antibiotics, but this is going to be like we need multiple things to help cure them. We need antibiotics and we need to have surgery or the injection if that’s the route the owner decides to take.
And then another question I get is, how do I prevent pyometra? So, really the only way to prevent pyometra is to spay them. There are lots of people who do not spay or reasons for people who do not spay. There have been so much controversy around this, tons of studies that try to determine what are the optimal ages of spaying.
They've done studies to try to figure out what the benefits of not spaying versus spaying was, which diseases will occur because you didn't spay versus which diseases occur because you do spay. Does behavior become an element in this? Like if you spay, does it actually change the behavior of dogs? This is a huge topic of debate even in the veterinary community itself.
So, one of the things I will say is that yes, it does prevent a pyometra, absolutely, but you still can potentially get that stump pyometra like I was talking about. It is a rare thing, but it is a possibility, and really that's the only true way that you can prevent pyometra.
The vagina has to have bacteria in it. It's a normal thing. And unfortunately, like progesterone is a normal thing that's going to occur as well and it's going to produce these hormones, it's going to make that uterus large and it's going to make it a perfect place for bacteria to want to go. So, really, the only way is to, like I said, do a spay if that's the case.
Another good question I get is, “Well, if it's just a spay, then why is it more expensive than a spay?” Like I said, this isn't just a spay, this is a very complicated spay. It takes a lot of effort to get that pet stabilized before, during and after. It's a lot more medications that we're using. It's not just a simple spay. Like yes it is a spay, it is that procedure but it has so much more that goes into it.
Another question I get is, “Well, can my dog or cat have a litter of puppies or kittens after having surgery from a pyometra?” So, that's a no. As long as that uterus is gone and those ovaries are gone there is no way to have puppies or kittens after that. There's just nowhere for them to grow, so no, they cannot.
And then I had this question asked to me a couple of weeks ago and I thought this was an interesting question. So, somebody asked me, “Well, do all veterinarians spay and neuter their pets?” So, you would think that the answer was yes. Because we have so many people who are in the fields where decreased animal population and stuff, that's not actually true.
There are a lot of veterinarians who don't spay and neuter their pets. There are multiple veterinarians even at my own clinic that don't spay or neuter their pets. When I'm asked the question for myself, I do spay and neuter my pets. I do it at a time though when I feel like it's going to decrease the risk of certain things for that very specific pet. So, I treat each one of mine as an individual pet.
And I have a Great Dane who if I spayed her at a later age, it decreases the chances that she's going to hurt her knee, so get a ligament injury in her knee. It’s going to decrease the chances of her getting a very specific type of cancer called osteosarcoma, cancer of the bones. If I didn't spay her, then it will also put her at an increased risk for having things like memory tumors or ovarian tumors.
So, I had to pick a time that I felt was going to be the best for her. Like when am I going to decrease the chances of her getting things like mammary tumors and when am I going to decrease the chances of her getting things like osteosarcoma? And it's going to be different for each type of pet. Golden Retrievers, we worry about hemangiosarcoma, they're very prone to that which is a type of cancer of the blood.
So, what age is it best to spay those dogs? Large breed dogs are going to be more affected by certain cancers than small breed dogs. So, there's a lot of things that plays into each one of these elements. It used to be that we said every pet by eight weeks old, six months old, should be spayed or neutered. But that’s not necessarily the case.
But I won't get into that because, again, that was not an emergency thing. That is more like a general practice thing.
So, the next thing that we're going to talk about is our animal fact. So, hopefully, you got through all of that, hopefully all of that made sense for what a pyometra was. And this one is actually going to be an animal fact that's closely related to pyometras.
So, if you don't know what a pangolin is, you should look it up. It looks like an ant eater that has scales. That's actually what their name means, is a scaly ant eater. They have a lot of cool features to them, but they're really only found in Asia and Africa. So, four species in Asia, four species in Africa.
What they do is that they have all these scales, there's just scales everywhere. They roll up into this little ball as their defense mechanism, it's like their little shield. So, that they can shield their stomach and their face because those are the two areas that don't have scales on them. So, they just roll up into this tight little ball.
These scales are so tough that a lion could not even bite through them. So, they are really tough. The hardest part about this though is that that also means that they're so delicate that if a person just comes and picks up the little ball, they could just take it with them. So, a lot of poachers tend to grab the little pangolins and then take them for their scales.
Other cool things really quickly about the pangolins though, is that they can eat up to 70 million insects an year, that's like ants and termites. I would love to have one in my yard, but their sticky little tongues can shoot up to like 28 inches into these anthills to get all of these out.
And yeah, one of the things that I thought about, I was like, “Well, aren't all the ants just like crawling up them?” So, they can actually close their nostrils and their ears so that the ants and stuff do not go on their nose and ears. It's a pretty great defense mechanism too, that's what I would think.
But there are scales, so their scales make up about 20% of their body. That's quite a significant amount, and it's made up of keratin. So, it's actually made up of all the same stuff, like your nails are made out of, just really thick keratin. But these guys are one of the most trafficked animals in the world because of their scales.
So, their scales are used for alternative medicine purposes. So, they've used it for arthritis and sepsis, like really bad bacterial infections of the bloodstream. They've used it to stop bleeding and they've even used it for pyometras. Like there are people who I've also seen on the internet that have just talked about how they've used this for pyometras.
There’re also poaching the meat as well but their scales is what we're going to be concentrating on right now. Because they have been one of the most highly poached animals, they're also very endangered animals.
So why am I talking about this? Why didn't I talk about this treatment option before. I'm like, “Hey, there's these two treatment options” and then I'm now, I'm like, “Wait a minute, there's a third treatment option, there’s like these pangolin scales.”
So, one, I don't talk much about it because alternative medicine is not my forte. Like I would talk to somebody who does alternative medicine to decide whether this was truly something that should be used or not.
But the second reason is because there's a medication that we would use, and it's called Yunnan Baiyao and it's become very controversial. That's what people have used recently or not recently used before with pyometras to try to help cure them.
But the company who makes the Yunnan Baiyao, they had sold a very, very large amount of pangolins scales. And in the U.S., you have to write on each one of your ingredients what is in every single product.
So, Yunnan Baiyao for the U.S. has to say on there whether there's pangolins scales or not, which there's not. It is not listed as an ingredient on there, but if they're made in China, China does not have to list all of those ingredients on there. So, you could potentially have pangolins scales in there.
There's lots of people who have done research and stuff to try to decide whether the company who did Yunnan Baiyao actually made their stuff with pangolins scales, but it's really hard to tell if they have or not. But all we know is this company did sell off a large amount of them which means that they had them for some reason. So, now, it becomes this moral dilemma for veterinarians.
So, some veterinarians are on the side of like, “Well, does it matter that they potentially had pangolin scales in their own products or some other product it’s not in the U.S. products. And so, does it matter if I buy that product and then give it to pets as a potential treatment option?”
We're going to save more pets that way possibly, because there's also not a ton of research to say that yes it absolutely does fix it. But are we going to save more pets that way and we don't really care as much about the pangolins and that they're potentially going to be extinct?
Or do we go the route of thinking, “Well, I don't want to use this treatment option because of the fact that we don't want to make the pangolins extinct. We don't want to keep poachers in business and so we don't want to buy that product even though it could potentially save some of our pets.” So, that's a really hard thing.
So, you'll see some veterinarians will have Yunnan Baiyao and some veterinarians will not. And so, if you come across this, you'll kind of know why. That's because some people don't want to partake in the fact that they even have pangolin scales in the first place.
Alright, so I know that was quite a lot on pyometras, hopefully, that made sense. Like I said, if you have any questions, always feel free to get in contact with me. I'm usually on Facebook the most, so you can usually find me at Vetsplanation Podcast, or you can email me suggs@vetsplanationpodcast.com
And as always if you know somebody who might find this stuff interesting, you know somebody who really likes their pets and wants to know more about their pets, please share this podcast with them and thank you guys, I really appreciate everything, and I will see you next week.
Thanks for listening this week. If you have any questions, comments, suggestions, or you just want to say hi, feel free to email me at suggs@vetsplanationpodcast.com.
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Thank you all again for listening and we'll see you back here next week.