D. E. Larsen, DVM
“I know you don’t believe me, Doctor,” Althea said. “But she is just not herself.”
Penny was a yellow lab cross, maybe more reddish than yellow, and smaller than most labs. Her toenails were long, causing her to be unsteady as she thrashed about on the exam table. Penny was one of those dangerous, friendly dogs. If you got too close, she would lick you to death.
Althea was a slender middle-aged lady who noticed our clinic while she was doing laundry next door. At one time in her life, she had been a medical technician. Now she worked nights at the hospital, transcribing records.
“I am finding it hard to think she is sick,” I said. “I don’t see too many sick dogs dance around on the exam table like this. Let’s draw some blood, and I will give her an antibiotic injection. We won’t have the blood results until morning. You can take her home, and I will give you a call when I get the results.”
“I feel a lot better with you running some blood on her,” Althea said. “And I am sure she will be more comfortable at home.”
“We can set up an appointment to recheck Penny in the morning about 9:00. We should have the blood results by then.”
Collecting a couple of tubes of blood from Penny was somewhat difficult. She was bouncing so much it was almost impossible to restrain her enough to get the needle in a vein. The blood collection was followed by an injection of Ampicillin. Then I lifted Penny down to the floor. She was instantly dragging Althea toward the outside door,
“I will get the appointment written down,” I said to a struggling Althea who was having trouble bringing Penny to a stop at the front desk. “We will see you both in the morning.”
I scanned the values quickly when Judy handed me the results of the blood work the next morning.
The white blood cell count jumped out at me, 29,000 white blood cells. There are not too many things that will cause that high of a number in the dog. But Penny was an older, intact female. A pyometra, a pus-filled uterus, was high on the list of possibilities.
“I think you should clear the schedule for the morning,” I said to Judy. “I am betting that we are going to have to schedule surgery for Penny.”
Right at 9:00, Althea came through the door with Penny. Penny was still bouncing around on the end of her leash.
“I know she still looks fine to you,” Althea said. “But she is even slower this morning. And I noticed a little vaginal discharge this morning.”
“Well, her blood results got my attention this morning,” I said. “Her white blood cell count was 29,000. In an older, intact female dog with vaginal discharge, the diagnosis is a pyometra, pus-filled uterus, until I prove otherwise. We can easily confirm that diagnosis with an x-ray.”
“I am on somewhat of a budget here,” Althea said. “What are the treatment options, and can we do those without the x-rays?”
“There are no options, the treatment is surgery,” I said. “We have to get that uterus out of there before we get into all sorts of complications. Surgery is diagnostic also. If we are correct, we save the cost of the x-rays. If it is something else, then we are back to square one. But doing an ovariohysterectomy while we are there would be to Penny’s benefit.”
“I think with my funds, we should just go right to surgery,” Althea said. “You can call it an exploratory.”
“That sounds good to me,” I said. “I am pretty confident of the diagnosis, especially with the vaginal discharge this morning. We will give her a bottle of fluids before surgery and continue the fluids during surgery. It would be a good idea to keep her overnight, but we can make that decision this afternoon.”
With that, we got started getting Penny ready for surgery. Althea was right, she was slower this morning. As we worked through the preoperative exam, I noticed that the vaginal discharge was increasing. She was dripping a foul-smelling vaginal discharge onto the exam table.
We got an intravenous catheter into her cephalic vein on a front leg and started a bottle of Ringer Lactate. I added a dose of IV antibiotics to the fluids, and we made Penny comfortable in a kennel while we set up the surgery room. I wanted to get the whole bottle of fluids into her before we started surgery.
With the catheter and the fluids already set up, anesthesia was easily induced. A good dose of Pentathol, and then with an endotracheal tube, we hooked her up to the Metaphane gas machine. When we got her on her back, it was evident that her abdomen was full, and the uterine discharge was really going now.
Often a pyometra will start with a closed cervix. The pus that develops due to chronic overstimulation of the uterine lining from estrogen just accumulates in the uterus. The uterus can reach a large size, at least as large as a full-term pregnancy, if not larger. When the cervix opens, a lot of the pus is discharged, and the dog may feel better for a time.
When we had Penny’s belly prepped for surgery and a second bottle of fluids started at a slow drip, I pulled on a pair of gloves and opened the surgery pack. In the mid-1970s, I wore a surgical mask, but I did not gown for surgery.
I started with a small midline incision. As soon as I could see the size of the uterus, I extended the incision to about six inches. Then very gently, I eased the right uterine horn out of the abdomen and laid it out on the surgery drape. Then I did the same with the left uterine horn.
This was one large uterus. In school, during my junior year in my surgery rotation, I had assisted with the ovariohysterectomy of a very pregnant Saint Bernard. With a third trimester pregnancy, that uterus was large. This uterus, on a much smaller dog, was just about that size.
I clamped the ovarian vessels, ligated them with 2-0 Dexon, used scissors to severe the broad ligament from the uterus along each uterine horn. There were a couple of larger vessels in the broad ligament that needed ligation. Then I clamped the uterine body at the level of the cervix and ligated the middle uterine vessels. I separated the uterus between two clamps, and with great care, not wanting to rupture the uterus at this point, I transferred the entire uterus to a disposal bucket. I took a deep breath with that container of pus safely disposed of in the bucket.
Now it was simple, I oversewed the uterine stump and returned it to the abdomen. Then just to make sure there was no contamination from the uterus, I changed gloves, surgery pack, and drape. Then I closed the abdomen in a standard three-layer closure.
With the slow recovery from Metaphane, I turned off the gas when I started to close the abdomen. By the time I finished closing, and we got Penny cleaned up, and back to the kennel, she was just beginning to wake up, and I was able to pull the endotracheal tube.
Wow, just wow. Penny wakes up, and she is back to her old self. It is always amazing when you remove a bucket of pus from a dog’s abdomen. Then give her some antibiotics and a couple of bottles of fluids. With Penny, she was bouncing off the walls of the kennel.
We pulled the catheter and checked her over. Everything was in order, and the incision looked good.
“You need to give Althea a call,” I said to Judy. “I think we can send Penny home anytime this afternoon. She will surely be quieter at home than she is here. We will check her back in a day or two, depending on Althea’s schedule, to make sure things are going along okay.”
Althea was pleased, Penny was jumping all over herself when Althea showed up. I was happy to see Penny pull Althea out the door.
The recheck was quick, Penny was almost uncontrollable. I mainly wanted to check the incision. It was fine.
“I told you the first time you saw her,” Althea said. “Now, you can see that I was comparing her to her regular activity level.”