We had a case in this weekend which reminded me of my first ever major surgery (summer last year).

There are many many reasons and active debates flying around constantly about the pros and cons of spaying/not spaying your bitch.  For me, the pros far outweigh the (questionable and not, as yet, scientifically proved only con that I can think of which is an increase in incontinence in spayed bitches depending on how old they are when spayed etc) cons.  Spaying itself is highly misunderstood by the general public (some people ask for it to be reversed!).  In the UK it is an ovariohysterectomy – removal of the ovaries and uterus.  In some parts of the world only the ovaries are removed (as they control the hormones).  The main pros for spaying are :

• prevents mammary cancer in later life due to the lack of oestrogen from the ovaries.  In fact, studies have shown if the bitch is spayed before her first season, the chance of getting mammary cancer is 0.05%, after the first season it increases to 8%, then 26% after the 2nd, then it increases dramatically to 70-80%!!  That is a great reason to get her spayed before or after the first season
• prevents unwanted matings and puppies which is, I think, an excellent reason.  What would you do if your bitch got caught whilst in heat?  Most owners are unaware that if you get her to the vets asap after it happens then she can get a course of injections to prevent the mis-mating resulting in her being pregnant.
• prevents womb infections which are most commonly called Pyometra, which is a serious and life-threatening condition and is what I am going to discuss in this entry.

Pyometras can occur anytime up to 12 weeks after a bitch has had a season.  The first week of a bitch in season is the week when they produce a bloody discharge, therefore the cervix is open to allow the discharge to come out from the uterus.  This allows the tracking up of bacteria from the vagina and thus setting up an infection in the uterus, which is vascular, moist and just ripe to house a bacterial infection. Pyometras are most common in the older unspayed bitch, but they can happen from any age although this is much rarer.

Having nurses in the vet practice on the reception and answering the phones can be an excellent tool to weed out actual emergencies from people over-reacting.  Luckily for my first Pyo case, the nurse who answered the phone call picked up on the vital signs and told me before i saw the consult that it sounded like a pyo.  There are two main types of pyometra that we see in general practice – open and closed.  Both usually show the same presenting signs that are very typical :

• off colour
• drinking more
• urinating more
• off food
• vomiting
• sometimes a vaginal discharge is seen

Open pyos are so called as the cervix which is at the opening to the pus-filled uterus is open and dilated so allowing the purulent discharge to come out.  In open pyos the dog is usually not as unwell as the dog with a closed pyo.  Closed pyo is the opposite to an open one – the cervix is shut which allows the pus to build up inside the uterus and results in a generally much sicker dog.  Sometimes the dog can go between and open and closed, with the dog feeling better and picking up when open, and then going downhill/feeling much sicker when it becomes closed again.

The bitch that I saw had been drinking more, off colour and vomiting for the last 4 days.  She also had a browny/bloody vaginal discharge and wasn’t spayed.  On examination, nothing abnormal was found apart from the obvious discharge and swollen vulva.  The owners were advised of the risks involved and the cost of the operation (which can run up to over £1k for really bad pyos).  The dog was then admitted and placed on a drip as fluids are necessary for such an operation, moreso for the possibility of toxaemia (blood poisoning) caused by the highly infected uterus releasing bacteria into the bloodstream (this can sometimes be very serious if they go “toxic” and into toxic shock).  Bloods can be done but they usually show a high white blood cell count (not surprising – fighting the uterine infection) and raised kidney levels (due to the toxaemia) and sometimes raised alkaline phosphatase (which is an enzyme which can be found in tissue breakdown) and so bloods are usually not done if cost is an issue.

The dog was then anaesthatised and the abdomen was clipped up and she was transferred through into the operating room.  There she was placed in dorsal recumbency (on her back) in a cradle to keep her secure and her hindlimbs were tied down to the table to prevent her slipping around.  The nurse then scrubbed her up whilst I scrubbed up and got gowned up.  Luckily, she wasn’t that overweight and she was a Staffie so she was fairly small in size – ideal for my first pyo!  Basically a pyo operation is “spaying” the dog – ie an ovariohysterectomy, but the risks are much, much higher as, in some cases, the uterus is so full of pus it can become really friable/thin walled and rupture.  This is very serious as it can leak purulent material into the abdominal cavity and cause a secondary peritonitis!  Luckily, in this case, the uterus was big but quite stable and not likely to rupture so long as I was careful with it!  Both ovarian arteries were located, ligated and the ovaries were released leaving the cervix left to ligate and bisect:

In the above picture, the ligated and removed ovaries are to the left, and the still attached uterus/cervix is to the right

The cervix was then clamped, double ligated (after anchoring the sutures through the middle of the cervix) and the uterus was removed cleanly and quickly to prevent any discharge leaking into the abdomen.

In the above picture, the ovaries are on the right and left (where the clamps are) and the cervix is where the scalpel handle is (to give an indication of size)

The dog was then sutured up and allowed to come round.  She was also given antibiotics and painkilling injections.  We weighed the uterus for our own interest and it weighed a good 2kg and the dog looked a LOT slimmer afterwards!

She recovered well and went home the next day with a course of antibiotics.  10 days later she returned to have her stitches out and was much better in herself and back to normal = happy all round.

Having your bitch spayed when young prevents so many problems in later life.  Even if you think the operation is expensive when she is young, imagine being faced with a £6-700 plus bill if she develops a pyometra.  This particular case was quite “simple” in the grand scheme of things but many complications can occur – such as the pyometra we saw on Saturday, where the uterus ruptured and she had to be kept in all weekend on fluids, iv antibiotics and at the time of the operation had to have her abdomen flushed out repeatedly to prevent peritonitis.  Prevention, as they say, is always better than cure (and much cheaper!).