Routine bitch spey after open pyo

Re: Routine bitch spey after open pyo

Gillian Mostyn — Wed, 27 Jun 2012 22:22:45 GMT

[quote user="Thomas Johnson"]In the practice I was working in at the time, bitch spays were under-priced and other ops, including pyometras could work out very costly. Not how I would want to structure prices, but as an assistant I have to charge as directed by the partners.[/quote]

Fair enough - I can see your point even if, like you, I disagree with the pricing structure.

Re: Routine bitch spey after open pyo

Alan Tevendale — Wed, 27 Jun 2012 20:16:51 GMT

I'm certainly in the spay pyo's as the far more preferable option camp but I do feel that cost does sometimes come into this. Most practices seem to charge bitch speys out as a price sensitive operation and as such keep prices artifically low compared to normal surgical rates. Yes the cost of a course of Alizin and antibiotics followed by routine spey often does match the cost of the pyo op in many cases however instead of one big hit in the case of the pyo the costs are spread over a period of weeks. In some cases this could mean the difference between being able to afford treatment or not.

Re: Routine bitch spey after open pyo

Thomas Johnson — Wed, 27 Jun 2012 18:54:11 GMT

[quote user="Alet Engelbrecht"]

Pardon my confusion - but it seems contradictory that there is 'an evacuation of pus' (by definition to empty) and on the other hand you say that large amounts of pus are unable to drain. I agree with your final statement, and I think that holds true with Alizin as well as - granted my experience is limited, but the one bitch I used it still had uterine pathology and that is what I have heard from others as well (including this forum). Therefore my doubt about the perceived cost or health benefits to the client and patient.

[/quote]

Sorry for the confusion, I meant that in my experience those treated with Alizin do evacuate the pus quickly. And in open pyos that go straight to surgery (no Alizin) there is a lot of pus that is unable to drain.

My prefered option is to spay pyos, and unless there were serious anaesthetic concerns I would always recommend that to the owner, but I do think Alizin has a place in the treatment of pyos.

Re: Routine bitch spey after open pyo

Thomas Johnson — Wed, 27 Jun 2012 18:51:09 GMT

[quote user="Gillian Mostyn"]

[quote user="Thomas Johnson"]I have used Alizin a couple of times, the most recent being a small dog with an "open" pyo where cost was an issue. Three injections of Alizin, a week of co-amoxiclav and a spay a month later was significantly cheaper than spaying her straight away.[/quote]

Why?

I don't find the time or materials for an open pyo surgery in a small dog to be more than that for a routine spay. In fact, the ovaries are often easier to ligate. I only charge more for a pyometra if the surgery is genuinely more difficult or time consuming. If the dog was fairly well (which I assume it was by the description of your medical management) why would the surgery have been so much more expensive if done straight away?

[/quote]

You have the advantage of setting your own costs. In the practice I was working in at the time, bitch spays were under-priced and other ops, including pyometras could work out very costly. Not how I would want to structure prices, but as an assistant I have to charge as directed by the partners.

Re: Routine bitch spey after open pyo

Gillian Mostyn — Wed, 27 Jun 2012 18:15:14 GMT

Why?

Re: Routine bitch spey after open pyo

Alet Engelbrecht — Wed, 27 Jun 2012 17:52:51 GMT

[quote user="Thomas Johnson"]

I have used Alizin a couple of times, the most recent being a small dog with an "open" pyo where cost was an issue. Three injections of Alizin, a week of co-amoxiclav and a spay a month later was significantly cheaper than spaying her straight away.

Also the uterus does not drain slowly after Alizin, the evacuation of pus, even with a "closed" pyo, is pretty dramatic!

On a slightly different point does anyone else feel that "open pyo" is a bit misleading as the cystic nature of some pyometric uteruses means that large amounts of the pus are unable to drain?

[/quote]

Re: Routine bitch spey after open pyo

Thomas Johnson — Wed, 27 Jun 2012 09:29:36 GMT

[quote user="Alet Engelbrecht"]

, at least not for medium to large breed dogs - you are looking at the cost of the drug for at least 4 injections, an ultrasound, a long course of antibiotics, in some cases still fluid therapy in the initial stages. Even in an animal that is compromised and an anaesthetic risk at the time - leaving a pus filled uterus to drain slowly is not going to speed up recovery.

[/quote]

Also the uterus does not drain slowly after Alizin, the evacuation of pus, even with a "closed" pyo, is pretty dramatic!

On a slightly different point does anyone else feel that "open pyo" is a bit misleading as the cystic nature of some pyometric uteruses means that large amounts of the pus are unable to drain?

Re: Routine bitch spey after open pyo

Alet Engelbrecht — Wed, 27 Jun 2012 08:31:42 GMT

[quote user="Mark Holmes"]If he was South African he could well have been discussing his wife![/quote]

Very true! And what did he say about her black eye? Nothing, he's already spoken!

[quote user="Alan Tevendale"]Generally I would agree that surgery is the best option but medical treatment can be used for several reasons. Obviously as previously stated if the animal would be otherwise unable to undergo anaesthesia then medical treatment may be prefered but also if for cost reasons the client would not be able to afford surgery at that stage medical treatment allowing a spey at a later date may be a reasonable second line option IMO.[/quote]

I don't think Alizin works out any cheaper, at least not for medium to large breed dogs - you are looking at the cost of the drug for at least 4 injections, an ultrasound, a long course of antibiotics, in some cases still fluid therapy in the initial stages. Even in an animal that is compromised and an anaesthetic risk at the time - leaving a pus filled uterus to drain slowly is not going to speed up recovery. Raging heart murmur perhaps? (although if endocarditis where did the bacteria come from in the first place?) I would have thought that the most important indication for medical management would be to breed from the bitch later - no true cost or health benefits really. I like medicine, but don't like it to be faffy when there is a straightforward no-nonsense alternative.

Re: Routine bitch spey after open pyo

Alan Tevendale — Wed, 27 Jun 2012 08:14:18 GMT

Generally I would agree that surgery is the best option but medical treatment can be used for several reasons. Obviously as previously stated if the animal would be otherwise unable to undergo anaesthesia then medical treatment may be prefered but also if for cost reasons the client would not be able to afford surgery at that stage medical treatment allowing a spey at a later date may be a reasonable second line option IMO.

Re: Routine bitch spey after open pyo

Tom Ward — Tue, 26 Jun 2012 23:00:25 GMT

Yep, you were all right, thank you! Pyo still grumbling, dog still well but getting pus on owner's bed. Speyed today, job done. :)

Re: Routine bitch spey after open pyo

Mark Holmes — Tue, 26 Jun 2012 17:05:54 GMT

[quote user="Alet Engelbrecht"]

As my repro's prof at vet school used to say: "If she isn't destined for breeding, spay da bitch" in a very strong Afrikaans accent!

[/quote]

If he was South African he could well have been discussing his wife!

Re: Routine bitch spey after open pyo

Alet Engelbrecht — Tue, 26 Jun 2012 16:03:29 GMT

Just wondering, was there a specific reason to go for medical management rather than spay the dog in the first place? Especially as it was well otherwise and the intention was to spay it later anyway. Alizin is a great drug and even though it is known to be used and apparently 63% effective against pyometra (last I checked), it is still not licenced for pyometra and the protocol is expensive.

I agree with Mark and probably would have spayed the dog in the first instance. I have only used Alizin once for pyometra in a very overweight and elderly (but certainly not too old to be spayed) bitch as the owner requested it. After a couple of months, the bitch started having a vaginal discharge again and I spayed her - end of story, appetite better than ever. Prior to spaying, the owner had forked out a lot more than the cost of a pyo on repeated alizin injections, antibiotics and scans. (It was a Golden Retriever).

As my repro's prof at vet school used to say: "If she isn't destined for breeding, spay da bitch" in a very strong Afrikaans accent!

Re: Routine bitch spey after open pyo

Alex Allen — Tue, 26 Jun 2012 09:48:22 GMT

Typically after medical control of a pyometra (e.g with Aglepristone) the ovariohysterectomy is performed 3-4 weeks after resolution.

Re: Routine bitch spey after open pyo

Hannah Wynne Richards — Tue, 26 Jun 2012 09:44:09 GMT

This is one where there's risks whatever you do Spay now and get a post-op haemorrhage and you could be criticised for doing it too soon-wait and the pyo flares up again and you could be criticised for waiting

All I'll say is give plenty of antibiosis as you may be cutting into infected tissue

Wynne

Re: Routine bitch spey after open pyo

Mark Holmes — Tue, 26 Jun 2012 09:30:59 GMT

I have spayed dogs in season, post caesar, post pyo and at pretty much any stage of the cycle. There is really very little difference. If its in and starved spay it.