Pyometra- your approach

Re: Pyometra- your approach

Chris Geddes — Wed, 20 Feb 2013 16:48:27 GMT

[quote user="CatherineThomas"]

[quote user="Matt Hilary"]

Would still favour a surgical approach where funds/health allow but have recently used alizin with success - used the protocol here: http://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=1&ved=0CDEQFjAA&url=http%3A%2F%2Fwww.belbergere.com%2Fdocuments%2FAlizinRevolutionaryTreatment.pdf&ei=rL4jUYWKNaio0AXq0oHIBA&usg=AFQjCNFfXBZYmwkm2fJBgbWEjeP-CBtzbA&sig2=MKVsF3KI0RUd7h4ik0cvGA&bvm=bv.42553238,d.d2k

Estimate cost of medical treatment (w/o complications) + later spay approx 2/3 of immediate surgical management for 20kg dog.

[/quote]

That link describes injecting on the inner aspect of the hind limb. Is there a reason for that? I've always just given them as a normal SC injection at the back of the neck.

[/quote]

Hi Catherine,

We recommend that Alizin is given into the scruff of the neck, in fact this is stated on the SPC. We also recommend massaging, and that only 5ml is given per injection site as the injection is irritant.

If anyone has any queries on off-label use please speak to one of our technical team (01359 243 243) or PM me.

Chris

Re: Pyometra- your approach

Glenn Hodgson — Tue, 19 Feb 2013 22:07:39 GMT

[quote user="Anthony Todd"]

[quote user="Glenn Hodgson"]I am a huge fan of pre-surgical renal assessment.[/quote]

That's why I asked about bloods' being in the diagnostic and therapeutic mix.....

[/quote]

Have not read all the thread, just chipped in my own tuppence worth.

As for prostaglandins Gillian, I think you are correct re lack of SA license. Great for "cow pyos" though!

Re: Pyometra- your approach

Anthony Todd — Tue, 19 Feb 2013 21:52:52 GMT

[quote user="Glenn Hodgson"]I am a huge fan of pre-surgical renal assessment.[/quote]

That's why I asked about bloods' being in the diagnostic and therapeutic mix.....

Surely they would help treatment decisions and, having known of one that had three full blood counts on the day of the op., Ii assumed they were routine?

Would have been nice to know in the case with the concurrent splenic mass?

Re: Pyometra- your approach

Julie Innes — Tue, 19 Feb 2013 19:30:13 GMT

I've always started ABs, tried to get them stable (eg with fluids etc), then operated. Some of the huge pyo's I've seen, I'd feel uncomfortable leaving all that pus there.

I was using alizin today (as a misalliance) and noticed that they state in the instruction that it's use in pyometra is "Off Licence", and hasn't been tested (or something!)

As an aside, I once gave buscopan to a doberman with what looked like a painful abdomen (wasn't thinking pyo). 10 minutes later about a litre of pus whooshed out onto my feet... (I still operated, though!)

Re: Pyometra- your approach

Gillian Mostyn — Tue, 19 Feb 2013 19:11:42 GMT

[quote user="Glenn Hodgson"]Am v.cautious of p.glandins.[/quote]

Am I being a bit thick? I didn't think there were any licensed SA prostaglandins???

Re: Pyometra- your approach

Glenn Hodgson — Tue, 19 Feb 2013 19:02:31 GMT

[quote user="Lucy K"]

Do you go straight in and spay or do you try and treat medically first?

The reason I ask is because I saw practice with a great SA vet this summer and she says she treats all pyometra cases medically now and she has suceeded with every one. Our surgery lecturer today told us to always spay in case of pyometra.

I'd be interested to see your views.

[/quote]

I treat medically primarily, this varies from some synulox to IV meds and the works if very poorly. Then cut.

I like to scan early and if the pyo looks huge then I cut it out prior to going home so I can sleep deeply.

I am a huge fan of pre-surgical renal assessment. Had a really sad outcome of a reasonably bright 8YO cocker that was euthed around the time of SO due to renal failure. After applying the retrospectometer I would have been more insistent re pre-op assessment.

Am v.cautious of p.glandins. Not my own case but have seen a g.dane drop dead 30mins post injection, quite distressing. It was somewhat sick though.

Re: Pyometra- your approach

CatherineThomas — Tue, 19 Feb 2013 18:20:19 GMT

[quote user="Matt Hilary"]

Estimate cost of medical treatment (w/o complications) + later spay approx 2/3 of immediate surgical management for 20kg dog.

[/quote]

That link describes injecting on the inner aspect of the hind limb. Is there a reason for that? I've always just given them as a normal SC injection at the back of the neck.

Re: Pyometra- your approach

Matt Hilary — Tue, 19 Feb 2013 18:08:09 GMT

Estimate cost of medical treatment (w/o complications) + later spay approx 2/3 of immediate surgical management for 20kg dog.

Re: Pyometra- your approach

Anthony Todd — Tue, 19 Feb 2013 02:57:46 GMT

[quote user="robloxley"]I'm not sure anyone's given up using antibiotics in pyometra[/quote]

I don't follow;

Re: Pyometra- your approach

Rob Loxley — Mon, 18 Feb 2013 23:36:45 GMT

[quote user="Anthony Todd"]Gosh,I'm the dinosaur here, but I remember that a high WCC, loads of neutrophils and a left shift meant you had a pretty active infection and you better do something quickly but that was then.[/quote]

I'm not sure anyone's given up using antibiotics in pyometra

Re: Pyometra- your approach

Anthony Todd — Mon, 18 Feb 2013 22:45:57 GMT

[quote user="robloxley"]How would a white blood cell count (I assume this is WCC) alter your decision making??[/quote]

Gosh,I'm the dinosaur here, but I remember that a high WCC, loads of neutrophils and a left shift meant you had a pretty active infection and you better do something quickly but that was then.

I suppose with a normal WCC you could try drugs first, particularly if there were anti-op factors, like a recalcitrant owner.

Re: Pyometra- your approach

Rob Loxley — Mon, 18 Feb 2013 22:24:57 GMT

[quote user="Anthony Todd"]Surely even a WCC would help?[/quote]

How would a white blood cell count (I assume this is WCC) alter your decision making??

Re: Pyometra- your approach

Anthony Todd — Mon, 18 Feb 2013 22:11:29 GMT

[quote user="Julian Earl"]

spay, spay spay. Cannot see the point of dragging things out for a very poorly dog. Touch wood never have GA problems and the dog is almost invariably near back to normal within 2-3 days. Just operate and get it over with , that's my principle.

[/quote]

Can't understand why no one puts bloods into the decision mix, particularly in these modern times, where all sorts of tests are performed once an animal shows any symptom at all.

Surely even a WCC would help?

Re: Pyometra- your approach

Virginia Campbell — Mon, 18 Feb 2013 19:37:51 GMT

[quote user="Alice Courtney"]Wondered what people would do in this instance: Elderly GSD with splenic mass but currently no signs, [/quote]

Alizin+antibiotics. Ditto in a young bitch that the owner really really wants to breed ( I tell them to breed at next heat then spay when pups a couple of months old). Could count on the fingers of one hand the times I have treated a pyo medically though.

Last pyo I saw was on Thursday afternoon. Good old vaginal discharge but pretty sick too; not vomiting but t105.5F and anorexic and dull (toddled into the consult room and promptly lay in lateral for the whole consult). 1litre of fluids and my evening consults later, I got on and extracted the bag of pus and threw it in the bin. Didn't want to leave that one for some poor unfortunate on Friday (I was off). Bit scared of leaving it for fear of uterine rupture and also leaving a pile of toxic IMHA/organ failure inducing nastiness in there (aren't a lot of the pyos supposed to be various shades of E.coli?)

Having said that, she might have done mighty fine with fluids + abs + alizin

Re: Pyometra- your approach

james herriot lied — Mon, 18 Feb 2013 19:30:39 GMT

[quote user="Alice Courtney"]

Elderly GSD with splenic mass but currently no signs, owners aware probably guarded long-term prognosis.

[/quote]

Don't take that one as a given: only about half of these are malignant. I used to be very anti-splenectomy with older dogs and masses, but have found enough response in recent years to consider surgery unless there are pressing reasons not to. In this case, it seems the pros for surgery outweigh the cons.

If this isn't a pyo, and is just vaginitis, then you may not get any response with alizin in any case.

Still going with the surgical option for pyos - had an immediately pre-rupture, closed pyo in today - luckily on someone else's surgery rota. A kilo-and-a-half of purple, necrotic uterus full of stink. I dread to think what might have happened if we'd looked at medical treatment first.

Re: Pyometra- your approach

Bob Russell — Mon, 18 Feb 2013 17:58:09 GMT

Alizin has worked well for me. I still get them spayed as soon as they are back to normal.

Closed pyos seen in evening surgery are open pyos by the morning and much brighter/fitter for surgery. That said last Fridays pyo was operated Friday and pretty much back to normal when seen Saturday morning!

If the owner declines surgery then Alizin should be worth using.

Quite a lot of the large dramatic splenic tumours have been there a long time and are not causing a lot of problems. The small bleeding ones are often more 'sinister'.

Re: Pyometra- your approach

Jo Cobbett — Mon, 18 Feb 2013 16:20:49 GMT

I would certainly consider Alizin in a case like this. I've used it in a few cases, some bitches that the owners wanted to breed from at a later date, a couple where the owner wouldn't countenace surgery in an elderly dog and the only alternative was PTS, and one where a bitch presented with simultaneous pyometra and psudeopregnancy and I didn't want to totally screw up her hormones, so we treated her medically for both and spayed a month later. So far it was worked perfectly in every case, the dog is pretty much back to normal in 24-48hours and the owners are really pleased. I always discuss with them that it's only really a temporary fix, so they still need to be spayed, but in your case when there's a high chance the dog may not survive until it's next season anyway, then I'd probably be reaching for the Alizin.

Re: Pyometra- your approach

Alice Courtney — Mon, 18 Feb 2013 15:58:45 GMT

Hi Julian, thanks for your reply. In other cases I absolutely agree, I have not treated a suspected pyo medically before & go for a surgical approach. However, the owner will not consent to surgery, and as I think it would be foolish to do so without performing a simultaneous splenectomy, I have to say I can understand his position. The dog's splenic mass is quite chunky now, so it may be that sooner or later my approach to the suspected pyo will be inconsequential, but I wouldn't like to bet the dog's comfort & life expectancy on the behaviour of a spleen! Poor dog...

Re: Pyometra- your approach

Julian Earl — Mon, 18 Feb 2013 14:51:17 GMT

Re: Pyometra- your approach

Alice Courtney — Mon, 18 Feb 2013 13:06:17 GMT

Just been re-reading this thread. Wondered what people would do in this instance: Elderly GSD with splenic mass but currently no signs, owners aware probably guarded long-term prognosis. Dog presented with purulent vulval discharge, scan showed no uterine fluid accumulation. Little change after 7 days antibiotics, and owner understandably reluctant to proceed with GA/spay/splenectomy...The dog seems relatively OK in herself (though it's one of those cases that's hard to tell if the dog's this bright at home & the owner has rose-tinted specs), and the owner really doesn't want to PTS if he can keep her comfortable for longer.

Would you add Alizin for medical treatment of pyo, and hope this makes her feel better enough to enjoy life for while, despite a splenic mass...? The owners are fairly realistic with regards to the long-term (or more likely medium-term, or possibly short-term!) outcome.

Re: Pyometra- your approach

Wren — Wed, 07 Dec 2011 11:25:08 GMT

I'm with the collie man (sorry, forgot who it was) who said 'spey, and as soon as I can'. As a predominantly equine/LA vet I haven't done a routine spey in 7 or 8 years but I do SA work OOH and find pyos much less daunting than the prospect of a routine spey. We don't charge much more for the actual op but the fluids/hospitalisation etc. add up. I'd rather have the bitch operated and recovering ASAP than sitting in a cage hanging over me and waiting to rupture. Even the collasped septicaemic ones seem fine with the GA (with appropriate care) and they all seem well enough to go home in 24hrs. Why wait?

Re: Pyometra- your approach

Claire McConnell — Sat, 03 Dec 2011 19:33:45 GMT

A pyo spay at my clinic would cost £350 for an average size dog inc fluids. And we are cheap for our area.

Re: Pyometra- your approach

Gareth Dowdeswell — Thu, 31 Mar 2011 18:52:54 GMT

Anecdotal I know... but in my previous job saw a Rottie with an open pyo (confirmed on ultrasound), o declined surgery so treated with abs, improved, then 6 months later same signs, so gave it abs again, warned unlikely to respond etc, and it responded again. 6 months after that same story again! I left the job at that point so not sure what happened to it in the end. The owner's hadn't wanted surgery for some family reasons, but think surgery would have worked out cheaper as needed about 3 weeks abs each time to get over the pyo!

Only tried to treat a couple of other pyos medically (all on financial/age grounds), they would improve for a couple of weeks then come in collapsed and get euthed. That was only with abs though, wasn't aware Alizin could be used, but as in most cases finances were limited probably wouldn't have used it anyway.

I think pyo surgery is definately more challenging than a standard spay - there's a greater risk of haemorrhage and the risk of rupture of uterus. At least in most practices owner's are charged the same whether the pyo does bleed, making the operaton take longer, or if it's straightforward, so the price should reflect that increased risk.

Re: Pyometra- your approach

Julian Earl — Sat, 26 Mar 2011 20:29:18 GMT

Because all the bacteria are dead, killed by all those neutrophils etc.

Re: Pyometra- your approach

Nicola Cole — Sat, 26 Mar 2011 20:17:08 GMT

[quote user="Martin Atkinson"]

Don't forget pyo's are sterile pus so antibiotics are not going to help.

[/quote]

Erm-how are pyometras sterile pus?!