Sunday, June 21, 2015

Pyometra. The Challenge of Finding a Happy Ending with this Preventable Disease. WARNING GRAPHIC SURGERY PHOTOS!


Tell me that you could look into those eyes and not try to save her?
The story is so consistently the same that I almost gag repeating it.

A middle aged dog walks into the clinic with the presenting complaint of  "not eating and lethargic."

Patient has not been to the vet in years and the dog is not spayed.


That's all I need to know....
The diagnosis is always the same;

This dog has a uterine infection and she is dying of internal infection. She has a pyometra.

She needs;
  • Surgery (usually) immediately.
  • iv fluids,
  • iv antibiotics,
  • about a day in the hospital, and
  • antibiotics for about 2 weeks after surgery.
The problem is always two-fold. The dog is dying in front of you and the client hasn't had their pet spayed for a reason; they never could afford to.

So, now their $250 spay is a $1,000 (plus) emergency surgery.

Me and Pheonix just before surgery.
And so it was with Pheonix.

I dare not even think how many dogs die simply because their owners couldn't afford, or didn't realize the importance of spaying, and then felt compelled to euthanize because the cost to treat was too great.

An ultrasound to confirm our suspicions.. a distended angry uterus takes center stage.
Pheonix should have had her pyometra surgery the evening that she  presented to us. She should have gone to the emergency clinic nearby and had the festering infection that used to be her reproductive system removed. The estimate for her surgery there was over $2,000. A $200 spay was now prived at a $2,000 life or death investment.

Pheonix returned the next morning and had what I call a "bare bones last ditch" effort to eradicate her of the uterus she never needed and now was rebelling against her.

All of the nasty discharge of an infected uterus.
It is far better for the pet to be expelling the infection than holding it within the uterus.
Diagnostics are nice. They provide answers to questions and little fearful voices in veterinarians heads. They are also considered "standard of care." Our nice politically correct way of saying "in the best interest of our patient they should be done." Another line item on an invoice that inflates a clients bill. There are many line items in this disease, hence, the hefty price tag. If Pheonix's owners couldn't afford the $200 spay, they definitely can't afford the $2,000 pyo surgery.


A uterus of gargantuan proportions. A mad, angry, nest of puss and fluid that feels like rotten heavy fermenting sausage.


Finished with Pheonix's surgery. It took me about two hours to remove her infected uterus. She had minimal blood loss and did very well under anesthesia. 

Post-op.
Can you see how much thinner she looks from the photo of her above standing up?

One long incision is required to get a 4 pound uterus out of the abdomen.




My video plea about this disease;


You aren't ever out of the woods until the endotracheal tube comes out, they open their eyes, and they walk home.

Waking up.
I have some very strong feelings about this disease.

Veterinarians tend to feel angry that clients get themselves into this dilemma. We recommend spaying at 6 months old to avoid this disease from happening.
Here are some of the reasons clients don't spay their dogs;
  • it was too costly to spay her, 
  • I forgot to do it, 
  • time got away from me, 
  • I was always planning on breeding  her, 
  • etc.
Clients find themselves at the ER or vets office with a quick diagnosis and an expensive treatment plan. This disease has no time to wait for the scrambling of finding funds amongst friends.

Pheonix got help from us because we have two things in place;
  1. The Jarrettsville Veterinary Center Good Samaritan Fund.
  2. Vet Billing Solutions.
I have a back up plan for my back up plans. For those clients who do not have pet insurance, or a pet savings plan in place (my favorite option), there is Care Credit. Most people don't have insurance (like 95% of our clients), most don't have pet emergency funds (like 80%), and most cannot qualify for Care Credit (like 80%). That leaves the huge majority of clients with a dying dog, a huge vet bill, and no options.

I know this. I am prepared for this. I have the most generous friends and clients in the world. If I ask for help they help. It is a point of pride I hold dearest to my own abilities to help a pet in need. We do not turn away a pet in need I can only say this and do this because I have help.

I also have Vet Billing. Every client who is denied Care Credit is sent through Vet Billing. They provide us with third party billing for the clinic. No longer do I have to act like the bank, the creditor and the bitter nag begging for reimbursement months after I have bailed our butt out of a disaster. 




Two days after her surgery Pheonix still refused to eat. I took a trip to the grocery store to buy junk food incentives. The rotisserie chicken was the lure that got her eating. After a post-op patient eats they get the green light to go home.



This is Pheonix at her two week post-op re-check.


Yeah, I can't say no to those eyes.


She is doing great!


Her incision looks perfect!


There are happy endings if you work a little harder than  you have to, and care a little more than you are expected to. Pheonix's bill was about $1400 when she left us. About $1000 for her surgery alone. She spent three days in the hospital (at her families request) and is expected to have a full recovery.

If your dog has is diagnosed with this disease please know this:
  1. It is treatable. I will know vets have to hedge and be cautious, but trying might save your dog, and giving up will not.
  2. Discuss every single possible option to getting your pet the emergency surgery they need. Cut every corner, decline every elective and make it happen. Max your credit card, get a cash loan, pawn your stuff, go to GoFundMe.com, PetChance.org, your faily, friends, VetBilling is through your vet (click here to see which hospitals participate), CareCredit.com, your vet, every vet in the state, whoever, where ever, and find a vet who will help you. 
I have unrealistic expectations. I will admit it. But, I will not let a treatable dog be denied care based on cost. It is not a widely held opinion. I am not alone with this opinion in this profession, but I would rather be ostracized by my peers than neglect my purpose. If you were provided the means and guidance to help I believe it is your responsibility to do so.

I saw a Facebook post the other day from a very well respected veterinarian and friend who posted, "I hate it when a dog has to be euthanized over such a preventable disease." I don't know the particulars of the case, but I don't ever agree with the statement, "has to be euthanized." Why is there a "has to be?" because we are the all-knowing and there is no chance? There is ALWAYS a chance! 
Please do not euthanize over this disease. 
Get your pet help!

If you have a pet question please visit the kind knowledgeable folks at Pawbly.com. Pawbly is free to use and open to anyone who cares about helping animals.

If you would like to visit us at the clinic please stop by Jarrettsville Vet in Jarrettsville, Maryland.

If you want to see my patients, share my vet stories, and chat via another platform I am @FreePetAdvice on Twitter.

Related Blogs;
Vet Billing Solutions  blog.

Working and Living in the Land of Liability.

How to Get the Best Deal at the Pet ER.




27 comments:

  1. Phoenix was very lucky to have you as her veterinarian. Another might not have been so caring and would have euthanized her when her family couldn't afford the surgery or because of her pain. My first impression of the story is to say that people shouldn't have a pet when they can't afford the care, but I also see that how dramatically the cost of veterinary care has increased. My dog sees a specialist for IBD that isn't controlled well and we pay between $200 - $500 at each visit depending on the tests and meds needed. At some point I won't be able to afford this ongoing cost. In addition my personal vet made the wrong diagnosis for this same dog mistaking an abscess for bone cancer. Ultimately my dog had to spend two nights at the vet hospital when the abscess burst which was a cost I incurred and no one offered to refund me for the biopsy I paid for. I guess this was a bit off-topic, but ultimately I want to say not to jump to conclusions about pet owners, both sides make mistakes and you never really know what is going on in the lives of other people.

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    Replies
    1. Hello,
      I agree with everything you are saying. It is a vicious cycle where the vets are expected (and then crucified ask Dr Pol) if we don't maintain a very strict standard of care, which significantly drives up the cost of care and subsequently makes more people reluctant to get care or wait until an emergency happens. When these invariably occur more and more people are inclined to euthanize. It is awful and it has to stop.
      The best advice right now is to try to educate people so disaster won't strike.
      I appreciate your time and thoughts,
      All my best to your gang,
      Krista

      Delete
  2. Bless you! I'm actually working on a blog post now about neutering Jax in the next couple of weeks. He will be six months old at the end of the month, and it's my responsibility to always be concerned about his health and well being. I love my vet. if I didn't have the $$ - she would (I have no doubt) work with me keeping the best interest of her patient (Jax) a number one priority. We would work out a payment plan. I commend you for sharing this post. Great job.

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    Replies
    1. Thank you for reading and best of luck in the neutering endeavor! (lol)..take care, Krista

      Delete
  3. Pheonix and her owner are very fortunate that she received the care she needed quickly. The photos were so interesting; thank you for sharing the facts about Pyometra.

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    Replies
    1. Thank you for reading..
      Have a wonder Summer chasing,,, well,, everything!

      Delete
  4. I never knew about this and I have had 6 dogs in my life. Of course, I've had all of them spayed, but the fact is-- no one ever talked about this! I will definitely be letting my pet owner friends about this!

    Thank you for the info.

    P.S. Sometimes, people should see exactly what a disease looks like. I am a fan of the pictures.

    ReplyDelete
    Replies
    1. Hello,
      I agree with you. It needs to be talked about, and people should be educated should they elect to forego spaying. It is heart breaking to see so many people euthanize before they even try to remove the uterus (I think this is ALWAYS based on cost). The photos drive home the reality of the seriousness of this and therefore I thought it was important to add them.
      Thank you for reading and leaving a comment.
      All my best,
      Krista

      Delete
  5. I am trying to keep my oldest Aussie out of pain so she can just pass of old age. She takes carprofen, one time a day and tramadol,2 or 3 times daily. She has diabetes, is close to blind from cataracts, and has a bad back and hips, without all the medicine she is overcome with pain. I don't want to put her to sleep just because of pain, but I worry that she will build up a tolerance to the medicine and I won't let her suffer.I pray all the time that she just pass es in her sleep. I have 2 other dogs and it can be hard to keep up with all the expenses, I lost an epi dog two years ago, We spent a minor fortune on her. They are a part of my family though and I would not let my family suffer with no medical care.great blog post

    ReplyDelete
    Replies
    1. Thank you for reading, but most importantly, thank you for being such a devoted mom.
      You and your Aussie are in my thoughts,
      I hope there is a peaceful passing.
      With Love,
      Krista

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  6. Thank you for sharing. We lost our 6 year old fur baby on March 13, 2015 after spending almost $15,000 trying to save her (yep that's three zeros). We had her scheduled to get spayed and then I panicked thinking why does she have to go through such an unnecessary surgery. No one had ever told us this was a possibility. My heart has been forever broken knowing we could have prevented this. We spayed our other (4 year old) fur baby shortly after, and shockingly discovered she was in early stages of the disease too. I tell everyone I can about our story because I don't want anyone else to ever have to go through what we did with our baby girl. Miss her every minute of every day. Erin

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    1. Hello Erin,
      I am so sorry for your loss. I am also sorry that your vet didn't discuss the possibility of pyometra over all of those years.
      I hope that you and your dog have many happy healthy years together.
      Again, my deepest sympathies and thank you for sharing your story. I hope I never see another pyometra either.
      sincerely,
      Krista

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  7. My dalmation sadly died a couple of months after surgery. Icwas young and naeve when i bought her. I had had a childhood dog before her and i was never told that bitches could get problems like this. It cost £3,000 for the op and aftercare. I would pay it all over again to have het back. I wish i had known. I wish this information was around at the time. I hope people take notice and read it all. Thank you

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    Replies
    1. I am so sorry for your loss. I agree that most pet parents never realize that this disease can be so terrible and even deadly. And that it is as simple to prevent if they are spayed.

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  8. Our dog was just diagnosed with stump pyo yesterday (we rescued her in Nov and were told she was spayed but didn't know the details- OVE or OVH). She is not symptomatic other than some discharge and we are starting her on antibiotics and will be doing surgery. The things is, she has also been incontinent starting about two months ago and the vet who performed her ultrasound believes that the cause of the incontinence is not the pyo but rather, something anotomically irregular but she is not able to see that area in the US because of the pelvis position. She is suggesting that we do a cystoscopy while we do the OVH to get a better look at what may be causing urine to empty (our dog was unresponsive to DES and proin). Have you ever seen cases of pyo/stump pyo that cause incontinence or does our vet have the right idea as far as next steps?

    ReplyDelete
    Replies
    1. Hello,
      I am not sure that I can offer much help on this case. It sounds like you have a good vet and have done most of the diagnostics that should prove most helpful. If at all possible ask about a referral to an IM specialist for help. Very best of luck

      Delete
  9. Hi I am from India.

    Hi my 14 year pameriyan is infected with pyometra. She is in terrible pain and stopped eating from past 1 week. She has become very weak (not able to stand). She is getting some kind of attack every hour. We had visited Vet last week and was prescribed some Antibiotics but its did not help. he said surgery can't be done until dog stabilizes. Vet has given of hope of her survival.

    She is severe pain, we are unable to see her in this condition

    Any suggestion if anything can done to improve her health?

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    Replies
    1. Hello,
      I am sorry to hear about your dog. I would recommend that you have your dog hospitalized, on iv fluids and antibiotics and placed in the most capable veterinary hands you have access to. I would also want her to be treated as aggressively as possible if her prognosis is poor. I hope that she improves and I wish you both the best of luck. krista

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  10. Thank you so much for your post. You seem to be an amazing vet with a big heart. I have an 8 yr old English Bulldog whom like others have posted was ignorant to this issue as well.her previous vet never Warned me of this issue either ! English bulldogs are very hard to breed so I was not worried about reproduction thus did not think spaying was so important. My poor bully had pyometra . The vet said she had a severe infection. She had emergency surgery this week and is currently retiring . My question to you is if having this surgery has any long term consequences? She seems pretty sad now and I'm hoping it's due to just having surgery... not a permanent issue. Once again thank you for your post. I hope it educates others!

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  11. I have a Blue Heeler that I love dearly. We got her when she was 6 weeks old and she stays inside. She is another member of our family. Less than a year ago I noticed her drinking more & cleaning her self as she does when she is in heat. She had not long just came out of heat (4-5 weeks). She had a discharge that looked like tomato soup. She didn't seem to have any other medical symptoms. I still was worried and began to search the web for possible causes of the discharge. I found that everything pointed to pyometra. I took her to the vet & that confirmed she had pyometra. We tried antibiotics from that Friday to the following Monday. But blood work results showed that it was getting worse. So Tuesday morning she went into surgery. It was $300 for 1st visit (Friday) Monday cost $250 & surgery cost around $650.
    I was told it would be $1200 for the surgery. I couldn't afford it but they had several financing options. I was able to use care credit which I am so thankful for. I would have done whatever was necessary to save her. She was only 3yrs old and now she is 4 & healthy & happy.

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  12. My Mum recently passed away (5 months ago) and I inhereted her 12 year old GSD bitch and today I have rushed her in for an emergency vet appointment. She has been discharging and has a lack of appetite and pees and drinks all the time! My vet told me that is pyometra and explained what it is and what complications and risks can occur but I did not hesitate and left her with the vet tonight for the op. It is now 11.50pm and I am awaiting a call from the vet with a progress report and hopefully my Mum's faithful old girl will survive the ordeal. The vet has told me that the cost will be £1000.00 ($1300.00) or so. I did not think that not having a bitch speyed when they were young could present such dangers for them in later life. Whilst typing this I got a call from the vet saying that the op went well but took 4 and a half hours from anesthesia to waking. Hopefully she will be able to come home tomorrow evening.

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    Replies
    1. hello,
      I hope that everything worked out ok? My best to you. Thank you for taking the time to read and leave a comment.
      Krista

      Delete
  13. Hello dr krista,
    Same situation as read, female went into surgery at 6pm bet called at 8ish saying everything went ok shes awake and calm.. next morning vet calls at 820am with the worst news possible. They left her by herself after surgery which i believe is one main reason she passed, vet couldnt give us a legit answer why she passed, besides her white blood cell count. Have u had this situation happen after surgery? Hopefully not

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    Replies
    1. Hello,
      While this surgery is often performed on very sick dogs I do not leave these patients alone in the clinic after we close for just this reason. They can become too cold, dehydrated, sick, etc. and are often not in the best of health when we do the surgery to begin with.
      I am so sorry for your loss.
      My sympathies,
      Krista

      Delete
  14. This is very helpful because one of my dogs was just diagnosed with pyometra and the surgery at the one hospital that said yes is very expensive I live in Mexico, NY does anyone know any vet hospitals near us?

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    Replies
    1. call the local rescues and shelters for advice on which vets are most affordable.. good luck

      Delete
  15. Why oh Why is the first time I ever heard of this disease/disorder when it became necessary to have the surgery done to my rescued Chihuahua? Approximately 8 years old and I've had her for over a year. She was in to have all of her teeth pulled due to decay. That was a seven hundred dollar bill.
    Two weeks ago I took her because of spotting and incontinence urinating. She had just come out of heat. The Vet said she doubted there was anything wrong. Her ultra sound showed nothing. She was then diagnosed with a "very bad bladder infection" and sent home with Clavamox. Near the end of the course, she was so sick she couldn't step up one step, barely walk or lift her head, and her ears drooped. The whites of her eyes were bloodshot.
    Taking her to the Clinic again, the male vet there said it was her back! He then finds a "very loud heart murmur" that the other multiple appointments obviously didn't. Finally at my insistence he did a second ultra sound and saw the uterus issue. Into surgery she went and a thousand dollars later she's home recovering.
    Why isn't this there more awareness of this?

    ReplyDelete