- Posted on December 27, 2014 7:18 pm
Today’s Diary Entry is sponsored by Eickemeyer
Normally I avoid graphic images here, however sometimes a picture is worth a thousand words, which is why I do not feel too bad about the photo on the right here. This is pyometra, a uterus full of pus that was removed from a dog, on the left you can see where it has ruptured and the pus is leaking out – this luckily happened after it was removed simply when we tried to move it to take the photo… If this had ruptured inside the abdomen it would have been very bad indeed.
So how did we get here? Well the 30 minutes before closing stampede happened again today, 5 patients arrived this time however unlike Christmas day which was completely crazy with just me and 1 vet there were 2 vets today.
One of the patients presented with discharge from the vagina, and abnormal findings on the palpation of the abdomen. Now this generally suggests pyometra, however we took her to ultrasound to confirm, and seeing the ultrasound image which showed the massive loops of uterus we knew the only hope for saving this dog was going be surgical.
Being an old dog, of a certain breed, and with heart problems the anaesthesia was going be very high risk. This dog had also had previous abdominal surgery for a caesarean section so it was also expected that there would be serious adhesions (where organs stick together) around the uterus. Now at this point in time we were struggling to get another doctor in, so with the 3 of us here, I was elected to assist in the surgery, I wasn’t entirely happy with this with so little experience for such a delicate operation but needs must and it was best chance for dog.
So starting prep, we get a call back from one of the other doctors that was able to come in for the surgery so I move to doing the anaesthesia. This scared me as I am just getting comfortable with running anaesthesia on healthy low-risk patients and this patient was nowhere near low-risk. At this point I was not sure what was worse doing the anaesthesia or assisting in the surgery.
Because of the high risk here I actually brought the emergency drugs with me into the operating room instead of leaving them in the prep room where they are normally kept. This was a little comfort as if I needed to I could do something, but still it didn’t make me entirely happy. Then trying to get the monitor working failed so I ended up with just pulse-ox and temperature to work with. However being abdominal surgery I could get access to the chest to listen to the heart, and actually monitor the heart rate manually.
I was just waiting for the surgery to be over so I could start waking the patient up, all my attention was on the anaesthesia however when the first uterine horn was lifted out and was the size of an salami we knew we had been right to do the surgery. The second uterine horn however had major adhesions, and when this was lifted out I was glad that I wasn’t assisting in the surgery. It was connected to the intestines and the bladder so was some very delicate work that took the attention of both doctors to remove.
Once the uterus was out the abdomen was closed, this was done with intradermal sutures so that there were no visible stitches for the dog to remove. It actually looked almost as if there had been no surgery, and then the extra doctor left and I was into recovery mode moving the patient from theatre to recovery and then starting the process of waking them up. I am not entirely sure why but recovery was very fast – I’m thinking this could be to do with the length of anaesthesia as usually procedures here are orthopaedic and very long so long recovery?
An hour later the dog walked out alive, and without the pyometra… Now when vets say pyometra is a very high risk in older bitches it really is, however vets are not always great at communicating just what a pyometra means. Hopefully as nasty as it is, this photo has giving you a very good reason to spay. This entire event (including my extra gray hairs) could all have been avoided by simply spaying the bitch when she was younger, and healthier.
EDIT: Saw patient for check up today and is doing very well, alert, urinating/defecating and walking with no signs of pain.Posted in categories: Vet School Diary