“Abby” a 4- year-old, intact (not spayed) female, Shih Tzu, was presented for blood in the urine, and being lethargic. The owner also stated that “Abby” had been in and out of “heat” for the past one to two months. She also had blood spotting for one month and was urinating in the house. “Abby” did get away from the owner while she was in heat so there was a possibility of “Abby” being bred.
On physical exam, “Abby” was bright, alert and responsive, but according to the owner not herself. “Abby” weighed 13.3 pounds, had a normal temperature, and a few mats in her fur. The rest of her physical was normal. Because of the blood in her urine, a urinalysis was done. The urinalysis dipstick showed blood, and sonic protein. The urine was then spun to look at the cells in the urine. The sediment was normal, a few bacteria (artifact from catching the urine), no red blood cells, white blood cells, or crystals. The conclusion was if “Abby” had a bladder infection it was not typical.
The findings of the urinalysis were discussed with the owner. It was strongly suggested that blood work and X-rays be done because “Abby” could have a pyometra (an infected uterus). The owner did not want to do testing at that time. So “Abby” was treated symptomatically with antibiotics for the blood in the urine. The owner was instructed to pay close attention to “Abby”, watching for a decrease in appetite, increase in thirst, or just not getting any better. If any of these signs occurred “Abby” was to be checked out again immediately.
Two days later the owner brought “Abby” in to be checked out because she was not doing any better. “Abby” had lost almost half a pound; she now weighed 12.9 pounds. Her temperature was normal, her appetite and activity had decreased and she was trembling. Her gums were paler than before and her belly seemed tender.
The owner allowed us to do blood work and X-rays of her abdomen. A CBC (complete blood cell count) and profile (serum chemistries) were performed in the hospital. The serum chemistries showed; one liver value, cholesterol, and one of her protein values were slightly elevated. The rest of her liver and all of her kidney values were normal. The complete blood cell count showed a very high white blood cell count with indications of an active infection.
X-rays showed a large tubular structure in the abdomen, which was believed to be the uterus.
The X-rays and blood work results were discussed with the owner. The only possible treatment to make “Abby” better was to do emergency surgery and to take the infected uterus out. “Abby” was then taken to surgery, after being placed on IV fluids. During surgery the whole uterus and both ovaries were removed. One side of the uterus was much larger than the other. The abnormal side was four times larger than the normal side. The larger side of the uterus had about two ounces of pus in it. A culture was done on the pus in the uterus and “Abby” was placed on a different antibiotic. “Abby” was also placed on pain medication for a few days. The culture was done to make sure the antibiotics that “Abby” was placed on would work.
“Abby” was rechecked the next day; she was doing very well. The culture results (which were received three days later) showed that the antibiotics “Abby” was prescribed would take care of any remaining infection that may be left over.
So how did “Abby” get this infected uterus? When “Abby” came into heat, because of the hormonal influences, she was unable to normally fight off infections. The cervix was dilated while she was in heat! This allowed bacteria to enter the uterus. In these cases the cervix can be open or closed. “Abby’s” was closed because she did not have a discharge of pus from the vulva. This condition occurs in middle-aged to older females that usually have never had puppies, although this can occur at any age. Signs often occur four to eight weeks after their last heat, but may occur as early as one week, or as late as 12 weeks. Some of the more common signs of pyometra are: loss of appetite, increased thirst, lethargic or depressed, vomiting, fever and maybe even a vaginal discharge. In “Abby’s” case, she did not have all of the signs.
(This was an actual case history from a local veterinary clinic, actively affiliated with the Hillsborough Animal Health Foundation.)
