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“Daisy Dukes”, a 1 year old female Chihuahua, originally presented to POTRAH because she had not been eating well for the 3-4 days before her appointment. She had become lethargic and had vomited. These symptoms can be descriptive of many diseases, but there was one other key piece of information: “Daisy Dukes” was not spayed.
Pyometra can be very difficult to manage and treatment typically requires removal of the uterus and ovaries (ovariohysterectomy, aka “spay”). Dogs that are diagnosed often survive, but infection can take weeks to resolve. If pyometra is not caught, death can occur quickly after symptoms begin. The process leading up to pyometra is a slow process. Infection in the lining of the uterus is established as a result of a hormonal change. Following estrus (“heat”), progesterone levels remain elevated for 8-10 weeks and thicken the lining of the uterus in preparation for pregnancy. If pregnancy does not occur for several estrus cycles, the lining continues to increase in thickness until cysts form within the uterus. The thickened, cystic lining secretes fluid that creates an ideal environment in which bacteria can grow. Additionally, high progesterone levels inhibit the ability of the muscles in the wall of the uterus to contract. Since the cervix is the gateway to the uterus, it typically remains tightly closed except during estrus. When it is open, bacteria that are normally found in the vagina can enter the uterus rather easily. If the uterus is normal, the environment is adverse to bacterial survival; however, when the uterine wall is thickened and cystic, perfect conditions exist for bacterial growth. In addition, when these abnormal conditions exist, the uterus cannot contract properly. This means that bacteria that enter the uterus cannot be expelled. The clinical signs of pyometra depend on whether or not the cervix is open. If it is open, pus will drain from the uterus through the vagina to the outside. It is often noted on the skin or hair under the tail, bedding, and furniture where the dog has laid. Fever lethargy, anorexia, and depression may occur. If the cervix is closed, pus that forms is not able to drain to the outside. It collects in the uterus causing distention of the abdomen. The bacteria release toxins, which are absorbed into circulation and may affect the kidney’s ability to retain fluid. These dogs often become severely ill rapidly. The will be anorexic, very listless, and very depressed. Vomiting or diarrhea may be present. In the case of “Daisy Dukes”, her cervix was open. The discharge was what alerted the doctor that she may have pyometra and her infection was caught early. Although it was caught early, that does not mean it was not an emergency. Her symptoms progressed quickly enough that an emergency spay was required for her survival.
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Upon taking her temperature, it was noticed that “Daisy” had a creamy vaginal discharge and an elevated temperature. These were key symptoms that prompted the doctor to further examine “Daisy” for pyometra- an infection in the uterus.