Published in 
 The Retriever Journal
Aug./Sept 2010

A Life-Threatening Emergency
(that you've probably never heard of)

written by Butch Goodwin
       of                     

Northern Flight Retrievers  

I am not a veterinarian. But when you carry on a breeding program or maintain a kennel full of dogs for training as I have over the years, you come to realize quite quickly that your veterinarian may become one of your very best friends. And since most vets are more than willing to work with you and teach you to recognize the symptoms you should watch for that indicate some of the more serious ill- nesses, you will do well to take advantage of that education and pick their brains whenever you can, even if you don't have a kennel full of dogs. 

Most dog owners have never heard of a pyometra. I hadn't when a really nice 15-month-old bitch that I had plans of someday breeding came down with one about 10 years ago. I saw no severe signs of sickness, but she was "off." She acted like she had a bellyache, only picked at her food, and was drinking more water than usual. I thought that maybe she had been eating grass or had been chewing on something. I decided to give it a couple of days and if she wasn't feeling better, I'd run her into the vet's office to get her checked out. That was a fatal decision. 

Before I go any further, let me tell you what I have learned about pyometra from the standpoint of a breeder. But first, I need to give the credit for much of this to my two vets - who I have relied on extensively and who have been willing to share their expertise with me over the years: Dr. Wayne Ashton and Dr. Brent Varriale of Snake River Veterinary Clinic in Fruitland, Idaho. 

The key to her survibal is you.

A pyometra is a serious infection of the uterus (womb), and all unspayed bitches are susceptible. It is a true veterinary emergency that few dog owners are familiar with and can be very difficult for anyone who has never seen it before to identify. Dr Varriale put it this way: "Because of the sudden nature of the infection, toxicity can develop quite quickly and the consequences can become deadly if left untreated. I guess the closest comparison I can think of would be human acute appendicitis, which can rupture without immediate treatment." 

One of his technicians added, "Since it can be tough to recognize, owners just think that their dog isn't feeling well and ignore it until it is often too late." 

Have I gotten your attention yet? 

Before we go on, please don't think that I'm going to get on a soapbox about spaying your female dogs; I'll leave that decision up to you. You might have a vision of one day having a litter of pups from that very wellbred female that you have such high hopes for. I sure can't blame you for that, and I hope that she turns out to be all that you expect of her. My purpose in writing this isn't to scare you away from breeding; however, having had to deal with four of these emergencies over the years, I want to give you a heads up about a potentially life-threatening emergency that shows up quickly; can be difficult to recognize; and, unless treated immediately, could likely kill your female dog. 

A pyometra can affect any unspayed female regardless of whether she has ever been bred or not. Although there does seem to be a higher incidence of pyometra infection in older dogs, it can occur at any age after the onset of her heat cycles, because susceptibility is related to the normal increase in hormone levels when she is in heat. 

During the heat cycle, the uterus opens up to facilitate the release of the blood that we typically see. The opening of the uterus also allows bacteria to enter. At the end of the cycle, when the uterus closes, trapped bacteria are normally killed off by the dog's immune system. When the immune system is incapable, for whatever reason, of fighting off the bacteria, a pyometra develops. 

As the condition escalates, the body transfers an increasing amount of fluid and white blood cells into the swelling uterus, causing the infection to make its way through the walls of the uterus and into the bloodstream resulting in toxicity and a possible life-threatening emergency. 

Dr. Varriale says, "Since a pyometra is a direct result of a previous heat period, it is normally evident as early as a few days to between one and two months after the end of the cycle but could also show up as late as four months after the cycle. 

"Often, an early indication of a pyometra is a pus discharge. This is classified as an open pyometra, and it is often noticed sooner because you can see a discharge of yellow or bloody fluid draining out through the vulva. But even though there is a discharge, if a bitch licks herself to keep herself clean, the discharge can possibly escape notice. 

"By far the most dangerous pyometra is the closed type," continues Dr. Varriale. "This means that the cervix is closed, [which doesn't allow] the accumulation of pus to drain. The buildup of toxic fluids in the uterus causes massive swelling. The closed pyometra often shows few noticeable outward signs that something is wrong, all the while the uterus is being stretched and, similar to an acute appendicitis, if left untreated, the uterus ruptures causing pus to enter the abdominal cavity. Peritonitis follows along with probable death." 

Let me give you a simple description to help you understand how dangerous this swelling of the uterus can be. A canine vagina and uterus is made up of a body with two horns extending up resembling a "Y." In a normal, medium-sized dog without any infection, the two extended horns are smaller than a pencil. When a pyometra infection develops, these horns become large and filled with fluids and swell to about the size of a cucumber, often more than a foot in length. The normal uterus of this same-sized dog weighs just a few ounces, but a pyometra can swell it up to as large as four pounds. 

I asked Dr. Varriale if certain breeds seemed to be predisposed, or if genetics or even unsanitary conditions (our retrieving breeds are always swimming or working in certainly less than sanitary conditions) seemed to increase the likelihood of contracting a pyometra. "Pyometras certainly aren't limited to any particular breed. Any unspayed female is susceptible," he said. "This week alone, I had four dogs in the clinic, from four different breeds, with pyometras. 

"As for genetics, I don't think there is any clinical evidence that genetics plays a part. I guess it is possible that some family groups might have immune system difficulties and maybe can't fight off infection as well, but I can't say that anyone has proven that genetics are actually directly involved. Also, I don't believe that the hunting breeds or breeds that work in relatively unsanitary conditions are more likely to get an infection. I don't think that anyone has done a study, but from the large diversity of dogs that we see in the clinic with pyometra - everyone around here has a retriever or a pointing dog or a cow dog and cow dogs work in the most unsanitary of conditions - I just don't see the correlation. I think the reason breeders like you seem to have a higher incidence of pyometra is simply because you can't carryon a breeding program with spayed females, and breeders just have had more dogs over the years and tend to maintain a larger group of dogs. But really, any unspayed bitch is susceptible to a pyometra." 

One of Dr. Varriale's assistants followed by saying, "What makes a pyometra so dangerous and the reason that we often don't see the dogs until their lives are at risk is that the symptoms are often easily missed due to their subtle nature and their similarity to far less serious conditions where a dog just seems not to be feeling well and may just appear to be 'under the weather.'" 

In my particular case 10 years ago, I saw the first pyometra in a very young bitch (about 15 months old, right after her second heat cycle). Because I didn't know the symptoms and thought she just had a bellyache, I waited too long (only over a weekend) and despite their efforts, I ended up losing her. The second of my dogs that had a pyometra had a litter of puppies and came down with the infection while she was nursing them. I asked Dr. Varriale if there was a way 
of curing the pyometra rather than spaying her, because she had a couple of very nice litters already and I really didn't want to lose her in my breeding program. Under his guidance we cured her, but he told me to watch her closely the next time she came into heat because after the next heat cycle there was a better than even chance that the pyometra would come back. 

Within a week or so of her estrus (standing heat), the pyometra was back with a vengeance and within just a couple of days of seeing the mildest of symptoms, I lost her. Recently, I have had two females with pyometra within a few weeks of each other. But now that I know what symptoms to watch for, I got them into the clinic immediately. I learned my lesson, regardless of how well-bred they are or how they fit into my breeding program. I had both of them spayed, and they are both now healthy and happy. I still blame myself for losing the one that we tried to cure; I don't want to lose another dog because of my selfishness. 

Since the key to a dog's surviving a pyometra is early detection, the most important aspect of recognizing that your dog is infected is being aware of any changes in her demeanor after the end of each heat cycle. (I have gotten to where I watch my bitches like a hawk after their heat cycles are finished.) The obvious symptom of open pyometra is a discharge of pus from the vulva. However, the symptoms of both open and closed pyometra can include vomiting, loss of appetite, lethargy, increased intake of water and increased urination, a distended abdomen, dehydration, and fever. But all of these symptoms are not always present. 

When you get your dog into the clinic, your vet can do blood work that - if it is a pyometra -will show increased white cell count and dehydration and how bad the infection is. Palpating, ultrasound, or a radiograph will show an enlarged, fluid-filled uterus. An X-ray can rule out a possible pregnancy. 

If you have an unspayed female, remember that the key to her survival is you. If your bitch has recently been in heat, watch her very closely, and if you see any signs of abnormal behavior, don't hesitate getting her to your vet. Hopefully, it will be something minor, but if it is a pyometra, you probably just saved her life .