Friday, February 27, 2015

Uterine Prolapse. Canine Edition


These are 8 week old Central Asian Shepherd puppies and their mom,
Dixie Carter, when they came to visit us for their first set of puppy vaccines.
The puppies were about 40 pounds, and there were 8 of them!

Dixie was a patient mom who gave birth to 13 puppies.
Sadly only eight lived.
Even for a large dog this is a lot of puppies!


This is Dixie Carter when I saw her two weeks ago.


Can you notice her haunched back end? This is a classic stance of a pet with pain She is tucking in her pelvis under the abdomen... and here is the reason why.


That pink fleshy mass protruding from her vulva is her uterus. Another words, her reproductive tract is slipping out the vulva. This is painful and dangerous to her health.

Here's why;

  • The uterus is a structure meant to be living safely up inside your abdomen. The tissue is not meant to see the light of day. Every time Dixie tries to sit down the fragile tissue is touching the floor. This causes it to be traumatized, bleed and become further damaged.
  • Damaged tissue responds by doing two things; bleeding and swelling. 
  • The swelling to the tissue is made worse with  every passing moment until the tissue either becomes infected, necrotic (dead), or ruptures. Now her already bad situation is dire.
  • To add to her dilemma the vulva and vestibule (area just inside her vagina) is also being stretched, which allows more of her uterus to fall out.
There is no way to treat this without a veterinarians quick intervention. 


Placing an i.v. catheter pre-op.
Dixie arrived on a Sunday with her predicament.

She had delivered 13 puppies 5 months ago. At three years old her owners wanted to breed her again.

The conversation unfolded something like this...

"I am not a reproduction vet. So, I'm pulling this info from vet school about a decade ago. Uterine prolapse, (this was the only thing I was sure of), happens after hormonally driven reproductive tract weakens and relaxes so much that it can essentially fall out the back. It usually occurs in females who have had vaginal deliveries and/or straining against the pelvic floor muscles. It is not uncommon in farm animals who are bred frequently and repeatedly."

"What can we do to treat it?"

"My recommendation is to spay her."

"Is there anyway we can breed her again?"

"Well, I am not a repro vet, and I can only tell you from large animal experience. In large animals we replace the uterus, sew it in, see if it stays, rebreed them, and if they prolapse again we slaughter, spay, or euthanize them. In many cases they re-prolapse. Every prolapse is another opportunity for damage to the reproductive tract, systemic infection, and possible adverse impact on their health. The safest and best option for Dixie is to spay her as soon as possible." I recommended that she be referred to the emergency clinic for surgery and overnight care. They asked about cost for this and were given an estimate of about $2500.

They decided to wait for us to do her surgery the next day.




Dixie was started on i.v. fluids, i.v. antibiotics, and placed under general anesthesia. After careful cleaning of her uterus we gently replaced it in her pelvis. The tissue had been exposed for 5 days. It was incredibly swollen and took about 45 minutes to replace in its normal position. This is done in awake patients for horses, cows, sheep, and goats. The only humane and effective way for it to happen in Dixie's case was with her asleep and on her back. A technician had to remain holding it in place for the entire length of her spay.

Yet another glamorous task of a veterinary technician; "uterus holder".

It took 3 vets to spay this big dog!
Traction to the uterus via the abdomen was required. As the technician pushed the uterus into the pelvis I pulled it back into the abdomen. This is exactly why this is only resolved with a spay.


Pulling the reproductive tract back into position.

Dixie's spay and uterine replacement surgery was not easy. It took three vets and two technicians to replace the uterus, hold it there, tie off her orange-sized ovaries, and her massively thickened uterus.

Poor Dixie has a very stretched vestibule.
But there just above my fingertips is her uterus, almost back into its normal position.


Thankfully Dixie is a very healthy, strong girl. She did marvelously through her surgery! When she woke up we gave her opioids to keep her calm and pain-free. She also went home with a fentanyl patch to provide three days of slow release pain control.

A dog that walks home comfortably after their spay is a happy sight!

Headed home Monday night.
Not too surprisingly Dixie came back to see us on Tuesday morning...
..because she looked like this.



But, happily, her abdominal incision looked like this..

A quiet, healing incision.
I want to add a personal note based on experience. I think that checking an incision 24-48 hours post-op is one of the most beneficial things we can do for our clients and patients. I am happy to see any patient of ours at anytime post-op to check the incision, answer any questions, and help my clients provide the needed after care. I do not charge for this. I have a hard time justifying charging for this. I think it discourages compliance, and creates an unneeded potentially damaging barrier between myself and my clients. I know that this policy has benefited my clients, my patients, and my ability to sleep peacefully at night. For the vets that argue this point, for whatever reason (some valid like the cost of our time), I suggest that you add the fee for re-checks into your surgery fee, and then tell your clients that re-checks are free. They will appreciate knowing this, and it is an excellent marketing tool that builds trust and ease into their perception of both you and your practice.

Getting ready for the post-op procedure.
Because her uterus was prolapsed again, (very common and should be expected), we decided to protect it from further trauma of siting on it, abrading it, or exposing it to the frigid February temperatures by enclosing it within the vagina.

A Caslick's procedure was performed under a local anesthetic block. Three sutures were placed to close the vulva and hold the uterus inside the vaginal vestibule.


A little time and as much protection as needed are all that are required to resolve this.

1 day post-op

6 days post-op.
I will see Dixie again on Sunday. That will be almost two weeks from the day of her surgery. I expect that her vaginal sutures can be removed and the uterus will have shrunk to almost a normal size.


For Dixie's spay and uterine prolapse surgery the cost was $1600. This included; i.v catheter, fluids (a lot of fluids), spay, additional assistance from vets and techs, 3 hours of anesthesia time, antibiotics and pain management for the day and after care, e-collar, fentanyl patches and hospitalization and all re-checks. It was a substantial bill made significantly larger due to her size and the length of the surgery time. If this happens to your dog seek veterinary care as soon as possible. The longer tissue is prolapsed the more difficult it is to treat and the higher your risk of failure.

Dixie always reminds me of a Polar Bear.
Two weeks post-op re-check




Her abdominal incision looks wonderful!
 
Back to normal!

A big smile over not being the subject of more embarrassing photos!

Related blogs;

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If you would like to discuss your pets condition I can be reached at the clinic, Jarrettsville Vet in Jarrettsville Maryland. I am also on Twitter @FreePetAdvice.

15 comments:

  1. Thanks for this description. It was fascinating. I don't understand why the uterus was replaced if the intent was to spay her. Could you explain why? Many thanks.

    ReplyDelete
    Replies
    1. Hello,
      To spay her we had to replace the uterus that was falling out of her vagina so that the spay could be done properly. The tissue was swollen, dirty, and very sore due to being chapped and chaffed. This tissue is very fragile and needs to be inside the vulva to be protected. We also needed to surgically remove as much of the reproductive tract as possible to help hold the tissue inside her pelvis.
      In women they use a mesh sling to hold it up in the pelvis (lots of advertisements on tv lately about these not working so well).
      I hope this helps,
      Thanks for reading and asking,
      krista

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  2. I had a stray kitten who got pregnant at 8 months, had only two kittens (both stillborn) and her uterus looked completely prolapsed, and was starting to smell. She was completely feral, and it was only because she was in pain/sick that we were able to catch her and take her to the vet, who recommended just putting her to sleep, which we did. Can a uterus just be removed at that point, or what that the only thing that could have been done?

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    Replies
    1. Hello,
      I'm sorry to hear about your cat. I don't know enough about this case to offer any opinion other than to praise you for getting her help and caring about her to seek medical attention. Feral cats are always tough patients. She would have needed quite a bit of TLC to nurse her back to health, if it was even possible, which it might not have been. I'm sure your vet was giving you the most compassionate advice they could based on the circumstances. If you hadn't intervened she would have died, although it sounds like she was pretty close to this already by the time you could capture her. You did the best you could, which is often times all we can do.
      Please spay and neuter the rest of the cats in the colony so that they don't reproduce and become another cat you cannot care for because they are feral.
      Thanks for reading and for caring,
      Sincerely,
      Krista

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  3. hi! my shihtzu/schnauzer mix dog has had 2 surgeries one for vaginal prolapse and another very recently for uterine prolapse. after her recent surgery she prolapsed again through her stitches in less than 2 weeks. regardless, she still seems very playful and eats a lot although i can tell from her stance based on your blog that she may be in pain. i asked the vet about it and she gave me 2 options. one was ovariohysterectomy (?) but is a very risky procedure since she almost went into anaphylactic shock during her last surgery. another was replacing her uterus again but there's still a chance she could prolapse again within a short period and is also risky for her state since most of her vulva tissue is now inflamed. this is the first time i read of dogs being put down from prolapse after searching online and on forums so i thought about asking for advice. I'm fairly new with pets and i'm scared that i might put her down when there's a chance of recovery for her but i also don't want her to suffer any longer. i also don't know how to open this topic to her vet :( thanks in advance!

    ReplyDelete
    Replies
    1. Hello Carla,
      There are a few options. You can ask for a referral to a surgery specialist. This is the best chance and place for her to be if you are worried about her ability to survive surgery. If you cannot afford this then I would either give her a little more time to see if it resolves. My guess is that it will not, or will for a little while and most likely recur. If she were my dog I would do the spay and take my chances (specialist preferred here). For me personally, I would rather walk away knowing that I tried everything to give her the longest, happiest life possible than watch her struggle with a condition that will in all likelihood worsen and diminish her quality of life.
      I wish you the best.
      P.S. If you have any pet questions please join us at Pawbly.com. It is free to use and will provide you with advice and support from other pet lovers.

      Delete
  4. Dear Dr. Krista. My dog is a Shipoo. She has experienced three deliveries but on her third, we found out she had vaginal prolapse about three weeks after. She was operated on for this condition. During the next heat, she was mated by a companion dog, also a Shipoo, and is now on her 2nd month. We are expecting her to give birth soonest. I have already requested the Vet to assist her during the time of birth. I noted though that her belly is getting bigger but she still showed no signs of giving birth (usual signs of pain, crawling to her place or underneath beds to hide, etc.). Will a dog in her condition show signs of giving birth?

    ReplyDelete
    Replies
    1. Hello,
      I strongly recommend that you have her spayed after this delivery. If she needs a c-section have her spayed at that time. I am presuming the vet tacked the uterus in place to the abdominal wall. She will show the normal signs of parturition but the uterus will/may not have the normal needed range of motion it needs to safely and efficiently expel the puppies.

      Delete
    2. Hello,
      I strongly recommend that you have her spayed after this delivery. If she needs a c-section have her spayed at that time. I am presuming the vet tacked the uterus in place to the abdominal wall. She will show the normal signs of parturition but the uterus will/may not have the normal needed range of motion it needs to safely and efficiently expel the puppies.

      Delete
  5. Hello. My dog was diagnosed two days ago with Vaginal Prolapse. It is getting worse. I don't have the the money for her to have the surgery. Do you know of a facility that helps people that can't afford the surgery?

    ReplyDelete
    Replies
    1. Hello,
      I am sorry for the delay. Please ask this question on Pawbly.com It is free to use an perhaps if you tell us where you are someone can offer some help.

      Delete
  6. If more dog breeders saw these pics and read the info perhaps they would realize that the dog's health is in serious jeopardy if you continued to breed your dog every or every other cycle. There are millions of puppies killed every year. We have enough puppies!

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  7. Hi i just wanted to ask what suture material did you use for the vulvoplasty?

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  8. Is it normal to euthanize a dog with a prolapsed uterus? Also what is the appropriate way to ask about a stray dog that was euthanized for this reason ? When a shelter or vet says "they did everything they could"..who holds them accountable and makes sure that they DID do everything they could ?

    ReplyDelete
    Replies
    1. Hello,
      Thank you for caring so much about this dog. Unfortunately some of these cases can be very difficult to treat adequately if the prolapse was severe or happened too long ago to be salvaged. If this was a stray I would be very concerned that perhaps that was the case? If you question the care given I would recommend that you ask. In the US there are animal welfare organizations to register complaints on behalf of pets. Perhaps there is one where you live?

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