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;

Rectal Prolapse in My Puppy, Jekyll's Beginning.

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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.