Pyometra

[originalnamehere]

I want to know the real risks, not the Bob Barker "spay and neuter now or your animal will die", of bitches who are not spayed developing pyometra.
Do you have any experience with it? Know anyone who does?

In all the bitches I've had or known, none have ever gotten pyometra.
Am I wrong to believe it's an overblown concern?

 

[ZephyrZoo]

@Deagle113

 

[YanchaOkami]

It depends on the individual.

My own girl at that time had it, a cared-for girl developed it as well (without sexual activities in the latter case).

It's a serious "natural" risk, but both cases were early detectable by symptoms and after a bit over 14 (one case was three weeks, as such 21 days plus additional medicals related to easier discharge of the build-up dead cells) days of antibiotics it healed off.

For me it's always important to check for specific symptoms, but for dog owners which don't have any idea about symptoms, causes (due to disinterest in it) it might be hard or very late to detect.. and that's potentially deadly. Same goes for knots / tumors building up anywhere.

The earlier something is able to get treated, the better.

Edit: From my experience it should not be linked to hygienic sexual activities. But some dogs are more sensitive for UTIs and comparables all their life, that's just individual difference. Some might not get even any bladder infection, ever. No possibility to say: "That's the main reason!" if same cared-for dogs differ in such aspects.

 

[MashaSobaka]

It is difficult to give numbers because it depends on many factors. Usually every fourth or fifth dog gets into it, but based on the experience of my own dogs and other people's dogs, it can be every tenth or twentieth.

You have to watch the symptoms and count the days of heat. If it is noticed early and the dog is young, it can most likely be cured with antibiotics, anti-inflammatory drugs, cervical opening hormone injections (in the worst case, uterine rinse).
In older dogs, however, surgery is usually the end, because the old body and the folds of the uterine wall and the internal balance of the uterus can no longer be maintained and the inflammation does not stop or it comes back at the next heat.

In the case of zoophiles, it usually rarely leads to death, because the symptoms are detected quickly. The number of deaths is already higher for dumber dog owners.
Dogs that have had puppies several times improve the rates, but they can also get pyo in the same way.
Of course, the operation is associated with a strong decline in sexual relations, possibly complete cessation, the muscles of the vagina shrink, the "O ring" becomes impenetrable, etc.

 

[MashaSobaka]

From my experience it should not be linked to hygienic sexual activities.

Yeah. Hygienic sex is important, but it is not the main cause of pyometra. Most female dogs never have sex with humans or dogs, but still get pyo.
This is a genetic trait, and the uterine wall becomes wrinkled with aging, while its hormonal balance is disrupted and bacteria settle, the production of purulent liquid begins, which contains toxins and is absorbed by the mucous membrane, in the last case the weakened uterine wall ruptures and the purulent stuff floods the abdominal cavity.

There are times when the male dog causes pyo, humans can also cause pyo, but this is rare case.
Pyo most often develops at or after the age of 6-8 (it can also occur at a young age, even at the first heat, but this is also rare).
The dog's ancestor, the wolf, did not live that long in the wild, therefore pyo-prone bitches were never selected by nature.

 

[Deagle113]

This is an excellent question, and a really valid concern. Lots of good points already so far, especially the part about early treatment and observation.

There are a small subset of veterinarians like myself who are pushing back on the primarily US narrative of spaying and neutering every single dog and cat every single time. There simply aren’t enough of us, and it requires going to a lot of extra effort to study and learn about managing intact dogs that many vets don’t have the time or desire to do during their busy days.

But to add my two cents:

First, the 25% often quoted incidence is gathered from clinical data from people who brought their pet to the veterinarian with pyo. Thus, it represents the entire dog owning population, many of which don’t pay half the attention and care to subtle signs going on with their doggos as zoos, who also pay close attention to their dogs heat cycles, something that is like pulling teeth to get the average client to do. That would be my guess as to why your observed rate is much lower.

Physiologically, we still aren’t sure exactly why pyo happens. The current prevailing theory is that it is caused by exposure of the endometrium (uterine lining) to repeated high levels of estrogen during estrus, and high levels of progesterone during diestrus. These two cycling hormones cause the lining of the uterus to thicken, and if the doggo is not bred—the uterine lining returns to normal post whelping—it simply continues to get thicker and thicker, which is why the incidence increases as the dog gets older and adds more uterine lining layers.

This thick lining can eventually form pockets that make it easier for normal fecal bacteria (E coli is #1) to set up shop and start replicating to a much higher amount than normal. As they chew away inside, they can eventually damage the uterus and make their way into the blood stream, which dumps a high number of bacteria to every major organ, and which is why it is such an emergency when late stage pyo dogs come into the clinic.

In this case, the reason it’s so important to spay is because the uterus has become a huge sprawling colony of bacteria and pus, and removing all of that, taking out the bacterial HQ, dramatically improves our odds of dealing with the bacterial infection in the rest of the body and saving the dog.

I usually spend a lot of time with my clients educating them on all the signs and symptoms of possible pyo in their intact girls, and when treated promptly the outcomes are always quite good, but things can still re-occur. If your girl has already had one pyo, you know the conditions are right, and you should keep a close eye on her.

In fact, the best treatment for pyo is pregnancy and puppies, as this will reset the uterine lining thickness!

 

[YanchaOkami]

The current prevailing theory is that it is caused by exposure of the endometrium (uterine lining) to repeated high levels of estrogen during estrus, and high levels of progesterone during diestrus. These two cycling hormones cause the lining of the uterus to thicken, and if the doggo is not bred—the uterine lining returns to normal post whelping—it simply continues to get thicker and thicker, which is why the incidence increases as the dog gets older and adds more uterine lining layers.

Very interesting - at the time of my studies years ago there was the hearsay of "let her welp at least once to lower the risks!" widely spread (it is still under common folks), but that's the first time a vet actually was able to describe the concept which lays behind. And it's a logical conclusion, thank you very much for the description.

As such it could lower the overall risk if a female intact dog was getting impregnated and bearing offspring at least once and technically the best risk prevention would be somewhat around half her expected life span. Aside the additional risks through pregnancy, which are a given.. but to balance those two factors out is related to fortune.

There is no hormonal (medical) way to induce this result without her actually welp, I assume? As it is possible to change the behavior of mucous membrane and uterus by hormones, but without actually giving birth to puppies (and the corresponding placenta membranes) I guess it's not possible to set the endometrium back to "default" artificially?

In this case, the reason it’s so important to spay is because the uterus has become a huge sprawling colony of bacteria and pus, and removing all of that, taking out the bacterial HQ, dramatically improves our odds of dealing with the bacterial infection in the rest of the body and saving the dog.

Understandable - if the infection is that far developed, it's always better to remove the not life-relevant tissue to reduce overall risks.

(E coli is #1)

That means there could as well be a high release of toxins by development and breaking down of bacteria and biological material through body anti measures from what I remember about Escherichia coli?

As such it gets even more understandable that an ovariohysterectomy to remove most of infected matter is recommended instead of trying to cure it out with antibiotics in such a late stage, aside from the stress for her body it's as well the necessary disposal of remains and toxins which additionally stresses (and potentially could kill) her.

 

[MashaSobaka]

at the time of my studies years ago there was the hearsay of "let her welp at least once to lower the risks!" widely spread (it is still under common folks), but that's the first time a vet actually was able to describe the concept which lays behind. And it's a logical conclusion, thank you very much for the description.

This theory is still there, but a litter does not bring significant risk improvement. This requires more litter. And this is not 100% either, because there are breeders whose dogs got pyo, even though 3-5 litters were born.
Pyo remains a risk for all zoophiles with female dogs. We have to live with that.

 

[Deagle113]

@MashaSobaka is correct. The actual risk reduction from having a litter is realistically small, and just like everything in biology there are always exceptions, and quirks of individuality or risk. If you figured out a hormonal or medical solution to pyo you’d be a millionaire.

 

[YanchaOkami]

If you figured out a hormonal or medical solution to pyo you’d be a millionaire.

Nah, no time for that. Would be an interesting solution, if the side effects are low enough, tho.

 

[Demigod]

Statistically speaking how significantly is the risk reduced for pyo if a bitch has a litter?

 

[Deagle113]

Statistically speaking how significantly is the risk reduced for pyo if a bitch has a litter?

To my knowledge, there aren’t any studies to ever examine this. Pyo is such a complex and multi factorial condition that we STILL don’t have a good grasp on even today. The litter thing is an educated guess of our profession based on current knowledge of the etiology behind it, and doggo reproductive biology.

 

[MashaSobaka]

If you figured out a hormonal or medical solution to pyo you’d be a millionaire.

Even if it existed, sterilization would be forced through propaganda.
Here are the main arguments by "idiots":
-pyometra, breast tumor (real)
-random puppies (only idiot owner)
-tendency to run away, behavior problem (only idiot owner)
-sexual dissatisfaction (wut?)

With such a drug, only the very first would disappear, there would still be 3 reasons with which the propaganda machine can continue to be operated.
There is no vaccine against Aujeszky's disease, even though it would be important. Researchers don't care. The researchers are not interested in more effective medical treatment of pyo either, because they have put their religion firmly on the side of surgery.

 

[MashaSobaka]

Nah, no time for that. Would be an interesting solution, if the side effects are low enough, tho.

There is a hormonal treatment that can be used to stop the heat (here Covinan), but it is only safe for occasional use. Its lifelong use can lead to pyo in the same way, even though there is no heat -> no thickening of the uterine wall, no folds. So that doesn't work either.

 

[amorousdog5]

Sadly, I'm 1/1 in terms of unspayed female dogs I've owned that got Pyo. Fortunately for me it was an open Pyo that I noticed pretty much immediately. The vet told me emergency spay would be a more certain way to save her than the hormonal treatment, so of course I got her the surgery despite believing it would mean the end of our sex life. Thankfully that was not the case; after her recovery it soon became clear that her sex drive had not suffered very much.

 

[MashaSobaka]

Thankfully that was not the case; after her recovery it soon became clear that her sex drive had not suffered very much.

This is a big lottery, it depends heavily on how the particular doctor operated and it also depends heavily on the effects of hormone deficiency.
Unfortunately, for the majority of people, the sex life is significantly reduced, complete penetration ceases.

 

[Ken Oh]

always wash your hands and penis very well use new lube and have a condom to get a minimum risk here.

 

[YanchaOkami]

This is a big lottery, it depends heavily on how the particular doctor operated and it also depends heavily on the effects of hormone deficiency.

It depends very much on the prior sexual life. The other aspects result mainly in variable risk and hormone-driven sexual interest, as heat cycles are no longer given.

If the female dog is experienced and enjoying it much (with a human), the risk for extreme reduction in her sexual drive can be significantly lower. As it is to quite a big part based on the dog's own interest. A dog which had no sexual experiences beforehand spay (or in male case: neutering) will have a very hard life to develop this interest, if at all. But a dog which has it already.. doesn't need to change much after such a surgery.

My recent dog had not the slightest reduction in her interest and multiple orgasms were as well possible after spaying, even as she took a bit more time / stimulation and was easier oversensitized, took longer breaks in-between. Surely it as well depends on the surgical measures, but a standard ovariohysterectomy leaves much room for her individual mental and interest-based requests of sexual activities.

And no, the hysterectomy was not based on pyometra, but malign tumors. On a pyometra with early recognition and limited infection areal I would never accept the surgery.

There is a hormonal treatment that can be used to stop the heat (here Covinan), but it is only safe for occasional use.

I know, there are as well chemical temporal castrations for male dogs available. But the side effects fill quite long lists for all of those chemical concepts, possible health-related problems are not that rare, as such no drugs I would ever recommend.

Even if it existed, sterilization would be forced through propaganda.

A common problem.

Only thing which helps in relation to the owners is counter-propaganda based on facts:

- Food acceptance and intake can vary, it's easier for female dogs to build up fat.
- Incontinence can follow quite often.
- Changes of the character and emotional balance are possible.
- This as well influences often the acceptance or unacceptable behavior in relation to other dogs.

- And - happened to the dog girl of a good friend of mine - if the veterinary didn't remove the stump completely, it's unfortunatly still possible to gain a stump pyometra. As such this risk is even with full "spay" ovariohysterectomy not completely nullified, if small remains stayed.

- One of the worst ones for long-haired dogs with underfur aka two layered fur: The heat cycles respective hormonal changes are directly linked to fur-change cycles. Without the hormonal origins it is not rare that the fur grows all year around and as well sheds.. all year around.

This resembles loads of lost hairs, possible scratching, four to five times more work with combing / removing underfur and so on. Fur pattern changes as well, either overly fattening or very straw-like, both can occur. And that's very stressing for any owner.

Been there, done that. As such.. No thanks to ovariohysterectomy, if it doesn't save the dog's life from otherwise deadly metastases.

 

[OffgridK9lover]

I want to know the real risks, not the Bob Barker "spay and neuter now or your animal will die", of bitches who are not spayed developing pyometra.
Do you have any experience with it? Know anyone who does?

In all the bitches I've had or known, none have ever gotten pyometra.
Am I wrong to believe it's an overblown concern?

out of my pack only 2 have had it, 1 possible 1 for sure.

So it really is a crap shoot.

With both it happened in the later years of their life, one had a litter, so I opted for spay as due to age and likely re-occurance and she had breast cancer issue in past I opted for that treatment rout for best chances, and she had a few great years of life

The second, age, and previous hit and run made any chance of puppies a high risk, so opted for full spay again as every thing pointed in it as being the best for her life quality

totality of circumstance and data is important at every intersection on the road of life.

 

[Strayward]

I want to know the real risks

https://onlinelibrary.wiley.com/doi/10.1111/rda.12103

Have a look at this study, it looks at a large population of Sweedish dogs, based by breed. It's a tad dated and by no means perfect, but probably one of the more comprehensive studies you'll find. If you scroll down a little, they break it down in "Table 1".

Here's my understanding of how the table works, 'cause it's not super clear at first glance:

Breed	Pyometra %rank	MTs %rank	P/MTs %rank	Total female dogs
Afghan	- 16% got pyo during their whole lives - The breed ranks 79th out of 110 in order of the most to least likely to get pyo - 21 individuals out of the 475 Afghans got pyo before age 10	- 26% got mammary tumors during their whole life - The breed ranks 17th out of 110 from most to least likely - 34 individuals out of the 475 Afghans got mammary tumors before age 10	- 34% got either or both diseases during their life - The breed ranks 55th out of 110 from most to least likely to get either or both of these diseases - 49 individuals out of the 475 Afghans got wither or both theses diseases before age 10	475 Afghans were in the study

 

[Strayward]

In fact, the best treatment for pyo is pregnancy and puppies, as this will reset the uterine lining thickness!

With all due respect, I disagree. While gravid, the uterus is less likely to get pyo. However, there's no reset of the lining. The risk of getting pyo on the next non-pregnant heat cycle remains increased.
The whole "having a litter" thing is if the dog got pyo but was still intended for breeding. If they succesfully undergo medical management they should be bred on their next heat (to have puppies before getting pyo again and ending up in surgery).

 

[amorousdog5]

https://onlinelibrary.wiley.com/doi/10.1111/rda.12103

Have a look at this study, it looks at a large population of Sweedish dogs, based by breed. It's a tad dated and by no means perfect, but probably one of the more comprehensive studies you'll find. If you scroll down a little, they break it down in "Table 1".

Here's my understanding of how the table works, 'cause it's not super clear at first glance:

Breed	Pyometra %rank	MTs %rank	P/MTs %rank	Total female dogs
Afghan	- 16% got pyo during their whole lives - The breed ranks 79th out of 110 in order of the most to least likely to get pyo - 21 individuals out of the 475 Afghans got pyo before age 10	- 26% got mammary tumors during their whole life - The breed ranks 17th out of 110 from most to least likely - 34 individuals out of the 475 Afghans got mammary tumors before age 10	- 34% got either or both diseases during their life - The breed ranks 55th out of 110 from most to least likely to get either or both of these diseases - 49 individuals out of the 475 Afghans got wither or both theses diseases before age 10	475 Afghans were in the study

When you read the study, it says that only dogs up to ten years of age are included in this study. Therefore the percentages given cannot possibly be from the entire lifetimes of the dogs. This presents a problem, because the math clearly does not work out when we compare the given percentages to the number of actual cases and total dogs (21/475 is not 16%)

I'm not sure I can say what these numbers actually mean, only that they don't appear to mean what you believe they do (aside from the ranking value, which seems to be pretty straightforward).

 

[Deagle113]

With all due respect, I disagree. While gravid, the uterus is less likely to get pyo. However, there's no reset of the lining. The risk of getting pyo on the next non-pregnant heat cycle remains increased.
The whole "having a litter" thing is if the dog got pyo but was still intended for breeding. If they succesfully undergo medical management they should be bred on their next heat (to have puppies before getting pyo again and ending up in surgery).

Thanks for the comment. I’m going to to hit the books and evaluate my understanding of this, as this is a very good point, and I want to be providing the best info for questions. Just serves to drive how how complex an issue pyometra is. .

 

[Strayward]

When you read the study, it says that only dogs up to ten years of age are included in this study. Therefore the percentages given cannot possibly be from the entire lifetimes of the dogs. This presents a problem, because the math clearly does not work out when we compare the given percentages to the number of actual cases and total dogs (21/475 is not 16%)

I'm not sure I can say what these numbers actually mean, only that they don't appear to mean what you believe they do (aside from the ranking value, which seems to be pretty straightforward).

You entirely correct, they limited everything to <10 years old and I bungled my explanation badly. Instead of "their whole life", I should have said "if we looked at the entire period from 0-10 years old", which is a completely different thing.

I think the reason the number of cases, number of dogs and proportion % don't add match up directly is because they don't actually have 475 afghans enter at age 0 and stay until death or 10 years of age. Their database had 475 afghans, of various ages, insured for various amounts of time at different points in their life. Some of them might be insured from 1-3 years old or something like that. Some of them drop out of the insurance program early, or join in later on in the study period and don't get to 10 years old, etc. Hence, they use statistical model to account for that. The math behind it all is quite beyond me however, so that I can't explain.

In the case of the afghans, my understanding is they had 475 participating dogs and 21 cases of pyo at varying ages <10 with which to build their model. Their model suggests that 16% of afghans develop pyo by age 10.

So that should have read:
- 16% of afghans in the statistical model got pyo by age 10. In other words, if we insured a bunch of afghans puppies for their entire lifetime, 16% of them would probably file a claim for pyo in the first 10 years. Or, if you talked to a bunch of people who have owned an intact female afghan through her whole life, we estimate that 16% would tell you their dog got pyo before she turned 10.
- According to that number, the breed ranks 79th out of 110 in order of the most to least likely to get pyo
- Their study population had 21 individuals out of the 475 Afghans insured that actually did filed a claim for pyo during the study period (this would give you an idea how much data they had available for their model. Like the Tulear has 1 case of pyo out of 286 dogs vs the german shepherd has 1600 cases out of 20 000 dogs, I'm guessing the numbers for GSD are more representative)

Again, this is what I'm getting from it, with my limited understanding of Cox regression. Hopefully I'm not too far off!

 

[MashaSobaka]

When you read the study

This study has already been criticized by several people, myself included. Only then did some idiot come and start hysterical that I must be smarter than the swedes , so I deleted the comment instead.

 

[amorousdog5]

You entirely correct, they limited everything to <10 years old and I bungled my explanation badly. Instead of "their whole life", I should have said "if we looked at the entire period from 0-10 years old", which is a completely different thing.

I think the reason the number of cases, number of dogs and proportion % don't add match up directly is because they don't actually have 475 afghans enter at age 0 and stay until death or 10 years of age. Their database had 475 afghans, of various ages, insured for various amounts of time at different points in their life. Some of them might be insured from 1-3 years old or something like that. Some of them drop out of the insurance program early, or join in later on in the study period and don't get to 10 years old, etc. Hence, they use statistical model to account for that. The math behind it all is quite beyond me however, so that I can't explain.

In the case of the afghans, my understanding is they had 475 participating dogs and 21 cases of pyo at varying ages <10 with which to build their model. Their model suggests that 16% of afghans develop pyo by age 10.

So that should have read:
- 16% of afghans in the statistical model got pyo by age 10. In other words, if we insured a bunch of afghans puppies for their entire lifetime, 16% of them would probably file a claim for pyo in the first 10 years. Or, if you talked to a bunch of people who have owned an intact female afghan through her whole life, we estimate that 16% would tell you their dog got pyo before she turned 10.
- According to that number, the breed ranks 79th out of 110 in order of the most to least likely to get pyo
- Their study population had 21 individuals out of the 475 Afghans insured that actually did filed a claim for pyo during the study period (this would give you an idea how much data they had available for their model. Like the Tulear has 1 case of pyo out of 286 dogs vs the german shepherd has 1600 cases out of 20 000 dogs, I'm guessing the numbers for GSD are more representative)

Again, this is what I'm getting from it, with my limited understanding of Cox regression. Hopefully I'm not too far off!

Assuming your interpretation is correct, that these percentages are mathematically calculated estimates and not actual observed data is a rather important point. Essentially it means that this is what the proportions of pyo should look like if it follows some expected pattern. However as real life has the potential to deviate from the expected, I think we must take these estimates with a grain of salt and keep our eyes open for more definitive data.

 

[Deagle113]

I’m glad @MashaSobaka and @YanchaOkami chimed in with extra experience and knowledge, appreciate you!

I spent a bunch of time today on digging around in the literature on this, and I asked some vets who are much smarter than me for resources and details.

I come to you with two additional nuggets to add to the discussion, which is rapidly becoming really interesting and a bit divisive and serves to highlight the complexity of this multifaceted condition!

1) @Strayward is correct about the endometrial lining not decreasing in thickness after pregnancy. The locations where the placenta attaches to the uterus, the placental sites, are the only things that change in thickness and cell composition.

As such, the pregnancy thing I was taught is actually primarily about having a litter in a high risk of pyo situation, as was referenced. Thanks for the correction and for new information—I learned a thing that I can set my clients, and myself, straight on!

2) There’s some promising science looking at the specific sub type of E. coli and the receptors it uses to attach itself to the endometrium: in the future we may be able to modify the micro biome of the gut to discourage the types of bacteria that are implicated in pyo and decrease the risk.

I think the broad assumption to still make is this is going to be a thing we have to deal with in intact female doggos, regardless of the risk percentage and mechanisms of it happening—being informed as to the clinical signs and when to bring your dog to the vet is probably the most important information about pyo that you can have.

 

[YanchaOkami]

Thank you for the update!

.. being informed as to the clinical signs and when to bring your dog to the vet is probably the most important information about pyo that you can have.

Definitely, but as far as the undertakings to modify the biome will result in a way to prevent bacterial infection by the mostly present bacteria, that's as well a good start. It can let many mammals, including humans profit from the development and study results. The initial infectious reason for a pyometra is not canid-exclusive.

 

[Demigod]

I’m glad @MashaSobaka and @YanchaOkami chimed in with extra experience and knowledge, appreciate you!

I spent a bunch of time today on digging around in the literature on this, and I asked some vets who are much smarter than me for resources and details.

I come to you with two additional nuggets to add to the discussion, which is rapidly becoming really interesting and a bit divisive and serves to highlight the complexity of this multifaceted condition!

1) @Strayward is correct about the endometrial lining not decreasing in thickness after pregnancy. The locations where the placenta attaches to the uterus, the placental sites, are the only things that change in thickness and cell composition.

As such, the pregnancy thing I was taught is actually primarily about having a litter in a high risk of pyo situation, as was referenced. Thanks for the correction and for new information—I learned a thing that I can set my clients, and myself, straight on!

2) There’s some promising science looking at the specific sub type of E. coli and the receptors it uses to attach itself to the endometrium: in the future we may be able to modify the micro biome of the gut to discourage the types of bacteria that are implicated in pyo and decrease the risk.

I think the broad assumption to still make is this is going to be a thing we have to deal with in intact female doggos, regardless of the risk percentage and mechanisms of it happening—being informed as to the clinical signs and when to bring your dog to the vet is probably the most important information about pyo that you can have.

Pardon my ignorance but if E. Coli plays a part in pyometra wouldn't keeping your bitch clean reduce the risk?

 

[MashaSobaka]

Pardon my ignorance but if E. Coli plays a part in pyometra wouldn't keeping your bitch clean reduce the risk?

Bacteria travel through the body. As long as the animal is young and there are no problems, the balance is maintained. In old age or due to other problems of the uterus, this is reversed and they multiply there. Most of the time, pyo is not caused by externally introduced bacteria.