This page deals with our foundation queen Maeve's experience with diagnosis and treatment a closed pyometra in an attempt to save her breeding career.
A hysterotomy, for a retained placenta, required one year of abstinence from breeding, followed by a false pregnancy that led Maeve into a pyometra. It is shared here for other breeders to learn from.
Treatment course is no longer determined by whether the pyometra is open or closed.
The medications used cause a closed cervix to open and drain.
Treatment must be done in a hospital with 24 hour observation in case complication requires emergency spay surgery.
With Maeve's first breeding following her hysterotomy (c-section) she went into a false pregnancy. Her following estrus cycle was at best week and she only showed a few signs for two days. We chose not to breed her until she cycled again. With her next cycle she was bred again to Balor. After breeding her, 3 times a day, three days in a row I noticed she was straining in her litter box and only a few drips of urine came out. She would stand in her litter box longer then necessary just waiting. I started watching her closely. She wanted me to come with her to the litter box. I made sure she was eating and drinking lots of water. Her behavior was normal except for this frequent litter box behavior. As I watched her I learned she was able to pass urine. I wondered if she could have some swelling or soreness from being bred that was causing her to feel the urge to urinate or could it be a bladder infection? This was a Friday. I kept a careful eye on her all weekend. She improved and by Sunday night I figured everything was feeling better and Maeve was back to normal. I was hoping for this breeding to produce kittens.
12-12-2007 - Today Maeve had an emergency visit with our Vets when I discovered she had a temperature over 105. This is a very high fever for a cat normal is 100.5-102.5. I was worried she had a bladder or urinary tract infection. I was concerned about possible medications used damaging any developing fetuses. Dr. Jarbeau took an x-ray to confirm his belief that Maeve had developed pyometra. "Was Maeve's uterus swollen because she had kittens?" was the thought that kept going through my head. In talking to the doctor it became clear that an early stage pregnancy was the least of our worries. We now needed to prioritize saving Maeve's life to the top of our list. Could we save her uterus for a future breeding? To answer that we needed to seek experts quickly. The doctor gave Maeve an injection of penicillin and sub q-fluids to help bring her temperature down ...cost $210.00....and we set off for Tuft's.
Below is the x-ray of Maeve. A cats uterus is shaped like a "Y". I've circled the area that shows one horn of her uterus enlarged.
We went from our Vet's office in Stow to the Tuft's University Veterinary School Emergency Room in Grafton. Maeve was taken in for blood work and a abdominal ultrasound. Her temperature was 105.8 The doctor we see consults with the reproductive specialist on staff. She also requests a second ultrasound done by their specialist. The diagnosis of pyometra is confirmed. The ultrasound shows a fluid filled uterus. Maeve is started on intravenous fluids, antibiotics, and Lutalyse, a prostaglandin to help open her cervix so the uterus can empty. Her blood work shows a mild increase in her kidney values, as well as elevations in white blood cells, indicating infection or inflammation. The ultrasound also showed the portion of her kidneys that collect urine and her right ureter are dilated. A urine culture indicates a bacterial urinary tract infection, including a kidney infection. Maeve will need to stay in the hospital for a week. Initially she will be in the ER once they know her treatment is working and she is stable, she will move to the cat ward for the remainder of her treatment. The doctor assures us that they have had good success with treating pyometra. Whether is it open or close does not matter. The thinking on this has changed. Open and closed pyometra are now treated the same. Closed pyometra no longer require an automatic emergency spay. If Maeve does not respond to treatment and she gets sicker she will have emergency surgery to remove her uterus.
While doing the ultrasound they also saw she has a hernia at the bottom of her old surgical site. The last suture in her abdominal wall had come undone and it was unable to heal closed. More on her past surgery can be read in Maeve's Murphy Litter Diary.
Pyometra is an endometrial infection. Endometritis is an inflammation of the the lining of the uterus. Most queens with endometritis have bacterial infections. During estrus, when estrogens dilate the cervix, bacteria normally present may migrate through the cervix into the uterus. Endometritis often progresses to pyometra.
I left Tufts with two deposits one for the current course of treatment and one for emergency surgery if it is needed to save her life......estimated cost of treatment $1800.00 estimated cost of surgery $2600.00. Cost info provided for those who think small hobby breeders make money.
12-13-2007 - Maeve's temperature is down in the 103's. She is not eating. The pyometra is draining.
12-14-2007 - This morning Maeve's temperature is down a little more. The doctors want to get another ultrasound to have a look inside to see how things look. The general feeling is that she is doing better and we can manage her treatment without surgery but they want to see the ultrasound first to be sure. This afternoon Maeve's blood work shows her kidney functioning is improving. The doctor I spoke with today was not sure if they can get the infection out of Maeve's kidneys. She is concerned that Maeve may become a chronic kidney (CRF) cat.
12-15-2007- Maeve is doing really well. The ultrasound shows she still has fluid in her uterus, which is not unusual. She will continue with the five day course of prostaglandins to help open the cervix more so this can drain. Her temperature is in the normal range and her kidney blood work is also in the normal range. I visited her last night for three hours. Once she relaxed she curled up next to me and groomed herself. She cleaned off all the residual ultrasound gel from her shaved tummy. I could clearly see her little hernia. It looks like an outty belly button about the size of the end of my little finger. I would have noticed this after her initial surgery before her fur grew back. I wonder is the swelling she has had recently caused her fatty tissue to bulge out through the opening. She will continue her stay at Tufts this weekend.
12-19-2007- Maeve came home Monday night. She was thin but has been eating well. She is trying to adjust to the feeling that she has kittens somewhere and she needs to find them. She needs to be on an antibiotic for 6 weeks. She loves plain yogurt so I am mixing her liquid antibiotic into a spoonful of yogurt twice a day. She thinks she is getting a treat. She will need a follow up exams in two weeks and in eight weeks. Her kidney function will be checked, it is back to the low end of normal, and she will need abdominal ultrasounds along with checking her urine to be sure the infection is gone. Initially the doctors felt Maeve would need to have her hernia repaired before becoming pregnant again. When I picked her up they changed their feeling about this. The reproductive specialist feels it will be okay and can be repaired if she needs a c-section or ends up altered. A requirement of treating pyometra is to get pregnant as soon as possible after treatment is successful.
Walking into the e.r. cost $150.00 to start, the initial, ultrasound cost $325.00, labs for blood and urine cost $ 285.00...hospitalization is $120.00 a day...add in all the little extras like iv drip set, fluids, and medications. Repeat charges for hospitalization, medication, labs, ultrasound charges for each day they are ordered. Maeve's total Tuft's charge was $1,999.26. This does not include all the follow up visits and ultrasound and kidney tests needed at 2 weeks and 8 weeks post treatment. (Cost info provided for those who think small hobby breeders make money.)
1-3-2008 - Maeve had her first check up today. Her abdominal ultrasound showed her uterine horns are now equal in size. The walls of the horns do show a thickening, possibly cystic endometrial hyperplasia . A common condition where the endometrium (lining of the uterus) becomes overgrown. The reproductive specialist at Tufts felt Maeve could now be bred as long any possible kidney infection clears completely. One of the ways to deal with an over growth of the endometrial lining is to become pregnant. The change in pregnancy hormones helps. Maeve's kidney test results were at the low end of the normal range and her urine specific gravity test results were low. She will continue with 4 more weeks of antibiotics and be checked again in 6 weeks.
Here is a photo of Maeve taken today with eyes aglow and her tail curled across her hospital boots. The fur on her arms shaved for intravenous lines is starting to grow back. She was watching the kittens from Finola's litter play.
We bred Maeve through three cycles and she failed to conceive.
We believe she will not conceive again and to save her from another pyometra we have retired and spayed her.
She will remain with us as Grandmother to our kittens.
Many breeders don't realize a queen has pyometra because cats are so clean. A breeder rarely sees any discharge. Many times it is a lack of kittens that clues a breeder in to the condition. A queen can become septic very quickly and if she hides how sick she is she may die. Immediate action is required if you think your queen may have pyometra.
The View From Grandma Maeve's Porch
Maeve's "enjoying the good life" Blog
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