A Hard Lesson

I'm sometimes surprised about what surprises me in this profession. A case last from last week is a good example.

A new client came in with an 8 yr old overall "healthy" cat because she saw some discharge from the "back end." Of course, there are a few possibilities with that description. The cat was indoor only and lived with her two other female litter mates. All of the cats were unspayed. 

Her reason for not spaying was them was she thought that the (one) reason for spaying - to prevent pregnancies - was eliminated because she kept them strictly indoors. This was NOT a wrong thought.

What she didn't know were that:
1. Having a uterus makes them possible candidates for developing a serious infection called a pyometra
2. Have a uterus/ovaries makes both dogs and cats have a HIGH incidence of mammary tumors later in life with cats having an 80% chance of them being malignant (dogs it's 50%). 

As I examined this sweet little kitty (she was only about 8 lbs), I felt her abdomen was rounded/distended and felt a bit abnormal (I could not palpated distinct organs) but the owner hadn't noted any changes in her "shape or size." Her appetite had been good so maybe she was a little bigger because she was older and not as active.  Also this whitish discharge (pus) was coming from her vulva. 

My years of experience screamed - pyometra. We ran some blood work to make sure her organ function was ok and that she was also feline leukemia/feline immunodeficiency virus negative.  I also put the ultrasound probe on her belly and found large pockets of fluid, consistent with a pyo.  Her blood work was all good except for a moderate anemia, which often goes along with chronic infections, and a high white blood cell count, consistent with our pyometra.

The only way we could save her was to do emergency surgery on her. 

So we got her admitted and over lunch break, did her surgery. In my 15 years of experience she was the weirdest and worst case (especially for a cat) I have ever seen. I will share some pictures below. At first I was baffled as to why I couldn't get the rest of her uterus out - the cranial portion of the horns on either side where we find the ovaries as well. I thought she had some massive adhesions at first (she had a few minor ones as it turned out but that was not the cause of the difficulty) , which was definitely possible given the inflammation going on inside her. However, as I enlarged the incision it became clear to me the uneven pocketing of pus that was going was creating a much larger portion of the horn than we typically see. It's usually just a very enlarged "Y" but evenly enlarged. Not in this case as you can see from the pictures.  Remember, this little girl is 8 lbs.

The large portions were very firm too so once we had them out I wanted to cut into them to make sure they weren't some type of mass. As it turned out, it was simply pus. 

The sweet girl made it through surgery just fine. She was carefully monitored by our wonderful surgical nurses. She had her antibiotics on board and her IV fluids running. She woke up and was extubated just fine, however, she never really came around. She continued to be very listless despite warmth and tender care and then her body temperature started to plummet and we lost her a mere hours post op.

Why you may ask? Well, she was very little and clearly this had been going on for longer than the owner could've have known. There is a very good chance she was septic (bacteria in the bloodstream from this very severe infection)  and that will often cause organ shut down in spite of what we do. We weighed her after surgery and she lost over 1 lb! That's how big her uterus was. That too could have been a bit of shock to her system. However, the flip side is if we did nothing, that uterus would've ruptured and she would've died a painful death. It was a lose/lose. 

This was a hard lesson for both the owner and me. The owner wasn't aware of the (other) dangers of not spaying and I thought for sure I could save her (call it a bit of pride in what I do and how I do it.) 

The one positive outcome is that she is now going to have her other two cats spayed and she has become a wonderful client. And we both learned something. 

Normally the enlarged uterus is symmetrically enlarged and in a cat, typically only as large as the lower portions - closest to the end of the "Y" that you see here - (not the BIG pockets)

I was happy to find only pus in these large pockets. 

One of our nurses, Kara, holding her in a warmed towel as she wakes up from surgery.