Uterine Bleeding -- pyometra? cysts? surgery?

User avatar
Lynx
RESIST

Post   » Wed Jan 23, 2002 11:31 am


Well, about two months ago Nina had some bleeding. It did not appear to be diluted with urine. Bactrim seemed to clear it up or it went away on its own.

The last couple days she seemed quieter and more reserved and I found some blood which I think has been positively tracked down to her -- and she seemed warmer than normal. She is otherwise eating and behaving normally. If Snowflake´s (pms pig) nipples are enlarged, hers may be also, as they are about the same size. No other symptoms -- no hairloss, nothing obvious.

I have an appointment this evening at 6:30 with the reputed better gp vet. He does not have ultrasound diagnostic equipment. I checked out old posts at CG -- Josephine mentioned diagnostics such as xrays, ultrasound, and bloodwork (to see if there is a systemic infection going on). From what very little I could find on the net, it would seem x-rays may not show things very well and would be better for diagnosing stones, that they would not help much with uterine problems (comment?).

Questions:
  • If the blood is not diluted by urine, is it highly unlikely to be a urinary problem but much more likely a reproductive problem?
  • Are there any other diagnostics that would definitely help? Is the only thing bloodwork would do is show the presence of an infection?
  • With a standard spay, are the ovaries usually removed so if there were any cysts, they would be removed too (I don´t feel any cysts)?
  • Nina is fat (this vet previously commented -- difficult to palpate). Does this mean she would be harder to perform a surgery on?

All the reproductive problems I read about seem to be "solved" by spaying. It seems if it is truly pymetra (unknown -- perhaps not that serious) this is an emergency situation and surgery would need to be done right away.

Both Pinta and Josephine have advised that pigs do not need to fast before surgery. Pinta states removing food 1 to 2 hours before the procedure is all that is necessary. Pinta noted how vital sterility during surgery is -- as abscesses can be a real problem. She mentioned antibiotics following any surgery. Pinta mentioned removing sutures in 10 days if they were used. Some incisions can be glued.

Josephine has mentioned: Good antibiotics: Baytril (enrofloxacin) or Trimethoprim Sulfa -- Baytril may be better since it is broader spectrum.

Ask for subcutaneous fluids (with B and C vitamins are good). Usually some will be warmed and used to rinse the peritoneal (abdominal) cavity of pus after a pyometra. She thinks it is essential for post-operative care in cavies.

"I would ask for a more potent pain killer like Torbutrol (butorphanol). I´m sure Oxymorphone can also be used, but it lasts longer. You want deep pain relief but not enough to knock them into oblivion forever so they don´t eat soon after surgery. Torb is a narcotic and is safe and effective for cavies. Carprofen (Rimadyl) usually doesn´t give as much deep tissue and long-acting pain relief, although it is good for other instances.

The towels, confinement, food supplementation, weighing, and observations are all good post-operative care. She needs to eat within a couple of hours of surgery so her gut keeps moving. Make sure the vet doesn´t fast her if she´s eating now. Cavies do not vomit and aspirate.


Josephine, the other pain medications you mention, is this post operatively?

As for post surgery, I found (and gave) some of the following advice.

Surgery -- recovery:
  • Ask for pain medication (rimadyl?)
  • Keep her on towels, change frequently (can watch pee and poop output and bleeding more easily). [white towels may work best for monitoring]
  • Put her in a confined area so she doesn´t move around alot and create adhesions (scar tissue) at the incision site
  • Of course make sure she has adequate food and water, extra vitamin C (Pinta has mentioned 50mg)
  • Weigh her and make sure she is eating
  • Watch her behavior (problematic behavior would include lethargy) and contact the vet if there are any problems.
  • Watch for swelling or an incision that is hot to the touch -- any pus indicates an infection
  • Ask your vet for any additional advice
Pinta: For ours, we keep them extremely confined (restricted in movement) for 5 days following surgery to reduce the chances of surgical adhesions, and then somewhat confined for another 5 days (no climbing or jumping). Then they are free to resume normal activities.

Any personal experiences, advice appreciated. I´m hoping Pinta and Josephine have a chance to see this before I see the vet.

User avatar
lisam

Post   » Wed Jan 23, 2002 2:54 pm


I just got back from the vet, Queen Amidala is still there, we decided to do surgery. He said the sooner the better, and is doing it on his lunch break. He said that an xray really doesn´t show much in a case like this, since the density of all the fluid filled organs is pretty much the same. An ultrasound would be better diagnostically, but that it would probably show that we would need to do surgery anyway, so he recommended doing the surgery anyway and saving the cost.

He felt that because of her symptoms it is most likely that she does have pyometra. He said that if it was her ovaries, for example a cyst, then there wouldn´t necessarily be the gradual weight loss that Amidala had. However, he also felt a lump, down in the area of her kidneys, that he felt should be checked out.

He stated that there is no cure for pyometra, except for spaying. He said that it is mostly seen in middle aged dogs that haven´t been spayed.

Thank you for the post surgery suggestions. I am awaiting a call from the vet to let me know how the surgery went. It was hard to leave her, knowing she might not survive the surgery, but didn´t want to upset the kids. I told them not to say goodbye, but to give her good wishes.

So Nina hasn´t shown any weight loss? Perhaps it is a cyst, or other problem with the ovaries, as opposed to pyometra?
Last edited by lisam on Wed Jan 23, 2002 2:57 pm, edited 1 time in total.

User avatar
lisam

Post   » Wed Jan 23, 2002 3:13 pm


The vet´s assistant just called, they are in the middle of surgery, and have discovered cysts on both of her ovaries. He is still unsure if the uterus in infected yet, it looks abnormal. They will call back after surgery for another update.

pinta

Post   » Wed Jan 23, 2002 3:13 pm


It looks like you have it all there. I have heard that surgery is harder on fat pigs but I can´t remember precisely why. I think it´s something to do with the fat layers and the anaesthetic. Might need more then usual? Really couldn´t say for sure - going by foggy memory.

It seems appropriate to assume blood without urine points to the ovaries. But Josephine would know for sure.

Many vets give heavy duty pain medication during surgery so the pig does go home with some form of long lasting relief. Post-op, I´ve had good success with Rimadyl(to help the recuperative comfort level).

A protective sweater like the one our vet rigged up for Tiramissou is excellent for protecting the surtgical site from contamination when she´s back home.

I think a course of post-op antibiotics is imperative.

Unfortunately, we are discovering more and more that bloodwork doesn´t give you all the info you hope for. The norms for pigs aren´t known, so often, you´re guessing at what the numbers mean. Our vet has found redoing the bloodwork in a couple of weeks is helpful to spot abnormalities.

I believe the ovaries and uterus is removed in a standard spay which means she will never get cysts again or ovarian tumours. But Josephine had better confirm.

When Tiramissou was spayed, our vet was surprised by the condition of her uterus. She sent it to the lab and got the diagnosis of pyometra. There was no indication pre-surgery that she had pyometra. She had gone in to be spayed for very obvious cysts. In her case, the pyometra was caught in the nick of time.

Although ultrasound is pricy, it does put your mind at rest as to diagnosis. We just had a sow ultrasounded for chronic hormonal pattern hair loss. I expected to see Cushings Disease confirmed or cysts that were out of palpating range. Nothing was found. The technician will do a follow-up ultrasound 2 months later for no charge to doublecheck. So, whereas without the ultrasound, we might have gone ahead and medicated for the "best guess" diagnosis, with it we know not to bother. We also know her health isn´t at immediate risk.

Although spaying is major surgery, most sows do come thru with flying colours. Vicki´s vet and others have performed dozens with no complications.

If you are aware of what to look for post-op and your vet is experienced(make sure he uses Isoflurane gas) chances are very high she´ll do fine. And the benefit of a spay is that you will have removed any further threat of reproductive organ problems.

The bottom line is; what are the risks to her health by NOT getting the spay?

pinta

Post   » Wed Jan 23, 2002 3:16 pm


Good luck Lisam.

Tiramissou had weight loss which was what alerted us to look for the cause.

User avatar
Lynx
RESIST

Post   » Wed Jan 23, 2002 3:48 pm


By the way, I´ve been watching her closely. It is definitely vaginal bleeding, only a very small but noticeable amount (now and then). Clean blood, no bloody urine. I was reminded by a friend that while guinea pigs are not known to have menstrual cycles with bleeding, it has been reported that a few will bleed a small amount -- a smear here or there -- for one to two days. Nina is one of my other pigs. She is plump, no weight loss, never behaves in a pms-y way. I´m trying to get a chance to talk to him to see if he feels since she is behaving otherwise normally, it would be wise to wait a day or two to see if it clears up. If I take her in, I´ll haul in all three pigs and see what he has to say about Snowflake too.

And good luck, Lisam. I sure hope the surgery goes well.
Last edited by Lynx on Wed Jan 23, 2002 3:48 pm, edited 1 time in total.

User avatar
lisam

Post   » Wed Jan 23, 2002 4:26 pm


Thanks. The vet called, the surgery went well. He said he was surprised at the size of the cysts. He also said the uterus had endometrial hyperplasia (spelling?), he said that the beginning stages of pyrometra were there.

Amidala is awake, they will keep her overnight. He likes to keep an eye on them after surgery. I will call back and check about pain medication and an antibiotic.

pinta

Post   » Wed Jan 23, 2002 4:44 pm


Can you list the signs that indicated something was wrong for other people?

I think symptoms are getting scattered all over the threads now.

User avatar
lisam

Post   » Wed Jan 23, 2002 5:30 pm


Amidala had a very gradual weight loss. I actually thought it must be her teeth, and was making an appointment to have them checked.

Then I read the thread titled "Crusty nipples--whitish deposit" and saw the pictures Lynx posted, and noticed my Amidala´s nipples look the same--larger than normal and with a kind of "crust" (which was light on her pink nipple and dark on her black nipple). She has also been exhibiting "PMS" symptoms--very aggressive and grouchy certain times (I assume it was when she was in heat), mounting the other sows. She had always been a dominant pig, but it was getting worse as time went on.

Today at the vet app. her teeth were checked, and they are normal.

Perhaps these posts should be consolidated under one thread in the reference and first hand account section? I wonder if Lynx´s pig has something entirely different--do sows with uterine infections or ovarian cysts have bleeding?
Last edited by lisam on Wed Jan 23, 2002 5:31 pm, edited 1 time in total.

User avatar
Lynx
RESIST

Post   » Wed Jan 23, 2002 5:49 pm


Snowflake is the pig exhibiting some of the same symptoms as yours. Nina (the pig in this thread) has not lost any weight, appetite and behaves otherwise normally. I just realized her nipples do look similar to Snowflakes though. Kitten´s (the other pig I have) are very small.

The vet called me this afternoon, and given her apparent health otherwise, said it would be okay to wait a couple of days. So I´ll bring her in Friday if there are still problems.

I also discussed Snowflake and will bring her in within a couple weeks (probably along with Nina, if she hasn´t already been seen) to see if she should be spayed. Sounds like he is experienced, uses isoflorane and is affordable (under $100). So I´ll check in with information as I get it.

I think Nina was really annoyed with all the looking and poking I did with her today. Wanted to make sure exactly what the symptoms were. She seemed pretty forgiving and didn´t run away when I pet her while eating.

Let us know how it goes with Amidala. I think correcting things early has such benefits. I sure hope her appetite picks up.

Perhaps when things are all sorted out, we can do a reference thread with links to these.
Last edited by Lynx on Wed Jan 23, 2002 5:52 pm, edited 1 time in total.

Josephine
Little Jo Wheek

Post   » Wed Jan 23, 2002 6:07 pm


I would definitely suspect the reproductive tract as the cause of the bleeding if it isn´t from a bladder infection or stones. That´s the next suspect anyway.

An ultrasound would probably be the best diagnostic tool in this case since things like a thickened uterine wall, some ovarian cysts, tumors, pus, stones, can all be indicated. Bloodwork would be the next diagnostics I would do after the ultrasound if I wanted to be thourough. Like Pinta suggests, it does not always show problems, but it can indicate infection/degree of infection or severe liver and kidney involvement. It can also suggest diabetes when suspected. Again, it is just another tool to help confirm possible diagnoses. If the diagnosis is a tumor or pyometra, the treatment is spaying.

In animal medicine an OVH (ovariohysterectomy), your basic spay, includes the ovaries and uterus. This would solve many ills and prevent later problems along the reproductive tract. My spayed sows have generally been more stable with their moods since they cease to cycle.

I´m not 100% convinced that those few people with sows that bleed "when they´re in heat" have completely healthy sows. I would have to see some negative diagnostics like urinalysis, ultrasound, and bloodwork to be sure there was not an underlying problem. Cavies can have transient bleeding with tumors, cystitis that may self-resolve partially or completely, and stones and bladder sludge.

I like to pre-medicate cavies and other animals with Torb as a pre-anesthetic drug for deep tissue surgery. It assists with anesthesia induction (especially on animals on gas alone) and recovery. Sometimes it is continued post-operatively for a bit more pain control since it is relatively short-acting (4-6 hours). I think oxy is 6-8 hours. As I stated before, eating post surgery is imperative so the patient´s status should be assessed at recovery for deciding pain management. I think carprofen is a good medication to send home for pain management post surgery since it provides some analgesia without sedation as the narcotics do.

Fat does increase surgery time a bit and some difficulty depending on the amount of fat. It does increase the need for some drugs and delay recovery from those drugs stored in the fat. Isoflurane is mostly rapidly metabolized and released upon lung expiration, which contributes to its rapid recovery and safety. Narcotics are something that would last a bit longer due to their action. There might be a few more blood vessels as well, but fat is not usually very vascular.
Last edited by Josephine on Wed Jan 23, 2002 6:09 pm, edited 1 time in total.

GP Lover
My home, ruled by pigs!

Post   » Wed Jan 23, 2002 6:51 pm


Josephine and Pinta, do either of you recommend spaying as a preventative measure? I know that with cats and dogs vets recommend it be done to avoid medical problems with reproductive organs in the future.

I often wonder if this would be a wise thing to do with cavies. I would be scared of the anesthesia however.

Thanks for your opinions. (Carol)
Last edited by GP Lover on Wed Jan 23, 2002 6:52 pm, edited 1 time in total.

pinta

Post   » Wed Jan 23, 2002 7:04 pm


My vet feels the surgical risks outweigh the potential benefits and will not spay unless there is a madical reason. She has never lost a dog or cat to a spay, but pigs are a whole different surgical proposition. They are not the same as a dog or cat.

Having lost 2 pigs to spays( one on the table and one post-op to surgical adhesions), I would not have the surgery done unless medically indicated. I have had 2 totally successful spays that saved my pigs´ lives. I suspect if I had another 10 spays done, they´d would probably be problem free, bringing my experiences back into the more normal statistical realm. Vicki of Jack Pine Guinea Pig rescue has had many, many successful spays and has had more complications with neuterings.

User avatar
Lynx
RESIST

Post   » Wed Jan 23, 2002 7:48 pm


Thanks so much for your responses.

Josephine, out of curiousity, would you think any blood in urine due to stones would also involve an infection (i.e. no infection, increased probability of reproductive problems)?

Regarding a something like a spay, how long does the surgery and recovery typically take? Does one drop off a pet for the whole day or stick around? (This vet is 40 minutes away. )

I wish this vet did ultrasounds, but it does not appear anyone around here has the equipment to do so on small animals (and has competent diagnosticians). Of the two recommended gp vets in the area, the one that has an ultrasound claims the wand is too big and they can´t do it.

I think you are right there is still a strong possibility something is wrong. I won´t assume Nina is off scot-free if she stops bleeding in a couple days. I´ll get them both examined, sooner rather than later.

Evangeline

Post   » Wed Jan 23, 2002 8:08 pm


Lynx-
I read the whole thread, but don´t know enough to really contribute to it. I´m hoping everything will be ok for your pigs, though.

User avatar
lisam

Post   » Wed Jan 23, 2002 8:46 pm


My vet did the spay during his lunch hour, probably about an hour or less. We left Amidala there after her appointment, and they wanted to keep her there for observation 12 hours after the surgery. I will pick her up tomorrow. I bet that each vet office does it differently.

I haven´t asked yet about the recovery time for a spay. Hopefully someone will know, if not I´ll let you know after I pick her up tomorrow. I do think, however, that the assistants and staff at my vet are more used to dog and cat spays, and may not be aware of the need for her to begin eating asap. I can´t wait to get her home tomorrow.

pinta

Post   » Wed Jan 23, 2002 9:01 pm


In my experience 10 days or so to complete recovery. They can seem fine after 3 or 4 days, but it is still important to restrict moverment so as to avoid adhesions.

Evangeline

Post   » Wed Jan 23, 2002 9:02 pm


Damn! Now, I´m paranoid. I´ve never had to deal with ovarian cysts or anything of the kind, and I´m always freaked out at the thought I could miss the first signs. This whole episode doesn´t help me feel more confident, either. I keep palpating my sows to the point I think I qualify as a pig molester and they have this look on their face, like "here we go again...".

Josephine
Little Jo Wheek

Post   » Wed Jan 23, 2002 10:14 pm


Cystitis is often present with stones, but we have diagnosed many animals with stones and/or obstructed urethras (male dogs/cats) without accompanying cystitis. So I generally don´t rule out stones completely if they are free of infection. I also do not rule out a bladder infection unless a culture (usually with MIC) is negative and/or the cavy has been on two different antibiotics. I put one of my sows through a bladder biopsy during a spay for cysts because her cystitis did not resolve with Baytril and there were abnormalities in an ultrasound. The histopath was negative, so we put her on Bactrim which immediately cleared up the infection! Had I known better, I would have tried the Bactrim sooner, but we didn´t even do a culture after a negative cysto urinalysis. She had no stones or crystals.

It is true that there are varying probes for the ultrasound. Cats and dogs typically use sizes less than 10 (mHz?). Cavies need at least 12 (the larger the number, the smaller it is). Your ultrasound tech can record the procedure and print pictures to send to specialists if necessary, but the probe part is a problem. Are there any teaching hospitals around? I wonder if a human pediatric type probe is small enough? You might have problems finding someone in human medicine who would sneak in a cavy, but it´s another idea at least. With the tapes/pictures it would be doable. I know many human medicine RTs who xray their own pets and send the films to their vet (sometimes with very interesting techniques and positioning)!


I´m not really an advocate of preventative spaying of cavies, but it does surely make a difference in their health. The sows I have spayed have been for medical reasons and have lived long, healthy lives afterwards. One was so thin I was afraid she´d die on the table or of complications soon afterwards. She lived three more years until she was euthanized for preexisting severe liver disease/complications!

User avatar
Lynx
RESIST

Post   » Wed Jan 23, 2002 10:25 pm


I´ll see if I can find out anything tomorrow. UVA has a lab research area (I understand they have guinea pigs). There might be a small possibility they would know something.

Pinta, exactly how confined an area would you offer for a cavy recovering from surgery? I have a 20X30 area but that is almost like a small cage. Are you talking really small? So they don´t have to walk to get anything? I know any confined pig would be angry and chewing at the bars. When I used to try blocking pigs in or out of an area so they weren´t all together (to give a pig a chance to eat some food) they would find some way to get through. They just didn´t like not being together.

Post Reply
29 posts