Part 1: Conventional Treatment Of Pyometra (Originally published November 10, 2016)
Part 2: Natural Treatment Of Pyometra (Updated December 2, 2016)
My mom always said the “shoemaker’s children go without shoes.”
So I carry a ton of guilt because I had the tools to prevent the surgery with my own dog Della when she became ill with pyometra … and I didn’t react. In our hospital we have had a lot of success treating pyometra in dogs and if I had to do it over again, I would have acted much sooner.
Fortunately Della survived, but only after a lengthy and scary battle. But I want to share my personal and professional experiences, along with the signs and symptoms to watch for, so you can take fast action when pyometra strikes your own dog … and avoid the heartache I narrowly missed.
So I’m going to discuss the conventional treatment options you have available for pyometra in dogs, along with a really promising new option.
But first, you need to know what pyometra is.
PART 1: What Is Pyometra?
Pyometra, or pyometritis (in Greek, pyo means pus and metritis means uterine inflammation) is a disease that’s seen more often in unspayed dogs over the age of five – but it can occur at a younger age as well.
There can be many causes of pyometra, yet the main one is a combination of hormonal changes that happen within the heat cycle of your dog. Every heat cycle, there’s a natural reduction of white cells from the uterus to allow for safe sperm passage, causing a lapse in protection that can decrease the ability to fight infection. In most dogs, these heat cycles usually occur twice per year.
In nature, most dogs would breed and either produce puppies, abort or not conceive because of another underlying condition, lack of nutrition, stress in the environment, etc.
When dogs continue to go through estrus (heat) without being bred, their progesterone levels remain elevated for eight to ten weeks – this thickens the lining of the uterus in preparation for pregnancy. The entrance to the uterus is the cervix, which remains tightly closed, except during estrus when it can allow bacteria that are normally found in the vagina into the uterus.
In a normal, healthy uterus, the environment isn’t susceptible to bacteria, but when the lining continues to thicken with every estrus, some dogs will have a tendency to produce cysts that can start to expel large amounts of fluid. When progesterone levels are high, it decreases the ability of the muscles of the uterine wall to contract, which inhibits the ability to naturally discharge the fluid and bacteria inside.
The unhealthy uterine cavity will continue to fill with discharge. And the dog’s body temperature, along with the absence of circulating air inside the uterus, creates perfect conditions for bacterial growth. This bacterial growth can lead to an infection of the uterus, or pyometra.
One form of pyometra is much more dangerous than the other.
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The Two Types Of Pyometra
There are two types of pyometra: Open and Closed.
Open pyometra occurs when the cervix is open. The open cervix gives the fluid a way to discharge.
Closed pyometra is when the cervix is closed. When the cervix is closed, there is no way for the infection and fluid to discharge – so the uterus continues to fill, leading to toxicity from the bacteria and if enough fluid builds up, the uterus can actually rupture.
This can cause septic infection and even death.
Closed pyometra typically ends in surgery because the infection has no place to drain. But in the case of open pyometra, there are several treatment options at your disposal – but the first and most important thing is to first have your veterinarian diagnose your dog.
If you decide to treat open pyometra at home (which is entirely possible with the support of your veterinarian and I’ll discuss this in Part 2), you must closely monitor her symptoms, including her temperature, and report this to your vet every two hours.
I’ll discuss the treatment options in a bit, but first, you need to know the signs of pyometra so you can watch your dog. The earlier you catch pyometra in dogs, the more success you’ll have avoiding emergency surgery.
A note to breeders: the use of progesterone or estrogen based drugs used for any reproduction condition can cause the same changes in the uterus and predispose your dog to pyometra. There are a few opinions on the exact physiology and causation, but all end with the same disease.
Pyometra Signs And Symptoms
Signs of pyometra can appear anywhere from two to eight weeks after your dog’s heat cycle, but we have seen them as late as 12 weeks.
The signs of open pyometra include:
- Any excessive licking after their heat cycle.
- Vaginal discharge (usually white, yellowish or green but it can also start off clear).
- The dog can seem a little “off” in behavior (if they are usually cuddly, they may become distant, or the opposite: becoming needy rather than their usual independent nature).
- They may be depressed, grumpy with other dogs or people, etc.
- They may drink more often than usual, or become lethargic or picky with their food.
The signs of later stage or closed pyometra include:
✓ Excessive panting
✓ Increased thirst and water craving
✓ Distention of the abdomen
✓ Fever often 104 to 106oF
If your dog exhibits even one of the following symptoms after her heat, seek veterinary help immediately. The most important thing is to catch any of these symptoms early!
Once your dog has been thoroughly examined by your veterinarian, including her cervix and discharge, we recommend doing an ultrasound and blood work. The ultrasound will show the size of her uterus and rule out possible pregnancy.
If she does have pyometra, there will usually be a marked elevation of the white blood cell count; there is a type of protein produced by the immune system called globulins that could also be elevated.
Not spaying your dog brings huge benefits to her overall health but it also comes with the responsibility of being a diligent guardian to your dog. You can do this by watching closely for signs and symptoms two to eight weeks post heat, supporting her holistically to prevent this disease from happening and avoiding all contact with intact males to decrease the natural urge to become a mother.
With pyometra, the sooner your dog is diagnosed, the better her prognosis. If she shows any signs of the above signs, take her to your veterinarian immediately.
A Contributing Factor
This is something I’ve observed in my own practice.
A natural, hormonal and sexually suppressive situation could lead to pyometra. For example, I’ve noticed that many females who have been in close contact with intact males but aren’t allowed to breed exhibit a higher incidence of pyometra.
It’s possible that the increased desire and possibly stronger triggers of wanting to be a mother could contribute to the abnormal hormonal changes. This could also support my observation that dogs who go through many pseudo or false pregnancies may suffer a greater incidence of pyometra.
If you’ve never seen a false pregnancy, signs can vary in so many ways. Common symptoms are:
- Nesting (constantly taking blankets and pushing them into a ball or nest).
- Taking all their stuffed toys into their bed.
- Whining more than normal, restlessness or seeming frustrated,
- Engorged mammary glands and even producing milk.
- Increased or ravenous appetite or no appetite at all.
- Wanting more attention or wanting to be alone.
In most cases, symptoms will appear between the second and third month after a heat, but I’ve seen them as early as one month post heat and as long as four months post heat.
Conventional Treatment Options For Pyometra
If you suspect your dog has pyometra, your best bet is to consult with a homeopathic veterinarian. This is your best chance at avoiding surgery. In Part 2, I’ll help you choose the right remedies so you can work alongside your vet.
But chances are, your vet will suggest a different approach from homeopathy, so I want to discuss some of the options he’ll give you. Then you’ll know the pros and cons of these conventional treatments before making a decision.
This is a synthetic steroid.
Historically, aglepristone has been shown to disengage progesterone’s support of pregnancy by blocking its receptors. By taking over the progesterone receptors, the drug also removes the effect progesterone plays in containing pyometra, allowing the dog’s natural uterus purging mechanism to occur.
This treatment is said to be quick and very gentle, and may help avoid surgery and that’s a good thing. However, your dog may experience inflammation and pain at the injection site.
These are a group of hormones that destroy the corpus luteum (a hormone secreting body in the female reproductive system). They have uterotonic effects, reduce the blood levels of progesterone and are known to relax and open the cervix, and contract the uterus to expel bacteria, fluid and pus.
Again, avoidance of surgery is the benefit of prostaglandin treatment, however there are several drawbacks, including:
- Side effects such as restlessness, panting, vomiting, defecation, salivation, and a painful abdomen.
- If the treatment isn’t successful, the dog is even sicker and a poorer candidate for surgery and recovery.
- Many veterinarians believe that because prostaglandins cause the uterus to contract, there’s a risk of the uterus rupturing, which can result in infection and acute kidney failure.
Aglepristone And Low Dosage Prostaglandins
These two treatments are sometimes combined. According to reproductive veterinarians, the two combined treatments offer the best solution, as long as the prostaglandin therapy is given in very low doses.
Estrogens are potentially effective, but come with worrying side effects such as further damage to the endometrium and potential bone marrow suppression. Many vets consider these risks far outweigh the benefits.
A New Option For Pyometra
Advanced new techniques are showing promise with both open and closed pyometra.
A transcervical endoscopic catheter that’s normally used for intrauterine insemination can be used to infuse warm saline containing prostaglandin F-2a into the uterus. An ultrasound is performed two days later and if fluid is still detected, the treatment is repeated.
Despite this new treatment option, ovariohysterectomy (or spay), still seems to be the treatment of choice for most veterinary hospitals.
I’m sure this is because the new technique is still in the testing stage; also the combined aglepristone and low dosage prostaglandin treatment has not been widely used, and is therefore not trusted in the case of a life-threatening illness.
Vets also recommend surgery because it not only eliminates the immediate emergency, but also prevents reoccurrence in the future. But performing a spay when the uterus is filled with bacteria is more challenging than a routine spay. And if you can avoid spay, you’ll avoid the loss of hormones that can contribute to other health issues. Sterilization is also undesirable when a breeder considers a dog very important to her line.
But if you and your vet opt for an emergency spay, then there are some questions you need to ask.
First, make sure your vet is completely confident in the procedure. This is major surgery that’s more risky than routine spay so it’s OK to ask your vet how often he’s done this surgery and if he feels comfortable with it. If he’s not careful, the uterus can rupture and fill the abdominal cavity with infection, putting your dog in real peril.
You also need to ask your vet if he will do a lavage during surgery. A lavage includes filling the abdomen with a sterile solution to decrease the risk of infection. Once the uterus is removed, the solution is sucked out along with any residual infection. Even if the uterus doesn’t burst, it can still leak fluid into the abdominal cavity, so a lavage is an important step to reduce the risk of surgery post-op.
If this is an emergency and outside of regular hours, you also need to ask your vet if there is anybody there to help him if the surgery goes wrong. If your vet isn’t fully staffed, then it might be a good idea to take your dog to a fully staffed emergency clinic for the spay – they’ll be better prepared should anything go wrong.
Most of the time your dog will do just fine, but it’s a good idea to be prepared for the worst. Complications may arise.
In part 2 I’ll share the homeopathic remedies that we used to deal pyometra without surgery, but if your dog needs to undergo spay, then here are two remedies that will help.
Homeopathic Remedies After Spay
Even if your dog ultimately has to undergo surgery, she’ll benefit greatly from getting remedies post-op. They will hasten her recovery. Most vets will be fine with you visiting your dog and giving her these remedies to help her recover faster.
Here’s the protocol we used at our clinic:
- Arnica 1M as soon as she’s awake to help with the physical and emotional trauma. Give this once every hour for three doses, followed by…
- Bellis perennis 1M for deep abdominal muscle trauma and pain, given every once hour for three doses. (If you don’t know how to give homeopathic remedies, it’s easy! Click here to learn more)
You can also work with your homeopathic vet to choose remedies that will help reduce the risk of many of the unwanted health issues that spay can cause, such as joint disease, urinary incontinence, weight gain, hormonal dysfunction and more.
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If you wish to TRY to avoid an emergency spay, the best approach is to work with a homeopathic veterinarian. Otherwise, you’ll need your regular veterinarian to work with you as a team and so often it can be done.
So in this second part of the article, I’ll share the remedies we’ve used with good success for pyometra in dogs. Click here to download it.
I discussed the signs and symptoms of pyometra in part 1. And the remedy you choose for your dog will rely greatly on what symptoms you see. But before you choose a remedy, you need to be ready to give a liquid dose.
Here’s how to do it:
- Fill an amber bottle with distilled or bottled water and add four pellets of the remedy. Allow them to dissolve for half an hour. The pellets may look like they’re still whole, but don’t worry – most of the remedy will disperse into the water.
- Succuss (bang the bottom of the bottle on the palm of your hand) three times. This slightly changes the dynamics of the remedy so you’re not giving the exact same potency with each dose. Succuss three times before each dose.
- Using the dropper fill 3/4 – to a full dropper place the liquid into the inside of your dog’s lips so it pools between her gums and lips. Try your hardest to avoid the dropper contacting her lips, as this can contaminate the bottle. If it proves difficult to avoid contact, it’s best to put a dropperful onto a teaspoon and pour it into her mouth.
- Once you’ve made your liquid remedies, watch your dog closely and give one of the remedies below that best fits her symptoms.
First Step: Aconite 1M
Give this remedy as soon as you even suspect something is off. Crush dry pellets and place them right on the tongue or gums. This is the only remedy you will give dry … the rest will be given by liquid.
Now go on to choose the next remedy.
For breeders, this dog could be the one who is not very interested in breeding or has a hard time going to term in her pregnancy, either due to abortion or delivering prematurely. She’s not the best mother or she becomes very depressed post-partum.
Often there will be a history of irregular heat cycles. If she has never been bred, then she is the dog who is usually very work oriented and confident, but becomes tired, depressed, worn out looking and worried. She may have had a history of urinary tract infections.
The labia are usually very swollen and the discharge is thick, often lumpy, colored anywhere from white to yellow to green. It’s really itchy – even burning – so you’ll see her licking or rubbing herself on the rug or her bed. If she is nauseated, it’s often in the morning.
Modalities (what makes her better or worse): Better from exercise; she’ll perk up if you take her for a walk; wants to be warm; seeks out the sun or fireplace … may want to be covered up; worse from cold air or drafts.
This girl might normally be a timid dog in general but when she’s sick, she becomes much more fearful, reactive or suspicious.
She may feel very cold to touch yet she’s worse by heat and will not tolerate being covered up. May seek out cooler places in the house (such as cold tile floors). She doesn’t want attention and may be growly if touched.
The Secale dog may have never stopped discharging from her heat and has a continuous oozing of watery blood that changes to offensive smelling thick brownish red, possibly even a blackish greenish discharge.
Modalities: She feels cold; worse from touch; worse from being covered up.
This is the cute, sweet dog who, on a good day, wants attention and to be smothered in kisses – but if she’s sick, she sticks to you like glue! She wants to be carried and even if she’s too big, she wants to sit on your lap, your feet, as close as she can be, clingy and always touching you. She may have been the puppy that had submissive urination or could have had puppy vaginitis.
The discharge is usually very thick but milky or yellow in color and acrid, so the skin around the discharge and her vulva can be red and sore. Because it’s so sore, your dog probably won’t rub herself on the rug or bed as you might see in the Sepia case.
Modalities: worse from the heat or stuffy rooms; you may see her lying down by a window to get open air or even though she is clingy she may want to be outside then come inside then go out again.
Don’t confuse this with restlessness: she just wants to be with you but also needs fresh air.
This remedy is for extreme septic states, but if your dog has these symptoms you must work very closely with your veterinarian! In a case with these symptoms, your dog will need to be hospitalized and on IV fluids; she should continue to fully discharge and her vitals should be good.
Pyrogenium is a homeopathic preparation made from rotten meat pus. Yes, it’s disgusting but that’s why it’s used for septic states. It’s a good remedy to have on hand and you can ask your veterinarian to use it. I’ve seen it help with septic situations prior to surgery.
The mental state is restlessness, as if your dog can’t find a comfortable place to lie down. The opposite may also occur and she’s too sick to even get up. Again, if your dog is like this she must go to your veterinarian to be monitored.
The discharge, as you can imagine, has been described as carrion-like: “a plant that smells like rotting flesh” and is thick, dark and bloody.
After You Give The Remedy
Watch your dog’s symptoms after you give the remedy. She may go into a very peaceful, relaxed sleep – and this is a good thing.
When she wakes up, she should look brighter or the same, but not worse. If she looks worse at any point, it’s not the right remedy and you need to choose a different remedy.
Repeat the remedy in the following sequence:
- One dose per hour, twice
- One dose every two hours, twice
- One dose every four hours, twice
If, after the third dose,( so in 4 hours ) she’s not showing improvement, switch to the next choice of remedy and start over.
Always use a new bottle to avoid contamination (and always sterilize used bottles before re-using them). Within 24 hours your dog should be well on her way to recovery.
Once you see your dog is on the mend, continue to use that same remedy once per day for a total of five days. Don’t forget to succuss the remedy before each dose!
Signs The Remedy Is Working
Once you give the remedies, how do you know your dog is on the mend?
Some of the positive signs to watch for include:
These are the negative signs to watch for:
If the discharge stops and she is worse in any way, immediately take her back to your veterinarian! This could be a sign that she’s moving into a closed pyometra, which is life threatening.
Along with whichever of the above remedies fits your dog’s symptoms, it’s also a good idea to give Carduus marianus 6c along with Berberis 6c three times a day.
These remedies are used for organ drainage and will support the liver and kidneys during the infection. Give them for two weeks, in the liquid dose.
We’ve had wonderful outcomes working with open pyometra with our clients with these same remedies. But remember, we have years of experience and we had a 24 hour monitoring service.
This protocol works, but for optimal safety, it should be done in conjunction with your veterinarian.
A lot of your dog’s common health problems can actually come from a damaged gut — and a damaged gut means damaged immune system. But the good thing is, you help repair this. Find out how here.