Incomplete spaying of puppy?

We got Bodhi from the SPCA when she was a day short of 8 weeks.
She was spayed the day before we got her, at 7 weeks and 5 days.

Fast-forward. Bodhi is now 21 weeks old, and she's on a third round of antibiotics (low dose). Basically, she's been on abx since she was 15 weeks old. For a pre-amble on symptoms and such, the topic where that was discussed is here:

http://www.pets.ca/forum/showthread.php?t=65349

The first round of abx showed a minor improvement, so we decided to go to round 2. After round 2, there was again improvement, but still bacteria and a high white cell count, and here's the kicker:

discharge

There shouldn't be any. She was supposed to have had a complete hysterectomy. But, since she was so young when she had it, the vet suspects that they may have left some uterine tissue on the cervix, and that it is the endometrial tissue that is left that is causing the discharge and the infection.

Anyone ever hear of something like this? If so,

1) can we expect Bodhi to get mild physical or behavioural symptoms of being in heat? She's now 5 months old, so technically, any time now, yes?

2) if this round of abx doesn't clear it, the vet suggests surgery to see if there is uterine tissue left, and if it is, to remove it. The vet considered it likely that this kind of infection would likely recur, and possibly regularly. Personally, IF this (uterine tissue left) is a correct diagnosis, I'd say it makes sense, but does it?

3) do we even want to consider getting the SPCA's original vet who spayed her to do this surgery, instead of our usual vet (with whom we're very happy) since it was an incomplete procedure? Is it really difficult to ensure that all the tissue is removed during a spaying in a young pup?

For what it's worth, our SPCA spays even at such a young age, because they have become a no-kill shelter, and they will not release ANY animal unless it's spayed or neutered. So basically, the moment they are ready for adoption according to their standards, the animal gets surgery.

I've heard of the problem before, Marcha. I think bendyfoot was talking about it a long while back. A small piece of uterus was left in and became infected. Can't remember if it was one of her dogs or someone else's, though. :o You might want to PM her in a few days if she doesn't see your thread.

Meanwhile, let me send along :goodvibes: for Bodhi!

Thanks Hazel. :)
I know that an incomplete spay can cause stump pyometra, so I am just making sure I know what's what.

Thankfully Bodhi is doing well other than being on the abx, and the vet seems to be on top of it too. He's been very good to give us discounts on the visits and treatment costs, just to be sure that we wouldn't run out of money while we're helping her. And Bo is growing like a weed - she's been growing 4lbs per week on average. She was 56lbs at her last checkup at 20 weeks. She's happy, cooperative, has a good appetite, sleeps well, and is a a wonderful cuddlebug. :lovestruck:

It is commonly referred to as Ovarian Remnant Syndrome (http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2002&PID=2679)

Even a few epithelial ovarian tissue cells can cause ORS to present itself.

46 Case study in pdf (http://jvdi.org/cgi/reprint/7/4/572.pdf)

Several causes have been suggested for ORS, including dropping of ovarian tissue, improper clamp placement, and a small surgical incision. Less than half of the cases in our report were from new graduates (received DVM degree less than 5 years previously). Some cases may be due to the presence of an accessory ovary or of ovarian tissue that has extended into the ligament of the ovary, a situation which has been reported in cats, cows, and women. Accessory ovaries can be small and have been reported to be located in the proper ligament of the ovary but separated by connective tissue from the normal ovary. If the normal ovary is removed, the accessory ovary may become functional. The ovarian remnants remaining in the bitch and queen can continue to cycle even without the presence of the uterus. Therefore, removal of the remnants during estrus or diestrus is recommended because enlarged ovarian structures (follicles or corpora lutea) make the remnants more easily identifiable.

Canadian Vet Journal Case Study ORS (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1082859/)

Have you contacted the SPCA about their policy if/when this occurs?

The studies above mention physical heat symptoms do present themselves as well as the prevalence of repeated UTIs etc.

I think if this is the correct diagnosis a repeat spay should be performed because there is still the risk of mammary/ovarian cancer or pyometra. :2cents:

Thanks Growler. That's very useful!

Would the presence of discharge indicate the presence of ORS, or would discharge be present even if there is no heat (does a bitch always have a bit of non-bloody discharge, or only during heat)? Bodhi doesn't otherwise seem to be displaying any symptoms of heat, nor has Bodhi had symptoms of UTIs (her abx are for a vaginal bacterial infection, which now may be an endometrial infection, not for a UTI).

I have not contacted the SPCA, but if the vet diagnoses ORS or stump pyometra, I definitely will be doing so pronto. Since we have the date of the spaying, it would be relatively easy to find out which vet performed the surgery too (even if they might not tell us who that is, our vet might be able to find out).

The in-heat discharge ranges in colour depending on the stage of the cycle from dark red to light pinkish-tan. Discharge stops when not in the heat cycle.

A dog that is not in heat or one that is spayed & has discharge would indicate either infection ie vaginitis or pyometra, possibly both.

Heya...HRP was right, we've had recurrent vaginal infections with our spayed female Jaida. Typically what we would see was a brownish discharge, but the last time it was actually bloody (and a bit scary). The discharge is usually accompanied by licking and often scooting. She's had 3 infections, all Staph. There was never an explanation for it, really; it was not stump pyometra, there is no reason to think that her spay was not done correctly. The bacteria is also apparently a particularly "wimpy" one and should be easily cleared up with antibiotics...but still we struggled. Our vets are a little stymied by it all.

Now, it seems that Jaida's vulva is quite small, and tucked up into her body ("retained" kind of). She also has a some extra skin folds surrounding the vulva. This can trap bacteria/urine/moisture around and in the genitals and cause skin irritation (what we're trying to manage now), and it can cause recurrant infections, either vaginal or UTI. We will soon be looking into having the extra folds of skin surgically removed in the hopes of reducing the skin irritation. We haven't had an infection for about 7 months now (knock on wood) and hopefully the surgery will also help prevent those. I don't know if any of that is an issue your pup is dealing with, but it's a thought.

Aww Bendy, that sounds so frustrating! I hope your pup is done with it, that the surgery fixes it for once and for all.

Growler, Bodhi's discharge is not coloured or tinged red or pink or anything remotely near it. At first, before abx, it was more of a pus-coloured discharge, and now it's more uterine discharge cells that are present when the vet did a smear. So it's not voluminous, it's not visible, but it's uterine discharge nonetheless. I don't see any other symptoms of the dog being in heat, she's not tucking in her tail, she's not scooting, she doesn't appear to have a swollen or swelling vulva.

She's due in the vet's office next week to see if there's progress - I will update this topic with the results. If anyone has any other thoughts, that'd be great. :)

Preliminary results are in. She's definitely got a secondary juvenile vaginitis, for which she's now received a shot of abx and an anti-inflammatory. We're not continuing the oral abx for now to see if the secondary inflammation was caused by prolongued use of abx (three low-dose courses consecutively). Vet spoke with the vet who spayed her, to discuss the surgery notes. For now, stump pyometra is ruled out, and ORS is not on the table unless she starts to show signs of proestrous. We're going to see what happens in 2 weeks.

Now, it seems that Jaida's vulva is quite small, and tucked up into her body ("retained" kind of). She also has a some extra skin folds surrounding the vulva.

If I'm not mistaken, this is what's called a recessed vulva. Two of our fosters to date have had it and we've chosen to wait until the first heat for it to correct itself. It's was successful with one puppy (we then had her spayed), we still have to wait for the other.

Early spay sometimes prevents the vulva from going into it's natural place (for lack of a better term).

This better explains it:

A recessed vulva is when the vulva is surrounded by perivulval skin that extends past the labia. There is no accurate definition or measure that determines exactly when a vulva is recessed, and the position of the vulva relative to the pelvis is not assessed. It may be that the perivulval skin folds become excessive so the 'recession' of the vulva may be relative to the skin. It is a clinically recognized condition that is particularly identified when a dog licks at the vagina, has incontinence, vaginitis, perivulval dermatitis or other sign indicating inflammation or irritation of the area. Other names for this condition include vulval hypoplasia

The pathogenesis is not proven, but early ovariohysterectomy was an accepted predisposing situation. Obesity so that the perivulval skin folds are exaggerated, is also implicated. Hammel and Bjorling (2002) studied dogs with recessed vulva and underwent vulvoplasty, where the perivulval folds were removed. They found that 7 of 34 dogs were intact yet still had a recessed vulva, so early ovariohysterectomy is not a cause in all cases. Ovariohysterectomy does affect the conformation of the vulva, especially when surgery is done during the prepubertal period. There was not sufficient information to assess the effect of obesity in their study.

Recessed vulva is implicated in urinary incontinence, urovagina, vaginitis and perivulval dermatitis. The effect of vulvoplasty in the study by Hammel and Bjorling (2002) was to eliminate vaginitis and perivulval dermatitis suggesting that conformational factors predispose bitches to these diseases.

It is suggested that a 'recessed' vulva prevents complete elimination of urine, and that urovagina may develop. This and the fold of skin around the vulva would predispose to inflammation and pyoderma.

Crawford and Adams (2002) found that dogs with a recessed vulva also was likely to have severe vestibulovaginal stenosis. Dogs with vaginitis responded to vulvoplasty if there was not severe stenosis. Likewise, Lighter et al (2001) found that surgery to remove the skin folds resulted in resolution of the perivulvar dermatitis and chronic urinary tract infection associated with this.

A recessed vulva is a common condition. Wang et al (2006) reported on 19 dogs with urinary tract disease and 12 normal dogs. 3 of the normal and 10 of the clinically affected dogs had recessed vulvas.

http://www.uoguelph.ca/~rfoster/repropath/surgicalpath/female/dog/female_dog_vulva.htm


Marcha, I hope you find some answers and some relief for Bodhi :fingerscr.

Thanks LP, that's a pretty good description. The vet ruled it out weeks ago as a potential cause. But - he says that juvenile vaginitis is not uncommon in puppies - spayed or not - and that it usually isn't even detected. It apparently often doesn't require treatment, but our vet chose to treat her for the initial bout because the vaginal discharge was less than 50% of the vaginal secretion - the majority of the secretion was pus. Thankfully Bo doesn't seem to be bothered by it - she's not licking or scooting or anything.

If I'm not mistaken, this is what's called a recessed vulva. Two of our fosters to date have had it and we've chosen to wait until the first heat for it to correct itself. It's was successful with one puppy (we then had her spayed), we still have to wait for the other.

Early spay sometimes prevents the vulva from going into it's natural place (for lack of a better term).

This better explains it:



http://www.uoguelph.ca/~rfoster/repropath/surgicalpath/female/dog/female_dog_vulva.htm


Marcha, I hope you find some answers and some relief for Bodhi :fingerscr.

I beleive the pre-puberty spay contributed to it, yes, and probably to other issues related to her musculoskeletal health. We opted to have our newest dog's spay delayed until after her first heat now that we've done our research.

We would have never had her spayed as early as she was ... but it is the requirement of our SPCA that every cat and dog that leaves their care is neutered or spayed. It was their decision to go this way after they adopted a no-euthanasia policy. In Bodhi's case, it was two days short of 8 weeks.