34 The Alpenhorn
Alternative Therapies for Common Canine Reproductive Disorders
By Marty Greer, DVM, Esq.
M
ost experienced breeders have encountered in their breeding careers a bitch with a reproductive disorder. Common reproductive disorders in the bitch include pyometra, mammary tumors, and agalactia (i.e., inadequate milk production). Traditional therapies exist for all of these disorders. In this article, I share some alternative, effective, and safe treatments with which many veterinarians may not be familiar. These alternative therapies might offer options to both the veterinarian and breeder that in certain circumstances could be useful.
The Bitch
This section describes several alternative treatments for managing pyometra, mammary tumors, and agalactia.
Pyometra
Pyometra—the mere mention of this condition brings most breeders to tears. It is so commonly discussed that breeders have reduced the word from a noun to a verb, as in "I think my bitch is pyoing." This is a serious, often rapidly progressive condition that at best is costly to the owner and the bitch and at worst ends a bitch’s breeding career and sometimes her life.
The most common treatment is to ovariohysterectomize (spay) the bitch. But surgery may not always be the best option, so medical treatment should be considered. Some bitches are valuable enough in a breeding program that medical therapy should be considered. Some bitches are just too sick to take to surgery and are better candidates for medical therapy.
Some of the drugs for medical management are off-label use meaning the FDA has not approved the use of that drug in that species for that purpose. However, the medical treatment protocol is sufficiently well established that it should be considered a viable option for selected bitches.
Pyometras can occur in bitches bred on their most recent cycle, in bitches who were not bred, in bitches following their first heat cycle, and bitches that were never bred. Pyometras most commonly start 6 to 8 weeks after the heat cycle, but can occur at any time in the cycle. Pyometras are very common—25% of bitches over the age of 9 are affected. For this reason, bitches who are no longer in a breeding program should be spayed. Any intact (unspayed) bitch who is sick should have pyometra on the list of differential causes of their illness. The most common symptoms include a loss of appetite, increased water consumption and urination, and vomiting. If the cervix is open, there is a characteristic vaginal discharge of blood, pus, or a combination. If the cervix is closed, there is no clue that the uterus is filling with pus.
Pyometra develops due to a combination of hormones that creates a uterus receptive to retaining fluid along with bacteria that move into the uterine contents. Remarkably, only a rare bitch (one who has peritonitis associated with her pyometra) will run a fever, so don’t assume there is no uterine infection just because her temperature is normal. There are probably many variations of pyometra causes, but these have not been well characterized yet.
If a pyometra is suspected, seek immediate veterinary diagnostics and treatment. Many veterinarians have been trained to "never let the sun set on a pyometra," so you should realize this can progress to toxicity, peritonitis, and death within a few hours of the development of the disorder.
Pyometras are most accurately diagnosed with ultrasound, by imaging fluid in the uterus. In rare cases, a pyometra can co-exist with a pregnancy. An odorous
Photo: N. Melone
Pyometras are most accurately diagnosed with ultrasound, by imaging fluid in the uterus. In rare cases, a pyometra can co-exist with a pregnancy.
June 2011 35
vaginal discharge may suggest a pyometra or a septic pregnancy. Blood work may show a normal profile, or may show an elevated white blood cell count (WBC) and elevated BUN and Creatinine (kidney values). Urine collection by cystocentesis should be avoided if a pyometra is suspected.
Medical management, usually done in the hospital, includes:
1. Fluids, usually IV or SQ
2. Antibiotics, I prefer clavamox unless the culture suggests a better choice
3. Lutalyse or similar prostaglandin, up to 5 injections a day.
4. Metoclopramide if the lutalyse or illness causes vomiting.
5. Bromocriptine to assist in dropping the progesterone, if it is elevated
6. Topical Misoprostil if the cervix needs to open.
Treatment requires a minimum of 5 days on prostaglandins, monitoring progress by ultrasound to assess uterine size. Antibiotics should be continued for 4 weeks. The bitch should be bred on her next heat cycle. Once her reproductive career is completed, she should be spayed.
Many bitches produce successful pregnancies after medical management. Mibolerone can be used to protect the uterine lining from progesterone exposure, particularly for bitches with a family history of cystic endometrial hyperplasia (CEH) and pyometra or bitches who have career pressures that prevent her from breeding at an early age.
Mammary Tumors
Mammary tumors are the most common form of cancer in the dog. The only way to protect a bitch from developing mammary tumors is to spay her before her 2nd birthday. This means most of us who breed our bitches will face this disease at some time.
Diagnosis of the tumor is based on palpation. Owners often detect these tumors during handling their bitch. You should palpate your bitches’ mammary chain monthly to find these lumps as early as possible. Even after a bitch is spayed, she is still at risk for tumors if she was over 2 when spayed. Most mammary tumors present as one or more firm nodules, sometimes in a cluster. They can be found anywhere along the mammary chain, but are most common near the nipples and most common in the glands closest to the rear of the dog. In general, the smaller the dog and smaller the tumor, the less likely the tumor is to be malignant. Bitches that have developed one tumor should be monitored closely for additional occurrences.
Confirmation of the type of tumor cells present requires surgical excision and histology (biopsy). Fine needle aspiration (FNA) is not recommended as there can be several cell types within the same tumor, leading to inaccuracy in the diagnosis. The only exception to this is if inflammatory carcinoma is suspected. With inflammatory carcinoma, the skin is angry, inflamed, painful and rashy along the mammary glands. Although rare, if this is suspected, a biopsy should be taken and submitted to the laboratory for histology. Removal of this type of tissue should not be attempted as the disease is rapidly fatal.
Over the years, veterinary recommendations have shifted from doing only lump removals (lumpectomy—excising the mass and immediate surrounding tissue) to doing radical mastectomies (removing the entire mammary chain) to again doing lumpectomies.
Confirmation of the type of tumor cells present requires surgical excision and histology (biopsy). Fine needle aspiration (FNA) is not recommended as there can be several cell types within the same tumor, leading to inaccuracy in the diagnosis. The only exception to this is if inflammatory carcinoma is suspected.
Photo: N. Melone36 The Alpenhorn
In most cases, one or more lumpectomies should be performed as soon as possible after detection. Watching the tumor instead of removing it is dangerous; the mass should be removed as they will always grow larger. Mammary tumors may seem to be stable in size until the bitch has another estrous cycle; then they often increase exponentially in size.
The only way to determine if the tumor is malignant is to submit the mass for histology—no one can distinguish a benign from a malignant mass without microscopic evaluation at a referral laboratory. Although there is no chemotherapy available for dogs for mammary tumors, there is still value in having histology done on the masses. The value is in having the peace of mind that the mass is benign or in knowing if it is malignant: in knowing what to watch for as the bitch ages. If the tumor was not completely excised or the cell type shows a tendency to be highly malignant, a second surgery shortly after the first to remove the entire chain or both chains, a radical mastectomy, may be indicated in rare cases.
If your bitch has a large mass that went undetected, is rapidly growing, or you were unable to have the mass removed when it was detected (such as the bitch was pregnant at detection), cabergoline or bromocriptine (off label use) can be used for 1 week pre-op to shrink the size of the mass. This makes the surgery easier on the bitch, the veterinarian and the owner. This protocol cannot be safely used if the bitch is pregnant or lactating.
Rarely, malignant mammary tumors can metastasize. Most common sites of metastasis are the lungs, liver, and bone. The good news is that early detection is easy and inexpensive—it only requires that you regularly monitor your bitches’ mammary chains with your fingers and report any changes to your veterinarian for evaluation. Expensive diagnostic tools are not needed to identify these nodular growths. Bitches can safely be bred and can lactate after lumpectomy in most cases.
Agalactia
Agalactia is the inadequate production and let-down of milk during lactation. In many cases, supplement feeding pups with a bottle or tube is required to support the pups nutritionally while treatment to assist lactation is initiated.
Successful treatment may require a multi-modal approach:
1. Warm compresses and oxytocin
• Inject oxytocin, then warm compress for 20 min, then put pups on to nurse:
• 1/2 unit Q 2 hours X 4 doses, then
• 1 unit Q 2 hours X 4 doses, then
• 2 units Q 2 hours X 4 doses, then
• 3 units Q 2 hours, then increase time between injections to 4, then 6 then 8 hours, then discontinue when lactating well.
2. Metoclopramide at the GI dose – 0.2 to 0.4 mg/kg 3 times a day for 5 days by injection or by mouth. In some bitches, neurologic signs may develop from this medication requiring discontinuation of the drug.
3. Domperidone may be useful instead of metoclopramide. Side effects are similar. There is an equine preparation available in the U.S.
4. Good nutrition at 2 to 3 times the bitch’s normal daily maintenance.
5. Excellent hydration. You can’t get blood from a turnip, and a dehydrated bitch can’t lactate. Be sure she has access to 2 to 4 times her normal daily water intake. Administer IV or SQ fluids if she is unable to take in or keep down enough water or other fluid (soup, ice cream) to remain well-hydrated.
Editor’s Note:
"Q" means "every." It follows that "Q 2 hours" means every 2 hours.
You can’t get blood from a turnip, and a dehydrated bitch can’t lactate. Be sure she has access to 2 to 4 times her normal daily water intake.
Photo: N. Melone
