Veterinarians

The old axiom of “Never let the sun set on a pyo” is too simple. The truth is that pyometra is a progressive disease that takes many days to fully manifest. If caught in the early stages, it is not yet life-threatening and can be treated safely and effectively using medical protocols. The best candidates for medical treatment of pyometra fit the following criteria:

• The bitch is important to the client’s breeding program and young enough to still contribute (usually less than 6 years old)
• Not yet showing signs of lethargy or depression
• Has purulent vaginal discharge (indicating the pyometra is open and not closed)

If these criteria are met, then you may decide to treat the pyometra using medical protocols. We recommend that all cases have confirmation of the diagnosis using ultrasound (measure horn diameters to track treatment progress), vaginal cytology, and deep vaginal culture using a double-guarded technique.  Until culture results are back a broad spectrum antibiotic treatment should be started. Consider that over 70% of cases involve E. coli and amoxicillin may not be effective. We usually start with both Clavamox and enrofloxacin until culture results guide further treatment.

Antibiotic treatment alone is not enough. You must also focus on decreasing progesterone and clearing the purulent material from the uterus. We recommend one of the following protocols. While following the protocols, the patient should steadily improve. If further deterioration in health status is noted, the decision to spay should be revisited.

Protocol #1

• Dinoprost (Lutalyse) 5-10 mg/kg SC q 4-6 h for the 1^st day; 25 mg/kg SC q 4-6 h for the 2^nd day; 50 mg/kg SC q 4-6 h for days 3-7. This frequency of injections may necessitate hospitalization.
• Cabergoline (compounded) 5 mg/kg PO q 24 h for 10 days (give separate from dinoprost injections)
• Antibiotic treatment as discussed above
• Ultrasound evaluations on regular basis to track progress
• Repeat CBC/chem to track progress
• IV fluids and hospitalization are needed if the dog is less than BAR/QAR throughout the treatment
• This protocol WILL cause the dog to become hyporexic or anorexic and nauseous. Vomiting is expected after dinoprost administration and diarrhea may also occur.

Protocol #2

• Aglepristone (Alizin) 10 mg/kg SC on Day 1 & 2, and then every 7^th & 8^th days (e.g., days 7, 8 and then 14, 15) until the end of treatment (i.e., return to clinically healthy status); only place 5 mL maximum in any one spot
• Antibiotic treatment as discussed above
• Ultrasound evaluations on regular basis to track progress
• Repeat CBC/chem to track progress
• IV fluids and hospitalization are needed if the dog is less than BAR/QAR throughout the treatment
• Alizin will NOT cause gastrointestinal side effects. If any GI side effects are experienced, it is likely from antibiotic therapy
• Alizin is not approved for use in the US. Some US veterinarians have obtained special permission from the FDA to import the drug for use in these cases. Kokopelli Veterinary Center is one of these clinics.

Protocol #3

• Aglepristone (Alizin) 10 mg/kg SC on Day 1 & 2, and 8; only place 5 ml maximum in any one spot
• Cloprostenol (Estrumate) 1 mg/kg SC once daily on days 3-7
• Antibiotic treatment as discussed above
• Ultrasound evaluations on regular basis to track progress
• Repeat CBC/chem to track progress
• IV fluids and hospitalization are needed if the dog is less than BAR/QAR throughout the treatment
• Alizin will NOT cause gastrointestinal side effects. If any GI side effects are experienced, it is likely from antibiotic or cloprostenol therapy
• Alizin is not approved for use in the US. Some US veterinarians have obtained special permission from the FDA to import the drug for use in these cases. Kokopelli Veterinary Center is one of these clinics.

After treating for pyometra, it is recommended to breed the bitch on the next cycle and spay her when breeding plans are finished. She will be at higher risk for pyometra again during any future non-pregnant cycles. While her overall fertility will not be as high as a bitch with a healthy endometrial environment, many bitches will go on to become pregnant on subsequent cycles.

For webinar presentations on related topics, see below:

• Non-Surgical Treatment of Pyometra – Dr. Bruce Christensen (2021)

When a client calls frantic that their bitch has been bred accidentally, the first thing to do is to assure them that they have options. We advise them to come in for an ultrasound evaluation in 4 weeks from the accidental breeding. If the ultrasound fails to confirm pregnancy, that is the end of the story. If she is pregnant, then, of course, she could also be spayed, and this may be a consideration if she is not intended for breeding in the future. But spaying during this phase of her cycle carries higher risks of post-operative bleeding. There are safe medical options that would allow her to be spayed during a safer stage of her cycle, or allow her to be bred later in a more controlled, purposeful setting.

Protocol #1

• Cloprostenol (Estrumate) 1-2.5 mg/kg SC on days 1 and 4; do not send the dog immediately home as it will very likely become nauseous and vomit for up to an hour after injection
• Cabergoline (compounded) 5 mg/kg PO q 24 h for 8 days
• On day 4 (when second cloprostenol injection is given), check serum progesterone. It should be baseline at this point
• Recheck in 7 days with ultrasound to confirm cessation of pregnancy
• This protocol WILL cause the dog to become hyporexic or anorexic and nauseous. Vomiting is expected after dinoprost administration and diarrhea may also occur.

Protocol #2

• Aglepristone (Alizin) 10 mg/kg SC on Day 1 & 2; only place 5 mL maximum in any one spot
• Recheck with ultrasound in 7 days to see if the pregnancy is fully terminated. If any embryos with heartbeats are still detected, give a third injection at the same dose and check again in one week
• Alizin will NOT cause gastrointestinal side effects.
• Alizin is not approved for use in the US. Some US veterinarians have obtained special permission from the FDA to import the drug for use in these cases. Kokopelli Veterinary Center is one of these clinics.

Whichever protocol is used, it should be started before 40 days gestation. If the protocols are started after this time, they will still work, but will result in active abortion (expulsion of the fetuses) rather than resorption. If you wait till very late in gestation, the protocols could result in obstructive abortion and need for emergency care.

For webinar presentations on related topics, see below:

• Accidental Mating & Pregnancy Termination – Dr. Bruce Christensen (2023)

Benign prostatic hyperplasia (BPH) and prostatitis only occur in intact dogs. Prostatic neoplasia can occur in both neutered and intact males, and actually occurs more commonly in neutered males, so advising clients that neutering protects their dogs against prostatic neoplasia is actually false. For a longer discussion on the question of whether to neuter or not (in general), click here. In the case of BPH or prostatitis, it is important to reduce androgen stimulation of the prostate. Castration is the most complete, fastest way to accomplish this. But castration is contraindicated in breeding dogs. It also may not be wanted by clients who otherwise have reasons to preserve the testosterone production in their dogs (e.g., working dogs or dogs prone to obesity). Client opinions should not be dismissed. Preserving a dog’s work drive and high metabolism contributes positively to the dog’s quality of life and to the human-animal bond. There are very good ways to treat prostate disease medically.

First, you should try to determine if you are dealing with simple BPH, or BPH complicated by infection (prostatitis) or cysts. Culture and cytology evaluation of prostatic fluid should be performed. Prostate fluid is most easily obtained through manual stimulation of ejaculation. It can also be obtained with more difficulty (and much smaller sample) with prostatic wash techniques. Fine needle aspirates (FNA) have also been used but are much more invasive and yield an even smaller sample to culture and evaluate. False negative results will be more common with FNA and prostatic wash techniques.

Any positive culture results should lead to treatment with an appropriate antibiotic. This would be one that not only is effective against the bacteria, but will have good penetration into the prostatic tissue. Fluoroquinilones and sulfonimides are good choices. Treatment should be for 3 weeks and have a follow-up culture after cessation of treatment.

Ultrasound evaluation of the prostate should be performed to measure length, width, and height of both right and left lobes, to evaluate parenchyma echogenicity, and to look for cysts or abscesses. Large cysts or abscesses (> 1 cm) may require surgery to resolve.

There are multiple medications available for treatment of BPH. Each has a different mechanism of action. Some negatively affect testosterone production, and therefore spermatogenesis, and some do not. In the US, a drug called finasteride is readily and inexpensively available. It works very well, and so we will only consider this treatment here. If you live outside the US, you should consult with a theriogenologist to find out what drugs are available to you.

Testosterone, itself, only weakly stimulates the prostate. Testosterone is converted in prostate cells by the enzyme 5-a reductase to the androgen dihydrotestosterone (DHT) and it is DHT that has a very strong effect on prostatic function. Finasteride inactivates 5-a reductase, thereby eliminating DHT and greatly reducing hormone stimulation of prostatic growth and function. Within about 6-8 weeks of finasteride treatment, the prostate will shrink to a size that will no longer be prone to bleeding or infection. Dogs will need to be on finasteride essentially for as long as they are intact. If they are taken off finasteride, their prostates will once again grow and could become problematic.

For webinar presentations on related topics, see below:

• Canine Prostate Disease – Dr. Bruce Christensen (2021)

For webinar presentations on related topics, see below:

• Neonatal Resuscitation: Improving the Outcome – Dr. Autumn Davidson (2022)

For webinar presentations on related topics, see below:

• Elective vs Emergency C-Section: Good Idea? – Dr. Autumn Davidson (2022)

For webinar presentations on related topics, see below:

• Alternatives to Spaying and Neutering in Dogs – Dr. Michelle Kutzler (2023)

For more information, please visit our Sterilization Options page.