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Message |
    
sharon hackel
Neonate
Username: Sheri
Post Number: 3
Registered: 07-2005
| | Posted on Sunday, December 03, 2006 - 11:43 am: | 
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Hello, I have a mare with a large pyometra. The vet came to start to treat her and we had trouble with the flush. The discharge is so thick that it is clogging up the stomach tube we are using to flush with (2 litres saline in, out, 2 times for a total of 2 flushes). It seemed uncomfortable for her (the mare) as she was trying to expel, I could see, but movement through the tube was really slow. We got about a shy quart of thick discharge out of her this one time. We are going to try again today. Any suggestions--bigger tube--how big?? Vet says he cannot get both finger and tube in cervix. I gave her estrumate to open her up 6 days ago but she is not very open. Thanks |
Heather Kutyba
Breeding Stock
Username: Heatherck11
Post Number: 349
Registered: 01-2006
| | Posted on Sunday, December 03, 2006 - 01:06 pm: |
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Oh goodness. I'm sorry Sharon.
I've got plenty of experience with pyo in cats and dogs (manage a small animal vet hospital), but don't have a "clue" with horses. Just never been there.
I wonder if sedating her would be of any help??
Surely Jos will have some feedback that may lend a hand.
JOSSSS!!!!! Calling in the expert!!!!! HEEELLLP!!  |
Jos
Board Administrator
Username: Admin
Post Number: 1084
Registered: 10-1999
| | Posted on Sunday, December 03, 2006 - 05:25 pm: |
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Possibly the first thing to consider is do you want to treat this? Although it may seem a desirable thing to do, if you are not planning on ever breeding this mare and she is not systemically ill (most cases of pyometra in the mare - unlike other species - do not result in systemic illness) or uncomfortable, then the effort and expense associated with treatment may not be warranted. Bear in mind that - especially with older mares such as you describe who often have other contributory factors - reoccurrence is quite likely.
If you do decide you want to clear it, you are actually looking at several issues that need to be resolved to some degree concurrently:
Lack of relaxation of the cervix;
The fluid (pus) in the uterus;
Failure of clearance ability of the uterus;
Causative agent for the pyometra.
You will probably need to start with attempting to relax the cervix. Use of a prostaglandin followed by cervical dilation may be of value. Note that in a perfect world the prostaglandin will cause the luteolysis of any remaining CL and result in a return to estrus (thereby causing a relaxation of the cervix), but in some cases of pyometra you will not see such luteolysis as there is no functional CL present. If you use the prostaglandin, it may be worth delaying treatment for 3 or 4 days following the administering of the PGF2a in the hopes that the mare will return to estrus, thereby allowing an easier drainage through the now-relaxed cervix. If there is minimal cervical relaxation at that point, digital dilation may be beneficial, as well as use of systemic estrogen and/or a prostaglandin-E cream applied topically to the cervix.
With a relaxing cervix, obviously drainage will be easier. There will be a degree of natural drainage, and this can be assisted with the use of a suitable lavage medium such as saline or LRS. Bear in mind when lavaging that the mare already has a distended uterus (with the pus) so the addition of further fluids is going to make the mare uncomfortable more rapidly than under other lavage situations (where there is not already copious uterine content present). Ideally a mare will be restrained in a palpation chute. A regular stomach tube can be used, or even soft plastic/PVC hose marginally thicker in diameter and of suitable length - the clear or semi-clear/white stuff, not a garden hose! - bought from the hardware store (it is good to round the end off slightly and sterilise this before attempting insertion through the cervix). Persistence and manipulation of the tubing in the cervix/uterus (sometimes described as "vacuuming"!) will usually result in a gradual increase in the amount of fluid and pus being recovered from the uterus. Use of an ecbolic (oxytocin, or a prostaglandin product) while lavaging can assist in clearance once the cervix is relaxed and/or the tube in place. Oxytocin being used during the lavage, and then "Estrumate" use to follow up after may be indicated as the latter will cause persistent uterine contraction over a longer period. The ecbolic will not only assist the clearance, but if the mare herself has uterine clearance issues, failure to use the ecbolic during lavage may significantly negatively impact the degree of fluid and pus that is recovered. Ideally lavage will be continued until what is coming out is as clear as the new liquid that is going in - it is quite likely that 2L will not be enough.
It is important if one plans on breeding the mare that the causative agent is identified and treated. This could be bacterial, fungal, a foreign body or a persistent breeding-related endometritis to name a few of the more common causes. Obviously if one does not determine the cause, and attempts to breed the mare, the likelihood of a positive outcome is significantly reduced. Additionally, prior to breeding, a uterine biopsy is recommended, as especially in long-term pyometra cases there may be significant damage to the uterine lining. If a biopsy is performed, and a "New Kenney" grade III obtained, it is quite likely that the desire to breed the mare is terminated right there, as there is only an up-to 10% chance that she will produce a live foal! Evaluation for uterine and cervical adhesions may also be advisable. While breeding the mare, she should be considered to be a mare susceptible to delayed uterine clearance issues, and treated (with lavage and/or ecbolics) accordingly. |
Heather Kutyba
Breeding Stock
Username: Heatherck11
Post Number: 351
Registered: 01-2006
| | Posted on Sunday, December 03, 2006 - 10:01 pm: |
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Jos,
Do tell, how did you get so darn brilliant?? Inquiring minds want to know .
Seriously though, thank you for being a good source of information/education and allowing us to pick your brain. Never can quit learning.
Heather |
Jos
Board Administrator
Username: Admin
Post Number: 1086
Registered: 10-1999
| | Posted on Tuesday, December 05, 2006 - 02:10 am: |
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I read a lot... |
Michele
Weanling
Username: Mich
Post Number: 31
Registered: 02-2006
| | Posted on Thursday, February 15, 2007 - 01:55 pm: |
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Joss, please could you answer this?: My 12yr old maiden mare was diagnosed with pyometra. It was treated and resolved. A biopsy was taken and evaluated and is in a Grade IIa category. What do you think her chances are of getting in foal and carrying a foal to term? Thanks very much. |
Jos
Board Administrator
Username: Admin
Post Number: 1181
Registered: 10-1999
| | Posted on Thursday, February 15, 2007 - 10:05 pm: |
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A grade IIA biopsy carries a live foaling rate of 50-80%. The majority of mares wil be a IIA.
If you can clear the cause of the pyometra so that it does not reoccur, and the biopsy was accurate, then you should stand a "normal" chance of a foal, seeing as the average foaling rate is around 60%. |
Michele
Weanling
Username: Mich
Post Number: 32
Registered: 02-2006
| | Posted on Friday, February 16, 2007 - 04:02 am: |
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Thank you! That's wonderful to hear Yay! Will give it our best shot using MCT etc. They seemed to think she has a 10-50% chance of carrying a foal to term so 80% sounds much more hopeful.
The vet seems happy that the pyometra is totally resolved. It might sound obvious to ask, but what could cause it reoccur?
The diagnosis was ''endometritis, acute, mild to moderate, diffuse and moderate, multi-focal''.
[Sorry about the spell error.] |
Michele
Weanling
Username: Mich
Post Number: 33
Registered: 02-2006
| | Posted on Friday, February 16, 2007 - 04:05 am: |
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Meant to also ask; she's been on 3 days of Gentamycin and 10 days of Cozole. How long before the inflammation and endometritis is resolved 100% so that she is a good candidate for breeding? Thanks. |
Jos
Board Administrator
Username: Admin
Post Number: 1182
Registered: 10-1999
| | Posted on Friday, February 16, 2007 - 10:29 am: |
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Are you sure that she was given a IIA grade, and not a IIB, because a IIB grade carries a 10-50% chance of producing a live foal...?
If the mare has for example poor reproductive conformation and/or delayed uterine clearance issues and/or compromised immune response the problem could reoccur.
If she is being treated systemically with the antibiotics, it is questionable if those antibiotics wil do anything to assist, as systemic treatments generally will not reach the reproductive tissue. Treatment route is normally intra-uterine. If it is being given intra-uterine, make sure that the Gentamycin was buffered - it will cause severe irritation if it was not.
Without knowing exactly what the causative agent was, it is difficult to predict how long it will take to clear and be ready to be bred. It is also worth bearing in mind that manyn of these mares are prone to a yeast infection following treatment with an antibiotic.
And be aware that reoccurrence is likely with many of these mares...  |
Michele
Weanling
Username: Mich
Post Number: 34
Registered: 02-2006
| | Posted on Friday, February 16, 2007 - 01:00 pm: |
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Thanks for all that info.
I just got the actual biopsy report and it says IIB but the vet's report which I initally received said IIA. Darn, my hopes were up for a while..
So obviously that changes the picture substantially. Is it worth going all out to breed her? I can't envisage never having a foal from this irreplaceable mare.
Perineal conformation: good, vulvar lips form a tight seal for full length but are thin. Negative for windsucker test.
Yes, she was treated systemically for the bacterial infection of Strep. zooepidemicus. I actually asked the vet to flush her with Genta. and he was against it. He said oral ab's (Corzole)and i.v. Genta would reach the reproductive tissue and that flushing with anything would cause more inflammation. I have always read that, as you say, flushing with ab's is imperative.
Do you mean Candida and what would one treat it with - systemically or intra-uterine? Maybe it would be advisable to treat her for it nonetheless? |
Jos
Board Administrator
Username: Admin
Post Number: 1184
Registered: 10-1999
| | Posted on Friday, February 16, 2007 - 09:31 pm: |
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I can't answer whether you should try breeding her or not - that's a decision you will have to make for yourself!!!
Can't really comment on what your vet says either. They may have their reasons for believing that the systemic route will work, I don't know. All I can say is that research by others has not found that to be the case.
Candida is one of the yeast spp. that may be involved, but there are others as well. You would not want to treat it unless it were present.
Good luck! |
Michele
Weanling
Username: Mich
Post Number: 36
Registered: 02-2006
| | Posted on Saturday, February 17, 2007 - 12:04 am: |
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Thank you for all the info:-)
Well after all this can't stop now!
If there is any sign of further infection or inflammation I will INSIST on intra-uterine ab's. |
Jos
Board Administrator
Username: Admin
Post Number: 1185
Registered: 10-1999
| | Posted on Saturday, February 17, 2007 - 01:09 am: |
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Make sure that the cause of the inflammation isn't yeast before you insist on antibiotic therapy!!! If you put ab's into a yeast-infected uterus it's not going to be pretty!!!! |
Michele
Weanling
Username: Mich
Post Number: 37
Registered: 02-2006
| | Posted on Saturday, February 17, 2007 - 11:08 am: |
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Ok, will definitely do so. Thanks again So much to learn, so little time - breeding season nearly over . Just have to do the best and hope it all works out... |
