Monday, December 5, 2011

Case Report: Debbie - why it is recommended to spay your cat when she's young

**Note: Pictures of surgery below - Beware to the squeamish!**

Dilute patched tabby cat
Debbie, pre-surgery
Debbie is a 2 year old stray female who arrived at Elizabeth Lake Animal Rescue to look for a home. She appeared to be pregnant on November 5th. She was active, friendly and had a good appetite. Pregnancy lasts about 63 days in a cat, and cats begin to show pregnancy at about 5 weeks along, so the decision was made to wait for the kittens. On December 2, concern arose that she was not yet showing signs of delivering the kittens, so she was brought to our hospital for an exam.

Lateral radiograph with no visible anatomy
Pre-surgical radiograph
Usually, ultrasound can detect kittens after two weeks of pregnancy, and the heartbeat can be seen on ultrasound after day 24. Debbie’s X-ray showed no indication of fetal skeletons – only large fluid-filled areas that obscured normal anatomy. Ultrasound also showed no sign of kittens – just large chambers of fluid.

Normal post-surgical abdominal radiograph
Post-surgical radiograph
Feline female reproductive anatomy
Feline female reproductive anatomy
This situation can quickly become an emergency if the fluid in the uterus is contaminated with bacteria (called a pyometra), so Debbie was taken to surgery to spay her. Unlike a normal spay surgery patient, Debbie was considered to be a critical case – she had to be checked for systemic infection, changes to her kidney and liver function, or other signs of poor health. Outwardly, she seemed to feel well. Although Dr. Bailey anticipated the surgery would go well, we had to be ready for the patient to quickly change from stable to crash status due to her delicate condition. Emergency drugs were kept at the ready, but her blood pressure, heart rate and oxygen levels remained stable. Sometimes in these cases, the fluid in the uterus is just a clear fluid with no cells or infection, in which case the problem is called a “hydrometra”. In Debbie’s case, she had something called a “hydrometrocolpos” which is fluid built up in both the branching uterus and in the vaginal canal. Dr. Bailey had to remove more of her reproductive tract than usual, because her vaginal canal was swollen with fluid to the size of her bladder, and if it had been left intact, it would have filled up again and been at risk for infection, due to abnormal anatomy (probably a congenital defect).

Normally, a spay incision requires about 2-3 sutures because the uterus is very small. In Debbie’s case, her three-pound uterus was so large that her surgical incision ran the length of her belly.

Financially speaking, a spay surgery usually runs about $200 whereas the kind of intensive-care surgery that Debbie had usually runs $800-1500, depending on the length of surgery and the number of complications that arise.
Normal and abnormal feline uterine anatomy
On the left, Debbie's uterus. On the right, a normal uterus
After a normal spay surgery, a cat will generally be spry, and want to eat almost before she can stand. In Debbie’s case, she required hospitalization on IV fluids overnight, and was not interested in eating after surgery.

Fortunately, she did very well overnight and was able to be released from the hospital. She is doing well at the rescue group, Elizabeth Lake Animal Rescue, and once she has her sutures out, she will likely be ready to look for her forever home!