Cipher has an infection, don't know why

[fbkeays]

It has been unusually warm the last few days. All of the dogs have been inactive. I slept in this morning. When I got up Brady said that Cipher didn't want her breakfast. I wasn't too worried. Figured to see if this continued and maybe call the vet on Monday. Brady kept on commenting on how quiet Cipher was. I told him if he was so concerned, he could take her temperature. He did. It was 104.9.
So off to the emergancy vet we went. Our regular vet does the weekend shift at the emergancy clinic. She palpated and said she felt a distended uterus. She said there was a white discharge from her vulva (I haven't seen any).
X-rays didn't show the uterus. Only some soft stool in the lower colon (she has had some soft stool) and a very large bladder. I was a little surprised as she peed a long time before we left. They asked for a urine sample and it was very easy to get.
The vet came up with three possibilities: pyometra, bladder infection or viral infection. She still doesn't want to eat her kibble. She is drinking a lot and peeing alot.
Here are the results of her lab work.
Blood:
Hematology
WBC 36.31 K/uL high, normal (5.50-16.90)
LYM 3.31 K/uL normal (.50-4.90)
MONO 5.13 K/uL high, normal (.30--2.00)
NEU 26.95 K/uL high, normal (2.00-12.00)
EOS 0.64 K/uL normal (0.10-1.49)
BASO 0.28 K/uL high, normal (0.00-0.10)
%LYM 9.1%
%MONO 14.1%
%NEU 74.2%
%EOS 1.8%
%BASO 0.8%
HCT 31.1 % low, normal (37.0-55.00)
RBC 4.85 M/uL low, normal (5.50-8.50)
HGB 13.3 g/dL normal (12.0-18.0)
RETIC 52.8 K/uL
%RETIC 1.1%
MCV 64.0 fL normal (60.0-77.0)
RDW 17.1% normal (14.7-17.9)
MCHC out of reportable range
MCH 27.32 pg normal (18.50-30.00)
PLT 146 K/uL low, normal (175-500)
MPV 14.81 fL
PCT 0.2%
PDW 16.6%
PCV 38%, TP 7.1, Serum- Clear
The only thing on the blood chemistry that was out of normal range is ALKP 220 U/L high, normal (23-212)

Urnanalysis by free catch
Color: yellow
Char: si cloudy
Gluc: -
Bili: -
Ketone: -
Blood: ++
pH: 7.0
Protein: +
Sp. Gr.: 1.005
handwritten additions:
Leuko: ++
Epithcleal cells clo (I can make out the rest)
WBC 20-40/HPF
RBC TNTC
Chains rods

[BostonRott]

So what is the plan of attack? Pyo is obviously a VERY serious problem and the differential needs to be made ASAP!!!

Did they try to culture the urine? Did they take a cystocentesis? This will easily rule in/out a bladder infection / UTI.

Are they keeping her? Planning on an ultrasound?

In all honesty, with that differential in a young, intact bitch I would not leave without an ultrasound of the abd.

[BostonRott]

Also, are they not worried about where she's losing blood to? Both her RBC and her crit are low. Her Hb is ok, so at least she's still able to easily carry oxygen (and is not in a volemic hypoxia), but I'd be wanting to know where that's going.

You list in the urinalysis the RBC as "TNTC." I'd be willing to bet that it reads TMTC - Too Many Too Count. Are you noticing red urine?

[fbkeays]

I forgot to add that they gave her a shot of ketoprofen. She is on clavamox, 375 mg twice a day for 10 days.
The x-rays did not show any obvious uterus between the bladder and intestine.
While I was fixing the dogs' dinner, she vomited a large handful of brown stuff. Assuming it was last night's kibble. She did take the clavamox and a little steak. Refused kibble.
Cipher is 15 months old in two days.

[fbkeays]

Originally Posted by BostonRott

Also, are they not worried about where she's losing blood to? Both her RBC and her crit are low. Her Hb is ok, so at least she's still able to easily carry oxygen (and is not in a volemic hypoxia), but I'd be wanting to know where that's going.

You list in the urinalysis the RBC as "TNTC." I'd be willing to bet that it reads TMTC - Too Many Too Count. Are you noticing red urine?

When talking to the vet, she just mentioned the high white blood count.
The TNTC was handwritten, but it is TNTC. The urine is not red and not overly dark.
Brady just took her temperature and it is 97.7. Would the Ketoprofen cause that? I am getting worried again.

[frontierrots]

Years ago my husband's LabX just fell over all weak and staggery. Rushed to vet they did boodwork which was similar to Cipher's, xrayed her abdomen and her uterus looked small

She was obviously in dire distress so they gave her a pain killer and a muscle relaxer and kept her. as soon as the relaxer took effect pus poured out of her vulva

She had pyo and was on her way to dying; $800+ in emergency surgery and a week at the vet and she recovered and lived to be 18. They said 8 more hours and she'd have been in their crematory

Get that girl back to the vet for an ultrasound and further diagnostcs

[moondog]

Originally Posted by fbkeays

The TNTC was handwritten, but it is TNTC.

It means "Too Numerous To Count", so the same thing Gretchen was thinking.

[hcelsa]

When was she last in season? Does she have normal cycles or does she short cycle/have extended cycles etc?

I too would be extremely concerned about pyo, and would not at all rely on an x-ray to rule out infection. If the vet can FEEL an extended uterus, I'd be asking for at least an ultrasound...

[flyballmom]

Originally Posted by fbkeays

Brady just took her temperature and it is 97.7. Would the Ketoprofen cause that? I am getting worried again.

Yes, it could lower her temp. It's an NSAID, like aspirin, or ibuprofen. It's the generic of Orudis. Her white count (WBC's) is EXTREMELY high...more than double. I'd be worried too and would do a recheck in the AM.

[fbkeays]

Originally Posted by hcelsa

When was she last in season? Does she have normal cycles or does she short cycle/have extended cycles etc?

I too would be extremely concerned about pyo, and would not at all rely on an x-ray to rule out infection. If the vet can FEEL an extended uterus, I'd be asking for at least an ultrasound...

Cipher had her second heat cycle that ended early May. There was 5 months between the end of her first and the start of her second. They lasted just short of 4 weeks. She is my first bitch, but they seem perfectly normal. Certainly not anything close to the horror stories I have been told about.
The x-rays did not show what the vet thought she felt.

[BostonRott]

Xrays do not reliably show soft tissue. Xrays are for bone. They can show some of the more solid organs, and fluid build up in the lungs, but I would not trust an xray to find a pyo.

[hmeadq]

Given what others have said I would push for further tests. Vets are sometimes likely to take a "wait and see" view rather then order expensive tests. Make sure your vet knows that you want whatever tests they would do on their own dog.

[BostonRott]

Any updates this a.m.?

[fbkeays]

I had to get to work real early so all I did was let her out to go pee. On the way out the door she stuck her nose in her food dish. Brady is staying home. He isn’t feeling great, but normally would go into work, but with Cipher being sick, he is staying home. I almost think he is having sympathy pains.
I did talk to the vet late last night. I miss understood her about palpating the uterus. She didn’t think it was distended. She is not ruling out the possibility of pyo, but she doesn’t think it really is. She said to call her today if her temperature doesn’t return to normal or if we do see discharge or smell anything.
I just got off the phone with Brady. He took her temperature and it is 100.5. A month ago she had a health cert to go to Canada and her temperature was 100.4 so I think this is normal for her. She would not eat her kibble. She did eat a meals worth of Natural Balance chub. She also had a fairly normal poop.
She is also back to taking over Brady’s side of the couch. She jumped up there when he got up to answer the phone. Before she was sleeping on the floor or on the other couch- places she typically doesn’t lay.
It might just be one of those things that you just doesn't know why the dog was sick. I am keeping fingers crossed that she doesn't develop pyo. I am feeling a lot more relieved.

[hmeadq]

I'm glad she is feeling better. Keep a close eye on her and give her lots of belly rubs...