2013 Clinical cases in small animal reproduction

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Slides of the talk we did at the 2013 NBVMA (New Brunswick Veterinary Medical Association)

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2013 Clinical cases in small animal reproduction

  1. 1. Clinical cases on small animal reproduction: Gonadectomy is no more the only solution! #NBVMA2013
  2. 2. Clinical on small animal reproduction Introduction  DYK? Canine & feline reproduction is very often one of the most common cause of veterinary consultation  DYK? Canine & feline reproductive physiology: unique features among mammalian species  DYK? The tools to better approach genital diseases in companion animals are more and more commonly found in our clinics… 7 clinical cases to give you an overview of what can nowadays be done
  3. 3. Clinical cases in small animal reproduction Case nº1: “Baila”, German Shepherd, 5 years old
  4. 4. « Baila » German Shepherd, 5 years Unspayed Last heats one month ago Clinical cases in small animal reproduction Case nº1: “Baila”, German Shepherd, 5 years old The owners have noticed a brownish vulvar discharge for two days…
  5. 5. Clinical examination: -Normal health parameters -T°= 37,5°C -Slight brownish discharge at the tip of the vulvar lips Clinical cases in small animal reproduction Case nº1: “Baila”, German Shepherd, 5 years old
  6. 6. What will you propose first to the owner? 1. Nothing to propose, the diagnosis is obvious 2. Performing a vaginal swab 3. Performing an abdominal US 4. Performing a vaginal endoscopy
  7. 7. Clinical cases in small animal reproduction Case nº1: “Baila”, German Shepherd, 5 years old Diestrus Brownish vulvar discharge Suspicion of open cervix pyometra
  8. 8. Clinical cases in small animal reproduction Case nº1: “Baila”, German Shepherd, 5 years old ?????
  9. 9. What do you suspect here? 1. Pyometra 2. Cystic Endometrial Hyperplasia 3. Vaginitis 4. Cervicitis
  10. 10. What to do then? 1. Perfom a vaginal endoscopy 2. Spay the bitch 3. Antibiotic treatment 4. Perform a vaginectomy
  11. 11. Why proposing a vaginal endoscopy? Clinical cases in small animal reproduction Case nº1: “Baila”, German Shepherd, 5 years old Determine where the affection is: -Vagina? -Subtle uterine discharge? Discriminate primary vs secondary vaginitis -Primary: bacterial infection -Secondary: resulting from the presence of a foreign body, a tumor, a vaginal malformation,…
  12. 12. Clinical cases in small animal reproduction Case nº1: “Baila”, German Shepherd, 5 years old
  13. 13. Primary vaginitis Clinical cases in small animal reproduction Case nº1: “Baila”, German Shepherd, 5 years old Investigate the all vaginal cavity! Visualize the cervical opening! What you should always do… Focal hyperhemia of the vaginal mucosa Presence of abundant purulent material  No cervical discharge… What you should see…
  14. 14. So, what about the treatment now? 1. Nothing 2. Antibiotherapy 3. Ovariectomy 4. Vaginal lavage
  15. 15. Antibiotic therapy BUT Always better to perform a vaginal bacteriology + antibiogramm at the same time! Clinical cases in small animal reproduction Case nº1: “Baila”, German Shepherd, 5 years old
  16. 16. Topical vs systemic??? Clinical cases in small animal reproduction Case nº1: “Baila”, German Shepherd, 5 years old Interest of a vaginal lavage??? Adjunction of NSAID or corticoïds???
  17. 17. In this case: -XXX during 10 days -Antibiogramm:  E. coli, sensitive to XXX Clinical cases in small animal reproduction Case nº1: “Baila”, German Shepherd, 5 years old
  18. 18. 10 days after Clinical cases in small animal reproduction Case nº1: “Baila”, German Shepherd, 5 years old
  19. 19. Clinical cases in small animal reproduction Case nº2: “Altai”, Azawakh hound, 3 years old
  20. 20. Consultation for persistent and abundant vulvar discharge going on for a week Clinical cases in small animal reproduction Case nº2: “Altai”, Azawakh hound, 3 years old
  21. 21. - In heats a month and a half ago - Accidentally mated by her father - Medical abortion: 3 injections of estradiol benzoate one day apart. Clinical cases in small animal reproduction Case nº2: “Altai”, Azawakh hound, 3 years old
  22. 22. - 3 weeks ago: purulent vulvar discharge/ treatment: antiobiotic X - No more discharge during a week - Recurred, treated with antibiotic Y Clinical cases in small animal reproduction Case nº2: “Altai”, Azawakh hound, 3 years old
  23. 23. • Good general condition, not hyperthermic • Light vaginal discharge observed, intense licking of the area reported by the owner Clinical cases in small animal reproduction Case nº2: “Altai”, Azawakh hound, 3 years old
  24. 24. 24 Uterine dilation… + Vulvar discharge… + 1.5 month after heats… PYOMETRA Clinical cases in small animal reproduction Case nº2: “Altai”, Azawakh hound, 3 years old
  25. 25. ANY IDEA ON WHAT COULD HAVE BEEN THE INITIATING FACTOR? • 1/ The natural mating that occured. • 2/ The treatment with antiobiotic Y. • 3/ The succesive antibiotic treatments. • 4/ The injection of estradiol in diestrus.
  26. 26. FIRST INTENTION TREATMENT TO PROPOSE? • 1/ Nothing: it’s an auto-limitating disease. • 2/ Do a bacterial culture and treat the bitch accordingly to the antibiogram’s result • 3/ Propose an OVH • 4/ Propose an ovariectomy
  27. 27. It’s a breeding bitch!!! IS IT DEFINITELY LOST FOR BREEDING? Clinical cases in small animal reproduction Case nº2: “Altai”, Azawakh hound, 3 years old
  28. 28. IS THE BITCH LOST FOR THE PURPOSE OF BREEDING? • 1/ Yes: there’s nothing else we can do • 2/ Not necessarily: there are medical alternatives that can be attempted, but the results are rather poor. • 3/ No: there are medical alternatives that can be attempted and these are highly efficient
  29. 29. Clinical cases in small animal reproduction Case nº2: “Altai”, Azawakh hound, 3 years old Please contact me for more details See Final Slide for contact information Medical treatment of pyometra
  30. 30. WHAT ABOUT FUTURE FERTILITY? • 1/ 100% • 2/ Around 80% • 3/ Around 50% • 4/ Around 20%
  31. 31. After medical treatment, breeding the bitch during next season is mandatory Recurrence rate ≈ 20% Medical treatment of pypmetra is efficient! This disease does not imply anymore the end of the reproductive carreer!!! Clinical cases in small animal reproduction Case nº2: “Altai”, Azawakh hound, 3 years old
  32. 32. Natural mating during the following seasons:  6 puppies ! « Altaïa», 3 year old Azawakh bitch
  33. 33. Clinical cases in small animal reproduction Case nº3: “Fernanda”, Am Staff, 5 years old
  34. 34. « Fernanda» Am Staff, 5 years Breeding bitch During an abdominal ultrasound… Clinical cases in small animal reproduction Case nº3: “Fernanda”, Am Staff, 5 years old
  35. 35. Clinical cases in small animal reproduction Case nº3: “Fernanda”, Am Staff, 5 years old
  36. 36. Suspicion of closed cervix pyometra… The owner didn’t see when the bitch was last in heats Clinical cases in small animal reproduction Case nº3: “Fernanda”, Am Staff, 5 years old The owners want to breed this bitch one last time…
  37. 37. Medical treatment Clinical cases in small animal reproduction Case nº3: “Fernanda”, Am Staff, 5 years old Please contact me for more details See Final Slide for contact information
  38. 38. But after 2 days of treatment… No vaginal discharge! ?????? Clinical cases in small animal reproduction Case nº3: “Fernanda”, Am Staff, 5 years old
  39. 39. Nothing changed… Clinical cases in small animal reproduction Case nº3: “Fernanda”, Am Staff, 5 years old Proposition of OVHX… But the owners REALLY want to breed this bitch!
  40. 40. At this point, what can you propose? 1. Nothing: the owner should look for another vet 2. A progesterone assay 3. Use a different antibiotic 4. Use XXX at a higher dose
  41. 41. P4= 0, 201 ng/mL !!! Clinical cases in small animal reproduction Case nº3: “Fernanda”, Am Staff, 5 years old
  42. 42. At this point, what do you suspect? 1. Really no idea… 2. A closed cervix pyometra not responding to the medical treatment 3. A severe cystic endometrial hyperplasia 4. A mucometra
  43. 43. Endoscopic approach… Clinical cases in small animal reproduction Case nº3: “Fernanda”, Am Staff, 5 years old
  44. 44. Endoscopic approach… 100mL of serous fluid recovered from the uterus!!! Clinical cases in small animal reproduction Case nº3: “Fernanda”, Am Staff, 5 years old Cytology: mucometra!!!
  45. 45. One week after… The uterine dilatation disappeared !!!! Was bred at her next heats: 5 puppies Clinical cases in small animal reproduction Case nº3: “Fernanda”, Am Staff, 5 years old
  46. 46. Clinical cases in small animal reproduction Case nº’4 “Mia”, DSH cat, 1 years old
  47. 47. Clinical cases in small animal reproduction Case nº’4 “Mia”, DSH cat, 1 years old Clinical examination Unspayed outdoor cat… Never received any treatment…
  48. 48. What will be your first guess? 1. Severe mammary tumors… 2. Generalized mastitis 3. Fibrosarcoma 4. Fibroadenomatosis
  49. 49. Definition: – Hyperplasia of the mammary tissue + inflammatory component –Hormonal determinism: P4 impregnation –Non neoplastic proliferation of mammary ducts and stroma Clinical cases in small animal reproduction Case nº’4 “Mia”, DSH cat, 1 years old Feline fibroadenomatosis
  50. 50. Clinical cases in small animal reproduction Case nº’4 “Mia”, DSH cat, 1 years old Feline fibroadenomatosis • Usually affects: – YOUNG adult entire queens during their first estrus: in average aged 3 months to 2 year old •Under progesterone impregnation •Or treated with progestins •In rare cases: – Prepubertal queens – Spayed queens – Tomcats
  51. 51. • General symptoms (uncommon): – Weakness, anorexia, hyperthemia – Pain • Local signs: – Quick growth/hypertrophy of the mammary glands: •Focused on 1-2 glands •Or generalized to the entire tissue - Mammary inflammation (uncommon) - Lactation (uncommon) Clinical cases in small animal reproduction Case nº’4 “Mia”, DSH cat, 1 years old Feline fibroadenomatosis
  52. 52. • Spontaneous regression: rare… • Frequent ulcerations (licking, friction) • Frequent septic/necrotic complications • Sometimes leading to death Clinical cases in small animal reproduction Case nº’4 “Mia”, DSH cat, 1 years old
  53. 53. In the case of Mia, what will you do now? 1. Ultrasounds 2. Ovariectomy… 3. Full mastectomy 4. Surgically remove one mammary chain, and one month later the 2nd chain
  54. 54. Clinical cases in small animal reproduction Case nº’4 “Mia”, DSH cat, 1 years old
  55. 55. What will be the 1st option as a treatment? 1. Medical treatment 2. Ovariectomy/OVH 3. Full mastectomy 4. Surgically remove one mammary chain, and one month later the 2nd chain
  56. 56. Surgical treatment: - Ovariectomy/OVH: do not always lead to mammary regression need to wait 2-3 weeks before seeing any medical improvement - Full mastectomy: considered as the last option 1/10 queen will die in the 3 days following this surgery Clinical cases in small animal reproduction Case nº’4 “Mia”, DSH cat, 1 years old Medical treatment: Please contact me for more details See Final Slide for contact information
  57. 57. • Regression observed 10 days after beginning of the treatment • Situation was back to normal after 35 days Clinical cases in small animal reproduction Case nº’4 “Mia”, DSH cat, 1 years old
  58. 58. Clinical cases in small animal reproduction Case nº’5 “Tequila”, Labrador bitch, 3 years old
  59. 59. • Also: – Had a litter of 7 puppies 15 days ago – For two days: no more interested in the puppies and not eating any more Clinical cases in small animal reproduction Case nº’5 “Tequila”, Labrador bitch, 3 years old Consultation for lethargy/anorexia that started 2 days ago
  60. 60. • Hyperthermia: rectal temp: 39,8°C • When looking at the mammary glands… Clinical cases in small animal reproduction Case nº’5 “Tequila”, Labrador bitch, 3 years old
  61. 61. What is your diagnosis? 1. Acute mastitis 2. Gangrenous mastitis 3. Mammary ADK 4. Fibroadenomatosis
  62. 62. What will be the most logical evolution? 1. Spontaneous regression 2. Abcessation… 3. Chronic inflammation 4. Death of the animal
  63. 63. What kind of tests could you propose here? 1. No need for anything else 2. X-rays 3. CBC 4. Ultrasounds
  64. 64. • Etiology: Bacterial infection: • Most common: staphylococci • E.coli or Steptococci • Predisposing factors: – Congestion of the mammary glands (inguinal glands +++) – Post-partum metritis(placental or foetal retention) – Skin irritation by the puppies – Unadequate sanitation protocols Clinical cases in small animal reproduction Case nº’5 “Tequila”, Labrador bitch, 3 years old
  65. 65. • General symptoms observed: – Hyperthermia – Lack of interest for the puppies – Prevent puppies from suckling • Local symptoms: – Inflammation/local pain – Milk contains Pus/blood Clinical cases in small animal reproduction Case nº’5 “Tequila”, Labrador bitch, 3 years old
  66. 66. Your client would like to know if he would still be able to breed the bitch… 1. Yes, no contraindication here 2. No because there might be a genetic predisposition to this disease 3. No because the bitch might not be able to properly care for the puppies 4. No, this is an indication for OVH
  67. 67. Symptomatic +local surgical care for the wound Antibiotherapy Milk bacteriology? Stop lactation Bottle-feed the puppies and wean them asap Clinical cases in small animal reproduction Case nº’5 “Tequila”, Labrador bitch, 3 years old About the treatment Please contact me for more details See Final Slide for contact information
  68. 68. Clinical cases in small animal reproduction Case nº6 “Vanda”, Am Staff bitch, 2 years old
  69. 69. Consultation for timing of ovulation regarding a chilled semen insemination Primiparous Heats start 8 days ago Chilled semen coming from Finland First consultation: - Vaginal swab - P4 assay Clinical cases in small animal reproduction Case nº6 “Vanda”, Am Staff bitch, 2 years old
  70. 70. 0 2 4 6 8 10 12 14 16 18 9h00 21h00 9h00 15h3013h4520h0015h0020h00 9h00 14h3020h30 9h30 15h0019h0017h0020h0010h30 30/10 31/10 02/11 03/11 04/11 05/11 06/11 07/11 08/11 09/11 ProgesteroneandLHbloodlevels(ng/ml) Dates and time of blood samples Pg LH Ovulation 5 à 10 ng/ml (15 à 30 nmol/L) LH peak Clinical cases in small animal reproduction Case nº6 “Vanda”, Am Staff bitch, 2 years old
  71. 71. 0 3 6 9 12 15 18 21 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 Days Progesteroneng/mL Ovulation Clinical cases in small animal reproduction Case nº6 “Vanda”, Am Staff bitch, 2 years old
  72. 72. 0 3 6 9 12 15 18 21 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 Days Progesteroneng/mL Ovulation « Vanda», 2 year old American Staff bitch Progesterone secretion in the bitch
  73. 73. P4=3,5 ng/mL Clinical cases in small animal reproduction Case nº6 “Vanda”, Am Staff bitch, 2 years old
  74. 74. P4=3,6 ng/mL9th day of estrus: WHAT TO DO? Clinical cases in small animal reproduction Case nº6 “Vanda”, Am Staff bitch, 2 years old
  75. 75. WHAT TO DO? • 1/ No need to worry yet, bring the bitch back in consultation tomorrow. • 2/The bitch is infertile, make an appointment for OVH • 3/ There must be something wrong, let’s do an ovarian US. • 4/ There must be a problem with the progesterone machine, let’s call the technical assistance.
  76. 76. P4=3,4 ng/mL10th day of heats WHAT TO DO? Clinical cases in small animal reproduction Case nº6 “Vanda”, Am Staff bitch, 2 years old
  77. 77. WHAT TO DO? • 1/ No need to worry yet, bring the bitch back in consultation tomorrow. • 2/The bitch is infertile, make an appointment for OVH • 3/ There must be something wrong, let’s do an ovarian US. • 4/ There must be a problem with the progesterone machine, let’s call the technical assistance.
  78. 78. Clinical cases in small animal reproduction Case nº6 “Vanda”, Am Staff bitch, 2 years old
  79. 79. WHAT’S YOUR DIAGNOSIS? • 1/ Hydrosalpinx. • 2/ Follicular cyst. • 3/ Luteal cyst. • 4/ Pyometra.
  80. 80. E2 secretion? Blocking ovulation Infertility Risk for pyometra +++ FOLLICULAR CYST Clinical cases in small animal reproduction Case nº6 “Vanda”, Am Staff bitch, 2 years old
  81. 81. Treatment: hCG or GnRH agonist? Hemiovariectomy? US guided aspiration? Kystectomy? NOT RECOMMENDED Clinical cases in small animal reproduction Case nº6 “Vanda”, Am Staff bitch, 2 years old
  82. 82. Following the aspiration… 12th day of heats: P4=5,44ng/mL 13th day of heats: P4=7,84 ng/mL The owner asked for the chilled semen AI No pregnancy Next seasons: no recurence of the disease, fresh semen AI, 10 puppies Clinical cases in small animal reproduction Case nº6 “Vanda”, Am Staff bitch, 2 years old
  83. 83. • Refered for infertility • Had unsucessfully bred 6 bitches Clinical cases in small animal reproduction Case nº7 “Youpi”, Eng Bulldog ,male, 5 years old Clinical examination: - No noticeable sign - Palpation of the testes: ok
  84. 84. What is the first exam to perform with this breeding male? 1. CBC 2. Biochemistry profile 3. Ultrasounds 4. Spermogram
  85. 85. • Semen collection: – 5 mL of semen – 500 M SPZ – 60% motile • But 84% of abnormalities, mainly coiled tails Clinical cases in small animal reproduction Case nº7 “Youpi”, Eng Bulldog ,male, 5 years old
  86. 86. What do you do next? 1. The male is sterile: propose castration 2. Ultrasounds of the genital tract 3. Perform another spermogram in the next 3 weeks 4. Blood sample to assay estrogens/testosterone
  87. 87. 3 weeks after, another spermogram Still >80% of abnormal forms, mainly coiled tails Clinical cases in small animal reproduction Case nº7 “Youpi”, Eng Bulldog ,male, 5 years old US of the genital tract performed…
  88. 88. Ultrasonography
  89. 89. What is your diagnosis? 1. Looks normal to me… 2. Looks modified, but hard to tell anything… 3. Prostatitis 4. Benign Prostatic Hyperplasia
  90. 90. Clinical cases in small animal reproduction Case nº7 “Youpi”, Eng Bulldog ,male, 5 years old BPHBPH BPH Ultrasound may not allow discrimination between the different prostatic disorders!!! Diagnosis of prostatic diseases
  91. 91. • Prostatic biopsy: – Histology: BPH – Bacteriology: no bacteria Clinical cases in small animal reproduction Case nº7 “Youpi”, Eng Bulldog ,male, 5 years old
  92. 92. Clinical cases in small animal reproduction Case nº7 “Youpi”, Eng Bulldog ,male, 5 years old Treatment Please contact me for more details See Final Slide for contact information
  93. 93. Clinical cases in small animal reproduction Case nº7 “Youpi”, Eng Bulldog ,male, 5 years old • 3 weeks after: - Decrease of the prostatic size - No modification on the spermogram • 2 months later: - Used for AI - Spermogram: – 70% motile SPZ – 580 M SPZ – 38% coiled tails Three Intrauterine AI: 7 puppies!!! Follow-up
  94. 94. Over the counter questions on small animal reproduction Conclusion  Canine/Feline reproduction: not only about surgical sterilization  Many “over the counter” questions that requires clear technical answers  What about the future?
  95. 95. Thanks for your attention!!! Feel free to ask your questions: emmanuel.fontaine@royalcanin.com www.linkedin.com/in/emmanuelfontaine twitter.com/DrEFontaine www.facebook.com/#!/emmanuel.fontaine.758 Follow our latest posts here: http://feeds.feedburner.com/DrEFontaineBlogs

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