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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)

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

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  • 1. Clinical cases on small animal reproduction: Gonadectomy is no more the only solution! #NBVMA2013
  • 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. Clinical cases in small animal reproduction Case nº1: “Baila”, German Shepherd, 5 years old
  • 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. 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. 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. Clinical cases in small animal reproduction Case nº1: “Baila”, German Shepherd, 5 years old Diestrus Brownish vulvar discharge Suspicion of open cervix pyometra
  • 8. Clinical cases in small animal reproduction Case nº1: “Baila”, German Shepherd, 5 years old ?????
  • 9. What do you suspect here? 1. Pyometra 2. Cystic Endometrial Hyperplasia 3. Vaginitis 4. Cervicitis
  • 10. What to do then? 1. Perfom a vaginal endoscopy 2. Spay the bitch 3. Antibiotic treatment 4. Perform a vaginectomy
  • 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. Clinical cases in small animal reproduction Case nº1: “Baila”, German Shepherd, 5 years old
  • 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. So, what about the treatment now? 1. Nothing 2. Antibiotherapy 3. Ovariectomy 4. Vaginal lavage
  • 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. 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. 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. 10 days after Clinical cases in small animal reproduction Case nº1: “Baila”, German Shepherd, 5 years old
  • 19. Clinical cases in small animal reproduction Case nº2: “Altai”, Azawakh hound, 3 years old
  • 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. - 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. - 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. • 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 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. 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. 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. 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. 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. 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. WHAT ABOUT FUTURE FERTILITY? • 1/ 100% • 2/ Around 80% • 3/ Around 50% • 4/ Around 20%
  • 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. Natural mating during the following seasons:  6 puppies ! « Altaïa», 3 year old Azawakh bitch
  • 33. Clinical cases in small animal reproduction Case nº3: “Fernanda”, Am Staff, 5 years old
  • 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. Clinical cases in small animal reproduction Case nº3: “Fernanda”, Am Staff, 5 years old
  • 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. 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. But after 2 days of treatment… No vaginal discharge! ?????? Clinical cases in small animal reproduction Case nº3: “Fernanda”, Am Staff, 5 years old
  • 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. 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. P4= 0, 201 ng/mL !!! Clinical cases in small animal reproduction Case nº3: “Fernanda”, Am Staff, 5 years old
  • 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. Endoscopic approach… Clinical cases in small animal reproduction Case nº3: “Fernanda”, Am Staff, 5 years old
  • 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. 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. Clinical cases in small animal reproduction Case nº’4 “Mia”, DSH cat, 1 years old
  • 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. What will be your first guess? 1. Severe mammary tumors… 2. Generalized mastitis 3. Fibrosarcoma 4. Fibroadenomatosis
  • 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. 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. • 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. • 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. 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. Clinical cases in small animal reproduction Case nº’4 “Mia”, DSH cat, 1 years old
  • 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. 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. • 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. Clinical cases in small animal reproduction Case nº’5 “Tequila”, Labrador bitch, 3 years old
  • 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. • 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. What is your diagnosis? 1. Acute mastitis 2. Gangrenous mastitis 3. Mammary ADK 4. Fibroadenomatosis
  • 62. What will be the most logical evolution? 1. Spontaneous regression 2. Abcessation… 3. Chronic inflammation 4. Death of the animal
  • 63. What kind of tests could you propose here? 1. No need for anything else 2. X-rays 3. CBC 4. Ultrasounds
  • 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. • 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. 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. 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. Clinical cases in small animal reproduction Case nº6 “Vanda”, Am Staff bitch, 2 years old
  • 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. 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. 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. 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. P4=3,5 ng/mL Clinical cases in small animal reproduction Case nº6 “Vanda”, Am Staff bitch, 2 years old
  • 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. 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. 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. 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. Clinical cases in small animal reproduction Case nº6 “Vanda”, Am Staff bitch, 2 years old
  • 79. WHAT’S YOUR DIAGNOSIS? • 1/ Hydrosalpinx. • 2/ Follicular cyst. • 3/ Luteal cyst. • 4/ Pyometra.
  • 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. 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. 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. • 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. What is the first exam to perform with this breeding male? 1. CBC 2. Biochemistry profile 3. Ultrasounds 4. Spermogram
  • 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. 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. 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. Ultrasonography
  • 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. 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. • Prostatic biopsy: – Histology: BPH – Bacteriology: no bacteria Clinical cases in small animal reproduction Case nº7 “Youpi”, Eng Bulldog ,male, 5 years old
  • 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. 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. 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. 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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