pyrometra

Question
I have a 17 y.o. pom with pyrometra.  She has glaucoma, going a bit deaf, has only 2 teeth left.  She seems well spirited, happy, good energy level.  The vet wants $1500. to do surgery and this is an awful disease.  Would you reccommend surgery, leave her alone until she shows signs of discomfort, or put her down now before she suffers?  Any opinion, advice is appreciated.  I have never had to make a decision like this.

Answer
She is counting on you to know what is best for her.  Here is some info on the disease-

In its simplest terms, pyometra is an infection in the uterus.  However, most cases of pyometra are much more difficult to manage than a routine infection.

Infection in the lining of the uterus is established as a result of hormonal changes.  Following estrus ("heat"), progesterone levels remain elevated for 8-10 weeks and thicken the lining of the uterus in preparation for pregnancy.  If pregnancy does not occur for several estrus cycles, the lining continues to increase in thickness until cysts form within it.  The thickened, cystic lining secretes fluids that create an ideal environment in which bacteria can grow.  Additionally, high progesterone levels inhibit the ability of the muscles in the wall of the uterus to contract.
Pyometra may occur in young to middle-aged dogs; however, it is most common in older dogs.  After many years of estrus cycles without pregnancy, the uterine wall undergoes the changes that promote this disease.

The typical time for pyometra to occur is about 1-2 months following estrus.
The preferred treatment is to surgically remove the uterus and ovaries.  This is called an ovariohysterectomy ("spay").  Dogs diagnosed in the early stage of the disease are very good surgical candidates.  The surgery is only slightly more complicated than a routine spay.  However, most dogs are diagnosed when they are quite ill so the surgery is not as routine as the same surgery in a healthy dog.  Intravenous fluids are often needed before and after surgery.  Antibiotics are given for 1-2 weeks.
The chance of successful treatment without surgery or prostaglandin treatment is extremely low.  If treatment is not performed quickly, the toxic effects from the bacteria will be fatal.  If the cervix is closed, it is also possible for the uterus to rupture, spilling the infection into the abdominal cavity.  This will also be fatal.

Good luck with her.
-Trish