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Post herniated disc surgery advice?

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Post herniated disc surgery advice?

Postby BBs mom » Tue Nov 27, 2018 12:50 pm

Hi everyone,

I'm new here, though I've been stalking around for a week reading posts. What brought me here: A week ago today, my 11 year old male cat BB had an acute disc herniation in his lower back, We have an idea of what happened though not 100%, but he was diagnosed and in surgery in under 48 hours (not sure if that means much?) and has currently been staying at the hospital during recovery, but he returns home tomorrow. his current point; paresis/partial paralysis and DPS loss in his lateral lower limbs and toes, with minor return in his right toes recently, and full paralysis/DPS loss in his tail (it is currently a limp noodle..). He cannot weight bear, though he is trying in his right leg. Hips and inner muscles/nerves are good though so he kind of half froggy legs scoots around, he cannot relieve himself independently either.
Unfortunately, the neurologist was unable to answer some of my questions and is not available tomorrow (they work in a very busy emergency clinic). We have a two week follow up after they return from vacation, but I'd really like it if I can get some things rolling and not wait two weeks if I dont have to. My hope is some of the more experienced fur parents on here may be able to provide advice from experience. I realize you are not vets, but a lot of things I've read on here have been more helpful than what the clinic has provided because of your personal experiences. Long winded, ok my questions:

Physio: I believe this to be a fairly crucial part in recovery, and I will be shown some home care physio, but I mentioned going to a professional PT as well and the neurologist seemed so-so in her answer. Would this not be beneficial for the first little while? I thought they may have other techniques? The other thing I thought of trying was hydrotherapy, for three reasons really; first,to help build his muscle and do our best to counter the muscle atrophy; second, to allow his legs to do some work more easily; third, my boys is a tad chunky (not obese) and could benefit from some weight loss to make life easier. I know cats hate water, I would like to try it though, has anyone done this with their cat? Did you notice any extra benefits over land physio?

Acupuncture: I have read this is a helpful treatment for this kind of injury, I get it myself, and wondered if it would be worth doing for him? If so, is it something I could start right away? Or does it have to wait a bit post surgery?

Bladder things: I've read a lot already on this, he will be a manual expression for the time being, or maybe forever, who knows and he dribbles when half full. While he is on cage rest, is it better to leave a diaper off him and just put a pee pad down? My husband and I both work full time jobs and though we've arranged our schedules best we can, he will still have a couple days in the week he is alone for 8 hours, is there anything I should do to make sure he is comfortable for longer periods?

Medication: I've read a couple posts regarding a drug called Nivalin. I couldn't find much info on its use in animals aside from a couple articles I couldn't understand, and the one or two posts on here regarding Sasha. I want to ask the neurologist about this, but is it beneficial? Has anyone tried it for a cat, or can cats not have it? Is it pricey?

Last question: What do you all do with your paresis/paralyzed kids when you are out or at work? Do you restrict them to a room or a crate? or let them roam free? I'm mildly afraid to do this, once he is more healed and able to come out because he is "that cat": who would try to do something silly and I'm afraid he'd get hurt, is that really a legit concern? How do the FT employed manage their special fur kids in this respect?

I am remaining positive, and am hopeful for a recovery of some kind whether full or partial. It will be a long road for the both of us I'm sure, and I'm sure my anxious thoughts will come and go (especially while learning to express his bladder..which I hope I learn quick!). Coming across this forum was a god send in anxiety reduction though, reading post after post made me more and more motivated and positive, I hope all of you taking the time to share your knowledge and experiences with others know how awesome you are :wub:
BBs mom
 
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Re: Post herniated disc surgery advice?

Postby CarolC » Tue Nov 27, 2018 3:52 pm

:welcome: Hi there, sorry this color of pink is darker than I thought.

BBs mom wrote:Hi everyone,

I'm new here, though I've been stalking around for a week reading posts. What brought me here: A week ago today, my 11 year old male cat BB had an acute disc herniation in his lower back, We have an idea of what happened though not 100%, but he was diagnosed and in surgery in under 48 hours (not sure if that means much?) and has currently been staying at the hospital during recovery, but he returns home tomorrow. his current point; paresis/partial paralysis and DPS loss in his lateral lower limbs and toes, with minor return in his right toes recently, and full paralysis/DPS loss in his tail (it is currently a limp noodle..). He cannot weight bear, though he is trying in his right leg. Hips and inner muscles/nerves are good though so he kind of half froggy legs scoots around, he cannot relieve himself independently either.
Unfortunately, the neurologist was unable to answer some of my questions and is not available tomorrow (they work in a very busy emergency clinic). We have a two week follow up after they return from vacation, but I'd really like it if I can get some things rolling and not wait two weeks if I dont have to. They're going on vacation? Did they give you someone you can contact while they are away? Is there someone still there who you can talk to? My hope is some of the more experienced fur parents on here may be able to provide advice from experience. I realize you are not vets, but a lot of things I've read on here have been more helpful than what the clinic has provided because of your personal experiences. Long winded, ok my questions:

Physio: I believe this to be a fairly crucial part in recovery, and I will be shown some home care physio, but I mentioned going to a professional PT as well and the neurologist seemed so-so in her answer. Would this not be beneficial for the first little while? They should advise you on this whether they are busy or not, this is important. My understanding is you do only passive range of motion physio following surgery. Doing active physio too soon could be detrimental. They should tell you what is allowed, and when it is allowed. There are a few things going on with a disk injury. At first the disk was putting pressure on the spinal cord, but the surgery removed the pressure. Along with the disk injury there were some chemical changes that occurred, and there needs to be healing from that. And because of the injury and the surgery itself, there is swelling that needs to go down. As far as I know, it is really important to rest him quietly and let the surgery heal and the swelling go down, which takes several weeks. Active exercise involving force or pressure or resistance or weight bearing will make it harder for the swelling to go down. You can't stop him from moving around or trying to stand up, but beyond that he should just rest. After the surgery is healed and the swelling goes down, then you could start to assess his condition and begin PT. I thought they may have other techniques? Yes, there are passive physical therapy modalities like cold laser that are safe to do soon after surgery. If you can afford it that would be worth looking into. The other thing I thought of trying was hydrotherapy, for three reasons really; first,to help build his muscle and do our best to counter the muscle atrophy; second, to allow his legs to do some work more easily; Yes, hydrotherapy can be done with cats. They need to tell you when it is allowed. Different surgeons have different guidelines based on their own knowledge of what is appropriate for the kind of surgery that was done. This type of injury is not something where, if you don't jump right in and do a bunch of PT, you will have a poorer result. Kind of the opposite. It is more like, you go step by step. You do surgery, you wait for the surgery to heal. Then you start a steady routine of appropriate PT and plan on continuing it for weeks or months. Nerves heal very slowly, but they do heal. I totally understand you don't want to miss doing something that would help, and then look back later and regret you missed your chance because you didn't know. Your cat is lucky to have someone willing to do whatever it takes. If you are like me and kind of Type A, the hardest thing is to just sit on your hands and wait, you want to get going, do something, make good things happen. But with nerve damage, good things come with time, and because of the need for healing from surgery, working the pet too soon can actually result in poorer or slower results. There are conditions where aggressive PT is desireable, for example with a stroke they might tell you to start PT immediately, but disk surgery seems to be different. The hospital really needs to tell you what is allowed and when. Ideally they should write it down and send it home with you, so you have something to refer to. I can't speak for the vet, but I suspect you will be told to rest him till the recheck, and then proceed from there. third, my boys is a tad chunky (not obese) and could benefit from some weight loss to make life easier. I know cats hate water, I would like to try it though, has anyone done this with their cat? Did you notice any extra benefits over land physio? I haven't done it with a cat, but I have done it with my small dog, and I have seen quite a few videos of cats doing hydrotherapy, and I would try it when he is given permission. One thing I can say is, if he does not seem to like it at first, do not assume he is a cat and will never like it. My dog did not like hydrotherapy at first and even got scared, but by starting with very short sessions in the water, then gradually making them longer, she came to love it.

Acupuncture: I have read this is a helpful treatment for this kind of injury, I get it myself, and wondered if it would be worth doing for him? If so, is it something I could start right away? Or does it have to wait a bit post surgery? With dogs you can start right away.

:arrow: :arrow: http://www.dodgerslist.com/literature/h ... ncture.htm

Bladder things: I've read a lot already on this, he will be a manual expression for the time being, or maybe forever, who knows and he dribbles when half full. While he is on cage rest, is it better to leave a diaper off him and just put a pee pad down? My husband and I both work full time jobs and though we've arranged our schedules best we can, he will still have a couple days in the week he is alone for 8 hours, is there anything I should do to make sure he is comfortable for longer periods? This is the most important thing right now. Hopefully he will be easy to express, but it would be good if you could try it once at the vet clinic on the exam table, so they can teach you. Also, not trying to cause worries, but just keep in the back of your mind, it is possible you may have some stress trying to express him the first few times, and if you can't get it done at first, you will need to be able to take him back to the vet to be emptied. It sounds like both of you work, so hopefully one of you has some sick leave or comp time or flex time or something, so you can take him to the vet if needed. I'm only saying this because expressing is something you learn by doing, and some people here have had to go back for a second lesson. It sounds like he may not be hard to express since he dribbles when half full, so you may be lucky and have no trouble at all. Tips on expressing, with many videos at the end of the article, are here:

:arrow: :arrow: viewtopic.php?f=5&t=16027

If you keep him on cage rest with potty pads, I am not sure they will be absorbent enough(?) It might be better to have him on some thick towels, and just plan to do laundry every day. Those potty pads are probably going to bunch up under him if he moves around in his crate. If it was my cat, I would leave the diaper off while he is on cage rest. Just keep an eye on his skin. By the way, is the incision in a spot that would be under the waistband of a diaper? Just curious. If he is not dribbling constantly, he'll likely be OK without one. If he dribbles a lot and develops redness on his skin, then having a diaper to absorb the urine will help keep the skin drier and healthier. Being alone for 8 hours should not be a problem. The only thing to keep in mind is they may be sending him home with a cone collar, I don't know. If that's the case, he won't be able to clean his fur or drink water until you come home and take it off. If you work close enough that you could dash home on your lunch hour and check on him and give him a drink, that would be nice. As for the towels, if you don't have any old ones, they have white bath towels for $1.99 at WalMart. You may have to look around till you find them, because they also have some for $2.99 and higher, but the $1.99 ones are perfectly good if you can find the display. I buy them by the stack here. :)
:collar:
Medication: I've read a couple posts regarding a drug called Nivalin. I couldn't find much info on its use in animals aside from a couple articles I couldn't understand, and the one or two posts on here regarding Sasha. I want to ask the neurologist about this, but is it beneficial? Has anyone tried it for a cat, or can cats not have it? Is it pricey?

Last question: What do you all do with your paresis/paralyzed kids when you are out or at work? Do you restrict them to a room or a crate? or let them roam free? I'm mildly afraid to do this, once he is more healed and able to come out because he is "that cat": who would try to do something silly and I'm afraid he'd get hurt, is that really a legit concern? How do the FT employed manage their special fur kids in this respect? Once he is fully healed he should be able to have the run of the house. Since you know him, you may want to have a look around and see if there are any changes that need to be made for his convenience or safety. Here is a wonderful video to give you an example.

:arrow: :arrow: http://www.youtube.com/watch?v=QdIBtw8_7No

I am remaining positive, and am hopeful for a recovery of some kind whether full or partial. It will be a long road for the both of us I'm sure, and I'm sure my anxious thoughts will come and go (especially while learning to express his bladder..which I hope I learn quick!). Coming across this forum was a god send in anxiety reduction though, reading post after post made me more and more motivated and positive, I hope all of you taking the time to share your knowledge and experiences with others know how awesome you are :wub: Very glad you found the forum. I suspect the first couple of weeks will go pretty fast. You spend a lot of time and attention fine tuning your daily routine at first, the crate, the expressing, etc. It's all a little different at first, but soon it will become the new normal. Hope you will post your experiences to pass on the wisdom for others who will be looking for answers. And pictures are always enjoyed! :D
:thankyou:
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Re: Post herniated disc surgery advice?

Postby BBs mom » Tue Nov 27, 2018 4:39 pm

CarolC wrote: :welcome: Hi there, sorry this color of pink is darker than I thought.

BBs mom wrote:Hi everyone,

I'm new here, though I've been stalking around for a week reading posts. What brought me here: A week ago today, my 11 year old male cat BB had an acute disc herniation in his lower back, We have an idea of what happened though not 100%, but he was diagnosed and in surgery in under 48 hours (not sure if that means much?) and has currently been staying at the hospital during recovery, but he returns home tomorrow. his current point; paresis/partial paralysis and DPS loss in his lateral lower limbs and toes, with minor return in his right toes recently, and full paralysis/DPS loss in his tail (it is currently a limp noodle..). He cannot weight bear, though he is trying in his right leg. Hips and inner muscles/nerves are good though so he kind of half froggy legs scoots around, he cannot relieve himself independently either.
Unfortunately, the neurologist was unable to answer some of my questions and is not available tomorrow (they work in a very busy emergency clinic). We have a two week follow up after they return from vacation, but I'd really like it if I can get some things rolling and not wait two weeks if I dont have to. They're going on vacation? Did they give you someone you can contact while they are away? Is there someone still there who you can talk to? My hope is some of the more experienced fur parents on here may be able to provide advice from experience. I realize you are not vets, but a lot of things I've read on here have been more helpful than what the clinic has provided because of your personal experiences. Long winded, ok my questions:

Physio: I believe this to be a fairly crucial part in recovery, and I will be shown some home care physio, but I mentioned going to a professional PT as well and the neurologist seemed so-so in her answer. Would this not be beneficial for the first little while? They should advise you on this whether they are busy or not, this is important. My understanding is you do only passive range of motion physio following surgery. Doing active physio too soon could be detrimental. They should tell you what is allowed, and when it is allowed. There are a few things going on with a disk injury. At first the disk was putting pressure on the spinal cord, but the surgery removed the pressure. Along with the disk injury there were some chemical changes that occurred, and there needs to be healing from that. And because of the injury and the surgery itself, there is swelling that needs to go down. As far as I know, it is really important to rest him quietly and let the surgery heal and the swelling go down, which takes several weeks. Active exercise involving force or pressure or resistance or weight bearing will make it harder for the swelling to go down. You can't stop him from moving around or trying to stand up, but beyond that he should just rest. After the surgery is healed and the swelling goes down, then you could start to assess his condition and begin PT. I thought they may have other techniques? Yes, there are passive physical therapy modalities like cold laser that are safe to do soon after surgery. If you can afford it that would be worth looking into. The other thing I thought of trying was hydrotherapy, for three reasons really; first,to help build his muscle and do our best to counter the muscle atrophy; second, to allow his legs to do some work more easily; Yes, hydrotherapy can be done with cats. They need to tell you when it is allowed. Different surgeons have different guidelines based on their own knowledge of what is appropriate for the kind of surgery that was done. This type of injury is not something where, if you don't jump right in and do a bunch of PT, you will have a poorer result. Kind of the opposite. It is more like, you go step by step. You do surgery, you wait for the surgery to heal. Then you start a steady routine of appropriate PT and plan on continuing it for weeks or months. Nerves heal very slowly, but they do heal. I totally understand you don't want to miss doing something that would help, and then look back later and regret you missed your chance because you didn't know. Your cat is lucky to have someone willing to do whatever it takes. If you are like me and kind of Type A, the hardest thing is to just sit on your hands and wait, you want to get going, do something, make good things happen. But with nerve damage, good things come with time, and because of the need for healing from surgery, working the pet too soon can actually result in poorer or slower results. There are conditions where aggressive PT is desireable, for example with a stroke they might tell you to start PT immediately, but disk surgery seems to be different. The hospital really needs to tell you what is allowed and when. Ideally they should write it down and send it home with you, so you have something to refer to. I can't speak for the vet, but I suspect you will be told to rest him till the recheck, and then proceed from there. third, my boys is a tad chunky (not obese) and could benefit from some weight loss to make life easier. I know cats hate water, I would like to try it though, has anyone done this with their cat? Did you notice any extra benefits over land physio? I haven't done it with a cat, but I have done it with my small dog, and I have seen quite a few videos of cats doing hydrotherapy, and I would try it when he is given permission. One thing I can say is, if he does not seem to like it at first, do not assume he is a cat and will never like it. My dog did not like hydrotherapy at first and even got scared, but by starting with very short sessions in the water, then gradually making them longer, she came to love it.

Acupuncture: I have read this is a helpful treatment for this kind of injury, I get it myself, and wondered if it would be worth doing for him? If so, is it something I could start right away? Or does it have to wait a bit post surgery? With dogs you can start right away.

:arrow: :arrow: http://www.dodgerslist.com/literature/h ... ncture.htm

Bladder things: I've read a lot already on this, he will be a manual expression for the time being, or maybe forever, who knows and he dribbles when half full. While he is on cage rest, is it better to leave a diaper off him and just put a pee pad down? My husband and I both work full time jobs and though we've arranged our schedules best we can, he will still have a couple days in the week he is alone for 8 hours, is there anything I should do to make sure he is comfortable for longer periods? This is the most important thing right now. Hopefully he will be easy to express, but it would be good if you could try it once at the vet clinic on the exam table, so they can teach you. Also, not trying to cause worries, but just keep in the back of your mind, it is possible you may have some stress trying to express him the first few times, and if you can't get it done at first, you will need to be able to take him back to the vet to be emptied. It sounds like both of you work, so hopefully one of you has some sick leave or comp time or flex time or something, so you can take him to the vet if needed. I'm only saying this because expressing is something you learn by doing, and some people here have had to go back for a second lesson. It sounds like he may not be hard to express since he dribbles when half full, so you may be lucky and have no trouble at all. Tips on expressing, with many videos at the end of the article, are here:

:arrow: :arrow: viewtopic.php?f=5&t=16027

If you keep him on cage rest with potty pads, I am not sure they will be absorbent enough(?) It might be better to have him on some thick towels, and just plan to do laundry every day. Those potty pads are probably going to bunch up under him if he moves around in his crate. If it was my cat, I would leave the diaper off while he is on cage rest. Just keep an eye on his skin. By the way, is the incision in a spot that would be under the waistband of a diaper? Just curious. If he is not dribbling constantly, he'll likely be OK without one. If he dribbles a lot and develops redness on his skin, then having a diaper to absorb the urine will help keep the skin drier and healthier. Being alone for 8 hours should not be a problem. The only thing to keep in mind is they may be sending him home with a cone collar, I don't know. If that's the case, he won't be able to clean his fur or drink water until you come home and take it off. If you work close enough that you could dash home on your lunch hour and check on him and give him a drink, that would be nice. As for the towels, if you don't have any old ones, they have white bath towels for $1.99 at WalMart. You may have to look around till you find them, because they also have some for $2.99 and higher, but the $1.99 ones are perfectly good if you can find the display. I buy them by the stack here. :)
:collar:
Medication: I've read a couple posts regarding a drug called Nivalin. I couldn't find much info on its use in animals aside from a couple articles I couldn't understand, and the one or two posts on here regarding Sasha. I want to ask the neurologist about this, but is it beneficial? Has anyone tried it for a cat, or can cats not have it? Is it pricey?

Last question: What do you all do with your paresis/paralyzed kids when you are out or at work? Do you restrict them to a room or a crate? or let them roam free? I'm mildly afraid to do this, once he is more healed and able to come out because he is "that cat": who would try to do something silly and I'm afraid he'd get hurt, is that really a legit concern? How do the FT employed manage their special fur kids in this respect? Once he is fully healed he should be able to have the run of the house. Since you know him, you may want to have a look around and see if there are any changes that need to be made for his convenience or safety. Here is a wonderful video to give you an example.

:arrow: :arrow: http://www.youtube.com/watch?v=QdIBtw8_7No

I am remaining positive, and am hopeful for a recovery of some kind whether full or partial. It will be a long road for the both of us I'm sure, and I'm sure my anxious thoughts will come and go (especially while learning to express his bladder..which I hope I learn quick!). Coming across this forum was a god send in anxiety reduction though, reading post after post made me more and more motivated and positive, I hope all of you taking the time to share your knowledge and experiences with others know how awesome you are :wub: Very glad you found the forum. I suspect the first couple of weeks will go pretty fast. You spend a lot of time and attention fine tuning your daily routine at first, the crate, the expressing, etc. It's all a little different at first, but soon it will become the new normal. Hope you will post your experiences to pass on the wisdom for others who will be looking for answers. And pictures are always enjoyed! :D
:thankyou:


Thank you for that great reply. Especially the physio part, First I'm def that person that is all over how to help, make it better and so on...but waiting makes sense, I figured there would be a lot of resting, but didn't know anything aside from passive ROM could hinder the healing :shock: . From what I was told, the RVT will be teaching us how to express him tomorrow during one of his designated expression times, which is fine, but we wont be meeting with the vet at all so... I'd hope they would send us home with care instructions at the very least and that she will relay some info to us. She didn't mention any of that on any calls and mentioned 'making a plan' for him so I thought we'd have an appointment with them before going home but I guess not. I will be asking about anything the RVT may not mention, including who to contact when they are on vacation.

In regards to the expression, we have a local clinic that is 24/7 that happened to be the clinic to see BB when this all started, so if we struggle on bladder expression we have a place already familiar with his situation for back up and I work for an animal shelter, so they tend to be fairly understanding. That said, this has been my biggest worry/point of stress. Im sure we'll get it eventually..I'm praying I get it sooner than later but I am nervous, my husband even more so but we are both dedicated to learning how.

I will definitely share/update on our newest journey in pet ownership as we go along (maybe not right away as it will be a little stressful in beginning I'm sure)
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Re: Post herniated disc surgery advice?

Postby critters » Thu Nov 29, 2018 10:07 am

:slant: I'm having a hard time replying because the coding changes after I hit the reply button, but I'll try to do it in several posts.

I've done hydrotherapy, and, in addition, it helps them to get used to baths, which tend to happen a lot with spinal cord injuries. I used life jackets so she could have some independence. I didn't use hydro with any of the SCI furs because they got better so quickly, but I had a girl with severe brain damage.

Expressing, especially for pee, is the biggest thing when they come home, if you ask me. It takes some practice to feel the "water balloon," so I'm glad you have help on that front. Not every vet thinks we can learn to do it, and not every vet is willing or able to teach it.

Cats typically recover pretty quickly, and most don't want to be cooped up long. :twisted:

You can find pee pads that are more absorbent, but they're rare and more expensive. Normal pee pads don't cut it, but you can use them underneath, to protect bedding, and use smaller or more easily washable things on top of them, in case he leaks.

Have they told you about gabapentin? Just like humans, critters can get feelings of bugs, pins and needles, etc. as the nerves recover. There are also meds that can help with pee; in my experience, some are better for a spastic (tight) bladder and others for a hypotonic (floppy) one. I've never heard of Nivalin.
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Re: Post herniated disc surgery advice?

Postby BBs mom » Sun Dec 02, 2018 12:33 pm

Thank you for the welcome! Sorry for a late reply, I've been extra busy since our poor guy just can't get a break, he developed a URI on his last days of hospital stay :(

critters wrote::slant: I'm having a hard time replying because the coding changes after I hit the reply button, but I'll try to do it in several posts.

I've done hydrotherapy, and, in addition, it helps them to get used to baths, which tend to happen a lot with spinal cord injuries. I used life jackets so she could have some independence. I didn't use hydro with any of the SCI furs because they got better so quickly, but I had a girl with severe brain damage.

>He has had to have a couple bum baths already as we struggle to find a diaper to fit properly :\. We got in touch with a rehab specialist who has rehabbed some pretty severe kitties with land and hydro therapy, she is coming to our home to assess him and see what we can do both at home, and later at their facility if needed, he's a bit of a beefy boy so I almost thought hydro may still benefit even from a weight loss stand point later on. Since my last post he has made some good strides; he now bears weight on his legs, though it is in a hunched position due to flat legged stance and walks (awkwardly lol) on his own for a bit (though we are still keeping him very limited, this is usually only in our small bathroom so not very much room to walk far anyway). His previously limp noodle tail is actually showing signs of gaining sensation back! It's almost as if..I'm watching it in reverse..as in, his current status is just like the early symptoms he presented, if that makes sense? I truly didn't expect to see such gains only 9 days post op

Expressing, especially for pee, is the biggest thing when they come home, if you ask me. It takes some practice to feel the "water balloon," so I'm glad you have help on that front. Not every vet thinks we can learn to do it, and not every vet is willing or able to teach it.

> We are still struggling to "feel" his bladder..everyone says water balloon but..I don't seem to feel that. We've currently been using expression/manual stimulation and seem to have success with that and get some good streams with a couple breaks in between, however I have no success with expression on it's own, plus it makes it hard to know if I've fully expressed or not when I can't find his bladder consistently. I've watched so many videos, and sometimes I think I can feel it but then it gets smaller and I lose it, it's probably because he's chunky, not obese but still have to dig further. This continues to be our biggest stress and think I need to visit the vet again and try expressing in front of them then let them feel it and tell me. He will still dribble, but it's much less than before. With sensation ever so slightly returning to his tail, I now am not sure if he dribbles less because we are expressing him well or if his sphincter is tighter...I've looked here, but just wondering if there is a particular method many have had success with? We've done on side and standing with similar results


Cats typically recover pretty quickly, and most don't want to be cooped up long. :twisted:

> Right!? His URI is in recovery and his motor skills have semi returned...in cat world that means let me out! I'm ready to rock!


You can find pee pads that are more absorbent, but they're rare and more expensive. Normal pee pads don't cut it, but you can use them underneath, to protect bedding, and use smaller or more easily washable things on top of them, in case he leaks.

> Both of you were right, normal ones are not absorbent enough (just from expressing onto them I noticed this). I'm lucky enough to work for a humane society and we get abundances of towels/blankets donated..far more than we can use so I can take from our overflow. I got some washable pads that are quite good for absorbing and give him thick towels and blankets to lay on and just change them a couple times daily (my laundry has..increased exponentially lol)

Have they told you about gabapentin? Just like humans, critters can get feelings of bugs, pins and needles, etc. as the nerves recover. There are also meds that can help with pee; in my experience, some are better for a spastic (tight) bladder and others for a hypotonic (floppy) one. I've never heard of Nivalin.

>He was on gabapentin pre surgery, but post surgery he was sent home with no meds at all since they decided he was not in pain. I half disagree, while he's probably not in huge amounts of pain, if we shift him around slightly he sometimes will get upset especially on his left side, which is the side slowest to recover. I didn't know that happened with nerve recovery, poor guy! I've since asked my vet if we can continue the gabapentin and she said that was fine. He came home with a hypotonic bladder I think (it dribbled a lot if 3/4 full), but he dribbles a lot less now and as I said above I'm not sure if some semblance of sensation is returning and its getting tighter, or if we are doing good at expressing him....how would I know if he has a spastic bladder? Is there something different I would notice? What do the meds do, help tighten/loosen? I saw nivalin on one post here, since then though I don't think he'd require such a drug since he seems to be regaining quickly.
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Re: Post herniated disc surgery advice?

Postby CarolC » Mon Dec 03, 2018 1:31 am

That is extremely cool that you work at an animal shelter! :trophy: :trophy: :trophy: Yes, bet you are going through towels galore. Now you know the reason why there are so many laundry smilies on the forum
:wash: :laundry:
not to mention cleaning smilies.
:mop: :vacuum: :scrub:
You might like to have a separate laundry basket or laundry bag for his laundry. They don't cost much if you feel like giving yourself a little treat and feeling organized. I just posted about cheap laundry detergent a couple of weeks ago. I don't know if they carry it where you live, but here was the post. :wink:

viewtopic.php?f=5&t=20057

It is wonderful that there is a therapist who will come to your house for the evaluation. Between the ability to stand (even if he is still down on his hocks) and seeing improvement in his tail, that is encouraging. I agree, I might have expected slower progress. There is something that may not exactly apply here, but have you heard of the 80/20 law? It's a general observation that often if it takes 100% of effort to complete a job, you will spend 20% of effort to get the first 80% of the job done, then the other 80% of effort to complete that last 20%. It doesn't exactly have anything to do with recovery from paralysis, but I guess I thought of it because you often see the majority of improvement in the first 6 months or so, but recovery from paralysis continues literally for years. For what it's worth, I have a very senior cat who walks down on her hocks, and that's just the way it is, but she is fine. Here is a picture of another kitty, Fripple, who also walked that way. This may just be temporary for your cat, but if it isn't he can still be a happy cat.

Fripple2.png
Fripple2.png (125.21 KiB) Viewed 340 times


You are probably right about his weight and expressing. It would make it harder to feel what you're doing if he's chunky. If you are succeeding with the expressing/external stimulation combo, maybe that is the best way for him, it doesn't matter how you do it, just getting it done. It seems like different methods work better for different pets, and you've found one that works. Great!! When you say you have tried various methods, I'm assuming you looked at all the videos at the end of the expressing article, right?

viewtopic.php?f=5&t=16027

Possibly his bladder is closer up to the spine than you might think from an anatomy chart, and that makes it hard to feel. The only way which works for me is to fish it down closer to the underbelly. With the cat in a standing position, I dig into his sides between the bladder and the spine, in order to have my fingers in position to move it down. If I were to try to express with it up there in the position where it naturally rides, I'd get nowhere. It only sounds impossible because people don't take into account how pliable the cat's abdomen is. If you have seen vets palpate the abdomen, you know that with a careful practiced hand, you can dig way into the abdomen like a very deep massage. I do not politey squeeze from the outside like playing an accordion. I form my hand into the letter 'C' (aka lobster claw), place my palm on the tummy, dig my fingers in (poking well into the sides) till I work the bladder down toward the palm of my hand, and then squeeze. I don't know if this is doable with an overweight pet, you'd have to experiment and see. But it sounds like you've already got a good method, so woohoo!

I did a video one time using a stuffed toy, trying to show what I mean about really digging my fingers in. Here is the link. I really don't know if the video is helpful or ridiculous. The point was to show how you can poke your fingers in, and by doing that on both sides, you can pop the bladder down toward the palm of your hand. The video is in this post

viewtopic.php?f=5&t=17272&p=90169#p90165

As for the pain meds, being in pain can make an animal tense up the abdomen, and you are trying to express him, you're better off with him relaxed, not tense with pain. And of course you just want him to be comfortable anyway. So if you feel like maybe you need to advocate for him a little, I'd go ahead and do it. They are depending on you to report what's going on. I know I would want pain meds if I just had back surgery. It's too bad he got a URI on top of everything else. Glad he is on the mend from that. :)
:medicine:
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Re: Post herniated disc surgery advice?

Postby critters » Mon Dec 03, 2018 10:28 am

BBs mom wrote:Thank you for the welcome! Sorry for a late reply, I've been extra busy since our poor guy just can't get a break, he developed a URI on his last days of hospital stay :(

critters wrote::slant: I'm having a hard time replying because the coding changes after I hit the reply button, but I'll try to do it in several posts.

I've done hydrotherapy, and, in addition, it helps them to get used to baths, which tend to happen a lot with spinal cord injuries. I used life jackets so she could have some independence. I didn't use hydro with any of the SCI furs because they got better so quickly, but I had a girl with severe brain damage.

>He has had to have a couple bum baths already as we struggle to find a diaper to fit properly :\. We got in touch with a rehab specialist who has rehabbed some pretty severe kitties with land and hydro therapy, she is coming to our home to assess him and see what we can do both at home, and later at their facility if needed, he's a bit of a beefy boy so I almost thought hydro may still benefit even from a weight loss stand point later on. Since my last post he has made some good strides; he now bears weight on his legs, though it is in a hunched position due to flat legged stance and walks (awkwardly lol) Yes, hock walking is very common, and the toes can contract as well. He may need shoes to help prevent skin breakdown if it goes on too long, and my Koi Boy, who'd been shot in the spine, had to use both custom shoes and custom splints because of his contractures. on his own for a bit (though we are still keeping him very limited, this is usually only in our small bathroom so not very much room to walk far anyway). His previously limp noodle tail is actually showing signs of gaining sensation back! It's almost as if..I'm watching it in reverse..as in, his current status is just like the early symptoms he presented, if that makes sense? Yes, makes perfect sense, and that's usually how it works, at least in a ballpark.I truly didn't expect to see such gains only 9 days post op

Expressing, especially for pee, is the biggest thing when they come home, if you ask me. It takes some practice to feel the "water balloon," so I'm glad you have help on that front. Not every vet thinks we can learn to do it, and not every vet is willing or able to teach it.

> We are still struggling to "feel" his bladder..everyone says water balloon but..I don't seem to feel that. We've currently been using expression/manual stimulation and seem to have success with that and get some good streams with a couple breaks in between, however I have no success with expression on it's own, plus it makes it hard to know if I've fully expressed or not when I can't find his bladder consistently. I've watched so many videos, and sometimes I think I can feel it but then it gets smaller and I lose it, it's probably because he's chunky, not obese but still have to dig further.
Probably so. This continues to be our biggest stress and think I need to visit the vet again and try expressing in front of them then let them feel it and tell me. He will still dribble, but it's much less than before. With sensation ever so slightly returning to his tail, I now am not sure if he dribbles less because we are expressing him well or if his sphincter is tighter... Could be either. I've looked here, but just wondering if there is a particular method many have had success with? We've done on side and standing with similar results I had to put Buddy on his back on a folded towel to get to his.I hope this turns out so you can read it, with all the coding, colors, and either this terminal or the network being wonky!!

Cats typically recover pretty quickly, and most don't want to be cooped up long. :twisted:

> Right!? His URI is in recovery and his motor skills have semi returned...in cat world that means let me out! I'm ready to rock!


You can find pee pads that are more absorbent, but they're rare and more expensive. Normal pee pads don't cut it, but you can use them underneath, to protect bedding, and use smaller or more easily washable things on top of them, in case he leaks.

> Both of you were right, normal ones are not absorbent enough (just from expressing onto them I noticed this). I'm lucky enough to work for a humane society and we get abundances of towels/blankets donated..far more than we can use so I can take from our overflow. I got some washable pads that are quite good for absorbing and give him thick towels and blankets to lay on and just change them a couple times daily (my laundry has..increased exponentially lol)

Have they told you about gabapentin? Just like humans, critters can get feelings of bugs, pins and needles, etc. as the nerves recover. There are also meds that can help with pee; in my experience, some are better for a spastic (tight) bladder and others for a hypotonic (floppy) one. I've never heard of Nivalin.

>He was on gabapentin pre surgery, but post surgery he was sent home with no meds at all since they decided he was not in pain. I half disagree, while he's probably not in huge amounts of pain, if we shift him around slightly he sometimes will get upset especially on his left side, which is the side slowest to recover. I didn't know that happened with nerve recovery, poor guy! I've since asked my vet if we can continue the gabapentin and she said that was fine. He came home with a hypotonic bladder I think (it dribbled a lot if 3/4 full), but he dribbles a lot less now and as I said above I'm not sure if some semblance of sensation is returning and its getting tighter, or if we are doing good at expressing him....how would I know if he has a spastic bladder? Is there something different I would notice? What do the meds do, help tighten/loosen? I saw nivalin on one post here, since then though I don't think he'd require such a drug since he seems to be regaining quickly.
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Re: Post herniated disc surgery advice?

Postby critters » Mon Dec 03, 2018 10:44 am

BBs mom wrote:Thank you for the welcome! Sorry for a late reply, I've been extra busy since our poor guy just can't get a break, he developed a URI on his last days of hospital stay :(

critters wrote::slant: I'm having a hard time replying because the coding changes after I hit the reply button, but I'll try to do it in several posts.

I've done hydrotherapy, and, in addition, it helps them to get used to baths, which tend to happen a lot with spinal cord injuries. I used life jackets so she could have some independence. I didn't use hydro with any of the SCI furs because they got better so quickly, but I had a girl with severe brain damage.

>He has had to have a couple bum baths already as we struggle to find a diaper to fit properly :\. Yes, I found that Buddy needed a MUCH bigger diaper than a human of the same weight would wear.We got in touch with a rehab specialist who has rehabbed some pretty severe kitties with land and hydro therapy, she is coming to our home to assess him and see what we can do both at home, and later at their facility if needed, he's a bit of a beefy boy so I almost thought hydro may still benefit even from a weight loss stand point later on. Since my last post he has made some good strides; he now bears weight on his legs, though it is in a hunched position due to flat legged stance and walks (awkwardly lol) on his own for a bit (though we are still keeping him very limited, this is usually only in our small bathroom so not very much room to walk far anyway). His previously limp noodle tail is actually showing signs of gaining sensation back! It's almost as if..I'm watching it in reverse..as in, his current status is just like the early symptoms he presented, if that makes sense? I truly didn't expect to see such gains only 9 days post op

Expressing, especially for pee, is the biggest thing when they come home, if you ask me. It takes some practice to feel the "water balloon," so I'm glad you have help on that front. Not every vet thinks we can learn to do it, and not every vet is willing or able to teach it.

> We are still struggling to "feel" his bladder..everyone says water balloon but..I don't seem to feel that. We've currently been using expression/manual stimulation and seem to have success with that and get some good streams with a couple breaks in between, however I have no success with expression on it's own, plus it makes it hard to know if I've fully expressed or not when I can't find his bladder consistently. I've watched so many videos, and sometimes I think I can feel it but then it gets smaller and I lose it, it's probably because he's chunky, not obese but still have to dig further. This continues to be our biggest stress and think I need to visit the vet again and try expressing in front of them then let them feel it and tell me. He will still dribble, but it's much less than before. With sensation ever so slightly returning to his tail, I now am not sure if he dribbles less because we are expressing him well or if his sphincter is tighter...I've looked here, but just wondering if there is a particular method many have had success with? We've done on side and standing with similar results


Cats typically recover pretty quickly, and most don't want to be cooped up long. :twisted:

> Right!? His URI is in recovery and his motor skills have semi returned...in cat world that means let me out! I'm ready to rock!


You can find pee pads that are more absorbent, but they're rare and more expensive. Normal pee pads don't cut it, but you can use them underneath, to protect bedding, and use smaller or more easily washable things on top of them, in case he leaks.

> Both of you were right, normal ones are not absorbent enough (just from expressing onto them I noticed this). I would express Buddy into a baby diaper, then dump it when it was full. I'm lucky enough to work for a humane society and we get abundances of towels/blankets donated..far more than we can use so I can take from our overflow. I got some washable pads that are quite good for absorbing and give him thick towels and blankets to lay on and just change them a couple times daily (my laundry has..increased exponentially lol)

Have they told you about gabapentin? Just like humans, critters can get feelings of bugs, pins and needles, etc. as the nerves recover. There are also meds that can help with pee; in my experience, some are better for a spastic (tight) bladder and others for a hypotonic (floppy) one. I've never heard of Nivalin.

>He was on gabapentin pre surgery, but post surgery he was sent home with no meds at all since they decided he was not in pain. I half disagree, while he's probably not in huge amounts of pain, if we shift him around slightly he sometimes will get upset especially on his left side, which is the side slowest to recover. I didn't know that happened with nerve recovery, poor guy! I've since asked my vet if we can continue the gabapentin and she said that was fine. He came home with a hypotonic bladder I think (it dribbled a lot if 3/4 full), but he dribbles a lot less now and as I said above I'm not sure if some semblance of sensation is returning and its getting tighter, or if we are doing good at expressing him....how would I know if he has a spastic bladder? A spastic bladder takes more pressure than normal. Is there something different I would notice? What do the meds do, help tighten/loosen? Yes. I saw nivalin on one post here, since then though I don't think he'd require such a drug since he seems to be regaining quickly.

That computer terminal blew and took the post I was doing, so I've tried to reconstruct it. I may have repeated stuff.
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Bladder meds

Postby FYI » Mon Dec 03, 2018 11:49 am

https://www.vin.com/VINDBPub/SearchPB/P ... R00442.htm wrote:The Leakers: Disorders of Micturition and Continence

Melissa S. Wallace, DVM, Dipl. ACVIM
Definition & Overview

A disorder of micturition is a lack of voluntary control over the elimination of urine. Disorders of micturition include disorders of urine retention (incontinence) and disorders of bladder emptying, which may or may not be accompanied by incontinence. True incontinence must be differentiated from inappropriate voiding of urine (i.e. behavior problems), lower urinary tract diseases causing pollakiuria, and from polyuria/polydipsia resulting in voluntary voiding in inappropriate places.

Normal Micturition (i.e. Neurology for Dummies)

There are two phases of normal micturition; the storage phase and the bladder-emptying phase. During the storage phase, the detrusor muscle progressively relaxes while the urethral sphincter tone remains high, which allows the bladder to hold a gradually increasing volume of urine. During the emptying phase, the detrusor muscle contracts while the urethral sphincter relaxes, allowing the urine to be eliminated.

The bladder muscle (detrusor) is smooth muscle that is supplied by both sympathetic (beta-adrenergic) and parasympathetic (cholinergic) receptors. Sympathetic stimulation causes relaxation, and parasympathetic stimulation causes contraction. The internal urethral sphincter is composed of smooth muscle fibers in the trigone and proximal urethra, and contains sympathetic (alpha-adrenergic) receptors. When these receptors are stimulated, increased urethral tone is achieved, which is the normal 'resting' state. The external urethral sphincter is striated muscle, and is supplied by somatic neurons via the pudendal nerve.

Normal micturition requires stimulation of the parasympathetic receptors in the detrusor, with a simultaneous decrease in sympathetic and somatic tone to relax the urethra and allow complete contraction of the bladder. Any imbalance in the coordination of these 'arms' of the nervous system can result in a micturition disorder. The parasympathetic and somatic control arises from the sacral spinal cord segments (S1 - S3) and travels via the pelvic and pudendal nerves, respectively. The sympathetic nerves leave the spinal cord at segments L1-L4 via the hypogastric nerve. Higher centers in the cerebral cortex, brainstem, cerebellum, and thalamus modify the reflex through the spinal cord. This complex system can be interrupted at many points from the brain to the bladder.

Causes of Incontinence

Incontinence is categorized for diagnostic evaluation based on history, observance of the animal's micturition, and physical examination findings. No other aspect of internal medicine is so dependent on these basic skills and less dependent on diagnostic testing. This is why these cases are often so frustrating to inexperienced clinicians or to those who do not routinely evaluate urologic patients.

An animal that can eliminate urine normally and has a small bladder after voluntarily voiding, but is incontinent during what should be the storage phase characterizes a disorder of urine storage. A disorder of bladder emptying is characterized by incomplete voiding, so that the animal maintains a large bladder, and the incontinence is usually an overflow problem. A normal dog or cat should have < 0.2 - 0.5 ml/kg of urine in the bladder after voluntarily voiding. Once the disorder is divided into either a disorder of storage vs. emptying, the search for an underlying cause can often be narrowed. There are neurogenic and non-neurogenic causes, as described below.

1. Neurogenic Origin - Upper Motor Neuron

A lesion cranial to the sacral spinal cord segments causes disruption of the inhibitory control by the higher centers, so that sympathetic tone remains inappropriately high during the micturition reflex. If the pelvic nerve is intact the detrusor will contract, but the urethral sphincter fails to relax, resulting in a poor urine stream and incomplete emptying of the urinary bladder. Over time, increased urine volume will cause bladder distention and an atonic detrusor muscle. When this becomes chronic, it is irreversible, which is why aggressive bladder management is so critical in cases of UMN bladder dysfunction.

An incoordination of the sympathetic with the parasympathetic actions of voluntary micturition is often termed reflex dyssynergia, and in some cases this can occur as an idiopathic condition without other apparent neurologic deficits.

2. Neurogenic Origin - Lower Motor Neuron

Lesions of the sacral spinal cord segments, pelvic nerve, and/or pudendal nerve cause reduced or absent pelvic sensation and loss of detrusor contraction. The bladder muscle will be flaccid and overdistended, which will lead to damage of the tight junctions of the detrusor and permanent bladder atony. As increased intravesicular pressure exceeds urethral outflow resistance, overflow incontinence will result.

3. Nonneurogenic Conditions

Anatomic abnormalities can result in incontinence, and these are often congenital conditions. Examples are ectopic ureter, urethral hypoplasia, pelvic bladder, urethrovaginal fistula, and congenital urethral sphincter mechanism incompetence. Acquired anatomic defects of the urethra or bladder can result from infiltrative disease, prostatic disease, uroliths, trauma or surgery.

Paradoxical incontinence is caused by partial or intermittent obstruction of the urethra that allows leakage around the obstruction when the bladder is full. Sometimes these animals leak urine at rest, but are obstructed when they attempt to voluntarily void. Examples are urethral calculi, neoplasia, and prostatitis/urethritits.

Urge incontinence is caused by severe irritation or inflammation of the urinary bladder. This causes a sensation of fullness and initiates a micturition reflex at a low filling volume. Cats with severe FLUTD often exhibit this type of incontinence, as do some dogs with cystic calculi or severe bacterial cystitis. The pet may act suddenly anxious, because he feels an urgency to urinate that he can not control. Detrusor instability (detrusor hyperreflexia) is an idiopathic functional disorder in which the bladder contracts at a very low filling volume, but the pet usually does not feel a sense of urgency. This condition is uncommon in veterinary patients, and results in frequent small volumes of urine being involuntarily voided.

Stress incontinence is the most common form of incontinence in dogs, and is more appropriately termed urethral sphincter mechanism incompetence. It is also called spay incontinence or hormone-responsive incontinence. The bladder emptying part of the micturition reflex is normal, but when the dog is at rest and the bladder is full, the internal sphincter tone is insufficient to prevent leakage of urine. The incontinence is typically at night or when the dog is relaxed, and is usually several hours after the dog has voided. This problem is most commonly seen in middle-aged spayed female dogs, but can be seen with other signalments. Causes are multifactorial, but individual anatomy, a pelvic location of the internal urethral sphincter due to removal of the broad ligaments during OHE, and lack of estrogenic stimulation to the receptors in the internal sphincter are all possible contributing factors. A dog with marginal internal urethral sphincter tone that becomes PU/PD may exhibit this type of incontinence as well.

Detrusor areflexia (atonic bladder) is a large flaccid bladder that can not contract, resulting in overflow incontinence. A lower motor neuron disorder may cause this, but so can any condition that causes chronic physical or functional urethral obstruction, which results in damage to the tight junctions of the smooth muscle of the detrusor. Urine retention with a large bladder is always considered a medical emergency, and should be managed by indwelling or intermittent urethral catheterization while a diagnosis of the underlying cause is being sought. Urinary retention is often accompanied by secondary bacterial infection.

Diagnostic Approach to Incontinence
History


This is the most important and difficult aspect of a micturition disorder evaluation. Terms like incontinence are often misunderstood by the client, and should be avoided. Try to find out what the owner is actually observing the pet doing that is abnormal or different than before. The owner should be questioned about any straining or interruption of the urine stream. The description of how and when the pet leaks urine is very important. Incontinence must be differentiated from pollakiuria or polyuria. Leakage of urine only at rest or during sleep is very suggestive of urethral sphincter mechanism incompetence. The pet's age may suggest the cause, as young dogs and cats are more likely to have congenital abnormalities. Geriatric pets are more prone to prostatic diseases or neoplasia, and young adult to middle-aged pets are more commonly affected with uroliths. A history of trauma or surgery may suggest the cause. Other signs such as fecal incontinence, changes in tail movement and/or lameness may suggest a neurologic problem.

Physical Examination

In micturition disorders careful attention should be paid to the size and position of the urinary bladder. A rectal examination and digital vaginal examination or preputial examination should be performed. A neurologic examination with particular attention to perineal reflex, anal tone, perineal sensation, tail movement, and conscious proprioception in the rear legs is important. After the P.E., it is helpful to observe the animal's micturition behavior. Palpation of the urinary bladder after voiding will help to distinguish whether the disorder is of storage vs. elimination. If the bladder size is difficult to palpate, measuring residual urine volume by passing a urethral catheter is advised. This will also help in ruling out partial urethral obstructions.
Minimum Data Base

The initial evaluation will include a CBC, chemistry profile, urinalysis and urine culture. Survey abdominal radiographs are necessary in most cases. These initial tests are useful to rule out urinary tract infection, urolithiasis, many causes of PU/PD and metabolic diseases.

Case-based Diagnostic Testing

Depending on the results of the history, P.E. and minimum database, the work-up can be tailored to the most likely causes. If the pet has evidence of a neurogenic cause, then a neurologic work-up or referral is indicated (e.g. spinal radiographs, myelography, epidurography, MRI, etc.).

If the neurologic examination is normal, then an evaluation of the lower urinary tract for structural disease is indicated, and the approach will depend on the age of the pet and the type of incontinence or voiding abnormality. For ectopic ureter evaluation, both an IVP and a complete lower urinary tract study (double and positive contrast cystogram plus vaginourethrogram) are often necessary. Finding evidence of hydronephrosis, hydroureter and pyelonephritis in a young dog (e.g. with ultrasound) is strong evidence that an ectopic ureter may be present. Cystoscopy and/or abdominal exploratory with cystotomy are often needed to complete the evaluation if structural disease is suspected from the contrast studies; these evaluations are often done by a soft tissue surgical specialist who can repair the defect at the same time.

Functional evaluation of the lower urinary tract requires urodynamic studies, such as a cystometrogram and/or a urethral pressure profile. A cystometrogram records the intravesicular pressure during bladder filling and detrusor contraction. A urethral pressure profile measures the intraluminal pressure over the length of the urethra during the filling phase. Simultaneous cystometry and uroflowmetry evaluates the micturition reflex during both the storage and voiding phase, but is technically more difficult and invasive. Because these studies are not routinely available to most clinicians, it is common to estimate the micturition dynamics based on astute observation, meticulous history and physical examination skills, and ruling out structural disease by ultrasonography and contrast radiography. Sometimes, response to pharmacological manipulation can further help to elucidate the disorder.
Therapy of Incontinence and Micturition Disorders

Urethral Sphincter Mechanism Incompetence

1. Diethylstilbestrol (DES); a synthetic estrogen, this may increase internal urethral sphincter sensitivity to catecholamines, or stimulate estrogen receptors within the sphincter. The dose is 0.1 - 1 mg PO SID x 5 days, then 1 - 3 times weekly. Small dogs receive 0.1 mg. size. Large and giant breed dogs receive 1 mg size. Medium sized dogs 0.25 mg size. Dosing is somewhat empirical; use caution to avoid estrogen toxicity (bone marrow suppression).

2. Phenylpropanolamine (PPA); this alpha-agonist stimulates the alpha-adrenergic receptors within the internal urethral sphincter, increasing resting urethral tone. The dose is 1 - 1.5 mg/kg PO BID - TID. Side effects are hyperactivity and hypertension. This drug may work in conjunction with DES in refractory cases. Down-regulation of the receptors may occur with time, but with cessation of the drug the receptors will become sensitive again.

3. Ephedrine; this is an alpha-agonist similar to PPA, but has more side effects such as tachycardia and dry mouth. It is commonly used in countries where PPA is unavailable. The dose is 2 - 4 mg/kg PO BID.

4. Imipramine; This tricyclic antidepressant has anticholinergic and alpha-agonist effects. It may be useful in some cases for urethral sphincter mechanism incompetence and for detrusor instability. Side effects are hyperexcitability, seizures, tremors and tachycardia. The dose is 5 -15 mg PO BID (dogs) and 2.5 - 5 mg PO BID (cats). I have not had good success with this therapy.

5. Estradiol cypionate (ECP); this potent and long-acting injectable estrogen should never be used for incontinence due to the very real risk of estrogen toxicity.

6. Testosterone cypionate; a respositol form of testosterone, which is sometimes useful in castrated male dogs or cats with urethral sphincter mechanism incompetence (a rare disorder). Side effects are prostatic hyperplasia and unwanted male behaviors.

Urge Incontinence and Detrusor Instability

1. Propantheline; an anticholinergic that reduces detrusor contractions. Side effects are dry mucous membranes, constipation and urinary retention with bladder overdistention. The doe is 7.5 - 15 mg PO BID - TID (dog) and 5 - 7.5 mg PO TID (cat).

2. Oxybutynin; this drug has both anticholinergic and antispasmodic (smooth and skeletal muscle relaxing) effects. The dose is 0.1 - 0.2 mg/kg PO BID. A side effect is ileus.

Disorders of Bladder Emptying with Increased Urethral Tone

1. Phenoxybenzamine; this is an alpha-adrenergic blocking agent, which relaxes the internal urethral sphincter. A side effect is hypotension. The dose is 0.25 mg/kg PO TID (dog) and 0.5 mg/kg PO BID (cat). This drug takes 3 - 5 days to reach therapeutic levels. Other alpha-blocking agents with a similar effect on the internal sphincter but more side effects are acepromazine (hypotension, sedation) and prazocin (hypotension). Be cautious when using these drugs simultaneously.

2. Diazepam; this is a centrally acting skeletal muscle relaxant, which decreases external urethral sphincter tone and spasm. Side effects are sedation and incoordination. Hepatotoxicity occurs in cats with repeated oral administration. Other drugs with a similar mechanism are dantrolene and baclofen.

Decreased Detrusor Contractility (e.g. atonic bladder)

1. Bethanecol; this is a cholinergic agent which stimulates detrusor contractions. Side effects are abdominal cramping and gastrointestinal effects. This drug has a weak effect on nicotinic receptors in the internal urethral sphincter, and is therefore best when used in combination with an alpha-adrenergic blocker like phenoxybenzamine. The dose is 2.5 - 10 mg PO BID to TID (dog) and 2.5 mg PO BID (cat). Other agents suggested to increase detrusor tone include metoclopramide and prostaglandin E2.


Pill Book Guide to Medication for Your Dog and Cat wrote:Bethanechol should only be used when the urethra is open, as when a catheter is in place, or with urethral relaxants because bethanechol can cause contraction of urethral smooth muscle as well. Theoretically, the bladder could rupture if bethanechol is given when the urethra is blocked, or in spasm
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Re: Post herniated disc surgery advice?

Postby BBs mom » Tue Dec 04, 2018 6:40 pm

Thank you all again for the responses. I feel like I should have posted in the incontinence section now lol.

CarolC I've watched your method a few times and it does kind of work with him, albiet I've only done it once semi successfully, last night on my own at the vets, but his bladder had only a small amount she said...I cant seem to do it at home on my own, and it doesn't help that I'm pretty sure he is fed up with his bladder being squeezed by a couple newbies that can't feel a bladder for their life apparently :oops:. The vet gave us prazosin last night, as I mentioned he isn't really leaking anymore and I thought he might be getting tighter. She only gave it for 6 days (once a day for 4 days, then every other for two days to wean him off) but I've read that prazosin can take up to 3 days to even work? Also, from what I've read around the forums, Phenoxybenzamine is the usual for that issue...? BTW that's an interesting law, I have not heard of it but it kind of makes sense and could def apply to paralysis/paresis ect, even if it's just general :D I'd be so ok if he only manages to walk on his hocks. He already doesn't seem to care so long as he can get out and move around. My later challenge will be that he is what we like to call an "up cat", I'm sure you can gather what that means lol but I've had my boy for 11 years and he means the world to me, so I have no issues adapting our home to his needs.

I saw the method you mentioned critters about on the back, one of the videos in the "how to express your pet" post had it. That is the only one I haven't been able to try since he is still healing and I'm a little nervous to put him on his back at the moment (how much you want to bet that's the method that works best :lol: )

We have his follow up on Monday with the neurologist, hopefully they can give me more insight on his progress level and where he currently stands, and I have yet more questions for them of course. I really just want to get the expressing down, with two people our method works but on our own I feel like expression would be much better. I'm trying to remain positive, but it's difficult when I feel like A) I'm not getting it B) I'm maybe hurting him, or putting him through discomfort C) I still have no idea what the heck a cat bladder feels like.
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Re: Post herniated disc surgery advice?

Postby CarolC » Thu Dec 06, 2018 12:47 am

When I first got my paralyzed dog, she was a stray who was found injured behind my workplace. She had surgery for a spinal fracture and while she was in the hospital they discovered she was in heat, which may have been why she was running the streets. I spent a month worrying, not knowing if she was pregnant, and not knowing if I was squeezing puppies every time I expressed her bladder. I could not tell what I was feeling when I squeezed those first few weeks. Fortunately, pets survive our learning curve. :)

I suspect your kitty is already associating the sqeezing with a feeling of welcome relief every time you express him. A lot of times the pet can feel he needs to go, he just can't quite make it happen. I know you are worried about whether you are doing it well enough, and how to accomplish it with just one person (I don't blame you), but at the same time I have seen people who are having trouble doing it at all, and that is a whole other level of stress, so I'm glad you aren't in that situation. This whole situation of having a newly paralyzed pet is probably one of the most stressful things most of us have gone through, it's not to be underestimated. And it's partly because you care so much.

Since he just had surgery, that may be making expressing harder. I had already been expressing my paralyzed dog for a year when she needed to be spayed, so I already knew what I was doing. However, in spite of that, following the surgery, I could not get her expressed at first no matter how I tried. The after effects of surgery somehow made her hard to express. It's just something to keep in mind, your cat may become easier to express after he recovers some and the sutures are out. As his nerves improve, in time he may start assisting you and working with you when you squeeze.

One more thing to keep in mind is, it is harder to express when there is stool in the colon. I don't know if you are having any issues with him eliminating. The bowel does more or less take care of itself automatically, but it can be slower and especially with cats, they can develop constipation. If your cat is not eliminating as often and as much as you think is normal for him, you might ask the vet about either lactulose syrup, or something I like better that I use for 2 of my cats, Miralax. It is a whole lot easier to express (and to feel what's what) when the colon is empty.
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Re: Post herniated disc surgery advice?

Postby CarolC » Thu Dec 06, 2018 2:29 am

Sorry for the double post. I went back to add something to my post a few minutes ago and the Internet crashed. It's back up now, so I'll just post again.

I was thinking about the issue of possible constipation. For example, just going on common sense, if you took your cat to the vet for surgery, and he boarded there a week, it is hard to know if he was regular or not. He probably didn't eat the day of surgery, and he was crated with no exercise, and perhaps a narcotic pain reliever to go with the surgery. Possibly he was not drinking as much while in the hospital. Or things may have slowed down because he was not eating as well. Even though they say "the bowel takes care of itself" (and that's true), you still have a recipe for constipation with lack of exercise and medication, drinking less, not eating normally.

It is possible he may have been developing some constipation before he had the surgery. Do you happen to know if he was regular in the days before surgery? I don't know if you and your partner both scoop the litter box, or if one person does it. If two people are doing it, you might not be as aware of whether he was eliminating as much as usual before the surgery, because each person thinks maybe the other partner scooped the box. I don't know, just thinking.

This is not exactly scientific, but if for example you usually scoop about 3" of stool out of the litter box every day, and if he was not regular while in the hospital, he could have several days' worth of stool in his colon if he is mildly constipated. For example, if he was still eating some, but went 4 days without eliminating, there could be 12" of stool in his colon. So then, even if he is eating better now that he is home, and eliminating more normally, it does not necessarily mean he is cleaned out and back to normal.

There was an injured cat here named Angel, who was rescued outdoors with no history. She was paralyzed and after the rescuer started caring for her and expressing her, she eliminated 16" one day and had two more 4" movements the next day.

viewtopic.php?f=10&t=5053
eieiohmy » Sun May 14, 2006 12:08 pm wrote:I really thought after passing about 16 inches of stool on Friday night/Early saturday morning and things were go back to "normal".

Well I was wrong! I often tease my furbabies that they are full of it, but in poor angels case, it is TRUE!

I got up early this morning around 4, we were having a bad storm, thunder, lightning and such. I went in and decided to try and express her. All day yesterday I wasn't having much luck.

Expressing caused two painful bowel movements. Each seeming a normal size, about 4 inches long. The pumpkin I started giving early Friday morning was making it's exit!

Then I woke up this morning around 9 and went in and she had, had another one. It was curled up about 4 inches one way and 4 inches the other. There was also a large wet spot, I figure trying to push that out helped her pee.


A vet can usually tell if there is stool in the colon. If you think your cat might be constipated, the vet could check that. It would not be at all surprising after surgery, and constipation can make it harder to feel the bladder and harder to express. Just a thought. :)
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Re: Post herniated disc surgery advice?

Postby critters » Mon Dec 10, 2018 11:10 am

In my experience with Buddy, phenoxybenzamine (PBZ) was good for a spastic (tight) bladder, and bethanchol was good for a floppy one.
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