Other Topic Incontinent Spay

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CarolC
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Other Topic Incontinent Spay

Post by CarolC »

This will hold little interest for most people currently on the message board, but I am starting this thread and will add to it during the next few days. I want to record of how it went if anyone comes along later who is in the same situation.

Situation is I rescued a female dog with a spinal fracture and rear end paralysis. She was not spayed and I wanted to spay her because she got urinary tract infections both times she was in season. However, I never did it because I have to express her bladder and bowel. This year she was found to have mammary cancer and the oncologist advised spaying her, which was done today.

The day before yesterday I gave her a dose of lactulose. I give it to her twice a week anyway, and this time I gave her a tiny bit more than usual. I wanted her colon to be cleaned out because the two positions I use to express her bowel were both likely to be uncomfortable following surgery. Also, it is harder to express her bladder when she is constipated, and I was worried about that. This morning (day of surgery) I expressed what was left in her colon, and expressed her bladder completely. I did it at 8 AM so I could easily remember how many hours it had been since she was expressed. When I picked her up at the vet I asked if she had moved her bowels or if she had been catheterized, so now I know that she has not moved her bowels or urinated since 8 AM.

Normally I express her 4 times a day, but right now I plan to express her every 12 hours, I don't know for how many days yet. What I hadn't planned on is the fact that she hasn't had anything to drink since this morning, so by 8 PM there may be nothing in her bladder to express. If her bladder is empty or nearly so, I am not going to try any aggressive expressing for a few drops. I assume that many dogs probably do not urinate until the next morning after surgery, and she is on antibiotics. She received antibiotics with her surgery, and will be on amoxicillin as a precaution (plus the fact that they pulled a tooth while she was under). The other thing is she has sutures instead of staples because of our situation. I had a consultation with the surgeon last week so we could discuss any ideas that might make this easier, and sutures were something he suggested.

She is home and is mentally alert but resting. She was given a painkiller that will last till tomorrow morning, and if we need it the vet will give us more pain medication tomorrow. I do not know if she can feel the spay, as it is rearward from her spinal fracture, which was mid-back. I suspect she can feel where they pulled the tooth.
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Bendy Kitty
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Re: Other Topic Incontinent Spay

Post by Bendy Kitty »

i hope the expressing goes well and doesn't bother her incision. that is quite a tricky situation!
hopefully she will pull through ok!

purrrs
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Re: Other Topic Incontinent Spay

Post by CarolC »

First express after surgery. I started trying to express her at 8:10 PM and ended at 8:26 PM with partial success. Gingerly tried the usual position of expressing her one-handed on the bathroom counter. After several fearful attempts I got a few drops of fluid with brown sediment in it. It took a while to understand what I was feeling. Her abdomen was rigid. I couldn't tell how full the bladder was or distinguish it from anything else. Finally realized the bladder was long but not fat, making it hard to find the trigger point. Tried more times, she began walking away from me each time. Twice she yelped.

She drank from a small puddle of standing water on the ledge of the lavatory and she isn't supposed to drink, but it was no more than an ice cube would have been. I let her sit on the counter and began to massage her neck. She was so tense. Her neck muscles were just completely tense. She put her head back and enjoyed it. Maybe she was too tense to urinate. I imagined taking her to the night emergency vet to be catheterized and decided to try another method.

Got out an incontinent pad to try expressing her on the floor with us facing opposite directions, her standing between my knees and boxed in with my feet. Tried that several times and she still tried to walk away. Finally managed to express some urine and she cried again, not from the squeezing I don't think but from the urine passing through the urethra. It was bright yellow this time. Praised her a great deal because I was so elated, showed her the wet spots on the pad and praised her and she seemed to understand. Turned the pad around and tried several more times. Then she coughed up the water she had drunk several minutes earlier and had a series of coughs like mild dry heaves, so that was it and we quit.

She's not empty, but that will have to do for tonight. As I was expressing her, her abdomen softened somewhat. I don't think it was from the little bit of urine she passed, but rather from kneading it. I'm disappointed that the ligaments I was hoping would be gone are still there. Still had to work around those. Glad we did this at 8 PM so I can watch her till bedtime to be sure there are no signs of internal bleeding as a result of the squeezing.

For the record, the incision itself was no problem. It is up so far toward her ribs it was not in the way at all. Also, I was able to squeeze fairly hard without her crying. I just couldn't find the trigger point, and she never lifted her feet off the ground like she usually does. I am a little worried about the brown sediment, which is probably red blood cells, but the urine we expressed the second time was entirely healthy looking. Glad I expressed her onto a surface where I could see the color of the urine. And she did stand up at one point while we were on the floor. I put her back in bed and she appears to be resting comfortably.
lesley

Re: Other Topic Incontinent Spay

Post by lesley »

you may want to try using a warm towel, wet or dry, and rubbing it against her bottom area as I found when my dog was incontinent, it would help her urinate very easily, due to stimulation.
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Re: Other Topic Incontinent Spay

Post by CarolC »

We tried again this morning at 8:10 AM. The bladder was fuller and a better shape and we produced a fair amount of urine, still bright yellow, but she still is not nearly empty. Her abdomen is still pretty rigid. I could feel the bladder but couldn't get it into the position I'd like. The vet had advised me not to push up against her back because the surgical areas are there. Usually I maneuver her bladder down into a position lower in the abdomen and squeeze closer to the ceiling of it, and I can't do that right now. She did not cry at all but is still struggling away from me. We normally don't get a complete express first thing in the morning so then I express her again about 11:30, which is what we'll do today. She ate her Milk Bone for breakfast and two bites of saltines.

I forgot to write yesterday, we scheduled her surgery as early in the week as possible so we'd be able to go the vet for help if needed. Also, I am taking several days off work. The reasoning behind that was so I'd be home all day to catch her bladder at the best fullness to express, however it looks like I'm just trying to stick to a schedule so far.
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Re: Other Topic Incontinent Spay

Post by Pam (Riley's mom) »

Thank you for the information, hopefully I'll never need it but it's good to have. I have two questions for you. You mentioned you gave her Saltines. Can you tell me why you do this and are they the low sodium kind? Also, what would the signs of internal bleeding be?

I hope your little girl is well soon.
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CarolC
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List of signs of internal bleeding

Post by CarolC »

These are the signs of internal bleeding which were given to me by someone on VetPet:

Signs of internal bleeding would be poor CRT (capillary refill time when you poke the gums); pale gums, mucus membranes, conjunctiva/eyelids; noticeably cool extremities or low rectal temp, weakness/lethargy or sometimes uncomfortable agitation; panting and rapid respiration.

However, I can't imagine what it would take to cause internal bleeding, as we did all kinds of forceful manipulations of her abdomen today (read next report) and she was OK.

The saltines were just regular saltines. They happened to be my breakfast and she showed an interest in them so I broke off two small corners and gave them to her so she would feel life was normal.

Do you mean Riley isn't fixed either?
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Re: Other Topic Incontinent Spay

Post by CarolC »

When I tried to express her again around 11 AM it went about the same as it had gone at 8:10 AM. Produced some urine, still bright yellow, still couldn't get a proper grip, still didn't nearly empty the bladder, she was still struggling away from me. I gave up and called the clinic and explained that I'd expressed her three times now since bringing her home but had not managed to empty her yet and it had now been 28 hours since she was fully emptied. They said to bring her in.

I thought they would just catheterize her and send us home but I was wrong. If she was a male dog they could have done that easily, but with a female the vet said you usually have to sedate them and use a scope to insert the catheter and he wasn't sure that was the best idea. He said there was a medication they could try that causes the bladder to contract. I asked if maybe someone else would like to try to express her, maybe someone with a different method or a different touch. For example, I do it one-handed but maybe someone could try two-handed. The vet was very willing to try this and got an incontinent pad. He tried quite a bit and was getting nothing. He tried her standing and also with me holding her under the arms. He said he thought he could feel some feces, and I was surprised because she hadn't eaten anything since Tuesday and she'd felt clean when I took her for surgery, but he was right. I asked if it was OK to hold her ragdoll fashion, which is how I usually express her bowel, and he said yes so I stripped out what was there, which wasn't a lot but some. Then he continued trying to get her bladder to express, squeezing her till her sides came together and bearing down toward her tail. It seemed like a lot of foreceful squeezing on someone who'd just had a hysterectomy, but he was the one who did the surgery and I could tell he was a vet who knew what he was doing.

She still wasn't urinating and he thought maybe she was empty but I knew she wasn't so I took her back and tried again the usual way with her standing against my stomach sideways. This time I got a grip on her bladder. Imagine us in the examining room and me saying under my breath, "I've got it! I've got it!" Then I expressed her without worrying about aim and flooded the table missing the pad entirely. Urine down the sides of the examining table and on the floor, but we were both just so happy, and he was surprised at how much it was. Her bladder had been hiding up near her tail bone like it sometimes does and I hadn't been able to fish it down till then. I'm not sure why it finally worked. Maybe because of expressing her bowel, maybe because I dug in harder after seeing all the squeezing he did, maybe because she wasn't trying to struggle away from me on the examining table, but I really think he moved things around with all his squeezing, or maybe he loosened up the rigidity of her abdomen like sort of a deep tissue massage. Anyway, it was such a relief to get her expressed finally, and it felt like we got about 95% which is good enough for now. Still have to do it again tonight. He was happy , too, and said there was no charge and he cleaned up the mess just as kindly as could be.

This sounds awfully rough when you think about it. It was actually done carefully by a surgeon with a lot of experience and an owner who was very familiar with the dog's bladder. I'm amazed at how good she was through all that. This is the dog who has to be muzzled to have her nails trimmed. I think she could tell from the atmosphere in the room that what was going on was something helpful, not something harmful, however rough it seemed. You might say it took all three of us to get it done.
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Re: Other Topic Incontinent Spay

Post by CarolC »

Last express of the day 10:30 PM. Same. Couldn't get bladder down into position, abdomen not soft, ligaments (or whatever) tight as wire, she struggled to walk away each time I tried. I got a bar stool and put her front feet on it so there was nowhere to go and she stayed still long enough for me to work my fingers up over the bladder in spite of the "wires". Expressed her onto the bathroom floor, don't care, I own stock in the paper towel company anyway. Produced a respectable amount of urine, I think it's enough. Even though I had a grip, it was just barely, so I couldn't tell if I'd really gotten it all when she quit urinating. Pretty close I think. Now she is resting in her crate again so I can observe her for a while and be sure I haven't hurt anything. Hope this gets easier soon.
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critters
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Wow!! That's quite a story.

Post by critters »

It seems to me another possibility would be cystocentesis, just draining her bladder with a needle through the abdominal and bladder walls. It sounds awful, but it's a pretty common procedure to get a good, reliable, uncontaminated pee sample from a critter, even unsedated. I didn't mention the difficulty with caths since it might not be the same as with kitties; for female kitties, the urethral opening is up inside the vagina, so it's difficult/impossible to get to.

LOL--Maybe she thought drowning the place was fair payback!!
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Re: Other Topic Incontinent Spay

Post by CarolC »

8:10 AM better this morning. Was able to express her on the bathroom counter, she tried to get away but the bladder was a little more accessible so we managed in spite of that. When I tried to double check how well we'd done by squeezing her a second time I think I could feel the end of the cervix, not sure. Didn't squeeze it since I wasn't sure what I was feeling, so I didn't get to really check the size of her bladder. Am supposed to start exercising her today to prevent adhesions. All I can think is, I can't imagine any adhesions taking hold considering the way I've been moving around everything in her pelvis every time I express her. Thought I noticed a slight odor to the urine as I was cleaning up--still looks OK. Gave her another dose of lactulose. Normally there would be a little bit to express from her bowel first thing in the morning and there was nothing. She ate her usual amount for dinner last night. In fact, she ate her usual amount the whole day. :)
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Cystocentesis

Post by CarolC »

Well, now someone reading this later will know it's hard to catheterize a female dog, and that cystocentesis is another option. I've never heard of it till you said it. Thanks.
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Re: Other Topic Incontinent Spay

Post by CarolC »

At 10:30 this morning, about 48 hours after her spay surgery, she was up and walking, following me from room to room as I did chores. She also hopped down to the sunporch level (a 6" drop) 3 times and asked to be brought back up 3 times. This surgery has not hurt her ability to do reflex walking, thanks be. She is now eating a rawhide twist as if she never had a tooth pulled.
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Re: Other Topic Incontinent Spay

Post by critters »

Guess she's moving on. Congratulations!! I know you're VERY glad to be through it.
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Re: Other Topic Incontinent Spay

Post by CarolC »

Yes, I was afraid she would somehow lose her ability to reflex walk, but she's fine. Still hard to express. 4:15 PM expressed small amount from bowel. Abdomen rigid, more like *hard*, still walking away, put her on bar stool again, expressed onto bathroom floor, knelt on bathmat to check urine, smells *fine*.
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