You mentioned her little mid-air squat when you go to express. You may start to notice her "helping" when you express, especially if you give her a verbal cue when you are about to start.
I like the fact that the therapist was suspecting it, and was right. That kind of gives confidence about the therapist in a way, don't you think?
Healing continues for a long time. Not weeks, or even months, but literally years. So glad for the good news!!!
I don't know what will come next, but I'm hoping she will begin to move one or both hind legs in hydrotherapy? Do you get to actually watch her when she goes to her session? Do you know if she's using her hind feet in the water yet?
Standing up is a pretty complicated thing, and I have never seen anything scientific about what I am going to say, but I *feel* like a long-bodied, short-legged dog has an easier time standing up because less balance is needed, while a more square built dog with shorter back and longer legs needs more balance to stand up because the center of gravity is higher off the ground. I could be wrong. If there is any truth in that, it's another reason why hydrotherapy is a help. Actual swimming requires no balance. The treadmill requires different degrees of balance depending on how high the water level is.
That makes sense about standing I feel like she is square bodied. I hope she can start to notice her feet again. I am sure that will be a good start.
Hopefully it's not another UTI, especially if the symptoms are different, but I agree I would probably get it checked or ask about it if you keep noticing it. I've never heard of green with a UTI, so I hope you will update if you find out what it was.
There is another supplement called D-mannose which helps keep bacteria from adhering to the lining of the bladder. It sounds too good to be true, but if you research it you can see it is supported by reputable vets. Here is one example.
https://healthypets.mercola.com/sites/h ... -dogs.aspx
One of our moderators was a university chemistry professor and she also recommended it.
In my experience with 2 paralyzed dogs, the incidence of UTI has been about 1 per year without a diaper and one every 2.5 years with a diaper. It can depend on so many things, including how hard the dog is to express and what position the dog drags in (for example legs trailing behind would get less dirt on the bottom than moving in a seated-with-legs-forward postion.
It also depends on the environment. For example one person here had a working dog that herded livestock in a wheelchair and loved to swim in the creek, and was getting exposed to bacteria in the creek, but the dog loved to swim. It can take a while to figure out where the dog is picking up the germs.
I used to even wonder about our beloved PT place. I loved it and loved the gals that did the PT and loved everything about it, but I think people walked through the rest of the hospital and probably picked up normal or hospital bacteria on their feet and then tracked some of that into the rehab area onto the mats. But that's just another example of why it's good to express when you come home from anyplace.
Is Stella spayed? I can't remember if you said. My dog got UTI's when she was in season, but since she's been spayed we don't have that problem any more.
For what it's worth, most dogs do not end up having long term problems with UTI's, which is probably little comfort right now when you are wondering if there is one. We had one male dog here named Waffles who was hard to express and had to be catheterized for a long time, and he was on a low dose of antibiotic for over a year, if I remember correctly. There have been a few people here (Pam and her dog Riley is one example) whose vets had their dog on antibiotic pulse therapy, which is one week on and 2-3 weeks off. I don't know how common that is, usually it isn't needed.
I'm still hoping she will get to where she can start helping you express, and with both of you doing it she can get even more empty and the problem may largely take care of itself. If you go to express and either count down or give a verbal cue, (I use "Ready, Freddy?") and then express, she will know when to help if she develops some ability to do so.
Don't blame you for wanting to stick with one vet if they didn't even read the record apparently. *sigh*
Basically I really need to get a new vet and am having massive difficulties finding one where I live that has any experience with handicapped pets.
Anyway my question is what are your thoughts on bethanechol. She told me to give her it 3x a day 10mg but I’ve only given it to her twice per day yesterday and today. Does this seem necessary, are there long term damaging affects, can this hinder her recovery? She is doing quite well even if she won’t walk again the bladder issue is the only one I’m worried about. Thank you!
I agree if you are not confident in your vet, I hope you can find one that you can trust. Yes, it could be hard to find one with much real experience with this. About all you can do is call around to each hospital and ask if they have any clients or have treated any with paralysis. Not to defend her for being rude one single bit, but I think she is mainly trying to cover all the bases with the bethanechol. It doesn't sound (?) like she is talking about keeping her on it long term(?) I get the impression she just wants the best emptying possible right now while she is trying to get every last germ she can out of the bladder and clear the infection.
Even if you are getting her properly empty every single time by expressing, there will still be a little urine remaining in the bladder. There is something called "residual volume", which means that even in non-paralyzed bladders with normal emptying, we all leave a little dab of urine in our bladder every time we go. Dogs do, too.
Based on the fact that she has been somewhat difficult to express ("tight"), I would have thought a medication to relax the sphincter would have been a first choice, either with or instead of the bethanechol which helps the bladder contract.
This is a medical article about medications for various bladder conditions (scroll to the end of the article). It lists bethanechol as being useful for an atonic bladder, whereas I thought Stella had tone.
This is what my Pill Book Guide to Medication for Your Dog and Cat says exactly:The Leakers: Disorders of Micturition and Continence
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.
It also says: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.
According to the MarVistaVet article above, urethral relaxants include diazepam or phenoxybenzamine, or some members here have been given robaxin for the same purpose.Food Interactions
There are usually fewer side effects if given on an empty stomach.
Contact your veterinaria if salivation or GI upset are pronounced or persist. Your animal may need a reduced dose.
Dogs: 5-25 mg orally 3 times a day
Plumb's Veterinary Drug Handbook 4th ed (not the latest edition) re Bethanechol says:https://www.marvistavet.com/bethanechol-chloride.pml wrote:If the patient’s urinary tract is not obstructed but has excess tone, it is helpful to combine bethanechol with a medication to relax the lower sphincter and urethra: diazepam or phenoxybenzamine.
People have made a lot of favorable comments about phenoxybenzamine, but I was told it takes a few days to build up in the system and reach full effect.If urinary outflow resistance is increased due to enhanced urethral tone (not mechanical obstruction!), bethanechol should only be used in conjunction with another agent that will sufficiently reduce outflow resistance (eg., diazepam, dantolene (striated muscle) or phenoxybenzamine (smooth muscle)).
For what it's worth, one person here found that bethanechol made her paralyzed male cat impossible to express.
If I was going to try bethanechol, I would feel better about it if given with a urethral relaxant. If she is drooling a lot, maybe ask the vet if you could try a reduced dose, 5 mg 3x a day, or something like that? The lowest I see looks like 2.5 mg 2x a day in the Leakers article above. If you notice she is harder to express, that is counterproductive and I would not use it without a relaxant.
I would also try to encourage her to drink more. Maybe stir some water into her food? Give her water with a little broth mixed in? Whatever you can think of to get more fluids into her bladder so you can express her more often and get the sediment flushed out.
The last thing that is in the back of my mind is about tone. I'm saying this because it seems like Stella probably has quite a bit of tone (or that was my impression from what you've said in the past). And if you are trying bethanechol without a urethral relaxant, she may have even more tone and be harder to express. Nobody that I know of has ever damaged a bladder from expressing a difficult-to-express dog, due to tone. If I knew of such a case, I would say so. But I did read something about cats one time that said rupturing the bladder is more likely after cystocentesis (where they use a needle to puncture the bladder to get a clean urine sample). I don't know how your vet collects samples, but I would try to fit the whole picture together, her normal tone, her possibly increased tone using bethanechol without a relaxant, and whether the vet is using a needle when collecting samples. If your vet is doing cystocentesis and Stella already has plenty of tone, personally I would want to be aware of all this if the medication increases her tone.
http://books.google.com/books?id=DtIIjF ... cat&f=true
Problem-based feline medicine - Rand (click to enlarge) Hope something in this helps. It comes down to a lot of reading and rereading. Glad it is Monday so you vet will be open to talk to.