Urinary concerns

Neurological Disorders Resources. Treatment and care for pets having pain or trouble walking or standing due to spinal injuries or neurological disorders like IVDD, FCE and DM.
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Rachel and Mac
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Urinary concerns

Post by Rachel and Mac » Mon Oct 01, 2018 12:36 pm

Hello, my 13 year old dog Mac (73lbs) was diagnosed with likely having degenerative myelopothy and at the time of diagnosis he suffered from incontinence (both urine and fecal) but he also suffers from cognitive decline so I attributed the "incontinence" to what appeared to be forgetting the routine and not true incontinence. The day of his xrays he was also shown to have a severe bladder infection and along with antibiotics & prednisone the dr. prescribed bethanechol and prazosin thinking that his infection might be due to ineffective bladder elimination, even though I pointed out that he didn't appear to be straining that I could tell. The night that I started him on the bethanechol (prazosin was coming) he peed an enormous amount and was excessively salivating. I called the vet the next morning and the tech that I talked to (as the vet wasn't in the office) agreed that it was okay to hold off on additional doses of the bethanechol as I expressed my concerns that maybe his belly band was causing the urine retention and not something else. Anyway, by that evening and into the next morning Mac had actually stopped producing any urine but for a tiny bit and I was concerned that perhaps he did indeed need the meds and got him started back up on both.
Now with the meds he is more lethargic (with additional mobility issues) than ususl and pees & salivates excessively (2 ultimate absorption pads, a belly band snd whatever is beneath him get wet) and I worry that the new meds msy have instigated a problem that didn't exist to begin with. Any thoughts? :? Thank you.
(Tomorrow we take Mac's 11yr old daughter Rachel in for the same diagnostics as she is having very similar physical symptoms)

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critters
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Re: Urinary concerns

Post by critters » Tue Oct 02, 2018 9:03 am

:welcomepurple: Wow, there's a lot going on there! Do you think the bethanechol is helping? My experience with that is with a spinal cord injury and a spastic (tight) bladder, and bethanechol made it MUCH worse. Prednisone increases drinking, and peeing, a whole lot, so that's probably figuring in. Personally, I know very little about DM, so I'm not much help. Do you know about the liner things that increase absorbency of pads, diapers, etc? I'm having a brain fart on what they're called, but I can get the name of one brand at home; I picked up a pack at the "food bank" to have, just in case. I'm planning to be online again Thursday and hope to have more into on that then.

Rachel and Mac
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Re: Urinary concerns

Post by Rachel and Mac » Tue Oct 02, 2018 10:07 am

When you say the bethanechol made things worse do you mean your dogged stopped producing urine. I honestly never even considered that mac had an issue with lack of production until after I discontinued the bethanechol due to the uncontrollable amount that was produced, then he essentially stopped producing all together so I started him back up. We have about 10 more days of prednisone Ieft so I guess the true test will come once that is out of his system.
Right now I use a belly band and 2 ultra absorbent Poise incontinence pads, is this what you mean by liners?
Thank you :)

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CarolC
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Re: Urinary concerns

Post by CarolC » Wed Oct 03, 2018 10:18 pm

I agree with critters, the predisone was my first guess, too. It can cause polydipsia and polyuria. Like you say, when he is off of it then you'll be able to tell better.

I'm thinking what the vet might have meant about ineffective bladder elimination is neurological, and is part of the loss of control you are also seeing with bowel incontinence. The dog with DM is slowly losing some degree of nerve function in the hindquarters. He can still tell he needs to urinate, he can still initate urination, but he may not fully empty the bladder, so there is a larger than usual residual volume of urine remaining in the bladder when (he thinks) he's "done". Having a little bit of stale urine always remaining in the bladder creates an environment where germs can grow and can cause a urinary tract infection.

A good way to check this is to have someone who is familiar with expressing take him out to potty. After he pees and you assume he has done all he's going to, they can put their hands on his abdomen and squeeze his bladder and see if more comes out. There used to be a really good video by Scout's House (which I think they no longer have posted on their website) that showed someone with an older dog who goes outside with their dog, lets him start urinating, then stands over him and puts their hands on his waist and helps him finish. :) This is something that can be done without medication.

Another possibility is something that may be unrelated to any drugs, but is common in older dogs, and that's renal insufficiency. The old kidneys do not work as well, the dog starts drinking a whole lot, and is not concentrating his urine. It's not an emergency but you might want to have him checked. The vet can take a specimen and do an in-office lab test of his urine. When this happened to my dog, we switched him to a renal diet (and malewraps) and he did well for several more years. Yes, he required a lot of changes of his pad, I want to say he went through up to 5 Ultimates a day, but that is going by memory so I can't swear. The malewraps saved us, I don't know what we would have done without them. Before his belly bands he was drinking his big bowl of water and lifting his leg all over the house while I was at work...on the cat tree, the bunk beds, the workbench, wherever. I had potty pads all over the house.

I am looking at an older edition of the Veterinary Drug Handbook. I am NOT a vet or anything medical. I do not see (?) salivation for prazosin or prednisone, but I do see it for bethanechol. There is a wide dosage range for bethanechol, perhaps you can ask the vet if he thinks this might be the problem and if there is any room to adjust his dosage?
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critters
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Re: Urinary concerns

Post by critters » Thu Oct 04, 2018 8:17 am

Rachel and Mac wrote:When you say the bethanechol made things worse do you mean your dogged stopped producing urine.He made pee, but he couldn't release it. I honestly never even considered that mac had an issue with lack of production until after I discontinued the bethanechol due to the uncontrollable amount that was produced, then he essentially stopped producing all together so I started him back up. We have about 10 more days of prednisone Ieft so I guess the true test will come once that is out of his system.
Right now I use a belly band and 2 ultra absorbent Poise incontinence pads, is this what you mean by liners?
Thank you :)
Oops, I forgot to look at the liners I have. Let me see if I can find something similar at Amazon...

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critters
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Re: Urinary concerns

Post by critters » Thu Oct 04, 2018 8:22 am

Oh, yes, that's certainly true about old, weak kidneys. Lots of drinking and peeing!

OK, here are 2 examples of booster pads or "diaper doublers." There seem to be a fair number of them.
https://www.amazon.com/15-75Lx4-25W-Abs ... ners+adult
https://www.amazon.com/Tranquility-TopL ... adult&th=1

Rachel and Mac
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Re: Urinary concerns

Post by Rachel and Mac » Thu Oct 04, 2018 9:14 pm

Would renal insufficiency not be indicated on a chemistry? We did both the chemistry and a urinalysis and the only thing brought to my attention was his bladder infection. We did attempt to take him off of the bethanechol and prazosin and so far so good as far as his urine production goes (no shortage by any means). He is now less lethargic but he is still weaker than before he started those two medications, which I guess could be a coincidence. Critters, are these similar to the items in the links you shared, do you think or are less absorbent?

https://www.poise.com/en-us/products/pa ... s/ultimate

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CarolC
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Re: Urinary concerns

Post by CarolC » Fri Oct 05, 2018 10:47 am

Rachel and Mac wrote:Would renal insufficiency not be indicated on a chemistry? We did both the chemistry and a urinalysis and the only thing brought to my attention was his bladder infection.
When they checked my dog and diagnosed renal insufficiency, the vet used a catheter to collect urine and then did a test where the results showed up in different colors. I have been trying to get a clear memory of it since reading your question yesterday and I'm still not remembering it in detail, that was 13 1/2 years ago. I have a printout from the vet in Feb 2005 that shows values on BUN, CREA, and PHOS, with graphs showing low, normal, and high value ranges. He was high in BUN and CREA. On the back I wrote a note from the consultation that says, "Renal insufficiency--just in the beginning because potassium still OK," and below that, "cats more potassium sparing than dogs, dogs do less well w/fluids". I must have asked if it would help his kidneys to give him fluids at home like I was doing with one of the kitties. In Sep 2005 BUN was still high but CREA was normal. That may have been because of the food.

Anyway, I think he used something like a One Step test strip, but I can't swear. I seem to remember him showing me the strip. Whatever it was, it showed a number of different results all at once and results were almost immediate, I don't think he even left the exam room. If the "chemistry" they did on your dog was similar to that, then I would think they already checked for it, but just to be sure you might ask the vet next time you talk to him.

13 is pretty senior for such a large dog. My dog that I was describing was 63 lbs when he began going down in the rear. We started using malewraps for him, and I finally put straps on the malewraps because with the need to change the pad in his malewrap, it was hard for him to wear a harness all day. Some harnesses can stay on during the day (not 24 hours, but waking hours). I didn't want to have to fight getting the wrap on and off around the harness, and I didn't want to have to put a harness on every time I needed to move him. Having the combination of a male wrap and belly harness did the trick. Here is a link to that.

https://www.handicappedpets.com/mediawi ... th_handles

Another thing that may help is to express his bowel if he is doodling in the house. Here are two links that may help.

http://www.freewebs.com/dmroster/bladder.html
viewtopic.php?f=5&t=18586

And also, I wanted to mention, there is a genetic test that can show if your dog is at risk for DM. Bobbie described it here:
viewtopic.php?f=22&t=13727&p=71695&hili ... ive#p71695

Here is an updated link to order the test.
https://www.ofa.org/diseases/dna-tested-diseases/dm

And one more thing, there is a medication that can be tried for "doggie senility". It is called Anipryl. I have no experience with it. My vet also mentioned that if the kidneys are not functioning well, the waste products in the blood stream can affect the dog mentally.

http://srdogs.com/conditions-and-diseas ... ysfunction

Rachel and Mac
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Re: Urinary concerns

Post by Rachel and Mac » Fri Oct 05, 2018 3:26 pm

Sigh, well I will look at the links you provided and we actually have anipryl on the way and fingers crossed it works. May I ask, how did you manage to change your dogs belly bands without making a huge mess? Mac is peeing a lot and almost every time I take his belly band off he pees more and trying to keep him on his feet while changing the band is so difficult. Plus we are also currently doing the anal expressions, I was taking him outside but now I just do it wherever he happens to be.

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Re: Urinary concerns

Post by CarolC » Fri Oct 05, 2018 5:28 pm

Hi there,

I didn't have that exact problem with Merlin when I removed his belly band. (It did not cause him to release more urine.) But there is a trick to changing the belly band standing up that is good for large dogs. Tiffany used it with her German Shepherd, Eros. Stand over your dog and straddle him so you are both facing the same direction (like riding a horsie). Now clamp his hips between your knees so he stays standing. It only takes a jiffy to bend over and change the wrap and you're done. :) The easiest thing is to have a spare wrap already prepared with the new pad in it, so you can whip off the used wrap and velcro on the fresh one super quick.

Another idea that I don't think was mentioned yet is, with a large dog you can use a disposable baby diaper inside the wrap, flat against him, instead of a Poise pad. If it has so much elastic that it doesn't want to lie flat on his belly (or if you think the papery ruffled fringe might be itchy), you may need to snip it here and there or trim it a little bit with the scissors before putting it in the wrap. This might give you more absorbency and coverage.

Something that may work for the extra peeing is when you go to change him, if you will first stand him over a potty pad or thick towel (or outdoors) and express his bladder while he still has his wrap on, so the urine is going into the wrap. Then change the wrap. Hopefully that way he won't dribble when the wrap is removed?
:mop:
Something similar can be done with the dog lying down. When he is lying on his side with his wrap off, you can take a disposable baby diaper and position it so it is a little under his male area/waistline, then flop the other half over so it is kind of encircling his belly and covering the male area. Then when you express him, the stream will be trapped in the diaper, which can be thrown away. This will keep his fur clean and dry.

There is an article here with a bunch of videos at the end demonstrating various ways to express a dog, standing up or lying down, and a bunch of them are for large male dogs. These are some of the videos that might be most helpful (there are a few others in the article). A couple of them are in a foreign language, but they show how to express with a fist, and the fist technique is good for large dogs or for someone who lacks strength, and they show it very well (you can turn off the sound if it is distracting).
http://handicappedpet.net/helppets/viewtopic.php?f=5&t=16027 wrote: http://www.youtube.com/watch?v=PlbYCoZ5HqI Expressing large male dog standing

http://www.youtube.com/watch?v=oHD0L2rJAcw Expressing large male dog lying on his side, cupped hand

http://www.youtube.com/watch?v=bEHSxUf2Nb8 Expressing large dog using closed fist technique

http://www.youtube.com/watch?v=lw6_T2FewZM Expressing large pitbull in a wheelchair (4:00-5:05)

http://www.youtube.com/watch?v=SXBkez3jxB8 Expressing a male German Shepherd dog lying down
I did actually find that one expressing video on Scout's House that I mentioned before. It is still on their website, but it gave a loading error when I tried to play it. It seems they have it hosted on Photobucket. Maybe it will play for you, I don't know. It's well worth seeing. Here is that link, for what it's worth. The "How To" videos are near the bottom, including one on expressing and one on DM.

https://scoutshouse.com/health-resources/our-videos/

Rachel and Mac
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Re: Urinary concerns

Post by Rachel and Mac » Fri Oct 05, 2018 6:10 pm

Thank you for all pf the links, I will check them out and the straddling technique. I have tried something similar but I was facing the wrong direction :-D

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CarolC
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Re: Urinary concerns

Post by CarolC » Sun Oct 07, 2018 1:13 pm

One problem I had with Merlin was when he got to the place where he needed help getting to his feet. As soon as I lifted him to a standing position using his belly harness, off he'd go, pulling me across the room or wherever. It's hard to control a dog with just a belly harness. As soon as he was up he didn't want to stay still, he wanted to get going. I made kind of a "patient lift" out of an engine hoist. It was good for holding him up while I got his 2-wheel cart attached, and later it was good to lift him off the floor and into his 4-wheel cart. But I found it was also good to tether him (I fastened his chest harness to it) so he would stand in one place long enough for me to change his wrap. Because squeezing the dog between your knees will hold him up if he is willing to stand still in one place, but if he's a big dog and he really wants to walk away, then it's hard to hold him with your knees. By tethering his front harness for a second, and holding his hips with my knees, he would keep still to be changed.

You can change a wrap with the dog lying down if you want. Unfasten the old one and tug it out from under him. Then feed your arm under his waist from back to belly, grab the end of a clean wrap, and hang on while you pull your arm back out, bringing it under him in the process, then fasten the velcro. It works, it just requires you to get in an awkward position for a minute.

I am attaching a link to the lift I made. I will also give a link to an expensive store bought hoist. You probably do not need to worry about this right now, but it's something to tuck away in the back of your mind. I already had a history of back problems when my dog went down, and I felt like whatever I spent up front to get him a good harness or some kind of lifting equipment was money well spent. I felt like I'd either spend the money to avoid injuring myself, or I'd spend even more in medical expenses if I strained something.

https://www.handicappedpets.com/mediawi ... _heavy_dog (homemade hoist that cost a little over $200)
https://eddieswheels.com/p/19/Therapy-Equipment (this is unaffordable unless you're really rich)

Another thing that is nice to know is the weight you are dealing with. If your dog can support himself on his front legs but you have to partially or fully support his hindquarters, it helps to estimate the weight. The average dog carries 60% of his weight on his front legs and 40% on his hind legs. So when my dog weighed 63 lbs, 40% of 63 was 25 lbs (less if he partially supported himself). Well, I can guarantee you that lifting 25 lbs many times every day was a great plenty, but it did help my state of mind to think, "I'm actually lifting 25 lbs." rather than, "Wow, I'm going around lifting a 63 lb dog all day." I do think that anytime he lurched or lost his balance or pulled, the lifting required was a little more than 25 lbs because of compensating for the extra motion. I would expect your dog may lose some weight later as he begins to lose muscle mass. I think Merlin lost about 11 lbs. altogether.

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Re: Urinary concerns

Post by Rachel and Mac » Sun Oct 07, 2018 2:18 pm

I am finding that holding Mac up while facing the same direction works better than my facing his rear but that it kinda squeezes his knees together and somewhat pinches the belly band in place and if not careful keeps it from getting seated correctly upon placement, but it is a bit easier otherwise. My next move is to buy a hind end leg hoop harness as I didn't realize how much the abdominal would get in the way (wondering if I could finagle some kind of waist attachment/belt for myself so that I am all hands free to do belly band any place in the house?. I want to consider a hoist but financially I am spread pretty thin right now with everyone's health expenses.
I feel like he is getting worse ever since his visits to the vet and all of the meds they have him on. Initially the tramadol helped improve his mobility but now that he was sedated and on all of the additional meds (we have stopped the bladder meds and he is peeing on his own) his mobility is non existent as well as his cognitive issues worsened. I want to say hindsight and all that but at the same time something had to be done...
Thanks for listening

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Re: Urinary concerns

Post by critters » Mon Oct 08, 2018 9:10 am

The pee pads I posted are used WITH a diaper or whatever to increase capacity.

As for when renal failure shows up on labs, I really don't know, but I'd think you're right that it should show up in the labs.

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