Recurring Paraphimosis in our IVDD Doxie

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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calgecko
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Recurring Paraphimosis in our IVDD Doxie

Post by calgecko » Tue Nov 20, 2018 9:51 pm

Our 9 year old Dachshund has had paralysis of his hindquarters for about 4 years now (IVDD) - we live in a single story home with lots of tile, so he gets around fine by dragging himself around the house. We know the timing of when he drinks water and when we need to express his bladder, and can often feel when his bowels are full, and can 'assist' in massaging the bowel to help him poop.
He's had recurring issues with paraphimosis in the past, and it's often timed with him squeezing out some poop.. his real legs will twitch forward, and the penis comes out, and he gets incredibly agitated (often trying to bite us as we assist). About a year ago, we talked to our vet about it, and they suggested a couple stitches to the opening of the sheath, reducing the size of the opening, to prevent the penis from coming out - it helped for a while, but lately (the last 2 weeks or so), it's been happening more frequently - several times a day. We have to keep a cone on him 24/7 to keep him from licking or gnawing on the exposed penis, but he's learning how to get the cone off. the other day, his penis came out so far, probably close to 6".. the base of the penis was exposed, incredibly raw and bloody, and after several attempts with sugar water and lube, we got it back in.. but with it happening daily, we don't know what else to do.. it's almost as if the nerve damage to his spine is contributing to this issue. We are giving him Metacam daily, as well as a sedative lately, just to keep him calm.. but this is no way for our poor guy to live.. what options do we have?

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CarolC
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Re: Recurring Paraphimosis in our IVDD Doxie

Post by CarolC » Wed Nov 21, 2018 12:26 am

:welcome:

Long answer. You could try gabapentin. It is not uncommon for a paralyzed dog to chew either the feet or the male area. It is a temporary phase that occurs in some dogs during recovery from paralysis. This is the second time I can remember someone reporting it happening unexpectedly after 4 years.

There is a theory that the dog licks and chews the affected area because he is feeling odd sensations, perhaps like the pins and needles sensation we feel in our arm when we sleep on it wrong so it goes numb and then it starts to wake back up. It is annoying to the dog and he will lick and chew the area trying to make it go away, and may not stop even when he draws blood. There didn't used to be any good treatment for it. There were various types of bad-tasting "anti-chewing" preparations to apply to the skin, such as Grannick's Bitter Apple, Banguard Topical Spray (to protect bandages from chewing), Yuk-2-E, or a homemade preparation of Bitter Apple and Liquid HeetTM, or such things as tabasco, but often the dog would chew anyway. People tried the cone collar, but like you said, dogs can get out of it. When it involved the feet, people tried some inventive solutions to protect the feet and legs by encasing them in protective coverings such as PVC pipe [edit: electrical conduit]. Then they started using gabapentin, and it has more or less solved the problem as far as I know. Below I am going to give several posts that occurred before vets were starting dogs on gabapentin, which are upsetting to read but instructive as far as showing how serious the problem can be.

Here is an example of a dog who chewed part of his p*nis off. I think this dog had been down about 8 months. You can read the whole thread at this link:

viewtopic.php?f=4&t=10910&p=63931

Very sad story here:

viewtopic.php?f=4&t=12546&p=65205

Here is the example of the other dog where it happened after 4 years. I remember it because it seemed so surprising to have it happen unexpectedly so long after the injury. It was a female dog who chewed her feet.

viewtopic.php?f=4&t=10910&p=63931

I would try the gabapentin, because without it I don't think any kind of "barrier" is 100% guaranteed for a determined dog. Possibly you could try tying the strings of the cone collar around your dog's standard neck collar to make it harder for him to get out of, until you see if the gabapentin is helping him not to bother it. As far as protecting the area, I'm not sure there is a foolproof way. A male wrap (male doggy diaper) might help a little, but I suspect he could get under it if he wants to. There is a different kind of male doggy diaper that gives better coverage, but I suspect a dog could chew through it. I would not trust any kind of clothing alone to provide protection for long. This is an example of a diaper that might slow him down, but not necessarily stop him.

https://www.amazon.com/Dog-Diaper-Wrap- ... 1047&psc=1

Here is a post from Marni about her dog, Simon. I'm not aware of him having a problem with chewing, but he did have a priapism and wore a doggy diaper which covered it.

viewtopic.php?f=10&t=4163&p=21489#p21489
Marni » Sun Jan 01, 2006 10:57 pm wrote: Thanks for the article. Simon's penis is usually out and he cannot retract it. Sometimes, I can retract it in hydrotherapy. He does not lick it excessively and it is not impeded by the opening in the prepuce. So, I'm not sure what the deal is. Maybe paraphimosis or some variety. I don't think it's phimosis. I have spoken with my local vet several times and he's not at all concerned. Says only concern would be if the penis got dry or cracked and this is not happening. Loval vet said to apply KY jelly to keep penis supple. It is already supple so I'm not applying anything. It would only encourage Simon to lick it off, I fear. Simon wears a male wrap and clothe baby diaper most of the time.
Here is a picture of Simon. I am partly including this picture so you know that some dogs have priapisms without chewing.
Simon1205.jpg
Simon1205.jpg (83.08 KiB) Viewed 762 times
Dianne's doxie Schnitzel sometimes had this problem but did not chew. And the stories above show that chewing can occur in other areas such as the feet. Tiffany's German shepherd, Eros, chewed off some toes and they were afraid they might need to amputate, but fortunately they did not. Sheri's JRT, Pete, also chewed his feet very badly back before they were offering gabapentin. He would chew, she would get him healed up, then later he would do it again, and this happened several times. I am not sure how you know when you are out of the woods. He finally stopped chewing and got better and that was a happy story.

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FYI
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Paraphimosis, entrapment, strangulation

Post by FYI » Wed Nov 21, 2018 11:08 am


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FYI
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Re: Recurring Paraphimosis in our IVDD Doxie

Post by FYI » Wed Nov 21, 2018 11:12 am

https://www.ncbi.nlm.nih.gov/pubmed/19501342 wrote: Top Companion Anim Med. 2009 May;24(2):49-54. doi: 10.1053/j.tcam.2008.11.001.
Priapism in dogs.
Lavely JA1.
Author information
Abstract

Priapism is a persistent penile erection lasting longer than 4 hours, without sexual stimulation. Priapism is categorized as either nonischemic (arterial, high flow) or ischemic (veno-occlusive, low flow). Ischemic priapism is considered an emergency in people. Reports of priapism in dogs are uncommon. This report describes 3 dogs with priapism; the first was considered idiopathic, the second was due to acute disc extrusion and subsequent T12-T13 hemilaminectomy, and the third was secondary to a lumbar meningomyelocoele. All 3 cases were suspected to be nonischemic priapism. The pathophysiology of the canine erection and a review of priapism in dogs and cats are discussed. Distinguishing ischemic versus nonischemic priapism and identifying and treating the underlying cause are important. Aspiration to obtain blood gas analysis may help classify the priapism and may provide pain relief. Ultrasonography aids in evaluation for vascular abnormalities and identifying etiology. If determined to be ischemic, then aspiration with the patient under sedation or anesthesia with or without irrigation should be done. Intracavernosal injections of phenylephrine and lubrication of the exposed penis are also recommended. If intracavernosal drainage and injections are not successful, or significant tissue damage has occurred, then penile amputation and perineal urethrostomy may become necessary. Systemic therapy could be considered if the priapism is not considered an emergency, and if intracavernous injections or surgical treatment are declined.

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CarolC
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Re: Recurring Paraphimosis in our IVDD Doxie

Post by CarolC » Thu Nov 22, 2018 5:24 pm

Hi Calgecko,

I'm sorry for double posting, but I've been thinking of you. Happy Thanksgiving, by the way. :D

Here is some more information about gabapentin from Dodgerslist:
http://www.dodgerslist.com/literature/drugs.htm#Neurontin wrote: Neurontin® (Gabapentin):

CAUTION: The commercially available human liquid product contains xylitol which can be toxic to dogs. It is possible to have a special formulation made at a pharmacy that does drug compounding so that it does not contain xylitol. Specifically ask/confirm with the pharmacist as the label will not likely list xylitol.

Like many other human drugs, Gabapentin started to be used in veterinary medicine to control seizures and in helping to control neuropathic pain (the burning and tingling sensations that come from damaged nerves) associated with spinal cord damage such as IVDD disc herniations. For pain control, Gabapentin is usually used in conjunction with other pain relievers which may later be tapered away. Gabapentin is also used preoperatively to minimize pain experienced after surgery.

Gabapentin should be used with caution in animals with decreased kidney, liver or renal function. It should only be used during pregnancy or lactation when the benefits outweigh the potential risks. The most common side effects are sedation, drowsiness, loss of balance, and rarely vomiting and diarrhea. Gabapentin can also cause a false positive reading on urine dipstick tests for urinary protein.
Oral antacids (products that are aluminum, magnesium based such as, Sucralfate, Mylanta, Milk of Magnesia etc.) will hinder absorption of Gabapentin so it is important to give the two medications at least 2 hours apart. Taking hydrocodone or morphine may increase the effectiveness of Gabapentin and the likelihood of side effects. Gabapentin will reduce the effectiveness of hydrocodone.

Gabapentin should NOT be discontinued abruptly because withdrawal may precipitate seizures or rebound pain. The dosage should be decreased over the course of two to three weeks.

Oral Bioavailability. Gabapentin bioavailability is not dose proportional; i.e., as dose is increased, bioavailability decreases. Bioavailability of Gabapentin is approximately 60%, 47%, 34%, 33%, and 27% following 900, 1200, 2400, 3600, and 4800 mg/day given in 3 divided doses, respectively.

Mar Vista Veterinary "Gabapentin" http://marvistavet.com/gabapentin.pml
http://www.drsfostersmith.com/Rx_Info_S ... pentin.pdf
http://www.drugs.com/pro/gabapentin.html

Ingrid
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Re: Recurring Paraphimosis in our IVDD Doxie

Post by Ingrid » Fri Jan 04, 2019 11:00 pm

Our little daschund did the same thing but to an area in her flank. She stopped after a few months and years later you an still see the spot self mutilated badly). I would agree with the gabapentin for nerve pain.
As for defecation try stimulating the rectum and below the rectum with a COLD wet wad of toilet paper while you are holding him over the toilet. It helps to make them push poop out on their own. Works great for our girl and two other paralysed daschund we've cared for.

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critters
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Re: Recurring Paraphimosis in our IVDD Doxie

Post by critters » Sun Jan 06, 2019 2:12 pm

:strobe: :strobe: to you both! :mrgreen:

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