Paralyzed dog with FCE

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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critters
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Re: Paralyzed dog with FCE

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Congratulations!
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CarolC
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Re: Paralyzed dog with FCE

Post by CarolC »

Oh, Thank Goodness! Woohoo!!!!! :yay: And I was just looking, this began around Feb 7-8, so you waited over 12 weeks before the therapist thought she had deep pain, and 14 weeks till it was clear. Wow! This is the best news.

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!!!

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Re: Paralyzed dog with FCE

Post by Rescuedogmom »

Yes I am so very hopeful she may start to help us with peeing. It’s strange even though she does now have deep pain she cannot feel me touch her low back and makes no indication of having control or ability to stand. Could it be that it’s very diminished and she isn’t feeling much yet? What do you think is next to come? The awesome therapist who said she has it also said we only have a couple weeks left to make the most improvements. I know you have seen differently, so I am just grateful she had regained it and know she can recover more. How I wish I could tell the neuro vet we saw the second day who told me her spine was “dead” and to put her down that it most definitely isn’t. Wow this has been a long few months but celebrating these small improvements! Thank you as always for being such a resource!
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Re: Paralyzed dog with FCE

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You're probably right that she doesn't have full feeling yet. As feeling returns, if you notice her beginning to lick or chew on any areas, that is a temporary phase some dogs go through and it can be treated with medication.

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.
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Re: Paralyzed dog with FCE

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You’re so right it’s hard to know what will come. She doesn’t respond to the toe skin pinch test but did to the large needle so I’m thinking it’s the very beginning of it returning. There is no kicking in her hydrotherapy but he did say he hamstring muscle are firing up we just want to see her pull her knee forward or kick with her leg. It’s great because I am with her he entire therapy session and he is so knowledgeable and shares exactly what’s happening.

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.
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Re: Paralyzed dog with FCE

Post by Rescuedogmom »

Hi quick update/ opinion? As you know Stella had a bladder infection back in April and we finished antibiotics around May 5 and she has been great. The past week I did notice a bit of clear discharge but no odor or leaking urine so I wasn’t alarmed. Today I noticed that the discharge after expressing her had a slight green tint to it :cry: . Do you think this could mean she has an infection again? I’m going to watch for one more day and then get a culture again if it looks off. Such a bummer we had our carpets cleaned for her so the only places her bum touches is when we are out at appts (usually diaper her) or once at a family members house last week.
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Re: Paralyzed dog with FCE

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Not sure about this. You do not always notice an odor with a UTI, I've had that happen twice. I don't think I've heard anyone describe a green tinge before? My one dog will often pass a kind of a clear mucus plug at the beginning of expressing but her urine is healthy. If you ask me, it's harder to tell what's going on with a female dog because the urinary tract and reproductive tract join inside the dog and share the same exit. On a human female you can more easily tell whether something is urinary or related to the reproductive system because they are separate. Here's a drawing.

smllFemalePel.gif
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.
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Re: Paralyzed dog with FCE

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So the green yellow tint went away and it went back to a clear discharge but I took her in anyway this morning for her ultrasound and urine draw. I will let you know the results. The ultrasound bladder image looked the exact same as it did last time which is very cloudy and almost like what I imagine mucous floating in there. My vet wasn’t there and another came in and said it looked like something was off but then didn’t know Stella was even paralyzed when I asked they express her. I told them to forget it and I would just do it myself. I am just going to wait to hear from my vet and the results. It is still upsetting but Stella doesn’t seem unhappy or uncomfortable so I just don’t know. Truth be told I am fine with her not walking as I have lots of tools for her mobility just praying she gets bladder control back so she doesn’t have to go through this.
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Re: Paralyzed dog with FCE

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I'm still hoping it isn't another UTI, but there are a number of things people do to try to prevent them. One is to adjust the pH of the urine. Personally I haven't done that very much. If the urine is either too acid or too alkaline, you can set the dog up for stones or crystals, which is a whole 'nother problem I don't want to create. I have used cranberry a little bit, kind of "as needed" when I suspected there might be a UTI starting, but I have not used it on a routine basis. You have to be careful with any human supplements. I found that a cranberry supplement I used to use was reformulated so it now contains xylitol, a sweetener that is toxic to dogs, so you always have to read the label. Though now they have a lot of such products marketed for pets.

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.

viewtopic.php?f=9&t=17195&p=89818&hilit=mannose#p89818

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* :roll:
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Re: Paralyzed dog with FCE

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HI thank you for that information. We got the results back and it is in fact another uti but a totally different kind. The first time it was ecoli and proteus and this time it is a staph infection. I cannot understand how/where she got this and it breaks my heart. I got her medicine cefpodoxime and am also thinking of starting her on the meds that make it easier for her to be expressed to make sure nothing is getting left behind. I actually had started her on crananidin which is cranberry pills for dogs last week. I have wondered about all the places I take her and who knows what she is microscopically exposed too. I am going to try and stay diligent and keep everything as clean as possible as I have been doing.. Meds are for 30 days but we are getting another culture in 3 weeks to check progress. She is spayed and I will keep you posted on how she is doing it was strange there were really no symptoms like the first time she had one. Other than the uti she is in good spirits and I purchased a hind halter to walk her with and she loves getting out with that. She is still not a fan of the wheelchair. Sadly no updates on further mobility changes/improvements and no awareness of her legs /feet yet.
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Re: Paralyzed dog with FCE

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OK. Frustrating only partly covers it. Well, good thing you caught it. Thanks for explaining what it turned out to be, I appreciate the information. I'm very glad you know exactly what the bug is, and have the medication for that exact type of infection. The expressing medication might be worth a try. Right now having an easier time expressing would be great. I think one pretty universal thing is to try to encourage the dog to drink more to keep the bladder flushed out if you can. There was a discussion about how mucus can sometimes be a benign condtion, but I also know of a case (with a cat) where it was associated with an infection. I guess that is why you can't just assume, you need to have such things checked. Glad you are doing a recheck before the end of the medication. I'm just sorry that now it is 3 weeks of more tension you didn't need, waiting to be sure you are getting it cleared up. If she is in good spirits, that is an encouraging sign!!
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Re: Paralyzed dog with FCE

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Hi there!! Looking for some advice again! Stella is wrapping up her antibiotic for her staph infection and I need some guidance. First off our vet prescribed her bethanechol at the same time as her anti biotic. I thought is was just for backup in case I ever needed to give it to her but she was quite rude in telling me at our appt this week that I should be giving it to her to help her fully empty in case some particle is left in. I am quite confident in expressing her now and she has a tight bladder but I can get it empty in one try. Apparently because she has sediment in her bladder (not sure why) we did another culture/ultrasound at 3 weeks on her meds still waiting on her results. So I started her on bethanechol yesterday but I have my worries and reservations about it. She already has started drooling which she has never drooled in her life! I asked about the side effects and the vet told me to read the handout she gave me. I’m rolling my eyes as I type this. Yes I read the hand out but I’m worried about my dog and I’m paying you to advise me. I truly feel she doesn’t really know much about disabled dogs.

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!
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Re: Paralyzed dog with FCE

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Here is some more information on bethanechol.

https://www.marvistavet.com/bethanechol-chloride.pml

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.
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.
This is what my Pill Book Guide to Medication for Your Dog and Cat says exactly:
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.
It also says:
Food Interactions
There are usually fewer side effects if given on an empty stomach.
Usual Dose
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
According to the MarVistaVet article above, urethral relaxants include diazepam or phenoxybenzamine, or some members here have been given robaxin for the same purpose.
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.
Plumb's Veterinary Drug Handbook 4th ed (not the latest edition) re Bethanechol says:
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)).
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.

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)
rupture.PNG
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.
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critters
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Re: Paralyzed dog with FCE

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That was our experience--beth. made Buddy MUCH harder to express because it made his bladder so spastic.
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Re: Paralyzed dog with FCE

Post by Rescuedogmom »

TWO Year Update!!

Wow this has been an entirely long overdue post and it feels surreal to even be sitting here today! I wanted to stop in and give an update on Stella to hopefully inspire and let others know it can be done. If you had told me that during the first 6 months that I would become a successful dog mom to a paralyzed pet, I would have had doubts. After Stella had an FCE on Feb 7, 2019, I started posting on here for help as there are so few resources for paralyzed pets out there. Carol, you were truly a godsend and gave me information and support that was difficult to find.

The first 6 months were so incredibly challenging mentally, physically, and emotionally. I knew that if I continued to persevere and took each day one at a time, there may be a chance we might just be successful or at the very least have had that much more time with our Stella. And so for the first 8 months I tried all avenues available (acupuncture, PT, hydrotherapy) to see if I could restore my dog’s ability to walk / have bowel movements independently etc. Once it became clear that indeed this was the best her condition would get, I scaled back and we went back to the basics. The single biggest thing which contributes to our success is a daily set schedule. We have set potty times (still manually express bladder), set long walk times, set drinking times, set meal times. She never took to the wheelchair from handicapped pets and that was ok! I knew she needed exercise and loves to walk so we found major success with the rear support harness from handicapped pets. I could not recommend that item enough. We can even do small jogs while I support her back end in the harness and we walk over a mile every day. We have even traveled several times with her on car trips and she absolutely loves it.

Every single day is an absolute blessing and I do not take them for granted. This has been a labor of love but I dare say by now this is just normal for us. My husband and I are so in tune with Stella and we communicate so well with her that she truly is living her best life despite her disability. I have so many tips for things that have worked well for us and others I would skip which I will hopefully compile soon. Anyway I wanted to encourage those out there struggling right now that if it makes sense for you and your pet keep going, stay strong, stay positive, and take each day as it comes. Well its time for our afternoon walk, take care. Peace and love.
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