Neurogenic bladder cases, in a word, suck. We don't have good meds for them- bethanechol/urecholine is the only one. Most pets end up being euthanized for it eventually because it is so hard for the owner to deal with, and for the pet to have multiple UTIs, urine scald, and possible pyelonephritis (kidney infection). My Max does not have neurogenic bladder, but he did have pyelonephritis bad enough to cause the removal of one of his kidneys, so it can be a very bad disease.

I think a holistic vet may be able to help, especially acupuncture. I've seen some pretty amazing things happen with it. I don't know much about herbs and other modalities, I'm just signing up for the acupuncture course now.

There is a patient at school who had stones completely block and destroy her urethra. The surgeons tacked her bladder to the inside of her abdominal wall and made an opening to the outside. She now pees through a hole in her side. Her owner keeps her in a diaper, and she is on pulse antibiotics for life. She also has to be cleaned every day. But she's a happy dog, and Mom is happy to have her for many more years (she was a young dog when it happened). The dog has been going 2+ years like this now. Obviously that is VERY experimental and not all surgeons would do it, and not all owners would be able to keep up with all the work or would even necessarily want to. But radical options abound if you are willing and able to pursue them.

Good luck with your baby. Please keep us posted on what the holistic vet says. Sorry I couldn't be more help.

Thank you for chiming in Meghane.

Obviously, the last thing I want to hear is that most pets end up being euthanized for this, but I appreciate your honesty. I'm also happy you said that acupuncture might help.

Since euthanasia is not an option for me (my dog is 10, but I just can't give up on her), I just have a couple of questions about what you said:

What is urine scald? Also, you mentioned stones...is that because this can lead to bladder/kidney stones?

I don't mind using a diaper, but the regular diapers I bought don't fit her right and she slips out of them. So I bought a washable cloth diaper online (where you put maxi pads in them), but she manages to get this one off too. Not sure how....she waits till I leave the room to do it.

Oh, I am also wondering if you think it's a good idea to keep her on probiotics? She finished the antibiotics about a week ago, and I've had her on Acidopholus since she started them. Should I continue them?

I will definitely keep you posted on my visit with the holistic vet. I'm going to him mostly for the rear leg paresis she has from the scar tissue, but I am now planning on making this bladder issue a priority as well (I guess I just didn't think he could do anything for it).

Thanks so much.

Oh, one more thing Meghane.

What about if I learn to express the bladder? Will that maybe help in terms of urine leakage, UTI's, and all the other things that can happen from neurogenic bladder?

Thanks.

I didn't think for a moment that you would euthanize your girl. 10 isn't that old, and I'd be doing everything possible as well.

You should learn to express the bladder, it will definitely help. It isn't difficult, just a matter of squeezing in the right place. You'll probably have to do it at about 4 times a day. It will definitely reduce the leaking and may help prevent UTIs. I can't remember how big your girl is. It can take some muscle in a bigger dog, but with a flaccid bladder it shouldn't be too bad. Does she stand on her own? That makes things easier too. I assumed that your vet already taught you how to do that for some reason, sorry.

Urine scald occurs when urine is in contact with the skin for an extended amount of time. It is basically a chemical burn, and it is painful. As long as you keep doing what you are doing to keep her clean, it won't occur. I wish I could help with the diaper thing, but I am completely inept in that department. I can never get them to stay in place either. But all the owners I know with a diapered dog get really good at it really fast, so just keep practicing, you'll get it.

Stones can occur anywhere in the urinary system, kidneys, ureters, bladder, urethra. If they block urine from flowing, the urine backs up and damages everything upstream- urine is not supposed to sit in any one place, and if it does it causes major inflammation, like the UTI in your girl. In addition, if the stones are in the bladder or urethra and prevent urination, it is a life-threatening emergency, because the bladder could rupture and then you have a belly full of pee, and that's no good.

I think probiotics are a great idea to help support her immune system and fight off UTIs. Also check with the holistic vet about optimizing her diet, he may make some suggestions there. There may be some exercises or physical therapy or massage therapy that may help her too. I think your decision to see a holistic vet is going to be a very good one:)

Hi Meghane,

My girl is a labrador retriever...she's about 75-80 pounds.

As for expressing the bladder, I actually googled how to do it last night. I tried it, and it's pretty difficult! Her bladder didn't feel flaccid - it felt really tight for some reason (maybe cause it's full). Needless to say, no urine came out. I'm sure my vet can show me how to do it *correctly*!

Oh, and yes...she stands on her own. Paresis might have been too strong of a word. Her thigh muscles are very atrophied and she has difficulty getting up after lying down for a long time. But she manages. And once she's up, she walks pretty well, aside from dragging her right paw a little and being a little wobbly sometimes. But she's definitely getting worse gradually.

I also googled urine scald - I see what you mean about the problem with that...I guess I could always deal with it if it happens, since their are topical antibiotics to help. That's been my whole motto of care lately - deal with things as they come. That's the only way I can handle all this!

I just ordered her 2 different kinds of diapers online (from the one I already have). These seem like they will stay on, so I hope they work.

Meghane, thanks so much for your time and your help. You have helped me more than you know. I feel much better about her situation and about going to the holistic vet.

Sawyer and I both THANK YOU.

There are 2 types of neurogenic bladder, called lower motor neuron (LMN) and upper motor neuron (UMN) bladders. The LMN bladder results in a very flaccid easy to express bladder that leaks a lot, unless not all of the nerves are affected in which case it could still be hard to express (there are 2 nerves that control the urinary sphinters, and one that tells the dog that the bladder is full, plus the one that controlls bladder muscle contraction- it depends on which nerve(s) is affected as to whether you get UMN or LMN bladder). The UMN bladder is always difficult to express, since the nerves controlling urination actually keep the urinary sphincter constricted. The leakage then occurs when the bladder just gets really really full. Most dogs with LMN bladder have decreased anal reflexes too, so if you touched her anus you wouldn't see it constrict (yes, we vets live a glamorous life). Without actually seeing her, I couldn't tell you which type of neurogenic bladder she has, but they are treated differently.

The lower motor neuron bladder is treated with the bethanachol, though not very well. UMN bladder is treated by relaxing the sphincters using diazepam and/or with alpha blockers- phenoxybenzamine, prazocin; depending on which nerve is affected. Sometimes UMN bladder is easier to treat than LMN bladder, it just depends on how well the individual dog responds to meds.

There is another type of neurogenic bladder which is called reflex dyssynergia, or an incoordination between bladder contraction and urethral sphincter relaxation. So you see a dog that postures to urinate, stops midstream, and dribbles especially after urination or while walking. It is usually difficult to express the bladder. It can be caused by spinal cord compression, which is why I eventually thought of it. The optimal course of action is to treat the spinal cord problem, but that is not an option with Sawyer. When we don't know why the problem occurs, we treat it the same as UMN bladder. I don't know if the meds would help with spinal cord problems, but I guess it wouldn't hurt to ask to try if her clinical signs match.

Forgot to mention, if Sawyer is leaking onto herself, you can rub petroleum jelly on the affected parts to keep urine from contacting her skin. Every little thing helps!

Good luck with everything. I know you have your hands full. Sawyer is VERY lucky to have you!

Hmmm...that's interesting about the different types. She seems to have components of each of the 3 types, but mostly the 3rd (reflex dyssynergia).

When you described the UMN bladder as leakage occuring when the bladder is really full, that sounds like Sawyer. Also, it was hard to express but I don't know what I'm doing...yet!

But the LMN similarity is that she was put on Urecholine/Bethanachol (of course, that doesn't mean much). What I also notice is that when I clean her up, she leaks very easily (while standing). Also, she definitely has an anal constriction problem because she constantly poops in the house (I usually just find it...but when I catch it happening I see that she starts pooping while lying down and then jumps up when she feels it coming out) - I always give her kisses and say good girl when she poops (how backwards is that?! I just don't want her to feel bad). Anyway, I will touch her anus when I get home to see how the reflex is.

As for the symptoms that go along with the 3rd type....everytime see pees she does posture to urinate, and then starts to get up and walk while still dribbling. Also, the recent MRI results (from 11/07) said something like "intervertebral spinal compression" - so the scar tissue is definitely causing compression.

Thank you for the tip about petroleum jelly. What a great suggestion. She usually leaks on her fur (on her thighs and tush) - do you think I need to put it in the fur?

Meghane, I want to tell you that all of your patients are so lucky. You are amazing. I will definitely look into this and hopefully do what's best for Sawyer.

Thanks.

Yep, just slather the petroleum jelly wherever she is getting wet.

You are such a great Mom for Sawyer. Not too many owners will touch their dog's anus, for any reason LOL! The details of what is going on will help both the holistic and your regular vet decide what to do next. Feel free to talk as long as necessary until you are sure they understand everything. Most of our diagnoses are based on the owners descriptions of the problems- you may not think it important but it may make a huge difference in the diagnosis and treatment. In Sawyer's case, it may not be as helpful as if we didn't know the general cause of her problems, but understanding what you are going through helps the vets decide how far to suggest going. You'd be surprised at the assumptions we make sometimes, how far an owner will go to make their pet feel better. And we are usually wrong. Just make it clear that you are willing to do pretty much anything for her, so you get ALL of your options. You don't have to do everything, but knowing your options enables the best decisions.

It's possible that the spinal compression is causing more than one type of neurogenic bladder. It may be a situation that you have to try different things and use what works best. And what works best may change based on the progression of her disease. I'm sure you'll continue being pro-active and in tune to her needs. I have no doubt at all that Sawyer will continue to get the best care possible.

You're welcome:)

Thanks Meghane...I like to think I'm a good mommy, but I'm just as blessed to have her in my life :)

I actually did the "anus test" as soon as I got home from work. She passed! I have no problem touching her anus, since I'm used to "trying" to express her anal glands since she gets blocked frequently (since she was a puppy).

You gave some really great advice about how to discuss this with both vets. I never really thought about the fact that vets deal with all kinds of owners, and it's important for them to know how much one will do for a pet. In my case, most vets I see know pretty quickly that I will do ANYTHING for my dog - and I mean ANYTHING! When I first when to the specialists for her surgery and radiation treatment, both the neurologist and oncologist were trying to turn me away from it since they thought the meningioma would very likely grow back within a year. As much as I appreciated their honesty, I decided that the 1% chance that it would NOT grow back was worth the investment (and heartache...she went through a lot). Well, it's been 4 years and she's still here, with no tumor regrowth :)

Well, I appreciate EVERYTHING you have helped me with. I will definitely post an update after we see the holistic vet.

Meghane,

Hi there. I just wanted to give you (and anyone else who's interested) an update on the holistic vet visit. First let me start with a funny - the vet tech picked Sawyer up before the case history began, and of course had his forearm pressing against her bladder....well, we know what happened! He got reemed out by the vet for doing that!!! But at least they were able to easily get a urine sample!
Oh, I also wanted to tell you that he says it's UMN neurogenic bladder.

After discussing Sawyer's case with him and the examination, he decided that he would do a whole slew of things since Sawyer's case is so complex. He is doing acupuncture, chiropractic, bee venom therapy, homeopathy, herbology, detoxification, and therapeutic nutrition. Everything was started today. For those that don't know bee venom therapy (BVT) is used in human MS patients (my holistic vet is the only vet in the U.S. offering this!).

He is doing both acupressure and "aquapunture". He is also doing "Auto-Sanguis therapy", which uses the patient's own blood to make a homeopathic medicine known as a blood nosode (I think this is called "homotoxicology"). He made this medicine during the treatment, and also used it in the aquapuncture phase of treament.

He recommended a home-prepared, mostly organic diet (he gives a "pre-mix" of essential nutrients, and then I have to add ground meat (in Sawyer's case, either venison or chicken with bone ground into it). I don't even cook for myself! But for her, anything.

He gave her herbal medicines (I think that's what they are) - the name on one is "cord tablets" and the other is "Pyrrosia14").

Also, and most worrying, is that he doesn't want me to vaccinate anymore. Now, her regular vet stopped all vaccines except for rabies after the surgery and radiation. But this vet wants me to stop rabies, and because there is no chance of her biting anyone or dog, I kind of agree. But I was worried about another animal biting her, since we go camping often. This vet said that she already has protection from 10 years of vaccinating. Any thoughts?

Oh, in case anyone is interested in what's in the food pre-mix (which is unprocessed), here are the ingredients: organic barley, rye and oats, dried unprocessed carrot, tomato, garden pea, lentil, spinach, parsley, garlic, powdered bovine colostrum, and spirulina. The mix is then simmered with ground meat (with the bone in it for calcium).

I will be going to him once a week for a few weeks, then every other week, then we'll see. I am very excited, so you'll all have to excuse me about the novel I wrote! Thanks for listening, and if anyone has anything to say about the treatment approach (good or bad), please chime in.

Thanks :)

Wow, sounds like Sawyer is getting the whole kit and kaboodle! And it sounds like you have a LOT to do!

Everything sounds good to me, except is she going to stop taking the bethanechol? With UMN bladder, she doesn't need it, as it tightens the urinary sphincter and that is already her problem. Also have you mastered the fine art of expressing her bladder? Sorry she has the more difficult problem to express, but I think you can handle anything that comes your way.

The vet makes a good point about the rabies vaccine lasting longer than the legal 3 years. However, the duration of immunity is tested on young healthy animals who are challenged in a laboratory setting. Real life is often more complicated than what is replicated in the laboratory. Not all dogs are healthy when vaccinated, and we don't always know that they didn't mount an appropriate immune response to vaccination; the viral load in real life varies quite a bit from the lab; animals bit closer to the CNS are more likely to get the disease. My concern in your case is that you know Sawyer has a risk of being bitten, which is bad enough in and of itself, but rabid animals also tend to bite people.

A couple of years ago, a properly vaccinated cat in NC savagely attacked several people in its family, and escaped through an open window. It was found later that day, and the family very reluctantly agreed to euthanize the cat and have it tested for rabies. It was positive. The parents said that if they had not found the cat, they would have never thought to seek treatment for rabies themselves or for their child who was also bit. They would have all died. And remember, this was a properly vaccinated cat. So while I am in total agreement that there are risks to vaccination which increase in some disease states, I am also very cautious about recommending against rabies vaccines because of the public health risk. Weird things happen, which is why the law (at least here in NC) is that all dogs and cats must be rabies vaccinated before 16 weeks, one year after that, and every 3 years thereafter. NC does not have a health exemption for rabies vaccines, but some states do. It would only protect you from a fine in case Sawyer was found wandering the streets and picked up by animal control.

The pyrrosia14 is used for a variety of urinary tract problems including UTIs. I haven't heard of cord tablets; I'd be interested to learn what is in them.

My Max (also a Lab) gets homemade food for his multitude of health issues- one kidney (the other one had to be removed due to an abscess), recurrent struvite bladder stones, mild heart disease, joint disease, food allergies. I can make 9 days worth of food in about 2 hours for him. He gets rice, chicken, eggs, mixed veggies, salmon oil, veggie oil, and a vitamin/mineral premix. His recipe came from a nutritionist because I was at a loss on what to feed him. My other 3 dogs are still on dog food (Solid Gold Wolf King) until I start making enough money to cook for them too. I do give them homemade food 1-2 times a week, plus they all get turkey necks or something raw 1-2 times a week as a treat. But I'd love to be able to cook for all of them. I like cooking, even for myself, though.

How's Sawyer doing after her BIG day? Most pets get a little worse the first 1-2 days after their first couple of acupuncture-type treatments, but then get much better. I hope she is feeling better already.

Hi Meghane,

Thanks so much for responding. Sawyer was acting a little weird immediately after the treatment - she was picking up her foot in a strange way. But later that night she seemed better than before the treatment (and it continues as I write this!)...she is not knuckling nearly as much and has not urinated in the house. Yes, I have been figuring out how to express her bladder. Works pretty well! The vet told me that I can keep her on the Urecholine since it's pretty harmless, but he doesn't think it'll do much, like you mentioned. I will have to speak with her regular vet about it - but it did seem like this holistic vet didn't see any point to it.

As for the rabies vax, I think I will stick with his advice. But I'm still a little weary. I mean, I'm not worried about her roaming the streets (she won't leave my side!), but I'm worried about camping. If she God forbid gets bit by a rabid animal, it can be treated, right?

That makes sense about the pyrrosia14 - I wish I knew what the cord stuff is. I'll ask next time I see him.

I can't believe you spend 2 hours cooking for Max! You're a great mom too! Why don't you make more food and just freeze it? You definitely put lots of work into cooking for him, but I guess if you like cooking it's not that bad!!

Thanks for everything, Meghane. You have been so wonderful. And I wish Max the best with his health issues...he's lucky to have a great mom who is so smart with animal healthcare!

If she gets bit by a wild animal, then best course of action is to take her to the vet immediately for a rabies vaccine booster. And if possible, collect the biting animal for rabies testing. Rabies is 100% fatal in animals and people once symptoms occur, with the exception of 2 people who are permanently disabled mentally and physically. Once symptoms occur there is no treatment, and the only thing to do is humanely euthanize before the animal becomes dangerous. It is hoped that a vaccine booster will make the immune system produce enough antibodies to fight the virus. In older pets, I worry about that not being the case, especially if the antibody level is already low from not vaccinating. Unfortunately we just don't know enough about vaccination to be able to accurately predict all the what ifs, which is why we err on the side of caution especially with diseases that can kill people. But no, there is no treatment for rabies.

Ok thanks. I may just get the rabies vax then. It just worries me too much.