Julie's Perry 2018 Conservative--Shih Tzu

Hi Julie,
Just came across your post, so sorry to read about Perry.
My thoughts and prayers are with you, wishing Perry a great recovery.
Take care,
Michelle and Keira

He still won't make any effort to pee on his own on the pee pad, Julie? He may have some bladder control. Or it could be the UTI, they can be very painful. Hopefully the antibiotic will help with that soon. Keep trying to see if he'll go on his own. Maybe put a leash and harness on him and let him take a few steps on the pee pad.

If it is the sphincter muscle that is tightly contracted, then there are drugs to relax it, making expressing easier. Bring up with your vet if meds would be appropriate with Perry's situation to decrease internal urethral sphincter tone.

—Phenoxybenzamine, a nonspecific α-adrenergic antagonist, decreases internal urethral sphincter tone. Clinical effects take days. NOTE: it is less potent than alternatives, with greater risk of side effects; obsolete in human medicine for urinary applications.
—Prazosin, an α1-adrenergic antagonist, decreases internal urethral sphincter tone and may cause marked hypotension. Prazosin appears to be an effective alternative to phenoxybenzamine in the male dog.
—Bethanechol, a cholinergic (mostly muscarinic) agonist, enhances detrusor muscle contraction.

Julie, it is possible to learn how to insert a catheter at home and be sterile about it.. Let us know what the vet suggests.

Did the vet mention any of the meds to relax the sphincter that Marjorie mentioned, like Prazosin or Phenoxybenzamine? I used this early on with Frankie and it made it much easier to express him.

The antibiotic for the UTI should be kicking in pretty soon and that may help also.

Julie,

Did the Tramadol dose change?   

Perry might be in pain from the urine scald or the UTI or the pain can be from his disc episode..  Usually after about 48 hours if the antibiotic is right for the UTI, they begin to feel better.. If not, perhaps another antibiotic would do the trick.  In some cases they have to do a culture to match the right antibiotic to the UTI..  Does he seem to be in pain when you are not trying to  express him?  Just trying to determine if his pain meds need adjusting again.. Or if it his UTI/Urine scald related..

It also sounds to me like he  would benefit from a calmer.. I use Colostrum with Tyler and it works like a charm.. It can change his cantankerous attitude when Neil isn't home to a much mellower Tyler..  Most Pet stores carry it in the supplement section where they keep anxiety and stress supplements..  Composure Soft Chews is one, that I know of.. Here is a list of different calmers:    www.chewy.com/s?query=Calming+dog+chews&nav-submit-button=

I just realized this is Julie (Nala's mama), too! Bless your heart. I don't know Perry's personality but if his first experience with expressing was painful (UTI), he may now associate that same pain with every attempt to express him going forward. In other words, it's sort of like my attempts with Tyson to get meds in... first taste of Tramadol (neck episode) his trust was broken... no go with every attempt going forward. I might as well have given the whole bottle to someone who could use it because it wasn't happening.


When Perry's antibiotic kicks in and it should within 72 hours if they are using correct med, his genital area should feel better and be less sensitive. (if UTI is the source of his unusual reaction/pain) Hopefully, he will feel better and settle down as you try to express going forward esp when he realizes it's not going to hurt every time. That is the positive of using the muzzle. He will be forced to recognize there is no pain now.  It may also be the urine scald on skin is causing him pain if it's involved and touched when expressing his bladder. I'm not sure where the affected disk is but typically if they have no feeling and nerves aren't connecting because of swollen disk, I would naturally guess expressing wouldn't cause pain. I'm with you, Julie. I would be stumped, too and searching for answers. 

It's tough for you to figure out how to help him....express him and keep him dry with his reactions. There's no way to know for sure at this point but it does sound like the pain may not be associated with the swollen disk because he seems fine until it's potty time going by your observations. 

I hope he feels better soon and things become a litle less stressful for you both! 

Julie, it is really hard for us humans to know which: relfex or brain directed just by watching the limb move. We need to also have confirming observation of head level involvement in order to confirm something is brain directed and done with purpose.
--- Does think about changing sides in his suite and then attempts to use his limbs to push into a different position?
--- Does he sniff an old pee spot and then choose to release urine there
--- Does he have an itchy ear and the attempts to scratch with his hind leg

I'm glad to hear you are better able to feel the bladder and recognize when it gets very flat that you have likely voided all the urine.

I can understand being reluctant to start the pred taper. Since no one knows exactly how long to use pred, a test for pain taper is the only way to know. Since your vet prefers backing off of pain meds, then I would touch bases to find out her preferred method.

Yes, when dogs have more severe symptoms as Perry does, the benefits of laser therapy can outweigh the risk of transport. Also acupuncture can be beneficial. It would be best to find someone to come to your home, if possible, to avoid the risk of transport. If you do need to transport him, be cautious of too much movement of the spine. I think you had mentioned once before that with Nala, you don't use a crate in the car but it would be best if you could buckle in the crate securely and pad the crate well to prevent too much movement during any necessary car rides. Does he get very excitable going to a vet? If so, then that might tip the scale towards the risk outweighing the benefit.

Please don't blame yourself for the urine scald, Julie. I know you're doing the very best you can caring for Perry. This has all been so stressful for you, with him being so painful when you expressed him. Hopefully once the UTI clears up, caring for him will be much easier.

Neuro function loss can mess with his penis. If the penis is not going back by itself and you see it out of the sheath, do put it back in so this delicate tissue does not dry out. With clean hands spritz a bit of water so you can slide it back in easier. Water soluable KY jelly is also good. Avoid petroleum based products like Vaseline. It shouldn't in any way be causing the nipping.

The UTI should be better soon and hopefully that nipping will stop. If you don't see any improvement in the next day or so, I would ask the vet to do a urine culture, which takes a few days to get the results back, to be sure the correct antibiotic is on board. A vet usually prescribes a broad spectrum antibiotic at first in hopes that it will target the infection but sometimes a urine culture needs to be done to pinpoint the exact bacteria.

Well, today, you can back off the pain meds to twice a day and always go back up immediately to 3x if there is pain. Got fingers crossed for no pain on the taper.

I'm glad you have a vet who has seen Perry give an opinion. Good idea on the desensitizing thing.

Hi Julie,
Have you considered doing one of those gofundme pages? Then if you have Facebook you could ask all your contacts to share it around to get it out ther.
Michelle

Julie, glad you have that appt with his regular vet tomorrow morn. If it takes drama to get across you want help so that you can help Perry, then put on your best act. The squeaky, but polite wheel, gets more attention. Tell your vet right up front PTS is not a treatment, you want help, you want a solution for the expressing.
---- Would ACEpromazine an hour before you express relax his muscles enough that he won't resist? Trazadone might work it can sedate, and calm behaviors... Might try an hour before you express. The vet can tell you if one of these two meds could work and what the dose would be, if it needs to be higher than what is currently prescribed.

Hang in there by thinking of every little positive thing to crowd out any thoughts that are negative. You will find a solution. While it is not the best to express every 8 hrs, if that gets you through this, then consider not trying to express so often. Now that he is tapering pred, he should be less thirsty and thus less urine would be produced.

((hugs)) and we'll be waiting to here what Perry's regular vet has for a solution to the expressing problem.

Just back from vets.

My vet also thinks Perry has some sensation in the bladder area.

Said to give him 25 mg of trazadone 2x a day, morning and evening to relax him to make expressing easier.

Vet tech showed me how she expressed him.

Hopefully this will help.

If not I'll get a urine culture done.

Also, vet gave me another week of clavimox, 125 mg, to give 2x daily, as Perry has a couple urine scald patches on his back legs.


[Moderator notes please do not edit
17 lbs
Prednisolone as of 3/17: 5mg 2x/day for 7 days
                      as of 2/23: 5mgs 2x/day for▲3 days, then 3/26 test taper for pain/neuro loss
Gabapentin still? 100 mg 3x/day
Tramadol still? 75 mg 3x/day
Robaxin still? 125mg 3x/day
Pepcid AC 5 mg 2x daily
Clavamox 125mgs 2x/day til 4/4 for UTI+urine scald
Trazadone 25 mg 2x/day to relax @ expressing]

She said Perry is making progress.

Thanks again for all the help and support.

No matter how many episodes you've been through, it gets lonely in the trenches!!