On Thursday May 31st, I dailogued with three Vets at KAH regarding BHRR's Emma and my ever growing concern that something was just not right with her urination. It is also clear that yes, she has a weak hind end; yet her balance seems a bit wobbly plus as mentioned from from the beginning in her blogs; it is somewhat hard for her to raise her head completely upright.
So, more research, more discussions with other Vets ensued and BHRR's Emma was presribed Tramadol 15 x 100 mg to give in addition to the Dermaxx for any continued discomfort she was possibly experiencing with urination.
Additionally, discussion was had to give her Duvoid/Bethanecol 10 mg for the next few days – 1/2 tablet SID (a medication sent home for cats that have been unblocked) to see if that shall help her contract to allow her to urinate. Prazosin 5 mg TID was also researched to help the urehtal muscle relax. The advantage over using Prazosin over something like phenoxybenzamine was that the Prazosin seems to demonstrate a dose-by-dose effect(ie rather than having to wait several days or longer to reach a therapeutic level).
We also conversed about inserting a catheter as since her spay, she had not urinated at all. As she was also just spayed, manually expressing her bladder without sedation would be very painful for her.
So, I made an appointment to bring her in on June 1st, to manually express under sedation and to insert a catheter.
Later, on May 31st, a diagnosis was also made on her possible condition – 'REFLEX DYSSYNERGIA' – synonyms – Dyssynergia, Detrusor-urethal dyssynergia, Bladder dyssynergia, Detrussor-sphincter dyssynergia
Reflex dyssnergia is a syndrome(so there is an underlying cause for this condition) is a syndrome that describes asynchrony between active contraction of the detrusor muscle and incomplete/absent relaxation of the urethral sphincters. The affected pet has normal initiation of voiding and posturing but urination is interrupted by contraction of the external urethral sphincter resulting in a urine stream tha tmay stop or occur in spurts. The urine stream may be narrowed or the pet may dribble urine. In many cases, the patient will strain and tend to assume a posturing or squatting position with production to no urine ie. functional obstruction.
An underlying anatomic or neurologic lesion has never been described in dogs with this syndrome and spinal imaging studies have failed to identify a cause. Some cases have neurological examination changes but most do not. In some cases, onset of signs were associated with prior sexual excitement in intact male dogs. Since the onset is often sudden, trauma or a small vascular accident in the lower lumbar spinal cord have been suggested as possible etiologies.
Disease Description In This Species
In one study of 22 dogs, affected cases were middle-aged male dogs(mean age 4.9 years) of large and giant breeds. Nine dogs had had periodic clinical signs for longer than one year.
Large breed dogs
Before I went home from work that day; one of her Vets advised to hold off on the Duvoid/Bethanecol 10 mg until the Prazosin was picked up and to give the Prazosin first and then the Bethanecol.
I took the script fo the Prazosin to the local pharmacy in Kemptville to be filled.