Caring for a Three Legged Dog or Cat
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Hello everyone,
So, I haven't posted in tripawds since I lost my Jersey Boy a couple of years ago. Unfortunately, my furry family is affected by cancer again ...
During late August 2018, my Emerson was diagnosed with lymphoma and given a prognosis of 6-8 weeks. I took him to an oncologist and treated him and he is in clinical remission. He's in really good spirits, (excited about walks and food ... and routine fighting and roughhousing with his lil brother Rocky). Right at the end of his treatment, Emerson had a bought of sterile hemorrhagic cystitis. We are about 4 weeks post diagnosis and I'm struggling with the thought that he won't go back to normal. Here's what I'm seeing:
Week 1: He was clearly in pain and unable to control urination. His urine was always tinged with blood and he was straining to urinate. I've kept him in diapers
Week 2: less blood also still in pain....and still really straining/trying to urinate frequently. Still diapered
Week 3: No blood... still straining/squatting to urinate frequently. But, he spent the week with my mom while I traveled for work (she has a fenced yard and he spent a lot of time outside). Mom told me that he was doing much better than week 1 (which was the last time she saw him). Not diapered at all ... he'd occasionally use a potty pad.
Week 4: He's back home with me this week... I essentially see very little difference since the end of week 3. he's still straining and often unable to control his urination. (For example, he'll have an accident an hour after a walk). I've had to put him back in a diaper to protect my carpet...
Has anyone else experienced this? Any advice on how to cope? Or any idea if this will actually improve ... or is my guy one of the few who will never recover.
I know that I have alot to be thankful for, but I'm exhausted, concerned that he still seems to be straining... alot and he HATES the diapers.... can you provide any advice to get us through?
Thanks for reading... please know that I am sending you peace, well wishes and positive energy+light! 
It was so good chatting with you last night and I'm glad you decided to post.
First, congrats on Emerson kicking lymphoma's ugly old butt! But it's such a bummer about the cystitis, I can see why you feel upset and like it will go on forever. For now, try to put those thoughts out of your head though. My guess is that this can be managed to a great degree. As I mentioned, Paula is the expert on this subject around here, so she has lots to say. I'll make sure she knows you posted.
In the meantime, what kinds of recommendations did your oncologist have to manage the situation?
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
Hey!!!
I actually talked to Paula last night and she has a lot of ideas... thinks that it does take some time for doggies to recover from this (Up to 2 months). Paula also has some recommendations for supplements/medications that Emmie can take that helped Nitro when he was struggling with incontinence. She also highly highly highly recommended that I see a naturopath and try Chinese herbs (I'll look into this for the end of the month).
I also talked to 2 vets today. Both are mildly concerned that he developed an infection and believe that we should do a urinalysis and culture to rule out infection.... because he would be at risk for a UTI and a UTI would manifest exactly the same as what I'm seeing.
I am a bit freaked out... because I plan to be away for work, all day tomorrow. But, I think i'll try to schedule an appointment for him on Friday to get the urinalysis......and hold off on the ultrasound.
Cancer sucks ...
The way he is straining does make it sound more like an infection, although Male dogs seem to get these less than females. Did you get my message about which meds to ask about?
Paula, the reluctant cystitis knowledgable one (calling myself an expert sounds presumptuous)
Nitro 11 1/2 yr old Doberman; right front amp June 2014. Had 6 doses carboplatin, followed by metronomic therapy. Rocked it on 3 legs for over 3 years! My Warrior beat cancer, but couldn't beat old age. He crossed the Bridge peacefully on July 25, 2017, with dignity and on his terms. Follow his blog entitled "Doberman's journey"
"Be good, mama loves you".....run free my beautiful Warrior
Thanks Paula!!!
I did read through your messages... and I took the time to "talk myself off the cliff" of taking him to the Emergency room last night. When I spoke with his vet yesterday, she told me that I can watch him for a day to see if anything changes... but she didn't consider it very-urgent or an emergency. She told me to watch for any signs that things are getting worse (vomiting, fever, behavior changes) as that would be more indicative of a more urgent situation. So we scheduled an appointment for urinalysis + culture ... and I watched him on my NEST camera intermittently while away for work today (he slept on the floor, couch, dog bed, under the kitchen table... you know super boring and normal. lol!!!)
I'm not going to do the ultrasound for now, because he's peeing just fine (everywhere ...LOL!!!!) he just can't *HOLD-IT* to make it all of the way outside. In fact, he's straining soo hard that he's 
'ing and peeing at the same time (pardon my graphic-ness). But, if the culture comes back negative I'll schedule the ultrasound immediately....
Earlier today I gave him some medicine for the watery- and gabapentin (Yep! I have collected a mini doggy pharmacy for him)... and he actually seems a bit more comfortable.
Thanks again
I'm really glad he's feeling better 😊
Hugs,
Jackie, Bo, Andy, Oscar, Phoebe, and the coolest feral tripawd kitty Huckleberry 
Whewwwwwww....... here we are, a few days later.
The good part: I found a local mobile vet and this is the first time I've used them for a not well dog. The dogs were THRILLED to have visitors when they showed up (they didn't realize that the woman was their vet). Usually, they're whining, shaking and an anxious skittering mess at the regular vet office. Not this time ... #score (ok, they charge you $30 just to come to your house.... expensive for 1 dog, but I think the price is worth it for the convenience and reduced stress).
The bad part: The mobile vet does not have ultrasound capabilities and tried to retrieve urine by feel. No luck. Told us to go to the emergency vet.
The 'badder'-part: We went to the emergency vet a while later and they weren't able to retrieve urine (although I waited to bring him when he had a full bladder). When they brought him back me, he emptied that bladder onto the floor... Urrrrghhhhhhhhhhhhhhh
The quizzical part: Everyone, and I mean everyone (Oncologist, Regular Vet, MY FORMER student [YES! she's a vet now! #soooproud]), believes that there is posibility for an UTI . Howver, the ER vet dropped 3 bombs which were 100% discordant with what I accept as fact. #1 She very matter of factly said "this type of cystitis is for life", #2 I don't think it's an infection because male dogs don't get infections easily. #3 Then she told me that she trusts a properly read urinalysis over 'cultured' urine tests... and sent me home with a cup to get a clean catch.
In typical fashion... I challenged her, asked her a million questions. She held her ground and sounded logical (even though I think her 'bombs' are opinion)
During the conversation, the ER VET told me a story .... someone had surrendered a cat to their practice that was struggling with cystitis... the owners wanted to euthanize the cat. They took the cat in and administered everything that I've already tried and the cat was still miserable. Then they learned about doxycycline in women suffering from cystitis. So, they gave doxy to the cat ... she said that the cat felt better in a short amount of time and the cystitis eventually resolved. So, she asked me if I wanted to try doxy....
ok.... so this is anecdotal evidence. (ie. correlation does not equal causation) I came home and voraciously searched the PubMed. And, there aren't any recent studies and NONE in dogs.... but I think of doxycycline as being an innocuous drug. So, I don't think that it will hurt. I'll talk to the oncology office on Monday...
Next tasks:
- Cook food, sprinkle probiotics
- Hand feed (Emerson is not eating well and must be fed by spoon. God help us!!!)
- Hide pills in cheese (Gabapentin, Doxycycline)
- Love Emerson (and Rocky) to pieces
- Be More Dog .. (Our normal vet remarked on how good he looked, full of energy, playful he was as he exuberantly greeted her at our front door)... Yep! Be.More.Dog.
But before I do any of this. I have a massage scheduled in 45 minutes. hahahahahaha! =)
Click here for ***backstory****
My first thought .. if they want a c&s on urine, it should be done with cysto, which they should have done before he peed all over the floor. That is the most accurate way to get culture and sensitivity. Just palpating his bladder can tell you if there's enough urine to get a sterile sample, clean catch was not acceptable for culture when i was a tech, which was about 12 years ago. It's ok for regular u/a.
I agree about the doxy, although i don't know anything about how it affects, or is affected by cancer, sorry. I have used it for my pup, and have seen several dogs get treated for Lyme without major side effects.
Male dogs, just like people, don't get uti as frequently as us girls, but it shouldn't be ruled out.
Question, what basis did the confirmation of cystitis for life come about?
I think i would be grilling for more answers, and although sterile urine sample with culture and sensitivity is more expensive, it will show specifically what his bacteria is sensitive to and show what are the appropriate drugs to treat it with. I would not allow C&S to be done with a free catch.
I'm sorry you're still having to hand feed him. I have been there with my Mitch too many times to count. Hopefully once he's feeling better you'll be able to wean him off to eating in his own. I will tell you one thing, lol. Mitch can be a primadona sometimes and he feeds off of the attention lol. Eating is important though, especially for you so way to go! 😁
You are doing a wonderful job of caring for your boy. I hope you can get more answers so you know better what is going on. Your mobile vet sounds like a gem ❤️
Hugs,
Jackie, Bo, Andy, Oscar, Phoebe, and the coolest feral tripawd kitty Huckleberry
Hey Kim, I have some thoughts....some things I agree with the ER vet, others I'm not sure. I feel male dogs DO NOT tend to get UTI's very often. I have no idea if this cystitis is for life - I'm not sure that is a given. As for a properly read UA vs a culture...obviously either one would need to be as sterile a specimen as you can get. I still feel a culture would tell the better story.
If Doxy wouldn't do any harm, I think I would give it a try. I know well the challenges of a dog who doesn't want to eat. Have you tried Mirtazepine to stimulate his appetite? It worked well with Nitro.
Kudos to you for exhausting every possible thing to deal with this. If it turns out this is "for life", as long as he isn't in pain from straining to go, I feel you can handle it. It sucks, it's annoying, its inconvenient, its frustrating... but I always told myself when Nitro was going thru this - there are so many worse things out there that we could be dealing with. Try not to drive yourself crazy over it. Does the Gabapentin help with the discomfort? Is there some kind of other pain med that can be used? Maybe this can't be "fixed", but I think it can be managed. Hang in there, you are doing a great job.
Paula and Warrior Angel Nitro
Nitro 11 1/2 yr old Doberman; right front amp June 2014. Had 6 doses carboplatin, followed by metronomic therapy. Rocked it on 3 legs for over 3 years! My Warrior beat cancer, but couldn't beat old age. He crossed the Bridge peacefully on July 25, 2017, with dignity and on his terms. Follow his blog entitled "Doberman's journey"
"Be good, mama loves you".....run free my beautiful Warrior
Hello again! And thanks again for all of the support.
We're about 24 hours post the first dose of Doxy. + gaba ... although I think it's a bit premature. Today already feels a bit better than the past few days. He's still straining and squatting in the house, but not as much as he has earlier this week. After another convo. with Paula, I have a better appreciation of how up and down this type of recovery can be.
To follow up on comments above (.... I agree with every comment/statement/concern above):
- To clarify, the "bladder tap" was attempted before he peed on the floor... even though the doctor tried and failed to withdraw urine.
- I agree that a truly sterile "bladder tap" sample would be the gold standard for testing for infection and to determine antibiotic susceptibility. However, the doctor argued a good point.... she told me that she's sent samples away for urinalysis and culture. And, the culture came back negative whereas the urinalysis detected bacteria (rods or cocci). Or she had patients that tested negative overall but improved after antibiotic (ie. pesky Mycoplasma would do this!!!) She said that she had prescribed antibiotics anyway. (As a former microbiologist/lab-rat, I have observed all kinds of wackiness when it comes to plating bugs and predicting susceptibility... so this is all completely plausible) When discussing "clean catch", she told me that I should try to capture a sample midstream .... with the rationale that they would *anticipate* a small number of bacteria because it wasn't a sterile catch. However, in most instances of infection, the bacterial count is much higher. Therefore a they would expect a higher bacterial count, if he were truely infect. Although this scenario sounds less than ideal, I think it sounds sufficiently logical (.. share your thoughts?)
- "What was the basis for the comment about cystitis for life?" Ha! great question ... this was her unsolicited retort to me saying that his cystitis hasn't improved since week 3. However, later in the conversation she directly contradicted her statement to say a cat in her care recovered from (non-chemo induced) cystitis..... I haven't lost faith that Emerson will improve, and even if things stayed the same, it's manageable as long as his quality of life isn't impacted. (So far, it's not a significant impact)
- I spent a bit more time on PubMed and am now convinced that Doxy has a dual effect. It works as an antibiotic and potent anti-inflammatory. Some studies even implicate it for use in combination with chemotherapeutic drugs.
- Here are papers showing benefit in various cancers:
- And a study in dogs suggesting that it may provide benefit when added to a protocol as combination therapy. because it can kill lymphoma cell lines (but no true benefit in dogs as an only drug)
- On the flip side, there was a study that claimed that Doxy antagonizes the effect of doxorubicin (he took this during his treatment).
- I'll call the vet, tomorrow. With all of this said, these are all very preliminary studies... *Side note* this forway into PubMed was a massive sidetrack. When I began searching I was interested in finding Doxy + Cystitis and Doxy + lymphoma (to see if it would interfere with the drugs, See comments under bullet point #4). I found a few, that indirectly told a story of Doxy effetively treating cystitis:
- Today I tried to hand feed him, but apparently, I was feeding too slowly because he came right over and dunked his head in the bowl and ate all of his food... and left me with a shiny, empty bowl.
- Does gaba help him with pain? Well, I'm not sure if he's in pain or if it helps ... but because of its mechanism of action, I don't think it would hurt.
And, although I'm not sure if something is 'wrong' (ie. infection) he's totally acting like himself. That's it for now...I'll let you know how things come along.
You are amazingly astute and so well read and well versed!!
My thoughts on clean catch is that if it's in a sterile cup and the person doing the catching can do so without touching anything but mid stream urine is good. The best way to do this is to clean his penis off before you take him out, and make sure the cup touches nothing but the urine that you're catching. I have no doubt right now that you're capable.
Not being able to get the cysto tells me that it's not their stronger point. If he urinated that much then i think they were not able to grab his bladder. Now, was he fighting them? Maybe.
I'm so glad
I'm glad you found the info on the doxy. I know it's kind of like a double edged sword but you are all over it.
Go ahead and laugh... But i believe you challenge the vet with your knowledge and intelligence.
It sounds like the doxy is making a dent. Less straining = more comfort. That's wonderful!!
Gabapentin does give relief. It's a great drug for phantom limb pain, and in humans (like my mom) it's a life saver. Some dogs stay on it intermittently for long term use, and for relief with aches and pains. My mom takes it twice a day after her back surgery and it makes a world of difference.
Yay for appetite!!! That's a sure sign that he's feeling better. You are doing a wonderful job!!!
I can't look at your links here (on my cell) i will check them out later. It's a lot easier to see on my pc, lol.
Can i just giggle here a little? The cystitis comment b/c it's been three weeks... Well... that's kind of the reason for culture and sensitivity. If he has that done and does not respond to recommend medication, then i would start looking at it being a long term project . Which is not to say that it couldn't be managed.
Looks like he's quickly responding a bit to the doxy, i would hang in to that right now.
You rock! ❤️❤️❤️
Hugs,
Jackie, Bo, Andy, Oscar, Phoebe, and the coolest feral tripawd kitty Huckleberry
Hello again,
... I don't think Emerson is too with the vet squirmy. I've seen how he acts while restrained and I've heard how he acts while restrained (@the oncologist). He's not bad at all. So, yeah, I don't think bladder taps are their 'strong suit'. LOL!
Anyways ... now that he's on antibiotics... I think it's unlikely that he'll have a positive culture. So I'm going to hold off on the pseudo-clean catch and reconsider if we start backtracking again.
For an update: More improvements today... less straining and he's doing a better job holding his pee and poop (I left home twice today and there were no accidents when I got home). He also ate his bowl of food ... and I caught him on camera eating his brother's bowl of food (... my fault, I should have picked it up when I left today). And, we only used 1 diaper today!!!
Also, talked to the oncologist and got the 'green light' for gabapentin and doxycycline.
Everything is cool over here. thankfully. I'm soo grateful
Great news Kim! Paws crossed things keep progressing in the right direction.
Paula and Warrior Angel Nitro
Nitro 11 1/2 yr old Doberman; right front amp June 2014. Had 6 doses carboplatin, followed by metronomic therapy. Rocked it on 3 legs for over 3 years! My Warrior beat cancer, but couldn't beat old age. He crossed the Bridge peacefully on July 25, 2017, with dignity and on his terms. Follow his blog entitled "Doberman's journey"
"Be good, mama loves you".....run free my beautiful Warrior
Oh wonderful news! I'm really happy to hear things are looking up. You are such a pawesome advocate for him!
Tripawds Founders Jim and Rene
tripawds.com | tripawds.org | bemoredog.net | triday.pet
That is really good news! Lol@ eating his brother's food, heheh. And his accidents are starting to phase down, even better! I am so glad things are looking up. He is a lucky pup to have such a diligent pawrent. You really have taken all of the measures to recover Emerson in the best way, and I love your attitude with it.
Hugs,
Jackie, Bo, Andy, Oscar, Phoebe, and the coolest feral tripawd kitty Huckleberry
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