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"Incontinence" Mystery Solved
by Judy Kody
(Excerpt from Summer 2004 issue of GCNM News)
Christine Boyd and "Cassie"
Christine Boyd adopted "Cassie" after she was returned by her first adoptive family in July 2001. Outgoing and energetic, Cassie was able to coax Christine’s shy Greyhound, "Betty Jo," to play and be sociable. Cassie was the perfect dog; until the licking started.
Early in 2003, Cassie began licking her "girl parts" – and not just on occasion, but almost incessantly. Christine noticed Cassie’s bedding was often wet, but she couldn’t determine if this was from urine or saliva from licking. Then began the odyssey: Numerous veterinarians were consulted. The initial diagnosis was incontinence and a prescription was given for a common drug used for strengthening the urinary sphincter muscle. When no improvement was noted, the pursuit for other solutions began.
Diagnosed with and treated for an assortment of ailments ranging from urinary tract infections to food allergies, Cassie continued licking and was exhibiting visible signs of discomfort as she hunched over and shivered while urinating. She also began to resist any cleansing of the area by Christine, which was part of the routine that had been prescribed early on. Her silken white hair soon began to discolor around the affected area and Christine became increasingly frustrated by the temporary or total lack of response to treatments.
After numerous opinions from various veterinarians, the mystery of Cassie’s problem began to unfold, literally – for it was a fold of skin that was causing her problem. Close scrutiny was almost impossible due to the tautness of skin obscuring the vulvar area, not to mention Cassie’s resistance to examination because of the discomfort. Urine stays trapped under the fold of skin and actually scalds and destroys the tissue, similar to the effects of a chemical burn. Many dogs with this abnormality have a concurrent urinary tract infection as well. Surgical removal of the fold of skin was suggested as the remedy for this condition.
A decision had to be made on whether to subject Cassie to surgery to correct her deteriorating condition. Evidence that Cassie’s sunny disposition was being affected caused even greater consternation for Christine, and she decided to launch an Internet search for information on surgical correction of this anatomical abnormality. One particular surgical procedure was cited frequently in her research; "episioplasty." The documented vast improvement for dogs receiving this procedure seemed almost too good to be true, but warranted further research. One study suggested this condition is more prevalent in spayed females, presumably resulting from the change in hormone levels, although other studies indicate prior ovariohysterectomy (spaying) did not appear to be an influencing factor. Other published studies hypothesized that a history of prior corticosteroid administration can cause this condition.
It is no secret that corticosteroids are frequently used in racing Greyhounds. According to "Care of the Racing Greyhound – A Guide for Trainers, Breeders and Veterinarians" Blythe, Gannon and Craig; "Injected corticosteroids are often used indiscriminately and incorrectly in the therapy of injuries" in racing Greyhounds. It has long been known that steroids, even when clinically unnecessary, have been administered to racing Greyhounds in spite of the well-documented, long-term negative effects. In addition to pharmaceutical hormones, the physical and psychological pressure of training and racing can stimulate an abnormally high production of cortisol – a natural hormone released in response to stress – which can eventually result in multiple organ dysfunction.
Dr. Andrea Speed
After consulting several veterinarians over the period of about a year, Christine elected to have episioplasty performed by Dr. Andrea Speed of De Anza Animal Clinic. Dr. Speed had previously evaluated Cassie in October 2003 and felt at that time surgery would be the best approach for this problem. Speed rarely sees this abnormality, and feels it is possibly more common in female racing Greyhounds since they are not allowed to "cycle" (come into "heat") normally. Female racers in heat would disrupt kennel life at the track and are routinely administered testosterone to prevent this. In Dr. Speed’s extensive experience with spaying retired racers in preparation for adoption, she has frequently observed abnormal vaginal development and other problems as well.
Not having performed an episioplasty before, but confident of a positive outcome, Dr. Speed did her own research on the procedure in a veterinary surgery publication. Always willing to consider new techniques, but cautious about not getting in over her head, Speed recalls her thought after studying the literature; "I think I can do that!" Concluding that the procedure wouldn’t involve a lot of dissection or avoidance of critical vessels or organs, she opted to do the surgery. Performed under a general anesthesia, and requiring about 30-45 minutes of surgical time, the procedure was described as "not difficult" by Dr. Speed and the patient was sent home with pain medication and an "E" collar to prevent licking.
Before surgery, the skin was so tightly stretched over the vulva, a full view of the unexposed tissue was not easily achieved during examinations. After surgery the full extent of the undoubtedly painful condition was glaringly obvious. Christine’s training as a trauma nurse did not prepare her for the post-operative appearance of Cassie’s surgical site. She said she "felt horrible" when she realized the extent of damage to the flesh of and around the vulva from the chemical-like burns due to the pooled urine under the fold of skin for months and months. Also, the persistent licking during the months prior to surgery had excoriated the skin, creating the appearance of "hamburger meat" in the now-exposed area.
Anticipating a lengthy and painful recovery, Christine was delighted to see Cassie show almost immediate improvement in her attitude and most noticeably, the absence of licking. "Out of habit," Christine states, "Cassie would turn around and go to lick every time she lay down, but once she stuck her nose back there, it was as if she thought ‘Hey, it doesn’t hurt anymore, so I don’t need to lick.’ She would stare at the sutured area for a moment, then flop over, and go to sleep. She has left it alone ever since!"
From this experience, Christine has learned, "That you just have to keep asking questions" when traditional treatments and diagnoses don’t provide relief for your animal. "Yes, it is time and money consuming, but if I had given up asking all over town, Cassie would still be suffering."
Veterinarians have easy access to information from many sources and they should be willing to investigate unusual cases presented to them. Don’t be afraid to ask your vet to do some homework and if he/she is not receptive to this approach in any situation regarding your animal companion, time to change vets.
"The surgery was a huge success!" Christine exclaims. "Now, Cassie is doing wonderfully. She is healed, dry and has normal-appearing pink skin and does not stay awake at night licking or have to clean herself the minute she urinates. She just feels better all around, not having the constant pain and irritation."
Particularly grateful to Dr. Speed and a few others who were "willing to listen to an obsessive-compulsive dog-mom and to look for solutions," Christine hopes imparting her experience will save someone a lot of money and time and hopefully prevent a lot of misery for their dog, as well.
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