Meet ‘Stitch’  (and Kyle -Vet Assistant)                                                      

Stitch came to see Dr. Cooke in April of 2021.  

The owner wanted a consult for his constant dribbling urine and fecal incontinence.  

He could not differentiate whether he had been urinating or defecating since birth.  The owner notes he had to wear a belly band/diaper constantly because of this.

In his first 2 years of life, he had chronic urinary tract infections, kidney infections,  dribbling urine, and fecal incontinence.  He would posture to defecate 15 times before he would actually defecate.  His constant straining led to constipation and later hemorrhoids.

Stitch’s mom had already taken him to her regular veterinarian and an internal medicine specialist to help him with his condition.  

Stitch’s Problem List                                  

• Dribbles urine constantly Urinary Tract Infections
• Hard time defecating
• Kidney Infections
• Hemorrhoids
• Soiling the House

Why Does Stitch have this problem??

Stitch’s problem likely is the result of his traumatic birth.  

 He was born with his intestines poking out (herniated) through his belly button /umbilicus.  His caregivers saved his life by replacing the intestines and suturing his umbilicus quickly.

At the time of their presentation to see Dr. Cooke, he was on testosterone injections every 4 to 6 weeks from the internal medicine specialist and Miralax to soften his stool and treat chronic constipation. 

His internal medicine workup included:

• abdominal ultrasound
• repeat urine cultures
• contrast CT excretory urography 
• All this testing found no abnormal prostate, ureters, or kidneys. 

While slightly better on the treatments from the internist, he was still dribbling urine and had to wear the belly band whenever in the house.  His owners wanted a better quality of life for Stitch so they sought out Dr. Cooke. 

Possible Reasons for Stitch’s Problem:

Congenital causes of urinary incontinence in male dogs include:

• ectopic ureter
• congenital urethral sphincter mechanism incompetence
• detrusor instability or hyperreflexia
• neurologic disease with various etiologies affecting lower motor neuron function
• Neurological lesions within the distal spinal cord of L1 to S3 (lumbosacral area of the spine) or affecting the hypogastric nerve or the pudendal nerve can be associated with urinary incontinence. 

This last possibility of lower motor neuron damage of the L1 to the S3 segment was presumed to be the culprit because of his birth trauma by Dr. Cooke.  

What Can Be Done for Stitch??

The treatment of electroacupuncture (EAP)  is an excellent modality to help ‘wake up’ the damaged nerves and help nerve conduction return to better function. 

Traditional Chinese Veterinary Medicine herbals were also recommended to help improve function but were not elected in this case, based on the level and amount of work up and cost to date by the owner.  EAP and Chinese herbals together are more powerful then either one of them separated.  However, both are very powerful modalities. 

The Traditional Chinese Veterinary Medicine pattern for Stitch is Lin Syndrome with Jing Deficiency.   Chinese medicine uses patterns instead of diseases to ‘work up’ a case.  This case pattern indicates dribbling urine and not holding urine in due to a lack of Chi (Qi) due to a congenital deficiency. 

On Dr. Cooke’s exam, Stitch’s tongue was pale, he had a dull anal tone, and he was hypersensitive to the panniculus stimulation down his spine.  His lesion was identified at L4 to S1.   

Panniculus stimulation is a simple procedure where the doctor softly pinches the skin near each vertebra down the spine.  A normal patient with a normal nerve segment will ‘sense’ (afferent nerve) the pinch and send a signal to the spinal cord and up to the brain; the brain then sends a signal back down the spinal cord to the ‘motor’ nerve (efferent nerve) to move!  A normal spine will say, ‘ouch, that is pinching me…better move to stop it’.  An abnormal response would be a lack of reaction or hyper-reaction. 

A total of Four Electroacupuncture (EAP) sessions were performed:      

First EAP  April 5, 2021

After the first treatment, he went outside the vet’s office right away and urinated like a normal dog.  He has never done this.  His belly bands were much drier over the next several weeks.  He voids more urine when he urinates vs. just dribbling his urine. 

Second EAP  April 19, 2021

Before beginning his second treatment, the owner noted that after his first treatment he is 15 to 20% better.  He urinates more easily now.  He plays with the other dogs after acupuncture and does not need to rest.  His urination is more consistent, and he is less ‘confused’ whether he is urinating or defecating.

Third EAP June 7, 2021

Before beginning his third treatment, the owner notes he is 60% better with his urination after the second treatment.   His belly band has only been saturated once since his last EAP.   He continues to improve on ‘knowing’ whether he is urinating or defecating. 

Fourth EAP Sept. 16, 2021

Stitch is now 70 to 80% better.   He rarely dribbles, only a little urine now, and that is while asleep, and it only occurs every 5th day or so.   The owners are very happy with his progress to date.  He does not have to wear the belly band around the house during the day now.  His quality of life has improved quite a bit. 

Case Conclusion

This case is a wonderful example of blending Western and Eastern Medicine medicine together.  Stitch was significantly improved once adding the electroacupuncture.  With only 4 treatments, he is 70 to 80% better.  He is no longer fecal incontinent, as he defecates in appropriate places and times.   Stitch improved more due to the electroacupuncture simply because the nervous system was directly stimulated and helped it return to better function.  Acupuncture is a very powerful tool that can be used in almost any case of weakness, nervous system issues, post-trauma, and for generalized wellness! 

The western treatment of testosterone and Miralax should be continued along with the TCVM treatment.  Additionally, Chinese herbals to treat the TCVM Lin Syndrome is another option to add to the course of this treatment.  EAP is recommended periodically to continue Stitch’s progress to date. 

Thanks for reading !!  I hope to have more blog spots and case studies for you to enjoy during the next year!

 

 

Wishing you your best health,

Dr. Denette O. Cooke, DVM, CVA, CVMMP