Specialist For Vulva Issues? - Update Post #34

[NeylasMom]

Here I him with my vajayjay posts again but Skye's vulva irritation is not resolving and I am so beyond frustrated right now. We did see improvement from the Apoquel and silver sulfa approach, but not enough so we went back and the vet gave us Muciprocin instead. Things seemed to be getting a bit better and then I ran out of the UT supplement she was on. Now she has what looks like urine scalding and is licking a lot. So she's back on Apoquel and a UT supplement and I am being super diligent about cleaning and watching her so she doesn't lick, but I think we need to do further digging.

All of this to ask - what type of specialist does one see for this sort of thing? An internal medicine vet? I'm freaking downright broke between Zuri's osteo costs and everything happening with Violet, but I feel like my vet is a bit too laid back in her approach at times. I could probably go back and pester her, but I've now seen them 3 times for this with no major change in treatment plans. I want cultures or whatever other tests they could run and I want to be reassured ther are no tumors or other strange things going on. They keep saying her vulva is the problem and it is recessed, but we didn't have this problem for the first 4 1/2 years of her life so something has to be going on!

Edited October 18, 2016 by NeylasMom

[palmettobug]

That's a tricky one--I'd say maybe a vet dermatologist? If the problem is not caused by urine leakage, the doctor may look for some external source of irritation.

[NeylasMom]

That's a tricky one--I'd say maybe a vet dermatologist? If the problem is not caused by urine leakage, the doctor may look for some external source of irritation.

Thanks, I did have that thought. However, don't think they'd know about possible abnormalities or tumor type stuff (would they??), which is so much less likely but I'd kind of like someone who can cover it all. But I do like our derm and he's reasonably priced as far as specialists go so maybe I should start there.

 

My poor girl is wearing panties right now. Trying them in an effort to keep her from licking the ointment off for longer after I apply it.

 

"Why mama, why?"

 

ETA: The more I think about it, the more I think maybe the derm is a good idea. I'll call my vet and the dermatologist's offices and ask what they recommend.

Edited October 14, 2016 by NeylasMom

[cmc333]

Is her urine acidic? That could play into the scalding.

[greysmom]

Yeah. I'd maybe start with a nephrologist (?) - a kidney specialist. Or a specialist in canine urology. You want someone who can tell what, if anything, is abnormal somewhere between her kidneys and her vulva, right? Could the issue be farther up the system? Or a problem with how her body metabolizes whatever could make her urine acid? Internist? Gastroenterologist? You need to find the source of the irritation, not just treat the irritation itself. IMO.

 

If you have a good, local, multispecialist clinic/hospital that might be the place to begin. And ask specifically about collaborating with the other specialties.

[Busderpuddle]

Could she have a yeast infection ? Have you tried any probiotics on her ? anti fungal cream ? I know that yeast can wreck havoc on people, causing them to have a burning feeling and irritation. I have not followed her previous story, so maybe I am way off base on this.

[tbhounds]

Two things to rule out--spay incontinence (leaking urine even slightly would cause scalding and encourage licking and could be anatomical changes where a vulvaplasty would be warranted.

A GP vet should be able to address both issues-no need to seek a specialist. Applying an antibiotic cream and giving apoquel certainly is not going to resolve this.

Personally, I would pursue the surgery at this time. I can't begin to tell you how many times I've heard from clients that finally pursued surgery that they wished that hadn't waited so long as the surgery was curative and everyone's quality of life has tremendously improved.

[cmc333]

Two things to rule out--spay incontinence (leaking urine even slightly would cause scalding and encourage licking and could be anatomical changes where a vulvaplasty would be warranted.

A GP vet should be able to address both issues-no need to seek a specialist. Applying an antibiotic cream and giving apoquel certainly is not going to resolve this.

Personally, I would pursue the surgery at this time. I can't begin to tell you how many times I've heard from clients that finally pursued surgery that they wished that hadn't waited so long as the surgery was curative and everyone's quality of life has tremendously improved.

I had a female terrier once who started out normal and as she got older, her anatomy changed and she needed a vulvaplasty. We didn't get her one due to a number of other medical reasons and her age, but I would have done it in a heartbeat. I had her Proin, I cleaned her with baby wipes, I used to give her "Bikini Shaves" to keep the hair down. And a round of abx every few months. Never could get her urine less acidic, no matter what foods I tried.

[Guest Sportingfields]

Two things to rule out--spay incontinence (leaking urine even slightly would cause scalding and encourage licking and could be anatomical changes where a vulvaplasty would be warranted.

A GP vet should be able to address both issues-no need to seek a specialist. Applying an antibiotic cream and giving apoquel certainly is not going to resolve this.

Personally, I would pursue the surgery at this time. I can't begin to tell you how many times I've heard from clients that finally pursued surgery that they wished that hadn't waited so long as the surgery was curative and everyone's quality of life has tremendously improved.

This sounds like excellent advice. If your GP can do all this, why spend extra on specialists, looking for something that isn't there and end up at the same spot, doing surgery?

[cleptogrey]

time for the big guns....http://www.vet.upenn.edu/veterinary-hospitals/ryan-veterinary-hospital

 

cornell is to far. it sounds like a major vet hospital is in order. philly is less than 2 hrs. away, right?

[NeylasMom]

Two things to rule out--spay incontinence (leaking urine even slightly would cause scalding and encourage licking and could be anatomical changes where a vulvaplasty would be warranted.

A GP vet should be able to address both issues-no need to seek a specialist. Applying an antibiotic cream and giving apoquel certainly is not going to resolve this.

Personally, I would pursue the surgery at this time. I can't begin to tell you how many times I've heard from clients that finally pursued surgery that they wished that hadn't waited so long as the surgery was curative and everyone's quality of life has tremendously improved.

How does one diagnose spay incontinence? There's no evidence of her leaking on bedding, etc. So how would we know it's happening?

 

Its helpful to know you've seen good results from the surgery. I would like to rule out other things we might be missing first, but it's obviously still on the table.

 

 

 

Thanks for all of the feedback so far. I'm going to talk to my vet first and see what she thinks.

 

Oh, and to answer questions, yes she's on a daily Probiotic. As far as her urine, the UT supplement has cranberry and other things that I believe are intended to change the acidity. I think stopping it may have worsened things, though her pH has never shown up as abnormal on her urinalyses or using a dipstick. But I'm not sure whether within normal but toward one end could be a problem?

Edited October 14, 2016 by NeylasMom

[Greys4Us]

You may want to ask your vet about trying Neo-Predef powder (neomycin sulfate, isoflupredone, acetate, tetracaine HCI). We have had several greyhounds successfully treated with this product. It's a dry spray and easy to use. One small bottle lasts forever. One of our females lived to be 13 1/2 and we used this product on her and she did well for 11 years. I never like to go the route of surgery unless it's absolutely necessary.

[Guest Sportingfields]

Sorry to have pushed buttons this morning Jen. I totally get it, you've been thru H%$# this year. You are terrific dog owner and I can understand, especially after what you went thru with Zuri, that cancer or something else horrible is on your mind, every time one of them sneezes. Having lost 2 pups to osteo, 1 to kidney disease, 2 to CHF and 2 from paralysis from CDD, I learned there is a fine line between being proactive and shaking the bushes for something that isn't there. Hugs and apology.

[cmc333]

You may want to ask your vet about trying Neo-Predef powder (neomycin sulfate, isoflupredone, acetate, tetracaine HCI). We have had several greyhounds successfully treated with this product. It's a dry spray and easy to use. One small bottle lasts forever. One of our females lived to be 13 1/2 and we used this product on her and she did well for 11 years. I never like to go the route of surgery unless it's absolutely necessary.

Oh yeah - forgot about this. I used this on Heidi also. It was in a powder form and I just sprinkled it on like baby powder.

[NeylasMom]

Sorry to have pushed buttons this morning Jen. I totally get it, you've been thru H%$# this year. You are terrific dog owner and I can understand, especially after what you went thru with Zuri, that cancer or something else horrible is on your mind, every time one of them sneezes. Having lost 2 pups to osteo, 1 to kidney disease, 2 to CHF and 2 from paralysis from CDD, I learned there is a fine line between being proactive and shaking the bushes for something that isn't there. Hugs and apology.

Don't apologize. I changed my response because I realized if I was having to say sorry if I sound bitchy it's probably because I sound bitchy. I just shouldn't post before coffee - I always sound grumpy until I have caffeine in my system.

 

Thanks for the Neo-Predef suggestion. Will mention it to my vet.

[NeylasMom]

You may want to ask your vet about trying Neo-Predef powder (neomycin sulfate, isoflupredone, acetate, tetracaine HCI). We have had several greyhounds successfully treated with this product. It's a dry spray and easy to use. One small bottle lasts forever. One of our females lived to be 13 1/2 and we used this product on her and she did well for 11 years. I never like to go the route of surgery unless it's absolutely necessary.

So I just looked this stuff up and it looks like it could be really helpful. The added benefits of being an anti-inflammatory and anesthetic seem like they would really help and I like the idea of a powder to keep the area dry. My vet is out today so I should hear back from her on Monday and will ask about trying it, but am thinking I might order it in the meantime so I have it on hand if she says yes.

 

Would I have to worry about her licking it off or would it be safe if she ingests small quantities? We're taking steps to prevent the licking regardless, but just want to make sure it wouldn't be unsafe if she accidentally were able to.

Edited October 14, 2016 by NeylasMom

[cmc333]

Don't know about licking it - Heidi couldn't reach to lick it. No one thing seemed to help her, it was just all the things together that gave her some relief. And wouldn't the cranberry juice make her pee more acidic? That was my problem with Heidi.

[NeylasMom]

Don't know about licking it - Heidi couldn't reach to lick it. No one thing seemed to help her, it was just all the things together that gave her some relief. And wouldn't the cranberry juice make her pee more acidic? That was my problem with Heidi.

That's what I thought, but maybe there's something else in the supplement that's helping? The awesome news is Vetriscience decided to make the supplement - which is one of their "Everyday" line so what's the freaking sense in that?! - available Rx only, but the feline one is still available and is the same thing, she'll just need to take 4 of them to equal the canine dose.

 

Here's what's in that supplement (this is the canine version, so the amts she was getting):

Active Ingredients Per Chew: D-Mannose, 400 mg; N-Acetyl-Glucosamine (Shrimp and Crab), 400 mg; Cranberry Extract, 200 mg; Bromelain, 200 mg; Corn Silk, 120 mg; GanedenBC30 TM (Bacillus coagulans GBI-30, 6086), 200 million CFU.

 

When I discontinued it, I continued the same probiotic so that wasn't it. I know bromelain and I think the n-acetyl-glucosamine are anti-inflammatory so maybe that's what was helping? And I just read that d-mannose supposedly prevents e coli from sticking to the urinary tract. While she's been negative for UTIs she has had bacteria externally. Maybe the d-mannose helps with that as well?

 

Who knows. It's very hard to tell what works and what doesn't but since I thought it was helping I figured best to put her back on it.

 

Any idea what would be too acidic in terms of her urine pH? I thought I'd try to keep an eye on it using the dipsticks in between vet visits, but it's hard to read those. On my last check I thought it was definitely between 6 & 6.5, probably closer to 6.25. I don't have results from her last urinalysis handy.

[cmc333]

That's pretty much normal I think. Heidi died over 12 years ago so I have trouble remembering much. More veggies, less meat/dairy to increase alkalinity. I know that sometimes Heidi would get a UTI before it would show up on the urine test. After a while the vets trusted me to know when to start her on abx. We cultured a lot to see which abx worked the best. We also tried some anti-fungals just because....

 

If Heidi had been younger and in better health otherwise, I would have opted for the vulvaplasty. As she got older, her skin sagged more around the vulva. Taking care of her problem just became a routine - once every two weeks, she got a bikini shave. I cleaned her and put the powder on her every evening and morning. I didn't mind the care, I just felt bad for her because I never came up with the perfect solution.

 

As for spay incontinence, I would just notice that after Heidi laid somewhere, it would be slightly to not-so-slightly wet. Perhaps since Skye can reach to lick her vulva, she licks before any pee dribbles on her bed?

[NeylasMom]

As for spay incontinence, I would just notice that after Heidi laid somewhere, it would be slightly to not-so-slightly wet. Perhaps since Skye can reach to lick her vulva, she licks before any pee dribbles on her bed?

You'd think she'd still leave spots sometimes though after she'd been sleeping? I'll have to watch more closely for signs of leaking.

[cmc333]

It's possible that she is leaking just a little and it's drying before she gets off her bedding. And depending on the material of the bed, you might not see it or think it's damp cause of licking. I didn't catch on till Heidi was leaking enough I could see the damp spot where she was laying. I didn't catch it as soon as it was first happening.

[Roo]

Have you noticed any dribbles behind her when she sneezes? That was my first clue with terrier Daisy, then I found a puddle where she'd been laying on the sofa. I had to quit her Incurin for a month and she licked like crazy during this time - she'd wake up quickly and lick like something was bugging her. Back on the Incurin? No licking, no puddles, no sneeze dribbles.

[Batmom]

Even if she's not leaking, her anatomy may make it hard for her to dry out properly after she pees. Leading to discomfort, licking, irritation, infection (bacterial and/or fungal -- these guys like moist places). You can help her out with some alcohol-free baby wipes and a soft cloth after she pees.

[cmc333]

I used to set Heidi up in the corner of the couch on her behind, hold her back legs open and wipe her down and then use the hair dryer on low to help dry her tummy and vulva area. I'd hold the skin away so it would dry then put the powder on. Of course Heidi was a westie, so easier to do with a smaller dog.

[Maddiesmom]

Does she have a hooded vulva by chance. Millie has one and she licks it a lot. And was ha ing accidents. She has been tested for uti stones etc and is given a bladder supplement everyday and has not had an accident since.