# Surgery or medication



## Lottierachel (Mar 3, 2013)

So Tilly has an incontinence problem, where she has accidents when she is asleep or relaxed, at worst it can be biiig puddles 2 or 3 times a day. We (the vet and I) are pretty certain it's hormone related incontinence, caused by lack of estrogen following spay. It's unusual for it to start this early, but certainly not unheard of.

At the minute, Tilly is on a liquid medication called propalin 3x per day. It works, but if she was to stay on it, it's a life time thing, the cert suggested we looked into a surgical procedure that involves a couple of sutures in the urethra/pelvic floor to tighten up the muscles, but there's a catch:

The surgery has a success rate of 50%, and of those successful patients, 40% still have to have some medication. The process would involve dye being put into her bladder, an ultrasound, an ECG and then an operation under general anaesthetic. The total cost would be about £1500 (most of this is covered under her insurance)

What would you do? Stick with the medication 3x per day, or go for the operation that might not work?

Poor Tilly


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## Mazzapoo (Jul 28, 2013)

If the medicine has no side effects for long term use I'd be tempted to stick with that as a non-invasive solution I think. Is it hormone replacement? 
50% just doesn't seem a great success rate for the op 

I'm sure you'll get lots of opinions on here that will help you make the choice that's right for Tilly xxx


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## Lottierachel (Mar 3, 2013)

The medication tightens the sphincter muscles. They used to give a hormone replacement, but found that that had more side effects.

Thanks for your input, Marion. It's hard to think about it when you're in the middle of it. Obviously, the ideal would be that she needs neither - neither option is particularly favourable! X


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## Mazzapoo (Jul 28, 2013)

Just had a quick google and found some dog owners who have been using propalin for their dog's incontinence problems for many years with no side effects at all and they've been able to reduce the dosage over time from 3 drops to 2 with trial and error (and vet's support) xxx


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## Cat 53 (Aug 26, 2012)

I would be inclined to stick with the medication.....given those operation outcomes. I would want a much better percentage than the ones quoted, if I was going to put my dog through that.

Have you checked around to see if homeopathy could help ( if you are not overly keen on pharmaceuticals?) might be an option. 

As a side query, was this possibility mentioned when you had Tilly spayed? We haven't had Phoebe spayed yet and was wondering how many of our little girls suffer as Tilly is doing? 

Big hugs to Tilly, the gorgeous girl. And to you. :hug::hug:


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## Tinman (Apr 23, 2013)

Oh it's such a hard one, Tilly obviously gets upset by it.
I'd do some more research like Marion and see what results others have had, if your vet can give you more optimistic results regarding the op - I'd possibly consider it - especially if the insurance covers it.
With a new baby in the house it would be great to have a wee free Tilly (bless her) you'll have enough pee going on with junior & be warned..... When very young taking their nappy off - the cool air makes them pee!! & baby boys can pee high...Haha be ready!! Xx


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## Nanci (Mar 1, 2012)

This is really is hard decision for you . . . I'm so sorry for you both!! If my math is correct . . . if only 50% success rate . . . AND 40% of the success rate has to still have some medication . . . that means only 10% complete success rate??? So the most likely outcome according to the Vet will still involve medication, just at a reduced dose. 
My head would want the surgery and the problem GONE . . . but my common sence and heart would not want my little girl to go thru that for such small odds of success.
Is she still weeing 3 times a day even with the medication?? That would be a factor if that is true.


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## fairlie (Sep 7, 2013)

As surgeries go I think this one is quite minor. I've known some people who've had it and if it's similar it involves quite minimal cutting and a quick recovery. Really just a couple of stitches. The dye and tests are standard pre op stuff and won't bother her too much. With Tilly so young and healthy otherwise I think I'd do the surgery and keep fingers crossed it helped even a little. Even if it allows you to decrease the meds a little you could consider it a success.

I'd also try as many holistic remedies as I could. Can dogs boost their estrogen with soy like people can? Would Tilly eat tofu?


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## dio.ren (Jan 18, 2013)

Lottierachel said:


> So Tilly has an incontinence problem, where she has accidents when she is asleep or relaxed, at worst it can be biiig puddles 2 or 3 times a day. We (the vet and I) are pretty certain it's hormone related incontinence, caused by lack of estrogen following spay. It's unusual for it to start this early, but certainly not unheard of.
> 
> At the minute, Tilly is on a liquid medication called propalin 3x per day. It works, but if she was to stay on it, it's a life time thing, the cert suggested we looked into a surgical procedure that involves a couple of sutures in the urethra/pelvic floor to tighten up the muscles, but there's a catch:
> 
> ...


I would go for the operation if it was Molly. I don't like meds and if they do work for how long? So sad that she has this as she is so young!


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## RuthMill (Jun 30, 2012)

I would find out if there are any more figures for success rates and outcomes. I find it hard to believe the surgery does not work if there's a surgical need.

If it's purely hormone related then I would have my reservations about the success of surgery. Can you get a definitive diagnosis?

If you are certain it's not a surgical problem (ie bladder prolapse from spay) then I would rule out surgery. I wouldn't be ruling out surgery until someone can diagnose one way or the other. 

Conservative management for a surgical problem is not a good idea. Surgical management for a hormonal problem will not solve the problem. I suspect this is why their success rates are so poor as they don't have a definitive diagnosis before proceeding with management plan. 

Sorry, awful for poor Tilly.


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## RuthMill (Jun 30, 2012)

Would you consider contacting specialists for another opinion?

http://www.cave-vet-specialists.co.uk/soft-tissue-surgery/


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## 2ndhandgal (Aug 29, 2011)

I think I would maybe be tempted to go for more investigations to find out if the surgery is likely to be effective for her as I know from friends experiences not all dogs are. 

The odds do not sound great at 50% and some requiring further medication but the way I read it 60% don't so I make that 30% being totally cured with never a need for other medication. 

Other things to consider - who is your insurance with and is it true cover for life. If it is they will continue to cover her for life for any further problems - if not then it might well be the case that if you are having surgery you need to do it before the policy year runs out.


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## Lottierachel (Mar 3, 2013)

Thanks for all your support and input.

Nanci - on the medication she is totally fine. No accidents.

Ruth - the lack of estrogen causes the muscles to slacken, what also happens is that the removal of the uterus can cause things to droop as the uterus kind of holds everything up and in place. The operation puts a couple of stitches in to pull the muscles back up and tighter.

We're at the vets tomorrow morning for a final ear check up so I might try to find out more.

Marilyn - I always knew there were risks with spaying, but for me the positives outweighed them and reduced the risks involved with not spaying. However, I think if I had my time again I would have gone against my vets advice and waited until after her first season.

Xx


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## RuthMill (Jun 30, 2012)

Lottierachel said:


> Thanks for all your support and input.
> 
> Nanci - on the medication she is totally fine. No accidents.
> 
> ...


I understand the causes and treatment but if it's solely down to lack of oestrogen, the weakening will persist even with surgery as the hormone isn't telling the muscles what to do. This is why I wondered if you knew exactly what the problem is because surgery would be more positive if it was simply to fix the bladder dropping down (prolapse). If it's a combination of lack of oestrogen _and_ prolapse she will need surgery and medication, surgery to fix prolapse, oestrogen to fix muscle tone. We do lots of this type of surgery on humans and it's really important know the exact cause before going forward with treatment, from what I've read about dogs this evening this is also true to get a positive result. 

I don't think it's a simple case of one or the other, it would be ideal if you could get a definitive diagnosis.


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## Mazzapoo (Jul 28, 2013)

All very interesting.......so maybe a second opinion would be a good idea - I know our insurance covers that so yours might?


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## Cat 53 (Aug 26, 2012)

Marilyn - I always knew there were risks with spaying, but for me the positives outweighed them and reduced the risks involved with not spaying. However, I think if I had my time again I would have gone against my vets advice and waited until after her first season.

Ah! So what age was Tilly when you had her spayed? I hope you find a way that works for both you and Tilly. If it was me I would check out homeopathy. Good luck with your next vet visit. Please keep us informed.


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## Lexi&Beemer (May 5, 2013)

It does make me question when vets and doctors say there is no side effect to long term use of medication as there is no evidence one way or another. Their little bodies really weren't designed to filter this stuff on an ongoing basis. The surgery success rates do seem worrisome. But I think I'd find a specialist to have it done as the 50% rate include surgery by all vets who do it. I'd find a specialist whose success rate is probably that much higher. 


Sent from my iPad using Tapatalk


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## DB1 (Jan 20, 2012)

Sorry to hear Tilly is having these problems, never a great time but feel for you having to worry about this when you should just be enjoying planning for the baby. I really don't know what I would do, think I would be tempted to try the op if I was convinced it really was a simple procedure, even if the chances of 100% success were low. How did you get on today?


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## Lottierachel (Mar 3, 2013)

Cat 53 said:


> Ah! So what age was Tilly when you had her spayed? I hope you find a way that works for both you and Tilly. If it was me I would check out homeopathy. Good luck with your next vet visit. Please keep us informed.


She was just over 7 months. I know quite a few people who have had their dog spayed at 6 months, so certainly not unusually young. I wonder if this issue is as com one in dogs spayed later? Who knows.

Got the all clear on her ears today. The vet doesn't know a lot about the surgery as there is only one vet in the practice group (there are 3 practices locally, and the vets rotate around them) who can do the surgery. However, she did say that they have a lot of dogs on propalin and many who have been on it for years and years. My vet said she has never come across a dog who has suffered complications from it. 

Currently, she has 0.25ml of liquid 3x per day, so not even 1ml per day! After 3 months, the vet will look at reducing this, and if that continues to work then we can look at reducing it further, possibly to as little as 0.1ml 3x per day.

I think for the foreseeable future, we are going to stick with the medication and then reevaluate at some point - maybe in a year or so there will be an increased success rate with the surgery or we will understand the specifics of her condition a little more.

As long as my girl is happy and healthy - I'm happy too x


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## RuthMill (Jun 30, 2012)

I honestly don't know if an earlier spay precipitates more risk for this type of complication. The logical thinking would be that this could happen no matter when a bitch is spayed, it's probably more of a case of luck as to whether a bitch gets this type of complication. Who knows, the research is very limited.


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## Peanut (Dec 1, 2013)

Yes, I think it would wait and see how she is reacting to the medication and do the research properly. Find if there are other options, vets that have experience in the procedure and then take a decision. It is obviously not a life threaten condition and if she is well, just wait. 

However, I would definitely research it. If 30% of dogs get cured with just a couple of little stitches, I would take the chance. The worst that it would happen is that she still needs medication. It would be rare that she has complications with the surgery. 

Good news about the ears!!!


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## arlo (Mar 11, 2013)

So sorry you are having to think about all these decisions, especially when you have your own hormones to cope with. What you are doing sticking to the meds for now would be what I would do. The fact that they are working for her is a positive. As you say a year or so down the line they may develop a operation with a much greater success rate. Big kisses to Tilly XX


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## Mazzapoo (Jul 28, 2013)

I think that sounds like a great plan, which will give you time to settle into your new routines as a Mummy too.  :baby: :kiss:


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## RachelJ (Oct 5, 2012)

Aww I am so sorry to hear about poor Tilly and you having to go through this - I dont come on here very often but just saw this and made me feel really sad  I was the same had Darcie spayed at just over 6months and so far has all been fine so to hear what you are going through I really feel for you and not sure what I would do in this situation, maybe like you say keep on the mediciation for now while Tilly is happy and all is working ok and then maybe look into it more and decide on the op at a later date.

Hope you get something sorted soon and Tilly back to full health - big hugs to Tilly and you xx


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## Marzi (Sep 17, 2012)

Sorry to read this - poor you having to make decisions that seem hard.
One of our GSDs, Sheba, who was not spayed until 3 months after her first season when she was about 14 months (so not an early spay) had this problem and was on propalin - over time we weaned her off it and only then used it if she went through a period of leaking - was definitely worse during the summer (we always thought hotter, drank more, exercised more) than in the winter and it definitely was the case that as she got older we seemed to use it less - Sheba lived until she was 13 and a half and I really don't remember her as being 'the leaky dog'!
My friend has a terrier that was spayed after she was rescued (over 1) and she also has propalin as she became leaky. Again she does not have it all of the time.

Please don't beat yourself up over this and feel that it is in some way YOUR fault. It just is one of those things... If you decide to have the surgery it may cure the problem, it is minor and Tilly will recover fine either way.

Tilly loves you - to her you are and always will be THE BEST.

Hope you and the Bump are well.


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## Lottierachel (Mar 3, 2013)

Marzi said:


> Tilly loves you - to her you are and always will be THE BEST.
> 
> Hope you and the Bump are well.


Oh Marzi this has brought a tear to my eye  She is certainly the very best to me too <3

It's funny you say about it being worse in the summer, because she didn't have the problem at all until maybe June, when obviously the hot weather started.

I have found that you can buy propalin from the official suppliers online for £8 a bottle (each bottle lasts around 2 months).

Did you always go on the vets advice on when to decrease the amounts or did you use your own judgement?


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## Marzi (Sep 17, 2012)

I just went with my own judgement - it is pretty obvious when they need some.

And bah pregnancy hormones, tears, tantrums and irrationality are all perfectly normal


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## Mazzapoo (Jul 28, 2013)

Lottie you might be able to claim for long term medication on your insurance and just get a regular supply from the vet?


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