C10016473 / invoice 10000

HISTORY: HISTORY/PRESENTING COMPLAINT
Urinary incontinence, no improvement on stilboesterol. Dribbling urine especially when sleeping, occasionally in larger volumes. Owner reports needing to wipe urine from furniture and beds smelling of urine.

EDDU normally. No straining or vocalising when urinating. Urinates frequently for marking behaviour.

PHYSICAL EXAMINATION
TPR - within normal limits 
Blood sample unable to be collected - became distressed, attempted muzzle which worsened response, elected to cease procedure.

PLAN
1. Cease stilboesterol.
2. Start propalin 0.4ml PO BID 
3. Gabapentin 2 capsules night before and 2 capsules morning of visit (at least 3 hours before appointment) for pre-visit anxiolysis. Sent home today.
5. Blood work to be performed at next visit in 3wks with pre-visit medication.

HISTORY: INsurance claim sent for 22&23/1

WEIGHT: 10.50
HISTORY: History:
- O describes urinary incontinence, specifically leaking urine while sleeping 
- Owner reports the dog sleeps on its back, allowing for observation of the leakage - photos provided in consult
- Desexed at anakie rd vets on 16/04/2025. updated patient file
- Owner has researched desexing and is aware of potential for urinary incontinence
- Behaviour: Has started to copy the male dog in the household by marking territory. O thinks that this has happened more since desexing

Physical Exam Findings:
BAR
sitting for treats but becomes uncomfortable when restrained for examination
able to listen to heart but could not adequately palp abdomen - feigned nip

Assessment:
1. Urinary incontinence, likely secondary to desexing (estrogen-responsive incontinence).
2. Potential increased risk for urinary tract infections due to constant trickle of urine.

Plan:
- Obtain a mid-stream urine sample for analysis to rule out a urinary tract infection.
- Discussed potential for hormone replacement therapy if no infection is present. This would involve starting at a high dose and weaning down to a maintenance dose (e.g., once or twice weekly).
- Advised owner on management strategies for incontinence, such as using waterproof covers on bedding.

Communications:
- Discussed the pathophysiology of post-desexing incontinence, relating it to the loss of estrogen and its effect on the urinary sphincter.
- Explained the rationale for ruling out a urinary tract infection before initiating hormone therapy.
- Discussed the two main treatment pathways for incontinence (estrogen vs. non-estrogen) and the current preference for low-dose estrogen therapy.
- Discussed the nature of urine marking in dogs as a form of communication, not solely a sexual behaviour.
- Advised owner on signs of a urinary tract infection to monitor for, including increased urination frequency, discomfort, or licking at the back end.