I am so pleased with how you helped Chalky. Your set-up is brilliant and I only wish that you were nearer to us. I cannot speak highly enough of all the staff there, especially Tom Cave.

Mrs Price

Treatment for Incontinence in Paralysed Dogs

This state-of-the-art treatment is now being offered by Nicolas Granger

Dogs are commonly affected by intervertebral disc disease (‘slipped disc’) in the back region. Small dogs such as Dachshunds, Shih Tzu, French Bulldogs, amongst many other breeds, are predisposed. This is often very sudden in onset and causes paralysis. Many dogs recover following diagnosis with MRI followed by spinal surgery but a proportion of dogs (~approximately 15% of them) can remain paralysed in the chronic phase of the disease. While the paralysis can be managed by the owner, a slipped disc in the back region in dogs will also lead to incontinence. This is a major issue for these pets. It can cause repeated urine infections, kidneys infection and skin sores due to the fur being soiled. Up until recently, the only way to empty the bladder was by gently pressing on the abdomen by hand or using catheterisation. But these methods cause pain, discomfort as can cause infections.

We developed (Dr. Nicolas Granger – Cave Veterinary Specialists, Prof. Nick Jeffery - Texas A&M University) a system for dogs - based on existing equipment for paralysed humans - that allows extremely efficient voiding of the bladder without having to use the above methods. It is composed of a small implant placed around the nerves controlling the bladder. The implant is activated by a remote that the owner of the dog uses daily when bladder emptying is required. With more than 20 companion dogs treated now over the past 5 years, we have strong evidence showing that the system is safe and efficient and can be used for several years without failing. It should also reduce infections of the bladder which is almost always the rule in chronically paralysed dogs. Finally, many dogs also have reflex incontinence, losing small quantities of urine through the day, and this can stop once the system is implanted.

We would like to raise awareness of this cutting edge therapy for pets as it is now fully available to affected dogs. You can find a scientific report by following the link below to an online open access veterinary journal: Journal of Veterinary Internal Medicine. The system is called ‘SARS’, standing for ‘Sacral Anterior Root Stimulation’.

http://onlinelibrary.wiley.com/doi/10.1111/jvim.12011/full

https://www.ncbi.nlm.nih.gov/pubmed/23194073

http://vetmed.tamu.edu/directorydetail?UserID=14336

https://www.spinal-research.org/restoration-urinary-function-spinal-cord-injury

Dogs eligible for this treatment are those with a ‘thoraco-lumbar’ spinal cord lesion (middle of the back between vertebrae T3 to L3) who have not recovered urinary continence (or faecal continence) after their injury. The cause of the spinal cord injury could be a slipped disc but dogs with other type of injuries such as trauma to the spine caused by road traffic or spinal embolism causing incontinence are eligible too. We can consider the implantation from 3 weeks after injury but it can be done at any time point after the injury. The treatment will not impact on future chances of recovery should there be new treatments for paralysis in the future.

For further information watch: https://www.youtube.com/watch?v=hh566lLl858

 


In February, Nicolas treated a dog with chronic paralysis and incontinence. For 6 weeks this dog had been unable to use his bladder because of a severe spinal cord injury and paralysis which required daily visits to the vet. He has now received an implant that sits in his lumbar spine and is fitted around the spinal nerves going to the bladder.  The implant is linked to a small receiver placed under the skin and can be simply activated by placing a remote system over this receiver (very much like one would do to read the microchip of dogs in the neck region). This system enables on-demand stimulation resulting in the patient's bladder being fully emptied.

Two months on from surgery this dog is doing well, having his bladder emptied four times a day. He is now fully continent.

By using this system it reduces the chances of future urinary infections, a major issue for these patients that can reduce their life-expectancy.

This was covered by BBC2 for a show reporting new advances in medicine for companion animals (called Trust me I'm a Vet).
 

 

 

Please contact Dr Nicolas Granger for further information at: NGranger@cave-vet-specialists.co.uk

Use of an implanted sacral nerve stimulator to restore urine voiding in chronically paraplegic dogs. Granger N, Chew D, Fairhurst P, Fawcett JW, Lacour SP, Craggs M, Mosse CA, Donaldson N, Jeffery ND. Journal of Veterinary Internal Medicine. 2013 Jan-Feb;27(1):99-105