Tami Morris has always been an animal lover with a big heart. When she was a little girl, she would try to bring cows and pigs inside the house to keep them warm. So when she got a call about an incontinent golden retriever puppy in need of a home, “I said yes. I didn’t think twice.”
The puppy was born with urinary incontinence, and the breeders suspected she had ectopic ureter. They couldn’t sell the puppy and they couldn’t afford the procedure she needed — and that’s how 7-month-old Willow came to live with Tami and Gary Morris.
Ureters are the tubes that carry urine from the kidneys to the bladder. An ectopic ureter is a congenital condition in which the ureter drains into an abnormal location. It’s the most common type of urinary incontinence in juvenile female dogs, and it affects large breed dogs such as golden retrievers more often.
In her first six months of life, Willow went through several rounds of antibiotic treatment to try to fight off urinary tract infections, which are common among dogs with ectopic ureter.
Morris’ regular veterinarian referred Willow to the Virginia-Maryland College of Veterinary Medicine’s Veterinary Teaching Hospital, where she was seen by Audrey Keebaugh M.S. ’20, clinical assistant professor of small animal internal medicine.
“The care and the love and the compassion at Virginia Tech was outstanding,” said Morris. “Everyone we’ve come in contact with there — the receptionist, the students, the doctors, the people that I paid when we left — all of them were so in love with Willow, because she’s pretty special.”
The Veterinary Teaching Hospital team determined that Willow had bilateral intramural ectopic ureters, meaning that both ureters were ectopic. Because an ectopic ureter is an abnormality with the animal’s anatomy, there are no medications that can address it. The procedure Keebaugh performed is the only option for the animal to live a healthy, normal life.
Willow made several visits to the teaching hospital before her procedure in October, including an overnight stay to treat her ongoing urinary tract infection problem with antibiotics.
The ectopic ureter procedure Keebaugh routinely performs is an example of interventional radiology. Applying successful techniques from human medicine to veterinary medicine, this procedure uses imaging to access the body without the large incision or recovery times of a traditional surgery.
Few clinics in the area have the equipment, training, and expertise needed to perform the minimally invasive ectopic ureter procedure, which means that people come to the teaching hospital in Blacksburg from far away. Morris drove two hours each way so that Willow could receive this treatment.
Using a technique called fluoroscopy, Keebaugh and her team use real-time X-ray imaging to guide the procedure. They don protective lead outfits under their gowns to protect them from X-rays and wear special glasses to protect their eyes from the laser used to cut into the tissue.
Because of the procedure’s location, Keebaugh uses scopes and stents to guide the laser — no incision needed. She then opens the tissue so that the ureter opens in the correct position. The whole procedure takes about an hour and a half to two hours, and because it isn’t invasive, the dogs are able to return to running and playing the next day.
“They did it that morning, and we came home that evening,” said Morris. “She walked out of the hospital without a diaper. She says, ‘Mom, I’m tired of these, and I’m tired of you washing them every night and cleaning me.'”
“What’s very rewarding about these procedures is that there’s something we can clearly fix. We can change dogs’ lives when they’re little puppies so we can give them a better quality of life long-term,” said Keebaugh. “The long-term goal is that the dog is urinary continent. If we don’t have complete continence for these patients, their continence is much better.”
Some dogs may have other urinary tract issues besides ectopic ureter that contribute to incontinence after the procedure. Willow is experiencing some leaking, which could be a result of a urinary tract infection or an issue with her urethral sphincter. Morris is working with small animal internal medicine resident Camille Brassard to monitor this problem, and Willow may have to take medication to strengthen the sphincter.
The ectopic ureter procedure is only one of several minimally invasive procedures offered at the teaching hospital, as both Keebaugh and assistant professor of cardiology Giulio Menciotti are interested in interventional radiology.
“I feel very proud of being able to offer minimally invasive procedures in this area, and I want to push more for it,” said Keebaugh. “This is the future; this is what we should be offering as the standard of care for our patients.”
For Morris, compassion sets the hospital apart from the rest.
“I felt very confident in the doctors because they explained all of the terminology to me. I felt very comfortable,” said Morris. “I can’t praise them enough. With the follow-up calls they made, they called when she was there overnight — to me, my four-leggeds are my babies, and they were perfect pediatricians. I feel like they gave every animal in that clinic the same love that they gave Willow.”
– Andrew Mann