Look Before You Leap

Notice: This case is a lengthy one. I will try and condense it to the relevant aspects, but the backstory and details help to make it so memorable.

A young couple and their infant daughter were up from Florida to run their family’s summer business a few years ago. They brought with them their 5 year old male Greyhound, Dunkin.

Living in a rural area, they let him out after dusk one night to do his business. He took off, chasing something. A few minutes later they heard a thud, and went to find him. His head was bleeding, and he was very painful.

They took him to the local emergency clinic, and he was treated for a laceration to his forehead. While he was there, they also found that he could not walk, stand, or move his legs on his own. X-rays were taken, and showed no fractures. The owners declined an MRI (due to cost), and he was started on pain relievers and anti-inflammatories.

In the morning, they looked at their pick up truck, and there was a dent in the side of their door panel. The dog was found the night before collapsed by the truck. So, Dunkin had run straight into their parked truck and dented it!

The next day he was transferred to my hospital. He was on a constant infusion of opiods from the emergency clinic, and still could not use his legs. He had a urinary catheter in place so he didn’t soil himself.

My thought process went something like this. Greyhound, young healthy, runs into truck, compresses or bruises his spinal cord. With no fractures, I was hopeful that with time he could recover.

Problems: If the trauma caused him to severely herniate a disc between his vertebrae, medications and time may not work. Also, greyhounds present an interesting challenge, tiny little bits of pain meds will make them loopy, but they also have relative LOW pain tolerances. So trying to figure out if he was more disoriented or painful on his treatment was a challenge.

I had a long discussion with the owners, ideally an MRI would give us a better understanding as to his chances for a recovery, but at 1800 dollars by itself, it was out of their budget. The one owner was pressing for him to be put to sleep, because he wasn’t better already. The other owner wanted to give him more time.

It had been less than 24 hours at this point. I explained that we could take it a few days at a time, try and get him comfortable, wean him off his medications, and see how his body responds. If he gets worse, yes, humane euthanasia may be in his best interest. I also explained that he could make progress, and then may plateau at a certain point, or he may make a full recovery, but that could take weeks, if not months.

Over the next few days, I got to know this dog really well, his likes, his comforts, his concerns. I weaned him off the constant infusion of Fentanyl over 3-4 days. I started him on oral medications instead. We kept him on prednisone to help minimize the swelling of his spinal cord. Every few hours he had to be flipped, have his foley bag emptied, be sat up, have his legs massaged and have repeated neurological exams.

Depending on his mental state, many of these had to be done with a basket muzzle on. This is the type of muzzle you see on greyhounds at the track, or the type from “Lady and the Tramp”. It allows them to open their mouth and breathe easily, but not bite you. Since most greyhounds that are in people’s homes are adopted after a racing career, they are used to them.

Eventually we had to work on getting him to eat, which means no more muzzle. Once I was able to get through to him, he started to understand that we were all there to help. Multiple times a day he had on electrical stimulation pads to mimic muscle contractions in his legs and back. He had laser treatments to help stimulate nerve conduction down to his paralyzed legs. He also received acupuncture treatments to help with pain. This allowed us to have him on less oral medications. And slowly but surely he made some progress.

After about 2 weeks, I was able to remove the urinary catheter. We then worked on starting to express his bladder for him, until his body got the right message that he could do it on his own.

After a month from admission, we had him off all oral medications. We continued to work with him multiple times a day, 7 days a week. He spent time in a lift apparatus to mimic him standing and walking. The owners would come and visit, and sometimes he would show them the little signs we were seeing. A little wag of the tail, a smile when they came in.

Occasionally one of the owners was still impatient and thought that he would not walk again. I had to reassure them that he was making progress. Could I promise him that he would walk again? No. However he was making progress, and therefore we had to give his body time. Time is the greatest healer.

A funny thing happens when you support and do everything for a patient. Sometimes they enjoy it. Sometimes they stop trying because they expect that you will continue to do it for them. That is why you have to condition your help. Challenge them to do something new. If it is the same activity day in and day out, we would all get bored. As the weather got nicer, we worked with him outside. We had other dogs, or cats, come into his area and interact with him, to stimulate his play drive. I had a checklist of tasks that he needed to be able to do every week.

And one day he stood up. His owners came to visit and I was talking with them, and he righted himself and shook on unsteady legs and pushed himself up and walked 4 feet to his dad. We were all happy. We tried to get him to do it again, but it had taken all of his strength. The next day, no walking. But the day after that it was like the lights came back on, and he was ready to get in gear.

It took him another 4 weeks to be able to walk consistently on his own. At that point, I was comfortable sending him home, but the owners did not feel that way. Due to their work commitments, they felt that he would be alone too much during the day. So he stayed until the end of summer.

During that time, he would follow his rehab nurse around the hospital every morning for 30 minutes. He went on walks outside for 20 minutes twice a day. He greeted clients and staff from behind the reception desk. We blocked off a spare exam room and put up baby gates so he could interact with the world. He essentially became our mascot.

When he came in, he initially weighed about 85 pounds. At his lowest during his recovery, he was 70. When he left he was 75 pounds. They went back to Florida and walked and walked and walked him. Dad took up running, and they both got back into shape. I got Christmas cards from them. And the following summer they drove up to visit, and he was 90 pounds, and all of it was muscle.

The owners continued to work on his recovery for that whole year, and if you didn’t read his record, you never would have known that he was inches away from being put to sleep. He had made a full neurological recovery, and all he lost was a summer.

 

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2 thoughts on “Look Before You Leap

  1. josna says:

    What an amazing story! I am sure, Dr. Brunke, that your love and care was a big factor in this patient’s recovery. You even thought of varying his activities every day; no doubt those details are not details, but crucially important. I have just one dog story on my blog that you might like to read; there is a medical element in it: http://josna.wordpress.com/2010/07/01/flash/

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