Dixie is a fifty-five pound Flat Coat Retriever Mix. When I met her, she was 4 years old. She had been brought to NY through a rescue group from the south that summer. She had been spayed and adopted to a wonderful family from the Lake George area.
A few weeks before I met her, Dixie had been shot in the neck with a rifle. The round had fractured two of the vertebrae in her neck. She had been found by her owner and rushed to a veterinarian for emergency stabilization. Once stabilized it was determined that her spinal cord was damaged and she had no function in any of her legs.
She was referred to a veterinary neurosurgeon in Latham, NY, but due to the metal fragments from the bullet they could not do an MRI. (Magnetic Resonance Imaging uses magnets, it would have pulled the bullet out of her body). She was then referred to Cornell University’s Veterinary Teaching Hospital. There she had a CT scan (no magnets) and a nine hour surgical procedure to stabilize her fractured vertebrae and spinal cord. Numerous screws and wires were used to support her spinal cord. After surgery was complete, she had another CT scan to verify the alignment of her spine.
Dixie remained hospitalized at Cornell during her immediate post-operative period and received rehabilitation through the vet school. In trying to get her closer to home (Mom was driving seven hours each way to visit her) she was transferred to my care approximately two weeks after surgery.
Upon her arrival, Dixie could wag her tail and had feeling in her legs but could not move them. After reviewing her CT scans and her case file, we admitted Dixie to start comprehensive rehabilitation. Dixie would be hospitalized 24/7 for two weeks and we would see what progress could be made. I discussed with the family that she may not regain any function or that she may only make a partial recovery. We would aim for a complete recovery and see how she responded. If, after two weeks, she showed improvement we would continue to work with her. I wasn’t sure how long Dixie would need to be hospitalized.
The first thing I set out to do with Dixie was to make friends. We would be working together constantly and needed a good relationship. That took all of ten seconds. Her tail wagged and she smiled as I petted her. We then set up a plan for Dixie. Her full time job would be to learn how to walk again. Like us, no patient can work constantly.
My plan for Dixie would include continuing the oral pain relieving medications she was already on. These were designed to minimize pain originating from the spinal cord. I also added in low doses of muscle relaxants and anti-inflammatory medication since we would be working with her legs and needed to keep them comfortable. Her rehabilitation sessions would be broken up into three 30-45 minute sessions three times a day. This would be done Monday through Friday and on Saturdays she would have a lighter workout day. Sunday would be her day of rest. Dixie would also receive acupuncture treatments twice a week for pain relief and to stimulate her nervous system.
My phases with any patient for neurological rehabilitation are this: First, we establish good pain control. There is no point in trying to do anything constructive if the patient is not comfortable. This can be established with a combination of medications, massage, laser therapy, electrical stimulation and acupuncture. Finding the right combination for each individual can take some trial and error.
The second phase is the actual rehabilitation. In early steps this is teaching individual muscle groups what to do. This can be done with electrical stimulation and therapeutic exercises. Some of those exercises include the very basic one of being upright. Dixie could not use her legs and she was dependent on us to keep her sternal or change which side she laid on. This was rotated frequently to avoid pressure sores. For small periods throughout the day, Dixie was placed in a sling and lift to stimulate her standing. This is not only good for her frame of mind (who wants to see the world lying down all the time?) but also for her spinal cord and nerves. The stimulation of her body standing helps to re-educate the nervous system.
Neurological rehabilitation goes through many smaller phases from working on individual muscle groups, simulating leg movement, teaching balance and eventually harmonizing those movements to teach the patient how to walk again. Along the way, there can be setbacks from pain as muscles can be sore from disuse. Setbacks can also occur from pressure sores, urinary tract infections or aspiration pneumonia, which can all potentially occur if proper nursing care is not practiced. Some patients will plateau at a certain point and may not make a full recovery. These can be difficult to identify because there is not necessarily a hard and fast rulebook on when each step of the rehab will occur in each individual patient.
The first two weeks went very well with Dixie. She adjusted to our hospital staff and settled in to a good routine with her rehab. Of course, she also had her say in it as well. When we were not working with her, I had planned to have her in the intensive care unit (ICU) so that she could rest and be observed. Remember, she had orthopedic screws and wires holding together her fractured vertebrae. After a few days of her whining and rubbing her nose on cage door demanding attention, we moved her into the rehab room full time. We had tried to avoid having her with us in order to allow her down time to rest and also as a safety precaution with her neck. Dixie would have nothing to do with that. She would have a rehab session and then relax and nap off to the side of the rehab room while we were all talking and working on other patients. She is a very social dog and wanted to be part of our day.
Each day, Dixie would be hand fed, stimulated to urinate and defecate, cleaned up, have her pain relievers and joint support medications and then start into her rehab sessions. We worked on changing the order of the sessions and treatments to provide variety for her. Each day she would have range of motion exercises in all four limbs, a full body massage, low level laser treatments, electrical stimulation of different muscles groups and time “standing”. We varied the standing from me supporting her to time in the sling and Hoyer lift. (See below).
Her family came to visit after the first week and she was very happy to see them. When they came the second week, we all agreed she was comfortable and doing well and agreed to continue treatment. We would re-evaluate her every two weeks to determine what progress had been made. Either the rehab technicians or I talked with her owner every day or every other day during the course of her stay.
After three weeks of treatment, we had seen some improvement in Dixie. Her tail wag was consistent and she needed less stimulation to urinate and defecate. She would often give us clues that she needed to go.
At five weeks, she had a consistent routine for going to the bathroom with very few mistakes. At this time, she also had become quite fed up with the sling and lift. In the last two weeks, we would have her in the sling for longer and longer periods of time to allow her body to be in a more natural position. The sensation of standing gave her nervous system positive feedback and she could look around to observe her environment. Unfortunately, she was not as enthusiastic about being in the sling and would slump and not cooperate as well with her rehab sessions when they involved it.
This is when we got a quad cart from Eddie’s Wheels. This cart is adjustable and designed for in hospital use for different sized patients with neurological injuries. The lift had wheels but was very bulky and not designed for mobility. In the quad cart, Dixie could go places. So each day, we worked on standing and walking. Dixie loved the sunshine and the attention she got and her enthusiasm returned. (See below for pictures and video in quad cart).
At this point, Dixie could not support her own weight but was starting to have small consistent movements in her legs when we pushed her in the cart. This is when we added in underwater treadmill sessions to her rehab. We phased out some of the electrical stimulation and I got in the treadmill with her and we worked on limb movement. The life jacket and buoyancy of the water made Dixie feel like she only weighed about 60% of her weight and her muscles were strong enough to support that.
Initially, she was very unsure about being in water and it took some time for us to adjust her to it. It eventually became a fun part of her therapy and we would alternate aquatic therapy and cart sessions depending on the weather.
At this time, Dixie and her family went back to Cornell for a follow up CT scan. This showed that her fractured vertebrae had healed and we would not have to worry about her injuring her neck or moving a screw and causing her pain or paralyzing her.
The CT scan required anesthesia and a long car ride each way, so we kept Dixie’s rehab light for a few days after. Once that had passed, we took to having her upright as much as possible and Dixie wanted to help. She was now making consistent efforts to right herself to a sternal position or she would roll over on her back to flip like a pancake.
I’m not sure when but I was very hopeful that Dixie would be walking on her own soon. That “soon” took a while.
Over the next four weeks, Dixie would make small improvements but was often not participating in her rehab. We changed her routine, her activity and had her family visit more often. Nothing seemed to make a difference. I discussed with her family the potential that she had plateaued in her recovery. We talked about getting her a cart for home and stopping for a while. Her mom suggested taking her home for a few days and I agreed. Maybe we all needed a break. So, Dixie went home for a three-day weekend to have some fun.
Sometimes a break is needed. Dixie came back with a renewed energy. She was making efforts to stand and started to bark if she wasn’t getting herself to the position she wanted.
That week, after an underwater treadmill session Dixie had her breakthrough. She was very wet and we got the hair dryer out to help. She was never a big fan of this (what dog is?) but always tolerated it. This time she stood up and walked away! It was only about four feet — but she did it! I was paged to rehab to see it and she did it again. I called her mom with the great news and she started crying on the phone.
Just as each patient’s neurological rehab progresses at its own pace, they also have their own motivation. For Dixie, that was getting away from the hair dryer. We would continue to use that consistently in her rehab and eventually just the sight of it was enough to get her to stand.
Over the next two months, we worked with Dixie four or five days a week and she spent weekends at home with her family. Seemingly each day she made progress and became stronger and stronger. She seemed to wear a smile on her face each day.
After nearly six months from the date of her injury, Dixie walked out of the rehab department on her own to go home. I saw her regularly for follow up visits and slowly weaned her off her medications.
Due to the nature of her injury, Dixie walked with her head down and her legs moving a bit like a crab. It was the prettiest walk I had ever seen. Over the next year, she went to the beach, the mountains and all over with her family. She got stronger and stronger. Occasionally, she would have problems due to her posture. We would work on those as needed with medication or with massage sessions by her family.
This is the last phase of rehabilitation: maintenance. Her recovery was a culmination of the emergency treatment, surgical correction and rehabilitation efforts of her owners, the rehab staff and most importantly Dixie herself. This team approach will be needed to maintain her mobility and comfort due to the severity of the initial injury. The importance of preventing obesity, keeping her mobile and active and anticipating the additional wear and tear her body will go through as a consequence of her injury and posture, all play a role in the quality of life Dixie will have going forward. And that is the phase of rehab that doesn’t end.
For a few years, I lost track of Dixie but was lucky enough to reconnect with her and her family last summer. She is doing very well and still having fun. Below is a recent picture.
For more information on Dixie, including her owner’s legal battle, check out this site. http://www.dixiethemiracledog.com/5001.html
Pictures of Dixie (double click to view larger image)
In her quad cart
First steps on her own. Note her crab-like posture.