Dealing with the cards we are dealt

This case is from a few years ago but I have been re-telling the story again lately and wanted to share it with you.

When I met Gus, he was a two-year old male French Mastiff who couldn’t use his hind legs and had no control of his bladder or bowels. The first time I examined him he urinated all over me. It wasn’t his fault but I knew we had a long road ahead of us.

Gus lived in Albany with his owners and their three small children. His dad was called back to active duty in the Army and left overseas. While Gus loved his mom and the kids, dad was the center of his universe. The day after his dad deployed, Gus kept looking for him at the front door; pacing and whining he kept searching for him. His mom would call him back to the living room to be with the family but as soon as he was there, he would head back to the front door to look for his dad.

After the third day, Gus started jumping at the door. One time he hit the handle just right and the door opened. Gus took off into the street. His mom yelled and ran after him, only to see Gus run over by a truck in the road. He was rushed to the local animal emergency room and was treated for shock and pain.

The truck had fractured a vertebrae in his lower back and caused a disc to herniate against his spinal cord. It also broke many of the bones in his tail. The damage was severe. He had no function in his back legs or tail.

The only two options were to pursue a neurosurgery specialist or euthanize him. Surgery would stabilize his fracture and take the pressure off his spinal cord. At the time, his mom could not reach her husband to let him know what had happened. Knowing how much he loved Gus, she made the decision to go forward with surgery.

The closest specialist was in Boston. So, mom, the kids and Gus drove out there. Dr. Stephanie Kube operated on Gus, amputating his tail, stabilizing the fracture and removing the herniated disc. After surgery, Gus could feel his legs but did not gain much function back. This can happen in spinal cord surgery. Sometimes function comes back quickly, other times very slowly, and, in rare cases, not at all.

Gus stayed in Boston for about 2 weeks after his surgery and began fundamental rehab there. But due to the distance away from home and the need for a formal rehab center he was transferred to my care.

After changing into dry pants, I admitted Gus for a week of rehab. I had advised caution with his mom and could not make guarantees that he would recover. We agreed to take it one week at a time and look for steady improvements. Gus had weighed 90 pounds before his accident and was down to 75 pounds. This was caused by muscle atrophy in his hindquarters.

Unfortunately, Gus was still too big to manage at home and was incontinent. He was being catheterized 3-4 times a day if he wasn’t urinating on his own. I did not keep a permanent catheter in him for three reasons. First, with a catheter in, I wouldn’t know if he had the ability to urinate on his own. Second, a catheter can put the patient at risk for infections and third, his bodyweight would compress it and occlude the line.

His front legs worked perfectly and he would lift himself up in the run to move around. He would also get fed up with his rehab and try to walk away. While most of the time he laid still for his rehab he would get frustrated some days.

Gus’s rehab was an all day affair. He was living at the hospital, so we worked with him for 15-20 minutes at a time 3-4 times a day instead of the typical 90 minutes straight. This gave him time to rest and also added variety to his day. Some days we had to change our plan if he had urinated or defecated on himself.

Gus had electrical stimulation to work the muscle groups in his back legs. He also had range of motion exercises, standing exercises and therapeutic laser treatments for his hind legs. His front legs were working hard supporting all of his weight, so we worked on those and his back muscles to keep him comfortable.

His mom and the kids came to visit him after a few days and we agreed to continue on for two more weeks. Gus became attached to my rehab technician, Rebecca, and I as much as we became attached to him. He enjoyed the interactions and always wanted to see what we were doing. After a few weeks, he started living in the rehab room permanently instead of the ICU. This allowed him more mental stimulation and actually made our lives easier. By having him there, we could do short exercises with him without taking the 20 minutes to get him up from the cage, over to rehab and back to his cage.

Each week Gus would make progress. We had to catheterize him less often as he gained sensation and the ability to urinate on his own. It was far from perfect but he made steps. I had him on medications to help stimulate bladder contraction and antibiotics since he had developed a urinary tract infection.

After a month or so, he could move his legs but wasn’t strong enough to stand to walk. The owner wasn’t sure she could continue on with rehab and was considering euthanizing him. We worked it out that he would stay with us for another few weeks but if he didn’t make more progress we would stop.

I completely understood and respected her concerns. Managing Gus was a full time job for Rebecca and I and we had the help of other staff at the hospital. Trying to do that and raise three kids would be impossible. There were still days Gus would either urinate or defecate on himself and require a bath. There was also the financial aspect to consider.

We had a cart from a previous patient that we started to use for Gus. Carts are great tools as part of rehab. They allow the pet to be upright and can be set either as a “walker” or a wheelchair depending on the ability the pet has. With his front legs working well, Gus could pull himself around the room in the cart. This minimized his chances of injuries and getting pressure sores on his back legs.

Gus also used a harness to keep his back legs up. Doing this on a land treadmill we could exercise his front half and two of us could move his back legs for him. One of us would hold the harness and the other would place his feet in time with his front legs. This was done to mimic walking and get input up his spinal cord that his legs could do this.

While he had made progress, the owner decided she could not keep going. Instead of euthanasia he would be placed in a foster home through a French Mastiff Rescue group. I had spoken with the owner about this and the group leader. Unfortunately they could not take Gus for a few more weeks. The owner could not afford to keep paying us, so we agreed that Gus could stay with us at no charge until the rescue group could take him.

During his time with us, we became very attached to Gus. He was a happy two year old who just wanted to play and didn’t understand why his legs didn’t work. He would get “jealous” of us working with other dogs and bark or whine. If we weren’t working with patients, he would bark at the door to have someone play with him.

His favorite toy was a soccer ball. He would nudge it back to you if you rolled it to him. He even learned to bump it back to you using his head. I would lob the ball at him and he could head butt it back. This game could last hours if you let him have his way.

We kept working with Gus each day. Although he had shown some motor function, he hadn’t walked using his back legs on his own. While it was still early, this troubled me because he would be very hard to place in a home with all of his conditions. And while he enjoyed his time in the cart, it made him twice as wide due to the wheels. This would make using it inside a normal house difficult.

About a week before the rescue group was coming to pick him up, I was working at the desk in the rehab room. My back was to Gus as I finished some paperwork. I was also racking my brain trying to figure out why he wasn’t walking. There were no other patients there and I was reviewing my notes again on him to see what I had missed.

Being in the room meant I was there to play with Gus. Well, that’s what he thought at least. He was laying at the opposite end of the room and would roll the ball to my feet. I could work and gently kick it backwards to him at the same time. This was the only way to get any work done, otherwise he would whine or bark for attention.

As the ball came rolling back to me it slid under the desk. I couldn’t find it with my foot and stopped reading his chart. As I bent down to find the ball, I felt Gus lick my hand. As I turned to nudge him away, I saw him STANDING on all four feet. I stepped back and he WALKED to me. Not his half-walk, half-drag but a choppy walk using all four feet.

I shouted in joy and got down to hug him. Gus of course walked right past me and got the ball. I had taken too long in his opinion.

Sometimes you just have to wait for the right time. Gus had waited and walked when he was good and ready.

I let his mom know that he was walking and she started crying over the phone. She was happy he had recovered but it didn’t change her situation. Gus faced a lifetime of medical problems ahead and she couldn’t provide the care he needed.

A week later, Gus left with the French Mastiff Rescue foster family. I made sure they had plenty of soccer balls to keep him motivated. I received updates from the rescue group the first year that Gus was doing well. After that we lost touch.

Patience, time and dedication can improve outcomes. Sometimes the changes in lifestyle or financial concerns change the outcome as well. Gus and his family may not have gotten what they wanted, but they got what they needed.

Advertisements