9-23-03 Found paralyzed
My little dog was found behind where I work on Sept. 23 at about 2:30. She couldn't walk and she had an open wound across her hips with ants in it. I took her to my regular vet who x-rayed her and referred her to the surgical specialists. She had a spinal fracture at mid-back in addition to the visible gash across her hips. She had surgery at 5:30. The surgeon actually whistled in a kind of serious, emphatic way when he saw her x‑rays. He pinched her toes together with a pair of pliers and got nothing, so she had no deep pain, but she did have the draw-away reflex. He had them write on her paperwork that she probably would not walk again and that we should consider a cart. However, when he talked to me he said that sometimes they can learn "spinal walking". There is a tendency for the back limbs to move reflexively, simply because the front legs are moving. You help the dog learn to use this reflexive movement to maximum effect.
9-23-03 Veterinary chart and referral
9-23-03
Exam - possible HBC, call owner
after exam - mm pale
paresis both rear legs
- large laceration of mid lumbar area
-LM at [...] to call
Rads: Fx / T11 w/ displacement
Send to [...] for Sx
-Send Rads with owner
1cc Pen SQ, cleansed wound w/ chlorhexiderm
9-23-03 Surgery consent form
On the standard surgery consent form I signed, the surgeon had hand-written, "No deep pain. Patient will not likely walk again."
9-23-03 Spinal fusion
The spine was realigned and set in place with pins and bone cement. The surgeon said eventually she would grow more of her own bone under the bone cement to stabilize the area.
The surgeon said it "reduced nicely" meaning went back into proper alignment.
9-23-03 Imaging report after surgery
Imaging Request Form
FINDINGS: Postoperative radiographs of the thoracolumbar spine are available for interpretation. These radiographs are compared to referral radiographs. A severe fracture luxation at T12-13 has been repaired. There was 100% overriding of the spinal canal at the T12-13 junction. There is a vertebral body fracture involving the caudal aspect of T12. There are fractures of the dorsal spinous processes of Lumbar vertebra numbers two, three, four and six. The liver is extremely small as the gastric axis is cranially displaced. The colon contains gas and dense granular material. The fractures have been stabilized with methyl methacrylate applied to the dorsal spinous processes extending from the tenth thoracic vertebra to the second lumbar vertebra. Pins are present in the right and left sides of the vertebral bodies in T11, T12, T13 and L1. The spinal alignment is improved however there is slight ventral displacement of the 13th thoracic vertebra relative to the 12th. Gas and staples noted in the dorsal soft tissues.
CONCLUSIONS: Stabilization of T12-13 vertebral fracture - luxation. Fractures of the lumbar dorsal spinous processes.
9-24-03 Hospital visits
They let me visit her--in fact they encouraged it. My visits were short because she was basically pretty out of it on the morphine.
9-25-03 Letter from the surgeon to our vet
On Tuesday, September 23, 2003, "Katie" [...] was presented for spinal fracture. The following is a summary of the visit:
History/physical Examination:
The patient was presented for paraplegia. The Patient had a displaced fracture/luxation of the 12th thoracic vertebra. Pain recognition was absent.
Diagnosis:
Spinal fracture luxation
Surgery Report:
A bilateral approach to the thoracolumbar spine was performed. The spinal fracture was reduced and stabilized with 8 pins constructed in combination with polymethylmethacrylate to produce an internal splint. Closure was routine.
Prognosis:
Good for survival. Poor for rear limb function.
Recommendations/Discharge Instructions:
Written instructions were provided.
In you have any questions about "Katie" or any others, please contact me personally. Thank you for entrusting your clients and patients to our hospital.
Sincerely,
[...], DVM
Diplomate ACVS
9-26-03 Discharge Instructions
Patient Information:
Katie (#4699)
Chihuahua, Brown/White
spayed female
1. Restrict activity to small area for 3-4 weeks.
2. Normal food consumption.
3. Monitor incision for signs of irritation, redness or infection. Call our office if you observe any of these problems.
4. Make an appointment for suture removal in approximately 10 days. We will re-evaluate the patient's progress at this visit as well.
5. Administer the medications provided as directed on the label. These are provided for pain relief and protection from infection.
6. Call with any questions or concerns. Given the patient's injury it will be appropriate to consider a K‑9 Cart for her comfort and mobility.
It is very important to monitor for food and water intake as well as for voluntary urination. If your pet is not eating and drinking as well as urinating appropriately please call as soon as possible.
If your pet can not urinate voluntarily upon dismissal from the hospital we will train you to express the urinary bladder. This is very important and must be done successfully at least every 8 hours. If you have difficulty expressing the bladder you should return to our hospital or your regular veterinarian promptly.
9-26-03 Four weeks of crate rest
I put her crate up on the kitchen table where she could see out the window, which made crate rest more interesting for her and saved my back from all the bending. When I had to change her bed I put her in a cardboard box so she wouldn't even think of trying to drag herself around.
She kept lying on her tail without realizing it and I would carefully fix it so she wasn't.
9-26-03 Pain meds
She was actually on pain medication for maybe 3 weeks or a little more. She was not restless except for about the last 45 minutes before it was time for the next dose, which made it hard for me to wait those 45 minutes but I did. Most of the time she varied from being happy with her head tilted back from the narcotics, to alert but calm, to sleeping. She seemed to know she needed sleep.
9-26-03 Hand-feeding
The day of the accident, she lost her home, her familiar smells, her familiar people, her familiar food. The only way she would eat was hand-feeding.
I had an impossible time trying to get my dog to eat following her accident. I received all sorts of advice, including mixing chicken broth in her food, and trying cottage cheese. One day I stood in the aisle at PetsMart and had to go get a paper towel from their "Oops! Clean-up Station" to dry my face because we'd tried every kind of healthy expensive food and cheap junk food there was and she wouldn't eat anything. Finally, I tried frying some hamburger, and that was the first thing she would eat.
I gave her half a slice of American cheese every day. I hoped the calcium might help her bones fuse, plus it has lots of other nutrients, and she liked it. I also gave her at least 1 1/2 inches of Nutrical vitamin paste every day.
9-26-03 In season
During her hospital stay following back surgery, they told me she was spotting and in heat. They didn't know if she'd been bred. They said it was not uncommon to have accident victims brought in that are in season. PLEASE NOTE: I spent the first 30 days I was expressing her wondering if I was squeezing puppies!!!!!
9-28-03 Emergency veterinary clinic record
Primary Complaint: Came in to get pain meds.
Veterinarian: [...]
S.O.A.P.
Abd = soft - see A
Incision CDI
meds: clavamox PO BID
Buprenex - gelA large soft bladder w/ dark yellow urine w/some
oder1) owner out of Buprenex gel
F see column
Homecare Instructions Owner to see rDVM /regular vet
or surgeon tomorrow for refill of
pain medication
& re: bladder expressionsTentative Diagnosis:
p/o back fracture x 5 days
(owner some difficulty
expressing bladder / out of pain
medications)Buprenex 0.06 mg im
Expressed lge soft bladder
(has tone)
9-28-03 Emergency vet expressed her bladder 30 min after I did
He put my small dog on the examining table facing long-ways, and had a towel under her back feet. He stood behind her so they were both facing the same direction. He placed his hands on her hips to hold her in a standing position, and laid his fingertips on her sides near the ribs end of the bladder. He then pressed with his fingerpads while slowing curling his fingers inward, therefore pressing back toward her tail at the same time he was pressing inward. When he did this, he produced a flood. I was very impressed and tried it and got zero.
9-29-03 Urinary tract infection
I suspected it because her urine smelled just like mine does when I have one. The vet did a blood test and found her white count elevated and put her on antibiotics.
9-29-03 Specialty hospital recheck
9-29-2003 Examination-Recheck
9-29-2003 Lab-CBC
9-29-2003 Baytril Inj 22.7 mg/ml
9-29-2003 Torbugesic Liquid
9-30-03 I printed out the K-9 Carts Physical Therapy tips
"Fill your bathtub with warm water, deep enough so that your pet’s feet are off the bottom of the tub. Support the rear of your pet and let them swim with the front legs."
"If you have a large dog and do not have a pool, call an equine (horse) center and inquire if there are any pools in the area that swim horses for exercise. They may allow you to swim your pet there."
"It is important that your pet retain normal range of motion in the limbs so that they do not become rigid and the joints immovable or frozen."
"When doing range of motion exercises, place the pet on its side and with the paw flat on your hand move the leg up and down towards the hip."
9-30-03 Exercises during crate rest
We did exercises twice a day, with her lying in her crate. They included bicycling her legs through the full range of motion, massaging her legs and feet, digging my fingers between her toes, and pressing lightly on her pads to see if she would push back.
I used to do "This little piggy" with my dog after her injury. On the last little piggy where it says, "This little piggy went Wee-Wee-Wee-Wee all the way home" I would close my hand around her foot and squeeze it and wiggle it, and she thought it was funny!
10-1-03± Learning to express the bladder
I actually went to the library and photocopied a side view of canine anatomy and laid it on the floor beside my dog when I was learning, to remind me of where the bladder was.
10-5-03 Wheelchair
I ordered a wheelchair for my dog.
When I measured my dog for her cart, my next door neighbor came over and helped me. My dog could not stand up at all, so he held her up while I measured her.
10-7-03± Stretching
The only response I saw in my dog as early as two weeks was that she would sit on her bottom with her back legs stretched out straight in front of her like a doll and she would point her toes and stretch her legs like a gymnast doing the seat position on the rings. She could also curl her tail into a semi-sickle shape when this happened.
10-7-03 Suture removal
At 9:45 a.m. I went in to our appointment for suture removal with a list of questions about expressing the bladder, whether Nutrical puts too much sugar in the urine, bathing, what she can feel, and the formation of puppies. A vet tech removed 32 staples and let me keep them. The surgeon showed me an x-ray of her spine stabilized with pins and bone cement. She still had no deep pain sensation.
After the appointment I went out to the reception desk and asked about physical therapy, but was told "No". The woman I spoke with did not give a reason, so I assumed it was because my dog did not have deep pain sensation. I explained the surgeon had mentioned physical therapy when I brought my dog for surgery, but the answer was still "No". (I found out later they were only starting the physical therapy department at that time and the program was not in full swing yet.)
I asked if there were exercises I could do at home and the receptionist called the physical therapist to the reception desk. She showed me how to hold my dog in a standing position and press down lightly on her hips repeatedly. I made notes on using ice packs, where to buy gel wraps, drawing circles on the bottoms of her pads, and uneven surfaces, and left feeling suddenly alone in the world with a paralyzed dog.
10-8-03 Still learning to express the bladder
I printed out Expressing the Bladder from the Disabled Dachshund Society.
10-28-03± Her wheelchair arrived
The cart arrived 5 weeks after surgery and I had to wait until the 6th week to use it.
11-4-03± Wheelchair was heavy
I just *knew* when I put my dog in, she would take off running like Willy did in the book and it would be a moment of pure joy. I was so excited about the cart that (I've never confessed this before) when the delivery truck pulled up to our door, I ran outside and ran up to the driver and actually scared him because he wasn't expecting it. I told him, "It's the wheelchair for my dog" and I guess he thought I was nuts.
She didn't care for it, it was disappointing. Even though we tried it a number of times, and adjusted it, etc., it seemed too heavy for a little dog. I think I bought the wrong brand.
I could never get it adjusted so she really looked comfortable. And it just so happened that the harness strap was almost over her spinal fusion where I did not want any pressure.