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772-878-0100

A Doggie Stroke

People always ask me, "What would you do if it was YOUR dog" (or Cat)?  This is difficult to answer because I do not want to prejudice or influence a person's decision in that way.  Recently, however, something happened in our "family" and Mike thought it might be a good idea for me to share this with our clients because this is what did when it happened to me.

It was a typical Thursday afternoon.  My husband, Mike, had left a little earlier to spend the afternoon at home and it was just about 2 PM when clients started arriving for the evening appointments.  I was on the phone with a client when Mike rushed in the back door with our lab, Bonnie, in his arms.  She is about 82 pounds but Mike's face was pale and Bonnie was limp not a good scene.  I mouthed "what's the matter" to Mike and he responded with, "I don't know but she can't move her legs."  I got off the phone as quickly as possible.  My hands shook as I ran my hands down her body.  She was trembling and her eyes were dilated.  I gave her a mild narcotic intravenously to ease any pain she was feeling and continued examining her.  Mike and Lisa were both talking about what had happened to her.  Mike said he was eating a sandwich while Bonnie and, one of our other dogs, Blue, were outside playing and running around the backyard like they always do.  All of a sudden Mike said that Bonnie started to scream and when he looked outside she was dragging both hind legs.  He ran outside, picked her up and brought her directly to the hospital.

Mike was impatient.  He wanted to know what was wrong and wanted me to do something ASAP.  It wasn't that simple.  Bonnie had lost control to both hind legs.  Her reflexes were not normal but a very important one called deep pain was still intact.  That was good news it meant that her spinal cord was still together, in one piece, it meant there was hope.  But as I examined her and she started to relax with the narcotic in her system, her head began to pull back and her front legs stiffened and would not bend.  This was a sure sign that there had been trauma to her spinal cord.  This was no bone or muscle problem.  She hadn't torn her knee up as Mike had thought originally.  This was a Schiff-Scherrington response and it gave me a clue as to where the problem was.  We took a radiograph of her back concentrating on the area where her ribs stopped.  I was hoping to see a disc that had calcified.  Instead I saw a normal radiograph of a four year old lab.  I went to the phone and called Dr. Julia Blackmore's answering service.  Dr. Blackmore is a board certified neurologist I consult with for neurological cases like this.  I told the service to tell her that it was an emergency and I went back to Bonnie.

Mike wanted me to do something, anything.  I did the only thing that I could do.  I told Lisa to get an IV catheter in her and give her 20 cc of dexamethazone, an anti-inflammatory.  Then I went to see my 2:15 appointment.  Ten minutes had elapsed since Mike had run into the building and I felt like I had been hit by a truck. I saw my 2:15 and my 2:30 and I still had not heard from Julia Blackmore and I was not about to do anything else to Bonnie without first talking to her.  I made another call to her answering service and this time I insisted that she needed to call me as soon as possible.  Then I checked on Bonnie and Mike and went to see my 2:45 appointment. No client knew that a mini crisis was happening during all of this.  We frequently juggle emergencies and hospitalized patient treatments.  I just never had to juggle my own family in this situation before.  During my 2:45 appointment, Julia finally called back.  I excused myself and ran into my office.  In a voice that I knew sounded panicky, I said that I had an emergency and that it was my own dog.  I tried to relate all the signs that I saw to her, to be as thorough as possible so that she could help me make a diagnosis without having Bonnie actually in front of her to touch and see.  She didn't hesitate; she knew what the problem was.  She said that it was FCE, fibrocartlaginous embolus.  My heart dropped.  It was not common.  I vaguely remembered it from vet school nine years ago, and that was the last time I had heard of it or seen it.  Julia said that there was nothing that I could do but be patient.  The anti-inflammatory would help, so would valium and some more mild narcotics.

What had happened is that a small blood clot had formed somewhere in an artery or vein running in her spinal cord.  It had broken loose, plugged the blood vessel leading to the spinal cord and caused the blood flow to stop to that part of her spinal cord.  Initially, it is extremely painful and scary.  Can you just imagine running along when both of your legs suddenly become paralyzed?  No warning, no sign of impending doom, then intense pain and paralysis.  To top it off a dog is still a wolf deep down inside.  Bonnie was alpha dog in our little pack.  Then she was paralyzed, not able to defend herself.  The wild instinct in her told her that she was in mortal danger of attack either by her other packmates or by anything else that would want to eat her.  That explained the dilated pupils and the fear when I first saw her.  Julia said that we would need to watch her carefully over the next 24 hours.  The lesion or injury should be worse on one side.  I would have to help her urinate.  We would have to move her limbs and massage them.  We would have to roll her from one side to the other so that the 'down' side would not have pressure sores.  If it was not one sided then the prognosis was worse and I should call her.  But if it was localized to one side, then we would have to wait some more.  Time, patience and a lot of TLC would heal her.

I told Julia that I remembered about FCE from vet school and that half of the dogs were euthanized.  Why was she so optimistic when I remembered it so differently?  Her answer was that most people just were not patient.  This 'doggy stroke' happened predominantly to young, active, large breed dogs and large breed dogs are hard to deal with in a paralyzed state.  Most people just did not give these guys enough time.  I thanked her for her time and told her that I would call her back the next day with an update.  I told Mike about half of what Julia told me and gave him a bag of IV fluids and medicine to take home with him.  There was nothing more that I could do in the hospital.  Besides, both Bonnie and Mike would be more comfortable at home.  Lisa had finished my 2:45 appointment and now I was on to my 3:00 appointment.

I do not know what I did or how the next three hours passed.  I got home about 6:15. Mike was on the floor with Bonnie.  Sitting next to her to keep her calm.  He had just given her a dose of valium IV because her muscles started to tense up again.  I told him everything that Julia had told me.  We knew what had to be done and we were prepared to give her every chance.  I checked her reflexes periodically through the evening.  We rolled, massaged and talked to her.  Our other two dogs were confused. In her panic Bonnie had bitten our third dog, Clyde, in the head. I cleaned the cut and put staples in it.  Blue was depressed. Bonnie was his.  She was his world, his playmate, his teacher, his chewtoy.  Now she lay there listless and not at all the tolerant friend she had always been.  She snarled and growled, warning them to keep their distance.  She was still alpha dog we would see that she did not lose her position, all she had to do was bluff them until she could get her feet back. I hand fed her vitamin enriched doggie treats soaked in water.  We massaged and comforted her.  It was a long night.  When the alarm went off the next morning, both Mike and I were hopeful.  We both felt that it was now worse on her left side.  And by that I mean that we saw her move her right leg - a small improvement but anything was welcome.  And I was not too sure but I thought I saw a lessening of her Schiff-Scherrington response.  We took her to work with us.  We did not want to leave her alone and we also wanted to monitor for other signs throughout the day.  I called Julia and told her that we felt it had localized to the left side of her body.  She suggested some blood work to rule out any unusual causes of blood clots or hemorrhage.  We sent it to the lab that day, knowing that with the weekend coming, it might take three to four days to get all the results we needed. By mid-afternoon, Schiff-Sherrington was gone and she could sit upright. Both hind legs still dangled but at least she could sit up by herself.  We stopped the valium but continued the high doses of prednisone and to prevent any stomach problems, we also began giving her Zantac.

By the morning of the next day, there was a definite improvement in her ability to move her front legs.  She began to urinate on her own and she had her first bowel movement in almost 48 hours.  We did notice that she was horribly depressed.  For people who do not have the attachment to their pets that we do, that may sound stupid but it was pretty obvious to us that she was depressed.  I was unsure if it was the high doses of prednisone that was doing it to her or just the obvious fact that she was paralyzed and could not do anything about it.  I started to taper her on the prednisone a little quicker than I normally would have just to rule out the prednisone as a problem.

I talked to Julia again and asked her why we could not do a mylegram just to see where and what the problem was.  A mylegram is a procedure where a radioactive dye is injected into one end of the central cavity of the spinal cord.  X-rays are then taken as the dye moves down the cord and areas that are damaged show up as a narrowing or complete blockage of the cavity.  She advised me again to be patient.  She had experience doing myleograms in these guys and she said that every time she has done one too soon, she had actually hindered or stopped any improvement that was going to occur.  If Bonnie was going to react like most dogs she should be up and walking on three legs by Monday (four days after the incident occurred).  If she was not up and walking on Monday THEN Julia said she would do the myleogram.  I thanked her again for being invaluable to me in this situation and numerous other times I have consulted with her on other people's pets.  We saw a small improvement on Sunday morning and by Sunday night she was up and walking on three legs.  It was not pretty, but it was walking!  Mike wanted Julia to actually examine Bonnie.  He was anxious and thought that it would be a good idea for the neurologist to examine her to ensure that she really was progressing as she should be.  So on Tuesday, Julia checked on Bonnie and confirmed that she was just fine for a dog that had a vascular accident in her spinal cord.

All the bloodwork came back normal or negative for any dreaded disease that could possibly have incited this problem.  And so as suddenly as it began just as slowly would it go away.  It would never happen again according to the literature and Julia.  And we would never know exactly WHY it happened to our happy, friendly girl.  Over the next few days she lost about 20 pounds.  Her muscles atrophied, wasted away, where the nerves were damaged and weakened.  We tapered her off the prednisone more and more and her personality became more receptive.  She still did not want anything to do with Blue and we made allowances when walking the dogs every morning (slowing down and not going as far so that she would not feel bad.)  We began feeding her twice as much as we normally did just to help combat the atrophy and we also began giving her Winstrol which helps build muscles, among other things.

It has been a number of months now, it seems much longer.  She is totally off all the medications and we have decreased her food to just a little above what we normally feed her.  Best of all, she is playing with Blue again.  She looks funny when she runs, kind of like a hyena but we see the joy in her face again.  I suspect that this time next year she will be perfectly back to normal or maybe just have a little limp in the left hind leg.  I also suspect that this will be just a memory that will fade for Bonnie.  She does not seem too concerned with it even now!  Will Mike and I forget as quickly?  Probably not.  I find myself watching the dogs more when they run and play not because I am worried that this kind of episode will happen again but because I see the sheer joy and enthusiasm for life that they have.  I have been taught a lesson in how precious that really is.
 
So that is the story of me and Mike and our dogs, mostly Bonnie.  And if your dog ever becomes paralyzed, all of a sudden, I can tell you from personal experience that I know what I would do.

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