Saturday, July 24, 2010

What happened to Mini?
The events that led to spinal surgery...

That's a picture of Mini, taken yesterday afternoon.

The IV in her leg is where she gets her hydromorphone drip to control the pain of Thursday night's emergency spinal surgery. So if she looks a little glassy-eyed in the picture, well, that might explain why - according to the surgeon, the drug is a notch stronger than morphine.

As bad as that may sound, I've just been told that we'll be bringing her home from the hospital today. A couple dozen people have asked what's happened, so I thought I'd try and offer an explanation here - hopefully we can track her progress over the coming weeks, as well.

Essentially, the next six weeks will determine if Mini can ever use her back legs again. How did it happen? We're not really sure, and neither are the doctors...

Two years ago, a set of unrelated x-rays indicated what our vet at the time referred to as early onset arthritis, as well as a calcium deposit forming in the mid-section of Mini's spine. Back problems are common in daschunds and corgis, and being a daschund/corgi mix, it wasn't necessarily a cause for panic. We did, however, take precautionary measures, buying a second set of dog steps for our house - giving us one for the couches in our living room, and another for the bed in our bedroom.

Last Thanksgiving, she was experiencing back pain. We knew because she would wince and/or give out a yelp if someone approached her suddenly (not necessarily touching her), was guarded when anyone would try and pet her (especially around the back, often yelping), slow moving around the house, and not really excited about walks. The vet prescribed a steroid treatment, as well as a mild pain reliever to help ease the recovery.

Much like a human, the best remedy for a back is rest - the anti-inflammatory agents in the steroid, as well as the pain reliever and close supervision, were intended to provide just that. She recovered after about a week, and we were told it was no doubt related to the calcium deposit and/or the arthritis. While we should be aware that it could happen again as she gets older (she turned nine in April, so was about eight-and-a-half at the time), we were told it wasn't something that required excessive concern.

About six weeks ago, Mini started favoring her back again. We had since transitioned her to a new vet, who at the time had just finished treating her for an aural hematoma (which is why one ear stands up, the other now flops). She recommended the same course of action as November's incident - 5 mg of Prednisone (steroid) twice a day, as well as Tramadol for pain relief. After two weeks of treatment, as we had begun to ween her off the Prednisone, we were growing concerned because she wasn't showing any signs of improvement. The doctor recommended going back to twice a day with the steroid.

After a week of this, I started to notice that Mini was favoring her right hind leg (left hind leg, if you were facing her). As her doctor had previously noted that we shouldn't be overly concerned as long as there wasn't an indication of nerve damage, this gave me pause - if her leg wasn't working, perhaps the nerves were starting to show wear. I brought her in for x-rays this past Tuesday (7/20).

The results indicated two spaces between her vertebrae that appeared smaller than the rest, but there were no signs of tumors or any other indications that this wasn't something we might be able to treat with a prescribed anti-inflammatory and continued pain relief over the short and long term. A new course of medication was prescribed, and we were on our way, encouraged that surgery would not appear to be a necessity.

That was Tuesday afternoon. Wednesday, she not only was wagging her tail for the first time in weeks, but also followed me outside and wanted to socialize with a few dogs that were walking by our house. She tired quickly and wanted to go back inside, but we were excited by the show of progress.

Thursday, she spent the first half of the day under the bed in our master bedroom, her safe haven as of late. I took her out at about 1:30 to administer the first set of daily meds, and while she hates the meds, she stayed with me in my office after that. She was whining a little, but nothing out of the ordinary after taking those wretched-tasting pills. She was holding her head up, as if craning to look at something, but I assumed that was because of either the pills, or just a comfortable position given her back issues. After about a half hour, she settled down and was just lying in her bed.

I got on a conference call at about 4:15, and since I tend to pace on longer calls, I started walking around the house so that I wouldn't disturb Mini in my office. At about 4:45, I noticed her, in a seated position, pulling herself out of my office and into our foyer so that she could be with me. It was almost as if she was scooting her butt (like dogs do to scratch that itch), only she was "walking" with her front legs, and her hind legs weren't doing anything.

I sat on the floor with her and pet her for a bit, and she was smiling, showing absolutely no signs of pain. I picked up her backside to see if she could support herself, and it fell like dead weight. I made several attempts to get her to stand on all fours, but her hind legs continued to slump into a seated position. I excused myself from the conference call and phoned Mini's vet immediately. Her regular doctor was out, but another vet - who was familiar with her situation as he consulted on Tuesday's x-rays - called me back at 5:45 and strongly urged us to immediately take her to a spine surgeon.

When dealing with paralysis, as was the case here, the chance of recovery drops dramatically after the first 24 hours, and waiting even overnight could make all the difference in the world. I called the surgeon, and we were at the hospital by 6:45.

The doctor we met with gave us a 75-percent chance of recovery if we had immediate surgery to decompress the pressure in her spine. We agreed to the surgery, and were then introduced to the surgeon, who actually offered a less-optimistic 50/50 chances of recovered mobility. Needless to say, we still agreed to the surgery.

We left Mini in the hospital's care shortly after 9pm, and received a call around 11pm, letting us know that her blood panels cleared her for anesthesia, and a myelogram - where they inject dye into the spine to see where the actual obstruction is - confirmed that the blockage was in the same area as indicated by the x-rays, and they would immediately proceed with the surgery.

A little before 1:30 am, I received a call from the surgeon, telling me that they had completed the surgery, but with "strange" results. Typically, an invasive spinal surgery such as Mini's - as necessitated by the x-rays - would result in the finding of calcified disc matter that results in the decreased space between the vertebrae. By removing that disc matter, the nerve damage can often be corrected. But in this instance, when the surgeon cut through the bone surrounding Mini's spine, he found no disc matter whatsoever. Instead, her spine was swollen, exposed, and rubbing directly against the bone - hence the irritation and eventual paralysis. The surgeon called it a "Type 3 Disc Protrusion," and something that he doesn't see very often.

While he admitted that he would feel better had he physically been able to remove disc matter - and what would have been the obvious cause of the problem - in this case, by removing the bone surrounding the spine (and the cause of irritation), he felt hopeful that similar results were possible. Post-surgery, he estimated that Mini's chances of walking again remained at 50-percent.

He did say that she was showing tremendous recovery from the anesthesia and surgery, and was lifting her head and trying to look around a lot sooner than many larger dogs would be in a similar situation. We agreed to talk again the next morning and set up a time to visit her, after we all (including Mini) had a chance to rest.

As can be expected, a morphine drip can have quite the impact on an eleven pound dog, and she was a loopy little patient when we saw her for the first time less than 12 hours after her surgery. That said, she recognized us all, and even started to whine when I left the room to get her some water. We sat with her for an hour, a lot of which was spent with the surgeon, and she spent most of that time dazed and content, resting in my hands.

The surgeon said he would remove the IV that night, transition her to pills, and was confident we could take her home the next day.

I promised Mini that, given her medicated state and starry-eyed stare, I'd play her one of my favorite Coachella DJ mixes when we got her home Saturday... Ironically, Fatboy Slim was on the radio when we got in the car to leave the hospital moments later.

Today's plan? We are heading out to buy a playpen - that way she can be with us at all times, but won't be able to move more than necessary - then we pick her up this afternoon, take her home, and begin the slow and hopeful road to recovery...

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