Hank. Cervical Disc Disease Management When Surgical Treatment is NOT an Option. His journey and recovery blog.

Hank was a statistic no one wanted to happen.

He is a beagle who is middle aged, lazy and overweight. He also spends his time outdoors with a hyperactive over exuberant nut case of a brother, Moe. Moe has everything going for him. He is active, lean, muscular, and full of energy. This lifestyle has made him a powerhouse, it has also made him a liability to his brother, fat, old, slothy Hank.

Moe, Caleb, Hank

Hank was found laying on his side unable to stand, move, or walk on a Friday afternoon. He was shaking, trembling, and crying in pain. His family brought him to see me on a Sunday after it was apparent he was not recovering on his own.

Now I am just like you. I heard his story, looked at his pitiful pathetic desperate self and thought, "Oh God! why did they wait to bring him in?"

This is what I saw when I entered the exam room the first time I met Hank and Caleb.
I will never forget seeing them.
I feared the worst...

I have been wearing a white coat for a while. It has provided me some important life lessons. One is to not assume or rush to judgement. Hank's family was overwhelmed with caretaking for their son, Caleb, who has spina bifada. Caleb is 8 years old and preparing for his 6th surgery this year. It was very clear very quickly that this family was taxed beyond what many of us could handle on a routine basis and now Hank was down and out. When I discussed my concerns for Hank, how he needed to be transferred immediately to a neurologist and how the optimal care for his current condition would require an MRI and decompression surgery with its $8,000 to $10,000 price tag, his family went white with anguish.

Hank was Caleb's best friend. His lifeline, and his inspiration for all of his surgeries. At every surgery Caleb carried in a stuffed version of his beloved Hank to keep him company.

My bright idea of publicly posting Hank's condition in an effort to gain social media assistance to cover some, or all, of Hanks medical costs was abandoned when Caleb's mom quietly mentioned that they already had a GoFund me site set up to help pay for Caleb's next surgery. How could I ask for help with Hank's medical needs when Caleb's were in competition for those dollars? There was no way I was going to ask, or beg, for help and have it cost Caleb. So I did what I believed was the only option left. I took Hank's case on as my own. No advertising, no reimbursement, no discussion of anything except to say to his mom "You worry about Caleb and yourself, and I will worry about Hank."

And so it was. After two nights in the clinic Hank came home with me. I arrived at home late Wednesday evening with a paralyzed Hank and an almost absent ambivalent husband who now expects that I take the critical cases home with me. A few minutes of basic technician training and my husband was enlisted in Hank's care and understanding that verbal protests would only damage our relationship and fail at discouraging my maternal veterinary compulsions.

After 14 days with us, including a week of almost completely sleepless nights because Hank refused to sleep on a dog bed at the end of our bed, and would only stop crying, whining and bellowing when I put him in our bed. Which is a ridiculously dangerous place to be because who wants a paralyzed dog to fall out of bed? AND he is peeing and pooping at unforeseen intervals.

Hank required 24/7 care. Multiple baths at 2 am because had to go to the bathroom, multiple times getting up to try to figure out if the whimpering and discontent meant he needed something like, perhaps,, food?, water?, pain medication?, to go outside?, to sit up?, to get more attention?, to see the cat who believed she also belonged on the bed?, to cool him off?, warm him up?, etc. etc. There is no exception to these pups being an intensive amount of work with an unknown amount of recovery time.

There were days I went to work exhausted and cranky. There were nights my husband hated me for inflicting these restless nights upon our bedroom. And, there were the endless questions of whether this was all for naught? Would he ever get better? Would his family take him back? Would that be best for Hank? What would the rest of Hank's life look like? Would he relapse in a week? A month? A year? Would he recover the next time?

Here is Hank's YouTube diary.

There are a few critical things I hope that everyone leaves this blog with;

1. These cases are difficult.

2. There is no rule book for time and prognosis.

3. These cases need affordable options provided to clients,

4. Never surrender hope.

5. Or let anyone steal your faith.

6. These cases deserve an opportunity to provide and offer the fertile ground of miracles a chance. If any vet tells to you surrender your hope IF YOU DON'T have a couple grand available immediately walk out and find another vet. 

7. Managing pain is possible, and these cases have a chance at recovery. Hank was trembling and panting for a week in discomfort. It was hard to watch, and I tried very hard to keep him as comfortable as possible, BUT, I did not out him in a drug induced coma. 

8. We got through it together! Me, Hank, my husband, and the staff at the clinic. Provide a supportive network or encouraging helpful people. Death is not an option I considered. I understand this is on a case by case basis, BUT, I was prepared for a cart and a dog who needed help for as long as Hank needed help.

What does Hanks future hold? I am not sure. He is home with his family. We talk often and we will continue to do so. Caleb has his next surgery next week. Our best wishes and thoughts are with him. We have faith,,,, sometimes that is enough.

Caleb comes to visit Hank, day 3.

Hank and his family day 10

There is a whole lot more information on IVDD on my other blogs. Please visit them. I think they answer every question I have ever had on managing this disease.

Hank goes home, day 17

IVDD. The Days Immediately Following the Diagnosis.

IVDD. Dr Kelcourse's Advice.

IVDD. A Tale Of Two Outcomes.

If you have a pet in need, or a pet question you would like to ask, please find the helpful people at Pawbly.com. It is a free and open community for anyone and everyone who loves pets.

I am also available via Facebook, Twitter @FreePetAdvice, and YouTube. 

Baby Brea

I received a text message last night that Brea had passed away very early this morning at the veterinary neurology facility.

She had been referred by us to a neurologist because she had been experiencing some severe back pain that had progressed to her not wanting to move. She had come in last week with reluctance to move and we quickly thought that it might be her back.

Back pain is rather common in dachshunds and beagles. But based on Brea's recent history of illness I was concerned that she might have meningitis.

Meningitis is inflammation of the meninges. In veterianry medicine we usually mean inflammation of the covering of the spinal cord. It is very painful and usually the result of an infection, although many times we don't know how or why it decided to land there. It is a very serious disease and can be very difficult to treat. You see your brain and spinal cord are protected by a protective tissue that keeps the bad stuff out of our most important and most valuable place, our brain and its peripheral extension, our spinal cord. When disease gets in it is now sealed in. There aren't the same super effective defense mechanisms in place here so the infection can lie undetected by our body, but wreak havoc on our primary nervous tissue. To diagnose this disease we need a spinal tap. This is not a procedure general practitioners do. We like to send these tests to the neurologists. (Something about a big long needle piercing into the spinal column gets us spooked, although all of the neurologists I know tell me it's actually easy to perform. I'll take their word for it).

Brea's arrival with yet another disease had us all scared. It was just a few weeks ago that she left the hospital after a 3 week stay from one of the worst cases of pneumonia that I had ever seen. Now she has severe pain that seems to be coming from her spine? OMG! How can 1 little sweetest-dog-ever, have another terrible affliction? My first thought is that this episode MUST be related to her last episode. We ran blood work, took her temperature and looked for any sign of progressive infection. Everything in the infection category was negative. Yet her exam still looked like spine, inter-vertebral disc disease, (IVDD). I called the neurologist to ask for his opinion. I didn't want to deal another crushing blow of devastating and expense to treat disease to Brea's family.

He agreed that she probably wasn't a meningitis case, but also agreed that we probably shouldn't start her on a steroid initially. We sent Brea home last week with lots of pain medications and a plan that if she wasn't better in 2 days, or if she worsened that she would go to the spine center.

Two days later she was not better, and she was sent to the neurologist to try to identify her source of pain and to try to figure out how we could lessen it.

Brea had a myelogram and it identified a disc in her spinal cord at the level of her cervical spine at C2-C3. The "higher" your disc disease is the more paralysis it usually causes. A disc at the cervical area will affect all four legs, versus a disc at your lumbar area affects your rear limbs. Also the nerves that control your vital organs live high up to. If you injure your spine at the very top (high cervical area, right by the base of your brain) it can actually stop your ability to breathe.

At 3 am Brea died. The consensus is that she must have extruded more disc material or she was so pyrexic (elevated body temperature, can happen from pain), that her breathing stopped. She had done fine during her myelogram, and was at the hospital for observation and pain management, but slated to be discharged for home care in the morning.

As soon as I heard about Brea I called her family. They are wonderful, kind people who have done more for any dog than anyone I have ever met. The first time I saw Brea was within 24 hours of them adopting her. They knew she was sick, but they adopted her anyway. And even though I wasn't sure that she would live through the day from her pneumonia they decided to try to save her. They stuck by her despite needing three weeks of hospitalization. As she got better she blossomed into a happy energetic inquisitive beagle. They had gotten her to help ease the anxieties of their other dog, Beau. Beau only knew Brea for a few short weeks. Between being quarantined for her first and last illness Beau and Brea only had a few weeks together.

There wasn't anything I could say to comfort Brea's parents. All I could say is how sorry I was, and how incredibly unfair it all seemed.

I sat on the phone trying to hold back tears and telling them how wonderful little Brea was and how incredibly lucky she was to have found them. What I really wanted to say was, "How can this have happened?" Not to place blame, because I just don't think there is any to point at, but how can that little bundle of baby beagle who was so adorable, so irresistible, abandoned, almost died a few months ago, have died from this? How could she be so young, and have been dealt such a shit hand?"

I told Beau's family that we would help them find a new friend for Beau. That I know they are shell-shocked and don't even want to think about it, but I will help them find and foster a healthy friend for Beau, who still needs someone to keep him from being alone and afraid.

I know I get too emotionally involved with my patients, but "Why?" I just don't have the answer to "Why?"

I am heart-broken for baby Brea and her family.

Such is medicine, I just doubt I will ever stop asking "Why?" It happens when you get emotionally involved, but I guess I will never stop doing that either.

To read Brea's blog please go to:

http://tinyurl.com/8lyjxnh