Thursday, June 10, 2010
In veterinary school, intervertebral disk disease was one of my favorite conditions to study. The neurological system is fascinating: how it functions, how it heals, how it affects every other system in such an intricate way. As soon as real life hits, I am no longer fascinated. I am crying and holding my good friend Ernie Dog who is scared and flailing and pained. We are racing to Banfield, The Pet Hospital of Papillion where Angela the Pet Nurse waits with life saving medications.
Mom had called me earlier in the morning. "Something’s wrong with Ernie! He’s paddling in a circle!" Luckily the kids and I were dressed. I grabbed my keys and stethoscope, and we ran out the door.
Ernie was born in Ceresco, Nebraska ten years ago. Mom and Dad adopted him as a puppy and named him after the small town’s furniture store, "Ernie’s of Ceresco." He is a Teacup Poodle, the smallest dog I know, weighing in at a perfect 4.0 pounds. He helps Mom teach preschool at Montessori Children’s Room. He has his own rug on which he works and has an impressive resume with years of experience. EVERYONE loves Ernie.
Minutes after hanging up with Mom, I am in the living room performing a neurological examination. Just looking at my goofy little friend, I know he is in trouble. Ernie is truly paddling in a circle, conscious, but hyper-reflexive, unable to stand, and otherwise severely neurologically compromised, to say the least. Seeing a pet, and even more so, a friend I love dearly, in the midst of a neurological crisis has to be the most disturbing thing I deal with as a veterinarian.
Acute cervical intervertebral disk rupture with spinal cord impingement. I take my tentative diagnosis and my tiny scared friend who is unable to hold any of his tiny legs still or unarch his neck and race to work with a quick call to warn Angela that we are on our way.
Fat dogs get intervertebral disk disease, chondrodystrophic dogs, inactive dogs. Ernie had not even been playing, he had been sleeping! It does not matter right now if this is fair or not. It matters whether I can bring Ernie through his pain, if he can return to normal function. Above all else, I need to protect the hearts of Mom and Dad. I know that I can not, and that is crushing me. I hold Ernie tighter and drive faster.
We arrive at Banfield and begin treatment. Finally, after enough pain killers, anti-inflammatories, and muscle relaxers to take down a small moose, Ernie is able to rest in my arms. I compound his very small medications (one pill of each medication crushed into enough cherry syrup to last the month) and type his very involved medical notes, all with my left hand while cradling Ernie in my right. He will literally not be set down again for three days.
I call Iowa State University Veterinary Teaching Hospital. I talk with Dr. Miller, explain his history, signs, medications, and response to treatment. Sometimes dogs with intervertebral disk disease need myelograms (radiographic contrast studies done under anesthesia to assess the location of injury and degree of disk impingement on the spinal cord and nerves). Sometimes they need a veterinary neurological specialist or surgical specialist to perform major neck or back surgery.
Ernie still might, but our plan right now is to provide supportive care and continue to monitor his condition. If he regresses or stops improving, I have orders from Dr. Miller to drop everything and come to Iowa State, day or night, where emergency, radiology, and surgery teams will be waiting. Mom, Dad, Russ, and I rearrange our week’s plans to make room for the trip we hope not to take, so very grateful that an entire crowd of specialists, support staff, and students awaits, just in case.
Friday, June 11, 2010
Ernie looks the same but is showing some very slight neurological improvements. Mom and Dad are amazing. They are literally carrying Ernie back to health. I know now he is going to be OK. Until this day, I did not know whether Ernie would survive his injury.
Saturday, June 12, 2010
Ernie is walking with much assistance. He can potty if he is held up. Dad and I rehydrate him one syringed milliliter at a time. Russ cooks him turkey and rice, which he gobbles up. Today was rough. Ernie fought hard. Ernie is winning. I am so proud of him.
He curls up in his kennel for about an hour in the evening. He could not curl up before this. His legs were so neurologically compromised he could only hold them straight out and bend them with help. He is beginning to heal.
Sunday, June 13, 2010
When he is supported on his right side, Ernie can walk for a few steps before he needs to rest. He is compensating for his wide legged stance and ataxia and “high step” very well. He is eating and drinking with help. He is so tired.
Monday, June 14, 2010
Ernie is walking without assistance. He looks up at his easy chair as if preparing to jump into it. “Six weeks of strict rest, and then we will see if I let you jump Ernie!” I remind him. He rolls his eyes and stands with his head down to let me lift him. I know this road to recovery will be very long, but Ernie Dog is going to get there, and we are all going to continue to walk there with him. What a week this has been. What a great family I have. And what an amazing little dog Ernie Nelson is.