Valley Forge Family Practice

Lucy E. Hornstein, MD

 

What's Wrong with Cricket?

 

 

At first glance there was nothing unusual about the Emergency Room waiting area where I sat anxiously waiting to meet the surgeon who was about to operate on my baby. The old magazines; the blaring television; the sign on the clerk's window stating that payment was due at time of service. The sign next to it caught my eye, however: "All patients must be on leashes. Thank you for your cooperation." That plus the fact that the TV was tuned to Animal Planet and the magazines bore titles like "Cat Fancier" and "Poodle Today" made me realize that despite my sixteen years of Family Practice I was very much out of my depth here at the Veterinary Hospital of the University of Pennsylvania.
 

Four years ago I had a cat. Three years ago I met my second husband and his cat. Two years ago we married and also acquired his daughter's cat. I was perfectly content with three cats and three teenagers, but my husband began "visiting" puppies in the pet store. As a loving and perceptive wife I eventually said, "You want a dog, don't you." As a clever man he responded, "We don't have to." But he kept visiting the puppies. One five month old female Pekinese in particular had him captivated. When my son asked if we could play with her I didn't see any harm. Somewhat to my surprise she wasn't yappy and annoying the way I was afraid a small dog would be. She was sweet and mellow and hardly barked at all. We took her home and named her Cricket. She was our baby.

 

The evening before Cricket's second birthday she began behaving oddly. It was hard to be sure but it looked like her right hind leg was dragging. Then the doorbell rang and she leaped up and ran normally. You're just faking, I thought. Still I called the vet, whose assistant returned the call and suggested that I try and keep her quiet overnight and see what she was doing in the morning. By the time the sun came up there was clearly something very wrong.

 

I lifted her up onto my bed as I did every morning so she could lick my ears but she just lay there, ears flat against her head, panting slightly. As she tried to crawl toward me her right hind leg was clearly paralyzed and the left appeared weak. I called the vet again.

 

"Sounds like a ruptured disk that probably needs surgery. Do you know how to get to VHUP?"

 

As it happened I did. It was right around the corner from where my step-daughter had lived for a year. Luckily for a Monday morning I was able to call my office and have them reschedule the few patients who had appointments, carefully loaded Cricket into an open box on the passenger seat of my car and headed into Philadelphia at the height of a Monday morning rush hour.

 

The stop and go drive seemed to take forever. Cricket sat quietly beside me, panting. My heart beat steadily faster as I realized she wasn't the least bit thirsty.

The parking attendant's halo must have been hidden beneath his Phillies cap. He was exquisitely kind as he showed me the way to the Emergency Room, parked my car and brought me my keys while I waited. Best five dollars I've ever spent.

 

I held Crickie in my arms as I signed her in. The sign notwithstanding, she wasn't going anywhere even without a leash. The resident who came out to triage her was as young as he was compassionate and competent. He took a brief history from me, then took Cricket into the treatment area to examine her while a student came out for a more extensive history. After a few more agonizing minutes they came out together and took me into a small room adjacent to the waiting area to discuss their findings.

 

"Cricket has a ruptured disk in her back, most likely at the level of T12-13."

 

I looked at them as if they had said it was January 32nd.         People onlyhave 12 thoracic vertebrae.It turns out that dogs have 13. Who knew?

 

"She needs surgery and pretty intensive nursing care for the next two to three months. There's no guarantee but it is entirely possible for her to recover completely."

 

The poor puppy was only two years old. Today was her birthday. With her sweet, gentle disposition I couldn't refuse.

 

In human medicine this kind of surgery is performed either by orthopedists or neurosurgeons. At VHUP it was the province of Ortho. I kissed my puppy good-bye and left her in competent hands but with a very heavy heart.

 

The surgeon called me later that afternoon after the operation. It had gone well, he said. He was very kind and knowledgeable and answered all my questions as clinically as I wanted. Apparently this was the most common surgical emergency seen in long, low breeds like pekes, dachshunds and corgis. I was surprised to learn that it could happen at any age. They saw one or two a day at VHUP so they clearly had a great deal of experience. I asked when I could see her. Not tonight, he said. She was still in ICU and groggy from the anesthetic, but we could come down and visit tomorrow evening. I hung up the phone trying in vain to picture a doggie ICU.

 

The next evening my husband and I again braved rush hour into Philadelphia. Parking was free after 5:00. Protocol was for us to be escorted up to the wards by first or second year vet students. As we walked down a wide corridor dogs could be heard barking occasionally. A sign reading "Exotics" pointed down a hallway. I saw a huge, beautiful dog lying on the ground on a large pillow, an IV taped to the cinderblock wall above him, completely unconscious. I think the sign on the wall said his name was Rusty.
 
Cricket's "ward" was a corridor with one wall consisting of metal cages of which only three were occupied. My heart sank the instant I saw her. The damp fur on her ears made her look like a drowned rat. The smell of canned dog food was unfamiliar; we always gave her dry food. The enormous shaved patch on her back caught me by surprise. It must have been four by twelve inches, with a long row of staples down the middle. She looked at me and emitted the most unearthly cross between a wail and a scream. With all the pain she'd been in the day before, she'd never made a sound. I was unnerved.

 

Leaning into the metal hole in the wall I gathered my pup into my arms as best I could. I talked to her and scratched behind her ears, trying to calm her down by letting her know I was here. She seemed to look right through me as she kept wailing. I turned to the students and awkwardly tried to pull rank.
 
"Has she been like this all day?" The two students who'd shown us up assured us that she'd been fine when they'd seen her earlier in the day, but I was freaking out. Finally a nurse came with some IV pain medicine for her. She told me that the Fentanyl patch that they'd placed earlier in the day sometimes made dogs dysphoric.
 
"You mean my dog is stoned?"
 
"Something like that, yes."
 
She talked softly as she gently took Cricket's paw to inject the medicine into the IV catheter. She was just as nice to me as she reassured me that the med she'd just given worked quickly. Sure enough within minutes Cricket was only partly conscious. My husband had to almost literally pull my arms away from her as we took our leave. My last sight of her wasn't completely reassuring: her head flopped next to the cardboard food container, eyes half closed, her little tongue hanging partway out. But at least she wasn't in pain anymore.
 
The next morning the surgeon called me again after rounds. Cricket was doing so well I could take her home that night if I wanted. Boy did I ever. For the third day in a row I set out during Philadelphia rush hour, this time taking my 17 year old daughter with me to hold Cricket on the drive home.
 
The nurse brought her down on a plastic cart, went over the discharge instructions with us, and off we went. As happy as I was to have my baby back, the hard part was just beginning.
 
Immediately postoperatively Cricket's back half was completely paralyzed, including her tail, which had still wagged when I had left her. Now she had to be either in her crate or literally at arm's reach. Although the instructions said we were to keep her off the furniture the easiest thing to do was keep her on the couch next to us. I sent my husband out to buy waterproof underpads to protect the fabric. Meals at the kitchen table were a thing of the past. We had to eat at the coffee table in the family room so someone could always stay next to Cricket. It was like having a newborn.
 
She refused to eat or drink for the first two days. Finally I offered her training treats from her obedience classes. Those she ate from my hand, so I sent my husband out to find dog food with the same soft consistency as the treats. As long as I broke them up and fed them to her by hand, she'd eat them. After a few bites she'd lap up a drink of water from a bowl if I held it up for her.
 
When I took her to the vet to get her staples out he checked her, then came back into the room and wagged his finger at me.
 
"You've been doing a terrible job of expressing her bladder."
 
Because Cricket couldn't urinate spontaneously, one of my biggest challenges that first week had been learning to squeeze her lower abdomen to empty her bladder for her several times a day. They  must have thought that as a doctor I'd have no trouble, but palpating a dog's abdomen was as new and unfamiliar to me as it was to any first year vet student. I had no idea what I was doing, and apparently I hadn't been doing it very well. The poor thing was terribly distended. No wonder her appetite was off. My vet kept her for a few days, got her bladder back in shape, and most importantly got her eating regular dry dog food again.
 
Luckily we had an extra dog crate that I took to the office and set up under the fax machine. I was also lucky in that Barbara and Debbie don't mind dogs. And so Cricket began coming with me to the office. Between her naturally quiet disposition and the fact that dogs sleep about eighteen hours a day, she spent most of the time in her crate. At the beginning I'd go and check on her between every patient, but she's been improving by leaps and bounds (so to speak.)
 
The first milestone was when her tail began wagging again. Then she began regaining some movement in her back legs. We were told at VHUP that we could take her out for walks by supporting her hind end in a sling. My old red scarf works perfectly. She still likes us to hand feed her, but at least it's dry food. And I've come to recognize a special sharp bark she uses when she wants a drink of water.
 
We've getting quite used to her in the office. She's usually so quiet no one even knows she's there. But there are some patients she insists on coming out and greeting. The vast majority love her. Then again, she's too cute not to love. She's so gentle I have no qualms letting strange children pet her. She loves it as much as they do. And there's something wonderfully calming about a tiny dog sleeping in my lap, head draped over my arm as I finish charting in the afternoon.
 
Several people have told me about little wheelchair carts for paraplegic dogs, but she's continuing to make progress. We were told to give it at least six months, but if she needs one later we'll look into it.
 
I have several physician friends who have their dogs in the office with them, so obviously I'm not unique. But Cricket is still special.
 
Nowadays as her front end walks and runs with the sling supporting her back, the hind legs follow in a sort of walking motion even though she doesn't have enough motor function to do more than just stand for a few seconds. She even bounds up curbs and bounces around whenever she sees other doggies, just like before. And in the morning my husband puts her up on the bed so she can lick my ears. My puppy is back.

 

 

Copyright © 2005  by Lucy E. Hornstein