Here we go again .....

Unfortunately, little Heidi had to have another spinal surgery, so I thought I’d start up this blog again to keep my friends and family up to date on her what’s happening.

I’ll first give you the update I just got from the Dr. this morning, then I’ll tell you the story of how we got here.

9:45 am January 1, 2010.

Dr. Devon Hague, the neurology resident who was involved with Heidi’s case on Monday night (and who got stuck working on the holiday today) just called to give me an update on how Heidi did through the night. Heidi had just come out of anesthesia last night when I left her and she was still a little confused and wimpering a bit. It’s normal for dogs to wimper when coming out of anesthesia, so they are used to it. But Mom sure wasn’t. It was really hard to see her like that. But, Dr. Hague said she ate dinner around 11:00 and that was good. Typically, a dog won’t eat if they are in pain. So they took it as a sign she was comfortable. She also said that Heidi was a little anxious during the night so they gave her some anti-anxiety medication and that helped her sleep. (It’s too bad they can’t dispense that medication to the parents too!). She is also on IV Fentanyl for the pain. This morning Dr. Hague said Heidi look good. She’s bright and alert and looks comfortable. The neurologic exam showed she was about the same as before surgery. Which can be a good sign. Sometimes they can be worse right after surgery due to swelling that can occur. But Heidi seemed about the same. She can stand on her own. She still has good function in her left hind leg, and still a deficit in her right hind leg. But, she commented that Heidi has good tone in her right leg (not exactly sure what that means, if she’s referring to muscle tone, then it may mean that she should have the muscle strength to use the leg if the signals from the brain can actually get there) we just have to wait and see how she progresses over the next few days. The earliest they would expect to see any improvement in her right leg would be tomorrow or Sunday. I am going to head out there today to visit with her and bring her her favorite stuffed rabbit toy.

If I have already talked to you most of what I’m going to describe below will be a repeat of what I’ve already told you. But I’m going to tell the whole story again anyway because it’s a little bit therapeutic for me.


12:30 am Monday, December 28, 2009

I just arrived home from the airport late Sunday night early Monday morning. (I spent a wonderful Christmas vacation with my family in Alabama.) When I walked in the door I expected to hear Heidi scratching with excitement at the baby gate upstairs (she’s confined to the top floor when I’m not home) but she was quiet instead. When I got up the stairs I saw she was wagging her tail but she was standing still shaking and her little ears were back trying to tell me something was wrong. When she finally did move around a little bit I could see she was wobbly on her hind legs – mostly the right hind. Well, my first reaction was OMG! because I’ve seen this before back when she had the herniated disk in 2008.

~12:00 pm Monday, December 28, 2009

So, I called Heidi’s Neurologist and Neurosurgeon who did the surgery last time, Dr. Larry Gainsburg in Catonsville, to try to get an appointment for Heidi. Dr. Gainsburg was on vacation. So they referred me to Dr. Steven Steinberg in Gaithersburg. But, Dr. Steinberg was also on vacation. So they referred me to Dr. William Bush of Bush Veterinary Neurology Services in Leesburg, Virginia. Then I called Dr. Gainsburg’s office back to let them know that Dr. Steinberg was on vacation, and they also referred us to Dr. Bush’s office. So, off to Leesburg we went. Dr. Bush wasn’t in that day so we saw Dr. Joli Jarboe and Dr. Devon Hague instead. Dr. Jarboe was very impressive. She was very methodical and thorough. And I really felt comfortable with her. I could tell right away that she loves animals just like I do. However, Heidi’s neurologic exam turned out to be inconclusive. There were a couple of reasons for that. First, during the day, Heidi had improved a little bit and wasn’t showing as much wobbliness in her back legs during the exam as she was the night before. And, Heidi is already a little weak on her right hind leg due to the knee surgery she had when she was 2 years old. The knee surgery she had on both hind legs to stabilize her luxating patellas (slippery kneecaps) didn’t hold up on the right side. As a result, it was hard to tell if she was having lg pain or a neurologic/spinal issue. The next step would be to do an MRI. Well, since Heidi looked like she was improving, and since the cost of the MRI at Dr. Bush’s office was about $600 more than if I were to have it done with Dr. Gainsburg, I decided to forgoe the MRI that night and try to see Dr. Gainsburg as soon as he got back from vacation on January 4. So, the Drs prescribed some medication for pain, told me to keep her confined to a crate and to watch her closely for any signs of getting worse.


Tuesday, December 29, 2009

The next day, Heidi was about the same, or maybe a little better, than she was the night before. Not perfect, but definitely better than she had been late Sunday night. When Dr. Bush’s office called to check on how Heidi was doing, I reported that she was doing ok and that I would call again if anything changed for the worse.

8:30 am Wednesday, December 30, 2009

This morning Heidi was worse. She didn’t want to walk and she didn’t want to put her right hind leg down on the floor. But I still couldn’t tell if the problem was in her leg or in her back. So I called Dr. Bush’s office and they told me to check in with Heidi’s regular vet Dr. David Tayman at Columbia Animal Hospital and see if he can determine whether she is having a leg problem or a neurologic problem before making the trip all the way back out to Leesburg. So I called Dr. Tayman’s office and got an appointment for 11:50. By the time of the appointment Heidi had gotten much worse. And when we arrived I was already in tears. As soon as Dr. Tayman took one look at her he knew it was a neurologic problem and that I should head back to Leesburg as quickly as I can to see if they could do anything to help her. Of course we were both thinking she had another herniated disk. And I was afraid to put her through another surgery. So I asked Dr. Tayman “Would I be a bad Mom if I put her through another surgery” and he said “Oh no, you wouldn’t be a bad Mom, it’s just a matter of whether surgery is indicated and whether or not anything can be done at all”. So, he got on the phone with Dr. Bush (Dr. Jarboe was off today) and talked to him about Heidi and let him know we were heading back to Leesburg. Then, he gave me a big hug and off we went. And he made me promise to call him when I knew something.

So, we get to the office in Leesburg and met Dr. Bush. Dr. Bush was equally as impressive. He is an expert surgeon. He was very friendly and introduced himself as “Bill”. He has a way about him that makes you feel like you and your pet are his most important case of the day. And he talks to you in terms you can easily understand. Even though I was holding back tears, I was starting to feel thankful that Heidi was in good hands and reassured that if anyone could help her, Dr. Bush and Dr. Jarboe could.

Dr. Bush walked through the results of the MRI and CT Mylogram with me on the computer. He showed me all the different vertebra and pointed out where the problem was. It looked like Heidi had developed scar tissue and a cyst at the old surgery site. He said this is very rare and he’s only seen it happen once before. But he felt certain that surgery to remove the cyst was the only thing that would help Heidi. He also said that it would be a very complex surgery so he wanted to wait and do it tomorrow so that he could have overnight to think about it and devise a plan. He also suggested that we ask Dr. Jarboe to come in tomorrow to do the surgery because he felt she is a better surgeon than he is and that Heidi definitely needs every bit of Dr. Jarboe’s surgical skills.

So, we made all the plans for surgery tomorrow, I emptied my bank account, and then I left Heidi there for the night and went home.

Thursday, December 31, 2009

Today, this wonderful human being and talented surgeon named Dr. Jarboe came into the office on her day off to do Heidi’s surgery. She had already been in contact with Dr. Bush over night and she knew what kind of challenge she was facing today. They let me visit with Heidi for a few minutes and talk with Dr. Jarboe for a few minutes before surgery. I really enjoyed our conversation. She also made me feel at ease but was very straight forward with me about the risks of the surgery. Heidi is a tiny little dog, she was going to go back in to a previous surgery site and do more surgery. So there was a risk of doing further injury simply by doing the surgery, and there was no way to know what the final outcome will be. And Dr. Jarboe wanted to make sure I understood what I was getting myself into. But I also sensed she respected me for wanting to do everything I can to help Heidi and she reassured me she would do everything she could. Dr. Jarboe loves her pets as much as I love mine and it was very comforting to know that. And I also knew that Dr. Bush was going to be there and Heidi would have the benefit of their combined experience and skill. I knew Heidi was in good hands.

The surgery took about 2 hours. Dr. Bush came out and asked if they could do another MRI so they have a baseline post-surgical MRI. He said its best to do it now because if she has any problems in the future they will have wished they had done an MRI right after surgery. The MRI took about an hour. Then I was able to sit down with Dr. Jarboe and Dr. Bush to talk about the surgery. Dr. Bush’s first comment was “it could have gone better, but it also could have gone worse”. It turns out, what he thought was a cyst wasn’t actually a cyst at all. It was a gelatinous material that appeared to be an area of dead spinal cord tissue. It was right at the old surgery site. They are not sure why the area of tissue died. Tissue can die if there is chronic compression on the area, But Heidi’s previous surgery should have removed the pressure that was there before on that area of the cord. Dr. Bush used the word “dumbfounded” to describe what they were feeling when they dissected down into where they thought they would find a cyst and instead found this gelatinous material. So we sat there and talked for a while and they showed me the before and after MRIs and you can definitely see that Heidi’s spinal cord has a lot more room to relax and decompress now. It looks like the surgery itself was a complete success. They got all the dead tissue out, and they even got out a little bit of disk material from the two adjacent vertebra because they were a little bit herniated already. So, that might actually prevent further herniation of those disks in the future. The only question now is how much damage was done to the cord and how much can the spinal cord heal itself. And that is something we won’t know right away. They say if we see some improvement by Saturday or Sunday then the chances are good that she could regain up to 90% of function in her right hind leg. But, if we don’t, then we really don’t know how much she’ll regain, and she may never regain function at all.

So, I am trying to prepare myself for that possibility. And I’m trying to convince myself that as long as she can pee, poop and eat, I’ll be happy. If she walks funny, or if she can’t walk at all, that will be perfectly OK! I can always get her a little doggie wheel chair cart if I have to.