Saturday, March 29, 2008

Ramp is built!

Yesterday my dear friend Steve (Ali’s too!) spent the whole day building a ramp for Ali so he can get up the 6 steps to the porch at my new place in Petaluma. I am tremendously grateful for him for building this for us – it was a big job and took hours! But now it’s all set up and all that remains (besides painting it) to be seen is whether Ali will be able to get up and down it okay in his new wheels (which won’t arrive for another [long!] two weeks). It should be fine, but of course I am nervous it will be too steep. Anyway, it is a tremendous relief to have the ramp built. Thank you, Steve!!! The materials cost about $200, but at least I didn't have to pay someone to build it (and thank you again, Steve, for also donating the paint!).

I spoke to my good friend and SF roommate, Courtney, tonight. They have started reluctantly interviewing people for my room and are sad about it – as am I! I looked up the listing for my room on Craigslist and it bummed me out; I remember us all writing the description together when we were looking for another roommate six months ago. This time it’s me being replaced – although nobody wants it! It will be hard when I go back to pack up my things once and for all. I have not been back there in over a month – ever since I left that morning to pick up Alec from the vet hospital. Right now it feels like I am just temporarily “away.” I don’t want to go back and say good-bye forever! Still, I can’t overemphasize how happy I am that Alec is here with me and doing so well all things considered. I am grateful I have this chance to take care of him and that is my one and only focus. While all this is true, saying good-bye to my old life will be sad too.

Saturday, March 22, 2008

The cutest thing.

Last night after I turned off the light and tucked myself under the covers of my air mattress, I heard Ali rustling around on his bed. I thought he was just changing positions but the next thing I knew there was a shepherd face inches from my own – he had dragged himself across the room and pulled himself halfway up onto the bed. It was so cute! Even though he really shouldn’t be dragging himself like that. It really startled me at first and then I started to laugh and helped him onto the bed. I guess he wanted a change of scenery. He slept with me all night. It was a restless one (there is barely enough room on that mattress for the both of us!), but I didn’t care.

Friday, March 21, 2008

Ordered the cart today! Now we just have to wait 3 weeks…

I placed the order for Alec’s cart from Eddie’s Wheels ( but now we have to wait 3 weeks for it to arrive. They take 2 weeks to build and a week to ship from Mass. to Calif. It is definitely a relief to finally have the order in. The measurements for these carts have to be exact and they are not the easiest to obtain. Juli, the rehabilitation specialist, and I measured him on two separate occasions (with another set of measurements done by myself and two friends for good measure) before we were comfortable that we had the precise numbers. We had some trouble getting accurate measurements across the top of his back, which is a part of the cart that is welded and definitely cannot be adjusted after the fact. If the cart does not fit right it has to be sent back and another cart built, meaning another 3 weeks and you have to pay for the new cart. So I really hope it fits him when it arrives!! My credit card has not been charged yet, but I think it is going to cost around $600.

And Alec is still going to the bathroom outside a lot so I haven’t really been expressing his bladder. I tried once early this morning but did not try for the rest of the day – I just let him go outside on his own. To see how well he was emptying (or not), I asked Dr. Leavey to stop by on her way home this evening to check his bladder with a catheter and she extracted four tablespoons of urine, which is not very much. So signs seem good that he is mostly emptying on his own, which is amazing! Fingers crossed that this continues.

Thursday, March 20, 2008

New medications.

I started Alec on Rimadyl and Ciproflaxin today. The Ciproflaxin is an antibiotic for a urinary tract infection – which I knew dogs in his condition were prone to but I was kind of bummed he contracted one so soon – and the Rimadyl is an anti-inflammatory to help with his front legs, which are becoming swollen and painful from his putting so much weight on them. He is already showing signs of arthritis. I can’t wait for his cart to arrive since that should help balance out his weight more evenly. The good news is that Dr. Leavey (my amazing local vet from Animal Hospital of Cotati) just had a bunch of Rimadyl donated and she said we could have it for free! I had just ordered another brand of anti-inflammatory from that was going to cost $100 for just a few weeks supply (why are all the medications he needs so expensive??), but luckily I was able to cancel the order after talking to Dr Leavey, who was has truly been our angel throughout this ordeal. She has been making house calls to check on Alec ever since his surgery and has not charged me once (in the beginning she was coming almost everyday). I am so grateful for her compassion! I really don’t know how we could have managed this far without her, especially during those first difficult weeks after surgery when I was struggling so much with expressing his bladder and had no idea if I was doing it right.

The photo: Juli the rehab therapist brought by a p-nut ball (aka physio-roll) to try to help with Ali's standing exercises. Someone (in this case, Maggie, my friend, co-worker, and future roommate) holds a peanut butter kong while I (try to!) hold his back legs in position and gently rock him back and forth to try to stimulate his nerves to "remember" walking. It's harder than it looks.

Tuesday, March 18, 2008

Signed a lease...

Since I have to leave my house (and fabulous housemates Courtney, Nicte, and Javier [and Courtney's dog Usha, who was Alec's best friend]) in San Francisco, I have been looking for a new place with my friend and co-worker, Maggie, who also found herself needing to move recently. We had not had much luck until we found a really gorgeous place in Petaluma, the bottom floor of an old Victorian house just about 15 minutes from work and in a nice neighborhood with two parks close by (also right across the street from a really good Thai restaurant, where we will never be able to afford to eat!). We had looked at some less expensive, but sketchier, neighborhoods in Santa Rosa and while I would not have minded these types of transitional neighborhoods “before,” when Alec was mobile, I would just not feel comfortable walking around a bad neighborhood with a disabled dog in a cart. Ali has been more protective of me than ever since his injury – I’m sure it’s because he cannot get up and check things out so he is trying to preemptively deter everyone through rather indiscriminate barking. Well, it seems indiscriminate to me, but in his mind I’m sure it serves a purpose! So, the anxiety it would cost me to live in the more gang-friendly neighborhoods is not worth the few dollars of rent it would save. Plus, I really did not want to move further north if I could help it. Petaluma is to the south of the ALDF office and closer to San Francisco, so this makes me happy as I am planning to go back and visit my old roommates a lot once Ali is good to go with his new wheels.

It all sounds good, right? Yes, but the place, although it is on the first floor, has 6 steps leading up to the porch. I didn’t think it would work because of this fact, but my good friend Steve said he could and would be willing to build a ramp if the landlord would be okay with that. I then checked with his rehab specialist and she said a ramp would be fine once he gets his cart. So, we went ahead and signed the lease tonight because everything else about the place seemed really great (well, obviously except for the fact that it’s not in San Francisco, but there is nothing I can do about that right now so am trying not to dwell!) – but now I am really worried. What if the ramp situation doesn’t work out? Did I just make a huge mistake?? I have had to make so many big decisions lately about me and Ali and our future and his well-being; it can be overwhelming at times. Hard to think we were cruising along enjoying a relatively uncomplicated life just 6 weeks earlier…

I stopped the Phenoxybenzamine completely today. I have been expressing him less but he has been going to the bathroom a lot on his own, so things seems to be going well in that area – for now.

Monday, March 17, 2008

Blog post on ALDF website.

My friend and co-worker, Paula, posted a sweet blog about me and Ali on the Animal Legal Defense Fund website. You can read it here.

Saturday, March 15, 2008

Going to the bathroom outside!

I started walking Alec outside briefly with a sling to support his back end 3-4 times a day and it has been working! He is actually going to the bathroom outside and he has not soiled his bed once (knock on wood!) since I took him outside for the first time Tuesday evening after our re-check appointment. I couldn’t be happier and I know Alec is too. As soon as he got outside and started sniffing, he began to go all on his own... I couldn’t believe it! This is going to make things so much easier for us if he is able to continue. I also started feeding him three times a day, standing up at an elevated food station (cardboard box I found in the supply room), and this has been working great. Thankfully, he has been excited about his food (before, he was more of a picky eater), and having him stand while eating and drinking is good therapy, as he should be standing and bearing weight on his back legs for several minutes a day. Then about 10 minutes after he eats I sling-walk him outside and he goes to the bathroom. I have been trying to keep to a strict schedule each day so that he gets into a regular routine. It is so much easier not having to change his bed several times a day – not to mention trying to keep him clean and dry! I am so happy about this. My back has been hurting quite a bit (the hind end of a paralyzed shepherd is heavy!!) but I am hoping the pain will subside and/or i will get stronger.

Tuesday, March 11, 2008

First re-check appointment:

Alec had his re-check appointment today; this was the first time he was back at Animal Care Center since he was discharged on 2/21. My wonderful friend April helped me load him into my van, which we did by sling walking him up a ramp, and the nurses wheeled him inside on a gurney when we got there. We saw the neurologist who performed his two surgeries, Dr. Lisa Tieber, and the canine rehabilitation specialist, Juli Dell’Era. Although I had sworn he felt it a few times when I pinched his tail recently, Alec would not react to pinches from Dr. Tieber so his prognosis was deemed “poor for return to normal function” based on his "persistent absence of deep pain."

Today marks four weeks after his surgery and I know that most dogs who are going to regain deep pain perception (DPP) do so within a few weeks of surgery. Still, I also get the feeling from the studies I have read that there may not be a preponderance of long-term data. In one article I read* the authors studied 70 dogs with intervertebral disk disease (IVDD) and of this 70, six were euthanized at the time of the initial examination at the owner’s request and nine more were euthanized within one month after surgery. Although seven of these nine were euthanized because of suspected or confirmed ascending myelomalacia (a terminal condition in which the paralysis spreads throughout the body), the remaining two dogs were euthanized within three weeks after surgery at their owners’ request because of a lack of improvement. So in just this one study eight of 70 dogs (approximately 12%) were euthanized very early on either before surgery or soon after because they had not improved. Combined with the fact that large dogs represent the minority of cases of IVDD and take longer to recover, I would surmise that there is not a ton of data out there about dogs like Alec. The doctor herself said she has seen amazing things happen with physical therapy, so I am going to try everything for him.

Now, there is this phenomenon called “spinal walking” or “reflex walking,” which I think I mentioned in another entry. Without regaining DPP it is unlikely (impossible?) that a dog will recover normal function – meaning conscious control of their back legs. However, some dogs develop reflexes that allow them to walk without knowing they are doing it. I guess it relies mostly on muscle memory rather than conscious control. Dogs who develop this ability walk with a “drunken” or wobbly gait – not quite normal – but it’s enough to get them around. I asked Juli, the rehab therapist, if she had ever seen this ability develop in big dogs and she said she had a Doberman that became a “spinal walker.” So it is not impossible in large dogs. The study I referenced above included a few large breed dogs, including one German shepherd, but the vast majority were dachshunds and other small breeds, so it’s hard to draw conclusions based on Ali’s size, but in this study 37 of the remaining 64 dogs developed DPP and the ability to walk. Among the dogs that did not develop DPP, four were euthanized 2, 4, 9, and 36 months after surgery, again, due to a lack of improvement and one dog died as the result of an attack by another dog 6 months after injury (how awful!).

Of the remaining dogs, seven regained the ability to walk despite a lack of DPP (although the authors don’t call it this, I believe they are describing “spinal walking”). They don’t differentiate the breeds of these seven dogs so I don’t know whether any large breeds were represented in this number. All seven dogs who regained motor function had a voluntary tail wag one month after injury, and Alec started wagging his tail when I walked in the room about 2-3 weeks after surgery. The fact that I noticed he wagged his tail is what prompted me to hunt down this study, which has been very informative and also given me some hope that even with a lack of DPP, Alec could one day walk. The authors of this study believed the voluntary tail wag was a good prognostic indicator: “Persistent loss of DPP did not preclude recovery of motor function, and dogs that did recover motor function developed a voluntary tail wag within 4 weeks after the injury” (Olby et. al., 2003, p. 768).

Additionally, according to this study, the average time for dogs without DPP to develop motor function was 9 months. So whatever happens, this is going to be a long road. It also made me realize I absolutely could not go back to my place in San Francisco. Even though I knew this was likely, I was holding onto hope that somehow it could work and we could go home…but it’s impossible. After the appointment I told my roommates I am definitely moving out. We are all sad, but this is the only option right now. Besides the stairs in my place in SF, it makes sense for us to be up here in Sonoma County, closer to Alec’s doctors and he will be doing his physical therapy up here too. I guess I had known this for of a couple weeks, but it became final in my mind today. And today was the day I started saying it out loud. Good-bye San Francisco.

Something kind of cool: During the re-check exam, even though Alec did not demonstrate DPP, Dr. Tieber noticed that he started peeing on his own when we stood him up. She said “look he’s doing that on his own! I’m not touching him.” And she seemed excited about this fact. She asked if he had done this at home and I said I didn’t know; I never take my hands off his bladder when he starts peeing! I get so excited when I find the spot I don’t want to ease the pressure until he stops. She said this means he is perhaps developing a “reflexive bladder” where they can go on their own somewhat but still need to be expressed. I told her about our ongoing problems with him pooping in his bed, especially overnight, and trying to squat (which he can’t do because his legs don’t work) but only flattening it and rubbing it into his fur and bedding (gross, I know – but try cleaning it up everyday!) and she suggested walking him outside in a sling for 5 minutes after his meals. She said for some dogs just moving and being outside stimulates them to go to the bathroom. I am skeptical but I will try it!!

Finally, I really like Juli, the rehab specialist. She is very knowledgeable and also really nice. She said she treats all patients as if they will walk again so the therapy will be the same for Alec whether he has DPP or not. Like I mentioned above, Dr. Tieber said she has seen amazing things happen with physical therapy…so we have to try, right? If we forego physical therapy, it is virtually guaranteed nothing will change, but with therapy there is a chance we could see improvement. Another neurologist said early on after Alec’s surgery, in response to my question about physical therapy, “Well, if he has no DPP there is no point in doing physical therapy.” Now that I have educated myself some more, this doesn’t make sense to me. Even without DPP, according to the study I keep referencing, some dogs recover motor function. I asked Dr. Tieber why he would say that and she just said “well, we have different philosophies about that.”

The next step is to get Alec measured for a cart (doggie wheelchair). Juli said they can be great rehab tools as well a means of mobility. It will be awhile before he can really run around with his wheels since he is still recovering from surgery, but in the interim we can use it for his rehab exercises. Currently I am doing physical therapy with him at home a few times a day, including passive range of motion (PROM) and standing exercises to get him to bear weight on his back lets. The latter are hard to do by myself (wiggly, heavy German shepherd!) and Juli said the wheelie cart will really help with this. The problem is Alec is starting to overcompensate, putting too much weight on his front legs (unfortunately I wasn’t discouraging this because I just thought he was getting stronger up front – woops), and he is already developing arthritis so it is very important he distribute his weight more evenly. She said the cart will really help with this, balancing out his weight. The measurements for the cart have to be very precise (if you make a mistake in measuring and the cart doesn’t fit, you have to pay for a whole new one to be made! And they are around $600) so she wants to come to us to do the measurements so he will be as relaxed as possible. We will do that this weekend. Oh, and I suspect he has a urinary tract infection (malodorous urine) so we started a urine culture on that. We will see. I came home from this hours-long appointment with my head buzzing. I feel like it was a lot of information to take in all at once!

As an aside, Alec has gotten very “vocal” since this all happened, barking at everyone much more than he used to, louder and without stopping when I tell him to. He used to bark occasionally when he heard something (or saw another dog across the street), but nothing like this persistent barking. I think he is overcompensating because he can’t move and feels vulnerable. Well, today I left the exam room to use the restroom and when I came back Dr. Tieber walked in and he started barking like crazy. She told me she had come in only a moment before when I was not there and he hadn’t made a sound! Apparently there is a protective element to his barking, which I did not know because I am always there with him when he barks so I just assumed he did it all the time. Either way, I will have to figure out a way to get it under control. He was reasonably well-trained before this happened, but now it’s almost like I have to start all over again with certain things…

* Olby, Natasha, et. al., 2003, “Long-term functional outcome of dogs with severe injuries of the thoracolumbar spinal cord: 87 cases [1996-2001],” JAVMA, Vol. 222, No. 6, March 15.

Thursday, March 6, 2008

Bladder expression has been going well, so I have scaled back the Phenoxybenzamine (most expensive drug EVER) to half the dose. If it continues to go well, we will scale back further.

Saturday, March 1, 2008

A couple days ago it suddenly became really difficult to express Alec’s bladder, even though I had been doing fine the last few days. I know it’s not my technique because I can feel the “balloon” now under my hands and everything was going pretty well…then suddenly nothing! After my local vet, Dr. Leavey, checked and also found him hard to express, the doctors at Animal Care Center prescribed Phenoxybenzamine, which is a drug that relaxes the urethral sphincter. This drug cost $144 for a one week supply!!!!! Unbelievable… just my luck that he was prescribed the most expensive drug ever. I asked one of the neurologists if he would have to be on it for the rest of his life and she said quite possibly, but the other neurologist said no, it’s very rare that a dog would have to be on it for a long duration and that the plan should be to wean him off it, if and when expressing starts to be easier again. Luckily I accidentally gave him only half the prescribed dose the first night and I found he was already easier to express the next day. I am keeping it at this dose and within a few days will scale back if he improves. I called Costco pharmacy, which is supposed to be the cheapest option, and they will only order this drug in bottles of 100 pills, which costs over $600 per bottle!! I really hope he does not have to be on this for the rest of his life. :-(

On a happier note, I walked in the room yesterday and Alec looked at me and wagged his tail! I got really excited. I don’t know if it means anything, but I will investigate. Either way, it sure was nice to see it wag again!! He does this thing where if I walk in the room he will just wag the tip of his tail. It’s really cute – I call it his “rattlesnake tail.” Well, that’s what he did. It was pretty cool.