Two Year Update: Plateau or No?

It has been two years since Alec became paralyzed after a disc shattered in his back, severely damaging his spinal cord. He underwent a multi-level hemilaminectomy (decompressive surgery) on February 9, 2008 and a second hemilaminectomy four days later on Feb. 13. He came out of the second surgery with no use of his hind limbs, no conscious control of his bowels, and no bladder function at all. Things looked bleak indeed, and when Alec presented for his first re-check exam with the neurologist six weeks later, he was given a poor prognosis for return to normal function, based on the fact that his deep pain perception had not returned. I began rehabilitative therapy with him, just in case, and ordered him a mobility cart (doggie wheelchair), which he used for 18 months. If you have been reading this blog, you know that Alec began to walk on his own about a year later (short walks around the block at first), and six months after that, he stopped using his doggie wheelchair altogether.

As I have written in other posts, the most important factors in Alec’s amazing recovery were: 1) regular physical therapy, and 2) time. Less quantifiable, but also instrumental, were my faith in Alec, and my boundless love for him. It has been an incredible two years, difficult and inspiring, confounding and rewarding. Because our wonderful rehab therapist in California, J., impressed upon me the importance of consistent physical therapy (to give him any chance at all to recover some mobility, as well as to preserve what he had left), I followed her advice very closely. It was a formidable challenge, but we persisted, Alec and I together, and it paid off big time; despite the scary hard times in the beginning, I feel like I won the lottery. Alec has been walking outside his cart for eight months now. His left hind leg is perfect as far as I can tell; his right leg lags, however, and cannot make a complete rotation. The result is he has an abnormal gait, or in layperson's terms: he has a pretty serious limp. It does not cause him pain, and he gets around exceptionallyreally well, but he has to wear a protective shoe on walks. Without a shoe, his foot will became scraped because his paw drags slightly – just enough to tear it up except when he is on grass or another soft surface (he does not have to wear the shoe inside). To complicate matters, his abnormal shuffle-step causes whatever shoe I try to wear out quickly; duct tape and shoe goo have become my allies in the battle against the deteriorating shoe. But neither holds up very well to the toe dragging. This small complication aside, Alec arrives at the two-year mile marker having exceeded all expectations.

After a year and a half of steady improvements, Alec now can walk for at least an hour at the park with no problem. He can also easily swim for the same amount of time, and his sessions in the underwater treadmill (UWTM) are now for conditioning and strengthening rather than rehab; each week we incrementally his speed. During that year and a half of Alec's gradual but unwavering progress, every milestone amazed me. With his initial poor prognosis (which eventually was upgraded to “fair” – I was so happy that day!), I took nothing for granted. Since writing this blog, I have had the good fortune to meet other caring people in similar situations with their dogs, some of whom struggle with patience, and I can honestly say I never had that problem. Things were tough, and I was frustrated and scared at times, but never impatient. I think it was a blessing in disguise that the neurologists gave me no hope! It made every little improvement seem the size of a miracle.

After all of these improbable improvements, including what seemed like the pinnacle of Alec’s protracted process of rehabilitation (ditching the cart completely – hallelujah!), at some point during the last six months, I noticed he seemed to have finally reached a plateau. This awareness came slowly. I am with Alec almost 24-7 and even his slight improvements sometimes were noticed by other people before me. It’s like when you live with someone and don’t notice the small physical changes, like a gradual weight gain. Often people will point out to me, “wow, he is getting around so much better than last time I saw him!” – that type of thing. People do still say that, but at some point, I stopped noticing measurable improvements in his mobility (as opposed to his endurance, which we have been working on with faster UWTM sessions and longer walks).

Not that this ostensible plateau bothered me – not at all. Alec had already come farther than anyone had expected, and even when it became apparent after eight months he might be able to walk again on his own, I was told his recovery would very likely not be complete. He may just regain enough ability to walk outside on his own to go to the bathroom and then come back inside, for example. So the fact that he is enjoying hour-long strolls in the park is nothing short of amazing to me! I always knew the improvements would stop. The suspenseful part was when? How well would Alec be doing when he hit that inevitable plateau? The answer, for which I am profoundly grateful, is very well indeed. Limp, schmimp…my boy is walking!

But what if a plateau is...not a plateau? Recently I was emailing with J., our former rehab therapist, giving her an update on Alec and asking her advice about whether she thought I should continue doing the UWTM with him every week now that he was walking on his own and had reached this plateau. Did she think I should concentrate on swimming instead? To my surprise, J. wrote: “I have seen dogs continue to progress 2-3 years out. I would not be surprised if Ali does the same. I don’t think his plateau is permanent.” Huh! I stared at my computer screen in wonderment. This had not occurred to me. I know the scant literature advises the majority of dogs will improve the most during the six months after surgery, but this was not the case with Alec. He continued to show significant improvements way past that marker. Was it possible he had more potential...even after two years? I had to find out.

So after doing some research on rehab vets in Oregon within driving distance, I decided to take Alec to a new specialist, Dr. Julia Moore of the West Hills Animal Hospital in Corvallis (an hour and half drive south of Portland). Alec has been to both rehab veterinarians in Portland, and I thought at this point it would be good to have him evaluated by someone who has never seen him before, someone who will look at him with fresh eyes. I called the clinic last week to ask if it made sense to bring Alec in for an evaluation, given that he is two years out of surgery. Dr. Moore called me to discuss Alec’s situation the next day and I was impressed with her on the phone. I explained that my goal is to learn whether Alec has potential to further improve (and if so, what can I be doing to help him reach his potential?), or if my focus with physical therapy should be maintenance at this point. I have no problem with the latter, but if there is something more I could be doing to help him improve – new rehab exercises or modifications to our routine – I want to make sure I am doing it and not giving up too soon!

We spoke for twenty minutes and she is clearly very experienced in this area. I got the impression she would have a lot to offer by seeing Alec. She also mentioned they are using a relatively new technique called cold laser therapy, for which Alec could be a candidate, and that he could potentially be helped by a modality called veterinary osteopathic manipulation (or VOM). She said she has seen incredible results with these therapies. I am pretty sure laser therapy has been available at other places I have taken Alec, but no one has suggested it before, so it could be that he is not a good candidate; we'll see. I asked whether she had seen improvements in dogs who were two years out of surgery, and she had. She said the first step will be to determine whether Alec’s lingering limp is due to proprioception (position sense/awareness of foot placement), weakness, or muscle shortening, and that there are different things we could try based on which it is. After our conversation, I was very excited for her to see Alec.

They were able to schedule us tomorrow morning, so we will be leaving the house at 7am and braving the rush hour I-5 traffic to head south to Corvallis for our 9:15 appointment. Alec likes to ride in the car, and he will be excited for a new adventure, so no problem there. While I hope she evaluates him and has ideas for new things to try, if her opinion is that Alec has gone as far as he can go in his recovery, I will be happy with that, too. I just want to know whether my focus at this stage should be on maintenance or improvement. I'd hate to NOT be doing something I could be; if this plateau could be temporary, then I want to do everything I can to help him get over it! I don’t want to be greedy, but if Alec’s right hind leg could catch up to his left, and if his gait could further normalize, this would improve things in many ways. He would no longer be in so much danger of injuring his paw, and his body weight would be distributed more evenly. Right now, he still puts excess weight on his front end, which stresses those joints and is not ideal.

So, as incredibly well as Alec is doing at the two-year mark, and as through-the-roof-thankful as I am for every single improvement, if I could be doing something more for him, I want to know about it! This is still a new world to me, and I am continuing to learn. Please wish us luck tomorrow; I will post an update after our appointment. As always, thank you so very much for reading, and for caring.