I'm not ready to use the "M" word...but...

Firstly, sorry for the lack of updates since Thanksgiving...I figured I would give you all a break...:^)


Second, I am NOT going to go back and rehash all the boring details that I outlined in the Thanksgiving update.  I think the entry before Thanksgiving said something about "Next...Cassi is released...".  I covered that in the TG update, so if you missed it, read that one.  I think that update brings you pretty much up to date...

Forward, I say...which is where Cassi is at also...moving forward!  As the title says, we are not ready to use the "M" word (miracle) yet, but she is progressing rather rapidly!  I hope I can remember the order we are seeing the improvement in, there is so much.  My first prediction was that she would be walking by year end, 12/31/09.  That was before Thanksgiving...since then, I have revised my prediction once to "by Christmas"...jokingly, I said "by December"...and this may not be too far off base...

I know, December starts tomorrow, but let me tell you what has been happening with her.  As I mentioned in the Thanksgiving update, she was, then, starting to use her muscles in her legs to "squat" down when I was expressing her urine.  The diapers are working out great at keeping her clean and dry, but I still express her to make sure she is emptying her bladder.  She has come to the point now that, when I take the diaper off, she starts her bowel movement...and goes into the "poop squat" as the muscles in her legs "remember" how to do this.  She will not defecate in the diaper anymore unless she is desperate. 

With this happening with her muscles, we incorporated the "standing" exercises into her regimen that Dr. Cheri of the PESCM had recommended.  We hold her up under the belly and place her feet right, so they aren't knuckling under.  She has a little balance problem on the hind end, but she started out by standing for 20-30 seconds while I supported the side she was leaning to (the right side seems a bit weaker).  Today she stood with my help for over 2 minutes!  When she is up, I have to hold her back because the front end wants to go!  We are allowing her a bit more freedom around the rest of the house, under our supervision of course.  And the supervision of her brother, Orion...

As one of my FaceBook friends, Ellen said ".....it is good she has a brother to help her remember what dogs do, walking and peeing outside etc...it makes a big difference..." and this seems to be holding true.  I keep telling Orion that it is soon going to be his turn to re-teach Cassi all those "dog things" that we humans can't teach her.  I feel he has already had an impact on her by just being here.  She is seeing all the things she used to do WITH him and, I think, that is speeding her recovery timeline.  I truly believe she would not be to this point if he wasn't part of our family...if she was an "only child". 

I have some of this progress on video and will figure out how to post them on my YouTube account and link them in.  I wouldn't believe it unless I hadn't seen it myself.  We are very pleased with her progress at this point and we are confident we will have our "little girl" back soon...BEFORE CHRISTMAS!  What a blessed event that will be. 

Today, she is out of her pen, relaxing in her normal spot.  Every once in a while, she will head towards the doggie door to try to follow her brother outside...but she doesn't have her special collar on that opens the door.  She is pretty fast on two front legs, but we don't want her to get too used to it.  We know she will walk again...the best part of this is...

Today we saw her tail wag...for the first time!  Yay Miss Cassi!  We love you so!

HAPPY THANKSGIVING...UPDATE!!!

I am jumping from the the track of the "back story" to give a current update of Cassi's progress...since it may take me a bit to catch up.  I am not only doing this for all your information, it is also helping me to chronicle what is happening with our baby in the hopes it will help someone else deal with this some day.  It is never hopeless...things just take patience.  Patience is something I have a hard time with, but I am learning real well with this event.  Plus, since Holly (Paige) and Alissa were out of diapers when Diane and I married, I have never had the "experience" of a newborn with the late night changing and light sleeping to listen for cries...until now...

Since last Wednesday the 18th, I must say there has been a great learning curve.  The first night home, we tried the "airline" crate that the two pups slept in when we first brought them home.  Miss Cassi didn't like that at all and complained with a "howl" that we had no I idea was in her...come to find out, the staff at the PESCM had experienced her crying out to "momma" for the few nights she was there.  "Broke their hearts" they said.  I ended up pulling her out of the crate and grabbing a couple blankets and my pillows and slept on the floor with her...if you can call it sleep.  Maybe 1-1/2 hours...maybe...next day I had a tax seminar to stay awake through.

Next day, Diane was in charge of her care.  She had to take her to a revisit to check her bladder to make sure we were doing our job and emptying it for her.  We weren't getting the bladder as empty as they would like to see, so we had to bring her back Friday morning.  Diane spent the rest of Thursday relaxing with Cassi and watching a movie with Alissa, who had come by to keep them company.  The first sign of any response in Cassi's hind end was when Alissa was helping Diane express Cassi by holding her legs out of the way, when all of a sudden Alissa said "Mom, did you see that"...Cassi's legs had "twitched"! 

I left the seminar early and arrived home around 4:00pm. Apparently, Diane had forgotten about the twitch, because she didn't tell me until later...after we had eaten and we were starting something on the DVR.  When she related the story to me, I immediately turned Cassi on her side and pinched a pad on her foot...she pulled her foot away.  This is the "deep pain" response that the doctor said she was hoping for.  When I took her in Friday morning, Dr. Jim confirmed what we had seen...and he was as pleased as we were.  And we passed the bladder test.

We have noticed daily improvement since Friday...her tail will move at the base when we pinch the tip, she shows resistance to stretching her legs...but ths biggest improvement we have noticed is, she is getting some muscle use back! More on that in a minute...

This will get a bit graphic...no pics though, I promise...
We went through a rough weekend (at least I did) being concerned that Cassi's bladder was distended.  I was not sure I was expressing her right and she wasn't releasing as I expected.  She was also leaving pools in her rest area...which made me think she was truly distended. Saturday, I called PESCM and asked them a few questions about how much urine to expect and they told me that I would have to contact our regular vet for anything about the bladder.  This confused me, but I called Dr. Kat at the Country Vet.  See, I was thinking that Cassi was releasing urine on her own and I was not able to get anything from her because of that.  Dr. Kat seemed to think that Cassi needed to come in and have a catheter reinserted to drain her.  I told her that I would monitor Cassi and call her later in the afternoon before they closed if I didn't get anything from her.  About 20 minutes later, I got what I wanted.  Worry was over for today.  Still had Sunday to make it through.  I don't know if she was just drinking less water or what, but the same thing concerned me on Sunday.  If the bladder gets too distended, it can damage the bladder muscles and she can develop a control problem.  I was concerned enough to, this time, call PESCM...again.  They were concerned and said I should bring her down soon.  Long story short (yea, right...), they said I was doing great at releiving her and she, more than likely, was releasing on her own now, hence the wet spots we were finding.  I asked if we could now go the diaper route...and they said yes!  Cassi has been wearing Huggies "ones" since last Sunday. 

Fast forward to Wednesday (yesterday)...While changing Cassi before her 9:00am doctor appointment, I was expressing her to make sure she was empty.  This started a bowel movement and, as I was holding her up under her tummy after positioning her legs and feet correctly, I noticed she was holding herself up in a (how can I say this...) poop-squat position.  After she finished pooping, I stood her up with my hand and slowly removed it (my hand, not the poop...that was already done)...and as I removed, she actually stood, on her own, for about 10-15 seconds!  I called out to Diane to come watch...but she wouldn't do it again.  Off  to the doctor we went for the staple removal. 

Staples came out and the wound looks great.  The hair is growing in pretty quickly.  She is sleeping in the rest area through the night without any whining.  We are transporting her around the house with us in the carrier we have.  When we watch tv at night, she is up on the bed with us...but I attach a leash in case we fall asleep so she won't try to jump off the bed.  The front half thinks it can do everything she used to be able to do.  She thinks she is healthy...except for that part that drags behind her...

Today, we are thankful for the progressive movement we are seeing.  We are thankful for friends like you that care and pray for Cassi to get better.  I have predicted that she will be walking by the end of the year.  Maybe sooner, but by the end of the year for sure.  Patince is a virtue learned slowly...

Our first visit after the surgery...

Day two, Monday the 16th...


When we talked to Dr. Cheri on Sunday night, she told us we could visit Cassi in the morning after "rounds" at 8:30am.  I think we were there at 9:00am and were ushered into a waiting/exam room.  We were furnished a "yoga" pad and large, soft towel to sit on the floor with.  They set all that up and told us Dr. Cheri (the surgeon) would be in to fill us in on what was happening.  I must say that ALL the staff at the Pet Emergency and Specialty Center of Marin are fantastically accomodating.  They asked us if we wanted water of coffee while we waited and told us Dr. Cheri would be a few minutes.  We just wanted to talk to Dr. Cheri and see our little girl...


A few minutes later, Dr. Cheri walked in and introduced herself to us.  We exchanged greetings and she got right to the issues.  She told us that she had performed a (ok, here come the BIG words) HEMILAMINECTOMY on Cassi's spine between T-9 and T-12 for the treatment of
INTERVERTEBRAL DISC DISEASE (IVDD).  IVDD is usually seen in short-legged, long-backed breeds like (of course) Lhasa Apso, Dachshund, Pekingese and  Shitzus. It is typically seen in the middle aged, overweight, under exercised dogs and Cassi falls into none of these catagories, as she is only 2+ years old and watches her girlish figure carefully (she's a picky eater...).  See the links I has provided above for more info...there's lots of good stuff out there on this.

Above, you see a copy of the Myelogram (click to enlarge) and can clearly see the spinal cord running through the spinal column.  A dye is injected along the column and flows with the spinal fluid...as seen around the spinal cord (dark) and fluid (light).  The dye/fluid flow and thin out just past right above the second visible rib from the right.  Where the fluid narrows is the swelling and damage to the spinal cord.  You can see the fluid widen out again towards the left side of the xray.


Dr. Cheri said there was "debris" from the ruptured disc that had spread to the two adjoining discs, which required her to open more of Cassi's spine than usual.  Cassi has a 5 inch scar from the incision. She has 15 staples to close the incision.  Her hair was shaved into what a friend termed a "reverse mohawk", which I thought was perfect...Cassi has always been a rebel.    Dr. Cheri said she was pleased with the outcome of the surgery, but she was hoping for some...any "deep pain" response from Cassi, but there wasn't any...no flinch with the pinch...but, as I said in earlier entries, this wasn't unusual.


Dr. Cheri then laid out the course of her treatment.  Cassi would be in the hospital for, at least, 3 days while they monitored her post-surgical condition.  As we would soon see, she was on a catheter so she could urinate, as she has no control of, basically,  anything below her rib cage.  They wanted to monitor her urine output so they could teach us how to express her so her bladder wouldn't get distended and damage the muscles that control it.  The bowel system has its own little brain that keeps it working, no matter what.


The Dr. Cheri says "Do you want to see her?"  Of course we do! "One of the nurses will bring her in..." and we settled on the floor. 

When the nurse brought her in, she was alert and happy to see us.  I think she would have been wagging her tail if she was able.  To the right, you can see the bag she was attached to.  The nurse advised us how to handle her (or, not handle her) and left us alone with her.  Cassi immediately climbed, as much as she was able, on Diane's lap and let out a big sigh.  She was happy to be with her momma...and she fell quickly to sleep.
Cassi is a bit skittish about loud noises, so I could imagine that being in a strange place, knowing something was wrong with her and being her first night away from her brother and us, she was not getting much sleep...except for the drugs.  She was on a fentanyl patch for the pain practically from her check-in.  I think the only good sleep she got was when we would visit for an hour or so.  She would say her hellos and settle in next to Diane or I and fall fast asleep.


Anyway, we got to spend an hour or so with her and were told that we could bring down her pink "bankie" and some familiar food.  She is a picky eater also and was snubbing her nose at their offerings...typical.  They evetually got her to eat some baby food, but it was pretty messy.


We came back that evening and sat with her for another hour plus.  We brought some Natural Balance Turkey roll down (which was exclusively "treats" up to this point, but is actually nutritional if you feed enough...) and she scarfed it down.  At least she was eating...we left a bag of pre-sliced for them to give her.


I visited again on Tuesday morning and Diane accompanied me that evening.  Pretty much the same routine as above, except this time she gave us "kisses" that she hadn't been giving since the incident.  Progress in our eyes...baby steps...it's going to be baby-steps.  I visited again on Wednesday morning...and got some good news!  Cassi can come home with us tonight!


Next entry...Cassi is released...

The surgery & the wait for the call from Dr. Cheri...

Dr. Jim was very adamant that he wanted their surgeon, Dr. Cheri Nielsen, to perform the Myelogram and the surgery (if indicated) and they were attempting to reach her to no avail.  At first they were saying we might have to take her to either San Francisco or Rohnert Park if they couldn't contact Dr. Cheri.  Then they told us they had arranged for backup surgeon to come in from another pet emergency hospital in Berkeley. Eventually, Dr. Cheri answered her page and agreed to come in and help Miss Cassi. We were happy that she had called in before we left the hospital.

After we said our "we love yous" and "see you laters" with hugs and kisses to Cassi, we headed home.  We were still unsure what, exactly, was the problem. When you take on the responsibility of pet ownership, you take on a responsibility to love, feed, care for and protect that little life with everything you have and, in return, you receive their unconditional love and devotion.  At this point, we were feeling kind of helpless...she was in the hands of the surgeon and doctors.  All we could do was pray she pulls through.  Being the nervous "parents" (we are not the owners, the dogs OWN US), we had lots of questions...important ones that we forgot to ask before we left...and they (PESCM staff) are very gracious and understanding of us calling 20 times a day (granted, I can't see if they are rolling their eyes or putting us on hold and saying "oh God, it's HIM again)...even their recording says something about "we understand...we are pet owners ourselves...".  Anyway, the all important question we forgot was...the timeline.  When was the surgeon scheduled to start...how long would the procedures take...you know, little stuff.

Still on Sunday the 15th...Dr. Cheri Nielsen was scheduled in at 8:00pm to begin the Myelogram, which would take about 45 minutes.  We were told that, if the Myelogram showed anything absolute, she would immediately begin the surgery (Hemilaminectomy) without a call to update us.  If the test wasn't conclusive, we would hear from her shortly after the test.  We actually heard from Dr. Jim Clark at around 8:45pm to let us know that Cassi indeed DID have a "ruptured disc" and that Dr. Cheri was starting the surgery.  This was, actually, great news...considering the alternative...a "stroke" type incident that presents MORE unknowns.  At least this was something tangible causing the problem...the ruptured disc had spread to the two surrounding discs.  In one respect, we were happy to hear the news...but now the (seemingly) long wait...

We were told, erroneously, that the surgery would take "about an hour"...and when 10:00pm rolled around, we were starting to get tense.  Again, I called PESCM and the desk person said she "would find out what's happening"...could I hold?  Sure...I can listen to their on-hold, self-promoting, fear-allaying message one more time...or two...or three.  When she returned to the phone, she said "the doctor said no updates until she's done..." and then added "but is looks like it's going well...we haven't heard anything to the contrary..." (paraphrased).  I then was told that I was misinformed as to a expected finish time...she corrected earlier info and said "it could take up to 2-1/2 hours...", which made more sense.  "Ok, thank you...and sorry to bother so much..." I said...and we waited.  Orion was walking around the house "barking" for Cassi to join him...he knew something was not right...more on him in later posts...

11:00pm rolls around and neither Diane nor I are even thinking of sleeping.  Diane is occupying herself at her desk, working to take her mind off things and make the time pass faster...I am sitting on the bed with Ori, holding the telephone saying "ring, damn it, ring..." every 5 minutes and, about 10 after, it rings...it is Dr. Cheri with the news...

"Cassi is coming out of the anesthesia right now and came through the surgery fine..." she says.  She tells us that she is still paralyzed in the hind end, but it is not unusual after the surgery.  She said she was hoping for a small amount of "pain response" after the surgery relieved the pressure on the spinal cord, but, again, it was not unusual for there to be nothing at this point.  "Cassi is on pain meds and will probably sleep through the night...you can visit her tomorrow morning..." Dr. Cheri said.  "Thank you, Doctor and thank you for coming to Cassi's rescue...we both appreciate all you've done tonight..." I said before hanging up.  Again we cried...and were glad Cassi was going to make it...

Next: The first visit...

Dr. Jim's diagnosis...

We first met Dr. Jim on November 3, 2007 under different circumstances.  If anyone remembers our 1/2 Pomm, 1/2 Yorkie, Goliath, that is the day we had to put him down due to complications with medication for Cushing's Disease after a long 13 year life.  Dr. Jim was so compassionate and reassuring at that time, we were SO GLAD to see he was working on our Cassi.  We knew she was in great hands.

They asked us into a room...which happen to be the same room where we said goodbye to Goliath.  Diane and I were beside ouselves (as well as beside each other).  We took turns "breaking down" from the unknown. We still had no idea that it was her back...we knew nothing.   A few minutes later, Dr. Jim entered the room.  He immediately cut to prognosis...she was paralyzed in her hind legs.  At this point, he didn't know what caused it and needed to run further tests.  He had been able to compose a course of planned tests and treatments.  They were to start with an x-ray, which wouldn't show them the discs but would rule out some things.  The other recommended test was a Myelogram, in which they inject a dye along the spinal column which enables them to, virtually, see the discs.  I will try to post the copy we got here somehow.  What it shows is an "obstruction" in the flow of the fluid, which, in essence, is a swelling of the spinal column which "narrows" the fluid to an undetectable trace through the affected area.


Dr. Jim was fairly certain this test would show the damage he suspected, a ruptured disc.  He went on with the next expected steps and the other possibilities if this Myelogram proved negative or wasn't conclusive.  Another possibility was some sort of "stroke" incident...and there wasn't much treatment along those lines. The option for the ruptured disc scenario was spinal surgery..."Hemilaminectomy" is the proper name.  And Dr. Jim said their surgeon was very good and familiar with this procedure.  All this being said, we were presented with a "range" that the costs would fall into...$6,500 to $8,500 .  The asked us to put down a "down payment", which we were thinking would be $1,000 or so...and gasped when they said "$7,500 please"...but there wasn't any other decision we could make...we love our animals like they are our children.  I asked if I could get online and check our balances at home (GoToMyPC) and found a card that Diane had with her.  We paid and we got to see Cassi before we left.  There was some difficulty getting a hold of their surgeon, Dr. Cheri Nielsen and they had an alternative ready...but Dr. Cheri called and agreed to come in for the emergency surgery...


Next post...The surgery and the wait for a call from Dr. Cheri...

How we noticed something was wrong...

Last Sunday, November 15th, was a morning just like any other Sunday...lazy, slow getting around to stuff.  Both Cassi and Ori went outside and did their business and, when they are good puppies, we reward with small treats.  We noticed Cassi didn't eat hers and thought nothing of it, because they occasionally have "tummy" issues...in fact, I ended up giving her half a Famotidine 10Mg as recommended for them by the vet.

As the day went on, we noticed that she wasn't eating anything...not her food or any offered treats.  I palpated her stomach and it felt "hard", which I still thought meant tummy issues.  At this point, she was still walking and jumping up on the bed, but she was lethargic and couldn't seem to get comfy.  The evening before this, she had been trying to eat grass, so all this was still pointing to "tummy".  We thought "if she could just throw up" she would feel better, but that wasn't happening.

Being Sunday, our regular vet wasn't open so we had to call the Pet Emergency and Specialty Center of Marin in San Rafael.  The examination fee of $72 was well worth the peace of mind knowing that it was just "gas" or something.  Off we went to San Rafael, Orion in tow (these two had never been seperated).  On the ride down, Cassi couldn't get comfortable and kept switching between Diane and I...and at this point she was still walking.  What she WASN'T doing was "shaking" like she usually does for the first 20 minutes of ANY car ride we take, which was unusual.  We knew something was wrong, but didn't expect what was next...

We checked in at the front desk and noticed it was very crowded, which is always sad to see.  The last two visits we had to the PESCM were not joyous occasions.  The people there are fantastic though and genuinely care about your animal.  Anyway, we were waiting in the lobby for about 10-15 minutes and both doggies were getting fidgety, so Diane decided to put Cassi down on the floor...and that's when we noticed she had lost the use of her hind legs...I must have turned pale as a ghost, because that's how I felt.  I scooped her up immediately, went to the check in desk and told them we had a drastic change in her condition.  She was fully lucid, just paralyzed on her hind end...the nurse came out and took her to the back immediately...ahead of a few other people.  They do a wonderful job of triage there and most the others were waiting to pickup their animals (a chicken, a rat and a few cats).  I think we only jumped in front of one other doggie that had an actual tummy ache.

Now we just waited for word.  "Pins and needles" as my Mom used to say...and a sick feeling in our stomachs.

Next post...Dr. Jim Clark's diagnosis...