Bailie's Story

by Lois Gaspar

March 31, 2008. This day is etched in my memory. It started as a usual Monday: the Beardies settled for the day and John and I going to work. John would be late getting home because of a Board meeting, so I was alone at supper time feeding the Beardies. Most of them eat in crates, so after they have finished eating everyone wants out. Bailie is the last to be let out. As I was letting Summer out of her crate, Bailie gave a quick yelp, but when I looked over at him, he was sitting in his crate with his usual grin on his face. After letting Summer outside, I went back to let Bailie out. Opening the crate door, I realized that Bailie was not coming out - he just sat there looking at me.

This was the beginning of our journey, for it was not just Bailie’s journey, but mine as well. Realizing that Bailie was not coming out of his crate, I got down to try to help him. He used his front legs to try to move, but he could not get over the edge of the crate. I got his rear feet over the edge and struggled to get his rear end to the front of the crate to get him out. It was at this point that I realized that Bailie had had a bowel movement in his crate (an unusual happening). Getting him out I tried to have him stand, but he was unable to stand and his rear end just went down again. Numerous thoughts were going through my head - had he slipped in the crate and broken something? Had he dislocated his hip? Using knowledge from my nursing career, a quick assessment of his joints and bones told me that they seemed OK... and he was not showing any distress - just that, “Fix it, mom” look the Beardies give me when something is wrong. I got him up on his feet again, holding him up, and did a quick neurological assessment. This was positive - he showed knuckling when his feet were bent back. There was something wrong neurologically with his rear end, but he was alert and appeared cognitively OK. John was still not home, but I expected him within the next 30 minutes. I also decided that this warranted a trip to the Emergency Vet Clinic in Cambridge as opposed to waiting until morning for my regular vet. I called the clinic to say I was coming.

John got home and we got Bailie into the van and I set off. Did I mention that the evening of March 31st was the foggiest evening/night we have had this year? The 30 minute drive took closer to 45 minutes, but we arrived safely at the clinic in the north end of Cambridge at approximately 9:00 pm. There was the usual waiting and as Bailie did not appear to be in acute distress, we waited until the vet was finished with another emergency. After listening to my description of what had occurred, the vet did further neurological testing. Bailie’s forelimbs were normal with no proprioceptive or reflex deficits. With his rear legs Bailie showed slight voluntary movement, had slowed reflexes and showed deep pain response. Other than his rear end, his assessment including temperature was OK. I was told it could be possibly one of three diagnoses: ruptured disc, which would require immediate surgery (but he was not showing distress), an FCE or possibly a tumour. I was not familiar with the abbreviation FCE and the vet saw my blank expression. She explained that FCE was fibrocartilanginous embolism - a small fragment (or fragments) of cartilage, probably from a disc, that gets into the small blood vessels that supply the spinal cord, eventually getting to a point where the blood supply to a small section of the spinal cord is cut off resulting in the destruction of these cells. The vet indicated that the prognosis (outlook) is generally good and suggested I take Bailie to the Ontario Veterinary College/Teaching Veterinary Hospital in Guelph for further testing to determine exactly what was wrong. She asked if I wanted to take him there. I knew what she was asking - did I want to go further, at what would be significant cost, for an 11 year old dog? Bailie had celebrated his 11th birthday in February but had always been healthy. To me, there was no doubt - anyone who knows Beardies, knows that at 11 years old they are “young”. The vet contacted the hospital in Guelph and we waited for them to get back to her (these days an emergency referral is sent an estimate of the cost and must agree to it in writing before they can go to the hospital). After all the paperwork was completed, Bailie and I set out into the fog for the drive to Guelph. I was grateful that I had preciously lived in the area and that I was familiar with the roads - the fog was quite bad. After finally arriving in Guelph at about 11:30 pm, we waited again and then were seen, another assessment done, and Bailie was admitted. The plan was for him to have an MRI in the morning. If it was a ruptured disc Bailie would have surgery that day. I got into the van and drove through the fog (which seemed even worse!), arriving home at 2 am on Tuesday morning.

When that alarm went off at 6 am, I decided there was no way I was in any shape to go to work. I called my supervisor and explained. After John left I tried to get some more sleep. The phone call from an intern finally came in mid-morning. Bailie was the same and his blood work (complete blood count and biochemistry showed no significant abnormalities. Bailie had been catheterized; the catheter would be in for a few more days and he had been put on Intravenous fluids. He had been given dexamethasone (a corticosteroid) following admission to reduce swelling of the spinal cord. The next call came three hours later. The MRI showed a lesion on the disc at the L3-L4 level of the lumbar spine and multiple lesions on the spinal cord at the L4-L5 level were seen which was consistent with a fibrocartilaginous embolism. The senior resident called late in the afternoon to give me an update and to explain what would be happening.. As far as the FCE was concerned, the treatment consisted of supportive therapy. There are no other interventions - no surgery, no magical medicines to fix an FCE. At this point he could not give me an idea of the eventual prognosis. Bailie was seen by the neurology team the next day (April 2) . They found purposeful movement in both rear legs, patellar reflexes in both hind legs, but a decrease in flexor reflexes in both hind limbs (with the left being a bit worse), decreased perineal reflex and a flaccid tail. They believed that these findings indicated an extensive lesion affecting the spinal cord segments at L6-L7 and S1-S3 (sacral area). Bailie was kept in the Intensive Care Unit for about 48 hours from admission then moved to the ward.

He was assigned his own veterinary student, Jen (who was in her final year and would be graduating soon). Jen was responsible for Bailie’s care and therapy - and also for calling me twice a day (I’m not sure which was the more onerous task!). Bailie’s therapy consisted of range of motion exercises to his rear legs and short walks with the support of a sling. When in his pen, his position had to be changed frequently to be sure that he did not experience any skin breakdown. By Bailie’s second or third day in hospital, I was told that he did not let the fact that he could not stand stop him from getting where he wanted to go. He moved around his pen by using his front legs to drag his rear after him. Yes, that would be Bailie - stubborn and determined - characteristics which I am convinced helped his recovery! And, in typical Beardie fashion, he was capturing the hearts of those with whom he came into contact. Bailie spent a week in the hospital, showing small improvements each day - beginning to swing his legs when walking in a sling, regaining some strength in his legs, beginning to support himself a bit, but still not able to get up, stand for any length of time or walk without support. His catheter was removed after four days and he was put on antibiotics for an infection. He was retaining his urine and had to have his bladder expressed. His bowel function was beginning to return. A repeat neurological consult was performed on April 7. This indicated improvement, but as Bailie was still unable to support himself or to get up on his own, they believed it was still too early to predict the outcome. After a week there was really nothing more they could do - he required only supportive care and therefore he was scheduled to come home.

When I picked up Bailie at the hospital, I was instructed about his exercises, his antibiotics and given a cream for his skin. Dragging himself around was causing his skin to become reddened. It needed care to prevent breakdown. I was given handouts of the exercises and was told that hydrotherapy might help, not now, but when he had improved a bit more. Before they brought Bailie to me, I was warned that they had clipped his coat. I was somewhat annoyed that they had done this without consulting me, but also realized that coat will grow out again. Bailie came home unable to stand on his own, unable to get up on his own, unable to walk without the support of a sling and requiring expression of his bladder to ensure proper emptying of the bladder. He needed aggressive physiotherapy. I was still not given any idea about the eventual prognosis. The regime required by Bailie was not going to happen if I continued working my usual 50 - 60 hours per week. I discussed with my supervisor my need to be home no later than 2 pm for Bailie.

And so began the second - and longer - part of our journey. I set up the four-feet by four-feet puppy pen in the kitchen for Bailie. The floor was covered with fake sheep skin throws and padded throws to help protect his skin. Since the kitchen is open to the family room Bailie could feel part of what was happening and be safe at the same time. During Bailie’s first week at home our regime consisted of getting him up and outside with the use of a sling first thing in the morning. Bailie’s bladder function returned to normal within a couple of days and did not require expression of the bladder beyond that time. After breakfast and before leaving for work I gave Bailie his physiotherapy exercises and a bit of walking (we were working on proper placement of his feet, since his feet were crossing each other when he tried to move his rear legs). We would repeat this at 2 pm, after supper and again before bed time (about 10:30 pm). Each day was filled with my job and Bailie’s therapy. Each day of that first week at home I began to notice slight improvements. You cannot imagine the joy to see Bailie standing independently (even if it was for only a few seconds that first time!)

After the first week at home we returned to Guelph for a follow-up visit. By this point Bailie’s bladder and bowel control had returned to normal; he had more purposeful movement in his rear legs; he was able to stand momentarily by himself. He could not get up unassisted, however; he could not walk without a sling to support his rear; when walking his rear feet crossed each other, thereby tripping himself. Basically they (his resident and the neurology team) said he was improving neurologically and that we should continue the aggressive physiotherapy plus consider hydrotherapy. I must confess to being doubtful about what hydrotherapy could provide beyond what could be achieved by other methods, but thought, “Why not”. I located a facility outside of Paris, Ontario which had a hydrotherapy pool and was only a 30 minute drive from home. I was able to take Bailie for his first session just a few days after the follow-up visit at the hospital.

Our therapy regime now included the physiotherapy four times per day, walking five to six times per day and a weekly hydrotherapy session. Now, you need to know that Bailie had never been swimming in his life - no swimming pool at home, no trips to a lake, no escapes from the yard to find the nearby river or creek and fall into one or the other. The largest body of water Bailie had seen was the spring pooling of the melting ice in the back yard. Initially Bailie was put into the hydrotherapy pool by use of a hoist (he would be put into an enclosed sling with holes for the legs to go through - almost like a dog jacket - and the hoist would be attached to rings on this jacket) . Bailie did not really like the feeling of being lifted up (or down) in the hoist - he usually managed to splash me well as he was lowered into the pool. Initially Bailie was only able to tolerate about 10 minutes of swimming.

The small improvements continued, sometimes daily, sometimes not. But I could see and feel the increase in muscle tone and gradually Bailie was able to stand unassisted a bit longer. The days began to blend into each other. One day merged into the next - passive and active exercises, and swimming on Saturdays - with gradual improvements steadily occurring. Finally a big day arrived (it may have been only a week to 10 days after being home) - I got home from work, walked into the kitchen and saw Bailie standing in his pen to greet me. He went back down fairly quickly, but I was so excited. Bailie had stood up on his own! And with this accomplished, soon came those tentative first independent steps, but with his rear feet still crossing each other, we had a major challenge. John and I commented that seeing Bailie each day that we did not notice the changes as readily as someone who saw him less frequently, such as the hydrotherapy therapist who saw him only once per week.

The biggest obstacle we faced at this time was proper paw placement when walking. I literally needed to guide his rear feet to the proper place when he walked or one foot would cross the other. Imagine walking outside with your Beardie with your hands on his thighs (yes, of course you are bent over!). This provided Bailie with the support he needed to stay upright and help to re-establish proper foot placement. Until we could get an improvement in foot placement Bailie would not be able to walk (he would literally be tripping himself). We were continuing the range of motion exercises and stretching exercises as well as walking. By this point Bailie was able to support himself very well. I decided to try placing a small rolled towel between his legs when he was walking. The towel was held in place by a doggie diaper. This kept his legs apart and he slowly began walking on his own.

By six weeks post-incident, Bailie was supporting himself, rising independently and walking without assistance, although we continued to work on foot placement since he would trip himself. Bailie still showed neurological deficits - his rear was not under complete control - it would sway and he was somewhat unsteady with his movements. By this point we were no longer doing passive range of motion on his rear legs, but focusing on walking as a primary exercise. We continued with hydrotherapy to continue strengthening his muscle tone.

Through the summer Bailie continued to show slight improvements. His coordination and balance showed slight improvements as shown by his attempts to “bounce” and yes, the day came when he tried to “counter surf”. His foot placement improved and he was able to walk unassisted.

Through all of this Bailie remained himself - one of the reports I received from his vet student while he was in hospital was that Bailie was “doing great mentally”. I mentioned that Bailie could be stubborn and determined. I believed these qualities helped his improvement. He was not going to let anything get in his way of going where he wanted to be, doing what he wanted to do - and if there was a problem, mom would fix it.

For further information about Fibrocartilanginous Embolism:

Fibrocartilanginous Embolism
Fibrocartilaginous Embolism (FCE)
Fibrocartilaginous Embolic Myelopathy
What to Do Immediately If Your Dog Has a “Spinal Cord Stroke”

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