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Groundbreaking treatment that so nearly succeeded

Barbara Todhunter described how her efforts to save
her stricken dog helped to promote a major development
in the treatment of spinal disorders

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How do I start to tell this tale?
I woke up as normal early Wednesday morning two years ago, sorry do not know the date. Emma was curled up on a sheepskin rug beside my bed as always. It was strange but she gave a funny stretch. I went down-stairs and expected her to follow but after several minutes I went to see where she was. I found her at the top of the stairs giving her self another stretch and then she tried to come down -stairs but her back legs were not responding. Down she came almost headfirst and then I realised all was not well. She bunny hopped to keep her balance so I helped her out side to go to the toilet. I settled her on her bed and gave her a paracetamol just in case she was in pain hoping she would relax whilst I was out.
I returned at approximately 2pm to meet Emma at the door with her legs straight out in front of her. I immediately phoned the vets and took her down to see them. They were convinced that she had slipped a disc and advised to keep her in pending an x- ray the following day. On Thursday the x-ray confirmed she had slipped a disc and that we had two options, one leave her to see if the problem rectified itself, two go immediately to Glasgow University hospital for surgery. In my opinion we had no option so our appointment and directions were confirmed via fax there and then.
By tea time that day we were on our way to Glasgow. Emma settled in the car comfortably but her bladder was filling up and we were not able to express the urine out. The weather was appalling and after several goes we found the veterinary hospital and arrived just before midnight on Thursday. We were met by Mark the duty vet who thoroughly examined Emma.  Apparently it transpired that Emma had a hole in a vertebra and when she stretched the disc popped through the hole and put pressure on the spinal cord. The only way to resolve this was surgery. By this time Emma had to have her bladder expressed to relieve her discomfort and with a kiss and a cuddle we handed her over to the very experienced staff.
I was on the phone the following day (Good Friday 2 years ago) to see how she was. The surgery entailed removing the disc between L2 and L3 vertebrae. By this time Emma had no movement in her back legs at all, but she was in no pain although her grace and dignity showed in her eyes.
I phoned each day to check on her progress. The staff were amazing! The surgeon Alex was wonderful! He advised an MRI scan which by this time the costs were mounting. But she was part of the family. The next weekend we were back at Glasgow to see Emma. We entered the waiting room and heard her barking as soon as we approached, a good sign. She came into the waiting room with a vengeance with her hips and back legs in a sling. She had a huge plaster down her back where she had been operated on, but looked happy to see us. Slowly the happiness went to tiredness and she lay down exhausted. Alex her vet came in and explained about the operation and her MRI results. Her reflexes were good and she had deep pain sensation, but obviously there was bruising on the spinal cord from the prolapsed disc. Now it was only time to see if the operation had worked.
 

Emma stayed at Glasgow University for approximately one month and I was constantly on the phone to monitor any progress. In herself she was fine. Her spirits were high and she was in no pain. The only other problem was that she kept getting urine infections which were treated with antibiotics. The vets decided that they could do no more for Emma and suggested that if there were no sign of improvement by the end of April 05 that she was put to sleep. However, they all knew how dedicated I was to giving her every possible chance to walk again as she had gone from being a very active cocker spaniel to being disabled within hours and Emma deserved my help. So Alex scanned the internet and found that Cambridge University were experimenting with stem cell implant surgery. On leaving Glasgow I was shown how to give Emma physio to keep her muscles healthy, but unfortunately they were beginning to deteriorate already. They also explained that it would be hard work keeping check on her toilet habits, but I was determined not to give up without a fight.

Alex phoned Cambridge and spoke to a surgeon called Nick Jeffrey explaining about Emma and asked his advice. To have this type of surgery there had to be a certain degree of immobility. Within days of bringing Emma home, I had spoken to Nick at Cambridge who encouraged me to take her to see him as she had to have a thorough examination. So off we went on the 600 mile round trip to Cambridge. Emma was brilliant. Even though she didn't have the use of her back legs she could still move about in her own way with me holding her up in a sling.

Arriving at the hospital we were met by the lovely Mr. Jeffery who immediately picked Emma up and carried her to his office. To say thank you for this lift, Emma had a wee all over his coat. He just laughed. We had a good talk and I had to explain in great detail what had happened for this all to come about. Nick in return explained what he could about the surgery and that the procedure was still very new but what he did say was that it worked on rats. After that, Emma was given an intense examination using all sorts of instruments to check reflexes and see her degree of deep pain sensation. I just closed my eyes and let him get on with it. He was the expert. Nick’s conclusion was that in his opinion Emma had only a 2% chance of walking again. He said he was willing to give her a fighting chance. The decision was mine.

I had to make a decision. It was easy. Before me was a man with the skills to try and make Emma better. Nick explained that he would have to take cells from the sinus area of Emma’s nose and culture them for about 2-3 weeks then inject the cells into the damaged area of the spine. I could go home and think about it or leave her there in his expert care and they could get started the following day. He added that Christopher Reeves had asked to have this operation just before he died. Because this was government funded I had to be prepared to travel to Cambridge every few months for the surgeons to assess Emma’s progress . So with a deep breath and lots of hugs for my brave high spirited little Emma the drive back to Cumbria started once again.

This was her last chance and even though this procedure was still in its infant stage I was willing to let them try. The operation went well the following day and Emma was recovering nicely. She was on pain killers and antibiotics just in case of any infection and eye cream for conjunctivitis. They were pleased. Arriving at Cambridge she was brought out at top speed with her back legs in a sling and a rather swollen head. Emma saw the car and couldn’t wait to get in. She slept all the way home and was delighted to have a good sniff around the garden with me being her back legs. Her spirits were always high. Within a week her head had reduced to its normal size and we got into a good routine. I had to work hard at her physio and even bought a machine to help. Her reflexes had to be kept active and the toxins massaged from her legs. If this had been a degenerative disorder I would have had her put to sleep, but because it wasn’t I had to try.

Urine infections still caused a problem and Nick was concerned that she would become immune to antibiotics and then the infection would go to the kidneys. He suggested giving her 500mg of vitamin C in her food each day, which I did. After two weeks at home Nick phoned to say the cells were ready. He said that they needed one particular type of cell and everything was ready for the implant. We collected her the following Saturday as arranged. Unfortunately Nick had to open the wound up on the back to inject the cells into Emma’s spine so she had stitches down her back again.

It was now just a waiting game as the cells take a long time to grow. I asked what to look for and Nick said that a good sign was if she started to wag her tail as a happy response and not a reflex response. Nick also showed me how to express her bladder as paraplegic people do. Apparently this was the first time he had done this and it worked. He said that the most common cause of death for paraplegic people is from kidney failure due to the bladder not being emptied properly.

This was a huge learning curve for me. The urine infection and conjunctivitis was a problem, but we kept the infection in order for the time being. I began to see sign of improvement with Emma’s movement. At first she could only shake down to her waist but now she could shake all the way down to her hips and she would kick her legs when I gave her a massage. This improvement continued and Nick asked if we would bring her down for an intensive week of physio so that he could take videos of her on a treadmill.

Yet again off we went on the six hundred mile round trip. Nick was so pleased and excited at her progress. After the week on the treadmill they decided that she was able to move her hips. She had no movement from her knees to her toes, but there was time yet.

Unfortunately there didn’t seem to be any more progress and the infections kept coming back. What I didn’t want was for Emma to become ill, so I decided that if she couldn’t walk in a fashion and be mobile by Easter of the following year, I would let her go with grace and dignity. Time went on and I reported to Nick as often as possible. Yet again she got a urine infection and I was doing my best to keep this at bay. Was this the beginning of the end?

Sadly Easter came closer and Emma had made no improvement in the last few months. I emailed Nick to talk though my decision about putting her to sleep as her infections were getting more frequent and this is not what I wanted for Emma. He was amazed at my dedication and patience and understood my decision entirely, but asked if we could take her down to Cambridge to be put to sleep so that they could do an autopsy to see why the operation had not worked. I agreed on two conditions: firstly that I was there to hold her so that she went peacefully with no struggle, and secondly that I could have her ashes returned to me. They agreed. I was proud to know that the information they would collect would go to help in the research towards helping humans.

So on 27 April 06 we went down to Cambridge for the last time. Emma did not feel a thing, she just went peacefully to sleep, and I know I did my best.

 

 

 

 

 

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