In this Episode:
Series 1 Episode Guide:
Frodo was found in the garden by his owners unable to stand and barely responding to touch. His local vet provided initial treatment and arranged immediate referral to the Queen Mother Hospital for Animals. He was rushed to the Hospital where he was met by members of the Emergency and Critical Care team who took him directly to the Intensive Care Unit, which was to become his home for the next week.
Frodo had a complex set of clinical signs suggestive of something affecting both spinal cord and brainstem. Trauma or poisoning are common causes of such signs. There was no evidence of serious trauma such as a blow to the head, which left poisoning as the prime suspect. A common household pesticide (metaldehhyde - found in most blue/green slug bait) which can cause similar signs was considered as there was blue material around Frodo’s face, however his owners ruled out access to such poisons.
Frodo was seriously ill. He was paralysed, very depressed mentally and had almost lost his gag reflex (the reflex causing swallowing and preventing food or liquid entering the lungs). He was at high risk of choking or developing pneumonia. Through the night he was stabilised by the Emergency Critical Care team, and in the morning neurologist Emma Davis took over Frodo’s management under the supervision of senior neurologist, Rodolfo Capello
Frodo’s head and neck were scanned in an MRI scanner, as his clinical signs still pointed to involvement of both brainstem and spinal cord. The scans provided detailed, high resolution images of Frodo’s spinal cord and brain tissue, and the results were surprising. The spinal cord was being compressed by a bone at the top of Frodo’s neck, causing the paralysis. The brain stem must have been affected when the bone initially shifted but there was no direct damage or compression.
A CT scan was arranged to provide more detailed information on the bony structures, and confirmed the MRI scan in very clear and graphic images. The scan also showed why the bones in Frodo’s neck had moved. The first bone in Frodo’s neck (the atlas) never properly formed. This meant that there was a significant weakness in his spine - the surprising thing being that such an active dog had not had a problem earlier in life.
Difficult decisions had to be made by Frodo’s family. There was a small chance Frodo might recover some use of his legs after resting. The problem in his neck however, would remain, with a high chance of relapse which next time could be fatal. The only other options were euthanasia or surgery, and Frodo’s owners chose surgery.
The surgery had two aims. Firstly, to remove the compression on Frodo’s spinal cord by moving the bones back to their correct alignment. The second aim was to encourage the two parts of the malformed atlas bone to fuse together, and then to have the first and second bones in the spine fuse together. Doing this would prevent the bones shifting in future and causing a similar compression of Frodo’s spine.
To allow the fusing to take place, screws and special bone cement were used to hold the pieces stable and in the correct position during the healing process. To stimulate the fusing of the bones a harvest of bone cells were taken from Frodo’s shoulders and once all the screws were in place this was introduced between the pieces of bone.
Surgery took approximately six hours and Frodo recovered from the anaesthesia remarkably well. There is concern with this type of surgery that spinal cord manipulations will cause further inflammation and swelling, affecting parts of the brainstem responsible for breathing. This would result in respiratory failure which, if not treated immediately by placing a patient on a ventilator, would be fatal. Now that Frodo has survived the surgery we can only wait to see if he will recover the use of his legs.