Yes, that's little one-eyed Aurora undergoing a CT scan on her neck last week at Peak in Burlington. We have a mystery here. As a result, this post might end up being the length of a mystery novel. Sorry!
Several weeks ago Aurora developed some neck pain, and responded quickly to prednisone. Once we tapered her off the pred, she remained pain free and became her normal self. But the week before last, she started yiking again and holding her head like her neck was painful. Pred initially helped, but we went ahead and scheduled her for a complete examination at Peak for last Tuesday. Clearly something was not right with her neck. It had been a year since she first came and had an ultrasound and echocardiogram, so she was due for a recheck anyway.
Last weekend she became very painful -- just crying out when moving -- so I contacted our internal medicine specialist, Dr. Marielle Goossens, to find out what kind of pain medication we could start her on until we got her to the clinic. (Being on pred eliminates many choices, and one you can use while on pred -- tramadol -- Aurora can't tolerate.) We put her on buprenorphine, which really helped.
On Tuesday, we began with Marielle doing her initial exam, followed by blood work and other tests:
Much to my total consternation, Aurora exhibited no pain whatsoever! That's a real obstacle, of course, because that makes it even more difficult to figure out where the problem is.
Here's the surgeon, Dr. Kurt Schulz, doing his physical exam and trying to pinpoint the source of her pain:
Kurt's vet tech Anthi is holding Aurora, while I'm looking through the camera lens in disbelief that no matter how Kurt moved her head or neck or other limbs, Aurora didn't yike at all! We had worried that the buprenorphine might mask the symptoms, but never to this degree.
This meant we really needed a CT scan to get an image of her neck for a detailed look. This is done under anesthesia, so first we needed her heart rechecked by the cardiologist at Peak, Dr. Don Brown:
On the left is vet tech Liz and on the right is the other doctor in the cardiology practice, Dr. Jenny Garber.
So this is where things got weird. Don discovered a growth of some sort flapping around in the mitral valve. It was attached to the valve wall with very thin fibers, and it floated around, buffeted by the blood flow. It was so large and recognizable that I could easily see it. He wasn't sure if this was tissue -- an abnormally formed part of the valve wall she was born with, an oddly shaped blood clot somehow attached to the wall (but how?), or "vegetative" matter, the result of infection somewhere.
Don turned to me at one point during the echo, pointed to that object in her mitral valve, and said, "Here's your worst case scenario. That thing could break off and disappear into her blood stream. If it did, I'd expect it to end up in her hindquarters somewhere."
I asked him if it was possible to surgically remove it before that happened, and he said no. Basically, that would be open-heart surgery and just not feasible.
After the echo, the action moved to the CT scan, which is what you see in the photo at the top of this post. I took that photo just after they had finished imaging Aurora, and here she is coming out of the machine:
The back of her neck and skull is shaved because she had a myelogram done to inject a contrast dye into her spinal column for the CT imaging. The dye makes the spinal structure and surrounding tissue visible on the scan.
I was with the radiologist, Dr. Mark Saunders, when he read out the images alongside Marielle. While there were areas in her neck where some compression was noticeable in a few vertebrae, it wasn't significant, couldn't really explain the pain she was exhibiting, and wasn't surgically "fixable" in any case. In other words: We had hit a wall. The only test we were waiting on was an analysis of her cerebral spinal fluids, but it was unlikely to tell us much at this rate.
I brought Aurora home that evening, along with Darla and Widget. Marielle had equipped me with extra pain meds for Aurora, and our goal was to keep her comfortable and continue to monitor her.
And Then...
All was well until Friday morning. Aurora was standing at the front door, waiting to come in, and had been barking to get our attention. I opened the storm door, she came in, started walking ... and suddenly screamed. And screamed.
I looked down and saw she wasn't using her right rear leg. She was holding it up, whimpering and crying. She hopped, shuffled, and cried out. Alayne came running to see what was happening.
We took her into the living room and set her on the floor. She continued to walk as if her rear leg was paralyzed. She was agitated, constantly trying to rustle up bedding, then lay down, get up, rustle the bedding, try walking on three legs, cry out, and start all over again. I took some quick video on my phone and sent it to Marielle.
When I saw Aurora not able to use her back leg, and seeing the pain she was in, my first thought was what Don Brown, the cardiologist, had warned us about: that thing in her mitral valve could break off and wash down her bloodstream, blocking blood flow to one or both hind legs.
I bent down to feel her foot. Sure enough, it was cold. My heart sank. Alayne and I looked at each other with one thought: Blood clot. (We've been through this before, except with cats, in whom it is much more common.) I texted Marielle and told her I thought Aurora had just thrown a clot.
Marielle called shortly thereafter, and I was soon on the way back to Burlington. She had alerted the cardiologist and the other radiologist on duty, Dr. Lynn Walker, that I was coming back with Aurora for an emergency.
As soon as I arrived, Dr. Brown came out, felt Aurora's leg, and said "very weak pulse," meaning blood flow had indeed been cut off. A few minutes on the echocardiogram we learned what had happened: That chunk in her mitral valve had broken off and disappeared into her bloodstream. Whatever it was, it was gone.
And a few minutes after that, in a room down the hall, Dr. Walker found it while doing an ultrasound on Aurora's leg. It had plugged up the femoral artery in her right leg. Blood was still getting around it a little, but the artery above the clot was much larger than normal because of the dam in the bloodstream created by the blockage. This was painful, but there wasn't much to do other than keep Aurora doped up on pain meds.
By the time I had arrived at Peak the warmth had already started returning to Aurora's leg. Puzzled by this, I asked Marielle how that could be. She said that the body almost immediately begins to compensate for the blocked artery by shifting blood flow to other vessels; it takes time, and occurred in Aurora faster than you might expect, but that's what was going on.
Marielle said Aurora's body would very quickly begin breaking down that substance -- clot, tissue, or vegetative matter -- by sending out macrophages to digest it and clean it out. The process might take a few weeks.
A lot more happened that day, and this post is already too long, but in a nutshell we are waiting on a new batch of test results, including a blood culture that could tell us if Aurora had a blood infection that could have created "vegetative" matter. She is now also on blood thinners. I am taking her back on Wednesday this week for more tests.
So now we are all wondering: Was her original neck pain being caused by clots that were traveling to the other end of her body? We don't know at this point.
Please keep her in your thoughts.
