Dog undergoes rare spinal-cord surgery as UPMC neurosurgeon, radiologists give assistance
January 29, 2017 12:00 AM
Deanna Alko kisses her dog, Anchor, a Leonberger, during a rehabilitation session Jan. 12 at Pittsburgh Veterinary Specialty and Emergency Center in Ohio Township. Anchor, who holds expert status in water rescue, underwent spinal-cord surgery to remove a tumor at Purdue University, along with input from human neurosurgical doctors in Pittsburgh.
Emily Langer, a rehabilitation assistant with PVSEC in Ohio Township, helps Anchor during a rehab session.
Anchor walks on an underwater treadmill during a rehab session.
Deanna Alko pets Anchor during a rehabilitation session on a treadmill at their Squirrell Hill home.
John Caldwell and Deanna Alko sit in their living room with their dog, Medley, also a Leonberger, in Squirrel Hill.
By David Templeton / Pittsburgh Post-Gazette
Last September in Littleton, Colo., Anchor achieved expert status in “water work,” with her impressive range of canine skills to rescue distressed humans in water. Yet, during those trials, the athletic, well-trained and boldly majestic dog startled everyone when she fell off the boat.
Only 1 percent of dogs participating in water work achieve expert status known as Water Rescue Dog Excellent. Adding to that, Anchor is the only dog in water-work history to achieve all three levels of certification in just one season, her owners and others say. The expert or excellent level is the highest achievement for water-rescue dogs in the United States, save for those in the military.
But the 5½ -year-old, small for a female Leonberger at fewer than 100 pounds, always had some abnormality in her back left leg. Still, a never-before fall from the boat drew concern the same day people were celebrating her accomplishments.
Soon after returning to their Squirrel Hill home, Anchor’s owners — John Caldwell and Deanna Alko — had a veterinarian recheck Anchor’s condition, previously thought to be degenerative arthritis. When the married couple were told the results of magnetic resonance imaging (MRI), they found themselves at the Pittsburgh Veterinary Specialty and Emergency Center in Ohio Township struggling to balance the heaviest emotions against hard facts and few options.
It turned out Anchor had a tumor of the spinal cord in her lower back. It was unclear whether the large mass was growing from inside or outside the spinal cord and whether it was cancerous or benign.
“Almost no one has experience in operating on the spinal cord of dogs,” said Dr. Caldwell, a 56-year-old UPMC cardiac anesthesiologist. “We were genuinely devastated.”
Ms. Alko, a UPMC certified registered nurse anesthetist, has been dedicated to training Anchor and her brother, a 7½-year-old Leonberger named Medley, in water work, with their lifestyle and household devoted to their pets. Medley has reached expert status a record nine times.
But now the news was crushing. Kendra Mikoloski, the PVSEC veterinary neurologist who diagnosed Anchor, said the massive tumor was compressing the spinal cord to 20 percent its normal size against the walls of the spinal canal.
“She had a long history of back-leg weakness,” she said. “Given her history, it was less likely to be cancerous” with the slow decline in leg function. But even a benign tumor filling 80 percent of the spinal canal posed immediate risk of paralyzing Anchor’s hind legs.
Unfortunately, Dr. Mikoloski had to tell the couple that spinal cord surgery “would be something a veterinary neurologist would do very infrequently” given the high cost and risk of damaging the spinal cord. If the result was paralysis, the dog would be put down.
But some dogs, as with people, are born to action and achievement. Knowing that Anchor faced paralysis if nothing was done, Dr. Caldwell and Ms. Alko made a decision.
What happened next involved a noted Midwest veterinary neurosurgeon and his team of 20, a UPMC neurosurgeon in human medicine and human radiologists, along with a series of decisions devoted to saving the life of a talented gentle giant.
“The basis of our decision is that we believe strongly that Anchor loves to work. My wife is her trainer and handler — I’m a support person — and the bond they have in work and in life is exceptional,” Dr. Caldwell said. “We don’t have children. We carry all our eggs in this basket, wisely or not, the way parents do with their kids.”
Ms. Alko said the foundation of water-rescue work is “take, give and hold” — take the opportunity, hold the bond sacred and give praise and love liberally. “It is my philosophy or way of life with my Leos,” she said. “It’s also how I wish humans would treat each other.”
Which is to say, their choice, if feasible, was spinal-cord surgery.
Scalpels and microscopes
Dr. Mikoloski had referred the couple to her teacher and mentor, Tim Bentley, an associate professor of veterinary neurology and neurosurgery at the Purdue University Veterinary Teaching Hospital, who has done rare spinal surgeries on dogs.
The challenge was on to determine if the tumor was operable. It also was not yet apparent whether the tumor originated inside or outside of the spinal cord, among other concerns.
Dr. Bentley said there are only two previous reports of dogs with the same benign “hemangioma” tumor that resembles a blood blister at the same location on the spinal cord. Both of those diagnoses occurred after the dogs had been euthanized.
There are three levels of spinal surgeries Dr. Bentley said he typical does — daily repair of slipped or fractured disks in dogs, once-a-month surgeries for tumors in the protective layer surrounding the spinal cord, and the occasional rare spinal surgery.
“But this is about as delicate as it gets,” he said. “The last time was 2011 when I truly had to go inside the spinal cord itself.” Such tumors can be inaccessible or intertwined with nerve fibers that, if damaged, can negatively affect the dog’s recovery or survival.
It was comparable, he said, to getting something out of a pop bottle without touching the bottle: “You can’t shatter the bottle or damage it,” he said. “And the spinal cord fibers I’m talking about are microscopic. You can’t even see the fibers.”
The spinal cord he described as a white tube or electrical cable. In Anchor’s case, the area was swollen and inside that white tube was a black and purple mass — the hemangioma that had grown over the course of many months and looked like blood oozing from a blood vessel.
Dr. Caldwell solicited the help of two human radiologists who are MRI experts to evaluate the tumor.
In the meantime, Dr. Bentley did his preparations with an important conference call with Dr. Caldwell and David Okonkwo, the clinical director of the University of Pittsburgh’s Brain Trauma Research Center, who holds various UPMC positions. Dr. Okonkwo said he first had to educate himself on the differences between canine and human spine anatomy, soon realizing the principals of anesthesia and spine surgery in dogs and humans are nearly identical.
Reviewing the MRI together through telemedicine communications, Dr. Okonkwo said, “I quickly discovered that Dr. Bentley was an incredibly thoughtful, detail-oriented doctor.” But Dr. Bentley didn’t have the tools he had available for human surgeries.
“Anchor’s tumor is very similar to a form of tumor we see frequently in humans,” he said, noting the importance of avoiding injury to the spinal cord.
“One key focus of spinal cord tumor surgery at UPMC is to maintain an adequate blood pressure so oxygen continues to reach the spinal cord, Dr. Okonkwo said. “Dr. Bentley and I discussed how to translate that principal over to Anchor’s surgery to preserve function in his hind legs.”
The worst-case scenario would involve no clear distinction between tumor and spinal cord, but Dr. Bentley said he discovered during the four-hour surgery in December that “it was easy to tell the difference.”
“Where Anchor’s tumor was is the most rare place to have a tumor inside the spinal cord,” he said. “But quite a few things lined up nicely to make surgery possible and a good choice for Anchor.”
The tumor was situated on the very top of her spinal cord with almost no healthy spinal cord tissue connecting the tumor with the spinal cord. Dr. Bentley removed the tumor successfully with only minor disruptions to the spinal cord. But it required 1½ hours of surgery while he looked through a microscope.
“The morning after the surgery, she could only walk with assistance,” Dr. Bentley said of Anchor. “The back left leg was working well but she couldn’t support weight. The temporary damage — the concussion, bruising and swelling — will go away over time. The spinal cord will wake up. The deficits will reduce.
“She may not be neurological normal but her quality of life will be normal,” he said.
Recovery in a fish tank
Three weeks later, Anchor is undergoing rehabilitation therapy at PVSEC five days a week, including walking on a treadmill inside a tub of water — a big fish tank — to reduce impact. Back home, Ms. Alko’s self-designed overhead harnessing method is used to reduce Anchor’s weight while she walks on a treadmill.
She’s getting stronger each day with improved use of her back left leg.
“Certainly John and Deanna love their dog and definitely were willing not only to drive a long way but do a lot to help Anchor,” Dr. Bentley said. “I am very fortunately a specialist doing special surgeries. My job is only possible because there are people both willing and financially able to have patients go through relatively major and expensive procedures. Unfortunately, it is not something everyone could afford.”
The surgery now serves, he said, as one of the more notable experiences in his surgical career.
“A case for such an invasive procedure doesn’t come up too often,” he said. “I even showed my mother the video of the surgery. If you show your mother, then certainly it is one of the rare ones.”
Back on the boat?
As it turned out, the surgical procedure turned out to be a bargain at $4,000, not including the cost of the MRI and daily rehab costs that will continue indefinitely. Their dog Medley also underwent chemotherapy last year for lymphoma and now is in remission.
“This is not for the faint of heart financially, and we get all that,” Dr. Caldwell said. “But we are willing to do without other things and emotionally and spiritually we spend 100 percent of our time devoted to our dogs.”
Dr. Okonkwo said Anchor has a chance at a full, healthy life “because a stranger, Dr. Bentley, has been mastering his craft for years and years.”
“It was an honor to help Dr. Bentley and Anchor in any small way I could,” he said.
A day after Anchor’s Jan. 18 checkup, Dr. Bentley said he was pleased with her progress even if will take six months before full results are realized. There’s growing hope she can return to some level of water work.
Anchor might climb back onto that boat.
But water work or not, Dr. Bentley said, “I hope Anchor now will have a long, happy life.”
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