Bo's Final Hours

As many of you know, I had to "put down" my best friend Bo yesterday. I had been posting consistently on his progress, and news had been getting better, but quickly changed in his final hours. I am going to include some pictures in this post that you may not want to see. I will put them at the end so you can skip that part if you don't want to see him. To see the, click on the "Read More" link at the bottom of this post.

I have been re-evaluating and re-thinking this blog. I have decided to make this blog more of a memorial of my friend, but also a resource for others to turn to if their family members have to deal with Inter-Vertebral Disc Disease (IVDD). You should see those changes in the structure to my posts in the next few weeks.

***Back to Bo's story***

On Thursday evening, I spent much of the night washing Bo's stuff. Toys, bed, towels... everything needed to be cleaned and ready for boy's homecoming.  Although not confirmed, we had discussed a time table for him to come home and I wanted to get ready for some "home healing" to recover from his paralysis. If things went well, the schedule was:

• Friday - check for "stability" and no further complications. If we could stop other issues from setting us back, we can then start focusing on the "big picture", which was recovering from his herniated disc and hopefully his paralysis.
• Saturday - re-check pnemonia. If pneumonia symptoms have improved, then we know that the antibiotics were working and we should have another 24-48 hours of recovery.
• Sunday to Monday - Possible release of Bo to come home for "in home" love and care.

It was the first time that we had discussed Bo possible coming home, which made me very happy. The original estimates were 3-5 days in the hospital, and all this would have been pushing 7 days (also increasing medical costs, which I will get to in another post). I was elated with the possibility of having my little guy at home.

Friday morning brought about more good news. Bo "looked" better (doctors use the term "clinically" better, meaning that you can actually look at him and see improvements, although tests may indicate something different). The plan for the day was to continue with the medical treatments for his pneumonia, and if things went well, we would also be removing his tracheotomy tube. This was great news.

(On a side note, I refrained from posting all of this information. For that, I apologize. I didn't realize that Bo's story had developed such a following, and I truly thank you for all the support you have all given. I don't consider myself superstitious or deeply religious, but I found myself thinking things such as "I don't want to post anything, it might 'jinx' all this good news we are receiving". It is strange how life and death decisions change your views in ways you never imagined. Again, more on this and other topics as I re-structure this blog.)

Friday went about as planned, and we got our Friday afternoon update call as normal. Bo's progress seemed good. The chest x-rays showed that pneumonia hadn't really improved, but it had not got any worse and we needed time for the antibiotics to kick in. Also, Bo was not getting as agitated and they were able to remove his tracheotomy tube. All of this was great news after everything we had heard over the last 5 days. I had visions of Bo coming home, recovering in an environment that was more familiar for him and less stressful. I felt that we had turned a corner.

"But there is something else." My heart sank. What more could there possibly be?


Bo started experiencing stiffness in his front legs. Our neorology specialist, Dr. Sullivan, was out of town at a conference, but working with Dr. Steele and conference-calling in on his progress reports. Dr. Steele explained that it might be "Schiff-Sherrington posture".

I was thinking the same thing you are right now, "what the @#$% is that?". Schiff-Sherrington posture is a phenomenon where the limbs tighten up and become stiff due to trauma or lesions to spinal cord area. Not the same as paralysis, but actually losing the mobility through stiffness. I researched this more through an online posting for A Practical Guide to Canine and Feline Neurology. Don't get me started on how dumb of a title that is. "Practical Guide" and "Neurology" don't belong in the same sentence, unless you are complaining about a stupid title like "A Practical Guide to Canine and Feline Neurology". Seriously, click on the link. You won't see anything "practical".

The cause of Bo's Shiff-Sherrington posturing could be one of two reasons:

1. The swelling from his surgery was changing and effecting his spinal cord in a different way. This could be putting pressure in different areas, causing this phenomenon and would go away as the swelling decreases. This would be considered "good news".
2. The changing in Bo's neurology could mean that his spinal cord was so severe that he has developed myelomalacia. Again, "what is that?"

Let me start by saying occurances of myelomalacia are rare. If you are reading this, then you or someone you love has or could be going through issues with IVDD. Please do not think your dog might have this and go running into your vet saying "well what about this?" The chances of your dog having myelomalacia are low. From what I was able to gather maybe 5-10% of only the most severe spinal injury cases develop myelomalacia. Severe spinal injuries from IVDD are rare, meaning that most of them are treatable. So think of it as a rare occurance in a rare occurance.

What is myelomalacia? In short (and from my understanding, not being a veterinarian or in the medical field), it is when the spinal cord suffers such a severe trauma that not only can it not repair itself, but the damage starts spreading and killing the rest of the spinal cord. It actually starts to liquefy. Think of it as gangrene, but spreading throughout the spinal cord. It is hard for me to write this, as the thought of this happening to my little guy hurts me so much.

What are myelomalacia's symptoms?

• Paralysis (Bo had this, that's for sure)
• Numbness to pain in areas LOWER than the injury (Bo's symtpoms? Check. In fact, Bo had lost "Deep Pain" or "DP" sensation. Something I didn't understand until I researched it. Again, I will post about this as well.)
• Loss of tone and reflexes in hind limbs due to softening of the spinal cord (Check.)
• Hyerthermia (Check.) Not to be confused with Hypothermia (when your core temperature drops below the required temperature for normal metabolism. See Leonardo DiCaprio in "Titanic"). Hyperthermia is the overheating of the body, such as in heat-stroke. Bo was overheating and that's why the vet tech's and doctors were using wet towels to cool him down.
• Dilated anus - I didn't check this one out. Didn't even think to look. Actually, probably better if you don't if your dog is incontinent like mine was.

How do you diagnose myelomalacia? Forget what you read online, because it will just confuse you. The testing is very simple (again, from my understanding, and I am not a veterinarian by any means). For Bo, they ran several tests to confirm it, but the easiest for you and I to understand is if his "paralysis" and "pain sensation" is getting worse. If you test his skin reflex (pinch his skin to see if it twitches) and find that the area that is effected is growing along his spine, then he probably has myelomalacia. Barring a total separate injury occuring (highly doubtful), this would be an indication that his spinal cord is dieing and impacting other areas.

What are the treatments for myelomalacia? There aren't any. It is terminal. As the spinal cord begins to die, it starts shutting down different parts of the body and organs. With each section of the spinal cord that dies, the nerves attached to it  that are connected to organs also die. This shuts down the organs permanently and completely. The fatal part is when the spinal cord area that is attached to the lungs dies, so does the lung function, and the patient dies of suffocation.

Again, don't go running to your veterinarian like "chicken little" screaming that your dog has myelomalacia! As I mentioned before, it is very rare. Your pet will be dealing with so many other issues before it even get's to this state. If you are talking to ANYONE that is discussing IVDD and surgery, they are probably a specialist in that area and know what they are doing.

Back to Bo's story. So we had 2 scenarios. One that would resolve itself if we gave it time. The other was terminal. The only way to find out one way or another is to wait for one more day and see where his pain/twitch reflexes were. If they were spreading, then he has myelomalacia.

On Saturday morning, I got a call from Dr. Steele. It was our normal progress report time, but it started with "I am calling you, and it is not good news..."


My heart sank, I got a lump in my throat, and we discussed the details of what needed to happen.

It may seem strange, but I am happy that things went the way that it did. Do not get me wrong, I love my dog very much. But I couldn't bear the thought of putting my boy down if he was paralyzed and incontinent. Yes, I understand that it would have led to a lifetime of suffering and pain for him if he did not come back from his injury. But to know he would have otherwise been healthy and it was truly a decision about "quality of life" would have been more difficult. This decision was taken out of our hands, and it was more about ending it quickly and painless, or slow and with suffering.

That... is an easy decision to make.

They had to give us a room with oxygen. I can't imagine having my baby
boy hooked up to this all the time.

You can see his surgery staples and incision. When we first brought him in
his "twitch" reflex stopped right above where the curve of his back ends in
this picture. By yesterday, it was just below the pink patch.

Me and my boy, Bo. I decided to wear the funny short I found when
shopping with him. You can tell he is obviously distressed.

Kissing him goodbye. He had to keep his head up because the congestion
from his pneumonia was making it so hard to breath. You can also see
his tracheotomy incision.

Bo Rito Ochoa 7/18/08 - 12/10/11