Broken Back in Fort Worth

[FortWorthSquaddy]

I'll post pic in a few minutes if I can reduce their density.

It's 2am. Got a 500.0 g male foxer 3 hours ago. He was found about >6 hours ago crawling in a yard.
Severely bent/broken back, but no visible (recent) injury. Lethargic, non-aggressive and cool but not cold (he's in shock).
He actively but weakly sought to cover up. He was covered with maggots and fleas from the waist down. I fear some necrotic patches of skin, but nothing has sloughed off yet. TYhere are a few fingernail sized discolored patches on his abdomen and inner thigh, and scrotum, which are blackened but supple and intact. Perhaps no broken skin. Found no blood, lacerations, puncture wounds or scabs, but I was unwilling to fight him too much for such an exam.

Treatments:

Prednisone dosed at 2mg/kg loading dose
Baytril 10mg/kg loading dose
Tramadol 2mg/kg loading dose
1 ml fox valley Day One 20/50 chaser because the above is NASTY
2 ml sub cutaneous lactated ringers for guaranteed hydration without digestive shock

warm water rinse off the parasites as best I can from shoulders down
1:4 dilution betadine:warm water rinse from shoulders to tail tip (let sit for a minute)
(straight betadine is OK, but I wanted to avoid thermal shock. Don't let straight batadine sit for too long on skin or it will (chemically) burn)
warm water rinse agian

Dried off. Still some fleas.
liberal application of neosporin in inguinal creases and scrotum.
Felt spine - it's broken (severely bent at wrong abgle) but not flexing at the break - probably local inflammation
Lower extremities adduct only. No foot or tail flexion.

Currently asleep but rouseable, covered, dark, on half a heating pad.

Is continued treatment humane? Did I miss anything?

- Joe

[sdeegz]

Wow Joe - unbelievable that this little guy is alive. I was heartbroken just reading your post - and impressed with what you've already done.
Can you get him to a vet in the morning?
I have a 10 month old grey with a spinal cord injury (long story).
It's so hard to give up when you know they've already tried so hard to survive.
I wish I had some great words of wisdom for you right now, but you've clearly done all you can for him tonight.
Please keep me posted, I wish I could do more to help you tonight.
Kind regards,
Sue

[FortWorthSquaddy]

I can't take off work in the AM with such short notice without MAJOR repercussions in the clinic. I can get him to a vet in the PM, and I can come home at lunch to check on him / express his bladder / etc.

Thank you for the kind words.

[sdeegz]

If you already have a pic you can post, that may help. Otherwise I would just let him rest in a warm, safe place (probably for the first time in a while by the sound of his injuries).
You did a great job, lets see what tomorrow brings :)
Good luck, and again please keep me posted.

[FortWorthSquaddy]

237115237114

[sdeegz]

Did you express his bladder? If so, any blood in the urine?

[FortWorthSquaddy]

I did not. I'll try that now...

Not easy. He's in pain. Looks like maybe a drop of serous seepage from his foreskin. Hard to see if it's urine, and I don't want to disturb him. I'll try again after I get a nap.
I'd rather be tortured than know this is happening to an innocent creature that can't understand.
I'll try to hydrate him with 50:50 Fox Valley 20/50 ( So I guess technically that would end up as 1:5 powder:water) tomorrow AM, and if he doesn't take it I'll hit him with another 2 cc of subQ Ringers. Ringer's DOES have calcium in it.

I can't find guidance on how much fluid is too much, though, especially if there is no urine data for a comparative.

[sdeegz]

Also sent you a private message

[TubeDriver]

Poor little guy.:(

It sounds like you are giving him excellent care for now.

:thankyou

[sdeegz]

Let me check, I may have the fluid info - having a hard time seeing straight at the moment (tired), but will send it ASAP if I can find it.
And I agree in regard to putting him through any more tonight - just have no idea how long he's been hanging around like that, and where the back injury is, concerned both with kidney issues and having a full bladder (I'm amazed at the amount of severely dehydrated squirrels I've seen with full bladders)

[sdeegz]

Sent fluid info via PM
Good luck -

[FortWorthSquaddy]

A better morning, but not a good morning. Another warm water rinsing to clear maggots, another liberal application of Neosporin to the underbelly, inguinal creases, and scrotum.
Still see no bleeding, no seepage. Methinks the maggots are feeding on skin that had lain wet for a day.

More Baytril, prednisone, Tramadol.
During our 3 hour nap, he did urinate on the tissue I left under him, but I wasn't able to weigh it.
He took 1 cc of FoxValley, but reflexively. He didn't want it. He did drink about 2 cc of water during his bath / rinsing. I will have more time at lunch to get him properly hydrated. So only 2 more cc Ringer's sub Q this morning. He can move his arms with purpose, but I think complete paralysis below that spinal angle. It's really high up there - like T5 ish. Just below the shoulder blades. Anyone with better eyes than mine? - I don't have a skeleton to compare, and that's not my forte'. I need a prognosis regarding bladder and bowel functionality over time.

I really need the gut feelings from y'all - if I take him to a vet, I think I know what they're going to recommend...

He will otherwise need constant special care if he makes it through this, and I don't have those resources.

[FortWorthSquaddy]

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[Nancy in New York]

Thank you for helping this little one.
We have many members here who may be able to open their home to a disabled little foxer.
We've pulled off some really huge miracles on this board.

There is a member on the board that took in a wild squirrel with a broken
back. He is now the love of her life.
Her user name is Busysqrl perhaps she can give you guidance.

I don't think the prognosis will be good either at the vets.
You only euthanize once..........and if we can find a home, it may be
worth it to wait if the vet is thinking of PTS. However, if this little one
will be in constant pain, death may be welcomed.

:grouphug :Love_Icon:grouphug

Here are a couple of her threads:


http://thesquirrelboard.com/forums/showthread.php?24956-Magnus&highlight=
http://thesquirrelboard.com/forums/showthread.php?26598-Magnus-is-not-well-need-advice&highlight=

[lilidukes]

First capstar kills maggots.

Every time I've seen an injury as severe as that the spinal
cord is severed. When this is the case euthanasia is a gift.
I am always ready to give them a chance to recover even if
they can never be released. But I will not let a squirrel suffer
in my care.

Please go to the vet. If it is just a break and squee can live
even if paralyzed then if you want the responsibility I say go
for it.

You will need

Capstar for those maggots 1/4 pill crushed and mixed in as little
water as possible and given orally 1 x a day for 3-5 days.

SMZ-TMP (ab) for UTI's
Silvadene (ab ointment) for sores

Dextamethasone or Pednisone (steroid) both are safe for squirrels

Metacam (never to be given with a steroid) pain and swelling
Tramadol or Bufenex (sp) for pain

:grouphug:grouphug:grouphug

[sdeegz]

Joe it looks like theres more swelling today - or had he just received SQ Fluids?
I think your assessment is correct in the location of the spinal injury. I' m afraid I can't help with bladder/bowel function returning in that area - I've always dealt with lumbar/sacroiliac injuries.
I think one way or another you'll have a better idea what to do after seeing the vet.
It still amazes me how they can live through this type of trauma.
Good luck today and keep me posted if you can -
Sue

[czarina]

I also am concerned with the level of pain this little guy is in. Is the Tramadol relieving it?
As stated, there have been some miraculous things accomplished here. I agree, the damage appears high on the spinal cord, so I am very doubtful that bowel and bladder function will return.
But, we can find placement, with experienced rehabbers, so don't let that be a deciding factor.
He does have the will to live, and that is a plus.
But if he is only going to suffer, euthanasia is a blessing. I'm noting the necrotic areas on his scrotum, poor little fellow must have been like this awhile, so poor little guy is a trooper.

Will your vet let you bring him home, if you choose to rehab him? (If it is decided that he will not remain in constant pain? )

:thankyou for caring for this little one. My thoughts and prayers are with you.:grouphug:Love_Icon

[PeeWee's Mom]

:grouphug:grouphug:grouphug

[FortWorthSquaddy]

Hard to tell Tramadol's effects due to the underlying shock. My goal in the next 2 hours is to rehydrate. I will take him to the vet for a mercy evaluation - I am not one to suffer the suffering of the innocent. I'll be on my way home to him in 5 minutes.

The vet will not force me to surrender - they know me.

If there is ANYBODY capable of taking on this awesome responsibility, I need to know IMMEDIATELY. I have to teach / tutor after work and it severely cuts my time, and this fella needs professional and continuous care NOW. My email will alert me that you responded. I took this guy in because it was an emergency, but I already have 5 outside and 1 inside. I don't have a free space for a partially paralyzed Warm Fuzzy.

If, however, in the opinion of the vet, he will never be continent, or if he will be in constant pain due to the subluxated vertebra, then I will give him as peaceful a crossing as is possible. CC - I could use a guiding paw - you knew what this was like.

Grown men don't cry, but they can sure get allergy attacks fast.

[FortWorthSquaddy]

That might be more swelling. I instilled the SQ in the nape and upper peritoneum. the bone edge protrudes to the skin.

Charley - I'm listening.

lildukes - VERY helpful. Thank you.

I'll post again when/after I get back into the clinic

[FortWorthSquaddy]

Slight progress. Not immediately dosing off once he gets his head covered again.
Tramadol again. Technically an OD - this is life or death and elevated liver enzymes are low on the list.
He took 4 cc sugar water by mouth, and a half cc of fox valley.
2 more cc sub Q
We got another warm bath/rinse and some more neosporin on his nethers and groin.
Saw no maggots finally. Yay.
Saw no fleas. Not as hopeful.
He does have some serous oozing in the abdominal area - prolly the breaches the maggots were after.
He can crawl with his arms, and when cradled preferred to curl up into a small C shape. I was amazed, given the vertebrae dislocations.
I am still convinced he has a very high untecoverable Thoracic spine injury.
Time to call the vet and tell them I'm coming.

[Nancy in New York]

Whatever the outcome, I'm glad this little one found his way to you.
If he comes home, I can change the title of your thread to start looking
for a permanent home for him.
Keep us posted, and THANK YOU so much for ALL of your help, always! :grouphug

[sandycheeks]

Wow that is a terrible injury. I feel sorry for this little guy and I cried a little. Just for the record grown men do cry. people who put on a tough guy act are usually insecure and not tough at all. Strong men are gentle and kind and help those who are weaker than them.
I am no squirrel expert but it would be a shame to put this little one down in my opinion. He has fought to stay alive very hard for a long time. I think he is saying he wants to stay alive.
No matter what the outcome thanks for helping him.

[sdeegz]

God Joe I wish you were closer - other than being outside the country, you couldn't be further.
Please let me know what the vet said.
Sue

[SammysMom]

Many more prayers from the Northeast...:grouphug:Love_Icon:grouphug

[TubeDriver]

I have nothing to add other than to keep this squirrel in my thoughts. :grouphug

[rocky63]

From someone that has had a squirrel with out use of it hind legs. If you are willing to take the time and necessary steps to ensure a good life for this little guy. He can live a long time with you and be happy. But you must be willing to do what ever it takes to work with him.
with proper care and food he will enjoy your company for year to come but you must give him the time every day to play with him to keep him active.
My Rocky love to go out side with me and sit on my lap and just look around and listen to the sounds and smell the fresh air.
I wish you the best in your decision on how you are going to decide what is best for this little one.

[FortWorthSquaddy]

It is with sadness that I report that I let "Squee" cross the Rainbow Bridge last night.


And if anyone had told me that "Squee" had been 'just a squirrel' they would have ended up on the receiving end of 'just a punch' or three to the face. And I mean every word of that.


So,
I remember vividly watching Charley Chuckles' playful antics in Abby's many posts, and that was my guide. I knew that Charley would 'speak' to me to help me make the right decision, and he did. Among the flurry of things I had to do to get ready yesterday right after work, so that I could care for Squee WHILE driving because we had to get to the vet in Southlake before 7, was that I needed to try to express his bladder. Although he couldn't feel it directly, it was obvious that the process caused him significant discomfort. All he wanted to do was rest. He was so tired of fighting. And while I possess the resources and ability to probably have won the immediate fight, at what cost, and for what prize? Would there ever be a day without a fight? It equally occurred to me that if what I suspected about Squee's injury were true, he would never be a happy free squirrel. And since he had once lived among the trees, I knew how this would affect him. Squirrels do have emotions, and they do feel pain - physical and emotional. I then knew exactly how this trip to the vet would proceed. Charley hadn't whispered when he spoke.

Squee first got a third round of Tramadol, was cleaned and dried again to clear him of annoyances, and I even put more antibiotic ointment on his wounds and nethers. No harm in that. He took a cc of Fox Valley, but much preferred the sugar water I had made him. It tasted sweet to me, so I reasoned it would taste sweet to him. No reason not to be sweet.

He took more than 5 cc of "Squeedialyte", and still managed to hold the syringe. He even bit down lightly on the nipple, holding it in place as I let him sip until he was content. He started to doze off in that position - his head rocking slightly in concert with the syringe as the car gently swayed. He then curled up into an upright C again, (I'm still amazed that he could do that without agony, but he preferred that position) and buried his head in the dark felt and rested as I cradled him. He liked it when I stroked his little head. Convenient, since that's the only part I could see or reach.

Before they could get started, and despite that he had been completely wild not 24 hours prior, the vet needed to have a name for their paperwork. Lilidukes - you may not have realized the name you had inadvertently given him - I answered "Squee"


Squee crossed the Rainbow Bridge around 8pm, a little tired but without pain, well hydrated, with a full belly and a clean body, and with the comforting smell of the most caring and loving human he ever encountered surrounding him. I could not possibly have done any more or any better in the short time I had with him.


And I know why Charley sent Squee to me. I am applying to medical school right now, and the process is grueling and arduous. It is difficult, and for me emotionally so, and therefore it is sooo easy to procrastinate parts of it. For example, I have to completely re-write my "perfect" personal statement because it sounds too much like a resume. People want to know _WHY_ I would make a good doctor. I have to convey what motivates me...
Caring for innocent little lives, making their lives better for however long I can.
I want to be a pediatrician, maybe a pediatric immunologist.
Thank you, Squee. Thank you, Charley. I needed a push. You will never be forgotten by me, and I just (re)immortalized you both.



For those of you with clinical backgrounds, what follows is Squee's clinical presentation at the vet. Otherwise, Stop reading now :-)

- Joe in Fort Worth
Squaddy to Roopert & Chester & Tail On & Tail Off & Albus & Severus
Foster Squaddy to P. Tiddlywinks and Rain


Presentation:
Squee had had a complete dorsal subluxation at T8 or T9, which was not stable. His spinal cord was transected. The dislocation was about 6mm dorsal. Localized swelling had only partially immobilized the injury, but was probably impeding venous return. Luckily, he couldn't feel that. But he could probably feel the inflammation above the break. I was gentle - he never did cry out or bite me. I did not wear gloves.

He had a small wound to the anterior chest and a small wound just superior to the break, midline, on his back. They were scabbed over and not bleeding. They did not seem to bother him in the scheme of things. I am not sure their significance. Claw punctures? I have no idea and don't like uneducated guesses.

He had no bladder or bowel control, and only parasympathetic distal muscle tone. He would have to have been manually expressed 3 times a day every day for the rest of his life, since having no sympathetic tone starting that high up apparently results in retention, not incontinence. He did not defecate in my care, suggesting he had been starving, had had diarrhea, or simply couldn't. My conclusion is the lattermost.

Squee was not completely free of the maggots (how many eggs had been lain?!?!), and the discolored patches of skin on his abdomen and inner L thigh were actually areas of missing skin. He had to have lain injured outside for more than a day. The "discolored" patched of skin I first described were MISSING skin - I was looking at the fascia above the muscles. They should have looked pink, not off-grey. The maggots were feeding off of the margins of these necrotic decubiti, since his distal perfusion was suffering. He had been covered - crawling - with maggots when I first looked at him. I cleaned him thoroughly again on the way to the vet. I would want someone to have done that for me.

His bladder was almost full again - I had successfully rehydrated him. He could bend fully forward into the C shape he preferred because the dislocation was dorsal to his spine - the dislocated vertebrae were simply not in the way.

His life would have been filled with uncomfortable mashing against his belly, being help tightly so he wouldn't squirm, constant cleanings to minimize UTI's and other infections. Unreasonable loss of Quality of Life. It would not have been humane to even wait till the morning. Each morning the Tramadol would have worn off a bit and he would be in pain. I spared him that.

I should have taken a better picture of his face.
I hope my chronicling this experience helps others who find themselves in my situation.

Thank you for reading.

- Joe

[CritterMom]

Well, what I think is that in a few years there are going to be some very lucky children and parents in the Fort Worth area.

Isn't it *funny* how so often, the right thing to do is the hardest?

You done good. :grouphug:grouphug RIP, Squee.

[Nancy in New York]

You did everything perfectly.
You thought of his quality of life, you gave him love, dignity, tears, and you
respected a little life that was brought into your care.
You had compassion, insight and integrity.

You helped Squee to pass safe, loved, and
as pain free as possible, and with a tear
or two shed.

Some are placed in our hands with their fate already sealed.
As wildlife rehabbers, we aren't suppose to save them
all. BUT we are suppose to ease their pain and suffering, know
our limitations, and give them the love and respect that we all
hope we get in our final hours.

You did your job well. :Love_Icon

Rest in Peace
Precious Squee 237171

[lilidukes]

Joe I am so sorry :grouphug

Each and everyone of these fuzz butts who cross our paths leave
us with something. But these kids we love so unconditionally also
take pieces of our hearts and souls. They make us better humans
in my opinion.

RIP sweet Squee run free :Love_Icon :grouphug :Love_Icon

[SammysMom]

Godspeed Squee...:Love_Icon:Love_Icon:Love_Icon

God bless you Joe, for making the difficult decision to do the very best thing for the very best and most humane outcome for Squee.:grouphug:Love_Icon:grouphug

[TubeDriver]

Sometimes the right choice is the hardest one to make.:grouphug

One of the most important lessons a medical person can learn is to really listen to their patients.


Gods speed Squee. You were loved and will be remembered for the fighter you were.:Love_Icon

[sassysquirrel]

Joe
Your compassion is beyond words. Abby will be so proud that Charley talked to you.
Squee passed with love and compassion.
Thank you for spending so much time with this little one. And then having to make the tough but right decision.

Do you remember Buster and Cinny? Do you ever see them?

[rocky63]

Squee :grouphug:grouphug:grouphug joe

[Charley Chuckles]

Joe,
I am so sorry you had to part with your Squee, I am however honored that you thought of my Charley Chuckles and that he was able to somehow connect with you :thumbsup I know CC has a new friend at the bridge and you can rest assured Squees is in great hands (paws:-)
Thank you for all you did for this little one :Love_Icon
Never losses, always blessings :grouphug

[Chickenlegs]

"As you do unto the least of these you do unto me" You made a loving God proud. You will be one helluva doc dear friend :grouphug

[California Squirrel Lover]

tears running down my face, I'm just so sorry. I'm so grateful, though, that he passed with such love and compassion, thank you

Rest in peace, sweet Squee, you are precious :Love_Icon:Love_Icon:Love_Icon

[czarina]

I, too am writing this through tears. What a wonderful gift you provided for sweet little Squee. He was safe, clean, warm, dry, predator free and pain free and most importantly loved while in your care. These are the finest things we can offer another living being.

And as for him "being just a squirrel", I'm sure it would be like that scene in the Movie Airplane, where everyone lined up to punch the insensative person.
You did a wonderful and generous deed for sweet little Squee.

Godspeed little Squee.:grouphug:Love_Icon:grouphug:Love_Icon:group hug:Love_Icon

[anniedancer]

Joe, you did a wonderful job, and made the right decision. Good luck with medical school....... if compassion could get you in, you'd have no problem.
Putting an animal "down" shouldn't be an easy decision. I have had to do it several times (pet cats). Horrible, but the responsible thing to do.
As an RN of 32 years, I have dealt with death many, many times. Worked for a hospice for several years, also nursing homes....not to mention 17 years of Med-Surg. I strongly believe in relieving suffering. Humans can, and should, make their wishes known before it's too late, as this makes the decisions easier for caregivers and doctors. Animals cant do this, and we have to step up to the plate.
The worst job I ever held was at a hospital associated with one particular religion (Im not saying which!). Patients could NOT be made "Do Not Resuscitate". It was against hospital policy! So, we were forced to prolong miserable, painful lives, with nothing to ease pain, shortness of breath.....nothing except our hands. It was horrible. We kept people alive for months, suffering a living hell. I still have nightmares about how people suffered there. I was delighted to leave and work at a much more progressive hospital, where morphine drips and other "comfort meds" were the norm.
Anie in Fl