Brain Injury, A Wee Little Success Story

The day I met PeeWee, I could have held her in one hand.  I could have...if her condition would have allowed it.  She weighed less than three pounds. 

I walked into the exam room to see a middle aged woman cradling the tiny dog in her arms.  The dog was a 9 month old female chihuahua with an injury of sudden onset.  The owner claimed that she had come home to find her pet in this condition.  She was unable to walk and wouldn't stop screaming.  As I reached to hold and examine her, the fearful scream that escaped her lungs filled the building.  She would not stop unless she was cradled safely and she repeated the scream each time that she saw hands coming toward her.  When I placed her on the ground, she could only turn in very small tight circles to the right.  She continued to circle until she was picked up again, screaming, and cradled safely.  Only then could she rest quietly. 


After a thorough physical and neurologic exam, it was clear that this pet was suffering from a brain injury.  I questioned the owner about how this may have happened, but all she would disclose was that her husband didn't like the dog very much.  Perhaps he had kicked or thrown her.  I recommended a referral to the neurologist, but the owner's limited funds would not even allow the pet to remain in the hospital for treatment of brain swelling.  I was left then with the only option of sending home oral medicines with the owner and a poor prognosis for recovery.  I prepared her that the condition may even worsen.  I begged her to relinquish the dog if she felt that her husband would harm it and advised her that a quite and calm environment was the only place for this pet during the recovery period.  The owner, feeling a sense of guilt and responsibility, did not want to euthanize or give up her pet.  She wanted to mend what her other half had broken. 

Three days later I received a phone call.  The woman tearfully explained that her husband could not tolerate PeeWee's screams and that she was not improving.  She offered to give PeeWee to me if I felt she could improve.  If not, she would bring her to put her to sleep. 

Yes, I replied.  Please bring her to me.  No need to even ask my wife about this one.  Bringing home a pet with a brain injury to a special education teacher was a free pass. 

When I re-examined her, I could see that she had worsened.  She still turned in tight circles to the right, but her fear and anxiety were ever-present.  Her fear of hands made getting food and medicine into her mouth a challenge.  She had lost weight and was dehydrated.  I was completely frustrated and unsure of the safest plan for this little creature.  So I did what all new graduates do, I called one of my professors. 

I explained the history and physical exam finding over the phone to the neurologist.   How can I help, being this long delayed from the injury, and how was I to handle this pet's fear of hands?  The neurologist explained that given this pets breed, "applehead" chihuahua, and likely trauma, her injury was most likely from a bleed around or inside the ventricles of her brain that was inhibiting cerebrospinal fluid flow and resulting in a severe hydrocephalus.  Short of proper brain imaging and placing a shunt, there was little to do other than treat the condition chronically with anxiolytic medicines and steroids.

My wife and I discussed it.  As newlyweds who had just purchased our first home, spending thousands of dollars on this dog was beyond our ability.   We decided to give her some time on the medicines.  If they didn't help after a month or two, we'd have to euthanize her. 

The pharmacist looked at me very strange when I explained that I needed the prozac and dexamethasone in a very concentrated liquid.  He would have understood if he could hear her screams. 

I decided that perhaps if she could get used to just one set of hands, she would improve.  One person feeding her.  One person medicating her.  One person loving her gently.  I would be that person.  Everyone else was instructed that she had to be left alone.  In the day, at the hospital, she remained in small bed in a cage where it was quiet.  At night she slept in our bathtub to keep her from circling into a corner and getting stuck.  I would hold her in my lap as we watched TV or ate dinner and she slowly got used to me.  Perhaps it was the prozac.  Either way, the screaming began to be less frequent. 

As her fears became less, I would gradually try to exercise her more.  I  would sit her in the middle of the floor and let her circle there until she got tired.  Then I would pick her up and let her fall asleep in my lap or in her comfy bed in the bathtub. 

Then one day, a small miracle happened.  I had placed her in the living room floor for exercise and my wife and I were cooking dinner.  We both experienced a feeling.  It was one of those strange feelings that come over you when something just isn't right, like when someone is staring at you through a window.  We both stopped talking and began to look around.  There in the middle of the living room floor stood PeeWee looking at us.  It was enough to bring tears to our eyes.  She stood very still looking at us.  It was the first time since we had known her that she was not circling.  So much was our excitement that we squealed and ran to her.  Her response....was to begin circling again.

That day was the beginning of many baby steps.  Over time she began to stop for longer periods of time and look around her.  The she began to move with intent.  She would travel in small circles until she reached a destination.  We began placing her food bowl and water bowl on opposites ends of the room and she would circle forty or fifty times to get from one to the other...but she got there!  With even more time, her circles began to get larger and larger until she could travel from one end of the room to the other in a large arc.  Best of all, so long as we moved slowly, she was no longer afraid of our hands.   

We were able to wean her off her prozac by the time she began living outside our bathtub.  Amazingly she remembered her potty training and interacted well with our cat, Hazel.  Hazel liked to torment her, but PeeWee was quick to find her voice and would give her a sound lecture on not being touched. 

Then the day came to find her a stable home.  You see, we were expecting a child and moving to another house.  We were unsure how PeeWee would handle these changes and wanted to find her a place where she would be safe and loved permanently.  I mentioned her to a coworker, Heather, at a local vet clinic.  She and her husband had no children and no plans for children.  They owned cats, which we knew that PeeWee tolerated well.  I was praying for a perfect match.

I brought PeeWee to work with me one day and asked Heather if PeeWee could stay up front with her where it was quiet.  One of PeeWee's quirks was that she had a surface preference.  If she was placed on a towel in the middle of a tile floor, she was simply unable to work up the courage to step off the towel.  I knew she'd stay put.  I reminded Heather that I was looking for a really great home for her and to let me know if she could think of anyone.  As the day went on, I found her talking to PeeWee and holding her in her lap.  I even caught her taking a picture of her with her cell phone.  Near the end of the day, I asked Heather if she'd like to try taking PeeWee home for a trial weekend.  There would be no obligation and I'd come and pick her up if she became distressed or a problem.

PeeWee never came back to our house after that.  So in love were Heather and her husband with the little dog that she rapidly acquired an entire wardrobe of tiny outfits, fancy carriers, and soft tiny beds.  Heather's home was so stable in fact that over time she was actually able to wean PeeWee off all her medicines entirely.  She became a normal little chihuahua.  Well, as normal as a chihuahua could be.  She retained many small idiosyncrasies, as the breed often will do. 

Since living with Heather, PeeWee has gone on to win several costume contests, has been pictured in the local paper several times, has had a bad knee repaired, and even become queen of the household cats.  She is certainly well adjusted. 

Two days ago, when I saw her again, it brought tears to my eyes to see the gray hair beginning around her eyes and nose.  What a blessing to see this dog live to become normal.  That little gray face that looked up to me was the same little face that stood still in my living room.  That tiny little screaming dog learned that not all hands will hurt her.  To see her walk and run in straight lines brings me overwhelming joy. 

It's a great reminder that, especially with brain injury, perhaps we give up too soon.  If we can find the time, money, and patience, perhaps a healing can take place.  If we can give enough love, perhaps a body and a brain can respond.  If we are gentle and kind, then perhaps we can gain trust.  If we are willing, perhaps we can take a tragedy and turn it into something inspirational and good. 

Thank you PeeWee for helping me learn a very valuable lesson.  You make a great little reindeer this year.