Patches, center, with her three puppies. (Photo courtesy of Flowerwood Dachshunds)

Dachshund breeder Dale Flowers has weathered many a journey with her dogs, shepherding them through pregnancies, even letting them sleep in her bed at night just weeks before their due date. But the medical odyssey she recently went through with Patches, named for her unique dappled marking, was unlike any other.

Thanks to recent treatment at UF’s Pet Emergency Treatment Services in Ocala and follow-up at the Small Animal Hospital in Gainesville, a very-pregnant Patches survived a near-fatal bout with pancreatitis. And not only did she survive; she gave birth within days of her discharge to three puppies, two of which survived and are healthy.

“Patches and the pups are doing fine,” Flowers said, adding that the puppies will turn 7.5 weeks old on May 2. She had reservations on both for adoption.

“I am very pleased with Patches’ progress and thank UF again for saving her and her babies,” Flowers said.

But the happy ending to Patches’ saga could have easily gone the other way. UF veterinarians came very close to spaying Patches due to the severity of her illness, which would have meant sacrificing the babies to save her life, with uncertain impact on Patches. Veterinarians wrestled with the best way to proceed, involving specialists from three different services, said Dr. Leo Londono, a resident in emergency and critical care.

Londono first saw Patches when she was admitted at the PETS after-hours emergency clinic and continued to work with the dog after her transfer to Gainesville for specialty treatment.

“We don’t see a lot of cases involving pregnant females that get sick, and we’re not always sure of the best way to proceed,” Londono said. “If the dog is painful, you can’t give too many pain medications, as this could affect the puppies. We weren’t sure if going to surgery was the right decision either, as anesthesia could have made her pancreatitis worse.”

Ultimately, veterinarians’ decision to administer aggressive therapy and give Patches more time to respond to it, resulted in Patches’ and her puppies’ survival. In addition, the relationship between the two UF veterinary clinics involved in her care allowed for a seamless transfer to Gainesville and the full house of experts available at the main Small Animal Hospital.

“This case really illustrates well how smoothly the two clinics work together,” said Dr. Carsten Bandt, chief of the hospital’s Emergency and Critical Care Service.”We were able to drive Patches to Gainesville and provide continuous care for her, as we do for the most critically ill patients who initially come to us through PETS.”

Patches ordeal started on Jan. 30, when Flowers found her prized 5-year-old dog on the ground and obviously in pain. Patches was hyperventilating and would not eat, Flowers said. When her condition didn’t improve after a few days of treatment, Flowers’ local veterinarian, Dr. Ashley Boyd, referred the dog to UF.

“Dr. Boyd said she might die if she were not admitted,” said Flowers, who has had Patches since she was an 8-week-old puppy. She described Patches as being very affectionate — a cuddler who loves to sleep in the crook of her arm and snuggle. She said Patches’ most recent litter was her fourth, and that her puppies had always been sought after in the past.

Veterinary specialists from UF’s emergency and critical care, small animal surgery and theriogenology services were involved in Patches case, illustrating UF’s multidisciplinary approach to problem solving and case management, Londono said.

“We learned a lot from Patches case,” he said. “The owner was very concerned about Patches, so if we had to sacrifice the puppies to save her life, we would have, but at the same time we didn’t want to rush into a decision when we didn’t have to. But sitting and watching and waiting wasn’t going to be enough either, so we decided to be more aggressive in our therapy and in the end that was the right thing to do.”

Flowers said the ordeal was an emotional roller coaster and one she hoped to never have to go through again.

“UF’s care of Patches was very good,” she said. “Everyone from the front desk to teams in the ICU knew Patches and had nice things to say about her. I received daily reports, sometimes twice daily, from Dr. Londono and I greatly appreciated that.”

By Sarah Carey

Dr. Alessio Vigani snuggles with Mocha Delight on Jan. 16 in the lobby of UF’s Small Animal Hospital.

Today a 6-month-old labradoodle from Tavares wrestles with her owners and runs like a normal puppy, but normal she will never be to anyone who watched her month-long struggle in intensive care at the University of Florida Small Animal Hospital, where veterinarians fought to save her from a severe tetanus infection.

Mocha Delight, or Mocha, as her owners call her, had the most severe case of tetanus ever seen or treated by UF veterinarians. When she arrived at UF on Nov. 13, no one thought she would survive.

“No one here can remember ever being able to treat and save an animal so severely affected by this type of infection,” said Dr. Alessio Vigani, a veterinary resident in emergency and critical care at UF. “When she arrived, she was in a constant state of tetany. All of her muscles displayed extreme rigidity and she was unable to eat. If you visualize a bearskin rug, that’s what she looked like; she was completely flat. That she could pull through at all is nothing short of a miracle.”

To her owner’s well, delight, the adorable puppy no one thought would survive was discharged to go home on Dec. 22. To see her now, “You’d never know anything had been wrong,” said Joan Standlee, Mocha’s breeder and original owner.

But in mid-November, Standlee found Mocha stiff against her cage door at the kennel where she was bred. Standlee took the dog, which had a fever of 110 degrees, to an emergency clinic and to two other veterinarians, including a neurological specialist, before bringing her to UF for treatment of muscle rigidity.

At that point, the dog had received an anti-toxin medication and penicillin injections, but UF veterinarians said these treatments are not effective once the tetanus infection has advanced to the severe stage.

Based on Mocha’s clinical signs, UF veterinarians diagnosed generalized tetanus, which is most commonly caused by the toxin spreading through the bloodstream.

Mocha, at right, with her family dog companion, Mollie, and her breeder and original owner, Joan Standlee, on Jan. 16. UF veterinary student Kyle Donnelly, at left, was one of the students who helped care for Mocha. (Photo by Maria Farias)

“We were the only ones with the facilities to be able to provide 24-hour intensive care as well as rehabilitation therapy,” said Dr. Justin Shmalberg, a clinical assistant professor who worked closely with Mocha during the rehabilitation phase of her treatment.

“She couldn’t open her mouth, so she couldn’t eat,” he said. “She received intravenous nutritional therapy and antibiotics, cooling treatments to bring down her fever and muscle relaxants to reduce spasms while the bacterial toxins worked their way through her system.”

Mocha was isolated in ICU for nearly two weeks to minimize any form of stimulation, which could lead to spasms and excruciating pain for the dog, veterinarians said.

After about 10 days, the toxins in Mocha’s body began to wear off and her muscles gradually loosened. At that point Shmalberg and a team of rehabilitation therapists began a regimen of physical therapy. For two weeks, six hours a day, veterinarians and technicians performed range of motion, ultrasound, acupuncture and even pool therapy on the young dog.

“We treated particularly sensitive spots with acupuncture,” Shmalberg said. “We did stretching exercises within the limits of what she would allow. We were just trying to assist the process. Our main concern was that her soft tissue and her muscles would ‘learn’ the abnormally flexed position, so we wanted to encourage movement as much as we could.”

Mocha’s rehabilitation treatment was as intensive as any animal has received at UF in the five years since the Small Animal Hospital began providing the service, Shmalberg said.

Tetanus is caused by a neurotoxin released by the bacterium Clostridium tetani. Spores of the bacterium can survive in the soil for years and in the body for months, and usually enter the body through minor punctures or scratches. Once in the body, the toxin spreads, causing painful muscle spasms in the neck, arm, legs and stomach.

Dr. Justin Shmalberg holds Mocha in front of the pool used for part of her rehabilitation therapy. Also gathered in the shot are other members of Mocha’s rehabilitation team. (Photo by Sarah Carey)

“While pinpointing the small break in the skin that caused Mocha’s tetanus is difficult, we think she probably acquired the infection through her umbilical stump or through small cuts in her mouth associated with teething,” Vigani said.

Dogs and cats are not regularly vaccinated to prevent tetanus because the disease is rare in those species, veterinarians say. As for Mocha, UF veterinarians say she is now fully cured and should not have any long-term consequences from the infection and intoxication.

“To us she is truly a miracle dog,” Standlee said.

Dr. Alessio Vigani with Jackie during a recheck appointment on Oct. 30, 2012.

By Sarah Carey

A dog bitten by a rattlesnake is now home with her owners and doing well after becoming the first patient at the University of Florida Small Animal Hospital to receive treatment in a new hyperbaric oxygen chamber, one of only a small number in the country being used in veterinary medicine.

The 1-year-old Siberian husky/Standard poodle mixed breed dog, named Jackie, was given a clean bill of health during a recheck appointment on Oct. 30, 11 days after her initial arrival at UF.

Her owners, Joe and Jan Smith of Clermont, Fla., found their beloved pet lying on a bloody floor near a water bowl filled with bloody red fluid on Oct. 18. Jackie had played outside earlier with other family dogs inside the family’s small, fenced yard but seemed fine when she came indoors.

After finding her collapsed a short time later, the Smiths rushed Jackie to the Leesburg Veterinary Emergency Clinic, where veterinarians told them Jackie had been bitten by a rattlesnake.

Jackie with her owner, Jan Smith, soon after they arrived for a recheck appointment at UF’s Small Animal Hospital on Oct. 30, 2012.

“They told us she had less than a 40 percent chance at survival,” Jan Smith said. “We wanted to do everything we could for her. She deserved a chance and we told them to go ahead with the antivenom therapy.”

Veterinarians treated Jackie overnight with two vials of antivenom, then recommended that the Smiths take Jackie to UF for continued treatment the next morning.

“When Jackie arrived, she was in shock and experiencing dangerously low blood pressure and accelerated heart rate,” said Dr. Alessio Vigani, a resident in emergency and critical care medicine at UF. “We provided fluid therapy and administered two vials of antivenom immediately after she arrived.”

Three more vials were given over the next 24 hours as Jackie, who had been bitten multiple times near her muzzle, struggled to survive. Within 12 hours, the tissue around Jackie’s bite wounds started turning black and had a copious bloody discharge. At that point, UF veterinarians decided that she would be a candidate for hyperbaric oxygen therapy.

“We thought Jackie might benefit from the treatment, as snakebite wounds are associated with tissue death,” said Dr. Justin Shmalberg, a clinical assistant professor of integrative medicine at UF. “Such damage generally requires extensive surgery and additional hospitalization, which adds a large amount to the bill and to the animal’s time here.”

The treatment is provided inside of a tube-shaped container known as a hyperbaric chamber, through which animals receive highly pressurized, 100 percent oxygen delivered to tissue that wouldn’t receive it otherwise. Shmalberg and UF veterinary technician Wendy Davies recently received extensive training in the safety protocols associated with the use of the hyperbaric chamber, which was installed at UF in mid-October.

Jackie is shown inside the UF Small Animal Hospital’s new hyperbaric chamber on Oct. 22, during the last of three treatments she received while a patient.

Over the next three days, Jackie received three treatments, each lasting about an hour. Although they were optimistic the treatments would help Jackie, UF veterinarians were nonetheless surprised by what they saw.

“After the first two treatments, there was an impressive improvement of the swelling, discharge and discoloration of the area,” Vigani said. “It was totally unexpected. The area that 24 hours before, we had no doubt would have required surgery, after the second treatment was almost completely healed.”

Although hyperbaric oxygen therapy is available and used worldwide in human medicine, with many scientific publications reporting beneficial effects for human diseases and in animal models, its use in veterinary medicine is relatively new, occurring primarily during the past decade.

Hyperbaric chamber technology is now being used by a small number of veterinary practices and an even smaller number of academic institutions to treat conditions that include non-healing wounds, particularly external wounds where there are concerns about blood supply. Crush and burn injuries and trauma injuries, such as might be caused by animals being hit by cars, being in dog fights or being bit by a snake.

Internal injuries with extensive tissue damage, such as pancreatitis, spinal cord and brain injury, are also likely to respond favorably to the treatment, veterinarians say.

Dr. Justin Shmalberg helps Jackie out of the hyperbaric chamber on Oct. 22.

Animals that receive hyperbaric oxygen therapy typically feel no discomfort, other than perhaps feeling some anxiety at being in a confined space, Shmalberg said.

“To a dog, it’s like diving down into water, with increased pressure around the body,” he said. “Anyone who has free-dived deeply knows that you need to be able to clear your ears. After that, most animals tend to fall asleep.”

He said veterinarians are still learning how often to treat animals, but that in general hyperbaric oxygen treatment tends to be performed once or twice a day, with about four hours between treatments to allow time for the animal to recover from the increased pressure in the environment.

“We are always looking for new and emerging ways to treat different conditions, such as non-healing wounds,” Shmalberg said. “While we are excited to have this new tool available, we also feel a responsibility to advance our scientific knowledge of how the technique is best used in animals.”

Such information will help veterinary practices refine the circumstances in which hyperbaric oxygen therapy will help to alleviate a patient’s symptoms, he added.

As for Jackie, her owners are ecstatic that the dog they call “a treasure to our family” is still with them.

“We are completely overwhelmed with joy that Dr. Vigani and the staff at the UF Small Animal Hospital were able to save Jackie’s life,” Jan Smith said. “Not only did they save her life, but they saved her from having surgery on her skin from the immense swelling. As I am typing this, Jackie has her paws on my chair and is licking my face and I’m smiling through my tears.”

Members of the Schmitt family with their dog, Cali, after Cali’s discharge from the UF Small Animal Hospital on July 20, 2012. Cali suffered from massive envenomation from an Eastern diamondback rattlesnake and spent two weeks in our ICU receiving emergency care to save her life. From left to right are Schmitt sons Daniel, Jacob, Michael and (petting Cali) Zach; Dr. Gareth Buckley, Dr. Alessio Vigani, Dr. Michael Schaer and two UF veterinary students, Allison Vansickle and Alison Sass. (Photo by Sarah Carey)

By Sarah Carey

Twenty-four vials of antivenin, 14 days in the UF Small Animal Hospital’s intensive care unit, countless hugs, kisses and Facebook shares later, Cali, a 3-year-old chocolate Labrador retriever mix, is home with her family in Tavares, living the life of Riley.

A YouTube video and Facebook page the family created to solicit donations to help pay Cali’s medical bills went viral, resulting in more than $19,000 being raised to cover her care, and in the process turning Cali into a celebrity among dog lovers from as far away as China and the United Kingdom.

“I expect you guys to treat her like Queen Elizabeth,” Dr. Michael Schaer, an emergency and critical care specialist, told Connie Schmitt’s sons Michael,15; twins Daniel and Jacob,13; and Zach,8, when they came with their mother to visit Cali on July 17, her last week in the hospital. It was one of several visits the family made to see Cali during her recovery from a bite likely inflicted by an Eastern diamondback rattlesnake.

Schaer explained to the Schmitts that once Cali left the hospital, it would take her awhile to regain her strength and to return to life as a normal dog. However, the Schmitts will tell you the gentle brown dog they rescued two years ago has never been a normal dog at all.

Cali entered the Schmitts’ lives when she showed up in their yard, looking sad and lethargic. A family friend and neighbor, a veterinarian, came over and treated Cali minimally, then subsequently at her clinic for infections in both eyes and ears, as well as for fleas and worms. The family posted a notice on Petfinder to see if anyone would claim Cali, who was thought to be about 1 year old. No one did.

“Her condition clearly indicated that she had been neglected for awhile, but she was housebroken and very obedient,” Schmitt said. “It took her about a month to heal to the point where she would even run with the boys outside.”

Two years passed, and Cali’s life evolved to one of chasing lizards, geckos and squirrels on the family’s one-acre lot. She had an unusually gentle personality, her family said, given the neglect she had experienced in her first year of life.

“We weren’t pet people, and although the kids had wanted a dog for a long time, Mike and I didn’t,” Schmitt said. “We used the fact that Mike is allergic to say no. But Cali changed all that. We fell in love with her, and even Mike was not reacting to her like he had to other dogs. She seemed so appreciative to us for taking her in and nursing her back to health and immediately took to us as we did to her.”

Schmitt’s son, Michael, once saw Cali tear off part of a dog treat and give it to another dog.

“One time I saw her take a biscuit over to a little baby in a stroller and drop it at her feet,” he said.

But on July 5 around 6 p.m., family members found Cali collapsed in their yard, foaming at the mouth and not moving. They then saw blood on Cali’s neck and immediately suspected snake bite. The Schmitts immediately took Cali to their local emergency veterinary clinic in Leesburg. Despite two vials of antivenin, however, Cali did not improve, so the next morning the family brought Cali to UF for continued treatment.

From July 6, when Cali arrived, to her discharge on July 20, she experienced a series of medical crises that included three episodes of re-envenomation; heart arrhythmias; an allergic reaction to the antivenin; and serum sickness, not to mention infection with high levels of E-coli bacteria. She also had three surgical procedures to remove dead tissue around her bite wound.

UF’s emergency and critical care team kept the family updated at every turn. In the first five days, whenever another two-vial treatment of antivenin was needed, the family would hope it was the last one. But then Cali would regress again.

“At that point, the stress of the surmounting bill was overwhelming, but we kept thinking that we had gone so far and we couldn’t let her die now,” Schmitt said. “So, with blind faith, we continued to agree to whatever she needed, knowing that we just couldn’t give up on her and that we would find a way to come up with the money to pay for her care.”

The family got busy thinking of ways to contribute to Cali’s bill. The family’s sons decided to donate everything they made in their summer jobs of mowing lawns and weeding to Cali’s care, and Schmitt picked up extra shifts at Disney World, where she works as a seasonal cast member.

Jacob Schmitt, 13, and his brother, Zach Schmitt, in background, pet Cali on the day of her discharge. (Photo by Maria Farias)

“By Monday (July 9), Dr. Schaer spoke to us and said Cali’s bill was quickly approaching $7,000 and that she continued to need antivenin,” Schmitt said. “He wanted to prepare us for the fact that at the end of the day, we might not have a live dog. We asked him if there would be a point where he would know that more antivenin was pointless, and it would be best to put her down. He said he wanted to try two more vials, and that we might have to have that conversation later that afternoon.”

At that point, the family was desperate and their YouTube video was born.

“The boys all got together and started pulling all the pictures they’ve taken of Cali since we got her,” Schmitt said. “We know that times are tough, and we thought that by asking people for $1 donations and asking for them to share our post, if we could spread the word far enough, we could raise enough funds to help offset the balance that we owed. We were nowhere near prepared for what happened as a result of the video.”

As the video and word of Cali’s plight spread, the family navigated through Cali’s medical rollercoaster with the support of what soon became hundreds of virtual friends and fans, some known to the family and many more, complete strangers. Their Chip-in online account for donations kept growing and growing, as more became aware of Cali’s situation and contributed to help her.

“I’ve seen a lot of snake bite victims, and some pretty bad cases, but this was the worst because of all the unexpected complications that were the result of the amount of venom Cali received and her reaction to it,” Schaer said. “Usually it takes a couple of vials of antivenin and a couple of days to turn an animal around, but in Cali’s case it was 24 vials of antivenin and two full weeks of constant care. That’s unheard of.”

UF veterinarians knew they had turned a corner in Cali’s care when, following a surgical procedure July 16 to remove additional dead tissue from the bite area, she showed no sign of re-envenomation. At that point, 22 vials of antivenin had been administered to Cali during her stay, and she had begun showing signs of an allergic reaction.

The Schmitt family with Cali. From left to right in front are Zach Schmitt, 8; Michael Schmitt, 15; and twins Jacob and Daniel Schmitt, 13. (Photo by Sarah Carey)

The medical team knew they could not give any more antivenin due to the risk of Cali going into shock. Had Cali shown further signs of re-envenomation, there would have been no way to reverse the effects of venom in her system. Cali almost certainly would have died.

But three hours postoperatively, Schaer was grinning ear to ear.

“Judging from the way she looks now, compared to how she appeared soon after the previous surgery, when the last re-envenomation occurred, I am almost ready to pronounce her out of the woods,” Schaer said at the time.

The next day, UF veterinarians told the Schmitts that Cali just continued to improve and that they were feeling much better about her overall prognosis. At that time, one final surgery remained to close the wound, but Cali came through the procedure with flying colors.

On July 20 her family came to Gainesville to take their beloved Cali home. Her family has continued to post updates about her progress on the Facebook page they set up for Cali, www.facebook.com/pleasehelpcali.

Schmitt says Cali has received many visitors and is being pampered at home every day. She is eating well, drinking a lot and getting lots of rest. Meanwhile, donations continue to pour into the Chip-in online account the family established when they first turned to social media for help.

Schmitt said any overage would be given back to UF to support help other animals. She said she and her family were “humbled and honored” to have been able to witness “the great things that happen at the UF Small Animal Hospital.”

“From the girls at the front desk to the technicians, the doctors and even the administrative staff, each and every person we have had contact with has been amazing, Schmitt said. “The love, caring and compassion in every person there is evident in the way they treat their patients and their families.”

Larry Ferguson is shown with his two dogs, Max, left, and Whiskey, right. Whiskey was treated by the emergency and critical care service at UF’s Small Animal Hospital after being bitten by a deadly coral snake in December 2011.

“Red on yellow, kill a fellow; red on black won’t hurt Jack” might be a familiar folk rhyme to many residents who grew up in Florida or elsewhere in the Deep South, as a helpful way to distinguish the deadly Eastern coral snake  from the harmless scarlet king snake it strongly resembles. But Larry Ferguson, who recently moved to Gainesville, Fla., from Arkansas, had never even heard of a coral snake, much less the danger they pose.

Alerted by his two dogs barking on Dec. 4, Ferguson went outside and found a colorful banded snake dead near one dog, and the other clearly distressed in the yard. A call to his veterinarian, Dr. Janine Tash of Aalatash Animal Hospital in Gainesville, revealed that the distressed dog, a 3-year-old pit bull terrier named Whiskey, had most likely been bitten by a coral snake.

Ferguson was told that the University of Florida Small Animal Hospital was the only place his animal could receive the antivenom that could possibly save his life. He rushed Whiskey to the hospital’s emergency room.

“In the yard, he’d been panting heavily,” Ferguson said. “On the drive to the ER, I could see him shaking. I knew he’d been bitten.”

Upon Whiskey’s arrival at UF, however, emergency veterinarians noted that the dog was “bright, alert and responsive” and were unable initially to visualize the snake bite, although they said this is not unusual because coral snakes have very small teeth.

Whiskey received antivenom, but unfortunately developed paralysis despite the treatment.

“Within only a few hours, Whiskey began showing clinical signs, becoming totally paralyzed and unable to breathe,” said Dr. Luiz Bolfer, a resident with the UF Small Animal Hospital’s emergency and critical care service.

Whiskey was placed on a mechanical ventilator and was kept on the ventilator for four days, because he was unable to breathe by himself.

The dog soon  began to have other problems relating to muscle damage caused by the snake’s venom. UF veterinarians determined that the dog had elevated myoglobin levels in his blood, which led to acute kidney disease. Whiskey was treated with several different medications to help perfuse his kidneys, increase his urine output, decrease the acid in his stomach, regulate acidic content in his blood, and control his irregular heartbeat, Bolfer said.

“Whiskey had no muscle ability,” said Ferguson, who manages a text book store in Gainesville.  “His diaphragm wouldn’t work. His lungs were fine, but his muscles wouldn’t allow him to use them.”

So Ferguson waited and hoped, with little to go on.

“My first inclination was to pay for the antivenom and if that didn’t work….” he said, his voice trailing. “I’d always heard of people spending a lot of money on pets. Initially, you might say you won’t do that, but you never know what you’ll do when you’re in the situation. I wound up doing a lot more than I thought I would.”

On the fourth day of his stay at the UF Small Animal Hospital, Whiskey started to breathe on his own against the ventilator machine. Veterinarians took him off of the ventilator to monitor his breathing, and noted that, although still paralyzed, Whiskey was able to breathe normally.

He began to improve a little every day, although veterinarians continued to treat him for the other problems and for pneumonia, a common complication associated with ventilator treatment.

“They told me the venom takes three to five days to go through the system and that his prognosis would be excellent if we would keep him on a ventilator during the time he was paralyzed.” Ferguson said.

“Finally, he started moving his legs and we moved him to a bed on the floor,” said Bolfer. “Whiskey was still not able to swallow due to his muscle paralysis, so we placed a nasoesophageal feeding tube that bypasses the mouth to deliver food directly to his stomach.”

On the eighth day of his stay at UF, Whiskey began eating canned food on his own. The feeding tube was removed and Whiskey began a program of physical therapy.

Ten days after being taken to the UF Small Animal Hospital’s emergency room, Whiskey was finally discharged and able to return home with his owner.

“He’ fine,” Ferguson said. “He’s just tired a lot, but he’s been walking a lot. He’s just a sweet dog to begin with.”

UF veterinarians finally found the snake’s tiny bite marks….on Whiskey’s tongue.