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.”