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Gifts in Action


Aspen’s Tale: A Winding Road to Recovery

By: Karen Gross Date: Feb 9, 2017

Dr. Kate Backel was concerned. In fact, the first-year Penn Vet resident was losing sleep.

Her patient Aspen, a six-year-old male Labrador Retriever, was in the midst of fighting a severe case of dermatophytosis (ringworm), complicated by the onset of a bacterial skin infection. His journey to recovery was proving to be a winding and particularly arduous one.

However, Aspen was a trooper, maintaining his upbeat demeanor despite itchy lesions on his face and painful ulcers on his hip and hind legs. He quickly endeared himself to the staff at Penn Vet’s Ryan Hospital. And he was fortunate to have an owner, Howard Hoffman, exceptionally dedicated to his healing and care.

But for Backel, there was a reason for the stakes to feel especially high: Aspen was her first patient at Penn Vet.

First Day, Challenging Case

Aspen at the beginning of treatmentOn a Monday morning last July, Backel was getting ready for day one on the job as a Penn Vet dermatology resident. She had previously earned her undergraduate and veterinary degrees at Cornell, followed by an internship at Red Bank Veterinary Hospital in New Jersey, where she found herself drawn to the practice of dermatology. She was eager to join the world-class Dermatology Service at Penn Vet’s Ryan Hospital.

“During my internship, I spent a couple of days at Penn Vet shadowing the Dermatology Service,” Backel explained. “I fell in love with the service and all of the people. Everyone is so friendly.”

On that Monday in July, Backel’s roommate—also a Penn Vet resident—had taken an early look at the transfer sheet alerting residents to the animals they’d be intaking in the morning. He gave Backel a heads-up that a dermatology consult patient had been admitted the previous day and kept overnight. It was a rare occurrence for the Dermatology Service to get inpatients admitted through the Emergency Service.

But, as soon as Backel saw Aspen, she understood the urgency of the case. And she was ready to jump in with both feet. “We decided he would be my patient, and I took over his care from there,” she said.

“Dr. Backel was assigned to Aspen, and I could not believe how nice she was,” recalled Hoffman, Aspen’s owner. He had traveled around two hours from his home in Harrisburg, Pennsylvania, so the dog could be seen at Penn Vet. A true animal lover who counts Temple Grandin among his heroes, Hoffman was already familiar with the high level of care at Ryan Hospital; eight years ago, he had taken another rescue dog there for treatment.

Hoffman adopted Aspen around two years ago, and while the dog had a history of skin issues, they had become noticeably worse in the week leading up to his ER admission. Although Aspen was being treated for a skin infection—attributed to underlying allergic dermatitis—he was not improving on the medications he had been prescribed. The lesions on his muzzle and around his eyes had worsened, and his hind legs had developed areas with sores and hair loss. There were also itchy patches on his left thigh and down his left and right hind legs.

At that initial exam, the cause of Aspen’s unsightly and uncomfortable condition was still a mystery. The possibilities included a severe bacterial or fungal infection, autoimmune diseases, and certain types of skin cancer.

Backel submitted multiple biopsy samples, a fungal culture, and a deep tissue bacterial culture to the in-house diagnostic labs at Ryan Hospital. Aspen’s fungal culture revealed that he was infected by a Trichophyton species of ringworm. Backel prescribed an antifungal medication, along with antiseptic shampoo baths twice weekly and a pain medication to help alleviate the dog’s discomfort.

Aspen's lesions were slow to improveBy early August, Aspen’s lesions appeared to be improving—but not at the pace Backel had hoped. Because of the severity of the ringworm infection, she decided to add a second antifungal medication to Aspen’s therapy.

And, Aspen was now contending with a complication: he had developed a bacterial skin infection. An antibiotic was also added to his medications to fight the methicillin-resistant staphylococcus.

“I think this is probably one of the most severe cases of dermatophytosis that I’ve ever seen, especially because then he developed a secondary bacterial infection. It was a challenge,” recalled Dr. Christine Cain, Section Chief of Dermatology and Allergy at Penn Vet and the supervising clinician for Aspen’s case.

Cain worked together with Backel throughout the course of Aspen’s treatment. “I was the point person making sure we had the diagnostic and treatment plan tailored to the patient,” Cain explained, adding, “While I was the primary mentor working with Dr. Backel on this case, we have other boarded dermatologists and pathologists who were all working together.”

“We are a teaching institution, and we all are very good at collaborating with each other,” she continued. “When your dog comes in to see someone in the Dermatology Service, they are not just seeing that one person. They are seeing multiple other specialists who are leaders in their field. And everyone is under one roof, which is great.”

A Turning Point – and a Twist

That collaborative spirit was especially evident during Aspen’s first lime sulfur bath at Penn Vet. Lime sulfur is known for its antifungal and antibacterial properties—as well as its notoriously foul smell. But that didn’t deter several veterinary students, two dermatologists, and the service’s pathologist from helping out during the bathing session. “There were a lot of us involved in his ‘spa day,’” Cain joked. “We were all rooting for him.”

The lime sulphur bath did wonders for Aspen!“We did a hydrotherapy session to clean up the crust and debris on his skin,” said Backel. “I think that helped gain better access in terms of the topical medications that we were using on him.”

“I think he turned a corner after that bath,” Cain noted. “He looked so much better the next time he came in.”

Unfortunately, another bump emerged on Aspen’s road to recovery.

“He was doing so much better and everything was going well. And then he developed some elevation in his liver enzymes towards the end of his treatment,” said Backel.

After two fungal cultures came back negative—a remarkable milestone, considering that Aspen’s ringworm had been so severe—Backel decided to take Aspen off the oral antifungal medication, with the goal of bringing the liver enzymes down.

Service and Sensitivity  

“Aspen is doing very, very well now,” said Hoffman during an interview earlier this month. “He’s quite active. We walk about an hour a day, and he sniffs so much! I’d say about 95 percent of his hair has grown back.”

Backel is in communication with Hoffman and his primary care veterinarian to continue monitoring Aspen’s liver enzymes and overall health. In fact, both Backel and Hoffman point to their consistent communication as a key component of Aspen’s recovery.  

According to Hoffman, “If I would email or call, Dr. Backel would always call me back, and we would talk about what was happening. Even on the weekend, she said ‘call me.’”

Aspen's coat was looking much better at the end of his treatment

To his credit, Hoffman was fully committed to staying on top of Aspen’s regimen of medications, baths, and checkup appointments. He shrugged off the significant commute from Harrisburg to Ryan Hospital. “It was easy to drive to Philadelphia because I knew they were helping Aspen. It was such a pleasure to sit in the waiting room and see the other dogs there, and to know they were also going to get help.”

Hoffman noticed that a broad team—from the dermatologists, to the vet techs, to the receptionists—was invested in Aspen’s improvement. But he is quick to recall Backel’s expertise and her above-and-beyond compassion for his beloved pet.

“Dr. Backel and the staff there did the right thing and they were quick to do it,” he said, adding, “Dr. Backel is so sensitive. I can just sense that’s her nature. And I hope she’ll always be like that.”

Sometimes, that kind of compassionate care means losing a bit of sleep.