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Ryan Hospital Philadelphia, PA

Golden Girl

By: Carole Cloud

Getting old is hard to do, especially if you are a homeless 10-year-old mutt with health problems.

Last summer, Pottsville’s Hillside SPCA picked up a senior golden mixed breed found Maribel, neurology patientwandering on Route 443 in the Pine Grove area of rural northeastern Pennsylvania. Maribel is at least 10 and very possibly older, and her chances of getting adopted were slim. Like many seniors, either human or canine, she had teeth problems and arthritis. She also had an abnormal gait from what was possibly a traumatic incident.

Living on the streets isn’t for the faint of heart, but Maribel’s life was never easy. She was born in a puppy mill, which are notorious for neglect, overcrowding, and malnutrition problems. The mill was eventually raided and closed down, landing Maribel in her first of many shelters. After cycling in and out of shelters, she went to live with an elderly couple, but they fell ill and were no longer able to care for her.

But on the Fourth of July, Maribel’s luck changed. Susan Galada, an anesthesiologist (for humans), had recently lost her elderly dog, so she came to Hillside SPCA to see if she might be able to rescue an animal in need. When Susan met Maribel, the bond was instantaneous and irreversible. 

“My initial response to meeting her was to burst into tears,” said Susan. “I bent down to her and she licked my cheek, and that was it.” Because Susan’s previous dog had numerous health issues, she had the routine down. She had everything Maribel needed: ramps, a swimming pool, and a good vet. “I had to take her,” she said.

The red arrow shows the mass compressing Maribel's spinal cord.Unfortunately, Maribel’s abnormal gait continued to worsen. Her hind legs wobbled and sometimes buckled under her. And she had periods of fecal incontinence. But Susan was committed to her new charge. She took her to see her primary care veterinarian, who found that Maribel, along with everything else that ailed her, was also suffering from hypothyroidism. As for the dog’s hind legs and stability issues, the vet recommended that Susan see a neurologist.

Susan and Maribel first visited Penn Vet’s Ryan Hospital in July 2014 for a consult with neurologist Dr. Evelyn Galban and neurology resident Dr. Jonathan Wood. Using magnetic resonance imaging (MRI), Drs. Wood and Galban saw that there was a substantial mass invading Maribel’s spinal canal and compressing her spinal cord, which could be a tumor.

The red arrow shows the mass compressing Maribel's spinal cord.Some tumors can be aggressive and locally invasive, while others are more benign. Until they were able to biopsy samples from Maribel, Drs. Wood and Galban could not accurately predict which form Maribel suffered from. What was clear, however, was that removing the mass would take a lot of pressure off of Maribel’s spine, thereby relieving the dog of what must have been significant pain. The decision was made to go in surgically to biopsy the tissue, while also removing as much of the mass as possible in a dorsal laminectomy.

But there was one more issue that needed to be addressed. It looked as if Maribel might have some mammary tumors. So at the same time as the neurosurgery team excised the spinal cord mass for biopsy, Maribel underwent a partial mastectomy in three mammary glands to remove four masses, along with a lymphadectomy to remove the lymph node that drains the caudal left mammary chain.

Dr. Evelyn Galban (l) and Dr. Jonathan Wood (r) perform the first surgery on Maribel.This complex series of surgeries took several hours and would have been hard on a young dog, never mind an elderly female stray. The biopsy revealed that, in fact, Maribel had been suffering from myxosarcoma, a spinal cord tumor. But the surgery was effective. Maribel almost immediately felt better. Within 48 hours, she was walking around, ready for her next challenge. And two weeks later, she had made steady progress and was markedly better. She could sit and stand with little hesitation, and her incontinent episodes had almost disappeared.

“We always know we will outlive our pets,” said Wood. “So to take on an older dog that may not have much time, but that you bond with, is a laudable act.”

But it wasn’t only Susan Galada who rooted for Maribel’s recovery. As it turns out, Susan’s neighbor, Evelyn, is herself a ‘Golden Girl’ at the spry age of 89. Maribel and Evelyn had become great friends, and Maribel spent a lot of time at Evelyn’s house, making sure her new adopted human was happy, too. In fact, Maribel had become an icon of Susan’s neighborhood, and everyone was delighted to see her feeling better.

Maribel and her neighbor and friend, EvelynMaribel did well following surgery and was walking and running more normally until December, when she appeared to be having trouble going up stairs and was walking with a wider-based stance. Susan brought her back to Penn Vet, where an MRI of the neck and spine revealed that Maribel’s troubles had returned. Expansion of her previously debulked myxosarcoma had led to compression of her spinal cord. The MRI also showed degenerative changes to her C6-C7 intervertebral disc with bulging leading to minimal spinal cord compression.

Maribel was started on a course of prednisone to help with pain management. However, this treatment course was not successful and, in early February 2015, she was admitted to the Emergency Service at Ryan Hospital.

Dr. Evelyn Galban (l) and Dr. Jonathan Wood (r) perform the second surgery on Maribel.When the neurology team examined Maribel, her hind limb gait was again abnormal. Maribel underwent a second dorsal laminectomy to remove her myxosarcoma and decompress her spinal cord. Drs. Wood and Galban were able to aggressively remove the invasive tumor without having to additionally stabilize Maribel’s spinal column. True to her nature, Maribel took it all in stride and was up the next day, doing her best to walk up and down the hospital hallways. Within a few days, Maribel was back home, visiting Evelyn, and making everyone around her smile.

Currently, Maribel is doing well at home. She no longer has the wide-based stance she showed when she was struggling to keep her balance, and has not been seen swaying as much. But her problems aren’t all behind her. She has shown intermittent lameness in her left hind limb, more likely due to orthopedic disease rather than a neurological deficit related to her tumor. As a result, she is less active.

Maribel feeling much better, with her doctors, from left, Jonathan Wood and Evelyn Galban.Her clinical team has recommended that she may benefit from fish oil supplements in addition to acupuncture, laser therapy, and swimming.

Although it is very difficult to differentiate more benign-acting myxoma from more aggressive-acting myxosarcomas, based on Maribel's previous imaging and concurrent herniated disc at the time of relapsing clinical signs, Drs. Wood and Galban believe it may be possible that Maribel has a more benign-acting tumor. At this time, multiple treatment options exist to treat her tumor.

What’s next for Maribel? She’ll come back to Ryan Hospital for an MRI in a few weeks, and potentially additional therapies, including radiation therapy. Her future is not certain, but her courage and endurance are undeniable.

“Maribel is very lucky to have found such an amazing home with a committed owner,” said Wood. “Seeing her get a second chance is certainly is something that makes our job so worthwhile.”