If Tennessee veterinarians ever want to talk teamwork they can turn to the travails of Tinkerbell for a case in point.
The 10-year-old Yorkshire terrier, owned by Cindy Plummer of Sweetwater, Tenn., has been under the care of Dr. Elizabeth Shull of Knoxville, and Drs. Kristi Lively and Rhea Morgan of Farragut, Tenn., the past seven years for blindness and brain damage.
“They are my angels,” says Plummer, in describing the trio. “They have been honest, candid and caring throughout Tinkerbell’s care. And they have kept each other in the loop in addition to me.”
Throughout the long-term case Plummer has put in plenty of road miles. Each visit to her primary veterinarian Lively’s hospital is 74 miles round trip and to Shull’s neurology practice it is 90 miles round trip. Dr. Shull is a Board-certified veterinary specialist who earned her certification with the American College of Veterinary Internal Medicine.
Tinkerbell was referred to Shull from Lively in July 2007 for a neurological evaluation due to blindness in her left eye and weakness in the left side of her body. Previously, she had been examined by Morgan, a veterinary ophthalmologist, who determined her blindness was due to a brain abnormality.
An MRI identified a cavity and inflammation in areas predominantly on the right side of the brain. Additionally, Tinkerbell was also found to have a congenital brain problem termed hydrocephalus (water on the brain).
“Toy breeds are at increased risk for this,” says Shull. “It may cause seizures and other neurological abnormalities or it may be asymptomatic throughout the dog’s life. In Tinkerbell’s case, the hydrocephalus was an added abnormality that could also be contributing to her symptoms, but how much was uncertain.”
Tinkerbell’s treatment by Shull was performed on an outpatient basis. Showing her dedication as an owner, every three weeks Plummer drove Tinkerbell back and forth to the hospital twice daily for two consecutive days, where Shull gave chemotherapy agent injections for the first two years. Subsequently, Lively has handled that procedure. Tinkerbell will require treatment indefinitely.
Shull continues to see Tinkerbell every six months, assessing her level of awareness, vision, strength, walking patterns and leg control.
“My role is to determine whether the disease is stable or progressive, and based on this I make recommendations for medical adjustments, if needed, to keep her disease in remission,” explains Shull.
Tinkerbell’s brain damage is irreversible, says the neurologist, and the dog has permanent abnormalities (blindness in the left eye, weakness on the left side of the body, circling to the right and mild disorientation), but her medication is designed to suppress the immune reaction and inflammation with the goal of preventing further destruction of brain tissue.
Tinkerbell remains under the care of Morgan, as well, to manage her decreased tear production and other primary abnormalities.
It is not unusual for patients with this dog’s disorder to only survive a few years, says Shull. “Tinkerbell’s survival is attributable to her own spirit, the dedication and extremely good care provided by her owner and the tremendous follow-up care given by Dr. Lively.”
Despite receiving several medications daily by her owner Plummer, Tinkerbell looks forward to each day. “She loves Cheerios for treats. She doesn’t play with toys any more but she runs around the other dogs while they are playing with toys. Her favorite spot is in my lap.”