Saving Lex the War Dog

Wednesday afternoons are typically slow at my veterinary clinic. Monday and Tuesday are full ,
Thursdays, a little bit more so, and then of course, Fridays can be crushingly busy as people try
to get into see my before the weekend. Usually I try to take Wednesday afternoon as a time to
get caught up on my files, call clients, or read technical articles. As I was slowly perusing
the
contents of a recent journal, my wife/receptionist, came back into my office, asking me to
speak to a new client on the phone. I placed my journal aside, and picked up the phone, "This is
Dr. Morgan, how can I help you?"
'Dr. Morgan?" he asked in a heavy Southern drawl, "This is Senator Walter B. Jones from North Carolina, thank-you for accepting my call" His voice was warm and soothing. "I wanted to talk with you about your stem cell surgery for dogs. Would you mind sharing with me how
the surgery works?"
Of course I was more than happy to explain the operation. I explained that our clinic had helped develop for dogs with crippling osteoarthritis. The surgery appeared to help regrow articular cartilage damaged by severe arthritis. The procedure involved collecting fat tissue from under the dogs skin, harvesting adult (or mesenchymal) stem cells from the tissue, then re-injecting
the purified cells into the affected joints. I explained that the procedure so far, had been very successful, restoring many dogs, who might have otherwise been put down, to full, happy active lives.
I could sense the elation in the senator's voice, as he followed up to what would be a career changing proposition for me.
"Do you think it would work in a dog wounded by shrapnel?" He asked.
I mulled over the question. I had used the surgery once to help a dog whose hip had been crushed by a speeding car, so I assumed the injuries inflicted by shrapnel might be similar. I told the senator that, sure I would love to help, but cautioned him that I couldn't guarantee any
outcomes. Finally, I let him know that this surgery was very expensive.
He asked for a rough estimate and I gave him one. After a few seconds pause on the phone, he responded that money could be appropriated. Intrigued, I wanted to know more about my potential patient and why a US senator was calling me to get involved. He proceeded to tell me the story of Lex the War Dog.
Lex was a bomb sniffing German Shephard who had been deployed to Afghanistan with his
handler Dustin Lee. The two had teamed up for many missions. However, on patrol in a heavily enemy occupied zone, Corporal Lee and Lex came under intense fire. An RPG (Rocket Propelled Grenade) hammered the armored vehicle. Dustin Lee was killed instantly and shrapnel from the grenade severely wounded Lex. The platoon had to fall back for cover. Try as they might, they
could not get Lex to leave the body of his friend. Finally, under cover of darkness, Dustin's fellow marines were able to retrieve his body and drag Lex to safety.
Lex's wounds were patched together as best as could be under the circumstances. In fact, so good was the field surgery that Lex would live through the ordeal, but unfortunately remained semi-paralyzed from the waist on down.
Naturally the Lee family, who resided in Mississippi was devastated at the loss of their son.
Because Lex had been with him up to the end, and because Lex could no longer perform his duties for the Marine Corps, the Lee family asked if they might be able to adopt Lex. Under a special congressional act, created by Senator Jones, the family was allowed to keep Lex.
The problem was the battle wounds were taking their effect on Lex. He had to be assisted to stand. Once standing, he needed to be towel walked outside to use the bathroom. His quality of life was deteriorating.
I don't know how Senator Jones got my name. I know the company I take my training from, Vet-
Stem published names of all its accredited members on-line, so maybe he or his staff found it
there. On the other hand, by this point, I had done quite a few successful procedures, so it is entirely possible he ran into one of my clients. None-the-less, he found me and I readily agreed to do the surgery. Given the families circumstance, I waived my fee. The stem cell transplantation procedure is an expensive one, and while he did not come right out and say it, I got the feeling that the normal $4000 price tag might be beyond the Lee's budget. Senator
Jones and I agreed to split the cost, so I wouldn't get too far in the hole.
Lex and a couple members of the family were flown up to Washington DC. The plan was, since the procedure itself took three days, and the recovery after that, with the physical therapy
would be difficult, I would keep Lex with me for a few weeks as he healed. Luckily, my big mutt
Buddy and Lex became fast friends.
When Lex was carried into my office on a Monday morning, I was shocked. He wrapped up in a blanket and seemed thin. His entire hindquarters had been shaved for the initial surgery. His
hair had only just started to reappear, giving him an even more despondent look. The owner
carried Lex back to my exam room and tenderly laid him on the floor. Lex attempted to stand up, but just didn't have the strength. As I proceeded with my physical exam, my heart sank.
There was definitely neurologic impairment to his hind legs. Any injury to the nervous system is by its very nature, serious. Nerve tissue, once damaged, does not heal well. A piece of shrapnel must have grazed the spinal cord affecting Lexes ability to use his back legs. They were not completely paralyzed, and he could take a few steps unsupported. But there was considerable disuse atrophy of the muscles in the hip and rear legs. His thighs were only about as thick as his upper forearms. Of course, this muscle weakness only contributed to his already deteriorated
state. After a few steps, he would just collapse to the ground in a heap. I had done countless stem cell surgeries, but they had all been in the treatment of advanced osteoarthritis. None of them involved patients with such severe nerve damage as well. At the time, I did not feel Lex's prognosis was good.
But here he was. The family had scraped enough money together to fly him up here and I had agreed to do what I could. I explained to the family my disappointment that there was neurologic component to his injuries, and frankly I did not know if the surgery would help or not. This would be my first time using stem cell therapy to treat a neurologic case. But I was game to try if they understood the risks, i.e not only might the surgery not work, it might also cause even more damage.
The Lee family were devout Christians. They told me that they felt guided here. The father said
it in such a straight forward, sincere manner, that it did not come off as weird. In fact, I tended to agree with him, although I have a difficulty admitting it out loud sometimes. The family said their good-byes and we started to prep for surgery. I had blocked off most of my morning so I could concentrate on this case.
The stem cell transplant procedure is based on the concept of mesenchymal stem cells. Stem
cells are pluripotent cells, that is they can transform into any cell in our body. When we are in
our fetal stage, stem cells are the progenitors for blood cell, lung cell, intestinal cells, etc. Note:
in human medicine stem cells are collected from the placenta and amniotic fluid, NOT the fetus as some conspiracists have suggested. In the Nineteen-nineties, Dr. xxxx of Case Western
Reserve University (a professor of mine at my alma mater) discovered adult stems cells. These are stem cells left over from our developmental stage. The highest concentration of stem cells interestingly was in adipose (fat) tissue. During the procedure, we perform general anesthesia on the patient and collect 3-5 ounces of fat. The fat is then shipped overnight to the Vet-Stem
facilities in California. The stem cells are harvested from the fat, purified and
concentrated.
They are then overnighted back to our hospital. We then sedate our patient and surgical prepare an area over the affected joints. A local anesthetic is introduced. A long needle is inserted into the joint space and an aliquot of the purified stem cells are injected. I have performed this procedure on many dogs suffering from advanced osteoarthritis and degenerative joint disease and have been delighted at the results. Dogs that could barely walk have the procedure. Afterwards, many owners report that their dogs are like puppies again.
The mechanism of action of the stem cells is unclear. Some scientists believe that the stem cell does what they did in utero, that is make new cells. Thus replacing damaged cartilage with new cartilage for example. Others claim that the stem cells initiate an anti-inflammatory cascade.
Either way, the procedure appears to have beneficial effects for the patient.
We placed Lex under general anesthesia for surgery on a Monday. I set about collecting the fat tissue from which the stem cells would be harvested. Making a deep incision to free up a piece of fat, I felt the distinctive sensation of metal hitting metal. As I removed the tissue, I could see
that my scalpel blade had ran into a piece of shrapnel. These bits of metal were more
than just foreign body objects in the flesh, they were pieces of the grenade that robbed the Lee family of
their only son and had paralyzed this dog. This was very emotional for me, and at first, I thought
I would keep the shrapnel to give to the Lee family. As I pondered the thought, I realized this
might be an awful thing to do. That I had found a piece of the object which had killed their child may only add more heart-ache to such a tragic situation. On the other hand, maybe seeing it
would help give the family closure. One thing was certain, I wouldn't keep it. I could not reduce this horrific reminder of the violence that occurred sitting like a mere souvenir on my bookshelf.
In the end, I threw it away. And while I noted it in my official records of the surgery, I never told the Lee family about the pieces of shrapnel I found. Maybe it was the ethical thing to do, maybe
it wasn't. It was just one of the many times a veterinarian in their career must decide based on what their heart tells them.
Lex did great through the surgery. Since we do not have a 24-hour facility at our clinic, I took Lex home with me (he is not the first patient to recover at our house overnight). I was a little worried if Buddy, our BOM (Big Ole Mutt) would be OK with Lex, as he could sometimes be finicky with other animals. But Buddy was just as concerned about Lex as the rest of us. He
complained not one iota when Lex found BuddVs bed and laid down for a night's sleep.
In fact,
Buddy, all 80 lbs. of him, curled right up by Lex. I had honestly never seen him do that with
another dog before. Kris, my wife stayed home with Lex the next day, to comfort him, and administer his medications.
On Wednesday we took him back to Georgetown Veterinary Hospital. The UPS guy was right on time with the purified stem cells, fresh from the Vet-Stem labs in California. We sedated Lex again and surgically prepped the right and left coxofemoral (hip) joints. We also shave a small
patch above the spinal cord near where the hip bones start. Using a long, but thin
needle, we placed a local anesthetic at each of these locales. Again, using a long, fine diameter needle we inserted the precious stem cells into each joint space. Additionally, we gave 1 aliquot intravenously. Finally, because I felt that spinal cord may have been damaged, I injected an aliquot of stem cells directly into the subarachnoid space, an area that surrounds the spinal cord
with a cushion of fluid. This last part was more of a try and see approach rather than based on
any empirical evidence that it would work. If done carefully and correctly, it couldn't hurt. Again, Lex recovered just fine, and we took him home to care and nurse him through the next 10 days until the Lee family could get back to Washington DC.
Over the next few days, I was amazed at the speed of Lex's recovery. I took him into the clinic each morning, and each evening when we got back home, I would do physical therapy exercises
with him. By day 3, he had begun to walk un-aided, By Day 5, he could stand up by himself and was able to walk for longer periods of time. One evening, long after our massage session had ended, I was sitting in my armchair reading before I went to bed. I thought I could hear voices
coming from the next room, so I put my book down and crept into the hallway to investigate.
There was my 9-year-old son Spencer with Lex's head in his lap. He was petting Lex and talking quietly to him. Curious, I did not let my presence be known, but just stood and watched Spencer patting Lex's head, Buddy dog laying down with the both of them. I heard Spencer whisper "It's O.K. Lex, you'll get better. My Dad is real good at making dogs better".
Usually it can take weeks to months for a dog to show this much improvement. Lex seemed
almost to be willing himself to get better. Indeed, by Day 10, he could climb stairs and use his back legs with only a minimal amount of observable weakness.
When the Lee family came to the clinic to pick up Lex, they had a TV crew from Fox News with them. I told them to wait in the exam room and I would go get Lex. The camera man started filming and I went down to fetch Lex. Lex could detect his family's presence in the building and
was jumping around like mad in his cage. When I opened the cage door, he flew out before I
could get a collar on him, and soared up the stairs. A chorus of "LEX!! !" greeted him as he ran into the room. This was the same dog that needed to be carried into our hospital just a few weeks before. As he bounded around his family trying to give everyone a kiss at the same time, the waterworks came on full tilt. It was such a joyous moment to see. The family was crying, I was crying, even the news team was crying. The Lee's left with Lex to return to their home in Mississippi. Lex and the Lee family would go on to tour the U.S. to promote fallen soldiers.
I have had my fair share of happy and sad endings. But for me, this was probably the highlight of my veterinary career. So many good people came together to help this family out. The people of Vet-Stem did not charge me for the stem cells, I donated my services, Senator Jones orchestrated the whole thing. It was the most moving, most important moment of my veterinary career. If I do nothing else in life, I can say I did this. I have a small thank you note from the Lee's. I keep it on my desk at work. It says simply "Thank you. You are one of our
Angels that our son and Heavenly father has placed in our lives".