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Angel's Long Way Home
Pennsylvania Ag Connection - 05/17/2018

Earl Welsh was home getting his family ready for his teen daughter's dance competition. Before they headed out for a long day, Welsh wanted to give Angel, their four-year-old Yorkie, some outdoor time. He and Angel headed into the quiet streets of Philadelphia for a walk. They would not come home together. Instead, Angel would end up in Emergency Services at Ryan Hospital. And Earl would face an agonizing decision about her life.

"It was so early -- there were no cars, no traffic," said Welsh. "I thought Angel would enjoy being off the leash. We were walking nicely through an empty parking lot when something spooked her, and she took off."

Into the street. And a moving SUV.

The vehicle ran over the little dog. Although -- luckily! -- its wheels missed Angel's tiny body, the muffler and tail pipe hit her.

The driver stopped, but Welsh had already scooped up the very still and silent Angel and was running to his car. "I didn't even think, I knew I was going straight to Penn Vet," he remembered.

Welsh raced through the city streets to Ryan Hospital. Located just a few blocks from Welsh's home, the hospital is a certified Level I Veterinary Trauma Center. Open all day and night, 365 days a year, it offers the highest level of patient care available.

At 6:45 a.m., Dr. Erica Reineke was just starting her shift. Angel was her first case of the day.

"As I walked into the building, Earl was pulling up with Angel -- he was distraught," said Reineke, Associate Professor of Emergency & Critical Care.

Nurse Gina Scholz, Certified Veterinary Technician, met Angel and Welsh in Ryan's waiting room and brought the injured dog back to Emergency Services, where Scholz and Reineke got to work.

Angel being treated by Ryan Hospital's Emergency ServiceAngel being treated by Ryan Hospital's Emergency Service

"Angel's gums were pale and her pulse was weak," said Reineke. "It was very clear she'd suffered trauma to her pelvic limbs. But she showed signs of pain when we pinched her toes and had movement in her hind legs, which made me less worried about spinal damage. So, our focus was first to stabilize and make her comfortable and then assess the full extent of her injuries."

Scholz -- who Reineke called an "essential and amazing" member of Angel's care team -- put in an IV catheter to draw blood and administer fluids.

"The blood work results were consistent with blood loss and shock. So, we gave Angel crystalloid fluids to resuscitate her," recalled Reineke. "Her blood pressure and heart rate improved, and she was more responsive."

Once resuscitated and stable, Angel was ready for pelvic x-rays. The x-ray images indicated a dislocated joint and broken hip bones, as well as a pubic bone fracture. Thankfully, although the injuries were extensive and serious, there was no damage to Angel's spine or bladder, which would have made the trauma much harder to treat.

In this x-ray, the red arrows point to just two of Angel's fractures.In this x-ray, the red arrows point to just two of Angel's fractures.

Because Angel had stabilized nicely and her injuries were treatable, she was a strong candidate for surgery -- and with surgery, her prognosis for recovery was good.

Now Welsh faced a hard decision.

While Angel slept, Reineke and her team consulted with Welsh, walking him through treatment options and costs.

"Surgery was going to cost more than I could afford," Welsh explained. "I was heartbroken to have to seriously think about putting Angel down because of money, especially when surgery would really help her."

Just as Welsh was about to sign the papers for humane euthanasia, he received great news. Angel's case qualified for support from Penn Vet's Charitable Care Gift Fund, financial assistance for qualifying pets with a good prognosis.

"Angel had an acute onset of trauma. It was very fixable, but owners aren't necessarily prepared financially when something immediate like this happens," said Dr. Deborah Mandell, Clinical Professor of Emergency & Critical Care, who cared for Angel the day after the accident. "Being able to provide financial support when patients qualify is always preferable to owners having to face painful end-of-life decisions about their beloved animals."

This series of flouroscopic images were taken during Angels' surgery. The middle and right images show two views of the hardware implanted to hold together Angel's pelvis.This series of flouroscopic images were taken during Angels' surgery. The middle and right images show two views of the hardware implanted to hold together Angel's pelvis.

Charitable care covered a portion of the surgery.

"I could manage the rest," Welsh said.

Angel remained in Emergency Services for two days. On Monday, she was transferred to Ryan Hospital's orthopedic services for surgery.

Dr. Matan Or, Clinical Assistant Professor of Small Animal Surgery, performed surgery. He repaired the injuries using screws and a stainless steel plate.

Angel recovering after her surgeryAngel sailed through the procedure, spending another couple of days recuperating in the hospital, where, said Reineke, she was "just the sweetest dog."

Ryan discharged Angel on Wednesday, March 21, with directions for care during her longer-term recovery. And days after she walked into the early morning with Welsh, Angel finally made it home to her family.

More than a month later, Angel is doing well and Welsh is thankful for a happy ending. "I thought that short time off the leash would be okay," he said. "I was so angry with myself but now am so relieved and happy to have our girl at home and getting back to herself. She's part of our family, and we love her."

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