This is a summary of the article by Ellen Kroll – download the full version here.
In Irish Wolfhounds specifically this condition occurs as puppies, generally, between 6 and 16
weeks of age. It manifests in the total loss of movement in one or more limbs, which
WHAT IS IT?
Fibrocartilaginous Emboli or Spinal Cord Infarction; also called Puppy Paralysis. This is an emboli made up of fibrous/cartilage type of tissue. Emboli is just plural for embolus. An embolism is: OBSTRUCTION OF A VESSEL BY A SOLID OR GAS MATTER WHICH HAS BEEN TRANSPORTED THRU THE BLOODSTREAM.
And the embolus can be a blood clot or air or, in this case, a specific type of fibro-cartilagenous tissue that gets lodged in the bloodstream and blocks further blood flow. When that happens to a blood vessel, whatever cells it was serving no longer get the benefit of nutrient/oxygen exchange resulting in cell death. This is called: ISCHEMIA or the lack of blood flow to a part or organ and the damage that occurs is often referred to as: INFARCTION or the tissue death that occurs when blood supply is lacking. You have probably heard the term myocardial infarction when this process happens to the heart muscle. Therefore, some people call FCE a spinal cord infarction. Doing a journal search, this term will give you more connects than FCE. In FCE, the source of the embolus is from the disc in between the vertebrae in the spinal column. Let’s take a look at where this occurs.
VERTEBRAL FORAMEN A diagram of the space that the nerve roots and blood vessels pass
through the spaces between the vertebrae.
VERTEBRAE WITH THE NUCLEOSUS PULPOSUS — Shows the actual disc between the
vertebrae with the central location of the nucleolus pulposus.
If you are looking at a diagram of the intervertebral disc, find the center of the disc. This central
area is the location of the Nucleosus Pulposus…a gel like material and this is what is found to be
the source of the emboli in FCE.
Now the $64,000 question is HOW? How does a bit of that disc material get into the blood
vessel to block the blood flow? There are several theories, but nothing proven.
- Trauma to the vessel bed causes communication of the disc material
- Persistence of embryonic arteries of the disc and herniation of the disc material into
those arteries. (This might be a likely theory in the case of young puppies) - New arteries forming in the disc due to chronic inflammation (This theory might be more
likely in the older animal.) - Herniation of the disc material into venous supply, then lodging in an artery.
None of these theories have been proven out consistently in autopsies on people or dogs.
FCE is usually a diagnosis of EXCLUSION. What that means is that the only way to positively
identify this disease is by frozen microscopic sections of the nerve to find the emboli after
euthanasia. So what if we would like to keep the dog alive? We diagnose FCE by elimination of
other probable disease processes. In recent years, advanced MRI imaging and expert
diagnosticians are successfully diagnosing FCE in live dogs. However, the advanced MRI and the
experienced specialist are not available to many pet owners in the US.
This makes it a very difficult disease for data collection and research. The diagnosis is actually
presumed FCE in any live dog.
WHAT DOES FCE LOOK LIKE?
It mimics many other conditions—there is no outward symptom that will be unique to FCE.
A typical presentation of FCE follows:
Puppy, active and normal…perhaps a history of trauma. Slipping, falling, and dropped.
Sitting position, unable to rise.
When placed in a stand, cannot walk forward…will often collapse into a sit
Deep pain response intact (somewhat controversial statement, but that is my personal
experience with Wolfhound puppies)
PAIN is not usually consistent with an FCE diagnosis. I have received several calls in the past
few years about pups that have a paralysis with an onset of severe pain…. screaming in intense
pain for 24 hrs or more with slowly improving condition and pain relief. My best guess is
trauma…not FCE.
Many of the human patients who succumbed to FCE reported a transient sudden pain on onset.
Many owners of dogs who were positively identified with FCE reported yelps of pain and then
no pain thereafter, just paralysis.
DIAGNOSIS
In my opinion, you need to get a neurological exam immediately. ALL SPINAL INJURIES,
WHETHER FCE OR TRAUMA NEED IMMEDIATE CARE!!!!! THE FASTER YOU GET VETERINARY
TREATMENT, THE BETTER THE PROGNOSIS. REMEMBER THE GOLDEN HOUR. It is critical to
determine if the symptoms are due to trauma/injury or FCE.
If you remember nothing else about this discussion: All dogs that present with a paralysis should
be immediately transported to a veterinarian who is willing to do a neurological exam and treat
the dog as appropriate for the symptoms discovered. (Do not wait until morning!) Steroids have
been the treatment of choice for FCE for many years. HOWEVER, recent research published in
2009 (Journal Vet Med Science 2/2009; 71(2) 171-6) suggests that steroid treatment in a presumed
FCE case does NOT make any difference in outcome. This study was not focused on Irish
Wolfhounds or even giant breeds, but definitely questions the wisdom of steroid treatment.
Diagnostic procedures will help us with a diagnosis, treatment and prognosis. If you find
evidence of trauma (swelling, redness, etc.) the treatment needs to start immediately. There
are conditions of the spine and paralysis that can involve infection where steroids alone could
make matters worse. If infection (discospondylitis or neurospora/toxoplasmosis in very young
pups) is suspected…. the neurologists that I have spoken with would concurrently treat with
antibiotics. The other common rule out with an older animal is cancer of the spine. Sudden
onset is the picture you get with FCE, not a gradual onset over days.
Lower Motor Neuron signs versus Upper Motor Neuron signs. This separation has to do with
the pathways that these nerves serve. In LMN disruption, you will see flaccid muscle tone where
with UMN, there can be a heightened tone to the muscle. LMN pathways do not recover as well
as UMN. Paralysis from FCE is usually complete in 24 hours. If you see worsening signs after that
timeframe, especially ascending paralysis…it is usually indicative of a softening of the spinal cord
and is a very grave sign. If there is little or no improvement over 14 days after onset, the
prognosis for recovery becomes very guarded. There is a better prognosis for lateral signs (one
sided).
Myelograms versus MRI in Wolfhounds: The myelogram is a radiography study where dye is
injected into the spinal column to look for abnormalities, swellings, disc protrusions, etc. This
procedure can be successful with dogs, but I have lost a young bitch in a myelogram procedure
and know several other breeders who have had dogs die during this procedure. Certainly that is
not the case with all Wolfhounds…. but I would recommend looking at an MRI as a less invasive
procedure that may give better information for us to rule out other disease processes in suspect
FCE cases. Especially MRI machines that are a TESLA 4 can give amazing detail for diagnosis. The
MRI would be considered the gold standard in this type of differential diagnosis.
Tough Decisions: I often receive calls from owners of young Wolfhounds with suspect FCE. Their
veterinarians are making recommendations on the diagnostic procedures involved and they are
EXPENSIVE. My own opinion (for what it is worth) is that you need to have a frank
discussion with your veterinarian about the cost of procedures versus the benefit of the results.
In other words, what will the information gained in that procedure do to affect the treatment
that we choose? Bottom line, you make the decision based on what is best for your dog.
TREATMENT
Antibiotics as indicated. Treat any trauma. NOTE: One Wolfhound owner treated two pups
several years ago with Intravenous DMSO in the first two days after onset. These pups had a
strong recovery. I have not discovered any further literature or research to support this
approach.
Supportive care: An article published in 2003 reviewed FCE and suspect FCE cases. Journal of Small
Animal Practice, (2003) 44, 76-80. One of their conclusions is that the EARLIER that
physiotherapy/hydrotherapy is started, the better the outcome. Because this ailment frequently
strikes puppies in the middle of their growth, limitation of free exercise with plenty of rest is
critical to preventing further injury to non-affected limbs. Although the location and severity of
the paralysis can radically change the level of care needed, the following components must be
addressed. Confinement/enforced rest with frequent passive range of motion exercises,
excellent bedding, opportunities to eliminate with support and good nutrition. High level of care
may be needed for first 10 days. Then, recovery to ambulatory state should be there if recovery chance is
good/. Look at options of carts/slings if necessary (recovering animals need exercise…not limited motions)
Complementary recovery techniques
Physiotherapy: Range of motion, gait training, hydrotherapy
Swimming: Provides for use of muscles, limits atrophy, doesn’t depend on gravity. Warm water
therapy pools may have advantages.
Acupuncture: ―Opening‖ of channels of energy along meridians. Eliminates stagnation and
increase flow of ―qi‖ in Chinese medicine terms
Chiropractic: Assists in correction of compensatory limitations. Most animals with FCE or
other paralysis develop stiffness, soreness or muscle adaptations to compensate for the
affected limb. (opposite front leg restriction example)
Massage: Tellington/Jones, standard, range of motion, fascia release techniques. All can help to
avoid compensatory damage
Nutrition: High quality proteins/vegies pulped for repair and growth. Vitamin E/C/B complex.
Trace minerals may be needed. Probiotics
Herbs: Arnica, rhus tox, homeopathics for inflammation and injury are indicated early in the
onset of FCE. Asafoetida is a Chinese herb that may assist in longer-term recovery.
SO, IS IT GENETIC????- Questions for breeders
Ninety nine percent of all the vet neurologists out there will tell you NO WAY. However, An
article from University of Utrecht (2000) reviews 8 IW pups with presumed FCE. Certainly our
breed has the tendency to FCE at a young age. But is it a tendency like bone cancer afflicting
giant breeds or is it a genetic fault that could be bred away from?
My personal data has revealed more than 5-7 lines involved worldwide with few common
ancestors in each of those lines.
In one example, one popular stud dog had been linebred several times and produced NO FCE
pups. In 3 subsequent outcrosses, he produced at least one FCE pup in each litter. His sire had
been bred both in outcross and linebred breedings with no FCE pups, but did produce one FCE
pup in his last litter which was an outcross.
So we are left with the question, what do we do as breeders? As with most things, it will be a
very personal decision. We have no proof that breeding an affected bitch increases the chance
of FCE. Yes, affected bitches have been bred without producing FCE. But, without data
collection on significant numbers of dogs, we will never be able to recognize a possible pattern.
Anne Janis, who leads the data collection for seizure disorders, rhinitis (primary ciliary dyskinesis)
and liver shunt has offered to collect information on dogs with presumed FCE. Difficulties in the
presumed diagnosis makes data less reliable than other diseases. Differing levels of expertise
and diagnostics may result in false positives. My hope in collecting anecdotal information in
large enough numbers is that we would see a trend toward random occurrence or distinct
patterns of inheritance. I would encourage all breeders who have a presumed or confirmed FCE
case to contact Anne Janis ([email protected]) with pedigree information. Anne will gladly
explain her data collection process.
The WITCH-HUNT PROBLEM—When improved diagnosis and testing allows us better
identification of the dogs and perhaps bloodlines involved, will we use the information
responsibly? Or will we treat those who have shared the information with us as somehow
irresponsible and unworthy? It is my opinion that it is human nature to gossip and bad news
seems to travel faster than good news. I ask each of you to consider positively supporting ALL
breeders who benefit our breed by sharing information on the health of our dogs
The IWHG is assisting the University of Nottingham with research into fibrocartilagenous
embolism (FCE, puppy paralysis). Irish Wolfhounds are the only breed where this occurs in
puppies, as most breeds are affected at around five or six. We hope that this research will
discover the cause/s of FCE and determine the most effective treatment for a positive
outcome.
If you have had experience of FCE or any form of puppy paralysis, please complete our
survey and make your experience count.
The survey can be downloaded at: http://www.iwhealthgroup.com/legacy/puppy-paralysis.html
References
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