Fibrocartilaginous embolism, or FCE in dogs, happens when an embolus (piece of fibrocartilage or possibly high circulating lipids in schnauzers) compromises the blood flow to the spinal cord, causing a spinal stroke. Symptom onset is usually rapid, often when a dog is active, and usually affects one side more than the other. Symptoms are neurologic in nature. While FCE’s are more common in large breed dogs, miniature schnauzers are the single breed most commonly affected. FCE in miniature schnauzers occurs in 24% of all cases reported in a 2016 systematic review. The following article looks more closely at FCE in miniature schnauzers, with a personal account as my dog, Patrick, suffered an FCE in August 2021.
Background
Patrick was a healthy 5yo miniature schnauzer, 5/9 on a BCS (ideal body weight). He lives with his mum (me) and his little sister, Betty – a 2yo miniature schnauzer. We live on half an acre in the Southern Highlands, NSW, Australia.
The Onset of FCE in Miniature Schnauzers – Patrick
The onset of an FCE is often associated with vigorous activity. In Patrick’s case, he had just greeted me after getting home from work at 6:30pm. I usually ignore him for the first few minutes when I get home as he’s an exuberant greeter. After he calmed down I noticed he was standing on his right front leg weirdly. The video below was taken within minutes of me first noticing Patrick didn’t look right.
I checked Patrick’s right front limb and there were no musculoskeletal restrictions explaining the new-onset lameness. Over the next ~30mins, he continued to regress and started to fall over more and look drunk through his back legs. The gait looked neurological (knuckling) and I took Patrick to a local GP vet for an assessment. It was 7:30pm by this time.
The GP vet agreed that Patrick had a neurological presentation but at this stage, FCE had not been mentioned as a possible diagnosis (I had rehabbed an Irish Wolfhound with an FCE but I didn’t realize FCE’s were common in miniature schnauzers despite owning them for >15yrs). As the presentation involved both the front and rear limbs it was likely cervical (neck) in location. Patrick was given a steroid injection and opioid and we agreed if Patrick continued to regress take him to the specialist vet 1.5hrs away.
Patrick was crated overnight. His movement continued to regress and in the morning he was unable to transition from the down position or sit. If placed in standing Patrick could walk in a straight line for ~5-10 steps before falling over – there was clearly a right-side bias to the presentation. Unfortunately, I didn’t get any video at this stage.
At 6am a friend drove us to the specialist vet in Sydney 1.5hrs away. We were in the middle of covid lockdown so on arrival I explained what was happening to the triage nurse in the car park. I was holding Patrick at the time and she asked me to put him down. He couldn’t stand at that point and just slumped onto his tummy. I was not allowed inside the building so we just waited in the car park (note: The specialist vet center was excellent and communicated incredibly well considering the covid lockdown).
After the emergency and surgical teams had evaluated Patrick the emergency vet came outside to discuss Patrick’s case. They did not think it was surgical and mentioned possible meningitis or another neurological cause. The medical team was about to start their rounds and would see Patrick. I also consented to an MRI as it was likely indicated in his case (both risks and cost). At this time we chose to leave Sydney and drive back home. Patrick was in the best place possible and the Specialist clinic had five other MRI’s that day so it would likely be hours before there were any answers
FCE symptoms are neurologic in nature and correlate to the area of the spinal cord damaged:
- If the front legs are involved (as well as the back legs) the FCE is cervical in location.
- If the back legs are only involved then the FCE is located somewhere between T3-L3.
- The FCE is lateralized if it only affects one side of the body.
Symptoms may include sudden paralysis, falling over their front leg, knuckling, or a drunken walk. Symptoms usually appear quickly, the dog might be suddenly paralyzed or they get worse over the first few hours. Symptom progression stabilizes within the first 24hrs.
The Diagnosis – C6 Lateralised FCE
At 4:30pm I received a call from the specialist vet outlining that the MRI had indicated a C6 right-lateralized FCE – Patrick had a spinal stroke in his neck. A lateralized FCE has a more profound effect on a single side of the body. The diagnosis confirmed why the FCE had affected Patrick’s right front leg and right rear leg the most, with more subtle deficits on the left side of his body. Patrick’s neurological symptoms had also stabilized and he had maintained deep pain.
An FCE has a characteristic timeline:
- There is a damage phase over the first 24hrs with notable neurological deficits according to the area of the spinal cord affected.
- Within the first 24hrs the neurological deficits stabilize. FCE is also considered to have little associated pain whereas disc injuries are very painful.
- The body is very good at re-establishing collateral blood circulation to the spinal cord, so after the first 24hrs, the neurological deficits start to improve, and over the coming days/weeks function returns.
- MRI is diagnostic but sometimes not necessary / cost prohibitive – clinical presentation can often be diagnostic if classic.
- Prognosis is dependent on the amount of actual damage to the spinal cord. If deep pain is maintained (the deepest part of the spinal cord) then there is a good prognosis with a >85% return to function. If deep pain is absent the prognosis is more guarded.
While you never want to see your dog having a neurological event, of the possible differential diagnoses FCE was probably the best (in my opinion). So long as Patrick maintained deep pain and his symptoms stabilized within 24hrs there was a good prognosis with no further medical or surgical intervention. If he had a disc prolapse/extrusion he would have likely needed surgery at an additional cost and risk. Meningitis brings its own medical complications and I was relieved when this was ruled out.
FCE Treatment in Miniature Schnauzers
There is no medical or surgical treatment for FCE, with rehabilitation needing to start as soon as possible.
Rehabilitation is an important part of FCE recovery for a couple of key reasons:
- Loss of muscle through disuse atrophy happens very quickly (“use it or lose it”). It’s important to try and safely maintain and build muscle mass.
- Dogs are also really good at developing bad habits (it’s easier to move on three legs rather than four, or drag the back legs). Rehabilitation tries to re-establish good motor patterning and habits (e.g. square sit, even stance, transitions, good gait – walking well).
Patrick had maintained deep pain and bowel/bladder function which meant there was a good prognosis. I knew I may never get pre-FCE agility Patrick back but I just wanted him to be able to toilet on his own and have a good life at home.
Day One of Rehab (Day 4 Post-FCE)
Patrick spent the night in the crate. The next morning I took him outside to the toilet. I expected to have to support Patrick and had already organized to pick up a “help ’em up harness” from the rehab clinic later in the morning. As you can see from the video below, Patrick exceeded my expectations and took some steps on his own without falling over. You have no idea how much I smiled when I saw this.
Patrick had his first rehab session later that morning. Unfortunately, I didn’t video during this session. He looked similar to the above video and we were very happy with the improvements since he was at his worst. Daily homework included:
- Assisted standing building duration
- Weight shifting towards the right side building duration
- Cookie stretches in down and standing
Patrick would also receive daily laser therapy, dry needling, and manual therapy including passive ROM and soft tissue massage. While we would have liked to use hydrotherapy as part of Patrick’s rehabilitation, he hates it and panics so much that the cost outweighs the benefit. The treatment was mainly aimed at muscle tone and joint mobility.
At home, we made some changes:
- Non-slip flooring – the local hardware store sold runner mats that you could buy per metre.
- Ramp – purchased from the local petstore.
- Crate – already owned
Week Two of Rehab
As you can see from the video below, Patrick is progressing well.
Exercise progressions included:
- Transitions from down to stand
- Introduction of cavaletti – cavaletti are great for rear-end awareness (think 4wd not 2wd) and also limb flexion (lifting the legs up rahter than shuffling). See the article on cavaletti for dogs for more information.
Week Four of Rehab
Patrick continued to progress well. We were slowly increasing his daily walks. Back in week 1, I drove to his favorite pee and poop spot about 300m from the house and let him walk about 50-100m in total. We slowly built up until he could walk to that spot. By week 4 he was able to do 1-2km.
Exercise progressions included adding instability to Patrick’s standing exercises. We also adjusted the weight distribution for both front feet up (more weight on back legs) and front feet down (more weight on front legs)
Two Months After FCE
As you can see from the video below, it’s starting to get hard to see any remaining deficits. I can still see subtle lameness especially if we’re out walking. We can now walk about 4km in total, so long as it’s not too hot. He was never really good in the heat but he definitely feels the heat more (or puts it on to try and get mum to feel sorry for him). My goal is to get him up to 5km walks (we were doing 12km before the FCE).
Conclusion
FCE is super-scary to go through as a dog owner. Those first few days were some of the hardest and most stressful I’ve been through (I don’t have kids and live on my own) – when I left Patrick at the specialist clinic I didn’t even know if I’d get my dog back. I knew the logic and the theory but it doesn’t make it any easier. Yes, Patrick was lucky I co-own a dog rehab facility. He was also lucky I could treat him at home. I was also lucky I have great friends who assisted in the early days (I couldn’t leave him at home alone).
If your dog suffers an FCE, use the support you have around you. Listen to your vet and seek out a rehab practitioner, even if you have to use a remote service if there are no local clinics.