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Neurological Disorders - Fibrocartilagenous Embolism (FCE)

Garcia's Recovery 


by Anna Lorenz 


I was asked to write about my experiences with a dog I own who was stricken with a major health problem, and the ways in which we handled him to recovery. The intent of this article is to let people know that if they choose, it is possible to nurse a Newfoundland through a lengthy recovery. The decisions we made may not be the same as anyone else's, but the ways, means and options we chose were right for us and our dog, Garcia. 
Garcia is an intact male Newfoundland, four years of age, 112 pounds of pure personality. I picked up Garcia from his breeder at 10 weeks of age. He was an outgoing and very attentive puppy, learning very quickly and growing normally. I looked forward to training and showing him in breed and for the working titles. He has the kind of personality I love to work with in obedience. He was shown twice in the puppy dog class at seven months of age. 
Without warning, Garcia had a Fibrocartilaginous Embolism at eight months of age. He weighed 117 pounds at the time. Garcia's Fibrocartilaginous Embolism, or FCE, left him totally paralyzed on his right side and with extremely limited functional movement of his left side. The effects of the FCE were very similar to a stroke. He was unable to even lie sternally and could not lift his head. He had Horner's Syndrome, drooping mouth, eye, and facial muscle on his right side. We had immediately sought veterinary help and contacted all the experts we could including experienced breeders of other breeds that are known to have spinal health problems. Garcia's breeder was very supportive of any decisions we were making and researched the problem with her contacts. 
Garcia was treated at home the first 36 hours following the FCE, and then went to an emergency and critical care facility about 1-1/2 hours from my home, where he remained for the next five days. The first 24-hour period following the FCE was the only time he appeared to experience any pain. He was given a short course of steroids and antibiotics. We decided that any surgical intervention was not an option we would take, and if that was the only treatment option Garcia would be euthanized. The veterinarians we consulted were very non-committal about his recovery. 
We took Garcia home and set our personal criteria to determine whether this dog should be euthanized or not. We re-evaluated his condition every third day during this period, and weekly later on in his recovery. Our criteria were: 
Was Garcia in physical pain? 
Was there any physical improvement? 
Was Garcia's mood depressed? 
We set up a room in the middle of our home for Garcia to keep him engaged in all the daily activity. We felt we had to keep him mentally stimulated in order for him to want to recover. We placed shower curtain liners over a large area of carpet. Over these we placed blankets and then a folded sheet [0 turn him with. The layer directly under Garcia was a large washable pad, which was quilted on top and rubberized on the bottom. These are made for hospital use, or for incontinent patients. We also used large disposable pads made for incontinent patients. Garcia was reluctant to soil inside the house the first day or two, but was able to urinate after the first 17 hours. I was very concerned with skin breakdown, both from the soiling and from pressure. I kept a clean-up kit in his room with paper towels, Self-Rinse Shampoo, clean rags, and a spray bottle of Listerine and water mixed (for freshening his coat). We became very adept at positioning the pads around him to make clean up easy and quick. He was washed every time he voided and we never had any skin breakdown or soreness. 
To avoid skin breakdown from pressure, Garcia was turned from side to side every two hours day and night, without fail. I found it simplest in the first three weeks to just sleep by him and set the alarm at night for every two hours. Thankfully, Garcia rarely voided at night and did not often need cleaning. 
I felt it was very important that in addition to recovering strength, Garcia should not be developing pressure sores 
from his forced inactivity, nor should his muscles be allowed to atrophy. In order to prevent these and other possible complications, I massaged all the pressure points on each side, (hips, shoulder, knee, ankle, etc.) every eight hours. I also did range of motion exercises on each joint, flexing and stretching each joint in turn starting with each toe, then ankle, then knee, and then hip. I then moved to the foreleg and did the same. The range of motion exercises were done every eight hours. This was NOT Garcia's favorite activity. Have you ever gotten one of those looks from your dog? "Why don't you just leave me alone!”?
We also wanted to avoid any respiratory problems from his inactivity and so my husband and I put bath towels under his armpits and hips and lifted and held him (dead weight) in an upright, standing position three times a day. The first week it was only for 30 seconds each time, and then we increased the duration of each "stand" by 15 seconds each week. 
We had to address his nutrition as well as avoid dehydration since Garcia could not lift his head the first week he was home. We held his head up and gave him water every hour or as often as he would take it and gave him soft, canned dog food and hamburger, rice, yogurt, whatever we could tempt him with in order to keep his caloric intake high to aid in the healing process. Treats were always available. Surprisingly, even with this rich "people-food" diet, we never saw any loose stools. 
At the end of his first week home, which was actually week two in his recovery, we were thrilled to see him lift his head by himself This improvement made it so much easier for him to drink water and to eat. I also started to feel some resistance to the flexing and stretching range of motion exercises I was doing. He became very vocal during the day, talking to us frequently, a habit that continues to this day. We encouraged the vocalization, more yodeling than a bark, feeling that this gave him an outlet to interact with us and our other Newfoundlands. 
We encouraged our other Newfoundlands to visit Garcia after week two. One of the most touching things I've ever seen was the sight of my two female Newfoundlands lying one on each side of Garcia, pressed tightly up against him, even though it was much too warm for them to be comfortable. They never touched his food or treats in front of them and repeated this "comforting" behavior several times a day for an hour or two at a time. 
Week three came and Garcia had gained enough strength to lie sternally and raise his head. He also continued to return some pressure during his range of motion exercises and we were up to 45 seconds in the stand position, although he was still totally non-weight bearing. Now I wanted to stimulate his desire to move and so I would pull him across the floor and out the door on his blankets. We would take him out to my grooming shop where we would put him in an out-of-the-way corner with a ring gate across the front of his spot and he would watch the comings and goings of a wide assortment of dogs and their owners. Then, after a couple of hours, we would pull/carry him back inside. 
By week four, we were up to over a minute in the stand position three times a day, when we were overjoyed to feel some slight weight bearing on his part! Not a great deal, but a definite effort on his part. He was able to flip himself over from side to side at will. This was a great improvement because we no longer had to turn him every two hours, however, he liked to lie on his right side, which was the more afflicted side. We had to prop him on his left with rolled blankets this week so he would not spend all his time on the one side. We continued to tempt him with soft canned and people food at this time. 
Week five came with definite improvements. Garcia was attempting to bear weight when we held him up, now up to I 1/2 minutes at a time. He was also moving his body around by pulling with his elbows and was kicking both legs when lying down. We decided it was time to start "housebreaking" again. We carried him out to firm footing and held him up in a stand position while exhorting him to "go potty." The second time out we met with success and we were back on a schedule outside from then on. We would also take him outside to the Newfoundland's play area and let him lie out there with the other dogs playing around him. This seemed to greatly stimulate his desire to move around and play with the others. 
Week six saw Garcia now pulling himself from room to room in the house, and with support from a towel under his belly, staggering out to exercise. During week six we had visitors stay at our home, and he was NOT going to be left in the other room. To our amazement he pushed himself up into a stand and hobbled across three rooms to join us! I think he was more excited than us to have made it all by himself Anyone who thinks dogs don't feel emotion should have seen his face! 
At that point in Garcia's recovery we set our personal goals for this dog. We felt he MUST be able to accomplish these milestones or we would euthanize him. 
He must not be in pain. 
He must not be depressed. 
He must be able to exercise himself. 
The most important: he must be able to play. 
We did not want to put any pressure on his neck since our vet felt the embolism was cervically located, C5, 6, or 7, so a collar was not an option. I found a tracking harness for him that fit similarly to a siwash harness, and this was a great help moving him around, helping him up or to walk on slippery surfaces. 
Today Garcia is over four years old and weighs 112 pounds. He has an extreme limp on his right side and drops to one knee to urinate. He has become very wise as to where the carpeting is for easy walking, and has learned to avoid the slippery spots, ice, etc. He is an incredibly happy dog with a bold personality. He can climb a full flight of stairs, one at a time by himself and does so every night. (A feat first accomplished when there was a bitch in season at the top!) He can come down by himself but we make him wait for us to walk in front of him because it makes US nervous, not him. He not only plays with the other dogs, he runs up and down the hills on our property as fast as any of our other dogs, albeit with a sideways gait. He has no fear of other dogs, even tackling my males who weigh 50 pounds more than he. He is slightly protective and possessive of me. He is a little uncomfortable in a crate because it is difficult for him to get up in one. He loves to go with me everywhere he can, correctional matches or classes at several different clubs, shows, Newfoundland events, even National Specialties. 
Amazingly, we still continue to see small signs of improvement in Garcia. He will never be completely healed but he doesn't know it. Everywhere I go people who have met him ask about him, praising his personality. He is a testimony to the incredible spirit and resiliency of our breed. He makes me proud to be an owner of Newfoundlands. 

Note from the Health and Longevity Committee:

FCE (Fibrocartilaginous Embolism) results when a piece of fibrocartilage breaks off from the disks between the vertebra and lodges in the blood vessels of the spinal cord or nerve roots. It can happen to a dog at anytime, at any age but typically happens to adult dogs between three and seven years of age. Its onset is very sudden. Severity of symptoms depend on the location it "touches "-the further up the spinal column, the more of the body will be affected. One or both sides of the body can be affected. There is rarely pain after the initial incident and the effects do not progress (i.e.: get worse). Diagnosis is frequently made by ruling out other spinal problems (herniated disk, broken vertebra). 
Treatment is typically a short course of steroids to reduce any swelling, supportive care and rest in the form of very strict confinement for 10-12 weeks. The cause is unknown but may be due to extreme, sudden movement that dislodges a piece of fibrocartilage. Also unknown is whether or not the dog, once affected, will be more susceptible to another episode. 
We would like to thank Dr. Kochin, Board Certified Surgeon, for reviewing these comments for us. He currently is on staff at Cape Cod Veterinary Specialists in Buzzards Bay, Massachusetts and has seen numerous cases of FCE. 

 

Reprinted from NewfTide 2004

 
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