Mystery paralysis

[clonmel08]

Our 11 year old Fox Terrier fell off my sisters bed. Initially he was limping on his right leg. Within 48 hours he began collapsing all four limbs. Within 4 days we took him to the vet for a diagnosis. Possibly IVDD. Over two weeks he deteriorated from walking on all fours to no use of all fours. He has deep pain reception in all feet. We did an MRI, spinal fluid tap and xrays, blodwork at the vet teaching hospital in Guelph, Ontario.
Unfortunately the vets cannot find the cause of his paralysis. I didnt think that would be possible following the history and tests. We have no idea what to expect or hope for. I just wanted to tell someone. We are commited to making his life as livable as possible for as long as possible. We are heart broken. We just lost his "brother" four months ago to old age.

[CarolC]

Hi clonmel08,

The fact that he has feeling in all 4 feet is a hopeful sign. Is he still at the hospital? Does he have bowel and bladder control? Is he on any medications? Have they recommended a course of treatment at this point?

[clonmel08]

He is at home following the MRI. He is not incontinent but we seem to have to help Express his bladder otherwise he will go 24 hrs+ before he can go on his own. He has not had any accidents and asks to go out. They took him off his meds, originally Meloxicam and gabapentin. This decision made by the neurologist at Guelph. His original vet, and Neurologist and the Emergency vet we saw are all in the dark but disagree on "likely" causes. So frustrating and sad. He seems to be comfortable and has only cried out if we accidentally put pressure on his front left, the leg he was limping on after the fall. He ran around for 2 days then started losing strength in his legs but could stand, since then less and less strength and cannot stand.

[CarolC]

Well, I don't know either, but having deep pain perception in his feet is a really good thing and cause for optimism. Did they mention any possibility of an FCE? That is an abbreviation for fibrocartilaginous embolism, often called a spinal stroke. FCE is a diagnosis of exclusion, in other words they rule everything else out by MRI and blood tests and they can't be 100% sure but decide it is likely a spinal stroke. That means they can't see a disk problem on the imaging, and nothing came back in the blood tests. He's kind of old for FCE, but the usual age range in the literature may be based on larger breed dogs where it is more frequent, and so far I don't see any studies on the age range of fox terriers or only small breeds who get FCE. Some studies find it more common in males.

Fibrocartilaginous Embolic Myelopathy
Fibrocartilaginous embolic myelopathy has been reported most commonly in large and giant breed dogs of non-chondrodystrophic breeds. However, it has been described also in small breed dogs (particularly miniature schnauzers) (1, 3, 4, 6, 44). The male to female ratio in dogs ranges from 1:1 to approximately 2.5:1 in different studies. The age at diagnosis in dogs ranges from 2 months to 13 years and 5 months, with a median of 4–6 years in the majority of studies (13).

If he just threw his neck "out of whack" when he fell, you'd think it would still hurt and he'd be letting you know. The great majority of dogs with FCE recover their ability to walk. They may have some residual ataxia (wobbly walk) but they get around fine and are happy and go on to live out their normal lives.

FCE normally happens in larger breed dogs, but fox terriers are one of the small breeds known to be affected.

Fibrocartilagenous emboli is more likely to occur in large or giant breed dogs. The most commonly recognized breeds are the Labrador retriever, German shepherd, Golden retriever, Doberman pinscher, Great Dane and mixed breed. These large breeds may be over-represented based on breed popularity. Smaller breeds such as the Miniature Schnauzer, Shetland sheepdog, Wirehair fox terrier have also been reported.

Since all 4 legs are affected, it makes it seem likely whatever happened was in the neck. If the problem in the neck was IVDD, the dog would be sore and painful, or even very painful, crying and needing medication, yet your dog is not on medication and is not painful in his neck, so that's really good. FCE can be painful at the beginning but the pain goes away within a day or so. Since your dog is not having neck pain, only leg pain, that is encouraging. I do not know if the leg pain was simply that he hurt it when he fell (that would be my guess but I am not a vet and a guess is only a guess). There is such a thing as referred pain, where you hurt one part of your body and feel it in another part, but I'd be inclined to go with the simpler explanation, he banged it up when he fell. You said he fell and then walked around for a couple of days, then began to have trouble walking. There have been dogs here where paralysis from FCE came on gradually, but I think it was more like a 24-hr period. It can happen after mild trauma. I don't know, it would be something to read up on. If it is FCE, he isn't going to get any worse and it is highly likely he will improve. If he was my dog, I would definitely give it some time and see how he does.

[clonmel08]

Thank you so much. Such a mystery, yes it is affecting all 4 limbs but the rear are the weakest followed by the one he actially injured falling. It took about 14 days for full loss of use. We are doing gentle exercises but wonder if steroids would help, or should have been used before now. Sad that the experts at OVC Guelph have given up on him. His own vet also- she says we are clients at OVC so won't treat him!? Not the kind of concern I would have expected but then I'm old so things are very different. We are long, long time clients. We feel like we are doing nothing for him.

[CarolC]

Again I'm not a vet, but I agree I would be thinking about steroids in your situation, too. They say they are not needed for FCE beyond the first couple of days, but nobody has been able to tell you what this is, and if it is disk-related steroids could be very helpful. We had a case here where someone had a dog with ANNPE who had improved somewhat but after 6 months was put on steroids for skin allergy and suddenly her walking improved. Another way to look at it is, unless he has some kind of other health condition that make steroids inadvisable, why not try them? I think there needs to be a wash-out period between an NSAID like Meloxicam and starting prednisone, but your vet should know if that is the case and how many days that is. (Prednisone and NSAIDs can sometimes interact and cause GI bleeding, so they don't want both in his system at the same time.)

Hopefully you can just have a very serious talk with your longtime vet and just clarify, the specialists checked him but it was all inconclusive, we're not impressed with the lack of results, and we still have a dog who can't walk and he isn't getting any treatment. They did not give us any treatment plan and he is not scheduled for any more follow-ups with them, therefore we are NOT still their clients, so he is back to being your patient like he always was, please help! I wonder if it would be more convincing if you and your sister both went in together. You could take a copy of the records from the specialists so your vet will have all the background to work with. And maybe a plate of homemade cookies...


Usually specialists can be very helpful, but I've had a couple of cases where they were just the opposite and my regular vet was the one who got better results. We're willing to do whatever we can for our pets, and sometimes we will spend a small fortune trying to get the best treatment and if it doesn't work out, the only comfort is we know we tried. But I agree, somehow it sounds like you need to get your regular vet back on his case if the specialists have done all they're going to. Tomorrow is Thursday, hopefully that isn't her day off.

[clonmel08]

Many thanks for listening and for your advice. I agree with you. We are going together for the serious action plan on Monday.

[LisainCAN]

Hi there,

First of all, I am so sorry about your dog. He is lucky to have you.

I have to say, I have heard stories about Guelph similar to yours. I always expect more from teaching hospitals, but in my experience private ones can be worse when it comes to long-term care or cases that are out of the norm. It would have been nice if Guelph had treated your case as one to be studied to help future dogs.

I am also dismayed for you, but not surprised, that your vet will not tangle with Guelph. I am fairly sure that it is the headquarters of the OVC. You need to ask Guelph to treat your case or discharge you. I am not sure what recourse you would have if they refuse since normally I would suggest a formal complaint to OVC, but ...

Perhaps, if travel is not an impediment, you could go out-of-province. The best teaching hospital, hands down, is the one in Ste. Hyacinthe, Quebec affiliated with the Universite de Montreal. They speak English. I doubt they would begrudge you wanting a second opinion. https://chuv.umontreal.ca/english/small ... -hospital/

As for any advice on the actual condition, Carol is the one to follow. She has tended to and seen many cases. Her experience is invaluable.

More and more in life I am at amazed at how industries that are geared towards animals actually lose sight of the animal at the heart. Keep your chin up and fight for your little guy. You are doing the absolute right thing.

[clonmel08]

Thank you. Support from other dog lovers is always so meaningful.

[LisainCAN]

Please keep us posted.

LOTS of support on here. This is one of the kindest and most informative forums for pets on the internet.

[clonmel08]

Im having a hard time. We lost my older dog in July after 3 years of intensive care. We are exhausted. We know we are not alone. We have talked to another neurologist, they simply dont know what is going on. They want to do many more tests but first rule out tumors, so they have booked an ultrasound. When did $700.00 become something we dont even think about? After that my sister has decided thats it. No more tests, we wont treat cancer. If the ultrasound is clear we are going to take him to a rehab place. I have made contact and they seem nice. After that we can only hope for some return of abilities.

[critters]

I don't expect that, for the most part, it makes a whole lot of difference what's causing it. I think that if it were something terrible, like a tumor, it would've shown up in some of that testing. It would be nice to know if it's brain or spinal, but vets can't always tell that, either. My little permakitten, now about 7 years old, was eaten by a big cat at just a few days old, and 3 vets declared him spinal cord injured with a brachial nerve (arm) injury. He has neither. He's globally brain damaged from shock with a fractured scapula (shoulder blade). It doesn't really matter as far as treating him, though. I think the rehab place is a good idea.

[clonmel08]

Thank you. Is it wrong to expect the neurologists to have some ideas? Robin is now paralyzed in three legs but has some movement/use in one front leg. He "seems"to be okay mentally. I mean he is coping. So just rehab for quality of life? No expectation of him ever coming back from this? Could he have brain damage from a fall from the bed? He is not e en a candidate for a cart now that he has lost the use of one of his front legs too.

[CarolC]

I'm thinking about this too, and I've been leaning in the same direction as critters, but I wasn't sure I was done thinking about it yet so I was waiting to see if anything else occurred to me. Still kind of turning it over in the back of my mind and want to be sure I'm not missing something. However what you just said may be helpful. Do you mean one of his legs has maybe improved a little? The one he fell on or the other one (not that it matters which one, just asking).

If this is something like an FCE (spinal stroke), there is strong expectation that he will improve and be able to walk again and his quality of life will return. The great majority of those cases improve and go on to live a normal life. It can take weeks or months to reach maximum recovery, and PT is so helpful, but the dog is happy and the dog's family is happy. And they say dogs that preserve deep pain sensation in their feet (like your dog) are the ones that are the most promising.

I'm still thinking and it's late, but would like to see what you say about the one leg not being paralyzed now, thanks.

I would also like to know, could you describe what exactly happened when he fell off the bed? Was he asleep and rolled off by accident? Did he yelp at all before he fell off? Did she give you any details? In the days before he fell he was fine, right? Thanks.

[critters]

Thank you. Is it wrong to expect the neurologists to have some ideas? It's not wrong, of course, but, while none of mine have ever been to a neurologist, we've had less than ideal interactions with other specialists, so I'm wary.Robin is now paralyzed in three legs but has some movement/use in one front leg. So he's better?He "seems"to be okay mentally. I mean he is coping. So just rehab for quality of life? No expectation of him ever coming back from this? Could he have brain damage from a fall from the bed? I doubt it, especially without other signs, like seizures, but something like a stroke is a possibility.He is not e en a candidate for a cart now that he has lost the use of one of his front legs too.Not even a quad (4-wheeled) cart? Not that I'd buy one at this point, but something homemade? It might be useful to hold him up up a PT capacity, like for eating and drinking and the like. I don't know how well a triplegic could move around, but it might be useful for some things. Besides, like Carol says, he's very likely to get better movement eventually, regardless of what caused it.

So about how big is he? I don't know any Fox Terriers specifically, but terriers tend to be smaller. If you can manage the nursing care, I'd just keep soldiering on and see what happens.