Fibrocartilaginous Embolism (FCE)
Updated: Oct 17
CROC commonly treats FCE patients in an attempt to restore as much normal bodily function as possible. Patients can present with a wide range of symptoms, from mild limping or incoordination all the way to near complete paralysis. While no one can guarantee that your pet will regain 100% normal function, there’s plenty to be done to give them the very best chance of doing so.
Check out Marley's recovery from her FCE! She presented with the most severe symptoms CROC has ever seen and was successfully rehabbed!
What is a Fibrocartilaginous Embolism?
Fibrocartilaginous Embolism, or FCE, is when a piece of connective tissue enters the blood supply to the spinal cord and blocks the flow of blood to the spinal cord tissues. This lack of blood supply causes part of the spinal cord tissues to die from lack of oxygen and nutrients, leading to neurological deficits for the patient. It is still not known exactly how this connective tissue enters the bloodstream. This condition is also referred to as a Spinal Stroke or Spinal Cord Infarct. While it is rare for a dog to experience more than one FCE, it is absolutely possible.
Symptoms of FCE occur quickly. Often during exercise or play time, FCE dogs generally experience significant acute pain and some will cry out from discomfort. They may limp, struggle to walk, or even experience complete paralysis immediately or within hours of the FCE. Usually, the worst of the symptoms have appeared within the first 12-24 hours and patients will start to improve from that point, with pain subsiding within 24 hours. Severity of symptoms is dependent on the location of the embolism along the spinal cord. Patients with embolisms higher up the spinal cord (closer to the head vs the tail) or those that cause larger sections of spinal tissue to die off tend to be the worst affected. FCE’s typically affect one side of the body more so than the other, but they are known to occasionally affect both sides.
In the best-case scenario, an FCE dog will only experience mild neurological deficits in one leg and never lose sensation in the affected limb. These dogs often make a full or nearly full recovery to normal function. In the worst-case scenario, the FCE will cause paralysis and loss of sensation in all four legs. While certainly a challenge, patients in this scenario are not without hope! CROC has successfully treated cases of FCE in which the patient is unable to even lift their head or swallow. Severely affected patients are unlikely to return to completely normal function, but with dedicated and intensive care, they can regain the ability to walk independently and relieve themselves appropriately.
Who is at Risk for Fibrocartilaginous Embolism?
FCEs most commonly affect large and giant breeds like German Shepherds and Irish Wolfhounds, though it sometimes occurs in small breeds like Shelties and Miniature Schnauzers and can happen with any breed or breed mix. It can occur in dogs of all ages but is most frequently seen in young to middle aged dogs. FCEs are not predictable or preventable.
Diagnosing Fibrocartilaginous Embolism
Because FCE symptoms can look like many other serious conditions, FCE patients often undergo several diagnostics to reach the correct diagnosis. General Practice Veterinarians can perform blood tests and radiographs to rule out other conditions but cannot confirm FCE using those diagnostics. Ultimately, FCEs are diagnosed by Veterinary Neurologists using Magnetic Resonance Imaging (MRI). MRI allows the Veterinarians to see the loss of perfusion to the spinal cord, therefore definitively diagnosing FCE.
Treating Fibrocartilaginous Embolism
There is no surgery or medication for FCE. Instead, treatment is focused on supporting the dog while they heal, encouraging limb use, and preventing muscle atrophy. They may need pain relief during the first 24 hours, but they are generally not painful after that initial period. Dogs with minimal symptoms may just need some assistance getting up or walking around but dogs that cannot walk will need more intensive care including assistance to relieve themselves and frequent repositioning to avoid the development of Decubital Ulcers (bed sores). The worst affected patients will need additional veterinary care to support hydration and nutrition if they cannot eat or drink on their own. This may look like hospitalization for several days with intravenous fluids and medications, after which, the dog will still require dedicated, round-the-clock care once back at home to ensure that they are kept clean, hydrated, and regularly repositioned.
As soon as your veterinarian deems it safe, starting Physical Rehabilitation Therapy as soon as possible will significantly increase your dog’s chances of maximum recovery. It’s important to note that dogs with minimal neurological deficits may recover fairly quickly, but those experiencing profound paralysis will require a significant commitment of your time and energy over at least the next 6 months, sometimes more. CROC will guide you through all the steps, stages, and details of this recovery but it will be up to you to follow through with the Prescribed Homecare between Rehab Sessions. Failure to participate in Home Care Exercises will severely impede your dog’s level of recovery.
What Does Rehab for Fibrocartilaginous Embolism Look Like?
The maximum healing of neurological tissue takes place over approximately 6 months. This means that we have 6 months from the time of injury to Rehabilitate your pet to their maximum physical ability. Some pets will regain independent mobility before then, but it’s important to stick with the 6-month plan, as many pets quickly lose ground if they stop Rehab too early in the recovery process. Success of Rehab does depend on your pet’s condition at the time they start Rehab. Pet’s that don’t have any movement or feeling in their legs will be at a greater disadvantage than those that are just weak and uncoordinated. Generally speaking, we can get a good idea of your dog’s potential for recovery within the first few weeks of Rehabilitation Therapy.
FCE patients begin their Rehab journey with Target Exercises intended to kickstart neurological activity. The nerves must be firing to be able to tell the muscles what to do. CROC often uses Electrostimulation Therapy (E-Stim) to help with this process. E-Stim uses low doses of electricity to stimulate nervous function but it doesn’t hurt. It can feel strange, like a tickle or in the best case, a big muscle twitch! Please note that E-Stim therapy requires us to shave small patches of your pet’s fur to allow electrical conduction through the tissues.
We’ll also start simulating the body’s normal movement to help your pet “remember” what that feels like and to work on maintaining good Range of Motion in all the limbs. Once we start to see any sort of muscle contractions in the legs, we’ll step up our exercises to get that muscle moving as much as possible, while also stimulating more nerves and muscles to join in. We’ll practice weight bearing, essentially re-teaching your pet how to stand on their own. Many exercises for FCE patients are focused on improving Proprioception or knowing where your body is in space. Because of the damage to the spinal cord, many FCE patients often can’t feel their environment or have no sensations to tell them where their legs and feet are. This is important because if we want to get your dog to the point of consciously controlled leg movement, they have to know where to move their legs in order to stand and eventually walk.
This initial stage of rehab is frequently the hardest for pet parents. It can be discouraging to be a few weeks into Rehab Sessions without seeing obvious improvement. Meanwhile, us Rehabbers are getting super excited over the tiniest little muscle twitch or spontaneous kick or even a few seconds of weight bearing. We’re excited about these seemingly insignificant improvements because they are big indicators for what your pet will eventually be capable of, so hang in there!
Hydrotherapy can be an exciting phase of their recovery. The buoyancy of the water allows for more movement with less effort, so we often see legs moving in the Underwater Treadmill before we see it on land. The Underwater Treadmill also allows them to feel the ground beneath them, so that continues to stimulate nervous function. Because they are walking in the water, instead of swimming in it, exercise in the Underwater Treadmill is low-impact, high resistance with slower, more controlled movements.
Through their recovery process, CROC continues to challenge your pet with a variety of exercises while also treating any pain that your pet experiences. Thermotherapy and Therapeutic Massage help to relieve tense muscles and increase blood flow. Therapeutic Laser Therapy not only helps increase circulation to the tissues, but it also encourages healing at a cellular level. Veterinary Medical Acupuncture stimulates the nervous system while also releasing endorphins which helps with pain relief.
Safety for FCE Patients
Changing Habits: Since many FCE patients rarely make a complete return to the level of function they had before the FCE, some simple changes at home can make all the difference in making it easier for them to get around. Rugs or yoga mats strategically placed around the house will help your dog to grip the flooring better, which reduces their risk of falling. The softer surfaces also make abrasion wounds on their paws less likely, although rug burn is certainly a possibility for some dogs. Ramps can make obstacles like stairs less challenging, although care should still be taken to monitor your pet while using these. Some pets will no longer be able to navigate stairs safely, so you might need to block them off entirely. Especially in the earlier stages of recovery, it can be beneficial to keep resources like food, water, bedding, or outside access closer to your dog and easier to get to. Closely supervise play time with housemates or other doggie friends since your dog will be weaker and more prone to falling.
Swimming: Swimming is rarely recommended for FCE patients. There is a video viewable at this link, https://www.caninerehaboc.com/post/swimming, that provides a visual for this, but we’ll explain here too. When dogs swim, they generally paddle fiercely with their front legs while keeping their back legs tucked up alongside their body. This type of movement means they are over-working their front legs and barely working the back legs. Swimming also puts immense strain and twisting movements on the spine.
Chiropractic: We know this is a soft spot and that many people enjoy chiropractic for themselves. Human Chiropractic has been practiced since the late 19th Century but is still in contention regarding its efficacy today. In Veterinary Medicine, Chiropractic is a very controversial and divisive topic. We do not want to shame anyone for previous choices made with the intention of helping their pet. We do feel compelled as thoroughly educated Veterinary Medical Professionals to share our perspective. At CROC, we have treated multiple patients that were receiving chiropractic care and were in significant pain when they came to us, which resolved when chiropractic sessions stopped while proper Physical Rehabilitation Therapy continued.
A good percentage of CROC patients arrive here after being referred by their veterinarian. Because of this, we have developed very close relationships with the local Neurological and Orthopedic Veterinary Specialists. CROC does not offer Chiropractic services because not a single one of these Board-Certified Specialists will support or recommend Chiropractic therapy for their patients. Even when consulting with Boarded Neurologists outside of Orange County, we have yet to find one that would approve of their patients undergoing Chiropractic treatments. At this time, there are no Peer-Reviewed studies to substantiate claims that Chiropractic is an appropriate (or even safe) treatment for Veterinary patients. In addition, the American Veterinary Medical Association, America’s leader in advancing the science and practice of veterinary medicine to improve animal and human health, has not published any policies supporting Chiropractic.
Reviewing Chiropractic on a basic level - Chiropractic treatment involves applying jarring and intense force on the body. Your dog’s spinal cord is trying to heal and is particularly fragile so the force of Chiropractic can push your dog to further injury. If your dog is experiencing enough pain that you are exploring other treatments like Chiropractic, please check in with us or your regular veterinarian first. There are certainly better and safer options for pain relief available.
The End Goal
Ultimately, our goal is to try to get your pet as independently mobile as possible. We hope that your pet can regain the ability to walk or even run and maintain control of their bowels and bladder. This isn’t possible for every patient and the ones that do… well, sometimes they learn how to do it in a different way than pet parents might have expected. Not all patients can regain conscious movement of their legs but instead learn something called a “spinal walk”. Spinal Walking is when a dog still doesn’t have sensation or proprioception in their legs, but they develop a reflexive walk. Since the signals aren’t getting through the spinal cord to the brain (and vice versa), they are instead relying on more basic reflex signals to get their legs moving enough for them to be able to walk. This reflexive walk isn’t always pretty but it is functional. If we’re given the choice between paralysis and a goofy looking walk, we’ll take goofy any day of the week.
What If They Still Can’t Walk?
At CROC, we always want to give Neurological patients the full 6 months of treatment before throwing in the towel. If we’ve reached the 6-month mark and still haven’t seen significant improvement, that’s when we start looking at a Cart, sometimes referred to as a Doggie Wheelchair. It’s important not to jump into using a cart too soon as once your dog starts getting around without using their legs, that pretty much seals the deal that they never will. For more information regarding Carts and what the process for getting one looks like, be sure to check out our in-depth article at https://www.caninerehaboc.com/post/the-wheel-deal.
The good news is that CROC rarely, if ever, sees FCE patients require wheels. However, not all FCE dogs regain independent mobility and the task of caring for a physically debilitated dog is a hefty one. It’s essential that you keep Quality of Life for you both as a top priority. If your dog is not recovering well and you are not prepared for years of intensive care, it’s time to start discussing the reality of the situation. We touch on this subject for your sake as well as your dog’s. Compassion fatigue is a prevalent concern for clients caring for FCE dogs with severe Neurological deficits. The hope is that as your dog progresses through rehab, the amount of effort you will need to put into their care will decrease. For dogs whose paralysis is more advanced or who don’t have control of their bowels and bladder, the strain on you to keep them clean and safe, as well as the physical strain of carrying them around, is enough to wear down even the most dedicated owners. We bring this up because we want you to know that we are available to you as you navigate your pet’s condition. We frequently support our clients through the big decisions and help them to find the plan that works best for them while keeping quality of life as high as reasonably possible for all involved.
Tools To Make Your Lives Easier
While your pet is re-learning to walk, they will frequently drag their legs and/or paws, so it is key to protect their paws from the scuffing and abrasions that will happen. Lots of dog booties are readily available for purchase, but our favorite is a rubber variety called Pawz. We like these best because they protect the paw while still allowing your pet to feel the textures of the ground and providing extra grip. With any dog booties, care should be given to appropriately size your pet’s paws and to only leave them on when your dog is on a surface that is harmful to their skin to rub on. Booties left on for too long can cause skin infections, reduced circulation, or worst case – be chewed off and eaten!
A good harness is a must! Your dog will depend on you for assistance, so your choice of harness makes all the difference in comfort for both you and your dog. Our favorite harness for FCE dogs is called the Help ‘Em Up Harness. It was created to help owners better assist their dogs without hurting their own backs in the process. It comes in two pieces, one to go around the chest and one to go under and around the pelvis. Depending on your dog’s abilities, your pet may or may not need the back half, but if they do, as their coordination and strength improves, the back half of the harness will become less necessary. It is comfortable enough that your pet can wear it for extended periods, and it is more ergonomic for you and your dog than just lifting them or using a sling. If you are interested in purchasing this harness for your dog, be sure to speak to us as sizing and fitting your dog can be trickier than it might appear. Please note that this harness still needs to be removed each day and kept clean to prevent any abrasions or skin infections. You can learn more about this harness at https://www.caninerehaboc.com/post/help-em-up.
If your dog doesn’t have complete control of their bladder and bowels, diapers and belly bands become good options to help keep your dog and your home clean. Some dogs lose urinary control before fecal, so in those cases, belly bands are a nice alternative for male dogs over a full diaper. Just as with humans, good hygiene when using diapers and belly bands is a must! Dogs left in dirty diapers for too long are at risk for urinary tract infections and skin infections. It’s also important to note that dogs instinctively want to avoid their waste, so being stuck in it is not great for their mental health. Disposable and washable options are readily available for purchase online or at major pet stores.
Use a good quality dog bed! Orthopedic Memory Foam beds are ideal. Your dog’s bed should be at least 1 1⁄2 times as long as your dog and at least 1-2 inches of thickness for every 40lbs of body weight. Encourage your dog to change positions, such as switching which side of their body they lay on. Laying in one position for extended periods of time can lead to decubital ulcers (bed sores) and significant stiffness. If your dog is unable to reposition themselves, it is recommended to move them from one side of their body to the other every 4 hours to prevent ulcers from forming. Once formed, decubital ulcers are difficult to heal, extremely painful, and highly prone to infection so prevention is best!
Is There Anything Else?
One of the best things you can do for your dog is keep them lean! We generally recommend a Body Condition Score (BCS) of about 4 out of 9. The less weight there is for them to haul around, the easier it will be to start lifting and moving their own body. Some FCE dogs are also old enough to have started developing arthritis, so all the more reason to reduce any extra work on their joints. For more information on the BCS and Weight Management, read our online article https://www.caninerehaboc.com/post/body-condition.
CROC works closely with you to make sure your dog is on the right supplement and medication regimen. Joint supplements, like Dasuquin w/ MSM, are helpful to support their joints as some parts of the body will be compensating for the weakness of other areas. A supplement for muscle growth/maintenance called Myos Canine Muscle Formula may be helpful for the FCE dog and is available online. CROC strongly discourages the use of marijuana products for FCE patients. While emerging research shows some promise for marijuana products in veterinary medicine, there is much more to be done and FCE patients are already weak and have limited coordination, making them poor candidates for this treatment.
Fibrocartilaginous Embolisms are a serious condition, but not a death sentence. Many dogs show signs of healing quickly after the incident, but those that don’t will require consistent and intensive rehabilitation for several months. CROC has had great success rehabbing our severely affected patients back to independent mobility but cannot make any promises that we can do so for every dog. It can be a long, challenging road, but we are here to walk it with you and support you and your pup through the entire journey.