Today’s case is one that many owners of Dachshunds can painfully relate to. We’ll meet Debbie and follow the story of her initial wobbliness that unfortunately resulted in an unhappy outcome. Debbie’s condition can happen in any breed of dog, but those with similar shapes to Dachshunds are especially vulnerable.
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Debbie the Daxie
Debbie was a 4-year old female entire Dachshund who lived with her siblings, Dottie and Daniel, and their owners. The owners had bred the siblings themselves, and kept three of the pups. Their mother, Agnes, sadly passed away a few years prior. Debbie was reportedly a very active dog at home and loved to play with a ball in the owner’s large garden, though it was noted she was incredibly anxious at the vets. She was seen regularly there for health checks, was intermittently on medication to control itchy skin, but was otherwise healthy.
The Incident in the Garden
One busy day at their local vet practice, Debbie’s owners came rushing into the building demanding to see a vet, worried that Debbie had ‘slipped a disc’ and was in severe pain. All the vets were occupied, so a team of vet nurses triaged Debbie. They identified that she appeared calm and in no severe pain, so she was not in a critical state. Having calmed the owners down, the nurses took a history of what happened while they waited for the vet to finish.
Debbie’s owners were inside, so didn’t see exactly what happened. But they knew the three dogs were out playing in the garden as usual. They went out to check on them and found Debbie in distress and walking abnormally, dragging one of her back legs. Leaving the other dogs safely inside, they came straight to the vets. They explained they were experienced Daxie owners and knew that Debbie had slipped her disc.
Initial Examination
Finishing their previous consult, the vet examined Debbie. They first started with a basic clinical exam, checking Debbie’s eyes, ears, nose, and mouth, heart and respiratory rate, temperature and so on. These were all normal. Believing Debbie’s problem was neurological and agreeing with the owners that a ‘slipped disc’ was a likely differential, they performed a neurological exam. They started at the head, checking the cranial nerves (nerves that control eye movement, sight, facial sensation, hearing and so on). These were also normal. Placing Debbie on the floor, the vet observed that she could walk but was dragging her back left leg slightly. She was walking in a straight line and her head was held normally. These signs mostly ruled out a problem within the brain itself, meaning the spinal cord was probably the location of the problem.
Palpating down Debbie’s back, they noted she did not react and was not in pain. The vet then gently pinched the skin on her sides, noting how much it rippled. The ripple (panniculus response) reduced as they went further down the spine. Finally, they felt Debbie’s hind legs. Her legs were well muscled and the joints moved well without any signs of stiffness. When the left foot was placed top down on the floor, Debbie could correct the position but it took her longer than with her right or front feet (knuckling response). Finally, the vet pinched between Debbie’s toes, and Debbie responded by pulling her legs away, meaning she had deep pain sensation.
The vet concluded that Debbie had a spinal cord lesion in the mid-lumbar region that was causing hindlimb mono-paresis – weakness of one hindlimb. Intervertebral disc disease, IVDD, (a slipped disc) was a likely differential, but other possibilities included damage to the spine itself, or a fibrocartilaginous embolism, FCE. Given Debbie appeared to not be in pain, the vet believed an FCE was most likely.
IVDD vs FCE
We’ll take a moment to explain what these two conditions are.
Intervertebral disc disease
IVDD is a degenerative disease of the discs between the spine. The discs are made up of a softer central nucleus pulposus, and the firmer outer annulus fibrosus. Think of them like the jam and dough of a jam doughnut respectively. The nucleus pulposus is mostly made up of water. The role of the discs is to provide flexibility and shock absorption between the bones of the spine. In IVDD, the nucleus pulposus dehydrates, resulting in diminished shock-absorption. This leads to strain when the discs are compressed by the spine.
In some cases, the strain occurs slowly over time. This results in the disc bulging outwards (slowly standing on the doughnut), termed IVDD type II protrusive. In others, sudden pressure on the disc causes catastrophic failure where the inner nucleus pulposus bursts from the annulus fibrosus (jumping on the doughnut), termed IVDD type I extrusive. In both cases, the spinal cord can be impacted – this leads to pain, paresis and paralysis. Daxies and other chondrodystrophic breeds (breeds with abnormally shaped spines) are genetically predisposed to IVDD, particularly type I.
A fibrocartilaginous embolism is a vascular disease
It occurs when there is a sudden blockage of the blood supply to the spinal cord. This results in the spinal cord losing function beyond the blockage. Anything can block this supply, but it is common that a piece of the nucleus pulposus breaks off and blocks the nearby blood vessels. Because the spinal cord has not been directly damaged, the condition is rarely painful. It is more common in chondrodystrophic breeds, like Dachshunds, who have degenerative spinal discs already. An FCE tends to only block the left or right side of the blood supply.
Though a clinical examination can help differentiate these conditions, a CT and/or an MRI are usually required for formal diagnosis.
Debbie’s Initial Treatment
Debbie most likely had an FCE in her lumbar spine because her paresis was one sided and she had no pain. The vet advised her owners of the likely cause of her sudden paresis. And advised that because she still had deep pain sensation in her feet, the prognosis was good. There is no direct treatment for FCE. The dog must be cared for until the blood vessels grow around the blockage and the blood supply resumes.
Depending on the severity of the paresis or paralysis, a dog will need rest, assistance walking and regular moving of the limbs to encourage blood flow. In some cases, the bladder cannot be emptied normally due to loss of the blood supply; so this must be manually done by the owner. Mental stimulation is also important to avoid a dog becoming depressed which could slow down recovery. Pain relief is not often needed. The recovery period can take anywhere from 2 weeks to several months.
In Debbie’s case, she could walk with some assistance, and thankfully was able to wee and poo herself
The owners thus found they could manage the condition relatively easily by keeping her indoors and taking her into the garden to toilet when needed. They made sure to bring her siblings in to safely play with her. And they gave her lots of fuss to keep her spirits up. They noted that she dragged her leg less and less as time went on; a sign that the blood supply was rerouting.
After around 4 weeks, Debbie returned to the vet for another examination. The owners were very pleased with her progress and felt she was pretty much back to her old self. The vet agreed, and found she was no longer paretic on her left hind limb, and had good motor function too. They advised one more week of rest, and then she could return to normal function. The vet did advise however to ensure the owners be wary with all their Daxies; further spinal problems were sadly likely given their breed.
The Incident at the Park
Debbie was not seen at her vets for a few months after her FCE-incident, and was generally doing well. However, one day at the park her owners decided to play fetch with her – though they knew they had to be careful, they hoped that a simple game wouldn’t be too strenuous on her back. Unfortunately, as Debbie turned round to run after the ball, she yelped loudly and fell to the ground. The owners once again panicked and rushed her to their vets again.
The previous vet saw Debbie again and was immediately more concerned. Whereas before Debbie was happy to walk and seemed comfy, this time Debbie refused to walk at all, her legs hanging limp. She was also whimpering a lot, seemingly in pain.
On exam, the vet again found no obvious abnormalities on a basic clinical exam or cranial nerve exam. This time, however, when they palpated down Debbie’s back, she let out a yelp. Both of her hindlegs appeared to be fully paralysed, with no knuckling response, reduced panniculus response, and no deep pain in either foot. Thankfully, her anus did appear to have sensation, though it was unclear if she could urinate consciously yet or not.
The vet advised Debbie’s owners that she likely had slipped a disc this time around. Debbie probably had had an IVDD type I extrusive event, where her intervertebral disc suddenly ruptured and impacted her spinal cord. Because she was fully paralysed from the mid-back down, and her feet had no deep pain, the damage to her spinal cord was likely serious. They advised that though conservative management similar to management of the FCE was an option, referral to a neurologist provided the best hope of Debbie returning to normal function.
Referral to a Neurologist
Debbie’s owners were keen to seek the best care available, but were worried about the costs. They knew that referral could cost thousands of pounds to pay for the expert knowledge and high-tech equipment. However, luckily Debbie had comprehensive insurance, and a quick phone call to their provider confirmed she would be covered for up to £5000 of care. Relieved, the vet rang the neurologist and referred her as an emergency, giving her pain relief in the meantime.
The neurologist saw Debbie the very next day, and performed another clinical and neurological exam – they agreed that IVDD type I was likely, and the prognosis without intervention was guarded. They recommended to give her the best chance of regaining function of her legs that she undergo spinal surgery. The owners were happy to agree.
Later that day, Debbie underwent a general anaesthetic and had an MRI scan
This advanced imaging technique enables us to look in detail at the spinal cord where other imaging modalities cannot view. The MRI confirmed the diagnosis of IVDD, identifying damage to the L4 disc and the nearby spinal cord. They also saw degeneration of several other nearby discs.
With a diagnosis in hand, Debbie was passed over to the surgical team for a hemilaminectomy of the fourth lumbar vertebra. This complex procedure involved exposing the spine around the injury, slowly burring away the bone so the spinal cord can be viewed, and then removing the extruded intervertebral disc material. This provides space for the spinal cord to decompress and heal, and prevents further extrusion of the same disc. The surgical site was closed and Debbie was woken up.
Post-Surgery
After Debbie’s surgery, she was hospitalised with the neurologist for five days. During this time, she received multiple painkillers and anti-inflammatory drugs to keep her comfortable. She remained on a drip to facilitate this. Her bladder was also catheterised – this was done to ensure she could be drained of urine regularly, as it was still unclear if the nerves to her bladder were also damaged. The nurses also took her outside daily using a sling for her back legs, to encourage her to move and prevent depression.
Once it was determined she was comfortable enough to go home, she was discharged. Her catheter was removed, but the vets were worried she could still not urinate herself – they taught the owners how to express her bladder manually, with the hope that she would regain function soon. At home, she had similar care as after her FCE, with strict bed rest, regular interaction, short trips outside and mental stimulation. She had to be turned regularly to avoid bed-sores, her bladder squeezed at least twice a day, and she remained on strong painkillers. This management would last for at least a month.
Final Outcome
Debbie’s owners worked incredibly hard for the month after surgery, ensuring that she did not get common complications like bed-sores and urine scald. They even took time off work to make sure she was supervised at home. On follow-up checks with the original vet, the surgical site seemed to be healing well, but there was concern her mobility was not improving. She appeared to be able to slightly move her hindlimbs now, but they were still far from normal. The vet advised that repair to the spinal cord can take a long time, but may not always occur. At this stage, they discussed what the owners might do should Debbie never regain function of her legs.
If Debbie remained fully paralysed on her back legs, the owners would have to consider if it was kind to keep her going – losing control of the back legs can result in damage as they are dragged along the floor, muscle wastage, bladder issues and general depression. Some of this may be able to be helped with the use of dog-wheelchairs, moving the legs regularly to maintain muscle, and regular expression of the bladder.
Her owners considered these options, but felt it was not fair on Debbie to remain locked in a chair while her siblings ran around
They also admitted that it would be very difficult for them to manage a paralysed dog, and couldn’t take more time off work. The vet said that it was an incredibly difficult decision, and if they felt it was not kind to continue, they would support that decision. They were also glad to see the owners were considering their own lives – though dogs are our world, it is important to consider how their care will affect us too. There is no shame in admitting that you are struggling with your pet.
Ultimately, Debbie’s owners agreed to continue for another two weeks to see if she made progress. Unfortunately, Debbie didn’t show any change from her last visit. Her owners made the difficult decision to have her put to sleep. She went peacefully in her owners’ arms.
Spinal conditions can often be very serious, life-changing and difficult to manage, as Debbie demonstrated. Though many have successful outcomes, such as FCE or even mild IVDD cases, some do not. Sadly, Debbie was one of the latter. If you have a Dachshund or similar breed, be extremely careful with exercising, twisting movements, jumping up or down, and other movement that can lead to IVDD. All of these dogs are at a high risk of spinal cord damage.
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