Understanding and Managing Fibrocartilaginous Embolism (FCE) in Dogs: A Comprehensive Guide to Recovery

Introduction: Navigating FCE Recovery in Dogs

Fibrocartilaginous Embolism (FCE) can be a sudden and alarming condition for dog owners to encounter. Understanding what FCE is, how it affects your dog, and the steps you can take to aid in their recovery is crucial. This comprehensive guide offers a timeline of recovery, home care tips, and exercises to help your dog regain their strength and coordination. Whether you're just beginning this journey or looking for additional support, these insights aim to provide clarity and confidence in managing your dog's path to recovery.

A quick overview

Fibrocartilaginous Embolism (FCE) occurs when a small piece of the inner part of the intervertebral disc or bone marrow enters the spinal cord's circulation. This blockage can impede blood flow, leading to spinal cord ischemia.

FCE often follows mild trauma or rigorous exercise, but it can also happen unexpectedly, even when a dog is simply walking. The onset is sudden, with dogs typically yelping in pain, which subsides within minutes. However, this is usually followed by weakness or paralysis.

Dogs generally stabilize within 12 to 24 hours. The specific symptoms and affected areas depend on the location of the spinal cord damage.

Treatment

While there is no specific medical treatment for FCE in dogs, the focus is on nursing and supportive care. Physical rehabilitation is crucial for recovering mobility and muscle strength, reducing muscle atrophy, and regaining coordination.

This guideline offers a timeline, goals, and home care tips to help your pup get back on their feet.

Immediate post injury to 3 - 7 days post-injury

Phase

Home Program

Initial Weight Support Goals: Noticeable muscle tone in the limbs Weight bearing ins standing with minimal support  Minimize muscle atrophy  Independant urination and defecation

Therapeutic Exercises: Assisted standing with support as needed PROM (Passive range of motion) with bicycling of the hindlimbs (and forelimbs) - 10-15 reps Flexor reflex exercises - eg. tickling under the paws and looking for any muscle activation Modalities: Cold therapy next to the spine where the injury occurred - 20 min if needed Gentle massage of affected limbs Other: Bladder expression in cases the require it Use of soft bedding and turning them every 4-6 hours to prevent pressure sores

1 - 2 weeks post-injury

Phase

Home Program

Weight support to initial motor function Goals: Pain-free activity Full weight bearing in standing Minimize muscle atrophy Movement of affected limbs at a slow supported walk Self-rotation - ability to turn themselves left to right

Therapeutic Exercises: Assisted standing and  weight shifting, gradually decreasing support PROM (Passive range of motion) with bicycling of the hindlimbs (and forelimbs) - 10-15 reps Slow leash walking with a support sling for 5 min, encourage stepping Flexor reflex exercises for the affected limbs Modalities: Gentle massage of affected limbs Other: Bladder expression in cases the require it Use of soft bedding and turning them every 4-6 hours to prevent pressure sores

2 - 4 weeks post-injury

Phase

Home Program

Initial motor function to good motor function with proprioceptive deficits  (toe dragging or knuckling of their paws) Goals: Improve awareness of their limb when walking Maintain normal limb ROM (range of motion) Increase muscle mass in affected limbs Maintenance of balance during turns on a moderately insatiable surface

Therapeutic Exercises: Assisted standing and weight shifting on a moderately insatiable surface PROM (Passive range of motion) with bicycling of the hindlimbs (and forelimbs) - 10-15 reps Slow leash walking with a support sling for 5min - 10min Turning exercises during standing with positive reinforcement held at various locations - concentrate on the weaker side Turning exercises during walking: circles and figure of eights - 5-10 reps Walking across unstable surfaces - 5-10 reps Walking over low and evenly spaced obstacles - 5-10 reps Caution: Choose only 2 - 4 exercises per session when exercising at home. Doing all of them may result in over-exertion and pain.

4 - 6 weeks post-injury

Phase

Home Program

Good motor function to with proprioceptive deficits to near normal gait Goals: Consistent proprioception with moderate to high intensity activity Affected limb muscle mass approaching normal Maintain balance during turns and negotiating obstacles while walking A consistent foot fall in early trotting

Therapeutic Exercises: Assisted standing and weight-shifting on an unstable surface Turning exercises during walking: Weaving poles gradually decreasing in distance Stair climbing 1 working up to 5 flights Sit-to-stand exercises, rising from an elevated surface Leash walking 10-15 min with 5 min incline/decline walking Trotting over even ground - 2-3 min Walking across an unstable surface - 10-15 reps Walking over 5-8 low and evenly spaced obstacles Caution: Choose only 2 - 4 exercises per session when exercising at home. Doing all of them may result in over-exertion and pain.

6 or more weeks post-injury

Phase

Home Program

Near to normal or normal gait Goals: Reduce proprioceptive deficits during high intensity activity Normal affected limb muscle mass Maintain balance during turns and negotiating obstacles while trotting

Therapeutic Exercise; Assisted standing and weight-shifting on an unstable surface Turning exercises with weaving poles Stair climbing 5-10 reps Sit-to-stand exercises 10-20 reps Controlled ball play Leash walking 20-30 min with 10 min variable inclines and 5-10 min working up to longer periods trotting Trotting across unstable surfaces Trotting over evenly spaced obstacles  Caution: Choose only 2 - 4 exercises per session when exercising at home. Doing all of them may result in over-exertion and pain.

Conclusion: Tailoring FCE Recovery to Your Dog's Unique Needs

While this guideline provides a structured approach to FCE recovery, it's important to remember that every case is unique. The progression of exercises and improvement will vary for each dog. Physiotherapists will tailor home management programs to fit your dog's specific needs, so it’s essential to follow their professional advice closely. By staying attuned to your dog's progress and adapting their care plan accordingly, you can best support their journey to recovery.