Living with Wobbler Syndrome
(appeared in ASLA Times Fall 2017 Issue)
(appeared in ASLA Times Fall 2017 Issue)
In January 2015, our family was dealt a devastating blow when our first Sloughi, Balad, was diagnosed with cervical spondylomyelopathy (CSM), or wobbler syndrome. CSM is a disease of the cervical spine or neck, in which the spinal cord and the spinal cord nerve roots are compressed. This compression occurs due to damaged discs or bony malformations of the vertebrae. The salient symptom is an irregular and unsteady gait with weakness. This “wobbly” gait is why cervical spondylomyelopathy is often called wobbler syndrome.
In late 2014, Balad had been experiencing difficulty stepping down from carpet grass to cement on daily walks. It first appeared to us that he was not seeing the transition from one surface to another. But as weeks went by it became more pronounced and we noticed that on occasion his front feet started to knuckle under. With Ron’s background in neurology research he was concerned the knuckling under of Balad's front paws was not due to aging but possibly due to a spinal cord issue. This is why we decided to see a veterinary neurologist.
We went to the appointment prepared to hear Balad had a spinal cord injury or even cancer. What we were not expecting was the diagnosis we got. Until that day we had never heard of wobbler syndrome. One way to confirm a diagnosis of wobbler syndrome is to have an MRI. Luckily, our veterinary neurologist, Dr. Veronique Sammut, works at VCA West in Los Angeles where they have an MRI scanner on site. We were able to get confirmation of the diagnosis within an hour. Balad had several discs compressing his spine in the neck (see Balad’s MRI scans below). Treatment often includes a combination of medication, home management, and/or surgery. Dr. Sammut said Balad was unfortunately not a candidate for surgery because of his age, the progression of the disease, and the specific location of his spinal cord damage. When asked, she said Balad probably had 12-18 months before we would have to make the end-of-life decision.
It hit us as we left the vet’s office that life was changing and it was changing right now. While Balad did not have a wobbly gait yet we knew it was coming and had no choice but to protect the delicate spinal cord. He could no longer use a regular collar for walks because any tugging could create more damage. This was so important that we weren’t even allowed to leave the vet’s office using a collar. The vet tech fashioned our leash into a makeshift harness for the trip home. The first thing we did was purchase a harness. However, we struggled with a normal harness because it would slide forward on his chest, so we combined two of them to make a larger harness with support across and behind his chest. This helped with his daily walks. Over time his balance and coordination worsened, and the harness was useful as a handle to steady him and keep him from falling.
Medication was our main hope to extend Balad's life and keep him comfortable. He was on the standard medication for wobbler syndrome – gabapentin and other medications for neuropathic pain along with corticosteroids to reduce the swelling that was putting pressure on his spinal cord. But Balad had too much muscle wasting on corticosteroids so he was switched to an NSAID. As is common, NSAID’s are hard on the stomach so he had to be carefully monitored for stomach upset and GI bleeding. As the disease progressed Balad required increased dosages. It was a delicate balance to find the right dosages to keep him comfortable while avoiding as many side effects as possible
Our daily lives changed to accommodate Balad’s new restrictions. We could no longer allow him to go up and down stairs because downward movements would strain his neck so we began taking turns sleeping downstairs with him. Balad would make sure he could see us and took comfort that we were in the same room. As time went on he would have an urgent need to go outside, and being in the same room meant we were able to respond faster and prevent accidents. His balance affected the way he walked even when his gait was not wobbly. We put down additional carpet runners to ensure he would not slip and fall. And while Balad was still young at heart and wanted to play, we had to limit his interactions with his sons, Aziz and Azilal. Over time he became less active and we worried he would develop pressure sores from lying in one position for long periods of time. We were familiar with an alternating pressure air mattress used for humans who are bedridden and we ordered one for Balad. Not only did it reduce pressure on his body and reduce the pain and stiffness from lying in one position for so long, it also helped him stay cool on hot summer days.
Even Balad made adjustments for his condition. We had pillows arranged at the back of the air mattress and he learned to position himself so he could throw his body down, hit the pillows just right and lay down where he landed. It was too much effort for him to change position once he was on his bed. When walking he would all of a sudden become weak, stop and his legs would slowly collapse. He would sink to the ground and take advantage of being down on the grass to sniff it as if nothing unusual had happened. It was hard to watch, yet he often resisted our help to get up off the ground, as if he wanted to do it all on his own.
What made wobbler syndrome so cruel for Balad was that his body was giving up and he did not understand why. His eyes were bright and when he was not in pain he was the same loving Balad we knew for twelve years. On bad days his eyes would search our faces for help. We could not explain to him what was happening. All we could do was comfort and love him. The months following his diagnosis were a series of ups and downs. Some days he had accidents in the house. As the disease progressed he was not completely emptying his bladder so he experienced frequent UTIs. This meant repeat visits to the vet and added stress to his already taxed body. He did not know if getting up from his bed would result in falling or not. One day he could barely walk and then the next day he would be almost normal.
We have our own business and work from home so we could be with Balad 24/7. We felt fortunate to be able to be there for him but it was isolating. We were living in this world of wobbler syndrome on our own. We told very few people what we were experiencing. We did not know how to explain it and why we were going to such measures for Balad. The answer for us was simple. He was a family member and deserved the most dignified life we could give him with this debilitating condition. We couldn’t stay at home and just wait for Balad to die. We took him camping in our RV, carrying him up and down the steps. He went along to dog shows with us. We made the necessary adjustments on those trips to accommodate his needs. While at home he stayed primarily in our family room, the center of family activity, so he could be part of everything we did.
We have our own business and work from home so we could be with Balad 24/7. We felt fortunate to be able to be there for him but it was isolating. We were living in this world of wobbler syndrome on our own. We told very few people what we were experiencing. We did not know how to explain it and why we were going to such measures for Balad. The answer for us was simple. He was a family member and deserved the most dignified life we could give him with this debilitating condition. We couldn’t stay at home and just wait for Balad to die. We took him camping in our RV, carrying him up and down the steps. He went along to dog shows with us. We made the necessary adjustments on those trips to accommodate his needs. While at home he stayed primarily in our family room, the center of family activity, so he could be part of everything we did.
When you are immersed in a situation like this you do not always see the changes as clearly as others might. We knew he was struggling but it was apparent he still enjoyed life. We were doing all we could to help him but as his neuropathic pain worsened the level of gabapentin had to be increased. A side effect of this medication can be dizziness. That combined with gait issues made it more difficult for Balad to do daily tasks. We knew eventually the gabapentin would not control the pain, no matter the dose. The disease advanced faster than we expected or were ready for. He still enjoyed being outdoors and being with us throughout the day but his walking became more difficult and it was clear the pain was going to become unmanageable. In August 2015, just seven months after his diagnosis, the time came to say our final goodbyes.
As the saying goes, hindsight is 20/20. In our case we can go back and see possible signs before Balad was diagnosed with wobbler syndrome. Symptoms often progress gradually,though trauma may cause rapid progression. Some symptoms we saw over a long period of time include oddly worn toenails (that we now know were caused by dragging of the feet), holding his head down when walking and/or running (presumably to alleviate pain), difficulty walking on slippery surfaces, and occasional difficulty standing up from a seated or lying position. In retrospect, we see these issues plus others that we wonder about.
There were times when Balad was perfect in the show ring and times when his gait was off – he had difficulty with his front feet, throwing them out in an odd fashion. It was not until later that we noticed his front paws knuckling under. Balad also never liked stairs. He always preferred to stay on one level of the house and only used the stairs when absolutely necessary. He struggled with non-carpeted surfaces. Our other dogs all did okay but he would avoid slippery surfaces by walking only on the carpet or carpet runners.
In April 2012, Balad suddenly had unpredictable episodes of what appeared to be severe hip pain and difficulty walking. Each episode would clear up within hours. We took him to the vet several times and he was never symptomatic at those visits. X-rays revealed no problems. The vet even commented that Balad had healthy bones and connective tissue, and the x-rays looked like those of a much younger dog. We treated him with corticosteroids and rest. It was never suggested that we see a specialist and six weeks later the episodes stopped. We now wonder if that was not a hip issue but the first real warning that he had wobbler syndrome.
Are all of these signs of wobbler syndrome, or just coincidences we now attribute to the disease? We’ll never know. By telling our story we want to make people aware that wobbler syndrome was confirmed in a sloughi and it should be taken seriously in the breed. Anyone who is concerned about their dog needs to work with a veterinarian to get a proper diagnosis. Because many of Balad’s symptoms became more noticeable when he was older we just attributed it to the aging process. If we had any inkling that this disease existed in sloughis we would have gone to a specialist earlier. Without our persistence to get the MRI and a definitive diagnosis we may never have known for certain what he died of.
As a good friend once said, there’s no crime in breeding a litter with a disease that you could not test for and did not know existed in the breed. Balad came from exceptional lines. We do not fault or blame his breeder or any breeders of his ancestors. He was a gorgeous Sloughi with a pleasant personality, good conformation and most importantly he was a beloved family member. We will forever be grateful to his breeder for introducing us to Sloughis and Balad in particular.
Now that we know wobbler syndrome exists in the breed we cannot be silent. If we remain silent and do not openly share information on what dogs are affected we won’t know if there is evidence for a genetic component to the disease in the Sloughi. It is time to move forward and become well educated on the disease. We need to be stewards who advocate for the breed – actively look for the signs of wobbler syndrome and work to remove it from the breed. As owners and breeders, the decisions we make now will directly impact Sloughis for generations.
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