Wobblers

You may already know quite a bit about wobblers, also known as cervical spine instability or CVI, but just so we are on the same page, let me outline *my* working definition of wobblers causes and treatment options

Diagnosis of Wobblers
Surgical Treatment of Wobblers

Causes

As I understand it, wobblers is a condition where the spinal nerves coming down from the skull/ neck area get pinched or have some sort of pressure put on them by the cervical (neck) vertebrae. The vertebrae can be moved out of correct position and cause the pressure/ pinching by genetic weakness of the vertebral ligaments, age related degeneration of the vertebral ligaments, or trauma. There is, to my understanding, also a rarer form of wobblers, caused by abnormal formation of the vertebrae causing bony spurs on the vertebra that can form on the inside of the spinal cord pathway or in between the vertebrae. These spurs then cause the pressure and/ or pinching of the spinal nerves.

With the pressure/ pinching, the spinal nerves are progressively injured and don't transmit the impulses well so the dog has difficulty walking or with maintaining stability (why it's called "wobblers"). You may also notice folding over of the feet, difficulty or reluctance to change positions, evidence of pain with movement..... Depending on where the nerve is experiencing the pressure and how MUCH pressure, determines what the symptoms are and how bad they are. If the pressure lets up intermittently, then the dog can seem to recover, then when the pressure reoccurs due to some external force or stress (like over activity), the dog has problems again. That's part of the problem with getting an accurate diagnosis. The symptoms are so varied from dog to dog, depending on where the problem is, how bad it is, how stoic the dog may be, etc. Wobblers/ Cervical Vertebral Instability then is a 'catch all phrase' that includes all the possible causes of why the spinal cord could have some sort of pressure on it causing damage.

The condition *usually* comes on slowly, but in some cases it can happen very fast. As I mentioned, sometimes it comes on without an obvious cause (thus the idea that it's genetic) and other times you can point to a cause-- such as a neck injury. The tragedy of wobblers is that without intervention, the condition continues to get worse and the dog's condition deteriorates.

Nerves will try to heal to a point, but they are not very resilient and once damaged, have problems with the healing process & nerve healing is very sloooooowwwww if it occurs at all. Once the nerve is permanently damaged there is/ will be no decrease in symptoms, and in a lot of cases the signs/ symptoms become severe enough (total loss of bowel / bladder function, inability to stand at all) to require the dog to be put down. So the whole idea is to get the pressure OFF the spinal cord/ nerves as soon as possible and prevent the pressure from reoccurring again. Treatment for wobblers therefore 1) hopefully corrects the condition so the dog improves back to 'normal' or as close to 'normal' as possible or 2) gets the condition stabilized so it doesn't worsen and allows the dog to maintain at what ever condition he/she is at at the present.

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Diagnosis & Confirmation     

In the majority of cases the veterinarian will make the diagnosis based on symptoms. However, sometimes he/she may suggest a myelogram to confirm the diagnosis of wobblers. A myelogram is an x-ray of the spine to visualize where the spinal defect/ pressure is occurring. The spinal cord is normally surrounded by fluid (spinal fluid) to cushion it from day to day bumps and bruises. The body is constantly replenishing the fluid as it slowly gets absorbed, but the body needs a certain level of the fluid to keep the nerves healthy. The way that the x-ray is done is to stick a long needle in between the spinal bones (vertebrae) as close to the spinal cord as possible and suck some of the fluid out. Then they put x-ray dye in next to the cord. The dye surrounds the bones and cord so that the surgeon can see every little nook and cranny in the spine and see the general outline of the spinal cord (which doesn't show up on a regular x-ray).

The problem is, myelograms can be non-diagnostic. In other words, the area of pressure may not fully show up on the x-ray and thus give an inconclusive result. In addition, a lot of creatures (humans as well as those with fur) are allergic to the dye itself so the critter undergoing the procedure may suffer severe side effects including the potential to die from it. They could suffer swelling of the cord from exposure to the dye, injury to the cord from the needle, infection which could end up as a brain infection, or at the very least, they are guaranteed an incredibly severe headache that will last for days.

Myelograms are risky enough that they've all but stopped doing them on humans since we get MRIs and CT scans and such. If you choose to get the gold beads, you do NOT necessarily need a myelogram. Myelograms are generally necessary for surgical intervention however.

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Standard Treatment Options

Medication           

Steroids (usually prednisone) can seem to help since the drugs lessen the swelling somewhat that the cord experiences from the trauma of the pressure. The dog seems to recover, but the cause of the wobblers isn't treated and the damage continues to occur. (The prednisone also has *major* side effects-- and you cannot just stop giving it to the dog abruptly. You have to gradually/ slowly reduce his dose or he could become seriously ill or even die from the withdrawal.)

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Surgery

Treatment options used to be only surgery but spinal surgery is so delicate that it wasn't very successful in a lot of cases. Veterinary surgeons are getting much more skilled, but the prognosis of the surgery still tends to be 'iffy' in a lot of cases. Success is dictated by how skilled/ experienced the surgeon is in doing spinal surgery, where the pressure is on the spine and how severe the damage to the nerves is. Since wobblers can go undiagnosed for some time, in many cases the nerve damage can be irreversible.

If a dog ends up going through surgery, the recovery from the spinal surgery is slow and very restrictive. During the surgery the dog has incisions made along his spine and the bones are cut away to help relieve the pressure. The hospital stay in the ICU is several days to several weeks, and the post surgery activity is very limited with small increases allowed over several months. From my understanding it's constant crating with little weenie exercise breaks (2-3 minutes a couple of times a day and gradually work up from there). I was also told, when exploring the surgical options, that I would have to keep my dog separated from
other dogs for the remainder of her life..... not an option in my multidog household! The cost of the surgery is also pretty expensive (3-8 thousand US dollars were the estimates I got in '99).

If you decide that surgery is the right option for you dog, talk with your vet to see what vet school is in your area, or vet specialist in your area that might do that procedure. Then I would question the doctor you are referred to closely to see how many spinal surgeries he/ she's done and what his/ her success rate is. Also ask what their definition of success is-- just surviving the surgery is a success in some people's opinion, while you've blown thousands of dollars and your dog is worse off than before the surgery!

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The Alternative: Gold Bead Treatment

As you read on Delilah's web site, there is also another option that is becoming available more and more is the Gold Bead Implantations. The treatment is based on the eastern medicine practice of acupuncture. According to eastern medicine, the body has energy "meridians" or pathways running down it at specified intervals. Then something interrupts the energy flow (called chi) then you get symptoms that we westerners call "disease". To treat the disease the acupuncturist inserts very thin flexible needles temporarily at strategic points to allow the energy to flow smoothly again and the body heals itself.

Acupuncture has provided some measure of healing for some wobbler dogs, but the dogs have to have the treatments every week or so for maintenance of the healing process. The gold beads work on the same principle as acupuncture. The beads are implanted at the affected energy meridians to allow smooth flow of the chi again-- but the beads are implanted permanently and therefore usually only one treatment is needed. The beads help to strengthen the ligaments that hold the vertebral bones in their correct place, thus allowing for pressure relief on the spinal nerves. There is also evidence that the effect of the Gold Beads affect how the vertebral bone actually forms thus also allowing treatment of the wobblers caused by bony spurs.

Occasionally the dog may have to go back for placement of additional beads, but more often the initial treatment is all that is needed.

In addition to the beads and just during the early recovery phase (first 3-4 weeks), a neck brace is also applied to help facilitate correct alignment of the neck while the nerves are initially healing since many wobbler dogs also attempt to compensate for the pain and discomfort they have been in by assuming odd positions with their necks. After about 3-4 weeks, the brace can be removed. Some dogs need a brace applied intermittently, but Delilah has not to this point.

Keep in mind that the gold bead recovery is still slow-- Delilah's total healing took place over 9 months to a year-- but it's not as restrictive with a minimum hospitalization. The cost is also A LOT less than the surgery. (700-800 US dollars vs several thousand).

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