In this episode we welcome Dr. Missy Carpentier, a veterinary neurologist from Minnesota, to discuss the fascinating and often complex world of veterinary neurology. Dr. Carpentier shares her journey from veterinary school to opening her own specialty clinic, Minnesota Veterinary Neurology, dedicated to treating neurological conditions in pets.
The trio delves into a variety of topics, including the increasing prevalence of neurological issues in popular dog breeds like the French Bulldog, the challenges of diagnosing conditions such as seizures and disc disease, and the importance of owner awareness in recognizing subtle signs of distress in their pets. With her expertise, Dr. Carpentier explains the different types of neurological disorders, the significance of proper imaging techniques like MRI, and the impact of conditions such as paroxysmal dyskinesia and cervical spondylomyelopathy on pets.
Listeners will gain valuable insights into what to do in case of a pet emergency, the innovative treatments available, and how pet owners can advocate for their furry friends. Tune in for an enlightening conversation that underscores the importance of understanding veterinary neurology and the passion behind helping animals lead healthier lives.
Whether you’re a pet owner, a veterinary professional, or just curious about animal health, this episode is packed with information you won’t want to miss!
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A Discussion On Veterinary Neurology
Welcome to the show. I am Dr. Alice Novotny Jeromin, a board-certified veterinary dermatologist, and I am Janet Novotny King, I am the doctor’s sister. I am not board-certified or a doctor’s mock during anything. I am here because I am a pet lover, owner, and rescuer. We are here to help you become the best pet owner you can possibly be, to give you some science-based factual information. We have some amazing guests and Alice. Who do we have?
First of all, I have to tell you a little story. I was walking on the beach the other day, and I was listening to this wonderful webinar on intervertebral disc disease. When you blow a disc in your back. I did not know what the hell that was until you got to the disc. IV disease. As I did to my L5. Anyway, I got home, and I’m like, “Who was that?” The veterinary neurologist is Dr. Missy Carpentier. She is a veterinary neurologist in Minnesota, building and opening her own clinic.
Kudos to you, Dr. Missy, because I did the same thing, and I will pray for you. It was still fun at the same time. She is the founder of Minnesota Veterinary Neurology, which is a specialty hospital for neurology only. I cannot tell you, Janet, from a veterinary point of view, how much that is needed. That is one of the things I want to talk to Dr. Carpentier about because she brought up so many good points about the most popular breed right now, which is the French Bulldog, and how it is like a little dog packed into a little skeleton. Welcome, Missy, to the show.
Thank you. I am happy to be here. It will be a great topic and much needed.
Give us a little bit of your background, please.
Specialization & The Path To Veterinary Neurology
I actually grew up on the East Coast. I grew up in Boston, just north of Boston. I ended up going to Ross for vet school and then finished up in Minnesota, where I met my husband. We have sled dogs, so we will never leave Minnesota. My husband stayed put in Minnesota. I went to do further training. One of the main things is how you specialize as a neurologist? You do your four years of vet school, but then there is a whole bunch else that you have got to do. I did a one-year rotating internship back in Connecticut.
Where were you in Connecticut?
I was at a VCA in Connecticut.
Which one?
At Shoreline.
I live in Geremia. We do not have a VCA.
I was there. I went and did a year postdoctoral fellowship in Missouri, where I then stayed to do my residency for an additional three years in neurology. I got to go be a real doctor and practice as a neurologist. I headed back to Minnesota, where I have been since, so I have been practicing in the area for almost nine years. I decided last year to venture out on my own so I could practice veterinary medicine exactly the way I want to help as many pets as possible.
I have to shout out to her because I owned my own practice, a sole practitioner as a specialist, non-corporate. I am so proud of you for doing that.
Thank you. I have come to learn that there are not too many of us out there, but hopefully it will change.
What are some veterinary neurology issues? What are the main ones?
Common Neurological Issues & The Importance Of Video
The main thing that we will see, seizures, of course, is definitely one of the most common medical conditions that we treat. What is interesting with veterinary neurologists is that we do both medical and surgical neurology. Whereas in human medicine, you will go see a medical neurologist versus a neurosurgeon. We actually do both, which is really fun because we get both sides of it. On the medical side, seizures are by far the most common.
We also do surgery because dogs have really bad back pain or neck pain secondary to a disc herniation, or potentially meningitis, or they come in and they have a really bad case of vestibular disease, which we usually think of as vertigo. You get off the roller coaster, and you are so dizzy, and dogs can present with that as well. Different tremor syndromes. There is a whole bunch that we will deal with, basically anything associated with the brain or spinal cord. Also, anything involving the muscles and nerves.
The other day I wanted to tell you, I’m in Florida, and I help out the Lee County Sheriff’s Department Animal Abuse Unit. Any veterinary questions, they can call me. I had gotten in touch with Missy the other day because one of their golden retrievers, their three-year-old golden that calms people down and calms kids down when they are from abusive environments, all of a sudden, is just having an on-and-off head tremor, not like every day. I am a dermatologist. I immediately emailed Missy, and the nice thing is that if they can video it, it is huge. It is such a help.
It has really changed the way we deal with seizures and tremor syndromes because it makes it so easy for us. It can be really hard to say in words what you’re seeing, especially as an owner. My own personal dog had seizures, and one of the first things I would say is that the seizure lasted ten minutes when in reality my dog’s seizures were always less than a minute, but it felt like eternity for me.
I think now owners are realizing how helpful the videos, you can say, “Wait a minute, that was only so long.” This is what was happening, and this is what was going on. It makes diagnosis of what is happening much more feasible for us because our patients cannot say, “This is how I was feeling beforehand, and then this happens. This was after.”
That’s my question. How do you know your pet is having a neurological issue?
Comes from the owner. I will always say they know their pet best. The number of times that I see pets as a second or third opinion, and they just say something is not right. I cannot put my finger on it. I do not know what it is, and we will go through everything. Even if I might find a normal neurologic evaluation, I will say, “You are telling me, though, something is wrong.”
Let us see if we can figure it out. The number of times I have found something going on in that pet’s brain, whether hopefully it is not commonly a brain tumor, but that can happen in certain areas, versus if they have got a disc herniation and it is causing them chronic pain. They may still be walking well, but something is off, and it happens time and time again. The owners really are the key players. There may be obvious signs.
Owners are the key players. They often notice the signs first because they know their pets best. Share on XA lot of times, there are obvious signs. “My dog will not shake his head anymore because its neck hurts, random screaming or crying out,” or “My kitty is falling over because it has a head tilt, or my pet is not jumping up anymore.” Those are very common and classic signs that we will see, and the owners will find them. Usually, they will go to their referring veterinarian or their primary veterinarian, and they’ll be able to say, “Yeah, this is not right.” They can either try to manage it, or in those other situations, they can always reach out to a local neurologist.
I had no idea. Neurology reminds me of the immunology part of what I do in derm. It is like something new all the time.
I practice in Minnesota, and during my residency in Missouri, I honestly only treated a handful of cats. What was really interesting when I came to Minnesota is I treated so many cats in Minnesota and Wisconsin.
What is the most common neurologic problem you are seeing?
We see vestibular disease very commonly. They like to get otitis media quite a bit, an inner or middle ear infection. That infection actually can extend into the brain pretty commonly in kitties. Cats are cats. They are going to do whatever they want. They can be walking around with a brain abscess, and the only thing they have is a little head tilt, but they can do remarkably well with treatment.
It really was learning a lot of new concepts that you read about in a textbook, but you were not necessarily seeing. In Minnesota and in Wisconsin, we see so many cases and procedures. We see them for disc problems, although they are not as common. They absolutely can have disc problems as well. Dogs are far more commonly going to be the ones with intervertebral disc disease.
What is a held head tilt? Is the cat like this?
They’re looking at you like this. Their balance is off. Usually, they will have a head tilt to one side. Their eyes, we call it nystagmus, their eyes may be moving back and forth or up and down, really rapidly. You just look at them, and you can just tell, “These poor things are so dizzy.”
“Old Dog” Vestibular Disease Vs. Serious Brain Conditions
On that note, tell us about the thing that I had a high school classmate of mine ask me about neurology. He has a fifteen-year-old black lab, and it woke up one morning with a head tilt and rolling around. Tell me about that.
In your older dogs, you hope that the situation that has caused that is what we call old dog vestibular disease. Usually, it is a condition where our older patients, and we call it idiopathic, and I will always tell my owners that is a fancy word for us, just not knowing what the underlying cause is, but we give it a name. Luckily, it is not a sinister cause. For some reason, that old dog has an acute onset of vertigo, and the good news is that it is going to improve over several days.
Idiopathic means we don’t know the underlying cause. I always explain that to the pet owners. Share on XThey may always have a residual head tilt, but a lot of the time in those older dogs, it can come on very suddenly. It is very scary, but they can do great. Now, of course, there are other more concerning things that can cause that in an older dog if they potentially had a stroke, what we call a cerebrovascular accident, or, unfortunately, a brain tumor. Usually, in those really acute cases, luckily, a lot of times it will be that old dog vestibular disease, and they can do well with just time and supportive care.
You do not rush to do an MRI on those? Do you say let us give it some time?
It depends on the owner, and it depends on the pet and what their condition is, and where my gut is telling me. If I am more concerned, maybe they are a patient that I’d be worried would be predisposed to have strokes or vascular accidents, maybe I’d say, “Let’s see what we’re dealing with so that we know.”
Granted, with the stroke, many times the dogs also will do fantastic, but it is good for us to know, so we can try to make sure we are treating the underlying metabolic problem. I am always a need-to-know person, so I always think that it is great to do an MRI, but a lot of times in the older dogs, I will talk to the owners and say hopefully this is what it is as long as everything else is telling me that their brain is not involved, otherwise.
When we are looking at a really dizzy patient, we say it is either peripheral or central vestibular disease. Mainly, that means something is going on outside the brain, which is what we want, of course, or inside the brain. Those old dogs with classic old dog vestibular disease should be presenting as something going on outside the brain. In those cases, I will usually say, “Why don’t we give it some time, support, and see where we are in a day or two, as long as things don’t progress.”
That is so sad.
As a pet owner, say my dog is having a seizure. I guess one of the best things to do is to grab your phone and do a video because that is going to help the veterinarian.
It always is. I will always say there is no way you are going to get that first seizure your pet has on video because you are going to be so freaked out. It is understandable. You are just going to want to make sure your pet is okay. If your pet does have a seizure, the biggest thing you can do is just try to make sure they’re in a safe area so that if they’re by stairs or on the couch or anything, we just do not want them falling off. There is nothing you can do to get them out of it faster.
Many times, they are going to drool, they are going to urinate, and they are going to defecate sometimes too. It can be really scary, but know that most seizures last less than two minutes. It is not common for a pet to pass from a seizure unless they go on longer. We start to hit a 5 or 6 minute mark, and we get concerned because their overall body temperature will go up, but most seizures are going to last less than two minutes. It will seem like an eternity, but try to keep them safe.
Once they are recovered and doing okay, definitely following up with your veterinarian to see what you need to do and what is going on, versus if you have a neurologist nearby, you of course can always reach out to them as well. There are a lot of dogs in the world that have what we call idiopathic or genetic epilepsy. There are a lot of dogs out there that have just been born with a seizure disorder, Border Collies, Aussies, and Labradors.
Any purebred dog has the potential basically to be what we call idiopathic or genetic epilepsy, but of course, there are many other cases. You just want to make sure they are safe, and they recover okay. Most dogs and cats, after a seizure, think about it. They just expended a ton of energy, they used up all their glucose, they’re thirsty, so they are going to want to eat, they are going to want to drink, they are going to want to pace around and get their bearings again. That is very common how they will act afterwards.
Will they be the same? Is there a change in the dog?
Most patients will totally return to normal, but it depends on the timeline. Some dogs, I have owners who say it takes them a minute, and then they are back to themselves. Other dogs, they can take a day. It all depends. Some dogs will have visual deficits immediately following the seizure, and then they get back to themselves. We call that the post-ictal period.
Depending on how long the post-ictal or post-seizure period is, most pets will return to normal. The majority will return to normal unless there is a more concerning cause with some other brain disease that is going on, and it is not that idiopathic, in which case, then we’d be worried about them not returning to normal, in which case, then we get more concerned about something going on within the brain itself.
3D MRI Technology & Anesthesia Safety
I read that you do some work with 3D magnetic resonance imaging. What do you do?
It is basically just a way that we are utilizing MRI to be able to do it so that we can get these really nice thin slices on MRI to give us a really nice image, and less time is really the best way to describe it. It is less time for the patient under anesthesia. That is the main thing. If you think about it, you and I are told, “Lay perfectly still for an MRI,” and we will lie there.
Many times, we need something because we get nervous or claustrophobic, but our patients are not going to understand that. They do have to undergo anesthesia for the MRI, and so whatever we can do to maximize their time in the magnet, and I say that by meaning whatever I can do to limit the amount of time they’re under anesthesia for, and also know that I am getting the images that I need to have diagnostic images.
I wish they had knocked me out.
Honestly, they wish they had knocked you out, too.
I was good. I did it, but they gave me a drug.
I have a question. If I have a dog that has never had a seizure before and they have a seizure, do I need to rush the dog to the vet right away? How many seizures do you allow that dog to have before you say, “We’ve got to do drugs?”
If your dog or cat has a seizure, it is always good to follow up with your vet. Make sure they recover okay. I would call them and just make a regular appointment. They can do blood work and make sure nothing has changed. We always think that a seizure always originates from the brain, but it could be something outside the body, whether it is a little glucose or something that is going on that could make it so that they’re having a seizure and make their brain unhappy is the best way to think about it.
We often think seizures always originate in the brain, but they can sometimes be caused by something elsewhere in the body. Share on XIt is always good after a seizure to follow up with your vet. My mentor, Dr. Denny O’Brien from Missouri, said everybody is allowed to have one seizure in their lifetime. It is what it is, but more than one, we have got to really look more into it, meaning doing an MRI or spinal tap or something along those lines, but after one seizure, definitely call and check in with your vet, that way they can get them into some blood work and make sure everything metabolic is okay.
I have to ask her this question because I just read about this. I use prescription hypoallergenic diets for another reason. This thing is called paroxysmal dyskinesia. Can you put that into lay terms?
Paroxysmal dyskinesia, it is a type of movement disorder. Basically, we’re trying to figure out in pets what potentially an underlying cause could be. A lot of times, we cannot, but there are some dogs that actually have sensitivities that can cause it. It has been shown in some, but not most, breeds, but there are certain breeds that can have food sensitivities, meaning we change their diet, and we take away those abnormal movements that they’re having. Usually, that’ll be something that’ll come in where owners are thinking it is a seizure, and then we find that it is going to be this movement disorder.
All of a sudden, it is gluten-less and gluten-free. Are we just discovering gluten?
We’re a little late in the veterinary community for gluten.
Do you see what I am saying? You’re hearing so many more of my friends say, “I found out I was gluten intolerant and I feel great.”
When we talk science, the likely the more we learn, the more we can figure things out.
I love it when food can fix what is wrong with you. I love that. Let us talk about disc disease because I love what you talked about in Frenchies and all those pushed-in faces. Are they really called that?
Intervertebral Disc Disease (IVDD) & The “Jelly Donut” Analogy
I call them my low riders. I mean, I love them, I just feel bad for them, honestly. We’ve created them. We are responsible for them and for their problems. That is why trying to come up with the best solutions for them, the poor things. Disc disease in general. There are many ideas about this disease out there. It has become common knowledge in the vet world, which is great. People will be like, “My dog has IVDD,” which is wonderful. Many times, I will see owners come in, and they say, “My dog’s been diagnosed with IVDD. What do I do?”
IVDD stands for intervertebral disc degeneration. All it means is that the natural discs that are next to the vertebrae bones of the spine have degenerated. Usually, when something degenerates, it calcifies or hardens. Normally, you can think of a nice, healthy disc like a nice jelly donut. This nice jelly center should be taking in all the forces to protect the spine. If it has hardened, then it cannot respond to those forces naturally.
Every dog and every cat, this happens more so to dogs, but in every dog you take off the street, they can have evidence of disc degeneration. Just because you take a radiograph and you say, “Here’s evidence of IVDD,” it does not mean that it is necessarily going to be a problem. That is always what I think is the one thing that I want owners to know, because they will many times come to me with a dog that is totally normal, but they’ve been diagnosed with IVDD on x-rays, and they’re so scared.
What I always try to explain to people is that this is a normal aging process that is going to happen. There are certain breeds, our lowrider breeds, which we call our chondrodystrophic breeds. The degenerative process starts much earlier. I have a Dachshund. It is one of the most common breeds we see. I love my little Dachshund, but I know that when she was just two months of age, her discs had already started to degenerate. It starts so young compared to other dogs, where they are 7 or 8 years of age. Our Dachshunds, our Beagles, our Frenchies, which have taken over the world and are the majority of what we see now.
Corgis, those are the dogs that are classically going to present with disc disease. That being said, any breed of dog can present with disc disease at some point where that disc is now a problem. When I say that the disc is now a problem, what I mean is that the disc is no longer in its natural spot. The disc naturally sits below the spinal cord, and if that disc misbehaves, it is usually going to go upwards. What is up is the spinal cord.
That disc can be causing pushing, what we call compression, on the spinal cord, but also, when it came up, it could have basically caused a significant bruise to the spinal cord. What we call that is a concussive injury. You are dealing with two problems there, and that is when it becomes an issue. It is not an issue just because it is starting to have this degenerative process. Though, of course, we know this disc could be a problem in the future.
It is a problem when that disc starts to misbehave, which is usually how I will phrase it to my owners. They know, and some people will say, “The x-rays show that it was this disc that was calcified or degenerative on x-rays.” Let us say it was the L2-3 disc, but we do an MRI, and it is actually the T13-L1 disc that is the one that is misbehaving and is causing a compression. Many times, I would say, “We cannot go just off the radiographs.” That is why we usually have to do more advanced diagnostics, and that is where we will bring the MRI or CT into it.
When that disc goes up, will it come back down again? Will the bruising be better? It just stays there. It keeps plugging there.
There are some that likely will go away and get taken in by the inflammatory processes that will start the inflammatory cascade. The majority of it will be there. That is one of the most common reasons I see dogs. They can still be up and walking and doing fine. These owners will say, “I understand my dog doesn’t have severe neurologic deficits, but he is in so much pain, and he is not responding to medications.” A lot of people think, “Unless my dog is paralyzed, I cannot do surgery,” which is so not true. I do surgery on so many painful animals because, to me, it is all about quality of life.
If your dog can walk, that is fantastic, but your dog has got to be comfortable, too. If medications are not cutting it, I will gladly look further into it and potentially do surgery. There are a lot of neurologists out there who also feel the same. That is just a common myth out there that owners feel like, “I heard that unless my dog is not walking, they are not going to do surgery,” which is not true at all. We might not come in at midnight to do it, but I am going to come in to make sure your dog is comfortable and taken care of.
Your dog’s comfort is key. If medications fail, you have to consider all options, including surgery. Share on XIs there physical therapy available?
Absolutely. Physical therapy is definitely something that will go on as part of the treatment protocol. Usually, if you have a dog, let’s say the dog is walking and just painful, we can try medications. You can definitely try what we call medical management, versus if things progress, they are paralyzed, they are really painful, they are not responding to medication. That is when we say, “Let us look further into this with the MRI, see what we’re dealing with.” If the compression is significant, let us go ahead and do surgery.
What is pretty amazing with dogs is that if your dog comes in and they are paralyzed. They cannot move those back legs at all, but they can still feel them. Something that we call pain sensation. They have an 85% chance with surgery that they can get up and walk again, which is pretty remarkable. Even when we have owners come in, and they are just so distraught, then they hear that number, of course, which is 85%, which is a pretty remarkable number for these paralyzed animals, as long as they can feel those back legs. They can do wonderful.
What do you do? You take the disc in surgery. Do you take the disc out?
In the back, the most common surgery that we do is called a hemilaminectomy. Basically, we make a little window in the bone, and we go in there, and we scoop out, I call it the misbehaving or the naughty disc material, that is no longer in its natural spot. We go in, we scoop that out. We take away the compression from the spinal cord, and you leave that disc material that is not misbehaving and is still in the natural spot alone.
What we have to recognize is that there is now a hole in the top of that disc. We need that to scar over. Regardless if you’re doing medical or surgical management, one of the main reasons that these animals will usually need to be strictly rested for 6 to 8 weeks is so that the hole has time to heal. No more disc material comes up and starts pushing on the spinal cord.
Is it usually just one disc, or will you find that it is the whole three or four?
The Specific Risks For French Bulldogs
No, it’ll usually be one disc that issues. You had brought up French Bulldogs earlier. French Bulldogs are by far one of the most common breeds. It is by now the most common breed that we see, because they have disc disease. One of the things that makes French Bulldogs that makes them different is that they change the way we look at disc disease. They’re in their own category from any other breed of dog that comes in, because they, unfortunately, many times do not do as well in really severe cases.
What happens is that when they have a disc herniation, they usually also have a tremendous amount of bleeding or hemorrhage with it. Even though they herniate one disc, they may have a huge blood clot that is expanding widely over many sites. They usually need a more significant decompression, but that also means there has been more compression or pushing on that spinal cord. We call that an epidural hemorrhage or EH.
We worry about that because usually, you have a disc herniation, then you have all this bleeding with it. These Frenchies may have just had a little bit of back pain a couple of hours ago, and now they are completely paralyzed. It really expedites the process where we say they go down quicker. They really are at any stage when they start showing signs of disc disease, more of an emergent nature. During my residency, it was the rule of thumb that you never sleep on a downed Frenchie because you want to give them the best chance, and the best chance is to do that as quickly as possible, meaning getting an image and then potentially surgery if that is what they need.
During my residency, the rule of thumb was to never let a Frenchie go untreated. You want to give them the best chance, which means acting quickly—starting with medication and, if needed, surgery. Share on XThe harder thing with these dogs, too, is that they are usually babies. They are usually two years of age when they have a disc herniation, which is much younger than our other breeds. It has been suggested that they have a poor recovery as well. That is something that is really hard when you have a young two-year-old dog, and you are going to be saying, “Lock them up for eight weeks.” These poor things.
With Frenchies, we have the ones who say they have a disc herniation. They are younger, so less than 2 or 3 years of age. Unfortunately, they have a 50% chance that it can recur. That is a big number for these people. Hopefully all, and I try to push everybody to have insurance on their dog, but either way, with Frenchies, it is still a hard hit to take that you have this young dog you’re doing one spinal surgery on. They recover well. They may have another one in one year down the line. Usually about 50% of them are going to reoccur and of those 50% that do, they usually do it within the first year of that first injury.
It is really hard, especially if you have these people where this is their first dog and they just got a Frenchie, and they do not know, and they’re so cute and lovable, and you’re having to go through all this. I am so thankful for this show as well, just so it can educate people, especially any breed, but also my Frenchie owners, to know that this is out there. It is a very scary thing to discover when all of a sudden your dog is paralyzed, and you did not know that it could happen.
Missy, what are you most passionate about in your work?
It really is just helping the animal. It is still the core. I think that is why I have ventured to do my own hospital, because I just want to be able to do things my way and help as many animals as I can. I do a lot of rescue work too. That is why I ultimately got into it. You get into the hustle and bustle of veterinary medicine, and you cannot always do things the way that you want. It is nice as I am aging that I can. I can get back to exactly everything that it was, and help just feel like I can help more and do more for my pets.
I want to ask her about Dobermans. Dobermans have this neck problem. Can you talk about that?
Wobbler Disease In Large Breeds
They get a condition called cervical spondylomyelopathy. It is also known as wobbler disease. The reason it is called that is that they wobble when they walk. Usually, what happens is that their spine usually they are older.
The lesion is here, Janet, so anything below that is funky.
Usually, what happens is that the spinal canal, which is what the spinal cord runs through, is narrower than it should be in the lower part of the neck. Kind of right on their shoulder blade area is the best way to think about it. Over time, as the spinal cord is impinged and pushed on, it becomes a problem, usually when they are older. Usually, what ends up happening is they’ll have this little tiny disc protrusion with it.
As opposed to an exploding disc, it is more of just a little bulge, and that bulge onto a spinal cord that has already been pushed on is usually what will push these guys over the edge. We call it disc-associated wobbler syndrome or DAWS. Those dogs many times will potentially need surgery. It depends on what we’re seeing on the MRI, but usually they’ll need surgery when they start to be significantly affected in all four limbs, have difficulty walking, some dogs can be completely down, and then the biggest thing, of course, is if they are peeing.
Dobermans have long necks like Great Danes do.
Great Danes get a different type of wobblers, actually. They get a fibrous one that happens more often when they are younger. They are usually the younger babies that get it, usually less than two years of age, when we’ll see those dogs versus the Dobermans, which are usually around 7 or 8 years of age.
I do not know how true this is, but I remember in vet school when we were drawing blood from a Doberman, they said never wreck that head back like that in case they have that to a mild degree, that you could really cause more injury.
I’m doing a lot of local work right now at different vet schools and different hospitals, and something that I will always preach is never to do range of motion on a dog or cat cervical spine because they can have some really bad disease going on in their neck. They can have a disc herniation, but there is more room in the canal in the neck.
They may not be as clinically affected and only present with pain. You’ll never know. Doing something like that can definitely be dangerous for them. I commonly will see dogs that have this luxation of their first and second vertebrae. It is called an atlantoaxial luxation. This follows me around no matter where I go. It is one of my favorite surgeries, so it is okay. Basically, they can present at any age.
Just recently, I had a six-year-old Yorkie who presented for neck pain, and it had had this waxing and waning neck pain. No other neurologic deficits, and those little dogs, I will always get a lateral x-ray in neutral spine, just keeping their head as is, just to make sure that everything looks okay. There it was. This dog’s spine basically went like this because its second vertebrae, as opposed to being nice and straight, were sitting up here. We had to end up stabilizing that dog’s neck. To your point, anything like that can significantly worsen any cervical disease that is present, especially with extreme ranges of motion.
Some of these dogs must be in so much pain, and we do not know.
They are so good at hiding it. Some of those owners who come in and they say, “My dog is just not right. There is just something I cannot say what it is.” I will find a disc problem. We will do surgery. They’ll come in at their two-week recheck, and they’ll just say, “I didn’t even know how bad my dog must have been affected because this dog is barking at things.
This dog is being crazy, feeling so good.” I’ll see that in some of my older patients, too, and people will say, “I just thought my dog was getting old,” and then they have the surgery, and then they feel like they have a whole new dog again. They are so good at hiding it, and that is why even if I do not find anything significant on my evaluation, I will always listen to the owners because they notice these little things.
I love owners like that, who are so in tune with their pets. Tell Janet about GOLPP?
GOLPP & Geriatric Nerve Degeneration
This is fascinating to me, too. Geriatric onset laryngeal paralysis polyneuropathy. Basically, what you may first notice in your dog is that their back legs seem a little weaker or they’re wobbly, and then they get laryngeal paralysis, which is basically where their voice cannot work appropriately. They can go outside and exercise on a hot day, and they can literally be sucking in air because they cannot breathe in and out appropriately. That will be present in our older patients. Many times, when they have that, unfortunately, it is more of what we call a polyneuropathy.
Meaning that more nerves in the body are affected. Our sciatic nerve is a very long nerve in the leg, and that one is affected. Your recurrent laryngeal nerve is a very long nerve that causes the breathing changes. With Dr. Diane Shelton, we just found it in younger Great Danes, and that paper should be coming out soon describing it. Though it classically is a geriatric onset laryngeal paralysis polyneuropathy complex, we can see it in younger animals as well.
There is really no treatment, right?
Unfortunately not. It is usually supportive care. In dogs that are having difficulties breathing, they can have surgery to open up their airway so that they do not have that problem. Opening up the airway does put them at increased risk for aspiration pneumonia. There are risks involved, but really for the quality of life that usually ends up being mad.
We use sedatives to try to keep them calm in certain stressful situations. In regards to their back legs, because it is a degenerative process, there is not anything unfortunately we can do but in those instances we’ll definitely say physical therapy trying to keep those muscles and limbs as healthy as we can, and utilize them as best as we can, keep them as strong as we can because unfortunately they will continue to get weaker.
I had sciatica, and I asked my chiropractor, “Is it sciatica or is it sciatic?” He goes, “It depends on the pain level. When it is really bad, it is sciatica.”
That is a good one, Janet. I never heard you say that.
I’d call him, and I go, “I have sciatica.
Now that it’s about you, it’s going to be about me.
Always about you.
I know. This is a good question because I do not understand it. When I blew a disc in my back just reaching down to pick up a colander.
It had nothing to do with the dogs. I just want you to know that.
I would wake up at 2:00 in the morning, and the pain was radiating down the lateral side of my knee. That knee hurt more than anything.
It is all connected.
Those are the nerves.
Is that right?
Yep. You basically had like a really bad neuritis happening. Inflammation of the nerves secondary to that disc. That is what we will see commonly. We’ll have some dogs present with really bad lumbosacral disease. At their tail base area is the best way to think about it. They can have really bad pain from that.
They’ll lift up a limb and just try to hold it up because they think that is going to relieve the pain. We call it a nerve root signature because they’re letting us know. First of course you’re going to make sure it is not a lameness for another reason, but then we’ll see them, and we’ll say, “This is because this poor dog’s sciatic nerve is pinched, and they are so painful they are trying to hold it up to make it feel better.”
Alice, were you holding up a leg during that whole time?
No, I have to tell you, my girlfriend came over and I came out of the bedroom. I thought someone was coming over, so I put a sweatshirt on. I was walking with my husband’s cane because he just broke his ankle, and she looked at me and went, “Alice.” I thought I must look pretty bad. Can I tell you, not to get gross, but the worst part was that it was hard to poop. When you blow a disc, you do not want any kind of pressure going on anywhere.
They ask you that question, are you having pain?
Nobody asked me that.
I have been to a human neurologist, and they ask you, “Actually.”
Let me just tell you, the orthopedic person that I saw here, the whole appointment was asking me about his German Shepherd.
Let us get back to my point.
On that note, I do want to ask about brain tumors. Obviously, the older pet likes the symptomatology.
They unfortunately can happen at any age, just like in people, but we see them more commonly in older pets. What makes them really tricky in our pets is that when we talk about different parts of the brain, we can talk about the front part, which we call the forebrain. We as people use our forebrain a lot. We will many times be able to know if we have a small mass in our forebrain because we will start to do things. We will go to drive somewhere, and we’ll say, “Shoot, where the heck was I going?” Forget these little things. With dogs, they do not really use their forebrain, nor do cats.
That explains a lot.
The problem with that is that they can have these huge brain tumors in their forebrain, and they’re acting totally normal because everything that drives their daily activity comes from what we call the reticular activating system, basically in the midbrain portion and backwards. They’re more hindbrain animals. Because of that, they can do their normal functions, they can do everything, and unfortunately, they have this large mass growth.
Animals' daily activities are driven by the reticular activating system in the midbrain and back. Problems here often go unnoticed until other brain areas are affected, triggering seizures. Share on XIt is not until it gets to the point that it starts disrupting other parts of the brain. Whether or not they will then start to have a seizure. It is very common in older patients that they present with seizures, and they have a large brain tumor. Otherwise totally normal because they do not use a large portion of that part of their brain. It is really disheartening for owners when they say, “I’m with this animal all the time. The only thing that has happened is they just had a seizure,” and they’ll come to see me, and they know this pet.
Unfortunately, we will find something like that. It is really hard because we almost wish they used more of that forebrain so that we could have clues earlier, so that we could be more helpful for these pets. Still, it does not mean there are no treatment options, depending on the type of tumor that we see. There are surgical options, and there is radiation therapy. Radiation therapy is definitely coming up, as we see that it can be very similar to surgery.
In regard to expected outcomes, so we could do that as opposed to a surgery. There is palliative care. Meaning just putting them on medications to try to help support them as best we can. Usually, that will be steroids, anti-seizure medications if they need it, or pain medications if they seem like they have a headache. There are certain breeds.
Any of your smushy-faced breeds, your brachycephalics, so your Boxers, your Frenchies. Frenchies, you can just plan on anything neural they can have. Your Boston Terriers, those cute guys, we do worry more about them having certain types of tumors as well. They can present more at that middle age, that 7 or 8 years, where you would not quite say that they are older yet, unfortunately.
I had Cindy, my fifteen-and-a-half-year-old Golden rescue, because I help out Golden treasures in Akran and then Southwest Florida here. She started having seizures and then was circling. My internal medicine best friend, Dr. Ward, I called heidi and she said, “Alice, you know what this is.” I knew. The seizures did not stop. That was our decision. Isn’t it true that they can circle in the direction of where the tumor is?
Yeah, basically, if they have something going on in the front part of their brain, let us say that they have something going on in the right part of their forebrain, and they’ll circle towards the right. The reason that they’ll do and they’re usually big white circles. Not like tiny tight circles.
All around the dining room.
They’ll do that because the right side of your forebrain controls the left side of the body and vice versa, so they basically cannot direct any attention to the left side of their body when they have something on the right part of the forebrain. We will check what we call their CPS or their knuckling abilities. Will flip their paws over and make sure they’ll flip them back over. We’ll see that sometimes, just on that side of the body. Some dogs will eat only half of their bowl. They will literally draw a perfect line down the whole, and they will just eat everything on the right side, but not all the food on the left side.
Now, what about a brain tumor in cats? Does that present the same way?
Yes. Kitties will present the same way. I will say they’ll present the same way, but my rule with cats is they can do whatever the heck they want. They throw everything at you. I can think I know stuff, and then a cat walks in and I am like, “You are through. You’re wrong.” They can present as well. The nice thing about cats having brain tumors, if we’re looking to put a positive spin on it, is that they commonly will get a type of tumor called a meningioma. If they do, we are more likely to be able to completely surgically excise the type of meningiomas that they have, whereas in dogs, we always know there is some residual disease, even if it looks like we got everything perfect. The nice thing is that surgical removal of the meningiomas could be curative for cats.
Those are slow-growing, aren’t they?
The number of times we have gotten reports from dermatologists that have done a CT or something, and they say, “Incidental meningioma.” Some of those owners just want to monitor it because their pet is not showing any signs, and we’ll monitor them.
It is funny because the name of a brain tumor and the word incidental.
I get it all the time. They were presenting because they were vestibular and they’ve had otitis media, and “By the way, you have this tumor on the right frontal lobe, or something.”
My girlfriend had a meningioma. My neighbor, she was unloading the dishwasher, and she just fell over in a seizure. Her husband, who is Italian, was like, “Joan, what are you doing there?” I asked her, and she ended up having two surgeries because I do not think they could get it all the first time. I said, “Joan, how did it feel to have that seizure?” She said, “All I could hear was Frank in the background yelling. I didn’t really have any feeling at all.” I was happy to hear that because I always wondered if, when you see a horrible thing happening to your pet, it is not like they are feeling anything, but they can still hear.
That is a really good point, especially when they are first going into it. I tell my owners, “Just talk to them. That’s the best thing you could do so that when they’re coming out of it, they just can hear your voice. They still may not know what’s going on, but of course, just allow them to have that comfort.
Alice, we have got to wrap it up.
I know, but I have one more question.
It is not a big word.
FCE: The “Spinal Stroke”
No, it is not because I cannot remember the name of it, but Missy, you’ll know it. I had adopted a Golden Collie mix, Nelly, and she was a year old. Abruptly, she went down. What is it called? Was it the embolism of the disc?
Fibrocartilaginous embolic myelopathy.
It sounds like it exploded. Tell Janet what that is. She totally recovered. She actually still, if I touched her one shoulder, seemed very sensitive there.
She went from walking to down.
I am sure she got back up again after some time.
She did, and nobody at the time knew what was wrong with her. After I went to vet school, I was not a vet then, I thought, “She had this FCE.” Would you explain that?
I describe it like a stroke to the spinal cord. The most common scenario that I hear is younger dogs, usually large breed dogs, though it can happen in smaller dogs, too. They are outside playing, all of a sudden, the owner hears this high shrieking sound, they go outside to find their dog dragging one back leg, not necessarily another. Usually, it’s painful when it first happens, but then after 24 hours or so, it should not be painful and should not have any back pain.
What happens is that a whole piece of the disc breaks off and ends up obstructing the blood flow. It literally is a stroke. It usually is more on one side than the other. Usually, they will be worse on the left side or worse on the right side. The good news is that those dogs are phenomenal. As long as they can feel those back legs, these dogs have 80% to 90% chance of getting them walking again. It can happen in the neck as well. The Schnauzer is of a classic FCE.
Good to know.
The other thing, too, that presents very similarly to an FCE is what we call, with IBP, you have your type 1, which is when that disc really explodes or herniates. Type 2 is more of that bulge, and we call it Type 3 now. Hansen wasn’t around there, so technically it’s Type 3, and what we call it is an acute non-compressive nucleus pulposus extrusion. What that is is basically some healthy nucleus. That healthy jelly part of the disc, a very small amount of it, will come up very abruptly and basically punch the spinal cord.
It bruises the spinal cord, but then it goes back down. It is only a small amount, and there is no aggressive movement to it. These dogs do not need surgery. They need time, but they are treated very similarly to an FCE because they’ll be painful for the first 24 hours or so. Luckily, everything subsides. Inflammation goes down. It is fine. It is supportive care.
That would be a lucky thing.
One of my technicians that I used to work with when I was in Saint Louis. She brought the dog down to see me and drove eight hours to get an MRI with me. That is exactly what she had. It was one of those worst-case scenarios. You do not want them to have a disc problem, but the best-case scenario is that he does not need surgery, and he should be able to get back to working after 6 to 8 weeks.
You could see that on the MRI.
Basically, what we see when we look at the MRI is that nice jelly center, that nucleus that we talked about, it should be nice and bright. What we see is that we compare it to other discs. There is less of it at that site, and then you can see the brightness of the bruised spinal cord on the MRI.
Isn’t that amazing?
Neurology is so fascinating. It seems to me it is changing every day.
Honestly, every day. It is really interesting. Keeps you on your toes. You’ll have the standard things, and then all of a sudden it throws you for a loop, and you are just figuring things out and learning things as you go.
The gluten thing, Janet.
Who would have thought?
Thank you so much. This is so informative.
I am so glad you agreed to do the show. It was so nice meeting you. I love the show that you run.
We have to ask you our guest question. What is your pet or human peeve? To me, it is noise in a coffee shop.
All this stuff goes back to neurology. Personally, what drives me nuts as a neurologist is when people say that a dog or a cat is non-ambulatory paraplegic because plegia means there is no movement, there is no motor function. If you’re saying non-ambulatory paraplegia, you are just saying it twice, and there is no need for it. That is one of my pet peeves. Another pet peeve that I know my technicians are going to give me is that they are just going to say, “Why didn’t you say it?” Is that a fontanelle, an opening of the skull? A lot of times, people will say, “Open fontanelle.” That is the other thing. Everything is so messy.
I hate it when I am a customer, and someone says, “No problem.” It is no problem, both are negative. I never thought about that. That is like a big no in the customer service world. I literally like the hair on the back.
Mine is instead of pruritus, pyritis. I never use that word.
Now that I am retired, I go to the beach for walks, and I listen to podcasts and webinars. When I hear pyritis, I’m like beep, into a different one.
Missy, it has been a pleasure. Good luck with your practice. Wishing you a ton of success.
Thank you very much.
I am so happy for her.
Thank you so much. This was great.
This is Dr. Alice Novotny Jeromin and Janet Novotny King saying thank you for tuning in. We appreciate you tuning in. Do not forget to share with your friends. Send us your questions, and we’ll put some of those big term words on the screen for you. Thanks, bye-bye.
Bye.
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About Missy Carpentier, DVM, DACVIM
Dr. Missy Carpentier grew up in Massachusetts and pursued her dream of becoming a veterinarian at Ross University School of Veterinary Medicine and The University of Minnesota College of Veterinary Medicine. Following veterinary school, she completed a rotating internship in Connecticut at VCA Veterinary Referral and Emergency Center. As her interest in neurology peaked during the internship, she then completed a one-year post doctoral fellowship in the Comparative Neurology Program at the University of Missouri College of Veterinary Medicine. Dr. Carpentier stayed in Missouri to pursue a three-year neurology/neurosurgery residency that was jointly performed at The University of Missouri College of Veterinary Medicine and Veterinary Specialty Services in St. Louis. At the completion of her residency, Dr. Carpentier received the American College of Veterinary Internal Medicine Resident Research Award for her work on 3D Magnetic Resonance Imaging of the Dog Spine in Hansen Type I Intervertebral Disk Disease.
Following completion of her residency, Dr. Carpentier moved back to her forever home of Minnesota to join her husband. She has been serving the Twin Cities and surrounding areas for the past 7 years and she is eager to bring this state-of-the-art hospital to Minnesota.
Dr. Carpentier enjoys all aspects of neurology, from the medical side of managing an epileptic patient to improve and maximize their quality of life, to the surgical side assisting a patient to be able to walk again and live a pain free life. Dr. Carpentier also brings the experience from the pet owners side, having to manage her own dogs with epilepsy, atlantoaxial luxation, and intervertebral disk disease (yes she takes her work home with her even when she tries not to!).
Outside of neurology, Dr. Carpentier enjoys spending her time with her husband, their two children, their Alaskan Husky kennel of competitive sled dogs, their numerous house dogs (Aidni is by far the best), and her two off the track thoroughbred mares.