Wobbler Syndrome: Panel Discussion
Wobbler syndrome is often misunderstood by veterinarians and their clients. It’s frequently considered incurable, and even unmanageable, but alternative approaches can be greatly beneficial for this problem. We asked a panel of integrative veterinarians for their input.
Dr. Ihor Basko: “Veterinary literature has used 14 names to describe this condition. This is in part due to the confusion regarding the mechanisms causing it. The name most commonly used in veterinary articles is cervical spondylomyelopathy (which means a disease of the neck vertebrae affecting the spinal cord). Other common names are CVI (cervical vertebral instability), CVM (cervical vertebral malformation), CVMM (cervical vertebral malformation-malarticulation), and cervical spondylopathy1.
“The term “wobbler” describes the wobbly gait of dogs and horses with this cervical condition. Dogs have difficulty walking and maneuvering over slippery floors. Some also develop front leg lameness or a lowered head stance, and even complete paralysis. My recent cases have included two yellow Labs, one American bulldog, and one long-haired Chihuahua with symptoms from pain to paralysis.
Dr. Cindy Lankenau: “This syndrome confuses veterinarians because in layman’s terms, the animals suffer from multiple etiologies such as cervical vertebral canal stenosis, cervical vertebral instability, disk protrusion, compression from synovial cysts, or hypertrophy of the ligamentum flavum.”
The five-pronged holistic approach
One must integrate good conventional diagnostic methods such as an extensive musculoskeletal and neurological examination, the evaluation of radiographs, blood chemistries and past medical history with exercise, training methods, diet and supplements along with specific holistic treatments. The focus of treatment would cover the following five areas.
1. Alleviate neck pain and inflammation
• Hydrotherapy (ice and moist heat, alternating) and massage at home or the clinic
• Cold laser therapy
• Trigger point therapy: dry needle or injections of vitamin B12, procaine, Traumeel, or saline
• Anti-inflammatory nutraceuticals: Omega-3 EPA/DHA, MSM and GLA
• Homeopathy: Christina Chambreau, DVM, CVH recommends carefully finding the similimum for the deepest cures, even with acute presentations. Asa Hershoff, ND, DC2 recommends the following for Acute conditions
– Lachnantes: pain as if dislocated, worse on right side, stiffness, spasm, icy cold between the shoulder blades, worse on waking and movement, better with warmth.
– Chelidonium: pressing pain, heaviness, neck and right shoulder range of motion loss, aggravated by heat, pressure and weather changes.
– Bryonia: painful stiff neck, weakness, trapezius pain radiating to shoulder and arm, worse with movement, better with rest and warmth.
– Cimicifuga: radiating pain on the left side, spasms, torticollis, aggravation from cold, damp, wind and movement, better with warmth and pressure. Dr. Lankenau reports that Finlay in The Educated Horse recommended the use of Cimicifuga in the case of any neck spasms.3 Cimicifuga racemosa is specific for heavy tensive, aching pain; as if dependent upon a contracted state of muscular fibers; soreness of muscular tissues, as if one had been pounded or bruised; stiff neck.4
– Others: Belladonna, Nux vomica, Gelsemium and Kalmia
• Essential oils: Topically, frankincense, myrrh, lavender peppermint, wintergreen, chamomile, helichrysum, blue tansy, camphor, etc. can be massaged into the neck alone or in combination.
• Chinese herbs: Topical and internal based upon TCM concepts – Move Blood and Qi, Open the Channels, Relieve Obstructions, Dispel Wind, Cold and Damp, Supplement Deficiencies.
• Western herbs: Topical and internal use of anti-inflammatory and pain reducing herbs:
Dr. Basko: Useful ‘Western’ herbals would be comfrey and/or arnica poultices for traumatic pain, boswellia, yucca, meadowsweet, wild yam root and nervines such as valerian, kava kava, skullcap and feverfew.5
“In Hawaii, we have many herbs growing wild that are used topically, pounded fresh and applied to areas of pain and inflammation such as Noni leaves (Morinda citrifolia), Ti plant leaves (Cordyline fructicosa), and Kava (Piper methysticum). Varieties of introduced species such as plantain, vervain, papaya, gotu kola, and aloe vera can be used, usually in combination with other herbs.”
Dr. Lankenau: “If we look for information from our American Eclectic Herbalist, Goss talked about Hyperemia of the spine with difficulty of voluntary motion and paralysis of the lower extremities and also of the upper limb.6 He used drop doses of Gelsemium, Cocculus indicus or Dulcamara. It has been suggested that a NO pathway is involved with Dulcamara.
“Felter and Lloyd used Capsicum for tired, painful muscles and as a counterirritant and analgesic. It has been recognized as a circulatory equalizer, moving the blood and clearing the capillaries of stagnant engorgement. This would indicate a Depressed Tissue State.7 Fyfe called Capsicum a powerful topical stimulant, of advantage where the circulation is feeble and there is need of such stimulation.8
“Capsicum can ‘significantly increase NO production’9 and improve endothelium health. This is very interesting in that a specific gene (CaCaM1) functions in ROS and NO generation in the Capsicum plant and is essential for cell defense responses in these plants.10
“Capsicum has additional proven antiinflammatory effects by modulating adipokine release and macrophage behavior. Capsaicin (8-methyl-n-vanillyl-6-nonenamide), one of the pungent components found in Capsicum, was shown to induce body heat and enhance blood flow as well as increase energy expenditure, and prevent oxidative stress. Rats treated with 3 mg/kg body weight of Capsaicin for three days showed a reduction in oxidative stress measured as malondialdehyde in the liver, lung, kidney and muscle. Liver glycogen was found to decrease after three days treatment with 3 mg/kg body weight Capsaicin. It was shown that Capsaicin can be a potent antioxidant.11
“Capsaicin also inhibited the expressions of IL-6 and MCP-1 mRNAs and protein release from the adipose tissues and adipocytes, whereas it enhanced the expression of the adiponectin gene and protein. The action of Capsaicin is associated with NF-kappaB inactivation and/or PPARgamma activation. Moreover, Capsaicin suppressed not only macrophage migration induced by the adipose tissue-conditioned medium, but also macrophage activation to release pro-inflammatory mediators.12
2. Improve blood flow and facilitate healing
• Hydrotherapy and massage
• Cold laser therapy
3. Improve nutrition and quell deficiencies
• Treat hypothyroidism
• Treat manganese, magnesium and zinc deficiencies
• Omega-3, GLA
• TCM herbs and food
4. Improve stability of the neck
• Physical therapy and stretching exercises
• Chiropractic adjustments
• Yai Tou: Japanese acupuncture moxa (Artemesia spp) burning on the skin on key AP points.
• Acupuncture and herbs
• Gold bead implants
Dr. Barbara Fougere: “Where possible, consider using gold wire implantation. This has been remarkable in alleviating clinical signs in patients, in this author’s experience. A treatment plan for physical therapy should be implemented. Chiropractic and acupuncture can be very helpful when applied constitutionally rather than merely symptomatically.”
Dr. Lankenau: “Careful application of low force chiropractic care can relieve many symptoms while acupuncture can relieve the obstruction of Qi in the neck area.”
5. Improve flexibility and strength
• Physical therapy, neck exercises and hydrotherapy
• Chondroprotective agents: chondroitin, HA, MSM, glucosamine
• Omega-3 fish oil
• TCM herbs In the Spring issue of IVC Journal, the same panel of three veterinarians will cover the Traditional Chinese Veterinary Medicine perspective, and provide case examples.
In the Spring issue of IVC Journal, the same panel of three veterinarians will cover the Traditional Chinese Veterinary Medicine perspective, and provide case examples.
1 Ronaldo C. da Costa, DMV, MSc, PhD, Dipl. ACVIM Neurology, Department of Veterinary Clinical Sciences, Ohio State University.
2 Hershoff, Asa, ND, DC. Homeopathy for Musculoskeletal Healing, North Atlantic Books, Berkeley, CA 1996.
3 Finlay. “The Educated Horse”, Fairman Rogers Collection (University of Pennsylvania), 1854.
4 Felter, H. The Eclectic Materia Medica, Pharmacology and Therapeutics, Cincinnati, Ohio, 1922; p. 466.
5 Neil, James. The New Zealand Family Herb Doctor. Mills, Dick, and Company. Dunedin, NZ, 1891.
6 Goss, IJM. Practice of Medicine; The Specific Art of Healing, Keener, Chicago, 1888; p. 305.
7 Wood, M. The Earthwise Herbal: A Complete Guide to New Word Medicinal Plants, North Atlantic Books, Berkeley, CA, 2009, p.94.
8 Fyfe, John. Specific Diagnosis and Specific Medication, The Scudder Brothers Company, Cincinnati, Ohio, 1909, p.453.
9 Chularojmontri L, et al. Influence of capsicum extract and capsaicin on endothelial health, J Med Assoc Thai, Feb 2010, 93 Suppl 2:S 92-101.
10 Choi HW, et al. The pepper calmodulin gene CaCaM1 is involved in reactive oxygen species and nitric oxide generation required for cell death and the defense response; Mol Plant Microbe Interact; Nov, 2009, 22(110), 1389-1400.
11 Lee CY, et al. Short-term control of capsaicin on blood and oxidative stress of rats in vivo. Phytother Res., May 2003, 17(5):454-8.
12 Kang JH et al. Capsaicin, a spicy component of hot peppers, modulates adipokine gene expression and protein release from obese-mouse adipose tissue and isolated adipocytes, and suppresses the inflammatory responses of adipose tissue macrophages, FEBS Letter; Sep 2007, 18;581:4389-96.
13 Travell, Janet, MD, Simons, D.G., MD, and Simons, L. PT Myofascial Pain and Dysfunction the Trigger Point Manual. Upper Body Part I, Williams and Wilkens, Philadelphia, PA, 1999. 14 Ronaldo C. da Costa, DMV, MSc, PhD, Dipl. ACVIM – Neurology Department of Veterinary Clinical Sciences, The Ohio State University.