- Tiffany Downing, RVT
Degenerative Myelopathy (DM)
Degenerative Myelopathy is a debilitating disease that causes progressive paralysis in dogs. The paralysis is due to the degeneration of the dog’s spinal cord, a process similar to the human affliction, Lou Gehrig’s Disease. This disease frequently leads to euthanasia or eventually death and there is no cure. However, there are things you can do to maintain your dog’s Quality of Life for as long as possible.
Diagnosing Degenerative Myelopathy
The diagnosis of Degenerative Myelopathy can be a shock to pet parents as dogs generally don’t show any signs of being at risk for the disease until symptoms appear around 8 to 14 years of age. The first symptom is usually scuffing of the hind paws or loss of coordination in the hind limbs, though this can be a sign of several other disease processes like Intervertebral Disc Disease, Spinal Tumors, and even Osteoarthritis, among many others, so it’s important to investigate all possibilities early on. DM is usually a diagnosis of exclusion, meaning that all other potential causes have been ruled out, leaving DM as the most likely cause. To do this, a thorough Neurological exam is to be performed as well as Radiographs and Bloodwork to get the most obvious answers out of the way. Further diagnostics may include MRI, CT scan, or spinal fluid analysis.
There is a genetic test available for pet owners to purchase online through the Orthopedic Foundation for Animals at https://ofa.org/degenerative-myelopathy/. This test is not used for diagnosis, but it can provide insight as to your dog’s genetic risk for DM. Dogs that have one copy of the gene are classified as Carriers and while it is still possible for a Carrier Dog to develop DM, they are significantly less likely to do so. Dogs with two copies of the gene are classified as At-Risk. They can only be interpreted as At-Risk as not all At-Risk dogs go on to develop DM. However, a dog showing signs that then tests as At-Risk can then be more easily diagnosed with DM and therefore given appropriate treatment.
Once purchased, the OFA Genetic Test is shipped to your home where you will then use the included Foam-Tipped Applicator Card to collect a DNA sample from your dog. You can do this yourself at home, no vet visit required. Once collected, samples make their way to the University of Missouri College of Veterinary Medicine where they are processed by the Small Animal Molecular Genetics Lab. When results are available, the OFA will report to you. As of January 2023, the cost for this test is $65.00.
While any breed or mixture of breeds can be affected, these breeds were proven to have genetic predisposition for Degenerative Myelopathy:
American Eskimo Dogs Bernese Mountain Dogs Borzoi Boxers
Cardigan & Pembroke Welsh Corgi Chesapeake Bay Retrievers German Shepherd Dogs Golden Retrievers Great Pyrenees Kerry Blue Terriers Poodles Pugs
Rhodesian Ridgebacks Shetland Sheepdogs Soft Coated Wheaten Terriers
Wire Fox Terriers
What to Expect
Patients in the earlier stages of DM will still be able to walk, albeit with progressively less coordination. They frequently struggle to rise on their own and will begin losing muscle mass in their hind limbs. Loss of strength and coordination in their hind limbs almost always leads to knuckling or dragging their paws, leading to abrasion wounds and worn down toenails.
As the disease continues to take hold, DM dogs eventually lose all voluntary movement of their hind limbs. They will also lose control of their bladder and bowels. They will no longer be able to walk but some will try to drag themselves around, which comes with its own set of problems. Paralysis continues to ascend up the body, eventually affected the front legs and diaphragm.
When Degenerative Myelopathy reaches the point where it affects the diaphragm, and therefore the pet’s breathing, there are no further options to maintain Quality of Life and euthanasia is strongly recommended. Dogs left to experience the final stages of the disease will experience great suffering and a slow, stressful death because they will struggle to breathe right up until the moment that they just can’t anymore. Ideally, a DM patient would have a kind and humane goodbye before their breathing is affected. Fortunately, there are a lot of options and tools available to you to maintain good Quality of Life for your pet for as long as possible. Life expectancy from time of diagnosis ranges from 6 months to 2 years.
What Can We Do About It?
Caring for the Degenerative Myelopathy patient will change as their symptoms progress, but there are things you can do! The good news with DM is that if your pet is otherwise well managed, it is a painless disease up until it affects breathing. We have even seen dogs with a history of chronic pain no longer feel that pain as DM moves up the body.
More Good News! – You’re in the right place!
Physical Rehabilitation has been proven to dramatically slow down DM’s progression. Underwater Treadmill therapy has specifically been shown to maintain their strength, stamina, and coordination for as long as possible and slow the progression of the paralysis. Other Rehab Treatments such as Laser Therapy help relieve pain, like muscles in the front of the body becoming sore from overcompensating for the weaker back legs. For Physical Rehabilitation to have the most beneficial effect on your dog, they will need consistent and frequent therapy. We have seen DM patients lose significant ground with even a short vacation (1 week!) from rehab. Rehab cannot completely stop the progression of DM, but it can greatly increase the quality time you get with your pet.
Tools To Make Your Life Easier
While your pet is still fully ambulatory on their own, it is important to protect their paws from the scuffing and abrasions. Lots of dog booties are readily available for purchase, but our favorite is a rubber variety called Pawz. We like these best because they protect the paw while still allowing your pet to feel the textures of the ground and providing extra grip. With any dog booties, care should be given to appropriately size your pet’s paws and to only leave them on when your dog is on a surface that is harmful to their skin to rub on. Booties left on for too long can cause skin infections, reduced circulation, or worst case – be chewed off and eaten!
Home modifications like adding rugs and ramps are quick and easy ways to help your dog get around the house more easily. Rugs and yoga mats make it easier for your dog to grip the floor, reducing their risk of falling. The softer surfaces also make abrasion wounds on their paws less likely, although rug burn is certainly a possibility for some dogs. Ramps can make obstacles like stairs less challenging, although care should still be taken to monitor your pet while using these. There will come a time where these obstacles are no longer safe for your dog to work around or over and should instead be avoided.
A good harness is a must! Your dog will continue to depend on you for assistance more and more as DM progresses, so your choice of harness makes all the difference in comfort for both you and your dog. Our favorite harness for DM dogs is called the Help ‘Em Up Harness. It was created to help owners better assist their dogs without hurting their own backs in the process. It comes in two pieces, one to go around the chest and one to go under and around the pelvis. In the early stages, your pet may not need the back half, but as their coordination and strength wanes, the back half of the harness will become your best friend. It is comfortable enough that your pet can wear it for extended periods and it is more ergonomic for you and your dog than just lifting them or using a sling. If you are interested in purchasing this harness for your dog, be sure to speak to us as sizing and fitting your dog can be trickier than it might appear. Please note that this harness still needs to be removed each day and kept clean to prevent any abrasions or skin infections.
As your dog loses the ability to control their bladder and bowels, diapers and belly bands become good options to help keep your dog and your home clean. Some dogs lose urinary control before fecal, so in those cases, belly bands are a nice alternative for male dogs over a proper diaper. Just as with humans, good hygiene when using diapers and belly bands is a must! Dogs left in dirty diapers for too long are at risk for urinary tract infections and skin infections. It’s also important to note that dogs instinctively want to avoid their waste, so being stuck in it is not great for their Quality of Life. Disposable and washable options are readily available for purchase online or at major pet stores.
Some clients elect to pursue a Rear Wheel Cart (sometimes referred to as a wheelchair) for their DM dog. Not all dogs are good candidates for this and it’s quite the investment so it’s important for pet parents to approach this with realistic expectations. DM dogs that are good candidates should be fitted for a custom-built cart while they can still use their back legs. When their cart arrives, they can get used to the cart by using it as support for their back legs, still moving their back legs and propelling themselves forward. As back leg function lessens, their hind limbs can be propped safely up and off the ground using either the padded bar or padded loops included in the construction of the cart. For more information about Rear Wheel Carts, be sure to read our online article at https://www.caninerehaboc.com/post/the-wheel-deal.
Is There Anything Else?
One of the best things you can do for your DM dog is keep them lean! We generally recommend a Body Condition Score (BCS) of about 4 out of 9. The less weight there is for them to haul around, the less strain is imposed on their already weakened body. Many DM dogs are also old enough to have developed arthritis, so all the more reason to reduce any extra work on their joints. For more information on the BCS and Weight Management, read our online article https://www.caninerehaboc.com/post/body-condition.
While there are no medications to directly treat DM, your pet may likely benefit from treating any other sources of pain and inflammation like arthritis. Joint supplements are also helpful to support their joints as the front of their body takes on the extra load. There are no clinically proven medications or supplements to treat Degenerative Myelopathy. CROC strongly discourages the use of marijuana products for DM patients. While emerging research shows some promise for marijuana products in veterinary medicine there is much more to be done and DM patients are already weak and have poor coordination, making them poor candidates for this treatment.
Quality of Life
We touch on this subject for your sake as well as your dog’s. Compassion fatigue is a prevalent concern for clients caring for DM dogs. As your dog’s DM progresses, the amount of effort you will need to put into their care will drastically increase. Especially when their
paralysis becomes more advanced or they lose control of their bowels and bladder, the strain on you to keep them clean and safe, as well as the physical strain of carrying them around is enough to wear down even the most dedicated owners. We bring this up because we want you to know that we are available to you as you navigate your pet’s condition. We frequently support our clients through the big decisions and help them to find the plan that works best for them while keeping quality of life as high as reasonably possible for all involved. At any time during your pet’s DM journey, we completely understand and support humane euthanasia as an option. When deciding “when it’s time”, it’s always best to go even weeks too early than a day too late.
Make sure to be realistic with your resources, your time and energy, and frequently check in with yourself. Are you still enjoying your dog’s company? Are they happy and still enjoying their favorite activities? At any point, are you building resentment for the amount of work your dog now requires? It is important to note that for any end of life evaluation, the fact that an animal continues to eat is NOT significant enough to delay euthanasia if other aspects of their life are filled with suffering. If you would like more information about how to properly evaluate Quality of Life for you and your pet, please feel free to reach out to us for assistance.
Overall, Degenerative Myelopathy is an awful disease to contend with, though there are certainly worse. There's a lot to consider when deciding how to move forward once your dog has been diagnosed, but having realistic expectations for yourself and your dog can help make the process a bit easier to manage. The CROC team is here to support you and offer advice at any time during your pet's DM journey but it's also a good idea to find support with your regular veterinarian and anyone else in your household.