The DM Diagnosis
Degenerative Myelopathy (DM)
This guide was compiled by a German Shepherd Dog owner who provided care for dogs with this disease. She is not a veterinarian. The guide is intended to provide general information and examples; it is not intended to be a substitute for expert advice and information that can only be provided by a qualified veterinarian familiar with Degenerative Myelopathy (DM).
Consult your veterinarian and neurologist for accurate and complete information about DM.
What is degenerative myelopathy (DM)?
DM is a disease that attacks the dog's nervous system and leads to progressive neural (nerve) damage over time. It may initially attack one side of the dog, or both sides. DM does not seem to cause the dog any pain. Onset of DM is usually between 5 years and older age (e.g. 10 to 12 years).
DM is progressive, which means the symptoms worsen over time. However, dogs receiving treatment may have periods of stability where there is no further degeneration for days, weeks, months or years. Dog owners will see "stages" of degeneration, with only very mild symptoms in the earliest stages. DM progression may be very slow in some dogs, and very fast in others.
Without treatment, progression from stage to stage of the disease is much faster so it is important to begin treatment as early as possible. Early diagnosis and integrated treatment slows the progression of symptoms for most dogs.
Many other diseases and certain types of injury (e.g., a spinal injury, low thyroid) cause the same symptoms as DM, so it is important to rule these out before assuming that your dog has DM. Also, DM may co-exist with other physical problems or diseases. Always ask your vet to perform the least invasive tests first (such as blood tests). Some of the more invasive tests (such as myleograms) present a significant risk of making DM symptoms much worse permanently. DM cannot be diagnosed by observation alone.
A comprehensive description of DM, tests and treatment options can be found on the internet at the address below. This is an article by Dr. Roger Clemmons, PhD. The treatments described by Dr. Clemmons were effective for my dogs, but your veterinarian may hold a different viewpoint about treatment than Dr Clemmons. Consult with your veterinarian for other treatment options. Be aware that most veterinarians are not specialists with detailed knowledge of DM, testing options or treatments. Urge your vet to consult with experts in the field if they do not know about DM.
The DM Support Group web site also has extensive information written in layperson's language (including testing information, care instructions and many very useful links):
DM and your dog
Your dog will adjust to the physical changes brought on by DM, and live a happy life, with your help. Mentally, dogs remain bright, vibrant, alert and playful (if that's the way they were before the onset of DM!). Sleepy or laid-back dogs stay that way, too. Dogs seem to adjust better if their owners remain positive and upbeat. Many owners report a new and incredible level of understanding, love and closeness with their dogs as the DM progresses.
DM does not cause any pain. As far as research can show, dogs feel numbness in affected areas (and this is consistent with what people feel who have similar conditions). If your dog is in pain or shows any difficulty with urination or defecation, inform your vet immediately and make an appointment.
As DM progresses into new stages, your dog will discover its new limitations and find ways of handling the new challenges. Seeing your dog learning new ways of moving and living with DM may be an emotional experience for you (especially if this is your first experience caring for someone who is differently "abled" or who is ill).
DM and You
You may find it very hard to witness the physical decline in your dog, in the same way it is hard to see a person you love become ill. If you are willing to walk this journey with your dog, there will be many unexpected blessings, profound experiences, gifts and astonishing things to learn as the dog shares experiences with you. This is true whether you are young or old, and it is true for children as well as adults.
Caring for a DM dog can be challenging in later stages of the disease, especially when you don't know all the tricks and hints that make life with a DM dog easier. Be confident that you will learn what you need to know over time from your veterinarian, and from others who have cared for a DM dog! There are many resources available to you that will help you learn quickly. Here is a short list of information topics you may need to become familiar with at different stages of the disease:
DM Symptoms and Course
DM symptoms may wax and wane, so early symptoms may appear one day and then disappear for weeks. Begin treatment EARLY for the best chance of delaying onset of symptoms.
In very early stages, symptoms may be very subtle. Owners may notice the dog's inside rear toe nails wear down more quickly, for example, or that the dog shuffles his or her back feet from time to time, or the dog's stride is shorter than normal. Later, the dog will begin dragging a back foot or both back feet all the time (that is, the leg is not lifted quite far enough and the toe nails drag as the dog walks). Eventually, one or both back legs become weaker and the dog begins to move more clumsily (especially when walking around corners). If the DM is left untreated, the rear legs may become paralyzed in 3 to 6 months after the initial appearance of symptoms. With early treatment, permanent paralysis of the back legs may be delayed 12 months or more (even years). There is anecdotal evidence of some dogs remaining stable (no significant degeneration with continuing ability to walk and run) for 3 years and more; these dogs had early treatment.
In later stages (after full paralysis of the hind legs), DM causes paralysis of the front legs and attacks the brain stem. Dogs may have seizures at this stage. Some small movements in the legs and head may remain, but the dog is able to move itself or remain in an upright position. At this point, palliative care is provided.
DM is not a fatal disease, so caregivers will need to free their dogs through euthanasia when the time comes. This is always a difficult decision but it is a very compassionate thing to do for a late stage dog.
DM affects each dog differently. With treatment, some dogs may live for years with relatively minor symptoms (e.g., toe dragging), while others loose mobility within a few months. Treatment provides the best quality of life for your dog, regardless of the rate DM progresses.
What causes DM?
The exact cause of the DM is not known. However, most researchers seem to think there are genetic, environmental and toxic factors. Research has not shown what mechanism triggers the onset of DM.
Is there a cure for DM?
There is no cure. However, as stated above, symptoms may be delayed with treatment. At the University of Florida, about 80% of dogs respond well.
The objective of the treatment is to delay onset or progression of symptoms, and to provide maximum quality of life to the dog over the course of the DM.
Treatment includes exercise, diet and dietary supplements, medication and other supportive measures. The cost of medications and supplements are reasonable for many people. If you cannot afford all or part of the medication/supplements, diet and exercise (at least 2 hours per week) alone may delay onset of symptoms or help the dog remain stable. Acupuncture has also been shown to slow symptoms.
Westlab Pharmacy in Gainesville, Florida (telephone: 1-800-4westla) appears to provide the cheapest and highest quality medications and supplements for the treatment of DM. Your veterinarian will need to call in a prescription for your dog. The cost is significantly less than purchasing items through local pharmacies or health food stores.
The Westlab web site is very informative and includes a complete description of the medications and supplements (www.westlabpharmacy.com); these can be printed out and given to your veterinarian for review. Westlabs works closely with Dr. Clemmons and the University of Florida.
Key medications are N Acetylecysteine, Aminocaprioc acid, and Antiox Q (or preferably Antiox QCB). See the Westlab information sheet for details. If your dog is on an incontinence drug, please tell your vet and Westlabs. DM medications may interact with incontinence drugs, and a simple adjustment to the medications or dosage may be necessary.
As a caring owner, you will hope and expect the medications and supplements to magically return your dog to "normal". While some dogs may experience dramatic improvement, others may not see obvious change or slowing of symptom development.
What happens after paralysis of the back legs?
Dogs with paralyzed back legs can remain mobile and physically fit with your help.
Dogs can absolutely live a happy and vibrant life even with the impact of DM. Your other pets will adjust, too. You may even see them grooming and caring for the DM dog.
Although it may be very difficult for you as an owner to adjust with the progression of DM, the rewards of caring for a DM dog are profound and may be life changing.
Caregiver Help Aids and Support
There are many tips that will help you provide care giving and yet minimize the impact on yourself and your household.
Harnesses to lift your dog's rear end
Dog Wheelchairs & Lifts
Wheelchair designs vary and some are easier to adjust and use than others. Ask lots of questions and get advice before investing in one. However, most dogs love the mobility, so they are really worth the effort and cost!
If your dog is fully paralyzed, a new or used lift is very handy. The Tylift company sells lifts that some DM dog owners found very helpful. Lifts are not for everyone, but if you have back trouble or a very large dog, they can come in handy for moving the dog with ease (the dog and dog bed can be moved at the same time).
Here are a few ideas; a search on the internet will yield more results:
Profleece and Bed Covers
Profleece is available directly from the manufacturer or at the La Paw Spa store.
Latex Gloves and Diapers
Help and Support
There are bonded and insured dog caregivers in some cities, but choose carefully. Also, vet techs may be able to help. Contact your vet for names. These people can care for your paralyzed dog while you go on vacation, go to work, or just hang out!
Support is available from other dog owners with DM dogs and handicapped pets. Two excellent sites are:
** Update December 2004**
Dedicated to beloved Zion, who showed us all how to live fully each moment, and that DM is nothing but a disease
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