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Symptoms of Degenerative MyelopathyWritten on June 20, 2011 by Mark Troxel, DVM, DACVIM (Neurology) and Charles Evans, MPT, CCRP Hospital: Massachusetts Veterinary Referral Hospital & Port City Veterinary Referral Hospital
With diseases like Degenerative Myelopathy, which have no cure, one of the most important coping mechanisms for owners can be information. It was with this in mind that this series of posts was created. There are many decisions that will have to be made at each stage involving not only your dog’s quality of life but the owner/caregiver’s quality of life. At the end of each stage presented below we will list the problems to be confronted and, if available, the means and/or decisions associated.
What is Degenerative Myelopathy?
Canine Degenerative Myelopathy (DM) is a progressive disease of the spinal cord and ultimately the brain stem and cranial nerves which, at it’s end stages, results in complete paralysis and death. The closest human equivalent may be Amyotrophic Lateral Sclerosis, or ALS, also known as Lou Gehrig’s disease. The same gene mutation is implicated in both diseases.
Degenerative Myelopathy has a slow, insidious onset with a slow progression of weakness. It is not uncommon for the signs to progress slowly, plateau, and then start to progress again. These symptoms often begin in one rear leg and then eventually involve both rear legs as the disease progresses; alternatively, it could affect both rear legs at the same time. This condition is NOT painful. As a result, with appropriate physical therapy and nursing care, patients with DM can still have a good quality of life for a significant length of time.
Early signs (Duration: 3-6 months)
DM initially affects the rear limbs. At first you may notice rear limb weakness and muscle loss, decreased coordination, loss of balance, difficulty transferring from lying down or sitting, to standing, and/or an inability to climb stairs, jump into the car, or onto furniture. These symptoms are also typical of other conditions, such as arthritis, hip dysplasia and other spinal diseases (e.g., disk protrusion/herniation). If you are seeing these signs you should contact your veterinarian and have your dog examined.
- Loss of balance
- Assistance needed for transferring position
- Damage to the feet and nails of the hindlimb.
- There are a number of harnesses and/or slings made for supporting the hindquarters. These will enable you to assist your dog in transferring from lying down or sitting to standing and they will allow you to help with balance/stumbling or weakness on walks. The harness may also help to prevent damage occurring to the feet from scuffing.
- Booties – There are a number of foot protection boots in the marketplace. We can help you with recommendations tailored to your dog’s needs.
- Physical therapy – Exercise modification can be important at this stage in prolonging your dog’s function. Shortening the walks but taking more walks daily is one solution. Swimming or walking in the water is also very effective in maintaining muscle mass. Check with a physical therapist who is a certified in canine rehabilitation for further information on home programs.
Note: The solutions to the problems at this stage are fairly inexpensive and not too time consuming. But the walks with your dog will be much more intense experiences since you will be counted on to help provide some mobility. You should check your dog’s feet daily for damage to the skin or nails.
Note: Degenerative Myelopathy has a slow onset and is NOT painful. If these early symptoms occur suddenly or if your dog is painful, you are most likely not dealing exclusively with DM. Make sure that your veterinarian, or a veterinary neurologist, examines your dog for other conditions that may involve the spine. DM does not come on suddenly. Other disorders such as disk disease, disk herniation, spinal cord tumors, and FCE (a “stroke” in the spinal cord) can also cause symptoms similar to DM, but with a much more rapid onset.
Intermediate Phase (Duration: 3-6 months)
The next stage of symptoms are knuckling or walking on the tops of their feet (loss of conscious proprioception), limp tail, crossing of the hindlimbs under the body (scissoring), or a rear leg drag. Check the two middle toes of the feet to see if there is unusual toe nail wear. The middle two toes are the main weight bearing digits of the foot.”
As the symptoms progress you will begin to see worsening signs of weakness and dragging the hindlimbs on the ground or floor. Urinary and/or fecal incontinence occur very late in the course of the disease You may also note a hoarseness or loss of volume to the bark.
- Increasing difficulty with walking
- More extensive damage to the feet
- Loss of mobility
- Quality of life issues
- A combination front and rear harness will help as the paralysis increases
- A wheelchair or cart will significantly improve a dog’s mobility and quality of life
- Aquatic therapy is very effective at this stage for maintaining forelimb muscle mass and quality of life.
- You will have to learn how to either express your dog’s bladder or catheterize the bladder daily
- You will have to check your dog and his bed daily to avoid urine scalding since they may not be able to avoid voiding on themselves or their bed
- This would be the first stage at which, because of quality of life issues (for both you the owner and the dog), euthanasia might be considered.
End Stage (Duration: 3-6 months)
In the very late stages of the disease progression is more rapid and you will see forelimb involvement with muscle mass loss to the shoulders and forelimbs. As the disease progresses, your dog will develop weakness in all 4 legs. Eventually, your dog will be unable to stand or walk. There may be residual head movement at this stage and they will not be able to remain sternal (on their belly) without assistance. The disease will then progress to the brain stem and eventually to the cranial nerves which may affect breathing.
The nervous system’s spinal cord and brain stem are the only structures affected by DM. However weakness from DM can have secondary effects such as decubitus ulcers (pressure sores), systemic infections, and urinary tract infections due to urine retention. There can be kidney, lung and heart failure. Death from DM results from multisystem failure.
- Systemic infections
- Decubitus ulcers
- Quality of life issues
- At this stage a forelimb and hindlimb harness is essential to move your dog around.
- There are quadriplegic carts or wheelchairs available which will allow you to move your dog around outside for walks.
- Constant vigilance will be required to prevent decubitus ulcers (turning schedules), urine scalding and sores or infections on the paws.
- Awareness of systemic problems such as bladder infections must be monitored.
- Euthanasia will become a higher consideration.
- Exercise will help to prolong you dog’s muscle mass and mobility.
- Aquatic therapy of either walking or swimming can even be more useful than walking. To date, professional canine rehabilitation (physical therapy) is the only treatment that has been shown to improve quality of life and longevity.
- Increased awareness of the level of nursing care necessary to prevent secondary complications such as decubitus ulcers, urinary tract infections and foot damage is also very important.
- The use of harnesses to assist in your dog’s mobility and later in your ability to move your dog around are also considerations.
- A cart or a progression of carts will not only improve your dog’s mobility but his or her quality of life.
- Dr. Roger M. Clemmons, an associate professor of veterinary neurology and neurosurgery at the University of Florida’s College of Veterinary Medicine, suggests that a combination of “diet, exercise, supplements and medications” may “slow or stop the progression of the clinical signs.” These statements have not been confirmed by peer-reviewed, controlled studies. Anecdotally, we have seen no significant difference in patients that were given these supplements/medications compared to those patients that did not receive them.
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