Degenerative Myelopathy (DM) is a neurological disorder characterized by progressive muscle weakness and ataxia, beginning with the hindquarters.  As the disease progresses the muscle weakness moves forward, eventually affecting the forequarters.  In the early stages of the disease, the dog typically presents with a wobbly and unsteady gait, often said to be "walking like a drunk."  The motor and sensory neuron damage progresses until the dog is no longer able to support weight on her hind legs.  As the paralysis sets in the hindquarters atrophy and the muscles wither away.  Bowel and bladder function is usually preserved until late in the course of the disease, though there are accidents in the house because of impairment in sensation and mobility.  Often the dog's bark becomes hoarse and weak.

DM is a presumptive diagnosis made by ruling out other causes of pathology, and definite confirmation of the diagnosis is only possible with necropsy.  Most of the research on DM has been done on German Shepherds because of the relative prevalence of the disease in that breed.  It is not clear whether DM in other breeds is the same disease as that found in German Shepherds, but it is generally thought to be an autoimmune disorder.  In terms of the progression of the disease, it is often compared to multiple sclerosis (MS) in humans, or alternatively to ALS, or Lou Gehrig's disease.  The course of the disease varies with individual dogs.  Progression can be either rapid or slow, and functional decline can be relatively steady or it may have periods of stability followed by further decline.

While there is no cure for DM as yet, there are ways to manage the limitations imposed by the disease.  The first obstacle is dealing with your own emotional responses.  A diagnosis of DM in one's beloved companion is devastating news, striking an emotional as well as physical blow.  Your once active companion is now struggling just to walk and maintain balance.  I spent a lot of time initially feeling very sorry for myself, and even sorrier for my dog.  One day I finally realized that the dog didn't seem to spend a single moment feeling sorry for herself, or for me.  She just kept doing what she needed to do, and had no problem indicating she needed help and accepting that help from me.  That was a turning point for me, and allowed me to accept the reality of this disease, taking it one day at a time just as the dog does.  I still have down days, but her matter-of-fact attitude really helps me cope.

Because DM presents with a gradual decline in function you don't need to make life and death decisions immediately.  There are some positive steps you can take to manage this disease.  First of all, strengthen the bonds of your social support network, which includes your vet, friends, neighbors, and e-list connections.  Make sure you have someone you can talk to, to share your feelings and to get feedback.  Be ready to explain your dog's condition to friends and family as well as complete strangers.  Be aware that some of your closest friends won't understand some of your decisions, but ask for their support even if they don't agree with you.  Remain flexible and open-minded because you won't know yourself what the next step will be or how you will handle it until faced with a decision.  The following guidelines are based on daily life with my dog Raven, who was diagnosed with DM about 2 years ago.  She is a medium-sized Berner girl, with top weight of about 74 pounds. 

Managing Mobility Problems

Your dog will prefer walking on her own as long as possible.  Assist her in doing so, even though it may be painful for you to watch her wobbly gait.  Help the dog maintain balance if needed, and slow your pace to accommodate her unsteadiness.  Using a leash adds some stability to the dog, and you may choose to use a harness rather than a collar.  Follow a program of regular low-impact exercise, along with a healthy diet, to help maintain overall strength.

As the dog's ability to walk declines, you may want to invest in a canine wheelchair.  I posted first to a local e-list to see whether anyone in the area had a wheelchair I could borrow, but was unsuccessful.  I purchased Raven's wheelchair from www.doggonwheels.com, and they were wonderful to work with.  They built a custom wheelchair based on measurements I e-mailed to them.  It was fairly easy to assemble and is quite lightweight.  The wheelchair was set up so that in the early stages of the disease the dog can still use her hind legs, but has pelvic support for strength and stability.  Later on, the back feet are suspended in stirrups to keep them from dragging on the ground.  The wheelchair is too wide and cumbersome to use in the house, but it is a great tool for getting the dog out on walks.  I also made a support strap to help lift her hindquarters.  These straps are available through several different commercial outlets, but I chose to make mine, using soft but strong fabric and a pair of wooden purse handles from the local fabric store.  The pelvic sling from the wheelchair also has a handle that can be snapped in place when the sling is not being used in the wheelchair and you are helping to carry the hindquarters.  I prefer the belly strap because I find it easier to use, but it does put pressure on a full bladder so be cautious when using it, especially in the house.  Once Raven lost her ability to walk, she was able to scoot around the house and the yard for a period of several months by pulling herself with her front legs.  As long as she could scoot she could still access her water dish.  Eventually her forequarters weakened enough that she no longer scoots around.  However, I can still get her to the back door by sliding her on a blanket.  I actually use a washable bed pad, which functions as an incontinence cover for her dog bed and has the added advantage of a slick waterproof bottom side which slides pretty well.  Once she is at the back door I use the belly strap to support her hindquarters and she is able to walk down the ramp and out to the yard.

Environmental Adaptations

While she is still able to walk your dog will feel unsure on her feet and will need good traction and non-slip surfaces.  If your house has slick flooring, such as vinyl or hardwood, invest in some inexpensive rugs and runners that are washable and have a non-slip backing.  It isn't necessary to cover the entire floor, but you will want to make a path through the house with the rugs.  Negotiating stairs can be difficult if not impossible, and they present a safety hazard as well.  My neighbor built a ramp off my back porch, eliminating the three steps down to ground level and making access to the yard much easier.  If the dog typically sleeps on an upper level of the home, at some point you will probably need to make adjustments in sleeping quarters to avoid having the dog climb the stairs.  

If you don't have a well padded dog bed, that would be a wise investment as well.  As the hindquarters atrophy the dog loses most of the tissue that pads bony prominences.  She will need a comfortable place to lie, especially when she is not able to change position on her own.

As the dog's ability to get around the house declines further, consider where the dog is spending most of her time.  Take your cues from the dog when determining where to place her for the day.  The dog may prefer a quieter part of the house, or they may want to be in the middle of the action.  I have a small house, but I have dog beds in a couple of different places.  Raven will usually let me know where she prefers to be at different times of the day.

Be aware that as the dog loses the ability to walk she will lose the ability to move out of an uncomfortable situation, or may not feel discomfort when she should.  For example, if the dog prefers to be outside for awhile check on her frequently to see whether she is in sun or shade.  If the dog seems to prefer lying on one side more than the other, try to alternate sides when you place her so she is not always on the same hip.  When her hind legs are paralyzed the dog cannot position them, so you may need to place the legs in a more natural position when the dog lies down.  You will also notice that the fur between her pads will continue to grow, and it is not being worn off by walking.  Trim the fur between the pads to improve traction.

Feeding and Watering

As the dog's physical abilities decline she may require somewhat less food each meal, and there may be a decrease in appetite.  As Raven's ability to get around decreased, I made some changes in the types of food I used as well as in the way it was being offered.  She had been getting a good quality kibble with occasional add-ins like cooked vegetables or canned salmon.  Once she was not able to easily access water, it became apparent that she needed to get more fluids in her food.  Now I add chicken broth and dilute it with about the same amount of water, and she almost always drinks the liquid from her food.  I offer water at other times to make sure she is well hydrated.  I limit the variety in her meals now to help maintain consistent bowel movements.  In fact, if she does not appear hungry at any one meal it may be because the dog needs to have a bowel movement.

Managing Incontinence

Incontinence is bound to be a problem, even while the dog still has good sphincter tone.  The dog may not sense that she needs to toilet, and even if she does she may not make it outside in time.  Even in the early stages, while the dog is still able to walk, walking takes so much concentration that she may not be able to focus on maintaining bowel or bladder control.  I use the same incontinence products used for people, and I do laundry more often.  I also use a pair of old slip-on sandals when I take her outside.  These are shoes I can easily slip into, and they can be hosed off when they get peed on.  Trimming away the long fur on the back of the legs and around the underside of the base of tail helps with hygiene issues.

Products I rely on include washable bed pads, disposable bed pads (chux in hospital terms), diapers, waterless dog shampoo, air freshener, and plastic bags for waste.  While the dog is more mobile you may need to use diapers to avoid having a mess in the house.  Several of the pet gear catalogs offer diapers specially made for dogs, or you can modify baby diapers by cutting a hole for the tail.  Up to this point I have used diapers for Raven only when traveling.  Now that she is immobile, I put a washable pad on her bed and then put a disposable chux under her bottom.  If she has a bowel movement it is relatively easy to roll up the chux and dispose of waste.  The washable pad usually stays clean and is used to slide her to the door.  If she urinates I use a wet paper towel and waterless shampoo to clean up her hindquarters.  At some point the dog may need help initiating urination.  Talk to your veterinarian about techniques to give manual assistance.

Travel Considerations

Traveling with the dog with DM requires that you do some advanced planning and travel with some extra gear.  I pack an incontinence bag, very similar to a diaper bag, and carry the products listed above.  If you plan on staying with friends, first make sure that their home is accessible to you and your pet.  In addition, make sure they are fully aware of the situation and willing to deal with anything that may come up.  Take your own clean-up supplies so you are well prepared for any accidents.If you will be staying in a hotel, reserve a room on the ground floor next to an exit door.  Make sure you enquire about stairs.  Raven attended the 2007 Specialty in Kentucky, and I had reserved a ground floor room next to an exterior door.  Perhaps I forgot to ask about stairs, but in any case when we arrived there were about 8 interior steps up to the ground floor room.  It was a bit of a challenge getting her up and down those stairs but we managed.  I had my own clean-up supplies and a very understanding roommate.  When you talk to the reservations clerk, they probably will think you need a handicap room, which often means handicapped-accessible bathroom.  Let them know ahead of time that what you really need is a room with no stairs to access, and exterior entry.

Activities

For a girl who doesn't get around very well, Raven has done some traveling this year.  Prior to the May Specialty, she traveled to Denver for the BMDCR draft test which I secretaried.  My driving buddy Stephanie and I stayed with our friend Elaine, so again Raven was in the company of some of her dog friends.  Because Elaine's house doesn't have a bedroom on the main level, I packed along an inflatable mattress and set up my own temporary bed.  It does help to be flexible when traveling with a special-needs dog.  The Specialty is a much longer road trip, and she was in a van with 3 other Berners and another human.  All the dogs managed the trip extremely well.  After returning home to Utah from the Specialty, my driving buddy and I made plans to attend BMDCR's first independent specialty.  Our hostess, Dottie, was well aware of Raven's condition and gave us ground floor accommodations with easy access to the back yard.  Raven spent her time with the eight other Berners there and had a great time.  In July my mother and sister visited from Florida and we took a road trip to Yellowstone and the Tetons.  I really didn't want to leave my special-needs girl with a dog-sitter so she went with us.  I made sure our motel rooms had a no-step entry, which met her needs as well as those of my 85-year old mother.  Fortunately the weather was mild enough that she could stay in the car, with windows down, while we watched Old Faithful erupt--right on schedule!  I'm sure Raven enjoyed the different sights and smells in this special part of the country.

In November I had the opportunity to go to Florida and spend more time with my mom and sister.  This time dog-sitting became a real issue, because I would be flying rather than driving.  When my friend Dino offered to take care of the dogs I was really grateful.  She knows my dogs, and I knew if Raven was with her I could relax and enjoy the trip.  Never mind that she lives in another state, that's just another short road trip.  I arranged a flight out of Boise and drove the dogs to Idaho the day before I was scheduled to fly out.  Again the weather was mild so Raven got to spend a lot of time in the back yard, rolling the grass and being the play police for the other dogs.  I had a lovely, worry-free visit with my family, knowing that the dogs were being well cared for.  Thanksgiving in Flagstaff, with her Great Pyrenees friends, was another road trip.   Raven has made this road trip every Thanksgiving of her life, and she enjoys seeing her furry white friends.

As of this writing, Raven is not using the wheelchair as it has become too demanding.  Since the Specialty in Kentucky there has been an appreciable decrease in strength in her forequarters.  She is still able to walk out to the back yard when I provide pelvic support, but she does fatigue more easily.  She easily made the transition to riding in a human-powered child's wagon, and looked quite the princess on a recent trip around the block.  No, this is not the ultimate in spoiled dogs.  When we visit Flagstaff my friend's parking area is below her house and requires a walk up the gravel drive to the house.  I thought it was important to make sure Raven was comfortable riding in a wagon before she has to do that in Flagstaff.  Besides, a trip around the block in a wagon is not that hard on the human pulling the wagon, and it keeps her world a little larger.  She still loves rolling in the grass, she enjoys road trips, likes to eat and loves her treats, and seems to have a good quality of life.

Conclusion

How to manage any illness is an individual decision for the dog's owner, based on personal philosophy and self-knowledge of one's ability to assume a caregiver role and cope with physiological problems.  With a progressive disease such as DM, you will make a series of decisions as the dog's ability to function declines.  Use your support network and your veterinarian to decide what course of action is best for you and your dog.  I never anticipated being in a long-term caregiver role, but each day when I look into Raven's eyes I know she is not ready for the Rainbow Bridge.  Not yet.  She still has a strong interest in life and has retained her affectionate, playful nature.  We are in a palliative care mode, so I help her with daily survival and try to keep her comfortable and enjoying life.  My family of dog friends helps make it all possible.

Update -- January 9, 2008

Pioneer's Raven v Krugerrand

April 7, 1997 - January 9, 2008

 

The sun shone brightly at the Rainbow Bridge this evening, a welcoming beacon to a new arrival.  Today we helped Raven cross the bridge, after a two year struggle with degenerative myelopathy.  In her own quiet way she showed incredible strength of character as her physical strength waned.  Though she hasn't been able to walk on her own for several months, every day she let me know she was glad to be here and life was good for her.  I figured as long as she wanted to be here, and I was physically able to manage her care, we'd just take it one day at a time.  Finally this past weekend she let me know the time had come.  Consistent with her whole life, she managed a tough situation much better than I did, and passed from this life peacefully and with grace.

Raven, I miss you terribly.  May you rest in peace.

 

Vicky Hall

Utah USA