German Shephard Dog Myelopathy

What is DM?

DM is also known as German Shepherd Dog Myelopathy, Progressive Myelopathy and Chronic Degenerative Radiculomyelopathy (CDRM). Myelopathy is a term that refers to any disease of the spine, (as opposed to Myopathy which is a disease of the muscles). DM is a condition known as an auto-immune disease where the immune system attacks the body?s own tissues, in this case being the central nervous system. This immune attack leads to loss of myelin (insulation around nerve fibres) and axons (nerve fibres).

What causes DM?

The reasons why this disorder develops is unclear but their are probably genetic, environmental and toxic factors which may all play a part leading to its development. A hereditary basis for this disease is suspected, although the study of the various factors is obviously complicated.

What are the most common early symptoms of German Shephard Dog Myelopathy?

Affected dogs often show a slowly progressive (over several months) hind limb incoordination, clumsiness, partial paralysis and weakness, with an increasing loss of mobility in the hind region. Crossing of the rear limbs and dragging of the claws are the early signs frequently leading to presentation for diagnosis. The dog may also scuff his feet (rear paws) while walking and have a mild sway to their gait, they may stand on the tops of their feet. Others signs may be loss of rear muscle. DM often affects each leg to different degrees. The onset of signs prior to presentation to a veterinarian or neurologist can be between 1 month and 1 year.

How long has DM been known?

Degenerative Myelopathy (DM) was first described as a specific degenerative neurologic disease in 1973. Prior to that time it was misdiagnosed as other conditions such as hip dysplasia and IV disc disease. Later, in England the disease was discovered and was termed Chronic Degenerative RadicoMyelopathy,CDRM.

How is DM diagnosed?

Unfortunately many vet's fail to correctly diagnose this disease in the early stages, usually they think the dog has arthritis or hip dysplasia. Initially the vet may perform a simple test commonly referred to as ?The bent knuckle test?. With the dog is standing the vet will try to turn his paw over so the dog is standing on his knuckles and then attempt to get the dog to place his weight on it. This is virtually impossible in a healthy dog, but when neurological problems of this type are present the dog is not aware of where or how his paw is placed. A DM Diagnosis is based on clinical signs (such as the bent knuckle test) and a history of progressive spinal ataxia (i.e. incoordination and clumsiness affecting balance and gait, which may be mild) and weakness that may have a waxing and waning course or be steadily progressive. A test to elimination evidence of any space occupying lesion may be performed, this is done using Myelography. This is an x-ray examination of the spinal cord, nerves and other tissues within the spinal canal after injection of a substance that is opaque to x-rays. It is performed to examine the lower spinal nerves. Myelography helps to rule out the presence of some other surgical problem, but a negative myelogram does not diagnose DM, it only excludes surgical disease. Spinal radiographs normally show wear and tear associated with spondylosis and spinal arthritis. These are not changes that are specific for DM, but are common amongst older dogs. The electromyogram (EMG) is another important diagnostic tool. The EMG would be normal in uncomplicated DM. This is done under anaesthesia and can be combined with the other tests that need to be performed. The needle EMG looks at the spontaneous activity of the muscle and helps determine whether there is evidence of disease in the motor neuron, the nerve, the neuromuscular junction or the muscle.

Why do the nails get worn?

The wearing of the inner 2 toenails of the back feet can be a sign to look for. Nails may become worn due to neurological problems caused by DM, which causes the dog to be unaware of where or how his feet are being placed. The dog may also not be aware that he is not lifting his feet high enough and starts to scuff them. Sometimes scuffed nails are found to have been an early sign.

What breeds are effected with DM?

DM seems to be one of the most common causes of hind limb defects in older German Shepherds. It appears with relative frequency in this breed although the disease has been recorded in a number of other large breeds including GSD crosses.

Is DM more common is certain countries or regions?

Our experience has shown that DM is apparent in many countries. It is true that the incidence of MS in humans is more common in temperate regions, but no one knows why for sure.

What age does DM typically strike?

The age at onset is 5 to 14 years. But it is mainly a disease diagnosed in older dogs.

Is there any treatment available?

Yes. The most effective treatment for DM to date is the regimen of Dr. Clemmons with includes exercise, vitamins and the two medications which include Aminocaproic acid. We have a link to his page were you will find full details of the latest up to date treatments.

Can DM be cured?

No. The treatment protocol of Dr. Clemmons, is not a cure but it may help prevent the spread of the damage and allow the patient to live a longer and better quality of life.

Is DM painful?

No. DM is not specifically linked to pain although if the dog loses the use of its legs it may feel upset and scared and may cry but this is not caused by physical pain.

Do dogs die from DM?

Dogs do not die from DM, but in the later stages of the disease, if the dog is paralysed complications may set in leading to its demise.

How does DM progress?

DM initially tends to wax and wane, with the dog going through good spells and bad spells. As the disease progresses you tend to get more bad spells and less good ones. Initially the dog may be unable to walk for a while and then become mobile again before losing the use of his back legs altogether. Treatment with Aminocaproic acid hopes to slow down the progression so you take longer to get to this stage but nothing can hold it off forever.

Does the weather - heat or cold, affect German Shephard Dog Myelopathy?

Yes. Heat may make symptoms worse because nerve impulses do not relay so well in the heat. As an example, years ago one test for Multiple Sclerosis was to give the patient a hot bath and to test their reflexes before and after. The worsening of symptoms whilst very unpleasant is only temporary. The cold weather may increase arthritis symptoms in old dogs and when really cold often makes us feel stiff, both of these may add to the dog?s problem of discomfort, but will not cause his DM or its progression to be any worse.

What else can be confused with DM?

The most common things tend to be Hip Dysplasia or trapped nerve. ?Disc trouble?, as it is frequently referred to often shows similar symptoms to DM due to the disc pressing on nerves. This is why a DM diagnosis is usually a result of a process of elimination.

Are vaccination boosters safe in DM dogs?

There is mounting evidence that vaccinations may play a role in the increasing incidence of auto-immune diseases. It is frequently recommended that humans with immune problems do not receive vaccinations. Unfortunately some vets do not even realise that DM is an auto-immune problem. The use of killed vaccines is advocated rather than live vaccines and it is suggested that the vaccines for different viruses should be given separately and not all together as is the common practice. The widespread recommendations seem to be that initial (puppy) vaccinations are spread out and started later at around 16 weeks. There does not appear to be any evidence to support yearly boosters of all the diseases. Currently every 3 years is starting to be supported.

What other problems do dogs with German Shephard Dog Myelopathy get?

If a dog is paralysed the lack of movement can cause problems. Pneumonia and fluid retention is one problem encountered and probably the most common is pressure sores (bed sores).

How can I cope with bedsores?

These ulcers or sores develop on patients who cannot or do not move. They start as red painful areas which may be difficult to see because of the hair. The skin breaks and then they develop into open sores. If infected antibiotics may help. Once a bed sore has developed it will heal only if pressure on it is minimised, so good nursing care is essential. A good soft padded bed will help to prevent them as well as of course making your dog more comfortable. The dogs position should be changed at least every two hours and it is important to wash and dry the pressure areas carefully especially if there is incontinence. A barrier cream may be useful for additional protection and frequent turning and attention to any minor sores may help.

How can I cope with incontinence?

Incontinence is not a problem in the same way in all DM dogs. Although involuntary passing of urine and especially faeces may be encountered, often the trouble is more to do with urine retention, a condition in which the sufferer is unable to empty the bladder normally. Sometimes the urine cannot voluntarily be passed at all which leads to an overflow problem this can be quite easily overcome. You can help to expel it by pressing on his/her side at the waist as you can feel the bladder there. It certainly helps and does not seem to hurt. If a dog is having urinary retention there is a risk it may lead to kidney damage or urinary tract infection. If your dog does have an accident, clean up and carry on as if it never happened. In the early stages he may feel upset that he couldn't make it to the garden, reassure him that its not a problem.

How do I bathe my dog if he is unable to walk?

A blanket bathe is often the easiest, using a baby bathe liquid. Your dog can be well sponged down with this and after being towel dried, baby talc can be used to freshen him up. Another option is to use the dry shampoos available for pets. Some are powder, others are a foam type. It is of course important to not leave the dog caked in foam/talc or wet as this may encourage bedsores to start.

How much and for how long do I exercise my dog, What exercise is best?

Exercise does not mean being shut in the yard or a 2-minute walk around the block. Many of the goals of treatment in DM are obtainable through regular exercise. Two forms of exercise seem the most useful: walking and swimming. Dr. Clemmons recommends starting with 5-10 minutes of walking or swimming every other day for 2 weeks. Then, increasing the length of exercise time to a goal of 30 minutes twice a week and a long walk of 1 hour once a week. If your dog already exceeds this limits, that is fine. However, remember to provide a day of easier exercise between vigorous workouts.

Should I be giving medications with or without food?

It may be better to give the medications with food to avoid the risk of gastric disturbance but always check with your supplier first.

Is Amnicar (Aminocaproic acid) worth trying?

Aminocaproic acid is only part of Dr. Clemmons program. According to Dr. Clemmons, clinical signs improve or go into remission for up to 4.5 years in about 20% of patients when it is used with vitamin E, B complex and exercise. In most cases that do not respond as dramatically it seems to slow the progression rate by 50% giving dogs almost twice the functional life. If started early, Dr. Clemmons complete program aims to stop the progression of DM. If started later it would usually aim to double the life expectancy. The acetylcysteine addition is said to greatly improve the odds, but again early treatment is crucial. Aminocaproic acid is not claimed to work in every dog, but not many of our miracle human drugs and treatments for serious diseases are guaranteed to work in every case either. The drugs certainly may help your dog and are at present our only chance. The earlier you start your dog on the treatment, the better, as there does seems to be a higher success rate when started early. Always consult your Vet before undertaking any form of drug therapy.

How do I know the medications are working?

The trouble with a German Shephard Dog Myelopathy treatment is that each dog?s DM progresses at different rates making it very difficult to tell if the meds are helping. We feel that the vitamin regime and exercise program is well worth doing. If nothing else it should certainly help a dog feel fitter and more supple.

What side effects do Aminocaproic acid and acetylene cause?

The only side effect that we know of is occasional gastrointestinal irritation. This presents a problem only in a few patients, usually who have pre-existing GI problems that the medication might exaggerate. A local pharmacist can help in determining whether any additional drugs might be contra-indicated or lead to possible drug interactions with the recommended therapy. The only known interaction is with estrogen compounds, but only in high doses. Always consult your Vet before undertaking any form of drug therapy.

Does acupuncture help?

Acupuncture is said to cause the release within the central nervous system of endorphins, (substances resembling Morphine) which act as natural pain killers. It has also been suggested that acupuncture may work by inducing a form of hypnosis or that insertion of the needles stimulates the peripheral nerves. One of our members has used it and so far has reported that her dog finds it very soothing, so much so that he actually falls asleep during his treatment. DM patients who have concurrent arthritis may benefit from acupuncture therapy.

How long before my dog will be unable to walk?

DM progresses at different rates in different dogs. When people talk about normal progression they often quote about 6 months till lack of mobility but PLEASE remember like the human disease MS, DM does progress at varied rates. It may wax and wane with more good days than bad or may seem to go into remission. What we do not know is how long each stage will last in each individual case although it does vary greatly. Exercise is an important factor influencing the course of the disease. Although the disease is progressive, there may be periods of apparent stability were the dog seems to stop getting worse but these are rarely permanent.

How can I help my dog if he becomes paralysed?

The most important part is keeping your dog happy and healthy. We made Zak a ?rear end harness? that goes going under and around each rear leg. You can now buy a MIKKI helping hand walkabout harness which looks much easier. Most dogs do adapt to carts very well, they are grateful for the mobility a cart provides and seem to believe they are whole again.

Is it fair to keep my dog once he becomes paralysed?

No one can tell you whether or not to keep your dog in this condition. Disability alone is not a good reason for having a dog put to sleep. If the only thing anyone needed to make them happy was the use of their legs then there would be a lot less sad people in the world. The hardest part with a dog with advanced DM is that although he is immobile his eyes seem to keep that glow. When it becomes unfair to the dog is when either you or him or both of you do not seem to be coping anymore. Some people call it a day just before they lose the ability to walk, other go on with the use of a cart for a long time. One of "Zak's members" kept her dog alive and happy totally paralysed on a cart for 13 months. No one can tell you how long to continue, it is between you, your dog and possibly any other close family/friends who are actively involved in looking after him. Some people will try to tell you that its very cruel to keep a paralysed dog, I always remind them of all the people who have to use wheel chairs and do not choose death as the other option. You must rely on your relationship with your dog to tell you when the time has come.

How will I know when my dog is ready for a cart?

Usually when your dog cannot go on his walks without one, but the more unable to walk he becomes the quicker he may adapt. Your dog may not adapt if he is put in a cart too soon as he may initially prefer to drag himself around, but watch those feet for injuries.

Do dogs adapt well to carts?

Yes. Most dogs do adapt quite easily to carts although you need to ensure that the cart fits and that the dog is comfortable in it. Many dog?s are almost trying to help you get them into it within days. If you are unfortunate in that your dog does not easily adapt, then the most important thing to remember is to be patient. It can be upsetting for you the first time you see your dog in a cart but this is a natural reaction and is down to the fact that you finally have to except that your friend will never be quite the same again. Your dog may be somewhat scared initially but this is purely a natural reaction to doing something totally new and is not a good reason to decide that a cart will not work. Dogs do need to be strong on their front legs of course. You will need to be sure that the person who supervises the dog and lifts him on and of the cart will be physically strong enough to cope. Dogs should not be left unattended indoors or out whilst in a cart.

Will people think I am cruel if I put my dog in a cart?

Only the same people who probably think that all disabled people should be ?put down?. There is nothing cruel about making the best of it. Remember, some people may feel very guilty because they know there is no way they would be prepared to make that much effort for their dog.

Can carts be used indoors?

The only thing preventing a cart being used indoors is lack of space.

Is it easy to get a dog into a cart?

The main problem encountered and unfortunately the most difficult to overcome is whether or not you are physically strong enough to lift your dog into a cart. This can certainly be a problem for an older or frail owner. Some owners have used purpose built lifts.

Can my dog defecate/urinate whilst on its cart?

Yes. Many carts are designed to allow the dog to defecate and urinate.

Can I make my own harness or cart?

It certainly is possible but should only be an option if for whatever reason you can not buy one. Remember the manufacturers have been making them for some time and already understand the problems you are likely to encounter.

How can I stop my dog injuring its paws?

Specially made dog boots are available and may help to protect your dogs paws. A product known as VET WRAP is a useful around the house but not very hard wearing and is unsuitable for use outside. Horse bandages may also serve the purpose.

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