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Degenerative Myelopathy

By: Dr. Arnold Plotnick

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Diagnosis In-depth

Diagnostic tests for degenerative myelopathy are performed mainly to rule out other causes of slowly progressive weakness and lack of coordination. Tests may include:

  • A complete medical history and physical examination. Middle-aged German shepherds with progressive neurologic dysfunction in the rear legs are highly suspicious for degenerative myelopathy. The physical examination is done to rule out orthopedic causes.

  • A complete neurologic exam. This is necessary to assess strength, reflexes, pain perception and other neurologic parameters.

  • Routine x-rays. These are taken of the spine and hips to help rule out hip dysplasia and intervertebral disc disease as a cause of the symptoms.

  • Myelography. This is a specialized radiographic procedure in which a dye is injected around the spinal cord to make the cord more visible on x-rays. This test may be necessary to rule out intervertebral disc disease and spinal cancer as a cause of the symptoms.

  • A spinal tap. This is a procedure in which a sample of the fluid that bathes the brain and spinal cord is taken. It is performed low on the spinal cord and may give information supporting a diagnosis of degenerative myelopathy. Many dogs with degenerative myelopathy may have an increased protein concentration in the spinal fluid.

  • Electrophysiologic testing. Tests to determine nerve function may be suggested to rule out other neurologic disorders.

  • Advanced imaging. Computerized tomography and or magnetic resonance image may be used to rule out other causes of the clinical signs.

  • Routine blood work is also recommended to assess overall health. Routine laboratory work may include a complete blood count, diagnostic profile and urinalysis. The results are generally unremarkable in dogs with degenerative myelopathy and without and secondary diseases..

    Treatment In-depth

    There is no consistently effective treatment for degenerative myelopathy and affected dogs usually progress to severe weakness and lack of coordination within a year of the onset of disease.

    Although no controlled studies have been performed to test their efficacy, the following experimental treatments have been recommended by some researchers:

  • Glucocorticoids. Given alone, these drugs will not alter the outcome of the disease. Instead they should be used during acute flare-ups, where there may be some benefit. Long-term use may be associated with side effects, including muscle weakness, which may only compound the weakness.

  • Vitamin and herbal supplements. High levels of vitamin E (2000 IU/day, orally), vitamin B-complex (1 high potency B vitamin complex tablet twice daily), vitamin C (1000 mg twice daily) and selenium (200 micrograms daily) have been recommended. Gingko leaves, a natural tonic herb, is recommended twice daily.

  • A home made diet consisting of pork, tofu, brown rice, and vegetables have been recommended as part of the overall therapy for degenerative myelopathy. (See diet instructions below).

  • Aminocaproic acid (Amikar®) is a drug that may reduce the spinal cord damage that occurs during the disease process and may slow the progression of the disease. The drug is most successful if given early in the course of disease.

  • N-acetyl cysteine, a potent anti-oxidant, when given along with aminocaproic acid, has been suggested as part of a therapeutic regimen.

  • Exercise increases circulation and oxygen delivery to nerve and other tissues, and improves strength and overall function in dogs with degenerative myelopathy. An alternate-day exercise program including walking and swimming is the best approach. A day of rest between each session is equally as important.

  • Nursing care that includes making sure your pet is clean and dry is essential. This becomes important as urinary and fecal incontinence occur to prevent urine scald and skin infections/ulcerations. It is also important to provide surfaces that allow your pet to have good foot traction. Use rugs or carpets in slippery floor surfaces where your dog may have trouble getting up. Many pets have muscle wasting and are less active which can cause skin breakdown. Padded bedding that can be easily cleaned is also ideal. Dogs with advanced disease can sometimes benefit form a "sling" to help them ambulate. Slings can be purchased commercially or you can make one at home by using a bath towel. You roll the bath towel long ways and use it as a sling. Place the middle section in front of your dogs back legs with the two ends over his back. You can use this "sling" to help him support his weight. This can be used to help your dog get in and out of the house until he is in the grass where he has better traction.

    Prognosis

    Long term prognosis is poor. The disease generally progresses over 4 to 6 months from the time of diagnosis ultimately causing loss of limb function and ability to walk and incontinence. Advanced disease will often progress to affect the front legs.

    Follow-up Care

    Optimal treatment for a pet with degenerative myelopathy requires both home care and professional veterinary care, with follow-up being critical. Administer prescribed medications, supplements and diets and alert your veterinarian if you are experiencing problems treating your pet. Follow-up includes serial physical and neurologic examinations by your veterinarian to assess the progression of the disease

    Homemade Diet

    The following is a recipe for homemade diet for German shepherds with degenerative myelopathy.

    2 oz. boneless pork center loin chop (boiled or baked)
    4 oz. tofu
    8 oz. long grain brown rice (3 oz. cooked in 6 oz. water)
    2 tsp. extra virgin olive oil
    ¼ cup molasses
    2 whole carrots (boiled, then cut up)
    1 cup spinach
    4 tbsp. green bell pepper (chopped and steamed)
    4 broccoli spears (boiled, then cut up)

    The above recipe makes one serving for 30 to 50 lbs of body weight. Portions may be prepared ahead of time and frozen. Just before serving, add:

    1 tsp dry ground ginger
    2 raw garlic cloves, crushed
    ½ tsp dry mustard
    1 tsp bone meal




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