By Lisa Muench
If you are a German Shepherd owner or someone considering acquiring a shepherd, you may have heard and be concerned about the propensity of the breed for hip dysplasia. Although this is a common problem in the GSD, its impact upon the quality of the dog’s life is far less than another common German Shepherd ailment, degenerative myelopathy (“DM”). I write this article both as the director of a non-profit devoted to saving GSDs and educating people about the breed and as the owner of a beloved shepherd named Katie who suffers from DM.
No one is exactly sure what causes Degenerative Myelopathy (also referred to as CDRM – Chronic Degenerative RadiculoMylopathy). The most significant research on this disease is being done by a veterinarian at the University of Florida – Dr. Clemmons. His theory is that DM is an autoimmune disease that occurs when the dog’s own immune system attacks its body, particularly the myelin sheathing that insulates nerve fibers and the axons that carry signals from the nerves to the muscles. Many have compared it to the symptoms and deterioration that occur in humans who suffer from multiple sclerosis, although others in the vet community contend that DM and MS are really two very different diseases and some, though they really have no explanation for what causes DM, challenge Dr. Clemmons’ conclusion that it is an autoimmune problem. Obviously, there is no consensus of opinion about exactly what DM is or what causes
The subject on which most everyone can agree, however, is that DM is a neurological disease which presents with a set of symptoms that are easily recognized by vets who see a lot of dogs who suffer from DM and often misdiagnosed by vets who are not familiar with DM. The disease can develop in almost any age dog, but seems most common in dogs 6 years and older. Initially, signs may be similar to symptoms associated with hip dysplasia and or arthritis (hence, the frequent misdiagnosis) – difficulty getting up, some dragging or weakness in the rear legs, etc. One of the symptoms which may clearly signal a DM problem is that the dog begins initially to drag its rear feet in such a way that the two center nails on both rear feet scrape and are often worn down to the point of bleeding. In time, the dog’s back end begins to sway, creating the appearance that the dog is in something akin to a drunken state or the dog may periodically crisscross its rear legs or lean to one side, etc. Some dogs begin to walk with a “goose-step” stride as they are struggling to keep their mobility. The dog may also turn its rear feet (“knuckling” their feet) over in such a way that it is literally walking on the top of its feet without any awareness of this. A vet who suspects DM (or other neurological problems) may test for the neurological symptoms of DM by turning/ folding a dog’s rear foot under and waiting to see if the dog immediately corrects the foot and goes back to standing on its pad or whether it remains standing on the top of its
The most significant challenge, initially, is to even get a diagnosis. Essentially, DM is a diagnosis of exclusion – ruling out other causes of the symptoms until the logical conclusion is that the dog suffers from DM. Similar neurological symptoms can be caused by a disc or nerve compression, by certain spinal deterioration, by a tumor, etc. The only way to determine whether one of these other problems is causing the symptoms is to have an MRI and/or a myelogram performed on the dog. Both of these tests are expensive (probably ranging from $1,000 to $1,500) and neither really confirms absolutely that a dog has DM, even if a tumor or disc/nerve problem is ruled out. It simply rules out other likely causes of the same symptoms. The other difficulty, besides cost, is subjecting your dog to either of these tests, is that it causes a stress upon the animal and stress, above all else, is thought to be one of the biggest aggravators of DM, frequently causing an irreversible worsening of the symptoms. Therefore, it becomes a tough decision whether to have the tests performed or not. Additionally, the surgery to correct the problem is another stress which can aggravate the DM if it is also
Once the conclusion is that the dog probably is suffering from DM (based either on ruling out other factors or simply by virtue of the symptoms the dog is demonstrating), treatment becomes the next question. There is no cure for DM – it is a progressive and debilitating disease that eventually completely paralyzes the dog’s hindquarters and may, in time affect the front limbs as well. Some dogs will lose control of bladder and bowels, others will not. In some dogs, deterioration from the scraping feet and a slightly wobbly backend to complete paralysis will happen in months, in some dogs it may occur over a one to two year period. The neurologist we saw with our girl Katie, who sees about 3 dogs EVERY month suffering from degenerative myelopathy, said the very longest he ever saw a dog last from initial symptoms until the dog was put down was three years, but he stressed repeatedly that this was the rare exception and that most dogs deteriorate rather quickly, usually in less than a year from initial onset of any symptoms. As the symptoms progress, the dog may become completely paralyzed in the rear quarters and that may spread, eventually, to the front limbs as well. Additionally, many dogs lose control of bowel and bladder functions and some begin to develop bedsores and infections from lack of mobility.
Since there is no cure, the question becomes whether there is anything you can do to slow the progression of this dreadful disease. The answer to that depends upon who you ask. Conventional wisdom in much of the traditionally trained vet community is that there is nothing you can do other than trying to minimize your dog’s exposure to stress. Dr. Clemmons, on the other hand, believes strongly that the progression of the disease can be slowed by a set of approaches designed to treat autoimmune problems generally. This approach really involves a combination of prescription medications (acetylsysteine and aminocaproic acid (known by the tradename “Amicar”)), vitamin and herb supplements (a long list including A, C, E, borage oil, co-enzyme Q-10 and many others that can be found on the website listed below), a special diet (see recipe below) and exercise. One of the exercises that is most strongly advocated for dogs with DM is swimming as it allows for the dog to maintain muscle tone while exercising in an manner which is unlikely to cause any injury.
People whose dogs suffer from DM have reported varying degrees of success with this combination of approaches and some people choose to use one or two of the approaches only. The vets that we have spoken with are not convinced that any of this really makes any difference but nobody really knows so most people with DM dogs are inclined to try it in hopes of extending their dog’s quality time. Dr. Clemmons emphasizes that the likelihood of his treatment plan helping to lessen and slow the symptoms of DM is far more effective if begun very early on when the dog first shows symptoms, rather than after the dog has really begun to show severe symptoms and signs of paralysis.
Turning to our own personal story, our Katie Kakes began showing signs of problems with her rear legs almost a year ago. At the time, she was suffering from impacted anal glands and we thought that part of her “walking oddly” might be attributable to the discomfort caused by the anal glands. We repeatedly had the anal glands expressed and, ultimately flushed. Nonetheless, we continued to see a worsening in her mobility with her rear legs – trouble jumping up onto the bed or into the back of our Suburban, a bit more hesitancy in climbing stairs, an occasional dragging of her back feet while walking, etc. We took her to two different vets, both of whom attributed her symptoms to a combination of arthritis and/or hip problems (though Katie has never had a hip problem at all in the 6 years we had her, having acquired her at 2 years of age when she was dumped in a shelter in York, Pennsylvania). All of these problems began around March/April of 2000. By July, we were noticing more problems with her legs – she seemed to be crossing them over on occasion (another symptom of DM) and was occasionally seen standing on the upper part of her foot, having curled her back feet under. Neither of these was an all the time occurrence but it disturbed us enough to go back to the vet and essentially demand that it be recognized as something neurological. After doing some basic neurological testing, the vet did agree that this wasn’t just hip dysplasia or arthritis. However, she indicated it could be age related spinal changes and suggested a full spine x-ray.
And so it was that Katie began a series of tests and procedures. The spinal x-ray showed a very healthy spine, especially for an 8 year old dog. Therefore, that didn’t seem to offer any explanation. In the meantime, the anal gland problem was also worsening and beginning to show signs of being a perianal fistula (a medical condition common in many dogs and not easily treated). The vet suggested that the combination of the neurological problems and the perianal fistula warranted a consult with a surgeon and so it was off to the specialist. Meanwhile, on the weekend before the consult appointment, Katie had to be rushed to the ER because one of her anal sacs had burst and she was bleeding rather profusely from the anal area. That problem was resolved fairly quickly and we were able to take her right back home again.
A few days later, the surgeon who saw Katie agreed that she suffered from perianal fistulas and that surgery would be the only way to really correct that. However, he felt that her neurological problems required more immediate diagnosis and attention. He agreed that her symptoms could likely be DM, but he indicated that they were also consistent with a disc problem and so he recommended getting an MRI (a myelogram – a contrast dye study – was also suggested as a diagnostic possibility but as less definitive than the MRI). So, off Katie went to a facility which specializes in doing MRI’s on animals. The results of the MRI showed that she had a disc related nerve root compression at the L7 area. Although this wasn’t good news, we were actually happy to hear that her neurological problems might be attributable to a condition that could be remedied with surgery. We suddenly began to think that our dog’s condition had a chance of being turned around.
Back to the surgeon we went with our MRI results. He suggested that Katie’s symptoms might well be because of this nerve compression and that surgery could be done to remove the disc that was compressing the nerve. He cautioned that it was remotely possible that there could turn out to be signs of cancer at the site of the compression, but that wasn’t likely. And thus it was that we came to schedule Katie for surgery on Tuesday, September 11, 2001. We had no idea, when we dropped Katie off at 8:30 a.m. that morning, that it would turn out to be a date that nobody would ever forget.
Later in the day, numb from the attack on America which had occurred only about a half hour after we had left our Katie at the vet, we got word that she had come through the surgery fine, that the disc material had hardened too much to actually remove it, but that it had been sufficiently shaved away from the nerve to alleviate the pressure it had been causing. Although no biopsy could be done because the material had hardened too much, the vet assured us that he saw enough malignancy to recognize it pretty much on site and he assured us that Katie did not have cancer. We were reassured and hoping that September 11th would turn out to be a good day for our Katie, though it had been such a terrible day overall.
Two days later we were able to pick Katie up and bring her home. She could walk with the help of a sling. She was forbidden from climbing stairs (Bob carried her up and down the stairs each day – all 62 lbs. of her!) and was to remain on restricted activity for about 2 weeks and then return for a checkup. During that time, she was able to walk and seemed about the same as she had pre-surgery with respect to the control she had over her hind legs, but we thought she would continually improve as she recovered from the surgery.
On her return visit in two weeks, Katie walked much the same as she had pre-surgery. The surgeon suggested that it was too early to tell whether she really did suffer from DM or whether she still had swelling from the surgery that affected her mobility. Her suggested that we get her on a regular regimen of swimming to start building her muscle tone and to speed her recovery.
We were delighted to find Showplace Farms, a facility in central New Jersey (about 5 minutes off of Exit 8 of the NJ Turnpike) that is a showhorse farm but that uses the water tank for the horses to also provide water therapy to dogs. Alison, the woman in charge of the therapy programs, is a true delight and as knowledgeable as any vet we have encountered on the subject of DM as she has seen far too many dogs who suffer from the condition – predominantly German Shepherds (figures report that of the dogs that suffer from DM, probably 75% to 80% are GSDs). We began taking Katie for water therapy twice per week.
Now bear in mind that Katie has never liked the water (in fact, hates it) and she was given to panic attacks when we first started taking her for swimming therapy. We were struggling with a dilemma of whether the therapy was helpful or whether, if she really did have DM, we were aggravating her condition by stressing her. We decided to persevere with the water therapy in hopes that she would eventually grow to like it, or at least tolerate it. She swam twice a week, but she ALWAYS hated it. We kept at it, however, because we were very concerned that her muscles would atrophy due to lack of exercise and further inhibit her ability to maintain mobility.
When we returned for Katie’s checkup with the surgeon about 7 weeks after the surgery, he watched her walk, agreed she was worse, shrugged his shoulders, said it was probably DM after all and sent us on our way. He said we could try a dog cart (see insert below) and that Katie would probably quickly deteriorate over the next six months. For him, that seemed to be that! When we asked about the surgery for her continuing perianal fistula problem, he simply shook his head no, as if to say that it wasn’t worth doing on this dog.
And so, left on our own, we wrote to Dr. Clemmons, via E-mail, and asked him for his opinion. We detailed everything that had happened with Katie and he wrote back to tell us that perianal fistulas in dogs with DM is quite common, supporting his theory that both are autoimmune related problems. He suggested some new drugs to try for treating the perianal fistulas (the antibiotics we had been given by vets had not made any difference) and he recommended that we stay the course with his regimen of meds, vitamins and diet, all of which we had had Katie on for about 4 months or more at that point. We also kept taking Katie for water therapy, although we did cut back to once a week. We wrote to Dr. Clemmons about our dilemma as to whether the therapy helped her or stressed her to the point where she was actually worse off as a result of it and he concurred that it was a hard thing to know. Of course, at this point, we were now feeling guilty that we had subjected Katie to an MRI and to surgery as the surgery had definitely NOT led to any improvement and the stress of that entire set of procedures could have actually hastened her decline from the DM. Everything seemed to be an unknown and nobody had any satisfying answers or suggestions.
Eventually, we decided to consult a veterinary neurologist for yet another opinion and he concurred that Katie suffered from DM. He routinely prescribes Dr. Clemmons’ regimen for his clients whose dogs are diagnosed with DM, although he admitted that he wasn’t convinced it made a bit of difference. However, his philosophy is basically “there’s nothing else to do and there’s no harm in trying it.” Although there is no known serious side effects of either the prescription meds or the vitamins and herbs, keep in mind that, for many people, it can be cost prohibitive as the combination of these items, plus Katie’s special med for the perianal fistulas (“Leflunomide,” running about $150 per month) is in excess of $250 per month. The neurologist was a super nice guy who spent a great deal of time with us but whose overall prognosis for Katie, and any dog who suffers from DM, was pretty much grim. He wished us the best, suggested that water therapy probably was doing more harm than good at this point for a dog who found it so stressful, told us we were about the best informed owners of a DM dog he had ever met and suggested that it was a sad thing that the vet community had no real understanding of this dreadful disease.
Since then, we have also tried acupuncture and chiropractic massage for Katie from a chiropractor who treats both humans and dogs. Although it has certainly not changed Katie’s condition in any monumental way, it does seem to make her relaxed and mellow and her back looks more relaxed and straight in the days immediately following the treatment. Some folks with DM dogs have reported good success with acupuncture and others have seen no effect at all. Everything about DM is somewhat trial and error and also a factor of not knowing whether what you are doing is making a difference and slowing deterioration from a more rapid rate than if you had done nothing. It is frustrating.
As I write this, in mid-March of 2002, Katie has gotten to the point where she is unable to stand up at all on some days and simply moves about by dragging her backend with her front legs. Other days she can stand and walk, although sometimes with frequent falls. On some days, she can actually get trotting and keep her self up which, according to the neurologist, is because her legs are sort of on automatic pilot when she is trotting and the inability of messages to travel from her brain to her legs doesn’t have the same impact as when she is trying to stand, turn or walk at a normal pace. While sleeping, she gets severe night tremors and muscles twitches and nobody completely understands the cause of those symptoms either.
In order to let Katie go out and take long walks and enjoy all the doggie smells and fresh air and be with her akita sister, Mitsu, we have been using a K-9 cart and HIGHLY recommend it as the best way for a DM dog (or for any dog suffering from paralysis) to still have quality of life. To this point, Katie has never lost control of her bowels or bladder and still relieves herself when she needs to by either doing so from the cart or by being walked in our yard with her back legs being supported by a sling that we use to hold her up (actually just a big bath sheet). She still likes to play with her toys (even though she can’t really chase them any longer), to go for car rides, to be lifted on the bed to cuddle and she still has a normal appetite. We have been told repeatedly by every vet and have read extensively too that there is no pain associated with DM, just tremendous frustration for the dog (and for the humans who have to watch their poor pet struggling). Dogs, however, always resilient, seem to find a way to cope with their handicap and so it is that Katie has adjusted to her life as a partially paralyzed dog.
It is sad to say that not much research is being done on this dreadful disease and many vets don’t really know much of anything about it. Both the military and all of the agencies who use German Shepherds in a working capacity (from police work to bomb detection to search & rescue) report losing many German Shepherds to DM. Nonetheless, according to our neurologist, the disease was first described and defined in studies overseas in the 1930’s and 1940’s and not that much new has been learned in the almost seventy years since it was first recognized. If you own a shepherd, if this is your breed, you cannot afford not to know as much as possible about this heartbreaking condition that afflicts so many GSDs. We recommend the websites below for more information about degenerative myelopathy.
For more resources on DM, click here.