Degenerative myelopathy (and arthritis)

[bit-bit]

I initially updated my old thread, but as little traffic as the dog boards get, I figured a new thread with an accurate title would be more visible.

Muffin is my 16 year old mutt, generally in good health for his age.  Over the last three or four years, arthritis in his hips has been slowing him down, but has been under control with aspirin.  The last few months, however, his mobility has been getting noticeably worse, and he's started leaving small feces around the house where he sleeps.  I initially thought it was just progression of the arthritis and old age, but the vet has diagnosed degenerative myelopathy - a nerve condition which is in some ways similar to HED in rats.  It has no treatment or cure, and can progress to full paralysis anywhere from a few months to a couple years after initial symptoms appear.  Unfortunately, his early symptoms (which involve hind end mobility) were masked by his arthritis, so he's probably had myelopathy for over a year now.  His time left with us is likely going to be measured in months, not years.

Since there is no treatment for myelopathy, the goal is just to keep the dog as comfortable and active as possible until euthanasia becomes necessary.  My heart is breaking thinking of that, because Muffin is still 100% mentally, and really has no other major health problems (aside from hearing loss, which doesn't seem to bother him at all) - if you don't see him walking, he looks and acts like a dog half his age.  In the meantime, my vet and I have decided that the best course is to treat his arthritis aggressively so that he has all the mobility he can, and I actually have seen some improvement after just a few days on his new regimen of Tramadol (pills twice a day) and Adequan (injections twice a week) in addition to aspirin.  He's no longer crossing his hind legs when he stands or leaning on furniture to support himself, though he still often can't get up on his own.  He also hasn't left a sleep-poop (we've taken to calling them grenades) in the last few days, though I don't think I can attribute that to the arthritis treatment.

Aside from medicine, the vet prescribes exercise - walks for as far as he can go, but at his own slow pace, twice a day (hydrotherapy is popular for DM, but not an option for Muffin, who is deathly afraid of water).  We've invested in a sturdy ramp over our stairs and a sling for lifting him in and out of the car.  Some DM dogs do well with carts (i.e. dog wheelchairs), but we probably won't go that route with Muffin, since he already has incontinence and the vet suspects front limb involvement - by the time his hind end is fully paralyzed, the other symptoms will make him not a good candidate for wheels.

I'd love to know if anyone here has been through this disease, and what your experiences were like.  I'll try to keep updates here about his progress.  Also, anyone dealing with long-term management of arthritis - what do you think of this regimen?  I had never heard of Adequan before, but my vet thought it was at least worth a try.

[Kati33]

There are tons of options out there for arthritis management. My own dog is on tramadol, dasuquin, duralactin and fish oil. I haven't done adequan injections with him, though I've seen them used quite a bit in practice. It really is a disease where some things work for some animals and others work for others. I think it sounds like you are taking the best approach you can and I hope Muffin has some good quality time left with you guys. It's really unfortunate when their body just can't keep up with the rest of them.

[bit-bit]

Thanks for the input.  His arthritis isn't the major issue (like I said, it responded well to aspirin alone until it was compounded by the DM), but he does seem to be improving slightly with the new treatments.  The Adequan injections scare me a bit - the vet showed me how to do it, and it's only subcutaneous, but I've never injected one of my pets (or any animal/person for that matter) with anything before. 

I forgot to mention that he gets fish oil as a general supplement.  I used to give glucosamine/chondroitin as well, but it really seemed to make no difference for him, and the research on it is very mixed - like you said, it's one of those things that seems to be case-by-case.

And to brighten up the thread a little, here's his sweet face 



It's never easy to see a beloved pet get old and sick, but I almost feel like it would be easier if it was something else - he seems like the same energetic, enthusiastic puppy he's always been, but without the ability to run and play like he wants to.

[applecavy]

I know a hound, Hunter, who has Degenerative Myelopathy, in addition to being like HED for rats, it's essentially the dog version of MS.
Hunter is probably one of the happiest dogs I know (he is 12) and his Dad got him a little dog wheel-chair we he has learned to use magnificently.

I feel like, if your dog is otherwise in good health, as long as you try and get him out frequently so that he doesn't poop the bed, he could still be happy for a long time.
For what it's worth, our dacshund has MDD (multiple disc disease) and though she has had spinal surgery, she is partially paralyzed. She's been unable to voluntarily go to the bathroom for about 4 years now. Every day we take her outside and express her bladder a few times a day. She only has accidents if we aren't on top of things!

[bit-bit]

Thanks for the positive stories, Apple.  Everything I've read online has been so negative, and even my vet (who has had a DM dog himself) wasn't too optimistic.  Muffin is a strong dog, so I can only hope he fends off the worst symptoms for a while.

I didn't know it was possible for a person to express an incontinent dog's bladder.  From what I've read, DM dogs with urinary incontinence (Muffin's is mostly fecal thus far, though he's had a couple of peeing accidents that I now think could be related) just have to wear diapers - I guess they tend to "leak".  His pooping is that way too - it can happen fairly soon after he's been on a walk and pooped, and it's always just a tiny amount.  Of course, I still try to get him out as often as possible, and especially before bed.  The grenades aren't a big deal, they're easy to clean up.  I do worry about when he starts having urinary incontinence, because I know diapers can lead to problems like scalding the skin, but my whole house is carpeted, so I don't think I could leave him to dribble all day.  But that's something to deal with as it comes.

In other news, I gave him his first at-home Adequan injection today.   He whimpered a tiny bit - he's a huge drama queen, so it's hard to know if he was actually in any pain or just protesting - but otherwise it went well.  He got a cookie (milkbone) and an ear rub, and I was forgiven.  It was definitely less traumatic on all involved than taking him back to the vet just to get it done.

[applecavy]

Good job on doing the shot!

Yes, you can express a dogs bladder, but it is much easier to do on a smaller dog. The easiest way I can explain it is that you hold them with your fingers underneath their abdomen, and feel for a water balloon. You put pressure there...nature takes care of the rest. The hard part is being sure that you've gotten everything, but we are pretty intune with Lucie's bladder by this point.

This is pretty good video;
http://www.youtube.com/watch?v=EhXQdKzAdN0

Obviously you cannot express a larger dog over the toilet, 

[Eileen]

While I don't have extensive experience in this, I am going through it now with a dog I found a few months ago. I found her trying to cross the street and she could't even make it across, her arthritis was so bad, and she was emaciated as well (think ASPCA dog). Even though she's put on 5 lbs, people still comment on her when they see her, but she is a very happy dog.

She has arthritis in her legs as well as degenerative myelopathy. She is on Rimadyl, fish oil, and Missing Link with Glucosamine/Chondroitin (what do I have to lose, if the glucosamine doesn't do anything so be it. The Missing Link has done wonders for her coat so I will continue). She can get up by herself but often falls when her front (or back) legs cross or give out. She is good natured and usually takes that as an opportunity to start rolling on her back. She cannot do stairs, so we have to carry her up & down them (not fun at 3AM when she has to go out, since we have to go down a flight of stairs to the yard). When we put her down from carrying her, we have to uncross her back legs before letting her go.

She used to sleep poop but doesn't seem to do that anymore, but she has absolutely no schedule to when she poops, and it seems she will almost never poop outside, but as soon as she comes back in the house, there it comes.. no matter how many times we take her out.

As far as the bladder, I don't know if this would be relevant in your dog's situation, but there is a pill for canine incontinence, if it is just involuntary peeing. PPA (phenylpropanolamine hydrochloride):
http://www.drsfostersmith.com/product/prod_display.cfm?pcatid=10776

Muffin is beautiful and I agree, I think as long as he is happy he can still  have a long life. You'll get used to the SQ injections. Before trying to express the bladder, talk to your vet about the incontinence pill, maybe it could be a consideration.

[bit-bit]

She looks like such a sweetie!  Muffin's hips/thighs have that same shape - so much muscle lost - but it's well hidden by his fluffy coat.  Do you know how old she is?

I definitely wouldn't try to express Muffin's bladder without a vet's advice.  He's still able to mark territory (though without lifting a leg) on walks and has only had a couple of accidents in the house, so hopefully it will be a while before he needs either medicine or physical help for that.  I'm glad to know there's a medicine option, though - if it works for him, I think that would be a lot easier on him than trying to express his bladder myself (have I mentioned he's shaped like a Corgi?  Access to the undercarriage isn't easy).

I'm actually amazed at how well he's getting around right now.  With the addition of Tramadol and Adequan, he's no longer crossing his hind legs when he stands or having to lean on the couch to stay upright.  He still occasionally loses balance and falls down, but it doesn't seem to be as frequent.  His gait is still stiff, and to move with any speed he does a "bunny hop" motion, using his hind legs in unison, but last week he wasn't able to run or hop at all.  I think the new drugs have taken him back about six months in terms of mobility (and it's been less than a week, so there could be more improvement to come).  It makes me so happy to see him prance around in excitement for a walk again.  He did leave some grenades yesterday, but of course the arthritis meds aren't meant to help with that.

[Eileen]

She is about 12, the vet thinks. (I took the pictures down because I didn't want to hijack your thread with my pictures, I thought of that after but I'm glad you got to see them:)

Unfortunately there is nothing to do about the grenades; my vet says sometimes when her dogs cough, one  can just pop out! Dogs, huh?....
But at least poop is easy to pick up. If you can control urinary incontinence I think it's half the battle.

I can't believe all the time how my dog just gets up & keeps going, and takes advantage of tripping to stop and smell the grass. They really know how to make the best of a situation.

It's worth it to ask the vet, and perhaps try it.  What it does is strengthen the weakened sphincter that is allowing the urine to come out. It isn't  that expensive, I think it was like $25 for a 30 day supply?

[bit-bit]

I didn't mind the pictures -  they weren't a hijack at all 

Yeah, cleaning up the grenades isn't a big deal.  They get flushed, and I shampoo the carpets periodically.  Luckily, he's never been prone to diarrhea, which would make things much less pleasant.

I'll definitely ask the vet about that medicine if/when he starts having urinary incontinence problems.

Muffin's attitude isn't quite as great as your dog's.  When he falls down on a walk, he'll sigh loudly and stare at us until someone helps him up.  I can tell he's frustrated by not being able to do things on his own, but once he gets back on his feet, he's happy again.

[applecavy]

Ah, I should have clarified! Lucie doesn't pee involuntarily, she can't pee. That's why we always have to express her.
It's like...the opposite of incontinence.

[bit-bit]

Ah, I should have clarified! Lucie doesn't pee involuntarily, she can't pee. That's why we always have to express her.
It's like...the opposite of incontinence.

Ahh yes, that makes more sense.  Muffin definitely doesn't have that problem - he still tries to pee on everything in sight like a typical male dog.

[Eileen]

I think one of the differences in my situation and yours ( and what makes mine a little easier to watch) is that I didn't have my dog when she was young, so I didn't have to see the changes. I think she was a marina dog that outlived her purpose, and they just let her go. When we first got her she would not have eye contact and was not interested in getting petted, or being part of things. Now she will look at us, and come over for a pet (but only one or two), and is mostly happy if she just knows  you are around.

So for her, falling down is no big deal as I think she spent most of her life pretty much alone. It's different for Muffin, so he is probably more sensitive to his changes. But, you're on top of them all and he has lots of support and love. That's the best thing we can do for them

[Rzrwyre]

I only got to skim the thread.  Tramadol (in people) can REALLY help in degenerative arthritis or other similar pain in some, not as much in others.  The other thingie sounds like basically glucosamine which sure couldn't hurt in terms of arthritis...worth a go!

Good luck to your handsome one!  And you, too.

Best,

Raaz.

[bit-bit]

Well, I had intended to keep this thread updated as a log of Muffin's progress, but I'm awful at updating.

Muffin's not doing great.  Last week, I had to start diapering him, as his urinary incontinence is now pretty much complete - he dribbles all day while he lays/sleeps, and often starts going full stream on his way out the door, but before he quite gets there.  I made a bunch of cummerbund-style diapers for him, and he's tolerating them really well - doesn't try to get them off at all, which I was worried about.

He can stand up on his own about 50% of the time now.  Otherwise, he'll bark at us to come pick up his butt.  He can walk, slowly and clumsily, once his butt is off the ground, and can still do the bunny-hop run when he's excited, but only for a few hops.  My husband is still taking him on long walks (around the block, which takes about half an hour now), but he has started falling periodically, which makes me think that walks might soon be a thing of the past (we have a yard he can go in, so they aren't strictly necessary).

The fecal incontinence hasn't really changed.  Yeah, he's still leaving presents around the house from time to time, but not any more often than he was a few months ago.  I prefer picking up solids from the floor than dealing with poo smeared into fur, so I don't plan on diapering that end.

He still eats fine, loves his people, and seems to be enjoying life, though it's obvious he's getting more and more frustrated by his lack of ability.  My husband thinks his time is coming soon, I think he has a few more weeks, but probably not more than that.

[Kati33]

I'm so sorry. Enjoy the time you guys have left together- big kisses to the sweet boy!

[bit-bit]

I just made Muffin's last vet appointment for Tuesday.  He's gotten to the point where the bad times outweigh the good.  He can't really stand up on his own at all, and can barely walk.  We've been dogsitting this week for my mother-in-law, and having a puppy in the house has really perked up his mood, but it's also made obvious just how little mobility he has left.  She'll go home on Sunday, then I want to give him a day of undivided attention and spoiling, and let him go out on a high note, because I honestly don't see any more really good days in his future.

[applecavy]

He will  have an excellent last day with you, I'm sure of it.

:hugs: