By Alan Green, Jennifer Au and Tracy Pejsa
There are many diseases seen in veterinary medicine that are not frequently discussed. In this edition, we see how profound an impact the combination of excellent diagnostics and expert rehabilitation capability can have on outcomes. Dr. Jennifer Au is CVRC’s lead surgeon and one of only a few board certified specialists in sports medicine and rehabilitation in the region. Tracy Pejsa is a licensed veterinary technician and certified in veterinary rehabilitation. Along with others on their team, they have made CVRCs departments of surgery and rehabilitation among the best in the country. They are this months guest authors.
Degenerative myelopathy (DM) is a progressive neurodegenerative disease affecting the spinal cord of older dogs. Commonly affected breeds are German shepherds, boxers and corgis but many breeds and mixes can be affected. Common clinical signs of DM begin with ataxia in the pelvic limbs, which may first be noted in one hind limb and eventually affecting both hind limbs. As the disease evolves, the dog progresses from ambulatory paresis (weakness) to non-ambulatory paresis then paralysis. Inability to ambulate typically develops within 6-12 months from the onset of initial signs. Eventually forelimb signs will develop as well (tetraparesis) along with muscle atrophy, dysphagia, voice changes and respiratory compromise. While DM is not painful, the prognosis is grave.
Degenerative myelopathy is a diagnosis of exclusion. The clinical signs can mimic other neurologic conditions including intervertebral disc disease, lumbosacral disease, vascular events and neoplasia. Orthopedic conditions such as bilateral cruciate tears and hip dysplasia can also be confused for DM. To complicate matters further, some dogs have more than one disease contributing to their clinical signs. A complete medical history, thorough physical exam and diagnostics including advanced imaging, typically MRI, are required. The only way to definitively diagnose DM is histopathology of the spinal cord postmortem.
Various empirical treatments have been proposed, such as aminocaproic acid and vitamins, but they lack supportive evidence in the limited studies available. There is one retrospective study evaluating 50 dogs that received varying degrees of physical rehabilitation that indicated intensive rehab therapy can increase survival time and duration of ambulatory time in DM patients compared to dogs with moderate or no rehab. While DM is progressive, the quality of life for pet and owner can be improved through education about the disease, reasonable expectations, assistive devices (slings, carts), appropriate nursing care and environmental modifications, such as non-slip rugs. We are proud to highlight two of our wonderful patients enjoying life in spite of their disease.
Enzo is a seven-and-half-year-old boxer diagnosed with DM in July 2015. Like most DM patients, he presented with ataxia in one hind limb, progressed to paraparesis, then plegia. He took some time adjusting, but is now using a wheelchair to get around. He still enjoys sunbathing and going on short walks. He is able to play with his toys and his housemate. He visits the rehab center twice a week for underwater treadmill sessions and massage therapy.
Jasper is a nine-year-old Labrador mix diagnosed with DM in October 2015. He also presented with ataxia in one hind limb that slowly progressed to plegia. He recently started using a wheelchair and now there is no stopping him! He loves to go for long walks around his neighborhood and explore the woods. He receives underwater treadmill and laser therapy sessions every other week.
While life is a little different for both of these dedicated families, they have adjusted to living with the special needs of their pets. While it is challenging at times, the pets have a wonderful quality of life and we are always here to help them along the way.