Degenerative myelopathy progression

[jmonet]

My dog Leila was diagnosed with degenerative myelopathy a year ago and at first it progressed fairly steadily until a couple of months ago. According to what i had read at the time i expected her to be gone by now. She currently does not have the use of her hind legs, she uses the Walking Wheels, and her front legs have gotten quite strong. In the last 2-3 months i have seen almost no change in her condition and I'm wondering if this is normal. We are getting by ok but I must admit it is hard since she is a 90lbs dog. Our main problem is urination. She is not incontinent but has constant urinary tract infections and her pee smells really bad. Her mental state seems ok too but she is very demanding of attention and whines/talks a lot and I'm not always sure what she wants. I'm not really sure what I'm asking but I'm wondering if others have similar experiences. Thanks!

[Bobbie]

First, many of the available estimates for DM are pretty much bunk- based on the assumption that in 6-9 months when your dog goes down in back you'll euthanize. With a cart, you can add a couple of years (or more) to that. Your limitation will come when you can't get him into a cart or use front wheels anymore.

It's normal for there to seem to be a plateau between going down in back and eventually going down in front. During that time the disease hasn't really stopped, it is just progressing slowly as usual and affecting trunk muscles. Eventually you may notice some sagging in her back or tummy muscles, and then tiring easily in front. As soon as you see any weakness in using the cart, add the front wheels, as if you let her stop moving first she'll lose a lot of strength.

Most owners of very large dogs don't go too far with front wheels, as getting the dog into the cart can be a major problem. If it isn't, and you can handle it, a dog with DM can have good quality of life even after not walking at all. But again, that's a lot harder with a 90 lb dog than my breed, so often the decision that quality of life is no longer good enough comes sooner for big dogs. Though some do manage, and take walks in bike trailer-sized strollers, and do well until the disease ultimately progresses to breathing problems. That's rare, even in small dogs, but can take up to four years after initial diagnosis.

UTIs are one of the things that can quickly compromise health and quality of life, and females have more of a problem than males with them. Are you expressing her? IF not, she may be retaining urine and allowing it to get more infected.

[CarolC]

Most owners of very large dogs don't go too far with front wheels, as getting the dog into the cart can be a major problem. If it isn't, and you can handle it, a dog with DM can have good quality of life even after not walking at all. But again, that's a lot harder with a 90 lb dog than my breed, so often the decision that quality of life is no longer good enough comes sooner for big dogs.

I think the "if you can handle it" part is also key here. It's hard to talk about it because it's so individual, what's right for you isn't right for someone else. I cared for a dog that went down at 63 lbs. He had been going down gradually for 2 years and I had been helping him, but he finally went down completely in 2008. By the end of 8.5 months my back was a trainwreck. Even if you do the lifting properly, there is cumulative wear and tear that occurs and builds up. Many more things can go wrong with your back than simply blowing a disk in your lower back, which is what people always think of when you talk about back problems. You want to keep going. You are focussed on your dog. You want to go the whole distance. At the same time, it's a race between what will go first, your dog or your own health. I can't tell you when enough is enough, I am one of the last people to consider euthanasia for an animal that still has mental faculties, can't do it. I hurt my health continuing to care for my large down dog. When I look back I do not see any other options and would have to do it again, because there just aren't good options for caring for a large down dog. We need them but we don't have them.

You have given your dog another year of life. You know how special that is. What about the year ahead? Chances are you currently have some physical breakdown that has occurred gradually, you are not living in the same body you were a year ago. Now that a year has gone by, possibly your dog is less able to help you than before, as well. So you are living in a damaged body, trying to help a dog that is needing increasingly more help. I don't know what to tell you, because in your position I would have to keep going, but just so you know, it may not be for free. In addition, as your body begins to feel the strain, it saps you mentally because you are constantly having to rise above the aches and pains to keep going. I said I became something of a "mechanical caregiver", lifting my dog, putting him in a cart, changing his belly band, etc., and did not have much emotional support to give him because I was exhausted. So even though we made it to the end, I not only am living with physical damage, but with the feeling that I did not do as good a job as I wanted, for all that.

I guess I would encourage you to perhaps tell your family doctor you have been assisting a large dog for a year, and see if you can get an evaluation by a physical therapist to assess what kind of damage you may have done. You may be fine or it may be an eyeopener. Without going into detail, there are problems that come with long term lifting that can be corrected if dealt with in time, but become permanent and set you up for other problems if you do not correct them. A lot of things are fixable but whether you can get yourself back into shape in the limits of a 12-session PT package or whatever your insurance covers is another question. However, since it is November, if you start PT now you can use your 2012 benefits and then in 2013 you may be eligible to have more PT covered.

[Bobbie]

You have to know it is okay to say you can't do it, even if you think someone else could.

Look at the "When is it time" document on Scout's House's blog at www.scoutshouse.com It's a quality of life scale for disabled pets, and a big part of the score has to do with the caregiver, not just the pet.

I cared for my Merlin through DM, until he was completely down. He got sick so I was spared having to decide when to let him go- I chose then not to let him suffer when the illness wasn't quickly resolved. But he was a 24-28 lb corgi and I still had a hard time doing all the lifting, bending, and carrying on top of the stress of having him down and losing sleep (DM dogs tend to get anxious and not do well at night, but even at the best you have to wake up and turn them. ) I can't imagine doing it with a 90 lb dog beyond where he could move on his own, and I'd never blame anyone who had to make the decision not to try. It's not a question of convenience as it would be if you wanted to move to a different apartment that didn't allow dogs (and people euthanize their dogs for that!) It's a quality of life issue and that quality affects you both.

It's also important to remember your dog is not counting the days. Your dog doesn't care if you say goodbye today or next week or next year- all he cares is a) that he is cared for and loved until the end and b) that you are there for him when the time comes. He does not dread it and he does not anticipate it.

If you do choose to go on we are here to help- Carol and others have a ton of experience caring for large disabled dogs. But it is okay to decide that this is it, too. Regardless of when, eventually you have to make that choice.