Sierra in the snow

Waiting for winter

I had been hoping for winter with it's cooler weather for Sierra. Well it's here now and it's not all I hoped it would be. The weather seems to be hard on her when she is outside for dinner. It's also hard for me to be motivated to take her for walks when it's windy and very cold.

She is doing well overall. She is still ambulatory, but has sudden falls when walking. She is able to walk up and down the stairs without help. She has not had any more episodes of incontinence. She is still on the supplements, which truly seem to make a difference. Exercise would also make a difference, but I've been less then successful keeping up with that piece.

Overall, she is happy and just like her "normal" self.

Just DM

Sierra is still doing well and still ambulatory. She has good days and bad days, but her decline is gradual and I appreciate each day. She is eating her supplements well these days with very little encouragement needed. She has had a few incidences of urinary incontinence. I am using people's chux pads under her bed to protect the floor as a just in case measure. I have noticed that as Sierra gets more ataxic she continues to have good righting reactions and often catches her balance before she falls. I appreciate this and hope to keep working on and preserving her righting reactions. There are many others going through the DM journey and I would love to hear from you- leave us a comment.
Sierra this summer with the DM sit and poor hip positioning.

Down the DM journey

Sierra has been doing well since recovering from the UTI with no more night accidents. She has finished her round of antibiotics and is already showing a good recovery overall. I notice that she is less ataxic after being off the antibiotics. She seems to be doing well in this weather, but I would like to be taking her for more walks.

Vet results

Sierra had a UTI. This explains her urinary incontinence. She has been dry at night since Friday (actually before her vet appointment). She is back eating her supplements at each meal and has shown a rebound in her standing. She fatigues a bit slower since being back on the supplements (from the Clemmons protocol). I am working towards a regular walking schedule again soon.

Vet appointment

Sierra has a vet appointment this weekend. She's been having nighttime incontinence. I am thinking she has a bladder infection. I am going to get that checked out and hope that it will clear up the incontinence issues. It's very hard to find doggie diapers LARGE enough for a great dane! I am laying down a plastic sheet under her bed to protect the floor and made clean-up easier. Back to the store tomorrow for another attempt to find the right diaper size. Who'd have thought?

All is well

I didn't forget to update. Without swimming there is less to write about.

Sierra has had some feeding/eating issues- mostly centering around how much she was eating. Her appetite appeared to drop, but part of me thinks she was fatiguing during mealtime and she was giving up. She is now back to eating 2/3 chicken backs during each meal. She has also accepted the kelp supplement again and this is being used to cover her pill supplements (E, C, B, Fish oil, CoQ10, garlic, lecithin and probios).

Swimming is over for the summer. We never got back into swimming after my vacation the end of August. The mornings were too cold and my afternoons are busy with work. She is losing some of the muscle mass she had built. I have noticed the changes in 3-4 weeks.

I need a better winter routine, but haven't put the time into writing it down yet. Sierra is still ambulatory and navigates the stairs with close supervision. She is doing well overall.

I have been thinking of doing some consulting for other families with DM dogs to help with household safety and comfort for the dog and caregivers.

Coming fall

The weather is quickly changing and swimming is coming to an end. I am hoping the cooler weather is easier on Sierra. She has not gotten back to eating 100% as she was before the antibiotics, but she is doing better and starting to eat her pills again. I have to come up with an alternate plan to swimming for the fall/winter. I plan on taking her for accupuncture, walking with weights and I guess I should get back to my home exercises. She is doing pretty good and I don't want to lose ground. I had a vacation and need to get back into a DM routine.

Rehab is hard work

Most vets and canine rehab therapist say that for dogs with DM that rehab is only maintenance. There is some truth to that in the fact that DM will still "win" in the end. However, Sierra's rehab has been REHABILITATIVE, meaning she is building muscle strength, endurance, coordination and improved functional skills for walking and playing.

The swimming is going really well. I am now timing her, rather then measuring her swimming by laps. We are doing 10min 2x/week. When we get to 20min 2x/week then I will add another day. I am just not sure how long the weather will hold out for me. I am not sure I can find a place to swim her through the winter.

I can still see a right sided weakness in her hind limb. It is apparent when she swims, walks and stands for long periods of time. I am able to do AAROM in the water to gain more range. This also seems to cue her to generate more force with this extremity.

It appeared that she had a setback that corresponded with the antibiotic use for her infected foot. The infection in her foot was mild and the swelling had begun to go down prior to starting the antibiotics. However, taking antibiotics with meals three times a day was a challenge for all of us. She didn't want to eat and I was force feeding her the medicine more often then not. After the course of antibiotics I have seen a gradual return of her hind limb function. I am not sure what the interaction was for her between the antibiotics and the DM, but it sure did scare me.

• Rehabilitation Tips
o It is important that all exercise be performed in moderation. Fatigue will only increase your weakness and rob you of energy that you need for your daily routines and the activities your pet enjoys.
o Passive range of motion exercises can be performed standing or in gravity eliminated position (such as laying down)
o Utilize light massage, regular exercise, and keep your dog mentally active. These are extremely valuable in maintaining muscle function and bringing about remission of symptoms. Deep tissue massage can stimulate muscle spasms.
o Swimming is the best activity, or other exercises in the cool water, because increased body temperatures can decrease the function of the nerves involved and make symptoms worse.
o Acupuncture has been effective for many dogs with DM
o (from : http://neuro.vetmed.ufl.edu/neuro/DM_Web/DMofGS.htm)
Rehabilitation is best achieved by an increasing schedule of alternative day exercise. Running loose on the owner's property is not adequate; regular periods of programmed continuous exercise are the most important. It is equally important that the patient with DM be allowed to rest on the day when exercise is not programmed. This will allow strained muscles and tendons to heal and increase the build up of muscle strength. The dogs do not have to be confined, only that they are not encouraged to do strenuous exercise on the "off" day. I recommend starting with 5-10 minutes of walking or swimming every other day for 2 weeks. Then, increase the length of exercise time to a goal of 30 minutes twice a week and a long walk of 1 hour once a week.

Bad Day

Sierra had a really bad day today. She refused her breakfast and lunch. She spit up what little antibiotics I tried to give her this morning. She ate some oatmeal and part of her dinner. I skipped her other doses of antibiotics today as she just won't eat. She was looking really weak behind during dinner and then tried to make it down the steps. I didn't have her collar on her from swimming yesterday and so her hind legs gave out on the steps and I had nothing to hold her with. I had to call my boyfriend to help her front end while I fixed her hind legs so she could get down the rest of the steps. She is now "locked" in the basement with us to prevent her from trying to get up and down the steps for the rest of the night.

DM TIPS

· Stress and Fatigue

o Avoid stress and anxiety. For anxiety use of aromatherapy oils included lavender, Roman chamomile and neroli (orange) oil has been successful.

o Fatigue is often among the first difficulties faced by people with MS and fatigue management is a vital area for occupational therapy intervention because of the impact of fatigue on all areas of daily living. In our pets with DM fatigue manifest in various ways. We may see fatigue that prevents our pets from doing things the love or appear to want to do, we may see them stop in the middle of a walk or ball game because they are fatigued. We may also see fatigue at the end of the day and our pet may be more likely to have an injury, fall or incontinence when fatigued.

§ Why fatigue is a problem: Because of damage in various areas of the brain, thoughts and actions require more energy than before. Think of the areas of damage as roadblocks. Each roadblock forces the messages in the brain to take a detour, so movements and thought take increased effort. Muscles with spasticity work against each other, so more effort is needed to complete a task. Depression is a major cause of fatigue for many reasons. Involuntary and poorly-controlled movements force the body to do more work than it otherwise would. Spasticity, depression and tremor are treatable causes of fatigue and should be discussed with the rest of the multi-disciplinary team.

o Fatigue management: here are ideas to limit fatigue in your DM pet

§ Take frequent rest breaks, do not allow your pet to “overdo” it on a good day- you may not see the after effects until a day or two later.

§ Keep your pet cool and comfortable

§ Help them relax through massage or just being close to them

§ Conserve energy, do not let your pet follow you around the house when you are busy doing chores or otherwise engaged. If you have stairs in your home, limit the times the dog is walking up or down the stairs.

§ Keep an activity diary of the things your pet does throughout the day, where he/she walks, sleeps and eats. Log any play time, exercise or therapy. Monitor activity in relation to fatigue.

o Depression is closely linked with fatigue in people with MS. Consider if this may be impacting your pet. Attempt to spend more time with your pet and provide comfort or activities that your pet enjoys. Help him/her conserve energy while lifting his/her spirits. Sitting out in the yard under a shade tree with his owner may be just the boost to decrease fatigue.

o Other symptoms, such as depression, being in pain, or sleep disturbance from bladder problems or spasms, can all worsen fatigue. Fatigue may also occur as a side effect of medications or be the result of inactivity, poor diet, stress or an infection.

o If necessary, ask your vet about medication for fatigue, there are several medications used in treating fatigue in humans related to MS.

Healing

Sierra's foot is healing and she is mostly not licking it anymore. I think we are through the worst of it. I felt all the old frustration come back- I've not felt that way since before her diagnosis. It was really hard to force her to eat the antibiotics and then fight with her not to lick her foot, while she is ripping off bandages and waking up at 3am to go lick her foot.

This means we'll be able to go back to swimming again this week. I will be putting some vaseline over the area with the sore to hopefully prevent it from become irritated again.

I haven't seen much change with her DM over the last two weeks. She has tired days and days where she is stronger, but it appears that she is holding steady.Standing during dinner time it hard work- I've been watching to see if she is sinking as much in the back lately and it looks like she might be standing taller during dinner these days.

I am going to be attending an introductory course for Occupational therapists interested in Canine Rehabilitation- and it's going to be taught by an OT I know!!

Sierra Walking Mid-July


Sierra needs a napkin- or why the grass works just fine.

Setback

Sierra has an infection in her foot and will be unable to swim until her foot is healed. She is on antibiotics in addition to all her other supplements. The antibiotics smell very horrible and will giver her a sick stomach if not taken with food- she must have them three times a day. She's not very happy with me right now.

She had a good time at the farm this weekend, minus the foot infection. She had some trouble navigating the stairs to the second floor, even with close supervision. She did enjoy running around and even met an older golden retriever. I think it might take a few days for her to recover.

She is now getting MORE supplements including lysine, lechithin, spirulina, kelp, nutritional yeast and some wheat grass. The co-Q10 and the evening primrose oil also came in with the herbal supplements. Luckily, she seems to like the herbs better then I do.

On a sad note, my co-worker had a great dane that was 2.5years old and passed away suddenly today from kidney failure. I have hugged Sierra a few extra times today for sharing over 8 years with me.

Time passes

Sierra is getting use to the routine of swimming and now gets herself into the pool on the second step. If I tell her the night before that we are going swimming, she gets me up in the morning.

DM still is taking it's toll with some days being good and some days being tough. DM is something you want to fight against and win over, but being a degenerative disease it won't go away no matter how perfect I am.

Updates

Sierra's swimming is coming along nicely. Her ears perked up when I mentioned swimming on Thursday morning- that's a good sign. She is still having a little trouble getting into the pool, but okay overall. She is really wiped out for the rest of the day and having two days off in between seems like it's pretty necessary at this point. I still don't have a stopwatch or video of her swimming, but hopefully soon. This time she actually let me suspend her in the water while she rested for a bit.

We will not be doing the Eddie's Wheel cart at this time. The used one from CA will cost almost the same as a new one. It's a really big expenditure at this time since she is still ambulatory. I figure I can wait until she is having more difficulty and order a new one if the cost is going to be basically the same anyway. Leslie at Eddie's Wheels had been very helpful throughout the process.

I have an herbal order ready to go through for Sierra and my horses. There were a few things I was missing off the Clemmons protocol. I am not sure how many more pill I can get her to eat though, as many days she doesn't want to finish what she's getting now. I am thinking about starting to grind the hard pills into powder and mixing them with her yogurt. Of course she might just then refuse her yogurt all together.

I have noticed that these warm/hot days have been tough on her. We spend more time in the basement together.

Progress

Sierra went swimming again on Monday. She was a little reluctant to get into the pool, but swam pretty good in the pool. She still gravitates towards the steps. I am teaching her to wait while standing on the steps. This will allow her a break as she is able to swim longer- take a break then do "more". I use a lot of the same cues with Sierra that I use with the developmentally delayed children that I work with. Short phrases or one word cues help her understand what is expected, "go swimming", "car ride", "up", "step", "wait", "more" and "all done" are her swimming words. I figure in 6-8 swims I will know if she is happy swimming or it she doesn't like it. If I say, "go swimming" and her ears perk up- then all is good, if I say it and she goes and hides or starts shaking then no more swimming for us.

I FINALLY got that last Eddies' Wheels measurement and called it in this week. The lady was very nice in taking the measurement and told me they just had a call about a great dane cart that was being returned. It was for a dog that almost matches Sierra's size perfectly, there are two measurements that are different by 1/2 inch. The dog in CA was an amputee, but got strong enough to not need her cart anymore. I don't know what the cost will be yet, but it's worth a try and it will be less then ordering a brand new cart. I think that the cart will allow her to walk further.

I have been slacking off on her exercises since starting swimming. As a caregiver I find that I can devote "X" amount of energy to her DM. I am 100% more careful and compassionate to Sierra since finding out about her DM. Shortly before her diagnosis I was getting pretty annoyed at her stepping on me and walking into me, she wouldn't "back up" or "move" when asked. This meant there was 115lbs of dog in my way and it seemed as though she was ignoring me. Now I understand that she is unable to "get out of the way" quickly and when she steps or falls on me it's because of the DM, not clumsiness. However, I have added the swimming, but lost some of the exercises. She is still on the nutritional diet, but I ran out of carrots last week and haven't replaced them. It's like a gain ground in one area only to lose some in another area. I have been working on tips for owner of dogs with DM and have a section about coping/caregiving. It brings the skills and emotions involved to the forefront. Caregiver is an emotionally and psychologically complicated job.

Swimming

Sierra went swimming on Thursday and the family seemed to love her. She wanted to play with their dog, but I was worried about the exertion of playing and swimming. Wise, as she was very fatigued after swimming. She swam about three circles in each direction around me before we got out of the pool. I was very thankful to have her lifevest on as it helped me direct her. Her plan as to swim in and back to the steps to get out. I am working on teaching her some words to association with swimming, so she will understand the process and feel less stressed. She was pretty tired after her short swim. She will go back on Monday (tomorrow). After swimming she had some trouble getting up/down the outside steps. She also threw up her dinner at 11pm that night. I am not sure if the vomiting was from drinking some pool water or from being fatigued. Luckily, she'll now swim in the morning and get fed in the evening, so hopefully no more vomiting. I need to get a battery for my stopwatch so I can measure her initial endurance and build her up from there. We're just going to do two days per week to start.

Pool

I have a lead on a local neighbor that may allow me to use their pool. We are going to meet them on Thursday. I bought Sierra a new doggie lifejacket as she has not been swimming in awhile and she is pretty deconditioned. I wanted to give her some extra buoyancy to start with. If we get the "all clear" from the neighbor then I will work out a program to built strength and endurance throughout the summer. I think that walking her in the fall and winter will work out okay, since it's cooler, but the hot weather is killing her. I really need someone to remind me to take the last measurement and send it to Eddie's Wheels to see if they have anything refurbished for her. Wish us luck for Thursday.

Falls

I am working on a recommendations list. Today I checked out the costs for acupuncture and listed on Craigslist my need for a swimming location. I have yet to take that stupid measurement.

Sierra fell down the bottom three steps yesterday and ended up with hind legs under the stairs and her front paws on the second step. She needed help to regain her footing and it was a bad way to start the day, but she doesn't seem to worried by her falls and slips. She now waits for me to help her down the steps at the end of the night for bedtime. I am trying to teach her to "stay" either upstairs or downstairs when I am running around the house with one last errand to do, rather than let her follow me. I think conserving her energy is going to be important in the coming summer months.

Daily DM

Sierra has been holding steady and has improved from her physical status at her original evaluation. I have been especially careful to protect her from the heat and over exhaustion. I have had to make some very hard decisions about leaving her home rather then taking her on longer walks or hot car rides- walks and car rides have been some of her favorite activities. However, the physical toll these activities take on her requires a day or more of recovery time. I worry that much like human MS, these stressors could send her into an exacerbation.

I continue to do exercises with her a few times a week. These exercises address range of motion, strength and endurance, sensory stimulation and balance.

ROM, strength and endurance- stabilize metatarsal and distal to the stifle, bring hind leg through anterior/posterior range of motion while dog stabilizes with contralateral HL. I feel a significant amount of spasticity when doing range of motion with Sierra's HL, this makes it harder for her to walk and clear her HL over rough terrain and contributes to knuckling

Strength and endurance- HL is held in dynamic flexion requiring co-contraction of trunk and contralateral hip, gluteal and biceps femoris stability, position is held until Sierra begins to fatigue

Sensory stimulation- HL is ranged to toe touch position in anterior/posterior plane, hind limb lifted to flexion and brought to floor with firm contact to increase proprioceptive input to joints, paw touching to contralateral HL, tail stroking. These exercises help Sierra recieve more information about her HL's. Also use of Linda Tellington Jones "promise wrap" for 20 minutes twice a day when she is having increased difficulty. I have also noticed that Sierra does her own form of sensory stimulation when she goes down the three stairs to go outside. She does not walk down the steps with her HL, but instead bunny hops off with a significant concussion upon landing.

Balance- I provide balance challenges through pelvis at the ishium in an anterior direction and watch for co-contraction and stabilization through trunk and scapula. Balance challenges are provided laterally on point of hip to increase stabilization of latissimus dorsi and oblique abdominals. Sierra has a significant right and left difference on her reactions to balance challenges with difficulty stabilizing her left side when a balance stimulus is applies through R hip. I would like to use a header or handler with her for these exercises to help keep her straight and symmetrical, as she often likes to turn to look at me.

Hopefully I will get some pictures of Sierra doing her exercises soon. I re-stuffed her begs about two weeks ago and this has provided her with increased comfort. I have one additional measurement to call into Eddies' Wheels to see if they might have a cart that would fit her. I want to have her transitioned onto a cart by fall before the weather gets too bad. I am still looking for a swimming option for her.

Weekly update

It's been harder to keep ahead of the things I feel I "need" to do this past week. Sierra has been holding steady and the weather has been wet, but mild here. I have one more measurement to send to Eddie's wheels, but a friend mentioned that I should call in the measurement to see how friendly and helpful the staff might be. The people at doggon wheels were very helpful and friendly and called me to talk about what carts that might work for Sierra.

We haven't been taking her on long walks, but several shorter ones per week and she is maintaining her strength and toe dragging less. The diet appears to be helping her hold her ground. I am doing some strengthening and balance exercises a few times a week as well. Still no where for her to swim.

My goal for the coming week is to get the last measurement done and a chart to record her exercises and walks.

Damn DM

I am new to this journey, but so far one of the worst aspects has been the good days/bad days aspect!!

Last week after starting the nutritional protocol and home rehab Sierra looked really good. She didn't cross, knuckle or drag all week. She looked straighter when standing and seemed perkier.

This week we're back to where we were prior to her official diagnosis. She's been draggin and knuckling, but she now knows, "Fix your foot" and will usually step correctly. At least she can still get up and down the stairs and sleep with us downstairs. I worry about her getting depressed when she can no longer be "part of the pack" at night!

I have a few leads on carts and have asked two manufacturers if they have any used carts available. I have been considering Eddie's Wheels and Doggon. I think my preference is for Eddie's Wheels. I took measurements last week, but will double check them before finalizing anything.

Static Standing

I tested Sierra's static (for the most part) standing on carpet: 3minutes 24 seconds

I honestly thought she would stand for longer- I woke her up from a nap for the test- so perhaps she wasn't very motivated.

I will also do the static standing test on the tile floor in the kitchen. I wanted to be able to monitor or measure changes in her condition. I will post her exercise/rehab schedule next week.

Clean bill of health

Sierra has a clean bill of health, outside of DM. She just had her blood work done, heartworm and lyme screen. Heartworm and lyme came back negative and her blood work all came back normal.

She is on intensive nutritional support for DM, following most of Dr. Clemmons protocol with some adjustments/additions for her diet. The first thing I have noticed since starting the nutritional support is that her nose is now soft and wet again- it's been dry and a bit crusty for a very long time. I don't think having a dog soft nose will help her DM, but it's an interesting change. I have also been monitoring her water intake closely because it is appearing to drop back to "normal" levels after being elevated for over a year!

I need to do a standing test and time how long she is able to stand- plan to do that this weekend and try to get more/better video of her current walking.

Diagnosis

Sierra is my 8y7m old Harlequin Great Dane. She received a rule-out diagnosis of Degenerative Myelopathy (DM) on Saturday 5/30/09.

She had been having symptoms for the last three months.

I am an occupational therapist and have been researching canine rehabilitation since learning of her diagnosis. I feel that I have a lot to offer my girl Sierra as well as others going though a rehabilitation with their pet. DM is degenerative as the name suggests- she will not recover from this- it will take her life eventually, but it's what we do between now and then that will matter most for her.

Sierra has had a full life. She has traveled many places with her people, she's hiked, swam and ran alongside my horses when I rode. She has many people who love her.

Here she is at Christmas time with her little brother, a chinese crested, Poe.