The ups and downs of DM

We've been doing swimming this summer, but less so then last year. She needs help to keep swimming with her hind legs this summer. Underwater treadmill would probably be more helpful at this point as it would require more hind leg use. She seems to enjoy the swimming and seeing her doggie friend Milkway while she is there.


She has both good days and days that are more difficult. I judge many of her days by how well she is able to get up/down the steps, whether or not she plays in the yard and how much trouble she has getting up from laying down. The DM journey is full of ups and downs.

Back to swimming

Sierra is back swimming again and has been very perky since her swim yesterday. We just did 5 minutes in the pool as I didn't want to push her too hard the first day. She swam the five minutes with ease and wasn't too tired the rest of the day. I am going to try for 7-10minutes tomorrow or Thursday (depending on the weather).

I am also going to work with the families dog that has been kind enough to share their pool with me as their dog is having some hind end weakness. Hopefully, I will have a video to follow in the upcoming weeks.


I only wish the water was this nice:

The pool water was a chilly 70degrees this week.

Waiting for aquatics

Sierra is having more mobility problems and has lost some muscle mass since she last hurt her foot/nail. I know pool season is just around the corner and I am hoping that will make a difference again in her mobility. Her biggest problem is the back three steps. There are too few for her to walk down carefully, so she tries to jump down her back legs and often looses her balance and falls. I try to cue her to go slowly, but she isn't always careful enough.

We also had some issues with the fabric from the CoolAroo bed. It's a stiff canvas and when Sierra sleeps her legs kick while she dreams. Since she has poor sensation she doesn't wake up while kicking her legs. This was causing rubbing and then bleeding on her legs. It required wrapping and protecting her legs. I am now using pipe insulation on the edges of the beds to protect her legs- it's been working great.

Finally, Sierra cut her leg while getting into the self service tub at the groomer. There was a lot of bleeding, but it healed pretty quickly and didn't have much of an impact on her overall. We are hoping to keep what skills she has until she is able to get back to swimming, then we might get some mobility and endurance back.

Spring is here

Time to get back into a walking program with Sierra.  She really loves her Coolaroo beds and they are really good at supporting her.  In addition, if she has anymore incontinence issues I can easily place a chux pad under them!  Here she is in her new bed

I bought the first bed in December and just purchased a second Coolaroo for downstairs.  She loves sleeping in this thing.

We're hanging in there!

Sierra has been hanging in through the winter.  She enjoys a quick run through the snow.  Here are a few pictures of her in her snow blanket for playing outside.

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Sierra went to the beach

Sierra got to take a few long walks on the beach this weekend. The beach is an ideal place to walk a dog with degenerative myelopathy due to the forgiving nature of the sand. She was able to walk for about 45 minutes the first day and over an hour on the second. This jump in the amount of exercise was a bit rough and it looks like she may need a few days of recovery, but it certainly helped improve her mood in the middle of January. Sierra did well in the car, but we continue to have difficulty with good positioning in the car. The back seat really isn't big enough to allow her to move around at all and the only movement she can get is a little weight shift or the weight shifts through the cars' acceleration and decelaration.

When traveling with dogs with limited mobility consider the following tips:

1. try to ensure good positioning and alignment when lying in the car (make sure all limb are aligned and not being crushed, twisted or laid on)
2. make sure your dog can shift his/her weight to avoid pressure sores, turn your dog from side to side every hour if they are unable to weightshift
3. offer water
4. stop and take rest breaks and get your pet out of the car, even if it's just onto the grass at a rest stop, allow them to take a potty break (including expression of the bladder if necessary) to minimize bladder infections
5. try to keep travel calm and decrease stress, some pets love to travel and enjoy the change of scenery and some become more stressed, know your dog and choose accordingly
   

winter blues

Sierra has been having a harder time getting around. She is a bit more unstable and the lack of exercise through the winter is really starting to show. If the weather will get a bit warmer it would be helpful for taking her on short walks. Right now her time outside is very limited. I wonder how much mobility and strength she will regain this year if we can get back to swimming. Also, she will be going in for her senior vet visit again soon.

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.

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.

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.

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.

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.

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.

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.