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.

Canine Rehabilitation course tomorrow.

I am very excited to be attending the first Canine Rehabilitation course for occupational therapists tomorrow. It's going to be a great day with hands on training. I feel like I will come back with greater insight into OT's role in canine rehabilitation as well as tools for continuing Sierra's rehabilitation.

The last few weeks have been tough for her. She tore open a nail on a walk around town and has been limited to the backyard and house. She seems to have lost some muscle mass and stability. I am glad swimming season is just around the corner.

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.

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.

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.