Cora's Page - Living with DM
On December 25th, 2009, Cora was able to play gently outside, eat some snow, and then decided to come back in to rest. December 29th she abruptly lost the use of her forehand, and was incontinent. She began suffering breathing irregularities, which later escalated into a grand mal seizure, and continued distress. She was gently released from her suffering at 10:15 pm, both of us holding her, at a nearby Emergency Center. She apparently had a brain tumor, the last stages of kidney failure, and lympho-leukemia. We brought her ashes home with us from Colorado.
Cora was 14.
She is greatly missed.
My expectation with these pages is to provide insight and experience as to what we have found works in our particular situation, dealing with a German Shepherd Dog (GSD) that "has" DM (Degenerative Myelopathy), with the hopes that it may provide help for those of you having to explore ways to fulfill long lives and enjoyment with your afflicted dogs. I also say "has" because DM is a diagnosis by process of elimination, and sometimes the process of elimination is more invasive and uncomfortable than dealing with possible DM head-on. That said, I will provide images, links, and directions to help you in your support of your companion.
Cora is our gorgeous, solid black, brilliant, German Shepherd.
Her adventure really began the weekend after Thanksgiving, 2008. She was, suddenly, almost unable to walk to her food dish, tripping and wobbling all the way. We had noticed for quite awhile that she was becoming unsteady, and could hear the tell-tale shishing of her hind nails as they occasionally dragged across the tile. But, she is also at least 10 years old, most likely older, as we are her 3rd owners and her history is a mystery, and there was much that was attributed to arthritis and old age also. She was stiff when rising and likes to sleep more, however, hip displasia has NEVER been a problem.
We had already done a lot of reading on the internet, and were somewhat prepared, although you never truly are. But now we were facing the developments, and we made the decision to press forward. As I told our vet , we are in this for the duration with her. And our vet supported us fully. And we began praying...
So, below I will give a small description, and then on it's related page I will post some photos and descriptions, of what I found worked and didn't work. Hopefully you will find things that will help you manage your DM companion more happily, and realize that immediate euthenasia is not necessary.
With God, all things are possible.
Cora is heavy, 87 pounds then, so I needed help lifting her to go outside for elimination. Towel-walking was not easy, nor comfortable for her or myself. So, after quite a bit of research, we settled upon the "Helpemup Harness" created by Blue Dog Designs out of Denver, Colorado. Their information is located here: helpemup.com. This is a beautiful piece of construction, and worth every penny. Well built, it has provided the support I need when learning to hoist her around as she needed to go outside, and then needed to be turned regularly. We rceived it very quickly (we did order 2nd day), and on Cora's second vet visit, she was quite nicely attired.
As she had also gained 5 pounds, it definitely helped me lift her as needed, as she was now at 92 pounds. I believe she is probably around 100 now, but we are watching the food intake a litle more closely.
DM GSDs, and dogs with disabilities, need to be turned regularly through the day (and night) and we were up doing that about every 3-4 hours in the initial weeks, but later, Cora figured out how to sit up, rotate her haunches while in a sitting position, and then drop back down on the other side, relieving herself of the discomfort. How she figured this out, I don't know, but as a result she made her life, and ours, much easier.
Go to Cora's Harness Page.
We also set ourselves to building a cart for her. Yes, there are many manufacturers out there, but we didn't want to wait the 3 weeks for the arrival of a cart, and the cost is high. I hear you saying, but what cost do you place on your dog's life quality? Well, my husband and I are quite blessed of God to do unorthodox things with what we find and what comes to mind, and we built her a very good cart of our own design, out of PVC with roller-bearing wheels, for a lot less money, and we had it done in a week. She has used it effectively several times now, so we have no complaints.
Go to Cora's Cart Page.
Incontinence was one of the greatest challenges we figured would face us, although it seemed we weren't there yet, but at the quickness that the paralysis set in, we prepared NOW, rather than wait. So off to the store, and begin examining what was available to us. "Depends" seemed to have the best options for a dog so large, and my husband pulled out the "Depends" Belted Shields with Buttons, that are adjustable, a 30 pack. These turned out to be the best for our needs, and the easiest to use and the most reliable. They also work very well with the Helpmup Harness.
There is also more to managing the normal elimination of a dog, and it's being sensitive to when they need to go, creating a routine to make it easier for the dog and you, and doing some of it manually. Yes, you need to stimulate the bowels to empty, even after the dog may have dropped a small pile to begin with. Sorry to sound so gross, but after you start doing it, you don't think anything of it, and it makes everyone's life easier. I'll give you more details on that, and what I found to work out better for me rather than using a surgical glove each time.
Go to Cora's Bathroom Care Page.
You may be wondering what Cora is eating...she is on Canidae Lamb and Rice, with a small bit of Canidae Lamb and Rice canned added to it. I heat a couple large spoonfuls of the canned food in a cup and add some water to make it a broth, and mix her food well with it. I also am adding a mix of supplements... they are: 1 capsule Solaray Bio E with Selenium (400 iu/100 mcg), Henry's Supreme Stress B, Kirkland Fish Oil Omega-3 concentrate, American Health Ester-C (500 mg), NOW B-12 (5000 mcg), NOW Lecithin Granules (97 % Phosphatides), 1/2 gram of N'Zymes Bac-Pac Plus, and ~ 2 tsps. honey. I will eventually double some of these supplements, especially the C, and perhaps the Bio-E.
She is also on Previcox (pain relief for possible arthritic discomfort - 227 mg 1/2 tablet daily) and Cephalexin (1000 mg a day of a long-standing infection). These were started long before the instability set in...
There is a lot of info out there, but the best sites I have found, and referred back to repeatedly, have been the following, and then I compiled much of that info with our personal experience:
http://dog2doc.com/neuro/DM_Web/DMofGS.htm (updated link)
Cora's Friend Heidi - click here to see pictures of Heidi!
December 11, 2009 -
Cora has come to a point where it's difficult to make the next decision. She's alert, some of the time, and she's very depressed most of the time. It may be harder for her to get over the impact this time around, she may just need more time, and support from us. Digging again into the internet after a visit back with the vet last weekend, more info was found on FCE. The cortisone shot would need to be given 6 - 8 hours after onset of symptoms, and in Cora's case it was at least 4 days. So obviously it was of no value for that application, but didn't help in any other case either. The remaining prescribed treatment is TLC. It's still possible that was what she suffered, but some of the statements I read indicated that it is non-recurring, and in this case Cora has suffered a large set-back and is more debilitated than last year at this time.
We have a weekend before us to think things through.
December 8, 2009 -
We've had a little difficulty getting the system under control, and with a short term of Flagyl, and Lomotil, Cora has stabilized and is pigging out on a bland diet of CHICKEN (emphasized because it is PEOPLE food, and always better!). We've determined that we are probably dealing with Inflammatory Bowel Disease, so Cora is on the home-cooked meals for quite some time now, most likely the rest of her life. Some of her symptoms are quite obvious that we've been seeing it set in for the last month, so really I am not surprised.
In the meantime, it made an impact on her ability to walk, and we have been set back easily 6 months, perhaps more. She's willing to work, but now I am the therapist, getting her up every hour or so to get the blood moving and keep the limbs limber, helping her do "push" exercises in the hind end.
November 30, 2009 - Update
I felt it was a time for an update, as things are getting away from me at times for keeping track of what has happened and when...revisiting what I have written here has been a very helpful refresher for my head, especially when having to deal with a colicky horse andmy husband's back going out, temporarily. I have been a bit distracted.
Cora is still here, and doing well, considering how far she has come over the last year. We are approaching the year anniversary of this affliction, not really a high point to make note of, except that she is still alive and going "strong". Heidi's mom Kathy was in touch via email, and I was shamefully late in replying, but Heidi is still with us, still strong, and it must have made for a blessed Thanksgiving to have her still with them!
In the meantime, we are repeating the loose bowels described farther down, the opinion being that she has an incredibly sensitive stomach and must really be regulated now for intake. She has no tolerance of Bufferin, as we have been off the Previcox for some time, so I had given the Bufferin a shot to see if there would be any improvement in the possibility of arthritic discomfort. An episode of vomiting, loose bowels, and general ill-feeling is something we all can do without, so the conclusion was - no.
But, for the last month, Cora has developed some inappetance, and has lost weight, so it was time to address those needs. Her diet was changed a few months back to the Canidae Salmon dry, but now it looks like we will be moving over to Canidae Salmon Grain-free canned food. We will probably also investigate adding to it with long-grain boiled rice, boiled potatoes, and other things that will not upset the stomach, mild, bland, binding agents, as the routine with the canned food only resulted in larger stools and a little more rapid elimination. A bit difficult for her to recognize when she needed to go out.
We've also ordered and received a dog blanket, a Weatherbetta Landa Deluxe, same folks who make my horses' winter sheets. This is a very nice blanket, with an ample amount of fill for warmth, one we think will help her enjoy her time out in any cooler, brisk weather during our outings, especially with her current weight. I purchased the blanket through StateLineTack, as so many retailers are running pretty nice sales right now. I don't mind a bargain when I can get one, and try to pass the tips on to those around me with similar needs.
Time for more rice... :)
May 4, 2009 - Update
Cora has continued to improve, slowly, and has attained a certain "plateau" for now, so at this venture we are really wondering if it is DM. The impact is still the same, though, a dog that has difficulty walking and impaired vitality, and is dependant more than ever upon those people that make up her family.
She walks "well", a little bent, or listing to one side due to the extreme left-hand weakness in her hips compared to the right-hand weakness, but she does get excited and tries to trot, ending up doing an absurd type of bunny-hop that makes us laugh, but then she gets to laugh back, roll her eyes, and hop even more. She tires quickly, so we limit the activity, feeling happy to just be able to walk to "our" place in the lawn (at our Starbucks/Time Out Of The House trip). She feels good enough to "slug" me with one of her paws when she isn't getting her treat fast enough, and she's feeling confident enough to lift her fore-quarters up to the bumper of the car before we lift her hind-end up to follow, to head home, and she is usually ready to head home. That surprises us when she takes that initiative, as it's not a regular event. We haven't relied upon the Depends for quite some time now, but we're keeping them around. Just in case.
She's maintained her weight well, actually even gained a bit, but well within a manageable range and not hard for her weakened joints to manage.
The last couple weeks we've been dealing with loose stools, but still foregoing the Depends, and figure this has resulted because Scott had back-to-back trips to VA, then NY, then came home sick, then a couple weeks later I came down sick, and then our daughter, and she and I are still dealing with it. At this point meetings again resulted in Scott's absence, and Cora had just had enough of the stress. I would get the dirty look, "you lost him, AGAIN?!" as she hobbled to the door and waited for him to come in, hopefully, unhappily hours before he was due to come home. But, we now had the intestinal fun, and insult to injury, I have to fast her after a dosage of Imodium (adult dosages). By the fourth day we start her back on rice and a tiny bit of dogfood, and a full dosage of N'zymes Bac-Pac Plus and 2 tablespoons of Aloe Vera juice (health food store) in the food. Introduce this very slowly, and she is usually back in shape within a week. My decision now is to keep this as normal maintenance for her. (We had an episode of very loose stools with her last year, where the Imodium had no effect on her, so I started her directly on rice and human supplements of lactobacillus flora and the aloe vera, and we had an immediate improvement, so that is the protocol I recommend right off the bat. A first dosage of Imodium to try to slow the peristaltic action, because she is hurting from it, and then follow with the natural support).
We've dropped off the Previcox, as she's been doing quite well getting up, slowly and carefully, and getting back down, slowly and carefully. She picks her routes very carefully so as to get around obstacles in her path, such as door thresholds - she crosses those very slowly. We let the Cephalexin run its course, but may need to resume that because of the long-standing problems she's been dealing with in her toes, they may be recurring.
Do we have the tests performed to rule out DM conclusively, and determine what has afflicted her? I hesitate to, because of the additional stress of such tests. Cora is easily between 10 and 12 years of age, probably closer to 12-13, beginning to grey more (but not much), but doesn't handle separation as well as she used to. I know DM does not improve, and Cora has. I know DM spreads to the front legs, and ultimately the heart and lungs, and Cora's symptoms have not. So, on the process of elimination, she probably doesn't have DM. However, I know I am well within my rights to claim that, based upon what we decided compared to what most people consider, elsewhere she probably stood a great chance of being put to sleep, just on possibilities of DM alone, and what continued care would involve. I read enough accounts online to know this is so. If I consider someone such as my step-mother-in-law, who has severely debilitating rheumatoid arthritis, euthanizing the pet would make the most sense. At least, so it would be argued...
We received a very nice letter from readers Kathy and Jim, and they gave us an account of what their Heidi has had to deal with, and related a different condition than I had been unable to find on the internet, nor had my veterinarian been able to define - Fibrocartilaginous embolism (FCE). By the way, Heidi is definitely dealing with DM.
From Kathy and Jim's account of Heidi's condition, their experience, and what little I have read right now, it seems it is as strong a likelihood as any we are dealing with FCE. So many of the symptoms we can relate to, except that Cora was not injured while playing or romping. But, health issues can strike one no matter what they are doing, we can all testify to such things. If it is FCE, then we may be at the best Cora is going to be, but only time will tell. At the onset of this experience, our vet administered a corticosteroid injection (right now from my meager reading, a steroid is part of the routine treatment for FCE), which resulted in no improvement. We actually think she was made somewhat worse, and the increased fluid intake and output didn't help Cora's comfort much. We were happy to dismiss that possibility.
For now, we're all bearing through the issues we're facing health-wise, and passing through those seasons, however long or short. And I need to close this right now because Cora is hungry, her rice is soaking, and she is moaning as if she is never to see another meal!
February 1, 2009, an update for Praise to our Lord, and to offer some additional tips...
Cora has apparently been doing some hard thinking, as to how to get herself around without our help. She has totally taken us by surprise by haltingly walking from one bed to the other, and letting herself down with control. She is also raising herself to a standing position, and circling around to let herself back down. We sit there stunned to watch her make these successful efforts, and of course it is followed by tons of praise!
Because of the amount of work she is taking on herself, I have decided to forego the Depends, and have so for the last 2 weeks. Her anal area is much tighter and in control than she was in Colorado, and the appearance is totally normal. But, I still regularly take her out and empty her, because the routine is one she shouldn't manage on her own, it should be monitored and supported. So far there have been no mishaps.
Her step is higher and more enthusiastic, she is carrying herself more lightly, and we believe she feels much better. She is definitely always happy when we are getting ready to run errands, she knows us like pages of a book, and is ready to go before we are, dragging herself up and heading for the door in her ackward series of steps, but each step gets her up higher and in better control. She will drag us with her if we aren't ready...
Keep your dog close, become his or her teammate, and he or she will work to meet you more than halfway...
January 15, 2009
Cora entered into this stage of DM rather quickly, right after Thanksgiving. We also knew that within 3 weeks we were going to be on the road on a trip to Colorado for Christmas with family, and she was accompanying us as usual. So, much of this we needed to think about quickly, thoroughly, and make arrangements for. We did it on the fly.
Cora wore her Depends, and I was her hind legs. My wonderful husband Scott assisted with lifting the front end whenever we put her back into the back seat of the truck (with camper). We swapped sides when we put her in, so she was regularly turned from side to side to eliminate soreness.
We had deeply padded the seat with a twin-bed foam pad (along with several quilts and sheets to also keep it clean from muddy prints and hair) and bolstered it in such a manner that she had a very large level surface she was able to be quite comfortable on, and slept fairly well. Her beds also have foam paddings added to them. When we got to Colorado, Cora figured out how to turn herself over, surprising us quite often that we knew we had left her in one position, and when we returned she was in the opposite position.
Upon our return home, I was noticing that Cora was actually attempting to use her feet more when we were carrying her about. I had noticed a bit of left-leg stepping action, when Scott would support her and I could observe, in Colorado, but now I could "feel" and see both legs making the attempt, so we now carry her in such a way that the legs are taking some impact and weight, and she is stepping more consistently. It is a plodding step, and she can't stand long independently, sometimes not at all, but it is much better than where we were a month ago, and again, it is a BIG help in supporting her and helping her feel more mobile.
I will hasten to add that, even though we have booties for when we were out earlier, we are not using them when "walking" because we are working hard at stimulating the feet and keeping the tactile feel going for her. So, we are spending some time each day to massage the legs, and bend and flex the legs into various "sitting" postions, to keep the joints flexible. Sometimes they make horrible noises, and we must be so careful to not injure her. We also massage her neck and shoulders, because it appears she has bulked up there considerably, from all the front-end work she must now perform, just getting up and down.
We also notice that there are days when she is very up and engaged, and very happy, and then following there will be days when she wants to sleep, can't seem to help it, and the day is quiet and less demanding. I have read that the DM dog needs to rest in between the active days, maybe that is what we are seeing.
Another thing, I have read it only once or twice, but Cora has not lost her ability to wag her tail. In fact, she can hammer the carpet quite well with that smiling appendage, and that is a very good thing.
Each day is one more day, and something new learned.