Our dog was diagnosed with degenerative myelopathy and given a poor prognosis. What can we do to give him the best quality of life?

Question: 

Over the last six weeks our 8.5-year-old Bernese Mountain Dog has exhibited a very unsteady back right leg, complete with knuckle dragging when walking. X-rays didn't show any structural issues. A CT scan confirmed this and the vet believes we are dealing with degenerative myelopathy. From our own research, we know this isn't good. Our primary vet prescribed pain medication and the vet that did the CT scan prescribed steroids in an effort to make things a little better. We realize it's only a matter of time before this disease takes its toll. However, I was wondering if there are any other things we can do to improve the quality of life and help our Berner get around better with the time we have left? 

Answer: 

There are many diseases that can cause hind-limb dysfunction in older large-breed dogs. Some of these diseases will not be visible on either radiographs or a CT scan and therefore must be diagnosed with an MRI scan or a spinal fluid analysis (spinal tap). Ideally, before pursuing presumptive supportive treatments for degenerative myelopathy, these other diseases, which include neoplasia, stroke, infection, degenerative stenosis, and auto-immune diseases, should be further ruled out with additional testing under the guidance of a veterinary neurologist. Furthermore, having your dog evaluated by an orthopedic surgeon to make sure no joint disorders are contributing to the walking problem is also recommended.  

Degenerative myelopathy is a genetic disease usually caused by a DNA mutation in the SOD1 gene; this disease is similar to amyotrophic lateral sclerosis (ALS) in people. There is a genetic test through the Orthopedic Foundation for Animals that can test your dog for the most common mutation associated with degenerative myelopathy. This test can be purchased at offa.org. In dogs with degenerative myelopathy, physical therapy, which keeps the muscles and joints strong, and the use of a Biko physio brace can be helpful in prolonging mobility for as long as possible. However, physical therapy can be harmful in some types of structural spinal or joint diseases, so getting an accurate diagnosis is very important. Later in the course of the disease, a hind-limb wheelchair can be used to provide mobility for going on walks when hind-limb function fails. Unfortunately, there is no cure yet for degenerative myelopathy. Thankfully, this disease does not cause the dog discomfort.