1 COMPOUND

Degenerative Myelopathy: 

Degenerative Myelopathy PHA 5933 Frank Allegretta Bobby Armstrong Amber Beitelshees Thomas Bertnick Mark Bierwagen Keith Schissler

Background: 

Background Genetic predisposition to German Shepherd dogs Age at onset is 5 to 14 years Autoimmune disease of nervous system Equivalent to multiple sclerosis in people

Diagnosis: 

Diagnosis History of progressive spinal ataxia and weakness Elevated CSF protein in lumbar cistern Negative electromyographic exam Inflammatory proteins with electrophoresis Elevated CSF acetylcholinesterase level

Clinical Presentation: 

Clinical Presentation Age at onset 5-14 years Reduction of rear limb and caudal axial musculature Paresis and proprioceptive defects of hind legs Resembles symptoms of hip dysplasia

Treatment: 

Treatment Exercise Dietary supplementation Other supportive measures Medication

Exercise: 

Exercise Important for prevention as well as treatment Walking and swimming most useful Maximizes muscle tone and maintains good circulation and conditioning Best achieved through increasing schedule of alternative day exercise

Dietary Supplementation: 

Dietary Supplementation Elimination of processed food if possible to avoid preservatives and additives Dogs share same problems as humans from eating saturated fats Dietary approach may prevent further deterioration

Dietary Supplementation: 

Dietary Supplementation Vitamins Antioxidants Membrane stabilizers Tonic herbs

Vitamins: 

Vitamins B-complex may help in neural regeneration Yeast good source of B-complex, trace minerals, and some protein

Antioxidants: 

Antioxidants Vitamin E reduces fat oxidation increases HDL slows progression of DM due to low levels of vitamin E Vitamin C potentiates vitamin E’s antioxidant capabilities dogs produce vitamin C Selenium

Membrane Stabilizers: 

Membrane Stabilizers Omega-3 fatty acids act as anti-inflammatory agents Gammalinolenic acid anti-inflammatory agent promotes growth of skin, hair, and nails may be useful in autoimmune disorders Coenzyme Q-10 assists in oxidative metabolism

Tonic Herbs: 

Tonic Herbs Ginkgo increases blood flow to brain Grape seed extract reduces free radicals Hydergine helps regenerate nerve cells and fibers Bromelain/Curcumin decreases circulating immune-complexes anti-inflammatory Feverfew potent NSAID without side effects of RX drugs

Other Supportive Measures: 

Other Supportive Measures Avoid monthly heartworm medications can increase immune responsiveness Acupuncture slows condition but does not stop progress Dietary cartilage supplements, cooked cartilage, or bovine gelatin Stress reduction

Medications: 

Medications Aminocaproic acid (EACA) inhibits process of fibrinolysis can reverse states associated with excessive fibrinolysis N-acetylcysteine (NAC) anti-oxidant with neuroprotective effects

Medications: 

Medications Etodolac (Etogesic Rx) Carprofen (Rimadyl Rx)

Aminocaproic Acid: 

Aminocaproic Acid Compounding and Administration: 2 parts EACA (250 mg/mL) with 1 part chicken broth (no sodium) dose: 3 mL PO q 8 h store at room temp with lid tightly closed expiration: 14 days Side Effects: stomach upset (nausea and diarrhea)

N-Acetylcysteine: 

N-Acetylcysteine Compounding and Administration: 1 part 20% NAC solution to 3 parts chicken broth (50 mg/mL) add sodium hydroxide to obtain pH of 7.4 in order to prevent GI distress dose: 75 mg/kg (1.5 mL/kg) divided tid x 2 weeks, then tid qod refrigerate with lid tightly closed expiration: 14 days

N-Acetylcysteine: 

N-Acetylcysteine Side effects: Nausea/vomiting administer with food to prevent may give ginger 30 min prior if GI irritation persists Diarrhea 1/2 to 1 mL blackberry root (as tea or in food) q 8-12h until resolved

References: 

References www.pawcare.com/rclemmons/DMof SG.htm www.westlabpharmacy.com/infosheet.html www.wheelchairsfordogs.com Johnston PE, Barrie JA, McCullock MC, et al. Central nervous system pathology in 25 dogs with chronic degenerative radiculomyelopathy. Veterinary Record. 146 (22):629-33, 2000 May. Waxman FJ, Clemmons RM, Johnson G, et al. Progressive myelopathy in older German Shepherd dogs. Journal of Immunology. 124(3):1209-15, 1980 March. Williams PA, Batt RM, Sharp NJ. Degenerative myelopathy in German Shepherd dogs: an association with mucosal biochemical changes and bacterial overgrowth in the small intestine. Clinical Science. 66:25P, 1984.