Saturday, January 14, 2012

Thoughts on Degenerative Myelopathy by Dr. Johnny Cross DVM

Dr. Cross and Llyr
Dr. Cross was Llyr's first Neurologist at Penn. I learned so much about Degenerative Myelopathy from him. No question was ever to simple even when I asked more than once. He and Llyr got along very well. I can't thank him enough for all he did for Llyr and me too. Here are his thoughts on Degenerative Myelopathy.

Although the overall prevalence for degenerative myelopathy is 1 in 500 dogs, the prevalence among certain dog breeds is higher.  This is certainly felt in the Corgi community, where the exact prevalence has not been established.  Pure numbers don’t put this disease in perspective because even if the odds were 1 in 10,000, and that 1 dog was your dog, odds wouldn’t matter to you.
Actually, my first experience with this disease process was with the similar disease seen in humans, amyotrophic lateral sclerosis (Lou Gehrig’s disease).  My best friend’s mother was diagnosed with Lou Gehrig’s disease in her early 40s.  We all watched as her ability to move slowly deteriorated.  I remember feeling as if she were a bright minded individual trapped within a failing body.  She understood everything I said, but had difficulty responding because speaking was hard for her.  I was too young to understand exactly what was going on, but I knew whatever it was lasted for several years and devastated her family and friends.
Now I’m a veterinary neurologist, and I see many patients with degenerative myelopathy.  Llyr is one of my favorite degenerative myelopathy patients.  I know as doctors, parents or friends, we are not supposed to play favorites, but I believe we all do.   His energy is amazing and more importantly, his ability to make everyone around him feel just as exuberant, is remarkable.  I quickly learned to feed him as if I was feeding our horse; keeping a flat palm, because the food and anything else in your hand will soon be in his mouth
Amy asked me to write a little on her blog, which I am happy to do.  I could write a long article on the history of the disease, pathophysiology, clinical signs, diagnostic tests, current and future treatments, and clinical experiences, but as a clinician I know, if I talk too long or write too much, my important points might be lost.  So I would like to make three main comments:
  1. Spread the word, testing is important.  In one study, all the Pembroke Welsh Corgis with degenerative myelopathy had the homozygous mutation for SOD1.   Some of the normal Pembroke Welsh Corgis tested homozygous for the mutation as well, likely indicating multiple factors are involved in developing the disease.  Regardless, this is one of the tools that will help us reduce the incidence of this disease and still allow people to have this wonderful breed.
  2. Don’t be swindled, there are no effective treatments to date (yes, this breaks my heart too).  Even on the human side for amyotrophic lateral sclerosis, there are only a few effective treatments, and those only improve outcome by a couple months.  If there was something effective for dogs, you would bet they would be using it in human trials.  I have contacted several companies claiming to have a cure, (which is illegal to claim by the way without substantial proof) and many never respond.  The rare few that do respond, respond without evidence their treatments work. It is all anecdotal.  Most of these treatments are not harmful from my experience, but I think it is important to realize there is a lack of clinical trials for many and the clinical trials that have been performed do not indicate efficacy.  Please don’t misconstrue this as giving up.  We should continue to strive for a treatment and spend our energy and money in areas that are helpful.
I do however; recommend physical therapy for several reasons.  It can serve as an excellent bonding experience with your pet, which is also vital to supporting each other.  It also keeps their muscles and joints lose.  This helps with cramps and with the abnormal strains placed on joints that don’t move as much as they used to.
  1. Form a community.  This can be done through blogging, cart races, doggie play dates, fundraisers, or whatever your heart wants.  If you are reading this, you likely know what it is like to have a dog with this disease and how distressing it is.  We need each other.  Additionally, forming a community will help us support each other and our dogs better.  Lastly, communities are the foundation for the next step of mobilizing the masses for research or clinical trials.  
Unfortunately, I don’t have the answers I would like.  However, I am encouraged by the heart and drive in dogs like Llyr.  This should inspire us to keep trying and doing the things that make both their and our lives better.  

Dr. Cross is now at VCA Veterinary Speciality Center
                               9745 Randall Drive
                               Indianapolis, IN. 46280

Dr. Cross is the first Veterinary Neurologist at VCA Veterinary Speciality Center. They are very lucky to have him!
Here is a link to Dr. Cross's biography and VCA Veterinary Specialty Center's web site:

Llyr and I will never forget you Dr. Cross and I wish you great success at VCA Veterinary Speciality Center!