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

                               317-848-0318

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:


http://www.vcaspecialtyvets.com/veterinary-specialty-center/departments-doctors/doctors/johnny-randy-cross/11152

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

Pictures of a very happy Llyr!

I wanted to share a few of my favorite pictures of Llyr at Physical Therapy.

Llyr getting a hug from Michelle. He sure looks like a teddy bear!

Llyr swimming with Michelle.

Llyr taking a break between laps with Dr. Stephanie Finley.

Llyr with Cheryl getting ready to swim laps.

And last, but not least because I will post more in the future. Llyr after swimming...a very wet Corgi!

For those who may be hesitant to get a cart

There are some people who may be hesitant to get a cart because for some reason they may feel a stigma is attached to dogs in carts. To be blunt to me that is a crazy notion, but I have heard of people that feel that way.

I have never really come across this when Llyr is out in his cart.  Some people may first say "poor dog", but when I tell them how well he does in his cart and how it has made such a big difference in his quality of life their eyes usually start to open.  Then they see him walking in his cart and how happy he is and we continue talking about carts and Degenerative Myelopathy.

I may be a bit biased, but I think Llyr is a very special Corgi. So many people come up to meet him when we are out and about.  Children are attracted to him especially disabled ones. Lately, complete strangers have recognized him from Facebook, The Daily Corgi, You Tube and his blog. In our little part of the world I think Llyr has helped some people that feel there is a stigma to cart usage.

Here is a link to Llyr's You Tube channel. I have videos of Llyr in his cart and also doing Physical Therapy. http://www.youtube.com/user/twocorgis9758/videos

Llyr also made the CBS national news in a story with wonderful pictures on what dogs and other animals can do in wheel chairs.
 http://www.cbsnews.com/2300-204_162-10009553-4.html?tag=page%3Bprevious

Halloween costumes still look great when your Corgi is in a cart! Llyr was all smiles!

So please give a cart a try. It really will make a world of difference in your Corgis quality of life!

Llyr's first custom K9 Cart Company East Dog Wheelchair

After close to a year in his loaner cart Llyr was starting to have problems walking in his cart.  His loaner cart had been adjusted twice for a better fit but, it was long in length and a bit to wide. He was also having trouble staying stable in his cart. After Dr. Parkes looked at his cart to see if anything else could be done we decided that it was best to have a cart made custom for his measurements. I was so lucky that Dr. Parkes was able to build the cart while we were there. It was a very long, hot July day, but worth the wait. Llyr's custom cart fit him perfectly and it was much lighter than his loaner cart.

This video was taken before his cart was completely finished, but you will see he is walking much better.  

I can not thank Dr. Parkes enough for all his hard work and time spent getting Llyr's cart made this day. Llyr's custom cart made a world of difference.

Llyr's loaner cart is now being used by another Corgi with Degenerative Myelopathy.

A day to be thankful

With DM there are some things to be thankful for.

First and foremost I am thankful for my boy Llyr. Despite the progressing of DM he still has  a good quality of life! I am thankful for his gusto for life and how he accepts and adapts to the challenges of DM.

I am thankful that there is a DNA test for DM and that there are some breeders that are testing their breeding stock and producing clear litters. Not enough though because some breeders have their heads in the sand, but that will be a topic for another post.
I am thankful that Llyr's original cart was able to be redesigned 2 times to be adapted to his needs and then his custom cart redesigned 2 times to his advancing DM. Thank you Dr. Parkes, Jamie and Rebecca at K9 Cart Company East.
I am thankful for the people on the Wheel Corgi Yahoo group that share their knowledge. I may not post  very often to the group, but I have learned a lot. A special thank you to Bobbie who started the group. She is quick to answer questions and has a lot of knowledge of DM. She also encouraged me to write this blog. She has written two wonderful blogs. Merlin's DM Blog where she chronicled Merlin's journey with DM. It is very informative and a must read for anyone who wants to learn more about DM. She also writes a bog called Merlin's friends which is a tribute to other Corgis who have gone to the Rainbow Bridge because of DM.
I am thankful for Dr. Stephanie Finley, Michelle and Cheryl at West Chester Veterinary Speciality Rehab Center for all they have done for Llyr and me too. They are like family now.
I am thankful for Dr. Cross who is now at VCA Veterinary Center in Indianapolis, IN. He is the first Veterinary Neurologist there. He was Llyr's first Neurologist at Penn Veterinary Medicine at The University of Pennsylvania. He showed so much compassion for Llyr and took wonderful care of him. I learned a lot from him. I am grateful to have know such a wonderful Vet. I miss him, but the people of Indianapolis are very lucky to have him!
I am thankful for Dr. Moeser.  Llyr's new Neurologist at Penn. We have only seen him once, but Llyr will be seeing him again in a couple weeks.
I am thankful for The Daily Corgi and Laurie Eno who has a never ending love and compassion for Corgis. She has featured Llyr many times on her blog and did a fundraiser for DM research. Her efforts raised a lot of money for DM and also awareness for this devastating disease. She has built a wonderful community with her blog for Corgi lovers worldwide.
I am thankful for Dr. Davis Diehl who saved Llyr's life by diagnosing his Thyroid Cancer and has been taking care of Llyr since then. She has advised me well and pointed me in the right direction in building a team of Vets for Llyr with his DM.
Lastly, I am thankful for my family and friends who understand and accept the love I have for Llyr and the time restraints that caring for him puts on the time I have to spend with them.

Degenerative Myelopathy and cart usage

In the beginning when Llyr was still using his back legs some I used a Walk About Harness. It had holes for his back legs and wrapped around his hind end with velcro closures on top. It worked okay for a little while. He was not able to stand on his back legs or use them with out assistance of the Walk About Harness. I was advised that it was best to get him a cart while he was still able to use his back legs. I was very fortunate to get a loaner cart that originally came from the Corgi Aid Cart Loaner program.

It was a K9 Cart Company East Cart. They are located in Oxford, Md. Since i did not live to far from Oxford, Md. I gave them a call and asked if I could come down for a fitting. So off we went. Here is a video of Llyr after his fitting in his cart.

What a wonderful day this was. You will see in this video a very happy Corgi! It was all I could do not to cry when I saw Llyr being able to walk, run and do anything he wanted to. Llyr's quality of life vastly improved the moment he got into his cart.

 Dr. Parkes at K9 Cart Company East took Llyr's loaner cart and fitted it for him.  Down the road when his loaner cart did not fit him properly because of his advancing DM I went back to K9 Cart Company East and had a cart custom made for Llyr, but his first loaner cart worked well for quite some time.

I can not say how important it is to find a cart company that their carts can be adjusted as your dog progresses with DM. Not all carts on the market can be adjusted properly. The best choice is a custom made cart specifically for your Corgi if you can afford it. Think of it as an investment for your Corgis quality of life. If you break down the original cost of the cart with the amount of time that your Corgi will be in it it is really worth it. I personally like K9 Cart Company East because I think they make the best cart on the market and they have wonderful customer service. This is only my personal opinion.  There are many different cart manufactures. Do your research and find what is best for you and your Corgi. I highly recommend if finances are an issue to look into the Corgi Aid Cart Loaner Program.

One of my favorite videos of Llyr

I made this video in July of 2011. To me it says it all. He is truly my best friend.