Updated April 13, 2021
How can I talk about one of the most hopeless diseases of dogs without sounding hopeless? Like this:
Many cases of degenerative myelopathy are probably misdiagnosed
It starts with Google. Put in either weak back legs or dragging back legs and you might only get the wikipedia page on degenerative myelopathy (DM).
You will see in a minute how wrong this is. Of course, vets don’t use Google, but they face their own major hurdles in getting an accurate diagnosis, as you’ll also see.
What Is Degenerative Myelopathy?
DM is a disease causing slowly progressive loss of neural tissue in the spinal cord. It starts with weakness or wobbliness (paresis or ataxia) in the back legs, eventually leading to complete paralysis. At this point the dog drags the back legs and cannot stand up on their own.
Further progression causes the same to occur in the forelimbs, plus urinary and faecal incontinence, and still further to respiratory failure. DM is now believed to be very similar to the human disease amyotrophic lateral sclerosis (ALS) or motor neurone disease.
The age of onset is late, with an average of 9 in large breed dogs and 11 in Pembroke Welsh Corgis. Large breed dogs diagnosed with DM go from mild signs to being unable to walk in 6 to 9 months. The same figure for smaller breeds might be slightly over 12 months.
Breeds Affected With DM
Degenerative myelopathy is now known to be a genetic disease. It was first described in the German Shepherd, and this remains the key dog breed we see with it. However, it can occur in almost any breed of dog, and especially these:
- Bernese Mountain Dog
- German Shepherd Dog
- Pembroke Welsh Corgi
- Finnish Lapphund
- Soft Coated Wheaten Terrier
- Cavalier King Charles Spaniel
- Rhodesian Ridgeback
- Boxer
Dogs usually only show the signs of DM after already breeding and passing it on. Therefore, although I am very critical of some breeding decisions, DM was nearly impossible to eradicate until the development of genetic testing.
Diagnosis Of Degenerative Myelopathy
Traditional diagnosis of DM has relied on identifying the signs in a dog of the right breed and age.
All affected dogs show at least some knuckling of the hind limbs (pictured here in a Cavalier King Charles). This is demonstrated by turning over the paw while supporting the body. An affected dog is unaware of the position of their paw and so does not return it, or does so slowly.
They will also often stumble and drag the hind legs. All these signs are typical of any spinal disease, such as:
- Intervertebral disc disease (type II)
- Lumbosacral stenosis
- Spinal tumours
It is often said that DM can be identified by a lack of pain, but this is very misleading. DM may be painless, but most dogs with severe chronic pain will display no signs. Therefore, I have also seen cases of severe hip dysplasia, cruciate ligament rupture or arthritis get mistaken for DM.
Degenerative myelopathy is described as a diagnosis by exclusion. The only way to prove it is to rule out all the other possibilities, which almost inevitably requires advanced imaging such as MRI. Sadly, this is unrealistic for most dog owners.
Does Misdiagnosis Matter?
My best clue that a dog doesn’t have degenerative myelopathy is when the disease progresses more slowly than expected. Getting the diagnosis wrong only matters if the other disease was treatable. This is certainly true for any painful condition.
Therefore, all dogs with suspected (but not confirmed) DM should at least go on a trial of pain medication. Even if they truly have DM, their signs may be caused by a mix of conditions including arthritis, and so some improvement is common.
The other neurological conditions are much harder to treat, but have possible positive outcomes with specialist surgery. The problem most dog owners face is that the investment in reaching the diagnosis is considerable, for such an uncertain outcome. That’s why, although I will offer referral as a best case, I won’t expect everyone to take it.
In 2020, here’s what I now recommend…
Genetic Testing For Degenerative Myelopathy
The genetic fault for most cases of DM is now well-understood and a commercial test is widely available around the world. Owners can even do it themselves. Here in Australia an SOD-1 swab costs under $100.
A positive test does not guarantee that a dog will be affected, but it’s a great tool for choosing which dogs to breed. That’s why I have hope for the future.
For dog owners facing the decision on whether to see a specialist it’s also potentially a great help. If a dog has a positive test, it makes the diagnosis of DM all the more likely. If on the other hand, the test is negative, or a dog has improved on a medication trial, then just maybe the disease is actually something that could be managed better if we knew what it was.
Treatment Of Degenerative Myelopathy
Even if your dog has DM, the outlook isn’t hopeless as long as you’re careful and know when to stop. They aren’t in pain so your big focus should be on maintaining quality of life.
I cannot stress this too many times: there is no treatment available for degenerative myelopathy. Not prednisolone or other corticosteroids, not vitamin E, not CBD oil. If you get a response to treatment, you should re-evaluate the diagnosis.
In the early phase of DM, much improvement in walking can be had just by adding more grip to slippery floors by the use of carpet runners etc. Then, as the back feet start to scuff on the ground, you need to prevent open sores from forming. There are plenty of people selling dog booties, or your vet can show you how to use products like ‘Vet Wrap’.
Negotiating stairs gets challenging so baby gates are a good idea. Special harnesses with back handles (such as the Rogz Explore®) are even available to help them go up and down or into cars. Physiotherapy and hydrotherapy have been shown to slightly prolong life.
As for the use of carts, my advice is to remember three important things:
- DM progresses quickly
- The front legs are affected not long after the back legs
- What you see on social media may not be the whole story
If you get a cart, you probably only have a short time before the front legs aren’t strong enough any more. I also worry a lot that the dogs aren’t always comfortable, so I ask owners to be very realistic and self-critical in using them.
Talking about euthanasia is a terrible place to finish, but it doesn’t have to be feared. Most dog owners who reach this point do so with their dogs retaining dignity and quality of life. They know they’re doing the right thing, and the actual event is much, much better than they ever expected or feared.
Have something to add? Comments are welcome below and will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia.
Hi Andrew, would like to thank you for your reply to my message regarding my English staffy. I so appreciate you replying and your advice. I agree with you and I will be speak with my vet about this.
Many thanks and kind regards,
Kerry Brawn
My soon to be 11 yr old golden retriever has weakness in hind legs, wobbly, hesitates to walk on slippery surfaces, steps are a challenge and is very unsteady especially if she bumps against something or someone, also gets tired after she stands for a short period of time and has to lay down. We rescued her at 3 yrs of age and she has always seemed unsure of foot placing and high stepping when she would walk. Over the yrs she has obtained the other symptoms I mentioned earlier but it has worsened. Last 4 to 6 months I have seen more challenges with her. Vet has said feels it is spinal cord related.. she definitely has the knucklely in toes and ataxia.. She is still pretty active and even runs but squats in rear when she takes off . She always bends back legs when standing rather than standing straight up.She puts lots of pressure on front feet to pull herself up from a lying position. She pants a lot and licks her front paws.or floor. Vet mentioned she could have some
arthritis in feet as well so she is taking Rimadyl. He says her range of motion in hips is good and only slight hip displaysis, I am currently looking for a harness for her that would help to get her on her feet from laying position and in in car to vet trips as well as getting up and down steps. Any suggestions you may have regarding a diagnosis would be most helpful. and also a recommendation for some type of harness. Thanks.
Hi Barbara. Regarding the diagnosis, you’re doing a good job but as you see from the article, getting a definitive diagnosis for DM requires ruling everything else out which is a big job. At the very least I would make sure that x-rays have been done as DM does not normally come on from three years of age whereas the Golden retriever is known to be a breed with one of the highest incidences of hip dysplasia. At the severe end it can easily mimic the signs of DM, even to the point of knuckling.
That’s a good question regarding harnesses. I have seen several with a nice big handle over the mid or lower back which are excellent for helping dogs in and out of cars and up and down steps. Sorry I don’t have brands to hand but they should be easy to find.
i have a harness type called HELP EM UP WORKS GREAT
Very interesting and THANK YOU for the great article.
My Wired Terrie mix 25 LBS started his 3 weeks dragging ONLY RIGHT rear leg and can no longer support his leg on the floor.
His right rear leg shakes a lot, and slips under the other leg…so sad, as he looks VERY healthy and active otherwise.
I took him to the Vet las week and was giving two different anti-inflammatory, but I stopped giving him because he is stomach sick now, sad, down, groggy, stopped eating and I think it is not worth it continue with medication. Now 3 days without the medication, he is eating and drinking water again 🙂
Read a lot about this, and I am still nor sure if this has anything to do with lime disease at all…I remember removing 2 ticks in the past 5 months.
So sad and do not know what to do…
Any inputs would be HIGLY APPRECIATED.
Hi Luigi. I have several comments. The first is that that certainly sounds like an adverse reaction to the anti-inflammatory tablets, but my experience tells me that you can always find a tablet that a dog will tolerate if you look hard enough. That’s just in case you need them in the future.
Secondly, we don’t see Lyme disease here in Australia, but the symptoms do not sound typical. What is likely to be wrong all depends on many factors but can often be narrowed down based on the age of your dog. For example, Lyme disease would be less likely in an old dog, where we might be thinking about arthritis, disc disease or degenerative myelopathy.
I dont know if you can advise on this, but my 15 year old beagle mix has something we thought was DM. It started in 2018 with some wobbly back end when walking. She now has a hard time walking on our hard floors and back legs give out and she cant stand up. Then after a few minutes she gets up and walks but not normal. Her thigh muscles are wasting she favors her left rear leg and licks it all the time. But both back legs are weak, my vet thought DM at first, but now isnt sure. When i massage her back by her tail she stretches her back legs out and i can push against her feet and there is resistance, like she is pushing back, does DM let them have strength to push back?
We are going to try treatment for arthritis again, but she never cries in pain, and if you rub her back and hips she seems to like it. So they say DM isnt painful, and she dont seem to be in any pain. But her back end is really weak, she can still climb up stairs and on the sofa she pushes up with her better right rear leg. Its 2021 and my vet thought by now she would be paralyzed, so now he is rethinking DM, but he isnt sure. I dont know what to do, he checked her spine for disc problems just normal old dog discomfort no slipped disc. But her back legs are wasting and weak, but she still walks and even trots after my other dog. Of course her back legs go out sometimes when out in the yard with the other dog, and on the hard floors. I guess what im asking is would she have remained mobile for so long with DM?
Hi Dana. It seems very unlikely to be DM, and the best thing you can do is investigate a little further. X-rays would seem most sensible as a first step. Otherwise we are just guessing. And as I say in the article, dogs rarely cry in pain regardless of the cause.
Hello Andrew,
Thank you for the article on DM, it was so good to find the article as it was simple to follow and explained wonderfully.
I have a nearly 8yr old female English staffy that is showing signs of DM. For over 12mths I have noticed a decline in her hind legs strength especially after exercising. Over the last six month she has declined more and I stopped
Intense running exercise, hard ball playing and also long walks. But the weakness reminds.
She has weakness in her back legs and her hips sway and her legs don’t seem to have good balance but she is still supporting herself. Struggles on hard floors and can no longer hurdle up onto the bed or couch and then is very hesitant to get down. Slow up stairs? She also limps on her front legs one more than the other. I have had her seen by the vet who worked each limb with no obvious pain, reflexes and flexibility okay. Prescribed anti inflammatories but no difference. Also have seen a chiropractor a few times and hydrotherapist twice. Chiro said her spin was tight and her flexibility and muscle strength needed working on.
Of a night she is hesitant to get up and move around and a definite struggling to get up after sleeping.
I’m not sure what my next move should be. X-rays? MRI? Medication? Bloods again? Genetic testing to see if she has the gene.?
I would truly appreciate your views, I know there is no treatment. What do I need to do to eliminate other condition and get a correction diagnosis.
Most gratefu
Kerry
Hi Kerry. I wrote this page because I noticed that Google tends to feed back a diagnosis of DM whenever you google weak back legs in a dog. As you’ve now seen, the truth is far, far more complicated. In your case, DM is extremely unlikely in this breed. A much more common diagnosis would be bilateral cruciate ligament disease. Therefore, I would start by getting not just x-rays, but examination of the hind legs under anaesthesia. The genetic test would be a good idea but I would be very surprised if it’s positive.
The most helpful explanation of DM I have found. We think our 12 yo Rhodesian may have DM. She will see the veterinarian next week to rule out other obvious causes of her hind leg weakness.