Help and support for dogs suffering from degenerative myelopathy (DM) and for their owners

The most important thing is that the dog suffering from the disease receives the most appropriate and effective support and help. This is what I try to help with in the following. There is no medicine for the disease!! The disease can be supported with dietary supplements and vitamins; the individual supplements support the functioning of the nervous system, can reduce oxidative stress and can help maintain general quality of life, but they cannot stop the disease. The medical literature does not take a position on this; in most cases it only makes a recommendation. The recommendations and suggestions for supplements that support the disease are largely based on the experiences shared over the past several decades by the owners who accompanied the disease throughout.

What everyone agrees on, however, is that in maintaining the quality of life of dogs suffering from degenerative myelopathy, physiotherapy and the continuous maintenance of the dog's movement play an outstanding role. In addition, movement-supporting aids provide help both to the dog and to the owner in making everyday life easier. Creating an appropriate home environment is also essential. It is worth spreading rugs over slippery floors, and protecting the paws with special socks against slipping backwards and against injury.

Dietary supplements, vitamins

Vitamin B complex

The B vitamins (vitamins B₁, B₆ and especially B₁₂) play an important role in the protection and nourishment of nerve cells. In the case of degenerative myelopathy, these vitamins can help support the functioning of the nerves and ease the symptoms.

How do the B vitamins help?

• Nerve protection: They support the integrity of the protective layer surrounding the nerves of the spinal cord (the myelin sheath).
• Metabolism: They help with the normal energy supply of the nerve cells.
• Slowing the symptoms: Appropriate vitamin supplementation (often combined with vitamin E) can slow the paralytic processes.

Vitamin E

Vitamin E protects the nerve cells as a strong antioxidant. Although it does not cure the disease, supplementary vitamin E therapy can help slow the course and support the general functioning of the nervous system.

How does vitamin E work?

• Cell protection: Vitamin E fights the harmful free radicals in the body. In this way it protects the nerve cells and their protective sheath (the myelin sheath) from further damage.
• It is an effective antioxidant that can improve the quality of life of animals struggling with neurological problems.
• Alongside vitamin E, vitamin C is often given as well to slow the process.

Vitamin C

Vitamin C (together with other antioxidants such as vitamin E) does not cure the disease, but based on research and veterinary practice it can support the dog's body and slow the process.

• The role and dosing of vitamin C in the disease: vitamin C is a strong antioxidant. It neutralises free radicals. These harmful particles take part in the death of nerve cells. In addition, vitamin C helps to regenerate vitamin E, which enhances the protective effect.
• How does vitamin C work? The dog's body also produces vitamin C itself, but during illness and stress the need increases. The aim of the vitamin is to moderate the inflammatory processes taking place in the body.
• Determining the amount: The dose depends on the dog's weight and breed. Be careful with overdosing: the excess vitamin C is excreted in the urine. However, too large doses can cause bloating or diarrhoea.
• Complex therapy: Vitamin C is not used on its own. For the most effective results, vitamin E and vitamin B are part of the treatment.

Omega-3 fatty acids (EPA and DHA)

Omega-3 fatty acids (especially EPA and DHA) do not cure the disease, but they effectively support the dog's nervous system and quality of life in the following ways:

• Reducing inflammation: EPA and DHA block the production of pro-inflammatory substances in the body, thus easing the irritation of the tissues around the spinal cord.
• Nerve protection: They support the membrane of the nerve cells and reduce oxidative stress, which can slow the ongoing nerve damage.
• Joint mobility: The compensatory posture used to make up for the loss of movement puts a great strain on the joints. Omega-3 has been proven to reduce dogs' joint pain and improve their movement.

The recommended daily dose is generally 40 mg of EPA and 25–30 mg of DHA per kilogram of body weight. This is most easily provided with high-quality fish oil (for example sardine or anchovy oil), which contains these fatty acids in concentrated form.

Magnesium

Although magnesium is essential for nerve and muscle function, there is no scientific evidence that it slows the course of the disease. The aim of the supplementary therapy is to ease the symptoms and improve quality of life.

The role of magnesium

• In dogs, magnesium supports the proper functioning of the muscular and nervous systems.
• Against muscle cramps: It helps prevent muscle cramps and supports proper muscle tone.
• Deficiency states: A magnesium deficiency can aggravate neurological problems.
• Dosing: in consultation with a veterinarian, about the dose appropriate to the dog's body weight. The body usually excretes excess magnesium.

Lion’s Mane

It does not cure the disease, but Lion's Mane stimulates the nervous system's growth factor (NGF). This supports the regeneration of the damaged nerves and the protective layer (the myelin sheath), and can thus improve movement and the dog's quality of life.

How does it work?

• Put simply, the process looks like repairing a torn internet cable. The communication between nerve cells is interrupted when the protective layer is damaged. Protecting the nerves: Lion's Mane contains nutrients that stimulate nerve growth (so that the nerves rebuild themselves).
• Reducing inflammation: It reduces the inflammation affecting the spinal cord.
• Quality of life: It improves the communication between the brain and the limbs, slowing the paralysis.

Dosing and tips: It is important to give the mushroom to the dog in extract form (capsule/powder or liquid), because this is how the active ingredient is absorbed best.

• General dosing: In general, 100 mg of extract per 4.5–9 kg of body weight per day is recommended. (video)
• In more severe cases: A larger dose may also be needed, but it is worth calculating this precisely.

Coenzyme Q10

Although it does not stop the process, as a supplementary therapy it can slow the course of the disease and improve the neurological and general cell-level metabolism, easing the symptoms.

• The role of Coenzyme Q10: a strong antioxidant that plays a key role in the cells' energy production (ATP).
• Cell-protective effect: it can help protect the nerve cells from damage.
• Dosing and use: Veterinarians often recommend Q10 supplementation in older dogs.
• General dose: Based on research and expert recommendations, this is typically 1 mg – 1.6 mg per kilogram of body weight per day, but in the case of neurological problems the clinical recommendations may even allow a dose of up to 200 mg per day for larger dogs.
• Absorption: The tablet or capsule should always be given together with fatty food, because that is how it is absorbed best.

Curcumin

Curcumin – the active ingredient of turmeric – can be effective in the management of the disease. According to research, through its anti-inflammatory and antioxidant effect it protects the nerve cells and can help slow the worsening of the disease. Dogs can thus keep their mobility for a longer time.

How does curcumin help?

• According to research published in the journal Research in Veterinary Science, the survival time of dogs receiving curcumin was significantly longer than that of their untreated counterparts (https://pubmed.ncbi.nlm.nih.gov/34564586/), and another study also supports this (https://www.mdpi.com/2306-7381/8/9/192)
• Protecting the nerves: It helps prevent the accumulation of mutant proteins in the spinal cord.
• Supporting the muscles: It reduces the breakdown (atrophy) of the muscles and stimulates protein synthesis.

How should it be dosed? Curcumin on its own is poorly absorbed in the body. Combined with bromelain (pineapple extract) or with healthy fats (for example krill oil), its absorption is more effective. The paste made from the spice (golden turmeric paste) is also popular.

Dosing: In clinical studies, generally ≈ 13 mg of curcumin per kilogram of body weight was used per day, but the powders and extracts differ in concentration. It should be given during meals, to spare the dog's stomach.

D-mannose

D-mannose can be an extremely useful supplementary treatment for preventing the urinary tract infections (UTIs) that appear in the later stages of the disease, which develop because of urine-retention problems.

How does D-mannose help sick dogs?

In the advanced phase of the disease, dogs often lose control over urination and defecation (incontinence develops). Because the bladder cannot empty completely or properly, bacteria multiply in the stagnant urine, which leads to severe urinary tract infections.

D-mannose is a natural simple sugar that helps in the following ways:

• It binds the bacteria: It prevents E. coli bacteria from adhering to the bladder wall.
• It flushes out the infection: The bacteria, attached to the D-mannose, are simply washed out of the body together with the urine.
• It is safe: It does not raise the blood sugar level, so it can be given to diabetic dogs too. It does not trigger antibiotic resistance.

Dosing and use

• About 250–500 mg per kilogram of body weight (that is, ~500 mg per 4.5 kg), once or twice a day.
• Warning: the product must not contain xylitol (birch sugar), because this is extremely toxic to dogs!

CBD oil

Although CBD oil cannot cure the disease, it can play an important role in maintaining the dog's quality of life.

The most important thing to know is that degenerative myelopathy is not in itself a painful disease, yet CBD oil can help a great deal in managing the secondary symptoms and easing the accompanying conditions.

How can CBD oil help?

• Neurotransmitters and neuroprotection: According to research, the combination of CBD and especially CBG (cannabigerol) supports the nervous system and can help slow neuroinflammation (inflammation of the nervous system).
• Easing compensatory pain: As the dog's hind legs weaken, the body weight shifts onto the front legs and the front section of the spine. This leads to serious joint and muscle pain, which CBD relieves excellently.
• Reducing anxiety and stress: The loss of mobility causes serious frustration and anxiety in dogs. The natural anxiety-relieving effect of CBD helps to calm the animal.
• Treating pressure sores: If the dog already lies down a lot, pressure sores can develop on the skin. CBD-containing ointments or the local application of the oil aid wound healing.

What to pay attention to when dosing and using it?

• Choose only a product intended for dogs: Buy a full- or broad-spectrum veterinary product that is guaranteed to be THC-free.
• Consult the veterinarian: CBD oil can affect the functioning of the liver enzymes (especially ALP) and can modify the effect of other medicines (for example painkillers, steroids).
• Gradual introduction: Start with the lowest dose recommended by the manufacturer (generally 1–2 drops), and only increase the amount after 1–2 weeks, if needed, while observing the dog's reactions.
• Side effects: In rare cases drowsiness, dry mouth or a mild digestive upset (diarrhoea, vomiting) may occur.

Physiotherapy and other therapies

Complex therapy is essential in the management of degenerative myelopathy. The most proven effect on maintaining quality of life comes – alongside appropriate vitamins and supplements and antioxidants – from regular exercise, physiotherapy (hydrotherapy, massage, laser), weight control, and the timely introduction of appropriate aids (dog shoes, lifting harnesses, wheelchair, laying non-slip rugs in the home).

Physiotherapy

Movement therapy, meaning the continuous performance of exercises designed specifically with the disease in mind, using appropriate aids, carried out on land. The exercises and movement therapy must strictly follow the stages of the disease, the dog's general condition and its continuous deterioration; the exercises must always be adjusted to the circumstances. The dog must never be overloaded, but its movement must be continuously maintained.

Hydrotherapy

Hydrotherapy is one of the most effective, scientifically proven treatments for easing the symptoms of degenerative myelopathy. It does not cure the disease, but it can slow its progression and significantly improve the dog's quality of life.

How does hydrotherapy help?

In dogs suffering from the disease, a gradual weakening of the hind legs, muscle atrophy and worsening coordination can be observed. Hydrotherapy uses the physical properties of water to treat these symptoms:

• Buoyancy: The water bears most of the dog's body weight. Because of this, the gravitational pressure on the joints and spine is removed, so the dog can move without pain, more easily than on land.
• Resistance: The natural resistance of the water when moving the legs helps to strengthen the remaining muscle mass and improves stamina.

Forms of the treatment

• Underwater treadmill: This is the most common and most effective method. With the help of the physiotherapist, the dog can step at a controlled speed, which helps maintain the brain–muscle connections (proprioception) and preserve correct stepping patterns.
• Dog swimming pool: In certain cases free swimming can also be used, provided the dog's coordination still allows it. Unfortunately, in Hungary this is only minimally feasible, as there are very few places with a swimming pool reserved for dogs.

Important considerations for the therapy

• Starting early: It is most useful if the treatment is started already in the early stage of the disease (when the first mild movement disorders appear).
• Only with a professional!!!! Hydrotherapy too must be carried out exclusively under the supervision of a well-trained physiotherapist. Too much or poorly chosen movement can exhaust the dog, which can worsen its condition. The therapist applies assisted treatment, helping the dog to move the legs correctly.

Laser therapy

Laser therapy is a safe, painless treatment that effectively slows the worsening of the symptoms. Its aim is to reduce pain and improve quality of life.

How does laser therapy work?

The essence of the treatment is that the spinal column is illuminated with a special, low-energy beam of light (soft laser) or with a high-intensity laser.

• Cell-level effect: The light energy stimulates the cells' energy production (ATP production).
• Reducing inflammation: It reduces the swelling and inflammation around the spinal cord.
• Protecting the nerves: It helps maintain the functioning of the still-healthy nerve cells and supports the regeneration of the muscles.

What results can we expect?

• According to scientific research, laser treatment combined with physiotherapy can significantly increase the survival time and mobility of sick dogs. (source)
• It delays paralysis: Dogs receiving the combined treatment stay on their feet longer than their untreated counterparts.
• Better quality of life: It reduces muscle cramps and compensatory pain.
• Pain-free movement: It supports the preservation of the strength of the back and trunk muscles.

The course of the therapy and combining it

Laser therapy on its own is not enough. The best results can be achieved with a rehabilitation programme consisting of several elements:

• Physiotherapy: Indispensable for preserving appropriate muscle mass.
• Hydrotherapy: Underwater treadmill or swimming, which relieves the joints.
• Laser treatment: The professionals apply it 1–3 times a week, depending on the dog's condition.

Massage

Dog massage and remedial exercise slow the course of the disease. The aim of the treatments is to preserve muscle mass and improve quality of life. Massage stimulates blood circulation and reduces the tension in the muscles.

The most important effects and techniques of massage:

• Improving blood circulation: Massage delivers fresh oxygen to the muscles. This helps prevent the muscles from wasting away while the dog is still moving.
• Pain relief: Because the hind legs weaken, the front legs and the back receive extra strain. Massage relaxes these overloaded, cramped muscles.
• Joint mobility: During so-called passive mobilisation, the professional carefully moves the dog's limbs. This helps prevent the joints from stiffening.

Practical advice for the treatment:

• The massage should always be carried out by a qualified physiotherapist. An inappropriate massage can harm the dog.

Acupuncture – regarding this I cannot share reliable information (ask the professionals about this; unfortunately, in Hungary this form of treatment is available only in 1–2 places).

BEMER therapy

BEMER, a physical magnetic therapy and vascular therapy, improves the dog's microcirculation. This enhances the oxygen supply of the cells. BEMER does not cure the disease, but it can reduce the symptoms, slow the deterioration and improve the dog's quality of life.

Why does BEMER help?

• Better blood circulation: The pulsating magnetic field aids blood circulation.
• Cell regeneration: More nutrients reach the nerve cells and the muscles.
• Reducing inflammation: It eases the joint pain, making movement easier.

The therapy is completely painless and has no known side effects.

Where is the treatment available? The device can even be rented for home use, but it is also available at well-equipped canine physiotherapy centres and at physiotherapists, where professionals help to put together the treatment plan. A BEMER bed made specifically for dogs is also already available on the market.

Tools, equipment

Tools and equipment that are absolutely necessary in order to improve the dog's quality of life, make it easier and protect the dog from injuries:

• Creating an appropriate home environment is very important; as the disease progresses, movement becomes more and more uncertain, so non-slip rugs (a yoga mat, a fitness-machine mat from Decathlon, runner rugs) must be spread over slippery floors.
• At the beginning of the disease the dog begins to drag its hind legs, as a result of which the hind-leg claws start to wear down and later to bleed. To avoid wounds, it is worth putting dog shoes on the dog's paws. Later on, this will also be essential for using the wheelchair, for as long as the hind legs are still on the ground.
• Several medical aids designed to prevent knuckling over onto the top of the paw are available; they can be found under the name step-correctors (paw-position correctors).
• A lifting harness, which helps to assist and support the dog's movement and protect it from falling. It is available in several forms; it is worth looking into each of them.
• A wheelchair, whose use is worth starting already while the dog is still able to move on its own. This way there is a better chance that the dog will feel comfortable using the device.
• A dog stroller/pram makes travelling and longer outings much easier; with its help, our companion, who can no longer walk, can take part in shared activities just the same.
• A raised feeding and drinking stand, with the help of which the dog does not have to bend down; it is easier on its back if the bowls are higher, especially if it can only stand unsteadily on its legs.
• Physiotherapy tools for home use (it is worth consulting the physiotherapist about this).
• Creating a calm, stress-free, loving environment is very important; as the disease progresses, dogs become more sensitive, more worried, more tense and more anxious, so it is very important that they continuously feel safe, and that we try to arrange things so that we never leave them alone!