Definition and cause
Degenerative myelopathy is a slow, progressive degeneration of the spinal cord, which often leads to loss of motor control of the hind legs. While no proven cause is known, it is believed that an autoaggressive process may be involved with the observed degeneration of the spinal cord. Although it is most commonly found in German Shepherds, degenerative myelopathy has also been seen in other breeds such as old English Sheepdogs, Belgium Shepherds, and Weimaraners.
Medical therapy rationale, drug(s) of choice, and nutritional recommendations
Once diagnosed, there is no proven therapy for degenerative myelopathy. Clemmons (1989) states that “the current treatment of degenerative myelopathy is designed to suppress the immune disease, but does nothing to correct the immune alterations which led to the disease state.” Clemmons has proposed an immune-mediated cause in German Shepherds, and as such recommends a combination of controlled exercise to improve tone and circulation, vitamins and other supplements, n-acetyl-cysteine, and aminocaproic acid (EACA), which have shown an improvement or stabilization of the condition in more than 50% of the animals with degenerative myelopathy. No controlled trials have been reported, however.
Most animals diagnosed with degenerative myelopathy slowly lose nervous control and become non-ambulatory within 1 to 2 years of diagnosis. Late-stage degenerative myelopathy is often complicated with both fecal and urinary incontinence. Clemmons (1989) offers a better prognosis (see medical therapy above).
Integrative veterinary therapies
The authors recommend an augmented version of Dr. Roger Clemmons’ protocol for the treatment of degenerative myelopathy in dogs. The enhancements to Dr. Clemmons’ program include adding the authors’ specific glandular, Chinese herbal, acupuncture, and homotoxicology remedies to his published protocol.
Gland therapy: Glandular brain, adrenal, thymus, and spleen supply the intrinsic nutrients that help reduce autoimmuine cellular inflammation, neutralize free radicals, and improve organ and nerve function. This helps to slow and spare the nerves from progressive degeneration (see Gland Therapy in Chapter 2 for a more detailed explanation).
Phospholipids found in glandular brain are a source of unsaturated omega-3 fatty acids, which are now believed to play a vital role in the development and maintenance of the central nervous system. High concentrations of phosphatidyl choline and serine are found in brain tissue. Horrocks (1986) reported on the potential clinical use of these nutrients in chronic neurological conditions.
General considerations / rationale
Many of the following considerations and recommendations are taken from the web site of Clemmons (2002): http: / / neuro.vetmed.ufl.edu.
“Diet may have a powerful influence on the development of chronic degenerative diseases. New information suggests a significant connection between dietary regulation and the progression and development of diseases such as multiple sclerosis. Eliminating toxins from processed food may help prevent a number of immune-related disorders. The current treatment of degenerative myelopathy is designed to suppress the immune disease, but does nothing to correct the immune alterations which led to the disease state.
Diet might help to correct this defect and allow the immune system in degenerative myelopathy dogs to stabilize. The principles of dietary therapy, including a homemade diet, are outlined here. For those who cannot cook for their dog, the basic diet should be supplemented with the additional ingredients listed below. It is best to choose a dog food that is close in protein content and is as natural as possible. Wild dogs were not meat eaters. They ate bodies, including intestinal contents that were often laden with plants and plant materials. Dogs have evolved so that eating animal fats and protein do not cause them to suffer the same problems as humans when eating these sources of saturated fats. Even so, dogs probably suffer from the same causes of dietary and environmental intoxication that affect humans.
Basic diet (1 serving for 30 to 50 pounds body weight)
2 oz. boneless pork center loin chop (boiled, baked, or fried in olive oil)
4 oz. tofu
8 oz. long grain brown rice (3 oz. cooked in 6 oz. water)
2 teaspoons extra virgin olive oil
1 / 4 cup molasses
2 carrots (boiled and then chopped) 1 cup spinach (cooked)
4 tablespoons green bell pepper (chopped and steamed)
4 broccoli spears (boiled and chopped)
This diet provides approximately 1,160 to 1,460 calories per serving. Poultry meat, beef, and lamb can be substituted for the pork chop. This alters the composition slightly, mainly by adding fat. The weight of the meat is based upon boneless weight. Most of the items can be prepared in a microwave.
Based upon the dog’s body weight, more or less will need to be prepared. For example, multiply all the ingredients by 1.5 times to 2.5 times for dogs weighing 80 pounds (daily caloric requirements may vary by dog).
This recipe can be made in advance, divided into appropriate quantities, and frozen. Just before feeding, thaw in hot or boiling water or defrost in the microwave.
To complete the diet, add the following combination before serving (recipe makes 1 serving; multiply or divide as needed):
1 teaspoon dry ground ginger
2 raw garlic cloves (crushed)
1 / 2 teaspoon dry mustard
1 teaspoon bone meal
Approximately 1 serving of the above diet equals 1 can of commercial dog food. The exact requirements for a dog can be approximated by substituting the diet on that basis. The dog should be weighed each week, and the amount of the diet increased if it is losing weight (or decreased if the dog is gaining weight). Eventually, the correct amount will be clear.
Many German Shepherds have sensitive stomachs; therefore, it may be wise to phase in the new diet by mixing it with existing food until the dog adapts. Start by mixing the diet with existing food in equal amounts. After 1 week increase the diet to replace 75% of the original food. After another week, switch completely to the new diet. This diet is balanced and high in most of the vitamins and minerals that dogs need. Any shortcomings can be corrected with the supplements given below.”
B-complex: B vitamins are water-soluble, and any excess amount is eliminated through the urine. They may help in neural regeneration and should be given to dogs. No dog should die while having cheap urine. There is altered absorption of some B vitamins in degenerative myelopathy, and supplementation can correct this.
Vitamin E: Vitamin E is an important nutrient that has been shown to have a number of physiologic and pharmacologic effects. It is a potent antioxidant that reduces fat oxidation and increases the production of HDL cholesterol. At higher doses it also reduces cyclooxygenase and lipooxygenases activities, decreasing production of prostaglandins and leukotreines. As such, it is a potent anti-inflammatory drug. It reduces platelet function and prolongs the bleeding time slightly in healthy individuals. There are no known side effects to vitamin E at levels less than 4,000 to 6,000 IU per day (except in cats, where levels over 400 IU / day might create hepatolipidosis). This drug slows the progression of degenerative myelopathy and corrects for low serum and tissue levels. In degenerative myelopathy, there appears to be a deficient absorption and tissue-binding protein which accounts for the low serum and tissue concentrations of vitamin E.
Vitamin C: Vitamin C works with vitamin E and helps with its regeneration, potentiating its antioxidant effect. Vitamin C supplementation does no harm, because the excess is excreted through the kidney. While dogs produce vitamin C in their bodies (unlike humans, pigs, and guinea pigs, who must obtain it from their diet), they may need vitamin C in excess of their manufacturing capacity when they are suffering from stress or disease.
Selenium: Selenium is an important mineral that has antioxidant properties similar to vitamin E. Vitamin E can replace the requirement for selenium in the body, but selenium cannot substitute for vitamin E. In addition, selenium does not cross the blood-brain barrier like vitamin E. On the other hand, selenium may help vitamin E to be more effective. Many plant sources are low in selenium and supplementation may be important.
Omega-3 fatty acids: Omega-3 fatty acids such as EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are the constituents of fish oils that act as anti-inflammatory agents. They may be worth trying in dogs with autoimmune disorders or arthritis.
Gammalinolenic acid: Borage oil, evening primrose oil, and black currant oil are natural sources of gammalinolenic acid, a fatty acid that is hard to get in the diet. GLA is an effective anti-inflammatory agent with none of the side effects of anti-inflammatory drugs. It also promotes healthy growth of skin, hair, and nails. It may be good for skin conditions, arthritis, and autoimmune disorders. It takes 6 to 8 weeks to see changes after adding GLA to the diet.
Soybean lecithin: Lecithin is a fat-like substance found in the cells of the body. It may combat atherosclerosis, improve memory, and fight Alzheimer’s disease in people. However, there is no scientific evidence to support these claims. On the other hand, lecithin is harmless. It is not necessary as a supplement unless a dog has degenerative myelopathy and the client elects not to use the diet outlined above (tofu contains plenty of soybean lecithin).
Coenzyme Q: Coenzyme Q, also called CoQ10, is a natural substance that assists in oxidative metabolism. It may improve the use of oxygen at the cellular level, and patients with heart, muscle, and nerve problems may find it worth trying in doses of 30 to 100 mg per day. Some people report that it increases their aerobic endurance.
Medication: The following medications are recommended by Clemmons:
Over the last 2 decades, we have found 2 medications which appear to prevent progression or result in clinical remission of degenerative myelopathy in many (up to 80%) of patients: aminocaproic acid (EACA) and n-acetylcysteine (NAC). Clemmons recommends giving EACA as a solution, using the generic product. This product, while designed for injection, can be mixed with chicken broth to provide a palatable solution for oral usage. Clemmons recommends mixing 2 parts of aminocaproic acid solution (250 mg / ml) with 1 part chicken broth and giving 3 ml of this mixture orally every 8 hours. In his experience, this mixture has been equally, if not more, effective to the tablet form of aminocaproic acid. Furthermore, the solution is much less expensive than the tablets. The generic form of aminocaproic acid solution can be obtained from American Regent,1l-(800) 645-1706 (outside of New York). The generic drug from American Regent may be obtained through prescription with the help from a local pharmacy.
An alternative source for aminocaproic acid is to have a compounding pharmacy make the solution from chemical grade EACA. WestLab Pharmacy in Gainesville, Florida, can be reached at 1-800-4WESTLA (1-352-373-8111) and can mail the medication and bill the client directly. Occasional gastrointestinal irritation is the only side effect that has been attributed to aminocaproic acid. This only presents a problem in a few patients, usually those who have pre-existing GI problems that the medication might exaggerate. A local pharmacist can help determine whether any additional drugs might be contraindicated or lead to possible drug interactions with the recommended therapy. The only known interaction is with estrogen compounds, and only in high doses.
Acetylcysteine is a potent antioxidant that has powerful neuroprotective effects. Clemmons gives 75 mg / kg divided in 3 doses a day for 2 weeks. After that, give the 3 doses every other day. The N-acetylcysteine comes as a 20% solution and must be diluted with chicken broth (or other compatible substitute) to 5% to prevent stomach upset. This new treatment is expensive unless purchased through compounding pharmacies. Again, WestLab Pharmacy has this product and can send it to clients upon veterinary prescription. Using N-acetylcysteine at the above dose does not appear to have side effects. It can produce vomiting and may increase the bleeding time. The GI upset is likely due to the sodium content of the pharmaceutical product, which requires high concentration of base to buffer to pH 7.4. WestLab’s product does not have as many side effects because the pH is reduced during preparation. Giving fresh ginger 30 minutes before and giving the NAC with food (or on a full stomach) often reduces this effect.
The combination of aminocaproic acid, N-acetylcysteine, dietary supplements, and exercise is the best treatment we have discovered. It corrects those aspects of the immune dysfunction, which we can treat, based upon our belief that degenerative myelopathy is an immune-mediated inflammatory disease. We always hope that all patients will respond to our treatment protocol. Although it does not work in all cases, this combined treatment has been up to 80% effective in patients diagnosed at the University of Florida. The chances of successful treatment are improved if the therapy is begun early in the course of degenerative myelopathy rather than later. A response to the drugs should be evident within the first 7 to 10 days. There are no other medications that Clemmons has found to provide any real benefits in the long-term treatment of degenerative myelopathy.
Chinese herbal medicine / acupuncture
General considerations / rationale
Degenerative myelopathy is due to Qi, Blood, Yin, and Essence deficiency in the Kidney, Liver, Spleen, and Stomach. The Spleen and Stomach produce the nutrients that in turn nourish the Muscles and Nerves and support the Kidney. Therefore, deficiencies in these organs lead to deficiencies it those structures. The Liver controls ligaments and the Spleen controls Muscles, so Blood and Yin deficiency in these organs leads to weakness and atrophy. The Kidneys control the Marrow or interior of Bones. The Spinal Cord is inside the Vertebrae, so this structure falls under the auspices of the Kidney. Qi deficiency in these organs defines the weakness seen in the condition. The Stomach also suffers from deficiency of Qi, preventing it from extracting enough Blood and fluids from food to reverse the pathology. There seems to be a genetic predisposition to development of degenerative myelopathy. It is most often seen in German shepherds. This suggests a deficiency of Essence, or genetic predisposition in Western terms.
Appropriate Chinese herbs
Achyranthes (Niu xi): Has anti-inflammatory effects. It can ameliorate egg white-induced foot swelling in rats, which may make it efficacious in decreasing inflammation in the spinal cord.
Licorice (Gan cao): Contains glycyrrhizin and glycyrrhetinic acid. These compounds have 10% of the corticosteroid activity of cortisone. If an autoimmune etiology is truly the cause, this property could be quite beneficial.
Milletia (Ji xue teng): May modify the immune system. It has an inhibitory effect on cellular immunity. It may decrease immune-mediated destruction of the nervous system.
Rehmannia / cooked (Shu di huang): Has anti-inflammatory properties and has been used for nervous system inflammation. It was one component of a supplement that also contained Rou cong rong, Lu han cao, Gu sui bu, Yin yang huo, Ji xue teng, and Lai fu zi that was used in 1,100 patients with myelitis. Seventy-three percent had significant improvement in clinical signs, and another 13% had moderate improvement.
Sichuan aconite (Chuan wu): Decreases inflammation.
Degenerative myelopathy is similar to multiple sclerosis in people. Acupuncture has been shown to help decrease symptoms in affected humans. Naeser (1996) reviewed studies in human medicine related to spinal cord disorders and multiple sclerosis. A total of 42 people participated in the various studies. Acupuncture was shown to improve incontinence and muscle spasms. One woman who had been unable to walk without assistance was able to walk short distances after 1 year of treatment. Clemmons (2006) has found that acupuncture therapy slows the rate of progression of the degenerative myelopathy in dogs.
General considerations / rationale
Degenerative myelopathy is a progressive Degeneration Phase disease with no known cure. Practitioners are unable to address such homotoxicoses until too late in the pathophysiology for cure. This condition may represent a genetic deterioration involving only a few breeds. Autoimmune disease is another possible cause. Theoretical approaches to such conditions involve draining the matrix, supporting organelle repair, and supporting energy metabolism.
The authors have not used homotoxicology as a sole agent to treat any patients with confirmed diagnosis of degenerative myelopathy, and are unaware of any published cases that have responded favorably in a measurable way. Success in assisting these patients has been reported by Wynn and Marsden using acupuncture, herbs, and nutriceuticals.
Clemmons feels there may be similarities to multiple sclerosis in humans, a homotoxicosis that has some history of therapy in homotoxicology. Unfortunately, many of the constituents of this experience are not available in the United States.
Classical homeopathic doctors have reported success in individual cases. While no controlled studies on homeopathy for degenerative myelopathy exist, further research may reveal useful information based upon known data on the use of aminocaproic acid and n-acetylcysteine (NAC) in conjunction with antioxidant therapy, Chinese herbs, and acupuncture as the desired foundational therapy.
Appropriate homotoxicology formulas
Aesculus compositum: Supports vascular tissues.
Arsuraneel: Useful when the patient feels there is no hope. Symptoms include weakness, exhaustion, disability, and polyneuritis. Contains Curare (also contained in Circulo-Injeel, Syzygium compositum, and Testis compositum).
BHI-Recuperation: Contains Causticum, Gelsemium sempervirens, and Plumbum metalicum, which are commonly indicated for weakness and paralysis.
Causticum compositum: Usually indicated for burns, radiation injuries, and other sharp burning pains, Causticum is useful for weakness of the rear legs and paralysis of single parts. Unsteady walking is a symptom. It is also contained in Barijodeel, Husteel, Neuralgo-Rheum-Injeel, Reneel, Rbeuma-Heel, BHI-Arthritis, BHI-Bladder, BHI-Recuperation, BHI-Tbroat, and BHI-Uricontrol. The ingredient Embryo suis has been used for muscular dystrophy. Other ingredients support chronic degenerative conditions.
Circulo-Injeel: Contains Curare for weakness and paralysis, as well as polyneuritis.
Coenzyme compositum: Supports metabolism.
Discus compositum: Combination remedy that supports connective tissue.
Echinacea compositum: May normalize inflammatory reactions.
Galium-Heel: Treats cellular diseases and provides matrix drainage. Contains Galium mollugo for detoxification. Also treats precancerous conditions. Echinacea augustifolia strengthens immunity and is used in inflammatory conditions. Useful in autoimmune conditions.
Gelsemium homaccord: Main remedy for rear leg weakness; trembling is common. Gelsemium is also contained in BHI-Back, BHI-Headacbe, BHI-Heart RX, BHI-Neuralgia, BHI-Recovery, BHI-Recuperation, BHI-Sciatic, Cerebrum compositum, Echinacea compositum, Spascupreel, and Spigelon.
Ginseng compositum: Treats weakness and exhaustion.
Glyoxal compositum: Depolymerizes homotoxins from receptors and enzymes and assists in energy production and receptor activation.
Graphites homaccord: Treats weakness in the lower back in overweight patients with history of skin affectations and constipation. Patients are easily chilled.
Lymphomyosot: Provides lymph drainage and immune support.
Lyssin-Injeel: Not available in the United States, but is included because this is homeopathically prepared rabies virus. Due to the possibility of progressive vicariation reactions resulting from vaccination, this remedy may prove helpful in some cases.
Medulla spinalis suis-Injeel: Nosode therapy for the spinal cord.
Neuralgo-Rheum-Injeel: Contains Silicea, and is a major remedy for vaccinosis. Also contained in BHI-Alertness, BHI-Migraine, BHI-Neuralgia, Cruroheel, Discus compositum, Spigelon, Strumeel, and Zeel.
Phosphor homaccord: Supports spinal weakness in thin animals that are prone to hemorrhage. Constitutional remedy.
Psorinoheel: Miasmic medicine that reaches deep homotoxicoses for all chronic diseases. Also act as an Excretion Phase remedy.
Schwef-Heel: Contains homeopathic dilutions of Sulfur, which activate blocked enzyme systems, assist in construction of structural substances of the matrix, activate blocked or stalled cases, and treat heaviness or paretic limbs.
Selenium homaccord: Treats weakness and exhaustion.
Testes compositum: Provides strengthening and drainage of the matrix in male patients with weakness. Contains Conium maculatum for ascending hindlimb ataxia, weakness, and hemiplegia. This also may be helpful for older dogs. Also found in Cerebrum compositum, Coc-culus compositum, Ginseng compositum, Rauwolfia compositum, Thyreoidea compositum, Tonsilla compositum, Ubicbinon compositum, Vertigoheel, BHI-Circulation, BHI-Dizziness, BHI-Ligbtheaded, and BHI-Stramonium Complex.
Traumeel S: Anti-inflammatory agent which activates blocked enzyme systems. Treats regulation rigidity.
Ubichinon compositum: Supportive of metabolism in cellular diseases and Degeneration Phase diseases.
Authors’ suggested protocols
Brain / nerve and immune support formulas: 1 tablet for each 25 pounds of body weight BID. These formulations contain glandular brain, adrenal, lymph, thymus, spleen, alpha-lipoic acid, L-carnitine, N-acetyl cysteine, phosphatidyl choline, and phosphatidyl serine.
The combination of these brain / nerve and immune support formulas contains the following nutrients per serving for a 75-pound dog:
Vitamin A — 3,750 IU
Vitamin E — 525 IU
Vitamin C — 750 mg
N-Acetyl Cysteine — 75 mg
Selenium — 105 meg
Lecithin — 300 mg
Phosphatidyl serine — 75 mg
In addition to the above 2 formulations which add multiple glandular support, Clemmons recommends adding the following nutrients and additional vitamins and minerals to those listed above to achieve his recommended, target dosage schedule of:
Vitamin C — 1,000 mg BID
Vitamin E — 2000 IU daily
Selenium — 200 meg daily
Vitamin B complex: Give high potency B-complex (with approximately 50 mg of most of the B components) to healthy dogs. Dogs with degenerative myelopathy should receive stress formula B-complex with 100 mg of most of the B components.
Coenzyme Q10: 100 mgs daily.
Fatty acids: Many versions of these substances are on the shelves of health food stores, from salmon oil to capsules of concentrated EPA. However, eating some cooked salmon or sardines may have benefits over capsular forms of the fish oils. Alternatively, dogs can be given ground flax seeds, flax oil, or hemp oil as a dietary supplement instead of fish oils. These materials reduce platelet function for a brief period in dogs, but it seems that dogs compensate for this within about 8 weeks. Omega-3 fatty acids replace the 2-series fatty acids over time. As such, cellular stimulation produces 3-series prostaglandins and thromboxanes. The latter does not cause inflammation nor does it reduce blood flow like the 2-series thromboxanes do. All dogs should receive 1,000 mg of fish oil capsule, 1 tablespoon ground flax seeds, or 2 sardines every day.
Gamma-linolenic acid: 500 mgs BID.
Lecithin / phosphatidyl choline: One-fourth teaspoon for each 25 pounds of body weight BID.
Oil of evening primrose: 1 capsule for every 25 pounds of body weight SID.
Blue-green algae: One-fourth teaspoon for each 25 pounds of body weight daily.
Chinese herbal medicine / acupuncture
The authors use a formula called Degenerative Myelopathy at a dose of 1 capsule per 10-20 pounds twice daily to effect. In addition to the herbs discussed above, Degenerative Myelopathy also contains Antler gelatin (Lu jiao shuang), arisaema / bile (Dan nan xing), astragalus (Huang qi), bamboo silicea (Tian zhu huang), centipede (Wu gong), citrus (Chen pi), dragon’s blood (Xue jie), earthworm (Di long), ginger (Ren shen), salvia (Dan shen), silkworm (Jiang can), and uncaria (Gou teng). These herbs help increase the efficacy of the formula.
The authors recommend the following acupuncture points: B118, BL23, BL30, BL60, ST36, Baihui, and GV4.
Homotoxicology (Dose.10 drops PO for 50-pound dog; 5 drops PO for small dog or cat)
The two protocols below are strictly experimental. The first is based upon current protocols used by Broadfoot; the second is based upon Reckeweg’s protocol for multiple sclerosis. Results, positive or negative, should be reported for further evaluation.
Broadfoot’s protocol for neurological degeneration:
Autosanguis Therapy (for the full procedure, see Advanced Homotoxicology: Autosanguis Therapy, chapter 33): (give half of each injection subcutaneously to patient and place the remainder in the symptom cocktail formula which follows below): Traumeel S, Galium-Heel plus Neuralgo Rheum, Circulo Injeel plus Engystol N, Discus Compositum, and Coenzyme compositum plus.
Ubichinon compositum. Give half of each injection subcutaneously to the patient and place the remainder in the following symptom cocktail:
Symptom cocktail: Phosphor homaccord, Gelsemium homaccord, Aesculus compositum, Ginseng compositum, and autosanguis (above) mixed together and given orally BID. Arsuraneel at 1 tablet BID orally.
Glyoxal compositum: 1 vial weekly. Circulo-Heel at 1 vial weekly.
Multiple sclerosis per Reckeweg:
Psorinoheel, Galium-Heel, Schwef-Heel, Graphites homaccord, Lymphomyosot mixed together and given 2 to 6 times daily. Injection therapy using Echinacea compositum (forte) and Cerebrum compositum every 2 to 4 days. Ubichinon compositum and Coenzyme compositum at intervals. Glyoxal compositum given once and repeated once change ceases. Medulla spinalis-Injeel (if available) given once weekly IM. Autosanguis therapy using the above-mentioned injections are recommended.
Brain / nerve and immune support formulas: Animal Nutrition Technologies. Alternatives: Immune System Support — Standard Process Veterinary Formulas; Immuno Support — Rx Vitamins for Pets; Immugen — Thorne Veterinary Products.
Coenzyme Q10: Vetri Science; Rx Vitamins for Pets; Integrative Therapeutics.
Lecithin / phosphatidyl choline: Designs for Health.
N-acetyl cysteine: Pure Encapsulations.
Blue-green algae: Simplexity.
Beyond essential fats: Natura Health Products.
Alternatives: Hemp oil — Nature’s Perfect Oil; Flax oil — Barlean’s Organic Oils; Eskimo fish oil — Tyler Encapsulations; Ultra EFA — Rx Vitamins for Pets; Omega-3,6,9 — Vetri Science; Evening primrose oil — Jarrows Formulas.
Chinese herbal medicine
Natural Solutions, Inc.
BHI / Heel Corporation