By Toby Erlichman, VMD, and Carol Lundquist, DVM
When we are blessed with a Bernese Mountain Dog that lives beyond its seven to nine-year predicted lifespan, we may be confronted with a multitude of other chronic health-related problems. In this article, we address the conditions of degenerative myelopathy, urinary incontinence, hypothyroidism, cognitive dysfunction syndrome and dental disease. Subsequent articles will discuss the topics of nutrition and osteoarthritis in greater depth. Each topic will be discussed from the perspectives of traditional, western medicine as well as holistic and alternative therapies.
Degenerative Myelopathy (DM) is an immune-mediated condition most commonly associated with German Shepherds and Pembroke Welsh Corgis, but the reality is that as our Berners are living longer, we are seeing it with increasing frequency. Degenerative myelopathy is characterized by hind end ataxia (loss of coordination) and weakness that may wax and wane or be steadily progressive. There is no cure. There often is hind end muscle atrophy, and fecal or urinary incontinence may be present. DM is believed to be an autoimmune disease with enough similarities to Multiple Sclerosis in humans that DM is considered MS of dogs. While the diagnosis of DM may be suspected based on clinical signs, definitive diagnosis comes, unfortunately, only with necropsy.
There are tests available from:
the University of Florida (http://neurovetmed.ufl.edu/ neuro/DM_Web/DMofGS.htm), and
the University of Missouri (http://www.cvm.missouri.edu/neurology/dm/) that will help identify carriers as well as affected dogs.
One must keep in mind that most of the data used in development of these tests comes from German Shepherds, so there may be false positives and false negatives.
The treatment of DM is multi-faceted, combining exercise, diet and traditional medications as well as vitamins and supplements. In addition, lifestyle and management changes such as using area rugs, keeping nails short and hair between the toes trimmed and using harnesses for support all help to make dogs with DM more comfortable.
Exercise is critical to maintaining muscle tone and improving circulation. Walking and swimming are very beneficial, with swimming taking the stress off joints, while improving muscle tone. Underwater treadmills offer the most effective form of water exercise. An exercise program must be started gradually because these patients may need time to allow stressed muscles to repair. Chiropractic and acupuncture are also very beneficial. Diet modifications may also help dogs with DM. Elimination of toxins from pre-processed food may help the immune system stabilize in dogs with DM. Recommendations for a homemade diet may be found at http://neurovetmed.ufl.edu/neuro/DM Web/DMofGS.htm.
Recommended supplements are also listed there and include vitamin B-complex, yeast, antioxidants such as vitamins E and C, selenium and omega-3 fatty acids.
Two medications have shown good success in the management of DM - aminocaproic acid (EACA) and n-acetylcysteine. These can be formulated into easy-to-dose forms by a compounding pharmacy. Stress reduction is also critical in the management of DM patients.
Urinary incontinence may be seen alone or in conjunction with other diseases such as DM. Senior dogs should be checked often for urinary tract infections. The best approach is for your veterinarian to perform a cystocentesis, which obtains a sterile urine sample directly from the bladder. Bacteria, as well as bladder stones, may be found and need to be treated as soon as possible. When not associated with a bacterial infection or bladder stones, urinary incontinence may be the result of diminished innervation to the bladder, urethral sphincter incompetence (common in older spayed females), bladder or urethral tumors or simply difficulty posturing to urinate. Antibiotics, where appropriate, dietary changes to dissolve crystals, urethral toning drugs such as phenylpropanolamine or non-steroidal anti-inflammatory drugs (NSAIDS) to treat bladder tumors may be prescribed by your veterinarian. Chiropractic and acupuncture, with or without electrical stimulation, are very effective for urinary incontinence. Herbals, such as wild yam, are also beneficial. There are several other herbal preparations available to help maintain urinary tract health.
Hypothyroidism, or underactive thyroid function, is common in middle age to older dogs and seen with relative frequency in Bernese Mountain Dogs. Common signs include weight gain, despite normal appetite, lethargy, poor hair coat, possibly including skin infections, and heat-seeking behavior. Thyroid function may be tested with a blood test - several are available, but the most comprehensive one is done at Michigan State University. Holistic treatment of hypothyroidism includes a healthy, balanced diet, kelp as a source of iodine, thyroid and adrenal glandulars and removing cruciferous vegetables and soy from the diet. The traditional approach involves the use of synthetic thyroid hormone replacement with a drug such as Soloxine.
Cognitive Dysfunction Syndrome (CDS) may also appear in our aging Berners. Common findings are changes in sleep/wake cycles, house soiling, withdrawing from family interaction, not greeting owners when returning home and even forgetfulness. CDS has been likened to Alzheimer's disease. A healthy diet, fish oil, B vitamins, antioxidants and Choline may help. There are several herbal preparations that may also be useful such as Memoractiv and Neurochondria. It is very important to make lifestyle and environment changes to insure the safety of these pets. Selegiline or Anipryl may also be prescribed by your veterinarian to treat CDS.
Dental Disease, including gingivitis and periodontitis, are extremely common in aging pets and can cause tooth loss as well as chronic pain. Infections may start in the mouth and travel via the blood stream to the heart, liver and the kidneys causing significant disease in these organs. The most notable sign of dental disease may be halitosis, or bad breath, but a look inside the mouth will reveal red and inflamed gums as well as plaque and tartar. Frequent brushing at home, as well as scaling by your veterinarian, will help prevent this from advancing. Dental radiographs will reveal bone loss and abscesses that may not be readily visible. Antibiotic therapy will help with the bacterial load in the mouth, and in some dogs may be administered in "pulse" fashion, with dosing at regular intervals through the month. Holistic products such as ozonated olive oil are very effective for gingivitis, and there are natural tooth sprays that are available. Appropriate diets, fish oils and antioxidants are also very effective in preventing dental disease.
While this is by no means an exhaustive list of problems seen in senior Bernese Mountain Dogs, it represents some of the more commonly seen ones and how they may be approached by traditional means as well as alternative therapies. Lab work, including blood and urinalysis, will help your veterinarian determine what the problem may be. This should be done every six months on senior pets.