Diseases of the Bernese Mountain Dog
Ageing and Senior Dogs
OVERVIEW OF AGING IN THE BERNESE MOUNTAIN DOG BREED
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Common health problems of aging Bernese Mountain Dogs
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)
The section on DM below was updated on March 25, 2019 - author permission granted.
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.
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University of Missouri in collaboration with OFA, VetGen, DDC and others test for the more common mutation only. GenSol has tests for both mutations. We recommend testing for both mutations. To order the test kit(s): http://www.gensoldx.com/#!blank/cffr (DM kit tests for the more common mutation, SOD1B kit tests for the more recently identified mutation).
Links
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.
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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.
Management recommendations may be found at https://ivcjournal.com/integrative-management-degenerative-myelopathy/. 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
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
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)
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
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.
Management of common musculoskeletal and neurological problems in senior BMDs
Aging Bernese Mountain Dogs, just as any aging large-breed dog, may be faced with one or more conditions that may affect their ability to get around comfortably in their environment. Often these issues are musculoskeletal, such as arthritis, or neurologic, such as lumbosacral stenosis, but may also be the result of a combination of these two closely related systems. Pain is often associated with these conditions, further limiting what the dog may be capable of doing. In this article we discuss various treatment modalities and the interplay of these modalities as well as techniques possibly to prevent these conditions from worsening.
When we have an affected senior dog, it is important to make the distinction between a musculoskeletal problem and a neurologic problem, as this will help define what treatment modalities will bring the best success. The goals of treatment should include controlling inflammation (and subsequent pain), increasing range-of-motion, increasing flexibility and proprioception (awareness of the position of one's body), and strength training.
We have all experienced pain, whether it is post-operative, trauma-related, or degenerative, such as arthritis. It is not so easy to get into rehabilitation when there is pain, so this is certainly something that needs to be addressed early on in our senior Berners. There are many oral medications, herbs and supplements that may be given alone or in combination to control pain and inflammation, ranging from Non-Steroidal Anti-inflammatories (NSAIDs, such as Rimadyl, Deramaxx, Previcox, Metacam and Aspirin), to steroids, to analgesics (Tra-madol, Amantidine, Gabapentin, Codeine and morphine-like drugs), to anti-inflammatory herbs (white willow, feverfew, turmeric, boswellia, celery seed, cayenne and devil's claw), to enzymes such as
​bromelain and papain that may help to "digest" inflammation. These oral forms of treatment could be used for painful conditions such as arthritis, chronic Lyme disease, trauma, chronic muscle pain, and some neurologic disorders such as intervertebral disc disease and lumbosacral stenosis, among others. Injections of Cortisone and Legend® (hyaluronic acid) directly into joints may also help manage pain and inflammation. Legend® is an equine product that may also be given intravenously. Physical modalities such as acupuncture (with or without injecting into trigger points), reiki, laser and microcurrent are also excellent at controlling inflammation and pain. TENS (Transcutaneous Electrical Nerve Stimulation) and NMES (Neuromuscular Electrical Stimulation) units are both used for chronic pain as well as muscle rehabilitation. Controlling pain will not only make the senior pet feel better, but it will make your job as the caretaker easier and more rewarding, motivating you to help them even more!
While pain may be somewhat managed with the above-mentioned medications, often it is only putting a band-aid on the problem. Without addressing the specific systems involved and attempting to return them to some function, the pain management will be temporary, at best. Once inflammation is decreased, it is crucial to begin to increase flexibility, balance and range-of-motion, thus increasing strength, which by itself will help to keep pain and inflammation under control. Chiropractic techniques will reduce subluxations (incomplete or partial dislocation, as of a bone in a joint), therefore increasing range-of-motion and decreasing pain and inflammation. Underwater treadmills and swim therapy, when available, are excellent ways to increase propriocep-tion and strength. Along with that there are many at-home exercises that may be done using a physioball or theraball that will help with core and trunk strengthening, stretching and overall strength training. Sometimes simply getting a dog to walk over a bunch of poles, or over pillows or couch cushions, will aid in strengthening their proprioception. This would be helpful in dogs with Degenerative Myelopathy. There are several good DVDs by Debbie Cross Saunders and Chris Zink that describe these exercises. Certainly the adage "move it or lose it" applies here.
Supplements may be used alone or in combination, as well as with other modalities, in the prevention and management of musculoskeletal and neuromuscular diseases. Probably the most familiar and widely known group of these would be the chondroprotectants. These help nourish joint spaces, keeping them fluid, as well as helping to decrease inflammation locally, therefore preserving joint integrity. Examples would be glucosamine and chondroitin (Cosequin® and Dasuquin®), pernna muscle, Adequan® (Polysulfated glycosaminoglycans) and hyaluronic acid. These may be started in Berners early in puppyhood, although some advocate waiting until growth is complete. They are readily available, very safe and well tolerated. Fish oils, or omega 3 and 6 fatty acids, are also commonly used in patients with musculoskeletal and neurologic disease, as they have good anti-inflammatory properties and are easily administered. Antioxidants are also widely used for both musculoskeletal disease and neurological disease. Green tea, a common antioxidant, is given in capsule form, while others used may include coQ10, pycnogenol, n-acetyl-cysteine, alpha lipoic acid and broccoli seed extract. Nutritional supplements such as MSM (often in combination with glucosamine and chondroitin), magnesium (used to relax tense muscles), malic acid and vitamin C may be used; silica promotes tendon strength and cetyl M may be used in cases of severe arthritis.
Keeping your senior dog's environment as safe as possible is an often overlooked aspect of management. Obviously care should be taken with steps, slippery floors and jumping on furniture. Some senior dogs may benefit from the use of various braces, slings and ultimately carts, if the loss of function is severe. Boots may allow an unstable patient to gain traction on slippery surfaces and have increased mobility as a result. Specially fitted neoprene braces may help to stabilize an unstable joint, allowing for increased comfort and movement.
While this is by no means an exhaustive list, it introduces the idea that there are many treatment options available to keep our senior Berners comfortable and moving about. Controlling pain and inflammation by itself is not enough for long-term management. A treatment plan should also include appropriate strength training, proprioception, balance and range-of-motion work. Musculoskeletal and neurologic disease may exist together or by themselves, and combinations of traditional and alternative therapies may be used to treat them.
Feeding your senior dog
Ask ten veterinarians their opinion on nutrition, and you are likely to get ten different answers. It is an area that is, at best, barely touched in most veterinary school curricula; and when taught, it is often presented in the context of herbivore nutrition. Much of what is learned by veterinarians is learned in practice, from continuing education, journals, trial and error, and yes, prescription pet food representatives. It is virtually impossible to stay current with all of the available diets, whether it is from a grocery store or a pet store. More often than not, when an owner is questioned about what diet he or she feeds the family dog, the answer is "the one in the green bag." This article will offer alternatives to the "green bag" approach to feeding senior dogs and dispel a myth or two along the way.
Dogs are carnivores, much like their cousins, the wolves. They have short gastrointestinal (GI) tracts, and therefore a fast transit time through the GI tract. Dogs are also a predatory species; from an evolutionary standpoint, their diet has included things like rabbit, deer and mice along with the bones, organ meat and the GI contents of these meals. Berries, nuts and roots also are a part of the evolutionary diet. Carbohydrates are minimal. Carbohydrates have slower transit times than proteins and they are digested in the large intestine, conducive to an herbivore diet, but not a carnivore diet. These needs must be considered when looking at senior nutrition.
The senior dog should have a comprehensive medical evaluation at least biannually. This will help to identify possible preventable diseases as well as address other diseases in their early stages. A thorough nutritional assessment should be part of this evaluation. Factors may be identified that put the senior dog at risk for malnutrition. Body weight, body condition score (BCS), a good oral exam (not just teeth, but gums, tongue and lips), and evaluation of the hair coat and skin should be done. Bloodwork will help identify potential problem areas or deficiencies. Keeping a food diary (including treats and supplements) may help your vet evaluate your pet's diet. The diet should then be looked at in the context of the individual dog's needs – for instance, overweight or inactive dogs should receive fewer calories. In general, the Maintenance Energy Requirements (MER) decrease by 20-25% in most geriatric dogs. There are plenty of very active seniors that maintain high energy requirements and are exceptions. A key consideration that drives the MER is lean body mass (LBM), which includes skeletal muscle. The LBM often will decrease with age. If a pet's energy needs decrease, but their energy intake remains the same, the pet will become overweight. This can be a significant problem in older BMD's as it adds considerable strain on potentially arthritic joints. Most commercially available senior foods contain reduced dietary fat and calories. Some will even have added fiber, which helps to reduce the caloric density. In reality, this may not be the best thing for our senior pets.
It has been held by most veterinarians that protein is not a good thing for senior pets and that restricting protein will help protect the kidneys. Research has proven this incorrect, and protein restriction is NOT necessary in older, healthy dogs. In reality, protein turnover may increase in older dogs, supporting the need for more dietary protein. When the dietary intake of protein is not sufficient for protein synthesis, the body responds by breaking down and mobilizing protein from lean body mass. This is called catabolism. These animals are in a protein-depleted state and may be more susceptible to infections and toxins due to an incompetent immune system, which depends on protein. Aging itself has a detrimental effect on protein turnover. When the calorie count of a diet is reduced, the percentage of calories from protein must increase in order to maintain the same protein intake. Since older dogs tend to consume smaller amounts of food, that diet needs to have a higher percentage of protein to meet their needs. At least 25% of calories should come from a good quality, highly digestible protein.
Some age-related diseases may be prevented by nutritional modification. Patients with cardiac disease should be on sodium-restricted diets. Dietary phosphorus should be restricted in dogs with chronic renal failure as this will slow the progression of the disease. Dogs with liver disease should have lower dietary protein to avoid hepatic encephalopathy. The most significant health benefit seen with nutritional modification is the prevention of obesity, which in turn may prevent secondary disease.Keeping the above ideas in mind, we can now talk about types of diets. As veterinarians, we have available and may offer several types of prescription diets.
There are diets that promote cognitive function, improve joint health and mobility, slow the progression of kidney disease, aid dogs with digestive issues such as inflammatory bowel disease, and restrict caloric intake. These come in the form of dry or canned foods. While dry foods are certainly convenient, the extrusion process used to make them may render some of the vitamins inactive. Canned foods, while a bit messier, will generally offer more protein and be more digestible. Recently, grain-free dry foods have reached the market. These are being marketed as an alternative for people who want to feed raw, but really can't. They are very high in protein, averaging 40-42%, and may not be suited for seniors for the above reasons. Home-cooked diets offer the ability to control the quality of the ingredients in their dog's diet. They should consist of 40-60% meat protein, 10% organ meat, 10-20% leafy vegetables, 20-30% fibrous vegetables and 5% fruit. Vitamins, minerals, essential fatty acids and calcium must also be supplied. Raw diets, often referred to as BARF (Biologically Appropriate Raw Food) offer live enzymes, phytonutrients, antioxidants, vitamins and minerals, and are composed of meat, bones, vegetables, offal and supplements. Along with home-cooked diets, raw diets require preparation time. Dehydrated diets, also available, remove only the water component, while maintaining the vitamins, nutrients, enzymes and phytonutrients.
While considering the dietary management of senior pets, supplements should be addressed. Probiotics, with or without digestive enzymes, may be offered. Essential fatty acids, kelp, alfalfa, algae, vitamins C,B,E and glucosamine and chondroitin are important in keeping our senior Berners nutritionally sound.
Authors
Toby Erlichman, VMD, and Carol Lundquist, DVM