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She has degenerative myelopathy and has developed severe…

Customer Question
She has degenerative myelopathy...

She has degenerative myelopathy and has developed severe anxiety at night. She rarely sleeps through the night now, and my parents and I are not sure what to do. Our vet proscribed melatonin and xanax, and that helps a little, but I am really hoping to find something that will help her sleep through the whole night. Nobody is getting good sleep

Veterinarian's Assistant: I'm sorry to hear that. Could be a lot of things that cause lethargy. The Expert will know how to help the dog. What is the dog's name and age?

Lethargy? Was that a typo?

Veterinarian's Assistant: Is there anything else the Veterinarian should be aware of about the dog?

Did you see my other message? She is not lethargic.

Submitted: 11 months ago.Category: Dog Veterinary
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Answered in 12 hours by:
9/10/2017
Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 11 months ago
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 35,538
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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You're speaking to Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

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Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 11 months ago

Rebecca, I'm sorry that your question wasn't answered in a timely manner and I'm sorry to hear of this with your dog. I understand your frustration. When a benzodiazepine such as alprazolam isn't as helpful as we would like, we're left with a true tranquilizer such as acepromazine which acts as an anxiolytic (an antianxiety drug) by tranquilization rather than being a true anxiolytic. Acepromazine can be prescribed by your vet and dosing will need to be titred so as to provide the appropriate effect yet not sedate to the point that excessive somnolence (sleepiness) arises. Dosing is variable at 0.25 - 1 mg/lb every 6-12 hours but many of us think that dosages at the higher end of this range are too high.

You appear to be describing sundowners syndrome - a form of cognitive dysfunction in dogs and humans. It's conjectured that the dark and quiet of night magnifies the sensory loss in these patients which results in their anxiety and subsequent vocalizing, aimless wandering, and other misbehaviors. Other indications of cognitive dysfunction include disorientation, changes in social and interactive behavior - becoming "needier" or, conversely, more aloof - changes in locomotor and sleep cycle behaviors, and loss of housetraining.

Unfortunately, this is a progressive disorder and often vexes caretakers unable to control inappropriate behavior. If additional medical problems exist - brain tumor, e.g. - seizures may arise and prompt the need for anticonvulsant drugs.

Ancillary care involves physically and mentally stimulating exercises such as swimming, massage, and range of motion exercises, encouraging relaxation, ensuring that she is taken out frequently to minimize the cost of elimination "mistakes", encouraging reestablishment of daily cycles by feeding at regular hours and at least a few hours before bedtime, and administering the alprazolam before bed. Specialized diets rich in antioxidants may be of value such as Hill's Prescription Diet b/d. The monoamine oxidase inhibitor selegiline (Anipryl) is the only drug licensed for use for the treatment of canine cognitive dysfunction in the States. Many of us aren't impressed with the studies supporting its use, however.

Cognitive dysfunction in dogs is just as difficult to manage as is Altzheimer's in humans. I wish I had some magic for your dog. Please respond with further questions or concerns if you wish.

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Customer reply replied 11 months ago
Thanks for your reply. She actually slept pretty well last night. I will talk to my vet about the meds you mentioned. I'm not sure if she has CCD or if the anxiety is related to her DM, though. I've read that Sundowning can sometimes occur in dogs with DM also. My parents and I have thought about trying to keep her mentally stimulated when we are not home with puzzle toys, like a kong full of peanut butter. Perhaps she won't feel so antsy during the day that way.
Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 11 months ago

You're quite welcome. Yes, the more physically active she is during the day the more likely she'll sleep better at night. I understand that keeping a dog with DM active can be a challenge, however. Yes, illnesses cause anxiety in dogs. I would expect that anxiety to manifest at any time of the day, however, unlike Sundowner's which manifests solely at night. Please continue our conversation if you wish.

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Customer reply replied 11 months ago
Well, she does seem to have bouts of anxiety sometimes during the day, but it just seems more pronounced at night. I guess it's just hard to tell if she has CCD too. She definitely is not really into toys as much any more, but even when she was younger she didn't play with them all the time: she's always been more of a cuddle bug. And the change happened sort of around the time when she began to have trouble walking by herself. I can't really tell if she's disoriented because she still seems to know where we keep food and where the rooms are and where the doors go outside are. She's definitely more needy than she used to be.
Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 11 months ago

Yes, there's likely to be a combination of factors at her age. Basic diagnostics in the form of blood and urine tests +/- imaging in the form of X-rays (chest) and ultrasound (abdomen) might be considered but MRI is the diagnostic of choice when investigating the brain.

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Customer reply replied 11 months ago
Would an MRI actually show evidence of CCD? I thought it was similar to Alzheimer's in that it was hard to find hard evidence prior to death?
Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 11 months ago

Not necessarily. There would need to be an anatomical change - shrinkage of the brain, brain tumor, e.g. - for MRI to find. Neuroimaging is also used to exclude other causes of dementia, such as normal-pressure hydrocephalus, subdural hematoma, and multiple infarctions.

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Customer reply replied 11 months ago
Oh, I see. Thanks for all your help
Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 11 months ago

You're quite welcome. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.

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Customer reply replied 11 months ago
Ok, thanks
Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 11 months ago

It's my pleasure.

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