PDA

View Full Version : Bentley has an appt: UPDATED w/PSOM info 3/22



BarbMazz
19th March 2007, 04:26 PM
I've made the appointment to take Bentley to the vet for tomorrow afternoon at 3pm. I've printed out all the information from Karlin's SM website, and also information about PSOM.

I'm really wondering about PSOM because everything seems focused on his right ear lately. His ear looks very clean and clear but when I try to look inside with a scope he will yipe, and then look very apprehensive and tremble.

I've also got some short video of his weird hopping scratching. I'm feeling pretty nervous and upset about him right now. :cry*ing:
I know it's time to investigate his symptoms further as I do believe they have gotten more persistent in the last 4-6 weeks.

Cathy Moon
19th March 2007, 04:52 PM
Barb,
So sorry this is happening to you and Bentley. There are PSOM and SM studies at OSU veterinary college. We took Geordie and had him examined last summer and almost entered the PSOM study. While we were there we met several cavalier owners whose cavs are in the SM study. The study pays a significant amount towards the MRIs, if that is a consideration. Good luck tomorrow. :flwr: :flwr: :flwr:

Nancy
19th March 2007, 05:00 PM
Barb, have you discussed all this with his breeder? If it's who I recall it is, she is very knowledgable about these things.

BarbMazz
19th March 2007, 05:18 PM
Barb,
So sorry this is happening to you and Bentley. There are PSOM and SM studies at OSU veterinary college. We took Geordie and had him examined last summer and almost entered the PSOM study. While we were there we met several cavalier owners whose cavs are in the SM study. The study pays a significant amount towards the MRIs, if that is a consideration. Good luck tomorrow. :flwr: :flwr: :flwr:

Thank you, Cathy. How does one go about getting involved with a study like this?

BarbMazz
19th March 2007, 05:19 PM
Barb, have you discussed all this with his breeder? If it's who I recall it is, she is very knowledgable about these things.

Yes, she is very knowledgable. I've emailed her a couple of times lately about other things and I've not received any replies. I'll do so again about this. Thanks.

Nicki
19th March 2007, 06:21 PM
Barb, I'm so sorry for your concerns about Bentley - he's such a gorgeous boy.

I hope the vet appt goes ok, please keep us posted. I think you have done all the right things in monitoring his symptoms and especially in obtaining video, that will be most helpful.

I hope your vet will be supportive and that the breeder will support you too.

Sending positive thoughts and our love.

BarbMazz
19th March 2007, 10:12 PM
Barb, I'm so sorry for your concerns about Bentley - he's such a gorgeous boy.

I hope the vet appt goes ok, please keep us posted. I think you have done all the right things in monitoring his symptoms and especially in obtaining video, that will be most helpful.

I hope your vet will be supportive and that the breeder will support you too.

Sending positive thoughts and our love.

Thank you, Nicki, for your kind thoughts. My vet has several Cavaliers in her practice; I know she's aware of SM. I've taken printed material in to her before to read. She seems to be very open-minded, and is willing to discuss anything at all so I feel confident that she will be able to help me decide on a good course of action.

Here's a link to a short video clip of Bentley today. It's rather dark, but you can see the way he scratches..and always only on the right side.
http://s2.photobucket.com/albums/y41/BarbMazz/?action=view&current=000_0001.flv

The video is two minutes long. This particular scratching time continued for another three or four minutes. I took him outside right after making the video and he continued to scratch out there until he pottied. I would say that most days lately he scratches like this around six times per day

Caraline
19th March 2007, 10:29 PM
Barb, I am really sorry that you and Bentley have to go through this. I hope that you get some good news. I'll be thinking of you.

BarbMazz
19th March 2007, 10:31 PM
Barb, I am really sorry that you and Bentley have to go through this. I hope that you get some good news. I'll be thinking of you.

Thank you, Caraline. Your nice thoughts are appreciated!

Karlin
19th March 2007, 11:37 PM
I had thought I had posted something on this study to the SM site but I cannot find it so I guess not. You should definitely contact Dr Cole right away as that may cover an MRI. She seems very nice. You can mention I told you to get in touch -- I was in email correspondence with her but haven't had tome to get up something from her info sheet on PSOM.

http://www.ackcsccharitabletrust.org/research/psom.htm

Good luck on your visit tomorrow.

Karlin
19th March 2007, 11:39 PM
This is her info sheet on PSOM:


What is PSOM?

PSOM is a form of otitis media (inflammation of the middle ear) that seems to affect the Cavalier King Charles spaniel (CKCS) in particular. Due to the mucoid nature of the disease and the fact that it is uncommonly associated with disease of the external ear canal, the condition has been referred to as PSOM or "glue ear".

What are the signs and symptoms of PSOM?

PSOM has been described in 43 CKCS dogs in one retrospective study in the veterinary literature (Stern-Bertholtz W, Sjostrom L, Wallin Hakanson N. Primary secretory otitis media in the Cavalier King Charles spaniel: a review of 61 cases. J Sm Anim Pract 2003; 44: 253-256). The presenting signs described from most to least common included pain localized to the head and neck, neurological signs (ataxia [incoordination], facial paralysis [drooping of the ear or lip, drooling saliva, inability to blink the eye], nystagmus [involuntary rapid movement of the eyeball], head tilt, seizures), itching around the ears, infections of the external ears, impaired hearing, and fatigue. These are some of the same signs seen with syringomyelia or progressive hereditary deafness which are diseases also identified in the CKCS. At the current time, there are no specific clinical signs that are associated with PSOM only.

How does PSOM differ from the more common infectious otitis media?

The biggest difference between PSOM and infectious otitis media are the prior infections of the external ear (otitis externa) seen in dogs with infectious otitis media. Infectious otitis media is usually due to an extension of an infection of the external ear (otitis externa) through the ear drum (tympanic membrane) into the middle ear. The most common clinical sign of infectious otitis media is recurrent otitis externa, which may manifest as discharge from the external ear, odor, redness of the external ear, pawing or rubbing the ear, head shaking and pain on palpation of the ear. In some instances, neurological signs may be present, as described for PSOM.

How does PSOM cause hearing loss?

There are two types of hearing loss, one is conductive and the other is sensorineural. Sensorineural hearing loss is due to an abnormality of the cranial nerve responsible for hearing, while conductive hearing loss is due to something impeding the ability of sound to get into the inner ear to the cranial nerve. The mucus present in the middle ear in CKCS with PSOM can cause conductive hearing loss by impeding sound from getting to the inner ear. Once the mucus is removed, hearing is restored. Hearing loss may recur if the mucus accumulates in the middle ear again. In the aforementioned study, the middle ear had to be flushed of mucus on more than one occasion in most dogs. Therefore, at the present time, we are unsure of the recurrence rate of PSOM after a middle ear flush.

Can hearing loss due to PSOM cause behavioral problems or changes?

Hearing loss in children due to secretory otitis media (SOM), a disease that appears to be similar to PSOM, has been associated with changes in speech, language, cognition and behavior. Therefore, it is possible that the hearing loss due to PSOM in the CKCS could result in behavioral problems or changes.

How do I know if my CKCS has PSOM?

As stated above, the clinical signs can be quite variable. Neurological signs described above or acute loss of hearing would be an indication to seek veterinary attention.

What should I do if I think my CKCS has PSOM?

The first step would be to schedule an appointment for your CKCS with your veterinarian for evaluation. However, diagnosis of PSOM and distinguishing the clinical signs from other diseases usually requires the expertise of a veterinary neurologist and/or veterinary dermatologist. Your veterinarian should be able to help you find a neurologist and/or dermatologist in your area who can further evaluate your CKCS.

Is PSOM unilateral or bilateral?

It appears that most CKCS have bilateral involvement, but it is possible for the disease to be unilateral.

What is the age of onset of PSOM?

In the above retrospective study, most of the dogs (86%) were between 3 and 7 years of age at presentation, but the ages ranged from 2 to 10. At the present time we are unsure if it occurs in puppies, and do not know how long it has to be present before clinical signs occur.

How can PSOM be diagnosed?

At the present time, the best test for diagnosis of PSOM is a CT scan or MRI. However, these tests will only tell you if there is material (fluid, mucus, pus, or a mass) in the middle ear. Plain radiographs (x-rays) may be helpful, but are not as sensitive as CT or MRI, meaning that a dog may have material in the middle ear, but it would not be identified on the radiograph. To specifically identify the material seen on the CT scan or MRI as mucus, a myringotomy (incision into the ear drum) must be performed if the ear drum is intact. For these procedures as well as the myringotomy, the dog must be under general anesthesia. Most of the CKCS with PSOM have an intact, bulging ear drum. However, a non-bulging tympanic membrane does not rule out the disease. A video otoscope is preferred to the conventional hand-held otoscope for the ear examination, since the video otoscope magnifies and illuminates the ear canal and ear drum to allow for a more thorough evaluation of the ear canal and a complete view of the ear drum. However, a normal ear exam does not rule out PSOM. Functional auditory tests may be useful in the diagnosis of this disease and include brain evoked auditory response testing (BAER, or hearing test) as well as impedance audiometry (testing to determine the status of the ear drum and middle ear), but to date the predictive value of these tests has not been studied. We are in the process of getting funded for a study to evaluate numerous tests for the diagnosis of PSOM.

What happens if PSOM goes undiagnosed for an extended period of time?

Currently we do not know how long a CKCS may have PSOM before clinical signs occur, so we are unsure if any complications may occur the longer the disease is present. Further, it is possible that the condition may be present in some dogs who may never show any clinical signs of the disease.

How can PSOM be treated?

Treatment is aimed at removal of the mucus from the middle ear. This is done by flushing the mucus out of the middle ear with the aid of a video otoscope or operating microscope and suctioning the mucus out of the ear canal. The mucus can be challenging to remove from the middle ear and external ear canal. In most instances, the mucus appears to be sterile, however, I recommend culturing the mucus to determine is there is a secondary infection present in the middle ear.

Are there any medical treatments for PSOM?

In the aforementioned study, after the middle ear flush, a number of treatments were utilized (topical and oral corticosteroids, topical and oral antibiotics, mucolytics), but their efficacy in prevention or treatment of the disease is unknown. To date, the only treatment with known efficacy is middle ear flushing.

What complications may occur as a result of flushing the middle ear?

Complications secondary to the ear flush include facial nerve paralysis, Horner's syndrome (elevation of the third eyelid), balance problems (falling over, difficulty rising), and deafness. These complications are usually uncommon and can be minimized by having this procedure performed by a veterinary dermatologist that has experience in middle ear flushing.

What is the cause of PSOM?

At the present time, the cause of PSOM is not known. Due to its similarity to secretory otitis media in children, there may be an underlying Eustachian tube dysfunction causing the disease. The Eustachian tube is the structure that connects the middle ear to the nasopharynx and allows equalization of pressure (ventilation) in the middle ear with atmospheric pressure, drains secretions produced within the middle ear into the nasopharynx, and protects the middle ear from nasopharyngeal sound pressures and secretions.

Is PSOM a genetic disease?

It would appear that this breed is genetically predisposed to developing the disease, but the mode of inheritance in not known.

BarbMazz
19th March 2007, 11:47 PM
Thank you, Karlin, for the information! I think I may contact Dr Cole, it certainly couldn't hurt to gather the information.

Cathy T
20th March 2007, 01:19 AM
Barb - please know I am thinking about you and Bentley and hoping you find out what is going on.

Spencer'sMom
20th March 2007, 01:23 AM
Good luck tomorrow, Barb. Spencer and I will be thinking of you.

BarbMazz
20th March 2007, 03:02 AM
Thanks, Cathy and Whitney. I'll be sure to post about the appointment tomorrow as soon as I get home.

I do think I'm going to call Dr Cole about the PSOM study at OSU. OSU is a bit more than a couple of hours from my house. I would definitely be willing to drive down there!

Cathy Moon
20th March 2007, 03:11 AM
Thank you, Cathy. How does one go about getting involved with a study like this?
Here is a link with contact information
http://www.vet.ohio-state.edu/95.htm
I don't know the name of their new neurologist, but everyone there is very kind and helpful.

Dr. Lynette Cole and Dr. Andrew Hillier are in Dermatology, and they are doing the PSOM study. They work closely with the neurologist, who does the MRIs for the PSOM study.

I met several cav owners while there who get MRIs and check up for their cavs having SM.

Jen
20th March 2007, 11:40 AM
I'm really sorry you're dealing with all of this, but good for you for doing your homework and staying on top of it. Please keep us posted. Good luck! :flwr:

BarbMazz
20th March 2007, 08:20 PM
Just home from the vet. She checked him over really well. She watched the video, and agrees that something is definitely going on. His ears are both very clean and clear, which I knew. She said it's now up to me; to MRI or not to MRI.

She was not familiar with PSOM, and took the literature I gave her to look over. Here's a general PSOM question; do the dogs affected with this get outer ear infections that lead into this? Or, can they have PSOM when their ears look very clean, and they've NEVER had an outer ear infection?

I guess I would like some opinions.... If you were me, would you call OSU about the PSOM study? Would you MRI? For those of you who haven't, could you please watch the video I posted and let me know what you think?

Karlin
20th March 2007, 08:55 PM
Your questions are in the info sheet I posted I think. :) Outer infections do not lead to this; it is within the inner ear and hence the ear needs to be punctured and drained, often more than once, to get the glue-like matter out. The ';plugs' can be large or small. Plugs seem very common in CKCS -- they show up regularly on MRI scans. Both Leo and Jaspar have them.

I would go to OSU if you can -- either get on the study or consider a separate MRI. If you can get the MRI done and get on the study this would be very helpful to you and would at least get a major expense covered. What you do at that point I suppose depends on the results, what the study would include, and what route you wish to take.

I would say you DO need to see a neurologist and OSU is the best place to go in your region. As a neuro will review the study MRIs this is an ideal way to get the MRI done and a full consult. Also you would be helping research. :)

BarbMazz
20th March 2007, 09:05 PM
Thank you, Karlin. That's what I thought about the PSOM; I wanted to make sure I was reading the literature correctly.

I put a call in to Dr Cole since I posted last. It would certainly be silly not to, and if Bentley would be accepted into the study it would be super, both for him and to further research.

I'll post again as soon as I hear from Dr Cole.

I so appreciate the fact that you've taken the time to put this literature up here, Karlin. What would any of us do without this resource?!? Please don't ever go away! :flwr: :hug:

Spencer'sMom
20th March 2007, 09:19 PM
I'm glad your appointment went well, Barb. Spencer was MRI'd in February and diagnosed with CM or Chiari-like malformation. Most of the time I'm really glad I did it since it did answer a lot of questions that deep down I already knew the answer to. There are some days when I think we shouldn't have done it because I catch myself watching him like a hawk and measuring every little thing he does. I need to remember that he's a happy little dog who for the time being thinks nothing is wrong with himself. I need to let him live and enjoy every day I have with him.

I hope you're able to get in the PSOM study. One of the new vets at our general vet practice just came from OSU. She raves about the entire Clinical Services department and particularly the strides they're making in neurology. Give Bentley a big hug from me.

Alison_Leighfield
20th March 2007, 10:17 PM
Do the MRI and know just what you are dealing with.
At least that way you will resolve your own worries and will be able to give the right treatment to help him out.
For myself the worry before knowing is worse than actually finding out. The rest afterwards I can cope with.

Alison.

Karlin
20th March 2007, 11:53 PM
For myself the worry before knowing is worse than actually finding out. The rest afterwards I can cope with.

I completely agree with this. I was far more upset before I knew what was going on than after, as I now could make decisions rather than fear possibilities. I sometimes worry about what might happen... but what I learned from the months before I had the MRIs was: you can waste enormous time and energy worrying pointlessly about all the wrong things (I though Jaspar had SM. He doesn't and is totally clear. I never imagined Leo did. I foolishly wasted time getting upset over what Jaspar was experiencing when all along it was Leo. And Leo was perfectly happy, and undoubtedly was better off being treated like a normal dog and allowed to lead a normal dog's life).

There are plenty of things to work for and care about that are a lot more constructive and rewarding than worrying about what may never happen. So I do my best not to worry but always am reviewing possibilities so that I have a range of game plans and I hope, never have to make sudden, unexpected decisions for Leo. I do what I can to stay on top of research and thinking, keep Leo happy and healthy, and support those who are doing the research that will give this breed a future. :thmbsup:

BarbMazz
21st March 2007, 01:35 AM
For myself the worry before knowing is worse than actually finding out. The rest afterwards I can cope with.

I completely agree with this. I was far more upset before I knew what was going on than after, as I now could make decisions rather than fear possibilities. I sometimes worry about what might happen... but what I learned from the months before I had the MRIs was: you can waste enormous time and energy worrying pointlessly about all the wrong things (I though Jaspar had SM. He doesn't and is totally clear. I never imagined Leo did. I foolishly wasted time getting upset over what Jaspar was experiencing when all along it was Leo. And Leo was perfectly happy, and undoubtedly was better off being treated like a normal dog and allowed to lead a normal dog's life).

There are plenty of things to work for and care about that are a lot more constructive and rewarding than worrying about what may never happen. So I do my best not to worry but always am reviewing possibilities so that I have a range of game plans and I hope, never have to make sudden, unexpected decisions for Leo. I do what I can to stay on top of research and thinking, keep Leo happy and healthy, and support those who are doing the research that will give this breed a future. :thmbsup:

Alison and Karlin; truer words were never spoken! I know I'm in a state of worrying over Bentley, and I have a wonderful :roll: imagination. I was so nervous today before this vet appt, which was totally silly. I think I will do my best to get him included in this study. If that doesn't work I'll have to find the way to afford the MRI.

Cathy T
21st March 2007, 03:49 AM
Barb - no special words of advice. I'm thinking of you. And it's really not unexpected for you to feel the way you do. Not knowing really puts our minds into overdrive!! I think you've gotten some good advice. Keep at it....you'll find out what is going on...and you will deal with it. :hug:

BarbMazz
21st March 2007, 12:10 PM
Barb - no special words of advice. I'm thinking of you. And it's really not unexpected for you to feel the way you do. Not knowing really puts our minds into overdrive!! I think you've gotten some good advice. Keep at it....you'll find out what is going on...and you will deal with it. :hug:

Thank you, Cathy. I know myself, and I'm a person who needs to know what is going on. Like Alison said, my imagination gets me in trouble, but once I know what's going on I can make the decisions that need to be made. It's the unknown that drives me batty!

Shay
22nd March 2007, 04:30 AM
Barb...Just know that I am thinking of you and Bentley and hoping for the best possible outcome for Bentley. :hug:

BarbMazz
22nd March 2007, 12:26 PM
I spoke with Dr Cole yesterday, and here's the info on her OSU PSOM study:

First, she is very nice and professional. She asked if Bentley had any of three things:
1. evidence of hearing loss
2. true neurological signs, such as drooling, head tilt, eye blinking, falling, limb weakness
3. air scratching, or persistent scratching at the ears.

Bentley has #3 without a doubt, and I'm thinking he may have some hearing loss. A dog only needs to meet one criteria to enter into the first phase of the study.

The study of the dog takes place over two days. The first day is evaluation day to see if they will proceed with the study. It consists of a general exam by, a neurological exam, a cardio exam and bloodwork. The charges for this are at the owner's expense; $240.00

If the dog passes the initial evaluations, the second day consists of
1. CT scan (Dr Cole said this is the "gold standard" for diagnosing PSOM)
2. an ultrasound of the ears
3. BAER hearing test
4. an impedimence (sp?) audiometry hearing test
5. another ear test where air is puffed against the eardrum

All of the above are done under general anesthesia. They do not look at the CT results until all tests are completed. I believe they try to determine PSOM using the other testing methods BEFORE looking at the CT results, otherwise the study would be colored. After the completion, they study the CT results to determine if the dog does, in fact, have PSOM. I think they compare these results against the other test results to see if they were able to determine PSOM using methods 2-5. The tests on the second day are free of charge.

If the dog is determined to have PSOM, they do the procedure to remove the mucus plug; slit open the eardrum and flush out the plug. They then do another CT to determine if the plug was completely removed. They ask you to stay over the second night, or to leave the dog there, until they are certain there are no complications before the dog travels again.

She told me it was my choice to have Bentley stay at the clinic or in the hotel with me. Since I'm about 3 hrs away, I'll stay in a hotel, and he'll stay with me there. I told her I was interested. She is booked through May, and will be determining June's study dates shortly. She'll be contacting me as soon as the dates are known.

I could kick myself, but I didn't ask her if the SM study is ongoing. I did mention SM, and told her I wasn't sure if the signs he is showing are possibly SM. I am going to put another call in to her today to ask about the SM study.

Shay
22nd March 2007, 12:47 PM
I'm, wondering Barb if those test will determine if he has SM as well? It sounds wonderful if you can find all of that out for such a low fee. I wish we had something like that close to me. I have suspected for some time that Lily has something going on, not sure what. I watched your video and she does exactly what Bentley does, in addition to some other things. It seems to be becoming more frequent, up to many times a day. She is only 7 mos old. My Vet wanted me to wait until she was a little older, and to watch her for more symptoms before he referred my to a neurologist. I will be very interested in Bentley's outcome from this study. I hope you are accepted into the study. Please keep us updated. I am wishing the best possible outcome for Bentley. :flwr:

BarbMazz
22nd March 2007, 12:52 PM
I'm, wondering Barb if those test will determine if he has SM as well? It sounds wonderful if you can find all of that out for such a low fee. I wish we had something like that close to me. I have suspected for some time that Lily has something going on, not sure what. I watched your video and she does exactly what Bentley does, in addition to some other things. It seems to be becoming more frequent, up to many times a day. She is only 7 mos old. My Vet wanted me to wait until she was a little older, and to watch her for more symptoms before he referred my to a neurologist. I will be very interested in Bentley's outcome from this study. I hope you are accepted into the study. Please keep us updated. I am wishing the best possible outcome for Bentley. :flwr:

Thank you, Shay. You're SO nice :flwr:
I've just sent off an email to Dr Cole asking her if the PSOM study can determine if SM exists as well. On the phone yesterday, she did confirm that SM and PSOM can truly mimic one another. I then asked her if the OSU SM study is ongoing, and if, in her opinion, I should approach Bentley problems from both angles. PSOM and SM can and do co-exist. I let you know as soon as I hear back from her.

Give Lily a hug and a kiss on the nose for me, would you?

Alison_Leighfield
22nd March 2007, 12:52 PM
If the dog is determined to have PSOM, they do the procedure to remove the mucus plug; slit open the eardrum and flush out the plug..


...and sometimes this surgery needs to be done more than the once...and even after this the build up can return (relapse), a bit like glue ear in children. It doesn't always have 100% results first time.
If it's only the deafness thats showing with PSOM (Primary secetory otitis media) and nothing else is bothering them then I don't think myself that I would interfere. :flwr:

Thinking of you both Barb, :flwr: hugs for Bentley (((X)))

Alison.

BarbMazz
22nd March 2007, 01:00 PM
If the dog is determined to have PSOM, they do the procedure to remove the mucus plug; slit open the eardrum and flush out the plug..


...and sometimes this surgery needs to be done more than the once...and even after this the build up can return (relapse), a bit like glue ear in children. It doesn't always have 100% results first time.
If it's only the deafness thats showing with PSOM (Primary secetory otitis media) and nothing else is bothering them then I don't think myself that I would interfere. :flwr:

Thinking of you both Barb, :flwr: hugs for Bentley (((X)))

Alison.

Thank you, Alison. Dr Cole explained the reason they do the second CT scan is to determine that the plug is completely removed. She seemed to feel that makes a difference in whether the plug returns or not.

I think I would rather this be PSOM than SM. He is obviously feeling something that's causing the scratching and headshaking. I hope he's not in too much discomfort. :(

Shay
22nd March 2007, 01:05 PM
Thanks Barb I will, and likewise to Mr. Bentley. :flwr:

Karlin
22nd March 2007, 03:12 PM
None of those tests will tell if there is SM I'm afraid. Only an MRI can reveal syrinxes. The neurological exam could verify that there are neurological problems though that lean toward an SM diagnosis, if there's no PSOM.

It is standard for them to need to repeat the procedure at least once on many dogs -- just so you know this is very common. I hadn't heard that a CT scan for the absence of the plug improves the success rate -- but this may be the case or may be something they are trying to verify. I always understood the plug rcan reform for reasons not understood.

That is interesting that they include air scratching as I had understood from other folks that this usually is not seen with PSOM but Dr Cole is definitely the expert on this odd condition, so I will change what I have told people in the past.

I would def. go ahead with this study. OSU is def. doing SM work still as well but I don;t know what phase they are at and oif they are taking new cavaliers into thr study. I think the study went on hold when their neuros all went elsewhere over time and they only just got a new person in recently. The Cavalier Health Trust funds some of the OSU research but hasn;t been very clear in what is going on, who is participating, or what any of the results have been over the past few years. icon_nwunsure

BarbMazz
22nd March 2007, 03:24 PM
None of those tests will tell if there is SM I'm afraid. Only an MRI can reveal syrinxes. The neurological exam could verify that there are neurological problems though that lean toward an SM diagnosis, if there's no PSOM.

It is standard for them to need to repeat the procedure at least once on many dogs -- just so you know this is very common. I hadn't heard that a CT scan for the absence of the plug improves the success rate -- but this may be the case or may be something they are trying to verify. I always understood the plug rcan reform for reasons not understood.

That is interesting that they include air scratching as I had understood from other folks that this usually is not seen with PSOM but Dr Cole is definitely the expert on this odd condition, so I will change what I have told people in the past.

I would def. go ahead with this study. OSU is def. doing SM work still as well but I don;t know what phase they are at and oif they are taking new cavaliers into thr study. I think the study went on hold when their neuros all went elsewhere over time and they only just got a new person in recently. The Cavalier Health Trust funds some of the OSU research but hasn;t been very clear in what is going on, who is participating, or what any of the results have been over the past few years. icon_nwunsure

Here's my email and the reply I received from Dr Cole this morning re; PSOM/SM correlation:
On 3/22/07 8:46 AM, "BarbyM@aol.com" <BarbyM@aol.com> wrote:

>
> Hi, Dr Cole
> We spoke yesterday about my CKCS, Bentley, entering the PSOM study. Thank you
> for the detailed information. It really helps me to know exactly what will be
> happening to my little guy while he's there. I am anxious to determine just
> what's going on with him.
>
> Since SM and PSOM can mimic one another, and can also co-exist, I have a
> question; are you able to determine if SM is also present when you do the PSOM
> study? And, if not, are there any SM studies ongoing at OSU? I'm wondering if
> I need to explore both possibilities? I'd appreciate your opinion.
> Thanks again! Barb

Hi Barb,

If we determine that Bentley does not have PSOM, or if he does have PSOM but
the clinical signs do not improve with the middle ear flush, then we would
consider SM as a cause of the clinical signs. When we do the CT scan, if
there are signs of SM, then the dog does have it....if there are NO signs
noted, that does not mean the dog does not have SM, and an MRI would need to
be done to determine if he had it or not. Right now, we do not have any SM
studies going on here at OSU.....

Hope this helps

Dr. Cole

I am definitely going to do the initial day of the study with Bentley. If he is eligible to continue to the second day then I will definitely do that, too.

Research is certainly tricky, isn't it?!? I can see the researchers must be very, very careful not to jump to any conclusions, and the results can be so foggy! My respect level is definitely rising for the doctors and researchers who struggle to maintain scientific method cleanliness!