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maneumann
15th November 2007, 01:45 AM
We have a darling little cavalier named jack Sprat who is only 7 months old and was diagnosed with SM at 5 months. He is doing rather well now that he is on medication (still showing symptoms especially in the am, but not screaming very often and walking normally vs. the 3 leg bunny hop he was developing prior to the meds).

We are traveling to Aspen soon for a ski trip, and would like to bring him along as he hates to be left behind! He would of course travel with us, not cargo, but I know this condition renders them sensitive to pressure changes. I asked Jack's neurologist at UC Davis and he was unsure how the plane would affect him.

So my question is, has anyone who has a dog with SM noticed an increase in their discomfort when traveling on a plane?

Many thanks in advance for the feedback.

ppotterfield
15th November 2007, 03:13 AM
Cathy Moon just had experience with Charlie traveling from California back to Ohio. I get the impression it was a rough trip. Do not know whether it had to do with cabin pressure or what. Cathy: If you see this, perhaps you can help. If she does not, you might send her a private message, as she is very busy right now with Charlie post-surgery.

Karlin
15th November 2007, 05:22 AM
I spoke to Clare Rusbridge on Cathy's behalf and she (Clare) asked a human SM expert. The human expert said that generally he didn't think the altitude would necessarily affect a dog because it would be in a pressurised cabin. However some people have definitely noticed side effects and atlitude can have other effects too. For a symptomatic dog, I' really not be inclined to fly unless absolutely necessary -- not because of the cabin preesure necessarily, but also because flying is going to be stressful and stress causes increased CSF pressure and that is what causes the pain episodes and the worsening of syrinxes. I'd only fly an SM dog to transport it for needed medical treatment if driving wasn't an option, but definitely not for holidays, etc. I'd be looking for a home boarding situation or a friend who could mind him.

I'm sorry to hear your little fellow has an SM diagnosis. I'm not sure what your treatment approach is longer term, but you are probably aware that for dogs showing such early symptoms, that medications probably won't be helpful for very long. Those of us with SM dogs (that includes me) base treatment decisions on many factors (and in my case I have two SM dogs which I treat medically) and it is a very personal deicison. But whenever anyone mentions really young dogs having pain episodes before age one, I do try to make sure they're aware of the arguments in favour of decompression and the high likelihood of rapid decline on medication alone, as all evidence is showing the earlier severe young dogs have surgery, the better the outcome.

maneumann
15th November 2007, 06:55 AM
Thanks for the responses -- I had a feeling it would not be a particularly good idea. Jack is just starting a diet from Monica Segal, an animal nutritionist who also happens to have a cavalier with SM, and he starts acupuncture next week. Our hope is that we can get him to one year so that he can have the surgery. We were told by our neurologist that if we did the surgery before he was full grown, that the symptoms could actually worsen and the syrinx could also reform. So at the moment, all we are able to do is treat him medically (with gabapentin and predisone) and hope. Poor little guy, I know his chances are not good being diagnosed so young. Heartbreaking. At any rate, I really appreciate the advice... I read everything I can, but there are so many unknowns and talking to people who have dogs with SM is so helpful. Thank you.

Cathy Moon
15th November 2007, 11:48 AM
I asked our neurologist if it would harm Charlie to fly home with me to Ohio (I adopted him from California), and he said it would be okay. I think he referred to the brain and spinal cord as a 'closed hydraulic system.'

Flying with Charlie was a bit of a nightmare because he has very severe SM symptoms, he didn't know me very well, he didn't want to be in the carrier, and he was in pain. He was sedated, but I found I had to give him additional Valium every two hours, which was more than the instructions said. At one point we were in peril of being removed from the plane after boarding because of Charlie's vocalizations.

I'm with Karlin; I would only fly a dog having SM if it was for medical treatment.

Karlin
15th November 2007, 05:06 PM
Hmmmm. On the contrary, my understanding from talking regularly to the leading experts on SM in cavaliers is that the earlier surgery can be performed, the better the outcome, and that a dog under one is a much BETTER candidate than older dogs precisely because it is still maturing and hence can bounce back faster, just as children tend to cope better with many surgeries than older people and heal faster. I have *never* heard that waiting is a better choice or that a growing cavalier is more likely to reform scar tissue. If anything a severely affected young dog is more likely to acquire significant damage during that waiting period that can never be corrected after surgery and may not even make it to the one year point. Cathy's Charlie is an example of a dog that was diagnosed at about 5 months and by the time he was 12 months he was having severe pain episodes despite medication and by the time he had his surgery, last week, had significant damage. We are all hoping he will get some reversal of some of his severe symptoms but if he had been done at 5 or 7 months his prognosis almost surely would have been hugely improved and he'd not have all the problems he now has. :( He was a rescue dog and the rescue people opted not to go ahead with surgery at the time. Cathy had the surgery within a week or two of adopting him.

I'd really, really recommend getting a second opinion from a neurologist very familiar with SM. Unfortunately there are few in California -- Dr Kortz is one and he sometimes is at UCD but I would consider at least speaking to Dr Harrington in Washington state, who has done many SM surgeries. I know the leading experts on this condition, such as Dr Rusbridge, Dr Dewey and Dr Marino, would immediately get such a young dog into surgery as a high priority. Clare believes some of the very good results Dr arino and Dewey are getting with their surgery is because they are doing it on much younger dogs rather than dogs who have suffered with the symptoms and consequent increasing permanent damage. Children also get the decompression surgery regularly. Scar tissue forms in about 20% of all cases in adults as well as younger dogs and in all the existing research the youth of the dog has never been cited as a higher risk for scar tissue formation.

If nothing else I would abslutely insist your neuro talk to Dr Dewey or Marino or speak to them yourself, as they have done dozens of surgeries, many on quite young dogs.

Clare has done the surgery with good results on a 12 week old. Her paper looking at longer term results found no difference at all for outcomes between young and older dogs but she told me recently she does feel younger dogs probably will have better outcomes because the earlier they are done, the less damage.

Screaming sessions fall on to the severe end of the pain scale the neurologists agreed upon at the London CKCS SM conference last year, and thus I'd be moving very fast to do the surgery if surgery were at all being contemplated.

maneumann
15th November 2007, 05:36 PM
I will get a second opinion immediately and let you know. Thanks for the names!!!

Karlin
16th November 2007, 06:41 PM
Checked with Dr Clare Rusbridge in the UK and she says she would definitely operate on a young dog. :thmbsup: She is the leading expert on this condition in CKCS.

maneumann
17th November 2007, 12:40 AM
Thank you, you are so kind to do that (not to mention adopting a dog with SM!)! Now I am getting terribly confused which is half the problem with SM, because I spoke with Dr. Harrington yesterday, who told me he saw better result with dogs over 1 year and recommended that I continue with acupuncture and medication unless Jack’s systems started rapidly progressing. He also told me that Dr. Kortz would be best since he is in CA and if there were complications, the proximity would serve us well. Additionally, we said a successfully surgery was relief for approximately 2 years (which corroborated what I read on a study housed on the cavalierhalth.org). If that is the case, and that is probably also open for debate, am I doing Jack a favor to operate on him at 7 months to give him 2 years?

I’ve called Dr. Kortz and hopefully will hear back form him soon. And Jack has his next appointment on Tues. with his neurologist at UC Davis, so I think your suggestion to have him call Dr. Rusbridge is right on the money. Given that she is the leading expert, unless there is an anomaly in the case, operating now is a strong argument. But, the 2 year prognosis is also grim. Has that been what you’ve witness or heard s well, or a more optimistic number?

Again, thank you for all of your help and advice… I can’t tell you how helpful it is. Make a decision is very difficult, so to have more quality information is invaluable.

Kindest regards,
Mary Ann

Karlin
17th November 2007, 01:43 AM
Well, the details of that study, which is probably Clare's, is in order. What Clare has said is that she generally begins to see about 50% of cavaliers have *some return of symptoms* by two years -- NOT that they only live two years and are then euthenised. I would guess this is what Dr Harrington meant. She has cavaliers 7 years out from the surgery now. Most need some medical management because of permanent damage already caused by waiting. Dr Harrington would probably differ from Dr Marino, Dr Dewey and Dr Rusbridge on the opinion of waiting. But as in any branch of medicine all practitioners have different opinions and the patient or the owner ends up having to weigh up their own feelings and where they want to place their trust. I would guess the three doctors above have done more decompressions however than Dr Harrington and also have certainly published more widely and presented at conferences. But they all differ too in other ways -- Clare often feels dogs can be managed medically that Drs Marino and Dewey would do decompressions on. I take Dr Harrington's point that waiting might be advisable IF there's no further or very little decline (though I've never heard of age being an issue), but personally, I would think a young dog showing signs as severe as screaming is probably going to decline over an additional 5-6 months. The really difficult thing is not knowing what will happen.

The best surgical outcomes seem to be coming from the special version of decompression done on the east coast by Drs Dewey and Marino and documented on their website, http://www.livs.org/livsnews.htm (http://www.livs.com). It seems so far to prevent the return of scar tissue which probably is what causes the return of symptoms. However they do not have long term results on this surgery yet. It more closely follows what is done for humans however and the use of a titanium mesh is quite standard to prevent scar tissue in humans.

You can read Clare's paper on following 16 dogs with the surgery on www.smcavalier.com (http://www.smcavalier.com) in the section on research, then on London 06. Also you can read about the LIVS surgery. The relevant bit of Clare's paper, which has since been published I believe:


Two months after surgery, 80% (12) had improved.
7 out of 12 maintained their improvement
1 of the 12 had tonsillar carcinoma and was euthenised
4 of 12 deteriorated between .2 to 2 years post-op
2 of those were euthenised
Of the 3 out of 15 that were unchanged, 2 deteriorated between .8 to 2.3 years post-op

In summary:
• 7 (47%) out of 15 dogs deteriorated to some degree, between .2 to 2.3 years post-op; the mean is 1.3 yrs; and two were eventually euthenised as a result
• Of the 15, 12 are still alive. One is 6.5 years post-op (mean = 2.5 years)

rory
18th November 2007, 03:52 PM
Jack Sprat!!! It's Rory's mom, Kendall - I'm a vet student and met you at UC Davis when you had your appoint with Dr. King and I talked to you about my dog, Rory. Too bad they didn't recommend surgery, although I figured they wouldn't. They are not big on the surgery there. But the truth is - with a dog as severely affected as Jack Sprat, you have few other options. I'd keep up with the meds and acupuncture but if he continues to decline, I'd seek a 2nd opinion and try to get him in for surgery as soon as possible. Even being a student at UC Davis, I got about 5 different opinions (and yes - they were all different!) from different neurologists.

Like Karlin said - as with most medical conditions, everyone has a different opinion on how to treat it! It can be quite frustrating as a pet owner but that's where your own proactivity must come in. You have to be your pet's best advocate.

I wish I was going to be there when you come in for your recheck on Tuesday, but unfortunately I'll be driving back up from San Diego. :(

Anyway, if you have any other questions, feel free to email or message here!!

-Kendall

maneumann
19th November 2007, 03:13 AM
Hi Kendell! So nice to hear from you. Did Dr. Harrington operate on Rory? We are also waiting to hear back from Dr. Kortz and I was hoping to ask Dr. King to call Dr. Rusbridge directly too. I'm starting to feel like surgery is the only option as JS is progressing, but still really having good days and the screaming is still 1-2 second and now only once every 3 days. That said, he still obvoisuly has all the other symptoms, scratching, gaging, yawning, etc. in plenty and the scrathing seems to be getting more frequent and longer. He also clearly has times where he is not feeling so keen, when he just lays around with his eyes open and does not want to move.

My biggest concern is "quality of life" post surgey. You seem to have had lots of luck with Rory, but I've also heard the opposite. :( Any thoughts?

Best,
MA

Karlin
19th November 2007, 07:27 AM
Dr Harrington did Rory's surgery.

Clare's article gives a pretty good summary of a range of dogs and how they improved, if they improved, etc. Most people I know who have had surgery for their dogs are very glad they did so.

maneumann
20th November 2007, 05:10 PM
Jack Sprat has an appointment with Dr.Kortz next Monday for a second opinion. I'm keeping my fingers crossed!

Best,
MA

maneumann
20th November 2007, 09:19 PM
Dr. King (Jack's UC neurologist) is the best! He said he would call Dr. Rusbridge to discuss Jack's case with her and Dr. Kortz has a association with UC Davis, so he will also get his opinion.

Anyway, I wanted to thank everyone for their advice and encouragement so that we can be sure we are doing all that we can for little Jack Sprat.

Cathy T
21st November 2007, 12:22 AM
Good for you! Do keep us posted, I'll be thinking about Jack Sprat (love that name!!)

natalieandmike
23rd November 2007, 10:56 PM
Hello--just wanted to check in. Rory's mum Kendall and Karlin have been a wealth of advice here, but as you know, you'll get a lot of opinions. I opted for decompression surgery on Bianca because she was starting the 'air scratching' and 3 legged bunny walk with some sensory irritation around her neck at about age 7-8 months or so..it didn't seem to be worsening, but I didn't want to risk her progression to the point of yelping, so I opted for the surgery. She is less than 2 weeks post op now and I swear (other than the ugly sutures and BAD supercuts hair cut!) she is doing FANTASTICALLY and you'd never have known she had surgery.

ISo, IMHO, I'd say go for the surgery. Nerve damage, once done, is generally permanent and best to avoid in the first place. Hoping for the best for you. take care!:dogwlk:

maneumann
24th November 2007, 04:46 AM
That is great to hear regarding your puppy! I'm still waiting to hear back from Dr. King; I don't think he has consulted the other 2 neurologist yet since Jack went in on Tuesday and it is Thanksgiving. I'll call him next week Wed., if I've not heard back from him before then. I am leaning towards the operation. By the way, how much does it cost? I'm guessing $6K-$8K.

Jack actually seems to be doing well (perhaps the acupuncture or home-cooked diet?), but he has more energy and is eating the right amount of food for the first time in weeks!

natalieandmike
24th November 2007, 02:08 PM
Well, like anything on the West coast compared to us in the Southeast, it's probably more expensive over there compared to here! But our surgery ran us about $4500 (that included Mri for $1500 and surgery for $3000). I was given a quote that surgery costs would be between $3000 and $4000 depending on complications, ICU time, etc. Luckily we were on the lesser end! I imagine in academic centers that expense might be a bit less, we went with a private neurology center since I liked them.

Oh, BTW, it's a bit late now, but for Bianca we had bought PetPlan health insurance and they are covering 80% of the cost less a $200 deductable! They reimbursed us in about 3 weeks for the MRI and we're waiting on the reimbursement for the surgery. In the future, it might be a consideration--I am really glad we got it. Good luck with your pup--it's a hard decision and I applaud you for doing the very best for him that you can...
Natalie and Mike

maneumann
24th November 2007, 07:30 PM
That is much better than I had expected! Jack Sprat had an MRI at 5 months, and his doctor has suggested a CAT scan prior to surgery. Also, did you do the surgery immediately after your puppy was diagnosed with SM? When she was 8 months? Did the neurologist warn against the bone growing back and a repeat surgery or was he/she very pro surgery?

It is too late for us on the pet insurance sadly, but we are on a waiting list for a second cavalier, a ruby, from a breeder who MRIs her breeding stock. That puppy will get insurance! Which type do you have?

Many thanks!

natalieandmike
24th November 2007, 08:42 PM
Our Bianca has very mild symptoms, and presented with some symptoms around 8 months or so, but I did elect to watch her for a couple of months to see if it got better. I kept a log. It really didn't seem to progress, but I noticed that they weren't getting better. Frankly with her mild symptomatology I was torn. But I felt that as she was so early on presentation, she may have progressed and that was enough for me. I couldn't have stood it if I saw her yelping. I'm a 'regular MD' so I was pretty familiar with nerve injury and surgery, so it didn't really scare me. I just wanted to make sure I was doing the right thing in my mind. Again, though, ti's a personal decision. I opted not to try medication because I thought that rX would partially 'mask' her symptoms and it would be more difficult to really assess whether she was progressing. She is 14 months now. I had the surgery done about 2 weeks ago. Basically I would have liked to do it about a month earlier, but life got in the way. And by the time you see the neurologist, followup-, other opinion, etc...and then schedule the surgery, it'll take about a month. At least that was how it worked around here.

I have PetPlan and I highly recommend it. I believe my underwriter even has a Cavalier and specifically it does NOT exclude MVD, syringomyelia, etc. which is why I went for it. It's not available in all states. Others mentioned Embrace, and PetCare--I don't know much about these, so I'd suggest reading on them if they're your other options.

Our neurologist was very pro-surgery given the fact that he feels most dogs progress without it. He has handled many cases and feels most comfortable with the surgery. By the time we got her there, she was about a year, so there wasn't any issue with 'growing', etc. I don't think he'd be averse, though, to having done it at less than a year, given his general 'pro-surgery' approach though. Again, you may find different opinions. I'm very pro-surgery myself because of my experiences. So I may be biased!:p

Take care. Let us know how Jack sprat does, we'll be thinking about him.