PDA

View Full Version : Madison diagnosed through MRI with SM



Bridam
12th January 2008, 08:49 PM
Hi. I'm new here. Our three year old girl was just diagnosed with SM.

Madison is three and has been showing mild symptoms for the last two years. She scratches many times a day, exhibits bunny hopping, walks a little funny, tucks in her rear, and will yelp occasionally when she's being picked up. We haven't notice much clinical progression over the years.

We have very good (and expensive) vets and have spent the last two years back and forth trying to find a resolution. We got side tracked with allergy testing and shots. It turns out that our baby is allergic to everything. Only after going through allergy treatment protocol did we convince the vet to recommend an MRI.

Her results came back a few days ago and the physical prognosis was far worse than we expected. The imaging report stated that she is severely affected by the disease. She has severe chiari. Her cerebellum has herniated. She has syrinxes covering 95% of her spinal cord.

After consulting with various neurologists including Dewey and (I believe) Rusbridge, our vet was not confident that, given Madison's lack of pain, the risk of surgery and recurrence outweighs the benefits. We are currently following Rusbridge's medical protocol and are giving her diuretics.

I've had read everything I can that's available online and have several questions about Madison's prognosis given the severity of the syrinxes. I've read of course that the clinical progression is variable and that surgery is often not indicated unless there are signs of pain. But, is there any reason for the syrinxes to get any worse at this point now that she is fully grown?

On the other hand, I am worried that, given the severity, if we wait too long, we'll find ourselves with no options. At what clinical and physical point are people getting the surgery?

Cathy Moon
12th January 2008, 09:49 PM
I'm so sorry for what you're going through with Madison.

Has a neurologist examined her yet? I would take her to see at least one neurologist for a neurological exam to find out if she has any neuro deficits and neuropathic pain, and to get an opinion on medical treatment or surgery.

I have a severely affected cavalier, Charlie, who recently had decompression surgery. From what I understand, the surgery will not make the syrinxes go away. It will only relieve the pressure on the brain and spinal cord from the back of the skull.

Charlie's neurosurgeon told us they get better results when the surgery is performed earlier in the disease. In other words, the longer the dog is symptomatic before surgery, the less successful the outcome.

Bridam
12th January 2008, 11:42 PM
I'm so sorry for what you're going through with Madison.

Has a neurologist examined her yet? I would take her to see at least one neurologist for a neurological exam to find out if she has any neuro deficits and neuropathic pain, and to get an opinion on medical treatment or surgery.

I have a severely affected cavalier, Charlie, who recently had decompression surgery. From what I understand, the surgery will not make the syrinxes go away. It will only relieve the pressure on the brain and spinal cord from the back of the skull.

Charlie's neurosurgeon told us they get better results when the surgery is performed earlier in the disease. In other words, the longer the dog is symptomatic before surgery, the less successful the outcome.


Thank you for your response. She hasn't been examined by a neurologist yet. My vet said there wasn't much point. Madison isn't showing severe clinical symptoms at this point. They have looked at her MRI and we didn't get good feedback. We were told that there isn't enough evidence that the surgery has long term positive results.

The local neurosurgeon who has done a handful of these here in Dallas told our vet that she has had to perform second surgeries on more than half her patients due to recurrence.

Karlin
13th January 2008, 12:00 AM
For Madison's sake, I will stick my neck out here and say your vets are wrong. Whatever your ultimate decision, you really do need a neuro consult especially with this severe an MRI if you want to make an informed decision on Madison's future -- neurologists will have a much better idea of what is going on and also a clinical exam by a neuro will likely reveal additional problems developing that vets cannot spot -- such as limb weakness, poor gait, pain points along the spine. Basically, vets are not specialists and this is a specialist disease. Most vets will never see a case of SM in their careers so they can be understandably misinformed.

On pain and how much damage has been done: dogs can compensate for the extremities of pain they would otherwise feel with the type of MRI your girl had because progression is slow -- but nonetheless, they are still burdened with a heavy weight of neuropathic pain. If you know any people with this, they will explain how debilitating this type of chronic pain is. Dr Marino showed a slide of a dog in at October's SM conference in Rugby, UK where he noted that if that dog just suddenly received an injury that caused that many syrinxes the dog would probably not live through the pain.

Syrinxes have been partially resolving with Dr Marino and Dewey's surgery. even when the syrinxes don't resolve the point of the surgery is to relieve pain and the removal of some of the skull to get rid of the herniation and hind brain pressure seems to accomplish that for about 80% of dogs at least within the first year.

The neurologists who met at the first SM conference in London in 2006 were unanimous on the point that dogs that are symptomatic before age 4 tend to be the most severe cases and develop the most pain. If you have an MRI like this now, I would go in and talk to Dr Dewey or Marino if you are driving distance of LIVS, and do so as a matter of urgency. I know from attending these events and talking to these neurologists as well as many people with SM dogs that younger dogs with severe MRIs often will suddenly go downhill -- even within days or weeks. Their CSF flow is so compromised by syrinxes and the herniation and malformation that at any point any small progression can cause them to crash.

Treatment is always a very personal decision but I think with younger symptomatic dogs with poor MRIs the feeling amongst neurologists is definitely that surgery probably offers the only chance for anything like a medium to normal lifespan and a decision to opt for medications instead needs to be understood in that context. Vets incidentally do not have the skillsets to accurately read and interpret MRIs so really you need a neuro to explain the MRI to you and discuss prognoses. It sounds like they may not be very familiar with the overall literature and papers given in the past two years on the surgery either -- Dewey and Marino have been having very good results so far (though have only been doing their specialised version of the surgery for about 2 years but all dogs are doing really well! Clare Rusbridge has about 50% doing very well post surgery up to 7 years after, with some having some return of symptoms but that being fairly manageable on medications. Only a small portion of dogs do not do well and those tend to worsen within a few months of the surgery. That's a very high rate of second surgeries by the surgeon mentioned -- usually the figure is more like 20%. Dr Marino feels many do not remove enough of the dura and thus scar tissue reforms so perhaps it is technique? Dewey and Marino to my knowledge have only needed to perform a second surgery on one dog in two years and that was due to a separate issue. Marino discusses it in his talk on the CDs noted below.

I'd have a look at paper 9 by Rusbridge and the Marino presentation after it from London 2006 here on my SM site:

http://sm.cavaliertalk.com/research/london/london06.html

Also you might be interested in the CDs of the Rugby conference as both Clare and Dominic Marino discuss surgical outcomes:

http://www.cafepress.com/cavaliertalk/4311456

Bridam
13th January 2008, 12:16 AM
Thank you so much. This is why I've been spending my nights searching out more information and looking for those caring individuals going through the same thing.

I'm inclined to get a second opinion but believe my vet's opinion was based on conversations with Dewey and Rusbridge. But there is no harm in getting a second opinion. I want her around for as long as possible. Thank you,

ppotterfield
13th January 2008, 10:18 PM
I do not have a dog who has been diagnosed with SM but our Bud Bud has had PSOM which at one time I feared may be SM. SM has not been totally ruled out but he is essentially asymptomatic since his PSOM surgery so :xfngr:.

Treatment decisions are so difficult and it is particularly difficult when you feel you must go against the advice of a Vet who may have been caring for your dogs for a long time and may have become a friend. If I were in your situation, I would want to confirm who has seen and read the MRI and if it has not been seen by a neurologist with extensive SM experience I would want to make certain that it was AND I would want to have a consultation with the neurologist, by telephone if necessary, not just have my Vet talk to him or her.

Am I correct from your post that you are in Dallas, Texas? Any one on the list have advise on a Vet neurologist in Texas or the Southwest that may be a good specialist to see Madison?

Best of luck to you and let us know what you find out.

Bridam
14th January 2008, 12:34 AM
Thank you. Tomorrow we are going to start looking for a local neurologist with experience with this disease to take over treatment/monitoring of this condition. It makes sense.

We'll start by calling the ones listed on this site. If anyone else has any other recommendations in Texas, it would be appreciated. Thanks,

Karlin
14th January 2008, 12:51 AM
In Texas, I would recommend:

Dr. Carley J. Abramson
Gulf Coast Veterinary Specialists
1111 West Loop South, Suite 160
Houston, TX 77027
Tel: 713-693-1111; 713-693-1122
E-mail: drabramson@gcvs.com
www.gcvs.com


She has been involved in considerable research on SM in cavaliers when she was in Ohio. Good luck and let us know what feedback you get. There are no 'wrong' decisions -- but it can be very hard to make the right decision for us and for our dog. It needs to be a mix of both, and with this condition, there's rarely a definite answer. But I'd only make a decision with a neurologist's professional opinion. They also differ in approach and technique, so it takes further weighing up of what seems right in each individual case.

Bridam
14th January 2008, 01:37 AM
In Texas, I would recommend:

Dr. Carley J. Abramson
Gulf Coast Veterinary Specialists
1111 West Loop South, Suite 160
Houston, TX 77027
Tel: 713-693-1111; 713-693-1122
E-mail: drabramson@gcvs.com
www.gcvs.com (http://www.gcvs.com)


She has been involved in considerable research on SM in cavaliers when she was in Ohio. Good luck and let us know what feedback you get. There are no 'wrong' decisions -- but it can be very hard to make the right decision for us and for our dog. It needs to be a mix of both, and with this condition, there's rarely a definite answer. But I'd only make a decision with a neurologist's professional opinion. They also differ in approach and technique, so it takes further weighing up of what seems right in each individual case.

Thank you. We'd really like to find someone in Dallas as this will be a long haul (I hope) but if there is no one here with experience, we'll make the drive!

Karlin
14th January 2008, 01:52 AM
I also checked Cavalierhealth.org. and she is the only one listed that is known to have SM experience (noted in red).

http://www.cavalierhealth.org/neurologists.htm#Texas

She would definitely be highly recommended though -- one of a handful in the US with strong SM experience both in practice, as a surgeon and in research.

Bridam
14th January 2008, 01:56 AM
I also checked Cavalierhealth.org. and she is the only one listed that is known to have SM experience (noted in red).

http://www.cavalierhealth.org/neurologists.htm#Texas

She would definitely be highly recommended though -- one of a handful in the US with strong SM experience both in practice, as a surgeon and in research.

I'm sold. It's just that my wife is pregnant and I work 70 hrs/week. It will be hard to make five hour trips. Once you get though the initial consultation, how often, on average, are people making return visits? I'm sure it's highly variable but it would be nice to know what we're getting into before we take the plunge.

ppotterfield
14th January 2008, 03:18 PM
I do not know for certain, but would anticipate that much of the follow-up care can be handled by a Vet in your area in consultation with the specialist. I would try for a telephone consultation with Dr. Abramson, who might be able to recommend someone in Dallas you could work with, or could give you a pretty good idea of how often you would need to make the drive back and forth from Dallas to Houston. Folks outside Texas (but never Texans) forget how big Texas!

Again, best of luck.

Bridam
14th January 2008, 04:19 PM
Thank you all very much. I called Dr. Abramson's office. When she calls me back, we'll see what we can do.

On another note, I really fear that she's starting to progress. She yelped for the first time last night jumping off our couch. And, she stopped wanting to jump on the couch. Small signs, I understand. It could also be that we are now hypersensitive. But, if these things bother me so, I can't imagine watching severe pain episodes.

Spencer'sMom
14th January 2008, 06:23 PM
Spencer has CM and sees his neurologist every three months.

Bridam
15th January 2008, 02:53 AM
I spoke with Dr. Abramson. She's very nice and I was impressed with her knowledge. She's done both shunt and decompression surgeries and has even combined them. She said that she'd have no problem monitoring Madison over long distance once we come up with a game plan.

I'm sending her the mri tomorrow and will try to make the trip as soon as possible--maybe even MLK day (I get it off). I'll keep you all updated. Again, my sincere thanks for steering me in the right direction.

ppotterfield
15th January 2008, 02:57 AM
Glad you got in touch with her. Keep us posted. We will keep you and Madison (and expected human baby) in our prayers.

Bridam
16th January 2008, 02:43 AM
Thank you all for your kind words. We have an appointment with Dr. Abramson for next Friday. It gives me some peace of mind to know that we are doing everything we can--although the above post about quick degradation gives me some pause. In the meantime, here is a puppy pic from almost three years ago:

http://render-2.snapfish.com/render2/is=Yup6G0G%7C%3Dup6RKKt%3Axxr%3D0-qpDofRt7Pf7mrPfrj7t%3DzrRfDUX%3AeQaQxg%3Dr%3F87KR6 xqpxQQQGx0lnxGPlxQQQG0lnGPlnnnqpfVtB%3F*KUp7BHSHqq y7XH6gX0QQ0e%7CRup6aQQ%7C/of=50,296,442

Claire L
16th January 2008, 11:04 PM
Don't have any advice to offer. Just want to let you know that I'll be keeping you all in my thoughts and prayers :hug:

Bridam
26th January 2008, 04:38 AM
Here is an update after consulting with Dr. Abramson today.

We made our way back and forth to Houston today (about 8 hrs). GCVS is an amazing facility that seems top notch. The feel is more like a hospital than a vet's office--very reassuring.

Dr. Abramson was very nice and extremely knowledgeable. She performed an exam and watched Madison walk up and down the hall. Madison showed normal gait and propioception in all limbs. Reflexes and cranial nerve function were normal. Dr. Abramson noted a right-sided head tilt and pain during cervical palpation, however. Clinically, Dr. Abramson classified Madison as mild at this point with no general pain (this made my wife very happy).

Her view of Madison's MRI confirmed that Madison has severe chiari with hydrocephalus and syrinxes (about 90% of her spinal cord).

We discussed both surgical and medical options. If we go the surgical route, she recommends a combo shunt/decompression surgery: the shunt aimed at reducing the hydrocephalus. In discussing this with her, we learned that she has performed many shunts. Her background was very impressive and she conveyed confidence in her abilities while being very respectful of the delicate nature of the spinal cord.

Medically, she put Madison on Prednisone and took her off the salex (as we've seen no improvement).

My wife and I have a lot to think about and want this to sink in before we make any decisions. Our goal, of course, is to keep Madison from deteriorating. We'll keep you guys updated on what we decide.

Whatever we do, we're very happy that we finally got Madison seen by someone with as much expertise as Dr. Abramson who will be taking over all care for Madison concerning this condition. For pushing us in the right direction, we sincerely thank you all.

Karlin
26th January 2008, 12:49 PM
I'm really glad you spoke with her -- it makes a huge difference to talk to a neurologist who is very knowledgeable and experienced in this particular condition I think. I have heard many good things about Dr Abramson over time. I know people do often wonder whether to talk to a neuro etc but I always feel people need as informed a viewpoint as possible to make informed choices. It makes us as owners feel more in control of a potentially difficult situation and more of a participant in the decision process rather than a confused onlooker. I know it really helped me with unnecessary worrying to get an MRI and consult. Before that I didn't know enough about what was going on and you can waste a lot of time worrying pointlessly. I always say, save the worrying for the times you really do need it -- it is so draining and unproductive that I'd rather know what exactly I should be worrying about rather than deplete myself due to lack of the best knowledge I can get. There are always uncertainties with SM but there's a lot we can do as owners to feel we are making the best informed decisions we can and it's funny in a way how just getting a clearer picture of what is going on (eg even just that clinical exam you had where a neuro can assess the actual affects on the dog right now -- something a vet doesn't know how to do and an MRI won't show on its own) really helps.

Bridam
19th February 2008, 11:46 PM
Well. Please keep Madison in your thoughts. Next Tuesday, she's going in for a shunt/decompression surgery with Dr. Abramson. We'll keep you updated after the surgery. Thanks again for all the support.

*Pauline*
20th February 2008, 12:37 AM
I've just found this thread. My heart goes out to you :hug: You have a lot on your plate right now what with the baby due too. I hope everything goes well on Thuesday, sounds like you have the best care possible.

Cathy Moon
20th February 2008, 12:44 AM
You and Madison will be in our thoughts and prayers. :hug:
:xfngr::xfngr::paw::paw::paw:

Cathy T
20th February 2008, 12:53 AM
Gosh....just now catching this thread. You've already been through a lot haven't you?! The prayers and good thoughts are coming strongly from our household. I'm so glad you've found someone to give you guidance and good direction. I think that's a big part of the battle right there....it's so hard when you just don't know what to do. Sounds like you are on the right path. Prayers and good luck to you.

Bridam
20th February 2008, 01:02 AM
Thanks. It's really hard to put her under the knife when she's not doing too badly at the moment--her symptoms are mostly that of annoyance. Nevertheless, she appears more prone to sleep and treads more and more carefully with each passing month. But, what drove this decision is the fear of regret if we don't do everything within our means at this point, she deteriorates, and it's too late to do anything about it.

Cathy T
20th February 2008, 03:03 AM
what drove this decision is the fear of regret if we don't do everything within our means at this point, she deteriorates, and it's too late to do anything about it.

Completely agree with you on that. I think about Natalie having Bianca's surgery done when she was only showing minor symptoms.....especially since the surgery is more successful when done before serious symptoms are showing.

ppotterfield
20th February 2008, 03:20 PM
Will be thinking of you next Tuesday and keeping you in our prayers. It is a courageous and loving decision to make.

Bridam
21st February 2008, 06:33 PM
You guys are great. Is there any kind of information, pictures, or videos I can gather and send to someone here or elsewhere that can be put to good use for others as they face this?

Bridam
26th February 2008, 03:19 AM
Well. I dropped her off today. She was so good. Didn't squirm or wimper when they took her off. It was so hard to do and drive back to Dallas without her next to me. Fingers crossed.

WoodHaven
26th February 2008, 03:21 AM
You and Madison are in my prayers.

Cathy T
26th February 2008, 03:35 AM
Praying for both of you. I can only imagine how difficult this is for you.

Karlin
26th February 2008, 07:45 PM
Thinking of you today. :xfngr:

I'm always interested in any videos done of symptoms, post op images, or personal case studies for my SM site. Most people find hearing about real cases and experiences to be especially helpful. :)

I have been planning a case study section for a while.

natalieandmike
26th February 2008, 10:54 PM
You're definitely in our thoughts! (Both ours and Bianca's). Hoping everything goes smoothly. :xfngr::paw:

Denise G.
26th February 2008, 11:35 PM
Just catching up to this thread--sending hugs and prayers your way. It sounds like little Madison is getting the very best care to be offered.:)

I'm in Dallas, too, by the way. It's very interesting (and comforting) to know that Dr. Abramson isn't too far away. :)

Cathy Moon
27th February 2008, 12:39 AM
Thinking of you and Madison. :flwr::hug:

frecklesmom
27th February 2008, 01:27 AM
I hope this was a day of reward for you and for Madison :xfngr:

Bridam
27th February 2008, 01:56 AM
It was. My wife spoke to Dr. Abramson. She said the decompression surgery went better than expected and described it as a textbook case. I didn't hear a report on the shunt but we are going to talk with her tomorrow.

The surgery started later than expected. It was supposed to start at 11:30 and by 5:00-I hadn't heard from them yet. So we started to worry. But once they called, my wife and I were quite relieved. So far so good...

Bridam
27th February 2008, 01:57 AM
Just catching up to this thread--sending hugs and prayers your way. It sounds like little Madison is getting the very best care to be offered.:)

I'm in Dallas, too, by the way. It's very interesting (and comforting) to know that Dr. Abramson isn't too far away. :)


Good to hear. If you ever go to the dog park by Whiterock, let us know and we'll get our girls together with your cav.

Karlin
27th February 2008, 11:03 AM
Oh I am happy to hear that! Wonderful news. :flwr:

*Pauline*
27th February 2008, 01:41 PM
the decompression surgery went better than expected and described it as a textbook case.

Very glad yo hear this. How are things today? When can Madison come home?

Bridam
27th February 2008, 04:15 PM
Very glad yo hear this. How are things today? When can Madison come home?


Not yet. They have to keep her a few more days... But, she's off the IV now and starting to move around. I hope to pick her up on Saturday.

Cathy T
27th February 2008, 04:44 PM
Oh....that is excellent news!!! So glad everything went so smoothly. Keep us posted on her, I sure think about her a lot.

Denise G.
27th February 2008, 10:08 PM
Good to hear. If you ever go to the dog park by Whiterock, let us know and we'll get our girls together with your cav.

Would love to meet up with you some time when Madison is feeling better. Hopefully, she'll be up to it by the time Spring has "sprung". :)
I don't usually go to the Whiterock dog park as I live in Addison and we have a couple of parks. But Mia and I would make the trip to meet little Madison. :)

So glad to hear she's doing better!:rah:

Cathryn
27th February 2008, 10:23 PM
Hi! Been away for a while so just catching up on things now. First and foremost :hug: you, your wife, unborn baby and Madison are very much in my thoughts right now, I am very glad to hear that the surgery went well and will watch the thread for progress reports on your very special girl.
:xfngr: For a speedy recovery for Madison.:luv:

Cathy Moon
28th February 2008, 01:50 AM
I'm glad to hear her surgery went well and she's doing well. :flwr:

ppotterfield
28th February 2008, 02:37 PM
Thinking of you and Madison and keeping our fingers and paws crossed for a successful result. Please do keep us updated.

Spencer'sMom
29th February 2008, 08:26 PM
I am so glad Madison's surgery went well. I am sure she'll be sooo happy to see you and your wife tomorrow.

Bridam
3rd March 2008, 01:05 AM
Update:

I picked Madison up from GCVS on Saturday. Although Dr. Abramson was off, I was pleasantly surpised to find that she came in just to see Madison off (indeed she had come from a marathon and was still wearing her running gear).

I have to admit, I was a little shocked at first to see Madison. I knew what to expect but it was still a little hard to see her for the first time. Her entire head is shaved and she has a 7 inch incision running from the top of her head to the bottom of her neck that is stapled up. Additionally, her entire right side is shaved and there is another small incision for her shunt near her belly. Dr. Abramson reminded me that it's just a bad hair cut that will grow back.

Another thing that surpised me was that Madison didn't seem too excited to see me at first. She seemed a little out of it. But, on the car ride home, she started going crazy in her crate so I pulled over and took her out for a minute. She apparently snapped out of it and decided she wanted me to rub her belly! My baby was back.

Now that she's home, she's restricted to a cage for one month. We can only let her out three times a day for 5 or 10 minutes. She is on a host of medications including Prednisone, Pepsid, Tramadol, Cephalexin, and Phenobarbital. We'll be tapering these shortly. After two months she can sleep with us again.

She's never been in a crate, so she's going crazy and barking a lot. I had to sleep on the floor next to her last night to keep her calm. She's also shaking a little when she's on her feet and has some back spasms. Generally, however, I'm surpised at how well she's doing considering she had brain surgery less than a week ago. Her staples come out in a week and then we have a follow-up at GCVS in a month.

Here is a video of her from today:

http://www.youtube.com/watch?v=p8UJXW0qI6A

Thanks for all your support and I'll update this thread as appropriate.

Cathy Moon
3rd March 2008, 02:10 AM
That's really good news - she's home and she looks very good.:flwr:

Lynn
3rd March 2008, 02:28 AM
It's so nice to know that Madison is home and I was surprised at how active she was! What a wonderful daddy she has that will sleep next to her on the floor to comfort her...she is a very lucky girl to have such love. I hope all continues to go well for your precious little one. Thanks for the update :flwr:

*Pauline*
3rd March 2008, 03:53 PM
A little teary after watching that. You're a very kind couple. Looks like she had a great coat on her, hope it grows back soon. She's very cute.

A big :hug: to you, you've been through a lot haven't you.

Cathy T
4th March 2008, 01:15 AM
Oh bless her little heart!!! :hug:You guys have been so strong for her. Your courage is truly admirable. Thank you so much for posting that video. Hopefully that will be a bit of encouragement for future patients.

Please keep us posted on her recovery. I think about her all the time and after seeing that video she will be in my thoughts even more.

Bridam
4th March 2008, 01:55 AM
Oh bless her little heart!!! :hug:You guys have been so strong for her. Your courage is truly admirable. Thank you so much for posting that video. Hopefully that will be a bit of encouragement for future patients.

Please keep us posted on her recovery. I think about her all the time and after seeing that video she will be in my thoughts even more.

I think it's important for people to realize through pictures or otherwise just what is involved with these surgeries. I'll take more pictures and videos as well as post more information on her recovery (fingers crossed). As you can tell from where we started at the beginning of this thread to where we are now, we owe a lot to you people and to others facing this in the future.

On another note, Dr. Abramson is reducing the phenobarbital because we think it is giving Madison the shakes.

Cathy T
4th March 2008, 02:33 AM
I think it's important for people to realize through pictures or otherwise just what is involved with these surgeries


Absolutely!! On quite a much more minor scale....I had seen pictures of what a dog looked like after patella surgery so when I picked up my Shelby I wasn't nearly as blown away by her appearance. Still cried my dang eyes out....but can't imagine how I would have reacted had I not been prepared.

Sandrac
4th March 2008, 01:28 PM
Wishing Madison a speedy recovery from her surgery. She certainly has a waggly tail!

Bridam
4th March 2008, 05:43 PM
Thinking of you today. :xfngr:

I'm always interested in any videos done of symptoms, post op images, or personal case studies for my SM site. Most people find hearing about real cases and experiences to be especially helpful. :)

I have been planning a case study section for a while.

I'd be happy to send you a copy of her mri, reports from Dr. Abramsom (maybe I should check with her that it would be okay with her to share), as well as updates on her treatment plan, post op pictures, etc. I think that information would be helpful. Unfortunately I did not get pre op video of her behavior but the other videos (not the serious one) are pretty representative.

ppotterfield
4th March 2008, 11:33 PM
Reading this thread with interest and with hope for a successful outcome. Thank you sharing. We all need to learn. We also need to pressure breeders to do the right thing and start screening not just for MVD but for SM as well. :hug: to you and to Madison.

TillyTommy
4th March 2008, 11:34 PM
Love and Best Wishes - :)

Denise G.
5th March 2008, 06:47 PM
Glad to see that Madison is doing so well!

Here's to a speedy, uneventful, complete recovery!:)

natalieandmike
6th March 2008, 12:26 AM
Don't be worried at ALL, the fur does grow back! In our (Bianca's case) now everything looks tip-top except her long hairs which started from the top of her ears are now only about 1 1/2 inches long-- and getting sloooowwwwlly longer...:rolleyes: but here's a before and after photo to make you feel better. I'm so glad everything went well with the surgery!!! (our neuro said Bianca was a 'textbook' case, as well, so I am sure that ALSO bodes well for you since Bianca is doing so great--knock on wood--after surgery).
Post-op day 4 when we were able to bring her home (the shiny thing is a Fentanyl patch)
http://farm3.static.flickr.com/2272/2035892870_c55c1fdfb9_m.jpg

Here she is 4 1/2 months later, at a gelato shoppe.

http://farm3.static.flickr.com/2068/2270318852_1d4b1698ed.jpg



Here's a somewhat better picture of the top of her head:
http://farm3.static.flickr.com/2384/2270318874_f63646aeff_m.jpg

You're doing GREAT, Madison! Best wishes for a speedy recovery!!:paw::paw:

Bridam
6th March 2008, 01:41 AM
Don't be worried at ALL, the fur does grow back! In our (Bianca's case) now everything looks tip-top except her long hairs which started from the top of her ears are now only about 1 1/2 inches long-- and getting sloooowwwwlly longer...:rolleyes: but here's a before and after photo to make you feel better. I'm so glad everything went well with the surgery!!! (our neuro said Bianca was a 'textbook' case, as well, so I am sure that ALSO bodes well for you since Bianca is doing so great--knock on wood--after surgery).
Post-op day 4 when we were able to bring her home (the shiny thing is a Fentanyl patch)
http://farm3.static.flickr.com/2272/2035892870_c55c1fdfb9_m.jpg

Here she is 4 1/2 months later, at a gelato shoppe.

http://farm3.static.flickr.com/2068/2270318852_1d4b1698ed.jpg



Here's a somewhat better picture of the top of her head:
http://farm3.static.flickr.com/2384/2270318874_f63646aeff_m.jpg

You're doing GREAT, Madison! Best wishes for a speedy recovery!!:paw::paw:


I've seen your beautiful girl and watched her progress, which gave us strength to move ahead with the surgery for Madision. Thanks!

ppotterfield
10th March 2008, 03:31 PM
Just checking to see how Madison (and you and your family) are doing. I think about all the special SM "kids" a lot. Hope all is going well and if there are setbacks that everyone is coping and keeping the faith.

Bridam
10th March 2008, 03:38 PM
Just checking to see how Madison (and you and your family) are doing. I think about all the special SM "kids" a lot. Hope all is going well and if there are setbacks that everyone is coping and keeping the faith.


She's doing really well. Thanks for checking in! She should be getting her staples out tomorrow. I am planning on doing a comprehensive update with some other observations when her stiches come out and then another when she sees Dr. Abramson again in three more weeks.

Cathy T
10th March 2008, 03:50 PM
Happy to hear she's doing so well. I think of her often.

Denise G.
10th March 2008, 07:29 PM
So glad to hear that Madison is healing up nicely! :)

Bridam
12th March 2008, 12:59 AM
She went to the vet today. The vet removed only about half her staples. Given the length of the primary incission, she seemed concerned about removing them all at once lest her incission tear open.

Madison is generally doing very well. We've still got ocassional yelping but it's getting less and less frequent. She is off of the Tramadol (pain killer) and Phenobarbital (anti seizure med). We've also tappered the Prednistone to once a day. The large quantity of meds made her pant a lot and shake a times. With the reduction in meds, we've seen improvement on both fronts.

Although it is still very early and she is medicated, we've noticed a great reduction in her symptoms. Where she used to air scratch 20 or more times a day, I've seen her scratch only about 10 times total in the last two weeks. While I never expected resolution of this behavior from the surgery, I'm going to keep track of this as it's interesting. Moreover, while it's far too early to draw any conclusions, it does appear like a weight has been lifted off her shoulders (could be reading into this after spending $8k on her :)). I, of course, have no idea what it must feel like to have water on the head or what it would feel like to finally get the relief that the shunt is providing. On a side note, I wonder why most other cavs aren't getting a shunt as well as the decompression.

She has developed another habit, which is also interesting. She now seems to do a body shake that reminds me of a peacock ruffling its feathers. She does this pretty frequently. It doesn't seem to bother her though and I don't know if it's like her way of stretching pain free after laying around all day.

She's having the rest of her staples out on Friday. I'll try to take some pics then. Thanks for listening to me ramble but I hope to catalog our journey for others facing this problem in the future.

Cathy T
12th March 2008, 02:42 AM
I am absolutely thrilled to hear that she is doing so well!!! Please do keep us updated on her progress.

Cathy Moon
12th March 2008, 12:38 PM
Thanks for the update - so glad she continues to do well! :flwr:

natalieandmike
14th March 2008, 02:17 AM
That's interesting that you mentioned the 'body shake' like a peacock! Bianca seemed to do that fairly frequently after surgery, but it has gradually abated with time to only a couple of times per day. We thought it was odd, but I thought it may have something to do with unusual nerve impulses firing and her getting a 'tingly' feeling along her spinal cord, thus feeling like she had to 'shake them off'. I attributed it to more feeling coming back after surgery. I know this is not very scientific! :rolleyes: Just thought you'd want to know.

Bridam
14th March 2008, 02:25 AM
That's interesting that you mentioned the 'body shake' like a peacock! Bianca seemed to do that fairly frequently after surgery, but it has gradually abated with time to only a couple of times per day. We thought it was odd, but I thought it may have something to do with unusual nerve impulses firing and her getting a 'tingly' feeling along her spinal cord, thus feeling like she had to 'shake them off'. I attributed it to more feeling coming back after surgery. I know this is not very scientific! :rolleyes: Just thought you'd want to know.

That's very helpful for me and others to know. Thanks!

Cathy T
29th March 2008, 04:22 AM
I think of Madison often. How is she doing?

ppotterfield
29th March 2008, 09:29 PM
Okay, I have waited two weeks since the last update and am worrying about little Madison. Need an update. If the news is good, we can all give a sigh of relief; if she is struggling, then we need to know so we can keep the prayers coming and give you all a virtual hug.

BevR
29th March 2008, 10:34 PM
I've just read this thread from start ot finish and am also a little teary eyed, I hope and pray that Madison is recovering well.

karenc
30th March 2008, 01:25 PM
Having read through this thread and watched the video through tears, I think Maddison is a remarkable brave little girl. I hope her recovery is ongoing and is becoming stronger everyday. Maddison is lucky to have wonderful caring owners. Wish you all luck and will pray for Maddisons full recovery.:)

Bridam
31st March 2008, 02:58 AM
Okay, I have waited two weeks since the last update and am worrying about little Madison> Need an update. If the news is good, we can all give a sigh of relief; if she is struggling, then we need to know so we can keep the prayers coming and give you all a virtual hug.


Sorry to keep you waiting guys. Once we got through the surgery, we've had to focus on getting ready for our first child, who was supposed to be here today but is keeping us waiting a little longer.

It's been almost 5 weeks now and Madison is doing just fine.

Per Dr. Abramson's instructions, we let her out of her cage almost a week ago. Let me tell you, she's a happy camper. And, frankly, it was getting hard to deal with keeping her separated from our other cav and having to sit and sleep by her cage all the time. She was a little weak after a month in a cage but she's moving around pretty well now.

No more yelping from the surgery at this point and her hair is starting to cover her incissions. She's basically off all of her meds.

Her scratching has come back to pre surgery levels. It seems that, once she started moving around, her scratching came back. My wife swears that she is scratching more than before but I don't think so. If memory serves me, it was this level of scratching that alarmed us enough to get an MRI in the first place. She also still lacks some control in her limbs and slides around the floor a lot.

On the other hand, I think Madison is holding her head up more when she walks. Before the surgery, she seemed to really keep her head down as if to minimize pain. Now, she's holding her head up nicely and is looking up and all around as she walks. She also seems to have better posture. She's still tucking in her rear but doesn't seem to be doing it as much. Finally, she does seem to be more playful and have more energy. Could just be pent up energy from being in a cage for a month--but who knows.

Our next appointment with Dr. Abramson is on the 12th. I'll give you guys another update and take some pics as soon as I can figure out our new camera. Thanks to all for thinking of Madison so much--it means a lot to us.

Cathy T
31st March 2008, 03:36 AM
Whew....I sure was glad to hear from you. I was so afraid no news was bad news but am relieved this isn't the case. Sounds like she's doing well. That's excellent news.

I had completely forgotten you were expecting a baby on top of all of this!! :shock: You do have a full plate don't you?!!

Bridam
31st March 2008, 03:39 AM
Whew....I sure was glad to hear from you. I was so afraid no news was bad news but am relieved this isn't the case. Sounds like she's doing well. That's excellent news.

I had completely forgotten you were expecting a baby on top of all of this!! :shock: You do have a full plate don't you?!!


Yeah. But I'm glad we took care of this before rather than after the baby. There is no way that we would take turns sleeping on the couch next to the cage for a month with a baby crying every two hours!

Cathy T
31st March 2008, 04:22 AM
That's the truth!

Karlin
31st March 2008, 12:05 PM
Wow you have a lot going on! :flwr:

On the scratching -- this is pretty normal -- Clare Rusbridge finds that most of her post op dogs remain on gabapentin for scratching for life. Any damage done before the surgery -- eg damage to the dorsal horn region that initiates the scratching -- usually doesn't improve much post surgery with many of the decompressions (LIVS seems to have better luck with their form of the surgery). Dr Marino at Long Island Vet Services (LIVS) says on average it is three months before they begin to see significant improvement post surgery -- so may that helps a bit in getting a sense of what might be going on and what to expect. I'd guess the limb weakness right now will be in part die to her inability to exercise at all -- her muscles will have atrophied a bit. So hopefully that will improve now that she is out and moving about!

Bridam
31st March 2008, 03:26 PM
Wow you have a lot going on! :flwr:

On the scratching -- this is pretty normal -- Clare Rusbridge finds that most of her post op dogs remain on gabapentin for scratching for life. Any damage done before the surgery -- eg damage to the dorsal horn region that initiates the scratching -- usually doesn't improve much post surgery with many of the decompressions (LIVS seems to have better luck with their form of the surgery). Dr Marino at Long Island Vet Services (LIVS) says on average it is three months before they begin to see significant improvement post surgery -- so may that helps a bit in getting a sense of what might be going on and what to expect. I'd guess the limb weakness right now will be in part die to her inability to exercise at all -- her muscles will have atrophied a bit. So hopefully that will improve now that she is out and moving about!

Yep. Dr. Abramson was very clear that she has not had luck resolving the scratching through surgery. The goal of course was to prevent further progression.

ppotterfield
31st March 2008, 03:32 PM
Thanks for the update. Hope the human baby is here soon and that he or she is healthy, happy and learns fairly soon to sleep through the night. We will keep you and your family, human and canine, in our thoughts and prayers.

arasara
31st March 2008, 10:14 PM
I just read through this entire thread and wanted to say thank you for posting it and also for being willing to share Madison's story with all of us. I have never dealt with an SM dog as of yet, but thanks to your experience and sharing, if it ever happens I will be much more prepared. I have enjoyed reading Madison's progression and I am glad she seems to be holding her head up more. :) Good luck with the new baby!!! :flwr: You'll have to let us know what he/she is and how he/she is doing!!! :flwr:

natalieandmike
31st March 2008, 11:17 PM
Thanks for the update on Madison! Best of luck with the new baby; congratulations in advance!!:dogwlk:

Rosewoodsteel
13th April 2008, 05:24 AM
How much does an MRI and surgery cost?

*Pauline*
13th April 2008, 09:26 AM
How are things now? I hope all went well with the birth of your baby. Would love to hear about it.

Bridam
14th April 2008, 04:20 PM
How much does an MRI and surgery cost?

The MRI cost $1,500 or so. The surgery cost $6,000--although a decompression surgery sans the shunt would have been closer to $3,000.

Bridam
14th April 2008, 04:50 PM
Okay. We've had a busy few weeks.

Sam was born on April 2. He weighed 7.5 pounds and was 19.75 inches long. He has brown hair and blue eyes. This is him having tummy time a few days later:

http://www.kodakgallery.com/Slideshow.jsp?UV=899990044856_66665474313&mode=fromsite&collid=74758863313.70250963313.1208184348401&conn_speed=1

Madison is doing well and her and Molly are adjusting to having Sam around. They sniffed him and are very interested in his bottles but otherwise ignore him. They're not acting too jealous at this point. We took Madison for her first walk and she was still bunny hopping all over the place.

I took Madison back to Dr. Abramson for her follow-up. She agreed that Madison is doing well and is walking better. As you can see in the slideshow below, her scar has healed up nicely. She's still itching pretty bad. For the itching, she prescribed Gabi--something. All in all, things are going well. Here are some pics of my girls. We like to give poor Molly spiked hair. Madison is the little one.

http://www.kodakgallery.com/Slideshow.jsp?UV=899990044856_66665474313&mode=fromsite&collid=74758863313.72235474313.1208184348400&conn_speed=1

Cathy T
14th April 2008, 05:11 PM
Congrats on the new family member!! What an adorable little boy. You have a beautiful family (4 legged and 2 legged members!!) Glad to hear Madison is doing so well.

Lynn
14th April 2008, 07:42 PM
Congratulations & Welcome Sam! What a beautiful baby he is!

Rosewoodsteel
15th April 2008, 12:28 AM
Will be thinking of you next Tuesday and keeping you in our prayers. It is a courageous and loving decision to make.

+1 to this.

God bless you, Madison and your beautiful new baby.

Bridam
1st May 2008, 09:37 AM
Madison is still doing fine. Her itching is still pretty bad, however. So, we put her on Gabapentin 100mg twice a day. The gabapentin seems to help a lot. She itches for less when she's on it and also seems to sleep more when she's on it (could be relief from the itching). It's just a shame that it wears off so fast--so we can never prevent the itching all the time. I wonder if she'll grow an immunity to the drug over time.

Cathy Moon
2nd May 2008, 12:07 AM
Congratulations on your new baby boy!!! :flwr:

Gabapentin usually lasts 8 hours, so she may need 3 doses per day.

Bridam
2nd May 2008, 12:48 AM
Congratulations on your new baby boy!!! :flwr:

Gabapentin usually lasts 8 hours, so she may need 3 doses per day.


Thank you. He's a handful. Have you experienced any immunity to gabapentin over time? By the way, I paid $.50 a pill. I'll shop around for the next round.

Spencer'sMom
2nd May 2008, 02:00 AM
Glad to hear Madison is doing so well. And congratulations on your new baby!

We just upped Spencer's gabapentin dose and he now takes it three times per day. I certainly can't speak from a scientific point of view but I do think he's developed some immunity to it. His disease is also progressing somewhat so it may be a combination of that and the fact that I don't feel the gabapentin provides as much relief as it did in the beginning.

Rachel Morton
5th May 2008, 01:24 AM
Hi all,
I'm probably in denial, but do symptoms necessarily lead to pain and illness?

My 11-month-old redhead does the scratching thing at night, and has done it since she was an infant. She has other occasional symptoms: tail chasing, slightly weak back legs, every once in a while a yelp when picked up. But she is otherwise healthy, happy, and super active.

Do I need to do anything? Is it possible she'll just have these symptoms the rest of her life, but otherwise be fine? Or is it necessarily going to get worse?

And if so, any recommendations for vets in Vermont?

Thanks for any advice,
Rachel
Burlington, Vermont

Cathy Moon
5th May 2008, 02:48 AM
Hi all,
I'm probably in denial, but do symptoms necessarily lead to pain and illness?

My 11-month-old redhead does the scratching thing at night, and has done it since she was an infant. She has other occasional symptoms: tail chasing, slightly weak back legs, every once in a while a yelp when picked up. But she is otherwise healthy, happy, and super active.

Do I need to do anything? Is it possible she'll just have these symptoms the rest of her life, but otherwise be fine? Or is it necessarily going to get worse?

And if so, any recommendations for vets in Vermont?

Thanks for any advice,
Rachel
Burlington, Vermont

Based on my own experience having cavaliers with SM, I would at the very least take her to a neurologist to get a neurology examination and to evaluate her for pain. I would try to find a neurologist experienced with SM. Here are two links for neurologists:
http://cavalierhealth.org/neurologists.htm

http://sm.cavaliertalk.com/diagnosing/diagnosing/neuros.html

If you cannot go out of state for a neurologist, it may be helpful to print documents from these links and take them to your vet. Perhaps your vet could follow the step by step approach: http://sm.cavaliertalk.com/

neves
6th May 2008, 06:03 PM
I just found this thread and I have to say I am so happy to find someone this brave and willing to help their cavalier. A big thank you for sharing Madison's treatment step-by-step. I wish all the best to your family (congratulations on the baby!) and of course Madison - I certainly look forward to keeping in check with how she is doing.

Karlin
7th May 2008, 07:07 PM
Do I need to do anything? Is it possible she'll just have these symptoms the rest of her life, but otherwise be fine? Or is it necessarily going to get worse?


In order: yes; not very likely; and yes, almost certainly given her age.

So, please: you do very urgently need to see someone as the things you are seeing indicate that if your dog does have SM she is already experiencing pain (and these are very suspicious symptoms and even if this isn;t SM, really MUST be addressed as they do indiocate some serious problems). Limb weakness in particular is considered a sign of rapidly progressing SM and is *a very serious symptom* -- Dr Clare Rusbridge feels that surgery is probably indicated -- or palliative care -- once limb weakness is there because it indicates a more severe form of the disease. At this point it is urgent to take some decision on the dog's future if you care for her wellbeing and do not want her to suffer unnecessarily, which I am sure is the case -- eg whether to consider surgery or to at least relieve her pain, expressed by these symptoms -- because anything not addressed right away will probably not be alleviated by surgery in the future as damage is generally irreversible.

Dogs under three or so that are symptomatic are generally the most severely affected and should at the very least be assessed and put onto adequate pain relief medication (as noted, scratching, yelping and limb weakness are all signs that the dog is suffering and trying to live with ongoing, already-existing pain. This out of kindness should be addressed).

I urge anyone who wonders whether to do anything because their dog doesn't seem to be showing very many symptoms, to please read some of the human SM sites to get a sense of the severe daily pain most symptomatic sufferers must live with (and how vague their expressed symtpoms are -- how does a dog tell you it has a massive headache?). All the researchers working in this area feel that by the time a dog is showing symptoms, even mild symptoms, it is already experiencing compromising pain. At the very least, there are many medications that could bring a better quality of life, even if only in the short term, to any dog with this condition -- a symptomatic dog IS SUFFERING.

The condition is almost always progressive and any dog showing symptoms under age 3 definitely needs to be assessed.

Bridam
9th May 2008, 06:01 PM
In order: yes; not very likely; and yes, almost certainly given her age.

So, please: you do very urgently need to see someone as the things you are seeing indicate that if your dog does have SM she is already experiencing pain (and these are very suspicious symptoms and even if this isn;t SM, really MUST be addressed as they do indiocate some serious problems). Limb weakness in particular is considered a sign of rapidly progressing SM and is *a very serious symptom* -- Dr Clare Rusbridge feels that surgery is probably indicated -- or palliative care -- once limb weakness is there because it indicates a more severe form of the disease. At this point it is urgent to take some decision on the dog's future if you care for her wellbeing and do not want her to suffer unnecessarily, which I am sure is the case -- eg whether to consider surgery or to at least relieve her pain, expressed by these symptoms -- because anything not addressed right away will probably not be alleviated by surgery in the future as damage is generally irreversible.

Dogs under three or so that are symptomatic are generally the most severely affected and should at the very least be assessed and put onto adequate pain relief medication (as noted, scratching, yelping and limb weakness are all signs that the dog is suffering and trying to live with ongoing, already-existing pain. This out of kindness should be addressed).

I urge anyone who wonders whether to do anything because their dog doesn't seem to be showing very many symptoms, to please read some of the human SM sites to get a sense of the severe daily pain most symptomatic sufferers must live with (and how vague their expressed symtpoms are -- how does a dog tell you it has a massive headache?). All the researchers working in this area feel that by the time a dog is showing symptoms, even mild symptoms, it is already experiencing compromising pain. At the very least, there are many medications that could bring a better quality of life, even if only in the short term, to any dog with this condition -- a symptomatic dog IS SUFFERING.

The condition is almost always progressive and any dog showing symptoms under age 3 definitely needs to be assessed.

You always make me cringe because I start to think that our ignorance and our veternarian's dismissal of this disease for two years meant that our Madison progressed and went untreated in pain for three years and now has irreversible damage. Knowing what I know now, I would go to a neurologist upon any signs. It's quite surprising how cheap a visit to one is. After that, you can make decisions about the much more expensive MRI.