View Full Version : Wanted to introduce myself/SM
30th July 2008, 05:51 AM
A couple of weeks ago my 3-year-old Watson, the love of my life, started yelping when he got up from lying down and did not want to go up or down our considerable spiral staircase. Once I carried him, he got the idea and started barking for a ride with me whenever I went up or down. After a day of this, I took him to the vet.
My regular vet examined him and got no pain response anywhere. Legs, neck, everything fine. He observed Watson walking and said that looked fine as well. He took x-rays, which showed nothing. He sent me home with a pain medication, tramadol and an article about SM, since he had showed some signs of pain for a couple of days six months ago as well, but that literally disappeared overnight. He said it might be worth looking into an MRI and seeing a neurologist if the pain persisted, but suggested it could also be just a "soft tissue injury" (Watson is still like a puppy when it comes to playing) that would resolve itself. I immediately bought "steps" for him to get on the bed and got out the ones we used when he was a puppy for the sofa.
A day later Watson was really no better, so my vet added Rimadyl. The next day, Watson was immediately 75% better. Maybe more. But not fully Watson again.
So we saw the neurologist, who happens to be one of those listed in red on Cavalier Health, Dr. Sammut in Los Angeles, who sees tons of SM cases in the area. She DID get a pain response in Watson's lower back, but said this could still be a result of SM... or not. She thought the MRI was probably a good idea for back and neck.
(NOTE: Watson has never shown any other SM symptoms that I've read about here and elsewhere, but he does have seasonal itching every year, like a clock, in the warm months. It always goes away by October. I give him an antihistamine and bathe him in a special oatmeal shampoo when he needs it. He does not scratch when he's walking. Based on all this, the doc does not think it's SM itching, and neither do I.)
A couple days later, Watson was no longer yelping at all, but still seemed to rise from lying down very slowly and deliberately. He had also started using the staircase again, without "asking" me for a ride.
Anyway, I decided to do the MRI. Neurologist called this morning and told me 1) that Watson does have a "small" SM "maformation" and a very small syrinx, 2) that Watson has two slightly bulging discs, one near his neck and one on his lower back, 3) that it's very doubtful the bulging discs are related to the SM (I forget her reason, but it made sense), 4) that she suspects the bulging discs are what's causing him his current pain, not the SM.
She added a diuretic, lasix, to the mix of tramadol and rimadyl. And even though Watson is not yelping in pain anymore and seems to want to do anything (even sometimes going around the steps at the sofa and jumping down on his own!), she ordered no stairs, no fetching, no beds/sofa without steps, and very short walks for 3-4 weeks. Then she wants to see him again. Sigh.
I feel lucky that we caught this early (probably wouldn't have if it weren't for the bulging discs, IF they're what's causing the pain), but I'm wondering if there's anything I should know since WE DID catch it early. Should I see about sending his MRI to someone else?
And what does "very small" mean when it comes to SM? What is the rest of his life likely to look like?
I'm also concerned that without his walks and playing fetch, Watson will get heavy, which will be harder on his discs. He's already a couple of pounds over what he should be.
Thanks so much for having this board!
30th July 2008, 07:18 AM
I am sorry you are having these problems and worries with your boy. While I am not going to be any help since I've not dealt with this problem before, I am sure someone will come along who can offer better advice.
I'll be thinking of you and good luck!
30th July 2008, 12:46 PM
It seems like you and your vet are right on the ball! it's excellent that your vet knows about SM and didn't wait around in sending you to a neurologist.
There are many cavaliers that live with mild SM and don't show any symptoms likewise there are others that when mildly affected are in some discomfort from time to time. All will be so different, just as the signs that they display are. Some scratch and others don't and some bunny hop on three legs when walking when excited and another might not. Others yelp which shows us pain but another might have a higher pain tolerance. You will have to watch your own dog and see what is going on, keep a diary and talk with your neurologist/vet about things that are happeneing, and things that help and things that don't.
Your neurologist will be able to talk about any progression, he will be the best person to talk with about meds and any other questions that you might have. Get a list ready for your next visit.
Also when he has been well rested and his disc problem has hopefully settled down some, you might see that it is the discs that are the cause of the discomfort and not the SM, what plans does the vet have for this? just rest and meds and regular follow ups? perhaps when you review at the next visit you could work on a gentle excercise plan together to keep his wait down and adjust his diet as well.
As for now keep him quiet and rested, give the meds chance to do their work and see your neurologist as requested, keep us posted, all the best,
30th July 2008, 06:34 PM
Thank you all. And wouldn't you know Watson's itching has begun in full bloom. Last night the bed was shaking. The twisting and contorting to get the itch can't be good for his back. I haven't given him his itching meds since Sept., and I remember my regular vet telling me I could give it quite a bit more than what it says on the bottle, but I don't remember HOW much. So I'm waiting for a call back on that.
But I'm suddenly thinking - COULD it be SM itching? I called the neuro, and waiting for her return as well. Itching starts in June or July and is always finished by October. I give him hydroxizine (sp?). It's all over his body - neck, back, feet, you name it. And it's nearly constant. It resembles flea itching, but as always, he's had his advantage and the groomer saw no fleas. Sometimes he gets dry patches that are visible.
I hate that he's now taking four meds (rimadyl, tramadol, lasix AND the itchy stuff) and wondering if there's something I should ask my vet about that will kill two birds with one stone, as in a steroid? I know you guys aren't vets, but it's so hard waiting for those calls back!
30th July 2008, 06:58 PM
Dr Sammut is a good neurologist; I know a few people who have gone to her in LA.
A small syrinx can mean huge amounts of pain, small amounts of pain, no pain. The dynamics of pain isn't very well understood with this condition because sometimes very mildly afected dogs are very bad while dogs with massive syrinxes are symptomless or almost so. The issue of pain seems to relate more to width of syrinx than size -- because if it is wider it has more of an effect on sensitive nerve endings in the spinal cord that affects pain experienced in other areas of the body (like ears, head, limbs etc). But it also probably has something to do with the way the CSF circulates in each individual dog so some are worse affected than others.
SM does tend to be progressive so typically, syrinxes will increase in size. I do have lots of the latest research info at www.smcavalier.com and there's more at www.cavalierhealth.org.
Ypu could be seeing a combination of SM pain with disk problems and seasonal allergies. If scratching always goes by season then maybe you are dealing with grass allergies, pollen allergies and so forth. On the other hand weather can also affect how dogs react. Many of us see more scratching during weather changes when pressure changes in the atmosphere.
Maybe you should ask to try gabapentin -- this is the most effective drug most of us have found for scratching. If it helps then you will know it is probably SM scratching as it wouldn't help with allergies.
30th July 2008, 07:13 PM
thank you, Karlin - you've given me some great questions for Dr. Sammut.
One more thing I've just realized: last July, when Watson's itching was getting really bad, and his fur becoming tangled and knotted within days after grooming/bathing, I ended up having him shaved just to make it easier on both of us. Unexpected byproduct: the itching stopped and didn't return until now. For some reason, he was fine the rest of that season.
We have these massive trees lining our street from which sap blows into everything, especially in summer. If you leave your car out overnight, it's filthy and sticky. So, I've always felt comfortable sticking with my assumption that it's the seasons. And I thought maybe that sticky stuff had nowhere to collect when his fur was short.
You're right about keeping a diary.
30th July 2008, 07:34 PM
Medrone is a corticosteroid and can be used in inflammatory diseases for both musclar and allergy dermatitis problems like the disc and itching that you are having. Perhaps a chat with the vet would help about this?
hope this helps,
30th July 2008, 07:53 PM
Dry patches do definitely sound like something going on with skin, not SM. But I have a dog I suspect has SM, has some spine pain, and she scratches a lot at her ears (why I didn't rehome her -- she was one of my rescues). But she also has dry skin down her back, flakiness, chews at her paws and licks them a lot more in common with allergies. I suspect she experiences a combination of both, some mild SM discomfort, some sort of skin or allergy issue, probably low level dermatitis (my vet feels not enough going on there to treat and didn't think it was an allergy). Only an MRI would really show what is going on -- xrays are not always accurate for spine related problems either.
30th July 2008, 10:22 PM
what does "rehome" mean?
And are you saying an MRI can reveal allergies or determine the cause of itching? She didn't mention this with regard to his MRI results.
Watson doesn't have dry patches now, but has in the past. Neurologist said to give his usual itching meds a couple of days, and see if it gets better.
Argh. So much to take in all at once. The discs, the SM, and the return of itching within days of that diagnosis. And of course we're going away for a week August 9th. Luckily, my housekeeper (more like my wife) loves Watson as much as I do and watches him like a hawk.
30th July 2008, 11:20 PM
what does "rehome" mean? I run Irish Cavalier Rescue (http://www.ckcsrescue.com) so I regularly have cavaliers that I rehome/find new homes for (you can see some of them listed in the breed rescue section). Lily was scratching from when I got her from the pound, so I was a bit suspicious it could be early signs of SM and did not rehome her -- I kept her as one of my own dogs.
An MRI won't show allergies -- I meant that with her spinal problems a few weeks back, I was told by my vets that an xray will not always show when there are disk problems. An MRI would however reveal those and any syrinxes or other problems related to CM/SM so really only an MRI would reveal what the pain was due to. The allergies or skin problems are another issue. She definitely has some form of mild dermatitis in a strip down her back. Hope that makes more sense. :thmbsup I am just making the point that I have a dog with some obvious skin or allergy related problems but that on top of that there is some spinal pain and thus she could have disk problems causing pain, and skin problems causing the scratching, but I suspect it is a combination of mild SM symptoms and her skin problems as the skin issue would not be causing the pain but I also don;t think her scratching at her ears is entirely due to her dry skin on her back.
2nd August 2008, 03:50 AM
It's been a tough night and day. Until last night, Watson was getting way better on the pain meds and anti-inflammatory. He kept wanting to play (which we ignored), and was doing fine on his steps to sofa and bed. I was carrying him up and down our spiral staircase for bed time. He was getting better. He was happy again.
Then yesterday I literally rolled his ball two feet away on the grass (I hate myself, don't hate me), Watson ran... and stopped too fast. And we had our first yelp in days. A few minutes later I was sitting on the sofa, and he wanted to join me. Not even wanting him to use his little 3-steps after what had happened on the grass, I picked him up (fine) and placed him next to me. But when I got up, he jumped off the coach - right past the steps, ignoring them completely. He yelped again. And from that point on until this morning he yelped every time he moved.
For the rest of the night I slept downstairs with him on the floor near me. He was clearly not feeling well. He's reinjured his bulging discs (I guess I should be posting on the disc forum, if there is one). Today he's a bit better. Getting up without yelps and wagging more, walking around a teeny bit. He's eating and goes outside to pee/poop. But still... what have I done? I'm worried he won't get back to where he was. At this point he's pretty much where he was when I first noticed something was up. The only good news (if you can call it that) is that this has made it clearer it's the disc problem that's causing this bout of pain.
The vet says I can add gabapentin to the rimadyl and tradmadol and wrote me a prescription. I just got it home. I feel horrible. I'll see if he needs it tonight.
2nd August 2008, 04:15 AM
I can only imagine how much you are beating yourself up about this. Am hoping rest and meds will make him feel better. I'm so sorry you are going through this.
2nd August 2008, 05:41 AM
Small sigh of relief. Gabapentin an hour and half ago with his second Rimadyl, and he's feeling better. Not letting him do anything, but he's wagging and licking me and definitely perkier and feeling better than last night. Stretching and resting in different positions, unlike last night. So I feel better too.
For your dogs that have SM, do your vets have you give gabapentin and another pain killer, like tramadol? Or just one? Just curious for the future. For now I'm happy to have both. Are there any risks or any issues any of you have had with tramadol + gabapentin + Rimadyl + lasix? Seems like so much! Since Dr. Sammut doesn't think his small syrinx is even what's bothering him, I'm wondering why the lasix? Especially if it means getting up to pee more, when his back hurts. Sorry for all the questions. it's still so much to take in.
And is there a separate thread for disc issues?
2nd August 2008, 01:43 PM
I had a dog that I suspected had SM and treated her with gabapentin which helped. She had a big pain incident but it pretty much returned to normal athough I noticed she held her neck stiffly. I heard about an amazing horse vet who was achiropractor and acupuncturist, both, so l went to see him. He said her back was twisted and hips a mess and after 3-4 treatments, she was so much improved that she didn't need to return. I also had another dog with a ruptured disc and she went from paralyzed to walking with IV steroid treatments. My point is that the back issues may be what is causing a lot of his discomfort and scratching may be putting him in positions that make it worse. If you can get both under control it may help a lot. Sounds like the lasix is a just in case the swelling from syrinx is causing the pain to alleviate the fluid pressure. I'm suprised he's not on steroids although that really acts as a diuretic.
2nd August 2008, 02:08 PM
Lasix is thought to help control the development and progression of syrinxes/SM in some cases as it reduces CSF pressure so it is most likely a preventative. But there are many cases where dogs have SM-like pain from the malformation alone. Many neurologists now automatically put dogs onto Lasix if they have a syrinx or possible Chiari pain. If a syrinx is forming, it is a sign that the CSF flow is definitely compromised and creating extra pressure and this is known to cause pain on its own. In humans, Chiari -- pain from the malformation and interupted CSF flow -- is a more common complaint I believe than SM.
Some dogs do take a mix of painkillers. Be sure to go back and ask Dr Sammut these questions-- remember, none of us is a neurologist or a vet, and only she knows the professional answers to why your dog is taking what he is taking, what the interactions could be and why she has chosen this mix. It isn't a good idea to assume anything that we are saying is a correct reply or matches her intentions. Have her write down her reasons or take notes right then from what she says, if you need them for reference as it can be hard to remember sometimes or confusing. :thmbsup: You are paying her as a consultant and these are all obvious questions to expect a reply to from a professional. :)
I'd really be penning and crating your dog until there's a lot more healing I think. I'd also be keeping him (via babygates or other barriers) where he cannot ever go into rooms with furniture on his own and when there, he must be lifted onto and lifted down from furniture anytime you are moving so that he doesn't jump down, or needs to be on a lap then penned in the room or crated while you are up and moving around. I'd also consider working now to train him to wait rather than jump onto furniture, and likewise wait to be let down. Recovery from back problems an take weeks or months -- you really do need to minimise activity even though it is difficult and be sure not to assume he is ready for further activity, even as mild as what you tried, unless you get a green light from your vet or neurologist. It is amazing how fragile they can be in recovery but think of how you'd be with severe back pain and how little you'd be able to do.
2nd August 2008, 07:32 PM
Karlin, we are now keeping Watson confined (via folding gates,etc.) to a small area. The sofa is there, but right now, without his steps, he won't even attempt. And I certainly won't put him there again - NO way. But perhaps soon I will block off the sofa altogether.
He's better even today from last night (one gambapentin really helped). I'm sleeping downstairs in a guest room and Watson's quite happy on the floor next to me w/his folding tumbling mat + comforter. It's hard for him when I have to go upstairs and I won't even carry him with me, but he seems to know it's for his own good.
So I hear you loud and clear!
Nancy, I asked about steroids. Apparently, steroids are not supposed to be used with Rimadyl. He'd need to be off Rimadyl for a few days first, and now is not the time. Perhaps in the future. Since my regular vet is the one who started the tramadol + Rimadyl combo, I'm curious to ask Dr. Sammut if that's what she would've started with.
Since we're going on vacation a week from today, I'm going to make an appointment to see her next week, just to answer a lot of questions and make sure I've got firm directions for my wonderful housekeeper who adores my dog as if he were her own. (She even calls me on her two days off to see how he's doing!).
I know you guys aren't vets, but you do have a lot of info, and I really appreciate it.
2nd August 2008, 09:24 PM
I really think I would get him in to see a neurologist. They are the experts in both SM and Back problems.
2nd August 2008, 10:00 PM
Um, we are seeing a neurologist, Dr. Sammut. She is listed in RED on Cavalierhealth as one of those who deals with a lot of SM. My regular vet referred me to her, yet in the few days before we saw Dr. Sammut, Watson had already started on tramadol/Rimadyl per my regular vet. Dr. Sammut is the one who reviewed his MRI and has been on the case since.
I'm just trying to learn about others' experiences as much as possible, and seek support, between now and my next visit with her.
2nd August 2008, 10:12 PM
Sorry, I did not realize. I hope your dog is on the road to recovery.
2nd August 2008, 10:27 PM
Thank you, Nancy. I've been learning quite a bit here.
Are there any other members whose dogs have SM (in our case, a very small syrinx thus far, per neurologist) AND disc problems in back/neck? I would love to hear your experiences.
And Nancy, I plan to ask her about surgery for Watson, so the syrinx does not get worse. He is 3.5, and I don't know that we've seen any symptoms SM yet, since the neurologist suspects its the discs causing problems at this time. But until I hear her thoughts, is surgery typically considered a good preventative measure for dogs like Watson?
2nd August 2008, 11:45 PM
My experience with disc problems is that when it got very bad, it was treated agressively. My choices were surgery or IV steroid therapy, hospitalized 3 days with steroids and liquid tagamet or pepsid, I forget which, to avoid the stomach problems such therapy brings. I opted not to do surgery because she had JUST had patella surgery, this was my Lhasa. She recovered so beautifully. So I'm wondering if they should start the steroid treatment, since he does not seem to be getting better and if you should be having that discussion with your surgeon.
3rd August 2008, 02:23 AM
I didn't actually mean surgery for the bulging discs but for the malformation/small syrinx. Before that starts to affect him one day.
But I will at least ask her about steroids for his back/neck bulging discs.
However, he is IS getting better. He's already almost back to where he was before my stupid ball/sofa move - and he was definitely getting better before that. But today - no more yelping, begged me for a walk (I escorted him to the backyard), is bringing me toys (I pet him and say good boy - that's IT.) And lots of rest.
3rd August 2008, 02:31 AM
Our little rescue cavalier, Charlie (now at rainbow bridge), was a patient of Dr. Sammut when he lived in California.
He didn't have disc problems in his back, but Charlie had early onset SM - he was only 5 months old when his symptoms became severe. Charlie had been having SM pain episodes and had neurological damage for many months before we adopted him, and Dr. Sammut prescribed Gabapentin, Metacam, and Lasix. Metacam is a similar drug to Rimadyl.
After his decompression surgery here in Ohio, Charlie was still taking Gabapentin, but his other medicines were changed (Omeprazole and Amantadine); our neurologist didn't prescribe Metacam or Lasix after his surgery, but Charlie did have two short courses of Prednisone.
Later, as Charlie needed more pain medicine, our neurologist added Tramadol with Gabapentin and his other medicines. Tramadol can cause constipation, so we gave him a fish oil capsule daily with one of his meals.
3rd August 2008, 02:36 AM
So the short answer is - no, he never took Gabapentin, Tramadol, and Metacam all at the same time!
4th August 2008, 12:43 AM
It seems there isn't really disc "thread", so forgive me for asking here. Just wanted some of your opinions before I see the neurologist Tuesday:
1. Is bathing to be avoided while a dog's recovering from bulging discs? Watson has has seasonal itching, and his epi-soothe baths really help him stop scratching. His hydroxyzine is helping a little, but not enough. Just my luck this had to coincide with his "itchy" season.
2. Are heat or cold helpful? I've seen pads for dogs to rest on that do both, but I'm not sure if they're helpful, and/or which is better for healing disc pain. We live in relatively moderate climate in California.
3. I'm looking at crating him for part of the day when the house is too "active". He's never been crated (is fully housebroken), so it may be hard for him. He's a large 23 lb cavalier (should weigh around 20, and is now on a diet). What size crate for this purpose? Watson likes to stretch out on his side while sleeping.
Thanks in advance. Don't worry - I'll get the docs thoughts as well.
4th August 2008, 01:33 AM
Some of those questions are probably good for the vet or doctor.
Just be aware if he has the surgery for SM, he will require crating for many weeks, all the time. This is far more involved to manage than disk problems. So overall it would be a good idea to start crate training him regardless -- it is very useful to have a place he can happily go for quiet time. I recommend an xpen as well.
I'd get a large wire crate -- maybe two feet by three, so he has lots of room to move around and stretch out. You can cover it with a towel to make it more enclosed and private for him. Get a crate, get a soft crate liner, and start feeding him in the crate and putting toys and nice things like treats in there. He will probably start using it by choice as a retreat (you can prop the door open or tie it back). Then you will want to try closing the door and increasing the time. My dogs are all quite happy to be crated for naps or at night when they are boarding. There's lots of info on crate training in the Library section. :)
I'd want to be sure the SM surgery was actually needed if you are also dealing with back pain. I also would wait til the back is fully healed before considering the surgery.
4th August 2008, 04:29 AM
I'm not talking about having SM surgery right now! He doesn't even have SM symptoms. I'm just talking about crating him to help heal his disc problems. I understand you know a lot about SM, but I don't believe there's any reason to jump the gun with so much to think about. Right now the neurologist, based on her exam and his MRI, does not believe he is suffering from SM currently. At least not yet, and possibly, hopefully, never.
If there was a disc thread I would've posted there.
4th August 2008, 12:42 PM
:confused: Sorry, but if you reread, you'll see I was explaining *crate training*, regardless of what it is used for. And no one is recommending SM surgery -- again, if you take a moment reread my last reply, I specifically say that *I would not consider surgery for SM* unless you are clear the symptoms you see are due to SM. I think maybe your own posts are what is confusing for those trying to help, if several of us have misunderstood the point of your queries... Nancy assumed you were talking about disk surgery but then you said no, you were talking about SM surgery:
Your own words:
I didn't actually mean surgery for the bulging discs but for the malformation/small syrinx. Before that starts to affect him one day.
So I simply explained if this was what you were considering, it's a good idea to have a dog already trained to be crated to ease anxiety with SM surgery -- but you are now saying you are talking about disks, and complaining about receiving advice for SM surgery? Crating for one or the other isn't a different process. :sl*p:
Um... OK. So let me start again with the same point: your vet and neurologist and orthopedist will certainly tell you, for EITHER disk or SM surgery you will need to crate rest your dog for best results, and that you run a high risk of re-injury or failure of these invasive, serious surgeries if you choose to take the same approach you have been up to now -- which clearly caused re-injury, even for a dog that hadn't had surgery. I had thought this was one key reason why you posted in the first place -- to ask for better management strategies as you confessed that the one you had used had caused further pain for your dog? And learn more about potentially managing SM and disk problems? That why I suggested crate rest even now, and/or use of an xpen. :thmbsup:
I cannot see how anyone is 'jumping the gun' to recommend generally, what most vets and neurologists see as normal care for disk problems OR surgery for any condition -- crate rest. Dr Marino for example recommends nearly three months of primarily crate rest post-op for SM surgery. My vets just recommended two weeks' crate rest for one of my dogs that has been in nowhere near the level of pain of your own with a minor back problem. Obviously it helps to have a dog already crate trained, if you have never done this before as it lowers anxiety and frustration for the dog (and hence the owner).
I am sorry you feel people offering supportive replies to your own questions is 'too much to think about'. Please remember that if you ask for public response to a range of questions, you may not get the replies you wanted, and people can only reply to what your questions seem to be -- and either way, many people are taking time to reply! I'm closing this thread, as I think it would be a good idea for you to direct your further questions to your neurologist and your vet, as talking face to face would no doubt avoid misinterpretation of replies or intent. :thmbsup: I know Dr Sammut is very supportive and would be willing to discuss the implications of either kind of surgery. I hope you find the only issue you face is some minor disk problems and not SM pain, as none of us with SM dogs would ever like to see another dog with that. You need to keep in mind that your dog definitely IS suffering from SM now regardless of whether he is symptomatic, and that it is generally a progressive condition, so do keep an eye on that (as I said, Dr Sammut is already treating him for SM by prescribing Lasix, so she obviously thinks he does need some medication for SM -- I'd talk further with her on that). Good luck with solving his difficulties.
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