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View Full Version : Our beautiful Ruby has just been diagnosed as having SM - devastated.



dizzy
16th November 2008, 01:20 PM
On Wednesday our beautiful little Ruby - 16 months - was diagnosed as having a SM - 3mm 'bulge' and 1 syrinxes.(apparently an unusual one as it is lore to left of spinal column rather than central) We are devastated. We return to the neurologist at the beginning of December and I am already thinking up questions to ask him. Up until Wednesday her only sign of something not right was after scratching her ear she had a moment of weakness in her right eye and seemed a little frightened for no more than 5 mins. Our vet said she could have made herself dizzy by scratching her ear. We decided to rule out the worst case and had her MRI'd - Now we find we have ruled it in. Since then I seem to be looking for symptoms when infact she doesn't really display any. She never yelps or winces in pain. She loves having her neck massaged. She does scratch occasionally - maybe 3 times a day or maybe only 1. If I simulate scratching her neck for her she does air scratch but apparently this is the 'Scratch reflex' and is normal in dogs. Anyway I suppose I just want reassurance that others have been where I am. SHe has been put on a low dose of diuretic for life. Anyone out there able to relate to our story or offer words of hope? Thank you x

Karlin
16th November 2008, 06:53 PM
Welcome to the forum and so sorry you have had this upsetting diagnosis. :flwr:

It is good that you are already aware of what is going on as that gives you more options to think about in terms of treatments over time and also means you can monitor her more carefully and react more quickly, as needed. :flwr:

Have you spoken to the neurologist at all or just your vet? I think you will find speaking to the neurologist will give you a lot more information. On the eye movements -- I would doubt this could be from becoming dizzy due to scratching -- I've never heard of this before -- but nystagmus, or problems with eye movements, are a known symptom of SM in humans and dogs so be sure to discuss this with the neurologist if you haven't (I am sure you probably have) and if she appeared frightened then it was probably related to some pain or lack of coordination connected to that I'd think?

Also I think the rubbing on the neck may be causing the scratching, myself -- those reflex scratches (which most dogs will do :) ) usually are more due to rubbing bellies or the sides of most dogs, not the top of the neck if that is where you are rubbing. But air scratching in cavaliers really means scratching when upright, not when you stimulate it, so you probably aren't seeing actual air scratching, but maybe a discomfort reaction due to rubbing that area. I really would try to avoid putting any pressure on the neck if you can -- move her to a harness for example so a collar isn't pulling at the neck; most dogs with SM are generally far more comfortable on a harness. I wouldn't rub at that area or anywhere around the spine if there's any question of a reaction.

There are videos of dogs with SM on www.smcavalier.com that might be helpful to you. The one of Chester in particular might help put symptoms in some context.

Scratching three times a day (more than once daily, actually), if they are SM scratches, is actually a fair amount of scratching according to the pain assessment diagram used by several of the neurologists to give a pain score to dogs (view it here (http://sm.cavaliertalk.com/painscore.pdf)). Some neurologists feel scratching is a far less worrying symptom and may just indicate some minor discomfort but others say it does indicate actual damage to an area of the spinal cord and can mean anything from minor discomfort to real pain, so it is good to keep an eye on it. If the diuretic doesn't stop the scratching, most neurologists will then recommend trying gabapentin (neurontin) as the next step.

Did your vet or the neurologist say a lopsided syrinx was abnormal? My understanding is that these are more common that syrinxes right in the center of the spine as more dogs scratch or have symptoms on one side only, but maybe it is the case more that while lopsided syrinxes are less common, they are more commonly associated with pain and symptoms. I do know they tend to be a bit more problematical because they start to press on the side of the spinal cord where they are larger, and this is what starts symptoms, whereas those in the centre take far longer to start pressing on the nerve endings at the top or side of the spinal cord. Dogs then have symptoms primarily on the side where the syrinx is pressing -- eg the dog will scratch to that side or develop areas of pain on that side.

There's a lot of info on my site www.smcavalier.com and you might be interested in the presentations in the London 2006 area of the research section where there's a presentation on syrinxes and pain. This is in paper five and there are links to the abstract and slides from that presentation.

This is from that paper:


There is a very strong association between maximum syrinx width and pain:

* Asymmetry of syrinx is only found in the dorsal half of the spinal cord, and is associated with pain. 79% of dogs with pain had such a syrinx.
* syrinx length is also associated with pain.

Results – dorsal asymmetry:
* Syrinx asymmetry only found dorsal half spinal cord
* Dogs in pain more likely to have dorsally asymmetrical syrinx
15/19 (79%) - dogs with pain
16/33 (49%) - dogs without pain (p=0.0419)
* Mean length of asymmetrical syrinx
5.15cm - dogs with pain
2.8cm - dogs without pain (p=0.0039)


You can see that in this study, more dogs had assymetrical syrinxes than symmetrical (31 of 52 dogs). These are my notes from that international conference and I am afraid they are not highly detailed but they were checked by the various speakers for accuracy.

Have you let her breeder know about this diagnosis? This is important information for breeders to help their breeding programmes. Also, is this a KC registered dog? If so the scan results would be very valuable to Dr Sarah Blott's work on the condition; I can send you some further information on this privately.

*Pauline*
16th November 2008, 08:19 PM
Yes I second what Karlin said about the harness and not to use a collar. I was told Dylan can never wear a collar again. I won't actually even stroke his neck or back now.

It sounds like you have a lot of questions and I'm sure all of them can be answered here. It's good to keep in touch with your neurologist too.

Love my Cavaliers
16th November 2008, 08:46 PM
And I will third what Karlin said about collars. Riley's neurologist said she was never to have a collar on again. Riley has severe SM and had surgery in June. Oz has the malformation but no syrinxes and I was told to use a harness on him also - no collars. And I am so sorry you are going through this. The time period following diagnosis is just a heartbreaking time. Everyone on this board will help you get through it though. Good luck at your next appointment.

*Pauline*
16th November 2008, 09:19 PM
Yes that's true Bev, it is a very sad time after finding out. You are not alone in feeling this and we will be here for you :hug:

pippa
16th November 2008, 10:21 PM
Thinking of you.

dizzy
16th November 2008, 10:36 PM
Thank you so much for your informative reply Karlin. And thank you all for your caring words. Ruby has always worn a fleece lined harness - never a collar. Also, the area I rub gently where she then starts to mimick scratching with her leg is her left flank not her neck - sorry if I mislead. She has never yelped or winced and I thank God that so far she has not given any sign of being in pain. She is scratching a bit more on her left side ( the area particularly that was shaved on Wednesday for her MRI) so hopefully it's just that - will monitor though) The neurologist was Martin Deutschland at Chestergates hospital - lovely Man and so caring. I probably mis understood what he said about her lopsided Syrinxe although he definitely said they were excited by what they saw as it was quite uncommon.... will check that out next visit. I would welcome suggested questions to ask him as I just listened on Wednesday. With regard to breeder - I think it's a case of burying her head in the sand. I told her about Ruby and she said - ' none of her dogs so far have screened positive to SM' very hard to believe that. Two friends bought Ruby cavs from her too - same age as Ruby but cousins. You can imagine how they are feeling now. Anyway - thanks again. Love Dawn x :)

dizzy
16th November 2008, 10:43 PM
Sorry meant to add Ruby is not KC registered. Her breeder seemed really good. Saw Ruby's mum and Auntie - clean breeding area - pups in house mixing with family and family pet Rottweiller! Lots of info given with Ruby which our vet was impressed with. Clear heart check with breeders vet and then subsequently ours. All checked out well - however now she seems quite defensive.... Mmmm

Karlin
16th November 2008, 11:14 PM
Dawn, I am sure you are right that you heard him correctly -- whatever he saw, he felt was unusual and I'd guess there's probably more than just the fact that the syrinx was lopsided alone but some additional things that surprised him. I've met Martin as well, and heard him give a talk and he is doing research in this area so he would know what he is talking about. :) All my dogs have been MRId at Chestergates, too!

Just on collars -- my SM dogs both wear collars for their identification but they both have moderate symptoms. So they are fine wearing them but I don't ever walk them using collars. Dr Clare Rusbridge has noted there are some SM dogs that, because of the position of their syrinx, are more comfortable walked on a collar than a harness, but just wearing a collar can be aggravating to some SM dogs too.

brotymo
17th November 2008, 04:40 AM
so sorry to hear of your Ruby's diagnosis. You will find lots of support and information here. :hug:

hbmama
17th November 2008, 06:15 AM
I am so sorry to hear about the diagnosis. Now that you know, you can do the right things for Ruby to keep her comfortable. There are alot of board members who have SM dogs that are managed well with medication and living modifications from what I have read. You have a wonderful fellowship of support and information here. Please keep posting on how she is doing. :hug:

Cathy Moon
17th November 2008, 01:00 PM
Hi Dawn, so sorry you're going through this.

Here are some questions for the neurologist:

Think of your dog's neurologist as 1/3 of a three way partnership [neuro, vet, you] in managing Ruby's lifelong, progressive illness. You're going to want to establish how often she will need to be seen by the neuro, whether the neuro will work with your vet for managing her medications, and how the neuro will respond to any emergencies if they should arise.

When Charlie was alive, our neurologist worked in a full service animal hospital, so I could call anytime of the day or night, and on weekends and holidays if we had an emergency. And while on the topic of emergencies, fnd out what the neuro considers to be an emergency - if my dog is in pain and the meds aren't working, it is an emergency to me. We also had an arrangement with our neuro and regular vet, where the neuro would call in additional pain meds for Charlie to our regular vet, saving us a 2 hour trip.

Also, and this is really important, if you are on a tight budget and the neurologist prescribes very expensive, complex, or out of the ordinary medications that have to be filled at a special compounding pharmacist - ask if they can work with you to prescribe more affordable medicines. [The exception to this would be if your dog is having decompression surgery!!!] I'll give you an example - Charlie needed 80 mg Gabapentin, which was very expensive to have filled at a compounding pharmacist. Geordie gets 100mg Gabapentin which costs $4.00 a month at our supermarket pharmacy for humans!!!

Think in terms of all the questions you would ask your pediatrician if you had a newborn baby with a serious illness. :thmbsup:

dizzy
23rd November 2008, 09:46 AM
Thankyou all for your caring informative replies. :rah:
Just over a week has passed since Ruby was diagnosed and I have found it quite an ordeal in some respects.

At first I noticed every little possible symptom ie scratching, a tiny wobble on her back leg when she got up from her nights sleep ( I mean tiny!). However, I could spend the rest of her lifebeing so finely tuned in to her that I would miss the enjoyment and fun of her being just Ruby.

So, I have made a conscious decision (along with husband and son) to try and put SM to back of our minds. When she has a scratch we just ignore it, she did one bunny hop yesterday on her walk so I have made a mental note of that and if it develops I will write it down for when I chat to Mr Deutschland in 2 weeks.

She has - so far - never shown a sign of pain when walking, scratching or indeed at any time. I am so tuned in to her that I know I would pick up on it. So, we have to move forward and just love every moment of being with her, like we did before the diagnosis and not let it hang over us. If ever she shows the tiniest amount of pain or excess scratching to what she does now I will be off to Chestergates! :dogwlk:

Thank-you all again - wonderful people that your are.


Dawn x

dizzy
2nd December 2008, 10:01 PM
Hi There,
Ruby went back for 3 week post diagnosis check - her bloods are fine so she can stay on diuretic. She is being kept on anti- biotics as her ears are a bit troublesome still - one has debris in and the other 'Martin couldn't see her ear drum'. She also has 'eye drops' for her ears! Still not so sure I fully comprehend Ruby's MRI results as Martin was in a hurry due to over running of surgery prior to Ruby being seen and also I find I am still trying to make sense of his first sentence and then realise we are on sentence 3! Such a lovely man though! Ruby has 1 leaky syrinx. He saw her air scratch but wasn't too concerned. So we are back to our own vets in 3 weeks for ear check up.
Dawn

LovesCavaliers
3rd December 2008, 12:44 AM
Just wanted to say how sorry I am to hear of yet another cavvie with this health problem. You will get lots of support here, so stay strong.

Mary

Indy
3rd December 2008, 12:10 PM
Very sorry to hear that.I hope this symptoms are going to be something Ruby and you can live with :xfngr: and they will not worsen.

Kate H
3rd December 2008, 09:41 PM
Oliver has a small syrinx and (so far:xfngr:) no symptoms, but he too has itchy ears at the moment (mites). I find that very occasionally he will apparently bunny hop or air scratch once, but if I let him sit down, all he actually wants to do is scratch his itchy ear for a few seconds and then he will carry on with his walk quite normally. And after a few days of Thornit in his ears, he's itching less anyway. So you may find that Ruby's scratching is less a symptom of SM and more just plain itchy ears. Oliver is very fit and healthy and leads a normal life, so I hope once Ruby's ears are sorted she will be the same.

Kate and Oliver

Karlin
4th December 2008, 12:55 AM
Martin is almost certainly talking about ear problems possibly related to PSOM. They do use antibiotics at Chestergates for this and find it works in some cases -- it is very hard to determine whether scratching is due to PSOM or SM. I am going to try their suggested treatment route for this with three of mine to see if it helps. Three of my four have PSOM which seems to be very prevalent in the breed and is probably one of the reasons many go deaf; Lucy is fully clear.