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Cathy T
28th October 2009, 02:38 PM
My six year old, Shelby, had been doing an odd behavior scratching related. I had her scanned a couple of months ago and she was found to have a large syrinx but no malformation. I've sent my scan to Dr. Rusbridge to get her interpretation. We haven't started any medication and am holding off until I get more opinions as to what is going on with her. Thankfully her symptoms are few and far between, for now. If anyone is interested in seeing yet another MRI of a syrinx, here is Shelby's. I've circled the syrinx in pink. It is very easy to see :(

http://img.photobucket.com/albums/v244/ctorres/02BBCA0E-1.jpg

*Pauline*
28th October 2009, 02:48 PM
Oh Cathy I'm so sorry :( It looks narrow but pretty long to me. Maybe it's width is the reason her symptoms are mild. What medication is she on? You were so kind to me when Dylan was diagnosed, I'll be thinking of you likewise. PM me anytime you need to talk :hug:

Sabby
28th October 2009, 03:43 PM
I am so sorry Cathy. Every day you hear of one more dog being diagnosed with this horrible SM. My friend has send her scan to Dr Rusbridge.

Cathy T
28th October 2009, 03:54 PM
I think what's really sad was my reaction. My vet's assistant and I were talking later. She said the doctor was so surprised at my calm reaction to the news. If my dog doesn't have a heart murmur or doesn't have a syrinx....I'm thrilled. It's almost as if I'm resigned to accepting it. I think that's sad. Not placing the blame on anyone here. My breeder has been so incredibly supportive. And, remember, Jake also came from her and has no problems, is still heart clear at 7 years old.

I'm just praying we can find an answer. This is why I continue to talk to people about SM and MVD, and the huge importance in supporting breeders who breed to better the breed. Breeders who health test. I had someone at the house yesterday on business. We got talking "Cavalier" (no surprise there ;)) and after I was through telling him about the huge health issues our dogs face, the importance in knowledge and education he said "I don't mean to offend, but why do they continue to breed them if there are such serious problems". How the heck do you answer that?? They are incredible dogs!!! They have the sweetest tempemants, are a perfect size, and are just the best. I told him, that's where as pet buyer it's up to me to support health focused breeders. They are the ones breeding to improve the health of the dog. They are doing what needs to be done and need support.

Karlin
28th October 2009, 04:18 PM
So sorry about Shelby's occasional discomfort! :(

I rotated the scan around. It is hard to know, but to me, it looks like there's actually mild compression at the base of the cerebellum -- also in comparison to images of mild malformation on Laura's site, would seem to be some compression? I will be interested to see what the response from Clare is.

Full cerebellum image from Laura Lang's site:

http://www.roycroftinformationcenter.com/Cavalier%20Infosite/MRI%20full%20cerebellum%20for%20comp.jpg

Rotated Shelby's image:

Cathy T
28th October 2009, 04:29 PM
Here is a rotated zoomed in copy. I'll be very curious to know what Clare sees as well.

http://img.photobucket.com/albums/v244/ctorres/02BBCA0E-1-1.jpg

Pat
28th October 2009, 05:24 PM
Hi Cathy,

Questions -

What percentage of Cavaliers are MRI'd and found to have a syrinx but no malformation?

Do they have any idea what caused the syrinx if there is no malformation? I've heard trauma can be a cause but knowing you, you would be very aware if there had been any trauma. How long have you been aware of the symptoms? If you didn't know about SM, would you have suspected something else like allergies or were the symptoms so mild that you would never have investigated them had you not known about SM? (I'm thinking about some of my Cavaliers born in the early 80's.....)

Did PetPlan pay for the MRI? I'm asking because I'm going to insure my 7 year old boy with them. He would have no pre-existing conditions (heart clear, no symptoms of SM) except for a grade 1 luxated patella in one leg, which should never be a problem.

What prompted you to take that step (MRI) in light of almost no symptoms? Did you have a "gut feeling" and/or were you doing it to contribute to research? I know that there are many (most?) of our Cavaliers with CM, but I'm now wondering if there are many that have syrinxes that have very mild or no symptoms.

Pat (sorry for all of the questions - picking on you since I know you!)

P.S. I wrote this before reading Karlin's post that perhaps there is some compression - do keep us posted if you can!

Margaret C
28th October 2009, 05:29 PM
So sorry about Shelby's occasional discomfort! :(

I rotated the scan around. It is hard to know, but to me, it looks like there's actually mild compression at the base of the cerebellum --

That is exactly what I thought when I saw the scan. It will be interesting to hear what Clare Rusbridge says.


They are incredible dogs!!! They have the sweetest tempemants, are a perfect size, and are just the best. I told him, that's where as pet buyer it's up to me to support health focused breeders. They are the ones breeding to improve the health of the dog. They are doing what needs to be done and need support.

I am so sorry about Shelby's diagnosis. SM cavalier owners are a group that no one wants to join.

You are right, supporting responsible breeders that do test and follow the health protocols fully, rewards them for their concern for the breed. Buying from breeders that do not test, or that bend the rules to suit their own purpose, makes it worth their while not to bother.

chloe92us
28th October 2009, 05:42 PM
Cathy- Thank you for sharing your scan.

You're right; it is sad that we expect and are fully armed to accept either MVD or possibly SM. I can honestly say I have never loved a breed as completely as I do Cavaliers, but some days I question whether or not I will bring any more into my life. :(

But then I ask myself; what else would I have? A mutt? Been there, done that; and she had a multitude of health problems too (granted, she was 14!). I just don't know. Unfortunately with Cavaliers, it seems the health problems they do have are very serious, expensive to diagnose, and impossible to give an accurate prognosis. Maybe that is the difference.

Cathy T
28th October 2009, 05:49 PM
What percentage of Cavaliers are MRI'd and found to have a syrinx but no malformation?



Extremely rare.....that is what led me to forward the images to Dr. Rusbridge to get her opinion.



I've heard trauma can be a cause but knowing you, you would be very aware if there had been any trauma.


Our initial thought was the result of trauma from her Rottweiler attack a couple of years back. She also has a herniated disk at the top of her spine, but that is not a huge issue at this time.



How long have you been aware of the symptoms? If you didn't know about SM, would you have suspected something else like allergies or were the symptoms so mild that you would never have investigated them had you not known about SM?


I started noticing it first part of this year. I initially thought she had an ear infection. She kept scratching at her ears. I took her to the vet and an ear infection was ruled out. Had I not known about SM I probably would not have pursued it any further and just put it down to a quirky thing she did. She does an odd scratching. She pulls her leg up and out and hops around trying to scratch. Then makes contact and scratches. It's the leg up and out that threw me and I knew it wasn't a normal behavior. I sent videos to a couple of people and my surgeon. Everyone came back with "anal glands" so I knew I hadn't gotten the behavior correctly on tape, I knew for sure it wasn't anal glands. When I took her to my surgeon, I didn't give her any of my suspisions (sm) just asked to her to exam her and tell me what she thought. She came back with Chiari and suggested MRI.



Did PetPlan pay for the MRI?


Yes, and this is why I went ahead with the MRI. Her symptoms are so infrequent and so mild (which is why I had a hard time getting it on video) that I probably would not have MRI'd her at a cost of $1200. If she were more symptomatic, I would have ponied up the money. But this is exactly why I went with PetPlan a couple of years ago. I knew they covered SM.



Did you have a "gut feeling"


Yep. My surgeon's assistant commented to me later that the surgeon was very surprised at my calm reaction to her diagnosis. Of course I was a mess inside, but it only confirmed what I already knew "in my gut".

I am waiting to hear back from Dr. Rusbridge to get her impressions. I am so grateful I have the resources and know the people to go to. So many people treat for allergies, ear infections, etc and never know that this is what is actually going on with their dog.

hbmama
28th October 2009, 07:47 PM
Cathy, I am so sorry to hear about Shelby's MRI. I know what you are going through, and even though we had a clear (no syrinx) MRI at 7 months, but confirmed Chiari malformation with crowding, Dottie had major symptoms, even after her procedure for PSOM.

As you know in my other posts, we are going with the omeprazole therapy for now and it seems to be working for her. I am not convinced that she hasn't developed a syrinx since her initial scan, but I don't see a need to re scan her just to find out, at least for now.

Pat, we have Petplan and they were wonderful throughout this whole ordeal. They covered our appointments, the MRI, the myringotomy and medications (after the co-pay/deductable that we had selected of course.) They even sent follow up emails and phone calls to see how Dottie was doing after treatment!
The guy that started PetPlan (at least in the U.S.) has a cavalier so they are partial to them there. I highly recommend them here.

Cathy, my thoughts and prayers will continue to go up for you and little Shelby, that she will be okay and not progress. Please keep us posted!:hug:

pippa
28th October 2009, 08:05 PM
Cathy so sorry to hear about Shelby's mri....you will both be in my thoughts.

Pat
28th October 2009, 08:09 PM
Thanks for all the info - I am going to sign up for PetPlan asap. I've never had pet insurance because I've always had so many pets that the annual premium would be $4,000+ or so which would be insane - I would have lost money big time. But now I'm down to four dogs and the cat. All have been incredibly healthy and I've just had to spend money on routine - dentals, blood chemistry and so forth. None of the four has a heart murmur. They are 14 1/2, 12, 9 and 7 - and now only the 7 year old is still eligible to sign up for PetPlan - the others are too old. I have felt pretty "safe" since the youngest is 7 but I guess SM could still become a problem even with older dogs who have never shown symptoms. I'm going to start with a "lesser" plan as they tell me I can upgrade the plan either at renewal or you can upgrade the plan once a year with no penalty.

The person who started PetPlan who has a Cavalier is a woman - she has sent me emails because I've contacted them so many times for info.

Pat

Love my Cavaliers
28th October 2009, 08:10 PM
It's so sad that the SM club keeps getting larger and that Shelby was the one who joined. You are so right about being resigned to either SM or MVD in this breed. Since Riley has SM, Oz has a murmur and 2nd degree heart block as well as the malformation (no syrinxes), I am just waiting for Oliver and Madison to come up with something. Had Oliver at the vet yesterday and at 8.5 years old, he is still heart clear (and my vet can hear a grade 1 murmur since they diagnosed Oz at 4 months of age). I was fully expecting them to tell me he had a murmur. And I am fully expecting Oz to develop syrinxes down the road. Sad, but it sure doesn't make me love the breed less. When I finaly get down to just one or two dogs, I will probably get another cavalier - but be smart about where I get it from. Like you though Kathy, my breeder has been phenomenal with the SM/MVD news on two of her dogs.

Karlin
28th October 2009, 09:21 PM
One statistic I have just confirmed with researchers:

Of 1,100 MRIs on the genome research database (of which 3/4ths were done for research purposes, not because they were dogs needing an MRI because they were brought in as symptomatic by owners), every single dog with SM also had CM.

So in cases where there seems to be no CM in an MRI'd dog, I'd certainly have a second reading done by one of the neurologists involved with the SM conferences, the panel that agreed on the grading scheme. A lot of neurologists clearly are unfamiliar with reading for CM. That's far more difficult than reading for SM; most people can see a syrinx once they know what one looks like on an MRI.

Karen and Ruby
29th October 2009, 12:56 AM
So sorry about Shelby's occasional discomfort! :(

I rotated the scan around. It is hard to know, but to me, it looks like there's actually mild compression at the base of the cerebellum -- also in comparison to images of mild malformation on Laura's site, would seem to be some compression? I will be interested to see what the response from Clare is.

I would have to agree- Ive just been looking back over Rubys pictures and her herniation is large but I would say that there is a degree of herniation there.
Im so sorry about Shelby- it seems like an everday occurance that we are hearing about another dog with an SM diagnosis. Its sooooo sad to hear x

antigone
29th October 2009, 04:55 AM
I'm so sorry, Cathy. It is easy to understand your reaction, though. As we live with our dogs and love them, we also watch them and know what is not normal. It would have been wonderful, indeed, if the MRI would have been clear. SM just seems to grind us down after a while, though. One more thing.. and then one more thing...pretty soon we just come to accept the abnormal as our new normal. It is impossible to stay in the state of intense worry and intense hope. Now we know. We don't like it. We HATE it but it eventually slips into being a normal part of our lives.

I am so unhappy because I know that it didn't have to be like this. If people would have listened and acted appropriately in the 90s this disease might well be gone or almost gone instead of gradually bringing down dog after dog; owner after owner.

The local paper has Cavalier pups for sale for $800. I see that and I know what is probably in store for those pups and their new owners. I feel like taking out an ad in the paper that just warns people about what they are likely to be getting if they buy those poor puppies.

I don't know what to say except I am sorry and I do understand.

Kathy

Claire L
29th October 2009, 09:11 AM
Cathy, I'm sorry your "gut feeling" has been confirmed :( I hope and pray that Shelby's symptoms stay forever mild :hug::hug:

Kate H
29th October 2009, 09:47 AM
Looking at Karlin's useful comparison of Laura's and Shelby's scan, it looks to me as if the brain ventricle in Shelby's is larger than it should be (dilated), which is a symptom of CM and is what eventually pushes the cerebellum downwards - effectively you're dealing with a dog with hydrocephalous. As I have discovered with Oliver, this in itself can cause problems in other parts of the skull (eg pressure behind the eyes), which could account for Shelby's scratching even if the syrinx is not yet causing damage. I wonder how much of the scratching we worry about as a symptom of SM is actually the result of CM - which may of course eventually lead to SM but is in itself a different condition. Hydrocephalous occurs fairly regularly in human babies - does anyone know if this is caused by a mismatch between brain and skull growth, as seems to be emerging in the Cavalier research? A friend's baby born with hydrocephalous also had spina bifida - ie damage caused to the spine (which sometimes includes the central canal) by the hydrocephalous.

Kate, Oliver and Aled

ppotterfield
3rd November 2009, 02:06 PM
Cathy:

Thanks so much for sharing. I had a similiar experience to yours. I had a gut feeling and expected Buddy's diagnosis this past summer. I never cried until weeks later when I was telling a friend about what we had learned and it was like everything caught up with me. Like you if I had not read alot about SM and been a member of Cavalier Talk I might never have followed up because Buddy's symptoms are also mild and I most likely would have attributed them to "that's just our BudBud." All that makes me believe there are many, many more Cavaliers out their who are symptomatic, but the symptoms are so mild that it is just attributed to allergies, "he's overly sensitve to pain" or, as you say, quirky behavior.

Hope all goes well with Shelby. You are being such a good canine parent.

Karlin
3rd November 2009, 03:20 PM
Kate, actually dilated ventricles are not the same as hydrocephalus (but hydrocephalus involves dilated ventricles). All my scanned dogs except one had dilated ventricles but none, according to Geoff Skerritt and Clare Rusbridge, has hydrocephalus. Hydrocephalus is a very extreme version of dilated ventricles... (see below). It also isn't the vetricles pushing down on the cerebellum (alone?) but the Chiari-like malformation and the fact that the skull typically slopes in and presses inwards at that point in this breed, causing hind brain compression (compression on the cerebellum). When this is extreme it actually forces the cerebellum down into the opening into the spinal canal (the foramen magnum).

According to Clare Rusbridge, no one yet knows what role dilated ventricles play, if any. In some breeds, huge dilated ventricles are actually normal. The neurologists note them on scans on the possibility that this may be significant and it may be useful to have those readings in future.

From Clare's website:


What is ventricular dilatation / ventriculomegaly?
The ventricles are four communicating cavities within the brain that are continuous with the central canal of the spinal cord. The four ventricles consist of the two lateral ventricles, the third ventricle and the fourth ventricle: They are filled with CSF, which is formed by structures called choroid plexuses located in the walls and roofs of the ventricles. When there is an obstruction at the FM the CSF can “back up” in the ventricular system, dilating the cavities. When ventricular dilatation is considered an incidental finding it is often described in MRI reports as ventriculomegaly. Severe ventricular dilatation resulting in brain compromise is described as hydrocephalous. Hydrocephalous as a consequence of CM is rare and most cases with ventricular dilatation have no associated clinical signs. Ventriculomegaly is also seen in other situations unrelated to CM and is particularly common in brachycephalic (dome headed) breeds.

You can see an image there as well: http://www.veterinary-neurologist.co.uk/part2.htm#8

I know a couple of the researchers do consider dilated ventricles to be significant in some way as yet unknown, and they often dilate further as SM progresses.

chloe92us
3rd November 2009, 07:29 PM
Cathy, have you heard back from Dr. R?

Cathy T
3rd November 2009, 07:47 PM
Yes. This is what her report said

Chiari like malformation of the caudal skull YES
Dilatation of the central canal / syringomyelia YES –C2-C4 (max width 3mm)
Syrinx may extend beyond the caudal limit of scanning
Ventricular dilatation MODERATE
Mucoid material in left tympanic bullae

I've forwarded the information to my vet who took the images.

chloe92us
4th November 2009, 12:36 AM
Cathy- Well, I guess it's just as you thought. What are your next steps? Just wondering since her symptoms are mild, what treatment you're considering and what meds (if any) she is now taking.

Big hugs to you.

arasara
4th November 2009, 01:34 AM
Cathy.. I know you've been really struggling with this issue and I'm glad that Clare wrote you back.. ***HUGZ** to you.. you're in my thoughts and prayers!

Will this "new opinion" change your course of treatment or have you decided that yet?

Bet
4th November 2009, 09:44 AM
Could I just say best of luck on what you decide to do about Shelby.

Also can I mention how lucky the Cavalier Breed is to have such Dedicated Person as Dr C Rusbridge.

I not sure of these facts, but I believe that a number of years ago ,when she saw a number of Cavaliers with this same condition ,she began to realize there was a Problem and decided to investigate as to what was happening.

The rest is now History.

ppotterfield
4th November 2009, 07:04 PM
Yes. This is what her report said

Chiari like malformation of the caudal skull YES
Dilatation of the central canal / syringomyelia YES C2-C4 (max width 3mm)
Syrinx may extend beyond the caudal limit of scanning
Ventricular dilatation MODERATE
Mucoid material in left tympanic bullae

I've forwarded the information to my vet who took the images.

Cathy:

Hugs to you and to Shelby. Hopefully, her symptoms will stay mild and she will have good quality of life for many years to come.

Our BudBud has minimal symptoms -- occasional, single yelps (not every day, maybe a couple times a week), some face rubbing and some scratching which from looking at videos I would not classify as SM scratching. He is now on Gabapetin (100 mg. 3Xs a day) and Prilosec. There has been some diminution of the yelps and face rubbing but they have not disappeared. He does seem happier. We just got back from the beach and he had a great time chasing birds and butterflies, digging for sand crabs (or to China, not sure which) and just playing with his Clumber sisters. He was zonked every night! He will have been on Gabapentin and Prilosec for two months in another two weeks and we will reassess dose and whether we need to try something other than the Prilosec.

They bring us such joy that it is hard to accept that they can experience pain and not tell us how to help them.