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View Full Version : Anyone with an SM dog...question about seizures (long)



Shay
2nd October 2010, 01:16 AM
My now 4 year old cav Lily, who started showing signs of SM at 3 months, was diagnosed a year ago with a syrinx and I was told by the neurologist that she was borderline for decompression surgery. We opted to treat with medication, and she is taking 50 mgs gabapentin 2x day and 1/2 omniprozal tablet. She seemed better for a while, with less frequent scratching episodes, but within the last 2 to 3 months, the face rubbing and scratching has become more frequent.

On Wednesday of this week, I came home and let her out, and as always, she quickly pottied and ran back in to get her treat. After her treat, I noticed that she looked like she could not find the floor with her back leg when she tried to walk. She would keep trying to put her back leg down, but it would never touch the floor, but not like a bunny hop. It was like she didn't know where the floor was. Then her front leg went completely stiff, and would not bend at her paw or her shoulder when she tried to walk. Her entire left side was like it was paralyzed. She kept trying to walk and would fall over. I picked her up, and her front leg was as stiff as a board just sticking straight out, and it was trembling. Then her head tilted to the left side. I held her and soothed her, and she just looked scared. I freaked out and called my husband to come home. When he got here, I put her down so he could see what she was doing, and she still kept falling. About 10 mins later she vomited everything she had eaten that morning, which was 7 hours earlier. Almost immediately after she vomited, she started walking normally. The entire episode lasted about 30 mins. She was listless the rest of the night, and last night it looked like her back leg was starting to go limp again, but only for a few minutes. I picked her up and tried to touch her front left paw, and she would pull it away, but would let me manipulate her right front paw. Then later, she was laying behind me on the back of the sofa, and she let out a deep sigh. I thought she was sleeping, but when I turned to look at her, her eyes were open and she was staring into space. I called her name several times and she didn't respond. I screamed her name, and nothing. I yelled for my husband, and when he came into the room, he called her and nothing. After about another 30 seconds, she looked up at us. Today she seems better, but not completely herself, but she is wanting to play some, and she is walking fine. Her appetite is as voracious as ever.

Does this sound like she is having seizures, or something else? What is so weird is the minute she vomited, she was able to walk again, like nothing had happened. It almost seemed like she had a stroke that had affected her entire left side. Even when she couldn't walk, she was trying to wag her little tail, but it would only wag on the unaffected side and would not go to the left, if that makes any sense. She never seemed to be in any pain during the episode. I have never had a dog with seizures, so I have no idea what a seizure looks like. There was no convulsing at all.

Needless to say, I was very distressed, as she has never had any seizures, limb issues or head tilt with her SM. And this just happened so suddenly, and then was gone after she vomited. Do dogs vomit after seizures? Her only symptoms with her SM have been face rubbing, itching, and the occasional yelp when you pick her up.

I found out today that we now have a neurologist in my city 2 days per week, who actually works with the neuro who diagnosed her at out vet school, and I was able to make an appointment with him for next week. I am so pleased we now can have her treated here in my city, in addition to our vet school if needed. Sorry this is so long, but if anyone has any ideas or had a similar experience with their dog, I would love to hear from you. It is a long time until next Friday, and if it happens again before then, I would like to know what to do for her if it is seizures. All thoughts are welcome. As you can imagine, this sweet baby is everything to us, and the thought that she has now progressed to seizures or lameness is heartbreaking for us. Thanks!

Edited to add:

We did have a vigorous time playing ball the day before this happened. The weather was beautiful, and she so loves to play ball, that we gave in. She kept running from the door to the cabinet where we keep her ball, so we just had to let her play a while in this beautiful weather. It is so hard to try to keep a dog who lives to play from it. I guess that is the dilemma with all SM owners. I guess that could have brought this on, and I could kick myself if I am the reason. But I think, I don't know how long she will be with us, is it fair the keep her from the things she loves so much?

Cathy Moon
2nd October 2010, 05:19 AM
I wish I could help, but I haven't had any experience with these types of symptoms. If you can capture an episode on video camera it would be helpful for your vet and neurologist.

It does seem odd that her food was still in her stomach after all those hours. I thought it moved through their digestive systems much quicker than that, so maybe that is some key information for your vet.

Like you, I face the same dilemma with Geordie's playing, but I do let him play daily with India if he wants to. If I can tell he isn't up to it, I will stop India from trying to play with him, though. I want him to have fun if he feels well enough to initiate it. If Lily wants to play I think I would let her, but you might want to ask the neurologist's opinion.

Edited to add: have you looked at the Episodic Falling website? Is there a similarity with the symptoms?

Cathy Moon
2nd October 2010, 05:28 AM
I just re-read your post and noticed her low dosage of Gabapentin. Gabapentin usually only lasts 8 hours, and that is a low dose too. She might need a stronger dose and every 8 hours for pain management.

Shay
2nd October 2010, 05:50 AM
Hi Cathy,

I told my husband tonight we needed to video these episodes, because sadly, not 15 mins after I wrote my first post, she had another episode. My husband wasn't home so I called my next door neighbor who works for a vet. She doesn't know anything about SM, other than what she has learned from me, but I felt better just having someone here, because it is so upsetting. As soon as my husband got home, I told him to set up the video recorder for me so that we can get one of these episodes.

This time I was getting ready to give both of mine their medicine before they went to bed. Lily always jumps up and props her paws on the trash can in the kitchen to wait for her treats and medicine. As I was getting the medicine out, I noticed she hadn't jumped up on the trash can, which she always does without fail, and when I looked down, she was in the same condition as Wednesday night. Front paw stiff, and back paw held above the floor, and falling over as she tried to walk. That lasted about 15 to 20 mins. My neighbor and I took her outside because she was trying to get to the door, and as soon as we carried her down the steps and put her down she vomited, same as last time. She ate about 9:00 this morning, so it had been 11 hours since she had eaten, other than her treats. My neighbor said that she saw her food still in the vomit, and like you, she commented that it was odd that her food had not digested. Again, after she vomited she started walking ok. It is the strangest thing.

I know what you mean about the playing. I agree, you just have to let them enjoy being a dog sometimes. Lily is so active, and the SM has never slowed her down. This new development has me so upset. I can't wait until next Friday. She is on a very low dose of Gabapentin, and I agree that it needs to be adjusted. As far as EFS, she isn't just falling over, she is trying to walk and can't because her front paw goes stiff and her back leg doesn't connect with the floor, and then she looses her balance.

Thanks for replying, and I hope your babies are doing well. This is such a horrible unforgiving disease.

Soushiruiuma
2nd October 2010, 07:23 AM
Having food in the stomach after that length of time is extremely odd. The gastric emptying time for most animals is about 2 hours, so after 11 hours you would expect just the frothy acid. I think the lack gut movement may be an important neurological symptom. The vomiting may be a sign that the sympathetic nervous system is abnormal.

One simple change that may be of no benefit (but should be incapable of doing harm either) would be to give several small meals a day instead of 1-2 larger meals. Eating activates the gut, which keeps everything moving through. Has her stool been normal? I don't want to alarm you, but an intestinal blockage would have been deadly by now. A small obstruction could possibly aggravate to this extent.

I would definitely call your neurologist, these symptoms are quite severe, and merit immediate attention.

Karlin
2nd October 2010, 10:00 AM
This could be epilepsy or any range of kinds of seizure. SM does not usually cause seizures, from what I have understood from Clare Rusbridge, but it is possible. I would not leave these to continue happening without urgently trying to find the cause and to try medication to prevent them, so if they start again I'd get an emergency vet appointment. :thmbsup:

As Cathy notes, she is on a very low dose of gabapentin -- generally such low doses need to be increased over time of you are seeing any symptoms, and generally to 3x rather than 2x as Cathy notes. My dog is on 150mg 3x for example.

Hope you can find a reason for the seizures as this must be very distressing. Some others with dogs with seizures may have some ideas.

Cathy Moon
2nd October 2010, 12:35 PM
The thought of an intestinal obstruction didn't occur to me, but since I've read Soushiruiuma's post I think I'd get her to an emergency vet as soon as possible.

Fingers and paws crossed that all goes well for you and Lily.

Shay
2nd October 2010, 03:43 PM
Thanks everyone for the suggestions. She seems fine this morning. I did feed her just about 1/3 of her food, and will feed the remainder over the rest of the day to see if this helps. She is pooping fine, and has not thrown up except for the two times I mentioned, after the two episodes. Her stomach is not hard or distended, or tender to the touch, so I don't think she has a blockage. But this is certainly something that I will bring up to the neuro when we go.

I did call my emergency clinic after the first episode, and they are the ones who told me they now have a neuro on staff two days a week, and to call the next day to see if he could see her. I did call, and was able to get her in next week. Our emergency clinic is also our specialty clinic during the day when the emergency clinic is closed, that has all the specialists in town. Heart, eye, ortho, internist...etc, but they never had a neuro on staff until recently. It is the same place I bring my other Cavalier for his MVD. I had called Auburn where Lily was first treated, to find out if they knew this doctor, and they told me he is on staff there, and works with doctor Shore, who was Lily's neuro at Auburn, so I feel good about that.

Pat
2nd October 2010, 05:31 PM
Just one thought to add - your description sounds much more like a vestibular episode than a seizure. I've seen both seizures and vestibular incidents many times. Vestibular episodes, however, usually resolve over a longer period of time than you describe - it usually takes hours to days to resolve. On the other hand, since vestibular problems are related to the inner ear/brain system that controls balance and equilibrium, that could explain the vomiting. Vestibular episodes are often mistaken for "strokes" by people who aren't familiar with them. They include what you describe - ataxia (walking like drunk), head tilt, problem on one side of the body, falling over, inability to walk or stand, twisted neck and body (I've seen dogs look like fish out of water flopping around). Another sign is nystagmus - which is a rapid eye movement from side to side. The difference is that these episodes are usually more severe than what you describe and take much longer to resolve. A member here (is it Bev?) has an SM dog who has/had vestibular symptoms so hopefully she will see this.

Another thought - what you describe about the rear leg lifted and not being able to put it down sounds like what happens with luxated patella when the knee is out of joint. That doesn't explain the rest, but wonder if there could be more than one thing going on.

I also immediately noticed that she is on a VERY low dose of gabapentin. Never heard of a dose that low; it is basically ineffective.

Pat

Love my Cavaliers
2nd October 2010, 06:16 PM
I agree with Pat that this sounds more vestibular than seizures. I had a German Shepherd with a true seizure disorder and they are two very distinct things. There are so many things about Lily's episodes that are similar to Riley's vestibular events. Riley was diagnosed with SM and had decompression surgery right before her 6th birthday (2+ years ago). She never had any of the scratching or pain episodes that seem so typical of SM. Her presenting symptoms were related to the damage to her vestibular system caused by the SM. At her worst, she sounded very similar to Lily - almost paralyzed, couldn't walk, sit, stand, but kept trying. She would have times in which she could only keep herself upright by walking while leaning against the wall or the kitchen cabinets. She was on gabapentin and steroids before surgery which had absolutely no effect on any of her symptoms, which is one reason we opted for surgery. She has (both before and after surgery) numerous vestibular events (that's what her neurologist calls them - we call it her exorcist event) in which she is at rest and her head and back whip into a backwards C shape and she has nystagmus. She is nonresponsive during these events and they typically last for about 30 seconds. She comes out of them wagging her tail and looking around for me and then is her normal self. She has never had the vomiting or the rear leg issue though.

Her only medication since surgery is 5 mg prednisone/day and Denamarin to protect her liver and she is doing so well - she is like a new dog. Her balance issues are still there but are so minimal. She will never be a "normal" dog, but she runs, she plays, and she is a happy dog. I'm so sorry you're going through this. It's a terrible and heartbreaking thing to watch your dog suffer like that. Maybe you can call Dr. Shore and see if he will up her dosage of gabapentin even before you see your neurologist. Good luck to you. PM me if you would like.

Love my Cavaliers
2nd October 2010, 06:20 PM
I meant to add this link to a web site on vestibular disease in dogs. Have a look http://www.canine-epilepsy.com/vestibular.html

Shay
2nd October 2010, 06:33 PM
Hi Pat....Thanks for the info! That is very interesting and my neighbor who works for the vet mentioned that to me as well, and she had a dog with vestibular, so she is very familiar with it. She did mention that you usually see it in much older dogs. When she was here last night, she had me hold Lily's head still and she looked in her eyes for the rapid movement, but didn't see that at all. The other thing that is interesting is that a blue tail lizard, of which we have many in the south, if eaten by a dog will cause a vestibular episode. The emergency clinic told me that it usually resolves in a matter of a few days, and there is no treatment, as it will resolve on it's own. So, I guess she could have gotten one of those, but I have never seen her eat anything outside, insects, lizards etc. but I guess she could have. Her symptoms do sound so much like a vestibular episode, and walking like she is drunk is a perfect description.

Today she is fine, like nothing happened. I am definitely going to push for the gabapentin to be increased. I asked the team at Auburn about that when she was diagnosed by them. Lily's symptoms were so minor at that time, they said they wanted her on the lowest dose possible. I think I am going to start giving her 3 per day, up until she goes to the neuro next week to see if that works better, but I know it definitely needs to be increased.

Shay
2nd October 2010, 06:53 PM
I meant to add this link to a web site on vestibular disease in dogs. Have a look http://www.canine-epilepsy.com/vestibular.html


Thank you so much for the info. Lily's episodes sounds so much like your Riley's. Lily's did last longer, but everything else is sounds so similar. I am so upset that a dog who had very minor SM symptoms, is now likely having these vestibular episodes. So I assume they never go away even with surgery? I am so afraid she will have one while going down the steps to our backyard, as we have a very high deck. I guess I am going to have to look at the surgery now, and I thought she would never need it, with such mild symptoms :( . In my response to Pat, I told her I was going to start today giving Lily 3 gaba's a day to see if there is some improvement. Three per day at her dosage would still only be 150 mil per day, so I don't think it can hurt.

I am so glad your Riley is doing so well, and I really appreciate all the info. Thanks so much!!

Edited to add: Lily also has PSOM and I never even thought of that as a reason, but after reading the info, I wonder if that may also be causing these episodes, or a combination of both her SM and PSOM. I have a battery of questions for the neuro next week.

Pat
2nd October 2010, 07:43 PM
Lily also has PSOM and I never even thought of that as a reason, but after reading the info, I wonder if that may also be causing these episodes, or a combination of both her SM and PSOM. I have a battery of questions for the neuro next week.

I think these could be vestibular type symptoms from SM and/or PSOM. I have seen the classic "old dog idiopathic vestibular" syndrome that your neighbor is familiar with. But I think with SM or PSOM there could be these more "mini" episodes that Bev describes. Since SM is a progressive disease and she began exhibiting symptoms at a very young age, you would expect progression of her symptoms over the years.

Pat

Bet
3rd October 2010, 09:35 AM
I think these could be vestibular type symptoms from SM and/or PSOM. I have seen the classic "old dog idiopathic vestibular" syndrome that your neighbor is familiar with. But I think with SM or PSOM there could be these more "mini" episodes that Bev describes. Since SM is a progressive disease and she began exhibiting symptoms at a very young age, you would expect progression of her symptoms over the years.

Pat


Could I just mention that our Pippa had the same symptoms as Shay, and as Pat mentioned ,our Vet said this was what her Problem was.

Our Vet kept her in ,and she did have a Full Blown Fit and had to be sedated.Thankfully she recovered

Bet

Shay
9th October 2010, 04:26 AM
It was a long day at the neuro. He thinks it was her PSOM most likely, since vestibular episodes, which is what he said she had, have to do with the inner ear, but possibly could be the SM related as well. He did say that vomiting is never a symptom of SM, and he really believes it's the PSOM. Since her MRI is a year old, we will have to get another one done. They also now can check gabapentin levels to see if her gabapentin needs to be increased, but he has to send the blood work to Auburn and I won't get those results until next week. He agreed she is on a very low dose of gabapentin, so he will probably increase that. He also saw a abrasion/ulcer on her cornea, and said her eyes are very dry, and when he tested her eyelids closing, she is not closing them all the way, so she has to go to an eye specialist to see about that. He said she has a very slight facial paralysis, that you can't see by looking at her, but that he detected from all the tests he did today, and is the reason her eyelids are not closing properly. More than likely from the SM. He said she has very minor reflex issues with her limbs, so that is good, and it doesn't sound like her SM has progressed very much. From the way it sounds the increased face rubbing, and ear scratching, is most likely the PSOM. He said the MRI from last year showed she had a very small syrinx, and if it hasn't enlarged, it was unlikely the SM was causing the increased symptoms. He said the face rubbing and ear scratching are both symptoms of SM and PSOM, but with her having the vestibular episodes, he is almost positive it is the PSOM that is the problem. Please keep her in your prayers, and thanks for all the info you guys gave me.

Blondiemonster
9th October 2010, 05:46 PM
Very interesting.. I too have a dog with both. She never showed any symptoms and i didn't know she had it until one day she "broke down" She wouldn't walk on the leach at all, she freaked out and bunny hopped...
So, we get the MRI, and sure enough, she has both SM and PSOM. A very bad MRI too. They relieve the inner ear pressure; her symptoms were gone. For two months. Her vet was in disbelief.
As of now she starts showing some mild symptoms of scratching again, mainly at her ears. I know PSOM comes back often...
It is very hard to know how much is the SM how much is the PSOM. They can also make each other worse!! The pressure in the ear can significantly worsen SM symptoms. (which was proved by my situation)
I am planning on getting her spayed in january, and most likely will combine it with another draining of her ears (after they look at it to see if it's necessary, but i believe it will) and maybe another scan/ (if Dr. Marino will still give me the free follow up one for his study on PSOM. Dont have an extra 2000 laying around at the moment 8))

Shay
9th October 2010, 07:59 PM
Very interesting.. I too have a dog with both. She never showed any symptoms and i didn't know she had it until one day she "broke down" She wouldn't walk on the leach at all, she freaked out and bunny hopped...
So, we get the MRI, and sure enough, she has both SM and PSOM. A very bad MRI too. They relieve the inner ear pressure; her symptoms were gone. For two months. Her vet was in disbelief.
As of now she starts showing some mild symptoms of scratching again, mainly at her ears. I know PSOM comes back often...
It is very hard to know how much is the SM how much is the PSOM. They can also make each other worse!! The pressure in the ear can significantly worsen SM symptoms. (which was proved by my situation)
I am planning on getting her spayed in january, and most likely will combine it with another draining of her ears (after they look at it to see if it's necessary, but i believe it will) and maybe another scan/ (if Dr. Marino will still give me the free follow up one for his study on PSOM. Dont have an extra 2000 laying around at the moment 8))


I know what you mean about the money. Lily's exam at Auburn when she was initially diagnosed was $1900.00. Yesterday's visit was $250.00. He told me they now do MRI's in the clinic where he is located, so I wouldn't have to bring her to Auburn, but the clinic charges $1900.00!! :shock:

I know Auburn's MRI was much less, but he said I may have gotten a discount, because they did a total workup for anything and everything while she was there. I will check Auburn's price again before I have it done. If I spend another $1900 on an MRI, it will pretty much exhaust the $3,000 that my pet insurance pays for each illness. I was trying to save the remaining amount for surgery if I ever decided to do that, which was going to be $2200.00. He will not clean out her ear without another MRI so I have to get that done. I know the plug in the ear does come back frequently. When she was first diagnosed with PSOM, he said it was not bad enough for surgery at that time, but apparently is now.

Blondiemonster
9th October 2010, 08:39 PM
hey sharon, its pretty minor surgery. They make a little "hole" and drain the ear. Though it does have some risks. Some dogs have it done about 7 times....
7!!!! :sl*p:

Shay
9th October 2010, 08:56 PM
hey sharon, its pretty minor surgery. They make a little "hole" and drain the ear. Though it does have some risks. Some dogs have it done about 7 times....
7!!!! :sl*p:

Thanks! That's good to know. Do you remember the cost? I wonder why he said he wouldn't do it without another MRI? All he said was he wouln't feel comfortable doing it without a new MRI, and I didn't ask why :sl*p:. I was on information overload and had been there for hours at that point, and Lily and I were both exhausted :lpy:.

Blondiemonster
9th October 2010, 09:14 PM
I find that extremely strange... Blondie was extensively tested at LIVS. It costs 2OOO but they dont do just MRI. They do catscan, bayer, etc... It's something they offer because they study SM. When they find PSOM on an MRI they instantly do the surgery while dog is under without even asking. It costed only 200 dollars extra. I don't think it's a good idea too put a dog under anesthesia just to diagnose the PSOM again... See, it cant be diagnosed without anesthesia... But it CAN be diagnosed without an MRI if its severe enough.. They look deep in the air with microscope to see if eardrum bulges out. Also done under general anesthesia. So, i find it strange your doc won't do it without another MRI... Since it sometimes be seen without even needing an MRI.. hence why I wanna kill 3 birds with one stone;
Th spaying (she's almost 4 , needs to be done), the new MRI (mainly to check progression of SM and recurrence of PSOM) . If the free MRI is not available I will most likely just tell them to do the manual ear inspection while she is under, and if they see the bulging ear drum, drain it.

Shay
9th October 2010, 09:25 PM
I find that extremely strange... Blondie was extensively tested at LIVS. It costs 2OOO but they dont do just MRI. They do catscan, bayer, etc... It's something they offer because they study SM. When they find PSOM on an MRI they instantly do the surgery while dog is under without even asking. It costed only 200 dollars extra. I don't think it's a good idea too put a dog under anesthesia just to diagnose the PSOM again... See, it cant be diagnosed without anesthesia... But it CAN be diagnosed without an MRI if its severe enough.. They look deep in the air with microscope to see if eardrum bulges out. Also done under general anesthesia. So, i find it strange your doc won't do it without another MRI... Since it sometimes be seen without even needing an MRI.. hence why I wanna kill 3 birds with one stone;
Th spaying (she's almost 4 , needs to be done), the new MRI (mainly to check progression of SM and recurrence of PSOM) . If the free MRI is not available I will most likely just tell them to do the manual ear inspection while she is under, and if they see the bulging ear drum, drain it.

They didn't do it when she was at Auburn, and I remember them saying it wasn't bad enough at that point. I am very curious now why he needs another MRI to clean out her ear. I don't think they can see Lily's from just an ear exam, and I know they originally told me it hadn't affected her ear drum. Questions and more quesiton.....:?

Blondiemonster
10th October 2010, 03:32 AM
How bad does it need to get? It's a simple surgery... It doesnt affect the eardrum but makes an "inside out vacuum" effect and the pressure bothers them. In really bad cases the eardrum will bulge out... But every dog is different and response different to pain and discomfort... I didn't even know you could see on the MRI how it affects the eardrum or not.. I would ask him a lot of questions. Maybe get a second neuro opinion...

Shay
10th October 2010, 05:51 AM
How bad does it need to get? It's a simple surgery... It doesnt affect the eardrum but makes an "inside out vacuum" effect and the pressure bothers them. In really bad cases the eardrum will bulge out... But every dog is different and response different to pain and discomfort... I didn't even know you could see on the MRI how it affects the eardrum or not.. I would ask him a lot of questions. Maybe get a second neuro opinion...

There are only two neuros in my state that treat SM dogs, and she has now seen them both. Dr Shores at Auburn is the neurosurgeon who first diagnosed her SM and PSOM, and he does the decompression surgery. I know people come from all over the country to see doctor Shores. He is supposed to be one of the best in the country for the decompression surgery. He is the one who said the PSOM was not affecting her eardrum based on the MRI. The neuro she saw Friday is also on staff at Auburn, but now comes here two days a week. I will more than likely take her back to Auburn for another MRI, and see what Dr. Shores says.

Karlin
10th October 2010, 01:39 PM
Interesting; don't have much advice to offer though I'd go back and ask about the issues you are now wondering about --


why is another costly MRI needed for an ear flush? (this is regularly done without an MRI and I don't understand why an MRi would be needed to do it)

if the MRI is only a year old what are the advantages of a new MRI?

why not just raise gabapentin dose? Is there any real benefit to (more costly) blood tests?


To me it would make sense to have the possibility of a PSOM flush while the fog is having an MRI but not many surgeries likely have that ability -- you'd need the availability of a full surgical set-up that is free at the time, and staff. Not too many places would be able to make an instant decision though there would be anaesthesia cost savings.

And yes, in the US, Dr Shores is definitely considered a very good neurologist :) He also would have different approaches to LIVS, also considered to be excellent. IMHO it is a good to have a range of opinions and approaches and ongoing research in different places.

Shay
10th October 2010, 04:13 PM
Interesting; don't have much advice to offer though I'd go back and ask about the issues you are now wondering about --


why is another costly MRI needed for an ear flush? (this is regularly done without an MRI and I don't understand why an MRi would be needed to do it)

if the MRI is only a year old what are the advantages of a new MRI?

why not just raise gabapentin dose? Is there any real benefit to (more costly) blood tests?
To me it would make sense to have the possibility of a PSOM flush while the fog is having an MRI but not many surgeries likely have that ability -- you'd need the availability of a full surgical set-up that is free at the time, and staff. Not too many places would be able to make an instant decision though there would be anaesthesia cost savings.

And yes, in the US, Dr Shores is definitely considered a very good neurologist :) He also would have different approaches to LIVS, also considered to be excellent. IMHO it is a good to have a range of opinions and approaches and ongoing research in different places.

I am very confused now as to why he needs a new MRI. I assumed, and of course I should never assume, that it was because he had to see where it is to do the surgery???? If you can't see it with an exam, how could he operate...I don't know :-?. When you think about it, if I had to get a new MRI, and then the PSOM surgery it would end up costing more than the decompression surgery, which is crazy!! I wonder if only a neuro can do PSOM surgery, and maybe I should try someone else, but who?? When I asked him about increasing her gabapentin, that is when he told me they had started checking gaba levels, and he wanted to see the levels before he adjusted the dose, and again I assumed this was necessary. When he calls me next week with the results from the blood test, I will ask the questions, and I have lots of them...again :sl*p:.

Blondiemonster
10th October 2010, 04:32 PM
you know Karlin, that makes sense. Since Dr. Marino was at all the tests Blondie went through (since she was his study object) he most likely drained the PSOM himself, and was readily available. After the fact, I am so happy they did this cause it made such a difference in Blondie's life.
He was with her all afternoon. I was told that only a neuro and a dermatologist (surgeon?) can handle the PSOM... That is if I remember correctly.
It makes sense they didnt drain your dogs PSOM right away, Shay, however, I would def ask all those questions karlin wrote.. Make sure you are comfortable with the answers they give you!!

Karlin
10th October 2010, 05:11 PM
Don't feel too upset: questions and concerns almost always arose AFTER the point you talk to a vet/doctor/etc... but they are working for you so you always should not be afraid to ask for explanations to better understand why they wish to do something. And you never have to take the option they offer.

I have not heard of checking gabapentin levels and would be interested in the reasoning for this myself. Given that so many of the dogs gradually need an increase in the dosage, I don't understand what knowing the blood levels will do -- though of course this could be useful/interesting info in its own right. But I'd want a justification of why it needs to be done, especially for a dog in such low levels. I haven't heard of anyone else checking gabapentin levels so am interested to know what benefits would be there in doing so vs the cost of doing so. There may be good reasons for checking!

Also: generally if the first MRI showed mucus plugs, I don't know what a second MRI would show that would be necessary in guiding an ear flushing. Vet can do a myringotomy (ear flush), not just a neurologist. I know they are often done without an MRI -- if the tympanum is bulging on a scope exam, a vet might do this procedure. The flushing procedure is nowhere near the cost of decompression. There's more info here:

http://www.vetlatranquera.com.ar/pages/wild/small_animal_26.htm

Otitis media is the issue with PSOM -- a middle ear problem, behind the ear drum (tympanum)

Shay
10th October 2010, 05:42 PM
Don't feel too upset: questions and concerns almost always arose AFTER the point you talk to a vet/doctor/etc... but they are working for you so you always should not be afraid to ask for explanations to better understand why they wish to do something. And you never have to take the option they offer.

I have not heard of checking gabapentin levels and would be interested in the reasoning for this myself. Given that so many of the dogs gradually need an increase in the dosage, I don't understand what knowing the blood levels will do -- though of course this could be useful/interesting info in its own right. But I'd want a justification of why it needs to be done, especially for a dog in such low levels. I haven't heard of anyone else checking gabapentin levels so am interested to know what benefits would be there in doing so vs the cost of doing so. There may be good reasons for checking!

Also: generally if the first MRI showed mucus plugs, I don't know what a second MRI would show that would be necessary in guiding an ear flushing. Vet can do a myringotomy (ear flush), not just a neurologist. I know they are often done without an MRI -- if the tympanum is bulging on a scope exam, a vet might do this procedure. The flushing procedure is nowhere near the cost of decompression. There's more info here:

http://www.vetlatranquera.com.ar/pages/wild/small_animal_26.htm

Otitis media is the issue with PSOM -- a middle ear problem, behind the ear drum (tympanum)


Thanks Karlin!! I will ask him about checking the gaba levels when he calls me. He did indicate this was something Auburn had just started doing, so it is new. The cost for the test was $45. When I said the PSOM surgery would end up costing more than the decompression surgery, I meant if I had to get another MRI at the $1900 cost he quoted, and the PSOM surgery. The decompression surgery was quoted at $2200 at Auburn, so it would cost more if I got the MRI at the clinic here where I saw him, which to me is crazy!! It's not like he doesn't have an MRI already. He brought a disc of the MRI done at Auburn for me to keep, and viewed it while I was there. The only thing he said was he wouldn't feel comfortable doing it without a new MRI.....hmmmm? I'm sure there is a reason, maybe the MRI didn't show it well enough for him.....dunno, but I will ask him when he calls. If you don't need an MRI to do PSOM surgery then I am stumped!!!

Karlin
10th October 2010, 05:57 PM
Oh that is a small testing cost then for bloods -- but wondering what it shows that is helpful in making decisions? Would be very interested to learn more.

I understood what you meant on the PSOM surgery -- was agreeing that yes, it seemed excessive to get another MRI just for this procedure given that it would make an ear flush costs close to a decompression. Maybe it is that they want to make sure the syrinx hasn't progressed so much that it is the culprit rather than PSOM...?

I always think there must be respect of these professionals as being the experts :); but at the same time I would want any and all costs justified especially if they vary from what others do. :thmbsup: I also think people should never be fearful of asking questions about anything we do not understand especially when it come to care, and care we are paying for. I like to know the various options and opinions, and I like a vet and specialist that discusses these willingly.

Shay
10th October 2010, 06:29 PM
Oh that is a small testing cost then for bloods -- but wondering what it shows that is helpful in making decisions? Would be very interested to learn more.

I understood what you meant on the PSOM surgery -- was agreeing that yes, it seemed excessive to get another MRI just for this procedure given that it would make an ear flush costs close to a decompression. Maybe it is that they want to make sure the syrinx hasn't progressed so much that it is the culprit rather than PSOM...?

I always think there must be respect of these professionals as being the experts :); but at the same time I would want any and all costs justified especially if they vary from what others do. :thmbsup: I also think people should never be fearful of asking questions about anything we do not understand especially when it come to care, and care we are paying for. I like to know the various options and opinions, and I like a vet and specialist that discusses these willingly.


I totally agree Karlin, and I am faulting myself for not asking more questions, which I usually do. This neuro was not as easy to talk to as Dr Shore and his staff, and was a little hard to understand. I had to wait an hour and a half to see him past my appt time, and my husband met me there and he was not happy to have to wait that long because he had taken off of work, so I was a little stressed. The Dr did apologize, and said they had some emergencies and were behind, so I certainly understood that. We ended up being there for a very long time, and I didn't necessarily feel rushed, but I did say to my husband that he was not as easy to talk to as Dr Shore. I wish we had more options here with neuros, but I am feeling now that I probably should have just taken her back to Auburn, and perhaps now I have spent money that would have been better spent at Auburn, because this guy will not do the surgery without a new MRI, and I am not going to spend $1900.00 for that. I will now have to start all over at Auburn, unless I can find a vet here who will do the surgery. I am going to check with my vet before I make a decision to see if she does the PSOM surgery. But I am very frustrated now, because Lilly is the one this affects. She has not had any more vestibular episodes, thank goodness!!