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ChloeTheCavalier
10th October 2010, 12:46 AM
Hello,
This is my first post. My name is Kelly and my family's Cavalier is a 4 year old blenheim named Chloe. She started exhibiting random scratching episodes about a year ago. I had never heard of SM and only after randomly coming across it online did I realize Chloe might have SM. She had never seemed to be in pain, and would only scratch and rub her face into the ground/dig ever so often.

http://www.youtube.com/watch?v=mz4Mq0EO2-A
http://www.youtube.com/watch?v=6KXxOM95ys0

I took these videos of her to show you her normal "episodes." Despite all this, she has always been very happy, playful, etc. Loves tug of war and chasing after things and always runs down the stairs to greet whoever just got home. ALWAYS.

I was planning on posting those videos on this board to get opinions on how we should proceed (if an MRI should be performed, etc.). I needed to do this because despite all my suspicions that Chloe has SM and the research that proves how common is is, my parents keep denying anything is wrong and saying Chloe's fine.

But today, Chloe did something she never did before. She was fine in the morning and then late afternoon she was acting a little off. I tried to pick her up to sit on the couch and she yelped. Then I noticed she was acting very lethargic, just laying down. We went out to dinner and just came back, and even after entering the door and calling her name, she didn't come downstairs. I walked to the stairs and saw her sitting on one of the top steps whining. She seemed to be wanting to come down but unable to do so. I opened the front door to see if she would scamper down like usual, but she still didn't move from the step. I walked to her and picked her up to carry her down and she yelped again.

Once I put her down outside, she peed. Now, usually after she's peeing and I head back inside, she runs after me back to the door. This time, she was very slow and struggled to get up the porch steps. Now she's laying down under the kitchen table, a place i never saw her lay down before unless everyone's sitting down around the table eating.

I definitely plan on bringing her in for an MRI now. My question is that what can I do RIGHT NOW to help her? Is there anything I can do to alleviate her pain or help this episode pass? Please help me. I feel terrible watching her like this and tomorrow I was planning on bringing her to Cavalier meet up.

ChloeTheCavalier
10th October 2010, 03:49 PM
So since last night since I posted this (it didn't appear until today because it needed to approved by a moderator), Chloe has been acting the same. She hasn't been able to go up or down the normal flight of stairs, and struggles to go up or down small steps. She can't seem to run and has no interest in playing with her toy. She still squeaks a little in pain when you move her/pick her up. However, her appetite is completely fine. She finished both he dinner last night and her breakfast this morning with her same voracious appetite.

Now I'm not too sure at all, but I feel this is very strange for SM for a dog to be going through a pain episode for this long (going on 17 hours now), especially with NO progression to this kind of pain. It was literally fine one day and the next, this. Is not being able to go up or down stairs a normal symptom of SM? I'm just thinking maybe it's not an SM pain she has but she may have hurt herself somehow else?

Shay
10th October 2010, 05:18 PM
I am very sorry you suspect that Chloe has SM. My dog started showing symptoms at about 3 months which subsided at about a year old. Her symptoms came back when she was almost three years old, and we had her MRI'd, and she was diagnosed with SM. Her symptoms were as you describe, yelping when picked up, face rubbing and digging in the carpet, ear and neck scratching. She has never done the classic bunny hop. Like your parent's, my husband was in denial, and kept telling me Lily was fine.

To answer your question as to what you can do for her until you get the MRI, there is a thread in sticky here in the SM and MVD forum on tips for caring for SM dogs. Karlin also has a wealth of information in stickys here about SM, and it would be great if you could read all of it, because I think it would answer many of your questions.

My only advice would be to get the MRI as soon as possible. If Chloe does have SM, there is medication that will help with the pain. If it is not SM, you will want to know what is causing her pain, and get her treated asap.

This site is a great resource, and is how I learned about SM. There are many people here with SM dogs, and they all have a wealth of knowledge. I hope Chloe does not have SM, but if she does, it is treatable, and many dogs have a great quality of life with the disease, mine included.

Good luck :thmbsup:

Karlin
10th October 2010, 05:23 PM
Hi and sorry it took a while for your posts to go up -- I do admin and have been out of the country all last week til yetrday and am just catchig up.

I am sorry about your worries with Chloe. I would definitely get her right away to her vet -- ot may or may not be SM but she is clearly in pain and having difficulty moving. This is typical of SM but also could be other issues. A vet can give her immediate pain relief that will at least get her a lot more comfortable than she is. Then, your vet will want to start the process of elimination for other things that can cause SM-like symptoms. If nothing else is conclusive, or if you feel your vet is tending to dismiss SM without seriously considering it, you might then likely wish to get an appointment with a neurologist at least for an initial clinical exam, which will reveal more to a neurologist than to a vet. Rod keeps a good up to date list of neurologists at www.cavalierhealth.org.

As she's ion pain at the moment, I would try to get an immediate appointment or else keep her as quiet as possible til tomorrow. She may like to be sheltered from bright light -- a light blanket over her crate for example might be appreciated. i would not touch her unless needed and don't use a leash on a collar. I wouldn't walk her -- just let her out to relieve herself.

It is actually really typical of some dogs with SM to have chronic pain that doesn't progress -- or that may disappear and return. Believe me, 17 hours is not long for pain -- some dogs with this are like this all the time unless medicated with pain relief or treated with surgery. :( A pain episode like this is more likely over time to be less severe as the dog adjusts to enduring with the new level of pain or loses feeling... it doesn't tend to keep progressing within a short space of time but rather over weeks, months and/or years as syrinxes slowly enlarge and/or spread down the spine.

I think you are right to be concerned and taking action now. I hope that helps a bit in understanding this strange and complex condition -- Let us know what the vet says. :flwr:

Karlin
10th October 2010, 05:32 PM
The videos are by the way, really good examples of how confusing this condition can be. The face rubbing and rolling on her back are at first appearance just some fairly typical dog play -- and both my SM-clear (MRI'd) cavaliers also do this to some extent -- but the possible telltale sign that would make me agree with you that this is worth investigating -- even without the new pain signs -- would be that she does the digging and rolling then flips to starts long extended ear scratching where it is hard to distract her from the intense scratching. :( Too many of us have also encountered that.

It is worth also considering PSOM which might also cause these symptoms including pain. There's info on PSOM and SM at www.cavalierhealth.org and my site www.smcavalier.com. There is such a high level of SM in the breed though that SM is probably more responsible I would guess for such general symptoms in the breed. All but one of my 4 MRId cavaliers has PSOM as well -- of those, two have SM and PSOM, one has PSOM but no SM, one has no SM or PSOM. Neurologists say they almost always see PSOM on cavalier MRIs.

jacies
10th October 2010, 05:35 PM
Hi Kelly I am so sorry to hear that you think Cloe might have SM. My little girl Chaos has SM and she does scratch and rub her face like Cloe in the videos but that is not necessarily what is causing her to act like that. As you say only an MRI would show that. It is obvious from what you say that she is in pain at the moment if she is yelping and cannot manage the stairs and I think your first course of action is to take her to your vet for an examination. He should be able to say if she has any tenderness on her neck or back and also rule out any other problems. He could also give her some pain medication and refer you to a neurologist for an MRI if necessary. Without a visit to your vet I don't think there is anything you can give her that would help if she is in pain. I certainly would not be taking her out until she has seen a vet.
Have just seen your following post and would add that Chaos was showing the symptoms of scratching for a long time but it was only when she hurt herself by jumping to catch the hosepipe that she first screamed in pain and so Cloe might have done something that you did not notice that has aggravated the SM if she has it. Even now, and she has been under treatment for two years, she can have times when she is much worse if she has over exerted herself.

ChloeTheCavalier
10th October 2010, 06:00 PM
Thank you everyone for your replies.

Just a quick update, Chloe has been improving a little. She's now following me around instead of hiding away and trying to snuggle with people. She is able to walk and sometimes run fine, but still avoids stairs (although twice she's jumped down from a bed and a couple hours ago, I saw her try to go down the long flight of stairs and get stuck in the middle, with her rear end on one step and her paws on the step below). I just took her out to pee and she saw something and ran, which was a good sign but confusing. She still makes some kind of tiny squeak/grunt when you pick her up. Overall she seems be in less pain than last night but definitely not anywhere near her normal self.

I can't type much now because I am leaving to see Dr. West at Animal Medical Center in in NYC for an evaluation (a neurologist familiar with SM in Cavaliers). I will update as soon as I can. Thank you all again. I'm so glad this board exists.

ChloeTheCavalier
11th October 2010, 02:47 AM
Hi everyone. Chloe was doing noticeably better today. Although she was still avoiding stairs and not acting as playful and active as usual, she was definitely more active than she was last night. When we went to the car to drive to the specialist, she JUMPED into the car as she usually does and in the car, she was alert and didn't seem to be so down.

We brought Chloe to Animal Medical Center in New York to see Dr. West and I have to say, I was very happy with him. He was so friendly and caring, knowledgeable about SM, and took his time to talk with us and explain the disease and different courses of treatment. Also, which I found notable, was that he didn't immediately push for a procedure, which has unfortunately been my experience with other vets. I highly recommend him.

He first performed a neurological evaluation and then brought us in to speak with him. At this point, she wasn't exhibiting the pain and reclusiveness she was the previous night, but Dr. West said that based on her previous symptoms, how she behaved last night, and his findings during the eval, that he was fairly confident she had a Chairi malformation/SM. However, he said it was very mild and the fact that she recovered fairly quickly from the earlier episode was a good sign.

During the evaluation, he found that some spots around her neck caused her discomfort when lightly touched. Also, she was experiencing vertigo, which would explain her inability/unwillingness to go up or down stairs. The vertigo is linked to SM because the cerebellum is the area in the brain that controls balance/dizziness, etc. It makes sense because she was fine walking and running but was unsure around stairs.

We were completely prepared (and expecting) to have an MRI performed as the next step, but Dr. West said that he didn't think her case was severe enough to warrant an MRI. On one hand, I was grateful to hear this but on the other, I just wanted it done so we knew exactly the situation we had. He suggested putting her on Prilosec everyday because it's a very benign medication that has more benefits and few risks. If Chloe started to exhibit more pain episodes or severe scratching, he said THEN we could try Gabapentin. But he admitted he had a bias against surgery, which I agreed with and was the reason I didn't go see Dr. Marino at LIVS (because I've read he always advocates surgery to treat SM).

Now, my question is, Dr. West made it seem as though Prilosec could me taken long term to manage Chloe's condition, because it didn't have any long term negative effects. However, I just got home and decided to read more on the medications, and came across this:

This drug is unlikely to be useful in the long term as therapy longer than 8 weeks duration is not recommended as this may increase the risk for stomach cancer.

This contradicts what Dr. West said so I'd like to hear opinions or additional information, if anyone has.

Anyway, Chloe's home now sleeping and snoring very loudly. She still screamed a little when I woke her up from the car and she's still not playing with any of her toys, but overall she is much better from how she was when I first posted. I will continue to update on her progress.

lovecavaliers
11th October 2010, 03:34 AM
Hi. I am sorry to hear about what Chloe has been going through. I brought my Jack to LIVS for his MRI and then to Dr. West for a second opinion. I want to try a year of medication management and then get him re-scanned before doing any surgery. I can only say this because he still has a good quality of life. If he did not I would have done the surgery ASAP.. I mainly responded to your post because I too read that about omeprazole and specifically asked Dr. West about it and he said that in later studies this has not been found and assured me it was safe. I even checked Clare Rusbridge's site and noted this quote about omeprazole," This is also an antiacid and in laboratory rodents long term therapy has been reported to result in changes to the stomach lining. However this effect has not been reported in dogs. Reported adverse effects include nausea, diarrhoea, constipation and skin rashes"
So it seems to be fairly safe for dogs from what I have read and heard. I hope Chloe is feeling better and back to her old self soon. best,Irene

Shay
11th October 2010, 03:49 AM
Glad you got in to see a neuro today. My dog takes 1/2 tab of omniprozal (Prilosec) daily, in addition to gabapentin. She has been on these drugs for a year. I'm not sure how much just the omnirprozal is going to help with the pain without gabapentin. The omnirprozal is supposed to reduce the production of cerebrospinal fluid, and the gabapentin is for the pain. At the suggestion of another member here, instead of giving mine the entire 1/2 of omniprozal at one time, I give her 1/4 in the morning and 1/4 in the evening and that seems to work better. My dog is diagnosed with mild SM as well, but verified by an MRI, and is on a low dose of gapapentin, which will probably be increased in the next week.

I brought mine to to the neuro last Friday, because she too has been having vestibular episodes (vertigo). He believes it is PSOM, which she also has, but could also be the SM. It is very hard to tell whether the SM or the PSOM are causing some symptoms. Some of the symptoms are the same with both.

I guess my only suggestion would be to ask him if the omniprozal alone is going to help with Chloe's pain. Glad to hear she is feeling better today.

Karlin
11th October 2010, 03:48 PM
On omeprazole -- this link to stomach cancer has also been discounted in humans now for some time, but unfortunately seems to linger on as a 'risk'. I am not sure what site is saying it wouldn;t be advised longer than 8 weeks -- is that for SM use? as it is actually routinely used for longer than that. I have spoken to neurologists who say even if there is a slightly heightened risk, this has been seen in very long term use -- and would be unlikely to affect a dog's lifespan. So personally I wouldn;t be worried at all. I did find the medical papers that dispute those stomach cancer reports and will have to see if I can find them again.

Karlin
11th October 2010, 03:58 PM
OK tracked this one down -- the slight association with cancer was ONLY in connection for a few conditions (which are NOT the conditions the drug is used for in cavaliers) and note they are thinking more on the lines of years and years -- as noted, at LEAST a decade to 20 years -- of continuous use to cause any possible (and rare) risk. This is for people, not dogs, but the evidence is pretty meagre and the risk would likely long surpass the lifespan of a dog. Even the 'no risk found' data below was over SEVEN years -- likely to be the time many diagnosed dogs would ever take these drugs as most are diagnosed at age two plus.

http://www.raysahelian.com/protonpumpinhibitor.html


Proton Pump Inhibitors and Risk of Cancer
Does the use of proton pump inhibitor drugs that reduce stomach acid, or the use of H2 blockers increase the risk of cancer of the esophagus or stomach? Common H2 blockers are ranitidine (Zantac) and cimetidine (Tagamet); and a common proton pump inhibitor is omeprazole (Prilosec). Dr. Mats Lindblad and colleagues at the Karolinska Institute in Stockholm evaluated 7 years of patient data entered into the UK general practice database. The team identified 287 patients with esophageal cancer and 522 with stomach cancer. These subjects were compared with 10,000 randomly selected subjects without cancer. The authors found some conditions for which acid-suppressing drugs are used, such as acid reflux disease, hiatal hernia and Barrett's esophagus, were associated with an increased risk of stomach and esophagus cancer. However, no apparent cancer risk was seen with other conditions, including peptic ulcer, gastritis, and indigestion. They found no evidence that the proton pump inhibitor drugs themselves increased the risk. However, Dr. Kenneth E.L. McColl, of the Western Infirmary, Glasgow, UK says "a major weakness in the study is the relatively short duration of acid suppressive therapy examined. The development of cancer in humans is a slow process. The period in question is really too short to identify or exclude any direct effect between acid suppressive medication and stomach or esophageal cancers." Gut, November 2006.
Dr. Sahelian says: I agree with Dr. McColl. It would take at least a 10 to 20 year longitudinal study to determine whether proton pump inhibitor drugs reduce or increase the risk for cancer and other health conditions.

Blondiemonster
11th October 2010, 05:09 PM
Sorry to hear about your dog's SM issues. You are in great hands with Dr. West. I too have gone seen Dr. Marino and then Dr. West for a second opinion. I love doctor MArino as well, and it's nice to know he is out there for us when things arent looking too bright anymore with the meds...
Marino actually recommended surgery to me, and Dr. West thought she wasn't severe enough for gabapantin. She was MRI'd at LIVS, and her MRI was real bad. But Dr. West said there was a disconnect with her symptoms. He did a full clinical exam on her that day.
My Blondie, is also very episodical. (like yours) She can have 2 bad days and then run around like a puppy for 6 weeks, only to then have 2 more bad days, especially when the weather gets bad. I am actually thinking of asking Dr. West for medication to give her only on those bad days. A painkiller/anti-anxiety of some kind.. Something to ease her mind.

ChloeTheCavalier
12th October 2010, 01:33 AM
Thanks everyone for the information and reassurances about taking Prilosec for long-term management.

Speaking of Prilosec, we have been giving her half a pill (10 mg) a day at breakfast as per Dr. West's recommendation. She threw up today which he mentioned sometimes happens, so we're reducing down to a third a pill.

As Chloe still seems to be in pain today, what do you all think about asking Dr. West to put her on Gapapentim as well? He did say to give the Prisolec alone a chance and see how she is after a a few days/weeks, but seeing her like this makes me want to help ease her pain now. At the same time, I don't want to overmedicate at the risk of the wasting its effectiveness at this time when it may really not be needed until later on (I'm completely guessing here based on reading how people generally have to amp up their dosage continually).

Also as I mentioned in a previous post, I was a little disappointed to hear we wouldn't be needing to do an MRI. In addition to wanting to get a full picture of the severity of her case, I also wanted to get a diagnosis on whether she has PSOM or not. I have this inkling that she has it and after reading Blondie's posts about many of her symptoms being resolved after flushing out her ears, I'd like to see if the same might be possible for Chloe.


Sorry to hear about your dog's SM issues. You are in great hands with Dr. West. I too have gone seen Dr. Marino and then Dr. West for a second opinion. I love doctor MArino as well, and it's nice to know he is out there for us when things arent looking too bright anymore with the meds...
Marino actually recommended surgery to me, and Dr. West thought she wasn't severe enough for gabapantin. She was MRI'd at LIVS, and her MRI was real bad. But Dr. West said there was a disconnect with her symptoms. He did a full clinical exam on her that day.
My Blondie, is also very episodical. (like yours) She can have 2 bad days and then run around like a puppy for 6 weeks, only to then have 2 more bad days, especially when the weather gets bad. I am actually thinking of asking Dr. West for medication to give her only on those bad days. A painkiller/anti-anxiety of some kind.. Something to ease her mind.

Blondiemonster- I would have gone to Dr. Marino since he's so involved in the SM/Cavalier issue, but I have had bad experiences at LIVS and my family refuses to ever go there again. Also, I don't know how I'd feel about a vet who generally always pushes for surgery. However, I'm interested in how you got your second opinion at Dr. West. It seems he gave the same diagnosis as Blondie to Chloe, about not being severe enough for Gabapentin. What medication is Blondie on now and how has she been since? What are her pain episodes like?

Today, Chloe's acting very mellow and a little sad. Her tail still wags when you speak to her or look at her but she doesn't like to get up, and she's very very slow getting up and down the baby stairs we have around the house (1-2 steps). Still eating normally but no interest in her toys, which is so unlike her. Usually all you have to do is look at a toy for her to run towards it and bring it to you. Now, I wave one her face and she seems to look at it and want to play, but can't bring herself to do it.

Anyway, her is a video of Chloe during better times. These were taken at the beach on Memorial Day this year.

http://www.youtube.com/watch?v=g98VubdUVlY

http://lh3.ggpht.com/_7CY1mj7CsjA/TLOsQNnrNMI/AAAAAAAAABQ/9LjU4kHvRuE/s640/IMG_1054.JPG

http://lh6.ggpht.com/_7CY1mj7CsjA/TLOsQaF9txI/AAAAAAAAABU/7zI3YW3RNq4/s640/IMG_1060.JPG

http://lh4.ggpht.com/_7CY1mj7CsjA/TLOsaNywmTI/AAAAAAAAABg/uEihIFmt43A/s640/IMG_1073.JPG
Tuckered out and sleeping in her favorite position when we got home.

Shay
12th October 2010, 01:56 AM
Sorry to hear Chloe is still not feeling well. Based on what you have said, Chloe's vestibular incident is very similar to my dogs. My dog is just now getting back to normal and starting to play again, and it will be 2 weeks on Wednesday that she had the first vertigo episode. Lily has vomited several times due to the vertigo, so that could be why Chloe vomited, and has nothing to do with the prilosec. Hopefully, she will start feeling better soon, as mine did.

As far as the gabapentin, as I said in an earlier post, my dog was diagnosed with mild SM a year ago at three years old, and put on a very low (50mg 2x day) dose. That worked very well for about 8 to 9 mos. I am just now asking the neuro to increase her dose, so I don't think that is too bad. Perhaps you could ask him to put her on the lowest dose possible that would manage her pain a little better.

As Karlin said, so many of the dogs that have SM also have PSOM, so it is very likely that Chloe could have that as well, and that could be causing the vertigo, as my neuro suspects is causing my dogs. Unfortunately, the gabapentin will not help with PSOM. It is a balancing act to try to manage the symptoms with these two diseases, and you just never really know for sure, and neither do the doctors, which one is causing the symptoms. Sometimes it a combination of the two.

Hope Chloe feels better soon, and please keep us informed.

Edited to add: The pics and video of Chloe are adorable...she is a cutie!!

Karlin
12th October 2010, 01:59 PM
Just my own opinion here, but I think it is kind of weird for a neurologist to make a judgement call on how severe a dog's case of SM might be without an MRI. As every neurologist I have spoken to has said, there is often NO correlation between severity of SM and outward symptoms for any number of reasons. It is impossible to judge severity from an external exam alone. It is thus also impossible to judge whether a dog is really priarily going to do best with surgery or could be managed on meds, if the owner wants that choice (in some cases you are looking at a very short timeline on meds alone with certain indications on an MRI). It is also impossible to give a definite diagnosis of SM without an MRI. I think it is strange that a neurologist would suggest an MRI isn;t called for at all if there are symptoms, and from the range of things being described, I think this sounds like a potentially serious case where you'd definitely want an MRI to evaluate where you are -- you are describing symptoms that my Leo, with a large and wide syrinx, has never shown. None of my three with SM have symptoms that pronounced.

I also think pain relief is the most important aspect of care for these dogs. If a dog is clearly showing pain I'd at the vert least ask for something to alleviate that pain like metacam or rimadyl alongside prilosec/cimetidine etc. If a dog is vomiting on prilosec why not use frusemide or cimetidine? For many dogs one works far better than the other. Or get gabapentin. If there are significant signs of pain as opposed to mild scratching I am not sure why a dog wouldn't be put onto something more adequate for pain relief right from the start.

My own opinion, but I'd be looking for a different neurologist, perhaps at LIVS or Dr Dewey at Cornell. I wouldn't want someone to push me towards surgery only unless there are very definite reasons for considering it in the individual case of a dog (bad MRI and pain indicating the dog has little chance otherwise) -- and you can always decline that option with any neurologist; treatment choice is a client's own -- but alternatively I would wonder why unless there are strong financial considerations, a neurologist would not encourage a client to at least know exactly what they are dealing with for a condition that can only be diagnosed with that one technique: an MRI -- and basing care on guesswork and not prioritising pain relief. Very few dogs that I have heard of do ok just on prilosec or similar. Almost none.

On meds: Clare Rusbridge's longtime experience now is that medical management is a case of regularly evaluating and adjusting medications and generally that most dogs need at least two and often a combo of three. She and many others have found a cocktail works best, generally gabapentin or Lyrica combined with a CSF inhibitor like omeprazole (Prilosec) or cimetidine or frusimide, plus a painkiller/anitinflammatory like metacam, tramadol, amantadine, steroids etc. If symtpoms continue to show -- scratching/pain -- then meds need to be increased/adjusted to a new mix. It is trial and error.

I am quite interested in trying the new medical cannabis-based spray, Sativex for Leo -- legal in Canada and in the UK and other European countries -- hopefully a dog trial might be done. It is known to relieve neurological pain/fibromyalgia often when nothing else works.

lovecavaliers
12th October 2010, 03:37 PM
I think if you want the MRI and can afford it, you should get one. My regular vet didnt think it was necc. so I just ignored him and booked myself an appointment with LIVS for the MRI. I am sorry that your family has not had good experiences with them. I personally felt it was very factory like and not a fan of the customer service HOWEVER, they have great vets and a 1.5 Tesla MRI. Likewise, I think they are the most cost effective for it. They probably will recommend surgery but you don't need to do it. They told me to get it for Jack within 2 months or he would suffer permanent damage. I needed to give medication a try first.
I now see Dr. West and he is very nice but I don't agree with everything he says. I guess I am very opinionated and fussy, however this is my baby we are talking about. I know him best, even though I am not a vet. I can tell when he is happy and when he is in pain better than anyone.
My point being , do what you think is best for Chloe. If you have any specific questions about LIVS or Dr. West feel free to PM me as I would be happy to help you out in any way via sharing my experiences.

Karlin
12th October 2010, 04:03 PM
That's a helpful perspective Irene. I think if I were there, I'd be working with both -- I think I'd want the workup from LIVS as it is cost effective, and I'd want their advice on meds but I'd be very conservative on surgery unless there was a very poor MRI, large syrinxes, plus pain. Dr Dewey I think is also in the region; don't think he is any longer actually at LIVS; he is also one of the pioneers in SM surgery.

ChloeTheCavalier
13th October 2010, 05:52 PM
Thanks everyone for your support and advice. Chloe is still improving little by little. She has taken interest in her bone, barks, runs more and has jumping from the bed, etc. She's still not herself though--still whimpers occasionally, seems to struggle to get up, go up and down stairs, lethargic.

One thing I find interesting is that since she first screamed on Saturday, she hasn't really been scratching much or face rubbing at all. I've seem her try to scratch maybe twice since, and it was definitely less animated and vigorous as usual. Maybe because she's been in pain?

After seeing Chloe still seemingly in discomfort and reading your replies, I called Dr. West's office yesterday and asked for a low-dosage Gapabentin prescription. I am picking it up today and hopefully we'll see additional improvement.

Shay- Do you think that if Chloe as PSOM, that would be causing her yelping and whimpering? I was thinking about holding off on the MRI as per Dr. West's suggestions and just going on the Gapabentin but I'd really like to see if she has PSOM and if found, treat it. What do you think? Would it be cruel to hold off on the MRI for now and possibly let her go on with the PSOM?

I think Dr. West didn't prescribe any pain meds because when he saw her, she was acting fine. She was very friendly and tail-waggy and alert but I think it's because she was in a new place with dogs and was just excited. He had said that if he had seen her as she was the previous night (hiding away, screaming, not moving much) he would have put her on something, but the fact that she recovered so well made him hold off.

While the financial reasons of an MRI were obviously a factor, we were willing to do it if Dr. West suggested we do it but instead, he didn't recommend it at the time and evens said if it were his dog, he wouldn't go ahead just yet. Depending on how Chloe reacts to the Gapapentin, I may schedule one anyway.

Another question I have for all of you is when I called Animal Medical Center to inquire about the MRI, they said the MRI alone would run around $2000, but the full treament they like to do is around $2500 because it includes a spinal tap and some other spinal diagnostic tests to determine other possible causes for the pain, any infections, etc. Do you think that is a good idea or should I just go with the standard MRI?

I would go to LIVS for a second opinion but again, bad experience with our other dog (RIP) and I just have a bad feeling about them, as if they try to fleece you for everything. Also, I called them just out of curiosity and they told me I'd have to do an $160 evaluation first before the MRI, even though I had already received a full neurological eval from Dr. West.

Shay
13th October 2010, 06:50 PM
Thanks everyone for your support and advice. Chloe is still improving little by little. She has taken interest in her bone, barks, runs more and has jumping from the bed, etc. She's still not herself though--still whimpers occasionally, seems to struggle to get up, go up and down stairs, lethargic.

One thing I find interesting is that since she first screamed on Saturday, she hasn't really been scratching much or face rubbing at all. I've seem her try to scratch maybe twice since, and it was definitely less animated and vigorous as usual. Maybe because she's been in pain?

After seeing Chloe still seemingly in discomfort and reading your replies, I called Dr. West's office yesterday and asked for a low-dosage Gabapentin prescription. I am picking it up today and hopefully we'll see additional improvement.

Shay- Do you think that if Chloe as PS OM, that would be causing her yelping and whimpering? I was thinking about holding off on the MRI as per Dr. West's suggestions and just going on the Gabapentin but I'd really like to see if she has PS OM and if found, treat it. What do you think? Would it be cruel to hold off on the MRI for now and possibly let her go on with the PS OM?

I think Dr. West didn't prescribe any pain meads because when he saw her, she was acting fine. She was very friendly and tail-Wagga and alert but I think it's because she was in a new place with dogs and was just excited. He had said that if he had seen her as she was the previous night (hiding away, screaming, not moving much) he would have put her on something, but the fact that she recovered so well made him hold off.

While the financial reasons of an MRI were obviously a factor, we were willing to do it if Dr. West suggested we do it but instead, he didn't recommend it at the time and evens said if it were his dog, he wouldn't go ahead just yet. Depending on how Chloe reacts to the Gabapentin, I may schedule one anyway.

Another question I have for all of you is when I called Animal Medical Center to inquire about the MRI, they said the MRI alone would run around $2000, but the full treatment they like to do is around $2500 because it includes a spinal tap and some other spinal diagnostic tests to determine other possible causes for the pain, any infections, etc. Do you think that is a good idea or should I just go with the standard MRI?

I would go to LIVS for a second opinion but again, bad experience with our other dog (RIP) and I just have a bad feeling about them, as if they try to fleece you for everything. Also, I called them just out of curiosity and they told me I'd have to do an $160 evaluation first before the MRI, even though I had already received a full neurological eval from Dr. West.


I am kinda in the same boat as you with the PSOM. The neuro will not do the PSOM surgery without doing another MRI at the cost of $1900.00, which to me is crazy. When she was first diagnosed with it, no treatment was offered, and it was kinda like it was not a big issue. Lily did much better with the gabapentin for several months, and yelping was never really one of her symptoms. She yelped only occasionally if you picked her up. When they yelp, it's because they are in pain, so certainly the PSOM could cause them to yelp.

If it were me, I would try the gabapentin first, and see if that helps, because gabapentin does not help with PSOM. If her symptoms improve with the gaba, then more than likely the SM is what is causing Chloe the pain. As far as the vertigo, it's so hard to say, but my neuro thinks that the PSOM caused that, but is not positive. She is much better with the vertigo now, and it did take almost 2 weeks for her to get over that spell, and get back to normal. So if that is what Chloe had, and it sounds so much like what Lily had, it does take a while for them to get over that. Lily is back to her playful self now. If you can, I would push for an MRI though, because that will tell you exactly what you are dealing with. Along with the MRI, they found Lily had a grade 2 luxating patella, which required no surgery, and she had injured a disk in her back at some point, probably from jumping or twisting. I try never to let her jump off a bed, or anything high. It's just good to know if they have a syrinx, and does give you some peace of mind knowing what you are dealing with, and lets you make decisions based on facts, and not just guessing. Even though Lily has a very small syrinx, she has moderate symptoms. Symptoms rarely follow the actual degree of the disease. The main goal here is to manage the pain, whether you choose surgery or not. The neuro told me Lily was borderline for surgery, and I opted to treat with meds to see how she did. I am just now asking for her meds to be increased after a year. As I long as I can manage her pain with meds, I will not consider surgery.

Every dog is different, and it's so hard to know what to do, but managing the pain is the first priority, so I think it was a great decision that you asked for the gabapentin. And as a said, I would get the MRI as soon as you can do it. Then you could rule out the PSOM if she doesn't have it, and you would know her pain was only from the SM or whatever else the MRI shows, and not PSOM. If she did have PSOM, then you could treat that as well. I am going to have to find someone who will do the PSOM procedure who does not require another $1900 MRI :sl*p:.

ChloeTheCavalier
14th October 2010, 03:53 AM
I am kinda in the same boat as you with the PSOM. The neuro will not do the PSOM surgery without doing another MRI at the cost of $1900.00, which to me is crazy. When she was first diagnosed with it, no treatment was offered, and it was kinda like it was not a big issue. Lily did much better with the gabapentin for several months, and yelping was never really one of her symptoms. She yelped only occasionally if you picked her up. When they yelp, it's because they are in pain, so certainly the PSOM could cause them to yelp.

If it were me, I would try the gabapentin first, and see if that helps, because gabapentin does not help with PSOM. If her symptoms improve with the gaba, then more than likely the SM is what is causing Chloe the pain. As far as the vertigo, it's so hard to say, but my neuro thinks that the PSOM caused that, but is not positive. She is much better with the vertigo now, and it did take almost 2 weeks for her to get over that spell, and get back to normal. So if that is what Chloe had, and it sounds so much like what Lily had, it does take a while for them to get over that. Lily is back to her playful self now. If you can, I would push for an MRI though, because that will tell you exactly what you are dealing with. Along with the MRI, they found Lily had a grade 2 luxating patella, which required no surgery, and she had injured a disk in her back at some point, probably from jumping or twisting. I try never to let her jump off a bed, or anything high. It's just good to know if they have a syrinx, and does give you some peace of mind knowing what you are dealing with, and lets you make decisions based on facts, and not just guessing. Even though Lily has a very small syrinx, she has moderate symptoms. Symptoms rarely follow the actual degree of the disease. The main goal here is to manage the pain, whether you choose surgery or not. The neuro told me Lily was borderline for surgery, and I opted to treat with meds to see how she did. I am just now asking for her meds to be increased after a year. As I long as I can manage her pain with meds, I will not consider surgery.

Every dog is different, and it's so hard to know what to do, but managing the pain is the first priority, so I think it was a great decision that you asked for the gabapentin. And as a said, I would get the MRI as soon as you can do it. Then you could rule out the PSOM if she doesn't have it, and you would know her pain was only from the SM or whatever else the MRI shows, and not PSOM. If she did have PSOM, then you could treat that as well. I am going to have to find someone who will do the PSOM procedure who does not require another $1900 MRI :sl*p:.

Thanks again for your help, Shay. Since Chloe and Lily's symptoms were so similar, I'm hoping she does as well as Lily did. Chloe took her first Gabapentin tonight and now she's very tired, even more so than she has been before. Compared to yesterday she seems worse because her tail has been permanently stuck between her legs. Her appetite is still great but she seems not so good today, unfortunately.

Last night, when we took her out she wanted to run and run and run. Her tail would wag, etc. Today, nothing.

http://i55.tinypic.com/izq5au.jpg


Do you think the drowsy effect from the Gabapentin has something to do with why she's so tired today? I asked the neuro for a low dose and saw at the pharmacy that he prescribed 100mg, 3x a day. Is that normal for a low dose or should I do 50mg 3x a day?

Also, I saw her try to scratch just now and still she didn't seem to be able to do it. It was weak attempt to scratch, unlike her previous vigorous scratching.

Shay
14th October 2010, 04:41 AM
I am so sorry Chloe is not feeling well. Yes, the gabapentin most definitely will make her drowsy, especially at first. I think Lily was really on an exceptionally low dose and as some have said here, almost to the point of not really enough to be affective, although I did see improvement in the beginning. I think three times per day is good, because Lily was only prescribed 2 per day, and gaba only works for 8 hours. I could tell by about 4:00 in the afternoon it had worn off, because she would start scratching. I think 100 mgs is a pretty standard first dosing, and I never understood why my neuro started Lily on such a low dose. When I asked about it, all he said was that he wanted her on the lowest dose possible, because she would be on it the rest of her life. I have still not heard from the neuro from last Friday, when he did a blood draw to see what Lily's gaba levels were so he can adjust her dose. I have a call in to him, and I am getting very frustrated. I am starting to feel like the visit last Friday was a waste of time and money, because nothing has really been done for her. Thank God she got over the vertigo on her own, for now at least.

I would go with the prescribed dose and see how Chloe does. You want it to be enough to manage her pain. She could be tired and hurting because she played so hard yesterday. Getting excited and vigorous play can make their symptoms worse. When Lily had the vestibular episodes, we had a vigorous ball throwing session the day before. Coincidence? Maybe, but it could have played a part. It is so hard to not let them be a dog when they want to play. Sometimes, they pay for it later.

It's good Chloe has an appetite, and Lily has never passed up a meal either. She loves to eat, and I am happy for that. Give it a few days, and if she is not any better, I would push for the MRI to make sure it is in fact SM, and there is not something else going on. I wish I could afford Lyrica, but right now it is not available in generic and probably won't be for a few years. It seems that owners who are using it are getting better results than with the gaba. But someone told me it was costing them like $2.00 a pill :shock:. With my rescue cav taking 2 meds a day for his MVD, there is just no way we can do that right now.

Please let me know how she is doing tomorrow. Fingers and paws crossed here she will better. :xfngr:

anniemac
14th October 2010, 06:24 AM
I am so sorry to hear that chloe is not feeling well. It sounds like Dr. West is great however I have a strong opinion about getting an mri. I agree with karlin that without an mri it is hard to determine amything. I really don't see how. I would like to share that ellas vet said that he would not recommend an mri and wait and see. I ended up getting an mri after making him give me a referral.

Ella turned out to be severe and even though it might not be the same, her progression was fast. Ella never yelped and others did not see what I did so saying symptoms to reflect severity is why I feel so strongly. Yes cost is an issue as I know. An mri is not mean surgery. It could give a prospective of what is going on.

I would also say ella will be one way and the next I thinking she seems fine. There could be other things than sm and an mri would confirm either way. Even it shows sm it doesn't mean the worse (surgery). I am so thankful I did not listen to her vet before more damage was done. Ella was sever so dn't think it is a reflection of chloe.

To sum up:
Symptoms seem to not reflect severity (ella did not yelp and still was playful)
Actually she still is sometimes.
Without mri and questioning the "wait and see" I stronly feel it was a saving factor.
Agree that dr. Dewey is well known and knows a great deal (actually my neurologist recently talked to him about an issue with ella)
I agree with blondiemaster that pushing surgery seemed concerning to me)

Finally the best point is you are in the right place. So many people offered support, a place where a lot of people care. I don't know what I would have done without these great friends I met. No matter what, people here will be there for you.

I know its scary and we hate to see our loved ones feel bad.

Please keep her posted.