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View Full Version : Chloe is going in for an MRI tomorrow.



ChloeTheCavalier
15th October 2010, 02:39 AM
(For background information, see this thread (http://www.cavaliertalk.com/forums/showthread.php?35859-I-suspected-my-Cavalier-has-SM-but-now-I-m-almost-positive.-Please-help))

Update on her progress:

Today she screamed a longer, shrill-ier scream than we'd ever heard when my mom went to pick her up to bring her down the stairs. She hasn't screamed since but it was scary to hear it.

Her tail is still between her legs 95% of the time. She's less tired than yesterday though and some good signs:
- She climbed up half a flight of stairs
- She's jumped on to and off the bed (even though WE TRY to not let her, she does it before we can interrupt)
- Appetite is still great
- She has taken in interest in her stuffed toys again

Bad signs:
- Scratching and face rubbing has resumed*
- Stairs are still approached uneasily or not at all
- No tail wagging

* = This is bad sign but I also think, maybe a good one? During her bad episode, I think she didn't scratch or face rub because the pain was so bad. Maybe this means her pain is subsiding? I don't know.

It's only her second day on Gapanetin and the neuro told me it usually takes a week before results are seen. Regardless, we're taking her to Animal Medical Center in NYC tomorrow morning for an MRI. Crossing my fingers that the results are good/don't show very severe progression.

anniemac
15th October 2010, 04:19 AM
I will be thinking of you. Keep us posted. My prayers are with you tonight

Shay
15th October 2010, 03:32 PM
I think you are wise to get the MRI today. Now you will know exactly what you are dealing with, and can treat accordingly. Please let us know how it went.

Good luck!

lovecavaliers
16th October 2010, 12:40 AM
Thinking of you and Chloe, I hope it is good news. Either way, I think you made the right choice in getting an MRI. You will now be empowered with knowledge and can keep moving forward in Chloe's treatment. Please post as soon as you are able with the results. I will be keeping my fingers crossed.

jld
16th October 2010, 12:49 AM
Will be thinking of you and keeping fingers crossed for encouraging news. Please keep us posted.

ChloeTheCavalier
16th October 2010, 03:29 AM
Thank you all again for your support.

The results are in. The MRI confirmed she:
- does have the Chairi malformation
- does have Syringomyelia
- does have syrinxes forming
- does have PSOM

The significant syrinx is in her neck, with fluid extending into her spine and spots of fluid along the spine. The doctor (who was not a neurologist, but a DVM in residency as Dr. West was off today) said he was rate her condition as mild to moderate.

I knew it was likely the case, but I definitely am definitely happy we did the MRI and now know the extent of the issue. They also performed a spinal tap to get for any infections or inflammation, and we should get the results on Monday.

As for the treatment, the doctor said we are to continue with our medication (10mg Prilosec 1x day, 100mg Gabapentin 3x day) and now also give her Prednisone 2x a day for the next 2 weeks or so until her next check up.

Now, interestingly (because I had never heard of this before in my readings on SM or seen it mentioned here), he also said we have to keep her crated for the next 4 weeks and completely restrict her activity. No running, playing, jumping at all. We're only to carry her outside to pee/poop and then carry her back in. If she has to be out of the crate at all, she has to be kept controlled (sitting or laying down calmly). Even when she starts to feel better after a week or so and is dying to be out of her crate and active, we have to keep her confined. It's supposed to prevent further injury to her spine and allow the medication to really go to work. Has anyone ever heard of this before?

Also, I asked about flushing out her ears to treat the PSOM and the doctor advised against it because he thinks the risk of causing more damage tyring to flush them didn't outweigh the benefits. Apparently, messing around with the inner ear can cause my irritation, disruption in the vestibular, more neurological damage...? He believes all the symptoms we've been seeing were SM symptoms so treating the PSOM wouldn't change them. I wasn't aware that ear flushing could cause damage, I thought it was a rather routine procedure with little to no risk. I really wanted to treat the PSOM because I know it can cause the scratching, face rubbing, pain and vertigo as well. Is it common to hold off on treating it when it has been diagnosed?

Here's a picture I just took of Chloe in her crate, where she'll be needing to spend the bulk of the next 4 weeks. :(

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

lovecavaliers
16th October 2010, 03:58 AM
I am sorry to hear the news about Chloe having CM, SM and PSOM. However, you did the right thing by having the MRI, now you know what your dealing with and can help her live a happier life.
I don't have any idea why they want her activity restricted. I personally have only heard of that after the decompression surgery or if there is a disc ruptured etc.
Hopefully others on here can shed some light on that.
I know when Jack had his MRI at LIVS, they will automatically do an myringotomy if they see PSOM, regardless of whether SM is found.
Likewise, the reason for limited activity shouldn't be due to having had the spinal tap because when Jack got a spinal tap at AMC by Dr. West two months ago, he had no restrictions once he was fully awake from the anethesia (except for sunscreen on his lovely shaved patch:o)
While the resident may be very nice, I would want to hear the reasons for restriction and not addressing the PSOM directly from Dr. West. I think he works most Sat's and Sundays so hopefully you can speak to him this weekend.
In the meantime, I am sure you are all enjoying Chloe being back home. She is a real cutie and hopefully will be feeling better real soon. Chloe is lucky to have such a loving and caring family. Keep us posted.
Best,
Irene

Shay
16th October 2010, 04:31 AM
As I said in a previous post, I know that vigorous play and excitement can bring on a scratching/pain session, but I'm not sure why he wanted her crated for 4 weeks. That does sound excessive. If I know Lily is not feeling well, I try to keep her quiet, until she is feeling better. Like Irene said, I have only heard of crating them for that long after decompression surgery. I know I always have a million questions after I get home from an appointment, that I forgot to ask while there. I would call them back and ask why she has to be crated for so long. I'm sure there is a reason, but I would ask them why.

As far as the PSOM, my neuro never even discussed treatment when Lily was diagnosed, and never acted like it was a major concern, or perhaps it was not something he recommends like your neuro. I wonder now. The neuro who I took her to last week, said he wouldn't even attempt it without another MRI, so maybe it is a more serious surgery than we thought ???

I'm glad you have Chloe home now, and you know what you are dealing with. I'm sure she will be feeling better very soon. Please keep us updated, and give Chloe a hug from me and my gang :hug:.

Karlin
16th October 2010, 01:11 PM
He probably wants her crated because she has had a spinal tap -- just guessing -- but this is a fairly serious procedure.

I think experts and vets split on myringotomy. It IS fairly routine and is certainly not remotely as risky as the SM surgery -- which in itself has a very low rate of actual problems reported during surgery or as an immediate result of it. There are risks as with any procedure for the ear flush. I have been told small risks of facial nerve damage etc. I think a lot of neurologists underestimate the potential role of PSOM in symptoms for SOME dogs. I have never heard of anyone needing to do another full MRI just to do an ear flush -- the plugs tend to develop very slowly. I would find it a bit ironic that someone would be concerned about an ear flush yet do a spinal tap -- the latter would be fairly controversial to do for some neurologists if there is really little to indicate a dog has anything else except SM. A spinal tap could cause body and functional paralysis and is certainly riskier, as far as I understand it, than myringotomy...

But I am afraid that on the general issues being discussed, as in everything related to health an especially diseases about which little is understood (CM/SM, PSOM) people need to seek various perspectives, read as widely as they can, and make decisions based on uncertainties. There is NO definite line of care. Every neurologist seems to approach these conditions differently.

The leading expert for PSOM is Dr Cole at Ohio State.


For anyone asking advice on health conditions, please remember: opinions expressed by people here are NOT informed medical perspectives -- this is very important to keep in mind!! In some cases what people believe to be fact may be totally incorrect. Often too people are posting the opinions of one neurologist or medical expert but their approach or take on these diseases may be completely different to someone else -- without being 'wrong'. So please, only use advice and perspectives expressed as a general set of ideas and take them to the experts to ask for their opinion and forming a treatment approach. And if anyone is not sure why their vet or neuro has taken a particular approach to care -- ring his/her office and ask. I'd certainly ring and ask why a dog needs to be crated for 4 weeks to make sure I understood the reasoning, for example. :thmbsup: We are paying them for care and should never feel we cannot ask certain decisions have been made about care for our dogs.

lovecavaliers
16th October 2010, 04:38 PM
Hi in response to my sharing about Jack's no restrictions post spinal tap. Even though it was with the same doctor at the same facility I by no means meant it to go against any advice the doctor gave you. I just was sharing my experience. Each dog is an individual and perhaps they did the tap in a different area. I am just curious as to the reasoning for the restrictions.

Hope Chloe had a good night.

ChloeTheCavalier
17th October 2010, 06:39 PM
Hi everyone,
I called Dr. West, the neuro, yesterday to clarify Chloe's post-MRI directions. He said the original instructions to keep her crated at all times was a little over-cautious and while he does want to keep her from jumping, running and playing, she can walk around and be out of the crate while we're home. While we're not home, she should either be in a crate or in a small carpeted room where she can't get on furniture or stairs. It was good news because that first night we tried keeping her crated, she was doing more harm to herself than she would if she were out of it! She'd cry and scratch at the crate and when we'd let her out, she'd lay down on the floor completely calm and content. :rolleyes:

Anyway, the prednisone must be doing its job (either that or the Gabapentin is finally kicking in) because already, she's acting much more like herself. Her tail is up and wagging (although there is a little kink in the base of her tail that still is pointing down and not completely loose) and she's trying to run and jump, but we're not letting her. We're still carrying her down/up stairs and outside, as well.

Also in my conversation with Dr. West, I asked about why we were advised not to treat the PSOM. He said he believes PSOM is secondary and the SM is primary, meaning that the PSOM is an effect of the SM. He acknowledged that this theory isn't commonly shared, but that's his belief. When I mentioned how a few Cavaliers have PSOM but not SM, he said he didn't agree and that those Cavaliers probably do have SM (albeit maybe without syringes present) and that MRIs weren't read correctly.

He also said that while PSOM can be treated, he's certain that doing so on Chloe would cause more damage to her and she'd be in temporarily worse condition immediately following. He said that her canal/ear plug right now isn't infected and to puncture it to drain it would open it up for possible infection. He seemed very adamant about not treating the PSOM, especially because it doesn't seem to be bothering her. At this statement, I said how during her scratching, she is scratching her ear directly and not the air most of the time, leading me to believe it's a reaction to PSOM pain and not the SM. To this, he said that her ear is not causing her pain because when you touch her ear area, she does not show pain at all--which is true, she seems to like it.

I still emailed Dr. Lynette Cole at Ohio State to possibly discuss a second opinion. I understand Lily's mom's doc said the same thing about the risk of treating PSOM so hopefully we'll get some more answers/info between the two of us.

Right now, Chloe is sleeping next to me. (One thing I always noticed about her is that even when she's sleeping, her eyes are never fully shut. Any other Cavalier owners notice this in their dogs?) She does seem much better the past 2 days, so I'm hoping for the best long term, especially after we take her off the Prednisone in 2 weeks. :)

Shay
17th October 2010, 07:24 PM
I have not yet e-mailed Dr Cole, but was planning to this week. Please let me know what she says when she responds. It is very interesting that we were told pretty much the same thing about the PSOM surgery. I am very interested to hear what Dr Cole says.

Lily does not close her eyes all the way either. Since Dr Sorjonen told me this, I have watched Lily and my other Cav while they are sleeping, and Lily always has a little slit when she is sleeping, while Alfie's eyes are completely closed with no slit. I was told by Dr Sorjonen when I brought her in a couple of weeks ago, that she has some facial paralysis that you can't see by looking at her, but he observed from his neuro exam, which does not allow her to close her eyes completely. He noticed she had an abrasion/ulcer on her cornea that he said was caused by her not closing her eyes all the way, and making the eyes dry. He believes this was caused by the PSOM, but could be the SM as well.....no way of knowing for sure. After researching this, there are also eye conditions in the cavalier that cause abrasions/ulcers and grayish spots on the cornea, which is what Lily's spot looks like to me. It is completely flat, and is a grayish color, and does not look irritated at all, and does not seem to bother her. So hard to tell, what causes what, with these doggies. He has referred me to an eyes specialist, so I should have more info after I see her.


So glad to hear Chloe is feeling better!!