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Jane P
24th October 2010, 11:47 AM
I know a lady with a cavalier whose vet has diagnosed the dog with SM and put her on Gabapentin. The vet told her that most cavaliers are diagnosed with SM by examination only and not by MRI. Is this correct?

I have told her that IMO she should have the dog MRI scanned as I think she may be showing signs of PSOM as well as SM (head tilt, one side of face slightly drooping) or at least have her referred to a neurologist for examination. However, she insists this is not necessary because her vet "trained under Clare Rusbridge and is an expert on SM"!

She really cares about the dog and is very concerned about the pain she is in but seems to believe this vet is giving her the best treatment. I'm not really sure what to say to her.

Nicki
24th October 2010, 12:06 PM
Hmmm the only definite diagnosis is by MRI, you are quite correct - but some vets who have experience with the condition are diagnosing SM, dispensing Gabapentin, and if the dog improves, they assume they are correct :(


Ideally you would want to see a neurologist at the very least - say to your friend that a vet is just like a GP, and if you had a heart condition, would you rather your GP dealt with it or a cardiologist...Maybe that will make her understand.


You could print off the stuff from http://www.veterinary-neurologist.co.uk/faq.htm - maybe that will help her to realise she is dealing with a very complex condition, and needs to have the treatment options explained to her by a neurologist.

Good luck - the only comfort is that at least the dog is getting pain relief, I think sadly many of us know dogs whose owners refuse to accept that there is anything wrong :(:(

Jane P
24th October 2010, 12:17 PM
Thanks Nicki. I have already told her about Clare Rusbridge's site and I know she has looked at it quite carefully. I will try the "GP" explanation as you suggest and see if that pursuades her.

RodRussell
24th October 2010, 04:37 PM
Every neurologist familiar with CM/SM who has written on the subject says that the only way to assuredly determine if a dog has CM/SM is to have the dog scanned by MRI. So many CM/SM symptoms are similar to those of other disorders (including such wide-ranging ones as skin reactions to insects, fly-catching, luxating patellas -- you name it) that there is no way a vet can accurately diagnose CM/SM without an MRI ...

... Unless, the vet just assumes the dog has SM because recent statistics have shown that over half of all scanned Cavaliers do, in fact, have SM.

See Karlin's list of SM symptoms, accessible via http://sm.cavaliertalk.com/diagnosing/diagnosing/symptoms.html

Halina
24th October 2010, 05:09 PM
Have they found any early detection signals such as build of dog?

Karlin
1st November 2010, 10:07 PM
No, nothing on build and while there are some internal skull indications these are subtle and very hard to see externally (especially as hair reshapes the way the head looks). But several neurologists do think breeding for smaller cavaliers increases the risk of the problem across the breed as the consistent element in predisposed breeds is being a toy or otherwise miniatarised breed. Having a flatter face/shortened muzzle is also directly connected to incidence of SM. So it is really the breed, not the build of the individual dog, that is the issue. Crosses of affected breeds can also have SM.

On the main question: most cavaliers are definitely diagnosed by MRI, not examination. The only definite way to diagnose is by MRI. That said: I will differ here and say that if there are strong indications a dog has SM on clinical examination then I would ask my own vets to let me trial a range of medications. Or I'd ask to see a neurologist for a clinical exam if there are cost issues for example with having an MRI. Given the incidence in the breed certain clinical signs are most likely to be SM. If there's a belief the issue might be related to PSOM then I'd have the dog scoped for that to see if there's any external evidence. If gabapentin helps then it almost certainly is SM. Head tilt and facial droop is also connected to SM. I MRId almost all my cavaliers for one main reason: research. I was already quite sure one dog had SM and her MRI confirmed it but I wasn't planning surgery and her symptoms were mild so if I'd had to pay full cost I'd never have opted for an MRI. The research MRIs enabled me to find one asymptomatic dog had SM and he eventually went on to have symptoms. Having an MRI is very useful to know what you are dealing with, but consider how high the likelihood is of any MRI showing SM especially in any dog over 5 -- by that age, almost certainly well over a 50% chance. It can be very hard to determine whether PSOM or SM is causing any particular shared symptom if both turn out to be present, as well. Unfortunately the conditions are so complicated! So in summary: I'd have an MRI if there is a low cost one available, or insurance, as that is the definitive approach. Or I'd have one if I wanted to have all options, including surgery, available. But I do not think treatment varies at all based on the MRI, except for a recommendation of surgery in especially worrying cases. A mini MRI at low cost generally is not adequate for basing surgery on... so it can be hard to know which choice to make.

Bet
2nd November 2010, 10:44 AM
No, nothing on build and while there are some internal skull indications these are subtle and very hard to see externally (especially as hair reshapes the way the head looks). But several neurologists do think breeding for smaller cavaliers increases the risk of the problem across the breed as the consistent element in predisposed breeds is being a toy or otherwise miniatarised breed. Having a flatter face/shortened muzzle is also directly connected to incidence of SM. So it is really the breed, not the build of the individual dog, that is the issue. Crosses of affected breeds can also have SM.

On the main question: most cavaliers are definitely diagnosed by MRI, not examination. The only definite way to diagnose is by MRI. That said: I will differ here and say that if there are strong indications a dog has SM on clinical examination then I would ask my own vets to let me trial a range of medications. Or I'd ask to see a neurologist for a clinical exam if there are cost issues for example with having an MRI. Given the incidence in the breed certain clinical signs are most likely to be SM. If there's a belief the issue might be related to PSOM then I'd have the dog scoped for that to see if there's any external evidence. If gabapentin helps then it almost certainly is SM. Head tilt and facial droop is also connected to SM. I MRId almost all my cavaliers for one main reason: research. I was already quite sure one dog had SM and her MRI confirmed it but I wasn't planning surgery and her symptoms were mild so if I'd had to pay full cost I'd never have opted for an MRI. The research MRIs enabled me to find one asymptomatic dog had SM and he eventually went on to have symptoms. Having an MRI is very useful to know what you are dealing with, but consider how high the likelihood is of any MRI showing SM especially in any dog over 5 -- by that age, almost certainly well over a 50% chance. It can be very hard to determine whether PSOM or SM is causing any particular shared symptom if both turn out to be present, as well. Unfortunately the conditions are so complicated! So in summary: I'd have an MRI if there is a low cost one available, or insurance, as that is the definitive approach. Or I'd have one if I wanted to have all options, including surgery, available. But I do not think treatment varies at all based on the MRI, except for a recommendation of surgery in especially worrying cases. A mini MRI at low cost generally is not adequate for basing surgery on... so it can be hard to know which choice to make.


DIAGNOSING SM

I wonder if I could mention this .

This was Posted by Katie Eldred on another Cavalier Forum Recently.

She is I believe ,could be the Oldest Living Cavalier Breeder alive to-day.

This is what she said,HOMERBRENT CAVALIERS ,for her ,had Beautiful and RECOGNIZEABLE CORRECT HEADS.

If you can find a Photo of CH Homaranne Caption ,you will see his Head was like what a Dogs Head should be like, not like the Pretty Look that so many of Cavaliers' Dogs Heads have to-day.

I am back to my what I believe again, the SM Problem is all in the Genes, as Karlin says ,about SM being Predisposed to Cavaliers ,did Cavaliers carry the SM Gene/Genes since they originated in the late 1920's and 1930's, they when the Cavalier was starting to be Miniatarised in the early 1980's, did the different Genes come to-gether and SM appeared.

I think it's different for the Cavaliers and their MVD Problem, it is a Fact that there were Cavaliers dying at a young age from Heart Trouble in the 1940's and 1950's ,as the Generations of Cavaliers have come through the years with Heart Trouble,then as a Result it's likely why the Cavalier MVD Problem is not improving ,is because there are now so many Cavalier Carriers of the MVD GENES around in to-days' Cavaliers.

It is no use saying that a Cavalier is Long Lived ,that Cavalier could still be a Carrier of the MVD GENE.

The Future of our Cavalier Breed depends on the Finding of the SM and MVD Genes.

Bet