PDA

View Full Version : Whether or not to MRI...advice and words of wisdom requested!



Jay
5th January 2011, 11:27 PM
I have always suspected that one of my Cavaliers, Monty, might have mild SM. He would yelp if not picked up in "just the right way". He didn't enjoy agility. He would often come up to a jump and just stop. A while back, he started to refuse to jump up on to the sofa. I had him evaluated by my vet. He x-rayed his back and found lumbar-saccral compression. We started him on Tramadol (25 mg) twice a day and the yelping stopped and he started jumping back up on the sofa. The vet wanted to start him on Gabapentin, so we started with 50 mg in the AM and 25 mg of Tramadol in the PM. He started yelping again and was very restless at night. We upped his Gabapentin to 100 mg in the AM and the vet wanted me to wean him off the Tramadol in the PM. I stopped the Tramadol and this AM, when I picked him up to take him off our bed, he let out a horrible scream (right in my ear). I am going to see what happens today and tomorrow, then contact the vet again. I am seriously considering having an MRI done, but if his pain can be controlled with meds, is it necessary? He did great with 100 mg of Gabapentin in the AM and 25 mg of Tramadol in the PM.

I am not sure if he actually has SM or if the pain is associated due to his back problem. He was always a "drama queen" so to speak, although I don't like that term, as having chronic pain is certainly not a joking matter. I just mean to say, that he has always been very vocal about things he didn't like (or he anticipated might happen....)

Suggestions? Words of wisdom? Advice?

edited to add....he was also born with a mild pulmonary stenosis. He is evaluated by a board certified cardiologist and has an echo done every 18-24 months. His stenosis continues to be mild and his Mitral Valve is good. He is not on any cardiac meds and has no activity restrictions. I do give him 30 mg of CoQ10 daily. He will be 7 years old in Feb.

Blondiemonster
6th January 2011, 12:23 AM
You can only know for sure if it's really SM if you have the MRI.
U can of course guess, and for some people the clinical findings will have to do because an MRI is not affordable. Most vets assume that when dogs improve on gabapentin etc. there is a good chance it is SM. The yelping is pretty typical.
Restlessness at night to. Does she scratch? Dig? Rub her head? Other symptoms?
If you have the finances available i'd recommend an MRI to find out more about the state of his spine and brain and skull etc..
If surgery is something you'd consider then an MRI is absolutely necessary as well.
I'd sure recommend it. SM is hard to deal with, and it gives peace of mind to know for sure.

Karlin
6th January 2011, 12:42 AM
If it is SM, it is probably more than mild (more like moderate moving towards more severe) if he vocalises in that way and shuns certain activities etc as all that is an indication of some significant level of pain. If you want a comparison, my Leo has a large but short syrinx that would be considered fairly serious SM but perhaps as it is central in his spine his symptoms have always been moderate and mostly restricted to scratching or a small yelp on bad days when touched around his sides. He has never screamed except one incident when he fell off a bed. He has never refused to do any activities and still leaps in the air when excited, jumps on my lap and the sofa etc.

It is hard to know what to do. As you have a spinal issue anyway perhaps that is the issue but I would think on the basis of long term behaviour that you are more likely to be looking at SM. On MRIs -- I would MRI if you want a definite answer, have the money or insurance, and would possibly consider surgery. In your place, I probably wouldn't -- unless I definitely was considering surgery. If he responds to meds I would try those. I'd have your vet look at Clare Rusbirdge's treatment protocol as if SM you would probably want him on a CSF inhibitor like frusemide or one of the many others, plus gabapentin. You can add a painkiller on top of that if it isn;t adequate. Clare's sheet goes through all the options in detail. 50mg gabapentin would have been quite low but perhaps that at 2x or 3x would be effective, or else 100mg. Personally I'd work with gabapentin and a CSF drug then if needed start with a low level painkiller like metacam. I have Tramadol but just for emergencies, when we thought Leo might be starting to have serious SM pain sessions after the incident last summer. Clare suggested only using it for emergencies.

But that was all specific to my own dog -- every individual case is different. But I'd certainly not only use gabapentin once daily.

Some feel Tramadol isn't a great drug for them to be on long term -- it does seem to cause dependency and some say dogs have a hard time being withdrawn from it. Gabapentin would generally be given at least twice daily and usually 3x every 8 hours so I'd be thinking of putting him on that perhaps. It tends to lose effectiveness after 8 hours.

Cathy Moon
6th January 2011, 12:48 AM
If you think he might have SM, you might want to take him to a neurologist for a complete exam. The neurologist would tell you if a MRI is indicated.

Monty's lumbar-saccral compression: is this a permanent condition? Does it require surgery, or will it heal with rest?

As far as Tramadol goes, I think it is only meant to be a short term pain drug (for surgery?), or for palliative end of life care. I don't think it is meant for long term use. I think dogs can become physically dependent on it. Geordie's vet would not prescribe Tramadol when his Gabapentin stopped working. I don't think Tramadol is used for dogs with heart issues, but I'm not sure. Geordie isn't allowed to take it. But Charlie had it for palliative care.

If the Gabapentin is being prescribed by your vet for Monty's lumbar-saccral compression pain, wouldn't he need it every 8 hours around the clock for it to be effective? That's how it is normally prescribed. You might want to ask your vet.

Pat
6th January 2011, 12:54 AM
Jay,

I am by no means an expert on SM, but I have two thoughts in response to your post. I'm sure that others will jump in and correct me if I'm on the wrong track.

1. If you are going to have a trial on gabapentin, it makes no sense to me to give the drug once a day. The drug is "active" for only 8 hours, so giving it once a day to me isn't going to give a good idea if the drug is going to be effective since two-thirds of the day the drug will have zero effect. If I started a dog on SM meds, I'd probably go straight to Lyrica so that I only had twice a day dosing to do. My friends who have SM dogs give Gabapentin three times a day and sometimes add Tramadol once a day to that during bad days. (And some of them have never had their dogs MRI'd.)

2. I've had dogs with mild to moderate disc disease, and I don't allow them to jump on and off furniture even when they are feeling okay. I have several sets of the dog steps (a three step to get to my bed and a couple of two steppers for sofas) and my dogs all use them - even the young and healthy dogs.

Pat

Cathy Moon
6th January 2011, 01:16 AM
These are all good points to consider.

I would like to add:

If you suspect SM, you'd really also want a prescription to reduce CSF pressure, as Karlin said.

Gabapentin is not expensive at all, while Lyrica is prohibitively expensive. I would use Gabapentin for as long as it works, unless money is not a concern.

With SM, I personally feel that regular neurology exams are necessary. We are asked to bring Geordie in 3-4 times per year, but they check him for facial pain and many other things. He needs blood tests too. We had been told his prognosis is guarded. I feel better getting these status updates. (Charlie had terrible facial and ear pain.)

anniemac
6th January 2011, 01:52 AM
I am so sorry and I hope things are ok. I would go to a neurologist first but personally I would try to have an MRI. It will help the wonder and be a tool for next course of action.


Its hard these decisions but I hope you get some answers to help

Sent from my Droid using Tapatalk

Karen and Ruby
7th January 2011, 09:19 PM
Hi Jay

Sorry you are having these problems with Monty but i thought Id add something to the, already fab words of advice you have.

I recently went back to see Dr Rusbridge with my 4 year old who has moderate SM.
Her last and only scan was when she was 2 which is when she was diagnosed.

I had been increasingly worried about Ruby as she had had 2 serious pain episodes in a relatively short space of time (5 weeks) and wanted to get her assessed again.
I thought that she may had done some disc damage as she was very sensitive in her Lumbar area.

Dr Rusbrigde asked me if I wanted to scan Ruby again to see what was happening. I asked if we would alter her treatment or medication if the results showed her SM had worsened OR there was disc disease.
To which we soon realised the answer was NO.

All we can do is help them out with a bit extra pain releif when they are uncomfortable and keep them safe. I bought some steps for her for the sofa and bed.


SO if you are already treating him as if you beleive he has SM and are giving him drugs to help the pain then will you do any different if you know either way?

get him assesed and get him on a diuretic and the gabapentin is an 8 hour drug so you will have that to think about to.

All the best

Zumie05
18th January 2011, 01:34 AM
I am curious if anyone MRIs their dogs who show little to no symptoms at all, just for peace of mind?

I have thought of this a lot. Every scratch and movement and yelp just lurks in the back of my head and worries me, and I want the peace of mind knowing if there is any malformation or pressure in my dogs brain/neck or not.

Is an MRI the ONLY way to figure out if a dog has CM or SM, or are there other less expensive ways to see if it is "likely" the dog either has or does not have CM or SM? Like for example, how much information can an x-ray give?

As a response to the OP, I would MRI in a heartbeat if the funds are available. Otherwise, this is why I am asking the other questions above!

Soushiruiuma
18th January 2011, 02:14 AM
I am curious if anyone MRIs their dogs who show little to no symptoms at all, just for peace of mind?

I will be doing the more affordable diagnostic scan on each of my dog's at age 5-6 if there are no signs of SM before that (these are becoming standardized to around $600 in the US now). These will be shared with the researchers, which I feel is well worth the expense.

Peace of mind, and contributing to future of the breed.


Is an MRI the ONLY way to figure out if a dog has CM or SM, or are there other less expensive ways to see if it is "likely" the dog either has or does not have CM or SM? Like for example, how much information can an x-ray give?

I think that CM could be diagnosed by x-ray, but not SM. The problem with x-rays is that that they really only show bone (or metal plates if you have those "installed"). SM is diagnosed by the soft tissues: brain, spinal cord, and the csf. None of which are apparent on an x-ray. MRIs give a good picture of the soft tissues.

Jay
18th January 2011, 02:32 AM
Well, just wanted to give you a quick update on Monty. It turns out that the morning screaming was due to a very angry and inflamed anal gland. I discovered it that night and he was at the vet's in the AM. He is doing much better now. He goes in for a final recheck tomorrow in the AM. I am still planning on having him MRId as his history still leaves me to believe that he may have some degree of SM. However, I am not feeling so rushed now. I am looking to find a good neurologist here where I live. I am putting out feelers among my "dog" friends for recommendations. I really need to get a handle on his meds. Right now he is doing ok with just the gabapentin in the morning. But I am not comfortable with not knowing what is actually going on with him.