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Ddavis
18th January 2011, 09:01 AM
Megan is going for an MRI scan tomorrow.

On the evening of 20th December I noticed she had gone paralyzed on the right hand side of her face. She was at the vet the next day and he immediately suspected a problem with the ears and she was booked in the following day for an ear check under anesthetic.

Turns out her eardrum was bulging outwards into the ear canal and that there was thick mucus behind the eardrum. The vet was not sure what it was at the time. We have since discovered the condition PSOM and suspect that. She was treated with cortisone and an antibiotic.

Currently the paralysis has not improved and a day or two after her antibiotics finished I had her at the vet again and her eardrum had started bulging again.

My vet then spoke to other vests and their opinion is that the paralysis is maybe not related to the ear problem … they are mentioning that dreaded word, SM!

Personally I have doubts in that there are no other symptoms like ‘air-scratching’ etc, but it would be good to either confirm or disprove it. I just find it strange that the first thing the vet wants to investigate regarding the paralysis is the ears .. now maybe it’s not the ears.

The paralysis is the whole right side of her face from the ear to the bottom jaw. I put tear gel in the eye a couple of times a day because the eyelid stays open. She has a very definite head tilt but at least the eye jumping (which she had on the first visit to the vet) has stopped which is confirmed by her better balance.

I am very nervous of what will be found, but I also want to know what the problem is. I am just worried that the PSOM is now not really being treated. However I hope that after the MRI, what ever is the problem can be treated as well as the ears.

So, one more sleepless night before her scan.

Charlifarley
18th January 2011, 10:27 AM
Best of luck tomorrow Darlene, hopefully the MRI will be able to help to diagnose what is wrong with Megan. Will be thinking of you. :xfngr:

sins
18th January 2011, 10:39 AM
Best of luck with the scan,
Try not to get too stressed over it,it'll help greatly with identifying the cause of the problem,regardless of whether or not it's SM.
It's sensible to do a scan when any neurological problem occurs.
Sins

Karlin
18th January 2011, 11:27 AM
Personally, I would agree with you and suspect PSOM.

It is good to see a neurologist though. You may find there are signs of SM because this is going to turn up in a lot of asymptomatic cavaliers -- but again given you see no other symptoms, it would seem unlikely that suddenly the case would be so severe as to cause facial paralysis. Whereas facial paralysis is a known sign of PSOM:


PSOM: A recent report in the veterinary literature has documented an otitis media (middle ear infection) that appears to affect the CKCS breed in particular. Due to the mucoid nature of the ear disease the condition has been referred to as primary secretory otitis media (PSOM) or “glue ear.”
Clinical signs of PSOM may not be presented (referred to as sub-clinical). If clinical signs are present, they may include hearing loss, neurological signs (facial paralysis, head tilt, involuntary eye movement, and circling, unsteady and clumsy walking patterns), neck scratching and head shaking.
The sample study indicated 40% of the study group had PSOM. A veterinary dermatologist treats this disorder by flushing the affected ear. The ACKCSC Charitable Trust is currently funding a study at The Ohio State University's Veterinary College.

From ackcsc website.

See also:

http://vet.osu.edu/research/primary-secretory-otitis-media-cavalier-king-charles-spaniels

From which:


he Cavalier King Charles Spaniel (CKCS) seems to have a predisposition to a non-infectious otitis media (OM) marked by mucus accumulation in the middle ear, hence the descriptive diagnosis of "glue ear". One or both ears may be affected. This OM is unusual because of its lack of association with concomitant external ear infection and because of frequent accompanying neurological involvement. These neuropathies include:

ataxia
facial paralysis
nystagmus
head tilt
hearing loss/deafness

Pain around the head and neck (with vocalization and/or guarding), scratching around the ears, external ear infection, hearing loss, or any combination of the above also occur. These presentations are due to mucus build-up in the middle ear, possibly as a result of Eustachian tube dysfunction. Upon otoscopy, the ear drum is often bulging outward due to mucus accretion behind it. PSOM seems to share many features with secretory otitis media, which is one of the most common ear problems in children. In the CKCS, PSOM can be misdiagnosed as progressive hereditary deafness or as syringohydromelia, two other disorders to which CKCS are prone. Therefore, development of a specific test or tests for PSOM, easy enough to perform in the office and affordable for the owner, will promote both appropriate treatment and accurate assessment of this problem in the breed.



Here's one article on PSOM:


Primary secretory otitis media in the Cavalier King Charles spaniel: a review of 61 cases
Authors: Stern-Bertholtz W.; Sjostrom L.; Wallin Hoekanson N.
Source: The Journal of Small Animal Practice, Volume 44, Number 6, 30 June 2003, pp. 253-256(4)
Publisher: BVA Publications

Abstract:
Sixty-one episodes of primary secretory otitis media (PSOM) were diagnosed in 43 Cavalier King Charles spaniels over a 10-year period. The principal findings were signs of moderate to severe pain localised to the head or cervical area, and/or neurological signs. Diagnosis was made by examination of the tympanic membrane and middle ear with the aid of an operating microscope under general anaesthesia. A bulging, but intact, tympanic membrane was found in most cases. Following myringotomy, a highly viscous mucus plug was found filling the middle ear. Treatment, consisting of removal of the mucus plug, flushing of the middle ear, and local and systemic medical therapy, had to be repeated between one and five times. The prognosis was good in all cases. PSOM is an important differential diagnosis in Cavalier King Charles spaniels with signs of pain involving the head and neck, and/or neurological signs.

This is often diagnosed and then treated without an MRI -- which seems an expensive approach to diagnosis given this is a common symptom of the condition and you already have a bulging tympanum. I'd probably question whether the MRI is needed unless insurance is covering this, and send the vets to read more on the condition.

Wagtails
18th January 2011, 05:10 PM
Will be thinking of you and your Megan tomorrow, Darlene. I know it's very distressing when they get strange symptoms, but you and your vet/s are doing exactly the right thing in getting a scan. It's really the only sure way to get an accurate diagnosis.

My Megan also has a slight facial paralysis now (Horner's syndrome) but she has learned to cope with it very well and I take extra care of the eye which does not blink. Cavaliers are such amazingly adaptable little dogs.

You will soon feel better, once the scan is done and you can get on with whatever treatment is prescribed for Megan. Good luck
http://i673.photobucket.com/albums/vv97/Cavviewagtails/Animations/Dog%20animations/GetWellSoonCavvie.jpg

Ddavis
19th January 2011, 08:17 AM
Thanks for all the encouragement and good thoughts. Megan is currently undergoing the scan.

Karlin, I hear exactly what you are saying and I have already given the vet some articles I printed off the net regarding PSOM. Unfortunately PSOM is not really known here (yet) and the vets are just getting their heads around the whole SM thing.

I am hoping that after the scan I can say 'I told you so' (ok, maybe just to my self :p), and we can hopefully get on with more aggressive treatment for PSOM.

I actually sent an email to Dr Cole last week asking for the latest treatment advice which I can give the the vet ... unfortunately I have not had a response. From what I have read it seems that it is a case of trying to remove the mucus and flushing out the ear.

I will report back as soon as I know the outcome of the scan.

Fingers crossed!

anniemac
19th January 2011, 09:04 AM
Keeping fingers crossed for you. Hope everything is ok. Prayers

Anne and ella

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Tania
19th January 2011, 10:24 AM
Poor little Megan, thinking of you both today.

Nicki
19th January 2011, 10:49 AM
Thinking of you - let us know the results as soon as you can :thmbsup:

:flwr::flwr::flwr:

Margaret C
19th January 2011, 12:10 PM
Thinking of you - let us know the results as soon as you can :thmbsup:

:flwr::flwr::flwr:


Thinking of you both. :xfngr:

Chamberlain
19th January 2011, 01:21 PM
Sending happy thoughts and best wishes your way!

Teresa
19th January 2011, 01:47 PM
Hard day for you!! Sending love your way!!

Ddavis
19th January 2011, 02:22 PM
Hard day for you!! Sending love your way!!

No kidding! I can collect Megan in half an hour but the results will only be ready tomorrow!!! More waiting!

love2driveinct
19th January 2011, 02:37 PM
More waiting! Sorry to hear it. Thinking of you...

anniemac
19th January 2011, 04:56 PM
Oh no! I hate that you have to wait more. Try to stay positive and sending hugs

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GraciesMom
20th January 2011, 12:20 AM
Always want to hear back from troubled parents

mommytoClaire
20th January 2011, 03:32 AM
Oh boy, was hoping to hear something today, because I think today was the day.

Ddavis
20th January 2011, 05:42 AM
I had to take Megan back to the vet half an hour after she got home last night!

She was not at all happy, very restless and kept looking like she wanted to get sick, was drooling very badly and not in the least interested in food or company.

Apparently the dogs go through quite a bit getting an MRI here (in a human hospital) and are put under for about an hour with a morphine based anesthetic. Then when they move her around to place her in various positions for the scan apparently the stomach acid could move around all over the place as even her stomach muscles are relaxed, then there is also the tube that get put down the throat!

They did check her lungs which seemed clear and her heart was still sounding good, but to rather be safe than sorry they wanted to keep her overnight for observation.

Just waiting for the call this morning that all is OK and she can be collected! It's just not the same around the house without her. Even my other two Cavs; Pippin and Tyla seemed to miss her! :(

Will also post the results of the MRI as soon as I know them.

Charlifarley
20th January 2011, 10:01 AM
Poor Megan, I hope she will be ok today and fingers crossed you will get good news from the MRI. It's horrible when one of the dogs is away from home, there is this big hole without them !

MishathePooh
21st January 2011, 12:58 AM
Misha was in the PSOM study with Dr. Cole. He did not have it, but they basically just make a hole in the ear drum and remove the viscous material. PSOM can recur so the operation may need to happen more than once. Dr. Cole was very nice - at the onset of the study she had no Cavaliers. Now she has several and works in rescue. I would think she would email you back.

Best of luck with your little one!

anniemac
21st January 2011, 04:57 AM
I hoping for good news.

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Ddavis
27th January 2011, 11:28 AM
Now I know I have reason to be a nervous wreck! And not from the results of the scan as I would have presumed, but from the effects of the anesthetic on Megan.

After her MRI she developed terrible acid burn to her esophagus and intestines and has been in and out of the vets ever since. I did collect her last Thursday after she spent the night in 'hospital' and she started to improve. But had a terrible night on Friday, when not vomiting bile was basically dripping out her mouth. After telephonic discussions with the vet I was to take all water away (she was not to let anything pass her lips) and be at the vet Saturday morning.

He booked her in again and put her on a drip this time with the hope that the medicine would work quicker. I was able to collect her again on Sunday evening. She had a terrible Sunday again! I think it must be to do with excitement as she was sooo excited to be home but then not long after started with all the bile drooling from her mouth and doing the motions of wanting to get sick.

After a few hours she did settle and has got a bit better every day. I am trying to keep her stress levels down, so no visitors to the house (and it seems to be working). She had a check-up yesterday and the vet is happier. She does however have a very bad case of 'the runs' and a touch of colitis now but she does seem to be on the mend. Her medication is for 20 days, so I think the trauma her stomach went through was quite something.

Needless to say, non of this is helping us get any closer to treating her PSOM. I did e-mail Lynette Cole in the USA for advise. I was very impressed that I got a response from her where she explained the treatment she would follow and said that the vet is welcome to contact her. It seems my vet will also now communicate with her.

Well the results of the MRI. Megan does have a small syrinx at the C2/C3 disc space but there is no cord signal change or 'mass effect on the cord'. This will apparently be unlikely to cause her problems during her life time!

So hopefully, once she has fully recovered from this disastrous episode, we could maybe start treating the original problem. We are all a bit nervous though about putting her under anesthetic again! At the moment I am just so relieved that she is feeling a bit better!

Wagtails
27th January 2011, 12:23 PM
Oh dear, Darlene, I am so sorry to hear about all the troubles poor little Megan has had and hope she will be feeling much better very soon. I must admit that I wouldn't put MY Megan through an anaesthetic again either, but then she is 12 years old, so it's different for a younger dog who might need one for other reasons.

In all the upset, the better news about the scan result seems to have got cast into the shadow! But I'm sure we are all glad to hear that it wasn't what you most feared.

Good luck little Megan and lots of hugs from your namesake in Worcestershire

http://i673.photobucket.com/albums/vv97/Cavviewagtails/Animations/Dog%20animations/Huggingdogs.gif

love2driveinct
27th January 2011, 09:33 PM
My goodness, what a lot to go through... hope she continues to improve so you can get back to the issue at hand.

mommytoClaire
29th January 2011, 03:22 AM
Oh my goodness, I can't imagine having to go through all that.

I imagine you are exhausted! And the poor baby.
Good news on the MRI though. At least now you can focus on getting her well from this other stuff.

Let us know how she does over the next few days.

Piper
29th January 2011, 03:54 AM
Oh what an awful experience for you guys!! I hope she feels better soon!