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anniemac
19th January 2011, 09:13 AM
I keep bringing this up because it has worried me. I don't know what to expect but I see more and more limb weakness. She is increasing in other things like rubbing, getting comfortable, being in crate too.

I did notice before I left on business trip something odd with side of face. I don't know if I'm being paranoid. I am anxious to talk more to her neurologist but he did say he has never seen it get to that point.

Last Sunday she was playing got in play position. Of course she ran for a bit but stopped but still had that spark.

I know no one can tell me what her future holds. Yet when I more her now she yelps. Did not do that. However she used to shudder to be touched and not as much.

I do have to carry her quite a bit, then she will have a run spree.

I think the face things concerned me before I left.

I am not sure if I want to really know future but then again I do so I can explore other avenues, like ultrasound therapy or even second surgery (which I doubt)

Would the facial issue have anything to do with something?

Maybe she will not be paralyized but I need new stairs because if I forget to move then she is stuck.

Can someone explain yet again if facial has anything to concern me? She already is on top dosage of lyrica and prednisone helped a bit. However seeing declining is troublesome

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anniemac
19th January 2011, 02:31 PM
Please delete. Reading on PSOM and maybe I was thinking too much or what people call me the over "Anne" alyzer

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RodRussell
19th January 2011, 05:18 PM
Please delete. Reading on PSOM and maybe I was thinking too much or what people call me the over "Anne" alyzer

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Anne, don't stop with the questions. You sometimes make my head hurt, but it is because your questions can be very probing.

paula12
23rd January 2011, 05:15 AM
Hi Anne

Bonnie suffers from paralysis in her right hind leg, like you it is a worrying thing wondering whether it will get worse. Bonnie would lose the use of her leg and virtually collapse on the ground, a couple of weeks ago this was happening almost daily and her inability to move would last up to about an hour and if you picked her up she would scream.

We have since put her onto gabapentin as well as the prednisolone, the paralysis hadn't happened for a couple of weeks, however it occurred last night, so I just picked her up and placed her on her cooling mat (at least now she didn't scream in pain) let her be and within an hour she was back to her normal self.

As I am writing this her paralyisis has happened again and to my relief she again didn't scream. The Gabapentin seems to be assisting with her pain control..overall she seems happier. However I always have tramadol on hand if her pain gets really bad.

All we can do for a beautiful little companions, is give them the best quality of life possible.

Paula..Bonnie and Molly

P.s Living in Australia I find the heat makes her condition worse

anniemac
23rd January 2011, 05:45 AM
I'm so sorry. I know how hard it must be. I think prednisone is what has helped her along with lyrica but I can't believe it happened while writing. That is so frightening. You mentioned a cooling mat. I got one too and found ella likes it.

Heat does make it worse for ella especially humidity. Also cold any change in temperature. Someone said they would move to arizona.
Ella hasn't got to the point of not being able to move yet sometimes she just freezes.

You are right all we can do is make them as comfortable as they can and help them. Its hard when you feel helpless sometimes.

Hugs from ella

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anniemac
19th February 2011, 04:21 AM
Rod, I could really use some help now. its almost a month since this and she is definately showing some paralysis or her face looks stuck. I took a picture and emailed her neurologist and the best way to test is to tap her eye lid at the bridge of nose something like that and see if she blinks. He can't tell from the image and wants video.

I only have one eye that blinks, I don't know what to expect. Can you please point me in the right direction? I have been really worried.




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RodRussell
19th February 2011, 05:08 AM
Rod, I could really use some help now. its almost a month since this and she is definately showing some paralysis or her face looks stuck. I took a picture and emailed her neurologist and the best way to test is to tap her eye lid at the bridge of nose something like that and see if she blinks. He can't tell from the image and wants video.

I only have one eye that blinks, I don't know what to expect. Can you please point me in the right direction? I have been really worried.

Anne, it sounds like PSOM. "Inability to blink an eye, ... facial paralysis" are known symptoms of PSOM.

What is Ella's status regarding PSOM. Refresh my memory on this.

anniemac
19th February 2011, 05:11 AM
She never was diagnosed with psom. Her last mri was in september. Wouldn't an mri diagnose then?

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anniemac
19th February 2011, 05:17 AM
I just read your site and she does seem to be having trouble hearing. It says an MRI is the diagnosis method.

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anniemac
19th February 2011, 05:36 AM
I did the test now because it is now and no she is not blinking her lip is dropped.

I should have never doubted myself

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RodRussell
19th February 2011, 05:41 AM
She never was diagnosed with psom. Her last mri was in september. Wouldn't an mri diagnose then?

Short of having another MRI, which I am not suggesting, I would ask the neuro to look at the MRI scan again and confirm whether there is or is not any PSOM visible. Maybe there was incipient PSOM in September and it has progressed since then. Or, maybe it is something other than PSOM. But, whatever it is, I think it is for a neuro to handle.

anniemac
19th February 2011, 05:49 AM
Thanks rod!

I am contacting him tomorrow. I have asked for the second image but I know either way it needs to be looked at again which I have asked.

I appreciate the advice

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Ddavis
19th February 2011, 10:32 AM
My Megan has complete paralysis of the right side of her face and her head also tilts quite badly.

She has PSOM but it was not picked up on a MRI (apparently it is a cat scan that picks it up best). However we know it is PSOM as the vet has seen that her ear drum is bulging out and he was able to extract a little very very thick mucus.

Megan has been on Prednistelone (spelling ... it is a cortizone). Anyway her head tilt is improving but the eye is still not blinking. This could take a loooong time to come right.

Strangely enough, when I got Megan as a five year old, she had no hearing. Now that she has been on coritzone and some of the swelling or mucus in the ear seems to have lessened, she is actually starting to hear.

She had a torrid time after the MRI and the vet is a little weary of putting her under anesthetic again so we are trying a slower longer term treatment plan.

What you MUST do however Anniemac is put Teargel in her eye 3 to 4 times a day. You need to keep the eye moist otherwise you open a whole other can of worms.

Good luck and let us know how she progresses.

anniemac
19th February 2011, 03:07 PM
Thank you for telling me that it wasn't picked up on the mri. I've spent another night worrying and sent an email to her neurologist. Is that the same as prednisone? She already is on that but thinking more and reading cavalier health, I have a very strange feeling because it seems her hearing is worse. Her lip is lowered. Thank you.

Her second mri was a follow up so I don't know. I know her eye is a whole other issue with drops several times a day.

Wouldn't it be nice to not worry all the time
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Love my Cavaliers
19th February 2011, 03:32 PM
Anne, what is Ella's dosage of prednisone? Riley is on 5 mg a day and her neurologist said I can go up to 7.5 mg a day for several days if I notice any signs of weakness in her legs. The 5 mg/day seems to really be a good dose for Riley. I seem to recall though that Ella is not on that much. Maybe she needs more. Prednisone is the only thing that has helped with Riley's weakness.

Wagtails
19th February 2011, 04:52 PM
I also have a Megan (now aged 12) who is totally deaf, has SM (but not PSOM) and is now suffering with what my vet calls "Horner's syndrome" ie a slight paralysis of her right eye and face.

It first came on after an ear infection, which I gather is common, and was very worrying at first, but seems to be getting a little better now. We haven't had any treatment for it other than the daily eye drops (Hypromellose) which I've been using for years anyway. As far as I can tell, it doesn't cause her any pain, but obviously I have to be extra careful about bathing and cleaning her eye as she cannot now blink it.

I was under the impression that this is "just" part of the normal progression to be expected with SM - is that right, Rod?

RodRussell
19th February 2011, 05:42 PM
...What you MUST do however Anniemac is put Teargel in her eye 3 to 4 times a day. You need to keep the eye moist otherwise you open a whole other can of worms...

I agree. Use some sort of artifical tears.

Karlin
19th February 2011, 11:04 PM
I think this is probably connected to SM. When I attended the presentation to vets on CM/SM by Jacques Penderis, he stated facial paralysis is a known symptom of SM, and others feel it is often connected. Clare says:


Dogs with a wide syrinx are also more likely to have scoliosis (curvature of the spine).yringomyelia may also result in other neurological deficits such as weakness and poor coordination and slow correction of abnormal limb position. Seizures, balance problems, facial nerve paralysis and deafness may also be seen; however, no direct relationship has been proven, this association may be circumstantial and it is important to rule out other causes.

PSOM is easy to see on MRI and most cavaliers seem to have it.

If a severely affected SM dog started to show facial paralysis, I would probably think it most likely to be connected to the existing severe SM. I just do not think, as some have advised on other lists, that this is remotely likely to be a separate health issue as it is known to be a possible symptom for to her existing problems. But you really need to talk to a neurologist.

I do not think I would put a dog that has been thru as much as Ella thru the repeat ear flushings under anaesthesia likely needed for PSOM if it were to be the cause.

lovecavaliers
20th February 2011, 01:13 AM
Ohh Anne, poor sweet Ella, please let us know what the neurologist says. How is Ella doing otherwise energy, eating, sleeping? Thinking of you both.

anniemac
20th February 2011, 03:23 AM
Her neurologist doesn't remember seeing anything PSOM related but has the IT Guy pulling images to check on Monday.

I have a feeling what Karlin said is its related to SM but I'm glad he is going to check anyway.

Ella is only on 2.5 mg of prednisone up to 5 mg a day. It is hard to tell by doing what he said because one eye doesn't close due to dog bite.

I caught a glimpse over a about a month ago. Then this week when she woke up, now more frequently. She is in kennel more and did not eat normal.

I have been upset this week and emailed him Tuesday. I had my breaking point last night when I saw her eye not blink.

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RodRussell
20th February 2011, 05:43 PM
Anne, a breeder who wrote to me about Ella's symptoms asked me to convey her suggestion that the problem could be a form of maxiliary myosotis, such as masticatory muscle myositis. Read about it here: http://cavalierhealth.org/masticatory_muscle_myositis.htm

Tania
20th February 2011, 05:57 PM
Whatever next :( These poor dogs :(

anniemac
21st February 2011, 01:12 AM
Thanks rod,

So much information you have. I will see what the neurologist says tomorrow.

Tania, there are so many issues that

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anniemac
21st February 2011, 01:14 AM
Sorry. I hate to assume it is something without having other things looked at. Thank you

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anniemac
21st February 2011, 10:43 PM
I asked ellas neurologist to look at previous mri images for psom and he responded that her right ear has image consitant with psom or an ear infection. So more questions of what next

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Karlin
21st February 2011, 11:04 PM
I've spoken to vets and a neurologist about maxiliary myositis before and they say it is always an early onset condition in cavaliers-- so would seem highly unlikely as an option with Ella.

Anne, the problem is that you probably cannot tell what the source is of this -- but surely most likely it is SM or PSOM. The options are pretty limited then in what you can do -- PSOM requires a GA, an ear procedure that can actually cause facial paralysis itself as a side effect, and almost always has to be repeated several more times. If SM, I think you would probably be looking at only redoing the surgery as an option for what might halt it. Both are serious and invasive procedures with risks -- in order to achieve what aim here? If it is not bothering her, and given that you already are aware she has been through a lot and is on limited time, I would just make her as comfortable as possible and watch for signs that her quality of life is deteriorating to the point where it may be time to let her go.

I feel for you; dealing myself with one with serious SM, and Lucy in what vets say are likely her final days or weeks with MVD. I think you need to be clear in your mind about what constitutes a decent quality of life if things are progressing, so you have this in mind as I find that helps me, and maybe rereading the good essays and links pinned in the health library section may help.

Pat
21st February 2011, 11:37 PM
I asked ellas neurologist to look at previous mri images for psom and he responded that her right ear has image consitant with psom or an ear infection.

I'm confused about that statement because I was with neurologist Simon Platt this afternoon reviewing an MRI (I'll write more about that later - it's been a very, very long day - four hours on the road and seven hours in the waiting room) and he explained exactly what PSOM would look like and what an ear infection would look like - and there is no question differentiating between the two. It is very obvious so I'm not sure why your neurologist wouldn't be able to definitely identify one versus the other.

Pat

Karlin
21st February 2011, 11:54 PM
Yes was thinking same... PSOM is easy to see, it is a murky whitish spot in the ear area.

Pat
22nd February 2011, 12:45 AM
Yes was thinking same... PSOM is easy to see, it is a murky whitish spot in the ear area.

That is correct. Dr. Platt showed me one ear that had a large solid black middle circular area - it is black because there is nothing there that shows up on MRI. He said that if PSOM was present, that solid black area would be all white - the entire area. Then he showed me the other ear and there were some thin white lines outlining the inner ear, but still black in the center - and he said that this was the beginning of an ear infection or a current ear infection and I should monitor that ear. It was all pretty fascinating.

I can't say enough good things about Simon Platt! I had a prejudice toward Auburn and Dr. Andy Shores after attending his AVMA session, but I'm now a big fan of Dr. Platt and I suspect their approaches to SM are different.

Pat

anniemac
22nd February 2011, 01:43 AM
I emailed images to rod but he wants to see her for further valuation. He knew I was in tears and asking about PSOM and given my emotional state, it is something he may want to talk face to face.



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anniemac
22nd February 2011, 01:49 AM
Not much changed in size like I thought. http://184.72.239.143/mu/aefc9917-07e8-cdb9.jpghttp://184.72.239.143/mu/aefc9917-07f6-f6b4.jpghttp://184.72.239.143/mu/aefc9917-0806-44e6.jpghttp://184.72.239.143/mu/aefc9917-0816-47b4.jpg

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mommytoClaire
22nd February 2011, 02:47 AM
Anne, I just wanted to say that I am thinking about you, and keeping you and your dear sweet Ella in my prayers.

You are such a caring 'momma' to Ella. I'm hoping for some glimmer of decent news in the middle of all this.

Hugs,

Cindy and Claire

Karlin
22nd February 2011, 03:53 PM
Anne, none of us here are medical professionals. You need to be talking directly with your neurologist about this. It is not a good idea to have people without any background in the area try to make a diagnosis from small, low resolution versions of MRIs posted to a discussion board. Some have made wild guesses in other places and IMHO it is insane to be trying to get adequate or accurate medical advice this way.

As I said, you really need to consider first whether the paralysis is affecting her in any kind of problematical way. Unless it is interfering with her ability to eat or swallow, I really don't think this is something that you need to be concerned about right now *but you need to talk to your neurologist* :thmbsup:. The second consideration is–what are you planning to do about this if it turns out this is due to PSOM or SM? Would you wish to put your dog through further procedures at this point?

I will wager that a neurologist will say that this side effect is almost certainly another symptom of the condition she already has. That's again, why it is best for you to go make a decision about this after a conversation/appointment with your neurologist and an evaluation of whether whatever you are seeing actually has any effect on her quality of life. This has been worrying you for a month now so you really do need to go see a professional with Ella. It isn't fair to her to keep asking for guesses from all of us when it sounds like she needs a medical evaluation.

So I am going to ask you to please first have a discussion with a professional on this issue now. Once you get a response and informed medical recommendations perhaps you will want to return here to ask people for a response. But I really do not want this same conversation running in a loop as it has been for a while now, because I think it is risky for you to be taking decisions without any direct professional advice, and I also think it increases overall anxiety and distress because you are getting so many/too many different opinions here and elsewhere, as you've asked this on several forums. It sounds like other issues bother her a lot more and she is having more pain -- that sounds like maybe it needs re-assessment from your neurologist even more.

I am going to close this thread for now and when you have an informed response from Ella's neurologist, you will be able to start a fresh thread based on an actual diagnosis. :thmbsup: