View Full Version : Asymptomatic?
23rd February 2011, 10:15 PM
The generally accepted wisdom is that many more Cavaliers have cm/sm than ever get diagnosed, because they don't show any symptoms. When Oliver had his first scan at the age of 6, and his small syrinx showed up, I would have said that he had no symptoms. Nearly 4 years later, having lived with his mild SM, I would say that I was wrong then. With hindsight I can see that the signs were there from the time I had him at a year old, but because they didn't seem very serious, I don't think I even mentioned them to my vet; it was just the way Oliver was.
For example, he has always been a restless sleeper, moving from bed to floor and back several times during the night - presumably trying to get comfortable; so perhaps he had headaches even back then. He has also always been slightly light phobic: at an indoor show, where he was looking up at strong fluorescent lighting, he would start to squint as if his eyes were hurting a bit. So I just kept him out of strong light as much as possible, and it didn't seem to bother him very much. Now, it is one of his major symptoms, due to his dilated ventricles, though again easily controlled by keeping him away from bright sunlight; it seems to be a slightly unusual and not very common symptom. Most GP vets would probably not recognise either of these as symptoms of CM/SM, and most owners, like me, probably don't take much notice of them. So perhaps the Cavaliers with undiagnosed SM aren't as asymptomatic as people think - we simply don't know all the warning signs which taken together could lead to a positive diagnosis.
I would guess that a lot of people on this forum could recount similar experiences of warning signs which are only recognised in hindsight, or early signs of what later became positive symptoms (not the generally recognised scratching, yelping, etc, but the more subtle signs that we missed at the time but now wonder if there was a connection). I wondered if it would be a useful exercise to list them, so that vets can become more aware of small pointers which, taken together, could suggest further investigation? Knowing what I know now about CM/SM, if I had a dog who was both restless and light phobic, I would take him to a neurologist pretty smartly! If more vets could say 'Well, given this collection of little things wrong, I think it might be worth checking out SM', we could be saving a lot of Cavaliers at the best some discomfort, and at the worst real but unrecognised pain.
What do people think?
Kate, Oliver and Aled
23rd February 2011, 10:53 PM
Great thread. Sorry my post is long ! You did ask :badgrin:
Molly has sm and did not show any of the typical symptoms, she became lame and was very quiet, now and again she would yelp! Molly had Luxating Patella (knee dislocation) assumed that was the cause of her pain! The Vet had never heard of sm, we took things further quickly after we saw Pedigree Dogs Exposed, then she was eventually diagnosed!
We also had Dougall (cm) Dougall did not show any signs of anything at all. He was a quiet dog, we assumed anyway. The only reason I scanned Dougall was because I could not bear the thought of not knowing. I would like to share with everyone the long road of problems (not typical) we had with our lovely boy. Dougall requires the same level of pain management as Molly:-
I want to post this to help people understand the poor dogs that are diagnosed with CM can experience as much pain or more than a dog who has been diagnosed with SM.
We had never owned a Dog before. It took us a year to finally make this big decision and commitment.
Molly and Dougall arrived into our lives as our cherished companions, we planned to devote our time and enjoy our two new members of our family with plans of trips away, perhaps try agility and generally have some fun with them.
Molly was diagnosed with sm in December 2008 after months of illness, the poor little girl was suffering terrible nerve pain, we were devastated at the thought of her suffering.
We couldn’t live with not knowing if Dougall was affected, we decided quickly to have him scanned.
Dougall did not show any extreme signs of pain. His back was very sensitive and it would spasm, he would chew his feet and he sat in a very strange position, it looked as though he was tucking his bottom underneath with all four paws in a row.
At the time, we thought he might have a skin allergy and his bad posture due to laziness as he also slept a lot. A quiet little dog we thought.
December 2008 – his scan revealed he had cm with moderate ventriculomegaly (Ventriculomegaly is a condition in which the ventricular system of the brain is enlarged. The ventricular system contains sac-like pockets called ventricles that are filled with cerebrospinal fluid (CSF).) - also known as dilated ventricles)
There is damage to his Dorsal Horn (In the spinal cord the pain impulses are processed by a “computer” this is called “The Dorsal Horn”) this damage has made is extremely difficult to manage Dougall on a day to day basis.
During the course of the following year, Dougall became worse, bad enough for him to lollop around and on occasions he would also cryif you picked him up. Dougall was prescribed zitac [Cimetidine - to reduce CSF pressure] and put on previcox [pain relief]. We also sought the help of a McTimmony Chiropractor (a more gentle approach than a traditional chiropractor). This lady worked with Dougall under the guidance of Dr. Rusbridge. I would not recommend this course of treatment without the strict guidance of your neurologist.
December 2009 - The scan revealed pretty much the same as 2008 except he developed psom (similar to glue ear in children – mucous fluid collects in the middle ear)
We continued with the medication and treatment for his back. If he was left more than three weeks or so, he would suffer acute pain in his back. We also tried acupuncture which unfortunately did not make any difference.
October 2010, We spent longer than normal on a beach; we kept a close eye on Molly who had to be carried most of the time. We didn’t take as much notice of Dougall as he was having a great time in and out of the water rescuing pebbles. As a consequence of this, he suffered acute pain in his back. We could not even pick him up without him yelping.
We took Dougall to see Dr. Rusbridge. It was agreed he was suffering and another scan was carried out, once again there was not any real change only that the psom had vanished from his left ear which is unusual.
After this episode we were very strict he saw the Mctimmoney lady once every 2/3 weeks, his medication has been changed to Gabapentin and Trocoxil [pain relief, dose given once monthly]. On the whole he seemed to be coping ok.
During the Christmas period, the snow and the Mctimmoney lady being away, he went five weeks without treatment. Last week poor Dougall was in a terrible state.....this is what she was said...
Thoraco Lumar area very raised and misaligned. Paraspinal muscles very tight, sensitivity in the shoulder, thoracic and lumbar spine and in addition it went into his Glutal and hind limbs.
Pelvis was misaligned which put extra strain on the lumbars and L/Sacral plexus which innervates the hind limb muscles is affected.
After a further appointment, Dougall is now more comfortable.
Molly and Dougall have changed our lives but not in the way we expected..They are rarely left alone, they are constantly monitored for signs of discomfort or worse, we take breaks separately, we live on a knife edge dreading the sounds of them suffering pain.
If we had not had the experience with Molly, we would not have realised, we would have assumed we had a dog with a bad back that was also lazy and worse...Dougall our lovely boy would be suffering..
So, thank you Kate for starting this thread.
24th February 2011, 12:18 AM
Dr. Marino said in the interview I did for the www.twolittlecavaliers.com sm awareness event that :
(Not fully quoted but) a recent study where greater than 50% were reported by owners "free of any clinical signs" upon further clinical evaluation 97% were actually found to have signs.
He said it tells us we need further education etc. but it is a shocking statement. I have to look back not sure if just cavaliers but it doesn't matter. The reality is education is key and I hate for a vet to say everything is fine, (unless very familiar which would probably still refer to neurologist. I too look back in hindsight at things I should have noticed.
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24th February 2011, 12:47 AM
I'm so sorry tania
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24th February 2011, 03:22 AM
Good post. Yes, Tania, I agree sometimes "just" CM produces more symptoms than SM. I am personally dealing with Jack's CM symptoms with medications. I also think many cavalier owners who don't know about this disease probably do not notice the "signs" and their dogs may suffer. I am now hypervigilent about symptoms, I will be walking and if I see a cavie scratching while sitting and waiting for a light to change I always wonder if its a sign ( I think I have gone to the other extreme). Some strange things that Jack did in excess which may or may not be related to his CM are: obsession with grass (more than any dog I ever have known and GI issues were ruled out) since a pup, excessive chewing on blankets, and a lot of eye staining. I really wonder about the eye staining. I notice even now that when he is having a bad day his eyes tear a lot more and even get red. He also gets a shooting back leg spasm thing which usually occurs when he is resting but not asleep ( i know that dogs dream and twitch at times). I think a lot of people may just look for the classic neck scratching and bunny hopping so it is good to bring up other possible symptoms.
Ok I think I am just rambling now but wanted to add my two cents worth:o
24th February 2011, 06:29 AM
GREAT thread! I have to agree that many owners many not "see" every little CM/SM symptom. Besides the air scratching, pawing at the head, head rubbing & paw licking Flash has some symptoms that are not usually listed:
Leg Twitch ~ Flash has a very obvious hind leg "twitch" that seems to annoy him occasionally when he is resting. He is awake and often puts his head on top of the leg to try and stop it. Medication has lessened the severity but before medication it would sometimes go on for hours. It was part of the reason he was so restless! It almost seems comparable to Restless Leg Syndrome in humans.
Light sensitivity ~ Flash still battles with this on some days. I remember posting it somewhere before. The camera Flash is a BIG issue but on some days any bright light is enough to cause it. He get's very "Squinty eyed" and just looks sad. His eyes also seem to tear a lot on these days.
Another odd symptom I have not seen listed anywhere before is nervousness.
On Flash's BAD days he get's very "spokey". He often barks at things that are not there and gets very afraid of things that have always been there. I am sure this is a symptom because medication nearly halted the problem in it's tracks. Now I only see short glimpses of it on his REALLY bad days. It is very obvious. He will suddenly FREAK out over a toy or the rug or a chair that has been there all day. He will jump away and just seem TERRIFIED. He will also bark at the walls or the floor and NOTHING will be there. He is very "focused" in this terror over specific "nothings". On his normal days he will hear a noise and run around barking looking for it. On his bad day's he is SURE it is that SPOT or THAT toy or THAT chair. Even after he has sniffed it and checked it out he is still TERRIFIED of it until the whole ordeal will suddenly pass as if it never happened. Sometimes it only lasts a couple minutes but before medication it would go on for HOURS.
24th February 2011, 12:02 PM
Thanks Tania for your post about Dougall. Oliver too seems to have problems from his CM rather than his small and narrow syrinx. He doesn't have PSOM but both his worst eye and his deaf ear are on his left side, so I do wonder if there is a connection - that is, whether the dilated ventricles that create pressure on his optic nerves and cause his light phobia are also in some way creating pressure on his inner ear and causing damage. We are lucky that so far his symptoms seem quite mild: lack of nerve reaction in his right front leg (which bothers him not at all), the light phobia which is manageable (he's only had one really bad episode, which led me to take it more seriously and be more careful), and some headaches which are more or less controlled with a mild dose of Gabapentin. If I hadn't had him scanned because like Tania I want to know what's happening (and there is a clear hereditary element), I don't think either I or my vet would have picked up any of these symptoms as related to CM or SM.
Oliver is also much more obviously uncomfortable when he lies with his chin on the floor (in the Cavalier Prayer Position!) - perhaps because this puts pressure on the front of the skull? If I gently roll him over onto his side, he immediately relaxes.
Kate, Oliver and Aled
24th February 2011, 11:41 PM
Looking back I realised that Minnie had been showing symptoms since she was about 18 months old, but they were so subtle that like many others we just thought it was normal for her.
Head Rubbing - she drops down and rubs her head as soon as I get her lead out to take her out for a walk.
Inability to jump onto furniture, walking strangely up stairs - about 3 episodes in an 18 month period. Vet said was muscle strain - probably caused from her doing agility.
Shaking herself when out walking and running round park - again nothing to worry us.
Head shy - when she was young she had some eye problems so had to have drops in for quite a while - thought this was because of this.
She never scratched or bunny hopped.
Squeal - on only a couple of occasions she squealed when fussed around the head.
However, Minnie has always been a very active dog, much more so than Cinders ever was. She will race around chasing birds/balls etc. and is like a little streak of lightning.
It was after a further bout of lameness a year ago that I decided to get her MRI'd with one of the sessions for the mini MRI's at Stone Lion as my Vet had more or less dismissed SM. This was for my own peace of mind. Was horrified when she was diagnosed with SM, a 7mm syrinx just off centre at C2, CM, AND PSOM!!
She is going to have a followup full MRI in April. After some tweaking with meds she is now fairly comfortable on Trocoxil, Pregabalin and Zitac (cimetidine).
Cinders my 11 year old has for the last year been showing some sensitivity on her left side, more recently this has spread to both sides near to her rear end and has got much worse. I really noticed it the last time the Groomer came as Cinders got very stressed and really didnt want to be trimmed. Vet thought is was spondylosis because of her age. She went in on Tuesday and had X-Rays & 3 teeth out as well! However, X-rays all clear - so we are now talking about treating her according to Clare Rusbridges protocol, and will discuss it further at her follow up appointment next week.
She is currently on Metacam and Tramadol. I don't feel I want to put her through an MRI at her age. It was stressful enough for her having the procedure done on Tuesday. My vet said her heart is doing really well, she has been on Vetmedin for 2 years now.
Its strange though - looking back over the last 11 years - Cinders has never been a dog that wants to be fussed - always a bit of a loner. This has been more so since she went deaf about 4 years ago. She will avoid other dogs wherever possible and will react if they come too close (she was attacked and bitten twice in her early years - so have always thought it was a reaction to that). Again she has had a few bouts of front leg/shoulder lameness - with no real reason for them. She has never liked her feet being wiped dry! Sometimes when she jumps up onto furniture or up the back door step her back legs don't always make it. So it maybe she has been suffering for some time as well and I have been so focused on Minnie that I feel really down about not picking up on Cinders problems sooner. :(
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