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View Full Version : MRI shows SM but no symptoms. hypothetical question regarding treatment



anniemac
27th May 2011, 05:34 PM
This question has been bothering me lately. Ella's neurologist is not a researcher or anyone well known, but he did speak a year ago to some people in Charlotte about CM/SM. He used a lot of Dr. Rusbridge's information but he said something that hit me more than numbers. He said (which is a number debated) it could be said around 50% of Cavaliers have SM. He looked around and said half of those here because many do not show symptoms which is why breeding.... I don't want to get into all that.

He said that the majority of the time he sees SM is from an MRI on a completely unrelated issue. The dog may not have symptoms but the MRI shows they have SM. When I interviewed Dr. Marino, I asked the question on what would you say to someone who has a dog that does not have symptoms but is diagnosed with SM. Of course he went into the surgery side. icon_whistlingbut I thought he would say something to not worry people. In breeding its one thing but as a pet owner, why would you want to know or have an MRI IF it was not for research and there were no symptoms?


A couple people mentioned having an MRI done and I wondered about it.
I feel surgery based on an MRI is way aggressive and even wonder about medication for asymptomatic cavaliers (long term effects etc)
Some may say go ahead with a CSF reducer but I don't know. I don't think I would want to know or maybe I would. I just want to know thoughts.

Blondiemonster
27th May 2011, 05:52 PM
If it wasnt for the post frontline issue last year i wouldve never known about her sm.. Id still not know... Would it have made a difference? I dont know.. Im still unconvinced thr gabapentin does anything. She is a sensitiven girl but a happy one. Id personally feel uncomffortable about surgery still as well as prednisone. I think neuros treat agressively.

Love my Cavaliers
27th May 2011, 07:01 PM
Oliver did have an MRI done, but not for SM symptoms. He had one done because he was symptompatic for disc issues and the MRI was the best way to determine the extent of his disc deterioration. So, in a way, I guess you could say that he had an MRI for symptoms, just not SM symptoms. Luckily, the MRI showed no SM and he was already 9 years old when he had the MRI.

Three of my dogs have had MRIs - Riley was obvious (SM Symptoms) Oliver as stated above, and Oz had one because I wasn't sure if he had EFS or SM (the MRI showed CM, no syryinx). Maddie shows no symptoms of SM at all so it would be hard to justify the cost. She had a collapsing episode about two weeks ago and I thought they might MRI her, but they think it might have more to do with her heart. They heard a slight click in her heart, but that's it - and it hasn't happened again.

Even knowing what I know now, I think I'd rather live in bliss until my dog showed symptoms (since I'm not going to breed). At least I know what to be on the lookout for now.

Kate H
27th May 2011, 08:47 PM
Oliver had his first MRI at the age of 6 because his father had produced a daughter from a different bitch with symptomatic SM, and his grandfather and great-grandfather had both had symptomatic SM, and I wanted to know what was happening - and yes, he has mild SM. At that time, nobody would have said that he had symptoms - but that doesn't mean that he didn't have symptoms, simply that no-one had picked them up. With hindsight, he had symptoms from the day I had him at a year old - he was mildly light phobic (which is now the main symptom of his CM) and he was a very restless sleeper, moving from bed to floor to armchair and back, so probably uncomfortable and possibly already having headaches.

There was a thread a few months ago reporting that a researcher had examined quite a large number of dogs with SM whose owners said they had no symptoms, and he found that 70% of the dogs actually had symptoms of SM (or CM). The problem is that SM symptoms cover a huge spectrum and can vary greatly from dog to dog. It takes an experienced vet to put a disparate collection of clues together and come up with the answer of SM. Oliver seems to have very few - if any - problems from his small syrinx; his headaches come from his dilated ventricles, which are caused by his CM.

When I say that Oliver gets headaches, most people's reaction is 'How on earth do you know a dog has got a headache?' - so they may well be missing the signs in their own dogs. I read an article recently by a woman with SM who had had decompression surgery, who said that one of her worst symptoms was tinnitus in her ears, as the level of fluid in her ventricles moved - she called it 'sloshing around' (I think we tend to look at an MRI and visualise dilated ventricles as absolutely full of fluid, but of course they can't be - the fluid is moving through the brain, even if far too slowly). I think Oliver may well have that - but we have no way of knowing. Three years ago I would have confidently said that Oliver was asymptomatic (and he still may be for SM, but not for CM) - now I wonder if there is any such thing, or whether we just can't know exactly what our dogs are experiencing

The basic Cavalier problem is Chiari Malformation and the uneven growth of skull and brain; both a syrinx and dilated ventricles are symptoms of that, each producing their own particular difficulties.

Kate, Oliver and Aled

anniemac
28th May 2011, 12:47 AM
I agree with what you said about oliver. The disc is what he said mostly is what people get MRIs for and find out SM also. Age definately is something to factor in.

Kate, I know what you are talking about with the eyes. I could tell a lot by ellas eyes. When she had surgery it was like the pain vanished from them. Even with CM and no SM if they are symptomatic (those that can recognize things) is different. I think that study about ones actually being symptomatic was from same interview. Symptoms can vary so much.

Thanks for your input.

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Margaret C
28th May 2011, 11:12 AM
He said that the majority of the time he sees SM is from an MRI on a completely unrelated issue. The dog may not have symptoms but the MRI shows they have SM. When I interviewed Dr. Marino, I asked the question on what would you say to someone who has a dog that does not have symptoms but is diagnosed with SM. Of course he went into the surgery side. icon_whistlingbut I thought he would say something to not worry people. In breeding its one thing but as a pet owner, why would you want to know or have an MRI IF it was not for research and there were no symptoms?


A couple people mentioned having an MRI done and I wondered about it.
I feel surgery based on an MRI is way aggressive and even wonder about medication for asymptomatic cavaliers (long term effects etc)
Some may say go ahead with a CSF reducer but I don't know. I don't think I would want to know or maybe I would. I just want to know thoughts.

I took Matthew and Tommy for scans when the first low cost breeders' schemes started in the UK. They had both been used at stud.

Tommy was a wimpy dog who very occasionally gave a yip for no reason but I really did not expect him to have a problem. I was convinced my sturdy Matthew was fine. ( It was only later that I realised that he had for years deftly avoided having the top of his head touched )

They both had a small syrinx in the same place.

My vet agreed I could give them a small dose of frusemide daily as a preventative. Who knows whether it helped or not?

For both of them symptoms came on slowly over the years, Matthew deteriorated more rapidly than Tommy and was PTS last year.

The scans were done in 2005, medication has controlled Tommy's symptoms fairly well for six years, although he is now on two gabapentin X 3 daily, metacam, & he still has the frusemide.

He is ten and a half but now appears older. He has a shambling gait, twisted neck, an inability to know where he places his weak quivering back legs so occasionally he falls sideways.

He always gets up wagging his tail & it breaks my heart.

He has started lying down suddenly with his head stretched between his paws, hard to explain but unmistakable when you see it. It is usually after his walk or excitement.
Matthew did it a lot, I think of it as the headache pose.

Despite all this I believe Tommy still has a reasonable quality of life. How do I know? Because what he does is paw continuously for attention if he was uncomfortable and at the moment my legs are not getting battered.

I have nobody to blame for Tommy's condition but myself. I bred him, but it was before I knew about SM or that his grandfather and father had it.

Tommy was from a half uncle to half niece mating , one of the classic breedings that was thought to double up on all the good genes that are in a breeding line. It seems so stupid now but none of us thought of the possibility that we may be doubling up on bad genes too.

I am not saying that all line bred puppies are bound to have inherited nasty genes, I am just saying that line breeding is the reason that inherited diseases become firmly established in breeds.

sins
28th May 2011, 12:18 PM
He has started lying down suddenly with his head stretched between his paws, hard to explain but unmistakable when you see it

Like this? Daisy has slept like this for quite a while now.

http://farm6.static.flickr.com/5134/5457942415_ce36e676e9_m.jpg (http://www.flickr.com/photos/39329774@N06/5457942415/)

I'm not at all convinced that going down the surgical route would make any appreciable difference to her quality if life (which is so so).Although she can go through some very normal phases.
It's such an invasive surgery with a lengthy recovery period and unless there is a sound reason for intervening, I feel medication is the route that best suits our particular circumstances.
It would at best perhaps buy her some time,but I'd rather let her go, than subject her to surgery when she's deteriorated so far in such a short time.
As for asymptomatic cavaliers being recommended to undergo surgery,I would think absolutely not!
Just because you can have surgery doesn't mean you should ? Especially when the surgical outcome is uncertain.
Sins

ByFloSin
28th May 2011, 01:14 PM
I agree with what you say Sins. As always you are talking a lot of sense. From what I have heard from friends whose Cavaliers have had the surgery, it is a truly awful operation with a protracted recovery period which seldom produces sustainable improvement.

Getting back to the discussion's roots, I had Rebel's scan done in 2009 to benefit research on clear over six Cavaliers. I paid the going rate for this. It turned out that he has SM, CM and curvature of the spine. Fortunately I kept the pictures because he recently became symptomatic for SM, his pictures providing valuable to my vet who knows nothing about the disease.

Somebody mentioned radical (I think that's the word) treatment being carried out by neurologists. When Rebel got sick I contacted Chester Gates for advice, but was told none could be given without him being seen there. This was not practical as I have no transport. I could access the area by train, but when I enquired about a taxi from the railway station I was told that none of the regular operators will carry dogs. End of.

I printed out Clare Rusbridge's treatment matrix for my vet, which she found invaluable, as Clare would not be able to advise because Rebel was diagnosed at Chester Gates.

The young lady vet is proving a winner in my eyes, being open and honest about the skills she has and those she has yet to acquire. Step 1 applicable to Rebel on the matrix was Frusemide, which has worked beautifully on low doseage. He even has some of his hearing back and the compulsive licking is only present on one of his few bad days.

Little Joe was first MRId because of epilepsy. The neurologist wanted to make sure there had been no congenital or traumatic brain injury causing the fits, which there was not - the bonus finding was that there were no signs of SM or CM, but of course he was only a puppy.

A couple of months ago I wanted to plan for the future, so paid the full cost of scans for Little Joe and Winston Alexander at Woodlands, which were sent on to Clare Rusbridge for interpretation. Both came back A's which means I do not need to make financial provision for costly SM treatment in the future. They are aged 5 and almost 4, so it is thought unlikely for anything to develop, particularly knowing that the Celxo lines they are bred from are clear and long lived. Of course, the information is useful to their breeder and she was delighted to hear my news.

mommytoClaire
28th May 2011, 05:00 PM
With the responses, does it not seem that many of our Cavs have symptoms, yet ever so slight that we ignore or miss them entirely? It's hard with the history of this breed not to read into every little scratch, or head rub.

When it finally gets noticed as something amiss, is it to a point where Meds would have helped earlier, since it's progressive in nature?

anniemac
28th May 2011, 07:30 PM
With the responses, does it not seem that many of our Cavs have symptoms, yet ever so slight that we ignore or miss them entirely? It's hard with the history of this breed not to read into every little scratch, or head rub.

When it finally gets noticed as something amiss, is it to a point where Meds would have helped earlier, since it's progressive in nature?

I'm sure since you are on the forum you are well aware of the symptoms. It doesn't hurt to learn about all health conditions not just SM. I would hate for people miss the experience of owning a cavalier for fear of developing SM. Sins said once that she made a
pact to not enjoy her puppy and what will be will.

I don't think there currently is a medication to help with progression. I did hear research is being done. Someone correct me. In terms of noticing earlier, I feel in terms of pain management and surgery is said more successful earlier. If no obvious symptoms, then enjoy. My feelings on it.

Flo, I think what you said about knowing from MRI and once symptoms developed being able to treat it is sort of how I feel. However, I would rather not know until symptoms develop then treat. Just my thoughts.

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Pat
28th May 2011, 08:32 PM
I thought about this very question long and hard before Tucker had his MRI, and I decided beforehand what I would do if he was diagnosed with SM.

I've known about SM for a very long time - since early 90's - and I think I know a good deal about symtoms. Tucker never had any of the obvious symptoms - sleeps like a rock at night and never moves (right next to me in bed), no light sensitivity or "look in the eyes" or anything obvious. I will say that there are some VERY subtle things that I could attribute to potential SM - occasional yelp or scratch - but those could be other things also such as disk disease esp. at his age.

His neurological exam was normal. His MRI showed CM, not too bad, and slight central canal dilation but no SM. His date of birth is 10/10/2002.

I had decided that if he had SM, I would start a trial course of lyrica - probably go straight for lyrica and skip gabapentin because of the 12 hour versus 8 hour dosage despite the cost difference. Then I would observe for a couple of months to see if there were changes in his demeanor or activity level. Tucker is a gentle, quiet dog with a very soft temperament so I'd watch to see if his activity level changed, etc. For the record, I think that a gentle, quiet demeanor could simply be his temperament and I'm not saying this is always a sign of SM! I might have also added a drug such as Prilosec, but I know that I would not use furosemide. I know that many use this drug, but it is not my personal choice because of what I know (through experience and years of observation on heart and kidney lists) about what the drug can do to kidney function. I personally don't agree with the monitoring recommendations for the drug on the SM protocols where it seems to be considered a benign drug, but that's just my opinion.

If Tucker were to ever develop SM symptoms in the future, I would start a trial of lyrica as above and probably get a second MRI since insurance would help pay for it.

My current second Cavalier (remember that I've had 12) is a spitfire whirlwind of activity with no SM symptoms. She is between 2 and 4. One day I will get an MRI for her, but I'd like to wait until she is older or until I see some symptoms. I would follow the same course as I planned for Tucker.

Pat

Karlin
29th May 2011, 03:08 PM
My own thoughts -- I think the only way to define 'no symptoms' really, is if a neurologist has confirmed *no clinical symptoms*. Sometimes people who will have read in great detail on symptoms simply do not see the signs in their own dogs, doing many of these same things, as 'symptoms', even if they see the in other people's dogs. The mind often does not want to accept what the eyes see; human nature not to want a problem to be one's own problem. But also many symptoms that are clear to a specialist are not seen by pet owners much less vets. So even a vet saying 'no symptoms for SM' just cannot be taken as a confirmation of no clinical symtpoms.

O surgery and results: I am aware of many people who have had excellent results from surgery; many more with good/acceptable results, and a few cases where things disimproved within months or a year or two. This pretty much fits the profile that neurologists themselves report -- it's a bit of a bell curve. The recovery generally isn't and shouldn't be long and arduous for most dogs. Some of the worst/longest recoveries I have heard of from owners have been with the titanium mesh surgery, but it is always hard to make any analysis based on what you see online for results, as often you only ever hear from the people who have problems. The largest problem seems to be that most dogs are quickly (eg within a week) wanting to play and run as usual and the difficulty is controlling their activity. Many people I know feel they let their dogs do way too much way too soon and this sometimes produced setbacks.

I would def. not do surgery as a matter of course but for many dogs it is likely the only chance of anything but a very short term prognosis. These include early onset, highly symptomatic cases, or dogs showing some symptoms but having a really poor MRI result. The younger the dog is with symptoms, especially pain rather than some basic scratching, the more likely I would opt for surgery asap after diagnosis.

I would never opt for or advise surgery on an asymptomatic dog or one with very mild symptoms. That said, I repeatedly see people talk about their dog with 'mild' symptoms when what they describe are moderate to serious/severe symptoms.

If I had a dog MRI with a syrinx but no symptoms I would immediately start them on a CSF reducer as there are cases where they are definitely know to have inhibited/halted the development of pre-syrinxes and possibly syrinxes. There's now good evidence that these meds reduce CSF flow which is considered the cause of the development of syrinxes so decreasing CSF flow has got to be a good preventative step and these meds generally have very low levels of sie effects -- plus there's a variety of different types so if one isn;t working well another probably will be helpful/not have side effects.

There are cases incidentally where neurologists have advised against surgery for all sorts of reasons, including SM being too far advanced, age of dog, and other complications. So it isn't always an option.