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goda
14th June 2011, 03:29 AM
Luka's Gabapentin has been increased to 4 times a day and he gets codeine 3 times a day. He also has Rimadyl which is supposed to be delicious but he won't eat it unless it is in a pill pocket. He gets that twice a day, air scratching is minimal.

We will be trying acupuncture next. Over all Luka is looking better. He has a healthy heart and is over all doing much better. SM is not the end all, I think as owner's most of us that get the diagnosis with the first dog, panic.

Dr. Kline said that this is no different than living with a disability. She seems very pro medication, and not so keen on surgery because of the extensive damage to his spinal cord already. If there is a sign of progression she is for surgery but seems to be more oriented with treatment.

Thanks for all your support and input.

meljoy
14th June 2011, 10:52 AM
Glad to hear Luka is feeling better. I hope he continues to improve with all the medication and of course love:thmbsup:

BrooklynMom
14th June 2011, 11:11 AM
Big hugs for Luka. He is lucky to have such a wonderful loving mom as you.:hug:

Kate H
14th June 2011, 11:21 AM
The general experience seems to be that getting the medication - both variety and dosage - right is a matter of trial and error for a few weeks or months, so let's hope you've now found the right mix to keep Luka comfortable.

Kate, Oliver and Aled

gamefanz
14th June 2011, 01:34 PM
I am so glad that Luka is getting the meds to help him and that surgery can be put off for awhile. Its great news! Hearing what you said helps me as a new puppy owner that this will not be a death sentence, that there are things that can be done to give your dog a good life. :hug: Becky

Karlin
14th June 2011, 04:06 PM
I am glad that the mix of meds is working -- great news, and that gives you time to consider options as things go along. :thmbsup:

I cannot agree with Dr Kline however agree that dealing with SM is like dealing with a disability. Most define a disability as an impairment to normal activity. While this may be an accurate description for a subset of cavaliers with symptomatic SM, it is still almost always progressive and for significantly symptomatic dogs (and many will eventually progress to that point) it often eventually requires euthenisation regardless of whether one opts for surgery or meds (see Clare Rusbridge's report on this). I am not sure many on the medical side would use 'disability' to accurately sum up what sufferers of SM, whether humans or our dogs, live with. To me, and I have three dogs with condition and have worked with/spoken to several of the key researchers and to others with affected dogs for going on 8 years now) that's like describing cancer or any other life threatening, often progressive condition as a disability. For the same reasons, I could not describe MVD as a disability and I think it would be hard to find a cardiologist who would consider it a disability as opposed to a potentially life-threatening and often extremely debilitating serious illness.

Most of us with affected dogs do not live with the certainty of management options we might have with a dog with a disability. I have had animal with disabilities, such as an amputated leg, deafness, etc. My only uncerainty with those conditions was making sure the animals did not get outside off lead, Or a mild concern about some increased prospect of arthritis. With SM cavaliers, you live with a day and day out concern that today may be the day a screaming fit happens, that meds cease to help, that you need to make a rushed decision on surgery or euthenisation. You have to weigh up every day how much pain the dog is living with, despite what the medications mask and the small comfort that they bring. Plenty of humans with the conditions say drugs do very little to help with the severe headaches or the disturbing skin crawling sensations, that we may only see in our own dogs manifested by occasional scratching–and no dog can tell you whether it has an unbearable headache (those who the face rubbing signs may sometimes indicate some degree of that). Human neurologists have very few tools to help people live comfortably with this condition, and as with the dogs, surgery often has to be repeated. If we choose not to have surgery for our dogs, we live every day with the concern that this has been the wrong decision. If we do the surgery, we live every day with the worry that this has been the wrong decision. Whatever the choice, you fear that it will eventually result in a dog needing to be euthanized earlier than what would have been the case if you hadn't intervened in the way that you did. :( of course, you do put it to the very back of your mind, but I have lived with this with one dog for over six years, and that worry is always there and increases over time rather than recedes. Any additional MRI almost always shows that a syrinx has grown.

I just cannot see how anybody could describe SM as a disability. :confused: Perhaps it is just a matter of semantics amongst neurologists, but using the word “disability” implies a fairly static, understood condition with some ease of management and care options that most evidence would suggest simply is not the case, especially for dogs with significant syrinxes and early onset symptoms. I guess the main concern for me is that as a term it gives a false sense of security that even those with dogs with few symptoms or a small syrinx just do not have, because you're always living with the prospect of progression–which can often be sudden and swift.

I am curious to know if others with affected dogs see it as a disability?

Charlifarley
14th June 2011, 05:06 PM
Most define a disability as an impairment to normal activity.



To be honest, I have never thought of Bosco's SM in terms of disability.
If I'm explaining to someone what he has, I call SM a 'condition', and in my own mind, whenever I see symptoms such as air scratching, or when he gets into a state rubbing his little face on the floor I always think of him having an 'affliction' - def: somthing that causes pain or suffering.:(

I'm glad to read that Luka is more comfortable now, good luck with his accupuncture.

Nicki
14th June 2011, 05:14 PM
I am quite shocked to hear SM described as a disability :( - I would not view it as such other than as a specific part of the condition if they are demonstrating lameness and neurological defects but these can be changeable too - and obviously they can become unable to access furniture or stairs and steps.

As someone who lives with a disability, and also has a very painful facial nerve pain condition, I am perhaps well placed to know the difference and how I feel about the two separate conditions. I totally agree with Karlin, she has written far more eloquently that I would have managed and expresses how I feel. Like Karlin, I have also owned dogs with disabilities and also multiple dogs with Syringomyelia, which does feel like a timebomb - it is an emotional rollercoaster and you are constantly watching for changes.

With disabilities it is difficult at first whilst you make changes to your environment, lifestyle and management [safety being the primary concern], but once these are in place there is little change and not the same emotional burden [nor generally the financial one]


Perhaps you would be kind enough to go back to Dr Kline with our comments - I really do not feel that this is something that should be being said to guardians of dogs with SM.


Management - often a cocktail of drugs is far more effective for management. I personally would be reluctant to give Rimadyl long term there are other safe options available, I'm sure you've seen the treatment chart on Clare Rusbridge's website.

Gabapentin tends to only be effective for 6-8 hours so four times daily can be helpful. Teddy was on 900mg daily which is the maximum [and extremely high] dose.


If you go for Acupuncture make sure it is someone knowledgeable about the condition as otherwise this could cause further problems.



We hope that Luka will continue to do well for a long time yet, it's wonderful that you have been able to get him the treatment he so obviously needed.

goda
14th June 2011, 08:40 PM
I am glad that the mix of meds is working -- great news, and that gives you time to consider options as things go along. :thmbsup:

I cannot agree with Dr Kline however agree that dealing with SM is like dealing with a disability. Most define a disability as an impairment to normal activity. While this may be an accurate description for a subset of cavaliers with symptomatic SM, it is still almost always progressive and for significantly symptomatic dogs (and many will eventually progress to that point) it often eventually requires euthenisation regardless of whether one opts for surgery or meds (see Clare Rusbridge's report on this). I am not sure many on the medical side would use 'disability' to accurately sum up what sufferers of SM, whether humans or our dogs, live with. To me, and I have three dogs with condition and have worked with/spoken to several of the key researchers and to others with affected dogs for going on 8 years now) that's like describing cancer or any other life threatening, often progressive condition as a disability. For the same reasons, I could not describe MVD as a disability and I think it would be hard to find a cardiologist who would consider it a disability as opposed to a potentially life-threatening and often extremely debilitating serious illness.

Most of us with affected dogs do not live with the certainty of management options we might have with a dog with a disability. I have had animal with disabilities, such as an amputated leg, deafness, etc. My only uncerainty with those conditions was making sure the animals did not get outside off lead, Or a mild concern about some increased prospect of arthritis. With SM cavaliers, you live with a day and day out concern that today may be the day a screaming fit happens, that meds cease to help, that you need to make a rushed decision on surgery or euthenisation. You have to weigh up every day how much pain the dog is living with, despite what the medications mask and the small comfort that they bring. Plenty of humans with the conditions say drugs do very little to help with the severe headaches or the disturbing skin crawling sensations, that we may only see in our own dogs manifested by occasional scratching–and no dog can tell you whether it has an unbearable headache (those who the face rubbing signs may sometimes indicate some degree of that). Human neurologists have very few tools to help people live comfortably with this condition, and as with the dogs, surgery often has to be repeated. If we choose not to have surgery for our dogs, we live every day with the concern that this has been the wrong decision. If we do the surgery, we live every day with the worry that this has been the wrong decision. Whatever the choice, you fear that it will eventually result in a dog needing to be euthanized earlier than what would have been the case if you hadn't intervened in the way that you did. :( of course, you do put it to the very back of your mind, but I have lived with this with one dog for over six years, and that worry is always there and increases over time rather than recedes. Any additional MRI almost always shows that a syrinx has grown.

I just cannot see how anybody could describe SM as a disability. :confused: Perhaps it is just a matter of semantics amongst neurologists, but using the word “disability” implies a fairly static, understood condition with some ease of management and care options that most evidence would suggest simply is not the case, especially for dogs with significant syrinxes and early onset symptoms. I guess the main concern for me is that as a term it gives a false sense of security that even those with dogs with few symptoms or a small syrinx just do not have, because you're always living with the prospect of progression–which can often be sudden and swift.

I am curious to know if others with affected dogs see it as a disability?

I think you are getting caught up with semantics, I think she meant to say it as a comfort that while his illness is going to end his life prematurely at some point in the future, the care management aspect is no different than someone who needs accommodations.

It didn't offend me, as someone who was in her office crying hysterically before, I think she was just trying to say that there are several options before surgery. She is very for Rusbridge's approach in treatment and mentioned I should research her writing on SM, which I have.

When you have a disability you always live with the prospect of progression.

goda
14th June 2011, 08:49 PM
I am quite shocked to hear SM described as a disability :( - I would not view it as such other than as a specific part of the condition if they are demonstrating lameness and neurological defects but these can be changeable too - and obviously they can become unable to access furniture or stairs and steps.

As someone who lives with a disability, and also has a very painful facial nerve pain condition, I am perhaps well placed to know the difference and how I feel about the two separate conditions. I totally agree with Karlin, she has written far more eloquently that I would have managed and expresses how I feel. Like Karlin, I have also owned dogs with disabilities and also multiple dogs with Syringomyelia, which does feel like a timebomb - it is an emotional rollercoaster and you are constantly watching for changes.

With disabilities it is difficult at first whilst you make changes to your environment, lifestyle and management [safety being the primary concern], but once these are in place there is little change and not the same emotional burden [nor generally the financial one]


Perhaps you would be kind enough to go back to Dr Kline with our comments - I really do not feel that this is something that should be being said to guardians of dogs with SM.


Management - often a cocktail of drugs is far more effective for management. I personally would be reluctant to give Rimadyl long term there are other safe options available, I'm sure you've seen the treatment chart on Clare Rusbridge's website.

Gabapentin tends to only be effective for 6-8 hours so four times daily can be helpful. Teddy was on 900mg daily which is the maximum [and extremely high] dose.


If you go for Acupuncture make sure it is someone knowledgeable about the condition as otherwise this could cause further problems.



We hope that Luka will continue to do well for a long time yet, it's wonderful that you have been able to get him the treatment he so obviously needed.

I really don't think she meant disability is a negative connotation. I didn't take offense to it, in a way it made me feel better to know this illness can be managed.

I didn't know a chart existed I am at the tail end of school and catching up.

He's been diagnosed for less than a month now. Obviously, I have a lot to learn still.

I don't know much about Rimadyl other than it is an anti inflammatory.

Nicki
14th June 2011, 09:37 PM
I think it would help you to see Clare's website http://www.veterinary-neurologist.co.uk/

At the top there is a tab called Syringomyelia, the bottom tab is downloadable PDFs - you want the treatment algorithm one.

Karlin
14th June 2011, 11:02 PM
in a way it made me feel better to know this illness can be managed.

But this is the point (not that the word disability has any negative context): many of us find SM really isn't usually an illness that can be managed very well at all once you start to get any significant level of symptoms, and whatever the level to start with, you live in constant, justifiable worry that it will progress to the point where it isn't manageable. That is exactly what I mean about the word being misleading. Progression is unfortunately the norm for SM, and managing with meds requires increased dosages in almost every case I know plus regular revision of the cocktail of drugs, meaning lots of trial and error and neurologist visits. On Luka's meds right now: many neurologists would also have a dog on some kind of CSF reducer -- it is one of the only drugs that actually is known to be able to slow (and in very early cases of small pre-syrinxes, even to halt) progression. You will see it is one of the first things listed on Clare's treatment algorithm.

You might consider a second opinion. Each neurologist has their own approach, but the level of damage to Luka's spine already indicates the disease has progressed very rapidly.

It isn't that there is anything wrong about opting for medications, but in such a context I find it especially hard t see how medications could be described to be managing a disability; the risk is that with continued progression they would only be able to provide palliative care and a closing window may exist in which surgery can do anything, if it was to be considered an option. Acupuncture does sometimes help to manage pain but again will not halt progression and as Nicki says, it is adviseable to find an acupuncturist familiar with SM.

There are indeed dogs with SM that can be managed on medications alone for a normal or close to normal lifetime; but these tend to be dogs with small narrow centrally positioned syrinxes with few symptoms.

Pat
14th June 2011, 11:03 PM
Luka's Gabapentin has been increased to 4 times a day and he gets codeine 3 times a day.

I'm curious because I don't think I've heard of anyone using codeine for SM. Is it uncommon to use this drug for SM? When my mom was in my home at the end of her life and we were working with Hospice, I remember that the drug was pretty strictly controlled though we did use it.

Pat

Karlin
14th June 2011, 11:13 PM
From Clare's website; maybe these will help?:


So if a syrinx is detected either by screening or because of investigation of another disease do I need to be concerned?
Syrinxes can progressively expand and a dog which is asymptomatic in early life may eventually become painful. However a narrow symmetrical (less than 3 millimetres wide) syrinx or central canal dilation is unlikely to develop a pain syndrome. Some owners opt for intermittent neurological examination or even repeat MRI to assess for progression. The real significance of asymptomatic dogs is that their offspring appear to have a higher chance of being affected and more chance of being symptomatic. For this reason breeders are advised to MRI screen (http://www.veterinary-neurologist.co.uk/trck/pepper/orderedlist/downloads/download.php?file=http%3A//www.veterinary-neurologist.co.uk/syringomyelia/docs/sm%2520mri%2520screening.pdf) their breeding animals.


Pain is positively correlated with syrinx width and symmetry i.e. dogs with a wider asymmetrical syrinx are more likely to experience discomfort, and dogs with a narrow syrinx may be asymptomatic, especially if the syrinx is symmetrical. Dogs with a wide syrinx may also scratch, typically on one side only, while the dog is walking and often without making skin contact. Such behaviour is often referred to as an “air guitar” or “phantom” scratching. Dogs with a wide syrinx are also more likely to havescoliosis (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.


What drugs are used to treat syringomyelia?
Medical management of syringomyelia is based on anecdotal reports as there has only been one clinical trial assessing the effectiveness of a novel neurogenic painkiller and results from this trial are still being analysed.
Typically the first drugs used for treatment of CM/SM are (unlicensed) drugs that reduce CSF pressure e.g. furosemide, cimetidine or omeprazole. The principle of this therapy is that reducing CSF pressure reduces the driving force contributing to the syringomyelia. Some owners report a reduction in signs of apparent pain.
If the pet is in pain then a non steroidal anti-inflammatory drug (NSAID) is often prescribed e.g. firocoxib, carprofen or meloxicam. This may be in addition to one of the drugs above.
For dogs with signs of neuropathic pain (e.g. severe pain; increased sensitivity to normally non painful sensation such as touch; and scratching behaviour) an (unlicensed) neurogenic painkiller is more likely to be effective for example gabapentin orpregabalin.
Corticosteroids are an option if pain persists or where available finances prohibit the use of other drugs however as these drugs can have more long term side effects the author prefers to avoid them if possible.


Are there any alternative therapy options?
Anecdotally, acupuncture and ultrasonic treatments have been reported to be useful adjunctive therapy in some cases. In some cases chartered physiotherapists (http://www.animalphysiotherapist.co.uk/index.html)are able to help alleviate signs. www.acpat.org (http://www.acpat.org/), acpat@calra.net . Care should be taken however as the response to these treatments is very individual and some dogs may actually be more painful afterwards. Spinal manipulation is contraindicated.


What is the prognosis for my dog?
Unlike mitral valve disease, CM/SM is rarely fatal however this does not diminish the importance of this painful disease and a significant number of dogs are eventually euthanatized as a consequence of uncontrolled pain. This is more likely in dogs with a wide syrinx and/or with first clinical signs before 4 years of age. Study of a small case series (14 Cavaliers) managed conservatively (eg with medications) for neuropathic pain suggested that 36% were eventually euthanatized as a consequence of uncontrolled pain. However 43% of the group survived to be greater than 9 years of age (average life expectancy for a Cavalier is 10.7 years). Most dogs retain the ability to walk although some may be significantly tetraparetic and ataxic.

Blondiemonster
15th June 2011, 12:40 AM
I'm curious because I don't think I've heard of anyone using codeine for SM. Is it uncommon to use this drug for SM? When my mom was in my home at the end of her life and we were working with Hospice, I remember that the drug was pretty strictly controlled though we did use it.

Pat

Here in the states they put codeine in over the counter cough syrup. In people they give codeine easier than vicadin and percocet. Tylenol 2, is codeine and acetaminophen and usually drug of choice for dentist patients. So it's controlled but not as controlled as class 2 narcotic such as percocet. (oxycodone) It's just an all around pain med, and I don't think it's ever given long term??? (meaning several years) as I think tolerance builds up fast!!

Pat
15th June 2011, 03:10 AM
Um...Atlanta, GA is in the states! But you know what, I was actually thinking of morphine when I wrote that post rather than codeine - morphine is what was so controlled when used for end of life palliative care, and that is the drug that was given to my mother. I did read up on both codeine and morphine in Plumb's Veterinary Drug Handbook.

But again - I don't think I've ever seen codeine or morphine listed as drugs used for SM - and I'm curious whether anyone else has had their neurologists prescribe these opiates. I've seen gabapentin and pregabalin used of course, a whole host of NSAIDS, steroids and Tramadol - and I think that's it. Have others used codeine or morphine for SM pain?

Pat

anniemac
15th June 2011, 03:17 AM
Um...Atlanta, GA is in the states! But you know what, I was actually thinking of morphine when I wrote that post rather than codeine - morphine is what was so controlled when used for end of life palliative care, and that is the drug that was given to my mother. I did read up on both codeine and morphine in Plumb's Veterinary Drug Handbook.

But again - I don't think I've ever seen codeine or morphine listed as drugs used for SM - and I'm curious whether anyone else has had their neurologists prescribe these opiates. I've seen gabapentin and pregabalin used of course, a whole host of NSAIDS, steroids and Tramadol - and I think that's it. Have others used codeine or morphine for SM pain?

Pat

Pat, I was thinking the same thing when I read codeine. Actually tramadol is controlled but that's not my question because I've never heard of codeine being prescribed.

Ella took tramadol everyday, which some say is only prescribed after surgery. I asked her neurologist and vet about long term on tramadol because of some concern, but I wonder if codeine is newly being prescribed?

Sent from my Droid using Tapatalk

anniemac
15th June 2011, 03:59 AM
I'm having trouble with the forum and posting long responses. Just wanted to say Karlin explained how exactly I felt and most others. Its a roller coaster and I'm getting tears thinking of it. Its so new to you and like Karlin said, there are always changes, questions about are you doing the right thing.

Just to hear disability concerned me. Karlin said it best. Also what are your expectations with acupuncture? Are you thinking instead of surgery?

Sent from my Droid using Tapatalk

goda
15th June 2011, 04:47 PM
I'm curious because I don't think I've heard of anyone using codeine for SM. Is it uncommon to use this drug for SM? When my mom was in my home at the end of her life and we were working with Hospice, I remember that the drug was pretty strictly controlled though we did use it.

Pat

It's a painkiller and FDA controlled.

goda
15th June 2011, 04:51 PM
Here in the states they put codeine in over the counter cough syrup. In people they give codeine easier than vicadin and percocet. Tylenol 2, is codeine and acetaminophen and usually drug of choice for dentist patients. So it's controlled but not as controlled as class 2 narcotic such as percocet. (oxycodone) It's just an all around pain med, and I don't think it's ever given long term??? (meaning several years) as I think tolerance builds up fast!!

I think you are mistaken, codeine in cough syrup is not over the counter in the United States. Every form of codeine is subject to FDA regulations.

goda
15th June 2011, 04:52 PM
I'm having trouble with the forum and posting long responses. Just wanted to say Karlin explained how exactly I felt and most others. Its a roller coaster and I'm getting tears thinking of it. Its so new to you and like Karlin said, there are always changes, questions about are you doing the right thing.

Just to hear disability concerned me. Karlin said it best. Also what are your expectations with acupuncture? Are you thinking instead of surgery?

Sent from my Droid using Tapatalk

We haven't decided against surgery, we decided it wasn't an option *right now*.

goda
15th June 2011, 04:57 PM
But this is the point (not that the word disability has any negative context): many of us find SM really isn't usually an illness that can be managed very well at all once you start to get any significant level of symptoms, and whatever the level to start with, you live in constant, justifiable worry that it will progress to the point where it isn't manageable. That is exactly what I mean about the word being misleading. Progression is unfortunately the norm for SM, and managing with meds requires increased dosages in almost every case I know plus regular revision of the cocktail of drugs, meaning lots of trial and error and neurologist visits. On Luka's meds right now: many neurologists would also have a dog on some kind of CSF reducer -- it is one of the only drugs that actually is known to be able to slow (and in very early cases of small pre-syrinxes, even to halt) progression. You will see it is one of the first things listed on Clare's treatment algorithm.

You might consider a second opinion. Each neurologist has their own approach, but the level of damage to Luka's spine already indicates the disease has progressed very rapidly.

It isn't that there is anything wrong about opting for medications, but in such a context I find it especially hard t see how medications could be described to be managing a disability; the risk is that with continued progression they would only be able to provide palliative care and a closing window may exist in which surgery can do anything, if it was to be considered an option. Acupuncture does sometimes help to manage pain but again will not halt progression and as Nicki says, it is adviseable to find an acupuncturist familiar with SM.

There are indeed dogs with SM that can be managed on medications alone for a normal or close to normal lifetime; but these tend to be dogs with small narrow centrally positioned syrinxes with few symptoms.

I asked her about the the CSF reducing med and she hesitated because it has barely been a month since he was diagnosed. I am pretty sure she wants to see how he can handle the regiment he is on now.

Nicki
15th June 2011, 05:09 PM
The majority of neurologists recommend they are put on to a CSF reducing drug immediately as this reduces the pressure as Karlin says above.

Often there is a huge improvement in the dog just from using a CSF reducing drug - Clare Rusbridge recommends Cimetidine [Zitec] as being very gentle on their systems but also effective. There are dogs on the forum who were given a very poor prognosis who are doing well several years later, mainly it is believed due to these drugs.

I would certainly want my dog put on this, it is not going to do any harm. The other medications are for pain relief.

I've not heard of codeine being prescribed before either - have been dealing with Syrinogmyelia for over 12 years and have done a considerable amount of research into the condition and treatment. Does Dr Kline have much experience with the condition? It just seems strange that she is recommending a treatment program so diverse from other neurologists.

goda
15th June 2011, 05:19 PM
The majority of neurologists recommend they are put on to a CSF reducing drug immediately as this reduces the pressure as Karlin says above.

Often there is a huge improvement in the dog just from using a CSF reducing drug - Clare Rusbridge recommends Cimetidine [Zitec] as being very gentle on their systems but also effective. There are dogs on the forum who were given a very poor prognosis who are doing well several years later, mainly it is believed due to these drugs.

I would certainly want my dog put on this, it is not going to do any harm. The other medications are for pain relief.

I've not heard of codeine being prescribed before either - have been dealing with Syrinogmyelia for over 12 years and have done a considerable amount of research into the condition and treatment. Does Dr Kline have much experience with the condition? It just seems strange that she is recommending a treatment program so diverse from other neurologists.

Well we have another appointment next week. I have never heard of Zitec (Do you mean zyrtec?) ..? I've heard or prilosec reducing CSF. Cimetidine is an antihistamine, which from what I have been told. You know I don't know so I need to talk to her again, if a lot of dogs in this forum have had positive results I think it's something to look at.

Pat
15th June 2011, 05:21 PM
OK - still looking for the answer to my question, which is:

Has anyone else ever heard of a neurologist prescribing codeine or morphine or other opiates for SM pain? I'm not asking what codeine is. I've checked all my various veterinary textbooks and speakers' notes from AVMA, etc., but this is the first mention I've heard of any vet using this drug for SM pain. Is this a new protocol?

Again, when I first posted I wrote "codeine" but I was really thinking "morphine" - although both are opiates. I do know many vets that prescribe hydrocodone for coughing related to heart disease, collapsing trachea, and/or COPD:

http://www.veterinarypartner.com/Content.plx?P=A&C=31&A=519&S=0

But from what I've read, codeine is a pretty weak analgesic. I also googled to see about interactions between codeine, gabapentin and an NSAID - I'd want to get a good handle on understanding that if I were giving all three drugs.

Anne - regarding Tramadol - I've used this long term for several geriatric dogs - daily for many, many months for pain control - for several reasons such as severe osteoarthritis and in dogs with cancer where quality of life was my paramount concern. My understanding from my vet internist is that it is a safe drug to use long term. It may be habit-forming but that was not a concern in the cases where I used it.

Pat

Blondiemonster
15th June 2011, 05:30 PM
Well we have another appointment next week. I have never heard of Zitec (Do you mean zyrtec?) ..? I've heard or prilosec reducing CSF. Cimetidine is an antihistamine, which from what I have been told. You know I don't know so I need to talk to her again, if a lot of dogs in this forum have had positive results I think it's something to look at.

Cimetidine is a drug to treat ulcers in humans. Its like prilosec.

Pat
15th June 2011, 05:41 PM
Cimetidine: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000628/

Zyrtec - Generic Name: cetirizine - this is a different drug and is an antihistamine, but this is not used for SM.

Niki - did you mean Zantac - that is a brand name for another drug used for GERD:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000094/

Or perhaps Zitec is a UK brand name; I can't find it when I google for brand names of cimetidine.

Pat

goda
15th June 2011, 05:45 PM
OK - still looking for the answer to my question, which is:

Has anyone else ever heard of a neurologist prescribing codeine or morphine or other opiates for SM pain? I'm not asking what codeine is. I've checked all my various veterinary textbooks and speakers' notes from AVMA, etc., but this is the first mention I've heard of any vet using this drug for SM pain. Is this a new protocol?

Again, when I first posted I wrote "codeine" but I was really thinking "morphine" - although both are opiates. I do know many vets that prescribe hydrocodone for coughing related to heart disease, collapsing trachea, and/or COPD:

http://www.veterinarypartner.com/Content.plx?P=A&C=31&A=519&S=0

But from what I've read, codeine is a pretty weak analgesic. I also googled to see about interactions between codeine, gabapentin and an NSAID - I'd want to get a good handle on understanding that if I were giving all three drugs.

Anne - regarding Tramadol - I've used this long term for several geriatric dogs - daily for many, many months for pain control - for several reasons such as severe osteoarthritis and in dogs with cancer where quality of life was my paramount concern. My understanding from my vet internist is that it is a safe drug to use long term. It may be habit-forming but that was not a concern in the cases where I used it.

Pat

This is my first dog with these health issues, I have finals for school this week, and while I would love to be on the internet for hours reading about it, I simply can't just now. I will ask my Neurologist about the codeine.

Are you recommending Luka try Tramadol?

Sometimes your responses however helpful are a little insensitive. I am doing the best I can with what I know right now.

The vet put him on the Rimadyl, I don't see much of a change, I don't know about the codeine, it's there to help with his [pain and discomfort. I have given him extra pain medication in the past because he had obvious discomfort.

I don't know I need another opinion, but as of right now, I don't have the time nor the money.

Karlin
15th June 2011, 05:58 PM
I think Pat's question was a general one, aimed at anyone with a dog with SM, not anyone in particular. I also didn't take at all that she is recommending Tramadol; she was answering someone's question. Pat is one of the best informed members on canine medical issues here :).


Has anyone else ever heard of a neurologist prescribing codeine or morphine or other opiates for SM pain?

No, I haven't.


Are you recommending Luka try Tramadol?

Tramadol is a far more serious painkiller. I keep it for emergencies with Leo but only needed it once when he had a serious pain session probably caused by a fall when he fell on his spine. The pain may have been directly or indirectly SM related or spinal/disk pain and unrelated. If current painkillers do not manage his symptoms it may be one to try but does have an addictive effect longer term for many dogs. Whether that matters or not? Probably not if the alternative is pain. There are many many options with painkillers.

Clare's treatment algorithm is really the best summary of treatment approaches and when to introduce what. She normally starts with CSF inhibitors. The original intent of meds like cimetidine or frusemide or omeprazole isn't really relevant to what they are used for with SM -- they all reduce CSF pressure. You really need to work with a neurologist on what to try and when but Clare's document is considered a gold standard by many, not least as she is so familiar with the condition and for a long period and has done much research in the area. She also manages conservatively, overall. A neurologist is bets to judge, by pain indicators and response, which meds are best and to recommend changes when they stop being effective.

jacies
15th June 2011, 06:17 PM
I have not heard of Codeine being used for treating SM. Just read up about and it seems that this is a narcotic and can cause addiction which Tramadol for pain relief would not. It would therefore seem that it would have to be withdrawn slowly if changing over. Chaos is on Tramadol for quite a long time now and it certainly has helped her.

Karlin
15th June 2011, 07:24 PM
Actually Tramadol is known to cause addiction (and hence withdrawal) issues for some dogs. Codeine is pretty mild as an opiate and would probably be less worrying in that regard than Tramadol. But really, best thing is to talk to a vet or neurologist for pros and cons of any drug. All drugs have some side effects and benefits may well outweigh any issues -- and side effects do not tend to happen to every dog, just to some.

Unfortunately there are not a lot of choices for managing some illnesses, SM being one of them. None of the medications is great for long term use. So selecting what works best is highly individual and needs to be based on lots of different factors, in discussion with a medical professional.

Nicki
15th June 2011, 08:42 PM
Cimetidine: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000628/

Zyrtec - Generic Name: cetirizine - this is a different drug and is an antihistamine, but this is not used for SM.

Niki - did you mean Zantac - that is a brand name for another drug used for GERD:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000094/

Or perhaps Zitec is a UK brand name; I can't find it when I google for brand names of cimetidine.

Pat

Sorry typing error it is ZITAC brand name for Cimetitdine but only in the UK I think. it is a histamine H2-receptor antagonist that inhibits the production of acid in the stomach - not an ANITHISTAMINE which is a totally different type of drug. Making this clear for others reading the thread, not having a go at you.


Tramadol- the effects seem to wear off fairly quickly and so it tends to be used for palliative care. It was tried for Teddy when he was really bad - not just used post op.


My understanding is that opiates are not that effective for nerve pain - certainly they are not for Trigeminal Neuralgia, which is a nerve pain condition. They are used post op, as in the Fentanyl patch for the pain of surgery not the SM though.


I'm glad you are going back next week and hopefully once you have finished your finals it will give you time to do more research. Sadly this condition still isn't that widely recognised and it is a situation where you need to be as informed as possible and be a partner in the management of your dog. [Although of course everyone should be in all management of your companions - and your own health] Vets and GPs do not have the time to research every condition as thoroughly as we are able to and they should be open to be being guided by our research, as long as it is form reasonable sources - there is much contradictory and incorrect information on the Internet.

I would strongly suggest taking in Clare's treatment diagram at the very least. At the end of the day you are paying for treatment and therefore can to a certain extent ask for what you want to at least be considered.

Pat
16th June 2011, 08:45 PM
Are you recommending Luka try Tramadol?

Sometimes your responses however helpful are a little insensitive. I am doing the best I can with what I know right now.

Oh, I'm sorry that I came across that way! I wasn't making any recommendations but just continuing to try to learn myself. Anne had asked about Tramadol, and I shared my experience in using it with a couple of geriatric dogs. I'm one of those people who pays attention to small details and has a good memory so I'll often pick up on anything written that seems new or different (such as using codeine to treat SM) and will ask questions about the new/different info. I know that being a stickler for details/facts can be very annoying and seem insensitive, but it has helped me learn a great deal over many years. I've not personally had a Cavalier (I've had 12) who had obvious signs of SM, but I've read a great deal about SM since the early 1990's. My 8 year old was recently MRI'd as part of a research project.

You are dealing with a very tough situation and are doing so much more than many because you are working with a neurologist. I think that a lot of comments that are made on threads such as yours are to share information not just with the owner who is making the particular post but to also share information with the many Cavalier owners who are reading this forum but who never post.

I've lost 11 dogs in the last 8 years, and although they were all in their teens, I've had a lot of personal experience in dealing with serious illness and loss of beloved dogs. So believe me when I say that I do understand the rollercoaster emotions involved (and trying to learn things very quickly while under stress) even though I almost always concentrate on "facts and figures" rather than feelings when I post here.

Pat

Nalu
20th July 2011, 10:11 PM
I hope your finals went well and you catch up on r & r. I'm wishing you and Luka the best!