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View Full Version : Cough was still there. Vet no clue about sm..



Blondiemonster
17th June 2011, 02:25 PM
Blondie was coughing a little and then it went away. Then one day i heard it again so off to the regular vet. No kennel cough and normal bloodwork so its still a mistery. Vet had never in her life heard if sm. I said id print out clares treatment algirythm and symptoms page... She alsi didnt know of psom. According to her the heart seemed normal. Its funny because thats what everyone said. But a cardiologist was able to detect a very slight murmur when we were at the neuro. I guess theres a lot specialists know ... Im so used to dealing with specialists now i felt the normal vet a bit... Uhhh... Simple??? Mmmm. That sounded bad. But its weird when you stand there and explain that omeprazole is a csf and she doesnt know...

StillPooh
17th June 2011, 03:19 PM
Perhaps it is time to book a full cardiology workup, with an echocardiogram. And maybe find a new general practitioner.

Blondiemonster
17th June 2011, 03:55 PM
The cardiologist who listened to her heart said "it was nothing to worry abou" it wasnt even a murmur but a pre-murmur. Im sure she wouldve recommended an echo if she thought there was a reason. But i agree on the vet. She is actually a new one. So hard to find a good gp.

goda
17th June 2011, 04:27 PM
Blondie was coughing a little and then it went away. Then one day i heard it again so off to the regular vet. No kennel cough and normal bloodwork so its still a mistery. Vet had never in her life heard if sm. I said id print out clares treatment algirythm and symptoms page... She alsi didnt know of psom. According to her the heart seemed normal. Its funny because thats what everyone said. But a cardiologist was able to detect a very slight murmur when we were at the neuro. I guess theres a lot specialists know ... Im so used to dealing with specialists now i felt the normal vet a bit... Uhhh... Simple??? Mmmm. That sounded bad. But its weird when you stand there and explain that omeprazole is a csf and she doesnt know...

Ugh, how disappointing. My regular vet was very honest with me and said "This looks neurological and it's out of my realm take him to anyone of these people."

Is she doing any better?

GraciesMom
17th June 2011, 04:38 PM
just seems like alot he does not know....especially things like omeprazole being a csf. All vets that I've dealt with have at least heard of CM, SM and PSOM

Blondiemonster
17th June 2011, 04:49 PM
Just random coughs here and there. I think it must be a seasonal allergy

Blondiemonster
17th June 2011, 04:50 PM
I agree graciesmom i wouldnt go back to that vet unless for something very simple. Quest for a great gp continues...

Pat
17th June 2011, 05:01 PM
My regular vet was very honest with me and said "This looks neurological and it's out of my realm take him to anyone of these people."

That attitude is a sign that you have an excellent vet!

Pat

Sydneys Mom
17th June 2011, 05:15 PM
Blondie having a cough scares me. After all I've been going through with Sydney right now, I think you should at least take her for a cardio check up. Hopefully it will be nothing more than allergies. I agree about finding another regular vet. Even if they don't have full cardiac experience, determining a murmur should be very basic for them. My vet diagnosed Sydneys murmur and kept close watch on it. When it started to get worse, she took an xray and determined it was time to see the cardiologist. The cardiologist, did an echo, scan and some blood work and determined at time to just keep a watch on it. It was more than a year later that Sydney needed heart medications. At least at that time they had something to compare it to.

It was also my regular vet that diagnosed his arrythemia. I had brought him in for an anal sac problem and she put the stethescope to his chest, looked at me and said, get him to the ER now! Not what I wanted to hear. While waiting for my ride to take us to the ER, I was asking questions and she said, his condition is over her head and she didn't want to guess at answers. She was very honest.

So now, Sydney's cardiologist is in charge of his care. She sends reports to our regular vet to keep her in the loop.The regular vet calls me and helps me understand some of the more medical terminology and she will also call the cardiologist to get clarifications on diagnosis. In a way she treats me and Sydney. I don't want to scare you, but I would urge you to see a cardiologist AND find another vet. At least this way, you have a baseline for any heart disease. Sometimes the symptoms progress very rapidly. Sydney went from good to severe in 3 months.

Good luck, I'll keep you both in my thoughts.

Pat
17th June 2011, 05:24 PM
Blondie was coughing a little and then it went away. Then one day i heard it again so off to the regular vet. No kennel cough and normal bloodwork so its still a mistery. Vet had never in her life heard if sm. I said id print out clares treatment algirythm and symptoms page... She alsi didnt know of psom. According to her the heart seemed normal. Its funny because thats what everyone said. But a cardiologist was able to detect a very slight murmur when we were at the neuro. I guess theres a lot specialists know ... Im so used to dealing with specialists now i felt the normal vet a bit... Uhhh... Simple??? Mmmm. That sounded bad. But its weird when you stand there and explain that omeprazole is a csf and she doesnt know...

I'm not at all surprised that she knew nothing of SM or PSOM. Not sure if anyone remembers, but when I attended the AVMA convention in Atlanta last summer (the main source of getting continuing education credits for practicing GP vets) I attended all of the seminars on SM, and in each there was only a handful of attendees - 8-14 or so vets. But in the seminars on liver disease, kidney disease, heart disease, there were hundreds of vets crowding the room. The SM specialists who were presenting all commented on how disappointing the attendance was at their sessions.

My own GP vet would not know of these conditions were I not her client. She has always been open to my bringing in material (from valid sources) about particular problems common to Cavaliers. One of her colleagues actually once phoned me to come in and do an "observation" on a Cavalier (the owner was not present). But many vets don't have an open attitude about input from clients. The best approach is to bring in printed material from a valid veterinary source (like papers from Clare or Shores or Dewey) and ask them to look the material over when they can.

I would expect that most vets would not know about proton pump inhibitors being used as CSF reducers because this is an off label use of the drug. One would only know that this drug is used for SM if they had read up on the condition, diagnosis and treatment.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000936/

A thought about Blondie's coughing - has any vet asked to do chest x-rays to check for primary respiratory disease (upper or lower airway)? Have you discussed the possibility that she is particularly sensitive to smog, pollution, etc since she is a "city" dog? We're having a lot of "bad air" smog days in the big cities where the weather folks say that sensitive groups should avoid going out.

Pat

Blondiemonster
17th June 2011, 08:10 PM
I'm not at all surprised that she knew nothing of SM or PSOM. Not sure if anyone remembers, but when I attended the AVMA convention in Atlanta last summer (the main source of getting continuing education credits for practicing GP vets) I attended all of the seminars on SM, and in each there was only a handful of attendees - 8-14 or so vets. But in the seminars on liver disease, kidney disease, heart disease, there were hundreds of vets crowding the room. The SM specialists who were presenting all commented on how disappointing the attendance was at their sessions.

My own GP vet would not know of these conditions were I not her client. She has always been open to my bringing in material (from valid sources) about particular problems common to Cavaliers. One of her colleagues actually once phoned me to come in and do an "observation" on a Cavalier (the owner was not present). But many vets don't have an open attitude about input from clients. The best approach is to bring in printed material from a valid veterinary source (like papers from Clare or Shores or Dewey) and ask them to look the material over when they can.

I would expect that most vets would not know about proton pump inhibitors being used as CSF reducers because this is an off label use of the drug. One would only know that this drug is used for SM if they had read up on the condition, diagnosis and treatment.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000936/

A thought about Blondie's coughing - has any vet asked to do chest x-rays to check for primary respiratory disease (upper or lower airway)? Have you discussed the possibility that she is particularly sensitive to smog, pollution, etc since she is a "city" dog? We're having a lot of "bad air" smog days in the big cities where the weather folks say that sensitive groups should avoid going out.

Pat


Thanks pat. I was planning on referring her to Clare's material.
Yes, xray would be the next step. I wanted her to check for tracheal collapse, but she didn't think the cough was serious enough. It's very random and mostly when outside. So when it doesn't go away that's what ill do,
Sydney's mom, I thought of the heart before and talked about this to Karlin, but considering she is 4 with not even a low heart murmur, and a cardioligst who literally said "nothing to worry about", 2 months back, a cough is not going to be related to the heart. This is only in the last stages of heart disease/failure when the fluids build up around the heart.

Sydneys Mom
17th June 2011, 08:30 PM
missed the part in your post about the cardio visit. glad you have that part under control. hope now you can figure out what the cough is all about.

Karlin
18th June 2011, 07:34 PM
Absolutely agree with all of Pat's points below. We need to cut vets a bit of slack here. :)

The CSF inhibitor aspect of drugs like omeprazole or cimetidine is not something probably 99% or more of vets or human doctors would know -- it is a side effect that has little relevance to the main reason it is prescribed. Specialists would perhaps be aware of it. None of these drugs as far as I know is even *licensed* to be used as CSF inhibitors. My own GP was very interested to hear they could be used in this way. CM, SM and PSOM are all *specialist* conditions that most vets would normally rarely to never come across or know how to diagnose -- and vets are pretty unlikely to know about these conditions which in general are known to affect one single dog breed amongst hundreds, in any significant way -- a breed that is still quite rare in in some countries such as the US. SM goes undiagnosed in humans as well, often for years, because few GPs or specialists in other areas that present similar symptoms know about SM/Chiari and its symptoms except perhaps as one amongst many hundreds of possible diagnoses.

A vet can be a great general vet without knowing about specialist conditions.

This is why 1) it is a great idea to print out Clare's general info on SM and treatment diagram for vets; 2) it is a much better idea to ask for a referral to a neurologist if you see persistent symptoms that are not effectively addressed by other treatments by a vet.

My own vets are great with SM now but initially had hardly heard of it. They will now refer cases that show typical symptoms that are not resolved by treatment for other possible causes, on to a neurologist.


I'm not at all surprised that she knew nothing of SM or PSOM. Not sure if anyone remembers, but when I attended the AVMA convention in Atlanta last summer (the main source of getting continuing education credits for practicing GP vets) I attended all of the seminars on SM, and in each there was only a handful of attendees - 8-14 or so vets. But in the seminars on liver disease, kidney disease, heart disease, there were hundreds of vets crowding the room. The SM specialists who were presenting all commented on how disappointing the attendance was at their sessions.

My own GP vet would not know of these conditions were I not her client. She has always been open to my bringing in material (from valid sources) about particular problems common to Cavaliers. One of her colleagues actually once phoned me to come in and do an "observation" on a Cavalier (the owner was not present). But many vets don't have an open attitude about input from clients. The best approach is to bring in printed material from a valid veterinary source (like papers from Clare or Shores or Dewey) and ask them to look the material over when they can.

I would expect that most vets would not know about proton pump inhibitors being used as CSF reducers because this is an off label use of the drug. One would only know that this drug is used for SM if they had read up on the condition, diagnosis and treatment.

anniemac
18th June 2011, 09:54 PM
That attitude is a sign that you have an excellent vet!

Pat

I agree completely. Even if a vet has heard of SM, it is personally discouraging to hear when a vet thinks they know enough to make conclusions above a neurologist. I think its good to be able to recognize something is neurological and familiar with symptoms, but to be the one to decide if an MRI is needed is not their place.

Sorry, I'm just speaking from personal experience, which I've said many times. IMO People need to understand, that just seeing a neurologist does not mean an automatic MRI! Let the specialists decide that. Like I have said before, I feared SM and vet thought "keep an eye on it" because he knew of SM and it is geographic. UM... also he said who is Dr. Rusbridge? Be careful of what you read because everyone can be an "expert". I think I will go with what I read online.

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