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View Full Version : Results are back .... pretty severe malformation and syrinx



GraciesMom
29th July 2011, 10:03 PM
I knew in my heart it was SM but was shocked how bad. It is shocking that Gracie has not been screaming all day long! Gracie has a fairly substantial malformation and one huge syrinx that runs from skull down much of her spine. It varies in width but is taking up nearly half the spinal canal in places. We start her on meds tomorrow which include: prednisone, tramadol and gabapentin. I do have questions as I do not want to put Gracie through major surgery until I am clear enough on its ability to give her a decent quality of life. First, when a young dog (14 months) has a major compression with a large dominant syrinx, what have we seen in terms of impact of surgery? I would be fine if her current level of scratching and discomfort stayed about the same, but sounds like it may well get worse over time even with meds and surgery?Second, what have those who used a mesh implant found in terms of positive/negative impact? Some are concerned that the implants can lead to infection and not sure they are really that effective in containing the problem. But others feel that it is very effective in terms of limiting formation of more problems?Third, what can we expect as worst side effects of the meds above? I am most concerned about prednisone long term, but not as familiar with the other two. So any experiences with these is appreciated.Lots to decide in the next few days. I know we must decide on surgery soon given severity of situation. I must admit that we may well decide not to have surgery and just give her the best life we can until we know it is time to let her go. The severity of the syrinx is pretty disheartening.

Love my Cavaliers
29th July 2011, 10:21 PM
I'm so sorry Debra, but you knew it in your heart. I can only give you my experience with Riley which has been a dream experience. Riley was diagnosed with severe and advanced SM 3+ years ago with a syrinx that covered more than 95% of her spine. After a second opinion, we opted for suregery even thought she was probably at the upper age limit for surgery (she was almost 6). She was treated before surgery with gabapentin and prednisone which had zero effect on her symptoms. In June of 2008 she had decompression surgery with the titanium mesh implant. After surgery, it took several months to hit on the right medication for her which was just 5 mg prednisone a day. She has been on that now for more than 3 years. The only side effects that I have seen are a loss of hair on her belly and her tail and some dry skin. I give her daily salmon oil. She also take a liver supplement daily and has her liver enzymes checked every 4 months.

She has had no problems with the mesh implant. She is a happy dog. She runs, she hunts in my yard, she catches chipmunks, she loves to go on walks. She does have weakness in her rear legs and can't jump well so I have stairs for her to get up on my bed and one of her favorite chairs. Our sofa is low so she can jump onto that. Her vestibular system was damaged before surgery and while the prednisone keeps it in check most of the time, she still has lingering balance issues. Her head tilt is still there, but not as severe as it used to be. She will never be a normal dog, but she is my miracle dog, and I never expected her to be alive and in as good shape as she is today.

For Riley, surgery was the right and only decision for a longer and better quality life. That doesn't mean it is right or wrong for Gracie or for any other dog. I've got to run, but I'll write more if you have more questions that I can answer later. Best of luck to you. Gracie will get the best care because you are her mom.

waldor
29th July 2011, 10:41 PM
I am so sorry that the diagnosis is what you feared. At least now you know, and can move forward with meds and proper care. Have you told her breeder? (I can't remember if she was a rescue or what)

Sydneys Mom
29th July 2011, 10:57 PM
I'm so sorry you got this diagnosis. I have no experience with SM so I can't offer any advice. I'm crying as I type this knowing that you and Gracie are suffering. Whatever decision you decide to make on the treatment will be the right one. Sydney and I are sending you lots of prayers and hugs. Love you both.

GraciesMom
29th July 2011, 11:09 PM
I did tell her breeder... Some good and not some not so good reactions. He knows now that he can't breed her sister. He told that he already had stopped breeding another line 2 years ago. He seemed genuinely upset but he is a JUDGE as well as a breeder and I do not know how much I trust him. He did not offer any help or support with expenses, nor did he offer helping us get another dog in the future. Of course, I would not want one from him anyway. He did say...and I agree... That CM/SM could very well end this breed. Unless breeders take drastic action, I fear it could happen.I appreciate the info from Love My Cavaliers and others as this will help us make a decision on what to do.

Reptigirl
29th July 2011, 11:18 PM
I'm sorry to hear those results :( At least she is getting the treatment she needs. I'm right there with you trying to figure out what is best... surgery or no surgery.

I have no experience with prednisone or tramadol. Mine are managed with either Lyrica or gabapentin + omeprazole. They all seem to be managed fairly well with the exception of the occasional "bad day". I know many members on here do well with prednisone but my neurologist seems to be against it until it is a last resort icon_nwunsure He is concerned about the long term side effects of taking it.

I know JUST gabapentin + omeprazole have been a miracle drug for poor Blitz. It has given him great relief despite having a syrinx that is so wide it takes up to 90% of his spinal cord in some places.

As far as gabapentin I was not told of any "long term side effects". Sorry I'm not much help but wanted to know we are thinking about you guys! :hug: I know how much it sucks.

Zumie05
29th July 2011, 11:32 PM
That is so scary seeing how mild to non-existent Gracie's symptoms have been to how large her syrinx is :( I am so sorry, but at least you know now and are doing all you can to keep her comfortable. Remember Gracie doesn't know anything is wrong, dogs live in the moment.

Holly
29th July 2011, 11:52 PM
This sounds so much like my experience with Scarlett... severe malformation and a HUGE syrinx but relatively mild symptoms. I'm sorry to hear this and I know how you feel.... that even though you knew it, it was shocking to hear how bad it actually is and overwhelming when trying to decide what to do. I am curious to hear everyone's opinions on the surgery. Scarlett has been well-managed on her meds and is already almost 5 years old. I decided to manage her medically due, in part, to her age but if she were much younger, I might have thought more seriously about the surgery.

I've had her on Gabapentin, Omeprazole, Previcox and, if needed, Tramadol for about a year and a half. Her bloodwork has always come back perfect. I am not sure about the Pred but that is something we may use in the future.

Good luck! I just went through this same exact scenario 4 days ago. Pat gave me the best advice when she said... Just remember that she is the same girl she was yesterday.

GraciesMom
30th July 2011, 01:03 AM
I am really curious now why the neuro prescribed what he did. Why no omeprazole? Why both gabapentin and tramadol if she is not yet in that much pain? They seem to do very similar things. Why a fairly high dosage of predisone? I will ask him but curious as to your thought on this. I hope Pat is here to weigh in.

It is unclear to me Reptigirl if Gracie's young age makes her more of a candidate for successful surgery or not. The neuro said yes and no. Her youth is more likely to make it easier to recover, but he said the potential for ongoing damage from syrinx or scar tissue may be higher due to having this so young. That last part is confusing to me and I need to get clarification.

Holly
30th July 2011, 01:12 AM
Our neuro had us do an NSAID (Previcox, Rimadyl etc) along with the Gabapentin. The Omeprazole is thought to reduce the production of CSF, I believe. I would ask him about adding something like that, bc I think it can be preventative.

mishy
30th July 2011, 01:26 AM
I am so sorry Debra that you received such devastating news about little Gracie. I have no advice to offer about SM as thankfully Bubbles does not suffer from this heartbreaking condition. My heart goes out to everyone on the board who is living with SM. Cavaliers are the most beautiful and loving dogs on the planet and I am deeply saddened that these wonderful pets have to suffer such pain and that the breed is in danger. You will get some valuable advice in the coming days from owners of cavaliers with SM and I'm sure you will make the right decision for Gracie. In the meantime, give her a hug from me.

gyoselyn
30th July 2011, 01:52 AM
I'm so sorry to hear about Gracie's MRI result. Corey too has a sever case of SM. We opted for surgery a year ago when he was 2 1/2 yo and last month we did follow up MRI. The result is mix. The good thing is there is no new syrinxes and the existing syrinxes remain the same in size. On the other hand the neuro said scar tissue may have developed but he also mentioned that this is pretty normal. I think the surgery somewhat has been helping to stop the syrinxes' progression on corey, should this continue in the future? we don't know and neither does the neurologist. I agree with Bev that the surgery doesn't mean it's right or wrong for Gracie and any other dogs. If you have any other questions feel free to PM me and I live in NC too :). Hugs to you both :hug:

Blondiemonster
30th July 2011, 02:27 AM
You know i already sent you a long private message. But I wanted to add something important.
We did a follow up MRI after 6 months from the first one and there was no progression, according to Dr. West.
I don't know if this was a coincedence or due to the omeprazole, but either way; it's possible.
Not sure what the result would be if we MRI'd again in a year but it sure would be interesting too see....

Holly
30th July 2011, 03:02 AM
You know i already sent you a long private message. But I wanted to add something important.
We did a follow up MRI after 6 months from the first one and there was no progression, according to Dr. West.
I don't know if this was a coincedence or due to the omeprazole, but either way; it's possible.
Not sure what the result would be if we MRI'd again in a year but it sure would be interesting too see....

You are treating with meds and decided against the surgery?

GraciesMom
30th July 2011, 03:03 AM
I continue to be mystified why we were not prescribed omeprazole.... Do the other meds on the list he gave us do the same thing? Everyone so far seems to to feel it has been very helpful. Got to ask that for sure on Monday. I think the followup MRIs are very interesting.... Wish there was a major study tracking those results for those getting various treatments. big hugs to all for your support and sharing your own experiences. Gotta PM gyoselyn and find out where she lives!

Holly
30th July 2011, 03:09 AM
I continue to be mystified why we were not prescribed omeprazole.... Do the other meds on the list he gave us do the same thing? Everyone so far seems to to feel it has been very helpful. Got to ask that for sure on Monday. I think the followup MRIs are very interesting.... Wish there was a major study tracking those results for those getting various treatments. big hugs to all for your support and sharing your own experiences. Gotta PM gyoselyn and find out where she lives!

The Gabapentin and Tramadol are for the pain. The pred suppresses the immune system.

Love my Cavaliers
30th July 2011, 03:19 AM
Debra, I was thinking about Gracie the whole time I was out for dinner with my friends and was wondering how you would feel about getting a second opinion on Gracie's MRI. I know it just really put my mind at ease to know that two neurologists said the exact same thing about Riley's diagnosis and prognosis and whether they would recommend surgery (both said 100%). Now, if you get conflicting opinions, that can be problematic. But, you could always send a copy of the disc over to Clare Rusbridge to take a look at. I believe she will do that - maybe for a fee though.


How are you doing? I know I cried a lot when I got Riley's diagnosis. I had just found out about SM that day and then found out she needed surgery and was sure that surgery was going to shorten her life if it didn't kill her (She had problems coming out of the MRI anesthesia). I hope you have some support for yourself other than your sweet little dog to hold.


I agree with Reptigirl that I don't think there are any long term side effects with gabapentin. I myself have been on it for over two years for migraine prevention and my neurologist calls it a very safe drug.

Keep in mind throughout this whole decision making process that you are going to do the best for Gracie given the best information that you have at the time and the best resources that you have available to you. You could have two dogs with identical MRIs and two owners who would choose different treatment options based on a multitude of reasons that no one else is privy to. We are here to listen, to share our stories, and to give you support no matter which route (medical or surgical) you decide to take because we know that you will have made that decision based on your love for Gracie and what you feel is best for her at this time.

Holly
30th July 2011, 03:22 AM
I agree with Bev-- what you choose to do here is such a personal decision and you have to do what you feel is right for your dog. But, I know what a hard decision it is and one that I wish we didn't have to make. You could also contact Dr. Schubert down at UF to see if he would give you a second opinion based on the MRI- he has a big interest in our Cavaliers and SM and sees a lot of them.

gamefanz
30th July 2011, 03:34 AM
Goodness I was hoping for a better result. I am so very sorry. I hope that what ever you choose to do that you can keep Gracie's symptoms managed. Many Many hugs to both of you:hug:
Becky

Blondiemonster
30th July 2011, 04:43 AM
You are treating with meds and decided against the surgery?

I am still not sure holly. Its been a year and i am still deciding... She is now 4 and 4 months and is doing allright on meds. Unless there is muscle weakness or a very serious rapud decline i am tempted to ride it out. If no surgery means she will maybe be 8 instead of 10 years old i wouldnt not want to put her through surgery... I dont even know if the surgery will help. If there was a guarantee it would be different... But i could change my mind any given moment. There is never a guarantee either way and we dont know how ling our fur babies will be around for...

Furrfoot
30th July 2011, 05:17 AM
http://i81.photobucket.com/albums/j213/boxart/smilies/sigh.gif http://i81.photobucket.com/albums/j213/boxart/smilies/heartpump.gif (((hugs))) http://i81.photobucket.com/albums/j213/boxart/smilies/heartpump.gif

mommytoClaire
30th July 2011, 05:18 AM
Oh Debra, I'm at a loss to know what to say. I know this has come as a shock, and I know you have shed many tears already. But remember, you have time to think these things through. You have time to do your own research, and ask questions. You've started on a regime, but it can be changed as you go down this path. Even a decision about surgery doesn't have to be made right this minute. Take your time, breath, love on Gracie, and I know that you and hubby will come to some decisions that will be best for you all.I just want you to know I'll be praying for you all. I just keep remembering all the folks on here whose dogs have beat the odds and gone on to live fairly normal and full life's. As has already been mentioned, she is the same beautiful girl today that you love and adore, and she doesn't know of the situation. Take your time, and know there are many here who care deeply about you and Grace. Big hugs.

BrooklynMom
30th July 2011, 06:11 AM
Oh Debra...when I saw the title of this post, I knew that it was you posting it and my heart sank.
I am SO sorry for you and Gracie. Through all the pain you must be feeling right now, also take a moment to give yourself a pat on the back for paying attention, knowing the signs and getting her the help she needed as soon as possible. She is so lucky to have you and I know you will do everything to help her. I have no experience with this, but Brooklyn will be off to the neurologist in the next month because her video looks just like yours and many others. I have just been waiting for the insurance to kick in. So I don't know what you are going through right now, but I can only imagine and it must be so hard. We are here for you, however you need us. There are more experianced ones on here than me, but I just wanted to send my hugs :hug:

Karen and Ruby
30th July 2011, 01:19 PM
Hi Debra

I'm so sorry that you have had this result, unfortunately its one of those clubs that no one wants to be in.

As others have said i'm sure that you have shed many tears already and there will be many more to come, I know how you are feeling right now but believe me it does get easier.

What actions to take can only be your desision for Gracie and as much information and advice as we give you it can only be your desision that you are comfortable with.

Don't let her age influence you too much, I think that over the last couple of years SM has become far more well known and for that reason dogs are being diagnosed far earlier in life and I don't think that should be the deciding factor in your choices.

My little one was diagnosed nearly 3 years ago and she has done remarkably well on medication management, thats not to say that the first few months post diagnosis was plain sailing as it wasn't. We changed her meds a few times before we found a combination that worked for her and she has been on that ever since with only the odd bit extra for a bad day.
I didn't know what SM was in the beginning and Ruby actually first showed symtoms at around 9 months of age when she screamed in the middle of the night for 'no reason' and then again at around one years when she couldn't play tug of war any more as it was painful and she would yelp out loud. If I had known about SM then, she would've been off to the Neuro then and diagnosed at a year old I'm sure!!

But she wasn't and it wasn't until PDE and her turning 2 years that she was diagnosed! I had the same arguements in my head as you and settled for Medication and the only reasons for that were my own selfish reasons. If I had put her through surgery and she had died at 2 years old then I would have failed her, I also had a full time job and wouldn't have been able to get time off for her recovery which is extensive ( I take a few days off when they are anaethetised for any reason) and also cost.

I figured that if she was comfortable and pain free on Meds and there was less risk involved then that was my choice and I do feel happy to this day with that desision- she lives a very full life and does 90% of things that any other dog does nad even if her life is slightly shorter due to that choice I'm at peace with that because she has lived a full life.

All SM dogs will have a bad day once in a while.

I hope you are OK and just remember that what ever you chose for Gracie, hse won't judge you and neither will anyone else!

GraciesMom
30th July 2011, 05:15 PM
I'm so sorry to hear about Gracie's MRI result. Corey too has a sever case of SM. We opted for surgery a year ago when he was 2 1/2 yo and last month we did follow up MRI. The result is mix. The good thing is there is no new syrinxes and the existing syrinxes remain the same in size. On the other hand the neuro said scar tissue may have developed but he also mentioned that this is pretty normal. I think the surgery somewhat has been helping to stop the syrinxes' progression on corey, should this continue in the future? we don't know and neither does the neurologist. I agree with Bev that the surgery doesn't mean it's right or wrong for Gracie and any other dogs. If you have any other questions feel free to PM me and I live in NC too :). Hugs to you both :hug:

Do you get the mesh implant which is aimed at controlling the scar tissue so it does not block spinal cord? That is not very common procedure yet so was just curious

Blondiemonster
30th July 2011, 06:04 PM
Do you get the mesh implant which is aimed at controlling the scar tissue so it does not block spinal cord? That is not very common procedure yet so was just curious

Dr marino at livs has done 250 mesh implants and swears by it..

Pat
30th July 2011, 06:17 PM
Do you get the mesh implant which is aimed at controlling the scar tissue so it does not block spinal cord? That is not very common procedure yet so was just curious

I'm pretty sure that Dr. Shores did Corey's surgery and used the duraplasty with fat pad graph (from the dog) and swine tissue.

Debra - I've got some thoughts and responses on meds (and I talked with Holly on the phone about them and we were pretty much aligned!) but I've got a tight schedule today and won't have time to post until late tonight. I did a good bit of reading last night in Plumb's on drugs and effects, etc.

More later,

Pat

Love my Cavaliers
30th July 2011, 06:41 PM
Dr marino at livs has done 250 mesh implants and swears by it.. Riley had the titanium mesh implant that Dr Marino uses 3+ years ago and she has had no problems with it - no scar tissue development, no loose screws, no infections.

GraciesMom
30th July 2011, 07:25 PM
Pat ....I always look forward to your insights because you know so much already, especially short-term treatment to help her be more comfortable. Just post when you can. I know you are so busy and we rely on you a great deal here.

I think not doing surgery would be a better option if Gracie did not have severe malformation and a large syrinx. Her scratching is already notably worse this week than 3 weeks ago. Everyone notices it is worse, even those who have been in denial before. So the question is if we do surgery, what procedure? What are pros and cons of swine duraplasty versus titanium mesh? Or no implant at all?

We do have insurance that should pay 80% but we also have to cover travel and hotel if we leave the area. Not a small cost. And know that she would have a long recovery period at home too. I can take the time off but will be a challenge.

Just gotta make sure this is the best thing for Gracie.... so hard to know what to do.

GraciesMom
30th July 2011, 08:25 PM
Well, so hard to know which one is best. Either way we go, long drive. There is a neuro, Dr. Narak, in Knoxville TN who does the duraplasty with swine tissue. Dr. Shores pioneered this but is much further from us in Mississippi. A few neuros in New York use the titanium cranioplasty... and then Dr. Schubert in Florida (Gainesville) uses the absorbable mesh called LactoSorb SE. Augh! The closest to me is probably Gainesville or Knoxville. Dr. Marino in New York appears to be the go-to person for using the titantium mesh, but that is the longest distance and likely to be much higher cost due to NYC area. No easy direction here....

Desrae
30th July 2011, 08:28 PM
I'm so sorry about the news, but at least your fears are confirmed and you can take steps to control this and help Gracie. This is the best place to be for cavalier owners, no doubt about it. Hang in there!:hug:

GraciesMom
30th July 2011, 08:37 PM
You are one of my heroes.... your battle for that sweet little abused dog is an inspiration. It really is.

Blondiemonster
30th July 2011, 08:38 PM
Well, so hard to know which one is best. Either way we go, long drive. There is a neuro, Dr. Narak, in Knoxville TN who does the duraplasty with swine tissue. Dr. Shores pioneered this but is much further from us in Mississippi. A few neuros in New York use the titanium cranioplasty... and then Dr. Schubert in Florida (Gainesville) uses the absorbable mesh called LactoSorb SE. Augh! The closest to me is probably Gainesville or Knoxville. Dr. Marino in New York appears to be the go-to person for using the titantium mesh, but that is the longest distance and likely to be much higher cost due to NYC area. No easy direction here....

If u do decide to go to ny there is a hilton right next to the hospital that is pet friendly and most people stay there during surgery...

GraciesMom
30th July 2011, 09:21 PM
I was going to look at those options pretty soon and you saved me a lot of work. It is still an option... as it going to Tennessee.


If u do decide to go to ny there is a hilton right next to the hospital that is pet friendly and most people stay there during surgery...

tara
31st July 2011, 03:47 AM
I am so sorry for what you are dealing with right now. I don't have experince with SM / CM, but I do have experience with the University of Florida and Dr. Schubert. After the accident, Holly was stabilized here for a couple of hours then I rushed her to UF where she was admitted at 7 pm on a Friday night. They did the surgery at 7am the next morning. Dr. Schubert was Holly's neurologist and advised during her surgery regarding best placement for plate, wires, etc. to minimize any chance of paralysis or incontinence. Like Holly (the human) mentioned in another thread, UF is an amazing place. Dr. Schubert was wonderful and did Holly's MRI before surgery. He has a lot of experience with cavaliers -- our regional rescue group has used him extensively. I dealt with many specialists, as well as, residents at UF and found them all to be excellent to work with. I was able to make a single return trip for Holly to see her orthopedic surgeon, neurologist, physical therapist and radiologist -- a nice thing about dealing with a university setting. A resident was also assigned to Holly's overall care and communication with me as I had to leave her there for a few days to return to Tampa. I got several phone calls a day from this resident updating me on Holly's progress. And the resident was in contact with the specialists for me, which made managing care easy from a distance. When I brought Holly home, I was in constant contact with UF on everything from medication, physical therapy, toileting concerns, etc.

I just can't say enough about UF, so it really might be worth contacting Dr. Schubert for another opinion. I know your head must be swimming now with all of these decisions. Please know that there is a community here thinking of you.

GraciesMom
31st July 2011, 04:36 AM
You are first person so far who has had experience with Dr. Schubert and that vet school. It is heartening to hear that this could be a viable option. I hope to find someone who knows more about the soluble mesh he uses to address scar tissue. I have no idea how quickly scar tissue forms, so not sure if that mesh stays intact long enough. Supposedly dissolves some by a few months out and then gone by a year.

lovecavaliers
31st July 2011, 05:09 AM
Hi Debra - I just wanted to add to the many messages that I was sorry to read your post. Everyone has given such good advice. I would definitely speak to your neuro about adding a CSF reducer like omeprazole until you decide on what the next step will be. It is so overwhelming trying to figure out what is the best route -surgery vs. medication. I still constantly second guess myself.
As far as the meds, my neuro has never had any problems with gabapentin even with dogs that have been on it for 10+ years. Predisone has more side effects so it is often the last drug to be given or used intermittently. However, some dogs do fine on a small dose daily for many years.
There is so many variables and every dog/owner is different. Whatever you decide we are all here for you.
If you decide to go to LIVS in NY, please let me know if you need a ride or anything. I live in Manhattan but my family is located 20 minutes from the clinic and are the biggest animal lovers. They all know about CM and SM from my Jack and would love to help another dedicated cavie lover. Please do not hesitate to ask.

lots of hugs to you and Gracie.

tara
31st July 2011, 05:46 AM
Debra -- based on my experience with Dr. Schubert and UF in general, I would definately look into getting an opinion from him. I'm a couple hours away, but would be happy to have you stay here if you need a stop-over for recovery. Gainesville is a nice univeristy town, so there are several reasonable hotels right near the veterinary center. UF is really a remarkable place. After Holly's accident, I got on the phone with a couple of cavalier people and was told in no uncertain terms to get Holly there as soon as possible. My main concern was neurological deficits due to the location of her spinal injuries-- post accident, Holly was paralyzed from the waist down and was completely incontinent. I wanted to do surgery to repair the fractures, but was concerned with her quality of life if she could never walk or potty on her own. Her vet here agreed that consulting Dr. Schubert was important, so he stabilized her and sent us on our way. I was able to call and make an appointment with the emergency department that same day -- like I said our intake was around 7pm on a Friday. I had neuro and surgical consults that night, then surgery the next morning. As I mentioned, Dr. Schubert helped direct the surgery to ensure the best possible neurological outcome.

The residents are well trained and were very helpful in staying in touch with me. I remember talking with the resident one evening -- I had told her that Holly was used to a high level of physical contact, so the resident took Holly from ICU and kept her on her lap to watch a couple hours of television in the student's lounge. Another evening, after Holly was home from surgery, she started bleeding from a suture line. I called at 2am and was given support as to how to handle the situation. Little things like that made me so comfortable with Holly's care. On our second post-surgical checkup, the resident I'd worked with during the whole process even took my daughter (who desperately wants to be a vet) on an extensive tour of the facility.

I have no knowledge of the mesh surgery and it's complications, but I think you would find Dr. Schubert to be a great source of information. Like I mentioned, he has seen several cavaliers who come into our regional rescue group. Owning a cavalier, I feel very lucky to have him relatively close should any neurological issues arise with Holly.

If you'd like any contact information or a place to stay along your way, please feel free to contact me. I would be honored to help in any way possible.

meljoy
31st July 2011, 12:42 PM
Debra,

Been away for the weekend so only reading this now. Im so sorry but at least Gracie has you as her Mum and in that she's a very lucky girl. Leo and I are sending hugs from across "the pond" to you both.
:hug:

GraciesMom
31st July 2011, 03:22 PM
Just giving her the gabapentin and tramadol now... Holding off on prednisone and omaprazole until Pat weighs in. I can tell that gabapentin is wearing off by morning. Not sure why he has her on it just twice a day. Other folks seem to be giving it every 8 hours. But just these 2 meds alone gave us a great day ... Best in weeks. She was actuaaly playful last night for a long time. That has been gone for a few weeks. And her eyes are happier. Was afraid these would make her dopey but not bad. Giving her full dose of tramadol at night only...half dose in morning.

Reptigirl
31st July 2011, 04:11 PM
Just giving her the gabapentin and tramadol now... Holding off on prednisone and omaprazole until Pat weighs in. I can tell that gabapentin is wearing off by morning. Not sure why he has her on it just twice a day. Other folks seem to be giving it every 8 hours. But just these 2 meds alone gave us a great day ... Best in weeks. She was actuaaly playful last night for a long time. That has been gone for a few weeks. And her eyes are happier. Was afraid these would make her dopey but not bad. Giving her full dose of tramadol at night only...half dose in morning.


Our neuro had Flash on Lyrica 2X a day to start with... When I talked to her after 2 weeks of "evaluating" how the meds worked I told her that it seemed to wear off mid-day and she bumped him up to 3X a day. I think they are looking for the lowest dose possible to keep them comfortable.

Holly
31st July 2011, 04:28 PM
I had asked that question in a previous thread... if Gabapentin is known to wear out of the system in 8 or so hours, why would anyone prescribe it only 2/day?? It almost seems cruel to me to give them some relief, let it wear off for too long so pain is felt, then give relief again. I can tell when it's starting to wear off with Scarlett bc she will start scratching or bunny-hopping. I try to be really vigilant so it doesn't get to this point. Occasionally, depending on the timing, she will end up getting 4 Gabapentin in a 24-hour period. Both neurologists I have seen said Gabapentin is pretty safe and it's ok to give her more, if needed.

I had a dogsitter a few weeks ago when I was ot of town who told me that Scarlett was having a lot of issues while I was gone-- hiding under chairs, scratching, etc... I almost died when I looked at her pill box and realized that both days, she had completely missed her mid-day Gabapentin!!! So poor Scarlett was only getting her Gabapentin in the am and evening. I hate that that happened, but it sure is a testament to how well the meds work for her.

In my opinion, after dealing with this for a couple of years, I think it's good that you're thinking hard about the Pred and trying the other meds first to see how much relief it gives her. I am saving Pred as a "Big Gun" if other things stop being effective.

Pat
31st July 2011, 05:34 PM
Just giving her the gabapentin and tramadol now... Holding off on prednisone and omaprazole until Pat weighs in. I can tell that gabapentin is wearing off by morning. Not sure why he has her on it just twice a day. Other folks seem to be giving it every 8 hours. But just these 2 meds alone gave us a great day ... Best in weeks. She was actuaaly playful last night for a long time. That has been gone for a few weeks. And her eyes are happier. Was afraid these would make her dopey but not bad. Giving her full dose of tramadol at night only...half dose in morning.

I'll do a series of posts instead of one long one......This first post may sound like a lecture, but it is directed at all of us not just to you! It's just an opportunity to make an important point.

First of all - the comment that you were waiting for me to weigh in scared the you-know-what out of me! No one should make medical decisions based only on what someone says on an internet message board. Here is a good approach, especially when dealing with a clinician with whom you don't have an established relationship. This is what I do to establish credibility and get to a relationship where the clinician and I are part of a treatment "team":

1. Print out any and all valid veterinary resources to read, highlight, and use for a discussion. In this case, I'd print Clare's treatment algorithm for vets and also pages from Plumb's Veterinary Drug Handbook on all of the various drugs that you want to discuss - prednisone, gabapentin, tramadol, any NSAIDs, omeprazole, etc.

2. If there are questions that you have from reading message board input/feedback, I'd list them on paper to ask the clinician. But be very careful - when you start a sentence with "I read this on the internet" you almost immediately "turn off" a medical professional and put him/her on the defensive. So you want the clinician to understand that your main sources are valid veterinary references but that you also have feedback from folks with dogs with the same problem. That 360 vet website is an excellent source for material by the way. There is crap on the internet and there is valid information on the internet - you want to immediately establish that you are smart enough to know the difference!

3. IF you do not follow discharge instructions you MUST inform the clinician what you are doing and why and give feedback on the results. The fastest way to destroy a relationship is to not follow instructions and not inform the clinician until later. If you aren't able to have a phone discussion or in person discussion with the clinician, I've found it useful to send a carefully written fax or email, being careful to cite sources. My cardiologist has commented to me how helpful it is when I do that in between appointments, because he can ponder the situation and then phone me for a discussion. He says that this is a very efficient use of time.

4. If you establish a relationship of respect and partnership, with full disclosure of what you are doing and why, there should not be a problem if you choose to not exactly follow the clinician's recommendations. This (deciding a treatment course other than what was recommended) very rarely happens with me and any of my vet team, but if it does, the clinician knows that I have made an informed decision and that I accept responsibility for the consequences. I am a member of the treatment team, but I'm also the coordinator and I am the final decision-maker.

I'll do a second post with feedback.

Pat

Pat
31st July 2011, 05:40 PM
Next - Plumb's Veterinary Drug Handbook - I highly recommend that everyone with a dog, esp. with a chronic illness, purchase a copy of this. This is (in the US anyway) the "Bible" that all vets and specialists use in their practice. A new one comes out every few years.

I have the 5th edition from 2005 - I've been waiting for the 7th edition which just became available for purchase last week. You can get it on Amazon for about $75 - the best money you will ever spend. I'll order the 7th edition soon.

P

GraciesMom
31st July 2011, 06:05 PM
Did not mean to scare you poor Pat! I am collecting info from several sources, before I call the neuro office on Monday to go over questions about meds. Sadly, neuro gave me NO info on the meds in writing and very little orally....it was like here you go, this is your stuff and go home. We had to press for info and never got clear answer on why prednisone. Definitely not impressed with him...not going to have a partnership as he will not do the surgery or followup based on our findings. When I call back tomorrow, he will be on vacation and I can talk to another neuro in the same practice (another city) that I know to be more informative on meds. Wish we felt differently but he never allowed many questions on anything. Pat, you have great points on how to approach this discussion. If needed, I will mostly cite medical treatment protocols from Dr. Rusbridge, Sandy Smith, etc. because that is where most of my concerns are coming from.


I'll do a series of posts instead of one long one......This first post may sound like a lecture, but it is directed at all of us not just to you! It's just an opportunity to make an important point.

First of all - the comment that you were waiting for me to weigh in scared the you-know-what out of me! No one should make medical decisions based only on what someone says on an internet message board. Here is a good approach, especially when dealing with a clinician with whom you don't have an established relationship. This is what I do to establish credibility and get to a relationship where the clinician and I are part of a treatment "team":

1. Print out any and all valid veterinary resources to read, highlight, and use for a discussion. In this case, I'd print Clare's treatment algorithm for vets and also pages from Plumb's Veterinary Drug Handbook on all of the various drugs that you want to discuss - prednisone, gabapentin, tramadol, any NSAIDs, omeprazole, etc.

2. If there are questions that you have from reading message board input/feedback, I'd list them on paper to ask the clinician. But be very careful - when you start a sentence with "I read this on the internet" you almost immediately "turn off" a medical professional and put him/her on the defensive. So you want the clinician to understand that your main sources are valid veterinary references but that you also have feedback from folks with dogs with the same problem. That 360 vet website is an excellent source for material by the way. There is crap on the internet and there is valid information on the internet - you want to immediately establish that you are smart enough to know the difference!

3. IF you do not follow discharge instructions you MUST inform the clinician what you are doing and why and give feedback on the results. The fastest way to destroy a relationship is to not follow instructions and not inform the clinician until later. If you aren't able to have a phone discussion or in person discussion with the clinician, I've found it useful to send a carefully written fax or email, being careful to cite sources. My cardiologist has commented to me how helpful it is when I do that in between appointments, because he can ponder the situation and then phone me for a discussion. He says that this is a very efficient use of time.

4. If you establish a relationship of respect and partnership, with full disclosure of what you are doing and why, there should not be a problem if you choose to not exactly follow the clinician's recommendations. This (deciding a treatment course other than what was recommended) very rarely happens with me and any of my vet team, but if it does, the clinician knows that I have made an informed decision and that I accept responsibility for the consequences. I am a member of the treatment team, but I'm also the coordinator and I am the final decision-maker.

I'll do a second post with feedback.

Pat

Pat
31st July 2011, 06:17 PM
Crap - had almost completed a long post on all the drugs, and there was a power hiccup and my computer shut down and it was all lost. Going to compose in word so I can save along the way and I'll paste over here. It won't be as articulate because I'm so short on time. Back hopefully in a few minutes.

Pat

GraciesMom
31st July 2011, 06:24 PM
She is a vet tech and has the 2007 copy. She is going to let me borrow it for a week. YAY!

Kate H
31st July 2011, 06:39 PM
Debra wrote: Not sure why he has her on it just twice a day

We had a discussion about this a couple of weeks ago. 8 hours is the average time that dogs take to metabolise gabapentin - which means that some will need it more often and some less often. Clare Rusbridge advises starting on twice a day (ie 12 hours) and then adjusting it to suit the metabolism rate of the particular individual dog. Meds for SM are a matter of trial and error for a few weeks or months as you and your vet work out which drugs and which dosage control pain in your particular dog. I think all vets start low and then up dosage as required - if you start too high too quickly you run out of options sooner, and may find yourself backed into a corner with no more pain-control options. Whether a dog needs additional gabapentin can often depend on air pressure - many of us find our dogs need help when the weather is particularly stormy or hot. But as Pat says, you need to keep feeding information to your vet/neurologist and liaising with them, so that they have all the data they need to make informed decisions about adjusting medication.

Kate, Oliver and Aled

GraciesMom
31st July 2011, 07:03 PM
Thanks....this makes sense. Gracie was soooooo much better already on one day of meds. We did see return of scratching this morning on her walk until we got more meds in her...



We had a discussion about this a couple of weeks ago. 8 hours is the average time that dogs take to metabolise gabapentin - which means that some will need it more often and some less often. Clare Rusbridge advises starting on twice a day (ie 12 hours) and then adjusting it to suit the metabolism rate of the particular individual dog. Meds for SM are a matter of trial and error for a few weeks or months as you and your vet work out which drugs and which dosage control pain in your particular dog. I think all vets start low and then up dosage as required - if you start too high too quickly you run out of options sooner, and may find yourself backed into a corner with no more pain-control options. Whether a dog needs additional gabapentin can often depend on air pressure - many of us find our dogs need help when the weather is particularly stormy or hot. But as Pat says, you need to keep feeding information to your vet/neurologist and liaising with them, so that they have all the data they need to make informed decisions about adjusting medication.

Kate, Oliver and Aled

Pat
31st July 2011, 07:31 PM
Sighmy lost post was good and I dont know if I can reconstruct.

These are my thoughts based only on my research, extensive reading, and experience, and this may or may not be in alignment with other pet owners and with vets/neuros. I have no problem with others disagreeing!

My strong preference is not to start treatment for any condition with a cocktail of meds. You cannot assess positive results or side effects when starting with a cocktail how do you know what to attribute to which drug? How do you know that you need all of the drugs if you start them all at the same time, especially considering that the goal of treatment is to use the lowest effective dose and least amount of medications. I realize that with an acute and/or serious condition, you may not have a choice. This is one reason that I start treatment for acquired valvular disease before onset of acute CHF. I also realize that effective treatment for many conditions is the synergy between medications and that monotherapy is usually not possible with these chronic conditions. Still, if I can add in a new drug every week or so, that is my preference.

Gabapentin appears to be a very safe drug. This would be MY preferred first line drug for CM/SM pain. Because of the nature of CM/SM pain, I would probably start at three times per day to assess the effectiveness in order to achieve continuous and controlled pain relief rather than up and down pain control. The dosage could be raised rather than the frequency of dose if there is insufficient pain relief. If an every 8 hour dosing schedule was difficult for me, Id start with pregabalin at a twice a day dosage. (I did see Kates comment and it does make sense; I still think Id start on a lower dose three times per day.)

I would absolutely use a proton pump inhibitor because of research that Ive done. I would want to read more on potential GI side effects if I were to use one of these drugs. I read a bit on the SM yahoo list about three weeks on/one week off dosage for omeprazole to protect the GI tract so Id want to explore those ramifications before making a final decision. My personal preference would be not to use long term furosemide this is because of a good deal of experience with the drug and understanding the side effects, particularly on kidney function. (Obviously Ive used furosemide for CHF and will use it again.) Id want to add a proton pump inhibitor pretty soon after starting gabapentin a week or so after I was comfortable that there were no side effects from gabapentin. Holly, I can find no reference that omeprazole cant be used with prednisone. If you look at Clares chart, you can see that these two drugs can be used together. It does appear that she recommends discontinuing NSAIDS if steroids are started.

Tramadol also in my experience and research appears to be a pretty safe drug. Id want to have that on hand for added relief if the gabapentin was not sufficient and/or for special instances (storms, grooming, stress, etc.). Id not want to start gabapentin and tramadol together initially unless I saw that gabapentin alone was not enough to control pain on a routine basis. Ive used this drug long term for geriatric dogs for other medical conditions with no problems. There is the potential for addiction, but that does not concern me for a dog with a chronic illness. Note that Tramadol is not an NSAID. It is an incredibly inexpensive drug.

NSAIDS my PERSONAL prejudice is that I just will not use NSAIDS at any time for any situation. The only situation that would change my mind is for a medical condition where I couldnt achieve pain relief with any other treatment and for which euthanasia was the only alternative. This is because of what I know about potential for major organ (kidney and liver) failure as a result of NSAID use. Others disagree with my view, and vets happily prescribe NSAIDS routinely.

Prednisone there are 8 pages in Plumbs on steroids and its just too long to try to summarize here. The most serious potential side effects are Cushings disease, diabetes, pancreatitis, GI ulceration, behavioral changes, etc. It is a powerful medication with a lot of potential consequences. I have used prednisone in the past for various conditions including allergies and cancer. Tucker is currently on a temporary low dose for flea bite allergy. If I used pred for a long term, Id do my very best to move to alternate day therapy. There is more potential danger of problems on an immunosuppressive dose which is 1-3 mg (cant remember if per lb or per kg and dont have time to find reference). I would consider it in a case like Bevs Riley, but this would be a consideration only if all other treatments were insufficient. Id personally prefer low dose pred to NSAIDS, but thats my prejudice.

On a final note, I strongly disagree with the minimum recommended monitoring parameters for many of these drugs. If my dog were taking these drugs, particularly furosemide, prednisone and/or NSAIDS, Id do full blood chemistry including CBC and urinalysis every three months or so. Every 12 months is just not often enough to catch major organ damage BEFORE there are symptoms and when you have a reasonable chance of turning organ failure around and saving your dog, particularly when first starting these drugs or when changing dosage. Again, this is my personal prejudice based on experience. Id also never add potassium supplements UNLESS blood chemistry indicated low potassium this is unclear on the chart. There are consequences to high serum potassium levels, including fatal arrhythmias. Also, particularly with a senior dog, I would run full blood chemistry and urinalysis BEFORE starting furosemide, prednisone or NSAIDS to establish baseline organ function before starting the meds. This should also be done before starting meds for heart disease.

Pat

GraciesMom
31st July 2011, 07:53 PM
I am so sorry you had to start all over. I am amazed you tried again, but so happy you did. I am going to use your references and others, such as Dr. Rusbridge, for my conversation on Monday. I am most concerned about starting prednisone at this point when not at all evident it is needed. Gracie is now doing notably better with mostly gabapetin, except that it seems not to last more than 8 hours for her so far. I have only tried a small dose of tramadol at dinner last night so not sure that is having much impact yet.

My other concern is that neuro prescribed no proton pump inhibitor given size of her syrinx. So sad that each of these options comes with notable risks that must be monitored closely. I am not thrilled about furosemide as an option either. And... how ironic that omaprazole is a GI med that can cause serious GI issues!! kinda like heart meds causing heart attack. augh!!!! Are there any other options? guess not.

So much to consider and greatly appreciate the input so that I can raise questions more effectively.

Pat
31st July 2011, 08:25 PM
My other concern is that neuro prescribed no proton pump inhibitor given size of her syrinx. So sad that each of these options comes with notable risks that must be monitored closely. And... how ironic that omaprazole is a GI med that can cause serious GI issues!! kinda like heart meds causing heart attack. augh!!!! Are there any other options? guess not.

So much to consider and greatly appreciate the input so that I can raise questions more effectively.

That would be my concern also. I have not extensively researched omeprazole and cimitidine - which is another option - since I've never had to use those drugs. But I believe I would use one or the other if I were treating for SM.

Pat

GraciesMom
31st July 2011, 11:21 PM
The cimitidine has much less scary side effects and you could take it longer term... but may not be able to take it with the other meds for SM. Or at least it may dampen impact of the other meds. Not sure about that and going to check into it.

mommytoClaire
1st August 2011, 04:27 AM
Wow, great thread for anyone who has a CM/SM dog, or may have to face that issue in the future. Debra, I'm amazed at how quickly you are picking up all this information, and absorbing it. I know it will ultimately help Gracie. Hugs to you both. By the way, how is hubby doing now that th shock has worn off a bit?

GraciesMom
1st August 2011, 02:26 PM
It sure helped to have this board and CavalierHealth.org so that I was better informed than many people who go get an MRI and know nothing about this awful disorder. MommytoClaire.... Hubby is doing better.... but not sure he will do well if we do not try surgery. It is scary because I am not hearing some not so good experiences with the duraplasty (swine tissue), but not sure if that is because the two cases I know about had other complications or if the procedure itself was flawed. So now looking at Dr. Schubert in Gainesville at University of Florida or Dr. Mareno in Long Island, NY... if we decide to do this.

The meds are helping but gabapentin definitely not lasting long enough. Morning walks are the worst because meds have worn off. Am going to ask for 3 per day, every 8 hours. Probably will dose at 11 pm, 7 am and 3 pm. Also going to ask about omaprazole at least for short term until we decide about survery.

keekycat
1st August 2011, 03:03 PM
[QUOTE=GraciesMom;398252]I am so sorry you had to start all over. I am amazed you tried again, but so happy you did. I am going to use your references and others, such as Dr. Rusbridge, for my conversation on Monday. I am most concerned about starting prednisone at this point when not at all evident it is needed. Gracie is now doing notably better with mostly gabapetin, except that it seems not to last more than 8 hours for her so far. I have only tried a small dose of tramadol at dinner last night so not sure that is having much impact yet.

My other concern is that neuro prescribed no proton pump inhibitor given size of her syrinx. So sad that each of these options comes with notable risks that must be monitored closely. I am not thrilled about furosemide as an option either. And... how ironic that omaprazole is a GI med that can cause serious GI issues!! kinda like heart meds causing heart attack. augh!!!! Are there any other options? guess not.

I don't know if I'm speakng out of line here but as a nurse I do know that if a patient is started on prednisone, which is a steroid, then they are almost always started on a proton pump inhibitor with names such as cimetidine, ranitidine, protonix, prevacid, and omeprazole to name a few. I do not know what is usually used in dogs but a steroid is rough on the gi tract in humans and cause stomach ulceration or worse a GI bleed. I do know that I have been on prednisone twice myself and it gave me severe heartburn hence I used omeprazole when I was taking it.
:yuk:
I'm not sure if this is of any value but I do feel it's worth questioning your vet about.

anniemac
1st August 2011, 04:39 PM
I am very impressed at how much time and information you are gathering and asking important questions. I'm very proud of you and I think being on CT fortunately/unfortunately gave you a little bit of an advantage because the unfortunate part of others going through this.

Karlin wrote one time about surgery that she thought it was hard to judge success stories by message boards alone. For every success story she knew a not successful story. Sorry karlin if I'm not saying it correctly but her point was she wanted to know research results to judge success of titanium, swine etc. The reason I'm saying that is the 2 non success stories with swine tissue have no comparison. Do people post more not successful?

Just trying to play devils advocate. What you are doing by calling and gathering as much information first hand is great. Remember that you are the best judge of what surgery you feel best with given your research and also talking to the neurologist. All of those are factors and I know how great a mom you are so even though there may not be a "right or wrong" decision, I know you will make the best decision that is right for gracie.

Thinking of you!

Sent from my Droid using Tapatalk

Karen and Ruby
1st August 2011, 08:17 PM
The cimitidine has much less scary side effects and you could take it longer term... but may not be able to take it with the other meds for SM. Or at least it may dampen impact of the other meds. Not sure about that and going to check into it.

Hi Debra

Just my two cents on this point, both my dogs are on Cimetidine, Ruby for over two and a half years and Charlie just over a year.
Ruby has aken it alongside Lyrica (Pregabalin) for just as long and iit doesnt dampen the strength of the Lyrica- she is literally a normal bouncy dog on it and I add Metacam (Meloxicam) if she has a bad day.

Charlie has the occasional bad day where he has Gabapentin alongside it which also works really well alongside it.

I have full bloods and the whole screening every 3 months for Ruby and have never had any side affects from the combination.

But I have never used Prednisone and although I have a Prescription for Tramadol on an occasional need basis I haven't had to yet!

GraciesMom
1st August 2011, 11:16 PM
You all have brought up some things that I learned today in talking to the assistant to the neurologist who may do the surgery... they were very surprised we were prescribed prednisone without anything for the GI. And very surprised no proton inhibitor, which could help both situations. I do have a call in to the prescribing vet on call (Dr. Bergman) and did not get a response today. But do not plan to add prednisone at this time until I talk to him personally about this. I may well defer to the neuro in Florida who likely will do the surgery as he seems to have a protocol that is more consistent with what I have been reading. One thing he also recommends is adding one thing at a time... starting with gabapentin and then omaprasole or cimetidine. I was very impressed with his office today... fast response, very thorough, asked alot of questions and let me ask alot... a world of difference already! :p

Pat
1st August 2011, 11:55 PM
One thing he also recommends is adding one thing at a time... starting with gabapentin and then omaprasole or cimetidine. I was very impressed with his office today... fast response, very thorough, asked alot of questions and let me ask alot... a world of difference already! :p

AHA - he and I obviously went to the same school!!

Pat

anniemac
2nd August 2011, 12:13 AM
You all have brought up some things that I learned today in talking to the assistant to the neurologist who may do the surgery... they were very surprised we were prescribed prednisone without anything for the GI. And very surprised no proton inhibitor, which could help both situations. I do have a call in to the prescribing vet on call (Dr. Bergman) and did not get a response today. But do not plan to add prednisone at this time until I talk to him personally about this. I may well defer to the neuro in Florida who likely will do the surgery as he seems to have a protocol that is more consistent with what I have been reading. One thing he also recommends is adding one thing at a time... starting with gabapentin and then omaprasole or cimetidine. I was very impressed with his office today... fast response, very thorough, asked alot of questions and let me ask alot... a world of difference already! :p

I'm so glad you were pleased with the office. It seems quite a few people have said good things about them. I'm sure talking to someone directly made you feel better.

Sent from my Droid using Tapatalk

lovecavaliers
2nd August 2011, 03:46 AM
As far as the safety of omeprazole. I too was concerned after reading it could cause stomach cancer with prolonged use, however my neuro stated that was tested on rodents and has never been shown in dogs. He reports having many dogs in his practice on it for years with no adverse response. I also read this passage from Clare Rusbridge's website regarding Omeprazole:
- "This is also an antiacid and in laboratory rodents long term therapy has been reported to result in changes to the stomach lining. However this effect has not been reported in dogs. Reported adverse effects include nausea, diarrhoea, constipation and skin rashes"

If anyone has any recent studies regarding the dangers of omeprazole in dogs please forward them to me so I can bring them to my neuro. Jack has been on it for a year and a half along with Gabapentin and keppra, He gets bloodwork every 6 months and so far all has been good with his renal and liver functions.:xfngr:

Gracie's Mom so glad you found a vet who listens and is attentive, makes life a little easier when dealing with such a major illness.

Margaret C
2nd August 2011, 07:13 PM
Debra,

Just back from holiday and catching up with the news. I am so sorry it is SM.

You are really impressive in the way you are tackling this and you are getting some wonderful advice and support on this thread.

Sometimes I feel really proud to belong to this forum.



Hugs to you and Gracie :hug:

GraciesMom
2nd August 2011, 09:32 PM
Started omaprazole yesterday for first time since gabapentin went very well. No side effects that I can see. Gracie's poop just slightly softer, but not diarrhea for sure. Other than that, omaprazole seems to be very beneficial. Yesterday was our best day in weeks! She ran through the house at 9:30 pm with her usual zoomies that had been gone for 2 weeks or so. However, I never heard from the neuro clinic that did the MRI at all. So I let Dr. Schubert advise me on adding the omeprazole.

Anniemac and RodRussell may be interested in what Dr. Olby told my vet by phone. Glad I did not wait for her to come back from maternity leave! Here is a quick summary:

"She did research on this about 6-8 years ago and she found that ~99% of the Cavs that came into the study had MRI lesions/narrowing/scarring. But only ~20% of them had any clinical signs. Almost all of those 20% showed scratching as a sign. But NCSU only recommends surgery if there are more serious clinical signs, such as pain - only a handful got surgery. Mostly because even with different types of surgery, the scratching does NOT resolve.


If the symptoms are severe enough for surgery, she recommends the duragen to attempt to limit scar tissue.


If the symptoms are NOT severe enough for surgery, she recommends omeprazole, gabapentin, pred etc"


Now this is shocking to me because if you wait until a dog is in major pain instead of having the surgery to keep them from having such pain... why bother??? :confused: Surgery is not about totally resolving the scratching... it is also about preventing more serious complications when you have major malformation and notable syrinx. Some are lucky that meds can help them for a long time, but Gracie's odds are not great. Soooooo glad I did not go there.

anniemac
2nd August 2011, 10:11 PM
Now this is shocking to me because if you wait until a dog is in major pain instead of having the surgery to keep them from having such pain... why bother??? :confused: Surgery is not about totally resolving the scratching... it is also about preventing more serious complications when you have major malformation and notable syrinx. Some are lucky that meds can help them for a long time, but Gracie's odds are not great. Soooooo glad I did not go there.

Well different neurologists are going to have different opinions about surgery but this comment goes hand in hand about what someone told me that happened to them when they went to NC State. The technician or neurology student said they would only recommend a MRI, if their Cavalier was being vocal or in obvious pain. I told her that if she sees symptoms and is worried, "waiting for them to be showing outward pain by yelping" is not the way to go. She got an MRI elsewhere and her cavalier is being medically managed.

I am familiar with the study she is talking about that was done in 2006 since I know two cavaliers in the study (you have met one of course they no longer were bred etc). This is from Rod's website. http://cavalierhealth.org/syringomyelia.htm

"4June 2007: Development of Clinical Signs and CSF Flow: Dr. Natasha J. Olby (http://www.cavaliertalk.com/forums/neurologists.htm#Dr._Natasha_J._Olby), board certified veterinary neurologist, and Dr. Sofia Cerda-Gonzalez (http://www.cavaliertalk.com/forums/neurologists.htm#Dr._Sofia_Cerda-Gonzalez), both at North Carolina State University's College of Veterinary Medicine's Department of Clinical Sciences, reported in June 2006 (http://www.cavaliertalk.com/forums/NCSU_2006_SM_Reports.htm) that they and team members at IAMS Pet Imaging Center, Raleigh, NC. are in the process of conducting a three year study to determine whether abnormalities of the caudal fossa and cervical spine predict future development of clinical signs of SM.
The NC State/IAMS Pet Imaging Center team also has been studying the dynamics of cerebrospinal fluid flow in Cavalier King Charles Spaniels, and the extent to which head positions of the dogs affect the flow patterns. They reported in June 2006 (http://www.cavaliertalk.com/forums/NCSU_2006_SM_Reports.htm) finding that turbulent flow occurs in dogs with SM and can be found within syrinxes, and that CSF flow velocity may be higher within the dorsal subarachnoid space of affected dogs. They stated that additional studies are needed to determine whether their findings are significant. For more information, go to http://www.cvm.ncsu.edu/docs/neuro_studies.html or contact Dr. Cerda-Gonzalez at scerdag@ncsu.edu"

What is this, "she recommends the duragen to attempt to limit scar tissue"

Debra,

I'm very impressed with all the information you are learning and taking the initiative to call several places and even others on forum. Gracie is in the best hands!

GraciesMom
2nd August 2011, 10:29 PM
I think you are right that this is NC State's take on it. And just not where I want to be. It appears that what she calls duragen is same thing as using mesh or swine tissue to control scar tissue from surgery. I think her term implies swine tissue only, but not sure.

GraciesMom
2nd August 2011, 10:30 PM
I am a bit obsessive about research....he he!!

anniemac
2nd August 2011, 10:35 PM
I am a bit obsessive about research....he he!!

Well I have been since January 2010 and read stuff all the time but you seem to know more and picked up so much in such a short period of time. I guess my brain isn't that functional. Anyway, we can chat later.

GraciesMom
2nd August 2011, 10:59 PM
Well I have been since January 2010 and read stuff all the time but you seem to know more and picked up so much in such a short period of time. I guess my brain isn't that functional. Anyway, we can chat later.Just kinda figured out if the swine tissue application is called duraplasty...then duragen is related to it. Just confirmed in some article on human surgery that is completely full of medical jargon. You and I had to get going on research. We had no choice...

GraciesMom
2nd August 2011, 11:06 PM
Well I have been since January 2010 and read stuff all the time but you seem to know more and picked up so much in such a short period of time. I guess my brain isn't that functional. Anyway, we can chat later.It is not the swine tissue barrier for scar tissue... It is the material that dissolves over time. Dr. Schubert did use this for a while, but may have been another company that made it. Here is link for Duragen:http://integralife.com/Neurosurgeon/Neurosurgeon-Product-Detail.aspx?product=599&ProductName=DuraGen%20Plus%20Dural%20Regeneration %20Matrix&ProductLineName=Duraplasty&ProductLineID=28

GraciesMom
3rd August 2011, 04:30 AM
I think that Zumie brought up a question in another thread about watering, red eyes related to SM or CM. Since we have had Gracie on meds for 4 days, her eyes are not tearing nearly as much and the whites are whiter. I used to have to wipe her eyes fairly frequently, but just once or twice a day now. What could be the connection...or coincidence???