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View Full Version : Sobering comments from neurologist today...



GraciesMom
30th July 2011, 12:22 AM
I reported in the SM/CM thread on our MRI results, which were NOT good. We have a tough battle ahead. But not here to get into those details. Wanted to share this for discussion. When we were talking with neurologist before the MRI, he said he could not REMEMBER when he scanned a Cavalier that did not have at least some chiari malformation.... Including Cavs who were there for other symptoms or illnesses that required MRI. He thought it was at least 2 years since he had seen clear MRI. Now he did say that he sees much smaller % with major syrinx formation but that he kind of assumed CM in all Cavaliers, especially under age 7. This floored my husband, but I thought this was very consistent with statistics we have seen reported here. what do you think?

Love my Cavaliers
30th July 2011, 04:28 AM
All 4 of mine have had MRIs for various reasons although only Riley has SM, but they all have CM which was an incidental finding on two of the MRIs.

BrooklynMom
30th July 2011, 07:25 AM
This is interesting.

Out of curiosity...I know what happens when a dog has SM...but what happens when a dog has CM? Is that painful to them? Do they go on medications or have surgery? Does CM lead to SM?

If all of our dogs were to (for argument sake) have CM...would we all need to be "doing something" like medication, etc. or is CM just something they have with no treatments attached?

Sorry...still learning all of this!

Brian M
30th July 2011, 08:12 AM
Hello Deb

If you view any of my holiday vidos and watch Rosie my ruby ,she had a full MRI last Oct and has CM
but no SM .Can you see anything wrong with her ,NO.Would like to PM you later ,stay strong .

Karen and Ruby
30th July 2011, 02:29 PM
This is interesting.

Out of curiosity...I know what happens when a dog has SM...but what happens when a dog has CM? Is that painful to them? Do they go on medications or have surgery? Does CM lead to SM?

If all of our dogs were to (for argument sake) have CM...would we all need to be "doing something" like medication, etc. or is CM just something they have with no treatments attached?

Sorry...still learning all of this!


It depends really- my boy has CM with pain and he is on medication for it. He has a diuretic which works well for his pain

http://a2.sphotos.ak.fbcdn.net/hphotos-ak-snc6/38854_467375344992_698579992_6183572_5531685_n.jpg


However to any one else looking in they wouldn't think he has ANYTHING wrong with hm!!! He is still very very active and loves life and has more energy than most dogs I know BUT when we are quiet at home his scratching is beyond excessive and he has facial pain- which I know as the white of his eyes go very red and his eyes water alot and he paws at his face!

So I for one wouldn't be to quick to say that just because they are active, they don't suffer.

I am pleased that he is on medication and I will let you know at the end of the year whether it has progressed or not!!!

Blondiemonster
30th July 2011, 03:47 PM
I was told the same by the neuro. He even said that syrinxx formation is pretty common to some degree on a lo of the mri's. Still doesnt mean a dog is gonna show symptoms.

Love my Cavaliers
30th July 2011, 03:48 PM
Aside from Riley, my 3 with just CM without SM are all asymptomatic. I had MRIs done on two of them for something totally unrelated to SM so the CM was an incidental finding and for Oz it was to help me determine if what he had was EFS (episodic falling syndrome) or SM. I know they're not alike, but his first episode occurred right after Riley was diagnosed with SM so all I could think of was SM. His MRI was the day after her surgery - talk about stress!!! All his MRI showed was CM and he is totally asymptomatic of either EFS or SM at this time.

Holly
30th July 2011, 03:52 PM
This is interesting.

Out of curiosity...I know what happens when a dog has SM...but what happens when a dog has CM? Is that painful to them? Do they go on medications or have surgery? Does CM lead to SM?

If all of our dogs were to (for argument sake) have CM...would we all need to be "doing something" like medication, etc. or is CM just something they have with no treatments attached?

Sorry...still learning all of this!

I know of dogs with no syrinxes (SM) and moderate CM who have far worse symptoms than my Scarlett who has severe SM and CM. Such a mystery... :(

Nicki
30th July 2011, 04:03 PM
Cavaliers have the highest serotonin levels of any breed this is why they have such happy personalities and waggy tails - sadly it also means that they are very good at disguising pain.

Also when the adrenaline levels are high, when they are excited, out for walks, running, agility etc, they are not so aware of the pain - my severely affected dog could run and even clear a 5ft fence if he wanted to get to me!! My vet could not believe it..


Originally posted by Karlin:


25% of cavaliers with SM symptoms have CM only, not SM


That's according to a research sample of clinically affected, scanned cavaliers in the new research paper out from Clare Rusbridge et al. This is the same one Rod notes in an earlier thread about 76% of these dogs also had further syrinxes lower than the C5 vertebrae (and thus dogs with syrinxes are likely to be worse than a mini scan will show).

Abstract below, but this excerpt from the paper interested me as it suggests a hitherto unexpectedly large number of dogs with clinical signs of SM (all dogs in the study had clinical signs)-- one in four!!! -- have CM only -- which suggests people with such dogs really need to be treating it AS WITH SM, not attributing the problem to some other likely cause (something vets also need to recognise):

The median age of the dogs included in the study was 5 years (1.2–10.8 years). CM was present in all patients. None of the dogs showed compressive craniocervical pathology other than CM. There was no evidence of SM on MRI in 12/49 (25%) dogs. In all dogs with MRI evidence of SM (37/49; 75%), SM was present within the C1–C4 region (Figs. 2 and 3). Of those dogs with SM within C1– C4 region, 76% (28/37) also had SM within the C5–T1 and/ or T2–L2 regions, but only 49% (18/37) had SM within the L3–L7 region.


Abstract

Chiari-like malformation (CM) and syringomyelia (SM) is an important disease complex in the Cavalier King Charles Spaniel (CKCS) but data about the anatomical distribution of SM along the spinal cord are lacking in veterinary medicine. The objective of this study was to define the anatomic distribution of SM in CKCS clinically affected by CM/SM. Magnetic resonance imaging (MRI) of the brain and the entire spinal cord of 49 dogs was performed and different morphological parameters compared.

Syrinx formation was present in the C1–C4 region and in other parts of the spinal cord. The maximal dorsoventral syrinx size can occur in any region of the spinal cord and the total syrinx size was positively correlated with age. Seventy-six per cent of CKCS with a cranial cervical syrinx also have a syrinx affect- ing more caudal spinal cord regions. MRI restricted to the cervical region may underestimate the extent of SM and the severity of the disease
process in the majority of dogs.







from

http://www.cavaliertalk.com/forums/showthread.php?36821-25-of-cavaliers-with-SM-symptoms-have-CM-only-not-SM&highlight=asymptomatic



There are several dogs on the forum who have very severe symptoms ***just*** from CM.

Sadly too many people are not aware of what to look for and many dogs suffer needlessly.




Briian, it's great to hear that Rosie is doing so well but can I remind you that you were the one who was so worried about her:



Yesterday Rosie yelped twice then came straight over and sat by me for comfort, then later on she had trouble sitting bending down and scratching with her back foot under her chin and she was very wary of twisting her body when she moved .

You reported she was chewing her feet and scooting excessively, despite her anal glands being clear - this led to her being MRI'd. In the past you have posted about her yelping "for no reason" and the vet not being able to find anything, and her being clingy at those times [many of us who have lived with symptomatic dogs report this with our dogs - they are very clingy when they are not feeling so good]

Karlin and others have commented to you that she may have symptoms as a result of CM http://www.cavaliertalk.com/forums/showthread.php?35882-Rosie-s-Problem-and-Chestergates&highlight=Chestergates

one of your original threads

http://www.cavaliertalk.com/forums/showthread.php?35777-Rosie-s-Problem-Advice-Please&highlight=Chestergates



Are you now saying that Rosie shows NO symptoms whatsoever???

Pat
30th July 2011, 04:44 PM
Cavaliers have the highest serotonin levels of any breed this is why they have such happy personalities and waggy tails - sadly it also means that they are very good at disguising pain.


Nicki,

Can you give citations for the above statement? I've heard this once before but I've never found the basis for this statement. If it is from the research in heart valve cell structure by Chris Orton and Mark Oyama cited below, I don't know if one can extrapolate to the statement above. Have you read research that makes that extrapolation? I've looked and can't find anything, and I'd be very interested to read anything on this.

http://www.akcchf.org/research/funded-research/1529.html

http://purinaproclub.com/Dog/ResourceLibrary/BreederResources/TodaysBreeder/e06cfeaa-e631-4f31-bfa5-f0976ec8dd5d/43894752-95d9-4fba-b3ef-fe0eac49841e

Thanks!

Pat

Nicki
30th July 2011, 07:16 PM
It's maddening Pat as I can't remember where it comes from :( I'm very careful where I research so I know it's not just something I've picked up on the Internet and I'm pretty sure one of the neurologists [poss Clare Rusbridge?] quoted it too.

I've done quite a bit of research into pain and know that in Fibromyalgia one of the reasons for the patient experiencing high levels of pain is low serotonin levels. It is recognised in pain management - but I can't quote any studies unfortunately.

Thank you for sharing those links - I didn't have those so they will be useful to read. I hadn't appreciated the link with MVD.

Pat
30th July 2011, 07:24 PM
Thanks! If anyone can find any citations I'd be grateful - I'm having a very hard time accepting that without references!

Pat (one of my college roommates once told me that my initials - PB - were an acronym for "picky bitch"!!!! She did say it with love!!)

Zumie05
30th July 2011, 07:26 PM
when we are quiet at home his scratching is beyond excessive and he has facial pain- which I know as the white of his eyes go very red and his eyes water alot and he paws at his face!

Out of curiosity, is redness in the whites of the eyes and watery eyes a symptom of pain in general? I have noticed that Coco's whites will occasionally go red, and on/off she has bouts of weepy eyes. She doesn't rub or scratch at her face however, but makes me wonder, especially with knowing that high seratonin levels disguise pain...as Coco is an exceptionally happy Cav.

GraciesMom
30th July 2011, 08:32 PM
Hey Brian M, The neuro did not get into details on how many he finds with CM that do or do not have a syrinx, just that it was definitely less. I do know quite a few dogs with MRIs that show CM, but no formation of syrinx yet. I am always relieved to know of any Cavaliers that do not have SM as a result of CM.

It is true that some have malformations in CM that result in symptoms, while others do not. Gracie has a pretty severe malformation with scar tissue, so that alone could cause some symptoms as I understand it. But most of her symptoms are classic SM signs.

Zumie... I have no idea about the eyes. I do know that Gracie has always blinked her left but her right eye does not blink as much. It also tears more, probably because she can't blink it as well. Her worst symptoms are on the right due to location of syrinx and malformation. I do not think this would be a coloration of the eyes issue... but who knows??

Kate H
30th July 2011, 10:04 PM
Oliver has a small syrinx which doesn't seem to cause any problems. Due to CM he has severely dilated ventricles, the cavities in the brain through which the cerebro-spinal fluid (CSF) passes - or should pass, but the CM slows down the flow of CSF and it backs up in the ventricles, pushing the brain outwards. So with Oliver the pressure from the ventricles interferes with the mechanism of his pupils, which close slowly and not completely; strong light therefore gives him a headache. His pupils are dark red. He also gets a headache when he lies flat on the floor with his head between his paws (the Cavalier Prayer Position!), presumably because the pressure of the floor moves through his jaw and up through the back of his eyes and meets the pressure from the ventricles. If I turn him gently on his side he immediately gets more comfortable. Because the ventricles are effectively cavities partly full of fluid which sloshes around finding its own level, Oliver is also affected by changes in air pressure outside. This result of CM is something that can potentially affect any dog with CM - how many of them are living with headaches because their owners (and even vets) don't recognise the symptoms of pain?

PAT: Dr Oyama's talk on his research into the connection between seratonin and MVD was a video a couple of years ago - Tania transcribed the talk and made it available to anyone interested. You should be able to find her link to the original video in the archives - if I can lay my hands on my copy of the transcription I'll check what it says about seratonin and pain, but at the moment it's gone walkabout!

Kate, Oliver and Aled

Brian M
30th July 2011, 10:51 PM
Hi Nicki

I think all responsible Cavalier owners should be and are concerned when they know there is something wrong and of course I was worried stiff about Rosie as I didnt know what was wrong ,it was her yelping and not jumping up that concerned me most, so I did speak to many learned Cavalier people and explained what I saw and none thought it was Sm .One is a great lady and a President of one of the clubs and has had SM dogs herself but she doubted it was Sm .And after Rosie's MRI with Mr Deutchland
and a thorough physical it was found it was CM and with a comment from him that he doubts if SM will occur,the yelping and her not jumping was confirmed by him and Mr Ben Keeley to be a back and disc problem ,she still chews her feet but Dermacton stops that and her anal glands are fine thanks to feeding Raw .I have never
said she has no symptoms now, but if one views any of my recent videos she seems absolutely fine and her surgeon Mr Ben Keeley confirmed
this only last week, but of course one never knows with Cavaliers what may happen next week .A phrase always comes back to me said to me by "Barbara Reese" ,"you know your own dog best" and I knew Rosie did not have SM .So I am happy she has no pain and runs normal eats normal and is normal ,I have had a complete MRI and many consultations with her neuro Mr Deucthland and we have seen an orthopaedic surgeon Mr Ben Keeley had XRAYs and consultations and both of them are happy and have no reason to want to see her again , so what can I do now ?If she is fine should I not rejoice .


Here she is, does she look poorly ?



http://www.youtube.com/watch?v=-jQLyNc4Zp4











http://www.youtube.com/watch?v=ATL7xrMW58Y&feature=related






http://www.youtube.com/watch?v=1QCR7e6BiIA&feature=related

Sabby
31st July 2011, 05:44 PM
Hi Brian
I am so glad your Rosie is doing great. And I know you have been to all the specialists and had an MRI done.

Can I just say one thing? If anybody has read the report of my Ebony’s MRI Scan about her CM/SM and her degenerating discs, it doesn’t make good reading. With everything that is wrong with my Ebony she will play and run just the same like your two in the video if I would let her. She is the liveliest out of my three. I have such a hard time not letting her do anything like this. When people look at Ebony and I tell them what is wrong with her they look at me if I am lying.

GraciesMom
31st July 2011, 07:10 PM
I will always hope that your Rosie does NOT develop SM. They can have some symptoms from just CM too, but I am no expert on that for sure. Monitoring her is the best you can do until we have concerns that more is going on.

Brian M
31st July 2011, 08:57 PM
Hi Sabby

Pls keep us all posted how beautiful Ebony is getting on.I am sure she will be back to herself soon as with you taking care of her as
you are too kind and caring a person for her not to ,Sabby she couldnt be in better hands than with you .Debra I too hope Rosie's condition does'nt
worsen but like all us Cavalier owners we can only watch and pray but when one looks at all those grim statistics and reads all the
posts from many owners I dont really know .I suppose we can only just concentrate on this minute and enjoy them now and try not to be to fearful
for the future otherwise the love and pleasure they give we would not be able to enjoy and return,and as you rightly say we can only watch and hope.

Bestest Wishes

bri

pos,daisy,rosie and lily

RodRussell
1st August 2011, 01:19 AM
Originally Posted by Nicki
Cavaliers have the highest serotonin levels of any breed this is why they have such happy personalities and waggy tails - sadly it also means that they are very good at disguising pain.


Nicki,

Can you give citations for the above statement? I've heard this once before but I've never found the basis for this statement. If it is from the research in heart valve cell structure by Chris Orton and Mark Oyama cited below, I don't know if one can extrapolate to the statement above. Have you read research that makes that extrapolation? I've looked and can't find anything, and I'd be very interested to read anything on this. ...

I can find these quotes:

"Healthy CKCS dogs had significantly higher serum 5HT [which is serotonin] concentrations than other healthy dogs predisposed to DMVD." Serum Serotonin Concentrations in Dogs with Degenerative Mitral Valve Disease. Arndt JW, Reynolds CA, Singletary GE, Connolly JM, Levy RJ, Oyama MA. J Vet Intern Med. Nov/Dec 2009;23(6) 1208-1213.

"Interestingly, Cavalier King Charles Spaniels, which are highly predisposed to DMVD as well as macrothrombocytosis, had significantly higher serum 5HT concentrations than did other breeds of dogs." Insights into Serotonin Signaling Mechanisms Associated with Canine Degenerative Mitral Valve Disease. M.A. Oyama and R.J. Levy. J Vet Intern Med Jan/Feb 2010;24:27–36.

I recall watching a video of Dr. Oyama discussing this topic, from the AKC/CHF's National Parent Club Canine Health Conference in October 2009, at which he discussed his on-going research on this topic. I do not recall him going so far as to suggest that maybe the high level of serotonin in CKCSs is the reason for their temperament. But I do recall it being suggested by email posters who had watched the video. Dr. Oyama's October 2009 video is here
http://www.akcchf.org/news-events/multimedia/video/matters-of-the-heart.html
I have not re-watched it since it was first put on-line. Maybe someone could take the time to do so and let us know if he did suggest a link between the serotonin levels and the CKCS temperament.

I recall he said that he is studying a serotonin receptor blocker (which I think probably is either ketanserin, a 5HT-R2A receptor blocker, or GR55562, a 5HT-R1B receptor blocker). The concern of the email posters was that these blockers could reduce the serotonin levels and thereby change the personality of the breed.

All of this and much, much more about serotonin research may be found at
http://cavalierhealth.org/mitral_valve_disease.htm#diet_and_drugs_to_slow_th e_progression_of_MVD

RodRussell
1st August 2011, 01:52 AM
Okay. I found this:


Over the years I have met a few people who have taken Serotonin to lift their spirits! Dr. Oyama mentioned out of all the dogs The Cavaliers are the Happiest Dogs in the World! probably because of the high levels of Serotonin. In laymans language, does this mean when MVD was not around, would the temperament of the Cavalier been different? Are the high levels of Serotonin relatively new. I will have a transcript of this around Wednesday if anyone would like a copy.

This is from the thread titled : "Dr. Mark Oyama's October 2009 Video on MVD" at http://www.cavaliertalk.com/forums/showthread.php?33777-Dr.-Mark-Oyama-s-October-2009-Video-on-MVD

anniemac
1st August 2011, 04:06 PM
Reading this yesterday got me a little upset but not at the statistics but because I think I took things the wrong way or I want to say how I feel. I don't want to point anyone out but I would like to say again that Cavaliers in pain with CM alone or with CM/SM should be treated the same emotionally. Thank you Nicki for pointing this out. There are many on the forum that have Cavaliers on several medications treating CM pain. I am NOT saying this to rise any debate but simply to be considerate of those.

However, even if Cavaliers have higher seratonin, I don't know if this is brought up to explain why some show symptoms with CM alone. I think Kate has done a great job explaining some of it without the reference of seratonin. I don't think these with extreme symptoms just don't take pain as well as others. There are many questions but can we just be thoughtful of those that need support also. There is more than just an increased level or decreased level to show symptoms.

Karen and Ruby
1st August 2011, 09:57 PM
Out of curiosity, is redness in the whites of the eyes and watery eyes a symptom of pain in general? I have noticed that Coco's whites will occasionally go red, and on/off she has bouts of weepy eyes. She doesn't rub or scratch at her face however, but makes me wonder, especially with knowing that high seratonin levels disguise pain...as Coco is an exceptionally happy Cav.


Hi There!!

It's a long story but I will share- its not a research approved symptom or anything like that but I do keep a close eye on the eyes as that was one of Ruby's major signs before she was pain medicated.

Ruby's eyes, from the age of 18 months or so onwards weeped EXCESSIVELY to the point where we had all sorts of tests done at the vets and even considered possible surgery of somesort to clear out her tear ducts or something like that- it was over 3 years ago!!
Anyway I would hae to dry her eyes constantly through out the day (every hour or so) and more so when the weather was hot. The area around her eyes was constantly wet.

When I first saw Dr Rusbridge I menioned the tearng and said I considered it a symptom of pain and she found it quite interesting- Rubys eye are a beautiful Hazel colour, full of wisdom and they aren't particularly bulbous-(unlike my Charlie which Ill get to in a min) so therefor don't see the whites of her eyes.
The weeping stopped one day after her first dose of Lyrica, our miricle drug, I consider the tears a sign of a bad day and for me it makes me think seriously about upping her dose for a bit to help her out. I mentioned my findings to Dr Rusbridge and she was very interested!


Now on to Charlie- he has very prominant eyes, they are 'boggle' eyes as I call them and he has one eye which isn't formed properly so when he looks straight on at me one eye is facing to the left! The whites of his eyes are obvious and can be seen all the time.
His eyes weep alot too and the 'bad' days that he has- i.e. more stratching and head rubbing, will be teamed with his eyes being quite blood shot!
I should mention that at the time of his MRI he had massively dialated ventricles that is thought to be the casue of his headaches more so than the malformation which isn't as cramped say as Rubys
I wonder often whether the pressure on the brain and the build up of pressure behind the eyes (Charlie also has a much smaller head than Ruby) is the cause of the tears and the redness!!


Anyway- like I say, my findings are just my findings and not the symptoms that you find listed for SM/CM but I certainly think its worth thinking about!!

Nicki
4th September 2011, 05:07 PM
Okay. I found this:



This is from the thread titled : "Dr. Mark Oyama's October 2009 Video on MVD" at http://www.cavaliertalk.com/forums/showthread.php?33777-Dr.-Mark-Oyama-s-October-2009-Video-on-MVD


Thank you so much for posting these Rod that's very helpful