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Sabby
15th January 2012, 03:36 PM
Another dog at MT with SM. They are writing.
His condition seems to have been causing him little discomfort. Probably getting one or two episodes a day but with a little distraction or a cuddle the moment is over. He isn’t taking any pain relief as it's not been needed. It's a terrible condition but it may not get any worse for a long time if ever.
What are they talking about? Obviously they have not got a clue, if the vet says he thinks the dog got SM and it has episodes then it should be on pain medication or at least see a specialist. I can see that poor dog being adopted by someone and it be living in pain all its life. I already emailed them about the Cocker with the SM and the response wasn’t great.
BEING FOSTERED IN ROMSEY,
HAMPSHIRE

http://webzoom.freewebs.com/manytearsrescue/Dogs2012/Bo-Cav-10-01-12a.jpg
http://webzoom.freewebs.com/manytearsrescue/Dogs2012/Bo-Cav-10-01-12b.jpg
10-01-12 Bo is a handsome 3 year old male
Cavalier Spaniel. A kind fosterer has taken him on as he came to us as a result
of a marriage break up in the fosterer's area. He is friendly with other dogs,
walks nicely on a lead and is desperate for a loving home. He has been seen by
the vet today. We initially thought he had an ear or tooth issue but the vet
feels it is more likely to be Syringomyelia, a condition typical of Cavalier
Spaniels. Bo may not have a great deal of time but he needs a loving quiet home
to spend his retirement.

14-01-12 UPDATE
http://webzoom.freewebs.com/manytearsrescue/Dogs2012/Bo-Update-14-01-12c.JPG http://webzoom.freewebs.com/manytearsrescue/Dogs2012/Bo-Update-14-01-12a.JPG
http://webzoom.freewebs.com/manytearsrescue/Dogs2012/Bo-Update-14-01-12b.JPG
Bo
is just brilliant. So obedient, he’s been walking off the lead from day one. So
friendly, to both people and other animals. He’s out in the garden with my free
range chickens, ducks, rabbits cats and guinea pigs without any trouble just a
bit of interest. His condition seems to have been causing him little discomfort.
Probably getting one or two episodes a day but with a little distraction or a
cuddle the moment is over. He isn’t taking any pain relief as it's not been
needed. It's a terrible condition but it may not get any worse for a long time
if ever. He’ll give you all the love you can handle and in return all Bo needs
is to be loved, cuddled, played with gently and if you do have another dog it
needs to be very gentle and not dominating. Ideally you’ll be with him most of
the time as he loves and craves company and he’d be fine as an only dog, only
because he is such an attention seeker. If you have a home without too many hard
wooden floors and you’ll be happy to have this little fella curled up on the
sofa and bed with you, please consider taking him home with you, you won’t ever
regret it. [/SIZE][/FONT]

Margaret C
15th January 2012, 04:12 PM
I agree Sabby,

I wonder just what they mean by "one or two episodes" a day? Possibly scratching or face rubbing if they thought it was an ear or tooth problem.

"It's a terrible condition but it may not get any worse for a long time if ever.


This is not true in a dog that is only three years old. Whoever takes him on will presumably not be able to insure him.

Poor little dog.

I will write to Many Tears. Although I have sympathy with the problem that rehoming dogs diagnosed with expensive illnesses create for rescue groups, it is cruel to the dog and unfair to any prospective owner to underplay the problem of SM.

This is going to become more and more of a problem. Rescue groups need to be deciding how they will deal with the increasing numbers of affected cavaliers that will need veterinary help in the future.

Sabby
15th January 2012, 04:24 PM
I agree Sabby,

I wonder just what they mean by "one or two episodes" a day? Possibly scratching or face rubbing if they thought it was an ear or tooth problem.

"It's a terrible condition but it may not get any worse for a long time if ever.


This is not true in a dog that is only three years old. Whoever takes him on will presumably not be able to insure him.

Poor little dog.

I will write to Many Tears. Although I have sympathy with the problem that rehoming dogs diagnosed with expensive illnesses create for rescue groups, it is cruel to the dog and unfair to any prospective owner to underplay the problem of SM.

This is going to become more and more of a problem. Rescue groups need to be deciding how they will deal with the increasing numbers of affected cavaliers that will need veterinary help in the future.

Hi Margaret

I have emailed them about a month ago about the Cocker they got with SM. There reply was only to fob me of. You might have a bit nore luck. I don't know who answered my email but it wasn't Sylvia.
My argument is that the pay out for cataracts and deformed limbs so at least the should pay to see a neurologist.

MurphysMummy
15th January 2012, 04:42 PM
I find this quite upsetting..as will everyone who reads this and knows about Syringomyelia..I hope a willing person will come forward and adopt this little one and i hope they have great knowledge of SM and will do all they can for Bo.
I will keep fingers crossed that the issue gets sorted and that Bo will see a neurologist..Dogs with neuro problems must see a neurologist..same with dogs with MVD must see a cardiologist...He needs to see a specialist.

Karlin
15th January 2012, 04:45 PM
Many Tears really need to get proper medical advice. "Fob off" ... :X have heard that before in this kind of context.

They clearly are practically clueless about what this condition involves and the costs to owners and likelihood of progression in a symptomatic dog of these ages. And I do NOT like the sound of 'episodes' -- god knows what that means.

Sabby
15th January 2012, 05:14 PM
Many Tears really need to get proper medical advice. "Fob off" ... :X have heard that before in this kind of context.

They clearly are practically clueless about what this condition involves and the costs to owners and likelihood of progression in a symptomatic dog of these ages. And I do NOT like the sound of 'episodes' -- god knows what that means.


Well when you read the advert for the bunny hopping cocker the foster says that if you are thinking of taking this dog on you should read up about SM. Obviously they have not done that themselves. The two dogs on there should have pain relief before they get a new owner. Otherwise these dogs will live in pain forever.
I think people that don’t live with a dog with SM don’t have any idea how painful this condition is and they see the dog do a few quirky things and they think it’s ok the rest of the time because it’s not showing distress or it’s not screaming with pain. It’s ok because they can’t know but I wrote a nice sympathetic email explaining my situation and like I said they just fobbed me off. Al least listen to someone that has some experience with SM.

Sabby
15th January 2012, 05:20 PM
I find this quite upsetting..as will everyone who reads this and knows about Syringomyelia..I hope a willing person will come forward and adopt this little one and i hope they have great knowledge of SM and will do all they can for Bo.
I will keep fingers crossed that the issue gets sorted and that Bo will see a neurologist..Dogs with neuro problems must see a neurologist..same with dogs with MVD must see a cardiologist...He needs to see a specialist.

Yes but if the rescue plays down the SM and they think there is no need to see a neurologist then the new owners won’t go and see a neurologist until the dog is in extreme pain. In a lot of cases it will go back to rescue as not many people will want to pay the lifelong costs for treatment especially without insurance.

twinklepaws
15th January 2012, 05:23 PM
I think Many Tears is a fantastic rescue who are doing a great job at rehoming so many ex-breeding dogs.
But I agree with all of the posts above. They seem to have no idea about SM, and he will probably be adopted by someone who also has no idea.
He looks like a gorgeous boy, I really hope he goes to a knowledgeable new owner and gets the treatment he needs.

anniemac
15th January 2012, 05:27 PM
Many Tears really need to get proper medical advice. "Fob off" ... :X have heard that before in this kind of context.

They clearly are practically clueless about what this condition involves and the costs to owners and likelihood of progression in a symptomatic dog of these ages. And I do NOT like the sound of 'episodes' -- god knows what that means.

I don't like the sound of "episodes" either. I think of "flare ups" that we see with our cavaliers due to weather changes, stress, activity, the kind of thing you pray will not happen but is inevitable but you adjust medication etc.. It is upsetting to think what these episodes are. There is nothing good I can think of in relation to that word.

Kate H
15th January 2012, 05:33 PM
As the owner of a MT dog, I agree with everything that has been said. I know the presence of a serious and progressive disease makes finding homes for dogs more difficult, but adopters really do need to know what they are taking on. If it is already on his veterinary record that this dog probably has SM, no insurer is going to pay for it - it will be down as a 'pre-existing condition', and even if the dog only needs one full diagnostic scan in his life, the new owners are looking at a bill of £1000 plus, not to mention lifelong medication. It's simply not fair on the dog to calmly say 'Bo may not have a great deal of time' when he might be able to lead a normal, pain-free life with proper care. And you cannot say that a 3-year-old with twice daily 'episodes' (whatever that means) 'may never get worse'.

On the same topic, I would have appreciated knowing when I adopted Aled that I was taking on a dog with a heart murmur. With a grade 2 when I had him at 18 months, which went up to a grade 3 at 3 years old, it is potentially serious but so far he has no symptoms at all, and with previous experience I know how to deal with it and take care to keep him fit and slim. I think I would have adopted him anyway. But other new owners may not be so knowledgeable and will need information and guidance - which they don't get from MT because they don't seem to provide their Cavaliers with even a basic quick run-over by a cardiologist's stethascope to ascertain the level of a heart murmur. I'm sure they could persuade a cardiologist to do that for nothing!

Kate, Oliver and Aled

ByFloSin
15th January 2012, 07:24 PM
All this worries me too, both for the dog and for anyone who adopts him. I was told by Geoff Skerett's staff that because Rebel was asymptomatic at 6 years old it was unlikely that he would become symptomatic in later life, but despite all the expertise of the people at Chester Gates Rebel developed full blown symptoms 18 months or so later.

If experienced neurologists can make wrong predictions then who are MT, or their vet for that matter, to be able to say that a 3 years old with 'several 'episodes a day' will not deteriorate and require expensive diagnosis and treatment?

Locally, my own well meaning vet is often completely lost when faced with Rebel's comparatively minor symptoms, needing to refer elsewhere for expert guidance.

Kate H
15th January 2012, 07:47 PM
Going a little off-topic to pick up on what Flo said, I think some neurologists took time to accept that SM was a progressive disease even with older dogs. When Oliver at the age of 8 had a second mini scan two years after his first and it was clear that his very small syrinx had doubled in size (though still small), one of the neurologists at Cambridge that I spoke to casually about it expressed real surprise that the disease was still progressing in a dog of that age. At that time (2009) there seemed to be a belief that if dogs hadn't been diagnosed by the time they were 6 or so, or didn't have severe symptoms at that age, they weren't going to get any worse. How wrong they were... But if even some neurologists have been slow to accept the full implications of the SM epidemic, it's hardly surprising that vets who have to deal with many other diseases as well, and people in rescues who have never met SM before, can get it wrong. But they need to go out of their way to learn, because CM/SM isn't going to go away.

Even more off-topic, hope you're doing OK, Flo.

Kate, Oliver and Aled

ByFloSin
15th January 2012, 10:14 PM
Going a little off-topic to pick up on what Flo said, I think some neurologists took time to accept that SM was a progressive disease even with older dogs. When Oliver at the age of 8 had a second mini scan two years after his first and it was clear that his very small syrinx had doubled in size (though still small), one of the neurologists at Cambridge that I spoke to casually about it expressed real surprise that the disease was still progressing in a dog of that age. At that time (2009) there seemed to be a belief that if dogs hadn't been diagnosed by the time they were 6 or so, or didn't have severe symptoms at that age, they weren't going to get any worse. How wrong they were... But if even some neurologists have been slow to accept the full implications of the SM epidemic, it's hardly surprising that vets who have to deal with many other diseases as well, and people in rescues who have never met SM before, can get it wrong. But they need to go out of their way to learn, because CM/SM isn't going to go away.

Even more off-topic, hope you're doing OK, Flo.

Kate, Oliver and Aled

How right you are in what you say Kate. Also deviating from the topic, I have got out the workup sheet I wrote for the vet in January 2011. Rebel was scanned in June 2009 at 6 1/2 years. In June 2010 I noticed he was deaf. Looking back at photos I took though, it was evident between 2009 and 2010 that he had become photophobic, as one eye was closed in each of them, even though many were taken outdoors in low light. By last January other typical symptoms had manifested, culminating in the SM typical howling, which led me to seek urgent treatment from the vet.

My local all rounder vet was very sympathetic, but told me at the outset that this is her first job since qualifying and she hadn't any experience of SM. Since that time we have pored over Claire Rusbridge's treatment matrix many times, tweaking medication to suit Rebel's symptoms. The disease is undoubtedly progressive.

All this goes to show that neurologists can be wrong and small animal all rounder vets can learn to get it right. I wish that the vet used by MT can be pointed in the right direction to be as well informed about SM as my vet is becoming.

Thanks for asking Kate. The internal stitches have dissolved, leaving me still a bit sore but able to sit down without wincing. I am still sore of course and now waiting to hear when the course of chemo will start.:yuk: I have to go back to urology in 3 months for the delights of the follow-up cystoscopy :xfngr:

Karlin
15th January 2012, 11:06 PM
Actually all the core researchers I have heard speak on SM have always said it can have full blown symptomatic onset at any age. :(

Clare Rusbridge for example has stated this in her FAQ for years -- since her very first one was done. At least 5 years now and she was saying this when I first contacted her nearly 7 years ago.It is actually the case (by a VERY long stretch statistically) that there is a far smaller chance of an older dog without symptoms getting symptomatic, especially severely symptomatic, so Chestergates and Cambridge would have been correct in what they said as it is unusual but not totally exceptional -- but very unfortunate.

The vast majority of dogs that will have severe SM at any point in their life have symptoms before age three. Worst affected dogs tend to show symptoms before age 1. There will be exceptions and syrinxes, once there, tend to progress -- including in older dogs -- or can develop for the first time.

It's exactly the same in humans. Most people who get symptoms show symptoms around young adulthood but can be younger or older.

But different experts can have different opinions, and people may also not express themselves clearly or what they say might easily be misunderstood as well. And of course people can be wrong. :) I think earlier on some neurologists felt that dogs that scanned clear early would almost always be clear (not Clare Rusbridge who has always said age 2.5-3-ish seemed to be a significant point and dogs scanning clear younger could definitely still develop syrinxes -- and age 5-6 also seemed a significant point after which dogs were far less likely to scan with SM/ have symptoms if they didn't already and statistically this indeed turned out to be the case (in other words a more formal clinical study matched what they were seeing in practice).

That is why the breeding recommendations feel clears over 5 are important and Rupert's Fund focuses on finding those dogs for research. The genetic research indicates some dogs seemed to have some protective element against progression to SM or significant progression of SM.

Jaspar scanned clear at 1 at Chestergates -- 7 years ago -- and Geoff Skerritt told me then that though he looked unlikely to develop SM -- mainly as he had a fair amount of clear space around his brain and minor compression -- that there was no certainty. He scanned clear again at 5.

Definitely agree rescues must get up to speed on this condition especially breed rescue and one dealing with lots of cavaliers such as MT.

Spangly
15th January 2012, 11:16 PM
Hello Flo, Could I just ask what you mean when you say SM typical howling?
It's something Spangle has always done but I've not seen it mentioned before.
Christine

Spangly
15th January 2012, 11:17 PM
Hello Flo, Could I just ask what you mean when you say SM typical howling?
It's something Spangle has always done but I've not seen it mentioned before.
Christine

murphy's mum
16th January 2012, 12:50 PM
Oh this is just heartbreaking. I do hope someone with some knowledge of SM adopts this poor boy. To gloss over this condition in such a manner is just to disappointing to put into words, it is indeed a worry to think what they mean by episodes. It could mean anything to a scratching episode, to a full blown screaming session.

It needs to be made clear to any new owners of this dog that an appointment with a neuro is a must, but unless the rescue brushes up on SM, this clearly will not happen :(

ByFloSin
16th January 2012, 06:03 PM
Hello Flo, Could I just ask what you mean when you say SM typical howling?
It's something Spangle has always done but I've not seen it mentioned before.
Christine

Sorry to take so long to reply Christine. I've been off line since this morning and only just got back on.

Perhaps the word 'howling' was a poor choice. 'Screaming' is perhaps a better descriptor. If you have seen PDE, which may still be available on the BBC i player, there is a dog featured doing just that. The noise is absolutely eerie and difficult to describe, but I can tell you that once you have heard it you will never want to hear it again.

Margaret C
18th January 2012, 06:35 PM
Perhaps the word 'howling' was a poor choice.

You can get affected dogs howling or 'yowling' , not quite the same as a scream but still very distressing to hear.



'Screaming' is perhaps a better descriptor. If you have seen PDE, which may still be available on the BBC i player, there is a dog featured doing just that..

You can see that clip from PDE on my cavalierpuppy website: http://cavalierpuppy.co.uk/ckcs-health-about-sm/



The noise is absolutely eerie and difficult to describe, but I can tell you that once you have heard it you will never want to hear it again.

I will second that. Monty really screamed

Margaret C
18th January 2012, 06:47 PM
I wrote to Many Tears, directing them to this thread. See my email & the answer below.

My concern would be where does a prospective owner research SM information? I hope they are lucky enough to find this site.


.................................................. ...........................

"Margaret,


Thank you for your concern and for providing valuable information on the condition. Bo has of course seen a vet, and we understand he is uninsurable. We are working within our vets advise. Any new owner will be advised to thoroughly research the condition.

Best Wishes

Vicky


Many Tears Animal Rescue
www.manytears.co.uk (http://www.manytears.co.uk)
01269 843084 - 10am to 3pm
SA14 7HB


From: Margaret Carter [mailto:mareve-ckcs@ntlworld.com]
Sent: 17 January 2012 19:37
To: info@manytearsrescue.org
Subject: Bo, three year old cavalier with SM



Hello,



I appreciate what you do at Many Tears, and I know this is not the sort of feedback you need but I was very perturbed to read about Bo, the three year old cavalier dog that has SM.



"His condition seems to have been causing him little discomfort. Probably getting one or two episodes a day but with a little distraction or a cuddle the moment is over. He isnít taking any pain relief as it's not been needed. It's a terrible condition but it may not get any worse for a long time if ever".



I think that the seriousness of this problem is being underestimated, both in the amount of discomfort this dog is suffering and the financial & emotional cost to anyone taking on a dog with early onset syringomyelia.

This cavalier's SM is likely to get steadily worse and it is wrong to mislead people as to what they will be faced with.



SM is becoming an increasing problem in cavaliers. Recent studies show that 70% of cavaliers will have SM by the time they are 6 years old. The earlier the symptoms show the more severe the deterioration is likely to be. The diagnosis is expensive, the medication is expensive ( my dog's pills cost over £100 per month ) and whoever takes on Bo will now not be able to insure him.



There has been a thread on a cavalier chat forum about Bo. The owners posting are all owners of SM dogs. http://www.cavaliertalk.com/forums/showthread.php?40550-Another-Dog-at-MT-with-SM



Best wishes,



Margaret Carter

www.cavalierpuppy.co.uk (http://www.cavalierpuppy.co.uk)

Sabby
18th January 2012, 11:03 PM
I wrote to Many Tears, directing them to this thread. See my email & the answer below.

My concern would be where does a prospective owner research SM information? I hope they are lucky enough to find this site.


.................................................. ...........................

"Margaret,


Thank you for your concern and for providing valuable information on the condition. Bo has of course seen a vet, and we understand he is uninsurable. We are working within our vets advise. Any new owner will be advised to thoroughly research the condition.

Best Wishes

Vicky


Many Tears Animal Rescue
www.manytears.co.uk (http://www.manytears.co.uk)
01269 843084 - 10am to 3pm
SA14 7HB


From: Margaret Carter [mailto:mareve-ckcs@ntlworld.com]
Sent: 17 January 2012 19:37
To: info@manytearsrescue.org
Subject: Bo, three year old cavalier with SM



Hello,



I appreciate what you do at Many Tears, and I know this is not the sort of feedback you need but I was very perturbed to read about Bo, the three year old cavalier dog that has SM.



"His condition seems to have been causing him little discomfort. Probably getting one or two episodes a day but with a little distraction or a cuddle the moment is over. He isn’t taking any pain relief as it's not been needed. It's a terrible condition but it may not get any worse for a long time if ever".



I think that the seriousness of this problem is being underestimated, both in the amount of discomfort this dog is suffering and the financial & emotional cost to anyone taking on a dog with early onset syringomyelia.

This cavalier's SM is likely to get steadily worse and it is wrong to mislead people as to what they will be faced with.



SM is becoming an increasing problem in cavaliers. Recent studies show that 70% of cavaliers will have SM by the time they are 6 years old. The earlier the symptoms show the more severe the deterioration is likely to be. The diagnosis is expensive, the medication is expensive ( my dog's pills cost over £100 per month ) and whoever takes on Bo will now not be able to insure him.



There has been a thread on a cavalier chat forum about Bo. The owners posting are all owners of SM dogs. http://www.cavaliertalk.com/forums/showthread.php?40550-Another-Dog-at-MT-with-SM



Best wishes,



Margaret Carter

www.cavalierpuppy.co.uk (http://www.cavalierpuppy.co.uk)


Hi Margaret
That’s the reply I expected.
We are working within our vets advise. Any new owner will be advised to thoroughly research the condition. Obviously like a lot of vets their vet doesn’t know a lot about SM otherwise he would have recommended the dog to see a neurologist, if there are episodes then surly this need investigating further and I am sure the poor dog needs pain medication. Many Tears spend thousands on eye operations and broken and deformed limbs, I am sure they would have £350 to see a neurologist.

Karlin
18th January 2012, 11:25 PM
Obviously like a lot of vets their vet doesn’t know a lot about SM otherwise he would have recommended the dog to see a neurologist, if there are episodes then surly this need investigating further and I am sure the poor dog needs pain medication. Many Tears spend thousands on eye operations and broken and deformed limbs, I am sure they would have £350 to see a neurologist.

Agree, agree and agree. Alarming that this is all a vet seems to think needs doing. :yikes

Given the incidence of SM in the breed and the fact that rescue dogs are very unlikely to come from health tested dogs, and the large volume of cavaliers they have coming through, it would be wise for their vet to become more familiar with the realities and seriousness of the condition (or to find a vet who is well informed about SM).

I think too it is absolutely the responsibility of the RESCUE to learn about this condition and provide informed and HONEST information about SM not just to a prospective owner of a dog like this that has SM, and early-onset SM too which is not good; but to ALL who adopt a cavalier. This was the norm for me in doing breed rescue and owners of the breed as a general point need to be aware of the condition and its symptoms just as they do with MVD -- as both are endemic in the breed and can be costly to diagnose and treat properly.

A dog is hardly 'rescued' if it passes from the hell of a puppy farm into the hell of living with improperly diagnosed and poorly or untreated chronic pain. :(

murphy's mum
19th January 2012, 07:20 PM
Your reply was almost identical to the one they sent me Margaret.

Paula,

Thank you for your concern. Bo has of course seen a vet, as you will understand he is uninsurable. We are working within our vets advise, of course it would be wonderful to have the full range of diagnostics available to us but we simply do not have the funds. Any new owner will be advised to thoroughly research the condition.

Best Wishes

Vicky
Many Tears Animal Rescue

www.manytears.co.uk (http://www.manytears.co.uk/)
01269 843084 - 10am to 3pm
SA14 7HB

Not a satisfactory reply in my opinion :(

ZoeF
19th January 2012, 07:36 PM
What are we going to do about all these gorgeous and loving little pups that did not ask for this! I know of many charities etc out there raising monies but do we need another for Rescue dogs with SM?!?!
My little Dave had surgery for his CM 10 weeks ago and is doing well. Here's hoping the SM doesnt progress. He is such a happy little fella and only wants to be loved. We have had alot of dog napping in the area and we have even purchased a higher fence...the thought of anyone taking my boy with no meds, no idea of his condition and leading him to a life of suffering makes me feel so sick. I have met 3 owners and lovely Cavs in the last month all recently been diagnosed.

Zoe and Dave

Margaret C
20th January 2012, 11:22 PM
What are we going to do about all these gorgeous and loving little pups that did not ask for this! I know of many charities etc out there raising monies but do we need another for Rescue dogs with SM?!?!
My little Dave had surgery for his CM 10 weeks ago and is doing well. Here's hoping the SM doesnt progress. He is such a happy little fella and only wants to be loved. We have had alot of dog napping in the area and we have even purchased a higher fence...the thought of anyone taking my boy with no meds, no idea of his condition and leading him to a life of suffering makes me feel so sick. I have met 3 owners and lovely Cavs in the last month all recently been diagnosed.

Zoe and Dave


Hello Zoe,

Welcome to you & the very special Dave.

You are right, we do need a Charity for rescue dogs with SM, but it would be impossible to raise enough money to even start addressing the need. And the situation is going to continue to get worse.

With each dog needing £1,500 -£2,000 just for the MRI, what we could raise would be a drop in the ocean. All we can do is cross our fingers when we ask worried owners "is your dog insured"

For a long time now those of us that receive phone calls from stunned owners of suspected SM cavaliers have despaired about the cost of diagnosing syringomyelia.
We feel so helpless when the owners have no insurance, or a basic level that pays out only a few hundred per year for each new condition.

It haunts us to know that these hurting little dogs will continue to suffer because vets are dismissive until there is a diagnosis from a neurologist, and because owners will not allow themselves to believe how painful SM is when they cannot afford to pay for effective painkillers.