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BrooklynMom
14th December 2012, 03:27 AM
Hey everyone! It's been a while!!

As you know I adopted a 6 year old cavvie to add to Brooklyn and I's family about 5 months ago - well, we had o have him MRI'ed recently as he has been head rubbing and randomly yelling and showing other odd behaviours that we could not explain in any other test.

Well, his MRI actually came back pretty good (better than I thought!) but he has what the neuro is calling a pre syrinx in the cervical spine through the C4 and C5.

Can someone help me understand more about a "pre syrinx"? We are putting him on 100mg of Gabapentin three times a day to start, as she is unsure if the pre syrinx is causing pain or not. Any one familiar with this?

He has no CM and his ventricles are good too.

Any thoughts would be so helpful - I love this little guy so much.

Thank you!

BrooklynMom
14th December 2012, 07:54 AM
Here is his MRI image

http://farm9.staticflickr.com/8478/8270978857_a18ec642c6_z.jpg (http://www.flickr.com/photos/32200327@N02/8270978857/)
Toby MRI Image (http://www.flickr.com/photos/32200327@N02/8270978857/) by kelseykakes5 (http://www.flickr.com/people/32200327@N02/), on Flickr

Soushiruiuma
14th December 2012, 09:40 AM
I'm certainly not an expert, and we have many on this forum who truly are SM experts. But I'll put forward my best understanding of a pre-syrinx. I'm a very visual person, so everything gets described in terms of images.

As best I understand a "pre-syrinx" is an area that has signs of moving towards being a true syrinx, and will probably get there if allowed to continue. In my mind I always see the meteorologists tracking storms as they come across the Atlantic (New Orleans native, this is probably a very culturally constrained view); the storms start as just some clouds milling around together, and then build. Through satellites they can watch as the little puff of clouds forms and develops into a major hurricane. The same with a syrinx, a pre-syrinx would be sort of at the same stage as a tropical depression or tropical storm, where they can see the organization and pressure changes, but it isn't big or strong enough to be considered a full syrinx.

I hope that makes sense.

Edited to add: I believe the approach is to treat the symptoms, rather than the "syrinx"; so if he is having problems, even with a "perfect" MRI, then the right thing to do is to try to relieve his pain, and see how he responds.

Karlin
14th December 2012, 11:49 AM
Good post Soushiruiuma -- like the meteorological explanation and the note at the end to treat symptoms and not be too concerned about the status of the syrinx. :thmbsup:

BrooklynMom, so sorry you are going through this. :( Hopefully things will stay where they are -- in an older dog with a presyrinx, odds are good it won't get a lot worse -- and you may actually be getting most of the symptoms from CM not SM (I would think this is the case -- maybe your neurologist could email Clare Rusbridge?). So yes, treat for the symptoms.

A pre-strinx is indeed the sign of a possible syrinx developing, a slight dilation (expansion) in the spinal cord that is not yet large enough to actually be considered a syrinx. I'd strongly recommend getting Toby on a CSF inhibitor as well, as Clare Rusbridge has occasionally seen prexyrinxes reduce or disappear from using a CSF inhibitor (eg cimetidine -- neurologists are not recommending frusemide any longer). For CM pain sometimes a CSF inhibitor works better than gabapentin. So you might try the CSF inhibitor first for two weeks and if discomfort isn't resolved, add back the gabapentin? I know this is the route Dr Rusbridge has taken with CM dogs (and in accordance with her own treatment algorithm). I am sure your neurologist is aware of her website and materials.

Let us know how he does! :flwr:

sins
14th December 2012, 06:48 PM
My understanding of a pre syrinx is that it is an accumulation of fluid within the spinal cord substance,rather than having formed a distinct fluid filled cavity(syrinx).
Clare Rusbridge has a very useful FAQ section on her website which explains all the definitions and terminology about the full spectrum of CM/SM and it's well worth taking a look through it.
http://www.veterinary-neurologist.co.uk/part1.htm
If he were my dog,I'd be happy to try the CSF inhibitor and see if that made a difference.I guess just use the minimum firepower to control the symptoms rather than weighing in with heavy duty meds...It's not a bad scan for a six year old and he may never progress to full syrinx formation.I would also keep an open mind about other possible conditions which may be causing his symptoms.
Sins

Karlin
14th December 2012, 07:32 PM
Yep that's it!

From Clare's FAQ:



What is pre syrinx?

The first stage of syrinx development appears to be (interstitial) oedema i.e. fluid within the spinal cord typically around a dilated central canal– so called pre-syrinx. The fluid is within the spinal cord substance rather than coalesced into distinct cavities.


There's also an image. And yes would def recommend everybody who owns this breed, reading the full FAQ to be up to date on knowledge about the condition. :thmbsup:

BrooklynMom is already acquainted with the stages of SM though... :(

karen baker
14th December 2012, 10:44 PM
Very interesting, posts explaining the cm/sm scans, i think i,am beginning to comprehend it a little better, i,am used to working in theatres with people, i had ruby scanned in april 2012, and worry that maybe i,am not doing all i should be for her, shes not actually showing any neurological signs, she has psom which showed on mri, she is very deaf, in there opinion surgery is not very satisfactory, and relapses are frequent, thats ok, we are adapting!!! she has cm/sm the syrinx is very similar to the one posted earlier, but i worry that i may be missing something, on her scan its comments : Today, the syringomyelia is not severe, and no neurological signs are related to this condition. I feel sure that ruby is,nt showing any major issues in regards to pain, she will be 7 in march, but they did want to scan her lower back, but i declined, (BECAUSE OF THE EXSPENSE), as i thought she could have disk problems, she would have episodes of pain on jumping, climbing stairs,getting into car, she would yelp, but touch wood shes not had a problem for about a year, she does,nt run now, but will break into a little trot, but is quite happy to walk, but trails behind, i was told recently she has grade 2 heart murmer, she is 12kg, and has been on a diet for 6 months through the vets, the weight just won,t come off, shes on royal cannine for neutered adults and has 50grams in the morning and 50 grams in the evening, in contrast sadie my rescue cavalier, an ex breeeding bitch, seems to be fine, 8kg and runs like a whippet, she is,nt displaying any signs of health problems she is 8 years, not mri scanned at this moment in time, but has had a troubled past. Am i just looking for something to worry about? Karen, Ruby and Sadie x

Karlin
14th December 2012, 11:08 PM
she would have episodes of pain on jumping, climbing stairs,getting into car, she would yelp, but touch wood shes not had a problem for about a year, she does,nt run now, but will break into a little trot, but is quite happy to walk, but trails behind,

Personally if she were my dog I'd think about talking to a vet or neurologist about trying her on some of the SM medications to see if they help. I do think she is showing neurological signs -- those would all be typical signs of some compromise/pain caused by CM/SM (yelping, difficulty jumping up, reluctance to run...). If she scanned with a syrinx of any size it is more likely I would think that this is affecting her than possible disk disease. Dogs do often grow to tolerate pain over time so this could be why she stopped showing signs with jumping, or maybe that particular pain eased...? But if she has disk disease this too should be diagnosed and treated -- often that can be done with an xray if pain returns.

I do think though that if she isn't willing to run, this is significant and should be looked into as she is compensating for some sort of ongoing pain, whether caused by CM/SM or disk disease.

karen baker
15th December 2012, 12:00 AM
Thank you Karlin for you advice, it makes sense now you,ve explained, i think maybe i,ve been too accepting, in what i,ve been told, i would love to see my Ruby run again!! But there just seems to be so many drugs, that they have to take for this condition, i don,t want her to be in pain, and i want the best for her, how do i know exactly what is necessary, i don,t want her pumped with endless amounts of drugs, my vet suggested metacam once daily 10kg for 4 weeks, back in the summer, but to be honest i did not see any difference. Do you think i should pursue this further? karen

Karlin
15th December 2012, 11:35 AM
Metacam rarely seems to works well on its own for CM or SM pain. I'd have your vet have a look at Clare Rusbridge's site (linked above) and consider trying some of the steps on her treatment algorithm if s/he feels there might be a relationship to Ruby's behaviour. Or ask to see a neurologist -- as she has been scanned, it should be possible to start her on a treatment programme, I think? Ruby is a relatively young dog to be unable now to run at all so I'd really think there would be a lot of scope for improving how she is feeling, whatever the cause. :)

Usually what would be done would be to try something like cimetidine for a couple of weeks; if no improvement try adding in gabapentin.

I've never found either of these medications affects in any negative way, my dogs that are on them. Of course there are always some risks to watch out for -- that's why Clare recommends annual blood tests just to monitor any changes. But Leo has had no issues at all in 8 years on these meds and they give him a very good quality of life. He can run and jump and play. I sure don't advocate overmedicating (or over-supplementing, for that matter) a dog -- but using meds to ease pain and give back quality of life is never over-medicating.

I'd also just want to add that some dogs are naturally not that playful with other dogs and a lot of adult dogs have no interest and are very annoyed by puppies, for example. Mine like to run and race but only two of them really play together (tug of war or fetching the same item back). I'd differentiate between unplayful behaviour that might just be an individual dog vs behaviours that could be or almost certainly are related to some physical disability or compromise (being reluctant to run, jump, interact). In other words, as relates to a separate thread, a dog that is simply a bit annoyed with puppies wouldn't immediately be a cause for concern to me! -- none of mine really likes puppies!! But a dog that is unhappy with many or most interactions, never is very playful or full of life, resists or totally avoids much activity, yelps now and then -- that would be a cause for concern that more is going on.

karen baker
15th December 2012, 08:10 PM
Thank you, i,am going to make an appointment for Ruby, after all nothing ventured nothing gained, i,am sure that one of them at my vets has good knowledge of this condition, i,am hoping they are aware of Clare Rusbridge's site, it will make things easier. I feel shes needs to be assessed further. I will let you know how things go. Karen,Ruby and Sadie x

murphy's mum
16th December 2012, 12:02 PM
Well, his MRI actually came back pretty good (better than I thought!) but he has what the neuro is calling a pre syrinx in the cervical spine through the C4 and C5.

Can someone help me understand more about a "pre syrinx"? We are putting him on 100mg of Gabapentin three times a day to start, as she is unsure if the pre syrinx is causing pain or not. Any one familiar with this?


Murphy has a pre-syrinx too, although he also has CM, we started on Cimetidine, and have now added 100mg of Gabapentin three times a day as well. Touch wood, Murphy is acting like a puppy again, he's such a pest when he wants to play now, he keeps pawing me until I get down on the floor and tumble about with him. It's good to see how different he is now, and I hope your little guy ends up feeling as good.


Thank you, i,am going to make an appointment for Ruby, after all nothing ventured nothing gained, i,am sure that one of them at my vets has good knowledge of this condition, i,am hoping they are aware of Clare Rusbridge's site, it will make things easier. I feel shes needs to be assessed further. I will let you know how things go. Karen,Ruby and Sadie x

Same for you Karen, I hope you get to see her run again, as I've said seeing Murphy go from looking like a little old man to turning into a puppy again has just been unbelievable. I worried to begin with I was looking for things that wasn't there, and was wasting my time going to see a Neuro, as his symptoms didn't really seem much compared to Misty, but seeing how well he is now, I'm glad I followed my gut and got him scanned :)

karen baker
16th December 2012, 07:48 PM
That would make me so happy!!!! I would love to see her run, i really don,t think that i looked into things enough, and now i realize that there may be options available, plus did,nt see the connections with the way she was behaving, i just thought it was normal for her, she was operated on as a 6month old puppy with bilateral luxating patella,and eye issues as well, and i just thought that maybe it was connected, and had slowed her down, shes always seemed unlucky with health problems, but now i feel that maybe a chat with our vet and discuss a programme for her. Many thanks Karen,Ruby and Sadie x

Karlin
17th December 2012, 11:42 AM
Hi BrooklynMom --

I missed on first reading that the diagnosis here is no CM but the existence of a pre-syrinx! This would be almost impossible unless he'd had a severe head injury of some type, at some point. But I just had a good look at the scan and enlarged it on my computer and for what it is worth -- I strongly think the diagnosis is mistaken about CM but that is most likely due to the neurologist not really being that familiar with 'seeing' it -- which unfortunately is not uncommon. To me at least, there looks like there's an indent at the cerebellum which means there is CM. As it is so rare for ANY cavalier not to have CM (so far there has only been one graded on the entire BVA/KC scheme, where a panel, rather than just a single neurologist, examines the scan) it would be very unusual to have such a dog and especially so if there's also a presyrinx.

I do not think anyone who is given a diagnosis of no CM can accept this as definite without submitting their scan to the BVA/KC scheme which has a panel of three neurologists familiar with CM.

There are a couple of neurologists -- who seem to be the only people routinely finding a few dogs for breeders, without CM. Having been told by one of these that one of my own dogs had no CM -- and a couple of years later, finding that CM was there in that old scan and even being able by then to clearly see it myself (!! -- the reason I asked for someone else to look at it) I just think that breeders (and pet owners if they want a definite diagnosis on CM) simply cannot accept a supposed 'clear' on CM without running it past a professional panel (or alternatively, having someone well known for diagnosing it, such as Nick Jeffrey or Clare Rusbridge or one of the other neurologists on the BVA panel, or Dr Marino in the US, examine it).

For breeders, if they accept the 'no CM' diagnosis from a neurologist (especially those who seem to have found such dogs when others do not!) and breed on the basis of that diagnosis, not seeking any confirmation -- then truly they are breeding for themselves (and sadly perhaps a premium they now feel they can charge for their puppies or their stud dogs) and NOT for the future of the breed. :( Be VERY WARY of breeders claiming they have CM-free dogs!!!

I would say to anyone told by a breeder that their dog is clear of CM -- to aks if they have had a second confirmation of that from a recognised neurologist (in the US, I'd recommend either Nick Jeffrey or Dr Marino at LIVS), or submitted the scans to the BVA/KC scheme. If they have not -- think about it -- why not? Might it be that they don't want their 'diagnosis' challenged? Might it be that they are aware that they are unlikely to get that diagnosis confirmed? Could it be that people who claim to be working for the breed's future, would really make the decision not to contribute what must be critical and deeply valuable information to the formal breeding schemes so other breeders and the breed can benefit?! The latter makes no sense at all -- unless they are well aware that their diagnosis is unlikely to stand.

For the pet owner I think being CM-free is less critical to confirm -- especially in a symptomatic dog that needs some kind of treatment. I think unless the diagnosis has been confirmed by a second opinion then anyone needs to assume their cavalier has CM. And just go ahead and treat the symptoms.

Clare Rusbridge will give second opinions on a scan but unless there's spare cash and a real desire to know this detail, I probably wouldn't bother; I'd treat on the assumption that you are dealing with CM/SM pain.

Kate H
17th December 2012, 12:35 PM
Like Karlin, I blinked at the 'no CM' diagnosis. CM alone can cause considerable pain, but whether it's CM or syrinx causing it, it's still pain and you can only treat the symptoms. So I hope you and your vet can get Ruby comfortable again - though finding the right combination of medication for your particular dog can sometimes take several months of trial and error.

Kate, Oliver and Aled

lovecavaliers
18th December 2012, 01:34 AM
Interesting thread.
First I wanted to say to BrooklynMom that I was sorry to read about your pup's diagnosis.
My Jack was diagnosed at LIVS in May 2010 with a "pre-syrinx" and mild-mod CM. I have been managing him with medications thus far. He will be 4 years old this week. So far his quality of life is good (knock on wood) while not completely living a "normal" dog life (he cannot tolerate long walks especially if it is warm out). He takes omeprazole, gabapentin and keppra. I have not had him re-scanned therefore I have no idea if this pre-syrinx has developed into a full blown syrinx. At his last yearly neuro exam the doctor said he was exhibiting less pain symptoms during his assessment than the previous year (same medications). I pray he is in my life for many more years.

BrooklynMom
10th January 2013, 08:18 AM
Thanks everyone for your thoughts and info!
I might have misheard about no CM...have a call with my neuro in one weeks time so I will ask her that specifically. My whole appointment after the MRI was a bit of a blur with emotions etc. so let me ask again to make sure. We are very lucky with our neuro, she is the leading neurologist in Australia, and the leader in SM with the Brussels Griffon breed...we are very lucky to have her, but like with specialists at times, they speak in speciist talk! So what makes sense to her or is easy to wrap her head around can wash over us. So I have a big list of follow-ups :) she is SO nice and really easy to talk to, so I will know more next week.

Also, like you all said, her main point was that regardless of the scan, we need to treat the pain and the symptoms - so we are doing that. He seems better on Gabapentin, but sometimes will have break through head rubbing/digging episodes - would this indicate another med is needed or a higher dose of Gabapentin? You can definitely tell when it is wearing off.

I know so much (almost too much!) about SM and CM that it is hard not to get swept away, but I try to always think like him and live day by day :) And for one, he is certainly much happier on meds! Bless.