View Full Version : SM?
7th February 2013, 02:04 PM
Gus is 11 yrs old....when he was 2yrs old he had a strange episode with pain and stiffness in his neck, it happened twice and he seemed in a lot of pain with his neck twisted to one side but each episode only lasted a few minutes or less. The second one was bad and we rushed him to the vets but it had stopped by the time we arrived. Anti-inflammatory's helped and x-rays done showed no problem.It never happened again... He had times over the years where he would get a sore neck/back but never anything as bad again. We discovered that his vaccines when given in his neck area was followed by pain and stiffness in his neck area and when this happened a second time we changed to having them given in his hind area. He was fine for years. Last year aged 10 he had reluctance to walk one day and looked in pain with his back the vet thought disc degeneration coupled with some other back problem and again anti-inflammatory's worked along with a course of cartrophan.
He has been well since except a couple of months ago he started slight head nodding and then it got worse and recently he was doing it more and more. Yesterday we went to the vets armed with video of this nodding. We seen the head vet.
He examined Gus thoroughly, looked at the video, asked a lot of questions as to how Gus is lately, looked over his past files, called in a colleague and they both went to the side to talk, I was getting worried especially by the look on my vets face, then he said they think it is SM...
I was shocked to say the least. I would never have thought especially not Gus. My vet thinks the nodding is pain episodes caused by SM, we thought mild seizures but the vet doesn't think so although he said there may be a little disorientation because of pain. He has known Gus and Pippin since puppies and DJ since I've had him and is a good vet.
He has advised not having MRI as it is too expensive and will only tell us what is wrong but we will still have to treat it with medication as Gus is 11 so surgery would not be something I would put him through. He doesn't want to put him on steroids for now and has given us a weeks supply of diazepam to see if it helps relax the muscles and stop the nodding, and we will proceed from there depending on how Gus is.The vet spent a lot of time moving Gus' neck and checking for ease of movement. Gus didn't seem to mind too much but the vet felt his neck muscles were very tense and the diazepam is to see if the muscles will relax and if so whether the nodding eases of not. He is only on half a 5mg twice daily and started them monday night, yesterday he didn't seem to be nodding as much. We also have metacam for his bad days and are to call the vet on Mon to talk about how he Gus is doing.
Gus is well in himself, eating, going for short walks,he loves his food especially a treat and will steal if he can he loves sleeping on my lap and will insist the younger dogs move to let him up as he is number one, he jumps on chairs (although nods a lot just before jumping or attempting to jump). He doesn't over scratch, but hates any kind of collar, always has and would scratch light one's off, so we don't use one. He always makes a strange 'coughing/hacking' sound after getting a drink, but it doesn't seem to be his throat that's the problem he kind of looks like he's unhinging his jaw!
Lately he runs to bed when he sees the grooming brushes come out, Licks his front paws, sometimes seems to stare into space but it doesn't last long, likes a good roll on his back but doing it more frequently, and now and again, rubs his face with his paw. one thing he has always done since the age of 2, after the strange neck incidents, and I forgot to mention it because it was just his 'thing', and a locum vet told us years ago that most dogs don't like to be lifted and passed it off...If you lift Gus from his middle he will scream almost as if you'd given him electric shock, we never ever lift him this way and always tell new visitors to our home, vets etc. not to, we always lift Gus with one hand under his rear and one under his chest and he doesn't even flinch. -we don't always be lifting him it's usually when he climbed on a chair to steal our food- now I'm putting two and two together and feeling it may be SM and I should have known or at least noticed, but all these things never happened together and only lately all came together
I am wondering has anyone else ever had a dog with SM who didn't have any ongoing symptoms and only really started to show pain/symptoms at such a late age?
Thanks for reading...
Just to add, the vet thinks Gus still does have some disc degeneration but it is stable at the moment and he also said that Gus has a great heart for an 11 year old dog and it would be unusual in his practice to find a heart as good in an old cavalier, which is good but a pity if he does have sm...
7th February 2013, 02:55 PM
So sorry to read this about Gus. I'm not much help in this area, but I was wondering if you were seeing a neurologist who may be better able to come up with a medication plan? I also know from reading here that Claire Rushbridge had a treatment protocol on her website that you could print off and show your vet. It was good that you got video of Gus to show the vets.
It is great news that at 11 years old, Gus still has good heart. Let us know how he gets on.
7th February 2013, 03:37 PM
My Oliver was diagnosed with CM/SM at the age of 6 but with hindsight he had been showing symptoms ever since I had him at a year old - squinting in strong sun or fluorescent light, restless sleeping, occasional episodes of scratching that seemed to be worse in the summer, an odd episode of temporary loss of use of his hind legs for a couple of hours - a lot of little things that no-one ever put together. Sadly, it sounds as if your vet is right, As Joyce says, a neurologist would be able to make a better diagnosis of symptoms and suggest a treatment plan (a consultant rather than your GP vet, so to speak). If you're not going to scan (and I agree - Oliver is only having a general anaesthetic if his life is threatened!), putting Gus on a course of gabapentin could confirm the diagnosis, because if his pain is neurological other painkillers may not be very effective, whereas gabapentin specifically targets the neurological pain caused by CM/SM. Karlin will be able to recommend a neurologist who is expert with CM/SM, and if your vet (who sounds very competent) hasn't seen Clare Rusbridge's treatment plan, you can download it at www.veterinary-neurologist.co.uk (http://www.veterinary-neurologist.co.uk)
Oliver's symptoms are slowly getting worse, but are more or less under control with medication and he lives a pretty normal life, enjoying long walks, still going everywhere with me, and generally being a wicked old man! I hope Gus's symptoms will be as well controlled and he will be with you a few more years yet, enjoying his old age.
Kate, Oliver and Aled
7th February 2013, 06:49 PM
You know that's the thing with this condition....How do we know? If some research is correct a lot more cavaliers are effected then we even know I read like 70% (or something don't quote me)..... I think that's why we as cavalier pet owners are going to get to the point where we want our dogs scanned just because..........I know that is not the answer but still. No loving owner wants their dog to be in pain and not know it.
From what you describe Gus is not in a lot of pain but some. I agree about not scanning him but maybe a neurologist appointment is needed, after all he/she would be expert advice. That's what I would do anyway.
7th February 2013, 06:50 PM
I think you actually have been having some classic symptoms of SM over his lifetime, I am afraid. The curved neck (scoliosis) is a very typical early symptom and pretty much only related to early-onset SM in this breed -- and then often goes away as the dog eventually adjusts to the pain level. The on and off sensitivity and pain at his neck over the years, and the difficulty after vaccinations, would be quite typical of SM pain as well. So would the dislike and scratching at any collar; the screaming when being lifted.
The good thing is you are now able to take action and help him get a lot more comfortable. :flwr:
I would definitely have your vet use Clare Rusbridge's treatment protocol and get him on cimetidine and gabapentin (perhaps omeprazole rather than, or in addition to, cimetidine). He would be far more comfortable. At his age I would not put him through an MRI but ask your vet if you can trial some meds. I don't think I would bother with the diazepam (see below).
The head nodding, as a general breed issue, is something some of us were recently discussing with Dr Rusbridge, coincidentally enough! She thinks this behaviour is most likely not anything to do with SM, but there's a very high incidence of this odd behaviour in the breed (yet another thing :( ) -- sometimes to the extent that the dog regularly falls. Researchers are not sure of the cause and hope to do more investigation into what causes this. My SM clear cavalier Jaspar does this but only very slightly -- generally when he is sitting up; he will look as if he is dozing off but it's a kind of head shaking/nodding. My Lucy did this to a mild degree as well. Generally not anything you need to treat if mild, but when it is really disabling for cavaliers (eg they are collapsing with it) steroids seem to sometimes help.
That said -- it could have other causes and your vet should do a proper investigation.
I would think Gus would be a lot better with traditional SM meds treatment asap. If your vet is reluctant to do this you could go down to Cork to talk to Jacques Penderis or the neurologist at UCD but I think a lot of vets would pretty much agree this is indeed almost certainly SM and be willing to trial some SM meds.
7th February 2013, 06:54 PM
Direct link to Clare's SM information:
7th February 2013, 07:21 PM
Thanks for that Karlin. Gus was nodding again today so I will be speaking to the vet this evening or tomorrow. You mention some dogs falling. Gus has fallen/tripped over, a few times in the last few weeks, not while nodding more when running (mostly for dinner) but when he nods he seems to sometimes almost lose balance, so the vet thought at first EF but after examining him and questioning me ruled that out.
My vet seems very well informed on SM and was asking me how much I knew about it and got quite annoyed about the high level of it in cavaliers and spoke to me and my husband at length about what is being done (or what he hopes will be done to try stream it out).
He mentioned the programme and follow up programme that we all watched and was mad about people breeding from dogs known to have SM. I am sure he must be familiar with who Clare Rusbridge is and won't have any problem with trialling meds. I will mention the treatment protocol and ask if he can check it out or show it to him when I go to him next.
I suppose the signs were there but because Gus wasn't seriously affected and with his disc problems and his 8yrs of seeming ok it went undiagnosed. I worry that he will get worse and be in pain. A little part of me worries that he would end up somewhere down the line having to be pts and that would be a shame as he has a perfect heart and I always thought he would be one to live to a ripe old age and slip off some night in his sleep. But that's just me thinking the worst, hopefully it will not progress too much.
7th February 2013, 09:18 PM
I wouldn't worry about it (if this is SM?) progressing too much, given his age; more to get medications right so that he doesn't go into the occasional pain sessions and perhaps this will also improve his balance. :)
Your vet could perhaps contact Clare through her website and ask her about this kind of nodding off.
The instability on his feet could be SM related and may not be connected at all to the nodding. Limb weakness/imbalance is another typical sign of SM.
It's great that your vet is up on these things. :D In Ireland, the CKCS Club has done basically zilch in terms of public or breeder education on SM. :( They have another 'meet the breed' type day coming up -- I wonder if they will offer prospective dog owners any information at all on MVD, SM etc?
Your vet may on going through Clare's material, feel comfortable working with that or may feel he wants to consult a neurologist. Sins recently posted the contact info for seeing Jacques Penderis in Ireland I believe -- he is on Cork every 2 weeks I think. I went to UCD for Jaspar's PSOM -- but didn't get much sense of their approach to/knowledge of SM.
Steroids are actually the very last thing Clare suggests using for SM -- only ever if nothing else is working. You may find the gabapentin helps with the limb issues. At the same time -- if he has had progressive SM since quite young and slowly had limbs affected, this may not be something that can be reversed or managed by medications.
Leo has always had poor balance if he is standing on a lap, say; but not collapsing.
7th February 2013, 09:39 PM
I'm interested in what you say about head nodding, Karlin. Oliver does it quite a lot, but licks his lips at the same time so I've always assumed it was a symptom of pain/a headache. He never did it in his younger days, and it has got worse as his general CM/SM health has started gradually deteriorating - evidence that it is a progressive disease, because he's now nearly 12. His headaches are pretty well controlled with his new drug, but he's back on gabapentin for his very wobbly back legs and has pronounced scoliosis in his spine. One of his first symptoms at the age of 8 was frequent stumbling on his right front leg, for example when going up kerbs, but that stopped once he was on gabapentin, although he still doesn't have much nerve sensation in that leg. So with luck gabapentin may help Gus's stumbling as well.
Kate, Oliver and Aled
7th February 2013, 11:59 PM
I vaguely remember the neurologist at the University College Dublin vet school also told me they see that nodding regularly in cavaliers, when Jaspar was there for a myringotomy.
11th February 2013, 09:00 PM
UPDATE: Spoke to the vet again today as the diazepam is making no difference and Gus' head shakes seems to be getting worse. My vet feels we should try phenobarbital (which I have at home because Pippin is on it for epilepsy) for 4 or 5 days as he feels Gus may be having focal seizures and I've to talk to him again on Friday.(or sooner if I need to)
I have checked out focal seizures online and some of them do look like what Gus is doing...would this be caused by SM?
11th February 2013, 09:21 PM
Clare's info says there is not a known connection but notes there could be as they are seen alongside SM.
I'd get him onto gabapentin and cimetidine even more urgently than or rather than pheno if your vet feels there is any chance of SM -- from what you describe I'd say most neurologists would feel there surely is a significant chance he has SM. You may find the gabapentin and cimetidine help to manage this. Gabapentin is actually used for seizures (original use) and also helps neuropathic pain. Your vet can use C Rusbridge's treatment algorithm. Prob will want to start at 100mg 2x or 3x and see how he does, and 50mg cimetidine 2x but can go to 3x.
11th February 2013, 09:26 PM
Had a look at a video of focal seizures and they are nothing like Oliver's head nodding, which I'm fairly sure is pain- and SM-related. He sits still and literally nods his head from level to down and back again quite quickly, licking his lips. He doesn't do it every day, and next time he does it I must note whether it happens when he's due his next lot of medication. Is this the sort of head nodding Dr Rusbridge was talking about, Karlin? Or more like the video of the schnauzer, who was staring upwards, scratching and very restless? Really, SM symptoms are like a bottomless pit - you keep on pulling up more and more of them!
Kate, Oliver and Aled
11th February 2013, 10:01 PM
Hi Kate- Oliver's head nodding sounds like what Gus does....I looked at lots of focal seizures online and a few looked liked what Gus does but not the Schnauzer. Gus does scratch too at times and while head nodding he seems to falter on his legs, he had a particularly bad episode on Sat where he seemed to be nodding his head while the rest of his body twitched but it only lasted a few seconds. He head nods everyday and it's gotten to be a few times a day in the last couple of weeks. Sometimes as much as three in an hour but they don't last long.
Karlin - I will speak to my vet again tomorrow, thanks.
11th February 2013, 11:23 PM
Hi all -- Clare was talking about a range of this behaviour from mild nodding with eyes part closed as if falling asleep -- can be up and down or side to side, which Jaspar does and he also nods head up and down while licking at his lips, in a kind of 1-2-3-pause rhythm. Or it can be be quite active jerky head nodding and legs can be weak and the dog might part fall over or completely fall over. In the worst cases, a dog's legs might go out from under them and they fall. They know it is something that is in the breed, and they don't know what causes it; called a 'myoclonus'. She also has said a mildish head nod/jerk is common in cavaliers as they age for some reason. This is what Jaspar has and what I had asked about a while back. I know other people with cavaliers with this issue, in some cases at the extreme end.
As Jaspar doesn't have SM and has this behaviour -- and had it at a time when he had been MRId clear -- I would guess they are right in guessing it is not directly related to SM. Maybe it is to CM or head conformation? -- just as so many have PSOM show up on MRI. Hopefully there will be some research on this in the future.
Clare did tell me that generally the behaviour is not anything to worry about unless it is causing collapse or is otherwise bothering the dog or is severe. She did say that sometimes steroids have helped more severe cases so that might be something to think about if it is really extreme. But I'd still want to try some SM meds if there's a strong feeling Gus has shown symptoms over his lifetime -- and your vet is willing to trial some SM meds. He could probably contact Clare to ask about the head jerking or you could talk to the neurologist at UCD?
11th February 2013, 11:36 PM
I googled this and what came up but several old threads from Cavaliertalk :).
So we have had quite a few cavaliers reporting with various levels of this kind of twitching/nodding/tripping behaviour, with the most noticeable behaviour almost always in older dogs. For example see:
11th February 2013, 11:37 PM
Yes, Oliver's head nodding is probably related to his CM rather than his SM, which is why he has a lot of headaches from his dilated ventricles - or rather had, as his new drug is controlling them pretty well. He is also, of course, nearly 12, so I'm having to recognise symptoms of age as well as symptoms of CM/SM (not to mention spondylosis as well!). It's the first time in thirty years I've managed to have a Cavalier this old, so I'm on a learning curve. (Isn't it terrible to say that - a breed this size should normally be living well into their teens. MVD and thoughtless breeders have a lot to answer for. Oliver has a good heart (Grade 2, not bad for his age), so we just have to get him through all the other things!)
Kate, Oliver and Aled
PS Aled is just beginning to show symptoms of his CM/SM and he is twitching - little muscle spasms like hiccups or a quick shiver. He's only 5.
12th February 2013, 12:29 AM
Sorry you haven't been able to figure this out yet and that so far medication hasn't helped. Karlin made a point about several threads about this happening with older dogs. It makes sense. During his last year, Sydney had focal seizures, not severe, but his legs would shake and it almost looked as if he was nodding off to sleep while standing or sitting up. Our vet said it's common in older dogs.
I hope you can get help to control this and his other SM symptoms.
16th February 2013, 06:45 PM
Further update.....Spoke to my vet again on Tuesday and he said he would still like to continue with the Phenoleptil until the weekend. Gus is doing well on it:) No nodding and no sitting around looking 'sad' he is more active than he has been in a while and seems to be in better form, more his old self. Also when he sleeps he seems more settled.
My vet feels, as we do, that this is a good result so, we've been advised to leave him on the 12.5 twice a day and monitor how he is doing. Vet says he was probably having focal seizures but may have had pain too, as he does not hang his head as low as he had started to these past few weeks. He thinks that he may still have SM. We will of course look at other meds should he deteriorate at all.
Thanks again for all the advice.
5th April 2013, 09:23 PM
Just an update...Gus started head nodding after a while on the pheno....another chat with the vet and we both decided that at the moment he doesn't seem to be in any pain just stops to nod his head sometimes and then continues on as if nothing happened, so we ceased all meds (apart from supplements) and he is in great form and even started playing with the other dogs for a while a few days ago. But now has gone back to being a relaxed elderly gentleman, except when there is food around
Vet agrees we will not really know if anything else like sm is going on apart from his disc degeneration without mri and we're not putting him through that so at the moment we
are happy to leave him with the odd nod that doesn't now seem to phase him....
any thoughts on this, hope I'm doing the right thing....
Love my Cavaliers
10th April 2013, 03:59 PM
I've just made the connection that Riley does this head nodding also. I noticed it this morning and remembered there was this thread and reread it. Interesting that there seems to be no connection to SM. Riley's nodding seems to be like Oliver's and Gus's except that when Riley nods, she almost always does lose her footing and falls over. I think this is because she has a badly damaged vestibular system. I'm wondering if she started this when we decreased her prednisone dosage 5 months ago. She sees her neurologist next month for blood work so I will ask about it. It never seems to bother her though and she gets right up. I'll let you know what he says.
11th April 2013, 10:24 PM
Thank you, I would be interested to hear your neurologists opinion. Gus almost falls over sometimes when nodding but doesn't actually fall.
Love my Cavaliers
30th April 2013, 03:43 PM
Riley saw her neurologist yesterday and I mentioned her head nodding. He said that unless it bothered her, or was very frequent, he was inclined to leave her prednisone dosage where it was and not increase it. He asked me to monitor the frequency. I was away for a week and have been home for 8 days now and haven't seen her do it once! Her neurologist said he had heard of it before but had never had another dog who did the head nodding before. He asked me to take a video if I can next time.
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