View Full Version : How has SM progressed for you...
30th April 2013, 10:34 AM
So Toby was doing well on Gabapentin, but the last three weeks, it hasn't been holding up....lasting less, breakthrough pain etc.
Then, last weekend, we had the worst weekend I have ever experienced - his SM yelps, turned into screams. I am haunted by the sounds :(
We have an Emergancy appointment with the neuro on Thursday...she is staying late for us. I just hope we can get the right meds adjusted for him. Right now he is on 100 mg Gabapentin three times a day, a starting dose, so we have lots of room to play and add new meds/doses etc. so that gives me hope.
I just don't think I understood SM entirely until the last week. A yelp used to scare me...and then I heard him scream :(
I am heart broken. His life has been such crap before we rescued him, I just want to do whatever I can to help him. We have his anxiety totally under control, got his patella fixed with great success, and now it is just the looming SM, which he has probably dealt with for years, but his old owners who stuck him in a cage and left him outside just ignored :( it hurts my heart.
I have a list of questions, Clare Rusbrisge treatment chart, etc. all on hand, and our neuro specializes in SM in the Brussles Griffon, so I feel set...but if you think of anything to add to my list or a random thought, do share! Talked to the neuro today, she is worried but feels we have a lot of meds and plans to begin to tailor for him...I hope so.
30th April 2013, 12:16 PM
Oh no, so sorry. There are lots of options for improving his medication cocktail and I know of this neurologist, she has worked a lot with a breeder named Lee involved with griffons. The disease is basically the same though CM doesn't seem as widely spread in griffons.
In your shoes, I think I'd definitely want to get him on cimetidine or omeprazole (sometimes they suggest both), raise the gabapetin and perhaps add an NSAID; there are a number of options.
I kept tramadol around in case Leo was having bad days after he went through a screaming session over two years ago -- but it has never re-occured and I think t is likely that he simply really hurt his back and/or syrinx falling off a bed (he doesn't have great balance due to SM and has to be watched as he likes to jump up on laps/sofas etc). Trocoxil can be given once monthly and gives an even dose of painkiller and Clare has found it works well for many SM dogs but isn't right for all, and may not be available in Australia. Clare does tend to advise steroids only as a last resort. Personally I agree with that -- they are definitely right for some dogs in some situations but a worryingly large number of vets/specialists seem to reach for them first and put dogs on them full time; they do have a large number of possible side effects, some very serious (eg Cushings disease and diabetes) plus can create a constantly hungry dog that can be hard for owners to manage, so if there's a push to put a dog on steroids I would always kind of dig in heels and ask for other possibilities first. I say that as someone who spent two years on low dose steroids without many side effects, thankfully, but wouldn't take giving them lightly. I do know Clare feels similarly but again not all professionals do so it is something to think about -- and for some dogs they bring back real quality of life so are the right choice in some cases. :thmbsup:
Best of luck and let us know how the meeting goes. :flwr:
1st May 2013, 02:26 AM
I do know Clare feels similarly but again not all professionals do so it is something to think about -- and for some dogs they bring back real quality of life so are the right choice in some cases. :thmbsup:
I agree that some are put on prednisone before other options are considered. On the other hand, I know cavalier owners that have exhausted all options and have a severely effected cavalier that refuse to add prednisone because of the side effects and cushions disease. It makes me so upset because, like you said, for Ella it gave her a better quality of her short life. Being on a larger dose is more concerning long term, but when you have one that is not having a good quality of life, you need to do whatever even if side effects.
I think Toby has many options before prednisone but I just wanted to comment. Toby is in good hands with the neurologist you have in sydney. I know Toby is having a hard time and you have such a big heart, I know it is killing you. As you and Karlin mentioned, you have more medications like a CSF reducer and I pray that he gets managed and I have faith that he will. I keep him in my thoughts always.
1st May 2013, 02:59 PM
I agree Anne, there is some ridiculous prejudice AGAINST using prednisone when it can really help. I cannot understand how people can let a dog suffer with severe pain because of a fear of another disease developing -- when it is not a high risk, simply a risk. The chances are greater that the dog will need to be euthenised due to the pain, or cruelly endure a very poor quality of life, then ever lose its life to a side effect of prednisone. And if life is shortened at least it will have been with great pain relief. These are the things we need to weigh up when dealing with pain sometimes. :(
I always think, if these dogs could talk, or were human children, or the owner had SM or a condition where prednisone truly brings relief they'd be getting it asap so why deny their benefits to dogs that may need them and have few other options? Prednisone enabled me to live a reasonably normal life for two years when I had severe vascular arthritis and there were few alternatives except much stronger chemo drugs. There are so few options that prednisone is actually part of diagnosing the condition -- if you go from severe pain to nearly pain-free within 8-48 hours after taking prednisone, you have the condition).
It is also very valuable for decreasing inflammation and pain when taking on a fast taper (eg the dog starts a high dose and rapidly tapers down and goes off it). There are few, if any, side effects most of the time to that method of taking it.
1st May 2013, 06:38 PM
Don't think anyone mentioned Lyrica.
2nd May 2013, 05:16 AM
Thank you all SO much. I have taken notes to bring to the neuro...we had to get the appointment pushed back until today, but we will be seeing her in two hours now. Toby has had another episode since, but we are on our road to helping him. So nice to hear we have much to try as well so I can help him get sorted.
My poor little man, he has been through so much, but I am so glad he is in my home now and was adopted. At least I know a lot about SM and knew the signs right away (which were so obvious to me, poor guy I imagine has been struggling with no help for a while). And I have the resources like this board to help me along. So endlessly grateful.
You know, I always feared SM before Toby, but never truly understood the depths at which it can worry you or how hard it is to experience something with your dog like this. Good thing he is the happiest boy ever...and we live each other so much. I think we bonded a ton after his patella surgery - what was once a dog that feared being picked up, spent 9 weeks being carried in my arms and now he is like a little noodle who wants to snuggle and be carried everywhere!
Will keep you posted on the appointment today - and thanks for the prednisone info too, good pros and cons.
2nd May 2013, 10:06 AM
So, we have changed over to Lyrica and added Omeprazole. I am really hopeful about this. The appointment went great, our neuro knows that I talk to other cavalier owners with SM and that we talk a lot about meds and things, and even though we and I are not doctors we share stories...and so she lets me ask all the questions about these drugs and why or why not they would be good for Toby.
If this combo is not helping - there are a few other things up her sleeve, but we have to slowly trial to get him the correct "cocktail". He has SM and CM, so this will either help, or it might need some tweaking - but I am hopeful. They don't use Lyrica that often for dogs in Australia (i.e. hardly ever) but she is close with Clare Ruthbridge and also knows that it has great results - so she is going to use Toby as a case study and if it is successful, to start to introduce it to more dogs in Australia.
The only open page is still that she wonders about epilepsy in Toby. That sometimes when he screams, he freezes and he has some other classic signs (apart from his SM/CM). But for now, we are going with the above, and praying, hoping and crossing our fingers that this helps us...the screaming could actually just be making him freeze vs. freezing and then screaming if that makes sense.
Thank you all for your advice, for listing meds to ask questions to at our appointment and for you support. It is because of these lists that I was able to open the conversation to things that I hope will allow Toby to begin to have a more comfortable life. xx
2nd May 2013, 06:25 PM
Glad it went well and that you feel you have these good options now -- it really helps so much to have a good relationship with your specialist! I just put Leo on to Lyrica and it's a real improvement over gabapentin. Hope it will be helpful to you too.
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