View Full Version : SM and prednisone update

11th June 2014, 01:00 AM
I've been posting about my dog Sammy's health over the past 7 years quite a lot. He had serious SM symptoms from about 1 year old. He was treated with Gabapentin for a year and finally prednisone, which kept him very stable over the past 6 years. Last Autumn he had a bad neurological/vestibular episode (which my vet at the time said was definitely a central brain problem rather than inner ear problem), from which he recovered really well. However, he had to be put on a higher dose of prednisone to control these new symptoms (blinking eye, head tilt and facial paralysis, and eventually collapse and nystagmus).

Unfortunately 7 months later, it looks like he has developed cushings from the prednisone. He is losing his fur, especially on his tail, where the skin also looks pretty bad. I have tried now (as several times before) to reduce prednisone and increase Gabapentin and tramadol instead. We got through 2 weeks looking good, but now in the last few days he's been scratching a lot and rubbing his face so much that his eye is infected. He is on 450mg gabapentin per day, 5mg prednisone every third day, tramadol at night, and now an antibiotic. I don't know what to do - to keep giving prednisone everyday, causing cushings, or keep giving him this blend of medication that still leaves him with some level of sm related suffering. His scratching/rubbing episodes are not constant and otherwise he just gets on with things, but his eye looks pretty sad. Lyrica for some reason doesn't seem to make any difference. He is also on furosemide and furtekor for heart failure.

Compounding it all is the fact that Sammy has never been MRIed. He hasn't been insured, I've been a student and his symptoms seemed obvious and urgent enough to make their treatment also obvious (Gabapentin made a clear difference). However, I have been wondering for years whether some of this might be caused by PSOM or even an allergy. He has been seen by an ear specialist who didn't see PSOM pain reflexes but was happy to do an ear flushing operation nevertheless (he said it wouldn't harm Sammy whether they found a problem or not). I decided anyway not to put him through it.

I guess I'm trying to simply update Sammy's story for anyone who followed it, gather some similar experiences, and possibly decide on some questions. My questions now are:

- has anyone seen red eye with pus as a result of SM or PSOM? (Sammy actually had a similar eye infection at 1 year old when first diagnosed and started on gabapentin).
- has anyone had to keep on prednisone despite fur loss? I am giving him Denamarin for the liver and feeding him a hepatic and renal friendly diet, but the fur loss has developed despite this. Was it worth continuing the prednisone anyway or did worse problems develop?
- how much scratching and rubbing do you tolerate before you figure that the medication is not enough?
- would there be any benefit in doing the MRI now? I still can't afford it, but if i knew it would make a difference in his outcome, I would find a way to make it work.
- would it be worth flushing the ears (a lot cheaper than the MRI) just to see if PSOM is part of the problem? The ear specialist seemed very experienced in this surgery. If it is PSOM, it would probably needed repeating though. But I would be happy to do that, knowing that it is making him better.

In short, any similar experiences and advice would be welcome!

11th June 2014, 04:01 PM
My understanding about PSOM is that you don't do the surgery to find out if the dog has PSOM, but because you already have diagnosed the PSOM as being there. I do not think I would put my dog through PSOM surgery unless PSOM was been diagnosed ahead of time.

11th June 2014, 06:41 PM
Yeah, I was a bit confused when the ear specialist was talking about it, since part of the time he was talking about just an in-depth exam (which apparently would anyway need general anesthetic) and part of time he seemed to be talking about making an incision in the membrane as part of the exam (but I might be mistaken). I do think I have the option of just having a more in depth look at the membrane and leaving it if it isn't conclusive. I am concerned about the anesthetic and his heart condition though.

The ear specialist didn't think doing a very expensive MRI was worth it, since if he has PSOM, it wouldn't solve the problem, whereas they can diagnose it "very easily" and drain it there and then with a "very simple procedure" that they do all the time and have the best equipment for. I got a bit confused to be honest. And I think I'm clutching at straws anyway. The pain is not just around his ears, but down his spine and back legs as well. He even does the classic bunny walk sometimes. And Gabapentin would only help SM, as far as I've understood - not PSOM.

Love my Cavaliers
11th June 2014, 08:02 PM
Laura I'm so sorry about your worries with Sam. I really only have experience with prednisone and hair loss with Riley and I kept her on it. Her poor tail looks like a rat's tail - there is no hair on it at all. Her thumping is so loud when she's excited you can hear it from outside the room because there's nothing to muffle it with. She has almost no belly fur and she has terrible dandruff. Her groomer says she has flakes as big as tortilla chips! Every summer she picks up some skin infection that she needs to take antibiotics for, for almost the whole summer as her immune system is so compromised. I do give her Salmon oil in addition to the Denamarin. After being on 5 mg/day for about 4 years, we successfully cut her back to 2.5 mg/day, primarily because her neurologist was concerned about her skin. Didn't make a difference and no fur grew back. She tolerated the decrease though but still has vestibular issues.

I don't know what you'd gain by having an MRI now. Wish I could help with the rest of it. Maybe try switching him to Lyrica?

12th June 2014, 01:45 PM
I'm sorry to hear that Riley's fur didn't improve! And that she also has such problems with her skin. Did you try doing 5mg every other day, rather than 2.5mg every day? I made that switch a few years back and although I saw a small increase in his symptoms, his blood tests and skin improved greatly. It was a good compromise. On the other hand, given Sammy's present circumstances, I understand that the every-other-day switch might not be possible.

Thankfully Sammy's eye is almost normal now and he's scratching much less. He seems to improve greatly the day after the prednisone and then deteriorate again over the next two days (especially when the gabapentin is wearing off). But I think I just have to work out the best possible routine to get him through that 3rd day. I do still have plenty of Lyrica from previous attempts to switch him to that, so I may try it again. He's on such a cocktail of medication at the moment that it's very hard to tell what is doing what.

But I'm relieved that he isn't still getting worse. :xfngr: also that I'll see some improvement with the fur... Your 'rat tail' is a good description, though it's only on the bottom end of Sammy's tail at the moment, which looks pretty odd!

Thank you for sharing your experience - it helps to hear from someone in the same boat!

12th July 2014, 10:57 PM
My youngest girl went on steroids as had allergies,PSOM,SM/CM.We had to wean off but had to start again after six months.Her bloods showed signs of issues such as Cushing's.She now gets 2.5mg every other day and I hope that will be enough in the future.We have dropped the Omeprazole with her taking steroid.Still on 20mg frusemide by twice daily,Gabapentin and Zitac.

Kate H
13th July 2014, 08:49 PM
Germarey, I'm puzzled that your girl is on both frusemide and Zitac, since they are both diuretics and are usually regarded as alternatives. Most neurologists no longer prescribe frusemide as long-term it may affect the heart. Something you could check out? Any diuretic carries risks for the kidneys, let alone two!

Kate, Oliver and Aled

13th July 2014, 09:08 PM
It seems to me that the PSOM that showed up in Bentley's MRI causes most of his issues, rather than SM. He has absolutely no problem with tenderness around the head, neck, back area; in fact, he revels in being petted, almost as if he's getting a great massage, but he rubs his head against my leg or the carpet and scratches at his ear area. He gets gabapentin 3 times a day and a small amount of prednisone every 3 days. (I don't want to get up & look at the bottle right now to see the mg!). He seems happy. I will say that the specialist at Missouri University where he got the MRI has the opinion that the ear flushing or surgery isn't necessarily a fix so we opted to not put him through that and it possibly coming back.

14th July 2014, 08:12 PM
Hi Kate
The Zitac is for stomach as well as to reduce CSF pressure. We know the risks of Frusemide but they have to be comfortable and bloods done every 3months or sooner if concerned.Just developed heart murmur so monitoring but is nearly 8.Neurologist wants drugs as they are bearing in mind this little dog had facial paralysis with Chiari at 5 months.
Thank you for your concerns trust me I watch them like a hawk!

14th July 2014, 09:30 PM
Thanks for your replies! Sammy also is not sensitive to touch around the neck. When his symptoms are bad, he will however move away if I reach to pat him on the top of the head. He does appreciate an ear rub though. Otherwise, he simply scratches a lot around the ears and neck (breaking the skin eventually), rubs his face and eyes, and chews his front and back paws. He also has some spine pain, though that could be due to spondolysis (which was also diagnosed when he was a year or so). The head tilt/eye squint/nystagmus/bunny hop/ataxia etc. could even be a separate problem, since they don't always coincide with the scratching.

Unfortunately his fur loss has continued. We were at the vets for more blood tests today, as well as a heart check up. All his counts (e.g. liver, kidney, blood sugar) were pretty normal again, but his blood was thin. He is a bit anemic. He was also tested for thyroid, though the results won't come back till Wednesday. The vet thought that thyroid may be the culprit for the fur loss and possibly an ulcer from the prednisone for the anemia.

His head was x-rayed just in case it would give any clues regarding PSOM. There was a difference between the left and right ear, with the right ear's 'wall' being thicker. Both middle ears looked quite bright though. So no real revelations there.

Unfortunately more x-rays also showed that Sammy now has fluid in his lungs. They then did an ultrasound of his heart. It isn't contracting fully and the left side is enlarged. So he's starting Vetmedin.

Poor baby. He's such a trooper. Every time he seems to be on death's door, he pulls through, tail still wagging away. When he was 1yr and the pain episodes began, I told myself that if I could get him happily to 8yrs, this will be a success story. He will be 8yrs in September. I'm now aiming for 10yrs (although secretly I'm thinking 12). As long as he's happy, I'll just keep treating all of these problems and symptoms and side-effects with every means possible. I'm determined to get him a long, full doggy life despite these rotten Cavalier diseases.

15th July 2014, 12:39 AM
Laura I'm sorry to hear of the problems with steroids and your various concerns. You've done a good job in caring for Sammy.

I wonder if you've tried trialing him on Lyrica instead of gabapentin? Many dogs do much better on it at a far lower dose and it is only needed twice daily. Leo was on 600mg gabapentin a day and is now on 50mg Lyrica 2x. He's a lot better on it -- his ears have grown out again for example.

I wouldn't do PSOM surgery unless a dog was shown to have it on a scan and it seemed as if the surgery was the best option. Often it has to be repeated several times, something to keep in mind.

On some other questions: I wouldn't bother with an MRI, and I think the eye issue is a separate one. Never heard of an eye problem related to SM or PSOM but the rubbing could have inflamed/infected it.

I would tolerate very mild scratching or head rubbing. Anything more than that indicates meds need adjustment. There are a range that can be tried other than tramadol, too.

15th July 2014, 03:31 PM
Thanks for your reply! I know I stuff my posts full of info and questions, so they must be pretty confusing to read.

I have tried Lyrica a few times, since I know it should be more potent. But for some reason, it just doesn't seem to have as obvious an effect as Gabapentin on Sammy, even at 50mg x 2 per day. I've wondered sometimes whether I should have tested it for longer (the most I've given it is a couple of weeks). I would prefer to use Lyrica, since Gabapentin is actually more expensive at the doses I'm using.

Sammy started Vetmedin yesterday. Surprisingly today his breathing seems worse. He's panting a lot and restless. Is there any way this could be part of an adjustment period to the new medication? I'm starting to really worry now... :( He's on 20mg Furosemide, Fortekor 2.5mg x2, and now Vetmedin 2.5mg x 2. We were out for a walk a couple of hours ago, so he might still be recovering from that.

Kate H
15th July 2014, 09:15 PM
Sorry you're having so many problems with Sammy. My Oliver too has both SM and spondylosis and it's difficult to know which is causing what. He has never scratched very much but he has always squinted, and as headaches caused by dilated ventricles (and therefore by his CM rather than his syrinx) have been his major symptom, I have always felt that squinting was all part of the same problem (have you noticed that other breeds simply don't squint in strong light?). So I would think that there is some connection there between Sammy's squinting and his CM/SM. Cavaliers are amazing survivors - at death's door one minute and then asking for breakfast and tail wagging. Oliver has had some symptoms most of his adult life but has just turned 13, so battle on with Sammy - getting to 10 will still make him quite a youngster!


Kate, Oliver and Aled

PS His worsened breathing may be an indication that he's not actually ready yet for Vetmedin, which is causing his heart to overwork, but others will know far more about it.

16th July 2014, 02:30 PM
Thanks Kate for your reply!

Sammy is still worrying me. His breathing improved yesterday evening, but today he is again panting quite often. He is also often just sitting/standing and staring at me. I have no clue what he wants or what I can do for him, since he has already been walked, fed, and given his medication. I think the Vetmedin might really have made him worse at this point.

I've also noticed now that his squinting eye really is on the right side where the thicker inner 'wall' was found in the ear. Moreover, I've now noticed that he keeps subtly lifting his right ear while he's squinting.

I'm now almost convinced that his problems include PSOM at least on that one side. But I can't do that in-depth ear check (let alone ear flushing) anyway without having his heart stabilized, since it requires anesthetic.

17th July 2014, 01:08 PM
Sammy's thyroid results came back and they were pretty normal. So the fur loss is almost certainly due to prednisone. I'm going to continue trying to find a combination of medication where his fur will grow back but he isn't suffering.

On the vet's advice, I'm keeping him on Vetmedin for a while longer and monitoring whether he is improving or continuing to pant more than usual. It's been warm weather here, so it could also cause the excessive panting. At least he isn't coughing at all or fainting, and he's still happy to go for evening walks up to 30min (on a cool evening, he's previously been trotting along happily for an hour). X-rays showed fluid in the lungs though and the heart isn't contracting fully, so I guess the Vetmedin is necessary.

No real clue still on the anemia - so we're just monitoring it too.

23rd July 2014, 04:18 PM
Update: Sammy's head pain symptoms are doing pretty ok on 2.5mg prednisone every other day plus lyrica and tramadol. The lyrica has nowhere near the same immediate effect as gabapentin on his scratching and squinting, but after a week of 100mg per day, I'm beginning to think it is indeed part of what is keeping him stable. But unfortunately I know he couldn't survive without the prednisone. Even now, I'm having to remove mats from his ears and armpits, and it's a waiting game until he gets his prednisone dose.

I'm starting him on Dermoscent spot-on treatment for his fur loss. Unfortunately I couldn't find Salmon oil after scouring the local stores, but this came highly recommended. So I'm giving it a go. It a treatment for skin problems that is applied in much the same way as Frontline. I'll keep posting on whether I actually see an improvement.

The biggest and most worrying problem now is most definitely his heart. It has been hot weather here for a couple of weeks now (25-30oC). I think the Vetmedin has helped since I haven't heard him cough once in the last week, but his panting is really scaring me. My apartment heats up in the afternoon, so he pants most during the day time and gets a bit better at night. I've been looking into ways to cool him down. Any suggestions?

I've been surprised though that he is still begging to go for walks; and still running around enthusiastically outside regardless. I've been trying to take lots of breaks to sit down in the shade, but he doesn't seem to want to rest. It's when we get home that the rapid breathing starts. Does that sound at all familiar to anyone? Should I be more strict about the exercise?

Kate H
23rd July 2014, 08:28 PM
Dear Laura

A few ideas for keeping Sammy cool in this horrible hot weather: keep curtains closed as soon as the sun moves round into the room, it really helps keep it cool. A fan will also help. Some people put a cool coat on their dogs when the nights are hot - might help Sammy during the day as well; if you can't get one locally, try the internet. And exercise early in the morning or late in the evening - in the UK the weather really hots up in the afternoon and stays warm until well into the night, so Oliver gets walked for 30 minutes at about 6am. Aled is in congestive heart failure and isn't being exercised at all at the moment. You may want to keep Sammy on lead - give him an interesting 'sniffing walk' rather than running around off-lead. The dogs don't know they're ill, and can't make the connection 'I ran around and now I'm panting', so we have to think for them.

Kate, Oliver and Aled

16th August 2014, 06:41 PM
Just to update, Sammy's fur is now growing back with gusto. Especially his tail, which was half bald with dry, black skin, is now covered with thick red fur that is growing pretty fast. Either this is due to the reduction in prednisone finally having an effect, or this is due to the dermoscent (which I've been using on him for 3 weeks now). Either way, I'm really pleased! For anyone who has had similar problems with fur-loss, dermoscent could be worth trying. I'll update again if it makes any difference at all to the condition and color of the fur on his sides. It's been blond since starting the prednisone 6 years ago, so if the color deepens, I'll know it's the dermoscent.

He's still squinting and getting eye-problems from time to time, which is directly correlated to his prednisone dose. Sometimes one eye even gets blood-shot before his prednisone is due. He's also still scratching his ears and chewing his back paws quite a bit when his dose is due. Lyrica and tramadol are helping with that a bit at least. He's been on 2.5mg prednisone every other day. I may still try to increase that a little to see if I can really get him comfortable, while still avoiding cushings.

Heart-wise he's doing pretty well too. The weather has cooled and he's not panting constantly anymore. I do think the Vetmedin has helped. Though he sleeps a lot at home, he isn't slowing during walks at all now. I think he might still have a bit of edema in his abdomen though. It seems a little full.

But mostly things are looking up at the moment!

Love my Cavaliers
16th August 2014, 08:03 PM
Laura - I had never heard of dermoscent so I googled it. Are you using the using the dermoscent 6 spot-on that comes in the capsules that you put between the shoulder blades? If Riley's fur could grow back on her tail that would be a miracle!!

16th August 2014, 09:39 PM
Hi Bev, yes, exactly that. It was recommended by a vet nurse and I thought it would be worth a try. It may be a coincidence and the regrowth may be due to lowering his prednisone 2 months ago. But even one month ago his tail was still losing fur and the skin was grey/black. This new fur started growing two weeks after starting dermoscent and today I was amazed at how his tail is already fully covered. So maybe it is actually working! I'm going to keep using it for at least another couple of months to see if there is a change in his side fur color.

17th August 2014, 10:33 AM
So glad that Samwise is doing better. Re his coast, it may be the dermoscent or the steroid reduction, but it could also be stopping the Gabapentin. I had one dog who was clipped (under sedation) whilst on Gabapentin and his hair didn't grow back, the vet couldn't believe it! He had hair loss on his belly and tail, was also tested for thyroid etc I've had several others with limited hair growth on Gabapentin, and it's a known side effect in humans.