I have 2 Cavaliers, one with MVD and one with painful Chiari/SM. She has been doing pretty well on pregabalin and omeprazole for over 2 yrs. Suddenly her symptoms worsened last week. It is so scarey to hear them scream in pain and be so helpless (I have to say week prior she had increased scratching). I took her right away to our regular vet as I had to wait to see the neurologist. She was started on prednisone 2.5mg 2x day and tramadol 25mg 2-3x day plus a shot of dexamethasone. I increased her pregab to 3x day. Steroids make them pant sometimes excessively- so make sure to hydrate your dog. She was about 70% better for few days and now she's back to the screams and cry anywhere from 1-3x day. She is scheduled to have decompression surgery this Wed. at Long Island Veterinary Specialists who specialize in this horrific disease. Please Please Please if the scratching persists despite meds or any signs of change/worsening of symptoms, get an MRI. My neurologist was so vague about how one can have a dog w/ severe symptoms and have a good MRI and have mild symptoms with a horrible MRI- so I figured if there's no rhyme or reason other than to exclude another diagnosis, then why put my dog under general anesthesia. Well it turns out, my dog has severe Chiari/SM. The surgery according to the neurosurgeons at LIVS is 96% successful now with fat transfer over the mesh (they will be publishing their new studies very soon)-- their oldest procedure using this technique was done in 2009 and the dogs are doing great to this date. Had I known this, I would've seeked this treatment months ago. Please don't wait until your animal is in excruciating pain. The other thing that was never told to me is that this disease is inevitably progressive- degrees are variable. You have to weigh you personal choices and the quality of life for your pet. Thank God I have Trupanion insurance on both my dogs. My other dog went into mild CHF on Valentines this year and is doing great so far with Vetmedin and Enalapril. I love this breed to pieces but it's devastating to have these illnesses without access to good medical care. I pray my thread helps others.