Please help!

[Jessicacavaliermom]

Hello all. I have a 5 month old cav who since 3 months has been randomly yelping like in pain and turning around to bite his back and legs. Immediately this concerned me. We tried rimadyl, nothing. Gabapentin seems to help some. We got full body X-rays, clear. I have insurance so I said let’s do the MRI to be sure it’s not my nightmare SM. those were clear as well. He has mild CM but no fluid buildup and neurologist confirmed that wouldn’t be causing any pain. Patella’s and anal glands both clear. I’m now back at square one with no answers and he continues to have these yelping episodes and it’s very distressing to myself and I’m sure not comfortable for him. Breeder seems not worried, says it could be a non healing injury (that can’t be seen on xray or mri?) or he will simply grow out of it, said she’s seen this before. Would love any advice or experiences yall may have, it seems very odd for this to be normal and I’m not convinced it is. We just have him continuing on the gabapentin for now.

 

[Karlin]

Hi and welcome to the board; I'm so sorry that you are having this perplexing problem and cannot find any clear solutions. Gabapentin helping would I'd think suggest possibly some kind of neuropathic pain/nerve pain, unless it is perhaps making him feel dozy and less inclined to notice whatever is bothering him. I am assuming the full body X-rays removed hip dysplasia as a possibility? Cavaliers have a higher rate of this condition than many breeds even though it is often thought of as a large breed issue. I'd wonder too if this is something spinal that isn't being picked up, a compressed nerve somewhere? I'm not a vet and am only offering some thoughts based on having had numerous cavaliers with various degrees of SM. CM will show in nearly every single cavalier on MRI as I am sure your neurologist likely noted to you. Keep in mind much depends on the abilities of the radiologist reviewing scans and details like the angles of the scans and positioning of the dog. As with human patients, different radiologists can see different things depending on experience and ability and areas of expertise. It does sound like SM, or CM as the cause, has been ruled out although I am not sure that all neurologists would agree that fluid buildup needs to be present to cause pain with CM; I know that fluid dynamics can be a key issue -- ie the way the cerebrospinal fluid is moving about the spine and brain.

Perhaps it would be useful to get a second opinion on the existing scans? I am assuming that some simpler possible causes of yelping and snapping at hindquarters have been ruled out, such as flea allergies or rabbit mites (Cheyletiellia)? I've known of a few cases where people had dogs snapping at hindquarters and feared SM but then found it was rabbit mites, which can be extremely irritating to dogs. Some vets don't seem that familiar with them because they affect dogs less frequently than rabbits and cats, but two of my cavaliers had these as puppies.

Neurologist Clare Rusbridge says this about alternative diagnoses (https://veterinary-neurologist.co.uk/cm-p-and-sm-s-clinical-signs/):

What conditions could have similar signs or be confused with syringomyelia

The most important diseases are other causes of pain and spinal cord dysfunction such as intervertebral disc disease; CNS inflammatory diseases such as meningoencephalomyelitis of unknown origin (e.g. granulomatous meningoencephalomyelitis) vertebral abnormities such as atlantoaxial subluxation; neoplasia; and discospondylitis. When scratching or facial/ear rubbing is the predominant clinical sign, ear and skin disease should be ruled out. The scratching behaviour for syringomyelia is classically to one distinct area.

I would think a dog having signs of CM would likely be showing other signs than snapping at hindquarters. These are the signs Clare lists on the same document:

What are the clinical signs of CM-P (Chiari-like malformation associated pain)

The most common signs vocalization (described as spontaneous, when picked up under the sternum, or when changing position especially at night), head scratching/rubbing reduced activity, reduced stairs / jumping ability, spinal pain, altered emotional state (behavioural change to become more timid/anxious/ aggressive), sleep disturbance and touch aversion.

 

[Jessicacavaliermom]

Hi and welcome to the board; I'm so sorry that you are having this perplexing problem and cannot find any clear solutions. Gabapentin helping would I'd think suggest possibly some kind of neuropathic pain/nerve pain, unless it is perhaps making him feel dozy and less inclined to notice whatever is bothering him. I am assuming the full body X-rays removed hip dysplasia as a possibility? Cavaliers have a higher rate of this condition than many breeds even though it is often thought of as a large breed issue. I'd wonder too if this is something spinal that isn't being picked up, a compressed nerve somewhere? I'm not a vet and am only offering some thoughts based on having had numerous cavaliers with various degrees of SM. CM will show in nearly every single cavalier on MRI as I am sure your neurologist likely noted to you. Keep in mind much depends on the abilities of the radiologist reviewing scans and details like the angles of the scans and positioning of the dog. As with human patients, different radiologists can see different things depending on experience and ability and areas of expertise. It does sound like SM, or CM as the cause, has been ruled out although I am not sure that all neurologists would agree that fluid buildup needs to be present to cause pain with CM; I know that fluid dynamics can be a key issue -- ie the way the cerebrospinal fluid is moving about the spine and brain.

Perhaps it would be useful to get a second opinion on the existing scans? I am assuming that some simpler possible causes of yelping and snapping at hindquarters have been ruled out, such as flea allergies or rabbit mites (Cheyletiellia)? I've known of a few cases where people had dogs snapping at hindquarters and feared SM but then found it was rabbit mites, which can be extremely irritating to dogs. Some vets don't seem that familiar with them because they affect dogs less frequently than rabbits and cats, but two of my cavaliers had these as puppies.

Neurologist Clare Rusbridge says this about alternative diagnoses (https://veterinary-neurologist.co.uk/cm-p-and-sm-s-clinical-signs/):



I would think a dog having signs of CM would likely be showing other signs than snapping at hindquarters. These are the signs Clare lists on the same document:

Thank you so much for your detailed response. Yes, I should also note that he has no sensitivity whatsoever around the head or neck. The only area in which he seems to have sensitivity is his lower lumbar. I have not heard of rabbit mites, but I will be googling them now and asking the vet if there are any tests that can be run. I have looked for fleas, and anything else like that that could be irritating him, and have found nothing. Yes, X-rays confirmed no hip issues and no bone changes, as well as his

 

[Jessicacavaliermom]

Thank you so much for your detailed response. Yes, I should also note that he has no sensitivity whatsoever around the head or neck. The only area in which he seems to have sensitivity is his lower lumbar. I have not heard of rabbit mites, but I will be googling them now and asking the vet if there are any tests that can be run. I have looked for fleas, and anything else like that that could be irritating him, and have found nothing. Yes, X-rays confirmed no hip issues and no bone changes, as well as his

Hi and welcome to the board; I'm so sorry that you are having this perplexing problem and cannot find any clear solutions. Gabapentin helping would I'd think suggest possibly some kind of neuropathic pain/nerve pain, unless it is perhaps making him feel dozy and less inclined to notice whatever is bothering him. I am assuming the full body X-rays removed hip dysplasia as a possibility? Cavaliers have a higher rate of this condition than many breeds even though it is often thought of as a large breed issue. I'd wonder too if this is something spinal that isn't being picked up, a compressed nerve somewhere? I'm not a vet and am only offering some thoughts based on having had numerous cavaliers with various degrees of SM. CM will show in nearly every single cavalier on MRI as I am sure your neurologist likely noted to you. Keep in mind much depends on the abilities of the radiologist reviewing scans and details like the angles of the scans and positioning of the dog. As with human patients, different radiologists can see different things depending on experience and ability and areas of expertise. It does sound like SM, or CM as the cause, has been ruled out although I am not sure that all neurologists would agree that fluid buildup needs to be present to cause pain with CM; I know that fluid dynamics can be a key issue -- ie the way the cerebrospinal fluid is moving about the spine and brain.

Perhaps it would be useful to get a second opinion on the existing scans? I am assuming that some simpler possible causes of yelping and snapping at hindquarters have been ruled out, such as flea allergies or rabbit mites (Cheyletiellia)? I've known of a few cases where people had dogs snapping at hindquarters and feared SM but then found it was rabbit mites, which can be extremely irritating to dogs. Some vets don't seem that familiar with them because they affect dogs less frequently than rabbits and cats, but two of my cavaliers had these as puppies.

Neurologist Clare Rusbridge says this about alternative diagnoses (https://veterinary-neurologist.co.uk/cm-p-and-sm-s-clinical-signs/):



I would think a dog having signs of CM would likely be showing other signs than snapping at hindquarters. These are the signs Clare lists on the same document:

Oh also, the neurologist I went to has cavaliers himself with SM and is very familiar with the disease. He had great reviews and referrals and that’s why I chose him, not saying people never make mistakes

 

[Karlin]

How often does he have the yelping episodes? How long does one go on for?

Mites are easy to check for -- needs a skin scrape; sometimes you can see what looks like 'walking dandruff' around the base of the tail or rump and those are the mites. They can be easy to miss, for some vets who just aren't used to looking for them, but I'd think it worth checking. Also, more info on checking for a flea allergy: https://www.petmd.com/dog/conditions/skin/c_multi_flea_bite_hypersensitivity.

I'd have your vet check really carefully for both.

 

[Jessicacavaliermom]

How often does he have the yelping episodes? How long does one go on for?

Mites are easy to check for -- needs a skin scrape; sometimes you can see what looks like 'walking dandruff' around the base of the tail or rump and those are the mites. They can be easy to miss, for some vets who just aren't used to looking for them, but I'd think it worth checking. Also, more info on checking for a flea allergy: https://www.petmd.com/dog/conditions/skin/c_multi_flea_bite_hypersensitivity.

I'd have your vet check really carefully for both.

I will definitely do that. Typically it is one Yelp for maybe a second and a bite towards the legs or back. Rarely (maybe three times since he’s been with us over the last 2.5 months) he will do it a few times in a row. Then acts like nothing happened afterward. This doesn’t affect his walking or activity in any way but it is possible that days where we had more activity it’s more common afterwards, maybe he’s stressing something?

 

[Jessicacavaliermom]

How often does he have the yelping episodes? How long does one go on for?

Mites are easy to check for -- needs a skin scrape; sometimes you can see what looks like 'walking dandruff' around the base of the tail or rump and those are the mites. They can be easy to miss, for some vets who just aren't used to looking for them, but I'd think it worth checking. Also, more info on checking for a flea allergy: https://www.petmd.com/dog/conditions/skin/c_multi_flea_bite_hypersensitivity.

I'd have your vet check really carefully for both.

I may still call the vet about it, but I’ve checked his entire back and don’t see anything. He’s black so I think I’d notice them, but who knows.

 

[Karlin]

I think it is worth having the vet do this -- many vets miss rabbit mites if only visually checking, rather than doing a skin scrape (and many don't know to check for them). It can also be hard to spot fleas, unless there are a lot of them, and a dog that has a severe reaction to bites doesn't need to have very many to cause the kind of whipping around and biting at the back or hindquarters that you're seeing. If it doesn't seem to bother him too much, and is more irritating than painful, then you could wait until your next planned vet visit? These basic but often overlooked checks for common issues are good to do, before moving on to further meds and scans, just in case they turn out not to be needed. Anal glands would be another thing that could cause this kind of behaviour, but as you say, you've had those checked. I think it's the yelping that would concern me most because it does make you wonder. Even if nothing has shown on scans, if other checks don't produce anything and there's no other obvious cause, I'd be thinking it seems likely to be a spinal or orthopaedic issue of some sort. In that case I might opt for a second opinion for a second pair of eyes.

 

[Jessicacavaliermom]

I think it is worth having the vet do this -- many vets miss rabbit mites if only visually checking, rather than doing a skin scrape (and many don't know to check for them). It can also be hard to spot fleas, unless there are a lot of them, and a dog that has a severe reaction to bites doesn't need to have very many to cause the kind of whipping around and biting at the back or hindquarters that you're seeing. If it doesn't seem to bother him too much, and is more irritating than painful, then you could wait until your next planned vet visit? These basic but often overlooked checks for common issues are good to do, before moving on to further meds and scans, just in case they turn out not to be needed. Anal glands would be another thing that could cause this kind of behaviour, but as you say, you've had those checked. I think it's the yelping that would concern me most because it does make you wonder. Even if nothing has shown on scans, if other checks don't produce anything and there's no other obvious cause, I'd be thinking it seems likely to be a spinal or orthopaedic issue of some sort. In that case I might opt for a second opinion for a second pair of eyes.

Definitely. I don’t think he’s due again for a while since he finished his basic shots, but he’s still covered under insurance so might make a trip of it. He screams at the top of his lungs when they checked his anal glands, and take his rectal temp so I’m wondering if not full glands maybe just some sort of sensitivity?

 

[Jessicacavaliermom]

I think it is worth having the vet do this -- many vets miss rabbit mites if only visually checking, rather than doing a skin scrape (and many don't know to check for them). It can also be hard to spot fleas, unless there are a lot of them, and a dog that has a severe reaction to bites doesn't need to have very many to cause the kind of whipping around and biting at the back or hindquarters that you're seeing. If it doesn't seem to bother him too much, and is more irritating than painful, then you could wait until your next planned vet visit? These basic but often overlooked checks for common issues are good to do, before moving on to further meds and scans, just in case they turn out not to be needed. Anal glands would be another thing that could cause this kind of behaviour, but as you say, you've had those checked. I think it's the yelping that would concern me most because it does make you wonder. Even if nothing has shown on scans, if other checks don't produce anything and there's no other obvious cause, I'd be thinking it seems likely to be a spinal or orthopaedic issue of some sort. In that case I might opt for a second opinion for a second pair of eyes.

Forgive the double reply but would there be any itching/hair loss associated with this? I’m willing to try anything I just can’t see anything, no excessive itching and no hairloss so wondering if that could still be the cause.

 

[Nicki]

Usually parasites are the first thing to be ruled out, before you would even consider an MRI - I would definitely do skin scrapings, some of these things are virtually invisible to the naked eye and you would not be seeing much in terms of hair loss etc. I would expect some itching, especially with rabbit mite, that is very itchy. However as it's easy and inexpensive to rule out, I would do that first.

Hip Dysplasia doesn't always show up until the dog is older and it causes changes ie remodelling of the joint. I always thought my Shih Tzu had hip issues but nothing was found until she was 5!