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Ruby's mystery pain...(We'd love some ideas/help!)

Riley, my SM girl, has been on 5 mg prednisone daily for almost 2 and 1/2 years and she absolutely needs it. Without it, she can barely walk. So for her it is a miracle drug. She has lost some of her fur - her tail looks like a rat's tail and her belly fur is very thin, but so far that is all I notice in terms of side effects. She has her liver enzymes checked every 4 months and takes a supplement to protect her liver. So far so good. As Karlin said, every case has to be evaluated separately and prednisone is giving Riley a good quality of life.

I'm so glad Maggie has responded so quickly to her medication. I also use the Greenie's pill pockets for Riley. They are really easy to use and as soon as she sees me getting one out of the packet she acts just like Mellie said Bella and Koda act - like an addict! What a relief to finally have a diagnosis and your neurologist sounds like a dream. Keep in touch. We all need the support from each other.
 
So much to deal with so fast....

Glad you have the results even if they are somewhat confusing at this point. Just know that you and your sweet Ruby are in my prayers. So glad she has such a lovely caring mommy
 
Is it possible to maintain some dogs on prednisone over the course of a lifetime? Lets say 5 + years? I would be curious to know...
 
Wow. I am just getting to read this thread the whole way through...SO many hugs to you and Ruby :hug:

It sounds like you are learning a lot along the way and have a wonderful team helping you out. I would be so distraught like you if this was happening to Brooklyn, but the more informed we all become, the more we can help our little ones. You are a special one to take in a puppy mill rescue and she was given to you for a reason...the powers the be knew that for whatever reason you can handle this, so stay strong, shower her with love (which it sounds like you are doing really well!) and stay strong.

Isnt it amazing by the way what love a wagging tail can bring. It is almost as if to say "it's gonna be alright, I love you". Nothing beats a wagging tail when our pups see us first thing in the morning. Cherish that.

Brooklyn and I are thinking of you!! :lotsaluv:
 
Sorry to hear you are dealing with this. I have a girl with SM and she is doing great on her meds and is a very happy girl. I give her meds to her using canned "spray" cheese and she loves it. It's much cheaper than using pill pockets.

Good luck to you. How wonderful that you have such a caring neurologist.
 
Two quick questions...

Hi everybody,
Thanks again for all the kind words! You're the best! I have two questions for anyone who can try and answer them for me.
The first one: Is COMS the same as SM? I've tried to figure this out online and still don't quite understand. I know she has "one syrinx at the level C2-3, Chiari-like malformation"
Also, last night, before bedtime and this morning after she'd been up a little while, Ruby did the head floor/couch wipe. She yelped one little yelp. It used to be many long yelps. The one last evening was about 12 hrs after her morning med dose (she'd just taken her night-time dose) and the am episode was right after her morning dose. Maybe her med levels were low? So, I guess this is my question: Even on pain management meds, do they still sometimes do thier "episodes" a little bit?
Thanks ahead of time for taking the time and responding to me. Like I said earlier, I'd hug you all if I could! (hey! maybe take you all out for dinner at this point!)
Have a good day,
Jessie
 
My SM girl gets her 100 mg Gabapentin three times per day- from what I understand, it lasts 8 hours in their systems. I can tell as soon as it begins to wear off and it's time for her next dose. If I am even a little off schedule, she starts up with the scratching and bunny-hopping. As long as I keep her on a regular schedule, 3/day, (sometimes 4, depending on timing) she is kept very comfortable. Perhaps you should see about giving the Gabapentin 3/day? I am not sure if you are also doing Omeprazole, but Scarlett gets that, as well (1/day, 10 mg)
 
Hi Jessie

To better understand the terms, I would check out the website cavalierhealth.org . It seems the terms Chiari-like malformation (CM or CLM) and caudal occipital malformation syndrome (COMS) refer to the same thing. SM or syringomyelia is when there is a syrinx present usually as a result of CM/CLM/COMS. Most (not all) cavaliers have a degree of COMS/CLM/CM but not all have SM.
Please anyone correct me if I am wrong.
 
COMS is a term that was supposed to have been dropped but even some of the people who actually agreed to drop it at a symposium in London -- because it is inaccurate and confusing -- still use it (I was there and saw them all agree that this was a very poor term for the condition.... :rolleyes:). It basically means the whole complex from CM to SM and can include either. All the grading certs evaluate SM as the relevant factor, not CM as CM alone only rarely causes pain (but obviously any kind of pain symptom should preclude a dog from being bred anyway so this is not really an issue with the certs).

Dogs often still have symptoms on medications and medications do tend to stop working. Leo still scratches occasionally and has some sensitivity sometimes. When he looks uncomfortable at all I add in metacam each day. If a dog is still showing pain then meds probably need to be addressed but generally you need to give two weeks or so -- just a few days isn't enough to gauge if a dosage is appropriate as it can take time to work. Gabapentin more than 8 hours apart generally does not seem to work for dogs with a lot of symptoms for the gap after 8 hours and until the next dose.

Is it possible to maintain some dogs on prednisone over the course of a lifetime? Lets say 5 + years? I would be curious to know...
Click to expand...

Yes -- lots of people take it for a decade or more, so dogs can manage a much shorter time span, but there's always the risk of side effects over time. A lot depends on the individual (whether people, dogs, cats etc) and the dose level. The lower the dose, the better. Often it can eventually be given on alternate days once the dose is tapered down to the lowest possible. It is in some ways (and was at first believed to be) a miracle drug -- it can literally make crippling pain totally vanish within hours -- but unfortunately has potential side effects over time (not everyone gets side effects and you can do things to mitigate them with supplements, diet etc).
 
You can read the minutes of the discussion on using the term CM/SM rather than COMS or other options here:

http://sm.cavaliertalk.com/research/london/london/minutes.html

The relevant bit relating to COMS:

Occipital hypoplasia and Caudal occipital Malformation Syndrome (COMS) -
These terms were rejected because there is no proof yet that the condition is related to
either a malformed or hypoplastic occipital bone(s). Current evidence suggests that
there may be other significant factors in the pathogenesis. In addition these terms can
be confusing as for example the term COMS may imply the malformation only or the
malformation and syringomyelia.

The majority vote was for the term Chiari-like malformation and syringomyelia
(CM/SM) to be adopted (at the current time). This term was perceived to have the
following advantages.

1. Chiari malformation is accepted for the description of the disease in the human
species and is the most commonly used term in scientific publications.
2. Chiari-like malformation refers to the complex syndrome seen in the human
species however the “like” implies some differences in the canine.
3. The term can be easily abbreviated to CM/SM– having a simple acronym is
especially important to dog breeders and owners.
4. The term Chiari-like malformation (CM) can be used to distinguish dogs that
do not have syringomyelia

Chiari-like malformation (CM) is currently defined as decreased caudal fossa
volume with caudal descent of the cerebellum, and often the brainstem, into or though
the foramen magnum.

Syringomyelia (SM) is currently defined as a condition that results in the
development of fluid-containing cavities within the parenchyma of the spinal cord as
a consequence of abnormal cerebrospinal fluid movement.
Click to expand...
 
Also, if she is having a bad night (it seems worse at night or when it is bad weather coming in), I give her Tramadol. I can gauge how she is doing just by watching her-- when she is having a rough time, you can just see it in her eyes, and she pants, fly catches, and digs at her bedding. Thankfully, it is rare for that to happen.
 
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