Question about SM meds.
Hi, My cavalier was diagnosed with mild SM and PSOM about two years ago. Her neurologist put her on 50 mg Gabapentin and 5 mg of Omeprazole. We had to up the Gabapentin to 100 mg soon after as she still had symptoms. She has stayed on that dosage for 1 1/2 yrs. a couple months ago, the scratching and biting started again. I spoke to the neurologist and she increasesed her Gaapentin dose to 125 mg. it really hasn't made a difference. She is still scratching and biting. I am seeing her vet tomorrow and will make an appt with her neurologist. Her neurologist seems pretty conservative about meds. My cavalier also has liver disease and is on 3 other meds for that and a special liver diet. So, I am giving her medicine 8 times a day. My question is ( since she is my first cavalier): I was just wondering if some of you could give me an idea of how long it was before you had to increase the SM meds the first time, how much were they increased and and was the Gabapentin and Omeprazole both increased or just the Gab.? I know this is a general question and every dog is different and you have to find the combination that works for your dog , but I was just curious as to what other members on this board were doing. Also , how many times have you had to increase the meds.over the years? As I said, this is my first cav. , and I am just trying to see what others are doing . I hope this made sense. Thanks for any insight. Judy
It sure varies... with Leo I had to increase his initial 75mg 2x soon to 3x then go to 10mg etc on up to 200mg 3x.
I'd be looking to try some other things -- such as adding cimetidine, which has very few side effects but often works when omeprazole does nothing (omeprazole does diddly squat for Leo). You can also try adding in a painkiller or go up on gabapentin. Those are very small conservative increases in gabapentin from your neurologist, all right. Lyrica often works better than gabapentin or works when gabapentin doesn't work for a dog.
This disease is so variable. Some dogs stay very stable for years. Others have gradual increases in symptoms. Some have maybe one or two noticeable declines then are stable. Others decline very swiftly. Others go fine for months to years then have declines. If financially feasible (eg through a low cost scheme) it can be very helpful to re-MRI. I have re-MRId both Jaspar and Leo for research and Jaspar who didn't have SM at 1 still had no syrinx at around 6. Leo had a syrinx at 1 and though it had gotten much larger and wider by 6, and he has needed increases in meds, he's managed pretty well on meds still, at age 9. But he is at about the borderline where he needs either painkillers or maybe a switch to Lyrica.
Neurologists can be vastly different in how they approach treatment. Some seem to me to be too slow and conservative and others too hasty to rush to surgery. The key thing is to work together to find some workable treatment options that you too are comfortable with.
Daisy was diagnosed by MRI scan in Aug 2011 and then had minimal scratching and according to her Neuro no sign of any physical pain ,so for the first 9 months she was put on 3x50mg Cimetidene which didn't seem to make any great change to her .We went back in June and Gabapentin 2x100mg was then added in and after three weeks of observing her there again didn't seem any sign of change so back to her Neuro who then added 1x10mg of Omeprazole and this time there was a big difference with no scratching and generally a brighter Daisy. We have to be ultra careful with her medication as Daisy also has a Grade 4 heart murmur and PSOM on one side and has just recently undergone a surgical procedure to remove a lump on her side ,but to watch her she is the same mischievous Daisy as she was four years ago ,she is now 5 1/2 and we have a confident future with the specialists she is seeing and I consider the biggest danger to her is her MVD and not her SM .She of course is on no medication yet for her MVD but we do give her certain supplements which we have agreed with her Cardiologist. Even though both Cimetidene and Omeprazole are CSF reducers Daisy's Neuro wants her to continue taking both as they act on her CSF in different ways .
You very often have to tweak medication for SM dogs, initially to find what suits them, and later to keep up with changes in their condition. Not all dogs do best on gabapentin - over 4 years we gradually increased Oliver's dosage to the maximum 200mg x 3 and he was still getting headaches. We're trying a different medication now (not Lyrica), which is working very well - for him. It's a bit a question of trial and error until you find what's right for your dog, whatever keeps them as comfortable as possible.
Kate, Oliver and Aled