I'm going to ring another vet first thing in the morning to see if they know about psom, I just have to do anything I can to save her.
Copied and pasted:
A skull X-ray is a series of pictures of the bones of the skull. Skull X-rays have largely been replaced by computed tomography (CT) scans.
X-rays are a form of radiation, like light or radio waves, that are focused into a beam, much like a flashlight beam. X-rays can pass through most objects, including the human body. X-rays make a picture by striking a detector that either exposes a film or sends the picture to a computer. Dense tissues in the body, such as bones, block (absorb) many of the X-rays and look white on an X-ray picture. Less dense tissues, such as muscles and organs, block fewer of the X-rays (more of the X-rays pass through) and look like shades of gray on an X-ray. X-rays that pass only through air look black on the picture.
A skull X-ray may help find head injuries, bone fractures, or abnormal growths or changes in bone structure or size.
Why It Is Done
Skull X-rays have largely been replaced by CT scans. A skull X-ray may be done to:
Find a metallic foreign object stuck in the skull.
I went down armed with all the information in PSOM to speak to the vet today. She had never come across it before but had a vague recolection of hearing about it before. She said that only a major veterinary hospital like UCD (university college dublin) would have the equipment and the facility to investigate a condition like that as well being able to perform such a specific surgery. She was going to ring UCD and see what they had to suggest.
I got a call back this afternoon and she said that while Lola has many symptoms of PSOM there were a few that she doesn't have. She doesn't seem to be in any pain or discomfort which I agree with. Also there is no itching or agravation with that ear at all. The ear drum itself looks perfectly healthy and clean with no sign of a pressure buldge from underneath. This is why they are questioning PSOM. She also spoke about SM but they basically ruled it out because of Lola's age, that she would have presented with some symptoms before now. Also Lola's head tilt they think looks neurological as she corrects it herself and then will just slip back into the tilt. It is not a guarding tilt, to protect a painful area.
Lola's age is a major factor to them. They said even if it was diagnosed as PSOM then it would most likely take multiple surgeries to correct and then there isn't a guarantee that this won't come back. They said it would be extremely unfair to put a dog of Lola's age through that amount of surgery and the risks definitely outway the possible outcome. The only way for them to be sure about PSOM is an MRI and that is not a runner as it would only lead to the above senario.
They suggested that we treat Lola as we are with antibiotics and steriods. The vet said, we can't rule out that it isn't just a middle ear infection that these meds will work for. She is in no pain or discomfort so to continue as we are for now and review the situation on Saturday.
There just doesn't seem to be a light at the end of this tunnel at all. I just hope it is as simple as an ear infection but I seriously worried that its not.
The ear drum should not show any bulging unless the wad of mucus is exceptionally large. Most cavaliers with PSOM do not have bulging ear drums when diagnosed.
They can treat her with the tiresome, knee-jerk cocktail of antibiotics and steroids, but if she has PSOM, those will not make it go away, and if the cause is neurological, antibiotics won't fix it either, although steroids may suppress the symptoms.
MRIs usually are expensive, and I am sure that PSOM surgery does not come cheap, either. So those are factors to consider. It is correct that one PSOM surgery may not solve the problem forever, but for an older dog, it may because the recurrence of the ball of mucus takes time to develop.
I am not suggesting that Lola's vet has this problem, but some vets seem incapable of recognizing that many cavalier owners tend to know more about certain peculiar disorders in the breed than the vets do themselves. Low blood platelet counts are a perfect example of that fact. And these vets tend to be offended when the owners bring information to their attention. We experienced this ourselves several years ago when we tried to explain to a "potential" new vet (for our dogs) how important it is to x-ray our cavaliers' hearts periodically to measure any enlargement over time. We even handed the vet a copy of Dr. Buchanan's article on how to perform those measurements. This vet shoved the papers back across the examining table to my bride, indicating that he did not take instruction on any veterinary matters from a mere pet owner.
Yes Rod, I totally agree with you. I was not welcomed with open arms when I came in with my sheets of information at all. I didn't want to be stepping on anyones toes and my information was only a suggestion with regard to PSOM and could they kindly look into it and see where we could go from there.
When I got the afternoon phone call after the "vets had a meeting" It was made very clear that if I wanted to pursue PSOM then I would have to go to somewhere else. :(
Meanwhile, Lola is certainly much more herself today, thank God. She is more alert and happy. The facial paralysis is still there, the head tilt is there intermitently, and the back right leg still slips from time to time. I know for her the day long vet trip is excruicatingly stressful. Lola is a rescue and while adores us, is not your typical cav at all. She doesn't like eye contact from "outsiders" (even close family who she would see alot), she does not want anyone bar us to pet or cuddle her ever etc so the vet trip on a healthy day does upset her, let alone when she is being poked and prodded and not feeling well.
We are just going to take it a day at a time for now, continue with the meds because we really have no other option at the moment and so far she is much better.
I can recommend other vets to try. They should know an xray will not give them any useful information for a possible neurological condition or PSOM and at this point they really should know about PSOM given how many cavaliers they see in any Irish vet office... :(
They are absolutely wrong about SM -- ruling it out on the bis of no symptoms in the past. They really need to read Clare Rusbridge's website.
This is the link to the general SM section; might be worth passing onto them:
And more here: http://www.veterinary-neurologist.co.uk/Library/
UCD would be the place to go for CT or MRI scans.
This is correct and with an older dog I'd agree with this approach if she isn't in pain.Quote:
They said even if it was diagnosed as PSOM then it would most likely take multiple surgeries to correct and then there isn't a guarantee that this won't come back. They said it would be extremely unfair to put a dog of Lola's age through that amount of surgery and the risks definitely outway the possible outcome. The only way for them to be sure about PSOM is an MRI and that is not a runner as it would only lead to the above senario.
To me sounds like Vestibular Syndrome (esp as Lola is older) or possibly SM or PSOM.
Not seeing a bulging eardrum isn't a reliable sign that a dog does not have PSOM.
Vestibular disease: http://www.petmd.com/blogs/fullyvett...e#.UiSFRuDRfzI
We have quite a few here who have had cavaliers with it, as they get older.
Note that the article above suggests not treating Vestibular disease but waiting to see if it improves.
Lovely to be in contact with you after so long.
Thanks for the information. Vestibular Syndrome is definitely a possiblilty but she has no eye rolling or eye movement and no nausea that is commonly associated with this. Basically I don't think we are going to know definitively without the MRI and for Lola's age and her temperment this is just not possible and we feel would be very selfish of us to put her through that.
She is comfortable and is in no pain. She is still able to let me know when it is dinner time and will do her twirling in the air then the food bowl comes out. She is happy here and while has improved somewhat is not totally herself. She is back able to jump up and down off the chair and she is only slipping on that back leg very occasionally, which she doesn't seem to notice as she just hops back up and continues running. The wooden floor doesn't help her though. The head tilt comes and goes, it was fully gone for a day which I was thrilled about but then arrived back the next day. She prefers sleeping on the floor now, which would be very unusual for her, so I was wondering does she feel dizzy from time to time.
Its so hard to know where this is going, its really a waiting game to see but for now I am loving her as much as I can. For the first time ever, on our vet visit on Saturday, two separate people commented on how old she looked. She is definitely showing her age for the first time, so much so the the vet said, that she wouldn't be surprised if she was older than we think. :(
Hi Sue: A CT scan may well give needed info as opposed to a far more costly MRI.
I am not sure that all symptoms are always apparent with conditions like Vestibular Syndrome.
The link I gave says:
And another link says eye movements (nystygmus) or nausea may NOT be present especially if it is not a severe case --Quote:
Dogs with idiopathic vestibular disease have some combination of the following symptoms:
A head tilt
They are unsteady on their feet and may fall over
They circle in one direction or even roll across the floor
Their eyes flick back and forth, up and down, or rotate in a circle (this is called nystagmus)
An unwillingness to eat due to nausea
Often, nut not always. It might be that she had the eye movements at some point where this wasn't noticed and they have stopped, as well?Quote:
The most obvious sign of vestibular disease in dogs and cats is a head tilt. Head tilting occurs when the disease obstructs normal feedback information from the brain that determines the animals’ special orientation. This disturbance is almost always associated with a disturbance in gait, commonly termed ataxia. Severely affected animals may circle or call toward the side of the head tilt or even roll to the affected side. The eyes will often jerk or sometimes circle uncontrollable (termed nystagmus). Chronically affected animals often no longer have nystagmus and some other symptoms may not be prominent. Vomiting may also be seen, presumable due to vertigo.
The vets might also consider myoclonus, which is unexplained neurological twitches and issues that can get as involved as having limbs go wobbly and the dog stumbling. Clare Rusbridge says this is very common in older cavaliers and only needs treatment if the dog's quality of life is compromised. I believe she uses on of the vet epilepsy drugs for severe cases but a vet could talk about this with her. But the head tilt might rule out myoclonus. Jaspar has it to some degree and just gets a wavery head now and then or looks like he is falling asleep while standing etc.
All in all, given her age and that you are seeing on and off improvement, I would wager this is vestibular disease and she'll probably simply improve to a good degree on her own.
I'd leave things and see rather than rush to get any scans or go to UCD. I'd recommend Fintan at Blanchardstown Vet, Susan at Palmerstown Vet or Pete at Bray Vet as good vets on these kinds of issues.
A stroke could be a possibility too. And yes a middle ear infection. But just sounds like vestibular disease.