SM and prednisone update
I've been posting about my dog Sammy's health over the past 7 years quite a lot. He had serious SM symptoms from about 1 year old. He was treated with Gabapentin for a year and finally prednisone, which kept him very stable over the past 6 years. Last Autumn he had a bad neurological/vestibular episode (which my vet at the time said was definitely a central brain problem rather than inner ear problem), from which he recovered really well. However, he had to be put on a higher dose of prednisone to control these new symptoms (blinking eye, head tilt and facial paralysis, and eventually collapse and nystagmus).
Unfortunately 7 months later, it looks like he has developed cushings from the prednisone. He is losing his fur, especially on his tail, where the skin also looks pretty bad. I have tried now (as several times before) to reduce prednisone and increase Gabapentin and tramadol instead. We got through 2 weeks looking good, but now in the last few days he's been scratching a lot and rubbing his face so much that his eye is infected. He is on 450mg gabapentin per day, 5mg prednisone every third day, tramadol at night, and now an antibiotic. I don't know what to do - to keep giving prednisone everyday, causing cushings, or keep giving him this blend of medication that still leaves him with some level of sm related suffering. His scratching/rubbing episodes are not constant and otherwise he just gets on with things, but his eye looks pretty sad. Lyrica for some reason doesn't seem to make any difference. He is also on furosemide and furtekor for heart failure.
Compounding it all is the fact that Sammy has never been MRIed. He hasn't been insured, I've been a student and his symptoms seemed obvious and urgent enough to make their treatment also obvious (Gabapentin made a clear difference). However, I have been wondering for years whether some of this might be caused by PSOM or even an allergy. He has been seen by an ear specialist who didn't see PSOM pain reflexes but was happy to do an ear flushing operation nevertheless (he said it wouldn't harm Sammy whether they found a problem or not). I decided anyway not to put him through it.
I guess I'm trying to simply update Sammy's story for anyone who followed it, gather some similar experiences, and possibly decide on some questions. My questions now are:
- has anyone seen red eye with pus as a result of SM or PSOM? (Sammy actually had a similar eye infection at 1 year old when first diagnosed and started on gabapentin).
- has anyone had to keep on prednisone despite fur loss? I am giving him Denamarin for the liver and feeding him a hepatic and renal friendly diet, but the fur loss has developed despite this. Was it worth continuing the prednisone anyway or did worse problems develop?
- how much scratching and rubbing do you tolerate before you figure that the medication is not enough?
- would there be any benefit in doing the MRI now? I still can't afford it, but if i knew it would make a difference in his outcome, I would find a way to make it work.
- would it be worth flushing the ears (a lot cheaper than the MRI) just to see if PSOM is part of the problem? The ear specialist seemed very experienced in this surgery. If it is PSOM, it would probably needed repeating though. But I would be happy to do that, knowing that it is making him better.
In short, any similar experiences and advice would be welcome!
My understanding about PSOM is that you don't do the surgery to find out if the dog has PSOM, but because you already have diagnosed the PSOM as being there. I do not think I would put my dog through PSOM surgery unless PSOM was been diagnosed ahead of time.
Yeah, I was a bit confused when the ear specialist was talking about it, since part of the time he was talking about just an in-depth exam (which apparently would anyway need general anesthetic) and part of time he seemed to be talking about making an incision in the membrane as part of the exam (but I might be mistaken). I do think I have the option of just having a more in depth look at the membrane and leaving it if it isn't conclusive. I am concerned about the anesthetic and his heart condition though.
The ear specialist didn't think doing a very expensive MRI was worth it, since if he has PSOM, it wouldn't solve the problem, whereas they can diagnose it "very easily" and drain it there and then with a "very simple procedure" that they do all the time and have the best equipment for. I got a bit confused to be honest. And I think I'm clutching at straws anyway. The pain is not just around his ears, but down his spine and back legs as well. He even does the classic bunny walk sometimes. And Gabapentin would only help SM, as far as I've understood - not PSOM.
Laura I'm so sorry about your worries with Sam. I really only have experience with prednisone and hair loss with Riley and I kept her on it. Her poor tail looks like a rat's tail - there is no hair on it at all. Her thumping is so loud when she's excited you can hear it from outside the room because there's nothing to muffle it with. She has almost no belly fur and she has terrible dandruff. Her groomer says she has flakes as big as tortilla chips! Every summer she picks up some skin infection that she needs to take antibiotics for, for almost the whole summer as her immune system is so compromised. I do give her Salmon oil in addition to the Denamarin. After being on 5 mg/day for about 4 years, we successfully cut her back to 2.5 mg/day, primarily because her neurologist was concerned about her skin. Didn't make a difference and no fur grew back. She tolerated the decrease though but still has vestibular issues.
I don't know what you'd gain by having an MRI now. Wish I could help with the rest of it. Maybe try switching him to Lyrica?
I'm sorry to hear that Riley's fur didn't improve! And that she also has such problems with her skin. Did you try doing 5mg every other day, rather than 2.5mg every day? I made that switch a few years back and although I saw a small increase in his symptoms, his blood tests and skin improved greatly. It was a good compromise. On the other hand, given Sammy's present circumstances, I understand that the every-other-day switch might not be possible.
Thankfully Sammy's eye is almost normal now and he's scratching much less. He seems to improve greatly the day after the prednisone and then deteriorate again over the next two days (especially when the gabapentin is wearing off). But I think I just have to work out the best possible routine to get him through that 3rd day. I do still have plenty of Lyrica from previous attempts to switch him to that, so I may try it again. He's on such a cocktail of medication at the moment that it's very hard to tell what is doing what.
But I'm relieved that he isn't still getting worse. :xfngr: also that I'll see some improvement with the fur... Your 'rat tail' is a good description, though it's only on the bottom end of Sammy's tail at the moment, which looks pretty odd!
Thank you for sharing your experience - it helps to hear from someone in the same boat!
My youngest girl went on steroids as had allergies,PSOM,SM/CM.We had to wean off but had to start again after six months.Her bloods showed signs of issues such as Cushing's.She now gets 2.5mg every other day and I hope that will be enough in the future.We have dropped the Omeprazole with her taking steroid.Still on 20mg frusemide by twice daily,Gabapentin and Zitac.
Germarey, I'm puzzled that your girl is on both frusemide and Zitac, since they are both diuretics and are usually regarded as alternatives. Most neurologists no longer prescribe frusemide as long-term it may affect the heart. Something you could check out? Any diuretic carries risks for the kidneys, let alone two!
Kate, Oliver and Aled
It seems to me that the PSOM that showed up in Bentley's MRI causes most of his issues, rather than SM. He has absolutely no problem with tenderness around the head, neck, back area; in fact, he revels in being petted, almost as if he's getting a great massage, but he rubs his head against my leg or the carpet and scratches at his ear area. He gets gabapentin 3 times a day and a small amount of prednisone every 3 days. (I don't want to get up & look at the bottle right now to see the mg!). He seems happy. I will say that the specialist at Missouri University where he got the MRI has the opinion that the ear flushing or surgery isn't necessarily a fix so we opted to not put him through that and it possibly coming back.
The Zitac is for stomach as well as to reduce CSF pressure. We know the risks of Frusemide but they have to be comfortable and bloods done every 3months or sooner if concerned.Just developed heart murmur so monitoring but is nearly 8.Neurologist wants drugs as they are bearing in mind this little dog had facial paralysis with Chiari at 5 months.
Thank you for your concerns trust me I watch them like a hawk!
Thanks for your replies! Sammy also is not sensitive to touch around the neck. When his symptoms are bad, he will however move away if I reach to pat him on the top of the head. He does appreciate an ear rub though. Otherwise, he simply scratches a lot around the ears and neck (breaking the skin eventually), rubs his face and eyes, and chews his front and back paws. He also has some spine pain, though that could be due to spondolysis (which was also diagnosed when he was a year or so). The head tilt/eye squint/nystagmus/bunny hop/ataxia etc. could even be a separate problem, since they don't always coincide with the scratching.
Unfortunately his fur loss has continued. We were at the vets for more blood tests today, as well as a heart check up. All his counts (e.g. liver, kidney, blood sugar) were pretty normal again, but his blood was thin. He is a bit anemic. He was also tested for thyroid, though the results won't come back till Wednesday. The vet thought that thyroid may be the culprit for the fur loss and possibly an ulcer from the prednisone for the anemia.
His head was x-rayed just in case it would give any clues regarding PSOM. There was a difference between the left and right ear, with the right ear's 'wall' being thicker. Both middle ears looked quite bright though. So no real revelations there.
Unfortunately more x-rays also showed that Sammy now has fluid in his lungs. They then did an ultrasound of his heart. It isn't contracting fully and the left side is enlarged. So he's starting Vetmedin.
Poor baby. He's such a trooper. Every time he seems to be on death's door, he pulls through, tail still wagging away. When he was 1yr and the pain episodes began, I told myself that if I could get him happily to 8yrs, this will be a success story. He will be 8yrs in September. I'm now aiming for 10yrs (although secretly I'm thinking 12). As long as he's happy, I'll just keep treating all of these problems and symptoms and side-effects with every means possible. I'm determined to get him a long, full doggy life despite these rotten Cavalier diseases.