I think Minnie may have SM.....

[Claire L]

is there any route that I can go down here(Ireland) before thinking about going to Chester???

When she is out walking she stops all the time to scratch. I thought it might just be the collar so I removed it and put her tags on her harness but she still stops to scratch. I also notice that she rubs her face along the floor once or twice during the day. She doesn't appear to be tender around the neck area and is quite happy for me to groom her.
She is such a petite little thing and so vulnerable that it just makes me weep to think that having been through such a hard time already in her short life, that now, she may also have this dreaded SM.
Any advice greatly appreciated.

[inca]

you said her tags ..............it may be worth removing them on her walk to see if she still scratches

the reason i have said this is a frend of mine has a dog that wears tags and he finds them very ittitating as when he walks they rattle and touch his skin
since removing them the prob has stopped

[Claire L]

Her tags are on her Puppia and don't touch her skin. Dogs are required by law here to wear their identity tags. I was thinking that maybe she is just not used to wearing stuff on her body. I hope that I may be worrying unneccesarily but I have to ask the questions .

[Karlin]

First some context for thinking about what to do:

Almost all cavaliers have the malformation which alone can cause symptoms, and somewhere between 30-70% of research samples from around the world consistently show SM -- so it is perhaps better not to worry about whether a cavalier has SM, but whether it is symptomatic SM that is causing problems and pain for the dog.

Now:

If this is the case with Minnie, a 5 year old that only scratches on walks is showing mild symptoms and would not overly worry me, personally. I'd also want to see more than that, before I'd be considering the likelihood of SM or the need for an MRI.

There are a hundred things that could cause scratching. If it is really bothering her then please see your vet to start to eliminate all the more likely reasons she is scratching, including mites, fleas, allergies, and PSOM (very few cavaliers have symptomatic SM).

If she isn;t bothered than I really would not put her through a further series of far more invasive tests to see if she has SM -- an MRI will cost over €1000 in Ireland, requires a general, and will probably only tell you what most of us would find anyway with an MRI -- the malformation, probably some herniation of the brain as this is very common, and perhaps the formation of some syrinxes. If you travel to Chester they will not offer much help on treatment -- the mini MRI they do for lower cost is really targetted at breeders, not diagnosis and treatment of affected cavaliers -- most cavaliers will need a far more thorough MRI than the MRI for treatment and Chestergates will tell you this. Thus it makes more sense to stay in Ireland.

There is no reason to MRI a mildly affected cavalier IMHO but you can have her go through a neurological exam at UCD without an MRI, if your vet is unable to find any other cause for her scratching.

Then with the neurologist's agreement, you might put her on something like frusemide to lower CSF pressure and see if that alleviates the scratching.

There's lots of info on my SM website. My vets -- Anicare -- are familiar with SM, especially Tanis, Susan or Fintan, and so is Adrienne at Beaufield vets in Celbridge, so if you are really concerned go see one of those vets and have them go through the process of eliminating other causes.

I do feel quite strongly though that given the consistent research results over the past several years, people who own cavaliers need to realise that it would be unlikely for them to have a cavalier without CM (Chiari-like malformation) and there's probably at least a 50-50 chance that any cavalier has SM to some degree. It isn't a case of other people's cavaliers having this problem and hoping yours doesn't have it, but a case where 90% plus cavaliers having at least some of the problem (CM and often the associated issues like herniation of the brain) and half or more having SM as well over a lifetime. That is why this particular condition is so alarming and so threatening to the breed. No researcher has yet had a sample that didn't fit this level of affectedness on MRI.

This is the advice I give on what to do if you think your cavalier has SM:

http://sm.cavaliertalk.com/diagnosin.../isthissm.html

[ppotterfield]

So sorry to see your post about Minnie Moo and your fear that she may have SM. I think all of us with Cavaliers have similiar fears. Follow Karlin's advise and hopefully Minnie Moo will have many happy years with you ahead of her.

It is so sad that our joy in having these wonderful little dogs is marred by such serious health concerns. And the proliferation of Cavaliers in puppy mills and by breeders who are not doing adequate health screenings before breeding is not helping. I know that responsible breeders are in a very difficult situation but breeding beautiful show dogs cannot take preference over breeding healthy dogs. Unfortunately, IMHO, if breeders cannot afford to do the appropritate heart and SM screenings, then they should not breed. I know this may have the result of making breeding impossible for some but at this point I do not think there is much choice.

I also believe strongly that all of us who have and love Cavaliers need to play whatever role we can in helping with research and public education so that hopefully these problems can begin to be under control. This may simply involve being honest with folks who inquire about getting a Cavalier about the health risks and the importance of using breeders who are following appropriate breeding protocols.

Claire, we will be thinking of you and keeping Minnie Moo in our thoughts and prayers.

[Claire L]

Thanks so much for the advice guys
I think I will keep a record of her scratching over the next few weeks and see how it goes. She was groomed today and she is one happy little girlie.

[Alison_Leighfield]

Claire,

Scratching doesn't always happen with SM every time.

It isn't, in my own opinion, always the first signal to watch for.

Only one of mine from all that were affected (4) ever sctatched at all.

It was the scooting, face rubbing and paws/bottom chewing that set my alarm bells ringing. Everytime.

Alison.

[Barbara Nixon]

Face rubbing could be her way of washing her muzzle, Claire. Mine do it if they have had food with gravy or something a little messy.

There could also be something on your walk thatvis mildly irritating for Minnie.

Try not to worry, says one who's worried about her boy.

[Maxxs_Mummy]

Hi Claire,

I agree with everything that Karlin has told you. I went with my Vet to a presentation/talk/slideshow on CM given by Geoff and Judith Skerritt and Michael Deutschland last Saturday.

I must say that sitting through the afternoon and also having a chance to ask questions and also chat to Mr Skerritt (my Vet knows him) after the event had finished, has put a lot of 'ghosts' to rest for me about CM/SM/SHM.

They are now beginning to think that the Chiari like malformation is quite possibly normal in Cavaliers & certain other breeds as so many of them have the malformation.

If I were you, I'd see your Vet and maybe ask if she could try some diuretics (Frusemide?) and see how Minnie does then.

A certain amount of scratching is normal for any animal and so is rolling around and face rubbing after meals & at other time etc - even cats and horses do it and so do animals in the wild.

Does little Minnie have any other symptoms or is it just the scratching and rubbing?

[Karlin]

I do want to be cautious here for Donna, Claire, and other readers with an interest in this area and clarify what researchers are saying from my direct conversations with researchers -- including Geoff Skerritt:

* None believes it is *normal* for any dog to have a malformation that leaves too little room for the brain and thus frequently not just places pressure on the base of the brain, but also forces it out through the bottom of the skull into the spine

* None believes it is normal for any animal to have such a deformation in its skull that redirects CSF flow to such an extent as to cause side effects including severe pain, seizures, and death. Anyone who believes this is 'normal' need only watch this:

http://s114.photobucket.com/albums/n...ent=Chris4.flv

Even experienced researchers who see SM cavaliers regularly found this extremely difficult to watch when it was shown at the London conference.

It is certainly not common in other breeds either, much less normal. Very few other breeds have the malformation and only Brussels Griffons seem to have it to such an extent that SM cases are becoming clinically noticeable. NONE has it anywhere near the level of cavaliers. My Skerritt himself told me that he sees at least 2-3 cavaliers with SM every single week and this has been the case now for at least three years. He sees almost no other breeds presenting with SM symptoms. To date I am aware of only a handful of Griffons with the condition -- and I do know the roster of affected breeds at this point from talking regularly to researchers. Mr Skerritt would not have any different info from what I have access to.

I think what he likely meant -- going by reports I have had back from numerous people at the same seminar -- was that it is so common in cavaliers that it must now (sadly!) be seen as the norm for the breed to have a worrying abnormaility -- which is quite different from saying it is 'normal' for any dog to have the malformation or that it is a normal condition in the breed. It is a *malformation*, don't forget -- no one considers this to a normal skull shape and that shape has been largely dictated by a very narrow gene pool and quite possibly the selection for a certain type of head shape over the past 2-3 decades. Indeed I know he expressed grave concern at the level of incidence in cavaliers and always has said this.

It is useful to be aware as well that Mr Skerritt does have some perspectives that are totally at odds with other researchers, including his choice of shunt surgery. I like Mr Skerritt but do know he is considered somewhat eccentric in that particular view as well as on some other points. He also has been very distanced from the research community for the past half decade -- indeed many are very anxious to know what his evidence from his case studies and conclusions actually are; many were deeply disappointed that he did not have the promised paper ready to give at the London conference as he was on the schedule to present data that many have wanted to hera for years now. An assistant was to actually give the paper but apparently he hadn't completed it. Mr Skerritt has probably the broadest case record so many are very eager to get his figures and the results of his treatment apporoaches (eg the rate of success he sees with drugs like frusemide).

As for what constitutes a normal behaviour: I agree entirely, many SM behaviours can easily be confused with normal behaviours if people do not understand what to watch out for, which is why I recommend people view the videos on the SM website, carefully read the symptoms document there and Clare Rusbridge's information, and then go thru the process I suggest (written with vet and neurologist support) on the site if anyone suspects SM as a *possibility*. In general SM cavaliers have far more prolonged and excessive versions of some common behaviours.

I have seen cavaliers that scoot and facerub in response to SM and it is quite different from normal behaviours -- as is SM scratching. The video of Chester really shows how intensive SM face rubbing can be and they can choose very abrasive items to face rub against. Those who have seen the difference in normal and SM behaviours tend to never forget those differences and can spot them fairly quickly, just as an experienced neurologist can.

Very little is known about SM and its development or progression; as one of the world's leading human SM experts said at the London event, he has struggled for a lifetime to make sense of it and it remains a great mystery. The same is true -- perhaps to even greater an extent -- of canine SM as the four legged stance of dogs seems to significantly alter CSF dynamics and affects the success rate of the surgeries done to relieve the condition in a way that doesn't happen with humans. Sadly, at this time no one can offer any definitive answers or reassurances -- only educated guesses based on ongoing research and clinical experience.