SM and airplane travel

[maneumann]

We have a darling little cavalier named jack Sprat who is only 7 months old and was diagnosed with SM at 5 months. He is doing rather well now that he is on medication (still showing symptoms especially in the am, but not screaming very often and walking normally vs. the 3 leg bunny hop he was developing prior to the meds).

We are traveling to Aspen soon for a ski trip, and would like to bring him along as he hates to be left behind! He would of course travel with us, not cargo, but I know this condition renders them sensitive to pressure changes. I asked Jack's neurologist at UC Davis and he was unsure how the plane would affect him.

So my question is, has anyone who has a dog with SM noticed an increase in their discomfort when traveling on a plane?

Many thanks in advance for the feedback.

[ppotterfield]

Cathy Moon just had experience with Charlie traveling from California back to Ohio. I get the impression it was a rough trip. Do not know whether it had to do with cabin pressure or what. Cathy: If you see this, perhaps you can help. If she does not, you might send her a private message, as she is very busy right now with Charlie post-surgery.

[Karlin]

I spoke to Clare Rusbridge on Cathy's behalf and she (Clare) asked a human SM expert. The human expert said that generally he didn't think the altitude would necessarily affect a dog because it would be in a pressurised cabin. However some people have definitely noticed side effects and atlitude can have other effects too. For a symptomatic dog, I' really not be inclined to fly unless absolutely necessary -- not because of the cabin preesure necessarily, but also because flying is going to be stressful and stress causes increased CSF pressure and that is what causes the pain episodes and the worsening of syrinxes. I'd only fly an SM dog to transport it for needed medical treatment if driving wasn't an option, but definitely not for holidays, etc. I'd be looking for a home boarding situation or a friend who could mind him.

I'm sorry to hear your little fellow has an SM diagnosis. I'm not sure what your treatment approach is longer term, but you are probably aware that for dogs showing such early symptoms, that medications probably won't be helpful for very long. Those of us with SM dogs (that includes me) base treatment decisions on many factors (and in my case I have two SM dogs which I treat medically) and it is a very personal deicison. But whenever anyone mentions really young dogs having pain episodes before age one, I do try to make sure they're aware of the arguments in favour of decompression and the high likelihood of rapid decline on medication alone, as all evidence is showing the earlier severe young dogs have surgery, the better the outcome.

[maneumann]

Thanks for the responses -- I had a feeling it would not be a particularly good idea. Jack is just starting a diet from Monica Segal, an animal nutritionist who also happens to have a cavalier with SM, and he starts acupuncture next week. Our hope is that we can get him to one year so that he can have the surgery. We were told by our neurologist that if we did the surgery before he was full grown, that the symptoms could actually worsen and the syrinx could also reform. So at the moment, all we are able to do is treat him medically (with gabapentin and predisone) and hope. Poor little guy, I know his chances are not good being diagnosed so young. Heartbreaking. At any rate, I really appreciate the advice... I read everything I can, but there are so many unknowns and talking to people who have dogs with SM is so helpful. Thank you.

[Cathy Moon]

I asked our neurologist if it would harm Charlie to fly home with me to Ohio (I adopted him from California), and he said it would be okay. I think he referred to the brain and spinal cord as a 'closed hydraulic system.'

Flying with Charlie was a bit of a nightmare because he has very severe SM symptoms, he didn't know me very well, he didn't want to be in the carrier, and he was in pain. He was sedated, but I found I had to give him additional Valium every two hours, which was more than the instructions said. At one point we were in peril of being removed from the plane after boarding because of Charlie's vocalizations.

I'm with Karlin; I would only fly a dog having SM if it was for medical treatment.

[Karlin]

Hmmmm. On the contrary, my understanding from talking regularly to the leading experts on SM in cavaliers is that the earlier surgery can be performed, the better the outcome, and that a dog under one is a much BETTER candidate than older dogs precisely because it is still maturing and hence can bounce back faster, just as children tend to cope better with many surgeries than older people and heal faster. I have *never* heard that waiting is a better choice or that a growing cavalier is more likely to reform scar tissue. If anything a severely affected young dog is more likely to acquire significant damage during that waiting period that can never be corrected after surgery and may not even make it to the one year point. Cathy's Charlie is an example of a dog that was diagnosed at about 5 months and by the time he was 12 months he was having severe pain episodes despite medication and by the time he had his surgery, last week, had significant damage. We are all hoping he will get some reversal of some of his severe symptoms but if he had been done at 5 or 7 months his prognosis almost surely would have been hugely improved and he'd not have all the problems he now has. He was a rescue dog and the rescue people opted not to go ahead with surgery at the time. Cathy had the surgery within a week or two of adopting him.

I'd really, really recommend getting a second opinion from a neurologist very familiar with SM. Unfortunately there are few in California -- Dr Kortz is one and he sometimes is at UCD but I would consider at least speaking to Dr Harrington in Washington state, who has done many SM surgeries. I know the leading experts on this condition, such as Dr Rusbridge, Dr Dewey and Dr Marino, would immediately get such a young dog into surgery as a high priority. Clare believes some of the very good results Dr arino and Dewey are getting with their surgery is because they are doing it on much younger dogs rather than dogs who have suffered with the symptoms and consequent increasing permanent damage. Children also get the decompression surgery regularly. Scar tissue forms in about 20% of all cases in adults as well as younger dogs and in all the existing research the youth of the dog has never been cited as a higher risk for scar tissue formation.

If nothing else I would abslutely insist your neuro talk to Dr Dewey or Marino or speak to them yourself, as they have done dozens of surgeries, many on quite young dogs.

Clare has done the surgery with good results on a 12 week old. Her paper looking at longer term results found no difference at all for outcomes between young and older dogs but she told me recently she does feel younger dogs probably will have better outcomes because the earlier they are done, the less damage.

Screaming sessions fall on to the severe end of the pain scale the neurologists agreed upon at the London CKCS SM conference last year, and thus I'd be moving very fast to do the surgery if surgery were at all being contemplated.

[maneumann]

I will get a second opinion immediately and let you know. Thanks for the names!!!

[Karlin]

Checked with Dr Clare Rusbridge in the UK and she says she would definitely operate on a young dog. She is the leading expert on this condition in CKCS.

[maneumann]

[FONT='Times New Roman']Thank you, you are so kind to do that (not to mention adopting a dog with SM!)! Now I am getting terribly confused which is half the problem with SM, because I spoke with Dr. Harrington yesterday, who told me he saw better result with dogs over 1 year and recommended that I continue with acupuncture and medication unless Jack’s systems started rapidly progressing. He also told me that Dr. Kortz would be best since he is in CA and if there were complications, the proximity would serve us well. Additionally, we said a successfully surgery was relief for approximately 2 years (which corroborated what I read on a study housed on the cavalierhalth.org). If that is the case, and that is probably also open for debate, am I doing Jack a favor to operate on him at 7 months to give him 2 years? [/FONT]

[FONT='Times New Roman']I’ve called Dr. Kortz and hopefully will hear back form him soon. And Jack has his next appointment on Tues. with his neurologist at UC Davis, so I think your suggestion to have him call Dr. Rusbridge is right on the money. Given that she is the leading expert, unless there is an anomaly in the case, operating now is a strong argument. But, the 2 year prognosis is also grim. Has that been what you’ve witness or heard s well, or a more optimistic number?[/FONT]
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[SIZE=3][FONT=Times New Roman]Again, thank you for all of your help and advice… I can’t tell you how helpful it is. Make a decision is very difficult, so to have more quality information is invaluable.[/FONT][/SIZE]
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[SIZE=3][FONT=Times New Roman]Kindest regards,[/FONT][/SIZE]
[SIZE=3][FONT=Times New Roman]Mary Ann[/FONT][/SIZE]

[Karlin]

Well, the details of that study, which is probably Clare's, is in order. What Clare has said is that she generally begins to see about 50% of cavaliers have *some return of symptoms* by two years -- NOT that they only live two years and are then euthenised. I would guess this is what Dr Harrington meant. She has cavaliers 7 years out from the surgery now. Most need some medical management because of permanent damage already caused by waiting. Dr Harrington would probably differ from Dr Marino, Dr Dewey and Dr Rusbridge on the opinion of waiting. But as in any branch of medicine all practitioners have different opinions and the patient or the owner ends up having to weigh up their own feelings and where they want to place their trust. I would guess the three doctors above have done more decompressions however than Dr Harrington and also have certainly published more widely and presented at conferences. But they all differ too in other ways -- Clare often feels dogs can be managed medically that Drs Marino and Dewey would do decompressions on. I take Dr Harrington's point that waiting might be advisable IF there's no further or very little decline (though I've never heard of age being an issue), but personally, I would think a young dog showing signs as severe as screaming is probably going to decline over an additional 5-6 months. The really difficult thing is not knowing what will happen.

The best surgical outcomes seem to be coming from the special version of decompression done on the east coast by Drs Dewey and Marino and documented on their website, http://www.livs.org/livsnews.htm. It seems so far to prevent the return of scar tissue which probably is what causes the return of symptoms. However they do not have long term results on this surgery yet. It more closely follows what is done for humans however and the use of a titanium mesh is quite standard to prevent scar tissue in humans.

You can read Clare's paper on following 16 dogs with the surgery on www.smcavalier.com in the section on research, then on London 06. Also you can read about the LIVS surgery. The relevant bit of Clare's paper, which has since been published I believe:

Two months after surgery, 80% (12) had improved.
7 out of 12 maintained their improvement
1 of the 12 had tonsillar carcinoma and was euthenised
4 of 12 deteriorated between .2 to 2 years post-op
2 of those were euthenised
Of the 3 out of 15 that were unchanged, 2 deteriorated between .8 to 2.3 years post-op

In summary:
• 7 (47%) out of 15 dogs deteriorated to some degree, between .2 to 2.3 years post-op; the mean is 1.3 yrs; and two were eventually euthenised as a result
• Of the 15, 12 are still alive. One is 6.5 years post-op (mean = 2.5 years)