12th January 2008, 08:49 PM
Madison diagnosed through MRI with SM
Hi. I'm new here. Our three year old girl was just diagnosed with SM.
Madison is three and has been showing mild symptoms for the last two years. She scratches many times a day, exhibits bunny hopping, walks a little funny, tucks in her rear, and will yelp occasionally when she's being picked up. We haven't notice much clinical progression over the years.
We have very good (and expensive) vets and have spent the last two years back and forth trying to find a resolution. We got side tracked with allergy testing and shots. It turns out that our baby is allergic to everything. Only after going through allergy treatment protocol did we convince the vet to recommend an MRI.
Her results came back a few days ago and the physical prognosis was far worse than we expected. The imaging report stated that she is severely affected by the disease. She has severe chiari. Her cerebellum has herniated. She has syrinxes covering 95% of her spinal cord.
After consulting with various neurologists including Dewey and (I believe) Rusbridge, our vet was not confident that, given Madison's lack of pain, the risk of surgery and recurrence outweighs the benefits. We are currently following Rusbridge's medical protocol and are giving her diuretics.
I've had read everything I can that's available online and have several questions about Madison's prognosis given the severity of the syrinxes. I've read of course that the clinical progression is variable and that surgery is often not indicated unless there are signs of pain. But, is there any reason for the syrinxes to get any worse at this point now that she is fully grown?
On the other hand, I am worried that, given the severity, if we wait too long, we'll find ourselves with no options. At what clinical and physical point are people getting the surgery?
Last edited by Bridam; 13th January 2008 at 12:27 AM.
12th January 2008, 09:49 PM
I'm so sorry for what you're going through with Madison.
Has a neurologist examined her yet? I would take her to see at least one neurologist for a neurological exam to find out if she has any neuro deficits and neuropathic pain, and to get an opinion on medical treatment or surgery.
I have a severely affected cavalier, Charlie, who recently had decompression surgery. From what I understand, the surgery will not make the syrinxes go away. It will only relieve the pressure on the brain and spinal cord from the back of the skull.
Charlie's neurosurgeon told us they get better results when the surgery is performed earlier in the disease. In other words, the longer the dog is symptomatic before surgery, the less successful the outcome.
Last edited by Cathy Moon; 12th January 2008 at 09:54 PM.
Reason: added text
India(tri-F) Geordie(blen-M)Chocolate(b&t-F)Charlie(at the bridge)
12th January 2008, 11:42 PM
Originally Posted by Cathy Moon
Thank you for your response. She hasn't been examined by a neurologist yet. My vet said there wasn't much point. Madison isn't showing severe clinical symptoms at this point. They have looked at her MRI and we didn't get good feedback. We were told that there isn't enough evidence that the surgery has long term positive results.
The local neurosurgeon who has done a handful of these here in Dallas told our vet that she has had to perform second surgeries on more than half her patients due to recurrence.
13th January 2008, 12:00 AM
For Madison's sake, I will stick my neck out here and say your vets are wrong. Whatever your ultimate decision, you really do need a neuro consult especially with this severe an MRI if you want to make an informed decision on Madison's future -- neurologists will have a much better idea of what is going on and also a clinical exam by a neuro will likely reveal additional problems developing that vets cannot spot -- such as limb weakness, poor gait, pain points along the spine. Basically, vets are not specialists and this is a specialist disease. Most vets will never see a case of SM in their careers so they can be understandably misinformed.
On pain and how much damage has been done: dogs can compensate for the extremities of pain they would otherwise feel with the type of MRI your girl had because progression is slow -- but nonetheless, they are still burdened with a heavy weight of neuropathic pain. If you know any people with this, they will explain how debilitating this type of chronic pain is. Dr Marino showed a slide of a dog in at October's SM conference in Rugby, UK where he noted that if that dog just suddenly received an injury that caused that many syrinxes the dog would probably not live through the pain.
Syrinxes have been partially resolving with Dr Marino and Dewey's surgery. even when the syrinxes don't resolve the point of the surgery is to relieve pain and the removal of some of the skull to get rid of the herniation and hind brain pressure seems to accomplish that for about 80% of dogs at least within the first year.
The neurologists who met at the first SM conference in London in 2006 were unanimous on the point that dogs that are symptomatic before age 4 tend to be the most severe cases and develop the most pain. If you have an MRI like this now, I would go in and talk to Dr Dewey or Marino if you are driving distance of LIVS, and do so as a matter of urgency. I know from attending these events and talking to these neurologists as well as many people with SM dogs that younger dogs with severe MRIs often will suddenly go downhill -- even within days or weeks. Their CSF flow is so compromised by syrinxes and the herniation and malformation that at any point any small progression can cause them to crash.
Treatment is always a very personal decision but I think with younger symptomatic dogs with poor MRIs the feeling amongst neurologists is definitely that surgery probably offers the only chance for anything like a medium to normal lifespan and a decision to opt for medications instead needs to be understood in that context. Vets incidentally do not have the skillsets to accurately read and interpret MRIs so really you need a neuro to explain the MRI to you and discuss prognoses. It sounds like they may not be very familiar with the overall literature and papers given in the past two years on the surgery either -- Dewey and Marino have been having very good results so far (though have only been doing their specialised version of the surgery for about 2 years but all dogs are doing really well! Clare Rusbridge has about 50% doing very well post surgery up to 7 years after, with some having some return of symptoms but that being fairly manageable on medications. Only a small portion of dogs do not do well and those tend to worsen within a few months of the surgery. That's a very high rate of second surgeries by the surgeon mentioned -- usually the figure is more like 20%. Dr Marino feels many do not remove enough of the dura and thus scar tissue reforms so perhaps it is technique? Dewey and Marino to my knowledge have only needed to perform a second surgery on one dog in two years and that was due to a separate issue. Marino discusses it in his talk on the CDs noted below.
I'd have a look at paper 9 by Rusbridge and the Marino presentation after it from London 2006 here on my SM site:
Also you might be interested in the CDs of the Rugby conference as both Clare and Dominic Marino discuss surgical outcomes:
In memory: Lucy
13th January 2008, 12:16 AM
Thank you so much. This is why I've been spending my nights searching out more information and looking for those caring individuals going through the same thing.
I'm inclined to get a second opinion but believe my vet's opinion was based on conversations with Dewey and Rusbridge. But there is no harm in getting a second opinion. I want her around for as long as possible. Thank you,
13th January 2008, 10:18 PM
I do not have a dog who has been diagnosed with SM but our Bud Bud has had PSOM which at one time I feared may be SM. SM has not been totally ruled out but he is essentially asymptomatic since his PSOM surgery so .
Treatment decisions are so difficult and it is particularly difficult when you feel you must go against the advice of a Vet who may have been caring for your dogs for a long time and may have become a friend. If I were in your situation, I would want to confirm who has seen and read the MRI and if it has not been seen by a neurologist with extensive SM experience I would want to make certain that it was AND I would want to have a consultation with the neurologist, by telephone if necessary, not just have my Vet talk to him or her.
Am I correct from your post that you are in Dallas, Texas? Any one on the list have advise on a Vet neurologist in Texas or the Southwest that may be a good specialist to see Madison?
Best of luck to you and let us know what you find out.
Phyllis in West Virginia USA with two Clumbers and a Cavalier Named Buddy
14th January 2008, 12:34 AM
Thank you. Tomorrow we are going to start looking for a local neurologist with experience with this disease to take over treatment/monitoring of this condition. It makes sense.
We'll start by calling the ones listed on this site. If anyone else has any other recommendations in Texas, it would be appreciated. Thanks,
14th January 2008, 12:51 AM
In Texas, I would recommend:
Dr. Carley J. Abramson
Gulf Coast Veterinary Specialists
1111 West Loop South, Suite 160
Houston, TX 77027
Tel: 713-693-1111; 713-693-1122
She has been involved in considerable research on SM in cavaliers when she was in Ohio. Good luck and let us know what feedback you get. There are no 'wrong' decisions -- but it can be very hard to make the right decision for us and for our dog. It needs to be a mix of both, and with this condition, there's rarely a definite answer. But I'd only make a decision with a neurologist's professional opinion. They also differ in approach and technique, so it takes further weighing up of what seems right in each individual case.
In memory: Lucy
14th January 2008, 01:37 AM
Thank you. We'd really like to find someone in Dallas as this will be a long haul (I hope) but if there is no one here with experience, we'll make the drive!
Originally Posted by Karlin
14th January 2008, 01:52 AM
I also checked Cavalierhealth.org. and she is the only one listed that is known to have SM experience (noted in red).
She would definitely be highly recommended though -- one of a handful in the US with strong SM experience both in practice, as a surgeon and in research.
In memory: Lucy