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Thread: Suspect SM

  1. #1
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    Default Suspect SM

    Hi, I'm so happy to find this board, and especially this forum for SM and MVD. I am hoping you can give me some guidance.

    We have suspected that my girl Sadie (almost 5 yrs old now) has SM. She does the bunny hop and air scratching when she walks, she scratches her neck/ear area, she's slowed down and sleeps more, she needs steps to get up to the couch because she won't jump up anymore, she won't jump off anything, and we have to pick her up in just the right place so she doesn't yelp, and she sometimes looks like she has a headache. These have all been mild and variable symptoms where they only show up once in awhile since she was two. But lately they have increased in frequency and she also started getting a head tilt (we noticed it just a couple weeks ago after we watched a video of her we had just taken) and she is getting some curvature of her spine at times. We are worried she might be in pain and want to do more to help her.

    We took her to our regular vet and she agreed that it sounds like it could be SM and getting worse. She took her through a bunch of exercises and she did pretty well on most of them, she didn't think she had any weakness in her legs for example. But she started her on Metacam and said if that doesn't do anything in two weeks, she'll try furosemide next, and then if that doesn't work she'll refer us to a neurologist and to think about doing an MRI to know for sure what we're dealing with. I am leaning towards doing an MRI sooner rather than later instead of trying this or that and not really knowing what we're dealing with and possibly causing more harm. What are your thoughts on this? Also, for an MRI can we just find any neuro to do the MRI or do we need a neuro who is experienced with SM? I know I'd want to get a very experienced neuro who has experience in SM if she needs surgery, but is that also important for doing an MRI? I'm in the state of Washington (USA) so any recommendations for neuros in the west or for our next steps would be most welcome. We are feeling a bit overwhelmed at the moment and want to do the best for our little sweet girl.

    Thanks so much!

    Teri

  2. #2
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    I feel your pain and confusion so acutely. My 5 yr old, Riley, was just diagnosed with an advanced and very severe case of SM, even though her symptoms were mild. She had an adorable little head tilt, some loss of balance - especially when she shook, she would fall over, she was not the best jumper, ands he stated having what I thought were mild (10-15 second) seizures. She still ran and played, but hated going for walks. I would get the leash out and she would run and hide. No scratching though, no bunny hopping, no obvious pain. And she had all of these symptoms since we got her at 11 months old. Nonetheless, I finally decided to have a neuro exam to make sure nothing progressive was going on. Unfortunately, the results of the MRI were not good and she had decompression surgery last week. Doing pretty well so far, but not back to her normal self yet. I would encourage you to do the MRI as soon as you can if you can afford it. Sadie's symptoms are too suspicious for SM. I live in the Chicago area so I can't help you with an experienced neuro vet. I went to a neurosurgeon at the veterinary specialty center near me, had the MRI and then took the MRI disc to another veterinary neurosurgeon. He agreed completely with the first vet's diagnosis and even admitted that since Riley's case was complicated, the first dr was the better one to do the surgery. He had done more of them and took on the more complicated and challenging cases in the area. So far, I have been pleased, but it is only 9 days since her surgery. She is on crate rest or can be held in my arms (guess which one I choose to do!). Good luck. Please have an MRI if only for your peace of mind.

  3. #3
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    I share your pain and we've been down this road as you would find in our thread about Madison. The only advice I can offer is that which was given to me when I was in your position: see a neurologist; here's a list of people in your state from sm.cavaliertalk.com

    Sanders, Sean G. Lynnwood, WA
    Bagley, Rodney S. Pullman, WA
    Harrington, Michael L. Tacoma, WA

    Also, isn't there someone at Berkley with a lot of experience with this? Maybe that's doable for you. Our thoughts are with you. Please keep us posted.

  4. #4
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    Thank you both so much for your support and information. I just finished reading up on the threads about both Riley and Madison and all that you both have been through with them. I hope they continue to do well, I will be thinking of them and you. Please keep us updated on their progress.

    Dr. Harrington was the most well known neuro in this area who had experience with SM, however according to his website he has left the area for Utah. I'm not sure if he's still doing the same things there that he did here though. Do we need an SM experienced neuro for the MRI? Does anyone know? I told my husband the other day that if Sadie ends up needing surgery we may need to pack up and drive to New York to see Dr Marino or Dr Dewey! Needless to say, we hope she won't need surgery. But agree with you that we need to find a good neuro and get an MRI.

    Thank you both again for your thoughts and support. It really means a lot to me to hear from you and not feel so alone in this journey we're embarking on. Take care and I will be thinking good thoughts for both Riley and Madison and your families.

  5. #5
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    I'm so sorry to hear about Sadie.

    I'd definitely see a neurologist as fast as you possibly can.

    This sounds like a fairly progressed case given those symptoms (bunny hopping and air scratching appear for no other condition that I now of, and if you look at Dr Rusbridge's pain scale for evaluating dogs with SM, these would not be considered mild symptoms but severe symptoms -- once a dog is yelping in pain on touch and having problems with movement and jumping onto things, that's the highest pain grade on the neurologists' scale below). Much could be done simply to relieve the pain your dog is experiencing. I'd ask your vet to try gabapentin if metacam isn't doing much -- it probably is not, as she sounds very pain sensitive now.

    Pain scale: http://sm.cavaliertalk.com/painscore.pdf

    It is a problem for diagnosis sometimes that vets often interpret scratching as 'mild' pain -- neurologists say it is evidence of serious damage to the dorsal horn area in the spine, and the nerve endings there. Likewise vets do not have the ability to evaluate effectively for limb weakness -- I know of people who have had vets say there's little problem whereas neurologists immediately pick up deterioration. This isn't to blame vets but to remind that they are GPs whereas neurologists are specialists with the training to evaluate for a neurological condition like SM. Because the condition remains relatively rare, vets often go for the more obvious diagnosis and are slow to refer someone on to a specialist but really for this condition even a week can make critical difference depending on the level of progression. Most neurologsts, if they feel a dog needs surgery, will rush to do it right away, as passing time -- even a few weeks -- means more potentially permanent damage.

    You can manage the pain with medications up to a point but sometimes only for a period of time. No medication will cure or halt the progression of the condition. You will almost certainly want to get an MRI especially if you are considering surgery.

    Dr Bagley is familiar with SM:

    Dr. Rodney S. Bagley
    Department of Veterinary Clinical Sciences
    Washington State University
    100 Grimes Way
    Pullman, WA 99164
    Tel: 509-335-6060; 509-335-0711
    E-mail: bagley@vetmed.wsu.edu
    www.vetmed.wsu.edu

    LIVS (Dr Marino et al) do one form of surgery but many do the basic decompression with good success. Very little so far is known about the medium to long term success of the surgery LIVS do -- they only have been following dogs for just over a year now, so keep that in mind. There are a couple of others doing the same LIVS-style surgery in the US and one in the UK now. It is a more invasive process though requiring sinking screws into the skull, which some may not feel comfortable about -- so do research carefully on what you think is best for your cavalier. Surgery of whatever type isn't a cure though, unfortunately, and results are variable. But for most dogs it does halt progression and for some definitely give extra lifespan than they'd otherwise have had.

    Be sure to let Sadie's breeder know she is having these symptoms. This is extremely important for breeders to know as it has serious implications for their breeding programmes and they will not want to risk producing other puppies with the condition in their lines.
    Karlin
    Cavaliers: Jaspar Lily Tansy Libby Mindy
    In memory: Lucy Leo
    Cavalier SM Information site:www.smcavaliers.com

  6. #6
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    Sorry to hear you suspect SM in Sadie....but glad you are being proactive and have come here for guidance and information.
    Cathy
    Loving mom to Jake, Shelby and Micah

  7. #7
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    Quote Originally Posted by Teri View Post
    Do we need an SM experienced neuro for the MRI? Does anyone know? .

    I don't think so. I think you can find out what the specific protocols are for performing the correct MRI and anyone can do it. You'll get some kind of summary from the MRI place but you'll then send your results to the neurologist with experience. That's what happened in our case.

    This may actually be an opportunity to save a little money. I think we got the MRI for under 1500 in Dallas but it would have cost us closer to 2000 if we had gotten it from dr. abramson's place in Houston.

    And, if you are serious about traveling for care. I can only say wonderful things about Dr. Abramson in Houston and her variation of doing both decompression (I think she said that she removes more dura matter than most) and a shunt. So far so good, fingers crossed.

  8. #8
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    Thank you so much for all of the information you provided as well as your opinions. One thing I may not have made clear about Sadie's symptoms is that the scratching and bunny hopping are worse (several times a day now) plus new signs now of scoliosis and head tilt and she won't jump up (never would jump down since we got her at age two so got her stairs to use for the couch). What isn't worse is she isn't yelping in pain when picking up, unless we pick her up under her front legs or around her middle. But we've been picking her up front and back, and keeping most of her weight in back without any yelping and so that hasn't gotten worse. But she will still yelp if we accidentally pick her up in the wrong spot, so we've been conditioned not to do that.

    Anyway, I have a call into my regular vet and hope to hear from her tonight about getting a referral for the MRI. Dr Sean Sanders has a place in Kirkland now and does MRIs which is only 1.5 hrs away. Dr Bagley, who is more familiar with SM, is 6.5 hours away but less expensive than Dr Sanders. Add in gas prices and one or two nights of lodging, and it could be equal in cost. So we're thinking about maybe doing the MRI in Kirkland since we wouldn't need to stay overnight and she could be back home sooner with less traveling. Unless its important that the MRI be done by someone more familiar with SM? We're willing to go to either place actually. I assume it would be just an out-patient procedure where she'd be able to go home in a few hours? Thoughts on whether one place is more favorable for the MRI?

    My vet is hesitant to prescribe gabapentin without a neuro consult or MRI. Our breeder is aware of the possible SM diagnosis and has been very supportive. What started this query was because we started seeing new signs so we visited our breeder so she could see her. Since she hadn't seen Sadie in awhile, we knew she would be able to see whether she seems worse or not. She was the one who said we needed to get going on some treatment with gabapentin, but my vet wasn't comfortable with starting her out on that. After doing research and hearing other stories, we'd rather just get the MRI done asap so we know exactly what we're facing and get a treatment plan from an neuro.

    If Sadie needs surgery, how do we find out which neurosurgeons have the best success rate? I have heard of some where they have a very small success rate, and others who have had a very high success rate. Is there a listing somewhere? I'd rather travel a bit and have a successful outcome.

    Karlin, you mentioned something about different forms of surgery. I assumed they were all about the same for SM, so obviously I need to learn more. What are the various surgeries out there that we'll need to choose from? And which ones show the most promise?

    Thank you all so much for listening and being here for us. I just can't thank you enough!!

    -Teri
    Mom to Joey (5 yrs old) and Sadie (4.5 yrs old)

  9. #9
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    I know little but this is a good site to visit

    http://www.cavalierhealth.org/syringomyelia.htm

    Thoughts of you in the upcoming days
    frecklesmom
    Learning new things everyday

  10. #10
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    They do need to sedate them for the MRI--in our experience, we dropped her off first thing in the morning and they wanted to watch her until the afternoon to make sure she was doing okay.

    Surgeries:
    (1) decompression
    (2) shunt
    (3) decompression w/ titanium mesh

    http://www.sm.cavaliertalk.com/treat...g/surgery.html

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