Suspect SM

[Karlin]

I am going to be blunt because I think you do need to see a specialist immediately: she has almost every serious symptom for this condition excepting screaming sessions and to be honest I would say she would not even need an MRI for diagnosis -- but will need one if you wish to consider surgery and I'd definitely have one so you know what you are dealing with. I cannot stress enough that these are all very severe symptoms and that she could go into very serious pain at any time. If she is showing less pain it will be because her body is actually deforming (the scoliosis) from pain to remove pressure on the syrinxes in her neck. She urgently needs proper medication and to see a neurologist for the condition so that you can make the best and most informed decision on what to do next. I would not lift her at all unless absolutely necessary and raise her food and water dishes.

To be honest: I would consider calling the neurologist I would want to do surgery, and explain all the symptoms as I think they will say this is fairly urgent, and see if you can bring her on the assumption that she may need to stay on for immediate surgery. If you are not considering surgery, then either neurologist would be fine as you'd be using medication for pain care primarily for as long as that will work. But I'd only go to a neurologist familiar with the condition. If Bagley is far away, and that is who you want to go to, I'd be talking to him and making arrangements to potentially go to him for the surgery rather than bring her back and take her again.

Please let us know how things go.

[Karlin]

Also: I have not heard of any specific neuros having better success than others but I am sure that may be the case. Some are more experienced than others; I'd trust anyone who has done many surgeries. I live in Ireland so don't really know much about the US neurologists though Harrington has been recommended by people I know. The success rate is good short term (80% of dogs improve) but a lot of dogs have a recurrence (25%) and some do well for couple of years then start to decline. The LIVS surgery has not been done long enough to track longer term results, which are the crucial results. They have good initial results.

The surgery is not a cure, it simply halts progression.

There's very little clinical information on the surgeries. Most published work is by Dr dewey/Marino and Clare Rusbridge.

I'd be looking for an experienced neurologist who can do this asap if you are thinking surgery. Would your vet not at least consider giving her steroids to try and ease the scoliosis etc?

[Love my Cavaliers]

Teri,

A consideration for choosing which facility to go to for the MRI would be whether they have the capability to care for Sadie overnight if necessary. Riley had a bad reaction either to the anesthesia or to the procedure itself. She woke up fairly quickly but had severe balance problems and nystagmus (erratic eye movements) and they decided to keep her overnight. The neuro thought she could have had some fluid shifts that caused the imbalance. They kept her quiet with some valium and IV fluids. When she came home the next day, she was back to her normal self. She had surgery 2 weeks later. I don't know if others have had this problem after the MRI or if Riley was unusual. My puppy, Oz at 11 months came through with flying colors and you could not tell that he had been sedated. Riley's surgery was a little different than just decompression. her surgeon has sarted using titatium implants - he feels that it reduces the chance of scar tissue forming post-operatively, hopfully eliminating the need for another surgery. Hope some of this info helps. Good luck.
Bev

[Karlin]

A good point on the MRI, though a reaction is pretty rare I think. The titanium implant is the LIVS surgery; I know a few others are now doing this too; it is more complicated than the regular decompression.

Clare Rusbridge's info on the basic decompression surgery: http://sm.cavaliertalk.com/treating/...g/surgery.html

[Teri]

Would your vet not at least consider giving her steroids to try and ease the scoliosis etc?

My vet has said she would try furosemide next and if that doesn't help, then she'd want to refer us to a neurologist. She doesn't feel comfortable starting her on steriods without a neuro consult or MRI. When she said that, my husband and I decided we didn't want to mess around anymore since we aren't seeming much improvement with the Metacam, so started this search on where to get an MRI, etc. I am hoping our vet will give us a referral, as I think that is what we need to see a specialist sooner, is that right?

Do you know if Dr Harrington moved his regular practice and surgery to Utah, or is he doing something else? His website didn't say anything about coming to see him in his new location. He is the most experienced I have heard in this area so might be willing to go to Utah for the surgery if he is still doing this, as he was our first choice before he heard he moved. Or do you know of any neuro surgeons of Harrington's caliber in the western part of the US?

Thanks for all the information and support. Yes, we are trying to get the MRI done right away and know we may need to do surgery too which is why I'm asking so many questions about it. Surgery is a big deal to me though, so I just want her to have a SM-experienced surgeon and will travel a bit to get her to one. And good point about overnight care. We will be sure they offer that service as well.

Thanks all!

[Cathy Moon]

Do you know if Dr Harrington moved his regular practice and surgery to Utah, or is he doing something else? His website didn't say anything about coming to see him in his new location. He is the most experienced I have heard in this area so might be willing to go to Utah for the surgery if he is still doing this, as he was our first choice before he heard he moved. Or do you know of any neuro surgeons of Harrington's caliber in the western part of the US?

Thanks for all the information and support. Yes, we are trying to get the MRI done right away and know we may need to do surgery too which is why I'm asking so many questions about it. Surgery is a big deal to me though, so I just want her to have a SM-experienced surgeon and will travel a bit to get her to one. And good point about overnight care. We will be sure they offer that service as well.

Thanks all!

There is a way to contact Dr. Harrington on his website, or you could email the Utah Pet Center from their website. That's how I contacted Charlie's neurologist here in Ohio. I received a phone call within just a few hours of emailing. Best wishes to you!

[Karlin]

If it helps your decision on what to do, I don't know (or believe) that Dr Harrington is any better or different to Dr Bagley or others in that region. I am going on only ONE person who has been to him, so really -- it isn't worth making a major effortto track down a single neurologist based on that, I think. Also Dr Bagley has a very good name as well. There are good neurologists in almost every state and the list of neuros on cavalierhealth.org lists Dr Bagley as having SM experience. It doesn't mean at all that others in the state do not -- it only means that someone has told Rod Russell, who manages that site, that this neurologist has seen at least one dog with SM. All the others listed may well have also treated many dogs with SM,but no one has reported this to the one person running a single website, so it is really a fairly tentative listing meant to give some basic help, not a definitive list of experience by any means. ie: That is only a minimal starting point -- I'd want to know directly from the neurologist, more about their practice and approach.

A better approach is to call the neurologist's office and talk directly to them about how many surgeries the doctor has performed, what aproach is taken to the surgery, etc.

In your place, I would be looking for the closest neurologist with experience, I definitely wouldn't drive many states away to see someone. Keep in mind that if you do the surgery the dog will need to be there for usually, a week or two, and it will not be very comfortable for the dog to be driven back post surgery for a long distance. This is a major surgery in which a piece of the skull is removed and the dog must be totally confined crated) for weeks afterwards. All those elements would go into any decision for me.

PS With all due respect to your very cautious vet, I'd consider seeing another vet willing to help ease Sadie's discomfort especially for such a clear symptom of severe pain as scoliosis (this is when the dog begins to permanently shape its body and spine in a way to avoid the pain of the syrinx -- it is the spinal equivalent of a limp -- the dog is twisting its neck awkwardly into a position that causes the least pain to it). Giving steroids short term is a common practice for all sorts of far more minor pain situations so it just seems odd not to do more for dog with such clinical signs.

This is Clare's description of clinical signs, written for vets and pet owners:

CLINICAL SIGNS
The most important and consistent clinical sign of CM/SM is pain however this may be difficult to localise. Owners may describe postural pain; for example, affected dogs may suddenly scream and/or lie with the head on the ground between the paws after jumping up or during excitement. It is also common to sleep with the head in unusual positions, for example elevated. Discomfort often appears worse in the evening and early morning or when excited and can be associated with defecation or may vary with weather conditions. Pain is positively correlated with syrinx width and symmetry (Fig 2); i.e. dogs with a wider asymmetrical syrinx are more likely to experience discomfort, and dogs with a narrow syrinx may be asymptomatic, especially if the syrinx is symmetrical. Dogs with a wide syrinx may also scratch, typically on one side only, while the dog is walking and often without making skin contact, such behaviour is often referred to as an “air guitar” or “phantom” scratching. Dogs with a wide syrinx are also more likely to have scoliosis. In many cases the scoliosis slowly resolves despite persistence of the syrinx.

SM may result in other neurological deficits such as thoracic limb weakness and muscle atrophy (due to ventral horn cell damage) and pelvic limb ataxia and weakness (due to white matter damage or involvement of the lumbar spinal cord by the syrinx). Seizures, facial nerve paralysis and deafness may also be seen; however, no direct relationship has been proven and this association may be circumstantial.

[Bridam]

If it helps your decision on what to do, I don't know (or believe) that Dr Harrington is any better or different to Dr Bagley or others in that region. I am going on only ONE person who has been to him, so really -- it isn't worth making a major effortto track down a single neurologist based on that, I think. Also Dr Bagley has a very good name as well. There are good neurologists in almost every state and the list of neuros on cavalierhealth.org lists Dr Bagley as having SM experience. It doesn't mean at all that others in the state do not -- it only means that someone has told Rod Russell, who manages that site, that this neurologist has seen at least one dog with SM. All the others listed may well have also treated many dogs with SM,but no one has reported this to the one person running a single website, so it is really a fairly tentative listing meant to give some basic help, not a definitive list of experience by any means. ie: That is only a minimal starting point -- I'd want to know directly from the neurologist, more about their practice and approach.

A better approach is to call the neurologist's office and talk directly to them about how many surgeries the doctor has performed, what aproach is taken to the surgery, etc.

In your place, I would be looking for the closest neurologist with experience, I definitely wouldn't drive many states away to see someone. Keep in mind that if you do the surgery the dog will need to be there for usually, a week or two, and it will not be very comfortable for the dog to be driven back post surgery for a long distance. This is a major surgery in which a piece of the skull is removed and the dog must be totally confined crated) for weeks afterwards. All those elements would go into any decision for me.

PS With all due respect to your very cautious vet, I'd consider seeing another vet willing to help ease Sadie's discomfort especially for such a clear symptom of severe pain as scoliosis (this is when the dog begins to permanently shape its body and spine in a way to avoid the pain of the syrinx -- it is the spinal equivalent of a limp -- the dog is twisting its neck awkwardly into a position that causes the least pain to it). Giving steroids short term is a common practice for all sorts of far more minor pain situations so it just seems odd not to do more for dog with such clinical signs.

This is Clare's description of clinical signs, written for vets and pet owners:

I totally agree with starting meds as soon as possible. There doesn't seem to be a point in waiting. We made that mistake relying on our vet before finding this forum. But, would the steroids afftect the way the mri would look by relieving a little pressure?

[Karlin]

Steroids wouldn't alter the syrinxes, as far as I know. I've never heard of any neurologist having problems with getting a dog onto medication prior to an MRI -- I think they'd generally view the dog's comfort as more important than any minor changes that might be caused with an MRI. I believe many neurologists do surgeries on dogs many months after an MRI anyway -- I don't think the MRI matters that much to the surgery except to show the existence and extent of SM. There is however some indication that information from cine-MRIs, which capture actual CSF flow, could eventually be used to determine what small changes within the surgical procedure might benefit a given dog. This has been the case in some human surgeries for Chiari and SM that I read about.

[Bridam]

Update?