Question about SM--Abbey just diagnosed-long post

[Karlin]

Omeprazole is one of the CSF inhibitors. It may be though that another would work better, or adding something else would work better.

I don't think you should be angry at vets for missing this diagnosis. This is like blaming a GP for missing SM in a human. They do not have the training in neurological conditions and most are clearly unaware of the prevalance of this health problem in cavaliers. However, I am sick and tired of some breeders arguing endlessly that vets 'overdiagnose' this as a 'bucket diagnosis' for almost anything involving scratching or pain -- in fact, as any discussion with people who actually have cavaliers with SM can confirm (how many people owning SM cavaliers do these breeders, with their vested interest in selling puppies, actually talk to? I know quite a few breeders however who REFUSE to reply to their pet owners though when they contact them with news that one of the cavaliers of their breeding has SM . Indeed I have a whole list of those), the exact opposite is true and the vast majority of cavaliers are not diagnosed for many, many months to years as vets simply do not spot the problem. Symptoms are very similar to chronic problems like allergies and for most vets who are unaware of SM in the breed, this is what they will diagnose. The drugs given for allergies will also help the pain and other symptoms. So the problem can easily remain hidden. And remember cavaliers are only one breed of many hundreds of breeds and mixes and dogs only one type of animal the average vet sees.

I don't think it is anyone's business who is unfamiliar with this condition to tell owners what decision they should make regarding care. First off, it isn't their dog. Second, many people view their pets as less a part of the family, and will pts rather than pursue more costly or involved treatments. That is their choice, but it isn't everyone's choice, especially when more advanced care is available. Third, the statistics for relief through surgery are actually quite decent, and many dogs are back up and around within a couple of days -- if anything the hard part is restraining their activities (which is really important). While the surgery is in a riskier area than say a patella surgery, the morbidity rate has been extremely low. Finally everyone has their own reasons for making care choices that can relate to the dog or their own philosophies or perspective. Some do surgery when I personally wouldn't. Some don;t do it when I personally would. But everyone has the right to make that decision for their own personal situation.

I just encourage people to read widely, be as informed as possible, but realise there is no right or even 'better' answer. There's only the decision you make after deciding what is right in your own case. I'd just not ask for others' opinions if they are upsetting.

[Pat]

Linda said: Dr. Shores told us he personally has done 14 of these in his 1 1/2 years at Auburn (I went jeez that isn't very many) and all have been successful. I do not know how many the other doctors there have done. My husband also spoke with the head neurologist but never asked that question.

Just a clarification - Dr. Shores is the only board certified neurologist at Auburn, so he would be the only vet doing the surgery there as there are no other neurologists there. So, 14 would be the total number of decompression surgeries done at Auburn over the past 1 1/2 years (I guess since Dr. Axlund left?). I agree with Karlin that 14 is a good number. If you have a chance, ask how many of those 14 were Cavaliers, and, if there were other breeds, how many of what breed.

In the US, to search for board certified specialists in a particular location, go to the ACVIM site and use their “locate a specialist” form. For example, you will find that at Auburn, there are five internists, one neurologist, two oncologists and NO cardiologist. (Which means I would stay in Georgia for a cardiologist!) For other specialties, go to the certifying organization (for surgeons, for ophthalmologists, etc.) to locate specialists.

I also agree with Karlin about not blaming GP vets. Most GP vets in the US do not KNOW about the existence of SM. They generally do minimum CE and do not stay updated. That’s why it’s important to take copies of actual veterinary papers to your vets and ask them to read and file the information. My vet often asks to borrow my textbooks as her clinic has less current material than I have at home. It’s generally only the specialists (internists, cardiologists, neurologists, ophthalmologists, surgeons, etc.) who keep up with the latest and greatest. And, in the US, the general pet owning public is equally in the dark about SM as you can see from Linda’s experience.

I also think that Karlin had some wise words about individuals making decisions about what to do in their own specific situations.

Pat

[Karlin]

One thing I'd add is that especially in the US or Canada (or most other countries!), I wouldn't expect vets to know about SM. Cavaliers are not common and are very rare in some states -- and a vet might never have come across SM in a lifetime of practice. My Irish vets were unfamiliar with it til I brought in Leo, showed them my MRIs, gave them Clare Rusbridge's information, etc. And here, cavaliers are one of the most *common* breeds! However, once familiar with it they have swiftly been able to identify several cases, all confirmed on MRI. My favourite vet at the practice says now, "Once you see it, it is pretty easy to spot likely symptoms." The scratching when present is fairly distinctive once you have unaffected dogs and affected dogs together, for example, but it can be very hard to recognise if you haven't seen them side by side.

Clare Rusbridge surveyed client owners and said the average period before diagnosis is 18 months to two years or so, so your experience isn't unusual.

I always suggest people print out the downloadable main documents at www.smcavalier.com and bring in to their vets or any local vets. Raising awareness may benefit other cavaliers or breeds that have SM.

[linderbelle]

Yes, I had come to terms with that one. I have changed vets but that was not the reason. I have gone to another one that has 3 cavs himself but he knew nothing of sm and he's the one who watched my video etc. and got me referral for mri etc. I took Bentley and Winston into him yesterday and we also discussed Abbey of course. I did say to him that I hope some good comes of this and that you spread the word about this and he said to me he was meeting with a vet friend last night and he was going to talk to him about it. So once a dog is seen over here and diagnosed I'm sure it spreads. You are definitely right about not that many of cavs over here. I'm not in that big of a city and very unusual to see one. The only place I've seen them is in a pet shop and only on like 2 or 3 occasions. Over here alot of the reason I think they aren't so popular is that they are VERY expensive. I don't know what the price of them over in Europe is --maybe cheaper. That makes me feel better about 18 months before they are diagnosed. Abbey I'm sure would have been much sooner but the allergy meds she was on masked the symptoms but eventually as I put it "the meds weren't cutting it anymore" and the symptoms started getting worse. Remember I found this board after we got Bentley and one day started reading about sm just out of curiosity and the more I read on here the more I couldn't stop. I'm sure eventually Abbey's symptoms would have gotten worse and worse but she would have been still on the allergy meds. It may have gone as far as her falling over etc. I am very very grateful for finding this board and I say Bentley was my gift from God and he saved my Abbey.

[linderbelle]

I might add that we got Bentley at one year of age so I think I found this board approximately a couple weeks of getting him and maybe after that I was on the boards approximately two weeks and read about sm. Another helpful thing is I have gotten two cavs since November from 2 different breeders and neither one of them mentioned sm. I have of course discussed it since then with them but it sure isn't something that was openly discussed by them and they are what is called "good" breeders.

[linderbelle]

Another note as this might help somebody in the future that suspects that their dog has sm. I knew my dog had it after readings on here. I have had phone conversations and e-mails with quite a few people that have/are going through the same thing that my family is going through. This is one woman's experience and I'm doing a copy and paste:

[FONT=Consolas][SIZE=3]I did research on the internet on Pip's on air scratching and took the paperwork to the vet. Here was her response (I'm not kidding): "Don't believe everything you read on the internet." She then gave me some expensive ear drops. She was clueless and didn't have the curiosity (or perhaps integrity would be the right[/SIZE][/FONT]
[FONT=Consolas][SIZE=3]word) to look into Pippin's symptoms more carefully. She did not follow up with me in any way. Now, in hindsight, it is infuriating.[/SIZE][/FONT]
[FONT=Consolas][SIZE=3][/SIZE][/FONT]
[FONT=Consolas][SIZE=3]I knew Abbey had sm--there was no doubt in my mind--she had soooooooo many of the symptoms. If you go to your vet and they say something like that either knock some sense into them or go to another vet.[/SIZE][/FONT]

[Pat]

Linda is in Macon, I'm in Atlanta - two hours apart. There are TONS of Cavaliers in Atlanta - I see them everywhere just driving around - on walks with their owners, at the vet's - everywhere. There are all kinds of Cavalier social groups here. I personally know probably over 100 people with Cavaliers in my area. I think someone posted in another group a link to a newspaper story that they are in the top ten most popular breeds in Atlanta. The word is spreading here among pet owners and vets about SM. When I got my first Cavalier in the late 80's, I had never seen one in person before (my first came to me via Delta Dash from the northeast) and it was very, very rare to see one in public. And of course you never saw them in pet stores, and Al Gore hadn't yet invented the internet (sorry.....a little US humor).

One of the worst things you can say to a vet (or a doctor for that matter) is "I read about ____________ on the internet." The reason is that there is a huge amount of misinformation, pure hogwash and snake oil salesmen on the internet. Most professionals are immediately turned off if you start a sentence that way. That is why I will find a veterinary or medical published paper or similar, read it and try to understand the basics, and then print it and take it to my vet or doctor so I can show them my source and then discuss it. The attitude of the vet/physician is far more receptive with that approach. It takes a little digging around, but you can generally find credible, valid sources. (This is why Karlin's and Rod's sites are so helpful - they cite their sources and you can usually find copies of the referenced materials or at least you can cite them.)

And regarding "good" breeders in our area - well, there are quite a few very successful breeders in this area (well known, very active in clubs, gorgeous dogs, win a lot, etc.) but that doesn't always mean they are health focused breeders. It takes a little time to talk with them and figure out if they are someone that you want to work with. And, if you have never heard of SM or MVD and so you don't ask, and if they never mention it, well then you have no way to judge because you are in the dark! Most newcomers to the breed just aren't that familiar with what they need to know.

Pat