Omeprazole/Phenobarbital?

Dottie was "symptomatic" (scratching, head rubbing, occasional yelp, air licking) when she turned about 7 months old. Vet referred her to neurologist after being looked at for allergies, ear probs, etc (negative for those). We had her MRI'd at that time, and she showed a "mild Chiari malformation with some crowding", but no herniation or syrinxes at that time. We were then referred to a veterinary dermatologist who specialized in PSOM, and had many Cavaliers as patients. He performed a myringotomy/ear flush followed by a schedule of meds and Dottie was much better, for a time.

The daily neck scratching, head rubbing, air licking, and very occasional unprovoked yelping did eventually return. Her hearing is excellent, (she can hear you whisper "cookie" from 30 yards away. On re-check, there was no bulging of the ear canal or any indication that she needed to repeat the procedure. She has never, ever shown any "air scratching" or bunny hopping that we have observed on walks or otherwise. She is basically a very bouncy, happy, loving girl that you can even play tug o'war with and she always comes back for more. She seems to be more "symptomatic" in the late afternoon, early evening, and does alot of staring at the ceiling, like she is seeing something that isn't there. Also, alot of air licking, but no snapping, like she is trying to catch flies.

Anyway, we took her back to the neurologist yesterday with our concerns, and of course, she was her happy, bouncy, adorable loving self and showed no signs of any discomfort. The dr reviewed her original MRI, put her through a series of touching, paw turning, and manipulation and got no pain response and her reflexes were good. Based on what we told him, he has chosen to put her on Omeprezole 5mg capsule once a day, and Phenobarbital 1/4g tab twice a day. We are to log any changes and see him again in one month. He didn't feel that she was chronically "in pain" warranting Gabapenten at this time, but says he will look at that down the line if things seem to deteriorate. (This is Dr. Wayne Berry who is very knowledgeable on the Cavalier and SM, also does the surgery with the titanium mesh implants, and lectures on this disorder.) So I do feel comfortable with his plan for now.

He did go over the possible side effects, but I was wondering if anyone out there has their dogs on similar meds and how they are responding to them.

Thanks in advance for your responses!

I know Clare Rusbridge and Geoff Skerritt have seen dogs' syrinxes improve (eg shrink and even disappear) on a CSF inhibitor like omeprazole, cimetidine or frusemide so I think this may be good practice for any affected dog to be on it from the start. Never heard of putting SM dogs on phenobarbitol, but different neurologists have different approaches. I've used all three of the above CSF inhibitors.

The malformation alone can cause the symptoms your describe. Clare recommends using a CSF inhibitor for such cases -- this is in her website FAQs.

Only around half of affected dogs show scratching as a symptom -- so lack of scratching wouldn't be unusual. That's good if a clinical exam by a neurologist didn't show any signs of overt pain.

Thanks Karlin for the reply. So far, no overt side effects here, and the scratching sessions seem to be fewer and shorter. She is still air licking once or twice a day, and staring at the ceiling as if she sees things that aren't there. (This is supposedly what the trial of phenobarbital is supposed to affect.) But, she seems calmer without that occasional frantic look she was having when she appeared to be uncomfortable. We haven't had any yelping at all either, when picked up or otherwise.

I am praying that she will not deteriorate.:xfngr: Will have a recheck and another evaluation in 3 weeks. Will post the followup.