Advice needed please!

Hi everyone. I would be really grateful for some advice about my cavalier, Dylan. He is 4 years old and has been showing some symptoms of SM for the last year although mostly quite mild. He has been on Metacam since March but my vet did not think he had SM. She x-rayed his head, spine and pelvis but only found slight hip dysplasia. She eventually referred him to a specialist and we took him for his appointment yesterday. We saw an orthopaedic surgeon and he said the x-rays taken by my vet showed the vertebral canal in the neck area was wider than the rest and that together with the symptoms I described he was fairly sure Dylan had SM. He said it was up to us whether he had an MRI scan which would give a definite diagnoses but would not make any difference to his treatment. My husband did not want Dylan to have the MRI scan and as the vet said we could book him in to have one any time in the future if we wanted I agreed not to have it done. My question is would there be any benefit to having the MRI scan? Dylan is insured.

Welcome to the board and sorry to hear about Dylan. It is actually impossible to make a guess that a cavalier has SM because the vertebral canal area is wider -- there have been several studies that have shown that the only way to definitively diagnose is by MRI; an xray will not show anything much of relevance as this is a soft tissue condition. I have never heard any of the neurologists who specialise in this condition or who have been involved in the studies that have looked at other ways of diagnosis say a wider canal would mean anything. Generally the problem has nothing at all to do with how wide the canal is anyway -- the problem is that CSF flow is obstructed and cavaliers of all shapes and head and spine variations areaffected. Syrinxes are fluid filled pockets that wouldn't be pushing the canal further apart. If a syrinx was that large and rigid I would think a dog would be in impossibly severe and intolerable pain.

At the same time you can tell a lot from symptoms, as the orthopedist says, and having an MRI would be up to you. But an orthopedist is not the right specialist to be talking to about SM usually. And it simply is wrong that the treatment is the same regardless of MRI. On the contrary, an MRI showing a large lopsided syrinx or several syrinxes would for me mean the need to consider surgery; as would other types of results. I would want the MRi done by a neurologist familiar with the condition to get correct advice on treatment, if you have that option through insurance and also if you wish to consider the widest range of treatments.

If you feel you would not opt for surgery regardless, then I'd be less inclined to consider an MRI and you could try working with the advised medications (under a specialist's guidance).

But I would check the list of neurologists at www.cavalierhealth.com or www.smcavalier.com (the first is more up to date than my site and also indicates if a neuro. is known to have familiarity with SM when possible) and at least get Dylan into a neurologist, not an orthopedist, for a clinical exam and to thoroughly discuss your options.

If he is having symptoms at the very least he should be tried out on a progression of medications as indicated on www.smcavalier.com or Clare Rusbridge's website SM faq.

Thank you for your response! Dylan was referred to an orthopaedic surgeon because his main symptoms were lameness, reluctance to walk and periods where he could not jump onto furniture/go up stairs and my vet did not think these were symptoms of SM. The practice we went to was one on the list of recommended neurologists on the website you mentioned and I assume if we asked for Dylan to be MRi'd then we would see a neurologist. He has periods where he isn't that bad and the Metacam seems to be enough pain relief at the moment. Can dogs with SM go through phases where they are OK? I don't feel as though he has been properly diagnosed with SM and am still unsure this is definately his problem. I am rather confused!

Yes they generally do go through phases. This is a progressive disease, so it is a good idea to know all your treatment options and talk to a neurologist as they are much better at diagnosing neurological consequences other specialists, and an owner, may not outwardly see.

I'd recommend reading the information pages on www.smcavalier.com and also Clare Rusbridge's information here:

http://www.veterinary-neurologist.co.uk/faq.htm

Metacam may be enough, but most symptomatic dogs do tend to need something stronger eventually as metacam is a pretty low level pain reliever.

Molly has had an MRI scan as a result of taking her to a specialist purely for lameness, she showed no other obvious signs. Now she is being treated by Clare Rusbridge specifically for her condition and not only for pain but also for trying to slow down the progression of the disease. If I were you I would not hesitate to see a Neurologist that knows about this disease.

because his main symptoms were lameness, reluctance to walk and periods where he could not jump onto furniture/go up stairs and my vet did not think these were symptoms of SM.

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Forgot to add: These are all common symptoms of SM. I'd refer your vet to Clare Rusbridge's website so that he is better aware of the condition, as it is present to a significant level in the breed. He was right to consider an orthopedic problem too and eliminate such a problem first but these signs would always be a consideration for SM especially if recurrent.

From Clare's website:

What are the clinical signs of syringomyelia?
The most important and consistent clinical sign of CM/SM is pain. Signs are very variable and can include vocalisation; withdrawn behaviour, unwillingness to exercise, difficulty or vocalisations on jumping, difficulty lowering the head to eat, and sleeping with the head in elevated positions. Sign of pain may be more apparent in the evening and early morning or when excited and can be associated with defaecation or may vary with weather conditions.

Pain is positively correlated with syrinx width and symmetry 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 (curvature of the spine).yringomyelia may also result in other neurological deficits such as weakness and poor coordination and slow correction of abnormal limb position. Seizures, balance problems, facial nerve paralysis and deafness may also be seen; however, no direct relationship has been proven, this association may be circumstantial and it is important to rule out other causes.

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From smcavalier.com:

Weakness in Limbs
Some dogs acquire a "rolling gait" that can worsen. They may show a lack of coordination. They may collapse easily, even falling over while standing. Sometimes brushing, grooming or bathing bring on collapsing episodes. They may fall over, usually to one side, when playing (though investigate Episodic Falling Syndrome as well; see www.cavalierepisodicfalling.com ). Dogs can start to have difficulty getting up and down stairs and couches and beds. They can have leg twitching episodes. They might not be able to balance well when set down. A paw or leg might go weak.

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General expression of pain
Often syringomyelia is first noticed because a dog begins yelping or whining or whimpering, even shrieking or screaming, seemingly for no reason. Again, this often occurs while on the lead. Pain episodes can disappear then return even after a year or more. Some episodes can be severe with the dog shivering with pain and crying out for long periods. Often the dog is so uncomfortable and tender that it cannot abide being touched in areas such as the head, neck or shoulders or even on an entire side. Sometimes the pain is so severe that the dog can not be picked up or held. Eyes may look pained. Dogs may pant with pain. In some dogs, weather changes such as storms or cold fronts seem to bring on pain episodes (some neurologists believe this may be due to shifts in atmospheric pressure which affect the CSF fluid pressure). When in pain, some dogs seclude themselves under tables, chairs or beds and may avoid light. Some seem to have episodes mostly at night. Pain can occasionally make the dog irritable with other dogs or with people.

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Thank you Karlin and Tania. I will definitely get Dylan seen by a neurologist and have an MRI scan. Karlin, I will pass on your advice to my vet.

Riley's main symptoms of SM were imbalance and a reluctance to jump, difficulty going up stairs, some falling over when she was trying to stand just on her back legs and falling over when she would do the whole body shake (which she did at least 20 times a day). She never had any scratching or yelping for no apparent reason. So, every dog with SM manifiests it differently. I'd suggest having a clinical exam done by a neurologist. They are more attuned than vets are to subtle signs that might suggest SM. Then you can decide whether you want to go the MRI route to get a definitive diagnosis. Good luck

Update on Dylan

I took Dylan to see Clare Rusbridge yesterday and he had an MRI scan. Unfortunately it showed he does have SM. He has a fairly wide syrinx (6.5mm), although it is not too long, at the top of his spine and a smaller one further down. Clare has started him on Gabapentin 3 x a day plus the Metacam he is already on and she will review him in a month. I feel so sad for my brave little man and just wish I had pushed my vet more to get him diagnosed sooner. They seemed to think I was being neurotic!