I am in shock

I don’t really know where to start. I am still in shock.
Yesterday I accompanied my friend to an excellent veterinary centre. This place is mainly to see specialists for anything you can imagine. If some of you remember Ebony’s mum had a bad turn about two weeks ago and the vet didn’t really find anything. My friend instincts told her that there was something wrong with her ears so she pressed the vet for an referral for an MRI. The vet called her paranoid but referred her. The Neurologist also agreed that if she could see CM on the scan she would do a full scan to check for SM. Well to cut a long story short we went there to find out what’s wrong with her ears, and there is something wrong I can’t remember exactly what it is called it is like glue ear in humans. But the biggest shock came when we saw the scans. The Neurologist described it as bad. She has CM and SM, there are three syrinxes in her spine. What we can’t understand that she doesn’t show ANY signs of discomfort, no scratching no tenderness on her neck or back absolutely nothing she is so full of life. I really don’t understand it as when I read all the posts on here the dogs with SM (especially with three syrinxes) are all displaying symptoms.
I ask the neurologist that of all the Cavaliers she has seen if there were any without CM and she just shook her head.

It can happen. Dylan's neuro said there is not always a correlation between symptoms and syrinx as is the case for Dylan, he does scratch etc but considering how bad his 2 syrinx are, you'd expect a lot of pain. Though I have to say, there are many other symptoms you probably wouldn't notice unless you were with the dog all the time.

I am in Shock

Sabby,

I was so sorry to read your Post,this is why Karlin ,Margaret and Carol, are battling so hard about the SM Problem in the Cavalier Breed.

I'm so sorry for your friend's result. There are two possible reasons for why she has not seen outward signs (a common result on scans as many who go to the club scanning programmes will confirm!).

Dr Marino explained this well at a presentation at the SM conference in Rugby where he showed a slide of a cavalier with a spine full of syrinxes and noted that because they develop slowly over time, many dogs simply adjust gradually to having them and to the pain. People who have neuropathic pain will confirm that this is often the case, you just get on with things. Dr Marino said that of the syrinxes had come on suddenly, say as the result of an impact, the dog would probably have died of pain -- it would have been intolerable. But they simply learn to live with it. That is why many SM dogs get scoliosis when younger -- where their neck bends in a C -- which is a reaction to the pain of a syrinx. They curve their neck to relieve the pain from the syrinx. But typically, scoliosis gradually goes away. The reason is most likely that the dog learns to live with that level of discomfort.

The other reason is that as Dr Rusrbidge's and Nick Jeffrie's work has shown, pain is correlated to the width and position of the syrinx. Large syrinxes that are lopsided and close or against the walls of the spinal cord cause pain. Smaller or more centralised syrinxes tend not to. Also CSF flow seems to be very elevant. Some dogs seem to have different flow patterns that cause less pain. This is known in humans -- there is published work on it.

The problem is that dogs with syrinxes tend to be a lot more likely to eventually show signs of pain. That is why it can show in older dogs who showed no signs for most of their life. They may just have adjusted to the pain.

My Leo has one large, short but wide syrinx in his spine. It is fairly central so we seem lucky that it has not caused more pain that it has. His scratching has gradually become more pronounced to the extent that he has scratched off the darker outer layer of hair on his ears, but to an onlooker he is a happy outgoing dog. Only occasionally is he sensitive to touch in certain areas. But he also has balance problems that would never be noticed by most people. Most owners might just joke that their dog is a bit clumsy. I know this is due to some limb weakness. Neurologists can do some clinical tests of a dog's reactions etc to see whether there are signs and sensitivities an owner can easily miss. This is oftem the case -- the signs are there but they are what specialists spot, not what owners notice.

It would IMHO be smart to start a dog with syrinxes on something like frusemide or cimetidine. There is some evidence that this slows or even halts syrinx development if started early enough -- and cannot do much harm.

Hi Sabby

One of the real problems with SM is that it manifests itself in so many different ways (which can also be symptoms of other unrelated conditions) and is so unpredictable. As far as I understand (though others will correct me if I'm wrong), whether or not a syrinx causes problems has to do more with its width than its length. As long as it is narrow, it may cause few problems; if it starts spreading wider (usually on one side) it starts hitting the nerves carried in the spinal cord and this then causes lameness, pain, etc. My Oliver's syrinx, for example, having been small and narrow until he was almost 8, has now started to interfere with the nerves to his right front leg, so that he has lost his reflexes and limps a little when he gets tired. We can only wait and see whether his syrinx will continue to widen - and cause more damage - or whether the frusemide he takes will inhibit it from getting any larger.

I don't envy the researchers trying to find a path through this minefield!

Kate, Oliver and Aled

My post overlapped with Karlin's, who is much better qualified than I am to answer Sabby's question!

Kate, Oliver and Aled

Thank you all very much for you replies.
Karlin: The Neurologist done these clinical tests before the scan and commented that she don’t think that my friends dog has SM.
We did ask the Neurologist if there is anything she can take to slow it down and she said NO.
I will definitely talk to my friend and tell her of what has been mentioned in regards of the frusemide or cimetidine.

I was sorry to hear about your friend Sabby. I just hate how baffling this disease is. I had Shelby MRI'd a couple of months back. She has a rather large syrinx but no malformation. She has very few symptoms and they are few and far between for now. I have sent my scans to Dr. Rusbridge to get her opinion. We are not treating Shelby with any medication right now, although that may change based on Dr. Rusbridge's interpretation of the scans. This disease just scares me so, this is why the need for research is so huge.

I am so sorry that you friend has had such upsetting results, but for her cavalier's sake thank goodness she followed her own instincts.


Best wishes

Sabby, I'm sorry to hear about your friend's Cavalier. In talking about the dog having no symptoms: your friend was convinced there was something wrong with her ears, right? So what was her dog doing that made her think that? There must have been SOMETHING that made her press for a specialist referral?

As the others have posted, there is still much research to be done before we have all the answers to this horrid condition.

My dog had every symptom listed (except the air scratching) and was obviously in terrible discomfort when she was only 7 months old. We had her MRI'd at that time and she showed a mild chiari malformation (which I understand is common in up to 90% of cavaliers) some "crowding" but no syrinx formation at that time. She also had PSOM and had the myringotomy followed by steroid treatment for several weeks following the procedure. She seemed much better and happier for quite awhile but the symptoms of discomfort returned. I now wish I had put off the MRI until she was older, because I don't really want to go through that again, just to see if she has started developing syrinxes now.

Anyway, on later rechecks, her ears were fine and her neurologist could not get a pain response or see evidence of limb weakness while he examined her. For now, we have her on 5mg omeprazole once a day and she seems happy and free of symptoms displaying discomfort. We rarely see the scratching now (which was up to 3-5 times a day before the medication) and she hasn't yelped since. We are hoping and praying that, at least in her case, this will stave off formation or growth of any syrinxes that she may have developed since her MRI.

If her condition worsens as she ages, or we see the symptoms return, of course we will re-visit pain management for her to keep her comfortable.

You had said that there was an episode that brought you both to the point of the MRI initially, which must have indicated extreme discomfort, at least at that time for your friends dog. I would hope the neurologist will closely follow the case and do what is best in that case. :hug:

FWIW, I've read here and in other SM web resources that furosemide is considered to be a benign drug. I've always vehemently disagreed with that view, although I've never challenged it.

I've not had a reason to study SM in depth, but I've done years of research on heart disease (endocardiosis/MVD and many other conditions) so I'm pretty knowledgeable about heart meds.

I would not give furosemide for a long period of time unless it was a matter of life or death and there were no better alternatives because of the potential for side effects including azotemia caused by reduced perfusion of the kidneys, excessive pre-load reduction leading to reduced cardiac output, activation of the RAAS (which is why furosemide is never used as monotherapy for heart disease but is always given with an ACE Inhibitor), electrolyte disturbances, etc. My cardiology texts recommend monitoring with blood chemistry and urinalysis before starting the drug, and then 7 days after the start of furosemide and then every several months, which is what I always did with dogs taking furosemide for heart failure, yet I believe I've read to monitor once a YEAR on the SM guideline sites. I would encourage people using furosemide long term for SM to do some independent research on this drug.

Pat

Pat, it is to monitor every three months for furosemide.

http://www.veterinary-neurologist.co.uk/syringomyelia/docs/treatalgo.pdf

I didn't like using furosemide because of its diuretic affects so have used both omeprazole and cimetidine instead. Some dogs do better on one than another.

Ah, thanks Karlin, I feel better!

Tidbit that I learned when my first Cavalier went into kidney failure (he was also in heart failure) -

Kidney failure shows up first in urinalysis - kidneys are about 75% destroyed by the time kidney failure shows up in blood chemistry profile (on creatinine and BUN). Urine specific gravity (USG) measurement will show that kidneys are not properly concentrating urine long before there are abnormal blood chemistry values. USG should be above 1.034 (in a first morning urine sample) if kidneys are working fine.

I never knew this before I had to deal with kidney failure - and I ran blood chemistry frequently but never did UA's even though the price of blood chemistry included a UA! Now I always run UA's whenever I do monitoring blood chemistry for all of my senior dogs. Learning about kidney failure early on gives you a chance to change diet and start doing intervention that will help your dog live with kidney failure. (By the way, daily sub-q fluid therapy kept my kidney failure dog alive for years and he died for other reasons.) The first thing my cardiologist did when Capers went into KF was to cut his dose of furosemide in half.

Sorry to get off topic and ramble on and on in my usual way, but this is a topic dear to my heart as I've had more problems with kidney failure in my old dogs than with heart failure.

Pat

chloe92us said:

Sabby, I'm sorry to hear about your friend's Cavalier. In talking about the dog having no symptoms: your friend was convinced there was something wrong with her ears, right? So what was her dog doing that made her think that? There must have been SOMETHING that made her press for a specialist referral?

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The Neurologist said that what is wrong with her ears is a separate condition and got nothing to do with the SM. My friend pressed for the MRI because two weeks earlier her dog had like a fit.

Sabby---The "fit" she had could have been caused by SM pain. That is what I was trying to get at. I know the glue ears is separate from SM---but a lot of times SM symptoms can look like the dog is having pain in the ear area. My point was that something had to have happened (symptom-wise) for your friend to push for an MRI. So, she was *not* symptom-free, as she did have an unexplicable "fit". What was this fit like?

2 year old with scratching beginning

We have a great 2 year old male Cavalier. About 6 weeks ago he started scratching his ears and head area. As I researched looking for skin issues I came upon the SM information. We didn't know about this problem and needless to say we are devasted. His symptoms are just the scratching, otherwise he plays, eats and is generally the sweetheart we love. Due to the excessive cost in our area of the MRI and surgery we will not be able to go that route. In the past we paid 4000.00 for our Shih Tzu back surgery and he had 4 more years with us living to 14, worth every penny. With our Basil we don't see much hope and with the MRI alone costing 2500.000 we just want to do whatever we can to make him comfortable.

Can anyone give us suggestions on what has worked for their pups? Thanks.

About two years ago, I learned about SM and decided to have everything else ruled out. X-Rays, TBD, blood tests, the whole nine yards. $500 later, everything is normal.

The only thing is Casey was still scratching, having intermittent trouble going in and out of our patio door (which is only 4" high), had stopped jumping on the sofa, and was yelping in pain about once a month. So, we assume she has SM and have been treating her since with pain meds (Rimadyl).

The difference has been amazing. We've found the lowest dosage that alleviates her symptoms (half a 25mg am & pm), but she still has "bad days" where I have to give her the full dose (25mg twice a day).

Rule out everything else before you automatically assume SM though.

Agree. I would never assume SM just from scratching, especially if it only just started up. Far more likely to be ear mites, allergies, ear infection, rabbit mites, flea dermatitis -- or PSOM. Yu have many things to do before considering an MRI.

Also gprobst, can you start a new thread on your dog's issues? I know many people will be happy to reply, but don't want someone' else's thread to go off topic to a new discussion as Sabby posted relating to her friend's situation.

On Sabby's friend's dog -- a fit is fairly serious. Was there hydrocephalus as well? Did the neuro think the fit was related to SM? Was it an actual fit, or a pain session? (the latter would be more the norm for SM and would be a pretty serious symptom). PSOM may or may not be related to SM -- not much is known about it. Dogs can have pain from PSOM on its own. It seems to be a separate issue. It is very common on MRIs. Of my four that have been MRId, three have PSOM to varying degrees. Only Lucy was clear. And she is the deaf one.

chloe92us said:

Sabby---The "fit" she had could have been caused by SM pain. That is what I was trying to get at. I know the glue ears is separate from SM---but a lot of times SM symptoms can look like the dog is having pain in the ear area. My point was that something had to have happened (symptom-wise) for your friend to push for an MRI. So, she was *not* symptom-free, as she did have an unexplicable "fit". What was this fit like?

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She described the fit like the dogs eyes were like fluttering and she was not moving at all, she had to carry her to the car to get her to the vets. She thought she was having a stroke. The vet done blood tests and that was it. She went of her food for a few days and the next day she had a lot of discharge coming out of the ears, that’s why she thought it had something to do with the ears. She went back to the vets and he just called her a paranoid dog owner and wanted to leave the MRI until she had another fit. The Neurologist doesn’t think that this is linked to the SM, but nobody can give us an answer to what coursed the fit. She has two things wrong with her ears, this glue ear thing and the something called otitus. Not sure if I spelled it right.
She spends all her time with her dogs except shopping and things like that. I also see the dogs every other day and as I am very aware (sometimes paranoid) about SM symptoms, my Ebony’s mum was the last dog I would ever thought of having SM. I just hope Ebony doesn't follow in her mums footsteps as she got a heart Murmur and two patellas I have yet to fix. Suppose all I can do is sit and wait and watch.