28th May 2011, 08:32 PM
I thought about this very question long and hard before Tucker had his MRI, and I decided beforehand what I would do if he was diagnosed with SM.
I've known about SM for a very long time - since early 90's - and I think I know a good deal about symtoms. Tucker never had any of the obvious symptoms - sleeps like a rock at night and never moves (right next to me in bed), no light sensitivity or "look in the eyes" or anything obvious. I will say that there are some VERY subtle things that I could attribute to potential SM - occasional yelp or scratch - but those could be other things also such as disk disease esp. at his age.
His neurological exam was normal. His MRI showed CM, not too bad, and slight central canal dilation but no SM. His date of birth is 10/10/2002.
I had decided that if he had SM, I would start a trial course of lyrica - probably go straight for lyrica and skip gabapentin because of the 12 hour versus 8 hour dosage despite the cost difference. Then I would observe for a couple of months to see if there were changes in his demeanor or activity level. Tucker is a gentle, quiet dog with a very soft temperament so I'd watch to see if his activity level changed, etc. For the record, I think that a gentle, quiet demeanor could simply be his temperament and I'm not saying this is always a sign of SM! I might have also added a drug such as Prilosec, but I know that I would not use furosemide. I know that many use this drug, but it is not my personal choice because of what I know (through experience and years of observation on heart and kidney lists) about what the drug can do to kidney function. I personally don't agree with the monitoring recommendations for the drug on the SM protocols where it seems to be considered a benign drug, but that's just my opinion.
If Tucker were to ever develop SM symptoms in the future, I would start a trial of lyrica as above and probably get a second MRI since insurance would help pay for it.
My current second Cavalier (remember that I've had 12) is a spitfire whirlwind of activity with no SM symptoms. She is between 2 and 4. One day I will get an MRI for her, but I'd like to wait until she is older or until I see some symptoms. I would follow the same course as I planned for Tucker.
29th May 2011, 03:08 PM
My own thoughts -- I think the only way to define 'no symptoms' really, is if a neurologist has confirmed *no clinical symptoms*. Sometimes people who will have read in great detail on symptoms simply do not see the signs in their own dogs, doing many of these same things, as 'symptoms', even if they see the in other people's dogs. The mind often does not want to accept what the eyes see; human nature not to want a problem to be one's own problem. But also many symptoms that are clear to a specialist are not seen by pet owners much less vets. So even a vet saying 'no symptoms for SM' just cannot be taken as a confirmation of no clinical symtpoms.
O surgery and results: I am aware of many people who have had excellent results from surgery; many more with good/acceptable results, and a few cases where things disimproved within months or a year or two. This pretty much fits the profile that neurologists themselves report -- it's a bit of a bell curve. The recovery generally isn't and shouldn't be long and arduous for most dogs. Some of the worst/longest recoveries I have heard of from owners have been with the titanium mesh surgery, but it is always hard to make any analysis based on what you see online for results, as often you only ever hear from the people who have problems. The largest problem seems to be that most dogs are quickly (eg within a week) wanting to play and run as usual and the difficulty is controlling their activity. Many people I know feel they let their dogs do way too much way too soon and this sometimes produced setbacks.
I would def. not do surgery as a matter of course but for many dogs it is likely the only chance of anything but a very short term prognosis. These include early onset, highly symptomatic cases, or dogs showing some symptoms but having a really poor MRI result. The younger the dog is with symptoms, especially pain rather than some basic scratching, the more likely I would opt for surgery asap after diagnosis.
I would never opt for or advise surgery on an asymptomatic dog or one with very mild symptoms. That said, I repeatedly see people talk about their dog with 'mild' symptoms when what they describe are moderate to serious/severe symptoms.
If I had a dog MRI with a syrinx but no symptoms I would immediately start them on a CSF reducer as there are cases where they are definitely know to have inhibited/halted the development of pre-syrinxes and possibly syrinxes. There's now good evidence that these meds reduce CSF flow which is considered the cause of the development of syrinxes so decreasing CSF flow has got to be a good preventative step and these meds generally have very low levels of sie effects -- plus there's a variety of different types so if one isn;t working well another probably will be helpful/not have side effects.
There are cases incidentally where neurologists have advised against surgery for all sorts of reasons, including SM being too far advanced, age of dog, and other complications. So it isn't always an option.
In memory: Lucy