Luka's SM Update

[goda]

Luka's Gabapentin has been increased to 4 times a day and he gets codeine 3 times a day. He also has Rimadyl which is supposed to be delicious but he won't eat it unless it is in a pill pocket. He gets that twice a day, air scratching is minimal.

We will be trying acupuncture next. Over all Luka is looking better. He has a healthy heart and is over all doing much better. SM is not the end all, I think as owner's most of us that get the diagnosis with the first dog, panic.

Dr. Kline said that this is no different than living with a disability. She seems very pro medication, and not so keen on surgery because of the extensive damage to his spinal cord already. If there is a sign of progression she is for surgery but seems to be more oriented with treatment.

Thanks for all your support and input.

[meljoy]

Glad to hear Luka is feeling better. I hope he continues to improve with all the medication and of course love

[BrooklynMom]

Big hugs for Luka. He is lucky to have such a wonderful loving mom as you.

[Kate H]

The general experience seems to be that getting the medication - both variety and dosage - right is a matter of trial and error for a few weeks or months, so let's hope you've now found the right mix to keep Luka comfortable.

Kate, Oliver and Aled

[gamefanz]

I am so glad that Luka is getting the meds to help him and that surgery can be put off for awhile. Its great news! Hearing what you said helps me as a new puppy owner that this will not be a death sentence, that there are things that can be done to give your dog a good life. Becky

[Karlin]

I am glad that the mix of meds is working -- great news, and that gives you time to consider options as things go along.

I cannot agree with Dr Kline however agree that dealing with SM is like dealing with a disability. Most define a disability as an impairment to normal activity. While this may be an accurate description for a subset of cavaliers with symptomatic SM, it is still almost always progressive and for significantly symptomatic dogs (and many will eventually progress to that point) it often eventually requires euthenisation regardless of whether one opts for surgery or meds (see Clare Rusbridge's report on this). I am not sure many on the medical side would use 'disability' to accurately sum up what sufferers of SM, whether humans or our dogs, live with. To me, and I have three dogs with condition and have worked with/spoken to several of the key researchers and to others with affected dogs for going on 8 years now) that's like describing cancer or any other life threatening, often progressive condition as a disability. For the same reasons, I could not describe MVD as a disability and I think it would be hard to find a cardiologist who would consider it a disability as opposed to a potentially life-threatening and often extremely debilitating serious illness.

Most of us with affected dogs do not live with the certainty of management options we might have with a dog with a disability. I have had animal with disabilities, such as an amputated leg, deafness, etc. My only uncerainty with those conditions was making sure the animals did not get outside off lead, Or a mild concern about some increased prospect of arthritis. With SM cavaliers, you live with a day and day out concern that today may be the day a screaming fit happens, that meds cease to help, that you need to make a rushed decision on surgery or euthenisation. You have to weigh up every day how much pain the dog is living with, despite what the medications mask and the small comfort that they bring. Plenty of humans with the conditions say drugs do very little to help with the severe headaches or the disturbing skin crawling sensations, that we may only see in our own dogs manifested by occasional scratching–and no dog can tell you whether it has an unbearable headache (those who the face rubbing signs may sometimes indicate some degree of that). Human neurologists have very few tools to help people live comfortably with this condition, and as with the dogs, surgery often has to be repeated. If we choose not to have surgery for our dogs, we live every day with the concern that this has been the wrong decision. If we do the surgery, we live every day with the worry that this has been the wrong decision. Whatever the choice, you fear that it will eventually result in a dog needing to be euthanized earlier than what would have been the case if you hadn't intervened in the way that you did. of course, you do put it to the very back of your mind, but I have lived with this with one dog for over six years, and that worry is always there and increases over time rather than recedes. Any additional MRI almost always shows that a syrinx has grown.

I just cannot see how anybody could describe SM as a disability. Perhaps it is just a matter of semantics amongst neurologists, but using the word “disability” implies a fairly static, understood condition with some ease of management and care options that most evidence would suggest simply is not the case, especially for dogs with significant syrinxes and early onset symptoms. I guess the main concern for me is that as a term it gives a false sense of security that even those with dogs with few symptoms or a small syrinx just do not have, because you're always living with the prospect of progression–which can often be sudden and swift.

I am curious to know if others with affected dogs see it as a disability?

[Pat]

Luka's Gabapentin has been increased to 4 times a day and he gets codeine 3 times a day.

I'm curious because I don't think I've heard of anyone using codeine for SM. Is it uncommon to use this drug for SM? When my mom was in my home at the end of her life and we were working with Hospice, I remember that the drug was pretty strictly controlled though we did use it.

Pat

[Blondiemonster]

I'm curious because I don't think I've heard of anyone using codeine for SM. Is it uncommon to use this drug for SM? When my mom was in my home at the end of her life and we were working with Hospice, I remember that the drug was pretty strictly controlled though we did use it.

Pat

Here in the states they put codeine in over the counter cough syrup. In people they give codeine easier than vicadin and percocet. Tylenol 2, is codeine and acetaminophen and usually drug of choice for dentist patients. So it's controlled but not as controlled as class 2 narcotic such as percocet. (oxycodone) It's just an all around pain med, and I don't think it's ever given long term??? (meaning several years) as I think tolerance builds up fast!!

[Pat]

Um...Atlanta, GA is in the states! But you know what, I was actually thinking of morphine when I wrote that post rather than codeine - morphine is what was so controlled when used for end of life palliative care, and that is the drug that was given to my mother. I did read up on both codeine and morphine in Plumb's Veterinary Drug Handbook.

But again - I don't think I've ever seen codeine or morphine listed as drugs used for SM - and I'm curious whether anyone else has had their neurologists prescribe these opiates. I've seen gabapentin and pregabalin used of course, a whole host of NSAIDS, steroids and Tramadol - and I think that's it. Have others used codeine or morphine for SM pain?

Pat

[goda]

Here in the states they put codeine in over the counter cough syrup. In people they give codeine easier than vicadin and percocet. Tylenol 2, is codeine and acetaminophen and usually drug of choice for dentist patients. So it's controlled but not as controlled as class 2 narcotic such as percocet. (oxycodone) It's just an all around pain med, and I don't think it's ever given long term??? (meaning several years) as I think tolerance builds up fast!!

I think you are mistaken, codeine in cough syrup is not over the counter in the United States. Every form of codeine is subject to FDA regulations.