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?