Luka's SM Update

[goda]

I'm having trouble with the forum and posting long responses. Just wanted to say Karlin explained how exactly I felt and most others. Its a roller coaster and I'm getting tears thinking of it. Its so new to you and like Karlin said, there are always changes, questions about are you doing the right thing.

Just to hear disability concerned me. Karlin said it best. Also what are your expectations with acupuncture? Are you thinking instead of surgery?

Sent from my Droid using Tapatalk

We haven't decided against surgery, we decided it wasn't an option *right now*.

[goda]

But this is the point (not that the word disability has any negative context): many of us find SM really isn't usually an illness that can be managed very well at all once you start to get any significant level of symptoms, and whatever the level to start with, you live in constant, justifiable worry that it will progress to the point where it isn't manageable. That is exactly what I mean about the word being misleading. Progression is unfortunately the norm for SM, and managing with meds requires increased dosages in almost every case I know plus regular revision of the cocktail of drugs, meaning lots of trial and error and neurologist visits. On Luka's meds right now: many neurologists would also have a dog on some kind of CSF reducer -- it is one of the only drugs that actually is known to be able to slow (and in very early cases of small pre-syrinxes, even to halt) progression. You will see it is one of the first things listed on Clare's treatment algorithm.

You might consider a second opinion. Each neurologist has their own approach, but the level of damage to Luka's spine already indicates the disease has progressed very rapidly.

It isn't that there is anything wrong about opting for medications, but in such a context I find it especially hard t see how medications could be described to be managing a disability; the risk is that with continued progression they would only be able to provide palliative care and a closing window may exist in which surgery can do anything, if it was to be considered an option. Acupuncture does sometimes help to manage pain but again will not halt progression and as Nicki says, it is adviseable to find an acupuncturist familiar with SM.

There are indeed dogs with SM that can be managed on medications alone for a normal or close to normal lifetime; but these tend to be dogs with small narrow centrally positioned syrinxes with few symptoms.

I asked her about the the CSF reducing med and she hesitated because it has barely been a month since he was diagnosed. I am pretty sure she wants to see how he can handle the regiment he is on now.

[Nicki]

The majority of neurologists recommend they are put on to a CSF reducing drug immediately as this reduces the pressure as Karlin says above.

Often there is a huge improvement in the dog just from using a CSF reducing drug - Clare Rusbridge recommends Cimetidine [Zitec] as being very gentle on their systems but also effective. There are dogs on the forum who were given a very poor prognosis who are doing well several years later, mainly it is believed due to these drugs.

I would certainly want my dog put on this, it is not going to do any harm. The other medications are for pain relief.

I've not heard of codeine being prescribed before either - have been dealing with Syrinogmyelia for over 12 years and have done a considerable amount of research into the condition and treatment. Does Dr Kline have much experience with the condition? It just seems strange that she is recommending a treatment program so diverse from other neurologists.

[goda]

The majority of neurologists recommend they are put on to a CSF reducing drug immediately as this reduces the pressure as Karlin says above.

Often there is a huge improvement in the dog just from using a CSF reducing drug - Clare Rusbridge recommends Cimetidine [Zitec] as being very gentle on their systems but also effective. There are dogs on the forum who were given a very poor prognosis who are doing well several years later, mainly it is believed due to these drugs.

I would certainly want my dog put on this, it is not going to do any harm. The other medications are for pain relief.

I've not heard of codeine being prescribed before either - have been dealing with Syrinogmyelia for over 12 years and have done a considerable amount of research into the condition and treatment. Does Dr Kline have much experience with the condition? It just seems strange that she is recommending a treatment program so diverse from other neurologists.

Well we have another appointment next week. I have never heard of Zitec (Do you mean zyrtec?) ..? I've heard or prilosec reducing CSF. Cimetidine is an antihistamine, which from what I have been told. You know I don't know so I need to talk to her again, if a lot of dogs in this forum have had positive results I think it's something to look at.

[Pat]

OK - still looking for the answer to my question, which is:

Has anyone else ever heard of a neurologist prescribing codeine or morphine or other opiates for SM pain? I'm not asking what codeine is. I've checked all my various veterinary textbooks and speakers' notes from AVMA, etc., but this is the first mention I've heard of any vet using this drug for SM pain. Is this a new protocol?

Again, when I first posted I wrote "codeine" but I was really thinking "morphine" - although both are opiates. I do know many vets that prescribe hydrocodone for coughing related to heart disease, collapsing trachea, and/or COPD:

http://www.veterinarypartner.com/Con...C=31&A=519&S=0

But from what I've read, codeine is a pretty weak analgesic. I also googled to see about interactions between codeine, gabapentin and an NSAID - I'd want to get a good handle on understanding that if I were giving all three drugs.

Anne - regarding Tramadol - I've used this long term for several geriatric dogs - daily for many, many months for pain control - for several reasons such as severe osteoarthritis and in dogs with cancer where quality of life was my paramount concern. My understanding from my vet internist is that it is a safe drug to use long term. It may be habit-forming but that was not a concern in the cases where I used it.

Pat

[Blondiemonster]

Well we have another appointment next week. I have never heard of Zitec (Do you mean zyrtec?) ..? I've heard or prilosec reducing CSF. Cimetidine is an antihistamine, which from what I have been told. You know I don't know so I need to talk to her again, if a lot of dogs in this forum have had positive results I think it's something to look at.

Cimetidine is a drug to treat ulcers in humans. Its like prilosec.

[Pat]

Cimetidine: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000628/

Zyrtec - Generic Name: cetirizine - this is a different drug and is an antihistamine, but this is not used for SM.

Niki - did you mean Zantac - that is a brand name for another drug used for GERD:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000094/

Or perhaps Zitec is a UK brand name; I can't find it when I google for brand names of cimetidine.

Pat

[goda]

OK - still looking for the answer to my question, which is:

Has anyone else ever heard of a neurologist prescribing codeine or morphine or other opiates for SM pain? I'm not asking what codeine is. I've checked all my various veterinary textbooks and speakers' notes from AVMA, etc., but this is the first mention I've heard of any vet using this drug for SM pain. Is this a new protocol?

Again, when I first posted I wrote "codeine" but I was really thinking "morphine" - although both are opiates. I do know many vets that prescribe hydrocodone for coughing related to heart disease, collapsing trachea, and/or COPD:

http://www.veterinarypartner.com/Con...C=31&A=519&S=0

But from what I've read, codeine is a pretty weak analgesic. I also googled to see about interactions between codeine, gabapentin and an NSAID - I'd want to get a good handle on understanding that if I were giving all three drugs.

Anne - regarding Tramadol - I've used this long term for several geriatric dogs - daily for many, many months for pain control - for several reasons such as severe osteoarthritis and in dogs with cancer where quality of life was my paramount concern. My understanding from my vet internist is that it is a safe drug to use long term. It may be habit-forming but that was not a concern in the cases where I used it.

Pat

This is my first dog with these health issues, I have finals for school this week, and while I would love to be on the internet for hours reading about it, I simply can't just now. I will ask my Neurologist about the codeine.

Are you recommending Luka try Tramadol?

Sometimes your responses however helpful are a little insensitive. I am doing the best I can with what I know right now.

The vet put him on the Rimadyl, I don't see much of a change, I don't know about the codeine, it's there to help with his [pain and discomfort. I have given him extra pain medication in the past because he had obvious discomfort.

I don't know I need another opinion, but as of right now, I don't have the time nor the money.

[Karlin]

I think Pat's question was a general one, aimed at anyone with a dog with SM, not anyone in particular. I also didn't take at all that she is recommending Tramadol; she was answering someone's question. Pat is one of the best informed members on canine medical issues here .

Has anyone else ever heard of a neurologist prescribing codeine or morphine or other opiates for SM pain?

No, I haven't.

Are you recommending Luka try Tramadol?

Tramadol is a far more serious painkiller. I keep it for emergencies with Leo but only needed it once when he had a serious pain session probably caused by a fall when he fell on his spine. The pain may have been directly or indirectly SM related or spinal/disk pain and unrelated. If current painkillers do not manage his symptoms it may be one to try but does have an addictive effect longer term for many dogs. Whether that matters or not? Probably not if the alternative is pain. There are many many options with painkillers.

Clare's treatment algorithm is really the best summary of treatment approaches and when to introduce what. She normally starts with CSF inhibitors. The original intent of meds like cimetidine or frusemide or omeprazole isn't really relevant to what they are used for with SM -- they all reduce CSF pressure. You really need to work with a neurologist on what to try and when but Clare's document is considered a gold standard by many, not least as she is so familiar with the condition and for a long period and has done much research in the area. She also manages conservatively, overall. A neurologist is bets to judge, by pain indicators and response, which meds are best and to recommend changes when they stop being effective.

[jacies]

I have not heard of Codeine being used for treating SM. Just read up about and it seems that this is a narcotic and can cause addiction which Tramadol for pain relief would not. It would therefore seem that it would have to be withdrawn slowly if changing over. Chaos is on Tramadol for quite a long time now and it certainly has helped her.