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Thread: What might it be like for our dogs? Teen with Chiari

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    Default What might it be like for our dogs? Teen with Chiari

    This is a very insightful article into what humans experience with the condition.


    http://www.pe.com/localnews/corona/s...9.3aa6af4.html


    Details correlate closely with what SM dogs owners see in their own dogs, including the coming and going of symptoms. And it's a reminder that probably most dogs suffer a lot from headaches which owners cannot perceive and hence a lot of the true pain of the condition is not on view, perhaps leading people to not get the medications for a dog that would relieve such pain. There is a research project at the moment to try to find a better way to assess pain in SM dogs.
    Karlin
    Cavaliers: Jaspar Leo Lily Tansy
    In memory: Lucy
    Cavalier SM Infosite:www.smcavaliers.com

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    One thing I guess I'm not clear on, and probably less clear on after reading the article, is the surgery. I mean, I know there is no cure, but it talks about him continuing to deteriorate. Is that only if he doesn't have the surgery? And if he's starting to have damage to the spinal cord, and they are now looking at surgery, isn't it now SM?

    Thanks for posting the link Karlin? What a horrible disorder.
    Cindy and Claire
    Claire was born on Feb7, 2010

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    Well, there are a couple of things to keep in mind. 1st of all is that researchers already know that CM/SM in Cavaliers and other dogs is not exactly the same as Chiari and SM in humans. In dogs, the malformation alone only rarely seems to cause symptoms, whereas in humans, Chiari alone is by far, the principal cause of symptoms which can be worsened by the development of SM on top of Chiari malformation. The malformation is also different in dogs, which is why many of the canine researchers agreed to use the term Chiari-like malformation. The human brain is also different in structure to a dog brain so the anatomy of cerebellar herniation is a bit different (dogs do not have cerebellar tonsils, which are the part of the brain that herniates in humans). There are different types of Chiari malformation in humans, whereas there is just one in dogs. Here's some more information and images of Chiari malformation in humans: http://emedicine.medscape.com/article/406849-overview

    Also, dogs walk on 4 legs and carry their head and neck horizontally, whereas humans walk upright and carry their head and neck upright. This difference seems to contribute to some differences in response to surgery between humans and dogs but is not very well understood.

    On this article in particular, I think what the writer is saying but perhaps not fully understanding, is that this child has begun to develop SM as well as Chiari malformation, and that is why the doctors wish to operate.

    On deterioration after surgery–in dogs as well as humans, the surgery only seems to stop problems for a time and it is very typical for humans to need decompression surgery more than once–so yes, the article is noting that he will almost certainly continue to deteriorate over his lifetime. But you also have to remember that humans live 8 times longer on average than the average Cavalier–so there is much more time for problems to develop in humans over time. Still, some level of deterioration was seen in at least half of the dogs in a follow-up group for decompression surgery in an informal survey written up as a paper by Clare Rusbridge. I am very skeptical that the mesh surgery will have much better results when looked at over a long period of time–e.g., the lifetime of the average dog. That said, “deterioration” can mean many things from a return of some mild scratching on down to the return of severe pain that ends up with the dog needing to be euthanized. I think very few of us would consider the surgery a failure if a severely affected dog that was experiencing significant pain ends up after surgery meeting gabapentin for some mild scratching. Most of us would consider that a successful outcome over the life of the dog. Clare's paper found that more dogs treated with medications alone ended up being euthanized but that many with decompression also were euthanized for pain eventually, too.

    But as the article notes with humans–as is also true for dogs–surgery is not a cure. It is an alternative that can give dogs that otherwise might have a very short lifespans, a medium to full term lifespan instead and many people will feel it is worth doing for that reason. Others will feel the risk of failure and the stress of the procedure or the cost of the procedure or the already severe symptoms of the dog mean surgery is not an option for their dog. It is a very personal decision, but any one opting for surgery needs to be aware that they need to take any claims that surgery will leave dogs medication free for life, or free of all complications, is at this point IMHO nonsensical. Data on the surgeries generally is very thin and in some cases nonexistent for anything further than a couple of years of postoperative evaluation. And, too, some of the claims do not fit with what I see people writing about on discussion boards or hear back from people who have had the various surgeries.

    That is why I have such a degree of skepticism over claims about one technique being significantly better or having medication free results for dogs. This skepticism has been increased by seeing researchers who initially made these claims, revise them over time to concede that they are having higher proportions of dogs needing medication etc (to me it always seemed very premature to make such claims based on only about a year of postop evaluation). I also am aware of a couple of dogs that have had serious problems or significant deterioration after the mesh surgery, for example, in these do not seem to have been included in research reports. Almost every dog I know of that has had the mesh surgery is on some form of medication afterwards, generally gabapentin but in some cases, an array of painkillers as well–and yet the official figures are that the number needing medication is trivial and I just don't understand how there can be this variation. perhaps it is a case that it is mainly the people who have problems that highlight them, but I honestly don't think that this is the case as I've come across so many people over the years who have had a range of these surgeries done on their dogs. I personally believe that many owners whose dogs end up with difficulties post surgery, or which go back on medications, do not report these things back to the original neurologist (for any range of reasons, but this would not be uncommon, just as most people do not return to their breeder to inform them of serious health problems their dogs have also for a range of complex reasons). So therefore, a lot of dogs that go on to have problems, might not be included in a researcher's small, postop research sample Or even inform their general notion of how successful a procedure is. I think it is really important for people who have had surgeries to keep their neurologist informed on any need to return to using medications or to report any deterioration so that statistics better reflect real-world results.
    Karlin
    Cavaliers: Jaspar Leo Lily Tansy
    In memory: Lucy
    Cavalier SM Infosite:www.smcavaliers.com

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    Default Another Story of a Human with CM/SM and owner of a Cavalier

    I too have heard people say surgery is a cure. This is a very raw subject because some people feel that Cavaliers die from MVD, but not from SM. Surgery can hopefully relieve some pain and maybe hope to stop progression. There is NO CURE FOR SM. I feel in some Cavaliers, surgery may be the best option but I have rarely heard of any that do not have to take some medication.

    Can I please add these articles? When my cousin went to a prayer group and prayed for Ella with SM, a mother said that her daughter had this. She explained surgery and said her daughter had heard of Cavaliers with SM and felt that she could relate. This article appeared in Royal Spaniels but I find it interesting she worked with Dr. Marino and also how she can make her living and Cavalier with SM more comfortable (as best as can be) knowing what things hurt her. I like part 2.

    http://twolittlecavaliers.com/2011/0...cm-part-1.html


    http://twolittlecavaliers.com/2011/0...cm-part-2.html
    Anne Proud mother of Elton 5 and Angel Ella

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    It also would be nice if you are in the USA, to join the walk. I will look into details because I have contacted one person before. I joined some human forums because Cavaliers can not speak and I wanted to know what it was like. I remember when House came on with an episode of CM. Everyone was real excited to FINALLY have some type of awareness. We think of our Cavaliers or other dogs but people living with this condition could use support also whether it is just to say hello. At one time, I read that Cavaliers might show some light with research, even if this isn't going to be the same, it is something we can learn from each other.
    Anne Proud mother of Elton 5 and Angel Ella

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    Quote Originally Posted by anniemac View Post
    It also would be nice if you are in the USA, to join the walk. I will look into details because I have contacted one person before. I joined some human forums because Cavaliers can not speak and I wanted to know what it was like. I remember when House came on with an episode of CM. Everyone was real excited to FINALLY have some type of awareness. We think of our Cavaliers or other dogs but people living with this condition could use support also whether it is just to say hello. At one time, I read that Cavaliers might show some light with research, even if this isn't going to be the same, it is something we can learn from each other.
    Good idea to join human forums... I was wondering in the article it says that 20 percent stay the same or worsen after surgery. Is it the same for dogs? When they say worsen does it mean worsen because of the surgery?? I always wonder if its actually possible for surergy to affect progression negatively.
    Mom of Blondie aka The Monster, my furry daughter and loyal friend!!!!!!!!

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    Quote Originally Posted by Blondiemonster View Post
    Good idea to join human forums... I was wondering in the article it says that 20 percent stay the same or worsen after surgery. Is it the same for dogs? When they say worsen does it mean worsen because of the surgery?? I always wonder if its actually possible for surergy to affect progression negatively.
    I think its hard to compare like karlin mentioned above. For me, success is relative. I would say unsuccessful definately if the dog had complications from surgery. How does one know what results would have been on medication alone? Its a tough decision.

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    Anne Proud mother of Elton 5 and Angel Ella

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    Red face

    Thanks Karlin and Anne. That answered a lot of questions. Since not as many people report back to the surgeon, it doesn't sound like we will ever get accurate numbers on our Cavaliers, and return of symptoms, and at what stage.

    I pray I never have to go through this with Claire. I've had two dogs with weird disease or disorders, and it can be so heartbreaking when no one has answers.

    Thanks again for sharing. I pray that someday very soon we can figure out a way to stop this disorder in our sweet Cavaliers.
    Cindy and Claire
    Claire was born on Feb7, 2010

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    Thank you for posting these, I will have a look through later, but I'm confused about this Karlin

    In dogs, the malformation alone only rarely seems to cause symptoms

    because of this thread http://www.cavaliertalk.com/forums/s...d=1#post377899

    25% of cavaliers with SM symptoms have CM only, not SM

    That's according to a research sample of clinically affected, scanned cavaliers in the new research paper out from Clare Rusbridge et al. This is the same one Rod notes in an earlier thread about 76% of these dogs also had further syrinxes lower than the C5 vertebrae (and thus dogs with syrinxes are likely to be worse than a mini scan will show).

    Abstract below, but this excerpt from the paper interested me as it suggests a hitherto unexpectedly large number of dogs with clinical signs of SM (all dogs in the study had clinical signs)-- one in four!!! -- have CM only -- which suggests people with such dogs really need to be treating it AS WITH SM, not attributing the problem to some other likely cause (something vets also need to recognise):

    The median age of the dogs included in the study was 5 years (1.210.8 years). CM was present in all patients. None of the dogs showed compressive craniocervical pathology other than CM. There was no evidence of SM on MRI in 12/49 (25%) dogs. In all dogs with MRI evidence of SM (37/49; 75%), SM was present within the C1C4 region (Figs. 2 and 3). Of those dogs with SM within C1 C4 region, 76% (28/37) also had SM within the C5T1 and/ or T2L2 regions, but only 49% (18/37) had SM within the L3L7 region.
    Abstract
    Chiari-like malformation (CM) and syringomyelia (SM) is an important disease complex in the Cavalier King Charles Spaniel (CKCS) but data about the anatomical distribution of SM along the spinal cord are lacking in veterinary medicine. The objective of this study was to define the anatomic distribution of SM in CKCS clinically affected by CM/SM. Magnetic resonance imaging (MRI) of the brain and the entire spinal cord of 49 dogs was performed and different morphological parameters compared.

    Syrinx formation was present in the C1C4 region and in other parts of the spinal cord. The maximal dorsoventral syrinx size can occur in any region of the spinal cord and the total syrinx size was positively correlated with age. Seventy-six per cent of CKCS with a cranial cervical syrinx also have a syrinx affect- ing more caudal spinal cord regions. MRI restricted to the cervical region may underestimate the extent of SM and the severity of the disease process in the majority of dogs.



    it seems to indicate there are many who have symptoms "just" from CM and I know we have a few on the board - I've personally known a few dogs who scanned with no syrinxes but were symptomatic.
    Nicki and the Cavalier Clan Our photos www.scotlandimagery.com
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    On the 20% figure–this is actually a well understood failure rate for the surgery in dogs too -- and that is only the initial failure rate. About 20% will decline within the 1st year. It is listed on Clare's page and has reoccurred across various research papers by others as well. I really recommend anyone interested in SM, or anyone with an affected dog, to read Clare's FAQ. :thmsbup:

    From Clare's site:

    How successful is surgery? Cranial/cervical decompression surgery is successful in reducing pain and improving neurological deficits in approximately 80% of cases and approximately 45% of cases may still have a satisfactory quality of life 2 years postoperatively (Rusbridge 2007). However surgery may not adequately address the factors leading to syringomyelia and the syrinx appears persistent in many cases (Rusbridge 2007). Much of the clinical improvement is probably attributable to improvement in CSF flow through the foramen magnum.
    On the 25% figure == thanks for that reminder Nicki– you are right, I need to change from describing this as “rare”. I had forgotten about that paper earlier this year which showed this far more significant percentage. I am very glad that you brought this up, because I'm in the midst of doing some work on SM information and need to include this in.

    My understanding would still be that dogs with CM only, rarely show more severe symptoms. I will see if I can get some more information from Clare Rusbridge. There's still a reverse of the situation with Chiari malformation and SM in humans, however–where my understanding is that the vast majority of people with symptoms have Chiari, and SM is an additional complication for some of them. I will see if I can clarify that. Given what was initially understood about dogs, we have come along so much further in the past 7 to 8 years that I've been following the issue and research. I know people often feel we know so little, but actually we know vastly more then we did in, say, 2003 when I was trying to get information on the condition.

    I know we would all like more answers, but the answers will not be forthcoming unless money goes into research and in particular, if breeders do not scan dogs for research. There are still very few scans coming forth from breeders into the research programs, and getting scans from older Cavaliers, especially males and most critically some stud dogs with pedigrees that connecting to so many of the well-known lines, would just be so important for trying to move understanding forward. I wish the international clubs would get behind these initiatives and create funds and create even more importantly, awareness programs around these conditions! There is still a dearth of information on most national club websites, and very little organized support for SM research or to try to get breeders to understand the significance of scanning older dogs. I hope some breeders who have been involved can convince others and their clubs to be more proactive in this area.
    Karlin
    Cavaliers: Jaspar Leo Lily Tansy
    In memory: Lucy
    Cavalier SM Infosite:www.smcavaliers.com

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