Gabapentin

[Kate H]

Sabby wrote: I wonder why he is so disapproving of Clare and this Forum.

I would guess because - quite unintentionally - this Forum sometimes comes across as a Fan Club for Clare Rusbridge! We go to see another neurologist having looked at Clare's algorithm, saying (or thinking rather too obviously!) 'I'm told frusemide isn't the best drug', 'Dr Rusbridge says...' - all said with the best intentions, but it can come across as not trusting the expertise of the neurologist you are consulting. So it's hardly surprising that they can get defensive. Yes, we do have a lot of practical expertise on this Forum, which can be wonderfully helpful, but we are not trained neurologists. A vet has his/her training, but a lot of their expertise comes from experience, of what drugs and treatment have worked in the past, and this will colour what they do now (though they should also be open to considering something new). For example, Oliver has been doing well on frusemide, but when his eyes started getting a bit worse, my vet consulted Dr Rusbridge about trying another CFS inhibitor and was told to keep him on frusemide until he could be scanned again. So Zitac isn't always the right thing for every dog. SM is a difficult condition to treat because it presents and progresses in so many different ways; different neurologists will have different ideas, and finding the right medication always seems to take time and experiment. If you're not happy with your neurologist, you can always get a second opinion elsewhere, but whoever you go to, you will still need to work with them over several weeks or months to tackle your particular dog's problems.

Kate, Oliver and Aled

[Margaret C]

Neurologists will have different ideas according to their own experiences in using different medication.

Geoff Skerritt is a very experienced senior neurologist, he has been a great friend to the cavalier breed in pioneering the first low cost MRI scans and talking to breed clubs all over the Country. He deserves our thanks and gratititude for all he has done.

Clare Rusbridge is the neurologist that oversees Tommy's treatment. She is very client friendly and open to suggestions from owners of the cavaliers she treats, and as most of you know I help her research through the Cavalier Collection Scheme.

Clare Is a wonderful vet and I am really thankful I live close enough to be able to consult her when necessary, but I feel that we must be careful to acknowledge and respect all the specialists that have helped our cavaliers & not create a feeling of artificial division between them.

[Sabby]

Neurologists will have different ideas according to their own experiences in using different medication.

Geoff Skerritt is a very experienced senior neurologist, he has been a great friend to the cavalier breed in pioneering the first low cost MRI scans and talking to breed clubs all over the Country. He deserves our thanks and gratititude for all he has done.

Clare Rusbridge is the neurologist that oversees Tommy's treatment. She is very client friendly and open to suggestions from owners of the cavaliers she treats, and as most of you know I help her research through the Cavalier Collection Scheme.

Clare Is a wonderful vet and I am really thankful I live close enough to be able to consult her when necessary, but I feel that we must be careful to acknowledge and respect all the specialists that have helped our cavaliers & not create a feeling of artificial division between them.

I agree with what you and Kate are saying, and I know he is an experienced Neurologist. But when Rossis mum is saying things like this;
He just doesn't make me comfortable discussing other
drug options and he seems to have the attitude that HE knows best. and I was put on the spot, like a child in the classroom

I think when your dog is in pain and you are tearing your hair out with worry it would help if you could deal with someone more human. That’s why I drove 3 hours to Clare and I think if it would be an 6 hour drive I would do that as well.

[Margaret C]

I agree with what you and Kate are saying, and I know he is an experienced Neurologist. But when Rossis mum is saying things like this;
He just doesn't make me comfortable discussing other
drug options and he seems to have the attitude that HE knows best. and I was put on the spot, like a child in the classroom

I think when your dog is in pain and you are tearing your hair out with worry it would help if you could deal with someone more human. That’s why I drove 3 hours to Clare and I think if it would be an 6 hour drive I would do that as well.

Fair points

[RodRussell]

I agree with what you and Kate are saying, and I know he is an experienced Neurologist. But when Rossis mum is saying things like this;

He just doesn't make me comfortable discussing other
drug options and he seems to have the attitude that HE knows best. and I was put on the spot, like a child in the classroom ...

If he is inclined to discuss his views, I would like to know what their sources are. In effect, put him on the spot. Does he rely only upon his own experiences with his other patients? Or, does he read and rely upon research reports? Has he published any research studies? If he does not like Dr. Rusbridge's views, what research does he prefer?

If he just blows off questions like these, then I'd probably move on to another specialist.

[cavluvver]

Thanks again for all your input, I value it very much as I feel like you are the only people I can turn to at times. I have had a terrible day. I came downstairs to find that Rossi had vomited all over the hallway carpet, more than once. I found him in the front room and he looked terrible. He could hardly move and since we came back from Chestergates his leg has been so much worse but we have to wait for the surgeon to come back on the 26th to operate. Rossi has only been on tramadol for a few days so I don't know if that has made him ill or something else, but I've only had him in the garden for slight exercise and there's nothing bad out there for him to eat or anything. I look after my 2 three year old grandsons so when they arrived I was mopping up sick. Rossi was prescribed tramadol (which I am now horrified to discover is highly addictive) alone because he wasn't improving with gabapentin, he seemed to be getting worse. I was told to give metacam if the leg got worse. Today he wouldn't even drink and turned away from food even his favourites. He clung to me like glue and seemed to be unable to get comfortable anywhere. He was even nodding off sitting up. I was distraught and found it really hard to give my attention to the boys who, even at 3 were very understanding when told Rossi was sick. I didn't give him tramadol in case it was that which made him ill, I will try it again in a few days. Just to clarify it is not Geoff Skerrit that has been seeing Rossi but another neurologist there. I am not trying to tell him that anyone knows better than him as he is the specialist and I had every faith in that. But I just think he should be open to discussion on other meds and be willing to discuss people's experiences(yours). I just want to do the best by Rossi. I DON'T KNOW WHAT TO DO AT THIS POINT. I have just managed to hand feed Rossi a few of his biscuits and he has had a drink. He is still hobbling around on his bad leg and keeps hiding under my legs. I will give him some metacam for his leg and I will see what tomorrow brings. All I do know is that I am really going to push to try a CSF inhibitor. Please, please give me all your views, it really helps me. Jackie

[Jasperxxgabby]

Hi Jackie
Regarding Rossi's stomach issues :-

Since June my Jasper as been on/off Tramadol and Metacam and he was having stomach issues but for the last month he as been having Antespin Tablets which I dissolve in water and syringe into his month, it coats the stomach and as made a difference for the good, I give it just before the morning tramadol and just before the evening tramadol with food, I tend to give him the Metacam early afternoon again with a little food. I know these stomach issues alone can be really miserable I do hope that things settle down.

Thinking of you and Rossi I truly hope things improve

[Kate H]

Jackie wrote: I am really going to push to try a CSF inhibitor.

I'm sorry Rossi is having such a hard time and hope he's feeling better. However, a CSF inhibitor is a long-term medication - it will (hopefully) reduce the CSF, but it won't make a great difference immediately, so I doubt if not being on a CSF inhibitor is making any contribution to Rossi's present problems, which sound like a reaction to the particular medication he is on. If the neurologist you are seeing is the young Italian on the staff, he may just be a bit inexperienced with SM (it is, after all, not the only neurological disease, though it may seem so to us Cavalier owners!) and trying to explain things in his second language. If you want to stay with Chestergates for practical reasons, I would have a word (by phone or email) with Geoff Skerritt himself and explain - without any tone of accusation or complaint - that you feel it is important that you develop a good relationship with the neurologist who is treating Rossi and that you are finding this difficult with this particular chap - as often happens between people, you just aren't connecting. Perhaps you would be able to see Geoff himself, or could be tactfully moved to another neurologist - I saw Ulrika Michal and she was very nice and helpful.

Kate, Oliver and Aled

[Brian M]

Hello jackie

How is Rossi today ,your last post made me so sad .

[Brian M]

Hi Jackie

Just another thought last year Rosie saw Martin Deuchtland at Chestergates a neurologist who I got on with fine ,but has since gone back to Germany ,and apart from having a full MRI which found she has CM also confirmed a problem with a couple of discs which were giving her pain
which may have needed surgery and MD commented to me "if I need a surgeon he knows a good one not far away" .So we took her to
http://www.nwsurgeons.co.uk/contactus.php and saw Ben Keely who was great ,and thankfully with rest only Rosie did not need surgery,
so if Rossi needs surgery for his leg NWS are another choice for and they are only down near Runcorn so for you straight down the M6.
Also NWS is the place our Cavalier Club Cardiologist is based who is very good and handy for us lot who live in the NW