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Izzie has appointment tonight - Think it's SM

I know how frusterating this can be. It is a long and confusing road. On one hand you want to rule everything else out, on the other you don't want to slow the process.
What pain medication do you have? I think that will help us to be able to answer your questions. For instance, Brooklyn's neuro did a trail of her on Gabapentin...which is for neurological pain (i.e. if she was doing better on it, that would be a good indicator of SM, but if she was not doing better it did not mean she did or did not have it, it just helps us to better understand). A generalised pain reliever might relieve any pain, but I would assume a neurological medicine like Gabapentin (or others similar) would point you more to neuro pain and it would not eliminate pain from say, a hurt leg.

I could be wrong though...others are much more knowledgeable about this than I am so I will wait for them to chime in. :)
 
Yes, Brooky's mum is right. If the pain is neurological, then gabapentin should quite quickly make a noticeable difference - but it won't make any difference to a non-neurological pain. It is a good pointer to the source of the pain - though not all neurological pain is from SM, of course.

Kate, Oliver and Aled
 
Thank you. He's only put her on Metacalm just now until we rule out everything else and then he would see about long term pain relief, I'll be sure to mention this to him on Thursday.

I gave her her first dose this morning and to be honest she slept for quite a large amount of the day afterwards. This evening though while her scratching is still there I've found she's not biting her back end nearly as much nor yelping, so I'm very glad she at least seems to be more comfortable.
 
Yelping on being lifted

Barkleigh has always yelped if you lift him and touch him under his forelegs. I just thought it was a tender spot! He just had an MRI to find PSOM (and he had it!) He had gone deaf and they fixed it. His MRI showed that he had a small Chiari Malformation and the doc showed us a comparison with a serious SM Cav. She said that Barkleigh would never have serious symptoms. Of course, now we are treating for suspect epilepsy. He does not scratch much, but I worry when he does.

Good luck to you both. Having done a big round of bills, insurance, and anxiety I know what it is like. Hope it is far less than you think.
 
Metacam is a pretty low level pain killer and generally doesn't work that well for SM on its own, so don't be surprised if there isn't too noticeable response. That's a pretty conservative starting point. I'd definitely see a neurologist if symptoms continue as working out the right mix of meds is a 'cocktail' approach for most dogs and one of trial and error, using medications unfamiliar to most vets (eg gabapentin) and not really in the knowledge realm of vets. The mix also generally needs to be monitored and changed now and then as well as one approach almost never lasts for the life of a dog with these conditions.

She said that Barkleigh would never have serious symptoms.

Unfortunately such predictions have not been backed by people's experience -- an older dog with only CM is unlikely to go on to develop serious symptoms with CM or get SM, but either can happen and have happened, and it is absolutely impossible to predict unless this one neurologist knows something no one else does! :) It is possible to say a dog is unlikely or less likely to have problems but you can never say 'never' with CM/SM, as all the main researchers have stated many times at seminars on the disease. :( It is why it is so frustrating and difficult for dogs, owners and breeders.
 
I can back up what Karlin says about even CM alone being a progressive disease. Oliver has had some discomfort from his CM ever since I had him at a year old. This has grown progressively worse; he was diagnosed with a small syrinx when he was 6, but now at 10.5 his neurologist still says that almost all his symptoms (headaches and light phobia) are due to his CM, although his syrinx may now have developed enough to be affecting his hind legs a bit. Some vets still don't seem to really have taken on board that CM/SM is a progressive disease, and that CM alone can cause considerable problems.

Kate, Oliver and Aled
 
Thank you everyone. We are back at the vets on Thursday and I will let you know how we get on. Just one last question..

As it seems our insurance won't be able to help (her symptoms started before taking it out), do you know how neurologists go about payment? Sadly I'm not in a position to pay out thousands of pounds, though I will be looking into measures to help me, for a MRI. I have a few hundred pounds put by which I can use but aside from that I'm at a bit of a loss..

I'm going to discuss it all with my vet on Thursday, but do you know if any of them along you to pay it up? I hate to have gone through all this and then in turn can't get a MRI because we can't afford it, and does anyone know what that would mean for her pain relief? Would vets be willing to give her pain relief for a period of time without an MRI?

I'm probably jumping the gun here a bit, since we still aren't sure what is going on. But what with us being referred I just want to be sure I know everything I can first, and I'm starting to feel sick at the thought that we're not going to get this sorted.

Thank you again for all of your kind words, it means a lot to be part of such a lovely helpful community of people who have went through the same kind of thing.
 
Well, here is my view. Ideally, people want to get an MRI so that they know what is going on. But in the case where this is going to be very costly, and there are already some obvious symptoms, and a person is not going to be opting for surgical treatment regardless, for whatever reasons, I would make it clear to a neurologist that you cannot manage the cost of an MRI but that you would like to have a clinical exam done and have their opinion and then to start trialing some of the possible medications to see if those help.To be honest, all evidence indicates that 70% of all cavaliers would MRI with a syrinx by the time they are 6 or 7 years old. and almost every single cavalier is going to MRI with CM. That means for a given set of symptoms, for most dogs the conclusion is going to be that they have CM/SM, and they are going to be treated accordingly. For many different types of possible illnesses, vets will try medications to see if they help before doing invasive tests, and so I feel quite strongly that in the case of an MRI, which can cost people 1000 or 2000 pounds, euro, or dollars, for most dogs showing symptoms that are generally tied to this condition, it makes more sense to simply trial them on medications to see what works. This is of course after a vet has done everything else to eliminate other possibilities–allergies, disc disease, etc.None of the medications used to treat SM are particularly risky, and certainly there are not going to be significant side effects, if any effects at all, for most of them used for short-term trial periods. Some of the symptoms are just so typical that most of us that have affected dogs reach a point where we could probably say with a pretty high degree of accuracy whether some other dog, scratching or behaving in a particular way, has SM. When other possibilities have already been eliminated, I honestly do not understand sometimes why people are pushed to do a costly MRI unless they either want to have a confirmed diagnosis and understand the extent of existing damage, or they want an MRI to consider the option of surgery.Or to put it another way–I have MRI'd all of my dogs, some of them twice, for the purposes of both diagnosis and research. I have worked with a neurologist and with my veterinarian to treat those that have SM. I have not considered surgery for any of the 3 that have SM, for a variety of reasons. If that were to change, then those dogs would go for a full MRI. 2 of my dogs that have SM did not have this confirmed by MRI for a couple of years, until I took them to the UK to have all of them done for research (mainly to get a 2nd MRI on my 2 related Cavaliers, one of which has SM and one of which is clear for reseacrhers, and also to have an MRI done on my lovely, late Lucy, whom the researchers expected would be a clear older dog at 9 given the dogs in her pedigree–and she was–thus making her very helpful for the genetic work the researchers are doing). So out of 3 with SM, one got an MRI confirmation when he was only just over a year old, and he was then treated by medications from that point onwards with a confirmed diagnosis–and he is now 8.5. The 2 others, I was quite sure from symptoms and from response to medications, that they had SM and it turned out to be the case. But they were successfully helped by medications long before they had an MRI confirmation.I do think dog owners should politely hold firm if they do not feel they can afford an MRI And would not seek the option of surgery–ask for a clinical exam and ask trial medications if the neurologist feels, on the basis of the clinical exam, that the dog is likely to have SM. there are obvious downsides to this: it may be that an MRI will reveal the dog really has very little time or chance of much of a life unless surgery is performed, and without an MRI, the owner will not know and choices may become more limited down the road. So there are many things to weigh in the balance, and many considerations, but I personally feel not every dog needs to have an MRI in order to be effectively treated (especially older dogs–say, over 4-5– that are showing symptoms, especially if they are not really severe).
 
Sorry for that solid block of text but board is quite glitchy at the moment! And took out all the paragraph formatting. :sl*p:
 
It's no problem Karlin lol, I still managed to get through it!

It was extremely helpful, I will be certain to discuss all of this with my vet on Thursday and the neurologist I'm referred to. I'm happy to at least know that she will be cared for whether we can afford the MRI or not and it's not just black and white. As long as I know my Izzie isn't in the pain and we can understand it a little better if everything else is ruled out - I'll be content. Thank you!
 
Seconding what Karlin said about MRIs, I was talking to a neurologist recently, as Oliver is slowly getting more symptoms of his CM/SM, about the need to have a full MRI (so far he's only had two mini scans) to find out what is going on. She said that though it would be interesting to see how his syrinx and dilated ventricles had developed, it wasn't essential, and I would do better to keep my money to spend on medication for him. Unless surgery is an option, whatever a scan says, you can still really only treat the symptoms you and your vet (and above all, a neurologist) can see. Finding the right medication is almost always a matter of trial and error for a few months, and then adjustment from time to time, but when the right combination is found for your dog, more or less normal life should be able to be resumed!

Kate, Oliver and Aled
 
One of my dogs was diagnosed in July with SM and the other with CM, both being symptomatic. It’s amazing how much I learned in this little time. It’s like doing a crash course in SM/CM. I am very lucky that my new vet is informed about SM and whatever he doesn’t know he is willing to listen to me and whatever I have learned on this Forum. I think my vet was amazed on how much I knew about SM. Not all vets are that accommodating and some like to dig their heels in not willing to listen to their clients.
I must agree with Karlin, if people can’t afford to do an MRI scan and have the dog examined by a Neurologist and it is clear that the dog might have SM then why not try pain relief as the most important thing is to make the dog comfortable and living without pain.
 
Not sure if I should just ask this here or make another thread in the Training area, however - we were at the vets today just for a little update and to book her in officially for her spay in 2 weeks time. And my vet remembered that I ran agility with my Izzie.

What are your views on continuing this with the likely SM? He said that he would be cautious of her hurting herself/spine and wasn't sure if I should continue purely because he hadn't seen a Cavalier with SM who competes in agility and didn't want to say it was fine when it wasn't.
She is never uncomfortable running her courses, and I've always said it's her training which keeps her so healthy and she thoroughly enjoys it. I never train her if it's too wet or push her very hard anyway, and I especially wouldn't now. I was almost quite upset as I felt like well, it's SM and awful, but I don't want her or me to be defeatist and give into it and let it affect her daily life. What is everyone's opinion?
 
I think it's a balance and I know Dr Rusbridge thinks this way. You do not want to lower your cavalier's quality of life if agility is something she really loves -- but at the same time, there are risks, the main one being that accelerated activity increases the pressure of the CSF which in turn may worsen the SM at a faster rate. If she isn't showing any pain and really enjoys the activity I'd probably continue with the agility but personally, I wouldn't compete and I'd do milder runs. I think one hard ting to judge is whether they are in pain or not. I think a lot of time they just go ahead and do an activity right through the pain, in part because it is a pattern and activity they know, in part because they enjoy it an in part because they are doing what we expect of them -- performing as we have trained them. I think that makes it very hard to judge pain unless a dog gets to the state of severe or disabling pain/discomfort. I know with my own Jaspar, one time playing fetch when young he had a head on collision into another of my dogs and was clearly concussed and staggering yet he kept staggering after the ball and it was almost impossible to make him stop!
 
Not sure if I should just ask this here or make another thread in the Training area, however - we were at the vets today just for a little update and to book her in officially for her spay in 2 weeks time. And my vet remembered that I ran agility with my Izzie.

What are your views on continuing this with the likely SM? He said that he would be cautious of her hurting herself/spine and wasn't sure if I should continue purely because he hadn't seen a Cavalier with SM who competes in agility and didn't want to say it was fine when it wasn't.
She is never uncomfortable running her courses, and I've always said it's her training which keeps her so healthy and she thoroughly enjoys it. I never train her if it's too wet or push her very hard anyway, and I especially wouldn't now. I was almost quite upset as I felt like well, it's SM and awful, but I don't want her or me to be defeatist and give into it and let it affect her daily life. What is everyone's opinion?

Hi Autaven

I know just how you feel. My Harley lives for agility; somebody even said once that he smiles all the way around the course. He started limping this summer and we thought it was an agility injury after all the Xrays and tests that didn’t show anything he had an MRI and it showed mild SM. He was limping constantly for about a month and suddenly one day it just disappeared. I only started competing with him last year and he was doing very well. Even after the limping stopped I didn’t do any agility for 3 month, we also do Rally Obedience and he does love it but I could see he was sitting on the sofa being unhappy, even my husband picked up on it and he normally doesn’t notice anything. I talked to my Agility Instructor and she goes out of her way to plan in a special course for Harley, definitely no A Frame and weaves. He does a low dog walk, tunnels, seesaw and low jumps. When I took him back for the first time he pulled me all the way to the hall and he barked all the way around the course he was so happy to be back. I only do agility with him once a week instead 2-3 times a week now and in summer I will sit out some rounds. I never competed with the KC as the jumps were too high for him anyway but I compete with the BAA and I have written to the person in charge and she will let Harley jump on the lowest jumps and I will only run him once instead of the 3-4 times I ran him before, and only do the jumping and tunnels. So he still does a little of what he loves.

Just to say that first I was completly against doing agility as I don't want to make it worse, but he was sitting at home unhappy, maybe some people won't understand this but he lives for working. Harley is not like my other two happy with walks, he doesn't even enjoy sniffing and walking he only comes alive when he can work. Even after coming from training after he had a little rest there he is bringing me the ball to play with him. So I decided to do a little bit of what he loves so much.

Also I know every dog is different and Karlin is right in saying that they do anything to please us even when in pain. With my Harley I knew straight away something was wrong as he never refuses anything but when it all started he refused to do the A Frame and went round it, not like him at all and I knew straight away something wasn’t right. (that was before the limping started) Also I can tell when he slows down.
 
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Thought I would just bring up this thread rather than starting a new one since all Izzie's information is here :)

We were back at the vets today for a little check over and we needed more Metacam. It wasn't her usual vet we saw so I was a bit iffy but she asked how she was getting on and I reported that her yelping for no reason has stopped and so has her biting her back end since going on the metacam - however she's still itching. It's not constantly, but it's enough that we notice it. (but of course we notice every itch any of the Cavaliers make).
She checked her ears for infection, her heart and her anal glands again and said everything looked fine so it was upto myself - keep her on Metacam and see how it goes or give her a 2 week trial of Gabapentin. I said that latter, purely because if she's still experiencing pain then I'd rather sort it sooner than later.

Now that I'm home I'm just wondering if there is any major side effects or anything that I need to look out for, and if this was the right decision? She did tell me all about it and about how she might be drousy etc. Thing is she still goes to agility (well we've cut down majorly on her training, and she only does competitions every other weekend as I really don't want to strain her, though she loves it so much) - am I still okay to go with her now that's she's on this or am I better leaving her a while to see how it goes? I'm reading all of the websites on here which are brilliant for information I just wondered if someone could tell me their personal experiences or have anymore info. My appointment in 2 weeks is with my normal vet so I'll discuss all of this with him too.

Thanks everyone :)
 
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There are very few side effects to watch for -- drowsiness being the main one but generally it passes off after a couple of weeks if the dose is right. Your vet may well start you on a low dose and often this isn't adequate so see how things go and if little change, you probably need a higher dose. She should be fine for agility. If anything -- a lot more comfortable. While I wouldn't do really intensive agility with an SM dog who has a lot of symptoms, I know Clare Rusbridge feels that there is no point in depriving a dog of what it enjoys. Leo has never stopped running around and chasing Jaspar when we go to the park and he has lived with gabapentin for almost 8 years now. :)
 
Thanks that's certainly made me relax! She's been put on 50mg twice a day, and we're back in 2 weeks to see how it goes :)
 
I don't think you need to worry. :) That's a low dose unless she is really tiny -- even my little Leo who is only about 15.5 lbs began on the recommended dose for his weight of 75mg twice daily. He really needed 100mg twice daily, eventually 3x and now gets 200mg 3x. But he is pretty comfortable on that -- mild scratching and occasional sensitivity on his side/neck in poor weather. That's over 8-ish years of being on gabapentin so he's been pretty well managed on it. You may find that low level works or may find you need to try a larger dose than that. I doubt she will be drowsy on such a tiny amount. Leo has never been drowsy on gabapentin.
 
Thanks. She's a little bit petite to be fair - she's 6kg (13.2lb?) :) But that's great, really glad to hear that I don't need to worry about long term use if it helps her. Such a relief! xo
 
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