Looking for advice

[fisher]

The fluid tablets were for the fluid build up on her brain apparently?? This happened so quickly we were shocked that 2days before we had a healthy puppy and now we were being told that she would need to be put down the vets primary advice was to take her back to where we bought her and swap her for a new one!!! But then he finished the sentence with we all know what will happen if you do!! By this point my partner was in tears thinking we had to put her to sleep and now she is back to normal imagine if we did she is a well loved part of the family and life would never be the same without her. We are however worried if this reoccurs so far we have seen two vets and one definitely diagnosed am and the other suspects sm my partner argued that it may be an ear infection affecting her balance but the vet just lifted her ears up looked at the creases but not inside with any kind of medical tool or took any swabs I do hope we find a vet experienced with cavaliers as at the moment were beginning to loose faith in vets as the seem to blanket diagnose all cavs regardless of age of symptoms

[Karlin]

It is actually not common at all for most vets to assume a dog has SM -- more often they know little to nothing about SM and miss the diagnosis in dogs that do have it and/or insist it cannot be SM (the experience that most people I've come across with SM cavaliers have had). Unfortunately, there is a very high incidence in the breed, and a much higher incidence in cavaliers bred from parents who were not MRI scanned and where the breeder didn't use the SM breeding protocol. Most cavaliers will eventually have SM I am afraid (70% at least is the current estimate by researchers) -- but most of those will either not have symptoms and lead a normal life or have mild symptoms. I have had five cavaliers and three have SM (on MRI). The general breeder experience when they scan seems to be about 50% of cavaliers they scan under 5 having SM (numerous breeders have made this comment on breeder discussion sites).

One thing that is very difficult, is for any of us to give a definite response, as your vets have actually seen your puppy with this problem -- whereas we haven't, and people can describe symptoms in many different ways. If you had two vets feel suspicious, then perhaps there is indeed more to look into -- however, as noted before, as you describe it this doesn't sound like SM and would be unlikely in a puppy that age. So perhaps some other issue.

The reason for the frusemide is that it is a diuretic and helps lower the pressure of the fluid (CSF< cerebrospinal fluid) circulating around the brain and into the spinal column, which sometimes will help SM dogs. I don't know if the diuretic affect would actually have much adverse impact on a dog with diarrhea or mild dehydration but possibly it could.

The prednisone would be to help pain but generally it is something only given when other medications do not work, or to give immediate help for painful symptoms. It doesn't sound as if you were seeing pain.

The vet(s) you saw do sound pretty callous but the concern would be that they both felt they saw something that may be a serious problem and possibly neurological. If it was just one, that would be one thing, but you are saying two checked the puppy and thought there was the possibility of SM, which is a bit more of a concern (not necessarily of SM but something beyond this being a weak puppy getting over a virus; a puppy would have to be really sick to lose control of their legs for a couple of days, so this to me still sounds more involved, one way or another). Did the vets actually tell you that you needed to consider putting down your puppy right away? You hadn't mentioned this in your initial post? That would be pretty extreme with any illness, especially one not yet diagnosed!

By the time an ear infection gets so bad that it goes to the inner ear and affects balance (which is considered an emergency and can cause permanent deafness) you should have seen very obvious, persistent signs of an initial infection such as persistent ear scratching and head rubbing and head pain/ear sensitivity (yet these can be signs of SM as well -- making it hard to diagnose on basic symptoms alone and impossible hard for vets to do without an MRI). An inner ear infection would be unlikely to clear up so fast or with a short term dose of antibiotics or would recur (usually several weeks of antibiotics along with other treatments are needed; also middle and inner ear infections would be really rare in a young puppy according to vet manuals). See http://www.petplace.com/dogs/otitis-...ogs/page1.aspx

However again -- I cannot understand how they would not then give a menu of options to you. One option would indeed be to return a puppy right away rather than be faced with large vet bills and the difficulty of having a dog with a serious health issue and this is one option that any honest vet would have to suggest, but it should never be the only option and I can't believe they thought there could be something as serious as SM yet didn't steer you to the next step, a referral to a neurologist. Vets do not have the ability to diagnose this condition in most cases as they don't have 1) MRI machines, which costs millions 2) the training to read MRIs for this complex condition and 3) the neurology training to then advise on treatment. Your old vets really do need more education and would be best steered to Dr Rusbridge's website as it has much detailed info for vets.

Most vets are good on cavaliers in the UK as the breed is so common. I would just ask around for recommendations on a good, solid general vet practice. A good vet would have given you much more information on possibilities and suggested a referral if symptoms did not go away or if they return.

As you have a much happier pup right now, I think your focus should be to ask around and find a vet practice you like. Angela would be a good person to email. If there is a more serious problem, the things you saw will recur and at that point, I'd get to your new vet and then go from there. It is always helpful to video any odd or unexpected symptoms for a vet which is easy to do on phones these days.

I would certainly explain to your new vet what you saw and went through just so that they know there was some strange episode that remains unexplained. If there is any chance at all of a suspected ongoing ear infection especially an inner ear problem, I'd immediately get her in to the new vet of your choice.

With neurological problems, symptoms can come and go so you will want to at least keep that in the back of your mind and act if you see anything recur. Hopefully whatever it was, will now be over.

[pippa]

So sorry you are having this problem, when as others have said you should be enjoying your new puppy...If she is well and active now just enjoy her and keep a close eye on her while looking for another vet. I think it's very unusual for two vets to assume SM with no diagnostic tests at all and a lot of different reasons why a young puppy especially one who has had a bug of some sort, could have been acting this way.

As Karlin says keep the neurological idea at the back of your mind and keep vigilant for further episodes like before. Not sure if I missed it but is she still on medication and did either vet see a problem or are they going by what you have described to them?

[pippa]

I just posted a reply to a post on another forum and while posting thought of your post, something to keep in mind

"my Gus has degenerative disc disease in his back. My vet mentioned SM when Gus was first having problems and when Pippin was having seizures aged 5 BUT said we should exhaust all other possibility's before we jump to that conclusion and then mri for SM. He felt at the time that too many people were assuming every problem with Cavaliers was SM and I feel I have to agree to a certain extent. SM is clearly a big problem but there are other conditions which I worry could be overlooked. As I said Gus has Disc disease and Pippin was having mild/strange seizures and refusing to jump up or climb stairs which turned out to be epilepsy. We did various tests and x-rays before we came to that conclusion. Neither of them needed an mri to see if it was SM and are doing well on meds.
If I were worried and seen no change I would of course have asked the vet to mri, which he probably would have done anyway, but I do feel if my vet and I had just thought SM straight away we may have missed what it actually was."

[Karlin]

We did various tests and x-rays before we came to that conclusion. Neither of them needed an mri to see if it was SM and are doing well on meds.

But again: if no MRI was done, SM way well be part of the problem and just be masked by whatever medication regime is being used. Any painkilling medication will help with SM symptoms too, and all the other kinds of scans will not supply any information that would help determine SM. If the meds are helpful then that is really good! And in that case I wouldn;t be pursuing an MRI. But the meds may well be helping with existing SM.

I've yet to encounter a vet who thinks every problem is SM and most often it's the opposite -- many owners have a very hard time convincing their vet that they think their dog needs an MRI even when it does turn out the dog has symptomatic SM, and given how few pet owners know anything about it at all, I cannot imagine any significant number of cavalier owners turn up thinking everything is SM (for example when I would routinely go through health issues with people adopting a rescue, some had heard of MVD yet with no awareness at all of the high degree of it in the breed, and almost no one had ever heard of SM). I think a lot of vets will gradually change their views as they become better educated about this disease (a lot are actually incredibly dismissive and can be quite rude -- I've come across a lot of those). When you have a 70% level of affectedness with SM and probably at least 95% with CM in the breed -- CM being a condition that causes more severe pain in humans and is more common than SM -- I think vets will need to start to question whether many ailments are not at the very least, made worse by underlying SM. The chronic headaches of SM may well underlie 'quiet' dogs and some problematic behaviour issues in the breed as well.

Given the scope for enduring, widespread pain with the condition, I think it's a lot better to err on the side of checking for SM at least with clinical trials of medications than to assume it isn't there, if there are suspicious symptoms and no absolutely clear alternative cause for a problem. If 70% have this condition by age 6-7+, then we all have to accept that for most dogs, it IS there, eventually. The level of affected offspring was 50% for dogs where one was scanned and one not scanned -- even that level of uncertainty tips the likelihood of a cavalier having SM to i in 2, incredibly high -- and most breeders of all sorts still do not scan.

With a puppy, the chances that it will show symptoms at 15 weeks are very small -- but as many here will testify, it is possible. With this little girl, the staggering and imbalance lasting for quite some time and then a sudden recovery are by any measure, strange and not easily explained. If two vets thought there was a possibility of SM then even though I sure wouldn't guess that to be the case on the basis of the symptoms described here, I would still remain very vigilant and want a thorough check up by a different vet who knows what happened, and then would be watching for any signs of further problems. I can't imagine most vets confusing a weak, ill puppy -- which they will see all the time -- with a puppy where something else is going on that is causing an inability to balance or walk. A two-day recovery to back to playfully normal from such a severe state is also very strange. The best advice I think is -- have a new vet check her out again, and keep a very close eye on her.

[Karlin]

One other thing that could cause short term problems would be ingesting some sort of poison -- I'd check the house and garden top to bottom. Slug pellets, cocoa mulch, any kind of chocolate, raisins, grapes, cleaning products -- any of these could cause poison symptoms and might result in a fairly swift recovery if the amount eaten was small enough not to make her too severely ill.

[clackdish]

hey andrew sorry to hear about the problems you are having ,im just down the road in middlesbrough but we came up to the croft vetinary practice in cramlington for two of our pups to have double patella ops and i cant speak highly enough of them ,dont know if you found a suitable replacement vet yet but they are worth a look imo ,the people we spoke to while we where there all spoke very highly of them and we even met someone who had travelled from harrogate to let them do a leg op on their dog ,their own vet recommended them as they felt they couldnt do the op required as well as croft ,malcom ness is based there and he comes highly recommended ,hope you find someone that gives you the help and advice you need
all the best
Andy

[fisher]

sorry i havent been on for a while but had some problems, but just to keep you updated belle has been completely fine, she has shown no symptoms of sm and what ever was wrong with her only lasted for 3-4 days.

thank you very much andy we will try them out, that is not too far at all for us

[pippa]

Good to hear