Best of luck Brian on this visit.
Daisy isn't taking anything yet is she? If she has a cough she might be at the point or close to it for starting medications if it means her heart is beginning to struggle a bit on its own and not clearing fluid (maybe she has a mild cough from some other illness at the moment?). Simon Swift will know the right approach for her.
I am not sure I understand the earlier talk on gabapentin -- was there actually a serious consideration of removing Daisy from gabapentin and not giving her Lyrica as an alternative?Or was it only to take her off if she went on Lyrica? I assume the former?
Personally, I would not think of Lyrica s a 'last resort' or using up options -- it is a newer and more efficient version of the old gabapentin, basically and thus would for many many dogs be a better and more efficient drug which isn't needed in as large a dose or generally as many doses -- so is also easier to manage. I'd never think of moving to Lyrica as a case of running out of options if it gives a better response! -- and as others have said, many regret not moving their dog much earlier to Lyrica simply because it is a more effective drug for their particular dog's case of CM/SM. It's like deciding to suffer along on a lower dose painkiller like aspirin when there are many more effective drugs available. There are lots of options to add other drugs alongside Lyrica as well -- hardly a last option. I would really recommend trying it if gabapentin is giving a so-so response now. At the dose of gabapentin Daisy is at, she would pretty much be at her maximum for her size.
Also may I gently suggest that (from experience) I really think it's better not to focus on what might seem 'outward pain' and not mistake that perception as meaning a dog is or isn't "in pain" -- with Daisy, if she needs as high a dose of gabapentin as 200mg 3x -- what my Leo is on and the highest he can go -- then she has significant pain/discomfort of some kind causing her to need that level of neurological painkiller. Leo too is like Daisy in that he mostly just scratches, is very active and outwardly happy -- but I have grown used to seeing that he does have periods of greater discomfort and SM is clearly a burden and he has a significant syrinx now though it doesn't stop him running around or enjoying chews/toys/travel (having just come back from Yorkshire (Laverock Cottages for our third time
)and 4-7 mile daily hikes!).
Scratching may not seem 'painful' as an outward response, but dogs are scratching for a reason. As humans say they most commonly experience terrible headache and intolerable skin-crawling sensations (which in my book would qualify as enormous discomfort and pain if I had to live with either) then I think it is hard to assume she is not experiencing pain or significant discomfort? Anyone with neuropathic pain will confirm the pain can be very difficult to tolerate yet not outwardly obvious or expressed and they just get on with life as they have to (there's good evidence with the dogs that they just grow to live with slowly increasing levels of pain too). I know Nicki amongst others -- as someone with significant neuropathic pain -- has said this so many times and the testimonial Tania posted from a Chiari sufferer also underlines this point. I'd aim for relieving her discomfort with whatever works best right now. I would not postpone for long, using something that could make her a lot more comfortable if it is an option, not least as none of us knows how much time our dog has left (as I know having one right now with both SM and MVD -- either could advance rapidly at any time). It would be distressing to find a dog might have done much better on a dfferent medication approach but not have used it because it was being "saved up" for a future that the dog ends up not having.
I really advocate giving the best possible treatment as it is needed.
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None of this is easy and it is hard to deal with both afflictions at the same time. :flwr: