Newbie and very worried....

hello everyone, i am Jayne a Brit living in Holland.
I have a 7yr old Cav called Charlie....and am worried he has started with syringomyelia.
It started 2 days ago, he was fast asleep and woke up with a start and did the snort that lets me know he needs to catch his breath, so i bent down to hold his nostrils together to help him, but before i could do that, he kind of lay flat and yelped and yelped and yelped, like he was is excruciating pain. In panic i had no idea what to do, so just called his name, he sat up and the yelping stopped. After that he was slow, like he didnt want to walk at a normal pace. So we rushed him to the vets and i instantly thought it was this SM, as i had read up on the SM condition and noticed that just lately he had been lip licking alot and air scratching around his ear on the left. Anyway the vet said he had a massive ear infection, syringed and washed his ears and gave him a pain killer injection and some ear drops. When he came home he was worn out and slept but when he went to get up he yelped, i am not sure if it was the actual getting up or it was raising his head but i think it was the latter. As the day went on he began to yelp more, so we took him back to the vet, who admitted he knew nothing about SM, but did some more work on him, he pulled his legs around, xrayed his spine and found he had a slight problem there but not enough to cause this much pain...he pushed his spine up and and his head back, to the side and then the other side, and Charlie never made a sound. So he concluded it was the ear infection.
So later that evening around 9pm he had been asleep and again tried to get up and yelped and yelped and yelped again in agony, but once up was fine, we also noticed he couldnt shake his head as he was trying to do so, but once he tried to he stopped immediately. So we called the night vet who admitted he knew nothing of SM, but asked me called back in 10mins while he went online. We called back and he said maybe a water tablet would help in case he had some fluid around the area of his head and said in his mind he thought we were right in self diagnosing SM, but when we told him he was 7 he then changed his mind.
So 2 days on....Charlie is running around like a puppy, sleepy but i think its the tablets as the new vet also put him on a tablet that stops the nerve endings feeling pain.
I have no clue what to do...is it his ears....is it SM? here in Holland i must admit the vets are not the best ive ever seen. To get a MRI will cost me 4000 Euros and i have to go to Belgium, which i cannot possibly do.
We have another dog, a Musterlander, who and the same time as Charlie starting iching and biting themselves and our normal vet treated them both for allergies, and we all thought it was something to do with the garden as it was both of them, but Charlie seemed to bite more, but that stopped with both of them a couple of weeks ago after numerous coursed of allergy stuff.
Are the pain killers just masking the SM or does he just have a massive ear infection....can anyone help me...is he too old at 7 to start with this condition?
Much appreciated
Jayne

I have no experience with SM I just want to offer support. I'm sorry you and Charlie are dealing with this I am sure you are worried sick. I do know the only way to diagnose SM is thur MRI, but the treatment is painkillers (someone correct me if I'm wrong) So painkillers masking the symptoms is a good thing. I'm glad he is feeling better now. But I think your going to have to wait to see if he improves as the ear clears up. Keep us posted.

Melissa

I'm sorry you are dealing with such worries, especially without vets who know what might be going on. This is however a specialists disease and most vets internationally don't know much about it (one reason why it tends to be misdiagnosed as allergies and ear infections often for many years).

Dogs of any age can start to show symptoms of CM/SM and actually it is probably more likely to be seen later on eventually in many dogs who show no signs earlier on. It is estimated from large research samples that probably 70% of cavaliers have a syrinx by the time they are the age of Charlie. Dogs likely to have more severe cases tends to show symptoms earlier, under age 2.5 or so; but any dog of any age can have problems with this horrible and frustrating disease.

It is really impossible to tell you what might be the cause of this as none of us have that expertise and of course, we cannot even see Charlie. However, a massive ear infection could cause the pain signs you see and it would take a couple of days to be addressed by medications. Also, I assume the other vet might have put him on a diuretic (water pill) of some sort which can help the pain of CM/SM. Painkillers also will mask the pain of SM -- most of us with SM dogs (and I have three) have them on painkillers of some type, or pills which basically work to decrease pain in some way.

The only way you can get a proper assessment is to see a neurologist. I would want a clinical exam rather than MRI in your case where the cost is prohibitive. A neurologist can tell you pretty quickly if there are neurological issues that are likely connected to SM.

There is also a degree of knowledge in the Netherlands on this issue. A number of breeders have been MRIing for years and working to reduce incidence of the condition. I had thought there were Dutch centres that are a lot less than 4000 euro for an MRI.

The Dutch cavalier club might be able to refer you somewhere or someone here might have some ideas.

If the symptoms have been addressed now, I would wait and see if they recur -- if so, then I would make an appointment with a neurologist familiar with SM and explain you want a clinical exam.

There's a huge range of SM info at neurologist Clare Rusbridge's website here:

http://www.veterinary-neurologist.co.uk/Syringomyelia/

as well as at Rod's www.cavalierhealth.org and my www.smcavaliers.com

You can get names of Dutch breeders who have MRI scanned and might have some ideas for you, here (just google the breeder or contact the Dutch club for contact info, if the club itself cannot give you info):

http://www.thecavalierclub.co.uk/health/mri/pick_view_mri.php?id=6

The UK club website lists this Dutch centre for scans:

Erik Noorman
Dierenkliniek Den Heuvel
Oirschotseweg 113 A
5684 NH Best

Tel: +31 (0)499 374205

Email: [email protected]
www.dierenkliniekdenheuvel.nl

And Dr Rusbridge has this info -- might be a good starting place to contact knowledgable breeders in the Netherlands:

www.cavalierkingcharlesgilde.nl/. Not a Breed Club but a group of 5 Dutch breeders who were among the first to screen their dogs for Syringomyelia using MRIs. Dana Schuller-kuyper was the first breeder to arrange ‘MRI screening days’ for cavaliers.

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Thank you Karlin, weve contacted the place in Best and we go for an MRI on Aug 10th, so then we will know for sure...again thank you

thing we are abit worried about is the duretic...the vet has given Charlie 60mg a day of furosoral, i think that is huge for a dog...could this be correct or as my vet doesnt have a clue is he just guessing

That sounds very high, yes -- but I see that it is described as 'a derivative of frusemide' so maybe doses would be higher. However this is generally not recommended anymore as a CSF inhibitor -- cimetidine or omeprazole (or a few others) is generally preferred as frusemide can be hard on the heart (unless cavaliers are in serious heart failure in which case it helps, oddly). It used to be regularly recommended -- this has only really changed recently.

See http://www.veterinary-neurologist.co.uk/part4.htm

You can get cimetidine and omeprazole over the counter in most countries. There's a treatment algorithm with dosage recommendations on Clare's website. But if you are seeing a neurologist on the 10th, then I probably wouldn't worry too much as it is only a week -- or I'd ring the neurologist's office and explain he is on this medication and ask if he should be left on it or left on that high a dose.

In your shoes, I would talk to your vet about taking him off frusemide and on to cimetidine (which has very few side effects). Most cavaliers would take 50mg 2x or 3x. The tablets usually come in 200mg size and you can cut them using a pill cutter. You can give your vet Clare's treatment algorithm. Her PhD is actually from the Netherlands.

Cimetidine in the commonly available form of Zitac comes in 100mg tablets that are very easy to break in half (they have a dent in the middle).

Hope you get Charlie sorted.

Kate, Oliver and Aled (both with SM)