5th March 2013, 07:25 PM
My 9 month old cavalier diagnosed with CM
He is only 9 months old, started to show signs as early as 5 months, this seemed to come and go, crying out without obvious reason, didn't like to be lifted or handled and he was displaying some very odd behaviours like head rubbing, ear scratching, sudden movements like chasing tail and biting his back legs. These episodes became more frequent and from doing research I realised he was showing many of the classic symptoms of SM so I had him MRI scanned. There were times when he seemed to be in so much pain that I couldn't touch him as he was reacting aggressively. After discussing with the vet Kookie was prescribed tramadol and vetergesic and an MRI was booked. It was an anxious wait of 3 weeks for the scan and results. The report from the radiologist states that Kookie has moderate CM with no visible syringomyelia at the moment however he stated that this could develop in later life, stating also that most cavaliers with CM do not show clinical signs. I was very relieved that there were no visible syrinxes. The vet has advised me to reduce the pain medication and he has prescribed prednisolone, thanks to this site and links to Claire Rusbridge site I have found that this will not be the best treatment plan. Can anyone here advise me if it is still possible to have a telephone consultation with Claire and if so how to contact her? I would also appreciate any advice from others who have knowledge of CM pain in their cavaliers. These last few weeks have felt like a roller coaster
Last edited by cavie3; 19th March 2013 at 12:45 PM.
5th March 2013, 11:24 PM
It is amazing how, in the year 2013, any UK vet could remain so ignorant about treating the pain of CM.
Originally Posted by cavie3
5th March 2013, 11:56 PM
6th March 2013, 10:33 AM
I'm sorry you have had this diagnosis and that your boy is showing such signs of pain. I would second Karlin - you need to see a neurologist (think consultant rather than GP vet) and get a second opinion on the scan. You don't say where you live in the UK, but if London is too far, there are excellent neurologists with great experience of CM/SM in other parts of the country - Glasgow University, Chestergates on the Wirral, Cambridge University Vet School, and others.
My Oliver does have a small syrinx but most of his problems seem to stem from his CM, which creates seriously dilated ventricles with resultant headaches and light phobia, though he has never had your boy's obvious pain (as Rod says, what is your vet thinking of, reducing his pain medication?!). CM is not to be taken lightly, and researchers are increasingly recognising that it can cause as many problems - and as much pain - as a syrinx. The radiologist may say 'most cavaliers with CM do not show clinical signs' - I would amend this to say 'do not show recognisable clinical signs' because some of the signs can be very easy to miss if you don't know what you are looking for. Oliver has squinted in strong light, been a restless sleeper, and head rubbed ever since I had him at a year old (he's now 11), but no one recognised these as signs of discomfort (head-rubbing is just one of those rather cute things Cavaliers do - but other breeds of dog DON'T do it, so in Cavaliers it's saying something). With most Cavaliers having CM, how many of them are living in discomfort, if not actual pain, because their owners don't recognise the signs?
Kate, Oliver and Aled
6th March 2013, 02:52 PM
Thanks so much everyone for your comments and very welcome advice. I have printed Claire Rusbridge's treatment algorithm and I see the current treatment plan for Kookie is certainly not the best way to go (introducing steroids, removing current pain meds gradually and introducing anti inflamatories). I live in the North so I guess Glasgow would be the nearest for me however I have emailed Claire at the Stone Lion Centre to find out if it is possible to give a 2nd opinion on the scan and a telephone consultation. I am trusting my gut instinct on this as I have felt for some time that something is just not right and at the very least I need to ensure he is comfortable and out of pain. I did start to reduce the pain medication and today he is having a very bad day so I will increase this again, I haven't started him on the steroids, whilst trying to get a neurologist opinion.
6th March 2013, 03:30 PM
Glasgow has had some good people there, so that's a good place to start as it's close to you.
I def would not reduce the pain meds.
Once you have an opinion, it is very well worth politely returning to your vet and talking through the diagnosis and treatment needed. It will help them to consider that option f other cavaliers present with similar difficulties.
In memory: Lucy
Cavalier SM Infosite:www.smcavaliers.com
6th March 2013, 03:32 PM
Forgot to add that one study concluded that about 25% of cavaliers in the group with CM alone showed pain from CM, so 1 in 4 is a considerably higher rate than the radiologist may be aware of.
In memory: Lucy
Cavalier SM Infosite:www.smcavaliers.com
6th March 2013, 04:57 PM
No one has mentioned this - but have you considered asking for a prescription for gabapentin as that is the main drug used for CM/SM pain? I presume that the vetergesic injection is something that he is not receiving on a regular basis but was just given initially, and he is only taking the tramadol at this point? I definitely wouldn't want to give vetergesic on any kind of regular basis as this is a pretty powerful opioid. This is not a drug that is commonly used for CM/SM pain.
Tramadol alone isn't very effective either for CM/SM pain. It is generally used to augment gabapentin or pregabalin.
You said that the vet is introducing NSAIDS - has that started yet and which one is under consideration?
I'd really recommend that you consider adding gabapentin asap rather than waiting for a neurology consult given the amount of pain that you describe.
6th March 2013, 05:51 PM
Thanks Karlin, I had a reply from Lions vets and they have advised that it is possible for Claire to look at the scans and offer a telephone consultation, she does however work by referral. I have rang the vet who has agreed to submit a referral for Kookie.
Originally Posted by Karlin
6th March 2013, 05:57 PM
Those statistics are very high, once I have the neuroligist recommendations I will as you suggested in your previous post talk through diagnosis and treatment with the vet.