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My 9 month old cavalier diagnosed with CM

cavie3

Well-known member
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
 
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... 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. ...

It is amazing how, in the year 2013, any UK vet could remain so ignorant about treating the pain of CM.
 
You would need to contact Stone Lion centre in Wimbledon. She has done distance consultations in the past. Contact info is right on her website.

If you are int he Uk it might make more sense though to go see her at some point. Or, depending on where you are,there are other neurologists to consult too. It is generally better for a neurologist to be actually able to see the patient, if at all possible. (y)

The treatment approach is generally the same as for SM -- Clare has a treatment algorithm you can download.

Unfortunately, steroids remain the medication of first choice for a lot of neurologists, too!! To me that simply makes no sense when there are other options with fewer potential side effects.

We also have several people here treating CM pain alone who can offer advice and support.

It might be useful to have Clare read your MRI for a second opinion as a lot of the scans where some radiologists/neurologists think there's mild or even no CM, turn out to be misread. A lot do not really have much ability to grade CM. Mild CM though can cause pain, still. The dynamics of pain in this condition are not well understood but there's evidence that CSF flow can vary in dogs (and humans) meaning there are other aspects than simply the degree of CM. Severe CM isn't always correlated to painful SM either, though of course the goal has to be to eventually breed away form ANY CM as it is not normal for an animal to have its brain compressed. :(
 
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?

:hug:

Kate, Oliver and Aled
 
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.
 
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.
 
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.
 
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.

http://www.noahcompendium.co.uk/Als...n_for_Injection_for_Dogs_and_Cats/-60224.html

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.

Pat
 
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.

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.
 
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.
 
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.



http://www.noahcompendium.co.uk/Als...n_for_Injection_for_Dogs_and_Cats/-60224.html

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.

Pat

Hi Pat, thanks so much for your post and the link re vetergesic,
The tramadol and vetergesic (not by injection) was prescribed 4 weeks ago and has been ever since, following the scan report last Friday I was advised to start Kookie on prednisolone, (I haven't done this) reduce the vetergesic gradually(I have done this) and keep him on tramadol for now. The vets intention is to remove tramadol and prescribed NSAIDS after we see how Kookie goes with the steroids. Before Kookie had the scan the vet told me they can't prescribe gabapentin without a diagnosis! Seems to me they don't consider CM as warranting gabapentin so I feel the best option at the moment is to get a neurologist opinion and she has agreed to make a referral to Dr Rusbridge.
 
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Just wanted to say I'm so sorry your Kookie is going through this, and I hope the doctors can help him.
 
'can't prescribe gabapentin without a diagnosis' Codswallop! If there is a delay in being able to get an MRI but the dog is in pain and CM/SM is likely, one of the things some vets do is to prescribe gabapentin and if it works, that in itself is a good indication of the presence of CM/SM or some other neurological problem, because gabapentin is not a general painkiller, it only works on neurological pain. Still, at least your vet is referring you, and Clare is incredible about making time for people, so hopefully you won't have to wait too long for proper advice.

Kate, Oliver and Aled
 
'can't prescribe gabapentin without a diagnosis' Codswallop! If there is a delay in being able to get an MRI but the dog is in pain and CM/SM is likely, one of the things some vets do is to prescribe gabapentin and if it works, that in itself is a good indication of the presence of CM/SM or some other neurological problem, because gabapentin is not a general painkiller, it only works on neurological pain. Still, at least your vet is referring you, and Clare is incredible about making time for people, so hopefully you won't have to wait too long for proper advice.

Kate, Oliver and Aled

That's very interesting to know that Kookie could have been prescribed gabapentin 4 weeks ago, even now he hasn't been offered this despite my asking for a referral to the neurologist. Take today for instance, he is normally such an energetic little pup but he has been listless, restless at times but subdued, not even up for going a walk. I am sure you have experience of this as your little on suffers pain from CM/SM and it is comforting to have support in what seems to be a an up hill struggle to get the help he needs.

Just wanted to say I'm so sorry your Kookie is going through this, and I hope the doctors can help him.

Thanks so much for your support.
 
I agree with what Kate has said about prescribing Gabapentin. Codswallop isn't quite the word I would use, but the stronger term I have in mind would get me thrown out of this list with a resounding thud :slp:

My local vet prescribes Frusemide, Metacam and Gabapentin for my boy who would otherwise have severe neuropathic pain from SM/CM without a problem, although I did give her a sight of his MRI pictures as soon as I received them from Chester Gates. Rebel is over 10 years old and quite comfortable and sprightly since establishing his treatment regime, which is proof enough for me that Gabapentin works well.

If you aren't getting the good working relationship with your vet after receiving advice from Stone Lion, then change the vet. End of.
 
I agree with what Kate has said about prescribing Gabapentin. Codswallop isn't quite the word I would use, but the stronger term I have in mind would get me thrown out of this list with a resounding thud :slp:

My local vet prescribes Frusemide, Metacam and Gabapentin for my boy who would otherwise have severe neuropathic pain from SM/CM without a problem, although I did give her a sight of his MRI pictures as soon as I received them from Chester Gates. Rebel is over 10 years old and quite comfortable and sprightly since establishing his treatment regime, which is proof enough for me that Gabapentin works well.

If you aren't getting the good working relationship with your vet after receiving advice from Stone Lion, then change the vet. End of.

Thanks FloSin,

It's great to know that others understand the problem of getting the right help for Kookie and I am grateful for all the advice from others who have gone down this road. Kookie suffered quite a bit of discomfort yesterday and during the night, with many scratching episodes, we had difficulty with grooming especially round the ears and eyes so he is clearly uncomfortable. Following the advice on here I rang the vet this morning informing her that Kookie has had another painful episode and asked if she can prescribe gabapentin whilst we await the neurologist's input. The vet said she will send the referral of today to Stone Lion, they won't have gabapentin at our local surgery as the drug is expensive but she will try to organise this for pick up later today. I don't want to make any rash decisions regarding the vet but if I encounter any problems following Dr Rusbridge's input then I would certainly consider this.
 
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So sorry to hear your going through this with such a young pup, just when he should be running riot too.

If you do need to end up seeing a Neuro in person, I can assure you that Glasgow as fantastic, I can pick up the phone at anytime, or drop an email and get a very quick response. Both of mine get treated there, and one has also visited the pain clinic there to get further help in settling him down. Finding the right meds can be tricky, but once the right ones are found it can make a huge difference to how they behave.

And I wouldn't think twice about changing vets if you have any concerns, I had to switch vets as they didn't believe my first one to be diagnosed had SM, or that she needed a referral! Needless to say we no longer visit that practice :)
 
So sorry to hear your going through this with such a young pup, just when he should be running riot too.

If you do need to end up seeing a Neuro in person, I can assure you that Glasgow as fantastic, I can pick up the phone at anytime, or drop an email and get a very quick response. Both of mine get treated there, and one has also visited the pain clinic there to get further help in settling him down. Finding the right meds can be tricky, but once the right ones are found it can make a huge difference to how they behave.

And I wouldn't think twice about changing vets if you have any concerns, I had to switch vets as they didn't believe my first one to be diagnosed had SM, or that she needed a referral! Needless to say we no longer visit that practice :)

Thanks so much for your post and the recommendation re neuro in Glasgow and glad to hear that they have been fantastic with your two. That is certainly encouraging for the future should Kookie need to be seen in person. I feel the biggest hurdle has been having it recognised that CM alone can cause considerable pain in some cavaliers. I am thankful therefore that Kookie has been referred now by the vet to the neurologist who can make the final scan interpretation and recommendations.
 
I rang the vet this morning informing her that Kookie has had another painful episode and asked if she can prescribe gabapentin whilst we await the neurologist's input. The vet said she will send the referral of today to Stone Lion, they won't have gabapentin at our local surgery as the drug is expensive but she will try to organise this for pick up later today.

Try and film what your little dog does, it may help with the assessment A picture is much better than words.

Gabapentin is not that expensive & you do not need to buy it at the vet. It is a human drug so she can give you a private prescription & you can get it from any pharmacy. A lot of us use Boots or Tesco.
 
What you say about Gabapentin is so right Margaret. Because I have two long term ill Cavaliers and Rebel's age, the partners at my vet's decided to charge Rebel's meds at cost with nothing added on for profit. This means that I pay very little, something like about £20 a month for everything he takes. They do of course charge £25 or so for his 3 month consultations though, but that includes his 6 monthly blood tests. They also send me monthly invoices, which means that I can pay by CT at a time to suit me.
 
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