Andre, my almost 6 year old Cavalier (and love of my life ) had been showing intermittent signs of pain for the past year. The symptoms would come and go - most noticeably he'd be reluctant to jump on the couches and beds but he'd resume again after a few days. Also, he seemed less excited about playing fetch - which he usually LOVES - and would instead take the ball and go sit in the corner whenever I tried to play with him. I took him to the vet last November and they found a hernia (he'd previously had a hernia surgery that hadn't healed properly), so they operated last December to repair his abdominal wall in hopes it would fix his pain. He had 3 weeks of rest and a few months of no symptoms. Then slowly symptoms started returning. Again, this September, I took him to the vet and she did x-rays and a complete orthopedic exam and found nothing, so prescribed a week of Rimadyl. That helped and he was fine again for a couple of months - jumping, playing, and generally very happy.
Two weeks ago, symptoms returned very suddenly and they were much worse than before - he was in very obvious pain. He wouldn't lie down and soon started yelping and screaming when we pet him. I made an appointment with my other Cavalier's neurologist right away.We had to wait two days for the appointment with the neurologist and those were two of the longest days of my life. Andre had a few TERRIBLE pain episodes and refused to walk, even to get up and go to the bathroom. I stayed up with him most of the nights, talking to him, trying to calm him down. When i dropped him off for the MRI, I was praying it was disc problem and not SM.
Unfortunately, the MRI showed: PSOM in both ears, mild SM, and 3 mild bulging discs. Yikes! He has two syrinxes, but the neurologist said they are fairly small. She was confident his current pain was due to the discs, but felt that the SM was playing a role by making it much more painful.
He is now on 5 mg Prednisone 2x per day(this is temporary to relieve the swelling in the spinal chord from the bulging discs), Gabapentin 100 mg 3x per day, and 10 mg omeprazole per day. He had zero symptoms of pain as soon as I added the prednisone. He's supposed to be fairly inactive for 4-6 weeks to heal the discs so I make him stay in his bed for most of every day.
The thing is...... I would have never thought to get Andre MRI'd for SM if he hadn't had the disc issue. My other cavalier, Harlow, who has CM/PSOM, face rubs & scratches several times a day, scoots, and yelps if you touch her wrong on her belly. I always thought she'd be my SM dog. An MRI at 2 1/2 years of age (when she had all these same symptoms) showed no syrinxes (although who knows if she's developed one by now). Andre has barely shown any symptoms other than the reluctance to jump and play over the past year, and I'm not sure if those symptoms would have even existed if he hadn't developed the bulging discs (since the symptoms would always resolve with some rest). He maybe scratches his neck a couple times a day for like 5 seconds each time and every so often (i noticed it once every week or two) he'd scoot. Also some minor yawning, groaning when we scratched his ears, and some rare air licking (any of which could have also been PSOM related). He also never liked it and was extremely resistant when we brushed him near his tail area.
The thing I'm trying to reconcile in my mind is putting a pretty healthy dog on drugs that will have very negative effects on his health.
Gabapentin I know is a generally safe drug, and Harlow has been on it for a few years with no side effects, so I have no qualms about giving it.
The Prednisone is temporary so, while it can have a lot of side effects, he was in so much pain that i'm ok with giving it for now.
What is really worrying me is the omeprazole. I know I need to give a CSF reducer. Even though his SM is mild at almost 6 years of age, if I don't give a CSF reducer and one or both of the syrinxes grow, I know I'll regret it forever. In a way, I'm probably lucky that his disc pain made me catch the SM now while it's still mild and I can slow the growth. But I'm just so worried about the side effects.
Short term side effects so far have not been great: Yesterday, four days after starting the omeprazole I woke up to him vomiting orange bile in my bed at 5 am and he's had an acid reflux coughing/gagging thing going on ever since. He also has loose, mucousy stools. I stopped the omeprazole last night and have been giving him slippery elm and also gave him apple cider vinegar before his lunch today and he seems to be better, but I just feel so sad that I'm taking a dog that is healthy in many ways and giving him something that makes him unable to digest his food and might make him much sicker in the long run. It COULD just be that the combo of the prednisone with the omeprazole is too much and once he's off the prednisone he'll do much better on omeprazole only, so I guess we'll see.
Long term side effects of omeprazole are even more worrying: I'm worried about reduced nutrient absorption, potential liver and kidney problems, and changing the pH of his stomach so yeast and bad bugs can grow, amongst other things (those other things being stomach cancer)
I've read through many of the threads on these forums and I know cimetidine is also an option that might have less side effects, but since it also reduces stomach acid, wouldn't it have the same long term side effects of the omeprazole that I listed above? Why is it better tolerated by many cavaliers on this forum? Strangely, when I was picking up the omeprazole presciption (I got a prescription so I can get it in 10 mg capsules rather than splitting 20mg tablets), I asked the pharmacist about cimetidine vs omeprazole and he said cimetidine has FAR more drug interactions than omeprazole and in his opinion was much worse in terms of side effects.... so now I'm super confused.
For people whose cavs are on these CSF inhibitors, is there anything you do to counteract the side effects? I would LOVE to know of ways I can protect my baby from the SM while also keeping the rest of his body healthy for as long as possible.
Some ideas I had were:
*replace the missing acid by adding betaine HCL to meals (for humans this is contraindicated if the person is also on corticosteroids or NSAIDS so this is off the table for Andre for the time being. Also, it seems like there's a lot of trial and error in getting the dose of supplemental HCL right, and if you give too much it can cause lots of discomfort)
*as alternative to HCL, maybe apple cider vinegar with or before meals (I tried this today and it helped his coughing/gagging but I'm not sure if it actually helps him digest his food and absorb the nutrients or it just masked the bad side effects he was having)
*digestive enzymes with meals
*prebiotic and probiotic supplements and/or kefir/yogurt that has live active cultures
*digestive bitters with meals (these are supposed to promote the body's natural HCL production so I'm wondering if they would be useless if the stomach acid is turned off at the cellular level by the omeprazole or the cimetidine)
*adding in vitamins: especially B12 and other B vitamins, also minerals like magnesium, calcium, zinc, iron, etc.
*extra virgin coconut oil every so often to protect against bad bugs and yeast
*maybe some liver support: milk thistle, etc.?
By the way, just one month before all of this, Andre was diagnosed with a grade 2 murmur (sooooo many diagnoses to deal with all at once ) so I feel it's even more important to keep his overall body healthy.
Any suggestions/comments would be sooo appreciated and I think they would be useful for others since so many poor cavaliers unfortunately have to be on these drugs.