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Thread: Chiari and Syringomyelia

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    Default Chiari and Syringomyelia

    I have 2 Cavaliers, one with MVD and one with painful Chiari/SM. She has been doing pretty well on pregabalin and omeprazole for over 2 yrs. Suddenly her symptoms worsened last week. It is so scarey to hear them scream in pain and be so helpless (I have to say week prior she had increased scratching). I took her right away to our regular vet as I had to wait to see the neurologist. She was started on prednisone 2.5mg 2x day and tramadol 25mg 2-3x day plus a shot of dexamethasone. I increased her pregab to 3x day. Steroids make them pant sometimes excessively- so make sure to hydrate your dog. She was about 70% better for few days and now she's back to the screams and cry anywhere from 1-3x day. She is scheduled to have decompression surgery this Wed. at Long Island Veterinary Specialists who specialize in this horrific disease. Please Please Please if the scratching persists despite meds or any signs of change/worsening of symptoms, get an MRI. My neurologist was so vague about how one can have a dog w/ severe symptoms and have a good MRI and have mild symptoms with a horrible MRI- so I figured if there's no rhyme or reason other than to exclude another diagnosis, then why put my dog under general anesthesia. Well it turns out, my dog has severe Chiari/SM. The surgery according to the neurosurgeons at LIVS is 96% successful now with fat transfer over the mesh (they will be publishing their new studies very soon)-- their oldest procedure using this technique was done in 2009 and the dogs are doing great to this date. Had I known this, I would've seeked this treatment months ago. Please don't wait until your animal is in excruciating pain. The other thing that was never told to me is that this disease is inevitably progressive- degrees are variable. You have to weigh you personal choices and the quality of life for your pet. Thank God I have Trupanion insurance on both my dogs. My other dog went into mild CHF on Valentines this year and is doing great so far with Vetmedin and Enalapril. I love this breed to pieces but it's devastating to have these illnesses without access to good medical care. I pray my thread helps others.

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    I'm so sorry to hear how much your girl is suffering. I do hope the surgery will give her real relief. Both of my Cavaliers had CM/SM but fortunately never had the screaming pain (or even much scratching), just headaches and tenderness in the front feet. But I was reminded that it is a progressive disease when my 13-year-old Oliver started getting more symptoms - some headaches in spite of medication that up to then had worked brilliantly, a bit of neck scratching, more painful front legs. If he had not had to be put to sleep in February for a different reason, he would have had to go onto Lyrica, and I have no idea where we would have landed up if the CM/SM had continued to progress. So having it mildly as a young dog is no guarantee that it won't get worse in old age. It truly is a horrible disease.

    I'm also glad that your dog in heart failure is doing well - long may it last. MVD is such an individual disease - some dogs in CHF live virtually normal lives for several years, others (like my other Cavalier who died of heart failure, also in February - not a good month!) only survive for a few months. What human beings have done to this very special breed...

    for both your Cavaliers

    Kate

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    Thank you for your post, Kate. I'm so sorry for your losses. I know one day I will be experiencing the same, and I will lose my best friends until I see them again-- but I know the pain will be very hard for me. They're my first loves- I always said I will forever have 2 Cavaliers, and I'm praying I don't experience too much heart break with the health issues that I'll be afraid to get another one. I might be bringing Bella home tomorrow- I'm happy and very nervous at the same time because I dread to see anymore suffering. I can handle discomfort, some scratching but hope to God nothing like before surgery. I never imagined this would happen and so quickly. She's been on pregabalin and omeprazole for almost 5 years and she went downhill in a matter of days. Only symptom ever was scratching. I will keep my posts going on her recovery. Thank you again for taking the time to reach out. I find owners of Cavaliers tend to be special like their wonderful dogs.

  4. #4
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    So sorry you have been through such a horrible experience. Your vet went the right route I think while you waited to see the neurologist; relieving pain as best as possible . I hope the surgery works really well for her and she can be made more comfortable!

    To give some context (as someone with 6 cavaliers with this condition, some for 11 years) -- I'd probably lean more toward the view of your original neurologist and wouldn't consider that they gave poor advice. My own opinion is that LIVS tend to have very strong opinions on this condition and the prognosis for cavaliers diagnosed with it and they do differ from just about everyone else managing it it, in that regard. They are co-founded by a neurosurgeon and as my late dad (a medical professor) said to me when I debated this issue and talked to him about LIVS, a surgeon is always going to see a surgical solution as the best and often only answer . That's not the view of all neurologists, by any means. Now, that comment is separate to the advice you have received on opting for surgery -- I absolutely agree that is likely your best, positive choice at this point and is what I would do too. But I know many people who have had this surgery done at LIVS and many if not most still do have to keep their dogs on the basic meds (eg gabapentin or Lyrica, for pain) and I do also know several who have had a long and difficult recovery period and some have not always done well, some euthenised after time. I really really do not wish to frighten anyone, but I do have some concerns about statistics and statements that are so optimistic (maybe I have spoken to the entire 4% that do not have 'success', but I sometimes wonder how LIVS defines success. I also wonder if these dogs with a porrer experience were included in their studies; I suspect not. I don't think it is a miracle surgery, but I think it is increasingly sold very robustly as if it is, to worried owners.

    The other aspect is that you are saying what I have heard many times and what always alarms me, too -- that LIVS tends to tell people all dogs progress, most will suffer, most will have terrible pain, most will die early without the surgery. This just isn't true -- there are many people whose dogs have little progression at all. I've had dogs with extremely mild symptoms of SM now for 9 years, all elderly dogs and most not on medications (and I've had one who lived a pretty normal life with a large syrinx, on meds, til age 11 when he passed away from MVD (he was diagnosed age 1, before he even showed symptoms,by a research MRI). There's also good evidence that while the majority of cavaliers will eventually develop SM, most of those dogs show no clinical symptoms (from a sample of over 500 cavaliers MRId for research in one study). So I just think none of this seems to get considered or included in the version of SM that LIVS gives dog owners and I don't know why not.

    None of this is to say that surgery is not the right option for your cavalier -- given the evidence I think it absolutely is, as I have said! But I think a lot of people with cavaliers with few and very mild symptoms are sometimes scared into what is a very costly and relatively invasive major surgery. In your shoes I'd have done exactly what you did -- manage first with meds and then if symptoms and progression warrant, consider surgery as the next step. I hope that makes sense! I fully understand your position and your choices but I also think there are many options in what owners do when they get a diagnosis. I think LIVS are at one end of a continuum on what to do; probably most others are not quite that prescriptive about what should be done. The reality is, no one understands this condition or the best approaches to take with it, it has been an enigma for human and canine researchers. The one thing we all know is that it is often a hideous and cruel disease and very costly for owners, and there has to be a mindset change about breeding approaches.

    The very best of luck with the surgery and let us know how it goes. You are definitely with some of the true experts on the mesh surgery.
    Karlin
    Cavaliers: Jaspar Lily Tansy Libby Mindy Connie
    In memory: Lucy Leo
    Cavalier SM Information site:www.smcavaliers.com

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    Thank you so much, Karlin. I definitely agree that the surgery is never near a miracle and many signs may continue needing meds (particularly b/c the syrinxes take time to resolve or may not as well as damage to the spinal cord). The only reason I did it was to get rid of the pain (the purpose of decompression), which I understand may not be guaranteed. Thankfully, so far no screams in over a week. I just want to clarify one thing for sure- LIVs never tried to sell the surgery, in fact I was in awe how they did not push for it; I've been seeing the neurologist there for years. One would think she could refer many Cavaliers for neurosurgery evaluation and MRIs. It was everything I read online trying to research info. on the disease and surgery is where I formed my opinions. It's a tough decision to make, no doubt. The benefits by far need to outweigh the risks. Bella is doing so much better-- I would say day 7 since her surgery. She was in considerable pain the day after physical therapy. When I found out they did electric stimulation over the wound- an already acutely inflamed, painful area, I was not happy and cancelled the next day's therapy. She is walking so much better. An occasional yelp in the morning, probably from stiffness. I'm doing range of motion exercises with treats that is really helping. So far so good. I have heard of successful stories that still developed problems, so I'll always be aware of any changes. Right now she is on a lot of meds until next week, then will be cutting some in half. In the middle of the night I usually still get up to give her cold water or ice chips which stops her desperate panting, and she falls back asleep. I truly respect your advice as you have so much experience with Cavaliers. I will keep my posts coming on Bella's progress. Thank you again. Madeline

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