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Vets that have knowledge on SM in the Solihull area?

Hi everyone!Stephanie did get back to us and said she couldnt rise the Gabapentin dosage at this stage as it was still too early. She said he he declined any more, to come in and see if we can put him on any other medication and maybe raise the dosage.We are a little worried about his progress as he is displaying new symptoms. His eyes when they go red, go really badly red too (like an almost bloody kind of a red) but before bed tonight, his eyes were back to a normal color. I could see he was in quite a bit of pain today just by his look :( . Hopefully we can get this sorted for him, I know theres not a cure but hopefully some sort of medication that can help with this kind of pain would be wonderful. Our Neuro did say that we could put him on other medications but she doesnt want to do that because they would be steroids and they would have side effects.Anyway, wel keep you posted!
 
My heart goes out to you both. It's so hard to watch this happening sometimes while loving them so much but being unable to help them. You have done all you can for now by speaking to Stephanie and now Ziggy is starting to feel better. I think there must be quite a few of us who have had to watch our dogs having a bad time during this period of unusual weather events. My Rebel has had to have his medicines tweaked due to similar reactions to it also, but he too is now improving.

I can only help a little by reminding you that we are all here to listen to your concerns and to try to bring as much comfort as we can. There will be a workable solution for Ziggy somewhere at the end of the tunnel, but perhaps not quite yet.
 
It's normal to have to tweak the medication for SM for a few weeks to find the dosage that is best for your particular dog. Dr Rusbridge regards steroids as the last option, when all other pain control has been tried and failed, because of their side effects. The maximum dosage for gabapentin is 300mg x 3 daily, so Ziggy still has quite a way to go on that, and some dogs do better on a refined form of gabapentin called Lyrica (prednisone). SM dogs are definitely affected by changes in air pressure, and that has been going wild lately, leaping up and down by 20 millibars a day. Even my normally well-controlled Oliver has had to have an occasional extra gabapentin because the changes in pressure were making his head ache.

Kate, Oliver and Aled
 
It's normal to have to tweak the medication for SM for a few weeks to find the dosage that is best for your particular dog. Dr Rusbridge regards steroids as the last option, when all other pain control has been tried and failed, because of their side effects. The maximum dosage for gabapentin is 300mg x 3 daily, so Ziggy still has quite a way to go on that, and some dogs do better on a refined form of gabapentin called Lyrica (prednisone). SM dogs are definitely affected by changes in air pressure, and that has been going wild lately, leaping up and down by 20 millibars a day. Even my normally well-controlled Oliver has had to have an occasional extra gabapentin because the changes in pressure were making his head ache.

Kate, Oliver and Aled

I think you've had a Senior Moment here Kate. Lyrica is pregablin not prednisone.

ZigsBro, although I agree that steroids are usually kept as a last option the most important thing is that your little dog should have his pain controlled. Quality of life is what should count most.

You know your boy best. He cannot speak for himself so you need to be his advocate when talking to the neurologist. Don't leave it too long if he continues to deteriorate, take him back and ask for his medication to be reassessed
 
:oops: You're right of course, Margaret - neither of mine have been on Lyrica, so I always think of it as Lyrica and forget its 'proper' name.

Kate, Oliver and Aled
 
I'd just add that it is never, ever 'too early' to address pain. If the dosage of gabapentin isn't working than the goal should be to raise it if that fits within the correct limits of dosage, and resolve the pain. Or add in other meds (steroids are the very last resort -- Clare's algorithm lists many others to try first. Many dogs need gabapentin or Lyrica, a CSF reducer like cimetidine or omaprazole, and sometimes an additional painkiller like tramadol). Once the pain situation has resolved then it is always possible to try to reduce back down and see if a lower dose can be used.

As others have suggested, it is worth going to the neurologist to have the medications adjusted as vets are really dealing with a condition they generally do not understand and medications they do not know (gabapentin/Lyrica). This is very, very common to need adjustment, especially for newly treated dogs initially, and then again over time. Generally meds need to be increased and sometimes changed over time. Best of luck in finding the right mix of meds to help.
 
Thanks everyone :)

We just ran out of Gabapentin yesterday. So we went back to Willows and got another box. This brings me back to the phone call my mom had with Stephanie, she said that we should start to lower it to 2 a day twice a day.... We thought we misheard this as surely.... Until after we got the second box of Gabapentin which was when we looked at his perscription paper which displayed 3 gabapentin 3 times a day for 30 days and then 2 for twice a day until the follow up, this isnt something we can just lower the dosage of surely?

The other day, my Dad fed him his morning dose of gabapentin and he coughed it up onto the floor (as I discovered a white capsule later on which definitely was gabapentin because of the markings on it) right after my Dad left the room. As a result, he was sleeping all day in the same spot almost all day and could barely open his eyes (like a pain squinting) and his eyes were also much reder.

So I cant imagine why we should lower the dosage? From what we experienced with the above we dont really feel all that comfortable with doing such a thing. I dont like doubting the neurologist as she obviously knows what shes doing, im just wondering why wed do that for? Is it to build up the dose in his body and then to bring it down to a permanent dose?
Any ideas?
Thank you all :)
 
Thanks everyone :)

3 gabapentin 3 times a day for 30 days and then 2 for twice a day until the follow up, this isnt something we can just lower the dosage of surely?

The other day, my Dad fed him his morning dose of gabapentin and he coughed it up onto the floor (as I discovered a white capsule later on which definitely was gabapentin because of the markings on it) right after my Dad left the room. As a result, he was sleeping all day in the same spot almost all day and could barely open his eyes (like a pain squinting) and his eyes were also much reder.

So I cant imagine why we should lower the dosage? From what we experienced with the above we dont really feel all that comfortable with doing such a thing. I dont like doubting the neurologist as she obviously knows what shes doing, im just wondering why wed do that for? Is it to build up the dose in his body and then to bring it down to a permanent dose?
Any ideas?
Thank you all :)

I don't know the answer to this one Bob, but I do think that you should speak to Stephanie on the 'phone to clarify what you should and should not be giving. I think you should also explain the present symptoms.

It's easy to make sure capsules or tablets are swallowed - Just pop the capsule in the mouth, hold mouth shut, gently point muzzle upwards so that the throat is taut, then gently massage the throat muscle until the dog swallows what might be held there. :cool:
 
I get 15 pills a day down my Aled simply by wrapping them in Aldi's cheapest pate! Cheese or a scrap of ham or chicken roll also work well. I find the dosage you are giving a bit incomprehensible. Your neurologist seems to be treating gabapentin as a painkiller (give a high dose to zap the pain and then lower it), which it is not. It's a pain preventive, which prevents neurological pain rising to the surface, so to speak. (Rather as in hospices they treat pain by giving frequent, often quite small, doses of pain control such as morphine so that the patient is never stressed by becoming conscious of pain.) It is therefore vital that the dog is given blanket coverage, which for most dogs means 3 times a day (my Oliver is better on 4 times a day). The average time it takes for the drug to pass through the body is 8.5 hours - as this is an average, some will be able to go longer between pills, some (like Oliver) will go less. If by 3 gabapentin x 3 you mean 9 capsules a day, this is the maximum dosage. Most neurologists start with just 3 pills a day, 100mg x 3 times, and then gradually raise the dose if the pain isn't being adequately controlled (and perhaps add in a painkiller like Tramadol, and also prescribe a diuretic such as cimetadine (Zitac) to lower the cerebral spinal fluid). But very few dogs in pain will be able to go 12 hours between (lower) doses, which is what 2 twice a day means.

You need to have a talk with Stephanie, explaining your concern that if a very high dose of gabapentin doesn't seem to be doing much, why is lowering the dose going to improve things. General experience with CM/SM seems to be that you need to tweak the medication for several weeks to find the right mix of drugs for your particular dog, and will need to do this from time to time in the future as it is a progressive disease.

Kate, Oliver and Aled
 
Thank you both, It never occured to me to use pate! We always have some of Aldis pate (Good ol' Aldi!) in so thats another thing to try when we finally run out of sausage! (Sausage slices can be a little tricky to make sure the pill stays put)

I completely agree, we'l be getting in touch with the Stephanie to find out some more information on the situation. Zigg has been improving ever so slightly over the past few days I think due to what I assume must be rising air pressure (I only started keeping track of it today) which is nice to see. I have noticed as a result of him seeming a little better that he has become slightly less fidgety which is very nice to see! I think once we finally get his meds evened out properly hel have more good days which will be nice.

Some more info on the red eye, I have noticed that they are at their redest in the mornings and at night (it can be an hour or so after the dose of Gab) :
5vE02nm.jpg


Not sure why they are so red in the mornings and at night as during the daytime they are still red but not as much of a vibrant red as they would be in the mornings or at night. I have also noticed thats when his squinting gets worse. In that particular photo I dont think hes squinting in pain, he was blinking his eyes at the time (i think). Il show the pictures to Stephanie and hopefully we might be able to do something about that! Il keep you all posted :)
 
Squinting in strong light is quite a common symptom of CM/SM. With Oliver, it's not just sunlight that makes him squint, it can be bright fluorescent light or even very white cloud seen through the window. Aled squints in sunlight but seems to be OK indoors. Both of them wear a sun hat in the summer! So Zigg may be squinting morning and evening simply because the lights are on. With Oliver squinting is a symptom of his dilated ventricles, which create pressure behind the eyes. A diuretic such as Zitac should help to relieve the pain from the ventricles by reducing the pressure. Red eyes are also quite common, but it would be worth getting your local vet to test for dry eye - this is a very simple and quick test that he/she can do on the spot, or you could ask Stephanie to do it. It is quite common in Cavaliers and very painful - Oliver has that too; ointment twice daily deals with it very efficiently.

Kate, Oliver and Aled
 
A PS to my post yesterday. If Zigg's eyes look sore, an immediate help, before you can take him to the vet, is Viscotears, which is very soothing. It is basically synthetic tears that lubricate the eyes but won't do any damage. They are used for humans so most pharmacies sell them at a very reasonable price. A useful thing to have in the house anyway. Aled has keratosis - not dry eye, he has plenty of tears but they are poor quality and don't keep his eyes healthy - so he has ointment in them twice a day, but sometimes they look sore in the middle of the day and that's when Viscotears really helps.

Kate, Oliver and Aled
 
Just a thought: Ouch my brain does hurt :confused:

As Holly P and I know so well, The Willows have an outstanding opthalmic department. I am sure Stephanie could arrange for Ziggy's eyes to be checked over by Christine, Heidi or any of the other experts. I think it might be quite a relief for you to have a definitive answer about the redness to Ziggy's eyes.
 
Hi both! It turns out the eye issues he was having were to do with SM. :(
We went to Stephanie 2 days ago (sorry I didnt reply sooner, I wanted to see the changes) and she wasnt happy with his progress. She said that we will be giving 2 gabapentin in the morning and 1 mid day followed by 2 at night. She also has prescribed us a very very very very low dose of steroids for him. She said his SM was a bit out of control (so to speak) and so the combo of the boosted gabapentin and steroids should help. He used to have a lot of bad days still and only a few good days. Well, 2 days, now since we put him on the new stuff and upped the dose of the gabapentin and the results have been very very positive! The weather doesnt seem to badly effect him as it did before, so far anyway. (Usually by now, hed be pretty bad)

Hes a lot more comfortable and is sleeping a lot better than he was before the new changes in his medication. Stephanie did say his red eyes were to do with his SM/CM and that the medication should help quite a bit with that. She wasnt wrong! :D
His eyes are a really nice white color most of the time and other times when you can see hes slightly effected, his eyes are a very very very pale pink to the point where you dont notice unless you really focus on it. Before, even if it was mild youd be able to see it easilly.

So far so good, folks! Hes a lot more comfortable now and his symptoms seem to be few and far between so far. Like said though, early days but its all looking so good! Thanks all for the information :)
 
Delighted to know how well you did with Stephanie. Ziggy must be feeling so very much relieved to have less than the awful pain he must have had earlier.

So far as my experience with Rebel is concerned, Gabapentin is my Rebel's wonder drug and I will continue to use it for as long as it works for him. I do so hope very much it will probe to be the same for Ziggy. At the moment, just as I've got Rebel back down to his 200gs maintenance dose, it will have to go back up to about 400 when the bad weather starts up again over the weekend.

Yesterday was a bonus. While the snow was coming down thick and fast he was out running and jumping around in the back garden and trying to catch the snowflakes in his mouth. He looked years younger than is usual for him these days and when he came back in he had a spring in his step. He's still bright and alert today - what a pity that is likely to change with the weather pretty soon!
 
Hi both! Hope your rebel was ok through all the weather!
Ziggy has had an amazing reaction from the new medication we are giving him!
These past 2 days have been amazing with him. No squinting, no paw licking what so ever (thats insane as he has always done that), no head shaking at all ( this used to be multiple times every hour or half hour), no weird walking (This would be an every other day sort of occurrence), no more sleep issues, no more difficulty waking up, no red eyes and even no head scratching!

Its all very early days yet, but hes doing amazingly well so far. I havent seen him this well in a good 2 years or so. Hes basically back to his normal puppy like state! We have yet to take him for a walk (We have bought a proper buggy for him so we can sit him in it if he falls frail on his legs when we are on a walk) yet which is where he always has issues, so wel get back to you on that.

As for him in him self, hes much more contented and happier and just has a much better vibe than he did before. Ofcorse, these are very very early days but things are definitely looking up for him, which im so glad about because he deserves it.

Anyway, Il keep you all posted!
 
So glad to hear Ziggy is doing well on his new meds. Fingers crossed he keeps on improving.:lotsaluv:
 
Hi everyone! Thought id put up a little update. Zigg has stayed pretty much the same thank god! Looks like the good bits are here to stay for quite a while yet which is so nice to see! The only thing I have noticed is that hes a little bit more uneasy on his legs now but other than that hes better than hes ever been since his SM symptoms started (when he was 3 or 4 looking back, we had no clue up until around now) so this is a lovely sight. Absolutely no paw licking, I can quite honestly say I havent seen him lick his paws in weeks... Its a bit crazy that hes so good with it to be honest!

We had a follow up appointment with Stephanie and she said shed like to bring the Steroids down a tad. I have to admit, Id be hesitant to do that as he can still have his bad days (although this is exceptionally rare now days) but the symptoms are near to non existant. Now a bad day just consists of eye squinting and drowsiness, thats all.. Although, before he takes his steroids and Gabapentin hes really bad, like around the time of 3am (I hardly ever sleep haha) you can see he can either barely open his eyes or his eyes are really red and his squinting.
Anyway, we'l keep you posted!
 
That's such good news (y) Ask Stephanie if you can give Zigg an extra gabapentin just before you go to bed. Otherwise overnight can be a long stretch. I do this with Oliver and it definitely seems to help him manage overnight. Long-term, steroids can have side effects, so they do need to be reduced or eventually phased out if possible, but I know how hesitant you feel - you definitely do not want to go back to the bad old days! But once the steroids have broken the pain cycle, Zigg may be able to manage on gabapentin, with perhaps a non-steroid pain killer such as Metacam in reserve for the occasional bad day.

Kate, Oliver and Aled

PS As you're going to the Willows, I assume you live somewhere in the West Midlands or thereabouts? If you do, the Companion Cavalier Club has a lively group of members in the area who meet up for walks and picnics and other activities. Non-members are welcome to join us, so would you like me to let you know when we're doing something? If so, message me your email.
 
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