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Whar's the point in treating dogs with SM?

Personally, I'd just jump straight to the gabapentin and a CSF reducing drug like omeprazole, which is over the counter (at least in the US). That's what Oz started on.
 
Oh I also just remembered and wanted to add, she said SM can cause pain but they often dont have pain and they just feel abnormal sensations like pins and needles

Where's the heading shaking emoticon when you need one!
 
Clare Rusbridge's algorithm (http://www.veterinary-neurologist.co.uk/resources/treatment_-algorthim_-2013-1.jpg) suggests starting immediately on gabapentin if there is phantom scratching. If there is yelping she suggests NSAIDS to control that sort of pain before starting gabapentin. Apologies - I was confusing (as always!) prednisone with pregabalin in an earlier post (my dogs have been on neither, which is perhaps why I get confused).

On not showing pain, I think that often we don't recognise it - and how on earth does she know whether a dog feels pins and needles? Tinnitus is a very common symptom in humans with CM/SM and I wonder if this is the cause of some of the head scratching in CM/SM dogs - but I've no way of proving it, unless we can breed a dog who talks human, or we learn to talk dog!

Kate, Oliver and Aled
 
Clare Rusbridge's algorithm (http://www.veterinary-neurologist.co.uk/resources/treatment_-algorthim_-2013-1.jpg) suggests starting immediately on gabapentin if there is phantom scratching. If there is yelping she suggests NSAIDS to control that sort of pain before starting gabapentin. Apologies - I was confusing (as always!) prednisone with pregabalin in an earlier post (my dogs have been on neither, which is perhaps why I get confused).

On not showing pain, I think that often we don't recognise it - and how on earth does she know whether a dog feels pins and needles? Tinnitus is a very common symptom in humans with CM/SM and I wonder if this is the cause of some of the head scratching in CM/SM dogs - but I've no way of proving it, unless we can breed a dog who talks human, or we learn to talk dog!

Kate, Oliver and Aled

By phantom do you mean, not making contact with the body? (air scratching) because she has never air scratched.

So with her chart would I want to do NSAIDs or gabapentin first because she has pain responses but then also scratches?
 
I have heard human sufferers of SM (and we have some stories posted on the site here) ad they say the skin crawling sensations of SM are simply horrific -- I think not just pins and needles but they are described like having worms crawling through your skin and extremely uncomfortable. That's why I think it is hard to quantify this type of discomfort, which is clearly pain of a sort. Also, the single most common symptom in humans is debilitating, sometimes extraordinarily painful headaches -- and this I think causes a lot of the headscratching. But again, it won't easily show on a basic exam, even by a neurologist. :(

Only on of my SM dogs air scratches and then, not often. But all scratch to some degree. If dogs are scratching Clare generally advises starting on gabapentin. I don't know many cases where only CSF or NSAIDS drugs alone have helped Or maybe just initially...); gabapentin (or pregabalin) tend to make all the difference for most. Gabapentin is cheaper and so it makes sense to start with that and generally, a CSF drug.
 
Just to add... sounds like you got a bit of a mixed bag (and vet students that need to read more on SM -- believe me, it isn't unusual for you, the owner, to know more going in!!).

The test on the hind leg would be a common indicator of possible CM/SM as it affects the hindbrain, which controls motor responses. I think she has her advice reversed -- I have never heard a neurologist advise to avoid medication if possible (!!!!) and I don't think you need an MRI. Steroids are also the last option Clare Rusbridge advises and in that sense I'd agree with the vet that you want to avoid giving that particular drug. But you might well find that a CSF drug on its own helps... or a CSF drug and low dose of gabapentin (eg 50-100mg 2 or 3x). I've one dog who does well on 100mg 2x for example. She doesn't have a lot of obvious symptoms but two different vets, unprompted, noted she likely had SM (which I believed too).

You could try cimetidine as it is available in generic form over the counter. If she goes on this it is wise to do blood tests every 6-12 months.
 
Well after tonight I definitely have crossed waiting 6 mos while doing nothing and having a re-check off the list. She had a very painful episode lasting almost one minute. She was following me from my sisters room and then jumped up on the couch before I could sit. I went in to pet her and she screamed out in pain when I lightly touched her. I jerked my hand away and was about to pet her to comfort her and then realized I shouldn't. Then she walked along the couch holding up her left front leg. After about 10 seconds she jumped back down on the ground by herself and was whimpering and cowering and still favoring that leg. Then eventually she was able to put it down and limp on it while still whimpering and then was back to normal. All the while she had a scared look on her face, I felt so bad for her! This is the first time she favored one of the legs while having a pain episode.

Then she went on to biting, gnawing, licking, rubbing, and scratching. :(

She jumped back on the couch and wanted to have pets so I obliged and luckily it didn't hurt her.

And the vet residents probably had help with leading them to think it was syringomyelia. I told the 4th year student after describing her symptoms that SM was my main concern so she likely relayed that to the residents. ;)

But I think it's safe to say that she does have it, even without an MRI.

I'm just wondering if the insurance will cover the medication without an MRI, or maybe they wouldn't anyways since only NSAIDs are cleared for usage in SM treatment. I guess I can do the pre-approval and see what comes of it. Even if we have to pay a few hundred out of pocket for the MRI I'm wondering if it would be worth it to help Clare Rusbridge out with her research and consider it a donation. Too bad it wouldn't count as a tax deduction!
 
I am so sorry that your girl has had this pain and discomfort. It's so horrible to watch a dog you love so much going through this and of course you want to prevent further episodes from happening again. A word of caution here though. It's absolutely fine to take advice from others like me who have affected dogs, but I for one keep updated copies of Clare's matrix to study myself, but I pass copies on to my vet, then discuss any new thinking with her before considering any changes or innovations to Rebel's personal treatment matrix. I know that I can always make a between checks appointment with the vet if anything worrying occurs. A vet who has been treating a particular dog for a large part of it's life know that dog quite well, including a full medical history, so would have the knowledge to safely prescribe or change the appropriate medication. Any professional treating your girl should also be made aware of any vitamin or over the counter preparations you are giving too, because there are some which may interfere with other prescribed medicines.

It sounds a good idea to me for you to have a chat with your insurers about pre-approval before going any further, but as it sounds as though the disease is progressing at the moment, I would sort this out sooner rather than later, then go ahead with whatever you feel able to do.

I don't want to intrude on your privacy - I have mine too, but it would be nice to know the first names of you and your dog and also a rough idea of where you are, e.g. I am Flo, living in Birmingham with my four named Cavaliers. This helps when discussing different medicines and their availability, generic names and perhaps the best neuro vets to use.
 
Oh don't worry I definitely plan on keeping the vet involved. She gave me her email address so I plan on shooting her an email with the algorithm link and my questions and won't put her on anything OTC without first discussing it with her. I want to put her on meds right away, if some of it is generic and OTC then it probably won't be too expensive so I don't really care if they wont cover it, especially if she needs it. I just cant do the MRI without them covering it. Luckily the CEO of the company has a cavalier, so hopefully the won't try to screw us over for no reason!
 
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Hey update on the heart appt:

She does have some degeneration on the right valve, but it will likely progress as it does with all cavaliers. But there are no secondary changes. We don't need to put her on any meds or change her activity level. She wants her to have another ultrasound in a year and if there are secondary changes then we will need to start medication. I told her about the syringomyelia concerns, and she is very knowledgeable about cavaliers it seemed like! She actually works with a group in Redwood city that whose sole purpose is to do imaging and so they would probably be cheaper for an MRI. I also told her the insurance may try to weasel out of paying up and she said she'd fight for us. :D So if we do the imaging I might have them do it instead.
 
Hey update on the SM stuff

I talked to the vet and we agreed to start her on omprezole. She said 20 mg split in fourths once a day. She wanted to add medication sequentially to see what helps her. I got prilosec 20.6 mg slow release, I hope that's okay. She said we can discuss Gabapentin if it doesn't help her in 1-2 weeks, but if we start her on meds we might want to get the MRI to see if there is a large syrnix because otherwise she feels she doesn't really need meds right now based on clinical signs.

As far as her symptoms she only had one more tiny yelp episode. She was rolling on the hind floor trying to bite her hind legs and let out a tiny yelp. And the usual licking, biting, a bit of fly catching, she seems to be more rolling a lot and trying to bite her hinds, but at least the yelping isn't every day.
 
Thanks for the update!

It makes sense to add stuff sequentially.

But the advice on treatment overall is, I think, incorrect. The size of a syrinx (surprisingly) often makes no real difference. There are a couple of studies now that show it is the shape of a syrinx, primarily if it is lopsided (as most are), that is related to pain.

Also, I think you are seeing plenty of symptoms that indicate a fair amount of discomfort of the type gabapentin addresses.

If money is an issue, you haven't insurance to cover it, and you would not be considering surgery as a possible approach, (any of the above) then I cannot see any pressing need in doing an MRI, which will almost certainly just confirm what you already suspect. Instead, I'd probably push to try gabapentin in a week or two and see if it makes a difference. A lot of people with affected dogs are quite taken aback to see how many symptoms they'd just grown used to, after they disappear or greatly lessen with gabapentin.

If your vet hasn't read the information for vets on Clare Rusbridge's site, I'd direct her that way. I've heard Clare herself and several other prominent SM vet researchers speak of seeing dogs with minor or even no syrinxes that show a lot of symptoms and dogs with syrinxes running the length of their spine that show few. The point is always to control the symptoms (ie the discomfort/pain) -- knowing the size of the syrinx won't generally have anything directly to do with that need. :)

Clare's site: http://www.veterinary-neurologist.co.uk/

PS I do agree that ideally, dogs could and should, perhaps, all have MRIs if SM is suspected. But I think from experience, that symptoms are often pretty clear and simply trialing meds will be enough to know if you are dealing with CM/SM and the aim then should always be to eliminate or greatly reduce symptoms.
 
Yeah that's what I've read so far in my research that the size can have a correlation with symptom severity but not necessarily always.

She's been on the prilosec now for 1 week and a day. She said it would take one to two weeks for it to take effect.

Her symptoms started changing before the prilosec though so I'm not sure if it has helped.

The frequency seemed to be decreasing but duration seems to be getting longer, though frequency has been picking up the last couple of days. Symptoms seem to have left during mid day (definitely decreased frequency), but still affecting her in the morning and esp night.

She woke me up with her scratching two nights ago for the first time.
She also scratched on lead for the first time. She started tilting her head to the right for about 10 seconds and then stopped to scratch at her ears, but only for about 15 seconds (so 25 sec total).
She also rolled on the hard patio floor and scratched at her ears for a bit and shes always refused to not roll over on anything but carpet, only for about 5 seconds though.

Licking still there but barely. Lot of biting but instead of paws seems to be at the kneecap on hinds a lot and just above the front paws. Also a lot on her lower back just before the tail, so much so its starting to get bald and scabbing.

Fly catching has stopped.

She seems to be rolling on the floor a lot and kicking her feet up in the air and just swinging her hinds from side to side. She bites at her hinds while doing this and sometimes growls. My sister's not convinced its a symptom since she sometimes wags her tail afterwards. Here's a video of it but only for 15 seconds, sometimes she does it for longer.

https://www.youtube.com/watch?v=4xTNfCtX8Is

Still rubbing her ears but not as much.

Scratches her hind find to her ears a lot though still.

She also has been using her hinds to scratch at the back of her front legs and sometimes her chest, though not that often but is something new.
 
That looks like an uncomfortable itchy dog to me. I completely agree with Karlin's post, your little girl does seem to have a lot of the neuropathic pain symptoms that are typical of SM.
 
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