Please advise needed, desperate

The neurologist from Chestergates called me, of course she would like me to take Ellie in again when Lucca returns. I did say it was difficult for me at the moment, and did she think that Ellie would benefit from having Omoprozole, and she said yes she thought it might help....
I have phoned my vet and asked that she give me a call when she is free.......
Personally I cannot see why they need to see Ellie again, she had her MRI scan in April......

I think it is a good idea to return if at all possible or see perhaps could someone else take her? The reason is because it is important for a specialist, and not a vet without the needed training and knowledge, to keep assessing neurological pain and whether a dog is getting adequate medication to address it. I cannot emphasise enough to cavalier owners who suspect SM or have a dog with it, that SM in humans is considered the single most painful possible condition and that much of the pain humans suffer is not easily visible as it involves severe headaches, crawling sensations under the skin, sensitivity to touch etc. Researchers feel our affected dogs almost surely feel far greater pain than we or that vets believe they are experiencing because it is neuropathic pain of this awful sort. Having a neurologist regularly assess CM/SM affected dogs is, I think, very important to give adequate care, and is especially important in the months following a diagnosis and the start of treatment. A neurologist is going to fairly quickly detect many things a vet will not. I cannot tell people enough how many times I've heard people with SM dogs say 'but they are not feeling any pain, thankfully" -- then they post a video and it is clear to people who have dogs with the condition, and know the typical signs, that the poor dog is likely in very significant pain. So please do go if you can for this important check and reassessment.

I would second what Karlin says. SM is a progressive disease - my Oliver was well controlled with medication from ages 8 to 13 and then at 13 his SM symptoms got noticeably worse; this became one (but only one) of several factors that led to his being put to sleep last February. It can take months to get the initial medication right, and then you will probably need to tweak it from time to time. You need a neurologist that you can trust, and even if you can't see him or her as much as you would like, someone that you can speak to on the phone when you need advice, send videos of symptoms to, and generally relate well to. Yes, the neurologist is the expert, but a good neurologist will regard the owner as part of a team, working together to keep Ellie comfortable. Hope Lucca will live up to this!

:hug:

Kate

Responding to what Karlin says - I'm not sure whether there is such a thing as a CM/SM dog with no symptoms. I think we just haven't yet learnt to recognise all the subtle symptoms of pain - think how the list has grown over the last few years, so why shouldn't there still be more we don't yet know about?



Kate

I will make a point of going as soon as possible , in the meantime will get my vet to phone Chestergates and get the correct dose of Omoprozole for Ellie and hope it helps her.
On my initial visit to see Lucca, I took my iPad with Vidio clips of Ellie to show him..it clearly showed her head bobbing,her scratching and bottom shuffling etc:
Her limp is showing no sign of improving, and I know keep giving her Tramadol isn't good, but I have given her one tonight , this is why I need to get the SM under control.....I really don't want her to have the operation for LX.....but she cannot walk around like this too long.....My poor baby.

Phoned vets at 9 to ask if I could speak to vet, but it seems unlikely she will phone me back today ,as she has a full surgery....but fingers crossed.
Does anyone think I am trying to interfere too much?
I can tell that Ellie is depressed ( why wouldn't she be) ......I need to go and see Lucca when he gets back from holiday, in the meantime I was just trying to see if there was any other medication she could try for her SM.....

Hi Ann,
I don't think you are trying to interfere too much. Not at all.......we have to advocate for our Cavaliers, we are all they have and they depend completely on us.
You are doing your very best for Ellie, that isn't interfering.
I hope the addition of the Omeprozole to her meds helps to make her more comfortable. Hopefully by the time you go to see Lucca again, Ellie might have been taking the Omeprozole for long enough to show any improvement (or not) in her SM.
It is so difficult for you to know how much discomfort, or what appears to be depression is caused by her SM or her LP isn't it.
I really hope that seeing Lucca will help you to make more sense of everything and enable you to make decisions for Ellie.

Take good care of yourself as well as Ellie, as I know you are recovering from surgery.

xx

Phoebe you are so right, I think she does get depressed and more so now as she is not getting her walks....as you have said with your precious bundle, we become so close to our dogs and they with us, that we know what they are thinking.......So we know the difference when they are plain fed up or in pain or both.
My vet phoned me late yesterday after her surgery and we had a chat, she is the first to admit that she isn't an expert on SM...She is going to try Ellie on Omeprozole ,but wants to phone Chestergates next week to get the correct dose.......She says I really need to have a good chat with Lucca, so I will make a telephone appointment with him for when he gets back from holiday ...I don't no why he would need to see Ellie again, and of course he is going to push for the LX operation..... I still don't want to put her through that big operation, with her having SM , her heart murmur and her age........BUT I Carnt see any other solution, she is barely putting her leg to the ground........Having had a knee replacement myself,I know the pain from knee surgery.....
It's a good job I bought the dog buggy for her, she really enjoys her trips in that ( Carnt think why my hubby refuses to push a bright pink buggy) .......I tried to put a picture up,but Carnt fathom it out!......

Hi Ann,

I think Lucca would want to examine Ellie again not just to see if there has been progression in her SM symptoms, because of course there can be, even in the space of a few months, but also to consider what combination of meds or introduction of new meds such as Steroids might be necessary.
If Ellie can barely put her leg to the ground, then she must be in considerable discomfort and I would imagine that even the most basic things like going outside and squatting to perform her toileting must be difficult for her. As you say, you know how unpleasant the pain can be after knee surgery, but of course if Ellie had surgery, the pain would pass after a period of recovery. Ellie would then be able to enjoy her mobility again, at the moment she is constantly disabled and constantly in pain with her LP.
I understand that there are a number of factors to consider, such as her age and her heart condition, but despite these other considerations, Ellie might well be with you for a good few years yet and if she doesn't have LP surgery, then how good might those years be? I suspect that this is why Lucca is pushing for her to have the surgery.
It's such an easy thing for him to say however when he has no emotional attachment to your baby and he can just view things in a very practical and quite dispassionate way. Sometimes that is the sort of advice we need though!
Try to get Ellie's SM meds sorted out as soon as you can (so that you can see the wood for trees remember?!)

I'm not sure my hubby would push a bright pink buggy around with a dog sitting in it either!

xx

Hi again, you are right in everything you say and I DO take it all onboard......Do you think Lucca would might want to do another MRI scan? I hope not because it would be another anaesthetic .
Walking slowly seems worse for her and when she stands still ,her leg just touches the ground lightly....But if she sees a cat, she runs down the garden ....I find that strange..
I am going to phone on Monday and make the appointment to speak to him on the phone, and if he needs to see her, then we WILL get there.... I will feel a lot happier if her SM symptoms can be better controlled.
Thank you again for getting back to me, I know you are busy......Hope you have good news on the parents front.x

Standing still or walking puts maximum weight on the legs - good for turning fat into muscle. Running fast, the legs hardly touch the ground and very little weight is put on them - so she can chase cats! As your first MRI is fairly recent, I wouldn't think there would be need for another any time soon. Most times, if new symptoms arise, the neurologist has a pretty good idea of what is going on and can make an informed guess at changes in the spinal cord.

Kate

Hi Ann,
I know how you feel about the possibility of Ellie having to have another MRI. It is possible that Phoebe may be having partial seizures and so in the future, Lucca has said that he may well want to carry out another MRI. I'm not keen because I don't want her to have a general. I guess I will have to consider all the pros and cons when the time comes.
If Lucca does want to perform another MRI, you could always ask him to hang fire until Ellie has tried a different combination of, or new meds. If you observe an improvement in her, then an MRI shouldn't be necessary and of course it is less than six months since her last one.
If Ellie does have the LP surgery, would it be carried out at Chestergates? If so, you could ask Lucca to refer you to the appropriate consultant in order to have a chat, it might help you to make a decision. I asked him to do that for me when I wanted Phoebe to be examined by a Cardiologist.
Fortunately Phoebe's pet insurance pot is not yet empty but eventually it's going to run out! And I don't know if that is something else that you also have to take into
consideration as well.
I probably won't be about on here for the next few days, will check in when I can.

xx

Yes that makes sense why she can run but not stand.....I cannot stand for more than a minute or two (my other knee needs operating on ).
So glad now we have good insurance, I think there is about £4-000 left and six months before renewal date.
but I expect knee op will be costly.... Dreading what next years premium will go too!!
I thing there is a vet hospital closer to us than Chestergates....I am guessing but I think it could be St Helens?
We will choose nearest one I expect...
Let's hope the Omoprozole helps her SM when she gets it, and then I can tell Lucca when I get to speak to him.....
At lunchtime I couldn't find Ellie (panic)........she was sitting in the garage next to her buggy

I have just had a phone call from my vet, she is going to prescribe 10mg of Omoprozole daily for Ellie to try, and I have a telephone appointment with the neurologist Lucca at Chestergates next Thursday....That gives us time to see how Ellie reacts to it.....Apparantly it's only safe for them to be on it for approx 10weeks ?....

Glad that you're getting Ellie better organised! Omeprazole works to reduce the pressure created by the build up of cerebral spinal fluid; it's a diuretic that reduces fluid generally. It is widely used for CM/SM and the only normal side effect is that in reducing CSF fluid, it also reduces fluid generally in the body and long-term this can potentially damage the kidneys and liver. So dogs on it should have regular blood tests at least every 6 months. But, with that proviso, it is definitely safe for a lot longer than 10 weeks! I know dogs that have been on it safely for years. I think your vet may be confusing it with another drug, acetazolamide, which is sometimes used for the same purpose but should only be used for a short time. I'm sure Lucca will be able to sort this out for you. Omeprazole, or a similar drug called cimetadine, together with gabapentin are the standard CM/SM drugs, though it can often take a few weeks of tweaking to get the dosage right. I do hope Ellie will soon begin to feel the benefit.

Kate

PS Don't forget to send me your address for the jacket.

Thank you Kate, I have got the Omeprozole,so will be starting today.......I always worry about the reaction with new tablets, and I think she is the first Cavvi that our vets have used it on....And to be honest if I hadn't popped back on to this great site I don't think Ellie would be trying it yet.....

Ellie has improved on the Omoprozole , so now I have to make the decision whether to get her Luxating Patella done.
She was doing OK ,but then yesterday she ran around too much and now she is hobbling about on three legs.
We had been trying to keep her quiet and had greatly reduced her walks to just ten mins.......
I am so worried about her having the operation...she is ten next month and has a heart murmur ......But she is not a happy dog as she is.......Its an awful decision to make, has me in tears a lot......
Advise please....l.l

Is your vet seriously considering patella surgery in a dog this age? Most would not, I think. Personally, I would not do it in a dog that age unless there's really no other possible option. I'd be looking at management and maybe painkillers? Also are they sure it is a patella and not related to SM? Problems as they get older with hind legs are not uncommon in SM dogs.

Sorry she is nine next month not ten.....It is defenetly her patella and both legs are affected......She has Loxicom every morning and I have Tramadol to give her if necessary . Tonight she has a job to walk and not really putting her leg on the floor......She has been sat with me and panting. She has had a Tramadol and is still in pain.....
I really don't want to put her through the OP but what choice have I got? If her other leg goes as bad..........doesn't bare thinking about!......

Patella surgery has a long recovery time and is far from easy on dog and owner. I wish I knew an easy answer for you. Personally, if the dog were in excellent health otherwise, it might be an option. But Ellie is dealing with so much already and how would she react to being laid up? Can the vet help out with pain management?