MRI for Abbey

**Jen** · 2nd August 2005, 10:26 PM

I'll keep my fingers crossed for Rory. We're in the midst of all the research that is now being done and that's a great place to be if this is indeed SM. There are more options now than there were even a year ago. If it is SM you'll make the decision that's right for you, only you can do that. Our vet is pro-surgery, as he heard directly from Clare that once cases get worse the surgery isn't as effective. That's new information from what she'd intially thought even a year ago. For the surgery, there are two options from what I understand. There is the shunt and then there is the actual full surgery. Our vet said he's had great sucess with only the shunt version, and only once where he's had to go back and do the full surgery. He's also treated mild cases with only meds, but again, it's what is considered mild that is so hard to determine. Abbey's only yelped three times, but there are days that she'll stop 1/2 dozen times to scratch while walking around the block. Other days she's totally normal.
A full MRI is needed for either operation, so that is something you'll need to think about as well in terms of having to have another MRI done at some point if you opt for surgery. Once we get Abbey's lumbar xray back, we'll then know if we do in fact need a MRI. If so, we're opting for a full one just to have all basis covered.
Just some things to think about, but try not to get overwhelmed. You're doing more than a lot of people are, so Rory is very fortunate. Keep your head up and stay positive--you've got a great support system here as well.

**Maxxs_Mummy** · 2nd August 2005, 10:47 PM

I agree with Jen, a full lumbar MRI is better if you want to know definitely. If we'd only had the partial MRI done they would never have found Maxx's syrinx's as they are right at the base of his spine.

To work with your neurologist is the best thing and also to feel comfortable with whatever you decide is best for your own dog.

I will cross my fingers and Maxx will cross his paws for you both.

Tbh, I think that the only reason they see more affected MRI's is that the MRI's are so expensive and unless the dog has symptoms most people wouldn't a) pay out for one &/or b) want their dog to undergo a general anaesthetic for an MRI if it was a pet and not used for breeding.

I know that unless Maxx had shown symptoms that we couldn't get to the bottom of then there is no way he'd have had it done. He was 'fixed' at 6mths and is just the baby of the house. Not a show or stud dog

**Karlin** · 2nd August 2005, 10:58 PM

The frusimide (furosimide in US) is Lasix the heart drug -- it lowers the pressure of the CSF fluid which eases the pressure that causes the syrinxes. When I had my two scanned in Feb really only very few neuros prescribed it for SM, primarily Skerritt at Chestergates Hosptial in the UK who also is a strong believer in shunt surgery. He feels the frusimide helps in about 80% of cases and he told me that he likes to re-MRi in a year or two to see how the syrinxes are. Sometimes they actually diminish or even disappear using frusimide, he says. He feels the decompression (skull) surgery is too risky. The latter isnl;t technically brain surgery; what they do is remove a bit of the skull to allow more room for the brain. It is delicate surgery but according to neuros who do it, has had very low mortality> But about 25% of cavaliers grow scar tissue at the site which can cause a recurrence of the symptoms. Dr Dewey in NJ is pioneering using titanium mesh at the surgical site (as in humans) to halt scarring. he has only just started doing this so no results yet.

Interestingly more neuros seem to be prescribing frusimide now including Clare. She didn't do this until a few months ago. I waver between going for the shunt or the decompression if needed. Hardly anyone does the shunt so that's interesting that your vet does it, Jen. I think a lo9t of the dogs that have had surgery on the other list (for dogs with SM) all had it when they were very severe cases so aftereffects would be excpected to be bad. Lots more than are on the list have had the surgery and also, some of the newer cases -- done when dogs weren't so far along in symptoms -- seem to be going really well. I wuld have been initially really wary of the surgery but am far less so now as more info is becoming available.

I tend to listen to what Skerritt says -- I believe he has been treating this longer than anyone anywhere -- first case noted by Xray in I think 1978? -- and he has far more anecdotal evidence of what works. Also he is old fashioned in a way -- more liekly to take a conservative approach. Clare doesn;t believe in surgery until the first sign of pain or weakness.

I do think SM is very prevalent in the breed -- I trust Clare's very high figures of at least 50% plus plus some other stats she has notn yet announced but will soon -- and if so affected dogs exist on a huge spectrum with only the few (but increasing numbers) having severe SM. Leo runs and plays since diagnosis with some daily scratching but nothing extreme, no pain, no discomfort that is visible. I watch him like a hawk.

PSOM is very common in conjunction with SM and seems to be common full stop. It is not associated with SM -- but Skerritt says he sees some degree of it in almost all cavalier MRIs. Both mine have mild cases.

**Maxxs_Mummy** · 2nd August 2005, 11:09 PM

It was Mr Skerritt who prescribed the Frusemide for Maxx, Karlin. He was also one of my Vet's lecturers at Uni!

My own Vet informs me that the 'malformation' has been seen in just about every single Cavalier that he has ever carried out a Post Mortem on icon_yikes shocking really. He is also convinced that most Cavaliers either carry SM or suffer from it.

Mr Skerritt also told me about PSOM being present in most cases of SM too. He doesn't really recommend surgery on PSOM for Maxx as he said it doesn't necessarily always work the first time, or the second and if it's not causing pain then it's best left alone.

**rory** · 2nd August 2005, 11:34 PM

Thanks everyone for the info. I really appreciate it. I am glad we're so much further along in knowledge and research than we were a year ago, but I still feel like we're still in the experimental phase of treatment. My mother and co-workers (vets) ask what the treatment options are and the success rates and I just don't know.

karlin - any idea on the success rates of the surgery/surgeries? The main reason I want to do the MRI now is because I heard (I think on the chiari list) that the success is inversely related to how long the symptoms have persisted... And that the surgery can't correct the damage that has already occured, but just prevent further deterioration?

So maybe waiting to do surgery until it's severe is not the best idea?

**Karlin** · 3rd August 2005, 12:13 AM

The surgery won;t correct neurological damage that has already occured but does ease or eliminate some symptoms caused by the syrinxes that aren't actual damage. The recovery time is long; people say up to a year for some of the problems to stop and remember it is quite invasive surgery too -- that said many cavaliers are doing really well even just 2-3 weeks later. They need about 2 months of very little activity though Clare likes them to get back on their feet and doing things before some of the other neuros seem to.

Clare and neuros like Dr Harrington in Washington state recommend surgery ONLY when the dog is showing pain or weakness. Or I suppose if the MRI shows severe syrinxes even if the symptoms aren't (yet?) that bad or if there are other indications that it should be done. Leo has moderate syrinxes and Clare says to do the surgery as soon as he shows any pain/weakness. Mr Skerritt would advise shunting if needed. I'll get them MRId again in Feb. I think if a neuro isn;t really keeping up with developments in the area, the decompression surgery may seem very experimental but I no longer feel that way about it, and it is used regularly on human SM patients. My ain wish would be that there were some data on shunts vs. decompression. One breeder had a dog shunted by Mr Skerritt over 5 years ago that is doing fine, on no medications at all, and his symptoms were far worse than Leo's. Skerritt is well known in vet circles; has written a couple of vet textxs I believe. My vets knew who he was immediately. I really liked him. I also really like and respect Clare.

I am hoping for my SM website to do some email interviews from time to time with some of the neuros/researchers. I will put some of these questions to them. I am hoping to get Clare, Dr Dewey, Dr Harrington, Mr Skerritt.

Rory keep in mind that many of the things rory is doing would be possible with PSOM as well. Remember I though Jaspar had SM and it turned out to be mild PSOM. Mr Skerritt said the sympoms were very similar.

Donna I had the same advice regarding PSOM from Mr Skerritt and my vets. Not to do the flushing (it can take between 1-5 times to get the plug out) unless the symptoms get severe.

**Jen** · 3rd August 2005, 02:12 PM

Rory wrote:

So maybe waiting to do surgery until it's severe is not the best idea?

This is what we were told by our vet, that the longer you wait for surgery the more less likely it will be effective. He said Clare was initially against surgery, but is now opting for it sooner than later because of the results in the later cases.

**Jen** · 3rd August 2005, 02:24 PM

Maxx's Mom wrote: If we'd only had the partial MRI done they would never have found Maxx's syrinx's as they are right at the base of his spine. te:

This is so interesting to me, because I am convinced Abbey's lower back issues and her SM symptoms are related. The neuro at the U said it's unlikely they are, but I've read cases like this where the syrinxes are not in the typical neck region but lower down the spine. Having read this, I am leary that this Dr doesn't see the connection or is skeptical that her symptoms and her lower back issues are related. He found this sensitive area when she was standing, he ran his hands down her spine, pushing on areas to see if she'd react. When he came to the spot right before her hips she'd go into a sit positon when he'd put pressure on this area. She didn't wince, didn't look back at him, who knows if sitting was what she thought he wanted her to do, but she did it three times during the exam. Given this, he feels she may have some sensitivity in this area, which is why we're starting with a lumbar xray before we MRI.

**Karlin** · 3rd August 2005, 02:32 PM

I also believe that the location of the syrinxes may not affect what hurts where in quite so direct a way. The pressure of syrinxes higher up -- or indeed on an area of the brain -- may affect nerve endings elsewhere in the body. Lots of dogs have issues with their backs, hindquarters and legs (which is why this gets misdiagnoseed as spine and disk problems so often) and I am pretty sure these are not usually due to syrinxes lower down but the whole-body effects than SM can have.