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3.5 Month Pup Showing SM Symptoms - Next Steps?

Hi All,
.
We have the sweetest ~3.5 month old tri color boy, Barkley, born on February 16 and coming from an AKC registered breeder, who seems to be generally reputable.

He has now had all of his shots other than rabies (which comes in 3 weeks).

He weighs 9.5 lbs, as of yesterday.

He loves all dogs and people and is super eager to please, loves to play, and is coming along very well with his commands.

Unfortunately, he also seems to be showing some classic signs of SM (see below) and my wife and I hoped this could be a good resource to find advice as we're currently feeling pretty overwhelmed and want to make sure we do right by our little guy who we love so much.

Symptoms

Leg Weakness in Mornings - It took us roughly a month to realize but our boy (who has improving recall and will usually come when called) was having trouble getting out of his crate in the mornings (even when heavily encouraged) and would sometimes collapse on his back legs when trying. At first we were worried about hip dysplasia. At his checkup, about a month ago, the vet suggested puppies often have week legs and trying to do some work to strengthen them.
  • Timing: This seems to generally be the case only in the mornings. Even compared to times in the day when he has been sleeping for several hours in his crate, he is much slower to get up and seems to struggle most to climb out of his crate in the morning or in the middle of the night.
  • Progression: This actually seems to be getting slightly better. We have been walking him up some hills and asking him to sit and get up again on our rug every day. It used to take him several minutes to get him out of his crate in the morning and now he seems to be able to do it much more quickly (maybe takes him about 30 seconds).
  • Evidence: I have some iphone videos of this (the first likely displaying some other SM symptoms as well) but unfortunately I can't seem to upload them here. Here's a google drive link that hopefully will work: https://drive.google.com/drive/folders/1KozMzlOgyA5YTdXJomG_q-aOeeysRhQD?usp=drive_link
Leg Weakness After Being Picked Up & Put Down & Shaking Whole Body - We live in an apartment building so need to carry him down the stairs to go outside and go potty. Sometimes when he's put down on the ground, he walks very slowly and gingerly at first and then give his whole body a shake (like a dog drying itself off when wet) and then seems to be able to walk much looser and more freely.
  • Shaking on Lead - He does this type of shaking frequently when walking on his lead. I would say maybe 1-2 times per walk. It's probably notable that we walk him on a harness, not with a collar, so it's likely not putting as much pressure on his neck.
  • Evidence: The "shaking to get going" video shows the type of shake that he does, although often times he is moving much slower before doing it (see google drive link).
  • Otherwise he often seems to be capable of running/walking very fast.
Scratching Neck & Front Legs & Abdomen and Biting at Legs - By far the most frequently at night in his crate before bed (very rarely during the day, which I know is a hallmark of SM) Barkley will scratch at his neck and bit his hind legs. He does this most frequently on the left side of his front leg and neck but will occasionally do it on the right.
  • Evidence: "Scratching & Biting" Video
Scratching + Walking - He will maybe ~5 times per day while walking (either on the lead or freely in our apartment) scratch with his hind legs (I believe it's almost always the left). He typically will actually make contact either with his abdomen or with his front leg and then keep going. Each incident seems to be limited to 1-2 scratches (i.e., it does not go on for an extended period of time or force him to trip).
  • Evidence: This has thus far been infrequent enough that we haven't really been able to catch him on video doing it. I would say it looks the most liike what the dog @ 1:39-1:41 of this video:
    is doing.

Phantom Scratching: He will occasionally (I noticed 2 times today, maybe 6hrs a part) do a phantom scratch with his hind leg without making contact with anything (unfortunately, my understanding is that this is the single biggest telltale sign). Unfortunately, we also realized tonight that when he was lying down we were able to trigger this reflex by scratching the left side of his neck.
  • Time Frame: I actually think he has been doing this (rarely) since we brought him home at 8 weeks. He actually seemed to do this slightly more when he first came home to us (although at the time we didn't know it was anything to be concerned about in cavs).
  • Evidence: (a)"Neck to Trigger Phantom Scratching" video. (b) the "First time getting up ever" video (which again, he has improved greatly here) shows him seeming to do some phantom scratching with his back legs while sitting (see google drive link).

Pain: At least for now, he does not seem to react with pain when we touch the back of his head or his ears or his neck. Sometimes when walking on the lead outside he will randomly stop and sit down (we fear this could be pain related, but suspect that it has more to do with behavior, since typically he does this in the same places around our apartment complex).

Insurance

Fortunately, Barkely has Trupanion and has been covered since we brought him home. We are able to afford his deductible without too much trouble.

Vet Discussion Thus Far & Timeline

We first mentioned his weak hind legs in the morning to the vet in early May (we did not mention many of these other symptoms above, since we didn't think anything of them at the time). We were worried it looked like hip dysplasia. The vet mentioned trying to strengthen his hind legs (which we have been working on and does seem to help him with getting out of his crate in the morning).

Yesterday, we went to the vet for another check up and mentioned our concerns with the symptoms above. He said it was definitely something to monitor (although he'd only dealt with one case before himself) but that it would be rare for SM to present in a puppy this young, so that his hope was that the symptoms were attributable to other things rather than something neurological.

However, today, we noticed 2 more instances of the phantom scratching, and also unfortunately this evening, that we could trigger it by scratching the left side of his neck after he'd been playing for about 15 minutes (which from doing some research seems to be clearly associated with neurological disorders).

Advice on how to proceed? My wife and I are obviously feeling heartbroken and overwhelmed about all of this (particularly given how young he is) and would welcome any advice from this community as to next steps to take here.

We live in Atlanta, and see that there are two board certified veterinary neurologists in our area. Should we be trying to get an appointment with one ASAP?

Is he too young for an MRI?

Is he too young to start treatment?

Obviously these are things to discuss with a veterinarian, but if anyone has any input or experience to offer (or even just kind words), we would really appreciate it.
 
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As an update, his phantom scratching seems to be increasing.

Last night 1-2 times when very excited, he would sit and reach for his ear/neck with his hind paw and miss by a few inches.

He also seems to be doing his "air guitar" a few inches off the ground with one leg when walking on the lead a few times almost every time he walks on the lead now.
 
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Hi and I'm so sorry you are worried about this possibility. I am not sure if I might have responded to you on another discussion group elsewhere already, but will do so again here. The reason I wonder if I responded to you was because a video of an adorable puppy was posted to a FB group that showed the kind of shaking out you describe and this looks totally normal to me :). That's just showing stress release and relaxation and happiness, generally. I've done courses with behaviourists where they always suggest praising a good shake-out, because it's a nice behaviour to trigger, and relaxing for the dog.

The comments your vet has made are generally correct -- puppies can be quite wobbly at first and also they do scratch a lot and chew at limbs etc so some of this may just be normal puppy behaviour. Also sometimes them might attempt to scratch towards the neck and appear to phantom scratch when walked because they are only just being introduced to a collar or harness and thus scratch towards it but not with much intent. Also, of course many dogs have a scratching reaction when lying down and touched in certain areas.

Also, hind legs are not generally affected with SM, if there's hind leg weakness it's usually spinal or hip related or perhaps a luxating patella. Generally only front legs are affected by SM and dogs will stumble and not be able to re-right their paw easily if it is turned under while standing.

It also is more unusual for younger puppies to show symptoms.

That said: phantom scratching is the most telltale symptom. You could ask for a neurology referral for a clinical assessment and I'd try to capture what you feel may be phantom scratching in particular and also a video of your pup showing any weakness you are concerned about. A neurologist can do a good body-exam to see if it elicits any response they feel is concerning. If a dog isn't showing signs of pain I'd be reluctant to MRI a puppy this young as symptoms and response to medication are a good basic diagnosis and you can save doing an MRI until you see whether you wish to consider surgery, for example, or want to assess where your dog is at. Dr Clare Rusbridge the leading CM/SM specialist often waits until dogs are over 1 and bone growth is complete before doing MRIs to determine whether to proceed with surgery, for example because much can change as the puppy grows. That said some wish to get a definitive diagnosis but having had many cavaliers with varying degrees of SM -- all of which lived to old age and died from other causes -- I personally do not bother with MRIs any longer as symptoms being addressed by the basic meds is pretty much confirmation. I'd only do an MRI these days to either help with a breeder's breeding programme by supplying MRI info, or if I were considering surgery.

Unfortunately assured breeder schemes generally don't mean too much in terms of many breed health issues because most have minimal testing requirements, much less even recommendations. They tend to only indicate a breeder maintains a decent premises and does basic health checks that any vet can do. For cavaliers, breeders really should be doing MRIs on their breeding dogs and ideally repeat again after age 5 and follow age-related recommendations for breeding and testing (parents should be at least 2.5 years, MRI'd and cardiologist tested for MVD, as the bare minimum).
 
Hi Karlin,

Yes, you did see my wife's post! We decided to put it both places, with a little more detail/more videos on this forum, since we had read good things about the expertise here!

OK, so on the air scratching we will work on getting a video of him doing it to show the vet/neurologist, but it typically looks the most like the dog @ 1:39-1:41 in this video. He will often do it 2-3 times when walking on the lead per outing, although not necessarily in rapid succession like the dog shown in that part of the video. It would often be more limited/spaced out. It is also often slightly even less distance of the ground with his hind leg, maybe only a few inches from the ground.


Last night, after playing tug for a while (and maybe being a bit overstimulated) he did an air scratch for his ear/neck with his hind leg and missed by a few inches, almost exactly liked the dog @ 2:05 in the YouTube video. He did the same type of air scratch, one time yesterday, stopping suddenly when walking on the lead and reaching for ear/neck but coming up short.

Thank you so much on your input on the MRI, etc, that aligns with what we were thinking! We will read up Dr. Rusbridge's work as well, but think your explanation makes a ton of sense.

This is obviously a question for the vet/neurologist as well, but in your opinion, would it be too early for a puppy to start basic medication if a neurologist deems SM likely and he continues to show symptoms?

Thanks again!
 
It's not too early at all for meds. However -- you have a ways to go before confirming this is what's needed. I'd suggest using Rod's list of recommended neurologists on his www.cavalierhealth.org website and ask your vet for a referral for a clinical exam. You can state you do not wish to do imaging at this time in advance, but to talk to the neurologist and have a clinical exam, to consider if you have something to be concerned about, and next steps.

Clare Rusbridge's website has very useful information especially if you can work your way through some of the vet terminology. Cavalier Matters is very good on pet-owner friendly explanations (just be aware you often need to hit the arrow to see the next page), while Cavalier Health has both owner-friendly but more detailed discussion, and the heavy duty medical stuff and all the latest research.

Personally, I wouldn't MRI until and unless I wanted to take a decision that included surgery, and probably not until a dog would be old enough for surgery. This is because I don't like putting dogs through procedures if the end result for treatment is the same, and with CM/SM, if a dog responds to meds then that's pretty much a diagnosis. Clare had posted a paper on FB by other researchers a while back that notes this approach. This paper by Clare is very informative if you can handle the vet terminology: https://bvajournals.onlinelibrary.wiley.com/doi/full/10.1136/inp.m1869

IF you do have a younger dog showing symptoms then I would probably want to eventually MRI to consider surgery simply because younger symptomatic dogs are often worse-affected. If you do opt for an MRI at some point (and Clare tends to wait until over a year, so that growth plates have fused), you can get a second opinion virtually from Clare, I believe she still will do these consultancies. If I were facing those decisions, I would want Clare's view as she takes a considered and more conservative approach than many who will always jump to recommend surgery. But that's me.
 
It's not too early at all for meds. However -- you have a ways to go before confirming this is what's needed. I'd suggest using Rod's list of recommended neurologists on his www.cavalierhealth.org website and ask your vet for a referral for a clinical exam. You can state you do not wish to do imaging at this time in advance, but to talk to the neurologist and have a clinical exam, to consider if you have something to be concerned about, and next steps.

Clare Rusbridge's website has very useful information especially if you can work your way through some of the vet terminology. Cavalier Matters is very good on pet-owner friendly explanations (just be aware you often need to hit the arrow to see the next page), while Cavalier Health has both owner-friendly but more detailed discussion, and the heavy duty medical stuff and all the latest research.

Personally, I wouldn't MRI until and unless I wanted to take a decision that included surgery, and probably not until a dog would be old enough for surgery. This is because I don't like putting dogs through procedures if the end result for treatment is the same, and with CM/SM, if a dog responds to meds then that's pretty much a diagnosis. Clare had posted a paper on FB by other researchers a while back that notes this approach. This paper by Clare is very informative if you can handle the vet terminology: https://bvajournals.onlinelibrary.wiley.com/doi/full/10.1136/inp.m1869

IF you do have a younger dog showing symptoms then I would probably want to eventually MRI to consider surgery simply because younger symptomatic dogs are often worse-affected. If you do opt for an MRI at some point (and Clare tends to wait until over a year, so that growth plates have fused), you can get a second opinion virtually from Clare, I believe she still will do these consultancies. If I were facing those decisions, I would want Clare's view as she takes a considered and more conservative approach than many who will always jump to recommend surgery. But that's me.
Thank you so much Karlin!

We were successfully able to get Barkely a neuro appointment on July 18th (nothing sooner was available in our area :( but we're on the cancellation list if something pops up). He needed some blood work to get a referral but we were able to get that done today.

The neurologist we were able to get an appointment with was unfortunately not on the list on the Cavalier list of board certified vets, but our thought was it was best to get him seen ASAP and we can work on finding him more of an expert later.

I wondered if you had any thoughts on the following:
  1. Thankfully, knock on wood he doesn't do it nearly as much during the day, but at night before bed in his crate, he's been frantically scratching at the back of his neck and ears (usually making contact, but a few air scratches) and biting his back paws and digging at his bed. Hopefully this is something that gabapentin might help him with, but before we're able to see the neurologist do you have any suggestions on something that might soothe him? Lying by his crate and speaking in a low voice helps a bit, but it's still pretty hard to watch and he seems to be very uncomfortable for 20 minutes or so before sleeping. I saw that Claire R's paper mentioned CBD so I was thinking maybe this was something we should ask our vet about.
  2. He seems slightly more inclined to phantom scratch after we've been playing with him. I'm loathe to stop doing that because it seems to be his favorite thing in the world, but I'm wondering if we should do it less frequently?

You've been so helpful thus far and I know you're busy so we'll try to stop throwing so many questions at you after this.
 
Oh please ask all you want. :)

I'd print this out: https://veterinary-neurologist.co.u...-medical-treatment-algorithm-2018-locked-.pdf -- it's a single sheet version of Clare Rusbridge's treatment algorithm -- and bring it to your vet for further discussion. You could trial him on gabapentin. If the scratching then stops, you likely have your diagnosis there. Dosage is prescribed by animal weight. You'd probably start with twice a day and see what happens. You could also ask to try an NSAID, such as metacam.

I still think the jury is out on what is going on. So many of these things might be shown by normal puppies. Our great pyrenees pup chewed at feet, scratched, bit at himself, chased his tail, did that digging on his bed -- and this isn;t a breed that gets SM and he's a normal adult (though scratches towards his elbows still which kind of can look like air scratching, but he has a benign liquid-filled cyst there that sometimes must irritate him. The other point I'd make again, is that puppies this young tend to scratch towards their neck or side at collar or harness when on walks as they just aren't used to the collar/harness. It can look like air scratching but actually is a kind-of attempt to scratch while walking. The digging could just be normal stuff too -- dogs often dig at their beds, my adults dogs do, including the pyr and Newfie, or yes, could be redirected SM or other discomfort.

This isn't to reject your concerns or what you are seeing; it's just to say it can be really hard with puppies to know what's going on and it might be CM/SM or could have other causes including just normal puppy behaviour. My own vet has noted to me how difficult it can be to not get worried about cavalier puppies showing the self-biting/chewing and scratching etc that is pretty normal with all puppies. So I'd try to enjoy and play with him as you have been. Clare BTW has often said she advocates dogs continuing with activities they love, such as agility, even with CM./SM as long as it is not bring on pain. She has noted there's some evidence the endomorphin release from doing exercise may well make a dog more, rather then less comfortable. With a puppy you definitely do not want to lose weeks of important activity and play, either, as these are critical mental and physical development times for him.

If it's any help if he does have CM/SM nothing will significantly change in the coming month as you wait for your appointment. Even if you were opting for surgery, most neurologists recommend waiting for many more months. If you do opt to try meds with your vet, then ask the neurologist's office of you should take him off anything in advance of the appointment. Just NB too that steroids should not be prescribed; they are viewed as a last-option medication as there are many other options and also, they can affect MRI images. It doesn't;t sound as if that's anything your vet is thinking about. You don't seem to be seeing signs of obvious pain, do you? Also: Clare doesn't believe chewing at feet is a sign of CM/SM...
 
From Clare's clinical signs sheet on her website (https://veterinary-neurologist.co.uk/cm-p-and-sm-s-clinical-signs/) :

My dog is very itchy with rubbing at the head, chewing of feet, scratching the belly and other places – is this syringomyelia?

No – this more likely a skin condition (allergies / fleas / Malassezia etc) and your dog should be investigated and treated for such. Syringomyelia can be an incidental finding on a MRI and/ or a dog can have more than one medical condition. Syringomyelia does NOT cause generalised pruritus (itchiness). See also phantom scratchingand signs of CM-P.
 
From Clare's clinical signs sheet on her website (https://veterinary-neurologist.co.uk/cm-p-and-sm-s-clinical-signs/) :

Hi Karlin,

He is generally bitey at his feet and tail, but does the air scratching specifically maybe ~5-10 times/day. He primarily does it with his back left, but occasionally with his back right as well.

This is the video I was planning on showing the neurologist next month (air scratching with his right hind leg): https://drive.google.com/drive/folders/1hdwDN4xYAPu0gCO5v67jz6yMpLrT0Cui?usp=drive_link

Generally the scratching is low the to the ground (like in the video), but he sometimes will bring it closer to his head/neck.

He does it both when sitting down (like in the video) and also when standing on his other three paws.

Some days he'll only do it once or twice, but others more frequently. It definitely seems more common when he's on the lead (we do use a harness for him) or when he's excited in the evenings.

It's a difficult time because (maybe for the better, it's relatively infrequent and hard to catch on video) so I try to watch him to gather video evidence so that we can't get him some help from the neurologist, but then obviously I don't want him to be air scratching because I know it means he's uncomfortable. And I'm of course hoping that medicine can help him, but then am feeling scared about his prognosis showing phantom scratching as such a young puppy.

At least he seems so happy and full of joy right now and doesn't really seem to show signs of pain.

I know there's not much anyone can do to help, but it just feels cathartic to write this out.
 
I'm glad it helps at least a bit to release some stress by talking further about this. I can't view your video, as you'd have to give access to your drive. I know it is really hard to wait on an appointment, but it will come up fast. Enjoy Barkely right now and do lots of things with him -- this is a fun time with a puppy and he's learning all sorts of things and enjoying exploring. Rereading your earlier posts I hope you are no longer concerned about his shaking out, as that's such a nice thing to see and shows he's happy. Also the fact that he's moving well and quickly is all good. Given that he moves so well when up and going I'd think that's probably more important than getting into a standing position in the morning. Also, sitting down mid-walk, or laying down, or freezing in place or sitting down to scratch are all just really typical puppy things on walks. A year ago I was going through all of that with a big Pyrenees fluff ball. BTW walks should be limited to 5 minutes for every month of age in puppies or can put to much stress on joints -- their joints aren't fully formed at this young age. So 15 minutes a day at 3 months, 20 minutes at 4 months and so on. At this age, just the socialisation, introduction to new things, noises, people, dogs etc on walks is more important than getting any distance exercise. Puppies play so much at home that they'll always get exercise.

One thing I've learned from having lots of CM/SM cavaliers over the years, plus heart disease eventually in all and some other conditions to manage -- is try not to worry until you know you have something to worry about, and even then, try not to obsess about what could happen because it's just impossible to tell. I wasted so much time and anxiety over things that never actually happened and when some things did come along, it often was not what I'd worried about anyway. Meanwhile I knew people who lost dogs due to accidents or sudden onset illnesses (and I lost a cavalier to the latter at only 5). And my cavaliers with CM/SM, degenerative myelopathy and heart disease all lived til at least 10.

Please let us know how the appointment goes and come here anytime to post or ask anything you'd like.
 
Barkley had a very good day yesterday. Almost no air scratching and did some great walking on his leash outside. Was feeling very optimistic.

Today has been bad. Yelped loudly when playing and started lots of air scratching shortly after. It’s continued intermittently since then this afternoon. He’s teething so maybe yelp was pain from that, but doesn’t feel like a coincidence with the air scratching.

At least his neuro apt is only a few weeks away.
 
Glad he had a good day yesterday but sorry not so good today. Has the weather changed? Changes in air pressure can have a noticeable effect on symptoms.

I really hope you get some answers at your appointment.
 
So sorry for the uncertainties, it's so hard to have to wait. I'll be eager to hear what your neurologist has to say, and fingers crossed for you all.
 
Poor Barkley had a pretty good week, but is easily having his worst day ever today.

Was rubbing his head on the carpet this AM and has been air scratching every couple of minutes. Sometimes he loses his balance and stumbles when doing it 😔. His legs will sometimes just twitch when he’s sitting too. Also doing some just actual rubbing at his neck and ears which then turns into biting his feet.

At least he still seems happy enough and is running around our apartment and playing.

He finally has his neuro appt on Thursday so hopefully we can get him some medicine soon.

I’m hopeful this is just a tough day but fearful that this will be the new normal.
 
Oh no, This must be so stressful for you. I'm really glad you are now coming to the week of your appointment as I am sure it will at least feel better to be moving forward and determining exactly what is going on. Fingers crossed for you.
 
I'm so sorry to hear this, it's really distressing for you both.

Hope today will be better and it's not long until your appointment now, thank goodness.
 
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