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Please advise needed, desperate

ann

ann

Well-known member
Ellie is almost nine, she was diagnosed with SM this year and we are still coming to terms with that, she is on Pregabalin and Tramadol ( Tramadol sparingly )
She had a mild Luxating patella from a pup, and we were surprised when we were told at vet hospital, that it is now grade four!........the hospital wanted to operate, but our own vet said she thought Ellie shouldn't have op, as she had enough to to endure with her SM and also a heart murmur....we totally agreed.
Well ten days ago she started limping very badly, holding back leg up and in obvious pain, we were on holiday and phoned emergency vet who said give extra Tramadol and rest her......we are now home and seeing our vet on Monday....
Ellie's SM is bad, and the thought of putting her through a major painful op, just doesn't seen fair......
She is pottering round the garden ok, and I take her out in a dog buggy.....I am recovering from a major back op myself and hubby and I are in out seventies.....
ps: forgot she is also on Loxicom......
 
Oh dear, I am so sorry that Ellie is having such a bad time.

I agree with your vet about sparing her from the surgery; she has quite enough to cope with with having SM and who knows how much extra stress the anesthetic would carry with it.

If she were mine I would try a slight increase in the Tramadol. I used it sparingly for 2 or 3 years with Rebel too, but I didn't hesitate to give extra when his mobility was compromised or the pain levels became more severe. Remember SM is a progressive condition, so is subject to frequent change, even the weather or air pressure can make symptoms much worse, so look at what is happening with Ellie and adjust the medications accordingly.

Lastly, if you don't think the symptoms are too severe to cope with using the medications you already have, then don't hesitate to speak to your vet. There are other drugs and treatments readily available which may well give relief.
 
.Flo thank you so much for helping.
Ellie was on Gabapentin before we tried Pregabalin , and she has gone from two to three a day......My vet always seeks advise from pet hospital......It seems the next step would steroid treatment........They seem very wary of upping her Tramadol, but I have given her an extra dose when she has been in a lot of pain......I cannot bear to see her in pain....rarther it be me..
I am so glad to have found this forum again.....only people with dogs with SM etc can understand what us Mummies are going through.....please keep talking to me, I am feeling very lonely and upset.....
 
Hi Ann

Sorry you're having such a tough time with Ellie - CM/SM does tend to take over your life! Like Flo, I would be wary of surgery because it could be so painful for her. I would let Ellie do what she can, otherwise rest her and take her in the buggy. With a younger dog steroids can produce long-term side effects, but this wouldn't be such a problem with a 9 year old. The prime concern at the moment is to keep her comfortable. I hope you and your vet can manage to do that.

:hug:

Kate
 
Thank you so much Kate....I think we all agree (except the head vet at the hospital) that it would be cruel to put Ellie through a big op on both legs....
Apart from Tramadol and Loxicom, what other pain killers can I suggest to my vet?. She seems to want to ask the vet at the hospital for his advise (and he is VERY against too many pain killers, as he wants to operate).....
I just want to keep Ellie as free from pain as is possible, like all of us with our babies.......
 
There are othr effective medications here for SM, which I haven't had to use for Rebel, but there are others here who have. I am thinking of Omeprazole and Lyrica in particular, but I believe there are others too. There are ever increasing little cocktails of medicines tweaked and tweaked again to relieve the SM symptoms for many dogs.

Has your vet looked at Dr Clare Rusbridge's Algorithm. You will find a link to it on the SM Section of this Forum, plus a lot of other helpful advice. I gave a copy of this to my GP vet because she had no experience of SM until she took on Rebel, but she found it invaluable and I am told that she spoke to Clare on the telephone a couple of times when she wasn't too sure what to do next.
 
Thank you Flo,
My vet phones the vet at Chestergates for advice, but I will mention Dr Claire to her on Monday when I see her.
I have just been reading some of it and it's very interesting. I think Lycra is the same as Pregabalin? And that's what Ellie is on.......Thank you again for taking the time to help me, it's very much appreciated........Ann.....and Ellie woof woof
 
Took Ellie to vet today, her advise was to rest Ellie as much as possible ,and take her back in two weeks if no improvement . She then thinks we should think about Ellie having the surgery. I asked if she had heard of Dt Claire and she said no.....I also asked if she thought Ellie should be taking Omoprozole and she said no....
I came home and had a good cry, .....how can I put my dog through so much more pain, and yet I no if I don't, her legs are just going to get worse.......Advice anyone?
 
Personally, I don't like your vet's approach. I would avoid surgery. Do you have other options for neurologists who could see Ellie? You do not have to stay with a vet just because you started going there.
 
When Ellie had her MRI, the vet at the hospital said she also had grade four LPs, and that in his opinion she should have her legs done.....So I think my own vet is also now agreeing with him, whereas at first she said it was too much for Ellie because of her SM and heart murmur.
I can only hope if we rest her, she will improve, or I have to watch her struggling to get around....
Sleep won't come easy for me tonight.........
 
I'd really try to have a neurologist see Ellie about these decisions; they are difficult ones to make. If she is having SM pain despite being on Lyrica (which is pregabalin) she needs her meds adjusted properly by a specialist. She could be on a range of other additional things (which are all pretty inexpensive) or she may need a higher dose of pregabalin. But usually neurologists put SM dogs on a mix of medications rather than one on its own, especially for breakthrough pain.

I'd also want to be sure the joint pain she is showing is actually the patella and not due to SM?

The other consideration is: would undergoing surgery create more pain for her, or is she suffering more pain having a bad patella remain unaddressed? Vets have very limited ability to deal with these issues, which is why I'd go to see a specialist if you can.
 
Karlin, thank you so much for helping...let me try and answer a few things........Ellie was diagnosed at Chestergates and the vet was a specialist in veterinary Neurology..he also diagnosed LP grade four both legs and said back in April she should be operated on ( both my own vet and me thought at that time it would be too much for her, but she is worse now)
Her medication is.....Loxicam once a day and Pregabalin 25 mg three times a day.....and I have Tramadol,but only to be given sparingly...
If I go to ask my vet a question, she usually rings hospital for advice....
Ellie has breakthrough pain from SM and usually after she has eaten around five, she has head nodding and becomes very restless .
She is in more pain now and limping badly, her LPs is just popping in and out.....
I know she needs op for this, but I cannot stand the thought of putting her through such BIG ops when she is already in pain....and is almost Nine......I am extremely grateful for your advice..........
ps....I do agree that if her SM was under better control, I might consider the operation on her legs.....might!
 
Hello Ann,
I'm sorry you and Ellie are having such a tough time of at the moment. I also have an SM dog and she was diagnosed at Chestergates. We used to see Ulrika, but as she isn't there anymore Phoebe is now treated by Lucca.
My girl is on Pregabalin (Lyrica) 25mg three times a day and I was told that was the maximum dose for her weight. I would imagine that you were told the same so it's a case of increasing or introducing some other medication to try to keep Ellie more comfortable. Phoebe also has a small dose of Metacam every day, we have started her on a low dose because her stomach doesn't deal with meds very well and also so that we have room to increase it on her bad days or in the future as her breakthrough symptoms progress. There is no doubt that the Metacam is helping her along with the Lyrica. I'm not sure if Ellie could have Metacam as well as the Tramadol. It would be a good idea to have a chat with the neurologist at Chestergates I think.
Phoebe is 8 years old and has several serious health problems so there is an awful lot to consider before we can change a medication, add anything or consider any kind of medical procedure. It is a very difficult situation and I understand how you must be feeling about coming to a firm decision about surgery for Ellie.
I always keep one thought in the forefront of my mind when making decisions about Phoebe......quality of life.
For as long as she still enjoys doing what dogs do, which is going for walks and having the opportunity to sniff anything and everything whilst out and about (even if only for short periods) which is what they love, enjoying her food and having great big cuddles, then her life is still good.
If however her mobility is so reduced that her life is miserable or greatly compromised, I would consider the option of surgery.
We want to keep our babies with us forever, but I have had to accept that for my Cavaliers, quality of life is absolutely paramount. Only you can make decisions for Ellie but I would try to see your neuro again to have a good chat. Would it be possible for you to speak to the consultant that would possibly be carrying out LP surgery on Ellie? You might find that hugely reassuring.
I hope things settle down soon for Ellie and I'm sending you a wee hug to help you feel less lonely about all of this.

xx
 
Oh wow Phoebe we have the save vet.......Luca......I will get back to you, we have just come back from the park (Ellie in her buggi)....loves it ��
 
Hi Phoebe (sorry is that your name or your doggies?)
It seems that our girls are on the same meds....Ellie takes Pregabalin 25mg three times a day and has Loxicom in the morning ( it's the same as Metacam) and then Tramadol when I think she needs it.....
I have only seen Lucca once in April, when Ellie had her MRI......
My vet phones Lucca to ask about Ellie, and I think the next step would be Steroids (something I am not keen on, but may well have to try).......... I do know he thinks Ellie should have the LX operation....But her SM is not fully under control, I can tell when she is in pain, it's dreadful, she sits and stares at me... So how can I put her through a big operation...
Yes she is in pain now, ( she has been hobbling about on three legs for two weeks ) my vet wants her to have no walks for another couple of weeks to see if she improves)...then I have to decide what to do.....
I completely agree with you that it's the quality of her life that matters, and right now I think it's the SM that needs addressing .....She can run round the garden even though it's on three legs.....
I am so sorry about your poor doggie, but you seem to have got her meds under control, somthing I havnt achieved yet......If I speak to Lucca, it will be.....Steroids and LX operation.....I know they are the experts, but our doggies are our babies, and sometimes I think we can disagree, or am I wrong?
We have been to the park this morning, and Ellie sat in her buggy and I just knew she was loving her outing.....Now she is fast asleep and snoring.....Later after her meal.....she will start with the panting and restlessness...scratching the carpet ETC....
Anyway I will shut up now, but I am SO grateful for all the help I am getting.....makes me feel as though I have friends that LISTEN.....thank You......
 
Hi Ann,
Forgive me but I shall have to keep this brief because I'm off to visit a poorly parent in hospital in a few mins.
You absolutely can disagree with your consultant and have a right to do so. Any treatment Ellie has must be with your consent and you must feel comfortable with it.
I actually told her neuro what I intended to do with the Metacam. I know her constitution so well now and knew that just dosing her up with Metacam without doing so gradually, would cause her to have dreadful bloody poops and a very poorly tummy. I introduced the Metacam over several weeks starting with tiny doses in her morning food and increasing them very slowly. It hasn't caused stomach issues thank goodness and it is helping.
What dose of Loxicom does Ellie have? Perhaps after or with her meal she could have a further small dose to control the restlessness?
I wonder if starting Ellie on steroids might help everything generally?
If you feel that Ellie's SM is not under control properly, how about just coping with one thing at a time and dealing with that first with the Steroids? Give it a few weeks and then revisit the LP problem? I've been in a similar situation with Phoebe where you end up not being able to see the wood for the trees because you are worrying about so many things at once............how about breaking things down into manageable pieces?
We are very limited as to the meds that Phoebe can have because everything sets off her inflammatory bowel disease, sadly the only thing left for her now will be steroids when her other meds are not adequate, but I know without a doubt that her stomach will never tolerate them and I think that Lucca understands that, but doesn't know what else to suggest.

Must go now, but you are certainly not alone in dealing with a Cavalier with more than one serious health issue, it just ends up feeling like a scarry blur at times and you think no one else could possibly understand!

xx
 
Hi Ann

You have every right to ask for a second neurologist's opinion - perhaps taking Ellie to see Dr Clare Rusbridge (that's the algorithm one! But also the UK's top expert on CM/SM and a very nice person as well)? I realise Merseyside to Farnborough in Surrey is quite a trek - Clare is based at Fitzpatrick's Referral Hospital, home of Noel Wotsit the TV vet - but she is brilliant at disentangling situations. At the moment you, your vet and Lucca, with the best will in the world, aren't disentangling anything - neither Ellie's CM/SM pain nor her painful patellas. Sometimes it just needs a fresh pair of neurologist eyes to see some fresh possibilities. And there are other possibilities: for example, my Oliver's main problem with CM/SM was dilated ventricles giving him splitting headaches; gabapentin really didn't help it because the basic problem was pressure, rather than the pain it caused, but a neurologist suggested a drug used to reduce cranial pressure in humans with epilepsy and bingo! the headaches went. The CM/SM specialists are constantly looking around for more medications that could be safely used for dogs - Oliver took part in several trials on CM/SM pain and pain drugs at the Royal Veterinary College.

As Phoebe's mum says, there is a way through the wood, but the first tree is getting Ellie's SM pain under control - only then can you fairly estimate the risks of a patella operation.

:hug:

Kate
 
Kate thank you for your help....I would love for Ellie to see Claire, but it's just too far unfortunately , and I am recovering from a major back operation too...You are quite right about nothing getting done and I am going to get in touch with Lucca and tell him that I WANT Ellie's SM sorting out.....In fairness to him, he has only seen Ellie once and did ask that we go back......But my illness has prevented that, and my vet has been phoning him....But he needs to see Ellie again at Chestergates, or speak with me on the phone.....
If he can get Ellie's SM under control, I would really have to think hard about the LX operation. She is nine soon,and hopefully she has more years left, but it's not fair to her to be confined to the house.....she loved her walks....
I am taking her out every day in her dog buggy and she loves it....but while I am getting the Excercise , Ellie isn't.
Has anyone else with a SM dog noticed they have increased pain later in the day? And if so, do you know why?
 
I would definitely go and see Lucca again and have a really good talk. From the biography on the Chestergates website, he isn't particularly a CM/SM specialist (we tend to forget that there are other neurological diseases to specialise in!), so it might be worth taking Clare's algorithm with you and discussing with Lucca any options open to Ella before starting on steroids, which Clare always regards as a very last resort because of their side effects. If he can't come up with any alternative to steroids, you might be able to persuade him to phone Clare and discuss it (and perhaps how an operation might affect Ellie). Sometimes it can help to give steroids for a limited period, just to break the pain cycle, and then ease back into pregabalin.

Oliver used to have his worst headaches when he was dozing, regardless of the time of day. When they are alert and doing things, especially going for walks (or buggy rides! My Aled, who had mild CM/SM but was in heart failure last year, loved his), dogs have a great capacity to switch off from pain, but when they are dozing their guard is down. There may also (though this is my guesswork!) be a connection between temperature and increased pain. Human temperature tends to go up in the evening; if a dog's does the same, this may put pressure on the spinal fluid and cause irritation because it can't increase its pace due to CM (I'm sure you know this is why excitement produces scratching in CM/SM dogs - the only time Oliver really scratched was when I was putting his harness on for a walk). But this paragraph is really guesswork - I expect someone will come up with a proper answer!

:hug:

Kate
 
I have emailed Clare,but it's doubtful she will call me back.....I also phoned Chestergates, Lucca is away for two weeks, so she said she will get the other Neurologist to phone me regarding Ellie's Medication.....So maybe I will get somwhere....
Time I actually did somthing.....Thank you for the push, I needed it.....
Ellie also scratches a lot when excited, especially when the Grandchrildren come......I have to ask them not to play much with her.....how sad is that, makes me cry just writing this..........I WILL get her better help, thanks to all of you for helping me.....
Just ordered her some steps to get on the settee, stop her jumping....I will do anything for my girl.....
Any advice from anyone is much appreciated....oh and also raised her food dishes.....
 
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