What to do if you think your dog may have syringomyelia
As awareness of syringomyelia grows, more people are likely to become concerned that their cavalier is showing signs of having SM. This naturally will cause worry -- in many cases, unnecessary worry. Although several research studies now indicate that nearly 90% of cavaliers have the Chiari-like skull malformation, and at least half may develop SM over a lifetime, it is also true that in the majority of these dogs at this time, the effects seem to be mild. In most cases the dog will never show any symptoms or they will be very mild, and the dog will live an outwardly normal life -- though it is important to keep in mind that, as in humans with SM, the dog may be tolerating unknown discomforts that are not expressed in noticeable symptoms, such as headaches, skin-crawling sensations, and some form of chronic pain.
The concern among researchers and responsible breeders now is to halt progression of the condition in the breed and to limit or eliminate pain, so that succeeding generations will not acquire more severe forms of SM (SM appears to grow in severity in successive generations). Unfortunately, because of its apparent complex mode of inheritance and the high incidence in the breed, researchers currently feel it will not be possible to eliminate the condition entirely in the breed.
If you are concerned that your cavalier may have CM/SM, it is important not to jump to any conclusions but to have your vet carefully eliminate other possibilities first before seeking specialist help. These are the steps you will want to follow:
You will want to read through the symptoms document and Dr Clare Rusbridge's introduction to syringomyelia, Syringomyelia Made Simple (both these documents are also available at these links as downloadable Word files that you can print out). As the symptoms document points out, many of the behaviours listed as potential symptoms stem from normal cavalier behaviour. The difference generally is in severity or frequency or oddness of behaviour -- a cavalier with SM doesn't just scratch, but might scratch obsessively, or perhaps does air scratching, where its hind leg makes the motion of scratching but without making contact with its body, often when being walked on a lead. This site also has several video clips showing the behaviour of affected cavaliers that can help you determine if your cavalier is showing suspect symptoms. If you read through both these documents, view the clips, and still think your cavalier's behaviour is suspect, then it is time to eliminate possibilities other than SM.
You will now want to make an appointment with your vet to discuss your concerns and eliminate all the other potential reasons for why your cavalier is showing symptoms that concern you. Be sure to print out both the symptoms and Syringomyelia Made Simple to take with you to give to your vet, as still, very few vets know about this condition or realise that it appears far more frequently in cavaliers than other breeds.
* If your dog is scratching a lot, your vet will want to test for likely causes including fleas, mites (ear and/or body), skin conditions, or allergies.
* If your dog is showing pain, your vet will want to check for injuries, back problems, or impacted or infected anal glands.
* If your dog has weak or stiff or painful limbs, your vet will want to check for injuries, luxating patellas (loose knee joints, a known issue with small breeds), hip dysplasia (a known health issue in cavaliers), or possibly episodic falling syndrome.
* If your dog is having seizures or fits, your vet will want to check for epilepsy and episodic falling syndrome (both are known breed issues in cavaliers)
For some of the symptoms, your vet should also consider PSOM, or primary secretory otitis media, a middle ear condition similar to 'glue ear' in children. With this condition a mucous plug in the middle ear can cause scratching, pain, hearing loss and even neurological symptoms including seizures -- all quite similar to some SM symptoms. There is more information on this condition at the end of the symptoms document and there is a link to a journal article on PSOM in cavaliers in case you or your vet wish to purchase it (it is not overly medical and is understandable to the general reader).
If at this point your vet cannot find any other explanation for the odd, obsessive or painful behaviour, then it is time to check for syringomyelia. You should ask your vet for an appointment with a veterinary neurologist, preferably one familiar with SM in cavaliers. A neurologist will talk to you about the symptoms and in some very severe cases, symptoms alone will enable a neurologist to make a diagnosis. More likely, if the symptoms warrant it, the neurologist will want to schedule an MRI (magnetic resonance image), the only way to make a definitive diagnosis. There are several clinics in the UK that do low cost diagnostic MRIs, while North Americans may be able to get a low cost MRI done through a research project or at a clinic established by Long Island Veterinary Specialists; for details on their low cost CM/SM clinic, click here). There are some other North American low cost sources for MRIs listed on the Low Cost MRI page on this site. However some of these projects and clinics only do partial MRIs of the head and neck -- enough for diagnosis but not adequate if you then opt for surgery for your cavalier. So it may make more sense to have a full MRI if you strongly suspect SM; discuss these options with your neurologist and the MRI centre. Also, different MRI machines produce varying results so you want the best possible MRI you can get.
If you have received a positive diagnosis for the skull malformation and/or SM, then you should discuss this carefully with your neurologist and get a recommendation on what your next move should be. As Dr Rusbridge says in Syringomyelia Made Simple, no one can make a decision for you on what is best to do, and you need to weigh up what is possible, and what fits your dog's needs and your capabilities. Surgery -- either a shunt or the decompression surgery may or may not be an option for your cavalier (decompression is far more widely done; only Chestergates Animal Hospital in the UK routinely performs the shunt surgery); if it is an option, you need to consider which type of surgery, and whether this is the right approach for you. There are also medication options to consider. There is no cure for CM/SM, and it is often progressive in dogs showing symptoms, so make sure you carefully consider all options and the prognosis for each.
You can also join these email discussion lists:
SM support list: http://groups.yahoo.com/group/CKCS-SM-support/
SM general discussion list: http://groups.yahoo.com/group/CKCS-SM
There’s an SM Forum as well on the CavalierTalk.com CKCS discussion board