Chiari Malformation & Syringomyelia

[lehughes]

Hi Laurie,

I work with a Cavalier rescue, and so we tend to see a good number of COSM/SM dogs (presumptive diagnosis typically). Usually, they are geriatric with little to no known previous history and varying degrees of clinical signs.

The goal with most of these guys is conservative management, which I have found to be a bit frustrating.

My treatment goals from a conservative standpoint have been focused on pain control first, followed by working on maintaining core strength, balance, and proprioception. So far, I have not had one become “asymptomatic” with therapy.

Am I correct in thinking that the neurologic findings and phantom scratching are simply not going to improve, and I should consider a case successful if their pain is well managed and their symptoms at least plateau/stop progressing and they are independently functional? Or should I be aiming for more?

Here’s what I tend to offer to most of them:
Meds: NSAIDs or pred, Omeprazole, and then titrate adjunctive drugs like Gaba, Pregabalin, Amantadine, etc based on pain level
Herbs: Cervical Formula, Body Sore mostly (Jing Tang Chinese Herbals)
Modalities: Assisi Loop at home, In clinic laser therapy, electroacupuncture
Exercise: typically UWTM once pain is stable combined with a HEP, but sometimes we will do the land-exercises in clinic too.
Luckily, the main foster is very capable with HEPs at home.

Am I missing anything or do I just need to reset my expectations?

Thank you as always!
SB

[lehughes]

Hi S.

Now, as for these dogs, from a rehab perspective, it’s two pronged.

1. Root of the problem - brain stem / nervous system
2. General health (HEP, UWT, in clinic exercises)

3. (for me as a non-vet) would be to ensure other things, such as Meds, have been discussed / prescribed / taken as per the rDVM.

So, #1 is your best chance of reducing symptoms. Maybe you can’t make the dog asymptomatic… but perhaps you can reduce how symptomatic the dogs are.

You don’t say where you are directing your laser. I would laser the brain stem and upper cervical spine region. Lots & High doses. I might also consider upper cervical acupuncture (local points, and central points along the GV meridian). AND, mobilizations to the OA, AA joints and maybe cervical traction (see how the dogs do with this - if they are super reactive, then sometimes the manual therapy can set off an episode… but then you learn what is tolerated and what is not. No long term harm.) Ah, and craniosacral therapy might be a consideration. Helps in some.

So, ’sort of’ yes that success is pain management and plateau of symptoms and independently functional… but I do think we can help to extend the amount of time / intensity of the episodes.

I help this helps…

Cheers,

Laurie