Riley has Syringomyelia

It was those three simple words that instantaneously crushed our hopes of enjoying a normal future with our 17 month old puppy, Riley. All of the hopes, plans and dreams of our beautiful puppy growing up into a healthy, active dog who lives well into his teens seem less sure with the uttering of these three words: Riley has Syringomyelia. We found out yesterday, at 3:05 pm, after his MRI was done and the radiologist was kind enough to take us aside and slowly go through his films.

A bit of history on Riley: We have had concerns about Riley since he was a puppy. Specifically, we've been worried that he may have Syringomyelia (SM) which epidemic with the Cavalier King Charles Spaniel (CKCS)breed. Our initial concerns were, admittedly, based on some very broad symptoms that are not uniquely specific to SM. We brought this up with our vet in NJ when he was a puppy and he poo-pooed it. When we switched Riley over to our old vet back in New York City last fall, we mentioned it to Dr. Mlekoday and she said (correctly) that the signs and symptoms of his "air scratching" and his extreme tenderness (that causes yelping) when touched under his arms and around his neck should just be presumed to be a tick unless (at some point later on) it is suddenly accompanied by pain. Well, it never has been until now. Of late, his scratching can go on for quite prolonged periods of time. It's totally maniacal behavior. Compulsive. Uncontrollable. But he's only 17 months old, and lots of behavioral quirks can go on until after he's two. So, really, there has constantly been this underlying belief of, "It's nothing and he'll grow out of it."

The tipping point was this past weekend. Ethan was sitting quietly on the couch, Riley was fast asleep next to him. All of a sudden, for no reason, he leaped up out of his sleep and started shrieking and yelping in pain. We couldn't calm him. He did it a second time later that night when sleeping next to Michael and then he started to favor his back left leg. All of this together triggered a gut instinct in Ethan and it made us very suspicious. (Ethan's side note: Call it clinical intuition, but my practice of podiatric medicine and surgery is -like most good clinicians- based on my gut feelings in many ways. My gut told me this was not good.)

We decided that, even though an MRI is phenomenally expensive, the cost of not knowing and not treating this early enough could be greater. So we called yesterday and scheduled him for the MRI today. We just came back from his MRI and he's resting comfortably at home. Sadly, my instincts were correct; Riley has Syringomyelia (SM). A pretty significant case of it, too. The lesion (syrinx) goes from the brain-stem/Cerebellum as far down as the MRI imaged (past C-6). More than likely, if we scanned him all the way down to the tip of his tail, there'd be more lesions, too. That's what the veterinary radiologist said.

We spoke with our family Vet, Dr. Jen Mlekoday, this morning and she felt that we should head over to see Dr. Jason Berg up in Yonkers, NY. She said that he was involved in some of the earlier studies and research in the United States on the phenomenon (and subsequent epidemic) of SM in CKCS. So we have an appointment with him for Monday morning and will likely have more information then. We have been looking, though, at surgical specialists in SM in The CKCS around the country and there are quite a few, so we'll need to do our research before committing to anything one way or the other. We have started Riley on Rimadyl 25 mg daily to help decrease inflammation around the inflammed structures. This is step one and we'll see if this helps at all.

A PICTURE SAYS A THOUSAND WORDS:

Below on the left is a "Normal" MRI scan of the Brain and Spinal Cord of a Cavalier King Charles Spaniel. It is labeled and for anatomic structures:



















Below on the right is not Riley but a labeled scan of another Cavalier King Charles Spaniel with Syringomyelia. Note the differences from the above (normal) scan:
















And here, below, is Riley's MRI from yesterday. Note the severe swelling of CSF about the spinal cord, the extrusion of the medulla through the foramen magnum, the hydrocephalus and edema in the ventricular system. The syrinx, though not visible in its entirety on this view, extends the full length of his C-spine: