Chloe B

Author:
Dr Dave Tittle | BVetMed | CertVA | MRCVS | GP Certificate in Western Veterinary Acupuncture and Chronic Pain Management | RCVS Advanced Practitioner Veterinary Anaesthesia

Contact:
To correspond with Dr Tittle please e-mail us at [email protected] 

Case History

  • Name: Chloe B
  • Age: 5 Years 10 months
  • Sex: FN
  • Species: Dog
  • Breed: Cavalier King Charles Spaniel
  • Lifestyle: Family pet
  • A brief history of the animal’s family history:
    Owner had since puppy. Family pet who is adored by owner.
  • Interventions:
    Medical intervention only.
  • A brief history of the problem which animal is being treated for:
    Chiari malformation – diagnosed at 5 months via MRI after head nod noticed. Subsequently monitored via MRI as clinical signs progressed to syringomyelia with Chiari malformation. Now (5 yrs 10mths), progressive addition of medications to try and control signs over the years. The owner repeatedly declined referral for surgery.

Examination findings

Supportive media:

Routine blood tests – Chem 17 and electrolytes throughout life have always been within normal ranges, with the exception of hypokalaemia and pancreatitis following the introduction of frusemide to her drug cocktail at 3yrs. This was immediately withdrawn and alternative therapies instigated.

Treatment

Current Medication

Active Proprietary name Dose
Robenacoxib Onsior 60mg SID
Topiramate Topamax 25mg BID
Pregabalin Pregabalin 20mg BID
Cimetidine Zitac 100mg TID
Oclacitinib Apoquel 3.6mg SID

Complementary Therapy 

Active Proprietary name Dose
CBD/CBDA/Terpenes ElleVance 7mg BID

Special instructions: 
Owners to encourage her to mobilise and exercise where possible.

Owner education:
Owners are very informed and willing to try most medical interventions to improve her QOL. Oclacitinib was introduced following a sole case report in Germany, suggesting an improvement in clinical signs in one dog.

Measurable outcomes and Conclusion

Outcome:
She was initially very lethargic following the addition of ElleVance but emerged from this after a few weeks. She is much less frantic, although some separation anxiety signs remain. Historically, she would follow her owner around the house but is more likely to stay on the sofa when her owner leaves the room.

Remaining problems and goals:
It is expected that her condition will progress and deteriorate further. However, there are limited additional medical options available.

Conclusion/ Discussion:
She has now been stable on ElleVance, in addition to her conventional medications for eight months (currently). She can now wear a harness for up to 15 minutes without evoking a scratch reflex. At the eight-week stage, for the first time in 2 years, we have been able to collect a jugular blood sample without some form of sedation. Historically, this has been quite difficult and dramatic due to her intense scratch response. She is far less frantic in the consulting room, and her owners report less so on car journeys also. Her owners say that for the first time in years, she will now play with toys and seek to interact to play.