Puppy Care and House Training Handbook


First an foremost I think it's important to understand the mental development of a puppy. This paraphrased excerpt is taken from a book and author I highly recommend reading. Richard Wolters, Family Dog. In fact, in years past when raising large breed dogs, I would require prospective buyers to read this book prior to purchasing a puppy for me.

Ch.3, pg.12

" 0-21 Days Of Age. The first critical period. During these first three weeks the puppies mental capacity is almost zero. The puppy reacts only to it's needs-warmth, food, sleep and it's mother. But abruptly on the 21st day, his senses seem to turn on like a light bulb.

21-28 Days Of Age. It's during this stage the puppy absolutely NEEDS it's mother. The puppies senses are beginning to function, it's brain and nervous system begin to develop. The world around him is very frightening and taking him from his mother could be drastic.

28-49 Days Of Age. The puppy begins to notice and react to his surroundings, venturing from his mother to explore. At this point his brain and nervous system has developed to adult capacity, yet without the experience. He's been with his litter mates and mother long enough to understand he is a dog. The social order and pecking order begins to take place. The puppy learns to fight for his food or becomes timid and gives in. It's desirable for the puppy to live in the litter long enough for him to shape his personality and competitive spirit, yet not past this point as it could become detrimental. It is believed that at exactly 49 days, 7 weeks of age, it is time for the puppy to be removed from his mother and litter mates. At this point, although physically immature, his brain will have attained full adult form."

( I will add here, I am a huge fan of the 49 days theory. However, due to state laws and the actual tiny, vulnerable size of toy breed puppies like the Cavalier, I often do not place them into their new homes until closer to 8-10 weeks of age. )

49-84 Days Of Age. The trainer and the puppy should start to get to know one another and bond. The person who will solely be training and caring for the puppy will now be in place of it's mother. Through feeding, care, new surroundings and play.During 7-12 weeks of age, a bond will begin to establish that will have a permanent effect on the puppy. Human contact during this age has in Behavior Laboratory research shown to be almost key to the puppy's future prospects as an adult. Puppies that were isolated UNTIL just 16 weeks of age were shown to grow into dogs that were incapable of being trained properly and fully, let alone becoming adequate companion dogs.

Simple commands can be taught during this stage. SIT, STAY, COME.

84-112 Days Of Age. This is when the puppy is ready to start his real training. This is the time a young dog declares independence. At this time, dog and trainer resolve the problem of who is leader and who is follower. With consistent training and reinforcement. Dogs have a strong desire to please. This becomes one of the most valuable tools we have."


Part 1:

I am a firm believer in crate training. It is a HUGE tool and honestly, most dogs come to know it as a safe place, their space, where they can go unbothered and be left alone. It's also extremely handy for you when house and potty training and developing boundaries. I recommend starting out with a much smaller crate than your puppy will eventually grow into. They need enough room to stand up, turn around, and lay down comfortably in. The main reason for starting out small is to prevent them from having enough room to potty in one end of the crate while sleeping in the other. Dogs by nature don't want to mess in their 'house'. They're going to be much more likely to hold it until you take them out this way. And therefore, create good habits from the start. As the puppy grows, I increase the crate size, UNLESS, they seem to still want to potty in the crate. Then we'll just wait a little longer. Now each dog breed is different with potty training. I feel like the males always tend to struggle a little more before they reach their point of being trustworthy. We have to remember, with toy breeds it's going to take longer than with say a large breed puppy like a Labrador. At 8 weeks they weigh almost what a Cavalier weighs at adult maturity. There is a great difference in bladder sizes at this age! While it may feel you're not gaining much ground for a time, remember your training and consistency won't go un-awarded. It is just going to take time for their little bodies to reach a point of cooperation with what you're teaching them. I believe it took 4 weeks to the day of bringing home my first Cavalier that I could tell things really 'clicked' for her with the potty training. She was beginning to recognize the signs early enough to tell me and still have time to get her to the door and outside. I was so proud of her!

For successful potty training, it is essential that you use the same route, same door, same area EVERY time you take your puppy potty. Use the same verbal command as well. Try and use the most streamline location without a lot of doors or stairs. Somewhere the puppy can easily access while still within your sight and hearing. And with a simple opening of the door lands them in the yard able to relieve themselves. Some owners have even found putting a bell on the door handle that the puppy can reach helps both puppy and owner communicate.

I also recommend blocking off an area in the house for the first month or two that is free-space for the puppy without having the entire house at their disposal. Usually the kitchen area where there is no carpeting or rugs to soil or that will retain scent that would cause your puppy to want to potty there again intentionally. It also makes it easier to notice if your puppy needs out or has an accident, rather than finding it in a remote corner of another room a few hours later. If you allow your puppy into other parts of the house, say you're going to be in the living room for awhile, use a long leash so you can keep tabs on their whereabouts. It may seem a little extreme to keep such a tight leash on your puppy. But the best way to train your puppy to be a trustworthy adult is PREVENTION. Don't give them a chance to learn it's okay to dig through the trash or eat your shoes and you won't have to struggle with breaking a bad habit later.

Take your puppy potty often. And be sure to praise, praise, praise them EVERYTIME they potty. Make a BIG deal about it and exaggerate! If, and most likely when, your puppy has an accident in the house: I simply tell them "No" in a normal voice, and then bring them straight out into the yard and praise them, wether they've gone again or not. Clean the accident area well, as lingering smells can cause them to want to potty in that same spot again. If it is on the carpeting it is usually effective to paper towel sponge most of it up. Then pour some water with a little white vinegar or a drop of mild soap on the area, and again using paper towels or old towels step down firmly and soak up as much as possible to get it out. Doing this a couple times if needed. Simply spraying FeBreeze or some odor remover over it will not take away the smell. Dogs have a very good sense of smell and you won't fool them unless it's actually been sponged and rinsed out of the carpet. Rugs of course can just be thrown in the wash.

After every meal, after every nap, after every playtime, take them out potty. Limiting food and water a couple hours before bedtime/crate is very effective in preventing accidents. Now again, we have a toy breed puppy here, they by no means will be able to make it all through the night without a potty break for awhile yet. But we still want to do our best to set them up for success. ( I don't recommend free feeding until after they're completely house trained and if they are able to self moderate and not overeat. Obesity leads to a shorter life span and lowered fertility as it makes them susceptible to diabetes, joint and ligament stress and much more.) I even avoid having water available at all times the first week or two, as this makes it much easier to be aware of when they've drank or eaten and therefore are going to need out. Puppies systems are pretty fast moving. If they eat or drink a little, it may only be 3-5 minutes before things are ready to move on out. So don't waste anytime heading for the door directly after mealtimes and again 15 minutes later!

If your puppy has an accident indoors, make your reprimand brief but to the point, and again, take them straight outside to help them understand. Even if they no longer need to go, it still needs to be reinforced that outdoors is the spot. I'm not a huge fan of puppy training pads unless you truly want them to use them for the duration of their life. Say if you're in a high story apartment without yard access, etc.

Puppies are demanding, busy, quick and can wear us out! Don't ever hesitate to crate your puppy if you need a break, can't be watching them with your full attention, or, need to get something productive done or leave the house for a bit! That's what the crate is for. To allow you to do what you need to do knowing they're safe and not getting into something they shouldn't be or that could harm them. Just be sure to give them the chance to potty before crating them and enjoy a couple hours to yourself. Now, I'm a big fan of taking my Cavaliers with me everywhere-when it's possible. I even have the privilege of bringing my dogs to work. Just be sure to think through what you'll be doing, where you'll be going and wether the temperatures are going to be too hot or too cold for them to be left in the car for a bit. Sometimes they can come, sometimes they stay home.

Part 2:

Chewing is a natural part of puppyhood and continues into the adult dogs life. It's not a bad thing if your puppy is trained what is and isn't appropriate to chew. And close attention early on will pay off big throughout your puppies life. Puppies lose their 28 or so baby teeth around 4 months of age and their new ones, totaling 42, will grow in by about 6 months of age. So keep an eye on things during this period to make sure they're growing in correctly and one doesn't need to be pulled. Again, I will emphasize how important it is to use your crate as a tool during this stage. If you can't keep a close enough eye on your puppy to prevent them chewing something that isn't theirs, crate them. Puppy proof your house, keep them closed off into a smaller area or room like the kitchen for the first few weeks, try and keep shoes and human toys, electrical cords and trash cans out of reach and sight. Leave a variety of their own puppy safe toys, rawhides, large frozen carrots and balls where they can easily access them. This helps them learn what toys are theirs. Anytime you do notice them chewing on or playing with something that isn't for them, I recommend first picking up one of their own toys and then walking over to them. Nothing more than a simple, normal voiced, "No" is needed, while taking away the object and immediately replacing it with their own toy followed by praising them several times. This just simply helps them understand, hey that wasn't mine, but it doesn't matter 2 seconds later because I've got my own toy and mom or dad are really happy about it!

Part 3:

Exercising and the hyper-out of control puppy. Exercise and play time indoors and out are important throughout any dogs life. However, a young puppy shouldn't be taken on excessively long walks, allowed to run up and down a bunch of stairs, jump off furniture or be rough housed and chased by other adult dogs it can't compete with just yet. They need small 12-15 minute play sessions, some tug-o-war, chase the ball or bottle or a short walk around the yard a few times, beginning and ending with a potty break. Often I will try and have these play sessions before I know I'm going to be gone for several hours or before I put them in their crate for bed at night. This way they're naturally ready for a nap time. If your puppy gets really wired or 'out of control' hyper, often it's a good sign they need to go out potty. But if that's already been tried and they're beyond listening and behaving, or too wound up from a longer than normal play session, you guessed it, crate time. They may not be happy about it, but hey, we all need some alone time now and then!

Part 4:

The first several nights, maybe even the first week of nights will be rough. But hang in there and stay firm! It'll be so worth it in the end! I try to stay up a little later than normal, feed them dinner early in the evening, and limit water an hour or more before bedtime. Have a good play session, some snuggle time and a potty break and put your puppy in an out of the way location in their crate. Somewhere they won't keep the rest of the family up all night! Like a spare bedroom or laundry room. Put a towel or blanket over the crate to help them feel cozy and safe. And prepare to hear some serious protesting! I've had some of my puppies carry on for several HOURS the first night or two! But it's amazing just how quickly they figure out it gets them no where. Then by the end of the week I can usually put their crate in a more central location where I can hear them if they need to go out in the night. I only let them back out of their crates when they've been quiet awhile. Or of course first thing in the morning, or if they've been sleeping 4-6 hours and begin to wine needing to go potty. Plan on late to bed and very early to rise the first couple weeks until they get more on a schedule and can hold it longer. Remember, using a smaller crate during this time is key, it helps reinforce that they don't want to potty in their 'house' and therefore must hold it.

Part 5:

Kibble and treats. I recommend offering your puppy all the kibble they can eat in 5 minutes 3-4 times throughout the day. Don't be alarmed if they don't eat more than a couple teaspoons at a time or get easily distracted. Their tummies are little and and they can't hold a lot at one time. Feed a high quality puppy kibble until 6-9 months, then transition to an adult kibble. I like to use a grain-free formula. Nutro-Source or Taste of the Wild are excellent choices. The Dream-Bone brand edible rawhides are a great choice. They're easier to digest and safer than animal hide rawhides that are often from China or radiated and made of hard to digest animal hide. For treats and snacks, fruits and veggies can be favorites. My dogs especially like fresh or frozen green beans, carrot slices, large frozen carrot chunks, apple slivers, and zucchini either fresh or I sprinkle a tiny amount of garlic salt over them and put them in the food dehydrator. Cheerios are also a great option. For training treats I use something a little more persuasive like dehydrated jerky bits, liver, chicken, bacon bits, etc. I'm a big treater. It doesn't have to be a huge treat or snack, just a tiny morsel of persuasion. Each time I call them and they come I treat them. When I let them out potty and they come back in I treat them. If we're on a walk and I call their attention back to me and they look and come I treat them. Even as adults. It ingrains in them that they will be rewarded for staying alert to my voice and commands. Treats aren't just for official training sessions, they're for every time a positive behavior is exhibited. I will even purposely call them when I don't actually need or want them yet, rather than waiting to call them only when I see them about to run after a rabbit or wander over into the cow pasture. I want them to be so used to responding that other distractions aren't so irresistible that they won't listen.

Part 6: Illness or Injury.

Puppies are in one sense a lot tougher than they may seem. They're so small and clumsy. However, the nature of the situation can change things quickly. If your puppy shows any signs of vomiting, diarrhea-with or without blood or lack of appetite don't waste anytime in a vet visit. A 2# puppy can dehydrate much quicker than a large Labrador and things can go down hill fast decreasing the chance of a full recovery. Two most important things to remember with diarrhea or the possibility of Parvo or Corona Virus is act quickly, call your vet at the first sign of trouble and prevent dehydration. Banana bitters are great for firming up stools, simply peel a banana and scrape the inside of the peel and poke down your puppies mouth every hour or two until you can get to the vet. Syringe or dropper feeding water frequently or even in severe cases sterile saline injections under the skin until a vet is available have been able to save a puppy from death or life long complications due to these viruses. Parvo Virus, Corona Virus, Giardia, Coccidia and parasites, including fleas and ticks can all cause a host of problems. The sooner you know what's going on, the sooner you can properly treat the puppy and get them back on their feet. If you're puppy is lacking appetite, seems lethargic, or is vomiting and does not seem to be defecating or is straining during bowel movements without success this can be a serious sign of blockage which can be deadly. Any signs of lethargy or jaundice, yellowing of the whites of the eyes, or lack of quick capillary refill of the gums or pale or purple blue gums can be a sign of kidney or liver failure. Which may or may not be caused by poisoning, blockage or age and a failing system. Keep things like fertilizers, antifreeze, round up, household cleaners and detergents, electrical cords, small objects and mouse traps or poisons all out of reach. Think much like you would childproof your home for a toddler. If you don't have it out of sight and out of mind, there's an awful good chance they'll find it. Simple injuries or scrapes can simply be cleaned out and some tea tree oil or other disinfectant applied. Any injuries to the eye that cause redness, irritation or a film or cataract like blur on the lens to form need immediate attention. They can lose their sight if left untreated! This can happen from an allergy, or debris from an outdoor romp or from playing rough with another dog or toys. Cavalier's also tend to be somewhat of a snub-nosed breed and have smaller windpipes than other larger dogs. It's a good idea to keep some children's liquid benadryl on hand in case of a bee or wasp sting that could easily otherwise become tragic. Keep in mind also that they won't handle hot weather and length of time outdoors in extreme heat as well some breeds either. Some dramamine or other vet approved relaxant can also come in handy for those prone to car sickness. Ear mites can be treated with a solution from your vet and maintenance for prevention can be done by simply wiping the ears out with a barely damp cotton ball or cotton round and then dropping 2-3 drops of one part tea tree essential oil (use a high grade oil like Young Living or DoTerra brand, some essential oils are made toxic due to the way they are chemically processed and can then be very dangerous to people and animals) and 10 parts extra virgin organic coconut oil in a dropper and massaging into the ears. I usually do this after bathing. Because that way I can make sure any water that may have gotten into the ear is wiped out. Ear mites are easily suspected if the ear seems dirty, have a bad smell and especially if your dog is shaking their head and scratching their ears excessively. Some dogs are more prone to ear trouble and may need the hair around the inner ear 'plucked' or tweezed by your vet to allow more air. "Yeasty" ears can also cause discomfort are often a sign of a diet high in corn and other grains or food related allergies. It's wise to treat ear trouble quickly as let go it can cause premature deafness. I also add tea tree essential oil to their shampoo as this naturally repels fleas and ticks and helps dandruff and other skin irritations. I like to add Brewer's Yeast powder supplement found at health food stores to their feed daily as this is a natural way to repel ticks and fleas. It has a high vitamin B content that fleas and ticks literally don't like the taste of. This can also be given to your cats as well. 1/2 tsp daily should be sufficient per 10# body weight. And most dogs love the taste of it.

Genetic problems and other disorders.

As we continue to create a man-made dog of various breeds, we are also going to begin to see more and more genetic and physical problems that vary from breed to breed. I want to discuss a few that are specific within the Cavalier breed and their symptoms to help you be aware should your puppy develop any of them and need additional veterinarian care. It's something as a breeder we never want to see one of our puppies or owners go through, but unfortunately no matter how careful we are with our breeding program, some things are just out of our control. If you do at any point in time experience one of these disorders please keep us informed, as that is a huge way we can gain knowledge to make adjustments in our breeding program for the future of other puppies.

Fontanel: This is when the "soft spot" on the top of their skull does not completely close by the time a puppy reaches the age it is normally ready to leave it's littermates. Leaving nothing but skin to protect the brain. This can result in complications later, IF it does not resolve itself by around 4 months, specifically hydrocephalus-water on the brain. Causing seizures, blindness and other behavioral changes.

Hernia-Umbilical: Umbilical hernias can be heredity, caused by cutting the umbilical cord too short, or excessive stress on the umbilical cord during delivery or soon after from the dam. The mode of inheritance is unknown, but this condition is minor in comparison to other health issues and very common in toy breeds. And, fortunately an easy an inexpensive fix that can be taken care of before the puppy ever leaves the litter.

If the umbilical ring does not close immediately after birth sometimes a little fatty tissue is trapped on the outside of the abdomen after the ring closes causing a bubble-like area where the umbilical cord was attached. If the bubble cannot be pushed back up into the abdomen it is called a non-reducible hernia. If the bubble can be pushed back up into the abdomen then it is called a reducible hernia and surgery is advisable if the Cavalier King Charles Spaniel is going to be bred. Most of the time a reducible hernia will turn into a non-reducible hernia as the puppy matures.

The American Kennel Club (AKC) does allow this hernia to be surgically corrected and the dog can still show. The other types of hernias (Inguinal, scrotal or perineal) may not be surgical corrected and still show in AKC conformation.

A companion pet owner need not be alarmed if their new Cavalier King Charles Spaniel puppy does have an umbilical hernia. It can easily be corrected during the spay/neuter process or just left as is since majority of the time they pose no threat to the dog. In the unlikely event where an umbilical hernia becomes painful to the touch, red or swollen, take your dog to be examined by a veterinarian as soon as possible.

Keep in mind that umbilical hernias can appear on many different breeds of dogs. Most Cavalier King Charles Spaniel breeders will inform buyers of the condition prior to placement.

An umilical hernia does not lower the value of a Cavalier King Charles Spaniel puppy since it is so common in the breed and a very minor health issue easily and affordably correctable.


The condition is the result of abdominal organs, fat or tissue protruding through the inguinal ring. Inguinal hernias are presented as skin-covered bulges in the groin. They can be bilateral, involving both sides, or unilateral, involving only one side. Inguinal hernias are more common in females than males, but to occur in both sexes. As with umbilical hernias, most inguinal hernias will shrink or disappear as the puppy grows, although you must keep an eye on the size on the hernia.

An inguinal hernia does not lower the value of a Cavalier puppy since it is so common in the breed and a very minor health issues easily and affordably corrected.

Hernia Scrotal:

Affect Only Male dogs. The tube that descends into the scrotum is too large, which allows intestines to descend into the scrotal canal. This type of hernia will also need to be watched carefully and if it does not repair on its own it will need to be fixed during the neutering process.

A scrotal hernia does not lower the value of a Cavalier puppy since it is so common in the breed and a very minor health issues easily and affordably correctable.

Mitral Valve Disorder and Heart Murmurs: 

A brief discussion of the structure and function of the heart and a classification of cardiac murmurs facilitates understanding the difference between normal and abnormal cardiac conditions in CKCS.

Each side of the heart has three chambers separated by two valves. On the right side of the heart, the right atrium receives deoxygenated blood from the body and transmits it to the right ventricle. The right ventricle pumps the blood into the pulmonary artery and then the lungs. The tricupsid valve separates the right atrium from the right ventricle and the pulmonary valve separates the right ventricle from the pulmonary artery. After blood is oxygenated in the lungs, returns to the left atrium and is pumped to the body by the left ventricle by way of the aorta. The mitral valve separates the left atrium from the left ventricle and the aortic valve separates the left ventricle from the aorta.

Heart murmurs are vibrations caused by turbulent blood flow across structures inside the heart. Murmurs are classified in three ways: first, according the valve causing the vibration; second, by the timing of the vibration in relation to the pumping function of the heart, and, lastly by the intensity (or grade) of the murmur. There are six grades of cardiac murmurs:

  1. The faintest murmur, heard only in an extremely quiet room with a good stethoscope with a still and quiet patient with complete concentration by the listener.
  2. A faint murmur, but can be easily heard with additional concentration by the listener.
  3. A moderately loud murmur, easily heard.
  4. A very loud murmur.
  5. An extremely loud murmur, which can be heard with the stethoscope lightly touching the skin.
  6. The loudest murmur, which can be heard with the stethoscope not touching the chest wall. This murmur can also be felt (palpated).

Common Heart Murmurs Heard in CKCS

There are several types of heart murmurs heard frequently in CKCS. They may be innocent, flow murmurs not suggestive of disease, or pathologic, indicative of genetic, inhereditable valvular heart disease.

Innocent, flow murmurs. These murmurs are caused by normal turbulent blood flowing across heart valves of young dogs. These low-grade murmurs (less than a grade 2) decrease with age as the heart matures and are not associated with congenital heart disease.

Murmurs associated with heart disease. CKCS are susceptible to abnormalities of heart valves on both the right and left side of the heart. These abnormalities may be present and evident at birth and therefore are considered congenital. Examples of these include aortic and pulmonary stenosis and the patent ductus abnormality. Mitral valvular disease is considered separately and is felt to represent an adult (mature dog) onset, representing genetic heart disease. The valve itself is normal at birth, but in some dogs degenerates prematurely and sometimes rapidly, leading to disease.

Careful physical examination and additional testing facilitates the diagnosis in a young, asymptomatic dog. Over time, progressive deterioration of the congenitally abnormal valve produces symptoms. Narrowing of the pulmonary valve (stenosis) is the most common valve affected on the right side of the heart. On the left side of the heart, both the mitral valve (leaking or regurgitation) and aortic valve (narrow or stenosis) may be affected.

Pulmonary Stenosis. Stenosis of the pulmonary valve produces a systolic murmur heard on the right side of the sternum. The intensity of the murmur is proportional to the severity of the narrowing of the valve and enlargement of the right ventricle. In mild cases, one may only hear a grade 1 or 2 murmur. In more pronounced stages, the dog may develop right-sided heart failure with peripheral edema. In its most severe form, the pulmonary valve is severely deformed and narrowed and the right ventricle enlarged and weak. The right ventricle then fails and cannot pump blood to the lungs, a fatal condition.

Mitral Value Disease. Malformation of the mitral valve is characterized by valvular thickening and redundancy and/or degeneration of the muscles which support the valve. These structural changes allow the blood to leak backward from the left ventricle into left atrium during the pumping action of the left ventricle. This systolic murmur is best heard on the left side of the sternum. Progressive leaking leads to enlargement of the left atrium and ventricle. As blood floods the lungs, the animal develops exertional shortness of breath, and has decreased exercise tolerance. Eventually heart failure results.

Aortic Stenosis. Narrowing of the aortic valve produces a systolic murmur best heard on the left side of the sternum. Similar to pulmonary stenosis, the intensity of the murmur correlates with the degree of severity of the narrowing of the valve. With progressive narrowing, the left ventricle enlarges and thickens in an effort to generate sufficient pressure to propel the blood forward into the aorta. Eventually the left ventricle fails and is unable to eject blood to the body. The murmur is then is barely audible.

Patent Ductus Arterious. Before birth, blood bypasses the deflated lungs through the ductus arteriosus, a hollow blood vessel connecting the pulmonary artery and the aorta. At birth, the lungs inflate and the ductus arteriosus closes, thereby separating the pulmonary and systemic blood flow circuits. In rare situations, the ductus arteriosus fails to close (a patent ductus arterious) and blood flows from the aorta to the pulmonary artery when the left ventricle contracts (systole) and from the pulmonary artery to the aorta when the left ventricle relaxes (diastole). The murmur is continuous, heard in both systole and diastole, on both sides of the sternum. The loudest component is the systolic murmur. A patent ductus arteriosus results in excessive pressure and volume of blood in the lungs. Eventually, both sides of the heart fail. It isn't abnormal for very young puppies of the Cavalier breed to have a murmur show up during an exam. Being a toy breed, with a slightly oversized heart, tends to makes them prone to this scenario. However, if this has not resolved itself by 4 months of age, it could be a concern.

Patellar Luxation: 

The patella, or kneecap, is part of the stifle joint (knee). In patellar luxation, the kneecap luxates, or pops out of place, either in a medial or lateral position.

Bilateral involvement is most common, but unilateral is not uncommon. Cavaliers can be affected at a very young age as well as later in life, but typically it occurs in Cavaliers within the first year to eighteen months.

Although the luxation may not be present at birth, the anatomical deformities that cause these luxations are present at that time and are responsible for subsequent recurrent patellar luxation. Patellar luxation should be considered an inherited disease.

Signs vary dramatically with the degree of luxation. In Grade 1 there may be no indication initially and diagnosis can only be made by palpation. Over time, with further breakdown of soft tissues, the dog may become lame. In Grades 2-3 lameness may only be evident when the patella is in the luxated position. In Grades 3-4 dogs may exhibit a crouching, bowlegged stance with the feet turned inward and with most of the weight transferred to the front legs. Pain can be present in some cases however most animals seem to show little irritation for Grades 1-2.

Sudden bilateral luxation may render an older Cavalier unable to stand and so simulate neurological disease. Care must be taken not to misdiagnose patellar luxation for some form of neurological problem.

Most Cavaliers can lead a normal, pain free life with Grade 1 patellar luxation; however surgery is highly successful for the more severe forms of this disease. There seems to be a vast difference in charges for this surgery and owners are encouraged to obtain estimates from a variety of different veterinarians and orthopedic specialists.

Syringomyelia-SM: Overview:
Syringomyelia (SM) is rapidly emerging as a severe inherited condition in our Cavaliers. It is a progressive neurological disease that varies in severity. Cavaliers unfortunately are affected by SM in larger numbers to any other breed. It is found in all colors, in all lines, and affects both sexes. Signs are usually noticed in dogs between 6 months and 3 years but it has been diagnosed in Cavaliers up to 10 years old. At present the condition can only be identified by MRI scan or by clinical signs. SM occurs when a Cavalier is born with not enough room in the space in the skull that contains the back of the brain. Damage is caused when fluid (CSF) surrounding the brain is forced through a smaller than normal opening, into the spinal cord. The most common symptom is scratching on, or in the air near, the shoulder when the dog is excited or walking on a lead. However this is not the only symptom and it is not always present. Some refer to SM as “neck scratcher’s disease” because scratching the neck is often a sign of the disease. It is similar to the human condition, Chiari type 1 malformation (or Arnold Chiari in some older texts).

Many symptoms attributed to SM often have nothing to do with this disease so it is important for a vet to eliminate other possibilities first, including PSOM (Primary Secretory Otitis Media) (Link to Other Health Info), or 'glue ear', which causes similar symptoms and can be found in Cavaliers. Allergies to many things, including diet, can also cause dogs to rub their heads on the floor. Ear infections, ear mites, skin conditions or skin irritants like mites or fleas can cause a dog to scratch obsessively or scratch or shake the head and ears. Some dogs are also yelpers, especially when excited. It's a good idea to eliminate more common possibilities first before exploring whether a dog has Syringomyelia. It is important not to read into a Cavalier’s symptoms when they wipe off their face on the carpet after their meal, seek out cold floors on which to sleep, enjoy a good scratch now and again or simply want to be left alone for a while. These are all normal canine behaviors that should not be confused with SM.

The primary symptoms (usually at least one of these is present) are described as:

  • Excessive Scratching especially while on the lead, and often 'air scratching' where the dog scratches in mid-air, leading to a 'bunny hop' gait as the dog tries to scratch the air with one leg and walk. Sometimes touching the dog's ears brings on scratching.
  • General Pain is often first noticed because a dog begins yelping or whining or whimpering for no reason. Pain episodes can disappear then return even after a year or more. In some dogs weather changes such as storms or a cold front seem to bring on episodes.
  • Weakness in Limbs where some dogs may show a lack of coordination. They may limp slightly. Dogs can start to have difficulty getting on and off couches and beds. A paw or leg might go weak. Some dogs will lick at their paws or legs obsessively, often until raw.

The secondary symptoms are described as:

  • Seeking Cool Areas or Restlessness where an affected dog will shift constantly rather than sleepcomfortably.
  • Head shaking, lip-licking. Dogs often will shake their heads and ears, yawn excessively (probably an attempt to clear pressure they feel in their heads), or lick at their lips excessively.
  • Head rubbing. Some dogs start to rub their head from side to side on the floor as if their heads hurt, doing this excessively (NB: normal dogs will do this with pleasure, often before rolling on the floor). They sometimes 'mush' their face against the floor.
  • Digging or pushing. Some dogs begin to dig obsessively at carpets or sofas. They may run along the length of a sofa pushing themselves against it. Again, this behavior is normal in many dogs; with SM dogs, the activity is frantic.
  • Nerve damage, stiffness, seizures. This can affect a dog in many ways, from loss of feeling, hearing, or muscular movement. Some dogs have neurological problems with their eyes. Nerve damage seems to be progressive with this condition though some dogs have little or no visible damage and others have severe damage. Some dogs develop a stiffness in the neck, back and/or limbs. In severe cases the neck may bend to the right or left ('neck scoliosis'), or the whole body may bend into a 'C' shape when the dog runs. The head may tilt permanently to one side or the other. The dog may have head tremors. Some dogs begin to have seizures, in some cases, several a day.

Understandably, such descriptions can be confusing – how much scratching is 'excessive', for example? Some people might turn to their vet with such questions, but many have found their vets were unfamiliar with syringomyelia.


The only way to confirm a diagnosis is by MRI (Magnetic Resonance imaging). This is essentially a picture of the water content of the body presented in a series of slices (like a loaf of bread). The syringomyelia can be easily visualized as a pocket of fluid (syrinx) within the spinal cord. There would be two reasons to have an MRI performed on your Cavalier: a) to rule out syringomyelia so that the dog can be treated accordingly and b) when it is determined that the dog must have SM surgery.

Managing with Drugs:

Medical management can help but typically does not resolve the clinical signs. Signs in mild cases may be controlled by non steroidal anti-inflammatory drugs (NSAIDs) e.g. Rimadyl. Corticosteroids are very effective in reducing. Although corticosteroids are effective in limiting the signs most dogs require continuous therapy and subsequently develop the concomitant side effects of immunosuppression, weight gait and skin changes but sometimes there is no alternative and the lowest possible dose should be used to control signs. For a CKCS the typical dose would be 5mg prednisolone or 4mg methylprednisolone daily/on alternate days. Gabapentin (Neurontin; Pfizer) is successful in some dogs. This drug, originally patented as an anticonvulsant, is licenced as a neurogenic analgesic for humans. The canine dose is 10-20mg/kg two/three times daily which for a CKCS typically works out at a dose of 100mg two/three times daily. Gabapentin can also be given in combination with NSAIDs. Side effects are minimal and for this reason Gabapentin is preferred over corticosteroids. Oral opioids are also an alternative for example pethidine tablets at 2-10mg/kg three to four times daily or methadone syrup at 0.1-0.5mg/kg three to four times daily. Acupuncture appears to help some dogs. If the dog has seizures, then these can be controlled with phenobarbitol and potassium bromide.


The only option for severe cases of SM is surgery which entails opening the foramen magnum by removing a portion of the occipital bone and usually part of the first vertebrae (foramen magnum decompression surgery). The aim of surgery is to improve the dog’s quality of life and/or to stop or reduce further progression. The surgery may not reverse the damage and most dogs still have a tendency to scratch. There is more chance of success if the surgery is done early in the course of the disease before permanent damage has occurred. In older dogs surgery is advised only if the dog is deteriorating. Signs may recur in a proportion of dogs after several months/years due to redevelopment of syringomyelia. The newly created “space” from surgery may fill in with scar tissue. If this happens, repeat surgery may be indicated. Dogs are hospitalised for a few days until comfortable and then discharged on a combination of non steroidal anti-inflammatory drugs (e.g. Rimadyl) and Gabapentin (Neurontin). This is withdrawn when the dog is comfortable (about 2 weeks in most cases).

General Management:

Some dogs prefer to sleep or eat with their heads up therefore it may be prudent to elevate feeding and water bowls. Purchasing a lightweight harness may help with the scratching when taking dogs for a walk.