What is your experience with SM?

Hi Everyone - I really need feedback.

To those with dogs diagnosed with SM: Did you opt for surgery? How long ago? Is your dog doing well as far as improvement compared to pre-surgery? Would you do it again if you knew then what you know now? Why or why not?

To those who opted not to put the dog through surgery: How long ago was the dog diagnosed and what has been your expererience?

Lastly, can anyone clarify what the heck it means when people say that the surgery stands a fair chance of stopping or slowing down the progression while others say the surgery is about pain mangement and doesn't actaully stop progression? It seems that even veterinary websites use the word "progression" in various contexts. To me, if the SM returns, nothing has really been stopped.

Thanks for any and all feedback

Which site have you found that says the surgery doesn;t halt progression? It will, unless scar tissue forms, halt progression beyond where the dog currently is. However, damage already done may cause a further decline ion the dog's condition. The SM never goes away -- a dog that had SM is always going to be affected by it and the syrinxes may never go away.

My Leo was diagnosed two years ago, many months before he became symptomatic (he was MRId at a low cost clinic for cavaliers). I treat him with neurontin and he has gradually become symptomatic. If he worsens beyond a certain point I will likely have Clare Rusbridge do decompression surgery. Those I know who have opted for surgery are very happy they did so. Most had young cavaliers with very bad syrinxes or very bad symptoms. It is however an invasive form of treatment and many choose other options for a variety of reasons.

Dr Dewey and Dr Marino believe their form of decompression achieves better results. You can read Dr Marino's explanation of this surgery in his presentation here:

http://sm.cavaliertalk.com/research/london/london06.html

The summaries of the Nov SM conference will give you the state of the art thought on SM.

Naturally, now that I need to refer to it, I can't find the site :roll:
So, it does stop progession, but there may be scar tissue or some other issue that causes the problem to resurface, correct? Thus the need for more than one surgery sometimes?

So, the main reason for considering surgery is that we want to stop progression rather than wait until more damage is done. The goal would be to have one surgery done early so that further surgery is not required. One can hope. My confusion lies in the fact that some people opt not to have the surgery performed. Other than expense, which is a reality issue here so I am not minimizing it one bit, I don't understand this. If indeed progression can be stopped, why not do it as soon as a diagnosis is made? I appreciate the risks involved, but it seems that not having the surgery is even riskier in the long term (?)

I'm aware of Dr. Dewey, but we're in Canada and I expected that the U of Guelph would also offer this surgery. Someone said they don't and if that's so, I imagine that Dr. Dewey is a very busy man what with dogs from both countries being taken to him.

Karlin, thank you for your quick response and for offering this great resource.

Hi Monica -- I hadn't read your sig and realised it was you; of course I know you as a friend of cavaliers and member of various cavalier sites.

Your guess is right -- it seems to be scar tissue formation around the surgical site that causes recurrence. Dr Marino said they'd had very good success with resolution of syrinxes with their method using the titanium mesh. Most of their dogs so far do not even need any medication long term but they only have results from one year out. Clare has found that syrinxes rarely resolve after the 'normal' decompression but that pain does tend to be relieved though the dog may still scratch -- and hence may be on neurontin long term. I have found neurontin is very comfortably managed by my Leo. You might also look for Clare's presentations at the same link above as she has some quite interesting results that she reports on dogs that are up to several years out from the 'normal' ecompression surgery and has an interesting presentation on pain.

If I were in the US I would be talking to Dr Marino or to Dr Dewey and would be willing to travel to have their surgery done as I think the results are better though it is a more involved procedure. I am not sure if they now work separately or still both do the surgery thru LIVS (www.livs.org -- you can go there and click into a whole description of their version of the surgery).

They have not had a recurrence of scar tissue so far in any of their dogs -- they have done the surgery on about 22 when Marino gave his talk. You can see his slides as well at the UK club website -- I haven't had time to link to all the slides as well from my site. Jaime would be a good person to discuss this directly with if you know her or Sandy -- both are very up on what Dewey/Marino are doing and have had dogs have this procedure.

In my case I have not chosen to do the surgery as I am not sure if Leo will progress to where he is truly uncomfortable. Clare is more conservative in doing surgery than Dewey/Marino who are very disposed towards intervention. This may be cultural to some degree or the fact that they are surgeons and se a surgical solution as the best option.

There are many reasons people do not opt for the surgery -- many are not comfortable with the type of surgery, or this type of intervention, or the cost is prohibitive or they hope they won't see enough progression to warrant surgical intervention. Also if dogs are older than 6 they are generally not good candidates and sometimes, an MRI will reveal for whatever reasons, the dog isn't a good candidate.

I feel Dewey/Marino are having such good results so far that they may have removed the issue of recurrence for most dogs (well, most do not have recurrence anyway, but not all benefit greatly from the surgery as they have it after a lot of damage has been done). But it is quite an involved and delicate surgery. To date they have not lost any dogs.

Send me a PM if you'd like a couple of direct contacts for people to talk to regarding the surgery.

Hi Monica, :flwr:

I have PM'd you.

Alison.

Karlin, I'm glad I checked the board. I haven't received your PM. Would you mind sending again?

Thanks!