View Full Version : surgery vs medication
24th October 2007, 06:16 PM
My 1 year old cavalier, Seamus, was diagnosed with CM yesterday via an MRI. His neurologist is recommending surgery over medication (due to Seamus' age and the long term effects of medication - and that medication treats the symptoms, but doesn't attempt to resolve the underlying issue). For those that have first used medication and then after using opted for surgery, what precipitated this decision? Has the surgery helped? Any advice would be welcome.
24th October 2007, 07:20 PM
I have two affected cavaliers and haven't done surgery for either -- one a rescue so I don't know her age -- but she has only mild symptoms (scratching). My other SM dog was MRId at 1 so I knew he had CM/SM but he didn't show symptoms until close to 2.5.
Some neurologists seem to almost always recommend surgery (more so in the US than UK for example) and it is true that in general, the condition is progressive. But progression is highly variable. Some neurologists feel dogs can be managed medically. Clare Rusbridge, one of the leading authorities in this area, is one of the latter. But early onset CM/SM is a special case as noted below.
To my mind a decision for surgery for me and my dogs really depends on the level of the symptoms and the seriousness of the MRI. If a dog is strongly symptomatic at under 3 the chances are that this is a more severe case and the earlier the symptoms, the more severe the CM/SM is likely to become and the more rapidly it is likely to progress. Some of the damage caused by progression is not reversible so the longer surgery is postponed the more damage that may be done. There is some evidence that the earlier the surgery is done, the faster and easier the recovery.
The surgery won't actually address the underlying cause (in the strict sense) and hence cure either CM or SM but it can relieve the pain and symptoms and prevent further deterioration. In some cases it is really the only option for any medium to long term chance at life (this especially so with young dogs with CM/SM, as the prognosis is far worse for these). Whereas medical approaches only attempt to relieve the pain (though there is also some indication that CSF inhibitors -- drugs that slow CSF flow and reduce pressure in the dog's head/spine -- may also slow or stop the development of syrinxes).
I am not sure what long term effects of medication your neurologist is concerned about but most medications used for CM/SM have very few side effects and many dogsthat have the surgery continue to need those medications anyway -- gabapentin and some form of CSF inhibitor, like frusemide or cimetidine. There are dogs that have been on these long term already with very few side effects. In some cases though the effect of the drug decreases over time.
I have some comparisons of medications vs surgery on my website:
There are papers discussing surgery and medication on the same site in the research section under London 06. On Friday of this week there will be presentations in Rugby in the UK on both the surgeries and long term medical treatment.
What kinds of symptoms are you seeing? If they were strong enough for you to have decided to go for an MRI, then they are probably significant. Given the young age of your cavalier, this would be considered very early onset CM/SM and surgery would probably be the best chance for any longer term quality of life -- but there's unfortunately never any certainties with this condition. That's one thing that makes it frustrating.
About 20% of surgery cases relapse within 6 months and either need a repeat of the surgery or are treated medically for pain or fail to recover. In Clare Rusbridge's presentation in London this time last year, she noted that nearly half of her surgery dogs saw some return of some pain and symptoms over time. You can find her paper as noted above. One thing to keep in mind more generally is how many dogs clearly have this condition and never show any signs -- indicating progression is highly variable! But as you have an early onset dog, I would in your shoes definitley be considering surgery as the best option, if there are not other reasons you don;t want to do it (there are many perfectly valid reasons why someone might not opt for surgery -- it's a very personal choice).
24th October 2007, 09:18 PM
Seamus exhibits fly catcher's syndrome, scratching of his neck, excessive lip licking, excessive yawning, and shaking of the head. He doesn't yelp in pain or show other signs of severe pain. I'm leaning (although not sold on it) towards the surgery given his multitude of symptoms and age. I've noticed the fly biting has become more intense over the past month and happens more frequently which worries me that he could be one that would show a more rapid progression.
Thank you for the references. I'll be reading up and doing further research before making a firm decision. I just want to be sure I'm going down the path that gives Seamus the best chance.
24th October 2007, 09:34 PM
We have several members who have opted for surgery and some who have opted for medications, and hopefully they will see this over the next while and can talk to you about their experience.
Did the neurologist rule out PSOM for these symptoms?
They are very similar. With cavaliers, it is a lot less common for the Chiari-like malformation alone to cause symptoms. On the link above, check out the story of Trouble.
However those signs can also be CM and you could start to see syrinxes form over time.
You can also read through the archives here as I have set them to public access:
Just click into 'messages' in the upper left corner.
25th October 2007, 07:11 PM
Abbey is one of the rare cases of no syrinxes and yet presenting symptoms. During her MRI, she stopped breathing so they had to stop the procedue and didn't end up getting any images of her lower spine. So, we think she doesn't have any syrinxes, but yet she very well could in lower spine...
For now, she's considered to have CM and is managed on meds (Gabopentin). She's progressed soemwhat, but given she's 5 and her symptoms are relatively mild, we're managing them with meds. We plan to have another MRI done in '08 with the goal of getting the full spine image, to see if any syrinxes have developed. At that point, we'll evaluate whether to increase her meds or to do surgery. I really doubt we'll do the surgery though, but who knows what she'll be like at that point. It's a very personal decision, as only you know your dog and know what their symptoms are. I would say though, given how young your dog is, and the fact that it's presenting symtoms enough for you to do an MRI, that I would probably consider surgery if it were my dog--given the young age and the seemingly rapid progression.
28th October 2007, 11:33 PM
According to Charlie's vet records (we just adopted him), he had severe symptoms as early as 5 months of age. He was diagnosed with a syrinx almost one year ago. Just based on his current pain episodes and how physically handicapped he is currently at just under age 2, he was a surgery candidate at a very young age. We're hoping and praying it isn't too late for surgery now.
He is uncoordinated and he falls over sometimes. He can barely stand on a smooth floor. He doesn't have the use of his front paws; when he chews or plays with toys he only has his mouth and the floor to position his chew/toy. It is difficult for him to urinate and defecate, and his tail cannot wag when he walks.
Physical problems aside, he is a very cute, sweet and loving little dog. It's amazing how he rises above his illness to play like a puppy. He is very much a puppy on his good days. :luv:
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