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View Full Version : Surgery for dogs with only the malformation, no syrinxes



Spencer'sMom
25th June 2008, 03:15 PM
I know several dogs have had surgery for confirmed SM but am not familiar with whether surgery is performed for dogs who only have the malformation. Spencer had another MRI yesterday and like the scan he had last year, it shows a moderate-severe cerebral herniation but no syrnizes. While he's definitely uncomfortable and scratches, rubs his head, licks his paws and scoots, he's fortunately never exhibited any outwardly visible signs of pain, such as yelping or screaming. He's on 200mg of gabapentin three times a day, which has greatly controlled the symptoms. I've haven't spoken to our neurologist yet but he seems to be very pro-surgery, though he was pretty sure Spencer would have syrnixes at this time. Thought I'd check in here to see if anyone has experience with having decompression surgery for CM only.

Karlin
25th June 2008, 05:33 PM
I know that Clare recommends surgery herself for many dogs showing symptoms with the malformation alone. She feels they are very good candidates as they do not have any permanent damage caused by syrinxes. She would likely argue that in many cases, scratching etc is a sign of pain but not as extreme as crying out -- both she and Nick Jeffries argued that scratching is a sign of pain at the 2006 conference. She includes it as a sign of pain or neurological malfunction on the pain scale the neurologists agreed upon in 2006:
http://sm.cavaliertalk.com/painscore.pdf

In humans, the Chiari malformation alone tends to cause serious problems and the same symptoms as SM (see http://www.conquerchiari.org/index.htm for some very insightful material on what humans experience).

For some dogs it appears that the malformation, even when very mild, can disrupt CSF flow and pressure in such a way, in some dogs, so as to cause pain and discomfort (which isn't surprising when this is very common in people -- more common I think than SM).

Just for comparison, Leo has syrinxes and is on about half the dosage of gabapentin Spencer is on.

Cathy Moon
26th June 2008, 02:23 AM
After having gone through the surgery with Charlie, I would seriously consider it in your case. If you could correct the condition before a syrinx forms, I think it would be worthwhile. After a syrinx forms it will not go away. Knowing what I know now, the earlier it is done - the better.

What about getting a second opinion? I hope you won't think I'm pressuring you, though. It's a very personal decision.

Bridam
26th June 2008, 03:22 AM
After having gone through the surgery with Charlie, I would seriously consider it in your case. If you could correct the condition before a syrinx forms, I think it would be worthwhile. After a syrinx forms it will not go away. Knowing what I know now, the earlier it is done - the better.

What about getting a second opinion? I hope you won't think I'm pressuring you, though. It's a very personal decision.


+++++++++++++1. If only I knew then what I know now.

Spencer'sMom
26th June 2008, 12:48 PM
What about getting a second opinion? I hope you won't think I'm pressuring you, though. It's a very personal decision.

Hi Cathy. We got the MRI done as part of the Penn SM clinical trial. We didn't qualify for the trial since Spencer doesn't have a syrinx and thus didn't get a chance to meet with their neurologist. I sent the disc to our neurologist to look at and like your idea of a second opinion. I'll see if our vet can call a couple of the neurologists in Virginia to see if they'd be willing to review both MRIs.

Karlin
29th June 2008, 05:47 PM
I'd pick one of the neurologists marked in red on www.cavalierhealth.org as that indicates someone familiar with SM.

One thing to consider first perhaps is trying Spencer on furosimide alone. And also: did he have PSOM on the MRI? Clare says to use furosimide to determine if the problem is actually pain from CM or PSOM (if CM it will probably respond to the furosimide).

Sometimes PSOM will produce all the symptoms you describe.

Did Penn give any kind of analysis to you on the MRI? You could also consider talking to LIVS as they are not far from you.

Spencer'sMom
30th June 2008, 01:22 AM
Unfortunately no info from the neurologist at Penn (Dr. Long) since we didn't make it into the study. I wasn't allowed "upstairs" when Spencer had his neuro exam before the MRI and evidently it was pretty obvious on the MRI that there were no syrinxes so I'm not even sure Dr. Long reviewed the images.

Good idea on the SM note on Cavalier Health. Spencer's regular neuro has that notation and I also saw the other one with that note when Spencer was 9 months old. I didn't like that one at all. I made an appointment with a neuorlogist our regular vet really likes for Wednesday. I spoke with her nurse on Thursday and evidently this lady has seen quite a few Cavaliers with SM and CM. But she doesn't operate- refers clients to Dr. Dewey or Dr. Marion for surgery.

Karlin
30th June 2008, 01:34 AM
They are the doctors at LIVS. :) You could also go directly to them, but it makes sense to see someone more local if you also are working with your vet, and then decide what to do next. It is always a hard call as there are no certainties.