View Full Version : questioning surgery for SM
15th December 2009, 10:13 PM
I have been doing alot of research about the surgery on KCC after MRI results. But, I've been doing even more now on human SM and Chiari Malformation. When reading about the human illness surgery is not the most recommended form of treatment. Humans seem to control symptoms with the same meds we have our cavs on. There are also some good information about holistic methods of treating pain.
My question is, and hopefully Clare Rusbridge will read this, why are so many Cavaliers being subjected, recommended etc for the surgery and not humans? Are our dogs being used as case studies for possible methods to help humans. While that is commendable it is also not to my liking.
My dog underwent a very expensive cranioplasty surgery, the most modern available, and he was part of a grant study. Now, looking at what they have to say regarding the success in humans of surgery I'm starting to question if our beloved animals are not being used as sort of guinia pigs....I know that this will really start a mass hysteria among cavalier owners whose dogs are suffering from SM but.....on the other hand could it be that because our beloved breed is affected in such a high degree, that doing surgery and follow-up is needed for human research.
I like the thought that Ollie's death might have some good come out of it but I also wonder if just treating him, as most humans are treated, with meds only, might just be the best method.
Please, someone with medical vet experience answer my question. I will continue to do all I can to get low cost screening for breeders to try and cut down the incidence or maybe, if we are at all lucky, eliminate it from certain lines through good genetic breeding, are we putting our beloved pets through surgery to further the good of mankind??????
I am begging for an answer from someone who is a vet or experienced in the field of canine neurosurgery.
15th December 2009, 10:37 PM
Dogs are DEFINITELY NOT being used to test techniques for humans -- if anything it is the other way around! -- the surgery techniques for dogs have been developed and improved based entirely on the human techniques. :thmbsup: Surgery is often the ONLY option for humans -- the pain is too excruciating. For many people, it is also the best option. I am not sure where you are getting the information that it isn't? Maybe this is a confusion over the fact that most doctors won;t recommend surgical treatment unless surgery is felt to be necessary -- hence from that angle, yes, most would probably initially be on medications, and many would always be on them. Some would really need surgery right away, and some will need it eventually (that is pretty much the approach of many vet neurologists too though there is evidence that doing surgery early gets the best results). The success rate for humans is actually better than for people, with many seeing their syrinxes shrink or even disappear. Unfortunately that deosn't generally happen with dogs, perhaps because they walk horizontally -- this isn't well understood. LIVS helped develop the surgery Ollie had because it is the most successful approach with humans and also does generally cause a reduction in syrinx size, something that doesn't happen with the regular SM surgery. The results from the cranioplasty with dogs has also been very good -- so far, better than the results with regular surgery, but there sadly will always be exceptions and right now, the long term results are not known.
Clare Rusbridge has done a comparison of surgery vs meds and given this as a paper at the SM conference in 2006 and also it is in her PhD thesis -- her conclusions are that she prefers to give meds until they are no longer helping then recommends surgery, but also recommends surgery in particular cases. In almost all cases she recorded for this overview, dogs progressed. The dogs on meds generally had to be euthenised before the dogs that had surgery. Dogs with surgery lived longer, overall.
Surgery is definitely not a cure, nor are the medications. When surgery doesn't work -- and we have a few people on the board who have had this terrible experience -- it is deeply upsetting. However I do not know of any cases where surgery itself was the cause of the problems after surgery; generally the dogs have had problems that the surgery was not able to control.
Surgery doesn't tend to reverse any damage already caused -- by the time a dog is symptomatic, neurological damage has been done. Surgery generally will halt and stabilise the dog (or human). Humans may need the surgery repeated over their lifetime because scar tissue forms causing the obstructions again (the cranioplasty is one way of limiting this which is why it has been introduced for dogs). Meds in almost all cases will not stop progression for humans or dogs. The decision on whether to operate tends to be taken depending on the rate of progression, the size/shape of the syrinx, whether it has started to cause pain that meds don't relieve...there's no simple answer or one size fits all.
But rest assured the surgery in dogs is definitely not done to experiment on what might help humans -- it is already known that dogs respond differently and there would simply be no point -- humans walk upright, dogs horizontally; the skull is carried in a different angle on the spine, etc. There isn;t any direct benefit to trying something on a dog and guessing whether it will work on humans. Where research is likely to help is in understanding the genetic basis for the condition and how it tends to develop, because it is a rare condition in humans but has a fairly high rate of occurrence in cavaliers, giving a naturally occurring population. The CKCS genome work in Canada is of enormous interest to the human SM community; there's a post about it on the ASAP site still I believe. The last SM conference on cavaliers was held as an adjunct to the human SM conference in the UK and attended by many human SM researchers and physicians.
15th December 2009, 10:57 PM
The information comes from the internet. When I went to LIVS and Ollie was MRI'd I had not had him on any of the medications used before I brought him there. The doctors told me that his prognosis without surgery was a 2 year life span with probable paralysis. With surgery 80% progressions stopage. But..I was never told that medication might be the best first step for treatment and see how he reacted to the medication. The same medication he was on continually after surgery until his death.
I know this is a great animal hospital with some of the best neuro surgeons around, but going into this with knowing nothing about what might be wrong with him I am now surprised that they did not recommend trying medication first.
I have my son, a nuclear radiologist looking at Ollie's MRI CD just to tell me how made it looked at the time of the scan. Not that he is an expert on cannine, by any means, but he is on human diagnosis. Hopefully he can set my heart and mind at rest.
Again, thanks for your quick response. I hope to have the University of Florida as my first low cost screening hospital in Floirda soon. I'm working on it even if it will only be four times a year for breeders and cavalier owners. I am going to continue working as hard as possible but I can't help but wonder. Why wasn't I told to try medications before drastic surgery?
15th December 2009, 11:13 PM
Just as with human doctors, vets vary in their opinions on how to treat diseases. The standard for any caretaker position is to use "current best practices", but the interpretation of that is not always the same. Is the method that has been traditionally used but has side effects and really only delays disease the "best", or is the new high-tech method better? The decision will come down to what literature your vet agrees with, and what results they have seen in using the methods previously.
In the future you may want to ask your vet about alternative treatments, why they do or don't recommend them, and ask for some references (journal articles, etc) to help you decide what is best for your pet.
15th December 2009, 11:21 PM
Different specialists view the choice of when to do surgery differently. If Ollie was symptomatic and they felt he had probably only a 2 year prognosis, that is likely a fairly severe level of SM. Much depends on shape and width of the syrinx(es). Many feel that with medications you only stop the pain and progression and damage continues until a point where surgery is unlikely to help either. Ideally, all the options are carefully discussed. In the US there's generally a more surgery-oriented approach to many conditions, animal or human and I am sure this too influences recommendations.
I have to stress again that medications are only masking pain -- they are not halting progression and for some dogs progression can be extremely fast -- literally in days or weeks a dog can go from a happy active dog with seemingly no problems to a collapse for which surgery is no help. The decision for many of us on how to treat is extremely difficult. The medications are also not always benign -- they can have life-threatening side effects/organ damage over time especially at high dosages. Again, just as it is generally the case that most dogs will improve initially from surgery and stabilise, it is also true that most dogs on meds will tolerate them well (but most of us with dogs on meds have to keep increasing them and our dogs continue to worsen, slowly or quickly; we all hope the former). Some dogs hardly progress at all. But there are always exceptions and for those dogs and owners, it is especially hard to know if the right road was taken.
You really need to address these questions to LIVS to best understand why the recommendation was made, though. I am sure they will take the time to discuss this with you and talk though the scans as well.
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