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View Full Version : Surgery for Blitz ~ Titanium Mesh Questions ? Experience & Advise needed!!!!



Reptigirl
27th June 2011, 08:13 PM
I have asked about this before but we are arranging for Blitz to have surgery soon and I really am confused.

I have been very determined that if Blitz undergoes surgery I really want to do everything I can to prevent the scar tissue. I could be wrong but I REALLY feel titanium mesh may be his best option. His neurologist seems to feel very differently.

His neurologist has quoted me the following information today....

"There has only been 1 published study on titanium mesh in this kind of surgery. That was back in 2007. Since then there has not been any scientific data to prove that it is a better choice."

"Studies done on surgery WITHOUT titanium mesh show that approx 40% of dogs will develop scar tissue within 3 years."

"While the study done with titanium mesh showed a much lower rate of scar tissue development the time frames for the study were different then studies done without the mesh."

"The main goal of surgery is to slow down the progression of the disease. We are just trying to add a few more comfortable years to his life."

"With the surgery most owners report a decrease in symptoms to some degree but dogs usually are not going to be symptom free. Most dogs go on to still need daily medication. "

My neurologist has never used titanium mesh in this kind of surgery but has consulted with other neurologists & feels that it would be very easy to do. He personally feels it will not affect the overall outcome of the surgery BUT may slow down the recovery.

He is working now to track down a reasonably priced source for the titanium mesh. At first he quoted me over $1000 extra to use it... but now has dropped it down to about an additional $500....

While I feel I am going to go with my gut feeling on this and go with the mesh I REALLY would like more information & opinions from people who have had the surgery done. Especially now that we are getting down to the last few weeks before surgery I am really looking for more information!

Uh, I am SO nervous about this! I only want whats best for him! It is stressing me out because he is SO happy & active right now! He almost acts like a puppy! This is just such a hard choice for me. I know its for the better...

StillPooh
27th June 2011, 08:48 PM
No advise to offer except to say that I would not want a surgeon's first time doing ANYTHING to be on my dog. Especially if he is not supportive of the idea.

Perhaps you should get a second neurology consult with one who is familiar with using this mesh?

Blondiemonster
27th June 2011, 09:07 PM
Dr marino in long island has done 200 off those succesfully. No way you can have it done there? Not sure how far u live. If not, talking to him or emailing him may help. Id never let a surgeon perform this on my dpg either without experience. Karlin has said that there is not enough proove about titanium mesh as opposex to regilar decompression surgery and that its better in any way, but its certainly not worse. The surgery is a bit more tricky and risky. I hear you though we have to choose the option with the best possible outcome. Its something i need to learn more Bout... Also i think riley from lovemyxavaliers has had the mesh and is one of the succes stories on here.. Id have to know more but i know ella for instance had the regular and developed scar tissue. Have u looked into swine tissue surgery? Also, not too scare you but dr marinos very first case of mesh surgery was unsuccesful .. The dog died. He told me because they were still figuring it out.

Reptigirl
27th June 2011, 09:08 PM
I wish it was that easy... the closest neurologist to us is about a 4 1/2 hour drive away! The next one is about 6 1/2 hours away. I'm a full time mom to a 2 year old without much help. If there was another one within a reasonable distance I would consider it. I can hardly make the 9+ hours round trip of driving to this one alone... let alone farther.... not to mention gas at nearly $4 a gallon!

He had done many of these surgeries. He just has never used the titanium mesh... From my understand not many vets do the titanium mesh in the USA.

Blondiemonster
27th June 2011, 10:33 PM
Sorry to hear that. Its amazing what you do for blitz considering everything else!!

Reptigirl
27th June 2011, 10:56 PM
Dr marino in long island has done 200 off those succesfully. No way you can have it done there? Not sure how far u live. If not, talking to him or emailing him may help.

I live in south Texas :neutral: If I could win the lottery or something then I would do it in a heart beat! Sadly, making that kind of trip is far out of our budget.



Also, not too scare you but dr marinos very first case of mesh surgery was unsuccesful .. The dog died. He told me because they were still figuring it out.

*Where is the utterly TERRIFIED Icon when I need it!* Thank's for the info...definitely something to think about.

StillPooh
27th June 2011, 11:32 PM
I live in south Texas How far are you from Texas A&M (http://vetmed.tamu.edu/services/neurology)?

Reptigirl
27th June 2011, 11:37 PM
How far are you from Texas A&M (http://vetmed.tamu.edu/services/neurology)?

That's where are neurologist is. It's about 4 1/2 hours away...

Blondiemonster
28th June 2011, 12:09 AM
I would see if ur neuro can collaborate with marino in some way or email dr marino and ask him if he feels its safe... I have his email pm me if you want it. Also, u didnt answer my question about swine tissue surgery. It may be less risk and with same scar tissue reduction results...

Reptigirl
28th June 2011, 12:58 AM
Sorry, I had asked about the swine tissue the 1st time I spoke with him and he had never done it and was not interested in considering it at all. :confused: He did not say NO the to mesh, just that he didn't feel it was necessary in the surgery. He said he had talked about it in the past with a few patients but they had decided not to do it because of the lack of scientific evidence. He seems to feel strongly that it is not needed for the surgery to be successful... but in my opinion 40% of the dogs having scar tissue by 3 years post surgery... well in my opinion that not good enough odds. :( I mean its MUCH better odds then if I DON'T do the surgery.. uh, I thought this was going to be an easier then it is turning out to be. I have just gotten so attached to these dogs.... especially Blitz! He knows he was saved and every day the loving look in his eyes as he follows me around. :lotsaluv: I just can't stand the thought of not giving him the BEST chance possible! I thought I could be happy knowing that no matter what they were much better off then before I got them. But now even that is not good enough!

Will be sending you a PM

Love my Cavaliers
28th June 2011, 01:18 AM
Riley did have the decompression with the titanium mesh implant 3 years ago and she is doing so phenomenenally well. Medication she took pre-operatively for SM including gabapentin and prednisone had absolutely no effect on her symptoms. She is now on 2.5 mg prednisone a day (I've just successfully reduced her daily dosage by half!!!) She loves her walks, playing in the yard, she runs after squirrels in the yard, and she is happy. Because she is on daily prednisone she goes to the neuro every four months for bloodwork and she has a complete neuro exam which is always completely normal. She is definitely a success story. She has not had any setbacks at all. Is that due to the titanium implant? I don't know. She was old also when she had the surgery. She was almost six years old which is the cut-off for surgery for a lot of neurologists.

Regarding the swine tissue, Linderbelle's Abbey is the only one I know who had that surgery two years ago and I know she's having difficulties right now. Again, is it because the swine tissue failed? There's no way of knowing. Was her SM worse than Riley's to begin with? Again, don't know. Before surgery, two different neurologists told me Riley's SM was very advanced and very severe.

I wish you lived near Chicago. I'd send you to Riley's neurologist. I've just been so happy with everything about Riley's surgery. Her recovery was about 8 weeks of restrictions - difficult in a multi dog household, but not impossible. To tell the truth, I was not sure about the surgery until at least six months post-op. It took a while to figure out her meds but once she was settled, I started to relax. Her neurologist's name is Dr. Michael Podell. All 4 of my dog's have seen him for various reasons and Oliver my oldest has also had surgery with him (cervical disc decompression).

PM me anytime. if I can help you with any more information I will.

Reptigirl
28th June 2011, 01:34 AM
Thank you for this information. I'm glad to hear of your success story! I have taken the names & info of these two neurologist from the Cavalier Heath page and I'm going to pass them on to our neuro tomorrow.

lovecavaliers
28th June 2011, 02:50 AM
Oh Sharon I completely feel for you. I know that surgery is most likely in Jack's future too. I live a 45 minute drive from LIVS- Dr. Marino but have my doubts about the mesh. I have heard on other forums of dogs getting bad infections from the mesh and the recovery time is usually longer (~3 months I was told).
Other than Abbey's case (which hopefully will improve) I have heard of 3 or 4 success stories with swine and the recovery period is much less. I have also heard of a few without any duroplasty who have done well.

It is all so very confusing and I hope I didn't confuse you more. Did your neuro say how many cases he has done and what the success rate was?

Karlin
28th June 2011, 03:09 AM
I think we all pretty much agree that no one can make determinations on success of a given type of surgery from single tales of success or failure. I, like many other people, am really anxious to see some actual published, peer-reviewed articles on the different methods of treatment from meds to surgery.

At the moment I confess that I do not believe the claims for the mesh surgery quite jibe with the bulk of actual cases that I have come across -- eg claims being made that there are rarely complications or that almost no dogs need follow on meds. Almost every dog I know of that has had the titanium mesh is on at least one medication and many have had follow on complications, some including very severe pain. Probably not more complications or difficulty than with regular decompression, and perhaps there is indeed a better long term result due to limitation of scar tissue, but nothing has yet been published that looks at medium to long term results of these different surgeries. I have not seen any presentation that incorporates in some of these anecdotal stories of infection, poor results, pain or to any significant degree, continued need for meds. I have to believe that the people who post about these issues must represent many others who do not post -- so it just seems to me that there is a gap between claims around follow up cases, and actual experience.

I also do not think that using swine tissue gives noticeably different results than the other forms of decompression which just use variations on swine tissue. It is simply a fatty tissue patch of one kind or another.

At this time I would take claims for results with a grain of salt especially if there is a material benefit to anyone for doing a surgery over other types of approach and a lack of published results or if these are out of kilter with what owners report.

I do think that in some cases surgery is probably the only option -- serious symptomatic cases for example, and particular, any dog under 2-3 with significant symptoms and especially obvious pain. If I had such a dog I would opt for surgery.

Prednisone is a fairly heavy level of medication to give a dog as a permanent necessity post surgery. Not that there's any issue with needing it, but it again underlines that it isn't quite the case that certain types of surgery have no need for medications afterwards. I have wondered how careful and broad the followup is for many of the dogs post surgery because I think many do start to have symptoms and owners go to their vet or a different neurologist that is perhaps closer for adding on medications.

Or maybe the only people I come across are those with dogs that do not do as well as the claims made for 'most dogs'.

I would simply say that I am not convinced that one form of surgery for decompression is significantly better than any other, because I know of equal numbers of successes and failures offhand for most approaches to decompression and some do not fit with claims made for individual approaches made for certain approaches. I have attended presentations over the years by several of the people doing the various approaches to this surgery and know many people who have opted for various types of surgery. If I were to go for the mesh surgery I would want it done by someone who has done it before.

I do know people who have done the regular decompression who have had great results, and who have had it fail. I know of people with the mesh who have had great results, and others who have had it fail.

Personally I would not at this time do the mesh surgery on my own dogs because it is more complex, I don't like the idea of screws in the skull or the lack of long term knowledge about whether those plates may move (I know of some that did move in dogs operated on earlier), and the recovery is long and slow.

Blondiemonster
28th June 2011, 03:14 AM
Why did he not want to consider swinr? Dr shores i believe is the specialist of swine? Anyone? He was in south carolina or somewhere and now in mississipi? Cant remember but if it was my dog, id ask for a phoneconsult with him to be ultra informed.

Blondiemonster
28th June 2011, 03:22 AM
I think we all pretty much agree that no one can make determinations on success of a given type of surgery from single tales of success or failure. I, like many other people, am really anxious to see some actual published, peer-reviewed articles on the different methods of treatment from meds to surgery.

At the moment I confess that I do not believe the claims for the mesh surgery quite jibe with the bulk of actual cases that I have come across -- eg claims being made that there are rarely complications or that almost no dogs need follow on meds. Almost every dog I know of that has had the titanium mesh is on at least one medication and many have had follow on complications, some including very severe pain. Probably not more complications or difficulty than with regular decompression, and perhaps there is indeed a better long term result due to limitation of scar tissue, but nothing has yet been published that looks at medium to long term results of these different surgeries. I have not seen any presentation that incorporates in some of these anecdotal stories of infection, poor results, pain or to any significant degree, continued need for meds. I have to believe that the people who post about these issues must represent many others who do not post -- so it just seems to me that there is a gap between claims around follow up cases, and actual experience.

I also do not think that using swine tissue gives noticeably different results than the other forms of decompression which just use variations on swine tissue. It is simply a fatty tissue patch of one kind or another.

At this time I would take claims for results with a grain of salt especially if there is a material benefit to anyone for doing a surgery over other types of approach and a lack of published results or if these are out of kilter with what owners report.

I do think that in some cases surgery is probably the only option -- serious symptomatic cases for example, and particular, any dog under 2-3 with significant symptoms and especially obvious pain. If I had such a dog I would opt for surgery.

Prednisone is a fairly heavy level of medication to give a dog as a permanent necessity post surgery. Not that there's any issue with needing it, but it again underlines that it isn't quite the case that certain types of surgery have no need for medications afterwards. I have wondered how careful and broad the followup is for many of the dogs post surgery because I think many do start to have symptoms and owners go to their vet or a different neurologist that is perhaps closer for adding on medications.

Or maybe the only people I come across are those with dogs that do not do as well as the claims made for 'most dogs'.

I would simply say that I am not convinced that one form of surgery for decompression is significantly better than any other, because I know of equal numbers of successes and failures offhand for most approaches to decompression and some do not fit with claims made for individual approaches made for certain approaches. I have attended presentations over the years by several of the people doing the various approaches to this surgery and know many people who have opted for various types of surgery.

I see it like this with the mesh: how does the potential benefit of less scar tissue ( even if ten percent) wheigh against the risks brought on by mesh surgery (that is more or different from regulAr decompr) If it was certain that there was at least a ten percent reduction and the risks of mesh are not life threatening or significantly more than others id go for that. But we dont know do we? Not even the ten percent? I too wonder why marino or anyone hasnt published a study post 4 or 5 years. I just dont understand. Also karlin, do u meet the people who had complications of the mesh on forums or real life? Fprums will most likely be filled with more problematic dogs and owners that need support.

Karlin
28th June 2011, 03:33 AM
I know one of the people personally and she has two dogs that have not done well with the mesh.

Others belong to people I would have known a long while online. I don't know about the reports elsewhere about infections etc. I think decisions like this are very personal. I do wonder if the people doing mesh surgeries are aware of the various problem cases and do wonder abut the claims about how many do not need meds.

I do definitely think that people are more likely to post if they have issues rather than if they do not. Some of the cases I am thinking about though are people who began to post before diagnosis and continued to post after, or who contacted me privately after to say they were having problems. It just makes me wonder about how dogs were chosen to be included in the group being tracked.

I would be delighted to find one type of surgery gave significantly better results but on evidence/lack of evidence/anecdotal reports to date I am not convinced. It would be great to have a proper comparison study, medium if not long term! And a broader study of meds compared to surgery results.

Blondiemonster
28th June 2011, 03:36 AM
I know one of the people personally and she has two dogs that have not done well with the mesh.

Others belong to people I would have known a long while online. I don't know about the reports elsewhere about infections etc. I think decisions like this are very personal. I do wonder if the people doing mesh surgeries are aware of the various problem cases and do wonder abut the claims about how many do not need meds.

I do definitely think that online people are more likely to post if they have issues rather than if they do not. Some of the cases I am thinking about though are people who began to post before diagnosis and continued to post after, or who contacted me privately after to say they were having problems. It just makes me wonder about how dogs were chosen to be included in the group being tracked.

I would be delighted to find one type of surgery gave significantly better results but on evidence/lack of evidence/anecdotal reports to date I am not convinced.

When u say "not done well" do u mean no improvement or continued decline or post op complications? Just curious as to worst case scenarios

Karlin
28th June 2011, 03:40 AM
Decline after surgery over time. In another case, a dog was euthenised.

Blondiemonster
28th June 2011, 03:47 AM
I actually saw in marinos first study thay 2 dogs out of 12 were euthanized. What was remArkBle to me is that both dogs where the ones who had vocalizing screaming episodes pre surgery listed as their symptoms. (among other things) i thought that probably wasnt a coincedence as to how far evolved they were before surgery in terms of pain.

anniemac
28th June 2011, 02:22 PM
Shannon,

This is my *opinion* from things that both you and Karlin said along with Ella's neurologist. I would quote them but there are on several different posts. One thing Karlin said is it is hard to get an idea from people on forums. It is one experience vs. another is so little to judge things on. I can say what I have heard (two cavaliers with great results) Riley and another one whose syrinx has seen to decline in size. This cavalier was part of his study. That is only two, yet weigh that against the two negative results Karlin knew about. You have been on this forum long enough and have been treating Blitz for SM to know the best for your situation. You know how he is reacting to medical management which also played in my decision.

Ella's neurologist said some of the same things as yours and Karlin. He said he wanted to see long term results before actually stating that it is worth it. He has done them before *I think* but it was offered as an addition to the surgery prior. He said is it worth the extra $1000, risk *he said it was *riskier*, recovery time, etc. he could not say without seeing reports from long term studies. As far as your neurologist saying it was a somewhat simple procedure, I dont know. However, I do know that Ella's neurologist said that there was more risk from drilling holes and placing screws.

Karlin said one thing Ella's neurologist was concerned about which was the long term results from the screws in the skull. Whatever Karlin said it was the same which I can't say right.

My personal decision was based on where I lived, the neurologist Ella saw and wanted to do her surgery, among other factors which varies by individual. If I lived in NY close to Dr. Marino and Dr. Dewey would my decision be different? Probably. I did not want something more complicated done by a neurologist (even though I was extremely happy with him) that did not have as much experience with this procedure.

In case others read this and are deciding on surgery, I will say this. (You have been treating Blitz with medical management so may differ with age, etc.) This is what I will say FWIW. You know Ella developed scar tissue. This was shown on her MRI in September 2010. You can see past threads or remember but I thought I would have to take drastic measures like a second surgery but due to other things (I waited). What I saw as declining fast started to become managed with changes in medication. I thought she had months but she could have had years. I'm not sure and will never know. However her neurologist said it could be a couple months she had, but that was not the case.

One last thing. I too find it strange the number of Cavaliers said to no longer need medication after surgery. You know this but thought I would point that out also.

Blondiemonster
28th June 2011, 05:41 PM
So tricky... Mesh and the extra risk? Or no mesh and MAYBE morr chance of scar tissue... I do think id trust marino with the screws since he is so skilled in it he even does chihuahuas! (had a few diagnosed with sm). But dont know about screws in skull long term.. Its all just a guessing game.

Reptigirl
28th June 2011, 06:49 PM
Sometimes I wondering if that the dogs who do not do well with surgery would not have done well no matter what? Maybe the mesh or swine tissue works longer for dogs who would have benefited from surgery but for the dogs that do not do well maybe there was nothing that could have helped???

Love my Cavaliers
28th June 2011, 07:31 PM
Sometimes I wondering if that the dogs who do not do well with surgery would not have done well no matter what? Maybe the mesh or swine tissue works longer for dogs who would have benefited from surgery but for the dogs that do not do well maybe there was nothing that could have helped???

I've been wondering about that myself too. I think maybe that's one of the best points that's been brought up. I keep wondering why it seems like Riley was one of the lucky ones. She could barely walk straight before surgery and yes, she is now on long-term prednisone - not an ideal solution - but for her the combination of a low dose now of daily prednisone (which didn't work pre-operatively) and the surgery has helped her live an almost normal 3 years post-op. I couldn't ask for anything better. No post-op complications from the screws or the mesh, nothing. I just thank my lucky stars that for her it has worked.

lovecavaliers
19th July 2011, 12:34 AM
Sharon, just checking in to see if you made any decisions about Blitz's surgery?
It is so hard, I am dreading the day I have to decide about Jack but, knowing this disease and his young age I fear it's inevitable.

How is Blitz doing otherwise?