View Full Version : How does one decide which neurologist to go to??
8th August 2011, 06:04 PM
Been keeping up on Debra's post about Gracie and it made me look into the different neuro doctors mentioned along with any in my area that are supposed to be specialists with SM. I'd like to be prepared if (heaven forbid) Polly was ever diagnosed and needed surgery for this condition. When you look up board certified neurologists on the cavalier health website, it lists several, with those with experience with SM highlighted in red. Like for Debra, living in NC, there are 2 vets highlighted (including Anne's doc, Dr. Bergman) so just wondering what makes the one she has chosen in Florida a step above the rest?
I live in Michigan and see that "Dr. Michael Wolf" is highlighted and upon googling his name I ran across this site which makes the facility sound rather impressive and describes him as a "World renowned Veterinary Neurologist"
The neurology center in which he works
It just all seems kind of daunting as to 'Who's the best". I'd like to have a general idea as to where I would need to go if something like this were to ever happen (or if I meet anyone who needs any suggestions). I would travel anywhere if I had to, I'm not concerned as to how close to home it is...I'd go to China for her if I had to! LOL. I'd just want the best with the most experience.
8th August 2011, 06:30 PM
I actually think there is no way you can answer or define “best”–I know I would have very different opinions about who I think are the “best” neurologists and approaches to treatment, compared to some of the people others might think are the “best”. There are also plenty of people with lots of “experience”–but that still would not necessarily indicate someone that I would judge as being best for the kind of treatment I would like for one of my dogs with SM. I've personally spoken to aroun a dozen of the leading researchers/neurologists in this area and they are all different to some degree, in approach and philosophy and many of them vary quite a bit in the way they do decompression surgeries. Some claim they have better methods than others, but from my own perspective, the jury is still well out on this one as there is little medium to long-term data. Some of the data relies on owner evaluations as well, which can be pretty subjective. I would have to see a lot more long-term evidence on the differences between various surgery techniques and what material is used during the actual process to think it makes one iota of difference whether a person opts for one approach over another.
Rod notes himself that while the red type indicates a neurologist that somebody–and it could be anybody with any opinion–has had some experience with in treating a dog with SM, the red type does not indicate anything more than that, and is not a specific recommendation for any of these neurologists. I know there are many people that are highlighted in red that I personally would not take a dog to for example. I would have to have a pretty clear idea about the person who was making the recommendation as well.
I think what people decide makes a “best” choice comes ideally from learning as much as possible about SM and how a particular neurologist approaches and treats it. And then it comes from actually going in and talking to those people–perhaps getting more than one opinion from neurologists that you are aware may have different approaches. Some people will like a certain kind of personality as well, and sometimes the personality of the neurologist is more important to people than their approach to treatment. The bottom line really is that the owner needs to be as educated as possible in all the various approaches and then discuss those approaches with the neurologist they go to see, and perhaps at least one other as well to get a different opinion. And then you have to weigh up those discussions and go with a gut feeling as well as an intellectual apprehension of those discussions.
I don't think anyone can say any one person is the best person to go to or that any one approach is the best approach. There isn't enough data to make any clear claims at this point, and treatment remains a highly personal decision with no right or wrong answers as long as the dog's pain is addressed. Or to put it another way, a newly qualified neurologist with little direct experience of treating cavaliers with SM might well be a much better choice and a much better Dr. than someone with experience. Or maybe not. Different people will have different opinions.
8th August 2011, 06:34 PM
First, I hope Polly never has to see a neurologist. Ella saw Dr. Brofman and not Dr. Bergman but either way, I went to Dr. Brofman because he is in Charlotte. The first step would be to see a vet to rule out anything else. If you ever need a referral to a neurologist, look at Rod's list on www.cavalierhealth.org (http://www.cavalierhealth.org) and he has a list of board certified neurologists (ones in red are familiar with SM). You can't do anything until you have an MRI. If you flew to FL and found out (best case) that Polly had PSOM causing the symptoms, it would be a wasted trip. Ella had an MRI to confirm her status. With this, I could have gotten a second opinion to decide on surgery, I thought of going to LIVS, but in the end decided on Dr. Brofman because of location. He isn't specialized in surgery (even though he has done several) like Dr. Marino, Dr. Shores, Dr. Shubert, etc. I don't know of any in the west. I had the decision on surgery or not, what kind, where to go, etc. This is when I looked at information on different types and had to weigh that choice. This is when I would look at who is specialized in what surgery.
You may never have that decision but that places a big factor so I wouldn't go all the way to a place if that is not going to be something you even have to deal with.
It's always good to get information and recognize symptoms but if Polly isn't showing any symptoms then you never know what the future holds. There could be some new procedure, neurologist, etc. So I guess it depends on what is going on?
8th August 2011, 06:36 PM
I just read Karlin's post and I agree. I thought Dr. Brofman was the "best" in treating Ella. Most of it had to do with how I could go see him every other week. I was able to keep in touch over Facebook and he was good at getting back with me. We had a good relationship.
8th August 2011, 06:47 PM
Thanks for all the info! I can def see how it may be hard to pick "the best". Polly has so signs or symptoms (knock on wood) but I guess I always like to be a bit overly prepared when it comes to her lol. I would probably get an MRI done at the Animal neurology center with Dr. Wolf which is within 30 mins or so of me to confirm what was going on (a facebook friend of mine with a cavalier just had an MRI done there and was very happy with the doctor and staff) and then go from there on deciding who to proceed with if surgery was needed. At least I would have a lot of support and personal experiences to reference from all the wonderful people I have met on this board.
P.S to Anne- Oops! Sorry about the Brofman/Bergman mix up :)
8th August 2011, 06:57 PM
They were partners. Dr. Brofman recently moved so I've seen both of them.
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8th August 2011, 08:44 PM
An example of how neurologists differ and this is something not as serious as a surgery decision. Rod and some others said that tail chasing could be a symptom of SM. I emailed Ella's neurologist recently and he said it most likely is behavioral but could be a secondary symptom of SM. So he had heard it could be a symptom for SM. Went to partner (Dr. Bergman) for a consultation and he told me that it would hurt a cavalier with SM to chase their tail??? :-? Anyway just an example....
8th August 2011, 09:17 PM
For me it was Chestergates as I had read about it here on CT and the neuro then was Martin Deutschland ,since left ,and IF there
is a next time it will be Chestergates again and this time Mr Geoff Skerritt who has done so much for Cavaliers and SM here in the UK and Ireland .Plus
the bonus is its only 20 minutes from where Ilive .
Love my Cavaliers
8th August 2011, 09:31 PM
When I took Riley to the neurologist for the first time, I was very naive. I had never heard of SM (hadn't found CavalierTalk yet) so I just went to the neurologist that my vet recommended. Luckily, he was very familiar with SM and diagnosed Riley within 30 seconds of seeing her just based on her physical symptoms and hearing her history. I still took her to another neurologist for a second opinion, but he said that if it were his dog, he would want Dr. Podell (the first neurologist) to do the surgery because Riley's SM was complicated by a large cerebellar cyst and he thought that Dr. Podell was a more skillful surgeon for something like that than he was!!!
Luckily i had the choice of two neurologists close by me and Dr. Podell has been absolutely wonderful with Riley and very attentive to me. From the beginning he has called me back promptly and made sure my concerns were tended to. Since Riley goes in 3-4 times a year for bloodwork, I wanted someone close by also. He also does a complete neuro exam then too.
Last time I took Riley in for her checkup, I was sitting in the waiting room with a mom and her 7 year old daughter who had made a card for Dr. Podell with a drawing of her dog and it said "Thank you for saving Foxy". That and about 100 other cards and pictures are on multipe bulletin boards in his office. Very cute.
He definitely has a soft spot for cavaliers too - he adopted a 3 year old ruby last year and now takes her to my groomer.
So, I guess I'd have to say, I just feel comfortable with him and Riley has been lucky that her surgery has been a success. Knowing what I do now, I probably would have done a ton more research before I blindly settled on Dr. Podell, but it felt right at the time and that was the most important thing to me once I had made the decision to do the surgery.
8th August 2011, 10:11 PM
I agree with everyone's comments about finding the "best" for you and your dog differs for everyone.
In your post you mentioned a "Dr. Wolf",a friend of mine reported that she used to take her cavie to a wonderful neuro in Canada named Dr. Wolf and was so sad that she had moved to the US to practice, just curious if that was the same Dr. Wolf. I think the clinic in Canada was associated with the University of Guelph (?sp). If so, my friend said she was the "best":o
Hopefully you will never need to take Polly to any neurologist!
8th August 2011, 10:45 PM
I pray that Polly never needs to consult a neuro. But i also did some research on this months ago and it was a huge help. In my process, I talked to several Cavvie humans in the USA who had surgery for CM and also read as many posts here as I could find. I read Karlin's resources, Dr. Rusbridge website and CavalierHealth.org too. After researching this and getting and her MRI results, I knew my priority was a neuro who really believed in and had experience with both decompression and using a mesh to replace the bone removed. I also decided that i preferred one who also covers the mesh with either swine tissue or some of the dog's own fat tissue. That is my OWN conclusion of what we wanted, not the perfect answer for all, so let me state that clearly. Once I narrowed that down, the options were not many. It immediately ruled out NC State and any other vet neuros in my area. Only a handful of folks do this in the Eastern USA. What led us to decide on Dr. Schubert and University of Florida was rave reviews about both...from everyone I talked to who had been his patient. Another well-known surgeon has moved to a different place...and much less accessible. The most well known place never called back despite several efforts. So.... It ended up being a less difficult choice than we expected. So far! I am VERY impressed with the hospital and Dr Schubert. But surgery is tomorrow. I think you will find somewhat similar situation in your area. There just are not that many options.
9th August 2011, 03:00 AM
Erin, great post. I think, regardless of symptoms, the fact that you are doing research is fantastic. Of course, I hope you never have to go any further with it. But who knows, maybe your knowledge will help another.
I am familiar with Dr. Michael Wolf. 13 years ago, we had consulted with him in regard to a neurological disorder my English Cocker had. From what I remember, he was a very caring knowledgeable Doctor. We had a very strange situation with my Cocker, that I won't take up space on this thread to talk about, but we spent 2 years trying to find answers, and he was the only one that seemed to be able to put a name to her disorder, though there was no definitive test for the disorder.
My Vets are all graduates of Michigan State, but they sent me to Dr. Wolf, so I am sure they had/have great confidence in him. Right after I got Claire, I ran into a client at my Vets whose Cavalier had SM and had just had surgery. She actually owns, I think she said 3 Cav's. I could ask my Vet how her dog is and who she used for surgery. I had only learned of SM a few weeks before that when my Vet was educating me on it during our first visit with Claire. I didn't know of SM before that.
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