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View Full Version : Surgery Ė Am I doing the right thing?



PattyG
13th May 2013, 06:41 PM
For those of you who have gone through SM surgery with your dog can you tell me if you feel it was effective for your dog? Did it actually alleviate symptoms? Do they come back at some point? I canít find study results for dogs that have had the surgery several years ago, only results for dogs within the first year or so post surgery.


I know that the recovery is long, but how long was it before your dog seemed to be relatively back to normal and how did you manage to keep you dog inactive for so long?

My 2 year old Maddie is a mill rescue and has exhibited symptoms since she came to me at 11 months old. She doesnít give any indication that she is in pain, but does neck scratching, particularly while walking on lead.


I took her to see Dr Marino at LIVS who accepted her into his study group. An MRI showed that she has PSOM in both ears as well as signs of SM. She has developed a syrinx. They did a myringotomy while she was anesthetized for the MRI but that didnít produce any noticeable effects. Dr. Marino has recommended that we not wait to do surgery for the SM and do it now.

Iím very nervous not only about the actual surgery but about the recovery process as well. Maddie is a young and very active dog living in a multi-dog household (She has 2 Cavalier sisters and a German Shepherd sister as well). I donít know how Iím going to keep her quiet and inactive for months and months. I will be taking time off from work to be home with her for a few weeks after the surgery and I can bring her to work with me after that which will make it easier but it will be hard for all the dogs to be separated from each other as they are closely bonded.

I guess Iím looking for reassurance that Iím doing the right thing or her, Itís very hard to know that my decision will cause her months and months of pain when I look at her today and sheís not in pain now. However I could never forgive myself if I put it off and her SM progressed to the point where she was suffering.

Iím grateful to have found this group and appreciate and advice you can offer.

Thanks, Patty

Margaret C
14th May 2013, 11:55 PM
I have had a few SM cavaliers but here in the UK we tend to try and manage the dogs on medication rather than go for surgery.

I understand surgery can buy some extra time but symptoms often return and the dog still needs to be medicated.

However, there are some USA owners on here that feel surgery saved their cavalier's life. Hopefully they will be able to tell you of their experiences.

Good luck to you & Maddie.

Love my Cavaliers
15th May 2013, 01:29 AM
I'm going to apologize in advance because for some reason my enter key isn't working so I can't separate my paragraphs. Sorry. Riley had SM surgery 5 years ago. Her primary symptoms were vestibular, so instability and balance problems. She never scratched and I never knew she was in pain before surgery, only in retrospect. Her syrinx covered approximately 95% of her spinal cord and was complicated by a large cerebellar cyst. I got a second opinion before I opted for surgery and both neurologists told me that surgery was her best option for a better quality of life. She had the titanium mesh implant which for her has been great. Recovery was long, but probably longer and harder for me (at least psychologically) than for her. I continually questioned whether I had done the right thing, whether I had shortened her life or whether I had indeed given her a better quality of life. I cried often, especially when I looked at her shaved head. She looked like a half-shorn lamb. It took months to figure out the right meds and the right dosage of meds post-operatively. Once that was managed, things picked up, but it was trial and error for close to four months. Then it was probably another year before I stopped looking at her with pity and thinking that she was going to break with every move she made. I also did not trust that anyone else could take care of her as well as I could - even my husband. I thought no one else would be alert for the subtle changes in her behavior that might spell trouble. Let me tell you, it was exhausting! Five years down the road she is a delight. She is active and happy and loves life. She will never be normal, her vestibular system was too badly damaged before surgery and she will be on life-long meds, but she's living the good life. She goes on walks, races around the yard with my other dogs, chases chipmunks in the yard (and catches them), and is my little snuggle bunny. For recovery, I set up an X-pen attached to a crate so she had more room to move around and also to separate her from my other dogs - particularly my rambunctious tri-color who was 11 months old at the time. She was either in the crate/pen or in my arms. The hard part about being in my arms though was if the other dogs started barking and all jumped off the sofa at the same time, she would try to jump also - and managed to jump out of my arms once before I knew what was happening. Not a good thing since jumping increases intracranial pressure - a no-no after surgery, but she's fine and we all make mistakes. I don't know if Riley is the exception, but her surgery was such a success. I never thought she would be alive today. I treasure each day with her, probably more than my other dogs because I didn't think I'd have these days. No one can tell you you're doing the right thing. You have to believe it in your heart and know that based on the information you have you are trying whatever you can to give your dog the best life you can. I wish you the best of luck.

anniemac
15th May 2013, 04:24 AM
Bev gave some great points. First one is that surgery is a very hard decision and I too questioned if I was doing the right thing. Only you will know what you think is best.

First I would like to say you are in good hands with Dr. Marino because he is one of the most if not the most experienced with surgery. That being said, he is more opt to suggest surgery. He is right that it is better to opt sooner than later before any damage is done. However, I know of others that opted not to and are doing well on medications.

The problem I have is that people (including myself even though I knew it would only stop progression), feel that it will cure things or make them as you said "normal". I know of one cavalier that actually had surgery with Dr. Marino that did not require any medications after. All the others (including my Ella) also need medical management.

I feel that Riley and Ella were very similar. The balance issues were what alarmed me and like Riley, Ella didn't scratch that much. Riley is a success story but I feel I made the right decision but if I had to change things I would have opted for what Riley had with the titanium mesh. Someone correct me if I'm wrong, but i believe Dr. Marino pioneered that technique. He may do something different now.

Bev gave you good information about what to expect after surgery. I do not regret things but as margaret said surgery is more common in the united states. I also feel like Bev and even though Ella is no longer with me (due to other things) I feel she wouldn't have been with me as long as she was without it or at least long enough to find the right medications to treat her symptoms.

Everyone is scared when they opt for surgery but you have to know in your heart that it's the best thing. It would not hurt to get a second opinion. Even though I'm an advocate for surgery, I can sense that it might be a good idea to get a second opinion even though Dr. Marino is one of the top neurologist in this field.

anniemac
15th May 2013, 01:57 PM
Let me clarify about being an advocate for surgery. I only feel that way for certain circumstances but it is the owner that knows best. With Ella, medications were not working at the time and I felt I did not have time to experiment with different medication combinations. She seemed to be progressing fast. I felt surgery could "buy her some time".

It is a major surgery and should not be taken lightly. At the time, the neurologist said he can't be sure how long Ella has. It could be 3 months or longer because progression is different with each dog. Ella did not have a long syrinx but it was affecting her being able to walk. The progression seemed really fast and whenever medications at the time, did not help.

I do have one problem with surgery. Sometimes I get fear that people believe its a cure. It's not and that one case where they did not need medication, I think is an exception. I think owners should assume they may/will need to continue with medications.

People may think that in Ella's case that it was unsuccessful because she developed scar tissue. That is more common with decompression surgery alone and is why Dr. Marino, Dr. Dewey and Dr. Berry use titanium mesh to hell prevent scar tissue. I have found that is more successful and since you are seeing Dr. Marino you will be in good hands.

I will never know if I tried different medications, Ella would be ok with that alone. In fact, she did find the right combinations and was managed for a long time. I still feel that I made the right choice but i would only change adding some type of modification (titanium mesh, swine tissue etc).

I read your post again and that it is part of a study so I imagine cost would not be a factor. You are lucky that you do not see any pain yet. I can still remember that painful look.

Good luck!

Rdituro
21st May 2013, 12:35 PM
Hi Patty,
I live on Long Island. My 4yr old Winston just had the surgery for his CM & SM 6 1/2 weeks ago. We opted to go to Redbank NJ to Dr Glass for his surgery. Our neurologist at West Islip advised us for the money we are going to spend to go just an extra hour to Redbank. I did hear great things about Dr Marino though. 1st thing is if you can afford the surgery I would recommend doing it ASAP. What happens is the more time that goes by the more the nerves are damaged. I wish I had done it sooner. Winston did present with a lot of scratching all of a sudden then he started to bite his feet. Dr Glass does NOT use the titanium mesh. He theory is that that procedure was developed for humans with this condition & the anatomy is different & not necessary for dogs. The mesh adds so much to the cost but thats Not why we chose to go that way. I have read of instances of titanium mesh being used & the dogs still develop scarring. That's his theory & that's a decision you will have to make. I'll tell you the recovery is so much better with out the mesh. I also have a multi dog household but it wasn't to difficult to keep the separated. I had to keep him on the leash to walk him & walk him separately from the other dogs. I gated off part of my kitchen & kept crates everywhere.
So am I glad I did the surgery? Yes! At first he almost seemed worse after the surgery but a lot of that was the wound healing. Yes he is still on the same medication he was on before. The reason I'm glad I did it is because I know he shouldn't get worse & he may even improve. He is very happy & since I've had him groomed after 2 months he's very perky & almost his old self.
I was so lucky & fortunate because his regular vet was so caring & concerned that he helped me research all of this & helped me make the desicion to have the surgery & where to go for it.
What ever you decide let us know & we will support you! Good luck with this very agonizing process. Any questions ask.

Blondiemonster
25th May 2013, 01:40 AM
I wanted to share the other side of the medal. 3 years ago we went to dr marino. My girl blondie has a 90 percent syrinx. He said if we didnt do the surgery shed be oaralyzed within a year. I didnt have a good feeling about the surgery.. And decided against it. Well.. We are 3 years later and my gurl is doing better than ever. Shes been on gabapentin which hasnt been raised and under treatment of a different neuro. Shell be 7 soon. No matter what happens now I am at peace and happy with my decision. I wanted to show u that its possible to be under succesful medical management years later.


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Blondiemonster
25th May 2013, 01:43 AM
I wanted to add she also on omeprazole for 3 years now


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anniemac
25th May 2013, 01:49 AM
I wanted to share the other side of the medal. 3 years ago we went to dr marino. My girl blondie has a 90 percent syrinx. He said if we didnt do the surgery shed be oaralyzed within a year. I didnt have a good feeling about the surgery.. And decided against it. Well.. We are 3 years later and my gurl is doing better than ever. Shes been on gabapentin which hasnt been raised and under treatment of a different neuro. Shell be 7 soon. No matter what happens now I am at peace and happy with my decision. I wanted to show u that its possible to be under succesful medical management years later.


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Good point Lynn. I think of that often. It is so hard and I will never know if I had waited what will happen. Some neurologists are more about surgery than others. I feel that it is something that you need several opinions. Exactly what you need Lynn. Glad to hear blonde is doing so well!!

Blondiemonster
25th May 2013, 12:38 PM
Yes we just are so blessed Annie. It almost seems as if shes better than 3 years ago.. I wonder at a rescan what it would show. We rescanned her at 6 months with no changes in MRI.


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Love my Cavaliers
25th May 2013, 07:52 PM
Lynn, I am so happy that Blondie is doing so well, actually better than expected! And that is the hard part of deciding whether or not to do surgery. I just think you have to trust your gut. Anne and I felt that for Ella and Riley surgery was the right choice. Lynn, you mentioned that you didn't have a good feeling about the surgery and opted out. No right or wrong choices, just individual choices. As it turns out, surgery was the right choice for Riley and medical management was the right choice for Blondie. All you can do is make sure you have gathered the most information you can so that you can make an informed decision, and then make the leap and know that whatever you decide to do you are doing with your dog's best welfare in mind.

lovecavaliers
27th May 2013, 03:22 AM
Yes it is definitely a tough and very personal decision. I was at a similar crossroad 3 years ago with Jack. Jack also had his MRI at LIVS and I was told by the same doctor that Jack would be paralyzed in a year. I went for a second opinion and this neuro suggested we try meds first. I did that and 3 years later, things are stable and Jack can still run and play (he is not completely "normal" but I deep down feel his quality of life is good). If the meds stopped working and quality of life went down, I would consider surgery again.
I say get a second opinion and then go with your gut.
Good luck, my prayers are with you.

Blondiemonster
31st May 2013, 10:54 PM
I agree. Get a second opinion from a neuro who treats conservatively and likes the medical route. When that neuro also says surgery the choice would be easy... I dont like ti hear that livs used the paralyze scare tactic on you as well. Because it almost seems as one... Thats what my second neuro said too. He thought it was unethical to suggest that sice nobody could know that.


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Pat
6th November 2013, 07:49 PM
Bumping this up to the top also for Monica and Ellie.

Pat