Anyone with an SM dog...question about seizures (long)

[Blondiemonster]

I find that extremely strange... Blondie was extensively tested at LIVS. It costs 2OOO but they dont do just MRI. They do catscan, bayer, etc... It's something they offer because they study SM. When they find PSOM on an MRI they instantly do the surgery while dog is under without even asking. It costed only 200 dollars extra. I don't think it's a good idea too put a dog under anesthesia just to diagnose the PSOM again... See, it cant be diagnosed without anesthesia... But it CAN be diagnosed without an MRI if its severe enough.. They look deep in the air with microscope to see if eardrum bulges out. Also done under general anesthesia. So, i find it strange your doc won't do it without another MRI... Since it sometimes be seen without even needing an MRI.. hence why I wanna kill 3 birds with one stone;
Th spaying (she's almost 4 , needs to be done), the new MRI (mainly to check progression of SM and recurrence of PSOM) . If the free MRI is not available I will most likely just tell them to do the manual ear inspection while she is under, and if they see the bulging ear drum, drain it.

 

[Shay]

I find that extremely strange... Blondie was extensively tested at LIVS. It costs 2OOO but they dont do just MRI. They do catscan, bayer, etc... It's something they offer because they study SM. When they find PSOM on an MRI they instantly do the surgery while dog is under without even asking. It costed only 200 dollars extra. I don't think it's a good idea too put a dog under anesthesia just to diagnose the PSOM again... See, it cant be diagnosed without anesthesia... But it CAN be diagnosed without an MRI if its severe enough.. They look deep in the air with microscope to see if eardrum bulges out. Also done under general anesthesia. So, i find it strange your doc won't do it without another MRI... Since it sometimes be seen without even needing an MRI.. hence why I wanna kill 3 birds with one stone;
Th spaying (she's almost 4 , needs to be done), the new MRI (mainly to check progression of SM and recurrence of PSOM) . If the free MRI is not available I will most likely just tell them to do the manual ear inspection while she is under, and if they see the bulging ear drum, drain it.

They didn't do it when she was at Auburn, and I remember them saying it wasn't bad enough at that point. I am very curious now why he needs another MRI to clean out her ear. I don't think they can see Lily's from just an ear exam, and I know they originally told me it hadn't affected her ear drum. Questions and more quesiton.....:?

 

[Blondiemonster]

How bad does it need to get? It's a simple surgery... It doesnt affect the eardrum but makes an "inside out vacuum" effect and the pressure bothers them. In really bad cases the eardrum will bulge out... But every dog is different and response different to pain and discomfort... I didn't even know you could see on the MRI how it affects the eardrum or not.. I would ask him a lot of questions. Maybe get a second neuro opinion...

 

[Shay]

How bad does it need to get? It's a simple surgery... It doesnt affect the eardrum but makes an "inside out vacuum" effect and the pressure bothers them. In really bad cases the eardrum will bulge out... But every dog is different and response different to pain and discomfort... I didn't even know you could see on the MRI how it affects the eardrum or not.. I would ask him a lot of questions. Maybe get a second neuro opinion...

There are only two neuros in my state that treat SM dogs, and she has now seen them both. Dr Shores at Auburn is the neurosurgeon who first diagnosed her SM and PSOM, and he does the decompression surgery. I know people come from all over the country to see doctor Shores. He is supposed to be one of the best in the country for the decompression surgery. He is the one who said the PSOM was not affecting her eardrum based on the MRI. The neuro she saw Friday is also on staff at Auburn, but now comes here two days a week. I will more than likely take her back to Auburn for another MRI, and see what Dr. Shores says.

 

[Karlin]

Interesting; don't have much advice to offer though I'd go back and ask about the issues you are now wondering about --

• why is another costly MRI needed for an ear flush? (this is regularly done without an MRI and I don't understand why an MRi would be needed to do it)
  
• if the MRI is only a year old what are the advantages of a new MRI?
  
• why not just raise gabapentin dose? Is there any real benefit to (more costly) blood tests?

To me it would make sense to have the possibility of a PSOM flush while the fog is having an MRI but not many surgeries likely have that ability -- you'd need the availability of a full surgical set-up that is free at the time, and staff. Not too many places would be able to make an instant decision though there would be anaesthesia cost savings.

And yes, in the US, Dr Shores is definitely considered a very good neurologist He also would have different approaches to LIVS, also considered to be excellent. IMHO it is a good to have a range of opinions and approaches and ongoing research in different places.

 

[Shay]

Interesting; don't have much advice to offer though I'd go back and ask about the issues you are now wondering about --

• why is another costly MRI needed for an ear flush? (this is regularly done without an MRI and I don't understand why an MRi would be needed to do it)
  
• if the MRI is only a year old what are the advantages of a new MRI?
  
• why not just raise gabapentin dose? Is there any real benefit to (more costly) blood tests?

To me it would make sense to have the possibility of a PSOM flush while the fog is having an MRI but not many surgeries likely have that ability -- you'd need the availability of a full surgical set-up that is free at the time, and staff. Not too many places would be able to make an instant decision though there would be anaesthesia cost savings.

And yes, in the US, Dr Shores is definitely considered a very good neurologist He also would have different approaches to LIVS, also considered to be excellent. IMHO it is a good to have a range of opinions and approaches and ongoing research in different places.

I am very confused now as to why he needs a new MRI. I assumed, and of course I should never assume, that it was because he had to see where it is to do the surgery???? If you can't see it with an exam, how could he operate...I don't know :-?. When you think about it, if I had to get a new MRI, and then the PSOM surgery it would end up costing more than the decompression surgery, which is crazy!! I wonder if only a neuro can do PSOM surgery, and maybe I should try someone else, but who?? When I asked him about increasing her gabapentin, that is when he told me they had started checking gaba levels, and he wanted to see the levels before he adjusted the dose, and again I assumed this was necessary. When he calls me next week with the results from the blood test, I will ask the questions, and I have lots of them...again :sl*p:.

 

[Blondiemonster]

you know Karlin, that makes sense. Since Dr. Marino was at all the tests Blondie went through (since she was his study object) he most likely drained the PSOM himself, and was readily available. After the fact, I am so happy they did this cause it made such a difference in Blondie's life.
He was with her all afternoon. I was told that only a neuro and a dermatologist (surgeon?) can handle the PSOM... That is if I remember correctly.
It makes sense they didnt drain your dogs PSOM right away, Shay, however, I would def ask all those questions karlin wrote.. Make sure you are comfortable with the answers they give you!!

 

[Karlin]

Don't feel too upset: questions and concerns almost always arose AFTER the point you talk to a vet/doctor/etc... but they are working for you so you always should not be afraid to ask for explanations to better understand why they wish to do something. And you never have to take the option they offer.

I have not heard of checking gabapentin levels and would be interested in the reasoning for this myself. Given that so many of the dogs gradually need an increase in the dosage, I don't understand what knowing the blood levels will do -- though of course this could be useful/interesting info in its own right. But I'd want a justification of why it needs to be done, especially for a dog in such low levels. I haven't heard of anyone else checking gabapentin levels so am interested to know what benefits would be there in doing so vs the cost of doing so. There may be good reasons for checking!

Also: generally if the first MRI showed mucus plugs, I don't know what a second MRI would show that would be necessary in guiding an ear flushing. Vet can do a myringotomy (ear flush), not just a neurologist. I know they are often done without an MRI -- if the tympanum is bulging on a scope exam, a vet might do this procedure. The flushing procedure is nowhere near the cost of decompression. There's more info here:

http://www.vetlatranquera.com.ar/pages/wild/small_animal_26.htm

Otitis media is the issue with PSOM -- a middle ear problem, behind the ear drum (tympanum)

 

[Shay]

Don't feel too upset: questions and concerns almost always arose AFTER the point you talk to a vet/doctor/etc... but they are working for you so you always should not be afraid to ask for explanations to better understand why they wish to do something. And you never have to take the option they offer.

I have not heard of checking gabapentin levels and would be interested in the reasoning for this myself. Given that so many of the dogs gradually need an increase in the dosage, I don't understand what knowing the blood levels will do -- though of course this could be useful/interesting info in its own right. But I'd want a justification of why it needs to be done, especially for a dog in such low levels. I haven't heard of anyone else checking gabapentin levels so am interested to know what benefits would be there in doing so vs the cost of doing so. There may be good reasons for checking!

Also: generally if the first MRI showed mucus plugs, I don't know what a second MRI would show that would be necessary in guiding an ear flushing. Vet can do a myringotomy (ear flush), not just a neurologist. I know they are often done without an MRI -- if the tympanum is bulging on a scope exam, a vet might do this procedure. The flushing procedure is nowhere near the cost of decompression. There's more info here:

http://www.vetlatranquera.com.ar/pages/wild/small_animal_26.htm

Otitis media is the issue with PSOM -- a middle ear problem, behind the ear drum (tympanum)

Thanks Karlin!! I will ask him about checking the gaba levels when he calls me. He did indicate this was something Auburn had just started doing, so it is new. The cost for the test was $45. When I said the PSOM surgery would end up costing more than the decompression surgery, I meant if I had to get another MRI at the $1900 cost he quoted, and the PSOM surgery. The decompression surgery was quoted at $2200 at Auburn, so it would cost more if I got the MRI at the clinic here where I saw him, which to me is crazy!! It's not like he doesn't have an MRI already. He brought a disc of the MRI done at Auburn for me to keep, and viewed it while I was there. The only thing he said was he wouldn't feel comfortable doing it without a new MRI.....hmmmm? I'm sure there is a reason, maybe the MRI didn't show it well enough for him.....dunno, but I will ask him when he calls. If you don't need an MRI to do PSOM surgery then I am stumped!!!

 

[Karlin]

Oh that is a small testing cost then for bloods -- but wondering what it shows that is helpful in making decisions? Would be very interested to learn more.

I understood what you meant on the PSOM surgery -- was agreeing that yes, it seemed excessive to get another MRI just for this procedure given that it would make an ear flush costs close to a decompression. Maybe it is that they want to make sure the syrinx hasn't progressed so much that it is the culprit rather than PSOM...?

I always think there must be respect of these professionals as being the experts ; but at the same time I would want any and all costs justified especially if they vary from what others do. I also think people should never be fearful of asking questions about anything we do not understand especially when it come to care, and care we are paying for. I like to know the various options and opinions, and I like a vet and specialist that discusses these willingly.

 

[Shay]

Oh that is a small testing cost then for bloods -- but wondering what it shows that is helpful in making decisions? Would be very interested to learn more.

I understood what you meant on the PSOM surgery -- was agreeing that yes, it seemed excessive to get another MRI just for this procedure given that it would make an ear flush costs close to a decompression. Maybe it is that they want to make sure the syrinx hasn't progressed so much that it is the culprit rather than PSOM...?

I always think there must be respect of these professionals as being the experts ; but at the same time I would want any and all costs justified especially if they vary from what others do. I also think people should never be fearful of asking questions about anything we do not understand especially when it come to care, and care we are paying for. I like to know the various options and opinions, and I like a vet and specialist that discusses these willingly.

I totally agree Karlin, and I am faulting myself for not asking more questions, which I usually do. This neuro was not as easy to talk to as Dr Shore and his staff, and was a little hard to understand. I had to wait an hour and a half to see him past my appt time, and my husband met me there and he was not happy to have to wait that long because he had taken off of work, so I was a little stressed. The Dr did apologize, and said they had some emergencies and were behind, so I certainly understood that. We ended up being there for a very long time, and I didn't necessarily feel rushed, but I did say to my husband that he was not as easy to talk to as Dr Shore. I wish we had more options here with neuros, but I am feeling now that I probably should have just taken her back to Auburn, and perhaps now I have spent money that would have been better spent at Auburn, because this guy will not do the surgery without a new MRI, and I am not going to spend $1900.00 for that. I will now have to start all over at Auburn, unless I can find a vet here who will do the surgery. I am going to check with my vet before I make a decision to see if she does the PSOM surgery. But I am very frustrated now, because Lilly is the one this affects. She has not had any more vestibular episodes, thank goodness!!