Update on Bailey

Just catching up now...

Im so sorry that you have had this news. It truley is devastating to hear those words.
At least you know now and as others have said you WILL get to the point where you can look at Bailey with out crying but right now I know that is all you want to do.
Find something that works for you and Bailey- it took us a good few months of trying before we wound something that worked for Ruby and now she is really comfortable with what she is on.
Surgery is a really really scary word for me and I cant even contemplate doing it to Ruby as Id rather have her comfortable for however long than contemplate her suffering surgery and it not even working and having her die in considerable discomfort and pain. She would not tolerate being still and confined for that long.

Good luck with whatever you choose and we are all here for you when ever you need it!!

I am hoping someone can point me in the right direction on what to do next.

Bailey has an appointment at the vet on Friday to discuss her medication but I am thinking this may be a short term solution.

I think I am leaning towards surgery. If she was older then I would probably opt for the medication but the fact that she is not even three yet really worries me.

Is it unrealistic to think she could live a normal life span with only medication when she is only three at the moment? Would surgery have a better chance of halting the progression?

I know no one can really answer these questions but I am really just thinking out loud and would appreciate any feedback.

Would it be possible for me to get a second opinion from a neurologist who has a lot of experience with SM? Has anyone done this?

Hi again.

I agonised this very same decision in May this yr when I found out about Rubys SM.
Medication can be very effective and all a neurologist will tell you (we see Clare Rusbridge) is figures and maybes and only you can decide what is best for Bailey.
Ruby is also young, she will be 3 on Tuesday and too be honest I went through the:

a) Surgery now with a possibility she could deteriorate rapidly and die after which would be a waste of life and if she did make it through she would be crated for weeks with no quality of life (what she is used to) for a long while
b) stick with Meds and hope they are working, with no real way of knowing so but for a re scan next yr to compare, and then in a few years look back and wish I had opted for surgery as the pain is too much and she has to be allowed to sleep forever.

I do have a tear just thinking of so and its the hardest desision Ive had to make and thats with probably the best neurologist on our side helping us through.

My view on things is that Ruby is an extremely active dog, she does Agility, obedience, swimming and loves nothing more tha a run around the reserve looking for squirrels and ducks. To put her through surgery and keep her locked up for weeks seems against her will for me and Im sure if she could talk she would ask "just let me be...as comfortable as i can"
So thats what we do, the best Pain releif there is, and Furusomide which I pray every night is working. Only time will tell but for now she is stronger than ever and i know ive made the right desision xx

Wish you well

If you are at all contemplating surgery you should absolutely get a second opinion from a qualified neurologist. You can get a copy of Bailey's scan on a CD and then either take it to another doctor or send it to Care Rusbridge. I believe you will have to pay for a consultation either way. When Riley was diagnosed and surgery was the only recommendation by her first neurologist, I took her MRI scan on a CD to another neurologist. His recommendation was exactly the same as the first doctor, and because Riley's SM was complicated by a significantly sized cyst, the second doctor said I should have the surgery performed by the first neurologist since he was more experienced.

Riley had surgery in June of 2008 and I am so happy I did it. Recovery is long - at least 12 weeks until you feel good about doing the surgery because they finally seem more like themselves again - but it's not that hard to get through it. If you go the surgery route, plan to do it at a time when you can spend good quality time home with Bailey so she is not alone. More than a year after surgery, the recovery is just a distant memory now. I have no regrets. I did what I thought was the best treatment in consultation with two doctors, and I would do it again.

Whichever decision you make (surgery or medication), there will probably be times in which you question that decision and wonder why you didn't make the other decision. That is really natural and to be expected - although I do have to say that in Riley's case, I never question my decision now. I did during her recovery, but not anymore. Plus, I have the added benefit that her trial of medication while waiting the six weeks for surgery had no effect on her symptoms. For Riley, surgery was the right decision. I know you will eventually come to peace with your decision, but it may be awhile. Good luck and you can ask me anything abou the surgery or recovery. We are all here for you.

I hadn't read Karen's response all the way through before I posted my missive - but I think it's great that you get two different viewpoints of treatment options from people who are happy with their decisions. I think the message to take home from this is that you know your dog best and you will decide what you think is best for your dog. What works for one dog may not be the best for another dog - and it also depends upon your own personality and your own situation. There is no right or wrong. There are probably more people on this forum who are managing their dogs with medication that have opted for surgery, but that doesn't mean that surgery is not a good option. Get a second opinion and then trust your heart when you weigh your options once you have treatments options and prognoses laid out for you. It's not easy. We know that.

Thank you for both those different viewpoints. If I do consider surgery I will definitely get a second opinion. I would love to get Clare Rusbridge's opinion as she seems to be the most experienced.

As I mentioned Bailey has a appoinment at the vets to discuss medication on Friday. I think this is probably the best place to start and I will just take things from there.

Thanks again :hug:

Clare actually does not advise crating for weeks -- indeed, she doesn't advise crating at all once the dog is home . Neurologists differ quite a bit on this issue. You can read her full advice on surgery on her website as she explains her approach.

http://www.veterinary-neurologist.co.uk/faq.htm

It is also extremely rare for a dog to die right after surgery and few problems have been reported. The problem is medium to long term (as 80% of dogs improve right away after surgery as the pressure is gone) -- for some dogs it is that the symptoms return eventually because scar tissue ends up covering the area again and in worst case scenarios, come close to where the dog started. Most dogs don't have this degree of difficulty though even if they do get scar tissue.

For younger dogs with significant symptoms that signify a more severe case of SM, surgery is probably the only chance the dog may have for a medium to normal length life.

The statistics are worse for medications alone, all else being equal.

Much depends too on the type of syrinx, its shape, how fast the progression is... and so on.

Leo started to have symptoms at about 2.5 though he was diagnosed by MRI on a research scan (I was sure he was my 'clear' dog!). He needed gabapentin by about age 3. He has a large short syrinx that is in the centre of his spine -- lopsided large wide syrinxes tend to cause the most problems. Medication has managed his condition though he has gradually become more symptomatic. I keep his condition under review. In his case, Clare viewed his recent MRIs and thought if he was doing OK on medications that that was a better option for him.

A good neurologist familiar with SM can certainly give you advice on possibilities and advise on the basis of yur current MRI. For some dogs, that MRI may indicate surgery would be better than medication, and vice versa.

You can contact Stone Lion about having Clare give a second opinion on an MRI but it is better to bring your dog for a proper appointment if you are considering surgery, I think.

Most dogs that have surgery actually do really well, really quickly. the neurologists that advise long crating are the ones doing the mesh surgery which is far more involved than a basic decompression s screws are sunk into the skull, etc.

from Clare's website:

How successful is surgery?
Cranial/cervical decompression surgery is successful in reducing pain and improving neurological deficits in approximately 80% of cases and approximately 45% of cases may still have a satisfactory quality of life 2 years postoperatively (Rusbridge 2007). However surgery may not adequately address the factors leading to syringomyelia and the syrinx appears persistent in many cases (Rusbridge 2007). Much of the clinical improvement is probably attributable to improvement in CSF flow through the foramen magnum.

Should my dog have surgery or not?
The cases where surgery is clearly indicated and most likely to be considered successful are dogs that are painful and responding incompletely or not at all to medical management.

How long does it take a dog to recover from surgery for syringomyelia?
At Stone Lion Veterinary Centre postoperative dogs are hospitalised until the dog is comfortable enough for injectable painkillers to be discontinued. After discharge it typically takes 1-4 weeks before the dog returns to normal activity levels.

Will I need to confine my dog after surgery?
At Stone Lion Veterinary Centre postoperative dogs are not crate/cage restricted after discharge. Exercise is limited to short 5-10 minutes walks 2-4 times daily over the first 2 weeks postoperatively and then, depending on the dog’s progress, gradually increased over the next 4 – 8 weeks.

What is the recurrence rate after surgery?
In some cases scaring and fibrous tissue adhesions over the foramen magnum seem to result in re-obstruction and 25% to as many as 50% of cases can eventually deteriorate (Dewey et al 2005, Rusbridge 2007). This can be as early as 2 months postoperatively.

Will my dog need medication after surgery?
Even after successful surgery it is possible that your neurologist may recommend continuing some medication for example cimetidine or omeprazole to reduce cerebrospinal fluid production or painkillers because the damage to the spinal cord has resulted in a neuropathic pain syndrome.

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