CM/SM Sugery Questions....?

We are considering surgery on Flash in the coming months and I am looking to hear from other people on their experiences.

As many of you know Flash came to me at about 12 weeks of age showing moderate SM symptoms.

By 6 months of age I would call his symptoms sever. He was diagnosed with CM by MRI. His records read :the cerebellum was crowded and partial herniation was noted, the fourth ventricle was enlarged, and the brain stem was deviated (medullary kink)."

Here we are 3 months since his MRI. He is getting 20 mg of Lyrica 3 Times Daily.

Our neurologist suggest that due to his young age we need to think about surgery sooner rather then later.

Although his medication has been working he still shows mild SM symptoms. He has way more good days then bad days but his "bad days" seem to be getting much worse.

Flash does not show any problems walking to limb weakness. He does however paw & scratch at his head (top of his skull particularly), air scratch and rub his head. On his bad days he is very sensitive to light and just recently seems to not be able to tolerate being brushed on his back/hind quarters. His weirdest "symptom" is during some episodes he becomes nervous.and for lack of a better word... paranoid. He will jump up and bark at nothing...at the air, the wall, the floor.

I know surgery is our best option for long term care. I was just wondering if I could hear from other people on how the surgery went.

I am very worried about the surgery it's self but my biggest concern is recovery. I know the dogs need to be kept calm with restricted activity for many weeks. Flash is still a full of energy puppy. Unless he is having one of his really bad days you can expect him to spend several hours a day bouncing off the walls playing :razz: Also, I have rarely used a kennel for him so being restricted in a crate would send him in a frenzy. He is always by my side.


I know it is a risk but my biggest fear is to go through the surgery and in the end have him no better or WORSE!


From what I understand most dogs show at least a little improvement and some show no improvement but do dogs ever get worse?


I feel so torn. I want Flash to have the best care possible but I'm scared of making the wrong decision for him. Right now it seems he is enjoying life and I worry I'm thinking about surgery too soon.


Has anyone on here gone through surgery with a puppy? Our neurologist explained that given his young age and his very quick and progressive onset of symptoms that she would only expect him to manage on medication between 1 & 3 years at most. She explained that if we let it get to the point medication is no longer working that sever brain damage could occur and then surgery may not help at all.

Any insight would be greatly appreciated.

I can't help with any answers to this issue, but was wondering how old Flash is now? Has his breeder been contacted so they know he has SM?

I just wrote the longest reply and erased it. Maybe that's good

This is a very big decision and I strongly believe that it is personal and you have to feel comfortable with whatever decision you make.

Why I feel like this is ella had surgery and developed scar tissue. If she had titanium mesh, swine tissue would that be less likely, research says yes. Do I regret it no. It is upsetting but at the time I knew it was what I felt was best. Ellas neurologist is more conservative and would like to see long term results before doing a more risky surgery. (You have to drill screws) he did not know what the risk vs. Outcome would be and plus it was $1000 more. Rod don't comment on that b/c it was my choice at the time. There is more research now so if you do choose surgery that is another decision

So I didn't. Earlier surgery is done the better the outcome because less damage is done. Younger they develop sm the worse it may be. There maybe people on the forum that puppies have been on medication for several years and were told they would not live long. You can look at research, make a choice but there are no knowns. There is always a risk in anything. Some may have complications in surgery. Some may not react to medication.

surgery is not a cure and I don't really read into dr. Marino saying a lot never have to take medication again. I personally know one cavalier he talks about b/c her results were remarkable. Two years later and her syrinx has almost disappeared. That is one cavalier so I know there is truth that some do not need medication but to do it thinking that is going to be the result is not something to count on. I went the surgery route because of progression and severity. I hoped it would halt progression maybe give me a couple more years but I take precaution when people think of it as a cure. I've been told "I thought she had surgery, isn't she fine now" no. Some may show less symptoms or none, some may just scratch, the point is you can not know but you can look at research and gather as much information and make the choice you feel comfortable with.

I know this is so tough.

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Activity:

Extremely important to limit activity. This is my personal opinion. They had major surgery and some neurologists will say a certain procedure is less recovery time etc. I just feel its better to be on the safe side. Ella was restricted for 1 month and then an extra month. The second month was going to be limited but we kept her or tried to longer. She stayed with my mom at about 8 weeks after surgery and she was saying how she was running after birds and I was so upset.

She seemed worse after that. Was it the cause of her scar tissue, probably not. Some dogs are more prone to develop scar tissue because of something my neurologist said. Maybe he said that so I would not blame myself, but I think its true.

You would have to crate flash. I mean strict activity which is real hard to do. I don't know how people do it with other cavaliers. The main point of restricting activity is to not do more damage. They had serious surgey and you do have to be careful not to cause harm.
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I would definitely be looking into having surgery sooner rather than later with a puppy. Definitely listen to what your neurologist is telling you.

I have lived through the scenario of surgery delayed for over a year on a puppy who had severe symptoms at age 5 months, and would not recommend doing this.

After reading Dr. Marino's information on twolittlecavaliers.com I would want to go with a neurosurgeon who takes Dr. Marino's approach; he looks at both MRI and a special CT scan to determine the cause(s) of compression. This is a recent approach starting in 2009, I'm fairly certain. There is something called AOO atlanto-occipital overlapping which can also cause compression. I'm pretty sure our Charlie had this as well as CM, because his surgery was more involved than the usual decompression - we were told additional surgery was performed.

Is there another neurologist nearby that you could take Flash's MRI to to get a second opinion? This might help you to feel more secure in your decision. When surgery was first recommended for Riley, I took a disc of her MRI results to another neurologist who gave her a full neurological exam, read her MRI, and gave me the same recommendation as the first neurologist and then even recommended that the first neruologist do the surgery since Riley's SM was complicated by a large cerebellar cyst and the first neurologist was more experienced. Now the caveat here is that this costs extra which may be a concern. But maybe another neurologist could even just read the MRI results which would cut down costs some.

Riley had decompression surgery with the titanium mesh implant two years and 8 months ago and is doing phenomenally well. She is like a new dog. She will never be a normal dog. She still has SM and will have to take prednisone for the rest of her life to control her symptoms, but it does control them. It had no effect on her before surgery, so I know that surgery was the right thing to do for her. If I had to do it all over again, I would make the same decision in a heartbeat, but I would have made it earlier had I known about SM.

Now Riley was not a pup when she had surgery, in fact she was almost 6 years old, so maybe it was easier to keep her quiet during her recovery because she was older. But then again, I also have a household of three other dogs which complicated her recovery since they all wanted to play with her, especially the not quite one year old puppy. I kept a crate in my living room and she was either in the crate or in my arms. The crate ended up being Riley's sanctuary from the other three dogs. Eventually I added an x-pen to it to give her more room. She was allowed several 5 minute leash walks outside - no running or jumping. I believe the theory behind that is that running and jumping increases intracranial pressure which you don't really want after this type of surgery. We gradually worked up to short walks down the street.

Truthfully, I think the recovery period was harder on me than on her. I felt so badly for her, but she just seemed to take it all in stride. If Flash is not used to the crate, maybe use an x-pen which would give him more room. You could put a bed in there and then some toys when he's through his immediate post-op period.

I believe most dogs are still on medication post-operatively. It took quite a while (6 months) to figure out which meds and which dosages were right for Riley. We went through all the typical ones and ended up with prednisone which is a miracle drug for her. I will take the side effects for the quality of life it has given her in combination with her surgery.

WHile we were searching for the right medication for her post-operatively, I continuously questioned my decision to put her through surgery and whether I had shortened her life by doing so. There was just no answer to that question. Now that she has been stabilized with her meds, I don't question any more. I think it is just human nature to always question and to second guess ourselves. Did I do the right thing, the best thing? You make your decision using the best information you have at the time and you listen to your heart and you trust in yourself that you are doing what YOU think is best for your dog.

Cathy Moon said:

I would definitely be looking into having surgery sooner rather than later with a puppy. Definitely listen to what your neurologist is telling you.

I have lived through the scenario of surgery delayed for over a year on a puppy who had severe symptoms at age 5 months, and would not recommend doing this.

After reading Dr. Marino's information on twolittlecavaliers.com I would want to go with a neurosurgeon who takes Dr. Marino's approach; he looks at both MRI and a special CT scan to determine the cause(s) of compression. This is a recent approach starting in 2009, I'm fairly certain. There is something called AOO atlanto-occipital overlapping which can also cause compression. I'm pretty sure our Charlie had this as well as CM, because his surgery was more involved than the usual decompression - we were told additional surgery was performed.

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I think what Cathy is saying is very good. I personally feel what he said about being proactive and sooner than later is how I feel. It's a big decision and I would take time to look at what Cathy said and others. Dr. Shores in Auburn does another procedure using swine. I just feel like its best to do what you are and gather information and determine the best place to go etc.

I am sorry I am taking over the thread but even though I knew at the time I was comfortable with the decision, I am now faced with whether to do another surgery and how that is an extremely complicated procedure. I would get another neurologists opinion but even though I wish it was sooner, you need to make sure to talk to other neurologists and not make a rush decision or operation. Get the best neurologist or talk to one. It might be worth it in the long run.

A friend saw my neurologist but opted to go see Dr. Shores for surgery because she read about swine tissue.

Sorry you are facing this decision. It is very tough knowing what to do because so many dogs present so different and progress so differently.
I was told by Dr. Marino in May of last year to have the surgery on my Jack bc he was so young showing symptoms (remember he has CM and a "pre-syrinx"). Dr. Marino said I needed to decide within a few weeks to avoid permanant damage. I felt uneasy going through with surgery being that he didn't yet have a "true syrinx" and I had not yet tried medication. Therefore I got a second opinion which differed hugely from Dr. Marino's opinion. Obviously Dr. Marino is an expert in this area but Jack is doing well on meds right now, so maybe I did the right thing, maybe I didn't. Time will tell. I def. have not ruled out surgery if things change.
Basically if you get two respected neuro vets give you the same advice as I believe Riley's mom did, I would go with that, hopefully they won't give you different advice as I received. If that ends up being the case, either seek a third or go with your gut. Good luck!