Margaret C
Well-known member
This Brit did not understand a word of what you were talking about
The most remarkable little dog ever. Riley gives hope to all of us.
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Surgery vs. medication
- Thread starter 3cavies
- Start date
This Brit did not understand a word of what you were talking about
The most remarkable little dog ever. Riley gives hope to all of us.
How old is Maggie? That would be one element of any decision that I would make, as would the result of the MRI. If the syrinx is quite small, or is long and quite narrow, then I would probably not choose surgery, at least not now, especially if she is an older dog. If the syrinx is wide and especially if it is lopsided and it looks likely to progress, especially if she is younger, then I would be considering surgery.
There is no solid evidence that doing surgery younger improves the dogs chances. some neurologists think this possibly could be the case, but that is a long way from actually doing a study to confirm it.
The difficulty is that different neurologists think differently on this topic as well, so it is hard to get a hard and fast answer. There are some who were very gung ho for surgery, particularly in the US, and there are some who prefer to work with medications. But medications will not reverse the problem although there is some evidence that perhaps CSF inhibitors can slow or stop the development of a syrinx, especially when it is very small.
I have two dogs who have never done more than scratch mildly. One of them I have now had for four years and she has never progressed and her syrinx is quite small. The other is seven and also only scratches. For either of these dogs I would never have considered surgery, and I strongly disagree with the neurologists who say that as soon as you see there is a syrinx, you should do surgery because SM always progresses. It may “always” progress but as with any health condition progression is highly variable and I cannot imagine having put either of these dogs through a very invasive surgery that often has a quite long recovery and potential complications.
I also know of statistics from a study that show over half of dogs over age 5 who had no clinical signs at all scanned with SM. If the condition “always progresses” then for many many dogs it certainly does not progress to a point were it even causes symptoms that would ever warrant removing a piece of the dog's skull. That said, older dogs can always progress.
My own parents are medical people, and they would feel strongly that you don't do surgery until there is a good reason to do surgery, with any condition. with SM, there are many points at which it might be a good reason–but I do not think just the presence of the syrinx and a very mild symptom is the starting point for taking that decision right away.
I stress again that this is my own opinion but it is based on both my own experience with dogs that have not been put through surgery, and knowing many others that are older and either have SM or have not been diagnosed but I would say surely do, where I cannot imagine that surgery would have been a sensible option. The difficulty is–it's a guessing game. And of course there are reasons why people feel they would never do surgery, and those are perfectly valid too, as is the decision that surgery offers the best option and should be done right away. It is such a personal decision and choice.
There is no solid evidence that doing surgery younger improves the dogs chances. some neurologists think this possibly could be the case, but that is a long way from actually doing a study to confirm it.
The difficulty is that different neurologists think differently on this topic as well, so it is hard to get a hard and fast answer. There are some who were very gung ho for surgery, particularly in the US, and there are some who prefer to work with medications. But medications will not reverse the problem although there is some evidence that perhaps CSF inhibitors can slow or stop the development of a syrinx, especially when it is very small.
I have two dogs who have never done more than scratch mildly. One of them I have now had for four years and she has never progressed and her syrinx is quite small. The other is seven and also only scratches. For either of these dogs I would never have considered surgery, and I strongly disagree with the neurologists who say that as soon as you see there is a syrinx, you should do surgery because SM always progresses. It may “always” progress but as with any health condition progression is highly variable and I cannot imagine having put either of these dogs through a very invasive surgery that often has a quite long recovery and potential complications.
I also know of statistics from a study that show over half of dogs over age 5 who had no clinical signs at all scanned with SM. If the condition “always progresses” then for many many dogs it certainly does not progress to a point were it even causes symptoms that would ever warrant removing a piece of the dog's skull. That said, older dogs can always progress.
My own parents are medical people, and they would feel strongly that you don't do surgery until there is a good reason to do surgery, with any condition. with SM, there are many points at which it might be a good reason–but I do not think just the presence of the syrinx and a very mild symptom is the starting point for taking that decision right away.
I stress again that this is my own opinion but it is based on both my own experience with dogs that have not been put through surgery, and knowing many others that are older and either have SM or have not been diagnosed but I would say surely do, where I cannot imagine that surgery would have been a sensible option. The difficulty is–it's a guessing game. And of course there are reasons why people feel they would never do surgery, and those are perfectly valid too, as is the decision that surgery offers the best option and should be done right away. It is such a personal decision and choice.
3cavies
Well-known member
Karlin,
Thank you for your response. It makes sense and seems like a logical approach. It also echos our feelings right now as well. Maggie turned 3 in Feb. She has one syrinx that is quite long, but narrow and one smaller one. The vet we are using (and have for years) is really wonderful. By his own admission, he was not that familiar with SM, but he is working closely with the Neurologist in Auburn concerning Maggie's treatment. They both think treating with meds first is the best option and like you said, it may have progressed as much as it's going to. If that's the case, I can certainly live with the scratching and not put her through the surgery. I think we're all on the same page now. It was just such an emotional thing finding out in the beginning and I've been in panic wanting to make sure that we are doing the right thing for her. This forum is a wonderful resource of support and information. Thanks again.
Thank you for your response. It makes sense and seems like a logical approach. It also echos our feelings right now as well. Maggie turned 3 in Feb. She has one syrinx that is quite long, but narrow and one smaller one. The vet we are using (and have for years) is really wonderful. By his own admission, he was not that familiar with SM, but he is working closely with the Neurologist in Auburn concerning Maggie's treatment. They both think treating with meds first is the best option and like you said, it may have progressed as much as it's going to. If that's the case, I can certainly live with the scratching and not put her through the surgery. I think we're all on the same page now. It was just such an emotional thing finding out in the beginning and I've been in panic wanting to make sure that we are doing the right thing for her. This forum is a wonderful resource of support and information. Thanks again.
I should clarify that it will almost certainly continue to progress (I have rarely heard of a repeat MROI where nothing has progressed), but that as long as syrinxes are narrow and not lopsided and pushing towards one side of the cord or another, she may well just continue to have mild scratching. It is impossible to say. If she is insured I'd probably in your place, opt for meds and re-MRI in a year or two assuming she is not showing a lot more symptoms.
I'd just stress again that this *isn't* actually common opinion. There are two specialists I can think of who feel this is definitely the case and therefore generally argue for immediate surgery. There are many others who think it is likely the case or could be the but amongst those almost all seem to feel that unless the dog is showing certain clinical signs of pain and/or has a poor MRI, they generally suggest waiting and trying meds rather than immediate surgery.
People may feel they are most persuaded by one or the other of these views. But really there are no answers and I'd always advise people give the most weight to what a neurologist they feel comfortable with says and advises. It is useful to share experiences of this sort but keep in mind we are not speaking as medical experts -- and there is no right answer or often any possibility of knowing the best answer with SM (except IMHO to be honest and know when it is time to let a dog stop suffering and not keep a dog in regular and serious pain alive for our own comfort :flwr:.
I think you have plenty of time right now to consider options.
I'd just stress again that this *isn't* actually common opinion. There are two specialists I can think of who feel this is definitely the case and therefore generally argue for immediate surgery. There are many others who think it is likely the case or could be the but amongst those almost all seem to feel that unless the dog is showing certain clinical signs of pain and/or has a poor MRI, they generally suggest waiting and trying meds rather than immediate surgery.
People may feel they are most persuaded by one or the other of these views. But really there are no answers and I'd always advise people give the most weight to what a neurologist they feel comfortable with says and advises. It is useful to share experiences of this sort but keep in mind we are not speaking as medical experts -- and there is no right answer or often any possibility of knowing the best answer with SM (except IMHO to be honest and know when it is time to let a dog stop suffering and not keep a dog in regular and serious pain alive for our own comfort :flwr:.
I think you have plenty of time right now to consider options.
RodRussell
Well-known member
Stacy, has the scratching been Maggie's only symptom? When did you first notice her doing it?
3cavies
Well-known member
Hi Rod,
Yes, the scratching is the only symptom. She has shown no signs of pain. I noticed it about a year ago, took her immediately to the vet as I had read about SM. It was so minor that he first thought it could be allergies. We changed food, used special shampoo etc. She then only seemed to do it if she was on lead. During a recent certification test for AAT where she had to be on lead, the scratching was bad. I called the vet and insisted on an MRI. (Looking back, I should have done much sooner). Our vet just had not had experiences with this as we are one of just a few Cavalier patients. Her symptoms are not that bad, My main concern is them progressing to where they would be bad and have her in pain.
Yes, the scratching is the only symptom. She has shown no signs of pain. I noticed it about a year ago, took her immediately to the vet as I had read about SM. It was so minor that he first thought it could be allergies. We changed food, used special shampoo etc. She then only seemed to do it if she was on lead. During a recent certification test for AAT where she had to be on lead, the scratching was bad. I called the vet and insisted on an MRI. (Looking back, I should have done much sooner). Our vet just had not had experiences with this as we are one of just a few Cavalier patients. Her symptoms are not that bad, My main concern is them progressing to where they would be bad and have her in pain.
Blondiemonster
Well-known member
The progression will most likely be a slow one and you will be able to keep track of her symptoms and she will tell you when she is not doing well or is getting uncomfortable. It wont be overnight. I agree with the above advice i think u have time... I am doing the same for my girl because i know she will tell me when its time to have her surgery.