Surgery for Blitz ~ Titanium Mesh Questions ? Experience & Advise needed!!!!

[Love my Cavaliers]

Riley did have the decompression with the titanium mesh implant 3 years ago and she is doing so phenomenenally well. Medication she took pre-operatively for SM including gabapentin and prednisone had absolutely no effect on her symptoms. She is now on 2.5 mg prednisone a day (I've just successfully reduced her daily dosage by half!!!) She loves her walks, playing in the yard, she runs after squirrels in the yard, and she is happy. Because she is on daily prednisone she goes to the neuro every four months for bloodwork and she has a complete neuro exam which is always completely normal. She is definitely a success story. She has not had any setbacks at all. Is that due to the titanium implant? I don't know. She was old also when she had the surgery. She was almost six years old which is the cut-off for surgery for a lot of neurologists.

Regarding the swine tissue, Linderbelle's Abbey is the only one I know who had that surgery two years ago and I know she's having difficulties right now. Again, is it because the swine tissue failed? There's no way of knowing. Was her SM worse than Riley's to begin with? Again, don't know. Before surgery, two different neurologists told me Riley's SM was very advanced and very severe.

I wish you lived near Chicago. I'd send you to Riley's neurologist. I've just been so happy with everything about Riley's surgery. Her recovery was about 8 weeks of restrictions - difficult in a multi dog household, but not impossible. To tell the truth, I was not sure about the surgery until at least six months post-op. It took a while to figure out her meds but once she was settled, I started to relax. Her neurologist's name is Dr. Michael Podell. All 4 of my dog's have seen him for various reasons and Oliver my oldest has also had surgery with him (cervical disc decompression).

PM me anytime. if I can help you with any more information I will.

[Reptigirl]

Thank you for this information. I'm glad to hear of your success story! I have taken the names & info of these two neurologist from the Cavalier Heath page and I'm going to pass them on to our neuro tomorrow.

[lovecavaliers]

Oh Sharon I completely feel for you. I know that surgery is most likely in Jack's future too. I live a 45 minute drive from LIVS- Dr. Marino but have my doubts about the mesh. I have heard on other forums of dogs getting bad infections from the mesh and the recovery time is usually longer (~3 months I was told).
Other than Abbey's case (which hopefully will improve) I have heard of 3 or 4 success stories with swine and the recovery period is much less. I have also heard of a few without any duroplasty who have done well.

It is all so very confusing and I hope I didn't confuse you more. Did your neuro say how many cases he has done and what the success rate was?

[Karlin]

I think we all pretty much agree that no one can make determinations on success of a given type of surgery from single tales of success or failure. I, like many other people, am really anxious to see some actual published, peer-reviewed articles on the different methods of treatment from meds to surgery.

At the moment I confess that I do not believe the claims for the mesh surgery quite jibe with the bulk of actual cases that I have come across -- eg claims being made that there are rarely complications or that almost no dogs need follow on meds. Almost every dog I know of that has had the titanium mesh is on at least one medication and many have had follow on complications, some including very severe pain. Probably not more complications or difficulty than with regular decompression, and perhaps there is indeed a better long term result due to limitation of scar tissue, but nothing has yet been published that looks at medium to long term results of these different surgeries. I have not seen any presentation that incorporates in some of these anecdotal stories of infection, poor results, pain or to any significant degree, continued need for meds. I have to believe that the people who post about these issues must represent many others who do not post -- so it just seems to me that there is a gap between claims around follow up cases, and actual experience.

I also do not think that using swine tissue gives noticeably different results than the other forms of decompression which just use variations on swine tissue. It is simply a fatty tissue patch of one kind or another.

At this time I would take claims for results with a grain of salt especially if there is a material benefit to anyone for doing a surgery over other types of approach and a lack of published results or if these are out of kilter with what owners report.

I do think that in some cases surgery is probably the only option -- serious symptomatic cases for example, and particular, any dog under 2-3 with significant symptoms and especially obvious pain. If I had such a dog I would opt for surgery.

Prednisone is a fairly heavy level of medication to give a dog as a permanent necessity post surgery. Not that there's any issue with needing it, but it again underlines that it isn't quite the case that certain types of surgery have no need for medications afterwards. I have wondered how careful and broad the followup is for many of the dogs post surgery because I think many do start to have symptoms and owners go to their vet or a different neurologist that is perhaps closer for adding on medications.

Or maybe the only people I come across are those with dogs that do not do as well as the claims made for 'most dogs'.

I would simply say that I am not convinced that one form of surgery for decompression is significantly better than any other, because I know of equal numbers of successes and failures offhand for most approaches to decompression and some do not fit with claims made for individual approaches made for certain approaches. I have attended presentations over the years by several of the people doing the various approaches to this surgery and know many people who have opted for various types of surgery. If I were to go for the mesh surgery I would want it done by someone who has done it before.

I do know people who have done the regular decompression who have had great results, and who have had it fail. I know of people with the mesh who have had great results, and others who have had it fail.

Personally I would not at this time do the mesh surgery on my own dogs because it is more complex, I don't like the idea of screws in the skull or the lack of long term knowledge about whether those plates may move (I know of some that did move in dogs operated on earlier), and the recovery is long and slow.

[Blondiemonster]

Why did he not want to consider swinr? Dr shores i believe is the specialist of swine? Anyone? He was in south carolina or somewhere and now in mississipi? Cant remember but if it was my dog, id ask for a phoneconsult with him to be ultra informed.

[Blondiemonster]

I think we all pretty much agree that no one can make determinations on success of a given type of surgery from single tales of success or failure. I, like many other people, am really anxious to see some actual published, peer-reviewed articles on the different methods of treatment from meds to surgery.

At the moment I confess that I do not believe the claims for the mesh surgery quite jibe with the bulk of actual cases that I have come across -- eg claims being made that there are rarely complications or that almost no dogs need follow on meds. Almost every dog I know of that has had the titanium mesh is on at least one medication and many have had follow on complications, some including very severe pain. Probably not more complications or difficulty than with regular decompression, and perhaps there is indeed a better long term result due to limitation of scar tissue, but nothing has yet been published that looks at medium to long term results of these different surgeries. I have not seen any presentation that incorporates in some of these anecdotal stories of infection, poor results, pain or to any significant degree, continued need for meds. I have to believe that the people who post about these issues must represent many others who do not post -- so it just seems to me that there is a gap between claims around follow up cases, and actual experience.

I also do not think that using swine tissue gives noticeably different results than the other forms of decompression which just use variations on swine tissue. It is simply a fatty tissue patch of one kind or another.

At this time I would take claims for results with a grain of salt especially if there is a material benefit to anyone for doing a surgery over other types of approach and a lack of published results or if these are out of kilter with what owners report.

I do think that in some cases surgery is probably the only option -- serious symptomatic cases for example, and particular, any dog under 2-3 with significant symptoms and especially obvious pain. If I had such a dog I would opt for surgery.

Prednisone is a fairly heavy level of medication to give a dog as a permanent necessity post surgery. Not that there's any issue with needing it, but it again underlines that it isn't quite the case that certain types of surgery have no need for medications afterwards. I have wondered how careful and broad the followup is for many of the dogs post surgery because I think many do start to have symptoms and owners go to their vet or a different neurologist that is perhaps closer for adding on medications.

Or maybe the only people I come across are those with dogs that do not do as well as the claims made for 'most dogs'.

I would simply say that I am not convinced that one form of surgery for decompression is significantly better than any other, because I know of equal numbers of successes and failures offhand for most approaches to decompression and some do not fit with claims made for individual approaches made for certain approaches. I have attended presentations over the years by several of the people doing the various approaches to this surgery and know many people who have opted for various types of surgery.

I see it like this with the mesh: how does the potential benefit of less scar tissue ( even if ten percent) wheigh against the risks brought on by mesh surgery (that is more or different from regulAr decompr) If it was certain that there was at least a ten percent reduction and the risks of mesh are not life threatening or significantly more than others id go for that. But we dont know do we? Not even the ten percent? I too wonder why marino or anyone hasnt published a study post 4 or 5 years. I just dont understand. Also karlin, do u meet the people who had complications of the mesh on forums or real life? Fprums will most likely be filled with more problematic dogs and owners that need support.

[Karlin]

I know one of the people personally and she has two dogs that have not done well with the mesh.

Others belong to people I would have known a long while online. I don't know about the reports elsewhere about infections etc. I think decisions like this are very personal. I do wonder if the people doing mesh surgeries are aware of the various problem cases and do wonder abut the claims about how many do not need meds.

I do definitely think that people are more likely to post if they have issues rather than if they do not. Some of the cases I am thinking about though are people who began to post before diagnosis and continued to post after, or who contacted me privately after to say they were having problems. It just makes me wonder about how dogs were chosen to be included in the group being tracked.

I would be delighted to find one type of surgery gave significantly better results but on evidence/lack of evidence/anecdotal reports to date I am not convinced. It would be great to have a proper comparison study, medium if not long term! And a broader study of meds compared to surgery results.

[Blondiemonster]

I know one of the people personally and she has two dogs that have not done well with the mesh.

Others belong to people I would have known a long while online. I don't know about the reports elsewhere about infections etc. I think decisions like this are very personal. I do wonder if the people doing mesh surgeries are aware of the various problem cases and do wonder abut the claims about how many do not need meds.

I do definitely think that online people are more likely to post if they have issues rather than if they do not. Some of the cases I am thinking about though are people who began to post before diagnosis and continued to post after, or who contacted me privately after to say they were having problems. It just makes me wonder about how dogs were chosen to be included in the group being tracked.

I would be delighted to find one type of surgery gave significantly better results but on evidence/lack of evidence/anecdotal reports to date I am not convinced.

When u say "not done well" do u mean no improvement or continued decline or post op complications? Just curious as to worst case scenarios

[Karlin]

Decline after surgery over time. In another case, a dog was euthenised.

[Blondiemonster]

I actually saw in marinos first study thay 2 dogs out of 12 were euthanized. What was remArkBle to me is that both dogs where the ones who had vocalizing screaming episodes pre surgery listed as their symptoms. (among other things) i thought that probably wasnt a coincedence as to how far evolved they were before surgery in terms of pain.