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Results are back .... pretty severe malformation and syrinx

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(((hugs)))
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Oh Debra, I'm at a loss to know what to say. I know this has come as a shock, and I know you have shed many tears already. But remember, you have time to think these things through. You have time to do your own research, and ask questions. You've started on a regime, but it can be changed as you go down this path. Even a decision about surgery doesn't have to be made right this minute. Take your time, breath, love on Gracie, and I know that you and hubby will come to some decisions that will be best for you all.I just want you to know I'll be praying for you all. I just keep remembering all the folks on here whose dogs have beat the odds and gone on to live fairly normal and full life's. As has already been mentioned, she is the same beautiful girl today that you love and adore, and she doesn't know of the situation. Take your time, and know there are many here who care deeply about you and Grace. Big hugs.
 
Oh Debra...when I saw the title of this post, I knew that it was you posting it and my heart sank.
I am SO sorry for you and Gracie. Through all the pain you must be feeling right now, also take a moment to give yourself a pat on the back for paying attention, knowing the signs and getting her the help she needed as soon as possible. She is so lucky to have you and I know you will do everything to help her. I have no experience with this, but Brooklyn will be off to the neurologist in the next month because her video looks just like yours and many others. I have just been waiting for the insurance to kick in. So I don't know what you are going through right now, but I can only imagine and it must be so hard. We are here for you, however you need us. There are more experianced ones on here than me, but I just wanted to send my hugs :hug:
 
Hi Debra

I'm so sorry that you have had this result, unfortunately its one of those clubs that no one wants to be in.

As others have said i'm sure that you have shed many tears already and there will be many more to come, I know how you are feeling right now but believe me it does get easier.

What actions to take can only be your desision for Gracie and as much information and advice as we give you it can only be your desision that you are comfortable with.

Don't let her age influence you too much, I think that over the last couple of years SM has become far more well known and for that reason dogs are being diagnosed far earlier in life and I don't think that should be the deciding factor in your choices.

My little one was diagnosed nearly 3 years ago and she has done remarkably well on medication management, thats not to say that the first few months post diagnosis was plain sailing as it wasn't. We changed her meds a few times before we found a combination that worked for her and she has been on that ever since with only the odd bit extra for a bad day.
I didn't know what SM was in the beginning and Ruby actually first showed symtoms at around 9 months of age when she screamed in the middle of the night for 'no reason' and then again at around one years when she couldn't play tug of war any more as it was painful and she would yelp out loud. If I had known about SM then, she would've been off to the Neuro then and diagnosed at a year old I'm sure!!

But she wasn't and it wasn't until PDE and her turning 2 years that she was diagnosed! I had the same arguements in my head as you and settled for Medication and the only reasons for that were my own selfish reasons. If I had put her through surgery and she had died at 2 years old then I would have failed her, I also had a full time job and wouldn't have been able to get time off for her recovery which is extensive ( I take a few days off when they are anaethetised for any reason) and also cost.

I figured that if she was comfortable and pain free on Meds and there was less risk involved then that was my choice and I do feel happy to this day with that desision- she lives a very full life and does 90% of things that any other dog does nad even if her life is slightly shorter due to that choice I'm at peace with that because she has lived a full life.

All SM dogs will have a bad day once in a while.

I hope you are OK and just remember that what ever you chose for Gracie, hse won't judge you and neither will anyone else!
 
Question for you

I'm so sorry to hear about Gracie's MRI result. Corey too has a sever case of SM. We opted for surgery a year ago when he was 2 1/2 yo and last month we did follow up MRI. The result is mix. The good thing is there is no new syrinxes and the existing syrinxes remain the same in size. On the other hand the neuro said scar tissue may have developed but he also mentioned that this is pretty normal. I think the surgery somewhat has been helping to stop the syrinxes' progression on corey, should this continue in the future? we don't know and neither does the neurologist. I agree with Bev that the surgery doesn't mean it's right or wrong for Gracie and any other dogs. If you have any other questions feel free to PM me and I live in NC too :). Hugs to you both :hug:

Do you get the mesh implant which is aimed at controlling the scar tissue so it does not block spinal cord? That is not very common procedure yet so was just curious
 
Do you get the mesh implant which is aimed at controlling the scar tissue so it does not block spinal cord? That is not very common procedure yet so was just curious

I'm pretty sure that Dr. Shores did Corey's surgery and used the duraplasty with fat pad graph (from the dog) and swine tissue.

Debra - I've got some thoughts and responses on meds (and I talked with Holly on the phone about them and we were pretty much aligned!) but I've got a tight schedule today and won't have time to post until late tonight. I did a good bit of reading last night in Plumb's on drugs and effects, etc.

More later,

Pat
 
Thanks all....great insights to consider

Pat ....I always look forward to your insights because you know so much already, especially short-term treatment to help her be more comfortable. Just post when you can. I know you are so busy and we rely on you a great deal here.

I think not doing surgery would be a better option if Gracie did not have severe malformation and a large syrinx. Her scratching is already notably worse this week than 3 weeks ago. Everyone notices it is worse, even those who have been in denial before. So the question is if we do surgery, what procedure? What are pros and cons of swine duraplasty versus titanium mesh? Or no implant at all?

We do have insurance that should pay 80% but we also have to cover travel and hotel if we leave the area. Not a small cost. And know that she would have a long recovery period at home too. I can take the time off but will be a challenge.

Just gotta make sure this is the best thing for Gracie.... so hard to know what to do.
 
Cranioplasty versus duraplasty....

Well, so hard to know which one is best. Either way we go, long drive. There is a neuro, Dr. Narak, in Knoxville TN who does the duraplasty with swine tissue. Dr. Shores pioneered this but is much further from us in Mississippi. A few neuros in New York use the titanium cranioplasty... and then Dr. Schubert in Florida (Gainesville) uses the absorbable mesh called LactoSorb SE. Augh! The closest to me is probably Gainesville or Knoxville. Dr. Marino in New York appears to be the go-to person for using the titantium mesh, but that is the longest distance and likely to be much higher cost due to NYC area. No easy direction here....
 
I'm so sorry about the news, but at least your fears are confirmed and you can take steps to control this and help Gracie. This is the best place to be for cavalier owners, no doubt about it. Hang in there!:hug:
 
Desrae....

You are one of my heroes.... your battle for that sweet little abused dog is an inspiration. It really is.
 
Well, so hard to know which one is best. Either way we go, long drive. There is a neuro, Dr. Narak, in Knoxville TN who does the duraplasty with swine tissue. Dr. Shores pioneered this but is much further from us in Mississippi. A few neuros in New York use the titanium cranioplasty... and then Dr. Schubert in Florida (Gainesville) uses the absorbable mesh called LactoSorb SE. Augh! The closest to me is probably Gainesville or Knoxville. Dr. Marino in New York appears to be the go-to person for using the titantium mesh, but that is the longest distance and likely to be much higher cost due to NYC area. No easy direction here....

If u do decide to go to ny there is a hilton right next to the hospital that is pet friendly and most people stay there during surgery...
 
Thanks for the info!

I was going to look at those options pretty soon and you saved me a lot of work. It is still an option... as it going to Tennessee.

If u do decide to go to ny there is a hilton right next to the hospital that is pet friendly and most people stay there during surgery...
 
I am so sorry for what you are dealing with right now. I don't have experince with SM / CM, but I do have experience with the University of Florida and Dr. Schubert. After the accident, Holly was stabilized here for a couple of hours then I rushed her to UF where she was admitted at 7 pm on a Friday night. They did the surgery at 7am the next morning. Dr. Schubert was Holly's neurologist and advised during her surgery regarding best placement for plate, wires, etc. to minimize any chance of paralysis or incontinence. Like Holly (the human) mentioned in another thread, UF is an amazing place. Dr. Schubert was wonderful and did Holly's MRI before surgery. He has a lot of experience with cavaliers -- our regional rescue group has used him extensively. I dealt with many specialists, as well as, residents at UF and found them all to be excellent to work with. I was able to make a single return trip for Holly to see her orthopedic surgeon, neurologist, physical therapist and radiologist -- a nice thing about dealing with a university setting. A resident was also assigned to Holly's overall care and communication with me as I had to leave her there for a few days to return to Tampa. I got several phone calls a day from this resident updating me on Holly's progress. And the resident was in contact with the specialists for me, which made managing care easy from a distance. When I brought Holly home, I was in constant contact with UF on everything from medication, physical therapy, toileting concerns, etc.

I just can't say enough about UF, so it really might be worth contacting Dr. Schubert for another opinion. I know your head must be swimming now with all of these decisions. Please know that there is a community here thinking of you.
 
Thanks Tara...

You are first person so far who has had experience with Dr. Schubert and that vet school. It is heartening to hear that this could be a viable option. I hope to find someone who knows more about the soluble mesh he uses to address scar tissue. I have no idea how quickly scar tissue forms, so not sure if that mesh stays intact long enough. Supposedly dissolves some by a few months out and then gone by a year.
 
Hi Debra - I just wanted to add to the many messages that I was sorry to read your post. Everyone has given such good advice. I would definitely speak to your neuro about adding a CSF reducer like omeprazole until you decide on what the next step will be. It is so overwhelming trying to figure out what is the best route -surgery vs. medication. I still constantly second guess myself.
As far as the meds, my neuro has never had any problems with gabapentin even with dogs that have been on it for 10+ years. Predisone has more side effects so it is often the last drug to be given or used intermittently. However, some dogs do fine on a small dose daily for many years.
There is so many variables and every dog/owner is different. Whatever you decide we are all here for you.
If you decide to go to LIVS in NY, please let me know if you need a ride or anything. I live in Manhattan but my family is located 20 minutes from the clinic and are the biggest animal lovers. They all know about CM and SM from my Jack and would love to help another dedicated cavie lover. Please do not hesitate to ask.

lots of hugs to you and Gracie.
 
Debra -- based on my experience with Dr. Schubert and UF in general, I would definately look into getting an opinion from him. I'm a couple hours away, but would be happy to have you stay here if you need a stop-over for recovery. Gainesville is a nice univeristy town, so there are several reasonable hotels right near the veterinary center. UF is really a remarkable place. After Holly's accident, I got on the phone with a couple of cavalier people and was told in no uncertain terms to get Holly there as soon as possible. My main concern was neurological deficits due to the location of her spinal injuries-- post accident, Holly was paralyzed from the waist down and was completely incontinent. I wanted to do surgery to repair the fractures, but was concerned with her quality of life if she could never walk or potty on her own. Her vet here agreed that consulting Dr. Schubert was important, so he stabilized her and sent us on our way. I was able to call and make an appointment with the emergency department that same day -- like I said our intake was around 7pm on a Friday. I had neuro and surgical consults that night, then surgery the next morning. As I mentioned, Dr. Schubert helped direct the surgery to ensure the best possible neurological outcome.

The residents are well trained and were very helpful in staying in touch with me. I remember talking with the resident one evening -- I had told her that Holly was used to a high level of physical contact, so the resident took Holly from ICU and kept her on her lap to watch a couple hours of television in the student's lounge. Another evening, after Holly was home from surgery, she started bleeding from a suture line. I called at 2am and was given support as to how to handle the situation. Little things like that made me so comfortable with Holly's care. On our second post-surgical checkup, the resident I'd worked with during the whole process even took my daughter (who desperately wants to be a vet) on an extensive tour of the facility.

I have no knowledge of the mesh surgery and it's complications, but I think you would find Dr. Schubert to be a great source of information. Like I mentioned, he has seen several cavaliers who come into our regional rescue group. Owning a cavalier, I feel very lucky to have him relatively close should any neurological issues arise with Holly.

If you'd like any contact information or a place to stay along your way, please feel free to contact me. I would be honored to help in any way possible.
 
Debra,

Been away for the weekend so only reading this now. Im so sorry but at least Gracie has you as her Mum and in that she's a very lucky girl. Leo and I are sending hugs from across "the pond" to you both.
:hug:
 
Meds already helpin our girl

Just giving her the gabapentin and tramadol now... Holding off on prednisone and omaprazole until Pat weighs in. I can tell that gabapentin is wearing off by morning. Not sure why he has her on it just twice a day. Other folks seem to be giving it every 8 hours. But just these 2 meds alone gave us a great day ... Best in weeks. She was actuaaly playful last night for a long time. That has been gone for a few weeks. And her eyes are happier. Was afraid these would make her dopey but not bad. Giving her full dose of tramadol at night only...half dose in morning.
 
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