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Thread: What might it be like for our dogs? Teen with Chiari

  1. #11
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    Thanks for posting all of these reads, they have really got me thinking as well as opening my eyes. I always say "I just wish Brooklyn could talk!", I guess our closest thing to that is humans.

    As with any surgery, human or animal, there are always risks and nothing is ever 100%....I know this from personal experience, going in for a "routine surgery" last year and coming out with severe complications that will affect me with pain and walking for a lifetime. That's something I think will always be wondered and can only be personally answered, and it is unfortunate that our pups can't weigh in on it. There are so many questions...do I? don't I? Will it be worse if I...? Will it be better if I...? What if? Why didn't I? There are never going to be answers to those questions. Even if this was a "cure" or became "routine", it is still surgery and any surgery poses great risks that have to be weighed out, because even if it is a 1 in a million chance that there will be a complication...there is that 1.

    I think we were paired with our own individual dog(s) for a reason and they trust us and give us these decisions to make for them because they know that we will do the best we can for them with what we have. We will give them surgery if we think it will help, and we will stick to medications if our gut tells us to do so. I guess that is the problem, it is so personal, such a heavy decision for a "parent" to make on behalf of another living being (our dogs). This is why all of you are so special...we are all making these decisions for our cavs on a daily basis and they trust us to research, talk and explore. They trust us to have conversations like these so that each of us, as individuals, have a tool box of information to make decisions for our dogs weighing up all these heavy "what ifs...". It is so hard, I know, to battle the "what if", but at some point life just guides us that, for whatever reason, was how the story was meant to play out.

    That was a babble. Sorry! Thank you for all this reading though, it is really great to pour through and think about.

  2. #12
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    Quote Originally Posted by BrooklynMom View Post
    That's something I think will always be wondered and can only be personally answered, and it is unfortunate that our pups can't weigh in on it. There are so many questions...do I? don't I? Will it be worse if I...? Will it be better if I...

    I think we were paired with our own individual dog(s) for a reason and they trust us and give us these decisions to make for them because they know that we will do the best we can for them with what we have. We will give them surgery if we think it will help, and we will stick to medications if our gut tells us to do so. I guess that is the problem, it is so personal,

    They trust us to have conversations like these so that each of us, as individuals, have a tool box of information to make decisions for our dogs weighing up all these heavy "what ifs...". It is so hard, I know, to battle the "what if", but at some point life just guides us that, for whatever reason, was how the story was meant to play out..
    I totally agree. The problem is even with results saying 20%, I believe its what one defines as successful? One would say ellas surgery was unsuccessful because she developed scar tissue. However, did it give me more time to figure out medication to help her? How would that compare with medication alone? Did it give her more time? Is the time of recovery worth the other?

    All I know is before surgery she was not chasing a ball, hiding under the table, bed, anywhere, shaking her head constantly. After surgery, it was like her old self again. I started to see the symptoms return but I don't think to the point of before. So in my eyes, I would do it again. Some other people wouldn't. So personal.

    I don't know if scar tissue is worse than bone or if it makes it worse but I guess we get information, make the decision when we feel its best and can't look back.

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    Anne Proud mother of Elton 5 and Angel Ella

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    Quote Originally Posted by anniemac View Post
    I totally agree. The problem is even with results saying 20%, I believe its what one defines as successful? One would say ellas surgery was unsuccessful because she developed scar tissue. However, did it give me more time to figure out medication to help her? How would that compare with medication alone? Did it give her more time? Is the time of recovery worth the other?

    All I know is before surgery she was not chasing a ball, hiding under the table, bed, anywhere, shaking her head constantly. After surgery, it was like her old self again. I started to see the symptoms return but I don't think to the point of before. So in my eyes, I would do it again. Some other people wouldn't. So personal.

    I don't know if scar tissue is worse than bone or if it makes it worse but I guess we get information, make the decision when we feel its best and can't look back.

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    Good point about the scar vs bone. See , i still think the succesrate with this surgery seems a bit of a long shot, for the seriousness of the surgery. Its the reason i am hesitating... I think 45 percent may still have good quality of life post 2 years is poor. I know that marino claims differently post 2 years. (more succesrate i believe it was 80 percent in the 2007 study?) Now does that have something to do with titanium mesh vs regular decompression? The 45 percent of dogs in claresnresearch, would they have done fine on medical mgmt? I know she claims a 30 percent euthanasia rate post 3 years on medical managament. Well cimpare to the 45 percent post 3 year op that still have good quality of life? Is that enough? I do wanna add that when a dog is seriously heading downward or suffering on meds , it can be the only shot. After all i learned about sm though i am glad to at least manage medically, even if just for a while...
    Last edited by Blondiemonster; 11th August 2011 at 01:55 PM.
    Mom of Blondie aka The Monster, my furry daughter and loyal friend!!!!!!!!

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    Quote Originally Posted by Blondiemonster View Post
    Good point about the scar vs bone. See , i still think the succesrate with this surgery seems a bit of a long shot, for the seriousness of the surgery. Its the reason i am hesitating... I think 45 percent may still have good quality of life post 2 years is poor. I know that marino claims differently post 2 years. (more succesrate i believe it was 80 percent in the 2007 study?) Now does that have something to do with titanium mesh vs regular decompression? The 45 percent of dogs in claresnresearch, would they have done fine on medical mgmt? I know she claims a 30 percent euthanasia rate post 3 years on medical managament. Well cimpare to the 45 percent post 3 year op that still have good quality of life? Is that enough?
    I have read Dr. Rusbridge's information when I was thinking of surgery. I think I got the 20% figure from that but thought it was decompression alone. I Know Karlin and also Ella's neurologist was worried about the long term results, but since you are thinking of surgery with Dr. Marino, I would ask him. He has some published information here http://www.caninechiariinstitute.org...-professionals which I bought the book. I also had Dr. Rusbridge's book and I can't remember how many Cavaliers were in that study.

    I too don't think that only 15% needed medication after surgery according to his report, but this was from them being examined after a year.

    "Currently, 73 of 103 dogs with MRI confirmed CLM treated with FMD with cranioplasty had at least a 1 year follow up and were evaluated. Results of our current ongoing study revealed 62/73 dogs (85%) improved after FMD and cranioplasty and needed no long term medications, with 11/73 (15%) requiring intermittent medication to maintain quality of life. Additionally, although it has been reported the majority of syrinx formations remained unchanged on visual estimation, our objective syrinx evaluation using MRI syrinx volume calculations revealed length measurements preoperatively and 6 months post-operatively in 13 of 21 dogs (62%) had decreased in both average syrinx length and volume, 29.4% and 45.6% respectively, while 4/21 (19%) remained unchanged (Fig 23). Future studies are underway to identify reasons why most dogs experience syrinx resolution while others do not, and if there abnormalities in the latter going unaddressed."

    Lynn,

    Since you are seriously considering surgery with Dr. Marino, I would ask the questions Karlin had and also the ones you mentioned. I would see if this is from the publication in 2007 or if there is updated information. I think someone said the % needing medication has changed, but overall the development of scar tissue is less. I can't find it but I did read scar tissue makes it worse than without. It might be in the book on the Canine Chiari Institute. You can also read Pat's transcript from a seminar where Dr. Shores talked.
    http://www.cavaliertalk.com/forums/s...ghlight=shores

    However,

    Since Blondie has seen Dr. Marino and that's who you are considering, it would be best to ask him directly. I'm sure we would all want to know if he has updated research.
    Anne Proud mother of Elton 5 and Angel Ella

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    This is from an e-mail and notes from Dr. Marino. I think it might be in the online book also.

    "Similar to humans, about 25% of canine patients require re-operation
    due to excessive post-operative scar tissue formation with FMD alone. It has been reported that worsening clinical signs associated with scar tissue impingement typically occur within 3 months of surgery. Cranioplasty offers a protective covering for the recently decompressed cerebellum and has reportedly decreased the frequency of scar tissue formation in patients after surgery to approximately 1-2%. "
    Anne Proud mother of Elton 5 and Angel Ella

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    It's also interesting to note that:

    "Currently, 73 of 103 dogs with MRI confirmed CLM treated with FMD with cranioplasty had at least a 1 year follow up and were evaluated. Results of our current ongoing study revealed 62/73 dogs (85%) improved after FMD and cranioplasty and needed no long term medications, with 11/73 (15%) requiring intermittent medication to maintain quality of life."

    Karlin wrote:

    "That is why I have such a degree of skepticism over claims about one technique being significantly better or having medication free results for dogs. This skepticism has been increased by seeing researchers who initially made these claims, revise them over time to concede that they are having higher proportions of dogs needing medication etc (to me it always seemed very premature to make such claims based on only about a year of postop evaluation). I also am aware of a couple of dogs that have had serious problems or significant deterioration after the mesh surgery, for example, in these do not seem to have been included in research reports."

    What about the 36 cavaliers that did not have a follow up? We don't know and it could be they didn't report back. Isn't he using a new technique with with both mesh and tissue now? I don't know if this has updated results.
    Anne Proud mother of Elton 5 and Angel Ella

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    I do not really want to get into a discussion of specific claims from specific places. I made the points on a general basis, and let's leave it at that. I think that some of the discussions on specific neurologists and their techniques and criticisms or recommendations are better taken off line between people, please.
    Karlin
    Cavaliers: Jaspar Leo Lily Tansy Libby (foster) Mindy (foster)
    In memory: Lucy
    Cavalier SM Infosite:www.smcavaliers.com

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    Quote Originally Posted by Karlin View Post
    I do not really want to get into a discussion of specific claims from specific places. I made the points on a general basis, and let's leave it at that. I think that some of the discussions on specific neurologists and their techniques and criticisms or recommendations are better taken off line between people, please.
    Sorry Karlin,

    Please edit my comments as you see fit.
    Anne Proud mother of Elton 5 and Angel Ella

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    Quote Originally Posted by anniemac View Post
    Sorry Karlin,

    Please edit my comments as you see fit.
    Me too. It was only my intention to point out therelativity of success rate.
    Mom of Blondie aka The Monster, my furry daughter and loyal friend!!!!!!!!

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    The comments that are there are fine. I just do not want critiques of specific researchers as opposed to general points about various surgical techniques and experiences, but people are free to discuss anything they wish privately amongst themselves.

    My skepticism about how surgery is presented, is not helped by some owners being told that ALL dogs with a syrinx will suffer terrible pain or need to be euthanized within a year or 2 if they're treated with medications only . This is patently not the case, and I do not know how any neurologist can believe this to be true if they follow any of the research or talk to any dog owners. there is plenty of evidence from all the existing Cavalier MRI studies that older dogs with no symptoms at all scan with syrinxes, sometimes quite extensive ones. I know many, many dogs treated with medications alone that are quite comfortable on that regime, and many dogs clearly go their entire life without any symptoms or with only very mild symptoms. Given that I have 3 Cavaliers with SM, only one of which is on any kind of major medication, and that he has been quite comfortable on that for many years and will very shortly turn 8 (with the other 2 dogs being around 8 and around 5 or 6) -- I really think it is very wrong to tell owners that a dog with a syrinx, especially dogs showing few or no symptoms, must have very costly and invasive surgery. If Leo had had surgery of whatever type at a year and a half when he was diagnosed, who knows whether he would not have had scar tissue complications or other issues arise. I just think making a decision for surgery is very complex. If I had a dog with a lot of symptoms Or certain kinds of syrinx, I would probably opt for surgery especially if the dog were young. It isn't an issue of not believing in surgery; it's an issue of how some techniques are promoted and what owners are told.

    I would like people to weigh up very carefully how they make decisions on treatment for their dogs–and keep in mind that there are many different opinions among specialists… so that what people are hearing regarding treatment are opinions, not any kind of definitive truth–because there is still so much that is unknown and not very well understood about treating this condition. Some specialists are very gung ho on surgery and others are more conservative. Some feel very strongly about one type of surgery over another. As has been discussed elsewhere–it's important to find a specialist that you're comfortable with and whose opinion you respect–And be aware that another specialist who is just as experienced might have a quite different view.

    Bottom line– I am very cautious when claims are being made for any treatment approach, when there isn't a lot of long-term clinical analysis there yet. I look forward to more studies being done and more information becoming available over time. Better yet, I would like the day to come when there is a genetic test for this condition, and when breeders can make choices that start to eliminate this problem in the breed. If they are unable to, I really think there is a massive moral issue on whether this breed is viable if huge numbers of dogs face a future of the kind of pain that is possible with this condition (known as one of the most excruciatingly painful conditions in human medicine). This particular illness is just a huge challenge for the future of this breed.
    Karlin
    Cavaliers: Jaspar Leo Lily Tansy Libby (foster) Mindy (foster)
    In memory: Lucy
    Cavalier SM Infosite:www.smcavaliers.com

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