16th September 2011, 08:35 AM
Questions about SM surgery-experience of neurologist and out-of-area treatment
I was first on this forum about a year ago when my 3 year-old was diagnosed with SM. She was doing better on and off with medication management. We have tried Gabapentin, Omeprazole, Lyrica, Prednisone and Amantidine. After gaining 6 pounds in one year and worsening symptoms, we decided to get an MRI. The MRI showed a severe case of SM and the neurologist is suggesting surgery.
I have learned so much on this forum and I'm so glad to have found this resource. I have a couple of questions and I would love any feedback.
Thanks in advance
1. I know there isn't a magic number, but how many SM procedures on Cavs should a neurologist have under their belt for you to feel comfortable?
2. For those that traveled far away from home from surgery, what cons are to be expected after surgery? What was your experience with long-distance follow-up care? Does anyone feel comfortable seeing their local neurologist for follow-up care after choosing an out-of-area neurologist?
20th September 2011, 04:23 PM
Hey there.... have done this myself
We traveled about 9 hours by car to Gainesville, FL to have the surgery done. We did alot of asking around and sadly, NC State University had their only experienced neuro out on maternity leave. I do think it is worth it to find a surgeon you trust, but it is not easy to have a long trip on top of everything else. You will not find that many neuros who have done dozens of these, except for Long Island Vet Specialists in NYC, which specializes in this surgery. We did explore going there but they took a long time to call us back and that trip would have been a gruelling drive in some of the worst big city traffic ever. We also did not really want to fly due to Gracie's condition after surgery.
As we did research, there were only a few others within a day's drive for us to consider. And, we wanted to go with someone who used the same technique as they use in Long Island ... titantium mesh implant to control the scar tissue. That got us down to a handful of people and we decided to go with Dr. Schubert at University of Florida Vet School. One, he was highly recommended by people here and other SM resources. Two, the Small Animal Clinic also is very highly reviewed.
So, we drove down on Sunday, have our consultation on Monday and surgery on Tuesday. We sent him the MRI results in advance along with videos of Gracie. I also composed a brief history of her symptoms. We stayed a hotel almost across the street from the vet clinic that allows pets. I can't say enough great things about the facility and Dr. Schubert. It was so well run and he was very engaged and patient in letting us ask lots of questions. We were probably with him for nearly an hour.
After the surgery, they had someone update us by phone every few hours on how she was doing. The only thing I think they should have done differently was keep her another day or two before discharging her to go home. While she clearly was happy to be out of the hospital, she did have a bad pain episode that we had to deal with by taking her to an emergency clinic. I just think it was too soon. On hindsight, we should have stayed another 2 days in the area so that we would be there to deal with any post-op issues. But hubby wanted us to get home.
On the trip back, Gracie was fine. She was fairly heavily medicated and sleep most of the trip on my lap. It was the day after that she had the "pain windup" issue, which is basically the pain nerves going into overdrive and they have to give them extra meds to back it down. But, after that, we had no problems.
Dr. Schubert's staff has been great in working with us remotely after the surgery, even on a weekend, to adjust her meds, get reports, etc. We never had a problem getting up with someone to help within 30 minutes or less. They even faxed all her records to the emergency clinic very fast so that this was already available before we got Gracie there. That is something you need to ask..... how available are they after the surgery if problems arise?
Dr. Schubert has only performed about 15 of these surgeries...mainly because many people never opt for surgery. There are really not that many done. But he is known for being really good and I talked directly with 2 people who had him do SM surgery for them.
After surgery, we have not seen a neuro here except at the emergency clinic. Instead, Dr. Schubert has advised our regular vet as needed. We do not have access to a good neuro in our area at this point, so not really any choice.
Here are some things that you may want to consider:
Hope this is helpful.... I am here if you have any specific questions.
- Is there a hotel nearby that allows pets?
- How long can you be away... could you stay over a day or two after the surgery?
- How well does your dog travel by car or plane?
- Do you have a second person with you to help? It is hard to drive especially if just you. I held Gracie while hubby drove.
- Are they okay in a hotel? can you help it feel more like home by bringing toys and other things they are used to having?
- What is the schedule for appointment and then surgery so hopefully not 2 trips?
- What is their plan for followup after surgery?
- What medications do they provide for pain after surgery? Gracie has pretty low pain threshold and needed more meds than they gave her.
- How well do they work with other practices post-surgery?
22nd September 2011, 04:19 AM
Great detailed list Debra!
Oh goodness, I remember the pain issue after you came home. But I just knew in my heart that Gracie would be fine.
Nicole, so many here to support you how ever you need. Take care.
Cindy and Claire
Claire was born on Feb7, 2010
25th September 2011, 09:10 PM
Hi Nicole -- sorry that you are needing to consider other options.
I would want a neurologist that has done enough surgeries to have some experience -- but depends on the neurologist. For some that might mean half a dozen perhaps? I wouldn't want to be amongst the first few. But I also wouldn't feel it needs to be dozens of surgeries. The procedure is actually a fairly clear approach and a neurologist will have done many varied surgeries on skull/brain areas of dogs generally.
I would not feel follow up needs to be with the same neurologist if very far away but seeing the same person that knows the dog and di the surgery would be the best option IMHO, at least for initial follow up. There are a couple of people in Calif doing surgeries. You also are very close to UC Davis vet school.
Also as Debra has noted, neurologists can advise your own vet. Adjustments to meds etc can often be done this way.
In memory: Lucy
Cavalier SM Infosite:www.smcavaliers.com