S M Surgery ?

[Brian M]

Hi

Firstly I am not contemplating surgery neither for Daisy nor myself but would like members thoughts on it ,as when I do read comments from people who have decided to go down that route it always seems more of an American way more so than here .
Daisy thankfully seems stable in fact to me she seems no different than when I didn't know she was suffering from SM and her only medication is Cimetidene but we take her back for an annual assessment in August but no matter what happens in the future I don't think I could ever go down the surgery route .

Thanks

Brian

Ps I also mention Daisy's SM whenevere she goes to our Vets and ask there opinion re pain in case I
am missing any obvious signs but working with the theory that we know our dogs best she still seems
the same as Geoff Skerritt's comment last August ie "Daisy shows no sign of clinical Pain ".

[anniemac]

Sometimes I wondered, did I do the right thing for surgery. It does seem more people in the USA opt for surgery.

1) I thought of Ella's age. She still seemed fairly young

2) her MRI was severe and so were her symptoms. She was to the point she would not run or chase a ball. I knew surgery would not "cure" her but it would stop progression

3) she seemed to progress fast.

Looking back, I think surgery gave her time to get the right medications to work. Downside, Ella was one that developed scar tissue. I can bang my head thinking if I didn't would she have been better off or would she not be with me (given she didnt leave me for other reasons). Would the pain been so bad for her. It's EXTREMELY personal and I feel on a case by case basis.

[Hopeful4now]

Hi Brian,

I think it's always important to trust your intuition. What's your gut tell you in any given situation? Mine has never steered me wrong. Doctors and MRIs and other specialists may tell you one thing, but only you know your dog (I know you said you're not contemplating this for Daisy, just using "you" in general) and you see her eyes every day. Does she look like she can fight this and withstand surgery? Can your wallet?

My pup Dagny who is now 6 mos old was diagnosed with CM/SM via MRI at 4 mos (my first post here was my thread 'My puppy was diagnosed with SM') and it was devastating. Just thinking about surgery made me cry and for now, she's stable on meds and will be re-MRI'd in August to see if there's any progression. I know surgery is a very real possibility in the future but a huge part of me doesn't want to go that route. Why? Because it's not a cure and in many cases the dogs develop scar tissue, have to be reoperated on, the surgery doesn't help etc. If someone told me that Dagny would be 80% better after surgery, I'd jump in a second, but because the odds aren't even close to that, I'm not sure it's the most rational decision. I try to remain objective and think what I'd want someone to do for me.

I think everyone will have a different opinion on this, but one thing is the same. We all love our dogs and don't want them to suffer.

PS: I'm American.

[Nicki]

I did put one of my dogs through surgery for SM - I took him down to Clare Rusbridge at Stone Lion in London.


Clare Rusbridge gave this information:
Cranial/cervical decompression surgery is successful in reducing pain and improving neurological deficits in approximately 80% of cases and approximately 45% of cases may still have a satisfactory quality of life 2 years postoperatively. However surgery may not adequately address the factors leading to SM and this appears persistent in many cases. The clinical improvement is probably attributable to improvement in CSF flow through the foramen magnum. In some cases scaring and fibrous tissue adhesions over the foramen magnum seem to result in re-obstruction and 25% to as many as 50% of cases can eventually deteriorate. This can be as early as 2 months postoperatively.

My experience is that the disease will progress in a 1/3 of cases and this manifests as increased pain (e.g. frequent vocalisations and other behaviour suggesting discomfort). There may be ataxia and paresis however it would be unusual to progress to paralysis.

My bold highlights - we have to remember the short lifespan of our dogs, the average life of a Cavalier is only 9-10 years, so even the one month confinement following surgery is quite a long period of time for them.

It is very hard to make a decision as there seem to be mixed results, we hear of a lot of cases not doing well post op, but not sure if these are reported back to the surgeon as sometimes they are producing figures quoting very high rates of success, especially in the US. There seems to be little in the way of organised studies to demonstrate the effectiveness of surgery, but I don't think this will change as it is impossible to know whether the dog would have deteriorated anyway - this is a progressive disease but it progresses at different rates in different dogs, and sometimes they seem to remain the same for many years.



My own dog was very severely affected, he had the worst scan we had ever seen [the cerebellum was prolapsed right through the foramen magnum, but you would not have known it as he showed very little in the way of symptoms] we were told that surgery was really the only option for treatment for him. He had an amazing recovery from surgery, he remained on some medication but sadly within 6 months the symptoms returned. He deteriorated fairly rapidly and was euthanised 10 months post op to prevent further suffering.

It is quite traumatic both for the dog and the guardians, you will read many stories on here, sometimes things don't go too well and they have a difficult recovery.


I feel we gave him the best possible chance BUT I don't think I would opt for surgery again. This is just my personal opinion and also takes into account our personal situation - the very long journey involved, the time away from home, and the effect on everyone. [I'm full time carer for my husband in addition to having multiple health issues myself] This was only made possibly by the kindness of friends, in particular Margaret Carter on the board, who not only accommodated us but also took us to and from Clare's practice. [and put up with Rupert, who had to travel with me and caused chaos wherever he went, fortunately he was really well at the time although it was actually only about 7-8 weeks before his last illness . We took him to a large pet store and he was either up the shelves trying to get to the goodies or diving underneath them to pick up things that had been dropped there! Wonderful to see a 12 year old enjoying himself so much!]

The other dogs have all been treated medically, also with homoeopathy and now McTimoney chiropractic treatment too [under the guidance of my neurologist]. We have had mixed results - sadly the cocktail and high doses of drugs Teddy had to take to keep him comfortable, apparently caused heart and liver issues I think when we have been through years of treating our dogs we tend to forget that actually these drugs are very powerful and not everyday veterinary medicines.




We were fortunate that our insurance covered 90% of the cost of the surgery but obviously not the travel, accommodation, meals etc So there is a financial consideration too. We all want to do the very best for our dogs but you have to think it through very carefully - probably best to do this at the time of first diagnosis.


You make a decision at the time based on the information you have before you, discussions with your neurologist/neurosurgeon and vet, hopefully also with your family and friends. You can torment yourself over whether it was the right thing to do, but you cannot change the past, you did your best out of love for you dog.

[Nicki]

There is lots of helpful info on http://www.veterinary-neurologist.co.uk

http://sm.cavaliertalk.com/ and http://cavaliermatters.org/

[Love my Cavaliers]

Riley's journey through SM surgery has luckily been a success story. She was diagnosed with severe and advanced SM complicated with a large cerebellar cyst. Preoperatively, medications made no difference in her symptoms. Two different veterinary neurologists told me that surgery was her best option for an improved quality of life. Now, we are in the US and it does seem that we are more quick to jump to surgery here. However, with two neurologists telling me the same thing, I opted for the surgery. Riley had the titanium mesh implant.

Recovery was long and difficult and we struggled to find the right post-op medication for her. I spent many, many days questioning whether I did the right thing for her, whether maybe I had shortened her life with the surgery. Once her neuro put her on prednisone she was like a new dog. And she has been in the almost 4 years since her surgery. She still has her bad days, but overall she is doing phenomenal. She is my miracle dog and i am so thankful that she is still with me four years after her surgery.

Would I do it again with a different dog? I don't know. I trust Riley's neuro implicitly. He did cervical disc decompression surgery on Oliver when he was 9 years old and Oliver bounced back from surgery like he was a puppy. I guess it would depend on how bad the MRI was, what my dog's symptoms were, if medication helped at all, and what the neuro's recommendations were. I would definitely want a trial of medication first before I jumped into surgery. Surgery was no picnic for either Riley or me, so if meds worked, that would have been ideal for her. Unfortunately for Riley, they had no effect.

Bottom line is that it is a very personal decision made based on the facts you have before you at the time, weighed against all the personal factors (do you have insurance, can you afford it, your own value system and beliefs, etc). You make the best decision you can at the time for your dog and then you trust yourself that you made the right one. Either for surgery or against surgery. Whichever choice is made, no one will say you don't love your dog because you made that particular choice.

[shyjazz]

when trudy yorkies MRI showed SM it was a shock, but other then a couple of fits, which was why she had the MRI, no symptoms. a couple of weeks later, she couldnt use her back leg and was collapsing. tests have showed its due to SM. gabapentin wasnt doing anything, so now shes on prednisolone. im hoping this will work as the next step is surgery. I dont want her going through that. shes my best mate, only 7yrs old, but the stress of the op, and being away from me isnt fair on her.

[nicolse]

I'm American and I did go the surgerical route for Tobey. He had unexplained neck pain from November to February; none of the usual symptoms; he was "managed" with pain meds until I gave in and had the MRI. I was stunned he had SM, but because of the degree of his pain (w/ and w/o rx) I felt I had no choice and I'm glad others here are having luck with rx as their choice.