My Melvin and the lingering fear SM

[Pat]

Mel's doctors said they have a different surgical maneuver that I have never heard of. They said they would be going in from the UNDERSIDE of his head and doing the surgery from there.

What does this mean? Through the soft palate? Through the throat? ????!!!!!

Surely there has been a paper written about any "newer/better" surgical techniques. I'd want to read that paper! What is the location of the surgery center that is doing this procedure? A vet teaching school?

Pat

[MelsCavieMum]

I just started learning about this yesterday, directly after Mel's diagnosis, so it's a bit hazy. I'll call and ask the Doctor if he has any material I can read and also forward on to all of you. It is a univeristy, it is the University of IA in Ames, IA. Dr Jeffries would be doing the surgery. I'll call today.

[Kate H]

Dr Jeffries is Nick Jeffries, I think, who was the leading neurologist at the Cambridge University Vet School before he went to Iowa a couple of years ago. So he has a long experience of SM, but the proposed surgery seems a bit mind-boggling - I'm sure there'll be a paper about it somewhere. Have you heard anything about it, Karlin?

Sorry that Mel and his family have to go through all this - SM really is the pits.

Kate, Oliver and Aled

[RodRussell]

... Mel's doctors said they have a different surgical maneuver that I have never heard of. They said they would be going in from the UNDERSIDE of his head and doing the surgery from there. I had only ever heard of the surgery which took place at the top of the head behind the base of the skull. My doctor is swearing by it and says that the other patients they have done this on have had great results stopping progression and relieving symptoms. ...

This may be syringosubarachnoid shunt surgery. It is discussed here: http://www.cavalierhealth.org/syring...htm#--_surgery (scroll down from the top of that link to the sub-title "syringosubarachnoid shunt". Did the vets mention the name of the surgery, and whether it was aimed directly at the syrinx, rather than at the skull?

[Pat]

This may be syringosubarachnoid shunt surgery. It is discussed here: http://www.cavalierhealth.org/syring...htm#--_surgery (scroll down from the top of that link to the sub-title "syringosubarachnoid shunt". Did the vets mention the name of the surgery, and whether it was aimed directly at the syrinx, rather than at the skull?

But if it is shunt surgery, the shunt is inserted into the subarachnoid space, which is still on the "top" of the dog and not on the "underside" of the dog's head. The "underside" word is what is throwing me. Maybe they didn't communicate very well. I'm really curious.

Pat

[MelsCavieMum]

I am very confident he said "underside" because it threw me too. I have requested some reading material and reports of the surgery and will follow up again if I don't hear back soon. It scares me no one here has heard of it

-Lauren

[anniemac]

I am so sorry to read about melvin's diagnosis. I know your mind must be spinning. I just want to say a couple of thoughts from my own experience of having a cavalier that I opted for surgery. Karlin, pat, rod and others will know more than I will on the technical (scientific) aspects of this, but i would like to share thinking back on things I felt.

. Like Kate said, Dr. Jeffries is well know in the world of SM so you are in good hands. With that being said, I have never heard of this surgery and of it was me, I definately would want to know more. I personally felt pressure to make a decision fast. At the time, Ella's neurologist was new to the titanium plate Dr. Marino was using to help prevent scar tissue. He wanted to know more long term results at the time. I felt Ella was pregressing fast and I didn't have time to figure out if medical management would help.

I don't know looking back if I would have changed my decision (Ella developed scar tissue) but the other surgery was risky. Whatever you decide, get as much information as you can. Don't feel you need to decide right away. It's a big decision and surgery has worked well for a lot of cavaliers and I would do it again. Just try to step back (I know it's hard) but two weeks of research or learning about this new surgery will not do much damage while Melvin is on medication. Then go into surgery knowing that you are know all you can. Even with Ella's scar tissue I still may have opted without the titanium at the time. It's very personal and a tough road and I wish you and Melvin all the best.

[Love my Cavaliers]

My experience for Riley was very different. Up untl she had her MRI, I had never heard of SM and was totally floored when surgery was presented as her best option for quality of life. I had not found CavalierTalk then. I elected to take her MRI results to another neurologist who gave me the same diagnosis, but said that because of the severity of RIley's SM and because it was complicated by a cerebellar cyst he would want the first neurologist to do it if it were his dog! So back we went to Dr. Podell who did the decompression with the titanium mesh implant. I happenend upon Cavtalk whie I was waiting for RIley to recover from her surgery.

Riley has been one of the lucky ones with SM decompression surgery.It has been more than four and a half years and she is doing great She'll never be normal, but she was older when she had surgery and ths had more damage done by the time she had surgery. But, she is a happy dog and loves being alive. She loves to run in the yard and go for walks. She doesn't play with my other dogs any more, and has times where she hides under tables and chairs to get away from them. She can't jump, so I got stairs for her to get up onto the sofa and my bed. She is such a love - for her, surgery was absolutely the right decision.

Like Anne said though, I waited several weeks after diagnosis while I got a second opinion. It gave me time for the diagnosis to sink in and it helped me feel that I was getting the most information I could in order to make an informed decision. Whie others will be able to help you, ultimately the decision is yours to make for Mel and that's a hard one. Wishing you all the best.

[Margaret C]

. I knew this was going to happen, but I still can't help but be heartbroken. Up to the last moment I was hoping it was some strange and uncommon infection that could be treated with a daily regiment of Peanut Butter and couch-snuggles. I suppose I should work on my attachment to blind hope.

I have never heard our desperate wish that it be anything but SM described better.

I am so very sorry that peanut butter remedy is not going to work and I am also very interested in the proposed surgery. Nick Jefferys is very well known in the UK. In fact he was the Neurologist I first started collecting cavalier tissue samples for in 2007 when he was at Cambridge. Melvin is in good hands.

[Karlin]

A diagnosis of SM is really hard and you do need time to absorb it and think about all this is being proposed as it can indeed seem so very sudden even when one has suspicions.

I've never head of a surgery that would take this approach so am interested to hear what he says in more detail. I have a feeling this may simply be another way of describing some version of the titanium mesh surgery or perhaps the swine tissue graft. I can't imagine how they would be coming in from the actual underside of the skull? There haven't been any papers or reports done on an alternative method of that sort as far as I know, and haven't heard it mentioned from other neurologists.

It would be very interesting if there is another alternative being tried.