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My Melvin and the lingering fear SM

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
 
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.
 
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
 
... 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/syringomyelia.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?
 
This may be syringosubarachnoid shunt surgery. It is discussed here: http://www.cavalierhealth.org/syringomyelia.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
 
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
 
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.
 
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.
 
. 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.
 
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.
 
Okay, after several consults with Dr. Jeffries and a second opinion, I have more information. Mel (in addition to SM) may have a vertebrae in his spine that is overlapping his skull in the general direction of his brain. We are going to do a CT scan to confirm this, but the surgery proposed for Mel is directed at removing this obstruction. Dr. Jeffries is proposing that we take this route as opposed to the graft or mesh surgery and is hopeful it will relieve some of his symptoms. Neither neurologist I spoke with seemed to have much confidence in the grafting or mesh procedures and this scares/depresses me. Mel's syrinx is considerably large and I do feel that some additional measures must be taken, I feel responsible for his condition and how severe it is. Every time Mel had a crying fit I took him to the vet and so many of them just kept telling me he was too young to have SM. I wanted to believe them so much I ignored my suspicions and called him quirky.
Karlin, Your right about it seeming sudden. Though I wasn't surprised at his diagnosis I feel every change (anticipated or current) in our lives so acutely I don't know what to do. When Mel isn't around to be upset by me, I cry so profusely. I vacillate from angry to sad so much during these times, I feel like I'm a crazy person.
In the end, I am sure I feel as all of you do. I just want to help him so much, to make him better no matter the cost- and no one can give us the guarantee we so badly need.
 
So is he talking about a laminectomy (or a laminotomy) as well as decompression of the foramen magnum and duraplasty (but without any swine tissue or titanium mesh graft)? Did you hear any of those words used? Or is he talking about doing a laminectomy only and NO decompression (removing the piece of bone from the skull)?

I looked back at my notes from the 2010 AVMA lectures - the one from Dr. Andy Shores - and copied this:

"Also, on the subject of "more" decompression, it seems to me that the laminectomy at C1 that Dr. Shores does results in further decompression, albeit decompression of the spinal cord rather than the brain." Dr. Shores was doing a laminectomy at C1 on all of his decompression surgeries.

Pat
 
Mel's mum wrote: I feel responsible for his condition and how severe it is. The only people who are in some measure responsible for Mel's condition are the breeders over the years who have not taken SM seriously - it didn't suddenly appear with MRI scans, people have had screaming dogs and still continued to breed from them or their progeny long before that. And many vets just don't do their homework on how widespread SM is in Cavaliers and what the symptoms are. And it takes a lot of confidence for a lay person to disagree with their vet and demand a second opinion. If I had known more, I would have queried my Oliver's early symptoms long before he was diagnosed at the age of 6. And I'm more and more certain that my Cavalier before Oliver had quite serious SM and probably spent his 10 years of life in considerable pain - but he had other health issues that confused the situation and none of us recognised it or did anything about it. So don't beat yourself up too badly - SM presents with so many different symptoms that we all miss some and only recognise them with hindsight.

Kate, Oliver and Aled
 
Dr. Jeffries indicated that he was not planning on doing the foramen magnum and duraplasty at this time (just the removal of the vertibral bone). Should I ask him about doing both? I would hate for Mel to have to go through surgery... but that sounds insanely intense.
 
I agree with what Kate said. Please don't beat yourself up because you are doing all you can now. I too wondered if I only did something sooner or did I not notice this... How long did I think it was ear infections, allergies, etc. It is so hard and like Kate said symptoms can mimic so many things. Take care of yourself as well as Melvin.
 
You can only go by what information your doctor is giving you and trust that your doctor is giving you the best information for your dog. It sounds as if Dr. Jeffries is very well known and respected. I would ask about the implant or skull decompression to see if he thinks that Mel might be a candidate for it later on down the road, but that this is the more immediate problem right now. Maybe once the pressure is released, he'll do fine on medication. At some point you have to put your faith and trust in your doctor, make a decision, and go with it. Realize that it was a hard decision and other people may not agree with it, but you made it wth the best information you had in front of you at the time. And you made it with only love for Mel in your heart, because you want him to grow up to be an old cavalier, and to live as pain-free and as happy of a life as he can, running and jumping and playing and enjoying life. No one can ever fault you for whatever decision you make with that in mind. Mel is a lucky dog to have you and we support you.
 
Realize that it was a hard decision and other people may not agree with it, but you made it wth the best information you had in front of you at the time. And you made it with only love for Mel in your heart, because you want him to grow up to be an old cavalier, and to live as pain-free and as happy of a life as he can, running and jumping and playing and enjoying life. No one can ever fault you for whatever decision you make with that in mind. Mel is a lucky dog to have you and we support you.

Could not have said it better. I know I shared my experience earlier but I felt and still feel I made the best decision. It is the hardest decision but we are here for you.
 
Thank all of you so much for what you have said. It means so much to me to hear consolation and support from those who have been through this before. Hindsight is really kicking me right now, but I'm trying not to focus on it so I can move forward and get Mel the help he needs. I will keep you up to date as we do. Dr. Jeffries has been great and very welcome to discussing all of my questions for the past three days, so after much deliberation (and several late night discussions) we booked our hotel and scheduled his surgery for Tuesday 3/19.
 
Just catching up on this thread, and wanting you to know I'll be thinking of and praying for you all as you go thus path to get Mel into a more comfortable position.

So much, and you are truly doing your very best.
 
I am new to this forum and I just want to say that my thoughts are with you going through this difficult time, I am sure that Mel knows you are by her side all the way.
 
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