One of the issues is that doing the surgery before there is significant pain -- but an MRI indicates a problematical syrinx, or several -- is that there is growing evidence of greater long term success. Waiting until there are clear signs of pain may mean permanent neurological damage, and/or poor recovery and/or scar tissue formation that may ultimately recreate all the earlier problems or make them even worse. The difficulty for neurologists and owners is that dogs can't explain when they have pain and even neurologists can only gauge certain types of pain.
Owners also have a hard time understanding and measuring neuropathic pain -- it isn't very obvious much of the time especially in an animal, which will instinctively hide pain. I've seen so many owners say 'my dog is in no pain' who go on to also note 'but...' their dog 'only' scratches regularly (most neurologists consider this a sign of pain and existing and often permanent neurological damage to the dorsal horn -- which is why so many dogs remain on gabapentin post-surgery for life -- the damage is already permanent), or yelps but not all the time, or shows a bit of tenderness but not all the time. On
the pain scale agreed upon by the neurologists in London in 2006 most of these things happening even *once a week* is considered a significant indication of pain. Neurologists do a special set of tests to check how compromised a dog is -- vets and owners will not generally see these subtle indications themselves (that is why the dog gets referred to specialist to start with
). And headache is the main indication of pain in most humans with CM/SM-- but how do owners tell their dogs have serious headaches? Neuropathic pain also tends to come and go -- humans will talk of good days and bad days with chronic neurological pain.
On another list a person spoke of seeing a video shown at one of the major club shows by neurosurgeon Dr Marino from a study on pain in animals, that showed a dog that wagged its tail and showed no problems when its owner came into the room, but shivered and shook with obvious pain when the owner was gone -- an indication of just how hard they will work to NOT show us, their owners, their true level of discomfort and distress.
So really there are many factors that go into a surgery recommendation from experienced neurologists. The best approach I think is to discuss the 'why' of any recommendation and also ask if there are existing signs of pain that might be missed by the owner and take it all into consideration when making this often very difficult decision.
I've seen a lot of internet postings elsewhere recently from people who haven't even been to a neurologist with an affected dog, implying there are floods of dogs with no pain and no problems all being told to have this surgery by unnamed neurologists. These posts have no specific references -- the poster always seems to have 'heard' of these stories. If so, where? I run two of the four primary discussion areas for owners of affected dogs, and am a member of the third and read it daily, and I haven't come across them. I was on the fourth list for a long time and doubt there's a hidden group of people who never post anywhere else all of whom have been advised to have surgery when there's no real indication this should be done, or done only on their old dogs. I am wondering where all these stories are being discussed and who the owners are... and some of the post are not very sensitive towards the owners who actually are forced into having to make decisions on behalf of their dogs that none of us ever want or should have to face in the first place
. Most of the people I've seen make posts about this seeming flood of asymptomatic dogs going for surgery are people who have never been through this experience themselves.
Meanwhile, I've talked to many of the neurologists, and dozens of owners have reported their experiences to me publicly or privately over the past four and half years, and I truly don't know of any neurologist who takes such a recommendation lightly.
There are of course also many reasons not to choose a surgical route. Those perfectly good reasons can be highly personal, based on one's own philosophy on surgical intervention, one's finances, ability to manage a post-op dog, age and condition of the dog, other health complications, etc etc.