Puppy Odin's Eye Problems: An Update
Posted at 10:48AM - Comments: (25)
The little guy's eye took a bad turn recently and we still have no real answers.
Over a week ago, I took Odin to what was supposed to be his last appointment with the veterinary ophthalmologists at the U.C. Davis Veterinary Medical Teaching Hospital (VMTH) on Tuesday. Three weeks prior, the resident doctor said it looked like Odin’s eye was slowly improving, and was stable enough to start reducing and then eliminating the medications I have been applying to the eye. He received no medications for a week prior to this last appointment.
Read previous coverage of Odin and his littermates:
At the appointment, a different resident doctor (veterinary ophthalmologist) reviewed the notes from Odin’s past visits, and carefully examined his eyes with various instruments. She confirmed what I could see with my bare eyes – that Odin’s eye looked essentially unchanged since the appointment three weeks earlier. She noted that the eye still displayed signs of edema, and that I could consider continuing the doses of hypertonic saline ointment (which helps the eye rid itself of extra fluid), or not – it appeared that the eye was stable. I explained that I have a family waiting to hear the final prognosis, and ready to adopt him. She said there was no reason to not go ahead with that adoption.
One funny (not funny) thing: he was a little squinty during the exam. But, in my experience, I’ve seen him display more sensitivity on some days than others. I wasn’t worried.
I'm not kidding - THAT NIGHT he started squinting more and the eye got teary. I called the doctor the next day and asked whether the exam might have irritated the eye, and should I put him back on the antibiotic drops or something?
She said that the exam shouldn’t have caused any irritation (and, in fact, none of the previous examinations had) but that to be safe, I could start giving him the antibiotic drops and the hypertonic saline ointment again. And, of course, if his eye started looking bad, I should bring him back to the VMTH or take him to my local vet.
That afternoon, Odin started moaning with obvious discomfort. I still had some liquid gabapentin in the refrigerator, left over from when his eye ulcerated many weeks ago. (You should see all the medicine bottles I have, as we have changed his medications many times in the past couple of months.) I started giving him the liquid gabapentin for pain.
The next day, the eye looked even more blue with edema and he was still moaning in pain when the gabapentin wore off. I called my local veterinary hospital, but the one veterinarian who deals with eyes and who has seen Odin before was not on duty for days. So I resolved to take him back to the VMTH first thing on Friday.
Fortunately, the same doctor who saw him three days prior was on duty again. She immediately agreed that the eye is more swollen (has more edema), but there is no sign of an ulcer or infection. She told me to stop the antibiotic, keep him on the hypertonic saline ointment, put him back on the NSAID drops from many weeks ago, and gave me a refill prescription for more gabapentin.
Discouraged, I asked about the likelihood that this inflammatory process would keep recurring. All along, since his first visit to the VMTH ophthalmology department, we had hoped that the initial inflammation in the eye was from an event that started when he was still immune-deficient, when his body was still healing from the demodectic mange and malnutrition, and that we've just been trying to heal it all this time. The eye ulcerated early on, started healing, and then ulcerated again when a chunk of mineralization in the eye gouged the surface, but since then, it's been slowly getting better. This was the first time it got worse again, for seemingly no reason.
She said, well, we don’t know why it has happened, there is clearly something wrong with the corneal endothelial layer in that eye . . . But then a little light bulb went off in her head and she said, “One of our residents is actually recruiting patients for some studies we are doing on a drug that is available in Japan that treats the endothelial layer of the cornea... Would you like information on the studies?”
Would I? Would I? (Insert punchline of childhood joke here.)
So, currently, I am discussing Odin’s possible inclusion in the UCD VMTH studies of this drug with the family that is interested in Odin, to see if they would be willing to do what the study requires: apply drops of the medication to his eye four times a day for a year, and take him to the VMTH every three months for a year for follow-up examinations. We're still talking it over.
But I would like to commit Odin to the studies whether my friends decide to adopt him or not. If they don't, I will just keep him, or keep trying to place him with someone who is willing to do the study follow-through. I think it's a great chance to treat his eye – AND to get all the follow-up exams, AND perhaps contribute to science, and possible FDA approval?
Also, as a study participant, if the drug doesn't work, he might be considered for another study on a corneal transplant! These are done frequently on humans with diseases of the same layer of the cornea. I know this because, bizarrely, my husband has an inherited disease (called Fuch’s dystrophy) that causes the same layer of the cornea to malfunction, and after years of management of the disease with medications (all the same ones that Odin has been prescribed!), my husband finally had corneal transplant surgery on one eye and then, months later, the other.
But we hope it doesn’t come to that. The medication, which has been approved for use already in Japan, sounds very promising. I’m hoping that it can improve and perhaps stop the dysfunction of the problematic corneal endothelial layer in his left eye. He’s such a nice puppy – preternaturally calm and mature in his behavior, friendly to everyone he meets, and smart! And, he absolutely hero-worships Woody, following him around everywhere, sleeping intertwined with (actually, usually ON) the big dog, and play-wrestling with Woody at every opportunity. I’m NOT PLANNING ON KEEPING HIM! But he’s no trouble at all. And sweet. And cute. ARGH!
Really, my only resistance to keeping Odin is wanting to give Otto his rightful space and time as king of the household until he’s gone. And I’m a bit worried about Otto right now.
In Otto’s last two examinations, tests of his urine have showed a worrisome trend. The urinalyses have shown that his urine is growing slowly less concentrated – often a sign of chronic kidney failure. We’ve been watching it.
Otto has always had this funny habit of drinking a lot of water right after my husband or I come home. We walk in the door, he greets us happily, and then goes to his water bowl and tanks up. It’s almost a tic – as if he doesn’t drink the whole time we are gone, but will only drink when we come home. But lately, we have both noticed that, in addition to his lengthy drinking sessions when we come home, he is drinking a lot more water at other times, too. So I collected a sample of Otto’s first-thing-in-the-morning urine and took it to the vet the other day; that’s the best sample to check the urine’s concentration, to see how well the kidneys worked overnight. The results indicated that his urine was too dilute. I made an appointment to see his veterinarian immediately. I’ll let you know what’s next as soon as I know.
Don’t get me wrong: Except for the drinking, he seems totally fine. His energy is good – so good, in fact, that the person I have been taking agility lessons from thinks that 11-year-old Otto – not super-athletic, three-year-old Woody – is my best prospect for taking to an agility competition.
One day, when I was getting ready to leave for an agility lesson, Otto was acting so dejected that I texted the instructor and asked if I could bring my older dog, too. She said, sure. I had last taken Otto to about 10 agility classes about six or seven years ago, but he loved it then (all except the weave poles, which we had barely begun to try).
At this lesson, when it was his turn, Otto bounded around me, full of excitement and enthusiasm. He raced toward every obstacle I indicated, flying through the tunnels and over the A-frame and teeter. He had to be reminded to “wait” with two paws on and two paws off at the end of those contact obstacles, but sheesh! It’s been YEARS since we practiced those things.
After the lesson, my instructor thoughtfully noted, “Woody is clearly the more athletic dog, and you guys have a good connection, and he’s got good basic obedience skills . . . but you can see that he’s not yet clear on the point of it all – he’s not excited about any of it yet. Otto doesn’t care what the point is; he’s just thrilled to be out there and doing anything you ask him to do!”
It was an easy observation for her to make. Otto is like the kid who always sits in the front row and puts his hand high in the air every time the teacher asks any question; he loves being praised (and treats!) for doing any behavior he’s asked. And if he doesn’t know what’s being asked, he happily starts offering random behaviors, trying to guess what might be rewarded. My New Year’s resolutions involved taking Woody to an agility trial some time this year, but it might be that Otto and I get there first. I’ll let you know about that, too.