Friday, February 23, 2018

Mason's eye removal (enucleation) and teeth extraction surgery: Days 8 - 14 (two weeks) post op

 Everything's been pretty much the same. The eye wound continues to look better each day.  Around day 7 I noticed he started doing normal full yawns again.  Before that he was only half-opening his mouth. His fur is really starting to fill in, too.  Around day 10 I suspect most of the swelling went down enough for him to begin to get the caved-in look (you can see where his skull's eye socket ends and the void begins), but the "lips" of the wound are still sticking out, so the overall look is pretty weird.  On day 12 Mason got his stitches removed!  Read more about that below.

Day 8:

Day 9:

Day 10:
We were supposed to be going on "short leash potty walks" according to the vet instructions, but instead we went on an overnight canoe camping trip! His eye wound started to get the caved-in look, but right around the incision site it was still coned out, so it's looking pretty weird right now.

 Mason found his sacred orb in the van.

Day 11: We returned from our canoe camping trip and I forgot to take photos of his eye, but here is a photo of him between two canoes.

Day 12: Stitches got removed today so that means no more cone! There are some photos of before the stitches came out and after photos.  Mason had 4 external stitches and a couple of layers of stitches under his skin.  The stitches came out easily and quickly and I don't think Mason even felt it.  The vet also said the stitches in his mouth are healing well (those will dissolve).  She even gave him permission to eat his hard kibble again and she said I could start brushing his teeth in a week.  For an hour or so after the stitches came out I could actually see the hole that the stitches left (it was very small, the exact gauge of the thread that was used) and then later in the day I noticed some reddish clear liquid in the hole, and then even later there were small scabs there.  He has one scab near the center of his eye that I probably didn't notice before because a stitch was covering it.

 Mason hates the vet (even more so now!) so this is my special technique to keep him calm while we are waiting at the vet.
 After the stitches came out:

 13 days post op:
His fur is mostly growing back but there is still a weird bald patch right above. You can also see the scab in the center.

You can see stitches where his little loose tooth was pulled on the top.
Mason's teeth after they were cleaned and six were pulled. 

14 days (two weeks) post op:

Everything is pretty much same as usual.  Last night he had a small amount of bleeding as if he had rubbed off a scab.   

Monday, February 19, 2018

Mason's eye removal (enucleation) and teeth extraction surgery: some bad news

I got the histopathology ("the microscopic examination of biological tissues to observe the appearance of diseased cells and tissues in very fine detail") results of Mason's removed eye today.  The vet said it looked like he had primary glaucoma, and his ophthalmologist confirmed it.  His ophthalmologist suspected he had secondary glaucoma caused by the mature cataract in that eye, so she was surprised to hear it was primary.  She told me to use the left over Dorzolamide eye drops from his other eye on his one remaining eye twice a day to help delay the inevitable (my wording, not hers).

The ophthalmologist mentioned Endolaser surgery being an option in his remaining eye (...for $8,000).  It has an 85% chance of saving whatever vision he has left and a 95% chance of keeping his eye pressure low.  She doesn't perform it until after a spike in pressure because the other 15% is the chance that she accidentally blinds him, which is less horrible when you already know he's definitely going to go blind from glaucoma.  She also said that when his pressure spikes it is very important for him to see an ophthalmologist in 1-2 hours.  They could then add drops to his routine or use a needle to remove some of the fluid in the eye to relieve the pressure and hopefully save his vision.

Friday, February 16, 2018

Mason's eye removal (enucleation) and teeth extraction surgery: Let's talk money $$$

I know a lot of people don't get down right personal and talk about money, especially the exorbitant amount of money they just spent on a small animal.  Well, I'm about to reveal it all: exactly what I paid, estimates from the vet, estimates from the ophthalmologist/specialist. To be clear, the year is 2018 and the location is a city: Philadelphia, PA.

Mason's eye removal surgery, teeth cleaning, and 6 teeth extraction ended up costing me $2,139.71.  Ouch!  Just to be clear, I expected it to be $1000 less.  Not because the vet quoted me incorrectly, but because I didn't think Mason's teeth were that bad.  The estimate I got from my normal vet for eye removal surgery alone was $1,507.  If I were to get his teeth cleaned and 0 teeth pulled it would have been $500.  If I got his eye removed and teeth cleaned at the same time it would be $1,300 if 0 teeth were pulled.  Whaaaat? The teeth cleaning would basically be free and the eye removal would be $200 less? Can that be?? Yes, yes it can.  It has to do with anesthesia packages.

I spent another $270 for the histopathology (dissection) of the removed eye. This will tell me if he had primary or secondary (in this case, caused by his untreated mature cataract) glaucoma.  If it is primary, he will be started on glaucoma-preventing eye drops immediately.  If it's secondary, we just keep a good watch on his good eye.  I didn't want to spend $270 on his dead eye, but the ophthalmologist highly recommended I get this done and she wasn't making any money off that recommendation.

Before the surgery, I upgraded Mason to the most thorough blood test which was $275.  My thinking behind that was that I didn't want to put an unhealthy dog under anesthesia and risk him dying, and I also didn't want to pay $2,409.71 on a surgery for an unhealthy dog.

At my vet, a regular teeth cleaning with no extractions would have cost $500.  At Mason's previous vet, they quoted a teeth cleaning at $1,200! Make sure you shop around a little.  It's amazing and fortunate that pet healthcare costs can be broken down so efficiently into estimates - it is not like that for people at all!
A good amount of this surgery price was the quantity of teeth he had to get pulled, and more anesthesia time. The price of extractions depends on the number of roots the teeth has, the more roots the higher the cost.
1 root - $58, 2 roots - $68, 3 roots - $104, carnassial tooth - $112

I paid so much more than I ever thought I would spend on a pet.  But if Mason even lives for one more year it will all be worth it... but he better live to be 18 since it cost that much......

Here were the other estimates I received from Mason's ophthalmologist:

Intravitreal Injection:  $350
This is the least expensive and least invasive choice.  An injection in the eye destroys the cells that produce fluid in the eye.  By decreasing the production of fluid, the intraocular pressure should remain permanently low.  It's done during an office visit with local anesthetic.
I didn't choose to go this route because my ophthalmologist said that many owners who do this to a otherwise healthy dog end up having problems in the long run, but their dog will be to old/unhealthy to get it removed later. 50-90% (Ophthalmologist said 75%, vet said 50%, internet says 80-90%) who get this procedure will get phthisis bulbi (shrinking of the eye), which looks pretty nasty. Since the eye is still there, it can still become injured (it's blind, so the dog could bump it) and it could still get cancer or other diseases of the eye. In some instances more than one shot is required which really bumps the price up.

 The ophthalmologist had me do a google search of "Phthisis bulbi" and she told me which images were actually it, because many inaccurate images come up in the search.

 This is a German Shepard with phthisis bulbi (shrinking of the eye)

Enucleation (eye removal) with histopathology (labratory testing of removed eye: $2,300 - $2,700
This could have included a prosthesis put in the empty eye socket to "fill" it before they sewed the eyelid shut.  My ophthalmologist used to do this to all her patients but since a few patients have rejected the implant years later she stopped making it standard procedure.  This prevents the caved-in look.

Evisceration with Orbital Prosthesis and third eyelid flap:  $2,900 - $3,500
This is when the inner eye is removed and replaced with a black ball, but the outer shell of the eye, eyelids, third eyelid, and all muscles remain intact.
 I didn't go this route obviously, but I did think about it.  This is the most "normal" looking option but it's also the most painful and relatively high maintenance.  Many of the dogs with this procedure will require moisturizing eye drops eventually. Mason's ophthalmologist said the only reason the price is higher for the prosthesis is because the dog will need to be on intravenous pain medicine for an entire day.  One of the vet techs even leaked to me that one woman who had this done to her dog was calling after a month asking if it was okay that her dog was still crying and moaning! In the end, prosthetic eyes are for you, not your pet.

The eye on the right is a prosthetic eye.  Source

Glaucoma and Cataract Laser surgery were also options, but I didn't receive an official quote since the ophthalmologist said they would be around $4,000 - $5,000.  That is way out of my budget, especially for a procedure that is not 100% successful.

Management for comfort with topical drops 
This is only feasible for up to two years if you are lucky.  Human glaucoma drops stop being effective on dogs rather quickly.

I was paying $30 (pressure check only by vet tech) to $80 (pressure check and eye examination by ophthalmologist) every 1 to 2 weeks at the ophthalmologist.  When a dog's eye pressure is high, it needs to be monitored often.  If his pressure had lowered to a comfortable level and stabilized I probably could have had more time between visits.

Mason was on 3 eye drops 3 times a day.
Dorzolamide cost $25 at my local vet or $50 at the ophthalmologist for a 6.8 mL bottle that would last approximately 4-6 weeks.
Predinsone Acetate cost $120 (I got it for $60 at Costco) for 10 mL and would last about 6-8 weeks, or $80 ($40 at Costco) for 5 mL.
Latanoprost (5 mL) costs $25 at the ophthalmologist, or $60 at CVS.

I went through my receipts and I spent about $455 on ophthalmologist visits and just about $230 on prescription eye drops in two months.  I also bought two bottles of Ocu-glow at $75 each.  That brings my management total to $835 for around two months!

Pet (and people without insurance) prescription cost tips:
Go to Costco if you have one near you!!! You don't need a membership to get huge (50% for me) discounts on prescriptions!

Walgreens also has a prescription program where you pay a $20 yearly membership fee and can get a certain % off prescriptions.  It's called Walgreens Prescription Savings Club.  I don't remember exactly, but I believe if I joined the club I would've got Mason's $120 prescription for $90.

Wednesday, February 14, 2018

Mason's eye removal (enucleation) and teeth extraction surgery: Days 5 - 7 (one week) post op

The swelling has been going down consistently every day.  He's been trying to scratch and rub his eye when his cone is off.  He's sneaky about it though, so I keep the cone on all the time when he's unsupervised. He's always rubbed his face/mustache on people and things to scratch it, and he's been doing that still and has been trying to do it with his eye wound.

 This photo and the next few are from his 5th day post op.
 Still a little redness.

 Eye wound is starting to be less "cone-ish". The swelling is going down and its getting closer to his skull.
Mason's ears stuck upright after I took off his cone.

On day six the redness in his eye was completely gone.  I stopped by my boyfriend's work and Mason made the rounds and was very happy about seeing his friends.  He was rocket-butting around in the field outside and had a couple good rolls in the grass.  He was feeling gooood.

 Mason on the 6th day.

His cone got all wet because he just drank some water.
Aww he's still just as cute.

Day 7 was pretty uneventful.  He's still himself and the eye wound continues to heal a little more every day.  He had his first provoked rocket-butt in the house (he only does it when provoked), which is a good sign of him not being in pain. I'm still giving him pain medication because I feel like it's better safe than sorry, but I'm starting to ween him off them now that he's one week out.

One week!

Monday, February 12, 2018

Mason's eye removal (enucleation) and teeth extraction surgery: 2-4 days post op

I'm happy to say that Mason is mostly back to being himself now.  He definitely ebs and flows in his healing.  After the second day's evening personality spike, he was back to being a little less himself the following morning.  By day four he is mostly back to how he normally is.  I've been giving him the maximum dose of pain killers every 8 hours throughout this time.  The vet thinks that's what could be upsetting his stomach, although his grumbly stomach and wet burps are getting less and less frequent at this point. He's had 3-4 instances of having a really small amount of poop slip out under his tail.  The vet said this is because the pain killers might be relaxing his muscles a little too much.  I've also noticed his nose is dripping clear liquid pretty often.

One thing I've noticed now that he's had his left eye removed is that when I'm walking him on the leash and I go to turn left I will often times end up tripping over him because he can't see my body language.  Although this has happened to us on walks a few times before, it's happening more now. This leads me to believe that he still had some, even though it was definitely very poor, vision in that eye before it was removed.
 On day 2 his eye is still very red and bruised.

 On day 3 he is still very happy to eat his textureless wet food.
On day 4 it looks like the redness is slowly subsiding.

As for my feelings, I have gotten over feeling so bad for being the cause of his current pain.  We ran into a dog-buddy of his in the park and the owner immediately said he was sorry about the eye.  And later I was thinking just how not sorry he needed to feel about it.  Mason will be in less pain in the long term than he was with the eye and teeth.  I also feel like he's still just as cute as he was before his eye was removed.  This is pretty superficial, but I wasn't positive I would feel that way.  He was a remarkably hansom dog (this has even been verified by every vet he's seen - and they are professionals!).  I am just happy he can stare into my eyes for an awkward/uncomfortably long time and I still have an eye of his to stare back into.

Thursday, February 8, 2018

Mason's eye removal (enucleation) and teeth extraction surgery: day of and 1 day post op

 Mason at the vet before the surgery

Day of Surgery:
I dropped him off around 8am at Northern Liberties Veterinary Center and cried when doing so.  They said he was Dr. Draper’s only patient today.  The woman at the counter said she could call me after they do the dental X-rays to let me know how many teeth would need to be pulled and that put me at ease.  I was expecting three, including one tiny really loose tooth he’s had for a couple months.  The nurse who took him in the back said she should be done around noon.  At noon I had still not received the X-ray phone call so I was hoping she had finished the surgery and not had to pull many teeth at all and just did it without calling.  At 12:30 I got the call that she thought he really needed six teeth pulled.  If she was being aggressive she even could have pulled two more.  This blew me away and shocked me!  I knew his teeth were pretty bad but I’m pretty good at brushing his teeth daily.  I got extremely anxious because he didn’t have that many back teeth to begin with and I thought he would never be able to eat kibble again.  I thought his life would change more significantly with that many teeth being pulled than losing an eye he was already blind in.  She said there was significant bone loss around the teeth because of pockets of infection that ate away at it. He had to get two teeth pulled on the bottom and I thought all his bottom teeth looked great.  All of the teeth were molars or carnassial teeth – large teeth with three roots.

I got a call from the vet at around 2:45 to let me know his surgery was completely finished. He was just starting to wake up from anesthesia and was looking around.  That was a relief.  The vet said he did great and handled being under anesthesia for that long well.  They wanted to watch him for a little while longer and I could pick him up at 4.

When I picked him up he was pulling on the leash to get to me and was wagging his tail a little.  On the walk to the car he crashed into walls with his cone a lot trying to sniff them.  His walking was slow and seemed a little off, too.  When we got home he was mildly happy to see my boyfriend – wagging his tail just a little again.  Many of the blogs I read about eye removal recovery said their dog was so happy to see them and didn’t seem any different when they picked them up after surgery.  Unfortunately, this was not the case for Mason.

His face has a lot of extra skin so those wrinkles are normal, normally just hidden under his fur.
At home I fed him his new canned food and he scarfed it down! He hadn’t eaten since the night before so I’m sure he was hungry.  It made me feel better that he was interested in eating his food. The vet recommended I give him half what he normally would eat, wait 2 hrs to make sure he kept it down, and then give him the other half if he readily ate the first half.  He ended up eating both halves. I gave him his antibiotic and pain pill with peanut butter and he drank an obscene amount of water. 

I sat next to him and pet him for a couple of hours.  I couldn’t tell if he liked it or not.  He never wags his tail when you pet him and the only way you know he likes it is if he paws at you to continue or moves his front leg so you can reach his belly better.  He did move his leg a little for me to scratch his belly, but he wasn’t acting like he normally did.  Also, I don’t know if it’s because he only has one eye now or because his good eye is a little droopy from the anesthesia or pain meds, but he looks a little pissed off all the time now.  Usually his token look is “concerned”.  He also is doing a lot of grunt-sighing.  He would sigh pretty regularly before, but this is different.

He wouldn’t sleep, which was very weird for him.  Sleeping is his #1 favorite activity.  He looked really tired and I would see his eyes get heavy and just when I thought he would fall asleep he would change positions. My boyfriend thinks its because the last time he fell asleep he woke up with six less teeth and one less eye and he didn’t want anything like that to happen again while he was sleeping.

I took him out to pee without the cone.  He sniffed a little and he peed quickly and then led me back to the house.  Normally, he’s very picky about where he pees and will take forever to find “the perfect spot”. When I took him out to pee before bed we were crossing the street and a cat was crossing the street at exactly the same time only 10 feet from us but he didn’t see it because it was on his no-eye side!  That made me feel pretty sad for him.

I was told by the vet that I can take his e-collar off him if he’s being supervised and I’ve been doing that.  He has no interest in scratching or pawing at his eye, but I put the cone on when I leave the room just in case.  He definitely prefers it off.

I also spent the evening making him a soft e-collar.  It was good to take my mind off the pain he was in and it made me feel like I was doing something to help him. He really hated the plastic cone the vet gave him and I couldn’t imagine him getting any sleep in it.  I went to Petco before to buy wet food and the soft cones there were $40! I wasn’t about to spend that on something he would only need for a week after dropping the money I did on his surgery.  I used the plastic cone as a pattern. I made the cone out of canvas, some bias tape, cut up plastic clothes hangers and velcro.  I ran the bandana he usually wears through the loops to tie around his neck because it was soft and thick and probably wouldn’t dig into his neck. I don’t think it bothers him to wear it. 

 The e-collar in progress.

He slept on his bed on the floor by our bed the first night.  We didn’t want him in the bed because he isn’t supposed to jump and we didn’t want to bump him in the face by accident in our sleep.  He seemed to sleep through the night.

Day 1 Post op:
I got up while he was still lying in his bed and went to the kitchen to prepare his food.  I was so happy to see him walk into the kitchen wagging his tail.  He ate his food quickly again.  He still has an odd walk, like a limp.

He’s been sleeping a lot today.  He left his bed to come sit on the couch with me, which is something he normally does, so that was good.

He was very happy when my boyfriend got home.  He let out one small bark (usually he barks a few times when people come to the door) and got up off the couch to greet him and was wagging his tail a lot.  That was reassuring.  But shortly after that he vomited just a little bit.

He woke up in the afternoon from sleeping and I took him outside.  When he got off the couch I discovered he had some poop mooshed under his tail.  He still hasn’t had a bowel movement, but the vet said it could take 24 hours because of the anesthesia .  This time he led me around the whole park we live across the street from, and his ears perked up when he saw a squirrel.  He is still walking slow but normal now.  When we got back inside I cleaned up his butt and then when I went to put on the e-collar he had a nice long  grumble about it.  Then he seemed like he was going to vomit again and he probably swallowed some.

 Sleeping on the couch on Day 1 post surgery in his home-made e-collar

Late afternoon was a huge turning point for Mason: He pooped (after almost 48 hours) and more importantly he seemed like he was himself again! We had a couple of friends visit and he got up to bark at them when they were at the door, and then seemed very happy to see them! Whole hearted tail wagging and everything!  His good spirits lead us to give him some roasted chicken from our dinner, which we NEVER do! I went to bed feeling so much better about this decision after seeing his personality come back for a few hours.

 Mason's eye is very red, has some swelling, and you can start to see the development of a massive bruise that takes up almost all of the shaved fur area