Thursday, February 8, 2018

Mason's eye removal (enucleation) and teeth extraction surgery: History

I, of course, had a freak out the night before my 8 year old dog Mason’s surgery.  I was unsure if I was making the right decision.  It’s a lot of pressure making a big decision like that for another being. I was put at ease after I did a couple hours of late-night Google searching and read so many amazing recovery stories of dog eye removal, however, I found very little about tooth removal and nothing about getting both surgeries done at once.  I wanted to be that resource for other anxious dog moms and dads.

Mason's History:
I adopted Mason when he was 3 years old from a rescue in Delaware, but he is originally from Taiwan.  His pregnant mom was abandoned in an apartment.  The rescue took her in and she gave birth to mason and his sister.  They were in people’s homes until Mason was adopted out to a family in Taiwan.  They kept him for 1.5 years, until they had a kid.  That’s when he was flown to the US to the sister shelter in Delaware.  I think his temperament has a lot to do with the fact that he’s never been a shelter dog. I would argue that he’s the best dog I know, and I think many friends and anyone he’s met him for at least 5 minutes would support that claim.  He’s relatabley awkward, charms people by scratching his mustache on their legs, doesn’t beg (unless he knows you are weak), and loves getting pets although he won’t wag his tail to show it (a clear sign of weakness).  His striking good looks are only out shined by his good behavior.  He’s very low energy aka chill, and we bring him everywhere – from local bars to friends’ parties to weddings to art studios, and even on long canoeing and camping trips.

 Mason as a puppy in Taiwan


Mason on the nose of a kayak

 Mason being zip lined over a treacherous river during a camping trip

Mason on one of our many canoe and camping trips
Mason (in his altered tube with a plywood floor) and I tubing the Delaware River

Mason wearing his backpack on a hiking/camping trip with a similar sized buddy
 Mason with me at work

Mason’s eye history:  Mason has had a cataract in his left eye (from here on out referred to as his “bad eye”) for at least the past couple of years.  His eye looked really white and cloudy.  We’ve always figured he didn’t have very good vision even before the cataract. He ran into a fence once, and he loses track of his ball (excuse me, I meant sacred orb) when we throw it often.

A stupid alley cat really threw this story off.  There’s a stray cat who has a litter of 7+ kittens every season and likes to give birth to those kittens in our neighbors alley, which is adjacent to our alley (We live in Philly – everyone has an alley!).  Mason and our friends’ dog Banjo were of course out in the alley trying to see the cat and kittens through the fence.  Apparently Banjo’s owner discovered a scratch on her eyebrow the next day and thought it was probably from the momma cat. I figured Mason must have gotten whacked too. He had a few days of squinting in his bad (left) eye.  After that eye started to get better his third eye lid would show in the evenings when he got tired on his right eye.  Another few days after that both his eyes weren’t looking very good – constant squinting and the third eye lid showed up in the evenings still.  I started doing hot compresses on his eyes (he had eye problems before and the vet recommended this and it really help) for a couple of days and when that didn’t help anything I scheduled an appointment with the vet.

 Mason's eyes after the cat incident
 Mason's third eyelid showing

I started going to a new vet with this appointment (explained later) and she definitely wasn’t an ophthalmologist.  She did all the eye tests and everything was normal except he had a mature cataract (duh) and had high eye pressure.  Her pressure readings were all over the place from 21-50 I think because she wasn't the best at taking the readings. In comparison, his other healthy eye has consistently had the pressure of 9.  His weird eyes were not a result of the cat.  They were caused by glaucoma. The vet recommended I see an ophthalmologist in the next two weeks and she sent Mason home with a glaucoma eye drop.  I found three doggie ophthalmologists in the Philadelphia area: Upenn in Philly, VSEC in Levittown, and Center for Animal Referral and Emergency Services (CARES) in Langhorne all had a range of wait times for new patients from 3-12 weeks.  I scheduled a far-out appointment for two of them and told them to call me if anything opened up.  CARES called back with an appointment for Mason after a week.  I was thrilled because I had scowered the internet for info on these doctors, and the CARES ophthalmologist had great reviews mentioning her. Dr. Martha Lowe gave him a full exam for $135 (half the price of the other two ophthalmologists) and I was, and still am, very impressed with her.  His pressure measured 21, but he still was able to see light and shadow in that eye. She prescribed him with two glaucoma eye drops:  Cosopt (dorzolamide/timlol) and Prednisolone acetate.  On the following visit his pressure was still high and she said he had lost the ability to see light and shadow.  She also prescribed a third eye drop, Latanoprost, and that’s when I noticed an improvement in Mason’s eye.  It started to look less blood shot and he started chewing rawhides again.  His pressure ended up stabilizing in the low-mid 30s for a few visits and then it got very high again.  The ophthalmologist said that a pressure in the 30s can be comfortable, but it’s likely the pressure spikes and drops throughout the day, so it’s possible he’s in pain at times.  With the pressures like 50, he definitely has a constant headache.  His eye was always bloodshot, was visibly bulging, and started to get a blueish tint to it.  The vet said the blueness was because the pressure was so high.

 Mason's bad eye with mature cataract
 Mason hates the vet.  Leaving the door open while we waited for the doctor helped his anxiety a lot, which helps keep his eye pressure from spiking.

Here is a list with the date and Mason’s eye pressure measurement:
  • November 22nd, 2017: 21-50. prescribed Cosopt (dorzolamide/timlol) eye drop
  • November 28th: 21. prescribed 2 eye drops: Cosopt (dorzolamide/timlol) and Prednisolone acetate
  • December 12th: 50. prescribed a third eye drop (Latanoprost), declared blind in bad eye
  • December 28th : 33
  • January 12, 2018: 67. ran of Latanoprost so he missed a few doses which explains the very high pressure
  • January 19th: 50
  • February 2nd: 49
  • February 6th: eye removed
 Mason also has the very beginnings of a cataract in his good eye.  This was pretty sad to hear, but I saw how slowly his bad eye went from being an immature cataract to a mature cataract.  It took around 2-3 years.  The ophthalmologist said there is nothing you can do to prevent a cataract, but she did recommend Ocu-glow.  Ocu-glow is a pill with antioxidants that are supposed to benefit eye health.  It is the most researched dog eye vitamin on the market.  They have done more clinical trials than any of its competitors.  And no, I am not sponsored by Ocu-glow, but man, do I wish I was because it costs $75 for 90 pills, and at 35lbs Mason has to take two a day, so they go fast.  As this is the only hope for his good eye, I am throwing all my money on this product. Fingers crossed! 

Mason’s mouth history:  When I adopted Mason at three years old he had already had his teeth professionally cleaned once.  I go through periods of brushing his teeth for 2-3 months and then I’ll get out of the habit and not brush them for a month.  His bottom teeth look very white and clean and his top back teeth weren’t looking too hot. The ones in the way back had a lot of yellow tarter and it was even brown in some spots.  His breath was bad, bad enough to earn him the nickname “Mr. Stink”.  I noticed his breath would improve a lot when I would brush his teeth often.  He is a slow eater.  It would take him 3-4 minutes to finish a bowl of kibble.

 Mason's teeth.  That small tooth next to his canine has been pretty loose for a couple of months and I knew it would have to be pulled.

Information about Glaucoma and bad teeth
There is a wealth of information about Glaucoma on the internet and I recommend you read that.  It’s even better if you get a good vet/ophthalmologist and ask them a ridiculous amount of questions. This is just how I understand it – in layman’s terms as they say.

“Dr. White” checking in! (I am not any sort of doctor, this is just a funny joke – my last name is White and I’m giving medical advice, get it)

 The eye is filled with clear blood that is constantly circulating through the eye.  My dog’s ophthalmologist described the eye as having a faucet and a drain that facilitates the movement of this clear blood.  When a dog has glaucoma, it’s like the drain is filled with a bunch of rice (presumably from when you washed out the rice pot and didn’t empty the drain catcher – c’mon I hate that!).  It will still drain, but it will drain slower than it should and the eye’s pressure will rise as a result of this slow draining.   Mason was prescribed two eye drops at first. I don’t remember which does which but one of them was to slow down the rate of the “faucet”, and the other was to prevent any other “rice” from building up in the “drain”.  Fun fact: I asked the ophthalmologist where it drains to and she said it is reabsorbed by the body.  No, your dog isn’t crying tears of clear blood.

There is primary and secondary glaucoma.   Primary is genetic, and secondary is caused by something else. Primary is often caused by the dog having too sharp of angle to their drain and is more common in specific breeds. Secondary is often caused by diabetes, as blood sugar levels can cause the pressure to spike so high that the dog can go blind in a number of hours.  ***Glaucoma is also caused by cataracts*** This is something I had no idea of and was never told.  Signs of glaucoma are squinting, watery eye, bloodshot eye, and bulging.  If your dog has cataracts and then you notice these signs you need to act quickly!!  If the pressure gets high enough it will cause permanent blindness. Another fun fact: Vets refer to the eye as the “globe”.

There is no cure for glaucoma in dogs.  Human glaucoma eye drops are prescribed but they become ineffective in a matter of months to up to two years if you are lucky.  Even glaucoma surgery doesn’t offer a permanent solution.

This is loosely what my vet said interpreted by my bad memory:  Pockets below the gum line form when the gum disconnects from the tooth.  Bacteria can get inside these pockets and eat away at the tooth and at the jaw bone that holds the tooth. The result is bone loss and the tooth becomes unstable because its roots/support system are compromised.  This can cause pain that your dog just learns to deal with.  If bad teeth are left in for a long time the bone loss will continue.  This can eventually lead to the jaw bone being broken easily because of the weak points in it!!  Someone I know even has a dog that's teeth got so bad that they just cut the front half of its bottom jaw right off! And its happy as can be. The vet said the body is able to refill the lost bone once the teeth are gone.  She also said that she knows of dogs with no teeth that are still able to eat dry kibble!  Dogs really are amazing and resilient and that’s a fact that both certified veterinarians and “Dr. White” can agree on!

And if you would like to read a more professional description of glaucoma and it's treatments, I recommend this website:

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