Hunter
Hunter came into the rescue the end of August 2011. He had been adopted 2-½ years ago, but was returned after the family who adopted him had life changing events and could no longer keep him. When he was returned, he was seeing a vet specializing in ophthalmology for his eye issues and came to us with two eye medications as well as a eye lubricant. Dr. Jan Ashmore (Schrag Animal Clinic) looked at his eye, examined his meds, and referred us to Dr. Gwin, an ophthalmology vet in Oklahoma City. He was to continue on medications that she prescribed for him until he saw Dr. Gwin. The diagnosis was severe “dry eye” or Keratoconjunctivitis sicca. She explained that dogs have three different lubricant glands in the eye area, mucus secreting glands, oil glands, and one that produces saline, which provides the liquid portion of tears. In Hunter, the saline producing glands were either non-functioning or barely functioning, meaning that his eyes were very dry.
Hunter doesn’t have the wide-eyed, big round eye look that we all associate with dogs. He squints all of the time or even keeps his eyes closed. I found through searching the internet more information about the disorder, which described Hunter’s issues exactly.
In a dog with dry eye, the bright, glistening sheen normally seen in the eye is replaced by a lackluster appearance in which the cornea is dry, dull, and opaque. Recurrent bouts of conjunctivitis are typical and eventually the cornea becomes ulcerated or inflamed, cloudy, and loses transparency. Without treatment, the dog can eventually become blind. Dogs with dry eye usually must maintain eye treatment the rest of their lives.
There can be many reasons for dry eye development. Immune-related diseases are thought to play a major role, but also the reason for the condition many times cannot be explained. Some breeds of dogs are predisposed to the disorder. Injuries to the nerves that innervate the lacrimal glands (tear ducts), infections of the middle ear, or injuries to the tear ducts themselves can play a role as well. Some dogs are born without tear ducts. Some dogs that must have their third eyelid removed for Cherry Eye or other issues can develop dry eye. We know Hunter was normal at one time, because he was in the care of the rescue previously and was normal. Because Hunter’s issues include both eyes, more or less, equally, his problem is thought to be immune related.
Diagnosis of dry eye is made by measuring the volume of tears. The Schirmer Tear Test involves placing a commercial filter paper strip with measurements into the dog’s eye at the inner corner (where tears gather) and leaving it for one minute to see how much of the strip is wetted. Normally, the strip should be wet to a distance of 20mm. In dogs with dry eye, the strip wets less than 10mm (often less than 5mm). Hunter’s initial tear test at Dr. Gwin’s office was 0-2mm, in the severe category.
I bought some Genteal eye gel to use on Hunter at the suggestion of Dr. Jan. She said it would work better than the gel she gave us and used that with the Cyclosporin drops she prescribed. Hunter would have huge wads of thick, tenacious goop in his eyes every day. I found that after a bath, his eyes would open and he seemed to see better for awhile, so started using a saline flush before putting his drops. I would try to get some of the goo out also between drops. So his daily regimen was intense. Eye drops were ordered twice a day at this point. It was a job to keep it all done.
Hunter in his Doggles...he really needs them; the sun hurts his eyes
The highly anticipated appointment came, the Schirmer test was done and we were sent home with three eye meds this time. The Cyclosporin remained part of the regimen, plus Tacrolimus ointment, and a dry eye solution were prescribed. The meds were to be used three times a day. We really got busy at this point! My husband usually does at least one set of drops a day due to our work schedules. Occasionally, he will develop a look to his eye’s that look “infected”, so I’ll add an antibiotic drop a couple of times a day also.
Cyclosporin and Tacrolimus are both drugs most often used in humans to help prevent rejection of transplanted organs. They lower the body’s immune system so that the immune response is diminished. For dogs with dry eye, the medications are compounded in corn oil or ointment for the eye. These drugs are also very expensive. Every vet visit along with the medication refill for Hunter is around $250.00 with the rescue discount. One refill will last a little over a month with two of the meds and a little less with the third.
The dry eye solution prescribed was very helpful. I’m not sure what is in this particular solution, but in my attempts to try to figure out what it could be, I ran across articles describing a solution containing ingredients that help break down the heavy mucus that collects in the dog’s eyes. That is exactly what this stuff did for Hunter. I no longer needed to flush or attempt to remove that stuff, the solution kept it down. Hunter appreciated that a lot and so did I. He really hated those eye washings and after doing some reading, I found they aren’t particularly helpful overall. But also, it is said that you have to keep the gunk out, so it’s a catch 22.
December 15, 2011
Hunter napping
We are now three months down the road and Hunter is really no better. His Schrimer test in October was 2-5mm, which is still in the severe range. We will return next week Dec 20th to Dr. Gwin for another test. I anticipate no real difference. The only difference I see in Hunter is that he is getting tired, can’t really see well at all, and seems depressed. He does navigate around the house well and manages to go outside to eliminate, but he doesn’t see well. I’ve never been around a blind dog, but he navigates like I would imagine one would. He doesn’t have any peripheral vision and can’t tell when someone is close to him. When you walk up close to him, he panics and backs up into you instead of moving away. Even talking to him to warn him doesn’t help much. He just can’t tell what is in his immediate environment. Small dogs seem to sense that they can be easily hurt and are very vigilant about danger in their environment. Most of the time, humans don’t have to worry about stepping on a dog…the dog will move first. Hunter doesn’t have that self-protection instinct, so the humans have to be more careful when he is up and about. He tends to spend most of his time sitting with me or on the couch or a doggy bed. He follows me around the house and he sleeps a lot. I think his eyes cause him pain. It is really difficult to figure out when dogs are in pain sometimes, but he makes little grunting sounds when I put drops in, or mess with his eyes. I think it hurts and I think he’s tired of it. I’ve recently discovered a better way to keep his eyes clean of the crust and discharge that tends to accumulate from his eyes after a day or two of drops. I just use a wet, warm washcloth now with barely a touch of Johnson’s Baby Shampoo and wring it dry. I also use Johnson’s to wash his head when I bathe him. The corn oil in the drops makes his head greasy quickly. An ophthalmologist I went to personally once had me use it for cleansing around my eyelids and it really doesn’t burn. Some of the tearless dog shampoos will still burn the eyes. I figure if it’s good enough for humans, it’s good for Hunter.
There is a surgical treatment for KCS or dry eye, if the drops are not helpful. It is considered a last resort when management fails. The operation involves transplanting the duct of the parotid salivary gland up into the corner of the eye. Saliva will take the place of tears. The operation has several significant disadvantages. One is that the volume of tears may be more than the drainage system can handle. This can result in a watery eye and the accumulation of mineral deposits on the cornea and face. Eye drops are still necessary to keep the cornea from becoming occluded. Plus when the dog smells food, etc, and salivates….his eyes will run. Another solution is to simply remove the eye globes and sew the eyes shut.
None of the options for Hunter are wonderful. The eye drops are labor intensive, probably painful, and also very expensive for life. Both surgeries have many disadvantages. Oklahoma Yorkie Rescue has many challenges ahead in making decisions in caring for this precious pup.
Did I mention that Hunter is just the sweetest doggy ever? He is such a loving little soul that it’s amazing. After all he has been through in his life…life at a puppy mill as a breeding dog….losing his precious family…and dry eye, he still loves his people. He doesn’t like to be hugged and kissed much, but prefers to do the kissing himself. He loves to lick and when he does, he nibbles. Those love nibbles are so sweet. I’m not so sure that much of his licking isn’t his reaction to the eye drops as he does more of it when he gets them, but I choose to interpret it as sweet.
Sally Boyster (Hunter’s Foster Mom)
12.20.11
Hunter had his visit with Dr. Gwin today. His Schrimer test was 3-5mm, which is no real improvement after 4 months of treatment (at least). We talked today about the surgery for this condition, which is called a Parotid duct transposition. Dr. Gwin reiterated that individual dogs react differently to the surgery and that there is no way to tell how a dog will react until afterward. Some dogs produce too much saliva as I described before and others don’t. Some do very well and others not so well. There are simple additions to his diet that can be made to help with the problems associated with constitution of the saliva causing crusty residue on his corneas. Its buttermilk powder (yes the stuff you buy at the grocery store) and vitamin C. He says those additions help a bunch. Who knew? He still will have to use drops some…maybe not so often and so many. It will depend on his individual reaction and needs. The rescue plans to go ahead with the surgery. He will have his first eye done Jan 12th. Please keep Hunter in your prayers that his surgery will end his pain (his pain issues were really what made the decision). I feel very certain that Hunter’s eyes hurt him a lot and according to Dr. Gwin, one thing the surgery will do is help the inflammation and irritation that is causing him pain. I manged to get a pic of him with his eyes open, at least as much as they ever are…it’s the first pic and still hard to see them. This is Hunter all dolled up for his doctor visit today! We try to look snazzy for Dr. Gwin! This is a website that explains the surgery really well.
Parotid Duct Transposition Information
Sally Boyster (Hunter’s Foster Mom)
Hunter...you can see his eyes a little if you really look...
A little better pic of Hunter...all dolled up!
February 23, 2012
Sorry that it’s been so long since I’ve written an update on Hunter. It’s been a busy time. Hunter had his surgery January 12th as planned. The original decision was to operate on the right eye first, as it was a little worse than the left. Dr. Gwin started the surgery by locating the parotid gland on that side and during that part of the procedure, the gland, which seemed strange to him, tore. He called me and we decided to go for the left eye. The surgery on that eye went very well. Hunter tolerated the surgery well and came home that night. Aside from a lot of pain the first few days, he did very well. Our eye drop regimen changed in that the normal eye drops went into the right eye, but different drops went into the left. My head was spinning trying to get this all straight! Plus, he had a bunch of oral meds. He was on pain medication for about 5 days and he really needed that! We also had to start the Vitamin C and Buttermilk powder (yes the stuff you buy at the grocery store!) about a week ahead of the surgery. Those two things have become Hunter’s special treat! He is a picky eater, so his buttermilk powder goes into a little cottage cheese that he gets every day. He looks forward to the cottage cheese treat and the other dogs are very jealous! Those two things work to help keep the calcium salt deposits from the saliva from collecting quite so badly around his eye.
His eye is getting better! He opens it wider now and his right eye even seems a little better also. Dr. Gwin explained that for some unknown reason, sometimes the eye that wasn’t operated gets better too after surgery on one eye. In Hunter’s case that situation would be wonderful, because it’s is unlikely that his right eye can be done. The gland on that side, for lack of better words, is just squirrely. It isn’t located where it should be and is very fragile. It had to be repaired after the attempt to cannulate it, and likely has scar tissue now. So, we hope that eye gets better. These days, Hunter just seems like he is interacting more, especially with the other dogs. He and my Yorkie, Fletcher, have become great friends and allies. He has started to bark some, especially when I come home. It’s really funny, because he seems surprised that he can actually make noise. He wags his tail more. He just seems happier. When we returned to see Dr. Gwin two weeks after surgery, he told me that Hunter’s result has been perfect. His eye doesn’t run all the time like some dogs, but it keeps his eye moist. He doesn’t have much crystal formation around his eyes. Occasionally, if there is a really good smell around here (think bacon cooking) his eye will run and drip, but it isn’t often or a problem. His face will get gunky and stiff on the left side after several days, but it cleans up well and it really takes days before that happens. I have to clean the crystals from his eyelids about once a week. Those crystals are a little weird, but it’s not a bad job to do and there really isn’t much. I had an opportunity to talk with his adopted mom and learn more about the history of his eye problem. He has battled this for about a year now and was going to vets and a doggy ophthalmologist the whole time. The whole thing just became too much for her family, when they could see that he wasn’t getting better. This situation really points out a big issue with pet ownership in general. You just never know what might happen to them! Veterinary care can be just as expensive these days as going to a people doc. It’s a big responsibility to take on and shouldn’t be taken lightly…..and that is why I only have two of my own! I would adopt every dog I foster, but I know I couldn’t afford to care for them like they should be cared for. That thinking sure helps my sadness when it’s time to send them out to new homes! His former owner sent me a couple of pictures of Hunter taken before all of this happened to him. I think you will be surprised at the difference a year with chronic dry eye can do. Here are his pictures from last year. I love his wide open eyes!
Hunter Before Dry Eye
Hunter Before Dry Eye..Isn't he Beautiful?
Also, there is a picture of him right after surgery. They shaved his face bald. I just never would have believed they could shave a dog head this close to the skin. With the rest of his hair fluffing out around it, he looked like a Lion. I took him for grooming a couple of weeks ago and they evened him out. The hair is growing back fast on his face and has covered the scar on his cheek. It won’t be long until he has grown back out. I promise to get some better pictures of him and post them soon.
Sally Boyster
Hunter’s Foster Mom
Hunter right after surgery....
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When you come home from a long day at work, no one is happier to see you than Logan. After a victory lap that you’ve made it home safely, he’ll curl up on the couch and watch your favorite tv show with you. He may get in your lap for some loving attention but is pretty happy to just rest next to you after a few minutes of that. If you dare get up from the couch to get a snack, he says, “You snooze, you lose.” and calls dibs on your seat by stealing it from you before you even get to the refrigerator. Or if you have a pillow, he’ll happily put his head there and fall asleep there like he thinks he’s human. When you talk to Logan, he may not understand all the time, but his ears perk up in the cutest way to show you that he is a good listener and will be there to listen to your problems. He can be a bit stubborn and doesn’t like to come when called but you won’t have to worry about that much since he’ll be by your side more times than not anyways.
oy to have around and hardly ever barks but will let you know if someone is at the front door. He loves his people and his “girlfriend” aka a poodle mix is teaching him how to enjoy the company of other dogs too. He would probably be best with someone who is home more than not but he says he enjoys the presence of people so much he doesn’t care who you are as long as you love him with all your heart.
