Thursday, June 28, 2012
Background - Part Two: Blindsided By Glaucoma
After making the six-hour drive (round-trip) to see veterinary ophthalmologist, Dr. Corbett, at MedVet in Worthington, Ohio, Justin and I immediately began administering Lexie’s medications just as Dr. Corbett had prescribed: three and a half antibiotic pills each morning, steroid drops in each eye every six hours, and her ibuprofen-type medication (I forget the name) twice a day. We did this religiously for about four days without seeing any improvement in Lexie’s eyes, but I wasn’t really worried because Dr. Corbett had said we probably wouldn’t see improvement until after a week.
Then, on about the fifth day following Lexie’s trip to Ohio, Justin and I decided to take Lexie and her sisters, Jocie and Sam (see the Introduction section of my blog below), to visit his parents. The girls had a blast running all over the fenced-in yard and exploring Justin’s parents’ home. It was during that visit, however, that I noticed Lexie’s left eye was looking cloudier than usual. Upon further inspection, I discovered the whites of her eyes were also extremely red. I wondered if this was due to her blood pressure being elevated from all the excitement, and I hoped that the redness in her eyes would decrease after she went home, settled down, and had a good night’s sleep.
Well, the next morning (Monday), not only were her eyes still very red, but her left eye had gotten even cloudier than the day before. At that point, I felt it was time to call Dr. Corbett to schedule Lexie’s follow-up appointment. After scheduling her appointment for that coming Wednesday, I spoke with one of the ophthalmology vet techs, and she recommended I take Lexie back to see Dr. Ellis, our local vet, to have her eye pressures read that day. She said that what I was describing sounded like Lexie’s eye pressures might be building up, which is a sign of glaucoma. Not only that, but those pressures can increase very quickly and cause Lexie to lose her sight within a matter of hours!
I immediately called my brother, Zach, and asked if he could take Lexie to the vet for me after he got off work. He agreed, and about an hour or so later I received a call from Dr. Lilly at Animal Care Clinic, who was filling in for Dr. Ellis that week while she was on vacation. Dr. Lilly said that Lexie’s eye pressures were dangerously high, and she told me I needed to take Lexie IMMEDIATELY back to MedVet in Ohio for emergency treatment. She said she would call MedVet to let them know I was coming. As soon as we hung up, I found my boss and tearfully explained to her that I probably wouldn’t be able to come into work the next day because I was about to rush my Doberman back to Ohio. She said that was fine, but as soon as I got back to my desk I received another phone call. Apparently, when Dr. Lilly called MedVet to tell them I was coming, she spoke with Dr. Corbett, who told her an immediate emergency visit was not necessary. Instead, Dr. Corbett prescribed two new eye drops for me to give Lexie every eight hours, and I was to bring Lexie back to Animal Care Clinic the next day to have her eye pressures checked again. If the eye pressures were decreased at that point, then it would be okay for us to just keep our Wednesday appointment. Thankfully, the new eye drops were successful in bringing down her pressures, so that Wednesday Lou and I headed back to Ohio to see Dr. Corbett.
At this point, I was starting to feel like the butt of some sort of cruel joke. Wasn’t it just a week ago that I had been SO happy and relieved to hear an that Lexie WASN’T going blind? What was all this talk about glaucoma and having to lower her eye pressures so that she wouldn’t go blind within a matter of hours??!?! Dr. Corbett never mentioned the possibility of glaucoma developing, nor did she tell me anything about this serious, sight-threatening condition! Were there signs I could have been watching for? Was Lexie at a greater risk of going blind now because I didn’t realize she was developing glaucoma?
I was bursting with questions when we arrived for our follow-up appointment at MedVet on Wednesday, June 20, 2012. Dr. Corbett was just as nice as ever and seemed genuinely disappointed that Lexie’s condition had taken a turn for the worse. After examining her, Dr. Corbett explained to me that Lou had apparently developed glaucoma secondary to her anterior uveitis. Here is what happened (at least, how I understood it):
Dogs have a sort of “drain” in their eyes, which allow fluids to, well, drain from their eyeballs. If that drain becomes clogged for some reason, the fluid cannot escape and then pressure begins to build up in the eyes. If that pressure builds up too high, it causes permanent vision loss. That, in a layman’s nutshell, is glaucoma.
Now, there are two different kinds of glaucoma: primary and secondary. Secondary glaucoma is when it develops due to another underlying condition, such as anterior uveitis. In Lexie’s case, her anterior uveitis had caused her eyeballs to become inflamed, and the swelling is what caused the drains in her eyes to clog. Dr. Corbett explained that if we could successfully determine the cause of her anterior uveitis, we could hopefully treat it, which would then get rid of the inflammation and allow those drains in her eyes to re-open; thus, also getting rid of the glaucoma.
First thing was first, and that was determining the cause of Lexie’s anterior uveitis. We had already ruled out an eye injury, and we had been treating her with medication as though the cause was either a tick bite or an autoimmune disorder, but we still hadn’t ruled out cancer, fungal infection, or disease of her internal organs. Therefore, Lexie underwent a chest X-ray and abdominal ultrasound, both of which thankfully came back completely normal. As relieved as I was to find out she did not have cancer or anything else wrong internally, that only brought us right back to square one: assuming her anterior uveitis was caused by a tick bite or autoimmune disorder.
Dr. Corbett decided to treat Lou much more aggressively for the next two weeks by adding an oral steroid, Prednisone, on a tapering dose, maintaining the antibiotics and steroidal eye drops, and also adding three different eye drops to treat her glaucoma, which were intended to help stabilize and maintain the pressures in Lexie’s eyes at a safe level. Dr. Corbett told me that after two weeks of this aggressive treatment, we would have a much better idea of Lexie’s long-term prognosis, which we would discuss at her next follow-up visit.
I was very careful with the wording of my questions, but basically I told Dr. Corbett that when I left there the last time, I left under the impression that there was not any danger of Lexie going blind, so I just wanted to make sure that I had a full understanding about what was going on with Lexie’s condition so that I hopefully wouldn’t experience any further heartbreaks or disappointments. Dr. Corbett never acknowledged or apologized for the fact that she did not at least give me a heads up about the possibility of Lou developing secondary glaucoma, but I did appreciate how nice Dr. Corbett was and how she made me feel as though she had all the time in the world to answer my questions. I also felt confident that Lexie was receiving the best possible care at MedVet.
This time, as I made the three-hour drive back to Huntington from Worthington, I was relieved that at least Lexie’s condition wasn’t life-threatening and still slightly hopeful that her new aggressive treatment would cure her anterior uveitis and glaucoma, but overall I was just extremely saddened and disappointed by the fact that there was now actually a strong possibility that Lexie could go blind.
Justin and I literally had to set alarms on our phones to remind us which medication Lexie needed at what time, but we continued to administer all of Lexie’s medications, just as Dr. Corbett prescribed, 24/7. The cloudiness in Lexie’s eyes did actually clear up for a couple of days, which made me hopeful, but on Sunday night I noticed her right eye was starting to turn really red once again. The next morning, her right eye was very cloudy, both eyes were extremely red, and her right eye even looked like it was bulging a little bit. Even worse, it was obvious that she wasn’t seeing much more than shadows and light. I called MedVet as soon as I got to work, and they advised me to take Lexie back to Animal Care Clinic to have her pressures read. So, I left work, picked Lou up, and dropped her back off at Animal Care Clinic.
Finally, just as I was leaving to go pick her up, Dr. Ellis called me. I expected to hear a progress report on Lexie. Hell, I was even expecting the report to be bad. What I wasn't expecting was that Dr. Ellis was about to present me with the hardest decision I've ever had to make...