Aleeya's Eye- Nictitating Membrane Won't Retract?

[Guest sorenkkg]

If your appt. is with Dr. Ziegler, you will have the best of care. The IO pressure would concern me.

 

 

I hope so, and re: pressure, yep. But yesterday it was lower than the night before, so that's good, but also consistent with the diagnosis of uveitis apparently.

 

 

Today's report: just dropped off the fecal sample, and the vet tech said her bloodwork was in, so one of the vets should be calling today to tell me about it (wish she could've...).

 

Aleeya's eyes are OPEN today !!! DH gave her the 6am drops, but she already looks way more normal than yesterday. I guess the various treatments are working and she's getting some relief.

 

IOP test is at 11:15, will report back after.

Soren

 

 

p.s. I got some sleep last night and feel way less weepy than yesterday, which is also good for all members of this house.

[Guest BiancasMom]

When you have glaucoma, the pressure in the eye is too high. With uveitis, it is too low. I guess I am confused how it can go from glaucoma to now uveitis? My Australian Shepherd had uveitis, secondary to his autoimmune diesease. (Lupus) We took him to the opthomologist and it was under control in no time. We used the pred acetate eye drops as well. He did seem quite painful, he was photophobic (sensitive to light) and squinted and teared quite a bit. In the end his eyes were fine. I would much rather it be uveitis than glaucoma!

Edited April 21, 2010 by BiancasMom

[DevilDog]

I'm so glad Roscoe is better! That does give me a bit of hope for my girlie... How long did it take from start to back-to-normal for you guys?

 

 

So far, she's not on any oral antibiotics-- just Panacur in case it's worms and Tramadol pills for pain. We should have blood tests back tomorrow though. This is sooooo weird b/c we just did a wellness check last week and it was all fine for her, but I guess we need to go more in depth with the blood tests.

 

The eye drops right now are Maxitrol (neomycin and polymyxinB sulfates and dexamethasone (that's the steroid part)) and a gel that goes in her lower lid (Fucithalmic gel, which is all antibiotic).

 

 

We'll see the eye specialist Thursday... meanwhile, they've got her blood, and if she ever poops they'll have that too and they can have all the blood they want to test for anything they can find, I just want this over and her better.

 

 

How long did it take from start to back-to-normal for you guys?

 

Once he got on the right meds (the 2 antibiotics), it was with in a couple days that he seemed soooo much better.

 

So far, she's not on any oral antibiotics-- just Panacur in case it's worms and Tramadol pills for pain. We should have blood tests back tomorrow though. This is sooooo weird b/c we just did a wellness check last week and it was all fine for her, but I guess we need to go more in depth with the blood tests.

 

I had Roscoe in to the vet 2 weeks before the incident also. One of his eyes was a bit weepy and the vet took a look, did a couple basic tests (for tear production and a scratch/ foreign body) and took a good look at the eye and everything came out normal. He took a turn for the worse literally overnight. Roscoe's blood test and tick panel also came back normal.

The eye drops right now are Maxitrol (neomycin and polymyxinB sulfates and dexamethasone (that's the steroid part)) and a gel that goes in her lower lid (Fucithalmic gel, which is all antibiotic).

 

Roscoe was also put on an eye drop which contained antibiotic. This improved things for a bit but the infection came back worse. It wasn't until he was put on the INTERNAL antibiotic that he got better. My vet told me this is because uveitis is caused by something internal... not an infection of the eye itself (or something like that).

i highly suggest you ask for an oral antibiotic just in case.. you don't want this to come back when the eye drops are done. As I said, Roscoes drops showed improvement but didn't get to the root of the problem.

 

 

 

Edited April 21, 2010 by DevilDog

[Guest sorenkkg]

Update: saw one of our regular vets today for a check of Haka's toe, and the pressure in Aleeya's eye.

 

Her eye pressure I think is the same or lower than yesterday-- good in that it's not glaucoma, bad b/c uveitis goes along with lowering pressure. But, about status quo so there's that.

 

Her eyes are showing some particles inside, but the vet couldn't see well enough, so she's glad we have the referral to Dr Zigler tomorrow. She says he's got all the fanciest gizmos and will run a huge battery of tests.

 

In this vet's experience, many cases of uveitis are ideopathic, no pinpointable cause. Not sure how I feel about that.

 

That said, her bloodwork from yesterday came back, and she is negative for the things they tested her for: Lyme, Erlichia, anaplasma phagocytophilium (what is that?), heartworm.

 

So, I'm going to let Dr Z know that this is not a Canadian dog-- she's been in the NorthEast US and Canada, but born in VA and I think having her puppies in either OK or KS... so I'd want her tested for all sorts of other things and stuff you guys mentioned.

 

I just got a call from the vet-owner of our normal practice, to check that I did get the results (and check on me since I had a breakdown in her waiting room ) and she said that after the bloodwork, they might ultrasound her abdomen-- and I said-- I think I know what you're getting at and I WILL NOT TALK ABOUT THAT NOW

They are so quick to jump to cancer with my greyhounds, it drives me sort of nuts.

 

Anyway-- she's a bit doped out on the Tramadol I think, but her next eye drops are at 2pm, then Panacur in food at 5pm, drops at 6pm and 10pm, eye gel and Tramadol at 12am, and drops at 2am... So I'll be around trying to stay awake and amused...

 

Thanks all!

S.

[DevilDog]

Wow, you're going through the same thing I did. My vet also mentioned the ultrasound of the abdomen. I never got that far because he ended up at the internal medicine specialist.

 

Roscoe also had "particles" or cloudiness of the eyes.

 

I'd bet she has uveitis. Please update after you see the specialist tomorrow!

[Guest sorenkkg]

Update-- we have our appt at 2pm today with Dr Zigler. I called to find out if I should give her 2pm eye drops, and they said No, but bring them with you.

 

She's getting sort of fussy about letting us do the drops, maybe she's just annoyed

Eyes are like yesterday-- open, still pretty bloodshot, a little goop but not bad. Could benefit from a warm compress I bet, I guess I'll do that after the doctor.

 

Time for tramadol and eye gel. Wish us luck for later, and I'll report back.

Soren

[Guest sorenkkg]

Update-- had our appt with the specialist, Dr Zigler:

 

 

First off-- Aleeya was universally loved by ALL the folks at the emergency/referal hospital. Wow! They went nuts over her! I had her muzzle on for a bit in case she tried to eat a patient, and we got at least 2 Wow, what a pretty muzzle, such a pretty girl, etc. They loved her collar also (silk thistle in Watermelon, by nancyb )

 

Ok, down to business: we had Dr Z's assistant take a history (and scratch Aleeya's ears for 5 minutes), and she redid a bunch of tests-- she did the scratched eye test (negative); tear production test 9mm/min in right eye (bit low), 14mm/min in left eye (more normal).

 

Did the pressure of each eye: right eye 3/5 mmHg left eye 5/8 mmHg This would be way lower than Monday night, and consistent with uveitis.

 

Here's the "assessment:

Examination reveals 2 - 3+ aqueous flare with inflammatory debris adherent to the anterior lens capsules in both eyes. The irides are thickened in both eyes. There is moderate episcleral congestion. The posterior segment looks fine in both eyes.

IOP is low (as expected in uveitis)

 

Diagnosis- anterior uveitis

 

 

Here's what we're doing-- we had a bit talk about the blood tests they did this week (lyme, erlichia, heartworm, something else see above somewhere). He then listed just about everything I had put on my note, that I learned about on the internet

 

So they took a new blood draw and are doing another CBC, and titres for toxoplasmosis and neospora. We will do chest xrays at my regular vet, b/c the fancy digital xray at this place was being serviced today

 

He changed her medication, here's the new regimen:

Doxycycline 100mg 3 pills, 2x a day

 

Deramaxx (non-steroidal anti-inflammatory, cuz he doesn't want to depress her immune system in case there is an immune issue going on)-- 100mg 1x a day

 

Prednilosone Acetate 1% 10ml - 1 drop in each eye 4x a day (thank g-d, because doing the other drops every 4 hours was getting really old, fast).

 

Fucithalmic gel - small amount 2x a day

 

Tramadol as needed for pain (someone tell me what a stoic, drama queen, greyhound looks like in pain?)

_____________

 

His summary says that we will try to find a cause, and if none is found (he said like 60% of uveitis has no cause?) we will find a maintenance program to treat the symptoms.

 

 

So, that's where we're at. Not really different than before 2pm today, except I get to sleep through the night now

 

Oh, and she's scratching her face a lot less, so we are taking off the cone for a bit and she seems happy with that. Celebrating by, you know, sleeping

[Batmom]

The prednisolone acetate drops should make her feel a lot better. Hugs for you and special girl.

[Guest sorenkkg]

Thanks! She's not scratched her face since we got home from our walk, and I did the first of those drops at 6pm... so far so good. I just did the 8pm doxy, deramaxx, and fucithalmic gel...

 

Did you know they make Greenies pill pockets in BIG size? LOL cuz we need them, that deramaxx pill is like a lifesave candy, minus the hole

[HopeForHounds]

Sounds like you've got a good treatment plan. Keep in mind that the Doxy should be given for at least 4 weeks. Our vet was bit leery of the high dose and the length, but I got her some info from here and she agreed to do it. I'm praying she tolerates it well and most of all that it works. Hugs to you all.

[EllenEveBaz]

So far, so good. Keeping paws crossed here. Hoping you get some sleep.

[Guest sorenkkg]

I've got 2 weeks worth of Doxy, and I'm going see the Dr again in 10 days for a recheck, so I can mention it then... he is giving it knowing that it might hit something he isn't or can't test for, so I can't imagine him saying no to 2 more weeks of it... Let's see how she does on it first?

 

Are there side effects you guys know of for any of these things I should know about? They said stuff about if there was blood in the stool or if she throws up, not sure if there's anything else?

 

 

[Guest BorzoiMom]

Deremax is a chew able tablet. Unless you have a different form than I had.

[Guest sorenkkg]

Deremax is a chew able tablet. Unless you have a different form than I had.

 

 

:lol OMG no one told me ...

 

They don't say anything about being chewable, they just say "give 1 tablet per day orally" and keep away from children.

 

Well-- she's sort of chewing them anyway since I'm wrapping them in a lot of "pill pocket" and she just does her thing.

 

Personally, I think I get points for making her believe that getting her Doxy or Deramaxx is a TREAT for putting up with her eyedrops

c'mon, who's a clever mom!?!? (ok, I guess I didn't invent this, but it's working for us, so, hey)

[Guest BorzoiMom]

Well, now you can save a little money off the pill pockets. Give them a smell, should smell a little. I can imagine how many pill pockets you had to use!

[Guest sorenkkg]

Well, now you can save a little money off the pill pockets. Give them a smell, should smell a little. I can imagine how many pill pockets you had to use!

 

Actually, it's funny, but I finally found out that pill pockets come in 2 sizes!

there's the small one, and there's a BIG one now. the small one I think says capsules and the big one says pills, or vice versa?

 

Anyway, I got them before I saw these deramaxx pills of hers, b/c Haka's Zeniquin is a big one, and he has to take 1.5 of them...

 

Silly boy doesn't want to take a whole BIG pill pocket though, so I cut it in half and mush it up-- I think they are literally 2x the size of the small ones.

 

One of those covers 1 deramaxx pretty well though-- I smelled it on it's own, and it smelled like one of my vitamins so I just wrapped it, and she maybe crunches it a bit...

 

All is going ok, I think. Her eyes still look a little cloudy to me, and I'm probably paranoid but they seem a bit bulgy. I'm really hoping I'm paranoid.

 

and of course, now I'm staring DEEP into Haka's eyes too and wondering if he's hiding anything in there

 

sigh.

 

time for the midnight drops

S.

[Guest sorenkkg]

Update: Just got Aleeya back from her chest xrays at our regular vet's office.

 

I had menatally blocked *why* they were xraying her chest but now I know-- she is cancer free as at the first look of the xrays. He's going to wait for them to dry and look again closely-- says "she's got a lot of chest to look at"

 

We are to continue the meds, and keep our f/up appt with Dr Zigler next monday. The rest of the tick titres etc should be back by then, but it's looking like there might not be a cause for this uveitis.

 

Oh-- and he checked her eyes, and the "aqueous flare" which is the particles floating, which was 2-3+ (on a scale of 5, I asked) is now GONE woo hoo!!!

 

Her whites are still a little red, so I picked up some more fucithalmic gel (say that 10x fast ) and we are good to go.

 

So, I took her to PetSmart-- how often do I get her out and not with Haka also? She was a hit at the store of course, and didn't eat any other patrons

She couldn't find a toy she liked, so I got her this one in blue (on sale-- all the toyshoppe brand ones are I believe) and some more pill pockets and her breakfast OMH cookies

 

She is now, you know, resting comfortably

[Guest sorenkkg]

Update:

 

Saw the opthalmologist today, checkup #1 after initial consult.

 

Here's what he has in his notes (my comments in bold italics):

 

most general tests normal (menace, plr, tracking, dazzle 3).

 

Right eye 8 mmHG

Left eye: 5 mmHG

 

normal is 15 per eye.. .so she is definitely still quite low.

Assessment:

examination reveals that the previously noted aqueous flare is resolved. The inflammatory debris adherent to the anterior lens capsules in both eyes is unchanged. The irides are no longer thickened and look quite normal. The episcleral congestion is resolved. (so, much is improved)

 

There is inflammatory debris in the anterior vitreous which was not noted at the last visit (uh oh).

the IOP's remain low suggesting some persistence of the uveitis even though the anterior component of the uveitis is improved (so, good and bad?)

 

Diagnosis:

Anterior uveitis: improved (yay)

Posterior uveitis: does not appear active but may be causing persisten hypotonia (so, this is either new or he couldn't see it last time b/c of all the other stuff in the way)

 

Treatments/Medications:

 

Continuing on the Doxy 2x a day for a few more weeks (will be 5 total I think by the next time we see him-- all titres came back negative also)

 

Prednisolone drops-- down to 3x a day (so, maybe I can go in to work one day...)

 

Discontinue Deramaxx

 

And here's the kicker--- Starting 48hrs after the deramaxx ends-- Prednisone 50mg tablets-- 1/2 a tab 2x daily for 3 days, then 1x daily for 7 days, then 1x daily every other day until finished.

 

Sigh. Also, not going in to the office if she needs to pee every couple of hours.

 

 

He really debated and hemmed and hawed about putting her on Prednisone. He *knows* what a PIA this will be, and is trying to get her to a lower dose as quick as possible.

He weighed the anti-inflammatory benefit against the potential issue of her having an autoimmune disorder of some sort (which might be exacerbated by the pred). But the continued eye pressure and the new debris he saw really bothered him.

 

Also-- she's lost about 5 lbs and I mentioned she's only eating about 1/2 to 2/3 of her daily food alotment. Is that normal spring diet change, or the meds, or the underlying issue? Who knows. He was "disconcerted" by her lowered appetite though.

 

 

so-- the downside is the Prednisone. Haka was on it once for a few days ages ago-- there was some peeing in the house, not disasterous. Any advice anyone can give on what to expect over a longer period like this?

 

but, one upside-- along with increased thirst, she might get more appetite! I seriously hope she wants to eat more of her regular food, b/c I'm considering all the food amendments people here talk about, but I've been holding off. Aleeya is the type of silly pup who, if she gets a treat in her food, will expect it all the time

 

 

So there we are-- we start the prednisone day after tomorrow, so please do share your thoughts with me.

 

thank you for all your good thoughts, wishes, comments and support! This has gotten me through the past few weeks and I'm so appreciative!

 

Soren

[greyhndz]

Oh, goodness... well, if it's of any comfort, I was diagnosed with posterior uveitis in 2005 due to an underlying autoimmune disorder. The reason your ophthalmologist is using prednisone is that the prednisolone drops work well for anterior uveitis (iritis) but not for inflammation in the intermediate or posterior portions of the eye.

 

The prednisone taper is pretty standard for autoimmune/inflammatory diseases, and the ophthalmologist really sounds like a very savvy vet. Aleeya will probably drink more, pee more, be more hungry, pant, and even be a little wired! But the side effects improve as the dose decreases.

 

If uveitis persists or recurs as she comes off steroids, he might recommend putting Aleeya onto a long-term immunomodulating drug, such as azathioprine, methotrexate or cyclosporin. I'm not sure if this is also true for dogs, but in human medicine, the thought is that after 2 years on an immunomodulator, the immune system is "reset", and often the drug can be tapered down and stopped.

 

I did not go onto oral steroids - I went directly onto methotrexate and within 6 months was in remission. The methotrexate was finally tapered after 2 years in remission, and I've been off MTX for 2.5 years - still in remission.

 

Uveitis can be controlled, and it sounds as if your ophthalmologist is doing everything right to make that happen!

 

Hugs to my uveitis-sister!

[Guest sorenkkg]

Thank you for that Jordan! So happy to hear that your experience ended positively, and WOO HOO for remission!

 

 

I was pretty worried when she was first diagnosed... then I started to sort of hope there was a "reason" for her uveitis, but the "reasons" didn't really sound all that good to me and as things are being struck off the list (no TBD, no infection, no C on the xrays, bloodwork is pretty ok for a grey...) I'm not sure what to think .

 

so today was autoimmune discussion day I guess . I'd still like to know what brought this on, and so suddenly. But I think I may have to settle for treating the symptoms, possibly forever, or as you said, for a while until maybe things "reset" themselves.

He did mention that if the Prednisone gave us a good result, he would move her to a different steroid, but I didn't catch the name... I think it's the one with the A?

 

He is supposed to be the best vet eye doctor in the area (I have no knowledge of these things, but I'm hearing good things about him) and he's got a great way with her-- came in and asked what her favorite scritch area is and was very gentle, and has a sense of humor. Been in the biz 30yrs from what I can see of his diplomas and certificates. Apparently did some eye surgery on a Siberian Tiger! (cataracts I think)

 

 

I'm glad I'm able to work from home so I can watch her and take her out, and that the 2x a day pred is only for 3 days, so hopefully that will be the brunt of it.

And if she eats more, then I'll be double happy! She's gotten so skinny.

 

Thanks again for your support-- here's a pic of the little monkey from the other day, with her shiny eyes!

 

[Guest Stripeyfan]

Get better soon beautiful girl!

[Guest sorenkkg]

Update-- I'm a bit of a mess today

 

got her to eat her dinner last night by adding beef broth. That was a relief. She started the Prednisone yesterday, so we're changing the walk schedule, I took them out at 4pm, 9pm, and then a quick walk just for her around 12am (i'm still up anyway).

 

Today she was walked at 6:30am, then I gave her another break at 9am, and I'll do 11:30am, then maybe around 2, then both of them at 4pm, etc.

 

She didn't eat breakfast today though-- usually she gobbles her OMH giant cookie. Today, nothing DH had to put her pepcid in her mouth, she didn't want the pill pocket in any way at all.

 

I got up and she did take some soft treats, like her lamb jerky treat and some wellness soft treats.

 

I ran to the store and got some of her kibble's brand in wet food-- she does Eagle pack holistic, so I got some fish blend, duck, and some chicken/chicken liver. I also picked up some fresh food-- never tried it, but I know it's soft, and less likely to make me gag than the canned.

 

That was a hit at least -- I put about 1/4c in a bowl, and she took out a big chunk and ate it on her treat mat... Haka stuck his nose in and tried to eat some too, so I hand fed him a nugget at a time so that she could get more without big brother hogging all the food

 

I guess if found something she likes I shouldn't be so stressed, but I am... She's down a good 5lbs from her normal 67, and is looking skinny. She came to us from the farm at 59, and was quite bony. So we don't have much play here.

 

I was hoping the Pred would up her appetite, but I've read (maybe) that it could be making her gums or teeth sore? Is that true?

 

I am giving pepcid 2x a day now, so hopefully her tummy isn't what's bothering her. Poops so far are ok.

 

sigh...

 

 

S.

[Guest Stripeyfan]

:grouphug to you and Aleeya. Get better soon pretty girl!

[Batmom]

Haven't heard about pred making gums/teeth sore, but if she had an existing infection there, then it could happen.

 

Kind of a longshot, but might ask your vet about the possibility of fungal infections. The common ones are histoplasmosis and blastomycosis. One of them does cause uveitis moderately often but I forget which one.

 

Hugs and scritchies to you and your pretty girlie.

[Guest sorenkkg]

Thank you

 

we all just had a nice nap... I took some time off from work, and things always seem better after I've gotten some sleep. Also, Aleeya has gone from 11:30am to 4pm without a pee-- she's such a good girl!

 

I'll inquire about the fungals-- weird thing is, Haka's toe is still inflamed, so we're thinking it might be fungal-- treating topically for now, want to see if it works at all before putting on an -azole drugs again (he was on some for a while last year when they thought he had ringworm).

 

So maybe they both have somthing? unlikely in healthy dogs, but I'll mention it to the next vet I see, regardless.

 

I appreciate the scritchies and I'll give Aleeya the hugs