Our dear senior dog Pepper continues to struggle with health problems. We forked out some big bucks for sight-restoring bilateral cataract surgery in January via Bliss Eye Care, a veterinary ophthalmologist in Medford, Oregon. It was totally worth it. And luckily we have had a wonderful experience with patient care and follow-up with this office.
A little over a week ago, we noticed a white spot developing in Pepper's right eye. Kelvin sent photos to the ophthalmologist in Medford and she responded promptly with suggestions about treatment of a corneal ulcer and hypopyon (liquid pus level) in coordination with our local vet. Pepper had two local visits with fluorescein staining and intra-ocular pressure checks as well as a complicated medication regimen beyond her maintenance ketorolac eye drops including 6-8x per day ofloxacin, 4x/day terramycin ointment, twice-a day doxycycline orally (I can see how patients struggle with compliance with multiple-daily dosed meds). We thought the eye looked a little better (less dense whiteness) this week but, despite it being pretty inconvenient on short-notice, we arranged a bit of on-call coverage at the tail end off my Monday call and Kelvin agreed to take Pepper up to Oregon on Tuesday for a squeeze- direct in-person exam at their request. Her right eye looks perfect and she seems to still be able to see well out of it.
The ophthalmologist diagnosed Pepper with "large temporal paraxial keratomalacia," described as a severe, melting corneal ulcer. She said that this was unrelated to her cataract surgery but just due to her breed and age (her being on prednisone probably also had a immunosuppressive role). Treatment options were reviewed with Kelvin and included continuing medical therapy (~60% success), Corneal Collagen Crosslinking (CXL) intervention (~80% success in 21d), or surgery (conjunctival graft, curative, but leaving vision compromised). The CXL was not cheap but, due to our limited time with capability of trips, we opted to proceed and the doctor was able to complete it the same day.
Pepper is now on even more medications than she was before, including atropine eye drops every 48 hours, EyeQ amniotic eye drops 4x per day, Moxifloxacin eye drops 6x per day, Terramycin eye ointment 4x per day, toradol to the left eye daily, meloxicam (a non-steroidal) orally daily, and twice-daily oral doxycycline. She was asked to continue her liver supplement Denamarin but hold her chronic prednisone for the time being. The topical meds are supposed to be separated by 5 minutes which is tricky to juggle (and remember! This is up to eighteen med administrations daily unless I miscounted!). She is supposed to stay in a cone and Kelvin has a return trip in two weeks, after two other back-to-back out-of-town trips he had planned (one for Danny's wedding and another for a conference).
Prayers for healing for her are appreciated! We obviously love our fur child a lot and wish she didn't have so many seemingly acute-but-severe conditions! With hope, she doesn't end up losing her eye (enucleation) but one working/seeing eye is still better than none!
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