Saturday, July 1, 2017

Gilbert 's Cockapoo Glaucoma

One afternoon my little therapy cockapoo dog Gilbert just curled up whimpering in his doggie couch at my office while my disheartened patient shared the depth of his melancholy with me. I just thought that my assistant had again forgotten to take Gilbert out for a walk and he was desperate to go.  I was working overtime as usual, but realizing something more serious was wrong with Gilbert, apologetically wrapped up my session .  Sadly Gilbert was stiff and in obvious pain. I picked up my loving little guy in my arms and carried him to the car.  On the way to Oak Hospital I called only to hear they were closing and wanted me to go to Oak Hospital’s Burrard location.
With the little guy whimpering and traffic a mess I was devastated with thoughts of self recrimination raging in my head and the physical pain in my chest.  At the hospital I told the girl “Gilbert’s got a red and  is in such pain he’s frozen.” I’d noted the red eye while I carried him in. She spoke to the veterinarian in the back and returned saying rather matter of factly,  “We can’t see you now. The earliest would be at midnight.”  It was 6 pm.  It seemed impossibly long.
Then I thought of the tens of thousands of parents and children across Canada desperately waiting in emergency rooms for over worked suicidal doctors.  I couldn’t judge.  Even though I personally had given my life to healing, working in the areas of greatest needs, gravitating to those least cared for and most marginalized.
What could I do. I’m a doctor and have all my life responded to emergencies and given all I can.  I just held my stiff whimpering little dog in my arms and  cried in my car ,praying to God to help us.   I drove to Laura’s knowing Gilbert would be more comfortable with her present. She loves him as I do.
At midnight I returned and learned that Gilbert had glaucoma, increased pressure in his eye, a true ophthalmic emergency that because of the delay had already likely lead to blindness. Thankfully Dr. Douglas made the correct diagnosis. I’d diagnosised the condition in humans and saved the sight of some patients when I worked as a country family physician. I’d used a Schiotz Stainless Steel Tonometer and was impressed that Dr. Douglas had a much more advanced digital device.
When I told him I’d treated glaucoma in humans, Dr. Douglas, a bright young Irish doctor, explained, “It’s easier with humans, only because they can tell you their eye hurts. In dogs we never know early because for them it’s just like having a headache until it gets really bad and then it’s like the worst migraine. That’s when we realize something is wrong and find the glaucoma too late. It’s common in cocker spaniels and poodles.  Usually coming on in older age.  The optic nerve is damaged by the intraocular pressure on it.   There’s a real risk for both eyes going blind and the hope is that we can save the second eye knowing the dog is now at risk. “ I really appreciated that Dr. Douglas was frank but caring in his sharing of the facts with me.
That night he provided the drops to lower the pressure in the eye and addressed Gilbert's pain with an injection. He gave me tramadol to take home with the eye drops. . Somehow. Gilbert and Laura and I made it through that first night.
At the follow up with sophisticated veterinarian ophthalmologist Dr. Ford I learned that Gilbert, who liked Dr. Ford,  was indeed blind in his left eye.  He was also at risk for the same in his right. Her examination confirmed that the drainage from both eyes was decreased.  “I know it's still awful, “ she said, “but blindness in a dog is not as bad as it is for humans. A dog's sense of smell is like sight to a human.  A lot of older dogs are blind and no one knows it because they experience the world and navigate mostly by smell. I’ve a blind dog myself and no one really knows it."
If the medication didn’t bring the pressure down then the usual option she explained was to have the eye surgically removed .There was a procedure for injecting the eye but it was used mostly in older dogs and not as certain as the surgery.
I continued Dr. Ford’s recommendations of the Dorzotimol 2% and Travopro .004% eye drops,  to be given 15 minutes a part ,three times a day for the next three months.   The problem was Gilbert did not at all like these drops and even growled at me after a few days of tolerating the treatment. I think they must sting or it was just too much of a nuisance for him.
I was so thankful that Martin, Tiny’s dad, gave me some ‘wild salmon treats’ he’d used on Tiny. “Tiny will let me do anything to her if I give her one of these treats.” Martin said.  Well, armed with the gift pack of ‘smoked wild salmon treats’ Gilbett’s whole attitude towards his medication times changed.  It became play and a reward for him. Grizzly Super Treats, USA made are what  continues to work for us today.
Gilbert and I moved to the care of the Western Canada Veterinarian Eye Specialists. Lori the assistant has been with them for years and made Gilbert so at home. I loved her professionalism.   Dr. Christina King examined Gilbert with touching sensitivity and agreed with Dr. Ford.  His pressure had remained in the 40’s despite treatment and he really seemed less happy overall despite the eye drops and the daily Metacam, an NSAID , like ibuprofen, for dogs.  We discussed surgery and I agreed, arranging a date.
Laura and I took Gilbert to Big Bar Lake as his pre surgery treat. He loves the wilderness. He was able to be off leash on that trip as well.  We knew he was blind now as he’d miss the yellow ball when we threw it on his left side. Gilbert never misses a yellow ball.  He loved sleeping in the tent too. Tenting is his favouite.  Laura, a real trooper, says, “Tenting is not my first choice of sleeping accommodation but I’m glad to do it because you and Gilbert love camping so much.”  Gilbert was in dog heaven camping. I just had to make sure Laura has a comfortable camp chair and a cup of coffee waiting for her when she stumbled out of the tent in the morning.  It was a great weekend.
On Tuesday at 8 am I took Gilbert to the Western Canada Veterinary Eye Specialists.  I left him with confidence with Lori.  She loves animals.  They love her.  Gilbert was happy and trusting.
I don’t know how I compartmentalize. I’m under incredible stress with conflicting demands of government and patients and no resources, daily threats and emergencies, and always afraid I’ll miss something but thankful for the  great staff and colleagues I have toda.  Despite that I couldn’t help but worry between patients standing distracted at times.  Mary Lou and Judith, the office staff,  knowing what was happening, made extra certain everything was covered for me. I was so thankful.
I got the call that Gilbert was out of surgery and had done well.   I was surprised by the depth of my relief, tears welling in my eyes as I said a silent prayer of gratitude . He’d be over his anaesthesia and ready for pick up in an hour.  I managed to see more patients . I was thankful when it slowed that Dr. Horvath,  ever considerate,   said he’d cover anyone else who came,  so that I could go to Gilbert.
The little guy was stumbling like he was half asleep when I saw him.  He wore the Cone of Shame that would stop him scratching. I was overjoyed to see him.  My little trooper.  That first night was tough. He was moaning in pain and I was so thankful for Tramadol because twice I had to give it to him and twice he settled.
Seeing what a wonder drug opiates are I couldn’t help but question the recent Justin Trudeau government’s attack on opiate prescribing and legitimate patients in face of the illegal fentanyl epidemic of deaths caused by the importation of Chinese fentanyl and heroin trafficking. Just like with the Liberal attack on the law abiding gun owners because of criminals killing people with illegal guns here was another example of how good citizens were punished by the incompetent Liberal authorities all the while they promoted cost saving euthanasia. Well I was thankful in the wee hours of the night holding my little dog post surgery that I had tramadol for him. Holding him comforted him till the tramadol took effect bu the metacam just hadn’t done the trick.  Aging I’m terrified of this young pot smoking super rich PM.  Pierre Trudeau exploded abortion into Canada with ultimately millions of babies killed mostly because Canadian families can’t afford to have children with the high cost of living.  Now the Liberals were giving us euthanasia  pot smoking and denying us opiates and real pain relief.  I feared myself opting for death rather than living under this  evil regimen. I can’t say how many times I’ve thanked Gilbert for keeping me alive.  Like parents who tell me they wouldn’t suicide because of their children I just know that Gilbert gives me that extra reason for living that gets me through the hardest of days.
After that first night Gilbert was fine.  He didn’t like the Cephalex antibiotic.  Nortoriously acidic, he event spit it out when I sneaked it between slices of roast beef.  His eye healed remarkably fast and with no swelling or redness I stopped forcing the cephalexin on him after three days. He didn’t need any more tramadol after the first couple of nights. By day 3 he was only on the Metacam.  Mostly he hated the cone.  He loves to lick his paws. He also loves to sniff other dogs genitals. Well he couldn’t lick his paws with the cone and other dogs didn’t like being coned by Gilbert trying to sniff their genitals. It was a rough time for the little guy. He’d also bang into  everything, blind on the left side and catching the cone on every step.
What a truly intelligent little guy. By the weekend he was scooping his yellow ball in his two paws and tossing it in the air to catch it in his mouth.    We stayed at Laura’s several nights  and she patiently rubbed his tummy and his back for hours. He’s such a suck.  She gave him all his favourite treats and with less clutter at dog level at her place he banged the cone less often.
Dr. Christina King had said what Dr. Douglas and Dr. Ford had, that the condition was progressive and that he might well lose his sight in his other eye.  She gave me Cosopt, a dosalomide and timolol combination ophthalmic solution for his good eye, a drop twice a day. Thank’s to Martin’s wild salmon treats Gilbert doesn’t mind the twice a day imposition.
Ten days after the surgery, on Thursday I took Gilbert back to the Western Canada Veterinary Eye Specialists for his suture removal.  Lori was as delightful as ever. Gilbert was surprisingly glad to follow her to the back despite that being where they’d taken out his poor little eye.  Moments later he was back again with me, without the cone and his wound looking healed and splendid.
Dr. Christina King could have put a prosthesis in the eye . Having trained in surgery I expressed concern about the complication of any foreign body.  She reassured me that they did really well but yes there was a slight risk.  As well, she said,  “ I mostly don’t recommend them for dogs like Gilbert whose hair normally covers his eyes. In less hairy dogs, the prosthesis really does look better but once Gilbert’s hair grows out I don’t think anyone know.”
As a sailor I’m now on the look out for a little black pirate patch for my side kick Gilbert
He’s happier now.  His old playful exuberant self is back.  Both Laura and I have noticed that his personality has changed with the surgery. “He’s his old happy go lucky self” Laura says.. We suspect that despite the drops he probably had  chronic pain and was out of sorts.  But now he’s really happy.  He’s such a joyful little character.
“Gilbert’s now the one eye pirate companion of Sailor Bill”, a friend quipped.  Dad called him Monkey Dog.  Another friend says I should get Monty Python’s dead parrot for Gilbert to wear on his back.
In my low period, thinking of Gilbert going blind and feeling helpless, vulnerable  and unloved by God, Laura sent me a picture of a blind old dog with a younger dog tied with a rope beside him.  The caption to the pictures was ‘dogs have seeing eye dogs too’.  If getting him a seeing eye dog is the worst the future holds, life is good.
We are so thankful to Dr. Christina King and Lori for their continued care of Gilbert.


Anonymous said...

you have all of our best wishes
and prayers

kilili said...

I hope things are getting well with both you and Gilbert. Our family adopted a dog a few months back and since this is the first time I've ever had a dog, I never knew what I had been missing. Truly man's best friend (only don't let my wife know that I said this.)


haykind said...

Thanks Kilili, Gilbert is doing well. I'm glad you've joined the experience. Who else is overjoyed to see you when you're gone a very short time. He's done well since the surgery. Happy like a puppy once again. I continue to give him drops in hope that pressure stays down in the good eye and he retains his sight.