|Chances cataract surgery adventure|
We were hoping to get our 7-year old dog, Chance, safely to his one-year diabetic anniversary with no cataracts. But only a few months after diagnosis, the holistic vet noticed a "cloudiness" in Chance's eyes, and the vet ophthalmologist confirmed the developing cataracts.
The ophthalmologist, Dr. C., immediately started Chance on prednisone eye drops as a preventative measure against inflammation, which can prevent successful cataract surgery down the road.
Somehow, we kept full-blown cataracts at bay for almost a year, but during one of Chance's routine check-ups with Dr. C. in January, 1999, he said "It is time."
Dr. C. wondered how Chance had been coping with his near-blindness. It seems Chance had been bluffing pretty skillfully, because we had noticed only small things, like some hesitancy on stairs, and less interest in fetching his tennis balls or chasing his mortal enemies, the squirrels. But the cataracts had developed very suddenly and rapidly.
It was always assumed that Chance would have the cataract surgery when the time came, so there was very little discussion with the vet or ophthalmologist about any other options. While I think we would have made the decision to go ahead with the surgery anyway, we should have discussed it a little more fully with the vet. A dog's age, stress-level, and the owners ability to commit substantial time and money to the surgery and post-operative care should all be considered. Dogs can and do adjust to blindness, and this should be taken into account when thinking about whether or not to put a pet through such a serious procedure.
The cost for the cataract removal operation was approximately $1800 for both eyes, and this included the follow-up appointments. Dr. C. did not recommend lens implants for Chance, and we agreed. Eye drops and other prescriptions can be quite expensive, but since most of them are also people medications, we found it more economical to purchase them at the local pharmacy rather than at the vets office.
The ophthalmologist set the surgery date for February 23, which gave us a month to get used to the idea! One complication: we had recently discovered that Chance had a broken molar. Dr. C. thought that Chance would be at great risk of infection if he proceeded with the cataract operation while this tooth was untreated. So we had the tooth extracted immediately. Chance had a "partial" blood panel done at this time, so Dr. C. did not think another blood panel was necessary prior to the cataract surgery.
A side-effect of the tooth extraction was that Chance's bg levels started to come down shortly after he started the course of antibiotics (Clavamox) prescribed when the tooth was removed. This was the first dramatic change in Chance's bgs in six months.
Dr. C. gave us several eye drops for Chance, which we started three days before the operation. From 8 pm onward the night before Chance was to have no food (water was ok). We were instructed to give him half his morning insulin. I was concerned about Chance's bg levels going too low with no food, but Dr. C. explained that the bgs are monitored during surgery, and a glucose drip is easy to administer if the dog goes too low; but little can be done to help if his bgs start to spike.
We tried to keep our nerves under control for Chance's sake! We took Chance to the clinic at 7:30 in the morning. Dr. C. performed the operation at 9 am, and I phoned a few hours later to see how Chance was doing. The surgery was complete; they said he was "groggy, but ok". That is all the information we had until we went to pick him up when the clinic closed, at about 6 pm.
The surgery didn't go as well as we'd hoped. Apparently his lenses had hardened considerably since the last eye exam, and this made the cataracts more difficult to remove. His eye pressures were very high (40 and 25 right after surgery, down to 21 and 24 when we picked him up); some lens fragments had also leaked into his eyes and it took extra time to find and remove them; the back of the lens was opacified which also complicated the surgery. This meant that the operation took almost three hours to perform, which was well over the standard time Dr. C. schedules for cataract surgery.
The doctor was very concerned about infection and inflammation. Chance was given a steroid injection to help treat inflammation, his medications were changed, and the vet added Baytril antibiotic tablets to the list of medications we were giving Chance.
A big shock when we arrived to pick Chance up was his appearance: he had been shaved around his eyes (including the eyelashes) and they looked purple and sore. I wish Dr. C. had warned us about this!-- because we honestly thought that something horrible had gone wrong with the surgery.
Dr. C. fitted Chance with an Elizabethan collar or "cone" to prevent him from scratching his eyes, and we led Chance to the car and home. Chance was very disoriented, had no vision at that time and was unable to move without guidance.
He crashed into things, constantly worked at removing
the cone, and the eyedrops seemed to be hurting him. All this, combined with the account
of the difficulties during surgery and his shaved and sutured eyes, had us questioning
whether we had been wise to put Chance through such a trauma.
Another appointment a few days later showed that
Chance's eye pressures were under control, at 9 and 13. We were almost positive that some
of the shaved hair was growing back! And since we now only made Chance wear the cone after
eye drops (when he wanted to scratch) and overnight, he seemed a little happier.
Now, four months later, Chance is off ALL eye drops
and medications. His next eye appointment is six months away. Occasionally when one eye or
the other looks a bit red, we will give him an anti-inflammatory drop, which alleviates
the redness very quickly. Dr. C. provided us with an emergency kit in case the eye
pressures spike when we are unable to get Chance to the vet. This kit includes the oral
glycerin syringes, tablets, Xalatan and careful instructions.
Chance is now almost completely blind. This, according to the vet ophthalmologist, is age-related only. It happened quite slowly, so that it wasn't stressful for him -- and we almost missed it entirely! Initially there was an occasional hesitation when out walking, and furniture seem to have the nasty habit of jumping into his path. Then, when a tossed tennis ball would sail in front of his smiling face with no response, we knew for sure he was losing his eyesight. He did have a couple of years of good vision and squirrel-chasing.
His blindness has not slowed him down much at all -- he is still both curious and courageous, unafraid to forge ahead anytime he is outside. He knows the words "step" and "careful", which help him navigate quite smoothly.
The big question: would we still have done the surgery, knowing what we know now? As I said earlier, the procedure is much more serious and risky than I imagined, is not necessarily permanent, and is downright dangerous for an older dog. Aside from considerable expense there is a hefty commitment after the surgery, involving careful monitoring, administering medications and going for follow-up vet visits.
That said, our beautiful boy did get a couple more years to "see the world" and the expense was not a problem for us at the time. But the severity of the complications Chance experienced, and the fact that he went blind anyway, would make me think very carefully about it and certainly do a little more research before choosing such a surgery.
The most important thing at any stage is that Chance is happy and enjoying life, which is exactly what he is doing, even at 13 years.
Contributed May 1999