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Glaucoma - Onset, Diagnosis and Management
  • hanaluluhanalulu
    Posts: 195
    Hi, everyone. I did some searching and couldn't find a specific thread on glaucoma and harnesses. If there is one, please let me know. I'd love to read any and all information out there.

    Evie is 6.5 and was diagnosed with primary glaucoma last week after a trip to the emergency vet. She's currently on 2 sets of eye drops twice a day (not fun to try to get in), 2 painkillers, and a neuroprotectant.

    I've researched a lot and have learned that a harness is an absolute must, as a dog pulling with a collar can result in increased ocular pressure due to pressure on the jugular vein. What I'm having difficulty with is finding out what kinds of harnesses work best for dogs with glaucoma.

    We currently have a puppia harness, but I'm concerned that there is still too much pressure on her neck. I had a step in mesh harness that sat lower across her chest, but it stretched out and the size down is too small. I really like the mesh harnesses for Evie, as she hates harnesses, and she appears to be most comfortable in mesh. We have an EasyWalk harness that clearly applies no pressure to her neck, but she DESPISES it and it doesn't seem like a great option when we need to have a harness on her long-term (being out and about or hiking).

    Does anyone have any experience with this or suggestions? Does anyone have a pup with glaucoma and use a puppia harness or similar one? Do you think that even though a puppia sits low on the neck, it disperses pressure enough to eliminate concern of increased intraocular pressure? I really like the harness, but don't want to cause her any unnecessary pain from raised IOP if it applies too much pressure on the neck and jugular vein.

    I'm open to having multiple harnesses for her - some made for longer-term use and some for her to wear around the house and still be comfortable.

    And finally, I urge all of you to have your pups' eye pressures checked regularly. The pain my girl has endured over the past week has been so intense (they said her pain was equivalent to probably my worst migraine, non-stop) and it's been very hard to watch her go through it. The rise in her eye pressure (pressure of 70, they like to see it under 20) hit hard and fast and we sadly already lost vision in it. We face potential enucleation and likely loss of vision in her other eye within three years. While it can't be cured, perhaps you can catch it sooner than we did and lengthen the time your pups can see.

    Thank you ahead of time for any harness suggestions and thoughts on the puppia.

    [mod edit: changed title due to OP request]
    Post edited by sunyata at 2015-07-31 10:35:59
  • hanaluluhanalulu
    Posts: 195
    We had Evie's follow-up appointment with the ophthalmologist. He told us that the puppia harness definitely distributes the pressure enough away from her jugular vein and neck, which is great news. Eventually I would like to try to get her into a Ruffwear harness, but we have to take baby steps towards getting her comfortable in a harness, especially with all of the changes she's going through.

    I was initially worried because the puppia soft harness appears to slightly sit low on the neck and was perhaps putting too much pressure on it, but he said it was a great harness and was doing its job. Additionally, due to Evie's petite structure, her chest to neck area kind of looks like it melds together, which is also why it appears to sit on her neck so much.

    We are looking at first eye removal within the year and will now begin heavily researching ECP as a potential surgical option to postpone loss of eyesight in her good eye.
  • sunyatasunyata
    Posts: 8589
    @hanalulu - First off, this sucks. I am so SO sorry that you and Evie are having to deal with this. :(

    Since there is not a ton of information on glaucoma on the forum, can I ask that you keep us updated and maybe give us a bit more information on what led to her diagnosis?
    Bella 2Mountains 2Nola 2
    Casey, with Bella and Nola, hanging out in the mountains of Virginia.
    I Wander, I Ride
  • @hanalulu - thanks for contributing some of this info. I have been educating myself on glaucoma since it is one of the issues the breed is knwown to have and because it often shows up after two years old (which means that even some responsible breeders have bred dogs that eventually get diagnosed with glaucoma after their breeding years are done). I think that the point about harnesses is a great one.

    @sunyata - I'll bump some of the other glaucoma threads since I've previously posted in them (so they're a touch easier for me to find).
  • sunyatasunyata
    Posts: 8589
    @violet_in_seville - Thanks for bumping. I searched and found those threads when hanalulu first posted (just to make sure it was not a duplicate topic), but since there really is not a lot of first hand experience with it on the forum (which is a good thing), I figured her experience with Evie would be good to document here. Thanks!
    Bella 2Mountains 2Nola 2
    Casey, with Bella and Nola, hanging out in the mountains of Virginia.
    I Wander, I Ride
  • AntoinetteAntoinette
    Posts: 887
    @hanalulu-I am so sorry that you and Evie are going through this and I am sending you healing and positive energy for you and Evie.

    I will make absolutely sure that I keep an eye for symptoms on Quake since he is 4 years old. The next time we see the Vet I will ask that an eye examination be done.

    Please keep us updated on Evie's condition. Quake and I are sending Shiba hugs!
  • hanaluluhanalulu
    Posts: 195
    Thank you very much for the kind thoughts. We are heading off to a vet appointment to check her eye pressure, but I will make a detailed post upon returning. I'd love to share this knowledge I'm gaining with all of you, to help catch it sooner and to help anyone who has to go through this unfortunate situation themselves.
    Post edited by hanalulu at 2015-07-28 20:51:27
  • hanaluluhanalulu
    Posts: 195
    I think if possible, we should perhaps rename this thread to be something a little more all-inclusive as I will share our journey with glaucoma here. Forum administrators: please let me know if there is any way to do this or if this would be appropriate, as I see I can no longer change the thread name.

    Disclaimer: Please keep in mind that all information is strictly what we've learned so far. I'm sorry if anything listed isn't accurate, but to the best of my ability and memory, I believe it is. When it comes to (surgical) treatment, it's more a grey area and there are many varying opinions and some of this is a reflection of my own opinion given our situation.

    Installment one of our journey so far:

    I'll first share the story of what happened and will follow-up with what we've learned since later tonight.

    This has been such a journey already, with lots of emotions and ups and downs. On Monday, July 13, Evie came downstairs at about 10p and her eye was partially closed. Within 30 minutes, she was holding it completely shut. We decided that we would bring her to the vet first thing the next day. The next morning, however, her eye looked much better. It was almost all the way open. So (SHAME ON ME), we decided to keep an eye on it. (A few years ago, Evie held her eye shut and we took her immediately to the vet for what was a corneal ulcer. It was not my intention to not take care of her eye immediately, I just so wrongly thought it was better). My boyfriend left for work around noon and said that her eye still looked better.

    We came home around 7p that night and discovered that she was once again holding her eye shut. It looked slightly puffy. I contacted my vet tech friend and asked for the signs that would tell us it was time to go to the emergency vet so I knew what to watch for. By 11:30p it was evident we would need to go to the emergency vet. Evie was incredibly uncomfortable and restless. She was trying to hide in the darkest spots of our house and would shift, lift her head, sit up, lay down, scoot - non-stop. She was clearly nauseous and in pain - licking her chops incessantly. She then began to softly cry every single time she shifted - so softly, you almost couldn't hear it (it was heart breaking). We quickly got ready and headed to our local emergency vet, expecting a corneal ulcer, some pain meds, some eye drops and a happy dog within a week's time. Boy, we were wrong.

    Initially, they didn't think it was glaucoma, even though her eye appeared cloudy. They didn't feel any hardness to her eye. The vet wanted to run blood work because she noticed the nausea and felt the eye issue was caused by a systemic infection. I pushed for the eye work up first - the fluorescent stain, pressure check, and evaluation. I told her I'd very willingly spend the money on the blood work if it was warranted after evaluating her eye first. Sure enough, around 2:00a, we found out Evie has glaucoma, at which point I lost it a little bit and started bawling.

    The pressure in here eye was 70 and it should really fall under 20. Above 50, they quickly begin to lose eye-sight, sometimes within a matter of HOURS (part of the importance in getting your pup in quickly for eye issues). Primary glaucoma can hit hard and fast because sometimes we aren't likely to notice the first symptoms (cloudy eye, sensitivity to light, inflamed eye / red whites of the eyes). I've beat myself up so many times over the fact that we didn't bring her in earlier that day. They administered anti-nausea and heavy-duty pain med shots (I've NEVER seen her so drugged), as well as eye drops aimed at bringing down the pressure in her eye quickly. At 3:00a, they wanted to keep her over night, but the ophthalmologist on call told them they should let us bring her home, as we would be heading in to that department at 7:15a and she would receive a full work-up.

    Bottom line: Primary glaucoma is an emergency. You can potentially save your dog's vision (or some of it) by getting them in as soon as possible. The best chance of saving vision is bringing the pressure down quickly within 24 - 48 hours; however, with very high pressures, since blindness can occur within mere hours, time is of the essence.

    I'm off to a dinner, but will post on everything we've learned about glaucoma symptoms and treatments afterwards.
    Post edited by hanalulu at 2015-07-29 00:58:07
  • hanaluluhanalulu
    Posts: 195
    Installment two:

    We got home around 4:00a from the emergency vet and were back at 7:15a for Evie's ophthalmologist appointment. At this appointment, we learned that Evie had no real vision in her eye - she didn't blink for light and had no menace reaction (covering the good eye and quickly pushing hand towards her eye), but had a light reflex. I forget the specific name, but the vet would shine a light next to the bad eye and the good eye's pupil responded. One thing that is interesting - she mentioned that asian dogs' eyes are more flexible and forgiving than other breeds and felt that we may see some slight regain in vision (we have!!!). She set us up on an eye drop and painkiller regimen and essentially sent us off for 10 days to get Evie's pain and inflammation under control. She did answer many of our questions, but honestly, we were too tired and shocked to have our ducks in a row with questions. She assured us we'd go over everything at the 10-day appointment.

    Our 10 day appointment was this past Saturday. She's regained some vision - probably just shadows and rough shapes, but it's wonderful news. We ended up going back to the vet today because she's been squinting her eye again. Thankfully, her pressure didn't increase again... we simply ended her pain killer regimen too soon because the inflammation is still bothering her. We also received information on what to do in an emergency (how to page them, what to administer, etc.,).

    Now, on to the informational portion. For those who don't know, from what I understand, primary glaucoma occurs when the drainage angle in the eye is partially blocked and the fluid can't drain out quickly enough. Additionally, the channel in the eyes where the fluid drains out can start collapsing and the spongy, porous material that is in between may also be less porous to begin with. The fluid build-up causes the pressure. As the fluid builds up the eyes can physically bulge, putting pressure on all of the vessels, parts of the eye, and optic nerve, causing blindness. Ouch! Eye drops can help reduce the the output of fluid and help with the drainage. However, this is not a permanent solution, as eventually, glaucoma wins and the drops no longer work. Additionally, we've been instructed to treat her good eye with drops immediately. Average onset of glaucoma in her good eye is 8 months without beginning treatment now and 30 months if we begin treatment now. In short, she will eventually be blind.

    I've hit every emotion possible, but try to land on the positive - she's not dying. Dogs are resilient and I've heard they adjust very well to being blind. Some do experience depression initially. I've read two books on how to train, help her find her way around the house (scents, rugs / textures, bells, etc.,), and how to help her enjoy life. I have one more on the way that I've heard is excellent (Living with Blind Dogs). I know I will have ups and downs, but try to remain positive for her, as I've noticed she feeds off my energy even more than before.

    Please see installment three (I'm writing a novel and reached a character limit, so I've split this post up).
    Post edited by hanalulu at 2015-07-29 01:12:06
  • hanaluluhanalulu
    Posts: 195
    Installment three:

    Here is our current medication schedule:

    Eye drops (until enucleation / eye removal each eye):
    In the AM: 1 drop Latanoprost in bad eye only. Wait at least 5 minutes. 1 drop Dorzolamide in both eyes.
    In the PM (12 hours later): 1 drop Latanoprost in bad eye only. Wait at least 5 minutes. 1 drop Prednisolone Acetate in both eyes. Wait at least 5 minutes. 1 drop Dorzolaminde in both eyes.

    Cost: Latanaprost $22 a bottle at Costco; Dorzolamide - free sample at vet, $61 at King Soopers, waiting to price at Costco; Pred Acetate - $65 at King Soopers, $28 with online discount coupon at Walgreens

    Painkillers (as needed for pain):
    1/4 Tramadol every 8 - 12 hours. 1/2 Carprofren every 12 hours.

    Cost: Tramadol - $22 at vet; Carprofren (Rimadyl) - $44 for 20 pills at vet

    Other (until both enucleations):
    1/4 Amlopodine pill (a neuroprotectant) once a day.

    Cost: Amlopodine - $11 at Costco; $7 at King Soopers

    In the beginning, eyedrops with Evie were TREACHEROUS (gotta love Shibas!). She fought so hard and everything we tried from restraining her to sitting with her and calmly talking to her failed. We felt incredibly defeated in those first few days wondering how on earth we were going to accomplish these drops twice a day when she wouldn't let us administer the drops. By the way, many people are on a 3 times a day eye drop schedule. It all depends on how well their eyes respond to the drops. We likely will end up at the every 8 hour mark.

    Information we've picked up on so far:

    Harness, harness, harness!:
    On top of this, we learned that she needs to be in a harness. The pressure of a collar if the dog pulls on a leash can increase the intraocular pressure. What I couldn't find on the internet was the best type of harness. After speaking to the ophthalmologist, we did learn that the Puppia harness is perfectly fine. Although it sits low on her neck, the harness still redistributes pressure across the shoulders and chest. We were going to try the EasyWalk harness with her since it applies no pressure to the neck region, but (1) it doesn't fit her as well as I'd like, (2) it doesn't seem like a great option as an "all the time or hiking harness", and (3) she really freaking hates it! Ultimately, I'd love to get her into a Ruff Wear Front Range harness, as well.

    Surgical treatment options:
    We've been instructed that there are several surgical treatments that may prolong vision and help with fluid and pressure reduction. We are still in the process of researching these procedures to see what we want to do. Currently, we are at a point where we could opt to treat her bad eye with one of these surgical procedures, but have decided not to due to her loss in vision. One option is to place a shunt in her eye that would help drain fluid, which has an average success rate of 25% after 1 year and of course a risk of blindness from the surgery. Additionally, the shunt could cause irritation and other issues. This procedure runs around $3,500. Another option we are looking into is Endoscopic cyclophotocoagulation (ECPC), which also comes with risks such as cataracts, blindness, and retinal detachment. With this procedure, the lens is removed and small incision is made. With a laser, they blast the ciliary bodies that produce the aqueous humor (the fluid). There is another laser surgery where they haphazardly blast from the outside of the eye, which is not a consideration for us. I've read so far that ECPC tends to have a better success rate in prolonging vision and intraocular eye pressure (IOP), however both can cause blindness or can be unsuccessful at controlling pressure. A friend of mine opted for the ECPC treatment on her dog and gained 3 years of vision. She said she'd do it all over again if she went back in time. This procedure also ran in the $2 - 3,000 mark after all was said and done.

    Some eye specialists only perform shunt surgeries, some only perform ECP, and some don't perform either. I've called every specialist within our area (near and far) and am still waiting on some callbacks for more information. I plan on making an appointment with an ophthalmologist who performs ECPC and has excellent reviews. He's far away, so we also have found a local specialist for maintenance care. In addition, the dog must be a candidate for the procedure. Not all dogs are always good candidates.

    The end game:
    Ultimately, especially if your dog is diagnosed young, glaucoma usually wins. What does this mean? Eventually, treatments will fail since there is no cure and your dog will go completely blind. When vision is lost, the pain is typically still present. At this point, enucleation (eye removal) is recommended. There are several options - (1) some opt to have a prosthetic eye placed for aesthetic purposes, (2) enucleation where the vet sutures the eyelid closed (many vets opt to put a prosthetic in to prevent sinking, but this is again for aesthetic purposes), and (3) for dogs who perhaps cannot be under anesthesia long, there is an option to inject something into the existing eyeball to kill the ciliary bodies (I think, I'm less familiar with this as it's not something we'd choose to do) and prevent pain.

    We will likely be looking at removing Evie's bad eye within the year. I know at this point I want to do the enucleation with NO prosthesis. To me, it's not worth any potential risk of irritation or infection. I've found an eye specialist at CSU who uses a mesh suture inside that prevents any sinking. It's $1,500. Most eye specialists charge around this amount. Keep in mind that regular vets can perform this surgery, too, for a lot less. I've found one vet that uses an inside stitching technique that usually prevents sinkage (but can't guarantee it) and charges a lot less. I'm still working on finding the surgeon I feel most comfortable with. I'm not opposed to sinking, as the aesthetics are really just for me, but I'd love to find a good surgeon who can prevent sinking without the use of a prosthetic. I'm working hard to iron out what I know I want to do and don't want to do so that if we are faced with an emergent, emotional situation, it's already been decided (even though circumstances could certainly change and some treatments may not be available to us).

    We still have a lot of research to do and specialists to speak with (although, there are actually only 5 eye specialist clinics that I could find within a few hours of us). We'll keep you posted and informed as we continue our journey. I can't stress enough how important it is to take eye issues seriously. If you think it warrants a trip to the emergency vet, it probably does. Trust your gut. All sorts of eye issues can be incredibly painful or cause permanent damage, glaucoma or not. I recommend having your regular vet regularly perform eye pressure tests and exams if possible. At least that way, you can catch it and hopefully avoid severe pain and prolong vision by being able to monitor and anticipate. And most of all, I hope you don't have to go through this with your beautiful life companions.
    Post edited by hanalulu at 2015-07-29 01:10:29
  • sunyatasunyata
    Posts: 8589
    @hanalulu - Thank you for the detailed write up. I can only imagine how heartbreaking this is, but I am glad that Evie seems to be doing well with the treatment. Hopefully things stay positive for you guys.

    As for the title of the thread, just let me know what you want to change it to, and I will make the edit.
    Bella 2Mountains 2Nola 2
    Casey, with Bella and Nola, hanging out in the mountains of Virginia.
    I Wander, I Ride
  • hanaluluhanalulu
    Posts: 195
    @sunyata - Thank you for the kind words. As for the title of the thread - I see there is already a thread entitled "Glaucoma" and I honestly don't have any better ideas. I'm not opposed to the title remaining the same since it was actually not made clear to me initially that the harness was important. I didn't foresee this thread moving the direction it did, or else I would have certainly posted up initially in that other thread. :)
  • Atlus2015Atlus2015
    Posts: 85
    @hanalulu Thank you so much for the indept write-up, as well as sharing your story with us, and your thought process and research, especially now at this time. You really have provided us with a great read, and very informative on what Glaucoma is, early diagnostics, and even what to do if we get into the same position.

    I have a few suggestion for the name of the thread, possibly:
    "Glaucoma - Development and Onset." or "Glaucoma - A First Hand Experience"?

    it really does give a very good indept review of some key things:
    indicator of early onset + education on early testing
    how to comfort your companion during the onset
    what to do and choices to make following diagnostics.
    Post edited by Atlus2015 at 2015-07-30 14:41:54
  • @hanalulu - really, thanks again for documenting your experience so thoroughly. While we all hate that Evie and you are going through such an experience, I think that you're doing a real service to the community by highlighting just how serious the condition is and precautions people can take regarding screening and post diagnosis.

    We do have other threads on testing and a bit of info buried in life story threads, but nothing that goes into this much detail on a condition that is commonly listed as a health concern in shibas and it would be great to have so much of the information in one place.
  • hanaluluhanalulu
    Posts: 195
    @atlus2015 - Thank you for the great suggestions!

    @sunyata - Would you be okay with "Glaucoma - onset, diagnosis and management" or "Glaucoma - onset, diagnosis and treatment?" Something along those lines. Perhaps this can become the central glaucoma information thread since it's becoming ever-evolving?

    @violet_in_seville - I'm happy to share our story. Anything I can do to help someone else in this position is important. I felt so lost in the beginning and the Internet became overwhelming! Just trying to think positively now!
    Post edited by hanalulu at 2015-07-31 09:18:41
  • sunyatasunyata
    Posts: 8589
    @hanalulu - Done. Thanks again for sharing your story. Give Evie some extra belly rubs from us.
    Bella 2Mountains 2Nola 2
    Casey, with Bella and Nola, hanging out in the mountains of Virginia.
    I Wander, I Ride
  • hanaluluhanalulu
    Posts: 195
    Thought I would share some photos so everyone can see what Evie looked like when we started to really notice something was wrong. It hit so fast, and by the time we noticed, it was too late to prolong eyesight in her bad eye. That's why the eye checks are so important! (I know, I'm a broken record, but want to get that point across to hopefully the prolong the time before you have to feel the heartache we feel now).

    Evie - the first night (Monday, 7/13, around 10p). We noticed her eye was partially closed.
    photo IMG_3361_zpsvtlazc9y.jpg

    Later that night, she started holding her eye shut all the way. The next morning, she was holding it open again.

    Evie - the second night upon getting home from work (Tuesday, 7/14). (Please excuse the mess, we are packing and throwing away anything possible because we are in the middle of moving!)
    photo IMG_3367_zpsegsw4zpd.jpg

    Evie - the second night again. At this point, it was very clear she was in a tremendous amount of pain.
    photo IMG_3372_zpsyy5n9ndq.jpg
    Post edited by hanalulu at 2015-08-06 23:04:45
  • hanaluluhanalulu
    Posts: 195
    The sweet girl on night 2 (Tuesday, 7/14 / early Wednesday, 7/15) around 3:30a, after getting home from the emergency vet. She was given a painkiller shot. She was definitely showing the effects of the painkiller!
    photo IMG_3379_zpsw0tco6is.jpg

    Evie, a couple hours later, back at the vet for the 7:15a appointment with the ophthalmologist. (You may notice she has a collar on - this was before we knew the importance of using a harness only with glaucoma).
    photo IMG_3385_zpsusdnzgf6.jpg

    Another. With her sweet little tongue poking out in her drug-induced state.
    photo IMG_3384_zpsvpllpncq.jpg

    Our new medicine regimen. We are currently off of two of the tablet bottles (painkillers).
    photo IMG_3530_zpssg4gb7is.jpg

    The nurse board.
    photo IMG_3528_zpsedg05axw.jpg

    The next week, last Tuesday, 7/25, when I noticed she was having difficulty keeping her eye open again. We rushed her back to the vet (e-vet appointment was 2 weeks prior on 7/14, 10-day check up was on 7/22 and they took her off the painkillers at that point. They determined last Tuesday that she needed to go back on painkillers, which we just finished this past Monday, 7/28).
    photo IMG_3440_zps2z4a7ihq.jpg
    Post edited by hanalulu at 2015-08-06 23:05:45
  • hanaluluhanalulu
    Posts: 195
    We have another check up this coming Saturday and will keep everyone posted on anything we learn.

    And now for a few happy pictures!

    Evie on Monday, when we took her for a hike up in the Frisco / Breckenridge area. We wanted to make sure she could have some really fun adventures this summer before we lose any more eyesight. Can't wait to get her in a Ruff Wear Front Range harness!
    photo IMG_3488_zpswjkeisld.jpg

    photo IMG_3487_zps5pabmwai.jpg

    Scared of this post in the ground, but trying to be brave and check it out.
    photo IMG_3520_zpsdbmzd3v1.jpg

    In the car, being a great girl.
    photo IMG_3521_zpsjjocnmji.jpg
    Post edited by hanalulu at 2015-08-07 07:58:19
  • Thanks again @hanalulu for posting some pics and filling out the greater picture of what the onset of glaucoma can look like.

    I admit that earlier I had a freakout this week because of an unusually teary eye and called the vet and brought one of my pups into the vet (they fit me in between appointments though they were fully booked that day). Just for everyone out there, getting a pressure check on the eye is pretty easy. The vet will give your dog some numbing eyedrops to reduce the discomfort and then they typically will do two readings (in case one is off) on each eye with a very small instrument. The whole thing takes about five minutes (not including the time taken to calm the pup down). As stated in one of the earlier threads on glaucoma, if the dog is struggling a lot and the vet tech is holding them super tightly, it can throw off the reading. It's really pretty easy and totally worth the peace of mind to get a baseline reading.
  • hanaluluhanalulu
    Posts: 195
    @violet_in_seville Glad to hear it was a false alarm it sounds like. Any idea what it was? Allergies perhaps?

    Yes, I second that. The pressure check is super quick and easy!
  • hanaluluhanalulu
    Posts: 195
    We just came from Evie's scheduled eye check. Sadly, the drops are already beginning to fail us. Her pressure in her right eye is up to 27, and that was only 2 hours after receiving her eye drops. This means that we now bump to 3 times a day on drops in the right eye and additionally means that eye removal will be here within just a few months. Just 10 days ago her pressure was great - 13 or 14 - and that was 8 hours after the lost drop administration. The good news is that pressure in her left eye is holding steady at a good level (10).

    I truly thought today would be a simple check up and everything would look great for maintenance purposes. I knew eye removal was coming within the year, but never anticipated it would be here quite so soon. We will hold out as long as the drops can keep her pressure down to a non-painful level since she did regain some vision. Our next check up, barring any issues, is on September 5. Lots of bumps in the road with glaucoma. I honestly was just feeling settled and accepting of this and now I feel a little derailed today. I will get back on track after I let myself have a day to feel sad. I think this whole journey will be full of these moments, but my goal is to generally be very positive and accepting so I don't feed any negative energy to Evie. Dogs already feed off of our energy so much, and I read that as they lose eyesight it only increases.
  • Kira_KiraKira_Kira
    Posts: 2482
    I'm so sorry, I commend you for sharing this difficult journey while remaining strong for your Evie! She is lucky to have you.

    Now I'm concerned and am wondering how often eye pressure tests should be done? Should you begin them at any particular age? Will my usual vet be able to perform them or would/should I go to a specialist?

    Thank you for bringing this serious condition to our attention, your story could save another Shiba's eyes in the future.
    Cynthia, Proudly owned by Kira
    Kira the Cream Shiba Inu 吉良 - Facebook Page
    Follow Kira on Instagram! Kira_the_cream_shiba_inu
    Kira's Life Story & Photo Thread - Chronicles of Kira

    “Dogs are not our whole life, but they make our lives whole.”
  • @kira_kira - your usual vet can perform a pressure test, you don't need a specialist for that. Glaucoma is genetic so it is also good to check with your breeder to see if any of their dogs (either in their breeding program or related) developed it later in life. Onset is often after 6 years from my understanding and unfortunately quite a few popular studs developed it after they were already used in various programs.

    CERF btw is meaningless when it comes to a propensity for glaucoma. Unfortunately, while it is not uncommon in the breed, there seems to be a lot less awareness of it and due to the average age of onset, it can be more difficult to screen out when deciding on a breeding even though it is the genetic issue that often has the greatest impact on quality of life. The only screening that a breeder can do is for narrow angle glaucoma (which is only one of the types of glaucoma, but I believe it is the most prevalent in nihon ken) which does need to be performed by an opthamologist I believe.

    Also, you can do a pressure test at any age, but I think some people recommend that it happen when they are young, 1.5-2, so you can get a good baseline reading in case anything should happen in the future.

    @hanalulu - I'm sorry to hear that Evie's deterioration is going more quickly than originally estimated. You both are holding up amazingly.

    We had Bear checked out and all was fine. The vet didn't see anything but gave us some mild antibiotic drops as kind of a preventative measure. He's constantly sticking his head into foliage (along with his sister) so most likely just an allergy thing. I've started wiping their faces with a damp paper towel after they come in from outside. I was just being extra cautious (Bear actually had his CERF redone and a gonioscopy done this past April) but it was well worth the peace of mind, and the vet was understanding about fitting me in between appointments even though they were slammed that day.

    [edited to add]

    For any one lurking or a new member who has yet to purchase a dog: responsible breeders should be testing for hip dysplasia, luxating patella, CERF, and a gonioscopy (and possibly thyroid checks too). Gonioscopies are performd by opthamologists, but most big vet clinics and quite a few evets I've seen, do have opthamologists on site.
    Post edited by violet_in_seville at 2015-08-10 13:18:56
  • hanaluluhanalulu
    Posts: 195
    @violet_in_seville Thank you. We are doing our best! Right now the goal is to get moved and settled prior to her surgery. This timing is pretty rough and I just hope she can hold out long enough. Loss of eyesight isn't the end of the world, but I look at her and she's just so darn cute! When we have to have the second eye removed, I am going to miss the shiba squint greeting SO much. But she's going to be such a cute little pirate dog and blind dog, too.

    I'm so happy to hear that Bear was fine. Are the precautionary antibiotics drops working?

    Yes, Evie has primary angle glaucoma. It is the most prevalent type and is genetic. Secondary glaucoma I know can occur as a result of another eye issue or eye injury. Evie's iris is beginning to stick to her lens, which is further closing the drainage angle for the aqueous fluid to drain.

    I would also agree with a baseline pressure test at a young age of 2. I think from 5 years and on, pressure tests should become a routine part of annual visits. Our ophthalmologist said 5-6 is the typical age of onset, but he has seen it occur in shibas much younger, too.
  • AntoinetteAntoinette
    Posts: 887
    @hanalulu-I thank you so much for your chronicling of Evie's glaucoma in an effort to help the rest of us Shiba Parents. I am so very sorry that Evie's condition has worsened in her right eye. I admire your courage and your dedication to your furry angel Evie. I am sending you and Evie hugs and positive energy.
  • Thanks for awesome information, My big concern is how do you manage to test the eye pressure, my Shiba wont stay put if someone want to touch her face, or basically if they want to do something to her she will get air borne. I don't think she let anybody to take the eye pressure, any suggestion?
  • hanaluluhanalulu
    Posts: 195
    @parissa_wall2 - I'm so sorry for the delay in response. A lot of times the vet can use calming mechanisms to assist with keeping your pup calm for testing. You bring up a great point though - a struggling dog's eye pressure may not read correctly.

    To be honest, Evie thrashed and was very difficult the entire first week we started applying eye drops. It required a lot of patience, time, and training with high-quality treats. We found a really special treat she loved and decided it would ONLY be used for eye drop time. Now she generally lets us put them in without a second thought.

  • hanaluluhanalulu
    Posts: 195
    An update on Evie -

    Our last eye appointment in December told us that her right eye pressure was starting to creep up. It was at 23 (want to see it under 20). They remove the eye at 35 and when the eye is no longer capable of vision.

    This past Sunday at 1:30p, Evie began squinting and holding her eye shut. On Monday morning, I woke up and she was holding both eyes shut. My stomach dropped. We got an appointment for 6:00p Monday night and luckily the only reason her left eye was closed (and even goopy!) was sympathetic. The left eye still looked healthy and beautiful.

    The bad news? Her pressure in her right eye was at 55: painful and now suddenly fully blind. They advised us that the vision would not come back this time and the pressure would not come down, as we were maxed out on treatment options for the eye. After a lot of crying and sadness, on Tuesday, as advised, I called and made the appointment for Thursday, January 14. They had no openings this week, although I called twice on Tuesday to see if they had any cancellations. None.

    Tuesday night I got home from work and she was so clearly in so much pain. I cried again, this time because of how much pain she was in and how miserable she was. I couldn't see how she could possibly make it another 8-9 days with the pain getting even worse. Yesterday morning I called again. No cancellations. I reached out directly to the eye specialist and told him her pain was getting worse and we needed to do something to get her through 8 days. He agreed with my concerns and is fitting her in today.

    When I left work yesterday, I wondered if I made the right call, pushing to move the surgery date up. I walked in the door and Evie had both eyes closed, was hiding in the dark, softly crying and shaking. I made the right decision.

    While I've been so sad this whole time at the idea of losing her vision and eye, I'm grateful we can give her relief from this unrelenting pain. Glaucoma is a monster.

    Today will be emotional and I am anxious for it to be over. Saturday is her birthday, and I am sad she has to spend her birthday like this, but I think she will feel tremendously better.

    Post edited by hanalulu at 2016-01-07 07:58:52
  • sunyatasunyata
    Posts: 8589
    @hanalulu - Oh Evie. :(

    I am so sorry that she made such a turn for the worse. But I am glad that she is having the surgery today and will be on the road to recovery shortly.

    Keep us updated on how she does post surgery.
    Bella 2Mountains 2Nola 2
    Casey, with Bella and Nola, hanging out in the mountains of Virginia.
    I Wander, I Ride
  • hanaluluhanalulu
    Posts: 195
    @sunyata - Thank you for the kind words. It all happened so fast this week. I've heard recovery usually is pretty quick for them to start feeling better (after 3- 4 days they can seem pretty back to normal!) I am so anxious for her to be done and us to be home tonight!
  • @hanalulu-I am so very sorry that your darling Evie is doing worse. Please know I am sending love and healing energy. Please keep us updated.
  • hanaluluhanalulu
    Posts: 195
    @Antoinette - Will do and thank you very much!
  • Thanks for the update. So difficult to hear how much pain she is in but glad they could fit her in this week. Really, thank you so much for sharing the details. Glaucoma is one of the main issues commonly found in shibas but there is very little talk about it when we discuss general health issues and testing for the breed.

    I hope she feels better soon!
  • hanaluluhanalulu
    Posts: 195
    It was such a relief to pick Evie up and get her home last night. I held it together really well all day. I was very composed dropping her off because she feeds off my energy so much and is very sensitive. I didn't cry all day until I got off the phone with the vet saying her surgery went great. Then the floods came.

    Her surgery was at 2:00p and I had her home around 6:30p. The effects of the anesthesia were very noticeable last night (aside from being groggy). Evie was shivering and crying (I don't believe the crying was from pain based on everything they gave her, including a 24 hour Rimadyl pain shot).

    Evie has been a bit guarded and has not wanted to shut her eye. Although she lost vision in the right eye on Sunday/Monday, I think it must feel very odd to all of a sudden have an emptiness where an eye once was. This may sound strange, but I've found that classical music, specifically harp, calms her (and I've heard this can especially help with fully blind dogs).

    We fed her a small amount of chicken, tiny bit of broth from boiling the chicken, white rice, and pumpkin last night. She was starving, which I took as a great sign. I fed her again this morning and she was again starving.

    For after-care:
    -We are to keep a cone on her for 2 weeks.
    -She's only to have leashed walks for 2 weeks (no romping and running).
    -Check-up in 12-14 days to see how healing progress is going.
    -Antibiotic once a day for 10 days
    -1/4 to 1/2 a tablet of Tramadol every 8-12 hours
    -1/2 a tablet of Rimadyl every 12 hours
    -Discontinuing Latanprost drops (which were only in the bad eye)
    -Discontinuing Amplodipine (neuro protectact/assisted with keeping pressures down)
    -Continuing Dorzolamide twice a day in left eye
    -Continuing Prednisolone once a day in left eye

    A couple of photos from last night:
    photo 8991b2c0-afef-472a-85ec-b6eb0134da15_zpsrgpqysa0.png

    photo 8991b2c0-afef-472a-85ec-b6eb0134da15_zpsrgpqysa0.png

    Seeing her was really hard, but the first thing I told her is that she's beautiful. As horrible as it looks, I think the eye specialist did an excellent job. He used nonabsorbable sutures inside and out and tucked the exterior sutures in so we have nothing to remove. She will continue to bruise and swell for a couple of days, but we will see that come down beginning about day 5.

    I chose to have no implant, as that's just cosmetic. And for the interior sutures, the eye specialist and I chose absorbable sutures. It's very common for non-absorbable sutures (or meshwork sutures) to be used in the interior when no implant is placed to help reduce sinking. We decided to go as natural as possible to reduce complication as much as possible. I don't care about sinking, I just want her to be comfortable and healthy. I should mention that the incidence of complication with non-absorbable sutures or with implants are really pretty rare and it's a very personal decision. CSU Veterinary Hospital in Fort Collins uses non-absorbable sutures and performs a meshwork suture (no implant). I leaned that way for a little while until I decided that caring about the sinking was also just for me. She's resting now and I'll try to post an update again soon.

    Thank you all for the kind thoughts and words! I really hope that documenting our journey sheds some light and helps to provide information. I felt like there was such a lack of detailed stories for me to find on the internet.

    Post edited by hanalulu at 2016-01-08 08:52:24
  • hanaluluhanalulu
    Posts: 195
    I realized I accidentally posted the same photo twice. Here is the other photo I meant to post (both the previous photo and this one are from last night):

    photo 8824cfa9-4c06-4111-96d6-de5dae96841d_zpseprbkqhq.png

    Here are two photos from this morning:
    photo fbd74686-a2b4-40f5-8870-ee83392b7e58_zps7qxjl9d2.png

    photo 616f2b29-14b3-49ca-ae8d-3bb388d7763a_zpso7zrfmta.png

    They said a little bit of drainage/oozing from the eye is normal today and that a little blood-tinged drainage from that side nostril is also normal. We've had both.
  • I just want to say that I am so sorry for what you are going through with Evie, it can't be easy. She is beautiful shiba, with a wonderful person taking care of her! Big healing hugs sent for you both :)

    Thank you so much for taking the time to document everything so well. I just know that your experiences will help anyone else who might have to go through this.
    photo d48c316d-ce82-4a25-89fa-c1b57a673aa8_zpsqzf1t0cc.jpg
    Forever in our hearts.
  • pyleapylea
    Posts: 235
  • NikkitineNikkitine
    Posts: 776
    Lots of prayers and healing energy for your sweet Evie. Thank you so much for sharing your experience with us.
  • JuniJuni
    Posts: 1269
    I hope for a speedy recovery and a happier Evie afterwards. It is so hard to see our loved furry ones suffer.

    Juni has always acted "weird" after she has had anaesthesia. I think it can make them dizzy, nauseous and even get a bit of hallucinations. So she never wants to lie down and nap, she feels better if I hold her tight or if I prop her up against some pillows.
  • @hanalulu-Thanks so much for keeping us updated and for documenting everything so well. I can only imagine how difficult it must be for you to see your darling Evie suffer. I am sending you and Evie lots of hugs and healing energy.
  • hanaluluhanalulu
    Posts: 195
    Thank you all for the positive thoughts! Evie is healing up rather nicely. I'm anxious for us to be back to normal so she can get out of the awful cone. She unfortunately cannot be trusted out of it as she immediately tries to rub and scratch.
  • ehu_guyehu_guy
    Posts: 23
    @hanalulu - Thank you so so so much for keeping us updated. Sending a lot of positive thoughts to you and Evie. She's so lucky to have you. My heart is so heavy thinking of what you both had to go through.

    I'm definitely going to have Ehukai's eyes checked (he's 1 year and 5 months) and the littlest squint he makes now gets me worried! Thanks again for sharing. I know your post is going to help so many.
  • hanaluluhanalulu
    Posts: 195
    It's been a little while since I last posted and I wanted to provide an update on Evie. A couple of weeks ago, she had a dreaded pressure spike in her eye. I could tell because she was holding her eye closed. I called in to work and took her to the vet. They were wonderful - initially they had us tacked on at the end of the day, but the vet noticed us on the schedule and told rue front desk to call us back. Since it's glaucoma and the first spike in this eye (that we were aware of based on symptoms), he had them fit us into the schedule immediately.

    We received the news we've been hoping would wait as long possible - glaucoma hit Evie's second eye. We have been giving her two different maintenance drops and they added a third to help reduce intraocular pressure. I had to make a decision that day as to whether we wanted to have a shunt put in to possibly prolong eyesight (there's a 50% chance she would have vision in one year from the surgery). I decided I wanted her to go naturally and didn't want to put her through any additional stress or anesthesia. We've determined she's probably lost 30-50% of her vision in this eye so far from the pressure spike. She can't see very well at night or in the dark and will bump into things.

    Now we wait. Eventually, like in the other eye, the drops will stop working and it will come time for her eye to be removed. Last time, we got about 6 months before this happened. I feel very sad but slightly more at peace than with the last eye. I'm so sad she won't have any vision soon, but I also feel that the last round taught me acceptance and the realization that blindness compared to excruciating pain is not the end of the world. (Someone please remind me I said this and felt this way when enucleation time rolls around!) There's also a certain amount of comfort in knowing what to expect and how everything works now. With the last eye, all is the unknowns and the decisions were hard to deal with. This time, we know how we want to handle things - no shunt or ecpc to try to prolong vision, no prosthetic eye, and dissolvable sutures only. One correction to her surgical post above - I mistakenly listed at one point that he used non-absorbable sutures. He only used absorbables.

    One game changer is that in March of last year we unexpectedly inherited a second dog. Luckily he gets along pretty will with Evie, but he can be a pretty grumpy guy. I don't think he will be that amazing seeing-eye dog type you may have seen YouTube videos on, but hopefully they will be able to coexist well once Evie's vision is gone.

    Thank you all for being so supportive on this journey with us. It's heartbreaking, but I remind myself it's not life-ending.

    P.S. She healed beautifully from her first enucleation and I will try to post photos soon. She occasionally has bumped into things on her blind side but really adjusted beautifully. She's one darn cute pirate!
    Post edited by hanalulu at 2017-02-17 02:34:34
  • hanaluluhanalulu
    Posts: 195
    I should have described our course of care better in the previous post.

    Evie has been receiving one drop of Dorzolamide Timolol twice a day and one drop of Prednisolone Acetate once a day since diagnosis of glaucoma in her first eye. We have now added one drop of Latanoprost twice a day. We have full prescriptions of Rimadyl and Tramadol on hand in case of a flare up or obvious pain. We have the ability to increase the drops slightly (to three times a day), but at that point you are often just buying weeks.

    Below are some photos, as promised.

    Evie, 2 days post-surgery in January 2016. This was her birthday pupcake.
    photo 0048ebf1-c36a-434b-98e2-5766ab100cd5_zpsyouxzwpq.jpg

    About a week post-surgery in January 2016.
    photo 733a9291-d164-477e-a692-be5535192a3c_zpsnviplcn5.jpg

    A couple weeks post-surgery.
    photo 983bd246-8743-4fd7-8bf0-04b00fadd565_zpsxca4rjzs.jpg

    photo c43eb280-f195-4c54-9b97-5620ce74de6d_zpsiov7d4pl.jpg

    All healed up!
    photo ae14dcb8-76f1-4295-90f5-7b1390c3ba84_zps5cqrhemi.jpg

    photo 5e2117fe-b680-44e8-b8fd-2aa1ed62a71e_zps285t4hut.jpg

    photo 4dd56339-bb46-4dad-862b-5c0d5c2d22ee_zpsbh18nwqx.jpg

    The new dog (we think he's about 12 and may be a Corgi/Cavalier King Charle's mix. My boyfriend's father passed away unexpectedly last March and we inherited this grumpy little guy).
    photo 09aa71e8-99b5-46b0-ab6b-6581ae637fd3_zpsecvccfvs.jpg

    photo 5fa3e8a2-0f16-469c-8f58-43190dfdb4a0_zps3rg8xsq7.jpg

    Evie's pressure spike from a few weeks ago (January 2017).
    photo 82c5db37-b69e-4a17-9c9f-ced58f222cb9_zpsn5qgonnf.jpg

    Post edited by hanalulu at 2017-02-17 03:18:31
  • sunyatasunyata
    Posts: 8589
    @hanalulu - I was actually thinking about Evie yesterday. I am so so sorry that you are dealing with this again. But I am glad that you feel more at peace with it and that Evie is getting excellent care. *hugs*
    Bella 2Mountains 2Nola 2
    Casey, with Bella and Nola, hanging out in the mountains of Virginia.
    I Wander, I Ride
  • @hanalulu-Thank you so much for your update and I am so very sorry you and Evie are dealing with this again. Evie is getting much love and excellent care. Quakey and I are sending peaceful thoughts, Shiba hugs and healing.
  • hanaluluhanalulu
    Posts: 195
    Thank you both very much! We are training with her in commands now so hopefully she knows what they mean once she loses eyesight. Things like: step up, step down, easy, stop. I hope it's helping... I can't tell yet, but I want try to say these any time we do one of these things and really now need to start reinforcing them more. Once we get these down, I'd like to try to teach her right and left.

    One thing that's bothering me is that she has a cyst on her back we've been watching. It's getting bigger - about nickel size and I just don't know if I should have it removed or try to continue to wait out her eye surgery. We have had it aspirated twice and it was non-cancerous both times, but I don't want it to get too big since it's on her lower back about 2 inches above her tail and there isn't a ton of extra skin there. I am really scared to put her under anesthesia twice in such a short period of time (with how her eye is going, I really would be shocked if we make it 6 months before she needs her eye removed).
    Post edited by hanalulu at 2017-02-20 04:44:20
  • AnjyilAnjyil
    Posts: 776
    This is so sad :( I hope everything turns out for the best. This post has been a real eye-opener about things that can happen later on down the line. Thank you so much for sharing.
  • Mochi920Mochi920
    Posts: 357
    Thank you so much for sharing. Evie is so lucky to have such an amazing owner who is strong in these tough times and loves and cares about her as much as you do. :) I'm sorry you have to go through this.
  • hanaluluhanalulu
    Posts: 195
    Thank you @Anjyil and @Mochi920 !

    Just wanted to post an update that it's been about 29 months since Evie's diagnosis of glaucoma in eye #1 and we are still holding strong (*knock on wood*) in eye #2. We've honestly made it longer than I thought keeping her second eye and I'm grateful for all the time we are blessed with. Her pressure has been slowly creeping up towards 20 and we have a check-up again in about a month. I've been taking her for lots of fun hikes so she can get some good adventures in and I don't intend to stop when we do lose the second...we'll just have to make some adjustments!

    Another not so fun note - her eye drop prices have been fluctuating dramatically between medication price increases and difficulty in my pharmacy being able to get their hands on them post-hurricane. Even with GoodRx and Costco, some of her drops have more than doubled in price.

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