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Glaucoma - Onset, Diagnosis and Management
  • hanaluluhanalulu
    Posts: 195
    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 - 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
  • 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
    Post edited by hanalulu at 2015-07-29 00:58:07
  • hanaluluhanalulu
    Posts: 195
    Post edited by hanalulu at 2015-07-29 01:12:06
  • hanaluluhanalulu
    Posts: 195
    Post edited by hanalulu at 2015-07-29 01:10:29
  • sunyatasunyata
    Posts: 8589
  • 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
  • hanaluluhanalulu
    Posts: 195
    Post edited by hanalulu at 2015-08-06 23:04:45
  • hanaluluhanalulu
    Posts: 195
    Post edited by hanalulu at 2015-08-06 23:05:45
  • hanaluluhanalulu
    Posts: 195
    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
  • @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
  • 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
    Post edited by hanalulu at 2016-01-08 08:52:24
  • hanaluluhanalulu
    Posts: 195
  • pyleapylea
    Posts: 235
  • NikkitineNikkitine
    Posts: 776
  • 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
    Post edited by hanalulu at 2017-02-17 03:18:31
  • sunyatasunyata
    Posts: 8589
  • @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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