Saturday, April 18, 2009

A New Challenge

I forgot to acknowledge Nova's 5-month ampuversary here. But, on the 11th of April she was celebrating 5 months as a Tripawd! So exciting! Happy Spring, everyone! Last week a duck decided to lay some eggs in the bushes right in the front yard. Stupid duck! Not exactly the safest place with two stalking, duck-loving Great Danes! Thus far I have managed to keep the girls from eating the eggs although yesterday I caught Emmy "mid-lick". We haven't seen the Mom around in awhile, so are not sure if she abandoned the eggs once she saw the hulking creatures who enhabit our property:
We have a new challenge that we have been dealing with these past few weeks that is not related to her amputation or her cancer in any way. Many of you already know that, on top of her challenge of being on 3 legs, Nova also has the challenge of being blind in one eye. She was diagnosed with uveitis and glaucoma in her left eye a few years ago, and since that time has been blind in that eye. It was hard because we never really knew for sure that she was TOTALLY blind in that eye, but all exams indicate that. With a dog you never really know for sure.

Glaucoma causes pressure in the eyes, and it must be treated for the rest of her lifetime with expensive eyedrops. In the past, the pressure would increase occasionally, which would require us to tweak her medication. But each time, a change in medication would take care of the problem, and she'd be fine again (still not seeing out of the left eye, but the pain would be better).

About a week before we left on her "road trip", we noticed that the left eye had been bulging more than usual, and it was starting to cloud over more, when it really hadn't before. I knew something had changed. She still seemed very happy, although she would occasionally not come for her breakfast or dinner. I called her opthamologist, and he said to put her back on one of the drops called Xalatan. Argh. Xalatan is REALLY expensive, and comes in such a tiny bottle that it barely lasts. The employees at the pharmacy call it liquid gold. So I sucked it up and got another bottle of Xalatan, knowing that last time it did the trick. I was just hoping she didn't have to stay on the Xalatan forever.

I was nervous about having pressure issues with her eye while we were on vacation, because we would be in a somewhat remote place, and so far away from her specialist. We started her back on the Xalatan and a few days before we left on the trip, took her to her regular vet to get the pressure tested. It had come down from the mid 40s to the mid/low 30s, so everyone took that as a good sign. The optho said to keep her on the Xalatan throughout the trip, then check the pressures when we returned.

I gave her all her drops religiously on the trip, but looking at it, it seemed to be getting worse. She didn't seem like she felt bad, in fact, she was more active on the trip then I had ever seen her. But if you look back at the pictures of the trip, and look at her left eye, you can tell there is something there that is not right.

I took her in to the vet on the Monday after Easter and it was bad news. The pressure had shot up into the mid 50s. I called the optho and had to wait all day for a callback. While I was waiting, I researched info on what the options were from here. The eyedrops were getting to the point that they were very expensive, and it is time consuming to give them. Each must be given in a specific order, at least 5 minutes apart. And the Xalatan was really breaking the bank! During my research, I read about the extreme pain that comes from glaucoma. For pressures in the 50s, many sites said that that pain was similar to an extreme migraine headache in a human. UGH! I've had migraines, and I can't imagine doing ANYTHING while in that sort of pain. This girl is amazing. I certainly would have no interest in a sunny day like this if I had a migraine. I would be holed up in my bedroom with the shades drawn.

The optho insisted that there was no way he could tell me what to do without seeing her in person (which of course means an expensive specialist visit at MVS, the fancy-pants specialist facility an hour away in Southfield). My regular Dr. wasn't in, so I had to see someone else, Dr. Lorimer, who I ended up liking better than Nova's regular optho. I had read alot about ennucleation (taking out the eyeball and inserting a prosthesis, then sewing the eye up), and the expense scared me. I am all about positive thinking with Nova's cancer diagnosis, but it didn't seem to make sense to spend a ton on an ennucleation when I have no idea how many months (or years??) she has left.

Dr. Lorimer examined her and agreed that we had reached the point where the pressure in the left eye could not be controlled by medication. The eye either had to be removed, or there was the option of injecting something into the eye to "kill" it (actually kills the cells that create the fluid that causes the pressure). The second was the option I preferred, but the Resident Vet I talked to seemed to think that it was not an option for Nova. I asked about the cost of ennucleation, and was shocked that it cost MORE than Nova's amputation surgery! There is no way I could justify that financially. Especially when I had no idea what type of road there was ahead for her cancer.
(Emmy has been a wonderful sister to Nova, and has helped her through her ruff times! She has become Nova's protector in a way.)

Thankfully, Dr. Lorimer said that he thought that, given Nova's situation with the cancer, that an intravitreal injection was the best option for her, and thankfully it was a fraction of the cost (just a few $100). It could be done as an outpatient procedure, and she would have to be put under full anesthesia. The procedure was typically reserved for geriatric dogs, or dogs who might not otherwise have long life spans ahead of them. It was hard to accept that Nova might not have a long life ahead of her, but if the procedure works, it will keep her pain down for the rest of her days. The eye will turn strange colors (it is a cloudy white now) and will look strange, and will ultimately shrink to smaller than a regular eyeball. But it seemed a better option than putting her through major surgery to sew up the eye anyway.
The surgery went well, and I have noticed no difference in her mobility, which is a relief. That means she was definitely already blind in that left eye, and had already been compensating with her right eye. Right now the right eye is okay, but she does have an immature cataract in there, so there may be more problems that develop in that eye. The plan is to wean her off the eyedrops in the left eye (they are still needed for the next few weeks because of the inflammation caused by the injection), and then keep her on the eyedrops (not Xalatan thankfully!) in the right eye as a preventive measure. My hope is that she will have vision in that eye for the rest of her life. I don't want her to become a blind Tripawd, but if she does, I am sure she do all she can to adapt.

On top of all of this, there was some blood in her urine which might be an indication that the Cytoxan she was taking to keep the cancer from growing might not agree with her. It is common for Cytoxan to cause bladder damage. ARGH. Just what I need is bladder problems in a 121-lb. Great Dane. Her oncologist recommended that we take her off the Cytoxan for a week and check her urine to see if she is healing. My whole life has become one medical issue and drama after another with this dog. But it is so rewarding when I see how happy she is. When this all gets to the point where she is not happy anymore, it will be hard to handle. But thankfully we are not there yet.
Even given all her afflictions, Nova considers herself one lucky dog. Lucky to have a family who loves her, takes care of her, and showers her with affection every chance they get. She especially loves getting snuggles from Daddy!

1 comment:

Jerry G Dawg said...

Oh Nova, here we thought you just had a twinkle in that eye! We had no idea it was so serious. But we are sure glad you're doing well. You are SUCH a trooper! Keep it up sweetie, you're our hero.