Part Three—My Aging Dog
Brillo’s eyesight was overtaken by cloudy white cataracts. He was fourteen when a veterinary ophthalmologist told me he was “not a surgical candidate” for cataract removal. Brillo became isolated in his deafness and blindness. His outgoing personality receded into unsureness around dogs he didn’t know, new environments, and experiences he was not familiar with. He withdrew from life—and became uncharacteristically clingy with me. He slept more and more. He lost interest in food. But when awake he constantly searched me out as I moved around the house.
Sometimes I stood right behind him but he’d trot to another room in search of me. I felt guilty leaving him at all, but for extended absences I placed him with friends and dog buddies he knew. He still loved walks but only in familiar areas that his brain knew the courses of. He followed his nose, not his ears or eyes.
Once again, I asked Dr. Converse for an ophthalmologist referral. I wanted a second opinion. Brillo was still so healthy, I thought we might have one or two more years together and I wanted that time to be as high a quality as I could make it.
Dr. Converse was quick to reply to my pleading for Brillo’s eyes. He told me it pleased him to work with a pet owner who was willing to advocate for their pet and utilize all modern veterinary medicine could offer. I was stunned that a doctor of skill, experience, knowledge, and compassion was continuously hampered by the limitations of pet owners’ priorities—whether they were lack of emotional attachment, fiscal ability, or the appreciation for the caliber of connection that a pet bestows upon their caregiver. He and I agreed that veterinarians and pet owners should be partners in doing all the best we can for our vulnerable animal companions.
“There’s a new guy in town,” Dr. Converse told me and handed me a business card. “See what he thinks.” I flew home a Googled the website.
My heart skipped a beat when I saw who “the new guy” was! He was Dr. Matt Chavkin, one of the first, and most renowned, veterinary ophthalmologists in our area! Dr. Matt and I went back twenty-five years with my own previous dogs and the rescues and fosters we had worked with. Then he moved away. Now he was back!
Preparing for the Miracle
Days later Dr. Matt determined that Brillo was a candidate for cataract surgery—if he passed the preliminary tests. At fifteen, Brillo was older than the “average” cataract patient, but I felt confident that Dr. Matt and his team could restore a quality of life to my little old man that had been lacking. We planned the needed tests.
The Two Preliminary Tests
First was the retina check. There is no point in removing cataracts if an individual (human or animal) has damaged retinas. The retina lies at the back of the eyeball and reflects the images drawn through the front lens and sends that data to the brain to interpret. With cataracts, no light passes into the retina and therefore no data is sent to the brain. In humans, the lack of data can sometimes cause an active brain which loses visual input, to experience visual hallucinations. No one knows if these hallucinations exist in dogs but there is no reason to believe they are different from us. Perhaps the complications of aging, that are impossible to explain to dogs, are the basis for the behavioral changes we see in our pets–as their blindness progresses, especially when combined with the isolation of deafness.
An electroretinogram (ERG) is an electronic pulse test that shows the retina behind the cataract and projects that image on a computer screen. First, the doctor administers sedation medication to calm the reactive dog. Dogs may need to be sedated for this test, but Brillo didn’t need to be. He sat still and enjoyed the close contact of humans completely focused on him!
Next, Dr. Matt dripped dilation drops into Brillo’s eyes and we waited twenty minutes. The mature cataracts grew to ghostly white disks. Brillo looked like a Zombie dog! Once dilated, Dr. Matt applied anesthetic eye drops. After a few moments, he placed two acupuncture-sized needles—one in the forehead and the other behind the occipital bone of Brillo’s head. Dr. Matt inserted a small contact lens-like electrode into the first eye, and shot bursts of bright lightening from a hand-held light gun into the contact electrode. The electrode measured the electrical activity of Brillo’s retina in response to light. As the light flashed, the electrical response traveled from the electrode to a TV-like screen, where it was viewed and recorded. He then repeated the test on Brillo’s second eye.
The second surgical qualifying test was the ocular ultrasound. Dr. Matt performed an ocular ultrasound to look at the hidden eye structure behind the cataracts. He applied water-soluble ultrasound gel and placed a high-frequency linear probe directly on the anesthetized cornea. He gently rotated the probe and scanned the inside of the eyeball with minimal topical pressure. In regular ultrasounds, the soundwaves echo off internal obstacles, but an optical ultrasound uses a pulsed light to emit soundwaves via the photoacoustic effect– when light produces heat, increased pressure is expressed in the form of a soundwave. From there, a transducer measures the returning soundwave in the same way as traditional ultrasound. Optical ultrasound provides greater variability than the standard ultrasound. Ocular/Eye Ultrasound is a quick and non-invasive way to evaluate for the most common ophthalmic pathologies with very high sensitivity and specificity.
In Brillo’s left eye even I could see a dense field of “floaters.” Dr. Matt said he could restore some vision to that eye but it would be blurry at best. Brillo’s right eye had only a few floaters and Dr. Matt felt good vision would be accomplished.
Preparing for Surgery
Four days before surgery Dr. Matt gave me anti-inflammatory prednisolone eye drops to apply to Brillo’s eyes. The first two days were to be twice a day, the second two days three times a day. These drops prepare the eye for surgery by quieting any possible irritation
For the last few days before surgery I wanted Brillo to be strong, well nourished, and clear-lunged. . Brillo’s appetite had decreased over the last year, so I periodically gave him an appetite stimulator (courtesy of Dr. Converse). I gave him small administrations of appetite stimulant, and as much of his food as he would eat. I walked him every day so he could clear his lungs, in preparation for the two-hour anesthesia he would undergo during surgery.
The night before surgery I gave Brillo his last meal—canned special diet (he has had periodic bouts of pancreatitis), with yummy shredded, drained white chicken breast mixed in. I set the alarm but didn’t need to—I was too nervous to sleep.
Part Four—Miracle Day for the Miracle Dog
At 6:30 am. on surgery day, I dressed Brillo in his sweater and new harness (no collars after eye surgery), then drove to Dr. Matt’s office. We arrived ten minutes early and Dr. Matt was not in yet so I again walked Brillo around the building for a final lung clearing, pooping, and bladder emptying. As the sun rose orange above the snow bank at the end of the parking lot, Brillo and I saw Dr. Matt arrive. He bent down to welcome Brillo and then together we went into the hospital. Once in the brightness and warmth of the examination room, Dr. Matt took Brillo from my arms, reassured me, and went through the surgery theater door. I went home alone to wait.
When Brillo was anesthetized, Dr. Matt laid him on his back on a special air pillow that could be pumped up to the most supportive level to reduce bodily strain and yet to immobilize Brillo’s body. At no time was Brillo “tied down” to a flat, hard operating table. Brillo’s body was kept warm on the heated bed. I had warned Dr. Matt that when Brillo had a cancerous anal gland removed years before, Brillo became hypothermic during surgery and they had to wake him up and warm him. The operating veterinarian had to leave the healthy gland, even though I had asked for it to be removed also. Worried, I asked Dr. Matt to work on Brillo’s best eye before the eye with the floaters—just in case they had to pull him out before finishing. I hoped for at least one eye to be restored if they ran into anesthetic trouble. Dr. Matt agreed to do so.
Dr. Matt sat at Brillo’s head and worked on him by bending over from an upside down position. The process of cataract removal is called phacoemulsification. After making small incisions in Brillo’s cornea and lens capsule, Dr. Matt sat with his right foot on a paddle that controlled the power of the emulsifying ultrasound generator. He inserted an emulsifying needle connected to the machine and controlled by his right foot paddle emitted sound “markers” to let the operating team know the various levels of power that were responding to even the tiniest pressure from Dr. Matt’s foot. He controlled the high-frequency ultrasound vibration and pulverized each lens, reducing the hard calcifications to what he described as “a Slurpy” consistency, then removed the gel by vacuum.
Dr. Matt’s left foot controlled the foot paddle that operated the magnifier on the machine. Although Dr. Matt had magnifier cameras in front of him, the images were also transferred to a larger screen on the machine for the team to monitor.
The foot paddles freed Dr. Matt’s hands to control the needles—for emulsification and irrigation—as he vibrated each cataract. Dr. Matt later explained how hard Brillo’s old age cataracts were to break down, as opposed to diabetic cataracts which are softer. Once each cataract was emulsified and removed, he inserted artificial lenses into Brillo’s eyes, and sutured the corneas closed. Dr. Matt pioneered the suture size and technique he uses to best anchor the new lens and deter irritation, slippage, or failure during healing. The infinitesimal sutures eventually absorb and do not have to be removed. He also sutured the outside corners of Brillo’s eyelids to further stabilize the new lenses.
Two hours later, Dr. Matt called and told me Brillo had done very well. Brillo had no problem with the anesthesia and was waking up with one of the staff technicians holding him. I was appreciative because in my years as an on-site shelter medical volunteer, I’ve seen how disoriented pets can become as they wake up from anesthesia. The comfort of a human holding a groggy pet helps avoid emotional trauma, agitation, and possible physical injury as some pets throw themselves around in delirium.
Brillo came home later that afternoon with a clear plastic “Cone of Shame” to keep him from touching his eyes with his paws or accidentally bumping into anything as his vision healed and cleared. I was loaded up with more prednisolone eye drops, plus an antibiotic drop, and instructed to apply them every four hours. Although I didn’t have to apply the drops overnight, my worry woke me up several times that first and subsequent nights at all hours, and so I did apply them anyway.
Brillo was also forbidden from jumping on furniture, running, playing, or navigating stairs for the first several days. I placed a baby gate in front of the sofa, took him outside to potty on leash, and carried him up and down stairs. He was too groggy to run, didn’t play, and pretty much stayed in his beds in front of the fireplace or next to my bed. He didn’t seem to mind the e-collar cone, but then he was an elderly dog who had just come through a rough time.
The First Days after the Miracle
When I awoke the next morning, I was half expecting Brillo to jump up and down, barking excitedly that he could see! True to form, he slept late and woke to me staring at him. Dr. Matt told me it might take up to two weeks for Brillo’s new sight to “settle” and become defined. When he woke, he was still groggy from the drugs the day before so I carried him to the yard. Gingerly, he padded his way through the snow, found his favorite trees and shrubs, and peed like always. Because he was on a leash, I couldn’t tell what he saw or how he interpreted what he did see.
We came back inside to the kitchen where I made his breakfast. Not normally a morning eater, I thought he’d be ravenous with no real meal since the night before the surgery. He’d nibbled a bit upon his return from the hospital, but ended up sleeping most of the evening and night. Brillo did eat more but didn’t show any change in enthusiasm. Again, I was disappointed that he wasn’t as excited as I was.
When I took Brillo outside the second day, I didn’t put his leash on. I watched him closely as he slowly navigated the step down from the patio to the snow covered yard. He trotted his normal pace to one of the trees, peed, and then headed out on his normal yard patrol. He had learned to navigate by scent and his pace and course made it impossible to tell if he was experiencing improved sight. I watched over him from the patio sliding glass door, as I always do when he is in the yard, wrapped in my warm, fluffy white robe.
THEN, at the far side of the yard, Brillo raised his head and looked towards the house. Still unsure of what he was seeing, I waved “hello” to him. His tail came up and began to wag! He jerked to attention and stared at me. I waved again. Suddenly, Brillo began to trot—right towards me! He might have thought my casual wave was our old hand signal meaning, “Come,” but I didn’t care. He saw me! He interrupted his patrol and was coming to me! My heart leapt with joy!
Continued in next blog~