Eyes out!

This morning was fun, but actually went fairly slow.

We started off the morning at 8am with a case that J took. I went in to restrain the golden retriever while she did her exam. [Note: how many golden retrievers named Bailey do you know?] All we found was some scleral injection (the white of her eye was red), and very slight aqueous flare (inflammation between her cornea and her pupil). Since she's had no changes in vision, no pain, no squinting, no - well - anything, we were kinda confused. We went out, presented the case to Dr K, and she groaned and said "I HATE Golden Retriever Uveitis", to which J and I kinda tilted our heads and humored her. Fortunately, Dr D offered to take the case (she was supposed to be prepping for a horse surgery). We went in, Dr D re-examined the dog, and diagnosed her with, ta da, Golden Retriever Uveitis! It's essentially an idiopathic (we don't know why it happens) disease only of Golden's, that will probably eventually cause the eye to get glaucoma, which is very painful and often results in blindness. Under the microscope, Dr D said she could see lots of pigmented cells floating around in the anterior chamber of the eye - but we didn't see those because we're not supposed to touch the scope.

Next, I saw my own appointment, with a little sneezy Pekingese. Ugly old little dog - but very sweet and adorable. It was the fourth or fifth visit that he'd had with the ophtho service, and it was a three week recheck of a deep corneal ulcer. The danger with deep corneal ulcers is that they can go full thickness and then the eye pops and that's bad. I stained the eye with fluorescein (orange strip, the dye is green/yellow), and nothing showed up! I was actually incredibly happy to tell the owner that the eye was completely healed, that all medications could be discontinued and the e-collar didn't have to be worn anymore, and that he didn't have to come back unless something new and different happened. Even though he had to wait a little bit to get a Dr in to double check my findings, he was a happy happy man. It was fun to be able to have such a positive experience with a client!

Next I went into R's appointment, a little mini poodle with cataracts in both eyes. The cataracts were almost complete, so the dog was pretty much seeing the world through frosted glass. The owners were VERY interested in cataract surgery, which meant that we had to make sure that the dog would be able to see if the cataracts were removed. This was a slight problem, because when we shined a very bright light into the dog's eyes, nothing happened. In either eye. Even if he was seeing a very hazy view from the world, having a spotlight shined in your eye in a dark room should make your pupil's constrict a little bit. So we actually go to do an ocular ultrasound, which showed some vitreous degeneration but no retinal detachment (age related changes with little to no effect on vision). Next we got to do an ERG (the EKG for the eye to measure electrical activity). I was busy doing other stuff while they did that, but unfortunately the dog failed the test. The eyes didn't respond at all to the light during the test, and produced only baseline electrical activity. This means that the dog would not have been able to see even without the cataracts, which makes him not a candidate for cataract surgery. Best quote from that appointment, spanish wife elbowing white geek husband, "SEE! I told you it wasn't the tortillas that were making him blind!"

Then I hung around to wait for a noon appointment that was just supposed to be a fake-lens (cataract surgery) recheck, the surgery was done at Cornell and the owners have since moved. When the owners still hadn't checked in by 12:30, I was sent to go up to the waiting area and call to see if the dog was in the waiting room at all. He wasn't. When I got back, I made the technician check the messages, and the owner had called at 8:30am to say that he couldn't make it because of the weather. Because of the craziness of the morning, and the fact that they removed a horse's eye this morning (I wasn't in on that one), no one had gotten around to checking the voicemail.

In the afternoon I grabbed the first appointment (at 1:30), because J was still finishing up an 11am appointment (that dog ended up being there until 5pm doing various stuff). Since we went into the appointment fairly sure that we would end up taking the cat to surgery, J was supposed to take the appointment. Instead we compromised, and I did today's workup and paperwork, and she'll get to scrub in on the surgery tomorrow and do all the paperwork that goes with that. The cat was a beautiful 16 pound gray Maine Coon Cat who was just the mellowest cat ever. I was totally in love with him. Unfortunately, instead of a right eye, he had a mass the size of a golf ball completely filling his eye socket. We did a short workup, including chest radiographs to check for mets (cancer likes to hang out in the lungs) and to evaluate his heart because he had a roaring murmur*. The owner finally elected surgery, and he'll have surgery at 9:30 tomorrow morning. This case is sweet, because the only reason the owner let the mass get that big was because he was under the impression that the cat would not live through surgery due to the murmur. Apparently on Friday he came in on emergency because the surface of the mass had become infected and the eye was smelly and rotten. It was completely clear of infection today, thank god. But the owner came in today with the knowledge that even though the cat might not live through surgery, the mass was bothering the cat enough to take the chance. I can't imagine coming to the vet with the fact that your cat is not going to live, despite obvious health other than the eye. What a sweet, well meaning, but uninformed man.

I grabbed one last case at the end of the day, a miniature poodle who had his eye removed two weeks ago and was coming in for suture removal and a last recheck. We did the recheck, took out the sutures, and once again got to tell the owner that he did well and that he doesn't have to come back unless a new problem develops. Also a very good feeling!

Tomorrow: grand rounds (Dr P's presenting one of them), 9am recheck appointment that's mine, J's cat eye enucleation at 9:15am, R's dog eye enucleation at 10:45am. Teaching student labs: 1-5pm. Then home for the night!