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A Warm Environment in the Cold Weather

Winter Clinic dos 2014

Been cold enough for you out there? It sure has been for me. I like winter. I enjoy skiing, sledding with the kids, playing frisbee with my dog Tess after a fresh snow, the Winter Olympics this year. a warm fire, Christmas….but wait! I feel like it has been about 9 degrees all season long. Trust me, this is not a big complaint. I lived in Wisconsin for 7 years so this is nothing. And don’t get me started on snow days at school when it closes if it might snow! Alas, that’s one reason we live here is the enjoyment of a change of season and the different activities each season brings. But it is always nice to find that warm spot in the middle of a cold day to keep one comfortable and secure.

That’s what we try to bring here at the Animal Eye Clinic when it comes to veterinary health care. In today’s world of corporate businesses, veterinary medicine is inching along that path. Lot’s of big companies and hospitals out there that present a vast array of services to appeal to the pet owner of all walks of life. One-stop shopping with multiple specialists in the same building, collaborating together to bring you the best service possible. These clinics are wonderful and are, for better or worse, replacing the university teaching hospital as the place to go for complex case management due to their ubiquity and ease of access in many urban settings. I use and even recommend them with complex cases that require overnight care, constant monitoring due to multiple problems that require multiple specialists to manage.

But not all problems require easy access to all of these health care professionals. Some specialties, ophthalmology among them, can thrive as a stand-alone practice. In that situation, the doctor(s) have more control over the environment, staffing and cost of the services being offered. It allows for a more personalized approach to health care, something that is often lacking in human medicine and can certainly occur in veterinary medicine in the larger style practice. In fact, the so-called “boutique medicine” MDs are trying to bring back the old feel of the doctor patient relationship by having less patients and more time to talk to them rather than running as many patients through the door as possible.

If this sort of personalized care sounds good to you, the Animal Eye Clinic in Wilton is your place. I see less patients, spend more time, have a wonderful staff that’s been with me for years and practice in a warm, friendly and clean environment. We give you all your options, educate you so you can make good choices, and repeat it if you need to hear it again. And if you need other specialists to get involved in the management of your pet’s care, I will send you there without reservation. It’s all about making sure you get the right treatment with the right person for the problem that brings you through our door. I know it is a choice for you to come here and we want to insure you made the right one.

What is the coolest animal you have seen?

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This may be one of the more common cocktail party questions that veterinary ophthalmologists get asked! Not that eyes in any species are not cool, but a little exotic flavor can spice up the conversation. Fortunately for us veterinary ophthalmologists, the anatomy of the eye is very similar from species to species. There are significant changes when going from mammal to bird to fish since the anatomy is altered to maximize performance depending on the environment in which an animal lives, however, the main structures are present in most eyes. Disease states will also be different based on these living conditions and expectations of performance since these conditions are varied. Thus, understanding the species variations is important to help one in coming up with a list of differential diagnoses for a given lesion in a given species. Alas, this part is interesting to the ophthalomogist but the attentive crowd at the cocktail party may start to thin! And so, we stick with the coolest creature answer and go from there!

Fortunately, the instrumentation used to examine the dog, cat and horse will also work for the mouse, elephant and eagle. As shown in a prior posting, the slit lamp biomicroscope and the binocular indirect ophthalmoscope are mobile instruments that, if one can get close enough, will allow a good view of the eye in dry conditions. Yes, sedation is occasionally needed for uncooperative animals, but most creatures can be evaluated without much in the way of heavy restraint. Dare I say, even with angry dogs and cats, trauma to the doctor or technician is usually limited to the occasional scratch with proper positioning and respect.

At this juncture, my caseload is mostly limited to the animals that can walk, fly, swim or get carried into the clinic. Large animals, including the exotics, require a field visit which are done on a selective basis. Some of my colleagues specialize in horses or farm animals and some of us may have a relationship with a local zoo, for example, to assist in those needs. We have helped with the Norwalk Aquarium on occasion as well as with numerous wildlife rescue agencies in the area. I will admit, it spices up the day for us, too, to get a break from the dogs and cats that make up 95% of what I see. Therefore, most of our exotics come from these realms as well as second opinions from local boarded exotic specialists.

Enough chatter! Here are some pictures of some patients that have graced our practice. Some we can help and others have sustained too much damage to repair. But most are attached to someone who cares and is willing to treat them with the hope of making their life better!

Grumpy the monitor

Nile Monitor in the exam room

Nile Monitor in the exam room

Grumpy above is a Nile Monitor that presented for evaluation of a hazy eye. All animals with a crystalline lens can get cataracts and Grumpy was no exception. Fortunately for him, it only affected one eye so a performance decline was not evident. As long as he can see his food and amble about his environment, cataract surgery, although a possibility in reptiles, is not needed. He was quite friendly, however, it is always nice to have a handler around to help with restraint!

Monitor normal

Monitor normal

Monitor cataract

Monitor cataract

Sugar Glider

What is a sugar glider you ask? These cute little creatures are omnivorous gliding possums typically found in Australia. They are marsupials and get their name from there enjoyment of nectar and glide like a flying squirrel. As with many nocturnal animals, sugar gliders have large eyes to help them see in the dark. The one I saw was a pet that developed inflammation and glaucoma which is increased pressure inside the eye. This guy was very sweet, easy to examine due to his large eyes and liked to hide in a pouch the owner strapped around her neck.

Sugar glider with glaucoma

Sugar glider with glaucoma

Kangaroo

Speaking of marsupials, kangaroos and their cousins are very interesting critters that ophthalmologists will see for cataracts at a very young age. Hand raised orphans fed cow’s milk become affected because of a metabolic inability to convert the galactose in the cow’s milk to lactose. This allows a product called dulcinol to accumulate in the lens which pulls fluid into it, makes the fibers swell and a complete cataract forms. The cataracts can be prevented by the use of a milk substitute used in human infants with inherited galactosemia instead of a standard cow’s milk. Cataract surgery can be performed in these species with limited success because the vitreous, the gelatinous substance between the lens and the retina, becomes opaque as well with an unknown substance. So if surgery is performed, you not only have to remove the opaque lens but the opaque vitreous as well which is rather sticky and handles like old cotton candy. Unfortunately, even if successful with those manipulations, they also have a high tendence to develop glaucoma after surgery presumably from drain obstruction. Prevention is the key here.

Kangaroo in the exam room

Kangaroo in the exam room

Kangaroo with cataracts

Kangaroo with cataracts

Cod

The Norwalk Aquarium will call me every once in a while to look at animals there that have ocular changes. Most display fish are exactly that, one of many in a tank used for education. However, survival of the fittest may still hold truth both for large tanks or small. When one cod got bilateral cataracts, the question was whether this would affect the fish to be able to adequately eat and protect itself in the tank. Lens extraction was performed in this cod (the lens was shifted or luxated out of position as well) to assess whether this surgery would positivley effect the fish itself. In addition, we were also assessing the anesthetic regimen and, if successful, would it be a consideration for other more “prized” fish in the future.

Gil the Cod cataract and lens luxation

Gil the Cod cataract and lens luxation

Seals

The seals at the Norwalk Aquarium have had occasional issues associated with trauma or common risks in captive pinnipeds. Cataracts and luxated lenses are occasionally noted in captive seals and we assisted with the followup care after lens surgery was performed in the past by one of my colleagues and her team who specialize in pinniped disease (who knew, right?!). We have also assisted with management in corneal injury or degeneration in the older members. Be careful looking at these critters who can be fast and unwilling to hold still! This poor girl had a degenerate cornea we watched mother nature mend with some supportive care by their great staff to avoid surgery.

Corneal degeneration in a seal

Corneal degeneration in a seal

Raptors

Birds of prey are fascinating creatures with excellent vision and beautiful ocular structures to aid them in hunting prey. Many of the wildlife rescue organizations will see, treat and release these birds if they are not critically injured. Unfortunately, trauma to the head of these birds is not uncommon, usually associated with motor vehicles, and the eye is often involved. Our role is to assess these birds to see if there is vision and if there is any reversible issue that can be improved with medication or surgery. This all factors in to the ultimate decision as to whether the animal can be released back into the wild or used as a display bird. I have seen hawks and owls primarily. We even did cataract surgery in a great horned owl after we designed an intraocular lens to use to get the visual acuity back! The hawk and owl below were not so lucky with significant damage to the left eye (hawk and owl) and central nervous system (owl) that rendered them blind.

Hawk with trauma to left eye

Hawk with trauma to left eye

Barred owl with traumatic eye injury

Barred owl with traumatic eye injury

Alas, I am starting to ramble and this digital cocktail party is moving along. I could still tell you about the giraffe, fox, gekko, rooster….hey, wait, here comes the passed hors d’oeurves. Ask me about it at the next party! Waiter!!!!

Put Another Lid on It!

Welcome back from the holidays! Hope everyone had a wonderful season full of family joy and giving. Our family here at the Animal Eye Clinic had no complaints as apparently all were on the “nice” list and the New Year rang in sweetly. And now that we have weathered the latest series of storms, I guess it means back to work for all full time!

We had last started a discussion about lid disease. We see lots of patients here with a variety of lid maladies that affect its position, function and appearance. Some are genetic in origin, many are acquired

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Merry Christmas!

From all of us at the Animal Eye Clinic to all of you, may you have a very Merry Christmas, a Happy Hanukkah and a Happy New Year! May your travels be safe and family be healthy and happy. We all hope and pray that the new year will fill us with peace and prosperity after such a trying 2012 especially here in the Northeast. Many thanks to all who visit us here in Wilton as we try our best in our little niche to help you and your furry friends at home stay comfortable and sighted!

Lisamarie, Katie, Christina,

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Put a lid on it!

The eyelid is involved in many diseases that we see and treat on a regular basis. Its function to protect the eye is an important one, whether it be to act as a barrier to prevent direct trauma, to limit bright light irritation or to distribute the tear over the corneal surface. Some species have an extra lid where others have no lids at all! I’ll take a couple of posts to address the lids and we will concentrate on congenital issues here. So take off your lid and stay awhile as we talk about the eyelid and some of

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How do you see what you’re doing?

A common comment veterinarians hear is about how our job is so difficult with a patient that cannot tell us what is wrong. Well, sometimes less is more! Our patients talk to us in different ways with clinical signs and symptoms that help us determine what and where the problem is without the confusion of speculation and interpretation and emotional embellishment of those features that we all do as humans. We use our senses and powers of observation along with listening to the heart and lungs and palpation of the body to get most of the answers in general practice.

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Looking ahead to the New Year

I can’t believe the way time has sped along here in the Northeastern United States. We have gone from storm to storm this year, enduring “hurricanes” in the summer to heavy snow at Halloween which combined for almost 2 weeks of life without power at both my home and the clinic. No good sales on generators this holiday season you can bet! Thanks to battery powered equipment, we were able to cobble together a service for those of you with non-surgical problems that inspection, conversation and medication could provide an answer. Thanks to all who survived these times and even

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My Ten Year Anniversary

Sassie and Dr. Stuhr

It has been a decade since I became the sole owner of the Animal Eye Clinic in Wilton and it stuns me to think of all that has happened over that time. When Dr. David Covitz gave me the keys and I promptly found the basement in the old clinic had flooded the next morning, it hit me right between the eyes that this was now my baby to care for and shape into the practice I wanted it to be. Ten years later, I can gladly say that the journey so far has been a

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The Confusing World of Drugs

An ongoing concern for both doctor and patient is the use, accessibility, cost and delivery of medications for ourselves and our patients. You can’t go a day without reading in the newspaper about a recall of a drug, an unexpected side effect or misuse of a medication that created significant complication. Whether a drug is for human or veterinary use or both, there will always be questions as to how to treat, when to treat, where to get, what to expect and how cheap can I get it to make life easier for all involved.

Left me wax poetic a bit

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Spring has sprung…and with it…

Well, finally the snow has cleared and the Northeastern United States is no longer looking like the Arctic. The only snow that remains around here are the frozen remnants of the largest piles of plowed snow with bits and pieces of driveway gravel left in its wake. After a long period of hibernation, out peeks a crocus and the hints of daffodils which harken to warmer days that we strain to remember. And in a flash, people wil be complaining about the humidity and be hunting for shade! The joy of living in a seasonal climate!

As the Spring season begins,

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