Email! Tweets! Snapchat! Instagram! Facebook! Yikes!!!

We have so many ways to communicate with each other and yet the art of communication seems to be getting lost in the chaos.

Multitasking, usually in the form of a downward stare at a cell phone, occurs constantly in our society even if the action is right in front of our face. We try to stay one step ahead of our day, knocking out an errand while doing another, getting a jump on the next event all while staying in time with the constant deluge of emails and texts that raid our devices. Not that many of these communications are truly that urgent, but we have chosen to make them so. If one doesn’t respond in an hour the alarm bells ring. Can’t be reached? C’mon, that’s impossible these days unless you make the effort to hide.

Now I get this, sometimes our days’ dealings warrant a constant level of information and communication. Staying abreast of each others actions, the movement in the market or changes in the geopolitical scene, for example, dictate we keep in touch. Or even more familiar, a child’s constantly changing schedule of school, practices and lessons that alter last minute due to weather delays that plague a parent’s well-thought-out day. Thank goodness for the cell phone then!

So what does this have to do with your pet’s eye problems and the Animal Eye Clinic? For one, people want information so they can make educated decisions. So they look up what they think is their pet’s problem based on external symptoms and come in with lots of questions along with a touch of anxiety based on all the different diagnoses they were able to research on the web. A red eye? Oh my, the things you might find are endless! Our goal here is to decrease your worry and anxiety by narrowing that list of issues with diagnostic tests or, even better, by giving you a definitive diagnosis with specific treatment options. We give this information to you verbally and in writing in case you are overwhelmed and forget what was said. This also insures that you will be looking up the right disease if more information is what you need. What a relief!

Just as importantly, you know you will be getting our total attention as we are firmly fixed in the present to take care of you and your pet. My staff, many who have been with me for years, will look you in the eye, say hello and take your history upon arrival. I create the time and space in our comfortable and friendly office to sit down and examine your pet and then talk about all the things I see. We give you this information so you feel comfortable and don’t just give you a short handout and a prescription to fill. We try our best to run on schedule for your appointment as we know your time is important too! Our goal is to educate and communicate and that is what makes this practice special.

I could certainly be busier, double booking appointments, hustling in and out of exam rooms and leaving you and Dr. Google to sort through the details. That’s just not our style. All we ask of you is to unplug from the world and turn off your phone for the time it takes to examine your friend and impart this information. Be an active participant in your pet’s health knowing that all the craziness of the world, the emails and texts, will still be waiting when you leave the building! As an advocate for your pet, I want to insure that you also leave smarter than when you entered with less anxiety, more information and a feeling that you and your pet are in good hands.

I want to take a minute to again thank you all for trusting in us the last couple of years. We, like many, had our curbside protocols to try and keep each other safe while still providing the care that your pets needed. Doing that sight unseen, with sometimes only a phone call and a pass-off to a masked staff member, was difficult for many. We tried our best to make this comfortable for you knowing that you could not see our smile or watch us handle your dog or cat without you in the room. Well, I think we did OK, as most pets are quite comfortable in our office and my staff is fabulous at handling even the most nervous or critters….and owners! And now, months later, we are finally seeing some of you face-to-face now that we are back to business as usual. It feels odd to have potentially seen a pet multiple times and had never seen the owner! We have had lots of introductions recently which has been great. And honestly, I have missed the side conversations that make interacting in person more enjoyable and fun. Give me a smile, a handshake and a face-to-face conversation over a Zoom call any day! Thanks for patience and understanding!

In addition, I want to thank may staff (Colleen, Francine and Mariah) as well as my office manager (LisaMarie) for their hard work during this time. Like the postman of old, no bad weather would slow them down from going outside to get your pet or bringing your discharge instructions after a visit. They, as always, are the first line of communication and your first impression as to how we operate here at the AEC. Our goal to make you and your pet feel comfortable during the visit and educated at the conclusion so you can make good decisions starts with them the moment you call to make an appointment and continues until you pull away. I appreciate all they do and similarly appreciate the respect that you show them as part of the team. And their patience in times when clients temporarily forget their manners, as can happen when we are worried or nervous, is a credit to their professionalism and caring personalities. They make this place go so say “thank you” if you get the chance!

Back to work we go….SEE you later!

I have taken a conservative approach up to now due to at-risk relatives, travel, friends with lingering cases, and the significant impact to our team if anyone is infected. However, I believe it is time to open our doors once again as we continue to provide excellent and personal care for your pets and their ocular issues. I truly appreciate the patience and respect those who have come our way have shown me and my staff during this time. I truly understand that taking your pet away from you, into an unfamiliar space with a doctor they, and you, have not met has been trying for many. Alas, I think our communications have tempered those fears and most have had a good experience. And truth be told, many of your pets are better behaved and calmer for the exam without you around!

So starting today, we will go back to business as normal (mostly!) allowing an individual to come in for the exam without a mask if willing. Feel free to wear a mask or ask me and the staff to if you are uncomfortable. And we can certainly bring your pet in while you relax in the car if you prefer. Clearly, stay in your car if you have any symptoms or risk so as to not infect the staff. Simply call from the parking lot once you arrive as prior. We will try to limit our time in the rooms which are small and have suboptimal air circulation to prevent viral infection.

Covid is not over, but we are adjusting to the changes as time moves forward. Hopefully, like the last time I wrote a similar note, we won’t regress back to a stricter protocol. Be well and see you soon!

As infection rates are dropping and those getting vaccinated are going up, we too will start to “open up” and resume our normal modes of practice. Our place is small, however, with suboptimal air flow in exam rooms that are kept dark to allow our examinations. Thus, as we begin our transition, we will likely start having clients of new patients that we have not met enter the clinic with their pet to be seen in our one exam room that has a window to allow fresh air circulation. We will still take your history over the phone before the visit and finalize the check out process outside after to decrease our time together inside. This may at least give some familiarity for new clients as we continue to take care of recheck patients on a curbside basis. If and when the viral concerns continue to diminish, we may allow recheck patients and owners in the building as well. Alas, the jury in not completely back yet on Covid so it makes sense to me to take a cautious, step-wise approach.

If you are allowed to come in with your pet and are vaccinated, you do not have to where a mask. Please wear one if you are not vaccinated. And, at any time, we may change these rules depending on the day, patient traffic or health status of myself and the staff. Bear with us!

Last, but certainly not least, if you have come here or do come in, say a special thanks to my staff. They have been working very hard over the year trying to manage any and all concerns which has been a bit of a challenge. Questions and worries, anger and sadness, tears and doubt have all been present with many owners over this period and my staff’s patience and professionalism has been outstanding. Happily, we have had more than our share of happy patients and clients as well! As always, we appreciate everyone’s understanding of these challenges we have faced and look forward to some normalcy this year.

ADDENDUM: It seems like Covid-19 has a different plan than us and the Delta variant is creating concerns. We will cautiously approach this problem and may decide to resume curbside protocol as positivity rates increase in our region. If you are allowed to come in, a mask will be required for all at this time. Be well and be safe…

In the meantime, we are open. Veterinary medicine is considered an “essential business” which allows us some latitude to work and care for your friends. If your pet has an eye problem that we are following or are a new patient referred to our practice, we will be here during normal business hours to attend to the problem. Using common sense and the advice of your veterinarian who referred your pet, you can determine whether you need to come in now or at a later date. We will still see you for non-emergent elective issues if you so choose. Please make educated choices as to whether it is in your pet’s and your best interest to travel to our facility. Clearly, stay home if you or others in your house are sick to minimize the chance of viral spread.

Business as usual is rather unusual now and that is true for the AEC. My philosophy is to educate you so that you can make smart decisions for your pet. This usually involves a bit of discussion and I love to draw on a diagram in the exam room to help you with visual images. This practice will be put on hold, or at least the visual part, as social distancing will temporarily change our procedures. As of now, we will only allow your pet into the hospital for examination. Following, we will dispense our clear, type-written discharge instructions with any pertinent information about the problem along with medication needs and/or surgical options. This will be delivered to you outside where you wait in your car. Depending on how busy we are, I may come outside to talk from a safe distance or we may need to connect by phone before the day is through. Our hope is that this process will keep you and the staff safe from this challenging virus.

To facilitate this process, we will take the history by phone when making the confirmation call for the appointment. When you pull into the parking lot, a sign will remind you to call the front desk and one of us will come out to get your pet. If your dog is ill-behaved at the vet, you may want to place a muzzle prior to handing them over to the staff. As usual, cats or other small creatures should be in carriers.

As always, we appreciate the trust you put in us to take care of your friend’s needs. This social/business distancing is odd for all of us especially taking your pet away from you to examine. Alas, we are a kind and gentle crew and we will continue to try our best to make this a positive experience for all.

Be well…

A clear cornea in a dog...with a small lid tumor on the lower lid

The uncomplicated cornea abrasion is simply treated with topical antibiotics to prevent infection along with an Elizabethan collar to prevent self trauma (yes, the dreaded collar is essential!). Healing of these superficial lesions is from side-to-side where the surface tissue (epithelium) slides over the abraded surface rapidly to heal the wound. This should occur within a week in most cases. Searching for a persistent underlying cause such as a foreign object or offending hair is required when initially presented. I see very few of these simple erosions here as most general practitioners can identify these lesions with a dye called fluorescein that stains the cornea and, if simple, go away prior to needing referral with the treatment above. It is the complicated or persistent ulcers that generally prompt a specialist’s evaluation and care.

Superficial corneal erosion in a cat

Our focus for this posting will be for the ulcers that become infected or degenerate leading to a loss of tissue. The cornea is made up of layers of collagen, the bulk in the center called the stroma. If an injury penetrates the epithelium and bacteria are presented to this layer, some bacteria in the environment release enzymes called collagenases that can digest the collagen. This can happen rapidly which can progress to a full-thickness hole in the eye resulting in rupture of the globe. Contrarily, this can be slower process leading to a more sloping defect of variable depth. We can also see a similar process in old dogs with degenerative disease where tissue loss without overt evidence of bacteria can lead to a similar appearance. In general, if the depth of the divot is less than 50% of the corneal thickness then medical management is the norm. If the divot is greater than 50%, surgery may be considered due to the loss of structural support and thus an increased risk for rupture. This depth is evaluated by a tool called the slit lamp biomicroscope which is the workhorse for our examinations of the front part of the eye. Let’s look at how we identify and approach the non-surgical ulcers first.

Small but deep ulcer with an early vascular response

Above is the photo of a young Pug-mix with a small but deep corneal ulcer. Different than the first photo of the cat, this ulcer looks deeper even with the naked eye. In addition, the eye is a little more angry with an increase in discomfort with redness to the whites of the eye along with small vessels at the edge of the cornea. This activity is consistent with infection and is certainly common in this breed and others with prominent globes like the Pug. With our slit lamp, we could assess that this ulcer was 50% of the way through the cornea. For perspective, the cornea is roughtly 1/2 millimeter thick, so high magnification, a steady hand and good training is needed to evaluate the depth.

Diagnostic tests often utilized in this scenario include corneal scraping to look for inflammatory cells and/or organisms (cytology) and culture of the lesion to assess for bacterial growth. These tests are helpful in that the cornea is typically devoid of inflammatory cells so seeing just a few is significant. If these are white blood cells typically seen in times of infection, the culture sample might be submitted to help determine if bacteria are present and what antibiotics may be useful in killing them. While awaiting for the results of the culture (cytology is done on site in many instances), antibiotics are typically started. Other medications that may be employed include drops that dilate the pupil to help with internal ocular discomfort, serum drops to try and stop the collagenase activity, oral antiinflammatories for intraocular inflammation and pain along with the aforementioned dreaded E. collar. Frequency of medication is variable but is usually higher in these cases (4-6x/day or more) with serious infection vs. the 2-3/day utilized in a non-infected ulcer for prophylaxis.

Initial healing of the stromal ulcer 3 weeks after initial visit

Healing of these ulcers is often facilitated, and frankly necessary in some cases, by vessels that advance into the region of tissue loss and encourage regeneration or rebuilding of the collagen. This may create more potential for scarring, however, is an acceptable trade off rather than rupture. Dogs in particular can have pigment migrate into these regions which, if large, can significantly affect clarity. However, when small like with this lesion, can be clinically insignificant. In the first photo, I think you may appreciate that the vessels have already migrated in and filled in our hole with some residual inflammatory material (white spot) in the deeper tissue. When healing was complete, a focal brown spot without any tissue loss was all that was left. In the final photo below, you can see this region along with some fine granular material unassociated with the ulcer. A good outcome without the need for surgery for him!

Now some dogs may epithelialize (the surface tissue slides over and covers the ulcerated area) without concurrent thickening of the underlying tissue. Thus, a divot may remain but the ulcer by definition has healed. The is called a corneal facet. An area of weakness my remain but may be safe if the depth remains less than 50%. It may slowly fill in given time or remain the same. We may have pets that come in with facets that are deeper and leave well enough alone especially if they have a relatively sedate lifestyle where repeat injury seems unlikely. The photo below shows an old dog with a shallow facet with a rim of vessels but reasonable clarity to not warrant any additional intervention.

Shallow facet after a healed stromal ulcer

These are just a couple of a examples of when and how medical management is chosen and the potential results of such an intervention. Some dogs and cats get more vessels, pigment and scarring and others get less. The challenge for us is to initially stop the digestion, encourage a reaction and then try to reverse the process to improve the clarity. Different species have different levels of reactivity and scarring that we try to manipulate as best we can. Next time, we will discuss the surgical choices in those patients where the risk of rupture is high without giving some structural support.

The staff, spouses, friends and party crashers of the Animal Eye Clinic want to wish you and your pets a wonderful holiday season filled with joy and love! May 2020 be the best year yet!

Each year the AEC, along with many other ophthalmologists across the country, will examine animals with an active service job for free! It is part of our way of giving back to these wonderful animals that help us in so many facets of our daily lives. This occurs every May so if you missed this year, you can try again next by going to www.acvo.org and searching for the Service Animal Event.

THE CRITTERS OF THE AEC!!!

Why are we here and why do we do what we do? That’s always a good question to ask one’s self and one that has been tossed around lately in my family as we are in the midst of college hunting. That’s a whole different topic as time passes but is so much more apparent when we look at others, like our children, rather than ourselves. But I digress….we are here because we enjoy animals and taking care of them. Of course, that can’t be the only reason and any veterinary school applicant or counselor will tell you this. But an inherent love of animals has to be present. This is usually evident and develops with our interactions with pets when we are young and continues as we become adults. Dog, cat, hamster, goldfish, horse…you name it, usually one or more wheedles their way into our hearts and is the gateway to working with animals.

So I got to thinking, what critters are in our lives now that we are here taking care of yours? And thus follows a brief expose of the best dogs and cats in the world (don’t we all have one?!) for you to enjoy!

Introducing Tess Stuhr, best frisbee catcher in town! She’s 9 years old now and has been a perfect fit for our family. She is always outside with us, wanting to be one of the boys whenever we are playing sports in the yard or driveway. She has the drive and smarts of an Aussie but the ability to chill when it’s time to relax. We love her!

Budsters, the informal name for Chester Abdul Tobias III, is our new addition last year. This Maine Coon has fit right in and loves to sit on your lap especially when you are reading the newspaper or doing homework. His timing is impeccable! Tess will occasionally remind who is the primary pet of the house, but he’s a cat and doesn’t care!

Ariel and Jasmine are Lisa Marie, our office manager’s cats. These kitties came into her life shortly after her older cat passed and were the rays of sunshine she needed to brighten the day. You couldn’t ask for a more loving pair!

Zeke is Colleen’s dog who harkens from Oklahoma. He looks forward to the treats she can flip him from her Puppy Cam App she has on her phone. He has boxer in him so she is somewhat biased to those types that come into the clinic!

Weasley is Suzanne’s love and this is from a girl who used to be afraid of cats! He rules the roost and let’s her live there, or so he thinks! He must be magical as his name comes from Harry Potter…

Maggie is Kelly’s crazy girl who has kept her busy with all her antics. You can see the devious look as she sits in the picture! Like every lovable lab, she is non-stop which keeps Kelly and her family on their toes.

Boe is Chris’ latest addition, a kitty he and his fiance saved from the streets of West Virginia. As with many of our pets, sometimes they have the penchant of finding you rather than vice versa. Apparently he has gotten bigger which is too bad….he’s quite cute at this size!

We hope to see you and yours soon!

When our patients present with clear discharge, my first question is whether we are making too much tear in response to irritation or whether the outflow pathway, or tear ducts, are compromised. One could presume that in the former instance discomfort would be a feature. This will be manifest as squinting, pawing, rubbing and/or redness to the eye or around the eye. In the latter, discomfort may not be a big feature even with lots of moisture pouring out of the eye.

Diseases with discomfort that present with tearing are many as this is a non-specific sign. However, the nature of the discharge would suggest that infection is not playing a big role otherwise we would see yellow-green discharge. Similarly, significant irritation with marked inflammation my have more mucus or a grey-white discharge. For example, the hallmark of conjunctivitis is discharge but usually one with color. Irritation from foreign bodies or offending hairs may create corneal erosions that are irritating but not infected and thus a clear discharge along with discomfort will be the result. Issues where the lid conformation is abnormal create surface irritation due to the adjacent fur rubbing on the eye. Tearing can then occur during this process which can spill onto the face either directly from the irritation or from a wicking effecting where the tear spills over the lid margin onto the side of the face adjacent to where the lid rolls in. Entropion is the technical name for lids that roll in as a result of genetics (primary entropion) or secondary to globe retraction from surface irritation like a corneal ulcer (spastic entropion). Resolution of the primary entropion by surgery to roll out the lids or appropriate medical or surgery treatment to cure the irritant that causes the spastic entropion will stop the tearing. It’s all connected! Typically a good ophthalmologic exam will reveal the problem.

If upon inspection and testing we rule out surface disease then investigating the outflow system is warranted. Tears are produced by glands that exit through the conjunctiva onto the surface of the eye. These tears then need to be “removed” either by evaporative drying or out through the ducts that are located in the inner aspect of the lids and pass under the surface of the conjunctiva and skin, shortly through bone and into the nose. Most of our patients, except the rabbit, have an upper and lower duct that then join together before exiting the nose. The opening to the duct is called the puncta. Obstruction or narrowing anywhere along this pathway may make the path of least resistance to go over the lid margin and onto the face. This is commonly seen at the inner aspect of the eyelids rather than the outer aspect by the ear. The length of this duct varies with species and breed and thus different issues can affect its passage depending on the type of animal.

The lower puncta is easily viewed here as the small non-pigmented circle just inside the pigmented lid margin.

Two tests are used in the exam room to evaluate the patency, or intact nature, of the duct system. The first is a passive test, called a Jones Test, where fluorescein dye is placed on the eyeball to see if this dye flows into the nostril region. This dye glows with a blue light and can be easily seen. This test is easy to perform and will tell you if the “plumbing” is working. However, a negative tests does not necessarily tell you that the duct is not patent since flow rate can be slow or the duct may be narrowed which affects the time it takes for the dye to get to the nose. Also, it does not tell if the flow is going through both ducts near the globe initially. Another benefit of the test is that the dye may wick onto the face quickly in some dogs with hair issues that draw the tears onto the face before they get into the puncta.

The second test is more active called nasolacrimal flushing. In this test, a small cannula or catheter connected to a syringe of flush is placed in the upper or lower puncta and gently pressed. The fluid should come out the other puncta and, when obstructed with a finger, out the nose. This should occur with minimal resistance. Most dogs and some cats are amenable to this with just a topical anesthetic. We get information as to whether the openings are intact, if flow out the nose is present, if there is any resistance to outflow and potentially release of a loose blockage.

Fluorescein dye wicking onto the face instead of going into the puncta due to hair and lid anatomy.

A common entity we see in young dogs is an abnormal development of the lower opening or puncta. An imperforate puncta is when a sheet of tissue is present over the opening due to improper formation at birth. The duct is typically present just under the surface. This is much more common to be seen with the lower puncta. Opening this puncta under a short anesthetic event can improve and sometimes resolve the overflow of tear in the affected eye.

Cats rarely get imperforate puncta but commonly get herpes infections. One manifestation of herpes when acquired as a neonate is the development of adhesions of the conjunctiva to the cornea, third eyelid or itself called symblepharon. Tearing can be noted if these adhesions are associated with the puncta or tear ducts even if the infection is cleared or inactive. Basically these adhesions are scars from the infection. Surgical resolution is typically unrewarding since they recur, however, this is usually good news if all we are left with is tearing. A full discussion of herpes is not necessary here.

Obstruction downsteam of the puncta is less common. Dental or sinus disease can theoretically present with tearing due to the proximity of these structures and the tear duct as it passes into the nose. Mucus plugs are occasionally flushed out but are not too common. Other symptoms may be present if there is trouble downstream of the puncta.

A result of the tearing that bothers many owners, but rarely the dog or cat, is the brownish-red staining of the fur in the wet region as seen in the first photo above. A pigment called porphyrin in the tears reacts with the fur and creates a brown tinge that is very obvious on our white dogs such as Poodles, Bichons and Maltese. This discoloration can happen at any time and is not indicative of any disease process. There is no specific product, diet or medication that resolves this issue much to the chagrin of many. The good news is that this is a cosmetic issue rather than a medical one. The degree of staining may decrease if there is a primary issue when can address that will minimize the overflow.

That’s a wash here! Maybe by the time you have read this the sun will be out!

We love to see all your pets, clothed or not, and appreciate you trusting us with their ocular care. See ya on the runway and enjoy the winners!

IN THE EVENING FORMAL WEAR CATEGORY, EDDIE IS SHOWING OFF HIS THREADS ALONG WITH HIS RESTORED VISION AFTER CATARACT SURGERY…CONGRATS, EDDIE!!!!

IN THE SLEEPWEAR CATEGORY, DAISY SHOWS OFF HER FULL BODY PJs IN SEASONAL RED!

THE TEAM COMPETITION WAS WON BY THIS SNAPPY PAIR, LUCE AND DEZZIE!

THE CLASSIC PLAID DIVISION WAS TAKEN BY BENNY!

THE OUTDOORSMAN AWARD WAS GIVEN TO BO WITH HIS EARTH TONES PLAID!

IN AN ANTICIPATION OF A SUMMER THEME, LUCY IS SPORTING A FLAMINGO LOOK!

LASTLY, FOR ALL AROUND GOOD LOOKS, WHEATIE, AKA THE MAYOR, SHOWS OFF HIS YEAR-ROUND PANACHE!

DON’T BE SAD, BEAN, YOU WON THE PARKA DIVISION!