Eyeball Update and Outings with Boca

March 19th marked the one-year anniversary of Boca's conjunctival graft surgery on her right eye, an experience I'm very glad to have behind us. Poor Boca had to wear the Cone of Woe for a total of ten weeks, and it was an extremely stressful time as she stumped a number of professionals with her non-conventional response to treatment and to this day we still have no clear diagnosis. We were also navigating our first major pet insurance claim, a story which thankfully had a happy ending. It was difficult to know what the right thing to do was at the time, with advice from every angle, but we absolutely made the best choice for Boca in order for her to retain her eye and vision.

Eyes Wide Open

No more squinty eye!

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Boca's Ocular Ordeal...Is Over!

I am thrilled to report that following Part I, Part II, Part III and Part IV of Boca's non-healing corneal ulcer saga, things are finally getting back to normal at the Ginger Sister residence. My three-day weekend was the perfect time to fade out the cone, and while I watched her like a hawk that first day, Boca is far more interested in chewing all the things, sunbathing and napping than rubbing her eye. 

Her eye looks better every day. There is minimal watering, and she is holding it all the way open full time - something she hasn't been able to do in months. If you are curious what it looks like, the photo is here behind a cut. This was taken Friday - the edges of the graft are still sort of raised but it should continue to thin and smooth out. I think it is so incredible that the veterinary ophthalmologist attached the graft with teeny-tiny micro stitches. Can you imagine the steady hand that must take? 

I hope that chronicling my experience will be helpful to others since I could find very little personal documentation about the surgery online when I was researching. We have a re-check appointment on Thursday and after that it will probably be a month before we need to go back.

Boca has been such a trooper through everything - maintaining her goofy, optimistic spirit - but she was so obviously happy to free of the cone! She can fit in her crate (where she loves to sleep of her own accord), curl up in a ball, gnaw on antlers and most importantly, play biteyface with Ruby every morning again:

A video posted by Lara Elizabeth (@2gingerdogs) on Apr 4, 2015 at 6:55am PDT

Boca's Ocular Ordeal: Part IV

Part I

Part II

Part III

Hopefully, this series will be winding down as Boca's eye improves day by day following her conjunctival graft surgery two weeks ago. We had a recheck appointment last Saturday, and a few days before I was feeling very discouraged as she still wasn't holding her eye open very much. The day before the appointment, she seemed to turn a corner and by the time we saw the ophthalmologist she was very happy with her progress and said we were on the right track. Boca does seem to be a slow healer, something to take note of. 

She is now off all oral medications, with eye drops twice a day, and is doing better little by little. The appearance of the graft changes as time goes on, and I was told that was to be expected. Right now it is in a very red/pink phase but she holds it open more and more. I was surprised that even though the graft covers a good portion of her eye, she still has a swift blink response, which tells me she retained a good deal of vision. The vet said that the graft will smooth out over the next couple of months until it is fully incorporated with the cornea. We have another appointment next week and with supervision, Boca should be able to lose the cone over the weekend - no Easter bonnet for her!

I expected to be alarmed by how Boca's eye looked - especially because her graft is much bigger than most of the photos I found online. Instead, I am just thrilled that she is feeling better, that she got to keep her eye, and that she is the same goofy, loveable girl. One of her nicknames, Bocacabra (a play on "Chupacabra") fits even more perfectly now. I've decided to call it her "supernatural eye" and this has certainly taught me some lessons about inner and outer beauty that I will delve into in a later post. Dogs are the very best teachers of acceptance and adaptability, aren't they?

I continue to be impressed with Boca's insurance company. They issued payment yesterday for her surgical claim and even with my high deductible ended up covering about 75% of the total bills. I've started a pet insurance discussion group on Facebook. Having worked in the insurance industry for fourteen years, six of those in horse insurance, I am comfortable with the jargon and happy to talk about policy wording and comparisons. I hope you'll join, and watch for my pet insurance post coming soon. Meanwhile, Boca, Ruby and I will be getting back to normal at our house with fewer vet visits and no more cone!

Boca's Ocular Ordeal: Part III

Home from surgery on Thursday afternoon.

Who knew that I would still be writing about a seemingly minor eye issue months later? In review, here are Part I and Part II. Boca Face had her conjunctival graft surgery last Thursday. She was her usual wonderful, cheerful self at the vet hospital, but I had an especially hard time seeing her led away. General anesthesia is always a worry, and I just didn't know what to expect with regard to how her eye would look afterward and if it would finally be the end of this long process. Adding to my uncertainty was the fact that for the day or two before the surgery, her eye had been doing much better and her comfort was increased, so here I was making her worse again with the hope that it would then finally swing the other way. She was squinty again on Thursday morning so ultimately I still felt I was making the right decision. 

I was told that Boca's would likely be the last surgical procedure of the day because it was the longest, and not to expect a call until after lunchtime. I was surprised to get a call from Dr. N. at 11 o'clock reporting that Boca was out of surgery and doing well, and that I could pick her up later that afternoon. Boca was groggy and disoriented when I arrived, and I was given her new medications and discharge instructions. I wasn't able to see much of her eye because they put one stitch in the outer corner of her lid to hold it partially closed. She whined most of the way home and seemed happy to be back in familiar surroundings, where she immediately laid down in the dining room. Ruby needed a walk and I intended to let Boca rest, but she pretty much insisted on coming along, so we kept it short. 

She continued to improve over the weekend, wanting to play with new toys we got in our Bark Box and enjoying a beautiful spring weekend. She is a fairly low-energy dog to begin with, so pain medications really knock her out. She spent a lot of time laying on her bed on the patio and snoozing on the sofa. It's hard at this point to tell how her eye is. It is still watering a lot but I was told that is normal. The graft is supposed to integrate with the cornea within about a week, and we have a re-check appointment on Saturday. I don't know when the eyelid stitch will be removed. Complete healing can take up to eight weeks. She holds it open just a little when we are walking or when she is getting a treat, and I have glimpsed part of the graft, a thin layer of semi-opaque tissue. It so far looks better than most of the pictures I've seen online. I hope it will soon feel better, and am maintaining my faith in the skill and confidence of the professionals. 

A note about pet insurance: I'm in the process of developing a full post on pet insurance, but for now I will just say that it has been a lifesaver for me. While the claim was initially denied, their decision to accept the appeal based on my vet's analysis was very fair and since then they have paid every line item from every invoice, responded quickly and compassionately to all my questions and pre-certified Boca's surgery. I was even able to make arrangements for the insurance to pay the vet directly. My first claim payment was direct-deposited into my bank account nine days after submitting the invoice (all the rest of the pre-surgery charges went toward my deductible). I really don't know what I would have done without the insurance and will always consider it an essential part of pet guardianship.You just never know what can happen - I considered Boca my "low-risk" dog and so put her on a high-deductible plan, then ended up having a multi-thousand dollar claim within the first year. I'm so thankful that I was able to make treatment decisions for her without feeling constrained by finances.

Boca's Ocular Ordeal: Part II

Poor squinty girl.

Sadly, Boca's eye issue continues and this will be an ongoing series - Part I can be found here. It's hard to believe that Boca has been squinty and uncomfortable for about 7 weeks now, and I've lost track of how many appointments we've had with the specialist. On Thursday we had another re-check appointment and surgical options were discussed. The first of these is a thermal keratoplasty, in which heat is applied to the cornea and a series of shallow incisions are made to create a surface for better adhesion. Due to Boca's poor (and unusual) response to the diamond burr debridement, the confidence level for this procedure is much lower than it would normally be. The second, more serious and more costly procedure is a conjunctival graft, in which a flap of inner eyelid tissue is bonded over the eye. This introduces a blood supply to the cornea and promotes healing. Vision can be impaired depending on the size and thickness of the flap, but it is the surest way to retain the eye and restore comfort, with a very high success rate. Because it's likely we may arrive at the graft if the keratoplasty failed, the specialist is more strongly recommending it as the primary option. 

A soft contact lens was placed in Boca's eye at Thursday's appointment, with the hope that it would provide her some relief and even allow some additional healing, but unfortunately even wearing the cone collar, we lost the lens within 24 hours. It was a cool idea - the lens had four black dots around the edge so I could easily see when it was in her eye and I think it did help for a short time. We did not find the contact, but I didn't spend a lot of time looking since putting it back in was not a possibility anyway. 

 Still loves her walks!

At first I was really upset about the idea of the graft surgery, because it will permanently change the appearance of Boca's eye, but I have a fairly short time-to-acceptance phase, and after having my little cry, I think I am prepared to move forward once some other things are in place. She will be my beautiful Boca Face no matter what, and dogs are the very best example of unconditional love. As long as she is comfortable and can hopefully keep her vision for the most part, I will be happy. At this point, the main thing I am waiting for is for the decision on my pet insurance appeal. This will determine if they will pay for the cost of the surgery and the treatment to date (minus deductible, which is high but has already been met and exceeded). I want to also touch base with my regular vet to get a non-specialist perspective. Several people have asked why the eye cannot just be removed - my understanding is that since Boca is not blind in the eye, enucleation is not the best option - its only benefit to my knowledge would be economic. I have also reached out to the shelter director in The Bahamas, to see if she may have some vet connections that might know of some tropical condition that the vets here could be missing. As it is, Boca has been seen by two regular vets and three accredited veterinary ophthalmologists, so we have gone above and beyond second opinions. Still, I think the more information I can gather the better, before making any big decisions. The graft is done under general anesthesia which is always a worry; however, Boca did fine with it when she had a tooth extracted shortly after I adopted her.

As for the Potcake herself, she is doing well under the circumstances. I have been trying to give her breaks from the cone collar which she is very appreciative of. She did grouch at Ruby this weekend because Ruby tried to lick her eye and I'm sure it is painful (as well as unsanitary). She is getting twice-daily eye drops and Rimadyl and maintains her great appetite and cute cheerfulness on walks. She still hoards all the toys and bones on her bed. She had everyone in the waiting area at the vet's office laughing because as I was checking out, she was sprawled out on the floor with her frog legs and her tail wagging. Such a delightful girl. We appreciate your good thoughts as the pieces come together for an eventual resolution to this prolonged problem.

UPDATE 3/10/15 - This morning I received notification that Boca's pet insurance has reversed their denial and has accepted the appeal of our corneal ulcer claim. This is the best possible news and I am incredibly grateful to our ophthalmologist for her influence on the insurance company's decision. 
 

Still hoards all the stuff!