Loving My Little Life With Two Wonderful Dogs

A room full of dogs and books is my idea of happiness.

Happy Ruby Tuesday! While I don't do it on a weekly basis, my aim with the Ruby Tuesday updates is a more "old fashioned" blog post of the journaling type. Back before blogging became so popular, I had a LiveJournal account where I shared thoughts, poetry, pictures and travelogues. My account is still active, in fact, and while I don't write there regularly, I love having more than ten years of my life chronicled there. Some of my very favorite blogs lean toward the wordy, honest and personal, and so I like to have an element of that here, where I can look back on the daily details of life with Ruby and Boca, these two precious dogs that have been with me through some of the most difficult times and also at a time when I am doing some serious introspection.

Recently I said to a friend, when asked what my big life dream was, that I thought I would like to move to Spain and rescue dogs. She looked momentarily surprised, and I realized that wasn't what most people expect, especially now that I am single. No babies, no weddings, nothing very ambitious or extraordinary, but something very definitely including dogs. I'm incredibly grateful that I live in a time when that is becoming increasingly acceptable, and increasingly normal. Lately I've been simplifying, reevaluating. I'm finding that some things that used to be important to me (like fancy shoes and late nights out dancing) have fallen by the wayside, and some things I thought I'd never want (like living somewhere rural) have become suddenly intriguing. While  I occasionally hear things like I'm too wrapped up in my dogs, the great majority of my friends and family are supportive of my somewhat solitary, but personally satisfying lifestyle, and they get it when I just want to stay home with my dogs. (Either that, or I make a point of surrounding myself with only people who do).

During the week, life is largely routine, especially when incorporating the care and feeding of The Ginger Sisters into the few hours between waking and work, work and sleep. I find comfort in this routine, and waking up as I did this morning to find Ruby laying on her back, nestled into the crook of my arm and gazing up at me, is often the best part of my day. Right now my dad is living with me, and I'm blessed with knowing my dogs have company while I'm at work and can spend these warm afternoons sunbathing outside. The weekends are when the real fun happens: sitting on the patio playing ball with Ruby, making them special treats like the frozen goodies pictured above (Freezy Pups mix and Merrick PowerBites treats), walking through our little slice of wild marshland between the light rail station and the town house complex, photo shoots and silly trick training sessions, trips to visit family, outings to new places, or blissful reading breaks on the guest room daybed in the best light.

The girls are doing splendidly overall. Ruby has had some great moments (passing people fairly close on walks and not barking) and some not-so-great moments (going berzerk over horses on TV despite my efforts to DS/CC with peanut butter). I took her out for a training walk this weekend and she did very well with checking in and maintaining focus on me (which is a huge deal for her). My secret was using some of Boca's "pill cheese" - more on that in a moment - good old processed American cheese product. Her reactivity means a lifetime of management, but when I look at the big picture, I can see some remarkable changes. She is never relaxed outside, but I am seeing little moments when we are close to home where her body becomes looser and even get a tail wag once in a while. She solicits pets every evening (with very particular requests: inner thigh and back scratches).  Her relationship with Boca is beautiful to watch, and while they can get carried away sometimes with their play, I see a lot of really sweet, gentle interaction, too.

Boca remains her delightfully easygoing and goofy self - she is the first dog I've had who can happily take a nap at the vet's office. Unfortunately, we've still been spending quite a bit of time there. We had only a short reprieve from the Ocular Ordeal before she started developing an opacity in the other (left) eye. At this time it is not causing her any problems or discomfort, but the ophthalmologist is still unable to determine a cause. We are trying a long course of doxycycline in hopes that it will slow down any progression if there is a bacterial component. I'm not as stressed out about it as the first time, because at least we know the treatment/surgery route to go if it does get worse. After our appointment on Saturday, Boca and my dad and I discovered a pretty park full of little lakes and streams. It was refreshingly serene even though it was in the middle of town, and a place I could safely bring Ruby, especially on one of my Fridays off. We even spotted a huge turtle in one of the ponds!

Time seems to go by faster and faster - just like people are always telling you it will - and I want to make the most of this summer. Everything is gorgeous and green right now following our more than twenty consecutive days of rain. This weekend I hope to get a lounge chair for my patio, so I can read out there while the girls sleep in the sun. I have planted marigolds and tomatoes in containers and I am going to plant some herbs and lettuces as well. I want to scout out more places to take Ruby - taking Boca first is a perfect way to do so, and also gives me the opportunity to have some one-on-one time with her. I am hoping to attend BlogPaws in Phoenix with Boca next year, and need to be sure she is comfortable in more busy and crowded situations. We have some fun events coming up - a potcake fundraiser at a sports bar and a graduation party at a local park - which will be perfect practice! It's my favorite time of year (from now until October), and I'll be spending it with my two favorite girls.

What little things about life with dogs make you the happiest?

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!

Boca's Ocular Ordeal: Part I

I love you even when you have a cone on your head.

I've been putting off writing this post. I thought if I waited long enough, I could tell the story start to finish and it would have a neat resolution and only one installment. It's been a month, and this will now be part one of Boca's Ocular Ordeal. Since adopting her officially last May after fostering her for three weeks, Boca has had a spot in her right eye. It is a tiny, jelly-bean shaped opacity that did not cause her any apparent problems and was diagnosed by our regular vet as a Florida Spot.

Toward the middle of January, I noticed that Boca was squinting quite a bit and her right eye was frequently tearing. Our regular vet prescribed eye drops and thought it could be allergies or some mild inflammation. We went back for a second visit in less than a week when I did not see improvement. While they did not see much uptake of the stain (which is a neon yellow liquid picked up by any abrasion on the cornea), they changed medications and said we would treat as a superficial corneal ulcer. Normally, these will heal within a few days on their own. 

Unfortunately, Boca's eye was still squinty and watering the following week, so I took her to a canine ophthalmologist at an emergency and specialty clinic where I've spent many hours with Freya, Lasya, Nina and Ruby. This was Boca's first visit. The ophthalmologist thought the spot was possibly scar tissue from past trauma and did not agree with the Florida Spot diagnosis. She did see a corneal ulcer with the fluorescein stain and recommended a procedure called diamond burr debridement, which was described as a tiny dremel that would create a new surface on the cornea to promote healing. It is a common and fairly succesful mode of treatment and although it sounded terrifying to me, only required a numbing drop. When I picked Boca up she was happy and seemed more comfortable, but in the weeks following she has still not improved. Her eye now has a large cloudy area extending over the pupil and despite being on pain medications it is clearly very irritated and continually teary. This is what is known as a 'complicated' or 'indolent' corneal ulcer. In my research I learned that they are frequent enough in Boxers that they are sometimes called 'Boxer ulcers.'

We've had several more visits to the ophthalmologist and have tried several medications including a very expensive, very heavy-duty antibiotic eye drop, all with disappointing results. Last week we tried a steroid drop but the results were not dramatic enough to warrant continuing. I can tell that the vet is as frustrated as I am and we just seem to be on the unlucky side of the statistics for this condition. Tomorrow we will see the third of three specialists at the clinic, and we are hoping for a fresh approach or new idea. There are several different surgical options and I think we may be at the point of discussing them. Because Boca already had an abnormality in that eye, it will not be covered by insurance, even though the vet wasn't able to say definitively whether the spot is the proximate cause of the issue.

The worst part of this has been seeing my poor, sweet Boca in pain and not being able to solve this and help her. Overall, I think she is handling things better than I am. She is wonderful about her three-times-daily eye drops and has a wonderful, joyous attitude. She loves getting breaks from the Cone of Woe when we go on walks and have cuddle time on the sofa. She has even figured out how to chew on Benebones and antlers with the cone on. The staff at the specialty clinic all adore her (one declared Boca her "favorite dog ever") and I've been extolling the virtues of Potcakes on the heels of her charm. The waiting game is a tough one when it comes to our beloved pets, and a medical mystery is not the prize you want to win from the veterinary grab bag. I'll continue to update as I know more, and if any of you have dealt with this eye condition I'd love to compare notes. In the meantime, I'll try to take inspiration from my easygoing island girl and keep my chin up through our latest challenge.

Further Reading:

Corneal Ulcers from Eye Care for Animals