Monday, November 24, 2014

Entropion, the Feline Version. Why A Cream Can't Cure Everything.

Most examinations start the same way; Patient and clients escorted to an exam room by technician. Technician gets history, weight, temp and a summary of presenting need. This appointment was a little different from the get-go; cat on scale, parents waiting, and scribble in chart reads, "Client wants eye cream." I entered the room with an open mind and a blank exam chart page.


On the other side of the exam room door I was greeted with; "Doc, we are just here for a cream." Not much of a "hello," and straight to business.

But let me go back and set the stage. Sitting before me on the exam table was a cream colored rather tawdry looking fellow. Standing in front of him were his parents, an elderly coupe who also doubled as his muscle and protection. They were not here for a chat, they simply wanted an  eye cure cream,. They appeared to be on a tight schedule, and had no desire to meet me or start this relationship with a silly nicety like, "Pleasure to meet you Corky, I'm Dr. Magnifico. what brings you in to see me today?"

"OK, what kind of cream?" I replied. It is sometimes better to meet short and direct with the same and those routine examinations can get a bit mundane.


"Well, our friends had a dog with the same condition and their vet prescribed a cream which cleared it right up." Sit, sigh, fasten your seat belt. There is some mysterious illustrious miracle cream out there that never has a name,, yet people seek to find again,,perpetuate its elusive existence,  and the legend lives on. Much to the chagrin of every veterinarian there is not a cream that has magical powers. We treat a condition after it is diagnosed, then maybe after there is a cream. And, I promise we do not withhold the "miracle creams or pills" for the other clients.. After I explained this hey stepped away from the table and allowed me access to their cat, Corky.

"We saved the goop in the eye so you could see it." (For those of you out there who do this I would like to add a small polite humble side note; We know what goop looks like, and we believe you. And, personally, I am going to wipe it away becausse no one wants to sport goop in public. That's just embarrassing).


They rambled on for some time as I stood scribbling the important tidbits of information sprinkled between the miscellaneous stories of past veterinary experiences. It also seemed that they didn't see my white coat as bringing much to the proverbial treatment table..something about the "eye had been this way for years",,,"the goop gets bad and then a cream (still didn't know what cream we were referring to) gets it better,"  "Corky is an indoor only cat," and they "wanted the best for him." OK, common ground, I felt a bit more empowered and they took a pause.. (I think just to see if I was still present).


We are trained to start with a history. A good listener makes a good veterinarian. But the path to greatness is paved with good intentions and a thorough examination. 

This is what I saw..
Can you see Corky's problem?
 Maybe if you compare the top photo to this one?


Corky has entropion. His bottom eyelid rolls in and the hair on the lid brushes the cornea every time he blinks. This is painful and traumatic to the cornea. In an effort to reduce the irritation the eye produces excessive tears. The only way your eye knows how to get rid of an irritant is by flushing it out.

After a brief discussion and a tiny bit of  reinforcement that I was comfortable with both the diagnosis and treatment plan Corky's parents eagerly signed him up for his corrective surgery the following week. Turns out their initial gruff demeanor was just a case of over protective parents.. I have a very big place in my heart for people who adore their cats, and  they truly wanted nothing but the best for their Corky.

Corky left the exam with eye ointment to help heal the abraded cornea, updated vaccines and some pre-op blood work. His initial consult was $260.00. He was scheduled for surgery the next week, pending normal blood work.

Here he is on surgery day.


Entropion surgery entails correcting the eyelids so that they lay normally over the eye. This requires removing the slack or excessive skin so that it can open and close normally. This allows the tears to be evenly distributed, thereby keeping the eye clean, lubricated and protected. Corky had too much skin on the bottom lid. To tighten up this he needed an elliptical piece of skin removed.


 Corky also had an excessively long bottom lid so I shortened it.


Post-op Corky's right eye looks better already!


As with most patients with entropion, the condition is bilateral. Although Corky's left eye was not goopy it did roll in a little bit, and a little piece of lower lid was reoved to keep him squint free on the left side all of the rest of his days.


Post-op Corky has incisions under both eyes and an eyelid correction for the bottom lid on the right side outside (lateral).


Post-operatively Corky also needed an e-collar. Never over look this important medical device. A cat will lick or rub something that hurts. It is very important to keep the eyes protected from the paws rubbing, especially in light of needing to apply ophthalmic ointment every few hours. I know every pet hates an e-collar but they can save you both time (not needing to re-do the incisions), and money (again, not needing to re-do the surgery).  We place the e-collar on before they wake up completely as it can be difficult to do when they have all of their faculties and weapons on stand by.


Corky's surgery cost was $378.00. This included an i.v. catheter, i.v. fluids, anesthesia, entropion surgery bilaterally, pain medications post-op for three days, an e-collar, and ophthalmic antibiotics. 

Here is Corky at one week post-op, still a little bit of discharge but the cornea looks good, The eyelid is not red, swollen nor is it inverted and rubbing the eye.



The other important finding is that Corky holds his eyes open and they appear calm, quiet, and comfortable.


This is Corky at two weeks post-op. I do not charge for post-op re-checks. For me it is about encouraging compliance and monitoring, and assisting my clients and patients with an optimum outcome.


I spoke to Corky's parents today. It has been about a six weeks since his surgery. They reported that there has not been any eye discharge and that he is doing very well. Their only concern was that the hair we shaved for his i.v. catheter and around the eyes wasn't growing back as well or quickly as they had expected. I told them that sometimes this happens, we don't quite know why, but over time it should.

So, what I am most Thankful for this Thanksgiving? Having a job that I love, clients who love their pets, and a family to be surrounded by. Happy Thanksgiving Everyone!

If you have a pet question you can find a slew of helpful generous people at Pawbly.com. Pawbly is a free resource for pet people to ask questions, share advice, build relationships and we are always centered around how to provide better care and resources to pets. Pawbly is free for everyone.

If you would like to talk to me about my pet services at the clinic, Jarrettsville Vet, in Jarrettsville, Maryland, you can find information here. Or visit me on Twitter @FreePetAdvice.

17 comments:

  1. Happy Thanksgiving to you and yours! Good job girl !

    ReplyDelete
  2. This is awesome! I found this while looking for entropion surgery because my cat just had one, he was able to remove his cone and rubbed his eye and now image kid is rolling a bit out (unlike rolling in as it was before the surgery)
    His stitches are in place and he is not bleeding but he tore some of the skin around the stitches, maybe he tighten them? I would be really thankful for any advice you have as you seem to be great at your job, this cat looks awesome

    ReplyDelete
  3. Thank you, this is very helpful. Any tips on keeping his eye clean post surgery without risking an infection or getting in too much contact with the sutures. My kitty's entropion was also corrected bilaterally and there is a bit of discharge as well as gunked up tears. The left eye also appears a little cloudy. The right looks clear and bright and has no discharge. However the left was affected worse by the condition than the right. Any advice? Anything to worry about? Thank you!

    ReplyDelete
  4. My best advice is to see the vet every 2-3 days for the first week or two. Keep the e-collar on.. I am looking into a product line called protectivepetsolutions.com I havent used them yet, but I will be for these surgeries. Let me know if you use them and like them.
    If you get concerned see a vet ophthalmologist.
    Good luck!!
    Thanks for reading

    ReplyDelete
  5. How was Corkys mood before, imeadiate and soon after?
    My cats entropion has gotten worse and its time, I think the last few week she seemed depressed over it, and simply doesn't explore the house like she used to.

    ReplyDelete
    Replies
    1. Your cornea (the clear glassy covering of your eye is incredibly sensitive. Anyone who has ever gotten an eyelash in their eye, OR, any kind of trauma or injury to their eye will tell you it is intensely painful. Pain in the eye is demonstrated by squinting, discharge, and pawing or rubbing at the face. Every pet that I have ever done this surgery on was much happier after the procedure was done. They were also able to hold the eye open and use it again,, a sure sign of success!

      Delete
  6. My beautiful Bella needs this surgery. She is a healthy but elderly 14 years old. My great concern is putting her under anaesthesia. Is it too risky. My vet explained she would do additional tests xray of heart, kidney function etc before hand. Additional cost of course, but worth it. Would appreciate you opinion. I have been putting off the surgery as I am afraid. I know she has some discomfort and I am cleaning her eyes and putting in drops to provide some lubrication.

    ReplyDelete
    Replies
    1. Hello,
      I think that not making a decision because you are afraid is not what your pet deserves. If you truly want your pet to be happy and healthy medical care is a necessary component. If you trust your vet you should do whatever you can to keep your pet comfortable and healthy. If you are still unsure seek a second opinion, ideally from an ophthalmology expert.
      I understand you love your pet, but you shouldn't love them so much it affects their health adversely.
      Good Luck

      Delete
  7. This comment has been removed by a blog administrator.

    ReplyDelete
    Replies
    1. hope i didnt say something bad, i see my post was removed.

      Delete
    2. hello!
      I dont know where the comment went!!?? I didn't remove it. It may have had an unknown address and been removed by blogger? I so apologize for that. I don't ever remove a posted comment (although I do not post spam or mean comments).
      much love
      krista

      Delete
  8. Hello! I'm not sure anyone will see this in time, but how in the world do you calm an agitated cat after this surgery? He has the cone on, but will not stop trying to remove it. We wrapped him in a large bath towel to calm him but can't keep him wrapped in it overnight. I was hoping he'd be sleepy after surgery, but it looks like it's going to be a very long night. I've read on another veterinary page that Dramamine (.25 of a pill) may help to calm him, but don't feel comfortable putting more medication into his body. Are there any suggestions, or do we just have to stay up all night (and possibly tomorrow night too)? Thank you very much!

    ReplyDelete
    Replies
    1. Hello,
      I am sorry I didnt get to this sooner. If you ever need a question answered please find me at Pawbly.com. I suggest a quiet, dark enclosure and lots of bedding to snuggle up in. Most cats calm down in a quiet small carrier or enclosure. Also I would call the vet back and ask for something for both pain and sedation. I cannot offer specific advise on a drug as I don't know your cat or the medications already given.
      I hope that he is better soon

      Delete
  9. Hello All! I've never posted anything in my life, but this correspondence is sooo super helpful as we head into entropian surgery with our kitten, now 6 mos. old at the end of the week. Any chance you have an updated picture of Corky---did her hair ever grow back? would love an updated picture!!!

    ReplyDelete
    Replies
    1. hello,
      I am sorry but I do not have an updated photo. But, the hair did grow back and her eye looked normal. I don't think anyone could have ever told the difference between them.
      take care, best wishes to your kitty.

      Delete
  10. I just wanted to say thank you to all that posted in here. My PPD had this surgery and it has been a miracle! her eye are just as they used to be wide open and useful, she is also like a brand new cat enjoying and exploring everything she can! Its been a few months now and she looks PURRRFECT!

    ReplyDelete
    Replies
    1. Hello Ann Marie!
      I am so glad to hear that things went so well!! Much love to you all,
      Sincerely
      Krista

      Delete