Oh the new vocabulary Humphrey has acquired in the past week: sclera, hyphema,stromal, malacia.
Humphrey's right eye corneal ulcer - the bad one - remains fully healed. However, that eye has an existing cataract (which we knew) and has hyphema: evidence of previous bleeding, which seems to be new. Perhaps he had trauma to the eye last Friday or something? But for now, therapeutic focus is totally on the left eye.
Recall a week ago the superficial ulcer on the left eye had fully healed (in fact, it had been healed for 3 or 4 weeks). Somehow, Humphrey managed to get another quite terrible lesion on that good cornea! The diagnosis is "moderately severe deep corneal ulcer with actively dying tissue" (in other words, a melting ulcer). Did you know that the cornea has four layers? It does! The outermost layer is called the epithelium, followed by basement membrane, then the stroma, then the Decemet's membrane. So, when the diagnosis is a stromal ulcer, you know how deep it goes. The seemingly simplest things can cause a corneal ulcer: an eyelash or rubbing the carpet the wrong way.
That means that the awful treatment resumes: a cone, drops every two hours, and some pain medication to help things along. Recheck in two to three days (it will be two based on appointment availability!).
Because this was a second ophthalmologist, Humphrey noted a difference in treatment styles. He asked, "Do I need another corneal crosslinking (CXL)?" Recall that CXL is an "adjunct" therapy in which riboflavin (a type of collagen) drops are applied every 5 minutes for 20 minutes, then UV light is directed to the area. The idea is that this should accelerate healing. Humphrey had this procedure at a very steep costs ($1,200) in Toronto by Dr. Hockeypuck's veterinary technicians.
Interestingly, in Toronto Humphrey asked questions about CXL's efficacy, how much it helps, risks, and the proportion of success. Dr. Hockeypuck's staff acted insulted to be questioned, and could not offer any data on efficacy. Humphrey's own research revealed that as an adjunct therapy, it appears promising to speed healing but there is no clear data on its actual results. The new ophthalmologist, Dr. Yankee, said she does not use CXL because (just as Humphrey determined in his research) it's an adjunct therapy and she is not convinced it has any real or significant benefit.
Whereas Dr. Hockeypuck prescribed 5 drops every 4 hours, Dr. Yankee prescribed 2 drops (plasma, and Vigamox) every 2 hours. The latter is consistent with most published protocols for dealing with corneal ulcers, so Dr. Hockeypuck's approach is puzzling (but - anecdotally - it was quite effective 4 weeks ago). She also incorporated lubricating drops into the mix, which Humphrey suspected were in order based on previous eye exams (even brought it up to Dr. Hockeypuck who said no way).
While Dr. Yankee had a slightly better bedside manner than Dr. Hockeypuck, she was nonetheless hurried, curt and came across as adverse to questions, as though it was an inconvenience (though to her credit she answered them). Yet, for the steep fees, the consultation with the actual ophthalmologist was minutes. This is a very different experience compared to the doctors in ER, cardiology and surgery at the very same clinic that Humphrey consulted in the past.
Humphrey's continued concern with costs resulted in some interesting developments - and despite his best efforts he got ripped off again!! Recall (here and here) that he has the retail pharmacy costs of many different ophthalmology remedies and ointments committed to memory (especially after being charged $77 for a $17 bottle of Atropine!). At Dr. Yankee's office, he indicated that he needed another bottle of Vigamox antibiotic drops, which Dr. Yankee's assistant offered to fill. Humphrey inquired about the price, stating it is $25 at his pharmacy. The assistant said, "Oh, it's about $30 I think, maybe $40."
"If that's what it is, then I'll just get it here to save me a trip to the pharmacy." The assistant said she would double check, so when she handed him the bottle he assumed that it was not more than the estimate.
In the chaos of "checkout," (there were several dogs present and everyone was spunky), Humphrey paid his bill without looking at the itemized list. When he got home, he realized he was charged $70 US for a $25 CDN bottle of drops! He called Dr. Yankee's clinic - no returns once it has left the building.
When it comes to obtaining veterinary pharmaceuticals, these clinics are Lucy holding a football to Humphrey's Charlie Brown. Despite his best efforts, they somehow manage to pull the football out of the way before he gets to kick it.
In terms of consultation fees, Dr. Yankee charges $185 for the first consult including tests, compared to Dr. Hockeypuck's $300 plus tests. But a big difference exists in follow up visits. Dr. Hockeypuck charges $85 for a follow up, and t Dr. Yankee's follow-up visit is $150. Humphrey also had to pay $50 to have his blood pressure checked!
Caveat emptor, people and dogs!
Meanwhile, Humphrey expects to win this battle eventually - but how to win the war when a cornea seems so vulnerable to tearing? Perhaps he will have to wear goggles all the time (wouldn't be the first time, right?)? Stay tuned to find out....
And for anyone who wants to know more about the cornea, this is a fantastic article.
No comments:
Post a Comment