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| Eyes as darling as these need to be protected! |
As Humphrey noted in a recent post, the costs of veterinary ophthalmology in Toronto are outrageous when compared to equivalent human healthcare and procedures. He has had several follow-up examinations with his ophthalmologist, none longer than 3 minutes with the doctor. The wonderful news is that his corneal ulcers were declared healed, and that means no more cone! He will not miss the nicknames he endured while wearing that contraption: Coney Island, Coney Dog, Conehead, and of course Director James (Jim) Coney.
While four of Humphrey's five eyedrops (atropine, plasma, Tobrex, and Vigamox) were discontinued, he was instructed to continue Disodium Edatate (EDTA) for chelation of calcium deposits in or around the cornea. In addition, on Thursday the ophthalmologist also prescribed something called Isathal, which is an antifungal containing fusidic acid. Humphrey's guardian asked a lot of questions about it, much to the visible annoyance of veterinary staff, and was told it is a benign antibiotic for longer-term use.
After Humphrey's first application of Isathal, he showed signs of great discomfort and scleral redness. His guardian emailed the ophthalmologist, only to receive a response at closing time saying the individual was away from the office, and to contact them on Monday if problems persist.
After his Friday evening Isathal application, Humphrey rapidly lost his vision! To the point that he was totally blind.
Lack of Continuum of Care in the System
Clearly, Humphrey needed immediate medical attention. Humphrey's humans called every single emergency clinic within 40 km to determine who might have an ophthalmologist on call. Not one facility did. The three of them got in the car and made haste to get to one of the 24-hour clinics, and were able to complete the paperwork by phone on the way there so they could be seen immediately.
After various tests (that further confirmed the corneal ulcers were healed from a fluoroscien stain), and pressure tests to ensure the eye was mostly OK, the veterinarian on duty concluded "suspected uveitis" and instructed Humphrey to discontinue Isathal, and to administer Voltarin drops as an anti-inflammatory, and Tobrex as an antibiotic. She also recommended continuing EDTA, though the humans were skeptical since EDTA seems to irritate Humphrey's eyes.
The veterinarian on duty said that the facility does not have specialized ophthalmologic equipment for other sorts of tests, so she could not determine the state of the retina or iris. She also confirmed that to the best of her knowledge, no ophthalmologists were on-call after hours in the city.
The lack of on-call specialists appears to be a real problem, and one that would be easy to remedy.
By comparison, in Southfield, MI, Blue Pearl Pet Hospital has an ophthalmologist on-call at all times for emergencies like Humphrey's.
UPDATE: As readers know, on Friday the ophthalmologist was not in to take a call before the emergency. On Monday, he would not answer questions by phone or email because it was "surgery day," and on Tuesday and Wednesday, he simply did not bother responding.
On Thursday (almost a week later), Humphrey's guardians called in with questions, and being the last day before a long weekend, that ophthalmologist was not in! So after some largely not useful information from the person who answered the phone, they made an appointment in the United States.
Fee Disparities: By Species and By Country
As Humphrey detailed in his recent post, the costs of dog ophthalmology services are many times the costs of similar services for Humans. Similarly, costs of identical medications are at least double in most cases when purchased from a veterinarian versus at the local (human) pharmacy. The example he cited previously was Atropine, which is $17 at Shoppers Drug Mart, but he paid $77 for an identical compounded bottle. This trip, Humphrey was able to price-compare for a new bottle of Tobrex antibiotic drops. At the clinic, he would have paid $40 plus tax, but at the pharmacy on the way home, he obtained the identical drops for $25 including tax.
The consult fees are much more reasonable for dogs in the US! Recall for a Toronto ophthalmologist, the fee is $300 plus the costs of tests. At Southfield, MI's Blue Pearl, the cost is $185 US and three major ophthalmology tests are included in that fee. That represents significant cost savings even with exchange, and the assurance that an ophthalmologist could weigh in on an emergency like the one Humphrey just experienced.
Luckily, All's Well That Ends Well....
Despite some terrifying moments and hours when Humphrey experienced total vision loss, everyone was relieved when his vision began to return about 4 hours later before any treatment commenced. While it may be a coincidence, the veterinarian who saw him said that it's quite possible Humphrey has a hypersensitivity to fusidic acid, and that may have caused temporary blindness.
As he approaches the 24-hour mark, his vision continues to improve. Fingers crossed!
UPDATE: No more blindness occurred as of a week later! However, they were unable to get any meaningful help from the veterinary community in Toronto.
Humphrey also did a bit of additional reading about the latest round of drops now that the emergency was over and there was more time available. Turns out the NSAID he was prescribed (Voltaren) can impede healing, and can compromise the cornea in otherwise healthy eyes with prolonged use! Not one of the three vets consulted mentioned this! (He sent emails to his regular vet and to the ophthalmologist inquiring about their opinions on the new treatment immediately after the emergency - not one response!). This is highly questionable practice, since using an NSAID could do more harm than good!
Finally, Humphrey filled out an online form for the pharmaceutical company that manufactures Isathal to report an adverse effect. He could not believe that he received a call back in less than an hour by an actual veterinarian to follow up! The vet was very inquisitive, and took additional information to submit to Health Canada to record this as a side effect. The vet noted that he believes most veterinarians fail to report such things to the manufacturer.
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