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!