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Parotid Duct Transposition

What are the problems during and after surgery?
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I am afraid I don't know enough about this surgery. I tried just now doing a little research on it online, but headed straight into extremely technical info. which I could just about half understand, and it was so complicated I couldn't write it all up for you!

It would be a good idea if you posted your question to Dr Aleda Cheng on the "Ask a Vet" Forum. You may not get an answer immedately, but do persevere, because you will get an answer.

Scroll down this page, and you will see a link through to that (on the right down this page)
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You really do need to discuss this with the vet who (I presume) has recommended this surgery. Ask, and I'm sure your vet will explain all you will need to know.
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I assume your dog has keratoconjunctivitis sicca?  What treatments have you tried?  What medications have you used thus far that have not worked?  

The surgery itself isn't terribly risky, or at least no riskier than any other procedure where anesthesia is involved, but it's not a perfect solution either.  It's possible for salt crystals from the saliva to form in the eye, causing serious irritation and more problems.

Because it's like a last ditch effort to lubricate the eyeball, parotid duct transposition is reserved only for cases where all other attempts at treatment have failed.  I know I asked above, but what medications have you tried thus far that have failed?

Ghilly
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Yes, for many months we have tried ALL the medication treatments available without success and surgery has been suggested.  We are interested to hear first hand from dog owners who have had the Parotid Duct Transposition procedure for their pet, with their experience as to after surgery problems (if any), and the eye maintenance thereafter.
Also, the effect the surgery has on the pet's behavior, and any other information that may be helpful.
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Have you tried Optimmune?  It contains cyclosporine, but it is an ointment, and far superior to liquid drop formulations that also contain cyclosporine.  I have seen animals that have loads of hyperpigmentation in the eye and almost total opacity become almost normal looking eyeballs after a couple of months of Optimmune use.  If you did try it, how long did you use it for?  The reason I ask is because it takes at LEAST 30 days to start to see any kind  of improvement, and in severe cases, it may have to be administered at least twice a day until the eyes start to improve.  After they start to improve, you can try administering it once a day for a week or so, and if the eyes are going to regress, you will see it in that short a time and can increase the administrations to twice a day again.  

If you have tried cyclosporine drops (as opposed to Optimmune, which is an ointment), and have not had success with them, it could be because the drops use soap as a stabilizing agent, which has the unfortunate side effect of irritating the very eyes that the drops are supposed to be helping.  The drops also do not stay with the eye more than a couple of minutes, whereas with the ointment, it's thick and it stays with the eye for hours, providing much better coverage and protection.  The vets that I wworked for prescribed it regularly, and I was VERY impressed with the results.  Optimmune succeeded where other cyclosporine formulations failed.

By the way, what breed of dog do you have?

Ghilly
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My five year old Westie had the surgery last week.  It's great to see the tears.   The vet saw him yesterday and said he was progressing as expected.  However, as of last night he seems to be regressing.  When he eats and the tears start to flow he squeezes his eyes shut as if he were in pain.  He keeps his eyes shut all day long.  Even when he is outside he will not open them.  Three days ago he was not doing this. I'm wondering if the ph of his tears is bothering him. There is a watery yellow discharge that develops along his eyelash line.  It is not the same discharge that resulted from his dry eyes. I'm waiting to hear from the vet.  
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Spoke to the vet.  One of the side effects of the surgery is mineral deposits in the eye.  It's the yellowish discharge around his eyelashes.  It is a result of the difference in ph.  We will try putting him on a prescription diet such as a dental diet.  My dog produces a lot of tarter.  Perhaps they are related.  In the meantime I will be constantly cleaning his eyes.  I would not have done the surgery if it had not been for a serious ulcer he developed while we were out of town.  He required surgery to repair the damage.  
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The dog definetly has dry eye. Surgery has been suggested as he has zero tears in left eye & 8 in right by Schirmer Tear Test. We are trying to find information such as yellobird 500 has given.
He is a pound dawg. Some have said he looks like a Catahoula. I believe he is a dalmation - terrier mix with blue eyes and 78 lbs of love!
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Thank you for your response. Sorry to hear things are not working out right.
Hopefully the diet will help. I wonder if the surgery reversible if when my dog is done and want to go back?
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her's my story.  My 5 year old WEstie went in for a yearly checkup March 4th of this year.  his tears were down to 5 in both eyes from a previous 7 to 11.  He was put on Prednisone and Docicycine.  We changed to the gel form of Genteal and Tacrolimus.  The vet said he would drink more and he did.  She recommended surgery for the first time.  Casper has been her patient for 2+ years and she had never even suggested that there was a surgical solution.  Within a week my dog was worse.  I used saline soltion to clean his eyes.  The next day he wouldn't pen his eyes.  I put the solution in my own eye and discovered it wasn't fresh.  I immediately called the vet and she said surgery would solve the problem.  The next day I went to another eye specialist and Casper had an ulcer in the center of his eye.  It healed with a minor scar right over his pupil.  His tear production had elevated to 7.    The scar healed within the week.  Unfortunately,  we were scheduled for a 4 day spring break vacation and I couldn't back out.  Casper stayed with his usual dog sitter.  When we picked him up he was squinting again.  Now he had an ulcer that was so deep it required surgery to repair.  His eye would be scared and some vision lost.  I opted to do the parotid duct surgery at the same time.  The worst side effect according to the vet was a slight mineral buildup due to difference in ph.  It has been over a week since the surgery.  The vet seems to consider the surgery a success because his eyes look good.  The problem is that Casper won't open his eyes.  He is in such discomfort that he spends all day with his eyes shut tight bumping into everythng.  He responds to my rubbing his eyes which tells me they itch. I spend all day tending to his eyes, medicating them with drops to numb, heal,and lubricate his eyes.  We've changed his meds several times.  We are even trying to change the normal ph of his body with vitamin C pills. I returned t the vet yesterday and he says Casper just has to adjust. Then he charged me for the visit! Does anyone ever adust to itchy eyes?  I dn't think so.  I wonder if I had not been to the vet in March would I be in this situation today?  

Please note, I asked at the vets office if this was a common surgery.  I was told that as of a month ago it wasn't very common.  But for some unusual reason they are doing one or two on a weekly basis.  The surgery on both eyes was over $2600.  That doesn't include several hundred dollars in meds.  The vet charged me for yesterday's visit.  I wonder if it is the newest way for them to make quick cash or if there has been a recent seminar or paper published that has made this surgery popular.  In my opinion,  there are too many unkowns afterwards.  My vet is guessing at this point without any assurances.  He seems satisfied with his work. The fact that my dog is  a completely different dog ( miserable, sedantary, sad) seems irrelevant to him.  

If anyone has any experiences with this surgery, please post them here.  We need to help each other.  I don't trust the vets to be truthful.  I asked all the questions up front and searched the internet and it didn't help me.  My dog turned out to be a guinea pig.

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Found this on the net.  Hope it helps.


http://www.willows.uk.net/information-sheets/ophthalmology/parotid-duct-transposition.htm
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Avatar_m_tn
We share your feelings about vets. That is why we are researching online before surgery.
Or if there is another way......
Thank you for the link.

I probably did not phrase my question well enough to attract others.

Blu's ophthalmic specialist has been doing a bunch lately he says. Six in the last three weeks.....$$$$$ Same price range as yours.
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Thanks for the link information.  I hope my  Westie isn't one of the exceptions.  I went for a second opinion today.  Found the vet on http://www.vmdb.org/clinic.html.  A listing of veterinary ophthamologists who are part of the Canine Eye Registration Foundation (CERF).  I was very impressed with the vet.  She advised me that she performed the surgery as a last resort.  She also said most, if not all dogs had issues with the calcium minerals in the eyes from the saliva.  In addition, the surgery did not eliminate the need for daily medication (EDTA to dissolve the minerals).  Most dogs will be on it forever.  She changed his meds and increased the dosage of EDTA drops and Atropine.  She also made a serum from his own blood.  Drops of the serum are to be applied to his eyes daily.  I'll update when there is an change.

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Update on my westie.  Today he is considerably better.  He is opening his eyes and is more alert.  He is not bumping into everything.  Two days ago we began weening him off the prednisone because because his blood test had irregularities.  This may be the reason  he is more alert.  I am very happy to see such a change in him.  
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I am sorry to take so long to get back to you.
Glad to hear that your westie is feeling better.
I appriciate your keeping me advised.
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Casper, has had a setback and I don't know why.  Twice we've taken him for a walk and both times e has returned with his eyes closed tght.  It has taken three long days for him to open them again.  His walks were short as always.  I now walk him about two hundred feet and back home.  Even that has proved to be too much.  He won't open his eyes today.  He's afraid to step out into the yard.  I have to carry im over the one step.  I have to clean his eyes every morning.  The saliva cakes on his hair and smells terrible.  I spend all day putting drops in his eyes.  The EDTA (he'll need forever) needs to be refrigerated making long outings an inconvenience. Casper is losing his appetite and therefore losing weight.  He was better off before the surgery. My westie is miserable and so am I.  Think long and hard before sing this surgery.  Get a second opinion and ask every question you can think of and request the answers be put in writing. If not let the vet know you are keeping records.  Then maybe you will know better what to expect.
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Thank you for the update. I am so sorry to hear this sad news.
Thats why we am trying to find out all we can as we are set for early August.
We put Tacrolimus & cyclosporine (6:00AM, 2:00pm & 7:00PM) three times a day and Teargel/Severe every hour starting at 7:00AM untill 10:00PM. So we know about not bring able to go places and travel.
I am starting to put out questions in other forums. If I find anything I will  inform you.
I hope Casper can make a recovery!!
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My Brandy had PDT surgery in January 2006.  She has done very well.  The surgery was by her left eye.  Recently she developed a "stone" or crystals in her parotid duct and she is going in tomorrow to get it removed.
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I see you are in Miami.  I am in Homestead.  There is a wonderful Opthalmologist veterinarian in Homestead.  Are you satisfied with your vet?
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Thank you for your response!

I am glad to hear your Brandy has done well after surgery, but sorry to hear she has developed a crystal in the duct.
My primary concern is my dog’s comfort / quality of life.
What I would really like to know is  - what the daily routine has been following surgery.  
Have the number of medications / drops become less, and also what is the frequency of administering drops throughout the day.    And any changes in behavior.

We are trying to find out all the pros & cons before we have surgery done. Right now we are using Cyclosporine & Tacrolimus drops 3 times a day plus Teargel severe dry eye gel every hour(6AM –10PM) to keep his eyes comfortable.

Who is your ophthalmologist? We may get a second opinion.

Would appreciate update as to removal of crystal.
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I haven't had to use any drops since her PDT surgery.  Her duct was working very well.  Before she had the surgery, I couldn't keep her eye moist enough with drops.  Nothing worked. She became a very normal regular dog after she had healed from the PDT surgery. She was operated on late this morning. The opthalm. had to cut into the PD in order to remove the crystal.  The surgery took 2 hours (looking through a microscope).  She tried to work the crystal out with pressure, but it would not move so she had to surgically remove it.  Brandy now has a stint in place.  Dr. Tucci described it like cutting a hole in a hose, the hole has to be closed or fluid will leak out the side.  I will pick her up tomorrow afternoon.  They wanted to keep her overnight and she will be sedated for the next few days.  Fortunately I was planning on taking next week off anyway so I will be home with her.  The important thing is that the stint stays in place until all is healed.  If it is possible, I will email you the link to Dr. Tucci's web site.
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Casper is doing better.  A culture identified the presence of E-Coli bacteria in his eye.  He must have picked it up outside while sniffing around.  Maybe it happened because his vision was temporarily impaired due to the surgery.  I don't know.  It is almost healed and he is opening his eye more.  As far as the meds,  He is still on cylosporine, EDTA (to dissolve the calcium crystals), and several others because of the ulcers.  I believe he will always be on the EDTA because he produces a lot of crystals. Maybe it is related to the fact that he produces a lot of plaque on his teeth.  His face is constantly wet from the saliva, and it smells bad.  I wash his face with a washcloth every couple of days.  I don't know ow difficult it will be when his hair grows back.  He is behaving normally now.  Thank you for the suggestion of a doctor in  your area.  I am happy with the one I currently have. Dr. Pellicane is the third one I have been to.  She is very thorough and puts everything including a detailed diagnosis and instructions in writing.  However, I would like to know the name of your doctor, just in case.
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Thank you for the update. All information is appreciated!

Glad to hear that Casper is doing better.

Our Ophthalmologist is in North West Miami - If you live in the Miami area??

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I have a 6yr-old German Shepherd with pannus and KCS for which I am considering PDT surgery.

She is seeing residents and faculty in the ophthalmology department at the Veterinary Teaching Hospital at Michigan State University who are recommending the surgery. The estimated cost is $1300 to $1700 for both eyes (done at the same time). I'm curious to know if any of you had a salivation test before your surgery to establish adequate saliva. My dog had one and adequate saliva production wasn't confirmed so I will need to repeat that with favorable results before I ultimately decide. Clearly, Casper's saliva production sounds adequate or excessive, but did any of you hear instructions about training your dog to salivate in your abscence? This group of doctors is being very direct about the post-op need to train your dog to salivate based on some regular sound that you establish; making Pavlov's dog out of your man's best friend so that his eyes stay lubricated regardless of your presence or the possibility of food. I wonder if mineral deposits are at all related to stints of low saliva production that dries and fails to flush through (possibly followed by overproduction making the eyes look well wetted when you are home), although these ophthos also warned me of possible medication to remove said deposits.

She'd been on the tacrolimus to fight the pannus for almost a year before we had any tear-production issues, but last Thanksgiving weekend she began to squint and it's been downhill ever since. We've recently switched to cyclosporine because there is a slight chance that she could respond to that and produce some tears, but it sounds highly unlikely. She will need one of these drops 2x/day forever just to mitigate the pigmentation from the pannus. I've been using Genteal severe since December and she is outwardly very happy and healthy aside from visibly severely irritated conjunctiva. I use a lot of Genteal, about 6 or 7 10ml tubes a month ($50-$60), but her corneas have substantial vascularization to repair the damage that is evidently done while I'm at work. Also, the condition of her corneas is deteriorating even over the last six months and I already don't go anywhere after work so I can get home to put the Genteal in. It's, of course, the last thing I do before I go to work and I think she sleeps all day. So she will still show me her corneas when I get home, but they are noticeably dry. They keep doing Schirmer tests because it's a teaching hospital but they always get 0 and I know from my efforts it hasn't changed in 6 months.

My dog's condition is caused by a general immune mediated disease process. This is one of several immune-mediated problems that she has, for which she will have to have treatment until she expires. So, even though she is doing well and plays and is very happy, her disease process could attack the liver, or kidneys or adrenal system at any time (among any other) that could lead to quick mortality. I don't really want any possibility that her (or my) quality of life changes for the worse as a result of electing the PDT, so I appreciate the comments here. It might be true that I will still decide to let her vision deteriorate to preserve the quality of life that she has left for the duration of life that she has left, but I think I would let her go before I took her eyes out, so the fork in the road is really right now. The fact is, I have to decide very soon which route to take and I don't have much of a way to know what's really best for the both of us.

I guess I need to hear from someone that is pleased with the PDT, although I think it unlikely that they are spending their free time looking for veterinary ophtho pages to post their wonderful experiences. It is we with the continued problems that spend our time giving feedback, an unfortunate fact.

Good Luck to all of you and your pets!
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We have tried a couple of different forums but not much response.

We also are trying to find out all the pros & cons before we have surgery done. Right now we are using Cyclosporine & Tacrolimus drops 3 times a day plus Genteal severe dry eye gel every hour (6AM –10PM) to keep his eyes comfortable. Luckily there is someone home all day.
Our opto said he would check saliva just before the operation.

The possible cause for our 6 yr olds dry eye was a medication (had implications of causing dry eye- if we had only know before) that was administered & he had an allergic reaction to it.
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I am very happy with the results from my Brandy's PDT surgery done 3 1/2 years ago.  I've posted a bit earlier.
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Going to Dr. Tucci this coming Wednesday afternoon for a second opinion.
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Hi Mary,
My 4 year old Golden had PDT surgery in May. She is doing really good her eyes look bright and wet except she still gets gunk in them.  I have to wash them out a few times a day.  I'm pretty sure it isn't mineral deposits yet.  Does this happen to your dog?  if so, what do you use to clean them out?  What do you use to "bait" your dog? How often do you feed them?  Rosie has already gained weight and she isn't very excited about pretzels anymore.  The vet says gunk is fine as long as her eyes aren't fused shut in the morning and they look bright and open which they do...  

Sorry for all the questions!  

Thank you!
Jill
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Hi Jill,

It did take a while for Brandy's eye to stop producing goop - I call it...  Lean Treats are good to get her eye to water, also a little cheese, or bit of chicken.   It has to be really yummy to them.  Dr. Tucci, her surgeon, uses Lean Treats when I take Brandy in for a check up, etc.  I feed my dogs twice a day.  They are miniature dachshunds.  Sometimes I used sterile saline solution to clean her eye - NOT the kind to clean contact lenses, but the one safe for use in the eye.  Ask your pharmacist.
Mary
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I have two 6 year old german shepards who are brothers. Both of them developed KCS at age 4 and symptoms appeared in both dogs during the same week. It was uncanny, almost as if it KCS was contagious.
      We have run the gamut of all the available drugs. Currently we use  a cyclosporine ointment and tacrolimus drops three times a day, plus eye drops and clear eyes ointment to lubricate their eyes. The Pilocarpine seemed to agitate the dogs and the effect on tear production was unclear so we are currently not using it.We are considering the PDT surgery.  If anyone has updated information on the procedure or insight into new forms of treatment, it would be great to hear from you.
Thanks to all and the best to you and your best friends.
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I have changed Blu's Opthalmologist veterinarian because he " did not have time to do research" on some of my questions. I now use Dr. Tucci
(recommened by maryC24) who is excellent! Does research. Told us that the surgery is only 60% effective. you may or maynot have problems afterwards. If it does not work it means eye removal....
Blu's ( age 6) problem started right his regular vet gave him a antibiotic shot Tribrissen
(http://www.veterinarypartner.com/Content.plx?P=A&A=617&S=2) .

Which can cause dry eye. Were your dogs given any shots?
We are using Cyclosporine & Tacrolimus drops 3 times(6am, 1pm & 7pm) a day plus Teargel severe dry eye gel every hour (6AM –10PM) to keep his eyes comfortable.
We are getting ready to change his diet to one with antioxidents in it and omega3 fish oil to see if we can clear out(Hope, Hope) and get his tear ducts operating again (this is being done under Dr. Tucci's supervision). his STT is 7 left eye & 3 right eye. It seems his right eye works some times & sometimes not.
Dr. Tucci is going to a seminar in the beginning of September and hopes there is some new information out there. If I hear any thing I will post it here
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It has been several months since my Casper had the surgery. I have since lost Casper.  He was hit by a car three weeks ago.  We are devastated.
Anyway,  the surgery simply created a whole new set of issues we had to deal with.  After weeks for numerous medications we finally were down to two on a permanent basis. Cyclosporine three times a day and  EDTA drops 4 to 5 times a day.  The EDTA was to dissolve the calcium crystals that form in the eye from the saliva. I also had to feed him small snacks throughout the day.  The excess saliva formed a brown crust around his eyelids  and on his muzzle that required constant cleaning.  Almost every day I had to moisten the area and use a flea comb to remove the  crust around his eyelids and muzzle.  He hated it.  His muzzle was always brown and impossible to clean.  The constant extensive cleaning was necessary to keep bacteria from forming.  Casper's white face never looked clean again.  I regretted the surgery every single day.  Casper was much happier before.  
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I forgot to add.  Casper slept at my bedside. Recently, he was very reluctant to come to his bed until after I was asleep.  My husband and I were certain it was because he knew I was waiting to put the evening meds in his eyes.  Casper was an incredibly docile dog.  He was a very good patient.  I don't know how other dogs would respond to the constant cleaning and combing of the eye area.  The saliva would cause the hair on his muzzle to clump and harden.  A couple of times the flea comb pulled a whisker out.  That had to hurt.  I felt guilty all of the time.  

I understand that every case is different. Surgery may be necessary in some cases.  Hopefully, my experience will help you have a better conversation with your doctor.  Good luck.
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I am so sorry to hear about Caspers death.
As I said earlier, a 60% success rate is not very good in my mind. We will continue to do our daily treatment every hour with Genteal, Cyclosporine & Tacrolimus x3. Forget about the surgery.
I just purchased 18 tubes Genteal from Walgreens(on sale & coupons) ended paying $5.06 a tube. a good buy.
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We decided not to have the PDT surgery and have continued with a course of
Cyclosporine 2% 3 times a day, Tacrolimus 3 times a day, and Equate Artificial tears and Clear Eyes severe dry eye ointment from Wal-Mart.I wish I could offer something new but that seems to be all we can do at this time.
Have you seen anyt improvement in Blu's eyes as a result of the new diet? I have given the Boys omega 3 fish oil 1000mg twice a day but have not yet altered their diet from that of Purina Benefil.
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My dachshund Brandy had PDT surgery 4 years ago this coming January.  I tried using drops, tacrolimus, Cyclosporine,.... all sorts of meds, change in diet, etc. but due to the fact that I am single, have to work, and Brandy really had a severely affected left eye, we just had to have surgery.  It was successful and she requires no drops to keep her eye moist.  She has had some issues with the eye, but the only other alternative was removal of the eye.  I wish you the best of luck!
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Our Optho says the amount of fish oil per day per dog is :
22mg/kg/day Orally
Which means that Blu who is 81lbs gets 810mg per day. You should check with your vet to make sure you are not giving them too much fish oil.
It is said that in about three weeks you MAY begin to see more tears.
We will see...
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So Dr. Tucci suggested fish oil?  She has never mentioned it to me.  Perhaps because Brandy had the surgery.  I hope it works for Blu
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We mentioned it to her. It is supposed to work in people & we asked if it might help Blu. Its worth a try. We will see if any new stuff comes up, she is going to her seminar this week. And the next week we will see if any tears are up on the STT when we see her.
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Pebbles is a min pin we rescued a year ago.  She just had the PDT surgery on her right eye last Wednesday (10-28-09).  She will have the left eye done in December.  So far, we are surprised at how well the eye is doing.  Most of the swelling is gone.  When she first wakes up, she has a little bit of gunk in her eye, but considering how bad it use to be, it is a major improvement.  She gets four drops a day of Neomycin and Polymyxin B.  I guess dogs will react differently to surgery just like people do.  I'm glad we had it done.  Pebbles was a worse case scenerio in that she was producing zero tears.  Now her eye is wet and a glossy black.  She isn't having any problems and doesn't try to keep her eye shut.  Our vet only charged $900 for both eyes.  

We are like you and both work full-time, so we couldn't give her drops like she needed throughout the day.
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Where do you live Mary?  I'm on Social Security and can't afford 2800 for both of my dogs eyes.  The prices of everything now days are unbelievable.  I live in Dallas and it's dry here to begin with.  My dog Webster has zero tears in both eyes.
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I live in Homestead, FL, just a mile from Dr. Tucci's office fortunately.  I'm not sure how much she would charge for surgery on both eyes.  Good luck to Webster and you!
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i am considering having my dogs eye removed vs the surgery- i dont think i can afford the upkeep of possible crystals, meds, etc. have any of yall done this? i feel horrible leaving my puppy in pain. she has been on optimune, tear drops and several other meds the past few months and we have had no success. i know it bugs her and i feel so horrible. she won't come when i call her anymore because she knows i'm going to put meds in her eyes. i wanted to do the surgery but after reading all of the after expenses i don't think i can keep up(im a college student). however, i am worried because her other eye isn't producing a ton of tears either so she could possibly lose both eyes. i would just feel absolutely horrible. what would yall do? does anyone have any info on success rates vs failure rates from the surgery? i would do it if there was little chance of it causing thousands and thousands in more damage. i'm just so torn as to what to do. i feel so helpless. also, does anyone know of any dog insurance that will help cover this issue? or one that will help even though it's a prior condition?
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btw- my dog is a 5 pound pure bred poodle. are there any other options people have used that have helped? she is always getting ulcers from the lack of tears as well.
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I could not have my dogs eyes removed. If it came to that I would have to put him down. I can think of very little else that would be worse to a dog than losing its sight. One day I can see and next day my parents made me blind???? We have been trying Fish oil +Omega3. We had a check up after 3 weeks on Fish oil & it seemed he went from 2 STT to 4 STT
But his eyes do not look any better we will find out in Feb when we recheck. We are trying to use controlled monitering when we check - How long before check were meds applied. we are using a one hour time frame
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our westie had pdt last wednesday on one of his eyes, and is scheduled for the other soon. his eye was a lot better the first couple of days and then this morning he cannot open it. is that common?
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We are still using genteal severe eye gel and giving him fish oil but we dont know for sure if his tears are increasing.
It looks like a very slight increase. We HOPE!!!
We will find out next month we he goes in for a recheck.
We are lucky to be able to administer to him all day like we do.
We got dry eye from a sulphur shot that he was alergic (allergic) to-his whole face and neck swelled up twice its size.
Down hill from there.
But we do not want to do surgery because there is only a 60% chance it will work and you may still have to medicate his eyes. If it does not work you then have to remove his eyes!
Hopefully you are seeing a Opthalmologist.
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This is a heart-wrenching decision.  My dog Mika is a 6 year old Yorkie.  I lost his friend, another Yorkie  last year (at age 5) to a collapsed trachea.  Mika has one good eye, and other has 0 tears.  We tried Tacrolimus for several weeks, with no success.  We use Sicca drops for lubrication.  I do feel the experience has changed his quality of life, due to always having to have someone administer the drops.  I have the surgery scheduled for next week, but after reading all these posts, I am concerned.  I trust my doctor, but there is no guarentee.
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As you may have read, my Brandy had PDT surgery 4 years ago.  There have been issues, but her eye is comfortable, I don't have to give her drops and she seems a very happy soul.  Dr. Tucci loves her!  Last May, her parotid duct got clogged by a "stone" formed within it.  Dr. Tucci removed the stone and it is flowing again.  I have gone through periods of having to express the duct 2-3 times a day, but currently everything is working perfectly.  She does have to take 1/2 tablet of Simplicef daily, but this is easily placed in her food.  Brandy was soooo uncomfortable and in pain before she had the PDT surgery in 2006.  I am so glad that she had the surgery.  In my opinion, in my case, there was no alternative.
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Thank you.  I will probably go through with it....it is just really hard.  Can you tell me what the recovery was like?  I was told he will have to wear a cone for 10-14 days and it is vital to keep the eye protected while it heals.  Some bigger dogs will dig with their cones in the snow-I live in Minnesota.  Mike likes to bury his face in the snow, so I'm going to be watching closely.   I am home, and don't mind doing some drops daily, but wish not to annoy him by constant checking and cleaning a re-moisturizing.  He will probably enjoy getting a Charlie Bear when needed more that a drop or ointment.  :-)
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Oh...and what is Simplicef?
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Recovery was not difficult for me..... I don't remember having to put drops in, but not sure.  I stayed home with her.  I have a second doxie and I did not want her (Amy) to bother Brandy's eye.  She was good and they snuggled a lot.  I had to take Brandy back to the surgeon the next morning for a post-op check-up.  Actually I brought Brandy home just 2 hours after her surgery - not normally done, but it was a Friday, Dr. Tucci was sure that Brandy would be more comfortable at home.  I was a bit shocked when I got her - she was moaning - not in pain but due to morphine, plus the affects of the anesthesia.  All turned out well, I am fortunate that I live so close to the surgeon's office - just 11 blocks.  If you like, we can exchange email addresses and I can send you a couple photos.  She had to wear the dreaded cone for about 2 weeks.  Simplicef is an antibiotic.  Mary
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Mary I sent you my email address, but not sure it worked.  Did you receive it?   Thx.  Paula
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My 10-year-old mini Schnauzer, Fritz, developed KCS a year ago last November.  I have followed early posts on this website early on and have taken note of the various methods of treatment in use.  I have two minis and last year my pet expenses exceeded $5,000, and this did not include surgery, other than Fritz's teeth cleaning.  I have tried early on switching his diet to one that did not include grains, but my female developed such an disgusting odor that I abandoned that after a couple of weeks.  Fritz does not respond well to fish oil; he will not swallow the capsules and seems to develop a queasy stomach (barfing) when I sprinkle it in his food.  He likewise does not do well with a fish-based pet food.

I believe that he developed this condition very shortly after switching him from Science Diet to another brand of pet food.  So I can't help but feel that part of the cause may be food sensitivity/allergy.  He does suffer from skin-allergies (to grasses, I think), and forms tartar on his teeth very quickly.  He seems to do better on lamb and rice-based foods, but his triglyceride levels are way over the top, so he is now on a chicken-based low-fat prescription diet which, it appears to me, is not as good for his eyes.

He is on Tacrolimus x3, cyclosporine x3, presnosolone acetate x2, and 25mg doxecycline daily, with administration of Genteal ointment, Idrop, Soothe XP, and artificial tears frequently throughout the day.  His tear production was 0 and 6 last reading, which was a decline from the previous tear test.  His last ulcer left him with a deep corneal facette in his right eye, but there is good blood circulation which I'm told is a positive.  He also has mild entropion on both eyes from squinting.

I am reminded that parotid duct transposition is still an option, but 60% success rate does not sound all that encouraging to me.  The above posts have really not reassured me.  With all his problems, Fritz is still a happy dog, but there is increasing coloration, although at this point minimal, that causes to me search for additional information that might lead to more effective treatment of his condition.

Is it felt that Optimune is more effective than the cyclosporine suspension?  We are investigating the possibility of using an aqueous solution, but with medication costs as they are, I am investigating all possibilities.

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Hi! I realize it's been a while since anyone has added to this post, so not sure if you're still checking in, but I was curious if you did end up going through with the PDT surgery? If so, how did it go?
I am scheduled to take my dog in for her surgery in 2 weeks. She's a 2 year old Jack Russel, who's had symptoms for about a year. We've tried every drop out there (optimune, tacrolimus, pilocarpine - none of them have worked for her left eye - it's been at 0 since her first Schirmer test - the right did go from 2 to 22). She still gets the tacrolimus and lubrithol (tear gel), but no improvement.
I've been agonizing about the decision to give her the surgery, but her optho has basically said I have 3 options - surgery, remove the eye or put her down. As I can't stomach the thought of options 2 and 3, I've gone for the surgery. I was a bit put off by the price at first (the optho wanted $2400 for just the one eye, and still a lifetime of tacrolimus for the right). I live in Canada and our vets are for some reason way over priced. I did find one in Michigan that is able to do the surgery for $920. I've gone to see them and they seem competent, doing about 1 of these surgeries per month. Apparently it's quite common. They did give me some interesting info that her regular optho never bothered to share with me. One, Sophie is diagnosed as having juvenile KCS, and in the majority of cases, the eye will never respond to drops. Two, for some reason, the left eye is the worst one in about 90% of cases. I wish her Canadian optho had told me this. It makes me feel better knowing she's not overly abnormal.
So now she's going for the surgery and I've been told for most dogs, there are no issues. The biggest side effect I was told about (from both opthos) was the development of crystals due to the different pH of her saliva. I was directed to get her some distilled water to eliminate the excess minerals and help her eye heal. Also, I might have to go the Pavlov route and teach her to salivate on command. Both of those things I can deal with, but I'd like to know if there was anything else I should watch out for.
Any help/info would be greatly appreciated.
Thanks.
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My pembroke Corgi had pdt surgery 4 years ago.  It was a complete success and I would do it again.  Her tear count was 0 in both eyes. Medicine did not work.  I was putting drops in her eye every hour. Now, she has developed some problems. I think there is a clog in her right eye. No drainage. Please tell me how they unclog the eye. Hope you are still checking this site. Thanks.
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Her duct might be clogged by the formation of a 'stone' in it.  This is what happened to Brandy.  She had to have surgery to remove it.  The second time she developed a stone, I dropped Brandy off at her eye doctor's office every day for the entire day (Monday through Fridays) so that the staff could express the duct several times a day (while I was at work).  This, in addition to me giving her a teaspoon of dried cultured buttermilk powder with each meal.  The stone was either expressed out or the buttermilk powder caused it to disappear.  When they x-rayed her after the month of her being dropped off at the doctor's, her duct no longer had the stone. If you prefer, email me (***@****)  Mary



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Hope your baby's surgery went well. I do not like the options you were given either.
No we have not done surgery as yet. We are hopeful.......
At last Dr visit 4 months ago Blu's STT for his right eye had increased to a 5 count - one hour after last genteal application. 12/22 is his next visit and we will be checking at one & one-half hour to see if there is really an increase not just a fluke. I just noticed that back in the begining I posted the eyes backwards - (Should have been -  zero tears in right eye & 8 in left STT  )  Left eye has increased a little also. I will post results after next visit.
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We have a 6 yr old black lab, had puppy strangles after we had brought him home approx @ 10 wks old. Our eye vet said this is not why he has dry eye. He was dx this yr in April. We have tried all drops, now he cannot take cyclosporine as this seemed to irritate his eye more. It has been a rough go, Dr says all we can do is make him comfortable & she prescribed another ointment. Am considering the surgery but after reading all of the problems don't know what to do.
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Went to appointment and Blu's left eye went to 13 STT while his right eye dropped back to 0 Stt. we are going back in a month to see if this is an intermittent condition. Since he started with 0 went to 3 then to 5 now back down to 0. Confusing.
Left eye stayed pretty much the same ( 7 ) all along and now jumped to 13. If I was not there each time I would have my doubts about the staff doing the testing.
We will see......
Hope all had a Happy Christmas and have a wonderful New Year!!
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Taco had Pdt surgery in his right eye about 2 months ago. He still squints. I wash he eye several times a day  he forms crystals in his lashes. His eye has a blue haze the vet says he has too much acid in his saliva. We put buttermilk powder in his food to try and change the ph balance. It's not working. The vet wants to remove part of the saliva gland. Says he too much saliva.  Any suggestions? Anyone else have this happen?
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Well, Sophie (the 2 year old Jack) had her PTD surgery Nov. 22. I'm still extremely glad I went ahead with the surgery, but it hasn't been an easy month. She had complications the day of the surgery and a few hours after the vet called me to tell me everything was OK, they called back to say her face was swelling like crazy and they didn't know why and had to go back in. She basically had the same surgery twice in less than 12 hours! I couldn't go to her as I live 4 hours away from the vet (I'm in Canada, vet is in Michigan - went there for price reasons - Canadian vet wanted $2400 plus tax, US guy did it for $890 including all meds, collar, food, etc - and that includes the dollar conversion). Anyway, I was totally stressed as I was getting updates every 2 hours or so all saying "we have no idea what's going on". Turns out nothing was wrong internally (it is possible for swelling to develop if the duct is damaged during surgery and the cheek can fill up with saliva - that's why they had to put her under again to confirm). I got to pick her up the next day and take her home with me and everything seemed fine, except that she wasn't producing enough saliva (it was supposed to be spilling over her eyelid onto her face and she made just enough to pool at the bottom of the eyelid). It took about 3 weeks for it all to start working and her eye to start looking "normal" when it all went downhill again. I called the US vet and they suspected an eye ulcer, so I had to bring to Canadian vet to get her checked right away and they said, yes, she had one. So back she went on a series of drops and ointments, but her eye didn't get better. She had the same symptoms that Nancie mentioned - the crystals on the lashes and a haze at the centre of the eye. She was keeping the eye shut and squinting again and rubbing at it even though she would produce enough saliva - it wasn't dry eye, it was irritated eye. The US vet made some calls and ordered a new ointment (EDTA - not sure what it stands for) but it's to break up the crystals in her eye. I've had her on that for about 5 days and it seems to be helping. To get rid of the haze, he has me give her another ointment (short form is NPD) every 2 hours for this week. We'll go back Monday to see how it did. He froze her eye too and wiped all the crystals off but there is still a haze in the middle where her eye gets the most exposure to air.
Anyway, I know I'm sounding like there are all these problems, but really, to me, she is a thousand times better than she was pre-surgery. I am still glad I had it done but really do want all the problems to be over. I still see hope with her current condition, I didn't without the surgery. She was on cyclosporin and tacrolimus for months and never went from 0 in the left eye. Her right went from 2 to 25. I hope that now we can control the saliva pH with diet, I just have to find the right food. I haven't tried the buttermilk yet, but definitely will get some. Also, changing her from regular tap water to distilled helped.
Good luck. I will post more later after Monday's appt.
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My Brandy had PDT surgery in January 2006.  She developed a stone in her duct just over a year ago and had to have it surgically removed.  Ever since then, I have given her 1 tsp. of buttermilk powder with each meal.  She loves it!  I find the buttermilk powder in my grocery, right next to the canned milk section.  For Brandy, PDT surgery was the only answer and I am so glad that she had the surgery.  She was so uncomfortable that she rubbed an ulcer on her eye and had to have a graft done at the same time as the PDT.  Her Opthalmologist's office is just 11 blocks from me and we have been going there many times.  She has to take Simplicef with every meal.   There is a vet opthalmologist who specializes in PDT surgery.  My Opth. vet has been in touch with him regarding Brandy's case.  The stone, etc.  My opth. vet's name is Dr. Teres Tucci and her practice is called Veterinary Specialists Inc. in Homestead, Florida.  She happens to be on Facebook, should you want to get in touch with her.  
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Hi Mary!
Just a quick question about the buttermilk powder - I went to get her some yesterday and the only type I found said it was made with sweetened cream and sweetened whey. I don't want to cause tooth issues now if there is added sugar in there. I did get it as it was the only one there, but I wanted to know if you had a specific brand that you used that didn't contain sugar. It's not to say that Sophie doesn't like it - she licked the bowl clean at each meal! I just don't want to create another health issue down the road.
Thanks for all your advice so far.
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I ordered the buttermilk powder on line. It has to be pure buttermilk powder. Google it. I'm out of the country and get back Sunday. I'll send the link if you want it
Nancie
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Hi, I'm new to this site but I just wanted to share my experiences with dry eye.  My miniature schnauzer was diagnosed at the age of 1.  
We tried everything in the way of eye drops but his reading was 0 in the left and 3 in the right and nothing seemed to help.  We were told by his opthalmologist that 50% chance the surgery would help.  As the only option was surgery or removing his eyes, we tried the surgery.  It was hell for abnout 6 weeks as he kept having complications, but finally things settled down.  Now I am so glad we had the transposition surgery done.  He is a perfectly normal, happy little boy, playing with his toys.  Before he was a sad little puppy who walked around squinting or with his eyes shut and never wanted to play.  we give him EDTA eye drops once a day but he doesn't seem to form any crystals.  Just have to wash his face every time he eats but it's so worth it.

Gale
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Hi all,

My 5 yo yorkie was diagnosed with PDT almost a year ago. I debated for that time about whether to have the surgery.  We went ahead last week and the verdict is still out whether it was successful. My little one has many of the same symptoms many of you shared, i.e. still squinting his eye, very sedetary, gunk around the eye, etc...and we're still doing the daily meds (at least 7 for the eyes and two oral).  I go back tomorrow for a recheck, the 3rd in 7 days.  He also developed an ulcer.  I was hoping to see some improvement by now but not yet. I'm trying to stay optimistic but it's been very difficult, as many of you know.
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I have an english bulldog with dry eye since she had surgery to remove her cherry eye 4 years ago.  The last 3 years have been very bad.  I give tacrolimous 2x and genteal severe.
She always winds up getting infected so every month she goes on antibotics.  Her new opthamolgist gives her simiplex antibiotics but cephalexinn 500mg 2x daily always works too.  I am so sick of this regiment of giving the poor dog eyedrops, she runs from me and I dont blame her.  She always gets treats after the drops.  I have spared no expense on Lola.  She has been on the best food.  I went the raw (BARF) route for many years thinking it was a food allergy.  We live in the Wash DC area and I noticed that her best time is winter. Her worst are fall and spring when the molds are growing outside.  I also went the holistic route and I do think that acupunture works somewhat.  Also, homeopathic remedies worked for a while.  Recently I started cooking brown rice and givning lots of it and I noticed she was better.  I recently ran out of fish oil and I noticed she is worse, so that definitely helps.  Her opthamolgist discussed the surgery but says it does not work on small dogs much, but on big dogs it works.  Lola is a medium 50lb dog and the vet never did it on a bulldog. The vet said you are trading one problem for another with the mineral buildup but the dog will be more comfortable.  After reading the negatives posted, and the fact that you still have to give drops, makes me decide not to do it.      
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Natural tears have antibacterial properties, so it is not surprising that bacterial infections are common with dry eye. Cyclosporine /tacrolimus have been shown to decrease ocular bacterial infection because of improved tear production. In severe KCS with poor tear response to the treatment there is a lot of mucus. This mucus is food for bacterial growth . These bacteria may not be disease-causing bacteria but need to be controlled. It’s important  to give mild OTC antibacterial drops(et polysporin )every two three days. This will eliminate inflammation and green mucus and also the need for genteal gel application  from 6-8 times a day to 2 to 3 times a day.
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I just want to tell you that we had the surgery done on my 12 pound miniature schnauzer and I am so thankful every day that we did.  I don't know about bulldogs but it definately does work on small dogs.  It's been over a year now.  Yes, there were complications and trouble at first and he squinted every time he ate for a month or so.  Now he's adjusted to it and is the happiest little boy in the world.  I have to put EDTA drops in his eyes once a day and that is absolutely no trouble at all.  He's not in pain and he isn't going blind as he would have without the surgery.  
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Unfortunately, KCS that  isn't responsive to cyclosporine or tacrolimus, is a lifelong condition for a dog and it's owner. There is not a  surgical "cure." If a veterinarian recommends PDT surgery, it is because the current condition of the patient's eyes would likely improve after the procedure, even with the surgical side effects considered. I know the frustration first hand as I am a veterinary technician who has worked in veterinary ophthalmology. I am also the loving owner to a three year old mix breed dog, diagnosed with KCS at three months of age. She has never been responsive to medications, and my husband and I are currently preparing to have the PDT preformed on her. My best advice to those in this same situation is 1) Sometimes "managing" a condition is the closest thing to a "cure," and 2) Find a veterinarian who doesn't rush you into a decision. One who will take the time to answer questions and give you all of the facts, good and bad, so that you can weigh your current situation against your possible future situation. All patients and owners are individual cases. When a vet tells you The Best Possible Outcome, know that there are also many Gray Areas, as well as A Worst Possible Outcome. There is no way of knowing which area your pet will fall post operatively. When a vet tells you that your pet is A Good Candidate for a surgery, he or she has no way of knowing exactly how things will turn out in the end. The hope is always to bring comfort to your dog, physically, and to you, emotionally.
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I have a 3 year old Min Pin whom has dry eye.  Left eye surgery was about 3 months ago and went wonderful with no problems.  Tuesday we have done the right eye, I am really worried about her eye this time being or healing right....the swelling is alot worse this time, she doesn't want to drink or eat very much, and she has gooky looking stuff coming from her incision and mouth area, and she also constantly is licking the collar that is around her head to protect her eye like her mouth is dry. (not sure if casue she is not eating or what). Also this eye does not produce much fluid as did the last one did.  We did not have any of this the first time.  Just wondering if I am not giving it enough time to heal or if maybe something has went wrong.
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It is saddening to see the instant distrust that owners adopt when their pets medical/surgical case is not an instant success.

The overwhelming majority of vets are diligent caring professionals. All medical and surgical therapies have failures and this is the same for human medicine.

Do not assume just because your case is complicated and expensive that you have been mistreated. By all means, ask questions and be aware of the risks. Many dogs find relief from the PDT surgery after a long period of experimentation with medical treatments. The fact that a small percentage do not respond well does not mean your vet was negligent/uncaring/uninformed.

Tim
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I have a 3 year old beagle Boston terrier mix. She had her pdt surgery almost a year ago. She is having now with her eyes. Winter time she doesn't really go for long walks. I'm not sure if it's bc of the nice weather but out of know where her eyes are getting irritated and she will close them for days and actually walk into things, such as doors sofas and walls. Please help I don't know what to do I feel terrible that she is in pain
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My 9 year old maltese was diagnosed in February with Severe Dry Eye (KCS).  He has been on Tacrolimus, Cyclosporin, Genteal, Pilocarpine, Interferon, Optixcare, KCS solution, Flurbiprofen, etc.. None of them have worked, his right eye is still at 0.  He developed a corneal ulcer 2 weeks ago. His ophthalmologist has suggested the PTD surgery which he is scheduled to have it on August 2. If anyone has any suggestions on whether or not to have the surgery I would greatly appreciate it.  I keep going back & forth with my decision.  I have read about the potential complications of the surgery which really worry me. Thank you!
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Hi,

I'm glad I stumbled on this thread. My corgi, Finn, was diagnosed with dry eye last year as well. She was seeing a specialist for months after being wrongly treated for pink eye for a few months. She was on a ton of meds. She still kind of is. But it was determined it would be a life long battle so we are on optixcare and cyclosporine 3 times a day and she has a really greasy antibiotic that is applied right before bed.

I've also been on and off about the surgery. I'm really afraid of it backfiring. We only have one eye specialist in my area. He's actually based out of Denver but comes to my town twice a week. He quoted me at 1900 per eye. He only operates on one at a time. Her left was the first one to go bad. Then the right followed a few months after. So it would be the left eye.

Reading everything about the crystals and the possible eye removal freaks me out. I'd rather continue meds her whole life if it atleast kept her vision fine. He told me it only works 2/3 and I don't want Finn to suffer more than she already is. If anyone still checks this threat, please reply with suggestions.
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Hi BR!
I had my Jack Russell's eyes done over 2 years (you can scroll up and read my earlier posts). Sophie was one of those dogs that didn't have a 100% success rate according to the vet, but to me, she's perfect. When she was first diagnosed, both her eyes were bad. Her left had a Schirmer reading of 0 and right was 2. We were able to bring her right one up, so she only had surgery on the left one. We were still using Tacrolimus for the right eye, one drop every day. Since then, her right eye has shot up to 30 and we've dialed it back to one drop every 2 days. The left eye gets EDTA every day. She has good days and bad days. Some days, she looks absolutely normal, you'd never know she had issues. Other days, not so much. The biggest problem for her is when she pants a lot (on really hot days, running around the dog park, when good food is cooking, getting a really good treat) her face just gets completely soaked from her own "tears". Usually I just carry napkins with me and soak up some of the excess fluid when she gets really bad. I know this probably doesn't sound reassuring, but I would do it all over again in a heartbeat. I guess what I'm trying to say is that you have to be willing to put up with some potential side effects, but it's worth it in the end. There will still be some growing pains as you figure out how to deal with everything but I think it will be worth it in the end.
As far as the cost, have you called around? I actually travelled for 3 hours to another vet to have the surgery when the local optho wanted $2400 per eye. I found one in Michigan that did it for under $1000. So it was worth the extra travel for me. I live in Canada (an hour west of Toronto), so I looked in Detroit, Buffalo and even KY (where I have some friends). I explained the situation and all of them were willing to help out even without a vet referral (as long as I forwarded all her results to them). I'm just suggesting you look outside your immediate area if possible.
Hope that helps somewhat. Good luck with your puppy! They really make life better.
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There is a cure that has worked for us. I have been trying to post a comment by put have thus far been unable to. Will try this then is if successful will get back to you.
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We tried everything, including Optimmune and various drops and ointments, but she was getting worse and worse and was starting to fall off the kerb etc when out for a walk. We took her to an ophthalmic specialist who recommended duct surgery but this was really scary when we googled success rates etc. She said there was a very slim chance that a new ointment might work, and it has!!!! It is called Tacrolimus Monohydrate
Or Protopic 0.1% She is so well now. We use it twice a day. I prayed for a miracle as I was so worried for her and thought she might never be ok again. Please speak to your vet. This is about thirty pounds for a tube that lasts approx six months, whereas optimmune was fifty pounds for a tiny tube.
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Check my post!! THe may be an answer that will work for you. We were desperate, and I could barely sleep I was so worried.
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Thankl you for the information. Blu's doctor said she is going to a meeting next month and will research it.
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Good luck! I've no idea whether it will work in your case too, but we are delighted with the progress our dog has made. I apply the ointment last thing at night also and so she wakes up alert and wide eyed. She is in the garden now, chasing magpies, and is a different dog to how she was seven or eight weeks ago. The Protopic has been great.
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