Parotid Duct Transposition

[hoppes7]

What are the problems during and after surgery?

[ginger899]

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)

[ginger899]

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.

[Ghilly]

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

[hoppes7]

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.

[Ghilly]

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

[yellowbird500]

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.  

[yellowbird500]

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.  

[hoppes7]

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!

[hoppes7]

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?

[yellowbird500]

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.

[yellowbird500]

Found this on the net.  Hope it helps.


http://www.willows.uk.net/information-sheets/ophthalmology/parotid-duct-transposition.htm

[hoppes7]

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.

[yellowbird500]

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.

[yellowbird500]

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.  

[hoppes7]

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.

[yellowbird500]

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.

[hoppes7]

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!!

[MaryC24]

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.

[MaryC24]

I see you are in Miami.  I am in Homestead.  There is a wonderful Opthalmologist veterinarian in Homestead.  Are you satisfied with your vet?

[hoppes7]

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.

[MaryC24]

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.

[yellowbird500]

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.

[hoppes7]

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??

[tjb1130]

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!