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Skye going back for pannus recheck 08/05/11 #169279
07/22/11 09:51 PM
07/22/11 09:51 PM
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PositiveDog Offline OP
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I have posted on other threads that I am concerned that Skye's pannus eye drops, optimune, are not working as good as the ointment had been.

If not that, she could be developing cataracts, I suppose. She will be 8 in October and her eyes are much more hazy than are Buddy's who is 11.

Anyway - she was diagnosed at MedVet in September of 2007 and I really liked all the testing and care they gave her. They are very respectful of the dog and enjoyed that she is well mannered and they had no struggles with her.

So back we go - I spoke with the opthomology department and let them know I would just like them to take a look - how are the eyes progressing, any new issues, better medication, etc.

We go 08/05 - I could have taken her sooner but can't get off work until then.

I will come back and post what they see and advise.

Meantime, if you have any questions or suggestions for my time with them to discuss the eyes, post it here. I will keep a list and ask until they kick me out. whistling


Bonnie

With approval of my friends:

SamCat, 03/2011
Bennie the 12 1/2% GSD 02/2013

Seiko, Solo, Sophie, Skye and Buddy - bridge dogs who taught me so much
Re: Skye going back for pannus recheck 08/05/11 [Re: PositiveDog] #169286
07/22/11 10:28 PM
07/22/11 10:28 PM
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Originally Posted By: PositiveDog
We go 08/05


Bonnie, no suggestions or advice but my thoughts will be with you on Aug. 5. Please give Skye a big hug from Sean. hug


Sean - 1998/2014
If there ever comes a day when we can't be together, keep me in your heart I'll stay there forever.
Carleton DOB unknown
Neely - 2003/2015
Gizmo -2008/2011
Neeko -1991/2005
Re: Skye going back for pannus recheck 08/05/11 [Re: SeanRescueMom] #169291
07/22/11 11:28 PM
07/22/11 11:28 PM
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I'm glad that you'll have a consult and get all the new and upcoming info.


I will have to put my thinking cap on and see if I can think of any good questions.

The one that immediately comes to mind, is what do you do with a dog that appears to be allergic to cyclo and tac, and isn't well maintained on pred? According to my eye doctor, Max's response to those meds - redder 3rd eyelid and ground glass look on the cornea is from an allergy to the med, which I believe.

Those two eye meds, I believe, come from some fungal something or other. I suspect that they aren't supposed to have any of the actual fungal stuff in them after processing, but I wonder if there are any remaining proyeins in them.

I usually ask too detailed and specific questions - Max's opth just kept saying that things that had happened weren't possible, or that those things "just happen" with pannus.

I am curious about the doc's opinion on systemic absorption of eye meds, just out of curiousity smile

Okay, that's it for now !

I sure hope he puts together a good plan for Skye!


MaxaL (aka LisaT)

Jazmine, mini-mix, 10/18/2011
Max-n-Indy
Max, 5/2001-2/2012, RIP my partner, my Regal Boy
Indy, 5/1997-10/2010, RIP my friend, my teacher

Health Index
K9 TBD info and Tick List Links
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Re: Skye going back for pannus recheck 08/05/11 [Re: MaxaLisa] #169309
07/23/11 02:17 AM
07/23/11 02:17 AM
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Los Lunas, NM
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Hoping the best.

I am thankful that Kayos is well managed on Pred and Tac drops. She gets Pred 2 times a week and Tac 2 times a day. What you think are cataracts may just be old dog eye. Kayos has developed that too but there are no cataracts and her vision is unaffected, the eyes are just a bit cloudy. She was just at the eye vet on 7/5. The eye vet says the grainy eye is a side effect of Pred so we follow-up every 6 months.


Kathy

PAM, URO3, UCD, UACH Tidmores Rising Star Lydia "Mayhem" CD,BN,RE,AX,AJP,OFP,P1J,CA,DJ,HT,TKN,TC,CGCU, RATN 4/4/12
Jeli, (Pembroke Welsh corgi) CGC, RATI 5/13/19

Lucky, Wolf, Max, Kayos, Havoc - gone not forgotten. gsdhalo
Re: Skye going back for pannus recheck 08/05/11 [Re: Kayos] #169319
07/23/11 03:23 AM
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PositiveDog Offline OP
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Kathy - remind me, how old is Kayos?

Right now Skye gets only the cyclosporine (optimune) so it could be she needs a second med. It is good to hear the eye changes may not be pannus related. Thank you.

She does seem to have good sight. She has no trouble at all catching her ball or other smallish objects.

I should have taken her for a recheck long ago just to be sure she is getting all she needs.

She did great with tacromlimus when she had perianal fistulas so I wonder if that will be better for her eyes as well. Like Lisa, I wonder about what system absorption of eye medication.

I won't update this a lot until after the appointment, but will be making notes on your ideas, suggestions and questions.

Thanks!

Last edited by PositiveDog; 07/23/11 03:25 AM.

Bonnie

With approval of my friends:

SamCat, 03/2011
Bennie the 12 1/2% GSD 02/2013

Seiko, Solo, Sophie, Skye and Buddy - bridge dogs who taught me so much
Re: Skye going back for pannus recheck 08/05/11 [Re: PositiveDog] #169327
07/23/11 04:00 AM
07/23/11 04:00 AM
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MaxaLisa Offline

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Oh, I have another possible question.

The ophthalmologist mentioned that there are lots of different eye meds that can be tried, and I think (this was in 2005, so I'm not sure I remember right) he was alluding to even several different type of steroid eye meds too. Just like for oral use, there is pred, prednisolone, dexamethasone, etc., do they have different versions of steroid eye meds that act different in the eye? Is it a matter of half-life?

I have a couple of eye drops here that I do believe are good for the health of the eye and prevention of cataracts. The zinc/C drops I've been using for Max and I seem to work well for his eyes. There are also carnosine eye drops that used for me and Indy, though I haven't tried those for Max...just never got around to that.


MaxaL (aka LisaT)

Jazmine, mini-mix, 10/18/2011
Max-n-Indy
Max, 5/2001-2/2012, RIP my partner, my Regal Boy
Indy, 5/1997-10/2010, RIP my friend, my teacher

Health Index
K9 TBD info and Tick List Links
http://www.rabieschallengefund.org/
Re: Skye going back for pannus recheck 08/05/11 [Re: MaxaLisa] #169331
07/23/11 04:13 AM
07/23/11 04:13 AM
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Colorado
Kris Offline
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I just received this email today. This new drug isn't available yet since the trial is just starting, but maybe good to keep in mind for the future. Hoping Skye's appointment goes well and there's no dramatic change in the eyes!

Quote:
Greetings!

My name is Tomo Wiggans, and I am a veterinarian at the CSU Veterinary Teaching Hospital in Fort Collins. The reason why I am writing is because I am working with one of our ophthalmologists, Dr. Julie Gionfriddo, on a clinical trial for dogs with pannus. Since German Shepherds (especially in Colorado) are predisposed to this potentially blinding condition of the eye's cornea, we are reaching out to local rescue groups and kennel clubs with this announcement.

We are looking for newly (or never-been) diagnosed dogs with pannus, or those who are poorly controlled despite eye medications. We are looking to try a new topical anti-inflammatory medication called Galavit (GVT), which in humans and other animals has been shown to be quite safe. It has been used in humans for over 40 years in other countries and is now undergoing clinical trials with humans here in the US. This would be in addition to standard therapy for pannus (which is usually steroid eye drops and/or cyclosporine eye drops/ointment). One eye would receive the new drug, and the other eye would receive a placebo (and both eyes would receive standard therapy).

In order to be eligible, dogs must not have any other concurrent systemic or eye disease and must not have well-controlled pannus. Owners must be able to bring the dog back for 5 rechecks at approximately 2, 4, 12, 36 and 52 weeks after the first visit. At each visit (including the
first) a complete and routine ophthalmic examination will be performed and digital photographs of the eye will be taken. There are NO invasive procedures that are part of this study. Currently, owners are financially responsible for the initial visit (~$95) and standard drugs, but all subsequent rechecks and the new drug and placebo drug would be free of charge. If drastic improvement is seen with the new drug, we could start it in both eyes and furnish it for free as long as we have a supply. We are also hoping to receive further funding so that all charges could be covered and even reimbursed if necessary. Furthermore, if owners know of non-German Shepherd dogs with the disease, all breeds are eligible.

If you could please forward this to any and all German Shepherd owners that would be interested, we here at CSU would greatly appreciate it!
If you have any questions, please do not hesitate to email me back with any and all questions you might have (I currently do not have easy phone access, but hope to soon). I am more than happy to go over the study in more detail. If owners are interested in an evaluation at CSU, they may call (970) 297-5000 to schedule an appointment with the ophthalmology service. They may also ask to speak to Cheryl, our technician, about scheduling by going through the above phone number. Thank you again!

Tomo Wiggans, DVM
Post-doctoral research fellow
Colorado State University, CVMBS
Veterinary Teaching Hospital


Kris
~~~~~~~~~~~~~~~~~~~~~~~~
Samson, GSD, 10/13/07
Annabel, Keeshond, 4/21/11
Petie, Toy Poodle, 5/5/07
Kitties: Meezer, Bob, Mia and Dewey
Re: Skye going back for pannus recheck 08/05/11 [Re: Kris] #169374
07/23/11 04:19 PM
07/23/11 04:19 PM
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We'll all be sending positive vibes for your vet visit on the 5th! Continued good thoughts for Skye to see, feel, and do very well. She's such a wonderful girl with an adorable smile! smile


Patti
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Grimm van den Heuvel, "Donnerpratzen"
Smokey The TeddyLion, DLH purrbuddy

Dir gehört mein Herz
Re: Skye going back for pannus recheck 08/05/11 [Re: Braverhund] #171559
08/05/11 12:03 AM
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PositiveDog Offline OP
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Skye's appointment is at 10:00 tomorrow morning. This is a good kind of appointment for several reasons.

She is not in any crisis so I am not going in with fear.

She has good eyesight if her ability to catch a ball or spot a cat half a mile away are any indication.

She is almost 8 and has done good with treatment for about 4 years.

Our main goal is to make sure her eyes are as good as could be expected for her age and whether a different medicine would better serve her at this point. I am taking notes tonight from the previous responses. I am wondering about tacromlimus since that took care of her perianal fistulas so quickly. We will see.

She doesn't know she is going for a ride of almost an hour. Skye used to get car sick (motion) on any ride over about 15 or 20 minutes. She copes with this by lying on the floor in the back seat area. Going through towns she will ride on the seat now, but if I pick up speed or drive on hilly or curvy roads, or lots of trees or poles flashing by she goes back to the floor.

How smart is that?

Side note - my mother, who is 81, has macular degeneration. It is the kind that can be treated and I take her once a month for pictures of what is going on in her eye and most months a shot (yes, in the eye, but beats going blind) to treat the disease.

She is so in tune to the fear of losing eyesight, she keeps asking about Skye and wants me to call as soon as leave the office. I wish my mom's eyes were as easily treated as Skye's pannus. teary


Bonnie

With approval of my friends:

SamCat, 03/2011
Bennie the 12 1/2% GSD 02/2013

Seiko, Solo, Sophie, Skye and Buddy - bridge dogs who taught me so much
Re: Skye going back for pannus recheck 08/05/11 [Re: PositiveDog] #171605
08/05/11 05:57 AM
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What a smart girl Skye is with the carsickiness! (Have you tried ginger capsules?)

I think movement is pretty easy for them to spot, even if it's only slight. It's distinguishing a white plastic back, or rolled up newspaper on the driveway, from a sleeping white cat that gets tricky wink

I really think that, unless you start seeing stuff on or in the eye, they retain that vision, though they probably get pretty nearsighted? I wonder if older K9 eyes to the trifocal thing too?!?!?!?

Max is the only dog I know that had a problem with the tac. Or the cyclo. Or most anything else *sigh*

I think the appointment sounds great!

My mom also has MD, one of each type in each eye. Terrible. She takes supplements to help control it, I guess it's too advanced for the shots, I'm not sure. I sure wish they'd get a good treatment for that too.

Drive safely tomorrow!


MaxaL (aka LisaT)

Jazmine, mini-mix, 10/18/2011
Max-n-Indy
Max, 5/2001-2/2012, RIP my partner, my Regal Boy
Indy, 5/1997-10/2010, RIP my friend, my teacher

Health Index
K9 TBD info and Tick List Links
http://www.rabieschallengefund.org/
Re: Skye going back for pannus recheck 08/05/11 [Re: MaxaLisa] #171630
08/05/11 11:08 AM
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Bonnie how sweet your mum is wub

Wishing you and Skye a positive trip.


Molly Moo (aka The Piranha, 4 legged mouth) GSD (31/10/09)
Cooper GSD (The Gremlin) 19/10/11
Texas - Tabby cat (Feb 1996-2013) Run free sweet Teppie
Paris - Tabby cat (Feb 1996-2013) Run free my beautiful girl.
Re: Skye going back for pannus recheck 08/05/11 [Re: MaxaLisa] #171649
08/05/11 01:28 PM
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PositiveDog Offline OP
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Lisa, there are two types of meds injected into the eye and the doctor determines which is best. The shots in the eye is a type of protein that encapsulates the blood veins that grew there. The protein absorbs the blood and the sight is clear - until they grow back again.

The kicker - the drugs were first used on hemorrhoid patients for a long time. An ophthalmologist thought 'hmmm..if this shrinks the blood vessels in that area, what might it do do for MD?' And trials the first treatment for wet macular degeneration were born.

Mom has lost her direct sight in one eye, but has peripheral vision in it - typical for MD. Unfortunately Mom started this early on into this type of treatment and at first they thought that once the films showed the blood was gone, the shots could be discontinued. No longer, because they now know if it comes back it roars in strong and huge - and there is no going back.

Mom has gone every month for a long time - occasionally if there is no blood for 3 months in a row they stretch it to 2 months.

She is now on the stronger med (about $2000 a shot, but her insurance pays it) and she has pretty good sight in other eye. When it even starts to go bad, another shot.

MD is not hereditary but you an bet I look at one of those grids at least once a month to see if lines are squiggly so I could catch it in time.

I have your questions written down, so if I don't garble them when I ask, we'll see what I learn.


Bonnie

With approval of my friends:

SamCat, 03/2011
Bennie the 12 1/2% GSD 02/2013

Seiko, Solo, Sophie, Skye and Buddy - bridge dogs who taught me so much
Re: Skye going back for pannus recheck 08/05/11 [Re: PositiveDog] #171684
08/05/11 06:54 PM
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Bonnie,

Thanks for the MD info...Mom's eyes are pretty shot, so they don't use any treatment for her, but we have to get her in fast if they start getting worse. I"m glad that your mom is getting care, can you imagine if she didn't have insurance?

My optometrist uses this machine for the eye, which is a bit like an ultrasound for the eye, and it measures the layers of thickness. I guess it's really good for MD and also for the eye issues that diabetics get. I pay an extra $25 or $30 every 3 years or so to have it done:

http://www.maculacenter.com/Procedures/OCT.htm
http://www.villageopt.com/docs/OCT_Education.pdf (large 10MB file, but cool pics of what the report prints out)

I've only had it done twice, and there are some areas that concerned me after the first one, so I started on my mom's eye vitamins. I DO NOT want to get this.


I hope that you guys have a really good appointment. No worries if you forget about the questions, but looking forward to hearing how it went!


MaxaL (aka LisaT)

Jazmine, mini-mix, 10/18/2011
Max-n-Indy
Max, 5/2001-2/2012, RIP my partner, my Regal Boy
Indy, 5/1997-10/2010, RIP my friend, my teacher

Health Index
K9 TBD info and Tick List Links
http://www.rabieschallengefund.org/
UPDATE Skye going back for pannus recheck 08/05/11 [Re: MaxaLisa] #171703
08/05/11 07:42 PM
08/05/11 07:42 PM
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PositiveDog Offline OP
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OK, we are back and this will be long - sit back with your coffee, soda or a beverage of choice if you have an interest in pannus (and Skye, of course.) popcorndrink

First the best of all news. Both ophthalmologists (hereafter called DRs just to save key strokes) and the tech kept commenting on easy Skye is to work with. Finally, one of them said, "OK - I am just going to give Skye the title of "All Time Favorite German Shepherd in our office." happyboogie

Apparently they see a lot of scared, high strung or just weak nerved dogs and said they tend to hide under the chairs or move around to avoid them - or bite. I am very fortunate with Skye - her background is Amish puppy mill, to kill shelter to rescue all by 3 months old. She has the best, calmest temperament I could ask for - and still has her zoomie days!

Enough of that.

We saw two DRs because one was considering specializing in the eyes and was visiting, so bonus time.

- Skye's tears were rechecked (good), her eyes were numbed for a pressure test (great) and they viewed her eyes with several lights and scopes.

- The sad news is that her pannus was considered to be "rampant" and I was correct that cyclosporine (her brand was Optimune) was no longer working for her.

The DR said she was as almost as bad as she was when diagnosed 4 years ago. teary

- This could be due to the change to cyclo drops instead of ointment. Apparently, even when it appears the drops are staying in the eye, they often just go down the tear ducts and don't do as much good for the eye. Ointments stay in the eye longer so it is preferred by them. (For those who don't know, the ointment became impossible to get. But it has again become available just within the past few weeks.)

However, they said it is more probable cyclo is not the right medicine for Skye's.

- Their choice is tacrolimus and they especially since Skye's perianal fistulas cleared up so quickly on tac, they think this is a good choice. It will be in ointment form again and it is already ordered.

We are to do a follow up in their office at the end of the month. If necessary they will add a second med (help me, Lisa - dexa or des something? Skye was on it with cyclo when first diagnosed, but then they phased it out.)

Hopefully, tac alone will do it.

***QUESTIONS ANSWERED:

Q -what if a dog is allergic to cyclo and taccrolimus?
A: It is really rare for that to happen (ah - but then there is Max) so it is more likely that the allergic reaction is due to something else in the compound. Since corn oil is most often used as a base, if your dog is allergice to corn, they will be allergic to the drops if corn based. Said to ask your optho to get the meds with one of the different bases: vegetable oil or peanut oil are both possible.

Skye's tac will come from Stokes Pahrmacy and it has none of those oils in it, but I forget what it is compunded with. Darn it. Hope it is on the package when it comes.

Q: Should I worry about systematic absorption of the tac? Pannus is due to an auto-immune disease, creating a situation where the body mistakenly thinks it is attacking disease, but it attacks healthy cells. Tac depresses T-cells (which is why it is used for some cancer treatments.) I think they said Dex does that also.

Even if tac would be absorbed into the system, it would do no harm for dogs with this type of problem. That is probably too simplified, but I am not good at putting it all together as Lisa is.

Q: have you heard of the study at CSU doing trials using GVT (Galavit) for treatment of pannus?
A: No, they had not heard of it, but they say they welcome new treatments so that dogs not responding to current ones can get help.

I forgot to ask about combo of different steroids or zinc products, but they did say they would add dex to the tac if necessary.


Let's talk about the cost:

I really enjoyed my visit today. The DRs let me have all the time I wanted. The visiting Dr so enjoyed Skye she asked if she could also use the scopes and look into her eyes - sure! They answered everything I asked and more.

They faxed the prescription to stokes Pharm (who called me before I got home, so the first delivery is on the way.

$143.00 for the visit. That includes a starter pack of the tac to tide Skye over until the package arrives.

Also - the tac costs only $27.50 including postage and it will always arrive 5 - 7 days from my call to them.

That cost is about $10 less than I was paying for the cyclo, so the cost of the vist will be repaid in less than a year just from that savings.

Priceless - that's what it is worth in peace of mind to know Skye is getting a specialist and most current treatment possible.

Well worth i(If you want the # for Stokes Pharm to compare what you are paying or any compounded meds, send me a PM)

Thanks for reading all this!






Bonnie

With approval of my friends:

SamCat, 03/2011
Bennie the 12 1/2% GSD 02/2013

Seiko, Solo, Sophie, Skye and Buddy - bridge dogs who taught me so much
Re: Skye going back for pannus recheck 08/05/11 [Re: PositiveDog] #171721
08/05/11 09:26 PM
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Malinois16 Offline
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Why do they do a pressure test? My vet never suggested that for Lincoln and I am wondering if I should have that done when I go in for a re check.

Re: UPDATE Skye going back for pannus recheck 08/05/11 [Re: PositiveDog] #171722
08/05/11 09:27 PM
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Bonnie that sounds like a nice visit. I think you already knew the meds weren't working, you just didn't know how bad she was.

Let's all cross our fingers and paws that just one med will do the trick for now. Then you always have something you can add down the line.

Give Skye a hug for me.


Val da Tiger

Fuzzybutt the cat.
Neilla the Big White puppy.

RIP Cheyenne - AKA: Digger, CheyChey Girl, Cheyenne Large and In charge. 2/16/02 - 2/27/16
RIP Raya - AKA: Raz-a, Ray a Sunshine, RayBestos, the little one, Silly Girl. 9/21/05 - 6/27/14
RIP Lakota - AKA: Bubba, Big Boy, BooBoo (the other part of the Binky and BooBoo team). 1/19/03-9/19/2011
RIP DeeDee - AKA: DD Poo, Little Bit, Binky (part of the Binky and Booboo team) 6/23/02-6/20/11
Re: UPDATE Skye going back for pannus recheck 08/05/11 [Re: Wisc.Tiger_Val] #171726
08/05/11 09:40 PM
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Thank you for the update on Skye. I've got my fingers, toes, eyes and boobs all crossed for this med to help your sweet Skye do well and feel well! crossedfingers crossedfingers crossedfingers She's a special girl and so very well-loved. Sending good thoughts and healing vibes to your goodhearted girl! gsdhalo


Patti
Frauchen von:

Grimm van den Heuvel, "Donnerpratzen"
Smokey The TeddyLion, DLH purrbuddy

Dir gehört mein Herz
Re: UPDATE Skye going back for pannus recheck 08/05/11 [Re: PositiveDog] #171730
08/05/11 10:00 PM
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Originally Posted By: PositiveDog
OK, we are back and this will be long - sit back with your coffee, soda or a beverage of choice if you have an interest in pannus (and Skye, of course.) popcorndrink


Bonnie, read thru your entire post - no coffee but I could use a cup and, of course, an interest in Skye.
Glad to hear she will be getting a specialist and the best treatment. Hugs to both of you. hug


Sean - 1998/2014
If there ever comes a day when we can't be together, keep me in your heart I'll stay there forever.
Carleton DOB unknown
Neely - 2003/2015
Gizmo -2008/2011
Neeko -1991/2005
Re: UPDATE Skye going back for pannus recheck 08/05/11 [Re: SeanRescueMom] #171735
08/05/11 10:17 PM
08/05/11 10:17 PM
Joined: Jun 2010
Posts: 3,129
Fairfield, Ca.
Schnickle Fritz Offline
Carpal Tunnel
Schnickle Fritz  Offline
Carpal Tunnel

Joined: Jun 2010
Posts: 3,129
Fairfield, Ca.
great visit. i am glad that you were able to talk so long with them.


Have a great day!!!
NLS

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Fritz vom Banach TR1 TT RN RA BN NW1 BH 10/10/09
Cuvee' d' la Maze ORT-BCA BH 01/14/11
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Re: UPDATE Skye going back for pannus recheck 08/05/11 [Re: SeanRescueMom] #171736
08/05/11 10:26 PM
08/05/11 10:26 PM
Joined: Jan 2010
Posts: 19,670
Northern CA
MaxaLisa Offline

Global Moderator
MaxaLisa  Offline

Global Moderator

Joined: Jan 2010
Posts: 19,670
Northern CA
Bonnie,

That sounds like a great visit, and Skye, what a good girl wub I hope the car ride was okay for her!

HOw disappointing that the eyes were not much better, and that the pannus is flaring, but the good news is that they aren't worse, and you knew that there was an issue. I didn't know that about the drops going through the tear ducts as the reason why they don't stay in the eye. That makes sense, just didn't think of it that way. That's how my optometrist says the tac/cyclo gained access to max's nose, since the tear ducts drain through the nose too.

At RR pharmacy, I think I paid about $40 for the 5g tube of the .03%, and you pay less if you buy two at a time, but I wasn't using it that fast, so ordered only one. Sounds like you have a better deal.

The dex (whatever it is!), has a longer half-life than regular pred, I think, so it is better for something like the eye. I probably should use that for Max's eyes, but my vet only carries it mixed with abx, and he appears sensitive to that, so we just use the straight pred.

Sounds like a great visit, and good results, and Skye's eyes are going to feel much better very quickly!

Thanks for all the update!


MaxaL (aka LisaT)

Jazmine, mini-mix, 10/18/2011
Max-n-Indy
Max, 5/2001-2/2012, RIP my partner, my Regal Boy
Indy, 5/1997-10/2010, RIP my friend, my teacher

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