Ophthalmologist appointment, take 2!

In some ways our appointment yesterday was pretty disappointing from my point of view, at least at first. We were a little early, so we enjoyed the nice weather outside and walked all around the building. Reo was hopping up and down from the curb, going around trees and bushes, and marking where all the other dogs before her had done their business before her!

When it was finally time for our appointment, and we went into the exam room, Reo was really distracted and wanted to sniff everything - she seemed fairly excited (I'm sure she was picking up some on my excitement, too). Dr. C came in and tried to get her to come to him - again, she was really distracted with all
of the smells and couldn't have cared less about Dr. C or his assistant! She gave them both courtesy nubbin' wags, but that was about it!

I gave him a quick update on all of the things that we had done with Reo post SARDS diagnosis (trying to fit 7 months in 5 minutes isn't so easy!). Dr. C was throwing some cotton around, but again, Reo was not focused in the least, and had her nose to the ground most of the time.  I tried to get her to sit and focus, and I would do the cotton test, but wasn't having much success, either.  I kind of wished we could have talked for a few minutes and let Reo get all the sniffs out before proceeding with the testing. :-/

I asked if we could do some functional testing. Dr. C said that they had an obstacle course for large dogs, but that it wasn't appropriate for small dogs (whatever that means!). So, we set one up in the exam room with a chair, the doctor stool, trash can, and my purse. She went through it just fine, and didn't bump one thing!

Then he turned the light off and did her eye examination, while I blabbed on about the treatment we pursued, and the "evidence" we had for her regaining some sight.  His examination showed a "blind" dog - Reo had no menace reflex, and no dazzle reflex. Her PLRs were sluggish, and slightly incomplete. None of this was a
surprise to me - I already knew all of that.

He said that her retinas were "thin", but did not seem detached/very reflective based on the exam. I asked him whether or not he would expect a SARDS dog to have detached/degraded retinas after 7 months of being blind.  I wanted to uncover whether Reo's retinas still being intact was an indication that she still had some retinal activity.  Unfortunately, it seems that this answer isn't so straightforward - another case of "every dog is different". He told me the story of a patient who went blind due to something other than SARDS, and this dog's retinas are normal over a year after blindness. So, maybe not all dogs' retinas go through the apoptosis to destroy them?  This was surprising/confusing to me - I thought if the retina is not used by the body, the body destroys it.  Will have to look into this a little more...

We talked a lot about adrenal exhaustion vs. IMR and IVIg. He is really familiar with Dr. Grozdanic's work. His impression is that Dr. G is taking a lot of flack from the vet community because there are so many different variables with his protocol, and not enough control groups to be a "real" study or show "real" results. This was surprising to me, and disappointing also, as my impression of Dr. G's work was that it was considered a breakthrough in the vet community.  Just goes to show that if a theory is outside the traditional lines of thinking, it can/will be met with resistance from at least some.

I gave him some of Caroline's research papers to review or have on file, including some of restored vision, and also a dog that got IVIg treatment but still developed adrenal exhaustion. We agreed it was really unfortunate that her papers are "dismissed" by the vet community because they are not peer-reviewed (and because Caroline doesn't have DVM after her name), as if it discredits a particular study of a dog.

We reviewed Reo's bloodwork - there was no denying that she has made progress!  Dr. C was interested in this, but it was "outside" his area of specialty, so didn't make too many comments.

Ultimately, Dr. C said that all that mattered was that we thought that Reo had made improvement, and if we think that she can see based on her "real life" tests, than that was a great thing. His examination revealed that if Reo was not blind, her vision would be very, very limited.

At first I thought he was being dismissive and flip, and it sort of offended me!! I wanted to do more functional tests, obstacle courses, take her outside and show him how good she does on her own. I wanted to turn him into a believer, if you will, and prove to him that she has some functional vision!

After some discussion, I decided not to repeat the ERG, or get an ultrasound. I didn't want to put Reo through the stress of both tests, and I didn't want to pay several hundred dollars for Dr. C to tell me she's "still" blind. :-/

I feel like he just wasn't interested enough in the curiosity of Reo's case to really put forth an effort into pursuing a lot of functional testing. Though unfortunate, and upsetting to me at first, I accept it. I had a good cry after leaving the office - mostly my own frustration - and felt better afterwards. I think I was frustrated from my own high expectations, and those expectations not being met.  I also feel frustrated that research from Dr. Grozdanic, Caroline Levin, and Dr. Plechner are being dismissed, when it is so clear to me (and others whose dogs have undergone treatment) that progress can be made!!

It's true that we know Reo better than anyone, and we know that she has some functional vision left.  She went hiking in the woods and did fantastically, for crying out loud!!  In the end, that is enough for me. We will continue to share our story and blog, and do what we can to raise awareness for SARDS, and
the success with the treatment we pursued. Ultimately, I'm happy that she is on her way back to health - regardless of how much she can see, or for how long her vision returns.

I am keeping the faith!  :)