You may recall that Pearly was diagnosed with Rocky Mountain Spotted Fever, last November, and that after it was apparently cured, she had a relapse at Christmas time. The specialist released her on January 9th and we were optimistic that she would be fine. When I last posted about Pearly, in mid January, she was showing a little redness in her eyes but I hoped we were on top of that by giving her prednisone drops. Not so. Within a couple of days, her eyes were clearly on a steep downhill slide so we took her back to the specialist on January 23rd. She was quite unhappy that Pearly had had a second significant relapse. She put her on a month's worth of antibiotics, "to try to buy us more time between relapses." Relapses go with Rocky Mountain Spotted Fever.
Don't look if you are squeamish:
The specialist offered to recommend someone so that we could get a second opinion and we set up an appointment to see him the following morning, which was a Tuesday. I was out of my mind with grief. I read up on secondary glaucoma and learned it was extremely painful and that the eyes often had to be removed. That night, while she was out in the yard, Mr. Wonderful looked at her eyes with his flashlight and nothing shone back. Evelyn's eyes glowed. Pearly's were just dark. I was just this side of a meltdown.
The next morning, February 7th, Pearly woke up and couldn't see, at all. Her tail was down and she moved at a hunched over crawl as if the world was going to buck her off. She got lost in the corner and was on the edge of complete panic. The look of fear and confusion in her swollen eyes, clouded over and bluish white was horrible. It just killed us. She kept bumping into walls and was so scared.
The good news is that although the first specialist said Pearly had an inflamed optic nerve, the second specialist said her optic nerve looked fine and that he didn't believe she had optic neuritis in the first place. What Pearly had, he said, was uveitis throughout her entire eye, both sides, front to back, which means the whole things were swollen and inflamed. He couldn't tell if her retina was detached because it was too swollen to see back there. Obviously, a detached retina is a bad thing that could lead to blindness. That being said, since she'd twice gotten her vision back, he was guardedly optimistic that it would happen again.
Now, the big question is, "what caused the uveitis?" He needed to know that to know how to treat it. He didn't think the uveitis was caused by Rocky Mountain Spotted Fever. He suspected it was an auto-immune problem. He changed Pearly's medication around and set up an appointment for a week later. He also asked me to take her to her regular vet to get a complete blood workup.
As bad as that was, I felt considerably better when I left his office and headed straight for the regular vet to get the blood work. Once there, they drew blood and we waited on the results. The regular vet took a look at the results and became quite alarmed because Pearly's white blood cell count was very high. Long story short, she was worried that Pearly had lymphoma, a cancer of the blood. Are you freaking KIDDING me???? Mind you, she didn't have swollen lymph glands, a fever, or any other indications that she was sick other than her eyes. Still, the regular vet was concerned enough that she thought we should take her to the Oklahoma State University Veterinary Hospital to see an internist. After consulting with the second specialist, they set up an appointment for us to go to the veterinary school hospital in Stillwater, about an hour and a half away, on Thursday.
Seriously, this had turned into a really bad week.
I nearly drove Mr. Wonderful insane over the next twenty-four hours fretting over Pearly and lit up the internet seeking answers. I scared myself silly. In the meantime, Pearly was starting to regain her eyesight, very slowly. On Thursday morning, we drove up to Stillwater and by that time, Pearly was starting to be able to see enough to avoid bumping into everything, although she clearly couldn't see anything in focus or beyond a few inches in front of her nose. At that point, we were thrilled with her progress.
Happily, based on the the original blood work, OSU were confident that she didn't have cancer. Instead, they thought the high white blood cell count was due to the prednisone she was on. They re-did the bloodwork and the count was half what it had been two days, before, making them all the more confident that she was fine, other than her eyes. And as for her eyes, they noted that they were responding to light and that the pupils were even.
I was so relieved.
By the time Pearly and I went back to the second specialist for the one week checkup, on Valentine's Day, she had regained a great deal of her sight. Her vision wasn't good but she was no longer so debilitated that she was getting lost in the dark or running into the walls all the time. The second specialist was delighted with her "exceptional" response to the medication and quite optimistic that she was going to recover. He said that she still had some fluid behind her retina and is certainly not out of the woods, yet, but there was no question that he was excited about her progress.
Since that time, she has continued to improve and is beginning to act like our Pearly, again. She hasn't yet regained all her sight and her eyes are still slightly swollen, but if you didn't know of her difficulties, you probably couldn't tell. She is getting back her night sight (her eyes shine brightly in the flashlight) and she is no longer having difficulty taking things from our hands. She has also stopped running into walls, poor baby. So at this point, we are guardedly optimistic that THIS time, we'll get to the bottom of her troubles. She has really been through it.
A note of explanation about the different approaches of the two specialists might be in order.
The first specialist believed Pearly's eye problem was caused by Rocky Mountain Spotted Fever, a bacterial infection carried by ticks. The only way to "cure" Rocky Mountain Spotted Fever, an infection, is to kill the source. You do that with antibiotics. Even if "cured," the patient is subject to relapses so it tends to come back when you are under stress. It is like one of those weird tropical diseases. Rocky Mountain Spotted Fever doesn't always affect the eyes but it often does. Oral prednisone is often offered in the beginning to treat the symptoms because it brings down the inflammation in the eye, reducing the likelihood that the eye will be permanently damaged. As soon as the eye stops being inflamed, they generally take them off oral prednisone (which suppresses the immune system) so that the body's natural immune system can attack the infection along with the antibiotics. This is what the first specialist was doing.
Unfortunately, Pearly kept "relapsing" and the first specialist believed that she just couldn't get ahead of the Rocky Mountain Spotted Fever even though she kept treating her with antibiotics. The repeated "relapses" put Pearly at risk of developing secondary glaucoma. That was her reasoning.
Alternatively, an auto-immune disease is when the body has an out of whack immune system that is attacking itself. That would be the source of inflammation. Any number of things can trigger an auto-immune problem. Vaccinations are considered one of the main culprits but usually, you never know, for sure, what caused it. My own uveitis that I had at about the same time Pearly got sick was successfully treated as an auto immune problem.
The remedy, typically, is to put the dog on prednisone, which suppresses the immune system. The trick is to keep the dog on prednisone long enough for the body to get a grip on attacking itself, and then wean off the prednisone when the body has stabilized its over active immune response. Because the immune system is suppressed, many vets also put a dog on antibiotics at the same time to keep an opportunistic bug from attacking.
A dog with Rocky Mountain Spotted Fever who is put on prednisone, alone, could be a sitting duck for it to roar back and attack since its natural immune system would be suppressed. But a dog with an auto immune problem rather than Rocky Mountain Spotted Fever isn't helped by antibiotics because the problem isn't infection.
So what all this means is that the first specialist treated Pearly for Rocky Mountain Spotted Fever, i.e., with antibiotics. That wasn't helping Pearly. When she would get worse, the specialist believed the infection was still there and that she was relapsing, as is typical for RMSF. Instead, if the second specialist is correct, Pearly was actually suffering from an untreated auto immune problem that would respond to prednisone but as soon as the prednisone was stopped, the inflammation would roar back.
The second specialist based his diagnosis of auto immune problem on how she looked and how she has responded to the treatment given to her, to date. Additionally, the blood work he ordered showed that she had a high platelet count and this is inconsistent with Rocky Mountain Spotted Fever. He put her on a relatively high dose of prednisone for a significantly longer period of time than with the first specialist with the goal of allowing her system to stabilize and stop attacking her own body. He plans to start slowly weaning her off the prednisone beginning in another week. In his opinion, the reason Pearly has been "relapsing," is because her body never stabilized to begin with. He believes she never stayed on prednisone long enough for that to happen.
Fingers crossed that she will fully recover - and, happily, I just looked over and she was catching popcorn Mr. Wonderful was tossing her!
On a happier note, our friend, Julia, made her annual visit along with her Samoyeds, Blind Willie and Tarka. Pearly wasn't feeling well enough to be particularly sociable but Evelyn was her usual Miss Hospitality. She and Tarka had a great time romping in the front yard and talking to the neighborhood horses:
Happy Quilting, Penny, Evelyn and Pearl