Speaker 1: You were listening to petlifradio dot com and.
Speaker 2: Good morning or good afternoon to all. I'm welcome, welcome
to Askavets with Doctor Jeff. I'm your host for the
next thirty minutes, doctor Jeff Werber, and we are here
for you. We're here for your pets, and we don't
have to have any specific topic. We can talk about
anything or I just want to hear from you and
hear about the relationship you have with your pets. I
have ten amazing I have five dogs, five cats keep
me very busy and fortunately a large bed. I often
joke that if they made a bed bigger than a
California King, I can actually get more. But right now
it's pretty full house. So I want to first of all,
we're here, thanks for our sponsors Forstraw. First of all
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Or if you're online listening to us live. By the way,
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Life Radio, you can click on the Ask the Vets
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You'll see me and you'll see a great picture of
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dot com, and Mark, our great producer, will forward that
to me live on the air and we can answer
your questions.
Speaker 3: So really no excuse.
Speaker 2: You can get a hold of me easy anyway. So,
because I seem to have some followers that are very
embarrassed and very shy to join in the conversation to
give us a call, I have no idea why.
Speaker 3: I always have kind of a planned topic.
Speaker 2: And what I've been trying to do is go through
a lot of the different organ systems, a lot of
the endocrine diseases.
Speaker 3: And first of.
Speaker 2: All, we started with a lot of the symptoms like limping,
like vomiting. Now we're sort of honing down a little
bit to specific parts of the body, specific areas, and
we've been dealing with the endocrine system. And we've talked
about Cushing's disease, and we've talked about Addison's disease. We've
talked about the different diabetes diabetes melodists, the sugar diabetes,
diabetes insipidus, the water drinking diabetes. So what I'm trying
to do is equip you with knowledge. Knowledge is king.
It's so difficult to walk into that veteranani's office with
a complaint and they say, okay, we're going to do
X Y Z. And you're at their mercy because you
don't understand.
Speaker 3: Any of this stuff.
Speaker 2: And I want you to be able to say, whoa
time out, doc, Let's let down here.
Speaker 3: What are you thinking? What do you think the problem.
Speaker 2: Is based on the history, based on the physical. And
if you ever get an answer like, well, I have
no idea. That's why we're doing all.
Speaker 3: These tests, nix that doctor wrong.
Speaker 2: Because good history, good physical The doctor should have an
eighty percent accuracy thoughts of what is going on, and
then you order up the appropriate tests to rule in
or rule out the eighty percent likely diagnosis. If all
that comes back negative, then then you could start doing
more tests because then you have a more of a difficult,
challenging case. But a good diagnostician, a good doctor, all
he or she needs is a really good history. So
make sure when you go in you give them a
really good history, accurate, don't leave out any detail because
you think it's stupid.
Speaker 3: There's no detail that's too stupid.
Speaker 2: Then are really good physical and then you piece everything together,
you piece your findings you piece the history and then
you come up with your game plan because based on that,
he or she should have a pretty darn good idea
of what the problem is. Now he's just got to
prove it, because you can't treat something based on that hunch.
But now you choose the appropriate tests. But you beat
a blood test, what do you including the blood test,
X rays, ultrasound even in some cases an MRI if
it's something neurologic.
Speaker 3: Or a CT scan.
Speaker 2: But there really should be a game plan based on
information attained from that history and physical So we've been
talking about the eye problems. That's the organ system we
been covering, and we started talking about a condition. The
lay term is called cherry eye. The reason they call
it is because it is a prolapsed gland of the
third eyelid. Now, the third eyelid is if ever watch
a dog or cat blink, there is a membrane that
starts on the inside corners and it comes up.
Speaker 3: Over the eye.
Speaker 2: And that is a really good protective mechanism for dogs
and cats that might be hunters, might be going through brush,
they get a lot of things in their eye, so
a blink, it's in the eyelids closing. It's that third
eyelid coming across the eye. Well, inside that third eyelid,
there is a gland called the gland of the third islet,
appropriately named, of course, and it is a lymphoid type gland.
It's a very reactive gland. And as we discussed if
you were listening last week, there are a number of
conditions and a number of breeds that will make that
gland cause.
Speaker 3: That gland to just become huge.
Speaker 2: And when it does, it can fit in the pocket anymore.
It's too big, so it actually pro lapses out. It
pops out. So you walk home and you have that
Cocker spaniel or the English bulldog, or the lasso or
the shiitsu or the Sharpei, the chow chow, and you're
gonna see this huge, pink round gland just popped right
sitting in the corner of the eye. And that's why
they call it a cherry eye because it kind of
looks like a cherry. And the key is, we don't
want you to panic. It is not an emergency. And
as I started mentioning last week that we had a
I had a case. Interestingly, one of my patients ended
up going to an emergency clinic at night with a
cherry eye. Now, mind you, it looks pretty scary to you,
But any qualified doctor would have looked at that and said,
missus Smith, I understand, it looks pretty bad, but it's
not as bad as it looks.
Speaker 3: It's certainly not an emergency.
Speaker 2: What I'm gonna do is I may want to do
an ice stain just to make sure that the cornea
is fine.
Speaker 3: That's justified.
Speaker 2: Then we'll give you some ointment depending on the results
of the stain.
Speaker 3: Baby a little cortisone ointment. If the stain was negative, because.
Speaker 2: We don't like to use corticosteroids on an eye with
an ulcer or an erosion or a scratch on the corny,
that would have been all needed to it. And then
the advice would have been go see your regular doctor
in the morning.
Speaker 3: Well what happened was they I.
Speaker 2: Think I alluded to this that I think their training
was not one of the USAT schools, and I believe
I was right. They took the dog into surgery, which
highly inappropriate, highly inappropriate for an emergency facility.
Speaker 3: Who is relying on their local.
Speaker 2: Veterina hospitals to actually feed them nighttime in emergency cases
to step on those toes.
Speaker 3: You don't bite the hand that feeds you. That is
not an emergency.
Speaker 2: But not only not only did they do the surgery,
she did the wrong surgery, she actually removed that gland.
Now let's go back twenty five years where even when
I was in school and when I grabbed scud, that
was the treatment of choice. The treatment of choice was,
oh my god, we have this huge gland. Let's cut
it out. No problem. And there wasn't a problem, very
simple surgery.
Speaker 3: Ah.
Speaker 2: But how do we find out about the problem is
that these same dogs as they aged were more prone
statistically more prone to a condition called KCS corado conjunctivitis SEEKA,
also known as dry eye. And we then learn, and
we probably knew, just didn't know the significance, the true importance,
that the gland itself has a function of accessory tear production.
So it's not just a gland in there to be
a reactive lymphoid type land. It actually serves a purpose,
a purpose that.
Speaker 3: Most young dogs don't need.
Speaker 2: But as they get older and their tear dugs start
to dry up, that land is significant. So when you
remove it, you're leaving this dog with no choice other
than to get some really dry eye problems when it's older.
So for years, the treatment of choice has been not
to remove the gland, but to tuck it. So what
we do is we will create a little pouch on
the inside of that eyelid and we will make a
little cut. It's all done on the inside, so you
see nothing when you pick up nothing on the outside,
and so we evert That means we turn the gland
basically the third eyelid inside out, and we make a
cut almost like a CBSI. We make a little curve
cut on top of it and a curve cut below it.
We use little undermining, which means we just open up
a little space. We then stuff that gland into the
space we've just created, and we take our two edges
that we've just created by doing this two cuts, and
we sow them over that gland, that large prolapsed gland.
So the gland is still there, the gland is still functioning,
yet it's out of sight, so we still have and
are getting the advantage of the tear production that we
need from that gland. So when these pets get older,
they have no problem. Now it's also interesting is that
another technique is to in this one I used to
do when I first learned it, you know, it kind
of it was the accepted technique. I find it much
more difficult and the results are no better than the
pocket and just tucking the gland inside the pocket that
you've created. But it's a way to take that gland,
put a couple of sutures through it, and go through
the third eyelid, and we actually pick up a piece
of periostium.
Speaker 3: Well that means a.
Speaker 2: Little bone covered membrane that sort of coach all bone,
called the periostium, and we grab it at the orbital rim,
which is the bone right here under your eye.
Speaker 3: You know, you could look.
Speaker 2: At a skeleton and you see that the socket where
the eyes were. Okay, that's called the orbital rim. We
pick up a little piece of periostium, and then when
we tide our suture, it takes that land and brings
it right down to the level of the periostium of
the lower orbital rim. And again that's another way to
keep it out of sight, out of mind. I just
find that is a little more challenging, more technically challenging,
and at the end of the day, it's not worth it.
The creating the pocket is just as easy as I
was easier and you get the same results.
Speaker 3: So anyway, that.
Speaker 2: Concludes our discussion on Terry. I'm gonna talk about a
little bit more when we come back. Don't go away,
and you know, hey, save up your questions once again.
Give me a call eight seven seven three eight five
eight eight eighty two, or when I come back. When
we come back from our break, I want to see
two or three messages. And I know that there are
listeners out there that have had problems with their dog's eyes.
Speaker 3: I want to hear about them. Let's see if we
can't solve them. So don't go away. We'll be right
back here on pet Life Radios. Aff's doctor Jeff.
Speaker 1: We'll be right back right after these messages. Stay tuned.
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Speaker 3: And welcome back.
Speaker 2: You're here live with doctor Jeff Werber, your host. I'll
ask the best with doctor Jeff here on cut Life Radio.
So another discussion that we started, I think it was
two weeks ago, maybe it was last week that we
wanted to finish up as well, and it was the
treatment for cataracts. We talked about cataracts that is a
basically a thickening, a consolidation debris within the lens itself,
making the lens white, a lens that dogs and cats
can no longer see through, as opposed to nuclear lenticular sclerosis,
which is a normal age change. Buy and large, far far,
far far more dogs and cats will get sclerosis. Then
they get catarac cataracts. We see secondary off into diabetes.
We can see juvenile cataracts in some breeds, but most dogs,
most cats, as they age are going to get something
called lenticular nuclear sclerosis, which is that kind of that haziness.
You look at the pupil that's normally black, it's more
of a it's like a hazy gray, a little whitish maybe,
And as dogs get older and you look at them
in certain light, you see that reflection and you think,
oh my god, my dog's going blind.
Speaker 3: My dog is a cataract. Not the case, not the case.
Speaker 2: It's an age change, I guess technically, because it is
a consolidation within the lens itself, you could call it
a pre counteractus condition. But in order for that to
turn into a condition a cataract where the pet can
no longer see, that pet would have probably have to
live to about thirty or forty, and as we all know,
ass that's not going to happen sosis age change.
Speaker 3: Don't worry about it.
Speaker 2: You might notice it in advanced stages. The pet might
have a little more difficulty at night, in low light, etc.
So help them along maybe with stairs, but generally they're fine.
And as I mentioned, that could be why. Let's face it,
dog's vision of all the senses, and we mentioned this
before is probably the weakest. So when you are walking
into the house or walking down the hallway from your
bedroom at night and your dog is sleeping somewhere and
sees you coming and gets up and starts barking, it
to A, you probably disturb their sleep.
Speaker 3: B they can't see you.
Speaker 2: They don't often see you as well in low light,
especially if they have this condition cause thurosis. So as
soon as they hear your voice, as soon as they
get pick up your smell, oh my god, they stop
right away, and then they're happy. They all starts wagging,
and so anyway, just be aware. Now let's talk surgery.
Most general practitioners and I do a lot of eyework,
and I do not do cataract surgery. So once again,
if cataract surgery is needed, most likely you will be
referred to a board certified veterinary ophthalmologist.
Speaker 3: What does that mean?
Speaker 2: Just like you're human aphomologist, says a veterinarian who did
four years of veterinary training and then they did an
internship for a year, and then they applied to a
residency either in private practice at some private practice eye
specialty clinics or at one of the University of Veterinary
schools and does a three or maybe even four year.
Speaker 3: Residency in ophthalmology.
Speaker 2: We're talking highly trained, we're talking great equipment, and we're
talking a doctor who only does eyes. They'll do more
all the species typically, but it's only eyes. So don't
go ask to them to help solve your gogga cats
skin problem or the vomiting problem or the limping.
Speaker 3: All they do are eyes.
Speaker 2: Now to do the surgery again, it's amazing how things change.
But a surgery is done using a piece of equipment
called a faco emulsifier. They actually make a little hole
in the eyeball, go into the lens and it's almost
like a road ruter.
Speaker 3: It's like a suction.
Speaker 2: It's pulverizing all that the material inside a lens and
it's sucking it out. Okay, a faco lens a mulsifier,
so it makes it into a liquid and it sucks
it out. They take the lens out and they actually
implant a lens, an artificial lens. So after a mulcifying
making the lens into mush and removing it sucking it out,
they then sew in another lens. What's so interesting is
that these lenses that they implant actually have the ability
to correct the poor vision that dogs typically have, so interestingly,
a dog after cataract surgery probably will see even better
than he did before he even developed cataracts, which is
so cool now some of the things that have changed
years and years and years ago. The theory was that
if you had a dog a pet with cataracts, you
would actually One of the options was to wait let
the cataract mature, because as the cataract would mature, they
would form sort of clumps of the material within the lens,
and then in a mature cataract, the white part the
clumps would be whiter, meaning more compacted but smaller, and
sometimes a dog who couldn't see at all with the
immature cataract might see with the mature cataract. So the
thought was let's leave them be, and then if the
second eye starts developing the cataract, let's see how the
first eye is doing and go from there. Well, that
theory is now changed. Now the theory is, if you
are considering surgery, do it right away. Now if you
have two eyes that have cataracts, meaning bilateral cataracts, and
they're both immature, they're both fairly young, some might feel.
And this is where you sit and talk and have
the discussion, and finances obviously is coming to the picture.
Do you do both eyes at once, which is obviously
more expensive, hoping that at least one of them will
take and that you have only one anthesia from a
safety standpoint, but it's going to cost you more because
you're doing two eyes. Or do the one ant of
sesa and one eye. See how that pet does. And
if that pet does fine, you can see well, Remember
they have an implanted lens. The lens is going to
make them see even better than they did before the
cataract developed in the first place.
Speaker 3: And then stop right there.
Speaker 2: But if that I didn't do well after surgery for
some reason, and there are always complications with cataract surgery,
then do the second eye, so you're only spending the
more money if needed. But remember that's now two anethesis
instead of one, so you can argue back and forth.
You can make a great case for either. Dogs, especially
dogs that get the cataracts, really only need one eye.
Their depth perception is not that great anyway. Secondly, even
if you do both at the same time, there's no
guarantee that both will take. So then you said, well,
I just spent money on two and didn't need it
all only one took, I may as well just on
the one. Certainly, if you did the one, you wouldn't
be sure which one is the one that would take
and which one wouldn't take.
Speaker 3: So there's no easy answer.
Speaker 2: It's just something you have to sit down and decide
from a financial standpoint, from a practicality standpoint, from an
aide standpoint, and do you want to subject this dog
or cat to two aneseses when that's probably the riskiest
part of the surgery in the first place. And that's
what you kind of have to think about, and it's
sort of that the mental strategy. But the truth is
that it is a surgically correctable disease. Dogs with post
surgery having the lens implanted seem to do very well,
and I've known both. I've known many of my clients
have opted to just get it doun all at once,
one anesthesia, pay the extra money, and if you get two,
that's great. If you get one, that's okay. Others have
opted to just go for one. I would say most
of them have worked out fine and only needed one surgery.
Some of them had to go back in for the
second eye because the first one didn't do well. But regardless,
it is a treatable thing. But the key is from
the surgical standpoint now it is easier for the surgeon
and it's better for the pet to do the surgery
when the cataract is younger. So therefore, I would advise
that if you're considering it, don't wait the way we
used to for that cataract to become super mature. If
it develops it's a true cataract. The funding exam shows
that we cannot get through the lens, or the ophthalmologist
concurs that it is a cataract, then I would say
just go ahead and do the surgery sooner than later.
So I am off in about an hour for Las
Vegas for the Western Venini Conference, and I will report
back to you when I get back, and then from there,
I may be going to New York. I'll be doing
the Better Show and maybe even Fox and Friends next Sunday,
so I will keep you apbreast.
Speaker 3: And let you know what's going on.
Speaker 2: Anyway, thanks for joining me here on pet Life Radio's
Aspets with Doctor Jeff. I want to thank our sponsors
once again, pro Sense and Calm. I'm bummed that none
of you had the guts to call in. I know
you have pets out there. You wouldn't be listening to
pet Life Radio if you didn't have pets, So kind
of get the courage to give a call in, even
if you just want to talk about your pet. I
love talking pets anyway. Thanks for joining me, have a
great week, and we'll see you next Sunday.
Speaker 1: Let's Talk Pets every week on demand only on petlight
Radio dot com.