The Glaucoma diary or How Pippa became a pirate
Wunderdog's canine editor lost her eye to glaucoma a year ago. Nina May recounts the battle and the adjustment after the loss
It started with some angry pink in Pippa’s eye. The usual, I thought – too much fun chasing bubbles in a muddy pond. We’ve had ‘pink eye’ so many times before that Pippa would put in the anti-inflammatory drops herself, if she had opposable thumbs.
But this time, the drops made no difference. The vet had warned us there might be something more serious at work – glaucoma. He showed me how to feel across the browline to check for any swelling that would signal increased pressure – the key symptom for glaucoma – and, indeed, the inflamed eye felt raised.
This pressure imbalance in an eye means fluids are inadequately drained from the eye. When this persists, it damages the optical nerve and eventually causes blindness. Although glaucoma is more common in older dogs, it can occur in young ones as well, and some breeds are more prone to it (see below). Our vet referred us to a veterinarian ophthalmologist, John Beel, in North London for closer inspection. Pippa bumped into two walls on the hour-long public transport schlepp to the appointment, despite being on the lead and me keeping close watch, and she was generally slow and dizzy.
Once in the consultation room, Beel used tests I recognised from my own eye exams: yellow dye dropped in the eye, a bright light shone into the eyeball in a dark room to inspect the back of the cornea, and a pressure measuring device. Since I too have glaucoma, I had come to this appointment with a spectrum of expectation based on my experience: best-case scenario would be pressure-reducing drops, worst-case scenario would be an operation to fix the eye. But as it turns out, dogs are not humans.
Beel confirmed the glaucoma suspicion and diagnosed the eye to be blind, therefore useless to Pippa. Even worse news was the pressure: at 48mmHg it was off the charts. Pressure in canine eyes should be somewhere between 10mmHg and 25mmHg. Research suggests pressure between 25mmHg and 30mmHg causes some damage to the optic nerve, and above this it is painful due to the enlarged globe of the eye. Above 40mmHg the sphincter muscle (the circular muscle that functions as its constrictor to the pupil) becomes paralysed. Pippa’s reading was a hell of a headache – for both of us.
And then came the shock: this was beyond what glaucoma pressure-reducing drops can achieve. Drops can lower pressure at best by 20%, which would leave Pippa still with a continuous headache. The optical nerve was damaged beyond repair, and in any case canine ophthalmology is less advanced than the human equivalent. The solution was to remove the eye.
I had agreed with Beel to try the pressure drops anyway – we reasoned the worst they could do would be to not work. He assured me that no vet likes to remove an eye: “These kinds of operations feel like we lost the fight. But if the dog is better off without it, that’s what we should do. And they adjust tremendously well.”
On the way home I started crying uncontrollably. We were quite the sight on the tube home, with my face largely covered in blackened tears and mascara gunk, and Pippa’s white face discoloured by the yellow drops. But before we even got home, I decided we weren’t going to give up. I have clinical depression and anxiety attacks. Pippa is a street-smart rescue dog with a catalogue of ailments. Neither of us would be here if we were quitters. A quick online search recommended broccoli and increased exercise to reduce pressure, and salty foods were bad (who knew?).
Looking back, what was a I thinking? Broccoli and another round in the park don’t cure a blind eye. Nothing does. The drops achieved some success, in our case the difference between a terrible and a noticeable headache. Instead, it got worse and the drops quickly became something like a double-edged sword. Pippa got a small scratch on her lens, which can be created by something as tiny as a grain of sand flung up by a passing car. A healthy eye can heal itself quickly, but a glaucomatous eye is no longer capable of repairing itself. The drops, which can sting anyway, acted like salt on a wound, causing Pippa to flinch and yelp as soon as they covered the scratched lens. Back to the vet we went.
After this second appointment, our canine pharmacy grew with antibiotic drops to avoid the scratch becoming infected, plus a lubricant to make the eye more comfortable. Together with the pressure-reducing drops, I now held Pippa’s head to drip some chemical substance into her eye eight times a day. This was no life, but we were fighters.
Or were we? It dawned on me that with the scratch-problem Pippa’s beach and swimming days were over. But for a dog who may as well have been a seal in a past life this cut out her greatest joy. No matter how many limbs are hurting and eyes squinting, a whiff of sea air still sends her into a puppy-like frenzy. The decision came down to drops vs sea – and with that it was clear that she would be better off without the eye.
Since the pressure had stabilised, I decided to wait until after Christmas, another six weeks, when I would have had time to stay at home with her to help with the recovery. But the eye developed yet more complications: internal bleeding tinted the entire eye so red that the difference between the brown lens and the supposed ‘white’ was hardly visible anymore. On a bright day, the sunshine highlighted the problem so painfully that I cried every time I looked at her, and she was clearly depressed, closing her eye and her dropping her head. I made the appointment immediately. Pippa would spend her first Christmas as a one-eyed pirate.
The enucleation was a routine procedure for Beel, and Pippa indeed recovered tremendously well. The nurse took her for a tiny walk as soon as Pippa had woken up, and there was no discharge and no discomfort apart from the humiliating cone of shame. Medically, this was a success: the operation went well, the patient better than before, recovering fast.
Being a pirate
Fast forward a few months, Pippa the Pirate, as she was now known, did start to change. On the bright side, she had more energy again, occasionally running with her friends or me in the park and playing furiously with her toys at home. But over the weeks, her confidence received a few knocks: jumping on the bed became taxing, anyone approaching from the wrong side startling, and strangers meeting us in the street started to react more often with pitying rather than adoring utterances – and she seems to understand the difference.
One of the most upsetting changes to me has been the reaction by children. I spoke to our young friends, aged between two and five, ahead of Pippa’s operation to ensure them she would be happy and still up for a lot of cuddles. But I didn’t realise that a child coming up to her from the wrong side can frighten her, so an attempted hug can scare her into growling at the hugger. This has caused some tears.
And in the street, kids who don’t know Pippa have on occasion been scared as soon as they realised she only has one eye. They would pull their arms and bodies back as if she had the plague. One boy even ran off to his dad, screaming.
That old soul
Pippa’s spirit is still alive – I am certain of that, but it is changing. Hellenistic philosopher and Stoic Hierocles conjured a wonderful image of the soul that it lives in the heart and constantly stretches out its tentacles and relaxes them to make impressions on all the body parts and receiving impressions in return. This is the equivalent of the animal perceiving itself.
But with one sensory organ down, what happens now? Does the soul receive less information about life, or does it redirect its tentacles? Behaviourlists often argue that the sense of smell becomes stronger in one-eyed dogs. Pippa certainly sniffs more, but it doesn’t replace sight, no matter how unimportant sight is for dogs in the first place. Even a bad eye can detect the shadow of an approaching body or an obstacle in its way. A heightened sense of smell is also useless when trying to jump on furniture, and if a small person doesn’t approach her from the front, smells may not enter her nose fast enough. The set-backs since the loss of vision cannot wholly be made up by a keener nose, so will the soul eventually retreat from the outside world?
I believe bodies need to be whole. I never had an invasive operation, and the only thing missing from my body are two wisdom teeth. But having witnessed many battles with life-threatening diseases that included invasive surgery and loss of parts, I know the soul changes afterwards. Some people become bitter, some fighters, and serious diseases always marks a patient’s face. Bodies may adjust, but the soul is never the same.
For us, there won’t be bitterness, but a commitment to keep the soul excited about the world. Pips is now allowed in the bath tub and started splashing around and chasing bubbles (for hours, if I’d let her). She has also developed a new-found adoration for younger boy-dogs, and her selective hearing is better than ever.
Pippa, it seems, is on team Hierocles. Dogs are excellent Stoics, taking life in their stride and being happy with little. She prefers to walk on the lead and trusts me to look out for obstacles. She also appreciates the personal service I provide now by carrying her to bed in the evening. Pippa is happier without the headache, there is no doubt, but the soul takes time to adjust.