On Sunday afternoon, the day I wrote my last post where Del had regained his vision, he went outside for a few hours, and when he came back, his vision had worsened again and his pupils were dilated. Another confusing thing for us. Now, we questioned just how much the visits to the vets, and what was administered there, had caused the sudden blindness.
We took him back to the vet yesterday morning, having not given him any metacam or pred eye drops since Friday, because we were thinking we would change onto oral steroids instead. The vet said she was a bit surprised that he seemed so pain-free, having not had anything for pain relief. We talked about the blindness, discussed the various risks associated with the different treatments. I shared my concerns about metacam, the FDA warning, and the potential side-effects of the pred eye drops.
The vet said the same thing as you,
@Keit. That in her opinion, even though there are risks with any treatment, low doses of metacam in cats is relatively safe, and that she gives it to her own cats. Also, during the consultation, it did occur to me and my wife that the two occasions when he was really sick and we took him to the vets, and he came home blind... well, before we took him in, he basically hadn't moved for two days, and so if he had lost his eyesight, we wouldn't really have been able to tell. When he's at his worse, lethargic and not eating, he's not roaming around the house, and also, he keeps his eyelids half-closed. What we can say for sure in those times is that his eyes are very cloudy.
The vet explained, if I understand this correctly, that the cloudiness is antibodies produced by his immune system. And that the dilation of the pupils may just be his eyes trying to get more light, due to the fact that he can't see anything.
We talked more about toxo itself. The vet said that most of the times where she's diagnosed and treated it, it's actually been in dogs. This is due to the fact that dogs are not the main, end-host the toxo is designed for, and when it gets into them, it causes them a lot more symptomatic issues. She said it usually doesn't cause serious symptomatic issues in cats because biologically speaking, the toxo would want the host to be as well as possible so that it can carry on it's own life cycle. The vet was sharing this with us because the subject of treament plans and what is the long-term prognosis is something that she is inexperienced with and that she is also learning more as we go. I thought it showed strength on her part that rather than try to appear to be all-knowing, or reassure us without foundation, she admitted that she hadn't had much experience with the condition in cats.
Based on your feedback, Keit, and the discussion we had with the vet, we've decided to keep him on the metacam, and switched the eyedrops from the prednisolone to Acular, an NSAID. We're going to give the metacam once every two days, preventatively, and use the Acular when required. His vision seems pretty good yesterday and today. The cloudiness in his eyes is mostly gone again.
The vet is going to contact the lab to ask about what we need to do when he's finished the clindamycin, whether we should test for the toxo again. She says he may never get it out of his system, and has been forward enough with us in the last two consultations to bring up the subject of "quality of life"; as in, if he has the toxo forever, and his immune system continues to react to it forever, then that's going to be horrible for him. I asked about whether the idea of long-term immunosuppression is a viable treatment option, and she said obviously that would be something we could try with the oral steroids, but that in itself obviously comes with it's own potential problems.
To my knowledge, these two drugs are not supposed to lead to such a problem. At the same time uveitis is often the reason for blindness in cats.
