Eosinophilic keratitis and... birth control pills?

Hello,

My cat Roxy's eye has had some discoloration ever since she had a severe
infection back in February. I took her to the vet several times and
tried lots of different medications. The infection came under control,
but her eye has never gotten back to normal.

So this morning I brought her to an animal opthalmologist. He dilated
her pupils, looked inside her eye, and pronounced that she had
"eosinophilic keratitis". And then told me that the best treatment
for it was (human) birth control pills. WTF??? He gave me a print-out
about it, and the list of possible problems arising from taking the
pills was alarming. So I'm not too keen on giving that to her.

The other medication he suggested was an anti-herpes drug, which he
said would not help at all if she didn't have herpes. This cat is 9
years old and I've believed that she has herpes since she had a
positive result from an eye swab at 6 months old. She's been mostly pretty
healthy, except that she's more sneezy than most cats, and one of her
eyes (not the eosinophilic keratitis eye) has always drained down her
nose, probably from scarring of the tear duct during a bad URI when
she was a kitten.

Anyway, this doctor doesn't believe she has herpes, but because (from
his point of view) "it's a possibility", he wanted to cover all the
bases. The main treatment, according to him, is the birth control pills.
But I decided to take a conservative approach and try the herpes drops
first. So I'm going to give those to her for two weeks. If those clear
up her eye, then (1) I'll know for sure that she does have herpes, and
(2) she won't need the birth control pills. If it doesn't clear up, then
I agreed to try the pills in two weeks, but I am pretty nervous about
it. I mean, *I* wasn't even willing to take them myself, back when such
things were necessary. Of course, Roxy would get a much smaller dose
than a grown woman would get, but I'm still leery of it.

Has anyone here done this, or heard of it? Pros and cons? Other approaches
for dealing with the keratitis?

The vet seemed like a typical doctor who is not used to being questioned.
He was a bit arrogant (eg, he completely dismissed Lysine as a treatment
for herpes, and he was 100% certain of his diagnosis after a short exam).
He also seems to be completely invested in the Western medical model, and
not open to other approaches. I mean, he wasn't horrible, he did respect
my decision to try the anti-herpes drops first, but he implied that in two
weeks, I would be getting a bag of the b.c. pills.

Anyway, feedback, suggestions, pointers to good reading, etc, would be
appreciated!

Thanks,
Joyce

On Mon 18 Jun 2007 09:37:07p, wrote in rec.pets.cats.health+behav
:

The vet seemed like a typical doctor who is not used to being
questioned. He was a bit arrogant (eg, he completely dismissed
Lysine as a treatment for herpes, and he was 100% certain of his
diagnosis after a short exam).

You seem to be concerned about both the diagnosis and his choice of
treatment, so if I were in your shoes I would get another opinion.
Eyes are not something to mess around with. And any vet who
doesn't believe that Lysine will help with herpes symptoms is not
one I would put my trust in. I've seen it happen. Of course Roxy's
problem may or may not be herpes, but to dismiss it as a herpes
treatment puts up a red flag in my mind.

He also seems to be completely
invested in the Western medical model, and not open to other
approaches. I mean, he wasn't horrible, he did respect my
decision to try the anti-herpes drops first, but he implied that
in two weeks, I would be getting a bag of the b.c. pills.


What are the drops? From what I've been told, anti-viral drops are
mega expensive and some vets don't even stock them. What did he
sell you?

--
Cheryl

on Tue, 19 Jun 2007 01:37:07 GMT, wrote:

My cat Roxy's eye has had some discoloration ever since she had a
severe infection back in February. I took her to the vet several times
and tried lots of different medications. The infection came under
control, but her eye has never gotten back to normal.

So this morning I brought her to an animal opthalmologist. He dilated
her pupils, looked inside her eye, and pronounced that she had
"eosinophilic keratitis". And then told me that the best treatment
for it was (human) birth control pills. WTF??? He gave me a print-out
about it, and the list of possible problems arising from taking the
pills was alarming. So I'm not too keen on giving that to her.

I don't blame you. Human birth control pills have powerful hormones and
I would only try that as a last resort. Keep in mind, however, that I
have absolutely NO experience with this diagnosis. I just did a little
bit of reading and it appears from what I read that a postitive diagnosis
of Eosinophilic Keratitis cannot be made without a corneal scraping and
cytology. Did he do this? This could also be used to determine if Roxy
has Feline Herpesvirus Keratitis, which apparently is present in a third
of all cats diagnosed with Esosinophilip Keratitis according to the
articles I just skimmed. So he really can't rule out herpes without
further testing, or, IMO, determine what type of keratitis it really is.
Keep in mind that it could be both.

I would get a second opinion. One of the articles I read suggested that
topical steroids in the eye (eye drops that contain prednisone) in
gradually decreasing doseages may be effective long term. Since
Eosinophilic Keratitis is a granulomatous process (something I am VERY
familiar with), that makes sense. Did he even offer that as a suggested
course of treament?

The other medication he suggested was an anti-herpes drug, which he
said would not help at all if she didn't have herpes.

What drug is this? I have a 10 month old kitten with herpes who does
quite well on L-lysine (so far) but sometimes I worry that it may not be
enough and am interested in other options in case we ever need them.

snip

Anyway, feedback, suggestions, pointers to good reading, etc, would be
appreciated!

This doctor sounds like an ass. He may be right on with the diagnosis,
but I think he's behind the times with the treatment options. I'm also
very suspicious that he discounted herpes off the cuff as he did. It may
not be the primary disease process, but it sounds like it's probably part
of it.

My 3 year old is seeing an opthamologist Wednesday and I'm very nervous.
I hope he's not an ass, too!

How did Roxy do after being dilated? Did she also have to be sedated at
all for the exam? I have no idea what to expect.

--
Lynne

Cheryl wrote:

What are the drops? From what I've been told, anti-viral drops are
mega expensive and some vets don't even stock them. What did he
sell you?

Cidfovir. And you bet it was expensive - $70!!

Joyce

Lynne wrote:

I read that a postitive diagnosis
of Eosinophilic Keratitis cannot be made without a corneal scraping and
cytology. Did he do this?

No, but the regular vet at the animal hospital where I took her when the
outbreak was really bad did do it. And I had that hospital fax over all
their records of tests and treatments so the eye doctor wouldn't duplicate
any of their work. He got his diagnosis both from looking into her pupils,
once they were dilated, and reading the info in her chart.

This could also be used to determine if Roxy
has Feline Herpesvirus Keratitis, which apparently is present in a third
of all cats diagnosed with Esosinophilip Keratitis according to the
articles I just skimmed.

Yes, and that's the conservative estimate. It's controversial - another
study says it's 76%.

So he really can't rule out herpes without
further testing, or, IMO, determine what type of keratitis it really is.
Keep in mind that it could be both.

Good point. One thing I read was that if a cat has herpes and it's focused
mostly in one eye, the keratitis will appear in the *other* eye. I don't
know why that should be, but that is exactly what's happened with Roxy.
I noticed because I thought it was odd that she'd get this in her "good"
eye.

I would get a second opinion.

I just might. But visits to vet opthalmologists are also not cheap.
Today's visit cost $225 - including the office visit, some in-house
lab work, and very expensive medication.

One of the articles I read suggested that
topical steroids in the eye (eye drops that contain prednisone) in
gradually decreasing doseages may be effective long term.

If Roxy has herpes - which is what I've been assuming for 9 years -
then prednisone is a Very Bad Idea. Any suppression of her immune system
would give the virus free reign to break out.

If the anti-herpes med doesn't work, then I think I will insist on the
prednisone *drops* first - before going to systemic medication.

What drug is this?

I'm giving her Cidfovir. Apparently it's helpful for AIDS patients who
have CMV, among other things.

I have a 10 month old kitten with herpes who does
quite well on L-lysine (so far) but sometimes I worry that it may not be
enough and am interested in other options in case we ever need them.

I've heard too many good things about the lysine to dismiss it just
because some vet waves it away. I just think it's par for the course,
and I don't believe it means the doctor isn't a good doctor. It just
means he has a bias. Some doctors I've seen will sneer at any kind of
approach that isn't the straight Western pharmaceutical model. That's
their bias. (Maybe they've had too many nice dinners on Big Pharm's tab?)
It does mean they're limited, especially in terms of treatment - but
could still be a good diagnostician.

My 3 year old is seeing an opthamologist Wednesday and I'm very nervous.
I hope he's not an ass, too!

Me, too! It seems to be a common symptom of Specialist-itis.

How did Roxy do after being dilated? Did she also have to be sedated at
all for the exam? I have no idea what to expect.

She didn't need to be sedated. But Roxy is a pretty good-tempered kitty,
very patient, doesn't freak out too much. The dilation didn't seem to
affect her that much, although she certainly *looked* upset. (Big
black eyes.)

Good luck with your kitty's exam!
Joyce

on Tue, 19 Jun 2007 07:49:40 GMT, wrote:

If Roxy has herpes - which is what I've been assuming for 9 years -
then prednisone is a Very Bad Idea. Any suppression of her immune
system would give the virus free reign to break out.

Ah, I didn't even think of that. Very good point. It would likely only
cause it to break out in her eyes since opthamologic prednisolone barely
enters the bloodstream, but the eyes would be a very bad place for that
to happen.

If the anti-herpes med doesn't work, then I think I will insist on the
prednisone *drops* first - before going to systemic medication.

Yeah, it's such a Catch22... I hope the anti-herpes meds work. If it
doesn't help the eye with eosinophilic keratitis, don't be too hesitant
to try the pred drops. I read a little more and it seems to be a pretty
standard protocol even in cats with FHV. Also, be absolutely certain the
course is adequately long or it will not be effective. The best way to
attack inflamation in the eyes is with a full course of therapeutic doses
in the beginning which *very gradually* taper off.


I'm giving her Cidfovir. Apparently it's helpful for AIDS patients who
have CMV, among other things.

Interesting. I really hope it helps. Maybe supressing the FHV will allow
her body to fight the EK...?

I've heard too many good things about the lysine to dismiss it just
because some vet waves it away. I just think it's par for the course,
and I don't believe it means the doctor isn't a good doctor. It just
means he has a bias. Some doctors I've seen will sneer at any kind of
approach that isn't the straight Western pharmaceutical model. That's
their bias. (Maybe they've had too many nice dinners on Big Pharm's
tab?) It does mean they're limited, especially in terms of treatment -
but could still be a good diagnostician.

You are right, he could well be an excellent diagnostician. I just hope
he's not right about the best treatement.

She didn't need to be sedated. But Roxy is a pretty good-tempered
kitty, very patient, doesn't freak out too much. The dilation didn't
seem to affect her that much, although she certainly *looked* upset.
(Big black eyes.)

That's amazing--in a good way, of course! I have no idea how Rudy will
be, but figured it would be very stress inducing for a kitty to have his
or her eyes examined.

Good luck with your kitty's exam!

Thanks! I'm trimming his claws tonight. Just getting him into the
carrier should be 'interesting.' I feel less nervous after reading about
Roxy's visit, though. BTW, my dog's name is Roxy (short for Roxanne).
Good choice!

--
Lynne

Lynne wrote:

Interesting. I really hope it helps. Maybe supressing the FHV will
allow her body to fight the EK...?

That's what I was thinking.

Thanks! I'm trimming his claws tonight.

Good idea. I should have done that for Roxy's exam, but luckily it
turned out not to be necessary. She's usually cooperative, but if the vet
does the wrong thing, she will scratch.

Just getting him into the carrier should be 'interesting.'

Here's what I do - helps a *lot*:

- Turn the carrier on its end, with the opening facing up. Then go
get the cat.

- Lower the cat into the carrier, supporting his weight with one hand,
and grasping the scruff of his neck with the other. Grasping him by
the scruff of the neck will help to subdue him. (Don't carry him just
by the scruff of the neck, though.)

- As he gets lower into the carrier, you'll need to brush away the odd
front or back paw that's trying to block him from getting in. Do that
with the hand that supports the weight. Being held by the scruff of
the neck is uncomfortable, and definitely a bad thing for you to do
for any length of time, but I don't think it's bad when you've almost
got him into the carrier.

- When you have most of him inside, you can then give him a push down
and quickly close the door.

I feel less nervous after reading about Roxy's visit, though.

That's good!

BTW, my dog's name is Roxy (short for Roxanne). Good choice!

Thanks. My Roxy's name isn't short for anything. It's an evolution
from "Roswell" to "Rozzy" (which I hated) to "Roxy". Why Roswell?
Because when she was a kitten, she had a skinny little triangular
face with huge eyes, and she looked just like an X-Files alien. (I
dropped the "Roswell", though - she's too girly for that. )

Here she is, somewhere between 4-6 months old, with her "alien" face
(and, my god, those ears):

http://www.sonic.net/~jwermont/cats/...otos/roxy3.jpg

Here she is as an adult. (This was taken several years ago.):

http://www.sonic.net/~jwermont/cats/...xy_perfect.jpg

Joyce

on Tue, 19 Jun 2007 23:01:50 GMT, wrote:


Here's what I do - helps a *lot*:

Great advice, but I recently read here that if you wrap them in a towel,
you can get them in the carrier pretty easily. By the time they figure out
how to get out of the towel, they are in the carrier! I'm quite hopeful
this will work. Last time we went to the vet, I simply could not get him
in the carrier. He was loose in the car and wanted to sit on my head the
whole time.

Thanks. My Roxy's name isn't short for anything. It's an evolution
from "Roswell" to "Rozzy" (which I hated) to "Roxy". Why Roswell?
Because when she was a kitten, she had a skinny little triangular
face with huge eyes, and she looked just like an X-Files alien. (I
dropped the "Roswell", though - she's too girly for that. )

We actually named her Roxy, but it has evolved to Roxanne and Roxy Anne, as
well as a variety of other completely unrelated nick names.

Here she is, somewhere between 4-6 months old, with her "alien" face
(and, my god, those ears):

http://www.sonic.net/~jwermont/cats/...otos/roxy3.jpg

Here she is as an adult. (This was taken several years ago.):

http://www.sonic.net/~jwermont/cats/...xy_perfect.jpg

Oh, she's so pretty! I love her markings. Let us know how she does, will
you?

I'd share my photos, but Google's Picasa ate my albums and I haven't taken
the time to recreate them.

--
Lynne

On Tue 19 Jun 2007 03:49:40a, wrote in
rec.pets.cats.health+behav
:

How did Roxy do after being dilated? Did she also have to be
sedated at
all for the exam? I have no idea what to expect.

She didn't need to be sedated. But Roxy is a pretty
good-tempered kitty, very patient, doesn't freak out too much.
The dilation didn't seem to affect her that much, although she
certainly *looked* upset. (Big black eyes.)


Ah, I had to go through that today, too. Had the big black eyes,
too. Bad news (good news?) is that I have to quit smoking. Quit
smoking or risk going blind. I always thought smoking would cause
something lung related or death, but not blindness.

Purrs for the drops to help her and keep us updated!

--
Cheryl