Good for the soul…

I’ve known for a while now that being a one dog household wasn’t going to suit me in the long run. I wanted to give some of the raw nerves time to settle, to adjust to life without Winston, and understand Maggie’s new health issues before charging off to fill that particular void. That was the right decision, of course. Bringing home a new dog in these few weeks of the year when work is at its most exhausting and when I’ve been a lot more emotionally fragile than I’d like to admit was a recipe for nothing good. For a moment in my life I’m exercising a rare modicum of patience.

I’m watching, though. Researching. Finding rescue organizations that sound like they won’t be too overbearing and intrusive to deal with. Weighing the pros and cons of puppies versus older dogs and trying to determine what might be the right fit when the time comes. I’d be lying by omission if I didn’t also admit to seeking out the bulldog breeders, too – even after swearing long ago that I’d never consider having another one. Despite the litany of known problems, the wrinkly little bastards have an undeniable charm to them.

I’m not quite ready yet. I want to get over the hump with the current Very Big Event so I’m going home closer to my baseline level of aggravated and annoyed rather than at an ampped up, spontaneous nose bleed level of seething rage with which I currently contend. I’m almost there – assuming I avoid having a stroke between now and the first Friday in May.

That’s the objective date I’ve set for myself to start looking in earnest – going beyond flicking through thumbnails on websites. Truth be told, knowing that the search for the next member of the pack is just over the horizon is probably what’s let me keep plugging away the last few weeks without completely slipping off the rails. As it turns out, even dogs that aren’t yours yet, purely notional dogs, are good for the soul.

Partial diagnostic credit…

After a morning road trip through some of Pennsylvania’s finest horse country and 30 minutes of abdominal scanning, it turns out that my regular vet had the diagnosis right, but gets only partial credit on the underlying cause. Still, I count that as exemplary work for a condition that presents as a shitload of things that don’t feel like they should really be logically related.

It turns out that Cushing’s is the correct diagnosis, but rather than a tumor of the adrenal glands, the glands themselves were “significantly” enlarge. In fact they’re currently 5 times bigger than they’re supposed to be and hammering out cortisol like its their full time job. Since we’ve ruled out an adrenal tumor, that basically leaves a growth on the pituitary glad as the last culprit standing.

In many ways, the adrenal tumor would have been easier to treat – open the abdomen, remove the tumor (and the accompanying gland), and the symptoms go away. It’s an invasive operation with good success if the dog survives surgery and the first week of recovery. The problem is that 30% of dogs that have this treatment don’t get past that first week. I’m a betting man, but when you’re looking at odds of one in three chambers having a live round, I’d have an awfully hard time pulling the trigger.

I’m waiting now for my regular vet to get the report and work up the treatment plan. My best estimate is that it will be to treat with daily medication to reduce the amount of cortisol being made rather than something surgical. My reading shows that surgery for pituitary-involved Cushing’s is possible, though exceedingly rare for dogs. What this really means for Maggie is she’s likely going to have to take some fairly high powered pills twice a day for the rest of her life. There’s going to be more home monitoring and increased testing at the vet to confirm that everything is working normally. Basically it’s nothing that life with a bulldog didn’t prepare me to deal with already.

There’s a catch, of course. Without dragging her back to the specialists and ordering up an MRI of her brain, there’s no absolute way to know if this tumor is benign or malignant. Research says the large majority of pituitary tumors in dogs are benign. With an average canine MRI running into several thousands of dollars, I’m inclined to let the odds dictate our response on this one. If it turns out to be something more aggressive, the options I’m willing to pursue decrease fairly dramatically anyway.

The prognosis for all of us is the same in the long run, so there’s very little advantage to be found in trying to plan against it. With all that said, I’m cautiously optimistic that we can strike on a way ahead that maintains or improves the brown dog’s quality of life in the short and may even mid-term.

Specialists…

I’m old enough to remember taking the family dog to a vet who ran his practice out of a converted shed in his back yard. Treatment for most any ailment was a shot of antibiotics and a bland diet – his weapon of choice was boiled hamburger and rice. It was the middle 1980s and the very notion, at least in the mountains of western Maryland, that there should be anything remotely like a “specialty” vet didn’t cross any of our minds. Dogs got their rabies shot every 3rd year, ate table scraps mixed with their dry food, and all lasted for somewhere between 8 and 10 years.

Flash forward 30 years…

My bulldog, being typical of his breed, assembled an impressive roster of medical professionals on his “healthcare team.” Cardiologists, allergists, orthopedic surgeons, and anesthesiologists over the course of treating his many various conditions. My labrador, now into old age herself, has already acquired a opthmologist. In the coming weeks it’s likely we’ll add a radiologist, an oncologist, and a general surgeon to her list.

Veterinary medicine as it exists today – with the ability to diagnose and treat the family dog in a remarkably similar way to how how I’d be treated if I walked through the doors at Hopkins with the same symptoms – is a marvel. It’s also a money making juggernaught, but that’s a separate discussion. The practice I’m taking Maggie to this week in hopes of working up a final diagnosis and beginning outline of a treatment plan includes easily a thousand or more years of combined experience in emergency medicine, cardiology, dentistry, dermatology, radiology, neurology, oncology, and ophthalmology, in addition to maintaining six surgeons on staff. Their posted resumes are suitably impressive (yes, I’ve read them all). I’m cautiously optimistic that all this will translate into identifying what the best options look like for the road ahead.

I’m walking into this week with just enough knowledge based on internet deep diving and journal article reading to hopefully ask reasonably informed questions. I’ll be counting on this bunch to know the line between what science can do and what science should do. Don’t get me wrong here, I’m thankful that the state of the art has grown beyond crate rest along with boiled hamburger and rice, but there’s more than a little bit of me that misses simple, country diagnostics and treatment – and its inherent acceptance that the power of medical science to extend life has, and should have, logical limitations.


Diagnosis…

After several rounds of testing, we have a preliminary diagnosis for Maggie of adrenal-based Cushing’s disease. Not being a vet, but being one hell of a good researcher, I won’t attempt to explain exactly what Cushing’s is beyond the fact that it’s a disorder likely being caused by a small tumor located on the adrenal gland that’s making her cortisol levels to go wonky and producing a host of potential symptoms.

In Maggie’s case, the symptoms include excessive thirst / drinking and the accompanying excessive urination, hair loss, and general weakness. At this stage, the disease doesn’t make her feel bad or cause any pain. Based on my observation she’s giving absolutely no indication that she even knows she’s sick. The primary treatment, should it prove to be adrenal-based, seems to be surgical removal, although there are some non-invasive options based on my cursory reading.

I won’t dwell on details at this point, frankly because I don’t have many real details to dwell on yet regarding Maggie’s particular diagnosis. Next week, we’ll be taking a bit of a road trip to a specialty vet who will do an ultrasound to visualize the suspect area and, hopefully, confirm a diagnosis so we can identify the appropriate course of treatment.

I’m already racking up a list of research I need to do between now and then – the success rates of the surgery in question, post surgical life expectancy, impacts on quality of life, and so on. I’ll also have to take a long hard look at my personal ethics with regard to invasive surgery for a dog that by any standard definition has already reached into the “old age” range. Believe me when I tell you it’s times like this when I hate being an analyst by professional and disposition. It’s one of the rare moments when being dumb and happy would appear to be a blessing.

The research and worry is all for a bit later though. Right now it’s Friday evening and I have a happy and contented, if not exactly healthy, dog sitting next to me wanting undivided attention. Tending to that feels like it’ll probably be the most productive and cathartic thing I’ve done all day.

Vetting or: The tale of a sick labrador…

Over the years I’d grown so accustomed to having one sick dog and one well that last month I even noted my budget had gone wonky from the unusual lack of vet bills. You’d think by now I’d know better than to open my electronic mouth and temp drawing the wrath of whatever from high atop the thing. If you thought that, of course, you would be wrong. My mouth has been, is, and seems likely to continue to be my worst enemy.

After a few incidents and observations over the last week or two, what I seem to have now is just one sick dog. Not falling over, edge of the mortal coil sick, but sufficiently sick that we’ve already run two diagnostic panels in as many days and scheduled the next – which promises to be an all day affair for my sweet brown dog later this week.

It’s one of those times when I’m ill served by having a professional and personal bent towards research and analysis – particularly as there’s absolutely nothing I can do about the situation until we strike on a test that does something more than confirm some of the possibilities. Just now we’re tracking it as potentially a kidney issue or a liver issue or the wildcard diagnosis of Cushings disease.

I’m told by those in a position to know such things that all of these are treatable – at least in the sense that it’s often possible to slow down the degenerative processes involved. Time, however, is a remorseless bitch and treatable does not mean “curative.” That at some point everything that’s alive will eventually be not alive is pretty much just one of the rules of nature. Even the best care simply prolongs the inevitable for all of us.

Maggie isn’t in pain. She’s her normal, happy labrador self. That’s something. Personally I’ll feel better when we have an enemy I can fight on her behalf, but for now I’m trying to be calm and contented in giving her endless chin rubs and maximum attention.

The final details…

I can’t say enough good things about the people who helped facilitate the post mortem “care and feeding” for my boy over the last few weeks. From the staff at VCA Glasgow to the Delaware Pet Crematorium, the were absolutely professionals who went above and beyond to treat a simple dog like the entirely beloved member of the family that he was.

I’ve never intended to have human children. I still don’t. Despite enormous societal pressure to the contrary, these furry creatures who share my home are in many ways the family I’ve selected for myself. In life, and in death, I begrudge them nothing.

I was able to bring Winston’s ashes almost two weeks ago. They were returned in a cloth covered box that for most things would have been entirely fitting. After living with it for a few days, though, I knew there needed to be something more substantial – something more in keeping with Winston’s room sized personality. This good and loyal dog needed a more fitting monument.

Although I couldn’t raise a Lincoln-sized memorial, I was able to find what I feel like is a fitting final vessel. This past Friday evening I made the transfer from one to the other, adding in a few small tokens that rather laughingly made me feel like I was interring a pharaoh rather than “just a dog.” That, too, felt fitting.

So now, Winston’s earthly remains rest in the only place I could think of as fitting for him – among and alongside my most treasured possessions, my books. We’re all slowly getting use to the new normal here, but it’s been awfully nice to have this final detail sorted and in place to help mark that change.

A final gift…

For most of last week I wasn’t fit for service. Sure, I managed to feed and bathe myself and tend to the life, health, and safety requirements for Maggie, Hershel, and George, but otherwise I was lost in the tall grass. If I had needed to submit a readiness report, it would have read “not mission capable.” Anything that wasn’t essential just got left on the side of the road.

I don’t handle grief well. I don’t suppose most people do. My approach is almost universally to put my head down and grind through whatever the situation is in low gear. I doubt that my psychologist friends would call it a particularly healthy coping strategy, but it’s what I do. Drawing inward, circling the wagons, defending the keep – call it what you will, but history tells me that it’s what works to get me through to the other side of any individual crisis of the moment. 

Consequently to all that, most of the administrative minutia of life stayed on the wayside until I was better able to get and keep my head “in the game” as it were. That means this week I’m just now starting to pick back up with the business of keeping the household running smoothly – groceries, laundry, and cleaning. It was also time to check in on the administrator’s panel for the blog and pay some fees, and tend to the minor details that keep my small part of the internet up and running.

It was in checking the back office side of the blog that I discovered one last gift that Winston gave me. Without me knowing it, my tribute post to a good and faithful dog rocketed into first place as the single most viewed post in the nine year history of this blog. In fact it didn’t quite double the previous “most viewed” record, but it came awfully close. It turns out the internet isn’t always the dumpster fire we make it out to be. Every now and then its collective users can find a way to leave even the most jaded among us more than a little bit surprised with their generous spirit and kind support.

Winston raised the bar on me while I wasn’t paying attention. If I never write another thing to exceed that mark, I’ll be more than happy with the result.