Another vetting…

Yesterday Maggie and I swung by the vet so they could pull another urine sample. I’m expecting the culture to tell us one of two things: 1) Maggie’s UTI has cleared and the infection wasn’t what has been causing her wildly increased drinking and peeing or 2) Six weeks of progressively more aggressive antibiotics have failed to overcome the infection.

If it’s the former, the consulting internal medicine doc we saw last month has already proposed a preliminary course of action based on treatment to roll back a worsening of Cushing’s symptoms that isn’t indicated by the basic test of cortisol levels. I expect at least another trip to Malvern if that’s the result. If it’s the latter, well, we’ll have to see what’s left in the options box if this particular infection is truly uncontrollable with antibiotics.

I’m in the rather odd position of actively hoping that her Cushing’s has gotten worse. It’s at least the enemy I know – one that we’ve had good success wrestling into an uneasy truce if not submission over the last couple of years. It’s at least a fighting chance for some improvement. The same doesn’t seem to be true if we’re dealing with an unchecked infection.

There’s not much to do now until we see what we’re dealing with. It’s one of those rare times when I wish I was just a little more low strung and zen.

Because common treatments just won’t do…

Good news: After almost three months of flailing around trying to sort out why a certain elderly chocolate lab is drinking approximately 87 gallons of water a day, we have a preliminary diagnosis and presumed way ahead. Her most recent culture came back from the boffins and they confirmed that she was dealing with a bladder infection (although that diagnosis doesn’t completely rule out needing to eventually reevaluate how we’re treating her for Cushing’s). 

Bad news: According to the vet, the strain of bacteria we’re after is “extremely resistant” to almost all antibiotics. 

So, in the finest tradition of every dog I’ve ever had, we’re tipping into the more exotic options because the common treatments just won’t do. The antibiotic the doc thinks she’ll respond to is no longer on the market – or at least not produced in quantity for human consumption. Apparently when used in humans it has a bit of an unfortunate side effect of screwing with our bone marrow. The vet encouragingly warned that I should “definitely wear rubber gloves when handling that stuff.” That’s comforting.

Since the drug we need isn’t mass produced, Maggie’s vet very helpfully called the prescription into a local compounding pharmacy so they can whip up the 84 pill, two-week course of treatment. As troubled a medical history as I saw living with a bulldog, this is the first time I’ve ever needed to hire our own pharmacy. You’ll forgive me if I still question the reason of people who like having new experiences. Like this, they often feel like opportunities I’d be perfectly happy to avoid. 

I did talk to the pharmacy yesterday afternoon. They wisely wanted payment before they start mixing up whatever witches brew they’re working on. I suspect their business is one people appreciate up front, but blanch at patronizing when the bill comes due. Better for everyone this way.

I begrudge these animals nothing, but there are many days when I can’t help but consider how lucky we are in this household that there are no college funds to raise, daughters who will eventually want to get married, or anyone buying designer clothes.

Breaking up… sort of…

I did it. I told our current vet that although I’ve been happy with their service, I’m leaving to pursue less expensive basic medical care for two of the three furry little hooligans who share my house. Maggie will be staying put for the time being. With her thickening medical record and established relationship with the primary doc and specialists, I don’t want to rock that particular boat by reading someone new into the project at this late stage. George, of course, gets his own once a year trip to the local exotic vet practice.

Jorah is due for his annual checkup and vaccinations in a few weeks, so there wasn’t much room to put off decisions any longer. Thanks to the internet, I think I have our new vet (or vets, plural, since they’re a multi-person practice) picked out. It’s still a twenty-five-minute drive (but what isn’t when you decide to live in the middle of nowhere). Their online reviews seem impressive enough. They have on-site hydrotherapy, which is nice if I ever need to go that route again. They also have offer self-contained boarding, day care and grooming. I’m not altogether a fan of boarding, and it’s been a rare enough event that I’ve ever had to leave a critter behind, but I appreciate having the option bolted on to the medical facility.

If I’m 100% honest, I’m not sure this place will be much cheaper than where we’re leaving. They’ve got a whole lot of infrastructure that needs to be paid for and kept up. It’s definitely not the old-fashioned country vet I thought I wanted for them. What it does have, beyond the obvious, is the virtue of being open for 12 hours on weekdays and 10 hours on both Saturday and Sunday.  That’s the kind of thing that could save a guy at least a couple of emergency vet visits over the course of an average pet lifetime. I’m probably willing to pay a little bit of a premium for that… so we’re going to give this outfit a test run starting in July and see how it goes.

Schlepping across Pennsylvania…

Almost two months ago I noticed that Maggie had started drinking approximately an Olympic sized swimming pool’s volume of water every day. I assumed it was a return of some of the symptoms that led us to her Cushing’s diagnosis. Several rounds of testing more or less proved that wasn’t the case. Her Cushing’s remains controlled, but there was bacterial growth in her urine sample – diagnosis: urinary tract or kidney infection.

After the first week of antibiotics there wasn’t much improvement, so they changed up the prescription to something a little more powerful. Two weeks of that showed some vague signs of at least getting her seemingly endless thirst under control. We’re almost through the second two-week round of antibiotics – for a total of five weeks under treatment.

Overall, she seems far better than she was two months ago. She’s not draining off a gallon of water every time I refill the bowl. She’s not struggling to get her feet under her to stand up and her back legs aren’t apt to fall out from under her every time she tries making a turn on an even remotely slick floor.

When we were in the worst of it, I scheduled an appointment with an internal medicine specialist – basically what I expected was a hail Mary play to find out if there was anything that the rest of us had missed and provide a fresh set of eyes to look over an increasingly thick medical record.

Having a dog that drinks non-stop in and of itself isn’t a huge deal when I’m mostly working from home. All that water has to end up somewhere, but it’s not hard to open the door every hour or two or even to get up in the middle of the night for a trip outside. Starting back to work in the office on a more regular basis created a bit of an issue. As much of a dog lover as I am, living with a critter that can’t help but pee all over the house or whatever room you’ve tried to waterproof isn’t a realistic option… and have you even looked at what getting a dog walked two or three times a day would cost?

I kept the appointment with internal medicine – knowing that if I cancelled and there was any backsliding, it would take a month or longer to get another appointment. I still want a set of fresh eyes to give her the once over and either confirm that we’re getting after the right problem or find out if there’s anything that can reasonably be done to coax a little more quality of life out of the situation. Maybe it’s overkill for a 13-year-old lab, but it’s why I went schlepping across Pennsylvania today.

A rare moment of indecisiveness…

I’ll admit that a decade ago I picked the vet whose office location was the most convenient. I was just back to Maryland with a bulldog who at least once a month seemed to need to go to the vet immediately. Their office being between five and seven minutes from the house was a much appreciated convenience.

That office closed a few years ago and folded many of their clients, myself included, into their sister facility twenty-five minutes away. We’ve gotten good service there and I like my regular vet and the staff, but their fees tend towards eyewatering territory on a pretty regular basis.

I’m leaning towards transitioning the two youngest members of the household over to a different vet – one that’s still locally owned and operated (and presumably with lower costs for basic veterinary care). With Maggie’s long and complex history over the last several years, though, I expect to keep her with people who know the full back story until we’ve played that hand all the way through.

Part of the reason I liked the big corporate chain vet in the first place was having ready access to emergency and specialists “in the family.” With a host of them now sprung up within reasonable driving distance, I’m not sure that’s the selling point it was then. It feels likely that nothing more than the inertia of dealing with a known quantity is what really kept us where we’ve been this long.

Or not. I’m currently feeling mightily indecisive… and since a decision isn’t needed right the hell now, I’ll probably continue to dither for a bit yet.

Sleeping arrangements…

Maggie slept on my bed at night for most of her adult life until fairly recently. Usually over the course of the night she’d find her way to the floor and sometimes fine her way bac to the bed sometime in the early hours of the morning. A few times I’ve had to lift her up since her days of making the jump on her own seem to be over. In the last couple of months, she’s opted to stay put at floor level. I suspect getting herself back down for a late-night patrol was getting to be as hard on her joints as jumping up to the bed was. 

I’ve offered up steps and ramps, but even when lured with treats she doesn’t seem to have an interest. I’m not going to force the issue, so I suppose this is just the new normal night time arrangement. 

As much as I don’t miss the nightly barrage of dog breath and farting, there’s definitely part of me that misses the convoluted positions I’d need to get myself into so she could sprawl. I miss the regular head butts requesting a few more ear scratches before sleep came on.

Everyone trips over themselves to post cute puppy pictures and talk about the challenges housebreaking and training. Not many talk about the unique and often more trying experiences of making home comfortable for an aging dog. I guess those posts don’t translate as well to social media. They certainly don’t garner as many awws and likes. I have to think if more people did have those discussions, it would help an awful lot of people be better prepared for some of the harder moments of pet ownership. 

Nobody expects…

Maggie’s test results were not what either her doctor or I were expecting. We were both more or less convinced that her Cushing’s had advanced a bit and her meds would need to be dialed in a bit to correct for that. What two days worth of testing showed, though, was that her Cushing’s is well controlled and those numbers are almost exactly where they were a year ago.

Her tests did reveal a higher than expected number of white blood cells in her urine sample. The cause, ultimately, is unknown… but we’re treating it as a persistent, low grade urinary tract infection since that’s the most likely suspect. Maybe we’re on to something, because she has perked up a bit since we started her on mountains of antibiotics twice a day. Nobody expects the Spanish Inquisition, I suppose.

My poor old girl is still drinking copious amounts of water – maybe slightly less than a week ago – but she’s getting a round a bit better so for now I’m willing to call this at least a temporary win. We’ll see how things look in two weeks when the last of the pills runs out and we’re back to her normal maintenance meds.

This is definitely one of those times where I’m exceedingly happy I never had an interest in having kids… their basic care and feeding, wanting to go to college, or getting married would have eaten into my “Medical Care, Veterinary” annual budget line to an unacceptable degree.

Sickly or otherwise…

I dropped my dear, sweet, elderly chocolate lab off for her next round of tests this morning. A series of x-rays shows that the swelling in her front leg is almost certainly a very large and somewhat inexplicable hygroma – basically her leg holding a whole lot of fluid. It seems to be disappearing as quickly as it came on. It’s looking far better this morning than it did on Friday afternoon.

The other test for today, the ACHT stimulation test, should optimally confirm what we suspect – that her body has built up a tolerance to the current dosage of Vetoryl that’s been holding the symptoms of Cushing’s at bay for the last year or so. If that’s the case, we should be able to adjust the dosage upwards and buy her some more time. That’s what passes for a best-case result with her these days.

At almost 13, fighting this kind of rear-guard action is probably as much as we can hope for. How it ends, of course, is inevitable for all of us, but as long as she’s in control of her mental and physical capacities – and not in pain – I’ll clear the decks to give her the quality life that she’s earned from our long years together.

Maggie is the kind of happy go lucky dog that will follow anyone anywhere. Hand over her leash and off she’ll go. Normally she goes without so much as a second look. This morning, while the tech was leading her back the hall to her room for the morning, my girl gave me a look over her shoulder, making sure I was still there. My breath caught and in that brief moment, I had “all the feels” watching her disappear into the back room.

I haven’t always been that maudlin. I suspect the endless flow of years continues to give me an enhanced perspective on just how quickly things can change regardless of how much time, money, or expertise you pour out. 

We should have results from the stim test tomorrow. For now, sickly or otherwise, I’m just awfully happy to have her home.

On the day after…

Maggie has been home from her adventure at the emergency vet’s office for a little more than 24 hours now. She’s sleepy after a day of being poked and prodded on top of not feeling well – and I think she wishes Jorah would leave her alone to rest quietly, but she’s even putting up with his periodic efforts to annoy her. I think she’s reached the point in her recovery where the biggest issue is her obvious disgust at how little boiled chicken and rice is put in her bowl at meal time. 

After loads of bloodwork, a few x-rays, and plenty of diagnostic back and forth with the vets, it seems the final reason for violent sickness is going to be “unknown.” Off the record, both the vets and I agree that the most likely cause is having found and devoured something tasty, but moderately toxic while patrolling the yard. If you’ve ever had the opportunity to live with a Labrador, you’ll understand that “she probably ate something” is a perfectly reasonable rationale for illness. 

I never rest well when any of these fuzzy little bastards is sick, so hopefully this one is well and truly on the mend… again.

Going around the clock…

The last time saw all 24 hours on the clock would probably have been the stretch between June 9th and 10th in 2004. That night I waited in a line that eventually snaked halfway to the Washington Monument for the chance to slowly shuffle through the Capitol rotunda and pay my respects to Ronald Reagan. That night, I got in line around 8 PM and came down the west steps of the Capitol just as the sun was starting to come up. I got back to my apartment in Columbia around 7:30 that morning and promptly collapsed on the couch, staying there until after noon. It was a long day.

Today was another one of those long days. It started with frantic cleaning and the realization that the resident Labrador was getting sick faster than I could clean up after her. Then a high speed drive across northern Delaware to the new and improved emergency vet (followed by an attempt to clean whatever the tarp didn’t contain during our trip. Then two hours of waiting in the parking lot while the medicos made their preliminary evaluation and we reached collective agreement that she’d be better off with some professional oversight if only for the next half a day. I managed to get home at just about the time I’d usually be getting out of bed. Of course, trash needed emptied – because my God, the smell – and a mop run over things on more time before even thinking about laying down.

I tried to sleep. I really wanted to. I think between fits and starts I probably snuck in an hour or maybe 90 minutes of shut eye, but the habit of being awake in the early hours of the morning proved to be too strong to dispense with in just one night. So here I am, blurry eyed, fueled by caffeine, and trying hard now to stay awake in the hopes that tonight everything will get back on schedule.

How well that sought after night of rest comes to pass depends almost entirely on the always temperamental gastrointestinal tract of a certain, recently troublesome, chocolate Labrador.

Wish us luck.