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.

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.

What Annoys Jeff This Week?

Medical Experts. Watch the news long enough and you’re going to find out a few simple medical truths. Eggs are good for your or possibly bad for you. Coffee is good for your brain, but bad for your heart. Exercise keeps your cardiovascular system in tip top shape, but can damage your heart and skeletal system. Everything from radishes to ordinary tap water apparently causes cancer in mice. I think doctors are pretty good at the micro level of telling us what’s wrong with us individually, but I’m not sure they’ve got the sense God gave the common rooster when it comes to figuring anything out at the macro level. When it comes to what’s good or bad across an entire population, it doesn’t seem like they have a clue.

Jerry Sandusky. Hasn’t the news cycle moved far enough away from this that it’s not really a story anymore? Seriously, can’t a Kardashian get knocked up and spare us all from another three months of Jerry’s kid touching extravaganza?

Hopped-up Meth Heads Eating People. Zombie lore is clear on one point. The only immediately effective method of stopping a impending undead attack on your person is detaching the zombie’s head from its body. This is traditionally accomplished in one of two ways, using a shotgun or a two-handed long sword. In a pinch, a fire axe might also get the job done, but its sweet spot is much smaller than the other methods and is therefore not recommended except when other options are not available. As they did in the Wild West, the answer to the latest rash of face eating is clearly to deputize the citizenry, arm them with shotguns and long swords, and send them out to roam the streets to defend the living. At least this way, stories of the impending zombie apocalypse would reflect both sides of the ongoing battle between good and evil.

WaWa. Usually I can count on WaWa to sell me a pre-packaged salad, a bottle of water, and a bag of chips a couple of times a week. I’ve been in twice this week looking for lunch and both times their “salad chiller” was blowing hot air. Sure, lettuce and assorted other greens might stand up to that for a while, but diced ham and chicken will probably not respond quite as well. I watched a few people pick up a lukewarm salad and walk away happy enough with their decision, but there’s something about trusting glorified gas station attendants to know when a food item has gone off makes me more than a little nervous. I think I’m going to have to pass for a while. Keeping perishable items chilled doesn’t seem like it should be too much to ask.

Be sure to tune in tomorrow for the next installment of “From the Mailbag.”

Can’t stay away…

After what seems like an excessive amount of scanning, poking, prodding, and stressing, my faith in the marvel that is modern medical science, is somewhat less than complete. The good news is that there are no obvious signs of things that could cause me to suddenly drop dead. The bad news is that whatever it is that’s causing my head to occasionally explode remains as a diagnosis of “uhhh… we’re not really sure, but here’s some heavy duty pain meds to take in case it comes back.” Now I’m as big a believer in better living through chemistry as anyone around, I think It’d still rather know what it is than what it isn’t. Since that outcome is apparently a bridge too far, I’ll follow my other tried and true solution and try ignoring the problem until it goes away on its own.

… And now back to your regularly scheduled blogging hiatus.

Update…

OK, so it seems that the most likely culprit that sent me to the oral surgeon on Tuesday is some kind of infection. At least that’s the early diagnosis. The authoritative word will come back from the biopsy that he sliced out of the roof of my mouth… Yeah, and incidentally, if anyone every wants to take a hunk out of the roof of your mouth, I highly recommend looking for an alternative course of action.

A funny thing happened on the way to the emergency room…

OK, well maybe it wasn’t so much a funny thing as a ridiculously painful thing. After putzing around the yard most of the afternoon and busying myself shoving furniture around the living room, I noticed a dull ache that seemed to be centered around the bottom of my sternum. No big deal, thought I… I probably just pulled something heaving the couch into its new position. Grabbing a cold beverage and Tylenol, I started making dinner. Well, that lasted about 15 minutes before the pain started moving up and across my chest. Now, I’m not a fancy big city doctor, but I have a sneaking suspicion that this isn’t a good thing. After putting it off another ten or fifteen minutes, I knew it was time to go.

Having a bit of a “typical man” streak, I loaded the address of the local emergency room into my Garmin and set off. I certainly wasn’t in enough pain to justify calling an ambulance… Yet. It’s a quick drive to the ER, especially on a Sunday night, but when the waves of nausea set in, a 5 mile drive seems like it takes hours. Every stop light becomes a personal affront to my sense of order and well being. By this point, I really feel an overwhelming need to toss my cookies. Drawing up a reserve of determination not to spew all over my car’s interior, I drove on. By the time I get to the hospital, I was feeling more or less like someone was busy sticking me in the chest with an ice pick. It’s absolutely as much fun as it sounds.

After five hours of poking, prodding, having blood drawn, getting chest x-rays, EKGs, and meeting with 2 ER doctors, they decided that what I actually had was a bad case of acid reflux. There must be something to their diagnosis, as after giving me some ass-tasting meds and filling a prescription for Nexium, I was feeling much better. Although I’m feeling better and enjoying the unexpected day away from the office, now annoyed at the thought of what’s going to be a ridiculously large bill for a case of heartburn. I’m even more annoyed that I have to take more time off tomorrow to go visit my new “primary care” doc, who I was conveniently referred to by his friend running the ER. He’s supposed to be a specialist in stomach stuff and one of his partners is apparently a hot shot cardiac guy… so two birds with one stone, I suppose.