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?

1. Data mining. Every time I start thinking that data mining is becoming too invasive and privacy becoming too fragile, the interent reminds me that it’s still pretty far away from going Skynet and killing us all. You see, I know this because companies that specialize mining “big data” keep feeding me ads about how to find and finance the “perfect engagement ring.” I’ll admit to having a passing interest in gemstones, but I can’t claim a need or interest in actually buying them. I have neither the inclination or reason to do so… and I’ve never once searched the internet for one. The cloud might know our reading tastes and hold the secrets to our collective perversions in our search results, but in many ways it doesn’t feel like the interent knows me at all.

2. Domestic enemies. All newly hatched federal employees take an oath of office. The one I took isn’t too far different from the one taken by a typical Army officer or even the one sworn by members of Congress. Unless I missed an unprinted annex or codicil, though, my oath to support and defend the Constitution didn’t include an oath of poverty and it certainly wasn’t an oath of unpaid servitude. That there are near on 400,000 people who swore an oath to support and defend the Constitution against enemies foreign and domestic currently fulfilling their oath without pay is an embarrassment – made all the worse because each day they bring back more an more “unpaid help” in order to avoid inconveniencing anyone. Excuse me? It seems that if you’re going to have a shut down of something the whole point is to make it as inconvenient and painful as possible. And these twatwaffels are sure as blue hell “inconveniencing” the people they expect to pay out of their own pockets for the privilege of coming to work. I blame President Trump. I blame the leadership in both the House and the Senate. I blame every single member of Congress who uses this as an opportunity to grandstand. And I increasingly think I know who the “domestic” enemies are that our oath featured so prominently. 

3. Blood. Blood as a rule doesn’t bother me. I can see people bleeding and not flinch. The rivers could run thick with the stuff and I’m not sure I’d notice… but let me be strapped into a chair at the local doctor’s office and have someone start sucking vials of my own precious life-sustaining fluid from my veins and I’m apt to go all cross-eyed and pasty. I just feel like medical science should do us a favor and step beyond the age of leeches here.

What Annoys Jeff this Week?

1. Second Monday. Look, I’m 100% thankful for the unscheduled Federal holiday on Wednesday. The unintended consequence of this Executive Branch largess, though, was that this week had what is effectively a “second Monday.” Going back the the work after a bureaucracy-free and relaxing weekend is a regular, recurring minor trauma that fills Sunday evenings with angst and dread. Once the week gets going though, the follow-on weekdays are each slightly less traumatic than the day before. Plopping an unexpected day off down in the middle of the week created an unnatural imbalance in the normal flow – and in doing so made Second Monday feel even worse than regular Monday. It’s hard to believe that such a thing is possible, but there it is.

2. Cubicle Hell. For all of the wonderful management literature written extolling the virtues of “open concept” workplaces, none of them bother to take into account how the average employee may actually require some time to analyze, read, or complete a work product that requires some level of concentration. I only bring it up because of the increased frequency of people holding entire goddamned meetings with groups of 4-5 others spilling out into walkways or shouted over the top of adjacent walls. Multiply that by as many as 5 of these impromptu “meetings” fired up all at the same time, well, you might as well sit back and start counting ceiling tiles because even pretending to look productive under the circumstances is a lost cause.

3. The human tailbone. I’m not a fancy big city doctor, so I don’t know exactly what a tailbone is supposed to do for a person. I reckon it’s mostly like an appendix – except that when something goes wrong with it it doesn’t burst and kill you so much as it stays right where it is and hurts like a sonofabitch whenever you sit down. In any case, it seems to me that there should be some kind of corrective option beyond, well, just don’t sit so much. That’s fine advice, I suppose, when your day isn’t spent tethered to a desk and reading  volumes of fine print for the minutia that someone is trying to bury in the fine print. And yes, before someone points it out, I know that Churchill worked at a standing desk. He also worked in the bathtub and I am, clearly, no Winston Churchill. 

What Annoys Jeff this Week?

1. Stomach. My stomach has been trying to kill me off and on for the last few days. It’s not debilitating or preventing me from getting on with my day, but it’s made food something of a dice roll, meaning that I traipse through the day mostly hungry in order to avoid workday unpleasantness as much as possible. Of course continuing to pour coffee down my throat probably is doing nothing to mitigate the issue. Realistically, though, if I’m going to be hungry also having me uncaffeinated feels like it’s just asking for more trouble than we’re trying to avoid.

2. Perceived time. We humans have a bit of an odd relationship with time. We struggle mightily to measure it down to the merest fraction of a second, but it’s really how we perceive the movement of time around us that matters most. I’m grown increasingly interested in the perception of time after sitting at my desk for 37 hours on Tuesday, but finding that the most recent Saturday lasted only 192 minutes.

3. Be nice. Someone from time to time will suggest that I should make an effort to be more understanding – to “be nicer.” I’m sure the suggestion is well intentioned, usually implying that I’d be more approachable, less apt to judge, or in some way become a kinder, more sensitive human being. Seriously? Have you met most people? Piss off with “be nice.” I’ll continue to respond and react to people as their actions and attitudes dictate. If you’d like me to be nicer, I’d recommend convincing people at large to be a little less dumb. It’s a win-win for everyone.

What Annoys Jeff this Week?

1. Inefficiency. Look, I’m delighted that Big Pharma is reimbursing me 93% of my out of pocket costs for the meds that one of the smart docs from Hopkins tells me will contribute to being able to continue to living better through chemistry. I’d be even more appreciative if their reimbursement scheme allowed for ordering more than a 30-day supply of the stuff at a time. Everything else rolls in as a 3-month supply that’s simple enough to refill once a quarter except this one little pill. It feels like I’m online getting that one refilled or coordinating the refund about every seven days. If you’re going to spend the money either way you could save us both processing time and effort by doing it four times a year instead of 12.

2. Single points of failure. The world is full of people who want to gather all decision making and power unto themselves. I’ve never understood that particular logic for several reasons. First, the ones who seem to be drawn to absolute power are generally the last ones who should be engaged in decision making. Second, there’s nothing more ridiculous than a few dozen people standing around knowing what needs done but being paralyzed for lack of having someone explicitly telling them to do it.

3. Consistency in the space program. I really wish we lived in a country that had consistent and achievable, manned and unmanned space exploration goals. I want NASA to be above politics and be maybe the one instrument of government that is the best reflection of ourselves. I want to see big rockets with the stars and stripes plastered to the side hurtling American astronauts back to the moon and then getting their ass to Mars. To think that’s not the next logical step in exploration is nonsensical and flies in the face of humanity’s eternal struggle to expand into the unknown. Other people will tell you this should be way down on the list of priorities, but those people are wrong and should be quiet.

Jeff and the case of the $100 toothbrush…

My dental hygienist has been hectoring me for years to buy an electro-mechanical toothbrush. She promised better dental health overall and fewer sessions with the drill. Still, I resisted the honey being poured into my ears. Mostly I resisted what I considered an extravagant expense in replacing a simple $2 toothbrush (that the dentist use to give me for free every six months), with a several hundred dollar battery powered model that also required regular brush head replacement. Frankly, I assumed the mechanical toothbrush would last about as long in my household as the electric razor I tried and promptly threw away twenty years ago.

After not a little bit of consideration I bit the bullet and ordered up one of these sonic cleaning marvels that was on offer as part of Amazon’s big site-wide yard sale. I’m trying to be open minded, though the fact that I just spent $100 on a toothbrush still feels like something of a patently ridiculous expense.

I’m going to do my best to give this thing the benefit of the doubt. It’s got until the first scheduled brush replacement to show me its worth. If it proves to be a case of a fool and his money, I’ll be perfectly happy to go back to ordering 10 packs of old school toothbrushes from Amazon for $5. Or maybe I’ll just knock out all of these awful teeth with a ball-peen hammer and get titanium chompers. At this point I’m starting to think that’s also a perfectly reasonable long-term solution.