A very good girl…

I remember the day I brought Maggie home like it was yesterday. I wasn’t even looking to add another dog at that point. It was a few weeks before Christmas and I didn’t want the inevitable headache of taking a puppy on a 1600-mile round trip drive. Then a friend at the office put up a “free puppies” sign. Mama had died giving birth and the large litter was eating the family out of house and home. It was a fire sale – everything must go – before they were dropped off at the shelter. Surely there wasn’t any harm in going to take a look. As I recall, people from our office ended up taking some if not all of that litter.

I came back after lunch that day with a sleepy chocolate lab snuggled down inside my coat. For the next almost 14 years, she was my shadow. Through the successes and failures of life, tens of thousands of road miles, changes of jobs, changes of houses, there she was with a wagging tail and a smile on her face. Maggie was one of the most consistently happy dogs I’ve ever had the privilege of knowing.

For the last few years, though, Maggie was also a very sick dog. Sometimes it felt like we were keeping her together with bubblegum and bailing twine, but she was always game for another trip to the vet and eager to greet everyone there. As long as she was up for pressing on, there wasn’t a test or procedure I was unwilling to try or a specialist I wasn’t willing to meet. Over the last week, despite some new meds, I watched that old spark slowly fade away. 

There’s more we could have done. The vet would have pumped her full of more meds if I’d have asked for them. It would have been so easy to go down the road of calling for extraordinary measures, but she deserved better. She deserved to meet the end walking in under her own power and while she still had some of the old nobility about her.

I couldn’t ask her to suffer so I didn’t have to – not after so long together, not when she’s done everything I’ve ever asked of her and so much more. 

From start to finish Maggie was a very good girl – a once in a lifetime dog. 

My life was incalculably better because she was part of it and is now the darker for her absence. I’m going to miss her terribly.

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.

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. 

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.

My life with dogs…

I was talking with a friend of mine last night – and by talking, I mean keeping up a decade old text conversation – and mentioned if I ever write another book I’m pretty sure its title is going to be My Life with Dogs and Other Things that will Fucking Bankrupt You.

Here’s the backstory:

Maggie has had a fatty lipoma on her shoulder for the last five years. We’ve treated it as a cosmetic thing up to now, but it’s finally grown to the point where the medicos tell me it needs to come out – or at the very least be “de-bulked.” For the last year or so I’ve been rolling the dice in determining if we’d go to surgery or if an old dog with Cushing Syndrome would make it to the point where surgery was necessary. Doc tells me where at that point now. The good news is that means my girl is relatively healthy. The bad news is it means we’re putting her under the knife fairly soon.

I talked to Maggie’s vet last night. Given her age and the general presentation of Cushing, I was prepared to hear that the results of her bloodwork were all over the map. They weren’t. Everything was basically where it should be for a dog whose disease is well controlled. So, small mercies there. In trying to decide how to approach the lipoma on her neck/shoulder, we also did a series of chest x-rays – mostly a due diligence to see if benign had become something more problematic or infiltrated her chest wall. The pictures show that it hasn’t.

The only minor pre-surgical issue we have was a slight presence of bacteria in her urine. It could easily be something that was introduced during the collection process, but in an abundance of caution prior to putting a decent incision into my girl, we’re starting a course of antibiotics to make sure all is clear before she heads in for surgery.

The doc did give me the option of taking Maggie in for an MRI – which would give a far more detailed view of the mass than simple, old fashioned x-rays. If I thought we were looking at something more involved than removing a large, but reasonably simple lipoma, I’d have probably given it more consideration, even knowing it would end up being a $2,000+ bill. I appreciate that this vet walks me through all available options, but doesn’t attempt to push in the direction of the more expensive tests. Even as he was discussing the MRI, he was clear that level of diagnostic testing was probably overkill in Maggie’s case.

I’m working with the scheduler to get a time for surgery and Maggie is getting an extra ration of cheese to hide her enormous antibiotic capsule. All that’s left to do now is wait and see how it goes. I’m sure that won’t cause any gnashing to teeth because I’m well known for my patience and low key approach to animal care.

Updates on a chocolate lab…

A couple of weeks ago, I took Maggie in to the vet for her regular checkup. As they get older, I approach these visits with increasing trepidation with every dog – mostly out of the fear that the vet will find something that should have been obvious to me, but that I missed simply due to familiarity, or that the regular blood work will show something new having gone out of whack since the last visit. For better or worse old dogs are just like old cars or old people – sometimes shit just stops working for no other reason than it’s old and broken.

Given Maggie’s last six months and the extensive vetting she had to get over her stomach trouble, I had lots of tests forming the baseline. Some of them I was expecting to be bad just as a matter of course. Others I expected to have gotten worse over time. It didn’t quite work out that way.

Maggie’s blood work came back with all the key data points “in range.” Even if it’s being held there through the advanced application of chemistry, it was as good a result as I could have hoped for – and not the one I was expecting. At a minimum, I went into this series of tests assuming that we’d be dialing up her medication to hold the same ground.

There’s no hiding the gray in her muzzle. My girl is still and old dog. She’s still got Cushings. But for the time being it hasn’t gotten worse. It’s still being effectively managed with her current dose of medication. Believe me when I tell you I don’t take that for granted for even a moment, because I know just how quickly the opposite can become true.

Although Maggie’s checkup was mostly good news, we’re headed over to the veterinary ophthalmologist in two weeks to get some small lumps and bumps looked at. One is purely cosmetic and has been there for a few years now, though it’s gotten bigger and is prone to bleeding when she rubs it. The other, most likely a small benign tumor or skin tag, is starting to form on the inside of her eyelid. This new one is the most troublesome to me since it’s in direct contact with her eye, though I’d like to see them both gone for her comfort and my peace of mind.

Optimal control…

We were back to the vet this past Friday with Maggie. She has to stick around with them for a few hours for a bit of follow-up testing for her Cushing’s. There’s no remission or recovering from it, but symptoms are treatable, so finding the best course of treatment for her is important to me.

This last test shows that we have the meds dialed in to the point of “optimal control” for her ACTH levels – meaning we’re able to hold her cortisol levels more or less where they need to be to reduce the laundry list of Cushing’s symptoms. Under the circumstances, it’s just about the best possible outcome available.

It was a long six months in getting here – with three or four visits to the regular vet for testing, schlepping across Pennsylvania for an ultrasound, and several variations on the medication of choice to get things under control. It hasn’t been an inexpensive proposition, though I refuse to do the math on either the amount of time or money expended. I know I’m incredibly fortunate that neither one of those factors drive the train when deciding what’s best for my sweet, lazy chocolate lab.

The fact is, Maggie is an old dog. She’s coming up on her 11th birthday in October. I’m under no delusions about how this ends – for her, for me, or for any of us. For now I’ll appreciate that I, through the marvel of modern veterinary medicine, was able to buy her some more quality time. Beyond that, everything else is background noise.

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.