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.


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.

An update on the herd…

Editorial Note: I stumbled on a few “Ask Me Anything” questions I got a few months ago and had completely forgotten about. Over the next week or two, I’ll do my best to work them in to the schedule.

Tonight’s AMA question comes from someone I’ll Identify as LS. LS asks, “Update on the pet situation, please! Now that the intro period is over, how are Maggie and Winston and Hershel getting along? How have you and the dogs had to adjust your routines for the cat? Is there a pecking order? How can you tell?”

Maggie, although the youngest of the two dogs, is generally the pace setter. She’s the one who most often engages the cat – although it’s not so much an effort to play as an ongoing uncertainty and fascination with the creature that has access not just to the horizontal space in the house, but also operates on the vertical axis. Her main role seems to be one of investigating all the things that go “bump” when Hershel is up and moving. By contrast, Winston is his truly ambivalent self in their interactions.

I should say that Winston is ambivalent up to a point. He’s the grand old man of the house – with arthritic joints and plates and pins holding him together, he doesn’t generally appreciate the rough and tumble moments. That hasn’t stopped Hershel from wanting to pounce and play, but his efforts are usually met with a growl or with Winston’s best impression of a charging bull. I don’t expect that’s surprising from a very senior bulldog.

For all of his innate cat tendencies, Hershel has very much assumed the role of “third dog” in the household and is often found following along behind the other two. The best example probably comes each morning when I’m leaving for work. Maggie and Winston have always gotten a treat – a peanut butter Kong or other tasty morsel – when I leave. It became such a fixture of the schedule that they sit patiently at the laundry room door until it’s disbursed. It took a few months for Hershel to catch on to the program, but now he’s sitting right along with them waiting for his. I didn’t set out to turn him doggo, but at least in some respects that’s what’s become of him.

At best, they get along like all three have been together all their lives. At worst, they tolerate each other. Generally I’ve come to the conclusion that they’ve all more or less decided that they’re part of the same pack. Mercifully, there’s been minimal adjustment to the household routine – the only exception being the baby gate that keeps the litter box from becoming an open buffet for a particularly ill-disciplined chocolate lab. The gate is a nuisance, but what it prevents is undoubtedly worth the effort.

Is there a moral to the story? Hard to say, really. Dogs and cats can apparently live together just fine. I’m sure that has as much to do with the temperament of the individual animals as it does with anything else so I won’t take any credit there. The whole lot of them are badly trained and entirely spoiled – which is 100% my fault, of course. I find, though, that each one of them is completely endearing for their own particular set of reasons and take absolutely no steps to correct their behavior in any way.

Impatiently waiting…

I should start by confessing that I’m almost use to confronting all manner of canine medical problems. It’s one of the less charming, but utterly unavoidable side effects of living with an English bulldog. It’s just something you come to expect. I’m not entirely sure he can surprise me anymore. Usually my response is more of a “Oh, he’s broken again.”

It’s when the Labrador retriever pulls up with the medical mystery, I’m admittedly taken completely by surprise. She’s been a mercifully healthy dog and I’m more than appreciative of having at least one that doesn’t need nearly continuous medical supervision.

Unfortunately last week I discovered Maggie had a lump about the size of half a golf ball under the skin just below her ribcage. A trip to the vet and biopsy obviously followed – and in the meantime I’ve been spending the time keeping my mind off it as much as possible. Patience, as we know, is not one of my great virtues. Since I don’t run my own diagnostic lab, of course, there’s nothing for it but to wait and see what results come back.

I’ll do it, but I will in no way commit myself to doing it patiently.

What Annoys Jeff this Week?

1. Coat blowing. I dearly love my ever-loyal, if somewhat ditzy, chocolate labrador. She is the operative definition of a kind and loving soul. But honest to whatever God there is in heaven if she doesn’t stop blowing her winter coat soon I’m going to lose what small slivers of sanity I have managed to hang on to lo these many years. It’s like the whole bleeding house is covered in a fine, slightly fluffy film of dog.

2. The other email. Without delving into any specific details, I have an alternate email address that occasionally gets used for work. In part it’s annoying because I can’t access this account from my desk. Fortunately, almost no one ever uses that address so it’s not completely inconvenient. That being said, if you don’t log into the damned thing about once a week, you start getting nasty messages from the Great Email Monitor threatening to cut off your access. Once they do that you’ve got to start from scratch setting up a new account, which could take as long as 247 work days to complete. Since I really do need this account for about one message ever 8-10 weeks it effectively just creates a barely essential pain in the ass that requires me to set up a calendar reminder to schlep next door once a week to log in, look at an empty inbox, and ensure that the account stays active for another week. You’ll forgive me, I hope, for being only slightly vexed (but not at all surprised) by such a patently inefficient process.

3. Acting surprised. A major musician has died under unclear or suspicious circumstances. I’m not sure why anyone would be surprised that a music superstar might have succumbed to the effects of legal and/or illegal medications. It’s not like this is the first time music and drugs march down the same road. It’s the fact that anyone from fans to media pontificators can pretend such events are anything other than “as expected” that’s farcical. A man is dead and that’s sad enough in its own right, but when it’s self-inflicted I have a hard time finding it an outright tragedy.