Tag Archives: testing

I’m pretty sure it’s a racket…

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Tomorrow will start the first of a series of various doctor visits and lab appointments that I really had been hoping would somehow magically fall off my calendar. I’m sure they’re all very important and will reveal many interesting and entertaining things, but it’s a level of shit to do and sick leave I don’t want to burn off that’s just uninspiring.

A month or two ago I got myself an endocrinologist, who seems nice enough, but is determined to build her own history rather than just going on the eleven years of records I sent over from Johns Hopkins. So, over the next six to eight weeks, I’ve got multiple appointments lined up for basic blood work, thyroid testing, pituitary testing, a “nutrition assessment,” and one or two other things I’ve got noted as “Endo Appointment – UNK” on the calendar. I assume they’ll tell me what I’m there for. At this point, it only feels like I’m missing tests for color blindness and hearing.

The good news, I suppose, is as far as I know there’s nothing new actually “wrong” with me. The doc didn’t appear alarmed and used phrases like “establish a baseline.” Since I feel fine, my numbers are basically hanging around where they have been for a decade, and they didn’t immediately throw me in the hospital to conduct these tests, I’m proceeding from the assumption that this is either a) standard procedure for bringing a new patient into the practice or b) an unsophisticated scam to bleed me for copays while charging Blue Cross a small fortune. Either one feels entirely possible at this point – and both feel like some kind of a racket.

Now that the bathroom is in spitting distance of being done, I thought maybe this would be the time to get back to the series of dermatologist appointments I paused in the spring. Turns out that was wildly optimistic. Maybe I’ll see him again in November… assuming there isn’t some other ridiculous thing that comes up between now and then.

Partial diagnostic credit…

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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.