What Annoys Jeff this Week?

1. Scolding. “Your test results are always oddly good for someone… like you. That won’t last forever.” Doc, look, no one knows better than I do that I’m a walking timebomb. Someday this glorious temple of gluttonous debauchery will fall down and sink into the swamp. I know that. But today, it seems, is not that day. And I don’t intend to spend every day from this day to that inevitable day at an indeterminate time in the future doing things I hate (like jogging around the neighborhood) or eating things that I hate (like kale). Even the healthiest of us eventually drop dead. There’s nothing all the gifted practitioners at Johns Hopkins can do to stave off the end that comes for us all. Better to spend those limited days, I think, doing and eating, things I enjoy.

2. Agreeing with Speaker Pelosi. I never feel entirely well when I find myself agreeing with Speaker Pelosi. Fortunately it’s something that doesn’t happen particularly often. In the case of the House select committee on the insurrection of January 6th, it’s the only investigative vehicle left open to the Speaker in the face of a Republican congressional caucus that would rather hide from or obfuscate the truth than nail down the details of what really happened, who was involved, and what motivated them. Sedition and insurrection are among the most vile offenses against our republic. Making the details surrounding what happened plain is in the vital national interest. If elected Republicans are too afraid of the results of the investigation to call for one, well, that’s probably a decent sign that one is needed without delay.

3. Seven hours. There are seven working hours between me and a nine-day weekend. If that’s not legitimate grounds to be annoyed, I don’t know what is.

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.