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.

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.

The final details…

I can’t say enough good things about the people who helped facilitate the post mortem “care and feeding” for my boy over the last few weeks. From the staff at VCA Glasgow to the Delaware Pet Crematorium, the were absolutely professionals who went above and beyond to treat a simple dog like the entirely beloved member of the family that he was.

I’ve never intended to have human children. I still don’t. Despite enormous societal pressure to the contrary, these furry creatures who share my home are in many ways the family I’ve selected for myself. In life, and in death, I begrudge them nothing.

I was able to bring Winston’s ashes almost two weeks ago. They were returned in a cloth covered box that for most things would have been entirely fitting. After living with it for a few days, though, I knew there needed to be something more substantial – something more in keeping with Winston’s room sized personality. This good and loyal dog needed a more fitting monument.

Although I couldn’t raise a Lincoln-sized memorial, I was able to find what I feel like is a fitting final vessel. This past Friday evening I made the transfer from one to the other, adding in a few small tokens that rather laughingly made me feel like I was interring a pharaoh rather than “just a dog.” That, too, felt fitting.

So now, Winston’s earthly remains rest in the only place I could think of as fitting for him – among and alongside my most treasured possessions, my books. We’re all slowly getting use to the new normal here, but it’s been awfully nice to have this final detail sorted and in place to help mark that change.

The very best good boy…

Where do I even start?

One day a living, breathing bundle of floof comes into your life, helpless, with his puppy breath and needle teeth and need to pee every 37 seconds. If you’re doing it right, you end up hopelessly enmeshed in each other’s lives – which seems patently unfair given that you know going in to it that theirs is likely to be so much shorter than yours. Still, if you’re very lucky you get to have a decade’s worth of good years – of way more good days than bad ones.

The good ones are the days you mostly remember. That’s the way it should be. The bad days, though, those can be brutal even if they are less individually memorable. They’re filled with self doubt and unanswerable questions about what a dog thinks or feels or needs you to do that they can’t do for themselves. The worst are the moments when you’re tempted to heroic measures – the phrase people like to use to justify prolonging a pet’s pain to spare their own. God knows I was tempted and tempted badly to buy another few weeks, but not with full knowledge of the price that he’d pay for my momentary cowardice.

The last few weeks have been a lot of raw skin, itching, limping, falling, yelps, and crying as he couldn’t command his body to move as it should have – as he knew it was supposed to. Even at the end, his eyes lit up just from my laying there with him on the vet’s floor, rubbing that spot just between his ears that always got the best reaction. I got one last lick on the back of the hand and I got to bury my face nose to nose with him and remind him one more time that he was the very best good boy. I was lucky to have been able to share a part of my life with such a dog. My last living memory of him will be of soft snoring and a few last sonorous bulldog snorts before his mighty heart finally went quiet.

If it were an option I’d have gladly slashed years off my own life to have one more good day with Winston. The best I can manage just know is acknowledging the mercy that he’s no longer in pain and struggling with every step just to please me. The truth is, all he ever had to do to make me happy was be there when I got home.

Today wasn’t one of the good days, but it was the price paid for so many that were.

What Annoys Jeff this Week?

1. The time of the year. There’s a popular perception that people’s moods tend to improve has we head into the Christmas season. Maybe that’s the case for some, but not so much for me. By this time of year I’m just about worn down to the nub from relentless repeats of leaving home in the dark and returning there many hours later again in the dark. I loath and despise this time of year for the simple reason that for all practical purposes it means living like a mole for two months. If I manage to leave work on time and if it’s not cloudy, I do manage to catch the last few rays of watery sunshine on an occasional weekday. On a good day at mid-winter that lasts for somewhere between 5-15 minutes. So while everyone else is preparing their celebration of the birth of the Christian’s nailed God, I’ll be over here quietly awaiting the solstice and celebrating Sol Invictus.  

2. Thirty minutes. That’s how long it takes my work computer to boot up from a cold start on the average day in the office. Look, I can dick around for the first 30 minutes of the day with the best of them, but it doesn’t feel like a particularly great use of time. But hey, whatever. I can only use the tools and resources I’ve been assigned… Which is why I keep a stack of magazines on my desk.

3. Bulldogs. I love my bulldog. He’s almost eleven now. He’s got a permanent limp, only hears when he wants to hear, and seems happy enough to pass the time between feeding and being let outside lounging comfortably in one of his beds. He’s an old man and I don’t begrudge him any of that. For the last two months, though, we’ve been trying to get on top of what’s become a particularly aggressive skin issue. After two month of antibiotics and medicated baths we don’t seem to be any closer to a solution than we were at the back in late October. The condition itself isn’t something unusual – we’ve been working with bad skin for years – but the amount of time it’s taking to knock this one back is far more than history suggests should be necessary… and don’t get me started on $80 bottles of pills that don’t seem to do a damned thing. I love my bulldog, but if you find yourself ever thinking you want to fall in love with their wrinkly little faces, my advice for you is to take a hard pass. I’d never deny this one anything, but get yourself a dog instead of an eating, breathing, ongoing medical disaster… unless you have a sick desire to take lots of time off for vet visits and would rather not have to worry about disposable income. Then, by all means, bring home that adorable, smushed faced little pup.