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.
Yesterday Maggie and I swung by the vet so they could pull another urine sample. I’m expecting the culture to tell us one of two things: 1) Maggie’s UTI has cleared and the infection wasn’t what has been causing her wildly increased drinking and peeing or 2) Six weeks of progressively more aggressive antibiotics have failed to overcome the infection.
If it’s the former, the consulting internal medicine doc we saw last month has already proposed a preliminary course of action based on treatment to roll back a worsening of Cushing’s symptoms that isn’t indicated by the basic test of cortisol levels. I expect at least another trip to Malvern if that’s the result. If it’s the latter, well, we’ll have to see what’s left in the options box if this particular infection is truly uncontrollable with antibiotics.
I’m in the rather odd position of actively hoping that her Cushing’s has gotten worse. It’s at least the enemy I know – one that we’ve had good success wrestling into an uneasy truce if not submission over the last couple of years. It’s at least a fighting chance for some improvement. The same doesn’t seem to be true if we’re dealing with an unchecked infection.
There’s not much to do now until we see what we’re dealing with. It’s one of those rare times when I wish I was just a little more low strung and zen.
I did it. I told our current vet that although I’ve been happy with their service, I’m leaving to pursue less expensive basic medical care for two of the three furry little hooligans who share my house. Maggie will be staying put for the time being. With her thickening medical record and established relationship with the primary doc and specialists, I don’t want to rock that particular boat by reading someone new into the project at this late stage. George, of course, gets his own once a year trip to the local exotic vet practice.
Jorah is due for his annual checkup and vaccinations in a few weeks, so there wasn’t much room to put off decisions any longer. Thanks to the internet, I think I have our new vet (or vets, plural, since they’re a multi-person practice) picked out. It’s still a twenty-five-minute drive (but what isn’t when you decide to live in the middle of nowhere). Their online reviews seem impressive enough. They have on-site hydrotherapy, which is nice if I ever need to go that route again. They also have offer self-contained boarding, day care and grooming. I’m not altogether a fan of boarding, and it’s been a rare enough event that I’ve ever had to leave a critter behind, but I appreciate having the option bolted on to the medical facility.
If I’m 100% honest, I’m not sure this place will be much cheaper than where we’re leaving. They’ve got a whole lot of infrastructure that needs to be paid for and kept up. It’s definitely not the old-fashioned country vet I thought I wanted for them. What it does have, beyond the obvious, is the virtue of being open for 12 hours on weekdays and 10 hours on both Saturday and Sunday. That’s the kind of thing that could save a guy at least a couple of emergency vet visits over the course of an average pet lifetime. I’m probably willing to pay a little bit of a premium for that… so we’re going to give this outfit a test run starting in July and see how it goes.
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.
I’ll admit that a decade ago I picked the vet whose office location was the most convenient. I was just back to Maryland with a bulldog who at least once a month seemed to need to go to the vet immediately. Their office being between five and seven minutes from the house was a much appreciated convenience.
That office closed a few years ago and folded many of their clients, myself included, into their sister facility twenty-five minutes away. We’ve gotten good service there and I like my regular vet and the staff, but their fees tend towards eyewatering territory on a pretty regular basis.
I’m leaning towards transitioning the two youngest members of the household over to a different vet – one that’s still locally owned and operated (and presumably with lower costs for basic veterinary care). With Maggie’s long and complex history over the last several years, though, I expect to keep her with people who know the full back story until we’ve played that hand all the way through.
Part of the reason I liked the big corporate chain vet in the first place was having ready access to emergency and specialists “in the family.” With a host of them now sprung up within reasonable driving distance, I’m not sure that’s the selling point it was then. It feels likely that nothing more than the inertia of dealing with a known quantity is what really kept us where we’ve been this long.
Or not. I’m currently feeling mightily indecisive… and since a decision isn’t needed right the hell now, I’ll probably continue to dither for a bit yet.
Maggie’s test results were not what either her doctor or I were expecting. We were both more or less convinced that her Cushing’s had advanced a bit and her meds would need to be dialed in a bit to correct for that. What two days worth of testing showed, though, was that her Cushing’s is well controlled and those numbers are almost exactly where they were a year ago.
Her tests did reveal a higher than expected number of white blood cells in her urine sample. The cause, ultimately, is unknown… but we’re treating it as a persistent, low grade urinary tract infection since that’s the most likely suspect. Maybe we’re on to something, because she has perked up a bit since we started her on mountains of antibiotics twice a day. Nobody expects the Spanish Inquisition, I suppose.
My poor old girl is still drinking copious amounts of water – maybe slightly less than a week ago – but she’s getting a round a bit better so for now I’m willing to call this at least a temporary win. We’ll see how things look in two weeks when the last of the pills runs out and we’re back to her normal maintenance meds.
This is definitely one of those times where I’m exceedingly happy I never had an interest in having kids… their basic care and feeding, wanting to go to college, or getting married would have eaten into my “Medical Care, Veterinary” annual budget line to an unacceptable degree.
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.
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.
One of the convenient features of the Great Plague is that more places will just email you things that usually have to be filled out in their office so you can take care of them at home. Anything that removes that human to human interface is a net good overall in my book. Look, I know some of you out there thrive on this human contact foolishness, but in a lot of ways I feel like I’m over here living my best life in a world finally designed for avoiding people.
The joy of being able to dispense with a bit of one-on-one human interaction this morning was tempered somewhat because I was filling out Maggie’s pre-surgery paperwork. The 4-page packet included basics like my contact information, what medication she’s currently on, and a summary of the procedure and expected costs for my initials.
This particular pre-surgical packet also included, what I can only think of as “advance directive for dogs.” The vet wants to know just how heroic the measures should get if something goes horrendously wrong during the procedure. The forms I’ve seen in the past include everything from the standard do not resuscitate, to providing CPR, to using electrical defibrillators and even more invasive options. Since this surgery is being taken care of at the local vet’s office rather than one of the big emergency clinics we frequent, we were limited to DNR or performing basic CPR.
I’ve probably filled out a dozen or two of these forms over the years – mostly for myself, but more than a few for the animals. My own advanced directive is relatively straight forward and I’ve passed it out to a slew of doctors over the years – CPR is fine. Machines are fine. But the moment we hit the point where my big beautiful brain is damaged or I’m alive only by virtue of the machines, go ahead and pull the plug. I’d like to hold out for the point where the techies can download my consciousness into a computer, but if that’s not an option feel free to let me go.
With the animals, though, the temptation for me is to keep them with me at all costs using whatever tools veterinary medicine can bring to bear. I always resist the strong temptation to tell the vet to be heroic, though. It’s not the easy choice, but it’s the right one.
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.