Do not resuscitate…

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. 

My life with dogs…

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.

There’s never an entirely clean bill of health…

We’re back from Jorah’s first adult trip to the vet. Weighing in at 60 pounds on the nose, he’s nominally “full grown.”

His side-eye is strong.

I was optimistic (foolishly) that this visit would be just the usual weigh in, vaccinations, and pats on the head (for him, not me). We managed all that, of course, but because he’s one of my dogs, there was something a little extra. I’ll never be the kind of guy who has perfectly healthy dogs, it seems.

I asked the vet about a “spot” on Jorah’s leg. I’ve never managed to catch him licking it or even found it damp, but it looks very much like a areas on his right foreleg that’s been licked incessantly. With a diagnosis of “nothing obvious” we arrived home with three weeks worth of prednisone and two weeks worth of cephalexin and the vague hope that a course of steropids and antibiotics would work their magic.

If they don’t, we came home with a cone of shame too… but I promised my boy we’d only go there in extremis.

Lumps and bumps…

Having an old dog means there’s really no end to the lumps and bumps you’re going to find on them today that weren’t there yesterday. I’m told fatty lipomas are particularly common in old Labrador’s – and Maggie has more than her share of those. As long as we confirm that they’re not malignant, I’m more or less happy to leave them be rather than subject her to an invasive surgery to correct something that’s basically cosmetic.

The story is a little different when it comes to the most recent tumor. This one is growing under her right eyelid and if left unchecked could cause damage to her eye. That falls well into the category of “not cosmetic.”

We schlepped over to the most local of the region’s specialty vet’s offices this morning to meet with the veterinary ophthalmologist for the first of what’s likely to be several consultative visits. They ran a few tests, poked and prodded, and looked deeply into her eyes… and confirmed that “yep, that’s a tumor and we should probably cut it off.” At least that part wasn’t a surprise.

Maggie’s overall prognosis is good. The procedure is fairly straightforward, so we’re not breaking new ground in veterinary medicine. That’s not to say the procedure is inexpensive, of course. It’s not the kind of vet’s office you ever walk into thinking that the visit is going to be budget friendly. It’s the price of progress. At least that’s what I keep telling myself.

The only question now is whether I want to get another consult with the surgeons to see if taking off one of the large fatty masses on her shoulder is something we should think about adding in to the surgery. On a younger dog in my mind the decision would be a no brainer. With my girl pushing 12 now, I’m hesitant to take on anything invasive that isn’t strictly necessary.

At least I know what I’ll be spending the weekend pondering.

The slightly abridged story of another sick dog…

Since I seem to be permanently destined to have at least one sick dog on the premises, I suppose it’s only fair that I throw out a little update on what we’ve been up to since late last Friday.

The short version is that over a span of about an hour on Friday night I watched my already sickly chocolate lab go from her normal self to drooling, vomiting, and blasting out unimaginably large quantities of liquefied, high pressure shit. I undertook the “40 minute” drive to the nearest emergency vet with great vigor and complete disregard for pesky details like traffic laws and personal safety. I was more or less convinced that by the time we got there, I’d be dropping her off for a necropsy rather than treatment. I never thought I’d be happy to hear a dog retching and hacking in the back seat. For Friday at least it was the sound of not being dead yet.

After 36 hours of treatment, blood tests, fists full of medication, an ultrasound, and round the clock monitoring, the official diagnosis is “we don’t really know.” The symptoms don’t really present as something directly related to her Cushing’s disease and the ultrasound didn’t show anything radically different than what we saw back in March. Inconclusive.

In the absence of a solid medical diagnosis, I’ve arrived at a speculative cause for all this last week’s problems. What I think happened is that sometime around 6:30 Friday night the dogs found something in the yard – perhaps a mushroom – and noshed on it. For Maggie, already compromised with Cushings and general old age, the result was sudden and violent illness.

The key to my speculation doesn’t actually involve Maggie at all, though. When I got home from the emergency vet around midnight Friday, Jorah’s crate floor was spotted with drops of something. At first I attributed those drops to a reversion to peeing in his crate, but a closer look showed that he too was drooling prodigiously. In Jorah’s case, though, it lasted just a few hours and dissipated. He never showed any signs of feeling badly otherwise, which I know from sitting up through the small hours of Saturday morning waiting to see if I needed to drag another dog in for heroic measures of treatment at weekend rates.

I talked to our regular vet last night and laid out the timeline of events, went over the details from the file, and presented my own observation of the events. Without being led there, his first opinion was that it sounded like they had both eaten something and promptly got sick in proportion to the strength of their respective systems. It’s not exactly a confirmation of my logic, but I was glad to see that his analysis of the available evidence mirrored my own. Unless something is proven otherwise, “ate something” is going to be the official story of what caused this week’s series of unpleasant events at Fortress Jeff.

With leaves coming down and the ground covered it’s going to be horribly difficult if not outright impossible to verify any of this. It’s going to be harder still to comb the area for anything that could further agitate the situation. Part of me knows we’ll be relying on some level of luck in avoiding future problems. It’s not optimal, but we’ve lived here a fairly long time now without something in the yard causing mayhem and chaos. One bad day out of 1200+ isn’t necessarily a cause for panic, but I’d be lying if I said I wasn’t looking at the compound with a new level of unease.

The screecher next door…

Sitting around the emergency vet on a Friday night with not much to distract you leaves a lot of time to think… and to observe the comings and goings of those moving around you in the world. The thing I observed most on Friday night… and then again on Sunday morning was the genuine imitation outrage that so many people felt when they were expected to pay for their pet’s emergency treatment.

The ones in the treatment room right next to mine would have been hard to miss, even if I wasn’t casting around for something to occupy my mind while we waited. They’d have been hard to miss because just after 11PM, one of then started screeching that the estimate to treat their dog was “too damned much” for what they seemed to think was a simple treatment – blood work, xrays, and emergency surgery to set or amputate a broken leg.

The value people put on things is always curious. You’re at a vets office in the closing minutes of a Friday night. They have a huge staff who are all being paid for overnight weekend work. They have diagnostic imagery tools that a decade or two ago would have been rare at a lot of rural hospitals treating people. You’re paying to have access to doctors, techs, and technology at a time when almost nothing else is open. As much as the staff at one of these places may love animals, money is what keeps the doors open at times when you might otherwise have to wait 48-72 hours to have your dog seen.

Look, I don’t love spending emergency vet kind of money, but I get why it comes with a premium price tag. Even if I didn’t get it, I’d know better than to scream at the twenty-something young tech who’s trying to walk me through the options because I’m not an awful human being. I’m sure someone will say lashing out angrily is a perfectly natural response in a stressful circumstance… but I’d really prefer it if they didn’t lash out and agitate the people who I’m going to need focused in on taking care of my own pup after they’ve finished up with the screecher next door.

Of testing and cautious optimism…

I took the morning off today, to take the youngest pup in for another round of testing. The blood tests and urinalysis done over the weekend pointed steadily at major problems with his kidneys, perhaps even towards renal dysplasia – basically a developmental anomaly that would all but guarantee kidney failure in fairly short order after the initial onset of symptoms. That wasn’t what I was expecting to hear, but I spent most of the night last night reading every article and journal entry I could get my hands on without a subscription. If that was, indeed, the worst case scenario, I wanted to know what we were up against. Nothing I read gave me a warm fuzzy.

This morning’s round of testing has given cause for a bit of cautious optimism. Jorah’s urine was concentrated, had appropriate color and smell, and its specific gravity was low, but still in the target range for normal. Those things wouldn’t likely be in the case if his kidneys were in the process of failing. He’s schedule for a trip through south eastern Pennsylvania on Friday to see a specialist and get an abdominal ultrasound. Barring an invasive biopsy, it’s the surest way to verify that his kidneys are correct in size and shape. Cautious optimism.

Since the mass consumption of water is something Jorah’s done since the day I brought him home and we’ve established that his kidneys are concentrating fluid and his blood isn’t showing any of the other likely issues, one of the remaining outliers could be that he’s just obsessed with drinking. The fact that it’s possible I gravitated, in a building full of dogs, to one that could have a touch of good old fashioned OCD probably shouldn’t be in any way surprising.

We’re still a ways off from having a truly definitive answer, but moving the one that’s effectively a short term death sentence more towards the unlikely column feels like a pretty good day’s work.

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.

Something of a novelty…

After six days of waiting impatiently, I got a call back from the emergency vet Maggie visited last week. The good news is that the tests they ran confirmed the preliminary diagnosis of a urinary tract infection. After the long and growing list of canine ailments I’ve dealt with over the years, a run of the mill UTI was just about as good an outcome as I could hope to have.

Because in this household we can’t do anything entirely basic, Mag’s urine culture showed that the E. coli bacteria causing the infection wasn’t likely to be fully treated by the particular antibiotic originally given. It did, fortunately, help alleviate the worst of it. Since I’m looking for knock-down, drag-out eradication, though, I’m more than happy to spring for the second 10-day course of targeted antibiotics. It’ll be a small price to pay to get my girl to a place where she’s a) more comfortable, b) not as likely to pee all over the house in the dead of night, and c) can resume her duties as my 70 pound live action foot warmer.

A few weeks ago I laughingly posted on Facebook about a meme showing the average dog owner spends $1000 a year on care and feeding. That sounds awfully low to me, even for a bare minimum of food and medical care. As the science of human medicine marches forward, veterinary medicine marches along a few steps away… with the a corresponding increases in price for the kind of services that owners can now expect and demand.

I’m very thankful that this time around, we didn’t have to chase down anything too dramatic or crash into an aggressive treatment plan. You’ll forgive me, I hope. “Normal” illnesses are still something of novelty here.

Old dogs…

People will spend a lot of time telling you about the trials and tribulations of life with a new puppy. Poke around Google and the internet is littered with Twitter and Instagram accounts dedicated to the foibles of puppy ownership.

You’ve got to dig a little deeper to find the blogs and message boards that talk about what it’s like to live with an elderly or ailing dog. It’s not the wide-eyed adorableness and puppy breath side of having pets. It’s the astronomical vet bills, fists full of medications, and a body slowly wearing out even when the spirit is still more than willing.

Old pets are heartbreaking not just because we can sense that our time together is growing short, but also because their compressed life cycle points us inexorably towards our own fate at some point in the future. It’s one of the reasons I’m always a little bit perplexed by people who give up and give away their old pets. They have no sense of the broader context of life.

My dear sweet Maggie had a bad morning today. After years of perfect behavior, I knew she was embarrassed and upset. I could read it all over her face – and especially in her eyes. Climbing out of bed to scrub the bedroom carpet wasn’t exactly on my list of things to do today, but looking at those cloudy brown eyes I couldn’t even bring myself to scold her. Going on 11 years together she’s earned the benefit of a few hundred doubts.

Maybe this morning was a one off. Maybe it’s a warning sign of things to come. I’m trying not to let the first thoughts of my sleep addled brain read too much into it. I hope beyond measure this isn’t something that will become the new normal… but if it does, we’ll cope. Maggie is the grand dame of the family I got to pick for myself. She’s entitled to expect that level of effort in her golden years.

I wrote most of this before seeing the bloody urine this evening that set my alarm bells clanging – and before I took off to the local emergency vet to have my girl checked over. Maybe I’m paranoid or at least a bit too cautious. I’ve also seen how fast things can go bad and when warning signs start stacking up, it’s not the moment to prioritize time or money.