Nobody expects…

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.

Sickly or otherwise…

I dropped my dear, sweet, elderly chocolate lab off for her next round of tests this morning. A series of x-rays shows that the swelling in her front leg is almost certainly a very large and somewhat inexplicable hygroma – basically her leg holding a whole lot of fluid. It seems to be disappearing as quickly as it came on. It’s looking far better this morning than it did on Friday afternoon.

The other test for today, the ACHT stimulation test, should optimally confirm what we suspect – that her body has built up a tolerance to the current dosage of Vetoryl that’s been holding the symptoms of Cushing’s at bay for the last year or so. If that’s the case, we should be able to adjust the dosage upwards and buy her some more time. That’s what passes for a best-case result with her these days.

At almost 13, fighting this kind of rear-guard action is probably as much as we can hope for. How it ends, of course, is inevitable for all of us, but as long as she’s in control of her mental and physical capacities – and not in pain – I’ll clear the decks to give her the quality life that she’s earned from our long years together.

Maggie is the kind of happy go lucky dog that will follow anyone anywhere. Hand over her leash and off she’ll go. Normally she goes without so much as a second look. This morning, while the tech was leading her back the hall to her room for the morning, my girl gave me a look over her shoulder, making sure I was still there. My breath caught and in that brief moment, I had “all the feels” watching her disappear into the back room.

I haven’t always been that maudlin. I suspect the endless flow of years continues to give me an enhanced perspective on just how quickly things can change regardless of how much time, money, or expertise you pour out. 

We should have results from the stim test tomorrow. For now, sickly or otherwise, I’m just awfully happy to have her home.

What Annoys Jeff this Week?

1. The yawning gap in medical care. I’ve blown off most of my own medical appointments since March but the animals have all hit theirs on time or as needed. That probably says more about me as a person, or at least my priorities, than I’d really like to think about. It’s probably a function of simplicity, too. I can pull up to the vet, hand off the critters for a bit of the old poke and prod, and find a nice shady spot to wait. My doc, on the other hand, wants me to schlep into an office, sit in a socially distanced chair, and wait around with other people who have God knows what plague spewing from their face holes. I’m sure it’s completely irrational, but I’d have to be quite near death’s door myself before I thought that was a good idea.

2. Failure to communicate. I’ve long suspected that the biggest problem faced in dealing with Great Plague is one of basic communication. Given the patchwork nature of our republic (combined with a relentless 24-hour news cycle desperate for things to fill air time), the public is presented with as many as fifty different, often conflicting bits of advice on mask wearing, the benefits of social distancing, and what businesses can be open and how many people they can service. There’s also the discomfiture when schools must close, but bars and restaurants can be open. There may well be fine, scientific reasons for why this is perfectly reasonable, but on its face, it’s a position that feels like it defies common sense.  Add in the fact that science, by definition, isn’t a static and recommendations change based on new data and it’s a recipe for public confusion. Frankly, I’m not even sure that cohesive national-level messaging and policy would do much in the face of how much conflicting “information” is available through every website that proports to carry the latest news or medical advice.

3. America’s Mayor. In September 2001 Rudy Giuliani was lionized as “Americas Mayor” for his grit and determination in leading New York City through the aftermath of the terrorist attacks that brought down the World Trade Center. His steady hand on the tiller and regular presence at press conferences, exuded a calm that almost none of us felt at the time. Fast forward almost twenty years and it’s hard to believe we’re even seeing the same person. From his presser live from the parking lot at Four Seasons Total Landscaping to his performance yesterday in federal court, where he seemed to forget the name of both the presiding judge and the opposing counsel, the mayor appears to be a poor shadow of himself. For those of us old enough to remember him as a masterful leader when we most needed one, it’s an awfully hard thing to watch.

On the day after…

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.

A bloody mess…

The morning feeding here starts most every morning at 5:30. It’s usually a completely uneventful part of the day. Today it wasn’t, of course. It was a bloodbath.

For the prior 24 hours Maggie had been growing a fearsome looking lump under her incision. It was worrying enough that I changed her follow up appointment to this afternoon rather than waiting for Thursday, when it was originally scheduled. We fell seven hours short of that appointment when she dove into her breakfast and the dam broke – leaving a trail of blood tinged fluid dripping down her shoulder and quickly spattering the floor.

“Not good,” my initial early morning response. Maggie didn’t seem bothered at all. She didn’t even slow up on inhaling her breakfast.

Over the next three hours, what I’ve now learned is a common post operative condition called a seroma, steadily grew smaller as the fluid continued to drain – mostly into the kitchen floor. I’ve mopped today. A lot.

Our vet assured me this is all fairly normal. He was happy enough with her progress to take her sutures out, and advising “just let it drain” while handing over another 10 days worth of antibiotics just to ward off any future issues.

So here we all are, confined once again to the kitchen in an effort to keep random canine bodily fluids from soaking in to more sensitive parts of the house. I can only hope this iteration won’t take nine months.

I’m happy my girl is on the mend… though I wish it would involve just a little less oozing.

What Annoys Jeff this Week?

1. Numbers. This blog is my own little catharsis and never really intended as clickbait, but sometimes I really do wonder what sorcery is behind the numbers. My view and visitor numbers have been all over the map for the last few weeks. There’s no seeming rhyme or reason for days that are up or down. Posts that I think should be a hit end up idle and those that I thought fairly bland rack up visits. After fourteen years of doing this, you might be tempted to think I’d have a clue. If you thought that, however, you’d be 100% wrong.

2. Incredulity. The number of times in the last six weeks that I’ve been asked some version of “Aren’t you starting to go stir crazy?” is telling… if only because it reveals how many people don’t really “get” me at all. I’ve got books, critters, ready access to food and liquor, the ability to have almost anything on earth delivered to my front door, and can leave at any time for goods and services that need to be sourced locally. I feel no fear of missing out. Staying home isn’t punishment for me. It’s the life I thought I was going to have to wait another 15 years to have for myself… and after sampling it, I can assure you going stir crazy is the very least of my worries.

3. Persistence. Maggie has been quite a trooper, never so much as attempting to lick or scratch her enormous incision. Keeping a certain white and brown young canine sibling from trying to lick it all the time has been my other full-time job this week. Seven days into healing and he’s mostly stopped – though not before a few full-blown screaming fits on my part. I can sense him still searching for an opportunity. I usually appreciate and even respect that kind if persistence, but in this one case, I’m going to need him to knock it the hell off.

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.

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.

Updates on a chocolate lab…

A couple of weeks ago, I took Maggie in to the vet for her regular checkup. As they get older, I approach these visits with increasing trepidation with every dog – mostly out of the fear that the vet will find something that should have been obvious to me, but that I missed simply due to familiarity, or that the regular blood work will show something new having gone out of whack since the last visit. For better or worse old dogs are just like old cars or old people – sometimes shit just stops working for no other reason than it’s old and broken.

Given Maggie’s last six months and the extensive vetting she had to get over her stomach trouble, I had lots of tests forming the baseline. Some of them I was expecting to be bad just as a matter of course. Others I expected to have gotten worse over time. It didn’t quite work out that way.

Maggie’s blood work came back with all the key data points “in range.” Even if it’s being held there through the advanced application of chemistry, it was as good a result as I could have hoped for – and not the one I was expecting. At a minimum, I went into this series of tests assuming that we’d be dialing up her medication to hold the same ground.

There’s no hiding the gray in her muzzle. My girl is still and old dog. She’s still got Cushings. But for the time being it hasn’t gotten worse. It’s still being effectively managed with her current dose of medication. Believe me when I tell you I don’t take that for granted for even a moment, because I know just how quickly the opposite can become true.

Although Maggie’s checkup was mostly good news, we’re headed over to the veterinary ophthalmologist in two weeks to get some small lumps and bumps looked at. One is purely cosmetic and has been there for a few years now, though it’s gotten bigger and is prone to bleeding when she rubs it. The other, most likely a small benign tumor or skin tag, is starting to form on the inside of her eyelid. This new one is the most troublesome to me since it’s in direct contact with her eye, though I’d like to see them both gone for her comfort and my peace of mind.