A very good girl…

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.

Another vetting…

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.

Schlepping across Pennsylvania…

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.

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.