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.

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.