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.

Vetting or: The tale of a sick labrador…

Over the years I’d grown so accustomed to having one sick dog and one well that last month I even noted my budget had gone wonky from the unusual lack of vet bills. You’d think by now I’d know better than to open my electronic mouth and temp drawing the wrath of whatever from high atop the thing. If you thought that, of course, you would be wrong. My mouth has been, is, and seems likely to continue to be my worst enemy.

After a few incidents and observations over the last week or two, what I seem to have now is just one sick dog. Not falling over, edge of the mortal coil sick, but sufficiently sick that we’ve already run two diagnostic panels in as many days and scheduled the next – which promises to be an all day affair for my sweet brown dog later this week.

It’s one of those times when I’m ill served by having a professional and personal bent towards research and analysis – particularly as there’s absolutely nothing I can do about the situation until we strike on a test that does something more than confirm some of the possibilities. Just now we’re tracking it as potentially a kidney issue or a liver issue or the wildcard diagnosis of Cushings disease.

I’m told by those in a position to know such things that all of these are treatable – at least in the sense that it’s often possible to slow down the degenerative processes involved. Time, however, is a remorseless bitch and treatable does not mean “curative.” That at some point everything that’s alive will eventually be not alive is pretty much just one of the rules of nature. Even the best care simply prolongs the inevitable for all of us.

Maggie isn’t in pain. She’s her normal, happy labrador self. That’s something. Personally I’ll feel better when we have an enemy I can fight on her behalf, but for now I’m trying to be calm and contented in giving her endless chin rubs and maximum attention.

What Annoys Jeff this Week?

1. The time of the year. There’s a popular perception that people’s moods tend to improve has we head into the Christmas season. Maybe that’s the case for some, but not so much for me. By this time of year I’m just about worn down to the nub from relentless repeats of leaving home in the dark and returning there many hours later again in the dark. I loath and despise this time of year for the simple reason that for all practical purposes it means living like a mole for two months. If I manage to leave work on time and if it’s not cloudy, I do manage to catch the last few rays of watery sunshine on an occasional weekday. On a good day at mid-winter that lasts for somewhere between 5-15 minutes. So while everyone else is preparing their celebration of the birth of the Christian’s nailed God, I’ll be over here quietly awaiting the solstice and celebrating Sol Invictus.  

2. Thirty minutes. That’s how long it takes my work computer to boot up from a cold start on the average day in the office. Look, I can dick around for the first 30 minutes of the day with the best of them, but it doesn’t feel like a particularly great use of time. But hey, whatever. I can only use the tools and resources I’ve been assigned… Which is why I keep a stack of magazines on my desk.

3. Bulldogs. I love my bulldog. He’s almost eleven now. He’s got a permanent limp, only hears when he wants to hear, and seems happy enough to pass the time between feeding and being let outside lounging comfortably in one of his beds. He’s an old man and I don’t begrudge him any of that. For the last two months, though, we’ve been trying to get on top of what’s become a particularly aggressive skin issue. After two month of antibiotics and medicated baths we don’t seem to be any closer to a solution than we were at the back in late October. The condition itself isn’t something unusual – we’ve been working with bad skin for years – but the amount of time it’s taking to knock this one back is far more than history suggests should be necessary… and don’t get me started on $80 bottles of pills that don’t seem to do a damned thing. I love my bulldog, but if you find yourself ever thinking you want to fall in love with their wrinkly little faces, my advice for you is to take a hard pass. I’d never deny this one anything, but get yourself a dog instead of an eating, breathing, ongoing medical disaster… unless you have a sick desire to take lots of time off for vet visits and would rather not have to worry about disposable income. Then, by all means, bring home that adorable, smushed faced little pup.

Nose job…

I interrupted a perfectly nice telework day today to take George over to the reptile and exotic pet veterinarian in the next county over. One of the most endearing qualities of your average small sized tortoise is that they are a remarkably low-maintenance animal to keep around. Keep their enclosure clean and stocked with things to push around or climb over, daily feeding and watering, and they almost take care of themselves. Except, of course, for the times when they don’t.

Despite my best efforts to provide sufficient rough surfaces to keep George’s beak in check, it was obviously growing too long and would eventually give him trouble eating. The tortoise nose job turned out to be a 5-minute exercise with a Dremel tool that people all over the internet say you can do yourself. Honestly for less than $50, it’s well worth letting the professionals handle carrying out the task and giving the old boy the once over.

Maybe I’m too use to dragging a bulldog to the vet, but a quick trip where everything was easy and there wasn’t a massive bill due at the end almost felt like a let down – like something too easy. Then again I wasn’t the member of the herd getting a nose job with a Dremel so it’s hard to say what “too easy” might actually look like. I should probably just be satisfied that for the moment all the creatures are in reasonably good health and not racking up new bills.

Impatiently waiting…

I should start by confessing that I’m almost use to confronting all manner of canine medical problems. It’s one of the less charming, but utterly unavoidable side effects of living with an English bulldog. It’s just something you come to expect. I’m not entirely sure he can surprise me anymore. Usually my response is more of a “Oh, he’s broken again.”

It’s when the Labrador retriever pulls up with the medical mystery, I’m admittedly taken completely by surprise. She’s been a mercifully healthy dog and I’m more than appreciative of having at least one that doesn’t need nearly continuous medical supervision.

Unfortunately last week I discovered Maggie had a lump about the size of half a golf ball under the skin just below her ribcage. A trip to the vet and biopsy obviously followed – and in the meantime I’ve been spending the time keeping my mind off it as much as possible. Patience, as we know, is not one of my great virtues. Since I don’t run my own diagnostic lab, of course, there’s nothing for it but to wait and see what results come back.

I’ll do it, but I will in no way commit myself to doing it patiently.