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The only thing necessary for the triumph of evil is for good men to do nothing. ―Edmund Burke

Sick Dog: Deciding what to do…or not to do

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Cassie is getting steadily worse. Today she can barely drag herself around, and she refuses to eat anything, even a single piece of the fancy kibble I give her for treats. Twice now, this dog has been so sick that I thought she might die, very soon.

I’ve made another appointment with the “second opinion” vet — turns out the one I saw out there was actually a part-timer, a kind of visiting vet, but now the regular guy (who sees my son’s dog) is back. This afternoon, he will have the joy of seeing a cranky old lady and her sick little dog.

This is what I think…oh, no. Make it this is what I’m sure of: The drug given for supposed Valley fever, fluconazole, is making her very sick. All of the symptoms she’s suffering, except for the bloody urine and the wheezing, are listed as side effects of fluconazole. We do not have any empirical proof that the dog actually does have Valley fever: the first test came back negative for Valley fever. This is not uncommon, and so we moved forward with the first vet’s diagnosis.

The longer the dog is on this drug, the sicker she gets. Today she will eat nothing at all, and she can barely move around, except to piss out an occasional lake on the family room floor. She is incontinent and unable to get to the back door before it all comes pouring out. Of the phenomena she’s suffering, almost every one of them appears in the University of Arizona Medical School’s list of fluconazole side effects in dogs:

  • loss of appetite
  • nausea
  • vomiting
  • diarrhea
  • excessive drinking and urination, or leaking urine while asleep
  • lethargy

If she doesn’t start to eat, she’s going to starve to death. I cannot afford to hospitalize a dog and keep it on life support so as to administer a toxic drug on the off-chance that three to six months of such treatment will beat back a fatal disease.

I can see four reasonable scenarios to explain what’s going on:

Possibility 1: She in fact had the contagious bronchitis that was going around, but because she’s elderly, it took longer for her to get over it and so it was mistaken for a chronic, endemic disease. In this scenario she does not now and never has had Valley fever; what ails her is either a respiratory infection or the side effects of the drug.

Possibility 2: She does have Valley fever acquired fairly recently and, as is not uncommon, it hasn’t shown up as a positive titer yet. In that case the drug is causing most of the symptoms, with the exception of the cough.

Possibility 3: She’s had Valley fever for awhile (just about any human or dog or horse that lives for any length of time in the low deserts of Sonora, Arizona, and California harbors Valley fever, usually asymptomatically) and it has advanced to the point where it is causing symptoms. In that case, the drug is still causing most of the symptoms, but it’s not likely to do much good.

Possibility 4: Now for something completely different! She has neither bronchitis nor Valley fever, but some as-yet-undiagnosed ailment that is much more serious. Her symptoms may be indicative of that…or may be the side effects of a drug she doesn’t need.

Just talked to First Opinion Vet, who finally had time to call me (it’s the lunch hour here). His money is on Possibility 4. He thinks there’s something more going on than Valley fever. He says the only way we can find out is to mire ourselves in every more complicated and expensive tests, and where the end-point would be is anyone’s guess. He feels that is not a good thing to do to the dog…and I will say, neither do I. Even if I could afford to be sucked into a vortex of medical testing for a dog that is at the end of its natural lifespan, my sense is that it would be cruel to put her through that — especially since it’s likely to be pointless.

As for me, I’m putting money on Possibility 1: she had bronchitis, was inappropriately treated for it, and got over the cough in the normal course of events. And what we’re looking at now is the result of a drug that did nothing for the ailment but has worked wonderfully to make her spectacularly sick.

I had already decided, before His Vetship called, to take her off the drug, stand back, and watch what happens. If she dies, she dies. Like all of us, she’s gonna die anyway. When he called and heard my whinge — and more to the point, heard that the dog not only is not improved but is lots worse — he agreed that we should quit giving her ALL the drugs, including even the small amount of Temaril-P. If it’s true that the worst of the ailment arises from the drugs’ side effects, she may feel a little better even if the underlying problem is something we haven’t figured out yet.

Which, IMHO, is a veterinarianly way of saying “ooops!”

Let’s see what happens next.

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5 Comments

  1. Poor Cassie! I hope taking her off fluconazole will cause her to bounce back. It sounds like she never had Valley Fever anyway. Good luck with her.
    I too don’t see the sense in spending lots of money on an animal when the animal is very elderly and nearing the end of a natural lifespan. It is just not compassionate.

    • She surely isn’t well this morning. She seems to have her ups and downs; right now she’s deep in a down. Yesterday I thought she was better: though she refused to eat the dog food I’ve been giving her and Ruby, she did eat some hamburger that I cooked on the grill. Twice: a quarter pound in the morning and another quarter pound in the evening. But this morning she refuses to touch it. She’s just laying there on the floor…frankly, from a human perspective it looks like she’s laying there waiting to die.

      But…wait…she just got up and walked outside. Well. That’s something. At least she CAN walk.

  2. Sorry to hear all this. Hopefully the removal of the drug does make things better. If it is the drug causing the issue, then it sounds like having her live with the disease itself would be better than trying to treat it. Or maybe she’ll show a recovery. Or, like the possibility #4 you listed, maybe it’s neither the drug nor the potential illness, and something worse.

    I agree with you on not doing a whole lot more testing. I had a cat years ago that they found a lump on it’s neck. They said it was probably cancerous but did I want to do a biopsy and check? As I had no interest in putting a then-15-year-old cat through cancer treatments, I declined. About nine months after that, one day she stopped eating, went and sat in a corner she never had sat in, looked at me, and I knew what I had to do. That sucked, but it was definitely better for her that way than a biopsy and who knows what else, for likely the same outcome.

    • Yup. That’s pretty much what Cassie is doing right now. She’s about stopped eating — managed to coax a few bites down her just now, but then she just shoved the next little piece aside. Try again: shove it out from under her nose. I don’t think she’s long for this world…but…but wait! Here she is! Swilling water, which is going to give her a choking and wheezing fit. Swilling as LOT of water…yes, choking and gagging (as usual)…walking into the room…flopping down on the floor. Hm.

  3. Oakley was sick for three weeks after her vaccinations. She couldn’t eat or walk. I slept on the floor next to her every night and one fine day she slowly began to recover. You just never know. Give your pooch a bit more time off the meds. You never know.

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