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Doggy Update: Death Refuses to Have Her

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So Cassie the Beleaguered Corgi seemed better after mid-morning. She kinda sprang back. Along about 2:00 p.m., we had an appointment with a vet at the clinic where my son takes his dog. My, that was a refreshing drive: only took about 10 minutes to get there, as opposed to the 40-minute drive required to arrive in MarvelVet’s precincts.

I explained my questions and misgivings to this vet. She allowed as to how these were reasonable questions and thought that indeed there was some ambiguity in the various indications. All in all, though, she agreed with MarvelVet that what ails the dog is probably Valley fever.

However, on this check-up Cassie seemed significantly better. Whereas MarvelVet was alarmed because he could hear the congestion in her little chest, today no such sounds were audible. Her temperature was down to normal. Her cough has been better most of the day. She only wheezed once at the vet’s office.

She (vet) also said the fluconazole should have few bothersome side effects in dogs. She thinks Cassie has been dragging because of the ailment, not because of the cure. And she suggested testing her again in three or four weeks, by which time she suspects the titre will change from negative to positive.

Hm.

The incubation period for Valley fever is 7 to 28 days after exposure. If you believe this is a new infection, that would make sense: this summer we had several dust storms that blew into the hood. Because we’re in the rain shadow of the North Mountains, we do tend to be protected from so-called “haboobs,” a stupid sell-newspapers name for dust storms, but this year they were pretty fierce. So…yeah…maybe she picked this up over the summer.

But the truth is, if you live in Arizona’s low desert, you’re exposed just by virtue of living here. You can harbor the fungus for a long time without ever noticing. The if something happens to dent your immune system, voilà! You notice…  And 12 years of doggy age — some 70 years± of human years — most surely is enough to dent your immune system. WhatEVER,,,the likelihood of her having picked it up over the past decade or so is extremely high.

So this vet: she’s from Trinidad. I liked her a lot. She spent a lot of time examining the pooch and chatting with the human, and it was clear she really knew what she was talking about. Yeah: I was impressed.

She and her husband, an IT dude, are so revolted by the political situation in our country that they’re seriously thinking of moving back.

And therein lies the brain drain issue: they’re only two of the many young professionals I know who speak of leaving the country. Permanently. If we haven’t stupided down America enough, the present administration is busily delivering the coup de grâce: when all the bright young men and women leave, we’ll have only a few smart old people left to keep the nation on track. And once they’re gone? Bye-bye American Republic, hello Banana Republic.

But as for the dog? She seems much better right this minute. She drags in the morning, but by mid-day perks up. There’s hope that she may still have a year or three of the good life. Or maybe even…greatness…

 

Doggy & Human Ups and Downs

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Luckily for the Human, it had agreed to host a dear friend and cat for an hour or so, while hordes of Realtors swarmed through their house, which they’re putting up for sale. They didn’t want to be there, and they surely did not want their cat there, while a bunch of strangers cavorted around the place. So the wife went to the beauty parlor and the hubby and kitty came over to the Funny Farm.

This provided a therapeutic break for the Human. I really needed some company this morning. The damn computer was working hard to thwart me at every turn — had a helluva time trying to catch up with the gerjillion tasks running late, and whenever I did manage to get something more or less posted, it invariably went up wrong, so I had to delete stuff and try to dork with it to get it to do what it was supposed to do and UGHHHH! I hate that kind of thing under the best of conditions, but when with even a small degree of extra stress, it drives me CRAZY!

And there was plenty of extra stress. Cassie the Corgi seemed even sicker than usual. She had a hard time eating the food I put in front of her. And when I smushed some dog food around her morning pill to get it down her, Ruby pounced and grabbed it.

Honestly, I do not know which dog swallowed the pill, but I’m pretty sure it was Ruby.

So this means that every time I have to medicate Cassie, I’ll have to lock Ruby behind a door in another room. One more fun hassle to make life grand.

Things went downhill from there. Mostly in the computer department.

Enfin, with the cat and the guest here, the dogs were locked up in the back bedroom. Good place for ’em!

When I returned from delivering my friend home and released the hounds, strangely enough Cassie seemed much more perky.

This morning I’d have said she was pounding on Death’s Door. Five hours later, she trots into the backyard, chases Ruby a short way across their racetrack, and appears to have lost the limp.

Yes. A limp is a symptom of disseminated Valley Fever, so as you can imagine the fact that for the past few days she has barely been able to hobble up the hall has been making me crazy. Yet another of the many things to make one crazy.

But she limps all the time. She’s always limped off and on, ever since I got her 10 years ago. Just not this badly.

Maybe it’s not from whatever is ailing her, but maybe she was injured. I have to lift her both on and off the bed. It’s possible I accidentally twisted her or kinked something, unknowing, and maybe that’s why she was limping. Or maybe Ruby gave her a whack when I wasn’t looking. WhatEVER. For a brief shining moment, she’s been limp-free.

In about 40 minutes, I’ve got to start yet another long trek toward Scottsdale, this time to visit the vet my son uses. I want a second opinion about the Valley fever theory. Several second opinions to address several concerns:

To wit: Can we please get empirical proof that this dog really has Valley fever before putting her on a drug that’s clearly making her sick and then proposing to keep her on it for six months to a year? Or more?

The dog came down with a cough at the time some sort of respiratory infection was epidemic. The cough improved when treated with antibiotics and a cough suppressant, but it persisted longer than expected. Is it not possible that it took her longer to get over a viral bug because, for godsake, she’s 12 years old! She is an elderly dog. Like an elderly human, she may not recover from infections at the speed of light. Is it not reasonable to suspect that the elevated neutrocil and monocyte values might reflect an ordinary viral respiratory infection, not Valley fever? Might the congestion Dr. B saw on the X-ray be pneumonia or bronchitis, rather than Valley fever?

Does it really make sense to dose a 12-year-old dog with a drug that makes her sick, and to keep her on it past her normal life span? Seriously?

Damn it! I hate to be one of those patients. But my innate skepticism just will not go away.

And my innate skepticism has served me exceptionally well in the past. One might even call it, say, a kind of survival mechanism.

Second Opinions…and you didn’t think of this…WHY???

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Ever realize your mental field of vision has some blind spots? Like you don’t think of the MOST obvious things, just because the circumstances were outside the routine parameters?

Like, for example, one of my Standard Operating Practices. To wit:

Whenever a doctor utters some pronouncement, always get a second opinion.

During the late, great boob adventures, I learned that one in spades: always, ALWAYS get a second opinion.

Seems like common sense, doesn’t it? You could even say it seems, yes, “obvious.”

Well. Then howcum it’s not obvious to get a second opinion when the person uttering the pronouncement is not a medical doctor but a veterinarian?

Even when that veterinarian is a very smart vet, a very excellent vet, indeed quite possibly the best vet in the Valley? His opinion is highly informed. Highly smart. Very likely right. But still…we are lookin’ at one man’s opinion here. One man’s highly lucrative opinion…

Comes the crack of today’s dawn, Cassie is really not well. Although her cough is gone, she’s visibly very sick. This pining away began slowly in the days after I began administering the Valley fever drug fluconazole, and as of today, she has developed a limp. She’s still eating, but not with normal corgi enthusiasm. She has become intermittently incontinent: if not taken outside often, she may urinate, apparently involuntarily. Yesterday, when I came home after a 3-hour absence, I found her sitting at the door in a lake of urine.

But the cough is gone.

But…the cough was gone before we started her on this stuff…

What if the drug itself is what’s making her sick now?

The reason she’s on the drug, even though the Valley fever test came back negative, is that MarvelVet doesn’t believe the test. He says (correctly) that the test often produces false negatives. Looking at other elements of the test results — neutrophil, monocyte, and albumin levels — he deduced enough probability that she might have Valley fever to justify putting her on fluconazole.

Hm. Izzat so?

With this nagging thought in mind, I called my son’s vet and got an appointment tomorrow. Then trotted over to MarvelVet’s office to pick up the new bottle of pills he’d ordered up…and, while there, asked for a copy of the test results. These, I intend to offer to the Second Opinion Guy, along with a raft of questions…

Why might a lowly editor in mathematical biosciences question the diagnosis of a graduate of a fancy university veterinary program? Well…

  1. Neutrophil and monocyte levels can be elevated (as Cassie’s are) by any infection. She had a severe cough for a couple of weeks, which could have resulted in these elevated readings.
  2. The albumin level was low but not outside the reference range. Here, too, any infection can affect albumin level, as can liver damage. Fluconazole elevates liver enzyme levels, often an indicator of a liver damage. Also, at 12 years of age, this dog is elderly; “normal” values shift in older animals.
  3. No symptoms of disease were ever evident before this episode. The dog shows normal signs of aging – slowing down a bit, a little grizzled around the muzzle – but has been active, playful, alert, and always ready to eat, until the current coughing spell occurred. The coughing could be caused by Valley fever, but it also could be caused by a severe respiratory infection. So, I suspect, could the elevated neutrophil and monocyte levels.
  4. A contagious bronchitis has been going around the Valley, to the extent that on first hearing about the cough. Dr. B assumed that was the issue. In a daily mile-long walk, Cassie sniffs a lot of dog pee and often greets other peoples’ dogs, and so it is reasonable to believe she was exposed to a contagious disease.
  5. The incontinence and lethargy are classic signs of fluconazole side effects. She experienced neither before exposure to the drug. I’m concerned about keeping the dog on a drug with many unpleasant and dangerous side effects for 6 to 12 months, especially since there appears to be a possibility that the problem is a bronchial infection, not Valley fever.
  6. Where humans are concerned (not dogs), the Mayo Clinic states the first line of treatment is rest, even in the event of severe symptoms:

Rest
Most people with acute valley fever don’t require treatment. Even when symptoms are severe, the best therapy for otherwise healthy adults is often bed rest and fluids — the same approach used for colds and the flu. Still, doctors carefully monitor people with valley fever.

The dog improved notably when I started tricking her to ingest more water. She cannot drink well because, like many corgis, she chokes when she tries to drink. However, when a small amount of kibble is floated in water, she manages to take in the whole bowl of 1/4 to 1/2 cup water without gagging. When she drinks more water, she seems to feel better. As long as she’s not sinking below the waves in a lake of pee…

So the questions to address with a) Second-Opinion Vet and then, depending on what S-OV has to say, with b) First-Opinion Vet are all what-ifs…

What if…the coughing really was caused by the bronchitis that F-OV originally diagnosed? What if…the reason the cough persisted so long was simply that she’s 12 years old: a very aged dog. By one account,that would make her between 69 and 74 years old, in human years. And that assumes that she really is 12 years old. She could be significantly older…remember, I got her at the Humane Society. Ever watched dog rescue folks at work? They have only the vaguest clue. When asked what a dog’s age is, they come up with a number based on such things as the condition of the dog’s teeth and its overall appearance. Typically they’ll say “two” because people think that’s the age at which a dog is house-trained and stops eating the furniture. If she’s just one year older than that, then she’s in the range of 74 to 78 human years. Two years older, and we’re lookin’ at the equivalent of a human in her late 70s or early 80s.  Which, we might add, is exactly how this dog is acting.

So what if she actually had a severe case of bronchitis and took longer than a week to throw it off, a) because it was a bad bout of it and b) because she’s an old lady and old ladies don’t get over sh!t very fast. If that were the case, it would explain the high neutrophil and monocyte levels and the low albumin level.

And given that we can’t really know, one way or another, if that’s true in the face of the unreliability of the Valley fever titre test, what if the Mayo Clinic is right? What if the best first-line approach is to leave her alone? Would she be harmed by taking her off the side-effect plagued drug and watching to see what happens?

Do we really want to put a dog that’s at the end of her natural life span on a drug with many unpleasant and dangerous side effects for 6 to 12 months? That is, for longer than, under the best of conditions, the dog is likely to live?

Seriously?

 

 

What d’you make of this story…

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So, I cannot bear the prospect of reading another word of academicese…there must be something better. Like, for example,

This interesting story just in from NPR, found on the LA station’s website.

Take a read of it, and then tell me: what do you make of this piece?

To my eye, it comes across as a sophisticated, well written version of what we used to call a “sob story”: a human-interest newspaper piece specifically designed to twang the readers’ heartstrings, thereby selling more papers.

It would be cynical, though, to say that’s exactly what this is. Because it’s not. Exactly. Homelessness — leaving out the “drug-addicted” aspect for discretion’s sake — has become a vast problem in this country, and it’s getting bigger fast. Putting a human face on the grimy, road-worn souls milling around outside your office, hitting you up for a handout when you sit down for breakfast at a restaurant, panhandling on the street corners, chasing you around the grocery store parking lot, and rummaging through the trash bin outside your home (to say nothing of stealing everything in the yard that’s not red-hot or nailed down) is a sure way to help Americans understand the dimensions of the problem and that the people caught up in it are people.

Still. Enough is left out of this report that you…well…you wonder.

For example: here we have a report that the tent camps our vagrants put up along sidewalks or (here in the ’hood, for example) next-door to a middle school are controlled by criminal gangs, who extort money and drugs from the occupants. One could even call these street-campers “renters,” since in effect they’re renting space from gangs. “(LAPD Officer Deon) Joseph says the landlords are the gangs. In order to stay on the block, he explains, one woman here was forced by the Grape Street Crips to give up her entire Social Security check every month.”

Okay. If she’s getting a Social Security check, the minute that thing comes into her PO box or arrives down at the social service agency where her mail comes in, right in that moment she has enough to get on a bus and ride out of town. Even if what she can afford is not very far. Every Greyhound bus in the country follows some route out into the boondocks. So…why doesn’t she wrap up her tent and her belongings, take herself to the Greyhound station, and ride out into the sticks, where the Crips are unlikely to follow?

True, the thugs may stop her from wrapping up her tent. Though it must be said: if Officer Joseph knows as much about these folks as he seems to in the article, why would she not go to Officer Joseph (after dropping her meth pipe and other paraphernalia in a trash can or hiding them someplace near the Greyhound station) and ask him to stand by while she packs up her stuff and watch while she boards a city bus and makes her getaway? Maybe Officer Joseph could even drive her to the Greyhound station.

If you’re sleeping in the rough, chances are sleeping in a national forest or on BLM land is going to be a lot safer and a lot more comfortable than sleeping on the streets. When SDXB and I hitch-hiked through the back country of Canada and Alaska, we slept under roof exactly two nights in three months — because it was raining so hard that even he would not put up with it. A couple of times, when we were in a small city, we camped overnight in a parking lot. And I’ll tellya: asphalt or concrete is damned uncomfortable to sleep on. The ground — dirt — is far preferable. And the boondocks are far preferable to an urban setting: quieter, and though there are a few crazies stumbling around out there plus the occasional bear, surprisingly few Crips and Bloods.

We have an observation from a social service worker, who sounds very experienced:

“They are you or me divided by circumstance,” says Georgia Berkovich, of the Midnight Mission. “A catastrophic illness in the family that depletes their savings. A victim of domestic violence who would rather live on the street than be with their abuser.”

Financial issues and the lack of affordable housing are increasingly impacting women. No one never imagines they’ll end up on these streets, Berkovich says. “First you would stay with friends and then you’d stay with family and maybe you’d wear out your welcome and you say ‘we’ll just stay in our car.’ “

Yeah. But…if you have a car that you imagine you can stay in, then you have four wheels that will get you out of town. You can camp in most national forests and on BLM land for nothing. For what you could get by selling that car, you could buy a small tent, a sleeping bag, a camp stove, a few camp pans, a plate, and a cup, with a wad of dough left over. That and a decent jacket and boots will equip you for living on the land — one helluva lot better than anyone is equipped to live on the street in some gang’s territory.

Something is left out of this NPR story. Maybe it’s simply an answer to the question why stay in a gang-ridden city when rural areas have services for the poor and the homeless?

Interestingly, homeless levels are significantly high in the rural counties here in lovely Arizona. My guess would be the conditions described in this NPR piece are largely the reason. Poverty rates are higher in our rural areas, so that would tend to push up the numbers of homeless. But dollars to donuts, the rates of urban homelessness — city people who lose their livelihoods and their homes — increase the numbers of homeless in the boondocks. Because anyone who knows how to camp knows that you can live better beside a stream than you can beside a freeway.

Cassie the Corgi, Redux

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So around 6 p.m. the vet’s staffer called and said the dog’s Valley fever test came back negative.

Hallelujah!

However, said she, he wanted to talk with me but he had just gone into emergency surgery. Okay.

Along about 8 p.m., he calls. He says he suspects the test is a false negative (which, if xyou look it up, you’ll find is commonplace) because the X-ray looked very telling and other aspects of the blood tests he ran are strongly indicative of Valley fever. Yea verily, the UofA College of Medicine’s page on canine Valley fever reports, “Sometimes tests are negative early in the infection, especially the Valley Fever blood test, and they may need to be repeated in 3-4 weeks to establish the diagnosis.”

Having already come across this factoid in my first round of frantic reading-up on Valley fever as it manifests itself in dogs, I’m inclined to suspect he’s right.

He suggested we keep on giving her the fluconazole, at least until such time as we can run some other tests or watch and wait. He was heartened when he heard that the dog seemed to have revived late in the day, despite pounding at Death’s door, and that she seems more alert and active today, though she’s still obviously under the doggy weather. That she’s eating and drinking normally are positive signs.

Interestingly, they compound the drug at their office, which allows them to give it to patients for significantly less than you can get it if you have to go to a pharmacy with a prescription in hand.

She’s still plainly sick. But she seems a little better today, or at least, she has seemed so for a few hours. She’s flopped on the floor just now…need to pick her up, put her back on the bed, and turn on the steamer for her again. Poor old dog.

Cassie: Still Extant…

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…as far as I can tell.

Cassie-off-leashWhen I left the house this morning, Cassie the Corgi was very sick, indeed. Worse than before, by far. Coughing and choking and gasping for air and actually wheezing.

In the absence of a doggy thermometer, it’s impossible to confirm or de-confirm whether she has a fever, but her schnozz certainly felt very hot. I mopped her head with cold water — an effective way to address impending heat exhaustion in a dog, BTW. Works better with dogs than with humans because of the difference in the way the brain circulates blood.

She seemed unimproved.

Comes time to leave for choir, the thought crosses my mind: Lady, this dog is not going to be alive when you get back here…

Really, I thought she wouldn’t make it another three hours. She couldn’t walk a few feet across the floor without gasping for air.

But…I was supposed to be down at the church, so off I went, misgivings or no.

So after cruising southerly two or three miles, I go to turn left from Main Drag NS onto Least Annoying Main Drag EW to get onto Main Drag Leafy Parkway, whereinat resides desired House of God. Traffic clears, I make my turn, and

POP! There’s some clown on a bicycle in front of me, on the WRONG SIDE OF THE ROAD, flying through the intersection in the crosswalk.

That is, he’s not traveling on the righthand side of the roadway, as is the law here in our garden state. He’s on the lefthand side, riding on a sidewalk. He’s  in the crosswalk  legally — we both have the light, of course. But he’s not where a motorist would expect to find him, because he’s riding on the shoulder against the traffic.

I jam on my brakes. He jams on his brakes and in his alarm very nearly falls on the pavement. By now cars that were wayyy on down the road are upon us — traffic flows at 45 to 50 mph on that street. He looks confused and scared. I holler GO GO GO!!!! and he jumps back on and dodges out of the way in the nick of time.

Holy cripes. What is the matter with people?

Stumbling across the church parking lot, I think THIS is a towel that I need to throw in. Unnerved by the biker episode and really worried about the dog, I announce that I can’t stay, turn around, and come home.

Not over yet, though:

When I climb back into the car to leave the church parking lot, I notice the statement the vet’s office-lady gave me. I would swear she said the bill was $45. No. They engrossed FOUR HUNDRED AND EIGHTY FIVE BUCKS from my checking account!

Holy mackerel! And that’s just to try to figure out what’s wrong with her! He gave me the pills for free, which was mighty kind of him ’cause it turns out that drug goes for — hang onto your hat — $200 a bottle!!!!!!!

I fly back to the house. From inside the garage I can hear Cassie barking merrily. WTF? She could barely drag herself across the floor 30 minutes earlier.

Fling open the door: they’re both doing the welcome home Odysseus how was the Trojan war? dance. They streak out the side door, as usual, like rockets. Cassie doesn’t get far, but she does manage to work herself up to a dead run. Briefly.

Which is better than what I expected: just plain dead.

Well, we’ll find out tomorrow whether the dog’s lung inflammation is really Valley fever, or if she has some other kind of infection. He said he was sure it wasn’t cancer, so I guess that for $485, we can discard that notion.

There are two similar drugs on the market that are cheaper than fluconazole. In fact, this stuff is for the disseminated state of VF. If it’s just in her lungs so far, then we could probably switch to one of the other drugs, which are a lot cheaper. Dr. Vet and I are going to have to have a little chat about this…

Makes “let nature take its course” look depressingly like good advice, doesn’t it? I guess if I have to put her to sleep because I can’t afford exorbitant amounts of money to get her over this thing…well…