Coffee heat rising

Dispatches from Hell

Walmart(!) Neutralizes a Day from Hell…

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A cold day in Hell…

Yes. Walmart, bless its corporate heart, managed to bring a quick, neat end to what started out as a Day from Hell, morphed briefly into a sad but real Day from Heaven, and then began to slide downhill again.

Cassie the (Ailing) Corgi had a pretty good day yesterday — at some moments possibly even rising to a 10 on a scale of 1 (about to expire) to 10 (back to normal). Foolishly, I thought, oh gosh! she’s gonna be OK!

You’d think I’d know better by now, wouldn’t you? 🙄

Beginning about 1 in the morning, she started coughing again. And coughed the rest of the night away. By morning she was so exhausted she was immobile.

I call the New Vet at 8 a.m., the instant they open.

In the interim between the time the dogs and I roll out of the sack and the time I can reach the vet, I pick up the laptop and, in the course of glancing at the news and waypoints, visit a complicated draft “page” at Plain & Simple Press where I store material waiting to publish it. Yesterday I spent HOURS updating and fully formatting it, an endless, tedious, mind-numbing job.

This morning? It was A.L.L. G.O.N.E.

Yes. Hours of brain-banging work, disappeared. And no, I couldn’t retrieve it for love nor money. But there wasn’t much time to fret about it…

The vet’s staff asks me to bring in the dog at 8:45.

This was pretty tight because I had to sing at a funeral at 10. And this was not one I was about to miss, since it celebrated the life (and presumed afterlife) of a lovely friend.

Okay. Brush teeth. Wipe off yesterday’s make-up. Throw on some fresh make-up. Lift the dog into the car, where she collapses in a limp pile. Fly through the rush-hour traffic, to the extent that one can fly through such a thing, and make it with eight minutes to spare. Time ticks by as the vet and I and her underlings discuss. It’s pushing 9:15. I still haven’t fed Ruby and still am not dressed in the requisite black duds and still have a half-hour or more to get back to the house and another 15 minutes to get down to the church. Nor, we might add, have I had breakfast or even so much as a swallow of coffee.

Seeing that I’m getting anxious, they suggest I leave the dog at their clinic, where they will test her again for the alleged, never-proven Valley fever and test for heartworm, which can cause the same kind of coughing, lassitude, exercise intolerance, and bloating. At this point, the new vets persist in the theory that the problem is not the diagnosed adrenal tumor but in fact is yet-to-be-provable Valley fever. This is entirely possible: dogs frequently test negative on the first try at Valley fever testing. It has, however, been more than 4 weeks (by far) since the first effort, so if she does have the disease, by now she should test positive. They want to put her back on fluconazole. I tell them I’d rather put her down, it made her so sick. They propose another concoction that has even worse side effects.

I fly out the door and arrive at the funeral rehearsal right at 10 a.m., to the director’s surprise (since I’d emailed her that I’d be late). On the way there, I reflect that she was also taking prednisone during the last go-round with fluconazole. Prednisone had some mighty baleful effects on the dog. It occurs to me that there could be some drug interaction.

The funeral comes off very lovely. Dear friend and leader on the choir who just had hip surgery showed up and, amazingly, managed to get up the stairs and participate in the whole ceremony. Old friends who have been off the choir, beautiful voices, also attended: a joy to sit with them and listen to them sing again.

Later, when I get back to the house, I look the drug interaction question up and discover — from Pfizer, the horse’s mouth — that discontinuing fluconazole causes increased metabolism of prednisone, which leads to adrenal insufficiency. Which would explain quite a lot…possibly we could try the fluconazole in the absence of prednisone to see if it will go down any more easily.

Along about 3 p.m., I get back to the veterinary. Cassie is barking and looking pretty perky. WTF? She was at Death’s Door in the morning…I had to carry her through the house to the car and then carry her from the car in the vet’s door.

They did another chest X-ray, since they never were able to extract the image I paid for from MarvelVet. They also did a heartworm test and sent off for another Valley fever titer.

However, it’s beginning to look like the dog probably does not have Valley fever. The white area around the lung and heart that MarvelVet cited as proof of his hypothesis was gone; the sound of her chest has been clear for several weeks, and still is. New Doc believes the problem is and has been a bronchio-pneumonia, probably of bacterial origin because the doxycycline we gave her for the UTI she developed seemed also to help clear up the cough…and doxy is the drug of choice for doggy pneumonia.

Unfortunately the doxy made the dog so sick I had to take her off it after 19 days (of 21 prescribed). She thinks, though, that the dog may be on the mend, and she’ll be OK if we can soothe the cough.

So she suggests Robitussin DM, in a dosage she specified.

 As for the adrenal tumor, this new intelligence just in:

  • New Vet doubts that any of the dog’s symptoms have been caused by the adrenal mass, which the sonogram doc believes to be nonmalignant. New Vet says most adrenal tumors in dogs have no symptoms (this is not altogether accurate, but let’s put our money on it for the moment.)
  • She thinks the bloat probably originated with the prednisone, which should not have been given in conjunction with fluconazole.
  • Other more classic fluconazole side effects, including anorexia and stupor and obvious misery and diarrhea and labored breathing, were caused by…yeah: fluconazole.
  • Taking her off the prednisone without titering her off even more slowly than I did would have caused adrenal symptoms, and giving fluconazole at the same time as prednisone can cause adrenal insufficiency that may or may not go away in the absence of the drugs.
    • Read: we’re talking about an iatrogenic problem aggravating a misdiagnosed ailment…
  • She doesn’t seem to have an explanation for the extreme swings in the dog’s well-being: yesterday Cassie was at a 9 or even a 10 on the 1-10 scale; this morning she was back down at a 1 or 2.
  • The dog does not have and probably never has had a collapsed trachea.

So…if our furry friend picked this up while nosing around in the grass during a doggy walk (which is how such infections spread among dawgs), I guess I should feel lucky Ruby didn’t get it, too. Actually, Ruby did cough some, very mildly and for just a few days; she may have had it and thrown it off because she’s so much younger.

This poses the possibility, though, that Cassie could recover. Maybe.

Now, as for that Robitussin DM: for veterinary purposes, the stuff has to have 20 mg of dextromethorphan and 200 mg of guaifenesin per 10 milliliters of sauce. Ohhkayyy…

So I figure I’ll trudge down to the Walgreen’s, stand in line till the cows come home, ask a pharmacist to direct me to the correct concoction, and…ugh, how awful does that sound?

Why do that when I can order it up from Amazon?

Right.

Right?

R-i-i-g-h-t.

Amazon offers approximately 87 gerjillion variants of Robitussin DM. The only one that has this particular proportion of active ingredient-to-active-ingredient-to-inactive-ingredients comes in “prepackaged spoonsful.”

Say what?

I do not want spoonsful, prepackaged in plastic waste or not. This stuff has to be hoovered up into an oral syringe so it can be squirted down the hound’s gullet.

Now in the middle of evening rush hour, whereinat you can not turn east out of my neighborhood because of the effing stupid “reverse lanes” the city has inflicted on us, I set out for the nearest Walgreen’s, which rests near the corner of GangBanger’s Way and Commuter Nightmare Parkway East. This, I dread, because I’ve been harassed in that store’s parking lot before and do not look forward to more harassment. The other nearby Walgreen’s is here in the ‘hood — couldn’t pay me to unlock my car doors in front of that place, especially not at dusk. The third Walgreen’s is way on down East Commuter Nightmare Parkway; though I can turn into its parking lot (where I also have been harassed), turning out of it in a direction that will bring me home is, shall we say, highly problematic.

O shit o hell o damn i do NOT want to do battle with any one of those dreary Walgreen’s.

But…right about then it dawns on me that I don’t hafta. There’s a Walmart on the way to Nearest Walgreen’s. It’s on my side of the road (no illegal or risky left turns across torrents of traffic) and its exit guides me straight to a left-turn lane that sets me on my way home, via Gangbanger’s way. Hot dayum!

Get into Walmart. It’s crowded — I have to park a long way from the front door. This — crowdedness — is a good thing, because drug-addicted panhandlers tend not to pester anyone when there are a lot of people in the parking lot. Into the store without incident. Quickly snab a fine young pharmacist; tell him the challenge. The kid is ready to rise to it. We sally forth into the cold nostrum aisle, and darned if he doesn’t find a version of Robitussin DM that comes close to the required proportions.

I say this is 20 mg of dextromethorphan and 200 mg of guaifenesin to 20 milliliters of sauce, not to 10. He points out that the solution to this is simply to give the dog twice the suggested dose.

Yeah. Well: we do have the possibility that a rushed vet could have the proportion wrong.

I say the solution is even simpler: give her the suggested dose and see if it works. Often OTC stuff like this will work with less than the recommended dose. If it does: bully. If it doesn’t, so then I just give the second half of it. He allows as to how this is an acceptable plan.

I grab the dope, head for the door, and in spite of a hectic scene find a cashier standing there all by his little self. Pay and shoot out the door without having to wait a minute.

Traipse to the far end of the crowded parking lot: not a single panhandler in sight. Yes!

Thank you, Walmart! Who’d’ve thunk it?

Shingles Vaccine Wow II

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Holy mackerel, did that shot make me sick! If the extortionate price doesn’t make you sick, by golly, the vaccine itself sure will.

Growing up on the shore of the Persian Gulf, about as third-world as you could get in the 1950s, I enjoyed a lot of shots. Every malign disease known to prey on personkind was endemic in Arabia, and Americans living there had to take shot after shot after shot after shot. Every six months, I was hauled down to the hated clinic for yet another round of jabs: typhus, typhoid, cholera, tetanus, diphtheria, smallpox, whooping cough… They didn’t have polio shots yet, so whenever there was an outbreak, every kid in camp was dragged down to a portable and stuck with a vialful of gamma globulin — and lemme tellya, that stuff hurt! Of the routine shots, though, typhoid and cholera were probably the most painful.

But none of them hold a candle, for lengthy acute aftereffects, to this accursed Shingrix concoction. Holy shit!

Administering it is actually not very painful. But shortly after it’s been pumped into a muscle, your arm starts to hurt magnificently. This spreads up your neck, across your shoulders and back, down into your legs. Before long every muscle in your body aches. And your head? Wow, what a headache!

Unfortunately, I can’t take aspirin, ibuprofen, or acetaminophen. So these little aches and pains are just something I get to enjoy.

Hardly slept at all last night. I probably fell asleep for about an hour around 1 or 2 a.m., and that was it.

Then this morning I had to get up, climb in the car, and traipse across the city to the dermatologist’s office, south of Sun City(!!). At 9 a.m., the rush hour is still on…so that was jolly fun. Really, I shouldn’t have been driving the car at all, that’s how sick I was. BUT…I managed to shoehorn myself in to the doctor’s schedule  this a.m. to have them look at a recrudescence of this damn thing on my hand. They insist it’s not growing back and that it’s healing up. Yeah. Right.

Soaking in a hot bath for awhile helped some — which was surprising, since the stuff made me feel like I had a fever of 110 and I thought what was needed was cool water. But it’s damn cold in the house — we’re having some kind of a cold snap — and I just couldn’t force myself to stand in a cold shower. Surprisingly, the hot water helped.

That notwithstanding, I still hurt from stem to stern by the time I had to roll out the door.

God, how I hate driving in this city! It’s just like Southern California now: mile on endless mile of bumper-to-bumper, aggressive traffic through tracts of ticky-tacky housing and shoddy strip malls. And wherever you’re going, you can’t get there from here without an endless trek. Horrible place!

Especially when you feel like hell… 😀

To get out of the ’hood, I had to pull an “Arizona turn.” That’s when you dart out in front of traffic bearing down on you from the left, floor it to keep from getting hit, veer into the center turn lane, and make a Uie. This was the only way I could turn west on Gangbanger’s Way this morning. Ultimately, I had to do two Arizona turns: one to get out of the clinic’s parking lot and turn east to come home.

You wonder why I insist on a six-banger? Yeah.

All that notwithstanding, I was happy to be able to get a vaccine that at least has (heh!) a shot at providing some protection from shingles.

Shingles is decidedly not an ailment you want to enjoy.

Some years ago, I met a woman in Portal, a little dump in the Chiricahua Mountains. The Chiricahuas host a research station run by the American Museum of Natural History. It’s quite a place, and it attracts droves of high-powered scientists. These folks arrive there and fall in love with the place. The Chiricahuas form what is known locally as a “sky island”: with its own ecology, the area looks much like Bali Hai.

As a result, a number of very high-octane scientists take up temporary residence in Portal, and some of them retire there. This woman and her husband were among those who decided to retire. They built a home in a beautiful little canyon and took up bird-watching.

Shortly after they arrived there, she came down with shingles. A bad case of it. By the time I met her, she’d had it for two years, and it wasn’t getting any better. It had wrapped itself around her torso, so that she could not breathe or move without constant pain. About all she could do was huddle on the sofa, trying to stay still. She was, in effect, crippled.

At that time, there was no immunization for shingles. If you’d had chicken pox and you were pushing old age, you had a good chance of getting it. In fact, one in three older Americans get shingles. Some, obviously, are not as severe as her case. But…there’s no way of knowing who is going to get a crippling vase of it and who is gonna get off light.

I remember looking at that lady and thinking, holy shit! whatever you do, DON’T GET OLD!

Well. The alternative is fairly drastic, and so far I haven’t felt inclined to take advantage of it.

So even though the present episode was a passing miserable moment, and even though I’m really pissed that something so important to public health should be priced exorbitantly and not covered by Medicare D, I’m really, really glad to live in a time where the shot is available.

Image: Chiricahua hoodoos: By Zereshk – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=4171231

DogUpdate: A kind of reprieve

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Well…the (formerly) Fatal Vet Appointment got put off till mid-afternoon, because they had entered the Doomsday Appt in their calendar as the 19th, not today (???????? Not easy getting competent help, is it?). Can you imagine how I would have felt if I’d shown up there at 9 this morning expecting to shove Cassie’s raft out to sea, only to be told wooopsie! come back next week!

Argha.

At any rate, I took both hounds up there to get their claws clipped at the same time I confer with this vet about Cassie’s fate. Because it’s been almost three months since either of them has had a walk on asphalt and concrete (which keeps their claws sanded down), they both had scimitars sticking out of their toes.

So along about 2:30, it was off to the vet on the northeast side, a little easier drive than the junket to MarvelVet’s and, as I’ve designated her in my mind, an opportunity to confer with a source for a second opinion.

This vet felt Cassie was, of course, on the decline, but not as bad off as the Senior Drama Queen has thought. She thought it was best not to subject the dog to any more treatment, since it seems that Cassie is even more hypersensitive to drugs than her human is. She got her hands on the report from the guy who did the ultrasound, who also works for her practice, and said it indicates the little pooch does have a large growth on her adrenal gland but it probably is not malignant. That notwithstanding, the dog does have Cushing’s disease (a manifestation of the tumor’s interference with the adrenal function). She certainly thought the dog’s days are numbered, but not in the single digits. When I remarked that MarvelVet estimated she has about 3 months, she visibly restrained herself from wincing and then said she does not emit predictions of life expectancy because the risk of being wrong is extremely high.

She also thought it was a positive sign that in Cassie’s ups and downs, the ups tend to return to 9s and even 10s, if for brief periods.

She did a fairly involved inspection of the dog’s joints and concluded that she has arthritis in her hips and shoulders and that probably explains a) her tendency to drag me backward while Ruby drags me forward and b) the episode of obvious pain that occupied several days earlier this week.

They clipped the scimitars off both dogs’ feet. Ruby, still being mostly a puppy at heart, is always effervescent and so if this made a difference to her, it was impossible to discern. Cassie seems A LOT cheered by being able to walk around more comfortably. So presumably those claws’ deforming her gait contributed to her arthritic discomfort. Just now, despite a long car ride, a mildly stressful vet visit, and a long wait in the car while I made a run on the mega-Fry’s at Tatum  & Shea, she seems pretty perky (comparatively). She’s barking conversationally, walking around, merrily crapping on the flagstones, and in general appearing to still be alive.

MarvelVet may be right about the 3 months. But that’s a lot different from 3 days…

Tomorrow I’m going to start trying to walk Cassie just a few yards up the block in back; then retrieving Ruby and doing the regular 1-mile walk with her. The vet didn’t think Cassie would ever get back up to a full mile-long junket but thought she might be able to build back up to a block or so. She thought this might help her.

So it goes…

Black Cloth and Ashes

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Two funerals in the past week or so, and now we have to sing at another on Friday.

California is burning down. Friends who live near or in the fire areas are, if not fleeing for their lives, in an uproar of terror for those whose lives are being upturned.

Yesterday I made an appointment to take Cassie the Corgi in to the vet to be put to sleep. Monday morning. She was in such bad shape she could barely walk, and could not step up over the threshold of the back door without being lifted over it.

Forthwith my son appeared, to argue against it. She was in such terrible shape, though, that I couldn’t take very seriously the argument that she might not be so bad off. He actually offered to pay the $1,000 it would cost to do surgery to remove the supposed tumor on her adrenal gland (without realizing, I think, how complicated and iffy that surgery is).

But…

But today, she’s sprung back! The limp is almost gone (she’s always had a little limp, but yesterday she was crippled). She’s barking again. Though she still has a bit of a tragic expression and she’s still bloated (a sign of Cushing’s disease), she seems relatively…cheerful, I suppose. She’s about 80% of normal.

So…now I don’t know what to do. It’s possible she was injured…maybe her back got twisted while she was being lifted onto and off of the bed. Or maybe something happened that I didn’t observe.

If she continues at 80 to 90 percent, I suppose on Monday I’ll have to cancel the appointment. Or maybe take her in and ask the vet if she can come up with something to treat her. There are a couple of drug treatments for Cushings that can extend a dog’s life. But they have nasty side effects that probably will make her plenty miserable in their own right. So…what? I substitute one horror for another? Why?

Meanwhile, the effort to freeze the supposedly benign tumor off my hand seems to have failed. It’s healed up and the scab has fallen off and it still itches frantically. At night along about 1 or 2 in the morning it starts burning, awakening me with pain radiating up the arm. Lovely. So I guess we’ll have to jump through that hoop again…or actually do surgery on it, after all, which probably is what should’ve been done in the first place.

So…helle’s belles. Who knows?

Hallowe’en Doggy Update

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Welp, Cassie the Corgi is not yet among the Undead. She had a pretty good time last night greeting young trick-or-treaters, though she fell asleep before the flood of kiddies subsided. This was OK: Ruby took over the job of loving up each and every kid and their parents, aunts, uncles, and friends.

Is she better? Quite a lot. She rarely coughs now, and when she does it’s very mild, a single huff or two. She’s a little livelier. She’s come out of the bathroom nest and usually parks herself near the human. The urinary incontinence is gone, the tragic look is gone. She’s gained back the weight she lost. She’s sleeping through the night, and she’s taken up barking again.

Is she well? Nope, not by a long shot. Though she’s back to her normal 21 pounds or so, she does look misshapen and strange. This can be a symptom of Cushing’s disease, which could be brought on either by the alleged tumor in her adrenal gland or simply by the prednisone she was given. If it were a side effect of the prednisone, though, you’d expect it to start clearing up by now. I wish I’d known the potential side effects were as extreme as they are; I would never have given it to her. And I do wish the vet had clued me that her cough might have been managed with over-the-counter human cough medicine. She probably has recovered from the fluconazole side effects, at least to the degree that she’s going to. And she seems to have thrown off the side effects of the doxycycline, although she’s releases a Great Flood every time she goes outside to pee. On the other hand, she drinks a lot more water than normal. She’s still weak and indolent — doesn’t want to get up and walk around the house, and most certainly can’t be taken on a doggy-walk.

Do I think she’s long for this world? Probably not. The median life span for a dog her size is 12.2 years. She’s right there. In fact, she may be older than that. Under the best of circumstances, no matter how much longer she lives, she’ll be living as an “old” dog.

I can’t afford a lot of expensive treatment for a dog. When I got Cassie, I had a job…and yes, I could afford vet bills, within reason. No longer! At this point, I certainly can’t afford the bills that already, pointlessly, indeed harmfully have run up in excess of a thousand dollars. So…no, she’s not getting surgery for the supposed tumor on her adrenal gland. I don’t have another thousand dollars (plus, plus, plus, plus….) to throw into keeping a dog alive indefinitely at the end of its normal allotted lifespan. Not that I don’t love my dog and I don’t want her to live forever. But that I think it’s as cruel to keep a sick and aged dog alive, just as it is cruel to keep a hopelessly sick and aged human alive.

And honi soit qui mal y pense.

Every time I think about this, I get angrier at the first vet, who foisted the prednisone on her, delivered a dire diagnosis based on a guess (without considering whether the symptoms in question could have been side effects of the prednisone), and then put her on a drug that damn near killed her.

This guy used to be one of the finest vets in the Valley. Then one day when I called his office, I got put on hold and serenaded with one of those endless blab-a-thon advertising tapes typical of chain veterinaries. You know: first the list of scary-sounding things that can happen to your pet and then the pitch for all the services the veterinary offers and then the hustle for this, that, and the other unnecessary extra treatment and service and then the “did you know?” insulting Q&A time-waster, yakity yakity yakity yakity…. These are typical of the veterinary chain operations, so I surmised that he must have bought into one of those.

And yeah: he’s not so young anymore. He needs to save up for retirement (no, believe it or not veterinarians do not earn all that much). So it makes sense that he’d up the amplitude and sell out to a chain that might pay him a guaranteed salary or percentage. Personally, I really dislike those chain clinics and avoid doing business with them. But this was my favorite dog doc, and it would take a lot to dislodge me from him.

But in the past I’ve not had him hustle me for unnecessary treatments, emit incorrect diagnoses whose purpose seem to be to put the animal on expensive and inappropriate medications, or try to persuade me of things that are overtly, obviously incorrect.

Whatever.

Whether Cassie will ever fully recover is doubtful. I think she’ll die of old age before that happens. Or of Cushing’s disease, assuming the diagnosis of an adrenal tumor is correct. But at least for the moment she doesn’t seem to be unduly uncomfortable.

Corgi: The Saga Continues!

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Well…this is pretty amazing. I’ll tellya…even though I hoped for SOMETHING good, I sure wouldn’t have expected this.

  • Cassie the Corgi, after about 40 hours off the UTI meds, is almost 100% back to her old doggy self. I’d put her at about 95% improved.
  • The cough is gone. As in GONE gone, not “gone under most circumstances.”
  • The UTI (urinary tract infection) cleared up within three days after I started giving her the doxycycline.
  • Within 24 hours of quitting the doxycycline, the malign side effects began to fade. And 36 hours later: unnoticeable by the human.
  • The labored breathing: absent. She’s breathing normally: no straining, no hyperventilating, no apparent pain. (Difficulty breathing is a side effect of doxycycline in dogs.)
  • The corgi bark: BACK IN BUSINESS. Never thought the sound of a yapping dog could be music to one’s ears… But yea verily: not only is she barking as usual, she is not plunging into a coughing fit every time she has a yip to yap.
  • Stoned lethargy: pretty much gone.
  • Suspected pain: well hidden, if not disappeared.
  • Interest in Life, the Universe, and All That: very close to normal.

Does she have adrenal cancer? Could be. Couldn’t we all? This is an elderly dog. When you get to be an elderly anything, you do not deny the possibility that something will carry you away. Any day now. And we are not afraid of that, because we know nothing lasts forever and that does not scare us.

That notwithstanding, one bears in mind that 50% of mysterious growths on the mammalian renal gland are benign. So: it could be nothing. If it’s “something,” then that is not surprising and because we are not surprised, we can cope.

So I have a call in to 2ndOvet — second opinion vet, the one who does not altogether buy the Valley fever theory and who said the dog needed to be treated for a urinary tract infection when 1stOvet claimed the test results said otherwise, yes the very 2ndOvet who begged to differ by remarking that the UTI lab numbers came back as high as they can get.

Virtually every drug I’ve given this dog has made the dog sick, including a drug for something that was real (i.e., the observable, testable, provable UTI). Let us recall all that I and many others have had to say about the pernicious influence of Big Pharma on the practice of medicine, and consider the fact that said influence extends to veterinary practice. And then let us consider the effect of inflicting two or three drugs on the pooch.

Of interest, isn’t it?

Begins to make Christian Science (yea verily, the faith of my — very long-lived — ancestors) look almost sane.

{sigh}

So. Cassie did not, after all, get driven to the vet’s office to be dispatched to her Maker this morning. As things stand, as of 12:28 in the afternoon of Monday, October 29, it does not appear that she will make any such journey. Indeed, it looks a great deal like she will be helping to stuff small children with candy from the neighbor’s driveway, come the day after tomorrow.

Happy (Amazing!) Hallowe’en!
y
Dia de los Muertos!