Pets

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?

 

 

Never a dull moment, all right. Cassie has been sick for the past 10 days with an alarming cough and general lassitude. The vet put her on a couple of dog drugs which off the bat seemed to help significantly. But just as I thought she was healing up, the cough came back.

So this morning it was off to the vet, a 40-minute drive through late rush-hour traffic. After considering the details and X-raying her lungs, he found a lot of congestion up near the top of the lungs and near the heart. Between that and the elevated temperature, he suspects Valley fever.

Jayzus!

So he did some lab tests — results won’t be back until Monday — and handed me a bottle of fluconazole and said to take her off the stuff she’s been taking and give her two of these a day. Call back on Monday to see whether his suspicion is correct.

I remarked that about 15 or 20 years ago, a friend had a dog with Valley fever, which they dosed mightily with an antifungal. The stuff was astonishingly expensive in the U.S., where patients are regularly ripped off — he was a lawyer and couldn’t afford the treatment…had to drive into Mexico and bring the stuff back across the border. He said the newer drugs work much better, and that if she does have Valley fever, chances are very high that the fluconazole will work on it.

ohhh-kayyy.  The course of treatment is 6 to 12 months, though some dogs have to be medicated for the rest of their lives.

It’s credible, as off-the-cuff diagnoses go. Every time the two dogs go out through the side door to the garage — which is every time I come home, and then some — Ruby shoots out like a rocket and Cassie chases after her, hot on her heels. So a couple times a day she gets the quarter-minus ground cover sprayed right up into her face. And dusty desert sand is exactly the stuff that harbors the pathogen (coccidiodes).

Valley fever is endemic in the low desert. If you’ve lived here any length of time, you’ve had it. Used to be when they tested you for TB — as they would if you wanted a job as, say, a teacher or a nurse, or just on general principles — you would test positive, simply because the Valley fever antibodies would trigger the TB test. Don’t know if that’s still true — I avoid jobs that require invasive and nosy medical tests or investigations, and so haven’t had another TB test in years. But the point is, everybody who lives here gets it. And so do a lot of dogs: 6 to 10 percent of dogs in Arizona’s Maricopa, Pinal, and Pima counties get it. Like humans, most infected dogs throw it off quickly and probably develop lifelong immunity. But anything that compromises your immune system…such as, say, old age…can cause you to develop disease symptoms. And Cassie is 12 years old: about 69 in human years. As far as we know…she could be older than that.

Fortunately, her symptoms suggest the disease is still confined to the lungs and has not yet begun to disseminate through her body. If that’s the case, the drug should get it under control and she may live a normal lifespan.

A “normal” lifespan for a corgi is 16 to 18 years… We shall see.

Do not even think, DOG, of whatever it is you imagine you’re gonna do!

What we have here is one very sick little corgi, Cassie the agèd corgi, and one corgi that believes she is the Queen of the Universe (even though it is self-evident even to benighted humans that Cassie is the Queen of the Universe), and therefore, OUTTA MY WAY, YA CRAZY FOOLS!

Ohhhhh gawd, Dear Gawd, please spare your Humans ailing corgis and bossy corgis. At least, do not allow them to occupy any one of Your rooms at the same time.

Human to the Ruby: Let Cassie breathe in the steamer’s mist, because it’s good for her and will make her better.

Ruby to Human: We do not know or care what “good for her” means, because we are a Dog and we do not possess altruism.

Human to the Ruby: Ohhhh gawd! [Repeats prayer to Gawd of Humans, above, with verve.]

***

Cassie has come down with what the vet speculates to be some sort of bronchitis. Apparently it’s going around. The Human suspects it to be a viral infection picked up from Ruby, who acquired it first and quickly tossed it off.

Problem: Cassie is eight years older than Ruby.

You see the dilemma: Ruby is at the prime of her life,  as strong and as fierce and as wonderful and as outta my way ya crazy fools as she will ever be.

Cassie is elderly. In human years, she is about 69 or 70 years old. This would make her as elderly as the Human, which, while still vigorous, is best described as “past its expiration date.”

Called the vet. Described the issue. Underling said “come pick up these drugs.” These appear to be a) an antibiotic and b) a steroid.

Many errands were being run along with the trek across the city to the vet’s office. Shortening an excruciatingly long story, let us say it was somewhat after 1 p.m. before the Human stumbled back into the house.

These drugs are supposed to be given twice a day: once in the morning and once in the evening.

By the time the Human gets back to the Funny Farm, Cassie is choking and gagging and barely able to breathe. The Human decides to dose Cassie forthwith — late in early afternoon (what CAN one say?) and then to dose her again around bed-time, around 9 p.m. if we’re lucky.

This will much shorten the time between today’s putative doses.

The Human imagines this will amount to a kind of attenuated double dose, which the creature hopes will help, as the Cassie is in fairly desperate shape.

Meanwhile, the Gods of the Internet say that bronchitis-inflicted dogs benefit from a steamy shower (FAT EFFING CHANCE!!!!!)  or steamer, just as do ailing specimens of Homo sapiens, an odd creature, indeed.

SO…the Human fills and plugs in the steamer and aims it at Cassie’s favorite nest on the bed. Places Cassie in the direct flow of the steamer’s humid plume.

The Ruby demands to be Up. She stays up long enough to shove the Cassie out of the steamer plume’s way, then demands to be Down. The Human places the Ruby on the floor and continues trying to write this post.

The GODDAMN DOORBELL rings!!!!!

The Ruby has one of her customary sh!t-fits.

The Cassie, freaked, now demands to get Down.

The human, 4/5 nekkid, heads for the front of the house.

It’s the neighbor’s cleaning lady, despatched to the Funny Farm to deposit said Neighbor’s key after a day of slaving, said Neighbor having left the premises.

Ruby, left to her own protective doggy devices, has gone freaking baths!t. By the time the Human and the Cassie arrive at the front door, Ruby has leapt atop the sofa’s side table, pushed its decorative contents onto the floor, and is prepared to LUNGE THROUGH THE DOOR the instant it is opened!!!!!!!

A-A-N-N-N-D….you wonder why the Human is given to drink?

Ohh welll! The barking frenzy this elicits from the Cassie does NOT cause paroxysms of canine coughing. First time today. This is good. Either said cleaning lady is not perceived by Cassie the Corgi as a threat (unlikely, given that a moth can be perceived as a threat…) or the dope I just whacked the dog with somehow managed to work.

Or else Gawd is feeling adequately amused and chooses to refrain from any more antics.