Funny about Money

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

Dog: Can’t win department

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Or is it the Department of Little Women?

I do have the worst feeling I’m being little-womaned here. But on the other hand, one also has to admit that the vet is emitting every sign of trying to be helpful…many of which signs are above and beyond the call of duty. But…but, indeed… Read on:

So at 8:30 this morning — Sunday — I present myself and my dog at the office of the charming and genuinely concerned (I do believe) MarvelVet. I explain that the dog has been much better after I unilaterally took her off the fluconase, a drug for Valley fever. She has begun to eat again, and she’s acting more like her old self: shaking off the deathly lethargy and resuming her favorite barking habits. The cough is gone.

He remains convinced that the dog does have Valley fever. That may be true. But in the absence of empirical evidence, my stand is that we have no proof of it, and that we’re making her unnecessarily sick by giving her a drug whose side effects include complete inappetence, extreme thirst, uncontrollable incontinence, lethargy, loss of interest in surroundings, inability or unwillingness to move around, diarrhea, vomiting, and gastric distress.

He now says, “Those are symptoms of Valley fever.”

I say, “That is a list of fluconase side effects that appears at the University of Arizona Medical School’s web page.” He replies with the usual snort that you can’t believe anything you read on the Internet. I reply that the University of Arizona Medical School is a credible source.

See? That is little-womaning: the assumption that if a woman says something, it must be stupid, uninformed, or both.

So used to that kind of male behavior am I that it doesn’t especially bother me — beyond the obvious annoyance factor. What does bother me is that those are NOT the symptoms of Valley fever, nor are they the symptoms she presented with. I took her to the vet because she had a persistent cough, not because she was peeing on the floor (she was not), consuming undue amounts of water (she was not), off her feed (she was not), lethargic (she was, to a degree), or suffering diarrhea or vomiting. This circumstance presents one of two possibilities:

  1. Either he doesn’t know the difference between the symptoms of Valley fever and the side-effects of a powerful medication; or
  2. His mind is made up and he simply refuses to listen to what the little woman has to say.

He proposes to have another vet, who’s a specialist, do a full-body ultrasound of the dog, in hopes of getting to the bottom of the problem. He says he will arrange this at no cost to me. Tentatively now, this is slated for Tuesday.

Okay. If he’s being honest, this could be useful.

Or not.

I am very wary about it. Why?

For one, the Mayo Clinic states — in reference to human cases, as you might expect — that the best course of action for Valley fever is usually no action: rest and hydration is the recommended treatment.

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.

And then over here at Medscape, we have this statement about work-up (i.e., testing and physical examination) for Valley fever:

Because most patients recover spontaneously, pursuing documentation of coccidioidal infection is not imperative unless the patient is immunocompromised or has signs of severe progressive disease or dissemination. Diagnosis requires isolation of the organism in culture, identification on histologic specimens, or serologic testing.

[Medscape is a website for physicians and clinicians. You have to subscribe to get the full dope on most topics.]

At this time, the dog does not have signs of severe progressive disease or dissemination. To the contrary, she’s showing every sign of improvement.

In any event, does this strategy apply to dogs? I truly do not know. However, I see that the University of Arizona’s website invites questions…and so… Yes. I just sent off a query asking if dogs respond differently to Valley fever infections than humans do….and specifically asking whether those two blurbs of advice apply to dogs. Watch this space for a report.

My friend whom I quoted as having lost three dogs to Valley fever says she actually has had four die of the disease. Each time she spent phenomenal amounts of money trying to keep the dog alive. One dog was on medication for years…and the stuff was costing her $300 a month.

Three hundred dollars is my entire household budget, exclusive of utilities.

Valley fever represents a huge profit center for the veterinary industry. Says the UofA Med School: “Owners spend hundreds to thousands of dollars each year, especially in Arizona, diagnosing, treating, and following up care for their dogs with Valley Fever. It is estimated that valley fever costs all Arizona dog owners at least $60 million per year.”

Holy sh!t. No wonder the guy wants to get the dog on fluconase, proof that it’s needed be damned.

He told me to put her back on the stuff. I said if we were going to do that, it would be better to put her to sleep, because it makes her so sick that she effectively has no life. This was when he tried to tell me the side effects were Valley fever symptoms — even though it’s dead obvious the dog has none of the “symptoms” now that the drug is wearing off. He backed down when I said I would put her down before I’d give her any more of the stuff.

I did have to point out to him that with a Ph.D. and a job as a technical editor, I do know the difference between a university medical school’s data and a woo-woo web page. It’s hard to convince some people. 😉

He tried to tell me she was not behaving in a normally peppy way. I refrained, having already said quite enough, that at 12 years of age a dog is not supposed to be peppy.

He handed me, also free, a half-dozen cans of PD and urged me to feed it to her. For those who aren’t into long-term pet ownership, PD is short for “Prescription Diet”: it’s a spectacularly expensive dog food distributed exclusively through veterinaries. He thought it would help her feel more like eating. And it’s true, she does need to gain back some weight.

But…BUT… She’s regained her appetite and is now eating just fine. The baby food scheme worked to jump-start her eating. After I got her eating that stuff, I poured half a bottle of it over a regular plate of her food, and she inhaled it. And this evening? During the battle to feed Charley, Ruby, and Cassie without being tripped or pounced by any of them, I forgot about the baby food whilst struggling to get her and a plate of food behind a door where Charley and Ruby couldn’t grab it. She inhaled her dinner anyway.

And PD…hmmm. It’s distributed in New Zealand. Know what that means? It means it’s likely made in China. They are very secretive about where the product is manufactured — can’t even find a clue at the venerable Dog Food Adviser watchdog site. If they’re not telling you, they don’t want you to know. Eh?

Her cough is essentially gone. She chokes on water — as she always has (the pup does, too: it seems to be characteristic of corgis) — and that causes her to wheeze, but once that passes, she no longer is coughing. That suggests to me that it’s every bit as likely that she had bronchitis as that she has Valley fever. Maybe more likely: she wouldn’t get over the cough that quickly on just a few days of the poisonous “cure,” and it would have come back by now if she really hand VF.

He noticed she was breathing rapidly, which indeed is something that she does. I couldn’t tell you if she’s always done it, because I haven’t been sensitized to the pattern of her breathing before this. However, here we have a genuine woo-woo Web page that suggests it’s no BFD:

Tachypnea is the term for rapid breathing in dogs and unless consistent or combined with other symptoms is usually nothing to worry about.

Laboured, difficult breathing or Dyspnea is more serious and you should consult your vet immediately as it could be the sign of a serious problem. Read on to find out…

Ohhkayyy…reading on: Potential causes:

Heat.

Nope: not while snoozing on a bed in an air-conditioned bedroom.

Mitral valve disease

Could be, I suppose. Cardiac problems have already been suggested as a possible cause of the coughing.

Congestive heart failure

Another strong possibility. Remember: she’s 12 years old.

Cancer

“However, lung tumours (Adenocarcinoma) are the exception and can cause coughing and panting along with rapid breathing. This form of cancer is more common in dogs over 10 years of age and could be the cause of older dogs breathing fast or more heavily than usual.”  Hmmmm…. Yeah, that’s a possibility. But MarvelVet said, when asked, that the X-ray he made showed no sign of cancer in her lungs.

Anemia

Usually caused by a hookworm infestation. Not likely in our parts: hookworm is not endemic here, and these dogs spend most of their time loafing in the house.

Cushing’s Syndrome, which results from overproduction of cortisol caused by a benign tumor of the adrenal gland.

Unlikely: she doesn’t have any of the other symptoms.

Collapsed trachea, in which the tracheal rings begin to collapse, and as air is squeezed through, a characteristic honking cough results. This also can cause fast breathing while the dog is resting.

Highly likely. The habit of choking when drinking water is also suggestive. And how is collapsed trachea treated? By golly: “Cough suppressants, bronchodilators, corticosteroids (to control inflammation), and/or antibiotics. In obese patients, weight loss helps decrease respiratory effort. Although treatment is not curative, a study released in 1994 showed that 71 percent of dogs treated medically showed a good long-term response.”  And what has caused Cassie’s cough and other symptoms to go away: Temaril-P…an antihistamine with a small amount of prednisone. Uh huh!

Why did I need to be told, eh?

Am I being irrationally paranoid about this? MarvelVet is a nice man, a visibly intelligent man, who seems to be genuinely, heartfelt concerned about the welfare of dogs and cats. He is an excellent vet.

Seriously: am I utterly off the wall to suspect overtreatment, a rush to possibly unnecessary treatment, and a strong money motive here? Maybe I’m too suspicious, too skeptical, too jaded after so many other experiences along those lines.

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Author: funny

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2 Comments

  1. Poor Cassie.

    Practically speaking – if the dog DOES have Valley Fever – you’re not going to treat her for it. The treatment is too hard on the pup, and too expensive to pay for long term.

    So – does it really matter if she has Valley Fever or not?

    If you’re right, and she had bronchitis – the initial treatment may have kicked it down enough for her to get over it – or your thought of asking for another round of that treatment, seems solid.

    If she does have Valley Fever – it feels like the best course of treatment is rest and fluids – in which case, if the steroids were making it easier for her to get liquids – another round of them seems like it can only help?

    Doctors are focused on FIX the problem – but at her age, the focus may be better to be on quality of life – if the cure is just as bad as the disease – does it really make sense?

    Difficult questions – it would be easier if MarvelVet was not so obviously caring and wanting to help the poor pup – one doesn’t want to discard the knowledge and experience that he does have – but ultimately, you want to do what’s best for Cassie and for you.

    Hope to hear that Cassie continues to improve.

    • Today (Tuesday, only two days later), the dog is visibly, significantly better. Each day she gets stronger and more like her old self. This afternoon she was racing around and barking, something she hasn’t done for what seems like two or three weeks. I keep returning to the fact that the test results are negative, that the serology section specifically says a titer test is contraindicated, and that she seems to be getting better.

      The latter, of course, COULD be an illusion fostered by the prednisone…

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