Coffee heat rising

Valley fever in dogs

…and the Dust Settles

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Après le déluge…yes, the dust does settle.

Today — Monday — nothing on the calendar. Thank God. With any luck, no lunacy will occur today.

Cassie the Corgi is getting a lot better. She was already throwing off the cough when Second Opinion Vet put her on doxycycline for the urinary tract infection MarvelVet opined was negligible. Whether the antibiotic is making a difference, I couldn’t say…except since she’s been on it, she’s improved markedly. This morning she endured being lifted off the bed without a coughing frenzy. It looks a great deal as though she’s going to recover and also as though the alleged adrenal tumor was something I didn’t want to know about. Or need to know about: at 12 years of age, this dog is going to pass on to her furry fathers pretty soon, and something has to spirit her away. If that’s the something, then that’s just the something, and there’s not much anyone can do about it.

Late last night, I remembered that you can polish grocery-cart scratches off your white car with one of those wall-scrubber sponge things. Duh! Why did I not think of that before? So I ran out to the garage and tested it, and lo! It did rub off some of the lesser “scratches,” which actually are paint from the flatbed. There are a couple of real-life gouges in the bumper’s paint, but most of it is not gouges but black stuff scraped ON to the finish, not scraped into it. It was dark out there last night, of course. Whenever I get my act together this morning, I’ll try this by light of day and an open garage door.

The car is running fine. Its bashed tire is not going flat.

Speaking of flat, I’m flat broke, budgetwise, and the economy, as predicted by a certain skeptic of your acquaintance, is about to go down the tubes. But what the heck…it’s not the first time. 😀

I still do not have a new AMEX card. Looks like the post office once again delivered the mail to Manny’s house: Manny and Josie live one street to the north. Stupidly, our streets bear the same name, and so postal workers and various service persons routinely go to the wrong address. And  Manny will NOT forward misdelivered mail! They just throw it in the garbage, far as I can tell.

So now presumably the garbage scavengers (of which we have a-plenty) have had access to my name, address, and a brand-new AMEX card. 😀 Today I have to call American Express and get them to send me a new one. Again. Meanwhile, I still have no credit card!

Nor do I have a card for my Medigap insurance. Today I’ll have to jump through that set of punch-a-button hoops, too. Together, those will absorb some time and create some more unwelcome aggravation. Oh well.

Speaking of unwelcome aggravation, the alleged squamous cell carcinoma is looking somewhat better today. I suspect Young Dr. Kildare’s pronouncement — that I have skin cancer, not ringworm — was yet another misdiagnosis. It takes about two weeks for the antifungal cream to kick in…and last Friday was the start of Week 2. It may be that not enough time had passed, by the time I saw YDK for the gunk to start to work. Last night I was NOT awakened at three in the morning with frantic itching and burning. And the lesion looks less inflamed than it did. In the “looks” department, I have to say it sure does look a lot more like images of tinea manum (ringworm on the hand) than like images of skin cancer. They are, in some ways, similar. But…well…we shall see.

In exploring the Hypochondriac’s Treasure Chest That Is the Internet, I learned that an outbreak of ringworm can be brought on by prolonged stress, which can weaken your immune system.

That would explain a lot, eh?

Coccidioides…the causative organism?

And speaking of aggravation, I remain convinced — nay, I’m more and more convinced — that MarvelVet misdiagnosed Cassie grievously — and possibly deliberately. I think this dog picked up whatever bug was going around, the one his staff told me at the outset she probably had and for which they originally prescribed the Temaril-P, which acts as a cough suppressant. I never did learn what that bug was…whether it was viral or bacterial. But its signal characteristic was a cough. Cassie may not have thrown it off as fast as expected because it either progressed to a bacterial infection or started as one.

She was slowly getting better by the time 2Ovet prescribed an antibiotic for what she says is about as bad a UTI as a dog can get. But two days on doxycycline and voilà! The cough has subsided to the point where she no longer hacks and wheezes when lifted off the bed and even sometimes can drink water without choking and wheezing. Doxycycline is a broad-spectrum antibiotic — meaning it acts on the two broad classes of bacteria, gram-positive and gram-negative.  What this means, if my speculation about the cough is correct, is that it would attack the cause of the cough (assuming it’s not viral) as well as the cause of the UTI.

There are some serious risks to broad-spectrum antibiotics. On the other hand, there’s a serious risk to pneumonia, too…

I wish I were not such a damn cynic…but I am. I cannot get past the suspicion that the “misdiagnosis” I sense was deliberate misdiagnosis. MarvelVet’s claim that Cassie’s UTI was negligible and did not need to be treated was just plain false. I saw the results; the numbers were as high as they get. The dog had a serious UTI, and that is why she was bleeding into her pee. He may have realized that treating her with an antibiotic likely would clear up the cough. And that would take me and my dog and my credit card out the door.

Valley fever is a huge profit center. The cost of treating the disease is bracing, and the treatment goes on for a minimum of six months but often for the remainder of the animal’s life…which can be years. One of my friends, who says she’s lost four dogs to Valley fever, said she was spending $300 a month on the drugs. MarvelVet has a link to a compounding pharmacy (a remark he made suggested he owns it or has an interest in it), and so he was giving me a month’s worth of pills for $40. But…either way…just think of that.

At $40 a month, that’s $480 a year. Just 10 doggy patients diagnosed with “Valley fever” — correctly or not — will bring you $4800 a year. But if you can get $300 a month, that’s $3600 per patient per year, or $36,000 a year if you can diagnose 10 dogs with it. Holy shit! That doesn’t even include the $500 he charged for the tests.

MarvelVet has a large, active practice — he is a very busy man, indeed. And one could argue that he’s so busy that of course he makes an occasional mistake with an off-the-cuff diagnosis.And you certainly could figure that 10 cases of Valley fever would be on the low end for that practice.

I’d like to believe this was a mistake. But…man! The money motive is there, in a big way.

As for the adrenal tumor? Well…the dog is 12 years old. She’s not going to get out of this world alive. She’s near the end of her breed’s average life span. It would be surprising if she didn’t have some life-threatening ailment.

Just now, though, she surely isn’t behaving as though her life was threatened. Half of adrenal gland growths are benign. So she does have a 50-50 chance of staying well. At least for awhile.

From Bad to Worse…

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Okay, so…This gets better and better.

What we have here is a dog that’s been pounding on Death’s door for the past two weeks. Pee pads all over the floors, because she’s only marginally continent.

So there’s the underlayment of “bad.”

Moving on toward “worse”:

Vet decides the dog has Valley fever: puts her on a drug that nearly kills her. I take her off the drug, but continue with an antihistamine-con-prednisone, which seems to soothe her some. She improves.

Vet remains convinced that the problem is Valley fever, even though we have no empirical evidence to prove it. He wants to see her at 8:30 Sunday morning. I have to be at choir at 10 a.m., and it’s a half-hour each way to the vet’s office.

Saturday we have a half-day choir shindig. During the five-hour absence this engenders, the dog pees and craps all over the family room. The pee pads worked…but…hell.

No, I can’t leave the dog outside in 100-degree heat. And now it’s raining: no, I can’t leave the dog outside in the rain.

Dog is better, but far from dancing on the top shelf. I learn to bribe her to eat by doping her food with baby food. This works, within limits. She still is obviously pretty sick. Is she on the mend? Maybe. Or…is she just showing the salutary effect (highly temporary) of the antihistamine/corticosteroid combo?

Haven’t gotten any writing done: missed the whole week’s worth of posts at P&S Press.

Sunday morning my son shows up to drop off his dog — the dog that can not ride in a car without having a nervous breakdown — so that he can drive to Colorado to visit his 104-year-old grandmother. He appears as I’m trying to bolt down breakfast before I have to leave for the vet, hoping that if I can just get fed and get my makeup on and my hair up, maybe I’ll be able to race direct from here to the church and get there in time for the 10 a.m. rehearsal.

In the ensuing chaos, of course, I get neither painted nor combed.

Off to the vet, who is kind despite little-womaning me and who suggests I bring her back on Tuesday for a full-body ultrasound scan, which he will deliver gratis. I don’t feel I can turn this down despite my nagging suspicion that this is a device to pull me into still MORE fabulously expensive treatment on this poor old dog, whose time would be about here even if she did not have some as-yet-undiagnosed ailment.

Fly home, drop the dog in the house, paint my face, slap up my hair, and fly out the garage. Turn the corner and…my hair falls down. Park the car and struggle until I get it back on top of my head — have NO idea what it looks like except that it undoubtedly is not good. Shoot into the choir room right at 10 a.m.

Sit through a long, VERY high-church service. You’ve heard Episcopalians are a dime short of Catholic? That’s wrong. We leave Catholic in the dust.

Okay. It was a very beautiful, very affecting, and amazingly wonderful service and I wish we could do those all the time. Our musicians leave everyone of any persuasion, religious or otherwise, in the dust. 🙂

Drive to AJs, buy enough tomatoes and stuff to cook up some pasta for lunch. Having had it, buy a four-pack of Guiness. So much for that damn wagon!

Race home. Pick up the soggy doggy pee mats. Clean up the dog mound that by now has glued itself to the floor so that I have to soak it loose by covering it with a paper towel saturated in Simple Green and letting it sit.

Fix a pretty damn good lunch/dinner. Consume two of the beers. Feel richly justified in doing so.

Fail to get much else done yesterday.

Rain starts to fall. Charley, who’s not too bright. likes to stand in it and then track in fresh mud. In the middle of the night, he goes out through the dog door and forgets how to get back in. I have to roll out of the sack, track him down through the downpour, and coax him back into the house.

Today: Wake up, as usual, around 4 a.m. AC is pounding away. I think I hear the motor shut off upstairs, but…the fan keeps running.

And running. And running. And running…. WTF?

Get up, stumble down the hall, and try to figure out the hated Nest contraption. Finally ascertain that even with the unit shut off, the fan continues to run. Nothing that I do will shut off the effing fan.

Get on the phone to the Nest people; reach a tech in Idaho. Nice thing about Google is they make their people work 24/7. Great place to work, eh?

With him directing my sticky little fingers, I fiddle around and fiddle around and FIDDLE around. I want my Honeywell old-fashioned mercury-driven no goddamn digital crap REAL THERMOSTAT back. Nothing works. I draw the line when he asks me to go out in the rain (it’s pouring), shut off the breaker switches, and fool with the wiring in the thermostat. I say I’m calling my AC guy. He resists — they do NOT want other techs fooling with their equipment. I say I am not fiddling with the wiring in this thing. He says if I’ll let him know when the guy gets here, he’ll get on the phone with him and coach him. And if we do that, they will cover the cost of the service call. I do not say I have a service contract, which may or may not cover this antic.

I get off the phone with this guy, having failed in every way to shut off the fan, along about 5:40. At ten til 7, the fan finally shuts off on its own.

No wonder, I think, noooo wonder my AC bills have been so high: the damn thing has been sucking hot air into the house whilst trying to cool the interior air 20 degrees below the ambient temperature,.

At 7 a.m. I reach the AC company. They call back to say one of their guys just walked in the door and they will send him over to work on my fiasco before he starts his full (!!) day of jobs.

I email the Nest/Google guy to let him know, as instructed, that the AC dude is on his way.

Cassie, having been made to choke down a quarter of a blue pill with a chunk of the present pork chow, is unhappy and can’t get through the whole dish of food. I decide to try one of the cans of PD MarvelVet foisted on me. Fake stew.

The stuff stinks to high heaven. Charley and Ruby fly into a BERSERKER ecstasy at the first whiff. Fight my way into the back bedroom, slam the door on Ruby and Charley, set the dish down in front of Cassie.

She sniffs at it tentatively, refuses to get up out of her reclining-Sphinx position. Takes a bite. Stands up and starts scarfing. She inhales the stuff, which leaves the bedroom stinking like an abbatoir.

She now has consumed two full meals, one of home-made dog food and one of made-in-China foodoid. This is good because she’s lost so much weight her spine is sticking up.

Meanwhile, I realize we’re almost out of said home-made food. Good GOD I don’t want to drive back down to the AJ’s in the rain to buy a roll of Freshpet dog food. Fortunately, one package of chicken thighs is left over from last month’s Costco run. Get that out to start defrosting it. I figure starting this evening I’ll spike her regular ration (1/4 pound) of real food with a half a can of commercial food, and in the interim give her a half-bottle at a time of the baby food I bought to lure her into eating her regular food.

Quarter to ten: AC tech shows up. Never did hear anything from Nest’s precincts. Wouldn’t matter anyway: our guy has been trained in the Nest and knows how to fix it. He takes the thing apart and discovers…the wires are wet!

Holy sh!t.

Onto the roof with our guy. He finds the wiring is sun-rotted and a mess, and the low-voltage stuff has worked loose where it enters the attic. He rewires the unit, gets the system to working fine again. Seals up the open-air feature as best he can with a LOT of silicon (it’s supposed to keep raining through Thursday) and says to call a roofer and get him up there to seal that thing up good with tar.

That’ll be two hundred dollah, please!

So much for this month’s budget. Which was overdrawn anyway…

He mentions that they’re looking for an office lady to answer the phones, book calls, and do some light bookkeeping. That would allow me to pay bills like this and even buy an iPhone. I think about it. 7 a.m. to 3 p.m. My favorite hours, actually, for an 8-hour day — I used to work that shift on my first job and loved it, because it left a bunch of time before everyone else got off work to run errands and generally enjoy life.

On the other hand…it’s..{choke gag!} a JOB. Don’t much like the idea of leaving the dogs (possibly singular) alone for 8 hours at a time. And…truth to tell…I don’t wanna work anymore.

Speaking of the which, in the middle of all this my beloved Korean journalist emailed: would I edit an 8,000-word paper that needs to be at the publisher by Friday?

Should I say no, given the madness ongoing?

Did I say no? Not on your life!

On the way out, AC tech leaves the gate hanging open. Ruby somehow slips out the front door and escapes! I do not notice this. The AC guy has to turn around and go back out rather quickly, and when he does so he spots the dog. She bounds over to him and he captures her. That’s a God’s miracle…under normal circumstances that dog would be half-way to Yuma by now.

He is so distracted by the corgi sideshow — as am I — that he forgets to pick up the $200 check I was writing as these antics were under way. He leaves the premises unpaid.

Today I have to try to figure out if a payment I made to renew the New York Review of Books has gone astray and an AMEX charge account number stolen. I paid through bill-pay but, in the glory of its new Web interface, the credit union screwed up and bounced the payment. So I used a renewal form, charged it to the corporate card. I did not have time to drive this piece of paper to the Post Office — normally I would go in person to the PO to mail anything even remotely financial. In a hurry, I decided to take a chance and put it in the outgoing slot in my mailbox.

Error…error…error….

Day or so later, I notice the mailbox flag is still up. WTF?

Often the mailperson doesn’t even bother to come down our street, especially if the only thing to deliver is trash. So I figure he probably didn’t come by, so I’d better retrieve the thing and carry it to a post box.

Empty. SOMEBODY has picked up the envelope. But if it was the mailindividual, s/he should have pushed the flag down by reflex. We get as much mailbox theft here as we do car break-ins and petty theft from yards, so the natural thing to surmise is that a meth-head ripped it off.

Another day or so later I checked AMEX online. The charge hadn’t gone through, but neither had any unauthorized charges. Today I have to back into that thing and try to figure out whether the drug pushers have got my credit-card number. Shit. I should’ve known better.

Phone rings as I’m sitting here typing this. 800 number. Eff you!

<click> <click>

I really need to get rid of this land line and replace it with an iPhone. But that will require some concentration and a lot of time to learn to use it. And hassle. Lots and lots of hassle.

Thank goodness there are two more beers in the fridge! 😀 If you can’t see the sun through the clouds, do you have to wait till it’s over the yardarm?

A little…doggy miracle?

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Just yesterday, you may recall, I again thought Cassie was pounding at Death’s door. She went in the closet and tried to hide in a corner (again). There wasn’t much I could do about it today: getting into the vet proved to be impossible around a two-hour  choir rehearsal followed by a lengthy special religious hoe-down.

During today’s long-distance sing-a-thon, I got an elaborate earful about Valley Fever from a friend on the choir who has lost three dogs to it. Spent the afternoon in a Holy Blue Funk, singing to God and His Archangels whilst contemplating the demise of my little doggie. Probably tomorrow at 8:30 a.m. sharp, when I’m supposed to show up at the vet’s doorstep.

But…then…on the way home, them thar Angels began to speak. Nay, even to break out into a little song of their own. And the verses went like this:

  1. When you called the vet about her cough, dear Estupida, the first reaction there was that she had a contagious bronchitis that’s been going around. They did not say whether they thought it was bacterial or viral, nor did they put a name to it. They only said they’d been seeing a lot of it, and then said “come get these blue pills.”
  2. The handy-dandy blue pills DID make it better. But when the cough hadn’t completely gone away after 10 days or so, Estupida, you called back expecting to cadge another bottle of blue pills. Instead they invited you and the dawg to make a trip across town to the veterinary.
  3. The vet opined that what ailed the dog was Valley fever, based on an X-ray that proves nothing. That X-ray could also image pneumonia or a bad case of bronchitis; it could also image a heart inflammation caused by heartworm, endocarditis, or congestive heart failure. Any of these would cause a severe cough. The blood panel came back negative for Valley fever but showing elevated values for a couple of measures that can be elevated by any kindof inflammation or infection. Yes, often VF tests do come back negative even in the presence of coccidiomycosis. BUT it is not unreasonable to suspect that such a test could come up negative because of the absence of coccidiodes. A second veterinarian at a different veterinary clinic suggested this and stated that she felt the test results were ambiguous and should be repeated after three or four weeks. So: we have no empirical proof that the dog really has Valley fever.
  4. Nevertheless, assuming the dog probably had VF, MarvelVet put her on a fearsome anti-fungal drug called fluconazole, which is nasty stuff with superbly nasty side effects. Within a few days of beginning this drug, the dog began to grow weaker and exhibit signs of failing health:

Total loss of appetite
Extreme thirst
Incontinence of Biblical proportions
Lethargy
Loss of interest in everything around her
Inability or unwillingness to move around.
Diarrhea
Vomiting
Gastric upset

ALL THESE SYMPTOMS are listed by the UofA Medical School as side effects of that drug in dogs: https://vfce.arizona.edu/valley-fever-dogs/treatment

And wouldn’t you know: she kept on coughing. By now she’d reached a point where every time she tried to drink water, she would choke on it and then start wheezing!

The blue pills are Temaril-P, which contains an antihistamine and some prednisone and whose purpose is to suppress coughing and reduce inflammation. When we took her off the Temaril, the coughing got worse. When we put her on the fluconazole, she got really, really sick.

Sooooo….this leads us to, goddammit,…

  1. What if the problem is NOT Valley fever? What if it isn’t any other fearful disease, either? What if the initial cause of the cough actually was the bug that was going around? She’s the same age I am in doggy years…and the last time I caught a chest cold, it took SIX MONTHS to shake the cough. Maybe the vet’s first guess was right, and it’s simply taking her a long time to get rid of the cough because she’s 12  years old.

Just now my money is on Numero 5.

Tomorrow I’m going to ask him to prescribe more of the Temaril and propose that we keep her on a low dosage for about ten days or two weeks. THEN wean her off and see what happens.

Whaddaya bet the pooch is still alive in ten days or two weeks? And still kickin’…or rather, kickin’ again?

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.

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.