Friday, September 9, 2011

How I Spent My Summer

This summer was just as stressful as the past three summers have been. My sweet little cat, L, who is somewhere around 17 years old, was sick the past three summers. Her health problems may stem from the mauling that occurred on my driveway and brought her to my home seven years ago; some may be age related. But the past three summers she's had such a severe bladder infection and lost weight each time that she never regained, that I swear, I thought each summer would be her last. She went from 8 lbs to barely 5.5 lbs. This year, amazingly, no bladder infection, no chronic constipation. Could it be the Chinese herbs Dr. M has her on are working?

So I started the summer afraid what it might bring for L. I didn't think it would be Mr. Big whose health would be under assault.

Poor guy. After losing our beloved Pupgirl in February, he lost weight. He scraped his back, and they clipped a tonsure-like circle to clean the wound. At the end of March I took him in for a senior dog wellness check, and his thyroid (he's been on thyroid medicine for about 2 years) was great, all his various values were great, and other than being 11.5 years old, he was great and in good health. We decided to wait a month and then check on him again if the fur hadn't started to regrow.

When a month had gone by and it hadn't, his vet suspected Cushing's disease, given this one symptom (lack of fur regrowth) and his age. There were no other symptoms. Ya'll know how vigilantly I watch my animals. Heck, I inspect the poop every time I pick up (which is every day). Weird, I know, but it shows how dedicated to these animals I am. So had he had any of the other symptoms, I'd have noticed.

Urinalysis in April indicated high ALP, but nothing else. Dexamethasone suppression test in early May indicated Cushing's. ACTH stimulation test a week later proved it. Ordered the Trilostane, the compounded medicine his vet wanted him to take because it has fewer side effects, from the pharmacy in the Big Metropolis, which he started taking just as Tall Boy arrived in his new home (my home). A month later, another ACTH stim test. Numbers are still not right, so Dr. M-the-first (not the acupuncture/Chinese herb vet, but his regular vet)  lowered the Trilostane dose.

Mr. Big then had a severe case of diarrhea. Off the Trilostane for a week, then back on. Then he began drinking a lot, peeing a lot, eating unusual things ravenously (dirt, twigs, he even pulled a paper bag out of the cupboard, tore a large piece off, and ate it). Lots of phone calls between me and Dr. M-the-first then ensued  because I was worried he was one of the few dogs that reacts to Trilostane. Dr. M-the-first consulted with 2 internists, then a third, over Mr. Big's case; they all agreed he has Cushing's disease. "Then why is he having symptoms now after two months on the Trilostane that he didn't have before he was diagnosed?"

Then in mid-August, Mr. Big had diarrhea again, the most severe case in the ten years I've owned him. Back off the Trilostane for 3 days, on a bland diet for a week and a half, and my insisting there's something wrong, Rear end weakness had started by then, another symptom of Cushing's he didn't have before he was diagnosed. We did a third ACTH stim test at the beginning of September, and I insisted on another complete blood panel (after the one done in late March; and these are not cheap, Gentle Reader), because I know something is wrong. Dr. M-the-first, perhaps flippantly, said it wasn't Cushing's but perhaps neurological.

We are fortunate that the Old Town has one of the 100 veterinary neurologists in the country, so to spite Dr. M-the-first and prove him wrong (being petulant can be expensive), I made an appointment for Mr. Big. He saw Dr. G last week, who agreed with me that Mr. Big has no neurological problem; he's old, yes, but everything checked out fine in his neurological assessment. But Dr. G did consider that there could be some underlying internal reason not visible in a physical exam. He recommended an ultrasound. Then he tracked down one of their internists to talk to me about the Cushing's. The internist agreed with me that something was wrong if Mr. Big was worse on the medicine than before. Meanwhile, the stim test results of the day before had come in and Dr. V, the internist, had them faxed to this hospital from Dr. M-the-first's hospital while I was there. Mr. Big's cortisol levels are perfect now, so the Trilostane is doing it's job, but his thyroid, which had been perfect at 3.1 on March 31, was 6.3, well beyond the canine normal of 1-4.  Dr. V reduced Mr. Big's thyroid meds by one-third, and said that the ultrasound would be useful, but we could wait. Dr. M-the-first reduced the Trilostane dose by 0.1 ml, even though Dr. V thought we should wait to see if the thyroid med reduction worked.

Having lost too many animals to cancer or rare things like bullae emphysema-caused spontaneous pnuemothoraxes, I scheduled the ultrasound. That's why I work two jobs, so I can spend my money the way I see fit, and keeping my animals healthy is how I see fit to spend it. A stroke of luck--the ultrasound showed Mr. Big is just fine. No masses, his adrenal glands look fine, his kidneys and liver look fine, and I breathed a huge sigh of relief.

Dr. M-the-first admitted he hadn't thought that the thyroid had been affected by the Trilostane. Apparently in getting one part of the endocrine system under control (the adrenals), we upset another that was being controlled by meds (the thyroid). Dr. V said that within 4 or 5 days, Mr. Big should start to feel better if that was the problem, and it looks like it was. By Sunday, he was drinking far less and not spending every moment outdoors eating dirt. He was moving around more, seemed perkier and happier, and didn't tire as easily on his daily walk. He even raced around the backyard, chased by Tall Boy, and leapt (leapt!) into the wading pool.

I almost have my boy back. Hopefully, with the thyroid back under control, and the Trilostane working, his fur will start to regrow. In addition to the shaved patch on his back, he's lost patchy fur in places on his body and on his temples. Maybe by the holidays, it will have started to regrow. I almost have my boy back.

So that's how I spent my summer. Spending lots of money at the various veterinary hospitals around town, worried about The Zoo, terrified I was going to lose someone.

But the weather is finally starting to dip below 80 degrees Farenheit at night, the humidity is dropping, which means autumn is on its way, Tall Boy and I are in our second obedience class, my class that I teach is underway so that second paycheck has started arriving, and I am breathing a little. Finally,

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