Monthly Archives: October 2011

Maizie is Still Not Dead

death and dying, Politics and Culture, true story, , , , , ,

(Originally posted: 10/30/2011 — See update at end)

Just wanted to follow up on the October 1 post, Whose Dog Life Is It Anyway, as I’m still getting occasional responses.

I’m writing the follow-up because dogs like humans are now living longer, but as with humans, extended life is not necessarily quality time, and may involve living with chronic debilitating conditions that require extensive and expensive treatment.  More owners of geriatric pets are faced with a dilemma.  Is it better to treat or to let nature take its course, and at what point is euthanasia the best option? So I’m going to review Maizie’s treatment, its outcome, and lessons learned, in case this is useful for other people with geriatric dogs diagnosed with Cushing’s, who come across this in their web travels.

Maize, a Jack Russell mix, is (probably) 15 years old.  While she had abnormal liver enzymes indicative of Cushing’s disease, she was asymptomatic until July when she began to drink excessive amounts of water and urinate all over the house.  She also could no longer hold her urine while sleeping or lying down and would wake up wet.

Testing revealed it was indeed Cushings. The two most effective treatments are either Lysoderm or Vetoryl.  Lysoderm is the older treatment.  The medication itself is less expensive than Vetoryl, but dosing can be tricky.  Both drugs require frequent and very expensive monitoring in the form of invasive tests. The little research I did, led me to think Vetoryl would be a better choice.  The vet started Maizie on 60 mg a day, based on the Dercha’s (the manufacturer’s) recommendation for her weight.  Had I been paying more attention to the very helpful Canine Cushing’s forum,, I would have insisted they start her on less.  As one of the more experienced consumers later told me, despite Dercha’s recommendations, there’s “no rhyme or reason” to how dogs react to Vetoryl.  A big dog may do well on 10 mg a day, while a Chihuahua might need 30.  Within ten days the polydypsia and polyuria had abated.  Her first ACTH test showed that her cortisol level had come down.  A more experienced vet, might have noticed it came down too much and too quickly.  She didn’t and neither did we. The vet, at our insistence also started her on something for the incontinence that was still ongoing when she was sleeping. The medicine was called Pro-in.  This was another one I wish I’d researched more on the net.  Pro-in is the same formula as the old formula for Dexatrim, an OTC diet-pill for humans.  The formula was banned for causing strokes in humans.  Anecdotally, at least, the same problem is seen in dogs.  Maizie seemed to lose her appetite almost immediately upon starting it.  We lowered the dose and then stopped it within a couple of days.  In retrospect, the reaction may have been a coincidence, though who knows?  In any case, she was going downhill.  Her cortisol had crashed, and she was in an Addisonian crisis.  After prednisone, IV fluids, and an overnight at the vets, she came home, tapered off the pred and was once again symptomatic for Cushing’s.  More tests and she was restarted at 30 mg a day of Vetoryl and DES for the incontinence. (Yes, that DES). She crashed again. The second time was so bad that we couldn’t get her to take the prednisone and she had entirely stopped eating.  A two-day stay at the vets with more fluids, and more prednisone got her eating again.  The bill was astronomical.

She came home.  Again we had to taper her off the pred.  The vet wanted us to bring her back for an expensive test to see if she was permanently Addisonian.  We declined.  Clearly she wasn’t.  Her thirst, appetite and peeing were back.  She still had the Cushings.  Rather than start her on an even lower dose of Vetoryl, we made another decision.  I bought Wee-Wee Pads.  As we couldn’t live with the polyuria and were heading toward euthanasia,  this was a kind of a “hail-Mary pass.”  To our astonishment, she figured out what we wanted her to do with them within two days.  All it took was putting the pads over the areas where she was most likely to urinate, praising her when she went on the pads, and scolding her when she didn’t.  Suddenly, we weren’t slipping in urine puddles.  We weren’t upset.  She wasn’t nervous.  She still signals when she has to move her bowels or just wants the opportunity to troll the buffet that is Amsterdam Avenue.   We still walk her several times a day.

I wouldn’t have thought we could live with the pads, but here’s the thing — her urine is so dilute it doesn’t smell and the pads really do absorb ten times their weight in fluids. It’s easier than dealing with cat litter.

At this point the only medication she’s on is the DES, which is still working the way it’s supposed to and keeping her from wetting herself in her sleep. What she can’t do is hold out very long when she’s awake.

We are also giving her melatonin as a supplement, which may or may not be doing anything, but is touted by some as a natural alternative, and may slow down tumor growth.  We’ve also started her on wet food only.  This also may or may not make a difference, but she’s old and she likes it.

The take away for us is:  If we had known that the Vetoryl would bring her so close to death, and how expensive treatment would wind up being — not only because of the required ACTH tests, but because of the iatrogenic Addison’s, then we would not have started to treat her.  While Cushing’s is progressive, treatment probably does not extend life in geriatric dogs, and the high cortisol levels actually help alleviate symptoms of other age-related conditions like arthritis.  If we’d known how easy it would be to train her to use the pads, that’s what we probably would have done in the first place.

Because every case is different, I’m hesitant to give advice, but if your geriatric dog is diagnosed with Cushing’s, here’s what I would recommend:

1. Read the forum. The people there are consumers not vets, but some of them may be more knowledgeable  than your vet regarding treatments and side effects.  While I had looked at the forum, I didn’t realize how helpful it could be.  The people there will ask you to give them your lab results.  Give them the information and take their advice.  Ask them questions before making decisions.

2. Both Lysoderm and Vetoryl have some pretty severe side effects, including permanent Addison’s.  You might be better off finding out which medication the vet has more experience with and going with that. Also if your vet does not have extensive experience with Cushings, find one who does.

3. If the vet is using Vetoryl, insist they start at a much lower dose than Dercha recommends. They started Maizie at 60 mg.  If she’d weighed a couple of pounds less, it would have been half that.  I wish they had started her at 10mg.   Treatment protocols call for testing after 10 days, so if the low dose doesn’t work they can gradually raise it.  That does mean you’ll be living with the symptoms longer, but the cost to you and your dog will be less.

4.  Consider NOT treating.  Most people begin treatment only when the polyuria becomes a problem.  Treated or not, most dogs with Cushing’s are dead within two years.  The Cushings may be masking other problem like arthritis, especially in geriatric dogs, and per the earlier information the medications can be pretty nasty.  If your dog is NOT symptomatic and Cushings is only suspected because of tests, consider starting some safe alternative treatments like melotonin and/or flax seed oil.  Melotonin may slow the growth of the tumors that causes the cortisol to rise, delaying your dog’s becoming symptomatic. If your dog is symptomatic, consider whether or not these are symptoms that you and/or the dog can live with. In Maizie’s case the main symptoms are excessive urination and excessive drinking. The drinking isn’t all that excessive. That is, she doesn’t seem to be dying of thirst, just drinking about two or three times as much as she used to.  The urination was making us all nuts until she learned to use the pads. We are all happy now.

5.  If you aren’t blessed with a house in the country that features a doggie door, buy Wee-Wee pads.  Even without Cushings, as your dog ages, she or he may need more walks than you can reasonably supply.  They are far superior to paper, and as stated earlier, training and clean up are simple.

——-

Update: 7/15/13 — Maizie crossed the rainbow bridge on Saturday, July 14, 2013. Euthanasia was a tough decision as there was no one “This is it” moment. She’d been having gastrointestinal issues for a while and losing weight. It finally reached the point where medication wasn’t helping to stimulate her appetite, and her sense of smell and taste were diminished to where she would reject anything that wasn’t loaded with sodium. Basically, her last week, she was eating only Chinese take-out duck, and chicken-shack rotisserie chicken, and even those reluctantly, with coaxing, and not enough. (Yes, we tried healthier alternatives including homemade foods.) At the same time, she seemed hungry, and we knew that must have been torturous.

She died of age-related conditions, that weren’t related to Cushings. Again, this is only our story, but I would urge anyone whose dog has been diagnosed to learn everything you can, find a vet you can trust (We changed vets after we decided to take her off Vetoryl) and consider both the age and temperament of your dog. In Maizie’s case, the stress level of frequent vet trips for the testing the medications require would have killed her even if the drugs themselves didn’t. We hope we gave her the best possible quality of life in the two years since her diagnosis, and are sure we made the right choice in taking her off the anti-Cushings meds.

Sequel and Sensibility

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PD James at 91 is about to publish her novel, Death Comes to Pemberly, a mystery-murder sequel to Pride and Prejudice.  No need to worry — Wickham, seducer of teenagers and the rake you love to hate, is the one who gets it.

James has stated she always wanted to do this.   Godspeed.  Short of murder, ninety-one year olds should be able to do whatever they’d like.

But how do we (myself and anyone who cares to comment) feel about this? Is this, as Martha Stewart would say, “a good thing”?

In principle I’m not against sequels, prequels, and reboots written by authors who didn’t write the original, but I have my own rules for which ones interest me.

There are sequels that happen because readers can’t let a character go.   This seems most prevalent in detective fiction, with authors continuing to write books featuring Sherlock Holmes, or in the case of Perchance to Dream, Philip Marlowe.  Have any of these ever surpassed the original or even come close?

Perchance to Dream by Robert S. Parker was officially sanctioned by Chandler’s heirs after Parker had completed Poodle Springs, Chandler’s unfinished last novel.  Authorized sequels may work for hardcore fans but they box writers in.  Parker said he wouldn’t do another because he “didn’t want to spend [his] life writing some other guy’s books”

There is also, of course fanfiction which doesn’t enter into the “official” canon, and is often written by amateurs.  This is more prevalent when the originals were  television series or even comics as opposed to novels, and almost always when they are of a particular genre, especially science fiction and fantasy.

Another example of the authorized sequel is Rhett Butler’s People by Donald McCraig. Authorized stories bring with them restrictions. McCraig had to maneuver around the overt racism and defense of chattel slavery embedded within the point of view of the original, which would not sit well with modern readers, while at the same time not  wavering too much from its conception of its characters.  He chose to ignore the storyline imagined in the previous continuation, Scarlett by Alexandra Ripley, a bodice ripper, set after the original, in which Scarlett goes to Ireland, where race is not an issue.  McCraig downplayed the love story, and focused instead on deepening our understanding of the protagonist. The book  received a decent critical reception,, but didn’t do well with hardcore fans. While Ripley’s sequel was panned, it was a commercial success, giving readers what they wanted, more than eight hundred pages of  Scarlett.

Sequels authorized or not, that stay close to the intent and perspective of the original, are primarily written to please fans and sell books.  They don’t bring anything new,  except possibly an ending in cases where the writer didn’t finish the story, or a resolution to a part of the story the creator left hanging.  By their nature, they  do better if they are offering more of the same.

Recently, there’s been an invasion, of horror-parodies, pioneered by Quirk Books. These include Pride and Prejudice with Zombies, Sense and Sensibility with Sea Monsters and The Meowmorphosis, in which Gregor Samsa awakes one morning to find he has been transformed into a giant adorable kitten.  I will confess to never having read any of them and having no interest in doing so.  A five-minute sketch or YouTube video I could see, but they are stunts, not novels.

Another kind of continuation, taking place in what Lost fans might call the “sideways-verse” is a bit more interesting.  These books deconstruct the original, recounting the story in a way the original writer never could have imagined.  A great example is Jean Rhys’  Wide Sargasso Sea, which brings us Jane Eyre as seen through the eyes of  the madwoman in the attic herself and her keeper.  A fully realized tale of Rochester’s first wife, Wide Sargasso Sea is set partly in the West Indies and deals with racism, colonialism, and the powerlessness of women to control their own destiny.

There is also a very unauthorized  take on Gone with the Wind. The Wind Done Gone,  by Alice Randall, tells the story from the perspective of a completely “new” character, Scarlett’s slave half-sister — the child of Mammy and Scarlett’s father.  Randall’s story gives us a different take not only on the characters we know from the original, but on the ones we barely see — the house slaves who have their own agendas.  The problem with Randall’s book when compared to Rhys’ is that Rhys parodied a true classic still taken seriously, while Randall looked at a story so dated by its racism and nostalgia for the “old south” that one wonders if a parody was even needed. In terms of readership, Rhys was offering something new, a way to examine issues around feminism, race, class, and colonialism by hearing from characters who didn’t normally get their own books — Creole women, British servants. By the time Randall’s book came along, we already had original stories about the ante-bellum South told from the point of view of slaves.  Who was her readership?  Fans and apologists for GWTW wouldn’t be interested, and she’s not telling people who dislike the original anything they don’t already know.  To pull off the deconstruction model, you have to be deconstructing something that serious people still take seriously.

And so back to James.  Will Death Comes to Pemberly be a success?  Commercially, I predict it will be a smashing one. I’ll buy a copy.  James is not Austen, but she’s no slouch as a stylist. She knows how to tell a story, especially a mystery.  She has a huge audience even without the Austenites, and the Austenites won’t be able to resist.  She admits to having had a lifelong passion for Austen’s work.  She’s writing, in a sense, professionalized fanfic — not authorized, not the same genre, but told with  love and respect for the source.  Most likely, she’ll present the characters as we know them.  Darcy will not have turned into a wife-beating philanderer. Elizabeth will still be Elizabeth.  And if Mr. Collins is a less than passionate husband, or Mary has never married, but has chosen to set up housekeeping with a female friend, we won’t delve too deeply. Will it have the reverence of an authorized version?  I suspect it will, to the extent that it will strive for historical accuracy and won’t veer far from our expectations of how characterize will behave.

Will it tell us anything about Austen’s world that Austen herself was unable to perceive?  Doubtfully. If Darcy’s money comes from plantations in the West Indies, we won’t learn about the conditions of the workers..  The servants at Pemberly will continue to be mostly invisible.  The resolution of the mystery will not reveal a larger rot at the core of society.

Yet, by bringing in murder most foul, won’t something change?  This is to be a mystery, not a love story or one that ends, like most of Austen, in a marriage. Then again, perhaps an announcement of Kitty’s engagement will come in the final chapter,  assuming of course she isn’t exposed as a murderer and hanged for killing her brother-in-law.

Quiz, kids: Free e-book if you can answer me this.

New York Stories, Politics and Culture, writing/blogging/publishing related, , , , , , ,

I was having a discussion with my better half about Spalding Gray, the late great storyteller/performance artist. There was a story about him in this week’s New York Times Magazine even though he died in 2003.    There was also a documentary about his work made in 2010.

Back in the 1980′s and until the early 90′s I saw him perform many times in lower Manhattan, and once after I moved to Vermont when he was “on tour.”  His death hit me hard, in fact it seemed like it hit the whole City hard.  He disappeared one night, and was thought to have jumped off the Staten Island ferry.  His body wasn’t found for a while, so one could imagine him off on another adventure, the soon-to-be subject of a monologue. Sometimes, I still daydream that it was a mis-identification.  Spalding Gray is alive and well, in hiding, gathering some new material.

There’s a reference to him within the first 10% (the Kindle sample) of my novel Loisaida — A New York Story, which is set in the late 1980’s. He isn’t named, but there are several clues that it’s him.

Here’s the quiz, kids:  The first 5 people who can correctly (1) pinpoint the reference and (2) tell me which of his performance pieces it is referencing will get a free e-book copy of Loisaida in any e-book format, gifted to them or the person of their choice.

I’m figuring if you can get the reference or are even interested in trying, you probably are the audience I’m seeking and will enjoy the read.

DO NOT POST YOUR ANSWER as that will ruin it for everyone, but leave me a comment below letting me know you know. I will then email you giving you my email address and you can send me the answer.

Whose Dog Life Is It Anyway?

death and dying, New York Stories, Politics and Culture

Following my mother’s stroke, she sometimes knew she was in a hospital in Albany.  Other times she thought she was in a library in Queens.  However, when asked by the Bollywood-handsome resident whether or not she wanted the feeding tube, she replied quite coherently, “Not if it’s not going to make me better.”

She had a DNR, and her wishes were clear. Medication that might prevent more clotting in her brain would probably cause her heart to go, and the meds for her heart would have brought more clots to her brain (as would doing nothing).  But even putting in the tube and waiting for nature to take its course, would have been prolonging her agony.  As my sister said, “If she can’t eat ice-cream, what’s the point?”

With dogs it’s different.

Meet Maizie, a Jack Russell-mix-rescue.  My better half took her in in 1999 when she was probably somewhere between two and four years old.  Do the math.  He was going to give her to a friend as a companion for her other dog, but when the two dogs met, Maizie attacked, and the friend got a nasty-Maizie bite while trying to break it up.  After that, my future husband knew he had something “special” on his hands.  When we began dating, and I brought up his possibly moving in, I had the feeling he was waiting for Maizie to die first, but oddly enough, she liked me, and there wasn’t a problem until that unfortunate incident in the elevator about which we never speak.

Maizie never had a 100% accident-in-the house-free record, but I was able to “un-paper train” her.  She got the idea that the apartment was not for peeing and was pretty good about it.  Then in July,  that changed. Suddenly, there were puddles of clear looking pee all over the apartment. She was waking up unconcerned in her own urine, and drinking water by the bucketful.

So off to the vet, who had long suspected Cushings, quite common in older dogs and treatable. We were warned about the expense involved. Medication requires expensive monitoring and over-medication could cause the dog to slip into Addison’s disease and die.  If the cortisol levels don’t go down enough, however, the symptoms will persist.  So there’s a protocol that you have to commit to.

Some people choose not to treat older dogs, not only because of the monitoring, but because lowering the cortisol may bring out other conditions like arthritis which high cortisol actually alleviates.

We discussed our options, including putting her down.  How long did she really have?  The end was inevitable.  Why wait till she was suffering?  Why put her through all the vet visits?  But were we being selfish?  Reacting only to the cost of treatment and not really thinking about her best interest?  We couldn’t live with the pee.  Or could we?  My husband probably could.  He was at work all day, while I mostly work from home.  Why do I hate her?  It’s not like I’m a neat freak.  Why draw the line at dog pee?  Was he thinking I was being mean, wanting to kill his dog?  She was his dog, before she was ours. Had I ever even liked Maizie?  Hadn’t I just married him for the health insurance to begin with?  Did we really even know each other? Could this marriage be saved?

Besides us, what about her? What the hell is the best interest of an animal?  Does a dog contemplate her mortality?   Would she be terrified of being put down because she knows what it is? Or would she be terrified because she’d read our anxiety and guilt, and because she knows that no good ever came from a vet visit?

We chose to treat.   We didn’t really want to take that anniversary trip to Italy anyway.  About three weeks in, her symptoms had mostly abated, but then she crashed. She could hardly move, wasn’t eating, had no sparkle in her eyes. We were ready to put her down, but the vet convinced us this was nothing more than a bump in the road, a medication management issue.  With a little “pred” and  a lower dose of the Cushings drug, she could go on for years.

Why was I suddenly remembering the last year of my 1973 Dodge Dart, and why was the vet suddenly reminding me of my old mechanic?

The clincher was Maizie herself.  She  rallied as soon as we got to the vets, a situation that probably caused her diminished cortisol to rise, and she really did seem to be saying, “Please don’t kill me.”

The second time she crashed, she was on the lower dose.  She stopped eating.  We couldn’t even give her the prednisone. By the time we brought her in, she needed  IV fluids and critical care.  Her electrolytes were messed up.  After her first night, the vet asked us to visit to see if we could coax her to eat.  We both left work, but we couldn’t get the normally voracious Maizie to try more than a few bites.  She still had to stay over till the next evening, but finally her appetite returned and her electrolytes were good.

A few thousand dollars since her diagnosis and she’s home, tapering off the pred.  They don’t want to withdraw it too quickly, lest she go into shock.   She’s back to peeing clear streams and drinking constantly.  Today, there was a minor victory when she finally figured out what the wee-wee pads were for. but it was probably just coincidence as she ignored them later.

Where do we go from here?  Possibly she’ll be ok once we taper her, at least for while.  The meds may have had the effect of screwing enough with the endocrine system to lower her cortisol for a while. However, given how rapidly her thirst and appetite have returned, we suspect that even without the pred she’ll continue to urinate in the house. I’m not talking about the occasional age-related accident by the way.  I’m talking about walking her every two hours and still seeing about eight indoor accidents a day.  I’m talking about the feeling of dread I now experience whenever I hear her lap up water. I’m talking about comically slipping on wet floors when we get up in the middle of the night.  I’m talking about … an unsustainable situation.

Excuse me, but there she goes again.

The vet says if the symptoms remain once she’s off the pred, we could try an even smaller dose of the meds.  The real experts, other dog owners who I’ve met on the forums, report that with this particular pill there’s no rhyme or reason. Sometimes big dogs do well on very little and tiny ones need a lot, and a more experienced vet might have started her on a really low dose, and worked up, which could have saved us thousands and not brought her to the brink of oblivion.  I’m terrified of seeing her crash again, but beyond that, we’re going broke.  The test they “need” before they can restart her will run upwards of $400 dollars. Then it’ll be around $100  for the new meds at the lower dose.  After that, in  another two weeks they’ll need  to recheck her levels.  The meds we have in the house are useless because they are capsules and not easy or safe to split.  We can’t even try going rogue and splitting them because without a very expensive scale that measures milligrams we can’t measure the dose, and even if we could we’d need another refill if it worked.

My husband suggested, “You work in Washington Heights, surely you know someone with a pharmacy scale and a soft-spot for dogs.”  He is considering bluntness telling the vet,  “We don’t need more tests. Just give us the script or the dog dies.”

In the end, she dies anyway.

Hindsight is perfect.  Surely, if we knew all this, we would have put her down weeks ago, maybe.

Update:  Just adding a quick link to this video about our relationship with our animal companions via  the late, great George Carlin.  “Same shit, different species.”