Category Archives: true story

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.

Tempus fugit or in search of affective-time

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

I may be losing my mind.  Or it may hormonal (I’ve been going through “the change” for about three years now).  It could also just be a normal part of aging about which I didn’t receive adequate warning.

I’m talking about “time.”  Time changes as you age.  It moves faster.  This is not a secret.  Since time immemorial, the old have warned the young not to waste their youth.  We are mortal, corporeal, and temporal. Tempus fugit. We’ve always known this, and yet…

Kitty Carlisle, who was old for a long time, famously said, “You know you’re getting older when every day seems like Monday.”  We don’t think enough about the ramifications that many of us exist in different time zones, even as we work and live together.

I am not so much asking where did the time go, as I am amazed by its acceleration.  In a normal day in my twenties or even thirties, I might get up, go running or do some other exercise, read a paper, have breakfast, all this and somehow be at work on time.  Then after work there would be socializing.  Sometimes even activities that extended into the next day.  Still the rent got paid — by which I mean checks were sent, without even using the “time saving” Internet, but written and mailed.  Other tasks were also taken care of.  Yet now, I start on an assignment and the day is gone.  It used to be that dull tasks felt like that they took forever.  Now every time I look at a clock, hours have passed no matter what I was doing, and I wonder, “Where did the time go?”

It feels more and more wrong.  Like I’m in an episode of Twilight Zone or on that island in Lost.   People with certain psychiatric conditions talk of “losing time,” but I can account for my time. It’s not really lost, just gone.  Maybe there’s always a generation gap because the old and the young are experiencing a completely different sense of time.  Maybe it’s a miracle we can even see each other.

Is any of this making sense?

I noticed early on that things were getting faster.  Even as a teenager it was clear to me that summers were much shorter than they used to be. At some point in my twenties, I recalled a party and realized it had happened, five years before, which was astonishing. But by the time I was thirty, there were people I hadn’t seen in ten years.  Now it’s twenty, thirty?  And they always show up in Facebook, and you either don’t remember them at all OR it’s like yesterday.

Time’s winged chariot is approaching quickly.  The issue is not that I (probably) have fewer tomorrows than yesterdays, it’s that the remaining tomorrows will feel shorter and shorter.  In the way that we experience time, childhood is not our first 12 years, it’s probably closer to half of how we feel time even if we live to be a hundred.  I’m going to coin a phrase here, I think, “affective time.” Affective time is not time on the clock.  It’s time as we experience it.

Affective time is why an infant panics when his mother is gone, but may attach to a babysitter within minutes.  Affective time is why you may remember how you spent your childhood waiting till you would be a “teenager” like your cool big brother four years your senior, and it felt like you were never, ever going to reach that goal.

The implications are this: At twenty you may look ahead and imagine another sixty years of activity.  You may think that if you are lucky, and the genes are good, life will be long.  It won’t be.  You’ll never have enough time. It’s almost irrelevant if you die at forty or eighty because after forty every time you blink, it’s your birthday.

So here’s my very unscientific imagining of an 80-year life span divided into affective time.

Age 0-3:  3 chronological years =  Time moves so slowly we can’t even measure it.  Everything feels like forever.  The good part is, you won’t remember most of it.  The bad part is whatever you experience will somehow stay with you and influence who you are for the rest of your life.

Age 3-13:    11 chronological years =   25 years in affective time

Age 14-24:  11 chronological years =   20 years in affective time

Age 25-35:  11 chronological years =   15 years in affective time

Age 36-46   11 chronological years =   10 years in affective time*

Age 47-57   11 chronological years =     5 years in affective time

Age 58-80   23 chronological years =     5 years in affective time.**

*Middle age is the point at which affective time begins to move more quickly than actual chronological time. Keep in mind that the above chart is an estimate. Affective time accelerates constantly, so between the chronological age of 36 – 40 affective time may still be slower than chronological time, but from 41- 46, it may begin to speed ahead of it.

**If you live past 80, it’ll be happening so fast, you’ll get motion sickness standing still.

Mortality is kind of a bitch.

Meat

Politics and Culture, true story, , ,

“A rat is a pig is a dog is a boy.”    — Ingrid Newkirk, President, PETA

I’ve always had an ambivalent relationship with meat.

Where I’m at now is a belief that if one is not a vegan, one can at least be conscious of what meat is, not celebrate it, and try to limit the damage by both cutting down on consumption and seeking less cruel options when possible.

Back in ancient times before I’d graduated high school, I considered being a vegetarian.  I graduated early, mid-year and needed to do something before college and so I volunteered on a kibbutz, because I was sixteen and a half and it was the only way I could figure out to leave home and go really far away without my parents reporting me as a runaway.

The volunteers were assigned different duties.  There was stacking the dishes as they came off the dishwasher.  I still remember the large cockroaches that sometimes came off with them.  There was spritzing the orange trees with insecticide.  I don’t think they could get the “migrant” workers from Gaza to do it, so they used us.

And there was of course gathering the chickens.  They’d get a shipment of newly hatched chicks, raise them in a giant coup which was of course spacious when the chicks first arrived and then increasingly crowded as they grew.  After a relatively short time, I think about eight weeks, the chickens would be ready to go to market, gathered and stuffed into a truck.  Grabbing them required boots and thick gloves.  There were certain instructions since an injured chicken would not be considered kosher.

At five a.m, a few of us would wade into the packed coup and scoop up chickens by their necks.  They’d squawk and peck, doing their best to defend themselves.  As I made my way through scooping up one or two at a time as others pecked at my boots amid the noise and the shit smell, I mentally referenced IB Singer’s famous line, “In their behavior toward creatures, all men are Nazis.”

I stopped eating meat after that for several years, though I really wasn’t a vegetarian.  I never quit fish.   I’d been fishing a couple of times.  Somehow even seeing fish squirm when taken out of the water, I didn’t feel the consciousness was the same.  A fish was not a dog to me or even a chicken.

In the years that followed there were different meat/non-meat variations. I briefly tried to be an honest vegetarian and give up fish.  I dated meat-eaters and went along for the ride.  At one point, after not having eaten chicken in years, I was staying in a Mexican beach town.  There were a lot of chickens running around.  Often these local birds would wind up being served at the restaurants that lined the beach. It didn’t seem like a terrible life for those chickens — they went around minding their own business, living their lives and every so often one or two of their number would get snatched up and ….  Not much difference than for any of us, and the meat tasted damn fine.

At some point I wound up where I am now:  I eat poultry on occasion, generally if there aren’t many alternatives though possibly at a restaurant if there’s some “free-range” available. Except for duckie.  How I can watch the ducks in a pond and find their antics immensely soothing and then eat these birds as though they were a vegetable is beyond me.  But there you go.  Probably if I knew anything about life on the duck farm, I wouldn’t do it.  But I remain woefully and willfully ignorant on that score.

I don’t as a rule eat mammals, which is not to say that I don’t ever eat them but we’re probably talking about under 5 times in ten or more years.  I won’t eat pig though.  Nothing to do with any religious inclinations or even the taste.   To me a pig is a dog is a boy.  The way they are farmed is extremely cruel and there is good evidence that they are as smart, if not smarter than dogs.  Pigs in some fundamental way seem more like us than any non-primates.  They are almost hairless, social, love to wallow in dirt, will eat anything, defend their young, and aren’t always that great about personal hygiene.  Really, if you’re going to eat a pig where do you stop?  Long pig was the Maori term for human meat, and even if you weren’t planning to go that far, explain to me exactly the difference between a pig and a dog?

But that’s the dilemma isn’t it?  A vegan would argue that we all feel pain, and people love their pets even rabbits and yes, even chickens and ducks.  The emotions we attribute to certain species and not others is not rational or even universal.

Which of course brings me to my menagerie — which I’m not planning to eat, ever, but do have to feed daily.  I’ve got a dog and two cats.   PETA offers information on going veg for your “animal companions.”  While my dog could conceivable live on veggie diet, I can’t imagine she’d like it much, and as for the cats — clearly these little vermin catchers (or would be vermin catchers as they are stuck in a vermin free apartment) were not meant to be vegetarians.  The big guy, a very vocal, Russian Blue, would probably make my life a living hell if I even tried.

Lately, because of several factors including the expense, ecological waste of cans and concerns about quality — I have started to cook meet for my animal companions. Specifically, boiled chicken, maybe with some beef liver or other cheap cut.  The thing about it is, this puts me in touch with meat.  Literally and viscerally.

There’s just no way I can look at a whole, headless chicken and NOT think of it as a dead body.  As for the cow’s liver — you could replace it with a human one and I probably wouldn’t be able to tell the difference.  Cooking meat, the smell of it in my home, picking the meat off the bones, the awareness of it’s constant decay, the need for care and cleanliness lest I containment my entire kitchen, the bloodiness of it, well kind of makes me think.   I understand how and why we (humans) eat meat; I don’t quite get how we continue to be so blind to what it is.  You don’t have to kill it to realize what it is, you just have to touch it, smell it, and see it.

So of course this has made me think more of the ethical compromises we all make.  I wonder how pure even the vegans are.  How many of them insist on going veg with their dogs and cats?  But how can they justify not doing so, and choosing one species above others?  And what about the bees?  Vegans don’t eat honey, but how do they feel about the subjugation of bees used to pollinate crops?  How many insist on not eating fruit or vegetables cultivated with the labor of captive hives?  Why is it okay to have animal companions like dogs and cats but not egg-laying hens?  Chickens developed as domestic animals and they lay eggs, so why is it not okay to “exploit” that if the chickens also get something (a nice roof over their heads) for their trouble?  I do understand objections to milk and cheese.  Good milkers need to give birth to calves, and all those excess calves especially the boy ones aren’t needed.  Plus once a cow reaches a certain age, she’s no good as a milker anymore and retiring her to pasture is an expensive option.

Some might call me a hypocrite because of my half-assed stand on these issues and loads of inconsistencies.   I’m waiting for when biotechnology can bring us real “cruelty free” meat.  I imagine future meat farms that will be vast labs in which meat will be grown organ by organ, and its cultivation involve no pain to anyone.  But that brave new world will no doubt face its own moral issues and questions.  Meantime, I’ll continue to aim for simply paying attention and trying to do less harm.