Won the battle, lost the war

Where did this week go? Crammed full, as usual. Long days at work, lots to do at home. Wednesday I did have some fun, going to Ikea and out to lunch with a girlfriend. It was a nice respite before gymnastics/piano/dinner/homework/bedtime/work again.

I have an old patient who I've been treating for a year now with Cushing's disease (hyperadrenocorticism). This is a super-complicated disease. The patient has to take just enough medication to kill off just enough adrenal gland to make them have normal cortisol production. Not enough, and they are out of control. Too much, and you can destroy the entire adrenal gland and end up with Addison's disease (hypoadrenocorticism) - the opposite disease.

My patient, a sweet geriatric dachsund, was extraordinarily hard to regulate. The test to check the adrenal gland function is expensive ($130) and requires two blood draws over a few hours. I would tweek her medication, then retest in 4 weeks. Tweek again, and retest in 4 weeks. And so on, for nearly a year.

The owner was a dream. She never complained about the frequent visits or the costs. She called me with every slight change in symptoms. Her goal was always to make her pet's life as good as possible.

This week she came in for her adrenal test, but now she had not been eating for nearly 3 days, and had vomited. Was her adrenal gland over suppressed? My patient seemed so depressed. I ordered a full blood panel (another $100) in addition to her usual test.

Amazingly, for the first time her adrenal gland function was normal. I'd hit upon the right combination of drug for her. Unfortunately, her kidneys were in failure. We put her on fluids for 24 hours, but saw minimal improvement. An ultrasound revealed end stage kidneys -- little hope for recovering any function. By now, she hadn't eaten in 5 days.

Her dedicated owners decided to stop treatment and end her suffering. It was a decision I supported. They came in red-faced and sad for her euthanasia. I was crushed, too. After a year of frequent treatment, the staff and I were quite fond of her. I was frustrated that I'd finally got Cushing's disease under control, only to by side-swiped by kidney disease.

The patient was quiet, sweet, and ready to go. The owners said goodbye, and I did, too. As I bent down to her, she licked me on the nose - always before she had been reserved, but I think this time she could see how sad I was, and she was actually trying to comfort me. For the first time, she reached out to me. Her breath was stinky from uremia and dental disease, but those kisses were so sweet and precious.