24 November 2015

In This. . . Grave . . . Hour - Fuck Fuck Fuck - Perhaps The Most Fateful In Our History - Bugger Shit Shit.

The most clear, beautiful day we've seen in a week arrives, yet 'tis a dark, grave time at Mil Colinas.

Accept it: we live in the tropics. Accept it: I am an excellent diagnostician . . . by anyone's standards. And I have a complete understanding of blood work/chemistry and internal medicine. I know what your platelet level should be. I can make your eyes roll back in your head discussing a left-shift of your differential. See?! You're already rolling your eyes.

So imagine poor Rusty. Perhaps he mentions an ache, or a new insect bite . . . or perhaps it's merely a series of sneezes. I go through my routine interrogation. Okay, honey, we've now ruled-out dengue fever, bot fly larvae, meningitis, encephalitis, and the common cold. You'll live.

But things are a bit different for me with Jill The Pill. She can't respond to my Atticus Finch interrogation. 

Jill's blood work is back, and the pedestal on which her veterinarian stands remains upright and strongly intact. No, Jill's blood work is not perfectly within normal limits, but neither does it clearly indicate canine anemia (which isn't anything like human anemia --  I know you were curious), which would truly indicate tick fever. 

My poor physicians. Jill's poor veterinarians. I am completely unable to blindly follow doctors' orders. I need discussion . . . give-and-take. Like it or not, we are going to discuss a differential diagnosis, be it mine or Jill's. The willingness of my physicians (and Jill's) to discuss tiny nuances in blood work or symptomatology is my measure of an excellent health care provider. Both Jill and I are in good hands.

Jill probably has tick fever. Why? Because she lives in Costa Rica and had ticks. And now that I know what we're facing, I can cope. In fact, my stress level is down to almost zero.

A few numbers in Jillet's blood work are on the low-side of the normal range, but nothing too alarming. There are two numbers, however, which aren't wildly off the scale but do seem to indicate tick fever. I stared at these numbers for an hour trying to rationalize why they might be meaningless. I had to concede . . . those numbers don't bode well. The only way definitively to know about tick fever is to perform additional tests (smear/titer testing). I'm not opposed to additional tests, but neither do I want to wait for results before beginning treatment for this potentially deadly condition. On the other hand, why subject Jill to 30 days of powerful antibiotic treatment (antibiotics that will kill her good bacteria, too, as a side-effect)? 

Decisions, decisions. Our wonderful vet did agree that ultimately the decision was mine . . . not in a shirking-her-responsibility way . . . in a Kathy-you-know-your-stuff and you-know-your-dog way.

So I went to the human pharmacy today for human antibiotics for Jill. Unfortunately, her specific antibiotic loses its efficacy when taken with dairy products. Unfortunately, Jill needs a probiotic in yoghurt (dairy!) to counter the kill-the-good-bacterium effect of her prescription. She also needs vitamin B12, which is easily added to her diet via Ensure. Whoops, dairy, again. Antibiotics BID. So getting into her tummy B12 and a probiotic laden with dairy is all about timing. I'm on it.

I see that you're overly concerned about Jill's health. Linda, you especially. Fear not. If there is a single thing in life at which I am 100% competent, it's management of a sickly patient . . . canine or human. Right, Becky? Jill could not be in better hands if she was in the ICU at Johns Hopkins. 

It's been a completely unnerving 72 hours. But now I can see the dragon that is tick fever and attack. I am fully in my element during this grave hour. Lo que hay.