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How Far Will You Go?August 02, 2006 Rhodry's had allergies since he was young, most noticeably to oak pollen. I never noticed any particular sensitivity to oak pollen in myself before Rhodry came along, but dogs and their people do develop affinities, so now we sneeze together. This year the pollen passed (a lot of the leaves got munched by caterpillars) but Rhodry's sneezing and wheezing continued. It got worse. Some nights I'd wake up to his snuffling. It'll pass, it'll pass, I kept telling myself; it always had before. Then one day in early/mid-July he was so lethargic that he didn't rouse himself from the lawn when his cookie-bearing friends walked by. At the barn he trailed after me dutifully but his heart wasn't in it. That spell lasted less than 24 hours, but I was shook. Of course I should take him to the vet, I thought, but equally of course I was overdue for my annual visit to the optometrist -- which I take even more seriously since those two retina reattachments left one of my two extremely myopic eyes pretty much unusable; if I can't see, I can't work -- and what with unexpected truck repairs, unexpected mattress replacement, and expected dental work the summer was already turning out to be financially, ahem, challenging. For a few days my mind set me up: your eyes or your dog, Rhodry or your livelihood. The heart had a better idea: Better living through plastic. In five minutes one morning I made Rhodry an appointment with the vet and me an appointment with the optometrist. I'll pay it off eventually. My vet and her assistants checked Rhodry out. I described symptoms. Vet said the lethargy might be linked to cancer of the spleen: tumor bleeds, dog gets draggy, bleeding stops, dog feels better. The congestion and the nasal drool might be related to allergies, or they might be related to tumors in the sinus cavity. A Lyme disease test would be a good idea. I'd already figured that out. What the hey, my plastic limit is up in the stratosphere somewhere. I said OK to Lyme test (the high-tech version that pinpoints how high is high; Rhodry has been chronically "low high" while showing no symptoms), OK to thyroid test, OK to urinalysis. Meanwhile we'd treat the apparently allergy-triggered sinus infection with Doxycycline and an antihistamine. Within 24 hours Rhodry was breathing more easily and obviously feeling better. By the time the vet called on Thursday to say that his Lyme test was actually low, the urinalysis was clean, and everything else was within normal limits, he was pretty much himself -- given that summer is no malamutt's favorite season, that is. Truth to tell, I hadn't really thought his day of lethargy was caused by cancer of the spleen, or that his snotty nose was the result of tumors in his head, but it was good to know for sure. Around the same time I'd been describing to some other horse people Allie's penchant for peeing on the trail: some horses never pee under saddle, but I can count on Allie to pee at least once and often twice on an hour-and-a-half-long trail ride. Allie's also an enthusiastic water drinker, especially in hot weather. One person told me privately that "excessive" water consumption and peeing were signs of insulin resistance and that she was concerned about Allie. I said, as politely as I could but probably too testily, that over the last few years I'd had the opportunity to observe the eating, drinking, peeing, etc., etc., behavior of quite a few horses and so I didn't think Allie's water consumption was "excessive." If Allie started displaying any more concrete symptoms, I would of course reconsider. A day or so later I recounted these stories to another horse friend. She'd recently had a physical; her doctor, whom she likes, had manually felt something between her stomach and her backbone, thought it might be an "aortal aneurysm," and recommended an ultrasound. My friend had the ultrasound (she has insurance). It turned out to be nothing. We shook our heads and rolled our eyes a bit: it seems lethargy can't be just lethargy any more, and congestion and runny nose can't be just signs of an allergy-aggravated sinus infection; and if a horse pees too much on the trail, maybe she's insulin-resistant; and that palpability in there might be an aortal aneurysm. The tricky thing is that of course they all could be signs of something serious -- but in the overwhelming majority of cases they aren't. I've been poking and prodding and kicking this around ever since 9/11, because it's pretty much a variation of "That person with a beard and an Arabic name could be a terrorist -- could be thinking about possibly committing a terrorist act sometime in the future -- but the odds against it are overwhelming." The question is "How far are you willing to go to reduce the odds to zero (allowing, of course, that this is impossible without ending Life As We Know It)?" If the subject is medical and your resources are unlimited, you can order every test in the book. (I know a few people who won't take "there's nothing wrong" for an answer. They'll keep testing till they find something.) But if you're talking about a whole society, the cost of reducing the odds beyond a certain point is astronomical, maybe just in money, maybe in other things as well. Testing routinely for the worst-case scenario when the worst-case scenario is pretty rare seems to be a factor in the deep malaise affecting the U.S. health delivery system. Some people profit directly from the tests; others are afraid of what might happen if the tests aren't done. The war on terror has long since turned into a sustained terrorist campaign, but plenty of USians don't see it because they're not being asked to pay the price for making USians feel safe. Wish I could offer some cosmic solution, but I can't. It's worth thinking about, though.
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