Fanconi Syndrome, Part 2

Yo-Yo and I showed up for our appointment at the vet's on the Wednesday before Thanksgiving. Since I had earlier left a list of tests that my poor little dog needed, I expected to walk in, have the techs draw Yo-Yo's blood, and then get me the results. With that information, I would discuss protocol variables with Dr. Young Snot. I already knew that the discolored urine test strip meant Fanconi syndrome and was eager to get Yo-Yo on the pilling regimen that would make the disease a manageable, chronic condition.

Dr. Young Snot had other ideas, however. She was unhappy that I was playing the doctor and diagnosing rare illnesses based on pages I had downloaded from the web. "It's good to see that you've done internet research," she noted with condescension, holding up the protocol I had printed and delivered beforehand. "But none of the doctors here have ever had to diagnose this disease."

On the one hand, I understood her patronizing manner. I have had a similar experience: 18-year-old students from area high schools rated D and F by the state who tell me what excellent writers they are. These young people, with their essentially meaningless diplomas, believe they know more about effective composition than I, a veteran teacher and published author. I could sympathize with Dr. Young Snot; I'm certain that she has seen her share of clients who drag in all kinds of crap off the internet and don't know the difference between credible and bogus websites.

On the other hand, her dismissal really angered me. I might not have ever pithed a frog or dissected a kidney, but I am far from stupid and know my breed and its health concerns. I am also capable of reading and understanding scientific literature, even though I might need a dictionary by my side while doing so. I have been a client at this practice for over ten years and have never waved internet printouts at any of the doctors. I don't interfere during an examination and always follow the doctor's instructions. When the Old Man injected Eudora, my ancient cat, with cortisone [$70 visit] because she was clawing at her face—"It's a food allergy, and this will fix her right up"—I didn't complain when, two weeks later, Dr. Young Snot discovered the abscessed tooth [another $200] that the Old Man had missed since he didn't even bother to look in Eudora's mouth.

Dr. Young Snot was unable to run the Venous Blood Gas Panel, a test necessary for detecting the acid levels in Yo-Yo's blood, because the office didn't have an I-Stat machine, a fact that no one mentioned to me when I left the list of tests that I needed performed. Dr. Young Snot wanted instead to do only the urine analysis and a senior blood screening. These tests, which cost $127, had to be sent out to an independent lab. With them, Dr. Young Snot would confirm or rule out Fanconi syndrome. "Why spend money for a very expensive blood gas panel if you don't need it?" she asked.

She drew blood for the senior screening as well as a heartworm check—"Might as well while she's here"—and sent us on our way [total bill = $193]. I had hoped, after leaving the office, to know how many and which pills I would be administering, but instead I had a five-day wait for the lab to return results. "I'll call you on Monday," promised Dr. Young Snot. "It's probably not Fanconi syndrome, and you can bring her back for her shots since she's overdue."

While waiting for the lab results, I was plagued with anxiety and guilt. Although the protocol notes that dogs lead fairly normal lives with the correct supplementation, basenji people always discuss Fanconi syndrome in tragic terms. That I couldn't immediately start the pilling was also frustrating. If I had tested the dogs every month as recommended, how much sooner would I have caught the problem? Yo-Yo was showing few if any symptoms. She was a healthy weight and had a nice coat and skin, all things negatively affected by the disease. She had been drinking slightly more, but I had [mistakenly] attributed that to a very long, very hot summer, worse than usual because we had lost so much shade after last year's hurricanes took out one-third of the neighborhood trees.

Late on Monday afternoon, I still had not heard from Dr. Young Snot. I called the office as soon as I arrived home from work. The techs told me that she was with a client and would return the call. In my imagination, I saw her in front of the computer visiting the same websites where I had done my research, trying to make sense of Yo-Yo's test results. The basenjis and I sat by the phone, unable to take our afternoon walk, waiting to hear. Elizabeth came over to walk Bug for me, but Yo-Yo refused to leave the house for more than a quick pee and seemed as impatient as I for the news.

I decided that at 4:45—fifteen minutes before the office closed—I would call back and demand my $127 test results. At 4:43, the phone finally rang. Dr. Young Snot said that yes, Yo-Yo had Fanconi syndrome [big surprise]. Yo-Yo did have sugar in her urine [yet another big surprise] and a high level of creatinine in her blood [1.8 when the reference range is 0.5 - 1.6]. The high creatinine level meant abnormal kidney function. The good news, though, was that she was heartworm negative [wow, another big surprise]. I'm sure that I imagined it, but I thought I heard in her voice disappointment, not that Yo-Yo was sick but that my unschooled diagnosis had in fact been correct.

Since none of the doctors at this practice had any experience with the disease, Dr. Young Snot wanted to refer me to a specialist, which meant postponing the start of the protocol even longer. I told Dr. Young Snot that I wasn't bothered by her lack of experience, that we could learn the ropes together, but she felt uncomfortable and had already consulted with a doctor who had treated a couple of dogs with Fanconi syndrome. Dr. Young Snot couldn't say enough good things about the specialist and the huge veterinary compound where the doctor worked, but I was demoralized by another expensive trip to see someone who didn't have considerable experience with the disease but would charge me twice as much for the privilege of working with her.

I was able to get a copy of the test results and could compare some of the numbers on it with those that Dr. Gonto mentioned in the protocol. Yo-Yo seemed very close to normal, and I realized that if I hadn't fostered Java, hadn't tested all of the dogs because of a remark that the coordinator made, but had brought Yo-Yo in for her regular annual, that the disease would still be undiagnosed. In this situation, a well-informed basenji owner did know a little more than the vet.