Fanconi Syndrome, Part 3

After Dr. Young Snot explained her apprehension about treating Yo-Yo, I quickly made an appointment at the area's huge veterinary specialist compound, comprised of four separate buildings and 15 different vets. A week later, we made the long drive and found our building, Internal and Avian/Exotic Medicine. As we sat in the waiting area, we listened to a macaw squawking from the bird side. Dr. Young Snot had described the facility as someplace so nice and so advanced that a human being would feel comfortable receiving treatment there. When a tech put Yo-Yo's front leg into a blood pressure cuff and pumped it up [$25 charge], I was convinced. That we waited 45 minutes past our scheduled appointment time before seeing the doctor was another factor reminiscent of a trip to a human health facility. While Yo-Yo shook beside me, I was happy to observe that regular art decorated the walls, not posters from drug companies advertising medication my pets just had to take.

No matter how impressive the facility was, seeing a specialist is no fun. I waited knowing that the only reason for the visit was a health issue so rare our regular vets couldn't handle the problem. When I glanced at the other patients and their humans, I knew that they were in dire straits as well. One woman left an exam room in tears. The doctor had had to admit her rottweiler for overnight care. The receptionist whispered that after putting down two of her own—one only three years of age, the other four—she would never have another of the breed. Rottweilers must have their own health issues.

When we finally met the doctor, I did find her very impressive, despite my annoyance at the long wait. While Yo-Yo hid under the hardwood bench in the exam room, this woman took out a blank form and asked me all kinds of questions. She wasn't rushed or impatient as our regular vets could be, wrote down all of my answers, and encouraged me to ask questions of my own.

After getting Yo-Yo's health history, she folded her hands and told me that no published scientific research proved that the time-honored protocol made the slightest bit of difference in the progression of Fanconi syndrome. She had seen some owners adhere to it religiously and others who just monitored blood gases. She didn't come out and say it, but she intimated that all the animals progressed identically. The last dog she had treated with Fanconi syndrome lived until 12 [an age I would be happy to see 6-year-old Yo-Yo reach].

I told Dr. Skeptical that I wasn't bothered by the lack of published scientific research. Basenji people had lots of anecdotal evidence that the protocol helped, so I wanted to try it. I realized later, while digesting this whole afternoon, that a scientific study would be nearly impossible to arrange anyway. Fanconi syndrome is incredibly rare outside of the basenji breed while basenjis are rare themselves, so finding enough candidates for a double-blind study would be difficult. To further complicate the research, no basenji owner I know would agree to enter a dog into the study and then receive placebos in place of the meds that the protocol recommends. My understanding is that to prove the protocol's effectiveness, some dogs would receive sugar pills so that researchers could compare the results of those unlucky participants to the dogs who got the real thing. Only under these conditions could the researchers show that the "protocol-ed" dogs lasted longer and did better. Not even in the name of hard science and to make progress toward journal-verified treatment would I allow Yo-Yo to be part of such a study, a feeling I'm sure all basenji owners would share.

After our first discussion, Dr. Skeptical left to prepare the estimate. At this point I was a little panicky. Dr. Young Snot had said, "Why spend money for a very expensive blood gas panel if you don't need it?" Since the blood and urine work that she had performed cost $127, I assumed that the Venous Blood Gas Panel must be double or more in price. I figured that with the expensive exam fee for a specialist, I'd be lucky if I got out of there under $500.

When Dr. Skeptical returned, I was pleasantly surprised. The blood gas panel cost only $40. She wanted to culture Yo-Yo's urine, looking for an infection that might not be readily evident in Yo-Yo's diluted pee. "It's dark, warm, and sugary in there--the perfect place for bacteria!" she noted. This test was a pricey $110 but recommended in the protocol, so I agreed. The exam fee itself was a whopping $125 [compare that to the $36 the regular vets charge], but I really appreciated never feeling rushed and getting plenty of opportunities to ask questions. Dr. Skeptical explained that follow-up visits would be half that price. She also wanted to do an ultrasound of Yo-Yo's kidneys [apparently they had all the toys in the back]. To culture urine, she explained, she would have to insert a needle right into poor Yo-Yo's bladder so that the sample would be sterile and the lab wouldn't be growing bacteria picked up outside the body. So many dogs these days are overweight that the ultrasound is usually mandatory to find the bladder. "Yo-Yo's nice and trim, though, so I think I can find it by feel," Dr. Skeptical added, and we dodged that expensive bullet. She wants to perform the ultrasound at the next visit just to see if my poor dog has shriveled little kidneys or ones that are a normal size.

Yo-Yo got hustled into the back and returned 15 minutes later. Eventually Dr. Skeptical rejoined us with the blood gas results and showed me how to calculate the dosage of sodium bicarbonate [pCO₂ = 37.9 mmHg; pH = 7.252; dosage = 80 grains or 8 tablets]. I knew that some Fanconi dogs took as many as 40 pills daily, so I was happy to learn that in addition to the vitamin and amino acid supplements recommended by the protocol, Yo-Yo needed only 8 sodium bicarbonate pills per day, 4 with breakfast and 4 with dinner. At this point I didn't know what challenge administering the pills would pose, but 8 per day was a way easier number than 32, the highest dosage in the protocol.

I asked Dr. Skeptical if she thought Yo-Yo was asymptomatic or symptomatic as I didn't understand the distinction, and the difference determined how much of the other supplementation Yo-Yo would require. She seemed a little stumped by the question. On the one hand, Yo-Yo looked perfectly healthy and had nearly normal blood readings. Dr. Skeptical had said earlier, "Look, based on her blood work, she feels fine, so don't let what you know about the disease affect how you treat her. Just let her be a dog!" On the other hand, Yo-Yo was drinking and peeing slightly more—although I couldn't tell if that was the result of all the hard play and emotional upset of having our foster boy Java around. Dr. Skeptical finally concluded that drinking more = kidney damage = symptomatic, but she didn't seem entirely convinced.

I left with the blood gas results in hand, something I had wanted for over two weeks. We would have to return in 10 weeks to see if the sodium bicarbonate supplementation was doing its job stabilizing blood acid levels and preventing organ damage in Yo-Yo's body.