“So I was thinking along such lines, one recent Saturday morning as I took a shower alone, musing about those things and more, a whole range of things, from “It’s time to get him neutered” to “It’s time to turn him over to a sheepdog handler who can use his oomph.” Then I remembered he was invited to my friend’s party, so he’d better get a shower too–and some Axe Body Spray.”
Tag Archives: imerslund-grasbeck disease
by Lisa Lanser-Rose
It was déjà vu. In July, Mick got sleepier and sleepier and then pitched into a nightmarish tailspin that whirled with terms like “sepsis,” “hemorrhage,” and “acute collapse.” The beginning of October, it all happened again, exactly the same way, only this time we were broke. And tired.
Back in July, Mick miraculously healed. He found an appetite and energy like he’d never known before. In October, same turnaround, only faster, more vigorous, too good to be believed. His vet started calling him “Miracle Mick.”
Back in July, the only diagnosis we got was hypoparathyroid disorder. His ionized calcium was rock bottom, and his parathyroid hormone levels confirmed the diagnosis. However, the doctor admitted, it explained few of his chronic symptoms, the lethargy and lack of appetite.
It also didn’t explain why, just two weeks previous, his calcium levels were normal. “I’m mystified,” she said. “But if I stretch it, I can make the hypoparathyroid story work. But I know it’s not the answer.” And she sent me home carrying a feverish, feeble, and frail puppy, a sack of liquid antibiotic , a bag of syringes, and a prayer that it wouldn’t happen again.
We kept his ionized calcium up with medication, but it happened again anyway–the fading appetite, the lethargy, the slow descent, and then the sudden free-fall.
This time, however, the new vet, Dr. Specht from the University of Florida’s Small Animal Hospital would not commit to any one “story.” He uncovered more mysteries. First, in the aftermath of the October disaster, Mick’s B-12 was normal but his folate was low–that made no sense. And Mick’s white blood cell count was low before the onset of sepsis. Had it been low before the sepsis last time? The new doctor gathered all the data he could. He had student interns make charts. He had lots of story lines to follow: pancreatitis, small intestine disease, trapped neutrophil syndrome, cyclic neutropenia, pyruvate kinase deficiency, immune-mediated hemolytic anemia, and more.
Then, in all his careful investigation, Dr. Specht discovered that, in a moment of crisis, the doctor on the night shift had given Mick emergency interventions, which included a B-12 shot. That would explain the discrepancy between his B-12 and folate numbers and indicated a possible diagnosis: Inherited B-12 Deficiency, or an inability to absorb B-12 through the digestive tract. It didn’t explain the white blood cell count. It also didn’t explain what happened to Mick in July. If the cause of all Mick’s problems was a B-12 malabsorption, why did he bounce back in July? There’s no record of him being given a B-12 shot then. “But it might have caused the low parathyroid numbers,” he said. “Maybe Mick doesn’t have hypoparathyroid after all.”
Dr. Specht ordered a month-long series of blood tests to watch how his B-12 and white blood cell levels fluctuated. In the first week, his B-12 plummeted. Bingo. Mick can’t absorb B-12 from his food. He’ll need B-12 shots the rest of his life. To my relief, his white blood cells held steady–so far. Right before my eyes, Mick got bigger and stronger. I began to relax.
Mick was a new dog. In two weeks he went from 24 to 32 pounds. Even his bones seemed to grow. Although he was a year old, his testicles had stayed as tiny as spring peas, and his vet said we might as well leave them; “He needs all the help he can get.” Now, suddenly even those bulked up. His shoulders and hips muscled out. Best of all, though, I love watching him run.
I used to take him outside and throw toys for him, only to have him retrieve once or twice, stumble, and lie down. Now he didn’t wait for a toss, but ran great circles around the yard for the sheer joy of running. He galloped through the house, from one bedroom to another, making figure eights on and off the beds. He’s fanatical in his observations of the cat’s traffic patterns. As if he’d rigged her with a GPS, he knows exactly when she’s moving toward a sink, from her litter box, or out the back door. How much of him was muted all year! His joy, his appetite, his fulfillment–how fragile we all are!
We have new problems now. Mick’s a year-old dog making a six-month-old’s discoveries. His speed, strength, and agility are like cool, new Christmas presents. He caroms off the couch glancing at me as if to say, “Look, Mom! Check this out!” When he hears the cat leap into the bathroom sink, he roars in and hits the vanity with the force of a ram. And worst of all, my gentle boy, the one the vet told me would “make a great service dog,” is gentle no more. With new oomph in his rump, he rockets up and knocks people’s noses. He claws their arms. Where once he rolled onto his back and wriggled for small children, he now nips their heels and tugs their tee shirts. These are training challenges I fully expected to have with a young Border Collie. He’s not my first. But Alby, Mick, and I had spent a year living with Sick Mick. Mighty Mick has swooped in and changed all the rules.
We’re still in the midst of the month-long series of blood tests. Once a week Mick is getting a B-12 shot and a count of his white blood cells. Meanwhile, he not only eats all his Science i/d, he goes back to lick the bowl. It’s a basic dog behavior that I’ve never appreciated so much before–all those months of wringing my hands and offering food after food while he wasted away! No, I’m more than happy to step up training to accommodate a bigger, stronger, more assertive dog–the dog I always knew Mick could be.
The more I read about the causes of B-12 deficiencies, the more confused I get. A simple B-12 malabsorption problem can’t explain everything. Is this really what almost killed him twice? If so, why did he come back in July without the shot? Should I be afraid there’s more wrong with Mick? Why doesn’t he show permanent neurological damage?
The fact is, we might never know the answer. Bottom line is he is improving, day by day. It’s been a long year for us, and it’s not over yet. Maybe I’m getting close to a “crash” of my own–I still haven’t let myself work through how harrowing those two crises were, perhaps because the blood work’s still out.
Meanwhile I wonder, as I do in times like these, why a dog matters so much to some of us, and not to others. Wouldn’t be easier, and cheaper, to care less? How do you harden your heart? And what do you lose if you do?
September 28th, which was the second time Mick nearly died, I nearly let him go.
Three days off the IV later, he was bounding around the house. That had me spooked. More and more specialists were working on his case, but we still had no idea what was trying to kill Mick. I was overjoyed he’d escaped death again, even if my knees were still knocking.
Then, as soon as he was strong enough, I took him two-and-a-half hours north to the University of Gainesville veterinary hospital, where Dr. Specht told me to turn around and drive back home. Mick’s illness was too mind-boggling. Dr. Specht needed days to go over all his files and test results. That was a Wednesday. Dr. Specht was supposed to call me Friday with a hypothesis and a plan. He called—but only to ask for still more time. “As long as he’s doing okay, I’d like to take the weekend to keep investigating.” Mick wasn’t just doing okay, he was thriving like never before. I said okay.
Monday Dr. Specht called and talked for an hour. He said Mick was complicated, and probably more than one disease was at work on him. The primary suspect was cobalamin (B-12) deficiency, but he might also have Trapped Neutrophil Syndrome and Pancreatic Lipase Immunoreactivity. If not those, then Coombs’ Disease, homocystemia, pyruvate kinase deficiency, lymphangiectasia, inflammatory bowel disease, a motility disorder, or a malabsorptive disorder. “It’s also not impossible that bone marrow cancer might be crawling around in there, so we can do a biopsy.”
“You lost me at lymphangiectasia,” I said. “I’m not sure we have this kind of staying power.”
“Let’s start conservatively,” he said. We ordered a few basic tests through our local vet and arranged for the results to go to UF. We waited.
The results are in, but we’re still waiting for Dr. Specht’s analysis and recommendations. Mick’s cobalamin was low, which is good news—one kind of B 12 deficiency explains many of Mick’s mysteriously menacing ailments, and it’s easy to treat. But what’s causing the deficiency? Does he have other disorders? How low do we let his B 12 go?
Meanwhile, there’s nothing deficient about Mick. For the first time in his life, he’s a full-blown Border Collie. He’s rocketing around the house, yapping at the door, barreling after the cat, trying to boss us around. Most astonishing: he cleans his bowl, morning and night. He’s grown so fast so suddenly, he’s almost caught up to his brother Sweep, something I gave up hoping for.
It used to be he’d eat a whole bowl, then half, then none, and lie down despondent. We used to pace the aisles at Dog Lover’s searching for a dwindling numbers of foods he hadn’t yet tried. Right before his last near-death crisis, we realized we’d run out, and what was the point anyway? By then I knew, it wasn’t the food, it wasn’t his care, it was his body, and I thought no one could help us.
But now, Mick eats and heartily. He jumps and barks and roos while I open the can of Hill’s prescription i/d. I even saw the dog who refused all kibble steal a piece from the cat.
One day a week or so ago I thought he might have eaten an ibuprofen he found in the bottom of my daughter’s closet. I hardly had the energy to race him back to the vet, yet again, but I did. All he needed on top of everything else was a little poisoning and kidney failure. The assistant told me no ibuprofen was found in his stomach, but he really surprised her. “Mick is a new dog! He’s clattering around his cage and barking for attention—especially when we pay attention to another dog. And you won’t believe it. Dogs hate activated charcoal so we usually have to force it, but he ate it!”
Mick was a new dog. Was he going to be as sweet? Was he going to be as eager to please? Was he still going to be the charming darling that everybody loves? Also, Mick has been “cool” in the old-school, Sean Connery as 007 sort of way, always fearless, always amused, always a twinkle in the eye for the ladies. Nothing rattled him. Would he still be my delightful go-anywhere, do-anything, gal-winning pal?
I’d grown afraid to train him or take him anywhere. “I don’t want him to catch any germs,” I said. “I don’t want to wear him out.” But he had more energy than ever. The truth was I was afraid to risk loving him again. I avoided training and socializing, anything that suggested Mick had a future that could be taken from us. If I invested any more in him, it would just hurt all the more if I lost him.
Gradually I restarted our training. “He’s ready,” I said, but really I was starting to feel safe. We dusted off his old tricks, revisited our basic manners, and finally tackled our skateboard lessons again. By the time Intro to Agility started Mick was in orbit.
But the first round of blood test results have been in for a week. I’ve called and left messages. Today the front desk said Dr. Specht emailed me, but we’ve exchanged emails before. I haven’t gotten an email. They said he’d try again by 5:00 today, but still no email, and here comes the weekend.
I think it’s okay, though. Mick is doing great. He’s ready for his walk now, and it’s a beautiful evening in Florida. Have a great weekend, everyone! Mick says, “Roo!”