Note: this is entirely about caring for my beloved, aging Poo. If you find such medical discussions tedious, feel free to skip this one ... there's no surprise interesting stuff at the end. It's rather technical.
It was time for his annual bloodwork again. I took him in last Saturday, and they called me with the results on Wednesday (they had a little snafu so I didn't get them right away). I didn't see a vet this time when they drew the blood, because my favorite Dr. Nokes wasn't available, so it was just a 'tech appointment' for a blood draw.
Ergo, it wasn't Dr. Nokes who called me with the test results, but just a random clinic doctor who happened to be there when they came in. I'd never met with her before. She seemed nice enough, and told me Tyler's blood tests were "excellent." Her exact word. She said she saw nothing there to be concerned about. I was relieved, and didn't ask for specifics.
I said I'd come in in a few days to pick up the refill of his thyroid medicine and my copy of the test results.
So I did that today, but found some mildly disturbing things on the test results.
For one thing, his chloride was a little high. I don't know what that even means, or what might cause it. But I don't like anything being out of the reference range - or at least, I like to know why.
Then two white blood cell counts were off - neutrophils were low, and lymphocytes were high. Not excessively, either one, but out of the reference range.
I tried to look up online why any of that might be, but only found vague things. Elevated lymphocytes can be due to anything from an infection or inflammation to leukemia. (we're not even going to bother to entertain that thought, because if that happened, there'd be nothing to be done about it anyway). But everything I read indicated that usually they are both either low or high. I couldn't find any reason one would be low and the other high.
One last thing - there was a 'comment' from the lab that said Tyler's red blood cell count indicated he was 'normocytic' - I had to look that one up, which ended up meaning anemic. It's a kind of anemia where his red blood cell counts look normal, falls within the reference range - but actually there's a too-low volume of red blood cells overall.
So, why did this vet tell me his results were 'excellent'?
A couple thoughts. None of the numbers were exorbitantly out of the reference range. And I do know that different labs even use different reference ranges. So this (ironically) isn't a hard and fast science, apparently. For example, for the lymphocytes, which is referenced in percentages, the reference range was 12 - 30%, and Tyler's was 35%. But something I read online gave a lymphocyte reference range of, like, 8 - 35%. In which case, his would have been (borderline) normal.
So that may be why the doctor didn't seem too concerned about the number. Though it was a significant increase, as last November's test result was only 19%. And I'm still not sure why she didn't mention his anemia, which seems important.
Now, to backtrack, for a short bit of time now - I'd say approximately a week, as sometime just before or after his blood work, this started - Tyler's been acting like he doesn't feel well. It's hard to pinpoint only because it started very subtlely, and he's a very low-key dog anyway. (If he were human, he'd be British). Ever since he began 'getting up there' in age, when something very subtle begins to bother him, I'm never sure whether it's just a normal effect of aging, or something that needs addressed. And he always seems to be so subtle about these things!
He's been kind of mopey and lethargic, looking just depressed and sad, seeming to favor his back legs a bit, and having a harder than usual time with stairs. He stopped jumping up on anything (he used to like to sleep on the kids' futon, which is pretty low to the ground). But at first it, again, seemed fairly mild, and I just decided to wait and watch, and see how he faired.
Just in the last couple days he seemed to get worse, being even more mopey and lethargic than usual, and starting to yelp in pain when he moved certain ways or when I tried to pick him up.
I would have liked to discuss the test results with Dr. Nokes and addressed those other issues at the same time, but he's not going to be back at the clinic until some time next week, and I didn't want to wait that long since Tyler seems to be feeling worse. I wanted to do something sooner (but do not even remotely trust the rest of the vets at this place).
So I did some research and some thinking, and here's what I came up with.
The mopey, lethargic lack of energy could well be caused by the mild anemia. The mild anemia could well be caused (unfortunately, and I'm mad at myself) by Tyler's diet. When I changed his diet last year to help with his kidney issue, I stopped using the Missing Link Plus supplement I'd been using for years. It has a lot of ingredients in it, and though they're all natural and very good things under normal circumstances, I was unsure whether any of them might have an effect on the kidney function ... and since I was working hard to help them, I didn't want to take any chances on giving him anything that might counteract that. So I stopped using it, but I didn't replace it with anything else. But that was Tyler's source of iron, B vitamins, and many other things that he probably needed. Since his home-cooked diet became more limited on the 'kidney plan,' he probably wasn't getting a full array of everything he needed. And I -stupidly (which is why I'm mad at myself) had not switched over to a multi-vitamin-and-mineral supplement on his new food plan.
I knew I should. I even bought one. But I was so worried about giving him anything that might counteract my kidney-fixing, that I only gave it to him sporadically, not on a regular basis.
So ... that could possibly be the cause of the anemia.
I'm solving that (if that is in fact the problem) ... but more on that in a minute.
The Missing Link also contained glucosamine, which is good for joint health and support, so when he lost that supplement last summer, he also lost that support. I figured if he had a problem, I'd just add a glucosamine / condroitin supplement to his diet, but he never seemed to have a problem, and I forgot about it - till now.
I have no idea about the chloride. The only thing I read about that is that it's an electrolyte, and tied with sodium and potassium (both of which were normal for Tyler), and can be effected by water consumption. I'm wondering if that could also be an effect of his misbalanced diet (with no vitamin supplement) but I do have to wait and ask Dr. Nokes about that one.
So ... I stopped at the pet store and the local health food store on my way home, and stocked up.
First, I found doggy aspirin, something I'd never seen before. I'd wished for the past couple days that I had something to give him to quickly alleviate the pain (the supplements alone would take longer to work) but was unsure if it was okay to give dogs people aspirin, and forgot to ask the vet. So I snagged some of that. I gave him some when I first got home, and I do have to say within an hour he definitely felt better - he's moving around more, voluntarily, and doesn't look quite so 'sad' (or in pain).
I also bought a bag of commerical, but holistic, all natural dog food. I have reverted to healthy 'commercial' food before a couple of times, and it can have it's benefits. During the winter of 2008-2009, Tyler was looking thin and bony, and I switched him to such a food for a few months, and he bulked up and had a lot more energy. But I switched him back to home-cooked when his test results showed the first signs of kidney problems. (the food didn't cause it, and I know that for a fact, but the reason for that is long and complicated, so I'll spare you the details).
So I bought some of that type of food again to try for awhile. He also lost 3 lbs. sometime in the last couple months (another potential side effect of anemia), so I'm pretty sure that this food will help him get back to his normal, healthy weight of about 20 to 21 lbs. Plus, it is laden with vitamins, minerals, and all-natural healthful things, which I hope to help him with his anemia problem.
It also has glucosamine, which should begin to help with the hip problems. But as a bonus, I also bought a glucosamine and condroitin supplement too. I am unsure whether it's possible to give too much, so I thought I might only give him a half-dose of the supplement, at least until I talk to Dr. Nokes. But worst case scenario, I can use the supplement when I put him back on his home-cooked diet - because after awhile, I will.
So ... back on a commercial, holistic healthy food to help him gain weight, have more energy, increase his iron and B vitamins and hopefully fix his anemia, glucosamine and condroitin to help his joint problems ... and hopefully he'll be back on track. And like I said, already this evening, just with the doggy aspirin, he's about 65% better. So being in so much pain might have been a huge part of the problem.
And, I'll wait to talk to Dr. Nokes about the chloride, neutrophils and lymphocytes ... and maybe have him tested again in a few months to see if a diet change effected any of that. Though it also occurred to me that since inflammation can cause an increase in lymphocytes, and apparently Tyler's arthritis had ramped up and he probably had swelling in his hip joints, that might account for the slight increase in lymphocytes. Not entirely sure about that one, though.
But ... his kidney numbers were FANTASTIC! Both well back into the normal range. So, that part of my scheme over the last year worked, anyway.
I mentioned that using healthy commercial food had helped in the past, but that I planned to put him back on home-cooked later - and one may wonder why I would do that, if the store-bought stuff always helps fix problems. Well, there are a couple reasons. I still believe that a whole-food, 'real-food' diet is best for him. Even the healthy store-bought brands are still processed and no longer fresh food.
The tricky part about the home-cooked diet is making sure Tyler's getting everything he needs - vitamins, minerals, etc. And as I mentioned, since the different types of food going into his diet had become limited last year to help the kidneys, he probably wasn't getting everything he really needed - not enough to cause any fast, noticeable problems, but just enough of a deficiency to creep up on him over time.
I use the healthy commercial food as a 'quick-fix' - it is complete and contains everything he needs, so it will quickly bring him back to balance, rather than me juggling a bunch of supplements and hoping I get the right mix.
But once he's back in balance, I like to go back to the home-cooked diet, and each time I try to then adjust which supplements he's getting, to maintain the balance I just restored. So, for example, this time I'll make sure he's getting enough iron and B vitamins to keep him from getting anemic again, and I'll either start using the Missing Link again, for both vitamin and mineral content, and joint support, or I'll add a glucosamine/condroitin supplement.
It's always a big balancing act by this point ... fix one thing, something else goes awry. Like juggling jellyfish. In the dark. Blindfolded.
But, one day at a time ... and this evening, at least, is good.
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