Tag Archives: inherited juvenile cobalamin deficiency

Miracle Mick

by Lisa Lanser-Rose

Mick cheated death--twice.

Mick cheated death–twice.

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.”

Mick in intensive care, July 2013

Mick in intensive care, July 2013

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.

September 30th, there was almost nothing left of him.

September 30th, there was almost nothing left of him.

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.”

We started to train again. Mick loves showing off!

We started to train again. Mick loves trying new things–and showing off!

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.

Audrey couldn't believe her good fortune--the dog was gone again!

Audrey couldn’t believe her good fortune–the dog was gone again!

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!

Mick makes friends everywhere--but now he's not always gentle.

Mick makes friends everywhere–but now he’s got to learn to  hold back.

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.

Mick's starting to question his standing in the world.

Mick’s starting to question his status in the neighborhood. Does he really have to listen to this kid?

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?