July 2, 2021

White Dog has moved into the bedroom to be with the rest of the White Dog Army at night. The loss of her pajama party sister, Bella, in the office left White Dog alone and lonely down the hall from the rest of us. 

Thursday's long conversation with Dr. Julia led us both to the conclusion that we needed to take an entirely different approach to helping the Little White Dog of My Heart.

With all of the test results in, we know that WD's physical ills are typical senior issues...arthritis, the start of cataracts, her spinal impingement, high side of normal liver values, and her just drained pancreatic cyst...nothing to generate the levels of her reaction.

What if, Dr. Julia suggested, White Dog was suffering from dementia? She had just read a new paper about Canine Cognitive Disorder that she found enlightening. The cries could be anxiety rather than pain. That is not to say, she quickly added, that there is not pain like you and I feel just having an old used body; and she should still have pain management medication. But fearfulness and being vocal are not uncommon; and it is not unusual for several of the symptoms to "just appear" seemingly without warning. At soon to be 17, White Dog is certanly of an age to exhibit this kind of distress; and she gently cautioned me "seventeen IS nearly 85 in terms of human equivalence...generally considered end of life range." I hated hearing those words and drew in a breath. "Are you suggesting we help her cross?" I asked thankful we were on the phone and she could not see the tears perched waiting to flow. "No," she immediately responded, "not at all. But think about palliative not regeneration. And we can provide White Dog with a very comfortable and interactive part of life with your family still."

"I know you are reeling from Bella's loss today and I don't want to change up too much right now. Plus this is a bad weekend for pups with fireworks and such so let's not jump too quickly. I would like to shift her from tramadol to trazadone which will help her anxiety. But we will have to trial-and-error dosing so I do not want her on it this weekend in case it is not enough. So stick with the tramadol at dark, when it is likely to get noisy. The pain med will help her sleep through the booms. Call me on Monday with a report and we will start redirecting our approach; for now continue as things are."

"I am thinking," Dr. Julia said, "White Dog needs the galliprant and the gabapentin for her aches and pains so we may keep both. The metronidazole we will continue only untill she has three days of being solid. Then we will try the trazadone at a low dose...that we will almost certainly need to finetune so not until we are past pet hell weekend.

"You and Steve have dealt with psychological needs of seniors. Love her. Give her attention when she indicates she wants it. Make sure she is connected to the pack and does not isolate. You seem to have her eating...it looks like she gained half a pound from last time. Call me on Monday."