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Hi Brenda, thanks for your question. Can you give me more info on Lenny?
1) What dosage of tramadol is he currently on? How often is it given?
2) Was labwork performed during his checkup?
3) Did the vet elicit any pain when he performed the exam?
4) What risk does he have of head trauma (is he allowed to roam freely in the yard, backyard, neighborhood, etc).
This info will help me to give you the most useful info.
Was any labwork run during his visit?
Did the vet find any overt pain (we usually don't use tramadol unless there is pain, but it's always good to check)?
With your concerns of lethargy coming and going, I would also be concerned about eye or head trauma. A lot of dogs will make a vast improvement when we give medications, but the improvement can either be short-lived or them feeling well can cause them to overdo it--causing them to then have similar or worsening symptoms later on during the day. As well, it's often seen that dogs with head trauma are slow to rouse and may sleep harder than normal. This can be due to inflammation in the area causing him to feel unwell.
I would be curious if your vet would want to try some steroids with Lenny. The white blood cell line is only moderately elevated and we can sometimes see an upward shift in the WBC's when a pet has recently received trauma to their body. We like to avoid steroid usage, however, if we're dealing with an infection. There's certainly a "should we or should we not" concern here because the infection (if he has one) is not obvious. You also did not mention that he's on antibiotics, which makes me believe your vet suspects that this is not related exclusively to an infection. I would discuss this with them, for sure. Steroids can be of great benefit when there is trauma involved as it helps to reduce swelling rapidly. If benefits of steroids is to be seen, we usually start seeing an improvement within the first 24 hours after it is administered. Depending on treatment protocol, your vet may wish to do a simple injection or to place an IV catheter, run fluids and administer a different type of steroid. Either may be of great benefit to Lenny.