A Good Day and Night

I am so happy and grateful to report that there have not been anymore seizures since yesterday at 5:21 am. Brady had a great day yesterday. He looked good, his eyes were bright and alert and from all indications he felt very good. We played fetch with his tennis ball for a really long time; he didn't want to quit but I made him take a break and then later went for another round of fetch. He even got to go for a ride to the pharmacy to pick up his new dose of medicine.

Per Dr. Katherman's instructions, I increased his Zonisamide dose by 50mg starting with last night's evening dose. So he will be getting 250mg of Zonisamide in the morning and 250mg in the evening for a daily total of 500mg. Phenobarbital and Potassium Bromide doses will remain the same.

Praying that things will continue to go well and that we will have a long seizure free stretch!

Seizure Monster rears its ugly head again!

At 5:21am Brady had another seizure which makes two seizures in 23 hours. It was pretty much the same as the one he had at 6:41am yesterday morning. He didn't lose bladder control and again it was a little shorter in duration than past ones lasting about a minute or so. I inserted the valium suppository at 5:24am once the convulsing had stopped and he was lying there calmly as he does before he regains consciousness and is aware of anything. By 5:25am he was up and on his feet. At 5:30am I gave him some rescue remedy on a small piece of bread along with two-thirds of a cup of dog food. At 5:35am I gave him all of his meds. Brady recovered quickly, although this time he was a bit wobbly and unsteady on his feet at first but that improved in a matter of 20 minutes or so.

I called Dr. Katherman and fortunately was able to speak with her right away. She is increasing his Zonisamide by 50 mg twice per day. The intention is to see some obvious control over his seizures and there is room to increase the dosage according to his latest blood work. Hopefully, the Zonisamide will be more effective at an increased dose since it is now obvious that the initial dose that he started on isn't doing the trick.

I am thankful that Brady has recovered from both of the seizures quickly and seems to be doing fine. I am also thankful that as hard as it may be to see this, both Jeff and I are handling things a little better each time. But I must say, I really despise this ugly seizure monster and want it to go away!!!

Making Tracks to Defeat Canine Epilepsy

Please Mark your Calendars: PURPLE DAY is March 26, 2010

Please wear purple on March 26th!

To support Epilepsy Awareness Globally for canines and humans!

Same Disease Different Species

Toby's Foundation is partnering with www.purpleday.org


Can you and your dog help by wearing purple on March
26th to increase epilepsy awareness for canines and humans and show
your support for this worldwide initiative?

We are representing canine epilepsy in this effort
though we want to show our support for both humans and canines affected
by this disease.

Wearing something purple is a simple way for you to
reach out and help so please wear purple on March 26, 2010. Purple is
the international color for Epilepsy!

For more info please visit us at
www.tobysfoundation.org/whatsnew.htm
and click on Purple Day.

Many people do not realize that dogs suffer from this
disease.
At the American Epilepsy Society conference Dr. Ned Patterson
tells people "Same Disease Different Species"
By joining together we can help increase epilepsy awareness worldwide for
people and their pets with epilepsy.

Brady's seizure clock re-starts

I'm sad to report that Brady's seizure clock had to be re-set this morning. At 6:41am, our sweet boy had a seizure. Of course, we've have hoped and prayed that he wouldn't have any further seizures, but we must be realistic and as hard as it may be, we must deal with them as they come. It has been 41 days since the last seizure, one day short of making it 6 weeks. Although I consider this seizure a grand mal it seemed to be less violent and less severe than those of the past. There was no loss of bladder control which is a positive since normally he does lose bladder control. There were other positives as well, it was of shorter duration, approximately 1.5 minutes, 2 minutes at the most of actual seizure activity, the convulsions weren't as violent as usual. The teeth gnashing occurred but also seemed less severe. There was plenty of drool but not an enormous amount as in the past. Since the seizure took place on our bed, I sort of laid over his body and held him close to the bed. Once the seizing stopped I picked him up and laid him on his bed on the floor so that once he came around there would be no chance of falling off the bed. The post ictal phase was much better than usual, there was almost no pacing and he seemed calmer and not as anxious as in the past. Also he didn't seem very ravenous at all, although I did give him two-thirds of a cup of dog food, and normally he is literally starving. The seizure happened only 4 minutes before he was due his medication. He recovered quickly and was on his feet by 6:46am, so all said and done it was 5 minutes total (from the minute the seizure began until he was on his feet again) as opposed to the usual 7-8 minutes. At 6:46am I inserted the rectal valium and at 6:48am gave him all of his medication plus quite a few drops of rescue remedy on a small piece of bread. Over all it was more toned down than the others. He wasn't wobbly or uncoordinated when he got up and walked around. His balance was good and he was able to walk down the stairs on his own.

At that point he was just fine and we went about our normal activity. We didn't get to go on our normal morning walk because it was pouring rain, but he would have been fine to go had it not been raining. Needless to say I have been watching him like a hawk since and am so thankful that I am able to do so.

I spoke with his neurologist on the phone and she recommends that we don't do anything different at the moment with the Zonisamide. There is room to move up to a higher dose if needed but it hasn't been long enough to say for sure if we need to. Also his Potassium Bromide dosage was just changed at the end of October and every time the dose is changed for that drug, it takes another 4 months to reach a steady state. It should be at a steady state by the end of February. Dr. Katherman is looking for better control of his seizures than only going 6 weeks between seizures, but said it will take some time to see a good trend. She is looking for that trend to happen over a period of time. So for now we will leave all meds at their current dose and pray that no seizures come again for a long while or never again would be a dream come true. Hopefully this time we will see much more time pass on his seizure clock and of course we will continue to pray that we will never have to re-set that clock and that he can become seizure free forever.

We put this all in God's hands long ago and will continue to do so. I will never forget what someone who lives with an epileptic dog told me recently and that is: God only gives these special needs dogs to those people who can handle it. I believe that applies to all special needs, not just epilepsy, and not just dogs, but all pets and people for that matter. Reminding myself of that statement truly helps me through the rough spots when life is not always smooth sailing. I am thankful that Brady belongs to us, that he is our dog to take good care of, and that we are able to do all we can do to help him through this dreaded disease. At times it feels devastating but then I quickly remember that we must be strong in order to help him when he needs it most.

Blood work results are in---Great news!

I spoke with Dr. Katherman, Brady's neurologist, today and the results are finally in. His Zonisamide levels are in the therapeutic range where we want them to be. Therefore, the Zonisamide will remain at the current dose as will the Phenobarbital and Potassium Bromide. When he has been seizure free for 8 weeks, we will have a further discussion on his medication. But first of all, we have to be sure that without a doubt his seizures are under control. Brady continues to do well and is adjusting to the cocktail of drugs that he takes. He has just recently gotten back to his ball playing and is able to run and catch the ball as if he never missed a beat. That was something he really missed for awhile because he was just too uncoordinated to run and chase a ball without the risk of injury. He would literally tumble over and want to keep playing. Going up and down the stairs and jumping on the bed are now much easier tasks for him than when he was first trying to adjust to the combo of meds. There were some nights especially when we would carry him up or down the stairs because he was so unsteady on his feet and would so easily lose his balance. There were times when he would be so weak in the rear that he's rear end would just collapse. We feared that he'd fall if left to navigate the stairs on his own. We are so thankful that he is adjusting to the meds and that he can do his everyday normal routine again because for one, playing ball is on the top of his priority list. It's wonderful to see the sparkle back in his eyes again too! For the most part he is as agile and coordinated as before. When he is just rising from being asleep or is tired, he may be a little clumsy, but hey, that's okay!

Thank you God for leading us to Dr. Katherman and thank you Dr. Katherman for being such a competent, knowledgeable neurology vet. Please let the medications continue to do their job!

Living with an epileptic dog

Most importantly, LIVE

Epileptic pets can lead happy,
fulfilling lives.

Do what's enjoyable; all the things that make anyone keep a pet. You may need to make some adjustments to avoid dangerous situations, but go have fun with your companion! Concentrate on the time your pet is happy and doing well, rather than dwelling on the small percentage of time when there are problems.

Most epileptic pets can live relatively normal lives. We can successfully control epilepsy in over 2/3 of the cases. These dogs may require daily medication, but they can still run and play and love. Even the best controlled epileptic will still have some seizures, but usually we can keep their occurrence down to a tolerable level. The number of dogs who have serious side effects from the medications is very small. Some may experience sedation, but this does not prevent them from being loving companions. They don't need to stay awake in class or behind the wheel, so if they need an extra nap in the afternoon, who cares!

Unless the seizures are due to low blood sugar or heart disease, there is no reason to restrict exercise in your pet with epilepsy. While swimming carries some risk of drowning should the dog have a seizure while in the water, most seizures occur when the pet is relaxed and quiet or sleeping. Thus the odds of having a seizure while swimming are pretty remote. Canine life vests are also an option.

An epileptic needs a high quality, balanced diet. Any top quality commercial dog food will supply the needs of your pet. Diets based largely on table food or less expensive commercial foods may require supplementation to maintain optimum health in your pet. Consult your veterinarian for specific recommendations.

Understanding Canine Epilepsy

What is a seizure?

A seizure occurs when there is a misfiring of neurons in the brain, causing an "electrical storm" of brain activity. In response to this brain activity, the dog's muscles react accordingly resulting in the physical manifestation that we recognize as a seizure.

What are some causes of seizures in dogs?

Seizures can be caused by a number of things, including, but not limited to:
- head trauma
- congenital defects such as hydrocephalus
- infectious diseases such as distemper or cryptococcosis
- hypoglycemia
- hypothyroidism
- ingestion of poisonous substances
- reaction to vaccinations or certain medications
- reaction to flea/tick preventatives
- organ disease
- bacterial infection
- brain tumor

These acquired causes may result in singular or multiple seizures. If seizures happen recurrently then the disorder is called "epilepsy". If the cause of the seizures is unknown, then it is termed "idiopathic epilepsy", which basically means that the dog is having seizures but we don't know why.

What is a seizure trigger?
A seizure trigger is some stimulus that can result in a seizure in certain dogs. What is a trigger for one dog may not be a trigger for another dog. When a trigger exposure level surpasses an individual dog's seizure threshhold, then a seizure results.

What are some common seizure triggers for dogs?

Some seizure triggers are more common than others. They include, but are not limited to:
- vaccinations, particularly Rabies vaccinations
- flea/tick preventatives, particularly Ivermectin (Ivermec)
- nutritional factors including protein levels, grains, chemical preservatives, artificial colors or flavors
- turkey meat
- herbs, plants or fragrances of rosemary or lavendar
- stress such as thunderstorms, fireworks, excitement, visitors, etc.
- changes in weather, air pressure, humidity
- loud noises or flashing lights
- over-exertion
- chemicals such as household or industrial cleaners, detergents, pesticides, herbicides, fungicides, fertilizers
- scented products such as air fragrences, perfumes, deoderizers, detergents/cleaners

How do I know if my dog is having a seizure?

Seizures can manifest themselves in a variety of different ways. They are normally divided into two catagories: general and partial. General seizures result from "electrical storm" occurs everywhere. Partial seizures result when the "electric storm" is limited to one area.

Further, there are a variety of different types of seizures:

Grand Mal (General tonic clonic) - These seizures involve the entire body of the dog. They will go rigid, collapse, and then begin flailing their legs in a characteristic "running" motion. Often also accompanying grand mal seizures is jaw chomping, excessive drooling, uncontrolled urination or defecation, labored breathing, failure to respond/rouse, vocalizations.

Petit Mal (Partial or Focal) - These seizures manifest themselves in one area of the body only. Simple focal seizures affect the area of the brain involved in movement. As such, the dog is often conscious and aware of their surroundings, while presenting twitching in one area of their body, commonly the face. A complex focal seizure affects the area of the brain involved in behavior. This will often result in the dog losing awareness of their surroundings while exhibiting abnormal behavior. Common behaviors are "fly snapping" or senseless running with seemingly little to no control. Complex focal seizures are also sometimes referred to as psychomotor seizures.

My dog had a seizure, should I take him to the vet?

Eventually, yes. But there is generally no need to rush to the vet immediately. If possible, allow the dog to recover from the seizure before adding the extra stress of a car ride and a vet visit.

Situations when you should rush to the vet IMMEDIATELY are:
- if the seizure lasts longer than 5 minutes (status epilepticus)
- if there are multiple seizures within 24 hours (clusters)

If the seizure lasts less than 5 minutes, the dog does not appear injured or in immediate danger, and is recovering safely on their own, then there is nothing that the vet will do at that moment. You would be better off to call your vet and let them know that your dog has had a seizure and follow their directions from there. Generally, allowing the dog to recover on their own and then scheduling a vet appointment for your soonest convenience is sufficient.

What do I do if my dog has a seizure?

First of all, stay calm! Gently move the dog to an area that is safe. If they have collapsed, move them away from stairs, corners, furniture or other hard objects that they could injure themselves on. If they are on furniture, ensure that they cannot fall off.

Keep your fingers away from the dog's mouth. In humans, there is a risk of the human swallowing their tongue when they have a seizure. This is not a risk for dogs. But there is a risk of your dog unintentionally biting you if you get your fingers in the way. The last thing you need is to have to run to the hospital for stitches and a tetanus shot when your dog is having a seizure.

Lower any bright lights and turn down the volume of any televisions or radios in the area. Limit extra stimulus that may cause undue stress to the dog as they are seizing.

Speak gently and softly to the dog, do not try to stop them from seizing or "wake them out of it".

After the seizure ends, allow the dog to recover at their own pace. Many dogs will be disoriented, confused, or uncoordinated when the seizure ends. Some dogs may be temporarily blind, not recognize you or other family members, know their own name or common commands. Pacing and aggitation is a common symptom after a seizure. Ensure that the dog does not stumble into corners or down stairs or get stuck behind furniture or in tight corners. Allow the dog to pace if they so desire. Once they are SAFELY able, offer the dog some fresh water to drink or a SMALL bite to eat (a single dog cookie, a couple of kibbles, etc.). Blood sugar levels can drop significantly during a seizure, and failing to raise them can result in more seizures. But be careful, raising the blood sugar too quickly can also result in more seizures. So be sure to only offer a small amount of bland food or treats.

The post-seizure (post-ictal) stage can last from a couple of minutes to a couple of hours. During that time, ensure that the dog remains calm, comfortable and safe.

It is important to keep a seizure diary for every seizure that your dog has. This will help you to recognize patterns and hopefully narrow down a trigger for your dog that may help in prevention of more seizures. In the diary, note the date and time of the seizure, how long it lasted, what the dog did during the seizure, any abnormal behaviour you noticed prior to the seizure, the weather of that day, what your dog ate that day and the day prior, what they did that day and the day prior, any changes in environment, any new cleaning products/chemical agents in or around the house, any activity in the neighborhood or places that you have visited with your dog recently, any recent vaccinations, medications or flea/tick treatments, and any other information that you can think of, even if it sounds silly at the time.


When I visit my vet after my dog has a seizure, what tests should I ask for?

The general course of action is to order a CBC and a Chemistry Panel. This will screen for infection/immune deficiency and organ health and function.

Something that is often not suggested by veterinarians, but is very important to screen, is a 6-panel thyroid test. There has been significant research into the correlation of hypothyroidism and seizures in dogs. Interpretting the results should take into consideration the dog's age, breed, size, and physical activity level. In many cases, a thyroid test may come back "within normal range", but still be lower than what is recommended when taking into consideration individual variances.

If all of those tests come back clear, then you may want to consider abdominal ultrasound and/or x-rays. A final step would include MRI, though this is an expensive option so is often not taken.

When should I consider medication for seizures?

Medication generally becomes an option if there are multiple seizures within the course of a month. If they are occurring less frequently than that, the risks of medication outweigh the risks of the seizures.

What are the primary medication options available for my dog?

There are two primary medications for treating epilepsy: Phenobarbital (Phenobarb) and Potassium Bromide (KBr)

Phenobarb is effective in 60-80% of idiopathic epilepsy and takes 1 to 2 weeks to take effect. Common side effects of Phenobarb include ataxia, excessive thirst, excessive hunger, incontinence, lethargy and exciteability. These symptoms will normally disappear after a couple of weeks. If they persist, contact your veterinarian. Phenobarb is processed through the liver, so close monitoring is essential (see below).

KBr does not have the same liver effects as Phenobarb, though it can be significantly more troublesome to the digestive system so should be given with food. KBr takes up to 3 to 4 months to reach full effect so should not be used if immediate control is required. To get around this time delay, a higher loading dose is often prescribed for the first week. When on KBr, chloride intake food levels must be monitored closely, and any switches in food brand or formula must be taken very gradually so as to not disrupt the levels of KBr in the blood. Common side effects include excessive hunger, excessive thirst, incontinence, exciteability, lethargy, ataxia, nausea, diarrhea, or bromide toxicity. These symptoms should disappear within a couple of weeks. If they do not, contact your veterinarian.

Some dogs require a combination of Phenobarb and KBr to obtain the best control.

Other seizure medication options include Keppra, Felbamate, Primidone, Gabapentin and Zonisamide.

What precautions should I take after medication is prescribed?

Routine monitoring is essential, regardless of which medication is prescribed.

If your dog is on Phenobarbital:
- a blood test to determine the level of Phenobarb in the blood is required 2 weeks after starting treatment
- a blood test to determine the level of Phenobarb in the blood is recommended every 6 months afterwards
- a chem panel to monitor GGT, ALT, and alkaline phosphatase (indicating liver function) is strongly recommended every 3-4 months

If your dog is on Potassium Bromide:
- if your dog was given a loading dose, then a blood test to determine the level of KBr in the blood is recommended after 1 week of treatment
- if your dog was not given a loading dose, a blood test to determine the level of KBr in the blood is recommended after 4-6 weeks of treatment
- subsequent blood tests to determine the level of KBr in the blood is recommended every 6 months afterwards
- a chem panel is recommended every 4-6 months to monitor organ health

What can I do at home to prevent more seizures?

There are a number of steps you can take at home to prevent additional seizures or to lessen the severity of impending seizures.

Nutrition plays an important role in our dogs lives. A home prepared diet, either cooked or raw, is recommended so as to avoid unnecessary fillers or grains, chemical perservatives, flavors, colors, or synthetic nutrients. Preparing meals for your dog takes significant research and effort, so should not be taken lightly. Though it certainly isn't rocket science, so with adequate reading and commitment, it is possible to provide a natural, safe, and balanced home prepared diet for your dog. If you are unwilling or unable to prepare a diet for your dog, then a high quality kibble is essential. For information on how to choose a good quality kibble, consult the Dog Food Analysis website and the Dog Food Project website. In general, if you can purchase the food at your favorite grocery store or at your vet's office, it is NOT a good quality food and is potentially doing more harm than good.

Changing how you clean and treat your home, yard, and garden can make a significant difference in the severity of seizures that your dog may have. Take into consideration the amounts of chemicals that you use around the house. Attempt to replace those chemicals with natural alternatives and limit the use of chemicals to only those that are absolutely necessary.

Consider a minimal vaccination protocol with your dog. Titer testing is an available alternative to vaccinations, so discuss that option with your veterinarian. Also source out natural alternatives to pest prevention. There are a variety of dog-safe natural insect repellents on the market, so check out your options.
Most importantly, do some independent research and reading. Veterinarians are not guaranteed to know everything about epilepsy. You know your dog best, and you are the best person to take the initiative to make a difference in your dog's life. Don't rely on everything that your vet recommends without asking questions, making suggestions, or requesting explanations. Take a pro-active stance in dealing with your dog's epilepsy, stand your ground for what you feel is right.

No news is good news.....

We still haven't received the results of Brady's blood work that was done on January 7th to see if the new drug, Zonisamide, has reached stable serum levels. I was told that they would probably be in on Tuesday, January 12th, however they were not. I've called the neurologist's office 3 days in a row because I am on pins and needles waiting. Brady is doing well but I am still anxious. The friendly receptionist, Lori, assured me that Dr. Katherman will call me as soon as the results are in and that if they are not in by Monday, they will be calling the laboratory to find out what is going on. So I am trying to chill out and not to worry.

In God is our trust. Everything that God does is worthy of our trust, and in His hands, we willingly place our life. Reminding myself of this helps in times of worry and fear, restoring peace and calmness. Whenever things get stressful, whatever the circumstances may be,
that statement is one that is constantly true and uplifting.

January 7, 2010 back to neurologist for 2 blood draws

On January 7th Brady and I went to Yorktown for another visit with Dr. Katherman. I was very happy to report to her that Brady had not had any further seizure activity and that after about 2 weeks of being on the Zonisamide we were beginning to see improvement with the ataxia. There was still some slight uncoordination from time to time but nothing compared to the way it was. He was there to have a Zonisamide peak and trough blood draw. A blood sample was taken at 10am and another one was taken at 12 noon.

Peak and trough are methods used to establish the effectiveness of a drug. Peak is drawing the serum blood levels after the drug is administered as it distributes rapidly and reaches its peak in therapeutic range.
Trough is drawing the serum blood levels right before the next dose. Trough is the lowest drug level that is needed to reach therapeutic range. If trough is > than normal, the patient is at risk for adverse effects. Therefore, the doctor should expand the time interval before ordering the next dose or decrease drug dose.

In general, a trough is usually drawn one hour prior to start infusion and the peak about one hour after the infusion finished.

Our little drunk sailor

I spoke with Dr. Katherman on Friday December 18 about Brady's continued wobbliness and unsteadiness. The ataxia that he was experiencing can be a side affect of both Potassium Bromide and Zonisamide, but the hope is that this side affect will subside with time. The definition of ataxia is loss of coordination of the muscles. Her advice was to divide his Potassium Bromide (600mg) dose into three 200mg doses per day instead of giving him 600mg all at once. In order to do this I would have to change him over to the liquid form since he was on one 600mg capsule that couldn't be split. As it turns out the liquid form is less expensive than the capsule form. Either way, Potassium Bromide has to be compounded by a compounding pharmacy. Not all pharmacies compound, something I was not aware of before.

The day after Brady's appointment with the neurologist

On December 16th Dr. Katherman called to get a progress report on Brady. I let her know that thankfully there had been no seizures. However, Brady was terribly unstable on his feet, very wobbly and uncoordinated. We were calling him our little drunk sailor. She said it could be the result from all of the seizure activity that he had experienced or it could be the side effects from starting the Zonisamide. Or it could very well be a combination of both things. Her advice was to give him some time and hopefully we would see improvement.

She also had the results of his liver function test that was done the day before and the wonderful, fantastic news was that his liver is functioning normally. That is an incredible blessing because all the years he's been on phenobarbital, only liver enzymes were checked never liver function. Dr. Katherman told us that checking the liver enzymes don't give any information about how the liver is functioning and only a liver function--urine bile acids test will reveal how the liver is actually working. It is a great relief to know that Brady's liver is functioning normally. It will be very important to have this test done periodically since phenobarbital can cause liver damage.

Another blessing

The cost of Zonisamide would have been extremely expensive if we were to have it filled at a regular pharmacy and run about $200 a month for Brady's prescription but thank God once again that Dr. Katherman directed us to Costco to have the prescription filled. The cost there was only $25.00!!! How wonderful!
How can the other pharmacies get away with charging such a ludicrous amount?!
One would expect it to probably be higher at an ordinary pharmacy, but almost 10 times higher? That's pure highway robbery!

December 15th, the day we get in to see the neurologist

As I wrote in the previous post after Brady's seizure at 10:27pm on December 14th, we tried to get some sleep so we would be somewhat fresh for our visit with Dr. Katherman. At 3:15am we were awaken by Brady have another grand mal seizure, this made 5 within a 20 hour period! I gave him a valium suppository once it was over but before he got on his feet. At this point both Jeff and I were a complete nervous wreck! Brady came out of the seizure fairly quickly as usual and seemed to be okay, but we were terrified that another one would start up.

Knowing that the neurologist's office was connected to the Emergency Vet, we decided to get ready and leave to make our trip to Yorktown. Our thoughts were that if another seizure did come on and it ended up being an emergency then at least we would be in route or have already arrived. We pulled out of our driveway at 4:20am and arrived in Yorktown a little after 6:00am.
Thank God Brady didn't have any more seizures and we didn't need to go to the Emergency Vet.
But at least we were there if the need arose. Our appointment wasn't until 11:00am, but once the office opened I went in to let the staff know what had been going on with Brady. The receptionist said that the Doctor would be in shortly and would be seeing us soon. It was about 9:30 am when we met with the Dr. Katherman. We were very pleased and impressed with both her and her staff. They were all very informative, helpful and compassionate. After talking with us at length about idiopathic epilepsy and the various methods and drugs of treatment, Dr. Katherman told us that her plan for Brady was to leave him on his current medications and to bring another AED (add-on epileptic drug) on board by the name of Zonisamide. It is a human anti-epileptic drug that has recently been used with great success in some dogs. We were cautioned that every epileptic dog is different and what may work for one may not work for another. Brady started on Zonisamide that very day. We left Dr. Katherman's office on what started out as a somber, dreary day with a new ray of hope!

The seizure clock resets on December 14, 2009

It had been 46 days without any seizures until 7:24am on the morning of December 14th when Brady had a grand mal. It lasted for 2 or 3 minutes and he came out of it fairly quickly. He seemed fine once it was over, ravenous, but otherwise fine. He is always ravenous afterward. I gave him 5mg of oral valium once it was over.
At 7:55am, 30 minutes after the first one, had another grand mal, which again lasted 2-3 minutes. This time I gave him a valium suppository (34.7mg) before he was up on his feet. At 8:10am, only 15 minutes from the second seizure, he had a third grand mal seizure which lasted 2-3 minutes. I gave him another valium suppository before he was up on his feet. After the third seizure he seemed much more uncoordinated than usual but within an hour's time he was okay.

At 8:40am we took him to Dr. Slayman; however; he stayed in the car with Jeff. She didn't feel the need to see him. And thank God he didn't have any further seizures. She directed me to increase the Potassium Bromide to 900mg from 600mg for 10 days and then to put him on a maintenance dose of 750mg once per day. We were instructed to leave the phenobarbital at 97.2 twice per day.

During my conversation with her that morning she asked me how I would feel about taking Brady to a neurologist and my answer was that I was definitely all for it!
I would have gone that day if possible. Her response was that I more than likely wouldn't be able to get in to see the specialist until after the first of the new
year. Once we were home I called the neurologist's office and she had a available appointment the very next day on December 15! Wow! I know that no one other than God had a hand in this! I am so thankful that we would be seeing a doctor who specializes in neurology, not to mention the fact that we were getting in right away. For the first time in quite a while, I felt very hopeful!

Brady did well throughout the rest of the day on December 14th, but unfortunately suffered another grand mal seizure that night at 10:27pm. This made 4 seizures that day! We were starting to get terribly worried by now. Once the seizure was over and before he was up on his feet I gave him a valium suppository and 2 phenobarbital pills (64.8mg). Finally, we were all able to settle down and went to bed to see if sleep would come.

December 2, 2009 Vet visit for more blood work

On December 2nd, Brady went to Dr. Slayman to have blood drawn to check to see where his Potassium Bromide levels were. He also received his rabies shot today and Dr. Slayman agreed that we could skip his other vaccines this time. The rabies shot really worried me, but it's the law.

December 4th....blood work results are in at 0.8. According to Dr. Slayman the therapeutic range is 1-3 (if on KBr only) and 0.8-2 (if on KBr in combination with another anti-convulsant drug). Per Dr. Slayman-leave his KBr dose at 600mg once per day and increase to 750mg if he has another seizure. Everything stays the same with Pb. (97.2 twice per day).

October 30 Lab results are in

Brady's Alk Ph liver value came in at 263 with 131 being normal. This wasn't cause for alarm according to the VRCC doctor. Although his Alk Ph value was twice as high as normal, it wasn't worrisome to her. There is cause for concern however when those values are 3 to 5 times higher than normal. His other liver values were normal.

Potassium Bromide levels were 0.6 which is not in the therapeutic range so I was instructed by Dr. Jones (VRCC ER vet) to increase the Potassium Bromide from 450mg to 600mg once per day. We also adjusted his Pb back up to 97.2mg twice a day.

His Triglycerides were normal and his Thyroid was 0.9, just a hair low, with normal being 1-4.

More seizure activity in October...this time he went 38 days seizure free

On September 23rd, Dr. Slayman started Brady on Potassium Bromide (KBr) at a dose of 450 mg once per day. This was considered a maintenance dose and not a loading dose since he was already on Phenobarbital. It can take up to 4 months for KBr to reach a therapeutic range. Brady's phenobarbital level came in at 29.1 from labwork done at the VRCC. Upon reviewing his lab results Dr. Slayman wanted to decrease his Phenobarbital (Pb)
from 97.2mg twice per day to 81mg twice per day in one week's time and we would re-check levels in a month or 2. Her reason was because she considered 29.1 at the high end of the therapeutic range and wanted to see that level lower due to the risk of liver damage. It shouldn't be a problem since he was now also on KBr.

Once again I was afraid to reduce his Pb dose and after explaining my concerns to her she agreed that we could leave the dose at 97.2 twice per day for a longer period. On October 25th, I reduced his phenobarbital dose down to 81mg twice per day as discussed.

On October 27th, 2 days after reducing the Pb dose, Brady had a grand mal seizure at 9:30 pm. It was his normal, for lack of a better word, type of grand mal. It lasted about 3-5 minutes and after 8 minutes total he was up and aware of his surroundings. An hour and a half later at 11:30 pm he went into another grand mal, which was basically the same of amout of time as the one before and he came out of this one quickly as well. However, at this point, we made the decision to take him to the VRCC (emergency critical care). If we didn't realize it before, we definitely realized it now, having a single grand mal seizure is much better than having these multiple seizures. Our fear of clustering had become a reality. Once at the VRCC, they kept him to monitor him for 24 hours (remember this happened in September as well). Brady did well and didn't have any more seizures. My plan was to pick him up at 9:00 pm on October 28th and unfortunately, my poor boy had another seizure right before I arrived. The doctor gave him valium in his IV and the seizure stopped automatically. I sat with him for 3 hours that night to see if another seizure was going to occur. It didn't and they consented to letting me bring him home. Of course, I had to sign a release form since it was against their medical advice. But I knew he would do better at home and if another seizure came on I would bring him back without a second thought. For the first time in all of this, they sent us home with rectal valium to give in case another seizure happened.

Again we would wait for the lab results to come in.

On October 29th, I increased his PB back up to 97.2mg twice per day.

Another downward spiral in September

On September 18th, one month from the last two seizures in August, the seizures returned with a vengeance. For the first time ever, Brady had a seizure that I did not witness somewhere between 10am and 11am, but all of the evidence was there.
He did well throughout the day and then another seizure occurred that afternoon at 5pm. He recovered as normal and did well again throughout the night. At 4:55am on the morning of September 19th, Brady endured a full-blown grand mal seizure. Once again he recovered quickly and seemed fine. Later between 7:00 and 7:25pm there was all the evidence that he had another seizure. This time he had a small abrasion above his left eye.
After this seizure, Brady just didn't seem to be himself and we decided that he should go to the VRCC (Veterinary Referral Critical Care). After all, this had never happened before, 4 seizures in 36 hours. They kept him to monitor him for 24 hours.
He did well while in the hospital and didn't have anymore seizures. I picked him up the night of September 20th.

Blood work revealed that the phenobarbital was on the high end of the therapeutic range, even so, the seizures are still occurring more often and are by no means under control whatsoever.

September 23rd Dr. Slayman decides to bring Potassium Bromide, another anti-convulsant drug, on board with the phenobarbital. The Potassium Bromide dose would be 450mg once per day.

Dear God please let this be what Brady needs to get the seizures under control!

With August came 2 petite mal seizures

Things went well again for Brady up until 7:19am on August 18th when he had a petite mal seizure. This was the first time he endured a petite mal; all of his previous seizures have been grand mals. A petite mal is definitely the lesser of 2 evils.
It was much shorter and much less traumatic. He didn't fall over on his side with this one. He had this one standing with me holding onto him. He was stiff and convulsing, but no real thrashing or paddling and just a small amount of drool as opposed to a massive amount of drool with a grand mal. He didn't lose control of his bladder either. It was over rather quickly and when it was he wasn't panting excessively and he wasn't staggering or weak. This one was definitely different than the others.

On August 19 at 4:33am another petite mal seizure occurred. This one was as mild as the one the morning before. After a conversation with Dr. Slayman, I was instructed to increase the phenobarbital from 81 mg twice a day to 97.2 mg twice per day and to recheck blood levels in a month. I set the appointment for Sept.25th at 10am.

Even though these 2 seizures were milder petite mals, nonetheless, he was still having seizures.

What is happening?! It seems more and more apparent that these awful seizures are getting harder to manage.

2 more grand mal seizures in July

Things went well for a while longer, 36 days to be exact, until July 13th at 12:21am when our poor boy suffered another grand mal. We were told to leave his phenobarbital dose the same.

At 4:24am on July 30th, the monster reared its ugly head again and Brady had another grand mal. This time only 17 days passed since the last one. Per Dr. Slayman's recommendation his phenobarbital dose was increased from 64.8 mg twice per day to 81 mg twice per day.
Once again we crossed our fingers and sent up many prayers for this to be the answer to getting these horrible seizures under control.

Another grand mal seizure

Unfortunately, our hopes of the May seizure being a one time break-through seizures were quickly diminished 25 days later on June 6th at 2:40am when Brady had another grand mal seizure. He recovered fairly fast and seemed like himself soon after it was over, just as he had after his seizure in May. On Monday, June 8th, I took him to the vet to check the phenobarbital level in his bloodstream. The lab results came in on Wednesday, June 10th, revealing that the phenobarbital levels were just below the therapeutic range so Dr. Slayman increased his dosage from 48.6 mg twice per day to 64.8 mg twice per day. Fingers crossed and prayers raised to Heaven that this would be the end of the seizures.

The Roller Coaster Ride Begins

After a year and 5 months of Brady being seizure free, little did we know that the smooth sailing was about to end and the roller coaster ride would begin. On May 12, 2009 at 6:09 am he had a grand mal seizure. Since starting the phenobarbital up again after the unsuccessful attempt to wean him off of the drug a year and 5 months prior to this seizure his dose was 48.6 mg twice per day.
Our vet recommended leaving the dose at the same amount in hopes that this would just be a one time break-through seizure.

Brady's first seizure

Brady has his first grand mal seizure at 5 years old. Our vet put him on a low dose of phenobarbital at that time because his seizure was so violent and he was very aggressive. It was my understanding that dogs aren't usually started on meds after one seizure but since his was so violent her recommendation was to get him on medication. He started his medicine and thankfully tolerated it well with no side affects, except for a little uncoordination at first, which really wasn't too noticeable and didn't last long at all. Things went exceptionally well from that day forward. He didn't have any more seizures after that first one and remained seizure free for over 2 years. Thinking back, we had no idea how fortunate we were that he stayed seizure free for such a long time! At one of his routine vet appointments, after him being seizure free for such a long time, our vet then recommended that we start weaning him off of his phenobarbital because he had not had any seizures in over 2 years. I should also add that his yearly lab work revealed that his medicine was in therapeutic range and that his liver values were good, which is important as phenobarbital can cause liver damage. I will never forget how leary I felt about that decision but you're supposed to trust your vet, right? Reluctantly, I started the weaning down process very slowly. It took 8 months to do and when Brady was down to only a very tiny dose, he had another seizure. :( That would make 2 seizures so far in his lifetime.
At that point, it was evident that he needed to be on the phenobarbital so back on it he went. The question that resonates constantly in the back of my mind, is if we had left well enough alone, would the seizure activity ever have started up again? If I could make the decision over again, I would have chosen to leave him on the low dose of phenobarbital and not wean him off of it. I just recently learned from his neurologist that once a dog has had a seizure, it is highly unlikely that he will never have another one. So it is advisable to keep them on medication even if there are no seizures occurring. Why tempt fate? It is a mute point now, water under the bridge, but at least it is something for others to consider if they are thinking about weaning the meds or lowering them. As the saying goes, hind sight is always 20/20.
Back on the phenobarbital Brady had another awesome streak! This time he stayed seizure free for 1 year and 5 months! Believe me when I say, this is truly a remarkable statement to be able to make.
Morale of this story: be grateful and count your blessings every day, don't become complacent
and don't take the good things for granted, especially good health, whether it be our health or our pets health. When things are going well, it is so easy to think 'it's supposed this way'. Unfortunately, it may not always be smooth sailing.

New to blogging

This is my first post on my new blog :) My reason for creating a blog is to have a dairy on hand of Brady's seizure activity. I already have a hand written dairy but I thought that if I could share our info in the form of a blog then it might be helpful to others who may be dealing with canine epilepsy and for those of you who are, my heart goes out to you and your epi-dog. Brady is our 10 year old australian shepherd who was first diagnosed with idiopathic epilepsy when he was 5 years old. In upcoming blogs, I will attempt to tell you his story and what has occurred with his epilepsy up until this point in time. I am extremely happy to report that he hasn't had a seizure in 26 days and we are praying that this good pattern will continue for as long as possible!