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.
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2 comments:
How did Brady respond to the KBR? Our dog could not handle the drug due to stomach issues.
When we first started Brady on the KBR he was pretty uncoordinated, unsteady and wobbly. We called him our little drunken sailor. His neurologist suggested that we divide his daily KBR dose into 3 separate doses throughout the day. Thankfully, that helped alot and he is back to normal. Although from time to time, he may be slightly uncoordinated but nothing in comparison to what it was. Thankfully the KBR hasn't resulted in any stomach issues for Brady. Sorry that your dog could not tolerate that drug and I hope you are able to find another one that is effective. Take care, Sheila
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