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.
Saturday, January 16, 2010
Wednesday, January 13, 2010
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.
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.
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.
Tuesday, January 12, 2010
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!
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!
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.
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.
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