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!
Monday, January 18, 2010
Sunday, January 17, 2010
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.
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.
Saturday, January 16, 2010
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.
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.
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.
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.
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