Brady's swollen cheek

On Friday night, March 19th, I noticed that the right side of Brady's face was swollen. Although he was eating just fine, playing as normal, and didn't seem to be in any pain, something was clearly going on. After looking inside his mouth, I discovered that the right upper carnassial (4th premolar) tooth was more than likely the culprit. The gum line above the tooth was inflamed and would bleed a little with gentle pressure on the gum.

I called the vet's office the following Saturday morning and at Dr. Slayman's recommendation, I decided to wait until Monday morning to bring Brady in. It was evident that it wasn't bothering him at the time and so it wasn't considered an emergency. If the tooth needed to be extracted, then waiting until Monday morning shouldn't be a problem.

Things We Can Learn From Our Dogs

Never pass up the opportunity to go for a joy ride.
Allow the experience of fresh air in and the wind
in your face to be pure ecstasy.
When loved ones come home, always run to greet them.
When someone is having a bad day, be silent,
sit close and nuzzle them gently.
When it's in your best interest, practice obedience,
Let others know when they've invaded your territory.
Take naps and stretch before rising,
Run, romp and play daily.
Eat with gusto and enthusiasm.
Be loyal.
Never pretend to be something you're not.
If what you want lies buried, dig until you find it.
Thrive on attention, and let people touch you.
Avoid biting when a simple growl will do.
On hot days, drink lots of water and
lie under a shady tree.
When you're happy, dance around
and wag your entire body.
No matter how often you're scolded,
don't buy into the guilt thing, and pout...
run right back and make friends.
Deight in the simple joy of
a long walk.

Enjoying beautiful days

Brady continues to do well; things are looking good. We've been spending some wonderful time outside the past few days playing ball, going for walks, and sometimes just sitting. The weather has been just gorgeous. Cool mornings giving way to warm afternoons and a big bright blue sky.

All of our dogs love being outside and especially on spring-like days like we've been blessed with recently (although, in all honesty, they will take any kind of weather). Whether running and chasing each other, rolling in the grass, playing ball, or whatever it may be, they go at it with gusto. Come to think of it, that's good advice to live by: enjoy each and every moment and give it your all. Remember to run, romp and play daily.

Keppra/Levetiracetam (generic)

Keppra: Keppra is an excellent long term anti convulsive treatment that has the added benefit of being associated with an exceptionally low incidence of toxicity. The draw back of Keppra at this time remains its high cost. Therefore, in most cases, Keppra is reserved for use in dogs as an additional anticonvulsant to be used in cases where seizure suppression has become refractory to doses of phenobarbital and potassium bromide that are approaching the maximum. It also may be a better choice than potassium bromide for additional anticonvulsant therapy for cats in cases where phenobarbital alone does not adequately control seizures.

Update

Brady has been on his new medicine, Keppra, for 6 days now and is tolerating it well, which is wonderful news. It is always scary to add another drug since the reaction to it is always unknown in your own dog. He's doing well and his motor skills are good. He hasn't been ataxic and is doing his normal everyday routine, which involves his long morning walk and daily ball playing. He can run after the ball as normal, without any tumbling over or losing his balance.He can go up and down the stairs, jump on the bed, jump up on us, etc.; all is done normally without any wobbliness or loss of balance.

One thing I have noticed is that his water consumption has gone up again; this is definitely a side effect of phenobarbital. It seemed that his love of water had diminished somewhat, but once again his water intake is up. Not a big deal whatsoever, just something I noticed. With the possibilities of side effects, this is one we can definitely live with.

Our Decision and Next Plan of Action

Per Dr. Katherman's recommendation, we have decided to add Keppra to Brady's cocktail of medication.

Keppra must be given 3 times per day. His dose will be 375 mg three times daily for a total dose of 1125mg daily, in addition to the other medications.

Zonisamide is being decreased from 250mg to 225 mg twice per day, for a total of 450 mg daily.

Phenobarbital will remain the same. The dose for that is 64.8mg twice per day, for a total of 129.60mg daily.

Potassium Bromide will remain the same as well. That dose is 2ml three times per day, for a daily total of 6ml=600mg.

This new medication schedule began on Monday morning, March 8, 2010.

Blood work results are in

On Friday, March 5th, Dr. Katherman called with Brady's blood work results. The Zonisamide levels were on the high end of the therapeutic range; thus being higher than what she prefers to see it. So even with the Zonisamide being on the high side, we still haven't gained the seizure control that we'd like. Potassium Bromide levels were low so there is plenty of room to increase that drug if needed. However, the Zonisamide must be decreased since it can cause problems in the long term if it remains at the current dose.

At the present time, our choice would be either to increase Potassium Bromide or to bring on another AED (anti-epileptic drug). If we choose to increase Potassium Bromide, it will take another 4 months until it reaches a steady state or efficacy. Also, rear end weakness and ataxia will be a very real possibility. The other choice would be to add Keppra, which has very minimal side effects and is fast acting. Per Dr. Katherman's recommendation, the rational choice at this time would be to add Keppra to the mix.