Thursday, August 28, 2014

Reluctantly Adding in Phenobarbital

Looking back at August, we've seen the duration and severity of Gracie's seizures lessen.  On August 16th, we increased the CannaCompanion hemp from 2 capsules to 3 a day.
These are the days we saw seizure activity:

Date Description
08/02/14 Mild <  90 seconds
08/03/14 Mild < 90 seconds
08/06/14 9:40am - Mild <  90 seconds
10:00pm Mild < 90 seconds
11:30pm Mild < 90 seconds
08/12/14 Mild < 90 seconds
08/13/14 3:15am - Mild <  90 seconds
11pm - Mild <  90 seconds
08/18/14 about 3 min, paddling / air snapping 
08/24/14 about 2.5 min, paddling / air snapping

Although we were glad the severity is less and her recovery time is much improved, we weren't happy to have this many in one month.  We have chosen to add the most common anti-convulsant, Phenobarbital. Phenobarbital acts by decreasing the activity in the brain cells (neurons) that cause the seizures to occur.

Beginning 8/27, we are starting with the lowest dose possible (16.2mg) for her in the hopes of minimizing side effects in coordination and liver values.

The following videos illustrate the body tremors she has been having and her mobility after a stronger seizure on Aug 24th:

 


  
From this site, http://vetmedicine.about.com/od/diseasesandconditions/a/CW-SeizuresPhenobarbital.htm. I have read
"When your dog or cat is first started on phenobarbital, you may notice that your pet is uncoordinated, unsteady on his feet or acts as though he is a bit intoxicated. This is a temporary effect and usually resolves as your dog or cat adjusts to the phenobarbital dosage. "

We will see what the month of September brings and hope she can remain my Amazing Gracie.

Friday, August 15, 2014

Cognitive dysfunction syndrome?

A little knowledge from the internet can be a dangerous thing - but we are wondering if Gracie also has "Cognitive dysfunction syndrome".  Over the past year or so she does occasionally exhibit these symptoms that goes along with what was once called "old dog syndrome".
  • goes to the wrong door or wrong side of the door to come in
  • stares into a wall
  • restless at night (although this improved once we stopped the potassium bromide)
  • tremors (seeing more of this occuring) 
 
I would like to avoid returning to the commonly prescribed anti-seizure medicine if possible so that we don't return to the strong debilitating side effects.  I will mention this to her vet and ask about choline.  I found this an interesting read, http://www.naturalawakeningsmag.com/Natural-Awakenings/August-2013/Preventing-Seizures/, which mentioned, "Patients have experienced good results with phosphatidylcholine, which works to stabilize brain cell membranes, and so reduce and prevent seizures, while also providing detoxification support for the liver. Phosphatidylcholine supplements are also used to prevent and treat another common neurological problem in pets—cognitive disorder (akin to Alzheimer’s in humans). "  The VCA offers  up this information, "Choline supplementation has been shown effective for treating cognitive disorders and seizures in both humans and laboratory animals. Recent studies support its effectiveness in treating cognitive disorders in dogs and cats." http://www.vcahospitals.com/main/pet-health-information/article/animal-health/choline/258

Monday, August 11, 2014

Tracking Gracie's Condition

So that I could monitor changes in Gracie's condition, I created a "report card" in Excel
(download a blank version of the MS Excel report card I created)
click to enlarge
 and have been keeping a log since her first seizure in  April 2013.  The log helps me see the big picture and remember conversations with her vet.  Here are some example entries...


1/10/2014

Increasing KBr med.
Results from blood work show liver values improving. KBr level unchanged at 1.3, so no change since 12/6 KBr increase.  Will now go from 1.8ml to 2.0ml  starting tonight.  Watch for gastro-intestinal issues or extra sleepiness.  Don't want to cause those - but the ultimate goal is to prevent a seizure.  Since she had one at the 1.3 level, we figure it is ok to try increase in med. And recheck in 8 weeks.
1/10/2014

Game plan
Do one thing at a time.  Up KBr and see if she tolerates.   Stop W/D to see if any stool changes.  If they loosen, add W/D to see if it helps.  (W/D is high fiber, which is good to absorb water for diarrhea but not very digestible so intestine has to work harder - not ideal with IBD.
1/11/2014
10:15 PM
Seizure
While on a walk, Grace began flailing her paw.  I picked her up thinking she had something in her paw but quickly saw she was air snapping and drooling.  I carried her to car and laid her down in the grass to wait for the seizure to pass.  After about 3 minutes she stopped and I held her in my lap as we drove home.  At home she was  good with walking (steady on feet) but was anxious and panting.  By 11:15pm she had settled down and went to sleep.
02/02/2014
8:30 PM
Seizure
While in the kitchen she started paddling paw and went into a full seizure.  Last about 3 minutes and it took about an hour to settle down and sleep.
......
06/28/14
Sliver moon
10:30 PM
Seizure
Mild seizure while sleeping by door.  Foaming and legs running and air snapping.   Ended  < 1.5 min  Longer time to settle down and sleep ~ 2 hours.
07/06/2013

HeartGuard
2nd dose of heartworm prevention.
07/02/14 - 15


Difficulty walking.  Frequent falls.   Sometimes she can walk normally and other times she can't stay up for more that a few seconds.  Can stand and eat.  For a treat, she can walk across the lawn.  Placing leash under back legs like a sling helps steady her.  Back left leg crosses and collapses on her.
07/11/14

Vet Appt.
Talked about mobility issues.  No conclusive answers.  Seems to be a balance thing to me. Is it weakness, sedation or neurologic? Blood draw to check levels
.....

8/2/2014

Seizure
Just returned home and at 4:30pm, she had a mild seizure.  Lasted < 90 seconds and was quick to recover.   No problem walking afterwards.  Got her 1st Hemp capsule on food with dinner.
08/03/2014

Seizure
3:30 AM, she had a mild seizure.  Lasted < 90 seconds and was quick to recover.   No problem walking afterwards and quick to settle down.  I was surprised  in the morning, that she was able to walk in the park without any issues and unaided.
08/06/2014

Seizure
Gracie was  kind of shaky today.  Mild seizure at 9:40 am with Mark. At lunch  and dinner she had some facial tremors.  On walk @ 10 pm she had a mild seizure lasting < 90 seconds and she was quick to recover.  No residual effects.  I gave her an addition hemp pill for a total of 3 today. She had another seizure at 11:20pm.
08/08/2014


Spoke to vet.  Give her full 10 days on hemp and then see how she is doing.
Options:
  • Do nothing and live with random seizures
  • Add low dose KBr back in - not hot on this since it still didn't control seizures reliably
  • Try a different seizure medicine and hope she can tolerate it better
8/7-8/11/2014


Mobility continues to improve.  Stools also more well-formed.  Weekend walks are back to normal.   8/11 - She crossed the street at a quick trot and leaped up over the curb!  What remains are the head tremors, soft stools and the occasional coordination issue indoors and outdoors.  She is now 18 days off KBr and 9 days on Canna Companion hemp capsules.

Looking back over the year, while on seizure medicine I can summarize to say:
  • 9 seizures while on potassium bromide (KBr) over 8 months
  • Bouts of diarrhea and urine infections have been common
  • Mobility and energy has decreased over time

Canna Companion for Grace

Having heard how medical marijuana is helping kids with seizures here in Colorado, I did research on a similar product for Grace.

I was very impressed with the information I found on http://www.cannaforpets.com.   I appreciate the scientific information and articles they provide to educate yourself.  The Cannabis product is developed, manufactured and sent by veterinarians.  Their site states, "Canna Companion is made with pharmaceutical and laboratory grade equipment and is in compliance with DEA and FDA cGMP recommendations, as they pertain to supplement manufacture for the strict purpose of oral administration to cats and dogs."

I ordered the capsules and my Vet asked that we wait at least a full week of her off the Potassium Bromide so we would know what the "best" she could be off the medicine.  I started adding it to her food on 8/2/2014.  The literature says to allow for 10 days for the hemp to get into her system - so we shall see what difference it makes after the 12th.  I am hopeful.

Contents of Capsule to be mixed with food.

Monday, August 4, 2014

Documenting the Effects of Seizure Medicine for Grace

Back in April 2013, Gracie started us on a new journey when she had her first seizure.  We took a "wait and see" approach before starting her on medicine.  The medicine choices - either Potassium Bromide or Phenobarbitol - are not without side effects.


These are pre-medicine videos that shows a happy, friskie 13 year old Sheltie.



In July 2013, we opted to start her on Potassium Bromide and did the routine blood work every 3 months to see if we were in therapeutic range.  As time would pass and the occasional seizure happen, we would up the dosage. 

She stayed pretty happy and normal.

In early July of 2014, Gracie stayed happy but started having trouble walking.  At her worst, she needed assistance standing to eat or potty.




By mid-July, I was worried that we might have to euthanize Gracie.   She was still engaged with us and wanted attention and food - but she was becoming more lethargic and unable to get around.  Her sleep patterns flipped and she was up frequently during the night.  I didn't get the feeling that she was ready to give up but it was difficult to wrestle with her physical deterioration and what would be best.

With this photo, we knew we had nothing to lose in stopping her medicine.



Her vet and I agreed to stop her seizure medicine completely to see if it was the medicine that was to blame.  Her blood values have been checked every 3 months and she was always in the lower end of the therapeutic range of the potassium bromide but I'm glad we took this chance.

By day 4 without the medicine, she began to improve.



As the medicine left her system, she returned to her normal habits and interest in things.  I thought we had seen the last of some of her endearing traits, but they are back.

On day 8, she was doing really well with her walking. That's my amazing Gracie!
 

Now the question remains.... what do we do without the seizure medicine?