Serious reaction to pb

[Ernies mom]

Ernie, my 4 yr old Lhasa was started on Pb back in July. Pre medication he was averaging one fit every 6 - 8 weeks, mostly very mild but it was decided to start meds after he had his first cluster fit which totalled about 20 mins. No fits at all since starting Pb which should be great news BUT...
About 7 weeks after starting Pb he became ill and deteriorated over the next couple of weeks. It was obvious that he was a VERY sick little dog and he was admiltted to the vets for the whole round of tests. He was diagnosed with AIHA, a life threatening haematological disorder. He started on a cocktail of drugs along with continuing his Pb, and for the first month seemed to do well. Then he stared deteriorating again and the results of his last 3 blood tests just didn't make any sense at all. I started searching the internet and found a few references to Pb actually CAUSING haematological disorders (for example AIHA). Apparently it's a very rare reaction, but not unknown. Fortunately I have a vet who is happy to listen to me and accept my input. When I told him what I'd found he agreed with me that it fits the profile of Ernies illness. He said it's such a rare reaction that he's never seen it in 20 years of being a vet, and it just hadn't occured to him until I mentioned it.
This leaves us with a dilemma. There's no question that he HAS to come off the Pb, and unfortunately he has to be weaned off slowly. I feel like I'm poisoning him every time I give it to him but I know it would be too much of a risk to just stop it cold turkey. The vet feel that because Ern is so ill right now, introducing another drug with all it's associated side effects would probably be even more of a risk than the epilepsy. So we've decided to take him off Pb and simply see what happens. If he goes back to his previous pattern of having one minor fit every few weeks then it makes sense to deal with the AIHA first, then readdress the epilepsy when he's healthy. In the meantime I was wondering if there are any alternative remedies anyone could recommend? And since I have to be prepared for fitting I've been trying to read up on means of managing them. Can anyone give me any info on use of ice packs or occular compression? At this point any advice would be gratefully received.
Sue

[MK's mom]

Ice packs work to help shorten the seizure and occular compression works as well, but not all of the time.

Has your vet mentioned potassium bromide instead of the Pb? You're dealing with more than one issue and that really compromises things. Ask your vet if you can have some valium or chlorazapate to keep on hand while weaning ERnie from the Pb. Both will settle him down and calm his brain, hopefully breaking any cluster seizures.

Vivian

[MK's mom]

Sue,

I just googled AIHA not knowing what the acronym stood for. Has Ernie just had vaccines by chance? I know that hemolytic anemia is believed to be caused by vaccines in some dogs.

Here is the link where I found the info:
http://www.peteducation.com/article.cfm ... icleid=399

Is Ernie on steroids for this, too?

Vivian

[Ernies mom]

In the last couple of months I've learned more about AIHA than I ever wanted to know!There are many things that are possible suspects in causing it, but none of them applied to Ernie (until I discovered the link with Pb) My vet said at the time that sometimes there's an obvious trigger but in the vast majority of cases you never actually get to know what caused it. At the moment he doesn't want to risk Kbr because Ern is so ill and the side effects could have devastating consequences. He did suggest keeping some valium at home and I'll probably be going to collect some tomorrow.
Sue

[Ernies mom]

Sue,



Is Ernie on steroids for this, too?

Vivian

He's on a whole cocktail of drugs for AIHA, including steroids. He's already suffering from a catalogue of side effects as well as the symptoms of the illness, which is why we are so reluctant to add another drug right now.
Sue

[MK's mom]

I don't blame you. If his seizures weren't that bad to begin with, I guess you need to address the anemia first.

Vivian

[AndyS]

About 7 weeks after starting Pb he became ill and deteriorated over the next couple of weeks. It was obvious that he was a VERY sick little dog and he was admiltted to the vets for the whole round of tests. He was diagnosed with AIHA, a life threatening haematological disorder.

Sue, I am responding to your post very late. I hope Ernie is OK.

In 2003 my three-year old epileptic standard poodle Paris was diagnosed with "protein-losing nephropathy, hypoalbuminemia, neutropenia, and normocytic normochromic regenerative anemia." They told me he had an auto-immune disease and would only survive another 2-24 months.

Fortunately, a doctor at Cornell thought it might be the Phenobarbitol. After switching to KBr, he improved dramatically. Today Paris is a healthy, happy guy! Still epileptic, but his regular bloodwork shows no signs of all those crazy things with long names.

If you want more details, I can email them to you.

[MK's mom]

Andy,

taht was good info you gave to Sue. I haven't seen her posting lately, you could email her privately with that information so she sees it.

Vivian

[AndyS]

you could email her privately with that information so she sees it.

Just did that, thanks for the suggestion.

[Ernies mom]

Thanks for the input Andy. When Ern was fighting AIHA our vet never even considered the possibility that phenobarb might be responsible but he was prepared to listen when I suggested it myself and, after reviewing Ernies records, agreed that it was entirely possible. We weaned Ernie off it over a 4 week period and his blood counts started to improve pretty much straight away. He has now been completely off phenobarb for just over a month. We also stopped all his AIHA meds a week later and his last blood test a week ago was completely normal. It very much looks like it WAS the phenobarb that caused it all. He's currently on no meds at all for his epilepsy and he's only had one very minor seizure so far. Obviously if/when his seizures become more frequent or more severe then we'll have to rethink the meds situation. My vet doesn't seem to be a great believer in the efficiency of Kbr alone, I'd appreciate any opinions on that.
Sue

[MK's mom]

HI Sue,

KBr is often the drug of choice because it doesn't cause liver damage like Pb does. Are you in Britain? If so, in the States vets will put dogs on Pb first because it's faster acting and will help cease the seizures if they're frequent. I don't know what the vets outside of the US prefer to do.

I'm glad your vet was willing to listen to you, that's a lesson learned for him as well! The internet is a wonderful thing. We can gather information for ourt pups because we have more time than a vet who has to treat so many different illnesses and can't possibly know it all. When we find one that is willing to listen to us and do his/her own research, it makes things better all around.

Vivian

[Ernies mom]

HI Sue,

KBr is often the drug of choice because it doesn't cause liver damage like Pb does. Are you in Britain? If so, in the States vets will put dogs on Pb first because it's faster acting and will help cease the seizures if they're frequent. I don't know what the vets outside of the US prefer to do.

Vivian

Yes I am in the UK and it seems that Pb is usually the first choice here too. Ern had almost no initial side effects from Pb and hits fits stopped dead. It seemed like the perfect drug for him until he became ill about 6 weeks later. As long as his seizures are very mild and infrequent I'd rather not put him on meds. He's still having regular tests on his hematology levels and I don't want to do anything that might interfere with his miraculous recovery. If / when it becomes necessary to consider meds again I'll discuss using Kbr with the vet. He says it's more often used as a combination drug with Pb and isn't so effective as a standalone drug but we'll only know for sure by trying it I guess.
Sue

[AndyS]

My vet doesn't seem to be a great believer in the efficiency of Kbr alone, I'd appreciate any opinions on that.

KBr was fairly effective for preventing seizures in Paris. Because he is severely epileptic, we had to keep dosage very high. His blood levels were 2500-3000 micrograms/ml. This caused him to be stoned all the time and his back legs were weak.

After a couple years his seizures increased and we added Keppra. This helped dramatically for a while but gradually was less effective.

Now he's on the complex (and expensive!) cocktail of drugs that you see in my sig file. He is a lot more alert than he used to be. I've got my fingers crossed, this isn't easy.

[MK's mom]

Andy,

YOu're not the only person on this list with a Standard Poodle that is hard to control. HIghvoltage Head has a SP, too, hopefully he'll see your post and the two of you can compare notes.

Vivian

[High_Voltage_Head]

Yes, it's a small world, Andy and i have already compared notes about pregabalin on a different list.

Judging from that drug list, it looks like it must cost a lot more to keep Paris going than Jackson. And that's really saying something!