Serious reaction to pb

This is the place for general questions about drugs, long-term treatment concerns, possible influences of other drugs (such as antibiotics, heartworm preventatives, or anesthetics) for epileptic dogs, and other concerns. Please note that we cannot make specific recommendations for individual dogs - for this, please consult your veterinarian.

Moderator: Box40Rin

Ernies mom
Posts: 8
Joined: Thu Dec 06, 2007 1:52 pm

Serious reaction to pb

Post by Ernies mom » Fri Dec 07, 2007 12:11 pm

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
Posts: 1708
Joined: Wed Mar 01, 2006 9:48 am
Location: Michigan

Post by MK's mom » Fri Dec 07, 2007 1:31 pm

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
Nathan
3.5 yo Irish Setter boy
First seizure 7/26/2013
Last seizure 3/24/2014
__________________________________
MK
5 yo Irish Setter boy
First seizure 1/25/06
Last seizure 9/4/2009

Aug 17, 2004- Sept. 22, 2009
May the shamrocks fall softly sweetpea

MK's mom
Posts: 1708
Joined: Wed Mar 01, 2006 9:48 am
Location: Michigan

Post by MK's mom » Fri Dec 07, 2007 1:36 pm

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
Nathan
3.5 yo Irish Setter boy
First seizure 7/26/2013
Last seizure 3/24/2014
__________________________________
MK
5 yo Irish Setter boy
First seizure 1/25/06
Last seizure 9/4/2009

Aug 17, 2004- Sept. 22, 2009
May the shamrocks fall softly sweetpea

Ernies mom
Posts: 8
Joined: Thu Dec 06, 2007 1:52 pm

Post by Ernies mom » Fri Dec 07, 2007 1:50 pm

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
Posts: 8
Joined: Thu Dec 06, 2007 1:52 pm

Post by Ernies mom » Fri Dec 07, 2007 1:55 pm

MK's mom wrote: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
Posts: 1708
Joined: Wed Mar 01, 2006 9:48 am
Location: Michigan

Post by MK's mom » Fri Dec 07, 2007 2:03 pm

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
Nathan
3.5 yo Irish Setter boy
First seizure 7/26/2013
Last seizure 3/24/2014
__________________________________
MK
5 yo Irish Setter boy
First seizure 1/25/06
Last seizure 9/4/2009

Aug 17, 2004- Sept. 22, 2009
May the shamrocks fall softly sweetpea

AndyS
Posts: 3
Joined: Fri Jan 25, 2008 2:23 pm

Re: Serious reaction to pb

Post by AndyS » Fri Jan 25, 2008 7:04 pm

Ernies mom wrote: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.
Last edited by AndyS on Fri Jan 25, 2008 9:10 pm, edited 1 time in total.
-AndyS

30 kg Standard Poodle "Paris"
Keppra 1125 mg tid
Felbatol 900 mg tid
Pregabalin 120 mg tid
Zonisamide 400 mg bid

MK's mom
Posts: 1708
Joined: Wed Mar 01, 2006 9:48 am
Location: Michigan

Post by MK's mom » Fri Jan 25, 2008 8:11 pm

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
Nathan
3.5 yo Irish Setter boy
First seizure 7/26/2013
Last seizure 3/24/2014
__________________________________
MK
5 yo Irish Setter boy
First seizure 1/25/06
Last seizure 9/4/2009

Aug 17, 2004- Sept. 22, 2009
May the shamrocks fall softly sweetpea

AndyS
Posts: 3
Joined: Fri Jan 25, 2008 2:23 pm

Post by AndyS » Fri Jan 25, 2008 9:05 pm

MK's mom wrote:you could email her privately with that information so she sees it.
Just did that, thanks for the suggestion.
-AndyS

30 kg Standard Poodle "Paris"
Keppra 1125 mg tid
Felbatol 900 mg tid
Pregabalin 120 mg tid
Zonisamide 400 mg bid

Ernies mom
Posts: 8
Joined: Thu Dec 06, 2007 1:52 pm

Post by Ernies mom » Sat Jan 26, 2008 7:43 am

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
Posts: 1708
Joined: Wed Mar 01, 2006 9:48 am
Location: Michigan

Post by MK's mom » Sat Jan 26, 2008 11:57 am

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
Nathan
3.5 yo Irish Setter boy
First seizure 7/26/2013
Last seizure 3/24/2014
__________________________________
MK
5 yo Irish Setter boy
First seizure 1/25/06
Last seizure 9/4/2009

Aug 17, 2004- Sept. 22, 2009
May the shamrocks fall softly sweetpea

Ernies mom
Posts: 8
Joined: Thu Dec 06, 2007 1:52 pm

Post by Ernies mom » Sat Jan 26, 2008 12:56 pm

MK's mom wrote: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
Posts: 3
Joined: Fri Jan 25, 2008 2:23 pm

Post by AndyS » Sat Jan 26, 2008 7:32 pm

Ernies mom wrote: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.
-AndyS

30 kg Standard Poodle "Paris"
Keppra 1125 mg tid
Felbatol 900 mg tid
Pregabalin 120 mg tid
Zonisamide 400 mg bid

MK's mom
Posts: 1708
Joined: Wed Mar 01, 2006 9:48 am
Location: Michigan

Post by MK's mom » Sun Jan 27, 2008 9:31 am

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
Nathan
3.5 yo Irish Setter boy
First seizure 7/26/2013
Last seizure 3/24/2014
__________________________________
MK
5 yo Irish Setter boy
First seizure 1/25/06
Last seizure 9/4/2009

Aug 17, 2004- Sept. 22, 2009
May the shamrocks fall softly sweetpea

High_Voltage_Head
Posts: 193
Joined: Thu Jan 25, 2007 10:00 pm
Location: Minnesota

Post by High_Voltage_Head » Sun Jan 27, 2008 1:18 pm

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!
Me: Kurt
Dog: Jackson the 6 y.o. Standard Poodle 55lbs
died March '08

Post Reply