Blood Test?

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.

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Blood Test?

Post by donodogs » Mon Feb 08, 2016 7:51 am

Our three-year-old dog (pit mix) has had epilepsy for a year-and-a-half now, and after his latest episode (nine seizures in one day, went into shock, aspirated on his own vomit and almost died), we're experimenting a little with his meds. He was originally on just one grain of phenobarb twice a day, but now we're trying to transition him from phenobarb to just potassium bromide and keppra.

Our vet laid out this dosage plan for us that included reducing his phenobarb every two weeks until he's ONLY on potassium bromide and keppra, except that she did so without a word about testing his blood levels to make sure it was safe for us to reduce his medication. The first time we reduced his phenobarb upon her recommendation, he has had a seizure a day or two after. He had also been on the loading dose for potassium bromide (1000 mg twice a day), and after one month she had us reduce it to the maintenance dose (500 mg twice a day). Two days after we reduced his dose, he had another seizure. I have read and heard from other vets that the loading period for potassium bromide is sometimes up to three to four months, but she seemed to think it was fine to take him off the loading dose after just one month, without checking his blood levels to see if it had been properly loaded.

My question is: Is it irresponsible for our vet to keep insisting we change the dosage of his medications without checking his blood levels first, considering the severity of his epilepsy, or am I blowing things out of proportion? I feel like I can no longer trust her to be thorough and reliable with treating my dog's epilepsy, because both times she has told us to alter his meds, he has had seizures. Any thoughts about this would be helpful, as we've recently changed vets and are not afraid to do so again if he could be receiving better or more effective and responsible treatment somewhere else. Are blood level tests standard when dealing with epileptic medication like this? Thanks in advance!

Gentle Jacob's mom
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Re: Blood Test?

Post by Gentle Jacob's mom » Tue Feb 09, 2016 6:53 am

No you're not blowing this out of proportion. If your gut is telling you to find another vet, do it. You know your dog better than anyone. If there's a history of seizures when lowering the drugs that would a big red flag.
Is she suggesting that the Pb caused the aspiration and that's why she wants to take out the Pb?
I would find another vet as soon as you can. You need to trust that you can turn to them in any emergency. Our vet unfortunately had to join our large group of epileptic dog owners last year. As knowledgeable as she was before she now knows exactly what it's like. Sometimes I don't even have to say anything and she gets it. As unlucky as we've been controlling Jake's seizures, we couldn't have found a better vet. Look until you know in your gut you found the right one.

MK's mom
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Location: Michigan

Re: Blood Test?

Post by MK's mom » Wed Feb 10, 2016 9:03 am

She's backing off on the drugs way too fast!! I'm currently backing of on Pb for my boy, but have only made one small reduction and it's been 2.5 months. My vet said they require 4 weeks between each reduction and if your vet sees that your boy is seizing and still wants to press on, then yes, you need to seek out a vet who isn't so uncaring or knowledgeable.
3.5 yo Irish Setter boy
First seizure 7/26/2013
Last seizure 3/24/2014
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

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Joined: Thu Nov 12, 2015 2:57 pm
Location: Calgary, Canada

Re: Blood Test?

Post by Jen_Gill » Wed Feb 10, 2016 3:45 pm

I think the most important thing is to find a vet that you feel comfortable and confident with. I think loading may differ with different dogs and severity. Bromide loading is not fun too watch and we only loaded our pup for 5 days before going to a steady dose. I know our specialist won't load bromide unless its under dire circumstances. The decision to load Rocco was made by an emergency vet. However, blood levels were taken before and after loading and again 6 weeks later to see where they were. Bromlide in general takes 4 months to reach therapeutic levels. Loading can be done short term to get the levels up faster. After loading however they can drop in small increments over the next couple months (or so we've been told). After a week of loading our guys levels went from 10-18.5. 7 weeks later he was having clusters again so another level was taken and his level had dropped to 17.5.

That being said we have found Bromide to be a great med for Rocco however we too are reducing the dose due to some undesirable side effects. Our specialist reduced it significantly due to the state Rocco was in from taking too much Bromide. We also began weaning Rocco off Keppra as we didn't feel it was making a difference. The dose was reduced by half and we will be working with that for 4 months and then hopefully taking him off of it completely.

It may be worthwhile to seek out a specialist. In Canada we have the choice of having a neurologist (we have 1 in Calgary) or working with an Internal Specialist which we opted to do as he took on Roccos case through the emergency. As I said before, the most important piece is that they are open to dialogue and hearing your thoughts and concerns. When they initially drafted a plan for our bromide reduction they wanted us to cease using the bromide all together for a couple days. I expressed that we weren't comfortable with this as I didn't feel that causing a cluster of seizures right after our pup had Giardia was a risk we were willing to take. Our vet understood that and together we decided on a reduction that we were comfortable doing. Its may also be worthwhile to ask for emergency meds that can be used at home to stop clusters. After reading this forum I requested Clorazepate for Rocco. We havent had to use it yet but its comforting to know we have something at home that could ease clusters for our pup.

Every dog is different but its important to feel validated by your vets and that you are comfortable with the plan put forward. Weaning meds is not easy. We are in the same boat and I feel anxiety every night before going to bed. Sorry for the long winded response. Good luck!
FS Feb, 2015
LS Nov, 11th, 2015

Phenobarb 90mg (morning and night)
Keppra 750mg (3 times daily)
Kbr 3ml (1200mg) (evening)
Gabapentin 300mg (3 times daily)

During Cluster seizures
Keppra 1500
Rectal Diazempam

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