A couple of months ago, our 12 yr old lab had 3 seizures within a 24 hour period. She never had seizures before, and the vet ER gave us some phenobarbital and liquid valium, and we brought her to our regular vet that following Monday.
Our best guess, without putting her through anything, is a tumor or something in her brain.
Early this morning (Saturday) at 2:23 a.m., she had another seizure. It lasted about 2 minutes, so we didn't have to give the liquid valium.
Her most rcent dose of phenobarbital was at 11:30 pm (Friday), when she got 1 1/2 tablets (that would be 48.6 mg) -- and then about 3 hours later, she seizured.
We've been giving her 1 tablet (32.4 mg) in the morning, and 1 1/2 tablets in the evening...like clockwork. Her blood test came back with this being slightly below therapeutic value, and up until today, she had no seizures once we started the phenobarbital a few months ago.
After she came out of the seizure, during her "wandering" phase, we gave her one more tablet of phenobarbital (32.4 mg) at 2:37 a.m.
The vet is closed today and tomorrow, but we'll be calling the vet ER since they have her medical chart there.
Does anyone have any experience with phenobarbital and doses in terms of brain tumor/brain cancer related seizures? or side effects of PB (other than the problems with the liver) ?
I'm going to ask the vet ER if it would be okay to "up" her medication to two tablets, twice a day or would that be too much? (that would be 64.8 mg each time, or a total of 129.6 mg per 24 hour period). She weighs in at about 45 to 48 lbs.
Thanks for any help...Sorry if this posts twice, I'm having a problem with it...
Question about phenobarbital
Re: Question about phenobarbital
First, did you give her the extra phenobarb dose at 2:37 a.m. on your own or did you call the vet first for direction?
There's a reason it is recommended to be given every 12 hours, so that peak levels can be reached and monitored. It could be she is in a "valley" period, where the levels are off, not truly reaching peak measurements. By giving a dose at an unintended time (too close to her p.m. dose and too close to her next a.m. dose) could throw the level off considerably and not really help to control a seizure later. A better option would have been to give her the valium (ONLY on advice and direction of your vet first), so the valium could act as a calming/sedative measure until the regularly scheduled morning dose of phenobarb.
To determine this, I would suggest taking her to your vet and leaving her there for one day. The vet can test her levels at any of the following intervals: before administration of the morning dose, or after.....or before/after the evening dose (although the dose should be changed for earlier in the evening, an ideal time might be 8 a.m. and 8 p.m., however close you can get that to fit your schedule). This can greatly help determining whether or not the dose needs to be adjusted, and exactly how and where (i.e., 1 tab in a.m., 1 tab in p.m., or even a third dose in the middle of the day, making sure to decrease the dose between intervals so the mg amount is not too high).
By increasing the dose to two tablets a day at the current mg amount, would be pushing it, and could lead to toxicity. Instead, either have her tested as described above, or the vet can alter the dose so that the total daily dose is even at each interval. Unless she tends to seizure at night, in which your vet will have to use his best judgment, I suspect this is how he came up with the original dose intervals.
DO NOT EVER increase or decrease phenobarb on your own, no matter what time of day or night, call your ER vet immediately for instruction. They will ask you the nature of the seizures (petite mal, cluster, grand mal - duration of the seizure - her behavior post-seizure, etc) and will advise accordingly.
I strongly suggest you discuss with your vet the option to test your dog for one day at his clinic. He can help determine a suitable schedule that will fit both your dog and your schedule. If he can't seem to find out the best dosage/interval for the phenobarb, it might be in your best interests to see a more experienced vet/neurologist and actually consider additional testing in the event something is going on undetected. You didn't mention if a baseline of tests have been done (like CBC and chemical profile, xrays, etc), but these are generally good tools for ruling out things that might be better addressed (kidney, liver, heart disease etc). Beyond that, don't assume there is a brain tumor without exploring the diagnostics necessary to reach that conclusion (at most, a CSF test and/or MRI would aid in determining that).
If you increase the dose based on assuming some tumor or brain tumor, and if there is nothing of the sort present, then you're risking toxicity of the phenobarb, mainly liver disfunction. See what I'm getting at here? It's usually best to test and rule out other potential causes before assuming something that may not be apparent at all.
Another option is possibly adding potassium bromide (KBr) to her treatment - this is usually reserved for very difficult-to-control seizure cases - it's early into treatment for your dog right now but worth discussing with your vet. If your vet is experienced with this, discuss it with him, but there might be some trial and error while adjusting the meds.
Granted, in some cases, some tests (mostly when used alone and not combined with other tests) reveal virtually nothing, in which the client chooses to pursue the treatment anyway. In some cases, this may be fine depending on the individual pet and his/her needs. However, the frequency and exact nature of the seizure activity is always a concern since it could progress into a worsening situation, the goal in treatment is to prevent any seizure in a 3-6 month time frame. After a seizure-free period of same, an attempt can be made to lower the dose. The important thing is that phenobarb levels are adequate and there is evidence the medication is working. This is an area that requires due diligence with testing her levels any time there is a suspected problem.
If your dog is on other medications for another unrelated condition, (including supplements and diet, treats etc), make sure your vet is aware of them. If your dog is on a flea and/or heartworm control product, also tell him.
I'm not sure whether you mean your dog was first diagnosed with seizure activity two months ago or was actually started on phenobarb two months ago, in another sentence you said she was started on phenobarb for three months. Either way, the test described above is probably going to be most helpful to determine her peak levels and where or when the dose may need adjustment.
There's a reason it is recommended to be given every 12 hours, so that peak levels can be reached and monitored. It could be she is in a "valley" period, where the levels are off, not truly reaching peak measurements. By giving a dose at an unintended time (too close to her p.m. dose and too close to her next a.m. dose) could throw the level off considerably and not really help to control a seizure later. A better option would have been to give her the valium (ONLY on advice and direction of your vet first), so the valium could act as a calming/sedative measure until the regularly scheduled morning dose of phenobarb.
To determine this, I would suggest taking her to your vet and leaving her there for one day. The vet can test her levels at any of the following intervals: before administration of the morning dose, or after.....or before/after the evening dose (although the dose should be changed for earlier in the evening, an ideal time might be 8 a.m. and 8 p.m., however close you can get that to fit your schedule). This can greatly help determining whether or not the dose needs to be adjusted, and exactly how and where (i.e., 1 tab in a.m., 1 tab in p.m., or even a third dose in the middle of the day, making sure to decrease the dose between intervals so the mg amount is not too high).
By increasing the dose to two tablets a day at the current mg amount, would be pushing it, and could lead to toxicity. Instead, either have her tested as described above, or the vet can alter the dose so that the total daily dose is even at each interval. Unless she tends to seizure at night, in which your vet will have to use his best judgment, I suspect this is how he came up with the original dose intervals.
DO NOT EVER increase or decrease phenobarb on your own, no matter what time of day or night, call your ER vet immediately for instruction. They will ask you the nature of the seizures (petite mal, cluster, grand mal - duration of the seizure - her behavior post-seizure, etc) and will advise accordingly.
I strongly suggest you discuss with your vet the option to test your dog for one day at his clinic. He can help determine a suitable schedule that will fit both your dog and your schedule. If he can't seem to find out the best dosage/interval for the phenobarb, it might be in your best interests to see a more experienced vet/neurologist and actually consider additional testing in the event something is going on undetected. You didn't mention if a baseline of tests have been done (like CBC and chemical profile, xrays, etc), but these are generally good tools for ruling out things that might be better addressed (kidney, liver, heart disease etc). Beyond that, don't assume there is a brain tumor without exploring the diagnostics necessary to reach that conclusion (at most, a CSF test and/or MRI would aid in determining that).
If you increase the dose based on assuming some tumor or brain tumor, and if there is nothing of the sort present, then you're risking toxicity of the phenobarb, mainly liver disfunction. See what I'm getting at here? It's usually best to test and rule out other potential causes before assuming something that may not be apparent at all.
Another option is possibly adding potassium bromide (KBr) to her treatment - this is usually reserved for very difficult-to-control seizure cases - it's early into treatment for your dog right now but worth discussing with your vet. If your vet is experienced with this, discuss it with him, but there might be some trial and error while adjusting the meds.
Granted, in some cases, some tests (mostly when used alone and not combined with other tests) reveal virtually nothing, in which the client chooses to pursue the treatment anyway. In some cases, this may be fine depending on the individual pet and his/her needs. However, the frequency and exact nature of the seizure activity is always a concern since it could progress into a worsening situation, the goal in treatment is to prevent any seizure in a 3-6 month time frame. After a seizure-free period of same, an attempt can be made to lower the dose. The important thing is that phenobarb levels are adequate and there is evidence the medication is working. This is an area that requires due diligence with testing her levels any time there is a suspected problem.
If your dog is on other medications for another unrelated condition, (including supplements and diet, treats etc), make sure your vet is aware of them. If your dog is on a flea and/or heartworm control product, also tell him.
I'm not sure whether you mean your dog was first diagnosed with seizure activity two months ago or was actually started on phenobarb two months ago, in another sentence you said she was started on phenobarb for three months. Either way, the test described above is probably going to be most helpful to determine her peak levels and where or when the dose may need adjustment.
..........Traci
Hi, Traci and thanks for the input.
I posted in the wee hours my time zone, and wasn't accurate about her initial seizure activity--probably due to lack of sleep, worry, etc. She was seen in the vet ER in July for seizures, then followed up with our regular vet. She was started on PB before we left the vet ER, and has been on PB ever since.
We called the vet ER about the extra PB dose. They did not suggest giving the valium at this point.
Thanks for your suggestion about leaving her at the vet's and scheduling tests of her levels during intervals. We'll be talking to the vet about this and her dosage and timing on Monday.
Yes, in July at the vet ER and at our our regular vet's, we did have her CBC and chem profile run, etc, but not xrays. Everything was within normal limits. Our vet's best guess was a brain tumor because she had seizure activity out of the blue, with no other history or problems. We decided that doing more tests at that time wouldn't affect how we'd pursue treatment, i.e. if it was a brain tumor or brain cancer, we would not attempt to have it removed. I know other people may have elected to pursue a definitive diagnosis. We're senior citizens and on a *very* limited income.
In July, I did ask about the KBr. We decided to try PB. We'll ask about the KBr again. The vet is aware of her food, treats, flea products, so he has the big picture, which I think is important too.
Thanks again for your helpful input-- (sorry if this posts twice--I'm having computer/internet probs)
Sparkly
I posted in the wee hours my time zone, and wasn't accurate about her initial seizure activity--probably due to lack of sleep, worry, etc. She was seen in the vet ER in July for seizures, then followed up with our regular vet. She was started on PB before we left the vet ER, and has been on PB ever since.
We called the vet ER about the extra PB dose. They did not suggest giving the valium at this point.
Thanks for your suggestion about leaving her at the vet's and scheduling tests of her levels during intervals. We'll be talking to the vet about this and her dosage and timing on Monday.
Yes, in July at the vet ER and at our our regular vet's, we did have her CBC and chem profile run, etc, but not xrays. Everything was within normal limits. Our vet's best guess was a brain tumor because she had seizure activity out of the blue, with no other history or problems. We decided that doing more tests at that time wouldn't affect how we'd pursue treatment, i.e. if it was a brain tumor or brain cancer, we would not attempt to have it removed. I know other people may have elected to pursue a definitive diagnosis. We're senior citizens and on a *very* limited income.
In July, I did ask about the KBr. We decided to try PB. We'll ask about the KBr again. The vet is aware of her food, treats, flea products, so he has the big picture, which I think is important too.
Thanks again for your helpful input-- (sorry if this posts twice--I'm having computer/internet probs)
Sparkly
Re: Question about phenobarbital
Just to give a bit more indication, can you try to describe the actual seizure activity?
In July, when she had the 3 seizures in 24 hours, were they separated by several hours, or were they close together like a "cluster" seizure? (cluster seizures tend to be close together - within an hour or so of each other, or in really severe cases, within minutes of each other). How long did each seizure last, and how long did it take for her to resume to normal activity? Once she came out of the seizure, did she immediately seek out to drink water, eat, or did she simply rest in a sedated-sort of way?
During that event, what kind of seizure activity was she displaying? Was she on the ground/floor on her side? Was she "paddling" at the air with her front legs? (i.e, the motion of swimming) Was she crying out or was she silent? Did she salivate, urinate or defecate during the seizure? Did she snap her jaws or were they and her limbs tightly rigid?
As for the event early this morning, was it similar to the events in July? Was her behavior coming out of the seizure the same or different?
I ask because sometimes the behavior of the seizure can help determine idiopathic or aquired seizure activity (sometimes it is status epilepsy, sometimes it is due to an old injury after aging, sometimes it is aquired due to a vital organ disfunction.
I also ask because if during her normal daily routine, she is otherwise healthy, active, bright and alert and does not have any cognitive disfunction, there is a good chance this may not be a brain tumor at all. Usually, there are accompanying and progressive signs that would alert you to a tumor of such, like progressive signs that heighten or worsen over a period of time. Brain tumors usually accompany signs of circling, pacing, disorientation, and cognitive and behavioral changes that are not characteristic of her routine or personality.
Brain tumors generally do not respond to anticonvulsants, nor phenobarbitol, and generally will simply progress, as well as behavior and cognitive function changes.
I understand the invasiveness of testing and the costs involved. However, just wanted to point out that sometimes there is an underlying problem that should not be overlooked in the event it can be treated. Think of it like this. Suppose she had a liver problem, or a kidney problem, and for some reason, that organ was not functioning correctly, and the seizures are a secondary problem to the original health problem. Treating the liver or kidney problem might alleviate the seizure activity, or at least, the severity and frequency.
Another problem with seizures is that we generally can not predict how they may progress. We do have a good idea however, if we know they are caused by organ disfunction or some other treatable condition.
If a CSF test or MRI is out of the question, has your vet at least offered to do a quick ultrasound to try to detect anything abnormal? (ultrasounds are much less costly than an MRI, no sedation needed).
The good news is, that if I'm calculating correctly, since being on phenobarb since July, it has been a good 4 months or so and only one seizure has occurred, and the seizure lasted only a couple of minutes. This generally means she is responding to the phenobarb, remember our goal - no more than one seizure in a 3-6 month time period, it looks good to me thus far. It could be that the phenobarb dose simply needs to be adjusted. It might not hurt to increase the dose slightly, but not so much that it might increase toxicity to the liver. Each time you have a phenobarb level done, also have a liver function test done as well.
Btw, common side effects for phenobarb are, mostly at higher doses, increased water consumption, increased urination, increased appetite, sometimes slight sedation. The same applies to KBr, but with KBr, the side effects are minimal and generally no risk of toxicity to the liver. With both drugs, in the event the vet ever chose to decrease the dose, it has to be done slowly, tapered slowly to the lowest dose possible without risk of seizure activity.
Hope this helps, I understand what you're going through and I really feel for you and your baby, seizures are tough, but many are manageable, it often just takes time to achieve that therapeutic level and of course, keep monitoring her routine/behavior etc at home and for any other signs of any other health problem - as well as get the necessary phenobarb levels done at proper intervals so you know it the dose needs adjusting or not.
In July, when she had the 3 seizures in 24 hours, were they separated by several hours, or were they close together like a "cluster" seizure? (cluster seizures tend to be close together - within an hour or so of each other, or in really severe cases, within minutes of each other). How long did each seizure last, and how long did it take for her to resume to normal activity? Once she came out of the seizure, did she immediately seek out to drink water, eat, or did she simply rest in a sedated-sort of way?
During that event, what kind of seizure activity was she displaying? Was she on the ground/floor on her side? Was she "paddling" at the air with her front legs? (i.e, the motion of swimming) Was she crying out or was she silent? Did she salivate, urinate or defecate during the seizure? Did she snap her jaws or were they and her limbs tightly rigid?
As for the event early this morning, was it similar to the events in July? Was her behavior coming out of the seizure the same or different?
I ask because sometimes the behavior of the seizure can help determine idiopathic or aquired seizure activity (sometimes it is status epilepsy, sometimes it is due to an old injury after aging, sometimes it is aquired due to a vital organ disfunction.
I also ask because if during her normal daily routine, she is otherwise healthy, active, bright and alert and does not have any cognitive disfunction, there is a good chance this may not be a brain tumor at all. Usually, there are accompanying and progressive signs that would alert you to a tumor of such, like progressive signs that heighten or worsen over a period of time. Brain tumors usually accompany signs of circling, pacing, disorientation, and cognitive and behavioral changes that are not characteristic of her routine or personality.
Brain tumors generally do not respond to anticonvulsants, nor phenobarbitol, and generally will simply progress, as well as behavior and cognitive function changes.
I understand the invasiveness of testing and the costs involved. However, just wanted to point out that sometimes there is an underlying problem that should not be overlooked in the event it can be treated. Think of it like this. Suppose she had a liver problem, or a kidney problem, and for some reason, that organ was not functioning correctly, and the seizures are a secondary problem to the original health problem. Treating the liver or kidney problem might alleviate the seizure activity, or at least, the severity and frequency.
Another problem with seizures is that we generally can not predict how they may progress. We do have a good idea however, if we know they are caused by organ disfunction or some other treatable condition.
If a CSF test or MRI is out of the question, has your vet at least offered to do a quick ultrasound to try to detect anything abnormal? (ultrasounds are much less costly than an MRI, no sedation needed).
The good news is, that if I'm calculating correctly, since being on phenobarb since July, it has been a good 4 months or so and only one seizure has occurred, and the seizure lasted only a couple of minutes. This generally means she is responding to the phenobarb, remember our goal - no more than one seizure in a 3-6 month time period, it looks good to me thus far. It could be that the phenobarb dose simply needs to be adjusted. It might not hurt to increase the dose slightly, but not so much that it might increase toxicity to the liver. Each time you have a phenobarb level done, also have a liver function test done as well.
Btw, common side effects for phenobarb are, mostly at higher doses, increased water consumption, increased urination, increased appetite, sometimes slight sedation. The same applies to KBr, but with KBr, the side effects are minimal and generally no risk of toxicity to the liver. With both drugs, in the event the vet ever chose to decrease the dose, it has to be done slowly, tapered slowly to the lowest dose possible without risk of seizure activity.
Hope this helps, I understand what you're going through and I really feel for you and your baby, seizures are tough, but many are manageable, it often just takes time to achieve that therapeutic level and of course, keep monitoring her routine/behavior etc at home and for any other signs of any other health problem - as well as get the necessary phenobarb levels done at proper intervals so you know it the dose needs adjusting or not.
..........Traci
Re: Question about phenobarbital
Hi, Traci, here's the specifics...
The bedroom where she and one of the little ones sleep with DH has the bed moved to the floor so the dogs (all seniors) can have an easier time of getting up on them to sleep. Anyway, DH who sleeps with one of those sleep apnea things in a separate bedroom, woke because our lab had fallen off the bed and was not acting right--this is around 2:00 in the morning on Sunday. He called to me and by the time I came in, I just noticed how hot DH's bedroom was and how darn hot her head and body felt. I dumped cold water on a towel and put that across the top of her head, then onto her body, then her paws--trying to cool her down. Checked her gums & they were fine.
She seemed disoriented, uncoordinated, panting and drooling and shaking while standing, unable to walk, so we took her to the vet ER. She was not diagnosed with a seizure at that time and her blood tests were normal--her chart said "ataxia."
Came home, all went to sleep for a while. Around 5:00 a.m. Sunday, we witnessed what was obviously a seizure. She was on her side on the floor, paddling actions with front legs and a bit with her rear legs, a bit of foaming at the mouth, "chewing" but not really snapping, and head banging on the floor. No crying, no urinating or defecating, no tightly rigid limbs.
We put a pillow under her head, a towel under her rear, and after a couple of minutes, she came out of it. Called the vet ER, said it was definitely a seizure and asked if we could we pick up some meds. Since they did not dx a seizure, they couldn't give any meds. We opted to wait and if it happened again, we'd take her to the vet ER. She had a disorientation period where she had trouble standing, "wandered" around and around, into corners, trying to get behind the furniture. This lasted about 60 to 90 minutes. He tail sticks out funny during this time--kinda straight out.
At around 2:20 in the afternoon of the same day, she has another seizure. Same kind as described above, but this one lasted close to 3 minutes. Off we go to the vet ER, saw the same vet we saw earlier, & our girl got an injection of PB and we came home with PB pills and 3 of those squirty syringes of liquid valium that goes in the rear end--and instructions about how and when to use it.
Her seizure early this morning was the almost the same as described above, but without the head-banging on the floor and almost no foaming at the mouth. Paddling, but no urination or defecation. As with before, after the seizure, she is uncoordinated, wobbly on her feet, wanders the room, goes into corners, tries to get behind furniture, and she face and eyes look confused, and it looks like she is not "with it" for about an hour or an hour and a half. Then, she starts to get a normal look in her eyes, her coordination improves, and her wandering around lessons quite a bit.
She's been deaf for about 4 years (no known reason or injury, other than aging--but she is able to hear us clap to get her attention, and she can hear the little ones barking at the mailman and neighborhood "invaders" and we've taught her some sign language--she is very smart!), had a bilateral ACL repair a few years ago, and other than that, she is healthy and mildly active and loves her tennis ball and her food. She is interested in people who come over, and is always happy to give them a sniff, a tail wag, and in turn, get herself a head scratch.
The only weird thing I can say about this morning's seizure is that last night, around 11 to midnight while I was watching TV and on the computer, she kept getting up and down off the couch more so than usual--like she just couldn't get comfortable.
Thank you so much for your specific input and your encouraging words. It's about time for more blood work anyway, so on Monday, I'll make an appt for that and I'll ask the vet about doing an ultrasound--would that show a tumor or ?
Again, thank you so much for taking the time to write out specifics for me as we travel this road with our oldest baby. If you can think of anything else, or have more input, I'd appreciate it! Thank you thank you thank you! Your words have been very comforting as I was scared silly when she had this other seizure this morning!
The bedroom where she and one of the little ones sleep with DH has the bed moved to the floor so the dogs (all seniors) can have an easier time of getting up on them to sleep. Anyway, DH who sleeps with one of those sleep apnea things in a separate bedroom, woke because our lab had fallen off the bed and was not acting right--this is around 2:00 in the morning on Sunday. He called to me and by the time I came in, I just noticed how hot DH's bedroom was and how darn hot her head and body felt. I dumped cold water on a towel and put that across the top of her head, then onto her body, then her paws--trying to cool her down. Checked her gums & they were fine.
She seemed disoriented, uncoordinated, panting and drooling and shaking while standing, unable to walk, so we took her to the vet ER. She was not diagnosed with a seizure at that time and her blood tests were normal--her chart said "ataxia."
Came home, all went to sleep for a while. Around 5:00 a.m. Sunday, we witnessed what was obviously a seizure. She was on her side on the floor, paddling actions with front legs and a bit with her rear legs, a bit of foaming at the mouth, "chewing" but not really snapping, and head banging on the floor. No crying, no urinating or defecating, no tightly rigid limbs.
We put a pillow under her head, a towel under her rear, and after a couple of minutes, she came out of it. Called the vet ER, said it was definitely a seizure and asked if we could we pick up some meds. Since they did not dx a seizure, they couldn't give any meds. We opted to wait and if it happened again, we'd take her to the vet ER. She had a disorientation period where she had trouble standing, "wandered" around and around, into corners, trying to get behind the furniture. This lasted about 60 to 90 minutes. He tail sticks out funny during this time--kinda straight out.
At around 2:20 in the afternoon of the same day, she has another seizure. Same kind as described above, but this one lasted close to 3 minutes. Off we go to the vet ER, saw the same vet we saw earlier, & our girl got an injection of PB and we came home with PB pills and 3 of those squirty syringes of liquid valium that goes in the rear end--and instructions about how and when to use it.
Her seizure early this morning was the almost the same as described above, but without the head-banging on the floor and almost no foaming at the mouth. Paddling, but no urination or defecation. As with before, after the seizure, she is uncoordinated, wobbly on her feet, wanders the room, goes into corners, tries to get behind furniture, and she face and eyes look confused, and it looks like she is not "with it" for about an hour or an hour and a half. Then, she starts to get a normal look in her eyes, her coordination improves, and her wandering around lessons quite a bit.
She's been deaf for about 4 years (no known reason or injury, other than aging--but she is able to hear us clap to get her attention, and she can hear the little ones barking at the mailman and neighborhood "invaders" and we've taught her some sign language--she is very smart!), had a bilateral ACL repair a few years ago, and other than that, she is healthy and mildly active and loves her tennis ball and her food. She is interested in people who come over, and is always happy to give them a sniff, a tail wag, and in turn, get herself a head scratch.
The only weird thing I can say about this morning's seizure is that last night, around 11 to midnight while I was watching TV and on the computer, she kept getting up and down off the couch more so than usual--like she just couldn't get comfortable.
Thank you so much for your specific input and your encouraging words. It's about time for more blood work anyway, so on Monday, I'll make an appt for that and I'll ask the vet about doing an ultrasound--would that show a tumor or ?
Again, thank you so much for taking the time to write out specifics for me as we travel this road with our oldest baby. If you can think of anything else, or have more input, I'd appreciate it! Thank you thank you thank you! Your words have been very comforting as I was scared silly when she had this other seizure this morning!
Re: Question about phenobarbital
It is a bit concerning that it takes awhile for her to recover from a seizure. Ideally, we like to see a much quicker recovery back to normal activity and awareness. It's not uncommon however to have a long recovery, it's just sometimes worrisome in some pets due to the nature of the seizure(s). That they still only last 3 minutes or less is still hope for response from her treatment, and given this new information about her, I'm more inclined to have you ask your vet to perhaps increase her phenobarb slightly, but test her levels first to try to reach a compromise in her dosage schedule.
The prolonged recovery could also be due to her age, in that her motor faculties may take a bit longer to recover.
Is anything else unusual occurring so late at night? If she sleeps with the bichons, are they restless at night or active when she's resting? Do you think she might be susceptible to external stimuli? Sometimes, some sort of stimuli can induce a seizure, whether it be noise, temps in the home, lighting, etc.
Your mention of her seeming hot to the touch - my sister had a dog who had seizures and they would most often occur if she was too warm or too hot. While this symptom in and of itself is rare, it is a possibility. Talk to your vet about that and other stimuli that may be affecting her at those times late at night, wee hours of the morning.
If you're home on a weekend or some night you don't have to work the next day, try to stay up late and observe the dogs when they are resting together (but try not to let them know you're observing), and don't change anything about the environment without first observing what is normally occurirng when you'd otherwise be sleeping. Some things you might want to pay attention to are lights (keep them dimmed super low or off, tv noise - best to turn off early so it isn't left on when you or hubby fall asleep - if there's a street lamp outside the window, or excessive traffic that can be heard through a window, etc. Not knowing where you're located, if you're in colder weather now, keep an eye on your thermastat for the particular room the dogs stay in and make sure it isn't too warm. If the dog's room is the same that the sleep apnea machine is used, you might consider an alternate sleeping arrangement if you can determine the machine may be too loud. Little things you may not notice on a daily basis but you might pick up on that might give you clues.
It sounds like you know what to do during and after a seizure event. However, just some tips: place pillows on the floor around her and try not to touch her, despite your instinct to do so. Having soft landings around her will protect her when she is seizing. Try to remain calm and quiet. Try to time the seizure, despite the difficulty when you're concerned about the seizure. Once the seizure is over, remain calm, and as quiet as possible, perhaps turn lights down very low, and keep noise to the barest minimum. Speak only in soft tones, with simple phrases to let her know you are there and with her for comfort. Keep obstacles out of the way but do not otherwise try to prevent her from running into things because your touch or stimuli could aggrivate the situation during recovery. Of course, call your vet at once if you detect a seizure is coming on, or in the course of, or directly after, for futher direction.
The biggest concern is during recovery, that she doesn't have another seizure shortly after, sometimes these can turn into cluster seizures and they are difficult to control. Getting her to the ER vet for hospitalization and observation would be the ideal thing to do if that occurred. The vet can even use pentobarbitol with phenobarbitol, the former acts as a sedative and combined, it's a good combination of control in emergencies.
Again, not trying to scare you, and it's possible that she won't ever develop cluster seizures if she's managed with phenobarb.
An ultrasound may or may not show some abnormality. Ultrasound can show fluid, sometimes masses, inflammation etc, but ideally, radiology or MRI will show more if the vet suspects a tumor in an area such as the spine or brain. Again, it doesn't sound like a brain tumor due to the absence of other symptoms, but there could be a lesion elsewhere in the body. Usually, when bloodwork is done as a baseline, xrays should also be done. If xrays are non-specific, then an ultrasound or MRI is usually the next course of action (with or without a CSF test). I do understand the costs involved, but wanted to let you know that of the additional options for testing, other than the xrays, the ultrasound would be the least expensive. It's entirely possible that at least at this point in time, give the phenobarb a chance, retest her levels, consider altering the dose and take it from there.
Do try to observe her environment for clues of external stimuli and discuss them with your vet so he has additional clues to go on. You might find you can reduce some of the potential stimulis that would help considerably. Getting her phenobarb doses adjusted to a more steady-state level, will also help.
Keep me updated, ok?
The prolonged recovery could also be due to her age, in that her motor faculties may take a bit longer to recover.
Is anything else unusual occurring so late at night? If she sleeps with the bichons, are they restless at night or active when she's resting? Do you think she might be susceptible to external stimuli? Sometimes, some sort of stimuli can induce a seizure, whether it be noise, temps in the home, lighting, etc.
Your mention of her seeming hot to the touch - my sister had a dog who had seizures and they would most often occur if she was too warm or too hot. While this symptom in and of itself is rare, it is a possibility. Talk to your vet about that and other stimuli that may be affecting her at those times late at night, wee hours of the morning.
If you're home on a weekend or some night you don't have to work the next day, try to stay up late and observe the dogs when they are resting together (but try not to let them know you're observing), and don't change anything about the environment without first observing what is normally occurirng when you'd otherwise be sleeping. Some things you might want to pay attention to are lights (keep them dimmed super low or off, tv noise - best to turn off early so it isn't left on when you or hubby fall asleep - if there's a street lamp outside the window, or excessive traffic that can be heard through a window, etc. Not knowing where you're located, if you're in colder weather now, keep an eye on your thermastat for the particular room the dogs stay in and make sure it isn't too warm. If the dog's room is the same that the sleep apnea machine is used, you might consider an alternate sleeping arrangement if you can determine the machine may be too loud. Little things you may not notice on a daily basis but you might pick up on that might give you clues.
It sounds like you know what to do during and after a seizure event. However, just some tips: place pillows on the floor around her and try not to touch her, despite your instinct to do so. Having soft landings around her will protect her when she is seizing. Try to remain calm and quiet. Try to time the seizure, despite the difficulty when you're concerned about the seizure. Once the seizure is over, remain calm, and as quiet as possible, perhaps turn lights down very low, and keep noise to the barest minimum. Speak only in soft tones, with simple phrases to let her know you are there and with her for comfort. Keep obstacles out of the way but do not otherwise try to prevent her from running into things because your touch or stimuli could aggrivate the situation during recovery. Of course, call your vet at once if you detect a seizure is coming on, or in the course of, or directly after, for futher direction.
The biggest concern is during recovery, that she doesn't have another seizure shortly after, sometimes these can turn into cluster seizures and they are difficult to control. Getting her to the ER vet for hospitalization and observation would be the ideal thing to do if that occurred. The vet can even use pentobarbitol with phenobarbitol, the former acts as a sedative and combined, it's a good combination of control in emergencies.
Again, not trying to scare you, and it's possible that she won't ever develop cluster seizures if she's managed with phenobarb.
An ultrasound may or may not show some abnormality. Ultrasound can show fluid, sometimes masses, inflammation etc, but ideally, radiology or MRI will show more if the vet suspects a tumor in an area such as the spine or brain. Again, it doesn't sound like a brain tumor due to the absence of other symptoms, but there could be a lesion elsewhere in the body. Usually, when bloodwork is done as a baseline, xrays should also be done. If xrays are non-specific, then an ultrasound or MRI is usually the next course of action (with or without a CSF test). I do understand the costs involved, but wanted to let you know that of the additional options for testing, other than the xrays, the ultrasound would be the least expensive. It's entirely possible that at least at this point in time, give the phenobarb a chance, retest her levels, consider altering the dose and take it from there.
Do try to observe her environment for clues of external stimuli and discuss them with your vet so he has additional clues to go on. You might find you can reduce some of the potential stimulis that would help considerably. Getting her phenobarb doses adjusted to a more steady-state level, will also help.
Keep me updated, ok?
..........Traci
Re: Question about phenobarbital
Hi, Traci, and thanks again for your helpful info. Our lab girl is actually 13 and 1/2 yrs old. Somehow, I thought she was 12, but I looked up her birthday and I misremembered.
Nothing unusual occurs late at night that I can see. In fact, for seizures 1 & 2, and 4 (the one she just had), I'd say she was asleep like we all were. For seizure #3, she was awake on her doggie pillow on the floor while DH and I were reading and watching TV.
Once it's bed time, we all lie down and settle in without any restlessness or activity. There is no TV in the bedroom. There is an alarm clock radio, but that is off until the alarm goes off. We hve double paned windows and that helps with noise reduction (although the littlest bichon is the only one with good hearing in that room, as my DH is functionally deaf without his hearing aids). There is not a lot of traffic on our street, especially at night. Our littlest bichon sleeps with DH and our lab, and the other little one is with me. DH has been using the sleep apnea machine for the past 3 years.
The nightlight is on in the bedroom and has been all her life. Maggie's deafness prevents her from hearing anything but a loud noise. I can't speak to any varying temp in the bedroom where she sleeps...she sleeps at the foot of the bed, and our littlest bichon is at the head of the bed, with DH in between, in a doggie sandwich. Except for seizure #1 when she was very hot to the touch, her body temp during seizures # 2 through 4 was normal to the touch.
I appreciate your extra suggestions of what to do during & after a seizure.
Generally, we talk to her even though we know she cannot hear us--it's the idea of our spoken voices conveying calming energy to her just in case some part of her little spiritself can pick up that energy in a way that can't be seen or measured. The first thing I do when I know she is seizing is to look at the time so I can time the seizure.
We were instructed that if she has a seizure lasting more than 3 minutes, to give her the 5 mg of liquid valium rectally, and if that doesn't help within a minute, to give her one more dose of 5 mg and bring her to the vet's or the vet ER.
I'll keep you posted on things, and thank you again.
P.S. Are you an angel???
Nothing unusual occurs late at night that I can see. In fact, for seizures 1 & 2, and 4 (the one she just had), I'd say she was asleep like we all were. For seizure #3, she was awake on her doggie pillow on the floor while DH and I were reading and watching TV.
Once it's bed time, we all lie down and settle in without any restlessness or activity. There is no TV in the bedroom. There is an alarm clock radio, but that is off until the alarm goes off. We hve double paned windows and that helps with noise reduction (although the littlest bichon is the only one with good hearing in that room, as my DH is functionally deaf without his hearing aids). There is not a lot of traffic on our street, especially at night. Our littlest bichon sleeps with DH and our lab, and the other little one is with me. DH has been using the sleep apnea machine for the past 3 years.
The nightlight is on in the bedroom and has been all her life. Maggie's deafness prevents her from hearing anything but a loud noise. I can't speak to any varying temp in the bedroom where she sleeps...she sleeps at the foot of the bed, and our littlest bichon is at the head of the bed, with DH in between, in a doggie sandwich. Except for seizure #1 when she was very hot to the touch, her body temp during seizures # 2 through 4 was normal to the touch.
I appreciate your extra suggestions of what to do during & after a seizure.
Generally, we talk to her even though we know she cannot hear us--it's the idea of our spoken voices conveying calming energy to her just in case some part of her little spiritself can pick up that energy in a way that can't be seen or measured. The first thing I do when I know she is seizing is to look at the time so I can time the seizure.
We were instructed that if she has a seizure lasting more than 3 minutes, to give her the 5 mg of liquid valium rectally, and if that doesn't help within a minute, to give her one more dose of 5 mg and bring her to the vet's or the vet ER.
I'll keep you posted on things, and thank you again.
P.S. Are you an angel???
Re: Question about phenobarbital
Even though she has been accustomed to slight noise or lighting, even after any seizure event, same noise or lighting could induce another seizure. Not that every pet reacts to stimuli like this, but some do, which is why we always recommend a dark or low-lit room, noise-free, without sensations as much as possible. (totally dark is not necessary, upon waking, they do need to see!) Even though she may be deaf, she might still be able to hear nuances of some types of noise (or vibrations).
You're doing everything right, let's hope she will respond better to the phenobarb treatment as the vet determines adjustments or tincture of time.
You're doing everything right, let's hope she will respond better to the phenobarb treatment as the vet determines adjustments or tincture of time.
..........Traci
Re: Question about phenobarbital
Update--Lab results came back, and Maggie's RBC, WBC is all normal.
Her kidneys are doing fine, but her liver enzymes are slightly elevated. She has a bit of nuclear sclerosis but she behaves as if her vision is still perfect.
The PB is at a therapeutic level so we are to keep her on 1 1/2 tabs twice a day (we started this on Saturday for her 11:00 a.m. dose, instead of the 1 tab in the a.m. and 1 1/2 in the p.m. that we were doing), and then a recheck in a couple of months unless she has another seizure, at which time we'll see our vet.
If she has another seizure, we will just let her ride it out, with the liquid valium as an option to use if it lasts longer than 3 to 4 minutes, but we won't give her any extra PB unless it's on schedule. No matter what the etiology, we wouldn't subject her to any surgery etc--but we'll keep her as happy and comfortable for as long as possible and as long as she enjoys her life, her tennis ball, her food, and her little family.
We're keeping our fingers crossed -- Thank you again Traci (angel !) for all your help and hand holding, information and support!
Her kidneys are doing fine, but her liver enzymes are slightly elevated. She has a bit of nuclear sclerosis but she behaves as if her vision is still perfect.
The PB is at a therapeutic level so we are to keep her on 1 1/2 tabs twice a day (we started this on Saturday for her 11:00 a.m. dose, instead of the 1 tab in the a.m. and 1 1/2 in the p.m. that we were doing), and then a recheck in a couple of months unless she has another seizure, at which time we'll see our vet.
If she has another seizure, we will just let her ride it out, with the liquid valium as an option to use if it lasts longer than 3 to 4 minutes, but we won't give her any extra PB unless it's on schedule. No matter what the etiology, we wouldn't subject her to any surgery etc--but we'll keep her as happy and comfortable for as long as possible and as long as she enjoys her life, her tennis ball, her food, and her little family.
We're keeping our fingers crossed -- Thank you again Traci (angel !) for all your help and hand holding, information and support!