Jetta’s Diary
09/20/08 6:15 AM– grand mal seizure (#1, first one observed), 60 sec. Took her in to see the vet. Exam and bloodwork revealed nothing. The vet recommended spaying Jetta as soon as possible.
10/1/2008– Jetta spayed
10/03/08, 9:00 PM– grand mal seizure (#2), 60 sec
10/09/08 — changed food from Purina ONE to Natural Balance Fish and Sweet Potato. Several friends believe that their dogs’ seizures stopped when they switched to something “better” than Purina ONE. I figure that it couldn’t hurt.
10/11/08 7:15 AM– grand mal seizure (#3), 60 sec
10/13/08– took Jetta to the vet to do a blood draw for a full thyroid panel
10/25/08 — Dr Kramer called with thyroid results all normal except T3 a bit on the low side. No indication of primary thyroid disease. Low T3 is probably due to some other metabolic problem (no examples given in the report).
11/04/08 9:00 PM– grand mal seizure (#4), 60 sec
11/11/08 3:00 AM– grand mal seizure (#5), 60 sec
11/11/08 6:00 PM — PB started in the evening. 64.8 mg, 1 1/2 tablets 2x per day (194.4 mg daily total; approx 9.48 mg/kg or 4.32/lb). Minimal side effects observed other than heavy sleep that night. Prescription filled at Wal-Mart, $8.88 for 90 tabs (64.8mg).
11/12/08– side effects minimal
11/13/08– side effects worsen (drowsiness, weak in the rear, unsteady on feet). Spoke to Dr Wishart and she said that these symptoms may pass within 1 to 2 wks, recommended continuing same dosage. No mention of a loading dosage.
11/15/08– Maybe slightly improved wrt motor control, drowsiness, but still far from normal. Left msg in morning for Dr Kramer to call me. Called SE Vet mid-afternoon and spoke to Dr Torrence about PB dosage and symptoms observed. He advised reducing dosage to 1 tablet 2x/day (129.6 mg daily total; approx 6.336 mg/kg or 2.88 mg/lb) and said that to go to 3/4 tablet 2x/day if symptoms persisted. Reduced dosage to 1 tab 2x/day beginning the evening of 11/15.
11/18/08– Jetta’s symptoms are significantly improved, but she still is weaker in the rear than I think she should be — or would like her to be. She seems to be worse when she first wakes up in the morning or after a long rest, appearing to be partially paralyzed in the rear. Am considering reducing dosage to 3/4 tablet 2x per day, but may wait another day and will consult the vet before doing so.
11/19/08– More improvement observed. Jetta is still a little unsteady on her feet, but can easily negotiate up and down the two steps when going in and out of the house. She also is able to jump up onto my bed without assistance and with only a little more effort than normal. Will continue 1 tab 2x/day until we do bloodwork to check PB serum levels. No seizures observed since the one on 11/11.
11/22/08– I decided to consult the vet about reducing the PB a bit more. Spoke to Dr Kramer about reducing PB dosage to 3/4 tab 2x per day and she said to go ahead and try it. She agreed that it would be good to find the lowest effective dose. Bloodwork will be done in 3-4 weeks because we changed the dosage and it takes time for levels to stablize. Weight: 44.3 lbs
12/5/2008– Jetta has been doing great on the lower dosage. She has virtually no side-effects and has been seizure-free…so far, so good. She is able to jump, run and play fetch as she loves to do. I’m still a bit on edge, but hopeful that we can maintain her at this dosage so that she can lead as normal a life as possible.
12/22/2008– Jetta continues to do well on the phenobarbital and I’ve been feeling more and more optimistic about her leading a normal life. I spoke to Dr. Kramer today about getting a smaller tablet size, one that was more convenient to split. I also asked her opinion on reducing the dosage again. She thought it was reasonable to try since Jetta has been seizure-free since she’s been on PB. The new prescription is one 30mg tablet twice per day. That works out to .75mg/lb or 1.5mg/kg. Cost for 120 tablets was $8.54 at Wal-Mart.
I will finish out the remaining 64.8mg tablets from the first prescription, so Jetta will be on 32.4mg 2x per day for another week or so.
12/24/2008 – So far, so good. No noticeable difference with the reduced dosage.
12/27/2008– Jetta continues to do well on the reduced dosage. It’s been about 5 days and I have not noticed anything that I would consider worrisome. She seems to “twitch” more when she’s asleep, but I don’t know if I am just looking for something or if she’s always done that. I also don’t know that it can be attributed to the PB — like a PB withdrawal symptom? Doubtful…
1/6/2009 – Started giving one half 64.8 mg tablet plus one 30 mg tablet each day. This will continue a few days until I finish the original prescription. I’ll then give her one 30 mg tablet 2x per day.
1/12/2009 – seizure around 8:25pm. About 30 seconds in duration and definitely milder than the other she’s had. She recognized me almost immediately. No growling or fearfulness. I gave her a homemade Frosty Paw. I’ll contact the vet tomorrow to discuss adjusting dosage. Very depressing….
1/13/2009 – seizure around 9:00pm. Similar to the seizure last night (1/12/2009). She recognized me almost immediately. No growling or fearfulness. I gave her a homemade Frosty Paw and a 30mg tablet of phenobarbital.
1/14/2009 — upped the PB dosage to 45mg 2x per day (1.5 30-mg tablet 2x per day). Dr. Kramer agreed that was the thing to do. She was disappointed to hear about the seizures, but still seemed to have some hope that we could reduce the PB over time.
2/7/2009 — I have not observed any seizures since 1/13. I still get a little nervous every evening around 8-9pm….
2/17/2009 8:00pm — 30 sec seizure, bordering on GM. “Blank” for a minute or two. I gave her a half of a 30mg PB tablet (15 mg)
3/29/2009 5:15pm — Same as seizure on 2/17; No additional med given.
4/5/2009 — new prescription started with PM dose.
4/7/2009 7am — about same as previous. About 1 hr after morning dose.
4/7/2009 2:20pm– A little shorter duration. Call to vet. She and I are both baffled as to why Jetta has had two seizures. She advised to give Jetta an additional quarter tablet if she has another one and call her.
4/7/2009 6:30pm- Short seizure, 15 sec +/-. Gave Jetta a quarter tablet. I then decided to check the label and discovered that the pharmacist had given me the wrong size pills — 30mg instead of 64.8 mg. Jetta was getting only half what she should have since the evening of 4/5. I gave her the other 3/4 tablet. She had another seizure around midnight.
Due to an error Jetta got 30mg tabs rather than 64.8mg tabs. Discovered and corrected Tuesday PM.
Hard lesson: ALWAYS check your prescription to make sure the pharmacy gives you the correct meds. The Vet had called in a new prescription for 1 64.8 mg tablet 2x per day. The pharmacy gave me an old prescription that was still in their computer. Live and learn!
4/8/2009 — Discussed prescription issue with the vet. She called the pharmacy and they claimed no fault. We decided to administer a loading dose for 7 days beginning with evening dose today. 2.5 30mg tabs 2x day
4/8/2009 6:45pm — 30 sec seizure
4/15/2009 — Reduced dosage to one 64.8 mg tablet 2x per day.
5/2/2009– Jetta’s weight: 44.7lbs
5/14/2009 5:52pm– 30 sec seizure, 2 minutes before she was due for her evening PB dose. Very disheartening. I was hoping we wouldn’t have to increase the dosage. Will call the vet tomorrow since I need to get a refill. I suspect she will advise staying on this dosage a bit longer. We still have not done bloodwork to test the PB levels because we keep adjusting the dosage. The plan is to measure peak and trough levels. I’ll discuss doing the testing when I call tomorrow since she’s been on the same dose for a little over a month.
5/14/2009 7:35pm– another seizure, about the same as the earlier one today…Gave Jetta a 30mg tablet PB. Drank tuna juice while at work. Water dish nearly drained. Pee accident. Effect of salt or excessive water ???
5/15/09 2:45am– petit mal ??? Pacing, unsettled behavior for about 15-20 minutes. Observed similar episodes 2x in the past month, probably 3-4 wks ago, but those were both around 7pm.
5/16/2009 — Morning dosage: one 64.8mg tablet + 1/2 30mg tablet PB. Total approximately 79.8mg
Spoke to Dr. Torrence about Jetta’s seizures. He recommended increasing the dosage to 1.5 64.8mg tablets 2x per day. He didn’t think that increased water intake would affect serum levels. I’m not 100% convinced he’s correct, but I can’t say he’s not right either. So, I’ll up the dosage and hope that does the trick.
6/04/2009– Took Jetta in for a blood draw to test trough levels of phenobarbital. They have to send it out to be processed, so it will be a few days before I get the results. She’s doing pretty well on the current dosage. No dramatic side effects. No seizures … knock on wood… but I have observed a couple of episodes that may have been petit mal seizures. Or not. ;-]
7/14/2009 — grand mal seizure, about 1 minute, 10:30pm. Gave her some tuna “juice” around 5pm — coincidence?
7/15/2009 — grand mal, about 1 minute; 2:20 AM. Gave 30mg Phenobarbital
Spoke to Dr. Wishart. She advised giving a normal PB dose. If Jetta has another seizure, would start her on KBr in addition to PB.
7/16. 2009 — 30 second seizure around 12:44AM; gave 30 mg PB
Called Dr. Wishart and she started Jetta on 300mg KBr 2 x per day (600mg total per day). Ron’s Apothecary is the only local compounding pharmacy. They had 100mg caps made up, so that’s what we started with. Cost was quite high…. Did some research online and ended up ordering KBr solution from Drs. Foster and Smith. Even with the shipping to Alaska, the cost per dose was very inexpensive.
Ron’s contacted me about a month later to let me know that they had automatically filled Jetta’s prescription. I called back to let them know that I didn’t need it. I told them that I was using KBr solution that I ordered and told them the price. They managed to meet the Foster and Smith price, so I will get the next prescription from Ron’s! I’m happy to buy locally as long as I don’t have to pay LOT more. If I didn’t live in Alaska, Foster and Smith would be less expensive since they would have shipped the prescription for free….
10/5/2009 — Jetta has not had any seizures since starting the KBr, but I’ve been noticing a gradual increase in side effects that could indicate bromide poisoning (bromism): sedation, ataxia, etc. The symptoms seem to be worse after giving her PB. I called Dr. Wishart and she advised that we should check the KBr levels.
10/10/2009 — Test results returned and Jetta’s KBr level was at 2. Target therapeutic level is 2-4 for KBr alone. When given in combination with PB, target level is 1-2. Dr. Wishart lowered the KBr dosage to 200mg 2x per day (400mg total per day). PB dosage unchanged.
10/17/2009 — have noticed a gradual improvement over the past week. Jetta seems more alert and more coordinated. Hopefully we’ll find the right dosage that will control her seizures and allow her to lead a normal life…or something close to it.
10/24/2009 — 100 days since Jetta’s last seizure. The KBr side effects seem to be improving bit by bit, but she’s still not 100%, especially certain times of the day. She did okay at practice, but was pretty done in after about 45 minutes. Jumping, even low hts, not so good, but some of that could be her lazy jumping style. ;-]
10/30/2009 — After 106 days, Jetta had another seizure just before 3am: grand mal, about a minute. It took 4 to 5 minutes for her to get up. Contacted the vet clinic when they opened and spoke to Dr. Kramer. She told me to increase the KBr to 250mg 2x per day.
11/13/2009 — No seizures since 10/30. Jetta seems pretty alert and is not having extreme side effects. I just hope the PB and KBr are at high enough levels. I should ask the vet about testing the PB level when I speak to her again.
COSTCO has opened their pharmacy and the price for Phenobarbital is considerably less than at Walmart, where I thought I was getting a good deal! COSTCO quoted $5.69 for 90 tablets, 64.8 mg. Walmart charges $8.88, I believe. I plan to transfer the prescription the next time the vet calls it in.
11/19/2009 — Jetta has had diarrhea for the past 5 days. I came home at lunchtime to let her out and found that she had pooped in the house. That made it easier to collect the fecal sample to take to the vet, but I was not too thrilled….
I also noticed that Jetta had managed to get a bag of treats off the counter and had chewed a tuna can (a clean one) that was in the recycling. She was behaving a bit odd and I suspect she may have had a seizure this morning. I stayed home this afternoon and about 3:15 pm, she DID have a seizure. I gave her 30 mg PB.
The fecal results came back negative, of course. The vet (Dr. Guillory) prescribed Immodium and Panacur to start with and said we might add metronidazole (flagyl) if that didn’t clear up the diarrhea. She doesn’t know of any potential negative drug interactions with PB and KBr.
I also asked Dr. Guillory about Jetta’s seizure meds. The last time I spoke to Dr. Wishart, she indicated that we would raise the PB dosage if Jetta had seizures again. Dr. G will leave her notes for Dr. W who will be in tomorrow. I think it’s time for another PB serum level test… The only one we’ve done to date was in early June, a little over 5 months ago.
Second GM at 11:25 pm. Gave Jetta 30 mg pheno instead of the diazapam.
11/20/2009 — Talked to Dr. Torrence and he recommended upping PB dosage to 1.75 tabs (64.8 mg size) 2x per day.
11/21/2009 — Took Jetta to the vet (Dr. Torrence). He did a SNAP test for giardia (results negative) and advised fasting Jetta for 24-hrs, then start back on reduced portion of her regular food. He also prescribed metronidazole (flagyl) in addition to Pepto and Immodium. Gave Jetta her 1st dose of metronidazole in the evening.
11/22/2009 — No significant change. I was out all afternoon working Pet Photos with Santa. Jetta was not hungry when I gave her her dinner, but eventually ate it. Noticed her stomach was VERY distended — worrisome symptoms…. Gave her some Gas-X just in case it might be bloat.
11/23/2009 — mystery of the distended stomach solved…. Jetta had broken into the bag of kibble and feasted while I was out. ;-] A “Vittles Vault” is on my shopping list! Diarrhea improving. YAY!
12/17/2009 — GM seizure at 11pm. Post ictal a little different. Much more restless than usual. Gave 1/2 64.8 mg tablet PB and 10mg diazapam.
12/22/2009 — called in a refill for PB and KBr. Started Jetta on 2 64.8 mg PB 2x per day.
12/31/2009 — started new KBr from Ron’s Apothecary
1/5/2010 — GM seizure at 6:30 am, about 1 minute. Gave 1/2 64.8 mg PB tablet. 19 days since last seizure.
Second GM Abt 6:40 pm, as she fell asleep.
Duration 1 min. Long tonic phase
Recovery longer than this AM. More restless, running into things. Gave PB 30 mg tab + 1/4 64.8 mg tab
1/6/2010 — pre-seizure behavior (partial seizure?) at 6:17am and 6:30am as she dozed off — jumped up and ran into other room. Gave her 2 1/4 tablets (64.8mg) at 6am per advice of Dr. Torrence when I spoke to him yesterday (1/5/2010). He said that if she had another seizure, increase the dosage of PB by 1/4 tab.
1/8/2010 – gave 1/4 tab (64.8 mg size) around 2am due to suspicious behavior…gave 2 tabs at 6:00am. More suspicious behavior at 6:30am. Gave 1/4 tab.
2/2/2010 — 8pm clingy. 8:20pm looked like start of seizure as jetta fell asleep. No seizure…
2/14/2010 — 6:44pm GM 1 minute, gave 1/4 64.8 mg tab PB
2/15/2010 — 7:37pm GM 1 minute, maybe less. Gave 1/4 64.8 mg tab PB
2/16/2010 — gave 2.5 tabs this AM (extra 1/4 tab). Spoke to Dr Guillory today about Jetta’s meds. She said to increase the dose to 2.5 tabs 2x per day. She also recommended measuring the peak serum levels of PB. Made an appt for blood draw on March 3.
3/3/2010 — took Jetta in for a blood draw to measure the peak serum level of PB. I also had a blood panel done to check on things and had Dr. Guillory check Jetta’s ears for a possible ear infection. Jetta has always had more wax than my other dogs, but lately I’ve noticed that they have been worse. Then on 3/2, I noticed that her right ear seemed to be bothering her. Ear infection confirmed. They cleaned Jetta’s ears really well and prescribed some ointment (Otobiotic) to be administered 2x per day for 7-10 days. The vet also said to clean her ears with Oti-clens 2x per week.
3/4/2010 — Dr. Torrence called with the blood panel results. Everything looked good except for thyroid function. He prescribed soloxine for 1 month, then a recheck on the thyroid.
3/6/2010 — Dr. Wishart called with the results of the PB test. They are within therapeutic range, but at the top. She said to keep Jetta on the same dosage of PB. If she remains seizure-free for 4-6 mos, we will try to reduce the dosage to hopefully avoid liver/kidney problems.
4/1/2010 — Discontinued soloxine. Jetta was not doing well on it. New bloodwork showed thyroid was within normal range, but she was displaying symptoms that might be due to the drug: excessive consumption of water, excessive urination (every 1-2 hrs). Urinalysis showed nothing other than dilute urine. Bloodwork indicated dehydration. If symptoms do not resolve, it may be diabetes insipidus or kidney failure. Supposed to recheck urine in 3-4 wks.
4/21/2010 — Jetta doing MUCH better without the soloxine. Water consumption and urination decreased — urination every 4-5 hrs, about what it’s been since she’s been on the PB and KBr. Haven’t done another urinalysis yet.
5/3/2010 — started new prescription PB, larger tablet size: 100 mg. 1.5 tablets 2x daily.
6/22/2010 11:30pm — GM, about 1 minute.
6/23/ 2010 12:30am — GM, about 1 minute; about 1 hr after the first. Gave 30 mg phenobarbital
6/23/2010 5:30 am — GM, about 1 minute; gave 50 mg phenobarbital. Gave her regular dose of phenobarbital (150mg) at 6 am.