Monday, February 18, 2013

Duncan's Drama

Duncan’s been dealing with seizures for just over a year now (not counting the two that occurred seven months before they really got started). He’s occasionally had patterns that last for a couple of months, but since going off the Phenobarbital, the pattern has basically been to randomly have a lot seizures. Adding the Keppra as a cluster-buster helped, but didn’t address the issue of the frequent seizures. Well, this all came to a head at 8:25 Wednesday evening when Duncan went into status epilecticus.

Just three days after a series of grand mals, Duncan fell into another seizure. I proceeded in the usual fashion – remove any furniture or other items that he might hurt himself on, start the timer, and get a notepad and pencil to track the GMs. About 10 minutes into the seizure, I realized that it didn’t look quite like the ones he’d been having. 15 minutes in, I called John and asked him to be on standby for a trip to the vet school. The next call was to the vet school emergency unit to describe what was happening and get some feedback. After a bit of back and forth, it was decided that Duncan needed to go to the vet school. I called John and asked him to come on over. By the time I got what I needed and cleared out the back of the truck, John was pulling in. I went next door to ask my neighbor and his girlfriend for some assistance with carrying Duncan. We flipped Duncan onto a spread and the four of us carried him out to the truck (answering the age-old question, how do you get 120lbs of seizing GSD into the back of my truck?). John drove, and we pulled into the vet school carport at 9:40pm.

The vets were able to get the seizure stopped fairly quickly, thank goodness. By this time, Duncan had been seizing continuously for 80 minutes. That’s right, 80 minutes. With no breaks other than two extremely short ones during the first 10 minutes. Even when he wasn’t in a full GM, he was having random spasms with no indications of consciousness. His temperature was 106.4 degrees (high end of normal is 102.5). They shaved his belly and went to work on cooling him down. When the vet came in to update us, we found out that Duncan had done some pretty significant damage to his two left canines. I saw him contort in ways he’d never done before, but didn’t realize he’d done that kind of damage. By the time John and I left the vet school, their main focus was keeping Duncan’s temp down and preventing any more seizures.

They did blood work Thursday to make sure there wasn’t any damage to Duncan’s kidneys or liver (all fine). They also kept him fairly heavily sedated most of the day, but switched him to regular meds Thursday afternoon. After a good bit of discussion with the neurologists, we decided to add 2000mg Keppra XR (extended release) to his regular 500mg Zonisamide (9 pills total), twice a day. Since Keppra has fewer side effects than Phenobarbital and potassium bromide, we’re hoping it will provide better control of the seizures without incapacitating Duncan. It’ll be a while before we really know how much it helps.

Duncan got to come home late Friday morning. He was extremely wobbly, both from the meds and the physical effects of the seizure. It was almost impossible to get him to focus on anything but napping – I even had to bring him dinner in bed. Reyna and Kodiak spent a lot of time checking on Duncan – Reyna was definitely stressed while he was gone and very happy to have him back.

We had an odd little incident Friday night. Everyone had finished their bedtime cookies, Kodiak was getting ready to do his regular post-cookie crumb check, but Duncan was still searching the bed around him to see if he'd missed anything. Kodiak was about two feet away from Duncan and he started growling. Reyna was instantly in Kodiak's face, growling and snarling at him. I dragged Kodiak over to his crate and Reyna followed right behind, growling and snarling the entire way. She's never before corrected Kodiak for snarking at Duncan, but apparently her therapy/service dog tendencies kicked in pretty hard. I guess I shouldn’t have been as surprised as I was, considering Reyna would walk over to Duncan every time Kodiak got close enough to check him out.

Duncan improved Saturday, finally getting some of his coordination back. He was better Sunday, and after work this evening he actually played with Reyna and Kodiak a bit. He still wants to sleep more than usual, but it doesn’t look like the Keppra will cause too much trouble with side effects. Of course, the big question is how much will it help. If we can get a couple of weeks between seizures, I’d be happy, especially if we aren’t dealing with multiple seizures each time.

Duncan had to have some help getting on the couch, but it was definitely his favorite place to be over the weekend. You can see some of the shaved parts on his paws, legs, belly and neck.

The poor boy was sitting even more off-kilter than usual Friday afternoon. He did seem to enjoy going outside and baking in the sunshine, though.

The rightmost tooth is Duncan's upper left canine. The dark spot in the bottom middle is the root. The second tooth from the right is his lower left canine. It should be as long as the upper canine, but its not anymore. The dark discoloration in the middle is the root. Duncan goes for a check-up this Saturday with the regular vet, and we'll have to decide if/when the teeth will need to be removed. One of the downsides to this type of slab fracture is that they can be prone to getting infected - not to mention they're frequently uncomfortable for the dog.

Paws crossed we never have to go through this again.

Tuesday, February 12, 2013

Yeah, Yeah

I know, I am waaaaaay behind on this. I’ll try to get caught up, one critter at a time. Let’s start with Duncan, since he always has something going on. Since his last update, he’s done some agility, started training for a draft test, lost weight, joined an epilepsy study at NC State University Vet School, and had a whole lot of seizures.

Duncan earned his VALOR Intermediate Jumpers title in November, and started working on Snooker and Perfect 50. There are a couple of VALOR fun days coming up and Nationals will be in late April. If all goes well, he’ll have a lot of qualifying runs, add a few more titles and have a ton of fun.

We’re planning to attend a draft workshop in early March to help us prepare for a draft test a couple of weeks later. Duncan’s been practicing his maneuvering and working on his weight training, since he has to pull a 20lb load during the off-road portion of the test. Granted, 20lbs isn’t much for a big fellow like him, but he still needs to get used to it. The hardest part for him is backing up, although he only has to move the cart 12 inches at the Novice level. I’m sure he’ll be ready for it by mid-March.

Now for the not so fun stuff…

Thanks to the Phenobarbital, Duncan packed on about 24lbs between January and November. That’s a lot more weight than is healthy for him. I started weaning him off the Pb in November, and he was completely off by late December. He’s now taking Zonisamide twice a day, instead. Being done with the Pb has been wonderful for him in the sense that he’s back to being the dog he used to be. Unfortunately, his seizures are coming more frequently and have been getting more severe. His last set was 7 grand mals in 21 minutes a couple of days ago, with 6 in 20 minutes just a few days before that. He had 10 grand mals in 31 hours over New Year’s. We’ve started a new cluster-buster protocol with Keppra that really seems to work, but the meds make him extremely ataxic so it takes a couple of days to recover from the treatment. We did get the great news in January that he’d lost 12lbs since November 1st. With luck, we’ll have him back down to a sleek 115lbs in another month or so.

Duncan was asked to participate in a study being done by the vet school (well, I was asked if I’d put him in the study, but you get the idea). They’re testing to see if external electrical stimulation of the vagus nerve will help increase the time between seizures and decrease the severity. I have a small device that I put against his neck two to three times a day for 90 seconds. We’ve been doing it for a few weeks now, and so far I’d say its not helping at all. Maybe after a little more time… One thing we have discovered is that Duncan really hates the thing for about 24 hours after a seizure. I think that’s pretty interesting, especially considering he’s actually slept through the treatment before.

Other than the seizures, Duncan’s doing pretty well. I’m going to give him a run at barn hunting in the next few weeks, and I’m hoping we’ll be able to attend a rally trial in May. It just all depends on how his noggin is doing, since he’s pretty much comatose for about 48 hours after a cluster. Paws crossed for the big pup!