6:30, 2:30, 10:30; Life With Keppra Vito

Right now, subject to change without notice, it appears Keppra is key in managing Vito’s seizures.  It’s been hypothesized that the stress caused by the side effects of the KBr counteracted the Keppra that time he had seizures while on both drugs.  We don’t have the side effects, other than the constant hunger, on NaBr.  2 attempts to remove Vito from the Keppra after therapeutic blood levels of Br were reached resulted in seizures in 22 hours or less.  Thus, Keppra is a permanent fixture barring any unforseen complication or a better treatment comes out.

How can such a wee little, rodent like dog control us?
How can such a wee little, rodent-like dog have such power over us?

Here’s the rub with Keppra:  It has a half-life of 4 hours, meaning at the end of 8 hours, it is gone, finished, no longer detectable, leaving the patient open to the possibility of a seizure. Even worse, a missed dose may actually cause a seizure.  It must be given every 8 hours to ensure maximum effectiveness. Not 3 times a day at the most convenient hours, shifting depending on outside activities, but every 8 hours.  This little factoid is why Keppra is rarely the drug of choice for dogs.  Compliance is nearly impossible except for stay at home pet parents.

Vito is a great laundry helper!
Vito is a great laundry helper!

Think about it:  the average day job is at least 8 hours.  Factor in commuting and you’ve already blown the timing of one dose.  Add 8 hours to the already late dose, and you’re looking at the next one occurring in the middle of the night, long after bedtime.  In order to get to work, the morning dose would have to be given hours early.  See the problem?

How does a mere mortal stick with a Keppra dosing schedule?  With great planning and forethought.

I leave for work so early, it’s practically the previous day.  Crabby gets up at 5:30.  He has a 6:30 alarm for Vito’s morning dose.  No chance of forgetting if his pre-work chores get out of hand, the alarm will remind him.

I have a regular alarm set for 2pm.  If I’m working, and the alarm goes off, I drop what I’m doing and go home for Vito’s 2:30pm dose (yup, I have a 2:30pm alarm too).  If my work was not finished before the 2pm alarm goes off, after Vito gets his Keppra, I go back and finish.

After a post-seizure bath.
After a post-seizure bath.

Both Crabby and I have alarms set for 10:30pm.  That’s way past my bedtime, and though Crabby usually stays up at least until 10:30, he has been known to fall asleep on the couch.  The dual alarms insures one or both of us is up to give the 10:30 dose.

In the event one of us can not make our appointed dose, the other gets a call.  Whoever can break away from work the easiest goes home for Vito.

If Crabby or I were to get hit by a truck or  contract some fatal disease, the availability of the other to go to the hospital to visit or claim the body is contingent on how close we are to one of Vito’s dosage times.  For example; if I were hit by a truck at 12:30pm, and Crabby were to receive notification of my impending demise, he is to immediately go home, wait for the 2:30pm dose, and then go to the hospital.  He will time the commute, schedule his miscellaneous emotions and other pertinent tasks and then set an alarm on his phone signaling when he has to leave the hospital to make it home in time for Vito’s 10:30 dose.

A couple weekends ago, Crabby and I painted the town one evening.  But not before I calculated the mileage to our destination, factored in weekend traffic, then gave a 15 minute buffer just in case, and set an alarm telling us when we had to head for home.

To make sure Vito’s schedule is strictly adhered to, we have a white board listing day and dosage time.  After each dose, a check mark goes in the appropriate place.  This keeps Crabby and I from ever having to wonder if the other goofed. Additionally, the snack reminder for Vito’s 2:30 and 10:30 doses are duly noted (Vito insisted on that).

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Photo taken the first time we tried to stop the Keppra.  Vito had a seizure 22 hours later.

Because no medication stops all seizures, and because Crabby has a tendency to freak just as much now as he did when Vito had his first seizure, to the right of the seizure board from a kitchen cabinet hangs the Vito Emergency Bag (VEB, since everything has an acronym now).  In it are a syringe pre-filled with a loading dose of Keppra and 2 syringes of rectal diazepam.  At first twitch, my job is to go to Vito.  Crabby’s job is to bring me the VEB.  Vito gets both the Keppra and 1 syringe of diazepam at the end of the seizure.

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To help us feel this is all worth it, all seizures past April (some occurring between January and April are missing) are noted on the Horde Board in the hallway by the back door.   That way every time we come home, we can count another day off the ticker from the last seizure.   As of right now, Vito hasn’t had a seizure since June 8, the longest he’s gone since we started medicating.

The plan had been, if we ever reached a significant gap between seizures again, to try to wean Vito off his NaBr.  We’ve decided not to go there.  Something is working and we just want it to keep working.  If we do a Br check and find it has dropped below therapeutic levels, we will know the seizures are being controlled by the Keppra alone. Until then, we change nothing.

And so is our lives until the day we die (the dogs are expected to outlive us after all).  There are those, even in the dog ‘community’ who don’t understand the short leash we have to home right now.  I’ve stopped trying to explain.

The only thing I can say is this:  Vito is not a sacrifice.  He was, is and always will be, a gift.  In other words, he’s worth it.

It's not fair that Vito has to go through so much.
It’s not fair that Vito has to go through so much.

The Once And Former

Remember when Morty moved in?  He just showed up in the driveway one day, smelling wild, and refused to leave.

Morty, the day he showed up, Memorial Day weekend, 2012.
Morty, the day he showed up, Memorial Day weekend, 2012.

No one claimed him.

Turns out, Morty and Crabby had a similar interest:  the love of nature and getting away from it all.  And so it came to pass that Morty became Crabby’s Main Mutt.

The Noble Beast in his element.
The Noble Beast in his element. (2012)

Morty had no fear.

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The ground was his bed and the sky was his blanket. If he got tired, he just lay down where ever he was and took a snooze.   He needed no comforts of home, the Wild was his home.

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So rugged was Morty, he could even carry his own pack and it never slowed him down.

2013
2013

But then things started to change.

2014
2014

And then they changed some more.

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And here we are today:

I present to you, The Once and Former Noble Beast, now known as Princess Morty.

Princess Morty, 7/4/15
Princess Morty, 7/4/15

Vito: The Cliff Notes

What a long strange trip it’s been!  At first I was going to do this as a newsletter, then as a novel.  Stack on top of that all sorts of events, tid bits and adventures I haven’t kept you up to date with, and, well, I give up.  You get the short version so I can try to play catch up on all the other events.

It's not fair that Vito has to go through so much.
It’s not fair that Vito has to go through so much.

While Vito’s seizures were disturbing, his post ictal states were even scarier.  Where the seizures maintained at less than a minute, 4 times within 24 hours, then they went away, the post ictals got progressively worse.  Vito would be so agitated he was practically scaling the walls.  He could never get enough to eat, often times being caught trying to munch on electrical chords, dog beds, sticks, stones, and the list goes on.  His constant crying was the worst.  Until he collapsed from exhaustion, some time after the 4th seizure, he was non-stop.  But we were told we were over reacting.  The seizure, and not the post ictal, was the more serious condition.  Just confine Vito to a crate if he won’t calm down.  None of the experts were there to see what Vito was like in these episodes. Be rest assured if it were their dog going through the torture Vito did, they would DO something.  But we were given no options other than to lock Vito up – not going to happen.

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In January, I gathered up the Vito Book containing all narratives and lab reports, the ultrasounds, his diet, etc. etc. and sought the opinion from a second internal specialist.  The only way to stop the post ictals was to stop the seizures, and to do that, we had to medicate.  I caved.

Because of Vito’s idiopathic elevated bile acids, phenobarbitol was not an option, so we were started on KBr.   The KBr side effects were identical to Vito in a post ictal state – highly agitated, voraciously hungry, constantly vocal, and his eyes looked worse than they did in a seizure episode, probably because his stomach was always upset.  He felt crappy.  We felt helpless.

We were told to stay the course, that the side effects would dissipate.  For weeks Vito couldn’t sleep through the night, and neither could I.  Most disturbing, the seizures, previously no closer than 30 days apart, got closer.  Even more disturbing, his between seizures, usually normal liver profile values were starting to skew.

Eventually, we just took Vito off the drug.  Our bad, we didn’t wean him, we just stopped it.  Within a week Vito was Vito again, and within another week, he had another seizure episode, and shortly after, yet another one.

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A new vet, yadda yadda, and we were told the problem with the KBr is that it was 4 times the dosage Vito should have been getting.  With great reluctance on our part, KBr was re-started, but at 1/3 the dose, to be given until the Br reached therapeutic levels in his blood, then we would reduce it.  The side effects returned, though not as severe as before, serious enough to mean we only woke up once or twice a night rather than many times, and Vito still felt crappy.  The seizures continued – by now, Vito having had more in a few months than he had in the previous year – and eventually Keppra was added as a back up until the Br reached therapeutic levels.

2 days after blood was drawn to confirm the sought after therapeutic Br level was reached, and while Vito was simultaneously taking Keppra, he had his first ever longer than a minute seizures, and first ever more than 4 in a 24 hour period.  When we got 2 weeks away from this episode, a liver panel was run and every parameter was seriously elevated.

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Now, let me take you back to pre-medicated Vito:  Seizures never reached a minute, there were never more than 4 in a 24 hour period, and they were never, with the exception of 1 event in 2014, less than 30 days apart, more often than not, longer – we made it 108 days once.  Immediately after a seizure episode, his liver values were elevated, but within a week, they would return to normal.

Medicated Vito has only gone 30 days between seizures once since being medicated, he was in a permanent post ictal state, and his liver was taking a hit.

I did some research on my own and found that an alternative to KBr for dogs who experience side effects is NaBr.  The vet had never heard of it.  With more than a little begging, Vito was converted to NaBr.  Within 2 weeks, the side effects, except for the hunger issues, went away.  Which brings us to April.

Remember that few months when I fell off the map?  Now you know why.  It was all about Vito.

Right now, Vito still takes both NaBr and Keppra.  No medication prevents all seizures, and the intention all along was to use Keppra to calm at the first seizure when it occurs.  In order for that to happen, he has to be off regular Keppra.  Our instructions were that if we ever reached 30 days without a seizure, to stop giving Keppra and see what happens.  We did, and 22 hours later, the seizure happened.  It was only 1, but still.  Since it was possible Vito was ‘due’ for a seizure, medicated or not, after several days, the Keppra was stopped again.  We made it 18 hours that time.  Again it was just a single seizure.  That was June 8.

So, Keppra is confirmed as controlling(?) Vito’s seizures.

We have no clue whether or not the NaBr is doing anything. If we can go another 30 days, actually 45, we will try weaning (as opposed to rapid stop) of the NaBr.  Keppra is forever no matter what, and if we can maintain him on just that, all the better.

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That, believe it or not, was the short version.  I was going to tell you about life with Keppra Vito, but by now you’re probably tired of reading, so I’ll save it for a future post.

In the end, I wish we never started medicating Vito.  It made his seizures worse and his life between them miserable.  I haven’t run a recent liver profile, but other than those weird bile acids, his liver was fine before.   I wish I could have found a vet who would listen to what I was saying rather than assume I was over reacting.  Sedation during a post ictal could have solved the problem and it would have had less long-term side effects.  But I’m just a crazy dog lady.  What do I know.

If anyone wants to start a GoFundMe for the purposes of paying my tuition at the new vet school that opened in Phoenix, I’d be all over it :)  Just saying…

Pablo and Gertie, Continued

A year ago, almost to the day, Crabby brought Gertie and Pablo home, after they had spent the day abandoned at a McDonalds, tied to a tree, with no water. It was 107 degrees.   There had been Facebook chatter about them all day, but other than the original poster taking water to them, no one stepped up to help.  Crabby took the long way home from work and brought them to The Ranch.

The FB photo posted last year of Gertie and Pablo tied to the tree.
The FB photo posted last year of Gertie and Pablo where they were abandoned.  An employee of a neighboring business took them water and checked on them throughout the day.

A sign was left at the tree the kids were tied to, in case their person had been in an accident or something.  A few days later, we got a call from a man claiming they were his dogs.  We were supposed to meet that evening, but he didn’t call me back.  So began a few weeks of him sending texts I told him I couldn’t receive, calls with changing stories, and the inclusion of an outside person with more experience than I in these situations.

First night at The Ranch.  Gertie was exhausted and very dehydrated.
First night at The Ranch. Gertie was exhausted and very dehydrated.

Mention was made of an ex-wife, so I posted several Craig’s List ads, just in case Pablo and Gertie were pawns in a domestic dispute. No responses, at least none that produced pictures or descriptions coming close to Gertie and/or Pablo.  Gertie didn’t have a micro chip, but Pablo did.  Unfortunately, his chip was never registered.

Time passed, Pablo’s appetite for the taste of human flesh made him un-adoptable, and we had a chunky vet bill to get his teeth fixed, so he was given his promise that Run A Muck Ranch was his forever home.  Gertie didn’t receive her promise until a vet recommended putting her down in October.

Gertie with her new BFF, Sarah.
Gertie with her BFF, Sarah.

Time continued to pass, Pablo became a huma-tarian (lost his taste for human flesh), Gertie proved the vet wrong by not only living, but thriving, and life went on at Run A Muck Ranch.

Last weekend I received a telephone call from the Mom of Pablo and Gertie, when they were Tuko and Cheyenne, before they were left at the McDonalds last year.

I’m going to keep the details vague because I don’t want to give false information, but according to the Mom, she found herself in dire circumstances and had to leave the state suddenly, causing her to make the heartbreaking decision to surrender Pablo and Gertie to The Humane Society.

The love of Pablo's life:  Marcy.  He likes his women wild.
The love of Pablo’s life: Marcy. He likes his women wild.

The man who abandoned the kids at the McDonalds was either a current or previous husband, got Pablo and Gertie out of the shelter at some point, and at some point later, abandoned them at the McDonalds.

For whatever reason, the man still had my phone number a year later, he and Mom re-connected in some form, he gave her my number, and she called me.

Gertie looooves furniture.
Gertie looooves furniture.

Life throws curve balls at people sometimes, and sometimes people have to make gut wrenching decisions.  In this case, Mom surrendering Gertie and Pablo to The Humane Society. The not knowing whether or not they made it out of the shelter alive, and if they did, were they OK…  from the sound of Mom’s voice, it was horrible.  She had been told many lies about the kids last year by the man who abandoned them.  She didn’t know what to think.

For her part, Mom informed me that, yes, Gertie lived with her for 10 years, but she was 2 when she was adopted, making her not 11 now, but 13.  From the sounds of it, Pablo was a velcro hound, constantly needing human contact, not the independent, “I’m too busy to cuddle right now” party animal he is now.  Most surprisingly, she said both Pablo and Gertie knew basic obedience commands.  When we attempted to get them to sit, Gertie couldn’t stop laughing and Pablo gave a look that was pretty clear in it’s meaning:  “I give the commands around here, not you!”.

When Pablo sits still, he likes to sit still on a person.
When Pablo sits still, he likes to sit still on a person.

The happy ending to all of this is that Mom now knows Gertie and Pablo are happy, healthy and most importantly, loved.

The sad ending is that since Mom now lives on the East Coast, she can only see them in photos, videos and stories posted here and to the Run A Muck Ranch Facebook page.  For that reason, I may post a little heavier about Gertie and Pablo.  Bear with me on that.  Getting Pablo to sit still long enough to get pictures that are more than blurs – that will be a trick.

Stanley, Now Known As Max, Is Back!

Time for my annual visit with Stanley, now known as Max!

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Though his name is Max now, and has been for several years, he refuses to respond to that name at Run A Muck Ranch.  Once he passes through the gates, he reverts to answering only to Stanley.  If I say “Max” he totally ignores me.

I was at MCACC west many moons ago to pick up a random ‘Long Timer’ to foster.  I never made it to the counter to check animal numbers for the intended dogs.  Before I could, I saw Stanley, in a glass viewing room, in the crowded counter area, bite the volunteer who was trying to take him out for a walk.  That bite was Stanley’s death warrant.  New Hope only existed for the cute dogs back then so there were no second chances.  Biting dogs died.

I guess you can figure out what happened next…

Stanley’s taste for human flesh continued, and re-homing just wasn’t in the cards.  There was no point in giving Stanley his promise.  He was too ornery for anyone else to want him.  But he was OK where he was.

Can you believe this creature could be such a menace???
Can you believe this creature could be such a menace???

About 2 years after Stanley came to live with us and long after we stopped trying to rehome him, we happened to take him and some of the other kids to dog park.  It was an innocent visit, but it was one that proved there was such a thing as fate.

Out of the blue, a strange woman appeared next to us and proclaimed that Stanley was the most beautiful dog she had ever seen.  Before we could stop her, and to our horror, she picked him up so his face was right against hers.

Stanley didn’t bite her.  Instead, he licked her face.

And now you know the rest of the story….

Stanley never had the sense of humor the other dogs did.  Indeed, no fun was allowed in his presence. Laps and people beds were for Stanley only.  Crabby and I were Stanley’s property and no attention could be given to any other dog without Stanley’s wrath being unleashed…. on the other dog.   That he had a chance to live in a lesser human to dog ratio home, under more civilized circumstances, with a rare someone he liked, was an opportunity we couldn’t pass up.  Though I shed a few tears when Stanley left us, I don’t think he ever looked back.

Stanley has lived with his mom and dad, his true mom and dad, since then and every time they go away Stanley and his super adorable sister Bergie come to stay with us.  Stanley and Bergie are the only ‘outside’ dogs permitted to stay with us with our insane number of resident beasties.

Bergie is quite malleable, unlike the Run A Muck Ranch dogs, so Stanley immediately took to her, in a non-menacing way.  Other people, however, well, let’s just say I’m pretty honored to be one of the few he greets with a kiss rather than a snarl.  Some things never change.

Bergie is the definition of adorable.
Bergie is the definition of adorable.

Every time he comes back, Max transforms into Stanley, and it’s like he never left.  Gertie and Pablo weren’t here last year and Stanley knew they were new.  That we allowed them in without consulting with Stanley first, well, we’ve already apologized and he’s already schooled them on the law of the land.  We really should be pleased with Stanley’s tolerance with the newbies, especially considering Stanley was #7 of 7 back in the day.  Some have passed away and several have moved in since Stanley left and we didn’t get his permission for any of the changes.

We may be ‘uncivilized’ by Stanley’s standards, but I think he enjoys letting his hair down once in while, especially because he is the alter ego of  Max who lives in the Normal World. Also, Bergie is only a minion.  The Run A Muck Ranch bunch are minions.  That they all submit to the dictatorship of Stanley, he really gets a kick out of it!

Bergie LOVES the fish pond!
Bergie LOVES the fish pond!
Unfortunately, she's gained quite a bit of weight since last year so she can't jump out anymore.  To make matters worse, with Hal and Charlie gone, she doesn't have horse manuer to roll in when she gets out :(  Bergie really loves being green,
Unfortunately, she’s gained quite a bit of weight since last year so she can’t jump out anymore. To make matters worse, with Hal and Charlie gone, she doesn’t have horse manure to roll in when she gets out :( Bergie really loves being green.
So a cat a dog and a hamster walked into a bar....
So a cat, a dog, and a hamster walked into a bar….

I’ve watched Stanley grow from a snarky young adult to a happy old man.  I really believe he loves his life in a stable home, while occasionally being given the opportunity to walk on the wild side.   There is always doubt in the heart of a foster mom as to whether or not she did right by her dogs. Stanley was, is and will always be, my biggest sucess story.