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…

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12 thoughts on “Vito: The Cliff Notes

  1. I’m so sorry to hear that Vito continues having problems. You’re right, he doesn’t deserve what he has to endure. The only consolation is that he has you and Dan to try to see him through it. The serenity of his face in the first picture of this post certainly belies the misery he has experienced. Hang in there. Squeeze Vito for us.

    1. Nothing since June 8 – fingers crossed! For Vito’s part, he gets snacks at every dose, so he’s liking that.

  2. Oh wow! I’ll share this with our doc. Not sure she has any better advice, but we get lots of seizure dogs in. And I’d say that you just completed about 100 credits toward that degree. 🙂

    1. 🙂 I think what happened in Vito’s case is that all vets we went to had a text-book protocol that lead to assumptions. In retrospect, once the specialist heard of the side effects, she should have recommended Keppra instead of waiting it out. Then again, the next vet said his dosage (450mg for a 10lb dog, incidentally) was way too high, even for a loading dose.

  3. I hope that you’re making a list of good and not-so-good vets that you’ll share. Vito has our best wishes. You, too because you need them.

    1. Best not to slander vets, ever 🙂 Crabby and I are fine, but Vito can always use good thoughts to ward off future seizures.

  4. So sorry poor little Vito has experienced all this horrid stuff. I had a dog with sever grand mal seizures over 20 years ago and he was on daily medication till the day he died (phenobarb as I recall) . It helped the seizures but in retrospect, I’m sure his liver failed in the end. Nothing like coming home from a bad day at work and finding your dog dead on the patio. I still wince at that image and thought. While more than a bit of a pill, we loved him to pieces and like Vito, didn’t deserve that. Paws crossed that the future gets brighter for your little guy. Know we’re all thinking of you and wishing for the best. 🙂

    1. Back then, Pheno was all you had, if the evolution of treatments is accurate. Back then, there may not have been accurate tracking of side effects, so people didn’t know the long term effects. Heck, even today people assume if there aren’t seizures the dog is fine, and internal problems progress to the point of no return. I thank our lucky stars that we are far enough into (your dog’s) future that side effects are known and we know what to watch out for.

      I understand and have lived your patio moment. For me it was the bedroom floor and our Zhonna. He never had a sick day in his life and then one day, I found him dead on the floor. He was only 7. We thought it was poison and had him necropsied to find out what it was. When the vet opened Zhonna up, she found him riddled with tumors, most assumed to be cancerous. And we never had a clue – like I said, he never had a sick day in his life. It’s been more than 10 years and I still hold my breath a little whenever I get home from work and give a little prayer everyone is OK before I even open the door.

  5. Poor Vito, Chienne and I send our thoughts and love and hope that everyone else is ok, particularly Gracie. It’s only been a few months since The Man died and I still miss him. Each time I see a new post these days, I stop and think before I open and read it.

    1. Though there will more than likely be more twitching along the way, Vito is doing much better now. It appears he is not one who can take KBr.

      As far as Gracie…. while I hate to tell you that along the way in these last several chaotic months she has gone blind, I am here to tell you she is still Gracie and will always be our Gracie, whether she can see us or not 🙂

      At some point when I can get get caught up, Gracie’s blindness will be covered in a post.

      That you still miss The Man and that you will never stop missing him means you did it right. Remember though, he wants you to think more of the good times than of the loss.

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