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.
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.
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.
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).
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, 2 syringes of rectal diazepam and Vito’s “chewing” toothbrush (hey, it soothes him to chew it, so who are we to deny him?). 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. He then gets his toothbrush to gnaw on until he’s fully back with us.
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.