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Hi, I am Dr. Peter and would like to help.
1- How often is your dog having seizures?
2- His pheno levels are being measured every month?
He went from having a seizure once a month, to twice a month, then weekly. He had a couple really bad ones. He's been on pheno-barb for a couple years now. He started off with 3 pills a day, then decreased to 2, then one. But he started having seizures again so the vet increased it back up to 4 a day. The vet started him on potassium bromide about 2 months ago (0.6 ml twice a day) and put him on L/D liver support food. She took his blood the other day and says his liver function is bad and now wants to increase the potassium bromide. She would literally test his levels every month if I let her, but I've been keeping it down to every 2 months or so, but he has other problems (bad knee and constant ear infections) so I am spending some major bucks on him. I think he has brain damage from the seizures because he pees and poops in the house fairly regularly (ruined the couch, all the rugs...)
I don't understand how the liver functions could get worse since he's been on the support food and the potassium bromide. That's why I think my vet (Dr.Chappall at Aspen Wing Bird and Animal Hospital in Loveland, Colorado) doesn't know what is going on.
1- When he was on the 4 pills of phenol, was he having seizures?
2- How often is he having seizures now?
He has not had any seizures since being on the 4 pills a day. The vet decided a couple months ago to put him on the potassium bromide cause "it would be better for his liver". But apparently things are not getting better.
Here is everything he is on:
-- Prescription Diet L/D food
-- Potassium Bromide liquid 250 mg/ml suspension (0.6 mL twice per day)
-- Pheobarb 15 mg Tablets (4 per day)
-- S-Adenosyl-100 (SAMe) 1 tablet per day
-- Dasuquin (1/2 tablet per day for bad knee joint)
Your vet is right in increasing the phenobarbital when the seizure activity increased. If she is concern about the liver then certainly adding the potassium bromide is another option. But, the phenobarbital needs to be decreased or discontinue. The dose your dog is on the potassium bromide is on the low end. You need to speak to your vet about increasing the dose on the KBr and gradually decrease the phenobarbital. The plasma concentration of the KBr should be between 2-4mg/ml if used without the phenobarbital and 1-2mg/ml if used in combination.
If you have additional questions I will be glad to answer them.
Thanks for the info. I have one last question...
I am going to ask to look at the liver function numbers today. Do you know what range I should be looking for? And how often should she be testing these values?
Many thanks! Also, is there such a thing as a specialist vet in epilepsy and if so how do I find one?
The normal liver enzymes numbers references change from lab to lab. As a general rule if there is a 4 fold increase then the high normal reference range that is significant. As far as a number that the liver enzymes should be once they are on phenobarbital, there is no number, but certainly below 4 fold. Liver enzymes are almost always elevated when on phenobarbital at least 1 fold.
A veterinarian that specializes in epilepsy would be a Vet Neurologist. You can find one by looking for a veterinary referral hospital in your area. If they do not have one they will be the best to ask where is the nearest in your area. If you follow the link below it will direct you to a veterinary specialty facility in your area; they can direct you to a neurologist.