Phenobarbital side effects--how long?

[jtrosen]

My dog (shepherd/husky mix, 73 pounds, 12 years old) began to have grand mal seizures last week. He had two seizures, one on Sunday and one on Monday, at almost exactly the same time in the evening. After the second seizure, the vet put him on phenobarbital (97 mg/2x per day).

He's been on it for five days now and is still pretty out of it. He is extremely lethargic (sleeps most of the day), has coordination problems, and weakness in his hind end. He walks veeery slowly. He's also extremely hungry and thirsty. I've read that all of these are possible phenobarbital side effects. How long do these usually last before the dog gets used to the medication? I'm hoping that these are not signs that something else is wrong, though I am aware of the possibilities.

[WhitneyMac]

We got the results for Sugar's blood work and Urinalysis yesterday. He said everything is normal and looks good. From the results she seems to be a perfectly healthy dog, except her creatnine level is just a tad bit above the high end of normal. I did not ask him about the blood pressure. I will have to check with him on that.

[tonyb286]

Hi. So far so good. At least your vet is starting to tie things down more and expanding the investigations. The extra blood work and urinalysis will be interesting, so do let me know what they say. I think there is room for cautious optimism. Just one question ... did they do a blood pressure check while you were there?

Tony

[WhitneyMac]

I really liked this vet! Not just because he gave me what seems to be, for now good news, but because he spent an hour talking with me and giving me hope and options for where we could go from here. I was also 30 minutes late due to being up all night with Sugar and he didn't have a "put out" attitude about it.

He started off saying he was reading through Sugar's medical history and saw that we had a concern with her flea/tick medication and didn't think that was an issue. UNTIL, he saw the ingredients on the packaging and now thinks that it is definitely possible that that could have been the cause for seizures since permethrin is one of the main ingredients.

Secondly, he said that he did not believe we were dealing with kidney failure. He said that there maybe some other issues that could be causing stress on the kidneys, but that she does not seem to have "failure."

Due to her hair loss and discoloring of skin he did a thyroid test. He also did another blood panel and a urinalysis. Hopefully we will get those results back today.

With all of the above in mind, he thinks we have some room to play with the seizure medication. We have decided to wean her off the Phenobarbital for now. We  started yesterday with just giving her half a pill 1 time in the morning (previously it was 1/2 2 times a day) and I am happy to say we had our first full night of sleep since we started the medication. She went to bed around 11pm with no help and woke up about 8am. Hopefully this will be a pattern! He also gave us diazepam to calm her when need be or if she does have a seizure. Obviously, I am holding off on this to see if she will return to her calm nature on her own without the pheno.

The only negative out of the situation was that he thought she may have a thyroid issue and that she maybe even older than we thought. He watched her behavior (pacing with no real destination) and mentioned that we might have a "geriatric" dog on our hands, but I am ok with that as long as she is comfortable.

For now, it is a waiting game and we are praying the seizures do not return without the Phenobarbital. He said he is confident however, that if they do return we can get her back under control.

[tonyb286]

Hi. My opinion, for what it's worth, is that this is kidney disease. Probably stage 3. If protein leakage is confirmed, then that's another confirmation. It would also be prudent to get your dog's blood pressure checked (more on that in my article, link given previously). The point is, at this stage, there are lots of things you can do to help prolong life and improve quality of life, but getting a confirmed diagnosis and starting the diet plan and maintaining blood pressure control are crucial.

The seizures are another matter ... it could be this was an acute episode, and a consequence of the flea and tick medication. The problem for your vet now is to find out whether it was acute (and therefore is now not a problem) or whether it is an epileptic type seizure that will get progressively worse without treatment.

Let me know what your new vet advises.

Tony

[WhitneyMac]

Sugars BUN level upon her first visit (12/28) was 43 and creatine level was 2.1

As of 3/20 her BUN is 23 and creatine is 2.4.

I asked for the recent panel they did, but this is the last one they sent me.

At this point, we have taken her off flea and tick medication completely. I do live in an apartment complex with a lot of dogs and have noticed fleas on her after walking her, but I have narrowed down where they are coming from and keep her from those areas. I truly feel the medicine had SOMETHING to do with her seizures. Albeit, we have only had her for 8 months and I know seizures can come without warning, I just find it odd they came on both times about 2 weeks after the application of the medicine and the reviews.

I know it can be tricky. I have made an appointment with another vet for Saturday, I am sure I already mentioned that. We were taking her to Banfield, who has been great with our other dog, but with a special needs dog I feel she needs a low volume vet that can spend time with her.

As far as hearing and sight, I am glad you brought that up. That is something else I plan to address with the new vet. I do believe her sight is normal, but the hearing is an issue. Before Sugar was on the medicine, when she was sleeping we would have to walk up to her and call her name several times before she heard us. We call her name and there is no response. If there is a loud noise in the room she looks to the total opposite direction to see where it is coming from. Not trying to dismiss any options, but again, this had been the case the whole time.

Thanks for talking through this with me and you have brought up several good points to bring to the vets attention.  I also plan on reading our articles to further educate myself on these conditions.

[tonyb286]

Hi again Well, there's a lot there to try and answer ... but I'll do my best.

It is quite wrong for the vet to say you can't tell what stage the kidney failure is at until stage 3 and beyond ... the first blood test (prior to managing the kidney failure diagnosis) is the one to look at, as it is the base result. The levels you need to diagnose the stage is BUN, creatinine and phosphorus. If you have that initial test result, let me know the levels.

The vet is right that virtually all medicines are difficult with kidney failure, because all medicines cause by-product toxins, which further stresses the limited functioning kidneys. Of course, this doesn't mean all medicines should be avoided ... but certainly those that are not crucial to your dog's well-being and good health.

Yes, avoid all flea and tick treatments, unless the risk of your dog catching fleas or ticks are high. FirstSheild is not a treatment that I am very familiar with, though I suspect it falls into the same category as many others that are chemical-pesticide based. You might want to have a read of a piece I did on this subject. You can find it here:

http://www.infobarrel.com/The_Dangers_of_Flea_and_Tick_Treatments_for_Dogs

In fact, both flea and tick treatments - and kidney failure - can cause seizures. Also, the question over the kidney disease is a fair one, because many vets misdiagnose and then treat something that may not be a problem anymore. I would strongly advise your vet undertakes a urinalysis, looking particularly for protein leakage. If there are proteins in the urine, then kidney disease is confirmed. The following article looks at the correct way to diagnose kidney failure - along with various other pieces of information you will probably find useful. That article can be found here:

http://www.infobarrel.com/My_10-Point_Plan_for_Dogs_with_Kidney_Failure

Taking your dog off phenobarbital is a risk, but maybe one worth trying. Dogs can have very serious allergic reactions and acute problems from some flea and tick treatments, and seizures are not uncommon. Taking her off the phenobarbital will test the theory that this was an acute reaction (very possible, considering the other allergic symptoms you have described). There is of course a great danger that the seizures will return, so talk to your vet about this before considering it. Also, don't just stop the drug suddenly, as it needs to be phased out slowly.

The barking remains a puzzle. I am still of the opinion this must be related to anxiety and petit-mal seizures, but it's very hard to be sure without seeing the behaviour first hand. I certainly don't believe it is "down to age", which is a strange comment from a vet. Did the vet check things like hearing and sight? Sometimes, older dogs that are starting to lose some hearing and/or sight, do get afraid or confused and bark as a consequence.

Okay. That's enough from me ... keep me informed.

Tony