Is it the Drugs?

Today Max had an acupuncture appointment.  We've had him on 10mg of prednisone 3x / week - essentially every other day, as well as his normal dose of Keppra (125mg 2x day). It's been a few weeks but Max is still seeming foggy when he's on those doses.  The plan is to keep him on the prednisone at the 3x / week for the next week (2 additional weeks total) to see how he does and then reduce him back down to a low dose..

On his prednisone days he gets his prednisone between 8-9am at breakfast... around 2pm he starts drinking water and then the water works start and we have a good solid 4 hours of peeing every 1/2 hour or so... sometimes in the house, sometimes out... the door is open... Not so pleased with the indoor peeing.   His regular vet has suggested dropping him down to 5mg of prednisone every other day - we don't know if that will work - but since he was on such a low dose before it may keep him from having the issues with additional thirst and peeing... worth a try - we'll know what to look for if it's too low a dose.

Kids... this is what happens when you pass out on drugs

And when you wake up you have a funny face!

We're going to start giving Keppra with meals to see if that slows down the absorption as well. He's been getting it with snacks but maybe not enough food in his belly.

He's still active and walking  - pacing when he's on the meds.. walking when he's not. He can hear, comes when he's called, he's started to chase #2 when he runs by, he'll also follow him. Today he jumped up with the other dogs and got into the morning scrum and thought about wrestling with them.. Then thought twice about it.. (smart boy - he's still a little weak and sensitive. He fell in a ditch and off his ramp when he was loopy on the meds and his shoulders are stuff and his back legs... ) 

He has not had any medication yet today - he'll have Keppra in a little bit, but at his vet appt this morning he chased a tennis ball and tried to catch it in the air and then walked around with it for a while.. which was a great sign!  He also jumped up when the rest of the dogs started barking at the FedEx truck and ran with them to see what was going on.  I am now realizing that his foggyness is most likely more drug related than anything else.. It's amazing to me that the same dose isn't working the same way it was before and he's more sensitive to it... but maybe you just have to monitor and adjust to the patient.  Body chemistry changes over time... I suppose another argument as to why all patients should be dealt with as individuals vs. all treated the same.. 

Max NOT on drugs at vet getting acupuncture and playing ball

Max and his ball

Max's Neuro Check up and anti-Seizure meds

Last week Max went in for his neurology check up, the first since his Cyber Knife.  He's been doing well.  We talked about how his hearing seemed to disappear when we lowered his prednisone dose to 10mg every other day so we decided to keep him on 10mg every day for now.  We're also working on weaning him over to the natural hydrocortisone. We did another full week of 10mg of prednisone every day, then the following week 10mg or prednisone every other day and on the other days we did 20-30 mg of natural hydrocortisone (soy-based and less effects on the liver/kidneys).  Now we're up to 10mg of prednisone and 2 days of natural hydrocortisone, then 1 day of prednisone and 2 days of natural hydrocortisone.  I'm happy to say Max's hearing and vision are great and I don't see any issues this time!

Dr. Young checked Max's eye as well and said it looked like it was healing well.  He could see through the cloudy scar tissue in his eye. He's doing well with his eye drops and anti-biotic ointment. He goes back to the eye doctor for a re-check next week,

The other issue we talked about were Max's anti-seizure medications.  All of the neurologists who have taken care of Max have suggested he be on anti-seizure medication .. just in case.  Dr. Joseph said he has seen dogs who have never had seizures have really bad ones that seem to come out of nowhere, and it's better to be on a preventative.  My one concern is, Max is not doing very well with these anti-seizure meds. He's not himself, and they make him very drunk.  He was first prescribed zonisamide. Max weighs 48 lbs. He was prescribed 200mg 2x/day.  He was pretty much a mess on this. It does take a while for them to build up a tolerance to the medication, much like you build up a tolerance to drinking or any other drug. Max had a really rough time and didn't seem to be building up any tolerance.  He lost his appetite all together, would vomit and had really bad diarrhea, and was extremely wobbly, anxious and walked around like a drunk guy.  I seemed to be able to get him to be ok on 100mg 1 time a day - given at night.  Dr. Young wanted to try at least 100mg 2x/day, but it's hard for Max to function during the day and we felt like his quality of life just wasn't there. The hard part is- you want them to have a good quality of life.. We went through this to save him, not to have him live the rest of his life in a fog.  Max is the Alex P. Keaton of Dogs!  He's always had serious OCD... He likes everything in it's particular spot, can't stand it when a dog can't walk in a straight line and needs to go run over and smell something..

Dr. Young suggested switching Max over to Keppra. He was prescribed 500mg 3x day.  The problem with this dose was that we gave Max his dose at 6pm and he did not wake up until 3AM the next day. Not even for dinner, or breakfast or to go out!  I couldn't even get his 2nd and 3rd doses in.  The next day I tried 250mg at night and he went out again and woke up to eat breakfast and then went back to sleep and around 1pm got up - very groggy, went potty, ate something, took a short walk, then another 250mg and he was out again until the next morning..   At this time, I'm hoping that he builds up some sort of tolerance to Keppra.   The positives of the Keppra are that he is not nauseous, his poops are solid, he doesn't seem very agitated, especially if I can get him out for a good walk in the afternoon.  He will sleep through the night.

I don't like to be woken up by drunk dogs in the middle of the night!!!

We had one little instance last night though, he didn't get his walk and was getting his exercise by walking all around the house (which he's always done if he doesn't get to go for a walk - think of a dog who needs to go to the gym religiously every day.. that's always been Max - so this isn't too abnormal for him) Anyway - at midnight he was doing his laps, and was drunk from his medication and I suppose stumbled over the dog bed where our rottie mix was sleeping, and she's apparently had it with Drunk Max. She jumped up out of bed with her horrible growley voice and decided Max needed his nose pierced.. you know.. just in case he decided he needed to get a nose ring with all the drugs he's been taking.. then she figured she should also pierce his tongue while she was at it... just in case Max REALLY wanted to be a rebel.. (Again - this is the equivalent to Alex P. Keaton getting a tongue and nose ring..... Sober Max has severe OCD... Drunk Max.. not so much.)

So Ms. Buttercup spent the rest of the night locked in Tom's office. She has yet to apologize to Max.  Max seems to be fine today.  Normally Buttercup is a lovely girl... like the rest of us though, she doesn't like to be stepped on or have someone fall on her in the middle of the night while she's sleeping, regardless of whether they can see or hear and especially not if they are drunk!