RMGDRI Special Needs Foster
Diego is the last Puppy from our Destination Litter remaining in rescue. He suffers from epilepsy and requires a number of daily medications and a very strict day-to-day routine to manage this condition. We are working to get his medications just right to prevent the seizures, but it will be an ongoing process until he reaches maturity.
Please Sponsor Diego
12/5/2019 – Overall, everything is going well. He’s got quite the regimen of pills but we’ll manage.
My German Shepherd Chief accepted him almost immediately, offering him his best toys and even started to wrestle. My Great Dane Ruewina was initially excited to meet him, but is more in shock at his size and is having trouble accepting his immaturity. This is the first ever Great Dane she has met. We’re taking things slow, giving everyone time to adjust at their own pace.
The similarities between Rue & Diego are crazy! The kids were having trouble distinguishing between the two of them. Thank goodness, they’re boy and girl.
He did have a seizure today that started at 11:58 am and lasted about 70 seconds. I picked up on the Aural phase (changes in his behavior before the seizure) and had enough time to shut my dogs in a room without them even noticing and clear the area in time before the seizure started.
Seizure was typical – anal glands were expressed, he did dribble urine – it wasn’t an entire bladder, but enough that the dog bed will be washed. After he had ~2 mins of ‘comatose’-like rest before he popped up and walked around like a drunken sailor. He’s currently resting on his bed.
12/7/2019 – Diego did end up having another seizure later in the evening about 9 pm. Lasted about 75 seconds, lots of froth, bladder leakage, etc. Setting that aside, yesterday was a great day and today has been just as great. I think today we can officially say that we have perfected his potty schedule and have had no accidents in the house at all so far. I took him over to the veterinary office to get weighed and he’s 99.8 lbs He soaked up the love from the technicians working at the time and it seems they look forward to seeing him later in the month.
A few things about Diego that I think are important: he’s a chair thief!! And once he’s asleep, there’s no moving him; his zoomies are intense – I described him earlier as a bucking bronco. He can be so calm and mellow and instantly become a bull in a china shop. If there wasn’t a wall behind my couch, I’m sure he would have flipped it by now.
12/10/2019 – He is 4.5 days without any seizures. Woot! Woot!
Today, I used up what was left of Diego’s food (that was sent with him) for breakfast. And the Chewy shipment is not here yet. I ended up feeding him my German Shepherd’s food which is Canidae Platinum, same protein as his previous food, but lower calorie. He had the Canidae for lunch and dinner today and ate it without issue. I do believe it is more filling for him because he ate all 3 cups at noon for lunch but only ate 1.5 cups for dinner and I had to force feed his pills. Next bowel movement will indicate how well his GI-tract handles the sudden change. I will let you know when that happens. . .
Anyways, tomorrow is his appointment. He will have a weight check and hopefully blood drawn. Dr. S encourages us to continue sending it to Auburn University. She said that’s the best place, plus they have a Neurology pathologist on board to help with dosing.
He received an enormous amount of attention from people at my sister’s office. I’m not sure of everything this office does but I know it assists families with communicating with the schools when it comes to students and needing extra services. They were more than excited to meet Diego and learn about his special needs. 😊
12/12/2019 – I’m sad to say the seizure-free count restarts today. He went 5 full days with no seizures and yesterday we had a minor hiccup when we started the day and that seriously screwed up his whole day. ( ☹ ) . He had a seizure at 6 am that lasted about ~70 seconds (dribbled urine) and another at 12:15 that last ~70 seconds (anal glands were expressed). Both seizures were typical and happened right before I could feed him his meals & meds.
He had an appointment last night where he met Dr. H. Setting aside Diego’s neurological condition. He is a healthy growing puppy. Dr. H (& the other staff members) were happy to meet him and Diego enjoyed the attention he received. He was one of the last appointments of the day and the weather turned white out/blizzard, so he had the place to himself for the most part. He weighed 98.2 lbs. So he lost a little more than a pound since I took him in this last Saturday. I’ll continue to monitor his weight like a hawk but Diego & Rue have been playing a lot together and we also need to consider that he has been eating a low calorie food for the last day and a half. I checked on the tracking for the Chewy shipment and it says it’s out for delivery today.
I have a lot of information that I’d like to bring to everyone’s attention, so bear with me because this could become a rather lengthy email. I’m going to list out Dex’s monthly expenses below:
- I estimate that Dex will go through ~ 84 lbs of dog food per month. If kept on his current food, that’ll cost ~$236.25 per month. If I can successfully transition him to a different food, still high quality but lower cost, I might be able to reduce the food cost to ~$136.50 per month.
- Medications – KBr 1250 mg BID – ~$85.00 per month, Levitiracetam XR 1500 mg BID – ~$145.80 per month, Zonisamide 325 mn BID – ~$37.80 for 100 mg & $9.00 for 25 mg, Tylan #0 capsule BID – $54 for 100 grams ( + capsule cost) –Total – ~331.60 per month
- Dr. S was running blood titers on Diego monthly, sometimes twice a month. It’s necessary to make sure that these medications stay within therapeutic range or else Diego has seizures. In order to continue running the same blood work and maintain Diego’s meds appropriately that’ll cost ~$755.25 per month for at least the next 6 months or until he stops growing and his med levels remain consistent.
- Dex is already neutered and given that he remains consistently healthy and no emergencies occur basic veterinary care (exam, vaccinations, HWT, fecal) I’d estimate to fall within $300-500 per year or $25 – $42 per month
As you can see, Dex’s monthly expenses listed up above to this point will come to ~$1365.10 per month or $16,381.20 per year!! And this does not include Neurology Specialist expenses which would be necessary in order to continue working locally with Dr. H. Given Dex’s care so far, Dr. H is totally on board with making adjustments to Diego’s care, whether it be blood work, meds, etc. under the direction of a Veterinary Neurologist.
An MRI with the nearby Veterinary University would cost ~$2800. As with any diagnostic, the MRI could show something or show nothing at all, but no matter the results, the information would be invaluable. In other words, an MRI could show a brain tumor or lesion or fluid on the brain and then we know that while anti-convulsant medication is reducing the amount of seizures, the meds won’t prevent Diego’s condition from getting worse. Or an MRI could come back clean and we could continue to work with a neurologist and see Diego through the growth period and hope that we get to a point where his med dosages remain consistent.
12/13/2019 – Yesterday, Diego was still experiencing some residual soft stool from the sudden change of food. And did have an accident in the house. In the process of cleaning up this mess, I found an almost perfect pill of Levetiracetam (Generic form of Keppra). I spoke to Dr. S about it and she said she had only ever found one pill like that. I brushed it off as a fluke until his next bowel movement which contained one and a half pills. And his poop this morning contained all 3. ***Could THIS be why he’s continuing to have seizures AND why this medication is never within therapeutic range?***
I immediately told Dr. S that I’m continuing to find his meds undigested in his bowel movements and I suggested that we adjust to the standard form of Levetiracetam instead of the extended release. She agreed. I will be using a bottle of Levetiracetam that Dr. S sent that is non-extended release until I can speak with Dr. H about refilling it at a local human pharmacy.
12/15/2019 – We’re into day 4 on no seizures. I’d like to think he’s transitioned well to the regular form of Levetiracetam but only blood titers will tell us. Those can’t be taken until 5 days after a med adjustment. We will continue to work with Dr. S & Dr. H on getting blood work completed.
12/23/2019 – He is 103.8 lbs. He had a last minute exam over the weekend in order to refill his Potassium Bromide medication. He goes through a lot of pills…..😳 As long as my math is correct, he should be good for a few weeks. Also, I started mixing his food. He’s had three meals so far and his stool has been unchanged. Keep thinking good thoughts. 👍🏼
12/25/2019 – Seizure-free count restarts now. He had a 14 day 9 hour stretch with no seizures.
We just got back from holiday festivities – Diego came with us. After unloading from the car, he became spooked. I tried to hug on him and talk him through but he went right into a seizure in the driveway. Lasted about 70 seconds, typical; anal glands were expressed; lots of froth.
12/27/2019 – Diego had another seizure this morning at 5:15 am. The seizure that occurred this morning happened in his sleep and I haven’t been able to pick up on a trigger yet.
The seizure itself lasted ~90 secs. But after the seizure was over, I still think he may have still been seizure-ing internally for another 15 – 20 mins. His breathing became sporadic in waves and there was a couple times I had to double check and make sure he was still breathing. Seizure itself was typical. Once he recovered, I was able to walk him outside to potty and he still ate breakfast with pills at 5:45 – 6 am.
He is almost completely onto the new food now. There has been no change to his stool at all. I’ll give him at least another week to become more accustomed to this food before I start tapering back the tylan and replacing the tylan powder with a probiotic. Diego is no longer receiving the extended release tablets. He has been on the normal release pills for about two weeks now and I am not finding any more pills in his poop.
On another note, I’d like to get Diego set up with the neurologist. This is something that we don’t have to rush into. I have kept Dr. S up to date on everything and she has been keeping Dr. L up to date. We can continue to work through Dr. L in the meantime. If there’s a chance that I could schedule this within the next week, that would be super awesome! But if we have to wait, that’s ok too.
1-1-2020 – Diego had a seizure this afternoon at ~2:20 pm that happened outdoors and lasted about 90 seconds. Seizure was typical with froth and expressed anal glands. Diego recovered quickly and after brief play with Rue, both are knocked out on the couch.
His bloodwork needs to be retaken. I will continue to arrange this with Dr. H but also think that scheduling his care with the neurologist is needed at this point.
Diego had another seizure just now (6:00 pm) while I was preparing his dinner. Lasted about 85 secs; typical; lots of froth and anal glands were expressed. His recovery was quick and he immediately ate his dinner. I let Dr. S know about his seizures and she has increased his Zonisamide to 350 mg. If Diego has another seizure in 3 days, I’ve been instructed to increase the Zonisamide to 375 mg.
1-2-2020 – Diego had another seizure this morning at 5:45 am …. it lasted about 90 secs and he recovered quickly. He ate his breakfast without issue and took his pills. Overall, the seizures are typical. We’ve only ever had that one really bad seizure. Since being here he’s had a total of 6 seizures- 3 of which happening in the last three days.
I have scheduled him an appt with Dr. B, a neurologist at UVS. His appt is on Tuesday at 12:30.
1-8-2020 – Diego is 6 days seizure-free.
He had his neurology appointment yesterday and traveled like a champ! He did great while checking into his appointment and behaved like an absolute gentleman. He seemed a little terrified of a 5 lb. Yorkie that was extra curious of this super mellow giant towering over everything. He weighed in at 109.6 lbs! He’s a big boy!
A good portion of this consult was spent talking about Diego’s history and what has led us to this point. Based on the left forebrain localization, Dr. B is suspicious that Diego has cryptogenic epilepsy rather than idiopathic epilepsy. Cryptogenic meaning that his seizures are of unknown etiology and are not associated with previous central nervous system insult known to increase the risk of developing epilepsy. If Diego does have an idiopathic form of epilepsy it is likely a refractory form which is typical of juvenile onset. After discussing with Dr. B our options, together we came to the conclusion of starting Diego on Phenobarbital. Dr. B also encourages that we raise funds for a MRI.
The hope is, that if Dex can go seizure free for a certain period of time (Dr. Bishop didn’t specify how long) that we might be able to start weaning him off of Keppra and/or Zonisamide. As of today, Dex is 11 days without a seizure. 🙂
1-14-2020 – Diego is 12 days seizure-free. He’s been on Phenobarbital for 5 ½ days now and does experience immense amounts of ataxia. Ataxia is the impaired balance and coordination that can be expected when starting a medication like Phenobarbital. Both Phenobarbital and Potassium Bromide can cause ataxia and the combination of the two drugs can often cause increased ataxia – Diego is definitely experiencing the “increased ataxia”. Dr. B assures me that Diego will adjust to the addition of this medication within 7-10 days. 5 days down, only 5 more to go. . .
1-29-2020 – (Drum roll) Today marks day 27 of no-seizures…. Woot! Woot!! Still waiting on results from blood work completed last week. Lately, I’ve been working weaning off Tylan powder and replacing it with a probiotic. Everything was seemingly going great until yesterday. Yesterday would have marked the 6th day of no Tylan powder, but he also had projectile diarrhea. So he’s back on the Tylan powder twice a day. This morning’s poop was 80% better already. It may take awhile to wean him off the tylan powder completely. I’m confident that I can maintain him on one pill every other day for a while and move to one every two days and so forth.
In a nutshell, once we got past the 20 day mark, it was like a banshee got let out of a cage. He is a very active, persistently playful puppy. He’s starting to jump up on things: counter, table, dog gate, etc. He lacks the strength to hold himself up on such things, but just being able to do it is new for him. He still experiences a lack of coordination, balance, but it’s not as bad as it was.
I forgot to add that he likes bobbing for socks. We have a dedicated sock basket where everyone’s socks are collected before they’re matched. And this weirdo buries his entire face into the socks, comes up shaking with mouthful! 🤣
Given his history of foreign body removal. I have been on my kids about shedding their socks in an appropriate area and we now keep the sock basket behind a closed door.
1-31-2020 – Diego’s blood work is in! Both Phenobarbital and Potassium Bromide are within therapeutic range!! Next on the to-do list is a CBC and chemistry profile to make sure all of his organs are in check, given the amount of medications he’s on.
2-1-2020 – Today marks Day 29 no-seizures for this guy! So great!
I heard back from Dr. B on whether or not we can start tapering back some of the anticonvulsants he’s not interested in keeping in Diego’s arsenal. Unfortunately, Dr. B wants to keep all medications the same. He does not recommend tapering any medications at this time and typically won’t start those adjustments until he sees a 6-month seizure-free interval. That’s a really tall order . . . .
2-4-2020 – Updated cost list: **Everything is based on a 30-day month**
Phenobarbital – $31.59, KBr – $82.48, Keppra – $35.16, Zonisamide – (100 mg – $43.49, 50 mg – $4.50, 25 mg – $5.65), Neurotrophin – $28.80, Hemp Oil Complex – $80.30, Omego Bits – $8.65, Pre/probiotic – $4.55, Pill pockets – $31.92, Nutro Wholesome Chicken dog food – $86.56 (eats about 60 lbs of dog food per month), Blood work – $550.00, Basic vet care – $25-$42 — Total – $1018.65 ** this does not include tylan powder & capsules, and does not include specialty care costs.
2-13-2020 — Diego is now ~125 lbs. and 10 month old. The biggest challenge for Diego (& us) is maintaining all of his medications within therapeutic range while he’s growing like a weed!! Diego’s primary veterinarian, neurologist, & RMGDRI’s veterinary director work closely together to make sure this sweet fellow stays healthy and seizure-free.
Today marks Day-42 of no-seizures. Which is so exciting for this guy! That is the longest stretch of no-seizures that he has ever had! Diego has a very mellow demeanor but loves to play with ropes and is an absolute glutton for food. He enjoys roughhousing with his foster Dane sister Ruewina but can also be found catching a good nap with her too. He loves people of all sizes and if given the opportunity, he will sit in your lap fully expecting to be loved and scratched. How could you not?!
2-14-2020 – I’m sorry to report that Diego experienced a seizure at ~4:30 am this morning. It lasted ~35 secs and he bounced right up and was ready to go outdoors to potty. While it is sad that he experienced this minor setback, it did not last nearly as long as his other seizures, there was no froth, no anal gland expression, maintained bladder and bowel control. I’d like to think that these are all good things. I’ll be reaching out to Dr. B to let him know and will update everyone once I receive a response.
2-18-2020 Diego is 4 days seizure-free. He has this oddly placed …. swelling? I’m not really sure what to call it or even better how it got to where it’s located. He doesn’t seem to know that it’s even there. He lets me touch the area …. he’ll let you scratch his tookus all day. It’s almost like a knot that you would get if you bumped your head, only this is off the back right point of his pelvis. I’ll keep monitoring it, it’s just weird that it showed up and even weirder the location.
2-20-2020 Diego had bloodwork taken today to check organ function since adding Phenobarbital to his daily drug regimen. Fingers crossed everything looks good.
2-28-2020 Diego is 14 days seizure-free! And got the results from his bloodwork. Everything is looking good. There’s a few values that fell outside the average range but Dr. H. assures me that these values are normal for a young growing puppy!!
3-3-2020 Diego’s neurologist Dr. B. had a chance to review his most recent bloodwork and said, “I reviewed the CBC and chemistry profile sent over by VCA North country on 2/20/20. The CBC shows no evidence of bone marrow suppression. The chemistry profile shows a mild elevation in alkaline phosphatase (231) from phenobarbital and or zonisamide, but no evidence of liver insufficiency (albumin normal at 3.4). The elevated chloride is an artifact of potassium bromide therapy. Basically I do not see any significant internal organ damage from the anticonvulsants. As a reminder the goal should be to get Diego seizure free for 2 months or longer. Ideally I would like to see a patient seizure free for 6-12 months before reducing or eliminating any anticonvulsants. A recent study showed that patients who had good seizure control, where anticonvulsants were weaned and seizure recurred, had a significantly more difficult time recapturing seizures the second time. “
3-7-2020 Diego is 23 days seizure-free. I had an ah-hah moment today in the driveway while out walking Diego for a potty break and figured out how he obtained that swelling on his tookus. Diego is always leash-walked outdoors on a retractable leash. He’s not usually a leash puller but likes the ability to distance himself when he’s doing his business. Occasionally, he forgets or maybe misjudges how much distance he can have and walks to the end of the retractable leash. For most, this wouldn’t be an issue but for Diego, the sudden stop throws him off balance and he falls down landing on the hip where the grape-size swelling is located. He did this just now in the driveway and has acquired a minor scrape across the already swollen area. Now that I’m aware of this, I’m going to be more mindful and try to catch his attention or be there to catch him if he falls.
3-9-2020 Diego has started to lose the fur on the underside of his neck. I have a call out to Dr. B. to see if the amount or combination of medications could cause this.
3-10-2020 I heard back from Dr. B.’s office and he doesn’t believe the amount or combination of medications would cause Diego to suddenly lose his hair and suggested that I make an appointment with Dr. H. to look into this further. I’ve schedule Diego an appointment for 3/19/2020.
3-15-2020 Diego is 31 days seizure-free!! In addition to hairloss on the underside of his neck, he’s losing hair on the backside of his ears, the outer part of his tail, and if you catch the light just right you can see the hair thinning out along his back. I also made a comment to my husband that he’s looking awfully chunky lately. I’m going to do a bit of research to see if there’s a senior version of the food he’s eating. He eats ~7.5 cups of kibble per day split between 3 meals. This is a decent amount for him daily, I’m sure he’d eat alot more than that if I let him. And he still acts like he’s starving. Anyways, if I can find a senior version (meaning lower calorie) I’m going to try mixing a cup of this into his meals. That way he’s still recieving the same amount of food, just not as much calories.
3-19-2020 Diego is 35 days seizure-free!! Today he had his appointment with Dr. H. Dr. H. performed a skin scraping to make sure he didn’t have any parasites like mites and took bloodwork for a thyroid panel. Scin scraping was negative however, the thyroid panel came back on the very low end of normal which unusual for growing puppy. Dr. H. said one of two things could be happening: (1) Diego could have hypothyroidism and require the use of medication (eeeecckkkk!!! Another pill!!!!! ) or he could be experiencing something called Euthyroid Sick Syndrome which is when another condition or illness is causing his thyroid to dip lower than normal causing him to appear hypothyroid when he’s really not. I didn’t get a chance to talk to Dr. H. about the ESS – it was crazy at the vet office today. But in order to determine what is happening, a sample of Diego’s blood will be sent out testing for Free T4. I will let you know once I have those results.
Want to help Diego even further? Take a gander at his Amazon Wishlist: https://www.amazon.com/hz/wishlist/ls/12LICCN1V5E3P?ref_=wl_share Anything purchased from his wish list will ship directly to his foster home, just select Diego’s Amazon Wish list shipping address.