Sunday, September 4, 2011

Time to adjust his meds.

A few weeks ago, we had mentioned in a post that Rilley seemed to have begun experiencing focal and localized seizures.  There had been about three incidents that involved short episodes of staring into space and one instance of "chattering teeth" while fully conscious.  At the time Rilley was receiving his medication twice a day; a dosage that we began shortly after returning from Minnesota in late May.  These new episodes were always taking place at the same time of day...late afternoon...close to the time of his next pill.

Obviously, we needed to figure this out and perhaps adjust his medication.  We contacted both Dr. Ewing, Rilley's local veterinarian and Dr. Pluhar at the University of Minnesota for advice.  A working theory was that despite being on a slightly higher dose for his twice, versus three times a day dosage, the levels of medication in his system were getting too low at that time of day.

This seemed likely, but just to be sure we took things one step further...but then again, don't we always?

The James Archibald Small Animal Clinic at the University of Guelph
We sought out the neurologist who originally diagnosed Rilley with the brain tumour, Dr. Fiona James.  It turned out that since we last saw her, Dr. Fiona James had left the Mississauga Oakville Emergency Veterinary Hospital but Sara managed to track her down at Ontario Veterinary College, University of Guelph.  We contacted Dr. James and she was more than willing to see Rilley, so Dr. Ewing drew up the referral letter and sent along some of his recent files.  In turn we gathered up all of his MRIs and headed out to Guelph.  Fortunately, the university there is only a 40 minute drive for us.

One side note:  leading up to this appointment Sara had discovered a test that could tell us what the levels of Rilley's medication would be at different times of the day.  There's one caveat however...this test is only done by one facility...Auburn University in Auburn, Alabama.  Now, I know what you're thinking...

"They're not seriously going to drive to Alabama for a blood test on their dog, are they?", we're not.  Obviously we've gone great distances to help Rilley beat this cancer so I can see where that thought would come from.  However, this test can be done by drawing his blood samples here and then shipping them to Alabama.  Interestingly enough, we also found out that if the test were done by the University of Guelph, it would cost half as much as through a regular vet office...there must be some kind of inter-university discount.

This test was discussed during our visit with Dr. James, however it was determined that it would be unnecessary right now.  After going over Rilley's medication and symptoms, Dr. James agreed that it did seem likely that the levels of Keppra in his system could be decreasing to below therapeutic levels before his next dose.  So she suggested that we simply increase his mediation a bit more.  If his symptoms disappear, then we know that was the solution.  If not, we still have a bit more room to play in which we can increase the dose.

We must admit that it was disappointing to switch from the twice daily dosing to three times daily, however over the summer it wasn't too difficult to do the midday dose as someone was usually home.  On the odd day that no one would be home, one of our good neighbours would stop in to give it to him.  Unfortunately, the new school year is upon us, so now that it is becoming vitally important for Rilley to receive his medication more timely, we need to find a reliable method of giving him his 3pm dose.  Dr. James suggested using a timed autofeeder and mentioned two different types that are available.  The first being an enclosed feeding bowl that sits on the floor and pops open at the designated time.  Sounds good, however given the fact that Rilley has a history of breaking into food containers, not to mention the actual fridge, this may not be a realistic solution.  The other type is one that we can mount up high which would drop his medication, encased inside of a Greenies Pill Pocket, down into a bowl.  The problem lies in trying to find one, this type doesn't seem to be as popular...just our luck.

So this is were I leave this post, we are on the hunt for just this type of feeder.

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