It’s been a little while since my last blog post, and there’s so much I could catch you up on. But today, I want to talk about one of the biggest changes in Forrest’s epilepsy journey: adding potassium bromide to his medication regimen.
Forrest started potassium bromide in March, making it his third anti-seizure medication alongside phenobarbital and Keppra.
Adding another medication wasn’t a decision I took lightly. In fact, I’ve always hoped to avoid adding more medications whenever possible. My main priority has never been to eliminate every seizure at any cost. It’s to find the best possible balance between seizure control and Forrest’s quality of life.
And that’s exactly what his neurologist and I have been working toward.
Why We Added a Third Medication
Despite being on high doses of phenobarbital and Keppra, Forrest was still having seizures. On top of that, his high dose of phenobarbital was taking a toll on his liver.
We needed to find a way to reduce his phenobarbital without sacrificing the seizure control it was providing.
That’s where potassium bromide came in.
Unlike phenobarbital, potassium bromide isn’t metabolized by the liver. Adding it gave us another way to help manage his seizures while allowing us to gradually lower his phenobarbital dose.
Since March, we’ve been able to reduce his phenobarbital from 120 mg twice daily to 97.5 mg twice daily.
That’s an 18.75% reduction in his daily phenobarbital dose!
His liver numbers have improved, which has been such a relief. Although some of his liver enzymes remain elevated, his current testing no longer indicates the true liver disease we were previously concerned about. Phenobarbital itself can cause elevated liver enzymes, even without actual liver damage.
We are still monitoring everything carefully, of course.
His phenobarbital is now at the lowest dose we can safely maintain without risking his blood level falling below the therapeutic range, so we’re holding steady there for now.
And this is why I can’t stress enough how important regular blood monitoring is for dogs taking phenobarbital and potassium bromide. Those blood panels help us understand not only how their bodies are handling the medications, but also whether the medication levels are where they need to be.
The Other Side of Seizure Control
While potassium bromide has helped us lower his phenobarbital, managing three anti-seizure medications comes with its own challenges.
Forrest has been dealing with quite a bit of restlessness, especially when we’re apart.
And if you follow us on Facebook, you know we’re hardly ever apart! I’m a homebody, and I was long before Forrest developed epilepsy. I genuinely enjoy being home with him.
But when I’m working, even though I’m just in the other room, he can become very restless.
He’s also experiencing some hind-leg weakness and instability, which can occur with anti-seizure medications. With three medications on board, two of them at relatively high doses, we’re trying to find a way to ease some of those effects without compromising his seizure control.
A few days ago, we started gradually reducing his Keppra dose under his neurologist’s guidance.
I’m hopeful this will help him feel a little more comfortable and steady on his feet.
It’s going to take time, though. We have to make adjustments slowly and carefully, watching for any changes or breakthrough seizures along the way.
There are no quick fixes when you’re trying to balance multiple medications, and I don’t want to rush something that could undo the progress we’ve made.
Learning What Seizure Control Really Means
One of the hardest things I’ve had to accept about epilepsy is that, for dogs like Forrest, a certain amount of seizure activity may be part of our lives.
Of course, I would love nothing more than for him to never have another seizure.
But epilepsy doesn’t come with a one-size-fits-all treatment plan.
Some dogs do incredibly well on one medication. Some may only have a seizure once a year. For others, including many Australian Shepherds and dogs with difficult-to-control epilepsy, finding that level of control can be much more challenging.
Anti-seizure medications are meant to help control seizures. They aren’t a cure for epilepsy.
And sometimes, the amount of medication it would take to try to eliminate every seizure could come at too great a cost to a dog’s quality of life.
That’s something I think about constantly.
Forrest has recently been making it longer between seizures, with a few stretches reaching 40 days. Every one of those stretches has been such a blessing.
And between seizures?
He’s still my Forrest.
He’s full of life, energy, personality, and all the silly little things that make him Little Dude.
He still wants to play, splash in the water, enjoy his treats, and be right by my side.
I hate that he has seizures. But I also don’t want the treatment for those seizures to take away the dog he is between them.
That’s the balance we’re working so hard to find.
What’s Next?
Forrest has another round of bloodwork coming up in about a week.
Along with monitoring his medication levels and liver values, I’m especially interested in seeing how his triglycerides are doing.
His anti-seizure medications have contributed to elevated blood lipids, so we recently transitioned him off Purina NeuroCare and onto a low-fat kibble.
I’m hoping we’ll see some improvement there, too.
Between the diet change, the phenobarbital reduction, and now the gradual Keppra adjustment, we’ve made quite a few changes over the past several months.
We’ll continue to take things one step at a time, working closely with his neurologist and making adjustments based on how Forrest is doing.
Learning to Breathe Again
I wish I could tell you the seizures get easier to watch.
For me, they haven’t.
I’ve gotten used to sleeping with one eye open, waking up throughout the night to check on him, and always being aware of where he is and how he’s acting.
He’s my heartbeat outside my chest.
And while living with a dog who has epilepsy certainly isn’t for the faint of heart, I do want anyone who’s just beginning this journey to know that things can get better.
You learn. You adjust. You find routines that work for you and your dog.
And eventually, you start to breathe again.
I still worry. I still have hard days. But I also have so many wonderful days with Forrest, and I’m learning not to let the fear of the next seizure steal those moments from us.
He is so much more than his epilepsy.
And as long as he’s enjoying his life, I’m going to keep doing everything I can to help him live it to the fullest.
I’d love to hear from you.
If you have a dog with epilepsy, have you been through similar medication changes? Has your dog experienced restlessness, weakness, or other side effects while taking multiple anti-seizure medications?
Please feel free to share your story in the comments. I know how much it can help to hear from other people who understand what this journey is like.
And if you’d like to follow Forrest’s journey more closely, we’d love for you to connect with us on his Facebook page, Forrest aka Little Dude, where I regularly share updates about his epilepsy, his progress, and all the wonderful moments in between.
From our lavender world of grace, we’re holding onto hope walking by faith. 💜
