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Discussion Starter #41
Yes, we agree that the dosage seems high but was only following dr and mfg orders. I don't believe its the result of the pheno because he has been on it for about a month now. This is the first day this is happening. I do have a call in to the neurologist and am waiting for her call although that could be hours. I don't feel its worth a trip to the e vet ......yet.
 

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This is really difficult, I have been their many times where my older Golden has been showing symptoms and I could not get a good answer on what was going on. I think as many have recommended, if your vet is not welling or able to help you figure out what is going on, then seek someone else. Doesn't necessarily mean your vet is bad, he/she just can't or won't help you in this situation at this time!

If they think you are dealing with a cancer, which they may be able to feel a tumor and/or see the shadow of a tumor on an x-ray, the only way they can diagnose a cancer is to do a biopsy. This procedure coupled with the time it takes to determine the type of cancer is hard to wait on. If they do not suspect cancer, then additional tests will have to be done. I always want a blood work-up and x-rays, these tests are not cost prohibitive and sometimes give good clues as to what you are dealing with.

I had three Goldens at the beginning of this year. We lost our Maddie, girl in January to cancer she was 14. Then in October, we lost our Spirit boy to cancer he was 13. In both cases we decided not to put either of them though surgery due to their ages and severity of symtoms. Both vets told us they might get another 3-4 months best case, but would have pain from surgery and then as the disease spreads, they would again be in pain. At this advanced age this was a high risk consideration.

Both of these dogs went down very quickly, from when we first noticed them getting lethargic, then having trouble walking and going outside. Then within a day or two they stopped eating, and then would not take water. Both times when they stopped taking water and had trouble walking, I took them to our vet where we determined it was time to put them down. Both times it tore my heart out, but these fine creatures, these loving companions, had given us their all, and they did not deserve to suffer. I knew when it was time. So will you when and if it comes...be brave and follow your heart.

I wish you good luck and hope that this turns out to be something your pup can recover from, giving you both more precious time. But if not, be brave and do what is right for your special Golden!
 

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Studies looking at the effects and possible drug interactions of CBD are very new so there's not much to go on yet. It does look like there's a possibility that CBD may potentiate Phenobarbital to some degree (though so far it doesn't look like a lot) but if there's any liver dysfunction going on that affect could be compounded significantly and could result in increased lethargy and lack of appetite. I know you mentioned blood work being done and everything looked ok so hopefully his liver is functioning normally.. but he's also 12. And in geriatric human medicine the mantra is "start low and go slow" when starting new drugs.

I wouldn't give the CBD again until he's eating normally and then (if I continued it at all) I would lower the dose by at least half to see if he tolerated a reintroduction. For humans, there's only one anti-epileptic CBD medication on the market and it's not a stand alone therapy - it's an add-on therapy that hopefully will improve the effectiveness of the main AED (anti-epileptic drug - in this case Phenobarbital). I wouldn't be worried about lowering the dose or discontinuing the CBD even before I had the prescriber's input.

To me, Phenobarbital seems a bit heavy handed for focal seizures but apparently it's the standard drug of choice in veterinary neurology because it's been used for a long time so it's the best known and understood - which is really important - the problem is that seizure meds are like anti-depressants, what works for one person (and presumably dog) doesn't work for another. It's trial and error until you find the right one.

I'd ask the neurologist if he/she would consider a newer anti-convulsant like Levetiracetam instead of the Phenobarbital and CBD. Sometimes Levetiracetam and Phenobarbital are prescribed together but it does not sound like that would be warranted in this situation (his seizures are not severe enough) and the combination would probably cause more ataxia than necessary.

Putting the meds aside, the previous comments about the seizures most likely being caused by an underlying condition are unfortunately probably right. Has he had x-rays? That would be a more affordable option than an MRI and could be done by your regular vet which would be cheaper than a specialist.
 

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Discussion Starter #44
Neurologist called. She thinks between the pheno and the cbd dosage, he was too sedated to eat. She wants us to lower the dosage to 10 drops tonight. Honestly, I don't think I will be giving him any unless he starts eating. He has started taking some food and treats. We put the pheno in his food also and because he didn't show any interest in eating anything at all, he didn't get any of his meds today. I have noticed that his "seizures" are increasing. Maybe that is telling us something. Perhaps the pheno is not controlling it to the point we want, but maybe its doing something?

All bloodwork did come back good, so we know that his organs are functioning properly. As far as doing any other tests we don't want to put him through anything more than we have to. If it is cancer, knowing won't do us any good because we won't put him through surgery or chemo. We along with the doctors are just trying to make his quality of life the best it can be. We know what our hard decisions will be looking forward. However, for now, we are not giving up on finding some relief for him. One thing I do know is that this is all being done for him....not us. As heartbreaking as the future may be, I won't let him go through any more than he can handle. Praying for some answers.
 

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Discussion Starter #45
quote "I'd ask the neurologist if he/she would consider a newer anti-convulsant like Levetiracetam instead of the Phenobarbital and CBD. Sometimes Levetiracetam and Phenobarbital are prescribed together but it does not sound like that would be warranted in this situation (his seizures are not severe enough) and the combination would probably cause more ataxia than necessary."



I will be asking about this, thank you.
 

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Perhaps the pheno is not controlling it to the point we want, but maybe its doing something?
Yes, the Phenobarbital is very likely lessening the frequency and/or severity of seizures. The lethargy and ataxia may lessen over time as his body gets use to it but I don't know about the barking (hyperexcitability) which is also a side effect of Phenobarbital.

If the Phenobarbital is reasonably controlling his seizures and the side effects are not affecting his quality of life too dramatically, then keep him on it and reintroduce the CBD once he's eating again and he's not too sedated - low dose though (like 5 drops for 5 days, see how he does, then try upping it to 10 drops for 5 days, see how he does, etc). You may be able to find a sweet spot where the CBD dosage is helping control the seizures a bit better than the Phenobarbital was able to alone, and who knows, it may even counteract the hyperexcitability too.

If it seems like the Phenobarbital isn't improving his quality of life enough or the side effects are too much, try talking to the vet about Levetiracetam. He won't be able to take the usual dose if his kidney function is poor since Levetiracetam is excreted through the kidneys. But your vet will be able to see his lab results and adjust the dose accordingly. Good luck and I really hope you're able to find something that keeps him comfortable!
 

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QUOTE=sopranosgal;7775696]As far as doing any other tests we don't want to put him through anything more than we have to. If it is cancer, knowing won't do us any good because we won't put him through surgery or chemo. We along with the doctors are just trying to make his quality of life the best it can be. We know what our hard decisions will be looking forward. However, for now, we are not giving up on finding some relief for him. One thing I do know is that this is all being done for him....not us. As heartbreaking as the future may be, I won't let him go through any more than he can handle. Praying for some answers.[/QUOTE]
I am sorry you and your boy are going through this. Many, many of us have walked this path with our senior dogs. It sounds like your thoughts are well focused on his best interests. Stay strong, pursue answers, and make his days as happy as you can for as long as you can. That's all they ask.
 
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Discussion Starter #48
He ate his dinner! No cbd in it. So I'm hoping that he either was too sedated as the doctor said or he didn't like the smell and taste. I will start it back up slowly as long as he keeps eating for a day or two.
 

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Discussion Starter #49
This will be one of my last posts. We had to rush Jake to the hospital last night. Suddenly his breathing was not right and he wasn't able to move. He had fluid (blood) around his heart. They drained it but anticipate it happening again. The cancer word keeps popping up and we are assuming that is what is causing it. His bloodwork is much worse than it was 3 weeks ago. A lot is going on with him and his prognosis is very poor. No matter what we do for him, he has very little time left. Jake is very very sick and we are hoping to get him home today. I would like his last days to be here rather than in the hospital. He loves being home. Thank you all for you help. I pray for all of you and your pups.
 

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I am so very sorry.
 

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This will be one of my last posts. We had to rush Jake to the hospital last night. Suddenly his breathing was not right and he wasn't able to move. He had fluid (blood) around his heart. They drained it but anticipate it happening again. The cancer word keeps popping up and we are assuming that is what is causing it. His bloodwork is much worse than it was 3 weeks ago. A lot is going on with him and his prognosis is very poor. No matter what we do for him, he has very little time left. Jake is very very sick and we are hoping to get him home today. I would like his last days to be here rather than in the hospital. He loves being home. Thank you all for you help. I pray for all of you and your pups.
Oh, I'm so sorry. I was hoping it might be something that progressed slower. I hope you find some peace in knowing that you're doing everything you can to make him as comfortable as possible.
 
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