February 11, 2019: Just Checking In
Beau has been on the Keppra for 10 days now, and he has not had a seizure since the one on January 28, which was the third of three that month. This means he is 13 days seizure-free, and I have to assume the Keppra is working. I’m very grateful for that!
There are some other little things that are not so reassuring: he saw his chiropractor this past weekend, and Dr. H found that while Beau’s head was not on crooked (the chiro’s favorite term for out-of-alignment conditions in the cervical vertebrae region), Beau’s head was giving off a lot of heat, which is not normal. I see clear discharge from his eyes, which is not normal for him; I have to clean crusts of ‘tears’ from under his eyes. And his snoring has become the sound of his breathing now, particularly after he’s had exercise — it sounds like his nasal passages are not clear. I don’t know what this means, but I know what it could indicate, and that makes me incredibly sad. Our dogs are too soon gone even with normal lifespans, and sometimes we are in such a period of ‘this is great, everything is harmonious and happy’ that we wish we could hit the ‘pause’ button on time. But time is inexorable, and I can only keep the wonderful experiences of Beau and the Boyz and Dee in my heart as they turn into memories, and diverge from reality. It sucks, but it’s better than nothing.
And for today, Beau is having a chicken wing for breakfast, and going to the nature preserve with us to explore the snowy woods.
February 4, 2019
As I noted in my last posting, I have a ‘seizure dog’ now. And his veterinarian is not sanguine about the outlook or the reason for those seizures: it’s very likely that Beau has cancer, somewhere in the brain.
In other words: there’s maybe a 15% chance that the seizures (three in 16 days) were caused by late-onset idiopathic epilepsy. The much greater chance, weighing in at 85%, is a brain tumor. You can’t like those odds!
How can we find out for sure? Well, for an expenditure of somewhere around $6,000, Beau could have a neuro consult and a complete neuro workup, including an MRI. The MRI would show us, pretty conclusively, any tumors in or on Beau’s brain. It might even show enough to allow the neuro staff to identify the type of neoplasm, and if we knew the location and type of tumor, the likely behavior and progression of it could be predicted. But I have a lot of gaps in my store of knowledge, and I’m going to live with this one. Six thousand dollars can buy a lot of quality-of-life things, like dog training classes, and vet visits, and really good treats, and tanks of gas for the car to take us to the nature preserve, and the Ag HS fields, and a whole bunch of other things that Beau loves and enjoys. He would not enjoy an MRI. So, no.
The less scientific way to find out, of course, is to wait and see. Beau started on Keppra (levetiracetam) to prevent seizures, and it will work until it doesn’t work. In other words, at some point the cancer will become too powerful to be reined in by meds. If that happens, Beau will have seizures even while on the anti-seizure med. We can increase the dose of Keppra then, and hope it prevents seizures for a while longer; the nice thing about Keppra, as opposed to phenobarbital or potassium bromide, is that it’s possible to give really high doses, because the drug doesn’t appear to affect the liver or liver enzymes. It has to be given more frequently than other meds, and Beau started at 250 mg every 8 hours. The frequency of dosing is due to the fact that levetiracetam breaks down rapidly in the body, with an elimination half-life between four and six hours. Beau doesn’t even need his blood levels monitored. All in all, it’s a terrific alternative to potassium bromide and phenobarb. One vet told me it’s the go-to drug for seizure control now.
What Beau’s seizures are not: they are not caused by liver disease, kidney disease, or a thyroid disorder. Those things can cause seizures in dogs, but a seizure is never the only sign of kidney disease, etc. Always, other symptoms accompany the seizures, and the malfunction of the organ can generally be seen in bloodwork. Beau’s CBC/chem panel contained no anomalies. His SDMA test, which is an early detector of kidney disease, was one point higher than the same test done two years ago. Beau, a Sheltie of very poor breeding, probably has kidney disease in his future – or if he doesn’t, that’s only because his future won’t be long enough to allow renal failure to develop. Goody goody gumtrees for that, eh?
No, all the indications are that cancer has developed in Beau’s brain. I would like that not to be the case, and if he has managed to be in the small percentage of dogs who develop idiopathic epilepsy at age 11, I will be thrilled. Well, okay, less than thrilled, but happier than the cancer option makes me. But eighteen dogs have found their way to me in the past 30+ years, many of them seniors, and all but the five now living here have passed away while in my care. I certainly know what death looks like, and more importantly, I know what a good life looks like, for my dogs. Even in managing to defy some daunting odds with Sander (who lived with a malignant oral tumor for more than seven years) and Heikki/Mike (who lived with ehrlichiosis for more than four years), I never kept a dog alive when they had lost the things they loved in life. A life with no joy is no life. So when the veterinarian told me that one of the signs of advancing brain cancer is inappetence, I knew with certainty that when Beau doesn’t want to eat, it will be time to make the decision about quality of life and time remaining.
But that’s not today. Today he seems unchanged; today he goes for walks and car rides and tucks into his meals with great enthusiasm. Today he gets his three daily doses of Keppra in sugar-free Jello pudding. Today, Beau is happy and life is good. Dogs have got this mindfulness thing down pat, don’t they.