Liver Enzymes

Goofiness after having a bath.

Well, this post will be about not so fun medical stuff, so feel free to skip it.  I got the results of Zephyr's blood work on Wednesday and unfortunately they showed that his liver enzymes have increased again.  About three weeks ago the Alkaline Phosphate had increased from 100 to 800, and now it's at 1,300.  The Dr. says this is probably from the phenobarbital.  Although all of the medicine he is taking, procarbazine and prednisone, can effect the liver.  I don't think 1,300 is really bad, but there seems to be continuous increase.  I just can't risk damaging his liver so, I am now transitioning him from phenobarbital to levetiracetam (Keppra).  Keppra doesn't harm the liver like phenobarbital.  This will be a slow transition over many weeks with decreases of 7.5 mg every four to seven days.  He is on his full dose of phenobarbital and full dose of Keppra until tomorrow morning when I'll make the first decrease.  He seems a little sedated from the addition of Keppra.  There is a chance that the Keppra won't control his seizures and they'll start again, which I'm very worried about.

I am a happy clean boy.

In fact we had an episode today.  Zephyr had his second dose of Keppra this morning, it's given every eight hours.  He was seeming pretty normal.  He and Astro played this morning and we took a short walk.  About 12:00 they were in the yard running and playing like normal.  They stopped and I called Zephyr up the stairs to go in.  As he came up he started holding his right front foot and walking funny.  I thought it was from pain, but realized it wasn't as he came in.  He was walking really different and it looked like that leg was contracting and kind of stiff and his head and neck was now tilted to one side and looked stiff.  I immediately thought it was a seizure but was confused because he's never had any like this, they have always been when he's sleeping and he loses consciousness.  When I saw the head tilt I of course also thought the encephalitis was back.  He laid down and I saw that his eyes were dilated too.  That always happens when he has a seizure.  I went to get the diazepam and he followed me.  I had him lay down and he started to get better so I didn't give the diazepam.  I think this happened in less than two minutes.  I sat with him a few more minutes and then had him get up.  He was still a little dazed and confused, but better.  I think he had what is called a simple partial(focal) seizure.  And, on the lengthy info page that came with the Keppra it says that changes in seizures can occur.  Online I found many things about people and dogs taking it that said they had partial seizures or more seizures from Keppra.  I do think the Keppra had something to do with this.  I also think that Zephyr is pretty sensitive to medications in general.  I always worry that rowdy play will cause a seizure, but he has played like that countless times and not had any problems. 

Enjoying some yummy fresh beef bones that I got at the Farmers Market last weekend.  Hopefully I'll get more tomorrow.

Zephyr was fine the rest of the day.  He did get pretty tired, and he seems sedated from the Keppra.  I had to leave twice for about 1 1/2 hours each time, which I hate.  Sara's mom said she always hated leaving her too.  I spent too much time today searching for info on partial seizures and Keppra.  If you all haven't noticed I'm a bit of a worrier.  Spending hours reading about and watching videos of seizures trying to figure out if that's what it was, how seizure meds. might not work, how they might work at first and then stop working, etc., etc, doesn't really help.  This is why I usually don't spend a lot of time reading the forums about encephalitis, epilepsy, chemotherapy, etc.  It just scrambles my mind.  Oh, and dreaming that Zephyr has liver failure, repeatedly, last night didn't help.   Welcome back stress.  Oh, that's right, you never really left did you. 

Cricket's Birthday Party

Happy Birthday Cricket!

A few weeks ago we were invited to Cricket's eighth birthday party.  Cricket is the Dachshund with her mom Kerry.  Cricket is recovering from a ruptured disc that happened suddenly.  She became paralyzed and Kerry had to rush her down to the Veterinary Neurological Center in Phoenix.  The same place Zephyr went to, but she had a different doctor.  If you look close you can see where her back was shaved.  So, this was an extra special birthday for Cricket and Kerry.  Charlie, the Papillon at Zephyr's foot, is also recovering from surgery on a back knee and doing great.

Cricket opens her presents.

Cricket had a great time.  She's allowed to walk now, but no crazy play.  Cricket is a very accomplished agility girl, so it's kind of hard to keep her down.

The boys play with their new friend Molly.

This was Zephyr's first time playing and running with other dogs since he got sick.  I was pretty nervous.  It was a warm day and I just didn't know how all the activity would effect him.  I still worry that something will trigger a seizure or the encephalitis.  I'm happy to say that he had a blast and there were no negative side effects.

Whip checks out the tall dogs.

Zephyr had a great time with all the dogs.  I think playing with dogs is his favorite thing next to coursing.  Zephyr did end up with a bit of a crush on Whip and had to be kept in line.  She's super cute, so I can certainly understand why.

"OMG!!!  I'm in Heaven!!"

Astro continues to perfect his methods for achieving the finest face covering.  I'd say he's come a long way since its first public debut.  Molly was doing a good job learning his technique.  Astro couldn't understand why all the humans shrieked and shooed him away when he came up to say hi.

"We are in a race!"

This was the longest that Zephyr had ran and played.  He stayed at the party for about 2 hours and I think almost half of that was spent playing.

Mouse wants some of the action too.

Mouse is the Dachshund that Astro had a great time running with early this summer.  She really wanted to play again, but it was hard with all the big dogs going crazy.  Astro and the lab (I'm blanking on her name :-( ) really hit it off.  They were wrestling until the end of the party.

Having the best time!

"Aaah, Don't get your cooties on me!"

Whip will gladly take that Ping Pong ball.

The humans played some Ping Pong and the dogs were very happy to help out.  I had taken Zephyr home to rest by this time.  Whip was our catcher.

Cricket is also an accomplished Ping Pong player.

Bones Would Rain From the Sky

Cricket gave out BBQed beef ribs as party favors!  Zephyr and Astro loved them, and they kept them busy for about an hour.

Six Months

We love you Dr. Barnes, Dr. Knowles, and all the vet techs!!!!!

It's been six months since Zephyr first got sick and was then diagnosed with immune mediated encephalitis.  It doesn't seem like it's been that long at all.  I am so grateful to Dr. Barnes in Flagstaff who recognized that something was effecting his brain and sent us right down to the Veterinary Neurological Center in Phoenix.  I am also extremely grateful to Dr. Knowles and all the staff at the neurology center for giving Zephyr the best treatment, which saved his life, and putting in extra effort the weekend he was there and the next week.  My boy would not be here if it weren't for all of these people.

"Look Ma, One Leg!"

Zephyr has been doing really well!  He hasn't had a seizure in 2 months!  WOOHOO!!!  I was pretty excited when he made it past one month but didn't say anything to anyone because I was afraid I'd jinx things.  Actually, at about one month some funny things happened.  One night Zephyr got up around 11:30 and I heard him walking around.  I got up and he was just walking around the house looking around.  Since he's got a pretty good appetite nowadays and I heard him bump the closet door (where he often hunts for treats left in my pocket) I thought maybe he was just up because he was hungry.  I also wondered if it was a small seizure because it seemed like he might have been a little confused.  It was definitely different than the night he got up and was walking around the living room because the cats had knocked the filled Kong out of the upper cabinet and were batting it around.  Then it happened again two nights later.  I'm still not sure what it was, another complicating factor is I'm always half asleep when these things happen.  But it hasn't happened again so I'm good with that.

"AAAHHHH!!  My mouth is bigger than yours!"

Zephyr's been taking procarbazine for about a month now.  Procarbazine is the milder chemotherapy medicine that he's taking everyday.  His white blood cell count doesn't drop really low like with the Lomustine (CCNU).  It was at 5,100 three weeks a ago which is just a little lower than the normal range.  So, his energy level has been a lot better and he's felt like playing and going on more walks.

"It feels so good to run!"

In the past week it's cooled off to highs in the low 70's, so even cooler in the morning and evening, and that has really helped him feel a lot more spunky.  The prednisone makes him sensitive to heat, plus he's pretty out of shape.  That meant there were many days this summer that he had to stay home.  

"Want to race?"

I've taken him on a few hour long walks in the last week and he's done really well.  This afternoon we went on an hour walk and then the beasts had a big play session in the house when we got home.  It was complete with running through the house, spinning around each other, flying on to the bed and then sliding across it.  :-)  That's when stuffy old Mom pulled out the treats and put an end to all the craziness.

Our pool for cooling the paws.  A few days this summer I thought about getting in myself.

Three weeks ago Zephyr had blood work done to check his white blood cell count and his kidney and liver function.  All of the medicines and chemotherapy can harm the liver.  Unfortunately, for the first time it did show that his liver is being effected.  His alkaline phosphorus had increased from 100 to 800.  The Drs. said that is not too bad, but it was enough to make me a nervous wreck for a few days.  Dr. Knowles suggested a supplement Denamarin that has SAMe and sylibin (from milk thistle) that helps the liver function.  As an added bonus the SAMe is supposed to help the brain.  I ordered some online and then called some local veterinary hospitals and luckily one had some in stock so I could start him on it right away.  Tomorrow he goes for a recheck, hopefully it will be better.  If not we'll have to consider a change in one of the medications, probably the phenobarbital.

"C'mon Zephyr, I double dare you!"

Zephyr's also gone to town a few times to the nursery and a bookstore.  He loves all the attention.  The boys also got to go to Crickets birthday party.  What a blast!  That was Zephyr's first time running and playing with other dogs in months.

The other day we were coming back from a walk and two women were walking toward us.  I could tell the older woman was sick.  She smiled when she saw the dogs and asked to pet them.  Zephyr and Astro were so happy to say Hi when she pet them.  They wagged their tails and were so happy.  The woman was so happy too, she said, "Do you think they can tell I'm a dog person?"  Then she leaned her face down and they gave her lots of soft kisses.  She told me about her three dogs that her son is taking care of because she's sick.  It was so sweet.  Someday we'll have to do the therapy dog certification.

"Oh no you don't, Astro!"

Since Zephyr's been more active I think he's built a little muscle and is looking a little more fit.  I've also stopped offering him food four times a day and, much to his dismay, I don't cook ground beef for him as often.  :-)  I have this thing about my animals eating a lot when they are sick.  It must be something like a mom that likes to cook for her kids and is always wanting to feed them.   

"Out of my way while I weave!"

To help combat Zephyr's boredom this summer and to keep his brain working well I started teaching Zephyr some tricks and playing games with them.  The best trick was teaching him to "shake".  This was a pretty big deal because Zephyr doesn't really like his paws touched.  I used the clicker and treats and was really impressed with how well he did.  It took a few weeks, but now he'll even do it for no treats and in places away from home.  We also play "Hide and Seek" and I've put them in stays while I hide treats throughout the house and then had them go find them.  Lots of fun.  Astro and I are taking a Rally class and I also practice the moves with Zephyr.  Zephyr's done Rally before too.  Zephyr also gets to practice agility; going through and around jumps with no bars, through the tunnel, and even weaving.  Astro's learning his weave poles, Zephyr was close before he got sick.  At first I thought he had forgotten them, but now he goes through them with guides.  He goes really slow, which is fine, because they are almost closed for Astro now.  I was just really happy that he figured it out and remembered.

Oh, remember how I said that I didn't think chemotherapy made dogs' fur fall out?  Well I take that back.  Zephyr's fur has thinned all over his body.  His chest, belly, and sides show it the most.  Some of those areas are almost bald.  But even the soft fur below and to the back of his ears is really thin.  Good thing I am knitting him his own full body Chemo Cap.

Still the sweetest goofiest boy.

By chance through GreyTalk I met a woman who's greyhound, Sara, went through the exact same thing as Zephyr and we have emailed a few times.  Sara was also seizing, couldn't walk, etc., and they thought they would lose her.  They did a very similar chemotherapy treatment, prednisone, and phenobarbital for almost a year.  It was so helpful to talk to someone who had gone through this and hear that all the things I was feeling she had felt too.  Encephalitis is a really scary disease and there's not much information available about it.  Sara's been off all treatment for at least 3 1/2 years and just turned 10!  :-)  Sara's recovery is the goal I focus on, it's so nice to know that another greyhound made it through.  Hopefully, Sara and Zephyr will also have their recoveries in common too.