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Just got results from Lily's blood test on gabapentin levels.

Shay

Shay

Well-known member
Dr. Sorjenon just called with the results from Lily's blood test to detect gabapentin levels. He said that it was almost non-detectable based on being administered at 7:30 AM, and the blood being drawn at 2:30 PM. He is increasing it to 3x per day, but not increasing the 50 mg dose. He explained how it is used for anti seizure meds and how it works for SM, which I already knew, but he wants to see how she does with the 3x per day plan before he increases the dose. He said this should insure there is no drop and it should keep her at even levels.

I asked why he needed another MRI to do the PSOM surgery. He said it is an invasive procedure that can sometimes do more harm than good, and can potentially cause permanent damage to the dog. He said he doesn't think anyone would or should do this procedure without a new scan. He did say that she may just need a CT scan, but he mentioned something about this not showing where her cerebellum was sitting?? Not sure what that means. He said that I should have this done at Auburn since they have all of her records and they have all the bells and whistles.

What he told me sounds very much like what Chloe's mom was told about the PSOM surgery yesterday when she got Chloe's MRI. Is this something new, or are some neuro's more conservative with the treatmet of PSOM? Perhaps Auburn is more conservative in their approach because Dr. Shore who first diagnosed Lily never recommended she have treatment for PSOM. I am still confused :confused:. I guess Auburn is my next step.
 
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Shay, I'm thinking that PSOM is really more of a dermatology issue than a neurology one. Both Geordie and India had CT scans and then PSOM surgery at Ohio State University Veterinary Hospital. Dr. Lynette Cole, a veterinary dermatologist was doing a PSOM study on CKCS at the time. Maybe you could get in touch with her with your questions. I will look for her email address link on the OSU site.
 
I too think it worth getting an opinion from Dr Cole. I have been told there are potential issues but in reality, there seem to be very few. Similar to the decompression which is a lot more invasive but also in practice has few complications on the surgery table or after as a result of the surgery alone. There is the separate issue of recurrence of problems and formation of scar tissue but the actual surgery has very few complications reported.
 
Hi Shay-
Interesting how both of us were given the same talk about treating PSOM. I mentioned this in my post as well, but I contacted Dr. Cole and hope to hear back from her soon. Keep us updated!
 
ChloeTheCavalier said:
Hi Shay-
Interesting how both of us were given the same talk about treating PSOM. I mentioned this in my post as well, but I contacted Dr. Cole and hope to hear back from her soon. Keep us updated!
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Will do, and let me know too when you hear back from Dr Cole. I am going to e-mail her today, or tomorrow.
 
I have been thinking about this and must say I still do not understand why blood tests are needed for gabapentin levels -- it is pretty well known that levels clear by about 8 hours after a dose is given no matter what the dose. Neurologists tend to prescribe by whatever helps address the symptoms, not blood levels. I've never heard of anyone testing for gabapentin levels. It all just seems an unnecessary (and somewhat pointless?) exercise. I know humans on gabapentin and their blood levels are not tested for levels of this medication, so just find it odd. I guess I'd want a pretty good justification for more expenses in treatment especially when they diverge from what others do!
 
Karlin said:
I have been thinking about this and must say I still do not understand why blood tests are needed for gabapentin levels -- it is pretty well known that levels clear by about 8 hours after a dose is given no matter what the dose. Neurologists tend to prescribe by whatever helps address the symptoms, not blood levels. I've never heard of anyone testing for gabapentin levels. It all just seems an unnecessary (and somewhat pointless?) exercise. I know humans on gabapentin and their blood levels are not tested for levels of this medication, so just find it odd. I guess I'd want a pretty good justification for more expenses in treatment especially when they diverge from what others do!
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I asked him that when he called me Saturday. He said that is shows how the dog metabolizes it, and if the dosing needs to be adjusted. Based on Lily's test, he said she metabolizes it rapidly. It was given to her on the day the blood was drawn at about 7:30 AM and by 2:00 PM, based on the results, it was almost non-existent in her system, 6.5 hours after she received it. I get all of that, but what I don't get is if she metabolizes it in 6.5 hrs, why am I giving it to her every 8 hours now. If you are testing to see how the dog metabolizes the meds, then why aren't you adjusting the dosing based on those results. Why is she not getting it every 6 hours? That's the part that doesn't make sense to me. Maybe I am missing something. And I told you the test was $45.00, but when I faxed in the claim form for her insurance, I looked at the statement again and it was $60.00.
 
Do not know if you have tried to contact and/or have heard back from Dr. Cole but from my understanding at present the only accurate way to diagnose PSOM is by either CT Scan or MRI. Dr. Cole has been doing a study to see if there are less expensive ways to make the diagnosis and to the best of my knowledge a CT Scan or MRI is still needed. What they do is a CT Scan to see if your dog has PSOM and then do the myringotomy (a surgical procedure in which they make a tiny incision in the eardrum to flush the mucous build-up). After the myringotomy they do another CT Scan to see if they got all or most of the mucous. At OSU, for the Cavaliers who are part of Dr. Cole's study, this is all done on one day under the same anesthesia but in some instances it would involve two procedures -- the diagnosis and then the surgery on two different days. Dr. Cole also does a BAER at the same time to see if hearing has been impaired.

One reason to do an MRI instead of a CT Scan (although the MRI is more expensive) is that the CT Scan is not an effective diagnostic tool for SM, i.e. you can diagnose PSOM and may be able to diagnose SM but a CT Scan that is negative for SM does not rule it out. An MRI can be used for both. Our Buddy had a CT Scan, was diagnosed with PSOM, had the surgery and did well for a while. Two years later when I suspected the PSOM had reoccurred we did an MRI instead of a CT Scan so we could see if we had PSOM, SM or both. (BudBud had both :(.)

Hope this helps.
 
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