[Ladymom]

The side effects from phenobarbital occur over many years. Lady was (and still is) on the highest dose possible for her weight for eight years before before her liver values were elevated. The liver is an amazing organ which can regenerate itself. I added Denosyl, started feeding her a homecooked diet for dogs with liver disease and her ALT is completely normal now. She will be 15 in 2 weeks.

A competent vet will monitor Elvis pheno levels with regular bloodwork. Other medications like KBr can be added. Add on drugs like potassium bromide (KBr) or Keppra can help control cluster seizures and often lower the dose of pheno necessary to control seizures.

When UC Davis saw Elvis his seizures weren't that frequent so they advised a conservative approach. Some dogs continue like that for years before they need medication. Some never do. Unfortunately, Elvis' epilepsy has gotten much worse quickly. Cluster seizures are a game changer. His seizures will most likely get more frequent and more severe until Elvis either dies during a seizure or has to be euthanzized due to irreversible brain damage. Worse case scenario and he does develop gradually develop liver damage over the years from from phenobarbital, his life expectancy will still be much longer than it is now.