Seizures. What I Tell Parents

My friend wrote an informative article on seizures it highlighted recommendations from another veterinarian, and some alternative therapies to stop a seizure. It was a wonderful article and it served as a springboard for this one. I asked her if I could use it as the backbone for this one and thankfully she agreed. The links to those are listed below.

Here is my article, my thoughts, experiences and advice on seizures.

Seizures, I see them all too often. They strike at any age, any breed, and in any range of severity.

SEIZURES IN CATS
As a veterinarian I see seizures in dogs. I have seen it in cats but all of the cats were ill, dying, or had some other very severe disease that precluded them to having seizures, OR, the cats were exposed to a toxin. Beyond a doubt the most common toxin that I see in cats with seizures is using an inappropriate flea and tick medication  Specifically, using a dog flea and tick product (that clearly says "DO NOT USE ON CATS") on a cat.

PUREBRED DOGS
Here is my observation. I don't think I have ever seen a seizure in a mutt. (I just looked that up, and yes, they occur most often in purebred dogs). In dogs seizures are most often a result of epilepsy. The statistics say that epilepsy is the most common neurologic disorder in dogs and affects 0.5 to 5.7% of dogs.

SEIZURE OVERVIEW
I just looked up the definition of seizure to provide it to you. Unfortunately it is cumbersome, confusing, and not at all user-friendly. OK, disclosure time, I AM NOT a neurologist. I am a veterinarian., but, in an effort to make this sensible I am going to describe seizures how I describe them to clients. If you have a pet with seizures it is always advisable to seek a veterinary neurologist before deciding on a definitive diagnosis and a long term treatment plan. A veterinary neurologist will have the most experience and widest range of treatment options for your pet, they are an invaluable resource for what might be a life long affliction.

A seizure is a hyperactive nervous system response in the brain. Think of the brain as an intricate network of electrical activity. When the wires all fire at once the brain goes into overload. This manifests as a seizure. Most pets have a seizure with three parts to it.

Prodrome Phase;
The first part is called the pre-ictal (prodomal) period. For some pets they will look dazed, confused, start pacing, start licking their lips, or act oddly. I inform my clients about this phase because I want them to start observing for this. My hope is that they can be preparing for a seizure before it occurs. Also, there are some triggers that can cause seizures. These can include light, noise, chemicals, etc. Knowing this we hope that these can be removed to help avoid a seizure. I also instruct my clients to close off the area that the seizing pet is in. I have seen family pets attack and injure the seizing pet because they do not recognize it, or they fear it. In the pre-ictal phase I instruct my client to get their emergency kit out.

The Emergency Seizure Kit should include;

• A blanket, to use as a transport tool, soak up urine, or protect the head from banging on floor.
• A baggie with gloves, lubricant and anti-seizure medications. I advise and give this to all pets on seizure medications or with re-current seizures.
• The phone number to your veterinarian, and the closest emergency hospital.
• Your pets medical summary, just in case you need to head to the ER

Ictus;
The second phase of a seizure is called the ictus period. This is the seizure itself. A seizure can look like rigid extension of the limbs and possibly the head, shaking of the body and limbs, the pet may urinate and/or defecate, and they may lose consciousness, vocalize, or salivate. The seizure should only last a few minutes. IF it lasts longer I advise getting into the car with your pet (be very careful to not get bitten or injured) and start heading toward the vet. A seizure is an electrical disturbance in the brain, it can be a life threatening occurrence. Wrap your pet safely up, ask for an assistant to help restrain them for the ride and start for help.

If you have been given an emergency seizure medication apply it as directed by your vet.

The subject of having an anti-seizure medication for use at home is somewhat controversial. It is my opinion that allowing the owners to have some ability to treat and stop the seizures is not only essential to the possible life saving of their pet it also benefits the owners to feel as if they can assist their pets in a time of an emergency. After all the goal is to simply stop the seizures and lessen the chance of them clustering (or recurring quickly).

If your pets seizure lasts longer than ten minutes you need to bring them to the closest emergency hospital for assistance from them to stop the seizure.

Postictal Phase;

The postictal phase is the phase after the seizure has stopped. After a seizure the pet is usually tired, disoriented, unable to stand or walk, confused, blind, hyperactive, or depressed. The postictal period can vary greatly in length from minutes to hours.

The First Seizure

If you believe that your pet is having their first seizure they should be immediately brought to your veterinarian. After a thorough examination a complete blood and urine should be done. I always tell my clients that I am looking for the "easy" answers to a seizure like imbalances in glucose, calcium, and electrolytes. All underlying causes for the seizure should be discussed and the rule out list for etiologies to seizures started.

After the first seizure I advise my clients to begin keeping a journal. Any clue that they can document helps in understanding and diagnosing the seizures. I look for any kinds of clues to try to find a cause. Remember to list all topical products all medications, including heartworm preventatives, any holistic or homeopathics, literally anything that goes on or in your pet. I also review all dog foods and snacks. I urge them to think and analyze every item that their pet is exposed to. In most cases the cause is not identified and the seizures are by default attributed to epilepsy, but in a few cases we have been able to avoid life long medication and lessen the seizures to infrequent enough to not need medication.

The first seizure appointment is a long exchange of what owners observed, how the pet appeared before, during, and after the seizure. A whole bunch of questions about diet, lifestyle, and environment, and the journaling I am asking them to start. We also talk about an emergency plan, the emergency kit, and our long term plan.


Long Term Plan
The long term plan should be discussed at the first seizure so that owners have some idea of the plan should medication be required. Epilepsy is the most common cause of seizures. If epilepsy is diagnosed the treatment is a long term anti-epileptic. In veterinary medicine we use phenobarbital or potassium bromide, or sometimes both.

There are varying guidelines for when to decide to add an anti-epileptic. Here is the advice I give my clients, and here is the advice I took when caring for my own pet. When the seizures become weekly, or when the severity increases to the point of being concerned about not being able to get them under control, or if they start to cluster (a cluster seizure is when they occur in close proximity to each other), then for me it is time to add an anti-epileptic. It is important to remember that these anti-epileptics are usually given for the rest of the pets life. They also should be checked routinely by blood monitoring. Drug monitoring can be expensive and the pets response to these drugs can be alarming and troublesome to some.

I tell my clients that the phenobarbital or potassium bromide is given to help control or minimize the seizures because seizures are life threatening events. If the seizures respond to the medications it is recommended to stay on them for the rest of their pets life. All anti-epileptics have a loading period. This is the period of time it takes for them to reach adequate concentration in the pet to control the seizures. During the loading period many pets act intoxicated. They stumble, are groggy, and seem dull. It is difficult for some people to see their pet this way. It passes over the first few weeks.

With every drug there are possible side effects. The longer you stay on a drug the more likely you are to see its side effect. Long term use of the anti-epileptics are damaging to the liver. Our hope is that the seizures will be long gone by the time the liver fails from the phenobarb or potassium bromide. This is another very important reason to check the blood levels checked and in the reference range.

I will continue this discussion about seizures next with an overview of the types of seizures seen in dogs.

Here are the articles published by DawgBusiness on seizures arresting them via a holistic method and another dog's experience with addressing seizures please see the links below;

http://dawgbusiness.blogspot.com/2013/05/how-we-handled-alexs-seizures.html


http://dawgbusiness.blogspot.ca/2012/08/veterinary-highlights-arresting-canine.html

If you have any questions or ideas for this article, or this blog please contact me.

I can be reached at http://www.pawbly.com/ at anytime for any pet question. Please visit me there.

Levi's Luck, and why we don't get a DVM degree online.

Levi’s story began very oddly.

Our first meeting.

I was called to the front desk one afternoon because, "There was an older gentleman in the reception area who had walked into the clinic and requested to talk with me."

I always get nervous when someone walks in off the street and asks for me by name. I knew I didn't have any appointments with anyone and he obviously was not a drug rep. (They, for reasons still not understood by me, always show up unannounced). I went out to the reception area and introduced myself with a hand shake, a smile, and a "hello." 

The man stood up, shook my hand and told me that we had already met and asked me if "I remembered this meeting?"

I slowly and quizzically said “No.” 

“I was here a few years ago with a friend who was here to euthanize his beagle.” (Still no recollection of any of this on my part). “You talked him out of euthanizing the dog because you believed he had a treatable medical condition and you said you would not euthanize the dog unless he was suffering and not treatable. I was so impressed by your compassion that I wanted to talk about my daughters dog with you.” (There was no dog with him. First red flag... Check).  

He went on to tell me that he had a 2 year old yellow lab that had had 2 seizures. He explained that his daughter was having some personal difficulties and that he and his wife were taking care of the dog, named Levi, for her. He went on to describe that Levi was a very active dog and they kept him outside in a chained enclosure. 

Somewhere in this discussion I asked him if he "was a client of ours?" 

“No, we bring our dogs to the clinic up the street.” (Red flag number 2. Check). He mentioned several times that he and his wife were “on a fixed income.” (I always secretly laugh at this. I mean, who isn't?) He went onto tell me that he had diagnosed Levi’s disease already. 

I asked "who had done this for him?" I expected he would tell me that the vet down the street had. 

Instead, I got “we found it on the internet.” (Red flag number 3. Check). Every vet in the world cringes inside when a client tells them that they have been doing their own vet school training online. 

When I asked him "What he based this diagnosis on?" 

He told me, that "Levi has had 2 seizures. The last one had lasted over 2 hours." And, that “it was really hard to watch him seizing for 2 hours, so he thought it would be better to euthanize him then let him suffer through another one of these.”

It was very clear that Levi needed a veterinarian to look at him. I told him that I would be happy to set up an appointment.

He asked "whether Levi’s presumed diagnosis was treatable?" 

I told him that "it certainly could be, but Levi needed an examination and work-up before anyone should diagnose him."

He then told me he was going to go back to the vet up the street and have him put down. He thought it would be cheaper than treating Levi.

I told him that "I believed this was immoral and unethical." I told him it was "$50 for a euthanasia here, which we would not do, and $45 for an examination." He once again repeated "that they were on a fixed income and he was sure that Levi was not treatable," and "he wouldn't put a penny out for him."

I had to take a deep breath and get out of the reception area. I was about to internally combust. 

"What the hell?" I thought. Did this man seriously just walk in here to tell me he was going to euthanize his dog? Was he asking for a professional opinion? Or a consent to his medical diagnosis? God help me not castrate him, or start screaming obscenities to him.  I asked him to follow me into the exam room. (Note to self, need to install sound proof walls in examination rooms). 

I realized that this dog, whom I had never met, owned by this man who wasn't a client, had no hope unless I agreed to do everything for free. I am happy to do pro bono work, but, I am indignant to provide it to people who can pay but would rather buy a new car, gun, cell phone, tattoo, or new replacement dog than help their companion when they need them most. 

I told him that he "could bring Levi in and sign him over to us and we would give him an examination, blood work, and come up with a treatment plan." He reiterated to me that he "would not pay for anything!" (I am not sure which part of free he was confused about?)


He left. I went to my office to settle my nerves. (Usually this means I take my dogs for a long walk). 

He came back the next day with Levi. I knew the minute I saw Levi that this was the right thing to do. Levi came bounding in the clinic door, tail wagging, tongue lashing out air kisses to everyone and everything he saw. I stopped thinking about how disappointed I was with this man and I reminded myself why I never choose the easy road. When I saw Levi I knew instantly that I loved this dog. He was all love but no manners. He looked like he had just escaped from dictatorship lead solitary confinement. Oh my goodness was he the worlds happiest dog!

As soon as the legal papers were signed we began performing every test we thought relevant, made up a treatment plan and observed him very closely. He had a seizure within the first few days with us. After a week I began calling clients to see if I could coerce someone into fostering him. I was very worried he might be having seizures at night that we weren't privy to. 

A seizure is a disorder at the level of the brain. In simplest terms it is what happens when the internal wiring and circuitry of your brain goes haywire. I remind my clients that it is always a life threatening event. I always make sure that my clients with pets that have seizures have an emergency plan. This includes emergency medications they can administer at home, and directions to the emergency facility if the medications don’t work.

Levi was tested for Lyme disease and was strongly positive for it. I was hoping that the seizures were a result of the Lyme disease. He also had a lot of discharge from his right eye. His right eye had what we call entropion. This means that the (lower eyelid in his case)rolls in and rubs the eye. If you have an eyelash, or other foreign body in your eye, you know it immediately and you try to remove it immediately. Think about having a whole bunch of hair rubbing your cornea (eyeball) every second of every day. You would do what he was doing, squint and tear, a lot!

Levi lived at the front desk for about three weeks. For every client who approached the front desk Levi would jump up, wag, and greet them. It was impossible to miss him, and impossible to dissuade him. He wanted to announce to the world that he was free and friendly. For one of our visiting clients Levi's hello caused her to fall in love with him even faster than I had. 

Within minutes of that smile she announced that she was "going home to tell her husband about him!" And, that she "was coming right back for him." She announced that she wasn't going home to ask permission, (the respectful thing to do in your marriage), but she loved Levi and needed to break it to her husband without the four legged bouncing boy breaking the news not-so- gently for her.  She came back a few hours later and took Levi home. I gave her a large supply of anti-seizure medications, explicit instructions, my cell phone number and an emergency plan. Levi did great in their home. He is still having seizures and is being treated for epilepsy (not the dreaded "untreatable" disease the internet had diagnosed him with). We also surgically corrected the eyelid deformity. His new family loves him immensely. He comes to visit often, tail wagging, kissing, and cuddling up to all of us. I am grateful everyday that he found a great home and that they love him in spite of his life-long disease. Levi has a great support system and medical team, dedicated to his well-being.

It has been about 6 months since Levi came to us. Last week the receptionists came to me, again, to say that there was "a man here to see me." This time I asked "whether or not I wanted to talk to him?" As soon as I saw him my heart sank. 

I trudged toward him and muttered a reluctant muffled “Hello.” 

“Do you remember me?” This time my answer was a definitive “Yes”.  

“I know I am not supposed to ask, and, you don’t have to tell me.” (the transfer of ownership papers he signed state very clearly that once JVC takes responsibility for a pet we do not give the former owners any further information on that pet). I took a deep breath again. I didn’t want to give him the satisfaction of relieving his guilt, (although now that I think about it, maybe he wanted to feel as if his medical diagnosis had been correct?). 

"He’s dead right? You had to euthanize him because he wasn't treatable. Right?”  

I confessed to him that Levi was doing very well. He had a wonderful family who loved him very much. After which he told me that he was going back to the breeder to buy a new puppy. 

I shed my professional composure suit. “You have no right to ever own another pet. You dumped Levi. A pet, just like every other living thing, requires time, care, AND, it might even  cost you a nickel if anything happens to them.” 

He stood up, said to me, “I knew you would be tough,” and left.

I am rethinking the walk in and request to see me thing.

If you would like to learn more about seizures, please see my blog on "Seizures What I Tell My Clients."

If you would like to learn more about entropion please see Corky's Story.


Meet Levi. This is pre-op for the eye. I will post post-op pictures in a few weeks, (after it has healed).

Happy Birthday Levi

"There is no such thing as too big to be a lap dog. Is there?"

Shotgun

Another grueling long day comes to an end.

Everybody needs a shoulder to lean on.

Pets With Santa

It has been over three years since I first met Levi. He is still a sweet, gentle, loving boy to a family who lost their son fighting overseas for our country a few years before Levi came into their lives. Levi remains at their side, helping to shoulder the grief of a loss that is deep and intensely painful. He has brought love, life, humor, joy, and levity into a family. His former family has no idea of what a wonder this boy is. To see one family purchase, chain, and then abandon and then another adopt, rescue, love, and honor the same dog is a true miracle and reminder of what the best of humanity looks like. 

There is always love to be found out there. Never give up on the power of second chances.

Update January 2016; I still see Levi every few months. I has been 5 years of watching him wag his way in the door. Many giggling visits with his family. Many tales of lab antics, silly dog capers, and he has remained the joy in a family who believes that the love he spreads far out weighs the condition he came with.

If you have a pet in need please join us on Pawbly.com. We  are a free pet information network with the sole purpose of helping pets live longer happier and healthier lives.

Levi, January 2016.. he had a long day of playing in the snow.