The First Seizure, Honey's Story

This is Honey.

She was brought in to see me last week after her parents had witnessed what they believed to be four seizures. The first seizure was at 7 am, then again at 8 am, 9:30 am, and 10:45 am. 

Honey presented to me as almost all of the dogs with seizures do. Looking perfectly normal. They walk into the exam room with their parents, wagging their tails, playful, inquisitive, and oblivious to any abnormal event as to ever happening.

They are so adept at hiding a problem that their parents are often left to debate between themselves that anything abnormal happened to begin with? At the time of the event they were "pretty sure" that it was a seizure, but now that their dog seems so normal, "maybe it wasn't?"

Here is how I approach a pet with a suspected seizure.

As soon as a client calls we ask if the pet is still having a seizure? If your pet is having a seizure you should follow these instructions.

If the pet is not having a seizure they should be seen as soon as possible at your veterinarians office.

On the first visit to the vet after a seizure we talk A LOT!

I want to know everything about your pet. Here is what I ask my clients;

1. Describe what happened in as much detail as possible. 
2. Time of day, 
3. Description of your pets behavior/episode, 
4. Length of time it occurred for, 
5. Does there seem to be any sort of pattern, 
6. Or association. For example does it occur around sleeping, eating, after long periods of not eating, stress, over exertion, or even play?
7. Actions/behavior before, during, and after episode
8. Last meal time and amount eaten
9. What kind of food do you feed your pet?
10. How would you describe your pets personality?
11. Last time of any preventatives given. Flea/tick/heartworm, etc.
12. Is your pet receiving any medications?
13. Does your pet have any history of illness?
14. Or disease?
15. Any history, or possibility of trauma? Falling?
16. When was the last time your pet was vaccinated?
17. Do you know anything about your pets siblings? Parents?
18. Is anyone in close proximity to your pet on any medications, topical, gel, or otherwise
19. Possible exposure to any toxins?
20. Is anything disturbed in any part of the home, or your pets environment?
21. Are there other pets in the house?
22. Are any of them displaying any abnormal behaviors?

I ask so many questions because the hope is to be able to identify a cause, eradicate it, and therefore cure the seizures.

There are about a million things that can cause, or predispose your pet to having a seizure. We call it :lowering the seizure threshold" and making a seizure a more likely to occur event. For people we know that certain medications, fluctuations in body systems and internal components, and even types of visual cues, like a strobe light.

At the first veterinary exam after the seizure I recommend a full blood work. This includes a CBC, chemistry, and urinalysis. If we find any other abnormalities we may recommend additional tests like an x-ray, ultrasound, fecal, etc. There are many things that can predispose, or trigger a seizure. The goal is to identify and address them so that your pet does not have any other seizures. I know that many people are afraid of environmental components, diet, and pet products like flea & tick preventatives, heartworm medications, etc. that could be the cause of the seizure. Please before you discontinue, or change your pets diet, talk about the risks of not using, changing, etc. these with your vet. 

If the episode happens again try to capture it on video. A video is the best tool available for us to understand what your pet is doing. It is the easiest most efficient way to insure we are all speaking in the same language and about the same clinical signs.

Here's what I tell my first time seizure clients;

Where there is one, there are likely to be more. I do not know when they might recur. In general, a pet is more likely to have additional seizures around each other, they tend to cluster. They are also more likely when waking up, after strenuous play or excitement, and often there are small subtle clues that they are approaching, like a change in behavior, facial expression, etc.. The more your pet has the more likely they are to have others. A diagnosis is often made by running tests, and your history. You play a vital part in helping to identify a cause and come to a diagnosis. But don't loose hope. Many times they pop-up out of nowhere, and many times they disappear just as mysteriously.

Honey is a perfect example. In the four day period that we first saw a seizure, she had a half dozen others. We prescribed valium to have at home to help stop her from clustering into others. None of the subsequent seizures were as violent as the ones she had when I saw her, and after four days, it has been weeks since she has had any others. Hopefully, that's the end of them. But, just in case, we have a plan to help her get a diagnosis, and a treatment to control them long term.

Honey.
In her finest.
Thank-You to her mom for sharing this picture.

I always share my own personal seizure story with my clients at the first visit. When I was in vet school I had a cat that had seizures. It was during my third year. At that time I was pretty much living at the vet school. I went off to campus at 7 am, and got back home at around midnight. Over a one week period my cat Squeak-box had four violent seizures. The first time it happened was at about 2 am. I woke up to a loud banging on what I thought was my front door. It turned out to be my cats head on the wood floors. It was awful to watch, and I was petrified that if I saw it four times in one week on a week that I was only home for a small portion of the day that she was likely to be having dozens of seizures. each seizure knocked the wind out of her for many hours. All of our detective work, diagnostics, and worry amounted to not one single answer. After that one week she never had another (that I witnessed). She went on to live another 15 years perfectly healthy.

Squeak Box

If you have any pet related questions you can find me at Pawbly.com, or on Twitter. I am happy to help if I can.

Please Always Be Kind.

What to do if your pet is having a seizure NOW!

If your pet is having a seizure NOW you should:

1. Move any and all objects away from your pet. SO that they do not injure themselves by hitting their head, (for instance on a table or chair leg).
2. Move all other pets away from the seizing pet. Close them securely away. Your other pets will not understand that your pet is having a life threatening event, and they might become scared and attack the seizing pet. I have seen many pets arrive at the clinic after having had both a seizure and being attacked. I believe it is something about your pet displaying erratic unfamiliar behaviors that cause the other pets to attack them.
3. If the seizure last more than 5 minutes, OR,
4. If the seizures are starting to cluster (occurring together in groups), THEN,
5. It is time to go to the vet or the closest emergency hospital!

Be very careful in picking up your pet. They may bite you. They might not even know who you are. Use a heavy towel to protect their face and mouth and to help you pic them up safely. 

At the veterinary hospital we use the "burrito method."

You may have to wrap the towel around the top of the head (keep the nose and mouth free for breathing), so that your pet cannot bite. It is easier to maintain control of the head and mouth with a thick towel that extends in front of the ears.

It is imperative to remember that a seizure is a problem in the brain, and that the brain governs every single thing in the body. A seizure can be, and should be regarded as a life-threatening event. It is an emergency. 

Be calm, be safe, and seek help.

Related articles on seizures:

What I Tell Pet Parents About Seizures

Honey's Story

If you have any pet questions you can find me at Pawbly.com, or on Twitter. I am happy to help you and your pet.

Please remember to Always Be Kind.

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.

Death By Accident

Yesterday our evening appointments were interrupted by a woman rushing into the clinc carrying in a white collie mix who was flat out. She was hysterical and her three young half-clothed boys followed like ducklings in tow.

When she erupted into the front doors her shrieking turned into a full exam room of screaming. The receptionists were frantically yelling, the waiting clients were awestruck, and then joined the bellowing, and even though I was only half-way through my examination with a client I too joined in on the hysteria. I literally dropped my papers, ditched the exam, and high tailed it (despite the receptionists screams to "RUN!") behind the congo line parade of delirium. It was pandemonium, and all the neighbors knew.

A very young, intact, long white haired Shepherd mix was placed on the surgery table. He was lifeless, but still breathing. He seemed to be entering a comatose state and I knew the minute that I saw his bright red-purple gums and the slightly watered down blood pouring from his rectum that he was a heat stroke victim. As I started to take his temperature the first number that flashed onto the digital read-out was 106. Within 2 seconds it beeped at its max read out of 108 degrees. I told the 3 techs scrambling for equipment that he was a hyperthermia and that he was likely going to die.

Terrible, cold, short, words to hear. But I knew that surviving 108 plus degrees internal body temp was physiologically impossible.

We immediately transferred him to the dental table so we could start hosing him off with water. I reminded the staff to use "cool" vs "cold" water because ice-cold water on an already way over heated animal causes the vasculature on the skin's surface to vaso-constrict and stop blood flow, therefore arresting the cooling process.

I then knew that I had to very quickly go out to talk to the family.

Three boys under age 10 flocked to me like I was some sort of relief aid worker. They were all in summer shorts, no shoes, and no shirts. It appeared that their dogs discovery had occurred mid- afternoon summer play time. Their mom, also in summer pool attire, was crying uncontrollably and kept asking me.

I asked the receptionist to sit in the exam room with the boys while I took mom across the hall to discuss Rudy's condition.

"How did this happen?" she asked.

As much as I didn't have a spare second to try to console her in her grief-ridden confusion I tried to explain hurriedly that Rudy was very hot, and that I needed to know if she wanted me to start emergency treatment measures on him.  although his internal core temperature was above what I could record and that I feared he was too hot to be saved.

She replied "Yes," in a momentary lapse of tears gurgling and incomprehensible babble.

She asked me, "What happened?" and I wanted to pick her up and shake her. It was my honest first response. How could she not know what happened? How did she expect me to know?

I replied back to her, "Ruby has gotten too hot. His internal body temperature does not even register. He is above 108 degrees and I am afraid he is going to die." I had no time for platitudes, and there were 3 techs in the back treatment area and her dying dog who needed me immediately.

She started to mutter something to the effect of "we only left him tied out for two hours..."

It was a 100 plus degrees outside and I was going to say things I would regret and Ruby was going to die if I didn't leave.

I ran to the back and we started to try to reverse the series of life-ending steps that his body had already started.

One tech was still hosing him down. To the touch he was almost completely soaked now.

The other two techs were trying to place peripheral i.v. catheters in his front leg.

I barked out orders as fast as I could. Ruby needed an i.v. catheter in each front leg and fluids as fast as we could deliver them.

My staff is incredibly competent and every technician in the building can place an i.v. catheter within seconds. Multiple attempts at light speed and they still didn't have one catheter in. They stopped their attempts and moved over so I could jump in.

He had no blood pressure, no palpable veins, and hence they had had no success in placing the catheter.

Because he was so hot his blood had already started to condense. They were expecting to see a "flashback" of blood when the catheter entered the vein, but he was too hot for the blood to "flash."  He was a patient with blood vessels like they hadn't seen before and their idea of normal was prohibiting them from believing that their catheters were in the vein. As I advanced the catheter there was only a teeny tiny drop of blood to flash. They were expecting his vein to be the normal tube like liquid-blood filled structure that healthy pets have. But he was no longer a normal healthy pet. I quickly taped the first i.v. in and moved to the other leg.

The other leg was so difficult that I had to do what we call a "cut-down." The vein was so small, so obscure, and so damaged that I had to cut through the skin to dissect the vein out so I could then try to place the i.v. catheter. It is a procedure we only do when everything else has failed and we are up against a wall. I placed the second i.v. and we started to push fluids as fast as we could.

"The fluids won't run," they reported to me as quickly as they started to squeeze the i.v. bags.

The veins were blowing because the "tube" of the vein had been heated up to a point where the tube broke down. Not only were the walls of the tubes breaking down, but the liquid-blood inside of them was no a jello-like consistency. He had essentially evaporated off the liquid and congealed his own blood. Both legs i.v. catheters were blown as quickly as we had started to push the i.v. fluids.

Within minutes of cool water cooling his temperature registered at 106.5. It was better than >108, but he was failing, and all of our attempts to save him were too.

He then started to seize. I tried to give an emergency valium dose to stop the seizure but seconds after the seizure started his heart started to beat irregularly.

At this point I looked at my staff. They were begging me to save him, and gazing at me as if I had some magical powers to stop and reverse time.

I said to them again "I am sorry, I think he is going to die."

I looked at Ruby and I said, "I am sorry."

His heart changed from too slow, during his seizure, to wildly erratically irregularly fast. He was in atrial fibrillation now. I grabbed for more drugs. His eyes opened, his head flew back, the pupils went fixed and dilated, and his mouth gaped open as if to release a harboring demon.

The techs begged me to put him down. One grabbed for the euthanasia solution as I wrapped my hand around the area of his chest where I could feel his dying bewildered heart take its last few beats.

As he took his last breath I pierced his heart with the pink fluid to relieve his struggle. He died before the fluid could assist him.

It had been less than 20 minutes and we had all witnessed what we all collectively agreed was the most excruciatingly horrible death.

I returned to the family to notify them of Ruby's passing. The boys, who had not seemed upset before, now screamed in a charged guttural grief stricken cry. Their mom held them and tried to comfort them. I could tell that she wasn't going to let herself cry while she stayed strong for her children.

The rest of the family arrived a little while later. I spoke to all of the adults together.

They didn't understand that 2 hours was likely an hour and 50 minutes longer than any dog could tolerate in 100 plus degree very high humidity heat. They told me that they never tie him up, but because the kids were out playing, and because Ruby was trying to corral them up, they had tied him to a bush. He had been jumping and barking and when they found him he was collapsed under the bush.

I tried to explain that dogs are about 2 degrees warmer than humans are, they wear a fur coat all year around, and that they have a very limited ability to sweat.

Ruby's death was a terrible tragic accident and my only hope is that his story will save other pets out there somewhere.

Please never leave your pets outside in hot weather. NEVER EVER leave them in a car. And if they start to pant its time to get them wet and cool them off.

Any pet over 103 degrees needs to go to a vet immediately!

My thoughts and prayers are with Rudy's family.



I saw this online recently. It is a petition at change.org.

It’s a sight that makes Dorothy Hearst desperately worried every summer: a car parked at a shopping center, a dog looking anxiously out the window, and no owner in sight.
Dorothy never leaves Emmi, a 3-year-old Labrador whom she adores, in her Subaru -- as a lifelong dog lover, she knows that in the few minutes it takes to run an errand, the temperature in a car can soar to almost 110 degrees. But many people don’t realize that even a 15 minute errand can be fatal for their beloved pets. For Dorothy, it’s heartbreaking. And what’s worse is knowing it can happen to even the most loving owners -- people simply don’t realize the danger. Dorothy knows that educating people would save the lives of countless dogs. That’s why she’s started a petition asking Subaru, which prides itself on its dog-friendly image, to make an ad warning drivers not to leave their dogs in the car during the summer.
As a Subaru driver, Dorothy appreciates all the ways the company has already shown it cares about dogs -- and she loves its popular "Dog Tested, Dog Approved" ads showing dogs test driving its cars with hilarious results. This summer, she thinks Subaru can use these creative ads to send an important message about the dangers of hot cars -- and save the lives of hundreds of dogs.
Subaru says 70% of its customers are pet owners, and Dorothy thinks this makes them the ideal voice for such an important, dog-friendly message. She's convinced that Subaru will jump at the chance to appeal not only to its own customers, but to dog lovers everywhere -- and she knows that this is one of the most powerful ways to make sure this summer, more dogs don’t die needlessly.** ask Subaru to save dogs’ lives by making an ad warning owners not to leave their dogs in the car this summer.
Thanks for being a change-maker, via Change.org see Dorothies petition.

The signing period for this petition has closed. You can notify Subaru yourself via their link at  https://www.subaru.com/shopping-tools/contact-us.html. Wouldn't it be nice if there was a way for automobiles to detect if a pet or person was in the car? It will happen someday.


For more information on the dangers of pets in cars see; http://www.petmd.com/dog/emergency/common-emergencies/e_dg_heat_stroke