Canine Epilepsy,Two Years On

img_1847I’ll never forget Holly’s first seizure.

It was August 11, 2016, two months short of her eighth birthday. We were hanging out in the kitchen–me getting ready to prepare lunch, her hoping for a handout–when suddenly her feet began to beat a rapid tattoo against the floor. At first, hearing it, I thought she was scratching herself or maybe having one of those occasional “dry humping” moments. Then I looked down … and knew at once that it wasn’t either of those things, but something new, something scary, and something definitely wrong.

Her eyes, usually soulful and mild, were wide and wild. Her feet skittered this way and that as if she was trying to keep her balance on ice or slippery polish. She collapsed onto her side, legs and feet paddling frenziedly, spine arched backward, jaws gaping so wide it was a wonder they didn’t crack, teeth bared, tongue lolling. Saliva gushed from her mouth and urine sprayed across the floor.

I yelled for my husband Ed, busy in his basement office, and fell to my knees beside her. “You’re okay, you’re okay, you’re okay,” I babbled, knowing she wasn’t. I held her, not restraining her, but just to let her know I was there.

This first grand mal seizure lasted approximately forty-five of the longest seconds of my life. In the time it took Ed to dash upstairs, it was already winding down. He made a quick call to the local vet clinic, and was told to bring Holly in immediately; they’d be waiting for her.

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Two and a half years — and 27 grand mal seizures later — we’ve developed a routine around these events. Although it still takes a lot out of us emotionally — it’s a helluva thing to watch — we now remain calm. (For those of you who’ve never experienced a dog seizing, here’s a YouTube video to give you an idea of what it looks like. I’ve never had the presence of mind to video Holly’s seizures.)

When she drops, our eyes go to the wall clock or a wrist watch. Timing the seizure is important not just for your records (it’s imperative you keep a seizure log), but also so you can inform your veterinarian of duration, severity, and any other observations. When Holly’s seizures began, they ran roughly 15-to-30 seconds, followed by 30-60 minutes of disorientation, hunger, and thirst. Those after-effects are still in play, but now we’re unfortunately creeping up toward the five-minute duration mark; the mark that worries veterinarians and canine neurologists because a seizure that long runs the risk of literally frying a dog’s brain.

That’s why — at approximately the two-minute mark — I head for the drawer of pet medicine in the kitchen to retrieve a syringe of Valium prescribed by our vet. I insert the needle-less delivery end into Holly’s rectum and depress the plunger. Within seconds, she begins to emerge from the seizure.

That’s not where it ends, however.

Now we stay close to monitor how quickly (or not) she begins to react to our voices.  Response time to gentle commands is skewed, and she often staggers and falls if left on her own. (I sometimes put her on a short leash to keep her close by.) I immediately take her outside — she often needs to urinate again, and sometimes defecate — and then bring her back indoors. Because she burns a lot of calories during seizure, she’s always ravenous afterward. I don’t want her to bolt her food, so I give it to her in small amounts, in a bowl. DO NOT try to feed your dog by hand, as you will get nipped. It’s inadvertent on their part, but I learned this the hard way. Your dog is out of it mentally and can’t differentiate between your fingers and a hot dog.

As soon as possible, we wipe down her chest and rear end to get rid of the saliva and urine. (Bath time can wait, but usually follows within 24 hours.) Within a couple of hours, she’s back to “normal.” I put that in quotes because the truth is, normal becomes a very fluid thing. Each time there’s a seizure, we must reorganize our thoughts into accepting whatever the “new normal” becomes. Holly is a little diminished by every episode — slower at regaining a response to commands (or forgetting them entirely and needing to be retrained), a temporary (although sometimes hours-long) loss of coordination, a slight difference in personality that only those who live with her can pick up on. It can be frustrating — and heart-breaking — but as I learned when dealing with my mother’s dementia, you must accept them where they are, not where you’d like them to be.

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So let me share a little of what we’ve learned.

  1. Canine epilepsy comes in two flavors: symptomatic and idiopathic. Symptomatic epilepsy has a diagnostic root cause such as cancer, stroke, autoimmune disease, liver disease, low blood sugar, exposure to toxins, infectious disease, or congenital brain abnormalities like tumor. Idiopathic epilepsy (Holly’s version) has no identifiable cause. Although it may be inherited — certain breeds seems predisposed to the condition — this need not be the case. Research is ongoing.
  2. Seizures strike without warning or pattern. The dog is unconscious during the episode and experiences neither pain nor panic, even though their eyes are open and they may vocalize.
  3. Although your first inclination may be to hold your dog or touch it during the seizure, be extremely careful. If you must touch them, keep your hands to the rear of your pet. Keep your face and hands away from the dog’s mouth. They can, and will, bite … and because they’re unaware, they don’t automatically release. You can suffer a debilitating injury if not careful.
  4. If your dog has a seizure, see your veterinarian as soon as possible. If the seizure lasts more than five minutes or your pet experiences more than one seizure in a 24-hour period, seek emergency help immediately.
  5. There is no cure for canine epilepsy. Medication is a lifelong therapy whose goal is not to prevent seizures (that, sadly, is impossible), but to reduce their frequency and severity. Because these drugs are not “one size fits all,” it may take time for your veterinarian to determine the correct dosage/combination for your pet. And bear in mind that may change over time. In Holly’s case, we’ve used a variety of drugs and combinations. All have worked for a time, but only for a time before needing further tweaking.
  6. You will also deal with a plethora of drug side-effects, which might include lethargy, muscle weakness, anxiety, loss of appetite, vomiting, and periodic soft stool. Please note that anti-epileptic medication should never be discontinued without first consulting with your veterinarian. To do so could endanger the life of your pet.
  7. Be proactive. This is frightening, but knowledge is power. Make yourself part of your pet’s treatment team. Talk to your vet and/or neurologist and ask questions. They should be open and willing to discuss treatment options and any other concerns you have. (And if they aren’t, find new practitioners.)
  8. Do research, but be skeptical of anything or anyone that makes exorbitant claims. When in doubt, ask your veterinarian to weigh in. Under no circumstances should you pursue a course of treatment without first checking its validity with your pet’s doctor(s).
  9. Have your pet examined at least one a year for follow-up.
  10. Remember that your dog’s better days will likely outnumber the bad ones, so enjoy your time with your pet.

 

 

Out of the Blue

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Holly

Note: This piece first appeared on the blog “Animal Bliss”  in December 2016. It was named a “Favorite Dog Article of the Week” on Puppy Leaks.

 

Out of the Blue: A First Experience with Canine Epilepsy

On August 11, 2016, our eight-year-old Australian shepherd, Holly, seized for the first time.

She was lurking at my side in the kitchen, hoping for a handout, when her feet began to beat a sudden, rapid tattoo on the floor. At first, I thought she was scratching herself or having one of those “dry humping” sessions she occasionally experiences, but when I looked down, I saw at once that this was something very different … and very, very wrong. Her eyes were wild, and her feet skittered against the floor as if trying to keep her balance on ice. In an instant, she collapsed onto her side, legs and feet pedaling frenziedly. Her jaws gaped wide, teeth bared and tongue lolling. Saliva ran uncontrollably from her mouth. She stared blindly as her spine arched in an extreme backward curve. Urine sprayed across the floor.

I dropped to my knees and placed my hands on her thrashing body, trying to let her know I was there. “You’re okay,” I babbled, even though I knew she wasn’t. I screamed for my husband, Ed, who was down in the basement. He came running.

Although it seemed to go on forever, in reality the grand-mal seizure lasted approximately forty-five of the longest seconds of my life. In the time it took Ed to rush upstairs, it was already winding down. With our regular vet forty minutes away, he instead called a local clinic and explained what had happened. They said to bring Holly in immediately; they’d be waiting for her.

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Seizures are an indication of brain disease and can happen for a variety of reasons. The term epilepsy is applied when more than one seizure occurs, even if over a span of several months.

Canine epilepsy comes in two flavors: symptomatic or idiopathic. Symptomatic epilepsy has a diagnostic root cause such as cancer, stroke, autoimmune disease, liver disease, low blood sugar, toxin exposure, infectious disease, or congenital brain abnormalities. Idiopathic epilepsy has no identifiable cause. Although it may be inherited–certain breeds seem predisposed to the condition–this need not be the case.

Seizures strike without warning or pattern, and there is no way to determine in advance when they will occur or how severe they will be. They are upsetting to witness, particularly the first time. Despite appearances, the dog is unconscious during the episode and experiences neither pain nor panic, even though their eyes are open and they may vocalize. Duration of a seizure typically lasts less than one minute, though at the time of occurrence it seems far longer to any human witness. If a seizure episode lasts longer than 5-10 minutes, or occurs more than twice in one day, emergency care should be sought immediately.

It bears saying that any dog which seizes for the first time should be examined by a veterinarian as soon as possible.

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By the time we arrived at the clinic, Holly had emerged from the seizure, but was far from normal. She panted frantically, racing back and forth at the end of her leash in confusion, always returning to us as if asking for an explanation for what she was experiencing. Her tongue hung from the side of her mouth like a piece of bologna, flaccid and uncontrollable. She was desperately thirsty and ravenously hungry.

Dr. Mordasky took a brief history, including contact information for our regular vet and details of the seizure, particularly duration and Holly’s behavior before and during the episode. She gave her a physical examination and drew blood for a workup to rule out poison, infection, or problems with her internal organs. The results came back normal straight across the board.

Since this was Holly’s first seizure–and might, with luck, remain her only one–it was decided to not place her on medication at that time. Seizure meds are extremely strong and carry many side-effects, not the least of which can be damage to the liver over time. In the event of further episodes, we were encouraged to keep a “seizure log” specifying date, time, duration, and behaviors.

We took Holly home, bathed her to wash off the dried saliva and urine, and watched her closely, flinching every time she made an odd movement. For almost a month, nothing happened. Then, on September 8, came the second seizure. This one was shorter than the first–a “mere” 15-30 seconds–with similar behavior afterward. It occurred to me that both episodes had coincided with her having been given heartworm medication approximately 24 hours earlier. I called our regular vet to get her opinion. Dr. Gamble felt there was some plausibility to the idea, so we opted to change Holly’s heartworm medication and wait another month to see what, if anything, would happen. On September 25, Holly experienced a third seizure, but we believed it might be residual effect from the previous heartworm meds, so again we waited. However, on Dr. Gamble’s recommendation, I made an appointment for a neurological consult at Tufts University’s Foster Hospital for Small Animals.

Three weeks passed without event. Our hopes rose that we had found the solution to the problem. On October 20, neurologists at Tufts evaluated Holly’s behavior, coordination, reflexes, and nerve function. Based on her glowing results–and because idiopathic epilepsy most often strikes dogs between the ages of 1 and 3–they determined that her seizures were likely structural in origin, meaning that they were the result of a brain tumor or stroke rather than an over systemic condition such as organ disease, endocrine abnormalities, low blood sugar, etc. An appointment was made for a follow-up MRI and spinal fluid tap on November 3.

Much to their surprise, Holly came through with flying colors. Dr. Scoda, the neurologist in charge of our case, went so far as to describe the brain images as “beautiful.” Without a clear underlying cause for the seizures, we were left with a diagnosis of idiopathic epilepsy Because Holly had not had a seizure in almost five weeks, the decision was made to continue to hold off starting her on meds.

“Frankly, we’re surprised she hasn’t had another seizure,” Dr. Scoda said. She smiled encouragingly. “Maybe she’ll be one of the lucky ones who beat the odds.”

Unfortunately, luck wasn’t in our cards. On November 6, Holly experienced her fourth seizure. Two days later, she had another, this one longer and stronger than all the others. That evening, she received her first dose of Zonisamide.

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Anti-epileptic drugs are a lifelong therapy whose goal is to reduce the number and severity of seizures. Unfortunately, they cannot eliminate seizures entirely, and breakthrough episodes are to be expected. These drugs are not “one size fits all,” and it may take time to determine the dosage that best fits the needs of your pet. You should never discontinue anti-epileptic medication without first consulting your veterinarian. Doing so could endanger the life of your pet.

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It’s now been nearly a month since Holly’s last seizure. We continue to deal with a plethora of drug side-effects–lethargy, muscle weakness, anxiety, occasional loss of appetite, vomiting, and periodic soft stool–but we’ve been assured that these should pass in time, allowing her to return to her “usual” self. That’s in quotes because the reality is that Holly will never be quite who she was before this began. She forgets commands and sometimes displays a lack of confidence she never exhibited before, but she’s still our girl and we love her. We will walk this road together.

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Things to remember if your dog has a seizure:

  1. See your veterinarian as soon as possible. If the seizure lasts more than five minutes or your pet has more than one episode in a 24-hour period, seek emergency help immediately.
  2. Be proactive. This is a frightening time, but knowledge is power. You should view yourself as part of your pet’s treatment team. Talk to your vet and/or neurologist and ask questions. They should be open and willing to discuss treatment options and any other concerns you may have.
  3. Do research, but be skeptical of anything which makes exorbitant claims. When in doubt, ask your veterinarian to weigh in. Under no circumstances should you pursue a course of treatment for your pet without first checking its validity with your pet’s doctor(s).
  4. If you and your vet decide to put your dog on medication, do not stop using it without first discussing this with your vet. To do so could injure, or even kill, your pet.
  5. Continue to keep a seizure log even if your dog is not experiencing seizures. Note any unusual behavior.
  6. Keep all vet appointments and have your pet seen at least once a year for follow-up.
  7. Lastly, remember that most dogs will have fr more better days than bad ones, so enjoy those times with your pet.

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Followup:

Holly remained seizure-free for six and a half months. On May 20, 2017, she experienced a petit mal seizure. Almost a month later, on June 16, she had a 2.5 minute grand mal and Keppra was added to her drug regimen.

She remained seizure-free for five months. On November 17, she had a 1-2 minute seizure in the early morning … and another that afternoon, of approximately 3 minutes duration. Her Keppra dosage was increased and an appointment made to consult with Dr. Hammond, a neurologist at Pieper Memorial Veterinary Center.

After her examination, Dr. Hammond switched Holly from Keppra to Phenobarbital, along with her standard Zonisamide. We went through a month-long adjustment period; she experienced many side-effects but those have largely worked themselves out. As of this writing, she has been free of seizures for two months.

Emerging

Apparently it wasn’t enough that I’ve been battling “le crud” for nearly three weeks. The universe also felt it necessary to shoot three more book rejections across my bow, plus a short story rejection.

On the other hand, I was guest blogger on Jeanne Melanson’s “Animal Bliss,” writing about our recent experience with canine epilepsy, and received this most welcome  note from her:

“Hey Melissa!

Your Canine Epilepsy post was included in a “Favorite Dog Articles of the Week” roundup post on Puppy Leaks (.com). Your post is mentioned in one of the blog comments as well.

Bravo, girl! Oh, how fun.

Woo-hoo!

Jeanne”

And, as a response to the rejections, that short story has gone out this morning to another magazine. Never say die.

This Has Nothing To Do With The Presidential Election

And aren’t you glad about that?

This has to do with pharmaceuticals. Specifically, the drugs we buy to give our ailing pets. As some of you know, our eight-year-old Australian shepherd, Holly, was recently diagnosed with idiopathic epilepsy. Idiopathic means that no underlying cause for her seizures has been discovered despite a thorough physical examination, neurological examination, MRI, and spinal tap. This is all to the good, although it remains in the realm of possibility that she could have a brain tumor or stroke(s) too small to detect. In any case, we have moved forward with medication–rather than, say, surgery–and Holly is now on Zonisamide.

Allow me to relate a little story which is the point of this post.

Holly’s regular veterinarian, the brilliant and illustrious Dr. Jenny Gamble, called the prescription in to our local CVS at my request, which is down the street and very convenient. When I went to pick it up, the pharmacist said, “Are you aware of the cost?” Ding, ding, ding! went my internal warning system, but what choice did I have? My dog was having seizures and needed meds to control them or risk suffering brain damage. I replied, “It doesn’t matter. She needs the drugs.”

Wanna guess what it cost me? Go ahead, I’ll give you a minute …

$180.72.

You read that right. One-Hundred-Eight-Dollars and seventy-two friggin’ cents for 120 pills. Thirty-days worth of medication. $1.51 per pill.

I went home in tears, positive that we could not support that sort of expense for long. So not only had we lost a cat that year, but now our dog, too, would have to be put down because we couldn’t afford the medication.

Because Dr. Gamble had never prescribed this drug before–and did so now in conjunction with Holly’s neurologist, Dr. Laura Scoda–she didn’t know the cost. I sent her an email to let her know so she could keep future clients informed. When she came to the house the following week to put down our other cat–yes, that’s right; it’s been a helluva year, pet-wise–she thoughtfully provided me with a list of possible alternative companies where I could purchase the Zonisamide. “I’ve heard that CVS is one of the pricier pharmacies,” she said.

I’m so naive. Silly me to think that drug prices are regulated across the board.

Armed with Dr. Gamble’s list, I made some phone calls and did some online research. I contacted Canadapharmacy.com, Costco, Wal-Mart, and Simply Pharmacy. All of them were cheaper than CVS. By how much you ask? At the high end, we’re talking around the $60-70 range, so roughly less than half the price of CVS. I wound up choosing Simply Pharmacy. It’s a 40 minute drive to get there, but it’s worth it. (I also recently learned they’ll mail prescriptions, so that takes care of that.)

Guess what I paid.

$39.00

THIRTY-NINE DOLLARS, an easily accomplished .33 per pill. CVS had charged me nearly FIVE TIMES that amount. “Obscene” is the word my husband used.

I’ve no wish to denigrate CVS. I’ve been a patron many times in the past and never had an issue … but that’s because I was ill-informed. I bet a lot of people are. Take the time and do the research, friends. It could save you a bundle of expense. As for me, I won’t be going back to CVS for anything, despite the convenience. It’s just not worth it.