Seizures in dogs (Day -296)

Dog bed

Something that has always got me is the first time I see something that I have read about or learnt about but never seen before. I came by today as a dog sat in clinic in its basket – asking for history I learnt that it was post seizure (what we call postictal in medical terminology). So a while later after stabilisation I am there when the back arches and the head goes towards the edge of the table so I reach to support it to stop the dog falling.

It is a split second and then that I realise what is going on. The mouth is wide open. The back arched. Legs fully extended sticking up in the air. And then the shaking starts.

It is the first time I have ever seen a full epileptic seizure in a dog. I now understand why pet guardians are so scared when their dog have a seizure and why we are taught that we need to support and educate them. It is scary. Even with all my training, knowledge and a great team of doctors around me it is a scary experience. We have already placed a cannula IV access and drugs so diazepam goes straight into the vein for quick effect.

The knowledge and ability of vets now to diagnose and treat dogs with epilepsy is vastly improved – in 1911 there was a paper published that actually suggested arsenic (a poison) as the cure for epilepsy. Now days however we have a range of anti-epileptic drugs including the newest drug Imeptoini which has less severe side effects when compared with phenobarbital and bromide. Statistically vets are able to manage around 80% of patients with epilepsy to a good quality of life; however it is management and so requires daily medication and attention.

It is very unusual however for the seizures to stop completely, however the treatment does reduce the frequency, duration and severity of the events allowing quality of life. It is however important to start treatment early as epilepsy is progressive and if there are repeated seizures there will be damage to the brain making further seizures more likely.

Something essential for owners is making a seizure diary to record when seizures are happening to help vets to manage the treatment to get this number as low as possible. There are even free online sites which you can use to record your dog’s seizures and monitor trends such as http://www.epiphenonline.co.uk/.

Unfortunately epilepsy seems to have a genetic link with a list of 48 breeds that have a higher risk of epilepsy than the general population. However the identification of the gene responsible for this has not yet been identified so it is not yet possible to do genetic screening tests. With this knowledge however it is important that dogs with epilepsy are not bred. In fact there is even a link between the sex hormones and seizure incidence so neutering and spaying may even form part of the treatment.

If your dog does have a seizure the best advice I can give is to try and stay calm, make sure that there is nothing around that they can injure themselves on, if you can place a folded blanket or towel under the head safely then do this to help protect it. Finally if it is the first time you’ve seen a seizure recording a video on your phone is a great help to your vet in working out the treatment.

The VET Festival for One Medicine – Day 2 Roundup….

Festival busker at vet festival

In his last lecture yesterday Noel said that he had txt God asking for the Sun to be turned on, and this morning it really was. For the first time all week my sunglasses came out of their bag and onto my head. However that is not what I want to write about so back to the VET Festival…

Today is day 2 (and the last day) of VET Festival 2015….

vet festival with Noels ordered sun

One of the first vets I met when I arrived at the Fitzpatrick Referrals center on Tuesday was Clare Rusbridge, one of the senior neurosurgeons at the center. On Tuesday I learnt a ton (I will write about this later!) and Wednesday even more, however today blew me away with an update on Canine Epilepsy. Pushing the limits of technology Clare used interactive txt polling to engage the audience. It was such a big topic that I will write a post just about this later, however the take home messages were that diazepam is not effective (I tested Clare’s reaction here to confirm it!) and that diagnostic tests do not exist for idiopathic epilepsy. Something else I was shocked by is that pharmaceutical companies consider a seizure drug “effective” if it reduces seizures by just 50% – personally this seems a low threshold for me…

Canine epilepsy with Clare Rusbridge

I then headed outside of the main lecture streams (they’re being recorded so I will watch every single one later!!!) however I wanted to learn some more about The Humanimal Trust. This new charity is all about vets and human doctors working together towards One Medicine – sharing expertise for the benefit of all. Even though we are both in the medicine field until today there has been little collaboration between vets and doctors. Actually when you look at the drug development cycle it takes around 13 years to get a new drug to market, and 10% of drugs do not make it on a mouse model… Yet if vets were engaged and dogs were used in the development the time and cost to develop new medicines would decrease greatly! The Humanimal Trust is all about animal and human healthcare moving forward together sharing advances.

The Humanimal Trust for one medicine

It then all became about the spine, such a small amount of time for such a big topic, and my first lecture with Noel. This was different to most with the opening words being about remembering that picking up a scalpel needs to be a carefully considered and thought out decision. It has become tradition for Noel to pick on a member of the audience to help with demonstrating different techniques, and today it was Ian Holsworth…

Noel Fitzpatrick demonstrating on Ians Holsworth

I then had the pleasure of hearing Laurent Findji talk about hepatobiliary surgery – this is surgery of the liver and gallbladder with the associated connecting duct to the intestines. Generally liver surgery is one of the more interesting parts of soft tissue surgery with some highly technical procedures. The liver is split into different lobes all connected to a central area – in terms of surgery the left liver lobe is a lot easier to remove than the right liver lobe. Also it is somewhere you need to be able to get good exposure as the liver sits right against the diaphragm at the end of the ribs.

Laurent Findji talks about hepatobiliary surgery

Something I was really interested in learning about were limb sparing surgery options where instead of amputation a bone (or part of one) may be removed and replaced with an artificial one or a part from elsewhere in the body. This was given by Will Eward from the Duke Cancer Center who is a vet and a human orthopaedic surgeon. During this I learnt loads that will be useful into my future – however the most important points were that when dealing with cancer it really is important that surgery should be planned properly, as correcting future mistakes can be devastating. Once a joint capsule is contaminated then it must be removed preventing artificial joints from being placed. The most dramatic surgery discussed here was a rotationalplasty which is where a knee joint is replaced with the ankle joint – success of this hinges on which way you rotate the foot.

Dr Jane Goodall speaking at VET Festival 2015

The last lecture of the weekend was delivered by someone that is a driver of change in the world for the better, Dr Jane Goodall. The room was packed, and this was the first speaker of the weekend to get a standing ovation from some of the smartest vets, vet nurses and vet students in the world. Dr. Goodall told her fascinating story of how she went from a little girl reading Dr. Doolittle to one of the foremost experts on chimpanzees. It is not my story to tell so I will leave it there; however it is a reminder of how one can achieve whatever they dream if they take the risk.

Dr Jane Goodall standing ovation

The VET Festival is now over; however the journey to One Medicine for One Health has only just begun and I hope that I, as well as you all will be part of it!