I’ve recently spent some time within some of the top oncology (cancer) referral vets within the UK and been in consults with people who have to be told that the biopsy says it is cancer. One of the most difficult questions that pet guardians will then ask is how long a loved pet has left – this is an awful question that has to be answered so carefully because we just do not know.
We try to use evidence based studies looking at different treatments when discussing the options – however these studies over use statistics to give averages. Unfortunately within veterinary research many studies only have a small amount of patients which is caused by the way the veterinary industry works. This means that when looking at a study with average life duration from start of treatment of 3 months that some dogs may have died at 1 week whilst others lived until 9 months or a year. I am personally starting to believe that statistics should be limited to use only in sample sizes over a defined minimum limit to improve reliability (I wrote about statistics here).
However what is missing from most of these studies is perhaps even more important and is the second question that most pet guardians ask. That is what the quality of life is like. It is something that may sound strange however it is much easier to quantify quantity of life (i.e. days) than it is quality (i.e. happiness) of a pet.
This is still something in it’s infancy within veterinary medicine – with humans we can explain that it will hurt now but it will mean that they are good later. The first time I saw this discussed was within surgery decision making in the AWSELVA journal in 2014 (J. Yeates & S. Corr) to evaluate treatment options based on the amount of painful time vs the amount of pain free time.
This is something that is difficult though as we need to define how we recognise the quality of life. For example if we consider movement as an indicator as recently there have been studies using accelerometers (step counters) to monitor the activity of an animal. A study just published used this to measure the physical activity in dogs receiving chemotherapy as an oncology treatment which may be acceptable.
However if we look at dogs with neurological problems that may have abnormal circling or pedalling movements then activity may not be the best quality of life. Here is where other techniques may come into play with things such as a seizure diary being kept to record frequency and duration of seizures to allow comparison of good time vs bad time.
Hopefully soon we will have better measures for the quality of life – and be able to apply these when making decisions that may impact animal welfare.
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.