Angie (00:00)
Welcome back to Tails of Truth, where we tell the truth about veterinary medicine. I'm Dr. Angie, and this is my co-host and veterinary nurse, Extraordinaire Jojo. And today we are going to talk about what happens when your senior dog has one seizure. Just one. What happens? Some people go to the emergency room and have a very interesting experience. And Jojo, I have to tell you, I've had like

I would probably say six or seven cases over the last three weeks of senior dogs. I know. It's just like everyone's having a seizure right now. that's had one seizure and they go to the ER clinic, you know, case, V E G, wherever. And these emergency vets are starting my patients on anti convulsants And I've got an opinion about this and I don't like it, because that's my job. Okay. It's my job.

JoJo (00:29)
That's a lot.

Okay, okay. Let's start for the

for the listener. Okay. Cause I wanna he I definitely wanna hear this. interesting too, because I just came from my family home where my brother's dog is having seizures, but what is qualifying a senior dog? What is that? Okay, so if you have a dog nine or older, this episode's for you. And two

Angie (00:50)
I'm getting spicy.

I mean like over nine.

Or like seven

if you have a really big dog. Sorry. Sorry. Yeah.

JoJo (01:09)
That's true. That's fair. Like if you have

a Great Dane and your dog is nine, wow. Like okay. Yeah. Okay. So and what would someone classify like if they're at home, what is a seizure looking like? 'Cause they can look like different things.

Angie (01:16)
Yeah. Good for you. Yeah.

Yes,

they can. And so I can I can cover it to the best of my ability because seizures can look like a lot of things. But one thing you have to have for it to be a seizure or you need to have is a post ictal aura, basically where the after the seizure they're out of it. Like they're not right for a while. there's a difference between passing out and having a seizure. And passing out, you pop right back up, you seem with it.

But after you have a seizure, you are kind of discombobulated. Sometimes dogs will try to bite. They don't know who you are. They might cry or whine. but usually seizures are when dogs have convulsions and they lose consciousness. They often fall on the floor, they get their bodies in really contorted positions. A lot of times there's like paddling. Yeah, they'll evacuate their

JoJo (02:16)
They wet themselves, yeah.

Angie (02:22)
Their colon, their bladder, like everything is just they are out of control in every way. Yeah.

JoJo (02:29)
Mm. And

it's so hard to watch. Yeah.

Angie (02:33)
It's terrifying. Yeah.

E after twenty years of practice when I watch Animal seize it still alarms something inside me. Even though like I know what to do now and I don't panic, inside I feel it's really disturbing. It's really disturbing. So

JoJo (02:47)
Mm-hmm. I mean I got chills

when you said it. It's just like one of my least favorite things to witness. It just is. So when it's your own pet, it's terrifying. So of course they're rushing to the emergency room because my gosh, what is happening?

Angie (02:52)
Yeah.

Yeah.

my gosh. Yeah. What's what's happening? Is this a stroke? What's going on? And what will usually happen is the things that we can do right away is we can run blood work. We're looking for things like really bad hypothyroidism, which rarely happens, but it can. electrolyte abnormalities, some other disease process that's causing the seizure. Now, ninety-nine percent of the time.

you're not gonna find anything. Blood work's gonna be normal or there's gonna be some unrelated disease there. there's probably not gonna be underactive thyroid giving the cause. And so unfortunately, in these very senior patients that have one seizure, our highest suspicion is that we have a brain tumor or some kind of brain lesion, which is scary.

but I also want to say there are a subset of dogs that I see that have one seizure in their senior years and then never have another one. So I had one patient that had I think it was like a lab mix, and he had a seizure, I think, when he was like 11, and they went to the ER and the the ER put them on put them on steroids and anti-convulsants. And

A year later, the dog walks into my exam room for a an annual wellness, you know, visit and still on prednisone, still on an anticonvulsant. I'm like, well, I think your dog forgot to have a brain tumor because obviously there was just that one seizure and then never again. So they started the steroids thinking, there's probably a brain tumor here, but there wasn't. And so what I want to encourage everyone is if your dog has only had one seizure.

JoJo (04:30)
Ha ha.

Angie (04:44)
d you don't have to do anything. You can take them to the ER if you want, because I know it's really scary. Sometimes you just need someone to tell you it's okay. And it's an expensive thing to do, but like sometimes you just need it. Or if they've had more than one seizure, then yes, take them because then that that puts your dog in a in a different category, meaning that we need to do something to stop them. And I'm all for treating seizures. If your dog's having regular seizures and if they're especially if they're having more than one in a day, like when they're starting to cluster up.

We really do need to treat them because seizures beget seizures. But after one seizure, putting your dog on an anti convulsant, in my opinion, is incorrect. Incorrect. I mean, it's probably happened to me out of the six or seven dogs that have come to me that have had seizures, the ER vets have put them on anti convulsants. I mean, probably over half the time.

And I don't like that because it's not always the anti-convulsant I would pick. And they're not having the conversations about all the different types of anti-convulsants and how well they work. Well I had one, I had one veterinarian put my senior, senior patient on phenobarbital. And I was like, don't do that.

JoJo (05:46)
Mm. What are they putting him on? Keppra

⁓ I didn't know that that was like

the the standard. Yeah.

Angie (06:00)
It used to be, but like not

after one seizure. But the thing is phenobarbital can be sedating. It can have side effects. And I just thought, don't, don't do that. That's my choice to make. You don't you don't get to make that choice for me because I'm the one that has to manage that dog on an anti-convulsant. And that phenobarbital actually does require managing. Like you need to do blood work afterwards and see if it's in the right level. And I just I I really just want to encourage people.

Unless your dog's had more than one seizure, don't you don't I mean, you can take anti convulsants home, but like it really does require a whole conversation with your GP, with the person that's gonna be managing your dog.

JoJo (06:41)
And why specifically senior dogs and not younger dogs?

Angie (06:45)
So if you have a younger dog that has a seizure, it's just a different conversation because it's not that that can't be a brain tumor. It's just that it's more likely to either one, never happen again. Like my pug had a seizure when I don't know, I think it was like three, and then he never had a seizure again. I I did, of course, rush him to the ER and get blood work.

JoJo (07:08)
Think

just so you know, I probably would too. Well, can seizures be caused by toxicities?

Angie (07:14)
Sure, sure. Absolutely. Yeah. ⁓ yeah. So it's like something could be going on, but like if n you know, you don't have any other neurological signs and it's just a seizure, it's o it's okay and your pet is otherwise acting normally. It's okay to wait for another one to happen. 'cause I mean, all we can do is, check some blood work which is by and large normal. I I have to say in twenty years I've never found a smoking gun on lab work.

JoJo (07:16)
Yeah. Okay.

Angie (07:41)
Not to say your dog couldn't be the one. And maybe you'd find something else that you're glad you found. it's just that it's a low yield situation. And so if I had like I had a sixteen year old big dog in my exam room the other day, and we just kind of looked at each other and I was like, Hey, if if you want to run blood work, I'll do it. But what are we gonna do with what we find? You know what I mean? Like at what point? this dog's kind of on hospice at this point.

You know, he's like a hundred and twenty years old. And I'm not I'm not saying I'm against intervention, but to what end? Like I I really do think we need to be thinking about that. I think emergency vets are often just really trying to like squash the problem, stabilize, that's their job. But when it comes to like making those kind of more longer term medical decisions, I think you should do it with your general practitioner.

JoJo (08:08)
Yeah.

So if I'm listening to this episode, I now feel a little terrified if my dog has a seizure and there's something we're thinking something's happening in his brain. And so well how do we how do we see that? Okay, go ahead. Yeah, yeah, sorry. Well, if we're if we're good with younger, we can say so the younger ones you're not so worried about it because it or you're worried about it 'cause it's something different.

Angie (08:44)
Yeah. Okay. Are we talking about that senior are we going back to the senior dog? Okay, okay. Okay. So if we're the senior dog.

Well, might be epilepsy.

It's something different. It's just a different conversation. Then a senior dog that has a seizure, the first thing we think of, I wonder if there's a brain tumor. And so you should know that. You should know that. That that's that's our first, that's our first worry. And then what do we do with that? And sometimes it's not. And sometimes they never have another seizure. And so I think what's tricky and scary about seizures is that you had this bad thing happen.

JoJo (09:01)
Yeah.

Angie (09:26)
And then you're waiting for the next bad thing to happen. And that is terrible and anxiety producing and uncomfortable.

JoJo (09:29)
Exactly that.

So then that's where medication, I'm like I just don't want it to happen again. So which is why people might feel like, Okay, I'm gonna s keep my dog on steroids and anti convulsants 'cause I don't ever wanna witness that again.

Angie (09:47)
⁓ because you think that maybe you can stop it. Yeah. I know. That's tricky. The steroids, I I wouldn't do that unless we have another one, just because steroids have side effects. That's yeah. Like the steroids you would use if your dog had a brain tumor are higher doses that you wouldn't want to just live on just in case. So I think that and I had one patient, this is real

JoJo (09:49)
Yeah.

I say that steroids can have quality of life issues. Yeah.

No.

Angie (10:16)
unrelated but related. I had one patient that was on carprofen, which is non-steroidal anti-inflammatory. He went to the ER, they found some other disease, they took him off the carprofen, put him on steroids. He's having all these side effects and he's probably not going to live to get back on carprofen because the steroids cause so much side effects. And so I really, I don't want my senior patients long term on steroids unless I I did it.

Like the you know what I mean? It's like part of me is like, don't muck up my case, ER vets. We need to have an ER vet on. So we really do. I have some beef. I probably don't have beef with them, but maybe they can help me understand. But it really it presents a problem. And it's not that I mean, sometimes I do use steroids, but for dogs with really severe orthopedic disease, taking them off of their non-steroidal anti-inflammatory and putting them on steroids can sometimes be

JoJo (10:49)
Yeah. We really do. You've had some beef.

Angie (11:12)
life threatening. And so I don't know, I really hesitate.

JoJo (11:16)
Well, and a in an ER doctor

prescribing and having them start an anti convulsant and a steroid Like there's no reason to do that in that moment if there's not an urgent situation in which they need to start that medication that night.

Angie (11:29)
A hundred percent. Yes. Like I and

JoJo (11:30)
So you can

it it should be like in human medicine where like follow up with your GP in the next two to three days.

Angie (11:35)
Yes,

yes. Absolutely.

JoJo (11:39)
Are they doing

that because GPs have wait lists and can't get people in?

Angie (11:43)
I have no idea why why they are doing that. Or are some of these ER docs, did they used to be GPs and they just miss it and they're like, I know what to do and this is what I would do, which is fine for them, but you're not following up. I even had one I even had one ER doc bring the dog back to check phenobarbital levels later. And I Yes. And I just thought

JoJo (11:52)
Yeah.

At the ER clinic? That's weird.

And probably expensive. That is n

Angie (12:13)
Well, yeah, like what do you what

what are we doing? Making appointments like at the ER? I don't know. I just was like, I don't get this and yeah, and maybe there was something there I I don't understand. But if your dog is a senior and has a seizure, I just wanna say, let's wait for the second one to happen. Let's let's get an interval. Because if the second one happens in two days, that gives you a lot of information. If it happens in two months

JoJo (12:17)
Yeah.

Angie (12:39)
That also gives you information. Like whatever's happening isn't progressing that quickly. Because even if a dog has epilepsy and has seizures every two months, we don't treat that dog. We find seizures every two months to be acceptable. And so I think that I I wouldn't rush to treatment until we know there's going to be a problem.

JoJo (12:59)
Hmm, if a dog is having seizures or episodes every two months, do you just talk about lifestyle changes for that dog? Because I'm thinking I'm just thinking as a guardian, if I'm leaving the house and worried that my dog's gonna have a seizure, I'm probably gonna crate my dog now when I leave.

Angie (13:07)
⁓ so

Yeah.

because you were afraid wherever they might have a seizure. Yeah. Yeah.

JoJo (13:19)
I don't want them to fall down the stairs or you know. But usually I

think they go and find a spot I think they know it's coming. Yeah. So they usually go find a a spot in the closet or something.

Angie (13:25)
They do know. They do. Yeah. I I'm sure it feels weird. Yeah.

For those dogs, I put them on C B D and I have some Chinese herbs I use. And so there's lots of natural ways to manage seizures, but I don't necessarily do them until I know what I'm dealing with. Because even C B D, and while I think probably all senior dogs should be on C B D for their joints and their cognitive dysfunction and all of that, I really hesitate.

To say, hey, your dog had one seizure. I want you to start spending, and let's say you have a 70-pound dog. I want to put your dog on therapeutic doses of CBD. It's gonna be $100 a month. Like I feel really wary of doing that just to do it. And you know what? And maybe this is like I need to prescribe more, but I one thing, one dynamic that I'm seeing with.

the general population and veterinarians is like veterinarians are like we're we're gold standarding everything. I don't think I mean I just made that a verb, but we're doing gold standard for everything. And it makes medicine inaccessible. And it I think it makes people scared to go to the vets because now I'm looking at you and be like, I'd put my dog on C B D and by the way, it's another hundred dollars. I know this office visit was a hundred dollars. I know you spent six hundred dollars at the ER last night. And so I I feel really protective

of being accessible and not overdoing things, even if it is a plant, you know?

JoJo (14:56)
Well, I had another thought came up. If we are lessening the seizures by starting them on anti convulsants right from the start, are we actually taking away our ability to know what's happening with the dog?

Angie (15:11)
I mean, at the end of the day, if the dog has a brain tumor, there's not going to be enough anticoagulants. Or not anticoagulants. anticonvulsants Sorry. my God, it's so Friday. Anticonvulsants to keep it covered up, if that makes sense. Like we could probably lessen them, the severity and increase the interval, maybe, but at some point that's gonna pop through. Yeah.

JoJo (15:19)
I was like, wait, well that's a shift.

Okay, and so let's just go through one practical piece too. So if someone's dog is having a seizure and they're listening to this episode and they're like, Okay, I don't have to rush to the emergency room, how are they managing that seizure at home? 'Cause there's some do's and don'ts.

Angie (15:52)
there's some do's and don'ts. Yes. So one, you don't want to put your hands near your dog's mouth, especially afterwards. Nice dogs will bite you. They're not themselves. They're not in the right mind. A lot of people are bitten by their dogs either during a seizure or post seizure. It's really, really common. so you wanna give them space. if they're about to crash into something, you wanna

give them space. But oftentimes it happens so fast that there's not a lot of time to do anything. And so, you want to make sure that they're not in danger. They're not going to swallow their tongue. they are probably going to urinate everywhere and defecate everywhere. So that's gonna happen. And then you just wanna like, give them space. don't try to feed them right away. Just give them space and let them come out of it.

JoJo (16:39)
Good tips. The the biting one. Everybody wants to just like pull them close and hold them and your dog's just not in their normal state of being. ⁓ it's not personal. Yeah, and it's not

Angie (16:48)
Right. They're gonna bite your in they're gonna bite your face. And they're not gonna mean

to. It has nothing to do with their personality. Yeah. Yes.

JoJo (16:54)
Yeah. Exactly. Okay.

Did you cover everything you wanted to?

Angie (16:59)
Yes. And if you want to talk about your dog that has seizures and if you want me to go over their medical records, and if you want to get a personalized plan, maybe you do want to talk about Chinese herbs and CBD, you can book a consult with me at boulderholisticvet.com. You can hit book a consult on the upper right corner We'll have a Zoom call, it'll be recorded.

And we can make a plan that is tailored just for you and your dog.

JoJo (17:26)
sounds great. And if there's not a time that comes up, please email us info at boulderholistic vet dot com and we'll find a time for you.

Angie (17:31)
Yes.

We will. Okay. We'll see you next time. Bye.

JoJo (17:40)
Bye.