Canine Epilepsy

Epilepsy was the first major condition Sara developed. For those who have not seen a dog have a seizure before, it's one of the most disturbing things you'll ever witness in your dog. It's even worse when it happens in the dead of night and you have no idea what is happening. The seizures normally lasted anytime from 1-2 minutes to 3-4 minutes.

Diagnosis
At the first opportunity we took Sara in to our regular veterinarian, Dr. Leanne Byers at All Critters Animal Hospital in Sammamish, Wash. While it was difficult, we videotaped a few of Sara's subsequent seizures so we could ensure a proper diagnosis. Dr. Byers later told us that it was difficult for even her to watch the video and she didn't know how we had the sense of mind to tape it. After some bloodwork and a few other tests, she was fairly certain it was epilepsy.

We wanted a definitive diagnosis and we also wanted to rule out everything else, so next came a consultation with Dr. Michael Harrington, a veterinary neurologist. He initially concurred with Dr. Byers that, based on all her symptoms, Sara had epilepsy and that we may never really know what caused them. In an effort to further rule out any other possible conditions, Sara was scheduled for an MRI.

The MRI experience was interesting in that there aren't too many veterinary facilities with this capability. There was a place about 35 miles south in Tacoma, Wash. that had one exclusively for animals, but we opted to take her someplace closer. The facility, located in Kirkland, Wash., was actually primarily for people so we had to go after all human patients had been seen for the day. It almost felt like we were sneaking in because the appointment was after 9 p.m. While we were waiting I noticed that the walls of the waiting room were adorned with autographed photos of the Seattle Seahawks. Wow. Sara was at a facility good enough for NFL athletes! I think I was more excited about that than Sara was.

Dr. Byers joined us as she had never witnessed or participated in an animal MRI before. Sara was prepped by a vet tech for the procedure, which she would be anesthetized for, and once the last human patient was done she was wheeled into the MRI room. The actual scan did not take that long so, while she was a bit groggy, Sara was ready to go and get out of there a short time later.

After review by the radiologist and Dr. Harrington, neither found anything that would directly be causing her seizures. Therefore, it was everyone's final conclusion that Sara indeed did have idiopathic epilepsy. Meaning they didn't know why she had it, just that she had it.

Treatment
We learned that her epilepsy could be controlled with medication. She was initially prescribed phenobarbital, which needed to be administered every 12 hours. It took a while to determine the minimum dosage required to control the seizures. The minimum was important because phenobarbital taxed the liver functions. One grain twice a day seemed to be the right dosage so she was on that dosage for the next several years.

We were warned that because this was a narcotic, we may notice her staggering about until her body built up a tolerance to the phenobarbital. We had to keep a good eye on her for the first several weeks as she would stumble and have a hard time keeping herself upright when she went to potty.

At this point, I'd like to point out that while Sara was a very sweet dog, she was also a very active and alert dog as well. This meant she would get up to investigate the slightest noise such as the house creaking in winter as the furnace warmed it or the sound of a car door closing outside. She would sit up, growl "arrrrrrrrrrrrrrr" and jump down off of her sofa perch to check out what the disturbance was all about. After starting on phenobarbital she was still the same sweet dog, but she mellowed out quite a bit. Early on, it did appear as though she was drugged. We don't know if we just got used to her being that way or if Sara started to adjust better to the medication, but Sara seemed to be as normal as she could be.

It was at this time, I setup a dog cam so we could monitor Sara while we were at work. The dog cam updated every 30 seconds and created a time lapse movie that we could review when we returned. This proved to be very helpful for two reasons. One, it gave us a little peace of mind when we were not there and two, it allowed us to document and monitor and seizures she may have suffered.

The seizures did not stop outright. The key here is that you get to a point where you can minimize the seizures so they are not happening every day, but instead once a month or so. We started to note what happened during the day in which Sara suffered a seizure to see if there was a pattern or a specific incident that may have triggered it. The majority of her seizures took place very late at night or very early in the morning, often after she had been asleep for serveral hours. We were not 100% sure, but she did appear to have seizures after long, eventful days such as going to see a vet for a blood draw or having a lot of people visit the house. We also did notice that Sara had suffered a seizure after going to take Santa pictures at the mall two years in a row. We don't blame Santa, but that tradition was short lived because of that correlation.

Modifying Treatment
In the summer of 2004 when Sara was diagnosed with an oral fibrosarcoma (cancer in the mouth), we were referred to Dr. Alan Schreiner to see if we could lower Sara's dose of phenobarbital. There was concern about the load on her liver. By this time she also had lupus so she was taking a whole set of medications for that as well. In addition, she was undergoing chemotherapy. Dr. Schreiner evaluated Sara's current dose of phenobarbital and suggested we supplement it with Neurontin (Gabapentin). The goal was to lower the dose of phenobarbital to help lower the load on Sara's liver. Neurontin apparently did not tax the liver as much. With some trial and error (Sara had a period of having more seizures than usual) we found a mix that worked.

Lowering the dose of phenobarbital also had a nice side effect. A few months after Sara's dose was reduced, the old Sara seemed to be back. She seemed more alert and her trademark "arrrrrrrrrrrrrrr" growl was back with every little disturbance. While we found this a bit annoying in the past, it was a great sound this time around.

Conditions

Here is a list of the conditions Sara had over a period of nine years (in order of occurrence):

1. Idiopathic Epilepsy (seizures)
2. Discoid Lupus
3. Lupus Profundus/Systemic Lupus Erythematous (The discoid lupus developed into this condition)
4. Corneal Dystrophy
5. Recurrent UTI (urinary tract infection)
6. Oral Fibrosarcoma (high grade)
7. Peripheral Neuropathy
8. Nodular Hepatopathy
9. Cutaneous Lymphoma

Sara

EmmaSara1_2
Originally uploaded by HenryYamamoto.

Meet Sara. This is a very special photo of her as it truly captures her spirit and personality. It was taken by Bev Sparks in Seattle, WA. I highly recommend her. And that's Sara's older sister Emma in the background.

Getting Started

I've been meaning to do this for quite some time and decided tonight was the right time. My hopes for this blog are to provide others with comfort, support and information if they have a dog with similar conditions. Over the nine short years Sara was with us, I've Googled many conditions, procedures and medications to learn about the many medical issues Sara suffered from. I often found others going through similar experiences and their words provided me with hope. My plan is to chronicle Sara's life and provide details on how her conditions were treated. If any bit of this information can help others, that's all I can hope for.

I'm not sure if I want to start at the end and work my way back from there or to start at the beginning. I'll decide before the weekend is up and start posting.