Kadie's "Episodes"

Kadie is a happy, beautiful (yep, I suppose that goes without saying!) Golden Retriever. Her owners noticed over the course of 2 years she has had multiple instances of possible seizure-like episodes. Kadie likes to spend most of her time out doors, so she could very well have had others that weren't witnessed by her humans. The one that brought her to us today was pretty typical of all the others. It seems she was just doing something normal, today it was drinking water, when her hind legs collapsed out from under her, followed by her front legs collapsing. Then she fell to her side and began paddling with her legs. The episode didn't last long, and her owner wasn't quite sure if Kadie was conscious throughout the episode or not. She seemed to be. She didn't lose control of her bowels or bladder, but she had at other times. Maybe it was because she had just come in from being outside that she didn't urinte this time. Who knows? We hadn't done a thorough physical exam or blood work on Kadie in quite some time so when Kadie's owners called to tell us of this occurrence, we advised them to bring her right in. They were very worried, as any of us would be.

Kadie seemed happy enough during her exam, as all good Golden's generally are. It was concerning that she had lost over 10 pounds since we'd seen her last, but her weight was good at this time-not too thin at all. She had no obvious neurological problems, her pupils responded normally to light, her feet righted themselves when placed upside down, a test of proprioception or "knowing" where her feet were in space. She could walk normally with out obvious swaying, tripping or wobbling, and there were no residual tremors. She did not show any signs of fear or pain, and her abdomen palpated fine-no obvious masses. We ran a complete blood panel which was essentially normal but couldn't get any urine-her bladder was still empty.

Ideally we would like to get a scan of Kadie's brain to rule out any brain lesions as the cause of these episodes. MRI's are fairly common in human medicine-I had one earlier this year on my shoulder after an auto accident. But they are expensive tests and would require a referral to a neurologist and a general anesthesia for Kadie-asking her to sit still for the time required to produce the scan just isn't possible in even the best behaved dog. I can think of only a handful of patients that received an MRI this year, including CJ, a way cool Border Collie with a spinal cord lesion that turned out to be an abscess only identified via surgery and biopsy and Prince, a Dachsund with a very serious (and common) intervertebral disc rupture and subsequent paralysis. I may write about these guys some other time as they were very interesting cases. Kadie won't be getting the expensive MRI at this time, but that's OK. Her history, her normal blood results, and her breed make her diagnosis of primary epilepsy a bit more likely, so we start off treating for that and see how she does.

We are going to start Kadie on an anti-convulsant medication called phenobarbital. It has been around for a long time, so we know a lot about how it acts in most dogs, what to expect for side effects, and how to monitor the blood for effects on her body long term. It can have effects on the personality of some dogs, but thankfully, these are usually transitory, going away after the first 5 to 7 days. If they don't, or if her blood work shows the effects on her liver becomes too toxic, we have numerous other anticonvulsant medications we can try. This is just a good place to start. The goal is to eliminate all seizure episodes, as every time she has one, Kadie lowers her "seizure threshold." This means that each seizure predisposes her to have another one, possibly another one more severe, or of longer duration. That is a scary thing for an owner to see, and such a helpless feeling not knowing what is going on or how to help. Hopefully Kadie's new medication will help her right away so she won't have to worry her owner's any more. Or worry her veterinarian!

Peace,
DrReneigh