Seizure Action Plan

This is our typical course of action when an epileptic seizure occurs. We have everything already in place all the time “just in case” and have learned this through trial and error really and what works best for Harrison. All dogs are different, but this is what seems to work for him.

Preparation takes the pressure off a little in a crisis

Advanced checklist: After a while you will do everything required on autopilot, but in the beginning it may help you function in a panic if you create yourself a checklist so you can methodically follow the steps.

Create a safe place: Our kitchen is Harrison’s safe place, as there are limited obstacles when we need to act fast. We switch the cooker hood/extractor fan light on (without the fan), which provides enough low level light without being dazzling. During the day, we shut the blinds to dim the light. He also has access to the garden easily from the kitchen for when he’s ready to go to the toilet. When a seizure strikes we pick up his water bowl (tipped over way too many times!) and move his bed and toys out to the hallway, then there is nothing left for him to fall over. We also lay down a couple of rugs which help him walk and stabilise on the floor, as he really struggles on the wooden floors after a seizure. We have 2 of these HULSIG rugs from IKEA which cover almost the entire kitchen floor and fit in the washing machine one at a time. Not bad for £9 a piece! 🙂

Emergency Meds: Always have your emergency meds ready to go. Packets and pills can be fiddly when you’re on red alert, so make your life easier by preparing so you can tend to your dog efficiently in a crisis.We keep Harrison’s emergency levetiracetam (keppra) tablets and valium tubes (diazepam)* in a specific container in the kitchen – ensure you always adhere to the drug storage instructions so they can remain as effective as possible. *Please note, this emergency medication was specifically prescribed and instructed by our neurology/canine epilepsy specialist.

Emergency veterinary attention: If things escalate at home, call your vet or out of hours emergency line ASAP. Save both numbers in your phone in advance so you can act fast. We have been advised to take Harrison to the vet should he suffer any more than 2 seizures within 24 hours, as he will need IV fluids & IV medication to stop the cluster of seizures.

Recording the seizure: It may help to keep a pen & notepad near the emergency meds. You need to make a note of the time, date, duration, any special characteristics of the seizure. You will need to keep a full seizure log to recording all of your dog’s seizure activity and if you visit your vet or a specialist they usually want to review this. There are lots of good seizure log templates available online, I found the templates available on the Epiphen website really good. I created my own version in Microsoft excel though, because I’m a geek! 🙂 Our specialist wanted a log which combined the seizure log and medication log as well, so was best to tailor it to suit our needs. Our first neurologist recommended the RVC epilepsy app tracker, but I found it a bit rigid and the export wasn’t in a very usable format either. It might work for some though 🙂

How you can help your dog

Remain calm and if you talk, make sure its relaxing and reassuring. Sometimes silence may be best. If you get any pre-ictal warning signs a seizure is incoming, turn off lights and other stimulus and take your dog to the safe place you have created for them. At this point, you can give them their emergency medication if they will eat it/take it (Harrison hasn’t ever been able to at this stage, as he’s already too spooked).

We have previously tried to put his Thundershirt on during the pre-ictal stage to see if it helped with his seizure or recovery or general distress. In our experience it didn’t seem to help much, but it did mean that he urinated during the seizure, which doesn’t normally happen (due to the compression I guess!). I will add, the Thundershirt has been effective in calming or relieving anxiety at times outside of seizures (when we started puppy class for example and  he wouldn’t sit still!:))

During and after the seizure your dog may overheat, so this is another factor when considering using the Thundershirt, as that will keep the heat in even further. We use ice packs and/or soaked towels to keep him cool. Its best to cool the ears & paws, an ice on the spine can help the seizure activity.

I should add, you need to react accordingly to your dogs seizures. If it lasts any longer than a few minutes and you have already tried diazepam to no avail, or don’t have any at home, then you need to call the vet ASAP. A prolonged seizure is called status epilepticus and can be very damaging/fatal. So read the signs and get the necessary help if you are worried. We had to do this when Harrison got stuck in a cluster, he had 9 seizures within 2 hours and needed IV drugs to break out of it.

Some people claim they have good results with natural calming products such as Pet Remedy or natural essential oils, even things like Bach Flowers Rescue Remedy. Rubbing essential oils into the ears or a few drops of rescue remedy in their water bowl or directly on the tongue can help.

Following the seizure your dog may be paralysed, deaf/blind, confused, disoriented but when they start come round you will want to get their blood sugar up. Some people suggest using a decent, organic ice cream but we found this too stimulating for Harrison, it made him go hyper. We find it most effective to give very small amounts of food often and scatter across the floor so he can sniff it out and find it. This helps to focus his attention and stop him going frantic or gulping it down too quickly.

When the seizure strikes:

  1. Stay calm.
  2. Turn off bright lights and other stimulus (mobile phones, games, tv, radio etc). If you have other animals, ensure they are kept away to avoid any unnecessary stress.
  3. Make a note of the time when things start kicking off.
  4. Take your dog to their safe place, as soon as its safe to do so (you may not always have this option before the seizure occurs).
  5. Protect their head and stop them hurting themselves during the seizure.
  6. Be careful around their mouth area in case they have a jaw snapping motion during the seizure, or in case they may bite out of fear.
  7. Administer emergency meds/remedies, if you are using any.
  8. Try to keep them cool.
  9. When they start to come round, remain clam and talk in soft, reassuring but positive tones telling them they’re a good boy/good girl. You may want to stroke them gently, but be wary as they may be a bit jumpy. Some dogs may show aggression as they’re so frightened, so be  very careful.
  10. Administer any post-seizure medication/remedies you have been advised to give as soon as you are able to.
  11. Give plenty of food, they will likely feel ravenous and you need to get their blood sugar up.
  12. Give your dog the time and space they need to recover and just ride it out together. Remember it is probably worse for you to witness, than for them to endure.
  13. If things don’t seem to be improving, call your vet/emergency line ASAP.

Harrison’s seizure events usually last 60 minutes from start to finish. This starts at the point of the seizure itself right through to end of the post-ictal pacing, restless period. After plenty to eat, some pacing about, toileting outside and a nice big drink of water, we know he is probably almost ready to crash out finally. We let him sleep and recuperate until he indicates to us he is ready for walkies or playtime. By the time he wakes up he is his happy go lucky, cheeky self again!

Nutritionist Help

We had a consultation with a canine nutritionist yesterday. After deciding to switch to raw feeding we were keen to enlist the help of someone experienced and knowledgeable in this area to ensure a smooth transition and a controlled approach.

I had done a lot of research myself of course, but like with the start of our canine epilepsy journey, it seemed a bit of a minefield, there were so many different comments and conflicting recommendations I thought we’d be best consulting someone who knows what they’re doing!

We had a great consultation with thedognutritionist which wouldn’t have been complete without Harrison having a seizure half way through….! Poor little dude, he made a speedy recovery though and is his usual self again after plenty of food, water and rest.

Admittedly, we’d made a few mistakes with his medication since the 1st November (administering the wrong meds at the wrong time) so we have had to implement a better system to prevent this from reoccurring. Obviously you are riddled with guilt after something like that, but at the same time we are only human and mistakes can happen.  I bought a new, larger pill box / dosette box to try and keep us on track. It has 4 compartments for morn, noon, eve, bed administrations. I managed to find it in Poundland, so was only £1, I noticed they’re very expensive in pharmacies! We actually need 5 compartments for 6:30, 7:30, 14:30, 19:30, 22:30 doses but the pill organisers with 5 sections were massive and really expensive. So for now we have kept the 2:30 dose in our original 1 week pill organiser as this is easier for our dogsitter as well, as this is the only dose she administers, so hopefully we can remember during the weekends and keep all his meds on track. I have re-labelled all the sections with correct times, drugs names and dosage too, so hopefully we wont have anymore mishaps for a good long while!

Going back to the raw feeding and nutrition, we’ve only got about a week’s worth of kibble left so are starting the transition now, starting off with a bland protein (chicken) and building up from there. I fed him some raw chicken yesterday as a little test and he wolfed it down, so I think we should be ok! Will be interesting to see how he takes to eating stuff with bones. A lot of people cite great success with raw feeding for epilepsy management in dogs. Our neurology specialist has mentioned ketogenic medium-chain TAG diet as well in her most recent report. This is a high fat, low protein, low carb diet essentially. Good job H loves coconut oil! 🙂 (I should probably get on a better diet myself, all this comfort eating is definitely taking its toll!)

 

 

Where do we go from here?

It’s been a while since my last post. We have been busy implementing the new medication plan, desperately trying to get Harrison’s condition under control and its been such a tough few weeks. Everything is new territory for us; new signals, warning signs, patterns, different behaviours, different seizure characteristics – it’s all completely new.

He had a few seizures whilst we were at work too, so we had to get a full time dog-sitter in which is very expensive, but we thought we’d stick with it for now whilst we try to get things to a manageable level at least and were advised by the neuro to minimise stress* as much as possible (*separation anxiety). The aim being to reduce the dog-sitting hours over time as his seizures strike less often.

I’m afraid we’re not quite there yet though, things are still very much in progress. We’ve not managed to reach a good stable, control level with his meds and have to keep fine tuning things. But overall, it is not looking good at the moment.

We’re pleased that his seizures have definitely become less violent, he recovers more quickly and he is only suffering 1 at a time now, rather than clustering into several. Which is good progress. But the frequency remains too often still, with seizures occurring every few days. Even the specialist is concerned and surprised by the fact he keeps on having seizures with all the meds he’s on. He’s a unique specimen that’s for sure! Poor little boy.

We’d already accepted when we started with the specialist early September that by Christmas we believe this will be sorted one way or another, his condition will either be under control or he wont be with us any longer. Its horrible to think like that, but I think we have already come to terms with it now. I am feeling less optimistic than before, as the specialist is so surprised his fits continue 😦

Further bumps in the road

I suppose it was foolish or blindly optimistic to think it would all be plain sailing since we consulted AHT on Harrison’s epilepsy.

Things have definitely been better, but the seizures keep coming, which we’re surprised and anxious about. Even Luisa seemed disappointed when I called to update her. She just explained she has a lot of work to do to get the right balance for him, but at the moment things are quite blind until we get true peak & trough blood samples taken to see how he is adjusting to his new dose, what kind of level does he have in his blood and is there more room to maneuver.

As ever, it never rains it pours, so amidst all of this Harrison has also had an upset tummy on and off too. In addition to the standard knock on effect that his ability to cope alone when we’re out at work seems to take a downward turn also (right back to square one).

So right now feels like groundhog day, we’re going over old ground with some of the behavioural changes and its so hard to see his separation anxiety exacerbated again, especially as we worked so hard to build him up to a good level. But, on a positive note the last couple of seizures (this morning and before that, on Monday morning) he has only suffered one fit in isolation (this is great progress!) thanks to the new seizure emergency plan we have with his meds and also he seemed to bounce back really quickly following the seizure too. He had his usual 1 hour of postictal pacing and bumbling into the walls, but after that was quite lively, energetic and coordinated. The devastating part is that both of these seizures occurred whilst we were out at work, he was alone in the kitchen. We have a camera setup so we can keep an eye on him, heartbreaking watching the footage of him convulsing on his own and coming round all confused and disoriented. Much harder than going through it in real life, to be honest!

 

 

The Expert Experience

The weight has been lifted from my shoulders.

We had an excellent consultation with Luisa De Risio at the AHT on Friday. Luisa is the leading author of a book on canine and feline epilepsy and she is a member of the International Veterinary Epilepsy Task Force. Luisa is an editorial board member of the Journal of Feline Medicine and Surgery and Associate editor of the Veterinary neurology and neurosurgery journal.

Things had deteriorated very rapidly with Harrison, so we got referred to AHT for what we considered to be the last chance we had to gain some control of Harrison’s condition, or we would have to make the decision to have him put to sleep as he was suffering too much.

So we attended the appointment feeling quite bleak and like this was our last chance really, but safe in the knowledge that if we had to make the final call, at least we could do so knowing we had exhausted every option.

So it was a relief and quite emotional to learn that the specialist is very confident she can help and there is loads of room for improvement. Yippee! So now, onwards & upwards! We can concentrate on getting his condition under control and if we end up with a difficult decision to make later down the line then at least we know we tried everything possible to help him.

Celebrating a mini victory!

Not wanting this blog to just be the negative or pessimistic ramblings of a desperate woman, I thought it was time to write something a bit more positive!

I am so pleased to say that Harrison is feeling much better today, thank goodness! 🙂 He’s celebrating by chomping on a brand new stag antler! 😀

He is still not 100% his usual self, but much closer to that than he was at the start of the week. Still a bit barky and bitey, but overall more calm. Our boy is coming back to us 😀

So we have our appointment with the neurologist tomorrow morning and will be able to discuss an action plan for how we move forward.

I believe with the right mix of medication and the appropriate meds for during/post seizure we will be able to manage this beast and Harrison can have a lovely, normal life.

Isn’t it funny how catching up on some much needed sleep alters your mindset completely on challenging situations! Being able to get on and do some housework yesterday was very therapeutic also and the window cleaner came today too 🙂

Current mood: Feeling optimistic & determined!

The bad run continues

We should have been at the airport now, sipping complimentary drinks in the Aspire Lounge at London Gatwick, waiting to board our flight to New York. I was so excited about it, my first time in NYC!

Instead I’m sat at home in a filthy, dirty house too scared to get up and start tidying and cleaning up as Harrison has  finally settled off to sleep and I don’t want to wake him up. The poor lad is exhausted, well, so are we. This recent blip I have written about before turned into a very rocky week long patch and we felt completely helpless. Leaving us with no choice but to cancel our trip to NY and get H in to see a canine epilepsy expert ASAP, before we lose him.

I was scheduled to go to New York with school in October 2001, but they cancelled the trip after the terrorist attacks. Maybe its a sign? Maybe I am not really ever meant to make it to New York?

Anyway. Things kicked off last Wednesday evening around 21:00, but the seizures continued for about 14 hours and he never really recovered in between, even though the duration between was longer than normal. Our vet prescribed keppra as a cluster buster, but it barely touched the sides. Yes the seizures seemed to subside short term, but Harrison was manic, frantic, endlessly pacing around. The brain activity was clearly still going on and the keppra was fighting against it, but it didn’t seem to be enough.

Then the seizures kept coming, we never expected more when he was put on keppra, but sure enough seizure activity broke through. I said there and then I didn’t feel comfortable leaving to go on holiday and we needed to cancel/postpone/reschedule and do whatever necessary to get him sorted. Crisis point you could say. Not sure how much more of this he or we can take.

So we’re booked in to see Luisa De Risio, Head of Neurology at the Animal Health Trust Friday morning. Essentially, if she can’t help us then no one can! Luisa is a leading canine epilepsy expert and has even published a book on the subject, which I refer to on my Resources & Info page.

Feeling optimistic, but at the end of the road really, this is our last chance to get him hopefully the right help, or we have to call it a day. It’s not fair on him and he’s not himself at all.

He barks constantly, like a frustrated helpless bark and is even biting us accidentally during play, but much harder than a play bite, so we can’t sustain this for very long.

For anyone who’s ever been in this situation, my heart goes out to you. It’s absolutely awful and you constantly question whether its fair to even carry on for the time it will take to try and regain some control. This moral, ethical conflict is really hard!

At least he is asleep for the moment, so we get a minute’s peace. But we’re living in fear that the phone ringing or any other external noise will wake him up and we’ll be sent right back into that sick cycle of frustration, which takes him so long to snap out of and settle down from.

At least after Friday’s appointment we should know whether there is any hope, or whether we’re just prolonging the inevitable. I’ve already made my peace with it and don’t feel that sad as I write this or think about it now. I know I would be sad, devastated, if we had to have our poor, sweet boy put to sleep, but I would feel reassured that we had taken things as far as we physically and mentally could, sought the best advice and care available and tried everything we could for him, before making any rash decision.