Another seizure...and then another...

Yesterday (6/26) we came home from work it and was a day like any other.  Stella greeted us at the door and then ran off to grab a toy (her strawberry ice cream cone) and then proceeded to tease me with it so I would mock scold her “hey, that’s MY ice cream…”; something we do every single day.  She and her sister, Betty, went out into the yard to relieve their bladders and then “walkies” was announced and they came running to put their harnesses on.  We noticed Stella was walking a bit slowly but it was very humid and we know she has that torn anterior cruciate ligament (see previous post).  We decided to cut the walk short and went back home; we had walked 2 blocks total.

As we walked in the door we proceeded to take off their harnesses as usual and the girls went to the water bowl.  Unfortunately both of us were in different rooms for just a moment when I walked back into the kitchen to find Stella “coming down” from what appeared to me to be another seizure.  She was completely disoriented, staring at nothing in particular and trembling.  I sat down on the floor and she immediately cuddled herself into me.  I held her and talked to her with a soothing voice all the while she trembled and stared off.  She was unresponsive to me saying her name and would not look at me.  Several minutes later I tried to move away from her but she was aware enough to know that I had moved and then slid herself back in between my legs.  As a test, I tried to give her a treat;  she smelled it in my hand but seemed confused as to what to do.
 

We remembered what the oncologist told us in April when we reported Stella’s first seizure (at least the first one that we know of).  Dr. F. had consulted with the neurologist at that time and we were told if it happened again we were to go to the emergency room.  At that moment it did not appear that Stella was in imminent danger so we chose to drive the 40 minutes to the specialty hospital’s emergency room rather than the one 5 minutes away from our house.  The specialty hospital is where Stella sees the oncologist, the orthopedic surgeon and where the neurologist is.  To keep continuity with all of Stella's health issues we feel it is important to try to keep all of her care at one facility if possible.  When we arrived Stella could walk, but very clumsily.  We explained what happened to the ER technician and she then took Stella to be examined by the Emergency Room physician.  10 minutes later they called us into a room.  The ER physician walked in with Stella bouncing next to her eating a cookie and then she proceeded to eat two more cookies.  She seemed back to normal.  From the time we noticed her behaving oddly to this time it had been approximately 1 hour.  The ER physician stated that all of Stella’s vitals were normal and because she appeared to be fine she did not want to give her any medication.  She stated that we could leave Stella at the hospital overnight where they would monitor her and the neurologist would see her in the morning or we could take her home and play it by ear.  Since Stella was bouncing about we decided to take her home.  The rest of the evening she seemed like she was 95%, just a little bit off, and she slept quietly throughout the night.

Today (6/27) at 5am, 12 hours from the seizure, we walked into the room and again saw her coming down from another apparent seizure.  She was standing and appeared to be frozen in mid walk with one paw up staring at the wall;  she looked like a statue.   Again I sat on the floor with her and she collapsed into my arms just wanting to be held. 

With both seizures she did not lose consciousness, she did not pee, vomit or defecate, and she did not attempt to vocalize.

We immediately put her in the car and drove back to the specialty hospital emergency room.  When we got there the ER physician (a different one) stated that he thought Stella appeared normal but we insisted to him, as her owners, we KNEW she was not normal and would need to see the neurologist.  We also discussed the fact that the neurologist had consulted with the oncologist in April and was the one who recommended an MRI should a series of seizures occur. 
 

Since we didn’t have a formal appointment and because Stella was seemingly not in immediate danger we were told to leave her at the hospital and the neurologist would see her at some point during the day and call us.  We were assured that until the neurologist saw her she would be monitored by the staff.
 

We told the ER physician that we indeed wanted Stella to have the MRI but wanted to be called PRIOR to anything being done to her outside of a physical exam.  We also told the ER technician this before we left.  The reason for this, explained in detail in an earlier post, was because we had a dog that had an MRI that showed a catastrophic event; the dog had no hope and would die within weeks.  Instead of calling us first, the surgeon chose to have our dog woken up and THEN called us to tell us the bad news.  So instead of giving us the option of having him put down while he was still under anesthesia, he was woken up and we then had to have him put down an hour later.  It was such a horrifying and infuriating experience.  We swore we would NEVER let that happen again and so we make our wishes CLEAR before signing off on anything. 
 
Luckily this was early in the morning and Stella had not eaten anything since dinner last night so she was good to go for an MRI or any procedures requiring anesthesia. 
 

Later in the afternoon we received a call from the neurologist’s assistant.  She stated they were about to start the MRI.  I asked if Stella was under anesthesia yet and when she replied “yes” I got a bit upset and told her we specifically asked to be called FIRST.  The assistant stated she was never told this and was very upset with the staff.  I told her the reason why we wanted to be called and said the bottom line was we just wanted to be clear that Stella is not to be woken up if there is a catastrophic finding; we were to be called first.  She said she understood and we told her we would head back to the hospital so we could speak with the neurologist when the MRI was finished.  A minute later the phone rang and it was the neurologist herself calling to apologize that they did not receive our instructions.  Dr. C. reiterated that what they would be looking for on the MRI would be any abnormalities in the brain, like a brain tumor.  She explained that dogs with Epilepsy are typically diagnosed before the age of 3 and that later in life it can often times be caused by a brain tumor or other abnormality.

We headed to the hospital and when we arrived they had just finished the MRI.  Incidentally, this was the first time meeting the neurologist.  We had spoken to her on the phone only; she was recommended to us by our regular vet and the oncologist. Dr. C. told us that there was no tumor activity and that the MRI was negative for any abnormal findings; thank goodness.  She also said they performed another abdominal ultrasound (which, oddly, we don't recall them telling us they wanted to do) and that her organs remain free of Mast Cell Tumors (just as with the last ultrasound  in April) and there was nothing alarming to indicate seizure activity.  She did however state that Stella had a “disc protrusion” in her neck.  Dr. C. believes this protrusion, although pressing on her spinal cord somewhat, was not likely to cause the seizures.  She also stated that they would not perform the surgery to repair these discs as the more pressing issue is the seizures and it should be addressed first. She explained that because Stella had not gotten into any toxins or had any head injuries there was a possibility of a viral infection such as Meningitis.  To test for Meningitis they would need to perform a Cerebrospinal Fluid (or CSF) collection; also known as a spinal tap.  Unlike with humans the spinal fluid is not collected through a puncture in the lower back, but from the neck and brain stem area.  Dr. C. explained that the risk was fairly high in doing this type of procedure because of the location of the needle puncture.  We asked if something were to happen to Stella as a result of the tap, would it appear days or weeks from now or would she know right away.  Dr. C. stated they would know right away as it would be obvious while they had her on the table. 

We discussed the situation in detail with Dr. C. getting her opinion on whether or not we should pursue the tap.  We had to make this decision fairly quickly as Stella was still anesthetized.  In the end we decided that because we still do not know what is causing the seizures, the neurologist said it was the obvious next step to take, and given the fact that she was already anesthetized and would possibly save her from anesthesia an additional time (good golly this dog has had a lot of anesthesia in her lifetime) we would allow the tap to be performed.  Also, Dr. C. said Stella should have no pain from the tap afterwards.  
 

One other thing we discussed was the fact that IF something horrible did happen at least Baby Girl was under anesthesia and wouldn’t feel anything, even if we had to let her go.
 

A short while later Dr. C. came into the waiting area and said everything went well and we should have at least preliminary results by tomorrow.  She did however warn us that the results may not come back as 100% normal because of the disc protrusion but that the results should still be able to tell us whether or not Stella has a viral infection.

In the meantime, Dr. C. has prescribed a pain medication, Gabapentin 100mg.  This medication although meant for pain (if Stella's disc issue should bother her) is known to possibly help prevent seizures when given at a high dose.  We are to give Stella this medication (pills) three times a day.  The technician explained to us that the medication can make Stella "loopy" and should it make her too loopy we can reduce it to twice a day. 
 

We waited several more hours for Stella to recover from the anesthesia and then took her home where she has been sleeping soundly after her big eventful day.