Seizure Treatment Plan - Day 6

Stella’s appearance and behavior are still alarming to us.  She is catatonic and seems extremely depressed.  We worry that she could possibly drown in the dog water bowl because her legs are still so unsteady and she continues to fall face-forward so we picked up the bowl each time we left the room.  She has little interest in eating or drinking but it appears it is because she is confused and cannot focus.  She has been lying on a kitchen rug for most of the day.  At times her eyes are open but she is completely glazed over.

A few times today I sat on the floor with her and she was shivering as if she were sitting out in the cold snow – although we have the air conditioning on it is set at the same temperature as for the past month.  Maybe this is just a result of the powerful drugs? 

Still two more days until we can confirm her treatment plan with the Neurologist.  We feel so startled by Stella’s current catatonic state that we have made our own decision to stop the Gabapentin and just give her the seizure medication.  She is completely non-functional, depressed and we cannot stand to see her quality of life diminished in this way.  If stopping the Gabapentin does not help with her catatonic state we have discussed the fact that if the Neuro tells us her current condition is likely permanent we will opt to discontinue the seizure medications altogether even if it means she continues to have seizures and it shortens her life.  We cannot and will not allow this to continue.

 

Seizure Treatment Plan - Day 5

We called the hospital this morning to inquire when we could pick up our Stella.  They stated that she had just been giving the last of the loading dose of Phenobarbital and was pretty zonked out so we should not pick her up until late afternoon.

We arrived at the hospital around 4:30pm and were given Stella’s discharge instructions by an ER technologist.  When she could not answer some of our questions she sent in an ER vet to speak with us.  We were told to give Stella ½ tablet of Phenobarbital (full tablet =64.8mg) twice a day.  We were told this medication schedule is very stringent; we need to stick to a strict schedule, making every effort to keep it at the exact same times every single day and to not skip a dose.  We were told this is extremely important for the medication to be effective.  We were also told to continue with the Gabapentin, three times a day.  When we asked why Stella would need to be on both medications the ER vet was unsure and said that until we spoke with the Neurologist we should continue to give it to her. 

With all the different medications Stella has been on the last two weeks we asked if it was ok to still give her the monthly Heartworm  medication and Frontline protection for fleas & ticks.  The ER vet stated she ‘thought” it was ok but since she seems unsure we will hold off for now.  We do not live in a wooded area and Stella does not come into contact with wild animals and with all she has been through we haven’t taken her for walks so she is seemingly safe in her own fenced-in backyard.

When the tech brought Stella out to us in the waiting area we were quite startled at her appearance.  She could walk but kept turning her front paws over as if waking on her "wrists" and then would stumble and land on her face.  She would stand herself back up but it took several seconds and then she would fall on her face again.  Luckily being a Pug she is not far from the ground (and her face is already flat!).  Hopefully this is just a reaction to being loaded with powerful drugs and once she is on s steady medication  regimen this will wear off.

When we arrived at home, we decided that until Stella could walk properly, we would line our kitchen with small rugs so she would hopefully have more balance and not slip on the tile.  We also will carry her to the grass portion of the yard to protect her from hitting her face on the concrete patio.

*Because we have had dogs with various issues with walking, whether sick or injured, we have numerous rubber-backed bath rugs that we keep for these such circumstances.  I highly recommend that all dog owners have these on hand if you have wood floors or tile – but I hope you never have to use them.  Also the rugs are easily washed in the washing machine and easy to store on a shelf.

The rest of the night Stella was seriously disoriented, more like catatonic.  Maybe Baby Girl will be better tomorrow after a good night’s sleep in her own home.  We have doggy stairs for the girls to get up in our bed at night but we are worried Stella may fall so we will have her sleep in the kitchen to keep her safe - her sister Betty will keep her company.

Incidentally, we have decided her stringent medication schedule will be at 6am and 6 pm every day.

**HELPFUL SUGGESTION – if your dog is ever in a situation where they are in the hospital overnight receiving IV fluids be sure to line your car with WATERPROOF pads.  We have a heavy duty canvas car hammock for the girls in the backseat.  It keeps them confined to the back seat are and yet they won’t get tangled in seatbelts or leashes.  We also keep soft blankets on the hammock for them (spoiled spoiled spoiled).  Even though we let Stella relieve herself prior to getting in the car, once on the road she passed out and as her body relaxed all the fluids from the past 15 hours(!!!!) just seeped out everywhere; right thru multi layers of blankets and even through the thick “waterproof” canvas.  I have a “Dog Recipe” that I use to remove pee and vomit and it does work however one of the steps requires baking soda and although the smell is out of the car I cannot get the baking soda out of the grooves of the pattern of the fabric on the seat.  It looks like a bag of flour exploded!!!!

This “recipe” is the best method I have ever found and works to get the pee and vomit smell out of carpeting and upholstery.  If you would like it, leave me a comment.


 

Seizure Treatment Plan - Day 4

Stella had 3 full doses of Gabapentin yesterday; it is making her even more disoriented. 

At 12:15pm today she had yet another seizure.  Again, lasting about 20 minutes.  Less than one hour later she had another.  This last one was the “worst” one she’s had so far.  At one point, as I held her tightly, her entire body seized into a hard rock; it felt like she had turned to stone.  This lasted for just a few seconds and I felt her muscles relax and then she just sat there shaking.  We made the decision that 5 seizures in less than 48 hours was too much (I believe it is called a “cluster”) and we decided to go back to the ER.  Although this was in the middle of the day, the “regular” hospital was closed as this is Independence Day. 

By the time we arrived in the ER it had been one hour since Stella’s last seizure began and she was just coming down from it; this was the longest one yet.
 

ER vet examined Stella and came back to us to explain what he thought should be done.  He stated that there was no more waiting to put Stella on anti-seizure medication.  When we asked about the possible live damage or failure he explained that we were at a point where we needed to think about her overall well-being versus just the liver.  He stated that although anti-seizure medication CAN cause liver damage it doesn’t mean it will happen.  If Stella continues to have seizures, the seizures WILL cause brain damage.  So tending to her seizures now takes precedence over what MAY happen to her liver.
 

The ER vet told us we should leave Stella in the hospital overnight so that he can start loading her with Phenobarbital; the anti seizure medication.  We asked why we could not do this at home and he responded that although we could go home with Phenobarbital pills they would give her a loading dose thru an IV so that it gets to her system immediately to hopefully stop the seizures sooner.  He stated they would monitor her closely throughout the night and we could pick her up tomorrow afternoon.  He told us the Phenobarbital would make her really loopy and he expects that she will sleep most of the next 24 hours.  We proceeded to ask a gazillion questions about seizures and Epilepsy.  The ER vet was very patient and tried to answer as many questions as possible but pointed out he is just there to stabilize Stella.  All the neurologic and treatment questions should be posed to the neurologist.  We knew this of course but you know how it is when you’re worried and scared and given so much information to process; your brain doesn’t stop to pause and your mouth just keeps going. Incidentally, the neurologist will not be back in the office until Monday 7/8, four days from now so hopefully Stella will be stabilized until we can speak with her about future plans.
 

Later in the evening we called the ER to check on Stella.  The ER vet said that Stella is responding really well and remains alert.  He said he was surprised as most dogs usually “pass out”  from the heavy medication but he also pointed out that there were a lot of Pug Lovers working on the shift and they were giving Stella a lot of attention.  There’s nothing Stella loves more than adoring fans!!



 

Seizure Treatment Plan - Day 3

This morning Stella had another seizure; the duration was about 20 minutes. We called the ER (it was very early in the morning and the “regular” hospital section was not quite open yet).  We spoke with an ER vet and inquired whether or not giving Stella just two doses of Gabapentin per day as opposed to the prescribed three might be the cause of this additional seizure.  We have only been giving her two doses per day because our schedules would make two of the doses just a few hours apart which is not recommended.  ER vet stated she was unsure but that we needed to do whatever we could to try to give Stella the three doses a day as close to eight hours apart as possible.  She asked if we could have someone come into our house in the middle of the day or if we could set an alarm clock to give her one in the middle of the night.  Once Stella is on the Gabapentin three times a day, should she have another seizure, we should bring her back to the hospital/ER.

 

We discussed what we needed to do to make this happen.  We have decided that we will have to come home from work during our lunch time each day to assure Stella gets the pill three times a day.  Luckily we only live 15 minutes from our workplace so it is just a matter of scheduling.  If this is what it takes to get her back to normal, then this is just what we’ll have to do.  This regimen started today.

 

Later this evening, approximately 12 hours from this morning’s seizure, Stella had another one.  Again, lasting about 20 minutes.  As usual, I sat on the floor with her and held her as she cuddled into me, shaking and looking scared.  As with the other seizures she was unresponsive to our voices or movement but remained seemingly conscious – I say “seemingly” because her eyes remain open, whether or not she is actually “conscious” during the seizures we do not know.  

 

Four hours later I walked into the room and it appeared to me she may have just finished another bout of seizure activity.

 

As of this writing, Stella is sleeping quietly on our bed next to her sister Betty.

 

By the way, we find it interesting that Betty (nor the cat) has any reaction whatsoever to Stella’s seizures.  I wonder what they think?  Do they know just to leave her alone?  Are they aware of what’s happening?

Seizure Treatment Plan?

Spoke with the neurologist’s assistant again today (who, in turn spoke to the neurologist on our behalf).  She states that the treatment plan for now is to keep Stella on the Gabapentin 100mg and wait.  The suspected diagnosis is “Idiopathic Epilepsy”; “Epilepsy with no known cause”.
 

We are to continue with the Gabapentin and if another seizure should occur we are to call.  The neurologist wants to wait as long as possible before putting Stella on anti-seizure medications because they are very powerful and can be damaging to the liver  We were told it can cause liver failure.  If we are lucky the Gabapentin will be enough to stop further seizures since Stella’s are considered relatively “mild”.
 

Stella remains fairly disoriented.  We are hopeful her body will adjust to the medication and she will return to her silly, joyful, Puggy self.

Spinal Tap Results

Got a call from the neurologist’s assistant today stating that Stella’s CSF tap (Cerebrospinal Fluid) results were normal; no meningitis or other viral infection.  We were told there was an abnormality but that it is linked to Stella’s protruding discs as the neurologist indicated would probably happen.  I asked the assistant how we are going to proceed going forward and she said we would need to speak with the neurologist on Monday as she is off today.  For now, we are to keep Stella on the Gabapentin 100mg until further notice.  We informed the assistant that we are giving Stella Gabapentin twice a day as opposed to the prescribed three times a day due to our schedule and the fact that two of the doses would be fairly close together.  She confirmed with us that it is better to give the doses only twice a day rather than have two of the doses be only a few hours apart.

Meanwhile we have noticed the Gabapentin is making Stella fairly loopy.  She seems disoriented and has not been as animated.

Later in the day I called our regular vet to get her opinion on treatment options.  Dr. A said she wants to defer all of Stella’s neurologic care to the neurologist.  Once the neuro has the treatment course that is right for Stella she, our regular vet, will maintain the treatment from that point with medication dispensing, follow-up bloodwork, etc.

We will speak with the neurologist on Monday (7/1) and find out the treatment course and suspected diagnosis.

 

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.