Thursday, December 18, 2014

Nutritional Management of Canine Epilepsy

by Nancy Kay, DVM 

Epilepsy is far and away the most common cause of seizures in dogs. 


While it is an inherited disease in some breeds, it can occur in dogs of all breeds, shapes, and sizes. Dogs with epilepsy typically experience their first seizure between one and six years of age. Epilepsy is a “rule-out diagnosis”, meaning there is no specific test to define that a dog has it. Rather, the diagnosis is made after ruling out other known causes of seizures.

The mainstay therapy for canine epilepsy consists of anti-seizure medications, using an individual drug or a combination of them. 

The impact of nutrition on seizure control was discussed in a recent article  appearing in the Journal of the American Veterinary Medical Association. Here are the article highlights.

Ketogenic diets

Diets that cause the body to produce an abundance of ketones (an acetone-like product made when fat is used as the primary energy source) have been used to treat epilepsy in people. These ketogenic diets are very high in fat, low in carbohydrates, and are calorie restricted. Typically, the ratio of fat to combined carbohydrates and protein is 4:1 or 3:1.

It is uncertain exactly how ketogenic diets provide benefit for some people with epilepsy. It is known that, in a state of starvation, ketones are the primary source of energy for the brain. An increased concentration of ketones on a regular basis appears to diminish seizure activity. Additionally, higher levels of omega-3 and omega-6 polyunsaturated fatty acids may subdue seizures by decreasing the excitability of nervous tissue and altering levels of brain chemicals called neurotransmitters.

Approximately two thirds of humans with epilepsy who consume a ketogenic diet experience a reduction in their seizures. These diets do have their drawbacks. Not only are they highly restrictive, creating issues with patient compliance, they can be associated with adverse side effects. For these reasons, ketogenic diets tend to be recommended for people with severe epilepsy who fail to respond to traditional therapy.

Whether or not ketogenic diets benefit dogs with epilepsy has not been adequately studied. Moreso than people, dogs are somewhat resistant to developing ketosis (high blood levels of ketones). Potential complications associated with feeding ketogenic diets to dogs include dietary deficiencies, nutritional imbalances, and issues caused by a high fat diet, such as pancreatitis, gastrointestinal disease, and obesity.

Phenobarbital, a drug commonly used to treat canine epilepsy, notoriously causes increased blood levels of a form of fat called triglycerides. Add to this equation a diet that consists of 80-90% fat, and one may be creating a recipe for disaster.

Effect of body composition

Although not studied in dogs, the authors of this paper suggest that the normal metabolism of anti-seizure medications (how long a drug dose lasts in the body after it is administered) may be altered in dogs who are significantly overweight or underweight. This can result in loss of seizure control because of medication levels in the bloodstream that are too low. Conversely, medication levels in the bloodstream that are too high can cause drug overdose symptoms.

The authors of this article emphasized that maintenance of an ideal and stable body weight is important for dogs with epilepsy. This can be a challenging proposition given that increased appetite is one of the most common side effects for many anti-seizure medications.
Effect of diet and urine pH

The rate at which anti-seizure medications are eliminated via the kidneys can be impacted by the pH of the urine. (The pH defines how acidic or alkaline a substance is.) One study documented that dogs whose urine was alkalinized (pH increased) experienced a more rapid elimination of phenobarbital compared to dogs with more acidic urine.

Dietary components influence the urine pH. Prescription diets used to prevent bladder stones and/or urine crystal formation in dogs do so by significantly altering the pH of the urine. Such diets should be used extremely cautiously in dogs receiving anti-seizure medications. The combination of treatments has the potential to cause loss of seizure control at one extreme and symptoms of drug toxicity at the other.

Dietary considerations with bromide therapy

Potassium bromide is a medication commonly used to treat canine epilepsy. The bromide component is interchangeable with naturally occurring chloride in the body. The key here is that the body maintains a constant sum of bromide and chloride. So, increasing one will cause a decrease in the other. For example, a sudden transition to a high-chloride diet would hasten the elimination of bromide from the body, resulting in lower levels of bromide in the blood stream and potential reduction in seizure control. Conversely, toxic levels of bromide in the bloodstream can occur if chloride intake is significantly reduced.

Sodium chloride- aka salt- is the major source of dietary chloride. Consistency in what is fed, including treats, is of paramount importance for dogs receiving potassium bromide.

Dietary supplements

In recent years there has been much interest in health benefits of the omega-3 fatty acids, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). DHA, in particular, has been found to play an important role in brain development. In epileptic rats, DHA and EPA have a protective effect on neurologic tissues, perhaps because of their anti-inflammatory properties. It has been suggested, but not documented, that long-term administration of omega-3 fatty acids may have a similar effect on dogs with epilepsy. Additionally, these fatty acids are known to reduce high blood triglyceride levels, a common side effect of phenobarbital therapy.

Taurine is an amino acid (a component of protein) that has been shown to have possible anti-seizure properties. A study using taurine in a limited number of epileptic cats documented improved seizure control. No such studies have been performed in dogs.

Take home messages

Clearly there is a great deal more to be learned about how nutrition can influence the management of canine epilepsy, including possible effects of raw versus homemade versus processed diets. The limited knowledge available at this supports the following recommendations:
  • Talk with your veterinarian about the role diet may play in managing your dog’s seizures.
  • Strongly consider dietary supplementation with omega-3 fatty acids for your epileptic dog, particularly if phenobarbital is part of the therapy.
  • If your dog is receiving anti-seizure medication(s), do not alter his or her diet before discussing the intended change with your veterinarian.
  • Avoid high-salt treats if your dog receives potassium bromide for seizure control.
  • Do not alter the dosage of your dog’s anti-seizure medication(s) without first consulting with your veterinarian.
  • Do your best to help your dog maintain a healthy body weight.

Have you ever cared for a dog with epilepsy? If so, did you alter his or her diet as part of the treatment plan?

***

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook


Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

Did you get your copy of Speaking for Spot yet?

If not, go get the book. It's likely the most important dog book you'll ever read.


Articles by Dr. Kay:
Reasonable Expectations: The Ability to Discuss Your Internet Research With Your Vet
Finding Dr. Wonderful And Your Mutt's Mayo Clinic: Getting Started
Even The Best Veterinarian Can Make A Mistake
A Different Way to Spay
Making Tough Medical Decisions For Your Dog: Lily's Story
If You Don't Know What A Lick Granuloma Is, Count Your Blessings!
Anesthesia-Free Dental Cleaning 
Talking Teeth 
Urinary Accidents
I Can't Believe He Ate That! Foreign Body Ingestion 
What Caused Murphy's And Ruska'sPneumothorax?
The Whole Picture: When The Test Results Don't Match What's In Front Of You 
Stop that Scratching
Veterinarians And Vaccines: A Slow Learning Curve
What is a Veterinary Specialist? 
Veterinary Specialists: Oncologist 
Veterinary Specialists: Cardiologist 
Veterinary Specialists: Internist 
Veterinary Specialists: Neurologist  
Veterinary Specialists: Surgeons 

Tuesday, December 16, 2014

Palmer's Hemoabdomen: Nearly An Unnecessary Death Sentence

by  Krista Magnifico, DVM

I met Palmer two years ago when she arrived with her mom and siblings fresh off a transport vehicle from a high kill shelter in the south. 


She was one of the many rescue kids we see because we work so closely with Black Dogs and Company Rescue. She happened to be walking into the examination room as my friends were visiting me in the front reception area. Within about 30 minutes of arriving at our clinic she was in my friends arms and on her way to her new home.

Palmer was in the clinic almost weekly at first as we struggled to get her up to date on her vaccines,  get her nourished, de-wormed and used to being on a leash with a family. We spayed her a short time later and she was the little black shadow who went everywhere with her busy family. I saw her, and spoke about her often.

On Saturday November 8, 2014  I got a call from Palmer's concerned mom

Palmer had vomited a few times, was panting and was lethargic. 

I asked if she had gotten into anything? Or had been injured? They assured me that she hadn't. I was getting ready to go to a dinner party and told them that I thought she should be brought to the emergency room. They elected to continue to monitor her through the night and wanted to bring her in to see me in the morning. At 9 pm I received another call that she had worsened and they were on their way to the ER. At 11 pm I called to check on them.

Palmer was pale, dyspnic  and tachypnic (short troubled, rapid breathing). 

She was critical. An x-ray of her chest was taken and showed that she had blood in her chest. She was placed in an oxygen cage to help her breathe better. I spent the next hour talking to them and the ER vet. It was a clear reminder of how frightening and fragile life is. The ER gave Palmer's family a $3,000 estimate and wanted a deposit. They couldn't afford this.

Palmer's chest is full of blood causing her lungs to be squished to the back of her chest.
Therefore, they cannot expand normally,
hence her panting and lethargy.

So Palmer's life was left hanging on an x-ray and a list of possible etiologies. 

Hard as we tried we couldn't get her history to fit a likely scenario. This is where an experienced ER vet, a diligent devoted and observant family, and a pet with a complete and accessible medical record make all of the difference in the world.

Her family left her at midnight to see if the conservative plan of oxygen, fluids, and time would help. At 8 am Sunday morning I called back to check on Palmer. Her family was electing to euthanize her because they couldn't afford to do all of the diagnostics the ER was proposing to try to diagnose her. They wanted to bring Palmer to me at the clinic to look at her. I was sad, frustrated, and my typical stubborn obstinate self. "Please don't bring her to me so I can kill her." It was a selfish thing to say. But I meant it. I told them that I was going to do whatever I could to save her. I meant that too.

I tried repeatedly to get some clue as to what had happened to her that could have caused this. 

They reassured me over and over that it couldn't be a toxin, or trauma. That left a few bad, and likely untreatable, scenarios left.

I called the ER again and spoke to the vet. We both knew that Palmer's family was leaning toward euthanasia. Together we talked about Palmer's case. The ER vet hadn't run any diagnostics outside of an x-ray because her family had declined them due to cost.

If Palmer didn't get a diagnosis quickly AND cheaply we believed she would die. 

It is a terrible real-life predicament.

"OK," I said to the ER vet. "Palmer is 3, it is probably not a tumor. And, even if it is we can't treat that. (Too expensive and very poor prognosis). There is no evidence of trauma. Just run a PCV/TP and a coag(ulation) profile. That's the only real possibility that is treatable."

Ten minutes later, and for less than $100, Palmer had a diagnosis; Rodenticide poisoning. 

She was bleeding into her chest from ingesting rat poison. Her family did not use it, and she had no known access to it, but it was inside of her and killing her. She was immediately started on vitamin K.

A few  hours  later she was still critical and still fighting for her life.

Her parents called me again and I opened my big mouth, again. "She needs plasma." The ER's price for this was $600. "I'll give you mine or pay for what she needs." A day later Palmer left the ER wagging and happy.

She made a full recovery in a few days.

Turns out she had gotten an animal carcass from the mulch they had delivered two days before she fell ill. (Don't use rodenticides anywhere. Please! .It kills more than rats every single day. There are more humane methods to keeping pests out of your house. (My favorite.. 4 cats!)).

Two days later she came to give me a hug at the clinic. I live, and work, for those hugs.

Palmer changed the way I practice medicine. 

She changed the way I am accessible to my clients.

I called the two emergency clinics that we refer to and asked them to call me if one of our pets was there and was being euthanized because of cost or uncertainty. I can't change fate, disease, or the fact that medical care can be expensive, but I can change that powerless fear that many people euthanize over. Or, at least I can try.

If you have any  thoughts on Palmer's story I would like to hear them. 

Please leave a comment below, or you can find me on Twitter @FreePetAdvice, or at the clinic, Jarrettsville Vet, or on Pawbly.com. Pawbly is an open online comunity for pet people. Our goal is to empower you, educate, and assist you in taking the best care of your pet as possible. Pawbly is free for everyone to use and open to all pet lovers.

***

Krista Magnifico, DVM owns a small animal hospital in northern Maryland, where she practices everyday. She wants to make quality veterinary care available to everyone, everywhere at any time; trying to save the world 1 wet nose @ a time.  Her blog is a diary of he day-to-day life & the animals and people she meets. 

Dr. Krista is also the founder of pawbly.com, free pet advice and assistance.

To contact her, you may leave a comment on her blog, email her or catch her on Twitter or Facebook.

Articles by Dr. Magnifico:
Don't Make This Mistake: Ruby's Death To Heat Stroke 
Parvo: Cora's Story 
Jake's Laryngeal Paralysis
The Tip Of The Iceberg: The Unexpected Dental Dilemma
The Ear Ache That Wasn't Going Away: Tottsie's Story
Cody's Eyelid Tumor
Ruger's Mysterious Illness
The Day The Heart Stood Still: Timber's Story 
Different Definition Of Comfort Food: Levi's Story 
Savannah's Pancreatitis  
Histiocytoma: Rio's Mysterious Bump
Von Willebrand's Disease: Greta's Story 
Alice's Heart Murmur  
Jekyll Loses His Tail Mo-Jo 
Pale Gums Are An Emergency: Bailey's Story 
To Amputate Or Not To Amputate: Heidi's Story
Lessons From A Real-Life Veterinarian 
Charlie's Life Saving Lipoma Surgery  
Understanding and Diagnosing The Limping Dog, Why To Probe The Paw 
Angus' Dog Fight And The Consequences
When To Induce Vomiting And When It's Not A Good Idea  
Abby's Survived Being Run Over By Car But Sucumbed To A Mammary Tumor


Do you have a story to share?

Your story can help others, maybe even save a life!

What were the first signs you noticed? How did you dog get diagnosed? What treatment did/didn't work for you? What was your experience with your vet(s)? How did you cope with the challenges?

Email me, I'll be happy to hear from you!

Monday, December 15, 2014

Adoption Monday: Jo, Rottweiler, Albany, OR

Jo is a sweet, playful, senior girl, in good health, weighing about 70 pounds.


Jo would love a family that has another medium to large dog to play with her.

Jo is good on a leash, knows how to sit, and I comes when called.


She could be your best friend. 

Jo was raised in a home with small children, lots of little animals, and kitties as well. She is house trained, spayed and current on vaccinations.

Please email Fran@k9homefinders.org for an application.

***

K-9 Homefinders & Rescue, Inc. is a no-kill, 501-C3 non-profit, organization that was started, in Albany. OR. in 1980, and they have been rescuing dogs for 30 years. 



Sunday, December 14, 2014

Retirement By Mr. Dawg Momma

by Jerry Rade

At the end of the  Summer I reached a point where I could retire. 


I thought that I had it all figured out and could avoid the pitfalls that are often encountered by people when they retire.

First, don't buy a pickup truck. 

If you have one, sell it or give it away as fast as you can. Buy a Smart car. Otherwise you will become the local mover for friends and family. You also get to clean up after renovations, bring in topsoil, etc. With a Smart car no one can ask you to help.

Move away from family and friends. 

Otherwise you become free labor. It's nice that everyone wants to help keep you busy, but no one is wanting to pay for the weeks you spend renovating their kitchen. It seems that retirement is often mistaken for free help.

So, Jana and I mover north to Jasmine's Ranch (not in a Smart car, we have a Suburban. You try getting two Rotties, a wife, and yourself into a Smart car). I had great visions of working through the day on our property and relaxing in the evenings.

My thoughts were that once Winter hit I could go into semi-hibernation. 

Since I no longer had to work I could get up when I chose, have a nice and relaxed morning, and just putter about for the rest of the day. After all, I was finally retired, right?

My plan was sound, but I didn't fully consider the missus's thoughts for how my life should now be.

So, I get up earlier than everyone else and get a bit of time for a coffee. If I sleep in I miss out. 

Then a bit of a walk outside with the dogs. Back in so the dogs can have breakfast. 

Then out for a leisurely one and a half hour walk with the dogs through the bush. Then it's back home and I usually have to run into town to get more ingredients for the dogs home-made meals. 


After all that I get to have a bit of lunch and then it's back out for another one and a half hours through the bush with the dogs. And, of course, out twice in the evening for the dogs' bathroom breaks.

So, it seems that my sweet, darling wife is making sure that I don't get bored, and the dogs are certainly enjoying the time spent running through the briars and brambles.

And I just keep thinking that going to work was much easier.

Articles by Jerry Rade:
The Ups And Downs Of Dog Ramps
Living With The Dog Mamma: (Part 1) The Rest of the Story
Living With The Dog Mamma: (Part 2) A Dog In The House  
Living With The Dog Mamma: (Part 3) Maybe Having A Dog In The House Isn't Such A Bad Idea After All  
Living With The Dog Mamma: (Part 4) The New Puppy
Living With The Dog Mamma: (Part 5) Big B
Living With The Dog Mamma: (Part 6) JD 
Living With The Dog Mamma: (Part 7) It's A Male Thing 
Living With The Dog Mamma: (Part 8) Females Versus Males 
Living With The Dog Mamma: (Part 9) You Can Train A Woman 

Friday, December 12, 2014

Veterinary Highlights: Lyme Disease And Ticks New Infosheet

Lyme Disease & Ticks new infosheet is available on Worms & Germs Blog.


It covers important topics such as what is lyme disease, what are ticks, where they're found, how they transmit diseases and how you can protect your dog.
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