Emergency Care - Related Articles

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Back Problems (T3-L3 myelopathy)

One of the most common spinal problems seen in dogs is paraparesis or weakness of the rear limbs. You may see that your pet suddenly cannot use his/her hind legs, or the problem may develop more slowly. In acute cases your dog may be completely normal and just a moment later unable to stand or walk normally. In chronic cases the disease may progress gradually making it sometimes difficult for owners to see the changes as the dog becomes weak over time. While older animals may gradually become weaker with time because of muscle wasting, they should not have signs of paralysis or abnormal coordination.

The signs of paralysis may be mild with dragging or wearing of the toes, reluctance to move or inability to walk as far, sitting down frequently during walks, or reluctance to jump or climb stairs. Signs can progress until the dog is falling spontaneously or when walking. In cases with acute and severe hind limb weakness-paralysis, you should have your pet examined by a veterinarian immediately (a complete physical exam and neurologic exam will be performed). Acute paralysis of both hind limbs is an emergency situation and time may be critical. Initial diagnostics most likely will include x-rays and blood work. More severe paralysis and delayed time to evaluation by a veterinarian may affect long-term prognosis.

Thoracic and lumbar spinal cord (the spinal cord running along your dog’s back) diseases are the most frequent cause of inability to use the hind legs. The diseases causing hind limb paralysis can be divided into compressive and non-compressive. The signs of paralysis in compressive spinal cord diseases are caused by external pressure to the spinal cord. The most common causes of spinal cord compressions are disc herniation, bleeding or fracture. In contrast, the non-compressive spinal cord diseases are caused by changes inside the spinal cord without pressure from outside. The typical example of such disease would be the interruption of blood supply to the spinal cord (fibrocartilaginous embolism) or bruising to the spinal cord caused by trauma. The distinction between the two groups is an important part of developing a treatment plan. The compressive diseases need surgical decompression as soon as possible and the non-compressive diseases require medical treatment. Advanced imaging (CT, MRI, or myelogram (a dye study)), performed under general anesthesia, is used to determine where the lesion affecting the spinal cord is located and if surgery is indicated. Surgery is performed to release the pressure on the spinal cord so that the material (disc material, a blood clot, or bone fragment) which has been pressing on the spinal cord and affecting limb movement is removed and the spinal cord can recover its function. In cases where no compression is found, medications or supportive care are indicated to help the spinal cord recover from trauma, blood supply interruption (FCE), swelling or secondary inflammation. In cases of suspected infection or inflammation, a cerebral spinal fluid (CSF) tap, for evaluation of the spinal fluid, may be indicated to make a diagnosis and guide treatment.

Two of the most common causes of loss of hind limb function are fibrocartilaginous embolism (FCE) and intervertebral disc disease (IVDD). FCE is where a small amount of disc material becomes lodged in a blood vessel and affects nerve function to the limbs. The hind limbs are most commonly affected, but the front limbs may be affected as well. FCE is often seen after a dog is playing in the yard, yelped once, and then is unable to use its hind limbs. It is generally a non-painful condition, but may be painful at first. Larger breed dogs are more commonly affected, but other breeds may also be affected by FCE. Pets usually respond well to medical management and aggressive supportive care with this condition, but the recovery period may be very long.  FCE is a diagnosis made by ruling out all other causes (with diagnostic testing, including advanced imaging). FCE may mimic intervertebral disc disease, which is a compressive lesion where disc material compresses the spinal cord. FCE requires advanced imaging in order to obtain a diagnosis and plan for surgery. Commonly affected breeds include corgis, dachshunds, basset hounds, beagles, French bulldogs, and Pekingese, and they can be affected at a young age. Other breeds that are affected include German Shepherds, Labrador Retrievers, and Doberman Pinschers.

Prognosis in the paralyzed patient is mainly dependent on the severity of paralysis at time of evaluation, the duration of the clinical signs, and the underlying cause. The best results are achieved when patients are examined and treated before the limbs are totally paralyzed (they are still able to use their legs, even if not normally). The prognosis may be guarded in patients with no pain sensation in the hind limbs. If deep pain perception is present or your dog is still able to move his/her legs, the chances for recovery are generally good if addressed in a timely fashion.

Victoria Fields, DVM

Blood Transfusions

Written by Julie Aiello, DVM

Many pet owners are surprised to hear that like people both dogs and cats can have blood transfusions. Here at VRCC transfusions of several types are done regularly.

Dogs and cats are most commnly given transfusions of packed red blood cells (PRBCs). PRBCs are used to restore the oxygen carrying capacity to the blood of a patient that is suffering from anemia (a condition characterized by a decreased number of red blood cells or hemoglobin in the blood), and are one of the most important blood components used in transfusion medicine.

Small animals may also receive a transfusion of plasma for conditions causing abnormal blood clotting and low protein levels. Most commonly these conditions are seen in animals exposed to rodent poisons such as D-Con.

Currently we get whole blood, PRBCs and plasma from blood banks where the blood donors are tested for many types of infectious diseases and are blood typed.  Years ago the only blood products available were from dogs and cats owned by staff at veterinary hospitals or community members.

Dogs and cats have blood types that are different from each other and different from people.

Cats have either type A, type B or type AB. Type A is most common in the US. Cats do have to be blood typed prior to the first transfusion as they produce antibodies to other blood types.

Dogs have a more complicated blood typing system involving many different factors. Their blood type system is called the DEA (dog erythrocyte system). Dogs do not have to be blood typed for the first transfusion, but do need blood typing for later transfusions.

Transfusions save the lives of many of our dog and cat friends.

Coyotes

Written by Vickie Fields, DVM

At CVES we have seen an increase in the frequency of coyote attacks on pets.  All wildlife, including coyotes, can be a threat to your cat or dog.  Here are some recommendations for keeping your pet safe.

It is recommended that you keep your dog on a short leash (not retractable leashes) when you take him out for a walk. Even within your backyard, you should closely supervise your dog and never leave a pet alone outside, as coyotes do come into yards. Commonly, life-threatening attacks are made when a pet is unsupervised within a fenced in backyard in an urban setting.

Do not leave any pet food outside. Garbage should be stored in a garage or shed. Trash should go out the morning of trash collection, and not the night before. Clean your garbage cans regularly to reduce residual odors that attract coyotes.

Cats should also be kept inside, or also supervised in a confined area if outside.

If a coyote approaches you or your pet, you can throw rocks or sticks to frighten it away. You will want to use a loud, authoritative voice to frighten the animal. Do not approach a coyote. Coyotes are more commonly seen at night, but when coyotes live in an urban area, they are generally less timid and are frequently seen during the day.

If your pet has been attacked by a coyote, he should be seen right away by a veterinarian for evaluation. Even if he does not appear to have sustained any injuries, he could be in shock or could have internal injuries that you do not see. He may have life-threatening wounds or injuries that need to be addressed quickly. The veterinarian will examine your pet and will start any immediate necessary treatment, and then develop a plan for further care with you.

At CVES we have seen an increase in the frequency of coyote attacks on pets.  All wildlife, including coyotes, can be a threat to your cat or dog.  Here are some recommendations for keeping your pet safe.

It is recommended that you keep your dog on a short leash (not retractable leashes) when you take him out for a walk. Even within your backyard, you should closely supervise your dog and never leave a pet alone outside, as coyotes do come into yards. Commonly, life-threatening attacks are made when a pet is unsupervised within a fenced in backyard in an urban setting.

Do not leave any pet food outside. Garbage should be stored in a garage or shed. Trash should go out the morning of trash collection, and not the night before. Clean your garbage cans regularly to reduce residual odors that attract coyotes.

Cats should also be kept inside, or also supervised in a confined area if outside.

If a coyote approaches you or your pet, you can throw rocks or sticks to frighten it away. You will want to use a loud, authoritative voice to frighten the animal. Do not approach a coyote. Coyotes are more commonly seen at night, but when coyotes live in an urban area, they are generally less timid and are frequently seen during the day.

If your pet has been attacked by a coyote, he should be seen right away by a veterinarian for evaluation. Even if he does not appear to have sustained any injuries, he could be in shock or could have internal injuries that you do not see. He may have life-threatening wounds or injuries that need to be addressed quickly. The veterinarian will examine your pet and will start any immediate necessary treatment, and then develop a plan for further care with you.

Diabetes and Diabetic Ketoacidosis

Written by:  Jen Hall, DV

Diabetes is a metabolic condition caused by inadequate insulin production or use by the pancreas leading to high blood sugar, high urine sugar levels, and dehydration.    Two forms of diabetes exist:

Type I) Insulin Deficiency

Type II) Insulin Resistance.

Dogs typically get Type I diabetes which is caused by destruction of the pancreatic cells that produce insulin. The average dog is 6-9 years old at the time of diagnosis and schnauzers, miniature poodles, Cairn terrier, Yorkshire terrier, and Samoyed are at higher risk. Any breed of dog can get diabetes. Female dogs get diabetes much more frequently than male dogs.

Most cats that get diabetes are middle aged and overweight prior to diagnosis. Being overweight can lead to insulin resistance, decreased response of cells to insulin, causing Type II diabetes.  Male and female cats develop diabetes equally.

Symptoms of diabetes in dogs and cats are:

-Excessive thirst

-Excessive urination

-Sudden weight loss/poor appetite

-Lethargy/nausea/vomiting

-Sudden onset decreased vision (in dogs)

-Weakness and trouble walking in the hind legs (cats)

If you suspect your pet has diabetes, blood and urine testing should be performed as soon as possible to confirm the diagnosis and start treatment immediately.  Untreated or inadequately treated diabetes can lead to a life threatening condition, called diabetic ketoacidosis (DKA).

DKA results when a pet is diabetic and not undergoing treatment or if the treatment for diabetes is not controlling the condition well enough.  DKA has three components:

1)     Hyperglycemia: high blood sugar.  Very high blood sugar draws fluid, sodium and potassium into the bloodstream and away from the body’s cells causing profound dehydration and electrolyte imbalance both in the cells and in the bloodstream.

2)     Ketosis:  due to low insulin production or insulin resistance, the body has been breaking down fat for energy in large quantities. The metabolism of fat results in production of ketones that enter the bloodstream. Ketones cause nausea and upset the pH balance of the blood triggering acidosis.

3)     Acidosis:  the blood becomes acidic.  The presence of ketones cause a drop in the bicarbonate levels.  Decreased bicarbonate levels in the blood result in low blood acid levels and disrupt the respiratory system resulting in heavy breathing.

Symptoms of Diabetic Ketoacidosis are the presence of the above signs of diabetes as well as:

-Severe weakness

-May stop drinking

-Heavy breathing

-Acetone smell to the breath (smells like nail polish remover)

-Coma

-Death

DKA is a life threatening condition that requires immediate veterinary care. Typical care for a pet with DKA is fluid therapy to correct dehydration, IV electrolyte replacement to normalize sodium/potassium/chloride/phosphorus levels, and insulin therapy to normalize blood sugar levels.  24 hour hospital monitoring with repeat blood tests is required until your pet is eating on its own, the blood sugar has been stabilized, and hydration and electrolyte levels are back to normal. Early treatment for DKA is associated with shorter hospital stays and better prognosis for recovery.  A typical hospital stay for a pet with diabetic ketoacidosis is 2-5 days depending upon the severity of the condition on presentation and response to treatment. After treatment of DKA, close monitoring of blood and urine sugar levels with the assistance of your veterinarian can help prevent recurrence.

Please call the Veterinary Referral Center of Colorado immediately if you feel your pet has the signs of DKA.

Foreign Body Treatment

What is a foreign body?

A foreign is any item that an animal has ingested such as rocks, bones, socks and anything else an animal will eat that is not food.

Does my animal need surgery?

There are diagnostics that must be done first to determine if a surgery is needed to remove the foreign body. X-rays are usually the initial tool after an exam is done. Objects that contain metal will show up easily on an x-ray (coins, rocks, batteries) while soft items will not. The veterinarian may be able to determine if a “pattern” of blockage has occurred from the radiographs. An ultrasound may be needed to further determine if a foreign object is in the intestines or stomach.

What can be done if surgery is not an option for me?

If a foreign body is not yet determined or still a possibility, the animal may need to stay hospitalized on fluids to re-hydrate them while repeat x-rays may be done later on to further determine if a blockage has occurred or if material is moving through the intestines.

If my pet has a foreign body, what are the signs?

The most common sign is vomiting multiple times, most notably vomiting after eating. Abdominal discomfort is also a sign where the animal will tense up when the abdomen is touched.  Lethargy and in-appetence will also occur.

What will happen if treatment is not performed?

If an animal has ingested a foreign object that has caused a blockage, the intestines will not be able to move fecal material through. Pressure can build up and the foreign object can puncture through the intestine causing bacteria to enter the abdomen resulting in septic peritonitis.  Emergency surgery is the only option at this point.

Ray Zeuner, Certified Veterinary Technician

Gastric Dilatation-Volvulus (GDV or Bloat)

What is GDV or “bloat”?

GDV (Gastric Dilatation-Volvulus) is a serious medical condition where the stomach has twisted on its own causing the blood supply to the stomach and spleen to be compromised. The stomach will expand with air causing more pressure on the diaphragm and producing a “bloated” abdomen. The only correction to this condition is emergency surgery to untwist the stomach.

What causes GDV?

There is no known specific reason for GDV. Much research has been done, but no conclusion has been made.  Researchers do agree that there are certain conditions that can increase the risk of a GDV. The most common conditions are large breed dogs (Great Danes, Saint Bernard, Newfoundlands) and deep chested dogs (Standard Poodles, Setters, Doberman Pinschers).

Can a GDV be prevented?

The best way to prevent a GDV is to have surgery for a prophylactic gastropexy, a surgery to tack the stomach to the body wall. This is best done during spay and neuters.

What are the signs of a GDV?

The two main signs are increased retching with no production and an abdomen that is distended or larger than normal and feels very tight. Other signs include lethargy, excessive drooling/salivation, panting, and pacing.

Will my dog recover from GDV?

The most important factor in successful outcome from GDV is the time between onset and surgery. Dogs can die in a matter of hours after a GDV occurs and the survival rate of post-surgery can be as high as 75%. The longer the time before surgery, the worse the recovery and outcome can be. Not all dogs will recover the same way and there is still a lengthy recovery which include2-3 days of supportive care.

Ray Zeuner, Certified Veterinary Technician

Hydrogen Peroxide Induced Encephalopathy

Steve Lane, Diplomate ACVIM – Neurology/Neurosurgery

Three percent hydrogen peroxide is quite effective in making dogs and cats vomit. This avoids a visit to a local emergency room or the family veterinarian in an immediate crisis. Reported to be safe when used in small amounts, what follows is a case presentation of hydrogen peroxide induced encephalopathy secondary to 3% hydrogen peroxide ingestion to induce vomition.

History

A 9-year-old mixed-breed dog presented for neurologic assessment after experiencing acute collapse following the administration of 3% hydrogen peroxide. One ounce of hydrogen peroxide had been administered to induce vomition after ingestion of chocolate. After vomition was not induced, the oral dosage was repeated 10 minutes later. Following the second dosage, immediate collapse with a non-responsive and nonambulatory status developed. Emergent presentation ensued.

Examination

At the time of presentation a mentally obtunded status was present. Vital signs were normal. The gums and lips were swollen and bright red. Abnormality was limited to the nervous system. Mentation was characterized as depressed poor response to auditory or tactile stimulation. Ability to maintain sternal recumbency was not possible. Cranial assessment revealed an obtunded mentation with central blindness, depressed facial sensation (symmetric) and absent conjugal eye movements. Gag reflex and tongue function were depressed symmetrically. A non-ambulatory status was present with symmetric motor function present in all limbs. If aided, a based wide stance with generalized ataxia and intentional head tremor was evident. Conscious proprioceptive reactions were absent in all limbs. Hopping reactions were present, although depressed in all limbs. Appendicular reflexes were normal. Spinal palpation was normal and non-painful. Based upon the neurologic examination findings, a diffuse encephalopathy was present. Based upon the history, hydrogen peroxide induced encephalopathy was considered as the primary differential, although it has not been previously reported in the veterinary literature.

Figure 1: T2-wighted coronal acquisition. Areas of fluid diffusion alteration are characterized by a fluffy white appearance. Change is restricted to the grey matter regions of the cerebral and cerebellar cortices.

Figure 2 and 3: Transverse T2 and FLAIR-weighted acquisitions. Areas of cortical hyperintense signal are whiter than the surrounding cortex.

Testing

A complete blood cell count, serum chemistry and urinalysis, bile acid assay, and serum lead levels were submitted. All results were normal. Supportive management utilizing LRS with KCL was instituted pending magnetic resonance imaging and cerebrospinal fluid centesis for analysis.

Magnetic resonance imaging was performed on the cranial axis. Pre and post-contrast T1, T2, FLAIR, T1-post-contrast fat sat and T2-gradient echo acquisitions in sagittal, coronal and transverse sequences were performed. Evident on imaging was symmetric, cellular fluid change characterized by hyperintense signal on T2 and FLAIR weighted acquisitions within the cerebral cortex, thalamus, piriform lobes, corpus callosum, and cerebellar cortex. Noted change was restricted to the gray matter of the cerebral and cerebellar cortices and brainstem. Cerebrospinal fluid centesis revealed a clear, colorless spinal fluid with normal cell count and differential. Protein concentrations were normal.

Diagnosis and Outcome

A working diagnosis of hydrogen peroxide induced polioencephalopathy was made. Supportive management was maintained with gradual and continued resolution of the encephalopathy noted over the initial 60 days. Prognosis for complete recovery is felt to be good.

Discussion

Hydrogen peroxide (H2O2) is a very pale blue liquid that appears colorless in dilute solution. Hydrogen peroxide was first isolated in 1818 by Louis Jacques Thénard by reacting barium peroxide with nitric acid. Hydrogen peroxide is a simple chemical compound. It is water with an extra atom of oxygen attached to it, H2O2. Hydrogen peroxide is valuable as an oxidizing agent like ozone, or bleach for example) because it can release that single oxygen atom in the presence of another reactive substance. This reaction is called oxidation or bleaching. Most people use hydrogen peroxide as an antiseptic. It turns out that it is not very good as an antiseptic, but it is not bad for washing cuts and scrapes and the foaming looks cool. The reason why it foams is because blood and cells contain an enzyme called catalase. Since a cut or scrape contains both blood and damaged cells, there is lots of catalase floating around. When the catalase comes in contact with hydrogen peroxide, it turns the hydrogen peroxide (H2O2) into water (H2O) and oxygen gas (O2).

2H2O2 —> 2H2O + O2

Catalase does this extremely efficiently — up to 200,000 reactions per second. The bubbles you see in the foam are pure oxygen bubbles being created by the catalase. Hydrogen peroxide always decomposes (disproportionate) exothermically into water and oxygen gas spontaneously.

Hydrogen peroxide can be toxic if ingested, inhaled, or by contact with the skin or eyes. Ingestion of hydrogen peroxide is an uncommon source of poisoning resulting in morbidity through three main mechanisms: direct caustic injury, oxygen gas formation and lipid peroxidation. Direct cytotoxic injury through lipid peroxidation can induce blistering of the oral and pharyngeal mucosa, laryngospasm and hemorrhagic gastritis. The production of foam in the oropharynx can lead to obstruction of the larynx or pulmonary aspiration. Early aggressive airway management is critical in patients who have ingested and inhaled concentrated hydrogen peroxide, as respiratory failure and arrest appear to be the proximate cause of death. Ingestion of concentrated hydrogen peroxide can result in the generation of substantial volumes of oxygen. In closed body cavities mechanical distension of a hollow viscus (stomach) secondary to oxygen liberation can induce gastric pain and increase the risk of perforation. Gastric decontamination is not indicated following ingestion, due to the rapid decomposition of hydrogen peroxide by catalase to oxygen and water. If gastric distension is painful, a gastric tube should be passed to release the gas.

Following ingestion, hydrogen peroxide undergoes gastric catabolism producing oxygen and water. When the amount of oxygen evolved exceeds its maximum solubility in blood, venous or arterial gas embolism may occur. The mechanism of CNS damage is thought to be arterial cerebral air gas embolism (CAGE) with subsequent brain infarction. Magnetic resonance imaging in this case demonstrated areas of restricted water diffusion and T2 hyper intensities in multiple vascular territories consistent with ischemia due to CAGE. Extensive cerebrocortical diffusion restriction with apparent gyral edema was evident at 3 days following ingestion, particularly in the parieto-occipital and cerebellar grey matter regions, bilateral. The pattern of imaging in this case closely resembles that of reversible posterior leukoencephalopathy in human beings with hydrogen peroxide ingestion and CAGE.

Conclusion

Despite the label indicating that hydrogen peroxide is toxic, it is reported safe to give to dogs to induce vomition since it induces vomiting and therefore does not stay in the body.

The recommended dosing of hydrogen peroxide is one teaspoon (5 ml) per 10 pounds of body weight. Vomiting should occur within 15 to 20 minutes. If no vomiting occurs, it is reported to be safe to repeat the 3% percent hydrogen peroxide dose once. While the use of hydrogen peroxide represents a safe, economical and, at home treatment to induce vomition, sentinel events can occur with life threatening ramifications. This is the first report of dilute (3%) hydrogen peroxide induced encephalopathy in a companion animal.

Pleural Effusion and Congestive Heart Failure

A Brief Glance at Difficulty Breathing

The medical term for difficulty breathing is Dyspnea (pronounced: disp-nee-uh).  It can either involve difficulty pulling air in or expelling air out. There can be multiple causes for difficulty breathing but the signs and symptoms are very similar.

Any animal experiencing difficulty breathing will show just that- trouble getting air in or trouble getting air out. The most common signs include fast and shallow breaths, breathing that involves pulling the abdomen in and out (abdominal breathing), gasping or panting (more concerning in cats), pale to bluish colored gums (due to lack of oxygen), coughing with/without production of fluid or mucous.  Less commonly weakness and/or collapse are seen.  Some or all of these signs can be seen together.

The two most common diseases that cause difficulty breathing are congestive heart failure and fluid in the chest cavity (known as pleural effusion). There are many other causes but the focus will be on congestive heart failure and pleural effusion. Both of these diseases can happen together and cause the same signs and symptoms. Unfortunately pets can go weeks to months without showing any signs or symptoms and one night can become really sick.

Pleural effusion

Pleural effusion results in a type of restrictive respiratory disease, by not allowing full expansion of the lungs. Fluid is present in the chest cavity, not in the lungs themselves, taking up space normally used by the lungs.   This could be caused by an infection, a build up of lymphatic material, congestive heart failure or cancer, among other causes.

Treatment for pleural effusion starts with oxygen supplementation. Oxygen makes these pets feel better immediately. A physical exam is done and based on results further testing may need to be done.    If the veterinarian is pretty sure of what is going on, treatment may be started right away.   Radiographs will allow the veterinarian to look inside the chest to see the heart and lungs.  Radiographs will also show any fluid in the chest. If there is a fair amount of fluid in the chest cavity the next step is to remove the fluid.  The veterinarian and technicians will remove the fluid using a needle and syringe, this process is called thoracocentesis.  This makes most animals breathe much easier since they can more fully expand their lungs.  The fluid is evaluated to see if a cause can be found.  Other treatments may include drugs called diuretics (to help remove fluid) or additional oxygen supplementation.  Antibiotics, chemotherapy, or surgery may be administered based on the underlying cause of the disease.

Prognosis is dependent on cause. Most animals feel much better after getting the fluid removed from their chest cavity.

 Congestive heart failure

Congestive heart failure (CHF) can show very similar clinical signs with very different treatment and cause.   Any pet that presents with difficulty breathing will be treated with oxygen immediately and x-rays will be taken.  If CHF is suspected then certain medications will be given right away.  A diuretic to help pull fluid out of the lungs will be given by injection.  Further diuretics will be given by injection while in hospital and then orally when sent home.  Other medications may be given to make the heart beat stronger, make it easier for the heart to beat and help to decrease the work the heart has to do.

Cardiac ultrasound (echocardiogram) is an excellent diagnostic to further evaluate the heart function and better define underlying heart disease to allow more precise treatment.  Heart disease is usually not curable, but can be very controllable.  Animals with heart disease can live a very happy life for years.

Any change in your pet’s breathing is considered an emergency and they should be seen immediately. Never hesitate to take your animal in or even call to speak with a technician or doctor. Feel free to call your local veterinarian or closest emergency facility if you have questions or concerns.

Jennifer Steinmetz, Technician

Seizures

Written by Luke Rump, DVM

What is a seizure?

A seizure can be defined as sudden and uncontrolled movement of the body caused by abnormal brain activity.

Seizures can be defined as generalized (grand mal), partial, focal, or psychomotor.

  • Generalized (grand mal) seizures are the classic seizure most people think of and the most common in animals.  The animal’s whole body is affected.  They commonly fall over, lose consciousness, paddle (look like they are running with very jerky limb movements), foam at the mouth, urinate and may defecate.
  • Partial or focal seizures involve a specific area of the brain so the seizure involves a specific area of the body, e.g. eye or facial twitching, one limb shaking.  A partial seizure may progress to a full body seizure (grand mal).
  • Psychomotor seizures are usually behavioral.  The seizures manifest as sudden behavioral changes such as running around frantic, howling, snapping, circling, sudden aggressiveness, etc.   Psychomotor seizures can also progress to a full body seizure (grand mal).

Seizures are separated into three phases:

  • Pre seizure or Aura:  Some animals appear to know that a seizure is going to happen.
  • Seizure period:  Generally lasts less than 1- 2 minutes (can feel like 10-15 minutes, especially when not expected or you have never witnessed a seizure before).
  • Post seizure or Post Ictal:  The animal will appear disoriented and may also experience blindness that can last minutes to hours.

 

What caused it?

Seizures are caused by abnormal activity of the brain.  This can be caused by intracranial (inside the brain) or extra-cranial (outside the brain) causes.

  • Intracranial causes include epilepsy, trauma, infection or tumors.
  • Extra-cranial causes include toxins, low blood glucose (common in young and small breed dogs), liver or kidney disease, some tumors, etc.

 

How do you diagnose the cause?

We often do not find the cause of the seizure behavior.

Testing to consider if your pet is having seizures includes:

  • Bloodwork to look for extra-cranial causes of seizures.
  • Neurology consult that may require further neurologic testing depending on the individual case.  Imaging of the brain by MRI and/or examination of the fluid surrounding the brain (cerebral spinal fluid) may be recommend by the neurologist after their examination.

Other testing may be recommended based on your pet’s individual situation and suspected causes, e.g. radiographs, abdominal or cardiac ultrasound, or tests for infectious causes of seizures.

Epilepsy is a diagnosis of exclusion.  We do not have any blood tests or imaging tests that diagnose epilepsy. We make the diagnosis of epilepsy by excluding other diseases and looking at your pets breed, age and results of diagnostic testing.

 

What can I do during a seizure?

Protect your pet from injury during the seizure.  Prevent them from hitting their head on something, falling off something, falling into the water.  Generally watch for their well-being during the seizure.

Keep other pets away from them during and after a seizure.

Record the time and length of the seizure.   Notice if anything seemed to trigger the abnormal behavior. Did it start with one body part? What did he/she do during the seizure? E.g. twitching, paddling, fly biting, urination, defecation or other observations.

Monitor the post seizure period (post ictal period). Note how long it lasted and what type of behavior he/she showed.

Do Not place you hand in your pet’s mouth to prevent them from swallowing their tongue (a common myth).  Placing your hand in your pet’s mouth increases the chance of you being bitten since your pet is not aware of, and cannot control, body movement during a seizure.

 

How do you treat a seizure?

The decision about treating seizures, and which medications to use, is based on known or suspected cause, frequency and severity of seizure behavior.

Emergency treatment of seizures (defined as seizures happening in pairs, groups, lasting a long time, or no period of normalness between seizures) consists of injectable and/or oral medications in an attempt to stop the seizure behavior.  This usually requires your pet to be hospitalized for care.

The most common medication used is injectable diazepam.  Often oral medications are started along with the injectable diazepam.  Oral medications may include Clonazepam or Leviteracitam, aka Keppra)

Long term treatment with anticonvulsants

The goal of long term seizure control is to decrease the frequency and severity of the seizures.

Initial medications:

  • phenobarbital
  • potassium bromide (KBr)
  • Other anticonvulsants: (these tend to be more expensive)
  • Zonisamide
  • Clonazepam
  • Clorazepate (Tranzene ®)
  • Felbamate (Felbatol®)
  • Gabapentin (Neurotin ®)
  • Levetiracetam (keppra ®)

Call your veterinarian or the veterinarians at Central Veterinary Emergency Services if you have other questions.

Wound Care

Written by Jen Hall, DVM

There are a variety of injuries that dogs can sustain including bite wounds, puncture wounds, lacerations (cuts), skin foreign bodies (objects that become lodged under the skin), and abrasions(skin scrapes). 

 Wounds are commonly painful and it is important to protect yourself from injury when you are examining and beginning initial treatment of a wound.  Even friendly dogs that you know well can bite when they are painful.  If you pet resists you touching the wound please call the Veterinary Referral Center of Colorado and take your pet in for immediate treatment.  Restraining your pet during a painful procedure can be dangerous for both you and your pet.

 The first step in wound care is to stop bleeding with direct pressure by applying a clean cloth to the wound and applying gentle pressure if your pet allows this.  Covering the wound also prevents contamination with further bacteria from the environment.  If this is tolerated you may attempt to rinse the wound with lukewarm tap water to hlep clean the wound and flush out dirt and bacteria.  Hydrogen peroxide can cause tissue damage and is not recommended for wound care.  After cleaning the wound as best  you can, you can place a temporary bandage to protect the wound. Cover the wound with a clean cloth or gauze and cover with tape under mild pressure if you are able.  If the wound is on the chest of abdomen you may place a t-shirt on your pet to cover it.  Please be aware:  bandaging a wound too tightly can result in decreased blood flow, cause tissue damage, and swelling. A bandage should be removed if you notice swelling, pain, or a funny smell coming from the bandaged site.

 Wounds can be very deceptive.  We recommend having your pet examined by a veterinarian if you notice any skin wounds.  Prompt examination and wound care with a veterinarian can help prevent  abscess (a pocket of pus from infection),  cellulitis (deep tissue infection)  and  provide the fastest healing.  A veterinarian can fully examine the wound and determine the next best steps for the wound care which may include:

  • sedation or anesthesia
  •  wound flushing and debridement (removing unhealthy tissue)
  • suture or drain placement
  • bandaging
  • medication for pain and infection.

 Please call the Veterinary Referral Center of Colorado if your pet has a skin wound or you have any questions about an injury your pet has sustained. 

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