Hecate update

Talked to my sister today, she had taken Hecate to the vet again to see if they can figure out why she's been having seizures and having trouble keeping her weight up. The neurological vet has determined that she has epilepsy which is what's causing the seizures and the internal medicine vet things she also has inflammatory bowel disease and that's what's affecting her weight. So it looks like she'll be on antacids and given some special steroid instead of prednisone. Please say prayers that this works!

Epilepsy in dogs:

The condition known as epilepsy does indeed occur in dogs. In fact, the problem is broken down into two different types of Epilepsy.

1. Idiopathic Epilepsy- Idiopathic epilepsy is when there is no known cause for the condition and it is assumed it may be an inherited condition.

2. Secondary Epilepsy – This diagnosis is used when a specific cause for the seizures can be found. A veterinarian will normally run a variety of tests to rule out possible physiological or toxic causes before diagnosing the dog as having the idiopathic version.

There are several types of seizures that are seen in dogs and there are many times an owner isn’t even aware of the problem. An epileptic seizure is the clinical manifestation of abnormal brain activity in the cerebral cortex.

These abnormalities can create seizures that vary from the mild “petit mal” to the generalized, full body “grand mal.”

An epileptic seizure itself can be broken down into four stages.

1. The Prodome – This stage can last from minutes to hours or even days before the manifestation of the actual seizure activity. This stage is typically characterized by changes in the dog’s mood or behavior.

2. The Aura – The aura stage is when owners first notice the initial signs. Some dogs will begin pacing, licking, salivating, trembling, vomiting, wandering aimlessly, hiding, whining or urinating. Other dogs may exhibit stranger activities such as excessive barking and attempts to get an owner’s attention.

3. The Ictus- This stage is the actual seizure itself. It is a period of abnormal activity in which the most common symptoms are that the dog may lose consciousness, gnash their teeth or appear to be chewing gum, thrashing about with their head and legs, drooling excessively, crying, paddling their feet as if running as well as losing control of their bladders and bowels. There are stranger types of seizures though.

Some dogs will frantically run in circles, others will just chew gum, some suddenly go blank and stare into space and then there are the ones that only have partial seizures in which the twitching is localized in one area. This could in the face, one leg, in the shoulder or over the hips.

4. The Ictal – This stage occurs immediately after a seizure. Owners often report the dog acts drunk, doped, blind or deaf. Other dogs will show signs of pacing endlessly or drinking large amounts of water. Some will seem to pass out and just sleep.

Some of the physiological reasons a dog may have secondary epilepsy are:

1. Hypoglycemia or “low blood sugar.”

2. Hypothyroidism – A condition in which the thyroid functions inadequately.

3. Disease – Seizures are a common symptom of diseases such as encephalitis and distemper

4. Lead poisoning – This can be seen in dogs that like to chew on items such as painted wood.

5. Brain Tumors – This is the most common cause of seizures that begin after the age of 5.

6. Hydrocephalus – The accumulation of excess cerebrospinal fluid (CSF) within the brain.

7. Eclampsia – This occurs when a lactating female’s calcium levels drop to dangerous levels.

8. Toxins – Pesticides, fertilizers, poisonous plants, arsenic, strychnine and chocolate.

9. Trauma – Trauma can occur from some type of severe blow to the head such being hit by a car, bat, kicked or fall.

10. Organ failure – End stage liver or renal failure can often cause

11. Parasitic – Severe cases of intestinal worms, end stage heartworms or even anemia from fleas and ticks can cause seizures.

Idiopathic Epilepsy is also called primary or hereditary epilepsy.

It as been proven that epilepsy often runs in bloodlines and new studies are showing that certain breeds are more likely to have the disorder. Some of the breeds it occurs in more often are Belgian Tervuerens, Beagles, Dachshunds, German Shepherds, Keeshonds, Boxers, Cocker Spaniels, Golden Retrievers, Irish Setters, Labrador Retrievers, Collies, Schnauzers, Poodles, Dalmatians and St. Bernards.

In some instances the seizure will be a one-time occurrence with no further episodes or after effects. In others dogs, epilepsy will be an ongoing battle for the owner and the dog. Just because a dog is diagnosed with epilepsy doesn’t mean he or she can’t live a long, happy life.

There are several medications that are often used to control or stop the seizures. The most common medications are:

· Primadone (Mysoline)

· Phenobarbital*** Dogs on Phenobarbital need to have their liver enzymes tested every few months to check for possible damage***

· Potassium Bromide*** Dogs taking this drug need to be careful with salt levels in the diet and whenever the brand of food is changed.

· Dilantin

· Potassium Bromide

· Valium (Diazepam)

There will be cases where the medications seem to have no affect and the seizures not only continue to occur but actually worsen. In most instances dogs that are kept on medications can lead pretty normal lives with few restrictions or changes in routine. Occasionally they will build up a resistance to some of the drugs and will need to change over to others or receive Valium injections to stop the seizures once they occur.

As with any disease or condition, your personal veterinarian is the best source for making a diagnosis, education and offering treatment options. If you suspect your dog may have either type of epilepsy and you see seizure like activity, take note of the time, date, length and type of seizure as well as the way the dog acts after the seizure has ended. Keep a record of these things for each episode and discuss the problem as soon as possible with the veterinarian. Remember to follow up the conference with information as to any further episodes so he or she will be able to lay out a plan of action for both you and your dog for the best possible results.

Inflammatory Bowel Disease in dogs:

Inflammatory bowel disease is a condition in which the stomach and/or intestine is chronically infiltrated by inflammatory cells. It is characterized by certain cells invading the wall of the intestine. The cells are those associated with inflammation, which is the body's result to an insult or injury. Inflammatory cells include lymphocytes and plasmacytes which are directly responsible for the body's immune response. Eosinophils are another cell commonly present in inflammation. Other inflammatory cells called neutrophils are responsible for the actual destruction of foreign invaders such as bacteria or clean up of damaged tissue. Finally, in chronic inflammation, normal tissue may be replaced by fibrous (scar-like) tissue. The types of cells infiltrating the intestine determine the type of inflammatory bowel disease that is present. Type of Infiltrate Type of IBD Characteristics Lymphocytes and Plasmacytes Lymphocytic-plasmacytic IBD Most common form of IBD Eosinophils Eosinophilic IBD Second most common form Tends to be more severe than lymphocytic-plasmacytic Fibrous Tissue and Eosinophils Regional Granulomatous Rare Similar to Crohn's disease in humans Neutrophils Suppurative or Neutrophilic Need to exclude bacterial infection as a cause of the infiltrate What causes inflammatory bowel disease in dogs? The cause of inflammatory bowel disease is unknown. Genetics, nutrition, infectious agents, and abnormalities of the immune system may all play a role. Inflammatory bowel disease may not be an actual disease onto itself, but a characteristic response of the body to certain conditions caused by a variety of factors. What are the symptoms of inflammatory bowel disease? The most common signs of inflammatory bowel disease in both dogs and cats are diarrhea and vomiting. The signs may vary depending upon the portion of the gastrointestinal involved, i.e., vomiting is more common when the stomach and upper portion of the small intestine are involved and diarrhea is more common when the colon is involved. There is an increase in the frequency of defecation, but less stool produced each time. There is often increased mucous or some blood in the stool. Sometimes stools become loose. Many times the diarrhea and vomiting may be intermittent (comes and goes). If severe, some animals become depressed, will not eat, have a fever, and lose weight. How is inflammatory bowel disease diagnosed? To be called inflammatory bowel disease, the condition must be chronic, infiltrates of inflammatory cells must be present, and other causes of these infiltrates (e.g., bacterial infections, parasites) have been excluded. History: The history of long-standing diarrhea and/or vomiting, weight loss, increased mucous in the stool and possibly blood in the stool would lead a veterinarian to consider IBD as a possible cause. Physical Exam: The dog may appear thin on physical exam. In some animals, veterinarians may palpate (feel) thickened intestines. Laboratory Findings: In most cases, the chemistry panel of a dog with inflammatory bowel disease is normal. If the inflammation of the intestines is severe, the neighboring liver and pancreas may also become inflamed. This results in an elevation of liver enzymes and/or amylase which is produced by the pancreas. There may be a decreased amount of protein in the blood, and if the vomiting is significant the electrolytes (especially potassium) may be at abnormal levels. In most cases, the complete blood count (CBC) is normal. Some animals will demonstrate an increase in the number of eosinophils in the blood. Radiography (X-rays) and Ultrasound: There is no consistent radiological finding in dogs with inflammatory bowel disease. The intestines may appear thickened and there may be more gas than normal in the intestines, but these signs can occur in many conditions. Biopsy: The only definitive way to diagnose inflammatory bowel disease is through a biopsy. The biopsy will demonstrate increased numbers of inflammatory cells in the intestinal wall. The types of cells which are present will denote what type of inflammatory bowel disease is present. Biopsies can be obtained through use of an endoscope or exploratory surgery. The stomach and intestines may appear normal to the naked eye, but microscopically the changes can be seen. In other cases, the lesions of the gastrointestinal tract are quite apparent. Rule Out Other Causes: Other causes of diarrhea and or cellular infiltrates must be ruled out. Therefore, in a complete work-up, a fecal exam would be performed to rule out parasites such as giardia, bacterial cultures would be obtained to rule out e.g., Salmonella, and further blood tests to rule out other concurrent diseases such as hyperthyroidism or liver disease would be conducted. How is inflammatory bowel disease treated? The treatment of inflammatory bowel disease usually involves a combination of change in diet and the use of various medications. Dietary Management: A food trial using hypoallergenic diets is usually one of the first steps in the initial treatment, and is used to verify the diagnosis. The key is to use a protein source and carbohydrate source the animal has never eaten before, such as duck and potato. The pet must eat nothing else, including treats, and the trial should be maintained for two to three months. If a hypoallergenic diet does not improve the condition, other diets may be tried. When the colon is the major portion of the digestive tract that is involved, diets high in fiber such as Hill's r/d have been beneficial. Oat bran could also be added to the diet to increase the fiber content. When the small intestine is the primary site of involvement, some animals benefit from a highly digestible, low-fiber (low-residue) diet. Diets low in fat are generally better tolerated in dogs with IBD. Carbohydrates low in gluten may also be helpful; avoid wheat, oats, rye, and barley. Homemade diets are sometimes used, however, they often are not completely balanced and commercial diets are preferred for the long term. As you can see, multiple diets may have to be tried before one sees improvement in the pet's condition. This takes a lot of patience on the part of the owner. Fatty Acids: Some studies have suggested that diets enriched in omega-3 fatty acids may help decrease the inflammation in the gastrointestinal tract. Eicosapentanoic acid and docosahexaenoic acid (fatty acids from fish oil) have been beneficial in human patients. More research needs to be done to determine their benefit in dogs and cats with inflammatory bowel disease. One of the most common mistakes in treating inflammatory bowel disease is to stop medication too early. Anti-inflammatory Medications: Various medications are used to reduce the number of inflammatory cells moving into the gastrointestinal tract. Sulfasalazine, 5-ASA, and Mesalamine Compounds: Sulfasalazine, 5-ASA, mesalamine, and related compounds are the drugs of choice in dogs with primarily large intestine involvement. They can, however, cause a condition called keratoconjunctivitis sicca (KCS or dry eye) so they must be used with caution. KCS results from an abnormally low tear production. Sulfasalazine, by an unknown mechanism, can irreversibly reduce the amount of tears produced. Sulfasalazine and similar compounds contain salicylates (so does aspirin) which can be very toxic to cats. So the use of these drugs in cats must also be closely monitored. Sulfasalazine or related compounds are generally administered at high doses and the dose is maintained 3-4 weeks after improvement is noted. Corticosteroids: Corticosteroids (such as prednisone) are the treatment of choice for cats with inflammatory bowel disease. Corticosteroids are used in dogs when dietary management and sulfasalazine do not adequately improve the condition. Azathioprine and Cyclophosphamide: These drugs are immunosuppressive agents and are generally used only if other treatments have failed or in combination with corticosteroids to allow a lower dose of the steroid to be used. These drugs can suppress the bone marrow (less blood cells are then produced), so again careful monitoring through regular complete blood counts is recommended. Metronidazole: Metronidazole can be used alone or in combination with sulfasalazine or corticosteroids. It is an antibiotic and also inhibits the immune system. Drugs Affecting Motility: Antidiarrheal drugs such as loperamide (Imodium) or diphenoxylate (Lomotil) can have some beneficial effects. Antispasmodic drugs have also been used in some cases. In the Future: Newer drugs are being used in humans with Crohn's disease and inflammatory bowel disease. The benefits, risks, and dosages of these drugs in dogs has not been determined. Some of these drugs include cyclosporine, sodium cromoglycate, and clonidine. What is the prognosis for dogs with inflammatory bowel disease? Inflammatory bowel disease can be controlled, but not cured. Control is dependent upon the proper selection of diet and medications, the correct long-term maintenance dosages, careful monitoring by the veterinarian and owner, and the absence of other concurrent diseases. Even so, persistence of mild signs, or recurrence of more severe signs may occur.

References and Further Reading

Dimski, DS. Therapy of inflammatory bowel disease. In Bonagura, JD (ed.) Current Veterinary Therapy XII. W.B. Saunders Co. Philadelphia, PA; 1995;723-8. Leib, MA; Matz, ME. Diseases of the large intestine. In Ettinger, SJ; Feldman, EC (eds.) Textbook of Veterinary Internal Medicine. W.B. Saunders Co. Philadelphia, PA; 1995;1241-48. Marks, SL. Management of canine inflammatory bowel disease. The Compendium on Continuing Education for the Practicing Veterinarian. 1998;317-32. Sherding, RG. Diseases of the Intestines. In Sherding, RG (ed.) The Cat: Diseases and Clinical Management. Churchill Livingstone. New York, NY; 1994;1239-50. Sherding, RG. Lymphocytic-plasmacytic inflammatory bowel disease of cats. Veterinary International. 1994;11-20. Sherding, RG; Johnson, SE. Diseases of the intestines. In Birchard, SJ; Sherding, RG (eds.) Saunders Manual of Small Animal Practice. W.B. Saunders Co. Philadelphia, PA; 1994;704-9. Zoran, DL. Pathophysiology and management of canine colonic diseases. The Compendium on Continuing Education for the Practicing Veterinarian. 1999;824-41.