Monday, November 1, 2010

Veterinary fact of the day: is it the brain or the heart?

This morning as I was walking out the door on the way to Lottery Day, I looked over at my golden retriever Jack and observed that he was having a small seizure. Jack does this from time to time and these days I don’t consider it a big deal (though of course when it first happened it was a very big deal, and I visited several vets about it). I sat with him until it was over, and then he was fine. Dogs are great; I would have been distressed for hours afterwards. (As I headed off to Lottery Day, now slightly late, I thought to myself: “This is the best excuse for being late ever! I should have thought of it years ago.”)

So, you are an emergency veterinarian, and a young woman brings in her newly-adopted golden retriever who, she reports, had a seizure this morning. Do you accept this at face value and explore only things that could be wrong with this dog’s brain? Or might another system be at fault?

In fact, it could be the heart. Some heart problems can cause collapse (“syncope”) which can look very much like a seizure. In both cases, the dog can collapse on its side, lose consciousness, and urinate or defecate. So how do you tell the difference?

Seizures can last several minutes. They usually don’t seem to be triggered by any particular activity, but the dog sometimes seems to be able to predict them (the “pre-ictal period”) and may act differently. During the seizure, the dog is likely to move its limbs in classic “tonic-clonic” motions, drool a lot, and possibly chew on its face (you know how with humans, they warn you to secure the tongue if you have a chance?). Afterwards, recovery can take a few more minutes in which the dog is not quite right (the “post-ictal” period).

In contrast, syncope is shorter, usually more like 30 seconds. It may be associated with exercise or a coughing fit. You are not going to see “tonic-clonic” limb motions during syncope; you are more likely to see the dog go limp. The dog is unlikely to drool or chew on its face. Recovery is a lot faster.

Jack’s seizures are extremely mild; he does not even lose consciousness. (A vet once told me that it can be hard to tell if dogs lose consciousness during a seizure and that I was probably mistaken. I replied that I had once attempted to take Jack’s favorite toy away during one of these episodes, and that he had managed to take it back, even with all his muscles contracted so that he had real trouble moving.) But they are clearly seizures.

So if your dog has a collapsing episode, now you know what to pay attention to so that you can help your vet figure out what’s going on.

What I did today: Lottery day! I got most of what I wanted, but not everything. Now my schedule is set for my core rotations from March 21, 2011 to March 5, 2012. After that I have two months of elective time until graduation (there is also some elective time built in to the preceding year). I have such fun electives planned, you guys! I am really enthusiastic about them. I don’t want to jinx them by reporting them here too early, but I’ll let you know how they go when they happen.

[ETA: A friend comments:

Be careful!  You say, “you know how with humans, they warn you to secure the tongue if you have a chance?”  This is an old wives’ tale.

“Do not try to stop the seizure.  Do not hold or restrain the person, nor put anything in the person’s mouth.  Care for a person who has had a seizure the same way you would for an unconscious person. …  Do not try to place anything between the person’s teeth.  People having seizures rarely bite their tongues or cheeks with enough force to cause significant bleeding.  However, some blood may be present.”

— American National Red Cross,
First Aid/CPR/AED for Schools and the Community, 3rd ed., 2006; p. 156.

P.S. Everyone should get basic first aid and CPR training…

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