Aksel

A Dog’s Life

Finding a way to live with canine epilepsy during the pandemic

It was bound to happen sooner or later, given the nature of Aksel’s disease and the nature of COVID-19-induced remote meetings.

But still, my heart dropped when I realized that my dog was having an epileptic seizure, just off screen, as I was in the middle of a Zoom call. 

“One sec,” I told the other participants as calmly as I could. “My dog is having a seizure.”

Seizures are pretty horrible to watch. In my Rhodesian ridgeback’s case, his whole body stiffens, his eyes go wide and staring, his jaws begin to chomp uncontrollably and finally he paddles his legs frantically as if he can outrun what has taken over his body. For him, the worst of it lasts only about a minute, but for me it feels like forever. Specialists say he’s not aware of what’s happening, but it looks terrifying.

This one was mild as grand mals go, and I have been lucky that Aksel is usually quick to recover and often falls asleep soon afterward. When his body relaxed and he became conscious, I slipped him the pills he takes to prevent a cluster of seizures, checked to make sure all seemed well and returned to the meeting, the whole time wanting to just get off the call and hold my dog, and yet also grateful that my current life allows me to be there almost every time he seizes. 

First seizure: 2 am, July 29, 2019, at the dogsitter, fell off the bed.

I have always been a bit of a crazy dog person — it’s been years since I have had any fewer than two dogs and sometimes two plus a couple foster dogs. And I have always been pretty lucky in having jobs where I could have my dogs with me. When Aksel, a ridgeback without a ridge, was diagnosed with idiopathic epilepsy in the summer of 2019, even my vet commented that if anyone’s dog was going to have seizures, at least it was someone like me who brings my dogs to work every day. 

As the pandemic wraps up, many of us working from home now need to transition from being able to be with our dogs full time back into the old normal. The effects of COVID-19 have strengthened the relationship we have with our pets, but also put some of us into a quandary — what do we do when it’s time to go back into the office or start socializing when we’d rather be home taking care of these creatures we love? Instead of doing what seems to have come even more naturally than ever in the pandemic — Googling for information  — I tried to be proactive and reached out to medical specialists.   

COVID Pups

Second seizure: 10 am, Aug. 14, 2019, in kennel at office, asleep 1-2 min, stiffened, padded, drooled and peed.

COVID has made the fact I have my pets around me all the time become considerably less weird. There’s hardly a Zoom without a catus-interruptus incident of a feline stalking the screen or dogs barking in the background setting off other dogs on the Zoom. Back in October 2020, Sen. Jeff Merkley was Zooming with Eugene Weekly’s editorial staff when all 90 pounds of Aksel decided to climb into my lap. Before I could be embarrassed, the senator sadly told us his own dog had recently died and it made him happy to “meet” Aksel.

The endless days of working from home during COVID have somehow made it more OK to admit that for some of us, pets are as much family as our human relatives are. Animal shelters across the country reported surges in dog adoptions, and puppy sales spiked as well, according to the American Kennel Club. Locally, Sam Schwartz of Greenhill Humane Society and First Avenue Shelter says though their adoption numbers “aren’t very different, we are seeing much more people interested in adopting.”

And, sadly, it remains to be seen if, as the pandemic wraps up, there will also be a surge in people giving up their pandemic pets. A survey by Merck Animal Health showed that 73 percent of those who became dog owners for the first time this year have considered re-homing them once the pandemic ends. 

Third seizure: A cluster of seizures first one 4 pm Sept. 5, 2019, then 10 pm, then 5 am Sept. 6. Spent the next day at the vet, started phenobarbital. 

I can’t help but to wonder if the relatively low life expectancy I have seen for dogs with epilepsy is not due to the disease but rather to dog owners that can’t deal with it. One study in the Journal of Veterinary Internal Medicine found that “the median number of years that a dog lived with epilepsy was 2.3 years,” and “the prognosis for dogs with epilepsy is dependent on a combination of veterinary expertise, therapeutic success and the owner’s motivation.”

Aksel and I have been dealing with his epilepsy for almost two years. At this point I am spending about $200 a month on his medications alone. The dog owners I know love their pets like family, but a disease like this is expensive and intimidating. Schwartz also tells me that Greenhill saw a huge increase during the pandemic in the need to help community members with pets. She says, “Last year we distributed over 50,000 pounds of pet food through our Community Pet Food Bank.”

I am a huge advocate for rescue dogs. My other dog, Biggie, is a foster fail out of Carson Animal Shelter in Los Angeles, and my last several dogs were rescues as well. Unlike other dogs, Biggie has not attacked Aksel during a seizure. Instead he tries to comfort me with licks.

Aksel is from a breeder. He’s the nephew of a ridgeback named Zella whom I shared with my ex. Like her, he is ridgeless, but where some breeders cull (kill) ridgeless pups, this one finds them homes as pets. When Zella died it broke my heart, and I wanted a dog as wonderful as she was. 

But where Zella was the elegant and classic aloof-to-strangers ridgeback, Aksel is goofy with the bonhomie of a slightly drunk frat boy. He loves everyone he meets and wants nothing more than to climb on your lap and stick his tongue in your ear. I suspect this is only exacerbated by the medications he is on to try to control his seizures.

Dogs with Seizures

Fourth seizure: 10 pm, Dec. 5, 2019.

Fifth seizure: 10 pm, Dec. 28, 2019. 

Seizures occur in three stages, pre-ictal or prodrome, where some dog owners say they can tell by the way their dog acts that a seizure is impending. Then the ictal stage, or actual seizure, where there is intense electrical activity in the brain; and post-ictal, which can last for hours or days. I have never seen anything pre-ictal in Aksel, and so far his post-ictal period is very short; he’s out of it and hungry for a little while. What is commonly called a “grand mal” seizure is now called a tonic-clonic seizure, where first the muscles stiffen and spasm (tonic) and then jerking movements begin (clonic). Contrary to popular belief neither dogs nor people swallow their tongues.

Sometimes, Aksel goes a month to three months between seizures, but I am always waiting for the next one. Epilepsy, as it turns out, can lead to a lot of superstition in dog owners. After Aksel’s first seizures, I started Googling right and left and immediately made myself crazy. Was it that I was feeding the wrong dog food? Was it the scents I diffuse in the office? Does rosemary cause seizures? Could I cure his epilepsy with a raw diet?

I joined a couple canine seizure support groups on Facebook and quickly left a couple of them, freaked out by the paranoia — I had enough of that on my own. I am still in one of them that is kind and helpful, and see dog owners across the world freaking out the way I did. 

You know what you should never do when you or your pet is diagnosed with a serious disease? Consult Dr. Google. Knowledge is indeed power, but internet knowledge is not the same as talking to an expert. 

Per my local veterinarian’s advice, I made an appointment with Dr. Daniel Krull of Columbia River Veterinary Specialists in Vancouver, Washington. As it turns out, there are just not many veterinarians specializing in neurology around the Northwest. There are none at the vet hospital at Oregon State University, and aside from Dr. Krull, the closest specialists I found were at VCA Northwest Veterinary Specialists in Clackamas. All had a several-month waiting list, but Aksel and I got into Dr. Krull quickly, thanks to an appointment that opened up.  

Aksel got a neurological workup and was diagnosed with idiopathic epilepsy. There was no indication of brain tumor or other disease, so I decided to forgo a spendy MRI or spinal tap. Krull carefully explained the disease to me, accompanied by white board notes, while Aksel lolled about drunkenly. Phenobarbital and a lot of other epilepsy drugs basically slow the brain down, so side effects are ataxia, meaning he lacked muscle control, and lethargy. Basically, Aksel was fully gorked for a while and gets a little wasted for a couple weeks every time he gets a new drug added to his cocktail. 

Epilepsy is a capricious disease. It can occur in any breed or mixed breed. I later reach out to Dr. Krull with some questions about epilepsy in dogs and he tells me that “a few predisposed breeds with a higher prevalence of epilepsy include Belgian shepherds, border collies, Labrador retrievers and Irish wolfhounds.” And he adds that some breeds “are more challenging to treat and less likely to be well-controlled on medications” —  this he says includes Australian shepherds, border collies and St. Bernards.

As luck would have it, or lack of it, Aksel’s epilepsy is not that easy to control. He’s now on phenobarbital, zonisamide and pregabalin every 12 hours. He also gets levetiracetam every eight hours after a seizure for 48 hours to ward off a cluster. These are all human medications being used for dogs. ​Dr. Krull tells me that it’s “rare to have drugs developed specifically for dogs. Often we see medications that have worked well in humans trialed with dogs. Typically there are pharmacological and safety studies performed.” 

But, he adds, when you have a dog whose seizures are poorly controlled and “on all of the typical anti-seizure medications, we don’t have much to lose from trying new medications.”

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Aksel

Studying Canine Seizures

Sixth seizure: 10 pm Feb. 3, and 6:45 am, Feb. 4, 2020, a cluster. We increased his levetiracetam. 

I went through what I call the stages of canine epilepsy: 1. Denial: Surely, this was a one-off caused by some outside factor like flea control. 2. Magical cures: Maybe CBD will fix it. 3. Twitchiness and paranoia: I can’t sleep or concentrate because I am waiting for another seizure. He sniffed a rosemary bush, he played too hard. 5. Acceptance: This sucks, but we can live with it. 

Talking to a neurologist helped, and since I am a proactive person, I started looking into other things I could do. 

I started buying Aksel a dog food made with medium chain triglycerides, which are shown to reduce seizures in dogs, per a study by the British Royal Veterinary College (RVC). I looked into a study on epileptic dogs and CBD at Colorado State University, and I enrolled him in a study on epileptic dogs by the University of Wisconsin-Madison’s Small Animal Neurology Service. Aksel qualified for the Madison study by dint of his age, history of seizures and the panoply of aforementioned expensive medications. 

I was unsure about the CBD study, so I decided to wait — CBD can elevate a dog’s liver enzymes and Aksel is already on phenobarbital, which can also affect the liver. So I will wait and see how the study pans out.

The Madison study involved Aksel wearing a FitBark collar — think Fitbit for dogs — tracking his exercise and sleeping habits for six months. Three of the months he just did his normal Aksel stuff, the other three he took a “supplement.” Other dogs were asked to change their exercise habits. 

Seventh seizure: 7:45 am, Feb. 25, 2020, in bed.

Eighth seizure: 7:45 am, Feb. 29, 2020, in back of car. Started zonisamide March 6.

Ninth seizure: 8:22 pm, May 9, 2020, asleep on my lap on the couch. Got video. Was wearing FitBark. 

One of the things the FitBark did was help me get myself out of the overprotective funk I had gotten into around my dog. I was protecting him from everything, including exercise. Tracking Aksel’s “BarkPoints” — a “system that measures physical activity in line with best veterinary practices in terms of ‘activity counts’ generated from 3D accelerometer readings,” according to the FitBark website — clued me into the fact I had let my dog become really inactive. We slowly began running, starting with long walks.

The study also asked us to video and track seizures. I use an app for tracking dog seizures from the RVC, and I record video on my phone. You feel helpless while watching a beloved pet gasping and paddling, and, weirdly, videoing gives you a sense you are doing something. It also helps track the length of a seizure. If one goes on for too long — for example, five minutes or more — or too close together it is called status epilepticus and can be life-threatening. The dog could overheat and it could kill him. I have emergency medications like nasal midazolam on hand to help arrest a seizure were that to happen. 

The videos, seizure log and data went to the study. The first round of results came out earlier this year, and I called Dr. Starr Cameron, the veterinarian leading the study, to ask her about what she found. 

One of the first things Dr. Cameron said to me was that we know more about seizures in sea lions than we do about seizures in dogs and cats. This is because it’s difficult to observe seizures naturally. You can induce seizures to study them, but she points out there are ethical issues with this, and induced seizures don’t look or behave like naturally occuring seizures. The FitBark allowed researchers to track the canine participants’ sleep and exercise. Aksel, like many epileptic dogs, tends to have his seizures while sleeping or waking from sleep, often at night.

10th seizure: 6:04 am, June 25, 2020, 6:04 am asleep in bed, head on my chest.

11th seizure: 2:49 pm, June 29, 2020, 2:49 pm dozing in his kennel at my office. 

Dr. Cameron explains that having seizures is the most commonly diagnosed and treated neurologic condition in dogs. Epilepsy occurs, according to Dr. Krull, in about one percent of canines. Generally, dogs are treated with the aforementioned anti-epileptic medications with their known side effects, including sedation and lethargy. 

But, Cameron says, “we do not have quantitative information to let owners know how much lethargy to expect — and if that is transient or more long-term.” So one of the goals of the study “was to compare activity and sleep in dogs with idiopathic epilepsy receiving anti-epileptic drugs to age- and breed-matched controls.”

Somewhere out there in FitBark land, Aksel was being compared to another ridgeback. 

The first part of the study — on sleep and activity levels — has wrapped up. Cameron says part two is to come, which looks at the effects of exercise on seizures. Part three looks to see if the FitBark can track if a seizure happened.

Cameron says, “We found that our epileptic dogs receiving treatment with medications had an average of 18 percent decrease in activity compared to age- and breed-matched controls. We did not find any difference in the sleep restlessness between the two groups.”

The interesting part about the exercise — beyond knowing I had been guilty of exercising my dog less after his seizures started — was that Cameron says, anecdotally in clinical experience, dogs are like people where exercise is more protective. So, like people, dogs who exercise tend to be healthier. After I talked to Dr. Cameron, much to Biggie’s disgust and Aksel’s delight, we started to run three miles about three days a week. On the days I feel like slacking, I remind myself that running just might be helping him. 

Aksel will reach the two-year mark of epilepsy this August. And this summer marks what is hopefully the beginning of the end of COVID-19 pandemic. I see others in my dog seizure support group get more and more worried about returning to work and not being there when their dog seizes. “In general,” Dr. Krull says of fears of not being there when your pet has a seizure, “the best we can do is to be aggressive and proactive with treating seizures to reduce the chance of a serious or life-threatening episode occurring at home.”

I am lucky that Aksel and Biggie come with me to the office. COVID-19 also weirdly took the pressure off of socializing, since I do fret when I am not there, in case Aksel has a seizure without me. I bought cameras I can watch him on when I do have to leave him. 

12th seizure: 9 am, Oct. 12, 2020, asleep in bed. 

13th seizure: 5:30 am, 5:30 Oct. 15, 2020, asleep in bed. Seizure was about 24 hours after last dose of levetiracetam. Increased zonisamide by 100 mg each dose on Oct. 20.

14th seizure: 1:09 am, Oct. 28, 2020, asleep in bed. 

15th seizure: 8:43 am, Dec. 4, 2020, asleep in bed. 

16th seizure: 4:30 am, Dec. 11, 2020, asleep in bed. Small seizure. Increased zonisamide again.

17th seizure: 8:20 am, Feb. 2, 2021, laying in bed.

18th seizure: 5:20 am Feb. 5 2021, asleep in bed. Short seizure, discussed medications with Dr. Krull.

19th seizure: 10:53 am, Feb. 16, 2021, small seizure — same as Feb. 5, just his head again. 

20th seizure: 2:55 pm April 30, 2021, asleep in bed.

21st seizure: 6:30 pm May 3, 2021, asleep in kennel at office. Started 75 mg pregabalin.

As this story goes to press, Aksel will have gone more than 30 days without a seizure. Dr. Krull would like to see him go four to six months. So we added the third medication, pregabalin, and Aksel is just a little more dopey and unbalanced than he was before. 

It makes me sad to give this dog so many medications, no matter how happily he wolfs them down wrapped in peanut butter. But he’s still with me and still happy-go-lucky. When COVID ends, he will be thrilled to leap onto local politicians’ laps instead of just into their video screens. For now he naps in my office as I type this, Biggie curled up beside him, dreaming not of seizures, but of snuggles, treats and perhaps his next adventure.