Kidney Disease and Seizures in an Old Dog: facing reality - CTV #37

Watching your dog having a seizure is an incredibly distressing event to witness. But what can you do to help stop their seizures if they're not having a fit caused by epilepsy?

Sometimes treatment is tough and the prognosis poor. Recognizing these situations is so important if you want to be sure that you’re making the decisions that are in your dog’s best interest.

Dog Kidney Failure and Seizures - call the vet podcast episode 37
Hi my chihuahua is 17 years old and she started throwing up some white stuff then she’s stopped eating. Next day she threw up white foam and slimy green stuff and last she stopped drinking water. Took her to the vet as she was diagnosed with kidney failure today.
She started having seizures last night there is anything I can do to relieve the seizures?
— Beatriz
  • Seizure causes are numerous. They fall into the five main categories of: Toxins, infection, organ dz, brain lesions, and epilepsy.

  • Controlling seizures involves making a diagnosis and then being able to treat, manage, or cure it effectively. When there is a disease causing the seizures, other than epilepsy, then anti-seizure medication alone will often fail to control the seizures adequately - especially in the long term.

  • Anti-seizure medication can though form part of symptomatic treatment plan while investigating and starting treatment targeted at the specific underlying cause.

  • The kidneys help to regulate hydration, body salt levels and filter out numerous toxins from the blood

  • In advanced kidney failure, seizures can result from the build up of toxins within the blood. This is typically only seen right at the end of long term failure, or if there has been a sudden failure - acute kidney injury - e.g. antifreeze toxicity. Seizures are a sign of severe and advanced kidney damage and unfortunately the prognosis is likely going to be really poor.

  • Whenever our pet has a really serious disease, we need to be realistic about the likelihood of recovery and whether ongoing treatment is resulting in an improvement, whether the condition itself is curable, as well as the condition of your pet (e.g. are they comfortable or in pain)

  • Vital that you work in conjunction with your veterinarian. It is important that you know what to expect, the likely outcome based on the treatment and investigation decisions made, as well as the potential costs involved.

  • Decisions need to be re-evaluated on a weekly, daily or even hourly basis. We always need to be thinking what the best decision is for out pet, not for us

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+ Full Transcript

Beatrice wrote this one saying, “Hi, my Chihuahua is 17 years old, and she started throwing up some white stuff. Then, she stopped eating. Next, he threw up white foam and slimy green stuff and last, he stopped drinking water.” She took her to the vet and was diagnosed with kidney failure today. She started having seizures last night. Is there anything that she can do to relieve the seizures?

It’s a really difficult situation that Beatrice is in. She's got her old, faithful companion. She's been with her for 17 years. So, she's a really old dog, which is a testament to the level of care that Beatrice has provided her over the years.

And I guess we'll start off by saying, there is a number of different things that can cause seizures. Certainly, kidney failure is one of them, but we can break them down into kind of several different categories, which is something to consider if your dog or your cat ever has a seizure.So, that's toxins or poisons, eating something horrible. So, something like slug bait would be a classic one.

There are infections are like meningitis. Organ disease. So this is where kidney failure fits in. But that could be liver disease. It could be a hormonal abnormality. So the pancreas is not working properly, for example. It could be a brain lesion. So thinking things like a brain tumor, something a mass on the brain, and then epilepsy being that fifth cause of seizures.

So, really controlling seizures, it involves getting that diagnosis right in the first instance and making the diagnosis as to what is causing that seizure and then being able to treat or manage or even cure that condition effectively.

So when there is a disease that's causing the seizures other than epilepsy, then actually just giving anti-seizure medication alone. So that could be phenobarbitone or phenobarbital. It could be Pexion Imepitoin and there's lots of different anti-seizure medication, but giving that alone will often fail to control the seizures adequately or as well as we would like them to be controlled. And that's going to be especially the case in long term management of a condition.

So, if your dog has eaten something and they're having seizures, then yes, giving anti-seizure medication while that toxin is being removed from the body will definitely help and is definitely part of treatment and even with an organ disease. If the very early stages, while we're just trying to stabilize your pet, then anti-seizure medication is going to play an important role but for long term management, long term prognosis, we need to actually try and treat that underlying condition.

I say, except with epilepsy because with epilepsy, what we are doing is giving anti-seizure medication. That is our main treatment.

There are other things that we can do to help reduce the likelihood of seizures, and those are becoming more and more apparent as more research is done in that condition. But things like diet can play a big role here. But all of the other things, we want to be trying to tackle that underlying cause that has resulted in the seizures in the first place.

So with Beatrice's dog, with her Chihuahua, we know that there's kidney disease involved. So, absolutely kidney disease can cause seizures. So the kidneys, they help to just regulate hydration so the water content within the body, the body salt levels, and they filter out numerous toxins from the blood. So they play a really important role.

There are lots of other things that they do and they're absolutely critical. You won't be surprised to hear with lots and lots of different processes within the body. So in advance, kidney failure then seizures can result from the buildup of toxins within the blood.

Now, really, this is typically only seen right at the end of long term kidney failure or if there has been a sudden failure. So, acute kidney injury here and an example of this would be due to something like antifreeze toxicity, which is potent this time of year in cats.

If the kidneys are really knocked out very acutely, very suddenly because of poison in this case. It could be because of infection up in the kidneys. Then also you may get this seizure activity.

But the bottom line is that seizures are really a sign of severe and advanced kidney damage. And the prognosis is, unfortunately, going to be really poor in a dog who's having seizures because they've got kidney disease.

So with that in mind, whenever we have a really serious disease, we need to be realistic about the likelihood of recovery, whether the ongoing treatment’s going to result in an improvement in a pet's condition, whether we're going to be able to manage that condition successfully or not. And you know, whether the condition itself is curable or not as well.

So in the case of kidney disease, with the exception of really acute kidney injury where there may be some reversibility in the damage that's been done, although by the time we get to seizures, that's going to be fairly doubtful, but once the kidney damage has taken place, the kidneys really, they can't regenerate. And so we're left with that level of damage. So we've got to, you know, be very mindful of the likelihood of being able to successfully manage and treat a condition in the long term.

It might very well be in the short term that there are things we can do to reduce those seizures, to control those seizures. But are they likely to help in the long term? Is it going to be a case of your dog or your cat being hospitalized for a period of time? That could be days. It could even be weeks trying to get everything under the under control when the reality is that as soon as they get sent home, they're just going to deteriorate again very rapidly. And is that fair to put your pet through?

So, it's vital that you work in conjunction with your veterinarian. And this goes for so many different conditions and pretty much everything I talked about in these podcasts. It's going to be vital that you work really closely with your vets.

You have an honest chat about what the outcome is likely to be, what the different options are with investigation with treatment with surgeries, what the difference those things are going to make to your pet’s long term prognosis because just because we can do something doesn't mean that we necessarily should be doing it.

That's something that I really strongly believe and I think we're seeing that in the human health field as well. We are potentially, and this is going to be personal opinion, but very often, we are overmedicalizing very serious conditions when actually the likelihood of recovery is very, very poor, especially when we're reaching the natural kind of upper limits of our lives.

Anyway, so she’s 17 years old. She's a very old girl. And whether it's fair to put her through an awful lot of treatment is something that you need to be open and honest with your vet.

Now, clearly, I don't know all of the ins and outs of the situation here. And it may very well be that it's thought that the potential outcome is very good with appropriate treatment. But it's important that you're aware of that when you're putting your pet through any intervention.

And costs have also got to come into play as well. When a pet is very ill, then often the costs can quickly mount up and so you need to be sure that you're able to afford that. And also, it's something that you're willing to go through given the likelihood of success.

So whatever decision you make, decisions always need to be reevaluated as well. And that could be on a weekly basis. It could be on a daily basis or in the case of a very sick pet, even on an hourly basis.

Making sure that you've got your phone with you. That your vet has your new number if you've changed address or if you've changed phone and always just be reevaluating that decision. Not thinking that because you've set down a certain pathway that you need to persist no matter what happens. You should always be reevaluating.

And then finally, we always need to be thinking of what the best decision is for our pet, not just for us. It's a very difficult situation to find yourself in when you're dealing with a serious disease no matter what's your what your pets ages but especially when they're older. We need to be realistic, and we need to think about what is best for them because it may well be that the time has come to let them go.

And these are all incredibly difficult situations to find yourself in and very difficult decisions to make especially when you happen to make them in the heat of the moment. Emotions are running high and it's really challenging. And I very much hope that you have got a vet who you trust and who you can confide in and who can help you through this difficult time.

If you do have an older pet, even if they're not struggling, then I do also have a couple of really comprehensive articles about palliative care in the first place. So that is for your pet, if they are unwell, if they have a condition especially a chronic long-term condition that maybe they're struggling or even if they've just been diagnosed with that.

Palliative care is definitely something that you should be aware of: the different options and should be considering, but then I've also got a very full article that takes you through the steps that you need to be thinking about to decide if it is time to say goodbye to your pet.

Like I say it's very difficult. It's a very emotionally-charged situation to find yourself in. And unfortunately, all too often I hear from people that their biggest regret is actually holding on too long and putting their pet through things that actually in hindsight, they only put them through so that they could be with their pet for longer and actually, they weren't in their pets best interest.

So, I will leave links to those two articles in the show notes and I hope that they will provide a little bit of relief for you and help you make any difficult decisions that you need to make. And I think it's important that even if your pet is healthy, especially if they are old, then you should be thinking about those things just so that when the time does come, and hopefully that won't be for a long time, but when the time does come, you'll be much more comfortable making that difficult decision.

So it's a really challenging topic that we've discussed today. And unfortunately, I can't always give advice that is going to result in a happy ending, but I strongly believe in being open and honest about likely prognosis and about what's best for your pet.

So I think challenging topics like this are really important for any pet owner to consider even when they've got a young pet because unfortunately, the reality of having a dog or a cat in our lives is that their lifespan is much less than ours. And so at some point in the future, you are going to be in a tricky challenging situation.

And I hope that even just by listening to this now, years, hopefully years before you're going to need to use this information. It's going to just mean that you're better set and more comfortable when the time does come. So I hope you find it interesting.

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