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Welcome to the Synaptic Tails podcast, where neurology meets practical tips in veterinary care. Hosted by Dr Emma Hancox, a Technical Vet Advisor at Dômes Pharma UK, alongside Dr Mark Lowrie of Movement Referrals.
In each episode, we explore the challenges of managing epilepsy cases in first-opinion practice - sharing clinical insights, lived experience, and practical strategies to support your patients and your team.
Season 1 introduced Dômes Pharma UK’s S.M.A.R.T. Approach to Epilepsy, offering step-by-step support on seizure management. In Season 2, we build on that foundation with even more focused conversations - tackling status epilepticus, seizure mimics, feline epilepsy, adjunctive therapies, and the power of teamwork in chronic care.
Join us as we unravel the complexities of veterinary neurology, share real-world stories, and empower you with knowledge. Together, let’s enhance the health and happiness of our canine and feline companions.
🌐 Learn more about Dômes Pharma UK: https://domespharma.co.uk
Access Vet Resources from Dômes Pharma UK at https://domespharma.co.uk/the-vet-vault/
🌐 Learn more about Movement Referrals: https://www.movementvets.co.uk
Movement Referrals is an independent, specialist veterinary hospital with practices in the North West and Midlands. Our aim is to provide high-quality but efficient Specialist referral services. We concentrate on orthopaedics and neurology, two of the most common reasons for referrals. We offer common referral procedures, such as TPLO, patellar luxation, and spinal surgery, at reasonable prices.
One of our fundamental philosophies is "getting it right first time." We not only provide more choice at better value, but we aim to objectively demonstrate our value through measuring and publishing our
Welcome back to Synaptic Tails.
I can't believe it, but today
marks the end of season two
of Synaptic Tails already.
How have we got this far?
It's, it's, it's been
a great journey though.
We've covered so much.
we have covered loads, particularly
combined with season one as well.
If you haven't listened to that already,
please do go back and, and have a listen.
So in today's episode, we're hopefully
going to bring everything we've learned
together and explore the role of the
whole team in helping dogs with epilepsy.
It's one of those conditions that's
chronic, progressive, and deeply
emotional for both owners and clinicians.
And joining me as always is
our resident neurology expert.
Thanks for being here, Mark.
Well, it's great to be here again and,
well, this is such an important topic.
I say it every week, but really no,
this one I think is one that's very
important and one I think we can all
relate to, whether you are a vet,
nurse, receptionist, or a pet owner.
Managing epilepsy isn't just
about the seizures, it's all
about teamwork, communication, and
setting realistic expectations.
I've certainly changed my way of
talking since our first season.
I think you told me off back then
about saying treating epilepsy.
I definitely say managing now.
But absolutely, so I think
let's start with the first
point of contact in practice.
I think that makes the most sense.
The receptionist or our
front of house teams.
What would you say their role
is in managing epilepsy cases?
Yeah.
Well, I see the receptionist as
being the person who often sets the
tone for the owner's experience.
When an owner calls after their
dog's first seizure, they're likely
to be panicked and emotional.
I think a calm, methodical
approach is really, really helpful.
Receptionists should ask key questions,
so you know, letting them know that things
like asking, is the dog still seizuring?
Are they safe?
And if the seizure's ongoing, really to
reassure the owner while advising them to
keep their dog away from hazards and avoid
putting their hands near the dog's mouth.
I can really imagine how scary it must
be for our receptionists to receive
these calls, especially if they've
not had to deal with one before.
I think having a practice protocol
or triage type sheet for seizures
can be really handy for this.
So where all the members of
staff know the right information
to get and can feel prepared.
Do you agree?
Do you have anything like that in place?
Well, absolutely.
The practice team is so important in
supporting owners, particularly during out
of hours calls, and of course that's when
most of these calls are likely to happen.
So for instance, a nurse who is familiar
with the seizure protocol can provide
clear instructions, so they might be
able to advise the owner to monitor
their dog and bring them in the next
day unless another seizure occurs.
That kind of guidance can be
incredibly reassuring during
those early hours of the morning.
Then there's practical advice like
moving furniture out of the way, maybe
dimming the lights and reminding owners
not to put their hands anywhere near
their pet's mouth is important because
I think they're worried they might be
choking this side of things, but it's
important to reassure that's not the
case, and actually there's more risk
to ourselves if we try and intervene.
Since seizures typically stop on
their own reassuring owners that it
should end within a few minutes, and
preparing them for postictal signs
like the temporary drunkenness or
blindness can be really, really helpful.
And actually, if an owner's informed about
that, when they see it, they're reassured
because they were prepared for it.
So these scary signs that we see following
seizures, if we let an owner know they're
to come, they'll be more reassured
and less concerned when they see them.
But beyond this, we can
direct owners to resources.
So leaflets, links online, or even
a quick guide on what to do during
and after a seizure can be helpful.
And these initial conversations really
lay the foundation for a trusting
relationship with the practice.
It sounds like they play a huge role
in calming down owners, and I think
it's, just picking back up on that,
providing extra information as well.
I mean, let's face it, we all know
that owners are going to go home and
Google, although alternative search
engines are available, um, their,
their epilepsy or their dog's epilepsy.
So providing those resources
can be really valuable.
And I think it is the thing now that
we have all this online, so either
having it on your own website or
knowing where to direct them to in a
controlled way is, is a good way to go.
And it, it just reassures the owner,
you've given them the information
they need at that time and space.
Now they will go away and they'll
search it and find out more, but if
that corroborates what they already
know, then the trust is built.
You know, that relationship is
moving forward and they'll want
to carry on and get everything
sorted through your practice.
Yeah, we can make sure it's a nice
reputable source they're going to.
And what about our veterinary nurses?
They're amazing, but where do they
fit into epilepsy management picture?
Yeah, nurses are pivotal, so I
mean, they're often the bridge
between the vets and the owners.
I mean, it's so common we hear we'll
speak to an an owner in a, in a consult
room, but it's only when they get outside,
they actually ask the real question
to the vets and the receptionists.
It's so true.
But after the initial diagnosis, they
can help reinforce what's been discussed
during the consult, and this might
involve explaining how to administer
medication, discussing some of the
common side effects, or just introducing
those simple tools like seizure diaries
that tell us that we're on the right
track and going in the right direction.
But let's not forget their
role in emotional support.
Owners often feel overwhelmed
after an epilepsy diagnosis, and
nurses can be given the time to
provide that extra reassurance.
It's also helpful if they can guide
owners on keeping seizure diaries and
taking videos of episodes, because as
we've learned already, I mean these
tools are invaluable for accurate
diagnoses and treatment monitoring.
It's such a good point I think really
highlighted to me during these, episodes
about, you know, seizure mimics and
cats in particular, how videos are a
real game changer to us diagnosing them.
Well, absolutely.
Smartphones have revolutionised
how we approach neurology cases.
I mean, I personally hate smartphones for
personal use, they've taken over my life.
But actually in the context of work
here, I think they've been absolutely
awesome in helping our patients.
Owners do often come in describing
these funny turns or fits, and as we
know, not all of these are seizures.
So video footage is going to
help us distinguish the true
seizures for other episodes like
syncope or behavioural events.
And what about seizure diaries?
You've mentioned them.
Do you find them helpful?
Oh, definitely.
Diaries help us track how well
medications are working and align
with the owner expectations.
It's so common that I'll get an
owner coming back in thinking the
medication isn't effective because
their dog's still having seizures.
But when we sit down and review a
diary, we might find that seizures
have potentially halved in frequency,
which by the scientific standards,
that would be considered a success.
Now, I, I'm not asking an owner to believe
it's successful because it won't feel
like that in their eyes, but at least
we're saying we've got something better
here than we had before, and it's a, it's
a starting point to move forward with.
Definitely.
I think that's so true as well
that you know, you can ask owners
or when was the last seizure?
Or they come in panicking, oh,
he only had one last month.
But actually if you look at the
diary, it was oh six months ago,
we always seem to remember the
kind of bad episodes, don't we?
So I think that managing those
expectations is, is key, really.
That's what I'm picking up.
And I think when we consider the the
vet's role or I, we just think about
diagnosis and prescribing medications,
but it really is so much more than that
and we really have to support our owners.
So how do you approach these conversations
during the first consultation?
Well, it's that first
consultation that's so important.
Owners need to understand that epilepsy
is a chronic, progressive condition.
I cannot repeat that enough.
And, and it's not commonly mentioned
in that first consultation.
There is no cure.
Our goal is really to manage the
seizures, not eliminate them.
I often use the analogy
of balancing scales.
So one side represents seizure control and
the other, the medication side effects.
So our aim is to find the right balance
for each individual dog, and it's
going to be different every time.
That's really, really
important to emphasise.
It's also vital to address
common misconceptions.
So, for instance, many owners assume
medication will stop seizures entirely.
Setting realistic goals really early on,
such as reducing seizure frequency by
at least 50%, the scientific standard.
Well, that helps prevent
disappointment later.
And what about the emotional side of
things, owners must feel so overwhelmed.
It's not uncommon that they come
and, you know, particularly after
witnessing their first seizure, to
think it's the end of the world.
They do.
And, and that's why
empathy is so important.
I like to reassure owners that epilepsy
isn't painful and doesn't mean their
dog can't have a good quality of life.
I mean, relating it to the
human condition can help.
For example, explaining that many people
with epilepsy live full happy lives, and
often they'll have relatives or friends
they might know they're epileptic,
and they'll sort of, that message
will hit home in a, in a positive way.
But it's also worth mentioning
this phenomenon of kindling.
So over time, epilepsy tends
to worsen due to the brain's
increased sensitivity to seizures.
And this is one reason we often
recommend starting treatment sooner
rather than later, even if it means
introducing lifelong medication.
Now, I've had owners who have felt
like this communication around this is
key, and reassurance is so important.
When lifelong medication is prescribed
to a pet, it can really feel
overwhelming at first, but it soon
becomes part of the daily routine.
And knowing your dog can still
have a really good quality of
life makes all the difference.
I mean, delivering phenobarbital
in a sausage twice a day, the dog's
going to come and find you and remind
you that it's time for medication.
I've had that before.
When the dogs become like their
own medication alarm clocks
coming to get medication.
it's, it's it's cute.
Let's be honest.
I I love that when the dog comes
and tells you that they need,
they need feeding and tableting.
Yeah.
And so speaking of medication, I
obviously, there's not a blanket
approach to everybody, but I find it
quite hard sometimes knowing when the
right time to start medication is.
Some owners are really worried about one
single seizure and worry about not going
home with medications and others don't
seem to be as, as concerned, I guess.
I think vets are often seeking advice
from people asking when is the right time.
And the reason there's no clear answer is
that there is never a single right time.
It really depends on
the dog and the owner.
It's the idea of like this contextualised
care that comes up more and more really.
So I say it depends on the pet.
If a dog has had a single seizure,
personally, I might hold off on
a medication unless the seizures
become more frequent or severe.
And then I suppose we'll look on the other
end of the scale for dogs with clusters
of seizures or status epilepticus, we
would start treatments immediately.
However, it should always be an owner
driven decision and they need the
right information to make this as
an informed, a decision as possible.
And I think being open and honest, you
know, we talked about it in the first
season as well, that that can really
set the, the tone for your future
kind of appointments and follow ups.
But I sometimes, I don't want to be
the bearer of bad news, particularly on
that first consultation, but actually
owners do appreciate that honesty,
It's that candid approach.
Yeah Exactly.
It builds a relationship and trust
and they'll know that you'll,
you'll say it as it is now.
I'm not saying you say it harshly,
but you just need to introduce it
early on so they're aware that's
somewhere that things might go.
Yeah, definitely.
And what about refractory cases?
I know in our episode earlier about
adjunctive medications and things,
we went into the kind of a physical
approach to them, but actually these
consultations can really test the
bond between the owner and their vets.
The vets are pulling their hair out.
The owners don't understand
why it's not getting better.
So do you have any tips on managing
these patients and their owners
whilst also still being realistic?
Yeah.
And, and this is when it really comes
down to it, it's when the cards need
to be on the table and there needs
to be a really frank discussion.
Refractory epilepsy, so where, where
seizures aren't adequately controlled
despite the multiple medications is tough.
It really tests that bond between
the owner and their vet as it can
feel like a never ending struggle.
Now adding a second drug like bromide
can help some dogs, but unfortunately
the success rate tends to drop with
each additional medication we add in.
So it really is a balancing act
of trying different combinations
while being mindful of side effects.
I do like the fact that as we
discussed in a previous episode,
there are alternative therapies and
there's growing interest in them.
So CBD oil or changing the diet,
there is evidence still emerging
that these can be of benefit.
So yes, you might have tried all
the conventional medications, but
there's still other options out there.
And these options might only
offer small improvements.
It is important to say to an
owner that may be all we get,
but they are unlikely to replace
traditional medications entirely.
And that said, for some owners,
it's helpful to offer these as
complimentary options alongside
their regular medications to see if
they can add some benefit without
detracting from the core treatment plan.
Owners love it when vets approach
these alternative therapies and say,
well, there could be something in that.
Let's give it a go.
These owners are desperate.
They will try many things and it's
important for us to guide them onto
the sensible things to try rather
than go completely crazy with things
that could be detrimental to the dog.
Yeah.
And you mentioned to me off air
actually earlier that your approach to
refractory patients has really changed
in these past even couple of years.
Well, I think that's true.
I think I, I definitely reached the
point with many of these patients
where they were on phenobarbital,
they're on potassium bromide.
You've added in levetiracetam, Gabapentin
was a drug that was quite new, so I'd
add that in and all I was doing was
adding in more and more drugs and you're
going to cause problems in doing that.
You know, these dogs are going to get
sicker and sicker and, and you know,
the liver's going to be doing a lot.
The kidneys are going to be doing
a lot and then other conditions
are likely to happen in these
patients just because they're aging.
But nowadays, I do think with
the diets, with these different
oils that are available, there
really are things there we can do.
And even if dogs are clustering, well,
maybe think, well, let's focus more on the
clusters rather than long-term management.
So intranasal midazolam is good.
I've known patients where you actually
need to hospitalise them for that cluster.
Maybe give them a constant rate infusion
of midazolam, they're okay then well,
you know, you keep 'em in for 24 to 48
hours, they're then okay for a period of
time and they might go another several
weeks or months until the next cluster.
Now, if that's what happens in that
pet, many owners in that situation will
feel that's a reasonable outcome that
they then carry on as before and just
accept every three to six months they
have to face this hospitalisation period
to try and get the dog under control.
So, so much I feel has changed and we've
got a lot more to offer . I can't believe
the amount of studies that come out
all the time that are supporting some
of these, these, things that I, myself
and maybe others were quite dismissive
of perhaps a number of years ago.
Yeah.
It's really evolving all of the time
and I think there is that, I think
move with a lot of things actually
into more of a holistic approach.
Looking at the whole picture, I
mean we, we've touched then on
the medical management of these,
but actually it sounds like managing
the owner really is, is key here.
Yeah.
And I, the term managing an owner, I
mean, I'm very aware we can't change a,
a person's behaviour, but I think it's
giving them the information so they can
make the informed decisions when it comes
to managing these cases with owners.
Absolutely.
We've said it, communication is key.
We cannot emphasise that enough.
I mean, it's really important to be
honest about the challenges we face with
refractory epilepsy, while also providing
reassurance that we're exploring every
option and doing everything we can.
Regular follow-ups and being open to
adjusting the treatment plan as needed
can help keep the owner's confidence
high even when things are tough.
I do want to bring empathy back in here.
It's, it's crucial.
I mean, I found that acknowledging how
difficult this journey is for owners
can strengthen that relationship.
Just acknowledging what the owners
are going through with their dog.
It can be a weight off people's mind
and go, I thought it was just me that
was going to have this battle, but
they, they appreciate that honesty.
Sometimes it's just not about the dog.
It's about supporting the owner through
their emotions and the frustration
that comes with not seeing those
immediate results that we all wish for.
Offering small victories, even
if they're just glimpses of
improvement, can help keep morale up.
But lastly, it's also important to
discuss quality of life regularly.
Helping owners understand the bigger
picture that even if seizures are ongoing,
the aim is to improve the overall quality
of life for both the pet and the owner
can give them a sense of purpose and
direction in managing the condition.
I think you said to me once that imagine
a, a person with epilepsy, if they
have side effects to their medications,
they have them every day, but they
only seizure what, every six months.
It's, it's that balance of
quality of life, isn't it really?
And it is, and it's difficult in people
because we have to handle heavy machinery.
By that I mean, drive cars.
That's true.
There is an importance that if you want
to be able to maintain that freedom of
being able to drive, doctors strive
for higher doses to ensure that the
seizures are infrequent and eradicated.
Now, we don't need to do that in dogs.
I've not seen a dog drive, a, car
around the street or anything.
Not Yet.
But we do need to give medication
when seizures are frequent.
And so, so important.
Giving the right amount of medication
to a dog and trying to eliminate those
side effects is great and is important.
So we don't need to be as
heavy handed as doctors are.
And I'm not criticising doctors,
you know, they've got a different
role and a different job here.
Do you actually find yourself
withdrawing medications sometimes?
Say if you know you've added this
and that and this and that, and
they are a refractory patient.
There's definitely times we need to
look at withdrawing medication and,
and the most common time in fairness
is because we're seeing side effects.
Yeah.
Now, if it's because of side
effects, we might need to
withdraw medication quite quickly.
And so we do it in a hospital
setting, but there are times when
we might do it because we think,
well, is it actually working?
Now, when I do that, I still do it
cautiously because there is a big risk.
We could make things a whole lot worse.
And when I do it, an owner
has to be fully on board.
It might be the owner will say to
me, well, I don't agree with you.
I'd, I'd rather keep the
phenobarbital going because
I think there's some benefit.
You can give them the reasons why,
but if they don't want to do it, then
don't do it because that will be the
patient that will have a terrible time.
But often owners are quite
keen to withdraw medication.
I do find that's, that's often the case
when they're on multiple medications
and it tends to be more me not
wanting to and owner's wishing to.
The other time, of course, is when
you've got a dog that has been well
controlled for a long time and is on
a lot of medication, and it might be,
historically it had horrendous epilepsy,
but now we're in a period where it's been
seizure free for three to six months.
That would be another time you
might start to consider it, but
I like a solid six month seizure
free period before I consider it.
Definitely.
Definitely.
I mean, it just sounds like, you
know, as much as we can look at the
medications, we're probably actually more
therapists to our owners in this sense.
Well, owner management is just
as important as managing the dog.
Each owner has unique priorities and some
may be more concerned about postictal
behaviour than the seizures themselves.
So taking the time to understand
their goals helps us tailor a
treatment plan that works for them.
And I think it's, it's been brought up
by us before, but these dogs that have
postictal aggression and their round
families with small children, I mean,
that, that is, that could be a devastating
outcome if we don't get on top of that.
So the seizure's not the problem there.
It's the behaviour following that.
And hence, medication
still needed to control.
It's also worth discussing
the referral options.
We've talked a lot about how
communication's important, and I know
many of you might be listening to this
thinking, well this is great, you know,
if you've got lots of time to do it.
These conversations are
brilliant and we're all tight
for time in veterinary practice.
So these specialist consultations
often provide owners with more
time to ask questions and better
understand their dog's condition.
And I say even if advanced tests
don't change the treatment plan,
the extra communication can
strengthen the vet owner bond.
So don't feel that referral is
always about advanced imaging.
It really isn't.
Advanced imaging is such a smaller part
of epilepsy diagnosis and management.
So I'd really want to stress that
today and I hope you've had that
throughout, that an MRI is not that
important to many of these patients.
I think it's really important that us as
GP vets remember that, that when we are
referring these epileptic patients, we're
not referring for an MRI, we are referring
to have that whole support from a referral
centre and, and neurology specialist
who has so much experience in this.
But a lot of time as well.
And that's, that's the thing,
you know, these chats help.
And I mean, certainly
where I work, I'm happy.
Then afterwards I'll say to an owner,
look, we've had this conversation.
We've spent an hour going through things.
They're going to get home
and think of more questions.
So I like to still maintain that
communication when they get home.
So that referral appointment would still
lead to them contacting me in the future
with other questions around their dog's
problems and just continuing to work as
a team with, with both their own vet and
themselves to manage that dog's problem.
Yeah.
And that's, that's critical really.
And I think, you know, something we've
explored before, but if you can provide
that realistic expectations, provide
that support, they are much more likely
to come back to you, as in us as vets,
rather than seeking advice elsewhere.
They are.
I mean, it's always quite nice when
you get an owner asking to see you.
Yeah.
I mean, you know, I, I think we're all a
little bit flattered or pleased they're
coming back and it's these conversations
that help that you might feel you've
had a difficult, tough conversation
with that owner initially, but over time
that will pay dividends and they'll be
delighted to come back and see you because
they know you were very honest and, and
well, and clear about what to expect.
Yeah.
Really great way of, of keeping these
owners informed and, and on a board
having a good relationship with them.
Yeah.
And ultimately means that
hopefully we're going to get better
outcomes for their pets as well.
But that's such a good point.
So Mark, I guess to wrap up,
what's the key takeaway for
practices managing epilepsy?
Epilepsy management is a team effort.
From the receptionist, first
phone call to the vet's diagnosis
and the nurse's follow up care.
Everyone has a role to play.
I mean, that's so, so important.
Clear communication, empathy and
realistic expectations are the
cornerstones of successful management.
And remember, it's not just about
treating the dog, it's about supporting
the owner through every step of
that really difficult journey.
Absolutely.
Absolutely.
So I thought it might be a fun way
hopefully to wrap up this final
episode to ask some, I was going to
say frequently asked questions, but
more questions that I'm just interested
in, Mark, that we haven't covered.
If that's all right,
Let's give it a go.
I mean, this is very much a, you have
no idea what's coming now, do you?
So
Really don't, but let's run with
it and, I just hope everyone,
everyone enjoys what they hear.
So I, we've talked about dogs and cats.
What's the weirdest species you've
ever had referred to you or seen?
Oh God.
There's, there's a few.
There's a few.
a few.
what I would say is I, I, I stick solely
with dogs and cats, so I'd want to make
that very clear initially that, my, my
expertise, my expertise is solely with
dogs and cats and, you know, these other
species I might have seen videos of,
of other, other animals fitting, a, a
rabbit, that's probably a bit, but, you
know, rabbits, rabbits quite common.
They, they quite commonly fit.
But then, you know, to move on to the
more unusual I can think, a snake was one.
A, a snake having a seizure.
How, how do you know it doesn't
have tonic clonic limbs?
No, and you know what, I, I think it's
true that the whole body jerks, but in
a way that makes, you know, it is more
likely a seizure than a movement disorder.
So a movement disorder, maybe the snake
would curl into unusual sort of patterns
and writhing sort of body motions.
But this was a, a snake that was actually.
Having tonic and then clonic
phases of the whole body.
So that was, that was
a snake with a seizure.
That is fascinating.
And then we moved to penguins.
Wow.
I'm so glad I asked this question.
Well, there was a penguin, so a penguin
and a zoo, which I can't disclose which
zoo, but there was a penguin that, well
actually didn't have a seizure, so I'm
being strictly a bit, a bit, rogue here.
But that was a, a, a penguin
with a movement disorder.
And again, it was where you
apply the same principles.
So you watch the episode, and I
didn't see the penguin in person.
It was a video that was provided actually
by a tourist, that had seen this.
And the, the zoo passed it on to me.
But it was a penguin that, was having very
slow movements of the limbs and the whole
body and twisting into unusual positions.
But because of the slow nature,
the fact it would last some time
and there was no postictal period.
It really supported the idea
of a paroxysmal dyskinesia,
so a movement disorder.
And importantly, that penguin's been fine.
You know, again, it comes back to
what I said about dogs and cats.
When they have these episodes, they
are completely fine in between.
And so they live a, a fairly normal
life in spite of the episodes.
So that, that's the penguin.
That's amazing.
I mean, you were saying about,
you know, treating cats three
times a day would be a pain.
I can't imagine if you had
to go and treat a penguin.
So I'm glad it didn't need treatment.
I was going to say, I, I
didn't fancy that conversation.
And then, and then you move on to, I mean,
there are things we see very strangely,
like lions and tigers and, and bears.
Oh, my, no, no, but no li lion
would be the other one I've seen
with, with neurological problems.
But moving away then from seizures,
you know, that, that, that was a,
a lion with a spinal condition.
But again, we're limited on what we can
offer that lion, I mean, you can, you
can put medication in the meat, but, but
we're, we're fairly limited on what we
can actually do to help in that scenario.
Probably not going to take some
monitoring bloods from that one
every year, three to six months,
maybe moving away from epilepsy.
Then what is your like
favourite area of neurology?
Oh, we've covered all of that.
Oh.
So, no, I know.
I love the movement disorders.
I think movement disorders are great
and, and actually the other thing
I like is, I like being able to see
how pets behave at home on videos.
So I am a big fan of videos and I've
said all along, you know, if ever
you do get a video of a, a dog or
a cat seizuring or doing something
similar, feel free to send it to me.
But actually just watching how
patients move that have neurological
problems is so informative.
And you may remember at vet
school you kind of get taught this
neurological examination and it's
really long-winded and honestly a
bit boring and takes far too long.
And I've never really liked doing that,
but I think you can target your exam so.
So well or sort of hone in
on key things you need to do.
Yeah.
By watching Gaits.
So you might have heard of the hands
off neurological exam and the hands on.
I really would much rather have a
hands off neurological exam than
do a hands-on neurological exam
because so much more information.
So I love the way the smartphone
can help you manage patients from a
distance and maybe advise on further
tests that can be done without
actually having to, to see the pet.
I think that's great.
That is really interesting.
So basically you've just
admitted in these podcasts that
you don't do a physical exam.
You basically just watch videos and
ask the owner lots of questions.
All, all, all I need is
the popcorn and I'm made.
So my final question then to you Mark, is
if you could give our GP vets listening
your top tips or top takeaways from
these episodes, what would they be?
That's a really hard one to
summarise it into a few top tips.
So I suppose the first one I'd,
give is to really remember that
epilepsy is a progressive condition.
So it might be bad today, but it
will be worse as time goes on.
And the reason I say that is again,
it's about telling the owner that from
day one, I think it's really important
they know that, and it, it might
change the course of how they treat and
manage their dog, but so, so important.
I think the other one then moving
on to like diagnosing epilepsy,
I'd want to reemphasise the
need to, there are some very
straightforward blood tests we can do.
But it's about preparing the patient.
So here I'm referring to looking
at the blood sugar levels.
So doing a glucose test, we all
measure glucose frequently, but
it's about doing it when a dog
has been fasted for 12 hours.
So when you get presented with
a dog that's had its first fits,
inevitably it's happened at a time
of day when the dog's had breakfast
or been fed within the last 12 hours.
So feel free to do blood tests,
but I'd get them to go away and
come back with the dog fasted to
do the blood glucose concentration.
And we are looking for a
value sort of above three and
a half millimoles per litre.
If it's below that, that's concerning.
If it's a bit borderline, then I'd repeat
it every couple of hours for the next six
hours to see if it does drop any lower.
And the last one, I suppose
I'd want to really give
Phenobarbital a bit of support.
because I think it is an abused
medication when it comes to,
the side effects it can produce.
And I think there's a lot of concern
from vets and owners about its
potential to cause liver disease.
Now it does happen.
Liver disease does happen, but I think
it's, it's blamed for it more commonly
than I think it actually happens.
So remember when you put a dog onto
, phenobarbital increases in liver enzymes.
I mean actually I, I kind of dismiss them.
I'm not worried about that.
You know, that's part of the
course with the medication.
But actually outright liver failure
is exceptionally rare in these dogs.
So if we use it correctly and we don't
go too high with our serum concentration,
so kind of keeping in that sort of 20 to
25 range and not going above 25, then I
think you're going to get a really safe
approach with using phenobarbital in that
dog and hopefully not too many problems.
That's so true.
And you know, speaking as a vet tech
for Dômes Pharma, that's definitely
one of the questions I get a lot.
Should I worry about
this dog's liver value?
So it's really reassuring to
hear you say that as well.
Well, I think that's all we've got time
for today and this series, to be honest.
But thank you Mark for such
an insightful discussion.
And thank you to our listeners for
tuning in for all of our vets and owners
out there, Dômes Pharma have recently
launched a My Epileptic pet website.
This is actually written by vets.
It contains various FAQs covering
everything from what to do
during a seizure to traveling
with my epileptic pet as well.
You'll also be able to find downloadable
resources, including a seizure diary.
You can simply search my epileptic
pet or the link will be in the bio.
And that really wraps up our
season finale of Synaptic Tails
Thank you again for joining us.
Mark, it's been really nice to have you.
Hopefully you've enjoyed recording these.
Oh, I have.
Thank you very much,
been a great, great time.
I thought he had just
tuned out already then.
And I hope you guys have enjoyed
listening to this series as
much as we have recording it.
Best of luck, Mark with the second
site, just opened, I think at
your second movement referral.
So you're going to be very busy there.
Thankfully, we got you in time.
And if you guys like this podcast,
please do feel free to get in touch
with one of us and let you know what
you liked and whether you would like
to hear any particular topics or
particular discussions that you want
to be covered in future episodes.
And we'll hopefully
see you all again soon.
Thanks.
Thank you.
Bye-bye.
Bye.