1 00:00:00,415 --> 00:00:02,295 Welcome back to Synaptic Tails. 2 00:00:02,755 --> 00:00:05,845 I can't believe it, but today marks the end of season two 3 00:00:05,845 --> 00:00:07,495 of Synaptic Tails already. 4 00:00:08,215 --> 00:00:09,175 How have we got this far? 5 00:00:09,775 --> 00:00:11,500 It's, it's, it's been a great journey though. 6 00:00:11,500 --> 00:00:12,890 We've  covered so much. 7 00:00:12,890 --> 00:00:16,155 we have covered loads, particularly combined with season one as well. 8 00:00:16,155 --> 00:00:19,305 If you haven't listened to that already, please do go back and, and have a listen. 9 00:00:20,565 --> 00:00:23,715 So in today's episode, we're hopefully going to bring everything we've learned 10 00:00:23,715 --> 00:00:28,035 together and explore the role of the whole team in helping dogs with epilepsy. 11 00:00:28,635 --> 00:00:32,415 It's one of those conditions that's chronic, progressive, and deeply 12 00:00:32,415 --> 00:00:34,845 emotional for both owners and clinicians. 13 00:00:35,325 --> 00:00:38,658 And joining me as always is our resident neurology expert. 14 00:00:39,258 --> 00:00:40,368 Thanks for being here, Mark. 15 00:00:40,563 --> 00:00:44,503 Well, it's great to be here again and, well, this is such an important topic. 16 00:00:44,503 --> 00:00:48,013 I say it every week, but really no, this one I think is one that's very 17 00:00:48,013 --> 00:00:52,033 important and one I think we can all relate to, whether you are a vet, 18 00:00:52,123 --> 00:00:54,358 nurse, receptionist, or a pet owner. 19 00:00:55,333 --> 00:00:59,083 Managing epilepsy isn't just about the seizures, it's all 20 00:00:59,083 --> 00:01:03,463 about teamwork, communication, and setting realistic expectations. 21 00:01:04,348 --> 00:01:07,528 I've certainly changed my way of talking since our first season. 22 00:01:07,738 --> 00:01:11,968 I think you told me off back then about saying treating epilepsy. 23 00:01:12,088 --> 00:01:13,768 I definitely say managing now. 24 00:01:14,368 --> 00:01:17,098 But absolutely, so I think let's start with the first 25 00:01:17,098 --> 00:01:18,628 point of contact in practice. 26 00:01:18,628 --> 00:01:20,008 I think that makes the most sense. 27 00:01:20,428 --> 00:01:23,038 The receptionist or our front of house teams. 28 00:01:23,488 --> 00:01:26,758 What would you say their role is in managing epilepsy cases? 29 00:01:27,283 --> 00:01:27,433 Yeah. 30 00:01:27,433 --> 00:01:30,523 Well, I see the receptionist as being the person who often sets the 31 00:01:30,613 --> 00:01:32,563 tone for the owner's experience. 32 00:01:33,043 --> 00:01:36,223 When an owner calls after their dog's first seizure, they're likely 33 00:01:36,223 --> 00:01:38,173 to be panicked and emotional. 34 00:01:39,193 --> 00:01:42,583 I think a calm, methodical approach is really, really helpful. 35 00:01:43,033 --> 00:01:47,623 Receptionists should ask key questions, so you know, letting them know that things 36 00:01:47,623 --> 00:01:49,533 like asking, is the dog still seizuring? 37 00:01:49,783 --> 00:01:50,623 Are they safe? 38 00:01:51,133 --> 00:01:55,153 And if the seizure's ongoing, really to reassure the owner while advising them to 39 00:01:55,153 --> 00:01:59,713 keep their dog away from hazards and avoid putting their hands near the dog's mouth. 40 00:02:00,718 --> 00:02:04,978 I can really imagine how scary it must be for our receptionists to receive 41 00:02:04,978 --> 00:02:08,788 these calls, especially if they've not had to deal with one before. 42 00:02:09,478 --> 00:02:13,798 I think having a practice protocol or triage type sheet for seizures 43 00:02:13,798 --> 00:02:15,418 can be really handy for this. 44 00:02:15,808 --> 00:02:18,928 So where all the members of staff know the right information 45 00:02:18,928 --> 00:02:20,848 to get and can feel prepared. 46 00:02:20,848 --> 00:02:21,598 Do you agree? 47 00:02:21,778 --> 00:02:23,528 Do you have anything like that in place? 48 00:02:24,088 --> 00:02:24,748 Well, absolutely. 49 00:02:24,748 --> 00:02:29,428 The practice team is so important in supporting owners, particularly during out 50 00:02:29,428 --> 00:02:33,748 of hours calls, and of course that's when most of these calls are likely to happen. 51 00:02:34,318 --> 00:02:37,858 So for instance, a nurse who is familiar with the seizure protocol can provide 52 00:02:37,858 --> 00:02:41,668 clear instructions, so they might be able to advise the owner to monitor 53 00:02:41,668 --> 00:02:45,488 their dog and bring them in the next day unless another seizure occurs. 54 00:02:46,118 --> 00:02:49,658 That kind of guidance can be incredibly reassuring during 55 00:02:49,658 --> 00:02:51,248 those early hours of the morning. 56 00:02:52,028 --> 00:02:55,568 Then there's practical advice like moving furniture out of the way, maybe 57 00:02:55,568 --> 00:02:59,228 dimming the lights and reminding owners not to put their hands anywhere near 58 00:02:59,228 --> 00:03:02,018 their pet's mouth is important because I think they're worried they might be 59 00:03:02,018 --> 00:03:05,168 choking this side of things, but it's important to reassure that's not the 60 00:03:05,168 --> 00:03:08,498 case, and actually there's more risk to ourselves if we try and intervene. 61 00:03:09,623 --> 00:03:13,943 Since seizures typically stop on their own reassuring owners that it 62 00:03:13,943 --> 00:03:17,693 should end within a few minutes, and preparing them for postictal signs 63 00:03:17,693 --> 00:03:22,253 like the temporary drunkenness or blindness can be really, really helpful. 64 00:03:22,253 --> 00:03:27,113 And actually, if an owner's informed about that, when they see it, they're reassured 65 00:03:27,203 --> 00:03:28,553 because they were prepared for it. 66 00:03:28,553 --> 00:03:33,113 So these scary signs that we see following seizures, if we let an owner know they're 67 00:03:33,113 --> 00:03:36,983 to come, they'll be more reassured and less concerned when they see them. 68 00:03:37,883 --> 00:03:41,543 But beyond this, we can direct owners to resources. 69 00:03:41,543 --> 00:03:47,063 So leaflets, links online, or even a quick guide on what to do during 70 00:03:47,063 --> 00:03:49,313 and after a seizure can be helpful. 71 00:03:50,063 --> 00:03:53,993 And these initial conversations really lay the foundation for a trusting 72 00:03:53,993 --> 00:03:55,883 relationship with the practice. 73 00:03:57,533 --> 00:04:02,543 It sounds like they play a huge role in calming down owners, and I think 74 00:04:02,543 --> 00:04:06,413 it's, just picking back up on that, providing extra information as well. 75 00:04:06,443 --> 00:04:10,073 I mean, let's face it, we all know that owners are going to go home and 76 00:04:10,073 --> 00:04:14,080 Google, although alternative search engines are available, um, their, 77 00:04:14,084 --> 00:04:16,145 their epilepsy or their dog's epilepsy. 78 00:04:16,145 --> 00:04:18,814 So providing those resources can be really valuable. 79 00:04:19,129 --> 00:04:22,489 And I think it is the thing now that we have all this online, so either 80 00:04:22,489 --> 00:04:26,719 having it on your own website or knowing where to direct them to in a 81 00:04:26,719 --> 00:04:28,879 controlled way is, is a good way to go. 82 00:04:28,879 --> 00:04:32,329 And it, it just reassures the owner, you've given them the information 83 00:04:32,329 --> 00:04:33,829 they need at that time and space. 84 00:04:33,829 --> 00:04:36,979 Now they will go away and they'll search it and find out more, but if 85 00:04:36,979 --> 00:04:40,129 that corroborates what they already know, then the trust is built. 86 00:04:40,219 --> 00:04:42,319 You know, that relationship is moving forward and they'll want 87 00:04:42,319 --> 00:04:45,649 to carry on and get everything sorted through your practice. 88 00:04:45,890 --> 00:04:48,440 Yeah, we can make sure it's a nice reputable source they're going to. 89 00:04:49,069 --> 00:04:51,199 And what about our veterinary nurses? 90 00:04:51,839 --> 00:04:56,373 They're amazing, but where do they fit into epilepsy management picture? 91 00:04:56,703 --> 00:05:00,003 Yeah, nurses are pivotal, so I mean, they're often the bridge 92 00:05:00,003 --> 00:05:01,713 between the vets and the owners. 93 00:05:01,713 --> 00:05:06,183 I mean, it's so common we hear we'll speak to an an owner in a, in a consult 94 00:05:06,183 --> 00:05:08,793 room, but it's only when they get outside, they actually ask the real question 95 00:05:08,793 --> 00:05:10,353 to the vets and the receptionists. 96 00:05:10,388 --> 00:05:10,888 It's so true. 97 00:05:11,913 --> 00:05:15,843 But after the initial diagnosis, they can help reinforce what's been discussed 98 00:05:15,843 --> 00:05:19,593 during the consult, and this might involve explaining how to administer 99 00:05:19,593 --> 00:05:24,393 medication, discussing some of the common side effects, or just introducing 100 00:05:24,393 --> 00:05:27,363 those simple tools like seizure diaries that tell us that we're on the right 101 00:05:27,363 --> 00:05:29,253 track and going in the right direction. 102 00:05:30,123 --> 00:05:32,763 But let's not forget their role in emotional support. 103 00:05:33,393 --> 00:05:38,013 Owners often feel overwhelmed after an epilepsy diagnosis, and 104 00:05:38,013 --> 00:05:42,063 nurses can be given the time to provide that extra reassurance. 105 00:05:42,663 --> 00:05:46,383 It's also helpful if they can guide owners on keeping seizure diaries and 106 00:05:46,383 --> 00:05:50,103 taking videos of episodes, because as we've learned already, I mean these 107 00:05:50,103 --> 00:05:53,973 tools are invaluable for accurate diagnoses and treatment monitoring. 108 00:05:54,588 --> 00:05:59,438 It's such a good point I think really highlighted to me during these, episodes 109 00:05:59,438 --> 00:06:03,968 about, you know, seizure mimics and cats in particular, how videos are a 110 00:06:03,968 --> 00:06:06,038 real game changer to us diagnosing them. 111 00:06:07,103 --> 00:06:07,823 Well, absolutely. 112 00:06:07,823 --> 00:06:10,973 Smartphones have revolutionised how we approach neurology cases. 113 00:06:10,973 --> 00:06:14,568 I mean, I personally hate smartphones for personal use, they've taken over my life. 114 00:06:15,068 --> 00:06:18,683 But actually in the context of work here, I think they've been absolutely 115 00:06:19,373 --> 00:06:21,333 awesome in helping our patients. 116 00:06:22,233 --> 00:06:25,923 Owners do often come in describing these funny turns or fits, and as we 117 00:06:25,923 --> 00:06:27,963 know, not all of these are seizures. 118 00:06:27,963 --> 00:06:30,573 So video footage is going to help us distinguish the true 119 00:06:30,573 --> 00:06:34,973 seizures for other episodes like syncope or behavioural events. 120 00:06:36,213 --> 00:06:37,833 And what about seizure diaries? 121 00:06:37,833 --> 00:06:38,643 You've mentioned them. 122 00:06:38,793 --> 00:06:39,873 Do you find them helpful? 123 00:06:40,173 --> 00:06:40,953 Oh, definitely. 124 00:06:41,403 --> 00:06:45,303 Diaries help us track how well medications are working and align 125 00:06:45,303 --> 00:06:46,863 with the owner expectations. 126 00:06:47,343 --> 00:06:49,953 It's so common that I'll get an owner coming back in thinking the 127 00:06:49,953 --> 00:06:53,223 medication isn't effective because their dog's still having seizures. 128 00:06:53,493 --> 00:06:57,513 But when we sit down and review a diary, we might find that seizures 129 00:06:57,573 --> 00:07:01,623 have potentially halved in frequency, which by the scientific standards, 130 00:07:01,623 --> 00:07:03,448 that would be considered a success. 131 00:07:03,838 --> 00:07:07,988 Now, I, I'm not asking an owner to believe it's successful because it won't feel 132 00:07:07,988 --> 00:07:11,018 like that in their eyes, but at least we're saying we've got something better 133 00:07:11,018 --> 00:07:14,468 here than we had before, and it's a, it's a starting point to move forward with. 134 00:07:15,323 --> 00:07:15,893 Definitely. 135 00:07:16,253 --> 00:07:19,613 I think that's so true as well that you know, you can ask owners 136 00:07:19,613 --> 00:07:21,413 or when was the last seizure? 137 00:07:21,413 --> 00:07:23,873 Or they come in panicking, oh, he only had one last month. 138 00:07:24,173 --> 00:07:26,993 But actually if you look at the diary, it was oh six months ago, 139 00:07:27,443 --> 00:07:30,173 we always seem to remember the kind of bad episodes, don't we? 140 00:07:31,163 --> 00:07:34,823 So I think that managing those expectations is, is key, really. 141 00:07:34,823 --> 00:07:35,963 That's what I'm picking up. 142 00:07:36,833 --> 00:07:42,473 And I think when we consider the the vet's role or I, we just think about 143 00:07:42,473 --> 00:07:47,063 diagnosis and prescribing medications, but it really is so much more than that 144 00:07:47,513 --> 00:07:49,433 and we really have to support our owners. 145 00:07:50,363 --> 00:07:54,233 So how do you approach these conversations during the first consultation? 146 00:07:54,668 --> 00:07:57,748 Well, it's that first consultation that's so important. 147 00:07:57,798 --> 00:08:02,028 Owners need to understand that epilepsy is a chronic, progressive condition. 148 00:08:02,358 --> 00:08:03,918 I cannot repeat that enough. 149 00:08:03,918 --> 00:08:07,578 And, and it's not commonly mentioned in that first consultation. 150 00:08:08,058 --> 00:08:09,078 There is no cure. 151 00:08:09,423 --> 00:08:12,603 Our goal is really to manage the seizures, not eliminate them. 152 00:08:13,423 --> 00:08:15,533 I often use the analogy of balancing scales. 153 00:08:15,533 --> 00:08:20,243 So one side represents seizure control and the other, the medication side effects. 154 00:08:20,243 --> 00:08:24,323 So our aim is to find the right balance for each individual dog, and it's 155 00:08:24,323 --> 00:08:26,003 going to be different every time. 156 00:08:26,063 --> 00:08:28,163 That's really, really important to emphasise. 157 00:08:29,243 --> 00:08:32,123 It's also vital to address common misconceptions. 158 00:08:32,153 --> 00:08:36,353 So, for instance, many owners assume medication will stop seizures entirely. 159 00:08:36,773 --> 00:08:41,453 Setting realistic goals really early on, such as reducing seizure frequency by 160 00:08:41,453 --> 00:08:43,793 at least 50%, the scientific standard. 161 00:08:44,133 --> 00:08:46,163 Well, that helps prevent disappointment later. 162 00:08:47,513 --> 00:08:53,453 And what about the emotional side of things, owners must feel so overwhelmed. 163 00:08:53,453 --> 00:08:56,753 It's not uncommon that they come and, you know, particularly after 164 00:08:56,753 --> 00:08:59,483 witnessing their first seizure, to think it's the end of the world. 165 00:08:59,858 --> 00:09:00,308 They do. 166 00:09:00,308 --> 00:09:02,618 And, and that's why empathy is so important. 167 00:09:03,098 --> 00:09:07,058 I like to reassure owners that epilepsy isn't painful and doesn't mean their 168 00:09:07,058 --> 00:09:08,918 dog can't have a good quality of life. 169 00:09:09,518 --> 00:09:12,248 I mean, relating it to the human condition can help. 170 00:09:12,248 --> 00:09:16,358 For example, explaining that many people with epilepsy live full happy lives, and 171 00:09:16,358 --> 00:09:19,748 often they'll have relatives or friends they might know they're epileptic, 172 00:09:19,748 --> 00:09:23,438 and they'll sort of, that message will hit home in a, in a positive way. 173 00:09:24,338 --> 00:09:27,638 But it's also worth mentioning this phenomenon of kindling. 174 00:09:27,638 --> 00:09:31,478 So over time, epilepsy tends to worsen due to the brain's 175 00:09:31,478 --> 00:09:33,488 increased sensitivity to seizures. 176 00:09:34,238 --> 00:09:38,128 And this is one reason we often recommend starting treatment sooner 177 00:09:38,308 --> 00:09:42,988 rather than later, even if it means introducing lifelong medication. 178 00:09:43,139 --> 00:09:46,769 Now, I've had owners who have felt like this communication around this is 179 00:09:46,769 --> 00:09:49,499 key, and reassurance is so important. 180 00:09:49,979 --> 00:09:54,239 When lifelong medication is prescribed to a pet, it can really feel 181 00:09:54,239 --> 00:09:58,649 overwhelming at first, but it soon becomes part of the daily routine. 182 00:09:58,949 --> 00:10:01,109 And knowing your dog can still have a really good quality of 183 00:10:01,109 --> 00:10:02,489 life makes all the difference. 184 00:10:02,699 --> 00:10:06,019 I mean, delivering phenobarbital in a sausage twice a day, the dog's 185 00:10:06,019 --> 00:10:09,029 going to come and find you and remind you that it's time for medication. 186 00:10:09,349 --> 00:10:10,214 I've had that before. 187 00:10:10,214 --> 00:10:12,914 When the dogs become like their own medication alarm clocks 188 00:10:13,814 --> 00:10:15,104 coming to get medication. 189 00:10:15,239 --> 00:10:16,159 it's, it's it's cute. 190 00:10:16,289 --> 00:10:16,839 Let's be honest. 191 00:10:16,959 --> 00:10:18,879 I I love that when the dog comes and tells you that they need, 192 00:10:18,879 --> 00:10:20,359 they need feeding and tableting. 193 00:10:20,399 --> 00:10:20,689 Yeah. 194 00:10:21,509 --> 00:10:25,604 And so speaking of medication, I obviously, there's not a blanket 195 00:10:25,604 --> 00:10:30,164 approach to everybody, but I find it quite hard sometimes knowing when the 196 00:10:30,164 --> 00:10:32,594 right time to start medication is. 197 00:10:33,224 --> 00:10:38,124 Some owners are really worried about one single seizure and worry about not going 198 00:10:38,124 --> 00:10:42,804 home with medications and others don't seem to be as, as concerned, I guess. 199 00:10:42,968 --> 00:10:47,108 I think vets are often seeking advice from people asking when is the right time. 200 00:10:47,618 --> 00:10:50,888 And the reason there's no clear answer is that there is never a single right time. 201 00:10:51,278 --> 00:10:53,768 It really depends on the dog and the owner. 202 00:10:54,108 --> 00:10:57,258 It's the idea of like this contextualised care that comes up more and more really. 203 00:10:57,258 --> 00:10:59,658 So I say it depends on the pet. 204 00:11:00,408 --> 00:11:04,293 If a dog has had a single seizure, personally, I might hold off on 205 00:11:04,293 --> 00:11:07,083 a medication unless the seizures become more frequent or severe. 206 00:11:07,893 --> 00:11:10,983 And then I suppose we'll look on the other end of the scale for dogs with clusters 207 00:11:11,043 --> 00:11:15,243 of seizures or status epilepticus, we would start treatments immediately. 208 00:11:15,873 --> 00:11:20,343 However, it should always be an owner driven decision and they need the 209 00:11:20,343 --> 00:11:24,183 right information to make this as an informed, a decision as possible. 210 00:11:25,188 --> 00:11:29,148 And I think being open and honest, you know, we talked about it in the first 211 00:11:29,148 --> 00:11:33,888 season as well, that that can really set the, the tone for your future 212 00:11:34,368 --> 00:11:35,898 kind of appointments and follow ups. 213 00:11:36,438 --> 00:11:40,668 But I sometimes, I don't want to be the bearer of bad news, particularly on 214 00:11:40,668 --> 00:11:46,218 that first consultation, but actually owners do appreciate that honesty, 215 00:11:46,298 --> 00:11:47,453 It's that candid approach. 216 00:11:47,453 --> 00:11:48,493 Yeah Exactly. 217 00:11:48,629 --> 00:11:51,839 It builds a relationship and trust and they'll know that you'll, 218 00:11:51,869 --> 00:11:53,009 you'll say it as it is now. 219 00:11:53,009 --> 00:11:55,979 I'm not saying you say it harshly, but you just need to introduce it 220 00:11:55,979 --> 00:11:58,469 early on so they're aware that's somewhere that things might go. 221 00:11:58,964 --> 00:11:59,864 Yeah, definitely. 222 00:12:01,184 --> 00:12:03,224 And what about refractory cases? 223 00:12:03,224 --> 00:12:07,924 I know in our episode earlier about adjunctive medications and things, 224 00:12:07,924 --> 00:12:12,844 we went into the kind of a physical approach to them, but actually these 225 00:12:12,844 --> 00:12:17,314 consultations can really test the bond between the owner and their vets. 226 00:12:17,884 --> 00:12:19,654 The vets are pulling their hair out. 227 00:12:19,654 --> 00:12:22,114 The owners don't understand why it's not getting better. 228 00:12:22,594 --> 00:12:26,254 So do you have any tips on managing these patients and their owners 229 00:12:26,554 --> 00:12:28,849 whilst also still being realistic? 230 00:12:29,344 --> 00:12:29,704 Yeah. 231 00:12:29,709 --> 00:12:32,854 And, and this is when it really comes down to it, it's when the cards need 232 00:12:32,854 --> 00:12:35,644 to be on the table and there needs to be a really frank discussion. 233 00:12:36,364 --> 00:12:40,024 Refractory epilepsy, so where, where seizures aren't adequately controlled 234 00:12:40,084 --> 00:12:42,989 despite the multiple medications is tough. 235 00:12:43,714 --> 00:12:47,614 It really tests that bond between the owner and their vet as it can 236 00:12:47,674 --> 00:12:49,204 feel like a never ending struggle. 237 00:12:49,894 --> 00:12:55,264 Now adding a second drug like bromide can help some dogs, but unfortunately 238 00:12:55,414 --> 00:12:59,517 the success rate tends to drop with each additional medication we add in. 239 00:12:59,997 --> 00:13:03,087 So it really is a balancing act of trying different combinations 240 00:13:03,087 --> 00:13:05,817 while being mindful of side effects. 241 00:13:06,792 --> 00:13:09,762 I do like the fact that as we discussed in a previous episode, 242 00:13:09,762 --> 00:13:13,152 there are alternative therapies and there's growing interest in them. 243 00:13:13,152 --> 00:13:18,222 So CBD oil or changing the diet, there is evidence still emerging 244 00:13:18,222 --> 00:13:19,792 that these can be of benefit. 245 00:13:19,812 --> 00:13:24,042 So yes, you might have tried all the conventional medications, but 246 00:13:24,042 --> 00:13:26,052 there's still other options out there. 247 00:13:26,802 --> 00:13:29,502 And these options might only offer small improvements. 248 00:13:30,042 --> 00:13:33,072 It is important to say to an owner that may be all we get, 249 00:13:33,312 --> 00:13:36,882 but they are unlikely to replace traditional medications entirely. 250 00:13:37,482 --> 00:13:40,902 And that said, for some owners, it's helpful to offer these as 251 00:13:40,902 --> 00:13:45,037 complimentary options alongside their regular medications to see if 252 00:13:45,077 --> 00:13:48,972 they can add some benefit without detracting from the core treatment plan. 253 00:13:49,632 --> 00:13:53,692 Owners love it when vets approach these alternative therapies and say, 254 00:13:53,692 --> 00:13:55,192 well, there could be something in that. 255 00:13:55,282 --> 00:13:56,362 Let's give it a go. 256 00:13:56,962 --> 00:13:58,132 These owners are desperate. 257 00:13:58,282 --> 00:14:00,682 They will try many things and it's important for us to guide them onto 258 00:14:00,682 --> 00:14:05,092 the sensible things to try rather than go completely crazy with things 259 00:14:05,092 --> 00:14:06,626 that could be detrimental to the dog. 260 00:14:07,196 --> 00:14:07,526 Yeah. 261 00:14:08,066 --> 00:14:12,896 And you mentioned to me off air actually earlier that your approach to 262 00:14:12,896 --> 00:14:16,676 refractory patients has really changed in these past even couple of years. 263 00:14:17,466 --> 00:14:18,186 Well, I think that's true. 264 00:14:18,186 --> 00:14:20,886 I think I, I definitely reached the point with many of these patients 265 00:14:20,886 --> 00:14:23,676 where they were on phenobarbital, they're on potassium bromide. 266 00:14:23,676 --> 00:14:27,576 You've added in levetiracetam, Gabapentin was a drug that was quite new, so I'd 267 00:14:27,576 --> 00:14:31,926 add that in and all I was doing was adding in more and more drugs and you're 268 00:14:31,926 --> 00:14:33,546 going to cause problems in doing that. 269 00:14:33,606 --> 00:14:36,666 You know, these dogs are going to get sicker and sicker and, and you know, 270 00:14:36,666 --> 00:14:37,626 the liver's going to be doing a lot. 271 00:14:37,626 --> 00:14:39,726 The kidneys are going to be doing a lot and then other conditions 272 00:14:39,726 --> 00:14:42,606 are likely to happen in these patients just because they're aging. 273 00:14:43,476 --> 00:14:46,716 But nowadays, I do think with the diets, with these different 274 00:14:46,716 --> 00:14:49,986 oils that are available, there really are things there we can do. 275 00:14:49,986 --> 00:14:54,006 And even if dogs are clustering, well, maybe think, well, let's focus more on the 276 00:14:54,006 --> 00:14:55,776 clusters rather than long-term management. 277 00:14:55,776 --> 00:14:57,846 So intranasal midazolam is good. 278 00:14:58,476 --> 00:15:01,776 I've known patients where you actually need to hospitalise them for that cluster. 279 00:15:02,271 --> 00:15:06,621 Maybe give them a constant rate infusion of midazolam, they're okay then well, 280 00:15:06,626 --> 00:15:10,341 you know, you keep 'em in for 24 to 48 hours, they're then okay for a period of 281 00:15:10,341 --> 00:15:14,361 time and they might go another several weeks or months until the next cluster. 282 00:15:14,901 --> 00:15:18,111 Now, if that's what happens in that pet, many owners in that situation will 283 00:15:18,111 --> 00:15:21,621 feel that's a reasonable outcome that they then carry on as before and just 284 00:15:21,621 --> 00:15:25,881 accept every three to six months they have to face this hospitalisation period 285 00:15:25,941 --> 00:15:27,471 to try and get the dog under control. 286 00:15:27,771 --> 00:15:32,911 So, so much I feel has changed and we've got a lot more to offer . I can't believe 287 00:15:32,911 --> 00:15:35,371 the amount of studies that come out all the time that are supporting some 288 00:15:35,371 --> 00:15:39,301 of these, these, things that I, myself and maybe others were quite dismissive 289 00:15:39,301 --> 00:15:41,551 of perhaps a number of years ago. 290 00:15:41,881 --> 00:15:42,181 Yeah. 291 00:15:43,021 --> 00:15:46,831 It's really evolving all of the time and I think there is that, I think 292 00:15:46,831 --> 00:15:49,771 move with a lot of things actually into more of a holistic approach. 293 00:15:49,771 --> 00:15:53,761 Looking at the whole picture, I mean we, we've touched then on 294 00:15:53,761 --> 00:15:56,941 the medical management of these, but actually it sounds like managing 295 00:15:56,941 --> 00:15:58,711 the owner really is, is key here. 296 00:15:58,861 --> 00:15:59,151 Yeah. 297 00:15:59,151 --> 00:16:02,386 And I, the term managing an owner, I mean, I'm very aware we can't change a, 298 00:16:02,386 --> 00:16:05,446 a person's behaviour, but I think it's giving them the information so they can 299 00:16:05,446 --> 00:16:09,646 make the informed decisions when it comes to managing these cases with owners. 300 00:16:09,976 --> 00:16:10,666 Absolutely. 301 00:16:10,696 --> 00:16:12,826 We've said it, communication is key. 302 00:16:12,856 --> 00:16:14,296 We cannot emphasise that enough. 303 00:16:14,296 --> 00:16:18,226 I mean, it's really important to be honest about the challenges we face with 304 00:16:18,226 --> 00:16:23,206 refractory epilepsy, while also providing reassurance that we're exploring every 305 00:16:23,206 --> 00:16:25,066 option and doing everything we can. 306 00:16:25,936 --> 00:16:29,716 Regular follow-ups and being open to adjusting the treatment plan as needed 307 00:16:29,806 --> 00:16:34,261 can help keep the owner's confidence high even when things are tough. 308 00:16:35,806 --> 00:16:37,516 I do want to bring empathy back in here. 309 00:16:37,516 --> 00:16:38,596 It's, it's crucial. 310 00:16:38,596 --> 00:16:41,536 I mean, I found that acknowledging how difficult this journey is for owners 311 00:16:41,536 --> 00:16:43,216 can strengthen that relationship. 312 00:16:43,546 --> 00:16:46,906 Just acknowledging what the owners are going through with their dog. 313 00:16:47,476 --> 00:16:50,596 It can be a weight off people's mind and go, I thought it was just me that 314 00:16:50,596 --> 00:16:54,496 was going to have this battle, but they, they appreciate that honesty. 315 00:16:54,896 --> 00:16:56,906 Sometimes it's just not about the dog. 316 00:16:56,996 --> 00:17:00,806 It's about supporting the owner through their emotions and the frustration 317 00:17:00,806 --> 00:17:04,166 that comes with not seeing those immediate results that we all wish for. 318 00:17:04,976 --> 00:17:08,576 Offering small victories, even if they're just glimpses of 319 00:17:08,576 --> 00:17:10,761 improvement, can help keep morale up. 320 00:17:11,576 --> 00:17:15,896 But lastly, it's also important to discuss quality of life regularly. 321 00:17:16,376 --> 00:17:20,456 Helping owners understand the bigger picture that even if seizures are ongoing, 322 00:17:20,696 --> 00:17:24,746 the aim is to improve the overall quality of life for both the pet and the owner 323 00:17:25,196 --> 00:17:29,846 can give them a sense of purpose and direction in managing the condition. 324 00:17:33,221 --> 00:17:39,706 I think you said to me once that imagine a, a person with epilepsy, if they 325 00:17:39,826 --> 00:17:44,026 have side effects to their medications, they have them every day, but they 326 00:17:44,026 --> 00:17:45,606 only seizure what, every six months. 327 00:17:46,396 --> 00:17:49,306 It's, it's that balance of quality of life, isn't it really? 328 00:17:49,711 --> 00:17:53,591 And it is, and it's difficult in people because we have to handle heavy machinery. 329 00:17:53,591 --> 00:17:54,791 By that I mean, drive cars. 330 00:17:54,791 --> 00:17:54,826 That's true. 331 00:17:55,824 --> 00:17:58,434 There is an importance that if you want to be able to maintain that freedom of 332 00:17:58,434 --> 00:18:02,164 being able to drive, doctors strive for higher doses to ensure that the 333 00:18:02,164 --> 00:18:04,534 seizures are infrequent and eradicated. 334 00:18:04,864 --> 00:18:06,244 Now, we don't need to do that in dogs. 335 00:18:06,304 --> 00:18:10,244 I've not seen a dog drive, a, car around the street or anything. 336 00:18:10,244 --> 00:18:10,524 Not Yet. 337 00:18:10,774 --> 00:18:15,274 But we do need to give medication when seizures are frequent. 338 00:18:15,274 --> 00:18:16,744 And so, so important. 339 00:18:17,114 --> 00:18:20,534 Giving the right amount of medication to a dog and trying to eliminate those 340 00:18:20,534 --> 00:18:22,899 side effects is great and is important. 341 00:18:22,899 --> 00:18:25,029 So we don't need to be as heavy handed as doctors are. 342 00:18:25,089 --> 00:18:27,609 And I'm not criticising doctors, you know, they've got a different 343 00:18:27,609 --> 00:18:29,049 role and a different job here. 344 00:18:30,069 --> 00:18:36,069 Do you actually find yourself withdrawing medications sometimes? 345 00:18:36,069 --> 00:18:39,519 Say if you know you've added this and that and this and that, and 346 00:18:39,519 --> 00:18:41,169 they are a refractory patient. 347 00:18:42,219 --> 00:18:45,159 There's definitely times we need to look at withdrawing medication and, 348 00:18:45,159 --> 00:18:48,689 and the most common time in fairness is because we're seeing side effects. 349 00:18:48,719 --> 00:18:48,899 Yeah. 350 00:18:49,349 --> 00:18:52,439 Now, if it's because of side effects, we might need to 351 00:18:52,889 --> 00:18:54,599 withdraw medication quite quickly. 352 00:18:55,259 --> 00:18:58,799 And so we do it in a hospital setting, but there are times when 353 00:18:58,799 --> 00:19:00,869 we might do it because we think, well, is it actually working? 354 00:19:01,289 --> 00:19:04,829 Now, when I do that, I still do it cautiously because there is a big risk. 355 00:19:04,829 --> 00:19:06,509 We could make things a whole lot worse. 356 00:19:07,199 --> 00:19:09,359 And when I do it, an owner has to be fully on board. 357 00:19:09,719 --> 00:19:12,269 It might be the owner will say to me, well, I don't agree with you. 358 00:19:12,269 --> 00:19:15,929 I'd, I'd rather keep the phenobarbital going because 359 00:19:15,929 --> 00:19:17,159 I think there's some benefit. 360 00:19:17,819 --> 00:19:20,409 You can give them the reasons why, but if they don't want to do it, then 361 00:19:20,429 --> 00:19:23,729 don't do it because that will be the patient that will have a terrible time. 362 00:19:24,449 --> 00:19:27,209 But often owners are quite keen to withdraw medication. 363 00:19:27,269 --> 00:19:30,359 I do find that's, that's often the case when they're on multiple medications 364 00:19:30,869 --> 00:19:34,379 and it tends to be more me not wanting to and owner's wishing to. 365 00:19:34,889 --> 00:19:37,259 The other time, of course, is when you've got a dog that has been well 366 00:19:37,259 --> 00:19:40,109 controlled for a long time and is on a lot of medication, and it might be, 367 00:19:40,109 --> 00:19:43,649 historically it had horrendous epilepsy, but now we're in a period where it's been 368 00:19:43,649 --> 00:19:45,479 seizure free for three to six months. 369 00:19:45,809 --> 00:19:48,239 That would be another time you might start to consider it, but 370 00:19:48,749 --> 00:19:52,139 I like a solid six month seizure free period before I consider it. 371 00:19:52,469 --> 00:19:53,099 Definitely. 372 00:19:53,249 --> 00:19:53,729 Definitely. 373 00:19:54,269 --> 00:19:57,209 I mean, it just sounds like, you know, as much as we can look at the 374 00:19:57,209 --> 00:20:01,559 medications, we're probably actually more therapists to our owners in this sense. 375 00:20:02,369 --> 00:20:05,699 Well, owner management is just as important as managing the dog. 376 00:20:06,494 --> 00:20:11,534 Each owner has unique priorities and some may be more concerned about postictal 377 00:20:11,534 --> 00:20:13,634 behaviour than the seizures themselves. 378 00:20:14,114 --> 00:20:17,204 So taking the time to understand their goals helps us tailor a 379 00:20:17,204 --> 00:20:18,884 treatment plan that works for them. 380 00:20:19,334 --> 00:20:22,484 And I think it's, it's been brought up by us before, but these dogs that have 381 00:20:22,484 --> 00:20:26,474 postictal aggression and their round families with small children, I mean, 382 00:20:26,474 --> 00:20:30,104 that, that is, that could be a devastating outcome if we don't get on top of that. 383 00:20:30,104 --> 00:20:31,724 So the seizure's not the problem there. 384 00:20:32,054 --> 00:20:33,374 It's the behaviour following that. 385 00:20:33,434 --> 00:20:35,954 And hence, medication still needed to control. 386 00:20:36,944 --> 00:20:39,944 It's also worth discussing the referral options. 387 00:20:40,044 --> 00:20:43,134 We've talked a lot about how communication's important, and I know 388 00:20:43,134 --> 00:20:45,684 many of you might be listening to this thinking, well this is great, you know, 389 00:20:45,684 --> 00:20:47,244 if you've got lots of time to do it. 390 00:20:47,514 --> 00:20:50,214 These conversations are brilliant and we're all tight 391 00:20:50,214 --> 00:20:51,834 for time in veterinary practice. 392 00:20:51,834 --> 00:20:55,224 So these specialist consultations often provide owners with more 393 00:20:55,224 --> 00:20:58,454 time to ask questions and better understand their dog's condition. 394 00:20:59,144 --> 00:21:01,904 And I say even if advanced tests don't change the treatment plan, 395 00:21:01,904 --> 00:21:04,784 the extra communication can strengthen the vet owner bond. 396 00:21:05,054 --> 00:21:09,044 So don't feel that referral is always about advanced imaging. 397 00:21:09,134 --> 00:21:10,064 It really isn't. 398 00:21:10,124 --> 00:21:14,594 Advanced imaging is such a smaller part of epilepsy diagnosis and management. 399 00:21:14,594 --> 00:21:17,914 So I'd really want to stress that today and I hope you've had that 400 00:21:17,914 --> 00:21:21,874 throughout, that an MRI is not that important to many of these patients. 401 00:21:22,384 --> 00:21:27,274 I think it's really important that us as GP vets remember that, that when we are 402 00:21:27,274 --> 00:21:33,679 referring these epileptic patients, we're not referring for an MRI, we are referring 403 00:21:33,679 --> 00:21:39,619 to have that whole support from a referral centre and, and neurology specialist 404 00:21:39,619 --> 00:21:41,479 who has so much experience in this. 405 00:21:42,184 --> 00:21:43,744 But a lot of time as well. 406 00:21:43,894 --> 00:21:46,174 And that's, that's the thing, you know, these chats help. 407 00:21:46,504 --> 00:21:48,784 And I mean, certainly where I work, I'm happy. 408 00:21:48,784 --> 00:21:51,274 Then afterwards I'll say to an owner, look, we've had this conversation. 409 00:21:51,274 --> 00:21:52,834 We've spent an hour going through things. 410 00:21:53,404 --> 00:21:55,054 They're going to get home and think of more questions. 411 00:21:55,054 --> 00:21:57,784 So I like to still maintain that communication when they get home. 412 00:21:57,784 --> 00:22:01,294 So that referral appointment would still lead to them contacting me in the future 413 00:22:01,294 --> 00:22:04,894 with other questions around their dog's problems and just continuing to work as 414 00:22:04,894 --> 00:22:09,184 a team with, with both their own vet and themselves to manage that dog's problem. 415 00:22:09,474 --> 00:22:09,684 Yeah. 416 00:22:10,204 --> 00:22:11,809 And that's, that's critical really. 417 00:22:11,809 --> 00:22:16,039 And I think, you know, something we've explored before, but if you can provide 418 00:22:16,039 --> 00:22:20,269 that realistic expectations, provide that support, they are much more likely 419 00:22:20,269 --> 00:22:25,924 to come back to you, as in us as vets, rather than seeking advice elsewhere. 420 00:22:26,209 --> 00:22:26,509 They are. 421 00:22:26,509 --> 00:22:29,239 I mean, it's always quite nice when you get an owner asking to see you. 422 00:22:29,244 --> 00:22:29,494 Yeah. 423 00:22:29,499 --> 00:22:32,089 I mean, you know, I, I think we're all a little bit flattered or pleased they're 424 00:22:32,089 --> 00:22:35,539 coming back and it's these conversations that help that you might feel you've 425 00:22:35,539 --> 00:22:39,439 had a difficult, tough conversation with that owner initially, but over time 426 00:22:39,559 --> 00:22:42,819 that will pay dividends and they'll be delighted to come back and see you because 427 00:22:42,819 --> 00:22:47,119 they know you were very honest and, and well, and clear about what to expect. 428 00:22:47,224 --> 00:22:47,284 Yeah. 429 00:22:48,109 --> 00:22:52,249 Really great way of, of keeping these owners informed and, and on a board 430 00:22:52,249 --> 00:22:53,449 having a good relationship with them. 431 00:22:53,554 --> 00:22:53,764 Yeah. 432 00:22:54,064 --> 00:22:56,764 And ultimately means that hopefully we're going to get better 433 00:22:56,764 --> 00:22:58,054 outcomes for their pets as well. 434 00:22:58,084 --> 00:23:01,294 But that's such a good point. 435 00:23:01,479 --> 00:23:05,499 So Mark, I guess to wrap up, what's the key takeaway for 436 00:23:05,499 --> 00:23:07,299 practices managing epilepsy? 437 00:23:08,394 --> 00:23:10,434 Epilepsy management is a team effort. 438 00:23:10,824 --> 00:23:14,004 From the receptionist, first phone call to the vet's diagnosis 439 00:23:14,214 --> 00:23:15,864 and the nurse's follow up care. 440 00:23:16,404 --> 00:23:17,844 Everyone has a role to play. 441 00:23:17,844 --> 00:23:19,824 I mean, that's so, so important. 442 00:23:20,244 --> 00:23:24,744 Clear communication, empathy and realistic expectations are the 443 00:23:24,744 --> 00:23:26,904 cornerstones of successful management. 444 00:23:27,954 --> 00:23:31,644 And remember, it's not just about treating the dog, it's about supporting 445 00:23:31,674 --> 00:23:34,734 the owner through every step of that really difficult journey. 446 00:23:35,124 --> 00:23:35,784 Absolutely. 447 00:23:35,904 --> 00:23:36,294 Absolutely. 448 00:23:36,474 --> 00:23:41,154 So I thought it might be a fun way hopefully to wrap up this final 449 00:23:41,154 --> 00:23:46,554 episode to ask some, I was going to say frequently asked questions, but 450 00:23:46,854 --> 00:23:50,184 more questions that I'm just interested in, Mark, that we haven't covered. 451 00:23:50,184 --> 00:23:50,994 If that's all right, 452 00:23:51,099 --> 00:23:52,029 Let's give it a go. 453 00:23:52,194 --> 00:23:55,734 I mean, this is very much a, you have no idea what's coming now, do you? 454 00:23:55,734 --> 00:23:55,974 So 455 00:23:56,074 --> 00:23:59,304 Really don't, but let's run with it and, I just hope everyone, 456 00:23:59,304 --> 00:24:00,534 everyone enjoys what they hear. 457 00:24:02,114 --> 00:24:05,599 So I, we've talked about dogs and cats. 458 00:24:06,354 --> 00:24:10,794 What's the weirdest species you've ever had referred to you or seen? 459 00:24:11,409 --> 00:24:11,789 Oh God. 460 00:24:11,789 --> 00:24:12,509 There's, there's a few. 461 00:24:12,619 --> 00:24:13,374 There's a few. 462 00:24:13,549 --> 00:24:13,869 a few. 463 00:24:14,094 --> 00:24:18,014 what I would say is I, I, I stick solely with dogs and cats, so I'd want to make 464 00:24:18,014 --> 00:24:22,564 that very clear initially that, my, my expertise, my expertise is solely with 465 00:24:22,564 --> 00:24:26,434 dogs and cats and, you know, these other species I might have seen videos of, 466 00:24:26,494 --> 00:24:31,399 of other, other animals fitting, a, a rabbit, that's probably a bit, but, you 467 00:24:31,399 --> 00:24:32,689 know, rabbits, rabbits quite common. 468 00:24:32,749 --> 00:24:34,129 They, they quite commonly fit. 469 00:24:34,129 --> 00:24:38,469 But then, you know, to move on to the more unusual I can think, a snake was one. 470 00:24:39,034 --> 00:24:40,869 A, a snake having a seizure. 471 00:24:41,740 --> 00:24:46,629 How, how do you know it doesn't have tonic clonic limbs? 472 00:24:46,984 --> 00:24:50,679 No, and you know what, I, I think it's true that the whole body jerks, but in 473 00:24:50,679 --> 00:24:53,949 a way that makes, you know, it is more likely a seizure than a movement disorder. 474 00:24:53,949 --> 00:24:57,009 So a movement disorder, maybe the snake would curl into unusual sort of patterns 475 00:24:57,009 --> 00:24:59,499 and writhing sort of body motions. 476 00:24:59,859 --> 00:25:01,599 But this was a, a snake that was actually. 477 00:25:02,724 --> 00:25:06,474 Having tonic and then clonic phases of the whole body. 478 00:25:07,224 --> 00:25:09,144 So that was, that was a snake with a seizure. 479 00:25:09,219 --> 00:25:10,469 That is fascinating. 480 00:25:10,839 --> 00:25:12,049 And then we moved to penguins. 481 00:25:12,669 --> 00:25:12,889 Wow. 482 00:25:13,589 --> 00:25:15,009 I'm so glad I asked this question. 483 00:25:15,399 --> 00:25:18,279 Well, there was a penguin, so a penguin and a zoo, which I can't disclose which 484 00:25:18,279 --> 00:25:20,999 zoo, but there was a penguin that, well actually didn't have a seizure, so I'm 485 00:25:20,999 --> 00:25:23,749 being strictly a bit, a bit, rogue here. 486 00:25:23,749 --> 00:25:26,179 But that was a, a, a penguin with a movement disorder. 487 00:25:26,269 --> 00:25:28,669 And again, it was where you apply the same principles. 488 00:25:28,669 --> 00:25:32,269 So you watch the episode, and I didn't see the penguin in person. 489 00:25:32,269 --> 00:25:35,939 It was a video that was provided actually by a tourist, that had seen this. 490 00:25:35,939 --> 00:25:37,499 And the, the zoo passed it on to me. 491 00:25:37,859 --> 00:25:43,899 But it was a penguin that, was having very slow movements of the limbs and the whole 492 00:25:43,899 --> 00:25:46,629 body and twisting into unusual positions. 493 00:25:46,629 --> 00:25:49,479 But because of the slow nature, the fact it would last some time 494 00:25:49,479 --> 00:25:50,909 and there was no postictal period. 495 00:25:50,909 --> 00:25:54,059 It really supported the idea of a paroxysmal dyskinesia, 496 00:25:54,059 --> 00:25:55,019 so a movement disorder. 497 00:25:55,469 --> 00:25:57,029 And importantly, that penguin's been fine. 498 00:25:57,089 --> 00:25:59,549 You know, again, it comes back to what I said about dogs and cats. 499 00:25:59,549 --> 00:26:03,059 When they have these episodes, they are completely fine in between. 500 00:26:03,119 --> 00:26:06,329 And so they live a, a fairly normal life in spite of the episodes. 501 00:26:06,569 --> 00:26:08,009 So that, that's the penguin. 502 00:26:08,309 --> 00:26:09,239 That's amazing. 503 00:26:09,479 --> 00:26:12,449 I mean, you were saying about, you know, treating cats three 504 00:26:12,449 --> 00:26:13,859 times a day would be a pain. 505 00:26:14,339 --> 00:26:16,859 I can't imagine if you had to go and treat a penguin. 506 00:26:16,859 --> 00:26:18,869 So I'm glad it didn't need treatment. 507 00:26:18,959 --> 00:26:21,089 I was going to say, I, I didn't fancy that conversation. 508 00:26:21,094 --> 00:26:23,609 And then, and then you move on to, I mean, there are things we see very strangely, 509 00:26:23,609 --> 00:26:25,649 like lions and tigers and, and bears. 510 00:26:25,649 --> 00:26:29,389 Oh, my, no, no, but no li lion would be the other one I've seen 511 00:26:29,389 --> 00:26:30,949 with, with neurological problems. 512 00:26:30,949 --> 00:26:33,589 But moving away then from seizures, you know, that, that, that was a, 513 00:26:34,129 --> 00:26:35,639 a lion with a spinal condition. 514 00:26:36,269 --> 00:26:40,709 But again, we're limited on what we can offer that lion, I mean, you can, you 515 00:26:40,709 --> 00:26:44,059 can put medication in the meat, but, but we're, we're fairly limited on what we 516 00:26:44,059 --> 00:26:45,619 can actually do to help in that scenario. 517 00:26:46,239 --> 00:26:48,409 Probably not going to take some monitoring bloods from that one 518 00:26:48,409 --> 00:26:49,939 every year, three to six months, 519 00:26:52,129 --> 00:26:53,839 maybe moving away from epilepsy. 520 00:26:53,839 --> 00:26:58,369 Then what is your like favourite area of neurology? 521 00:26:58,909 --> 00:26:59,720 Oh, we've covered all of that. 522 00:26:59,725 --> 00:26:59,934 Oh. 523 00:27:00,074 --> 00:27:01,039 So, no, I know. 524 00:27:01,039 --> 00:27:02,149 I love the movement disorders. 525 00:27:02,149 --> 00:27:05,629 I think movement disorders are great and, and actually the other thing 526 00:27:05,629 --> 00:27:10,159 I like is, I like being able to see how pets behave at home on videos. 527 00:27:10,249 --> 00:27:13,189 So I am a big fan of videos and I've said all along, you know, if ever 528 00:27:13,189 --> 00:27:16,219 you do get a video of a, a dog or a cat seizuring or doing something 529 00:27:16,219 --> 00:27:17,779 similar, feel free to send it to me. 530 00:27:17,779 --> 00:27:21,949 But actually just watching how patients move that have neurological 531 00:27:21,949 --> 00:27:23,389 problems is so informative. 532 00:27:23,389 --> 00:27:26,089 And you may remember at vet school you kind of get taught this 533 00:27:26,089 --> 00:27:30,049 neurological examination and it's really long-winded and honestly a 534 00:27:30,049 --> 00:27:32,029 bit boring and takes far too long. 535 00:27:32,749 --> 00:27:36,379 And I've never really liked doing that, but I think you can target your exam so. 536 00:27:37,399 --> 00:27:40,069 So well or sort of hone in on key things you need to do. 537 00:27:40,279 --> 00:27:40,339 Yeah. 538 00:27:40,369 --> 00:27:41,419 By watching Gaits. 539 00:27:41,449 --> 00:27:45,319 So you might have heard of the hands off neurological exam and the hands on. 540 00:27:45,859 --> 00:27:48,919 I really would much rather have a hands off neurological exam than 541 00:27:48,919 --> 00:27:51,859 do a hands-on neurological exam because so much more information. 542 00:27:51,889 --> 00:27:55,729 So I love the way the smartphone can help you manage patients from a 543 00:27:55,729 --> 00:27:58,849 distance and maybe advise on further tests that can be done without 544 00:27:58,849 --> 00:28:00,529 actually having to, to see the pet. 545 00:28:00,709 --> 00:28:01,489 I think that's great. 546 00:28:01,834 --> 00:28:02,764 That is really interesting. 547 00:28:03,094 --> 00:28:06,184 So basically you've just admitted in these podcasts that 548 00:28:06,574 --> 00:28:09,214 you don't do a physical exam. 549 00:28:09,484 --> 00:28:12,424 You basically just watch videos and ask the owner lots of questions. 550 00:28:12,424 --> 00:28:15,199 All, all, all I need is the popcorn and I'm made. 551 00:28:16,924 --> 00:28:23,554 So my final question then to you Mark, is if you could give our GP vets listening 552 00:28:23,854 --> 00:28:28,859 your top tips or top takeaways from these episodes, what would they be? 553 00:28:29,944 --> 00:28:33,544 That's a really hard one to summarise it into a few top tips. 554 00:28:33,784 --> 00:28:39,234 So I suppose the first one I'd, give is to really remember that 555 00:28:39,234 --> 00:28:41,334 epilepsy is a progressive condition. 556 00:28:41,514 --> 00:28:45,564 So it might be bad today, but it will be worse as time goes on. 557 00:28:46,224 --> 00:28:49,164 And the reason I say that is again, it's about telling the owner that from 558 00:28:49,164 --> 00:28:52,764 day one, I think it's really important they know that, and it, it might 559 00:28:52,764 --> 00:28:58,044 change the course of how they treat and manage their dog, but so, so important. 560 00:28:59,334 --> 00:29:02,934 I think the other one then moving on to like diagnosing epilepsy, 561 00:29:04,164 --> 00:29:06,894 I'd want to reemphasise the need to, there are some very 562 00:29:06,894 --> 00:29:08,784 straightforward blood tests we can do. 563 00:29:09,594 --> 00:29:11,124 But it's about preparing the patient. 564 00:29:11,124 --> 00:29:13,404 So here I'm referring to looking at the blood sugar levels. 565 00:29:13,404 --> 00:29:17,274 So doing a glucose test, we all measure glucose frequently, but 566 00:29:17,274 --> 00:29:20,574 it's about doing it when a dog has been fasted for 12 hours. 567 00:29:20,964 --> 00:29:24,774 So when you get presented with a dog that's had its first fits, 568 00:29:24,894 --> 00:29:27,444 inevitably it's happened at a time of day when the dog's had breakfast 569 00:29:27,444 --> 00:29:29,154 or been fed within the last 12 hours. 570 00:29:29,154 --> 00:29:33,624 So feel free to do blood tests, but I'd get them to go away and 571 00:29:33,624 --> 00:29:36,894 come back with the dog fasted to do the blood glucose concentration. 572 00:29:37,134 --> 00:29:39,384 And we are looking for a value sort of above three and 573 00:29:39,384 --> 00:29:40,804 a half millimoles per litre. 574 00:29:41,364 --> 00:29:43,914 If it's below that, that's concerning. 575 00:29:44,274 --> 00:29:48,414 If it's a bit borderline, then I'd repeat it every couple of hours for the next six 576 00:29:48,414 --> 00:29:51,414 hours to see if it does drop any lower. 577 00:29:53,694 --> 00:29:57,054 And the last one, I suppose I'd want to really give 578 00:29:57,054 --> 00:29:58,584 Phenobarbital a bit of support. 579 00:29:58,584 --> 00:30:01,764 because I think it is an abused medication when it comes to, 580 00:30:02,014 --> 00:30:03,514 the side effects it can produce. 581 00:30:03,514 --> 00:30:06,964 And I think there's a lot of concern from vets and owners about its 582 00:30:06,964 --> 00:30:09,319 potential to cause liver disease. 583 00:30:09,769 --> 00:30:11,089 Now it does happen. 584 00:30:11,119 --> 00:30:14,349 Liver disease does happen, but I think it's, it's blamed for it more commonly 585 00:30:14,349 --> 00:30:15,819 than I think it actually happens. 586 00:30:16,089 --> 00:30:20,889 So remember when you put a dog onto , phenobarbital increases in liver enzymes. 587 00:30:20,889 --> 00:30:22,779 I mean actually I, I kind of dismiss them. 588 00:30:22,899 --> 00:30:23,979 I'm not worried about that. 589 00:30:24,009 --> 00:30:26,409 You know, that's part of the course with the medication. 590 00:30:26,979 --> 00:30:31,209 But actually outright liver failure is exceptionally rare in these dogs. 591 00:30:31,209 --> 00:30:35,889 So if we use it correctly and we don't go too high with our serum concentration, 592 00:30:35,889 --> 00:30:41,139 so kind of keeping in that sort of 20 to 25 range and not going above 25, then I 593 00:30:41,139 --> 00:30:45,489 think you're going to get a really safe approach with using phenobarbital in that 594 00:30:45,489 --> 00:30:48,494 dog and hopefully not too many problems. 595 00:30:49,259 --> 00:30:50,184 That's so true. 596 00:30:50,184 --> 00:30:54,774 And you know, speaking as a vet tech for Dômes Pharma, that's definitely 597 00:30:54,774 --> 00:30:56,304 one of the questions I get a lot. 598 00:30:56,304 --> 00:30:58,134 Should I worry about this dog's liver value? 599 00:30:58,134 --> 00:31:00,474 So it's really reassuring to hear you say that as well. 600 00:31:02,364 --> 00:31:07,314 Well, I think that's all we've got time for today and this series, to be honest. 601 00:31:07,654 --> 00:31:10,414 But thank you Mark for such an insightful discussion. 602 00:31:10,474 --> 00:31:15,304 And thank you to our listeners for tuning in for all of our vets and owners 603 00:31:15,304 --> 00:31:20,374 out there, Dômes Pharma have recently launched a My Epileptic pet website. 604 00:31:21,064 --> 00:31:22,714 This is actually written by vets. 605 00:31:22,744 --> 00:31:27,124 It contains various FAQs covering everything from what to do 606 00:31:27,124 --> 00:31:30,604 during a seizure to traveling with my epileptic pet as well. 607 00:31:31,474 --> 00:31:36,004 You'll also be able to find downloadable resources, including a seizure diary. 608 00:31:36,724 --> 00:31:40,504 You can simply search my epileptic pet or the link will be in the bio. 609 00:31:41,614 --> 00:31:44,994 And that really wraps up our season finale of Synaptic Tails 610 00:31:45,174 --> 00:31:46,674 Thank you again for joining us. 611 00:31:46,674 --> 00:31:48,594 Mark, it's been really nice to have you. 612 00:31:48,594 --> 00:31:50,634 Hopefully you've enjoyed recording these. 613 00:31:51,564 --> 00:31:51,884 Oh, I have. 614 00:31:51,884 --> 00:31:54,654 Thank you very much, been a great, great time. 615 00:31:54,729 --> 00:31:57,169 I thought he had just tuned out already then. 616 00:31:59,149 --> 00:32:01,939 And I hope you guys have enjoyed listening to this series as 617 00:32:01,939 --> 00:32:03,439 much as we have recording it. 618 00:32:04,009 --> 00:32:07,989 Best of luck, Mark with the second site, just opened, I think at 619 00:32:07,989 --> 00:32:09,249 your second movement referral. 620 00:32:09,249 --> 00:32:10,959 So you're going to be very busy there. 621 00:32:11,229 --> 00:32:12,579 Thankfully, we got you in time. 622 00:32:12,999 --> 00:32:16,449 And if you guys like this podcast, please do feel free to get in touch 623 00:32:16,449 --> 00:32:19,959 with one of us and let you know what you liked and whether you would like 624 00:32:19,959 --> 00:32:23,259 to hear any particular topics or particular discussions that you want 625 00:32:23,259 --> 00:32:24,999 to be covered in future episodes. 626 00:32:25,299 --> 00:32:27,189 And we'll hopefully see you all again soon. 627 00:32:27,339 --> 00:32:27,894 Thanks. 628 00:32:27,984 --> 00:32:28,464 Thank you. 629 00:32:28,469 --> 00:32:29,109 Bye-bye. 630 00:32:29,269 --> 00:32:29,699 Bye.