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.
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.
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.