Dr Emma Hancox: Hi and a warm welcome to the new Synaptic Tails podcast.
I'm your host, Emma Hancox, a Technical Vet Advisor from
TVM UK, a Dômes Pharma Brand.
And I'm here in collaboration with Dr.
Mark Lowrie of Movement Referrals.
I'm sure you’re all familiar with Mark's name, but just by way of
introduction, Mark qualified from the University of Cambridge before working
in first opinion small animal practice.
Following an internship at the Royal Veterinary College, he moved to the
University of Glasgow to complete a residency in veterinary neurology.
Mark worked for several years at a leading multidisciplinary centre near
London, then as Clinical Director for another multidisciplinary
referral centre in the East Midlands.
Mark has a master's degree on steroid responsive meningitis arteritis
in dogs, and has a particular interest in management of movement
disorders, inflammatory brain and spinal disease and feline neurology.
He is Veterinary Consultant to the International Society of Feline
Medicine, the ISFM, and was awarded, finally, the prestigious national prize
of Petplan Vet of the Year in 2022.
That is quite some introduction Mark.
Welcome, how are you?
Dr Mark Lowrie: Sorry to make you read all that out.
Thank you very much.
No, all's good today.
And it's nice to be in this room
Dr Emma Hancox: Good.
Good.
For those that don't know, Mark has recently opened a new independent referral
centre in the Northwest with four of his orthopaedic veterinary specialists,
colleagues, maybe also friends, I think.
Tell us a little bit about Movement Referrals.
How's it going?
Dr Mark Lowrie: Oh, it's exciting.
I could talk about this all day.
So
Dr Emma Hancox: Please don't, I'm joking.
Dr Mark Lowrie: It was set up by five of us in total.
The other four are well-known veterinary specialists in orthopaedics, we want
to provide sort of high quality but efficient specialist referral services.
We obviously just concentrate on orthopaedics and neurology,
and they're two of the most common reasons for referrals.
We're able to offer common referral procedures such as TPLO,
patellar luxation, don't ask me about them, and spinal surgery
at really reasonable prices.
Given the dramatic consolidation of recent years in the veterinary
world, and the importance of GP vet recommendations in the referral process,
I suppose it's fair to say there's been a reduction in competition and
significant price inflation, so we really hope to provide more choice at
better value and aim to objectively demonstrate our value through
measuring and publishing our outcomes.
Dr Emma Hancox: That's brilliant.
Dr Mark Lowrie: I think it's important for owners to know what they can expect
when they take their dog for surgery.
What is the likely outcome going to be?
And if we can publish what we've done in the past, they've got
quite clear guidelines on that.
We've had a great few months.
We've not been open long, got big plans ahead, and we abide by the statement
of getting it right first time.
So that's one of the reasons something like canine epilepsy that we talk
about today is so important as I feel it's that first meeting that
can dictate the direction of an owner's decision and the direction
that things might take in the future.
Dr Emma Hancox: Absolutely.
And I think having both that neurology and that orthopaedic kind of influence
is really useful because, it's so easy in first opinion practice
to sometimes misdiagnose these.
So I guess it's great to see, or have, that influence of your
colleagues as well and have both of those kind of inputs and you can all
look at cases together sometimes.
Dr Mark Lowrie: The two marry together brilliantly.
So the number of times we'll see something that we feel is orthopaedic and it
becomes neurological and vice versa.
So it's great.
And as you said earlier on, I'm working with my mates, that's always
a good thing, always good fun.
Dr Emma Hancox: You always have to have fun when you’re at work.
That's brilliant though, Mark, we're so lucky to have you here.
Our new podcast will focus on how to manage neurology cases in first
opinion practice, hopefully offering you some tips and tricks that
we've both learned along the way.
Over the first few episodes, we're going to introduce you to TVMs new
S.M.A.R.T Approach To Epilepsy, and how to apply this to some real life cases.
Some of you may have seen this already in lunch and learns, so if
you haven't already, you can always book those via our website as well.
The aim of the S.M.A.R.T Approach To Epilepsy is to help you guide
conversation in first opinion practice.
So it's not really anything that you as vets don't know in practice,
but it's just there as a reminder.
S.M.A.R.T is, of course, an acronym because we all know how much marketers
love an acronym, and stands for speak, measure, advise, realistic and tailor.
So that's going to be our focus for the next few episodes.
This has been largely based on some recent work that was published at the
beginning of the year, in the vet record.
So from authors, Amy Pergande, Zoe Belshaw, Holger Volk and Rowena Packer,
which was the first to look at how owner perspectives of their vet and their
vet owner bond impacts upon decision making and ultimately how this impacts
upon clinical outcomes for epilepsy.
And this is why speak and communication is at the beginning
of that S.M.A.R.T approach because it's so important yet, honestly, is
quite often overlooked in practice.
I think I can hold my hands up and say, I always looked
at the numbers, to be honest.
This is something that we had discussed the first time we met, wasn't it Mark?
Actually, that kind of communication and time in practice
is one of the biggest hurdles.
Dr Mark Lowrie: Time.
Yeah, time.
There just isn't enough time.
Dr Emma Hancox: There isn't, really isn't, no.
Dr Mark Lowrie: And these cases don't come in when you've got lots of time.
They're inevitably going to come in when you've got 10 other patients to see.
The waiting room is full to bursting, dogs are attacking each other.
You can imagine the scene.
But the owner, when they first come in, they've obviously in the very
recent past, witnessed their dog have a fit, which is such a scary thing.
Dr Emma Hancox: Absolutely.
Dr Mark Lowrie: To see.
So you’re suddenly in this position counselling as well as preparing them
what's ahead, and you've probably got 5, 10, maybe 15 minutes if you’re lucky.
Dr Emma Hancox: If you’re lucky, I was gonna say.
Dr Mark Lowrie: So I think if you’re able to have a really long period
of time to sit down with these owners, it makes a huge difference.
And I'm sure as you’re all listening to this, you probably
think, I don't have that.
I don't have that time.
So signposting is really helpful here to get an owner to know where to
look to get the information they need because you’re not going be able to
provide it in the time that you've got.
I think there's a role for all members of the practice here.
So, the owner's phoned up, they've said my dog's had a fit, and they
want to book in to see the vet.
But the receptionist there, the person answering the phone can
help a little bit and say, actually we've got some information on this.
And you can direct them to that information, whether it's
something on your own website.
Some leaflets indeed, TVM could provide information around
this to support these clients.
I think that really helps just to settle them down while they're waiting
for that appointment or even while they're waiting in the waiting room.
Dr Emma Hancox: Yeah.
Dr Mark Lowrie: It can help enormously.
The other thing that's omitted is owners aren't prepared with what's ahead.
They're coming in having seen their dog have a fit, and they
never want to see that ever again.
Dr Emma Hancox: Yeah.
Dr Mark Lowrie: And that's not realistic.
We can't do that.
If we could, that would be amazing.
Owners need to be ready that there's gonna be a lot more fits ahead, most likely.
And the most important thing that's never ever said, if we are dealing
with epilepsy, which we'll assume here, this is a dog that's had its
first fit and it's got epilepsy, it's a progressive condition,
it's going to get worse and worse.
Now, that's miserable.
Dr Emma Hancox: Yeah.
And I think as vets, we don't wanna say that, we don't want
to be the bearers of bad news in that stressful situation, do we?
But it was certainly something that was picked out actually of that paper that I
mentioned, that actually being realistic with those owners and having that frank
conversation upfront was one of the, even if they don't wanna hear it, is one of
the positive outcomes from that paper.
So it's, as I said, it's stuff that you do know, but it's just putting that
into perspective a little bit as well.
Dr Mark Lowrie: And if you are that honest vet that gives that information,
that's what's gonna help that bond between you and the client because
they'll, you’re not telling the owners something they want to hear.
you’re telling them something they need to hear and they may not take
it well, they may take it great, but then they'll go away, have a think
about it and say, you know what?
My vet was really honest from the get go.
And that's gonna put you absolutely on the right grounding for the future.
So they know that, you’re not a miracle worker, but you’re there for them and
you can help advise them through it.
So that is so important right from the beginning.
Dr Emma Hancox: Yeah.
You mentioned that there was a role for other members of the veterinary
staff, you picked up the front of house staff there, and I think it is really
useful for them to at least have that kind of triage type advice as well
when they first get that phone call.
It just, again, instils that confidence.
But again, something in this paper is suggesting that owners like to talk to
the nurses as well and maybe confide a lot in them, some things that they
might not confide in their vets.
So actually, and we know that nurses are brilliant at doing their nurse clinics.
They will, often do things like OA clinics and things like that for us then it's
unfortunate that I don't see sometimes a lot of epilepsy type clinics where I
think actually they could get involved.
What do you think about that?
Dr Mark Lowrie: Oh, I think that's vital.
So I’ve mentioned the receptionist, but yeah, the nurse.
What can the nurse do?
So much!
So you've got that owner, they've turned up in the waiting room, their dog's had a
fit potentially, it's still having a fit.
We've got to remember that.
So triage, absolutely.
I think if there's a veterinary nurse available, who can bring
the owners and the dog to one side and have a chat with them.
If the dog's actively fitting, well clearly the role of the nurse is to
bring the dog through and make sure it receives that veterinary attention with
the vet immediately, so that's easy.
We know that.
I think everyone would be familiar with that.
But in the scenario where the dog stopped fitting, the owner's
probably still panicking.
And I think for the nurse to take them to one side, reassure them, but
something that isn't done much, and I think this is where the nurse can help,
is just to get information from the owners as to what it is they've seen.
Dr Emma Hancox: Yeah.
Dr Mark Lowrie: Now a vet can do this, but they haven't got much time,
so you don't want to spend a lot of the veterinary consultation talking
about how the fit looked, because you want to cut to the chase and get
to the nitty gritty of what's ahead.
So for a veterinary nurse, I think it's a really good opportunity for them to
ask key questions about what the fit looked like, to check it truly was a fit.
The smartphone's been amazing because the smartphone allows you to
witness these episodes in real time.
So in the past, an owner would come in, they say 'My dog's had a fit,
a seizure', whatever it might be.
And an assumptions made that's exactly what the dog's having.
But if you get video footage of what's happening, because
we never see them in practice.
In fact, I joke that I'm probably the best anti-epileptic device there is
'cause I never see a fit in practice.
Dr Emma Hancox: So we all need you just at home with us basically.
Dr Mark Lowrie: Just me.
Yeah.
I’ll come and I’ll take myself home with the owners.
I’ve not worked out my charge or hourly rate yet but we can do that,
I don't know, you can brand me.
Dr Emma Hancox: That's it.
We've got a new treatment from this podcast!
Dr Mark Lowrie: But if you can get the owners to, to film the episode, then
that helps because the vet, the nurse can look at that in their own time.
But the nurse can ask questions such as, well refer to autonomic signs
to say, has the dog been salivating?
Has it urinated during an episode?
If you are getting salivation during an episode, that for me
is a sure fire hit that it's a
Dr Emma Hancox: Yeah.
Yeah
Dr Mark Lowrie: If you've got a dog that's moving all four legs, very uncontrollably,
but remains alert, that's ringing an alarm bell, this might not be a fit.
A
great example of this would be, again, going back to that
busy consultation clinic.
Your vet's there seeing lots of cases in, lots of vaccinations, and
the odd vomiting dog here and there.
They're really busy running late, and the phone call comes through that an owner has
a dog that's fitting and the conversation would normally go, something along the
lines of, my dog's been fitting for the last 20 minutes and hasn't stopped.
So naturally the receptionist has taken that call and gone, you
need to come down straight away.
So they pile the dog in the car, they come down, the clinic's full to bursting.
And then this Labrador that's been fitting for 20, maybe 30, 40 minutes by the
time it arrives, comes running into the waiting room, bouncing around, crazily
looking probably the healthiest dog in the waiting room there and then, and
everyone thinks what's going on here?
This owner's been lying.
And of course the owner hasn't been lying.
This dog has clearly had a prolonged episode that was very
abnormal, but they've gone straight back to normal very quickly.
And when you get a dog that bounces straight back to normal very quickly and
back to normal consciousness and behaving normally, if they truly were fitting
for 20 or 30 minutes, that's not a fit.
Dr Emma Hancox: Yeah.
Dr Mark Lowrie: So something else was going on.
So your veterinary nurse can take a look at that dog and say, this is a really
normal looking dog given it's been fitting for so long and that then tells us maybe
this isn't epilepsy and to consider other possibilities for what might be going on.
Whereas, of course, if the dog comes in, it looks drunk, confused, blind, it
doesn't interact with the other patients.
Dr Emma Hancox: Yeah.
Dr Mark Lowrie: In the waiting room, yes, a fit is definitely
what we're dealing with.
Dr Emma Hancox: And that's, that can be both things really.
So yes, it's getting vital information that they can pass back to the rest of
the team, the vets that are in charge.
But also if that dog does come bounding in and is quite happy, they can almost
immediately reassure the owner that actually your dog is looking well right
now so not to worry so much
Dr Mark Lowrie: And that's great because then hopefully it calms the owners.
So they're ready to get the information they need to know what's happening next.
It's so difficult delivering information to someone who's panicking.
I always say if you’re in an emergency and you’re in a room with a big red
button on the wall that everybody can see, and you’re told to press the big
red button in a hurry, you never see it.
You look everywhere around.
You can't see the big red button.
You can only see the red button when you’re relaxed and calm.
So yeah, you want to calm an owner and then deliver the information carefully.
Dr Emma Hancox: Absolutely.
Just to summarize in an emergency situation, it's obviously, communication
with the owner is going to be important, one, in terms of ascertaining what's
happened and trying to get that accurate diagnosis, but also, to calm them down
as well, and to give them all of that kind of advice and time for that advice.
How does that differ, do you think, when you see them as
like a chronic, ongoing case?
So how would your kind of conversation change?
I guess it's now more about things like quality of life
of that pet and that owner.
Obviously we're still going to need to talk about the seizures
and their frequency, but perhaps more about quality of life now.
Dr Mark Lowrie: It is quality of life, and I think the owners, I’ve said
already, they need to know what's coming ahead, what's in the future.
So I don't mean crystal ball gazing, not that sort of thing, but for the
owners to know more fits will happen.
And what's that mean for a dog?
Now, I think it really helps here to relate it to the human condition of
epilepsy because also commonly you'll find that owner has some form of
experience of epilepsy in people, whether it be a relative, a friend, maybe in
the job they do, they come across it.
And if they know someone with epilepsy, I'd encourage them to speak to them.
Because if you speak to a person with epilepsy, they'll tell you
that it's not a painful condition.
There's no pain or discomfort.
Owners always worry about pain.
It doesn't matter whether we're talking about epilepsy or anything else.
Pain is always their number one concern.
So this isn't painful.
And when you speak to a person with epilepsy, when they have a fit, what
they'll say is they're completely unaware of what's happening in the moment.
And so, if they're in a room full of people and they have a fit, they're fine.
They've got no problem at all.
When they come round from the fit, it's everyone else in the room that's panicking
and doing things and maybe doing silly things like putting your hand in their
mouth to try and establish an airway.
Why would you do that?
But in the heat of the moment, people do these silly things and get bitten.
So of course we don't do that for dogs.
We keep our hands well away from their mouths.
But if you just apply logic to it, it's good to inform an owner that when
their dog has a fit, try not to panic.
Ensure they're in an area where they're not gonna hurt themselves because
they're gonna be thrashing around, usually at home, it is important,
I haven't said, but epilepsy always happens at home when a dog's relaxed,
it doesn't tend to happen out on walks.
We don't go out for a walk in the Peak District and see dogs fitting left,
right and centre, yet we know there's a lot of epileptic dogs out there.
Dr Emma Hancox: it's very true, actually.
I hadn't thought about that.
Dr Mark Lowrie: No, if you’re at the playground with your kids pushing 'em
on a swing, you don't tend to see, oh, there's a dog over there having a fit.
But, so it's always when they're relaxed.
So when they're resting at home, early in the morning, late at night.
Vets covering emergency clinics will be very familiar with the
phone calls, whereas vets during the day won't get them so much.
Dr Emma Hancox: It's true.
Yeah.
Dr Mark Lowrie: It does happen when these dogs are relaxed and not to worry
about treating their dogs normally.
They can go out on a walk, they can go about their daily routine.
But when they are fitting in the house, move the furniture out the way, make
sure they don't hurt themselves and maybe, if it's a bright room, dim the
lights, and just be ready to be there for your dog when they come round.
And a concern for a lot of owners is the behaviour following the seizure.
And I’ve come across a few situations now quite frequently,
where the seizure is a worry.
Of course it is for the owners, but it's the behaviour following
the fit that can be a concern.
The behaviour, typically we will see ataxia, so a drunken gait, blindness,
potentially all fairly transient, hopefully lasting, no more than 5, 10
minutes, but it will be longer if the seizure's been going on for longer.
But the big one is aggression.
Dogs come around really disorientated and they will show aggression.
Now that's probably fear aggression.
It could be the brain doing things.
It's hard to explain exactly why that happens.
But it occurs, and so owners can find themselves in quite a threatening
situation with their beloved pet.
And I think all you can say in that situation is just try
and keep away from your dog.
Allow it to be in an enclosed room, just to come round and hopefully
after 5, 10 minutes they'll be better.
But it's when children and other vulnerable family members are
present, that is a big concern.
And we can't treat postictal signs.
We can only manage the seizure activity.
So the fewer seizures you have, the less this aggression will be seen.
So it all comes back down to the medication and what
we can do to help with that.
Dr Emma Hancox: Yeah.
Oh, that makes sense.
And picking up on what you said about them being outside
can we still enjoy our walks?
Can we still go out for the day?
Can we still do all of these things?
And I think we don't want to see epilepsy as a life sentence for these dogs.
We're all here for them to have a good quality of life at the end of the day.
Dr Mark Lowrie: Absolutely, and I think there's two things I'd add there, but
the first one would be I’ve said that I'm a good anti-epileptic medication.
My second top tip here is taking dogs for a walk is a great anti-epileptic strategy.
It's not endorsed by anybody other than myself.
It is only my opinion, but I think taking a dog out on a walk, if they
are about to have a fit, as long as you've not caught it too late, I think
it can offset that seizure for a bit.
Importantly, I think it offsets it rather than prevents it.
But going out on a walk is a great activity to do.
I would be very happy to do it.
And then the second point would be dogs with epilepsy, they are really
normal dogs otherwise, so they, they can go about a normal life.
I can think of dogs I’ve treated where they're sniffer dogs, they
sniff out drugs and do all that
brilliantly.
but their life's interspersed with the odd fit here and there.
They're on medication, they're managed, they have a great quality of life and
they're doing a brilliant service.
Dr Emma Hancox: Yeah.
Dr Mark Lowrie: So that should be enough for these owners that are
faced with a diagnosis of idiopathic epilepsy, that actually their dog
should have a good quality of life.
Dr Emma Hancox: It almost doesn't make sense to me though, because when
I think about seizure activity, it's almost described as too much activity.
So why then stimulating them and going out for a walk and getting
them to hear things and do things and how does that stave it off?
That's just fascinating to me.
I guess we don't know.
Dr Mark Lowrie: And we don't know and I think, no, I think
it's a really fair question and I think it's important to say.
it's all right if so, if you litreally see your dog about to go into a
fit, this strategy isn't gonna work.
you’re already too late.
So I think if you are getting the aura of signs that a fit's
about to come on, it's too late.
But I think just distracting a dog with other activities, it just, it's
a way of allowing the body to function normally and it stops it happening.
But yeah, I have to be honest to say we don't know why it
works and it's not proven either.
This is my view but it seems to work well.
Dr Emma Hancox: So your two treatments that you’re advocate in here is
you and going out for a walk.
Dr Mark Lowrie: It's great, so much, you'll be out of business as a company
Dr Emma Hancox: We're going be, aren't we?
Why did we invite you again?
Oh dear.
on the flip side of that though, is it true that stressful environments,
so vet visits and things like that, increase the risk of seizures?
I think that's a concern of peoples, whether that be vets or owners.
I just use the word people there.
Is that true?
Do you see that?
Dr Mark Lowrie: Yeah,
it's quite rare, and seizures happen more commonly in relaxed environments, but
there's absolutely no question we come across the odd patient that it clearly,
the fit has a clear, stressful trigger.
So going into a vet we'll have dogs that maybe require some kind of sedative
or anti-epileptic medication before arriving to try and offset that fit.
It is rare, and it's not a common finding, but it does occur.
And other fits, they're called reflex seizures.
They're seizures that happen in response to a stimulus.
So there was a dog I saw once that it was going outside that actually triggered
a seizure, it was remarkably reliable.
So that dog, I wouldn't have taken for a walk to stop the fit, but they'd
go out and the light outside would just trigger a seizure, but take
them at nighttime and it was fine.
And noise.
Noise is another one that can trigger off epilepsy in dogs and cats.
And it's often not the kind of noises you'd think.
I'm not talking loud banging noises,I'm talking subtle noises.
And in cats in particular, it can be keys.
The jangling of
keys
Dr Emma Hancox: Oh, Or the rustling of something or...
Dr Mark Lowrie: You've got it, and banging a fork against a ceramic bowl.
What?
Banging is a strong word, gently tapping would trigger these things.
So there are definitely,
Dr Emma Hancox: I wonder whether it's to do with sound
waves or something like that?
Dr Mark Lowrie: And in cats it's fascinating 'cause it's older cats
that tend to get it usually in the second decade of life and half of
the cats that get this are actually deaf, which is unbelievable.
Dr Emma Hancox: That's, even more remarkable.
This is blowing my mind, Mark.
I'm not gonna lie!
Dr Mark Lowrie: It blew my mind and I can't explain it, but I think
sometimes it is, there's, it's the frequency of the sound in particular.
So it's not shouting or being loud that's triggering.
It's a subtle sound that may be still the wavelength is such that it's
still detected in these deaf patients.
But yeah, it's a real can of worms.
Some of these seizure triggers and it comes back to that really awful answer
of we don't know, but if an owner knows, we don't know, we're being honest.
We're being open, we're being honest, and I think that's really vital to help
that relationship and help work through the difficult situation of epilepsy.
Dr Emma Hancox: And so how often, again, something I see on these Facebook
groups is, how has anyone been able to find a trigger for their pets seizure?
How often do you think that we'll find those?
I know that's really difficult to try and put a number to, but do
you think owners should be like, I get the feeling some of them are
fixated sometimes on trying to find a trigger or a cause for that seizure.
I was under the impression most of them are just spontaneous.
We don't know when they're going to happen unpredictable, but perhaps there are some
triggers in some, could you put a number to those or is that really difficult?
Dr Mark Lowrie: A number is hard, but I think it's fair to say it's
really rare we find a trigger.
Now, I don't think that's because we're not looking.
Owners are very good
at noting when the fits were, seeing if there's a relationship with
feeding, with activity, with time of day, and I'd encourage them to do
that because sometimes it does allow us to find out what's happening.
A great case I can think of that I saw a number of years ago now was a dog that
always had a fit at half past seven on a Thursday morning, every week reliably.
So there's a clear pattern.
But why?
And so the owners didn't know why at all.
We treated the dog with medication.
It didn't seem to make any difference, but then they moved house.
And when they moved house, it happened at 10 o'clock on a Tuesday morning
and it was always
Dr Emma Hancox: I feel it's the binmen or something that.
Dr Mark Lowrie: How did you know?
Dr Emma Hancox: I just was trying to think of something that happened every week.
Sorry, I’ve taken your thunder away there.
Dr Mark Lowrie: No, fantastic.
But it's things like that.
So it was, it's, the bin men arrived at the house.
It was stressful for the dog and it triggered a fit.
So silly things like that.
And, it's, it was only the move of house that made them
realise there is something here.
What's the same in both situations.
It's clearly not time of day.
There's something happening at time of the day.
Dr Emma Hancox: How are they ever gonna avoid that?
They're just gonna have to put their bins somewhere else.
Dr Mark Lowrie: They had to go to the tip themselves, just just
go and, empty their own bins
Dr Emma Hancox: Oh, the things we do for our dogs.
This is all really great information, but I'm just wondering
how we're ever gonna do this.
Going back to the very beginning, how we're gonna do it in such
a short consultation time, what are the kind of key points that
you would want to bring out?
Dr Mark Lowrie: So when you've got the owner in the consult and you've got a
very short period of time, there are key points you always have to mention.
And it doesn't matter who the owner is, what the dog's doing.
I think it's important to bring these across.
Now you could provide this in a resource somewhere, a little
leaflet, a downloadable, PDF what whatever the owners need.
For me, I’ve said it already, but the number one thing is to say epilepsy
is a chronic progressive disorder.
These dogs aren't going to be fixed.
We will talk about medication later on, but medication, and we're all guilty of
it, we tend to use the word treatment
Dr Emma Hancox: Yes, I'm guilty of that for sure
Dr Mark Lowrie: When we say we're treating epilepsy.
I personally feel, if I was an owner listening to a vet telling me they're
going to treat my dog's epilepsy, that I'm gonna somehow get a cure.
Dr Emma Hancox: Or you’re gonna fix it.
Dr Mark Lowrie: We're gonna fix it and we can't fix it.
So it's important to use, I try and use the word management.
I think it's a more appropriate term, it's more understandable
and it sets expectations, but epilepsy is going to continue.
So the aim of managing seizures with medication is not to cure the seizures.
It's to try and get them under some form of control.
A quick fix is really unlikely.
And an owner will have to expect to have fairly frequent visits to the
vet to get some modicum of control.
That's really important.
Dr Emma Hancox: It's not just gonna be a course of medication and then stop.
Dr Mark Lowrie: No, and I’ve known that, dogs will be given,
prescribed, phenobarbital.
They'll go away for two weeks with a two week course of phenobarbital.
And because the owner hasn't understood, it's not the, it's not the vet's fault,
it's because probably that owner was very stressed in the moment they've done it
two weeks, they've stopped the medication.
Then we know what goes on then, we get withdrawal seizures,
the whole situation gets worse.
So owners need to know any medication you give is life long.
I think it's also important to say that adverse effects from the
medication are really, really common.
So all antiepileptic medication, despite what anybody says, will
have some form of side effect.
Now, hopefully that's mild and it's tolerable to the owners
and it's tolerable to the dog.
But we know that there are some dogs that are a bit more susceptible to
those adverse effects than others.
And if you've got a dog with loads and loads of fits, owners will
tolerate more side effects than those dogs that maybe just have one fit
every 6 to 12 weeks so it varies a lot.
So owners need to know that sort thing too.
And I think making sure owners know not to stop medication
suddenly in any circumstance.
You can stop medication, but it really needs to be done under veterinary
guidance and carefully and ideally slowly.
There will be situations when it needs to be stopped suddenly, if
there are terrible adverse effects, life-threatening, adverse effects.
But that's really rare.
Phenobarbital is a very safe medication.
I think it's got a lot of bad press.
I say, vets seem to, I'm gonna include myself in this.
I'm quite happy to give out steroids quite frequently.
I'm a neurologist, that's what I do.
So steroids are
given out frequently and almost, dare I say it, like sweets.
Whereas phenobarbital, people are a lot more reserved and concerned
by, I dunno why, because I feel phenobarbital is much safer medication.
Dr Emma Hancox: It's so true.
I’ve never thought about it like that, but I'm nodding my head vigorously over here,
Dr Mark Lowrie: So I think it's important for vets to understand that yes, they
are worried prescribing phenobarbital.
due to its safety profile, but actually it's much, much better than other
routinely used medications in practice.
I'd want to make that point so people are aware
Dr Emma Hancox: Perfect.
And I think actually we're gonna pick up on, measurements and management
of things like that of phenobarbital in our next episode as well.
I think.
Dr Mark Lowrie: I can't wait.
Dr Emma Hancox: I know.
Same.
Thank you Mark.
I think that's probably all we've got time for in this first episode,
but it has been really great speaking with you and finding out what we can
learn from the, from these experts.
Hopefully our listeners have found it as fascinating as I have, those triggers
that we were talking about, it's really fascinating for me and please tune into
our next episode where we were moving on to the second instalment of the
S.M.A.R.T Approach, which is Measure.
So hopefully we can pick back up that conversation that we maybe
just alluded to, where it comes to phenobarbital, adverse effects and
monitoring and things like that as well.
Obviously, we'll be joined once again by Mark to discuss the importance
of, managing our epileptic patients.
Thanks again, Mark.
Dr Mark Lowrie: Thanks, Emma.
Dr Emma Hancox: Thanks.
See you soon.