Seizures or syncopal episodes?
Age: 11-15 years
For some history, Bella is a 12 year old pug who is as healthy as you can expect a smushed face dog to be. She was diagnosed with a collapsed trachea a year or so ago but this hasn't presented any further problems than occasional coughing and clearing her throat. She has been slowing down for the past year or two, has had some odd habits pop up, like excessive licking of her paws and/or whatever is around them, more tear production with a stained face, and more frequent urination. Earlier this year, a blood panel at her checkup showed that Bella was having some kidney problems, normal for an older dog, and she was put on Hill's k/d. In October, Bella was having accidents in the house and was diagnosed with a bladder infection and alkaline urine that seemed to clear up with an antibiotic and Ammonil.
This Thursday, I stayed home sick from work and Bella was very clingy all morning. I chalked it up to her being a. her normal, up-my-butt people person self, and b. knowing I wasn't feeling so well. After a few hours, she started trembling, which I first attributed to being cold and then I noticed her rear legs were shaking when she breathed in and would relax when she breathed out. We went into the bedroom from the living room and Bella started coughing, then vomited. Then she fell over on her side and rolled to her back with stiff legs, completely passed out. The episode lasted about 20 sec and then she woke up and looked around very scared, she had lost control of her bladder. She lay there for a few minutes while I petted and cosseted her and then got up. Her back legs went out first this time and then she passed out again for another 20 sec or so. We of course called the vet and got her in right away, the only thing I could think of was that she had had a seizure. She was observed all afternoon, lightly sedated, given fluid and an anti-nausea injection and subjected to blood and urine tests and x-rays. There was nothing out of the ordinary besides a possibly enlarged heart, something in ber lings which was likely aspirated vomit and a VERY large mass of bladder stones. We sent the rads off to a specialist to make sure her heart wasnt enlarged and brought her home since she appeared to be doing ok, with amoxi and more Ammonil as the only other thin wrong was a high urine ph. Thursday evening she was very lethargic, not alert at all and we attributed it to the sedation and exhausting day.
When we woke up Friday morning, we realized Bella had wet the bed twice more in the night. Then she wouldn't go outside to potty. Then she collapsed again on the kitchen floor, front legs splayed out to her sides this time and on her belly. She again lost control of her bladder. Our vet reccommended us to an emergency referral who ran more tests and an EKG and suspected syncope rather than a seizure. They couldn't determine the cause, the EKG showed no arrhythmia, but wanted to make sure she wasn't going to contract pneumonia and wanted to make sure the syncope wasnt vasovagal due to the coughing/vomiting. The radiography specialist had since looked at her rads and determined her heart wasn't enlarged, her bladder was full of one big stone, and there was a little bit of fluid in her lungs. We were told that the only other thing we could do is take her to the OSU vet center to a cardiologist. She was sent home with a myriad of meds, clavamox, anti-nausea, tussigon, a bronchial dilator. Friday afternoon she was more like herself and today she seems like she's back to normal.
My worry is that this was not a syncopal episode but a string of seizures. With the research I've been doing since, I also wonder if she could have Cushing's syndrome. I unfortunately do not have another $1500+ to take her to the university canine cardiologist, or back to the emergency referral vet but would like another opinion. Any thoughts you could share would be most appreciated.
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Dr. Marie replied:
I'm sorry to hear that Bella is having these problems. You have been very thorough with her care.
I have had a number of cases like this where it is hard to tell whether a dog is having seizures
or syncopal episodes. It is often very difficult to tell what the problem is even with doing a bunch of tests.
My frist thought when you described her symptoms was that these were seizures
, but your vet has much more first hand information than I do and it sounds like their plan is a good one.
You haven't mentioned many things that would make me think of cushing's disease. Usually dogs with cushings are EXTREMELY thirsty and urinate huge amounts. I think Bella's urinary issues can be attributed to her stones and the resultant infection.
If these episodes continue, then if this were my case I would likely be giving you a few options. One is to have some more extensive testing done such as an ultrasound of the heart. Or, if that was too pricey, then to do a trial of either heart medication or seizure medication (depending on which was more likely.)
I can understand that this is very frustrating. It does sound like you're in excellent hands.
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Thank you for your prompt reply and the reassurance that we seem to be in good hands with our vet(s). Bella is our fur baby and this episode was very scary. As I'm sure most pet parents are in this sort of situation, we were quite emotional while at the vets' offices and didn't ask, or even think of, the right questions. Knowing that we are on the right path is comforting.
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