Tuesday, January 5, 2016

Ask a Vet: Should I Help My Dog Breathe During a Seizure?

Not long ago I treated a 3-year-old French Bulldog in the middle of the night. The unfortunate dog had suffered a seizure just before he was taken to my office. It was the dog’s first seizure.

As is typical for such a situation, the dog’s owner had a great deal of epinephrine and cortisol running through his bloodstream. He was stressed, and he was recovering from the shock of the event. However, also typically for such a situation, his stressed-out mind was trying to wrap itself around the idea that the dog had recovered completely and was not showing any symptoms whatsoever by the time they arrived at the emergency room at 3:15 a.m.

Dr. Eric Barchas with a French Bulldog patient. (Photo by Liz Acosta)

Dr. Eric Barchas with a French Bulldog patient. (Photo by Liz Acosta)

In fact, many things about the situation were typical. Frenchies are prone to seizures. Seizures, for reasons unknown to science (or at least to me), are much more common in the middle of the night. Seizures are dramatic and terrifying for owners, but they often resolve rapidly, leaving owners bewildered at how something so frightening — in which the dog seemed certain to die before their eyes — could leave no visible trace by the time they get to the vet.

The owner described the event in more detail, and almost all of the details were predictable. The dog had been asleep at the owner’s feet in the owner’s bed. The owner felt shaking; at first he thought it was an earthquake (Californians are accustomed to being shaken awake by temblors). Then he realized that the dog was convulsing.

The owner turned on the lights and was horrified to find the dog seizing on the bed. The dog had wet the bed, which he never normally does. The dog seemed to have trouble breathing.

So far, everything the owner described was very typical for a dog’s first seizure. Seizures are divided into three parts. The first so-called pre-ictal stage may include symptoms such as vocalization, panting, pacing, and disoriented behavior if the dog is awake. However, seizures most often strike dogs in their sleep. Therefore, the pre-ictal stage is not universally observed by owners.

French Bulldog by Shutterstock.

French Bulldog by Shutterstock.

Next comes the seizure itself. The dog may lose bowel or bladder control and then may become rigid (tonic) for a period of several seconds. The subsequent stage of the seizure consists of convulsions, also known as clonic activity. These types of very dramatic, grand mal seizures are also known as tonic-clonic seizures.

The clonic portion of seizures often seems to last an eternity. This is due to a human psychological quirk called subjective distortion of time. For a person in the throes of a very stressful or dramatic experience, time seems to stand still. Seconds seem like minutes. Minutes seem like eternities. There is no doubt: Witnessing your pet have a seizure for the first time is extremely stressful. Estimating the time that a seizure lasts is nearly impossible unless one uses a watch (or remains very calm). And it turns out that accurately measuring a seizure’s duration is important, because they rarely last more than two minutes (and they’re extremely dangerous if they do).

Seizures are metabolically demanding. As the body convulses it burns a lot of energy. Animals suffering seizures often become very out of breath.

What the owner told me next, however, deviated from the norm and also deviated from my general recommendations. He said that since his dog was having trouble breathing, he used his hands to hold the dog’s mouth open. I’ll come back to this in a moment.

The dog began to breathe better and then started to come to. He seemed disoriented and blind at first, and then began to rampage around the room, running into furniture and frenetically pacing. The owner threw on his bathrobe, grabbed his keys, and jumped in the car.

By the time the pair arrived 15 minutes later, the dog had completely recovered, but the episode had probably taken a year or two off of the owner’s life.

Seizures usually have a third stage, called the post-ictal stage. After the convulsions stop, dogs may seem blind and disoriented. They tend to vocalize, paddle, and pace. This stage usually lasts a few minutes to a few hours, and then most dogs recover fully.

French Bulldog by Shutterstock.

French Bulldog by Shutterstock.

I have written many times about seizures, treatment of epilepsy, and what to do in general if your dog has a seizure. But this story contained a detail — the owner holding open the dog’s mouth to assist with breathing — that made my skin crawl.

What, you ask, is so bad about that? The answer lies in rabies prevention laws.

In many areas, including where I live and work, rabies prevention laws require mandatory rabies testing for any animal that bites a human and then goes on to develop a significant illness, especially if that illness includes neurological abnormalities.

A seizure is a neurological abnormality. Therefore, any dog who bites a human and then has a seizure, or, depending upon how a public health official interprets the law, any dog who bites a human during a seizure, must be tested for rabies.

How likely is it that your dog will bite you during a seizure? Very likely. Dogs are not conscious during seizures. Their jaws often convulse involuntarily. The risk of a completely accidental bite is high. If you attempt to hold your dog’s mouth open, or if you mistakenly believe he might swallow his tongue and therefore reach in to grab it, you may well suffer a bite that is rendered involuntarily on the part of your pet.

So, you ask, what’s the big deal? How hard is it to test a dog for rabies? In fact, there is only one way to test a dog for rabies: The dog must be euthanized and then decapitated. The head is submitted to a laboratory for the brain to be evaluated microscopically.

I’m not saying that such laws make sense. But they exist in many places. If you are bitten during your dog’s seizure, an uncontrollable cascade of events could result in the untimely and utterly tragic death and mutilation of your dog.

Therefore, I generally recommend that owners of a seizing dog keep away from their pet’s mouth unless there is absolutely no choice. The dog will not swallow his tongue. And he’s not likely to die from lack of oxygen, either. The best choice is to stay safe, stay calm, and get to the vet as soon as possible.

Read more from our Ask a Vet series:

Got a question for Dr. Barchas? Ask our vet in the comments below and you might be featured in an upcoming column. (Note that if you have an emergency situation, please see your own vet immediately!)

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