What was causing Kuma's Seizures?
First, let's look at the basics of what a seizure is and what triggers it.
Kuma was not born with seizures and only started having them after being 16 years old, so they were non-epileptic. The cause of Kuma's seizures was not known so they were Idiopathic like most seizures. At first, Kuma had Grand Mal seizures that lasted about 4 minutes and had two stages to them. Later, Kuma started having various other kinds of seizures which included small 15 second conscious seizures that didn't seem to affect her at all. She even had episodes of "the fly catcher" which is not common.
Basics of What Starts a Seizure
The brain is made up of 100 billion neurons (as many neurons as there are stars in the universe) and each neuron has 10,000 connections. The purpose of a neuron is to fire or not to fire (inhibit), to go off or stay still. when a neuron fires, it affects the other neurons it is connected to and may cause them to fire as well. The neuron receives its instructions from two kinds of neurotransmitters, excitatory or inhibitory.
A neuron is in a state of excitement and it fires, or it is in a state of inhibition which causes calmness and sleepiness. There is always a balance which keeps the brain stable. A seizure trigger in the simplest format is just a tip of the scale in the direction of excitement. Once this happens, a neurons fires and causes thousands of others to fire. (During Kuma's seizures, all her neurons were firing at once, they were like firecrackers or and an electrical storm in her brain causing all her muscles fibres to fire all at once. She was like a ball of steel. You could not believe how much muscle she had and how hard it all was.)
One of the connectors to a neuron is a much larger connector and it stores Glutamate. When enough Glutamate is stored, it fires up the neuron. When too much is stored it completely fries the neuron and kills it. Things that cause Glutamate to fire up include dehydration, heat and more excitatory signals received from a transmitter.
There are transmitters that either provide excitement or inhibition. Gaba is a transmitter that provides inhibition. This is the basis of how Diazepam (Valium) works, it breaks through the blood brain barrier and provides the neurons with Gaba to inhibit the brain cells and make everything calm. But Valium is very short lived in this purpose. Yes one tablet of 10 mg made Kuma sleepy for 6 hours but it only released Gaba in the brain inhibiting the neurons and preventing a seizure for about 30 to 40 minutes. Given intravenously Valium is only effective in the brain for a few minutes and given anally it is not as affective and only lasts 10 to 15 minutes. This is why I asked them at the hospital to stop giving Kuma Valium after every seizure because it was not doing anything to prevent the next seizure and was only sending her deeper into a coma.
Another natural way of producing Gaba in the brain was Ocular Pressure. It worked on Kuma many times. The moment I felt she was entering a seizure or just getting too excited, I would grab her head and with my thumbs press on her eyeballs for about 5 to 8 seconds and repeat several times. Pushing in the eyeballs put pressure on the ocular nerve and also on the vagus nerve. This vagus nerve when stimulated instantly produced Gaba in the brain and the effect was immediate. Kuma would instantly relax and sometimes instantly put her head down and sleep or yawn.
Gabapentin is a pain drug that I started giving Kuma just before her dental surgery for her tooth pain. Gabapentin is know as an anti-seizure drug, but it is not really. It is believed that Gabapentin protects Gaba in the brain and it is supposed to dissipitate the build up of Glutamate so it doesn't cause the neuron to fire. None of this is true. I later read original studies that showed that Gabapentin has no effect whatsoever on the stored Glutamate. Gabapentin then has no effect on preventing seizures. Kuma's Vet later said the same thing and said that actually she thought that maybe the Gabapentin was causing Kuma's seizures.
The other pain pill I was giving Kuma was Tramadol. Now it is known to cause seizures in those that are predisposed to seizures. Why, because Tramadol is 25% opiate which causes excitement or a high. Every time I gave Kuma a Tramadol 100 mg tablet shortly after she became anxious and would get up and down and pace for 2 hours like she was trying to run away from something. Later, when I had Valium, I had to give it to her about an hour and a half after giving her Tramadol.
Just before Kuma's last seizure, I had given her half a tablet of Tramadol 50 mg and two hours later she had a seizure. I don't believe that this was the cause but it may have tipped the scale.
I didn't like any of the drugs I was giving Kuma for pain. They both had bad effects on her. I will write more about this later, but I weaned her off both drugs and she seemed to get much better. Both made her anxious, and the Gabapentin especially gave her bad Ataxia and accelerated her CCD Canine Cognitive Disease or old dog alzheimers. They really confused her and I hated seeing that.
What caused Kuma's seizures?
I will never know the underlying cause or when it really started but I have a few theories:
An Inner Ear Infection
An ear infection that spread to her inner ear and into her brain. An infection in her brain spreading from the inner ear would cause all the things that happened to Kuma. I did give her antibiotics for 7 weeks hoping that this would stop it but the only real way to know is through and MRI.
Even before Kuma's surgery, she experience Idiopathic Vestibular Disease. This is something that comes on instantly out of nowhere. All of a sudden she lost her balance, her head tilted to the right all the time and her right ear dropped down. She walked like a drunk trying to catch herself from falling. I gave her gravol and it made her sleep otherwise her world was spinning. She rubbed her right side of her face into the pillow to make it go away. After a few days she started to get better. In seven days she was walking straighter and in two weeks is was completely gone, which doesn't often happen.
In talking with the Vet, I mentioned about the ear infection and she checked Kuma's ear and said they looked healthy. But, I believe it was the inner ear that was infected. This is the only thing that made sense unless Kuma was developing a brain tumor for some other reason.
One month later, it happened again. Instantly Kuma lost her balance and everything leaned to the right and she walked in circles to the right. Her nose was dripping so I gave her antibiotics this time and it seemed to clear things up within two days.
It happened again a third time and I gave her the antibiotics but they didn't seem to make a difference this time. I kept them up for 7 weeks. I didn't like the fact that the antibiotics were destroying Kuma's immune system and I tried to build her immune system back up with vitamins, yogourt (probiotics) and amino acids.
Each time it happened to her right side. Each time she rubbed her right side of her face into the pillow. To me it wasn't idiopathic, there was a very definite and specific cause, we just couldn't find it.
The awful irony of this possible cause was the Kuma always cleaned our ears for us and I almost never cleaned hers.
A Brain Tumor
Five days after her surgery, Kuma had her first seizure. Each seizure cause nerve damage or killed neurons and paved the way for more seizures. Something from her surgery may have caused damaged neurons, a protein deposit, a lesion or a blood clot in her brain. Kuma's recovery from surgery was not good. She was supposed to start waking up a half hour after coming out of surgery or at least an hour after. Instead she was completely unconscious for 6 and a half hours after surgery. Her tongue was hanging out of her mouth. When She finally woke up, she was in terrible pain. It made me question whether she should have gone through the surgery. she woke up screaming, barking, crying and thrashing. She then would sleep for an hour and then wake up again screaming. This went on until it stopped for 20 hours. Then, finally, it was all over and she was totally relaxed. I took her out for a walk all around the park the next day hoping to help get rid of the drugs in her body and brain.
The surgery could have cause the begining of a tumor or protein deposit in her brain.
The causes and symptoms of old dog alzheimers, CCD, is dying neurons and undissolved protein deposits. Kuma did not have any signs of CCD before the surgery, but started having them later. The Gabapentin really accelerated this and took it from zero to really confused at times, standing in a corner and not knowing where to go, or seeing a white door and trying to walk into it thinking it was a field.
Poison in the Blood or Brain
Kuma definitely did not ingest any poison like antifreeze or lead based paint that would cause her seizures but she was given the two pain pills and the anaesthesia before the surgery. These all entered not only her blood but into her brain and they were poison for her.
I thought the first seizure was caused by me reducing her Gabapentin too quickly. I read on forums later that people said to them Gabapenting took months to stop and it was worse that stopping crack cocaine. I took Kuma from being on Gabapentin for only 5 days, from 1200 mg a day down to 300 mg a day. This may have triggered her seizure. Gabapentin and any other brain altering drug cannot be stopped instantly, it has to be tapered very gradually or it will cause a seizure in someone who has never had a seizure. Her Vet said all her dogs stop it without tapering and none ever had a problem. I put Kuma right back on the Gabapentin and then slowly got her off of it talking a month to stop. She obviously had withdrawal symptoms like imaginary pain.
Inflammation in the Brain
This is the most likely answer to what caused Kuma's seizures, but it brings us back to what caused the inflammation. It was either an inner ear infection or a growth in her brain.
Preventing and Stopping Kuma's Seizures
After each episode, I got a bit better. I read all I could about it. I started preventing her seizures by moving her when I thought she was getting close to one, getting up and walking. I read that she also has neurons not just in her brain but has them on the upper middle part of her spine. I applied ice packs to her upper middle back and when she was getting stiff and uncomfortable or her head was too hot, I put them on her head and all around her skull and neck, Sometimes she liked this and sometimes this annoyed her. My purpose was to reduce the heat in her brain. It seemed to work. The ice packs on her back actually shorted her last two episode by a half. But they did not speed up her recovery. I also applied ocular pressure to her eyeballs before or as soon as she started seizing.
The longest period Kuma went without a seizure was when I had her off all her medication except for Meloxicam (like Ibuprofen) for a month.
After her first seizures, I didn't take them very seriously because I thought they were just one time events and that she would not have any more. As she got more, I researched and learned as much as I could. In the end I had cold ice pack by the bed all the time and Kuma slept with an ice pack an inch from her upper back. I thought that I had these figured out but in the back of my mind I knew there was an unknown variable that I was missing that would trigger her seizures.
Things that Triggered Kuma's Seizures
I kept a diary of every hour of the day of what Kuma was going for the important things, like how she was feeling, her outinges, her food, when she peep and pooped, when she slept and anything else that I thought might be important. Later I read these pages, there are a lot, and I started to see recurring themes to the prelude or trigger for Kuma's seizures.
- Hot days and humid
- Stress from being off her routine or out in the car too long
After I tried to keep her cool, bought her a fan, had the air conditioning on full blast all summer which kept the garage at 58 F (I wore a sweater all summer and we didn't go out much) and I kept her to her routine and tried to keep her stress free.
Kuma's Recovery
Sometimes Kuma was up and drinking water within a few hours and sometimes it took a long time.After her 9th seizure I gave her Valium and she took a very long time to recover. She slept for 20 hours which really worried me because I knew she needed water and food and later she was weak for 4 days before she started to drink with strong licks and walk straight. Her 10th seizure, I did not give her the Valium and she was up walking and drinking in 5 hours almost recovered. Each time after a seizure, Kuma was extremely hungry and thirsty. The seizure in people can burn up to 9,000 calories, so it is no wonder she ws starved.
Most of the time it took Kuma two weeks or even up to a month to make a complete recovery but the basics were usually back within 24 hours. Each time you could see Kuma thinking things through, walking slowly to plan how to put her foot forward. She seemed to be relearning how to walk, how to drink water, how to eat. Each time it knocked her down, she got right back up and started learning how to get back to normal.
Yes, I felt bad watching Kuma get knocked down like that. It was awful. But, at no time did I see her frustrated and giving up. She always got back up and started trying to get back to normal. And every time she did get back to normal.
The only relieving thing about watching her seizures, they were absolutely awful to watch, was knowing that she was unconscious during them and did not feel a thing. The last thing that Kuma probably remembered was eating her dinner and then when she was waking up in the hospital she saw I was there but she didn't know how or why she got there. When she saw me, she took a deep breath and sighed with relief, she yawned and opened her mouth wide and curled the end of her tongue, then licked both sides of her face to get the hair out of her mouth and then lay back down like she was just waking up out of a really long sleep. This was just 30 minutes before she was put to sleep and this is why she should not have been put to sleep.