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benedetta7
benedetta7, Veterinarian
Category: Dog Veterinary
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Experience:  Companion animal medicine and homeopathy
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Our 13 year old dog had a seizure 7 weeks ago when we were

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Our 13 year old dog had a seizure 7 weeks ago when we were away. We were told by two vets it was a probable brain tumor and he was started on pheno. He was a stoner dog but did make some progress (according to the dog sitter) in getting up and getting in and out of the house. When we were finally able to get home, he got progressively worse and the we saw him have another seizure so finally accepted the brain tumor theory. He can't walk without us holding him up but will still go potty outside. He can eat--and wants to alot but has no personality like before. He whimpers and twitches which we were told could be small seizures. We insisted on him being put on steroids but it wasn't until this week after hearing a friend's stories about how much they helped her dogs and cats in similar situations. We are pissed no vet (at least 3 we consulted) mentioned this option earlier and maybe we could have slowed the progression and seen our dog again before it was too late. Now we are struggling with when to put him to sleep. He has no quality of life but he is eating. We don't know if he's in pain but he looks miserable. We haven't had him on steroids more than 5 days and it helped some but don't know if it's the most change we will see. We don't want him to suffer for just the possibility of improvement. Do you know if he is likely to improve anymore on steroids? When do you know it's time to put a dog to sleep?
JA: I'm sorry to hear that. This sounds like it might be serious. I'll let the Veterinarian know what's going on ASAP. Is there anything else important you think the Veterinarian should know about your friend's dog?
Customer: it's our dog. his blood work after the seizure came out ok so we didn't have him retested to look for some other cause.

Hello, this is Dr Benedetta, and I would like to help.

I am truly sorry this is happening to your dog, it is a tough situation.

To have an accurate estimate of the situation, the best thing would be to consult with a neurologist and have an MRI done.

This will give you better answers. There are also different antiseizure medications that can work better than phenobarb, and give less side effects. Again, a neurologist would be the best person to help.

Steroids are useful to decrease inflammation and sometimes reduce the size of a tumor for some time, but are not curative, at best they give respite. The positive effect is usually pretty quick to show, then it plateaus, when it happens at all.

Having said all that, unfortunately your dog has an incurable disease, and is not responding well to palliative medication.

There is no answer to your question" when is it time?" it varies for each dog and each owner. If he looks miserable, has no quality of life and is not likely to improve, it might be kinder to make peace with this horrible situation and let him go.

I am so very sorry for all you are going though, it is tough, and it is a difficult decision!

If I can be of further help, please let let me know!

Benedetta Sarno, DVM

Customer: replied 2 months ago.
What does it mean that they respond to steroids 'pretty quick'? How long should it take to see the most results and is it possible to increase the dose to see better results? Why didn't the other vets recommend steroids early on? It could have saved his quality of life for quite a while longer. I don't see the point in doing an MRI if it's incurable.

Usually for neurological disease, we start steroids at a fairly high dose, and the most response happens within 24-48 hours.

But that depends on the type of disease, it helps in encephalitis with a lot of inflammation, or in some traumatic conditions, not really on tumors. There are some cancers that respond to steroids, like lymphoma, but this tumor has not been diagnosed with any accuracy. Imaging would be useful to confirm the tumor, and visualize the extent of it.

It is not routine standard of care to start a dog on steroids for a presumed brain tumor, so I am not surprised it has not been recommended. And a brain tumor is statistically and clinically the most likely cause of seizure in a 13 year old dog.

So steroids are not generally indicated in these situation, but they are worth trying if anti-seizure meds don't achieve good control.

Hope this information helps!

benedetta7 and other Dog Veterinary Specialists are ready to help you
Customer: replied 2 months ago.
Since he's been helped by 5 mg of steroid twice a day, would it help to give him more to see if he gets even more improvement?. He weighs about 18 pounds.

sorry for the delay!

5 mg twice a day is a good dose for his weight, using steroids at an immunosuppressive level.

You could go up to 7.5 mg twice daily, still within the recommended dosing range, but I would not expect much change.

Still, given his miserable state, you don't have much to lose by trying!

Customer: replied 2 months ago.
He had an ear infection and a cyst under his ear (that appeared to have caked and oozing pus) when we got home (very bad pet sitter). A vet told us it would heal on its own but we did treat the ear infection. Is it possible that a bacterial or viral infection could have or still is causing seizures or symptoms like he's having? We may be grasping at straws but we don't want to put him down unless we are sure he has something incurable. We were told by the vet that his blood work at the time of the seizure looked ok (his BUN, PLT, and MCHC were all a bit high but she told us that could be normal since he'd just had a seizure). We don't want to put him through more unnecessary tests but just wondering about other things that could cause the same symptoms--can't walk much and turns to the right in circles, disoriented at times, heavy or labored breathing. Still eats like a fiend and can let us know when he needs to go out to pee and poop but has to be held up mostly. The days he's had 2 steroids he has walked on his own a little bit. Just let me know if there are other things that could cause these symptoms and the others I listed before. Thanks.

Thank for the extra information!

A bad ear infection that has perforated the tympanic membrane and has gone to the inner ear has the potential to cause meningitis.

Which can then cause seizures.

Also, old dogs are prone to vestibular disease, for unknown reasons, with falling over, circling, nystagmus.

However, that is different from full seizure, and it resolve itself in a few days.

So yes, at this point, infectious meningitis could still be on the table. But without an MRI, we would not know.

If you want to rule out other possibilities with some degree of certainty, he needs more testing,

Empirically a course of antibiotics,like clindamycin that penetrates the blood brain barrier, and a very good ear exam under light sedation, and/or radiographs of the head to look at the tympnaic bullae for evidence of disease could be tried.