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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 29013
Experience:  University of California at Davis graduate veterinarian with 45 years of experience
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I have a who is about 9-10 years old. She has started

Customer Question

I have a ***** ***** who is about 9-10 years old. She has started having... choking episodes? Seizures? Not sure what to call it.
She remains aware and while there does appear to be weaknesses and trembling the primary issue is that she seems to be choking and having difficulty breathing.She claws at her mouth, sometimes with both front paws. After the episode she is weak and trembly, but later returns to her normal energetic self.
During one of the very early episodes, she managed to scratch her eye rather seriously. We ended up taking her to the vet for that and had some blood work done at the same time. I did not realize then that these were reoccurring, but regardless, the tests came back 'normal'.
The seizures seem to come and go, and during the periods that she is having them, there does seem to be an increase in mucus in her stool.
Could she be choking on mucus? Does this sound like anything you have heard of. My daughter caught one of the episodes on her phone if that would help.
Submitted: 9 months ago.
Category: Dog
Expert:  Dr. Michael Salkin replied 9 months ago.

You're speaking with Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

Expert:  Dr. Michael Salkin replied 9 months ago.

Angela, I would very much like to see a video of an episode. Can it be uploaded to YouTube (or similar) and then give me the link to it? Remember not to mark it as "private".

Customer: replied 9 months ago.
I spliced two short clips together. They're not great, but you can definitely see and hear what's going on. (Please excuse the laundry, Lucy likes to lay in piles of clothes when I sort them) here is the link:
Expert:  Dr. Michael Salkin replied 9 months ago.

Thank you. Give me a moment to take a look, please...

Expert:  Dr. Michael Salkin replied 9 months ago.

This appears to represent a complex partial seizure (previously called petit mal and now also called psychomotor seizure) which is described as abnormal focal or asymmetric sensory or motor activity affecting any part of the body and which may be associated with autonomic signs, (salivation, vomiting, e.g.) and is associated with a change in mentation (mental status) and/or behavioral abnormalities. Sleep is the most common post-ictal (post-seizure) symptom. Mark your calendar for these events and for just what you witnessed. Lucy's vet will need all the information you can gather when deciding if Lucy should be prescribed an anticonvulsive drug. Most of us will accept one mild (lasting less than 5 minutes, no thrashing about, no loss of consciousness) event monthly before prescribing such a drug. Should she suffer another event within 24 hours of a prior one clustering is diagnosed and that may presage status epilepticus - the state in which seizure activity doesn't abate unless I heavily sedate or anesthetize my patient. She would then need the attention of a vet at your earliest convenience.

Seizures first arising between the ages of 1-5 years are usually considered idiopathic (unknown cause) epilepsy. Seizures arising after 6 years of age are often caused by brain tumor or, less commonly, adult onset epilepsy. Please respond with further questions or concerns if you wish.

Customer: replied 9 months ago.
Well they ALWAYS cluster. She already had 4-5 of them in the past 24 hours. This can occur on and off for several days, then there will be no more events for days or even weeks. They never cause her to sleep any more than usual, and if 5-10 minutes after an episode you ask her if she wants to go for a walk, she jumps around like her normal self.
She is completely aware of her surroundings during the episode There have been occasions where something will 'interfere' she will stop, run to a 'safe' location, and the fit will resume. Which does NOT sound like the epilepsy you described. It also doesn't explain the mucous.
The most notable change in her since all this began is that she has lost some weight and is a pickier eater. I can't see any 'cognitive' or behavioral changes despite there having been multiple cluster periods over the past few months.
This is kind of why I haven't been to the 'in person' vet. I don't have the money for 'maybe'.
Is there ANY condition that could result in the production of a thick mucus that could both choke her and cause GI issues?
Expert:  Dr. Michael Salkin replied 9 months ago.

Thank you. That's worrisome and should prompt initiation of an anticonvulsive drug - phenobarbital, levetiracetam, or zonisamide should be considered. Complex partial seizures CAN look as you've described. Excess mucus in the stool indicates a colitis. The colon is rich with mucus-secreting glands. There could be a connection between seizure activity and a colitis. Autonomic signs are consistent with complex partial seizures. The autonomic nervous system innervates the colon. The vehavior that was videoed constitutes the behavioral signs indicative of this type of seizure. It's unclear to me why thick mucus is being formed that then chokes her. Once again, it could represent another autonomic sign.

I understand your financial constraints. Unfortunately, comfirmation of the etiology of seizures can involve advanced (and costly) diagnostics in the form of cerebrospinal fluid tap and analysis and MRI. Please continue our conversation if you wish.

Customer: replied 9 months ago.
I understand that from what you saw on the video and from your cumulative experience with dogs, this clearly looks to you like epilepsy.
But I also understand that regardless of how many events she has in a day, or even multiple days, there are ZERO POST-ICTAL SYMPTOMS. There is no sleeping period, no disorientation, no behavioral changes, no mental changes.
She is completely 'herself' beyond a few minutes of shakiness and weakness which would be consistent with temporary loss of oxygen and the accompanying panic from being unable to breath. Plus she ALWAYS winds down from the 'fit' by breathing slowly & deeply through her nose- not panting, not drooling.
There is no excessive salivation during the event or vomiting at any point. Though one time my Ex reported that she coughed up a wad of mucus at the end- not vomit, mucus. There is always the mouth/face clawing, but she only falls when she attempts to get both paws into her mouth. She has NEVER lost consciousness and responds to visual, auditory, and physical stimuli during the event.
You watched a 50 second video, I have watched her and sat with her through dozens of these events.
Yes, it certainly has the APPEARANCE of a seizure, but beyond that, it matches NONE of the other criteria that you listed.
I fear at this point you are unwilling to even consider other possibilities.
Expert:  Dr. Michael Salkin replied 9 months ago.

I understand. You're correct, you've had the opportunity to witness far more events than I. I can entertain obstruction of her airway by laryngeal paralysis or tracheal collapse. Watching her breathe when lightly sedated can tell me if laryngeal paralysis is present and X-rays of her chest can identify a collapsed trachea. It's not unreasonable to pursue those diagnostics. Let's get other expert opinions for you. I'll opt out which will allow other experts to enter this conversation with their opinions.

Customer: replied 9 months ago.
Thank you, ***** ***** now see that this had been passed on to someone else. Whether that is due to a shift change or because I am argumentative, it still likely works in my favor.
It would be very remiss of me not to explore other possible causes for her distress . There is no cure for epilepsy. She is a ten year old dog I inherited when my mother passed away. I could throw away thousands on imaging that would likely confirm nothing and would definitely not CHANGE anything.
I could turn her into a vague shadow of herself with anti-convulsants that she may not even need all while she is suffering or dying from a zebra that was assumed to be a horse.
I would ask that whoever has taken over the conversation, please read ALL of the descriptions before replying. Perhaps the omission of relevant details in my initial message was to blame.
Take as much time as you want to review the conversation. I would rather have a deeper analysis of the situation two days from now than a quick answer. And I would like for you to proceed with the assumption that it is NOT epilepsy, because if it is, my course of action will be to do nothing or have her put to sleep, and I don't care for either of those options.
Customer: replied 9 months ago.
Sorry, I need to clarify that last statement. I'm not 'in denial', I honestly don't believe it fits the description of epilepsy beyond a somewhat superficial resemblance. But I acknowledge that I could be wrong.
If you seriously, and deeply believe it is epilepsy, and that there is no other conceivable possibility. I will need to have some data that relates specifically to why it does not adhere to ANY of the normal expectations for that diagnosis.
Thank you again.