Porter’s Status Epilepticus Episode

It has taken me 11 months to write this post, as it is a recap of one of the scariest days (and couple of weeks) we’ve ever had with our pups.

November is Epilepsy Awareness Month. For those of you who may just be joining our pack’s adventures, our 4-ish-year-old English Pointer, Porter, suffers from severe clustering Grand Mal and Focal seizures caused by idiopathic epilepsy. Eleven months ago, Porter almost lost his battle with this horrible disease when he experienced Status Epilepticus (SE) – a cluster of seizures lasting 5-minutes or more in which the dog does not return to “normal” in between seizures. If it is even possible for something positive to result from Covid, it is that both Brian and I were working from home at the time of Porter’s SE. Had we not been present for this SE episode, Porter would have seized to death.

December 22, 2020

At 8:44am, Porter began to seize. Porter’s seizures had become a regular…almost “normal?” event in our family. We acted quickly, but calmly, because we were prepared with Porter’s seizure protocol and armed with emergency injections. If he clusters, we give him the shot…end of seizures, right? Not this time. When we saw that he was clustering, Brian administered Porter’s emergency injection of Midazolam. However, despite giving the injections, this time, the seizures kept coming. The seizures were severe, emerging one-after-the-other, Porter was violently convulsing and was extremely vocal… it was one of the most awful things I have had to force myself to watch. Brian had given Porter the maximum number of emergency injections allowed with no success in stopping the clustering. Helpless doesn’t even begin to describe how we felt. Porter was then rushed to the emergency hospital.

We were informed that Porter was experiencing Status Epilepticus (SE), and that it was critical to act quickly because neurologic damage continues to occur until seizure activity has ended. The emergency facility was still not allowing clients inside because of Covid, so Porter was taken into the hospital, immediately admitted to the ER and placed on an IV with anesthesia. Standard procedure for a SE is for the dog to be placed on an IV catheter in order to administer anti-epileptic drugs (AEDs). Dogs are usually heavily sedated with anesthesia while receiving AED treatment. While this treatment is being administered, there are several risk factors:

Hypertension, and then hypotension – and both can worsen with addition of AEDs, so closely monitoring blood pressure is extremely important
Hyperthermia – temperature must be closely monitored and cooling efforts are often needed. After seizure activity stops, if the dog has been heavily sedated, hypothermia may occur, and warming may be needed at that time.
Difficulty with upper airways – gag reflex has to be monitored. If the dog is unresponsive, or if the gag reflex is insufficient, it may be necessary to intubate the dog to help prevent hypoxemia and protect the dog’s airway from aspiration.

We were told Porter’s prognosis was poor – as less than 25% of dogs who experience SE will not survive the hospital discharge. Given his current state, euthanasia was also suggested as an option. We refused to even acknowledge this as a choice for Porter until we could more clearly determine what his quality of life would be …IF he survived once he came off the IV.

Porter survived the IV procedure. However, once taken off the IV, the doctors reported that Porter had lost both his sight and the ability to walk (common for dogs who experience SE). Some dogs who are lucky enough to survive the AED therapy make a partial recovery, some dogs make a full recovery, and others remain disabled. Only time would tell for Porter. If he did not recover enough from this point to have a good quality of life, we knew we would have to help him cross over the rainbow bridge.

We were not able to visit with him during his hospital stay due to Covid restrictions. Although it was excruciating not to be there with Porter, the ICU staff kept us updated with photos and video of our boy.

December 23, 2020

In just over 24 hours, Porter’s vitals and response to medications were enough to convince the doctors that he had a fighting chance and could be released from the hospital. The days that followed Porter’s return home felt like an eternity as we watched for signs of improvement, indications of decline, and additional seizures.

When we brought Porter home, he laid motionless on the dog bed- eyes glazed over. I have to admit – after seeing him in this state, I began to prepare myself for having to say goodbye to him. The last thing we ever want is a poor quality of life for any of our fur-kids.

January 5, 2021

However, slowly but surely, over the next two weeks, Porter began to show improvement! His eyesight began to return, he was able to pick his head up… then sit up… then stand up…then walk!

As we celebrated his recovery, we also had to decide along with Porter’s neurologist and primary veterinarian, what to do from here. Although in the past, Porter did not respond well to Potassium Bromide, it suggested that we add this back in to his complex cocktail of medications. We believe that addition has played a major role in his recovery and our goal of aiming for zero.

Fast forward to November 2021

Porter went from having a seizure every seven to fourteen days… battling Status Epilepticus (and winning!)…to only having two seizures (one mild Grand Mal, and one mild Focal) in the past 11 months! To say we are thrilled is an understatement. Porter goes on walks, runs in the yard, plays with toys, and partakes in shenanigans with his siblings. He’s happy and loves spending time with any human or dog that will pay him some attention! He is an amazing warrior! At the same time, we know full well that Porter’s battle is far from over. The life span of dogs who experience SE is drastically shortened. In addition, the amount of medication Porter is taking can harm other organs, and also dramatically reduces the other drugs he can take that may help him battle other illnesses and diseases.

November 8, 2021

Porter had his annual neurological evaluation at BluePearl Pet Hospital. Overall, his neurologist is pleased with Porter’s recovery and current status. However, in recent routine blood test, Porter’s Bromine level was a bit high at 3.4 (normal is 1-3 mg/mL). Adjusting his Potassium Bromide dose at this point could put Porter back into an undesirable seizure cycle again, so his neurologist is reluctant to decrease the dose at this time. Porter’s liver panel displayed that his Albumin level was low at 1.8 g/dL (normal is 2.7 – 3.9). His low Albumin is not thought to be related to his abnormal Bromide level. However, we need to find out where Porter is losing protein – the cause of the low Albumin level. A urinalysis was done and came back normal. So now he will have a Fecal Alpha Proteinase Inhibitor test to rule out any gastrointestinal disorders that may be causing Porter to lose proteins. Porter will be monitored closely while the additional fecal testing is underway and discussions among his medical team are conducted.

In the mean time, we will continue to aim for zero as we celebrate each and every day with this very special and amazing soul.

Please help us spread Epilepsy Awareness by sharing Porter’s story.