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June 15, 2020 – Dr. Kelly Diehl talks with Dr. Karen Munana, a professor of veterinary neurology at North Carolina State University. The two discuss seizures in dogs and Dr. Munana’s Foundation-funded study to evaluate the use of a collar-mounted accelerometer to detect seizures in epileptic dogs. The two also do a little seizure myth busting.

00:09 Kelly Diehl: Welcome to Fresh Scoop episode 21. Learning more about seizures in dogs, novel treatments, and we'll be doing some myth busting today too. I'm your host, Dr. Kelly Diehl, Morris Animal Foundation Senior Director of Science and Communication. And today we'll talk with Dr. Karen Munana, a Morris Animal Foundation funded researcher, and veterinary neurosurgeon, and neurologist. Karen is a professor of neurology at North Carolina State University, and a long time personal friend. We're coming to you today, our quarantine edition is here in the closet in my bedroom. So only... You know, I do that with a close personal friend. Fresh Scoop is the monthly podcast of Morris Animal Foundation. One of the largest non-profit foundations in the world dedicated to funding studies to find solutions to serious health threats to animals and in each episode we'll feature one of the researchers we fund or one of our staff members discussing their work in advancing animal health. Whether you're a practicing veterinarian, technician or student or just an animal loving science geek, Fresh Scoop is the podcast for you.

01:24 KD: You can learn more about us at morrisanimalfoundation.org, and okay we'll get on with today's show. As I mentioned, today we welcome Dr. Karen Munana, a professor of neurology in the Department of Clinical Sciences at North Carolina State University. Dr. Munana completed her DVM at University of California, Davis, before moving to Kansas State University for her internship in small animal medicine and surgery. Dr. Munana completed her residency in neurology, and neurosurgery at Colorado State University, which is where we first met nearly 30 years ago, when we were very small children. Dr. Munana is board certified of course in neurology and she is a very popular speaker at both national and international meetings where she talks about her work in seizures and seizure disorders. Dr. Munana is a foundation funded researcher, with a primary research interest in canine epilepsy. And with a focus on evaluating the effectiveness of novel anti-seizure therapies and understanding why some dogs respond poorly to treatment. Hi Karen.

02:34 Karen Munana: Hi Kelly. It's great to be here with you.

02:36 KD: Yep. And thanks again for doing this when circumstances are a little tough outside. So I talked about your background and wanted to ask you a little bit about if you want to tell us about yourself and a little bit about why you decided to become a vet. And specifically, a neurologist?

02:56 KM: Sure. Well, I was born on the East Coast, but grew up in California. And as you mentioned I got my veterinary degree in California as well as my undergraduate degree. I always liked biology, and I always liked animals and I actually thought I wanted to be a marine biologist, and up until my undergraduate years, but as I learned more about marine biology and actually learned more about veterinary medicine, I decided that I wanted to change and become a veterinarian. So I changed a little bit later than most people who knew they want to be veterinarians. And I decided when I was an undergraduate. I didn't actually know too much about specialty veterinary medicine but in my first year of vet school during neuroanatomy class, I discovered that I really enjoyed neuroanatomy. And the nervous system was fascinating to me, and the complexity was really intriguing and the fact that you could break it down and really understand it and be able to tell where a problem was based on the clinical signs that an animal or a person showed, I just found really intriguing. And essentially neurology is like solving a puzzle, and I've always enjoyed doing puzzles, so I just felt it was, would be a great fit for me and really I've never looked back.

04:07 KD: Great I always found... I think you're one of the rare people who enjoyed neuroanatomy. It's a really... I think it was one of the hardest courses I ever had to take in vet school. So talk a little bit about... Tell me why you decided seizure disorders in particular, to focus on?

04:28 KM: Yeah, that's a little bit of an interesting story. So I started my research career studying inflammatory diseases of the central nervous system in dogs, which is actually a fairly common problem and an area that we don't know a lot about. And I was a young faculty at NC State, and one of my cardiology colleagues, came to me one day and said, "I have this friend, who has this device which is like a pacemaker that they're starting to use in people with epilepsy. Would you be interested in doing a study and looking at it in dogs with epilepsy?" And that actually was my very first Morris Animal Foundation funded grant, doing a clinical trial looking at vagal nerve stimulation in dogs with epilepsy. And I quickly found that number one, epilepsy is a pretty common problem. So it was a good area to study in terms of getting participants for the study, and I think what really sold me were the pet owners, pet owners of dogs with epilepsy. I'm sure with a lot of chronic diseases, they're very motivated, they're very knowledgeable and they really, really want to work with the veterinary community to help solve these problems and get cures for these disease or at least in epilepsy, get better control of these disease and improve the quality of life of their pet.

05:52 KM: So, after my first study and just working with this population of people and their pets, I realized that it was a really rewarding area to be in and an area that I felt like I can make a difference by studying it, and that really, I didn't look, haven't looked back from that day.

06:09 KD: That's so cool. Just to back up for the folks who are listening, because we do have some people who aren't veterinarians. Can you talk about what a seizure actually is? I think there's a lot of misperception about what a seizure is.

06:23 KM: Sure. So a seizure is defined as a transient paroxysmal disturbance in brain function, that is specifically associated with an increase in excitation of the nerve cells. So what that means is it's this episode of increased excitability of the brain that tends to start and stop spontaneously and it typically lasts from seconds to minutes. And what we see when we observe a seizure is a physical manifestation of that abnormal brain activity. So, we talk most commonly in veterinary medicine about generalized seizures. Some people will also call them grand mal seizures and the physical manifestations we see are typically a loss of normal consciousness and involuntary movements of the limbs. There may also be jaw chopping, there can be excessive salivation, there could be urination and defecation. So those are all the manifestations of the abnormal brain activity that we see. If we have seizures in specific areas of the brain that don't involve the generalized area of the brain, we may see specific problems. Some may just notice some twitching around the face. You may just notice a movement of a limb. So there's lots of different variations, but they're all due to abnormal activity of the nerve cells in the brain.

07:45 KD: So, which brings me to my next question, which is what kinds of things cause seizures?

07:51 KM: There is a whole gamut of things that can cause seizures. So when we approach a dog or cat that has seizures, we like to divide the causes and think about the causes separately into what we call as extracranial causes, which are those causes that arise outside the brain, and intracranial causes or those causes that arise inside the brain. And of the extracranial causes those things outside the brain, the two categories of diseases we think most commonly, are intoxications. So when the animal is exposed to or ingests some toxin that can have effect on the brain. And the other category is, what we call metabolic disease, when there's disease in another organ system that can cause either the build-up of toxins or the deficiency of a substance that can affect the brain, and in that metabolic category, the things that we think about most commonly are low blood glucose and liver disease.

08:48 KM: The other group of diseases that we think about are the intracranial or things inside the brain and we think in that case, about structural problems in the brain. So those could be either tumors, that could be an infection of the brain, that could be secondary to a stroke. But by far the most common cause of recurrent seizures that we see in dogs, it's a disease that we call idiopathic epilepsy and that is a disease where structurally... If we look at the brain for instance, with an MRI, the brain looks normal, but there's abnormalities at the cellular level, that tend to cause those cells to be hyperexcitable. And idiopathic epilepsy is presumed to be inherited in some breeds and has been proven to be inherited in other breeds.

09:32 KD: So, which is, okay, brings me to another thought which is, can you discuss... You talked about the different kinds of seizures, do you have a sense for how common seizures are in dogs, and cats? And then do you have any idea of the break down as far as extracranial versus intracranial?

09:51 KM: Yeah. So seizures we know are the most common neurologic problem that is seen in small animal practice in both dogs and cats. By far, they're most more common in dogs, than they are in cats. And studies have looked at the prevalence of seizures in the dog population, and studies have estimated that it can affect up to 0.75% of the dog population. So just under one in 100 dogs may suffer from seizures sometime in their lifetime. The prevalence in cats is less than that, but still commonly recognized. And in terms of the animals, talking more about dogs now, because we have more information, there's different studies have shown, but it's probably at least 50% of dogs with epilepsy meaning recurrent seizures, have idiopathic epilepsy. And smaller percentages would have either what we call the structural epilepsy due to a brain tumor or infection, or seizure secondary to some sort of intoxication or metabolic problem.

11:00 KD: Okay, so I... Before we get into some of the other things we wanted to talk about today, you've studied this a long time now. What have you seen as far as changes in our knowledge about seizures in the time that you've practiced? And also how we treat them just in a big sense?

11:24 KM: Yeah, I think when I started doing seizures on epilepsy, there was relatively little that we knew, and there wasn't much that was changing so we had some basic information and we had some basic treatments that we had been using for some time. And I would say probably over the last 10 or 15 years, the information we have has really exploded and that's been really encouraging to see. And it's been in areas really as diverse as the genetics of idiopathic epilepsy. There's been studies into why some patient's seizures are more resistant to treatment than others. There's definitely been a lot of studies on treatments, and there's been a lot of new medications that have become available in human medicine to treat seizures and we've been using a lot of those in veterinary medicine and there have been studies looking at those. There's also been studies looking at more from the caregiver perspective. So how does a chronic disease like epilepsy impact the caregiver, how does it impact the quality of life?

12:22 KM: And also looking at some differences in terms of comorbidities, so there's been recent studies that suggest that dogs with epilepsy are more predisposed to having behavioral problems than dogs without. And it's not due to the drugs that they're on and those sorts of thing. It's probably, again, due to some changes in their brain itself. And I would also say that, really, the scientific rigor of the studies being performed has improved so that not only has the quantity of information we have available to us now has gotten better, but also the quality of the information. So we still have a lot to learn. But we're definitely gaining new information each day which is really encouraging to see.

13:03 KD: Yeah, and I wanted to... That makes me think about how seizures are treated, because you just touched on it. So, what are kind of the general... You don't have to go into specific drugs, but sort of the general way seizures are treated in dogs. Let's focus on dogs. We'll not worry about cats.

13:20 KM: Okay, we'll focus on dogs. So the first thing, a single seizure itself usually does not warrant treatment. So, we usually talk about epilepsy as being recurrent seizures, meaning two or more seizures that occur at least 24 hours apart. So when an animal has recurrent seizures, at a certain frequency, we may recommend doing treatment. And by far, the cornerstone of treatment are anti-seizure medications. And there is a few, like I mentioned, that have been used for years and years in veterinary medicine. Those being Phenobarbital and potassium bromide. Then there are some other ones that are... Have been introduced in human medicine over the last 15 or 20 years, and we've been extrapolating their use and starting to use them in veterinary medicine as well. The two most common are drugs called Levetiracetam and Zonisamide. So mostly we're talking about anti-seizure medications again, with idiopathic epilepsy since there's nothing wrong structurally and it's not due to anything outside the brain all we can do is treat those animals symptomatically and give them medications to try to control their seizures.

14:32 KD: So that brings us to a really interesting and a talk that you gave last year, and I, for our listeners, I'm putting Karen on the spot because I thought this was absolutely... As an internist, I found this really, really fascinating. And you mentioned that you're really in tune with the community and there is a pretty active community of folks online, that are pet owners with pets with seizures and they talk a lot about all kinds of things. And you talked a little bit about home remedies and triggers and first before we get further into it, what prompted you to talk about, give this lecture on this topic?

15:09 KM: Well, it was actually my ignorance that prompted me. So like you said, I deal a lot with these clients in both in the clinics and in my research, and there is an extremely strong network of clients, pet owners with epilepsy and there's online networks, there's Facebook groups, and they're really there, and a tremendous source of support for each other. But amongst those groups certain ideas and thoughts go through and they become pretty much common knowledge in these groups and these communities and maybe aren't knowledgeable to us as practitioners. So I had several owners come and ask me about some of these remedies and quite honestly, I had heard nothing about them, so I thought, "Hmm, I think I need to look further into these and see what the truth is." And the two that kind of stick out to me, the most, the first one, which I've heard for years and years, is that after seizures, it's helpful to give dogs vanilla Häagen-Dazs ice cream.

[chuckle]

16:13 KM: And for me it struck me, I understood maybe the ice cream but the fact that it was Häagen-Dazs and vanilla struck me as kind of interesting. The other one that I've heard more recently is that you should avoid foods that have rosemary in it because that can trigger seizures. So both of those kind of... And owners ask me for my advice and I have to say, or I had to say before doing this project that I really didn't know. So I really wanted to look into where these ideas came from and what the scientific basis of them were.

16:47 KD: Cool, so this comes to the sort of discussion and myth busting part. So tell us a little bit about seizure triggers, because I had the same thing. When I was in practice, especially the full moon idea that they trigger seizures. So what did you find in your research of looking at seizure triggers?

17:06 KM: Yeah, so I think the ones that we think about mostly are the full moon. Seizures come in, a dog comes in with bad seizures or a dog develops, breaks through seizures. "Oh, it must be a full moon." We still say that to this day. And also change in barometric pressure. "Oh, it must be the weather's changing." So those are seizure triggers that have been mentioned for a long time. If you look into literature there's really little evidence to support those. So some owners believe that their dog's seizures are triggered by the full moon. And it may very well be. My guess is that probably the dog's inherent seizure cycle is on the same calendar as the full moon calendar happens to be. So it may be coincidence, but again, there's no data to suggest that. There are known triggers in humans. And I think the two that are mentioned most commonly are stress and sleep deprivation. And interestingly, there was a study done not that long ago in dogs, one of this, kind of this, in this new wealth of information that we have that looked at what owners reported as triggers in their dogs and the ones that were most common were hormonal triggers, so we know that dogs during their heat cycle are more prone to seizures.

18:19 KM: But then other things like stress. And stress was manifested in either a change in life situation, visitors in the home, change in daily routine, trips to the groomer, trips to the veterinary office, going to unfamiliar places and also sleep deprivation, similar to people, and owners usually reported that as altered sleep patterns.

18:40 KD: Cool, so that, it sounds like those could be things that people can at least watch out for and understand.

18:47 KM: Right, exactly. And most people learn over time what their dog's seizure triggers are. So for instance, I have some clients that know that every time around Christmas time, when their family gathers in the house and there's a lot of activity and a lot of new people, their dog is going to have seizures. So they have to make a decision, they obviously still want to gather with family, so we may do certain things in terms of treatment and be more aggressive or have additional treatments on hand, knowing that that may be a more difficult time for their dog in terms of the epilepsy.

19:19 KD: And so tell us a little now about the diet stuff. So you mentioned the rosemary and the Häagen-Dazs vanilla, I forgot about that, but what other diet things did you hear and what did you find in your research?

19:32 KM: Yeah, so diet has been an area that's been pretty intriguing to me because, again, as you talk to owners a lot of owners feel very strongly that what they feed their dog can influence their dog's seizures and how well they're controlled. And we performed a study some time ago as part of a larger study and we just asked owners, "What's your pet's typical diet?" And these were dogs. And over 50% of the dogs were fed what I would call either a special or exclusionary diet, and this included about a third of the dogs that were on a grain free diet, 15% that were fed a raw diet and a little bit over 5% that were fed a home cooked diet. So, a lot of dog owners when their dogs have epilepsy, again, through this network and from things they observe, they feel like putting them on a special diet may help. There was another study that came out, again recently, that showed about two-thirds of caregivers reported changing their dog's diets once they were diagnosed with epilepsy. And about 50% administered supplements to their dogs to help manage the epilepsy. And those supplements were either to help with adverse effects of medication or also to try to reduce the frequency and severity of seizures. So again, there's a lot of information and a lot of pet owners feel strongly about this, but we don't have a lot of evidence to back up a lot of their claims.

21:03 KD: Which I have two questions for you, but the first is, this came to me at Morris through an email, where someone asked me about ketogenic diets in veterinary patients. Can you talk about that?

21:19 KM: Sure, so the ketogenic diet is a diet... It's essentially a high fat diet that's shown, proven to be effective in people with epilepsy. And it's oftentimes given in children with epilepsy, and it's believed that somehow the ketogenic diet and that ketogenic state mimics a lot of the biochemical changes that occur in fasting and for some time, it's been shown hundreds of years that fasting can have an effect on seizure control. So they feed this ketogenic diet, and it's been shown to be effective, as effective as medications in some case, and it's used particularly in children. The big problem in humans and adults is compliance with the diet because it is a very rigid diet. So it has been looked at in veterinary medicine. And again, early on, there was a small study that we did looking at a ketogenic diet in dogs with epilepsy, and we showed that a ketogenic diet that sort of ketogenic diet did not have any positive effect on seizure control in the small group of dogs that we studied.

22:28 KM: More recently, there's been studies looking at modifications of a ketogenic diet and the one that's been looked at most commonly is a diet based on medium-chain triglycerides, or MCT diets and there is a commercially available diet that has that in it and there's also now some information about supplements using that, and there is some limited data to suggest that MCT diets can help control seizures in dogs with epilepsy.

23:00 KD: Diet brings me to my next question. Because as a gastroenterologist of course I think of diet and I think of the gut microbiome, my new favorite topic and I know that you and I were talking, you have a study that you're looking at the gut microbiome and I'm wondering if that is part of the explanation for the diet stuff. So, what are you finding and what are you looking at?

23:22 KM: Yeah, so that's something that is a very interesting thing in an area of pretty intense research now, the gut-brain axis and how changes in the gut can influence the brain and how the brain can influence changes in the gut. And it's been shown that the gut microbiome can be altered in a lot of neurologic diseases, things anything from schizophrenia to Alzheimer's, to some preliminary studies, maybe on epilepsy. So we're actually looking at a study right now evaluating the gut microbiome in dogs with epilepsy and comparing it to normal dogs in the same household. It's a preliminary study to really evaluate whether dogs with epilepsy and dogs being treated for epilepsy have any changes in their microbiome. And ultimately the thoughts of this is, are there different ways that we can treat these animals? So can we maybe because of changes in the gut microbiome, can we maybe devise some treatments that can, resulting from those changes that can impact those changes? Can provide us better control in dogs that aren't controlled with standard medications, alone.

24:38 KM: So it's still early in the study, we haven't gotten very far but that's essentially what we're exploring is how might the gut microbiome influence epilepsy in terms of the development of epilepsy and the treatment of epilepsy, with the ultimate goal of perhaps exploring alternative means of treating epilepsy in dogs.

24:58 KD: So do you think that might be... It may be the gut microbiome stuff that's influencing when people talk about diets in some of the stuff you see. Do you think maybe that's where the link is on those?

25:12 KM: Yes, it could very well be that. And one other kind of area that we've explored and thinking about exploring is a lot of dogs... Again, through this grapevine, you hear, but maybe we don't think about as much as veterinarians. A lot of dogs with epilepsy may also have concurrent, I don't want to say inflammatory bowel disease, but manifestations of allergic or inflammatory or immune disease that manifests in the GI tract with vomiting or diarrhea. So I think that's held reason. A lot of the reason some of these dogs are on special diets is because they have what the owners consider a sensitive stomach. But the thing is, is there a connection there? Yeah and are... Is that a general inflammatory state that is impacting the... That is involving the gut microbiome that can have an influence on seizures, and seizure control. And by all means that connection is well established in human medicine where people with inflammatory bowel disease, there is a stronger association, they have a higher prevalence of seizures in epilepsy than people without inflammatory bowel disease and Crohn's disease. So there's definitely an association in human medicine. There may very well be an association in veterinary medicine, and we just haven't really identified and explored it to a full extent yet.

26:33 KD: Great, so the other thing I think that was in that really good talk that you gave, was a little bit about what people do post seizure. So you mentioned the Häagen-Dazs vanilla ice cream, but what other things did you hear and what did your research show about what people do after the seizure?

26:52 KM: Yeah, so what people do, and I guess I should explain the Häagen-Dazs ice cream. I believe they say Häagen-Dazs because it's preservative-free and I believe they're saying the vanilla flavored it's because they don't want dogs to get chocolate which makes sense. And the ice cream is given to potentially treat hypoglycemia. That is concerning after dogs have a severe seizure could their blood glucose drop and the thought was that maybe ice cream is better than sugar or honey or something else that might cause a greater spike in blood glucose levels. I would say that although there's increased glucose utilization during a seizure, most normal dogs are able to maintain their glucose. So I'm sure the dogs enjoy getting the ice cream after their seizure, but their glucose probably isn't at a level that they need that. Unless of course they're a breed or a dog that's prone to hypoglycemia where it may be indicated. Dogs also have an increased appetite after a seizure, and some people think they must be hypoglycemic because they're hungry and that increased appetite is part of what they see in this postictal or after seizure period, and it's not attributed to hypoglycemia.

28:03 KM: Other things that caregivers may do. I think one of the things that's the most common one, is they'll put an ice pack on their dog's back and neck to provide skin cooling. And I think in general, that's probably not a bad idea, particularly if they have a generalized seizure and the seizure is prolonged because we can see an increase in the dog's core body temperature associated with that, and it may help with that. There's some discussion that perhaps using the ice pack could potentially shorten a seizure's duration and I think there's less evidence for that. By all means and I believe it came from it, there's studies that show that local brain cooling can terminate or prevent seizure activity. But that local brain cooling number one, is pretty dramatic cooling so the drop in temperature is more than an ice pack is going to do. It's often times focused on the brain or a specific area, and oftentimes it's provided for a lengthy period of time. So again, I think the ice pack may help in terms of if the animal develops a transient increase in their core body temperature associated with the seizure but is less likely to help to stop a seizure or prevent future seizures from happening.

29:17 KD: I wanted to circle back to your most recent Foundation grant, because it's pretty interesting and I think it speaks to an issue you brought up way early on in our discussion, which is the impact of seizures on caretakers, who worry about their dog having a seizure. Which I think was the impetus for your study. So can you talk about the study that you just completed and what you found?

29:43 KM: Sure. So we took a study, and as you mentioned, it was really to look at what tools do we have, not necessarily to treat the seizures themselves but to make the whole family unit more equipped to dealing with that and what can we provide caregivers to make them more comfortable and more effective in managing the seizures? So something that's gained popularity in human medicine are wrist worn accelerometers and essentially they're seizure detectors. So a patient with epilepsy will wear this wrist worn accelerometer. It's like a wristwatch, and it can sense when the patient is having a seizure and sends information to the caregiver such that those seizures can be identified and treated particularly when the individual is left alone. So we took on a study again, gratefully, we are thankful for the funding from Morris Animal Foundation to do a clinical trial to see how effective a device could be in dogs. So there are commercially available accelerometers that oftentimes are collar mounted and we used one that was developed by a company called Whistle Labs and their accelerometer we attached to the neck of dogs and essentially we wanted to determine how accurate they were. So we had the accelerometer on the dogs.

31:05 KM: We had the owners record the seizures that occurred, the accelerometer was getting data that we looked at for seizures and we again determined, or wanted to determine, how successful it was. And we had a period where we just used what we called a standard algorithm for the device and then we tried to individualize that algorithm for each dog to see if it would be effective. And the study has been completed and the results will soon be available. And what we found was that, accelerometry can indeed detect seizures. So we were able to detect some seizures, but the accuracy is quite low. So only about approximately 20% of seizures were detected in our study and we are still comfortable that it may be a technology that will be available in the future but we need to study it more. And in particular, dog seizures are so much different than people seizures and the device is on the neck, which is in an area of intense movement during a seizure. So we need to get more information on dogs that have seizures that are wearing this such that the engineers behind the device can optimize their algorithms and get us to a better point where we can do this.

32:24 KM: And I think one of the interesting things that came out of the study, is that one way that we were trying to capture the information that the dogs were having when the dogs were left alone was to have the owner video record the dogs, so the dogs had video recordings when they were left alone and it was a system that the owners could call up remotely, and see whether their dogs were having seizures are not. And I think just having that technology, be it their video recorders or the accelerometers, which they felt might help them detect, owners reported a significant improvement in their quality of life during the study, and again, even though the device wasn't effective, and we weren't doing anything to help the dog seizures, I think just having that technology and knowing that we're trying to do things to help them and giving them more tools to manage was a positive thing.

33:15 KD: Yeah, what I liked about that study... There were many things I liked, but I thought it was really cool. Sometimes it demonstrated the unintended consequences too or things because it was, the cameras were really good and we got doorbell cams now and everything so basically it was like a nanny cam for your dog, and it seemed like that worked really well too, just having the camera on a pet seemed to help people. And there's so many cool ways of, like dialing in to see what they're doing. So yeah.

33:47 KM: Absolutely, absolutely. Yes.

33:50 KD: That was really fun. So what is your take-home message for veterinarians and owners who are listening? And I know it's a pretty freaky thing to watch a dog have a seizure. I think people get used to them, but I get a lot of questions. Even from my neighbors if their dog has a seizure and it's scary. And, "What do I do?" What's your sort of take-home message from your experience of looking at this for a long time, now?

34:17 KM: Yeah. For pet owners, I guess a couple of things I would say is one, yes, seizures are very scary to watch. It's difficult to see your animal and deal with a chronic disease. And I think one of the added things about epilepsy is it's a chronic disease, and it's unpredictable, so you never know when that seizure is going to happen, but you're not alone. There are, like I mentioned before, fabulous support groups. There's groups online, there's Facebook groups, and they're just devoted to people who have pets with epilepsy and they're a huge support. So there's a lot of people to support you. A lot of people who've been in the same situation. One thing is don't forget about your veterinarian and please discuss with your veterinarian any of these alternate treatments that you provide, because you may think that it may not have effect on your dog's seizure control or maybe other aspects of your dog's health but it is very, a very important part of the big picture. So I don't discourage you from trying those things and going to those sources as additional support and information, but please discuss all of those things with your veterinarian because ultimately that person has the best knowledge of your pet's health and can make recommendations and advice to help you the furthest.

35:40 KM: In terms of veterinarians, I would say that it's important for them, for us to recognize that it is challenging to care for a pet with a chronic disease, and particularly something like epilepsy where they're so unpredictable. And it does impact owner's quality of life. And owners change their lifestyle because of their dogs and owners will oftentimes explore alternative or supplemental methods to try to get some control over the situation and help control their dog's seizures. So I think it's important for the veterinarian to be open-minded about these things and again to work with the owner to get the best treatment plan for an individual dog. So there's no one treatment that's best. People will say, "What do you recommend?" And my answer is, I don't recommend one thing because every dog is different, and there's different considerations in terms of the family unit, so you have to make the best decision for each individual pet and ultimately it comes down to, as a lot of veterinary medicine is open and honest communication between the pet owner and the veterinarian ultimately getting to the most effective management of the condition in that dog.

36:52 KD: Well, that sounds really interesting. Thanks so much Karen, for joining us and I'm looking forward to learning more about the outcome of your current studies, and more of your work on this topic in the future.

37:05 KM: Well, thanks, Kelly, it's always a pleasure talking to you and I really enjoyed discussing my research with you. Bye bye.

37:11 KD: Bye. Alright and that does it for this episode of Fresh Scoop. Once again, thanks to Dr. Karen Munana for joining us. We'll be back with another episode next month that we hope you'll find just as informative. The science of animal health is ever changing and veterinarians need cutting edge research information to give their patients the best possible care and that's why we're here. You can find us on iTunesSpotifyGoogle Play Music, and Stitcher. If you enjoyed our podcast, we would love it if you would go and rate us, because that will allow other folks to find us more easily. And to learn more about Morris Animal Foundation's work, again, go to morrisanimalfoundation.org. There, you'll see just how we bridge science and resources to advance the health of animals. You can also follow us on FacebookTwitter, and Instagram. I'm Dr. Kelly Diehl, and we'll talk soon.