For a patient admitted to the ICU, Ranger seemed a little out of place. Unlike the dogs kenneled on either side of him, Ranger was positively bouncing off the walls of his run. His tail was constantly wagging, and his head swung from side to side as he attempted to follow the movements of a dozen different people as they popped in and out through the swinging doors. Several toys lay scattered across his blankets, and occasionally he would suddenly whirl and pounce on an unsuspecting toy, wrestling it into submission before happily gnawing on it with the endearing blitheness of a puppy. Ranger was a 7-month-old Labrador, close to his adult size but behaviorally clinging to the vestiges of puppyhood. He was enrolled in a therapy dog program, destined to become a companion for a man with PTSD. It was a surprise to see my newest patient looking so darn chipper, especially compared to the tetraplegic Dachshund in cage 2 or the Corgi hooked up to the ventilator. But it’s not uncommon for dogs to appear completely normal between seizures, and looking at Ranger then I never would have guessed that he had had 3 cluster seizures out of the blue the night before.
So despite Ranger’s apparent health, he was admitted to the ICU for seizure watch, which basically consists of 24/7 observation by trained staff who will recognize the onset of seizures and administer medication to prevent the onset of subsequent episodes. As one of the 4th year neurology students, I inherited Ranger as one of my first patients of the rotation.
It was fascinating to follow Ranger’s case as we investigated the cause of his seizures. We systemically began ruling out categories of disease: We ran a complete blood count and chemistry profile to rule out low blood sugar or liver/kidney disease (metabolic causes); we gathered a thorough history and measured serum lead levels to rule out toxic causes; we submitted blood and CSF samples to test for various viruses and bacteria (infectious causes); we looked at CSF cytology to look for evidence of inflammation; and finally we performed a brain MRI to look for evidence of a brain tumor or other abnormalities (structural causes). When all of these diagnostics came back negative—good news—we concluded that Ranger had idiopathic epilepsy, a seizure disorder common in dogs 1-2 years of age.
Since he was no longer a viable therapy dog candidate on account of his medical condition, the neuro department helped investigate adoption options. Luckily, one of the neurology technicians was smitten with Ranger’s wide puppy smile and worked hard to adopt him. It took several agonizing days, full of frequent calls from the ICU staff about Ranger’s disruptive barking, but on Friday afternoon after more than 15 days in the hospital, Ranger finally got the green light to head home with his new family. I’ll never forget the top-notch care Ranger received, nor the bright-eyed pup who helped wake me up every early morning with a few well-placed puppy kisses.