Dear Diary,

Today was a tough one. All euthanasias are, but this one seemed a little harder. I had been taking care of this big guy for 2 ½ years. Ever since he was a squeaky little newborn. He started off so robust and healthy. Come to think of it, he really always looked that way, even today. When he was only 15 months old, things changed for him. He had his first seizure, and though I did not witness that first one, I was there for a terrible post-ictal period. That normally gentle giant growled and paced and barked for nearly 2 hours. When the switch finally flipped, he was exhausted, but so glad to see his family. His exam was normal. His lab work was pristine. I prayed that it would be a one- time event. But how often is that the case with youngsters like him? The next few months, waiting to see what came next, were a hopeful time. That wonderful boy finished growing. He filled out to be a handsome dog. He loved his people, and his Labrador sister. He was such a happy and eager to please guy. Even learned to catch a treat balanced on his nose…

Then the autumn came. The next time he had a seizure, his post- ictal phase was shorter, but still pretty terrible. And the seizure morphed into something uglier. The cluster. Acute Repetitive Seizures. And they were not impressed with the diazepam I presented them with. They just ended when they were good and ready. I know his mom was scared. All of his family was. Even the neighborhood kid seemed worried as he looked on from across the kitchen. I had just explained status epilepticus when the big one started. Twelve minutes of seizure activity whisked by. IV diazepam may as well have been saline. The big guy’s dad had said he would want euthanasia if the seizure didn’t break. I couldn’t argue with that. I wasn’t sure what would be left of him if he did wake up.

But it stopped. And though the big boy was wiped out, he gradually began to return to us. When his dad spoke to him, he didn’t raise his head, but he looked at him from under his heavy eyelids and wagged his nub in recognition.

I wished I had started his treatment after the first event. Maybe I could have saved him from that terrible day. He started on phenobarbital that night. We got him loaded and steady. Watched his labs, monitored for side effects. Adjusted his dose till we were in a sweet spot. He was a happy boy again, I think. But those damn clusters came back after a couple of months. His post-ictal phase was much better, and each seizure was shorter now that he was on medicine. But 3 seizures in 12 hours was not okay. So we added his potassium bromide. More lab work, more dose adjusting. He was really PU/PD, and good grief, could he eat! His mom worked hard on his calorie count, and we kept him trim.

It didn’t seem to matter that he was on two usually effective meds. His clusters kept occurring every 3-4 weeks. Always a minimum of 3 seizures in a day. They started to leave him more wiped out. The next day his Lab sister would lie close and comfort her hung over brother. I knew his breed had a genetic predisposition to seizures. I knew that onset of seizures before 18 months old was a poor prognosticator. I knew that failure to respond to 2 drug treatment made him unlikely to find success with a third drug.

But he was happy for most of each month. And he was loved! So I explained the odds to his family, but vowed to keep trying. We embarked on what would become known as the Keppra Honeymoon. When we first added this in, things seemed great. His intra-ictal time increased by a week. His seizures became even shorter. Sometimes they did not progress to complete seizures, and instead the big guy twitched and trembled for 15 seconds, then shook his head a moved on with his day. Post-ictal phase? It was not even noticeable. This was a good quality of life. We could manage like this. His family was happy. I was a hero!

Until I wasn’t. Honeymoons end. About a month ago, in fact. More breakthrough seizures. He was back to the full, miserable clusters. We used extra doses of Keppra when these occurred. I think it made the cluster smaller, at first. I think…

Then the day before yesterday happened. The big fella started his cluster that morning. He had 5 that day. None were terribly long. He got his extra doses of Keppra. He seemed more tired than usual, but he perked up when his dad came home from work. Yesterday was pretty quiet. Then, just before midnight, he woke his mom up crashing blindly around the bedroom. Post-ictal city! Staggering and fractious and unsure of who was around him. It took a couple hours before he could be given any more meds- he didn’t know who was around him, and he didn’t want them to come any closer! He finally got his extra Keppra. But he started another seizure a little while later. Then another. What else did I have available for this big guy? Diazepam wasn’t helpful. Now Keppra was not breaking the cluster either. And it was less than 24 hours since his last cluster. Gabapentin? May as well try it. So I did. But I think someone might have replaced those with PEZ because they did nothing.

By that afternoon, the big guy had had over a dozen seizures in 36 hours. I didn’t see the last one, but his dad said it was the most violent one yet. That sweet boy did not wake up from that one. He was cooked, I think. When I arrived, we knew there was nothing more we could reasonably do to maintain him, even if we managed to recover him from the events of the past days. I sat down in the floor and whispered my apologies for failing him into his ear. I kissed his head. He didn’t rouse at all.

Why didn’t I send them for a clinical trial?

Why couldn’t I think of something better, smarter?

Why did I have to fail this wonderful, sweet boy, and his family?

As I pushed the plunger on the Beuthanasia D, I cried. Both for the big guy, and his family. And for me.

Dr. Kristen Arp, Veterinarian

Dear Diary,

Today we lost our big sweet boy. After months of trying to control his seizures, we realized that there was nothing more we could do. Our hearts are broken. We first met him when he was a squeaky little newborn. He loved each of us so much, especially his dad! And we loved him. We were so lucky to have had these past months with him, and even the all the work to keep his meds straight, and to deal with his seizures was worth it. Thank goodness for his vet. She studied and read and worked so hard to give him a good quality of life. He wouldn’t have been with us so long otherwise. She cried today when she euthanized him. I know she felt like she failed him, and she apologized to him as she kissed him goodbye. Vets aren’t miracle workers, and that’s okay. We knew the chances that we couldn’t help him were really high. And we still had more than a year of really good times with him. That doesn’t seem like failure to me.

I cried today for what I lost. But I didn’t have to cry for what I missed.

Kristen Arp, Mom