Episode 1 – Neuro with Neary
Dr. Casey Neary, neurologist and neurosurgeon discusses common misconceptions about neurological cases and give us insight into what it takes to become a veterinary neurologist.
What You’ll Learn …
- What does is take to become a Veterinary Neurologist?
- What are the most common conditions seen by a Veterinary Neurologist?
- Are certain breeds more susceptible to neurologic disease?
- What is the biggest misconception about seizures?
- Will an epileptic dog need to be on LIFELONG seizure medications?
[Music]
Narrator:
Welcome to “Did You Know,” a new series by Partner Veterinary. In this series, we will explore all things veterinary medicine and all things Partner. In each episode, we will answer some of the most common questions we’re asked, from neurology to emergencies and everything in between. If it happens at Partner, we’ll cover it.
Speaking of neurology, first up is Dr. Casey Neary. neurologist and neurosurgeon. Dr. Neary will discuss common misconceptions about neurological cases and give us some insight into what it takes to become a veterinary neurologist.
Dr. Neary:
“My name is Dr. Casey Neary. I’m a board-certified veterinary neurologist and neurosurgeon. I practice with Partner Veterinary Specialty and Emergency in both Frederick and Richmond. I’m from Atlanta, Georgia. I did my undergrad at Auburn University, and I did my vet school at University of Georgia. Did some post-grad training at Cornell, and then did my residency in the DC area. I’ve been a veterinary neurologist for 14 years.”
Jen Mellace:
“So, first question: How does one become a veterinary neurologist?”
Dr. Neary:
“That’s a good question. On average, it’ll be about 13 years for your standard veterinary neurologist or veterinary specialist to achieve that goal and achieve that certification. It takes 13 years from when you finish high school until you become a working neurologist. That’s four years of undergrad, four years of vet school, a rotating internship, a neurology internship, and then a three-year residency in neurology and neurosurgery. So, it takes a lot of schooling, a lot of time. To become a neurologist, you end up having to pass two tests—one after the second year of your residency and then one after the third year. You get five years, I think, to pass both of those, and once you do that, you are a board-certified specialist or, in my case, a board-certified neurologist.”
Jen Mellace:
“That’s a big commitment.”
Dr. Neary:
“Yeah, it’s huge. It’s a time commitment, it’s a financial commitment. Your cohorts in vet school will go straight into working in practice right after vet school, and I did five extra years training with an intern and resident salary, which you could guess is probably not as good.”
Jen Mellace:
“Are there a lot of neurologist positions available in the country?”
Dr. Neary:
“Oh yeah, there’s definitely a mismatch between the supply and the demand. A lot of specialty hospitals want and need veterinary neurologists, but there are so few of us. We’re talking in the span of a couple hundred for the country, so it’s a small number. There are more hospitals in search of neurologists than there are neurologists.”
Jen Mellace:
“What would you say are the most common conditions seen by a veterinary neurologist?”
Dr. Neary:
“Two conditions stand out—one would be a brain condition and one would be a spine condition. The brain condition would be epilepsy, which is basically the definition of recurrent seizures from an unknown cause. These animals have a normal brain MRI; they are normal dogs and they just happen to have a seizure condition that is likely genetic or inherited. That does require seizure medications, and epilepsy is very prevalent in terms of the symptoms that I see as a veterinary neurologist. So that would be number one, or 1A. Then 1B would be disc-related problems. I’d say it’s probably 50/50 with epilepsy. Dogs have discs all the way from C2 actually down into their tail—cats as well—and we see a lot of problems when they cause symptoms like pain, weakness, and wobbliness.”
Jen Mellace:
“With older dogs—a dog who has gone all its life without seizures—can an older dog all of a sudden start having seizures, and is that epilepsy or is that something more neurologic like a brain tumor?”
Dr. Neary:
“That’s a good question, and that could be what I would consider one of the big misconceptions about animals with seizures. Every old dog that has seizures doesn’t necessarily have something bad or malignant—that’s just not the case. There is late-onset epilepsy, meaning we have a dog that is, say, older than six that has a new onset of seizures, and we don’t find an underlying cause. We could continue to not find an underlying cause with them, and they have normal exams. They live normal lives; they just have a seizure condition just like a more standard epileptic would. I should give the disclaimer that the older population, meaning six-plus, that has seizures does have a higher tendency and predilection for having things like brain tumors and strokes. But one of the misconceptions is that every old dog that has seizures has to be having the seizures secondary to something bad, and it’s just not the case.”
Jen Mellace:
“Are certain breeds more susceptible to neurologic disease?”
Dr. Neary:
“Yeah, we used to joke that for every non-Dachshund that I would see as neurologist, I’d see 40 Dachshunds. I thought that would hold true forever, and then the French Bulldogs came and kicked in the door. The French Bulldogs have taken over my number one breed. They’re not picky in where they like to have neurologic problems—it’s not just a back or neck issue like the Dachshund tends to get. French Bulldogs will get neurologic conditions affecting every aspect of their nervous system. So French Bulldogs, Dachshunds are going to be very high top five, but I’d also put in Shepherds and Boxers and Labs to some extent. There are certain breeds that are predisposed to certain conditions, but I think overall those would be probably the top five that I see as a neurologist.”
Jen Mellace:
“Does size of the dog matter?”
Dr. Neary:
“I tend to see more primary nervous system cancer in larger breed dogs than I do in smaller breed dogs. Apart from that, the sizes of the animals seem to get conditions pretty equally distributed throughout the size range.”
Jen Mellace:
“What is the biggest misconception about seizures?”
Dr. Neary:
“That old dogs when they’re having seizures—it has to be something bad, and it’s truly not the case. Also, that by looking at a seizure—violent seizure versus a very mild one—that somehow the severity of the phenotype, the severity of what we’re seeing played out with the seizure, somehow has some bearing on the malignancy or lack thereof of the underlying condition. That’s not the case because you can have animals with epilepsy have horrific seizures and multiple ones that are very violent, and then you can have dogs with inoperable fatal brain tumors that can just have a very faint twitching of the face.”
Jen Mellace:
“Will an epileptic dog need to be on lifelong seizure medications?”
Dr. Neary:
“Well, it really depends. Personally, I like to see an animal go 12 months seizure-free before I consider taking them off the medication. It’s also important to know, and what I try to set up in terms of expectations with the families I work with, is I’ll ask the family, ‘What do you think the odds are that if I put your dog on a seizure medication, what do you think the odds are that he will never have another seizure after that?’ A lot of people, I think, they answer with their heart and they answer with what their expectations want to be, but it’s really more like 85 to 90% of dogs with epilepsy will continue to have seizures despite medication therapy. Most canine epileptics will need to be on lifelong medications.”
“Now, a cat though is very different—cats always like to be different when it comes to veterinary medicine. Cats can have seizure freedom in up to 45 to 50% of cases, meaning that when you treat a cat with epilepsy that’s having seizures with medication, sometimes up to half of them will never have another seizure once they get put on the medication.”
“It’s also about balancing not only the seizures that the animal is having—is the medication impacting their bodies, impacting their quality of life? Because if it’s a medication that you couldn’t even tell the animal was on, has no side effects, no organ system damage, and they’ve gone a year seizure-free, I approach it as the old mantra: ‘If it’s not broke, don’t fix it.’ We know that this medication is doing something—do we want to try getting off of it and risk seizures coming back, or do we want to just stay on it because it’s not hurting anything? The way I think about it is that’s a good problem to have. If we’re sitting face to face 12 months down the road and Fluffy hasn’t had another seizure, we’ve got a good problem, and it’ll be a stress-free decision-making process.”
Jen Mellace:
“I know I’ve heard that epileptic medicine sometimes changes a dog’s attitude and makes them kind of drowsy. Does that just depend on the dog or does it depend on the medicine? Are there different medicines that you can try?”
Dr. Neary:
“Yeah, exactly. It depends on the dog, depends on the age of the dog, the metabolic rate of the dog. It depends on the medication really because there are some medications that notoriously have some side effects—side effects maybe clients perceive or side effects that are noticed at home, like phenobarbital and potassium bromide. But there are what I would call newer generation medications—I’ve been saying ‘newer generation’ for 15 years now—that have much less side effects. You can literally have a dog on this that you wouldn’t even notice a difference with blood work or hanging out with them for a week.”
“Sometimes it’s a trial and error thing. While one medication in one dog produces less desired effects regarding seizure control or side effects, you can give that same medication to even a littermate or another dog of the same age and breed match, and they move on with their life with no issues. Sometimes it can be a balancing act, and sometimes it’s a trial and error situation where you’re trying different medications to make sure you’re getting the highest amount of benefit with the lowest amount of side effects.”
[Music]
Narrator:
Thanks for listening to our very first episode of “Did You Know.” Be sure to follow us on social media to stay updated on upcoming episodes.