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Wednesday, September 11, 2013

When The World Gets Crooked

It won't happen to too many pets, but if it happens to yours, it will have you thinking that it's finally time to "put her to sleep." Your dog (or cat) will suddenly (as within a few hours) become extremely disoriented - probably to the point where she is running into things and falling over. There's a good chance she'll vomit, and for sure she will refuse to eat. You may or may not notice that her head is tilted, and her eyes are doing crazy things! You will see these symptoms and fear the worst. And who can blame you? This almost always happens to older pets: the ones that we are waiting and fearing something terrible is going to happen to anyway. And this certainly is something terrible.

Except, it often isn't as bad as it looks. I just described to you the symptoms that animals with vestibular disease often present with. Vestibular disease is a generic term which simply means there is a problem with the pet's equilibrium. The problem can be located in the inner ear, or more often in the brain. What the pet is experiencing is akin to someone spinning us around at a high rate of speed and then asking us to walk across the room. We will stumble, stagger, and maybe even vomit if we were spinning fast enough.

The various causes of vestibular disease in pets are still pretty mysterious to us. The most common maladies are "old dog vestibular disease" and "feline vestibular disease." The bad news is that we don't know what causes either one of these syndromes. The current thinking is that they are some form of vascular accident (think "stroke"). The happy news is that the prognosis is usually pretty good. Usually time, antivertigo drugs, and maybe some steroids work wonders for these patients.

Vestibular symptoms can less-often be caused by inner ear infections, trauma, or tumors. The prognosis varies in these cases.

My typical workup for a dog or cat with vestibular symptoms is to check the blood pressure (hypertension makes me suspicious of a vascular accident), and thyroid levels (hypothyroid dogs seem to be at increased risk for neurologic problems). I also do a thorough physical exam with special emphasis on the ears. The typical patient will improve over the next 2-4 weeks. If there is no improvement, I will do a more complete blood workup and skull radiographs to look for changes deep in the ear canals. If these tests are normal (which they usually are) and my patient isn't improving, the prognosis is less favorable and I am sending her to a veterinary neurologist for a second opinion and possible MRI.

I am happy to say that in my personal experience, about 80% of these pets do remarkably well, and the owners are REALLY glad I talked them out of euthanasia.

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